A Change Of Pace

   On Friday we took the last test of our last rotation of third year.  That's right, we're officially done with third year.  The end was pretty anticlimactic, considering how long I had waited for it to be over.  The Internal Medicine shelf was really hard, so I'm not really sure what my final clerkship grade will be, but I'm almost positive I passed.  We spent the weekend celebrating with classmates and finally getting to those "lifey" things we've been putting off for months.  We finally put in our garden for 2013, which I'm particularly jazzed about.

DIY succulent garden (inspired by pinterest) 

African daisies

Pink carnations (had to represent G Phi up in my garden)

Hydrangeas 

Napping puppy - oops, that's not part of the garden!

   Anyway, the weekend was really nice, and I feel like I got a bit of my "lazy" out, but tomorrow will entail a very different change of pace.  Tomorrow begins my very short study period for Step 2 CK.  Yes, I am freaking out about how few days I have to prepare for the big test, but I'm just going to keep pushing a little bit longer, and then have a real vacation after the test.  Funny enough, I think it will actually be nice to just study all the time for a change.  I won't have to try to impress anyone, and I can be on my own schedule and decide when I wake up, eat, sleep, etc.  

   In addition to my study crunch for the next couple of weeks, I have decided that I'm also going to use this time to lose some weight.  I was pretty healthy in the beginning of the year, but in the last month, Internal Medicine left me feeling exhausted, drained, and anxious - which is the perfect recipe for triggering stress eating.  So I've crept up on my weight again... But it's nothing I can't fix with a few weeks of diet and exercise, which I'm actually looking forward to.  So here goes!  Tomorrow is day one of working hard for a couple of weeks, but this hard work will definitely be rewarding in the end.  

How Will You Spend Your Last Birthday?

   There was a patient in the ICU, who was brain dead, with no chance of meaningful recovery.  I didn't know her that well, but just listened when we rounded on her as a team.  The residents were getting annoyed because the family was dragging their feet on withdrawing care.  Not that they were obligated to withdraw care, but they had decided they were going to withdraw care, but kept prolonging the date they were gonna do it.

   Our attending remarked, "You know, as young physicians, I understand it is very hard not to be judgmental of patients and their families. But please, you must try to understand what they are going through.  This woman is somebody's wife, somebody's sister, somebody's daughter.  And this is the last moment in her life.  Just think about that.  Think about what it'd be like to be in their shoes.  The husband hasn't been sleeping for weeks.  He's a wreck, and he is understandably having a hard time dealing with this, so let's give him a little compassion."

  And as the attending gave his speech, the nurse walked in and began hanging pieces of paper around the room.  As I looked closer, I realized she was hanging signs with a picture of a birthday cake saying "Happy Birthday".  I almost lost it.  Here this woman was, laying in a coma, surrounded by doctors and med students she never met, with tubes and wires coming out of every inch of her body, while her family was at home agonizing about letting her go, on what will be her very last birthday.

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!

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.