New Interns

The new interns have been working since July 1.  It’s crazy to think that just 2 years ago I was “one of them.”  They come in so excited to work and ready to learn everything.  I have really enjoyed working with our interns over the past 3 months.  As you could probably tell from my paucity of posts over the past year, 2nd year was RoUGh!!!  I was pulled in so many directions.  New responsibilities, but none of the “you’re new” attention or forgiveness.  It was perfect timing for the new interns to come and rejuvenate me and my excitement for this field and residency.

Thus far I’ve worked closely with some the new interns in both the OB and the GYN disciplines.  I was nervous about what type of basic science questions they would be asking due to recent graduation from medical school.  However, those fears were quickly alleviated.  I had no clue how much practical and clinical information I have absorbed over the past 2 years.  I love that I am able to share my own developing style with the new interns.  I realize how much I love teaching.  It is great to review topics and they have well informed questions.  It is such a different type of learning compared to medical students.

That being said, it is a little bit stressful to oversee the interns.  Because they are doctors now and have new-found responsibility, they try very hard to remain autonomous.  I have the responsibility of overseeing their actions, without necessarily micromanaging and hovering over them.  I have a bit of a “trust no-one attitude” and have a healthy sense of fear about relinquishing responsibility.  It’s a fine balance!  If they miss something, ultimately it is up to me to be watching over them and point it out.  I don’t ever make them feel that any question is a stupid question so that they keep me in the loop when questions come up instead of making decisions and mistakes that could be costly, so to speak.  It also allows me the chance to teach them how to be more efficient, while I work on being efficient in overseeing their work and my work.

Hopefully this is great preparation to be a great attending one day!

Mentorship in Residency

Last night our “class mentor” had my residency class over for our quarterly dinner.  He has been hosting these dinners since intern year, but they have become more meaningful lately.  It’s amazing to me that I am already 3 months into my THIRD year of residency.  Now the career advice is much less theoretical.  I really have to start making some decisions about the next chapter of my life.

We spent alot of time talking about fellowships.  I think all of my classmates have declared themselves as fellowship-bound versus generalist.  Most of them have begun working on research projects, arranging away rotations and meetings with key people in our department.  I have a project that I have been working on, but I’m not nearly to the point where I can publish.  I feel like I am in limbo right now.  I came into residency really thinking that I wanted to do a Maternal Fetal Medicine fellowship, and now that I have had more exposure, I’m just not so sure anymore.  My formal “personal mentor” is one of our younger MFM attendings and my “research mentor” is an MFM attending.  I love what I am doing, but I equally love doing robotic surgery and laparoscopic surgery and even a nice vaginal surgery case here and there.  It’s hard to accept that by doing a fellowship to become such an expert in one arena, you must sacrifice all of the other areas that originally drew you to the specialty of Ob/Gyn as a whole.

That being said, I plan to continue working with my mentors.  I have begun to talk more and more to my faculty about their careers, personal lives, and how they got there.  This is a unique time in my life where I am able to shape the direction the rest of my career will go.  I want to gather as many opinions as possible from these great mentors that are willing to share their experience.  Hopefully things will become more clear through all of these discussions.  If not, there is always the idea to be a generalist for a while to make up my mind and get my own personal life in order!

Theme Change

I’ve been blogging since December 2008.  I figured it was time to update the look of the blog.  This theme makes the date of each post stand out.  I would find myself having to search to find the date of the post on the old theme.  I thought the contrast on the side bar was easier to read with this theme.  The old one was bright green with white letters, which hurt my eyes after I got to the 3rd twitter update.  The font on this theme is also different.  I think that I can change that if I subscribe to some font website.  Not sure I’ll be making that effort.  Everything else with the blog is pretty much the same.

So, what do you think? Should I stick with the new theme or stick with what was working?

My Future Income

I remember when I started medical school, the Financial Aid Officer continually reassured me that although the student loans were paying for my education now, it was truly “my future income” that was going to allow me to one-day become debt free.  I managed to get a few large sum scholarships ($15,000 here, $10,000 there), yet I still graduated with about $140,000 in debt.  I have only been out of medical school for 2 years and I have already accrued over $20,000 in interest! 

It’s crazy because the rules changed and instead of being able to defer my loans (no interest accrues), I had to forbear my loans (interest accrues).  Of course, these things conveniently changed when I was finishing up medical school.  My school had a meeting for us with a financial planner who recommended at least paying on the interest while in residency so that the principal balance would be the same at the end of residency as it was at the end of medical school.  However, that is much easier said than done…

Since finishing medical school, I just haven’t found the extra cushion to start paying these loans.  I spent about $800 for USMLE Step 3 and it’s $125 a year for my resident training license.  I was planning to wait to pay my Alpha Omega Alpha lifetime dues.  However, once I saw that the lifetime dues increased from $425 at the time of graduation to $750 two years later, I figured I should just dish out the money before it’s $1400 for a lifetime membership!

At this point, I’m just ranting.  I say all of this to say I truly hope with all of the changes in our healthcare system and reimbursement that my future income will set me free… debt free that is. It may be time for me to have a 1-on-1 meeting with those financial planners.

Lessons Learned

Man…  I learned so much through just one patient encounter.  I am not talking about my medical knowledge, but rather about medicine and my own character as a doctor.

1. Attendings (even those with 15 years + experience) don’t always know more than you do.

2. Emergency Department physicians should continue call consults for any and everything, even when it seems “stupid”.

3. Always look at your own radiology images.

4. Trust your gut and don’t be afraid to advocate for your patient.

5. Journal club is important!

After reading that, you are probably wondering what happened. Well, I just finished with surgery and got a phone call from the Emergency Department.  This was one of those, “I just have a quick question, no need for a consult” phone calls.  They simply wanted to know where one of our OB patients needed to follow up.  It was presented that she had light first trimester bleeding with a normal pelvic ultrasound and blood work.  I decided to look up her ultrasound myself and turns out she has a cornual pregnancy! A cornual pregnancy is a pregnancy that is not in the correct spot.  When these things rupture the women can have life threatening hemorrhage.  You can think of it as a BAD ectopic (tubal) pregnancy.  Based on the size of the pregnancy, she was fairly far along to be presenting with the symptoms she was having.

So, I tell the story to my attending who decides the ultrasound looks pretty normal, and that they would send the patient home.  I kept mentioning that the position of the pregnancy was not normal, and they decided to ask the other attending coming on shift to take a look at the images.  The second attending agreed the patient could go home, but that we set up an urgent ultrasound appointment with the high-risk OB doctors the next day.  Now, I found it quite curious that it’s urgent enough to need repeat imaging in 24 hours, but safe enough to go home…  I decided that I would go and see the patient as a formal consult because this was not straight-forward first trimester bleeding, and I’m still convinced that she has a cornual pregnancy.  I examine this woman and she is very tender on examination.  I even went to review the images with the radiologist.  After taking a closer look they agreed that the pregnancy was not in the right position!  I present this information to my attending who still seems very apprehensive about operating on this woman.  Ultimately we did get the specialists involved and operated on this woman.  The surgery went very well since we caught it early.  We were able to offer the appropriate management under a controlled setting.

FYI – Certain details have been changed so as not to violate patient privacy.

Now, to elaborate on the lessons I learned.

1. Attendings (even those with 15 years + experience) don’t always know more than you do. I suppose that once you are away from taking boards, perhaps the more rare diagnoses and their appropriate management can slip away from your memory.  I basically had to remind two different attendings that the management for a cornual pregnancy is not outpatient management.  Had we sent her home, she could have ruptured and had a life-threatening hemorrhage.  The thing about being a successful resident is recognizing that it is okay to challenge your attendings, in a respectful manner.  Ultimately, you have to do what’s right for your patients.

2. Emergency Department physicians should continue call consults for any and everything, even when it seems “stupid”. I have to admit, I sometimes get annoyed from the little phone calls from the ED.  I mean if they are calling with a question, then it’s your obligation to look further into the story to make sure that you have all of the information to accurately answer the question. I could have easily given them the phone number for our low-risk clinic with strict bleeding precautions stating that first trimester bleeding is fairly-common.  Luckily I looked up the patient’s information to be sure that I was doing the right thing for the patient.  I’m happy that the ED doctor called me.

3. Always look at your own radiology images. The Radiologist may not be looking for the same things as you when they are looking at their 20th ultrasound of the day.  It’s one of the best lessons I learned in medical school.  I look at my own chest and abdominal x-rays, CT scans, and definitely my own ultrasounds.  Although I may not always get the diagnosis correct I have more of a grasp on what is normal and what is abnormal.  In this case, careful examination of the images caused the radiologist to change their report.

4. Trust your gut and don’t be afraid to advocate for your patient. As I’ve mentioned before, we are doctors because we want to help people.  This woman wasn’t coming in with a diagnosis stamped on her head and a fully detailed plan typed up in her purse.  No, she simply had bleeding and needed help.  It’s up to us to do our part to figure out what is serious and what is not.  When it’s serious, sometimes you have to be the one to convince an attending that more needs to be done.  Unfortunately, the attendings have to worry about litigation (we do too) and often hope to pass the buck to someone else.  That can often occur at the expense of the patient, so don’t be afraid to speak up.  If I had just listened to the first attending, I would have just sent her home and who knows where she would be.

5. Journal club is important! I had never actually seen a cornual pregnancy.  However, last year we had a journal club talking about the management of these types of pregnancies.  I actually really enjoyed the article and remember the take home point was: cornual pregnancies are bad and need surgery.

Hope you can apply these lessons to your own experiences!

CREOGs 2011

I can’t believe that it’s already been a year since my CREOGs 2010 post!  It’s been two weeks since I took this national standardized test that all OB/GYN residents have to take.  This year the test seemed a bit better.  For one, I wasn’t post call like I was during my intern year.  In addition, I have now done at least one rotation in all of the subspecialties that are on the exam.  It’s definitely easier to pick the right answer when you have had patients that required you to read about the subjects on the exam.  I suppose after an additional year of training, I definitely feel more knowledgeable.  The questions were pretty evenly distributed amongst the OB/GYN subspecialties, while also covering primary care/psych concepts.

Now, I should have prefaced this post with the fact that I have not yet received my scores.  A few residents told me that they actually did worse taking their exams second year.  It’s almost like because you know more than you did as an intern, you may overthink the answers and pick the wrong one.  I’ve also been under quite a bit of emotional stress for the past few months, so we shall see if that had any adverse affect on my exam score.  I’m still undecided on this whole fellowship business.  Nonetheless, I hope that I improved just to gauge my own learning.  If I do end up doing fellowship, 3rd year is definitely the year to score well.  I’ll keep you posted!

2010 In Review

Every year on my “blogiversary” December 3, I used to calculate how my blog was doing.  This year, for the new year, the stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Wow.

Crunchy numbers

Featured image

About 3 million people visit the Taj Mahal every year. This blog was viewed about 29,000 times in 2010. If it were the Taj Mahal, it would take about 4 days for that many people to see it.

In 2010, there were 25 new posts, growing the total archive of this blog to 396 posts.

The busiest day of the year was March 1st with 212 views. The most popular post that day was The Name Change Dilemma .

Where did they come from?

The top referring sites in 2010 were medobsession.com, codyreport.com, forums.studentdoctor.net, epmonthly.com, and catesobsessions.blogspot.com.

Some visitors came searching, mostly for med obsession, med obsession blog, perineal repair, medobsession, and dansko.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

The Name Change Dilemma February 2010
7 comments

2

 

Ob/Gyn Interviews October 2008
3 comments

3

 

About Me December 2006
2 comments

4

 

USMLE Books & Advice June 2007
4 comments

5

 

Boards Books May 2007
2 comments

One of the things that I noticed is that my most popular posts were ones written well before 2010.  I’m going to try to go back to some of those topics and help you all out with your journey through medical school and residency.  THANK YOU AND PLEASE KEEP READING!!!

Happy New Year

01.01.2011.  5 words: This year will be better.

Painful News

Last night I had a pretty horrible experience.  I was called down to the Emergency Department to see a patient that was only 4 months along and thought that she broke her water.  I ask the ED physician what the patient’s name is and it sounds very familiar.  I couldn’t quite put my finger on why I would know this woman’s name.  I thought maybe she was a medical student or someone that I had seen recently.  I walk into the room and I recognize that she is a patient that I had seen just 2 days prior in clinic.  In her clinic visit I could tell that she was very nervous about pregnancy in general.  I reassured her that everything would be okay and that she was going to have a healthy pregnancy.  I gave her hope that she was going to have a healthy baby.  There were no red flags for her to be worried like she was.

Here it is just 2 days later and she has broken her water.  Her baby is not far enough along to survive outside of her body.  I had to tell this woman that she does not have a healthy pregnancy.  She is not going to have a healthy baby.  After her exam, I broke the news that she had broken her water.  They saw it in my eyes before I said anything.  She started sobbing.  I sat there on her bed and held her arm.  After several minutes of talking and answering questions and letting her know it wasn’t her fault, I started to stand up.  She starts sobbing, “Help me doctor.  Please.  Please, help me.”  I sat back down with her with tears welling up in my eyes.  There is no help that I could offer her.  Well, not the help that she was looking for.  She kept asking for me to save her baby.   I was in shock as well.  She needed my help and I could not offer her the answers that she wanted.  I suppose her husband had to be strong for me too.  He kept saying, “It’s okay doctor.  You can leave her.  It’s okay.”  How do you walk away from that.  I just wanted to hold her arm and cry with her.

Eventually I did stand up.  Damn, that was painful for me and it’s not even my burden.  I asked the hospital pastor to speak to them.  I pray that she and her husband will recover.

My First Married Holiday

This is my first year as a married woman.  In the year’s past my husband (well at the time he was my fiance and boyfriend) has come to my home either on Christmas Day or the days surrounding the holiday.  This year I will be spending my first Christmas away from home.  I suppose I have mixed feelings about it.  On the one hand I am sad that I will not see my parents, siblings, aunts, uncles, cousins, grandparents and great aunt.  I have only seen Christmas done 1 way for the last 25 years, and that’s a comforting, familiar memory.

That being said, this year has already brought new memories and traditions to our newlywed household.  We bought our first tree.  It was nice picking out a tree that we were both excited about.  We jointly placed the lights and the ornaments together.  It’s been fun watching new gifts pop up under the tree as we wrap gifts for each other and for our families.  We bought new stockings and cute stocking holders for the home as well.  Another thing that we have enjoyed is receiving those photo cards from everyone.  This year we were able to make our own using some of our wedding portraits!  I’m looking forward to dinner with his family.  He has a large extended family like I do, so I know that there will be plenty of holiday cheer to spread!

I hope that you all have a Happy Holiday season!

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