Sunday, September 29, 2013


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.

Sunday, September 15, 2013

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!

Thursday, September 12, 2013

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.

Thursday, September 5, 2013

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.

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.

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.