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| Pediatrics is a heart breaking rotation for me. There is just something about sick children that softens everyone's heart. It has been quite busy since coming back from the States for a much needed Spring break. There hasn't been much time for catching up with old friends from the past or even with my friends here. Maybe it is just coincidence for me, but everyone in my team were female. I felt out of place. The attending, residents, pharmacist, nurses, and the other 2 students were all female. It doesn't help that the other 2 students have little toddlers of their own. I had no idea how to handle kids coming into this rotation. I am now doing Emerge shifts at the children's hospital, which gives me a little bit of free time because I get some time off after a night shift. Millions of kids coughing in my face, gastroenteritis, fractures, and suturing lacerations are the bread and butter of the children's emergency dept. Now that the Swine Flu has arrived, parents have been freaking out by the sniffles more so than ever, especially if they know someone who had just went to Mexico for Spring break. I'm fine with suturing wounds, but not when the kid's mom, dad, grandma, and my attending are staring. Peds residents are some of the nicest that I have ever met. While I was up on the wards, they played Jeopardy with us clerks, bought us coffee, made us breakfast on the last day, and checks and makes comments on my progress notes. Now that i have a little bit of free time in between my emerge shifts, i gotta set up my US electives in the Fall. I'm planning to go to Chicago or Indiana. Also, prepare for my USMLE step 2 and look up US residency programs. I've been feeling overwhelmed since the day i started here. I thought things would be better after I did the USMLE step 1, but no, it has gotten worse. How i love med school here. | | |
| So as of today, I have finally finished my Internal Medicine rotation. It was busy busy busy!!! Thankfully, I ended my specialty Cardiology rotation with a good evaluation and finished 2 days of exams. I'm happy about the evaluation because at this point i'm interested in internal medicine and I worked pretty hard at the IMCU. Apparently i'm above average for my level. Well, I don't think so but as long as they think i am! Unlike the past, there was no study break so I was going into the exams solely based on whatever i've learnt or read throughout the rotation. But finally... a week of rest!
I'm happy for the IMU seniors here. They've done well for themselves and managed to match into residency positions in the US and Canada. I hope i'll be able to do the same.
Tomorrow i'll be flying off to Washington DC. Since being in clerkships, i've come to realize that i've gotta go out and see the world every damn chance i get. We don't have much free time in medicine, and i guess the good thing about being in it is that it makes you appreciate your free time more and you actually go do more useful things with it. I can't wait to go do touristy things like take pictures at the White House. Monday i'll try to get my brother to pick me up from DC to go stay with him in Baltimore for a week. The thing is he is starting his clerkships as well and is on call tomorrow. Which stinks because it is a sunday. I can't wait to see my brother! He has a frikin grand piano at his home. I'm going to attempt to play again. I really do miss it. Recently i've fallen in love with it again and in between studying i've been watching documentaries on piano greats like Horowitz, Rubinstein, Richter, etc.
I'm quite exhausted. It has been some year. The good thing about medicine is, aside from the studying, it is hard to get bored. There is just so much to do, learn, and ponder upon. Tonight we'll celebrate a brithday of a friend. That should be nice. It's good to see the imu peeps once in a while. Meanwhile i gotta pack, do my laundry, and prepare for my adventure next week.
Oh shit, i'll be starting Pediatrics next week and i dont think im looking forward to that. I'm not good with kids and they tend to push me around. You work with a different set of rules in a children's hospital. I don't know the rules. Time to transition away from the sick elderly world.
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| Going into my nephrology ward rotation, I've never seen Diabetes as the devastating disease that it is. Almost all my patients who are having end stage renal disease have diabetes plus at least one of the following: destroyed sight, nerves, blood vessels, bladder and stomach function, and amputated limbs. It is sometimes very heartbreaking.
I know i'm not allowed to have favorites, but my favorite patient is this 40 something year old lady who has had every bad thing that one can't imagine happen to her in life. She looks way older than her age. I guess being so sick for so long does that to you. She can't even remember the last time she felt good. Most recently she lost a leg and her father at the same time. I see her first thing in the morning everyday: making sure her vitals are stable, good glycemic control, volume status, having a chat and focused physical exam, review dialysis orders, review her meds, write new orders, address any complications during the night, bring movies for her to watch, etc. As you can see, it isn't that hard to get attached to my patients. There are good days and bad days. Good days, i bring her a great movie i found and her face lights up. Bad days are like when she developed fluid in her lungs and we had to tap it and put in a chest tube for a few days. There are many other, sicker, patients who came in whole, had both legs amputated because of peripheral vascular disease, and are vomitting 10 times a day due to gastroparesis.
My rotation ended yesterday. This morning, after coming back from being on call at the other site, I gave her a call to see how she was doing.
Things were busy all month. I see my patients first thing everyday. I address any issues by either writing orders and getting it co signed by the resident/fellow, writing and calling for a consult in another service, and presenting my patients to my team during rounds. Lunch time was lecture/teaching time, and we get teaching in between and also on the floor. Almost as busy as MTU.
My team in nephro consisted of the attending staff, a fellow, a 1st year resident, and 2 clerks. Of course, you can't forget the nurses, who are all really sweet ladies (and refer to me as Dr Lee sometimes). One can't help to note that we looked like the United Colors of Benetton. We've got a Jewish attending, a Black fellow, an Arab, a white canadian resident, and yours truly, the Chinese guy. It wasn't a huge floor, so there were about 14 patients. I carried 4 patients, the other clerk 4, and the resident carried the rest. You don't usually get a fellow (in layman terms, a resident in a subspecialty, or a really senior resident), so we were really lucky. He was great guy who did lots of teaching and gave a lot of advice on the 'art of medicine'. The attending funny to watch. He is extremely hyperactive. He talks at the speed of sound, and compounded with him being always 5 steps ahead of you in terms of future management of the patient, i don't know what he is saying half the time. He is however, an extremely smart man who is part of the AOA (an american medical honor society) and who did his fellowship at Yale.
So anyways, the weekend is finally here. I'll be starting Cardiology clinics on Monday. I'll also be on call for MTU on Monday so it is going to suck. Final OSCEs and the Internal Medicine written exam is in less than 4 weeks. Fuck.
For now, I'll be happy going to breakfast at the local Greek grill on weekend mornings, and going to workout at the school gym. Spring is coming and the 10 inch thick layer of ice on the ground is melting.
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| After a month of working at the MTU, I think I'm enjoying it. Well, at least that's what i try to tell my self. Some days I function purely on caffeine. I love my patients. It may not be true the other way round at times. Some of the oldest and sickest patients are on my floor, and many of them were admitted with a gigantic list of issues.
Things can get complicated. For example, I had this one patient who presented to Emerge with shortness of breath and anemia. Aside from that she came in with a million other things such as: unresolving pneumonia, chronic kidney disease with baseline Creatinine sitting at 300 (normal would be less than 110), diabetic retinopathy and neuropathy, neuropathic pain, chronic obstructive pulmonary disease, yada yada. Don't even go to her bottomless well of medications. Following her from day to day was quite a mission. We didn't know what was causing her profound anemia, so we ordered a barrage of tests on her. We were considering Sarcoidosis (yes, this differential comes out on House MD quite a lot) at one point because she had some weird lung CTs, kidney involvement, some enlarged lymph nodes, and partly due to her ethnicity, but after working her up we decided it was something else. She somehow developed pericardial effusion, which is when you get fluid around your heart, and she had a pulsus paradoxus (it's this thing where you get a cool change in blood pressure with inspiration) of 10mmHg, which was pretty cool because i dont get to do that often. Anyways, long story short, yesterday, we finally managed to get an upper GI scope and Colonoscope done on her. We had always suspected her anemia was due to a bleeding somewhere in her GI tract, be it hemorrhoids or colon cancer. However, it turned out to be some oozing ulcers in her stomach. And now the shocker... she also had extensive melanoma in her stomach. What???? I was pretty shocked. I never thought you can get a primary melanoma in there. Metastasis from the skin, yes, but a primary?
Anyways, it was my last day there yesterday. I was a little sad, but I'll be moving onto Neprhology next which is less hectic(i hope). I need a little downtime too. Call nights at nephro won't be at the Emerge, which would be chilll. Stayed a little later than usual to finish off dictating discharge summaries and to write transfer notes on all my patients so that the next horde of people coming in to inherit my patients will know what's going on. You kind of get attached to them, as you see them everyday and they are your patients. I get quite good turnover, i guess because i'm such a great healer... lol. Anyways, my patients have been quite interesting, which also means a billion issues and a freakin long transfer note. There is this HIV guy i have that has all the opportunistic infections under the sun, but that's a different story.
Of course, last day at the service also means evaluations. I was a little surprised. Apparently i exceeded expectations in terms of knowledge. They did say that i was quiet. But my attending was nice about it. She said it is okay to be quiet, but sometimes it's good to show off that you know by answering questions. Oh well. Apparently i am conscientious and have good rapport with the patients. Well, i can remember a few of them who really liked me but some of them hated my guts because i kept coming in to examine them when they were trying to sleep. There was this little old lady, who, i can say was my favorite patient. Barium swallow showed a huge gastric cancer (for which she was crying all weekend and i felt sorry for her) but when we scoped her we found nothing. Telling her family the good news was wonderful.
The resident i worked with was a great guy too. All the residents, at least in IM, were really impressive. I'm only 1.5 years away from being a resident. I hope i'll be as good in the future.
One thing i do hate about this though.... i haven't had time to practise kung fu in 5 months at least. This freaking sucks. I tried to touch my toes and it hurt. I'm back to square one to where i was 6 years ago. I guess i'll try to set aside some time to stretch more.
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| I was working 7 days a week last week. Monday to friday, plus i was on call on saturday. Saturday call is the worst. I was rounding on my patients in the morning, settling any issues with them. Then after that i had to head down to emerge to do medical consults till sunday morning (my resident was kind enough to let me sleep a little in the call room). Then i headed back up to my floor to round on my patients again with my attending. By the time i got back home it was 1 pm in the afternoon, and i had to cook lunch. After lunch i cleaned up my room, did my laundry, and mainly housekeeping things. When that ended it was time to cook dinner. Phew.
Anyways, one of my patients died on Saturday. I went to check on him in the morning, and at about 2 pm, he was gone. I wished i was there, at least to be with the family. Instead, i was down at emerge. I wasn't as sad as i thought i would be. I guess it's because i knew his time was coming soon, and that he was in pain and death would be an escape from all that for him.
Days are long, but they pass quickly in Internal med. I guess there is just so many things to do. Checking in on my patients, doing physical exams, discussing with residents and my attending, going to 3 different types of rounds, following up on CTs, X rays, and bloodwork, teaching sessions, yada yada. At least i know im learning something.
I miss the Xmas and New Year break. It was good times. Got to spend time and travel with people i love.
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