Thursday, December 4, 2014

Doctors Make 3 Cents Less Than Teachers

I'm now in week 6 of 8 in the Internal Medicine clerkship - and I'm absolutely LOVING IT. While it's one of the less time-demanding clerkships so far (6 weeks of between 9.5hr days, 2 weeks of 12-hour nights at the hospital, averaging 3-6 hours of work per night at home, only two weekends scheduled with an average of 12 hours studying at home on off weekends), 70-100hr weeks are no small thing.

Friends and family regularly comment on the number of hours that we, even as lowly med students, pay to be at "work" in the hospital, then go home to be with our loved ones study. These comments are often followed by some paraphrasing of "Well, at least someday you'll be pulling in the big bucks." Here's something that, while it does not take into account certain nuances of tax law, various debt repayment infrastructures, variable interest rates and debt consolidation, it DOES do a fairly good job of drawing an eye-opening, relatively accurate comparison between something with which most people aren't familiar (physician hours and compensation) and something they might understand a little better (teacher hours and compensation).

What do you think? Don't forget to check the references at the bottom.

Thursday, October 30, 2014

Surprise for Wife!

So, this happened today:

I'm home on my day off while on third shift, so I've been studying most of the night.

I hear the door open downstairs.

Wife is home from work, also on third shift.

She yells from downstairs, "Honey! HONEY!"

I have an idea of what's going on, since I'd set some traps during the night...

Wife had found a surprise!

Third Shift

This week, I started my Internal Medicine rotation. While not the first where we've been on night shift (ObGyn and Peds each had at least one week of nights), it's the first where we have a total of two weeks with a 3-on-1-off schedule, with a smattering of day-time lectures thrown into the mix. This means occasionally getting home at 8am after a 12-hour shift, sleeping till 11:30am or so, attending lecture from 1:00pm to 3pm, sleeping from 3pm to 6pm, then working from 7pm to 7:30am again.

Today, I am on my "day" off. Day is bracketed by those nifty quotes because I've spent most of it trying to actually convince myself it really is daytime (it's currently 2:53AM). I leave more lights on in the house, and do my best to ignore the "AM" to the right of the time on my computer and phone. With only one day off in between sets of shifts, it's not really possible to switch back to first shift without really putting your circadian rhythm through the ringer.

And so, I study. I go on Facebook. And I study. And I realize all the things you can't do when you're awake on 3rd shift on your day off, like:

- Call / text your friends. Nobody's awake to answer, and if they did it would probably be pretty grumpy.
- Go anywhere. If it's not a grocery store, it's closed. (The one exception to this is The Grand Coney, one of my favorite places anywhere. Diner down the street. May go there to experience it in a bit, actually...)
- Check Facebook more than once. All the statuses are old.
- Go for a nice walk outside. It's very dark. And cold.
- Read on the porch. Again, dark and cold.

On third shift, certain things happen. For example, the other day I was doing a full neurological exam on a patient at some ridiculous hour between 2 and 5am. For those that don't know, a full Neuro exam requires that you assess orientation to person, place, and time. The patient knew their name and where we were, but couldn't tell me the date (day, date, or year). After several moments of pondering, the patient said, "You know, I just can't think of it. What IS the date?" And I realized I didn't know. No clue. I knew the year and month, but had no idea which twenty-something we were in of October. It took some awkward skillful deflection before I skirted the issue and continued the exam. As soon as I got out of the room I checked my phone for the date, have myself a shake with a couple mental *slaps* to the face, and continued on with my night.

3rd shift is definitely a very different way to live life.

Saturday, October 25, 2014

M3 - Pediatrics and Med-Peds

loved love Pediatrics.

After 8 weeks in Pediatrics (4 inpatient at the children's hospital, 4 in specialty/outpatient settings), I can safely say that I love pediatrics. Kids are awesome to take care of; they are (for the most part) really resilient, and are tons of fun to interact with when you can distract them from the reason they're at the visit / in the hospital. I love teaching, and (as I've said a million times when explaining to people the myriad reasons why I like Peds) nobody wants to know more details about a medical condition than the patient's parents. So far, I've found that (with very few exceptions) as long as you communicate well and efficiently, most parents are awesome to interact with. Sure, most parents have done everything they can to educate themselves, and sometimes this results in preconceptions that aren't entirely on base, for the most part the parents are incredibly appreciative of the fact that you are there to help their child.

I liked both inpatient (ie admitted to the hospital) and outpatient (pediatric clinic) settings. It seems really cool to be able to establish relationships with kids right from the time they're 2 days old and 8lbs heavy all the way to their 18th birthday. It's also awesome to see a kid come in to the hospital as sick as he's ever been, then see him walk home with his parents four days later because of the care he received from your team. Plus, I get to help a team of people solve problems! Sometimes they're more complex than other times, and thus sometimes easy, sometimes hard. Regardless, it's interesting; no two patients are the same, regardless how easy or hard their management is. You need to use different communication styles, different familial considerations, etc.

I wasn't expecting Peds to wow me like it did. I was expecting to enjoy it, but that's simply because I hadn't had any experience in Peds before. I wasn't expecting to love it because I didn't really know what Peds was. After 8 weeks, I don't really know how I could pursue a career that doesn't involve taking care of kids. Not to mention the fact that it would be cool to always know what's going on with my own, future kids... That would be cool too.

The thing is, I can tell that a lot of what I've enjoyed about Peds (longitudinal relationships, seeing a sick patient go home healthy, educating people about medical conditions, changing my communication and interaction to fit the needs of each patient situation) will translate to Internal Medicine (IM), which is my next rotation. Over the next 8 weeks, I will be assessing whether or not I enjoy IM as much as I've enjoyed Peds. I will need to decide whether or not I will need to take care of adults as well as kids in my future career. If I can't part with either...

Enter Med-Peds. According to the joking comments of a few Peds and IM residents I've talked to, it's the specialty for "people who couldn't make their mind up, so decided to do everything." Normally, IM and Peds residencies are a total of 3 years. With Med-Peds (a relatively new specialty), you have a 4-year residency in which you have two years each of Pediatrics and Internal Medicine. You rotate through alternating 3-month segments of Internal Medicine and Pediatrics so that at the end of 4 years, half your time was in Peds and half was in IM. This means that you essentially have 1 less year in each specialty to learn what you'll need to know to practice. You also get double-board certified at the end, sitting for the licensing exams for both Internal Medicine and Pediatrics. Despite the decreased time, you learn both IM and Peds in-depth. As one resident put it, they're the people you go to "if you want to know anything." The thing is, I love learning the details; it helps things stick in my head if I know the "why" behind the "what." I was always the person in second year as we began truly learning about pathophysiology who was constantly wondering, "Yeah, but what's the mechanism?" then going home, looking it up, and learning it to help me remember the particular condition or association at hand. That type of mentality is fostered in Med-Peds.

And so, that's the update for my current thoughts on a future career. There's still a lot of figuring out to do, but it's much more defined than back when I thought I wanted to do Emergency Medicine. Third year is definitely serving its purpose for me. I think I could be happy doing many different jobs in healthcare, but I've been learning that happiness is not all there is to the equation. It's also about what I and my individual skills can bring to the team - how I can best serve my patients - as well as how well the specialty fits you and you fit the specialty. Personal satisfaction plays a huge role in this decision-making process (how can I best help my patient if I'm not engaged enough to be sufficiently  up on their care?), but personal "fit" plays a huge part as well.

All right, it's currently my Saturday off (took the Peds shelf exam yesterday), and half-time is now over for the Michigan State University vs. University of Michigan football game. So, time to go.

Wish me luck over the next several weeks in Internal Med!

Tuesday, October 7, 2014

M3 - Perspectives and Lessons

The title says it all, which is a good thing because this won't be a long post.

I used to think I wanted to go into Emergency Medicine. I still think I could do EM, help a lot of people, and feel rewarded doing so. However, one thing that I've learned about myself so far during third year is that I could be happy doing a LOT of things. That proves definitively that 1.) medicine is the right field for me (as if there was any question), and 2.) it's not all about what makes you happy. I've learned that it's also about where you fit and what your strengths can do for the team in which you're working.

I have really loved working with the teams on my Pediatric rotation. I loved every minute of working in the hospital during my inpatient weeks. I felt like I fit. Communicating with the patients' parents about their treatment plans and diagnoses, being somewhat goofy and helping the kids feel comfortable even while they're feeling super sick, and then brainstorming with the residents and attendings about what could be going on as well as how to treat it - everything was SO COOL. It was really fun to be able to use my Spanish skills in a clinical setting again - haven't done that much since I was a medical interpreter way back in the day, which I actually don't think I've ever mentioned on here before. I used to be an interpreter at an Obstetrician / Gynecology office before I ever realized that I could go back to school to become a doctor... It was good experience, but only part-time, and I left it after a while to pursue a job that could better pay the bills. It's hard to be a full-time interpreter if you don't work at a hospital, and at the time the local hospital where I lived wasn't hiring.

Anyway, I definitely did not expect to feel so great about Peds. I expected to like it (kids are awesome, after all), but I didn't expect to really love it. It was a pleasant surprise... Let's just say that subsequent rotations have a lot to stack up against. I'm currently doing my outpatient weeks, and the excitement is not fading, merely changing.

All right, UWorld Step 2 practice questions are calling to me. Adieu.

Thursday, September 18, 2014

The MD Countdown

I've had a countdown going on my iPad for a while now. I figure I'll share a screenshot now and then. 
Here's the first:

The exact date is an estimate based on previous graduations, but it gets the point across.

In 2016, I will be a doctor.

Time to keep studying...

Saturday, September 13, 2014

Time, Med School, and Life

Yesterday as I walked through the hallways of the hospital, I had a few moments of profound contemplation. Specifically, I pondered the volume of time my classmates and I are devoting to future careers as doctors.

Most of the time these past couple of years of med school, I have just ridden the waves of exams, studying, simulated patient encounters, exams, and real clinical experiences. I don't often think about how much time this is taking. Our lives are finite, but it's easy to stop paying attention to that fact, getting distracted by everything that's going on. When that happens, it's easy for the significance of each day to slip by unnoticed. I don't like that so much.

I'm now 29 years old. I started this blog when I was 25, a year after I got married, then went back to school to become a doctor. People mention all the time how long it takes to become a doctor, but most people don't really know what that means. It's a statement of commiseration, but it usually stops there. It's okay, because it's really hard to truly get it without living it.

For me, the time involved will be a little longer than most because I had to go back part-time after graduating college to get the credits needed for med school. So for me it's been:

- 4 years of undergrad the first time around (2003 - 2007)
- 3 years of school part-time, then the application year (2009 - 2012)
- 2.3 years of med school so far (2012 - 2014)

So, I'm 9.3 years in at the moment, with about 1.7 years left or so before the total of 11 years of post-high school education before I get my MD and start residency. With my most recent specialty choices in mind (more on that at another time - I'm loving Peds right now, even more than ObGyn, so everything's still way up in the air), I'll have another 3 or 4 years in residency.

That will make a total of 14 or 15 years of undergrad+graduate education by the time I can start working autonomously as a doctor. If you think that the average male my age these days will live to about 90 years, that's about 1/6th of my lifetime spent in school after high school.

That seems like a lot. Maybe it's not. But sometimes it really feels like a ton - especially when I'm surrounded by family and friends who are busy doing so much more with their lives during their 20s. Having or adopting kids, building careers, establishing themselves in communities, settling into houses, planning for their futures - all things we continue to put off until "after med school." Sigh.

All right, enough self reflection. I've been feeling behind in my book-learning for Peds recently, so today will largely be spent doing practice questions, reading, and maybe reviewing some drugs.

Enjoy your day today! If you're in Grand Rapids, enjoy the street fair in Eastown for me. It looked pretty cool as I drove past it to buy Hobbes more dog food this morning.

Thursday, August 28, 2014

Obstetrics and Gynecology - A Review

I need a break from studying for my ObGyn NBME Shelf exam (it's tomorrow morning), so I'm going to give a recap of the ObGyn clerkship. You might be surprised by what I have to say (or, if you're an Obstetrician, Gynecologist, or one of my classmates who just completed ObGyn with me, you might not), but to sum it up - it was awesome. Really cool stuff.

I wasn't expecting to like it nearly as much as I did. No, I haven't decided to go into ObGyn. Yes, I'm still pretty undecided on what I want to do with my life (Emergency? IM? Family? ObGyn? Surgery?). Luckily, experiences shall abound in the remainder of my third year of med school.

Okay. So ObGyn was an amazing experience - especially in comparison to M1 and M2. I mean, sitting still and learning in lectures, then sitting still and studying from books/notes/coursepacks is fun and all (I mean it - I actually enjoyed didactic learning!), but nothing really beats getting to be immersed in a real patient care environment. Especially when stuff's happing - and stuff HAPPENS in ObGyn. Most of the time. There were a few lulls (mostly on nights when half the people are trying to sleep thanks to their epidurals), but there was almost always something to talk about, something to see, or at the very least something you had just talked about or seen that you had to then go read more about.

One thing I learned was that vaginal lacerations give me the heeby-jeebies. What's the technical term for that? Oh yeah - The WILLIES. Everyone knows they happen more often than not, especially the first couple of times a woman delivers. It's not necessarily the reality of them - once they happen, they're just something to repair, no problem *dusts off hands as though he's the one doing the repair instead of the resident or attending*. Rather, it's the waiting, when you're not sure how extensive the laceration is going to be. The baby's head is crowning, straining the perineum, the bridge of the nose just barely peeking into the world... It's that moment, right before everything releases. That's the moment that causes the most tension within my chest, and it really takes some getting used to.

Suffice it to say that I really don't blame the mothers when they decline the offer of a mirror.

Keep in mind, I'm not a squeamish guy. My mom had to hold me back so I wouldn't get in the way when they were setting my younger brother's arm after he broke it when we were kids. When I was younger and got shots, they always had to ask me to keep my head back so they could see what they were doing. I was that enthralled. Anyway, I'm not squeamish, but I never thought I would enjoy the operating room as much as I did. For those that don't know, Gynecology is pretty much a surgical subspecialty. They do A LOT of surgery. Hysterectomies, oophorectomies, tubal ligations, exploratory laparoscopies for endometriosis, vaginal vault suspensions, urethral slings, dilatation and curettage, etc.

So yeah. I'm not 100% sold on ObGyn, but General Surgery might be on the table now - I liked the OR that much. Just not so sure right now about the lifestyle. We'll have to see how my surgery rotation goes in January. Wife really doesn't want me to pick ObGyn or Surgery because of the demanding lifestyle. In her words: "Just please don't. If you do, I'll support you. But please don't."

But back to my recap. I delivered 14 babies and participated in 12 Cesarean sections! I also assisted in 18 major and minor surgical procedures. I got to see robots being used in surgery. I practiced my knot tying and learned to close bellybuttons and low transverse abdominal incisions (skin only). I learned a lot from people, experiences, and books. And practice questions. I've done about 450 questions w/explanations (about 150 of which I've done a second time), and I have about 50 more to do tonight before I'm done. Just took a practice exam and passed, so I'm optimistic about tomorrow morning.

So what do I NOT want to forget? Here's a short list:

  1. How it felt to hand the first baby I had ever delivered to his/her parents, and to then see the looks of joy on their faces. How that look was repeated with every set of parents in every delivery.
  2. How hard the residents work! For everyone that thinks med school seems hard, just check back in two years. Then, if I'm anything like the amazing residents that I've been learning from the past two months, you'll see something truly impressive.
  3. The moral considerations I wrestled with surrounding the management of the most complicated cases, and the conclusions that each physician must come to for him/herself.
  4. Wondering in my head about which fathers will cry, get woozy, or do really well - and almost always being wrong.
  5. Seeing the doctors and everyone else work as an amazing, fluid machine when managing an emergency. I have so much respect for everyone in healthcare and what they do together for their patients.
  6. How much I enjoyed everything (minus waiting for vaginal lacerations to happen).
  7. The huge awe I now have for my mom and all the other moms out there, having glimpsed what they go through. And thus, the never-ending respect and gratitude I will one day have for Wife if she gives birth to any of my future gangly-limbed kids. Those will be some mad props.
That is all. Back to the practice questions. Wish me luck tomorrow!

Wednesday, July 30, 2014

Third Year = Awesome - An Update

An image of almost exactly the same setup as on my first day of ObGyn.
Original image from:
Yeah, yeah, I'm behind in posting. I have good reasons:

1. Exhaustion
2. Lack of free time
3. Exhaustion

I'm currently just over three weeks into my Obstetrics and Gynecology (ObGyn) rotation, and it's AWESOME. Crazy, crazy, exhausting hours, but very cool stuff. To help you understand the hours, I'll put it this way: I just finished day 3 of a 20-day stretch where I am scheduled at least 12 per day, every day. No weekends. No breaks. Let me break it down a bit more for you:

This week, I'm on from 5:30am - 6:00pm every day in Labor and Delivery (L&D). Yesterday I didn't get home till about 6:45pm because a patient started pushing right at the end of my shift. It was great though, because I GOT TO DELIVER HER CHILD. I'm keeping a running tally of deliveries - more about that once this clerkship is over. Anyway, this Friday I start at 5:30am and don't get home till Saturday morning at 7:30am. That's 26 hours straight, so I don't go back in until Sunday morning, when I work 7am-7pm (12 hours). Then Monday through Friday next week it's 5:30am - 5:30pm in Gynecologic Oncologic Surgery. That Saturday I'm back in L&D from 7am Saturday morning until 7am Sunday morning. After that, I'm on 5:30am - 5:30pm Monday - Friday in Maternal Fetal Medicine - all high risk patients. Then, I get a two-day weekend before a week of 14-hour night shifts from 5pm - 7am.

I want to reiterate - this is exhausting, but TONS of fun. I didn't expect to enjoy the ObGyn rotation half as much as I am. The moments when a couple's new baby is born is indescribable. It's awesome to see tough guys cry the first time they lay their eyes on a new son, or the look on a mom's face the first time she sees her baby. So fun to be part of all of that.

I've assisted on more than 20 different surgeries in the past weeks, even getting to throw My First Stitch. Who knew that ObGyn was half surgery?!? Definitely not me. My first day of the rotation, I was able to be in the room during a da Vinci robot surgery (see above image). While I wasn't operating (students don't operate), I was able to observe as the resident and attending worked. It was really cool how much they could do through just one small port through the umbilicus (bellybutton).

In most of the other surgeries, I've been able to actively assist the resident and attending. At this point, I think C-Sections might be my favorite, but I'm not sure. My week of ObGyn (lots of surgery) is still coming up, so we'll see if that changes. It's just really cool to have surgery start off nice and normal and then all of a sudden BOOM a BABY is coming out of the surgical site.

I have been almost constantly in awe of what modern medicine is capable of these past three weeks. It's insane what we are able to do with the aid of anesthesiology. A patient can be awake and talking to you one second, and then two minutes later surgery is underway and you're inside them, working to make them better... Many times throughout each day, I take a few seconds to pause and think about what I and the other doctors, nurses, and techs are doing, and I'm humbled. We are so privileged to have the abilities and education that we have, but we are so much more privileged to have such profound trust as that which is placed in us by our patients.

I still don't know what I want to do. I just know that I made the right choice in pursuing a career in medicine. Yes, there are often frustrating, embarrassing, uncomfortable, and really exhausting periods of time, but the good outweighs the bad, no question about it. I love taking care of people, and even though (as a med student) I'm not the focal point of the patient's care quite yet, I'm finally learning how to move into that role. Yes, I might be constantly on the verge of nodding off whenever I move to a quite room with some white noise. No, I don't get to play with Hobbes as much as I'd like. And extra-big YES, I might be missing Wife more than ever these days, with both of us working 12+ hours most days. But in the end, third year is leaps and bounds different from the first two years, and I'm love it. Granted, that might be because I haven't had to take an exam yet (and won't have to for another four weeks), but there you have it.

Third year is off to a great start.

Thursday, July 10, 2014

My First Stitch

Today, I put my first stitch into the skin of a human being. It may or may not have looked very like or unlike the above umbilicus. Sure, the attending may have quipped good-naturedly as I started the first knot, "Boy, I could have gone on Christmas vacation already" before laughing then just saying, "Hahaha - just kidding. I love med students." When I finished the knot he asked when I had learned to suture, and I said mostly last week, but that this was the first time I'd ever been able to assist in closing on a person, he said, "Oh really! Well, good job then."

My resident made me feel even better when she said, "And his first closing was deep in a bellybutton, not some straight, superficial incision like my first time."

Yes, third year is a lot of work. We moved from one surgery to another for eight hours straight with no room for a meal, and only time for one bathroom break toward the end of the day. I'm not sure if that is normal or not, but I am enjoying it nonetheless. I did let my blood sugar and hydration levels get too low today, though. Had a sharp, cracking headache all day that slowly built into a blinding, pounding migraine by the end of the day.

Now, I'm settling down to some nice, passive lectures to finish out the day. On the back burner is the case report that is due next Wednesday, along with the many chapters of reading that I haven't quite gotten to...

Ah well. There's always the weekend!

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