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

Newsletter Catch-up, Year-end Wrap-up

As you know, I've not posted for a good long while. I've been going through a patch of uncertainty regarding my career, but have been able to work out a manageable plan. But I'll start at the beginning of the year.
2011 brought the second half of my third year of med school, to round off my first year of clinicals. I enjoyed some rotations, endured others, had doubts about becoming a doctor, and swung back with experiences that reminded me why I want to be a doctor. In June, I was able to rotate with my uncle, a doctor, and one of his colleagues, which was a good experience for me. My school told us to use July as a study month to prepare for our second run through the gauntlet that is the boards. In August, I had my first audition rotation, the idea of which is to impress the director of a residency program you're interested in. Having no audition rotations set up for September, I did emergency medicine since it's a fourth year requirement for my school.
I thought my rotations would be good preparation for the second board exam, but right at the end of September I found out I had failed it. This news came at a critical juncture, shortly after I had finished my first audition rotation and right before I headed off to start a gruelling four-month stretch of audition rotations. During this stretch, I had planned to pack my belongings into a storage space, be without a home, and literally live out of three or four bags. With feelings of inadequacy always lurking below the surface, failing the board, intimidation by the long string of difficult rotations, and the thought of being basically homeless, I started considering non-medical careers. That is, of course, putting it mildly. I was going to drop out of med school outright, but thankfully was able to think it through and decided the best course would be to at least graduate.

I think one of the major issues I had with medicine was feeling it had taken so much from me: the ability to have a relationship, a family, having free time outside of work, basically just having a life. Several events have shown me that I can have a real life, and I came to realize it can even coincide with a medical career (sorry, explaining the events would take too long). I have started warming up to medicine again and can stomach the idea of finishing med school and even going on to internship or residency. This is still a daunting task, but I am hopeful for what the future holds and am more grateful than ever for the support of loved ones.

Hope you all had a merry Christmas and will have a happy New Year!

Scott

EM Month Winding Down and First Interview

I was very proud of myself recently. I saw a patient with a history of panic attacks and meth addiction. Supposedly the meth from her most recent relapse had worn off and she was solely under the influence of a panic attack when she got to the ER, but I have my doubts. In any case, what I'm proud of is that I was able to calm her down with with a reassuring tone, redirecting her attention, and having her do deep breathing. This was an ego boost not only because I was able to calm a distraught patient, but more so because the whole time I was thinking what a mess her life is and how I didn't want to be dealing with her. So, yes, I'm bragging about my hypocrisy in some ways. It's important, though, to be able to get over your own feelings, judgments, etc. about a patient and be able to provide appropriate treatment. I thought I was already cynical, but this month in the ER with at least a third of my patients being drug seekers has really been an eye-opener and tried my standpoints on the cutoff between providing for patients' needs and being an enabler of unhealthy habits.

Another interesting patient was a quite mature, almost precocious, teen with abdominal pain. I needed to examine the patient's abdomen, and decided it would be best to do so without pants in the way (US pants, not UK pants). I was reminded of the Scrubs episode in which Turk is reluctant to see his doctor because he has to take his pants off for all visits. "Oh, you have a sore throat? Ok, take off your pants and I'll be back in a moment." This ER patient is also a Scrubs fan and I was able to connect over the pop-culture reference. With this patient's maturity level, I had already been able to establish a good rapport, but it was good to see how that personal connection can further put a patient at ease. After the initial ER workup, the general surgeon admitted the patient for observation since the pain was reminiscent of appendicitis, but wasn't as severe as would be expected, plus the appendix was not assessable on CT.

It's worth while to highlight some differences between the two patients above. For the drug addict, I had to step up my interaction with her from my default of not wanting to deal with her. For the teen, I was drawn into conversation and had to rein in my desire to chat in too informal a manner. In both cases, it was important to form a personal connection with the person while maintaining objective professionalism.

I was invited for my first interview yesterday. I have applied to both Orthopedic Surgery residencies and Traditional Rotating internships in case I don't get into an ortho program. The traditional path of medical education was to finish med school, do a generic internship year rotating through all major specialties, then do residency. Some residency programs, ortho included, have wrapped an internship into the curriculum as the first year of the program, and therefore take one step out of the process. My interview offer is with one of the internship programs, and the most convenient available interview date is this coming Monday. So, I had a flurry of activity booking a flight and hotel today. Thankfully the airport, hotel, and hospital are within a 3-mile radius of each other, so transportation is easy. Unfortunately, booking a 36-hour trip only five days in advance is pricey, and all the numbers are starting to run through my head: several hundred per interview trip, times 23 programs applied to, subtracted from what remains of my student loan for this semester... ugh. I'll be panhandling by November.

Scott

EM Rotation and Setting Up Auditions

This month has been fairly low-key as far as my emergency med rotation goes. Somebody in some office not affiliated with the ER docs' group set up my schedule, each day with a different doc, and the docs don't know I'm supposed to be there until I show up at the beginning of their shift. The unfortunate thing is I have to take both parts of my level 2 boards this month, plus go to a doctor's appointment an hour away. I asked the "somebody" if he could alter the schedule, which he obligingly did. However, I was left with an awful 11-day stretch with no days off amongst being at the hospital, taking an all-day test, flying to take another all-day test.... I decided to add in my own days off to even things out. Every now and then, there are perquisites to being in a new program with no one knowing what the hell's going on. I don't want to take advantage of this loophole by being lazy, so I may switch around the end of the month so I can experience an overnight shift instead of strictly day shifts.

I took the computer-based portion of my board the 6th and will fly out the 13th to take the practical portion, only offered in PA. In addition to these tests complicating the month, I am trying to set up audition rotations at hospitals that have orthopedic residencies to which I want to apply. I have been more successful than I expected, as I applied for the rotations a bit late in the game. I'm finding that sites' rotation coordinators can take several months to get back to you regarding whether you can rotate. When they do, three in a row have responded with a large packet of information that I had to fill out quickly and remit along with information directly from my school since the rotation had apparently already been scheduled for me. Twice, I have had to tell the coordinator that I already set up a different rotation while waiting to hear back.

The really embarrassing event was when I mixed up a couple programs. I already have a rotation set up at HFHS for October, and someone emailed me from BGMC, only identifying the program by its initials. Well, all the initials ran together in my mind and I thought she was contacting me about the rotation I had already set up, asking for paperwork I thought was already completed. So, I faxed back the completed paperwork, most of which was thankfully for BGMC. In my panic and confusion, I faxed back a few pages from HFHS as well. Totally mortified, I had to email the BGMC rotation coordinator, apologize profusely, and explain the situation with as positive a spin as possible. Not much room for spinning, unfortunately. In my defense, though, her email said something like "we have you penciled in for October but don't have any paperwork on you, so fill it out and send it in." Realize that this is the first time I have ever heard from BGMC, and had no idea I had been "penciled in" there. In any case, this all happened late Friday, so I won't hear back on the issue until Monday at the very earliest.

If you were able to follow that whole story, then I could sure use a personal assistant. I sill feel like I'm in Vegas, and I've been in Pueblo, CO for two weeks already. All this trouble keeping track of rotation sites and dates has been a good experience. I only have a handful of potential audition rotation sites, whereas my list of residencies is over a dozen if you include traditional internship programs. Since the rotation arm and the residency arm of a program are somewhat separate, I'm hoping my little mix-up doesn't reflect poorly on my quality as a residency applicant at that location. In any case, I'm determined to be more organized as the residency interview and application process gets more involved. It just wouldn't do to be in an interview and answer the question "What sets our program apart from the others?" with a list of things I like about another residency.

Well, it's after midnight and I still can't sleep, but I should try since I have to be at the hospital tomorrow.

Scott

August Newsletter

August brought my first audition rotation, on which I was trying to show off to the program director and other VIPs of an orthopedic residency program. This particular program is in Las Vegas, and it will be brand new when I graduate med school next year (May 19th, 2012). It was an interesting feeling doing an audition rotation. The knowledge that I might spend the next five years there made the experience sink in a little deeper. All in all, it was a good month and it went faster than I expected. The four weeks in Vegas ended on a high note when, on my last day there after work, I saw a woman helping a collapsed man and got to help get an ambulance and provide emergency care for him. I've been analyzing my actions so I can improve next time something like that happens and I'm trying to get a hold of the 911 recording to remind myself what all happened. The city communications person is not getting back to me on the matter, though.

My parents pointed out that this collapsing man was a good segue to my current rotation. Since August 29th, I've been doing emergency med. I like the diversity of cases that come through. I've seen a couple of patients who needed intensive care: a drowning victim and a patient with a STEMI. Other patients just need a pat on the wrist and are sent home, like a kid who had mild RUQ pain and a completely normal workup, and a psych patient who basically wanted someone to talk to and a bite to eat. There have been many patients filling in the middle of the spectrum, either. My only problem with EM is there is entirely too much medicine and too little emergency. I prefer the lacerations, fractures, etc. that can be fixed by slicing, casting, jabbing, or suturing. All this abstract stuff with lab values, liver function, body temperature, heart rhythm is too much for my concrete mind to wrap around. I'm improving, though. Each time I start a new rotation, it's taking less time to get in the swing of things. I am also getting better at general medical tasks like doing a complete H&P, which was a bear when I first started.
In the coming months, I have two more audition rotations set up. Sadly, they are both scheduled for October, so I'm trying to move one. In personal news, I am still struggling with my 30-year-old motorcycle. It's back in the shop, and I don't even want to think about how much it's going to cost to fix up all the little things going on with it. I swear, I should have been a mechanic. You make practically as much as a physician, don't pay malpractice out the nose, and your worst disgruntled customers are biker gang members, who mercifully won't sue you, and will resort to much more minor forms of retaliation like arson, murder, and the like. Anyway, once it's out of the shop, I plan on using it as my main form of transportation this month since it gets roughly double the gas mileage of my car.

Scott