In the Life of a Fickle Intern

February 24, 2011

Gunner

Filed under: Daily Lowdown — dailymedicine @ 22:49

In medical school there is a term for students who are super overachievers, even more so than the general population of medical students. This term is “gunner.” Being a “gunner” is not necessarily a good thing because it can be associated with being ruthlessly competitive in which you’re just annoying. However, for the most part, it just means someone who takes that extra step.

I don’t consider myself very competitive with other people. I look up to those who are smarter than me; I learn from those who work harder than me. This mentality was developed through many, many years of playing church league sports and sucking at all of them. You can’t really be competitive when you have the coordination of a two year old. I will readily admit this. However, I am amazingly competitive with myself when it comes to controllable circumstances that do not require innate abilities, hence I am my toughest critic when it comes to school, work, etc. I won’t admit it to my friends but I am “one of those people” who will study all the time, stay late at work just to make sure, and take that extra step, within reason that is.

I have one more rotation left before I am officially done with medical school. Though I have really enjoyed all the free time I’ve had these last few months, I have been mentally beating myself up for not utilizing this time to learn more. In attempts to compensate, I have dived head first into an array of projects from baking to cooking to reading to exercising, but somehow, I still feel guilty.

However, as luck would have it, I met a random Pediatric Anesthesiology on one of my many flights last month who has offered to teach me a little more about intubating children. He is a private doctor who has no students or residents so I would get to work with him one on one. That’s the best set up! Being completely and overly motivated, I have arranged with my school to do a double rotation this last month. In the mornings I go out to one of the hospitals and work with a Cardiologist to learn about EKGs (heart tracings) and in the afternoons, I go to the Children’s Hospital to learn about putting children to sleep. This is a bit ridiculous especially since I can only get credit for one of the rotations, but I’m so excited about this opportunity! I start Monday.

 

February 22, 2011

Rank Order List

Filed under: Daily Lowdown — dailymedicine @ 22:11

February 23rd is yet another landmark day for graduating medical students. It is the day that our rank order list is due to the National Residency Matching Program. The list that you submit will pretty much determine your future, as least for the next few years.

It is exactly what it sounds like. You rank the programs you interviewed at in a descending order of preference. Because this “Match” is a unbreakable contract for at least a year (you literally have to go to court), you only rank programs that you want to go to because it would suck to end up somewhere you hated. On the other hand, it would suck even more if you ended up jobless because you didn’t match. I ranked 12 programs out of the 13 that I interviewed with.

This system is kind of stressful. First off, deciding which program you like best is really hard. I have so many factors influencing my decision. I have friends in some places and family in other areas, not to mention the quality of the program, the location, and the residents. I tried to save myself from all of the hassle by ranking programs as I went on the interviews, but when it came down to it, I still had a hard time prioritizing my values. I’m still not sure if I put in the rank order that is best for me, but the good news is that I have so many amazing programs to choose from that I am sure it’ll all work out.

Secondly, after you decide on which programs you like and dislike, you have to wait 22 days to find out if any of these programs like you! Talk about anxiety and anticipation. Programs rank their applicants too, and through some high tech computer software, a “match” is made if both you and the program rank each other highly. The computer goes down your list until it finds a program that likes you, if any. On March 14th, you find out if you’ve matched (and have a job for next year). On March 17th, you find out where via an envelope handed out by the school. If you don’t match, that’s another story that I won’t dwell into at this moment.

Thirdly, you have to play the game. As I’ve mentioned before, this whole process is a big game. You have to know the right people, get the right numbers, write the right personal statement, say the right things. Though I did email my top four programs to tell them that I was interested, I don’t know if I am playing the game properly. I’m not sure what else I could have done.

And that is how the Match works. From the east coast to the west coast to the northeast to the south, I can end up anywhere! Everything is out of my control now. Fingers crossed. 22 days and counting.

February 15, 2011

Little Sister Updates

Filed under: Personal Ramble — dailymedicine @ 23:02

It has been eight months since the start of my relationship with Shana, my 14 year old little sister from the Big Brothers Big Sisters program. I initially signed up to be a big sister because I felt that I had something to offer, mostly time and energy. Be someone’s friend. I can do that, or so I thought.

Being the type of person who can talk to a wall, I am having the hardest time reaching out to my little sister. Every time we hang out, it turns into  “Twenty Questions” with one word responses. Though I do not feel any animosity or discontent from her, she has not opened up to me at all. She responds to my phone calls and text messages but she has not initiated any of her own. She always agrees to hang out though she never suggests it. And when we see other, she doesn’t talk.

I understand that she is shy and reserved, and I also understand that she cannot relate to me at all. She is the oldest of three children and pretty much the primary caretaker of her brothers. Her single mother works two jobs to support the family, and she has a lot more responsibility than most 14 year old kids out there. In no way am I pretending to understand her situation or to know how she is feeling because I don’t know. I just want to be there for her, but she is not allowing that relationship to develop.

I feel selfish for even feeling this frustration. I am not sure exactly what I was expecting when I volunteered for this, but I feel like I’ve failed in being that role model/friend for my little sister. The worst part is that I know that the year is coming to an end and I will have to move away in June. I dread bringing up that conversation, not because I think she’ll miss me or anything, but I know that she has had some issues with abandonment in the past and I hate that I have to play a part in that even if she notices it or not. I wish that I had more time to reach out to her. I did not think this through when I signed up.

It’s just frustrating. I want to be able to do more for her, but I don’t know what I’m supposed to be doing.

February 9, 2011

Lipid

Filed under: Daily Lowdown — dailymedicine @ 22:03

This month I am discovering all of these new, cool clinics in the VA. Though I won’t say that I am a fan of the system considering it has taken me two weeks to get any sort of access to it, I do have to admit that they have some great ideas!

One of my clinics is called Lipid Clinic. It is a clinic run by Endocrinologists and Cardiologists for patients who have uncontrolled cholesterol despite multiple drugs. The clinic takes place once a week. They schedule all the patients to come at the start of the clinic and they hold an educational session. A nurse practitioner projects all of the patient’s lab results on the screen and she goes through each patient and ask them about what they think about their progress. They each share with the group about what they did well in terms of controlling their cholesterol and what they could improve for next time. She then answers any questions they may have about their diet and exercise. It’s like a support network, like Alcohol Anonymous.

After-which, the patients have their appointment with the doctors who go over any last minute questions, make changes to their medications, and do final couseling.

What a great idea! The patients get the one on one attention needed from the doctor but they also have the social pressure to do better during the group counseling session.

In addition to the Lipid clinic, there are other clinics like Hypertension clinic, Chronic Heart Failure clinic, Diabetes clinic, all common, chronic problems that people have trouble managing. I’m so impressed!

February 7, 2011

Ambulatory Medicine

Filed under: Daily Lowdown — dailymedicine @ 22:31

Despite the personal nature of medicine, it is still a very organized, routinized, and mechanical field. We are taught to recognize signs and symptoms, process the information, and provide a diagnosis and treatment plan.

Throughout these last two years, I noticed a self-transformation in my abilities to talk to patients, to gather and collect information, to process that data, and to make a plan. I have become more efficient and confident in what I say and do. However, with this newly formed confidence, I have caught myself, more recently than not, taking less and less time with patients, forgoing the personal aspect of the doctor-patient relationship for only relevant information. This efficiency is great for the practice of medicine, especially in the Emergency Department, but I’ve realized that it can be a hindrance when it comes to mastering the art of medicine.

This month I am on ambulatory medicine which just means that I have clinics everyday. I was dreading this rotation at first because clinics are slow and inefficient, but to my surprise, I am really enjoying it. I love the fact that I can sit there for half an hour to talk to a patient about their diet or their feeble attempts to stop smoking without anyone rushing me to see the next person. Though I have actually done very little medicine so far, I leave most days feeling like I’ve done something. Most of these patients, especially in the General Medicine clinics, are there for normal check ups and follow ups. The majority of them are over the age of 70 and they just want to talk. I forgot how much I enjoy just talking to people and getting to know them! This is a nice change of pace.

 

February 2, 2011

Federal Employee

Filed under: Daily Lowdown — dailymedicine @ 18:23

Somehow I’ve managed to not be assigned to the VA (Veterans Affairs) hospital for any of my core rotations. However, two rotations away from graduating and I get placed at the VA for clinics. The VA system is a national network of government run hospitals and clinics. Every record of every veteran can be accessed from anywhere in the United States at one of the many sites. That’s pretty awesome! The EMR (electronic medical record) is simple to use, easy to follow, and very convenient, at least from my limited experience with it. However, as a federal employer, the VA requires a ridiculous amount of paperwork to access the system.

Even though I only have two afternoon clinics a week at the VA, I got to experience what it would be like to apply for a federal job. After maybe thirty signatures and an hour and a half long online course, I think I may have signed away my life without realizing it. In addition to all the forms and documents, I got finger-printed and I am currently having a background check performed. Once this is cleared, I will have to take an oath and be sworn into the system, after which I can access the computers to look up anything I want to on any patient. Sadly, I just need the patient’s vital signs and labs…

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