only 2 more days of endocrine....YAAAAAYYYY!

i live a pathetic life these days, and endocrine is OFF the list of interest (mostly because it is so damn tricky). life is pretty much 75% school and then 25% having a good time. but we still have a good time so thats all that matters.
its ok though, only 1 more year of classroom work and then they release me into the wild (what you would call the hospital). the more i learn the more i get excited. its also really fun to hear the 3rd years, who we got really close to last year, talk about their experiences.

oh, this was a fun quote from class today:
(after a question was asked to us about what drug you would prescribe a patient and everyone answered correctly):
"yes very good...theres really no science here this is just route memorization. theres really no way around route memorization in any subject.....whats your best long acting insulin? (as he casually goes back to the lecture topic)" -Dr. W

So today was our first standardized patient encounters of the year and my job was to counsel a patient on their drinking habits, even though they came in for back pain. it was an exercise on communicating with our patients and building repore again....blah blah blah. To get us back into the swing of things, they put us into groups of 6. Each one of us got 12 minutes with a SP (standardized patient--ps they call them standardized because every patient seen is the same to each student regardless of age or sex..they are all coming in with the same stories and symptoms so we can discuss them in lecture later). While we talked, 5 other students watched and then after the 12 min we got 5 min of feedback from the actor and our peers. after the encounter, the SP left the room and a new one came in. we had 3 scenarios, a diabetic patient, a smoker and an alcoholic then we had the same SPs come back and we pretended to do follow up visits. not sure if that makes sense but oh well.

Anywho, it was fine...nothing to write home about. its much more fun seeing ACTUAL patients. today was another 8:30 to 5 day and i got to unwind a bit by playing volleyball with my classmates. its always a good time. ok, im getting back to work. studying again till 12 and then bedtime.

a friend found this on the internet. sadly Ive tried all of them...the last one doesnt work. maybe it was because i feel asleep with the notes ON TOP of me rather than vice versa. hmmm..

to note; medical school mnemonics are WAAAY dirtier than that. think rated R, not G

round two...DING

Well, i just finished my second week of second year and am already sleep deprived, stressed and a little bitter about life. getting off of summer vacation/break is one thing but being thrown into school (especially with this new curriculum) is exhausting. I was speaking with my good friend/classmate Sarah who had gone on a long trip as well and both of us seemed to be in the same boat of depression. Not a true 'SIGECAPS' depression (that is a mnemonic for all the symptoms of depression we learned in Psych last year- sleep disorder, interest deficit, guilt, energy loss, etc etc) but just a minor depression...mostly sadness. It is very hard to have been allowed to sip from the glass of freedom and then now be dyeing of dehydration as it was taken away.... seriously, thats exactly what it feels like. free time has gone down the drain, sleep has been severely reduced and life is back to normal as a medical student. only now, I am an MS2 and classes are going to be more difficult and we are expecting to know stuff. i cant use the excuse that i am just a first year anymore. I CANT IMAGINE when one day i cant use the excuse 'I dont know, im just a medical student' or 'i dont know im just an intern' or 'i dont know im still in my residency.' There will be one day when i am on the top of the pecking order and i cant say 'i dont know' its gonna be Doctor, what do you want to do? and i will HAVE to know.....shit that scares me

well anyways, these two weeks have sucked (for lack of a better word). But last night I worked another shift at Montclair and that definitely added a bright light to the tunnel. First off, I got about 5 hours of sleep on Wednesday night mostly because I had coffee in the early afternoon and then couldn't fall asleep (and im sure anxiety wasnt helping) then I got up Thursday to be in class for 8am. After just an hour of one of our only lectures this week, i met with my small group at 9 until 12 going over our cases and answering the questions about differentials, further testing, treatments, mechanisms of treatment,etc. Then i took an hour lunch and went to OMM from 1 to 5. After OMM i went straight to the Montclair clinic were I worked until 10pm. Now THAT was a long day but it wasnt to bad because it was women's clinic and i have been wanting to work one for a while now.

SOoooo, one of my patients last night was a 41 yo F (who did not speak English). She presented for a routine women's health visit (you should start to learn the short hand too--42 year old female---that one was hopefully not to difficult). Basically, she was here for a pap smear and breast exam. This was the first exam I have seen and I felt privileged that this women trusted me to learn from her. The resident at the clinic did the exam, i watched as he explained and the clinic coordinator assisted. Sadly, the coordinator was the only one in the room who spoke Spanish and it was probably not the most uncomfortable experience for the patient. But, I was there and learned how to do both a pap smear and a breast exam and I will always remember her as my first womens health patient. There is another first.....and I may have ruled out OB/GYN with that one...

ok. its time for a nap, dinner and then a fun night of studying and playing music very very loudly in my headphones to keep up my moral. that is the silver lining of studying...good music. monday is our 2nd endocrine exam, its on the thyroid gland and adrenal glands...then next week we learn about the wonderful world of diabetes. that is gonna be an important week since its gonna affect my daily work for the rest of my life. ill try to pay attention and learn some stuff for my future patient's sake...cant make any promises though

back to spending the best days of my life (early 20s that is) studying. Only have a few weeks of them left since i turn 25 soon

summer made my body forget how to study

"I would be okay with being a quiter right now..."

Byron

PTH, FSH, LSH, GH, etc etc etc

"Studying endocrine = alphabet soup....CK14-, lower p27 index , PTH+, Ki-67+, cyclin D1 overexpression in >90%, DNA ploidy, Rb gene loss, HRPT2 gene mutation (hereditary hyperparathyroidism and jaw tumors syndrome)"
-Nolan

The acronyms just keep on coming....I think getting a medical degree is partly based on learning what a bunch of letters mean in the medical context. That way, you have to pay a doctor just to translate each others writing. its actually pretty brilliant!

Day One...again

Today was my first day of second year and it was.....uneventful. Unfortunately, school began just like every other day and before I knew it, I was sitting in a histology lecture again trying my hardest to keep my attention span. After 3 hours, we had lunch and got to catch up with each other but after that there was a realistic feeling of work looming. Our first quiz is Wednesday [in 2 days], then another one Friday and our first exam is Monday [one week from today]. We are going to be studying the endocrine system for 3 weeks and every week will be the same... Our school has changed the curriculum and we will be doing a part Problem Based Learning instead of lecture style. Basically, we are given 5 cases with questions and in a group of 10 selected peers we will meet up and come up with a diagnosis and answers to the questions. The quizzes we have are all based on these cases and then after the quiz we get lectured on them. If it sounds confusing its because it IS confusing and its going to take me a good amount of time to 'learn how to learn' best in this style of teaching. For example, this is next weeks schedule

Monday: Exam 1 [from the previous weeks material]

Tuesday: the entire day is blocked off to meet with our group to go over the 5 cases and for self study

Wednesday: 8:30am to 12-Quiz on the cases we covered Tuesday and then 3 hours of lecture on this material

1pm- 5pm-Essentials of Clinical Medicine [this is the class where we learn to deal with patients and see standardized patients [actors] every other week]

Thursday: AM is blocked off again for groups to meet about another 5 cases

1-4pm- Osteopathic Manipulative Medicine

Friday: 8:30am to 12-Quiz on the cases we covered Thursday and then 3 hours of lecture on this material

*note, there are some Medical Ethics classes and other randoms thrown in their as well. Also, this will change with each system but the general set up is the same.

As you can see, things are very different from the usual lecture day. I am not sure how i feel about it yet but im thinking positively and im sure it will be good for me to have my own free study days.

Sooooo, now that Africa and my incredible summer are behind me, im gonna go learn lots of stuff so i can eventually go back and be able to help [and not just look over people's shoulders].

And another thought, today was my last 'first day of school' EVER. Thats because next year [actually in July] I will be spending my first day of third year in a hospital...and then rotating in and out of hospitals. CRAZY to think about

ONE down THREE to go

Well, its been a lil over a week since my first year ended and its hard to reflect on what I just accomplished. It's also very hard to grasp that it has been a full year of quite possibly the hardest working year of my life. Having met so many new amazing people, I can't help but love what I am doing even though at times I was very miserable. Most of the time I was having fun, even if most of it was spent in the library. I was still in the library with friends and still had plenty of opportunities to get to know my classmates. Honestly, my classmates are the major contributing factor to my sanity. It actually is hard to relate to friends who aren't in my class because med school has become such a major part of my life....well, it IS my life. But, now I am on summer break and get 8 weeks of guilt free time. Right now I am sitting on my friend's couch in London just having made a great breakfast. I plan on sitting here for a lil while longer and then heading out into the city. Tomorrow is an England World Cup game and I am meeting a friend to watch it, should be a great time in a pub somewhere :) Then Thursday night I leave for MALAWIIIII!!!!!

Of course, I didnt let go of all responsibilities since break has started. Last week before I left for London, I volunteered for the third [or fourth, cant remember] time at the Montclair clinic. I had two patients, a Spanish speaking 45yo Male and a 44yo Female. The man was the first time i encountered a patient who did not understand English at all. I worked my way through it as best as possible. I led him to exam room one and with a smile on my face the entire time (it was the only way i knew to break the tension) I took his blood pressure, pulse, temperature, respiratory rate, height and weight. After doing his vitals, the only thing I could manage to say was 'dalor?' as I pointed to his eye [it looked a lil red and droopy...dalor means pain]. He said no....thats it. After an awkward pause and another smile, I told him [in english which he obviously couldnt understand] that I would be right back. I then got the Clinic Coordinator [our saving grace at the clinic...she helps us with everything] to interpret for me. Through her, we asked him a few questions and it was all I needed because he was just there for a BP check and medication refills for HTN and Diabetes.

After this patient I had a 44 year old lady who could speak English and suddenly I felt 20x more confident in myself. It seemed like a no brainer since i could ask her any question i wanted [retrospectively, having this spanish speaking patient was pretty good for my learning curve]. She was here for HTN medication refills but also because she wanted to switch her anti-depression medication. She was just put on them at her last visit 2 months ago and since then she was having major side affects of 'shaking' and 'trembling.' I asked her a ton of questions about her symptoms and didnt do any physical exam cause I didnt really think it through and didnt think it was needed. I went back to the resident and presented the cause and it became pretty clear that I did not do enough. He asked if I did any physical tests and educated me on why a neuro exam would be very important. So, I went back to the patient and did a full neuro exam to rule out any other causes. I did reflexes, muscle strength testing and sensation testing...all were intact and within normal limits. After going back and giving my pertinent negative findings to the resident, we went to see the patient together and ended up switching her medication.

Retrospectively, I really should have known to do the neuro exam and present this to the resident in the first place. We just learned about this a couple months ago and it should have been in the back of my mind when I was listening to the patient. I felt pretty stupid for having forgotten it. Its hard to see a patient, learn all their symptoms and really critically think while i am in front of them. Its hard enough trying to pretend and look semi-competent while in the exam room... its another to actually BE competent. So, I took this experience as a valuable one and next time, I will slow myself down a bit and not feel bad about thinking things through and making the patient wait while i study their chart and my notes. After all, thats what doctors are supposed to do, right?

On that note, I am also VERY happy I have been volunteering at the clinic because if I am already learning and becoming more comfortable with patients and charting, I wont make these basic mistakes when I start rotations. Then ill just look like a rockstar!

Anyways, it was a very long night at the clinic and we didnt get out until 10:30pm [we start at 5pm.] We had a resident that was pretty slow but he was also valuable as he spent a lot of time teaching us about the patients and also giving us pointers while writing our SOAP notes [the exam documentation complete with Assessment and Plan for treatment]. Sadly, its this kind of stuff that makes me dislike medicine. We spend about 20 minutes with the patients but then at least an hour on their chart. granted, charting will go much quicker and smoother when we are more experienced but for now, everything I am about to write gets scrutinized in my head a couple times before it actually get puts on paper. This is a legal document and I have to make sure everything is complete and accurate. Well... that and the resident and clinic coordinator have to sign off on our charts and i dont want to look/sound like a complete idiot. I havent been doing this for long but I should have some ideas of how to do this, it has been a year after all!

Every shift after our last patient appointment at 7:30pm, we all finish up our patients documentation [SOAP notes] and give them to the resident and then to the clinic coordinator to sign off. It has become a competition each shift to see who can write their chart without getting 'called back' from her to correct something.

I didnt get called back at this shift, she said my charts looked great and were done very well :)

A small triumph but a triumph nonetheless.

be back in a month when i return from Africa, will have lots of medical stuff to write about then!