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!!