Psych... just a bit crazy?

Didn't realize how long I have stopped having verbal diarrhea until I looked at the date I wrote here last! It's been 5 months! Got a bit caught up in the craziness of rotations and lost track of time (hopefully a good enough excuse). I have progressed and now I'm done with Surgery, Ob/Gyn, and Peds. My current rotation is Psychiatry and, needless to say, it's crazy...

I have done a few weeks of hospital consults and 1 week of inpatient service in a psych institution. But just from consults alone, I felt like this rotation is forcefully opening my eyes. I did not realize how prevalent depression is. Nor did I realize how many dysfunctional families there are out there. I don't think everyone is perfect but I did not think there were that many irresponsible parents out there. It is not rare to have a Psych patient tell heartbreaking stories of childhood and how they were mistreated and misguided by their parents. I have a lot of sympathy for some of those patients who end up developing anxiety, paranoia, or schizophrenia. The sadder thing is - there is no cure for most of those patients. The best thing you could do is to control their symptoms. But even with trials after trials of medications half of them still suffer (nevermind the countless side effects the medications bring with them). Overall, I feel that Psychiatry is somewhat a sad field. You need to be very stable and strong emotionally to be a physician in this field.

Peds was my rotation before Psych. To my surprise, I quite enjoyed it. Working with children was not as bad as I imagined it to be. NICU was great. With a slightly slower pace but a wonderful warm hearted team of physicians and nurses, many premature neonates were taken care of there. It was a very different and interesting atmosphere. I felt calm every single day when I was in the NICU. Even got to burp some little babies! That was fun :) PICU was also great but a lot more intense. There were a lot of asthma exacerbations, overdose, and head traumas (surprise?!). These kids range from a single digit in age to 18 years old. I was shocked to see so many head traumas in kids. I was more shocked to find out the cause of most of the head traumas is the lack of a bike helmet. Sigh... Safety precautions! Then I rotated in the ED again. Only this time, I stayed in the Peds section. I worked with amazing physicians who taught me a lot! I was happy to be reunited with ED for the second time. Next was outpatient Peds clinic. I also loved my experience there. Despite the fact that the illnesses are relatively mild compared to PICU or ED patients, I saw a variety of diseases and the atypical presentations in kids! (Kids are weird... period) I did somewhat get a headache from trying to memorize the immunization schedules...

Anyhow, just another day :) And that's my dog Taro. Take care everyone!

ER

Finally I have entered my last month of Surgery rotation - all of June I will be swimming in the Emergency Department (yes, ER experience is included in Surgery for us). The thought alone gets me excited like no other. On Tuesday I already had my first ER shift with a fantastic resident. It was a 10hr shift and I walked out of it happy and still excited! One nice thing about the ER is the variety of cases you will get to see. Things never get boring and time just flies when you are running from one patient to the next.

I'm starting to get ready for my shelf exam that happens on June 24th. This will be interesting as it will be my first shelf exam in rotations. Lots of question marks regarding exam style and difficulty are yet to be answered... by my actually doing the exam I guess hahaha...

It's getting hot in Saginaw. Surprisingly this town reminds me of Dominica. Weird right? I at times feel like the island weather is here in Saginaw! The heat and humidity... what a wonderful combination... I'm not complaining though, as I do think that sunny days are amazingly beautiful :) They keep minds fresh and moods happy.

The next 3 days will be night floats for me in the ER. It will be interesting to see how I adjust working consecutive night shifts again. Last time I did that was in Vancouver at the Cancer Society. Took me a couple of days to switch... that stupid biological clock and its circadian rhythm! :) Good night everyone. Hope your dream takes you on a tropical vacation (I hope mine will...)

Living amongst tubes and sutures..

Had a rough day yesterday working in the hospital. Sometimes certain situations and certain people make me feel like I'll never be good enough no matter how hard I work. I had been trying not to let these things bother me but I guess my defense finally had a hole punched in it... No worries though. Today I have already picked myself back up and got on with my life :) There is no use dwelling on unpleasant memories. Accept the fact that for some people you will never be good enough. Just do your best and you'll be at peace with yourself and the rest of the world.

Onto the cool stuff... I finally got to insert a Foley catheter and did it pretty quickly without any floundering. Honestly I was pretty proud of that. Now I just want to do more Foley's in the OR!!! Also saw an open tracheostomy done the other day. It was a pretty quick procedure but requires a LOT of attention to details, especially with the thyroid sitting in the way. I got pretty excited when my resident cut into the trachea and the air rushed out hissing... I know... I am a dork and a nerd hahahah :) Tomorrow we will be doing quite a few EGDs (esophagogastroduodenoscopies). That should be exciting since they'll be my first cases! Lots to learn. My brain is on a persistent high these days... along with stress. What a rush!

Carry on my friends! Show the rest of the world (especially those who don't believe in you) that you CAN!

I See You

What I really mean is... ICU. That's the spot in the hospital that I have been visiting a lot. A completely different ball game compared to regular inpatients on the floors. I still find it a little overwhelming when I start on a new ICU patient every time. Most of the time they will have an extremely long and complicated medical history with multiple hospital visits. And they will mostly likely have multiple tubes entering and exiting their bodies that I need to be following. The vitals, I/O, fluids, and wound care. I'm still learning...

At least it has been really sunny here and today I have half a day off. And tomorrow I don't have to wake up at 4am! That thought alone always brings me joy these days hehe :) Still a never-ending amount of reading but all of it is actually very interesting. A lot of information but hopefully it will all stick at some point. Oh surgery...

Mother's day is TOMORROW everyone! Don't forget to send your mom some hugs and love :) They are the best and totally deserve it. Love you mom!! Wish I could be there with you... Enjoy the weekend!

1/3 Way through...

Back from the dead. Sort of. That's if I don't count the sleep deprivation. Today is the last day of my first month in surgery. I'm on call tonight. And the following Monday I am starting under a different attending. 2 more months to go! :)

I have been learning a lot just rounding everyday on my own and with my residents/attendings. One thing I have realized is I like being at the bedside. In my first 2wk I was in the OR assisting surgeries. Most of those patients were outpatients with a post-op stay of 5hr max, so I never got to talk to them and know them. The only chance I had to talk to those patients were during the pre-op hour when they were getting prepped for surgery. However, when I started working with the trauma team I had a lot more exposure to inpatient care. Most trauma patients had to be in the hospital for days, some even weeks. Common injuries included falls (w head injuries), MVA, gunshots etc. I really enjoyed working with trauma. We got to follow up with patients everyday, learn their medical hx and follow their progress. I'm certainly getting better at writing those SOAP notes (so many everyday...) I feel.

Saginaw is quiet. Despite the unexpected snow/hail earlier this month, the weather has turned around. We are supposed to get sunshine all week coming up. I'm excited even though I'll probably not see much of the sunshine...

Missing home a little bit. And missing my friends. Hope everyone is doing well :)

Surgery

Finally I get to take a breather mentally and physically. Time to look back and try to remember what on earth happened in the past week! Surgery rotation has been tough. You can say it's intense, scary, exhausting, whatever terrifying adjectives you can think of - they all apply here. Having it as the first rotation ever also makes it just a little bit harder.

However, I am still alive.

Sleep is overrated. At least I have to keep telling myself that. Being on the hospital floors 12hr a day on average gets crazy after a while. You are always on the go. When your pager goes off, you'd better get your butt to where you are needed stat. The surgeries are fun but can be 'labour intensive'. When I scrubbed in for 4 surgeries in a row on day 1 and 3 in a row today, my legs nearly gave! Need iron legs if your goal is to become a surgeon. So far I have gotten to assist in surgeries and have had a few opportunities to suture. Also got a chance to being on the trauma floor with my resident when I was oncall.

Yes, I am sleep-deprived. Yes, I need to buy groceries. Yes, I need to read lots and lots of pages before I sleep tonite... :) Yes, I am a crazy medical student.

Getting closer.

Finally I can take a breath. Inhale past my dangerously inflamed tonsils. Pain!!!! Not sure how I survived the past 4 days with a fever and sore throat, yet still got a car, shopped for the new place, and got the essentials. I feel tired right now, mostly from the sickness. But all is good :) The basics are done. And I can focus on settling into my new place before rotation starts (in 5 days). First one is surgery and I just got notified today that I may be getting OB as the second rotation (also with Synergy). Will update once I get a confirmation.

I have been on a more or less liquid diet because of my throat. And even liquids hurt me when I swallow. Sooooo miserable. I want this pain to leave me for good!

The picture is a view to the outside from my (new) table hehe! Nothing fancy. Just cheap student furniture. There is lots of snow outside from over the weekend (which I gladly missed). Temperature is slowly going up but still low. I miss the Vancouver climate. Oh well, suck it up right? Yes yes...

Leaving again... but not on a jet plane.

This time I am busing to Seattle first and flying from there. Another big move... this time without the precious help of a roommate who knows everything. A bit stressed with everything that's going on. Plus I am missing a couple of documents, which means I have to re-enter US at some point to obtain my visa.

Going to explode...

Next destination: Michigan - again?

A few days ago I got a call from the school office. We worked out my initial schedule with my first rotation. It will be SURGERY. Yes... we shall see if that's a blessing or a curse. But it'll be at Synergy again in Michigan. That I am very happy about since I plan to do most of my rotations there. But time is tight now. The rotation starts on Apr 1 and I have a crap ton of things to take care of and/or prepare before the start date.

My long list of things to do included finding a place to stay, figuring out the best flight, finding a friend who can get me from the airport (no transit in Saginaw to take me to my place), contacting student loan services and on and on.... The moving is going to be a bit difficult this time, having to get furnitures on my own. We shall see how that works out.

Oh boy, will be on my way again in just over a week... Happy St. Patty's!

First step is over!

I received my score this morning for my USMLE Step 1 :) I won't be sharing my exact score publicly but what I can say is that I am happy with what I got (in all honesty I expected worse!). Caught me by surprise as I did not expect the score to come out today. This past weekend I spent my time in Seattle and got back to Van yesterday. And inevitably last nite was my catch-up-on-sleep night... so this morning I was still cloudy in the head when I checked my email. But was definitely getting palpitations when I realized my score report was only one click away!!

Finally I am going to be starting my rotations! So excited! We shall see what the future has in store.

What do I do with all this free time??

So the dreadful Step 1 is over. Well it was over on Thursday. I spent this amazing past weekend enjoying the city with great food and company. Today is sunny. And for the first time since a long time ago I am standing in the sunshine soaking it all in, letting the warm feeling flow through me. I can't stop smiling. Work hard and play hard. It is pure, beautiful magic.

Thanks to all the friends, family, and fellow medical students who sent me words of encouragement when I was feeling scared, anxious, nervous. With your support I made it over another obstacle, even though it is only one of the many to come. But you know, I am not scared. I know I have it in me. And I know you have it in you. Also we have one another. What is there to be scared of? Strength is a form of energy and it definitely transforms depending on the temperature of the situation. But it will always be strength.

I am still a bit antsy, knowing that my score is still yet to come out. But I am not going to hold back and prevent myself from enjoying my much-deserved free time! Yes, I am a med student and I put myself through what may seem like unreasonable torture. But the reason behind my behaviour comes through once in a while. It is the ultimate release that keeps me pushing my limits. And I love it.

No regrets.

3 more days

Monday, cloudy with showers. But I feel calm. This could be the calm before the storm but for now I am at complete ease. Gonna try to just go over some of my weaker areas between now and, well, wednesday. And will be taking Wednesday off before I do the exam on Thursday.

I don't feel completely ready for this exam. But I don't think I had ever felt entirely ready for any exams in my life. However, I feel that I have done all the studying I could so far and my brain is starting to get tired. That is how I know it's time for me to do the exam.

Will go running later today to keep my mind relaxed and fresh :) Have a good Monday everyone!

11 More Days!

Alright, alright... this countdown is a bit too fast! At least that is what it feels like to me. On one hand I am excited that I will be ending my miserable mad studying for a few weeks... on the other? Well, ask the nerves. I spoke with a friend who just took her Step 1 a few days ago. Talk about envy! I was feeling it... hahaha I just want this OVER with. But of course, I still need to do well. This is an exam that you can't just say 'I don't care' to.

I am consciously suppressing my thoughts that involuntarily drift towards holiday planning... Yeah, there will be so much free time after I finish this exam and I will be having my vacation while everyone else is working! Even though it's not summer I think I will be on cloud nine.

Lately I have been just going over blocks and blocks of questions since I have finished reading the texts. Lots to learn it feels like... never enough time. What is new?? Hahaha the typical medical student mentality. Anyhow, gotta rest and continue tmr! Good nite world.

Still alive...

I feel like I disappeared for a little bit. But I'm back. There are 20 days left till my Step 1 exam. I hope I will feel ready by the time it comes - trying not to push it back based on my pre-exam anxiety.

Studying has been really slow. Some sections like Neurology takes SO LONG for me to absorb. I ended up not going to the library because I am too lazy to travel. So since day 1 I have been studying at home, and it has been working out great. Lots of things have happened since - the good, the bad, the fear, the excitement. But you know what? You just gotta roll with it. No one promised that it is going to be a smooth ride. As long as you focus on your goal and deal with the curveballs thrown at ya, a little bump here and there makes things more fun :)

I have some friends who had to retake the Comp recently. And I admire them so much for trying again! That is true courage, regardless of the results. Compared to them I feel like I could learn to be stronger sometimes. Getting through medical school is a tough job. It is an unpaid full-time job with lots of over-time, still unpaid. Some may say otherwise. But for a person like me - average intelligence, average endurance, addicted to sleeping - I find it challenging. Yet, these challenges are what I live for. I am ok with not being the top of my class. I am ok with the extra hours I have to put in just to get a decent grade. If someone asks me whether they should goto med school, I will still say yes - but I will suggest that they first find ways to reaffirm their passion.

Lately through talking to some friends from time to time, I realized that what makes or breaks you is (for the most part) decided by you. We have the upper hand in most situations but we don't always see that. Maybe that is when good friends come in handy as they become the reflection of your inner strength. Yes, you need to see it again. Over and over.

Keep on moving. Because we are all in this together.

More things I learned...

1. Mittelschmerz is an actual word. It means 'ovulatory pain'. Occurs in a small portion of women of reproductive age. Basically the follicle containing the ovum ruptures (ovulation) and releases some blood, which ends up irritating the peritoneum. In some women this causes pain and could look like she is having an acute appendicitis.

2. If you keep your neck submerged in water, such as sitting in the deep end of kids pool - after a few minutes you'll get the urge to pee. That is due to the effect of stimulation of the carotid body, which with an unknown mechanism increase release of ANP (atrial natriuretic peptide). ANP increases Na+ loss through urine, thereby increasing urine output. You may feel too guilty to pee in the pool, but the kids won't...

3. If a patient has low blood sugar, check serum level of c-peptide. If c-peptide is high, you know the patient probably has an insulinoma (tumor of beta-cells of pancreas). If c-peptide is low, well, the patient has been stabbing him/herself with insulin needles too often!! The latter is called a factitious disorder, where the patient is conscious of his/her doing, but without a particular motive.

4. Atkin's diet. I'm sure we've all heard of it. It's based on the idea that fat cells can't absorb fat on their own. They need glucose (carbohydrate). So if you eat a lot of meat without any carbohydrate then all of the fat eaten is not absorbed. But come on.... carbohydrate tastes so good!! Think about all those freshly baked loaves of bread...

Happy Monday! :)

Some things I learned today...

When you get bored, think of the following...

1. Next time someone has garlic breath, a fun thought is that they are suffering from Arsenic poisoning (stomach pain, vomiting, delirium). Antidote is Dimercaprol to remove Arsenic from inactivated enzymes.

2. Thiopental is used in induction of anesthesia due to its short-acting nature. It's rapid plasma decay is due to redistribution into skeletal muscle and fat, NOT due to metabolism (although hepatic metabolism is required for it to be eliminated from body).

3. If someone stinks after sweating, it's because his or her skin bacteria are doing a very good job (and perhaps he or she needs to shower soon). Apocrine glands secrete vesicles of 'sweat' into hair follicles. But this usually has no odor. Odor comes from bacterial activity on skin surface!

4. 'Water-balloon' testes are due to serous peritoneal fluid flowing into and collecting in tunica vaginalis.

5. If you poke someone's perianal area with a pin and do not see a reflexive sphincter contraction, they might have Saddle Anesthesia. This is often caused by Cauda equina syndrome where a ruptured disc or a space-occupying lesion compresses the cauda equina.

Back to studying!!