In the Life of a Fickle Intern

May 30, 2010

Homemaker In Training

Filed under: Personal Ramble — dailymedicine @ 21:22

My family dynamic is very unique to most people, yet it is not uncommon among the Asian population. My mom is a homemaker. Not only is she the homemaker for my immediate family, she is the homemaker for the whole extended family. Even though my brothers and sisters are all married with children, they still heavily rely on my mom for a lot of things, the most important job of which is to be the indefinite babysitter. With this being said, my parents are about to leave for a month long trip to Vietnam. Though this is a very much needed vacation for them, there was some anxiety amongst the siblings on what they were going to do about their children, especially with school being out for the summer. To be fair, my siblings work amazingly hard and have ridiculously long hours so it’s not like they’re slacking. Between the four of them, brothers and sisters and in-laws, they had come up with a pretty intrinsic plan of who was to take off when before they found out that I was taking the month off to study for boards. With the new found knowledge that I would be available, at least more available than usual, I have been promoted, or demoted, however you want to see the situation, as the temporary help. Because the kids, all six of them, are old enough to take care of themselves without an actual babysitter, my main job is to do the grocery shopping and ensure that dinner is ready during the week, plus or minus transportation of the kids to their summer activities IF I am available during the day.

Though the task is a bit daunting since I don’t cook consistently, not to mention Vietnamese food, I am pretty excited about this “temp job”. It’ll be a good excuse for me to leave my books for a few hours a day and to practice my very novice skills in the kitchen. It’ll be a month long self-taught cooking class! Even though my parents are still in town, I made my first dish of the month tonight. Gumbo with chicken, shrimp, sausage, and a whole array of vegetables. It turned out surprisingly well!

Movies

Filed under: Personal Ramble — dailymedicine @ 09:55

I love movies. I love sappy romantic comedies about love. For many people, these movies are cheesy and predictable, but for me, they provide a fun escape from reality to live in a world where everything works out in the end and true love is the norm. With each and every plot, however similar or silly they are, I enjoy living vicariously through the characters with no guilt and no commitment.

Without much effort, a friend talked me into seeing a double feature tonight – Sex in the City 2 and Letters to Juliet. I understand that these are very “sophisticated” movie choices, but that’s the point. For four and a half hours, I let myself play with the idea that one day, I’ll meet someone who will sweep me off my feet and be the love of my life, with the perfect spectrum of characteristics, being amazingly charming and loving and all around flawless. As with every movie, as soon as the lights come on and the credits appear, I quickly come back to reality and realize that no one will ever meet all the criteria on my list, and I’m ok with that. Though I have become more realistic and practical with age, it is nice to let myself regress to my childhood fantasy of meeting Prince Charming, if only for a few hours.

May 27, 2010

Last Shift

Filed under: Daily Lowdown — dailymedicine @ 22:41

Today was my last shift in the ER at this particular hospital. It was a great end to my month. The patient variety was interesting; the pace was steady; the attending was great. Moreover, I had two of the 3rd year medical students who are on their family rotation come hang out with me in the ER. It was crazy because all of a sudden, I moved up in the medical hierarchy without realizing it. Having brand new 3rd year students follow me around was kind of weird in an exciting way. They had endless questions, one after another, about rotations, about writing notes, about taking shelves, etc. We talked about basic rotation survival techniques and test taking tidbits, and whatnot. For once, I was answering the questions instead of asking them. I did make the mistake of teasing one of the students about something she asked and the poor girl turn beet red. I wasn’t being malicious! I thought it was cute! I apologized profusely afterward, and I felt so bad for embarrassing her even though it was not an embarrassing situation. Apparently, I need to work on this personal censor ordeal! Hanging out with them today made me realize how much I’ve learned in the past year and how much more I have yet to learn. It was really fun, and I think I’m going to really like being a resident and working with students in the future, minus the teasing (unless I can get students who can handle it.)

May 26, 2010

Protocol

Filed under: Daily Lowdown — dailymedicine @ 22:41

I can’t decide if I like how everything in the ER revolves around protocols and algorithms. No matter what your complaint is, there is a T-form for it. A T-form is a preset worksheet that helps you focus your history and physical to that specific complaint. It took me a while to figure out how to use these forms efficiently because I would awkwardly try to fill them out as I was talking to the patient. I didn’t want to miss any of the suggested questions! Moreover, being the rigid and structured person that I am (professionally), I had a hard time using a worksheet to do a focus history and physical (H & P) when it had been drilled in my head to do a complete H & P for everyone, gathering information about everything from their childhood asthma attacks to their most recent finger jam. I’m exaggerating just a little there but I have been trained to ask a lot of questions. Having a preset form makes the whole process very mechanical, like an assembly line. Every patient is either a “Shortness of Breath” or “Chest Pain” or whatever it is that they are coming in for. In addition to these forms, there are set protocols for every pain that you may have. If you come in with chest pain, you get the “Chest Pain Protocol” which includes an EKG, blood work, chest xray, etc. to rule out heart attacks and arrhythmia, things that can kill you.  For the most part, this system works pretty well. It is efficient and it saves lives.  However, it can be excessive at times because with the proper complaint, you will get a slew of testing whether you want to or not. It’s just a different system and whether I like it or not, I guess I better get used to it.

May 24, 2010

Minor Panic Attack

Filed under: Daily Lowdown — dailymedicine @ 21:04

That title is probably a little melodramatic. After doing a set of questions this morning and being reminded of how horrible my long term memory is, I decided that maybe I should take the month off to study after all. My plan was to do a Radiology elective, which is only 4-5 hours a day, and study. However, after thinking it over, I will regret it if I don’t do well on the test. I have four option months this year, meaning I can do whatever I want with them, and taking a month to study for the board is justifiable in my mind. Moreover, now I will have time to take time off instead of feeling obligated to study all the time that I’m not working. My new goal this month, in addition to studying, is to get in shape. Done and done. I feel so much better about everything already.

May 21, 2010

Study Schedule

Filed under: Daily Lowdown — dailymedicine @ 11:34

I finally made a study schedule for Step 2. I have the test scheduled for June 21st so that gives me exactly a month to study. It’s a 9 hour test over everything I’ve learned so far in med school, so the goals for the next four weeks are to review, review, and to build up my test-taking stamina. The calendar is just a guideline; I change it as needed, especially when I get behind which is more often than not. This schedule is nowhere as intense as my Step 1 study plan. Now I have to actually take into account my work schedule and whatnot, whereas with Step 1, I literally studied on average of 12+ hours a day for a solid month. I’m so glad those days are over! As my sources, I’m using First Aid USMLE Step 2 CK and World Questions plus my own notes I’ve collected throughout my rotations. Hope that’s enough!

May 20, 2010

“If you want to…”

Filed under: Daily Lowdown — dailymedicine @ 10:58

I hate it when residents and attendings use the phrase “if you want to…” when they are giving you an option of doing something. In actuality, it’s not really an option, and the majority of the time, a med student, unless uncandidly brave, will always do whatever it is that is asked of them. There is one exception. When a resident or an attending offers you the option to leave “if you want to,” you get drawn into an academic dilemma. In your head, you’re shouting, “Of course I want to get out of here, you idiot!” but on the outside, you have to play your cards carefully or else you look like a slacker. Appearance is everything as a student. You have to appear to be interested, to work hard, to be curious, etc., whether or not you are any of the above is irrelevant. Being too eager to leave is usually advised against.

Last night was incredibly slow. After sitting around for six hours, I subtly hinted that it was much quieter than usual in the ER. After some small talk, my attending finally said, “you can get out of here if you want to.” I asked if he was sure, if there was anything else I could do, etc. Without appearing too eager, I let the offer sit for another 20 minutes. With a final “are you sure there isn’t anything else I can help out with?” I was out. The night was still young so I decided to drive home for the rest of the week. Sweet.

May 19, 2010

Temper

Filed under: Daily Lowdown — dailymedicine @ 15:31

I am ashamed to say that I lost my temper with a patient last night for the very first time since I started rotating in the hospital. A very drunk and belligerent young man came in after a fight with cuts and bruises all over his face. He had a laceration through the thickness of the corner of his lip which required suturing. Being the suture-loving person that I am, I volunteered for the job without realizing what I was getting myself into. Within two minutes of being in the room to get a quick H & P (history and physical), I knew that this was not a good idea.

To me, there are two types of drunks, the fun drunks and not-so-fun drunk. The not-so-fun drunks tend to be emotional, belligerent, mean, aggressive and/or they are vomiting (not a fan!). He was the stereotypical not-so-fun drunk, yelling and making a ruckus, attacking the nurse and just being an overall jerk. The only thing he had going for him was that he was not throwing up. Thinking that maybe his aunt who came with him would calm him down, I let her come back into the room. Ironically, the lady was just as crazy (though not drunk) as her nephew. They completely fed off each other! No wonder the kid is a jerk. Thankfully, she had to go take a phone call and did not return.

Suturing him up took over an hour, not because it was deep or difficult, but because he would not and could not stay still or stop talking while I was working on his lip. It wasn’t until he completely disassembled my sterile field, an sterile area that you create with sterile drappings and towels, that I lost it and told him to “shut up and lay still” plus a few other words. Despite my frustration, I felt so ashamed. I should not have let my anger control the situation. Though everyone found it amusing and no one got mad at me, I felt very unprofessional. Lesson of the night is to let patients sober up before attempting to fix them up (if it’s clinically ok to wait.)

May 18, 2010

Defensive Medicine

Filed under: Daily Lowdown — dailymedicine @ 13:42

The thing I fear the most about going into EM is that I will end up mostly practicing defensive medicine. With litigation against health care provider being the humongous business that it is, one misdiagnose can land you with a very expensive bill. Though this is always in the back of my mind, it wasn’t until last night when I was working with the fellow that I really experienced it.

As a young physician, the fellow is very thorough. He has a very low threshold for ordering tests to rule things out. His rationale is that with his limited experience and young age, he will get burn much more if he misses something. With that mentality, I watched him rule out a lot of stuff, for lack of better phrasing. I understand his viewpoint, and on a personal level, I thought he was a great doctor, but from a financial perspective, especially for the patient, some of the tests were redundant and probably not necessary. For instance, a patient with a history of recurrent cellulitis came in with a local flare up on her shin. He ordered an ultrasound to rule out deep vein thrombosis, an x-ray to rule out osteomyelitis, and the routine lab work. All of this was justifiable, but with her history of recurrent cellulitis, he probably would have gotten away with just basic lab work to rule out infection.

Worse yet, it was not just him who was practicing defensive medicine last night. The hospitalist, a doctor who specializes in patient care in the hospital, refused to admit a lady who came in with progressive neurological symptoms from a disc herniation because the neurosurgeon would not be available until the morning. He stated that he is not “putting his ass on the line without backup (neurosurgery) for a patient so sick. It’s all going to fall on me, man, if something happens to her overnight.” He actually suggested sending the patient home until the morning, when the neurosurgeon can see her. However appalling that may seem, this is not an uncommon problem amongst health care providers. Everyone is protecting themselves from lawsuits, sometimes even to the extent of forgoing patient care. This, unfortunately, is a reality in our current health care system.

Note: the lady was admitted in the end.

May 17, 2010

Irony

Filed under: Daily Lowdown — dailymedicine @ 16:50

I spend the majority of my time surrounded by sick people. I’m exposed to everything from the common cold to pneumonia, yet for the most part, I’m healthy as can be. Ironically, after a fun weekend with friends, I wake up completely congested with a cough that rivals a toddler with RSV and a voice that sounds surprisingly manly. Though it is probably just a mild case of laryngitis or some other viral upper respiratory infection, I got to enjoy some down time as I lounged on the couch at my parent’s house while my mom pampered me with tea and soup. I was living in the moment of complete laziness until my niece woke me up after she got home from school to ask me why I wasn’t at work. With that friendly reminder, I am once again in a hotel room getting ready for the ER. I’m taking on the night shift this week. Should be interesting.

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