Medical School Hierarchy

I often get asked about medical school and how it works by my friends and family. However, it didn’t occur to me how confusing the hierarchy of medicine can be until my nephew today asked if I was an attending. Here is a quick break down of the stages of my medical training:

Bachelor degree –> Medical school (4 years) –> Residency –> (Fellowship)  –> Attending/Private Practice

The length of residency is dependent on the field. The shortest residencies are three years (Internal Medicine, Pediatrics, Family); the longest is Neurosurgery, I think, and that is seven years. The first year of residency is known as your intern year. At this point, you are considered a doctor. (Scary thought!) After residency, you have the option to do a fellowship, which are often 1-2 years, to get more training in a specific area of your field. The goal of all of these years of schooling and training is to be a practicing physician. You can stay in the academic setting and be an attending who trains future physicians or you can go into the community to work.

That’s medical training in a nutshell.

Done

As pointed out by a friend last week, the title of this blog WAS a lie. I was not a fourth year medical student. However, as of noon today, I can say that I am no longer a liar. I am so pumped to be done with my third year of medical school. I thoroughly enjoyed all my rotations, some more than others. It ultimately came down to my interactions with the residents and/or attendings. I love the clinical experience at my school! For the most part, everyone wants to teach and wants you to do well. I’ve had such an amazing year, and I have no doubts at all that I will ever regret my decision to go into medicine.

My favorite rotations were Surgery and Internal Medicine; my least favorite rotations were Ob-gyn and Neurology (even though I had the best resident on Neurology.) With that being said, I am 90% sure that I am going to go into Emergency Medicine as my specialty. This way, I get both hands on procedural experiences of minor surgery and management experiences of medicine. I am doing a month of Emergency Medicine in a small county hospital about an hour from the city starting Monday. In theory, EM is the perfect fit for me. It’s a fast pace field with lots of variety and patient care. Moreover, it’s flexible and I get to work in the hospital. For the next few months, I have to decide if I like it in practice by actually working in the ER. I hope I do! Fingers are crossed.

Oral Exam

Our surgery rotation is the only rotation that requires an oral component in order to pass. I had mine this morning. I feel ok NOW, but last night, I was a mess.

The way the oral exam is set up is that you are called back into a room where an attending and a resident are waiting. They give you an one-liner scenario and that’s it. Your job is to make an assessment, order the necessary labs and imaging, make a diagnosis, and treat the patient. It’s role playing. The trickiest part is that the examiners can change the final diagnosis or the workup depending on what you say. This is what the surgery residents have to do in order to get their board certification, though they go into much more technical detail than we do.

I was very, very nervous about this test. I felt ok yesterday afternoon, but after a review session with a resident who kindly volunteered his time (even though none of us had him as our resident), I internally freaked out. He went over how we were supposed to organize our thoughts, etc. and gave us some practice scenarios. I did not feel ready at all. So instead of sleeping last night, I stayed up and re-skimmed my textbook. I cannot recall the last time I was so nervous about a test nor do I remember the last time that I did not get a full night of sleep before an exam. I did get about three or so hours of sleep, but due to fear of making a complete fool of myself, I kept on reading. I was so nervous this morning.

The guys showed up in ties; girls in slacks/skirts. It was a formal ordeal. They call back one student at a time. The waiting and anticipation was ridiculously nerve-wrecking. I was the 2nd student to go in my group. I had the clerkship director as my examiner. Luckily, I had met the resident examiner yesterday in a case, and he is super nice. Somehow I managed to stop hyperventilating and got through it ok. (I think? I hope?)

My two scenarios were 1) 38 year old obese lady post-operative day 4 from a gangrenous cholecystitis is now having respiratory distress, and 2) 55 year old veteran comes into clinic with a history of 6 months of leg pain when he walks. I stumbled through it, but 40 minutes later, I left in one piece! (The answers were pulmonary embolus and Leriche syndrome.)

I have been on an adrenaline high all morning, but now my body is about to crash. Quick nap and back to studying. One more test! I feel so much lighter now that the oral exam is over.

Hope

My last trauma intensive care unit call was filled with hope. The patients continue to surprise and inspire me with their stories and their progress.

There is a lady who was admitted on Easter Sunday after a terrible car accident where she died at the scene, was revived during shock trauma, and has been in the critical care unit since. She is now a quadriplegic and has extensive injuries to all her organs. Moreover, after weeks of attempts to salvage her crushed right leg by daily debridement of the dead tissue, the decision was finally made to amputate the leg in hopes of preventing further infections and sepsis. When I scrubbed in on one of those earlier debridements, I asked the trauma fellow (one of my many role models in life) about the ethical issue of keeping someone medically alive when physiologically, they could not survive on their own. The fellow told me that even if there is the slightest chance for someone to live, everything must be done to give them that opportunity. Everyone has a reason to keep on living. In this case, this lady has two young kids who needed a mother. I wasn’t completely sold. It didn’t make sense to me. Every time I visited the patient, she was unresponsive. However, yesterday, when I went in to check on her, her eyes were open. I asked her how she was doing, and she smiled at me. Now I understand. It does make sense. Despite the fact that she has little control over her body right now, she is still here mentally and emotionally. She is still a mother, a wife, a daughter, and a sister. She is still alive and therefore, she still has a chance.

My friend, Mr. Room 21, is doing so much better. He has a tracheostomy so he can only mouth words, but I still stop by to chat with him whenever I have a chance. Every time I see him, he thanks me. I’m not really sure why. It does give me that warm and fuzzy feeling though, as if I’m actually doing something right. His whole demeanor has changed so much since I first met him. He is no longer angry or fearful. He is so much more receptive to medical treatment now. I have to go say good-bye to him tomorrow. Last day of the rotation.

As for my young friend, her determination is so inspiring. There is something very special about her. She makes me tear up every time we talk. She told me yesterday that no matter what anyone says, she will walk again. I told her that I have complete faith in her, and I do.

It’s amazing what modern medicine can do. It’s even more amazing what people can do.

Misery Loves Company

It’s yet another Friday night in which I am sitting at my desk trying to cram as many concepts into my brain as permitted. I really do believe my brain has reached its limits, but I still aimlessly try to memorize every word in these review books. You would think that I would be more efficient at studying so that I don’t just memorize, but after 3 full years of medical school, I still haven’t figured out a better way to prepare other than to memorize as much as possible. To be fair, everything does make a lot more sense now than it did when I was first introduced to these concepts 3 years ago (thank goodness!)

Tonight the school had planned a celebratory dinner in the ballpark for all its students. The first year students are done with their curriculum; the second year students are done with Step 1 (board); the fourth year students are cruising till graduation. Even though they forgot that we (third year students) are still rotating and still studying for the shelf (in 4 days!), many of my classmates were planning on going anyways. Being the guilt and fear driven person that I am, I decided to stay in and study instead. However, unexpectedly, it has been raining all night and a lot of people aren’t going anymore. Though I hate to admit this, I feel so much better that I am not missing out on anything. I know it’s selfish, but I wanted to go celebrate too!

Now that my true colors are exposed, I feel like I can say anything. 🙂

Tomorrow is my last call in the trauma intensive care unit. Even though I am ready for this rotation to be over, I am really going to miss these calls. My residents continually amaze me every day. Apart from my internal medicine residents, surgery residents have been the most awe-inspiring people that I have worked with. I totally lucked out to have gotten to work with the people that I did! If I could function on little sleep, I would do surgery in a heartbeat. However, the idea of being sleep deprived for 5 years is holding me back.

Alrighty, back to studying!

Reality

A 25 year old young lady came in yesterday after an MVA. She was in the backseat unrestrained when the driver fell asleep at the wheel. She was on the way to a Nursing conference in New Orleans. She is now paralyzed waist down. The driver is unscratched. The other passenger is mildly injured. I teared up when my resident told her that her chances of walking again was very slim. She’s around my age.

It seems so unfair.

Retracting

My job in the operating room is to retract instruments, cut sutures, drive the camera (in laparoscopic surgeries) and if I’m lucky, close up the patient (close the incision). It didn’t take long for me to realize how much I dread retracting. My small frame and flimsy arms are not meant to pull back the skin, fat, muscles, etc. from the incision site for the surgeons to see what they’re doing. Despite using all my weight to retract, I still often get asked, “Can you pull harder?” Worst of all, my hands cramp up and start shaking, all within five minutes. It’s a little embarrassing. If I had known, I would have invested in a gym membership and a personal trainer to strengthen my arms before this rotation started.

Studying-induced hypersomnia

Today in my feeble attempt to stay focused and awake, I migrated from one study spot to another as soon as I felt the sleepiness setting in. I started off in my apartment at 6 am, got to starbucks #1 around 8 am, moved to the public library at 9:30 am, and ended up at starbucks #2 around 1 pm. I finally gave up and came home at 3:30 pm to take a nap. Dang sleep.

To be fair, I was actually being productive at the library. There was this guy who sat right across from me despite the fact that the whole area was completely empty and he would not stop trying to make small talk. I hinted not very subtly that I had a big test coming up and that I needed to study. After a while, I got a little sleepy so I put my head down for a few minutes and the next thing I know, he’s tapping me on the shoulder asking why I wasn’t studying. Awkward. Hence I left.

*Studying-induced hypersomnia is not a real disease, but if it was, I would have it. No doubts.

The Pre-Test Routine

I love medicine. I love learning about it. I love seeing it in action. I hate testing.

9 days left on surgery. 10 more days till oral exam. 11 more days till my last shelf ever.

Since I am well aware of my horrible ability to cram, I try to space out my studying for these shelves throughout the rotation. Usually around this time, I am in the process of reviewing material. However, with the weird work schedule on this rotation, I am still trying to learn new concepts. Eek!

I get more easily distracted the closer I get to the test. (For instance, I caught up on GLEE, played 4 games of Words with Friends on my phone, squeezed in two power naps, and managed to sign onto facebook at least every other hour, all in one day.) Because of this horrible quality, I usually have to camp out at the library or a public place to avoid my computer, my kitchen, my tv, and my bed (especially my bed). I used to completely turn off my phone for a few days before the test. I don’t do that anymore because my mom freaks out when she cannot get in touch with me, in the rare chance she might call. My family knows by now that I am not very pleasant or patience around this time.

I never want to not do well on a test because of my lack of preparation (to not do well despite my preparation is another story which is more justifiable.)

With that being said, I am going to turn off my computer for the night. Hopefully the TICU will be more cheerful tomorrow.

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