Day 2787: Inspirations and Ruminations

My two lovely friends have coincidentally updated their blogs on the same day (today!) inspiring me to do the same. This post has been about two weeks in the making with about twelve solid minutes of writing, here she blows.

Last month/November was my family medicine rotation. I am not sure how much I have talked about my desire to pursue family medicine (it probably got lost in my effervescence about penises urology), but in case I haven't told you, family medicine is on my short-list of careers...right up there with urology.

I had the opportunity to do my rotation in the Northwoods of Wisconsin -- 3.5 hours away from Milwaukee, with only one Asian family in the town where I worked. Surprisingly, everyone was not impressed by my perfect American English or strange almond eyes. Not so surprisingly, everyone was very warm and welcoming. Surprisingly, I really enjoyed working in a small town (of 3,500 people!). I got to do so much. I did every pap smear and pelvic exam on my own. I diagnosed bacterial vaginosis, and treated it no less, on my own. I did my own obstetric prenatal exam. I sutured (7 beautiful sutures) a kid's thumb together. I froze off moles. I injected cortisone into an elderly man's knee. I did a lot. Way more than my classmates did here in Milwaukee.

Even though family medicine is a lot of chronic problems, and people not understanding why they are still obese/a diabetic/have high blood pressure when they don't make positive changes in their life, family medicine is just that. Getting to know a family. In my case, I got to know a 50-year-old daughter and her 80-year-old mother, but that's besides the point. I could reference Joe Blow's mom when Joe Blow came in a week after her for an acute problem. It was really exciting to feel like I knew patients, even though I was only there for three weeks.

It seems the ruminating so far is just expressing how much I enjoyed family medicine and remembering that while I am on my urology rotation. Can you believe it? By 2014, I will hopefully have figured out what the heck I am doing with my life.

I really have so much to tell you all! I think I will stop here and pre-write some stuff to post tomorrow so that I actually have more than blog post for the month of December.

I love you all dearly.

Day 2436: Birthdays and funny stuff?

Happy birthday to my darling Nicki! (Kind of like that Prince song except Nikki is spelled 'ck' rather than 'kk' and by "kind of like" I mean not at all because that song is creepy-trashy.)

So, funny stuff? It has a question mark because after making the mistake of telling my Pathways (vague description in this post (wow! So long ago!)) advisor that I write a blog, he told me to send him the link. I told him it was pretty boring stuff, wouldn't you agree? I just update you on boring stuff. Med school = boring stuff. I'm not even my ever-so-funny self. Well, this is me attempting to be funny so that my advisor has something remotely entertaining to read (if he chooses to even read it. No pressure Mike. I'll only hate you forever if you don't. kloveyou). If I even choose to email him the link, that is.

Anyway, I am blogging to tell you all I am pretty much over anesthesiology. I have to wake up before sunrise to get to these lectures that I only somewhat learn from. Then, I stand around a lot and either get P.I.M.P.ed (Put In My Place questions that make me feel oh-so-valuable) or talked my ear off and I don't really learn much from either. Well, I learn from getting pimped but that's mainly because I am sweating half-a-bucket of sodium-chloride and am reminded at how dumb I am. GEEZ. Welcome to medicine, right?

I am slowly weaning myself off of surgery as a future career (and by surgery, I am referring to urology). As I am coming upon this realization through non-urology rotations, my pathways advisor told me that another doctor we work with has been "telling everyone" I want to do urology. Oh. Crap. Now, I not only have to impress the urology department during my December rotation (that was already on my To Do List), but now I actually have to... you know... impress them.

However, as a bonus, I get to figure out my life by 2014. I will have my family medicine rotation in November. Then urology in December. Then Jessica's life is figured out before 2014 is upon us. Yayyy! :\

Day 2422: Psychological Trauma

Okay team. I probably got a high pass/B in Psych. Why, you ask? Because I bombed the Psych Shelf exam.

I don't remember if I have explained this to any of you, but a Shelf is an NBME exam. An NBME exam is the same company/people that wrote my USMLE Step 1/my first (of three) boards I have to take to get my MD.

Okay, definitions out of the way. After getting the lowest possible pass ever on that exam, I panicked. I emailed the rotation coordinator right away and asked her a) did I even pass the exam? b) if they could regrade the exam, because there is no way I could have done that badly. Well, the coordinator was very helpful and assuaged my fears, even if she didn't regrade my exam. The coordinator emailed me a few days later telling me she received my clinical grade and it was an honors/A. Go me. Unfortunately, because I got the lowest possible pass on that exam, my A will probably fall to a B. Poop.

Oh well. This just goes to show you that I really am an awful test-taker. And this isn't a Jess-trying-to-be-humble statement. It's more of matter-of-fact statement.

It also doesn't help that everyone (except me) says that the Psych Shelf is one of the most difficult Shelf exams. Mainly because what we're supposed to know for the exam (i.e., what drugs do you treat someone with generalized anxiety disorder?) are not how things are done clinically. So, even though my classmate told me outright to study all the drugs, I was all questioned out (I did between 400-500 questions in the span of 10 days) and thought I was prepared for the exam. Well. I should have reviewed all the drugs.

Oh well. Now I know. It's pretty clear sailing from here. No more Shelf exams until next semester. I am on RPM (resuscitative and perioperative medicine), which is an anesthesiology, trauma and emergency medicine rotation. I just had my oral trauma exam this morning and it seemed to go okay. ABCDE! Airway! Breathing! Circulation! Disability! Exposure!

Okay, enough shouting. Talk to you all soon. I have a very exciting October ahead, filled with lots of friends and family visits! Yahoo! :D

Day 2405: My first grade of the year!

Okay. It's time for some honesty here Team Jess. Today, I received my first grade of my third year. And. It was good. So good, that I didn't even know what the letter meant when I received it (because apparently that's how little I do well in med school haha).

Background: My med school doesn't give As, Bs, or Cs. It gives Honors, High Pass, Pass. (So the same thing essentially.)

This is what I saw this afternoon:

What does this mean? Honors! High pass! THEY BOTH START WITH H!!! (Wheels turn in my brain. Wheels still turning. ...still turning (I am actually this slow people)) I THINK THIS IS AN HONORS!!! (back flip, forward flip, and now I am suddenly Ariel from Little Mermaid twirling through the ocean)

Then, four hours later, while texting a classmate, he informed me that they actually break down the grade for us. And, all you, my pretties, have to know is that I was on the low end of honors but I am pretty sure an honors is still an honors! Suckers!

In addition, we also got feedback. Here was mine:

Jessica was very self directed and was an obvious leader among her classmates. She always made herself available to see patients, participate in deliveries and surgeries. She demonstrated an increase in her knowledge base throughout the clerkship. She sought feedback and, importantly, listened to the feedback. Her questions reflected good insight into the topics at hand.

Very pleasant, enthusiastic, hard working smart student.

Look here Team Jess. I like myself. I think I'm pretty a-okay. Would I call myself a leader? Uh, no. I just ask questions that no one else wants to ask, because for lack of a better way to describe it, I don't really care how it reflects on me. Which makes me sound all James-Dean-too-cool-for-school, but all it really means is I don't care if I look dumb. My Dad told me this when I was in high school and it has always stuck with me. "Don't ever feel afraid to ask questions. How else are you going to learn things?" So. Here I am. On my clinical rotations, asking (probably dumb) questions, but how else am I going to learn? Apparently asking (dumb) questions is a pro on the clerkships.

Starting off the year strong! It's nice to know that what I was doing was (kind of/essentially) working. I have been so freaked out this past month because, at this point, I have gone through two clerkships and, until today, received zero grades. I could be passing or I could be honoring and not know it! I need to be getting honors, people! Luckily this fear has led me to study way more for my current psych clerkship (whose exam I heard is very nitpicky so I will be all ready in two weeks for those pesky details) and hopefully will motivate me to do well in all my future clerkships.

I have more stuff to blog about so look for it in the near future! Until then, friends ...yay me! ;)

Day 2401: On psychosis

While on the phone with a dear pal of mine today, I had an interesting thought on psychiatry. Well, two interesting thoughts.

1) I may not want to do psychiatry, but seeing it has pushed me more toward a possible career in family medicine.

2) Psychosis is one of the most rewarding ailments to treat in psychiatry. I currently have two psychotic patients on my child/adolescent psych service. One is purely psychotic, which doesn't bode well for her future as an adult. She sees things that aren't there, hears voices that no one else hears and is quite paranoid. My second patient had something resembling a first-psychotic break. It may have been substance-induced, but boy was it a doozy of a psychotic episode. Hearing things. Seeing things. "Flipping out," as the patient put it. BUT. When you give these psychotic patients the proper dose of the proper medicine, it is amazing to see how quickly these patients improve. Kid #1 is showing very slow improvement each day, but improvement nonetheless. Kid #2 is looking really good and will most likely go on to lead a fairly normal life.

Psychiatry isn't all mumbo-jumbo and talking about feelings. It's a pretty fine art to differentiate between depression or a medical condition causing depression (like hypothyroidism) and other things of that nature. Psychiatry isn't for me, but it has been an interesting rotation to be a part of.

Day 2400: On child psychiatry

As if learning embryology and going through my ob/gyn rotation wasn't enough, my two-week stint on child psychiatry is showing me that making normal humans is tough noogies. On top being freaked out your baby will be deformed or mentally underdeveloped or any number of things that can happen in utero, you have to hope and pray that your baby is normal, whatever that means. I have seen kids as young as 4 on my in-patient floor and kids of varying ages in day treatment. I have teenagers on my in-patient floor who have strong suicidal thoughts, straight up psychosis (audio and visual hallucinations) and a lot of aggression and ADHD.

Seeing these kids...I'm happy to know they are getting help but it's a little intense to see a 7-year-old on 4 medications! Honestly, seeing these kids freaks me out about having children. I want some (probably, eventually) but the fact you have to try to keep them sane and normal for their entire lives is a little overwhelming, wouldn't you agree?

All in all, I have learned a decent amount. I am getting bombarded daily with psych meds, which is good to refresh what I learned last year in pharmacology. Apparently, you can use clonidine (which is typically used to treat hypertension) to treat hyperactivity and impulsivity in kids with ADHD. Huh. Whodda thunk?

I really am going to try to post more regularly. I have more time to write, but I'm actually living life a little and socializing so that has taken away some of my motivation and drive to post. My posts are so boring most of the time anyway. But I digress. Here's hoping there are more posts! With pictures at some point too!

Day 2385: On to the next one.

Neurology has come and gone. The rotation here is...not the best. You round forever. From 8:30am until whenever all the patients are covered. I was very lucky to have attendings that were excellent teachers and very eager to do so. Nevertheless, the rounding was long, the time on my feet was long, and the amount of neurology I learned didn't nearly correlate to the amount of time I was on my feet. But. It's over. I learned a lot about stroke, which is near and dear to my heart given that my grandfather died of a stroke when I was six years old.

My neuro exam today was fine. Aren't all my exams fine? I have decided I am an exceptionally average test-taker so I am sure I scored average-ly on this exam. On to the next one, as the post title suggests!

What is my next rotation? Psych. I, not so jokingly, hope I get attacked on this rotation. I do not foresee my career heading towards psychiatry, so, like my past two rotations, I hope to get as much out of this month as possible. And that means getting all the crazies in front of me!

Let's see if I blog again before this month ends. Who knew it was easier to blog about studying and books than actual clinical learning?

Day 2370: With clinical learning comes less blog posts...

...apparently.

Okay, so this is going to be short and sweet. My Ob/Gyn rotation ended on Saturday, with my final 24-hour-call shift. It was nice to end it with the second-year resident I did my first call with.

Let's see...I have my Shelf exam (basically a test given by the same company/organization that created my Step 1/boards exam) tomorrow morning. Then, my classmates and I (whom I love and adore; I realize now how lucky we seven were to really like each other and get along!) are heading out to Lake Michigan to hang out on one of our classmate's dad's 30-foot fishing boat!

Memories from Ob/Gyn:

• I delivered a heroin baby in late July. The mother used heroin and cocaine throughout the pregnancy and her beautiful baby girl was delivered in our hospital. (Un?)Fortunately, the mother left her baby in the hospital and our hospital social workers got involved to get that sweet baby girl the home she deserves.
• My first c-section was for twins! At 26 weeks! (14 weeks before term, eep!) The mom was super sweet and those babies are slowly but surely getting bigger and better every day.
• I actually really enjoyed working with most of the Ob/Gyn residents. You hear the horror stories about these residents being b!tches and it was nice to see that that is just a fallacy. Or at least wasn't true on my rotation.
• I think surgery really bores me. I don't feel the desperate need to cut as other more surgery-friendly people do. I really enjoy procedures -- suturing, etc -- and maybe I like laparoscopy but I haven't seen enough laparoscopic procedures to know. I think this lack of love for surgery may slowly, but surely, close my urology door. We'll see though.

So, Shelf tomorrow then Neuro/Psych rotation on Wednesday. The learning never ends!

Day 2341: So much to talk about!

Hi hi,

I know. I know. It's been 16 days. With a life outside of school (sort of), you would think I would blog more, but there's actually very little time in the day once I get out of the hospital (again, sort of). Okay. Here are updates in my favorite form, bullets.

• I am on Ob/Gyn for 4 more weeks. I am on gynecology for the first three, and obstetrics for the last three. I have seen a few surgeries and many many return obstetrics patients in clinic. Also. I took call (call = 24 hour shift, 7am-7am) the first night ever (July 3rd) and I delivered a baby. NBD (no big deal). Except it was a giant deal. To answer everyone's burning questions...1) No, I didn't drop it. 2) No, the mom didn't poop on me.
• Boards scores are out. I passed! I got a lower score than I would have preferred, but it was probably the score I deserved. There are so many things I would do over about that exam, but I passed and I am just fine for family med and on the low (low) side for urology. Everything happens as it happens so whatever I will be, will be whatever I will be. (There was a lot of repetition in that, hope it made sense!)

Huh. I guess I didn't have that much to talk about, haha. I thought I did. Oh well. I should post pictures again soon, hey? These text posts are bo-ring.

Okay, if/when exciting things happen, I will let you all know!

Day 2176: Urology and unnecessary rudeness.

Hi! We had our elective lottery this week and I got urology, like I wanted! :) Hello full schedule of rotations!

This is the order: ob/gyn, psych/neuro, anesthesiology/emergency medicine, family med, urology, 1 week winter break, internal medicine, surgery, pediatrics.

Speaking of Ob/Gyn, I contacted the clerkship director (extremely early) to ask for time off in July for my friend's wedding (my third time as bridesmaid, much to the displeasure of my mother who believes I am now cursed/jinxed to never marry). Well, this is the "sweet" reply she sent:

Hi Jessica

We do not give time off from the clerkship for weddings.  However, you only need to report to your assigned hospital location on the weekends if you are on call.  Currently, we require two days of weekend call (separate weekends) and allow the students to create their own call schedules. I cannot promise you this policy will continue for the next academic year as we continue to review the clerkship, but I think you will most likely be able to work the call schedule out with your classmates to ensure you have that weekend off to attend the wedding.

Please contact me with any questions or concerns.

So, I think it means I will get the wedding weekend off. I think? I'll keep you all posted.

Tomorrow, I will shadow a urologist from 8:30am to lunchtime. Lunch with my friend L. Study time. Female physical exam (checking the cervix and uterus with a speculum, performing the bimanual exam). We had a little female exam demonstration/workshop last week and I showed my group how to do it since I was the resident expert (having done 4-5 this past summer; go me).

My new microbiology course starts on Friday, not fun. I am also giving a tour that day for med school interviewees (my aforementioned friend L is interviewing that day! Yay!) so that'll be fun (because I get free lunch and get to be my awesome self).

And! Jess might be working here in Milwaukee for 6ish weeks! Yayyyyy! Boo to the fact that she'll be here from May to June (the absolute worst month/six weeks of my life aka boards/Step 1 studying for 10 hours (no joke) a day). I'll make it work!

Day 2168: Tests and tracks

I got B4! Here is my schedule for next year:

• July 1 - August 15: Obstetrics/Gynecology
• August 16 - September 30: Psychiatry/Neurology
• October 1 - October 31: RPM (anesthesiology, emergency medicine)
• November 1 - November 30: Family medicine
• December 1 - December 23: Vacation/Elective (hopefully urology!)
• January 2 - February 28: Internal medicine
• March 1 - April 30: Surgery
• May 1 - June 30: Pediatrics

My pathology exam was awful. Everyone thought the test was infinitely harder than it should have been and this is why I hate med school exams. They test you on the most minute crap that is not covered on our board exams. Why would I bother learning it if I won't retain it a) anyway and b) for the actual exam that matters? Ugh. I didn't do horribly on the test. I would have liked to do better but seeing as how I could have failed (it was that hard), I'm pretty happy with my grade.

Anyhoo, I'm at research right now. Chatting with my boss about the direction of healthcare, talking about his stint on TV (telling people how to avoid frostbite) and chatting with the research assistants. I enrolled more patients today so that's exciting! Getting people for our study and using mi español.

Day 2158: More on rotations. NFL Playoffs!

Hey all,

I am hitting a wall with my studying, so, of course, I am going to write a blog post about hitting said wall. Post over. Thanks for reading.

Joke! Okay, so, I want to show you this.

Remember the post on rotations (selection)? Well, apparently, I have to pick 10 of the 16 tracks and hope the lottery will give me my first choice. As you can see, it was stressful trying to pick which other 9 I wanted and apparently, I don't know how to read because I wrote F14 and F15 twice. We will find out on Monday January 21st (tentatively; IT issues live in med schools) which track we all got. I am hoping for B4! That's my baby!

Also! The Packers play the 49ers today! Ahhhh! Who to support?!

I really need to paint/make a 49ers shirt if Jim Harbaugh keeps taking the Niners to the playoffs! Geez! A friend organized a little dinner + playoffs thing at a pub downtown so I'll be headed there shortly. Burgers + fries + classmates I actually like + football (especially Packers/49ers football) = a good time. Pictures to come!

Day 2156: Rotations!

Today my class had a big ol' mandatory meeting about my third year of medical school. It was both very exciting and very stressful.

Exciting: I am one semester away from beginning the most exciting part of my medical education -- rotations! I will be meeting patients on a daily basis and have a small hand in their care! I can't wait!

Stressful: There are 16 possible tracks and I don't know which one to choose.

Let me give you some background information. At most medical schools, there are 9 main rotations -- the Big 3: pediatrics, general surgery, internal medicine, and the Little 6: psychiatry, neurology, anesthesiology, OB/GYN, family medicine, vacation/elective. M3s will tell you to get the Big 3 out of the way. They are the longest rotations (2 months). Surgery sucks so you'll want to get that out of the way. Et cetera, et cetera. However, the administration today brought up a good point -- "it just doesn't matter." (This is the actual video played for us, ha!) Everyone will complete the 9 total rotations by June of 2013 so it doesn't really matter what order you do it in.

The only advice to heed is this: do NOT do what you think you want first, and do not do it last. Don't do it first because you're too green/ripe/new and won't know what you're doing (aka not very impressive to your clerkship director). Don't do it last because you could actually hate whatever specialty you thought you wanted and be scrambling like crazy in the first two months of your fourth year trying to decide on a residency specialty.

So, back to what I was saying about "stressful." I don't have any interest in pediatrics or general surgery. Thus, I don't really care if I get the Big 3 first. I am currently leaning towards family medicine. OR! Newsflash! I think I like urology! I have this weird thing for genitalia (which sounds really awful when you actually type it out) and it could be cool to help treat men and women (yes! Women need urological help too). Also, urology is surgical! Which is also cool. Procedural, people's junk, what more could a gal ask for? I emailed some people today to get some shadowing experience in to make sure I actually like it. More information about urology in a future post!

Oh, speaking of urology, I am performing the male physical exam next week, which has been very icky for my classmates and I am unnecessarily pumped about it!

Okay, so, stress, again. Sorry I get so distracted. Here is an image of what the schedules look like.

I am leaning towards having the Big 3 second semester so that I can get some clerkships under my wing before I impress people in family med and/or urology (my elective). But, track selection is a lottery system so I may not even get it! And! CRAP. With OB/GYN first, I should be able to get time off for the wedding I'm in (in late July) but babies wait for no one to be born! Although, if I got gynecology (aka no babies) for my last 3 weeks of OB/GYN, then I am sure I could get the weekend off. See what I mean about stressful?

All in all, an interesting day! It's too bad my mom had to rush off the phone or else I would have regaled her with stories of her daughter moving towards being a true blue doctor! :)