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.