Missionary Orthopod in the Making

So yesterday my dad had a partial knee replacement. Its so wierd when one of your own family members needs medical care and you are forced to trust another doctor. After the ortho doc came in and talked with my dad my mom called me and told me that the doctor reminded her of me because of his height and his wide smile. Of course my fickle self started to get excited about orthopedics again just from that, lol. SIGH. I just wish that I could make up my mind already.

I think I know why now I can’t go into OBGYN. I don’t want to be in a field where a nice subset of my patients don’t want me to treat them. Today a patient wanted me to step out of the room during her gyn exam. I mean do they really think that I enjoy looking at that stuff? I probably shouldn’t take it so personal but I really pride myself in personable to patients so having patients not want me is kinda hard for me to take. Anyway, I switch from gyn to Female Pelvic Medicine and Reconstructive Pelvic Surgery (FPMRS) tomorrow so that should hopefully be better.

Well I’ve been pretty terrible at posting lately but what can you say, that is life. For about 3 weeks I have been on my OB-GYN rotation. The way it works here is that you rotate through all the different sections of OBGYN (high risk, low risk, benign gyn, gyn-onc) during the course. I started on low risk obgyn and it was pretty amazing; I came in at like 5 am, saw the mothers that had given birth the day before and then left by 8 am! It was pretty cool interacting with the moms after delivery because they were often in so much peace post-birth. Some complained here and there of lower abdominal pain, but generally they were quite healthy. I still found myself wanting to play with the babies more than the mother so I’m pretty sure that OB is not for me, but the experience has been great. High risk OB was TERRIBLE!!! It was basically Internal Medicine, but this time the patients were pregnant. So I had pregnant patients with gallstones, pregnant patients with liver failure, pregnant patients with a history of seizures, etc. On top of this we would come in at the crack of dawn and leave pretty late. Right now I am on benign gyn and I am loving it primarily because we are in the OR 90% of the time. I find the OR very calming and comfortable, regardless of the surgery that is being done. On the service so far we have done a couple of hysterectomies  and the coolest part about this procedure is that they use the da Vinci robot! My attending was really nice too, he let me use the robot for a little bit and let me practice passing the suture from one robot hand to the other inside the patient. Honestly, if I could get paid to work with that thing 24/7 I would be in heaven.

Lately I have honestly been having day dreams about what specialty is right for me. Right now I am trying to decide between General Surgery, Urology, and Orthopedics. I have  researched each one out but and I still can’t come to a consensus. My biggest concern is that I would chose a field that is too complicated to be applied to overseas in missionary work. I truly want to be used by God where ever he would have me to be, and I don’t want to be limited in where I can be used by him. Technically, General Surgery is the most useful overseas because in theory you are trained in most types of surgery but that really isn’t always the case. These days general surgeons only really deal with bowel resections, gall bladder, spleens, and hernias. This is because there are so many subspecialists in the field so when you are training as a resident, many of the non-general surgery cases are taken by the fellows. Then, because many people don’t like the limited scope and terrible hours of general surgery, they often end up subspecializing anyway, so when I come back from the mission field, I would need to take up a fellowship. Then there is Orthopedics; I really honestly love the idea of being an orthopedic surgeon. I am big and tall so I fit in in that respect; I also like to use powertools as I work on my car or fix something in my house so in that respect I feel like I fit in. But I don’t think that my personality fits in with the field of orthopedics. I like to play sports but I don’t watch it and I definitely don’t follow it on TV, simply because I have more interests than that. And it seems like that is a semi-requirement (deep knowledge of sports and stats) to get into orthopedics here at Loma Linda. Also, while I could definitely get into the whole “fixing bones thing”, there is a lot of physics involved and I am not sure if I like the amount of physics that I would have to relearn for the field. But it is definitely applicable overseas in trauma situations, but it is definitely the furthest away from being  a General Surgeon that you can be also. Then you have Urology; they actually do 2 years of General Surgery as part of their training which is pretty cool. They are also probably the closet to being a General Surgeon while not going into General Surgery because they are trained to work on the bowel for some of their urological procedures. They also have a lot more office based patient contact and long term patient relationships than the  gsurg and ortho, which I actually like. They also get to use that million dollar da Vinci robot in their surgeries which is definitely cool to me. And even though I don’t like admitting it, urology feeds my desire to get into something competitive. So technically I am more so trying to decide between urology and general surgery both of which I think I would be perfectly happy going into. And the cool part is that when I talk to some attendings in the Urology department here at LLU, they expressed the same thing: That they liked both general surgery and urology, but decided to go into urology for various reasons. This is starkly different from the ortho attendings and residents who mostly couldn’t stand general surgery. And it doesn’t hurt that urology compensates quite a bit more than general surgery does and you don’t work as hard once residency is done. And urology definitely has mission applications. So I am going to move towards all 3 of these fields and leave my final decision up to what I end up loving during my surgery rotation, but I guess you can kind of see what I am leaning towards already.

I am in every way exhaused. Today is my birthday and I was at the VA hospital for 80% of the day. I like the experience I have had overall on my medicine rotation so far, but I am really ready for this stupid thing to be over now. Happy birthday to me……

So I went into the hospital yesterday with my white coat, dress pants, and bowtie, to pre-round on my patients. As I walk into the main unit past the nurses desk, one of the nurses calls out to me and says, “Good morning, Dr Chocolate.” Lol, I almost drop everything I was holding in my hands. I grinned and told her good morning back, and of course told my wife, so I think I am safe, but needless to say it was a funny way to start out my day. So with all that said, I leave you with my Photoshop picture of the day:

Modified image from HERE

So this upcoming Sunday will make the end of my first inpatient experience as a 3rd year medical student. I would say that the first battle that I have had internally this month has nothing to do with my rotation…the battle has been with which specialty I should pursue, Orthopedics or General Surgery. I’ve talked to alot of Orthopedic surgeons and alot of General Surgeons and I have done shadowing in both, and it is still hard for me to make my decision. Some folks caution against trying to make a decision too early in your junior year but that is a ridiculous recommendation. Of course you should go into each rotation with a mindset that you could actually go into that specialty, but if you are thinking about pursuing orthopedics, it is so competitive that you need to start getting things in order very early. My main problem is that no matter how hard I want to be gungho about Orthopedics, and make a crap load of money, and have the prestige of getting into a hard residency, and be known as the “Bone Doc”, and work with power tools…I just am not excited by the field and particularly bones. To be honest the gut anatomy is much more interesting to me, and in fact, the management of diabetic ketoacidosis (DKA) is really interesting to me too, along with a bunch of other things that ortho guys just don’t deal with and don’t care to deal with. Do I prefer to have to know a whole bunch about a lot like General Surgeons or do I prefer to know a whole bunch about less material, like ortho guys? Do I prefer getting dumped on by every surgical service like General Surgery, or do I prefer just getting consulted and giving my patients back like the Ortho guys? Do I prefer the prestige of getting into Orthopedics? And even more importantly, which field is more conducive to long term missions overseas? The last question is pretty obvious which makes me wonder why I am even struggling with my decision. But yeah, these are the thoughts that have been racing through my mind this month.

Besides those internal struggles I have had some interesting patients. I had a 20 year old Asian kid who had weighed over 500 lbs but lost about 200lbs taking weight loss drugs. Well, we aren’t sure if the drugs did it but now he has heart failure (EF=20%) and ESRD. Its really hard to break that type of news to a kid who is younger than me (of course I didn’t break the actual news, but it was hard standing in the room and watching his parent’s faces as the news was relayed). I also had a patient who was so appreciative of the care that “I” (which is pretty funny since I was just the person who came to see him the most) gave him that he gave me a card:

I think that that is the coolest thing about being a 3rd year student. You see the patient so much (more so than the residents and the attending) that the patients think that you are their personal doctor and that you are primarily taking care of them. Its nice to get this kind of feedback from my patients.

Over this rotation I think that I have also became better at presenting a patient in an organized manner, and better at trying to figure out what the next step in management is. I have also gotten better at going down into the ER and working a patient up for various conditions that they might have. I feel pretty comfortable with chest pain patients or patients who complain of fatigue. I’m not sure how different my patient population will be at the VA and how different their diseases will be, but I am excited for the change.Some things that I didn’t do well in is that I usually just read review books during rounds since I could barely hear the person presenting and since I don’t learn well from audio material. But that whole point of rounds is that you are supposed to be learning from them, so I do feel like some important info feel through the cracks, but I’m not sure how to maximize my learning from rounds.

Today is my day off so I plan to catch up on all the studying I have missed.

So it is 5:40am and I am almost done with my 32 hour shift of being on call. To be honest I know that I have it easier than the 3rd years did last year because I actually got 5 hours of sleep last night. Last year the 3rd years got 0-2 hrs of sleep when they were on call but I guess there are more teams now so the load isn’t as terrible. And to be honest I really can’t complain. This morning I ran into a fellow 3rd year who was on her surgery rotation and she had gotten exactly 5 min. of sleep last night because they were in back to back stab wound cases all night. I honestly felt envious because her cases sounded so much interesting and exciting and at least she has a real reason for losing sleep.

So I had some interesting patients. I had a 24yr old black male who 1 month ago suddenly became paralyzed on his whole right side. Neurology did like 6 MRIs and a lumbar puncture and they found nothing. They did however treat him with steroids which improved his paralysis some. So basically presented again with worsening symptoms to the ed so we had to admit him. He really is a mystery diagnosis so I hope the neurologists can figure it out.

I got the chance to pray with one of my patients who was bleeding seriously from a GI ulcer. I’ve been praying for the insight to see which ones of my patients I should offer prayer to and God has certainly been helping me. Speaking of religion, it really sucks being on call during the sabbath (sunset friday to sunset saturday). Last night I started studying after we had admitted all of our patients from the ED and i honestly forgot it was the sabbath. The week just feels like one big day when you are in the hospital.

Things might be looking up on the research and publication front so I’ll keep my fingers crossed.

So today I decided to be a little spontaneous and wear a bowtie with my dress up clothes to the hospital today. I got way more attention that I hoped to get; so much so that once we finished rounds the attending spent the last 15 min. talking to the whole group about how he is also a bowtie guy, and how he thinks I should get the bowties from Europe instead of the pre-tied ones from online, and how he would break his out his bowties but he doesn’t think the hospital is ready yet. Lol, I tell you the funniest part about being a 3rd year are the weird people you meet.

So if you live in southern California you would have heard about the massive prison riot today that occured in many of the jails. Almost 1200 people were involved and it mainly consisted of the Mexicans jumping the Blacks. Of course the Mexicans outnumber the blacks in this area so many of the patients that were rushed to the ED at the County Hospital I’m rotating at were black. It was kind of sad too; there was this Asian prisoner who was slightly darker than most Asians and he was mistaken for a black person and beaten up too. Just another day at the county hospital.

So this past Friday marked my last day on the first of three sections in my Internal Medicine rotation. I really am glad that I started off the way I did because I basically didn’t have to interact with residents; it was just me and the attending. This really allowed the attending to teach me one on one and I got to see what Outpatient internal medicine was like without the evil influence of mean residents that don’t teach and Q4 call schedules. My next rotation is at the  County Hospital and I am really excited. That hospital is notorious for giving you the best training not because there are better attendings, but because they are so understaffed that you take on a lot more responsibility than what you would have at the main LLU medical center. I was told that you almost really act as a intern of Internal Medicine which is pretty cool. I know that there will be sucky parts to the experience, but I’ve already seen that Internal Medicine can be fun, so I will take the good with the bad.

So far I can’t say that I want to change my future specialty to Internal Medicine, but from my experiences this past month, I definitely don’t mind the specialty at all. I really like the ability to sit down and talk with my patients and get into their world a little bit, and I like the intellectual challenges of working through their extensive history and figuring out what is wrong with them, and even more (what seperates us from nurses) how to manage their care. With all that said, I do believe that I can experience medicine in other fields too, so I am going to go into all the other specialties with a truly open mind.

My wife and I are both going to be at the County Hospital and our call days are back to back. So lets say that she was on call on Monday…we would both get to the hospital on Monday morning around 5:45 a.m. to pre-round like regular. I would then leave probably by about 7:00 p.m. that day, while my wife would not leave the hospital till around 11:00 a.m. on Tuesday. On Tuesday though, I would be coming in at 5:45 a.m. again to pre-round and staying until 11:00 a.m. on Wednesday. So there will kind of be a nice little span where we may not see each other. I don’t forsee this causing any terrible problems, but we really haven’t gone that long without seeing each other since we have been married so it will certainly be a new experience.

I tell you something is really wrong with me. When I was at the NMA conference is saw that most of the doctors and especially most of the general surgeons had blackberries. That fact combined with my fickle cellphone nature led me to get a blackberry bold. Lol I know that I have a cell phone problem but at least its better than drugs or alcohol :-).

So the upside of all this is that blackberries have a pretty cool WordPress blog application so I should be able to blog more about my day from my phone.

I tell you it is amazing what peer pressure can make you do :-).

So on Sunday I was at the National Medical Association (NMA) meeting in Las Vegas. The NMA was formed many years back when the AMA wasn’t allowing blacks doctors to join their group. It was truly amazing to see just a sea of black doctors roaming around greeting each other, laughing, and reminiscing about old times. It seemed like 85% of the doctors their either went to medical school at once of the HBCU medical schools or did their residency training at the HBCU medical school. Going to a majority medical school kind of made me feel left out but I quickly got over that and pursued the immense networking opportunity that was before me. I got a chance to talk to a bunch of surgeons who were chairs of their departments and they told me that the main weakness I had in my CV was a lack of research. So for this year getting on a research project is my main goal.

Unfortunately I had to fly back late Sunday night to continue my 3rd year rotations so I didn’t get a chance to meet everyone. However, back at the clinic today I actually discovered a midsystolic murmur in my patient that no one had heard before…it made me feel pretty jazzed for the rest of the day.

So right now i am on my Internal Medicine rotation and overall it is very chill right now. Basically I go in to the doctor’s office at 8 a.m. and I see patients until 12 noon. Then I go for lunch and in the afternoon to medical specialty clinics.  Like on Monday, after lunch, I was sent to work in a Gastroenterologist’s office and my experience was pretty great. Since I am only there for about 4 hours, I usually don’t get to see patients myself, but it is still good to see what a medical specialist does. In the Gastroenterologist’s office we basically saw patients who had chronic diarrhea and abdominal pain. What I enjoyed about it is that we had to really visualize and think about the anatomy of the abdomen. Learning the anatomy of the abdomen was one of my favorite activities during my 1st year of medical school.

On Tuesday, I flipped the switched and went into the GI Lab where they employ 8 foot long scopes to visualize people’s stomach, small intestines and colon. Getting to be a GI doc is really really hard; first you have to match into Internal Medicine which counts me out anyway because I couldn’t deal 3 years of Eternal rounding. But to get into a GI fellowship you have to basically kill of all your boards while in residency and you have to have extensive research with a well known GI doc. Even then there just aren’t enough spots so you may not make it in. But once you finish your fellowship the money truly starts to flow and if you sell your soul and decide to just screen colons all day for cancer you could rake in almost $1,000,000/year. Aside from how well it pays, seeing the procedures was actually pretty cool partly because I like the abdomen anatomy. The coolest procedure I saw was in a girl with Down’s Syndrome who had a pyloric stricture causing her food to sit in her stomach for very long periods of time So basically they fed a very long scope down her throat and into her stomach. Then they had to twist and turn the tip of the scope until they found the stricture in the pylorus. Once they found it they shoved the scope into the stricture and then fed a balloon down the scope into the middle of the stricture. From there they filled the balloon up with water or saline which stretched the  stricture open (and caused alot of bleeding but that was normal). After they were done the stricture was definitely better and they would have to repeat it in a couple of weeks to stretch it to a more respectable size. If you have a medicine mindset but you really like procedures I could see how GI would entice you. I enjoyed watching but I think I would need to do more than scopes all of my life in order to enjoy it.

Lately I have really been trying to decide whether Orthopedics is really for me so last night from 6 p.m. to midnight I went on call with the team. I was with a PGY-2 resident and a 4th year medical students on his Sub-I. I had the option of watching a surgery but I really wanted to see what their life was like and man was it busy. They just kept getting hammered with consults from the ED all night. And I realized what makes a student on his sub-I a rockstar; if you can take care of the consults it makes your resident’s life 10x better and they will evaluate you very positively. I got the chance to put on a split and before I went home I did one consult myself. Overall I enjoyed my experience although I’m still not sure whether I enjoy just managing my patient’s bone problems or also their AST/ALT levels or their K+ levels. When I wrote these lab values on my consult my resident told me that they were bone docs, and if the lab or scan is not directly connected to the bone then you should not include it; he said that for that stuff they would just consult to the Internal Medicine guys.

About 5 people in my class had to get pulled off of the wards because they failed Step I. I honestly feel so bad for them because I know it has to be a terrible experience. Besides that though the Dean’s Office said that our class average was quite high so that is promising. This weekend I am going to the National Medical Association conference because there is a submeeting where a bunch of prominent minority orthopods meet. I really want to start making connections and the meeting is in Vegas, so I decided to go. I’ll see how everything turns out.

Getting my Step I score and then talking to my fellow classmates reminded me about an important concept called CONTENTMENT. I mean when I saw my score I was absolutely ecstatic, just jumping off the walls because it was much higher than I thought it would be…I just knew I had been blessed by God. But as I talked to my friends who had gotten 254s and 268 my score started to lose it luster…which is stupid. You have to remember that someone will always score higher than you; being happy with what you have been given is an important principle that should carry into every aspect of your life. The book of Ecclesiastes in the Bible says, “Better one handful with tranquility than two handfuls with toil and chasing after the wind.” There will always be something better or something more but once we become content with what God has blessed US with we won’t worry about others. So trust me I am still happy with my score and when I hear how some of my friends did tremendously better I am truly happy for them and excited for THEM. Okay, I can’t think of anything else to write but I just wanted to throw that out there.

So I’ve finally calmed down about recieving my Step I score and all I can say is Thank you Jesus! Honestly, when I walked out of that stupid test I felt like I scored a 200 or a 217 because it seemed like I was guessing for many of the questions but it definitely worked out. It was funny because everyone actually thought that the scores would be out my midnight (Eastern Time) of the 15th, so when that time came the NBME site actually crashed because everyone was trying to log on, lol. When that turned out to be a big disappointment I went to bed not knowing when I would know how I did. At 8 a.m. n the 15th we have Grand Rounds which is basically a lecture made by some important person on some medical topic to almost everyone involved in Internal Medicine including the attendings, residents, medical students, and nurses. About 5 minutes into the lelcture I started to get really bored and I whipped out my iPhone to surf the internet, including StudentDoctor.net (SDN). When  I was on SDN I started to read reports of students saying that they got their Step 1 score so I hastiely started to check my score by logging onto the NBME site. When I tell you my heart was beating, it was truly truly truly about to rip through my ribcage and fly out of my chest as I was logging on. When I logged on I had to scroll down to the bottom of the page to see my scores and as I did my eyes started to bulge because I just couldn’t believe the score I was seeing. Some of my classmates saw the look on my face and asked me what happened. I mouthed to them that the Step I scores were up and all of them started to whip out their iPhones and BlackBerries and started to check their scores. Those that couldn’t access it on their phone acted like they had to use the bathroom but they really ran home to log onto their computer, lol. Either way it was a pretty great experience.

The score I got doesn’t guarantee my a spot in an residency…what it does is that it guarantees that at least I will get an interviewee which gets my foot in the door. Once I get an interview I believe that I can sell myself. The score I got is way above the average for general surgery and above the overage for orthopedic surgery. I still think that I am interested in these fields but to be honest I am not hating Internal Medicine either, so we will just have to see. Below is a little write up I made on how I studied for the test. If you want to see other people’s study plans then check out this thread http://forums.studentdoctor.net/showthread.php?t=589961 :

My study plan was basically to use UsmleWorld as a study tool. So starting from the beginning of the school year, as my school was going through the different systems (cardio, neuro, etc.), I would be reading that section in First Aid and then doing all the questions on Cardio, or Neuro, etc. in UsmleWorld. I only did questions on tutor mode and whatever I didn’t know and wasn’t in First Aid, or that was explained better on World, I would type up and put in my unbound..3-hole punched copy of First Aid. The following are the list of resources that I used to study:

Question Bank: UsmleWorld QBank (only on tutor mode)
Microbiology: Medical Microbiology Made Ridiculously Simple, UWorld Micro questions, First Aid Micro section
Biochemistry: First Aid Biochemistry section, UWorld Biochem questions
Pathology: First Aid (the whole book), BRS Pathology, UWorld Path Questions
Pharmacology: First Aid (the whole book), UWorld Pharm questions
Everything Else: First Aid and UWorld questions

As you can see I didn’t really stray away and use a bunch of different resources. For my personality and study style I felt it was better for me to read First Aid 4x over than to read 5 different books once. Now I think what worked best for me was that I was basically using all of these study resources since about the 3rd month into 2nd year. I really wanted to learn it slowly and not cram it all in at the end. Also, I wanted to learn all of the information as it was also being taught in class.

So overall I didn’t really have a set schedule but basically if we were on our Renal section in class then I would read about everything renal in First Aid. Then I would make tests in UsmleWorld that were only based on the Renal system. I would do each test on tutor mode, and whether I got it right or wrong, I would read the explanation and then type whatever knowledge I was lacking into a Microsoft Word document that was open. (This requires you to either have two monitors OR to run UsmleWorld inside of a virtualization software like VMWare Fusion so that your Mac or PC can’t detect when you take a screen shot of the information. I only took screen shots if I wanted to transfer a picture or graph from the UWorld explanation into my notes. If it was text then I just typed it up). This overall plan basically continued until I had finished all of the UsmleWorld questions (yeah all 2,035 of them) and read all of First Aid once. After that I basically read First Aid over and over as many times as I could ( which turned out to be only 2 more times) and I also took practice tests. Ideally, I would have wanted to get the UsmleRx Qbank and do their questions since it is based solely on First Aid material and it would help me learn First Aid better, but I ran out of time.

My upperclassmen mentor basically told me that the more stuff you read besides First Aid the less you know the facts inside First Aid. I really took this advice to heart and tried to know the stuff in First Aid. As you have probably noticed, I didn’t read RR Pathology at all; not because it isn’t a great book, but because it would have taken too much time to read it for me…time that was better spent reading First Aid and doing UWorld questions. I honestly think that 85% of the test is in First Aid and UsmleWorld. That other 15% you would probably get wrong anyway, lol, so don’t worry about it.

Here are my practice and real scores:

SAT: 1170 (out of 1600)
MCAT: 27N
NBME free 150= 242 (from medfriends estimate)
UsmleWorld Sim Test 1= 245
Comprehensive Basic Science Exam: 245-250
Real thing: Greater than a 240 (which is all that matters to me)

Honestly after I took the test I felt like I got somewhere in the 215s or the 220s. But everyone feels like crap after they take it. Don’t trust your feelings…trust your practice exam scores. Also, realize that medical school is a new game so don’t worry if you got a low MCAT score; you can more than make up for it on Step I (as you can see in my example). Also remember that each person does what works best for them. Read all of the posts in this thread and glean the study tips that best work for you. Taus’ plan is great but it may not work for you so pick and choose because in the end it will be you that will be sitting down for 7 hours and taking the test so you have to do what is best for you. My study plan fit my studying style (never going to lecture and just studying at home); for others it may be different. Also if you are a spiritual person, never forget God in the process; He can certainly fill in any inadequacies that you may have. I’m glad it is over and I’m glad that I can look forward to having options for residency. One hurdle down, one thousand more to go

I got my Step 1 score!!!!!!!!!!! I’m in the 240+ range and I am so happy!!!!!!!!!!!!!!!!!! The Lord is so amazingly good….I really am just so humbled and speechless. I’ll write a little more when I calm down.

So this week was my first week of 3rd year and so far I really love almost all aspects of it. I actually started off on outpatient (meaning not in the hospital and more so in a doctor’s office setting) for Internal Medicine so right now I am pulling 9-5p days with my weekends being free. I really have a great attending who really does enjoy his patients and who enjoys teaching students. Everyday he will take time to go through an important topic that I will probably face on this service like hypertension, diabetes, or cancer. He also gives me a fair amount of autonomy; he will go and see a patient in room 2 and give me the chart for room 1, telling me to present the patient to him once I am done seeing the patient. I am really not all that bad at interviewing patients verbally, but when it comes to writing everything down in an organized fashion on the progress note sheet I really had a hard time. But the great thing about 3rd year is that with practice you will eventually get better at it,and by the time this week was over my progress notes were definitely 10x better. I appreciate my attending also because he encourages me to think about the Assessment and Plan of my progress note. As a medical student it is very easy to get complacent and work up the patient via their history and their physical exam, but leaving the diagnosis and management to the attending or resident. What we often forget though is that in 2 years will be looked to for answers on what our patients have and how to treat it. So it makes sense to start the process as soon as possible even if what we write down is completely wrong…at least we are thinking about it.

In my first week as a 3rd year I have really seen how someone could fall in love with primary care. Personally I don’t feel like I am primary care person but certain aspects of it can really reel you in; I really love the fact that your patients consider you to be THEIR doctor in a very personal way. I realized this first hand because my attending is actually leaving soon to do a fellowship in another state and as each one of his patients learned that he was leaving they were expressing how much they would miss him, and exclaiming how it would be so hard to find another doctor as good as him, but how happy they were for him that he was moving on to a higher step in his career. I could also see the slight sadness in my attending who was excited to be advancing his career but who would miss HIS patients tremendously. Having patient-doctor relationships like that can really keep you going from day to day. I have really enjoyed walking into each room, introducing myself, and just sitting down and talking with my patients. Of course I talk about what is going on with them medically, but with some patients (especially the older ones) we talk about their hobbies, their children, funny stories, etc. I really do feel torn at times because my personality equally loves talking with patients and getting to know them, but I also love surgery and the tangible results you get from it…so yeah I’m not set on what I want to do quite yet.

I actually got some nice feedback today from 2 of my patients. I had seen each one and then left the room to present the patient to my attending. Then the attending and I went into the rooms and and he worked each patient up based on what I had discovered and based on what I had forgotten to do. What I like about my attending is that each time he walks into the room with me (after I have examined the patient first) he will greet the patient and then say, “So you have met my student physician, DoctaJay”. And today each patient exclaimed how much they enjoyed talking with me and how nice I was. And then one patient as they were leaving the room once my attending finished with them told my attending, “Keep him around (pointing to me), because he’s good.” I do not at all say this to toot my own horn; these comments from patients are the most gratifying thing I have experienced. You know its like all these years I have worked and studied to get to this point, and the positive affirmation from patients definitely makes it all worthwhile. Now of course some days my patients my not like me as much but I will definitely strive to remember the positive ones more.

One thing that they don’t tell you about 3rd year is that you really have to study almost as much as you did during your 1st year of medical school. Of course you are at the hospital or the clinic for most of the day and afternoon, but at the end of your rotation you have a shelf exam, and you need to be reading and studying every day to prepare for that exam or else you will repeat the rotation. Its been hard this first week to get into the habit of studying when I get home because the type of tired I am is different from tired I was last year. Last year I was tired from sitting in my chair all day and reading the myriads of books and notes. This year though I am tired from being on my feet all day and thinking about my patients; then when I come home, I’m expected to sit in my chair and study for as long as I can. I’m slowly getting a system down but it is still a little challenging. I’m actually very happy that I started off my Internal Medicine rotation in the clinic because I do come home at 5 p.m. My classmates who started off in the hospital for internal medicine only have 4 days off for the whole month which means that they are often at the hospital very early in the morning on weekends. I will be on that type of rotation next month but I am definitely enjoying my relative freedom now. It has been especially hard for my classmates who have kids because most of them just studied at home for the past 2 years. This is the first time that they are going almost 30 hours without seeing their wife or kids and it has been taking a toll on them. Medicine is a sacrifice and for some people, certain specialties just are not worth the time that they are away from their family.

Anyway, life is good; 3rd year is already looking to be like 400x better than 2nd year and I am really looking forward to seeing more patients on Monday.

From reading my last post it may seem like I went straight from finishing Step I to my 3rd year orientation but that isn’t the case at all. I bought a video game and played it til I beat it…I went to the beach and burned my notes from the first 2 years…I went out to a bunch of restaurants…I didn’t study. The combination of all those thing really helped me to rest. This past Monday marked our first day of orientation and overall the whole week has been pretty informative and boring.

My orientation week went like this:

MONDAY: The Dean of Career Advisement spoke to us about…our future careers and what we need to do in order to make sure that we match into our desired specialties. The information was pretty much a repeat of what you could have found out by reading the threads at the Student Doctor Network, but surprisingly a lot of my classmates don’t do this so I’m sure it was helpful to them. After that we had a long lecture on smoking cessation which I think is mandated by the government. After that we had our PPD test (test for tuberculosis) and then we were free.

TUESDAY: The Deans came back and informed us about what it took to pass each rotation our 3rd year, what would happen if we found out that we failed Step 1, what to do if we experienced sexual harassment, etc. After that I had to go to a mask fitting session (also mandated by many hospitals) where they fit me for a special mask that I would need to wear when I was around patients with serious airborne diseases. Also the coolest thing ever happened…I got my official hospital 2-way pager:

Most resident physicians hate these things because a new page usually means more work for them, but for the medical students it allows us to text message our fellow medstudent friends and do some work every now and then, lol. Also, when it goes off it makes you look important…whatever that means.

WEDNESDAY: The Deans of the school wrapped up our orientation and we had our arms examined to see whether we are positive for TB or not. Later that afternoon I had to go to the Loma Linda VA Hospital where they took us through a training session on how to use to computer system, how to log onto the system and access patient data, and how to search for important patient info. We also got our log-in information for the Loma Linda University Hospital today which was pretty cool too; I was excited about getting the log in information because for my first 2 years, whenever I would be in the hospital, I would already feel useless since I didn’t know much, and that feeling would get even worse when a busy resident would ask me to find some info quick on the computer and I couldn’t do it because I didn’t have log-in information yet.

THURSDAY: Today was called Ethics Day, where for reasons that still none of my classmates can understand the school decided to subject us to lectures on different ethics subjects from 9:00 a.m. to bloody 5:00 p.m.!!!! Never in my life had I been in lecture for that much time; I mean some of the information was useful like how to do deal with Jehovah’s Witnesses preventing their children from having life-saving blood transfusions or how to do deal patients wanting to discontinue their vent, but overall it seems like we could have gotten a 2 hour condensed version instead. Anyways, the only good thing that came out of this day was what you see below…MY NEW EMBROIDERED WHITE COAT!!!:

The white coats that we got at our white coat ceremony 2 years ago was just plain white and it had a button that had my name on it. These new coats still make us stand out because they are short but at least they look a little nicer. So with orientation done now, I am looking forward to starting my first rotation tomorrow. My wife and I both start off on Internal Medicine at the clinic; I’ve talked with a couple of 4th year medical students and they have recommended that I read Step-Up Medicine and that I carry Pocket Medicine in my white coat. I have a PDA loaded with UptoDate, Pocket Medicine, Tarascon Pharmacopia, Sanford’s Antimicrobial Guide, and Mobile DDx, so hopefully I should be covered for Internal Medicine.

My biggest fears about starting on Monday are that my book smartness may not translate into amazing bedside manners. I really desire for my patients to feel comfortable around me and at ease, but I also want to be able to treat them in the most efficient manner instilling confidence in them that they will eventually get better because of the care they are receiving. I guess I just want to be a well rounded and complete doctor who isn’t just good at surgery, or making the diagnosis, or making my patient laugh, but all of the above. We will see how it all goes.

So I took Step 1 yesterday and that test was truly challenging. I’m not sure how I did, but I’m praying in faith that it matches my practice test scores. I got my CBSE in and it predicted between a 245 and 250, which is still quite unbelievable to me, but whatever. I won’t find out my scores until July 15, so I’ll be praying until then.

So I’ve taken a couple of practice tests and the scores coming back are unbelievable to me, but I’m trusting that God actually makes these things reality. UsmleWorld offers 2 simulation tests (4 hours, 192 questions each) that are supposed to hopefully be harder than Step 1. I took the first one and they predicted that my score would be a 242. I was totally shocked by the number because it is vastly higher than I expected to get, especially since I felt like crap during the test because it was so hard. I thought that test was a fluke, so I took the free 150 questions that come straight from the NBME and I got 83%. If you plug that into an unofficial score calculator at http://www.medfriends.org/step1_estimator/, it estimated that my score would be a 245, which once again is vastly higher than I expected. I don’t know…if all this works out I will feel so stupid for fretting and lacking faith in what God can do.

Anyway, I take the test on Monday and right now it seems pretty stupid to study crazy hard since not much else will stick. I plan to go through the pictures and the high yield facts in the back of First Aid and kind of call it a day.

P.S.-interestingly enough, that site (medfriends.com) told me that if I used my MCAT score alone as a predictor of my Step 1 score, that my score would be a 226.

I must admit that studying is pretty hard these days. I know I need to hit it hard, but my brain keeps feeling overloaded. I break for 10 minutes, and then can only study for 15 minutes before I need another break. Honestly I feel like I’m just about maxed out…I can’t wait until I take this test and have a little vacation.

After any serious battle or tribulation, you must treat yourself. I have already preordered my treat, and it is set to arrive on June 19th:

Yeah baby!!!

The picture says it all:

It feels so good to be done. Now I plan to really try to go over all the section in First Aid that I feel weak in. Only a couple more days left.

I am so freaking sick of this Step 1 study crap already that I can’t even find educated words to describe it. Although I only have about 98 questions left out of the 2,035 Step 1 Prep questions from USMLE World, I am starting to feel more and more demoralized by the difficulty of these questions. I’m getting more right than wrong but at times I truly feel like I’ve learned nothing in my 2 years. I just feel like once again I’m gong to do just average on this test like I did on the SAT and the MCAT. For once I would like my hard work that I put into the first 2 years to actually manifest on a standardized exam. Okay, my rant is over.

So today I took the Comprehensive Basic Science Examination (CBSE) that basically every medical school in the U.S. gives their students. The CBSE is supposed to test and evaluate how well you know all the basic science you should have learned in your first 2 years of medical school. So in essence, the CBSE is almost like a pre-Step 1 test, and many have said that you tend to score within 5 points of your CBSE score. The test actually wasn’t too bad except for the fact that every since question was expansive and wordy with unneeded lab values. The test was 4 grueling hours and 200 questions long; I finished with barely any time to spare and now I have to wait about a week to get my scores back. The funny part is that I take Step 1 on the 15th, so I may not even get my CBSE scores back in time to see whether I need to push back my Step 1 date. If I do receive t before I take Step 1, I may not even look at it, because if it is low, it may depress me and cause me to jinx myself on the real deal.

At times I feel at peace about Step 1, and other times I have freak out sessions. Like today, I completely destroyed the Microbiology Subject Exam, but my Pathology Subject Exam was average. They say Pathology makes up most of Step 1, so I started to freak out, thinking that I need to push back my Step 1 date and really get on top of Pathology. After 1/2 hours of freaking out I decided to actually start trusting in God again; trusting that He will do what He has always done for me and my wife. Its so much easier said than done but I think right now that it is the only thing that will keep me sane. Anyways, I will surely enjoy my Sabbath, and then as soon as sun sets tomorrow night, I plan to hit it again, non-stop until June 15th!

So this past Tuesday marked the last test that I was required to take by my school…so I’M DONE!!! Last night I went to sleep without setting an alarm, which I havne’t don’t for the past month or so. It felt so good just to sleep; of course I still have Step 1 coming in about 11 days, but at least all the school required stuff is over. I honestly wouldn’t wish this year on anyway. 2nd year is so much more interesting than 1st year, but it takes so much more out of you. But I can honestly say that I am at peace with Step 1; I’m not sure whether I will do well or not, but I know that is is God’s hands. I’m just going to put in the work and see what results come back. Anyways, I’m tired now.

I woke up this morning not happy. We still have classes here at LLU and I have about 27 days until Step 1. I have finals starting this week and I’m stressed, tired, and truly sick of all of this. I know I should be grateful and glad for the opportunity to be in medical school; I know I should see this experience as an opportunity but right now it is just a source of unhappiness. I know 3rd year will have its share of unhappiness, but nothing can be this terrible. The stress seems almost insurmountable at times. I don’t know……

So at the time of my writing this post I have exactly 1 month 3 hours and 5 minutes until I take Step 1. During this time it is impossible to talk to any second yr. medical student that doesn’t have this test on their mind for a good part of the day. There is just an amazing amount of information that you are responsible for, and the NBME can pull a question from anywhere; and God forbid if your school has a subject that generally sucks in terms of quality of teaching because that makes it all the harder to get a grasp on the subject (and trust me, every medical school has one of those subjects). So you days are left with paraoxymal anxiety, optimism that everything will work out, despair over why you even decided to attend medical school, happiness that 3rd year is approaching, and sadness that Step 1 must occur before 3rd year can start.

Through all of this it is quite easy to forget where God has a hand in all of this. I can absolutely say, without a doubt that my wife and I are both in medical school together only through a miracle. We had some serious obstacles to both getting in and the Lord cleared those away. When I was a senior in college and I saw the seemingly insurmoutable challenges we had to getting into medical school I lost faith in His ability to work things out more than I’d like to admit. And when we finally saw everything fall into place we just knew that it was God, and our faith was strengthened. Now both me and my wife face a seemingly insurmountable obstacle called Step 1, and it is so hard to remember that the same God that got us through our previous challenges can get us through this one. It’s easier said than done, but I want to truly not fret about this test anymore. I’m going to do my best and know that my best will get me where God would have me to be.

I’m typing this currently from my blackberry so forgive me if there are spelling errors.

When I started college the preident’s wife, Dr. Baker told all of the freshman to start strong because it is much easier to maintain a high GPA than to increase a low GPA. I took her advice seriously and did very well my freshman year which was very good because when senior year hit and I didn’t feel like doing my school work my high GPA buffered my senioritis. Well I think that advice definitly applies in medical school. By the time you come to the end of your 2nd year you have studied more than you studied for the 4 years of college so technically the senioritis comes back. However I really started strong my 1st year and 2nd year so thankfully my current contempt for studying pathophys may not hurt me too much. I am jsut truly tired of the grind right and preparing for step 1 and finals is just more stressful. So I’ve decided that I don’t care about my finals that don’t directly apply to step 1. And by not caring I mean that I don’t plan to study hard for it. Now if I was on the brink of failing a class then this strategy would be much more difficult. So yes my class rank may drop a bit or a lot but I’d be much more happy with a good step 1 score. So my advice to premeds who are about to start med school is START STRONG so you can rest later.

So yesterday about 3 hours of my night was taking up in a mandatory CPR class. I’m actually glad that I took it because before this if someone collapsed in front of me I would have had no idea what to do. Now if someone collapses in front of me, I probably still won’t know what to do immediately, but eventually I’ll get around to it.

Well it is is 1:30 a.m. and I just woke up. I went to be around 8 p.m. last night and my body decided it had had enough sleep. I don’t mind though because I have tests next week that I am not ready for. I made the mistake (or maybe not) of studying so much for Step 1 that I neglected to spend much time on my current coursework. Hopefully I can make up for it by studying all day. This is my last normal test week of medical school!!! After this is finals and then Step 1 and then 3rd year!