Island Med Student

In addition to the information I posted about studying for the USMLE Step 2 CK, I thought I’d share with everyone my opinion (and the opinion of other students I’ve met) about which books are best for each core rotation/clerkship.

Internal Medicine: Step-Up to Medicine (Step-Up Series)

Surgery: Surgical Recall, North American Edition (Recall Series)

Obstetrics/Gynecology: Blueprints Obstetrics and Gynecology (Blueprints Series)

Psychiatry: Blueprints Psychiatry (Blueprints Series)

Pediatrics: I haven’t had peds yet, so I don’t want to put this info up yet. I will update this once I take peds, or get good opinions from other students who have completed it!

Check out my post on Medscape to learn about the scary world of residency applications.

Click Here To View the Entry

The past week or so has been hellish. It’s a long and twisted story, but the gist is that I have begun my residency application. Because of timelines and such, I must decide right now, right NOW, what I want to be when I grow up. In other words, I have to choose my specialty. I was brewing over various options, but I kept hitting various walls. It’s basically been a huge emotional roller coaster (thank you Micah for fastening the seat belt).

The big decision was whether or not I wanted to do family medicine, or psychiatry. I am passionate about both. I can see myself doing both. And then a wonderful person recommended that I look at some combined family med/psych programs.

And then BOOM! I found the absolute most perfect, best, awesome, killer program. As I read the description of the program on their website, I thought YES!! That’s me! That’s it! That’s what I WANT TO DO!

The one problem is that the cards are stacked against me. This is a very competitive program, and to make matters worse, it’s in a very IMG unfriendly state. I probably don’t have the best chances of getting in. But I don’t care. I found the program. I am sure that it fits me perfectly. I have always believed that if you want something enough, you can make it happen. So I am going to try and make this happen. I will also apply to many other programs, but I think I have found one that I will truly be happy in.

I’m just so excited right now. I have something awesome to look forward to, and to work towards. And that’s just what the doctor ordered.

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 was absolutely elated by the overwhelmingly positive response that my recent blog post received. The feedback and the poll results definitely proved one thing to me: I am not alone. Not only am I not completely insane for having doubts about wanting to become a doctor, but the vast majority of folks (98%, according to the poll results) have had some doubts about med school at some point in their life.

Reading all the responses to my post was an incredibly rewarding experience for me. Many people shared their own personal stories, and some also offered their advice. I feel so very fortunate to have an arena to share my thoughts, aspirations, and fears with the world.

It really got me thinking about what it means to have a blog, and especially one that is read by many people. It’s sort of like having your own set of personal therapists. I can bounce ideas off of, share my experiences with, and receive feedback from a variety of different folks. In some ways, it’s even better than a therapist I might randomly pick out of the Yellow Pages, as the readers of this blog are generally involved in the medical field, and hence can understand what I’m going through better than the “average joe.” Of course, blogging is no substitute for actual therapy. But it is an interesting complement to the typical therapy that existed prior to the advent of blogging.

Through reading the comments on my entry, I discovered some common themes in people’s stories. In doing so, it allowed me to hone in on some of the possible causes of my doubts about medicine as a career.

It seems as though being a third-year medical student provides some sort of breeding ground for doubts to thrive. After reflecting on this, I realized that this has a lot to do with my angst. Adding to this, is the fact that I worked for many years (14 to be exact) before going to med school. In fact, I had a full-time job even throughout my undergrad years. It wasn’t until med school that I gave up employment altogether. Now I’m a full-time professional student.

The problem is that the third year of med school (in the U.S.) is a limbo period. You are no longer focusing all your time on studying the basic sciences. However, you also know very little about the clinical world. While I have received much training on physical examination methods, history taking techniques, and many other clinical skills, I can honestly say that the majority of the time, I still feel like a complete idiot. I can’t consistently differentiate the various heart murmurs by auscultation. I still miss the vein many times when starting an IV. I have a hard time determining if a person has hepatomegaly. The list goes on and on, but I think you get the point.

As a student, I also have very little actual responsibility. Sure, the doctor listens when I present a patient, and takes my findings into account, but they will still usually go back and check things out for themselves. My treatment suggestions are heard, but they are still merely suggestions. The doctor who signs the orders has the ultimate say, and that’s definitely a good thing because I don’t trust my opinions very much.

As a fourth-year, you are still learning a lot, but from what I’ve seen, you have the confidence that comes with practice. And doctors are more likely to trust your findings and treatment plans.

When you take all of these factors into consideration, perhaps you can understand why the life of a third-year med student can be rough at times. When I worked at the AAMC, for example, I got paid to do tasks, and I did them all fairly well. As a third-year med student, I pay to do tasks, and I do them all fairly poorly. It’s an unnerving reversal of lifestyles.

After reading all the responses to my post, and evaluating my options, I’ve developed a rough draft of a plan for the next few years. I’m going to keep trudging along, and try to complete my M.D. degree. After I graduate, I will either apply for a psychiatry residency, apply to a clinical psychology Ph.D program, or perhaps I will open an animal rescue shelter. I really don’t know at this point. But for now, I will focus on the goal of receiving my “piece of paper” and try to develop some sort of plan along the way. I will also attempt to spend more time with my patients, and I have a feeling that in doing so, I will remember the reasons why I was initially inspired by a career in medicine.

Click Here To View the Original Post on Medscape

A few weeks ago, I had an experience that has really stuck in my head. The resident and I were performing a painful procedure on a patient, and I could tell that he was really enduring a lot of pain by the grimace on his face. As I’ve done in the past, I instinctively reached out my hand and held his hand in mine. I allowed him to grip my fingers, and told him to squeeze my hand as hard as he needed to.

He started squeezing my fingers, and suddenly his face turned from a grimace to a smile. The change was rather startling, and so I jokingly told him that I’d never seen a patient with such a huge grin on their face while undergoing such a painful procedure. He smiled even more and said that it was because he was so happy to hold such a “pretty girl’s” hand. I smiled back, and soon the procedure was over.

I think it probably makes common sense that hand holding might bring some relief from pain. We all reflexively hold a child’s hand when they’re in pain. And I believe that even the most callous people might agree that there is something powerful about the human touch. Hugs are an even better example. I don’t know when the hug was invented, but I’m sure that it’s been around for quite some time. People of all races, ethnicities, and cultures seem to use the hug as a means of displaying affection. And while certain cultures might value human touch to varying degrees, I think we all agree on its significance.

One of the most well known studies on the power of touch and the importance of physical and social interaction is that of Harry Harlow. In his famous experiments, he allowed rhesus monkeys to choose either a cloth or wire “surrogate mother,” both with and without a bottle of milk attached. Regardless of which mother had the bottle, the monkeys continued to choose the softer, cloth mothers. He also performed other controversial experiments, including ones where he deprived the monkeys of all physical or social interaction. The lack of physical touch produced monkeys with severe psychological pathologies, and in a few cases led to their deaths from self-induced starvation.

A study recently published in the journal Science also found some interesting results with regard to “warm hands and a warm heart.” The researchers found that if people were given something warm to hold, they subsequently described other people as having “warmer” personality traits, such as being more generous, more social, happier, and better natured. They also discovered that people who held something warm were more likely to behave in a friendly and generous way.

I’ve only begun to scratch the surface of the importance of the human touch, but you can see that the subject is much more than simply skin deep (pun intended). I tried to find some research that supports my anecdotal notion that holding someone’s hand who is in pain can serve to decrease their perception of the pain, but I was unable to find much research on this topic. Perhaps it’s a topic that will be further explored in the future.

But for the time being, I will continue to hold my patients’ hands. Whether they are in pain, or just very sad, or just very lonely, or even just very happy, I will continue to offer my hands to them. And hopefully when I need a hand to hold, someone will do the same for me.

Click Here To View the Original Post on Medscape

Yesterday was an uncharacteristically eventful morning. I awoke to the sounds of my doggies whining and I immediately knew that the only way to shut them up was to take them for a walk. I woke up my partner, Micah, and we hooked their leashes to their collars and headed down the stairwell of our apartment building. Halfway down, we saw a young man sitting beside a slumped over female on one of the stairs. While he looked distressed, it seemed like he had everything under control, so we just continued walking.

After taking the dogs to the park to do their business, we returned to our apartment building. Before we even got inside, the young man from the stairwell rushed out of the front door with a frantic look on his face. “Please, can you help me?!” he screamed anxiously. “Yes, what is it?” I replied. “My friend, I can’t get her up…please help!”

As soon as I heard those words, I spontaneously switched gears from doggy walking to emergency mode. When I opened the door to the apartment building and saw the young girl sprawled on the floor in front of the stairs, I immediately began creating a differential diagnosis. Could she have fallen and fractured her skull? What if she had become severely hypoglycemic and had a syncopal episode? Could she have just experienced a tonic clonic seizure? Perhaps she had a myocardial infarction secondary to a cocaine overdose? And of course, the most immediate possibility that came to my mind was that she was simply very drunk.

I was suddenly acutely aware of the details surrounding me. I noticed that the young man had a fairly heavy smell of alcohol on his breath and that his clothes were stained with paint and dirt. I surveyed the area and checked for any sharp or otherwise dangerous objects and saw none. I observed the position of her body and deduced that she most likely had not fallen down the stairs.

I leaned down to her and asked her loudly if she was okay. “No, he won’t leave me alone!” she replied. I asked her if she’d been drinking and/or done any other drugs and she admitted to drinking but denied using anything else. She was obviously agitated and as I leaned towards her I could detect alcohol on her breath. We went back and forth for a few minutes and she became increasingly belligerent and verbally abusive. She started screaming profanities at me and the young man, who I discovered was her boyfriend.

To make a long story short, I eventually realized that she was just very drunk and upset with her boyfriend. He was trying to get her to the car, and she kept physically attacking him and screaming. She made threats to attack me and called me some very unpleasant names. By this point, I had switched gears yet again into more of a psychiatric emergency mode. I tried using some techniques to calm her down and diffuse the situation. Luckily, having been called every name in the book already, her comments failed to offend or upset me.

After over an hour of failed attempts, I realized that I had no other choice but to call the police. So I dialed 911 and waited for the cops to arrive. They showed up just a few minutes later and I gave them a full report, including my information in case they needed to question me again. The police also failed to reason with the girl, so they eventually handcuffed her and hauled her off in a van to the police station for booking.

For the rest of the morning, I thought about the sequence of events surrounding the girl. I wondered if I would have responded to the situation the same way before going to med school. I guess most of it was really just common sense. But on the other hand, things could have turned out differently. She could have had no pulse, or been in the middle of having a seizure, and things would have been more serious. I don’t know if I would have responded as calmly or even remembered what to do. At the very least, I guess I gained some practice that I can use with actual patients in the future.

Click Here To View the Original Post on Medscape

My mind is currently filled with an amalgamation of excitement, fear and a feeling of accomplishment. A few days ago I found out that I passed the USMLE Step 1 (yay!). That once seemingly huge and insurmountable obstacle is now nothing more than a blip on the radar screen behind me. For a few days, I basked in the satisfaction of having a profound sense of achievement.

Today, I took the final exam for my psych rotation. I can proudly say that I finished my first rotation in the States, and judging by the marks on my evaluation, I did an outstanding job. So, that is behind me now as well.

Just when I felt like I could let out a huge sigh of relief and sit back and relax, I had a bomb dropped on me. I’m currently living in Baltimore, Maryland, and had hoped to do all or most of my clinical rotations here. My school has affiliations with many different hospitals all over the country, and around five of them are in the Baltimore area. When I received the paperwork with my rotation schedule for the next nine months, all of the relief and relaxation made a furious exodus from my body, and was immediately replaced with fear and anxiety.

I found out that I was scheduled to begin a surgery rotation in Brooklyn, NYC in three weeks, and that I’d be spending almost a year finishing my rotations in Brooklyn and two other cities in NYC. There was a point in my life where this information would have made me immensely happy, but I’m not currently at that point. You see, my partner and I just recently moved into an apartment in Baltimore. All of my earthly belongings are here. And that’s not the bad part. My partner is starting a graduate art program at a local university just a few blocks away. His program begins in September, and lasts for two years. So, what this means is that he won’t be able to come with me to NYC. Not only that, but practically speaking, I won’t be able to bring either of my dogs to the city. In just a few weeks I’ll have to leave my partner, my dogs, my apartment, all of my friends and family, and most of my belongings behind.

I’m still in the midst of working with my advisor to get some of my rotations scheduled in this area, but I’m not sure if it’s going to work out. If it doesn’t, I will be spending anywhere from nine to seventeen months away from everything familiar to me.

There is a part of me that is very excited about this upcoming adventure, but another part of me is scared to death to leave my life behind. One of the reasons that I chose the school I’m attending is because I knew that it would involve a lot of travel. I got to live in a foreign country for almost two years, and I knew that my clinical rotations could be scheduled at many hospitals throughout the country. But I think I forgot to take into account the effect of having to be separated from my loved ones (partner and doggies!). I’m questioning whether the adventure of travel is worth the sacrifice of leaving my loved ones behind.

But, I know that I’m up to this, and that I have overcome many larger obstacles in the past. So, I will just keep telling myself that, as I pack a small portion of my belongings into my two pink suitcases and hop on the bus to Brooklyn to discover what lies ahead.

Click Here To View the Original Post on Medscape

That’s right, I’m finally on my summer vacation! Today I took the final exam for my psych rotation. The good news is that I’m now ready to begin my next rotation. The bad news is that I’m having problems with the Ross clinical department. They scheduled me for the next 9 months in NYC. I wrote a Differential blog, which outlines the issues, but the gist is that I’m excited and upset right now. I don’t know what my future holds.

Either way, though, I have at least a week with no rotations, so I’m enjoying my time off. My current aspirations include going out and eating tons of Baltimore crabs, going to the beach, traveling to Luray to visit the fam, and visiting Six Flags to ride as many roller coasters as possible. If I can just find a swimming pool and some candy apples, my summer will be complete!

This whole Internet ordeal is really starting to rub my pancakes. We can’t seem to get Verizon to actually provide us with a service that works. I could go in to a full blown rant right now, but I shall not. The point is that I’ve barely been able to access the Internet lately, and it’s starting to drive me insane!

Speaking of insane, I have learned so much during my psych rotation. I can’t believe I only have less than two weeks left! Here is a very abbreviated list of new stuff learned:

1) What tardive dyskinesia looks like and how to treat it (there isn’t much you can do but discontinue the offending med, give vit E, and switch to Clozaril, if possible).

2) How to choose the best antipsychotic medication for a patient (are they obese? are they pregnant? are they elderly?, etc.).

3) Believing that you’re Jesus Christ incarnate does in fact mean that you are delusional, but it isn’t necessarily an obstacle to a fairly well adjusted life.

4) Patients with borderline personality disorder are indeed difficult to treat (actually, I already knew this one, but had the point reinforced).

5) The FBI and CIA are very busy bothering many innocent folks and should stop infiltrating and destroying families (okay, so this is according to my patients).

6) Some times you have to put your neck on the line to help a patient.

7) Grandiosity is a fabulous defense.

8 ) How to diagnose and treat mood and anxiety disorders.

9) The difference between obsessive compulsive personality and the disorder.

10) One theory of anxiety disorders is that they are a result of our subconscious homicidal instincts.

11) How to differentiate between delirium and dementia.

I just posted a few pics of the Boxcar Collision show the other night. I am too tired to add captions, so you’ll have to add your own.