Catching Up

So , I haven't blogged in.. a long time. Apparently, since August when I discussed the Mosque Debate that was going on at the time in New York.

I'll go ahead and summarize what's been happening in my life, of course with as many pictures as possible and extra length for things that take up extra brain space for me.

Infectious Disease (September)
Originally I was attempting to get an away rotation/elective in Infectious Diseases in New York but vaccines, yes vaccines got in the way. That's right, Jenny McCarthy was right, vaccines not only cause Autism but ruin lives in general. NO, that's totally wrong. Jenny McCarthy has her attention misplaced much to the detriment of Autistic and Unimmunized children in America, I'll expand on that later..

Back to my vaccines. I never got chicken pox as a child. Blame my nurse mother or my introverted, outcasted schoolage version of Robert, Robert -2.0.


Therefore I had to get a varicella titer. Turns out my titer was 0. Zero. Nil. No more anti-varicella antibodies in me. So I needed a booster, which I got a bit too late. It'd take weeks to months to change my titers and I gave up. Plus I found out my insurance wouldn't cover labs, later I found out said insurance wouldn't cover me, being 25 and somehow stuck in a noncoverage gap.

Oh Frustration.

Immune status, FAIL.

So instead of spending time in my favorite city, I teamed up with our ID Doc @ my home hospital. This was fun because I was able to function at several levels. Initially I backed up the intern on ID and we split patients. Then our intern switched to another doc and I became a sort of resident intern working with a visiting student. The ID team is like the super internal medicine team. We're consulted when the main teams , be it ortho, surgery, internal med can't figure out what drug to use or what's causing the fever, etc. Ask a couple questions, draw on some people's legs. ( I love outlining cellulitis legs because you get to draw on people) , and then round with the attending in the afternoon or night.

I had lots of fun on ID. I liked thinking at a different level and doing a careful review of the patient as a whole to try and pinpoint the reason why we were consulted. At one point , I considered this as a career option, but not so much anymore.

Pediatric Cardiology (October- 4 weeks and December (@ home) - 2 weeks)

This rotation probably was the hardest I will work all of 4th year. This was my favoritest rotation.

First, I started off kinda rough. I didn't really have a schedule to begin with, so I kinda floated around for the first week. At first, it seemed intimidating being the only student in a congenital heart clinic. My attendings were as follows (all Peds cardio):

Maternal/Fetal Echo Mainly
Electrophysiology/Syncope/Chest Pain
Interventional
Echos/ Regular
Peds Cardiac Intensivists


Second, I'm used to guessing my way to an answer or making assumptions and whittling my way to an answer and my attending wasn't having any of that. So I realized I'd have to quickly learn my way around murmurs, a good physical exam, EKGs, etc. And I did. By week 3, I could skim an EKG, diagnose a murmur and even guess a diagnosis, work up chest pain/syncope and counsel like nobody's business.

The attendings eventually were won over by me. I find that if I prepare with reading and come in with a smile, I can win most anyone ever. I loved my peds cardio patients loads. A sampling of the things I saw:

Kabuki Syndrome: In essence it's a congenital condition that can involve cardiac conditions, hearing defects, mental retardation, growth retardation, etc. The syndrome is named as the children take on the appearance of a "kabuki" doll. My little guy was super cool, playful (interestingly, 50% are described as unusually playful). We played with toys as the cardiologist counseled the parents.


HLHS: B-T (Or Sano) , Norwood, Atrial Septostomy followed by Glenn followed by Fontan. This is one of the more amazing patients to follow on peds cardio. The Hypoplastic left heart kids and friends (friends being the various kids who have shunts for reasons like atresias, etc) In short, with the use of gortex, some fancy stitching , connect the aorta to the right/single ventricle. You shunt blood into the pulmonary arteries , patch it here and there as the kiddo grows, hopefully you outpace the inevitable cirrhosis.




The Tet Kids. Patch this, band that, call it a day and wait it out. I do have a story that warms my heart a wee bit. Please indulge me. So I was working with the E-P doc and NP doing stress tests. A cute little blonde teenage girl with ToF comes in for a stress test to determine the nature of her dyspnea and sats. So there goes the stress test, it finishes and the girl sits down.

A few minutes in , she starts crying. We ask her what happened? She says " I want to go to college." We realize that for whatever reason, she thought she was going to get bad news, that she wouldn't live to college years.

The EP Doc in a very classic Dr. N way (Dr. N has these phrases he uses to relate to adolescents and he uses them consistently and somewhat awkwardly) goes, well the only thing that'd keep you from college would be your SATs and grades...

Then he follows up with his old adage. As far as your heart goes, it's fine.. but I can't say a boy won't break it.....

Syncope/ Chest Pain

So I know what you're thinking. First, what does Gatorade have to do with Syncope. Second, what kind of innuendo is gatorade aiming for here. Young female athlete perspiring selectively in her "thorax" area.

Vasovagal syncope, the body's inability to restore homestasis in the setting of orthostatic changes and stress. (At least that's my definition) For my teenagers, basically your tank ain't full and your pumper aint pumping appropriately so your brain says woah and your body says get low.. and ya faint or feel faint rather. So to fix this, you keep your tank full with some gatorade, before , during and after sports and in hot weather , even without sports. With further dysfunction such as the autonomic dysfunction of Pott's syndrome, you might throw in some mineralocorticoids such as Florinef (fludricortisone) and vasoconstrictors to clamp the vessels a little.

And lastly, a review on Marfan's. Many of us have read up on the Marfanoid appearance. The pectus chest, the long limbs, the lens dislocation, the MVP, the joint laxity, hyperextension, scoliosis, elastic vessel changes.


So we saw a young man who looks Marfenoid but the genetic tests were all negative but we were keeping an eye on him for his aortic root dilatation.

Cool kid, basically got to d/c his beta blocker and say: Sports, have it chap!



























And lastly, lastly. Autism and Vaccines

I could rant about this for hours and hours. But here's my line. Vaccines do not cause autism. There is the possibility that they might trigger an underlying disorder but that's like blaming someone who steps on a remote mine for the explosion, sure they set it off, but they didn't put it there.

I read a really great book about the whole "link" and the publicity and Jenny McCarthy's campaign.

Take home message: We will see a resurgence of diseases such as Measles, Mumps, Rubella, Rotavirus, Influenza, etc.


Sure, there have been circumstances where Rotavirus vaccines had been pulled off the market for an increased rate of intussusception and then there's the Guillain-Barré syndrome warnings.

From the CDC:

What happened in 1976 with GBS and the swine flu vaccine?

Scientists first reported a suspected link between GBS and vaccinations in 1976, during a national campaign to vaccinate people against a swine flu virus. The investigation found that vaccine recipients had a higher risk for GBS than those who were not vaccinated (about 1 additional case occurred per 100,000 people vaccinated). Given this association, and the fact that the swine flu disease was limited, the vaccination program was stopped.
Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine.

Well that's that. You've been updated. To follow: Med-Peds, the journey... where I talk about Med-Peds and the interview trail and why I chose this path for residency.

Finding a Place to Pray, The Mosque Debate

Summer of 2008, "The Last Summer of Medical School"

I did what I always did when I have a few days off and want to go have fun somewhere, I go to my second home, New York. While I can't call myself a tried and true New Yorker, I'd say being born in Brooklyn and living there for 5 years allows me some claim. I've probably visited there most every year after.

So I spent a week there between my first and second years of medical school. I did the things that touristy people do, I went to the museums, ate the gyros, etc , etc. Then comes Friday. You see while I'm certainly not the most committed Muslim, praying 5 times a day, etc. but I will always make a sincere attempt to make it to Friday (congregational/Jummah) prayers. If I'm not in Georgia, I usually google the nearest location and head that way around 100/130p. I was in the Financial District, having spent the morning at South Street Seaport at a Whaling Museum and Restaurant with Andrew and Helen. The nearest location was off Warren Street , a few blocks away from where the World Trade Center was.

Now, I've got a horrible sense of direction but I found the Masjid (place of prayer) readily enough. You see, the main "masjid" was the basement of a store that extended out into the street and across the street. There was two services, so one I saw one service come to completion. Men in their business attire, colors as varied as the rainbows, catching a service in the middle of their work day. As they filed out, a new group replaced them, joined by me. I attended, enjoyed a relatively short sermon and went about my day, just like the rest the attendees.

And therein lies the beauty of New York. It's a place where you can grab breakfast at the Dunkin Donuts run by an Indian Family, grab a gyro from the Arab vendor, eat dinner in Little Italy and go get some sketch electronics in Little China. I've been to a college Model UN conference hosted at the Marriot on 6th Avenue. I've debated with an Ethiopian Guy on the loving nature of Christ in New York City. I've walked through Central Park after a day at the museums. I've been to Columbus circle to go hear some Jazz with my cousin and aunt. New York is the greatest city I've ever been to. It's dynamic, it's accommodating, it's always moving, always awake.

Given that, I've felt ambiguous about this Cultural Center being proposed to be built near Ground Zero. In one sense, it's inflammatory in the sense that there is a strong emotional component to how we feel about 9-11 and the victims and their families. So the suggestion is that they move the Mosque to somewhere more P.C., less inflammatory, safer.

But that's not the New York I know. It's a place where things do stand in contrast to one another and things work because people are smart. They would want a place where their fellow citizens could pray and Interfaith Dialogues could take place. If Muslims like myself have failed in distancing themselves from the attacks of 9-11, it's not because we haven't spoken out against it or distanced ourselves. It's because we don't do a good enough job in taking part in the community we exist in, as Americans.

-Robert Karim Abdullah

Weeks 2 and 3, Halfway in/out of the forest

Week 2: High Risk OB / Maternal-Fetal Medicine

So I was told by slim shady (one my goodest friends in medical school) that I would rather enjoy High Risk OB as it involves treating moms with babies that are risk for things like macrosomia, Trisomies, etc. As such, I made sure I'd get a full week on this service.

She was totally on spot. Maternal-Fetal Medicine totally works for the pediatrician in me. Basically, using ultrasounds and other diagnostics, the high risk doc evaluates moms to be and counsels them on his findings. This doc that I worked with was awesome. He'd have the ultrasound techs do the ultrasounds, then he'd review the findings in his office. He'd correlate with any kind of other tests/screens that he might have. Then he'd go and talk to the patient. This is where I would tag along.

One of the more interesting cases was a finding of ventriculomegaly. Basically, the baby's ventricles were a touch bigger than expected. We ran through all the possibilities with mom and dad. While certainly not exhaustive, we split it into infectious, congenital (genetic), structural. We ruled out congenital as it is unlikely that a trisomy or genetic illness would have ventriculomegaly as the sole finding. You'd expect skeletal abnormalities or other defects. The US Techs were super helpful in explaining what they would look for to rule out Down's syndrome, etc. This sums up some of the findings that they look for:

I suppose this takes the whole nastiness of OB (GYN Exams, Diseases, Etc. ) and introduces a more cerebral aspect of it. Here, you use technology to help diagnose a developing baby. This particular day at the office as full of "your baby is normal, everything is okay."

Other than that, I spent my afternoons helping out on the floor. We also had two days at the County Health Department. It's really a student/resident run clinic and we get to do a good bit. Let me highlight my classic of classic moments at the Health Department:

At the conference table where we sign out to the residents, basically suggesting our treatment plan, etc.

Resident : So did you do a wet prep

Me: Yeah

Resident: and the results?

Me: Oh, the nurse hasn't told me them yet

Resident: What?

Me: Yeah, she took it.. isn't she gonna review it?

Resident: You're supposed to look at the slide

Me:......

Me:... yeah...

Resident: Go check if she still has it, if you did the prep, she ought not to have thrown it away

Me: Okay

Me (to nurse) : Hey, do you still have the slide I did

Nurse: uhhh, you didn't seem to want it.. so I threw it away

-FAIL-

Week 3: OB FLOOR

Floor is basically the heart of OB. Everything happens on one half the third floor. You basically enter via the card access door and your day begins and ends behind this door. There are four areas of activity :

3 South/ 3 Main - Postpartum peepz. This is where the moms go after they deliver. These are the patients that we round on at 6am. Most of the time.. it's a rapid fire question asking consisting of breast/bottle, circumcision?, nauseavomitingdiarrhea (I do sometimes say this as one word), birth control, pain, walking any?, tolerating food? any questions

3N - Other stable OB patients

L and D - laboring patients, patients that need close nursing. These ones are rearing up to pop em out. This is also where the OB OR Rooms are. C-sections, D and Cs and that kind of stuff goes down here. All the L and D rooms are built for delivery. There's a bed for baby, scrub gear to suit up, and the bottom of the bed comes out for maximum baby delivering optimization.

OB Assessment - As Mikey T. would say. OB Assessment is more like OB Ass. This is where preggos (I know this is a horrible word to use for mothers to be but it sounds funny and adds some edginess to my blog) who have any sort of complaint or are past a certain week time period go. So if they have a cough/fever/ SOB.. they get turfed here. As such, we have to evaluate them which means : H and P, Ultrasound (more than likely), Cervical Exam , Labs of some variety, waiting until we can safely send them home.

Call Night #2 - So this was my most tiring and exciting call night of 3rd year. I think I stayed up all night once on surgery but I can't remember.

So call began around 5p, now I'm the floor student so really call is no different than being on the floor so I basically signed up to be on the floor from 6a Monday to whenever they let me go after 8a Tuesday. Really, the fun didn't start till 730p. I had gotten my dinner of subway and was praying for a super quiet night but then I went upstairs and Mikey was there. Now Mikey is a bastardization of my resident's real name .. but we'll use it for blog anonymity purposes. Mikey tells me there's people in OB Assessment. We got stuck in OB assessment and floor stuff from 730p-1230a . We admitted a lady that was gonna deliver soon. At this point the following transpired over two hours

1230a

Mikey: So, that's pretty much it. There's labor notes that need to be written q2h on this laboring lady

Me:...

Mikey: But I'll take care of em

Me: [thank God]

Mikey: What's the number to your call room

Me: I'll text you when I find out, when do you think she'll deliver?

Mikey: I'd guess 5a/6a

Me: That's good, can get a fair number of hours (a fair number of hours on call = 4-5 hrs sleep, anything above that means someone was extra nice to you)

Mikey: call you if anything happens

Me: see ya [4-5 hrs sleep.. awesome.. ]

zzzzzzz

zzzzzzz

zzzzzzz

2: something am

[phone rings in call room, I wake up super confused and thrown off.. I reach for phone]

Me: Hello?

Mikey: She's laboring and ready

Me:.... okay

So then proceeds the craziest 1.5 hrs of my life. We get upstairs, Mikey confirms that I want to deliver this one. She's multigravida so it should go all right. I put my booties on, put on a face shield, ask for size 8 triflex, and it's go time. They didn't get the epidural in so she's in pain. She starts to contract. I have my hands in position, V to protect the bajingo with my right hand and other hand ready to protect baby's head. Baby starts to crown. Baby's head is delivered, reposition hands , right hand on top, left hand on bottom. Time to deliver the anterior shoulder... AND

holy crap, the baby has stalled... stuck.. beneath the pubic symphasis

residents take over

mcrobert's position is assumed : mom's legs are pushed back

pubic pressure is applied

baby is turning blueish

everyone is anxious at this point

in what seemed like an enternity, a decision is made to do an episiotomy, basically cutting the bajingo (at first I thought this was to give the baby some room, but later it was explained that this is really to give the person delivering more hand space to manipulate the baby so they can deliver; if you think about it, the pelvic anatomy dictates how the delivery goes, only anatomical manipulation will change the outcome, so a surgical cut doesn't do that)

baby is delivered

baby cries

I get a little teary eyed beneath my face mask , realizing that cry means that baby is alive

Mikey T: okay, let's get the cord blood and deliver the placenta

Me:....

I then proceed to get the cord blood and deliver the placenta which is really a bloody mess

----and finish --- , 1st deliver OVER

around 400a, after dictating, etc

Nurse: so did you see that roach

Me: what??

Nurse: it was on one of your gloves.. .. actually your glove, you started the delivery right

Me: yeah

Nurse : there was this roach.. that came from somewhere

Me: gross

Mikey T: yeah.. maybe I did see a roach

Me: [rolls eyes]

So that remained the running joke/urban legend the rest of the week .. that in the midst of this chaos.. a roach came from "somewhere" and ran across my glove and disappeared like a fart in the wind. So after that , Mikey T tells me to peace out and get some rest. I couldn't sleep of course and I probably netted around 2-2.5 hrs of sleep that night.

The baby turned out to have Erb-Duchenne's palsy (injury to C5, C6 nerve roots) from the shoulder dystocia. We definitely took the baby to the nursery to check her moro reflex and she had the classic waiter's tip. Per my OB attending, 90% resolve on their own with rehab.

So that was really the highlight to my week. Otherwise I'd been able to do a good bit besides take Histories and do physicals. I assisted on

I've done abdominal ultrasounds, vaginal ultrasounds, removed a cerclage, congratulated a bunch of new moms with my "your baby is beautiful". Thank God, I haven't seen a non-beautiful baby yet.

Lastly, here's some tidbits/definitions:

Cave of nastiness - One of my fellow students/friends made an reference to the cave of wonders in Aladdin. I told her that we're dealing with the cave of nastiness.

Wanting to palpate the fundus - I feel a strange desire to check every female's fundus after being on the floor.... Weird, I know.

Blending into the background, not getting introduced - Two things are tantamount to being a medical school. One is blending into the background and not being noticed. The other is walking in to a room with an attending and not getting introduced resulting in a very awkward encounter where you realize that they realize.. that they have no idea why you're there and who you are.

Over the top, getting in nice with people - Being nice to the point of demeaning yourself works.. and it works well. As long as you believe in yourself.. you can pull this off with good results. Nurses love my comments like "I'm no expert like them.. or these wonderful nurses... "

Bovie - I finally got to use the bovie electrocautery tool. It was the greatest surgical moment of my life when my resident hands me it and says.. cauterize that over there... AWESOMENESS It's almost like a miniature light saber for surgeons...

First Week of OB/GYN

So I've got less than 5 weeks left of third year and my last rotation OB/GYN.

I've been told this is the hardest rotation: long hours, lots of work, busy call, etc, etc.

I'll say this much to begin: It's not the worst thing in the world, haha.

OB is really unique in every regards. They deal with women's health, women's anatomy. Nobody else really deals with this aspect of health care. I mean if someone has a baby or they have issues with their baby making anatomy, it's OB/GYN's turf. Let's run through my days on Gynecology Surgery:

Preround at 6am - This puts me at waking up around 420a so I can have oatmeal and such and get to the hospital. I hate waking up early.

Presentations at 7am - Present to residents in conference room. We present on postpartum patients only so there's usually only 3-4 patients. This takes 30minutes or so , usually time to get a drink/coffee/quick breakfast before attending rounds

Attending sit down rounds around 8am - Attendings show up and we sit in a particular formation. Attendings sit in the comfy chairs at the table. The senior residents sit closest to the table. Other residents flank around and the students sit in a corner on the less comfy chairs , huddled together for support. Residents are the only ones that really talk during these rounds and mostly the senior resident.

OB is all about specifics. Presentations consist of mostly Gs, Ps, postive or negative, immune, bottle or breast fed, boy/girl , birth control, circs. I find it really strange not to talk about age or race which is vital in (internal) medicine.

Once this is done, we all flank out to whatever service you're on. There's High Risk OB, regular OB, Gynecology (Surgery), Reproductive Endocrinology, Oncology and Urogynecology. I was on Gynecology so really I just find surgeries I'd like to observe/take part in. So during this relatively short week, I saw two surgeries : I saw a cystectomy/ex-lap that went for 5.5 hours. We had to call in a general surgeon and resident because of extensive adhesions and bowel issues. They basically ran the show, mobilizing bowel to get to the cyst. The bowel has to be resected because of adhesions and whatnot. Ordinarily, such a long procedure would bore the bejeezus out of me but I was able to help as the unofficial circulating nurse, grabbing supplies and making calls while the real circulating nurse was doing stuff. Oh, I also had some precious duties which I'll enumerate:

Alcohol washer - The general surgeon perforated one of his gloves so I had to grab some alcohol and pour it over his hand over the dirty bucket without breaking sterile field.. as I was not scrubbed

Beeper retriever - The GYN surgeon needed me to retrieve her beeper, underneath her gown without breaking her scrub. That was precious.

Glass pusher upper - The surgery resident who I knew pretty well having worked with him on general surgery would occasionally and nicely ask for me to push up his glasses on his face. On one occasion he nodded to me to say "sup" as the surgery went on forever and I mistakenly took that for a cue to nudge his glasses up, that was a little awkward.

Gown untier - When scrubbing out, it's customary to help the attendings/residents get out of their gowns

Beeper caller backer - Occasionally when others are busy, I have to call back pages and say Did you page so and so? And then find out what they wanted and relay that to the attending/resident.

1 hour left and the general surgeon and resident dipped out, the GYN surgeon says: well Dr. Abdullah, go ahead and scrub in, I'm going to need some help. Now, I like scrubbing. Not the idea of suturing or doing surgical things, the actual hand washing. I don't know why this is but something is fun about washing your hands in this giant sink , not being allowed to touch anything. It's almost like hot lava except the lava is everything else besides the air above your waist.

After that, you have to hold your hands above your waist and use your glutes to open doors. There are two main ways to hold your hands above your waist.

There's the t-rex and the methodical evil genius finger positions.

T-rex hands: Hold hands above waist but not together avoiding touching ANYTHING

Evil genius/pensive pose: My variation is slightly different, I don't hold my arms so close to my body and I don't collapse my fingers inward , leaving them up like a tepee but I do have the evil genius look especially behind a mask and sexy scrub cap.

Anyway, I assisted with closure. I suctioned using the Yonker and kept tension on the sutures to close the midline incision. Then I totally placed some kick ass staples.

The next surgery I observed was the next day; it was a robotic hysterectomy. This was kind of neat because there's several monitors that show what's going on. Basically, one doc sits at a terminal and operates the robotic arms and the other assists by directly placing sutures into the trochars or manipulating certain things. Two things stood out about this particular surgery.

A. The robotic hands that are the DaVinci robot. It's like they made a miniature version of Doc Oc's arms and let them run the surgery:

and B. The pulling out of the uterus via the interoitus is like watching that dude rip out the heart in Indiana Jones. Especially when the dialogue went like this:

Second doctor: So I guess we'll have to cut the uterus in half to pull it out.

First doctor: No, I'll just pull it out

[everyone takes a few steps back]

First doctor : grabs the uterine manipulator and tugs , tugs some more and

WHOOSH .. it's out

I also learned that the porn industry borrowed the pelvic muscle trainer from work done by one of our attendings. Apparently, Kegel exercises are not only good for stress incontinence but for sexual performance as well.

Lastly, my first night of call was amazing. Not much happened at night, there was a fourth year student rotating with us and this particular resident doesn't page students. Too bad my other 5 are with the hardest working intern, ever.

5 weeks and counting.

25 years of awesomeness

To quote my cousin Abbie "You're like, halfway to 50"

So I haven't updated my blog in months, as evidenced by my lengthy prose in each of the successive posts. Really , I just didn't have the motivation or time to sit down and lay out my thoughts. I mean , some people take blogging as some kind of crude journal writing or whatever. For me, it's an avenue to help keep my friends and family updated and hopefully entertained.

In the end, I'm just happy writing and putting what's in my head on a screen. So what do I have to say, or rather what have I learned in a quarter of a century? Well, I'll make it into a series of quotes, bullet points, lessons, etc.

From Abbie again: You're a doctor so you're not technically a loser

What I've learned: While being a nerd certainly cost me in many ways in my teenager years, it's something I embrace now. Surrounding yourself with the right people and right environment translates that into helping patients and keeping your friends laughing.

I think most everything is worth laughing at

Laugh at yourself, laugh at obstacles.. it's hard to be a big bad wall in your way when someone laughs at you and jumps over you. I used to get in trouble for laughing during prayers and inappropriate times and while I certainly control that better now (furious tongue biting), laughing is so soul enriching. When your belly aches as much as your heart warms, that's a good laugh. Also the danger of laughing with gas. You see, I find farts hilarious. Imagine the loop that's created when you laugh so hard, you val salva, fart. Realize you farted and resume laughing.

Being a gentleman

I remember one of my friends calling me out for walking a girl in the rain, a girl who wasn't single. It was somehow low yield to do so. I do it because well.. it's what I do. Perhaps it's because I've been a big brother for almost 18 years that it's ingrained in me but I'm sure there's some lassie out there who wants her door held open for her.

Being a good listener

Psychiatry sharpened my listening skills. Sometimes you can learn a lot by doing very little but listening a whole lot. This pays off in life. I'd like to think remembering a very little but very personal detail about someone can have the ability to make their day.

"So you're half way through your twenties" - Aunty Cathy (Abbie's mom)

In one sense of the way.. holy crap. I remember several medical school people saying, medical school is all about delayed gratification. You sacrifice your twenties and you take out all kinds of money.. for this degree, this career. Sometimes I think.... "wait a minute.." but mostly I think.. " i totally am okay with that, i really really really really want to be someone's doctor.. "

Do you have a girlfriend Abbie/Maddy (sisters, my cousins that live in Mass.)?

Apparently, I have no reason as to why I don't have a girlfriend. Maddy insinuates to me during my cousin's graduation dinner that unless I'm the only person in Macon.. I've got nothing. I'm still working on that answer

So on a timeline , the highlights

Born couple weeks premature on May 30, 1985 12:59a (4lbs and some odd ounces) to one Leila Abdullah, LPN and Karim Abdullah at Brooklyn Hospital, NY. I spent the next month in the NICU because of feeding difficulties

1985-1990 - Lived in South Ozone Park, Queens, NY - attended Public School 121 - Kindergarten teacher was Mrs. Jenko. Most memorable moment: squirting ketchup in my ears on accident and freaking out because I thought I would never hear again.

1990-1998 - Lived in Margate, FL Elementary School/Middle School - little known fact, I spent a few months at a sketch magnet school for math before returning to my regular school. I also was rejected from Gifted Placement because of my inattentiveness and desire to play outside. Oh, and even better, I was once evaluated for speech. Good times.

1998- Moved to Lawrenceville, GA where I've called home since.

I've held several jobs in the past

Bagger/Carts - few months at Kroger when I couldn't drive, it was horrible and quit shortly

Publix - over several years I worked as a cashier, stocker clerk/cashier combo and then during college as a pharmacy tech

In house tutor - I tutored Precalc, Physics and Middle school math and science

ER Secretary - one of my more memorable experiences, I worked at the same hospital my mum worked at.. she would visit me in the morning as she came of for day shift as my night shift was coming to an end . The staff loved the fact that we were related.

Volunteered a good bit

High school/college volunteer - at the same ER I would later work at

HELP - working with elders at a local hospital

Countries I've been to: Canada, Guyana, US, Jamaica, Grand Cayman

States I've spent 24+ hours in: Florida, Georgia, South Carolina, Massachusetts , New York, Kansas, Colorado

Paraphernalia with celeb signatures: One item, a book signed by Queen Rania of Jordan. This was my very unique present from my second mom/aunt in NY.

Pets over time: Dog (George) in NY, Several Fish, Birds (parakeets in FL and currently Sam, our family's pet cockatiel)

Nicknames : Big Bird, Ice, Robby, Rob, Bert, R.A., Bobert, Bob, The Abdullah, Franco, Rober (pronounced row-bear as one would say in French), Karim

Crushes (not including college/med school)

Elementary School: Patricia, Nicole, Elise, Laura, Miranda

Middle School: Tiffany, Denise, Rosalie, Lindsay, Emma

High School: Lindsay, Patty, Jeanette, Meagan, Tanya, Amelia, Ashley

*there's probably more names.. these are the ones I remember though

Anyway, that's probably enough trivial me information. I am very blessed by the people that surround and support me. Most immediately and perhaps importantly are my parents, my sister, my Aunt Dolly and cousin Andrew in NY. Not to minimize other's contributions but these are the people I lean on that have always been there in the best and the worst. It is no coincidence I turned 25 in their presence in NY, not 48 hours ago. I have a great family, in general. I also have some kick butt friends who make me smile and feel awesome. I enjoy who I am and where I've been. I also look forward to the next great adventure.

Thanks for reading

To quote Barney Stinson (NPH) of HIMYM fame : Barney: In my body, where the shame gland should be, there is a second awesome gland.

Enter Psychiatry

Enter Psychiatry, the cushest rotation of my life. Psychiatry was in effect a 7-8 a to noon kind of bit. At our hospital there are no psychiatric residents, just attending. Two attendings work at a time. One attending is the Psychiatry Consult MD, meaning they are the triage doc. They determine if there’s a need to follow a patient for a while , admit them to the psych floor or wonder why the heck we were consult.

So consult service was neat. Days started off one hour before the attending showed up. This was usually 7/8a. We’d head to 6 East, the psych wing and find all the pieces of paper saying “Psych MD consult and some little scribble of why they were consulted” We’d then update our PSYCH MD list and divvy up the patients. There was three of us, so we split it three ways, giving new patients priority. Then we’d head out. Our plan of action went like this:

1. Find patient’s chart – this is probably the most involved task… any number of people can have the chart – other teams, case management, xray/procedures, chart gnomes, wizards
2. Collect billing sheet for psychatrist
3. Find out why we were consulted. This may or may not be readily apparent. If we’re lucky , it’ll say Consult Psych MD: r/o depression/suicide. But it’s never that simple, otherwise life wouldn’t be as exciting. Sometimes, there is no order for PSYCH MD. Sometimes there’s no clear reason on the chart. Then you proceed to step 3
4. Find nurse. Finding a nurse is really important on pyshc, moreso than other rotations . The nurse sees the patient the most and they can appreciate changes in patient’s mental status and hopefully.. the nature of the consulted. It also is a great way to meet cute nurses, I mean.. expand your social.. I mean… be really nice to nurses.
5. Find patient - another task.. sometimes you find the room AND BAM.. patient is MIA… could be smoking, could be getting something done or imaged, or one day I had a patient up and vanish (based on previous records, she’s done that before)
6. Talk to patient – psych histories are conversational. You want to assess the immediacy of need, the history and boil it down to : what can we do to help this person
7. Sit down rounds – students report to attending and we build a priority list of patients to see
8. On psych, some attendings want to see all patients on the list while others want to see teaching cases. So we round afterwards based on that
9. Round, learn, peace out for lunch
10. Occasionally we had things in the afternoon like lecture or conference but the latest we went was 2/3p
That was consult service. I saw all kinds of patients: personality disorders, substance abuse, plenty of suicide attempts, PTSD and my favorite, schizophrenics. I’ll tell you about two that I picked up on one day that were just special.

The paranoid schizophrenic
Pleasant AAM who’s sitting in his bed in the EC. He has a sitter which means he had some sort of suicidal ideation/plan. First thing I notice when I walk in is a sheet of paper covered with writing and symbols. This becomes my talking point. I introduce myself and sit next to this pleasant gentleman. I ask if I can look at the paper. The paper is filled with terms regarding chromosomes, genetics, cloning, formulas. My patient proceeds to explain that the government stole his secret for chromosomal liver transplants. [ I think to myself, oh this is going to be good. Not so much the oh you’re a nutcase good but I find a schizophrenics train of thought and delusions interesting. They have a thought disorder, their ability to relate their reality to you and their perception of reality are disordered, disjointed] My patient explains that he is a veteran and had been working on these formulas and really it boils down to him not taking his meds and having stressors in his life that made him want to hurt himself. I really ached after seeing him. It’s strange how some patients just jar you and feel for them.

The disorganized schizophrenics
Agitated Caucasian male that presented to the EC because he was found passed out on the street secondary to alcohol consumption with possible lobar penuomia. This gentleman was just.. well… a disorganized schizophrenic who had been living on the street for 10 years. He was disheveled, thousand yard stare, monotonous voice, wanting to go back to the streets. Our conversations usually started off normal. We talked about his pneumonia at one point:

… Me: so it looks like you have a pneumonia here
Patient: acknowledges what I say but then looks outside , starts rambling. Then he goes on to say: “this is the climate for walking pneumonia”
Me: [wtf?] Um, I suppose you’re right sir
Patient: grumbles/rambles … new word for that “grambles”
Me: looks over at IVs, sees Levaquin running. But it looks like you’ve got a more serious pneumonia that just walking pneumonia, that antibiotic over there covers things like lobar pneumonia [point for me… what what..]
Patient [unimpressed, continues grambling]

So I take in the rest of the room, seems like he has all kinds of random jars of liquids and trinkets from his travels. He has one worn backpack. So really our encounters consisted of conversations that started off okay with him mostly questioning things and then proceeding into a series of grambles. The day our attending met him, with our team in to (three students, one doc) our patient proceeded to go on a gramblage- grambling rampage. When asked if he’d like to spend time on our psych floor aka “the pavilion” (which is a hilarious name as it implies the psych unit is some kind of robe wearing spa that only the elite patients go to), our patient thinks it over. His thought process proceeds as follows

Well, I understand that you are offering me to go the pavilion
I’ve been there before
I’d like to walk around the hospital some more
Move floor to floor
You see, I need access to a library
Insert some reference to aliens/UFOs
I need to get a library card
Grambles about oil spill
I can research genetically engineered fish that can clean up the oil spill
[at this point, the attending motions for me to open the door and that the interview is done, saying to open the effin door]

We all proceed to file out, close the door and bust out laughing. It was ridiculous. The whole time we were all holding back, maintaining professionalism listening to our patient move from coke to central park to libraries to fish to aliens to cleaning up oil spills. For me, laughter is a coping mechanism that I’ve employed throughout life, especially now in medicine. There’s so much we see and do that we need an avenue to channel that experience, that stress. Some people take it seriously.. others like myself .. laugh..

So to wrap up psychiatry, I ended on three weeks of inpatient psychiatry. These were the “unit” patients. I’d see maybe 1-2 new patients in the morning, obtain a good history and see my continuity patients. Again, we’re the residents basically at our hospital. Our attending would let us lead team rounds. So nurses, social workers, our attending would all sit in a circle and run through the list talking about medication effects and mental state of our patients. Psych inpatient is very cool in this regards because the longer you were on the more it became “well, he’s still psychotic but I do believe he’s much more socially appropriate today.”

IM Team B

Internal Medicine: My old friend

So up until Internal Medicine, I had given up on adults. I had abandoned my sweet old ladies, my pain medication seekers, the chest painers, the crackheads, a lot of the patient population. I had given up on rambling histories that span decades. I had given up on those people that may or may not be neglecting information. Then I began inpatient internal medicine. This is the “wards” so to speak. If you’ve had the pleasure of reading House of God, these are the gomers and the TURFS and all the clever things Mr. Shems discussed. I would soon the medical student on Team B. My goal, not to make my residents and attending’s job any more difficult (per House of God). I expected to be let down, to side with the cynical resident, to resent the smell of .. well smell of patients in the morning, and to grow tire of the dreaded differential.

But ladies and gentleman (my loving readers), I didn’t. See, I started Team B and would be on Team B as the only student. There were two interns, an upper and our attending and me. I was the go to man so to speak and I loved it. A lot of my third year experience so far has been shaped by the people I work with. The residents and attending set the tone. For me, pediatrics was probably one of my more stressful, anxious rotations I worked in. Don’t get me wrong, I still want to do pediatrics , but not just pediatrics. Medicine was the complete opposite. We joked around, we said really inappropriate but hilarious things behind closed doors. We just didn’t get worked up over little things. So let’s discuss what it means to be on a team, who we are and what we do and how we do it. (queue “this is how we do it”)

The Team (from Top to Bottom)

The Attending - The boss, the fearless leader. The attending is the source of knowledge, the captain of the ship. He probably interacts less with the patient than any of us, time wise. The attending really spends the morning and early afternoon on the floor and then has other things like clinic and whatnot to do later.

My attendings: I had two different attending for my 8 weeks. One was an Indian guy who’s lifelong dream was to be a cardiologist. For anonymity , we’ll call him Brown Doc. So Brown Doc was essentially a coolster. You see, he was the kind of attending who liked to be involved in jokes and wanted to know why everyone else was laughing. He also thought he was funny when he made really inappropriate comments in public (public being the not safe zone of the floors vs. the rooms for residents/doctors that’s our safe areas). Brown Doc was also a one upper. If he asked you a question, and he does, a lot. You can have an answer and it may be right but he’ll ask you for another differential or something related just to one up you. For example:

Brown Doctor : Young AA Athelete drops on court from heart condition, what is it?

Me: HOCM , Hypertrophic Obstructive Cardiomyopathy

Brown Doc: Tell me about that

Me: ramble on for a little about sarcomere mutations, val salva maneuver, outflow obstruction, preload.. AD inheritance

Brown Doc: What’s another possibility?

Me: uhhhhh.. I don’t know

Brown Doc: [one up time] how about ARVD?

Me: uhhhh

Me: [waits for anyone else to chime in] What’s that?

Brown Doc: ARVD is arhythmogenic right ventricular dysplasia…

Me: [awesome]

Brown Doc grew to like me after first pissing me of my obnoxiously calling me my last name when first meeting me. He also was very appreciative of my efforts and thought much more highly of me than he let on.

My other attending , we’ll call him Dr. G. He is from Georgia, a southern gentleman. He is the quintessential IM attending. He’s very paternal in nature. He jokes enough where things are lighthearted but not overwhelmingly so. He was a big fan of boards questions, MKSAP questions. He’d print out one-three questions every day for all students and residents and we’d do these between rounds. He was also a stickler for rules which is mostly fine unless you’re trying to sneak out of a lame lecture after being on call overnight. He also made sure he pointed out good pathology and wanted you to do a thorugh exam. One of his other learning techniques was to assign us topics based on patients. For example, we had a patient that may have had HIV associated lipid dystrophy. Basically, it was my job to go home and read up on it and in 90 seconds , present the group an overview of the topic. This was actually really useful because he’d assign it to students and residents and we’d learn from one another. Dr. G, definitely one of my favorite attendings ever.

The Upper Level – The upper level is second/third year resident. They’re the team leader. Really, they’re in charge of overseeing all patients, acting as a liason when we consult other specialities and check behind the interns . My upper level, Josh was a cool guy. Josh was able to fart, laugh till he cried, just keep things light. At the same time, he was always on top of the ball. He taught us important things and encouraged us to be independent. One of the perks of being Josh though began one fateful call day:

[Robert heads down to the ER]

Robert: Hey Josh, what’s up

[biggest grin on Josh’s face ever]

Josh: guess what you get to do?

Robert: what’s that?

Josh: DRE man, snickers

[DRE is not the rapper but rather “digital rectal examination” – finger… in the butt, which for a lot of people is one of the most disgusting things ever, but I had grown desensitized to it during surgery]

Robert: got it man, consider it done

I’ve zinged Josh twice , perhaps more but twice in medical things. Once, I thought I heard an aortic regurg murmur, a low grade on this guy who had aortic ectasia on chest xray. Truth be told, I was listening super closely because I knew the chest x ray findings but even then.. Josh said he didn’t hear a murmur. The next day, Dr. G definitely said… there’s a murmur.. a faint one.. but it’s there. Robert -1 Josh – 0

The next zing was me totally dashing Josh’s dream diagnosis. We had a patient who had some finding that Josh felt a differential of aorto-enteric fistula was warrented. He was all excited and proud of himself when I ask: So, question, if he had said fistula, wouldn’t he be really sick? I mean if there’s a conduit from gut to aorta.. that’s serious. Josh, just started at me and said “thanks Abdullah”. Robert -2 Josh –o

Now in all fairness, Josh called me out on a variety of things but he really taught me a lot and we got along awesomely. He tried every now and then to catch me. One time we had a patient and Josh tells me to listen to her and tell me what I hear in front of the patient and family member. IN my head, I’m like… this’ll look really bad when I miss some kind of crazy thing like.. missing heart for example. So I listen, I hear what I think is a mechanical valve and I pull the ole medical student safe question re-ask:

Me: She doesn’t have a mechanical valve does she? [you see, if he says no… I can strike that off, but if he says yes.. it’ll confirm what I think]

Josh: I don’t know,does she

Me: [well played Josh, well played] Yes, I believe she does

Josh: good job

Because I had been the solo medical student for four weeks before working with my awesome partner, K Dub, I got a nickname for my frequent DREs. I was called rectal king. “King of the Rectal Exam”. Later, after one of the interns misheard my two nicknames Rectal King + Sexy Dark Chocolate, I became rectal candy.

The Interns – The interns are the workers, the grunt doctors of the medical team. They work the closest with the medical students. We are their personal bitch. If they need something, or something done, they will ask us. I worked with several interns. I’ll try to sum them each up

Captain Nascar - nuff said

Slick family medicine resident – so we also get a family medicine intern on our team as well, this guy was pretty cool and from Lebanon

Eminem’s little MD sister – this resident was one of the funnest, most hardworking residents I’ve ever worked with. She would throw down sick beats randomly and bust a move in the middle of rounds.

SS – SS was cool as well, she was laid back but worked hard and didn’t waste your time.

Persian – The Persian was a cool guy, really big about bedside manner

The Students – we’re the bitches on the team. Essentially, any rectal or random non-MD task goes to us. We see the patient for the longest period of time. We were fortunate on our team to be taken seriously for our suggestions. If I thought our patient was a good candidate for CPT, I expressed it.

Me – Well I’m pretty much an awesome medical student. But seriously, my MO is quiet sneaky but effective. I think a lot of people mistake my initially quiet and reserved demeanor for being shy. The thing is, given a few days, I was joking with my residents and helping make their life a little easier. I’m not the student that jumps on every question. I usually wait my turn and when thrown a curveball, attempt to hit a double. I’ve also learned to smile and joke with my patients, if they like me.. it makes my day a whole lot easier.

K-Dub – I worked with K-Dub, a classmate and friend , for four weeks. You see the things is, working with someone on a rotation can be quite different than hanging out with them watching Glee. In the hospital, you want to work hard and be seen as helpful. You also want to not ever make your partner look bad ever. Thank goodness, K Dub and I got along like PB and J. We supported each other greatly, kept the mood light and always gave each other credit in front of the attending. We also took our hits together, as a team.

So, IM was fun. Q4 call is the only downside to being on IM. We got to see crack chest pain, GERD chest pain, STEMI chest pain, NSTEMI chest pain, GERD chest pain, chest pain NOS. We saw a case of neurocystercircosis , unfortunately I was unable to visualize any worms in the patient’s eyes. We son tons of ascites patient, whether it was from alcoholism, cirrhosis, cryptogenic cirrhosis, etc. We saw diabetes, tons of diabetes. Anywhere from newly diagnosed to foot amputee diabetes. We also read tons of EKGs. Remember Brown Doc attending is heading off to cardiology fellowship so he loved having us cold read EKGs. I saw some interesting pathology like AML with sweet’s syndrome.

There’s probably a lot more that I’ve seen and have forgotten but needless to say, I miss IM Team B.