It has again been a long time and much has happened since my last installment (though I'm not sure something as infrequent as my posts can even be called "installments" which denotes some degree of regularity). Regardless, the catharsis that writing provides has prompted me to sit down and plug away at an update. I wonder sometimes if part of why writing in a "journal" (these posts are as close as I get) is so strongly encouraged is because it provides a medium for calming and healing turbulent emotions and thoughts…it's an interesting thought...
Anyway, let me first reiterate one of the big changes in my life: I am no longer a Wisconsin resident…
Part of me was ready for this change (the part of me that hates being cold all the time in particular. Also the part of me that enjoys the excitement of newness!) Having said that however, a part of me got left in that frozen northern tundra…I made some of those rare friends -- you know the type -- the ones you will still feel close to even after months/years of not seeing them. The ones who seem to glow with goodness and yet don't realize it (part of what contributes to their glowing, I'm sure). The ones who, no matter how much you try and tell them, will never really "get" how much they influenced you….those kind of friends! For four years they helped fill gaps that I am just now beginning to understand a little better. My years in Wisconsin remind me of my years as a missionary because both were far away from family and things that felt familiar. Both were times of "concentrated life and learning" (I don't know how to phrase it any better) that felt like 10 or 20 years of normal life experience crammed into 2 or 4 years respectively. And both were periods that in retrospect I can look back on and find strength in…
In late June after a wonderful visit from my parents, grandparents and Lance and after finishing a forensic pathology rotation I hit the road in my trusty Subaru -- that I have aptly named "Rocinante" after the horse in Don Quixote (I think it is a particularly fitting name since to the world's view Rocinante was a ramshackle glue-factory animal but Don Quixote saw him as a brave and valiant stallion who stalwartly took him around on his somewhat misguided quests to fight windmills and the such…I think it is just a name that fits…) Anyway, my brave little car and I hit the road for south Texas! Along the road I got to spend a night in Nauvoo, a night in Tulsa with some relatives and a night in Dallas with friends! Upon arrival I immediately set to work moving my stuff in, finding my way around and starting residency!
I began July 1st on a Neurosurgery rotation. I had a fair amount of anxiety about being so brand new and starting on something like neurosurgery but with the exception of one very long, tense night working to keep a patient alive (we were successful by the way) it was a really nice rotation and I learned a lot. August and now September have been a geriatrics rotation which have also been nice and allowed some quick weekend trips up to Utah to see and meet people. Next month will be on the acute inpatient rehab unit which will be very applicable to my future career (despite having the reputation of really long arduous hours). I look forward to things that are heading down the residency pipeline!
Now, as I mentioned above, the major reason I started writing this post after so long of a break is for the cathartic effect writing has on me. Somehow taking the time to organize my thoughts enough to write them down has a therapeutic effect on me and helps me to solidify certain concepts or ideas in my mind in a way nothing else does. With that said, I'm about to get a lot more somber, so for anyone who is not in the mood for somber feel free to stop now and watch this hilarious video of the funniest dog of all time! (http://www.youtube.com/watch?v=4LzMAXqu8qU)
Sometimes I like to picture what I call the "mental shelf". In my mind I imagine an empty room with a shelf attached to one wall. On this shelf are a variety of strange objects of different shapes, sizes, colors, ages, etc. Each of these objects represents an idea that I just don't really understand. From time to time I will go in this room and take one of the objects off the shelf, brush away the dust and examine it. This is akin to thinking about an idea or topic that I don't really understand for a while. Most commonly I am forced to place the object back on the shelf, no better understood than when I picked the item up and I leave it to be revisited at some future day. Occasionally however, when I am turning this object over and over in my hands a spark of understanding comes to me and when I put the object back on the shelf I understand it just a tiny bit better than when I started. Over the months and years these sparks accumulate and my understanding morphs over time. I'm not sure I'll ever fully understand these topics but I am confident that my understanding today is better developed than it was last week and it will be better developed next week than it is now if I keep visiting the objects on the shelf and spend time mulling them over. I do find that these "objects" (aka: thoughts or ideas) are generally among the big tough ones that don't have easy answers and if they do have answers they are probably different for every person...
Anyway, one of these "objects" that I have been visiting from time to time in my thoughts over the last year or so has been the idea of how Christ can mend that which is broken. At first I didn't even think of it in exactly those words or terms, but over time I have come to understand that the things I was thinking about could be boiled down to the idea of Christ's power to mend that which is broken. What I have come to understand is that each of us at any given moment have a part of us that feel broken. This feeling can be because of a loss we have suffered, or from loneliness, or depression, or from frustration at our circumstances or from feeling we have been betrayed or had our trust broken. It can come when we seem to fall into the same stupid sins over and over again. It can come in matters of family, friends, work (or lack thereof) and relationships. It can certainly come in matters of dating and the heart…I think we all have these parts of us that feel fractured and broken and we wonder if they will ever be able to be fixed…
Growing up and well into my adult years I would hear the phrase "Christ understands your pain and sorrows because he felt them all" or something along those lines, and for a long time I didn't fully understand how that was important. I believed it and felt that it was true. I just didn't understand how that was helpful. Frankly, it made me feel bad because I was miserable and why would I want anyone to feel the same way I did, even if it was the Son of God? It wasn't until I was well into what is generally considered "adulthood" (debatable in my case, I know) that I finally came to understand why it was important that Christ felt all the same pains I feel. What I realized is that the phrase I heard growing up is incomplete. It is the first half of an idea, but it is not the whole idea. If I were to rewrite the phrase it would go something like this: "Christ understands your pain because he felt it too, and that is important because he descended below these things and then overcame them, and now he can show you the way out!"
Elder Holland gave a talk in the April 2006 conference that has become one of my favorites. In it he said this:
"The Savior reminds us that He has “graven [us] upon the palms of [His] hands.” Considering the incomprehensible cost of the Crucifixion and Atonement, I promise you He is not going to turn His back on us now. When He says to the poor in spirit, “Come unto me,” He means He knows the way out and He knows the way up. He knows it because He has walked it. He knows the way because He is the way."
Now, I'm not saying that healing the parts of us that are broken will be a painless process, and I'm not saying it happens overnight. Just like setting and casting a broken bone is painful, and healing takes time; pulling our broken pieces together can hurt and will likely not happen on our timetable. What I believe however, is that healing can come. Whether it is my heart that is broken or my trust or my confidence, these things can be healed through the power of Christ's atonement.
The details are not important but I have had opportunity to put this mending power to the test in recent weeks probably as rigorously as I have ever had need of it. It has been hard and painful, and I'd be lying if I said that I felt completely repaired. I have some relatively good moments and I have some not as good moments. My heart and emotions often still feel like they are in shattered little pieces. But what I find comfort in is the knowledge that things can get better if I allow Christ's atonement to work in my life. Another "mental shelf" idea that relates is the idea of exactly what the atonement does for us and how to make it active in our lives. I have gone on quite long enough and I will not delve into these topics other than to say that I have learned that the atonement is not only for cleansing of sin (it is for that, certainly) but it does more. Among other things It "binds up the brokenhearted" (Isaiah 61:1) and we make it active in our life when we are obedient to commandments and when we live covenants we have made.
I think it is part of the mortal experience to always have some part of us that feels broken -- I think that is part of what "opposition in all things" means -- but I think that when we are yolked to Christ, those broken parts don't stay broken. They are repaired and made stronger than they were to begin with. I think this is part of what Christ meant when he said he would make weak things become strong unto us (Ether 12:27). The repaired/strengthened parts will always be replaced with new broken pieces but as we continue to yolk ourselves to Christ those parts will be repaired and strengthened and the whole repeating cycle results in a new and stronger and more Christ-like person! Admittedly, some breaks take longer to heal than others, but I think that is part of why the Atonement needed to be infinite! Because no matter how bad the break is, no matter how large a part of us is broken, and no matter how feeble and inadequate our best attempts may be; the atonement will fill in where we fall short, it will repair the broken piece no matter how large it is!
Anyway, I'm going to quit rambling now. I feel bad for making anyone strong enough to have read all the way to then end here be a part of my self-therapy session…sorry!
Best wishes to everyone and I hope to catch up sometime soon!
-Eric
Tuesday, September 21, 2010
Sunday, March 28, 2010
Graduation Announcement
I didn't have the money or time to pull together a real graduation announcement.
This was my compromise...
Saturday, March 20, 2010
Alamo city or bust!
So, the results are in and I'm thrilled! I'll be spending the next 4 years in beautiful south Texas (San Antonio)!
It's a great program and a great city, and I couldn't be happier!
I've spent an embarrasing amount of time in the last few days browsing pictures and forums about San Antonio and here are just a few of the gems I've found.
Wednesday, March 17, 2010
Long Overdue! (3/17/2010)
Family & Friends,
So, time flies and a year has passed since my last substantive entry…I knew this would be a danger when I started this blog. Despite my best intentions I wax and wane in my journal keeping – always have. Since this blog doubles as my journal, I guess this is just me back at my old tricks!
I will inevitably miss important details pertaining to the last year, but here is a brief blow-by-blow of my last 12 months:
Our story left our “hero” (note the quotation marks) just finishing his first month of ambulatory medicine. Despite an awkward experience or two, my big take-home lesson from that month was that I enjoy outpatient medicine where your patients come and go home again after the visit (vs. inpatient, where the patients are all admitted to the hospital and stay for…well…who knows how long! Could be a day, could be until death do us part!)
I then completed a month of inpatient medicine, 2 months of surgery, and then 2 months of pediatrics polished off my 3rd year of medical school. Here is what I learned from these rotations
• I like procedures, I even like surgery, but I do NOT want to be a surgeon! Why? Because I don’t hate myself (present/future surgeons, don’t be mad at me. That was a joke…sort of…) Really, it is because I don’t want that kind of lifestyle until I’m 60+. Also, I learned that while I like procedures, I do not like procedures/surgeries that take more than 1-2 hours. I get board and my legs hurt. Also, I’m pretty sure Robert Louis Stevenson had a surgeon in mind when he wrote “Dr. Jekyll and Mr. Hyde” because surgeons become different people when they get in the OR…seriously!
• Kids are cute and fun…but not when they are sick! And what is worse/more-cranky than a sick kid? Answer: a sick kid’s parent! I defiantly learned that being a pediatrician is for other people (bless their insane hearts!)
Around this time, I started to prepare my residency application. Here are a few highlights of what this entails:
• Writing a CV (which is a type of resume that we use in medicine. CV stands for “Curriculum Vitae” which is Latin for “make the shadow-box you built in 3rd grade sound like the cure for cancer, a clean-burning eco-friendly fuel that will replace oil, and an everybody-wins solution to the health care debate”
• Getting 150 letters of recommendation (really just 5…but it felt like 150). Here is how that process usually goes:
Eric: “Would you be willing to write me a letter of recommendation about what a wonderful student and human I am? Please make sure you include how well you know me and how you deeply wish that in another life you would have had a son as brilliant, motivated and hard-working as me.”
Attending: “Who are you and why are you in my way?”
• Writing a personal statement. This is a tricky one. Somehow you are expected to write about how incredible/amazing/talented/hard-working/good-looking/charming/well-rounded/environmentally-friendly/service-oriented you are. Also, you are expected to convey why you distain the thought of being compensated (with money) for being a doctor and why you would rather get paid in “warm fuzzy feelings” than receive a paycheck. (I exaggerate…but only a little!)
Shortly after all of my application preparation, I was fortunate to be able to drive to Utah and begin a 4 month stint at home with family! Here is how each of the 4 months broke down
• Month #1: I got to study about 8-9 hours a day and then take an 8 hour board exam. I think I have expressed my feelings about board exams in the past, and I will have many opportunities to do so in the future, so I will limit myself to saying that I’m glad it is done and that I passed just fine.
• Month #2: Infectious Disease rotation at the University of Utah hospital. Overall, this was a good rotation and I learned a lot. Also, I had my first few residency interviews (more on these later).
• Month #3: Physical Medicine and Rehabilitation rotation at the University of Utah hospital. I LOVED it! Admittedly, this is my chosen field, and I may be a bit biased, but really, it was great! At the end of the month I spent a wonderful Christmas at home with my family!
• Month #4: A “vacation” month where I stacked most of my residency interviews. Really this month was spent traveling and living the life of a “road-warrior”….(if I never have to see an airport or rental car again, so help me)…on the bright side though, I did get to spend a few quality days in Virginia with Lance seeing that beautiful state and a few days in New York seeing all that is Manhattan island. At the end of the month I drove back to Wisconsin in time to start another inpatient medicine month.
Let me state right here that invariably my time in Utah went faster than I wanted or expected it to. I never get to see all the people I want to, and those I do see, I never get to see enough. Those of you I did see, I hope I’ll be seeing more of you soon (more on this later). Those of you I didn’t see, I also hope to see you sooner than later (time will tell)!
Let me take a quick tangent right here about residency interviews and what that experience was like. Imagine this: you receive an email saying something like “Congratulations, we at the University of [fill in the blank] would like to extend an offer to interview at our program”. You call them up, set a date and then hang up the phone. Suddenly you realize that you do not live in that state and that before you can interview there, you will need to get there. You jump on Travelocity.com and book some flights (the cheapest flights, of course, arrive at 1:30am and the airport is 25 miles away from the hospital). Then you realize that you do not know anyone who lives in that city, nor do you know the how to use the public transportation even if it was running at 1:30am. You get on Enterprise.com and rent a car (the cheapest car is a neon blue VW Bug that makes you feel like you are driving inside of a blueberry) and then go to Motel.com and rent the cheapest room you can find (it is at the Bates Motel and you can still see blood stains on the wall from the last unfortunate medical student who stayed there). After arriving at the city of question at 1:30am (did I mention the 7 hour layover in Harrisburg?) you and your trusty GPS navigate your way to the motel (there is, of course a blizzard going on outside), crash for a few hours and then navigate your way to the hospital where you begin the interviews.
Most interviewers are pretty cool and do not make the experience too uncomfortable, but every so often an interviewer just want to nail you to the wall with questions like “how do you think we should solve the health care crisis?” (there is NO RIGHT ANSWER to this question and no matter what you say, you are WRONG!)
After the interview you try to drive back to the airport but the battery in your GPS is dead and you forgot the charging cord. You take the “scenic route” through cities with names like “Cottonville” and “Manitowoc” until you finally must use the force (Star Wars was on the motel TV last night) to find you way back!
Finally you arrive back home just in time to wash your clothes, choose a new tie and drive to the airport again for the next interview. After a few of these little trips, another thought strikes you: I’m a poor student and don’t have any money to be doing all of this flying/car/hotels thing! You call your bank and ask for another loan….
****
After moving back to Wisconsin and reconnecting with my amazing peeps out here (love you guys!) I’ve done 2 months of inpatient medicine (again, not my favorite). Which brings me to today…the day before match day!
Match day is a time-honored tradition in medicine. Here is a simple way of visualizing it:
• I make a list of all the programs I interviewed at (#1 on my list is my favorite program, #2 was my second favorite program, etc.)
• The programs make a list of all the applicants they interviewed (#1 was their favorite interviewee, #2 is their second favorite, etc.)
• Both lists get submitted to the mysterious NRMP (National Residency Match Program) which I’m convinced is an ultra-secret organization kind of like the illuminati.
• On a given day in March, a computer somewhere in the depths of NRMP’s secret headquarters runs an algorithm trying to match both lists up as high as possible on both sides. I like to picture an evil computer kind of like the one from “2001: A Space Odyssey” (“Open the pod bay doors, HAL”)
• A few days after the evil computer has done its work, all the 4th year medical students in the country gather at their respective schools and get handed an envelope with the results of the match inside. Prior to this point we are not allowed to know the results of the match. It is kind of like receiving a mission call, except for instead of receiving a call to serve a 2 year religious mission, it is a 4 year residency position…
That brings me to tomorrow, which is match day! Yikes! Tomorrow sometime between 11am and 1pm I will find out where I will be living for the next 4 years! My first choice is to return to Utah (why I hope to be seeing all of you Utah peeps again soon). Programs in San Antonio, Dallas, Detroit, Milwaukee, Cleveland, New York, Boise, and Richmond are also possibilities. Really, every program I interviewed at was good and I’ll be happy to end up at any of them, but a part of me is really hoping for Utah…
Anyway, that is probably enough out of me. Best wishes to all of you!
-Eric
So, time flies and a year has passed since my last substantive entry…I knew this would be a danger when I started this blog. Despite my best intentions I wax and wane in my journal keeping – always have. Since this blog doubles as my journal, I guess this is just me back at my old tricks!
I will inevitably miss important details pertaining to the last year, but here is a brief blow-by-blow of my last 12 months:
Our story left our “hero” (note the quotation marks) just finishing his first month of ambulatory medicine. Despite an awkward experience or two, my big take-home lesson from that month was that I enjoy outpatient medicine where your patients come and go home again after the visit (vs. inpatient, where the patients are all admitted to the hospital and stay for…well…who knows how long! Could be a day, could be until death do us part!)
I then completed a month of inpatient medicine, 2 months of surgery, and then 2 months of pediatrics polished off my 3rd year of medical school. Here is what I learned from these rotations
• I like procedures, I even like surgery, but I do NOT want to be a surgeon! Why? Because I don’t hate myself (present/future surgeons, don’t be mad at me. That was a joke…sort of…) Really, it is because I don’t want that kind of lifestyle until I’m 60+. Also, I learned that while I like procedures, I do not like procedures/surgeries that take more than 1-2 hours. I get board and my legs hurt. Also, I’m pretty sure Robert Louis Stevenson had a surgeon in mind when he wrote “Dr. Jekyll and Mr. Hyde” because surgeons become different people when they get in the OR…seriously!
• Kids are cute and fun…but not when they are sick! And what is worse/more-cranky than a sick kid? Answer: a sick kid’s parent! I defiantly learned that being a pediatrician is for other people (bless their insane hearts!)
Around this time, I started to prepare my residency application. Here are a few highlights of what this entails:
• Writing a CV (which is a type of resume that we use in medicine. CV stands for “Curriculum Vitae” which is Latin for “make the shadow-box you built in 3rd grade sound like the cure for cancer, a clean-burning eco-friendly fuel that will replace oil, and an everybody-wins solution to the health care debate”
• Getting 150 letters of recommendation (really just 5…but it felt like 150). Here is how that process usually goes:
Eric: “Would you be willing to write me a letter of recommendation about what a wonderful student and human I am? Please make sure you include how well you know me and how you deeply wish that in another life you would have had a son as brilliant, motivated and hard-working as me.”
Attending: “Who are you and why are you in my way?”
• Writing a personal statement. This is a tricky one. Somehow you are expected to write about how incredible/amazing/talented/hard-working/good-looking/charming/well-rounded/environmentally-friendly/service-oriented you are. Also, you are expected to convey why you distain the thought of being compensated (with money) for being a doctor and why you would rather get paid in “warm fuzzy feelings” than receive a paycheck. (I exaggerate…but only a little!)
Shortly after all of my application preparation, I was fortunate to be able to drive to Utah and begin a 4 month stint at home with family! Here is how each of the 4 months broke down
• Month #1: I got to study about 8-9 hours a day and then take an 8 hour board exam. I think I have expressed my feelings about board exams in the past, and I will have many opportunities to do so in the future, so I will limit myself to saying that I’m glad it is done and that I passed just fine.
• Month #2: Infectious Disease rotation at the University of Utah hospital. Overall, this was a good rotation and I learned a lot. Also, I had my first few residency interviews (more on these later).
• Month #3: Physical Medicine and Rehabilitation rotation at the University of Utah hospital. I LOVED it! Admittedly, this is my chosen field, and I may be a bit biased, but really, it was great! At the end of the month I spent a wonderful Christmas at home with my family!
• Month #4: A “vacation” month where I stacked most of my residency interviews. Really this month was spent traveling and living the life of a “road-warrior”….(if I never have to see an airport or rental car again, so help me)…on the bright side though, I did get to spend a few quality days in Virginia with Lance seeing that beautiful state and a few days in New York seeing all that is Manhattan island. At the end of the month I drove back to Wisconsin in time to start another inpatient medicine month.
Let me state right here that invariably my time in Utah went faster than I wanted or expected it to. I never get to see all the people I want to, and those I do see, I never get to see enough. Those of you I did see, I hope I’ll be seeing more of you soon (more on this later). Those of you I didn’t see, I also hope to see you sooner than later (time will tell)!
Let me take a quick tangent right here about residency interviews and what that experience was like. Imagine this: you receive an email saying something like “Congratulations, we at the University of [fill in the blank] would like to extend an offer to interview at our program”. You call them up, set a date and then hang up the phone. Suddenly you realize that you do not live in that state and that before you can interview there, you will need to get there. You jump on Travelocity.com and book some flights (the cheapest flights, of course, arrive at 1:30am and the airport is 25 miles away from the hospital). Then you realize that you do not know anyone who lives in that city, nor do you know the how to use the public transportation even if it was running at 1:30am. You get on Enterprise.com and rent a car (the cheapest car is a neon blue VW Bug that makes you feel like you are driving inside of a blueberry) and then go to Motel.com and rent the cheapest room you can find (it is at the Bates Motel and you can still see blood stains on the wall from the last unfortunate medical student who stayed there). After arriving at the city of question at 1:30am (did I mention the 7 hour layover in Harrisburg?) you and your trusty GPS navigate your way to the motel (there is, of course a blizzard going on outside), crash for a few hours and then navigate your way to the hospital where you begin the interviews.
Most interviewers are pretty cool and do not make the experience too uncomfortable, but every so often an interviewer just want to nail you to the wall with questions like “how do you think we should solve the health care crisis?” (there is NO RIGHT ANSWER to this question and no matter what you say, you are WRONG!)
After the interview you try to drive back to the airport but the battery in your GPS is dead and you forgot the charging cord. You take the “scenic route” through cities with names like “Cottonville” and “Manitowoc” until you finally must use the force (Star Wars was on the motel TV last night) to find you way back!
Finally you arrive back home just in time to wash your clothes, choose a new tie and drive to the airport again for the next interview. After a few of these little trips, another thought strikes you: I’m a poor student and don’t have any money to be doing all of this flying/car/hotels thing! You call your bank and ask for another loan….
****
After moving back to Wisconsin and reconnecting with my amazing peeps out here (love you guys!) I’ve done 2 months of inpatient medicine (again, not my favorite). Which brings me to today…the day before match day!
Match day is a time-honored tradition in medicine. Here is a simple way of visualizing it:
• I make a list of all the programs I interviewed at (#1 on my list is my favorite program, #2 was my second favorite program, etc.)
• The programs make a list of all the applicants they interviewed (#1 was their favorite interviewee, #2 is their second favorite, etc.)
• Both lists get submitted to the mysterious NRMP (National Residency Match Program) which I’m convinced is an ultra-secret organization kind of like the illuminati.
• On a given day in March, a computer somewhere in the depths of NRMP’s secret headquarters runs an algorithm trying to match both lists up as high as possible on both sides. I like to picture an evil computer kind of like the one from “2001: A Space Odyssey” (“Open the pod bay doors, HAL”)
• A few days after the evil computer has done its work, all the 4th year medical students in the country gather at their respective schools and get handed an envelope with the results of the match inside. Prior to this point we are not allowed to know the results of the match. It is kind of like receiving a mission call, except for instead of receiving a call to serve a 2 year religious mission, it is a 4 year residency position…
That brings me to tomorrow, which is match day! Yikes! Tomorrow sometime between 11am and 1pm I will find out where I will be living for the next 4 years! My first choice is to return to Utah (why I hope to be seeing all of you Utah peeps again soon). Programs in San Antonio, Dallas, Detroit, Milwaukee, Cleveland, New York, Boise, and Richmond are also possibilities. Really, every program I interviewed at was good and I’ll be happy to end up at any of them, but a part of me is really hoping for Utah…
Anyway, that is probably enough out of me. Best wishes to all of you!
-Eric
Tuesday, July 28, 2009
7/28/2009
It's been a long time! I promise I will try and write again soon...medical school & such gets this way sometimes...
Friday, March 27, 2009
03/27/2009
Family & Friends-
I find that when it has been this long since I last wrote, the best thing to do is choose the best 1 or 2 nuggets, write about those and ignore trying to "catch up" on 5 or 6 months worth of events….the only trouble now is remembering what those 1 or 2 nuggets might be!
I'm just now drawing to the end of my out-patient/ambulatory internal medicine month. Because medical school has its own lingo and the phrase "out-patient/ambulatory internal medicine" is pretty esoteric, let me rephrase by saying I'm finishing a month in a clinic much like you might think of when you say "I've got a doctor's appointment today". Out-patient means it is not in the hospital, rather it is in a clinic. Ambulatory means that the patients walk in and walk out in the same day (they "ambulate"). Internal medicine means it is simply primary care for adults -- they are the generalists who do not specialize in one organ system, rather they are trained to handle problems from almost any organ system. This month I have spent approximately 80% of my time working with patients who have common chronic problems such as high blood pressure, diabetes, high cholesterol, back pain and coronary artery disease, etc. The remaining 20% or so was spent on more acute things like gout attacks, asthma exacerbations, etc. For some reason (probably because most medical students are cowboys who like that adrenaline rush), Internal Medicine and chronic care in general gets a bad reputation. I heard over and over that I'd be board out of my mind this month, but I guess I'm just made of different stuff because I've really enjoyed things! Admittedly, it is frustrating to have to see a new patient every 15 minutes (I'm sorry, 15 minutes is simply not enough time to do anything, even in the best of circumstances!) but aside from the problems of managed care, I like the clinic life. Next month is an in-patient Internal Medicine month (meaning I'll be working with much sicker patients who have been admitted to the hospital). Traditionally this is one of the hardest rotations in medical school, so I'm trying to mentally prepare myself for the gauntlet ahead!
Well, really only a few stories are coming to my mind that might be even slightly entertaining to write about (and I'm not sure they are even all that great…we'll see I guess!) However, before I dive in, let me preface this as I have in the past: I will be using "medical words" (meaning I'll be talking about certain anatomy) and if this is likely to offend, feel free to stop now. Also, because I don't want any of the HIPAA Gestapo to come breaking down my door tonight, I will be changing certain details in order to absolutely protect the identities of individuals. Having said that though, I am not changing the major details of what actually happened, nor my thoughts & feelings (or lack thereof).
One thing that you find out as you work with different medical educators is that each person has a different level of commitment to your learning experience. On one end of the spectrum you have the doctors who really don't want you around and who only keep you there because it is part of their contract. When working with one of these doctors (let's call them the "Apathetics") you learn very little, but the ride is usually pretty smooth -- you be as inconspicuous as possible and they won't fail you out of medical school. On the other end of the spectrum you have what might be called "The Dedicated". These doctors (bless their hearts) do ANYTHING and EVERYTHING to ensure you learn something. While this is certainly the better end of the spectrum to be on, it can get a little excessive, as I learned to my dismay a week or two ago:
I was in the clinic with a doctor -- let's call him Dr A (I'd classify him as a "dedicated" but not excessively so) and our next patient happened to be another doctor who works as a specialist at one of the local hospitals -- let's call her Dr B (it is always kind of weird to be a doctor for a doctor…but anyway, that is beside the point). Dr B was in the clinic for a routine yearly physical exam. Dr A asked all the appropriate questions, did a brief yet adequate physical exam and was writing his note, when Dr B (someone I would classify as light years beyond the "dedicated" mark) turned to me and asked if I was going to be practicing my physical exam skills on her. Dr A tried to explain that when the patient was another doctor whom the student (me) may have to work with sometime in the future, he usually didn't have them do any physical exam in order to avoid any awkwardness. Dr B would have none of it! Ignoring completely the explanation of Dr A she began to grill me about how to do a proper cardiac auscultation exam…
At this point let me take a tangent and explain the full cardiac auscultation exam (auscultation means "to listen" usually with a stethoscope). Because the heart is divided into chambers and because there are multiple valves within the heart and because something may go wrong at any of these sites, a full cardiac auscultation exam involves listening to the heart at different places on the chest -- at each spot a different part of the heart can be heard better. This does not mean that at spot #1 you only hear the aortic valve, it just means that the aortic valve can be heard best at spot #1. At spot #2, the pulmonary valve is heard best, and so on.
Cardiac auscultation is fairly easy on a male because they lack certain chest anatomy that is present in female counterparts. Where things can get difficult is when listening to a couple of the spots on the female patient because breast tissue often needs to be held out of the way. Also, part of the exam involves finding the PMI (Point of Maximal Impulse). The location of the PMI gives an indication of how large the heart is (an enlarged heart can be a sign of impending heart failure). Again, finding the PMI on a male is not too hard…but in a female, it requires a lot of maneuvering of breast tissue.
Because of these complications, in a potentially sensitive situation such as examining a teacher or colegue, the cardiac exam is often superficial and unless there are symptoms or risk factors to suggest something is wrong with the heart, a superficial exam is all that is needed (Note: this may not be what the textbook tells you to do, but we live in the real world and in the real world, sometimes the cardiac exam is sacrificed in order to preserve dignity)
…okay, back to the story! There I was, getting grilled about the cardiac exam when Dr B said "show me the proper exam technique!" (and since she was the only patient in the room, it could clearly be surmised that she meant to have me perform the cardiac exam on her). I shot Dr A a quick glance as if to say "is that okay?" and Dr A gave me a look back that said "sorry pal, technically she is right and should get a full cardiac exam today…better luck next time!" With all the enthusiasm of a man walking to the gallows, I went through the motions of a cardiac exam, trying to be as quick and non-invasive as possible. Approximately 4 seconds later I had listened to all of the necessary spots, pretended I'd found the PMI and had backed up halfway across the room to give Dr B plenty of personal space. Now, because Dr B has a level-10 black belt in medical education, she knew what I was up to and was not going to have any of it! She made me repeat the full exam 3 or 4 times until she was convinced that I had learned something about how to do a proper exam. I'll not be more detailed in my explanation than that, but I don't think a world-class imagination is needed to paint a mental picture!
Let me emphasize that while this was an uncomfortable situation for me (funny in retrospect, yes, but still uncomfortable) there was no reason to think that Dr B had any motive in mind other than the proper education of a student. She works day in and day out in a field where she sees students who are not properly trained in physical exam technique because no one is willing to let the proper exam be done on them. "Dedicated" doctors have been known to go to greater extremes than that in times past to teach a student and by comparison I got off easy! (Also, Dr A was present in the room at all times, and besides she was probably twice my age or more!)
***
So this next story is probably not quite as memorable for the reader of this letter as the last story, but for me it was a real red-letter day!
There have been plenty of times in the past where I feel like I have no idea what is going on…I do take comfort in the fact that all 3rd year medical students often feel this way, but none-the-less I sometimes sit there trying to think of some distant piece of information I learned and all that comes to my brain is that the patient probably needs a tetnus shot (not that tetnus shots cure any of the patient’s problems…but sometimes that is all that comes to mind). Fortunately, things are coming together more and more every day, but regardless there have been a few times that if you could read a transcript of my thoughts, this is what it would look like:
"This patient has sarcoidosis of the lungs, how should we treat him?"
"Tetnus shot?"
"This patient has pseudomembranous colitis, what should we do next?"
"I know, give him a tetnus shot!"
"This patient has a bunion on his foot"
"Tetnus shot is just what he needs!"
"This patient has excessive earwax"
"Tetnus shot! (then a CT scan of his head!)"
But, a few weeks ago I finally, let me repeat, I finally heard something before my attending did! In listening to a patient's heart I heard a murmur, and it wasn't until I insisted that I heard something abnormal that my attending listened closer and agreed with me! We sent the patient for an echocardiogram and it turns out he had aortic stenosis (not a real good thing). While I feel bad for the patient, a part of me can't help but be excited that I finally caught something that no one else caught!
Anyway, that’s about it, so I’ll finish here.
Love you all!
-Eric
I find that when it has been this long since I last wrote, the best thing to do is choose the best 1 or 2 nuggets, write about those and ignore trying to "catch up" on 5 or 6 months worth of events….the only trouble now is remembering what those 1 or 2 nuggets might be!
I'm just now drawing to the end of my out-patient/ambulatory internal medicine month. Because medical school has its own lingo and the phrase "out-patient/ambulatory internal medicine" is pretty esoteric, let me rephrase by saying I'm finishing a month in a clinic much like you might think of when you say "I've got a doctor's appointment today". Out-patient means it is not in the hospital, rather it is in a clinic. Ambulatory means that the patients walk in and walk out in the same day (they "ambulate"). Internal medicine means it is simply primary care for adults -- they are the generalists who do not specialize in one organ system, rather they are trained to handle problems from almost any organ system. This month I have spent approximately 80% of my time working with patients who have common chronic problems such as high blood pressure, diabetes, high cholesterol, back pain and coronary artery disease, etc. The remaining 20% or so was spent on more acute things like gout attacks, asthma exacerbations, etc. For some reason (probably because most medical students are cowboys who like that adrenaline rush), Internal Medicine and chronic care in general gets a bad reputation. I heard over and over that I'd be board out of my mind this month, but I guess I'm just made of different stuff because I've really enjoyed things! Admittedly, it is frustrating to have to see a new patient every 15 minutes (I'm sorry, 15 minutes is simply not enough time to do anything, even in the best of circumstances!) but aside from the problems of managed care, I like the clinic life. Next month is an in-patient Internal Medicine month (meaning I'll be working with much sicker patients who have been admitted to the hospital). Traditionally this is one of the hardest rotations in medical school, so I'm trying to mentally prepare myself for the gauntlet ahead!
Well, really only a few stories are coming to my mind that might be even slightly entertaining to write about (and I'm not sure they are even all that great…we'll see I guess!) However, before I dive in, let me preface this as I have in the past: I will be using "medical words" (meaning I'll be talking about certain anatomy) and if this is likely to offend, feel free to stop now. Also, because I don't want any of the HIPAA Gestapo to come breaking down my door tonight, I will be changing certain details in order to absolutely protect the identities of individuals. Having said that though, I am not changing the major details of what actually happened, nor my thoughts & feelings (or lack thereof).
One thing that you find out as you work with different medical educators is that each person has a different level of commitment to your learning experience. On one end of the spectrum you have the doctors who really don't want you around and who only keep you there because it is part of their contract. When working with one of these doctors (let's call them the "Apathetics") you learn very little, but the ride is usually pretty smooth -- you be as inconspicuous as possible and they won't fail you out of medical school. On the other end of the spectrum you have what might be called "The Dedicated". These doctors (bless their hearts) do ANYTHING and EVERYTHING to ensure you learn something. While this is certainly the better end of the spectrum to be on, it can get a little excessive, as I learned to my dismay a week or two ago:
I was in the clinic with a doctor -- let's call him Dr A (I'd classify him as a "dedicated" but not excessively so) and our next patient happened to be another doctor who works as a specialist at one of the local hospitals -- let's call her Dr B (it is always kind of weird to be a doctor for a doctor…but anyway, that is beside the point). Dr B was in the clinic for a routine yearly physical exam. Dr A asked all the appropriate questions, did a brief yet adequate physical exam and was writing his note, when Dr B (someone I would classify as light years beyond the "dedicated" mark) turned to me and asked if I was going to be practicing my physical exam skills on her. Dr A tried to explain that when the patient was another doctor whom the student (me) may have to work with sometime in the future, he usually didn't have them do any physical exam in order to avoid any awkwardness. Dr B would have none of it! Ignoring completely the explanation of Dr A she began to grill me about how to do a proper cardiac auscultation exam…
At this point let me take a tangent and explain the full cardiac auscultation exam (auscultation means "to listen" usually with a stethoscope). Because the heart is divided into chambers and because there are multiple valves within the heart and because something may go wrong at any of these sites, a full cardiac auscultation exam involves listening to the heart at different places on the chest -- at each spot a different part of the heart can be heard better. This does not mean that at spot #1 you only hear the aortic valve, it just means that the aortic valve can be heard best at spot #1. At spot #2, the pulmonary valve is heard best, and so on.
Cardiac auscultation is fairly easy on a male because they lack certain chest anatomy that is present in female counterparts. Where things can get difficult is when listening to a couple of the spots on the female patient because breast tissue often needs to be held out of the way. Also, part of the exam involves finding the PMI (Point of Maximal Impulse). The location of the PMI gives an indication of how large the heart is (an enlarged heart can be a sign of impending heart failure). Again, finding the PMI on a male is not too hard…but in a female, it requires a lot of maneuvering of breast tissue.
Because of these complications, in a potentially sensitive situation such as examining a teacher or colegue, the cardiac exam is often superficial and unless there are symptoms or risk factors to suggest something is wrong with the heart, a superficial exam is all that is needed (Note: this may not be what the textbook tells you to do, but we live in the real world and in the real world, sometimes the cardiac exam is sacrificed in order to preserve dignity)
…okay, back to the story! There I was, getting grilled about the cardiac exam when Dr B said "show me the proper exam technique!" (and since she was the only patient in the room, it could clearly be surmised that she meant to have me perform the cardiac exam on her). I shot Dr A a quick glance as if to say "is that okay?" and Dr A gave me a look back that said "sorry pal, technically she is right and should get a full cardiac exam today…better luck next time!" With all the enthusiasm of a man walking to the gallows, I went through the motions of a cardiac exam, trying to be as quick and non-invasive as possible. Approximately 4 seconds later I had listened to all of the necessary spots, pretended I'd found the PMI and had backed up halfway across the room to give Dr B plenty of personal space. Now, because Dr B has a level-10 black belt in medical education, she knew what I was up to and was not going to have any of it! She made me repeat the full exam 3 or 4 times until she was convinced that I had learned something about how to do a proper exam. I'll not be more detailed in my explanation than that, but I don't think a world-class imagination is needed to paint a mental picture!
Let me emphasize that while this was an uncomfortable situation for me (funny in retrospect, yes, but still uncomfortable) there was no reason to think that Dr B had any motive in mind other than the proper education of a student. She works day in and day out in a field where she sees students who are not properly trained in physical exam technique because no one is willing to let the proper exam be done on them. "Dedicated" doctors have been known to go to greater extremes than that in times past to teach a student and by comparison I got off easy! (Also, Dr A was present in the room at all times, and besides she was probably twice my age or more!)
***
So this next story is probably not quite as memorable for the reader of this letter as the last story, but for me it was a real red-letter day!
There have been plenty of times in the past where I feel like I have no idea what is going on…I do take comfort in the fact that all 3rd year medical students often feel this way, but none-the-less I sometimes sit there trying to think of some distant piece of information I learned and all that comes to my brain is that the patient probably needs a tetnus shot (not that tetnus shots cure any of the patient’s problems…but sometimes that is all that comes to mind). Fortunately, things are coming together more and more every day, but regardless there have been a few times that if you could read a transcript of my thoughts, this is what it would look like:
"This patient has sarcoidosis of the lungs, how should we treat him?"
"Tetnus shot?"
"This patient has pseudomembranous colitis, what should we do next?"
"I know, give him a tetnus shot!"
"This patient has a bunion on his foot"
"Tetnus shot is just what he needs!"
"This patient has excessive earwax"
"Tetnus shot! (then a CT scan of his head!)"
But, a few weeks ago I finally, let me repeat, I finally heard something before my attending did! In listening to a patient's heart I heard a murmur, and it wasn't until I insisted that I heard something abnormal that my attending listened closer and agreed with me! We sent the patient for an echocardiogram and it turns out he had aortic stenosis (not a real good thing). While I feel bad for the patient, a part of me can't help but be excited that I finally caught something that no one else caught!
Anyway, that’s about it, so I’ll finish here.
Love you all!
-Eric
Tuesday, March 10, 2009
I swear I'm not dead!
Despite opinions to the contrary, I still plan to write my little entries about the funny and memorable moments of medical school and life...this has just been a really bad, what, 5 months?!?! **Sigh**
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