Thursday, July 30, 2009

almost done at the VA

tomorrow is the last day we'll be with our current residents. i'm kind of sad. my team this month was GREAT. we have to stay sat/sun with the new team for some so-called "continuity of care", and then we go to the university hospital for another month of general house medicine. the big difference is that the VA's health records are all computerized...you type up your daily notes and all the labs, images, etc, are on the computer. at U, you have to hand write your notes, but all the labs and imaging are online. you dictate your final notes.

i just took out some vegan peanut butter cupcakes (more like pb brownies, honestly). they are smelling heavenly. they're for my team...i just hope next month is as good as this month was!

so after a month of medicine, i can say that i know a bit more info than when i first started. my brain has started thinking more "like a doctor", and i'm definitely understanding better how to construct the impression/plan list. basically you break down everything that is going on with the patient and then talk about how you're going to fix or treat those problems. easier said than done, but i'm getting better. today i worked on a "final progress note" on a patient that i've been following since he came to the ER a week and a half ago. the hard part of the FPN is the "hospital course". you have to succinctly describe what happened while the patient was in the hospital so that the next person can look at it and know exactly the gist of it all. i had a hard time trying to put it all together...i sat with the resident as she went over my note and turns out i had all the important information, she just switched the order of some of my statements. but i had all the correct info! that made me feel really happy, like at least i didn't screw up on something, and i know better how to do them in the future.

yesterday we had a PIG photo shoot with a giganto check. it's all good and cute, the peds doctors were really impressed. job well done. i'm proud of my fellow officers. we worked really hard and it certainly paid off. i'm just waiting on getting the damn photos though...they are being slow on that end and it's starting to irk me just a bit! and i delivered the "real check" today...i hope the money goes toward something useful...i'm sure it will. all for the children!

my conference is next week and i still haven't finalized my slides. i need to practice. i'm kind of getting nervous. i've been so busy with hospital work that when i come home, i just sleep. this weekend, i'll be practicing for sure. the conference will be a nice respite from being here. i just hope i don't screw my talk up. 15 minutes in front of PROFESSIONALS. and i'm just a med student. it's kind of daunting...

rounds tomorrow are at 7:15. which means we get there at 6:00. which makes me very happy. normally we get there at 5, wednesday i got there at 4. so yeah, when i'm told "6:00", i am very very happy.

hopefully tonight i can do some weights. i've been meaning to exercise more, but when you're on call every fourth night it's kind of hard. luckily at U we'll be on call every fifth night (q5), so i'll get a little bit more "me time".

alright, time to work on slides, do some weights, and then bed. fun times.

Sunday, July 26, 2009

i have tomorrow off!

life is good...i stepped out of the VA yesterday at noon and i won't have to go back until TUESDAY! how exciting!

today i got a new book called "how to cook everything vegetarian" by mark bittman. i'm really excited about the prospects. the only reason i got it was because H got me a gift card to a local bookstore and today i actually went in to use it...fun times. not that i want to become a vegetarian, but i'm always looking for ways to expand my vegetable repertoire...

i'm currently debating ordering a bunch of various kaplan flashcards for step 2 studies. yes, step 2. not that i'm wanting to really study hardcore NOW, but i do need help shoring up my diagnostic skills, and i think these cards would help me out.

i went to the gym today...powerwalked for 30 minutes on an incline. it's amazing how fast your body gets out of shape when you don't have the time to properly work out. once medicine is over, maybe i'll have more time.

the green beans i have planted in my fake garden are starting to flower...i hope this means i'll have real beans in the next few weeks! the dill has died, but my parsley is growing baby parsley leaves. the mint is trying to take over my porch...maybe i'll try to trick one of the runners into growing in a different pot.

tomorrow i'm making this fruit "tatin" that i saw the barefoot contessa make on the tv. she used plums, and i'm going to use plums, blueberries, and strawberries. it's like a caramelly cake pie sort of thing, and i'm kind of excited to make it. also, i'll be making some banana muffins for my team. we're on call tuesday, and it's nice to have good snacks laying around.

i learned last week what melena smells like. just imagine the nastiest poo smell ever. we opened the door to one of my patients' rooms and the smell just hit us like a freight train. just awful.

also, i don't understand the logic behind a patient's family deciding that the patient should now be full code (previously DNR/hospice) because the "patient would want to be full code now". well, currently, the patient has severe dementia, is nonverbal, been coded several times, has a trach and requires ventilation, severe upper extremity contractures, and just lays in bed all day drifting in and out of consciousness. this poor person's eyes are just sunk into their head, no teeth whatsoever. when i went to see this patient before pre-rounds, i knew he was nonverbal, but i still make it a point to talk to the patient and explain what i'm doing. it's just good practice, and maybe he can hear me. i could hardly hear his heart over the loudness of his lungs. and then he scared me, because he coughed, i wasn't expecting him to make any noise towards me. and i let out a yelp, and then started laughing, and explained to the patient that he startled me and how silly i was. i tried to listen to his abdomen, but couldn't really get very far due to his contracted arms. quick check of his legs for swelling and then i told him goodbye. it was a little bit creepy, that whole encounter, not because the patient was scary or anything like that (ok, maybe just a tiny bit because of eeriness of it all), just the situation he was in. i don't know what the family is thinking, or their reasons for doing anything, and i shouldn't judge...everyone has their reasons. but i can't help but make a mental note that if were in that patient's position, i would want my family to just let me rest.

on another note, i've realized that whenever i talk to a patient, my redneck accent comes out in full force. maybe it's because i talk a little bit louder than normal to the older people so i can make sure they hear me. i thought it had gotten cleaned up, but for some reason, it's coming back with a vengeance. not that i care...it's amusing to see the look on people's faces when they see an asian girl talking all southern at them.

Wednesday, July 22, 2009

wtf?!

allow me to vent a tiny bit about something...people giving me an evaluation WITHOUT EVER SEEING ME DO THE THING THEY ARE EVALUATING! i got my half-way eval from my VA medicine attending...he said wonderful things. no complaints there. he just said i need to continue to read and learn and build my "knowledge base", but that is to be expected since it's my first rotation. plus one of my partners is a freaking genius who make a 260 on his step and knows everything about anything and isn't afraid to tell everyone about everything he knows. so of course next to him i don't know as much. alas...but the attending told me to keep up the good work and keep learning. how much more could i ask for?

but then i finally got my eval and grade from the ID attending. according to him, i'm just on the high end of "meeting expectations". ok. i can deal with that. but then i started to read what all the various categories were, and half of them HE NEVER SAW ME DO. why would that be? because on ID, we never got the opportunity to interview a patient by ourselves. we just shadowed. i'm not going to complain too much about the grade (because we were never really given opportunities for us to be graded upon), but it does irritate me that i just "met expectations" on patient interviewing when 1) i never interviewed a patient, and 2) if he DID let me interview and he watch, he would have seen that i am good at being very thorough! aaak!

alas.

//end rant//

in the end, can't complain too much...it could have been a lot worse, and my grade for ID is decent. but it is also irritating. grrr. at least he didn't write any comments down. who knows what he would have said. i'm sure he didn't really care in the end. everyone on ID kept wondering why they had med students PERIOD...i guess they don't really get students, so having 2 at the same time freaked them out.

i still haven't gotten my final neuro grade, and that is a bit bothersome. maybe i'll send them an email about that soon.

tonight i have to work on my presentation for the conference. they want my slides by next friday. ha. that kind of sucks, but at least i'll have it done early.

Thursday, July 16, 2009

follow up to a comment...and i think i like medicine?

on my last post, someone wrote:

how did u do in terms of your score? Will it still let u do whatever field you want?

i'm happy to answer, i'll just have to overlook the "u" replacing the proper "you"...i'm sort of a spelling freak! (i circle misspelled words in my textbooks all the time. PEOPLE, can you edit?!)

moving on...

i believe that with my score and some hard work put into step 2 and good strategic networking and applications, i should have no problem finding a residency i desire in peds (which i am most likely to do). who knows, maybe i'll change my mind about what i want to do, but i think i'll be ok. looking at just my numbers, i'm not the most competitive person, but i think as a package deal, i'm pretty darn awesome! i have no intention of doing surgery, maybe i'll look into neuro or even ob/gyn (the intern on medicine right now is ob/gyn and she is really trying hard to sell it to me, and she's all about me doing genetics after an ob/gyn residency to counsel the pregnant ladies) but nothing i desire to do is something that is considered super competitive. so i think i'll be fine. it will be hard work, but i believe i will be somewhere i am happy for residency. i doubt i'll be at CHOP, ha, but it will be all good in the end.

now on to medicine...it's kind of weird...i kind of like it! i don't know if it's something i will end up doing for reals, but i really enjoy the thinking and the thought processes and the NUMBERS! so who knows. the crotchedy old men are growing on me, but i am still holding out for other specialties...of course. who knows. and the ID subspecialty rotation has proven itself to be quite helpful...i recommend it for anyone thinking about doing it!

and funny, evidently i ask a lot of questions, so many questions that a schizophrenic patient told me he was tired of answering all of them. my residents thought it was funny...2 of them LOVED how thorough i am, and the 3rd year resident just thought i was weird because i ask a lot of questions. (but i think in a good way, obviously.) ha, well, better to know too much than not know enough!

oh, and i joined a book club at school. basically we'll read books about doctoring and medicine and ethics and whatnot. this month we're going to read "mom's marijuana" by dan shapiro. i'm excited! evidently he's going to come to my campus and do a talk, so i'll get to meet him. book isn't too long at all. i'm just excited to have an excuse to read stuff NOT too terribly technical.

alright, bedtime soon.

Wednesday, July 15, 2009

I PASSED STEP 1!!!

i am SO happy! that chapter of my life is closed. the first 2 years of med school are done. it feels so good to finally just be over and be into something new. i can finally officially call myself an M3.

i took the step on may 27. i had studied hardcore for a month beforehand. and then waited 6 agonizing weeks to finally view my score. i am just so glad that i don't have to repeat all of that.

here's to the second half of med school...i'm so glad that it's finally here.

Monday, July 13, 2009

it's been a while...

i think i might be almost adjusted to waking up at 4 to get to the hospital at 5 to be ready for pre-rounds at 6 and then class at 8 and then big rounds at 9. almost. i come home and then take a long nap. i haven't gymmed in over a week, probably almost 2, sleep is more important. my eating habits are all whacked out, but i'm doing good on not overdosing on caffeine. i've managed to stick to my one cup a day habit...

medicine is going well...my team is great. the residents are amazing. the cases are interesting, i enjoy looking at all the lab numbers and thinking and whatnot, but i have to say that sometimes, i find certain patients' conditions to be disgusting. case in point...i can now confidently say i do NOT like anything to do with COPD. the coughing noises and the spitting up gross stuff and the heaving...GROSS. other than that, medicine isn't so bad. i don't know why the lung stuff just freaks me out. i certainly haven't had that "oooh i want to do this" sort of emotion, but it is interesting and it's growing on me. who knows.

i've seen a lot of sad stuff too...most of the people in the hospital are there because they smoked their whole lives. people, JUST DON'T SMOKE. you do not want COPD and to hack up a lung everyday and not be able to breathe. you don't want esophageal cancer so you can't eat. there's a patient on the service right now with this huge tumor on the side of his head that is ulcerated and infected. he has brain mets. he has at least a dozen lung mets. it's so sad. then there's another guy with a decubitus ulcer. i saw his FEMUR through the open wound. no pain. i'm sure the ulcer hurt like hell when he first got it, but as it got worse and worse the nerves are killed off and then it doesn't hurt anymore. but i saw his bone. *shudder*

when we present our patients we have to follow a certain format. "mr. so-and-so is a ___ year old ___ male with ___ who was admitted on ___ for ___." well, it's sad when their problems list is a bazillion things. i had a patient who's medical history list was at least 10 items long. it amazes me how people don't take care of themselves. granted, sometimes, it just can't be helped that you get ill. but a lot of these chronic diseases occur because the patients just didn't eat well enough, or exercise enough, or smoked for too long, or just didn't pay attention to their bodies. if you think something is wrong, get it checked out. don't sit around and just let it fester. then you end up with brain and lung mets, when if you had just noticed that maybe you had a funky looking mole on the side of your head, you could have gone in, gotten it removed, and call it a day.

other than the sad cases, we do have some good ones. i like it when the patients come in sick, and we make them better. i know, it's basic, but i like it. i especially like it when a really ill person comes in with no hope of survival, and their families have decided to put them on comfort measures only. i think that's the most humane thing anyone could do for a loved one.

ha, so not to end on a depressing note, we had a 94 year old patient who was SO CUTE. omg, so cute. (also, he was my first patient to do a FOBT on...ha! and i still have my finger! it didn't get sucked in or anything...) he talked so much about how he worked on building the panama canal and various bridges and how he loved fishing in montana and whatnot. yes, he was super old, but his brain was very sharp. too bad his talking couldn't keep up with his thinking...

so on my list of things to do is take a nap, do some reading on FeNa and the various classifications of kidney failure. oh, and finish up some H and Ps. busy busy.

Thursday, July 09, 2009

drrr...

it is way too early this morning. been awake since 3:30 am. contemplated a shower, but have decided to just ponytail the hair and throw on my yesterday scrubs and get moving. blah!

Friday, July 03, 2009

ID is over! look out VA medicine...

with ID being officially over now, i think i can say that while i enjoyed being on the service, i don't think i will go into ID. all the women doctors were all hippy dippy and fun and i enjoyed their personalities, the men doctors were a nice array and everyone seems laid back and enjoys their lives. it's just, i just don't want to have to deal with the same types of patients over and over and over...not necessarily boring but i guess you could say that? HIV, hepatitis, osteomyelitis, cellulitis, etc etc...interesting things, the doctors all seem very happy to do ID, but i don't think i would be after a while. it gets kind of "cookbook-ish"...once you help someone with HIV get on a good medication regimen, they soar back into great health.

monday i am to be at the VA at 6:30 am to round. that means after i get my patients, i show up EARLIER. my colleagues on surgery have already had to experience this early morning nonsense, but this will be my first time. granted, on neuro i had to leave my place at 6:15 to get to where i needed to on time, but now i'll have to leave to get to school probably at about 5:30 to properly round on my patients and whatnot.

i'm kind of dreading starting VA medicine...well, the patients will be daunting enough, but moreso because i've witnessed some discussion about my third partner for the month that is less than ideal. it's already been made out in the open that this particular person "steals" patients from other students and shows no remorse for doing so. hopefully it was a one time fluke and the person doesn't do it anymore, but i am fully prepared to do some talking when i need to. finally now my team player skills and team management skills are going to come out...things i learned in engineering school. i think i have had every type of undesirable partner and effectively dealt with it all to come up with a good group dynamic in the end, so i hope that i can make this coming up month a good experience for all. the most memorable one was the guy who had a crush on every girl he worked with, but not in a good way...eek!

this weekend i need to sleep a lot to ready myself for VA medicine action and READ!!! i have a test next week and i want to make sure i do well.

OH, and i submitted my abstract and got a platform presentation AND a travel grant to go to a conference in august! i'm super excited. though i just made my hotel reservation and that pretty much wipes out the travel grant...haha. but H is going to go with me so the money will be well spent. i'm excited about the location, i've never been and looking forward to it!

ok, breakfast time, chao.