Football

Last July I bought tickets to the Chiefs-Denver game for me and my dad for a fathers day/thanks for fixing my car gift. I had no idea at the time that I would be picking one of the best games of the year. We are by trade Chiefs fans and every year I start as a hard core fan and normally mid-season I don't watch as often because I get busy and it isn't as important when you are 0-12. But this year as I watched their season take place I got more and more excited for the upcoming game. Their first loss was to the Broncos in Denver two weeks before our big game which only increased the excitement for our rematch. We got parking in advance, bought custom cut steaks, and put together our drinks the night before in preparation. I also went and bought a new long sleeve thermal and leggings to go under my jersey and jeans to keep warm. When the morning finally came, my dad and I had breakfast with the rest of our family and headed out.
By headed out I mean we headed to Walmart to pick up those last minute things we forgot to get the night before. Like extra gloves, a chiefs hat for my dad, and A1 sauce. (Or and plates because I totally left them on the table when we left.) The ride down we talked about the injuries, how perfect the weather was going to be, and made predictions about the final score. My prediction was 24-21 Chiefs. I unfortunately was wrong, but more on that later.
We waited in a long line of cars to get into the stadium and when we gave our parking stub to the parking people it looked as though we would be parking pretty far away from the actual stadium, which we kind of expected. To our surprise they directed away from everyone else entering the far out parking lot and toward the stadium. Somehow the parking I had gotten us was parking in the lot right in front of the stadium. It was perfect. Everyone was tailgating and there was no way out once you got in there. Most everyone was Chiefs fans though you would see the occasional Broncos fan walk by and get booed by the crowd. The atmosphere was perfect and the sun was shining. We were sure it would be a great day.
Entering the stadium was a whole new experience. We had lower level seats in the end zone and by the time we got into our seats the players were already warming up. It was incredible! The stadium was overwhelming big and the players looked so close. We were high enough up to be able to see the plays develop, but far enough down to see them up close. They couldn't have been better seats.
We got super into the game. The things that happen in the stadium that you don't see on TV are awesome. The crowd is super loud, everyone is very into the game, and their couldn't be more loyal fans. We stood the whole time, screaming until our voice cracked. I remember the 100  yard return getting us the 3rd touchdown of the game. I was screaming and jumping up and down. I think the Broncos fan next to me thought I was a crazy person.
Everything just seemed so perfect. Right up to the point where we started losing. But then we started to make a come back. I remember how disappointed I felt when we didn't get that last touchdown. But overall it was a almost perfect day. Sometimes luck is on your side.

On Family Medicine

Shockingly the end of my time on Family Medicine has quickly arrived. What I was sure would be a relaxing, slow month was nothing of the sort. As I stood in my grandparent's guest room Tuesday night packing up my stuff, we discussed how we couldn't believe it had already come to an end. Somehow I managed to accumulate an excessive amount of stuff in their bedroom. Come to think about it, I didn't clean out the dresser or closet. I also made a trip to walmart right before bed Tuesday when I realized I had left my toothbrush and toothpaste sitting in their bathroom. Spending the month with them was very different from my normal daily life. Coming home to a house with people who are eager to hear about your day and have dinner with you is the complete opposite of me normally coming home to a dark, quiet house. Time just goes by so fast when you are enjoying it.
I had the opportunity to work with two different physicians this month who loved what they did and made Family Medicine look awesome. Actually I enjoyed Sports Medicine so much that if ER doesn't work out for me, I think I will do Sports Medicine instead. I had the opportunity to hear afib and an aortic murmur in the same day and seeing the amount of patients I was able to see allowed me quickly show progress. I really enjoyed the rotation and I enjoyed the opportunity to talk with physicians about their life and career path. It is nice to know I am not the only female doctor-to-be who is interested in working on their career before rushing off to get married and have a family(not that there is anything wrong with getting married and having a family first). And the other doctor has more debt than me! It is easy to forget when you are working with people who evaluate you that they are also human with their own stories.  Life is different away from academic medicine and I greatly enjoyed it.
I could use another month doing the same kind of thing there and I really believe it would be extremely beneficial. However, the next rotation calls and I will be moving on to inpatient internal medicine come Monday. I have already set up my study schedule and have made my goals for my upcoming rotation. I have a feeling it is going to go just as fast as the rest of my rotations this year. Hopefully I finish getting Christmas ready before Dec 25th arrives.

Life in the Fast Lane

I was sure that this month I would have tons of time to get done everything I wanted to get done. But atlas it is the end of November and I hardly got anything done at all. I did see a dentist so I did accomplish one thing on my list. But I really thought I would finish my Christmas decor I'm making, make my sister's Christmas gift, get the house cleaned, catch up with all my old friends at home, see all of my family at home, and get healthy. Unfortunately it didn't really work out the way I planned. I am going to have to put off the gift I am making my sister for next year, I'm going to have to spend tons of time trying to get my house put together to enjoy it a couple of days before Christmas, and I am going to miss out on seeing a lot of people this month. I have successfully tried to get a little healthier. I'm still sore from my work out on Wednesday so I must be doing something right. Life is just always busy when you live it in the fast lane. Now I have an upcoming test and have to start getting busy getting done all the things for this rotation I was supposed to be doing all month. I will say that it has been overall an enjoyable month and I have learned a ton! My first couple of weeks I worked with a physician who does a lot of sports medicine and acute care. This last week I have worked with a physician who takes care of patients that are more chronic and more like the patients I am used to in my normal weekly clinics. I enjoyed the acute care a lot more, but I have still learned a lot of new information taking care of chronic patients in an insured population. The medications, tests, and options available for those with insurance are much different than those without. Since I don't have to deal with the documentation part of the medical world, I am able to see so many more patients and learn so much more by using my time to actually work with patients instead of spending hours working on documentation. After this week I will be switching over to Internal Medicine with my unit and I am looking forward to continuing on. This week with be another busy one with a couple Thanksgivings, the big football game, tests, and decorating. I'll have lots of updates coming the first week of December. Happy Thanksgiving to you and yours!

"Rural" Family Medicine

One of my required rotations is to do a month in "rural" family medicine in Missouri. I am doing my rotation in my hometown which I can't really consider rural with 70,000 people, but none-the-less I am really enjoying it. I have moved in to my grandparent's guest room for the month and have actually been able to be part of my family.  I go watch the little ones dance 2 times a week, go to the gym with my mother, and take care of all of those things I keep putting off like the dentist. Several times a week (when I have the time) I turn my grandparent's living room into my craft room and have watched more night time TV in the last 2 weeks than I have in the last 5 years. (I really kind of like Elementary.) Surprisingly, I feel even busier now that I am home then I did when my hours at the hospital were twice what I am putting in now. I thought I would be swimming in time, but atlas that is never the case.
Not to say that I haven't been spoiled, because I definitely have. The physician I have worked with for the last couple weeks starts at 9 in the morning, takes an hour lunch, and then finishes no later than 5 in the evening. Not to mention his half day on Thursdays.  Even with the shorter days and later mornings, I still have learned a great deal in the last couple weeks. I see more patient and see more of a variety in a day than I would in my normal adult clinic in a month. I have found one of my week spots, orthopedics. He sees so many sports medicine type patients and not only have I learned how to decide on imaging but there is a whole different world of medicines out there for people who have insurance.
Everything about this clinic makes me enjoy it. I have never found family medicine very appealing, but he makes family medicine look very attractive. Let's start with the general atmosphere. His whole staff gets along so well, works together perfectly, and share laughs constantly. Everyone is so laid back and interactive with each other and they were all so welcoming when I joined the team. And when I say team, I mean they are truly an amazing team. Each person has a role in the patient's care and it makes it so efficient. Patients don't wait very long to be seen and then are quickly on their way. There is no waiting around for hours. One of the other things I have really enjoyed is that the doctor treats his nurses and his students like his equals. He talks about his life and listens to our stories. We spent a half hour of our down time this week just talking about the differences in how be got where we are. We talked about how he came to decide on family medicine and his complete honesty was so refreshing. Not to mention it was nice to meet someone who has more debt than I do and is doing just fine. He is a picture of what I hope to accomplish one day. A physician who is able to take care of their patients appropriately, work as a team and have a good relationship with their nurses and techs, and still be able to go home to a family they are dedicated to at night.
So onward with what I have actually seen in the last couple of weeks. I saw the first patient I knew this week. I was completely awkward because it was a first for me. She was so much more relaxed about it than I was. Silly me.  Both me and the doctor I worked with this week had a couple, "I have no idea" moments this week. I had one lady come in with tingling in her hands and feet, but no diabetes and had already been tested for vitamin deficiencies. We are sending her on, but keeping track of her to see what rheum has to say. I realized seeing several patients that I remember a lot from boards that I didn't realized I still remembered. I saw several really adorable little ones. I must say the pen light I bought from the camping section at Walmart is the best investment I have made when it comes to little ones. They will let you do anything while they are shining it on the wall. I met my first autistic child. Broken bones, concussions, broken bones, concussions. Yep I'm an expert. Okay maybe not an expert, but I am much better than I was before. And then I got a lot of experience with changing meds on the chronic conditions that are common. And if you add on acute illnesses, allergies, infections, well checks, depression, ADHD, pain, memory difficulties, and strange bumps you pretty much have my 2 weeks. Did I mention I got to see a lot?
Come Monday I switch to a different physician and have to start getting up at a normal time again. I am hopeful it is as useful as the last couple weeks.

On and just 37 days and a few hours to Christmas. I am very behind!

Regression

While my time in the pediatric clinics has been over for a little over a week now, I still remember my time there fondly. It is funny how certain things make you regress back into childhood. Like water puddles when you are on vacation, tickling, and these special tiles in the pediatric clinic. My first couple of days I didn't even notice that they were "special." I just thought they were strange colored blocks on the floor. Like abstract. But a couple days in some of the other medical students were talking about stepping on them and being afraid they had broken something. These blocks were so cool! (note: I am easily impressed and amused.) Basically it was a block on the floor that when you stepped on it the color displaced. It was like paint in a ziplock bag or something. Once I discovered these gems, I found myself looking around the hallway every time I went to see a patient to see if anyone else was around so I could step on the blocks without being judged. I am sure they are there for the entertainment of the children, but heck there are times when I am still a child at heart.

Christmas! It is another thing that makes me a child at heart and fills me with unexplainable excitement when I allow myself to start decorating. It often takes me weeks to put up all my decorations with my busy schedule, but I start early. Shopping for decoration, putting them up, hot cocoa, Christmas music. You name it, it all fills me with a ridiculous amount of joy. Right now my house is half Christmas, half fall, with a sprinkle of halloween. It is rather beautiful. By the time December 1st comes around though, my house should look something like the North Pole.

I have gone home for the month of November to rotate in "rural" family medicine and come back to my own home on weekends to work giving me a little time to decorate each week. So far my time at home has been busy and enlightening, but more on that later. Work time!

Pediatric Clinics

For the last couple of weeks, I have been working in primary care pediatric clinics and I am loving it! Unfortunately, my time in pediatrics is coming to an end in the near future. I have my SHELF exam on Tuesday and on Friday I switch to my next rotation, rural family medicine. The last couple of weeks has reinforced my love for children, but reminded me that I still have so much to learn. Speaking of which, I should totally be studying, but I have Christmas fever. Anyone who knows me knows how much I absolutely love Christmas! Basically the first weekend in November I consider the beginning of Christmas season. I started shopping weeks ago and hope to be done shopping by the end of November. I don't really like the crowded stores. I prefer being able to enjoy my search for the perfect gifts without having to navigate my way through a bunch of other people. Plus unhappy people ruins my Christmas spirit. So the realization that next weekend will my decoration weekend has me a little side tracked today. I'm thinking a red and white Christmas tree this year and I am trying to figure out the best place for my Christmas village. This time next week I will be rearranging furniture, listening to Christmas music, and sipping on hot chocolate. It would be a total waste of time to try to convince me that it is too early, I totally respect everyone who waits until after Thanksgiving, but in my house it is hard enough to wait until after Halloween.
Speaking of Halloween, I am getting excited for the trick-or-treaters. I plan on decorating my door and have my bowl of candy waiting for the little ones. I just hope I get home in time to give out candy.
So back to pediatric clinics and perhaps a small snap shot of my 2 weeks of nursery. I learned a lot while on nursery and it comprises a good part of our exam, so I am glad I have that opportunity. However, I know that nursery is not in my future.
I have seen some really wonderful parenting in the last month. While in nursery, we were doing the last exam on a baby before the family went home when the dad and big brother came in. The big brother had to be about 2 years old and he was carrying in flowers for his mom. Talk about heart melting! While in pediatric clinic, I did a double well child visit for a 2 month old and her 3 year old sister. Both parents stood by listening, participating, and interacting with their children. The 3 year old continuous was saying either "hi mommy" or "hi daddy" and the parents would say hi back with a chuckle. Never getting frustrated with the constant interruptions which I found adorable. While examining the baby, mom read the 3 year old a book and with each turn of the page she would get excited and start jumping around. You could simply tell that the kids were well loved and thriving. I am a total sucker for cute kids, happy families, and successful parenting. It is a reminder that happiness and good parenting has nothing to do with economic status.

Things I have learned in clinic:
1. 2 year olds love pen lights. I mean seriously they could be entertained for hours. One kid shined it straight in his eye and laughed. All I could think was does that not bother you?
2. Ear exams are tricky. That being said, if you are examining an infant and need them to look the other way simple move your head to that side and they will turn to see what you are looking at.
3. There are way too many people out there co-sleeping with their infants.
4. Giving the "this is puberty" talk is a lot more awkward if you have define words.
5. There is nothing more encouraging than to sit and tell the doctor you are working with all the advice you gave the family and have them sit there and smile and nod their head.
6. There are doctors out there who are like me. Aware of our social issues and want to save the world.
7. It doesn't matter how hard I have to work, how early I have to be there, or how late I have to stay as long as I enjoy what I am doing, I am happy.
8. When I am on my A game, I do super well and parents will tell me everything. When I am not on my A game, apparently I am awkward.
9. I am still able to run down 2 flights of stairs and across a parking lot for a code even in my new dress shoes that have a heel on them. Glad I tested that out.
10. Pediatrics is such a happy place to be. Okay I already knew that.

Even though my pediatric rotation is coming to an end, I still have so much to look forward to and so much I have enjoyed. I learned a ton during this month, worked with some impressive physicians, got a recommendation letter, received tons of advice, and improved my clinic skills greatly. Next month, I get to go home and stay with my grandparents while working in my home town. I'm excited to be able to actually be part of my family for a few weeks. On December 1st, my father and I are going to my first NFL game which just happens to be one of the biggest games of the year. And I'm getting closer and closer to the time where I will get to spend all of my time either in pediatrics or the emergency room. Back to studying!

Time Off

Apple Cider Press

Time off from rotations, studying, and my part time job is almost impossible to find, but I got a couple days off this past weekend to see my family. Every year on the first Saturday in October my grandparents put on a Annual Apple Cider Party. They have been throwing these parties for more than 20 years. My grandpa has an apple cider press that is probably 150 years old that he has attached a motor to and my grandma spends days cooking in preparation. When I was a kid there was no motor on the press and so making apple cider was hard work. You had to cut the apples up and then hand crank the press. The motor really cuts down on the labor, but every once in a while you will get someone who wants to try to hand crank the press and my grandpa will put the handle back on.
There is nothing quite like homemade apple cider. For me, fall officially starts every year on the first Saturday in October.
For the last several years I have only been able to make it to the party for a few hours because of studying or work, but this year I really needed a whole day with my family. No matter how much you love what you are doing everyone needs a break. My 18 month old niece has become a walking, jabbering toddler while I've been studying. She has an very interesting group of known words and runs straight for the stairs even though they aren't her strong suit yet. I helped the kids put apple into the cider press which basically becomes a game of basketball between 5-8 year olds. I get the same questions every year about how much longer I have left and how things are going. This year I was excited to field those questions. I'm loving what I am doing and I only have a year and half left of this part of my journey. I enjoyed a long conversation with my grandpa's best friend who happens to be a dentist about what it is like to have conversations with non-medicine people. Apparently, non-medical people don't like to talk about guts at mealtimes. Who knew? And I was only asked once if I was going to get married any time soon. At sun down the 2013 Apple Cider Party was declared a success.
When the guests started to leave and the press shut down, we moved the get together into the house and continue on with drinks and cards. My whole family plays pitch and it normally gets a little wild in there. Lots of trash talking and telling of embarrassing stories. Laughing and sulking. It never gets old, but even I have joined the "old" crowd and when it hits 11 I'm exhausted.
Come Sunday I was able to sleep in before heading over for a little breakfast and goodbyes. Then off to my mom's for Sunday dinner. It has been weeks since I have been home for dinner and it was nice to have some home cooking. My nephew is also walking, but only a couple steps at a time. It is as if after he takes 2 steps he is surprised and falls down. My parents also adopted a little boy and girl who are 5 and 7 now. They spend from the moment I walk in until the moment I leave attached to my side. Nothing beats the excitement of children. They both are loving school and ready for halloween. We played several boards games and though the little guy normally likes to quit in the middle when he gets bored he made it through several games before dinner time. We found that Janga is right up his alley.
It's always hard to say goodbye when I know it will be another month before I will be home again. With my upcoming Pediatric Shelf exam and lots of hours left to put in it will be impossible for me to sneak home again until November.
Last week and this week I am spending in the Well Baby Nursery. Newborns are a whole different kind of world. Though initially I thought it would be difficult to flip a baby over to do the full exam, I have found it is pretty simple. Newborns are very peaceful. I spend a couple days in the NICU next week and then I am off to primary care pediatric clinic.

A little time by the fire

Lots and lots of cider

It's The Little Things

It's the little things that make the days worthwhile. Medical school can  be tough on the psyche because there is so much pressure and a big push to be perfect, to get everything right. Sometimes you don't get a whole lot of feedback and you are basically clueless how you are doing and what other's think. More than half of your clinical grades are based off of people's opinions and sometimes it is hard to make an impression and even harder to make a good impression. While other students fight this by being very assertive, I have never found that to be my strong suit. So when I'm drowning in stress and worrying about what people think it is the little things I count on. It is the little things that tell me I am doing the right things and on the right track.
Originally when I was thinking about this post I wanted it to be all about 1 simple statement a family made to my attending my last day of inpatient pediatrics, but then sitting down I realized throughout the month there were several times where I felt good about where I am in my education. I think the first statement was made by a nephrologist. During my first week of speciality team, I only saw endocrine patients for several reasons, but when given the opportunity to see a nephrology patient I was hesitant. The renal attending for whatever reason intimidated me. He seemed more formal and I thought it was much more likely I would "fail" seeing one of his patients then seeing one of the endocrine patients. I remember after I saw my first nephrology patient I was nervous about presenting and not knowing the right answers. By this time I was comfortable with my residents who I loved working with so that helped with the confidence level. I felt like I really clicked with the family and had a good rapport with them so that also helped. After I gave my presentation and was able to answer any questions he had I felt better. But it was the quick moment as we walked out of the room where he simply said, "that was very good" that made the difference. It was that moment where I felt very accomplished. A simple statement that made me want to do even better.
I continued to feel good about how I was doing on speciality inpatient rounds and by the end of those 2 weeks I felt confident in my ability to talk to kids, come up with plans, and give presentations. As I mentioned in a previous post, it was hard for me to see those 2 weeks end and part of that was because of the really good residents I worked with. I still feel like I owe a lot of my growth during this month to them making me comfortable and pushing me to progress. It was the last time that I saw my intern that was another one of "those" moments. In her goodbyes, she said "I am very impressed."Another moment where I knew I was doing okay.
Then there is the moment that inspired this post. It was my very last afternoon of inpatient pediatrics. We had a child come in with pneumonia and associated empyema who would need a chest tube for drainage. I went in first to talk with the family, get the history, and see how the little one was. The child was obviously uncomfortable and the family was very concerned. They had lots of questions and requests. It was very touching to see a room full of people who clearly really cared about this child. I answered all the questions I could and assured them I would get the answer to any of their other questions. The first thing I did was ask the attending to put in orders for some of the parents requests to get the ball rolling. After a quick presentation, a couple of phone calls, and entering some orders, the attending and I went in to see the family together. It was a nice moment when she told the family the same kind of thing that I told them. It made me feel like I had given them the right information and was on the same page as the attending. But the big moment for me was as we were leaving, the father said, "I just wanted you to know that your student did really well answering our questions and reassuring us. We felt a lot better after she came in."It was a moment of encouragement. I had given accurate answers, said the right things, and made a difference in the care of my patient. It is moments like this that make me want to work harder, to learn more, to be more. It is moments like that where all the stress, pressure, and exhaustion are worth it.

Nights

It has been an incredibly busy week. I finished up my week of overnights a couple of days ago and it has clearly done weird things to my sleeping schedule. Though I totally don't blame being up right now on my week of nights at school. This is because I just got off of work and I am due in at the hospital in a couple of hours. Sleep is overrated anyway. I really need to learn how to like coffee, but I digress. Nights was a good time. A totally different experience. Basically on nights you admit people to the different teams and keep them alive and stable until the day team comes in. Some nights were extremely busy with lots of admissions waiting for us when we got in and other nights were relatively quiet. We managed to make it through an entire season of House, though I missed parts of most episodes I got the general idea of each episode. It was a laid back atmosphere with everyone just trying to stay awake through the night. I saw lots of interesting cases, some sad cases, and practiced my auscultation and image reading skills. The resident I followed most of the week had lots of bits of advice to offer which were extremely helpful. I have seen 2 unvaccinated kids in the last couple of week(get vaccinated people it keeps you healthy.) I have seen countless abscesses in countless places. I can't think of anything more painful that having an abscess drained. Kids are not a huge fan. Imagine having a pimple that was several inches big and having someone push the pus out of it. You get the general idea.
I have seen some great parenting. Parents who just want their children to get better. Who love their children no matter what. Parents who show a huge amount of devotion to their children. They sleep on uncomfortable, short window couches for several days, eat cafeteria food, and call into work for a week. They support their children, make them laugh, and stay strong for them. On the flip side I have seen some not good parenting. Parents who skip nighttime feedings because they want to sleep through the night. Parents who stay at hotels for the week and roll in late into the morning and stay for an hour or two before leaving for the day. Not to mention a couple cases of abuse. These kids break my heart. I'd like to save the whole world. Though I know that isn't possible, I'm going to keep trying.

I also lost my stethoscope for a couple of day. It is an extremely stressful situation. I bought a lightweight replacement while I searched and searched. Finally I found it to my relief, but you never really know how much your expensive one means to you until you don't have it anymore. I am still trying to find the perfect scrubs. I tried a couple different brands this week in a couple different sizes. So far no luck on ones that are the right length and fit the right way. Maybe the next pair.

I'm very disappointed that this is my last couple of days on inpatient pediatrics. I have really loved the last month. As I was telling my big boss yesterday about the people who I have been working with at the hospital and the general attitude of the residents and attendings, I thought he made the perfect statement. "They are the way people are suppose to be or the way you wish people were." Happiness spawns more happiness. Happy people who love what they do and care about the people they help are inspiring. Somehow society undervalues those kind of people.

Being this busy has caused me to lose track of the world. Though I did a little catching up over social media one quiet night this week for the most part I have been MIA. On my way to work this evening I remember thinking, "I miss my mom." She texted me a couple hours later to check in. I guess she must miss me too. Choosing medicine you give up so much social time. You miss soccer games, sunday dinners, and friend time, but you appreciate the time you have even more. I definitely didn't know how much of a sacrifice dedicating my life to medicine would be, but I am still happy everyday that I did it. I couldn't imagine being anywhere else.

The Last Day of Speciality Team and The Beginning of the SP/JP Partnership

I went all week thinking about that awkward "well see ya later" I would have at the end of the week when I would leave the nephro/endo team for the last time on Saturday. I wasn't looking forward to when that moment came and not really because of what I was sure would be an awkward goodbye, but because I really enjoyed it. I woke up every morning between 4-430am, showered, had my tea, and headed off and I always looked forward to going back. I was excited to see how much progress I would make or what my day would be like before I left in the morning. And let me tell you, I am not normally a morning person. For several years I was the get up at 10-11am kind of person. I thought getting up this early would be TORTURE, but it wasn't. The week went smoothly and I again learned so much about kids and general medicine. I saw many diseases I had only read about and learned a more practical approach to several problems. I got even more encouragement for progression and when Saturday came I felt very confident about the progress I made during the week and how I was doing. I truly believe that the more comfortable that someone makes you feel while you are learning from them the easier it is for you to learn and the less likely it is that you will make some silly mistake because you're anxious. Working with the nephro/endo team I felt at ease everyday and knew that I would do a lot of learning each day. When Saturday came it was like any other normal day, I saw the 2 patients I had admitted the night before, got feedback, and wrote my notes. When the work for the day was done and I had done one last round to make sure my patients were okay, I said my awkward goodbyes which turned out to be not as awkward as I was expected. I really want to thank the team for how much help they gave me, but I know nothing I said would really convey how thankful I really was for the last couple of weeks. When I walked out of that room I felt satisfied with my experience and ready to take on the next big thing. Today I started general pediatrics. Sundays aren't your typical days, so I am hoping tomorrow is a little more smooth and I do a little better. I definitely need to brush up on my asthma!
One of the other exciting moments of the week was the beginning of my Senior Partner/Junior Partner relationship this week during adult medicine clinic. Every friday I do a half a day of clinic and when I started I had my own senior partner who taught me the ins and outs of clinic, physical exam, and history taking. This was my first "official" week as a senior partner though I had met my junior partner before. It definitely feels a lot different when you have someone who is watching and learning from what you do. I hope that I will be able to be a good partner for him and he will do well when it is his turn to do it on his own. He seems very advanced for his current education level and I am sure he is going to be a great member to our docent team.
Today's plan is to do a little studying on brushing up on pediatric physical exam. I'm also going to start working on my CV and personal statement. I suppose it is time to start putting that kind of stuff together. And then maybe a little nap :). Happy Sunday!

The Young: The beginning of pediatrics

My first two weeks of peds have been bittersweet! I love pediatrics. I love working with the kids and the parents. The residents are amazing and the attendings are awesome. Talk about a hospital full of super nice people. I get daily feedback and lots of help along the way. More importantly there is a lot of encouragement for growth and everyone's excitement and enthusiam for learning is refreshing. The other hand, the more bitter piece is that the kids are sick and on the service I am on now, they are normally very sick. I have been rounding with the Nephrology(kidney) and Endocrine(hormones) specialities for 2 weeks and though I have learned a ton, each patient has their own stories and will have their own struggles. These kids are mostly new onset diabetics, renal transplants, or otherwise sick in some long-term way. We have only had one little guy on service who went home healthy and wouldn't require chronic(long-term) care for a lifelong condition and even he spent 27 days in the hospital. We all like to picture kids as well taken care of, healthy and super active/happy, but unfortunately that isn't true for all kids. 
When my baby brother(who is most definitely no longer a baby anymore-he is like 6 feet tall) was young, he was diagnosed with type 1 diabetes. Talking to our dad about his feeling when it come to my brother's chronic illness gave me some insight on what some of these parents must be feeling and thinking. My brother was diagnosed almost 10 years ago and our father still wonders if he had dealt with things differently if things wouldn't have turned out this way. The answer of course is no. One of the things I love about the fellow I've been working with on the endocrine team is he always starts his first discussion with the family with the same speech. "You didn't do anything wrong. There was nothing you ate, nothing you fed your child, nothing you exposed them to that caused this. It was just something that was going to happen." Though the team deals with diabetic children every single day, for the family and the child this is new. It is life changing. These kids were harder for me, because of my brother. A lot of them were very sick and spent several days in the ICU before coming up to the regular floor where I saw them. Some of them were teenagers and others were tiny 5 year olds. One of my other favorite statements the endocrine team liked to make was, "you have to make diabetes part of your life, but you don't have to make your life diabetes." A good way to say that this is not the end of the line. Life will keep going even though right now it might seem overwhelming. I have definitely gotten pretty good at adjusting insulin doses and being able to evaluate DKA. I also have a great appreciation for the diabetic educators who play a HUGE role in helping these families get ready to go home and deal with this on their own. 
The nephrology patients for the most part were kids who came in after having a kidney transplant with various compliants. They were known to the system and were just special case patients who needed extra kidney attention when dealing with other issues like infections. However, the hardest patient for me to see was a new renal patient. She came in complaining of no real symptoms except occasional headaches for several months. She really only came in because her primary doctor told her that one of her lab results were abnormal and she needed to be seen by an inpatient doctor for evaluation. After lots of poking and tests and finally a renal biopsy, she got a diagnosis of IgA nephropathy. Basically some of the proteins created by her immune system were depositing in the kidney and causing inflammation and scarring. Her kidneys were slowing losing function. Her headaches were from high blood pressure. She went from being a happy teenager who just made the cheerleading squad to a teenager with stage 4 chronic kidney failure who would need long term treatment and would eventually progress to end stage renal disease and require dialysis or transplant. She is in the "this is not fair" stage and I couldn't agree with her more. If I could wave a magic wand and make it all better, I definitely would. But instead we will depend on science, research, and hope for a good response. For now however, she will get to return to life, get to be a teenager. At least for a little while. I hope it is much longer than expected.
I only have one afternoon and another full day left with the endocrine/nephrology inpatient team, but I feel like I have made a ton of progress! I have really enjoyed the residents and attendings I have worked with over the last week and a half. Part of this makes me want to do pediatrics first and then specialize in pediatric ER through that route, but for now I'm sticking with ER first. I am excited about finishing out this portion strong, learning everything I can possibly learn in a couple of days, and moving forward to general pediatrics come Sunday. I just hope next week's experience is just as valuable as the last couple weeks.

USMLE Step 1 Advice

These are the things that worked for me when I studied for step 1. The most important thing is to cover everything and stick to a plan. With that being said, if your initial plan isn't working then make modifications as necessary especially early on. I ended up studying for about 6-8 weeks. You will definitely be in a far better place if you study throughout your medical school years with First Aid then if you are looking at First Aid for the first time when studying for step 1.

General
1. I went through the material by using First Aid as a template. The basic stuff I just memorized as I went through. Then when it came to systems, I would go through first aid, then phys, then rapid path, embryo, anatomy, etc.
2. When you go through Qbanks do a full block(46), timed, unused and then go through the explanations when you are done. Add notes to your first aid as you go through and make a list of 3-5 things that you are going to master when you are done reviewing that block and then do it again.
3. I found studying the material more useful than doing just the Qbanks. This is different for everyone, but don't be afraid to focus on First Aid and other material and not Qbank if you aren't making as much progress as you want just using Qbank.
4. Regularly access how you are progressing and keep a list of the things you are accomplishing. It helps you to know if you are accomplishing thing and when you feel like you haven't done anything it is a nice reminder that you have done all these things and made all this progress.
5. Keep to a routine. Wake up and go to bed at the same time. Eat well, drink tons of water, exercise, drink tea, and have some "me" time. Go outside occasionally.
6. Set a goal score so you aren't just taking a shot in the dark. There is no reason to assess how you are doing if you don't know what you want. If you know what speciality you want to go into then there are charts to show the average board score of those who matched. You want to shoot for something over the average of your given speciality, but be realistic and don't set yourself up for failure.

Materials
1. FIRST AID! This is a skeleton of what you need to know and should be treated as such. It is a must have as anyone would tell you, but by the time you take boards half of the writing in that book should be your own from adding your own notes and information. Many things on step 1 can be found in first aid, but it isn't enough to get a good handle on a lot of the concepts or the details.
2. Goljan lectures. I would suggest doing these during path(I didn't but wish I had) and then doing them at the beginning of studying for first aid. These are really easy to listen to and he makes things that seem super difficult very easy.
3. Goljan Rapid Review Pathology. I LOVED this book! I think this is super helpful for understanding a lot of things and would suggest going through it. You can skip parts like the ear and eye which go into too much detail, but for the most part a lot of the information is essential. Knowing everything in this book will help you get above average.
4. BRS Physiology. This was useful for some sections. I liked the general information chap 1, endo, and GI. This is not necessary for success, but good if you are weak in phys.
5. QBanks. I used by UWorld and Rx. I wouldn't suggest Rx. I really only got it because I thought I was going to study for several months instead of just a few weeks. It has some good questions, but you are already spending a lot of money and it is not necessary. UWorld, however, is necessary. Unlike others who say you absolutely have to make it through UWorld, I don't think this is true. I did not end up finishing UWorld, but I do think you should do as much as you can get done. I learned more from first aid and goljan than Uworld but you need to know how the format questions and it helps to find your weak areas and helps you to know which concepts that you think you understand that you really don't understand.
6. NBMEs. I would suggest taking at least 3 of these, but if you can take them all and review the questions you got wrong. It is helpful to see where you are, but my score was higher than any of my NBME scores so don't freak out if you are not scoring where you would like. However, it is more like the actual exam than the Qbanks so do them if for no other reason then for simulating the actual exam.
7. Use some kind of Atlas for anatomy and look up anything mentioned in Qbanks and path in your atlas. First Aids weakest spot is anatomy.
8. Embryology. I did high yield. It has too many details for step 1, but I am still glad I did it because step 1 has more details than First Aid.

General Tips/Info
1. The pharm in First Aid is more than enough
2. The micro between first aid and rapid path is enough. You really don't need an extra micro book.
3. Review what normal XR and CTs look like so you can at least know what is abnormal and be able to take a good guess if you haven't seen it before.
4. Actually that goes for about everything. If you know what normal looks like and you have a good knowledge base, you can basically make a pretty good guess or eliminate things even if you have never seen it while studying.

USMLE Step 1: The Journey

The thought of studying for step 1 is something med students try to avoid their first couple of years and are happy to forget once it is over. It is a time where you brush up on all of your basic sciences and prepare to prove what you know on a standardized test. The stress that comes with the test is unimaginable. If there is a single most important thing you put on your application for residency it is your step 1 score. It is this magic score that determines where you can apply and in what speciality. No pressure!
I started with the best of intentions and was going to study for 7 months. I ordered my books and that first 2 weeks of that 7 months I did some reading, but then I got lost in my other responsibilities and step 1 studying took the back burner. I worked, finished some of my undergrad courses, and did some crafting. It was a joyous time, but eventually step 1 got closer and after a stern talk from the council on curriculum, I settled into a studying routine. I cut down the amount I was working and studied from the time I got up to the time I went to bed. I saw basically no one and sit in the same place everyday for about 8 weeks.
My normal day consisted of a morning routine(aerobics, tea, shower), First Aid, Qbank, and then a night routine(tea, sitcom, stretching.) I actually got very comfortable just doing that every morning and I really enjoyed it(I know I was surprised too!).
Well I enjoyed it when that routine thing actually worked out. Nothing in my life has been all that simple and some of the things that make me the happiest also have the ability to make my life very difficult. That first week was ideal, I made tons of progress. The second week, my grandma had a TIA. I am incredibly close to my family and when I got the call, I went straight home. We initially thought she had, had a stroke, but after a couple of difficult days she regained all function and was able to go home. First obstacle, check. A couple of weeks later, car problems. With boards just a few weeks out I was very worried about making it to the test which I would have to take a short road trip to get to. So back home for a little help from my dad. Second obstacle, check. Then the first sign of good news was my successful NBME on the 4th of July and to celebrate I headed home for a night with the family. You know that feeling you get when you can tell something is wrong or that look written across someone's face when there is bad news? Well with a combination of those things, I could tell sometime wasn't quite right at home. My grandpa was diagnosed with Stage 4 Lung Cancer which had metastasized to his brain the day before(sometimes knowledge is a burden). Third obstacle, check. After spending an evening with my grandpa, I had to put that at the back of my mind and move forward. I was feeling pretty good about all the progress I had made and with a week left before my board exam I got very sick. A combination of an ear infection, walking pneumonia, and costochondritis. I spent my last week studying on the couch, sleeping, and taking antibiotics, but luckily I was feeling 100% a couple of days before my exam.
The day before my exam I didn't study. I had a 2 hour drive to make and a hotel room booked close to my testing center. I got my hair cut in the early afternoon and headed out. After checking into my hotel, I ate at a local restaurant, took a bath, had my tea, and went to bed early.
The morning of my test, I surprisingly didn't feel nervous. I had actually felt much more on edge the week before. My biggest regret was not getting up earlier so I was more awake for my first block of questions. The test is 8 hours long with about 45 minutes of that being a break you can take in-between blocks of questions. Each block is 46 questions and you have 1 hour to complete them for a total of 322 questions.
Entering the testing center felt like entering a police station. It was a long hallway with chairs and a fridge at the end of the hall. I settled into a chair and waited. Shortly a lady came out of a door and gave me instructions on where to put my food and drinks, that I couldn't have a backpack, they would be taking all electronics which needed to be turned off, and all other things would be put into a locker. The final direction was to keep my drivers license with me at all times. After listening to all the directions, I followed her into the check in room. I was photographed, fingerprinted, patted down, and my things locked up. It is a very controlled environment. After sitting down you are provided ear plugs from the testing center, a small fan, and are watched my 3 different cameras. Good thing I'm not camera shy.
 The first block of questions was a little rough, but after a quick break which included jumping around and doing jumping jacks in the parking lot, I was ready to go and the last 6 blocks were successful.
After I finished the exam, I didn't have the initial wave of relief I thought I would have. Overtime I quit thinking about it, except on Tuesdays. Test results are always posted on Wednesday mornings, so I rarely slept well on Tuesdays. On the 4th Wednesday after my test, I finally got the email saying my test results had been posted. I was on my Psychiatry Clerkship and checked them after we got done rounding in the attending's office. When the results finally loaded up, I felt the urge to jump up and down, but contained myself in front of the rest of the team. I am incredibly satisfied with the results I got, though I can still remember 3 questions I should have gotten right, but didn't. Maybe one days I will forget those. Since the results have come in, I don't really think about it. Life has of course moved on and the next challenges of med school have already taken over.

Mania, Grandiose, and other things hard to imagine

As a 6 year med student you are required to rotate in several different "core" clerkships in your 5th year which includes Surgery, OB/GYN, internal medicine, psychiatry, and pediatrics. Basically it is 2 months(except for psych which is 1 month) where you learn all the basics to a field plus some obscure facts for your national exam while freaking out about what you are going to specialize in. After a long, stressful, and difficult 6-10 weeks of studying for step 1, I started my first clerkship at the beginning of August: Psychiatry. Before starting I thought I knew what mania was like, a general idea of grandiose would be like, and had a certain idea of what a month in psychiatry would entail. I couldn't have been more wrong. Nothing in a textbook can really prepare you for what the extremes look like and the frustrations that come with being in psychiatry. You are diagnosing patients who are having a break from reality or are overall difficult and though you may want to say "you stop that and cooperate." It would do you no good. They simply are not capable of the impulse control and decision making that those of us who are not suffering from mental illness take advantage of every day. These are some situations which stick out from the month.

The Manic with grandiose ideas: my first interaction with him was nothing short of memorable. Cursing at the staff physician and resident to get out of his room, shouting he had written the DSM and he was a physician who had diagnosed the attending with being a sociopath, and promptly refusing any medication. Through his 96 hour hold his list of grandiose beliefs grew and eventually landed him in a 21 day hold. He believed that he had served in the korean war and on the USSR(though he had not been born yet), had created the internet, had 5 doctorate degrees from any ivy league university before he was 5, owned his apartment building and the buildings on each side of him, that the staff were all foreign spies who had infiltrated the system and were keeping him against his will so he wouldn't warn the military that they were trying to steal the US reserve, that the officer that brought him to the ER was a russian spy, his neighbor a child molester, he had written the DSM and created all 3 tiers of psychiatric medications, and the list goes on. A meeting with him would surely end in him declaring you a nazi and sociopath. Did you know that Hitler ended up in a zoo? Yeah me either.

The Praying Schizophrenic: each schizophrenic has different delusions and hallucinations and though it is still not clear what this person's delusions and hallucinations are it is sure to be something to do with religion. He is also a diabetic which causes other special concerns, but a week ago he decided to start refusing all medications. Both psych meds and medication for his hypertension and diabetes. He also stopped eating, drinking, and sleeping. He simply sits in the same spot all day praying in a different language. Anytime he is disturbed, he becomes aggressive. He will get a long term injection and hopefully come out of his psychosis.

The "normal" suicidal patient: most people don't want to be in the mental hospital. It is a locked facility where you are checked on every 15 minutes if someone isn't constantly with you already. Your time outside is limited and otherwise you are basically in your room or the common area or groups. It is a very structured environment which is great for psychotic patients, but for others it can be terrifying. Your freedom is taken away and you are locked into a facility with others who are having a break from reality. I called this patient "normal" because she wasn't having a break from reality, however there is nothing normal about being suicidal. The attending physician was discussing personality disorders with us when there was an urgent knock on his office door. She came in sobbing and demanded to leave. To her dismay the answer was of course no. She then demanded to know if we could legally hold her against her will and the answer of course was yes. She was distraught. She had a career, a house, a dog, but she was depressed about not having a family and not being able to have children which eventually led to her to being admitted. After a 96 hour hold(which does not include weekends so more like 140 hour hold) she was release with resources, new medications, and an eye opening experience.

So what did I learn in psych? They have the most unpredictable patients, spend a lot of time dealing with legal issues, and are tested on a daily basis. I have no idea how much money they make, but I am sure it is not enough. Bless their hearts for being able to care for people who need it the most.

Today was my last day. I am curious to see how the patients who are just now starting medication and treatment will progress, but onward I go. Next week is the beginning of pediatrics. Wish me luck!

What the Heck is an FMD?

I first heard the term FMD as an 18 year old eager/stressed/overwhelmed first year medical student. I'm not sure if the person had made it up or heard it somewhere else but I still remember it. FMD=Future Medical Doctor. I thought it was super clever perhaps that is why I remember it. I was so easily impressed and had just begun my long journey as a FMD. There was nothing else in the world I wanted to do more than to be where I was at that moment. I had decided that I was going to be a physician when I was probably 8 years old and whether it was my passion for helping people or my hardheaded determination to stick with what I decided on, I never changed my mind. I learned about the 6 year medical program when I was a Freshmen in high school and from that moment on everything I did was to get into that program. When my acceptance letter came, I cried. Calling my grandma(who is by far one of my biggest cheerleaders) while crying, her first words were, "Oh honey, I'm so sorry." It was the tears, they confused her. Choking back my sobs, I said "grandma I got in." She of course was ecstatic and proud. Neither of us knew what the hell I was getting myself into. That first year of ups and downs and then just downs, I never really could picture myself as a doctor. Actually it probably wasn't until I got back my Step 1 score a couple of weeks ago that I really could see the light at the end.
It seems so surreal that in less than 2 years I will be writing prescriptions, getting even less sleep, and going by the title Dr. It was probably just a few months ago that I realized how lucky I am to have the experiences and opportunities that I have. I have been writing a crafting blog for a year and half now and it hit me while writing this last entry that I should write about my experiences. If for no other reason than to encourage those who are in my shoes when things don't go right, to keep some kind of correspondence with my family who barely see me, and just to look back on for a laugh when that FMD is just a MD.
I hope this blog will be entertaining, humorous, encouraging, inspiring, and above all worth the read!

Fall of Year 1

Spring of Year 1

Moving into the dorms...Do I have enough pictures???