One Month Until Fourth Year

   Yeah, I am still alive.  I've just lost track of time in the always-changing flip-flop sleep schedule that is Q4.  I am writing during the wee hours of my last overnight call in Internal Medicine.  Everyone said this rotation would go by fast, and shit - I believe it.  After this shift, I switch over to Kaiser for one more month of Internal Medicine, and then we officially start our 4th year!  This last month has been pretty darn busy with scheduling 4th year, long hours on IM wards, and trying to get some studying done.  Unfortunately, this rotation is so exhausting, I hardly have energy to study during the few hours I get off here and there.  Hopefully I didn't screw myself with my grand plans of only taking 2.5 weeks to study for Step 2 CK. 

   This last month has had its good notes and bad notes.  I'm enjoying the learning, and I continue to be humbled on how much there is to know.  I'm enjoying the patients, especially the characters.  In terms of my team dynamic, well, let's just say there is something to be desired.  We have an attending who loves to feel smart, so makes everyone else feel stupid in the process.  She is extremely unessecarily nit-picky and critical of everyone and everything, however, her criticisms have actually allowed me to realize how far I've come over this year.  For example, she was critiquing me on my lung percussion technique, which by the way, a cardiologist had just complimented me on a week earlier, and condescendingly ended with, "Sweetie, just practice your technique, ok?"  If this were to happen earlier in the year, I probably would have been very upset, felt inadequate, and doubted my abilities.  But when she told me this, I just laughed it off to myself, knowing that I was happy with my technique, and that I wasn't just being arrogant, because a cardiologist had commended me on my it a week prior. 

   I can't believe we only have one month left of third year.  I've pretty much been waiting for this year to be over after finishing OB/Gyn, so I'm really happy to be moving on to 4th year.  Looking back, I can't believe how far I've come this year, in so many different aspects.  It's absolutely incredible how much knowledge you pick up in one year on the wards, so much more than you ever could in any books.  I am so happy with how much I've improved with my histories, physicals, note writing, and presentations, though I obviously still have room to continue to improve.  What I'm most proud of though, is how much confidence I've grown.  I started this year out as a thin-skinned, self-doubting, unsure-of-myself med student.  I end this year as a medical student who knows her strengths, is confident in her abilities, and has a much MUCH thicker skin.  Now that I've developed a thicker skin to deal with all of the constant criticism, I fear that my thicker skin will hinder me from empathizing with my patients.  I don't ever want to lose the ability to connect with people, and I fear that it has already begun because I've become so accustomed to keeping my walls up.  Maybe further on in my career, when I'm no longer under so much scrutiny so often, I can strike a balance between thick and thin skin.  Maybe a semi-permeable skin, if you will?

   Maybe the fact that it's 3AM is making me all loopy.  Who knows. 

   Anyway, while scheduling 4th year has been stressful, I am really happy with the way things are turning out.  There are still a few minor adjustments that need to be made to my schedule, but I am really excited about my upcoming year.  So far, my schedule looks like this:

• Step 2 CK, 1 week vacation
• SICU
• Step 2CS, 1 week vacation (annual Oregon camping trip!)
• Gyn Onc
• ED Ultrasound
• Anesthesia
• Abdominal radiology
• Random 2 week vacation in October
• ED
• Month off for interviews
• Christmas Break
• Inpatient Psych
• Perioperative Medicine Special Studies Module
• Family Planning
• MATCH
• Spring OFF - vacation to Tahiti + (insert another amazing destination here?) with BF!
• Graduation!

I'm Going To Atlanta, Y'all!

   I recently applied to be able to attend this special MSFC Activist Leaders Institute conference.  It's held on a weekend in May, in Atlanta, and if picked to attend, all expenses are paid.  If you know me well, you know how much I love MSFC, and how involved I've been with our school's chapter.  This next year, my hopes are to become more involved on a broader, national level - and I think this conference is the first step in achieving that goal.  Not to mention, I always love learning more about reproductive rights issues, and there is always more to know about ways to advocate for women's health issues.

   Anyway, I was ecstatic to find out yesterday that I got picked!  I am so excited for this opportunity, and I absolutely can't wait!  It's the weekend after I take my Step 2 CK, so I'll be free and ready to mingle with other passionate and intelligent women's health leaders.  Eeeeeeeeee!!!!!!!!

   Now enjoy some photos of genital baked goods that appeared at a "genital bake-off" that BF and I held a few months ago...

Uterus cupcake

Vagina cupcake

Uterus ganache made by my friend, E (complete with IUD in place)

Ruzzle Adventures

   I'm not normally a game-playing type of gal, but my friends got me hooked on Ruzzle, a free app for iPhone. There's just something about it that's so addicting! Maybe it's because I always run out of time and wish I could think faster. Anyway, BF and I are really competitive and "trash talk" each other.

BF was all proud of himself for getting the highest scoring word of this round...

  Or maybe our trash talk is actually just talking dirty?  

Nights In The Hospital Are Reminiscent Of The Twilight Zone

   Last night I was on call, and while I was in the cafeteria gettin a snack during "power hour" (when it opens briefly from 11pm-midnight), the super flamboyant cashier tells me, "Wow, you have an amazing walk! I was watching you walk over here, and you look like a beauty queen or something."

Me (laughing),"Well, thank you. Maybe it's 'cause in my head I secretly think I'm a beauty queen!"

Cashier: "And you have a great smile too!" (Looks at my hand) "Are you married? engaged? Single?"

Me: "Oh, Uh I live with my boyfriend."

Cashier: "How's he?!"

Me: "He's good...."

LOL

   Last time I was on call, I ran into this gem in the ladies bathroom.  What's even worse, is that it stayed there for a good three days after that.  Way to clean the bathroom, janitorial staff!

Girl, you done left yo' weave in da bathroom!

   I'm really enjoying internal medicine.  My goals for this rotation are just to learn a ton, and 'study' for Step 2 CK in the meantime, since I'm taking it 2.5 weeks after this clerkship ends.  Fortunately, I've heard Step 2 is very internal medicine heavy, so I should be okay.  So far, I'm learning a ton, and I absolutely adore the demented old patients.  Crazy old ladies still need OB/Gyns, right?

I Like Adults So Much More Than Children

   I'm nearing the end of my first week on Internal Medicine, and I actually really enjoy it!  So far, I'm really having a fun time, and the patients are really interesting.  I have a lot to learn, but I'm really enjoying the process.  The Q4 schedule (overnight call every 4 days with regular days in between) is a little rough, but it also give you random time off, so that's nice.
   Yesterday, I did a MOCA on one of my old patients, and because he is a bit demented, he really struggled on it.  I just told him, "Oh, don't worry.  Just try your best!  These tests are a bit tricky!" After getting through the cognitive assessment with some frustration on his part, (and just to give you an idea of how bad he struggled - he scored a 14/30 after spending an hour doing it), I told him, "Thanks for being so patient with me!  That's it for now!"  And he replied, "Oh, you know, that was actually pretty fun.  It gets kinda boring sitting in the hospital so it was nice to have someone here."  Man, I love old people.




   Also, as an aside.  This is a thought I've had for a little while, but keep forgetting to blog about.  One of my big pet peeves is when residents/attendings are in the middle of talking to/listening to patients, and their pager goes off, and they rudely stop everything to read their pager.  I completely understand that we have to answer our pages in a timely manner, but it's so much more polite to just take two seconds to say, "Oh, please excuse me.  I just have to read this really quick."  I've seen people in the middle of a serious heart-to-heart convo with a patient, and all of a sudden BEEP BEEP BEEP! And they completely ignore the patient sobbing in front of them as they read their pager and fidget with it.  And then a minute later, they look back up at the patient and say, "Sorry, what did you say?"  That is so rude.  Just excuse yourself, so the patient knows that you still want to listen to them, and this page isn't more important than what they're saying, necessarily.

Try Not To Blink, Everything Will Pass You By

   How is it already March?!  I feel like just yesterday I was finishing up with the winter holiday break and starting out of my Primary Care rotation.  The last two months of Primary Care just flew by.  Overall, primary care was okay.  I liked the hours, and I loved getting to know some of the patients, especially the old sassy ones.  What I didn't really care for were the types of problems that the patients come in for: musculoskeletal aches and pains, coughs/colds, etc just doesn't really tickle my fancy.  I did, however, get really jazzed when a woman would come in with OB/Gyn-related issues.  At one point, I knew more than my attending did about contraception, and that patient really looked to me and trusted my input.  I also didn't care for the pace.  It seemed to me that the attendings and residents moved SO SLOW in clinic.  And a lot of the day was spent waiting for patients to show up - and then they would be super late and throw off the whole day's schedule.
   I can't believe that we only have one more rotation of third year.  I am so ready to be done with third year.  I'm so tired of being evaluated 24/7 by tons of different people, who seem to have been given a script of feedback to give.  "You did a great job, you're right where you should be. Just keep doing what you're doing.  No, I can't really think of anything that you can work on" = pass.  It's just annoying to me because I'm doing much better work clinically than I was in the beginning of the year, but I'm more tired and burned out, so I'm just not as bubbly and gung-ho about everything, and it seems like those qualities are more important in our evaluations.  On the bright side, I feel really good about the fact that I have come a long ways over this year.  I have picked up so much knowledge about taking care of patients, I have become a lot more efficient, and I think I am pretty competent at H&Ps.  What I'm most proud about, is how much more confident I have become over the year in several aspects.  I'm no longer afraid of attendings or residents.  I feel comfortable expressing my opinion and demonstrating my skills.  I am so much more comfortable with patient interactions now.  I have even gotten to the point where I start counseling and introduce some of my thoughts about the assessment and plan to the patient before even discussing it with anyone (only if I'm pretty sure I know what's going on, of course).  So regardless of what my evaluations have been saying lately, I know I've improved drastically over this year, and I'm very happy with where I'm at now.  I can't wait to continue improving and learning, too.

   Things have been extremely busy lately, and it seems like everything is gearing up in my life right now.  Primary Care had a ton of projects and assignments to fill up our free time.  The research I'm working on with one of the OB/Gyn residents just got IRB approved, so that's gonna start taking off.  MIRTH is next week, so I've been working with some classmates to pull that together.  I submitted an application to go to a special leadership conference for MSFC in May (I really hope I get it!).  There are a bunch of other things going on too, and third year is almost over, so we're planning and scheduling our fourth year, which is stressful but super exciting!  I've already scheduled my USMLE Step 2 CK and CS dates.

   So this weekend is a nice chance to "relax" before my next, and last, rotation of third year: Internal Medicine.  It's gonna be rough, I already know.  But my plan is to just hit it hard, and study really hard during it - that way I'm ready to take Step 2 CK a couple of weeks after it's done.  This weekend is also going to be half dedicated to "get my shit together" before getting cozy living under my rock for the next two months.