Reflecting on 3rd year...

I keep being MIA for a while since I've been so busy and not much to tell since I don't think anyone could understand what med school is all about... However, as I'm nearing the end of my third year, there are a few lessons that I've learned and want to share...

-Getting pimped sucks. Half the time when it happens, you will have the deer in the headlights look. Its okay when your attending is nice, but a lot of them are intimidating. Scrubs showed that feeling perfectly:

-Residents are pretty cool for the most  part. A few will want to make you suffer because they believe "med students have it way too easy," but they forgot that's what it means to be a student. Let us have these last two years of relative freedom before our lives end in residency.

-Even through three years of training -- two in the classroom and one with patients -- I still don't know anything. Period. There is so much you have to know that learning it all in med school is impossible. I've gotten comfortable saying, "I don't know, but I will look it up" on so many occasions.

-Years 1-2 absolutely SUCK. I honestly don't know what I did during first year. I feel like I barely studied, but I know I was studying and listening to lectures everyday. I think I should have taken those weekend trips to New Orleans and Chicago that my med school friends took. Second half of second year was awful, no doubt, but that was only because of Step 1, which was possibly the scariest exam I ever took.

-Year 3 is tiring. You go from sitting on your ass and studying all day to on your feet for at least most than 4-5 hours everyday. I'm not complaining, I like moving around, but the transition was tough. I went from studying at a desk for 12-14 hours a day to standing on rounds and then the OR for about 6 hours everyday. My feet felt like they would fall off everyday. The other thing that's tough with 3rd year is the fact that you still have exams to study for. So, not only do you have to keep up with your patients and study for your patients' conditions, you also have to keep up with studying for the rotation's exam at the end of the rotation. For example, I've been studying for my psych exam this past week as well as next week. You may say, "But Nads, aren't you used to studying for hours and hours? Why is it so hard?" Well, let's talk about hours. On my inpatient pediatrics rotation, I worked 12 hours -- yes, you read correctly, TWELVE hours -- everyday. I would wake up at 5:00am just get ready and be at the hospital by 6:00am, and we had to dress professionally/look nice so it wasn't like I was throwing on scrubs every morning which would have been sooo much easier. I would get off around 6:00pm and be completely exhausted. On lucky days, I would get out at around 4:00pm instead, but still be completely exhausted. I would also go to bed at 8:30-9:00pm just so I could wake up again the next morning to repeat. So, I had 2.5-3 hours to shower, eat dinner, and study... A lot of times, I wouldn't study and would watch tv instead. So no, I am no longer able to study for hours and hours.

-Fourth year should be AWESOME after December when all the interviews/stress is over. I'm already stressing about applications and personal statements and CVs that have to be written. Not only that, but I'm taking step 2 in about 5 weeks. Rest assuredly, you guys won't see me until September after I'm done begging for letters and done with my apps and done with my critical rotations in August and September. However even with all of that, I'm looking forward to January onwards since I won't be taking any really demanding rotations, and I will have three months off between January and graduation. I think this video sums it up the best:

-I wish you guys would understand how amazing this video is. I am going to enjoy my fourth year as much as I can. :D
ONE MORE WEEK!!!

Until the next one then.

Feedback

So today, I asked my attending for a one-week evaluation, and she gave me a very good evaluation even though I know she could not possible judge me accurately on any aspect lol. She does things very quickly and I'm not able to present adequately to her. I barely have time to give her an accurate history and the only thing that I'm usually able to say is the patient's name, age, sex, and presenting complaint. I never get to go into what I find in my physical exam. But, its all good, I will take my excellent eval and run with it. That's what you have to do. Take whatever they give you and run with it from good evals to days off to early dismissals lol.

I do have some concerns about how this doctor practices though. She's very very good and likes to do a lot of genetic testing on the catecholamine and folate metabolism pathway in the body, and she will supplement whatevers missing. The patients do very very well -- patients who are depressed get to stop taking SSRIs, patients with stomach problems are able to eat anything, etc. That's all really awesome, but I get a little worried since she doesn't do much of a physical exam. I feel like if I was an attending, I would definitely not trust my students' skills that much. I'm sure that most students are competent, but I think its a little risky not following up on everything that the student finds or doesn't find. She hasn't really given me any feed back on how I document my physical exam findings. At this rotation, I pretty much write the entire doctor's visit note on the computer, and then she comes in and writes three lines for the plan of care and signs it. All I'm saying is that I would double check everything. *Shrug*

Today, she also told a patient that I'm the only student that she has allowed to do so many well woman exams alone (but with supervision) because I'm "very good." I was bouncy after that :)

Until the next one then.

Don't Sit Down!!

Last week, my attending was gone for the morning. She had clinic somewhere up in Houston and said I didn't have to come and I should work with the PAs in the office. So I agreed partly because I want the experience and partly because I want her to think I'm interested to get a better evaluation. Well, the PA I was working with didn't have any patients scheduled for about 20 minutes, and the nurses' station for the PAs is really small and crowded. I went to the other nurses' station, sat down, and decided I would keep an ear out for the patients who would arrive. They let everyone know by the intercom through the phone system. While I was sitting there, the other PA came by and saw me. She said to me, "What are you doing here? You should be over there at our nurses' station." I said [very politely], "oh there was no where to sit over there, and there aren't any patients for the next 20 minutes..." And as I was about to say I was going to keep an eye out for new patients coming to the back, she snapped at me quite nastily by saying, "If you are waiting for patients, you should be where you can see them when they come" [which I already was] "because the schedule can change at a moment's notice and when you're a student, you aren't supposed to sit."

Umm leave me alone.

Med school can be brutal. I almost cried because I was having sort of a rough morning too lol.

Two hours later, she apologized and said that she "was looking out for me" so that the other PA wouldn't snap at me too. Umm I've worked with him three times so far, and he has yet to snap. He's actually really nice and tries to teach me. I like him. I dislike her -- a lot.

Until the next one.

Stories!

Pedi Butterflies

While I was on outpatient pediatrics, I had a lot of screaming kids to examine. Most of them were alright for the majority of the exam, but would scream when I or anyone else tried to check their ears because they would have to be pinned down. Anyways, I had one adorable 2.5 year old little girl who came in for some cold symptoms -- runny nose, cough, fever, and ear tugging for a few days. As I went to do my physical exam, her mom said that this little girl hates anything going into her ear and will scream bloody murder if anything comes close to it -- that included qtips and doctors looking into her ears. So I was thinking, crap how am I going to do this? I checked everything else first because she was actually pretty cooperative. When it came time to check her ears, I showed her the otoscope and said, "look at my fun flashlight," and pointed the light on her hands. When she smiled, I asked her, "Can I use the light to look for butterflies in your ears?" O.M.G. She face lit up, and she said in her baby way, "butterflies??" and held her head very still so I could check her ears. She even asked what color they were lol. The best part was that when I went back into the room with my attending, this little girl told the doctor that she had butterflies in her ears. Its a good thing she let me look since she ended up having an ear infection in both ears.

Miss Snooty Booty

Alright, so I'm not sure what was wrong with this patient, but she was a 50-something year old lady and she was unbelievably rude. The nurses had warned me she was their definition of a CAP -- a crazy ass person/patient. So I walked into the room and introduced myself, like I do to every patient I see. "Hi Miss ___, my name is Nads and I'm a third year medical student working with Dr. ____. I'm here to talk to you and do a physical exam before the doctor comes in," while shaking the patient's hand. I did my little spiel introducing myself and I held out my hand the whole time I said all of that. She just sat there and stared at me and ignored my hand in her face. I was a little taken aback, but I shook it off and started getting her history. She was pretty uncooperative. She kept asking when my attending would be in there, and why I had to do anything, and she complained that she had to wait for an hour. I explained how rotations work and that this helps me learn by seeing patients first. Then I asked her questions and she would stare at me like she knew I said something, but didn't hear it. So then I would ask the question again, and then she would give me a one word answer. It was so irritating. I went to examine her and I asked her to take off her jacket, but she said, "No I'm cold. I don't want to take off my jacket for a student." I got mad and left the room. This patient was totally fine when the attending came into the room. SO ANNOYING.

Mr Happy?

This story happened to me today. I had a 45 year old black male come in for a yearly physical exam. No complaints, no significant past medical history, and pretty healthy for the most part. I went in and did my thing. I did everything except the testicular exam. I stepped out to present to my attending and then we both went back in together. So my attending just talked to him for a while and figured out what screening labs he would need and I listened. Then the attending did his physical exam, and everything was fine. Then my attending asked the patient to just undo his pants and so we could do the testicular exam. The patient looked at me and asked me if I could leave the room. I've gotten this type of reaction before, so I didn't mind. I stepped outside the room, and just waited. So when they were done, and as the patient was leaving, he said apologized to me and said, "I'm sorry I made you leave the room even though I know you're learning to be a doctor. Its just that I've only ever been naked in front of pretty girls like you and I didn't want to get excited, which would be really embarassing..." Pfffft... hahahahahahaha... Humiliating for the patient, no doubt, but I found it hilarious :-P

Until the next one then.