I didn't have the money or time to pull together a real graduation announcement.
This was my compromise...
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**
Tuesday, November 25, 2008
11/25/2008
Family & Friends,
In anticipation of Thanksgiving on Thursday, I send my love and wishes that I could make it home to see people…but alas, I am scheduled to be on call Thursday (more on this in a minute) and will be in Wisconsin until Christmas time. Hopefully I can see a lot of you during the week I have in Utah between Christmas and New Years.
It seems to me that there are a few topics that I write about that get a lot of response from people. One of those topics is Chopper the mutant man-eating Godzilla dog who lives upstairs. The other is anything regarding me and OB/GYN – I guess the image of awkward ridiculous single me trying to deal with female-issues gives people a big kick (frankly it is funny in retrospect, though usually mortifying at the time!) Having said this, I guess I’ll be batting 50% in this letter. I really don’t have much to say about Chopper – he’s as big and dumb as ever – but I am 2 weeks into my OB/GYN rotation and I’m collecting embarrassing moments at an alarming rate!
Let me attempt to set the scene a little bit and describe what rotating through OB/GYN is like. First let me state that I respect most OB/GYN doctors I’ve met. Most are nice and reasonable people. They do good things and help with issues that need to be handled. I even find that I quite enjoy most of the work that they do (delivering babies is neat, surgery is neat, the medical chart notes they are required to write are short – a BIG plus in my mind) however, they have the WORST lifestyle! Seriously, you will never meet a bigger group of work-a-holic insomniacs in your life (outside of neurosurgery, that is). Every few days they have to be “on call” which means they work a ~30 hour shift (from 5:30am to about noon the next day) and of course as students we have to pull similar hours. I’m actually post-call today, which means I haven’t slept since 5am yesterday (it is currently about 4:30pm today). I will sleep tonight, work a 12ish hour shift tomorrow, sleep again and then begin another 48 hours of wakefulness. I’m only on this rotation for 6 weeks…I can’t imagine how people do this year in and year out! They are stronger than me I guess!
Anyway, most of the time I’m on the Labor and Delivery floor working with women who are actively in labor. What I do is meet the women when they first get there. I ask a whole bunch of questions, do a brief physical exam and then leave for several hours to write up all the information I gathered from the interview and exam. Several hours later I pop my head back in and make sure everything is going okay. This continues until the woman’s cervix is dilated to somewhere around 8cm. Once this happens the doctor and I rush in, throw on sterile gown/gloves/mask and join the nurse in helping the lady have her baby. I find it funny (maybe that is not a good word-choice) that really it is the nurse who spends all the time with the woman. The doctor and I just sort of show up for the exciting part and then leave again…strange, but oh well!
I have observed that there are several types of laboring women. There are those who have been down this road before. In fact in some cases the babies practically tap-dance their way out because mom’s pelvis just doesn’t offer much resistance any more. These women have sage-like knowledge and do not get ruffled when a stuttering medical student is catching their baby because they simply know that things usually go just fine. In many ways working with these ladies is nice.
On the other hand, there are ladies who would like to kill anything with a Y chromosome – or at very least hit us in a body part of their choice with a ball-pein hammer every time they have a contraction. Not that I can really blame them…I’m not quite sure how much I’d love some stranger sitting down observing me from, shall we say, an unflattering angle while my feet are in stirrups all the while I’m trying to defy the laws of physics by squeezing a cantaloupe through a drinking straw. Frankly, I might get a little grumpy myself!
My first day of work was something of a “baptism by fire” experience. Not only was I clueless about what I was supposed to be doing, I was on call, exhausted, and not yet emotionally calibrated to the birthing process (a feeling that comes surprisingly quickly once you have delivered 7 or 8 babies at 3am). That first night we had 8 or 9 births, 2 of which were emergency C-sections. I decided after that night that there are some fundamental laws of the obstetrical universe:
1) No babies will be born during normal daytime hours
2) All babies will be born between the hours of 11pm and 5am
3) All emergency C-sections will need to happen at exactly the same time even though there is only one team to perform the operations
That first birth really was quite the experience for me. In some ways it was one of the most disconcerting things I’d ever seen. A part of me felt like I was in a real life “Aliens” movie. The other part of me was in awe of the miracle of birth. I will say that despite all the blood and gore of birth, once that wriggling little baby was out and letting the world know he was UNHAPPY my heart sort of melted and it was easy to forget that I had just seen every law of physics shatter.
Well, I’m exhausted and need to cook dinner, so I’ll finish up. Love you all!
-Eric
In anticipation of Thanksgiving on Thursday, I send my love and wishes that I could make it home to see people…but alas, I am scheduled to be on call Thursday (more on this in a minute) and will be in Wisconsin until Christmas time. Hopefully I can see a lot of you during the week I have in Utah between Christmas and New Years.
It seems to me that there are a few topics that I write about that get a lot of response from people. One of those topics is Chopper the mutant man-eating Godzilla dog who lives upstairs. The other is anything regarding me and OB/GYN – I guess the image of awkward ridiculous single me trying to deal with female-issues gives people a big kick (frankly it is funny in retrospect, though usually mortifying at the time!) Having said this, I guess I’ll be batting 50% in this letter. I really don’t have much to say about Chopper – he’s as big and dumb as ever – but I am 2 weeks into my OB/GYN rotation and I’m collecting embarrassing moments at an alarming rate!
Let me attempt to set the scene a little bit and describe what rotating through OB/GYN is like. First let me state that I respect most OB/GYN doctors I’ve met. Most are nice and reasonable people. They do good things and help with issues that need to be handled. I even find that I quite enjoy most of the work that they do (delivering babies is neat, surgery is neat, the medical chart notes they are required to write are short – a BIG plus in my mind) however, they have the WORST lifestyle! Seriously, you will never meet a bigger group of work-a-holic insomniacs in your life (outside of neurosurgery, that is). Every few days they have to be “on call” which means they work a ~30 hour shift (from 5:30am to about noon the next day) and of course as students we have to pull similar hours. I’m actually post-call today, which means I haven’t slept since 5am yesterday (it is currently about 4:30pm today). I will sleep tonight, work a 12ish hour shift tomorrow, sleep again and then begin another 48 hours of wakefulness. I’m only on this rotation for 6 weeks…I can’t imagine how people do this year in and year out! They are stronger than me I guess!
Anyway, most of the time I’m on the Labor and Delivery floor working with women who are actively in labor. What I do is meet the women when they first get there. I ask a whole bunch of questions, do a brief physical exam and then leave for several hours to write up all the information I gathered from the interview and exam. Several hours later I pop my head back in and make sure everything is going okay. This continues until the woman’s cervix is dilated to somewhere around 8cm. Once this happens the doctor and I rush in, throw on sterile gown/gloves/mask and join the nurse in helping the lady have her baby. I find it funny (maybe that is not a good word-choice) that really it is the nurse who spends all the time with the woman. The doctor and I just sort of show up for the exciting part and then leave again…strange, but oh well!
I have observed that there are several types of laboring women. There are those who have been down this road before. In fact in some cases the babies practically tap-dance their way out because mom’s pelvis just doesn’t offer much resistance any more. These women have sage-like knowledge and do not get ruffled when a stuttering medical student is catching their baby because they simply know that things usually go just fine. In many ways working with these ladies is nice.
On the other hand, there are ladies who would like to kill anything with a Y chromosome – or at very least hit us in a body part of their choice with a ball-pein hammer every time they have a contraction. Not that I can really blame them…I’m not quite sure how much I’d love some stranger sitting down observing me from, shall we say, an unflattering angle while my feet are in stirrups all the while I’m trying to defy the laws of physics by squeezing a cantaloupe through a drinking straw. Frankly, I might get a little grumpy myself!
My first day of work was something of a “baptism by fire” experience. Not only was I clueless about what I was supposed to be doing, I was on call, exhausted, and not yet emotionally calibrated to the birthing process (a feeling that comes surprisingly quickly once you have delivered 7 or 8 babies at 3am). That first night we had 8 or 9 births, 2 of which were emergency C-sections. I decided after that night that there are some fundamental laws of the obstetrical universe:
1) No babies will be born during normal daytime hours
2) All babies will be born between the hours of 11pm and 5am
3) All emergency C-sections will need to happen at exactly the same time even though there is only one team to perform the operations
That first birth really was quite the experience for me. In some ways it was one of the most disconcerting things I’d ever seen. A part of me felt like I was in a real life “Aliens” movie. The other part of me was in awe of the miracle of birth. I will say that despite all the blood and gore of birth, once that wriggling little baby was out and letting the world know he was UNHAPPY my heart sort of melted and it was easy to forget that I had just seen every law of physics shatter.
Well, I’m exhausted and need to cook dinner, so I’ll finish up. Love you all!
-Eric
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