Thursday was my first call night of the year. It started out pretty slowly, with no new admissions and no issues with any patients for the first few hours. Then, about 6pm, it all started. The service "caps," or reaches its limit, at eight new admissions. We got our eight within about five hours. I ended up evaluating a leg fracture, possible bowel ischemia, pancreatitis, and a new rash in a patient with autoimmune disease. Around midnight, the resident, intern and I sat down to talk about our patients and write our notes. I was able to get all of my notes written in about an hour. (It's amazing how much easier it is to write a note without the book reports we had to do as third years.) I stuck around to help with any cross-cover issues, but even that was slow.

I slept from about 1am to 5am Friday morning, then got up to get ready for rounds (which are always early on post-call days). I goofed a little on one of my presentations, mostly because I totally lost my train of thought mid-sentence. Nobody seemed to care. After rounds, the team got some coffee (chai for me) and got to work putting in consults and following up on all the stuff that was done overnight. Then it was time for Morning Report, which, amazingly, I made it through without nodding off even once. I attribute that partly to caffeine, but mostly to learning about the "Violet Beauregard" species of zebrafish, which swells up like a blueberry when a certain gene is knocked out. I also went to noon conference, though I shouldn't have because I kept falling asleep. This is kind of pitiful, since when I'm taking call for real four hours of sleep will be a ridiculously high amount.

The rest of the weekend was basically spent either sleeping or socializing. Friday night, I went out to dinner at a place where the menu included "spoonfuls" of soup. Probably won't be going back there. Then I went in for rounds on Saturday morning, which were pretty short. Saturday night, I went to a friend's birthday party, which included fireworks when the cake was brought out. Not sparklers, not firecrackers. Fireworks, up in the sky. Crazy!

I guess I'll post more about this week, next week. Bye bye for now!

Everybody says that fourth year flies by, so I am trying to enjoy each day as it comes. So far so good!

Yesterday the team was on short call, meaning we were responsible for morning admissions. However, there were so many admissions during Monday night that we simply got three patients from that load, who had already been seen. Tomorrow will be my first long call day and my first chance to truly pick up patients of my very own. I'm excited. I've followed a couple of patients, presenting on rounds for the first time today. It'll be good to actually have someone for whom I've worked on the initial diagnostic puzzle. I'll let you know how it goes!

Well, my last "first day of school" ever is now over. As I've mentioned before, I am on the Morgan service, which is general internal medicine. Both my resident and my intern seem really nice. Proving that the medical community really is a small world, my intern is the brother of a Medicine resident that I often took call with last year, and the brother-in-law of an Ob/Gyn resident with whom I'll be working next month. My attending also seems really nice so far. I was asked a total of ONE question today on rounds. The rest of the time, the attending did a lot of teaching that wasn't prefaced by pimp questions. Understandable for the very beginning of the year. It could have also been because the team was post-call today, so the residents needed to get home. Tomorrow might be more pimp-tastic.

After today I am once again eager to sing the praises of the breadth of General Medicine. Among other things, I saw diabetic ketoacidosis, a huge nonhealing leg wound with possible underlying bone infection, pulmonary edema, gout, and lower abdominal pain in a female that required a pelvic exam (which was done by me). Cases discussed in morning report included intractable nosebleed in leukemia and serotonin syndrome. Noon conference covered the treatment of shock. Basically, these people know a lot about a lot.

The moment I really knew that this year is going to be different came right after rounds. Some random, tedious busywork sprouted up, and my resident looked me in the face and said, "Don't worry about it. That's the type of stuff I'd send a third year to do." Ba-dow.

Okay guys. To maximize my being an utter waste of space this week, I may have gone back to an online, text-based game that I played heavily back in late high school/throughout college. And by "may have," I mean I went back hardcore. I can't say that I'm proud of myself, but I have had a great time with it. I feel comfortable sharing this information with all of you because I still don't think I'm as big a dork as my friends Liz and Lindsey. They are, at this moment, watching the "Twilight" movie and working on a 1000-piece jigsaw puzzle featuring the Bella and the Cullens. I'm feeling pretty damn good about using text commands to kill monsters. So there you have it.

In other news, I start my fourth (and final!!) year of medical school on Monday. My first rotation is the general internal medicine service, also known as Morgan. I found out that I will be on Morgan 2, and my attending will be the director of the Internal Medicine residency program. In other words, one of the biggest of the bigwigs. I am a little nervous about this, as I feel that I need to know all of Internal Medicine in order to make a good impression. Not to mention the fact that I haven't done a truly full physical exam since... crap, since I was on Medicine the last time?? I'm in trouble.

I really wanted to write a long, glorious summative entry about my entire third year of med school. Well I just don't have that kind of time. Suffice it to say that I learned a lot about medicine. Seeing real patients with real disease processes, day after day, really solidified the things I learned from books during the first two years. I know that those hours of lecture and book studying made it possible for me to grasp the stuff on the wards. But overall, I must say, being in the clinical setting is so much more fun. I also learned a lot about myself, and the best way to interact with a wide variety of people. And finally, let us not forget that I got to do some pretty awesome things!!

My favorite individual rotations were by far Labor and Delivery, Gynecologic Oncology, and ENT. I've already talked about what I thought was cool about each of those things. The ability to deliver babies beats most other things in 'coolness.' Then there's the ability to skillfully perform big operations in a very confined area like the pelvis (or the neck!). Honestly, if I could get over the babies thing, and if I hadn't needed to start ENT research in third grade, I'd have a harder career decision to make.

By the way, exactly one year from RIGHT NOW I'll probably be trying to get some sleep before starting my first day of intern year. Man oh man.

On Tuesday I watched as, so far as anybody knows, ECT (electroconvulsive therapy) was performed for the first time ever on a patient with a cochlear implant. Based on the complete turnaround in the kid's condition, I am now an ECT believer. Oh, and it's not nearly as dramatic as its portrayal on TV or in movies. (Nothing in medicine is, I've found.) In fact, the first time I saw ECT done, I had to literally bite my lip to keep myself from blurting out, "That's it??" I got more of a rush out of striding purposefully through the OR suite before and after the procedure.

Wednesday was remarkable for being my last day in the hospital, and a day in which I didn't have to do much. The attending was in meetings all morning, and the fellow had teaching conference from noon to 2pm. I had lectures from 2-5pm. So by the time all three of us could actually get together, the day was all but over.

On Thursday morning, I only had to attend morning report and Grand Rounds. Before morning report, the other students sat around the table and had a good laugh at yet aother hilarious story about the wacky hijinks of the psychiatry clerkship. I, along with the other student who did the winning combo of Addictions and Child Consults, literally sat off to the side in a corner of the room. Instead of joining in the laughter, we were talking about how we've both needed to see counselors due to nightmares, insomnia, etc. since starting the rotation. I feel compelled to warn future generations of third years not to believe the hype. Psychiatry isn't a time for fun and hilarity, though many, many people will say otherwise.

Yesterday, I took the Psychiatry shelf exam. I thought it was okay. It seemed like every other question was about the indications for the different kinds of psychotherapy, which I didn't study as much as drugs, diagnostic criteria for the various conditions, etc. Nothing to be done about it now! After the exam, each of us had an individual exit interview in which we discussed our experiences with the clerkship directors. He didn't seem too perturbed by the fact that both of the Addictions/Child Consults students were emotionally crushed by the rotation. He said it's really "the luck of the draw," and sometimes other services are slammed with really emotionally tough cases. I have my doubts about that. But anyway, it's over now. As is third year!! I'll share my thoughts on the year as a whole a little later.

Yesterday morning I was able to go to an outpatient child psychiatry clinic to see, as my attending put it, "the happier side of child psychiatry." Seriously, 99.9% of practicing child psychiatrists aren't putting in eleven-hour days, mostly in critical care units. The patients I saw Monday morning had things like mood disorders, ADHD, and OCD. That's very different from acute stress disorder and delirium due to non-accidental burns.

In the afternoon, I went over to ob/gyn clinic to talk to a faculty advisor about my residency application. It went well overall. She's going to read my personal statement (which finally got written!) and give me some feedback on that. She also gave me lots of advice about things to look for in a residency program. She also asked me just what about ob/gyn gets me so excited. The problem is, I am so burnt out right now that it's hard for me to describe what I like about medicine, in general. I know that I want to be an ob/gyn, but the overwhelming thought in my head right now is that I just want to have a decent chunk of time during which I don't hate my life. Is that so much to ask?

The work week that just ended was a definite improvement over the one before. On average there was about one new consult each day, as opposed to three or four. Furthermore, the consults we got did not involve child abuse. Apparently last week's flood of abuse cases was an anomaly that left even the peds attendings shaken. So it wasn't just me!

That's not to say that last week was all puppies and rainbows. We had a pretty steady census of eight patients, six of whom are in intensive care. One of them is now headed toward hospice care. I sat in on the care conference during which the parents realized for the first time that the miracle they'd been hoping for probably wasn't going to happen. When the mom asked, "How do you let go of your child?"... hats off to anybody who can answer that question for a living.

Logged into the Portal (school interwebs thingie) today, and what do I see at the bottom??

"Portal page for: LaKedra Pam, VMS IV"

Guys, it's happening! This year might actually end!! Back in July, I remember settling into things with the thought that the end of the year was so far away, I might as well just accept the fact that I'd be a VMS III for the rest of my days. Now look at me! The Portal just called me a VMS IV!!

I haven't been writing much recently because I've been depressed ever since starting psych. Probably not true depression, but guys, this rotation sucks. It's just so hard. Not just the hours: I've had long days before, and I'm willing to accept 11-hour work days as karmic payback for thinking that having Psychiatry last would be like starting my summer vacation five weeks early. What really gets me is seeing kids who are extremely sick, or come from extremely bad home situations, or both. In this respect I really think the pediatrics clerkship does students a huge disservice. It involves zero critical care time, and most of the time the third years are shielded from seeing suspected abuse victims. All well and good, until one of those third years strolls into a child psychiatry rotation expecting to spend their time hanging out with cute kids!! My not-quite two weeks of child psych is probably tied with my five weeks of Colorectal Surgery when it comes to time I've had to spend in intensive care units. That Pulm rotation that bothered me so much back in August is laughable in comparison.

Every single day feels like it stretches on forever. I just have to make it through the rest of today, and tomorrow, and then I get a weekend. Which I have to spend studying for my shelf exam. Then I have four more days before that shelf exam. And then I'm done.

You have one emotional breakdown, and suddenly the whole psych department treats you like you're made of glass. I'm fairly certain my attending was actually afraid to break the news that one of our kids had gotten worse over the weekend, for fear it might crush my spirit. There was also the change in the department seminar schedule to include a discussion on dealing with emotional difficulties. Also, every sentence directed at me so far today has begun with "Would you be okay with..." as opposed to the usual "We need you to.." of third year.
I'm not complaining, just noticing.

Food for thought: I have more popsicles in my freezer (11) than I have work days left in third year (9).

Y'all, I will guarantee you that if somebody says "Oh, I got some great stories from my psychiatry rotation," that person did not rotate through Child Consults. I've gotten stories all right, but none of has been great. I've been spending most of my day seeing kids on the burn, trauma, oncology (cancer), and critical care units. Sad stuff, but I've been seeing really ill people all year. Seeing victims of child abuse in the emergency room... that's probably the biggest reason I cried every single day last week.

(Purposely being vague for patient privacy reasons:)
One of the patients I'm following is a kid under 7 who comes from a home situation that, at best, involved frank neglect with very un-awesome parents. As the medical student, with lots of time, one of my duties was to get the kid to talk about their emotions, considering the events that led to them being in the hospital. By Friday I'd formed some rapport with the kid, but they were still mostly very withdrawn and very very sad. At one point, the kid said that they couldn't be friends with me, because "I'll get in trouble with Mommy." Of course I asked why, and got the answer "Mommy says I'm not supposed to talk to black people."

Hokay. Well, having met the parents (who weren't in the room at the time), and with the gift of hindsight, this was not a surprising answer. But actually in that moment, I was flabbergasted. Even though I know full well that a child that young is only parroting what they hear at home, I was hurt, too. I think I recovered well, and went down the path of asking the kid if they thought people could be nice, "even if they don't look like you." The kid agreed, and we ended up playing a game of Candyland and talking a little more before I had to leave.

So at the end of the day, the attending, fellow and I met up to discuss all the patients we'd seen. The attending especially wanted to know how my "therapy session" with the kid had gone. I talked about how I'd gotten the kid to talk about some stuff, but they still wouldn't talk about feelings. I talked about playing Candyland. Then I told the above story. And my attending leaned forward, folded her hands over her knee, and said, "And how did that make you feel?"

Well, that was all it took. Every single raw emotion from the preceding week came flooding back. Out came the tears that I'd managed to hold in until getting home on previous days, and I broke down sobbing right there in the Child Psychiatry office. At first I was horrified to have lost my cool like that, but the attending and fellow were both very nice and very understanding. Of course, they had me explain just what has made the rotation so difficult for me, and how I've been dealing with it, and "What are you going to do this weekend to take care of yourself?" All in all, I think it was really helpful to finally talk to one of my 'superiors' about how rough things have been. I can only hope that the next nine days I work don't cause total emotional burnout.

As you might have gathered from the last entry, I had a great weekend. casibeth came up from ATL for the weekend. I had a blast hanging out with her and giving her a little taste of Nashville! (Seriously... most of the weekend involved eating.) And then, of course, there was the concert Saturday night. I found it amusing that I got to hear two of the staples of the mediocre cover band from Flying Saucer trivia*. Needless to say, "Chasing Cars" is much better as performed by Snow Patrol, and "Yellow" is much better as performed by Coldplay.

*Recent upheaval in my life: as of two weeks ago, trivia no longer happens at the Flying Saucer. It's now at a different place with fewer beers on tap, more items on the menu, fewer waitstaff (longer waits for food), fewer people (no need to tablesave), and fewer mediocre cover bands. It's taking some getting used to.

Moving on, I'm now on my last rotation of third year, Child Psychiatry consults. The team consists of two attendings who work on alternate days, a first year fellow, and me. One of the attendings has been one of my small group leaders since day 3 of med school. (I have a distinct memory of her welcoming my Ecology group to Vandy, introducing herself, and then telling us "I'll be your Master Clinical Teacher when you're third years." Third year seemed so impossibly far away, I couldn't imagine why anyone would have us look ahead that far.) Anyway, it's great, because she really really knows me. It's not so great, because she really really knows me. As in, if I'm not on top of things tomorrow, she'll know darn well it's because I spent two hours at trivia tonight.

Coldplay concert tonight. Amazing. Wonderful. Delightful. Ridiculously awesome!!

I like that they opened with "Life in Technicolor" and closed with "Life in Technicolor ii."

I like that they played every song on the "Viva La Vida" album, except "Yes" and "Reign of Love," both of which I can live without.

I like that they played "Green Eyes," a lesser-known song from the Rush of Blood to the Head album.

Once again, singing the chorus of "In My Place" along with the entire crowd was a highlight of my life.

Techno-ish version of "God Put a Smile Upon Your Face" + "Talk".. different, but cool.

Piano acoustic version of "The Hardest Part"!!!

Rediscovering the part of "Politik" ('give me love over this...') that always, always makes me cry.

I like that the background video for "Lovers in Japan" was so damn literal. Yes, please show footage of soldiers, marching on.

When Chris Martin led the audience in a Mexican wave of that involved no standing, but waving our lit cell phones... badass.

I will have no voice tomorrow.

It is tomorrow.

Highlights of last weekend...

Sunday morning, I went with 7 other people to Monell's, for family style, all-you-can-eat, down-home Southern breakfast. It was very tasty, but it wasn't really anything I couldn't get any time I wanted at home. Grits, eggs, bacon, sausage, and biscuits has pretty much been my default breakfast every single morning for my entire life. Seriously, when I was home for spring break this year, I had to warn my mom ahead of time when I didn't plan on eating that for breakfast. It has only been fairly recently that I've realized that not all my friends, even the Southern ones, have had similar upbringings. Now I'm not dissing Monell's, because I'm not at home now, and I'm certainly not cooking all that food for myself every day. I would definitely recommend it to people who aren't used to giant southern breakfasts. And I would bring my parents there, since they like to go out to eat at places with familiar foods.

On Memorial Day itself, I was mostly a waste of space. In the evening I went over to Centennial Park with Paige and Jo for a blues festival. It was an all day event, but we only saw the headliner-- Bobby Blue Bland. Or "Bobby Blue Bland and the Bobby Blue Bland Blues Band," as I said repeatedly throughout the day. That was probably annoying... anyway, my mom and most of her siblings love blues music, so I was quite familiar with Mr. Bland. I sent my mom a text message about the concert, and she texted back, "I am so jealous that is wrong i am the blue person in the family have fun". She's still working on punctuation, and capitalization, but she's getting better at the whole texting thing every day!! Also, she's apparently blue in color. I hadn't realized that.
*-*-*-*-*-*-*-*-*-*
So at the end of the long weekend, I had more days off Psych than days I'd worked on the rotation. It kind of felt like the rotation only just got started this week. I really like it so far. Still trying to tease out whether that's because I actually enjoy psychiatry, or because I enjoy it when the resident says "Bye! See you tomorrow!" shortly after noon. Maybe a little bit of both.

High point: The other day, one of my patients told the attending, "I was feeling bad, but then I talked to Laquita and I feel a lot better now!" She pointed to me as she said this, so I feel pretty confident that I am in fact the Laquita she meant. That felt really good, and not just because my attending gave me a huge beaming smile and approving nod. However, I later realized that if that patient comes back to the hospital relapsed or, God forbid, post-overdose or suicide attempt, my heart would break into tiny pieces. Reason #1 why I don't think I'm cut out for a career in psychiatry.

Low point: I recently had a vivid nightmare about being shot in the face after a different patient discussed his previous suicide plans in exquisite detail. That pretty much ended all my future sleep plans for that night. Reason #2 I'm glad my resident let me go home early, and reason #2 I'm not a future psychiatrist. (Also reason #17894823934634832 why I might need to see a mental health professional myself.)

This morning, I got to hear a lecture on disclosing errors. The same lecture that I thought was so awesome on the first day of medical school orientation. The same lecture that I'm starting to have memorized after hearing it at least four more times before today. I NEED to do my residency at another institution, if only to save myself from a future in which I hear that exact same lecture seven more times!

Hello dear readers. My Psychiatry rotation is now underway. The biggest reason I'm excited about this is it's my LAST ROTATION OF THIRD YEAR!!! So far things are pretty chill, which is exactly what I hoped for when I asked to have Psych and Neuro as my last block of the year. My resident called me a gunner when he found out I had no plans to go out last night. He stood by that assessment even after I told him I had no plans because I was on call.

Even in such a relatively laid-back environment, I am tired of being a third year, with a capital T-I-R-E-D. I don't know what I'd do if I were on Surgery right now. On that rotation more than any other, I think I wasn't evaluated based on any actual knowledge, or even technical skill, but on how happy I looked to be there. Or how well I faked looking happy when I wasn't. I think this because I recently got my evaluation back, and some of the comments basically said just that. I get the feeling I would have been better off had I studied less and devoted more energy to being loud and enthusiastic. At least in January it took me four weeks to "look tired." Now, I'm sure I look tired at baseline.

Call last night was pretty good. The intern who was taking evening admissions didn't seem too enthusiastic to have me there, but the overnight PGY-2 was awesome. He gave me some really good tips on taking a psychiatric history, and did some teaching about all the various psych meds. When I left at 9, he thanked me for being willing to "do work and stay late." With a q25 call schedule, it's not hard. The next time I have call, the rotation (AND THIRD YEAR!!!!) will be nearing its end.

This weekend has been full of studying for the Neurology shelf, which is on Tuesday. I appreciate having had this weekend to study, but I would have appreciated having a free weekend just as much, if not more. For this clerkship, I've gone back to the study method I used for the boards: all review questions, all the time. I've managed to do several hundred questions, thanks to a couple of hardcore Starbucks sessions. Thank you, caramel chai lattes.

The third years, lower half, have begun studying for Boards in earnest. I'm in Light Hall today, and they're all over the place!! I decided to come study here today because I wanted to wear scrub pants. This is a new personal policy I have: no scrubs outside the medical center complex. I decided to adopt this policy earlier this week. That's when I saw a surgical resident at the gym who thought it'd look awesome if he lifted weights in full scrubs (pants and top) and Rainbow flip-flops. I just know that I had my "You're a tool" expression on my face whenever I looked at him. Since I don't want to be associated with people like that, I am seriously scaling back my scrubs-wearing. Jeans have more pockets, anyway...

My last full week of Neurology is almost done. The shelf is on Tuesday. I took call Monday night, and there were four admissions to the General service alone. I think there were three admissions during the entire two week span prior to my joining the service. I am clearly the black cloud to end all black clouds. That's a term used to describe someone (usually a resident) who seems to attract patients to the hospital like moths to a flame. There will be no fewer than a dozen new admissions any time a black cloud takes call. Although now, it's not just when I take call. My mere existence on the service has caused the number of admissions to increase exponentially. I did predict this happening, before I even started General Neuro. Maybe my predicting it made it happen. Deep, I know.

Today, my resident gave me a teaching session with tips on how to examine uncooperative patients. It was really nice of him to take the time to do that, considering he was post-call. Alas, it made me late for lecture. For some reason, instead of just being more late in order to get food or go to the bathroom, I decided to forgo both. So by the end of our first hour, I really had to pee. While in the bathroom I missed hearing that there were extra free lunches in a different conference room, so I missed out on one of those. Then our second lecture was long by half an hour, so I didn't have enough time to get food before meeting our attending for afternoon rounds/teaching session.

I know that sounds super lame when it's typed out there, but it just about crushed my spirit as it was happening. It's Neuro. There's supposed to be time to eat on Neuro. I really don't consider myself an emotional eater, but once I left the hospital a nice bowl of Panera's broccoli cheddar soup sure did wonders for my mood. I stayed there for a productive study session. Then I had a nice long workout, then a nice hot shower, and then I watched 24. Now all is right with the world.

Liz was out of town this weekend for her sister's college graduation. That left me alone in the apartment with Guinevere and Percival. Since I believe that one becomes a Crazy Cat Person the moment cats outnumber humans, it was my Crazy Cat Lady weekend!! Wheee!

As soon as I had the apartment to myself, I tried really really hard to study Neuro. I ended up sleeping on the floor while the Music Choice 90s channel played in the background. Luckily Johanna saved me from my own lack of willpower by coming over to hang out and study. If I hadn't chatted with her on Friday night, I probably would have spent the whole weekend going from my bed to the couch without leaving my apartment or speaking to another human.

Instead, on Saturday I went to Whole Foods to study, but ended up spending more time thinking about fourth year stuff. Like my personal statement for residency applications, which is refusing to write itself. And trying to figure out just where in the country I'm interested in going. (It's a big country!! I'm taking suggestions.) I eventually gave up, and went to check out the local Latin American Street Festival with a couple of people. It turned out to be not that awesome (in fairness, we only caught the very tail end), so we went to dinner instead. Followed by giant ice cream cones at Maggie Moo's. Good times.

Sunday, I went to brunch to celebrate my friend Lindsey's birthday. You might think that Mother's Day brunch would be a madhouse, but the place we went to wasn't super crowded. It was one of the slowest brunches I've ever had. I think it took over half an hour just for our drinks to come. So it was well into the afternoon when I got home. After a workout and a few hours of The Food Network, I did a bit of Neuro studying.

(You know, if I actually bomb this shelf, I'm going to feel real bad about broadcasting just how little I studied.)

The class of 2009 graduated yesterday. Since it was a very uneventful day on the Neurology service, I was able go over to the med school auditorium and see most of the hooding ceremony. I teared up several times, but I didn't actually cry! Maybe I'm becoming less of a sap!!

After the grads marched out of the auditorium, I found myself semi-trapped in a huge mass of humanity, giving hugs and congratulations left and right. That's when one of my friends uttered what might have been his first words as a physician: "Oh, God. What happens now???" Nice. Soon after that, one of the Surgery professors, whom I affectionately call 'Mark Twain,' grabbed my hand, held it in a vise-like grip, and solemnly said "Your time will come soon, my daughter." Bizarre.

I went back to the hospital after that, only to be dismissed by my resident. So that was my whole day.

-------------
In less happy news, I think I might have a slight case of generalized burnout. Even though I'm not on a very time-consuming rotation, I haven't had the motivation to do anything once I get home from the hospital. Summoning the energy to make dinner or even watch TV has been a struggle. Studying and working out definitely fell to the wayside. Today was my first trip to the gym in over a week. I need to figure out where I'm going to find the energy to finish Neurology strong and make it through Psychiatry. Siiiigh.

I decided to write an entry about how my days have been going recently. I understand that this is probably very very boring, but that's all I've got these days.

I wake up at 7 and read the daily sign-out email. That's where the person on call the previous night lists any new admissions or issues with patients. This morning, my team had a new patient, and since it was my turn to pick up a patient, she was mine. So I ate a leisurely breakfast, got ready, and got to the hospital a little before 8. That gave me half an hour to examine the new patient before the scheduled start time of rounds. Now, we haven't actually started rounds at 8:30 since I've been on the service. I'd just rather sit around with my work done than tempt fate and be unprepared the one time things started on time.

(I usually try to completely finish my progress note(s) before rounds begin. There are two schools of thought on this. One is that we should wait until after rounds, when the day's plan for each patient is formalized, before finalizing the note. The other is that since medical student notes don't matter for anything, we should go ahead and put whatever plan we think is appropriate into the chart. I subscribe to the latter. I figure, those times when I do have people reading my notes, it's better that they see my own thoughts about what should be done for the patients.)

Rounds start closer to 9 than 8:30, and usually last an hour and a half. That's ridiculous for only three or four patients, but such is life. Sometimes I think certain people go into academic medicine because they just love having an audience on rounds. There are definitely personality types out there who would thrive on being the center of a circle of residents and students. Nevermind that it's a captive audience, powerless to do anything but pointedly check their watches while the attending blathers on about the Gemini missions and riding lawnmowers... sigh. Whenever I start to get antsy, I just remind myself that rounds didn't start at 6am. That helps me feel better, but only slightly.

Our patient list tends to have only three or four people on it at any one time. On top of that, for most patients we aren't doing much besides giving them steroids or plasmapheresis. That means there aren't a lot of "medical student tasks" for me to work on during the day. (Yesterday, I got to pull a central line, and that was pretty much the highlight of my day.) So after rounds, I usually read up on all the neurologic diseases in the world until it's time for our clerkship lectures, which go from noon to 2pm. After that, I usually do something (ie, sporcle) to fill the time until 3pm, when my resident tells me to go home. Then I go home. Exciting, no?