Island Med Student

Today was yet another wonderful, great, fantastic day of family medicine clinic. It was also my first day of real pediatrics. Up until this point, I’ve pretty much only dealt with patients who were 16+. Almost all of my patients were adults, and most of them have been older.

I haven’t had pediatrics yet, and in fact I won’t have my pediatric rotation until after I take the Step 2 CK and CS. However, peds is a part of both exams. So, I’ve been a little worried that I wouldn’t be prepared for the Step. The same thing goes for ob/gyn. But family medicine has saved me! Since family medicine includes pediatrics and ob/gyn, I’m gaining experience in both. And I really think this is helping to prepare me better for the Step.

My first patient today was a 4-year old child. She was sick and cranky and wanted nothing to do with the girl in the white coat (me). I consider myself to be pretty good with children. They tend to like my strange hair, brightly colored clothing, and general “clown-ness.” BUT, I have never had to poke, prod, and stick a child. Nor have I approached a child while wearing a white coat. Well guess what? Kids don’t like scary people in white coats trying to stick things in their ears!

Long story short, my patient was not having any of it. She cried when I got close to her, and refused to let me examine her. So, I had a thought. She was wearing an all pink outfit. She had a pink book bag. What to do? Well, my favorite color happens to be pink. So, I asked her, do you like pink? YES!! She loved it. So, I pulled out my pink phone. Many people like to make fun of my phone. Yes, I am a grown adult and yet my phone is covered with a pink cover, decorated with flowers. My screen is almost completlely covered with star and butterfly stickers. You think it’s silly? Well, my patient did not! She loved it!

So I asked her what her favorite cartoon was. Spongebob! Well, I pulled up episodes of Spongebob on Youtube. I made a deal with her. If she let me examine her, I would do so while she got to watch Spongebob on my pink, covered with stickers, phone. Deal!

I have so many other stories to tell, but not the time to write them. But I also ended up examining a 6 month old baby, and several other kids. I gave vaccinations. I bribed kids with stickers. I pulled out my phone on more than one occasion. Maybe my silly habits aren’t so silly afterall. Or at least not when it comes to pediatric patients.

My attending also gave me so many compliments on this shift. She said that I have outstanding bedside manner. She said that I make everything seem so natural. Like I don’t even have to try. The thing is, I don’t. I just like people. Old ones, young ones, purple ones, crazy ones, dirty ones. People are my people. And that turns out to be a very good thing in medicine! I can’t explain how great it is to be appreciated for what I just do instinctually. It’s just utterly amazing, and I’m so grateful to be able to connect with people.

More good stories and thoughts to come!

Note: First photo is me, and my insane phone. And the second photo is of a deserted building I pass by all the time in Bushwick.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I don’t want to bore you all and repeat yet again how much I’m enjoying family medicine. But anyway, I am!

Clinic is AWESOME! And I think maybe the best part is that I think I’m good at it. Everyone keeps telling me how natural I am at it. It’s tres cool.

However, there is only one problem. My Spanish is crap (and 90% of my patients are Spanish speaking). It’s gotten better since living in Brooklyn (in a very hispanic neighborhood), but it’s still far from good. The other day, I had 3 patients in a row who spoke almost zero English. It was nearly impossible to take their histories, and the “language line” is such a pain to use, that it’s almost not worth the effort. If I just spoke more Spanish, I could make myself indispensable, which is what I want to be.

So, I’m considering various options to learn Spanish. Anyone have any good suggestions? Rosetta Stone?! Obviously, just immersing myself in it is not working. I’m getting better, but I still need a lot of help (and using my electronic translator is just too slow…I want to speak it!)

Also, I wanted to post three pictures of some memorials that I see on my walk to the hospital every day. I just think they’re very cool.

I need to learn mucho mas Spanish! Ayuda!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I really can’t say enough how happy I am right now. I had perhaps the best day in med school thus far. I took the subway and walked to a health clinic a few miles away. I was set up with a resident and met four patients. The resident was so awesome! He let me do everything. I did the H&Ps, wrote the SOAP notes, and even wrote the orders for all the patients. I did good! My resident and attending both complimented me on my skills.

One of my patients presented with a simple complaint, but when I pressed further, she admitted to me that she’s been under a ton of stress lately. She ended up bursting into tears, and I ended up giving her a hug and consoling her. Is it okay to hug patients? Well maybe not in all cases. But I believe that I did the right thing. I think I’ll write more about that later. But she thanked me. She told me that I was a great doctor. I felt like I did something really, really good.

I am just enjoying family medicine so much. I also really liked my first out-patient experience. Up to this point in med school, and in my personal work experience, I’ve only dealt with patients in hospitals. It was so good to have some actual clinic experience.

I even diagnosed a dermatological condition that my resident had never heard of! Talk about impressed! Both my resident and attending gave me mad props for that one.

The weather was nice. I walked my doggies. I’m getting ready to eat some vegetarian chili. Life is good. Very, very good!

Note: Photo was taken at the end of a recent family medicine night-call. I was tired, but happy.

I just finished up my second week of my family medicine rotation. The first two weeks I was on night-call at the hospital. I have learned more in two weeks of rotating in family medicine than I did in twelve weeks of internal medicine. The residents give med students a lot of autonomy, and are also really into teaching. I performed my first pelvic exam, and I am now a pro at performing digital rectal exams. The patients I’ve seen presented with a variety of complaints. I’ve admitted both elderly folks, and a few children as well. I’m starting to actually feel like a real doctor. Not only that, but I think I might just be falling in love with family medicine.

If you asked me two weeks ago which speciality I planned on pursuing, I would have told you that there was a 90% chance that I was going into psychiatry. I have always loved psych, and I could easily imagine myself pursuing that specialty for the rest of my life. But now I’m starting to wonder if that’s true. I’m seriously considering what it would be like to pursue family medicine.

I think the coolest part about primary care, and family medicine in particular, is the variety of diseases and patients you treat. Instead of specializing, and focusing on just one aspect of the patient, you really have to consider the entire person. Not only that, but with family med, you treat all ages. You have to posses at least basic ob/gyn skills. You need to have a mastery of pediatrics. There is just so much more to consider, and the skill set seems larger than with other specialties.

Some people might liken the field of family medicine to being a “jack of all trades, but master of none.” But from what I’ve seen thus far, it’s more like “a master of a few trades, and a jack of many.”

The next two weeks of my rotation will be spent at a clinic close to the hospital. I am absolutely thrilled about experiencing all that the clinic has to offer. Thus far, I have only spent time as a medical student inside the hospital. This will be my first out-patient rotation, and I have a feeling that it’s really going to change my perspective and hopefully broaden my horizons.

I think another part of the appeal of family medicine for me is that I am distinctly aware of the importance of primary care medicine. I believe that the nation is in fact facing a shortage of primary care physicians, and I really like the idea of being a part of the solution to this problem.

The only issue is that I already scheduled two psych electives for this summer. If I’m not going into psych, it would be a better idea to pursue more electives outside of psychiatry. So now I have to decide how serious I am about this whole family medicine idea, and determine whether or not it’s in my best interest to change my schedule.

No matter how things turn out, I am so grateful to have had all the incredible learning experiences that I’ve been lucky enough to enjoy during this rotation. I guess only time will tell. But I’m excited to have a whole new world of possibilities opening up to me!

Click Here To View the Original Post on Medscape

I just got home from family medicine night call. Wow, what a great night! So far, I am absolutely LOVING family medicine. I’ve learned SO much! And we are allowed and encouraged to pretty much do everything for our patients, including the H&Ps, procedures, writing orders, etc. There is a lot of autonomy, and that’s just what the Dr. ordered for Kendra.

I don’t know if it’s the fact that I haven’t slept all night, or something else, but I am really having some profound life-altering thoughts. Before starting family medicine, I was 95% sure that I wanted to go into psychiatry. But right now I am having second thoughts. I really like family medicine. It’s interesting and good and nice and well I don’t have enough functioning neurons right now to say much more than that. I really like it.

Maybe I will have to change some of my electives. Maybe I will have to change my life plan. I dunno, but I know that I’m really digging it.

Tonight was my last family medicine night call. The next two weeks I will spend in a clinic, and hopefully with a doctor who I admire deeply.

Life is good. Life is great. Life is wonderful. (Anyone get that reference?)

My bed is covered with dog urine, but I know I should go to sleep right now, as I have things I need to accomplish tomorrow.

So, good night world! I am thankful for awesome doctors. I’m thankful for kind and awesome residents. I am thankful for my wonderful patients.

Sweet dreams of large women!

I don’t have much time to type right now. I have to leave in 3 minutes to go in for my family medicine night call. I’ll be tweeting the evening again, for all ye curious souls… Saturday nights tend to be busy in the ER, so I’ll likely be swamped all night.

On my one night off yesterday, I got to see my comfort face, Bindaloo, and my son Tom. I had a FAB night and got to dance at several different places. My dancing tends to involve a lot of knee skids and various acrobatic stunts, so I can judge how much fun I’ve had in a night by the number and intensity of bruises on my body the next day.

As you can see from the above photo, I had a blast last night!

Off to the hospital now!

So, I’m post-call right now. I walked home just after the sun had risen. When I got home, Molly (my doggy doo) peed on my bed. Nothing new. Now she’s jumping up and down on my bed while swatting at her bone. Nothing new. She just doesn’t get the fact that I’ve been up all night.

Funny thing is that I’m actually not sleepy. But I know that I “should” sleep, as I really want to hang out with some friends tonight (and tomorrow night I have to go back in for another call). But I kind of want to just stay up. But I know if I do, I’ll never make it until tonight. But I don’t wanna sleep!

Also, I’m hallucinating.

Note: Just took the above photo a few minutes after coming home from the hospital.

I see this sign almost every day, and it never fails to crack me up.

In other news, I’m getting ready to go in for another 12-hour family medicine night call. I’ve also decided to twitter my entire shift. You can follow my tweets here. Probably, no one really cares about my silly tweets! But honestly, it keeps me from being bored, so I’m gonna do it anyway!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

If you’re reading this right now, chances are that you read a lot of blogs, and hence have heard of Twitter, a social networking and micro-blogging site. I must admit that I am not the hugest fan of social networking sites, in general. My friends had to force me, kicking and screaming, to join Facebook. Getting me to join Twitter was an even more difficult venture. But eventually, I joined both. I still have mixed opinions on them, but I’m starting to like Twitter a little bit more. (Probably has something to do with the fact that I can’t stand all those stupid applications on Facebook. You threw a turkey at me? Great!)

Many medically related blogs have begun posting “tweets” from a variety of sources. Some people even go as far to say that Twitter micro-blogging might eventually replace the conventional blogs entirely. I’m not so sure about that.

In the news recently, surgeons at Henry Ford Hospital in Detroit have been “twittering” surgeries live. Surgeons have twittered kidney surgery, brain surgery, and are posting more and more every day. Several other hospitals have also started twittering surgeries and other procedures.

There are obviously a lot of issues here. Some people are all for this new trend, and think that Twitter has created a new, and possibly better way of teaching medical students. Even if you’re not inside the OR, you can still follow the steps of a surgery, and you get to hear about the decisions that the surgeons have to make, and what goes through their minds during surgery. It provides a whole new perspective.

In addition to teaching, it provides the family with real-time feedback during the surgery. No longer is it necessary for the family to sit anxiously in the waiting room for the surgeon to come out and update them on the status of their loved one.

Some people are very against this new trend, however. One of the criticisms is that surgeons should be more focused on the surgery, rather than the twittering. But from what I’ve read, there is always a senior surgeon with the patient at all times, and they trade off on who actually does the updating.

There are also patient confidentiality issues. Patients always have to give permission to allow the surgeons to publish the surgery. But other types of medical twittering bring up more confidentiality issues.

Inspired by this concept, I recently decided to twitter my entire 12-hour night call on my family medicine rotation. Obviously, when I was busy with patients, I was unable to update. But I tried to update afterwards as soon as I could. So, here is a Twitter snapshot of my shift (there are a lot of random thoughts, so feel free to skip to the end if you get bored):

6:30 p.m. – On my way to hospital for night call. Yippee!
7:00 p.m. – In rounds now. Always find your surgeon!
7:32 p.m. – Patient died and came back!
7:46 p.m. – 71-year-old mean man presents to ED…
8:00 p.m. – One hour down, only 11 more to go, and no admissions yet.
8:34 p.m. – Admitted a patient with chest pain and nausea… I’m thinking ACS, costochondritis or GERD…
9:36 p.m. – SWAMPED! Just admitted 3 patients back to back… did a stool guiac.
10:20 p.m. – Patient has rales, pitting edema and positive Babinski… what’s wrong?
12:08 a.m. – I haven’t eaten in over 12 hours. I’m starting to feel the effects.
12:47 a.m. – Just helped stop a patient from attacking the resident because she was Muslim.
2:30 a.m. – Sustenance, finally!
3:00 a.m. – There’s nothing like hanging out at Dunkin Donuts at 3 in the morning!
3:40 a.m. – Brain is showing signs of sleep deprivation… if only I had slept last night.
3:45 a.m. – My nose has elves in it and a resident stole my penlight.
4:00 a.m. – Espresso + step up to medicine book + empty room + black eyed peas = strange fun
4:15 a.m. – “Is this real life?”
4:32 a.m. – I think I have liver spots.
4:44 a.m. – Ativan is your friend. Never turn your back on your friends.
4:58 a.m. – The title of the section of the book I’m reading: diarrhea pearls
5:14 a.m. – Dead Kendra walking…
5:21 a.m. – Sitting in the hospital lobby with homeless people. All my patients are sleeping.
5:37 a.m. – Drunk guy in ER pukes on me and says “I want my free phone call.” I said, “this is not jail!”
5:44 a.m. – Bored again and decompensating.
5:57 a.m. – I think I just pulled up the anchor on the reality boat.
6:00 a.m. – If no more admissions, I can leave in an hour. For goodness sake do NOT come to my hospital!
6:05 a.m. – Walking laps around deserted floor of hospital. Kinda creepy, but keeping me awake.
6:15 a.m. – Walking through ED always gives me a lot to be thankful for!
6:17 a.m. – I would be much happier right now if I were in scrubs.
6:21 a.m. – I wonder if you can OD on twittering.
6:30 a.m. – 30 minutes and I can go home if no new admits. Thinking about blocking ED entrance.
6:50 a.m. – 10 minutes to go. I just had a flat out hallucination.
7:05 a.m. – FREEDOM! The sun also rises….

Congrats if you made it to the end of my tweets! It’s kind of interesting for me to go back and read this in my now fully rested state. It gives me a fun perspective on what was not entirely a fun night.

My tweets are obviously not in the faintest bit as exciting as real-time surgeries. But hey, I made no promises! Anyway, what do you all think? Is twittering in medicine a good thing or bad?

Click Here To View the Original Post on Medscape

It’s 7:30 a.m. on Saturday. I just got home from my first family medicine night call. It wasn’t too bad at all. I did about 5 admissions. I can’t say that I learned anything new, per se, but I did get some good practice at doing stuff like stool guiac tests (always fun!)

I decided to post my entire night on Twitter. You can view the tweets here.

I’m very tired right now, but not sleepy, thanks to the espresso I had around 3 a.m. I am pooped though. I should probably take a shower and brush my teeth right now, but I really don’t feel like it. So, good night!