Last Post

In the dwindling hours that remain for me to be called a medical student, I wanted to post one last blog entry for you all. I hadn't had time, but thanks to some drunk woman yelling outside the hotel room at 02:18, I am wide awake and able to write this the night before I lose my title of Student Doctor. Thankfully, my aunt was able to get hotel rooms near the graduation venue and I don't have to drive in early from where I live an hour away. Anyway...

Tomorrow is the big day, when I and the other members of the inaugural class of my medical school finish what we started four years ago. This is only one milestone in a journey that started not four years ago when we got our acceptance letters, but many years before that, when we first got the crazy notion to become physicians. It's only through the support of my family and friends that I got this far, and it's only with their continued love and support that I will be successful in the continuation of the journey. I want to thank each of you who have helped me along the way for your encouragement and the belief that I could accomplish this - I truly could not have done this without you.

In the weeks leading up to now, I have had the whole gamut of emotions: being excited that I will finally become an actual doctor, terrified that I will finally become an actual doctor.... Currently, I think the whole situation is too much for me to grasp. I always thought I would be more excited as the hours counted down to the ceremony, but with the combination of the finality not quite sinking in and the fear of the unknown as my internship approaches, I am emotionally neutral.

Speaking of internship, I have been accepted to a Traditional Rotating Internship, which is the fancy name for the training year that used to be the standard or newly-graduated doctors, so they could get more experience in first-hand application of the main areas of medicine before starting specialty training. While it was a disappointment not matching directly into a program to focus on a specialty more quickly, I am grateful to have a place to go next year. Since this program is only one year long, I turn right around and start applying to residency programs again, which is the same process as last year. While internship year brings quite a workload, I am expecting that it will just be a blur and I'll be in residency proper before I know it.

I may post one last, brief entry with graduation photos, but if not, my next posts will be at my new blog, Life of an Intern.

Scott

March Newsletter

At the end of last month, I noticed an interesting trend regarding my white coat. When I started rotations, I was careful to always keep it on a hanger during transport. Always. Next was placing it neatly on the car seat, then tossing it on the car seat, and finally I've taken to stuffing it in a bag. One could say this represents a shift from superficial matters to more meaningful ones, or from trying to meet expectations to just not caring. Without locking myself in to a viewpoint on the significance, I thought it would be interesting to share how actions change gradually.
Within the last couple months, I had been having a rough go of it again. I was fed up with medicine and looking into alternative career paths. Last month, I was re-reading some of my blog posts and was surprised to find how seriously I had contemplated dropping out of medical school in the past. This made me think about how easily I forget past unpleasant experiences. My current problems are the only ones of their kind I've ever known and I've never experienced them before. At least, that's what I thought. I'm exploring a new world and keep finding my flag planted firmly in the ground. Anyway, I hope I can be more cognisant of struggles, successes, and failures so I can learn from them and not keep re-covering old ground.

In the relationship realm, I've come to the point where I am ok remaining single and ok if I get married. While I sometimes pine for a relationship and other times feel grateful I have no commitment, my overriding feeling is one of peace with my situation, and my focus is on other aspects of life. Not to say that I don't notice pretty girls. One of the reasons I'll be sad to end my current rotation is that I'll never again see a dietician who works in the ICU. That's a story for another time, though.
Speaking of my current rotation, it is my last one of medical school! I'm finishing up with a few weeks in the ICU. After that, I'm hoping to get a job to help with cash flow until my first paycheck of internship. I'm not sure what sort of position I could get for only a few weeks, but I'll try.

As I will no longer be a med student come May 19th, I will be switching to my new blog site, Life of an Intern, shortly after graduation.

Scott

February Newsletter

I have big news! I was accepted to a traditional internship year in West Palm Beach, FL! I had to scramble since I didn't match anywhere. The match is the process by which training programs rank their choices of applicants, applicants rank their choices of programs, the rank lists are input to a computer, and the computer does some occult magic before spitting out the results of who's in what program.

Coming directly out of medical school, one option for the fresh doctor is to do an internship year, consisting of month-long rotations in the major specialties, then re-apply for a residency in the next application cycle. The other option is to start right into a residency. Or, if you're like me, the latter isn't much of an option. Anyway, the process is more convoluted for some specialties, but that's how it works if you're going for orthopedic surgery.

February's rotation fulfilled my Rural Medicine requirement. It was Family Medicine out on the eastern plains of Colorado. I know I was all excited last year when I finally finished what I thought would be my last interaction with Family Medicine, but I liked this rotation. My favorite part was having a large amount of freedom, handling many patient visits alone. The attending would always touch base with the patient, too, but for simple cases and ortho-related cases, she would mostly defer to my clinical skills and decisions.

Some of the more exciting cases pertained to toenail removal, oddly enough. One girl had an ingrown toenail and I got to remove a section of the nail. Another girl had somehow broken her nail during sports practice and most of the distal section separated from the underlying nail bed, and I got to yank it the rest of the way off (this case was also neat because the patient was reluctant to have the procedure done and I was able to talk her and her mother into deciding to do it. I don't condone strong-arming patients into decisions they oppose, but when you know a certain treatment would be best in the long run and the patient just has trepidation about the short-term unpleasantness, it's satisfying when you're able to talk them through their fears).

In both toe cases, I had to do a digital block before proceeding. A digital block consists of injecting anesthetic just past the MP joint near each of the four main nerves supplying the digit. I used lidocaine, which is shorter lasting, but sets in faster. Another option would be to use a longer-acting agent like bupivacaine, which also takes longer to take effect. If you want to be really slick, you could use both so you could start the procedure sooner and the patient would be pain-free longer. "So, why didn't you do that?" you ask. No, I'm not a monster; all we had was lidocaine coming out of our ears and one single vial of bupivacaine that had expired. Besides, when I was a kid, for anesthesia, you were lucky to get a stick to bite on, you had to walk uphill in the snow both ways to get to the doctor, and...

Speaking of anesthesia, at the end of February, I started a two-week rotation in anesthesiology. So far, it's not been as overwhelming as I anticipated. I have a good attending who likes to explain concepts and get me involved in patient care. Hopefully I'll get to intubate some patients and do arterial lines (placing the air tube into the patient's trachea and placing a catheter in an artery, respectively).

Keep it secret, keep it safe. Most of all, keep it real.

Scott