Catch Up June 16, 2009

I only have 8 days left until I’m officially an intern!! I’ve been “borrowing” someone’s wireless signal until my cable/internet guy shows up…

Anyways, these past few weeks since I’ve posted have been jam-packed.  You know how it can be painful to play “catch up” with a friend you haven’t talked to in months… I’m going to spare you all the nitty gritty details.  But just like those catch up calls, I’ll just give you the highlights:

- I graduated medical school: yep, I even giggled the first time someone from the hospital called me “Dr.”  I’ve gotten better at it now.

- I went to my home town for a joint graduation party with my lil bro that graduated highschool.  It was so much fun! My favorite food – Mexican, my favorite drinks – margaritas & appletinis, and of course lots of family and friends.  I raked in lots of cash, which will get me through the next month without a paycheck, and allow me to furnish my empty second bedroom!

- While I was home I did TONS of wedding planning in just 2 days: visited 3 reception sites with my mom and fiance, tried on 28 dresses at 3 different bridal salons with my mom and sister, picked out my bridesmaids and their dresses, and bought my wedding gown.

- I was a bridesmaid in one of my close friends’ wedding.  It was beautiful… she set the bar high for my own wedding!  I definitely have to invest in waterproof mascara for my own wedding – my tears were flowing for hers. The wedding means so much when you really know both the bride and groom, and know all the work that went into the relationship and the wedding.

- I met with Employee Health and will be cleared once I get my PPD read.  I’m surprised that I’m able to type given the soreness in my arm from my Tdap shot!

- I met with my GME officer and will be cleared once I do my ACLS and BLS training over the next few days.  It was great because I received my Resident Training License!  I was also pleased to be reminded that my $600 parking will be paid for, along with 3 new white coats (my sis got me one that’s embroidered, so I’ll be wearing that while my other ones are getting embroidered too!).  I’m also ahead of the game – apparently half of the Ob/Gyn interns will be starting a week late because they didn’t get paperwork in on time… I’m pretty shocked considering most Ob/Gyn’s at academic programs are type-A.

Well that’s the last 11 days in a nutshell!  I have ACLS tomorrow and orientation in just a week from tomorrow… getting nervous, but also excited.

Graduation Week May 31, 2009

After 4 years… make that 21 years…. of school, this week will end with the culminating event: the Hippocratic Oath Ceremony!  Yes, I will be Dr. Med Obsession in just 5 days.  Leading up to the event our school has several festivities planned out.  There are several banquets: one for the entire class, another for our affiliated school, along with a separate one for AOA.  There is also a senior send off breakfast the morning of graduation too.  Lastly, there is the graduation and a reception following.

I can’t wait for all of the events!  It’s exciting there are so many events leading up to the big celebration.  After all, it is a pretty big deal.  I guess after attending one of my good friend’s medical school graduations a few weeks ago, I realize just how special it is.  I mean, many of us have dreamed of becoming doctors for several years (myself since age 3), and now the moment is finally here.  I can’t wait for my family and friends to arrive and share this moment with me.  I’ll be checking in with you all throughout the week!

Transition to Internship May 21, 2009

As you may have gathered from my blog, the second half of 4th year is pretty relaxing.  Personally, I finished my all of my requirements for graduation on March 28.  Since then I have not even touched a book… well, except when I was packing them up for my move to my residency city!  So you can imagine, by the time I start internship, a full 3 months will have passed since I’ve been in a hospital treating a patient.  For those of you outside of medicine, that’s a long time.  There’s a reason that vacation time is limited as we started our clinical rotations.  You can get rusty pretty quick if you aren’t thinking about and practicing medicine on a daily basis.

My lovely medical school thought of a remedy for this gap in time, and for internship anxiety.  They offered a one-week “Transition to Internship” course in conjunction with our simulation center.  I am halfway through with the course and couldn’t be happier. Each day starts with 3 lectures, then a lunch break, and finally an afternoon of different simulations. So far we’ve had morning lectures on topics ranging from acute chest pain, dyspnea (shortness of breath), shock, and even a panel from current interns and cheif residents.  In the afternoon we went on to the simulator where each of us had to individually act as the patient’s doctor.  Thus far I’ve had to sort out diagnosing and treating a supraventricular tachycardia (heart beating very fast), a tension pneumothorax (lung collapse under pressure), and septic shock (inadequate blood flow to organs due to an infection).  We also had simulations where patients had problems with ventilator management, and how to place lines (arterial, central, and IV).

Talk about a crash course for internship!  Making some of these diagnoses seems simple enough, but when it’s on a patient simulator and you are watching the patient’s blood pressure tank and desat (oxygen levels drop) in front of you, you have to have a nice differential and begin treating quickly.  With the first few simulations I was pretty nervous and also frustrated on how long it takes to get a chest x-ray or labs back.  On any standardized exam, all of the info you need for a diagnosis presented in a question stem that can be read in 30 seconds or less!  The simulator forced you to use clinical judgement without all of these tests being ready instantly.  It was also funny because our attendings would act as the nurse and sometimes try to steer you wrong.  For example, for my septic shock patient my “nurse” was asking if I wanted to start dobutamine as a pressor for the blood pressure.  This is a case where you wouldn’t want to do that because the patient already has decreased vascular resistance and the drug would make it worse.  I had to tell him to start norepinephrine and the patient did alright!

What this week has showed me is several fold.  Of course, I still have so much to learn.  However, I really have come a long way from my first simulation as a 1st year where I would be afraid to speak up.  Here I was coming up with differential, ordering labs and imaging, and starting appropriate treatment on my own.  I learned when to call for help as well.  If you get to a point where you don’t know the dose… call Pharmacy.  If you are just in over your head, call your senior resident, shoot you may even have to call an attending.  And of course, get other specialties like cardiology or general surgery involved if need be.  I found this course to be invaluable and can’t wait for these next 2 days of class.  I feel a bit more ready to start internship now that my mind has been jogged.  I have to remain confident in my abilities (although not overly so) and be ready to hit the ground running in a month!

GME Update April 30, 2009

Well I got an email this AM that all of my forms were complete with the GME and the Medical Board… except a few minor glitches.  Apparently the photo I sent to certify that I will be graduating this year was too dark and the seal from my school was not visible enough.   I guess I’ll spend tomorrow taking a photo with more light and making sure that my school’s registrar affixes the seal correctly.  The other thing was my National Provider Identifier number.  This was all done online, so I didn’t realize I had to forward a printout of the info to the GME.  Does your program require the NPI?  Lastly was my ACLS and BLS certification.  Although my medical school is offering a course in a few weeks, I opted not to do it quite yet.  They are charging $195 plus $33 for the manuals!  On the other hand, my program only required sending in a deposit to hold my spot, which will be returned during Orientation.  Yep… FREE ACLS and BLS!  I suppose it will make my orientation week that much more packed, but after almost 3 months of vacation, I could use working a little bit.

I’m happy that that checklist is out of my way… still working on the checklists from my own apartment and my future apartment!

Schedule Preview April 27, 2009

Within a few days of finding out where I matched, I got a lengthy email from one of the new Administrative Chief Residents asking about preferred vacation dates and what types of rotations we would like to start with.  Well Match Day was over a month ago and I still hadn’t heard anything about what my schedule would be.

It’s a bit hard to pick out vacation dates a whole year in advance, but I did my best.  Of course, out of nowhere, my cousin who has been engaged for 2 years finally picked a date… AFTER I turned in my vacation requests.  On top of that the wedding will be before the fall!  So, I was hesitant to be one of the those annoying interns overly concerned with days off… but I like to believe that weddings only occur once and really wanted to be there for the wedding.  My email was actually very wel-received!  I was informed that the schedule had indeed already been created and unfortunately I would not be on vaction during that time.  However, I would be on night float, which means weekends off!  Now, I’ll probably be extremely tired going out to the wedding and back, but at least I don’t have to barter with the other interns about covering for me, or take the other alternative my chief offered: night float, OB, and GynOnc all back-to-back!

It’s nice to know for sure when I’ll be on night float, but I can’t wait to see the rest of my schedule!

My Facebook Addiction April 24, 2009

Right around the time that I graduated from college I heard about this site called Facebook.  I had a MySpace page that I used to keep in touch with my lil bro and sis who were in junior high and highschool at the time.  It always creeped me out a bit though with the random messages and friend requests that I would get.  The idea that Facebook was this exclusive site only available to people with .edu email addresses was appealing.  I convinced my boyfriend and best friend to join… actually I created their profiles .  I would get online occasionally and see if I could find old friends from high school, upload the occasional picture and that was about it.

Fast forward 4 years later and I’m hooked!  I log on to facebook at least once a day on my computer, not to mention the several times that I check it from my phone.  I now have 874 photos of me, 2 videos, 1100 “friends”, and countless wall posts.  I mean really… my whole life for the past 4 years has been chronicaled on facebook.  Half the time I’m not even really talking to people.  I’m looking at people’s pictures, confirming or denying friend requests, reading people’s “wall-to-wall” to be a bit nosey, and next thing you know like 3 hours have gone by!

I really hadn’t thought much about my addiction until my boyfriend told me about this recent article in Time magazine: “What Facebook Users Share: Lower Grades.”  While I haven’t had much of a problem doing well in medical school, it could be an issue for me when I have to take my knowledge to the next level in residency.  Who knows, maybe it did affect me in medical school.  Maybe I would have gotten more letters of distinction, maybe I would have gotten junior AOA instead of senior AOA… I’ll never know.  What I do know is that I’ve stood by facebook for quite sometime.  I’ve seen it go from facebook for only .edu emails to facebook for everyone to the new facebook to the new facebook to the new facebook.  I was there before the mini-feed, before the ads, and before privacy settings were so extensive.  Shoot I remember when it was just college people, now my highschool-aged little brother is on there as well as my mom and her uncle.  Practically my entire family tree is on facebook!

In light of realizing that I may be addicted to facebook, and that it may be associated with poorer school performance (haven’t seen the actual study data), and the fact that I’m entering the next stage in my professional career, I’m beginning to wonder if I need to say goodbye to facebook.  I really can’t believe that I even typed those words!  Seriously, whether I completely deactivate the account, or just remove 800 photos, I have to change my facebook habits.  I’ve already set up a few different lists with varying amount of access to my page, along with making me unsearchable on search engines.  I suppose I will have to have a marathon session on facebook (which wouldn’t be a first) and reallocate my “friends” to their appropriate lists in order to be sure it’s as private as possible.  Wish me luck battling this addiction!

What are those of you that are entering residency or new jobs or applying for professional school doing with your Facebook accounts?

On My Way to Licensure April 22, 2009

After tracking down my Dean to get the correctly signed and sealed recommendation form, my packet of information was ready to be sent to my program GME and the state medical board.  I see why we were given a whole month to complete the process!  I had to fill out a 9 page application for my program’s hospital, a 5 page application for the affiliated Veteran’s Administration (VA) hospital, obtain 5 recommendations: 3 for the GME office, 2 for the state Medical Board, document my employment history, document my graduation status, document my liability coverage, get fingerprinted, apply for my state resident training license online, and fill out the appropriate enrollment papers for ACLS, BLS, my employee health clearance, health insurance, dental insurance, vision coverage, life insurance, fitness room, and my pager/ID badge!  What a checklist to have behind me.

On top of that there were more fees.  Paid $138 for the resident training license application, $20 for official fingerprinting, $10 for my paperwork to be notarized, and another $11 on postage for priority mailing/delivery confirmation.  I suppose it never ends.  Nonetheless, I’m really excited that all I have left to do is complete the actual course for my BLS and ACLS certification, and provide a copy of my medical school diploma.  I can’t believe my diploma will be in my hands in just a month and I’ll have my resident training license shortly thereafter!

More Letters? April 1, 2009

After 2 weeks of waiting, my FedEx package from the Graduate Medical Education (GME) Office finally arrived.  Before picking up my package I had an email from the GME from my personal liaison.  I thought it was a bit of overkill to have a personal liaison until I opened the package.  There is literally a 2 page check list of forms that I need to complete in the next month.  The items range from proof of passing USMLE to getting certified in ACLS and BLS to more letters of recommendation.  Not only do they require that I get 5 letters of recommendation… they must be sealed in their specific envelope with the recommender signing over the sealed letter.  That means I will need new letters, and can’t simply ask my student affairs office to provide the letters that were used for my residency application.  I guess that liaison will come in handy since I’ll probably have a question or two somewhere along that long check list.

I guess I better get down to business.  It doesn’t help that for 11 days out of the next 2 weeks I will be out of the state on my mini vacations!  I have a lot to handle before I leave so that the ball can be rolling while I’m laying on the beaches of Miami.

No More Short White Coat! March 27, 2009

Today I finally get to retire the short white coat.  It’s a bittersweet moment.  I mean, seriously.  I remember starting medical school like it was yesterday.  The culminating event of our first year orientation was the White Coat Ceremony.  Everyone had their family and friends there.  We were in an auditorium and our name and undergrad was called as we took the stage to put on the white coat.  I was so happy!  No longer the premed… the white coat was like a status symbol.  I was now a professional student.  Instead of merely shadowing, perhaps I would be able to interview a patient or do a physical exam.  Every time I would visit my preceptor during first and second year, I would be excited to pull out my crisp, piercing-white coat!

Then came third year.  The coat became less starchy… perhaps a little less white.  Instead of it being a status symbol, it was a way for the asute patients and nurses to quickly identify that you were at the bottom of the totem pole!  Everyone knows that the medical student coat (at least at the majority of US medical schools) is short.  It also became a source of neck and upper back pain since I had it loaded up with every resource you could imagine: stethoscope, pens (several since residents never give them back), pen light, PDA (10lb right there!), Maxwell, folding clipboard, front pocket notebook for personal notes, larger notebook for patient intake notes,  pocket medicine (or Ob/Gyn for Clinicians AKA the red book, when on those rotations), reflex hammer & tuning forks (for Neuro), trauma shears, etc.  Man, that’s alot of stuff!

Fourth year came along and by that time I was smart enough to have a second white coat in the laundry rotation.  The pockets were still full, but I removed quite a few of the extra items that weren’t applicable to that rotation.  I even carried fewer pens, and just had the guts to ask for my pen back immediately after use by any resident or attending.  I did 7 weeks of Ob/Gyn sub-internships, 6 weeks of research and 2 weeks of anesthesiology that didn’t even require me to wear the coat!

That brings me to today… my final day of rotations as a 4th year medical student.  I cannot believe that it is over.  I will forever be Dr. Med Obsession, instead of “Med the 4th year student” or “my medical student.”  I am having a hard time realizing that I will not have a purpose to wear the short white coat.  Perhaps when internship gets rough and I want to reminisce about the great medical student memories.  I have the next 3 months to enjoy life before internship starts.  I suppose in that same 3 months, I may need to get some reading in so that I actually deserve for my coat to be a few feet longer!

Match Day! March 20, 2009

First of all, I want to say sorry for not posting yesterday (Match Day)… it was truly a busy day and I wanted to give you all the quality posts that you are used to .  Hopefully you at least saw my Twitter status with the great news!

So I show up to my match celebration 15 min before the refreshments were to begin being served, which was an hour and 15 min before we got to open our envelopes.  I was so nervous that I literally ate only 3 grapes and 2 orange slices!  I was running around talking to everyone, wishing them luck, etc.  The one day that I chose to actually be early to an event and it was driving me crazy.  About five min before it was time to open the envelopes my Dean took the stage to share some stats.  Apparently 78% of the class would be staying on the same coast – with 40% staying at hospitals affiliated with my home institution, and 24% at my home institution specifically.  As far as specialties go, 32% went into primary care, followed by 21% in surgery/surgical subspecialties, and 9% in radiology.  “All others” made up the remaining 38% (with 8% being Ob/Gyn).  Clearly I was distracting myself from the anticipation by taking notes!

Then the clock strikes and my Dean has all of our family and friends go outside to the terrace.  I had no idea what was going on.  I thought they were going to make us open the envelopes in solitude or something crazy!  Then we are told to go outside.  All of our envelopes are taped to the window in alphabetical order.  I find my envelope and grab my boyfriend.  We walk all the way to the back corner of the terrace.  I really only wanted he and I to be a part of this moment.  I flip my envelope over to open it and there’s a photographer standing right there!  So much for privacy.  I tear into the envelope (and the letter) and unfold it frantically.  There it was… the name of my #1 PROGRAM!!!  I started jumping, and laughing, and smiling.  I hugged and kissed my boyfriend so many times.  He did such a great job of capturing it all with my camera.  I was in total disbelief at what I was reading.  I must’ve read #1 program’s name over and over and over.  I actually took a picture of it to be sure!

Next I proceed to call my parents who were both excited.  I also called my best friend who got her #1 program as well!!  I spent the next hour running around to all of my classmates to see where they were going.  It was such an intense experience.  There were tears of joy and tears of disappointment filling the room.  There were hugs and kisses, screams and laughs.  Such an intense amount of emotion it was a bit overwhelming.  The hardest part was seeing the faces of the classmates that I knew didn’t get their first choice.  I suppose that’s the downside of the 3 week waiting period.  By the end, people were alot more open to sharing where they were going to end up.  So when I asked where they ended up, we both would know that they didn’t get their number 1.  Even more shocking was a classmate that was a stellar student, had stellar interviews, great personality, and got their 4th choice.  This classmate was just in shock… it’s still an amazing program, but since we’ve talked about it extensively, I knew how heartbreaking it was.  In the end though… at least we matched!

I spent the rest of the day eating and drinking.  First with my boyfriend.  Then with a few of my close classmates.  Then with my best friend and her classmates at a neighboring school.  The night concluded with me putting the final touches on my poster and heading off to the club and dancing the night away.  I suppose my school was smart for making us have to be at school the next morning for poster presentation set-up at 8am!  I definitely drank less and came home earlier because of that obligation.  That won’t stop me from partying tonight!

My last point, for those readers that have not yet applied, I will update my “Numbers” posts under the USMLE Books & Advice page if it may help to give you insight.  If I could match my #1, so can you!!