A Look back

So, 2009 is over. How did that happen? Here's a quick summary of everything that went on.

In January, I started second semester of M1 year, and we shortly had an ice storm to end all ice storms. Sadly, that meant we had a week off from school but still had to do work since there was a test the next week. In May, I finished my first year of med school and D began his first big promotion, and in June I spent the month working at a pediatrics internship that was incredible and life-affirming and really makes me want to be a pediatrician. In July we had a lovely vacation with my family and D began to realize just how much his new job sucked. In August, I lost my wonderful grandfather and began M2. In October, D got promoted again and now thoroughly enjoys his position. In November, I signed up for the boards, and in December, I somehow managed to survive the first semester of M2.

In 2010, I'll take the boards, start M3, and go on a fabulous spring break trip to Europe. Hopefully it will be just as awesome as it sounds.

The goose is getting fat

Twas the night after finals, and all through the house

not a creature was studying, especially not about diseases spread by a mouse.

(There's a lot of those, actually--the things you learn.)

My only problem (if you could call it that) with finals being over is the fact that I always wake up the next morning with a start, thinking I've overslept and wondering what I need to be studying. But then I realize that it's all over and I can sleep in another few hours (or eight). That's a good feeling.

Now I get two whole weeks with which to do absolutely NOTHING. Actually, not so much nothing, but now I get to do all the things I want to do without thinking about the multiple different types of ovarian cancer or hemorrhagic fever. Today I went shopping with my mom and sisters and then wrapped presents. Now all my shopping is done and my presents are under the tree and there is possibly no feeling in the world so satisfying. I'm such a Christmas dork. After dinner tonight, D and I watched the Muppet Christmas Carol, and I can't imagine that a five year old would have had more fun than me.

I'm particularly excited about Christmas this year because one of my cousins is due to have a baby any day now, and will get induced on Wednesday if she doesn't go into labor on her own before then. Which means we'll have a very brand new baby here for Christmas dinner (!!!). One more reason to celebrate. Can't wait.

Thanksgiving was lovely--I planned on taking the entire weekend off, but wasn't nearly as productive the Tuesday prior as I expected. It ended up turning out great--I was able to study for only the briefest amount of time each day and got immense amounts of work done. I always feel like I do my best work when I can do it in little bursts, at my own pace, when I want to, rather than forcing myself through hours and hours of work. Sadly, I don't go to medical school in Fantasy Land.

Now that we're back, it's the home stretch and the burnout is kicking in in serious ways. It doesn't help that, due to the time off for the holiday, we are now packing as MUCH SCHOOL into the final two weeks as is humanly possible. Honestly, it's pretty ridiculous. Oh well--two weeks and then it's all over (for two weeks).

Even so, as I walked to school this morning, I listened to Christmas carols on my iPod and couldn't help but smile.

Venipuncture

Cool news of the week: I drew blood for the first time on Wednesday! And I was the only person in my group who managed to at least half-way fill up the vial. I felt accomplished. Of course, I left a lovely bruise on my friend F's arm and she on mine, but what they hey, we have to learn somewhere.

It's actually kind of cool to learn on each other, because knowing that it really doesn't hurt that bad gives you a little more confidence to do it to someone else--and if you can do it on your best friend, you can probably do it to a stranger even easier.

One thing we did discover, however, is that phlebotomy is possibly the most ripe conversation topic for "That's What She Said" jokes of. all. time. I mean, it's kind of ridiculous. Witness said conversation between F and I after the session:

F: Ouch, I hope that didn't hurt you too much.

B: Not really, I think you just weren't in deep enough the first time. It wasn't so bad after you went in a little deeper.

F: Yeah, I think I was so worried about trying not to wiggle it around too much, I couldn't think about much else. Also, sorry for squirting all over you at the end.

I kid you not. We did realize at that point that anyone walking past us on the street would probably be appalled and/or laughing hysterically, so hopefully we were at least entertaining.

Alert the media

I just registered to apply to take the USMLE Step 1 (aka: The Boards) in June. $500 later, I am committed to taking the most frightening test in the world in a little more than six months.

Holy. Shit.

All the news that's news

It's coming up on test time again, so clearly, it is time for procrastination. Lots of things have been happening lately, though, so I do at least have some alterior motives other than getting away from studying.

First off, yesterday was my birthday, and it was fabulous. My family got me a new printer that prints wirelessly and prints photos that are better quality than I've recently gotten at any drugstore kiosk, so I'm currently waiting as it prints over 50 pictures from Germany the last time I was there--which, sadly, was over 3 years ago. It's just too darn easy for digital pictures to stay on the camera rather than going in the albums I buy for them...but hopefully now it will be easier to print them all in the loveliness of my own home!

This is particularly useful because it will be helpful to have my pictures from my last European adventure printed off before we begin our next one...because D and I are headed to Vienna for my spring break as a sort of "last hurrah before B gets sucked into the hospitals." I'm incredibly excited--for our one year anniversary, his gift to me was that we would save up enough money to do Europe again before our 2nd anniversary, and lo and behold we actually did it. I'm incredibly excited--we were going back and forth for a long time between Vienna and northern Italy (Florence, etc.), but ended up going with Vienna because it's my favorite city in the world and D hasn't ever been. We'll probably take a side trip to Graz while we're there, which is where I studied the last time. It'll be cool to show him everything I did and saw when I was there for so long.

In medical news, my time in the student-run clinics is almost over, which makes me really sad. Last Monday, I only got to see one patient, but he was an incredibly cute little boy who made me giggle. It will definitely be nice to have Monday nights back again for studying and such, but I'll miss working with people. Nice to have something to look forward to for next year beyond all this studying and board prep and insanity.

I also got to spend last Friday morning hanging out with the OB team on the labor and delivery ward as part of a special event a school club was hosting. Unfortunately, it was an incredibly slow day with only about 3 women on the wards (two of whom had just arrived and were not going to deliver their babies any time soon), but we did get to see one C-section before we left. It was really neat to watch, but I have to say that the more I do other things, the more I find myself to be a peds person. While we were watching the C-section on Friday, every other student in the room was completely captivated by the surgery (ooh! look at all the blood and guts and gore and grossness! Cool!!!!)--and I was too, until the baby was born. Once he was out, I was totally into him and what the pediatricians were doing--checking APGARs, reflexes, etc. I keep trying to give other specialties a clear shot in my head--I mean, I could end up liking something other than peds, and I want to have an open mind--but every time I do I just can't seem to get away from the kiddos. Maybe that's a good thing, maybe not, but I don't know that there's much I can do about it...just have to wait and see what happens next year.

Babies just turn me into a big ball of doctor mush.

Swamped

To use Katya's oh-so-apt description in her comment on my last post, I have been absolutely swamped this past week. The nice thing about second year is that the week after our exams (which I did quite well on) we have a week of nothing but ICM--which essentially means we show up for class and do nothing else. It's lovely, and I read three books just for pleasure and wallowed in the normalcy of it all--coming home at 4pm, watching tv, having dinner, hanging out with D, all that. Unfortunately, the first week back to legitimate studying has been sort of a slap in the face.

We started the week with lung pathology, which was the worst bear of a subject to get through, mainly because the professor was completely incapable of paring down the material--the first two lectures (one hour each) contained a grand total of 187 powerpoint slides. I mean--really? It took me about 4 hours just to slog through the material that day.

Once I got through that, however, the week has been alright, if busy--we started genetics, which I always enjoy, and are starting to learn about all the nasty bacteria that cause all the nasty diseases in micro, which is actually kind of cool. I precepted twice this week and actually knew what was going on with a few patients. It's probably silly, but I still find it utterly fascinating when I'm actually in the hospital and people are throwing around words and phrases and ideas that I've just learned about in class--it's a moment where my brain just sits there thinking, "Wait--this actually happens? In real life? To real people??!!" Too cool. Except, of course, when you realize that the disease that does actually happen in real life to real people is metastatic lung cancer.

In my preceptorship time yesterday, our first patient of the day was a middle-aged man who had been at work and had a seizure. They brought him to the emergency room to do a CT, and discovered that the seizure was caused by a spot in his brain that was probably a metastasis from lung cancer (which he never knew he had). When we arrived in the room to talk to him and his wife, we were basically explaining the biopsy that would occur later that afternoon to confirm the diagnosis. He was actually quite calm and understanding--his father had apparently died of the same thing, and he understood that we were not talking cure but comfort, and that he was looking at months (if not weeks) to live. His wife did not take it so well--she held herself together, but it was clear that she was terrified, shocked, bewildered by the sudden new direction their life had taken. What do you say to people when you're discussing their imminent death? The doctor I worked with was fabulous--exactly the right amount of kindness, understanding, and honesty I hope I can someday offer to people who are having the worst day of their life.

Of course, the weird part is you participate in something like that, something that has stopped that patient's world on a dime--you talk, and listen, and console, and offer advice--and then you go back to your day, back to the other patients and the studying and the work. It's a strange world, this doctor business.

Luckily, to shrug off the utterly depressing experience, my sister came home from college this weekend for the fall festival in our town and we're all going there for lunch today to pig out on elephant ears and chicken and dumplings and doughnuts. Thankfully, this will occur before my lecture on heart disease next week, after which I will probably never be able to eat fatty foods again. :-)

Fun Times

I hauled my butt out of bed this morning to show up at lecture at 8:00am. Too bad the lecturer apparently did not--so we spent about 20 minutes watching a Hulu Family Guy episode on the giant projection screen.

Yay, med school!

MGR

On Tuesday, I was (in a way) fully initiated into the profession of medicine.

I performed my first rectal exam.

Granted, it was done on a standardized patient--an actor who is trained to teach us how to do these things, in exchange for a hefty paycheck (after all--would you expose all your naughty parts to random kids to poke around on for free?). The good news: my SP was the veritable definition of professionalism and kept things quick and to the point--and, best of all, he lowered his gown when he was talking, rather than just letting it all hang out for us to stare at as he explained. Much less awkward than I thought it would be. The bad news: No matter what you do, however, there is still a very surreal element when you're sitting there with gloved hands, face to face with a stranger's nether regions, and being told that "you can press harder--it really doesn't hurt." Oh, the fun times.

The rectal part of the exam was actually the easiest part. The hardest was not laughing when we very suddenly switched from small talk to the SP just up and raising his gown to expose himself to us like nothing else was going on and this wasn't weird at all. The very worst part was that my partner (they send us in to learn the exam in twos) had to do this exam on her birthday. Happy birthday! Now stick your finger up this guy's ass.

All in all though, it's kind of nice to have the whole thing over with--I have to do the pelvic exam sometime second semester, but I'm not too worried about that because I've at least seen them done before. Unfortunately, it is now block week (tests on Friday), and so I will probably disappear for at least a while--but you never know. Maybe I'll get bored enough with studying to use blogging as an out.

Long Day

Yesterday, I left my house at 7:15 in the morning and got home at 10:00 at night. I'm not on call, I'm not even working in a hospital yet--but those almost 15 hours contained almost no studying whatsoever. I started out with two hours of lecture, followed by two hours of studying in the library, followed by an almost 6 hour shift in the pediatric ER doing the research thing.

Last Friday, my ER shift was slooooooooooooooooo.....w. I think there were a max of 18 kids on the list for the day (list = kids on their way, in the waiting room, or in an actual room being treated). Yesterday, the hospital gods got back at me by placing no fewer than 45 kids on the board at any one time. While this doesn't automatically increase my workload per se, since my duties really only include sitting and watching for kids to come up on the list with a complaint that might fit the studies we're doing currently, it sure did make things much more hectic. First of all, more kids overall means more kids with the right symptoms, which of course means more getting up, finding the doctor, talking to the doctor and/or nurse to see if they qualify, and finally heading back to my room because no one with abdominal pain is ever actually getting worked up for appendicitis.

In addition to the "normal" duties, I'm also helping another doctor with a more specific project where I get to give surveys to parents to see how they liked their ER experience. That in and of itself doesn't sound so horrible, except that it involves a lot more than you think--finding kids with appropriate diagnoses, finding all of their doctors to see if they're going home or getting admitted, randomizing, getting all the paperwork together, giving them the survey (which of course includes explaining it), filing all the paperwork, etc.

It used to be that ER shifts were basically study hall to sit around and get work done. Not so much any more. At least it's interesting, though--I do get to actually see and do more this way.

After running around like a chicken with my head cut off during the ER shift, I left early and headed straight for my new clinic. Background info: at my school, there are 4 clinics run by second-years (with physician preceptors, of course) that serve the indigent population for free in exchange for allowing us to tinker around and practice being doctors on you. We figure out who gets to work in which clinic and when by a lottery, which happened last spring. My lottery number was unfortunately very high, so I didn't get the clinic I wanted, and ended up being signed up for the very last rotation available in the spring. Sunday night, however, a friend of mine who helps direct the clinic I *really* wanted in the first place (because it serves a lot more kids) called me up to tell me that a spot had opened in her clinic starting Monday and would I like to work there instead for the next 8 weeks?

Obviously, I couldn't say no...so now I get to work in the clinic I wanted each Monday for the next 7 weeks (with weeks off for tests). And while this is all well and good, going straight from the ER to the clinic, where I remained form 6-9:30, made for a very, very long day even if I did see some rather interesting people. Highlights included a teenage girl for a checkup, a teenage guy for a physical, and an older gentleman who had bad allergies.

Now, unfortunately, I'm stuck today and tomorrow playing mad dash to catch up on all the work I should've gotten done yesterday, but didn't. Maybe I'll come up for air sometime in the next few days.

Frustration

So I was planning on writing my next post about how I actually find pathology interesting and rather fun (at least, in med school relative terms), or about the awesome time I had at my local drug/alcohol abuse shelter preceptorship last week, or about my 3 hours on rounds for my general preceptorship yesterday, but then this morning I got so mad that I just gave up.

In our pathology course, we have these lovely little group activities about once a week called TBLs. The TBLs are essentially set up to be group sessions wherein the entire class gets together in an auditorium (in groups) and various cases are presented by the professor. Along with the cases are questions that are supposed to relate the cases to what we're learning in class. We answer the questions on our own, then discuss with a group, then answer again. Supposedly, we learn how to apply basic knowledge to a more clinical setting this way.

This is all a fine and dandy proposition IF the questions posted have anything to do with a) what we've learned or b) legitimate clinical medicine. Unfortunately, thus far the professors have proven that really, what we need to know to do well is what they're thinking--it's a test on how well you can read the teacher's mind. We had a case today in which a good 10 symptoms and labs pointed to a diagnosis of Hemolytic Uremic Syndrome (I could explain, but if you go google it I'm sure you'll find something satisfactory). Literally, EVERYTHING about the case pointed that way--but the answer was not HUS, it was actually TTP (another blood disease)--and the only thing we were supposed to use to come to this conclusion was the fact that the lady was confused upon arrival. Supposedly, confusion = neurologic symptoms and HUS only affects the kidney. This is, of course, after they tell you that the main lab used to confirm TTP was negative. But oh--you should know that it could be a false negative, and the fact that she had any neurologic symptoms means it can't be HUS.

Wait. WHAT???

It's not just frustrating because the questions and answers are asinine. It's not just frustrating because I'm 100% positive that, were the exact same question on the boards, the answer would be HUS. It's frustrating because I know there will be questions on our exam that look like this, and I'll probably fail even though I know my pathology cold just because I can't read what the professor was thinking when they wrote the question. Ugh. It's awful.

In lay terms, it's kind of like having a question like this:

A normally healthy 25 yo male trapeze artist arrives in your ER after a tragic circus accident in which the blindfolded knife-thrower got startled by the elephant and lost control of the blade, which ended up 6 inches deep into the trapeze artist's aorta. Your patient's labs show massive blood loss, low serum iron, tachycardia and hypotension as well as neutrophilia. As he gasps for air, he informs you that he also was recently on tour in Africa, bitten by a mosquito, and later developed a high fever. His family history is significant for males who all died young due to massive bleeding after insignificant accidents, as well as beta-thalassemia and sickle cell disease, and his PMH is significant for allergic rhinitis and asthma, for which he takes Zyrtec. As a child, he had leukemia that was treated with radiation therapy and resolved.

What killed this patient?

a) Massive blood loss due to knife wound
b) Inappropriate clotting due to hemophilia
c) hepatic failure resulting from portal hypertension due to his splenomegaly from sickle cell-related hemolytic anemia
d) malaria
e) Histoplasmosis
f) aplastic anemia due to the radiation therapy he received as a child
g) None of the above--he was faking and just has a case of the sniffles--could you please refill his allegra?

Answer: E, histoplasmosis. You see, histoplasmosis is mostly spread by breathing in spores from bird droppings--the elephant in question lives right next to the birdcage in the circus animals' cage room. Said elephant stepped in the bird poop and the trapeze artist breathed in the spores a few weeks ago and contracted the infection in his lungs. Untreated, he has now developed a massive pneumonia, which killed him. Knife wound notwithstanding.

Space Filler

Yikes but it's been a while.

The problem with school is that there are lots of stories to tell--but the insane level of work required prevents me from having the time and energy in the evenings to do much anything other than collapse and watch How I Met Your Mother (which is my new obsession, by the way--everyone should watch that show. D and I can't get enough.)

I promise I'll fill in with lots of exciting stories shortly--hopefully by the end of the day (and maybe more than once!)--but for now I really need to learn about congenital immunodeficiencies.

Home

I don't know what to write, so I'll simply write the truth.

My grandfather passed away. He was simply one of the single best people I've ever known, and watching as his ravaged body began to breathe more and more slowly and finally just stopped has left me with a hole in my heart that only he can really fill. The good part is that my entire family--all of his children, their spouses, my grandmother, and me--was there with him to the end, cheering him on.

The infection had just spread too much--there was simply nothing more to do. We all felt it was best to just remove the medications except for pain control. He was more peaceful throughout the entire day than he has been in the past few, and looked comfortable even as he passed. Yet still, when it came down to it, my grandmother--the strongest woman I have ever seen, who spoke to him throughout the day to tell him it would all be fine, whose voice didn't even crack until the very end--broke down and wept. She broke my heart more than anything else. She is bereft--her best friend and husband of almost sixty years, gone after this incredibly exhausting struggle.

The most painful thing was knowing that just a week ago, when the infection came back after a few weeks of relief, he looked at my mom and told her, "I was almost there." He was so close to being able to just go home. That was everyone's greatest regret. He hadn't been home in three months, had been bounced around from hospital to rehab to hospital to rehab and back, and it was his single greatest wish. All he wanted was to be able to go home, and he never got to.

And yet. Yesterday, when it was finally over, I texted D to let him know. My phone has T9 and predicts what word you're wanting to write--the message I typed was, "He's gone." The numbers that spell the word "gone" are 4663. Incidentally, the first word that the phone recognized--spelled with the same numbers in the same order--was "home." He's home. He's finally home, free of all this pain and disease and fear and frustration, and I truly believe (as he did, so simply and passionately) that he is in a much, much better place, and that he is finally truly happy.

That's what gets me through, but it still hurts like hell.

Year 2, Week 1

I don't have much to post about the first week thus far, because the first week of school is ICM week (as I may have noted before), in which we have lectures that are very important to our careers as honest-to-god doctors (as opposed to studying drones, which seems to be our current job path), but require very little studying and outside work. Thus far this week, I have sat through lectures regarding patient notes and documentation, performing a knee and shoulder exam, and taking a history on a geriatric patient. I have gotten dressed up in my shiny white coat and brand new clothes (There may have been a shopping spree at the Limited involved. Oops.) and discussed a "patient's" substance abuse problems and come up with a differential diagnosis for a woman with "fainting spells." I got drenched this morning running in heels to get to the door after forgetting my umbrella.

But all of this pales in comparison to the fabulous experience of the video we were forced to endure in an effort to teach us the intricacies of the dreaded Male Genital and Rectal exam.

That's right, folks. We got to watch a video for almost 20 minutes describing in detail how to a) grope and b) insert our fingers into butts of men across America. The inherent embarrassing giggles and stunned faces were compounded by the fact that the professor giving the lecture was an incredibly old man who talked very slowly and left for lots of awkward silences. I tell you, it was scarring.

The worst part is I get the pleasure of actually practicing this fabulous experience on a real live person (who has volunteered his time to the tune of several hundreds of dollars) coming up in a few weeks. The excitement is palpable. Really.

Here we go again

Second year starts tomorrow. Weird. It still doesn't feel real.

The whole first week for us consists of our ICM class, which is essentially a class that teaches you things you actually need to know to be a doctor. Not that pathology and microbiology aren't important, but examples of my first week of lectures include: taking a abuse history, how to perform a male genital/rectal exam and a female breast/pelvic exam, developing a differential diagnosis, and strategies for breaking bad news to patients. For almost every lecture, there is an accompanying lab in which we have to dress up, wear our white coats, and perform said procedure/history/experience with a Standardized Patient (an actor who has been trained to act the way a patient might). Over the course of the next week, I'll take a substance abuse history, come up with a differential diagnosis (ideas of what all could be wrong with someone given a particular set of symptoms, and how you might go about narrowing down the options for a diagnosis), perform a knee and shoulder exam, and break the bad news.

Luckily, I went shopping yesterday and managed to get two three new dress shirts and two skirts, so I'll look fabulously professional doing it.

The other nice thing is that our entire first week, we have no days with class for more than a few hours, so it's a nice way to ease back into the schedule. Next Wednesday, however, the crap will hit the proverbial fan and I'll probably become a hermit again for a while. I promise to update, though--not least to save my own sanity.

Orientating and Dentistry

This week is orientation week at school, and while I don't have to orient myself, I'm acting as a unit lab advocate and helping out with some of the new first years.  For the past 3 days, I've gotten to go have a free lunch in exchange for answering questions and pointing people in the right direction.  The lab that I (and two of my classmates) are working with has been surprisingly quiet the past couple of days, but today we took a more informal approach and just hung out while everyone ate, and I think it went better--at least, I was actually more involved in advice-giving than I was when things were all official and "Any Questions?"

This morning, I had to go to the periodontist and have a gum graft done--a procedure where they took a piece of tissue from my palate and put it on my lower gums to keep them from exposing too much tooth (it's apparently a genetic thing).  The guy who did the procedure was very good--I didn't feel a thing as he was working--but the inability to move my mouth very well has become insanely tiresome already.  Seriously, I just took almost an hour to consume a plate of tater tots.  The quandry, of course, is that I'm hungry, but the idea of eating is unappealing.  Hopefully tomorrow will be better, because that's the day of the student activities fair--I have to run the pediatrics club table and we have cookies, which I would really love to have.  

Two weeks and counting

I officially have two weeks before the official start of classes, and those two weeks are going to be relatively jam-packed with all kinds of stuff.  Next week: meeting with a friend to get coffee/hang out/borrow a book, meet with my fellow "homeroom" coordinators to shop for decorations and decorate the room, meet with my fellow peds club officers to arrange meetings for first semester.  And that's just the official stuff.  I'm also still hoping to finish up our guest bedroom--we tackled the yard last week, though I'm pretty much giving up on getting the bathroom ceiling painted.  Maybe I can pay a friend to do it for me.  Then, the week after that is orientation, wherein I will have to be a mentor at lunch each day (though granted, the rest of the week will be pretty un-full).  

I find it more than just a little frightening that I buckled down and bought the Mother of All Review Books yesterday (aka First Aid for the USMLE Step 1).  You see, I not only have to survive the upcoming school year, with its promises of a pathology class supposedly so daunting that it will make us all want to stab ourselves in the eye (along with all of our other classes)--at the end of the year, I get to spend a month or two studying like a madwoman for The Boards.  In the US, you have to take 3 tests (or "steps") to become a fully licensed physician.  Step 1 is taken at the end of the first two years of medical school and covers pretty much everything you learned in those two years--anatomy, physiology, biochemistry, pathology, microbiology, pharmacology, etc.  Passing Step 1 is important, because not only do you have to pass to become a doctor at all, but your score is a very important piece of information that residency programs consider when you start applying in your 4th year of school.  Difficult programs--like orthopedics, plastic surgery, radiology, and dermatology--look long and hard at how well you did on Step 1 when they consider whether or not they should interview you, and thus, doing well is extremely important and the test becomes even more stressful.  

Since I'm interested in pediatrics (or some other form of general medicine), I don't have to stress *too* much about my step 1 score, but it's still one of those things that looms large over your second year of med school, and thus, I went ahead and bought a review book to supplement my studying throughout the year, in hopes that using it to direct my studies will help me get a better handle on where to start come May, when things kick into overdrive.  

But enough about medicine...it's a gorgeous day and I'm heading outside!

Busy Bee

Once I was done with my internship, I thought the rest of the summer would be spent in a lovely lazy haze...but alas, not so.  Since I've returned from vacation, things have been veritably hopping around here.  My grandfather is still in the hospital, although doing much better and likely to be transferred back to a rehab facility tomorrow.  But the fact that he is in the hospital takes up a lot of time in the day--my typical days for the past week or so have included getting up and doing some light work around the house, going to lunch with my mom, grandma, and sisters, visiting the hospital for a bit in the early afternoon, and then either going to the gym or doing house stuff with my mom (or both).  We've accomplished a lot--I helped mom organize several things in her house so that her fourth bedroom can be converted to a sitting room/closet space (and I can have the twin bed out of it for our guest room), my guest room is moving right along towards becoming presentable, and tomorrow we're working on my lawn--but it has made these past few weeks fly by so quickly that all of a sudden orientation week is only about two weeks away.  

And of course, there's still a lot to be done before then, including:

• Find and/or buy books, pencils, etc. 
• Organize what books I'm going to sell at the book sale
• Have several meetings with the pediatrics club officers, my fellow unit lab advocates, etc. 
• Decorate unit lab (kind of like med school homeroom--I'm being a camp counselor of sorts with a few other people and acting as a mentor for the new first years during orientation week, which includes decorating their room for them)
• Weed and mulch my front yard
• Actually finish the guest room
• (Hopefully) paint the bathroom ceiling
• And I'd like to finish my honeymoon scrapbook.

Oh, I'd also like to relax a little.  Ah,well. 

Vacation!

We just got back yesterday from our lovely vacation.  My grandfather is still in the hospital but things are pretty much just in a holding pattern for now, so no news there.  Now I get to spend 4 weeks (give or take) doing pretty much nothing until school starts (woot!).  This is a Good Thing, because that should give me just enough time to go insane with boredom and actuallywant to start studying again just in time for school.  (Of course, give me a week in and I'll probably be whining about the workload as per usual.)  

For now, though...some discreetly anonymous vacation photos!

Some Birds at sunset...

Taking a walk with D

Pretty view of the ocean and sea oats

Ibis on the beach

Our lovely pool

One of our itinerant lizards

The absolutely gorgeous beach

The end

I ended my externship last week in a bit of a blur...I saw lots of patients because the third years I had been working with were all done on Wednesday morning, so from then on it was just me and the attendings every day.  My kid with appendicitis came back for a check-up and is doing well, I saw several kids with hilariously interesting names, and I dealt with several more clueless parents.  I admitted a 12 year old to the hospital the day before her birthday--she showed up that morning for an allergy shot just like she does every week, but the 1.5 mile walk to the bus stop that she and her mom took her get her here (just like they do every week) was too much in the heat and sent her into a massive asthma attack.  It was scary and sad at the same time.  

Now I have a week at home and then Saturday we leave for family vacation in Florida, which should be a lot of fun.  The rest of my family is already there--they go for two weeks, but D could only get off of work for on, so we'll meet them down there.  This ends up being ok, because it gave us the chance to celebrate D's birthday (which is Wednesday) with his family last night, and that was a lot of fun.  

Today (and probably every day this week) I am going to be helping drive my grandmother around, because my grandpa is still--yet again--in the hospital.  He went in on June 1st for a hip replacement and was in for about a week.  He was doing well, got transferred to a rehab facility, and was moving right along with his therapy--but after about a week developed an infection from all of the antibiotics he'd taken to prevent the incision site from getting infected.  He went back to the hospital last weekend, stayed for a week, and then this past Friday went back to the rehab facility.  He was doing ok there, but Saturday morning when he tried to stand up his blood pressure was apparently so low that he collapsed, so now he's back in the hospital again, where they're trying to get his blood pressure up and continue to fight the infections.  It's getting very tiring for everyone, not least because the longer he stays in the hospital, the more disoriented and confused he gets and the worse off he becomes mentally.  We all want him to just come home, so if everyone out there in internet-land could say a quick prayer to your favorite deity, it would be much appreciated. 

Weekend Stories

Our anniversary celebrations turned out to be lovely--on Saturday, we ate lunch with my mom and sisters so that D could run out to the store alone (mumbling something about presents) while I went with my mom to pick up our anniversary cake.  Now, before you get all excited thinking that I am ridiculous enough to go out and buy another wedding cake just for our first anniversary, let it be known that our fabulous baker actually included in the price of our wedding cake last year that on our first anniversary they would make for us (free of charge) a tiny round mini-wedding cake, lest we have to undergo the awful tradition of freezing the top layer for a year.  Gross.  So instead, we had a lovely little chocolate cake that tasted much like our wedding cake did last year!  Hooray!  

Upon meeting back up after said cake-retrieving and gift-getting, we exchanged gifts--I got D a video game and the game Parcheesi (a long story--something he's wanted for a long, long time and we've never been able to find).  D got me a gift card to Walgreens so I can print photos (because I always want to but never have the money) and a book about Florence with the promise that we will put enough money in savings this year to book a trip for next Spring Break.  This is why I love my husband.  We played Parcheesi, got fancied up, and went out to a fabulous dinner.  It was a lovely day.  

Sunday we celebrated Father's Day with each of our respective families, and then yesterday it was back to work for my last week in clinic.  And oh, but there were a couple of gems...mainly that of the mother with her 2 month old baby who informed me that the baby was crying all the time and eating too much.  The baby was currently taking 8 oz. of formula every 1-2 hours (note: normal would be 4-5 every 3-4 hours at that age) and they were feeding him oatmeal because he "just went through food too fast otherwise and we can't afford to keep buying formula."  Holy.  Cow.  FYI:  2 month old babies should NOT be eating solid foods.  Especially things like oatmeal.  Jesus.  We had a loooooong talk about the fact that babies sometimes cry not only when they're hungry, but when they're in pain--like perhaps if their bellies are so stretched out from being overfed that they feel like they're going to explode.  

People crack me up sometimes.  

Anniversary

It's hard to believe, but tomorrow will be one year since D and I got married.  We're celebrating today, because tomorrow is Father's Day and our presence will be required elsewhere.  It's hard to believe out wedding was a year ago--but it's been a fantastic year.  We have a beautiful house, D's been promoted (twice!), I've survived a year of medical school, and we have settled into a fabulous "married life."  It's fun to reminisce about how much fun we had at our wedding.  It's even more fun to look forward and imagine what the next fifty years might bring.  

Here's to us. 

One of those days

Yesterday morning was one of those days where everything just clicked.  I saw three patients in clinic, and they were all interesting and different and had something (or multiple somethings) going on beyond the typical check-up.  The first was an early-teenage boy with high blood pressure, weight problems, and who was still occasionally having trouble with bedwetting (surprising fact:  as many as 1% of 15 year old boys still wet the bed and--medically--it's totally normal.  They just grow out of it later than most.).   The cool thing about him was that I knew what to do for each of his problems and it felt like I knew how to manage this complicated patient pretty much by myself (although part of it was easy--convincing his mother to actually give him all of his BP meds before his heart explodes on him).  Second kid was a 1 year old in for a check-up, mom was great, kid had an ear infection and cold, which I successfully diagnosed and knew how to manage.  Third was a very young teenage girl whose mom wanted her on birth control because mom was sure she was having sex and not telling anyone.  Turns out, she was (frightening)--and I felt really accomplished because we ended up having a very candid conversation about being up front with mom and up front with us so we could keep her safe, what she needed to do to protect herself, etc.  I think we may have actually gotten through to her on some level.  

I think I paid for the awesome morning with the afternoon, because my second patient (at about 2 or 2:30) was a 17 year old female with lower abdominal pain.  Those in the medical community will know that this complaint on this person is a recipe for a headache for any physician/resident/student/nurse/bum on the street, mainly because there are approximately 8 Trillion things that could be wrong and you have to work up for all of them because they're all BAD.  PID, ectopic pregnancy, appendicitis, STDs, gastroenteritis, colon cancer, the list goes on and on and on and on and on...you get the idea.  Luckily for us, we were able to narrow it down and ended up treating her in the office--but with all of the workups we had to do it took FOREVER.  By the time I saw my last patient (at 4:00), the mom was so cranky from waiting so long that I thought her eyes would shoot daggers at me when I introduced myself as the medical student.   

Days like this make me love my job.  

Trivia domination and the wonders of modern medicine

My trivia team won for the third week in a row last night, which was awesome.  My dad got us t-shirts and we wore them like the complete dorks we all are.  

No really exciting stories from yesterday--it's actually kind of odd, but without a particularly interesting or different patient, now that I've sort of hit a stride and gotten used to the routine of things, a lot of my patients seem to blend together by the time I get home and it becomes difficult to recall exactly what I did during the day.  The "different" patient yesterday was a 9 month old baby who was born at 23 weeks gestational age (note: 24 weeks is considered to be the threshold of viability...and even then, only about 5% of babies born that early survive).  She's still on oxygen and has lots of lung troubles--like lots of preemies--but it was amazing to see a kid that used to be less than a pound, who lived in an incubator for a long, long time with skin so fragile you could barely touch it, doing so amazingly well that she could show up to my office and look pretty much like any other baby.  Things like that make medicine pretty darn awesome.  The rest of the day was mainly spent doing well-child check-ups.  

The one other thing that did stand out about yesterday was the fact that another one of the doctors told me I was doing a good job (even better than some of the third years), and that if I was interested in peds he thought I would make a fine pediatrics resident.  Nothing like a shot to the ego, but in all seriousness it did make my day and get me out of the rather bored "i've only seen one patient all afternoon" slump I was in at the time.  And then I got to go talk to two sisters in for their check-ups who were actually lovely and polite and mom was great and they had some issues but were working on them and doing well.  Those are the patients that make the annoying, awful parents totally worth working through and forgetting.  

Weekend Ramblings

Yesterday at clinic was uber-slow...I saw a few kids in the morning there for weight checks and labs (read: they're overweight and we're trying desperately to do something about it before they're too old to care), and a few in the afternoon who were mildly ill but nothing too exciting.  Hoping today is more interesting.  

Our first wedding anniversary is on Sunday, so I went out yesterday and bought D's gift--a new video game he's been wanting and the board game Parcheesi.  Doesn't sound like much, but the Parcheesi is kind of a sentimental gift because it's something he's talked about wanting for about forever, but could never find and would probably never buy for himself.  So I'm hoping he likes it.  I wanted to get something really sweet and thoughtful--like a really nice watch that I could engrave or something--but we limited ourselves to $50 and he already has a watch anyway.  Pbbttthhh.  He can keep the card for touching memories, I suppose.  :-)

The weekend was nice--my in-laws brought over our amazing new bookcase/desk for the spare bedroom, so I'll post pictures of that once we get our absolutely ridiculous number of books and movies onto it and the room is half decent once more.  For now though, I'll apologize for the relatively boring post and get back to my regularly scheduled life-saving (*crosses fingers*). 

Holy Appendicitis, Batman!

The past two days have been fun, but busy, and I was going to write about all the cool stuff I did yesterday last night, but then I got sick.  Excuses, excuses.  Feeling much better this morning, but unfortunately I don't have much time to blog because I have to leave earlier than usual for our morning conference (essentially, a brief lecture meant to help us med students actually learn something about diseases and whatnot).  

The cool thing about yesterday was that I saw a lot of sick kids and actually got to think and learn about diagnosis and treatment a lot.  One kid came in with vomiting, diarrhea, and fever for the past 5 days for which he had been to the ER--where they told him he had a virus and sent him home with ibuprofen.  He went back two days later--same thing.  Two days later, he came to us, whereupon I poked around on his belly and he said it was tender.  The doctor poked around on his belly and asked him to point to where it hurt the most--at which point he stuck his finger right smack in the middle of his right lower quadrant.  We called the ER and told them we were sending the kid over for a CT and surgical consult for appendicitis immediately.  I know he had really, really atypical findings (most kids with appendicitis have more rapid onset of symptoms, and their pain is much more localized) but christ, you'd think someone at an ER would have thought at least on the second go-round that this kid might need to get some imaging done just in case.  Oy. 

Yesterday was also the day of the chromosomally challenged--I saw a kid with DiGeorge Syndrome who also had Tetralogy of Fallot and a heart murmur you could hear from across the room, and another kid with Williams Syndrome.  I also saw one kid whose adopted mom spent the entire time complaining about all these behavior problems he had and being pretty much the most negative person in the world--at which point we all wondered how much the kid was really acting up and how much he was just reacting to her negativity.  Saw a couple of cute babies for check-ups, and got told by one of the doctors that I'm doing better than the third years and everyone loves me. 

Love it when things just work out.  

ETA: Today, we found out that our suspected appendicitis kid was just that--a ruptured appendix with an abscess.  I may have actually contributed to the saving of a life.  I may, in fact, be the coolest person on the earth right now.  :-)

Thank You, Captain Obvious

Some highlights from yesterday at the clinic:

--14 year old kid complaining of headaches.  No other symptoms, absolutely nothing else apparently wrong with him.  Aleve seems to help.  

Me: "I see you failed your vision screen, do you have glasses?"  

Kid: "Yes." 

Me: "Do you wear them?"  

Kid: "No."  

Me: "Well, I think I might have figured out your problem..."

--9 year old who weighs 30 pounds more than I do comes in complaining of allergies.  

Me: "Is she currently on any allergy medication?"  

Mom: "Yes, she takes Allegra."  

Doctor: "Does she take it regularly?"  

Mom: *looks at kid*   

Kid:  *shrugs*   

Doctor:  "Did you take it today?"  

Kid: *nods*  

Doctor:  "Did you take it yesterday?"  

Kid: *shrugs*  

Doctor:  "Did you take it Saturday?"  

Kid: *shrugs*  

Me: "Well, I think I might have figured out the problem here..."

--10 year old in for labs and a weight check, as well as exercise and diet counseling (as kid is severely overweight).  

Me: "One of the easiest things you can do is just not keep junk food in the house.  Having healthy snacks on hand for when she gets hungry is the best option; then she won't want to binge on candy later."  

Mom: "Well I give her like a bag of carrots and some fat free ranch to snack on, and she'll just eat the whole bag!"  

Me:" Ok, well it might help to have some individual portions set aside in baggies so that she knows what a good portion is.  Or maybe you could do something like give her an apple for an afternoon snack so that once she's done, she's done."  

Mom: "But fruit has more sugar than candy!"  

Me:  *bangs head on table*  

But the real kicker here was that after the nurses drew blood and we discussed all of the different things she could do and work on to lose weight, Mom, Kid, and Sibling marched out the door as I walked down the hall to return to the charting area, and behind me I overheard mom saying, "Ok, let's go to McDonald's!"  *weeps*

Shoes and other adventures

The last couple of days this week were also really good--after Wednesday afternoon's experience doing things on my own, I basically just stepped up to do everything the third years were doing on Thursday and Friday.  And overall, things went really, really well.  I feel like I'm getting the hang of things and it all just comes relatively naturally.  I don't even get nervous walking in to visit the patients like I anticipated--everything just flows and I feel (again) like this is just my place in life.  

The only frustrating thing comes from the fact that the third years I'm working with are somewhat...well, just not very fun.  None of them want to do pediatrics (in fact, I'm pretty sure both of the guys are heading to ortho, and if you've ever heard of stereotypes in medicine, that should tell you something), and while I understand that it's probably been a long year for them and they're tired and all, they just seem so bored and out of it all the time.  It makes me hope I don't become jaded by the end of my clinical years and can actually still enjoy medicine as much then as I do now.  

Highlights of the past couple of days:

• I diagnosed a kid with strep throat!  Finally, a sick kid and a diagnosis that was overall pretty darn easy, since I've had it myself so many times.  
• Mostly saw a lot of well-baby checkups, but several were very, very cute.  
• Learned (and did) a couple of teenager check-ups and sports physical, including how to do the "turn your head and cough" and "safe sex/don't do drugs/don't be an idiot" discussion. 
• Saw a 16 month old baby who weighed upwards of 30 pounds and whose guardians informed me that feeding him a jug of juice every day was not the cause of his weight gain and diarrhea, and also that the idea that sleeping in the same bed with a small baby can kill them was "an old wives' tale."  *Bangs head against table.*  Even the doctor had trouble with that one. 
• Had the director of the clinic inform me that I was doing a really good job, especially for being only a second year (which she didn't realize prior to going over my note with me).  

Finally, the absolute highlight of the weekend was these:

which were originally $275 at the department store, where I have coveted them for a long, long time.  I had promised myself quite a while ago that once I graduated from med school and became a resident, upon receiving my very first pay check (the majority of which will all be spent entirely on paying off my inordinate student loans) I would head straight to the store and splurge, because they are not only lovely, but also the single most comfortable pair of shoes I have ever tried on.  Cole Haan got together with Nike to make a pair of pumps that feels like you're wearing tennis shoes, or perhaps walking on air.  Seriously, I have lusted after them.  So today, when I found them at TJ Maxx for a mere $50 (!!!!), I immediately purchased them.  And now, they sit in my closet, making me an incredibly happy camper.  

...And I did!

Lo and behold, yesterday afternoon the third year students had lectures and so I ended up being the only student around, along with 2 of the attendings.  As a result, I got to see all the patients on my own for the first time and do the typical 3rd-year thing.  It was really cool, and I honestly think I did a pretty good job.  I mean, there are questions I sometimes forget to ask and I don't know differential diagnoses from a hole in the ground, but I'm getting pretty decent at taking a pediatric H&P at the least and also getting better at writing a note the way they want one written.  In fact, while I'm sure it's still rather awkward and whatnot, I feel like I really do a good job of just talking to people, which is half the battle.  And more than that, I really enjoy it--it feels right, like this is what I'm supposed to be doing--which is a good feeling. 

Yesterday's list o' patients included a 2-month old for a check-up, a 9-month old for a check-up and follow-up on a previous URI (upper respiratory infection), and an 11 year old for a check-up and school physical.  It was nice to branch out with the 11 year old, because up to then all I had really seen were babies and really young kids.  Today, I'm hoping to get a sick kid or two since I haven't really done one of those yet.  Alas, with all the rain we've been having today will probably be slower than even yesterday (which was pretty slow).  

I could do this better (and other thoughts)

As yesterday was my second day at the clinic, I walked in not knowing for sure what I was supposed to be doing.  When I asked my director, she responded, "What do you want to do?"  Thanks.  I'd like to see patients please, but the manner of doing so doesn't matter so much.  She informed me that I could follow attendings, follow students, see patients on my own, pretty much whatever.  Again, not so helpful.  I mean, I can be proactive and all, but it was my second day and a little direction just to clarify to everyone else what I was there for might have been helpful.  Anyway, I took charge and immediately turned to the other female med student (who was getting up to see her first patient of the day) to ask if I could tag along.  I did, and we saw a couple of patients together.  On the third try, I grabbed the info to enter into the growth chart, and she asked if I wanted to do the work on this one.  And so, I did.  History and physical for an 18-month old well child check-up (aka a "shots visit").  And I wrote the note (with some help) and I presented it to the attending for check-out, and it all went pretty ok.  I felt good about it.  I also felt good about the fact that I am better at taking a history and talking to parents like they are people and not just drones than most of the other students I'm working with.  

After that patient, we went and had lunch, and I resolved that when I returned in the afternoon I would make an effort to see a patient or two on my own.  Unfortunately, there were very few patients scheduled for after lunch, and the other students/residents grabbed the first few up.  But then!   A patient!  And no one else was around!  I grabbed the chart, saw that it was a well-baby check up (easy to do, something I know), and sat down to do the growth charts and whatnot.  At that point, I realized that this patient's name seemed Hispanic in origin, and I looked at previous info to see that, indeed, the doctor they had seen previously was one of our attendings who speaks fluent Spanish.  Being an intelligent person and not wanting to jump to conclusions, I went to the room, knocked on the door, and asked the parents if they spoke English.  Apparently they did speak some, but I decided to double-check with the doctor.  She was busy, but essentially told me to get the physical and any info I could, and she would come later to help with the interview.  Awesome!  Unfortunately, another doctor standing with her (who hadn't been in that morning) stuck her head in to say, "She's not allowed to see people by herself.  Send another student."  Not awesome!!!

Now, I know that Dr. A this morning informed me that I could see patients if I want.  And Dr. B wasn't around to hear that and was pretty much going on the information she had yesterday, which was that I was supposed to shadow.  But still, it was so frustrating when all I wanted to do was take a history.  Alas, I am not one with balls enough to argue with superior attendings, and so I dutifully went with another student, whose history-taking skills seemed incredibly subpar.  No offense to this person, but he just...I don't know, just kind of went through the motions.  I mean, I know these guys have been doing this for a year now, and I know they're probably burned out majorly, and I know they're not interested in pediatrics as a specialty, but you'd think they'd at least talk to the parents with some level of confidence, even if they're faking it.  Just saying.  Anyway, he took the history with a little help from me (since Mom did speak really good English) and then let me do the physical, which was fun.  9 month old babies are hilarious.  We presented to Dr. Spanish and she came in and answered any questions the parents had that they couldn't articulate as well in English.  

The rest of my afternoon was spent learning about diagnosing and treating asthma, since we didn't have any patients.  It was actually really informative and fun, and I felt like I really learned something about medicine.  Hooray!

Other highlights:

• A mom who brought in her baby because he "just didn't look right."  Now, I know that parents know their kids best, but really, we're pretty sure she just fed the kid too much and he was feeling too full. 
  
• Watching one of my fellow students remove sutures from the finger of a really smart elementary-school aged kid, who commented on the whole process throughout. :-D
• Doing a well-child check on a young kid whose entire family came with to the visit--mom, dad, and three very young brothers and sisters who decided that my history would be the perfect time to start screaming and fighting.  It was actually pretty hilarious. 

First day

Yesterday was my first day at my externship, and while it felt a bit slow, I think it's going to be a good experience, especially once I am allowed to start doing more.  Essentially, here's how things work.  There are three third year students (who are really for all intents and purposes fourth years now--this is their last rotation of the year) working in the clinic currently, several attendings, and me (and some residents in the afternoon, but we don't really work with them).  When patients' charts get brought back to be seen, one of the third years picks it up, enters any pertinent information, and goes and does an initial history and physical.  They write a note and present the patient to the attending (in the medical world, "present" basically means tell the doctor above you everything you found out about the patient, including what's going on with their current illness, any past medical problems, family history, etc., and also what you think might be wrong, and how you think you can treat it).  Then, the attending and third year combo return to the patient, the attending checks them out (it's two check-ups for the price of one!) and either oks what the third year said or adds to it if necessary.  

Now, I'm not a third year yet and, while I know the essentials of a head-to-toe physical exam and history, I haven't done many H&Ps on kids or babies.  So for the first couple of days, the head attending of the clinic basically decided to have me simply follow attendings around, and then I'll get to pick up some responsibility and act more like a third year doing my own thing.  Unfortunately, while I'm simply following folks around, the day can be a bit boring because the attendings don't usually see all that many patients without a third year doing it first.  As a result, I'm rather chomping at the bit for some real action.  I did at least learn how to differentiate between iron-deficiency anemia and thalassemia!

Despite the slower nature of the day yesterday, I did get to see some interesting stuff:

• 2 month old and 2 year old kids whose parents spoke no English, in for their check-ups and shots (saw these with a really nice doctor who actually let me enter info into the chart/note)
• 6 month old who was decidedly against my looking into any orifice of his body
• 8 year old with asthma who I got to listen to and do a pulmonary function test with
• Several well-baby visits
• a kid with a previous UTI

Things of note:  parents can be incredible in every sense of the word.  Like the parents who spoke no English, who clearly cared so much about their kids that they drove a pretty long way in order to see a doctor who spoke enough Spanish that they could understand properly how to take care of their child's anemia.  Or the overweight mother of the overweight toddler who explained that the only reason the kid was gaining weight was probably because he liked juice a lot, because otherwise he ate healthy (*smacks forehead*).  Fun times. 

Vacation

I have now had the opportunity to be out of school for a week and a half, and it's kind of crazy how much time that seems to have taken as compared to the previous week and a half (which seemed to take no time at all).  This past weekend I traveled with my family to Arizona for my cousin's wedding, and this week I am spending the majority of my time helping my mom and sister prepare for her graduation party this weekend.  You honestly wouldn't think it was that big of a deal, but honestly--there's more to do than I would've thought possible.  This week, in fact, is a veritable maze of activities to get through--last night was commencement, tonight my (other) sister graduates from her technical school, Friday is the youngest sister's birthday, Saturday is commencement, and Sunday is the graduation party.  Then, on Monday, I'll be starting my externship at 8:30am.  After that, I'm sure the updates will probably be a lot more often--and, hopefully, a lot more interesting. 

Random side note:  I re-read Harry Potter and the Deathly Hallows on the plane this weekend, and finished it in bed this morning.  Maybe this is sad, but I seriously get intensely emotional every time I finish the book.  It's weird how the experiences with which we grow up become such a part of us, even when they're fictional.  For me, HP brought my family together during the busiest years of our lives, and when the 7th book ended, I think we all mourned a little for the loss of a friend.   Thankfully I can revisit all the books whenever I want and get the whole experience all over again. :-)

Ok, cheesiness over for today.  Time to pick up middle sister from school before I get thundered on. 

So, I survived.

This post probably would have made much more sense to write on Friday, when I actually was celebrating the joy of being done with finals and with M1 year, but at that point I was so exhausted and mentally drained that the sheer thought of writing about what had just happened was enough to make me ill.  Today, however, I woke up at 10:00 to a gorgeous sunny morning and don't have to do anything but go eat lunch and go to the grocery, so writing is much more palatable. 

The thing about finals is, they really weren't all that hard.  In fact, a lot of it was easier than our previous tests.  It's just that they're so long, and so draining in terms of nervous energy.  The way they work our test days is an effort to simulate the experience we'll have taking the boards next summer (oh my god...next summer.  That's scary.).  Essentially, for the boards, we have 7 one-hour blocks of time with something like 48 questions each and 60 minutes in which to complete them.  You get a total of an hour break throughout the day, which can be taken in whatever increments you like--ten minutes after each section, or you can skip some and use more for lunch, etc.  At school, they attempt to emulate this by having us take our exams in 6 one-hour blocks with fifteen minute breaks between each (although we take a 45 minute break for lunch).  The problem here is that in the boards, if you finish a section early, you can add to your break time, or you can just forge ahead and get done early.  On test days at school, if you finish early, you get the added bonus of just sitting around outside the test room for all that extra time, thinking of all the things you probably got wrong on the previous section.  They also put fewer questions on each exam (only about 30), so it's really common that people get done early.  I took about half an hour for each section, which meant I had a good 45 minutes between every block.  I was actually waiting to take tests longer than I was taking them.  Which gets kind of tiring.  

The good news is, I did really well on all my tests, although I left the first section sure that I had failed and was going to die.  Of course, I didn't, and I ended up getting good enough scores to get Honors in physio and biochem.  Hooray!  Then I went home, sat around, and ended up going over to my parents' house for dinner and a glass of wine, and then the whole family went to see Star Trek (which is awesome.  If you haven't seen it, go now.  Now!).  I was lucky enough to spend pretty much the entire rest of the weekend with D, which was a first since he just started his new job and finally has weekends off now.  It was lovely--we went shopping, got him a new phone, watched a movie, grilled out with some friends...it's the life I never knew existed outside of medicine and crazy work schedules.  If every summer weekend is like this one...well, it's going to be an awesome summer. 

Made It!!

Now if you'll excuse me, I'm going to go pass out and wake up in a week.  

Finals

Whoa, Grey's!  Seriously?!  That was ridiculous.  Also, made it quite impossible for me to relax last night like I should have.  Whoa.  Anybody else? 

Finals today.  I feel pretty good, although doing a couple practice problems last night I had a miniature freak-out wherein I came to the conclusion that I didn't know the heart as well as I thought and proceeded to feel the need to get up this morning and do specific questions for heart and circulation physiology...don't know if that was such a good idea or not.  I'm sure the info is all up there if I just relax.  Off for 6 one-hour blocks of exam.  Wish me luck!  

Too Early

It's 7:15am on a Tuesday morning and here I sit, preparing to study.  This is the only thing I hate about test weeks...there's so much to be done that I never feel finished.  I can stop for the day when I get too tired to continue, but it just makes the next day feel more pressured.  My original study goal was to finish all my flashcards yesterday, but with Mother's Day on Sunday and the migraines of the end of last week, things didn't go as planned and if I'm going to finish today, that will men 5 sections of biochem and 6 of GI physiology by the end of the day.  I'm hoping for most of that--I was pretty productive yesterday and felt good about it, so maybe the trend will continue.  As long as I have two pretty solid days for practice problems, that should do.  Right now I just feel like this test, more than others, is a mish-mash of mumbo jumbo in my head--it's like alphabet soup, and remembering what every single combination of letters stands for is what I worry about.  Ah, well.  It'll be over Friday. 

El Fin

I watched the finale of Scrubs last night, and it was so, so, so, so indescribably perfect.  The final sequence of "what might happen" set to Peter Gabriel's The Book of Love was possibly the best way anyone has ever come up with to end a show.  If they decide to bring it back next year, I won't watch, because to me, this was the epitome of an ending.  Don't know if there are any other Scrubs fans out there, but I sure hope so.  It's a fabulous show--I own every season and I could pull any of them out at just about any time and love them all over again.  I mean really--I cried.  Maybe I'm just a sentimental fool, but I think if you watch you'll agree with me. 

In other news, we are officially in the throes of finals week and I am officially getting tension headaches every day from staring at my computer too much, so I may not update a bunch this week.  Then again, I might, just to procrastinate.  I'm hoping to get an out this weekend with Mother's Day and with D wanting to see the new Star Trek movie (which, admittedly, looks pretty awesome).  

Final thoughts for the day--please keep my wonderful grandmother in your prayers, as her heart has begun giving her some problems again recently.  She is almost 86 years old, tough as nails and awesome in every way, but she has elected not to have bypass or any other open-heart surgery should anything go seriously wrong, which has us all rather worried about her current state.  She has a valve that leaks and has gotten progressively worse, and she is not a candidate for replacement.  As a medical student, it is the most maddening thing of all to know exactly how someone (most especially someone I love) will die, and to know that there is absolutely nothing anyone can do about it except wait (for who knows how long--days, or years) and make her as comfortable as possible when things get bad.  I think my mom is at peace with the idea of her (eventual, maybe sooner, maybe later) passing, but talking to my mom I find it hard to find that same acceptance.  She and my grandfather are the rocks of my family, and to think of losing them...well, I'll just ask for your thoughts.  

Living Space

Spent much of this weekend doing some things around the house.  Yesterday my mom got new living room furniture delivered, which meant that we inherited a couch, leather recliner, and chest/coffee table for our house.  The couch went out on our breezeway/porch, which we also finally (only a year after buying the dang place) decorated as a result.  It looks lovely--if very "man cave" esque (D loves Guinness and pub stuff, and since I've been very accommodating elsewhere in the house, I told him I refused to put all that up anywhere but the porch, which is more of a party room anyway).  We also, in effort to make room for the chest and recliner, rearranged our living room furniture and it looks so much better now--much less college apartment and much more welcoming and homey.  The house actually opens up into the living room when you come in the door now, rather than the living space being pretty much closed off by the position of the sofa. 

In celebration of all the new-ness and the "house feeling like a home"-ness, we had a few friends over for a party (and also watched the horses run in circles--what a Derby, by the way).  Everybody chipped in, we grilled out on our deck and ate on the porch/breezeway and then played board games and watched movies in the newly-arranged living room, and it was fabulous.  As D and I both put it, this is exactly the kind of day  we pictured having when we bought a house, and it's finally come together enough for that to happen.  It really was just a fun time, but it felt like such a huge success.  

Now, the next two weeks will be a spring to the finish--but for once, I feel more than up to the task.  And comfortable doing all the studying in my lovely house!

And then there was one...

One week.  ONE WEEK left.  Of classes, anyway.  Then I have to study like a mad woman for a week and take a day-long exam, for which I have zero to no motivation to study, but hey, that's all I've got to survive.  Then it's sweet freedom until August.  Makes me wonder how much more burned out I'll be next year, when studying for finals will only be prelude to the much more insane studying for step 1.  It's just such a happy thought to look forward to, isn't it? 

Today, though, there is much to be grateful for.  We have a pseudo-holiday today, which means no class.  Which means it is 11 in the morning and I am still sitting in bed with my dog, playing on the computer.  Shortly, I will get up, put on some clothes, drop a check off at the bank and go to the gym.  After that, I plan to come home, have lunch, study the past couple of days' worth of biochem, and maybe start reviewing some physio (but only if I feel like it).  D will get done with work at 6, and after that I plan on doing absolutely whatever I feel like.  It's the little things.  

Reason number 542 NOT to bring your kid to the ER...

I'm at the ER again today.  I think I just have the worst luck, because once again not a single kid has actually qualified for a study--don't get me wrong, we've had TONS of kids with abdominal pain and whatnot, but none who are being tested for appendicitis--mostly just constipated.  Woot.  It's a poopy kind of day.  Only kid who might have qualified for my other study had x-rays with him when he arrived, which ruled him out.  (ETA:  Finally had a qualifying kid come in at 15 minutes til my shift was up...ended up staying almost an hour late but it was worth it because I got to help run the ultrasound for his broken clavicle!)

Best chief complaint of the day: kid who was brought to the ER (yes, folks, the emergency room) because he had cotton from the end of a Q-tip stuck in his ear.  The US medical system at work, folks, right here in front of our eyes.  

I'm thinking of talking to one of the doctors here about finding someone who's doing a case review study that I could help out with and get published.  All the cool kids are doing it, apparently...and God knows I have to keep up with the crowd.  In all honesty, though, it would definitely be a boost to the CV if I had a publication, even if peds doesn't necessarily require it. 

We had our lottery for the student-run clinics that we can run in our second year.  Basically, the school has four clinics throughout the city that are essentially run by second year med students (reporting to legitimate physicians, don't worry), and we can get two elective credits for working once a week for seven weeks at one of them.  Obviously, lots of people want to do this, so to make it fair in terms of who gets to do it (and which clinic they get to work at) we have a lottery.  Everybody's name got randomly assigned a number and then today at the lotto session when they called your number you picked which clinic and which session you wanted to work.  Unfortunately, I had a pretty high number so I didn't get my first choice clinic, but I did get one that I think will be a fun one to work.  I'll be working for seven weeks next spring (at the end of the year, when I might actually know something and when things will stick the most for third year, I'm hoping) in a clinic that serves mostly women, some children, and a few men, most of whom are involved with a local half-way house.  I'm super excited and can't wait to get some more clinical experience under my belt.  

Only two more weeks of class, study week, then two weeks off before my externship starts!

Not waiting any more...

HE GOT THE JOB!!!!!!!!   :-D

So excited. Both of us are.  YAY!!!!!!!!!

Waiting

I'm playing hooky today because we only had two hours of lecture this afternoon, and my alternate option was staying home all day with D, who's off work.  I'll catch up with the lecture recordings later.  These last three weeks of actual class/lecture prior to our final set of exams are going to be fabulous--this week we are essentially done already, because I'm skipping class today, tomorrow we have a small group but no new material lecture, and all we have Friday is a Sim Lab (get to play with the dummies some more--no new material here either).  Next week is a short week with no school on Friday and a quiz on Thursday, so no new material there either.  The week after that we have PBL (problem based learning) modules, which means we sit around and pretend to be doctors for a while but don't have to actually attend lecture.  Then study week.  I'll take that, thanks very much.  

Today we are waiting on pins and needles to hear back from D's employer--he interviewed for a promotion within his company yesterday and we are hoping to hear back today.  This is the third such promotion he's interviewed for since February, and the past two times he has been told outright that he had the best interview, the best qualifications, but was not given the job.  Needless to say, things have been exceedingly frustrating.  He's taken it all extremely well, given the circumstances, and has kept improving his performance, so we're hoping for good results on this one--but things have been extremely political in the past, so it's hard to say what will happen.  Cross your fingers for us...

Baby Day at the Zoo

D and I took advantage of the absolutely gorgeous weather this afternoon and went to the zoo.  We got a membership last year and haven't been able to use it all that much, so it was really nice to spend the day enjoying the sun and hanging out (and getting some exercise to boot).  We actually sort of assumed no one would be there, because today's the day of a huge festival in our hometown and we figured everyone and their mother would be busy with that.  Unfortunately, we must have missed the memo that when all the single adult and older family types are out celebrating, everyone with a child under the age of 5 goes to the zoo.  The place was literally crawling with strollers.  I have never in my life seen so many in one place--except maybe Disney World.  It was crazy.  Luckily, though, little kids tend to be pretty into the zoo and it actually made for a really fun time, because not only did we get to enjoy for our own sake, but we got the additional hilarity of hearing three year old lisps proclaiming the virtues of meerkats.  

Now we're home and being domestic--I mowed the front yard, he's currently mowing the back and I'm studying the endocrinology of the reproductive system.  Because, you know, that's how we work.  

The continuing saga of the Mr. Hackencough.

We finished our sim lab experience yesterday--I presented the story of the guy I had interviewed (and, though we didn't give as much feedback as we had before with other people, it seemed to go over really well) and we discussed what we knew about acid/base levels and their relation to respiratory problems.  We also discussed/learned how we can adjust these kinds of problems with ventilator settings. We then got to troop ourselves into the Sim lab, where Mr. Hackencough was replaced with a simulator dummy hooked up to a ventilator.  Our sim dummies are pretty cool--basically, they look like CPR dummies, but they're computerized to the point that they breathe in oxygen and out carbon dioxide, they bleed, they have heart and lung sounds and pulses in the right places, and when we give them drugs, they react appropriately.  They also tend to be hooked up to monitors so that we can follow their vitals (heart rate, blood pressure, pulse-ox, etc.).  

The guy I had to "intubate" last week was presented to us with respiratory acidosis, and we basically went through the actions of fixing his vent, then watching him go nuts again (he developed further acidosis and uremia), fixed that, then he got better, and then he got worse again.  We "fixed" him a total of I think three or four times.  I love things like this, mainly because the doctors that work with my group did a really good job of letting us make the decisions and talking us through them, rather than essentially telling us what to do and letting us fake our way through the procedure.  I can't say that I feel like I would be able to handle a ventilator patient all on my own now, but I do feel confident that if I walked onto the wards tomorrow, I would at least have a basic idea of how it works and what to adjust to effect certain changes.  I also managed to remember all of the causes of anion gap metabolic acidosis (of which there are many--the mnemonic we were given to help remember was A CAT MUDPILES, with each letter representing a different possible cause, and some letters representing two), which pretty much made me feel like a badass in front of the attendings who were helping us.  

As I told D this morning, days like this are so incredibly re-affirming.  I am deeply, deeply satisfied with choosing medicine as a career, and things like this just reinforce that.  I'm sure I would probably be a bumbling idiot if you suddenly threw me into third year right now, but I feel confident about my abilities to take a history, present the pertinent information, and answer questions about the basics of the problem.  Of course, this should (hopefully) only improve next year with path and pharm.  We shall see. 

Crash

Last Friday, I was the representative from my clinical cases group that had to go up to our "standardized patient" lab to get a history for our next case.  For those not in the know, the SPs, as we call them, are trained actors whose job it is to act sick and give a history like a real patient would--essentially giving us a chance to practice doing doctor-ly things on people we cannot possibly harm.  They also usually give us feedback on things that were good or bad about us--questions we should have asked, procedures that were done well or left out, etc.  I've had several of these encounters before, interviewing "patients" for everything from back pain to depression to gout and learning to do a physical exam.  This time, I was one of twelve people who got lucky enough to have to interview a patient who was having trouble breathing, and who we could expect to completely decompensate before our very eyes during the interview.  

Obviously, I was rather nervous going in, but the lab leaders prepped us--just take a history, no physical, keep an eye on vitals.  He'll probably pass out and need to be intubated before you're done.  Ok--no biggie.  When the guy stops talking I'll go ahead and ask for the intubation kit (oh, and for those wondering who in the world these SPs are that would let us intubate them needlessly--the procedures are all performed on mannequin dummies).   I walked in, introduced myself, and took the history--pretty darn well, I'd say.  All the pertinent information was there:  What's going on, how long has it been happening, what makes it better/worse, other symptoms, past medical history, family history, even some social history.  Pretty much everything you could ask a patient who's hacking up a lung right in front of you.  And so I finish asking pretty much every question I know to ask--and he's still just coughing away.  There was no one in the room with me, no one to turn and show the vitals, no one to offer me labs or other information.  So I stuck my head out of the room and asked for labs.  "There are none."  Ok...   Sickly dude is telling me how frightened he is and wants to know when his wife will arrive.  "I'm sure she'll be here soon, sir, don't worry, we'll take good care of you and get you feeling better."  Finally, someone random comes in the room.  "Have you done your history?  Did you ask (X) question?  What about (X)?"  Done, done, and done.  I read him the entire history.  "Well have you done a physical?"  They told us not to, but whatever, so I listen to the guy's lungs (which, obviously, sound FINE since this guy is in fact not sick, but whatever).  Turn back to the helpful guy--"So what's going on with your patient?"   Well, he's sick.  He's having trouble breathing, started a few days ago, can't get up today.  His O2 sats are dropping, along with his blood pressure.  "No, I mean, what's going on with him RIGHT NOW?"  He's resting.  "Are you SURE?"  Crap.  

After ascertaining that Mr. Actor Guy was, indeed, no longer responding to my shaking him and asking him if he was ok, I turned to Mr. Helpful Guy (or, not so helpful at this point) and inform him that Mr. Actor seems to have passed out.  At this point, I got to intubate the dummy, which was in all rights pretty neat.  

My only question is, for this whole experience, could we make things a little a) more realistic or b) more timely.  If the guy was supposed to pass out on me before the end of the physical, then he should have.  If he didn't, then there should have been another doctor there because as a med student who has NO background in either pathology or pharmacology, I have no clue what to do for this guy other than watch him cough until he passes out and I can "intubate."   It would have been an awesome experience, were it not for the disorganization.  Ah, well.  Now I get to present him to my group and our resident/attendings who help out, so hopefully they won't bash me too much. 

Exam Week and Car Issues

Last week was possibly the most exhausting week ever.  I have never been physically tired after an exam, but I was on Friday evening.  I don't think I necessarily worked harder than I normally do for an exam week, but the sheer mountain of material that was covered on this exam--easily twice what we had on our last one--made for a daunting mental experience.  Then, on test day, we have six one-hour long exams, with a fifteen minute break between each and an hour for lunch in the middle.  This is supposed to get us ready for the boards next year, which follow roughly the same format, but the difference is that when you take the boards, you are not required to take the allotted amount of time for each section.  If you finish early, you can take your ten minute break and then start the next section at will.  For our exams, if I finish half an hour early on each section, I am simply treated to a forty-five minute break between each exam, which makes for a very long, very tiring day.  I came home, plopped straight down on the couch, and fell asleep for an hour afterward.  

The nice thing was, D and I got to go to the med school "Spring Fling" dance Friday evening, which turned out to be pretty fun.  Any excuse to wear a fun dress is ok by me.  The rest of the weekend was equally nice because I went shopping and rounded out a little more of my professional wardrobe for the externship this summer.  

This morning, I was all up and ready to go to class at 8 when I walked outside, threw my stuff in my car, turned the key, and...nothing.  Not a sound.  Not a click, whirr, or a light.  Nada.  I thought maybe it just needed time to warm up a bit since it's been unseasonably cold lately, but no dice.  Luckily, when I called my extended warranty people to see if there was any chance in hell that it was still active, it turned out that the car was still covered under warranty until June 11 (2009) or 75,000 miles, whichever came first.  My car has (literally) 74,800 + miles.  Thank God.  Triple A is coming sometime (supposedly) here within the next fifteen minutes to tow my car to the shop and I think I get a free rental car out of the deal.  Hopefully the whole business won't take too long, since I have to go to school and pretend to talk to patients about not smoking by three.  

Study, Study

Block exams this week...I was all diligent about making myself a study schedule, and haven't been horrible at keeping to it.  This morning I woke up at 7:30 and stumbled my way through three sections of biochem (that I was supposed to finish yesterday) and three of kidney physio.  

Now I have three days to do physio practice problems, but today there is still the matter of trying to catch up on biochem and neuro.  To keep up with my schedule, I'll need to get through about six sections' worth of flashcards each today.  Ugh.  

I went shopping with my mom yesterday and managed to procure two new tanktops from Martin and Osa for just $12 a piece, plus 30% off.  Sweet.  Also (finally!!) found a couple of pairs of khaki dress pants that might work for my externship this summer.  Now I just need a couple of dressier looking shirts and I'm set.  

Back in the ER

The title was going to be a throwback to "Back in the USSR," but I really couldn't find a way to fit "Big pediatrics hospital ER" into the lyrics.  I've got about another half hour left in this shift, which I wasn't all that excited about when I came in today, but has actually turned out pretty well.  I've just joined on to do another study in addition to the ones we've been working on, and in this one I actually get to recruit patients myself, rather than just paging doctors when something promising shows up.  Gives me something else to do, anyway.  Also, the head of the student research program is here today and just let me listen to a severely asthmatic little boy.  Crazy how bad this kid was--I wanted to tell him that I had asthma too, but he was pretty out of it.  It's all been grand, but unfortunately, it's prevented me from doing the serious catch up work I was planning for this afternoon.  

Last night I was all ready to be uber-productive, but then D got home from work around the same time as I got out of school, and we took a nap together because those 6-4 days are killer.  I woke up and did a marginal amount of studying, but then my mom called, and the whole family (who have been in DC all week for spring break without me, boo) was going out to dinner since they'd just gotten back to town.  They invited D and I to join, so of course we did.  Then we helped them take their rental car back to the airport.  Then we picked up a copy of Quantum of Solace, since it just came out on DVD.  And a copy of Sleeping Beauty, because I'm obsessed and those dang Disney people are about to put it back in "the vault" to prevent me from buying it ever again.  I also need to get my hands on the Sword in the Stone before that goes away too.  

In addition to the studying that's going on for our block exam next week, we've had an interesting little round of Problem Based Learning modules this week.  It's actually been rather enlightening--essentially reviewing physiology by discussing an actual patient case and figuring out what's wrong with this person in light of what we know about physio.  Unfortunately, it's brought to light a really interesting question for me--when do we actually learn how to apply all this stuff?  I mean, if you asked me right now how high hematocrit affects blood flow or how exercise affects oxygen's diffusing capacity in the lungs, I could pretty much tell you with no trouble.  But if you showed me a patient with symptoms of one of those problems, I feel like I would be completely lost at where even to begin.  I guess that comes as we go--and it's one of the reasons I'm really excited about my externship this summer.  I'm hoping (and have been told this is pretty much true) that it will be a huge help because I'll learn a lot about the day-to-day act of diagnosis, but at the same time I'm still not required to actually know anything so I don't have to feel pressured to study.  It's just flat up learning how to do things like take histories, do physicals, and apply the findings to diagnose (along with all this science stuff I've supposedly learned this year).  Should be interesting--and, hopefully, help me answer this question.