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.

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