There's an 80% possibility I will be doing Pediatrics

Hey, hey , hey
Wakey , wakey eggs and bakey
Frick Frack
Interesting
Innit Interesting?
Sweet Pea
Wild child
Peanut
-Dr. Justin Beverly (Pediatric Attending, Pimp Master)

So, Pediatrics, one of the most enjoyable and crazy rotations I've done so far.

I started off my Peds rotation on the floor and I'll say this much, the floor is intense. We worked like interns for lack of a better description. I was fortunate in the sense that there were four of us on the floor team. 1 student was always rotating on the PICU (Intesive Care Unit) while the rest of us remained downstairs.

So couple things to understand, the Children's Hospital is separate from the main hospital. You cross a bridge on the 4th floor of the main hospital to get to the third floor of the children's hospital, doesn't make sense to me either. Perhaps there's some kind of wormhole/vortex between the two buildings. Once you cross before 6am. well you don't go back till lecture at noon.. it's a completely different world. I'm thinking bridge to Terabithia except this Terabithia is full of RSV, contact precautions, tee-tee and poo poo. (But I digress, and btw just as an aside.. that movie "Bridge to Terabithia.. was really sad) Lastly, the bridge is one of the few areas in the children's hospital that has windows so really it is very possible you will have no idea what's going on outside during the course of the day until you cross the bridge on the way out the door for the day.



There's paintings on the wall and drawings submitted by past patients and bathrooms where everything is smaller. Since you're there at 6am , the nurses are winding down before shift change so there's a sort of lull in the predawn period. Then you make your way to the dungeon, the peds conference room. Here is where it all takes place. Here's where we divy up our patients, work on getting people home, changing orders, calling hospitals.. this is the think tank behind everything the pediatric team does on the floor. So begins the day

600-700a - Students wait for Interns (First Year Residents) to show up and sign out = the on call intern from the night before tells the intern coming on about anything crazy that happened or any new admissions, the students have to pay attention because we have to split up the patients as well
700a-930a - pre-rounds - visiting patients , checking labs, writing notes on the patients we have, this includes touching base with our intern before it's time for work rounds
930a-noon - work rounds- the whole team goes patient to patient and a student/intern presents the patient example: 12 y/o male presents with 5 day history of constipation and distension unrelieved by over the counter fiber supplements , he is currently on IV Fluids and a Go-Lytely drip. Labs are normal, etc etc. Constipation is a rather common problem. All joking aside, it's really obstructing medical care... HAHAHAHA (get it?) So work rounds is similar to what you see in Scrubs where the attending asks questions at the bedside, etc. One of our attendings, the one I quoted at the beginning is famous for his bedside questioning.
Noon - 130 - Lecture and Lunch
130-500p - Anything and everything that needs to get done on the floor from orders, discharges , new admissions, checking on patients, calling outside hospitals, calling the lab, etc


Then there's night call. Because of the holiday season, our night calls got stacked up. So instead of spreading six nights of call over 4 weeks, I had 3 nights of call two separate weeks = 90-110 hrs logged at the hospital ... KILLER. There's not a whole lot that's crazy about night call. Essentially the day team leaves and checks out to a night team. The night team just handles whatever takes place at night, writing for meds and handling new admissions. The only difference is that we have to call the attending at home to discuss patients before we admit them. As a student, we picked up whatever admissions we took part in. Since we usually write the admissions orders and take the histories, we know the patients quite well. So the next morning it'd be your responsibility to present the new patient. So let me digress and talk about beeepers:

I used to think having a beeper was awesome. It was some kind of reminder to the outside world that your were awesome and that somehow attractive ladies would realize that obviously you're some kind of important doctor who needs to rush off and call about pages and save lives.

I don't think that anymore. You see the beeper is your means of contact when you're not near your resident. So you think you're home free around 1100p/midnight and you settle in for uncomfortable night in our call rooms trying to get some semblance of somber when it goes off, the beeper ... the bastard of a beeper. It's 300a and you just sigh audibly.... and say something like SON OF A FRICK FRACK. So what is a beeper? It's a cock block of peace in your life. The funniest thing to observe is the collective loss of sphincter tone in a group of medical student when someone's beeper goes off. Everybody is sitting around our student lounge when it goes off. There's a little pallor in the face and we all hesitate, reach for our beeper and realize it's one unlucky soul's page and not our own. Realizing we didn't mess ourselves, we are all collectively relieved but silently mourn the poor colleague. So long beeper bitch, we shall live another day.

So a few things that I've seen on the floor that was interesting:

I took care of a little girl with Kawasaki's disease - basically a vascular disease in kiddos that can cause Heart Attacks in kids.
We has a cute bilingual kid who ended up with a wicked Strep Pyogenes skin infection.
We had a bunch of RSV-ers
I had a run of the mill abscess kiddo
I'm blanking on other things but yeah


So after my 3 weeks of floor madness, I had one week of PICU. PICU was awesome. Now here's a little dose of irony. The PICU, the Pediatric INTENSIVE Care Unit is less intense than the floor. My resident and attending were really laid back people. There's several reasons why the PICU is cool. One , you don't have to take as many patients. I started with one patient, a little dude who had RSV and was on a ventilator.

So time for another aside.

RSV - http://en.wikipedia.org/wiki/Respiratory_syncytial_virus
RSV is one on the most protean viruses known to mankind. Well, maybe not mankind so much but Robert-kind. You see with kids, most kids end up with a coughing spell that lasts for a bit and lingers, maybe a little tachypnea. Some kids need a little oxygen support and chill on the floor. Other kids, like my little man in the PICU end up being put on the ventilator , especially if they are premature babies. They just don't knock the virus out fast or strong enough.

It's weird entering a room with a little one hooked up to a ventilator and recording settings and checking tube feeds and medicines including an array of muscle relaxants (Versed and Fentanyl) . My job was basically to check his lungs, check hsi xrays, check his feeds and see how he was doing. It's strange watching the lungs slowly clear up and then hearing them clear up on exam. But that's PICU for you, you manage the basics.. airway, breathing, circulation....

So mid week I decide to pick up another little man. This little dude was a 4mo old male with Down's syndrome and had an AV canal which means , he really didn't have a nice separation of inflow and outflow in his heart



His main problem is that he'd have these spells where he'd desat (lose oxygen, turn blue) and brady (slow his heart) and it was thought that we was just shunting during these periods. He has a particular formula where he'd get fussy --> arch his back --> get worked up ---> mess his diaper --> desat/brady and then you'd just turn his O2 up a little and wait and he'd go back to normal. Well this little guy decided to do this to me and the nurse one morning. The nurse hadn't been seeing him and wasn't acquainted with these episodes but during my morning exam, he went through these steps and it played out something like this:

[Robert is examining his patient, putting his little nasal canula back on and trying to pat him back to sleep]
[Little dude starts arching back and turns gray/blue]
Nurse: He's desating , he's turning grey-blue
Nurse: where's the bag, bag him, bag him
Robert: [no words, proceeds to grab ambubag and starts inflating]
Nurse: it's not connected, where's the connector, oh my God
Robert: [is scared crapless... holy crap this kid's gonna die on me... what am I even doing?]

BREAK - so you need to realize that while all this is going on. There's a 16 y/o male with sickle cell who had respiratory issues, heart failure and kidney failure and all this stuff going on that early morning and they were trying to stabilize him to get him sent to Egleston so the PICU was busy. Also realize the rooms are transparent in PICU, nothing goes on without us really knowing

Robert: [thinking, where is everyone , holy crap holy crap.... ]
Respiratory: calm down, this kid does this
My Resident: walks in
- everything calms down as the little guy returns to normal, is breathing fast with retractions but otherwise going back to normal with some eye contact issues (maybe a little seizure activity?)

But that was PICU week, back to the basics... tweaking ventilator settings here and there... swapping out meds and fine tuning most patients. Rounds consisted of checking all new xrays, and visiting each patient with the nurse in the room, the resident, the student , the NP, and the respiratory therpaist all contributing. It's a very team oriented approach on PICU. Nobody is alone, everyone helps take care of the patient. It can get really crazy in a hurry but mostly it's just watch and wait. I enjoyed PICU alot and learned alot and also almost crapped my pants like my little guy who does crap his pants after almost dying....

That same little guy was smiling later that day as we checked on him. My resident commented "look at him smile while we talk about him almost dying" This is why I love peds...

One reason not to do peds is loss. We lost one of our patient en route to NY. He was an 8 y/o boy newly diagnosed with cancer in August (he was actually diagnosed when I was pediatric surgery and we were checking his chest tube to drain a suspicious effusion). Later, he returned for a little fever, upset stomach when I was pediatrics and he just had some cruddy looking lungs , earning him a ticket to the PICU. Well , he was starting to do better, on high flow oxygen and was ready to be transported to NY where cancer specialists up there were gonna better assist him. Well, he didn't make it for one reason or another, the family didn't want to do an autopsy. May he rest in peace.


So that catches us up to this past week, Newborn Nursery

So my only gripe with Newborn Nursery, I had to come in Sat/Sun morning but otherwise this was the greatest week on Peds for me. I showed up between 800a-815a and saw one or two patients and because of the holidays we had extra help so there wasn't any need to handle more patients.

Newborn Nursery is awesome, your patients range in age from hours to days, no more. Some of my babies, I'd see a few hours after being born. It's really unique in that babies are really durable straight from the get go. I mean they're ready to rock and roll straight out the bajingo. So the newborn exam... something the general public doesn't need to realize is something that I'm learning on the fly: The whole flipping the baby around and checking the head is really disconcerting if you realize that the person doing it is an amateur. I had one grandma who was very humored by me holding the baby in one hand and checking spinal reflexes.

So to top off my newborn week, I pulled a classic move during an interview, totally neglecting to check the gender of the new baby, I proceed to inform mom about spitting up patterns, stool patterns, cord care...etc then I casually proceed to talk about circumcisions ...etc.. and which point mom.. goes "she's a girl".... I'm like... oh.. so that's not relevant at which point mom, dad, my resident and I laugh at my faux pas. My resident totally covers for me by saying that it was unclear earlier the gender of the baby in the paperwork... thanks for that......

One of my favorite parts of the exam is eliciting the Moro reflex, basically you raise the lying baby up by the arms and drop them a little and their little arms should flail out as if they're startled... they do this too when you catch them off guard with a cold stethescope. It's their little way of saying "holy crap dude, take it easy"




Another one is called the galant reflex where you stroke parallel to the spine and their little hips swing to the side like a fish, "just keep swimming..."






So in short, this week was awesome. I worked from 815a-noon and then lecture noon-1 and then may or may not have a kiddo get born before 3/4p ... best schedule ever . One thing to marvel at is how healthy these little guys are. Mom may have STDs (which I've seen), mom may have done done drugs (have seen) and the odds may just be stacked against them but sure enough they start feeding, picking up weight and are sent on home......

This week more than ever convinced me that I will probably pursue a path in pediatrics. There's just something remarkably awesome about little ones getting better that makes you feel good. There's also this sense of high stakes. Kids will turn on you real fast. The healthiest looking kid can have an occult bacteremia /meningitis that just levels them within 24 hours. I think the patient population and the challenge , the stakes is what makes me attracted to pediatrics.

Plus, let's be honest... I can get away with saying things like "squishy", "poop", "whiny", "yucky" while giving report on pediatrics. The whole week, I wore a big ole button with a snowman. It's just so fun to take care of kids. Plus, let's be honest - "I help kids get better" bodes well with the LADIES....

Anywho, loyal readers

Merry Christmas, Happy Hannukah ... rest and relax....

Love,
Robert

Giving Thanks

Whaddup? So it's been a while since I've done this.. be inspired and subsequently sit down and write/type. The two things haven't really lined up recently.

So family medicine was fun. Somewhere between knee injections, shoulder injection, flu shots and a once in a lifetime urethral swab/torture... I found it quite enjoyable but not for me. What would be difficult is the paperwork, pain control and managing patients. When you think of medicine, at least for me, you think of healing, curing ... intervening in a disease process. With adult patients , you catch them somewhere in their disease process, most likely toward the chronic...preventing organ failure stage. Don't get me wrong, the long term relationship with the patients is really cool because every time you see them, it's not so much history gathering and trying to put the picture together.. it's more treating the acute problem and chatting about life.

So now I'm on pediatrics which I was really looking forward to. After two weeks, I'm back to being optimistic but it took some effort. You see, it's different being on pediatrics because you don't get nearly as much contact with your attendings. The bulk of the time is spent in this conference room without windows working on patients whether it be following labs, doing discharges, admitting, writing notes, etc. That can be really tiresome because I'm someone who likes to move about and see people but pediatrics especially with our residents is kind of a paradox. They tend to treat us like kids , making sure we ask to go get breakfast or coffee and always seem to want to keep on an eye on us to the point of us sitting in the room for hours doing very little. On the other hand, we also do a whole lot more. We're writing orders during rounds and doing discharges and admissions ... all we need is a signature but all in all it's really neat.. because now we can adjust oxygens, make and adjust medications and just ask our residents to sign off..... also the nurses and other residents will talk to us directly concerning the patients we're assigned to.

I mean my patients are really my patients. If they need something, I can write for it, get it signed. I can follow up on labs and operative reports .. I also check in on them throughout the day, checking my asthmatics making sure they are satting well. So all in all, it's been a good experience, having the responsibilities of an intern minus the ability to sign for my orders and scripts. The hours are ridiculous, I worked 110 hours from Monday to Monday... most of my days are 11 hour days but the great thing is that I'm on inpatient till Christmas then when I get back , no call, no weekends, good hours. Next week oughta be good :call Monday, Thursday, Saturday = another 105+ hr week.... oh... Peds how you steal my life away ... but after that I'm on PICU (pediatric intensive care.. i'm looking forward to that.... it'll mix my interest in critical care with pediatrics)

A few things that's been on my mind:

I'm really happy to be a Muslim. It's hard to appreciate but there's something to be said about praying in synchrony, saying Amen in synchrony with the rest of your brothers and sisters during prayers and today was especially unique in that we had both an Eid prayer and our Friday congregational on the same day.

Another thing to comment on, don't underestimate the value of great friends. i am really blessed in the friends that I have. I feel like each of my friends add their own unique spice/flavor in the casserole that is my life.

Regarding the girl situation, nothing to comment really. It's one of those, good things come to those who wait.... sometimes it's really hard to not want the good that seems so close... though...

All in all... Life is Good and wouldn't have it any other way....

Pain

Pain
2 a : usu. localized physical suffering associated with bodily disorder (as a disease or an injury); also : a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort (as pricking, throbbing, or aching), and typically leading to evasive action b : acute mental or emotional distress or suffering : grief
(from Merriam-Webster online)

For me, pain has to be one of the most frustrating aspects of going in to the medical field. It seems that everyone happens to know off hand when their Lortab is due for a refill or has some allergy to codeine and every other narcotic except oxy or lortab. How do you manage a patient with pain?

When I was on palliative medicine, we didn't concern ourselves with addiction or DEA stuff. We manage the pain, we make sure our patients our comfortable at the end of their lives. It seems so simple, so straightforward. We take an oath to do no harm and comfort measures fulfills this, yes.

But what about the guy who says he can't spend time with his family, that his pain is 10/10 but yet I can take his shoes off without him flinching. Later my attending asks what I noticed about his shirt? He was drenched in sweat. I also noticed the dilated pupils and the tremor... the man was more than likely having withdrawals...

How about the lady who explains that she can't work because she's in so much pain and because she can't work, she can't get money to pay for physical rehab that might attenuate her pain. She claims she has a family history of arthritis and that "everyone" takes Lortab.

"Do no harm"
How about when we can't avoid harming our patients?

Just the other day, I was "recruited" to do a urethral swab on a patient who wished to be checked for STDs. Everyone could hear him moan and OH OH and OWWWWW and EFFF in the hall as I attempted to get the best possible specimen I could.


Then there's emotional pain, the pain of loss:

My very first trauma case involved a child that was run over by a parent accidentally. The child was without substantial brain function on arrival. At one point, the team wanted to allow the father an opportunity to see his child, say goodbye. The whole team looked on as they saw a father ask his child to pull through to come back to him. The look of sadness on each of our faces, the ache in our hearts was one sort of pain. The pain of looking at your lifeless child on a trauma bay stretcher was another.

But yet we, we being future doctors, are trained to suppress emotions and to act in the face of uncertainty. I read about this study a year or two back:

http://www.news-medical.net/news/2007/09/27/30497.aspx
"Without some regulatory mechanism, it is very likely that medical practioners would experience personal distress and anxiety that would interfere with their ability to heal,” the researchers write."


So as a student doctor, doctor in training, medical student, how do I cope with these issue of mortality. Well, principally there's God. For many of my peers and myself, the concept of mortality and the peace we must seek with the fact that we can't prevent all outcomes is rooted in our spirituality.

“I have found the paradox, that if you love until it hurts, there can be no more hurt, only more love.”
Mother Teresa

rosary

the man in nine
with his rosary
clung to life
alone , was he

words we spoke,
not for him
but for us;
his time grows thin

death isn't clear
like red and green
the man in the bed
somewhere between

here we are
there he lay
the end of his time on earth
might be today



This week which isn't over quite yet but deserves and early entry, has been the most interesting and different week. It's still part of family med, which I've learned can be quite the model of inefficiency and prolongation but the palliative and transitions team is something special and unique. They are the doctors, NPs, PAs, nurses and all staff who help care for those people who are nearing death and their family/friends. they are among the most humble people and really there is not other way to approach it. here, medical professionals admit medicine has failed and that a patient will likely get worse or pass or remain in some kind of poor state. here, we rationalize and plead with families to consider code statuses and try to prepare them for the end, or perhaps the beginning, death.

My first day, I quip was the day I donned a black robe and scythe. For one reason or another, 5 patients passed on the team I was on. Just that morning, I went with the NP to go and try to have the family consider changing code status and help them help their loved one. Something divine occured as a code was called for a man who I can only describe as being totally intractable to pressors , very hypotensive. I remained in the room in the code and was told to glove up for compressions and before I could rotate in, death was pronounced at 1023a, monday morning. It was the first time that I saw someone pass , in front of me and somewhat dramatically. Sure , I've been in traumas where someone has passed but on that service, it's almost like the actual passing occurs outside the sight and interest of the the team. Here, death is very much part of your day. Then as that family was consoled, there was a weaning of a vent in another room with a man with cancer history and he passed shortly. A very different, accepting family had said their goodbyes and allowed us to do his final examination. To actually appreciate that this man has no pulse, no heartbeat, no respirations, no response to pain... and only has agonal gasps.. really is humbling....

Yesterday wasn't as eventful which is both good and bad. In medicine, uneventful might equal a slow long day but it also means people are living. This again.. can launch a whole conversation on "living". I would venture to argue , to say.. that not a whole lot of people are "living" very well in the hospital. It really is a bad place for a lot of people. Today, I prayed with the Palliative team for a lady whose family was changing her code status to DNR and basic comfort measure. Per the family, I learned of a charming wizened lady who was in her yard , planting trees only days ago and was highly independent. It's not unusual to see your own family members in these families and to feel close to them. Again, at one point the family laughed at the idea that I would get hit by the door as they awaited another brother and then we held hands minutes later.

I suppose I've learned that not everything can be fixed, contrary to what a surgeon might tell you.. haha. Healthcare workers are mortals but we also can work in concert with God's will... it's unique to be on the Palliative team....

-Robert

Family Med Week 2

So week 2 of family medicine started out super lame. I mean, we can't write notes and I don't know.. my partner Matt said it well "Family Medicine In Service is like the bastard child of internal medicine". It's just odd because family medicine basically admits and takes care of anyone who has some relationship with family medicine.

So that means we take care of chest pain, whatever pain, pancreatitis, psych issues, etc. The thing is , I feel like we are the epitome of inefficiency and I guess alot of that comes from coming of a surgical team. It doesn't help that sometimes the team gets kind of giggly. I'll just say this much, our head resident/chief is this really cute Indian girl but sometimes she just gets all giggly and I just..have a hard time taking that seriously

Night call was all right. It was my first time partnering it up. Matt and I each took an admission and then we helped our resident. She let us peace out at 1130p.. so I got 5-6 hours of sleep but call beds are remarkably stiff and horrible for sleeping.

Things that I saw that were interesting.. a lady with a possible C1-INH deficiency .. so weird.


Umm.. a pretty good week. My weekend has been great so far. I actually got up from morning prayers, today, Saturday which doesn't happen often. Then my pops and I got some coffee and then went to go help clean up a Masjid that we go to.

It's weird, that supposedly religious people neglect the most basic aspects of cleanliness. We spent time cleaning up all kinds of trash and packing up wood and whatnot. Then we washed out all these dirty pots that were stinking to high heaven. I mean, a masjid is a House of God, not just the inside but the outside as well. This isn't the first time my Dad and I did this kind of work only to have people come by, Muslims that is, look and walk away or comment on the good work and walk away. I mean.. why is it that people view this work as being below them.

A good weekend. My cocky surgery attitude is wearing off and being replaced by corny, lovable me.. this was bolused by seeing Forrest Gump, one of my all time favorite movies.

Family Medicine and Surgery regrets

So my first week of family medicine was kinda lame as beans.

I mean how many lectures do I have to sit through, and do they not think 3hrs is a long , painful lecture? There are quite a few studies showing retention of a lecture after x amount of time....

We actually had such a long break in family medicine, that I went over with a friend to help out in the surgery clinic b/c the students on surgery were doing orientation and they needed some help. That was alot of fun.

But the thing is, it's easy to be jaded or a little critical. Surgery is very .. busy.. get there early, round, hit the OR up, floor duties.. just go go go and when you're not busy.. you're reading or just recovering.

Family is just a different pace. I begin my inpatient duties next week so I'm looking forward to that.. seeing patients again and being part of the hospital. That's the other thing, the hospital was home base in surgery and family has their own clinic and building so you feel kind of outcasted.

But we do some unique, cool stuff. We did a substance abuse workshop where we had "patients" where we counseled them on substance abuse.. Turns out they were all active AA members who had real life stories. It was an amazing experience to hear their stories and learn what is effective for substance abuse counseling.

The thing about choosing your future field as a doctor is that there are questions you have to ask yourself. Will this offer me the lifestyle I want? Will I be as enthusiastic about this 15-20yrs down the line? Will I kick ass at it, will I be the best I can be and do right by my patients?

While I think it'd be crazy to be a trauma surgeon, I can't imagine getting up early or spending time in the OR day in , day out or being limited to seeing my patients in 10 minutes spurts spread over 5-7 hours because of all the little things that come up during the course of the day. I need to see my patients, I love explaining things to them and I thrive off that. The anesthetized patient .. well... they're dead to me ( literally, figuratively)


I guess I've learned alot about friends and love and stuff like that. It's one of those cathartic weeks. Also, with all this time off and breaks, you get to thinking. So here are some observations and random ones too:

Friends are friends for life, if they're not.. they're not really friends in the truest sense of the word. Time and space can't break a friendship. Your friends will always remind you of the good in you and keep you honest about the bad.

Love the person that loves you first. This is counterintuitive but makes sense. Not everyone can love you like you love them. They just can't.

Work hard , it's what the world needs and it always makes a difference.

Enjoy everyone around you. Don't miss an opportunity to talk to someone new or someone old.

Working out feels great.. except when your butt hurts from those glute exercises.

90s, best music ever.. hands down.. amazing replayability

Everybody likes a rap song with a heavy beat and heavy laden with innuendos

Every important relationship and most things that are important are simple.. complexity is unhealthy.

Girls are smart, and smarter than we think.. and often.. smarter than they let on... realize this. Stick to the ones that stick with you.. and be skeptical of the rest..

Guys are straightforward and simple.. some.. mainly girls, would call this dumb. Inferences and lack of clarity = mystery = we don't really get it.

God made sisters to keep their brothers honest. They always want the best for their brothers but are also the ones to correct them and to tell them which girls to avoid.

We're not all born with the ability to sense or feel out others.. so if you have a friend who can.. always consult them.. haha

...more to come...

Last Week of Surgery, some regret

So this week, I only had two days of surgery. Two days left on the trauma team. Two days of introducing myself as Robert, the medical student on your surgical team.

A few weeks ago, I would've said: no way, surgery is not an option. they're all pretentious asses who couldn't care less about their patients and would slice and dice to solve any problem.

This definitely is not the case. I have learned to appreciate surgery and the surgical approach especially when it comes to trauma. See, trauma is both simple and complicated. A patient comes in with any number of abrasions, breaks, bleeds, etc but the approach is very simple. ABC that Jazz: Airway, Breathing, Circulation --> disability, extremities....

Monday wasn't too crazy , few things here and there. I got to see a Swan-Ganz catheter placed , that was actually pretty cool since they are putting them in less and less and the whole placement is based on the pressure waves that are generated as you advance the catheter through the atrium, into the ventricle and then the PA and hopefully wedges nicely into a pulmonary capillary.

Tuesday was my last day, all I came in to do was round on my patients. I actually spent some time explaining an IVC filter to a patient and really connecting with her. One thing that's hard to do is appreciate that feeling that perhaps a patient doesn't know what all is going on and I sensed this, and I had a breakthrough. Mrs. "Smith" has a few questions and then she started asking me about my schooling and telling me about her family, it was a great way to end my surgical clerkship.

Wednesday we had our oral exam, I'm happy to say that I rocked out the Trauma cases. Our orals consists of three different docs giving us a variety of cases to work thought and do next step/management type questions. The resident doing trauma wasn't really able to stump me, gave me a "very good."

Thursday, I went and visited the 9th floor, kind of a farewell to the 9th floor nurse, a farewell in my last day as a member of the trauma team.


Farewell Surgery , perhaps you'll see me on a Trauma elective. You have the coolest docs and residents...

Surgery Week 7, Begin TRAUMA TEAM

So my last two weeks of surgery and I end with Trauma Team. This is interesting because my team happens to be the very people I took most of my night call with. Recall, Night Call/Float is the surgery team that covers everything surgical from consults to trauma codes to floor duties .

First things, first our attending is this bad-ass doctor who goes by his initials. For the sake of anonymity , I'll say it sounds like B.A. which he pretty much is. This guy is one of those pointers. The point to a nurse and say, yo, what's up... I mean... he's an older guy.. i don't know 50s and balding but his white coat says Trauma/Critical Care .. and his coffee smells amazing.This is what he drinks: http://us.myflavia.com/home/index.jsp

His only downside, he's easily distracted or gets sucked into some side conversation. There wasn't one day where rounds didn't take more than 2-3 hrs. The problem is , Trauma team can't continuously round because if a code gets called or an operation needs to be done or chest tubes/lines placed... then things get hairy.

Let's talk about rounding. This is the first time I've rounded with a full team (Me, Intern, 2nd year Resident, 4th year Resident, NP, and PA Student sometimes AND B.A.) on every patient and trauma has a bunch of patients under our care 20+

I feel like we're a little gang. We're all decked out in white coats and we hit floors in our little pack. Some of us scurry head to gather charts like nobody's business. Then we stick them in a little cart and roll out, literally. Basically, B.A. leads the pack and we enter the room. THE TRAUMA TEAM... it just sounds cool. I mean.. the TRAUMA team thinks you're read to go home.. THE TRAUMA TEAM.... even when i'm rounding on my own or checking a patient.. I tell them I'm the student on THE TRAUMA TEAM. The bulk of our patients are ortho type deals and we're just dealing with pain management, airway control, volume resuscitation... the basics. I remember one time , a nurse was saying that the "Trauma team" was coming to see some patient, and I was like... I am on the Trauma Team.... = Bad Ass

Nothing really exciting happened, just random things here and there. Today, we got a code at 745am.... which really cut into morning rounds...

It was unremarkable, just some methheads, shooting each other up. After that I just chilled until rounds, then I assisted with random floor stuff since we were missing our intern . I got to assist on two chest tube insertions which was kinda cool.

Some quote-ables from B.A.:

"Suck on that" (he was explaining that the patient can have ice)
" If it's big enough, I'd like to tap it" (referring to doing an IR percutaneous drainage of some abdominal fluid)

Update on 9th floor nurse - saw her only once this week, I guess having only one or two patients up there .. ... oh well But she's not really the apple of my eye currently, there's someone else...

That's it for now avid readers... a little relaxation and some major cramming for my Surgery Shelf Exam next week.

God Bless and remember to honor friendships and that chivalry is not dead.

Week 6- Last Week of any General Surgery, only 6 days of Trauma team.. no more night call

So I guess a good question is what is a normal day on the Private Surgery? I'll use a good surgery Robert/ bad surgery Robert scenario:

Good: Show up early so you can pre-round on your patients, a good amount is usually 4-5 patients. To beat our residents, this could be showing up anywhere from 4a-5a.
Bad: My best time has been 515a, but I'm usually on the floor with my printed list anywhere from 525a-540a....you'd think this wouldn't be a huge difference but depending on the day it can be. See if the residents have any early meeting or the both of us have conference.. then rounding commences early and one day I wrote only 1 progress note up

Good: After rounds, we usually have some sort of lecture(s)
Bad: I attend my lectures , I guess the bad is only when I get sleepy...

Good: After lectures/morning stuff, you check the OR schedule, pick a doc and kinda tag along with them.
Bad: Robert loves the floors and consults, so I've actively tried to avoid the OR by signing on to do histories on consult patients and assisting the intern. See the interns get least priority to go to the OR, they're obligated to the floor so help them = more floor time. Of course, this doesn't always work when you're asked to scrub in on something or your chief expects you....

Really, for me I tried to be on the floors as often as possible. If I wasn't there, I was reading in our student lounge. The perfect student would somehow be in the OR all the time and study between cases.. yeah not so much for me....


Here's how most OR experiences go. You wait around for the doc to show up. Then he does, usually 30mins-1hr30mins after the posted time... then the procedure starts. The doc / resident might tell you to scrub in or you may not scrub in. So let's discuss pros/cons scrubbing in vs. pros/cons of not scrubbing in but observing

Scrubbing
Pros:
You can get pretty close to the procedure, if not immediately adjacent depending on the patient and how many other people there are.
You can assist.
You can suture ate the end.
You can feel stuff... like "feel this thingy here"

Cons:
It's not so easy to leave, because you'd have to scrub out.. and that's very conspicuous.
You can break sterility... so you have to stay in a certain area and when you can't rest your hands on the drape.. you have to hold them in front of you like a Trex or crossed in front of your chest like a gang sign. [one of my classic breaks in sterility was touching a tube that was in the field.. but the tube itself wasn't sterile... so then I moved in the observe category]

Observing
Pros:
You can leave when you want to
You have more freedom of movement
You can answer phone calls and hand stuff in like a scrub nurse

Cons:
You can't get close, so sometimes observation = endless pacing/standing .. pretending to see things


So after the OR day has ended, random things can pop up like consults or floor jank. Some attendings round, some don't. I've enjoyed rounding.


So some notable moments in my week:

The colorectal surgeon that wasn't an ass:
So I was semi-warned that this particular surgeon was kinda mean and not worth scrubbing in on. Too bad my chief was all about me scrubbing in, but it turned out great. I mean I got some of the questions right and I mean the doc was really nice. I'm guessing he's either turned a new leaf or I'm just crazy. One of the funniest moments in rounding with him was walking in on a patient dropping a deuce , we totally just pretended like that was totally normal.. which I guess if you're a colorectal surgeon.. makes sense.. kinda

Floor doodie (duty):
So one day the OR was just not on and poppin like usual, so there was more random floor stuff to take care of. My intern thinks it was tedious but I was always just running to go do a consult or a decompression (= finger in butt, scooping poo). My intern was much humored by my enthusiasm as I rolled in the observation unit with gloves in hand and "let's do this"...

She really hit the nail on the head when she saw me with our other intern. She asked if I'd like to scrub into a breast case.. I was like errrr... I was helping with something else.. and she said " Yeah, you love that floor and consult stuff.. not the OR, you're weird like that" - truer words haven't been spoken

Night call:
I love night call for the most part. First , it's at night... I feel like a vampire roaming the empty halls and because there's less docs, you look even more balla in the scrubs/white coat combo... My last call night was awesome. First of all I had the chillest call team ever.. hard working dudes and gal but just chill.... I was doing some random stuff from 630ish to 1030ish Consults : Car V Tree and GSW to neck, then slept till 145a... totally didn't feel my pager go off in my pocket but woke up and rolled on down the ER. My last case that night was a young dude, got stabbed .with this really ridiculous story... ... hmmmm...... but that lasted till 430a.. just checking the CTs... etc... making sure he didn't have a pneumo.. turns out he had some pneumomediastinum but no reason for a chest tube so he was sent to the floor and a swallow study was ordered to make sure his esophagus isn't perforated....so then I grab a shower... and then I'm rounding by 530a on the floor to help out my team... then I get the "go home dude, you've been on call from my senior resident and I peace out" and begin Labor Day weekend, no more surgery call.. kind of bitter sweet...

The nurse on the 9th floor without a ring:
So my friends have explained to me the importance of checking for a ring.. and I happened to be rounding on the 9th floor where the bulk of my team's patients are and I notice her. She was the cutest, shyest, most amazing thing before 6am ... So I totally wanted to talk to her. Bear in mind, I usually have an open invitation to talk to any nurse if I want to "check on my patients" or ask about labs or something but she didn't cover any of my patients. My classic Robert/awkward moment was trying to find a computer to pull up some labs to stick in my progress note. I ended up finding one of those portable stations without a chair.. and it was right behind that nurse sitting down. I couldn't sit so I awkwardly leaned against the wall with my chart on the mini desk and tried to write my note.. looking like a tard..Then on my way back to the nurse's station, I ran into something... Smooth.....

Perirectal abscesses
For some reason, I have knack for ending up with all the clinic patients with perirectal abscesses. There's nothing much to add to that except the smirk the residents give me before I go into examine these patients...


Ah, being a junior medical student... is awesome

Week 5

So I'm back on a regular surgery team meaning... back to the OR... dern

This week is little strange, we have less patients per resident so I have to be rounding by 520-530a.. just to get three in before a resident follows up in front of me.

So let's segue quickly into fasting while on Surgery, it's tough. I'm reporting in before fasting even begins, but I've bypasses that obstacle by packing protein shakes and caffeine. What gets brutal is standing around the OR when you start to get sleepy... and you can't caffeinate up, caffeine is key to surgery, you need several boli throughout the day.. usually before lectures...

Other than that, more of the same. Trying to avoid the OR but ending up being in on one or two cases a day.. which by my luck has ended up begin 2-4 hrs... ehhhh I've learned to love clinic duty which surgeon-types don't usually like..


I've been in on lumpectomies/biopsies.. which means I'm holding a breast for extended periods of time. This is alot less ..provocative as it might sounds...

So my team has two interns who are two of the coolest people I know. One is cool... she actually reads my notes and asks me why i make certain recommendations.. the other is a really cool dude from Texas who always gives you little thumbs ups when you show up in the OR, just a really nice guy to work with. One day I tried to get all of us to put our hands in the middle and say "Team C" on the elevator.. i didn't catch...

Night Call
So this week was my 7th night call out of 8. ( As my surgery peers repeatedly tell me, I could've avoided 8 calls if I didn't so eagerly volunteer for Sept 5.. the Friday of labor day weekend.. oh well)... So let's review night call

First thing, is page or tell the intern/2nd year that you are the student to page
Second, the waiting game: you wait for that first page from the intern or the trauma code
once you're paged...you're usually out and about for a bit.. sometimes it'll be a one hit wonder and others that could be the last time you're in our student lounge. I remember one saturday where I was paged at 430p and didn't go back to the lounge till 4 or something ridiculous.
Trauma Codes/ Consults: ATVs are dangerous but probably won't kill you or compromise your vitals.. meaning i see more of these on consults.. but man.. some wicked lacerations and stuff. Motorcycles are dangerous but more on the code end...


Oh and I've learned that some nurses eat up the surgery look. One of my residents who is married totally had three nurses just swarming around him.. which turned out to be awesome for me when this hot one started talking to me.. too bad i was too nervous and replied in one word answers....

...well that's it for now


let's see what next week has to offer

Weeks 3 and 4 of Surgery

Week 3 Vascular - at our program vascular week = do whatever you want week... but it's a little more enigmatic than that. we still have to attend lectures so you can't get away with too much but you definitely don't have any patients to round on.. so i was able to sleep in till after 6a. Things I saw: CABG -Coronary Artery Bypass Graft- long procedure but pretty awesome. I mean you dissect out an artery and vein and then you plug in some tubes into the right atrium and aorta.. put them on the heart lung machine which is wild because when you split the sternum you can see the lung inflating and the heart beating.. then nothing.. they both stop... you hook up the artery and vein.. to bypass.. punch some holes into the aorta.. stick in the other ends of the graft.. and then put blood back in.. and lo and behold.. praise God.. they start pumping and breathing... that was awesome to watch... I saw two AVG graft revisions.. meaning grafts for hemodialysis fixed because they can get clots (on one of those procedures.. I tried to scrub in but didn't realize my resident wasn't there and the doctor totally called me out for not introducing myself... it worked out fine.. but let me tell you ...how sheepish i felt for the next two hours .. standing off to the side) lastly i saw a below the knee amputation .. this particular doctor lets students and residents do alot.. so I ended up helping suture and staple at the end.... this was actually the first time I'd seen my chief resident... who totally wanted me to two hand tie the sutures... which i can't...

Week 4 Peds Surgery- best week ever. I'd like to end there but let's hit some high points.

First.. it's awesome to see patients who are just as pissed as you are about waking up early. An example - I usually round by 530/540a so I can see 3-4 patients before my resident.. who is one of the coolest guys ever. i'll get to him later... but yeah.. I rounded on my patients, one of them has leukemia.. but has a bit of a tude... but it just makes for more fun... and he totally told my resident that he wasn't having abd pain this morning... but did after my "not soft palpation"... hahahaha... so I totally apologized for it the next day and we've been much better after that... barring early morning wake ups... Pediatric patients are just cool, I mean you can laugh in the room and have fun when rounding. That's key for me. If I can't laugh and goof around a little in the field I choose, then I can't do it...

So the rest of the week was rounding which I haven't really done till now because of the way my rotation was set up.. so if i were to summarize rounding.. it's like a small gang roaming the hospital tending to each patient on the service. I like to thing of ourself as a gang.. I saw a bunch of different procedures and fixes for congenital defects : right hemicolectomy for NEC, pullthrough for Hirschsprung, gastroschisis , pyloric stenosis repair, some I and Ds.... interesting stuff...

Oh and the NICU... has to be one of the most space-age areas ever.. I guess it's just something else to walk in there and some babies have the blue UV lights for jaundice... so there's this faint blue glow throughout.. and most of the beds are "Giraffe" beds = they open up.. like a spaceship...

Peds Surgery was just awesome for me. I mean.. my Resident told me to consider it and the locum tenens doctor from Atlanta complimented me.. It's hard to feel competent your first rotation in your third year and in surgery for me especially but I felt I did something right this week. And I want to be just like my resident: He's a southern guy , Christian, married and just nice as ever. His form of critique is like a little lesson from Mr. Rogers... , never curses or insults anyone.. thanks patients and staff... just unreal..

To end.. he told me the rules of surgery:
Eat when you can, sleep when you can, pee when you can and don't mess with the pancreas.

Then he added.. some people use the eff-bomb with the pancreas...


Hahaha, he literally said that... awesome.


Oh since this is my halfway mark..and I have my clinical skills bit tomorrow.. let me pro/con some of surgery


Pros
Very organized.. it's not that hard to find patients .. procedures and you know reasonably well... where you need to be
Procedures can really impact people's livelihoods, it's high yield
The residents are awesome in my program
Night call can be quite exciting with traumas
Clinic is fun (which I've learned most residents and people interested in surgery would not say... hahahah.. must be the meds/peds coming out)

Cons
Early mornings.... I repeat.. getting up before 430a.... wears you down
Hours - anywhere from 55 hours on vascular to 81 hours last week
OR - my mind wanders so readily it's not even funny.. as a student you can't do a whole lot so I imagine the inactivity of standing for hours.. brutal

Surgery in two weeks

So I am about to round out my second week on my Surgery Clerskhips.. time to muse and reflect

1. You are up early. Let's define early: Early is.. the time you usually wind down from a late night out..4am... Early is.. you're driving and there's nobody on the road.. 15 min trips can take 10 minutes ... early is .. you're not even really sure it's morning... early as in if you call anybody at this time except your friends at the hospital.. you will be injured... purposely

2. It's not fair to call surgeons stupid jocks who "heal with steal." I have met some smart surgeons , men and women who can just as easily function as internists if they so desired. However... this is not the rule per se.. so let's define surgeon as I have seen

The older you are, the more likely you are to embrace tradition whether it's sitting in certain places and whatnot. Older surgeons have a bad habit of referring to "back when" or how they could have done it "better"... and of course .. they are chauvinistic to say the least. Also, surgeons can be incredibly rude and impatient which is ironic in a way because they are very meticulous in the OR and incredibly intolerant of rudeness or anything you do to detract from listening to their lectures/pimping sessions with rapt attention.

3. The OR - you need to like the OR to like surgery. A lot of my distaste for the OR has to do with the fact that I am not very active in the procedures aside form retracting, cutting sutures and handing things... but I'm also MIA mentally when you hit the 2-3 hr mark, sometimes the 1 hr mark....

So let's highlight some of my own personal ... anecdotes

Week 1 - Alot of retracting and awkwardness. I spent a few minutes on each floor ending up staring at the end of a hallway without a door to the stairs or I'd take the longest route possible to get to where I needed to get going. On my first case, I was asked by my resident to tie a knot using a clamped hemostat... I decided to tie a regular.. run of the mill knot.. not knowing how to tie a two handed surgical knot.. so he showed me quickly and I couldn't do it.. this lasted for a good 5-10mins....

Week 2 - More early mornings. I learned that your hold scissors with your fourth finger, I was called out for holding them like a grandmother. There's more stories.. but I'm drawing a blank and I don't want to get too descriptive.

Now - it's 1020 something and I'm sitting in my student lounge. I was rounding till 8ish... and informed my weekend intern of my pager number. Then I napped/caught another hour of sleep --> breakfast --> do some boards questions... I imagine Saturday will be like Sunday... not a whole lot during the day.. then picks up at night with trauma calls and whatnot....

More

Rapid Strep anybody with a sore throat, 99% of the time, it will be negative. If this is the case, it's probably viral (see prior rule)

Juice is bad.

Babies need tummy time.

Babies get GERD for several reasons: shorter esophagus, lying down all the time and drinking mulk alot.

When we get an upset stomach or constipated, we deal and take meds. Babies get irritable and fussy.

Similac is the shit.

"It's okay for the doctor to look down there" .... precedes the most awkward of things.

When the doc says: you should see this.. it's never really good,especially when it involves fondling balls.

Things I Learned From Kids

So, I'm on my community medicine deal meaning I work on a project over the summer and shadow/ work with a Doc for four weeks. So I thought I'd share my revelations/observations. This will be ongoing..

Little kids hate ear exams, you'd think we were slowly advancing to them with a butcher knife the way the scream and writhe. It doesn't help that we pin down their arms but the irony is, the stiller the are... the less likely they'll be scraped or hurt.

If they're strep negative, afebrile, or we can't figure it out = it's viral.

People still don't grasp the idea that antibiotics don't work on viruses.

Viruses do what they want, when they want and even better, they like to set the ground for their buddy.. Mr . Superimposed Bacterial Infection.

Babies have the most paralyzing, disarming stares ever.

I love watching siblings interact. Maybe it's because I'm a big brother but when they laugh at the other one getting a shot/examined.. it just makes me giggle inside.

It's pretty damn obvious I'm not a regular.. I'm the only one in a white coat.

While, we're supposed to say we are medical student which I do, parents still prefer to call you doctor.. it makes you seem like you're legit.

Immunizations , most likely won't cause autism in your child but I can assure you poliovirus will cause polio and Hib will cause meningitis.

Mongolian spots are normal.. aka those random dark patches on kids... will go away with time.

Dysmorphic = looks weird

Kids love lollipops.

Quotes from Facebook

So in order to save these quotes, I'm porting them over from facebook to here.

"Can you come back later? I have some business I'm conducting with the Prince of Nigeria" - House MD

"2 things that aren't forgiven shirk and being in hufflepuff" - Nooreen Fatteh (fellow Ravenclaw)

"I don't have a favorite color. I think all colors are beautiful." - Nira Patel

"i recall a certain [insert medical student name] not leaving room for jesus when he was all up on me" - Jenny Thomas

"What friends" - Elizabeth Almon [in reference to anything I might say with the word "friends" in it]

"Your face...." - Helen King [i don't remember the exact context but it was a brilliant and well timed rebuttal leaving me disgraced]


"I hope they all die from a curry disease" - Andrew Mohamed

"1....2.....3.." - Robert Abdullah [2/17/09 - First Rectal Exam]

IHOP. [for Jenny and Umangi]

we can try to be happy broke bitches. - Umangi [referring to our future as doctors]

Failing to Succeed

So, I've had my share of pretty spectacular failures/mistakes.  Some would say .. why dwell in the past, why even give credence to such events. The fact is.. what I know now and where I am are  in part do to where and when I've stumbled. So here goes:

The Car Crash (April 2002)

Here's the basic formula :   underdeveloped frontal lobe + fast and furious fascination + futile attempts to impress girl + calculus tournament + drifting + techno = recipe for disaster

In short, I attempted to drift my 1997 Green Toyota Corolla, affectionally called the Green Wizard, into a Publix parking lot, the very same publix i was employed at. Much to the chagrin of my parents, more specifically my father, I misaveraged at 45+ mph, and ended up skidding over the curb(s) and into the grass , around a sign and then back on to the parking lot tarmac... only to utterly crush my rims and break parts of my front axel. 

Lessons Learned - 

1. riding the bus sucks when you can drive, especially when the annoying girl in front of you won't let you listen to your music in peace

2. movies aren't real life (for the most part, i'm still banking on romantic comedies  - esp 80s Cusack)

3. corollas and cars don't need to be drifted unless you're on some kind of race track and you have that luxury

4.  attempts to impress girls can be dangerous

Losing all Hope (2003-2005)

I entered college as a sophomore due to my AP credit standing. I applied and was accepted early decision to the University of Georgia and was offered entry into their Honors program with another scholarship on top of my Hope.  It took me two semesters to lose both my Honors standing and all my scholarships.  I didn't drink or do anything remarkably stupid. I just didn't study. 

Solution: I finished my last year of college (2005-2006) at home at a Gwinnett campus for UGA. I worked as pharm tech and volunteered at the hospital while I was there. I was a straight A student and actually got my Hope (scholarship) back my last semester.  

Lesson:

Hard work , prayer and support from those around you can fix any if not all mistakes. I recently asked my dad if he thought I'd go to medical school after my first year in college. He said no.. it wasn't until I moved back home and got serious that the possibility become a probability.   I was fortunate to finish college early because it allowed me to take the MCAT twice.. and get a score I was happy with and ultimately saved my subpar GPA. I also used my year off to work as a tutor and ER Secretary, experiences I wouldn't trade. 

So why write this?  

Sometimes I get the impression that we are taught to follow a protocol in life. You must finish high school, you must finish college in 4 years with all As and B, you must get a job to learn the value of a dollar. 

Fact is.. I don't think this is always the case. Have you ever asked your mom or grandma how she made that awesome curry [subsitute dish here]. Most of the time.. they have a general idea of ingredients but portions vary and it just depends how the chips fall as they may after you put in the work or preparing and cooking the dish.   That' how life is. You work hard, you set goals.. and things work out. Sure , sometimes things don't pan out well.. and you can't quite pinpoint why but perhaps it is these times that allows us to appreciate the times our expectations are met.. and even better , when they are exceeded.

So that's where I am now, winding down my second year of medical school... sitting for my first set of Boards on June 20 (iA).... and I couldn't be happier to be where I am. 

My next posts will include some.. quote-ables from medical school....

Cant Take My Eyes Off You - Muse

Med School Years 1 and 2, a recap

Okay, time for a little humor and reflection.

Acceptance Letter (some time in April)

My mom gets the certified letter and she's ecstatic.. for some reason it didn't hit me fully at the time... but I got progressively excited. (I think I was emotionally spent with my retaking the MCAT and getting the score I wanted and getting accepted to my first US school prior)

Orientation

Scope out brown people and people I know in undergrad, coincidentally who were brown. Orientation was like the first day of High School except in this High School, Middle Schools from all over Georgia sent students and they came in all sorts of shapes, sizes and colors.  

Getting White coated was surreal. I didn't even grasp what a white coat means. It's a blessing and a reminder.  It tells your superiors that you're still a tool who knows very little because you're wearing a short coat  but it is the only real thing that distinguishes us as medical students. 

First Phase 

I learned that everyone is smart in medical school. Even the dopey looking kid is smart as is the hot girl who everyone seems to gravitate towards to at parties. Which makes for a nice segue:

Med School tunnel vision/ beer goggles/ Hardy-Weinberg in action:

In medical school , especially at a smaller school like mine that's not lecture based .. we get to know each other well. We see each other ALOT. Living in Middle Georgia also cuts down external interaction. So there is  a strong tendency to skew your perceptions of people, especially those of that opposite sex.  The cute girl with the quirky smile  turns into the supermodel with the come hither look. The non-Caucasian girl who talks to you every once in a while suddenly becomes the Exotic Girl with good listening skills.  Let's just say that somewhere between burying myself in books and trying to salvage some kind of social aptitude, I've fallen repeatedly  head over heels which isn't healthy... for them [wink]

[as an aside/afterthought.. I tried once to drop the line  "yeah, most anything is funny when you're in med school" at a barista at a Starbucks trying to be clever and indicate my medschooliness  and charm her .... FAIL]

My first year was all about learning how to study which really isn't all that interesting. Basically, I've come to the realization that I study best where there are people around but people who don't or are smart enough not to interact with me.   I learned how to play flip cup with Diet Dr. Pepper. Though I hear, it's strange to gulp down a carbonated beverage.  Another point, med students can party hard. I suppose when your life is dominated by studying and late nights studying and waking up to study.. when it's time to party, party big. I did research over the summer of my first year which was interesting material but mostly I learned that I hate being organized and keeping track of my results, most of which failed repeatedly.

Second year has been much more exciting. Some highlights:

Smoking Cessation

So they paired us up with another medical student, one person would be the intervener and the other would observe and provide feedback. Basically we went room to room meeting "patients" with different stories and we tried to intervene and try to get them to stop smoking. My best observation was watching a classmate say "you know sometimes, you just have to crank a heater" - i had to try real hard to keep character but we all laughed afterwards....  I also discovered that I can be remarkably stubborn. The patient I ended up with refused to say that he smoked which confused me since this was a smoking cessation lesson. I basically refused to back down and came short of calling him a liar ... only to find out he was "dipping" not smoking... you had to be there... 

Male GU/Rectal Exam

So I'm told to count as I slip my finger into "the receiving area" but I don't quite grasp this , being the first student to go  so I end up counting out loud with my gloved finger in the air much to the delight of my peers.[ we're supposed to insert on 2.. not hold your finger in the air like a jackass]  So every once in a while, one of my peers will go "1...2...3"

Female Exam

No comment. This was one of the best instructed exams but the most invasive and disturbing in the sense.. that you get "intimately familiar with the insides"  very UNLIKE a man.. who's junk is all up and outside... 

Anywho.. my memory is failing me right now.. so enjoy a song that I can't seem to  stop playing:

To My Son

This post is a bit more serious/sentimental that my other posts but I'll quickly return to humor in my next one.. called Med School Years I and II, a recap.

Basically, I'd like to write some thoughts, tips, anecdotes as if I were speaking to my son:

You can be too smart. I remember reading in my middle school yearbook. "Sometimes you're too smart for your own good." The key to being smart is being smart enough to keep quiet sometimes. Not every question needs to be answered or every mistake corrected. Relish the moments when someone asks you a question and you are fortunate enough to know the answer. This is one of the reasons I want to be a doctor. I'd like to be blessed enough to "know the answer" and help someone.

Nice guys finish last is the biggest bunch of crap ever. Listen, nice guys do just fine. Sure the alpha males and cocky guys will charm the ladies. But at the end of the day , we can take care of business and provide. Plus, it's not always about the return. Don't hold the door open for the girl or tell her to text you when she gets home because you hope she'll fall for you. Do it because you know it's right. Karma, God , whatever you call it, prevails. Your friends deserve an open door and occasional compliment and you'll get one too when you most need it.

Being a nice guy doesn't mean you fold easily or are a wimp. Stand for what you believe in and with conviction. Yeah, we work out too. Chivalry is about holding the door open but it's also about slaying the dragon.

There's always time for family and friends and most importantly , God. Work hard and be the best you can be but that is not a mutually exclusive ideal. I've been in school the better part of my life. I like to do well.. but I also like to make my family laugh, be there for my friends and be at peace with God.

Be able to laugh at most anything. Try to be able to make anybody laugh, it's a priceless talent.

"Wit beyond measure is man's greatest treasure" - Motto of Ravenclaw and life. Wit is about delivery, content and timing. The right thing said at the right moment with right expression, priceless. It combines two important elements: humor and intelligence.

Learn to listen. Learn to listen. [yeah, I repeated it twice]. Two ears, one mouth kinda deal. Listening lets you learn more about a person, it also tells them you're willing to put them over you. People love a good listener. It also lets you be thoughtful when you incorporate things you've gleaned from listening. Alot of times, people need to hear what they say reflected back... my best friends are often those who listen to whatever I throw at them.

Learn to make a fool of yourself and not care. As long as you don't seriously hurt yourself or others. Making people laugh, and sacrificing some dignity is great. Not only do you entertain.. you make for a great story to tell later.

Write, draw, sing, play music. Express yourself in some manner, it helps to see what you feel and for others to appreciate your art.

Struggle to find the good in someone. Remember random things. We thrive off being cared for, so why not care for someone else. Simple gestures at the right time mean alot. I don't know how many times some days seem to plummet downhill or things just pile up and someone just says the right thing to keep you going or warm you up.

Be honest with yourself and with others. Honesty doesn't have to hurt. Honesty is best coupled with another virtue, diplomacy. Telling someone they're wrong is honest but suggesting that you remember seeing/reading something to the contrary but aren't sure is diplomatic.

Don't be self-deprecating. It's hard to do when you never seem to match up to the jock, look like Brad Pitt or can't quite pull of the John Nash genius. The fact is , you do have attributes that people like.. and you need to play to these strengths.

Lastly, remember you are blessed/fortunate. If you can read this post, breathe air, sit in a chair.. you are better off than someone else. God has made sure of that so appreciate it.. and when you do, God tends to give you more.

Like Day and Night

I'm not a morning person with rare exceptions to that rule.  So let's first define a morning person. A morning person in my world is someone who is able to function to some baseline extent in the morning and carry a demeanor that is either equal or greater than their average personality.  I am not that person. I am intellectually less-abled in the morning; I am quite angry/bitter; I'm definitely not myself. 

So why is this? There are many reasons but I'll examine a few. First, waking up and starting your day early is the mark of a efficient and task oriented person. They will accomplish something that day. While I certainly can be efficient , somewhere between my procrastination tendencies and my anger at being interrupted from some sort of slumber is not compatible with this M.O.

Mornings also signal the end of night. I like the night. While this presents and excellent opportunity to explore my fascination with vampires, I'll table that for some other time. See, take the weekend of example. A productive weekend for me would consist of a good amount of studying and play time. Most nights I'll make my way to my cocoon around 1 or 2am. Then comes Sunday night.. where I can't fall asleep to begin with . Subsequently I'm awakened sleep deprived and with the realization that the weekend has ended and so has my fun and free time. The opposite is true with the first morning of some break. I remember how glorious it was to wake up on the first day of summer break. To know that I don't have to go school or have to do much at all...was glorious. Even better, if I wanted to, I could go back to sleep. This is becoming an increasing rarity as medical school disfavors breaks.

Lastly, mornings go with productivity and being an "adult".  Part of me ... perhaps a significant part of me wants to remain a child. I like staying up really late playing video games, watching movies or reading a book. There's nothing like driving with your windows down with some friends around 1/2a  with the windows down and music playing and very few if any cars around. It's like you own the night. When I worked in the ER as a secretary, the overnight shift (7p-7a) was so fun to work. The directors were gone and we were mostly autonomous. We did and said what we wanted and still got work done.  

I suppose I wrote this article because I realize I have to play  by the rules these days. The rules say you wake up in the morning, drink your coffee and make your way through the day. In medical school, our tests are in the morning, we round in the morning... we do pretty much everything in the morning.  I look forward to those precious days and weekends.. where I can own the night and drive with the windows down...

Living in the Moment

Van Wilder: You shouldn't take life to seriously. You'll never get out alive. 

Sometimes we take those happy go lucky , funny people in our lives less seriously. It's an easy mistake to think that the guy/girl who seems to be always shooting the shit [a phrase that's fun to say but not nearly as fun to visualize.. unless you're one of those monkeys at the zoo... but that's more like flinging the poo] as not being ambitious or driven. 

Fact is, they don't forget that we don't know if we have tomorrow.. but by definition, we have now.  So that's my segue into some of my less serious moments in my past (you remember those Good Idea, Bad Idea  clips from Animaniacs? 

http://www.youtube.com/watch?v=f8PhzrmBgMI)

The Bread Cart

So I worked at Publix at the end of high school and the end of college and it's just a  gold mine for "good ideas." One of the best was the bread cart incident. You see bread comes in bread carts , tall steel carts that you can place trays of bread into. All that's important to know about them is that they're metal and hollow in the inside forming a sort of cage. So Ricky, my frequent co conspirator (who shares my very same birthday, incidentally) and I decide that I'll  get into the middle of the bread cart and he'll push/roll me down the ramp off the loading dock. Ideally, I'd stay on path between the wall of the store and the rail the leads to the bottom. It was all fun and games until I  sped up and the rack slammed into the side of the wall. I almost hurled from the impact. There's probably still a dent in the duct that runs outside that took a blow from the cart.  However, I imagine seeing me going down a ramp in the middle of a bread cart must have been quite amusing.

The Volcano

During my second year at UGA, I worked through a program called FOCUS and basically, they placed undergrad science majors into various schools in Athens-Clarke county and Oconee and had us work with science teachers and their students. My teacher let me take over science class on the days I visited. So, I decided we'd do the volcano experiment. I had all the students fashion playdough volcanos and used little candle jars to form the magma chambers. Then I dyed a bunch of vinegar bottles and gave each group a bottle and baking soda. The goal was try to see what mixture gave the best eruptions. It was quite enjoyable and the kids loved doing this. So I had left over baking soda and dyed vinegar and I decided I'd show them how to make little baking soda rockets with the bottles. So the teacher had them get their lunches and join me outside on the blacktop. Simply, you add baking soda to the plastic bottles and shake it vigorously and flip it over on its lid. The CO2 formed will shoot out the back and the bottle will go flying into the air with a stream of red foam behind it. So on my last bottle, I shook the bottle a little too long... and it exploded in my face, it was amazing. The students all ran up and were concerned something bad had happened. The teacher asked the same.  I was, but it was priceless seeing my stained  khakis, face and shirt. 

**dedicated to my brother who reminds me that it always feels good to laugh, even when you're hunched over with abdominal pain and hyperventilating

First Post

It's been a while since I've blogged, I'm pretty sure there's an inactive livejournal account somewhere and even  a Blogger account. 

I suppose an introduction is in order. My name is Robert. I'm a second year medical student studying in GA.  My Blog title is a direct reference to my tendency to get the scribe position in group. Basically, for a lack of a better word, the scribe is the group bitch. Any issues that need to be types, emails that need to be sent out or diagrams that need to be pulled up/created is under the scribe role.  Our school is PBL - Problem Based Learning

I actually like being a med student, in a sort of sadomasochist kind of way. Usually I have to remember which is which, sadist being enjoying pain in others and masochist, pain on self but being a med student is both. You see.. we sacrifice the better part of our 20s or 30s for some of my peers  and tons of loan  money (I'm talking a house downpayment and a nice car in order to work our way up a totem pole to become a licensed physician at which point an untimely law suit or act of stupidity can result in you losing all of it). The pain on others is well what doctors do. Just the other day, my right index finger was knuckle deep in a man's rectum feeling around for a prostate. Thank God for video games, my finger pivoting abilities were quite sharp ;)

However, those precious few times where I know the answer to the question or I can help a patient in any way.. makes it all worth it. Scenarior: (pretty) Nurse asks doctor that I'm shadowing to tell her what a G6PD test is, she can't find it in the code book. Doctor turns to me and asks, what's G6PD? I answer Glucose 6 Phosphate Dehydrodenase Deficiency Test... He nods, and I get an incredulous look from aforementioned nurse. My day is made. It's the little things.

So that's it for now.  I'm also going to keep a boards study countdown going (when I begin studying): 9 weeks...