I hate the match....

Welp here I am. In the middle of Illinois on an amtrak train from Chicago to Springfield on a Wednesday afternoon. Its beautiful outside so its a pretty ride. A nice time to reflect on what the last month has been. I cant help but keep thinking how difficult this whole process is and how much stress I am under. I try to suppress it, try to relax, try to enjoy all the traveling but its the uncertainty of everything that keeps making me want to curl up in bed and sleep for days.

Physically I am out of shape and am constantly getting sick, which makes sense with all the stress and working in the ED seeing kids and adults come in one after another with fevers, pharyngitis, pneumonias, you name it. I am also working in a new city with new bugs/ viruses that my body has never been able to adapt to so im not suprised by my lack of fighting capability. Also, I have stopped working out all together and I feel so gross.

 But emotionally, I am also out of shape. I just want to know where I am going. Its hard to live each day thinking /worrying about the future rather than living day-to-day. I am in Chicago, one of my favorite cities, and this whole month is kinda tainted with interviews and stress. I really really want to live here and go to residency in this incredible city but its just not that simple. Too many other factors are contributing. And i keep thinking, as much as I would love to go to Arrowhead and get incredible training there, what are the chances that I will meet a guy in the inland empire. Versus coming to Chicago and meeting a cute, smart, nice midwestern guy....which they have plenty of. This decision isnt just about where I will be trained best. It is about where my life will be best.

My 3 interviews in Michigan went well, but as much as I want to be excited about them, i'm not. A couple of the programs were great, the people were friendly and the hosptals nice. but when it came down to it, i know how unhappy I would be living in the middle of Michigan, far removed from a nice big city and loved ones. and really, im just not feelin Michigan.

Then, I had another interview in Michigan at a hospital in St. Joseph. It is right on Lake Michigan, 1.5 hours drive from Chicago. It was beautiful. Now this, this is a place I could get used it. The people were great and so was the location. So now I have another DO program I am considering. Its close to Chicago, so I could still come to visit and see familiar faces and its right on the lake so I can enjoy the time I have off. Its got me a little worried though, would I rather go here over Arrowhead? The little things are coming into play now too. The factors of free food, 8 hour shifts vs 12 hour shifts, cost of living, etc. I wish my mind wouldnt consider these factors but it has...and it constantly is. No day is ended until I ponder my choices whether it be on a train, car ride home or while falling asleep. Its exhausting. Im exhausted.

"In the words of M&M conferences, you only get one shot"
-a wise attending in the ER discussing how we need to widen our diagnostic tests

Resurrection Interview

This was it, the moment of truth. Interviewing at the program that I decided in November of 3rd year that I wanted to go to....

Lakeland Regional, Michigan

I worked Tuesday from 7am to 3pm and then walked to the car rental place, got my car and drove the 2.5 hours to St. Joseph, Michigan for my Lakeland interview. I missed the residents dinner that was planned for 6:30pm. I wish I would have gotten here sooner because when I got to the hotel that THEY paid for, I was in for a huge surprise  I walked into the room to find a 2 bedroom suite with a Jacuzzi tub. Jackpot! I took a nice warm bath, at my late dinner and unfortunately had to go to bed pretty soon after I got there because we had to be at the hospital early. It was a long day and I had another long interview day ahead.

The interview day was really impressive. I have heard great things about this hospital on the interview trail and those people were not exaggerating. Its a brand new facility, right on Lake Michigan in a beautiful area. The hospital itself is nicer than most hotels I have been staying at. Waterfalls in the front lobby, gorgeous patient rooms, elevator music playing throughout the hospital. Honestly, I wouldnt mind spending 4 years in this place. I had 2 interviews and both went really well. When I sat down with the PD the first thing he asked my was, "So, how was Arrowhead and how is Dr. M.” Apparently they are good friends. We had a good chat and he, along with so many interviewers, mentioned my glowing letter of rec from Arrowhead. He ended the interview on a great note of “any program, including ours of course, would be very lucky to have you. You are an incredible candidate with tons of experience and glowing letters of rec.” That was a nice little ego boost, I'll take them when I can get them!

Its funny how interviews can make you feel completely inadequate or just the opposite, like a rockstar. I felt great after that interview and decided that this was a place I will definitely be ranking.

After the interview I got into my rental and drove back to Chicago. I had to get back by dinnertime because I had my pre-interview resident dinner for my Ressurection interview the next day! I won't lie, I was thrilled to get back to Chicago to interview for my dream program. But, Lakeland was a very impressive place that made a resting impression on me. Before I left, I spoke with the coordinator about setting up a shadow day while I was still close by in Chicago.

Loving this program

Chicago is incredible. Its the perfect city. A great mix of nightlife, good fun people and midwestern feel. Living here for residency would be a dream come true. And the program I am working at would be a wonderful place to train. Such a diverse mix of patients, pathology and trauma mixed it. I am getting good feedback from residents and faculty and have a really good feeling about the program. One of my favorite attendings has a mix between cocky, abrasive, and teddy bear ish-ness. His bark is much worse than his bite. After a few shifts with me he said, “I like you. your smart. I would be OK with you coming here for residency.” Coming from him, this is a huuuuge compliment.

Dr. V is our student coordinator and hes awesome. So great to work with. Incredibly smart, nice [and pretty darn good looking too]. Every attending and resident I have worked with has been a pleasure to be around and learn from!

On the flip side, I just got my eval from the program I worked at in Brooklyn and they did not think I did as stellar. Its a weird feeling because I also had great feedback from attendings and residents but obviously something went wrong. To be honest, its not somewhere i would want to go but im still bummed. Actually i am a little angry also considering i worked so hard and spent a lot of time and energy to get a good eval and it turned out to be mediocre [at best]. Morale of this story is you win some, and most definitely lose some!

First ED Intubation

I did it! The first of what will eventually be a daily normal event in my career. I intubated a patient in the emergency department. I did it with the attending behing me and many people watching, waiting for me. Not to mention the patient that was de-sating on the gourney... Here's a detailed account of an event I will NEVER forget:

He came in by EMS gasping for air. As we hooked him up to the monitors and got IVs started on him all he could say was “im dying, please don’t let me die.” He looked like crap. He was using every accessory muscle he had to breath and even still satting in the 80s. Dr. R told me to sign up for him, he was going to be my patient. We discussed what was going on with him and what we were going to do with him. First we will try bipap lots of nitro, lots of lasix and then if he still is not improving we will probably have to intubate him. After giving him 30 minutes on bipap and lots of medications later, he was still not improving. I was sitting in the front charting on a computer when Dr. R walked up to me:

“Dorothy, we’re gonna need to intubate your patient.”
“Ok. Yeah I agree, he still looks like crap. So, what kinda blade do you like to use?”
“Doesnt matter to me. Your the one thats gonna be doing it.”
[huge smile on my face]
“Have you done this before?”
“Ive done an anesthesia rotation and intubated in the OR but not in the ED. This was be my first”
“OK well lets go. Theres a first time for everything and this might as well be it. ”

We walked into the patient's room and there were a couple nurses, the respiratory therapist, Dr. R, me, and of course the worsening patient. I tried to remain calm and not let my heart rate sky rocket but it was inevitable, i was pretty nervous. I got my equipment together, checked the light on my blade, got a 7.0 ET tube and put in my stillette. Got my ambu bag ready and we discussed what meds we were going to use. The whole time Dr. R was being his normal, semi-abbrassive self [which i was pretty use to at that point, i knew it was all a big act]. He was trying to make it a lil more stressful just to see how I dealt with the situation i think. We were about to push the meds and everyone went quiet and I had at least 7 pairs of eyes on me by this point.

Dr. R leaned over to me and not too softly said, “Im only gonna say two things to you: if you dont see the chords, dont try to pass the tube. and dont fuck this up.” [he then smiled and that was his way of letting me know he was there to help if i needed it]

“Yes Sir”

We pushed the Etomidate, then the Succ, we waited for him to de-fasiculate and then it was showtime. I saw his chest stop rising and no more condensation on the ambu bag. I took it off and confidently put in the Mac 4, lifted up towards the corner of the room and then looked for the chords. It took about 15 seconds [which felt like eternity] and I heard Dr. R say "what do you see?"

"epiglottis” I pulled back a little bit and then said “tube please.”

“you sure you see them?”

[in a much more confident and authoritative voice] I said “Yes, I see the chords, tube please”

I didnt take my eyes off the chords and someone placed the ET tube in my hand. I slid it in and watched it go between the chords. I gently took the mac blade out, hooked up the CO2 monitor, someone inflated the cuff and we watched for color change.

“good color change” -resp therapist announced

Dr. R took the blade and looked to make sure the tube was placed in the right spot.

“yup she got it. good job”

Thats all he said but i knew he was proud of me. I did it. I intubated my first patient in the ED, on my first attempt ever. Damn i felt like a rockstar.

and so my career as an ED doc has begun...

Chicago!

Done with Michigan...for the time being. Now I am in Chicago starting a new rotation tomorrow at a program that I have been wanting to to go since last October. Its a perfect mix of community medicine in Chicago with a great mix of rotations through the city. I am really excited and ready to work my ass off. If I could get into this program, I would be thrilled.

Its gonna be a rough month because I have a bunch of interviews scattered through the month. Actually I only have 2 days the entire time I am here to enjoy the city because every other day I have off I am traveling/ doing interviews. I am already exhausted and so sick of this process but it is still just the beginning. All my ACGME interviews are starting and this is where it really starts to count.

Here goes...

Interviews 3,4,5 coming up!

This week is gonna be rough. Flying to Detroit tomorrow, interview at Botsford on Wednesday, interview at Henry Ford Macomb on Thursday, interview at Genesys on Friday. Then flight to Chicago on Friday. Then starting my new EM rotation on Monday.

Im tired just thinking about it...

Airways; A little less foreign

Last day of anesthesia. It took 7 weeks and I finally feel more confident about the airway. Granted, I still have a lot to learn and I am not going to get difficult airways, but I know how to ventilate and intubate properly. I intubated someone this morning and did everything myself, from pre-oxygenation, bagging, to tubing. It was incredible to see how far I have come. Its an adrenaline pumping couple minutes and one day, I will be doing it alone as an attending in a much more emergent setting.

My entire career will be spent improving on these skills. I am very fortunate to have gotten a wonderful teacher who taught me a solid foundation on saving someone's life.

Interview Season

"Interview season: zero money, hurts to be social, gaining weight from dinners, suit starting to smell funny, developing a DVT from traveling.... All for a job that pays less than minimum wage for 4 years." -Jessie

Great Week!

This week I saw my first open heart surgery

I saw egg retrieval from a woman's ovaries and then under a microscope, I saw those eggs get fertilized [in vitro fertilization]. I saw a fetus be created!!

I did several propofol sedations by myself [or at least, with Dr. G by my side "taking orders" from me]. I became much more comfortable with conscious sedation and think I will be able to do this very confidently in the future [thanks to him.]

I am so glad I came back for another 3 weeks, it really helped give me more confidence and experience in techniques I will be using in the ED [except for the open heart surgery and IVF. those are just for fun :)

Oops

Just when i thought i was getting a hang of the airway, i go and mess it up. We had a case today and I tried using a miller blade to intubate. For some reason I just couldnt find the airway. I stood there with the blade in the patient's mouth and took a deep breathe. "I cannot see the airway" I said, looking for some kind of help from Dr. G "ok, so what are you going to do?" In my head all i could think was "damnit, hes not gonna help me at all" I took the blade out, hyperventilated again, then took another attempt. After about 20 sec I saw that I was doing some trauma to her pharynx [blood, def some blood] and dr. G took over. He of course got it. I was pretty embarrassed at how bad it was and how much trauma i caused.

Dr. G told me to stop worrying, this is the name of learning. i didnt do anything major, she would just be a lil more sore than she should have been after surgery. no major damage though. but i still felt bad. it was a huge learning experience and i have to say, i will learn my lesson on how deep i place the blades.

Second Interview- Arrowhead Regional Medical Center

Man, I hope this is it. Because I am sold on this place. Having worked here throughout my 3rd year then formally doing an EM rotation here in July, i see just how great it is. I took me some time to see other places and compare it, but really nothing else is a better fit for me.

Last night we had a dinner with residents. It was nice to see familiar faces and eat some free dinner and pazooki's. When I walked in there was a guy at the end of the table and he looked very familiar. When I had the opportunity, I asked him if he went to SDSU and he said yes. He loooked familiar because we went to undergrad together and also went through Barb's office. Later in the dinner, he came up to chat with me and [very nervously] asked "so what year are you?" i gave him a confused look and said "4th year, just like you." "your a 4th year in the program?" "No, I am a med student interviewing just like you." Apparently he thought I was a resident. I laughed and he said "well you just have that resident look i guess." i took that as a compliment and as a sign of good luck.

another conversation I had during the dinner was with an intern who gave us a piece of advice "give them something to remember you by, give them the "wow factor" that makes you stand apart." I was nervously trying to decide what mine was, and then i just got frustrated and gave up.

The actual interview day started at 6am..it was a very early start. I interviewed with their chief resident first and it was very informal. He said "this is very much a formality since your rotation with us was your interview." So we just chatted. I couldnt help but be nervous and I think I did an awkward job of chit-chatting [plus it was 6 in the morning, its hard to be excited at 6am].

My next 2 interviews were with faculty and the other chief resident, all had the same feel. Kinda rushed and very informal. again, they all knew me so it was just a quick conversation. We took a break from interviewing and joined the residents and med students in their didactic session and then at 11am we started the interviews again. I had one more interview with 2 residents I worked with and then to save the best for last, my final interview was with the program director.

The whole day made me keep thinking about how much i want to go there but how i shouldnt get my hopes up because i really have no idea where i stand. I know they liked me but im not sure if that means they liked me enough to have me as a resident or if i was just an enjoyable student. I wrote thank you emails after the interview and these were the replies i got:

"Thank you for your email. Strong work during your rotation and interview. Although we didn't have the opportunity to work together often, a lot of people had nothing but great things to say about you, and you certainly worked well with everyone. Best of luck during the rest of your interview season."
-one of the chief residents

"Thank you for your kind remarks. you are an exceptional doctor. I wish you the best and remember to follow the dream but patiently."
-one of the faculty members

I have no idea what this all means but i guess ill just keep my fingers crossed and my head leveled, i hate being disappointed so being realistic about this whole situation is the best way to be.

Anesthesia....again

Well shoot, I had such a good time in August, why not come back for another couple weeks! I already got Monday off because Dr.G didnt work and then got Wednesday off for an interview. So a 3 day work week doesnt sound to bad, especially when I am catching up on life and recovering from the last couple months!

Another Audition Month Down

I can sum up this month in some key phrases: sleep deprivation, long hours, lots of beers, lots of Jewish people, chronic fatigue, spending a lot of time on the subway, and NYC Manhattan living with great music and delicious food

There are some things I wont forget about Maimonides. Mostly, the diversity of the patient population was incredible. One minute I would be using a Russian translator, the next I would be using Cantonese. I saw pediatric patients since they had their own ED and I saw lots of very old and sick patients. I also tended to a lot of middle-aged, high strung, high maintenance patients with no real problems and left walking away thinking “why the hell are they here?” before I would go to present to my attending/resident. Either way, I learned a lot. Most importantly, I learned and began to understand why people say emergency medicine physicians “burn out.” There are people that use the emergency room for just that, emergencies. But there are also those that abuse it for so many other reasons and its frustrating and down right difficult to distinguish between the two. With America being the way it is, medical-legal issues come second to mind [first being, is this patient dying right now or not]. Because if they are trying to die on you, the answer if easy, make sure they live. and that is what we are trained for. But, if they are not dying, it is our job to make sure they are not silently and secretly trying to die on us. And to distinguish them from someome who is a hypochondriac, someone who wants a note off work to take a vacation, or someone who has psychiatric issues, is why this job will take a toll on people. I havent even graduated med school yet and I can see the “jadedness” shinning through my sometimes fake smile. “OK sir, let me just make sure I have the story right, Your 32 and you’ve had nasal congestion and vomiting for 1 day...Im so sorry to hear that, we are gonna do our best to make you feel better” [these words are forced through a fake smile and a simultaneous suppression of the words “why didnt you go to your primary care doc??”].
Granted, most people in the US do not have primary doctors so yes, i am going to be one for them. But at Maimo, most [not all] of these people had established PCPs whom they see often.... Thats when it gets frustrating.
I also learned that people will always surprise you. You may think and believe one thing but the truth is usually very different.

This job is exactly what i wanted in life, a challenge. At least i will always have interesting days!

Some Patients to Never Forget

the pregnant young teenager texting on her iPhone during a trans-vaginal ultrasound to confirm the pregnancy, then actually picking up her phone and talking to someone when it rang...and the trans-vaginal ultrasound probe is still inside her

the 89yo Russian man with a huge picture of Lennon tattooed over his chest, over his heart actually

the 19 year old Male with chest pain that I helped diagnose with pericarditis and then ended up having Troponins of 35 [myocarditis!]

the young lady who was having a miscarriage and brought in the contents in her maxi-pad. then showing us and actually seeing the fetus [with eyes!]. A white/clear piece of tissue about the size of my thumb nail and clearly resembling an alien. I held a fetus in my hand that day. incredible.

a young teenage girl being wheeled into the resuscitation room in the pediatric emergency room for an overdose after having found out she was pregnant. she posted a goodbye note to her friends on facebook, so they went over to her home and found her passed out in the bathroom. [she ended up being just fine, physically at least. this was her 2nd suicide attempt]

Working Hard

Through the rotation, I had 3 residents on 3 separate occasions tell me they were going to write an email to the clerkship director about how great I was doing. Actually, one of the residents stopped me one day to tell me she wrote a 3 paragraph email to him about me. She told me "I only write emails to him about people I think will add to the program and I think your gonna be a great doctor."

Talk about good impressions!!

Polish Speaking Patients!

This week I translated 2 times! and when i say translated, i mean did my best to string together sentences with the limited amount of nouns and verbs i know. It was awesome.  Now people know I can speak it and its spread around to some of the staff so they have informed me that if they need me they are gonna come grab me and I have no choice [obviously i dont mind]. 

One of the patients had their daughter with them that was probably my age. She was more Polish then me though, having an accent when she spoke English but not so much to make her seem fresh off the boat. I introduced myself to her mom in Polish when i realized thats all she understood and then I began to ask her questions. her daughter, realizing i suck, started to interpret for me so i gave up and spoke english. Later, i smiled and apologized for my bad Polish and the daughter smiled saying “oh honey its ok, its so cute you tried.” 

mean

I done good

One day on a peds shift, I was working with a new doc, Dr. B. It was the Sunday after my crazy interview/board exam week and had worked a 12 hour peds shift on Saturday [the day before] so needless to say, i was pretty tired! I was pretty run down and sick and it was pretty hard to pretend to be happy, spunky, and hard working while feeling like crap.  But, i still hit the ground running when i got to my shift and apparently it showed.

In the afternoon, Dr. B walked up to me, looked at my ID and said "Your a medical student?"
 "Umm, yes? What did you think I was?"
"Well you are performing at an intern level. Your presentations are wonderful and your just doing a great job and I had to stop and tell you that. I hope you will give me an evaluation to fill out about you. "(conversation continues about where I'm from, what I'm going into and him sellin the program to me!)

Then at the end of my shift another doctor took the time to stop me, thank me, and write down my name so she could remember me for my evaluation.

it was a great pick-me-up!

Last Exam of Medical School!

After driving to Long Island on Wednesday for my interview, I jumped into another rental car on Thursday night and headed down to Conshohocken Pennsylvania with Anna. I had to take my board exam, the physical exam portion. This is what my school has been training me for. In the last 3 years we have had dozens of patient/actor encounters on campus where they time us and give us specific tasks we need to do and a specific clinic note we have to write. Going into the exam on Friday, I felt very confident and prepared because my school had trained us well....and i dont say that very often!

On Friday, I got to the testing center at 7:30am and was there until 3pm. I had 12 patient encounters. Each was 14 minutes then we had 9 minutes to write up a clinic note. Right when that 9 minutes was up, we walked to the next room and started the next encounter right away. We had 4 "patients" at a time, then took a lunch break, had another 4, took a 15min break, then finished up with 4 more. It was exhausting and my hand was hurting by the end of the afternoon.

 It wasnt considerably hard, just time consuming and EXPENSIVE. The test itself costs $1200. Yuuuuup, they sure do know how to make money off of med students.

Ill find out if i passed in about 6 weeks. It has a 97% first time pass rate so i'm not too nervous [hopefully that doesnt jinx me!]

First Interview- Good Samaritan Medical Center

First interview down. Thank god I got beta blockers beforehand or else I would have had trouble keeping my voice from shaking!

The interview indirectly/ informally started on Tuesday night over appetizers and beers with 2 current residents and 3 other interviewees. It was a nice way to ask questions and relax. One of the residents was Wojtek, obviously polish. Another interviewee was Marcin, a polish guy from Detroit. He knew my old college roomate. Very small world!

The next day started at 10am with an orientation of the hospital and then a tour. There were 7 of us there. Right off the bat, I got a great vibe from the place. Everyone was friendly and i could feel the family vibe. After seeing the ED, we went to the medical education offices and sat in a large room eating our lunches. Around 1pm we were left alone in the large room and were called out 1 by 1. It was very nerve wrecking. I was fine until that point, that was when I took the beta blocker to kill the adrenaline. Boy did it work.

My first interview was with the chief residents, very informal just trying to get to know me. At one point, the resident quoted a wonderul line from a letter of rec that was in my file. She said I'd like to hear what you have to say about this line "it is refreshing to meet someone who is so well liked by everyone she worked with while working so diligently" or something along those lines... I got really emotional hearing that and had to pause to catch my breathe, I almost cried. Seriously, I said it out loud that I just had a wave of emotions and I really nearly cried from hearing such a nice comment. Finally hearing some feedback about how I was doing and reassuring me that I was noticed workin my butt off was very emotionally overwhelming. We dont get a lot of direct feedback so when it does come, its very much appreciated.

The next two interviews were much more stressful! First was 3 faculty members who pretended to be almost bored. Im sure it was an interview tactic because one was the guy who gave the orientation and tour and he was acting very differently. I tried my best to keep them all engaged. My interview strategy is to make people smile and laugh, and I know I did that quite a bit during the interview. So hopefully they remember me!


The next interview [the last of 3] had 3 faculty members interviewing me, including the program director. I felt relaxed during it and answered questions openly and honestly. One question I got was "What is one case or scenerio where you would feel very uncomfortable. As in, you walk in the room and want to run right away asking for help?"
 "Scabies," i answered "or any other bed bug type presentation. I can deal with blood shooting everyone but bugs I cant see make me cringe." This made them all bust up laughing and the doctor that asked the question said "great answer, havent heard that one before!"

In all 3 interviews I was myself. I was able to express myself calmly and smiled through all of it. I made them laugh several times and am positive they were able to get a good sense of my personality.

I drove to the interview which gave me a good chance to see the area. There are great homes and long island has a lot of money. Great to live there I'm sure...but not on a residents budget.
I left the day thinking I could see myself living and working there. The hospital was small but big enough to get a great education. We'll see how it compares to the other places I will visit!

STRESSSSS

Board scores are in, PE next week, first interview next week, trying to keep my shit together and act happy/energetic during all my shifts.

im exhausted just thinking about all of it!

First week in Brooklyn

Well, I am def not in Michigan anymore!! I went from suburban white population to the most diverse patient population ever! Its a crazy ED with TONS of people.
We had orientation on Monday morning and being emergency medicine, we had the rest of the day off. We then met Tuesday morning for lectures and then simulation lab.

Sim lab is great. Its a life-like [or as best as it can get] mannequin laying in a clinic bed with monitors, screens, everything. just like the ED. the room is small with a window in the back just like in interrogation rooms in the police department...the ones where they can see you but you cant see them. So the attendings running the sim lab stand back there and talk for the patient through the speakers in the room. and the mannequin blinks, has a pulse, breath sounds, all of that.  Its a great learning environment but very intimidating. its nice that we do it in a group, not by ourselves!

Then Wed I had my first shift and of course my first patient is a typical Brooklyn guy in his 30s. Ya know, the tough guy with lots of tattoos and a thick accent. Well, he was there for chest pain but it wasnt hurting enough to stop him from hitting on me. After i did a quick history and physical exam, I brought my attending over to see him. Immediately he says "hey doc, you gotta tell your med student to stop asking for my phone number. im married." the attending and I laughed it off. After we spoke with the patient and were walking away she pokes me in the side and said "you know, its kinda frowned upon here to hit on your patients." Thank god she knew he was joking and played along! I had some more trouble from that guy later but he didnt stick around for too long considering there was really nothing wrong with him [at least life threatening!].

Interview Invite #?? I lost count...

I have been getting lots of good emails asking me to come interview at their program. I have lost count actually, its up to 6 or 7. Keep em coming!! Still waiting for the ACGME programs though!

Thats It!

As always, the last day of my rotation came and went and it was just as anti-climatic as always. There is always the idea that you will say bye to people and they will tell you how great you were and that they will miss you...but the reality is no one else knows its your last day and most are too busy to care. Some say bye and 'good job' but thats about it. Some give you a hug, high five, whatever. Either way, you walk out of the hospital with relief that another month came and went and you worked your butt off.

on to the next!

"Congrats, You helped save that mans life"

Today was my last shift and it was a nice end. Helped save a life!

A 60ish year old man came through the door in full cardiac arrest. He had been in his car driving when others saw him vere off the road. Someone on the scene immediately started CPR and the ambulance came quickly. In the ED we kept CPR going, gave him meds and shocked him twice. He came back to sinus rhythm! We did a quick EKG on him and determined he was having a massive heart attack. Cardiology was called and within minutes he was taken upstairs to the cardiac cath lab to un-plug the vessel.

I heard later in my shift that he survived.

A couple other patients I had during this shift was a woman with a WBC count of 41 and INR of 22! Thats pretty unheard of!

Oh, and we had a 20something year old male come in for chest pain...which started when he was pole dancing at his party the night before. That was a fun HPI to illicit!

Almost done

Just as I was getting used to Michigan life, its time to move on. I have 2 more shifts in the ED here and then Im off to New York City for a month. I will be staying with Anna in Manhattan and working in Brooklyn. Im very excited.

My month in Michigan has been great. The first few weeks were a rough transition into a brand new world and I was pretty sick for about a week...with everything I was not my usual bubbly self. That has come back and I am bonding well with the other students and residents. I was offered [indirectly they hinted at the fact that they interview all students that rotate through] an interview but unfortunately it wont be while I am here so Im gonna have to fly back out for that later this Fall.

Interview Invitation #5

After getting in contact with the PD from Henry Ford Macomb, I set up an appointment to meet with her and visit the program [the same I did with Botsford last week]. Through this meeting and having a wonderful afternoon together, I was offered an official interview. Woo hoo!

Chief Complaint: Mom Sts Pt Ate Rocks

All apps in!

ACGME Apps in! That means I applied to around 50 programs with a total cost of around $800!

Californians everywhere

One of the residents I am living with is from the LA area, one of the attendings I worked with is from San Dimas, and I found out today that the chief resident I am working with is from Arcadia and went to Arcadia High. There is not a shortage of Californians out here....

"i promise to not be a douchebag by the end of residency..."
-Hillary

First Rejection

First rejection comes from a program in Michigan. I'm not heartbroken, dont worry. Just the way this process goes... What made this a lot more hysterical was this story:


I was working when i got the email. I was actually working with another visiting medical student who I have become friends with, call her K. We were speaking about interviews and such and I told her about my first rejection. I told her I got an email from another nearby hospital. She replied with "i didnt know programs email rejections" so i gave it to her to read so she could see what it looked like.

later in the day K and I were chatting and she mentioned her mom who is an ER doc. in fact, her mom and both her brothers are doctors. I asked her where her mom works and she blushed and bit and told me that it was at the hospital i just got rejected from. then she said "yeah, shes actually the program director there. it was a lil akward to read that email."

her mom wrote me my first rejection. HAH!

Visiting other places

This morning I went to visit Botsford Hospital in Farmington Hills. Its about a 40 min drive southeast of where I am living. The EM program is well known and after emailing the PD I set up a day to meet her and hang out in the department for a couple hours. I met an alumni from our school who is a first year there and shadowed him for a bit, then I spent some time with their chief resident [a 6 foot 4 gorgeous guy...time well spent I'd say.] I left after about 4 hours because I had a 2pm-midnight shift at my hospital.

I hope my time there helps me get an interview at the program!

Interview Invitation #3 and #4

Lakeland Healthcare in St. Joseph, Michigan

Good Samaritan Hospital in West Slip, New York

Week 3

The more I work in Michigan, the more i like it and feel a bit more comfortable here. The people are amazing. i have never had a bad experience or rude patient/ co-worker. The last couple weeks I have been getting to know the attendings, residents and staff and I am much more familiar now with the computer charting and 'lay of the land.'

I was on nights over labor day weekend. Saturday-Monday I worked 10pm to 8am. Unfortunately, my birthday on Sunday was me up at midnight and then sleeping the day away and then back to work the night of. I wasnt too upset because the resident [Dr. S] and attending [Dr.L] I worked with for 3 nights straight were great. Both were very funny and easy to work with so there was no problem with helping the time pass. On my last night a man came in around 5am after a horse stepped on his heel. His heel was basically flapping off and after X rays and an ortho consult, we decided all he needed was a tetenus shot and we sutured it back together. It was a very complicated lac so my attending helped me do the hard parts to make sure he could still use his foot properly. We did 24 stitches in all and it looked pretty good after.

Picture: On the left is my first time suturing EVER on a pigs foot. on the Right is the heel. I think I have come a long way :)

Of course labor day weekend was marked with lots of people drunk and hurting themselves. I did a lot of suturing, some of drunk people, some on kids. I am back on days now and having been challenged every day. There is always something new to learn in the ED.

I really like this program, hospital, and Michigan. These last 3 weeks have helped me shape my decisions a little bit on where I want to do residency but it is far to soon to make any actual decisions. My only thoughts now are that I think I would be happy living anywhere in this state.  I went to Chicago this past weekend for an AAEM conference and met several program directors from programs across the midwest. I then fell back in love with the city of Chicago and have become a little bit obsessed with the idea of moving there. If only all the programs there werent so hard to get into...

EMS Ride Along

My current rotation requires us to do 1 ride along with the county Sheriff. The special thing about them is that they are Paramedic/ Sheriff so they are allowed to arrest you and if they need to shot you, they are obligated to try to save your life right after. Basically, they respond to all calls- medical or not.

I got to the Sheriff Department in Flint, Michigan [voted the most dangerous city in the US last year] and had no idea what to expect. I met with a group of Sheriff's and then was introduced to Mike, the Sheriff/ Medic I was going to ride with. A 6 foot 4 in handsome 27 year old white guy, looked promising... until I stealthy looked at his left hand to then find his wedding ring.

The shift was from 3pm to 11pm and I had a blast. We rode around the city patrolling and when we werent responding to calls, we were scoping out the local real estate.

"Well thats kinda a cool house" -me
"Want it? You can buy it for a $1"

That was the theme of the night. We also stopped at Starbucks where we got free coffee just for being in uniform and got dinner to go later in the night.

We would cruise around and he showed me the city and then we would get a call, turn on the lights and sirens [of the Ford SUV] and we would speed like crazy.  I never felt scared because he didnt go to crazy, and would always slow down to a near stop when approaching an intersection that had a red light. We did go about 120 on the freeway though. And damn it feels great to be driving 80 on a city street and have everyone move out of your way!

 One of the first calls was a young man having a heroin overdose. This is also how we ended the night. In between we had a baby with a seizure, a deaf lady with a bug bite, a man trying to cash a fraudulent check at a gas station, etc Probably the most entertaining was a call we got at about 10pm, "women in her 40s shot" we responded to the call and when we walked into the bar, we found a middle aged white lady sitting in a chair with her leg extended, looking pretty comfy. Yeah, she was shot...with a beebee gun.

I am very happy I had this opportunity to see life as a first responder. It almost bums me out I did not try being an EMT or paramedic for a while. Life in the ED will be just as exciting though I'm sure. Im looking forward to doing another one this month if I have time and also doing another ride along in New York on my next rotation.

Still no Spanish....

I worked with the same attending for the last 2 days and he is wonderful. Loves to teach, challenge me with question yet is so encouraging and nice. Yesterday my first patient was a 20 year old who was a slam dunk case of appendicitis. I was suspicious of it, did some tests, clinical exams, imaging and then sent her up to surgery. I'd like to think I saved her life but its not exactly a mystery when your right lower quadrant starts to hurt, even she knew it was probably her appendix. damn. What made it super sweet was her uncle asking my out on a date before she was taken up to the surgery floor. I politely declined.

 Today was all about seizures, had several cases. Then the day ended with a 17 year old who was playing with a machete [why you ask? because he is a 17 year old boy] and got his arm sliced open. Was a 10cm laceration on his bicep that went pretty deep, deep enough for me to stick a quarter of my finger into the hole [after i numbed it up of course]. I ended up doing a double layer closure- took 5 stitches on the inside to put together the muscle then 15 sutures to close up the skin. I think i did pretty good for being tired, sick and tired [we had a lecture at 6 this morning].

I was very tempted to draw eyes and make a smiley face....

My first day without a Spanish speaking patient, EVER

Day 1

Well, after a brief spur of the moment excursion to salt lake city, I made it to Grand Blanc Michigan. My connecting flight consisted of an Obama hating 80 year old who wouldn't stop talking to me and my final flight had a good friend flying with me so it was a nice suprise to see a familiar face. We landed got our rental car (ford escape AKA my mini white escalade) and drove through downtown Grand Blanc to find somewhere to eat before we parted ways. After the 30 second drive through downtown...we found a place. After eating, I drove to the place im staying and was very lucky to find a great condo with a 4 month old golden retriever puppy. Im staying with not 1 but 2 EM residents. A lil intimidating but both are wonderful...and there is beer in the fridge.

Monday wake up was 6:30 and got to the hospital by 7:30. I walk in the main entrance and there is a hotel-like lobby with 4 story ceilings, a big fountain and a Subway Sandwich restaurant in the background. Not too shabby. Couldn't help but feel a lil overwhelmed in a new hospital, new city, new car, and a complete lack of direction. After the orientation, meeting a few people, and having breakfast with my $50 a week cafeteria stipend, I felt a lot better.

Orientation and tours ended around 10:15 and at 11am I started my first shift. Every person I met was welcoming and helpful. The attendings were the least intimidating doctors I have ever met. Each one was excited about meeting a new student and offered to help with anything I needed. I saw a lot of patients and it worked out that I had 4 SOB patients, 3 ending up having PEs. I helped my new roomate/ resident on a central line and attempted to start an arterial line but neither of us could get it (HIV pt with small vessels and septic so his BP was low--would be hard for anyone I imagine). I ended the shift with a 14 year old girl who had a seizure after smoking the new drug called 'spice,' a man made THC like substance that doesn't test + on any urine drug screens and is technically legal and very dangerous. She was fine but sad to see people making money off this stuff, legally...

I'm excited about my month here and look forward to more experiences. I'm nervous, of course, but forget all about that when working. I hope I don't do anything stupid at work (or home!) and can't wait to see more of Michigan. Detroit is close and I plan and driving to a couple other cities to check out other residency programs.

It's freakin humid as hell though...

Step 2s outta da way

This week was filled with obstacles yet i managed to survive and am proud of myself for it.

I took the COMLEX II on Monday consisting of 8 blocks of 44 questions, with an hour to finish each block. They are kind enough to give us a 40 minute break in the middle. I finished with a upbeat attitude knowing I did my best.

I then spent Tuesday hiking on the beach in SD and swimming in the ocean. My first full day off with no books for MONTHS.

Then came USMLE Step II on Wednesday, another 8 blocks with an hour to do each, ranging from 40-46 questions in each block... This test was no freaking joke. I was sweating through each block finishing with 30 seconds to spare. I got worked. I walked out feeling like I did not study enough and spent the next 2 hours driving back to LA in a fog of 'what the fuck just happened'. Needless to say, I am a little concerned about my score.

Now, I sit in the Salt Lake City airport [with free wifi thank you baby jesus]. I am on my way to Grand Blanc, Michigan to spend a month at a level 1 trauma center emergency department with a highly ranked emergency program. I am staying with a resident. Trying to not be nervous, think i am more tired than anything else considering i didnt get to much sleep last night. oops.

Interview Invitation #2

Arrowhead Regional Medical Center.

AKA the county hospital of San Bernardino County. the BUSIEST emergency department in California [LA County is second...]. Over 130,000 visits a year.

 Pretty. damn. excited.

Quotable Quotes

Im gonna start by saying I really dont know if I like Dr Oz or not, but either way, i was watching the show NY med and he had a pretty good quote in there that made me think. He was talking about his mail and reflecting on a thank you note from a patient and said:

"the fact that she wanted to say thank you is all i needed to know, i think thats what drives most doctors to do what we do. and thats why it hurts doctors so much when they get sued, because they feel like they did all this work, and they really did think they were doing it for the right reasons, and yet someone disliked them so much they sued them" -Dr. Oz

Needles and Tubes

4 weeks with Dr. G are over and let's just say I am not ready to intubate by myself anytime soon. Good thing i have 3-4 years of residency to perfect the art. In brighter news, my last shift was today [he gave me Friday off] and it was an Obstetrics day. So we spent the morning in the OR doing C sections which are always great, we had 1 scheduled and then had 3 crash [emergency] sections. All turned out well. Babies crying all over the place. I did a bunch of stuff, started IVs, did a spinal, did an epidural. Epic way to end a rotation. It was a great month and I loved everyone I worked with. Will probably be returning to do another 2-4 weeks in October.

Next up, COMLEX and USMLE Step 2.

as med students we joke about "saving lives" because most of the time, this has nothing to do with us. but today i can say, i actually saved a life.

Interview Invitation #1

I just got an email with the title "Invitation to Interview"!!!!

First interview invite is from St.Barnabas Hospital. An AOA emergency med program in the Bronx, New York. Date to be scheduled.

Could not be happier right now :) Still in shock that it happened so fast! Hopefully there are more to come!

The little things

Pure happiness is such a powerful feeling. Moments of true and pure joy do not come very often. Yes, you can be always be 'happy' but there are those moments when something just rushes through you and you are smiling uncontrollably and just feel on top of the world.

I had that rare feeling today. After 3 weeks of observing, assessting, and repeatedtly failing. Finally, things went just the way they were supposed to, I did just what I was supposed to, and with a Miller blade, I saw vocal cords and intubated all on my own. No help with adjustments, no help with the tube, nada. After I pushed the tube in, i waited to see condensation [to make sure it was in the trachea and not the esophagus] and then looked up at the monitor. I saw the CO2 waveform and I knew i was in. "wait, I did it?" I asked the doc. At this point Dr. G and the surgeon were continuing on, pushing meds and prepping the patient, at one point I heard Dr. G say to the surgeon "thank you for your patience" and he said back "no problem, we were all beginners at one point, right" ...and i just stood there in awe, not really listening to anyone, just looking at the monitor and totally forgetting any other responsibilites i had to do at that time. I was pre-occupied with smiling and savoring the victory.

After things settled down, I looked over at Dr. G and he gave me a 'good work' nod. I smiled and said I was so excited, I had finally got it. The surgeon overhead and said, "now dont forget to call mom tonight and tell her."

 Miller intubation blade. Gotta put the blade in a see vocal cords before you can pass the endotracheal tube:

Today I worse a space suit

Boards are coming up and i have not been studying nearly as much as I should be. I have been working more hours than imagined and thought this 'easy' rotation would give me lots of time to hit the books. not so. Though i love it, am learning a lot, and love the OR, i also spend a lot of down town with Dr. G which i should be using at home to study.

Today started out with me being very stressed and ended up helping remind me why i am where i am. because i love it.

We started the first case and I attempted to intubate but this guys tongue was ridiculous and i couldn't see shit, so like usual, Dr. G stepped in and helped me pass the tube. The orthopedic surgeon walked in shortly after and Dr. G introduced me to him and he gave his usual speech that he gives to all the docs he introduces me to "this is D, she will be here for 4 weeks on an anesthesia rotation, she is a 4th year med student, if you would be willing to teach her anything or talk about what you are doing it would be greatly appreciated." Most docs hear this and are like "yeah sure, nice to meet you [moving on]" this surgeon was like "yeah of course, wanna scrub in?"

In my mind im like "HELL YEAH I wanna scrub in" but on the outside i politely said yes while asking Dr. G if thats OK. He was all for it so I got to scrub in and assist on an orthopedic knee surgery replacement. Pretty freaking rad.

 We wear these helmets that have a shield over them [cause bone and crap spray everywhere....think saws and home depot tools]. The helmet has a fan on the inside to keep the screen from fogging up. so basically, we look like we are wearing space suits during the operation. Here is an example [this is from the internet, unfortunately i didnt get my phone out fast enough to get someone to snap a pic of me]:

The surgeon was hilarious and chatted with me the whole time we were working. When I told him I picked emergency medicine as my specialty and had been debating between EM and Ob/GYN he looked up, stopped working and said "Well, I have one question for you. Are you a raging bitch? Because if so, you should go into Ob/GYN. Those people are not happy." I laughed and reassured him I decided against it and was heading into emergency med.

Best part was this doc, who just met me, let me help him close with suturing, taking the time to teach me how to close each layer and then gave me half the incision while he did the other half. this does NOT happen often. AWESOME. he was rewarding me for holding retractors for an hour. it was an arm workout for sure. I tried my best to remain calm and not let me hands shake. I think i held it together pretty well though i was sweating through my scrubs :)

harder than i thought it would be...

3 intubations yesterday...all failed. I keep telling myself that this is a very hard skill to learn and its going to take a lot of practice. I voiced my frustrations to a friend also going into EM and he said
"It's easily the most difficult and dangerous procedure we do in the ED. That said, we're what, 2 months into our ER careers? We've got another 4 years of training to iron this skill out, and another 30 or so to perfect it. Sometimes we have to make sure our expectations are in line with our limited amount of experience."

This made me feel a lot better. I guess my concern is that the doc I am working with doesnt give me a whole lotta time to troubleshoot. Once i get in and fumble for about 10 seconds, he immediately takes over to 'show me how to do it.' Its very frustrating because i never really know what i am doing wrong each time. Intubating is a skill that has to be done right, quickly, everytime or else the patient dies. We sedate them then paralyze every muscle in their body. If we do not bag them and 'breathe for them' they die. If we do not get the tube into the right spot and ventilate them, they desaturate and die. Its a stressful 30 seconds and I am trying very hard to not be frustrated with myself for not doing it correctly yet.

But, I have plenty of time to learn...

PACU

Kid coming out of anesthesia:

"I didn't throw up on anyone did I?"

I reassured him, he did not.

Residency Application In!!

Submitted ERAS!! Finished my personal statement. Thats it! My residency application has been submitted and now I wait...and wait...and wait. Waiting for an email from residency programs wanting to interview me. Its the medical school application process allllll over again.

Difference is, I went on 3 interviews for med school. This fall and winter, I hope to get at least 15 interviews. thats 15 flights, 15 hotel rooms. 15 minimum, the more the better. Thats a lotta money....but hey, i shouldnt spare any expense at this point in my career right?

AOA [osteopathic] programs start looking at applications earlier than ACGME [MD programs]. Right now, I have applied to 13 osteopathic programs and when the MD programs open up to applications, I will apply to a lot more of them.

Here goes!!

OR Music

Let me tell you, if you go in for a surgery and there's music, and then when you wake up, someone has shut it off, that's Bad.

our lives

"I haven't watched tv since last summer." Really Olympic athlete? We should do one for med school. "I eat lunch each day in earshot of retching" or "I put my finger in a bum....everyday." Psssssh."

-Nikki

Surgery is so unpredictable

A case that started this morning at 7:30am did not end until 3pm. It was supposed to be a 2 hour case. It was a double procedure and started with taking out the ovaries of a women.

 It was being done laparoscopically and as I watched the screen I gasped when i saw what looked like a big hairball next to the ovary. Well, it WAS a big hairball. It was a teratoma, a benign tumor that is from several different tissues and can range from anything like hair, teeth, endocrine tissue, etc.  Gross.

After that, we closed her up and repositioned her. We had to take out one of her kidneys because it was non functional and was getting severely infected. This was only supposed to take a couple hours but things did not go according to plan. The patient received several blood transfusion during the surgery and after calling a couple surgeons in to help, everything was repaired and the patient did fine. Just goes to show you how in one second, things can change. Episodes like this help us to remember that things dont always go perfectly and though each day things may go smoothly, it just one second someone who potentially die.

Pimping

Dr. G and I standing at bedside checking if an epidural is placed properly because the women in labor is still in pain. Multiple family members and nurse in the room:

"What is the biggest concern I have right now in this situation?" -Dr. G
"umm, i dont know... [thinking Dr. G is talking to her, looks at me with confusion]"
"Oh no honey, he is testing me. Trying to put me on the spot in front of all of you." -me

happy to say i got the question right.

20+ years of school to figure out what the hell this all means...

Step 2

I forgot how much studying for boards SUCKS. I take my Step 2 COMLEX on Aug 20 and USMLE on the 22nd. Until then, I am working...and studying...and taking a lot of naps again.

A quote from my favorite Board Prep man Dr. BJ
"and if you have a headache after you have been binge drinking just FYI the drug of choice is not tylenol. that is not going to be good to give your fatty liver after you have been binge drinking."

he knows us med students all to well....

Blood

Watched a double IJ central line procedure and swan ganze catheter placement. Then a TEE to confirm. Soooo cool.

Playing video games

Glendale Adventist has a Da Vinci minimally invasive surgery robot. It is worth millions and is incredible. after putting in the ports and docking the robot over the patient, the surgeon scrubs out and using his own lil chair to operate. Today we did the anesthesia for a hysterectomy and the doc let me sit next to him and explained everything he was doing. pretty rad.

A new 3rd year

"Some strange events today:

-I got excited about new shoes for work that are more comfortable.
-When I heard 8:30PM to hang out, I thought, "man that is late"
-I watched Wheel of Fortune


Anyone know of any openings at Leisure World?"


-Chris D

This job is awesome

Monday I hung out with Dr. G for the day mostly watching him and him teaching me lots. he is a grrrreat anesthesiologist and teacher. everyone in the hospital loves him. This rotation is going to be wonderful, I am learning and doing a lot [and i get all the free food and coffee i want :)].

Wednesday we worked in the labor and delivery ward. I watched him do 2 epidurals then I did the 3rd. I watched him do a spinal anesthetic before a C section and I did the next one. Its very different to be in a C section on the other side of the blue curtain. Mom is completely awake and you are talking to her the entire time. and then there's dad sitting on the stool trying to look over and you repeatedly telling him not to look because if he passes out there will be no one to take care of him... I still LOVE OB and enjoy watching the birth of tiny humans. its such a crazy experience and everytime i fight the tears when mom and dad are presented with their new babes.

During some small talk with a mom during her C section I asked if she decided on a name, she said she was deciding between Eli and Isaac. I told her I liked Eli.

Later in post op [after the delivery], someone asked the name of the baby.
"Eli" she said, as she looked over and smiled at me.

i love my job

"That's latin right?"

fun is listening to my patient say the word 'proprioception' as she listens and joins the conversation my preceptor and I are having as she lays on the table post- c section.

John is not gay

John: u'll have to introduce me to some hot nurses
me: why not hot docs?
John: nurses have a looser set of morals
me: you think so?
John: i guess i'll go for a doctor
John: but only if he's cute :)
me: wow, slap in the faaaaaaace

Anesthesiology starts tomorrow

back in the OR but on the OTHER side of the blue curtain. My anesthesiology rotation starts tomorrow and with all of the excitement of my EM rotation and the worries of my looming board exams, I have not really given it much thought until now. And now that i am thinking about it, im getting really excited!

I love being in the OR and will get to spend the next 4 weeks there. I dont know my preceptor very well but I hope he will be letting my intubate, give anesthetics, do spinal anesthesias, etc. The excitement and anxiety of the Sunday before a new rotation is a fun but scary one.

Last shift

It was crazy busy and there were tons of traumas but our pods were packed so i stayed behind and helped run them while the resident was busy intubating and putting in chest tubes [my time will come!].

At around 3am I did my first LP [lumbar puncture].

 In lamens terms, I stuck a 6cm needle into the lower back of a women to rule out a sub-arachnoid hemorrhage as a cause of her headache. The spinal cord is not that low so there is no risk of paralization, but its still a tricky procedure. Unfortunately, i didnt get any CSF...only blood. [CSF is the spinal fluid...it should be completely clear...hence the name 'champagne tap' when you get clean CSF with no traumatic tap/blood].
It was my first try so I didnt beat myself up when after several attempts, we got a new needle and the resident tried. Made me feel a hell of a lot better when the resident tried several times and then had to call the attending because we weren't getting the fluid we needed.
next time will be easier, i hope...


Things quited down around 5am and I sat down with the resident and attending and good some great feedback from them. Couldn't be happier about how I ended my rotation at this incredible residency program! *fingers crossed for an interview there this fall!*

Patients

Saw a man with HIV and a CD4 count of 8, he was not going to live much longer :/


[trauma patient comes in, young lady screaming her head off to stop trying to kill her]
"whats your name honey" -charge nurse
"JESUS CHRIST!!!"
[charge nurse turns around. She calmly tells the nurse writing the chart] "Jesus, last name christ"

Lastly, the power of narcotic addiction:
-lady came in at 2am with 'cuts' on her fingers asking for pain meds. we gave her 2 norco and sent her home...she was obviously drug seeking.
-lady proceeded to lay in the parking lot in front of the hospital and got brought in by EMS
-lady demanded Dilaudid. we said no. she angrily left yelling and screaming.
[2 hours later--at aprox 4am]
-trauma alert, auto vs pedestrian. a lady had thrown herself in front of a car on the freeway on-ramp.
-lady comes in on the backboard. we notice...its the same lady.
-lady really wanted Dilaudid. lady also has multiple fractures including in her T spine.
-lady is now paralyzed.

Just some pictures

Helipad

Dislocated thumb, 4 year old

bicornate uterus on CT scan, looks like a heart

double layer lac repair at 3am

VP shunt on Xray

smashed distal 3rd and 4th digits

smashed digits after partial amputation in the ED

"I stepped off a curb wrong" -very very drunk man

the X rays after reduction of his ankle

Taking on more

Yesterday was the most challenging shift yet. It was relatively slow in the morning and then the afternoon picked up. At around 5 we had several new patients that just arrived and them we got several trauma activations. The residents went to go take care of the traumas and i was left alone to manage the pods. I wanted to show that I could be trusted with this responsibility and was doing pretty well. I also had to keep things together because sign out was at 7 and didnt want to make the residents look bad by not tying up loose ends in the charts and stuff.

I made one mistake by not asking for help sooner and got scolded a bit by one of the residents but when the shift ended she said i did a really good job and was proud.  I think I did pretty well under the circumstances and really, I can only get better from here right? I didnt get overwhelmed and I was still able to keep a smile on my face so I am proud of myself as well. As our shift ended a big black man walked into the ER with his wife, his lip and face was swollen and getting bigger by the minute. His allergic reaction was getting worse and we wanted to secure an airway before it was too late. It was a pretty dramatic event with at least 10 people standing around helping. The residents intubated him and after I went home and slept.

Who knew?

First time in my years as a med student that i really thought i was going to pass out...but dont worry, i didnt.

Let me preface, I was at a wedding the night before drank [Saturday night]...sobered up...drove home...got 4 hours of sleep before my 13 hour shift. oops.

Up at 5:30am... by 8am Sunday, still no food, water or coffee in my GI tract...
A guy came drunk as shit and had partially self amputed his entire foot. [he said he stepped off a curb wrong but to do that much damage he had to have drunkly jumped off a building..but he was probably too drunk to remember]. His tibia was sticking straight out and his foot was twisted to the left. Incredibly, he was neurovascularly intact so he didnt need to go straight to the OR. It was gruesome looking at it but it didnt bother me too much. that is, until the ortho resident had me help him reduce it before he splinted it....

I stood next to the bed holding his leg in my hand, knee under my arm. the resident stood at the foot of the bed and we each pulled in opposite directions. With a lot of force, he was able to put the ankle back where it was supposed to be. When he did this, i felt the cracking/ crunching sound of bone and was straining as it took a lot of muscle strength for me to hold his leg. immediately after, i began to notice little details like sweat dripping down my legs and getting a little dizzy. I turned away and kept breathing and smiling, talking to the patient and trying to act like i was fine so no one thought i was a wuss. I began to feel better but as I was looking away, I could not get the 'drip drip drip' sounds of blood dropping into a bucket below the foot.

"just keep breathing" i thought.

the feeling eventually went away. i have never fainted but i imagine this is what it feels like before you do...


Ironic situation of the day:
17 year old girl who hurt her ankle [got flown in by a helicopter off the hiking trail!]. Turns out there is no fracture, not even swelling. Its a mild sprain. She is crying her eyes out, loud as hell, grabbing onto "daddy"
vs
Man with partially amputated foot quiet for hours while waiting for ortho surgery [not a peep out of him, just some versed and he was fine]

They were right across each other in the trauma bay

New facts everyday

A wise fact I learned from an attending in the ED....

"Don't be a pussy" has no connection to being female. Please note the following word and definition.

Pusillanimous: lacking courage and resolution : marked by contemptible timidity. faint heartened. showing lack of courage.

Bet you didnt know that! I sure didint...

3 weeks in

The more I do this, the more I fall in love. I really don't understand why a medical student would want to do anything else? Every shift is so full of spontaneity, diverse cases, newly acquired procedural knowledge, and of course, lots of blood. I am enjoying everything about this rotation, the residents and faculty are wonderful and never to busy to teach, the staff and nurses are hilarious and also are always willing to help. The patient population is so wide and they are the sickest people I have ever seen. This week we had a male with AIDS that had a CD4 count of 8. That same shift I saw a man high on heroin and amphetamines that had his penis tattooed, stapled a huge scalp laceration, helped relocated several bone fractures, diagnosed a stroke.... i could go on forever.

I walk away from each 12 hour shift in a whirlwind. Not remember everything that happened because so much went on, exhausted yet awake on adrenaline. I get in my car. Take a deep breath. and smile like a lil kid in a candy store. Such a great feeling.

Shadower to Shadowee?

Today as we started our shift, a young guy introduced himself to the senior resident and said he would be shadowing him if that was OK. The resident welcomed him aboard and I introduced myself also. I was working in the same pod as this resident so I told him he could hang out with me.


What turned out was this medical student, between his 1st and 2nd year, shadowed me through our 7pm to 7am night shift.  A student...shadowing me. Just a trip. Time is flying, I feel so cliche when I say it feels like just yesterday when I was writing about shadowing other 4th year medical students.

Ultrasound ROCKS

The hospital got 3 new ultrasound machines which are amazing. Image quality and diagnostic accuracy are incredible. We use them in a large variety of ways, some examples: we use them in traumas to search for internal bleeding, in clinical workups to look for gallstones, and during central line procedures to locate deep veins. 

Each machine is worth more than a brand new car. And apparently the County got them by using money from speeding ticket fines. To many ironies to point out...

Quotable Quotes

A man comes in with un-controllable nose bleeding [epistaxis]
"do you have HTN?"
"Yes"
"do you take medication for it?"
"No, I havent taken anything for over a year"
"why?"
"because i have felt fine..."


3 AM on a Tuesday morning working Triage
"I have worms, these worms are eating my nerves. My legs hurt so bad. They are numb. I cant sit for very long because I have no circulation. Oh my god it hurts so bad."
[man then proceeds to lay on the floor in the middle of the triage cubicle]


Recently, we had a 20 something year old girl come in with a fork hanging from the base of her tongue. Apparently she had the stomach flu and couldnt eat for 2 days. After feeling better, she starting eating so ravenously because she was so hungry and somehow stabbed herself very hard with the fork. She couldnt get it out and came to the ER.

4th of July Shenanigans

Worked overnight in the emergency department in Pod D. Along with all the other normal cases, this is where the jail checks come [people who are being arrested and need medical clearance]. This is also where the suicide attempts and mental health patients come. Needless to say, it was pretty busy overnight.  Saw a good amount of motor vehicle accidents and other traumas. Everyone pitched in $5 and at midnight we had a BBQ outside in the trauma bay. It was a fun shift.

Some highlights:

Man comes in with huge black eye, blood in his ear, and lip split open needing stitches
"what happened?"
"i tripped and fell on a step"
"Wow, that must have been a pretty bad fall to get your ear, eye and mouth all at once?"
"yeah,  it must have been the alcohol. I just missed a step"


A prisoner comes in for ingesting a bunch of pills, has 2 security gaurds with him
"I hate white people. And I especially hate blue eyes"
"Well shoot, I guess I should find you another doctor"
[after seeing my name tag]
"Well shit, my grandmothers name was Dot so we ain't gonna have a problem at all"
"wonderful"

First week of the rest of my career

abdominal pains, 3 year olds with arm fractures, IV lines, lacerations, chest pain, casts, splints, traumas, helicopters, suturing, incision and drainage of abscesses, motor vehicle accidents, ultrasounds, jail patients, suicidal teenagers, teenagers being brought in by cops for medical clearance before they go to jail...and so much more. This is just a portion of what the first 3 shifts in the emergency department have been. Add this to the amazing people, practical jokes, pandora playing on the computers in the background, staff willing to help with anything, and fun down to earth residents...it has been a great rotation. I have only worked 3 12 hour shifts and the staff is already starting to recognize me and call me by name, I have made a great impression on some residents, met the program director, and have had a blast with all of this. I could not be happier and I am so glad I have found something i enjoy so much.

At the beginning of my shift today there was a huge accident on the freeway and the entire freeway was closed to clean up the mess.  While driving by, I wondered if I would see any patients in the ED when I got to work. Sure enough, the driver who caused it was in our pod.

PS At the end of my shift, I shook the hand of the doctor who pronounced Rodney King dead. Thats right. Hes practically famous.

Feelin good!

Week of vacation over. 

4th year rotations have begun. 

First up, my first emergency med rotation. SO FREAKIN EXCITED! My first shift isnt until tomorrow so I went in this morning for orientation and was home by 11am. Been studying and gonna start practicing my sutures on some pigs feet [thanks Dad].

tomorrow I start in Pod B...high acuity patients and TRAUMA :) 

Nostalgia?

This week was our last didactic week. Our last OSCEs. Our last shelf exams. Our last time on campus really. I wish I could say I was sad, or that I was nostalgic about it. But no, the only thing that mad me upset was knowing that my friends and I would be splitting up for 4th year....everyone going their separate ways to different hospitals and as much as facebook can keep us in touch, we will be apart.

Today, Thursday June 14, 2012, was the last time i had to sit in that lecture hall. I hope. Unless i failed something...or unless they bring us back for something stupid during 4th year. but otherwise, next time our class will all be in one room is graduation on Friday morning, May 17, 2013. When we get the title 'Doctor.'

studying...

"Welp, at least we can say we will probably be the tannest people at shelf exams tomorrow. Bahahahahaha"
-Nicole to LJ


Update: they were

"There is no such thing as a prescription for marijuana. Yes there is in LA, no there is not in real life"

-Dr White

decisions

"so last time we were chatting you were still debating specialties. any new revelations since then?" -me

"lisa wants me to do radiology so i can buy her nice purses" -Daniel

"thats a pretty good argument"

Last didactic week, EVER!

"Another study weekend - why are there so many interesting things on the internets? and why is my kitchen so dirty??"
-Alex

Last day of third year rotations!!!!

welp....thats it. 75%  over. 3/4 done. 3 down, 1 to go.... There are many ways I can say it over in my head but it doesnt matter, I still cant wrap my head around it. I have to start realizing that in less than 1 year, I will become a physician. I will be responsible for my actions. I will be responsible for lives [with a safety net of senior residents and attendings of course.]

This year was very difficult. As always, it was more difficult than the previous one. I assume next year will be more difficult than this year but I hope this is not true. 

I am excited to do rotations in emergency medicine and begin learning the skills I will use for the rest of my career. I am excited to focus on the field I know I will love. I am excited to move around the country and change up the day-to-day scenery. I am even more excited to begin applying for residency and becoming closer to settling in a new job. I am even MORE excited to finally start getting a paycheck....but, note to self, that wont be for another year.

to sum up, my core rotations are done. I have done all my pre-requisites. I helped deliver babies, did well child exams, rectal exams, cut people open, listening to schizophrenics tell me they were god, diagnosed people with fatal diseases, cried, laughed, loved, hated, become overwhelmed, gained confidence, lost that confidence, then gained it back [and repeated that cycle over and over again]. I learned how to practice medicine, how to answer tough questions from an attending without looking scared, how to speak to a patient without sounding like a kid, how to gain someone's trust, how to get over awkward moments like that time i was doing a lower extremity neuro general sensation test and the old man told me to keep going up...I have done a lot. and i am happy to say, I am proud of myself and my classmates for doing it. For learning it all, and staying sane. We have sacrificed a lot to get this far.

So thats it, this chapter is done and the next and final one of medical school is beginning. Bring it on 4th year!

Murmurssss

heard my first "washing machine" type murmur today. a pt with endocarditis. it was LOUD and you could palpate a thrill on his chest. crazy.

faint? "bitch please"

welp..spent the morning in the OR watching the diabetics get amputations. I was a lil uneasy about going because i think its a little un-natural to watch someone cut off body parts for purposes other than killing someone...but i got over this really fast once i got back into the OR.

"Hi Dr. C, my name is D, I am a medical student and will be observing today if thats OK with you."

"That's fine. As long as you promise not to pass out. And if you are going to, make sure it is not on my operating field."

"yes sir. I promise"


The morning began with a couple simple toe amputations. It takes like 5 minutes, seriously. Just get the scalpel, cut, cut cut and pluck that thing right off.

Next I saw them take off the big toe of a women and the metatarsal behind it. first time they used the saw...if i was going to pass out, this would be it. but no. of course not! At one point i was standing next to the resident watching her suture closed the site that once was the big toe and blood just dripping. i wish i had been able to take a picture.

Next up, below the knee amputation revision...meaning, he already had a BKA but the stump got infected, wasnt healing [ie wasnt controlling his diabetes so nothing was healing] so they had to cut more of his leg off. Mental image...using a scalpel to cut to the bone, then using a small saw for the fibula and then a 'string saw' for the tibia. then watching them use a very sharp big ass knife [think kitchen knife for your turkey on thanksgiving] to cut the posterior muscles. then watching them dissect arteries, nerves and tendons. pretty sweet.

last up, a symes amputation. Basically dis-articulating the ankle and heel bone and taking off the foot from there. tons of cool anatomy there too...

i left the OR and went straight to eat lunch. i was starving :)

amputation? no big deal

"have you been taking your diabetes medication?"

"no"

"how long have you not been taking your diabetes medication?"

"5 months"

"why have you not been taking your diabetes medication for over 5 months?"

"um...i've been really stressed"

"ok sir. we are just waiting for your MRI results and then will let you know if we need to amputate some more of your toes....but it looks like you might have bone infections in both feet."

"ok. can i go back to sleep now?"

love them patients

i musta been pretty tired this morning when rounding...didn't notice my patient had the words 'bitch please' tattooed on his forehead until i saw him again this afternoon... it was in cursive. pure class.

A recent grad

"If residency is as awesome as medical school then I don't know what people complain about. Maybe this is just the rose-colored glasses of hindsight but hot damn, all the great friends I've made along the way really made it all worth while!" -brent, a recent grad

healthcare rant

fact: on average, every 2 minutes a doctor spends with a patient, they spend 25 minutes documenting

this morning, i walked into my patients 'room' [curtain...] and asked him how he was doing. then i said "do you know what is going on, has anyone talked to you about the plan."

nope, i have no idea what is happening. i tried to explain as best as i could...but then i had to go to finish documenting his progress note before rounds started.

later in the day, instead of explaining what is going on and how we are helping, i spent about 2 hours writing transfer paperwork for my patient. by the time i was done, i was so tired i spent maybe 10 minutes with him and then left for the day.

our medical system is ridiculous.

instead of using time wisely, talking to the patient, counseling them, explaining what they can do to help themselves...we end up having a ton of paperwork and documentation to do in order to legally protect ourselves from lawyers. thus, we never educate the patient well enough and they return again and again for things that can be prevented.

our medical system is ridiculous.

the first time i nearly killed someone

The title may be a little more dramatic than the actual events...but really, i could have done something very bad. good thing there are many safety guards in place to protect my patients from me :)

this morning during rounds i had 5 patients to see and came in extra early to be on top of everything. i was doing great, looked like a rockstar, had all my notes and updates organized. wrote the orders the doctor and I discussed he glanced em over and we moved on. we saw a couple more patients and then went to the doc's office to get a lecture from him. not 2 minutes in, we got a phonecall. he puts it on speakerphone [like usual] and its a nurse...asking about our order. "I just wanted to clarify the order you left for patient X, you want 60 units of long acting insulin 3 times a day? He was only on 58 twice a day before."

crap

we verbally clarified the order to 60 units twice a day. the doc wasnt mad, thank god. he just went into a speech about mistakes, how it is easy to make them, and to triple check all the orders we write. [to note, that extra 60 units would have made him hypoglycemic putting him into a coma and probable death]. We were told that from the time we write the order, 7 people see it, read it, and double check it before it is actually given...several nurses, nursing clerk, pharmacist, etc.

food for thought: "The average, major teaching hospital experiences an increase in risk-adjusted mortality of roughly 4 percent in the July-August period."

 this is when new intern's [just graduated 4th year medical students] begin their residency...practicing medicine on 'their own' for the first time. granted, like this example, there are lots of things in place to keep us from killing patients...despite our best efforts. but, accidents still happen.

stay away from the hospital in July and August....