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!