Don't mess with a girl and her power tools.

Surgery is over! Time to celebrate in style--catching up on Teen Mom 2 (so much happened between season 3 and 4!) and Weeds, both totally appropriate shows for a future healthcare provider. This past month, I was at a local community hospital for orthopedic surgery. It was incredibly fun: personable staff, patient attendings, and a great co-rotator (or whatever you call someone on the same service). It was so much fun that I actually considered orthopedics as a career for a hot second. It's very hands-on (and you get POWER TOOLS!), and you can choose how much of a workout you want: from total joints (where you're throwing around the dead weight of entire extremities) to carpal tunnel releases (I loved all hand surgeries because it meant you got to sit down). One of the big draws for me was the isolation of one mechanical problem. You walk into the OR, hammer/chisel/saw, and walk out. As long as the patient is medically cleared beforehand, you don't have to worry about their COPD/CHF/diabetes. (Of course, this leads to a certain orthopod stereotype: http://www.youtube.com/watch?v=3rTsvb2ef5k) 

Alas, my flirtation with orthopedics was short-lived, mostly because my boards scores are nowhere near elite and after the fifth total knee replacement, it all started to look the same. The ortho fairy worked her magic on one of my previously internal/family medicine friends, and after two weeks, he's going for it (I've already booked him for my dad's knees). I am going to miss the super-cool ortho spacesuits, though. And the power tools. Really going to miss the power tools. 

Tomorrow, I start internal medicine, so it's going to be a big rule in/rule out month. I'm back on the road, and this time, I'm in the land of shoo-fly pie, buggies, and Shady Maple. That, plus the increasing anxiety I'm starting to get about boards/residency applications = good-bye, skinny jeans, hello sweatpants. 

It's exactly like Grey's, except I'm by myself and there's no drama.

I've finally made my way to the big leagues: surgery rotations! I'm finishing up my month of general and am off to orthopedics next month. I wasn't expecting to have a career epiphany this month (I value the freedom to eat/go to the bathroom too much to stand in the freezing cold OR for hours on end), and I didn't have one (thank goodness, or else my world would have been turned upside down). I'm with a surgeon who is in private practice in Philadelphia, and he defies any and every surgeon stereotype: he knows all of his patient very well (hugs them, asks about their children/pets), is well-liked and well-respected by the OR staff (always cracking jokes and rarely throws a fit), and is extremely patient when teaching inept medical students (like yours truly) how to scrub in for the first time. I don't know if he was really hardcore early in his career and has mellowed out over the years, or if he's just always remained goodhearted and down-to-earth, but I lucked out, because some of my classmates are counting down the days until they're free. What's also really interesting is that some of my friends who were gung-ho surgery last year are starting to re-think their career choice. It's an extremely tough lifestyle, and even if you want to specialize, you have to pay your dues during a five-year general surgery residency. I'm just hoping that, by the end of the year, I have half a clue of what I want to do when I grow up. 

Summary of this month: 
Hernias: You have a hole in the wall of your gut/groin, and now stuff (fat or bowel) is poking out. We (and by "we," I mean the surgeon; I'll just stand there and maybe hold the retractor or cut knots, if I'm lucky and don't mess up) will put a piece of mesh over the hole and sew you back up. No, we can't throw in a tummy tuck. 

Gallbladder: The little sack making bile is freaking out, so it's gotta go. You'll get some tiny cuts and we'll put a camera and some tools that look like mini versions of what delinquents use to pick up highway trash. 

Appendix: See gallbladder. Also known as "surgeon's boat payments" back in the day. I don't even own my car, so I can't speak to how true that expression is. 

Lumps and bumps: Something's there, and it needs to come out. (*Pilonidal cyst: Cyst in your buttock crack due to an ingrown hair. Also known as "Jeep seat" during WWII. Surprisingly common among men. Loved the looks I got when the male patients would have to get half-naked so the doctor could change the packing in the office. The more you know.) 

Next month: hips, knees, shoulders, and maybe some fractures or other bone traumas. I'm just psyched to see the intimidating tools the surgeons get to use (saws, drills, hammers and the like). It will also be the first time I'll be on a service with a classmate, so I'm looking forward to having a battle buddy. 

The other week, I went to a local art studio for a painting party with some friends.
This was the model...

...and this is my masterpiece. Good thing the extent of my
art responsibilities is drawing neuro exam stick figures.
I should give it to my parents and tell them my 5-year-old cousin made it.
At least then they wouldn't laugh. 

Happy Christmahanakwanzika!

Rotation life has been all over the place since my last post, so let me break it down for you like a fraction: 

November, Part I: Lungs with a PCOM Legend

During my first year, I was introduced to the PCOM Pulmonary Pack (kinda like the Rat Pack, except they didn't sing and dance (I wish), but equally as famous in PCOM circles). These guys went to PCOM together, trained together, and now practice together. After being knocked down and kicked in the chest from learning the intricacies of the kidneys, these doctors were a beacon of hope for a passing grade. They made the lungs easy to understand, and their lighthearted classes were full of anecdotes. So, when presented with the opportunity to enter a lottery to rotate with one of them for my elective, I jumped on the chance, and boy, did I strike gold--I got Frank Sinatra himself. Throw in that his children and I share an alma mater, and it was a match made in heaven. 

Over the next two weeks, I arrived at the hospital at 0545, read chest x-rays and CTs until my eyes bled, finally got to hear the differences between rales and rhonchi, and learned how to manipulate ventilator settings. It was a lot of fun, and I wished the rotation could have been longer. Then, on my last day, I looked at him and said, "And now, the end is near, and so I face the final curtain..." 

November, Part II: Home Is Where the (Patient's) Heart Is

To be honest, I was sort of dreading the thought of living with my parents for the last two weeks of my elective. Since it's an empty nest, showing my face every day would give my mother the perfect opportunity to ask me details about my life, nag me to run errands, and, of course, bring out any anxiety I had about applying for residency. Thankfully, it wasn't too bad since it was right before Thanksgiving, and she was more worried about my sister, who is a first-year law student (did you know that they actually have to come to class prepared?! And then have to speak?! I'd rather do a dozen DREs). 

As for the rotation, it was inpatient cardiology (mostly consults) with a little bit of interventional (cardiac catheterization and stent placement). The heart was, is, and always will be a weak area for me (see #2 on my previous post), and since I haven't had internal medicine yet, I had to work a little bit to get up the speed. One of the highlights of the rotation was my attending, an outstanding teacher and diagnostician. I was thankful that he broke down cardiac pathologies into the simplest analogies, because even though it made me feel like an idiot, it cleared up a lot of confusion. Not only was a he a good teacher, but he was also a cardio Sherlock Holmes. When called to the ER for a consult, he would read the abbreviated triage history, check some lab values (rarely imaging), turn to me and tell me his diagnosis. Then we would go see the patient, and a majority of the time, he was spot-on. I asked him how he could diagnose so quickly before seeing the patient, and he told me that all the clues were there; we just had to recognize them and figure them out. It gave me a new appreciation for Internal Medicine (one of my possible career paths) because while a patient may be admitted with a certain diagnosis, it is up to the IMED docs to get to the root of the problem.

December, Part I: The Rorschach of Shadows

This month, the 22 third-years in rotation group six reunited for a scintillating month of radiology, introduction to surgery, and a mess of other things. The first two weeks were spent in a dark room, looking at x-rays, CTs, and ultrasounds until we started convincing ourselves that the smallest shadow was cancer.  At first, you might think, "Ugh, radiology? Sounds awful," but think about this: PCOM is the only school that sits you down for two weeks and says, "This is how to read an x-ray/CT/US." Most schools (so I hear) have "radi-holiday," where you rotate with a radiologist, but the actual didactic portion is small. So yeah, sitting in a dark, cold room for 7 hours a day isn't the most exciting, but if someone were to hand me an abdominal film and said, "Go," I wouldn't be as scared as I was a few months ago. 

December, Part II: Lecture Grab Bag

After we emerged from radiologic abyss, we had a series of random lectures/sessions: introduction to surgery (how to insert a chest tube, gown/glove, tie surgical knots), surgical simulations, ACLS certification, and the always fun day-long medical ethics discussion. Since I'm not interested in surgery, those parts weren't terribly exciting, but what I did have fun with was the ACLS course, especially the simulated megacodes. Even though it was just a dummy, and even though I clearly had no idea what I was doing until right before the test, I felt a little rush as team leader. Running a code is, at best, an intricate, choreographed dance (at worst, complete chaos), and as team leader, you have to make sure that all the team members are working together and doing the right things to save the patient's life. So, who knows, maybe I'll be giving the Emergency Medicine route a second look. My friends said that they could see me in that field, but I think it was their polite way of saying, "...because you are loud, easily distracted, and not afraid to shout orders." 

Well, that was the calm before the surgery storm. Next month, I expect to be hating my life and putting a pox on anyone whose appendix/gallbladder/hernia gave him problems. I hope you have a great holiday, and a happy new year! 

Attending: "Read this EKG." Me: "Uh...he's, um, alive. Definitely alive."

Until now, I've written about why each rotation is the best ever. Here's a list of why rotation life (in general) isn't the rainbows and unicorns you envisioned while having weekly mental breakdowns while studying for boards. 

1. "I'm living out of my car at the moment. No, really. No, I didn't quit medical school."
Want an easy way to save an entire year's rent? Feel like thumbing your nose at your working friends by showing them that you can have fun living the life of a nomad? Pick all away rotations, (95% of) which guarantee housing! Good plan, no? Except that you will be carting around all of your earthly possessions in one vehicle for an entire year, and you better pray that you don't drive through the wrong part of town. While I didn't fall into this situation, I recently ended a four month block of away rotations, so I was very excited to return to my bed and sit on my couch. I even started bringing back my strawnguyland accent while away just to give myself an identity other than "temporary medical student whom you will forget as soon as you hand in my evaluation." 

2. Every four weeks, there's a brand-new opportunity for an attending to make you feel like you did nothing over the past two years.
You find out you passed your last shelf exam, you know your preceptor is going to write you a kick-butt evaluation, and you're pumped to start the next block. You introduce yourself to your attending/resident, feeling like you're going to discover the next major medical breakthrough in the next four weeks, and...then s/he pimps you. HARD. Then you go from feeling like you could kick Doogie Howser's behind to being absolutely sure that you are now the hospital laughingstock as "The Dumbest Medical Student Who Ever Lived." 

3. Why do these scrubs feel more snug? 
Oh, that's right. It's because I've been pulling 12-hour days and have little energy to do much else aside from eating whatever mystery meat dish the cafeteria is selling for dinner. Throw in some pie, too, because some most days, you just want to drown your sorrows in Crisco and fruit preserves. 

4. "Yes, Dr. Smith, it's so much fun to stand here and feel my spider veins grow by the minute while I watch you write chart notes." 
It's awkward, but it happens to everybody. Occupational hazard, but somehow I dislike this more than any awkward bodily fluid ejections I've witnessed.   

5. Those kids found Narnia faster than you found your way to the lecture classroom (plus that chick got to meet James McAvoy). 
Find the least angry-looking nurse in the vicinity. "Hi, I'm a new medical student, and I'm trying to get to room BGR67384 for grand rounds; how would I get there? Okay, so take these stairs to the fourth floor, then make 5.5 rights and 2.5 lefts, then go right at the fork, followed by straight at the walking traffic circle, then find an elaborately carved wooden door, knock the tune of "We Are Never Ever Getting Back Together*," and ask the hospital wizard for the grand rounds password. Then what? Do the Dougie?! That's it, I'm out. I'll just put a tracking device on my attending." 

*Side story: I was talking with a teenager about how I can't believe Taylor Swift is dating a Kennedy. Her response: "What's a Kennedy?" Cue my weeping for the future of America. 

It's like living in a Bob Ross painting.

Hello from the mountains of Western Pennsylvania! I'm in the heart of coal/steel country, where people say "yins" and the accent indicates our proximity to West Virginia. Although it is very pretty out here (the fall foliage reminds me of my days in the Hudson Valley), it makes where I was in central PA look like a bustling metropolis. I went to the local mall for some retail therapy, but I couldn't find the usual mall staples like Ann Taylor, Banana Republic, NY & Company, etc. So I kept walking around, thinking they were hidden in some magical wing. Nope. Desperate, I walked into a strange store called Boscov's, got freaked out by the neon lighting, and ran out. Now I get excited to go to Wal-Mart (maybe Dollar Tree, if I'm feeling dangerous).

Weston: Why are you climbing the scarecrow?
Me: Because I don't know what else to do! 

I'm in the middle of my psychiatry rotation, and I have to admit, it is much more exciting than I anticipated. The hospital is the type I hope to work for after I graduate--a large (500+ beds) Level I trauma center (with a big cafeteria with good food and good hours). There are separate units for adult, gero, and child psychiatry, and each is very active. My favorite experience has been the child psych week; I liked it so much that I still visit in the evenings and help the nursing staff when it's really busy. Plus, this being my fourth straight month on an away rotation, I know what it's like being in a strange place, away from family and friends, sleeping on a strange bed, so I figured I'd be a friendly face to the kids while they're adjusting. Some come from really tough home situations, and when they're discharged, part of me is sad because I know that chances are, their home situation (which contributed to the actions that landed them in the unit in the first place) isn't going to change, which will lead to continuation of these unhealthy behaviors. Thinking back to the newborns all wrapped up in blankets in the nursery last month, I want to cry because they're born with a clean slate, but it's the unfit parents and the malignant home life that lead to the classroom violence and the suicide attempts and the angry outbursts. They don't stand a chance. The little boys labeled as "out-of-control" are, deep down, the same as the well-behaved ones. They just want to play with trucks and get into tickle fights and eat ice cream three times a day, away from a stressful home/school setting. They say that it takes a special person to be a child and adolescent psychiatrist, and they're right. My attending delivers wonderful care to these children and their families, is an empathetic patient advocate, and still has enough energy at the end of the day to raise her own boys.

"Aww, look at the little kids playing underneath the
John Deere sign...wait, are they playing in CORN?!" 

Now, while I have enjoyed my time here (and I hear child psychiatrists are in high demand), I miss getting my hands dirty. More than that, I miss civilization. I've been keeping busy on the weekends by travelling to Pittsburgh to celebrate my long-awaited entry into my mid-twenties and to State College to go pumpkin picking, but I can't wait to sleep in my own bed, eat some decent food, and hit up the outlets. The outlets outside of Pittsburgh didn't even have a Yankee Candle, which is mind-boggling. Where else am I supposed to pick up my discounted, autumn-scented candles?

"Giving birth is the easy part. It's the repair that's the real work." -my family doc

How to sum up this past month: lots of firsts, and lots of lady parts.

First, the firsts:

1.     First flat tire (on the way up, in pouring rain): Guess who never had a male of any association (father, boyfriend, brother, friend, rando) teach her how to change a flat?  This girl.  Thank goodness for AAA.

2.     First high school football game: The residents can cover the local football games on the side, so I tagged along.  Pretty sure the resident regretted taking me after I wouldn't stop excitedly exclaiming, “It’s like ‘Friday Night Lights,’ but for REAL!”

3.     First visit to the magic land of Knoebels: Generally not a big amusement park fan, but props to how consumer-friendly this park is.  No admission fee, you pay per ride, you can bring your own food (although theirs is pretty good), and no parking fee.  Definitely a far cry from the paycheck-guzzling Disney World.

4.     First county fair (and first taste of fried oreos): I ate three times my normal daily caloric intake in an afternoon, and I don’t regret a minute of it.

5.     First visit to the Pennsylvania Grand Canyon: Late afternoon sun, the beginnings of fall foliage, and a good hiking workout, which was promptly cancelled out by the pumpkin pie I ate afterwards in a trance of autumn enchantment.

Now, the lady parts: If you haven’t figured it out, I’m on my Obstetrics and Gynecology rotation.  My days started at 6:30 am with rounding on postpartum patients with the OB team (1 intern and 1 senior resident, plus the attending), then morning report, then dividing my days among the following (with the team):

• Pre-Natal Center: Ladies find out they’re preggo at the local family planning clinic and then come to us for their pre-natal care.  First date is a full history and physical, and every visit afterwards is a quick check-in to make sure everything is going well.  I was sorta hoping I would be hanging out with a bunch of Junos all day, but sadly, none were as witty and none of the baby daddies were as adorkable as Michael Cera. 
• STD Clinic:  I won’t go into detail, but my college health service department was onto something when they drilled “No glove, no love” into our heads during orientation.
• Labor and delivery: 

Did your water break, or did you wet yourself?

Pushpushpush

That epidural works wonders, doesn’t it?

I can see the head!

It’s going to feel like a giant bowel movement.

She’s still only 3 cm?  Still? 

Pushpushpush

Don’t hold air in your cheeks when you push, otherwise you’ll burst blood vessels and you’ll look puffy.

*in my head* Please stop screaming. Please. Why are you screaming?  The first sound your child will hear when he comes into this world is you sounding like a banshee.  STOP.

Overall: I don’t think babies and lady parts are for me.  Well, maybe the babies, but I’d much rather deal with those adorable peanuts than the mothers, some of whom aren’t even old enough to have a routine Pap smear.  While I do not-so-secretly enjoy watching “Teen Mom,” it’s not as enjoyable when it’s occurring in front of you.

Central PA, it’s been real.   I’m off to the heart of the coal region in Western PA next month for Psychiatry (aka “The No-Touch Physical”).  Given my preference for hands-on rotations, we’ll see how this turns out.  

Excuse me while I continue to stuff my face with chocolate-covered macadamia nuts.

Aloooooha from the lovely state of Hawaii! 

View from the top of Diamond Head, a volcanic tuff cone

How you, too, can end up in the land of grass skirts and coconut bras: 

Family, networking, or completing a rotation at Tripler Army Base (if you are participating in the HPSP scholarship). One of my friends is rotating at Tripler in a few months, so it IS possible! Since I'm not in the military, I relied on the kindness of extended family. Don't be fooled, though: I had to jump through a number of legal paperwork hoops between the hospital and PCOM, so it wasn't always smooth sailing.


The rotation itself:

Koko Head = Nature's Stairmaster
(1,500 steps ascending 1200 feet; thank goodness
it was cloudy when we climbed it, or else I would
have collapsed from heat stroke)

The GI Clinic is located inside a hospital. The health system here is "open access," so when Dr. Smith (the PCP) tells Mr. Jones, "You need to get a colonoscopy," all Mr. Jones has to do is wait for a call from one of the GI staff to set up the appointment. Dr. Aloha (the GI doc) can look at Mr. Jones' e-chart (notes from the PCP, past procedures, etc) because everyone's within the same health system. Mr. Jones shows up, Dr. Aloha does the procedure, and Mr. Jones leaves with the promise of another date in 10 years. Dr. Aloha documents the procedure in the chart, which can be read by Dr. Smith whenever. Not all GI clinics operate this way; some bring in the patient for an initial consult, then do the procedure, then schedule a follow-up. Here, the GI docs rely on the clinical judgement of the PCP for the referral, and any follow-ups are done by the PCP (with the occasional phone appointment with one of the GI docs). 




Pros: 

I was more worried about breaking my phone than my head while
climbing the rocks at Laniakea Beach on the North Shore

• Hours are good (8-4ish)
• The cafeteria menu features Hawaiian and Asian dishes, a welcome change from the usual "mystery meat slathered in gravy." 
• The clinic is staffed by a handful of physicians, and about two dozen nurses, technicians, and MAs. It's always busy and there's always people around, which goes well with my self-diagnosed ADHD. When my attending's schedule is slow, I can easily hop on with another physician, or the physician that's on-call for the hospital. 
• It's straightforward. You walk in, say, "Hi, I'm Dr. Aloha, we're going to stick a scope in you, here are the risks involved," have them consent, and get down to business. When you're done, you brief them of your findings, and off they go. 
• During the procedure, the doctor has the support of (at the very least) a nurse and GI tech. More complicated procedures require more people. I like the team aspect; as the doctor, you can take comfort in knowing that should things go pear-shaped, you're not alone. 
• There's several branches of GI. Although the docs I work with do mostly screening procedures (EGDs and colonoscopies), you can go into transplant hepatology, hepatobiliary medicine, pediatric GI, or advanced endoscopy. 

Cons:

My friend's interpretation of when I told her
I went swimming in a shark cage last week 

• The usual risks of sticking a foreign object inside somebody: bleeding, perforations, etc. The other week, a patient's diverticulum was perforated, so she had to go for emergency surgery. Patching up a perf is a minor surgery, but still, it's an "Uh-oh" moment. 
• GI fellowships are highly competitive, so if I was dead-set, I'd probably do a couple more GI rotations, try and get an IMED residency at a hospital that has a GI fellowship, and network my butt off. 
• One of the downsides (depending on your personality) to being in a procedure-based practice is that there's little opportunity for building strong patient relationships, in contrast to family medicine.

Overall: I'm keeping GI as a viable career option. Regardless of what I end up choosing, this rotation has taught me that I would like to end up in a specialty with a lot of hands-on work and the opportunity to be a team player. Awesome weekend adventures (such as those featured in the photos), while obviously not required, would be a definite perk!