Surgery!

Quick intro to those unaware, med school is basically a two part process. First two years are mostly books, culminating in boards. First year is normal stuff, second year is abnormal. The last two years are the clinical years, when we're out in hospitals and clinics. UIC's third year has six rotations: medicine, surgery, family, peds, ob/gyn, psych.

As a newly minted M3 (feels weird to finally say that), we started our first for real clinical stuff last week. On top of that, a subset of us started out on surgery - a particularly intense rotation. Non-call work days range from 12-14 hours, 6 days a week. "Luckily" we're guaranteed 24 hours free of clinical duty. Nights when we're on call see that work day extend to around 30 hours (~29-33), and we're on call an average of every fourth night. By my math, that puts the work week at a minimum of 89 hours. Yikes. (Although as I'm finally finishing this post, I have a 3 day weekend...yay!)

Strangely enough, it doesn't seem that bad. I'm at an outstanding site in terms of med students, nurses, interns, residents, and attendings. Everyone's pretty friendly, helpful, and happy to be there. Most importantly: there is good teaching, the scut work is minimal, and our team lets us go at a reasonable time (doesn't make us come in unnecessarily early/stay ridiculously late). Even better, our team dynamic is actually really good - everyone from the chief resident down to the med students get along and work together really well.

The previous paragraph is key to making the next two months enjoyable, especially given the hours we'll be putting in. I say this because surgery rotations have a reputation of being the exact opposite of the site I'm at. I won't go into detail, but I've heard horror stories about some of the other hospitals - lots of yelling, crying, berating, scut work, and and even longer hours. It makes me feel legitimately blessed to be at such a good hospital, especially for such a potentially hostile rotation.

In the interests of minimizing medical jargon, I'll cut to some of the cooler moments so far.
-holding someone's gall bladder
-holding someone's appendix
- grabbing someone's thyroid and trachea...actually just being able to poke around someone's neck
-being arm deep in someone's abdomen...so much cooler than anatomy lab

Overall, the rotation's pretty cool and I'm reminded of why the field used to/still does appeal to me. Minimal paperwork, minimal rounding on patients, not too much thinking, and a lot of procedures (obviously). The biggest downside is the number of hours. And for me, that's a pretty significant downer. But we'll see. I still have my other rotations to get through, some of which are significantly different in their style of medicine. As of right now though, surgery is making it's way back onto my short list of specialties I'm interested in. Even better though, I'll be taking a one week elective in trauma surgery. It should be a nice mix of my two interests of emergency medicine and surgery. We'll see what happens.

Vacay

As I finish this post (been brewing for a week), I'm 4 days into my surgery rotation. ...And most definitely not on vacation anymore. Think 12-14 hour days: 5,6AM - 6,7PM. Long days, yes. But I don't mind it and the time somehow flies. All because I'm at a really good site with lots of really cool stuff and outstanding teaching. More on that in future posts.

Before that though, I'd been on vacation in one form or another for two weeks. Last week had been a bunch of clinical skills lectures/workshops - ABGs, IVs, catheters, respiratory therapy, lumbar punctures, phlebotomy, suturing, injections, EKGs, etc. It actually was really useful and fun, which was a pleasant surprise. Plus, the schedule was relatively light, allowing for...a real life!! I saw not one, but two movies during the week while also going out each night :)

The week before that , I was down in St. Thomas. It was all I could ask for out of a post-boards vacation. I felt ridiculously reenergized and alive coming back. Pics are up on facebook with more from another camera.

I made a few "friends" on the island.

Poser middle man: This dude was chilling at a local bar, patroned by all locals (of course). While we were playing darts, he walks up and starts talking. Being the closest person, I got the job of responding. This guy was apparently from Long Island, and moved down in 1989. Eventually, he starts offering me weed. I made the mistake of continuing to talk, and it comes out that he's the middle man and will take our money out to "a guy waiting in the parking lot." This mysterious guy is of course only available for a limited time. Once I make it clear I'm not buying his story, he then offers us a cab ride. No way in hell I'm getting in a car with that guy or anyone he knows. The cab offer came after telling him we have a rental car of course.

Drunk hotel dude: While classing it up in the hotel lobby with our canned beers, we notice a guy stumble out of a cab with a six pack in one hand and two beers in the other. He then makes his way over to our table and starts recounting the story of his cab ride. He chooses to sit right next to me, and reenact his "adventure." Said adventure included the cabbie putting his arm around him, massaging his back, and getting all up in his space. Mind you, he does all this to me while he tells his story. I kept begging for "story time" to be over. No such luck. I eyed the group for some help, but they're too busy laughing. The man would not stop until he finished his story. He then notes that he's partying it up somewhere in the hotel and gives us his room number. No thanks.

Hat hair: Not what you would think when I say hat hair. His hair had neither been cut nor washed in so long that it was bulky and stiff enough to be a large top hat of some sort. Apparently, I walked close enough to elicit verbalization the the effect of: "Nine million dollars, shit on your face!" Now, I'm not sure if the $9M was what he was charging or what I would get for said services. Either way, I didn't know how to react - so I didn't and kept walking.

Wildlife: With St. Thomas being less developed and in a different climate, there was some unique wildlife roaming around.

1.) Iguanas - they're everywhere. Even by the pool you can see anywhere from 3-6 just chilling poolside. Everywhere you go, they're there. Apparently they were first introduced to the island as a food source.
2.) Chickens - also all over the islands. Not quite as pervasive as the iguanas. These guys chill in slightly less developed areas of the island.
3.) Donkeys - who knew? Only saw these on St. John, and only two at that. We initially spotted them grazing at the roadside. Being curious, we stopped and checked out what was going on. Interestingly, they reciprocated the interest and walked right up to the car. I was busy fiddling with my camera while they walked up, so I was a little freaked out when I saw a donkey snout peering into the window.
4.) Deer - saw a deer while hiking through the jungle. That was a little unexpected. We somehow managed to get ridiculously close to it only to have it scurry away. And then caught up to it again, it then disappearing for good. A bit surreal, since it's so quiet in the jungle and it's really hazy in the jungle...out of the haze we just see a deer chilling.
5.) Bird. Not so noteworthy. Except that it was in the terminal at Fort Lauderdale's airport. Waddling about near a vending cart. That can't be sanitary. Nor does it speak well of how tightly closed off the terminal is kept. And no one other than us seemed to notice. Maybe it's part of the usual scene at FLL. It wouldn't surprise me.

FLL
I already mentioned the bird. For it being Spirit Airlines' hub, it was ridiculously undersized and overcrowded with touristy vacationers. I realize I fall into that category, but I'd like to think I'm not that obnoxious. On top of that, both times we layed over at FLL, our first boarding call was also our final boarding call. We weren't late or anything. They just never announced that our flight was boarding. And the people sitting at our gate never boarded the plane. Apparently, there's some other hidden gate through which to board. We were unaware of this gate.

So yeah, that's all I've got from the past few weeks. It'll probably be the most interesting nonmedical stuff I can write about for the next 8 weeks since I'm on surgery. I'll try not to bore it up too much with the surgery stories, but no guarantees...although it's probably marginally better than reading about the first two years of med school.

Done!!!

Hell yeah. Done. I have never looked forward to the end of something more than this. After eight hours and clicking "end exam," there was a huge, overwhelming feeling of freedom. Pure freedom. I walked out of that building with a glow and energy about me. I couldn't help but smile. Some people walking past me gave me some quizzical looks. I didn't care.

I legitimately hated the past month of my life. I'm not going for hyperbole or dramatic effect when I say that or the following. This has been the hardest, worst experience of my life. It's been the most stressful, tiring, draining, frustrating, and demoralizing thing I've ever done. And none of those things happens easily with me. Granted, I've had a good life and haven't had many life experiences or traumatic events. And yes, I know I chose this path. But still. I spent most of my waking hours studying. And reviewing. And not remembering. And getting owned by practice questions. (My average for ~1500 questions was a solid 62%.) Even when I wasn't in boards mode, I was annoyed at what my life had been reduced to.

I know it's become an old tune, but the volume of information is overwhelming. Two years of med school. No matter how much we study, we never can or will know it all. On top of that, the styles of questions makes it so much more difficult. And all of it reduced to a 336 question, eight hour exam. An exam that I'd like to think I passed. But on top of that, an exam that determines what specialty you can go into and where you can do residency. Luckily, I'm always good about not thinking big picture - otherwise I would've freaked out. Oh wait, that happened anyway.

I've been known to moan and groan when it comes to exams, and that's mostly what I did for three weeks. I'm usually pretty solid and stable with exams. This final week though, I actually freaked out a few times. I've apparently never done that before. I went through periods where I couldn't study, couldn't retain anything, couldn't focus. All I could do was sit there. Nothing helped - listening to music, taking a break, eating, taking a nap, jackassing on the internet - nothing. It wasn't only cognitive. I know it was for real because I lost my appetite at times (never happens when I study), my GI was all sorts of messed up, my heart was going crazy, legs were tapping like mad. I've been through my fair share of exams, and nothing like this has ever happened before.

On those occasions I freaked out, I didn't recognize myself. I didn't like who I was seeing and what I was. And apparently my study group took notice. They were the ones giving the pep talks, instead of vice versa. That was another hint that something was different.

I'm just thankful I have a tight group of friends going through the same thing. I usually went solo during the week. But I occasionally met up with my group during the week and definitely on the weekends. Even if I got less done, it was comforting and reenergizing knowing you're not alone.

Not that I think I did, but I if were to have failed (I just cringed typing that), I don't know if I could do this again. I would have to take a step back and really reevaluate my life, priorities, and what I want to do. And this is coming from someone who currently owes the federal government $100k.

Luckily, supposedly none of the other board exams are as bad. At least not USMLE Steps II or III (just took Step I). Specialty boards might be a different story, but that's way too far down the road. Up in the immediate future is a week in Saint Thomas. And in med school style, it's gonna be a cramfest - of doing absolutely nothing, relaxing, recharging, drinking, and making up for the past month. Already after just eighteen eighteen hours it's amazing how much stress, angst, and anger have melted away. I'm in such a different place than I was two days ago.

For reading my sob story, the best reward I have is of a Chicago sunrise ~540 the morning of my exam.

If You're Having Trouble Sleeping, Read On

I'm two days out. I'm also burnt out, worn out, and (since Sunday) freaking out.

Anyway, one more day of the same song and dance that's been playing for four weeks - with Wednesday being a little less hardcore. Here's a rundown of the bore that is a boards study day. Weekends I let myself sleep in. Sometime between 8-10.

600 AM: hear "The Final Countdown," smirk because it reminds me of Arrested Development's Gob, then frown/growl because I realize it's my alarm
630: finally get my ass out of bed
630-800: do the daily necessities: some form of exercise, pee, poo, bathe; load up on coffee, gatorade, granola bars, string cheese
815: wander towards the L and wonder if I'll get a seat; look over google doc study guide while waiting
830: get downtown; feel out of place as all sorts of suits, business types, and important looking people walk ridiculously fast and with a purpose; nod to the two homeless people I see everyday and wonder if they remember me; grab free newspaper
830-900: read aforementioned free paper while eating 1st of several unhealthy meals
915: settle into my spot at DePaul's 10th floor business library, stare at Sears Tower for a minute, start studying
1000: probably first of several 10 minute power naps on the day
1011: nonurinary bathroom trip
1015-100 PM: wonder where all my momentum from the day went as I feel sleepy; continued staring at Sears Tower
100-200: after waiting on the business crowd to get back to work, wander outside for second unhealthy meal of day
201: grab coffee, head back up; notice that the business school scene is more interesting than the med school equivalent, wonder why that is
230: guaranteed nap time
241: guaranteed bowel movement
300: wonder which of three homeless people will show up
1.) purple coat and beanie guy
2.) homeless Asian (?!) dude - always wearing the same suit and shades and always coughing/spitting into a cup
3.) read newspapers in the corner/bodily noise guy - the latter involves belching, throat clearing, coughing, sniffling, sneezing, farting, and probably pooing a little
301-415: get ridiculously sleepy and struggle not to nap; notice that the library has gotten insanely crowded somehow
415-730: get sudden burst of energy and wish I'd been this productive all day; ironically then burn out on studying and decide to leave
730-740: sit in awe at how all my shit ended up splayed out everywhere; get annoyed at how long packing up takes; wonder how it all fits in my backpack in a nonbulbous fashion
745-815: (maybe) grab some food to go, wander towards the L and head home
815-930: chow down, veg out in front of tv
930-1030: continued jackassing on internet and tv (this is why I don't/can't study at home)
1030-1115: hopefully finally get around to doing a practice block of questions
1116: laugh/cry at how low my score is
1117 PM-100 AM: go over the wrong answers and look up anything I don't know (a lot of both); add this new info to my running google document; continued sidetracking and distractions
100: ideal bed time
200: realistic bed time due to aforementioned jackassing
300: more of the same sometimes leads to this...and probably starting the next day later than I'd like

For those that like numbers, here's some for an average boards study day.
Ten minute power naps: 2-5
Fast food meals: 1-3
Cups (8 oz) of coffee consumed: 3-6
Cups of water/gatorade consumed: 3-4
Bathroom trips (urinary): 3-6
Bathroom trips (nonurinary): 1-3 ---> sometimes I add too much cream to my coffee
Minutes wasted checking email, facebook, news, espn, or youtube whilst also killing my phone's battery: >=30
Filipino culture books found in a business library: 1
Library workers I recognize and am thus forced to nod at everyday: 6, from different shifts :(
Starbucks employees recognized at DePaul Center: 5
Coffee places that've received my business, downtown: 6 (2 Starbucks, 2 Dunkin Donuts, 1 McDonalds, 1 Caribou Coffee)
Security guards recognized: 3
Times I ran out of highlighter and had to buy one: 2
Block radius willing to walk for a meal: 3
Total number of protests witnessed: 2
Times I hear emergency sirens: >=10
Large Starbucks coffee: $2.15 ($2.18 at the Starbucks half a block away somehow)
Medium Starbucks coffee: $2.04 ($2.06)
Large Dunkin Donuts coffee: $2.06
Medium Dunkin Donuts coffee: $1.84
Medium Caribou coffee: $2.18
Number of times closing out a library: ~once/week...which is more times than I've closed out a bar in the past month
Times I think "FML:" 0-4

Two more days.

So Close, I Can Taste It

And by tasting it, I mean coffee. Either that or the dry mouth secondary to coffee's diuretic effect.

But seriously, just a week away from being in the Caribbean. Doing. Nothing. I've never worked so hard schoolwise for so long. Boards: June 4. St. Thomas: June 7.

This is the weather down there. Don't get me wrong, Chicago's beautiful in the summer. But, it's all relative. And not Saint Thomas.

Lazy, Lame Happenings

I'm way too exhausted and lazy to write anything substantial. Maybe later I'll outline one of my boards studying days just to show how long and lame they are. Anyway, pics are said to be worth a thousand words. I'm thinking this might be my style for at least the next two weeks, if that. So here you go.

Not Your Typical Street Sign

Some of us were out in the Humboldt Park neighborhood (~4 miles NW from me) for brunch a few weekends ago. Needless to say, it gets real out there. It was Sunday morning around 9, and even as an urbanite, I honestly felt a little uneasy walking around out there. By chance, we parked under this street sign. A picture was of course required. (While we made sure the photographer didn't get jumped. Half serious statement there.) Given the ominous sign (no pun intended), the brunch place was surprisingly yuppified and had good Southern style food.

Light at the End of the Tunnel

T-minus less than two weeks from boards. Boo. However, that also puts me at ~2.5 weeks away from St. Thomas. Here's our hotel. Hell. Yeah. (!!!)

*Yawn*

A few totally unrelated, but more serious things. Congrats to those graduating - being done with school is pretty much baller. Also, hopefully none of you had anything serious happen back home on account of that storm last week. Personally, a tree introduced itself to the side of my sister's Camry. The Camry lost that encounter.

Anyway, the above title applies both literally and figuratively for the foreseeable future. I've got boards coming up on June 4th, and it's go time. Two years of med school reviewed in ~three weeks. I've been in half-ass mode for the past few weeks, but that's not gonna fly anymore. I've finally started feeling overwhelmed and panicked - to where I'm entertaining thoughts of failing...forcing me to get my ass in gear. Some might say I'm flipping my shit. Either way, no more jackassing, no more excuses - it's gotta be balls to the wall from here on in. So much information, so much integration. My last practice block owned me, at 45%. *sigh*

Sure, I did well in undergrad. But I was actually trying pretty hard then. I've for sure been trying the past two years, just not as hard as I could've been. Mostly on account of mild indifference towards grades. Now that I legitimately care, it's been surprisingly hard to get motivated - this is the one exam where I actually wanna do well. Personal problem, sure. Still a problem though.

In reference to "yawn," that'd refer to both the sheer lameness of the next few weeks and the amount of sleep I'll be getting. Decreased sleep on account of studying to some extent. But I've also gotta maintain my sanity somehow - keeping up on a few shows and keeping a (somewhat) reasonable weekend life. Both are little things to look forward to. A friend once proposed something interesting in undergrad that I feel particularly applies now: "welcome to [boards], pick two of the three: sleep, study, party."

In terms of big picture things to look forward to, some of us are gonna head down to St. Thomas for a week right after boards. I'm obviously ridiculously excited for that trip. Because 1.) I'll be done with boards 2.) I can veg out and do absolutely NOTHING 3.) hello Caribbean!

Until then, fml.

Dining It Up!

On any given day I eat between two and four meals. A few of those have been noteworthy over the past few months.

Cho Sun Ok
With one of my buddies being Korean and a UChicago alum, he has a good pulse on the Asian restaurant scene, and not unsurprisingly the Korean one. We finally took him up on this recommendation, and we weren't disappointed. Apparently there is a difference between between bulgogi and the stuff we had this time. Mostly that this was unmarinated. Sounds non tasty, but that's untrue. There's a few different sauces to dip the beef strips in and per Korean style, an insane number of side dishes come with. The soup I had was pretty ginormous too. Regardless of the place, I've decided pancakes are always a winner and definitely a go-to move.

~$20/person: shared appetizer, no alcohol, no dessert.

Mado
This place has a ridiculously unassuming facade that I've missed quite a few times. But on walking in, it's a cozy, classy, casual place. For the price and type of place, the portions were significantly larger than I was expecting. No complaints there. On top of that, the food was pretty good. I had the pork shoulder, which I motored through in no time - so delicious. Tried out some of their seafood stew which was pretty tasty - both in terms of broth and the shear amount of seafood they put in it. Tried some of the hanger steak, which was good but not nearly as tasty as the pork shoulder. The chocolate cream pie was pretty damn good - and I'm not usually a dessert person.

~$40/person: shared appetizers, dessert, byo w/o corkage fee

One Sixty Blue
Apparently this place has some MJ influence in it and the chef is a Charlie Trotter product. Either way, this West Loop place is pretty fancifully done and almost seems out of place in the neighborhood. But I guess that's true for a lot of stuff in that area. I got the lamb rack - two lamb ribs chilling against a lamb medallion. *So. Damn. Tasty.* However they prepped the lamb was pretty good to begin with. Combine that with the insanely good sauce and couscous - game over. Seriously though. Best lamb I've had. The other stuff doesn't even matter (even if delicious). If you go here, get the lamb.

~$60/person: shared appetizers, dessert, 4 bottles of house wine
We even got the private dinner room at no extra charge - which was pretty cool imo.

Disclaimer: previous opinions come from overworked, underfed med student whose diet consists largely of frozen/prepared food, fast food, and Filipino take-out. That said, I wouldn't exactly call myself a foodie - as much as someone that knows good food when he has it. Also, the places were a little more expensive than the average meal. But they're definitely tastier than the average meal and probably only about once a month.

Involuntary Insomnia

Study break time. Downing my eighth/ninth (?) cup of coffee on the day. I usually try to avoid more than a soda's worth of caffeine/day. I'm pretty sure that my waking state has become dependent on caffeine. I struggle mightily to stay awake without it...over the course of only a few days of hardcore caffeine. Not what I'm really used to. Weak.

Anyway, I'd have to pull an all nighter to get through a semester's worth of material in half a day - neither of which is gonna happen. Also not my usual MO. My standing policy: at least three hours of sleep before exams. Stupid finals. Weird thing is I'm not actually trying all that hard for this one.

On another note, outside study groups and two finals today I was able to enjoy the nice weather. Chilled over in Millennium Park: some repose from pathology and pathophysiology. But, I've also been relatively productive considering the amount of material and given amount of time. Also, since I've been doing a lot of work on my laptop, I've been on Pandora most of the day. Have some new music possibly lined up. Which is nice, since I'll be commuting out to a suburban hospital starting next week. I'm sure the carpool will appreciate the new music when it's my turn to drive.

Four down, two to go. I'm ridiculously excited that I've only got two more "traditional" finals left in med school. Ever. Psyched would be an appropriate word. Sleepy is also valid.

Getting Comfortable

The past few weeks, I've been heading into the ER a decent amount. Between having had most of the book stuff (e.g. biggies like pathology and pathophysiology) and some decent practice with physical exam, I'm actually starting to feel comfortable with eventually having the responsibility of being a doc. That is, I might actually be able to do this doctoring thing.

Of course, my comfort level is at the level of eliciting a history and performing a rudimentary physical exam. I'm in no way ready to start putting those H&P pieces together. No where near synthesizing a diagnosis and/or plan. At least not with any confidence or any high degree of accuracy. When I get things right, it's always a nice bonus. But most of the time the attending I work with still has to guide me toward the right assessment, differentials, and plans. Long story short, I'm more comfortable with H&Ps - half of being a doctor. Just not the figuring stuff out and fixing part...the other, more important half of being a doctor.

All that said, there's a decent amount of info floating around in my head. It's just ridiculously unorganized and unprioritized. That is, I don't have the experience to bring together seemingly random bits of info together. I don't have the experience to know what's all that important out of the ginormous amount of info shoved in my face. To make matters worse, not all of that info has been retained. And not just minutiae, but some big picture stuff (IMO). Hopefully studying for boards'll help with integration and retention.

And sure, there's a (lacking) base of info, but it doesn't really do all that good if it isn't applied. And that's what the next two years are gonna be about. That's what I'm excited about and what I signed up for. Hopefully.

Until then, I'm sitting in the middle of my last week of classes ever. About damn time! Six finals next week. Three weeks of hospital stuff. About a month to study for boards.

Honestly, boards scare me. For a few reasons. I'm less than two months out, and haven't been able to start studying yet. (In undergrad, I was ~2 months into MCAT studying). I've mentioned that I really want to do well on them - which breaks my med school trend of "eh, whatever." Why? I would love to 1.) stay in Chicago and 2.) do Emergency Medicine. Each of those would require above average board scores. And moreso if I want both. On that account, I'm seriously considering pushing my exam date back a week. That leaves me one week of break before rotations. I'd like more recharging/unwinding/traveling time after such an intense exam. But I'd also hate to be disappointed with my board scores and consequently not match into a Chicago EM program. All because I wanted another week to (most likely) sit around on my ass.

Like I said, I suppose it's what I signed up for.