Sunlight

Yesterday, as I left my first 24 hour trauma call at 7:30 AM, I saw the sun for the first time in a week.

I subsequently went home, climbed into bed, and was essentially dead to the world until 6:00 PM, much to my dismay.

Surgery is owning my life.

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Medical Student Progress Note: Trauma Surgery

Patient: Kay Isandos

Chief Complaint: the surgery service is insane

History: Patient is on Hospital Day 1 s/p one day on trauma service. She complains that rounds are run so quickly she is not able to orient herself to the patient before she is racing to the next room, but admits it’s a great physical and mental workout. She was unable to scrub into the OR today because her assigned laparoscopic cholecystectomy was bumped for an appendectomy. She is hopeful that she can scrub tomorrow, but reports still feeling very confused about the various surgeries and the expectations on the service.

She reports palpitations and some abdominal discomfort, but admits it was likely due to nervousness surrounding a Trauma, Priority Level 2 today. She participated insofar as she met a patient and provided him with several warm blankets before radiology took over and she was sent back to clinic, realizing her anxiety was pointless.

In the clinic, she was able to see three patients, though she struggled to compile the short, to-the-point presentations desired by attending surgeons when dealing with multiple patients who presented for follow-up for multiple gunshot wounds. Additionally, she was able to complete her first hernia exam successfully.

Her afternoon is described as “crazy,” rated 9/10 in severity and radiating to her personal life as well. She denies associated nausea or syncope. She is happy to have been released from her work early today, leaving plenty of time to study, study, study, and study.

Past Medical History: Has already completed OB/GYN, Peds, Family, and Psych.

Medications: Caffeine qday

Social History: Non-smoker, non-drinker. ?poor sleep and eating habits.

Pertinent Physical Exam:

  • Vitals: Occasional tachycardia, otherwise wnl.
  • General: Young female in no acute distress. Tired-appearing.
  • HEENT: Dark circles under eyes, but PERRL.
  • Cardiac: RRR, normal S1/S2
  • Respiratory: Lungs clear to auscultation bilaterally.
  • Abd: Hyperactive bowel sounds audible without stethoscope
  • Psych: No evidence of depression. Possibly delusional.

Assessment: 24F third year medical student with acute anxiety and significant confusion due to new involvement on the trauma surgery service. This is likely to improve without intervention in the near future, though if it does not, she has been advised to avoid surgery as a future career.

Plan:
-Continue caffeine PRN for sleepiness.
-Eat and sleep whenever possible.
-Study as much as possible to increase knowledge base and reduce confusion. Consult with residents when textbooks fail to appropriately treat problem.
-Consult with other medical students on the team when feeling overwhelmed.
-Continue participation on trauma service at 5 AM tomorrow and for the rest of the month, until service is understood and pt is able to roll with the punches.

I survived my first day! If not clearly evident from above, my brain is still spinning and trying to make sense of an incredibly busy day on a brand new service. But I tend to feel uncomfortable in the first few days… here’s hoping that things calm down (at least, in all the right ways) from here.

The One Where We’re Halfway There

First things first… as if this post could possibly get off the ground without getting this musical interlude out of the way:

Also, since it’s Veteran’s Day, I need to take this opportunity to say a huge thank you to all of the men and women who have served (or are serving) this country. I know service is an incredible sacrifice, and I’m so grateful for the courageous individuals that defend the USA.

Anyway, you heard me. I’m halfway through third year. Half of third year is complete.

…I have no idea how to feel about this. On one hand, I feel like I couldn’t possibly be done with half of the year. I still essentially fall flat on my face on a regular basis. I still forget to ask my patients some pertinent questions. I still stumble when I get pimped on the wards (though apparently I’ve gotten better at sounding intelligent despite my epic failures). I still can’t state my future medical specialty with any level of confidence. So, it would seem like I should have months upon months of training left this year, not just six.

On the other hand, I feel like I’ve grown leaps and bounds from where I was. My attendings have commented on my increasing comfort level with patients. The concept of writing my own “Assessment and Plan” doesn’t trigger a panicked email to a fourth year friend anymore. When my family med preceptor pimped two second years and me, I recognized I really HAD learned something when I was able to teach them many of the answers.

So maybe it really is okay for third year to be halfway through. Except that I know the hardest of third year is yet to come. OB/GYN, Peds, Family, and Psych were mere warm-up for the Neurology, Surgery, and Medicine that are to come.

And what better introduction to the more grueling aspects of medical training than four weeks of trauma surgery?

My hospital boasts an urban Level 1 trauma center, which means we get many of the most difficult cases of the area. I was lucky enough to receive one of a few coveted spots on the “core” trauma team, which allows me to spend the full month on the service, minus a much welcome four day break for Thanksgiving.

So what will this month entail? 24 hour calls. Scrubbing into operations for stab wounds, gallbladder removal, and exploratory surgeries. Constant pimping (and likely constant reminders that I have a lot to learn). Waking up at 4 AM and staying coherent until 7 PM or later. Sacrificing lunch to put in a few more sutures.

I’m nervous and terrified and excited all at the same time.

The One With the Psychiatry Study Day

Because you all really wanted to know what actually happens in my apartment when I claim to be studying all day… here’s the play-by-play, so you can even replicate it yourself!(Though I make no claims as to the success of these actions… replicate at your own risk!)

9:05 AM: Wake up feeling so incredibly grateful for sleeping in on that wonderful gem known as the WEEKEND.

9:07 AM: Realize that it’s not actually the weekend, it’s just the study day before a shelf exam. Buzzkill.

9:35 AM: Root through the freezer in an attempt to scrounge up an acceptable breakfast, since I’ve consumed most of my food in the two weeks since I’ve last grocery shopped. Decide that now is an appropriate time to rearrange the entire freezer in an effort to assess dinner possibilities for upcoming surgery rotation and make room for soon-to-be-assembled frozen crockpot meals.

9:56 AM: Settle on pumpkin Eggo waffles for breakfast. There are plenty of other meals today that can be healthy, right?

10:03 AM: Head to clerkship website to download the “Psychiatry Shelf Study Guide.” Pat myself on the back for initiating productivity so early in the morning.

10:17 AM: Remember that Modern Family was new last night, and I haven’t watched it yet. Remedy the situation.

10:41 AM: Hey, wasn’t it a new episode of How I Met Your Mother this week, too?

11:08 AM: HOLD UP. There’s going to be Boy Meets World sequel featuring Cory and Topanga’s daughter, and CORY is slated to play Mr. Feeny?!?!?!?! Mind. Blown. Must tell ALL friends.

My inner seventh grader took a moment to celebrate, just like this.

11:12 AM: It’s late enough for lunchtime, right? Hello, leftover fish burrito!

11:14 AM: Realize that my psychiatry shelf study guide is open behind my web browser.   Oh, right. Today’s a study day. Maybe I should attempt some semblance of productivity and read this study guide and do some practice questions. Maybe.

PSYCH PSYCH PSYCH PSYCH PSYCH

12:07 PM: You know what, Psychiatry? I’m going to multitask and catch up with some friends via online chat while I study. And listen to “Jazz for Reading” on Songza. How does that make YOU feel?

Oh, Michelle. I love your support.

12:50 PM: Dear NBME, Next time you make a shelf exam for Psychiatry, it’d be really, REALLY nice if it didn’t focus on neurology, which I have yet to complete. No love, K.

1:31 PM: Who thought it would be a good idea to have two very different medical problems and name them koro and kuru? WHY DID YOU DO THIS TO ME?!

Even Oprah thinks it’s a terrible plan.

2:45 PM: As an example of regression, “many medical students who return home act as if they are teenagers with regards to their parents or other hometown friends.” Geez, Lange. Tell me how you really feel. Before I have a mood swing and lock myself in my room with some emo punk music.

3:03 PM: Battle strong desire to complete online Christmas shopping before surgery rotation starts, which obviously means it needs to happen NOW and not this weekend. Spend the better part of an hour half writing explanations to psychiatry questions, and half compiling a list of loved ones who will be receiving gifts this year.

3:54 PM: Scramble out of my room immediately upon receiving text from my roommate that reads something along the lines of, “I’m making churros… do you want one?”

5:12 PM: Decide that my friend (A: “Good luck, good luck, good luck studying!”) is exhibiting signs of palilalia-ya-ya-ya-ya-ya. 

5:30 PM: Engage in a lengthy discussion about my upcoming surgery rotation with my roommate, who has already completed this block. Get simultaneously more excited AND more terrified to begin trauma surgery next week.

6:26 PM: Procrastinate reinitiating psychiatry work via workout session, even though it means changing out of pajamas. By the way, have I mentioned my new obsession with Blogilates?

7:23 PM: Make dinner. Honey pecan crusted salmon with caramelized leeks and carrots? A study day never tasted so good… even though I’m too antsy to wait for complete caramelization.

This is obviously what I did the entire time I was cooking.

8:35 PM: Realize it’s crunch time. Watch the video of that kid who gives the speech from Miracle for inspiration and hunker down for a few hours until bedtime.

…come 12 PM tomorrow, I’ll be midway through my third year and I have no idea how I got here.

20 More Ways to Know You’re a Medical Student

It’s another Medical Monday, so to all my first-time visitors today, welcome! You’re just in time for my second installment (see the first here!) of:

“You know you’re a medical student when…”

21. You celebrate when your surgical patient passes gas for the first time after surgery.

Oh, that’s WONDERFUL!

22. Your conversations typically go from “Hey, how was your weekend with your girlfriend?” to “So if you were on dialysis, would you want peritoneal or hemo?” in less than 10 minutes.

23. You refer to your after-work drinks not as “Happy Hour,” but as “Liver Rounds.”

24. You text your classmate to ask them to call when they are “s/p dinner.”

25. You’re frustrated at the end of your 14 hour day that you’ve accumulated 47 new emails that have not been “triaged.”

26. You insist that your Dansko clogs are NOT grandma shoes to skeptical friends.

27. You’ve been known to ask your friends to succeed with a finger-to-nose test and rapid alternating movements before you’ll allow them to leave the bar.

28. You discover you’re included as “essential staff” and report to your clerkship even in hurricane conditions.

29. When you’re sent home early in the hurricane, your first reaction is excitement… because you were just handed some bonus hours to study for the shelf exam.

30. You have multiple text books that wind up looking like this:

I’ll just highlight the most important points in First Aid…

31. You can carry out a meaningful conversation using only acronyms: “We have a LOLNAD with PMH of DM, HTN, and NSTEMI s/p CABG in 2003…”

32. You’re able to consume a meal while studying pictures of cadavers, details about food poisoning, and pictures of trauma cases. Dermatology, however, is a different beast…

33. You frequently get halfway through a story that is hilarious to you and realize your non-medical friend is barely paying attention and simply laughing when you laugh.

…uhh, sure?

34. Whenever given a baked good, you accept… but not without accusing the baker of giving you Diabetes.

35. You’re 24 years old, but you struggle to stay awake until your 9:00 PM bedtime.

Dinner after a long day in the OR…

36. You diagnose your cab driver with atrial fibrillation from the back seat of a van cab, based solely on his pulsating JVP.

37. You think it’s perfectly acceptable to wear scrubs out to dinner.

38. You find out about major news headlines four months late because you were so absorbed in studying for Step 1.

39. Your friends get annoyed when you’re constantly “examining” their moles, bug bites, and other dermatologic lesions, because it will help with your education.

40. Your favorite thing about the show Grey’s Anatomy is pointing out the medical mistakes.

That doesn’t even make SENSE!

PS: Interested in perusing other medical blogs or sharing one of your own? Click the image to check out Medical Mondays!


The One Where I Registered for Step 2 CK and CS

This week, my class was mandated to attend a sort of “Career Day,” which consisted of a room full of tables staffed by residency directors, attendings, and residents from the various residency options available to graduating medical students.

Except before we got to meet with these physicians, the administration demonstrated its ability to terrify me using just two PowerPoint slides. Suddenly, I could see the major due dates of the next 18 months of my life condensed into a few dozen lines of text.  After years of feeling as though graduation would forever be a distant thought, the reality of the fast-approaching end of medical school hit like a ton of bricks.

…it can’t be. It just can’t be…

Among these important dates was a reminder to register for the USMLE Step 2 Clinical Knowledge (CK) and Clinical Skills (CS) exams.* Always an early-bird, I decided to submit my registration this morning to ensure my ability to schedule the testing date of my choice.

And as if paying thousands per year to work my butt off at the hospital isn’t enough, I was reminded that a medical license doesn’t come cheap either.

The grand total for both exams, not including travel costs to CS?

One thousand seven hundred dollars.

Say WHAT?

You heard me. $1700 to spend several more hours of my life in relatively miserable situations.

Next time I drop $1700 in one shot, I hope it’s for Eurotrip: Remix, or one of the other thousand more desirable scenarios.

Medicine, you are SO lucky I love you.

*CK is a multiple choice test much like the Step 1 beast I tamed this past May. CS is a whole new monster involving observed interactions with standardized patient actors, which is available in only five American cities.

Rx: One Boost of Confidence

“Mr. Smith, I know you’ve seen a lot of doctors in the past year. I was wondering if you had any advice on how I can be a good doctor for patients like you.”

“Honestly? Just keep doing what you’re doing. You’re already there.”

 

So grateful for interactions with the Mr. Smiths of the world: those patients who give more to you than you could possibly give to them.