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.