Callous

"Intern year makes you callous in a way that you'd never imagine yourself being" ~2nd year resident.

Wise words, and oh, so true.  Is it the long hours, the feeling of helplessness, that what you are doing has so little effect on a person's ultimately outcome?  Or is it the rude patient, the inpatient nurse, the demands of too much to do in too little time?  Or is it simply the exhaustion that wrings your temples, turns your brain is a fog.  All you can do it stare at little blue check boxes and check them off.

We are all preparing for the holidays, a time in the hospital where residents work at half staff.  It means double the work for everyone.  It's so half of us can get a few days off while the other work.  We call it a "war."  It is not a good time to be in the hospital.

But I was reminded today by an attending, in a simple email.  That however hard it is for us to be in the hospital during the holidays, it's even harder for the patients.  So wear a jolly hat and stuff your pockets full of little candy canes. 

That's exactly what I'm going to do.

Dear (in)patients...

Here's how you can make your inpatient stay more successful:

1) Carry a list of your home medications.  I want to hug you when you whip out a piece of paper, however scrappy, with the meds you take at home and their doses.  If you can't do that, at least bring all your pill bottles.

2) If you get most of your treatment at one hospital and have been admitted to that hospital several times in the past year, for the love of God, please go back to that hospital!  Please don't decide on a whim to come to this emergency room, because "I was at my aunt's house and it was the closest one." Your usual hospital is only 5 minutes away from this one!

Fact: your care WILL suffer since we have NONE of your past medical records.  And you know none of your history.  And while we try very, very hard to figure out what is ailing you, it is impossible to get the whole story at 2 AM.  We will waste a lot of time on our part and your part figuring out what you did and didn't have done at the other hospital.  And this will make our treatment of you here much slower and worse.  All the extra CT scans you get here because we can't look up your scans at the hospital...well, that extra radiation will give you cancer later on.

3) Be an active participant in your care.  We love it when you ask questions; we like it even more when your family is involved.  (Family involvement = positive prognostic sign)  To maximize your ability to participate, ask your nurse about the hospital workflow.  What time does the team round in the morning?  What time does the attending (chief) doctor round?  When does the team discuss your daily plan?  These are opportune times to ask questions. Even if we don't have time to answer right away, your questions let us know what's on your mind.  And then we can better prepared to come by later to discuss them.

Random bits of pregraduation insight

>At a graduation party, in a discussion on succeeding in academia:

"Don't take no for an answer - paper's rejected?  Don't resubmit it?  Nonsense!" - Dr. H

"The rejection never stops...it gets worse the further along you are in academia, so keep forging ahead!" - Fellow

>Re: taking the boards

"If this is an issue of national security vs. taking the boards, I'm taking the boards!"

Post-interview, pre-match time

It's the beginning of February.  I am done with interviews (who hoo!) and just waiting.  How come nobody tells you that the waiting part is the hardest?  As an eager, premed college student, I remember an article describing Match Day at our school.  Exciting, but it was so far off then and only a dream.  I came across another one of those "Match Day" articles and it felt totally different.  It's real now, baby.  Somebody please write me a script for Xanax. :)

November life...

consisted of postponing the boards.  See previous post.  Who knew that relearning all of ob/gyn and ID (antipseudomonal drugs, anyone??) would take so long.  Or, probably more importantly, that I would be so unmotivated to study?  It's fourth year, man!

So now I am living life.  It's the least structure I've had in my schedule for some time.  There are things I need to accomplish each day - research, writing, boards studying, interview prep, etc, etc, - but it's totally 100% up to me to accomplish them.  Of course, in the past, I was also 100% responsible, but it's a little different when that responsibility consisted of going to class or showing up at the hospital.  The way my schedule works out, I am basically taking 4 months "off" to do this whole research/interviews/boards/etc thing.  Then I'm going to be a glutton for punishment and spend a month in the MICU (see knowing antipseudomonal drugs part - above).  And then, after that, I am going to spend 2 months abroad on an away clinical elective!  Our school has a formal clinical exchange program with an international medical school and each year, a few of us go there and vice versa.  I have wanted to do this program since second year, and I am so excited to go!

Now I am going to go learn those fetal heart tracings...

Why I'm looking forward to Step 2

All physicians know about the "boards" - they refer to the United States Medical Licensing Examination or USMLE. (There are specialty boards as well after that!)  To become a full-fledged doctor in the U.S., you must take 4 exams: USMLE Step 1, Step 2 CK, Step 2 CS, and Step 3.

Most students regard Step 1 as the most important. Consequently, a lot of preparation goes into preparation for Step 1.  I'll readily admit that I viewed Step 1 with quite a bit of dread.  It's over now, obviously, and I've just begun preparation for Step 2 CK.  However, this time around, I'm actually (somewhat) looking forward to the preparation.  Here's why:

1) It's going to be a great review for intern year.  I'm going into medicine and the bulk of CK is medicine.  And since I've been removed from my clinical years for a while, it's nice to go back to the material.  I'm beginning to dust out the cobwebs.

2) Outcome is directly proportional to effort.  There aren't not too many things like that anymore. 

3) USMLE World. You teach me so much.

4) How cool are mneumonics like CARDIACRIND* and WiLLiaM MaRRoW?**
*Causes of pericarditis:
Collagen vascular disease
Aortic dissection
Radiation
Drugs
Infection
Acute renal failure
Cardiac (MI)
Rhematic fever
Injury
Neoplasms
Dressler's Syndrome

**LBBB: W pattern of QRS in V1 and V2 and M pattern of QRS in V3-V6 vs. RBBB: M pattern of QRS in V1 and V2 and W pattern of QRS in V3-V6

Delightful

I am so delighted and moved by this video.