Island Med Student

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.

Life for me is pretty cool right now. Today was my last day of radiology. I have one week off until I start an adult inpatient psych elective. I take the USMLE Step 2 CK in 4 days. I will be taking the last NBME practice exam tomorrow. It should be an excellent proxy of my real score on the exam. I have all kinds of random medical facts floating around in my skull right now. Am I freaked out about the exam? Not really. In true Kendra fashion, I’m not really sweating the exam. I never was one to get my panties in a bunch about a test. It’s just yet another hoop that I have to jump through to prove that I can be a doctor.

In other news, I went on another awesome run today. I think I have run over 40 miles so far this week. Not too shabby. And I have the legs to prove it. Is it just me or is the best thing in the world going for a super long run, hitting it as hard as you can, becoming completely soaked with sweat, and then coming home and taking a shower and putting on comfy clothes? Seriously, it is so sweet.

I just ate some yummy vegan Thai food. Speaking of, Jorkers, thanks for the comment about my tagged Del Sol! You made me laugh so hard I almost peed my pants! (I liked it better than Pirates of Penzance.)

The food is kicking in, and my poor bones are tired, so it’s time to watch some mind numbing movies and call it a night. Only four more days of studying, and I can finally take a breather. Hugs to the world!

Note: Photo is me post-shower in my comfy clothes and chillin in bed. Miso happy!

Here is the long-awaited list of some more “stuff learned” in radiology. As always, this list is very incomplete.

1) You have to have at least 400 cc of fluid to be able to recognize and diagnose a pleural effusion on x-ray.

2) A positive HIDA scan is when you can’t see the gallbladder.

3) To best diagnose an aortic dissection, you should get a CT with contrast.

4) If someone ODs on heroin, you miss see massive pulmonary edema on CXR.

5) A right lower lobe pneumonia does not obscure the right heart/lung border, but the middle does.

6) A left upper lobe pneumonia obscures the left heart/lung border.

7) Osteomyelitis tends to go to the vertebral discs, not the body.

8 ) MRI can date a fracture, whereas x-ray and CT cannot.

9) A sign of tethered cord syndrome is a sacral dimple.

10) Charcot’s joint happens to diabetics. Because of neuropathy, they feel no pain, although their feet can be destroyed all the way to the bone.

11) A fat pad sign is seen with a fracture. The fluid in the joint displaces the fat pad, and you can see it on x-ray.

12) Osteomyelitis doesn’t show up for over 3 weeks on x-ray, so doing a bone scan can help you better diagnose.

13) Your “5 friends” on a chest x-ray are trachea, heart borders, hemidiaphragms and costophrenic angles, and aortic arch. You should also look at the hilum, and pulmonary vasculature.

14) Beware “breast attenuation” on female chest x-rays. The breast tissue can make the film appear more congested.

Note: Photos are of my bestest buds in Dominica, the Ren brothers. Oh how I miss them!

It’s Friday again. That means that I took another NBME practice USMLE Step 2 CK exam (3rd one out of 4). I totally spanked it. I am teeming with happiness right now. My study plan is working out even better than I had anticipated. I done real good. Anyway, my brain is now fried, so I don’t have anything else to say right now. I promise to write some really good stuff tomorrow, including fun radiology tidbits.

For now, enjoy these two iPhone pics I took today. One of a cute doggy doo behind bars, and another of a discarded tree. Seriously, someone threw away a perfectly good tree!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Today was a great day. After radiology, Micah and I went to a little mini-nursery and picked up some planters, plants, seeds, and soil. We made a little garden on my fire escape (soon to be bigger). It’s amazing how good your improvisational skills become when you have so very little space to work with.

I studied all day and then went for my daily run, which involves running over the Williamsburg bridge into Manhattan. Man, I love my runs. But I’m pretty pooped right now. I just realized I’ve run over 30 miles already this week. My poor muscles are dying. Actually, I took a bubble bath to help soothe my muscles once I got home. Then I splurged and ordered sushi delivery for dinner. So very, very yummy.

I’m completely pooped right now, so that’s all I have the energy to say. I have learned a bunch of stuff in radiology, but you will have to wait in suspense to hear all about it. Right now it’s time for a movie (instead of reading). I just don’t have enough brain power left to read words.

I can’t wait until my garden starts growing!

Here are some more random tidbits for your reading pleasure:

1) Sonar technology was first developed around 1942. Soon thereafter, some scientists put pregnant women in water, and were first able to visualize fetuses with sonogram technology.

2) Humans can recognize 16 shades of gray.

3) “Air is the enemy of sound,” when it comes to sonograms.

4) When using a doppler to visualize arteries and veins, blue means blood is moving away, and red towards.

5) If a patient has AIDS nephropathy, their kidney will appear all white on sonogram, and with hydronephrosis, it will appear all black.

6) Gallstones will cast a shadow on a sonogram because no sound can go through them.

7) To differentiate between a polyp and a gallstone on sono, have the patient sit up. If it moves, it’s a stone!

8 ) MRs stretch bonds between atoms, they don’t break them.

9) 90 degree deflection of hydrogen atoms is called “spin echo” imaging on MRI.

10) In MRI, a T1 image is a H+ molecule moving from the x-y plane to the z plane.

11) A T2 image is a H+ molecule regrouping into the x-y plane.

12) If you use gadolinium contrast for an MRI, the patient can get nephrogenic systemic sclerosis.

Note: I didn’t have any good radiological images to use for this post, so I picked some random iPhone images instead. Enjoy.

This past Saturday, to celebrate my one week of hardcore studying (hey, I like to celebrate everything!) Micah, Tom and I all went to the Atlantic Avenue Artwalk, which was billed as a totally free few blocks of open galleries, shops, and studios. I was a little disappointed by the fact that there were very few studios, and too many “stores.” But I had an awesome time seeing a few places. Our first stop was the Morbid Anatomy library, which was my main interest. I got to look through some awesome books that I had been really looking forward to viewing.

Later in the evening, my friends Keith and Carlos were able to meet up with us for some beers. I had so much fun enjoying the weather on Saturday, and then I basically laid around like a lazy bum on Sunday. Now it’s Monday, and it’s back to studying and radiology. Speaking of, I will be posting some more “stuff learned” later today. I also need to catch up on emails.

Anyway, we didn’t take very many pics on Saturday, but you can click here to view the ones that we managed to get early in the day.

Here is an incomplete list of some “stuff learned” thus far in my radiology elective:

1) For MRIs, in T1 images, fat appears bright and water appears dark. In T2 images, water is bright and fat is dark.

2) In a diffusion study, CSF appears black.

3) To differentiate between infarction and tumor, you need contrast, and tumors have thick walls.

4) If it hurts when you walk, but not at rest, think vascular claudication. If it’s the opposite, think neurogenic claudication.

5) If someone is on heparin, and they experience trauma, you can see a rectus abdominus hematoma.

6) Everything about uterine fibroid embolizations (UFEs), including indications, contraindications, complications, procedure, etc. It’s pretty cool!

Apparently, I also learned a bunch of other stuff, but I either can’t remember it right now, or can’t read my extremely crappy handwriting. So, that’s it for now!

Note: I have a very super cool book with radiological images, but unfortunately it’s currently packed up in a box being stored at my parents’ farm, so this is the best I could do on short notice.

Today is June 1st. I take the USMLE Step 2 CK on July 1st. That means I have exactly one month to study for the exam. I started my radiology elective rotation today. I specifically chose radiology for this month, since I will be studying, and the hours are short. Here is my basic study plan (not that you asked).

M-F:

7:30 – 9:00 – Get up, brekky, head to hospital
9:00 – 11:00 – Radiology rotation
11:00 – 12:00 – Walk back, clean up apartment, eat lunchy
12:00 – 3:00 – Read First Aid and “Crush” books, do USMLE World questions
3:00 – 4:00 – Dog walk/jog/exercise
4:00 – 6:00 – USMLE World questions
6:00 – 7:00 – Reply to emails, eat dinner
7:00 – 10:00 – USMLE World questions
10:00 – 11:00 – Shower, pleasure book, beddy by

That should give me about 8 hours of good study time in each day. I will then either take the whole weekend off, or perhaps study for a least a few hours on Sunday.

I learned a bunch of cool stuff in radiology today, but since I’m already behind on my studying schedule, I better quit blogging and start studying!