Call Rooms

Being POD 1 from getting my wisdom teeth out, I've been doing a decent amount of sleeping. Some of that's probably due to the vicodin. Overall, there's pretty minimal pain and swelling - which I'm pretty happy about. I figured I'd try out the vicodin or an equivalent narcotic combo since I've given it to scores of postop patients. I feel it's good practice to experience what patients go through, if feasible.

Wisdom teeth aside, all the sleep got me to thinking about how much I like sleeping in a bed I call my own. Then that reminded me of how some were unaware that on-call rooms existed in hospitals outside of TV. Well, here's a rundown of the one's I've been in.

Christ Medical Center, Oak Lawn, IL
Did eight weeks of surgery and was on-call an average of every fourth night. The surgery call rooms are actually a set of four rooms. Two single-bed rooms for the trauma and gen surg chief residents. Then two bunked rooms in the back for the trauma and gen surg junior resident and med student. The rooms are the length of a twin bed and the width of 2.5 twins. The beds were reasonable enough, it was just cold in the call rooms. And I usually like it cold. I didn't mind sharing the room, because it's not like we were ever there anyway.

The food was better than expected. Even better, I never paid for a meal. That's a perk of being in tight with the coordinator for meal tickets. A cool cafeteria lady who charges only $1 for your lunch also helps. And so does grabbing lunch in the OR suites' doctors lounge - both time and cost-efficient.

By far the best part about Christ's food was their hours. And by hours I mean that they were open from 130A-430A for the on call and night staff. Hell yeah. No other hospital's had the common sense (or more likely money) to do that.

Jesse Brown VAMC, Chicago
Did six weeks of psychiatry at the VA and took three nights of call. There's actually a wing in a newer part of the hospital dedicated to on call staff. That said, the rooms were even nicer than I expected. Especially from a federal institution. The rooms were basically converted patient rooms, each with their own bathroom, desk, bed, TV, and window! Oh and the rooms were ridiculously spacious.

Unfortunately, the food at the VA is exceptionally subpar. The chicken strips were okay at best. Between UIH and the VA it's quite the competition for my lowest rating. Making it worse, I had to pay for lunch each day I was on psych. At least my nights on call, meals were free.

MacNeal Hospital, Berwyn, IL
Did six weeks of ob/gyne at MacNeal with a week of night float on OB and took two Friday nights on gyne, for a total of seven nights. There are actually two call rooms for me to use. One is about five seconds from the labor/delivery floor. The other is about five minutes or a block away. The closer one is definitely nicer, newer, better lit, and better furnished. But this room was usually unavailable to me, since there's typically a family practice resident on call with the OB team.

The further one is older, in an empty part of the hospital, less comfortable, poorly lit, and cold. All that said, it's quieter. But it's also apparently for gen surg med students. I only discovered this my last night on call after getting paged to basically move my shit out. Meaning I had no place to sleep. Hell no to that. After talking to the nurses, I ended up sleeping in a patient room on the L&D floor. It was ideal: right in the middle of the action, quiet, comfortable, with a bathroom right there.

The food was reasonable at MacNeal. Paid only for a handful of meals, thanks to meal tickets and the doctor's lounge usually being stocked. Unfortunately, they didn't have late night hours. They do have a bank of vending machines though, from which I've gotten: hard boiled eggs, tuna sandwiches, White Castle burgers, and other assorted fare. Be jealous.

In Queue
I've got three more core rotations my M3 year: pediatrics x 6wks (at Christ again), family medicine x 6wks (Hinsdale, all outpatient), and internal medicine x12wks (Lutheran General). If I remember, or get this bored again, I'll update you on the bed situation for Christ's peds and Lutheran's IM med students.

OB/Gyne & More

Having just taken the shelf exam on Friday, I've closed out my ob/gyne rotation. All jokes aside, I actually enjoyed the rotation. Enough that it's still on my list of possibilities. Along with most other things, as I'll touch on.

Except for the demographic restrictions, the pathologies and scope of practice are pretty diverse. Ob/gyns function as a lot of women's only interaction with the health care system. As such, this provides for a decent amount of primary care and outpatient experience. Outside of usual primary care stuff, there's obstetrics, which encompasses its own breadth of experience including prenatal care, normal births, instrument deliveries, C-sections, and conception/infertility treatment. Entwined in all of those are maternal and fetal conditions and morbidities of pregnancy with appropriate management.

Then there's the gynecological aspect, including birth control, dysfunctional uterine bleeding, cancer screening/biopsies, pelvic organ prolapse, and urinary/fetal incontinence. Gyne is a lot more surgically oriented, e.g. D&Cs, hysterectomies, LEEPs, tubal ligations, and prolapse repairs.

As a specialty, ob/gyn encompasses a lot: decent amount of clinic/primary care, inpatient medicine, and getting to operate. Not many specialties offer that combination. Of course the downers include being on call (though not as bad as gen surg), malpractice insurance (highest risk specialty), and regional litgation (Illinois is one of the worst states). Overall, I was pleasantly surprised by the specialty - especially since I was expecting to hate it and immediately rule it out. I might even say that I'm giving it some consideration.

On the "when I grow up" note, I now officially have no idea what I want to do. The first decision people traditionally make is between surgical or medical fields. I can't even decide between the two and want to do both. I know I want to be in the OR. I thought EM would quell my desire to do procedures. But it's just not the same as being in the OR and getting to operate. That said, I don't want the majority of my medical practice to be based on surgical anatomy - I also enjoy thinking and working through medical problems.

So, I've basically got a few months to realistically decide on a specialty - and I've regressed on that front since M3 year started. Score.

Rotation Highlights

Clinically Sweet Procedures
Translation: things that may not sound so hot to you, but are actually big deals to med students.
1.) D&C: dilation and curettage. Basically an ablation procedure, most commonly applicable to the uterine wall in the context of dysfunctional bleeding. As a lower end operation, why is it a big deal? Because my resident and attending let me do one of them :)

2.) Fascial closure. If you were watching an operation, closing would be the most boring part. That's because it is. Unless you're new to operating and actually get to partake. Closing fascia is basically what keeps your insides inside you. Nobody likes herniating through their incisions. The most suturing action we get is usually closing skin. So closing fascia, fat, and skin was pretty sweet. Especially getting to do it more than once :)

2b.) Digression. My other operative things were from gen surg and have a bit of a better "cool factor."
-Taking a rake out of a foot.
-Washing out a compound comminuted distal tib/fib fracture. Why is it cool? Because you could see the fractured bones outside the skin, and it was basically my hand and some soft tissue keeping the foot attached to the leg.
-Laparoscopically taking out two gall bladders, with an endocatch and a grasper. Basically like playing one of those "claw" stuffed animal games, except with a camera, a lot smaller instruments, and a gall bladder. Harder than the residents make it look, and a pretty sweet opportunity for me.

3.) LMA placement: laryngeal mask airway placement. One of the anesthesiologists and I got along pretty well, so she eventually had me place a few of these airways. I thought it was pretty cool, her letting me place airways. Especially since I'm only a third year, wasn't on an anesthesia rotation, and wasn't an anesthesia resident or CRNA student. The head is suprisingly mobile and taut at the same time when under sedation. As such, I'm a bit tentative to shove things down people's throats. Apparently that's poor technique. Regardless, it was a good learning experience :)

30 y/o G6P2032 sAB @ 16 wks
Translation: 30 y/o with six prior pregnancies, two full term births, three abortions/miscarriages, and two living children. This lady was by far the saddest patient of my six weeks on the service. This lady comes into the ER and we get called because she miscarried her 16 week fetus at home and was still bleeding. The bleeding was secondary to not having delivered the placenta and uterine atony, both of which resolved after she spontaneously delivered the placenta on the bed.

Messed up: she brought the fetus in. We ended up examining it and it was ridiculously disheartening to me. It was a lifeless miniature baby at only a few inches long. Even more fucked up is the fact that this was her fourth miscarriage. I can't imagine the pain and suffering this family has gone through over the past few years. With this many miscarriages, she's long overdue for a workup, i.e. for antiphospholipid syndrome, lupus, or something else systemic. Her lack of insurance keeps her from doing this and four miscarriages is the end result. Poverty's also keeping her from a proper burial for this fetus. She wanted to take the fetus home with her and bury it, but the hospital wouldn't allow it.

Long story short: this patient's story was immensely sad and emotionally draining. Even for someone who's grown somewhat numb to morbidity and mortality. We didn't even speak the same language, but our faces told each other what we were feeling. It was a legitimate downer to that night on call.

NSVD
Translation: normal spontaneous vaginal delivery. As opposed to complicated labor such as failure to progress, asynclitism, breech presentation, or any myriad of indications for C-section. Getting to deliver a baby is considered a rite of passage in med school, and I'd agree with that sentiment. It's not the prettiest thing, but it isn't as disgusting as I'd been led to believe either. That aside, I think it's pretty damn cool to deliver a baby and be part of bringing someone into the world. I only delivered a few babies, but it was legitimately one of the highlights of my clinical career so far.

Lost in Translation
In medicine, there can be a disconnect in communication between providers and patients. Especially when talking gynecological history in younger patients.

"Are you sexually active? Because your pregnancy test came back positive."
-asked of a teen patient with a belly bump complaining of weight gain, nausea, vomiting. And yes, belly bump is the medical term.

"No."

"..."
"How'd you get pregnant then?"

"Oh, I'm not active."
"I just lay there."

Just so not all my anecdotes from my rotation are depressing downers or med student geeky.

Ortho & OB

It's been awhile since I've been on here. In that time frame, I've finished up neurology, had a friend tie the knot, watched the Rams and Illini win games, done two weeks of orthopedic surgery, and started six weeks of OB/gyne. Clearly only one of those is of any real life significance - congrats buddy. Other than that, not a whole lot of excitement from the clinical front.

Ortho
Orthopedic surgery deals with management of musculoskeletal problems. Some of the more common surgeries are shoulder and knee arthroscopies and some of the more common repairs are bone fractures and ligament/tendon tears (ACL, Tommy John, rotator cuff). And then there's the always popular hemi/total hip or knee replacement.

As for the nuts and bolt of the specialty, that metaphor describes the field pretty well. There's a lot of hardware involved: screws, pins, drills, mallets, metal plates, etc. It reminds me a bit of carpentry, as these tools are used a lot in conjunction with measuring angles, range of motion, and approximating fractures. It's a bit mechanical, maybe too much for my liking. It's a moot point anyway, since ortho is one of more competitive fields to get into.

OB/Gyn
I've been on OB for three weeks and dealing with pretty much anything birth related. By far, my most common patient is the high risk mother in for prenatal care and fetal screening. After that, there's a lot of women who come into triage for rule out pre-term/term labor. There's also some higher risk pregnancies at term coming in for labor induction and/or augmentation. And of course, there are deliveries and C-sections.

Overall, it's actually a better field than I thought. And I'm surprised at the number of people who have no problem answering pretty intimate questions and having a random med student involved in a lot of their care, including deliveries. I consider it a privilege to be involved in families' happiest moments. I'll admit, it legitimately puts a smile on my face - even if it's 330 in the morning. That said, the attendings have a pretty pervasive obsession for perfect prenatal care and deliveries. This mostly comes from the litigious nature of the specialty, which is especially exacerbated by practicing in Illinois (and Chicagoland). That said, I'm pretty grateful for the amount of stuff the attendings and residents let me do.

The next three weeks I'm on the gyn service, which is a lot more surgically oriented - scheduled C-sections, hysterectomies, tubal ligations, D&Cs, fibroidectomies, etc. It'll for sure be interesting and a nice reintroduction to the OR. That said, I'll actually miss OB and L&D, which I never would've thought possible a month ago.

The major downside of this rotation are the hours, at 11-13 hour days. Similar to surgery, but not as intense or busy. Patient volume is definitely site dependent though. The thing that was particularly rough working a week of 13 hour nights, from 6P-7A. It takes a little getting used to and once you finally do, it's back to working days. Overall though, I'm actually liking the rotation. Which is shocking, since I was pretty sure I was going to hate it.

Third Year Thus Far

Four months into third year at this point, with 2/6 core clerkships down: surgery and psychiatry. I've even knocked off a fourth year specialty (neurology), with another in the queue (orthopedics) - in the interests of more personal/interview time for myself next year.

I'm not gonna revisit the specifics of each rotation I've been through. Instead, I'm going to touch on their similarities.

Studying
Yes, I've harped on and on about how third year's a stark contrast to the first two, in that we aren't buried in books all the time. Key phrase: all the time. Yes, it's still med school and we accordingly still have to study. After all, I couldn't have learned surgery or psychiatry magically. Granted, you learn to some extent in the hospital. But in my experience, the hospital is more of a platform to apply what's been read, reinforce your learning with real patients, and a chance to show attendings and residents what you know. It also lets them get to know you as a person, which I'll touch on later.

At the end of each rotation, there's a "shelf exam." Why the term shelf? No idea. But that clerkship final is referred to as the "shelf." It's national exam of 100 questions given over 130 minutes, with a bajillion answer choices at times. Seriously, the bubble sheets go A-K for some parts. Akin to Step I, it's not just straight up recall. The questions are clinical vignettes reading a paragraph long in which have you integrate a lot of information together and whatever experiences you have. Then, question style can be tricky: secondary or tertiary in nature and/or patient management related. The last option is particularly hard at this point in our careers. Oh and the time crunch is very real and pretty severe, even for the psychiatry shelf. At the halfway point of both shelves so far, I was disconcertingly behind halfway pace.

Bottom of the Pole
As med students, we're at the bottom of the medical hierarchy. Even M4s are senior to us. At this point, we don't even have the luxury of having gone through the core rotations like fourth years have. As such, we're there for purely learning purposes - much like anyone who's not an attending: chief residents, residents, interns, M4s. Unlike those people, our base of knowledge and clinical utility is pretty limited, making us remarkably well suited for scut work - grabbing paperwork, transporting patients, food delivery, etc. Also, since we're new to the scene and rotating through different styles of services, M3s are remarkably awkward for the first few days on service. It's like being a high school freshman again, but having to pay for that experience.

Evals
I already mentioned the shelf exam and what that entails. Of note, it's worth 1/3 of our grade for the rotation. The other 2/3 comes from the attendings, fellows, and senior residents on service with us. Quick summary of what goes into those evals: interpersonal skills, knowledge base, work ethic, professionalism, intellectual curiosity, communication skills, technical skills, etc.

Also of note, comments made in our clerkship evals show up in our med school records. Along with board scores, these third year comments and clerkship scores carry pretty significant weight in residency apps. With all this in mind, being constantly evaluated changes everyone's behavior, to varying degress among different people. Most people don't ask if/when they can leave - even if all our work is finished. Instead, we wait on seniors to give us the ok. Most of my interns and chiefs have been pretty good about letting me go within reason. Others, not so much.

On the other end of the spectrum, there are the ass-kissers. I.e. always volunteering to give a presentation, bringing in journal articles, and just brown-nosing it up. Best thing to do is to not get too annoyed and stay out of their way. Even more annoying and malignant are those who do the above, while also trying to actively outdo/outshine other med students even if it means intentionally making them look bad. There's an understanding among med students that we won't steal others' thunder or try to one up each other in the interests of getting a good eval. Some people obviously don't believe in that mantra.

Work
As I mentioned, M3's primary purpose on the team is to learn. I also touched on how there's some scut work. Outside of that, our work consists of a few basic things we can contribute to the team.
Pre-rounding:
This is basically work that happens before rounding on your service's patients with the team. It'll consist of checking up on overnight changes from nursing and other services. I'll also see if yesterday's orders were followed through on and note any changes in patient conditions. There's follow-up on any biopsies, imaging, and consults that were placed. I'll also see my patients, see how they're doing, and do a brief exam in followup.

Rounding:
We see the service's patients together as a team, usually with the attending. Updates are presented by the med students, residents (who carry more patients, including ours) fill in any gaps we miss, and the attending talks about the patient and elaborates on any teaching points. We see the patient together and then discuss the patient's assessment and plan.

Consults/Admits:
Throughout the rest of the day, we finish up and followup on orders, imaging, and testing ordered on our patients. While all this is happening, your service will get called throughout the day for patient admissions to your service (e.g. recent stroke patient to neurology) or consults from your service (e.g. new onset numbness/weakness in a heart failure patient on the medicine service).

Avg. work day so far: surgery (5AM~6PM), psychiatry (8AM~4PM), neurology (730AM~4PM)
Avg. work week: surgery (75-100 hours), psychiatry/neurology (40-50)

Caveats:
This is the basic framework of a workday. Each service at each hospital with different housestaff will have their variations. The biggest variation comes with the surgical specialties. Prerounding takes place earlier in the day, rounding takes place throughout the day between cases, and consults/admits/floor work are handled between cases or after the operating day is over. OR time makes the work day that much longer, because we still have to medically manage and followup on our patients. That unfortunately makes morning (pre)rounds particularly abrupt and impersonal - there's only so much time that each patient can get in the morning if you have 40-50 patients to see in an hour. Not mentioned are lectures we have to attend and presentations we have to give. These are usually either around lunchtime or during the afternoon. Also not included in the workday are the hours spent studying, prepping for presentations, and reading up on upcoming cases. On last caveat: this all describes a typical inpatient/hospital day. I've yet to be out in the clinics.

So that's basically what a third year rotation looks like. There'll be different flavors depending on if it's medical/surgical, where you're at, and who you work with - but it's all variations on the same theme.

Rebuilding Years

I'd consider myself a fan of most sports. That said, my teams are the Rams, Bulls, and Illini. And I'd consider myself a peripheral Blackhawks, Cubs, and Bears fan. Not a whole lot to be excited about right now.

Rams
I haven't gotten the chance to watch any of their games, but I think I'm probably better off that way. Seriously, we're not just losing. We're getting demolished to the tune of 24-108 over four weeks. In years past we could at least put up some points. Not so much anymore. I just glanced over the schedule and there's no game that made me think "Yeah, we should win that one." Maybe the Lions, but they're actually decent this year. Maybe we'll tie their record and put up an oh-for season too.

Illini football
I have watched most of their games. It's just straight up frustrating to watch their games. Aside from the Illinois State game, it's been a clinic in how to get in your own way. Big play? Well done, let's make sure it was run in an illegal formation. Or that somebody got caught for tripping. Or if we do gain momentum, let's kill the drive by throwing a pick or racking up penalties. Much like the Rams, the offense was the stronger unit of the two. You would think that after three years of Juice and Benn and a year with Dufrene that we'd have a pretty good offense. Apparently not so much.

Bulls
I'm actually excited about their season to start. Last year's series with the Celtic was a damn good one and isn't a bad thing to build from. I'm one of those that was happy to see BenGo leave. Yes, it's a huge scoring void and yes, we lost some "clutch shooting." Regarding the latter though, if you jack up enough shots on your own whenever the hell you want, you're going to hit some of them. Double-pump fadeaways from the corner shouldn't be a go to move.

Illini basketball
Like the Bulls, I'm pretty excited about this season. The first round exit to Western Kentucky was pretty disappointing, but apparently we couldn't stop Mendez-Valdez. Either way, I'm actually a fan of McCamey - hopefully he's more consistent this year and doesn't disappear for stretches in (or of) games. Our freshman class is pretty highly regarded too with Richardson, Bertrand, and Paul. That said our team is pretty young, having lost Brock and Meacham and with McCamey and Tisdale being juniors. Regardless, I have pretty high hopes for the season.

Chicago Olympic Bid
Ousted in the first round and it wasn't even close, since we were supposed to be one of the frontrunners. We got 18 votes in the first round, Tokyo 22, Rio 26, and Madrid 28. It was fun while it lasted. I think it would've been pretty cool to have the Olympics in Chicago. It also would've forced a pretty massive infrastructure upgrade and infused a lot of cash into the city. That said, Daley eventually signed over the city to be responsible for cost overruns. Overruns which would have happened and may have run into the billions. (In contrast to other cities being backed by their governments.) But I see that as the price of being able to get federal and state funding for infrastructure including the CTA, Metra, and highways while also fast-tracking said projects. The Olympics would've also stimulated the development of economically depressed parts of the city: around certain venues and especially in the proposed Olympic village area.

As for the sports that are happening now, the Illini and Rams are a combined 1-7. At least my fantasy team is at 2-2. Yay.

Only So Much To Do

I'm about a week removed from my psychiatry rotation and one week into my neurology rotation. From a medical standpoint, I'm liking neurology more than psychiatry. From a symptomatic, pathophysiological, and diagnostic perspective there's so much more going on. And I personally find it a lot more interesting. That said, with some conditions, there's only so much that can be done sometimes. To some extent, this also rang true with psych.

Psych
PTSD: it's pretty devastating and disheartening what combat can do. There are three symptom clusters that need to be met for PTSD: reexperiencing, avoidance, and hyperarousal. (Makes sense, but vets are evaluated in detail against these criteria for diagnosis. Why? Because the VA pays PTSD disability. Obviously, some people will take advantage of this.) Each of these symptom clusters affects people in its own way, each potentially functionally and/or professionally disabling. Reexperiencing is what it sounds like - vividly having to relive whatever combat situations they went through, either spontaneously or after a triggering stimulus. Bad as that is, a fair number of vets end up using to try and prevent reliving their experiences. A large number turn to alcohol and heroin, with a decent number also using cocaine.

If they don't use, then they may overreact to seemingly benign stimuli, like walking in public or fireworks. Some vets can't be in large crowds, because they can't account for the whereabouts and actions of everyone. Some can't handle loud sounds like fireworks or the L, and end up prone on the ground for minutes at a time. It's literally a reflex they have no control over. They can also end up withdrawing socially, becoming dysphoric, anhedonic, and hopeless.

And the last complex of hyperarousal can be pretty debilitating. Some vets will stay up all night, either because they're paranoid about someone coming after them or because they're having nightmares and/or flashbacks. They can also become irritable and prone to anger outbursts.

While interviewing a Vietnam vet, he straight up told me that I made him uneasy. Although he was pleasant and cooperative, he admitted that his instincts still told him I was an enemy and that he could picture himself killing me. I'm grateful he has some control over those urges. Either way, PTSD can be a devastating and disabling condition. It can push people to do things they don't want to. It can push seemingly highly functional people to use. It can ruin the lives of people only a few years younger than us.

Neurology
MS: multiple sclerosis is basically an autoimmune process that attacks the myelin sheath surrounding neurons in the brain and spinal cord, leading to both sensory and motor deficits, which manifest for years as acute attacks and eventually deteriorate to progressive decline. It's pretty disheartening (to me anyway) to see younger people with MS attacks, e.g. becoming totally paralyzed in their legs. Granted, they usually get better after a few days of appropriate treatment, but there's still some residual weakness. On top of that, there's sensory loss, possible incontinence, and not knowing when you're next attack might happen. Not the best way to live life.

GBM: glioblastoma muliforme is a high grade tumor of the brain (astrocytes) with a very poor prognosis - 6 months without treatment and a maximum of 18 months with treatment. This is the brain tumor that Senator Kennedy had. One of my patients was diagnosed with GBM in August. He initally presented with left sided weakness and confusion. After imaging, biopsy, and pathology he was diagnosed with GBM. Since then, he's had two 3 week stays in the hospital, 2 shunts from his brain to his abdomen put in (to drain excess fluid), and 2 emergency burr holes in his skull to drain the excess fluid and edema from the tumor. He's also had a few runs of seizures and almost complete left sided paralysis at this point.

ALS: amyotrophic lateral sclerosis, AKA Lou Gehrig's disease. This is also the disease Stephen Hawking has, though his extended survival is the exception rather than the rule. ALS is a progressive motor neuron disease, affecting them at two levels of the motor pathway - both upper and lower. As such, people gradually lose all motor function, with most people dying secondary to loss of respiratory muscle function. The prognosis is grim, with a three to seven year life expectancy depending on time of diagnosis. One of my patients has this, and its at a pretty advanced stage. He's lost movement of all four extremities, and is developing trouble speaking and swallowing. At this point, his care is all palliative, e.g. a feeding tube. One of the sadder aspects of his care is getting end of life affairs in order, including a do not intubate (DNI). Reason for this is that he may end up in respiratory failure, but if he's intubated without a DNI he can actually live for quite a while - albeit while totally paralyzed. He'd also be conscious with intact sensation. Horrible.

All these patients have made me realize that while there's a lot modern medicine can do, there's a limit to its efficacy. It's mind blowing to me - it's taken me a lot of time and energy just to get the bare basics of medicine into my head, nevermind the clinical experience needed for general practice or the minutiae, protocols, and therapies for a given specialty. Basically, I know there's some stuff in my head, but I also know I don't know a lot. It's even more humbling realizing that there are some things we just can't do anything about. That's one of the tougher things to deal with, especially since we're all wanting to cure our patients - not just stand by idly providing palliative care.

Daily Grind Changeup

This morning I wake up to 3 UIC emails with the subject of "Urgent Official Announcement." Usually they're warning us about some mugging that happened recently. And it's always a useful suspect description of 5'8"-5'10" black male in his early 20s weighing 150-170lbs wearing dark jeans and a white T shirt. Racist? Not on purpose. That's seriously the description for 90% of those muggings.

Anyway, as you're guessing from the setup, muggings weren't the point of those emails. Instead, they all said something to this effect: "Chicago police remain at the scene of a barricade situation at the Westside VA Medical Center. UIC police say to avoid Damen between Polk and Taylor."

Guess where I'm working? Apparently, some guy killed his parents and then showed up to the VA ER around 1 AM. He then proceeded to shoot the ceiling, point the gun at himself, and then ask for help. The situation went on for another seven or eight hours, until he was finally talked down and taken in. Here's the news story.

Selfishly, traffic was a disaster on all the local roads. My five minute commute turned into 30 minutes. CPD, SWAT, and all sorts of media were buzzing around the hospital. On getting to the hospital, cops were understandably redirecting everyone around the ER. Amazingly (to me), the rest of the hospital carried on as usual.

Since I'm working with psychiatry, I got to talking to some of the other residents. Apparently the resident on call was about two minutes away from heading down to the ER to see a psych patient around the time this guy went off. Eesh. That obviously would've blown for the resident and the attached med student. Regardless, it had to have been shitty for anyone caught in that ER.

Anyway, no real point to this anecdote. Just a little deviation and excitement in my daily psych routine. Out of curiosity and since I'm finishing up psychiatry, I'd like to hear this guy's story - I think it'd be kinda interesting. Who kills their parents and then goes to an ER?

Stories from a Student Psychiatrist

I'm a month into my psychiatry rotation. It's a pretty stark contrast to surgery. Morning rounds consist of more than "Pain? Peeing? Farting? Pooing?" There's a lot more talking involved with the patients, and about dramatically different things. Of note, my work week maxes out at about 50 hours, while averaging a little over 40. As opposed to 90 hours work weeks, with some days approaching 34 hours. There's the counseling aspect of psychiatry, e.g. talking to depressed and/or suicidal patients. I'd say that happens on a daily basis. But there's also a decent number of other mental disorders to be aware of. require knowing a subset of behaviors, symptoms, and or signs and being astute enough to pick up on them. It's harder than I would've thought to keep the less common pathologies straight. And the psychopharmacology? Hell no. Too random a collection of side effects and drug/drug interactions.

Some interviews take about an hour. An interview while one call Saturday night took about 90 minutes. Another interview while on call one Friday night took almost two hours. The latter guy was suicidal, having taken ~30 Xanax two days before coming into the ER. As a quick summary of his sad story, he's bipolar and newly homeless. He came to Chicago working for a friend for about 4 weeks. He never got paid, so he quit and ended up on the streets. Without a mailing address, he ran out his meds and his bipolar flared up. He'd had several manic episodes, including binging and spending thousands on his credit cards. He's chronically passively suicidal - i.e. if it were up to him/if he had the balls, he'd already be dead. As a kid, he and his sister were sexually abused by several of her mother's boyfriends, and he still holds homicidal ideation towards some of them.

Another sad patient I talked to just a few days ago is a 21 year old Iraqi veteran. He left high school four months early because wasn't doing enough to help his friends and his country out overseas. After a few months of being deployed, he finds out his wife is cheating on him and that "their child" isn't his. A few months later, he gets knocked off a truck secondary to an explosion and ends up losing consciousness and with several microfractures in his neck. After the army downplays the incident, he is forced back to active duty. While serving with his neck fractures, he gets called out by one of his superiors for his "neck pain." This guy ends up in some sort of verbal altercation with his superior, after which he's sent stateside. After a few weeks, he's discharged with misconduct. The latter phrase is key, "with misconduct," because it means this guy gets no money from the Army and/or government and is ineligible for disability. He's four weeks into a six week hospital stay, after which he has no job or place to go to. Regarding the job, that's not likely for him since he's textbook PTSD. He can't handle large crowds because he has to be able to see where everyone is and what they're dong. He can't handle loud noises because he goes to ground everytime he hears one.

Since I'm on the consultation service at the VA, I don't see too much crazy pathology (no pun intended). Most of that stuff happens up in the psych unit, where two of my classmates got placed. The pathological highlights of my rotation include a schizophrenic and a conversion disorder. The schizo was interesting- he'd been in prison for ~22 years for making threats against every vice president (of the US). He has a secret service agent keeping tabs on him. He talks of a successful money counterfeiting scheme which he's used to finance an armory with cases of rifles, pounds of explosives, and crates of grenades. He was set to be discharged the day we saw him, but Secret Service said no - because Biden was in town that day.

Conversion disorder is basically when psychological stressors manifest themselves as neurological deficits. Long story short, she had a lot of job, money, and personal stress going on. A few weeks ago, this manifested as a left-sided weakness presenting similar to a stroke. On imaging, no deficits were appreciated. On exam, her neurological deficits are inconsistent with a stroke. During her interview, she's noted to have spontaneous left sided movement with minimal assistance from her right side. On asking about her psychosocial stressors, she gets annoyed and doesn't understand why we ask about them. On suggesting a link between stress and her deficits, she invents her own science and educates us about the "Cellular Tear Theory" and "Biomedical Pain Mapping." I must not made it through those lectures in neuroanatomy or neurophysiology. Interestingly, on giving her the timetable for stroke recovery and setting firm expectations, she's recovering pretty close to the timeline laid out.

So yeah, that's what I've been up to the past few weeks at work. Imho, it's not as interesting as surgery, but that's what third year's about. Figuring out what I do and don't like.

Post Op

Two+ months later, I'm done with my surgery rotation. Maybe the first of several. I came out of those eight weeks pretty psyched about what I'd just gone through. This bodes well as a possible career choice. A few days into my psych rotation, I realize I actually miss my surgery rotation.

That said, I worked my ass off. Boards aside, surgery was the hardest two months of work I've had so far. Granted, I'm pulling from a small pool of experience, but still. Here's some examples of the type of hours put in.

Longest:
work day (on call) - 34 hours...yes, almost a full work week
regular work day - 15 hours
consecutive hours awake - 48
work "week" - 13 days...aka no days off for almost two weeks
calendar work week (7 days) - 96 hours
surgery - 7 hours

Fortunately, those were extremes. I typically got up around 3AM to make it to the hospital by 5AM. On a good day I'd be out by 6PM, on a bad day not so much. And then there's the issue of taking call. On a good day I'd be out by 11AM the next morning, on a bad day past 3PM. Surprisingly, there are times when insanely functional on no sleep. On that note, I was averaging probably about 3-4 hours/night. It personally wasn't my favorite sleep regimen, but you can get used to it.

With all these hours, there's also a decent amount of material that we actually were supposed to have read up on and learned about. At my site with these types of hours, it's incredibly hard to study when you're averaging 80+ hours per week, including one or two nights of call a week. There's only so long you can run on fumes before needing to recharge. And those fumes usually were burned off long before leaving the hospital.

Long story short. I loved my surgery rotation. It's been bumped back up pretty high on a short list of interests. I'm seriously considering it as a career, though I'd prefer better hours and a decent lifestyle...aka a subspecialty (maybe ENT). I loved my rotation because of all the exposure and hands on stuff we got to do at our site specifically. That said, all the hours detracted pretty hard from study time. I'm pretty concerned about how I did on the surgery final, a national exam. We need a 59% to pass. On the few practice questions (not exams) I got a chance to do, I averaged around a 50%. Oy. The shelf exam is only 1/3 of our grade, yes. But - we still need to pass it to pass the rotation. We'll see what happens.

Until those grades come out, I've been living in ignorant(aka anxious) bliss in the psychiatry world. One week down, five to go. Stories to follow.

Grinding Away

Two more weeks and I'm done with my surgery rotation. The six weeks have resparked my interest in surgery. I've always had an interest in it, just not so into the hours. It's weird. A 12-14 hour work day actually goes by pretty quickly, especially if I'm in the OR for a large part of that. Even my on call days/nights go by pretty quickly.

It's the time when I'm not at work that blows. All the hours just wear away at you. Once my ass hits my car's chair, I feel whatever energy I have left drain out of me. Once I get home, it's hard to really get anything done - aside form sitting around. And I usually have shit to do - working on presentations, reading up on cases, and whatnot. These days I have to add studying for the rotation final to that list. Studying seems pleasantly foreign to me now. But, it's something I'll have to do, along with reintroducing myself to a library. Sigh. At least it's all clinically relevant and interesting stuff at this point.

Side note: props to those residents who have real lives and families...I've no idea how they do it.

Boring and whiny stuff aside, there's been a decent amount of cool stuff. I was on trauma surgery two week, so that was pretty cool. Highlights include taking a bullet out of someone's hip (!) and pulling a rake/hoe out of someone's foot.



It seems mundane, but getting to sew people up is still pretty cool for me at this point...and I saw plenty of that. I was on call on a Friday night, and needless to say, shit got crazy. About 20 trauma pages overnight, most of which were between 8PM and 3AM...most which were in turn violence related. Aka gun shots, stabbing, beatings. Went to the OR twice that night. One guy nicked his aorta, bowel, and lungs - he was bleeding out and ended up getting about 8L of fluid into him. I think he's still alive. Another had about 10-15 holes throughout his intestines and a few liver lacerations. He's doing okay to my knowledge.

As much violence as I saw on trauma, a decent number of them are bound to be shady characters. As in pieces of shit. Two of them shot each other while one tried to rob the other in a retaliatory effort for something. There's one particularly sad story that also pisses me off. Some pieces of shit teenagers thought it'd be cool/badass to try and jack a UPS truck. Except they used guns to try and take the truck. And shot the UPS driver in the back. The 29 year old driver who was working a legitimate job. He came in unconscious and in critical condition. He's stable now and doing well. Except for the fact that he's a paraplegic. Motherfuckers. On the note of shitty characters, there were a few domestic violence related traumas that came through as well.

There were also a few failed suicide attempts. One guy shot himself in the head and lived. He obviously aimed pretty poorly...and ended up shooting out his orbits. He's blind in both eyes now. And he wants to live now. Another girl tried to shoot herself in the gut. Questionable mode of suicide, imio. She lived and now wants to. But, she managed to nick her cord and is now a paraplegic.

As many sad/fucked up things as I saw in a week, there are also people who were just in the wrong place at the wrong time. Plenty of car/motorcycle accidents. A surprising number of pedestrians hit by cars. Decent number of falls from roofs, buildings, scaffolds. And of course, numerous alcohol related traumas.

In just a week, it was impressive how much shit I saw. It makes one a little jaded, and it shows in the culture of the trauma service. Everyone from residents rotating through trauma to the attendings are pretty cynical and jaded. I don't blame them though. It's enough of a shit show enough of the time that I'd be the same if I was onboard for more than a week.

Great Day

After a thirteen hour day and minimal food intake, how could a day be great? Let me tell you.

Team Dynamics
I've mentioned previously how lucky I am to be working with such a great team. Here's why.
1.) I'm in good with the interns: They don't scut us out too much. They teach a lot. They actually like and respect us. I can talk shit to them. Makes for a funner, lighter work day.
2.) Senior residents: See above, minus the shit talking. I'm in particularly good with the chief resident. He's verbalized this and the fact that I'm standing out of the group. This is doubly great since he and the other senior grade me.
3.) Attendings: Have had lots of interaction with the chief of surgery, med student director, and resident director. Med student director took greater notice of me after a presentation last week and have been getting along particularly well since. I'lll be scrubbing in with the chief resident, chief of surgery, and resident director on a particularly big surgery (Whipple) this Friday. Nice opportunity since the attendings obviously also grade us.

Though it may sound like it, this is all happening without cutting down my fellow med students. I'm insanely lucky to be working with such a good group of M3s - I wouldn't consciously step on them just for my own benefit. ...there are kids in my class who would. I have their back and vice versa with work and helping each other out.

White Coat Benefits
I don't openly put it out there that I'm a med student. In fact, I despise people who go out of their way to make this fact known. Who the hell do you think you are that you need to advertise yourself? A jackass is the correct answer. When meeting people, it only comes up if someone else mentions it or if they ask what type of school I'm in. On being asked what I do, I say I'm still in school - if they keep asking, I tell them.

That said, I don't mind the perks that come with other people finding out what I'm going into.

1.) Last winter, I forgot I had my white coat on under my winter coat. Part of it must have been flashing beyond my overcoat. After ordering a Polish sausage, the guy says "this one's on us" - after paying for my Polish. Didn't really know what happened, since I just paid for my dog. When I get home to eat, I find an extra Polish and fries. Nice.

2.) At 445AM this morning, I was rolling down a local road (95th St). I guess I got to going about 45 in a 30. You know how this story ends. I'm still gonna tell it. I get pulled over by two suburban cops. (The suburb is next to a not so great part of the city.) He must've noticed the white coat in my back seat. The abbreviated convo goes as follows:

cop: You a doctor?
me: Nah, just a med student.
cop: So you'll be saving my life someday?
me: Hopefully not.
cop: I'll be back.
...a few minutes pass...
cop: *Hands me a warning* Thanks. Have a good one.
me: Thank *you?*

I neither want nor expect special treatment because of what I'm going into. That doesn't mean I don't appreciate it :)

The Game Changer
I got my board scores back this morning. If you'll recall, this number has a big say in what specialty you go into and where you can go. I passed, which I was honestly expecting. The question concerning me was how well I did.

I did better than both my "realistic" and "hopeful" goals. (!!!) So yeah, I'm pretty psyched. The score is above average for most specialties, including EM and surgery :) It's only below average for some of the most competitive specialties (plastics, derm, ENT, radiology) which I'm okay with. It's actually on par with ortho, which is one of the most competitive specialties. My surprise comes from testing amid a pool of ~16000 of the brighter kids in the country. And still doing decently above average. Hence the excitement :)

In short, my score keeps the door open to quite a few specialty options - which is all I was hoping for. Self-flattery aside and long story short - I'm pretty excited about my board score!

Overall: good day!

Call. Oy.

My on-call night Thursday was particularly rough. For those wondering what it means to be on call, it means that you're covering your service (i.e. surgery) after regular hours into the next day until the full team gets back. Basically your work day extends through the night and into the next day. For me that meant in at 5AM Thursday and leaving at 11AM Friday...technically. Technically because there's supposedly a thirty hour workday rule. Much like there's an 80 hour work week rule. Both rules are more guidelines than anything. I actually left on time Friday. But my work weeks are at least 89 hours.

It's not *as* bad most nights, when I can get an hour or two of sleep. Thursday night was crazy busy though. Meaning me and the intern got no sleep. At times during morning rounds, I was pretty much a walking zombie. Before rounds, the intern fell asleep at the computer 3-4 times. Surprisingly though, I was good for the vast majority of the "day." The sleepiness only hit when things slowed down for a bit. The worst part was the hunger actually. My dinner was at 630P Thursday. I didn't eat a meal again until noon Friday. Fortunately, I'd learned to stuff my white coat with some granola bars. I went through about 8 bars that night/morning.

Before midnight it seemed like the pager was going off every 5 minutes. Some of the stuff was just nurses. Half of them were consults though. A consult is the worst type of page. Especially when only 2.5 people (chief resident, intern, med student) are covering four surgical services: thoracic, pediatric, general, and vascular surgery. A consult takes awhile because you have to do a quick read on the chart, look at vitals/labs/imaging, do a quick h&p with the patient, and then present to your senior(s). The whole process can take 30-45 minutes. And when consults start piling up, on top of regular nurse pages, postop checks, floor work, and whatnot - it gets a little overwhelming. There was a time when six consults had piled up between me and the intern. You just hope that no one gets missed or left behind. The best type of mistake is one where no one dies. In all seriousness. As interns or med students, we will mess up at some point. I'm constantly reminded by upper levels that it's all good as long as no one dies.

Quick side note about consults in the ER. Patients usually aren't too happy. By the time surgery gets a consult for an ER patient, they've already been there for 6+ hours. Abdominal pain, once ruled nonemergent, gets triaged lower on the ER's queue. Once they finally get seen by the ER, labs and imaging can take a while to get going. After all that, surgery finally gets consulted. No one likes talking to three members of the surgical team three separate times. On top of that, no one likes hearing they need surgery. It makes for interesting trips down to the ER.

As bad as things may sound, things aren't all that bad. The team's reduced to minimal numbers meaning there's a lot more for each of us to do. Spun in a good way, that means that I learn a lot more and get to do a lot more stuff when on call, vs during the day. While on call, we're also on page for the trauma service. Last Thursday there were about 15 trauma pages through the night. About 10 of those were gun shots/stabbings. Welcome to summer on Chicago's south side. On slower nights, I usually make my way down to the ER for trauma pages...since I'm interested in both trauma surgery and emergency medicine. And luckily, I'll actually get to rotate through trauma surgery for a week. It's supposed to be pretty cool and they supposedly let you do a lot of stuff...especially when on call. I already got to do a decent amount of stuff on my rotation through pediatric and thoracic surgery last week, so I'm pretty psyched.

Back to the sleep deprivation. It's real and thus has real effects. While pulling numbers on patients, basic things like reading efficiently become more difficult somehow. As long as I'm actively involved in something the next morning though, it's pretty easy to stay awake and perform similar to precall levels. It's even pretty easy to turn off the drowsiness and act wide awake while talking to patients. It's when things slow down the next morning that nodding off becomes an issue. On that note, driving is particularly problematic. Sitting is already a bad idea. Doing something boring, semi-passive, and monotonous is even worse. There were a few times when I almost fell asleep. And I did doze off a bit at a traffic light. Being on the phone definitely helps. But next time I have that rough a night, I'll probably take a nap in an on call room before heading home.

All that said, being on call is an interesting experience. Personalities change, things get crazy, and there's not a lot of sleep to be had. Since I'm on call tomorrow night, I think I'll get to bed early. It's a new strategy...getting plenty of sleep before going on call. Results TBA.

Last week's highlights:
-5 day old newborn with his stomach, intestines, and spleen herniating through the diaphragm into the left side of his chest and preventing development of that lung
-taking out someone's esophagus, part of which was done robotically...an eight hour surgery

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.

Warm Up, Layer Down

We've had some gorgeous weather the past few days - 50° on Saturday, with yesterday seeing temps in the 70s. It's this time of year that I start noticing people's different wardrobe choices, with regard to temperature. With temps in the fifties, I'll see anything from all out puffy coats to straight up T-shirts being sported. That said, I've got my own temperature appropriate model for layering up and down throughout the year. Your mileage may vary.

>75° Shirt and shorts. Nice and warm, but definitely the potential to sweat balls if walking around for awhile. Summer!

65-75°: Shirt and shorts/jeans. Comfortably warm. Preferred temperature, usually September, May.

55-65°: Long sleeve T with or without T on top and jeans. Probably my preferred temperature range. Mid spring/fall.

40-55°: Above with track jacket or other zippable sweater types. Shirt and fleece jacket. Straight up hoodie also acceptable. Also a decent temperature range.

30-40°: Hoodie and fleece. Peacoat and longsleeve shirt. Possible beanie and/or gloves.

15-30°: Peacoat and hoodie. Peacoat and layered shirts or sweater. Puffy and shirt. Beanie and gloves. I personally consider <20° to be cold. Average Chicago winter weather.

0-15°: Peacoat and layered sweater. Puffy and layered shirts. Beanie and gloves. Possible scarf. Occasional Chicago winter weather. At <10° all cold kinda feels the same.

<0°: Puffy. Layers, multiple. Probable scarf. Consider extra leg layer depending on windchill. Beanie and gloves. Damn cold - God forgot to leave the heat on. Cold, even for Chicago. Luckily, more the exception than the rule.

My system assumes I'll be outside for a bit and doing some walking. Note: I usually prefer it cooler, but I've also learned to err on the side of extra warmth.

The More the Merrier

I'm in line for some Hot Doug's (local hot dog place) today and the wait outside is about 45 minutes. Whatever, there's a group of us and it's not too cold. On looking around, there are these two women in front of us wearing full length fur coats. A little out of place, given the establishment we're in line for. Upon eavesdropping, their 40 minutes of conversation consisted of: needing to go shopping; not knowing what to do with boots/clothes that they can't wear but bought anyway; how much Patron and Grey Goose they went through last weekend; how they need more jewelry; trash talking their friends and significant others. It was pretty disgusting how materialistic and superficial they were.

Granted, I like nice things and fancy toys as much as the next person. But not to the extent of brazenly spending money for the sake of it and only having said activity to look forward to in life. Whatever.

On another note, tomorrow is Pi day and Chicago's St. Patty's celebration. Sounds like the perfect combo and a winner to me.

Randomosity

Yesterday was an absolutely beautiful day. At least, by local standards. Sixty-three in early March? No complaints. More of the same today ~60°! Unfortunately then it's back to reality for a bit...temps hovering somewhere in the 30s - which is itself at least above freezing. It'll be probably a month before highs are back into the 50s with regularity. I don't overtly despise the winters or anything, but I do feel more alive when days like today hit in the middle of winter. Jokingly, some of us think we have seasonal affective disorder.

Got some of my exam scores back a few days ago. Only one real surprise on one of them - a bit too close to the pass level for my liking. And actually, my lowest grade by far in med school. Maybe I'm getting a bit too nonchalant about school. I think I'm actually gonna try to stay on top of things for this home stretch. And ambitiously, I'm for real gonna start studying for boards. All the cool kids are doing it. Big picture-wise, I've worked a bit too hard to let a few months of jackassing mess up boards and residency apps. Especially if I wanna stay in Chicago.

On the note of resolutions, I gave up fast food again for Lent. Sure not the most original, but it makes things more interesting for someone who isn't home so much. I contemplated giving up elevators again, but I spend a lot of time on the eight and tenth floors of two buildings.

I got my schedule for next year. There are 24 different scheduling combinations that we rank and enter into a lottery. I, of course, got my nineteenth choice :/ I would've preferred my breaks distributed more evenly and the rotations done in a different order, but beggars can't be choosers - at least we're out in the hospital. For those curious, the six rotations next year are medicine, surgery, psych, family, peds, and OB/GYN. Hours-wise, I'm least looking forward to OB, surgery, and medicine.

Pretty run of the mill stuff - nothing too exciting. Unless you count Korean bbq. I'm kinda excited, it's been too long. T-minus an hour!

Uno Mas!

Got through another round of block exams this week. Woot. That leaves only finals until I'm done with class. Forever. Double woot. It might be because I'm so close to that, but I don't know if I could do anymore class stuff beyond this. I think I may actually be approaching max indifference. And half of the classes are stuff I actually like. I used to think tell myself patients are some of the reason I'm learning this stuff. That and some of it is kinda cool. Realistically, I'm not going to remember a lot of it. Read: biochem. Enter indifference. For example, I went out for a charity happy hour last Saturday and only planned on staying a few hours. Not surprisingly (and a testament to my willpower), it ended up turning into a late night affair - and I couldn't have cared less. Though, I was annoyed at having my jacket stolen :( Either way, last year I wouldn't have been out right before exams - it's prime cramming time in our world. That aside, less than six weeks until my last round of finals! Ever! And about three months until boards are done with. There's talk stirring of a south Caribbean cruise even. It'd be a damn nice way to top off classes.

On a totally unrelated note, this clip is pretty funny. At least imo. And it's educational. Had my first run in with CPD a few weeks ago for those wondering. Nothing major, but still semi-relevant.

Procrastination Devices

Over the past few months, I've occasionally brought my laptop along to reference some online videos. Naturally, this'll result in burning time to jackass on the internet.

Civic Pride
No, not of the Honda variety, but of the city kind. It's fair to say I'm a big fan of Chicago. I stumbled upon a site (galleries 1, 2) with some unique views of the city. Specifically, from the Trump Tower while it was under construction. It's apparently the second tallest building in America, which is kind of odd because it doesn't seem that tall in the skyline. Anyway, the pics are from a sweet vantage point and they're pretty cool, imo. You can see my neighborhood in the default pic for the second gallery. It's around the green area in the middle right part of the pic - left of the collection of red buildings. Props to the photographer for the pix, and bigger ups for sharing them.

I don't know much about the Olympic site selection process, and I'm guessing that most people don't either. Chicago's in the final running for the 2016 games, so I've naturally taken an interest in the process over the past year. More accurately though, it's interesting to see what the plans are for the city. In terms of venues, you've got obvious places like Soldier Field and the United Center. But they're also talking about a downtown marina and two of the city's biggest parks, in addition to building new venues and an Olympic Village. I think it'd be cool to check out events at places that are local to me. Plus it'd be sweet to host the games. Here's the site that finally went live detailing the IOC bid.

Totally Unrelated
Odds are someone's already found this site. Still funny though.

For the past few months I've been considering getting a smartphone. Mostly for the sake of M3 year and putting medical reference software on it. Of course, there are other obvious perks to having a smartphone. Having it for rotations was seriously the main impetus though. I personally don't like having a big phone in my pocket. That said, I ended up getting a Samsung Omnia about a month ago. I didn't really like the interface of the Storm and the HTC was too expensive.

After a month of usage, I pretty much love the phone. (Admittedly though, I've no real baseline for smartphone comparison.) It's got pretty much everything I would really need/want on it: pretty good 5MP camera, wifi, FM radio, media player, MS office, Opera browser. I do have three gripes with the phone though. There aren't that many extra apps or games available. Maybe there are, but I haven't been able to find them yet. A Verizon version of the Apple store would be nice. Of course, that's not really VZW's m.o. On that note, in true VZW style, they disabled the onboard GPS and force you to use their interface. Boo - no google maps or latitude for me. Finally, using all aforementioned features throughout the day, mainly internet and media player, kills the battery. I've pretty much gotta charge it every night. Guess I can't really complain about that, since it's supposedly got one of the better battery lives out there.

As for my initial concerns, the phone feels a lot smaller in my pocket vs. my old phone. And yes, I have put on some medical reference programs. I snapped the stitched picture below with my phone from a conference room that my group studies in. We're a fan of the view. And I'm a fan of the pic quality. Pretty much delegates my real camera to shelf duty.