The One Where Fourth Year is Like Preschool

Today, I donned my bright blue raincoat and red rain boots and trekked out into a downpour on what would be my very last first-day of school. After 22 years of first-day jitters and picking out new outfits, my formal education is just one year away from its end, and I can’t even begin to believe it.

But this year, my fourth year of medical school seems to bear more resemblance to my first year of school, in preschool, than my most recent year of school, my third year, and here’s some examples of how:

Pre-school/Fourth Year:

Teacher / Clerkship Director: So I know that sitting still all morning is really tiring, so instead of going to noon conference, why don’t you play outside in the sun or take a nap for an hour?

Third Year:

Clerkship Director: All noon conferences are 100% mandatory, and we may or may not be taking attendance… you’ll never know.

PS/4th:

Allows you a leisurely wake-up at 8 AM, and maybe even a mid-day nap.

3rd:

Demands that you’re up before the crack of dawn and fully alert by 5 AM, and you sure as hell won’t be sleeping again until at minimum 10 PM.

PS/4th:

Who doesn’t love snack time?!

3rd:

Hmm… did you even eat lunch today?

PS/4th:

No exams, just simple projects to fill the time and allow you to fully explore your creativity.

3rd:

Oh yes, and on top of working 5 AM – 9 PM, we’d like you to study for an incredibly nit-picky 100 question national exam every 6 weeks. You’re welcome!

PS/4th:

Plenty of time to get to know your classmates, visit with family, and enjoy yourself with friends.

3rd:

What’s a friend?

————-

Happy Medical Mondays and happy June!

For my new visitors, I’m K, a brand-spanking-new fourth year medical student in the US, fresh out of my Step 2 boards-studying cave and still growing accustomed to the bright lights and free time on this side of third year. I’ve got plenty of new blog ideas and, now that Step 2’s over, plenty of time to put them together, so stay tuned. For now, take a look around (and maybe even subscribe or follow me on FB/Twitter), or hop on over to visit our lovely hostesses Emma and Jane to peruse some other fantastic medical blogs.

The One Where a Stranger Caught My Happy Dance

I interrupt my Internal Medicine Shelf exam / USMLE Step 2 studying to bring you a very important message:

…I just walked (okay, I’ll be honest, danced) out of the hospital for the LAST time as a third year.

More than a few people witnessed my triumphant hospital exit…

And the next time I don my white coat and enter the hospital, I’ll be a fourth year.

…I can’t even believe it.

Excuse me while I take a moment to squeal:

I did it! I did it! I did it! It’s over! I’m no longer the low man on the totem pole! I’m a fourth year! I did it! So happy, so happy, SO FREAKING HAPPY. 

Andddd back to work.

<3, K

Have a Good One!

This morning, an elderly couple approached me in the hallway.

“Honey, can you help us find this?” the woman inquired, reaching out a tremulous hand with her instructions for reporting to her endoscopy appointment.

I smiled and waved them on, taking a few steps down the hall to point them to the Endoscopy suite.

“Thank you so much,” she nodded, retrieving her paper from my hand.

“Anytime,” I responded. “Have a good one!”

…it took me an entire flight of stairs to realize what I’d just said.

Oops…

The One I Should Duct Tape to My Head

via butthorn.tumblr.com

Medical Mondays and the One Where He’s Perceptive

“Good morning, Mr. B!” My resident announces our presence to our elderly, slightly demented patient. He’s been there for the better part of a week with a now improved acute kidney injury, but somehow I haven’t managed to meet this patient until today.

The patient pauses, his glance darting from my resident to me and back, eyes widening in surprise. “…TWO doctors? Two of them?” he asks incredulously, voice booming.

I smile and reach to shake his extended hand. “Not quite, Mr. B. He’s the only doctor for now. I’m just learning!”

Mr. B nods. “Just learning, I see. I see. God bless you, just learning!”

My resident’s eyes meet mine. “Yes, but she’ll be a great doctor someday.”

I pause, hoping that I’m not actually blushing.

Mr. B shoots alternating looks at the two of us again as my resident listens to his lungs. “Hey,” he says, focusing on me. “Is this your boyfriend?”

I watch color flood into my (admittedly very attractive) resident’s cheeks. “No, sir,” I respond. “He’s been a great teacher, though.”

Mr. B lets out a sigh. “Too bad. You’d make a great husband-wife team.”

I glance up at my resident, whose eyes betray his inward laughter and we exchange our usual smirks. And just for a moment, I wonder if that patient has caught on to something we haven’t.

–————-

I can’t believe it’s already another Medical Monday. Time has been absolutely flying this year!

To old friends: welcome back! Thanks for bearing with me and my spotty posting habits; I promise I haven’t forgotten about you!

To any new visitors: Hello and welcome! I’m K, a third year medical student, currently slugging my way through my Internal Medicine rotation. Somehow, I find myself with a mere six weeks left of third year, and fourth year cannot come soon enough… although I wouldn’t mind a little more time to figure out what residency to choose!

Internal Medicine: Week 1 Recap

On Monday, it’s probably safe to say I was legitimately terrified.

Obviously, I didn’t get any sleep on Sunday night, and instead I just sat on my floor wrapped in my own hair.

I just finished radiology, a rotation known for it’s relaxed atmosphere and minimal hours of “work.”

And this week, I started Internal Medicine, an 8-week rotation known for longer hours, intense pimping (aka: q-and-a sessions in which medical students typically get to be embarrassed by just how much they’ve forgotten from the USMLE Step 1), and just an overall larger workload, especially when making the switch from “radi-holiday.”

…except I basically hit the medicine team lottery.

I’m one of four students spending the first four weeks at a community hospital about 35 mins outside of the city, and I’m learning that friendliness of hospital staff increases proportionally to distance outside of the city. I mean, here, people say things like:

“Listen, if your stress level hits even 1/10, that’s too much. You don’t have to know all of the answers and I want to know if you’re feeling uncomfortable.” -Dr. Hospitalist

“I know you have two patients. But do you want a third? Wait, really? You want one? Are you sure? Really? You’re sure?” – my intern, who apparently is really worried about overworking me.

And no one ever makes me feel bad for not knowing an answer. Which is good, because there’s a lot of answers I’ve forgotten in the months since I took boards.

The staff of this hospital.

I was assigned to the team responsible for the less acutely ill patients, so the management plans tend to be fairly straightforward and our patient turnover rates are pretty high. Multiple times this week, I picked up a new patient to follow in the morning, only to help with the discharge paperwork by noon. Admissions typically come in overnight, so usually once my notes are (hand)written, there’s not a whole lot going on in the afternoon.

…which means that I’ve been getting hours upon hours of both independent study time and one-on-one teaching with both my resident and my attending on any topic of my choosing… and I’ve STILL been getting out by 3:00 PM (my classmates stay until 5-6 PM at least…).

This is how you leave the hospital at 3 PM for the fourth day in a row…

Basically, I have radiology hours along with the opportunity to interact with patients.

So I’m pretty much living the dream. Minus the part where I’m spending my one and only day off battling a GI bug, but I guess you can’t have everything.

The One Where I Whine A Lot

It’s another Medical Monday! For those of you who know me, welcome back! To those of you visiting for the first time, I’m K, a third year medical student in the US, and I’m pretty excited to have you here.

Except that the following incredibly whiny, stressed out post doesn’t make for a very good first date. Why don’t you check out my “You Know You’re a Medical Student…” series (20 Ways and 20 More Ways) first, and then visit my crazy once you’ve already learned to love me?

———-

This is me. Right now.

I think my stress level is reaching sub-Step 1 levels. (Yes, that is a level just below that induced by spending hours upon hours studying for a beastly 8 hour multiple choice exam that represents the first real grade received in medical school.)

Why, you ask?

It’s partially that radiology is just not my thing. Don’t get me wrong… being home, snuggled in my bed at 3:30 PM is totally my thing, and I’m sure I’d like radiology loads more if I was able to be a productive member of a team. However, my current activities include sitting in a dark room watching a resident dictate radiology reports, which is the equivalent of watching someone surf the Internet. And the lectures tend to be painfully boring and/or over my head (medical physics, anyone?).

Me, in most of my radiology lectures.

But the real reason for my stress is my fourth year schedule, which came out this past Friday. We have four mandatory blocks: a sub-internship, Geriatrics, Ambulatory, and surgical subspecialty.

The good news is I got the sub-internship I wanted in inpatient pediatrics (although my indecision re: residency picks makes this potentially NOT a good choice), and my geriatrics block is with at least two of my close friends. Additionally, my family med preceptor agreed to host me for my ambulatory block this summer, which I’m beyond excited for, provided the school allows me to switch the dates.

The bad news is that I got surgical subspecialty in July, which is terrible for several reasons:

1. This was me on surgery (so why would I ruin my summer?):

Evidence: of this misery, my tendency to bow out of surgeries early and excitement for the end of the block.

2. July is primetime to get letters of recommendation. I may not know what I want to do, but I know it’s not surgery… so why would I lose precious networking time on a block during which it won’t benefit me to network?

3. Perhaps the worst factor: I can’t change the timing of this block until the third year schedule comes out, which means it’s difficult to start scheduling my electives since I don’t know definitively when this mandatory block will be. Meanwhile, all of my classmates can start snatching up the best electives…

Bah. I want to just finalize my schedule and be done, but unfortunately this surgical subspecialty block is really cramping my style.

And don’t even get me started on the logistics of trying to find an international elective with appropriate dates.

Fourth year is NOT supposed to be this stressful.

FORGET it.

The One With the Summary of Radiology

 

 

The One Where Water Poured Out His Nose

“Sir, why don’t you tell us a little about why you came in to the hospital,” Dr. Weekend prompts the elderly patient, despite having heard his story from the overnight resident.

“‘Cause my head hurt. I’m not dealin’ wit’ it. Tired of it,” he snaps, clapping one hand over his left temple. “And I was bein’ confused. I got locked outta my apartment all night!”

“Okay. So your head hurt and you were a little confused. Anything else?”

“And my nose keeps runnin’ and runnin’,” he offers.

“Well, we saw a bit of a sinus infection on your CT, so that would make sense. Is it both nostrils?” Dr. Weekend continues.

“Nah. It just be the left one,” he offers with a sniff.

My attending nods and asks him to sit up in his bed so that she can go through a quick neurological exam.

And he sits up. And that’s when I see it:

He scrambles to hold a tissue to his nose, but not before I notice several drips of watery liquid pouring from his nose. My concern for this man immediately picks up a notch, and I look incredulously from my attending to my resident for signs of worry or surprise. But they don’t react.

“My nose always be drippin’ worse when I sit up,” he notes, humoring the physicians as they walk him through the neuro exam.

“That’s probably your sinus infection,” Dr. Weekend says, patting his shoulder for reassurance.

Now, I’m a third year medical student, the lowest of the low on the medical totem pole. There’s hundreds of diagnoses I have yet to experience, but I have had a run-in with a sinus infection or five. And never ever have I seen anyone with mucus pouring out of their head like water from a pitcher.

Instinctively, I’m sure of it: that’s not mucus. Despite never having seen it, I’m willing to bet this man has CSF rhinorrhea, a condition where the fluid that provides cushion to the brain is leaking through a nostril.

And suddenly, I’m faced with a difficult task: raising the possibility that the attending might be wrong in a world where in many cases, the medical student speaks only when spoken to.

We step into the hallway, and I inhale sharply.

“Dr. Weekend? Is that really just a sinus infection?” I begin slowly.

She nods. “It’s on the CT. There’s a big infection right in that left sinus,” she says insistently.

“There’s nothing else that could be?” I prompt.

“It’s the infection,” she says, her tone effectively ending the conversation. “We need to get an LP on this guy.”

And so we walked away, with me making a mental note to bring it up with the day attending on Monday.

But I wouldn’t need to. By Monday, Dr. Days has already ordered the tests and confirmed that this nasal fluid is CSF, and this man’s brain is bulging out into his nasal cavity.

—————-

This situation raises the dangers of the current medical hierarchy. Though I realize in hearing stories from trainees past, medicine has become much more open to input from students and residents, there is still this dynamic where it becomes incredibly difficult for a student to point out some attendings’ mistakes or oversights without overstepping boundaries or risking a poor evaluation.

I keep wondering if I should have pushed the issue harder with Dr. Weekend or the weekend resident, but I’m pretty sure that they both would have justified the current opinion and shrugged mine off as a silly medical student idea. I have always feared the day when my mistake led to an adverse outcome for a patient, but I never considered the possibility of recognizing a problem and being unable to convince those in power that it was a reality.

I’m grateful this man got his diagnosis, but it terrifies me to think that he may not have or he may have gotten there only after a life-threatening event. If something terrible had happened, would it have been my fault for not doing something? What was I supposed to do in this situation?

Have any of you ever had to stand up to an attending or a physician above you in the rankings? If anyone has any advice on how to approach this type of situation, I’d love to hear it in the comments.

Happies and Crappies: Neurology Week 3

The Happies:

1. I am having SUCH a blast doing inpatient neurology at the local VA. They pack four patients into the same room, and the room that my assigned patient is in is full of the nicest gentlemen I could ask for. Even though I’ve only been formally introduced to my own patient, they all greet me by name and strike up a conversation… it really helps to make the day better.

2. My lack of confidence in note-writing has been restored this week… my chief resident has been doling out a lot of compliments for my note-writing, and I’m so grateful to know that with a little effort I’m right where I should be. Or else my chief has lower expectations than the clerkship director. Hmm.

3. I passed my surgery shelf exam, even with significantly less study time than past shelf exams!

4. I discovered this, which may or may not nullify my Blogilates progress, but Nutella just might be worth it.

The Crappies:

1. My neurology shelf exam is coming faster than I can handle… it’s next Friday, and I’ve got a tight schedule this week with life-things. If only life drama hadn’t kept me from learning neuro well as a second year!

2. I have to take neurology call this weekend, even though it’s the weekend before the test. And I have the attending who has a reputation for being disrespectful of people’s time.

3. I had to respectfully decline an invitation that read as such: “Hello. Welcome to D’s Birthday, secret edition. The party is still this weekend, but tomorrow night, I’d like you to join me on a small adventure. Dress to walk outside and meet at XYZ location, and bring $10 to donate to the cause.”

4. My closet is currently an explosion of dirty laundry. And my apartment complex still doesn’t have a working dryer. And I have call this weekend and an upcoming exam. So uhh… these dress pants from the closet floor don’t look THAT bad… right?

Gearing up for a neuro-filled weekend, what with a call day and a study day… here’s hoping life doesn’t get TOO in the way.