Tag Archives: MS3

I’m Back, Let’s Recap (Step 2 board stuff)

To my amazing readers:

We really need to catch up! My last post left you somewhere near the end of third year. I was grinding out my last two rotations and feeling fairly uninspired. You see, it took all the reserve I had left to keep coming into clinic just as excited as my first day of rotations. I ended the year with ambulatory and family medicine. Two rotations that are classically considered “easy.” Working less than 40 hours a week, having weekends off and getting home by 5 pm was so foreign to me. Paradoxically, I tend to be less productive the more free time I have. A combination of a really long year and a lack of stress propelling me forward left me struggling internally to maintain my tireless enthusiasm. There was no sense of urgency. Even the medical cases were non-emergent. Well, I did have one blood glucose stick of 38 we had to call an ambulance for–and that was the most exciting thing that happened.  Needless to say, those two months dragged. I reconfirmed that my type of medicine is the worrisome kind–at least ruling it out.

I moved from one day being the last day of my rotation to the next day starting 4th year. I began the year with a Step 2 study block.

Board exams are basically the worst thing you ever have to do in medical school. Period. No matter how prepared you are, they are always terrible.  I tried to take away some lessons from my Step 1 experience–mainly that I needed to calm down, so I approached the 4 weeks I had to study much more relaxed this time. I was surprised I didn’t freak out once. Probably because I spent the last two days before the exam dancing around my living room. Doing the Dougie, even terribly, will kill all last minute nerves. Try it.

My study schedule consisted of waking up at 8 am, doing question blocks in Uworld, taking notes, reading my notes, and doing more questions, then going to bed around midnight just to wake up and do it all over again. I kept an excel spreadsheet and ended up doing about 2,900 practice questions. I also took three practice NBME exams. NBME number 4, 6 and 7. My actual score was within 2 points of NBME 4 and 6 and 18 points higher than NBME 7. (Don’t waste your time taking NBME 7 unless you are doing it just for additional practice questions.)

The exam itself was just as terrible as Step 1. 9 hours of answering questions leaves you feeling miserable and delirious. Even though I felt I totally failed, I did not sit and cry in my car this time, instead I took a celebratory selfie and moved on. I purposefully didn’t allow myself to think about the exam at all. If I felt my mind slipping back there I immediately redirected my thinking. This was because I actually thought I failed the exam. Only to find I did incredibly well. So just remember, feeling like you failed is inversely related to your score. The worse you feel, the better you did!

With that monstrosity behind me I FINALLY began what I have been waiting for: my Emergency Medicine rotations!!

Since I will be matching into EM, the beginning of my 4th year is filled with three, 1 month EM rotations: my home institution, a Kaiser hospital and a county program. Because EM deserves its very own blog post I will leave you here. All I will say is Emergency Medicine is awesome and any feeling of lassitude immediately dissipated the second I saw that neon Emergency Room sign. It is perfect for me.

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Photo I took during my away EM rotation. Southern California.

 

 

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Surgery

A few months back I had this dream. Nothing but water all around– I was walking on a rickety boardwalk, wearing my light blue surgery scrubs. I could taste the sea. The ocean spray on my face. My body was haggard. It was with my last ounce of strength that I moved my legs. I lifted my hands, they floated there for a moment, the breeze kissing my fingertips. I felt free. 

I imagined finishing 8 weeks of surgery would feel just like that–a release perfectly timed with my last bit of strength. So many mornings waking up at 5 am I cursed the path I had chosen. Cranky that I could not crawl back into my warm bed (it would sit empty for another 18 hours) instead I was off to the hospital. When you are in the thick of it–that release is all you can think of. Now that I made it–mostly what I feel is nostalgia.  It is funny how quickly you forget the tired mornings and late nights. All I remember now are the exhilarating highs.

Surgery was the most fun I’ve had in medical school.

I will not be a surgeon. I am going into Emergency Medicine and knowing that this rotation will likely be the only time that I’ll be spending in the OR, made it that much more exciting. I transformed from a clueless 3rd year med student, hands shaky, stupidly holding my needle driver like scissors…to a confident, somewhat less-clueless surgical student. By the end of two months I was able to read ventilator settings, remove chest tubes, tie knots, close a surgical wound nice enough to have the ultimate of critics–the scrub nurse–utter the words “beautiful.” I could prepare for rounds in 30 minutes flat, knowing every lab, urine output, nutritional status, vital sign and Flowtrack indicator for my patients. This training came at an incredible price. I stayed late. Studied even later. And walked around for 8 weeks sore as hell.

I will never forget the cases I came across. Terrible calamities. Now part of my training forever. A stabbing in the middle of the night. Gun shot wounds. Flesh eating bacteria. Total body burns. Fulminant sepsis. Amputations. Tumor in the heart. Every day I felt lucky to have the privilege of being in that OR.

Of all the specialties surgery will always have a special place in my heart. It was the only one that gave me pause. Ultimately, it is not right for me, but this rotation will be one I won’t soon forget.

 

 

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My Life as a Heart Surgeon

Ever wondered what it’s like to be a heart surgeon? Since my last blog post, I’ve gotten a chance to find out. I am doing my surgical rotation on the Cardiothoracic service. I haven’t settled on how I feel about it. Over the last two weeks I’ve gone from absolutely dreading it…to pure enjoyment.

My team is small. Just myself, my resident (R3) and our attending–the only cardiothoracic surgeon at our institution. Partly out of necessity since my  first morning I’ve been pushed into the role of “acting” sub-I/junior resident. At first having such high expectations thrust upon a meager 3rd year med student was terrifying. I felt as if I was failing at every step (and I was). My confidence crumbled as my inadequacies were brilliantly pointed out every morning. This was my first introduction to intensive care medicine. I knew nothing about management of drains, chest tubes, cardiac output monitors, ventilation settings, etc. I stared wide-eyed during am rounds as I had never even heard of most of the things my resident asked me to do. She pushed me at every opportunity. She knew exactly how uncomfortable she was making me. And she did it with just that purpose. Here was a person who was interested in seeing me grow. She was dedicated to my education.

So often as medical students we are given an easy pass…don’t know something, well that’s ok, you are “just” a med student. Not on this team. Every time I didn’t know something, I looked it up, wrote it down in my handy mini moleskin notebook and burned it into my brain. The embarrassment alone was enough not to let me forget it. Nothing was ever overtly said, but not knowing the answer to something is unacceptable to me (I put a lot of pressure on myself to be the best I can). I feel so lucky to have my resident on our team. She pushed me out of my comfort zone–in the process, I face-planted. Only to get up feeling like I actually can be a resident next year. Every day, I am starting to feel more comfortable about the non-theoretical medicine stuff. Like what meds we actually use to replete mag, how much do you give? When is it time to take out a blake? What CVP are you comfortable with? What are extubation criteria? How to remove a chest tube without giving your patient a pneumothorax. Nitty gritty medicine, you don’t want to waste time intern year having to look-up. After a 6-7 hour open operation our patients are fragile; their kidneys do funny things, their hearts get funny rhythms and there are a million reasons why we manage them in the ICU. With each passing day I’ve grown less terrified about how it all works.

As in most surgical specialties the days can be long. Really, really long. My record was starting the day at 4:30 am and not getting home until midnight after two long open heart surgeries. At the end of that day my feet felt like I just climbed Kilimanjaro. (Hint: I ordered compression stockings for rush delivery that night). I am in awe of our CT surgeon who is a mythical creature. He works like a machine. Never needing to use the bathroom. Barely eating and always up for adding on an additional heart case no matter how late in the afternoon the consult is. Heart surgery requires such a person. I have convinced myself that for 4 weeks I can assume the role of a machine, but not a day longer than that.

The surgeries themselves are amazing. Who doesn’t want to spend the day staring at a human heart. Stopping it. Then bringing it back to life again. Heart surgery is surprisingly formulaic and now having done 7 or so surgeries I can start to anticipate the next move. I know where to suction, how close to cut the suture, when to retract, when it’s my turn to step in and help with opening the thoracic cavity or what closure suture to use. Now that I know what I am doing, I enjoy the OR very much.

I didn’t know what to expect starting this rotation. I have been pleasantly surprised at how much it has challenged me. My resident is an amazing mentor. She’s found the exact style of learning that will take me to the next level of my training. A combination of uncomfortable pressure with the generous reward and satisfaction of knowing something I failed at before. If I can make it through this, who knows what else I’ll be able to accomplish.

Sometimes you have have to fail at something to learn.

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1st Break

I’ve been on vacation for exactly 14 days now. It’s amazing how quickly I’ve made the transformation from over-worked, dark-under-eye-circle concealing, one-track mind, med student zombie to a life of carefree leisure. I’ve been wearing make-up, blow drying my hair, going to the movies, not setting an alarm clock, seeing friends, spending precious time with my family, updating my closet and decorating our house. All things I forgot I seriously enjoyed. One could get used to this. For those of you not in medicine, the list above, taken for granted by most people reading this blog, are actually a rare luxury during medical training. Luckily, I have 4 more weeks before I start my next rotation. Sometimes working hard until an overdue, extra-long break is worth the sacrifice.

To catch my readers up on my life: Since I last wrote, I finished my pediatrics rotation. Tiny people patients are awesome. They are guaranteed to make you smile no matter what type of day you are having. I definitely enjoyed inpatient pediatrics more than clinic, but that is because I prefer acute medicine. Case in point, the time I enjoyed clinic the most was when we had to send one of our patients to the ED because they were too sick to be in our office. Identifying critical situations is kind of my thing…the thing I hope to do as a specialty.

I’ve completed 5 out of 8 rotations, with just a few more months of third year left. When I look back I can’t help but feel happy that I can put all that hard work behind me. It’s kind of like getting to mile 19 of a marathon, you’d be feeling pretty good you are there, but if someone told you there was a mistake and you need to re-run that distance–well you’d probably feel devastated to do it again.

After all that running, it feels great to hit pause. I need this time to soak in what I’ve learned and let my brain compartmentalize. To enjoy medicine. Funny enough, I still want to read, to do practice questions, even more than when I had to do them for the shelf exams. What can I say? Medicine is a deep-seated passion, even while on vacation.

Because I am not the type of person who can just leisure for too long, January is filled with exciting projects, including a research elective, supporting a dear friend’s campaign to provide girls education in the developing world, photography and spending a few days here and there in the emergency department. Not a bad way to start off the year!

I also turn 30 this month. So there is that. I’ll be celebrating with my best girlfriends of almost 20 years, doing a mini-road trip in Northern California.

Stay tuned. This month should be a good one.

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Ob/Gyn Life

To my neglected blog and readers, let’s catch up!

I successfully finished my psychiatry rotation with a clear understanding that psychiatry is not for me. It was the first rotation I’ve been on, where I wasn’t excited to go to the hospital. Work actually felt like work. The hours were wonderfully short in comparison to hospital life yet the days dragged on. I can’t put my finger on exactly what it was that didn’t appeal to me–in theory, psychiatry is fascinating– but it just didn’t grab me. Feeling ambivalent about your day is the surest way to cross a specialty off your consideration list. Done and done forever.

In comparison, this past week has been invigorating. I started my obstetrics and gynecology rotation and I am loving life. Driving in when it’s still dark out, seeing the sun rise above the hospital and knowing that I’ll be scrubbing in on gyn surgery, while the rest of the world is just waking up makes me feel alive. I love when things are happening–the busier the better. I like the fact my patient progress note is due by 6:20 am because we have a full day of surgery ahead and who has time for rounding. I love how hands-on everything is. It’s true, my back is killing me from standing and I arrive home too exhausted to cook dinner. Somedays, the thought of going upstairs is too much to bear and I end up falling asleep on the couch. The physicality of it is tough. It’s also tough to imagine going through life being this tired. But despite how draining the day is, I feel so incredibly fulfilled by what I am doing. I think that in a nut-shell is the dichotomy of medicine.

This past week, I’ve had time for exactly one thing–surgery. Unfortunately, that means my singular interest consumes my life. For two weeks, my marriage can easily handle that but much longer and I can see why doctors have such high divorce rates. I have a great husband who’s picked up dinner, vacuumed the house and even woke me up with Starbucks this week. But eventually, he’ll want a wife again. But this is the point of 3rd year of medical school– you get to put yourself in the life of various specialties and try on that life. Spend a few weeks walking in their proverbial shoes and see if you can handle it. We’re all looking for that perfect pair that fits just right. So far, I’ve felt most comfortable in my Emergency Room sneakers 🙂

In any case, I digress, I have 5 more weeks of ob/gyn which will include two weeks of clinic and two weeks of nights/days on Labor and Delivery service. What makes the rotation manageable are 4/6 weekends off and a dedicated lecture/study day on Fridays. This is the first rotation where I’ll be graded not only on my medical knowledge and interaction with patients but my (limited) technical surgical skills. Perfecting various suturing and knot tying techniques is certainly a new challenge for me–but it’s also really fun!

That’s it for now. I am quite literally too tired to write more. Until next time!

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Psych Rotation, how my own well-being improved and why that speaks to the medical profession

Third year of med school can be a grind: Long, relentless hours. No time to study, let alone take care of yourself. Rotations that just keep coming with nothing but a “golden”, rotation-free weekend in between. That is, until you get to your psychiatry rotation. Some have even called it psych-cation. So is the psychiatry rotation the vacation of 3rd year?

The answer is…not quite, but close. In comparison to inpatient medicine and my neurology clerkships, psych has been a welcome change of pace. My hours are 8 am to 5 pm, with a workload that can include maybe 2 or 3 new patients a day. I am currently on psych consult service, meaning I get called when a psychiatric patient comes through the ED doors or a hospitalized patient requires a psychiatric evaluation. As you can imagine, patient loads can ebb and flow. For unknown reasons, psych patients rarely show up at 7am to the Emergency Department, but combine a full-moon, a pleasant Friday night and our service can get pretty busy.

Being able to sleep 8 hours at night and come home around 5pm with enough energy to go on a nice jog has done wonders for my mood and my marriage. Because we have lulls throughout the day I can get my studying in while I am on service and that leaves my evenings free to do something I haven’t done since 3rd year began…relax. My husband is shocked to suddenly have me hanging around the house with free time. I’ve been so busy previously, his go-to answer anytime our friends call was “Maja is at the hospital.” Now, here I am asking if he’s up for a movie or binge watching TV shows–on a Tuesday night!

On a personal level, having this extra time to re-connect, even if for just a few hours a night is super important. I find us laughing more, talking about meaningful things (you know, going beyond the logistics of who is making dinner) and waking up smiling. So without trying, my psych rotation is improving my marriage and mental and physical health.

The hours of 3rd year had began taking their toll on my health by making me too tired to work-out. It turns out walking around the hospital and eating free cookies do not make a healthy routine. And de-conditioning is pretty much the worst thing you can do for POTS. Sorry folks, nothing can replace the heart benefits of a good cardio work-out. Luckily, I am back at it, logging some miles with my running shoes.

It wasn’t until I had time to slow down that I looked back to notice the unsustainable pace I was moving at. Of course when you have the time it’s easy to say here’s all the things I need to be doing to stay healthy– it’s when you are in the thick of it, sleeping 5 hours, feeling overworked and burnt out that your focus turns simply to surviving–who has time for the other stuff? So therein lies the dilemma.

My hope is that all the healthy choices I’ve been making in the last 2 weeks will continue as I move into my Ob/gyn rotation…at least those are my intentions. This slow down in my schedule has got me thinking a lot about how exhausting the other weeks felt at times. As a medical student we are lucky in the sense that those hours are fleeting and we can move on to more humane rotations (enter Psych). But as a resident those hours– the daily grind– it becomes your life.

For decades medicine has asked of us to become super-humans. The humans who need only a few hours of sleep, who can see the worst in people, who can face death and tragedy, who look in the face of hopeless situations and “fix them”, who can continue to log work hours when others are at home with their family….all with a smile and understanding heart. Thankfully my generation is seeing the ridiculousness of the above, no one can be that superhuman indefinitely–not without a cost. I won’t go into the depressing statistics of physician depression and suicide, or the abysmally low satisfaction rates. All I know is that a culture shift is way over due.

I don’t have the answer but I do hope that we can incorporate more balance into our profession. After all, physicians who are healthy and happy are more empathetic, productive and innovative, and more likely to stay in the field (just look at this wonderful research Stanford is doing). Somehow we must find a way to sustain the enthusiasm and dedication seen in medical students throughout our careers. The future of our field depends on it.

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Kids as Patients vs Brain Surgery

I’m wrapping up my Neurology rotation with 2 weeks at a children’s hospital–aside from having (mainly) adorable patients here is a list of things that have made this service particularly awesome. If you go to my school this list of “perks” may help you decide when picking between peds neuro, neuro surgery or ICU care.

  1. The hospital is colorful. Like seriously, there is a theme to every floor. You can’t help but smile when even the architecture of the building has color in mind. It is also a brand new hospital so everything is very modern.
  2. Parking is free. FREE!
  3. Parking is close! (when you savor every minute of sleep you can get, saving yourself 5 minutes of walk time is worth its weight in gold).
  4. Breakfast is free! The food is amazing with fresh fruit, pastries, yogurt parfaits, bagels, coffee. When you are a poor med student you can be easily swayed by the little things in life like starting your day with a full-healthyish- stomach.
  5. Lunch is free! I can’t rave as much about the lunch, but I will say it is 100% better than any of the other free lunches at other hospitals. It is always catered, so if you are not a vegetarian like me, you’ll probably love it.
  6. The electronic medical record is easily one of the best choices around. Super easy to look up stuff.
  7. The residents are super nice.
  8. The attendings are super nice.
  9. The patients are hilarious. Case in point, I was trying to examine my first little patient of the day and he looks at me and says “excuse me, you are interrupting my cartoons.” Absolutely the cutest.
  10. You have NICU patients. The tiniest, sweetest, humans around.
  11. The hours are very tolerable. Typically I start my day around 7:20 am so I have time to see my old patients and read briefly about any new ones I will be picking up. You have morning report (free breakfast!) at 8 am, which includes an hour discussion about one particularly interesting case and the teaching points involved. Followed by time to see and examine your new patient before rounds start around 9:45am. Rounds typically wrap up by noon lecture (free lunch!) followed by time to write your notes, check in on your patients before you head over to the main medical center for afternoon lecture at 4pm. You are free to go home after that, which is usually either 5pm or 6pm.
  12. Being able to put parents at ease is very gratifying. It feels tremendous when you can send a child home and they are all better.
  13. This hospital sees some of the rarest childhood illnesses you’ll come across. In one week I’ve already seen two cases of Guillane-Barre (overall incidence of 1 to 2 per 100,000 per year). You are guaranteed to learn a tremendous amount. The cases are all very interesting.

Now to the alternative….instead of peds neuro you have the choice of picking either neuro surgery or neuro ICU care. I was able to get a glimpse of the high of neurosurgery while on-call one night. This was the first time I’ve ever scrubbed for a case and it will easily be a memory that stays with me for a lifetime. The excitement of being in an OR is hard to describe. Furthermore, being in the OR when emergency neurosurgery is involved is like putting that excitement on steroids. Few things in life are as surreal as looking down on a human brain. The whole time I was standing in that OR I just kept thinking to myself how lucky I am that I am in this profession and have the absolute privilege of being in this room right now. The whole world disappears when you have surgical tools in your hands and get to watch someone literally fixing the human body. Of course, as thrilling as that experience is, picking neuro surgery as your elective comes with a price. You will have exhausting hours (think 5am start times), high stress, high pressure–yet all that comes with the prize of being in the OR. So choose carefully.

My favorite part of my neurology experience has been the camaraderie with my team. Everyone has been so eager to teach and learn. I’ve enjoyed all my co-workers. Actually, maybe I just miss having co-workers. Being in school full time was certainly an adjustment. Now I get to have a little bit of that feeling back of what it’s like to be around people you work with! Although I don’t get a paycheck, and the teams change all the time, it is nice to feel like I am working again.

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