I had a really long entry ready to go, but I didn't like the tone of it. Too whiny, too rambly. I'll try to hit the highlights with some bullet points. Warning: it might still be whiny.

--Counting the four shifts I mentioned last time, I had a total of seven shifts in nine days, punctuated by hours of lecture and a day of BLS/ACLS training.

--One of those shifts was my first in the pediatric ER. It started off splendidly, I was seeing patients on my own, and it was fairly busy. Diagnoses weren't as challenging as on the adult side, but the patients were a lot cuter. I remembered just how much I love hanging out with babies!

--Towards the end of that shift, the ED got slammed with multiple traumas, kids who were victims of a car crash. One of the kids expected to come in died on the way. Heartbreaking.

--I left my shift so keyed up that I only got about three hours of sleep before BLS/ACLS training. In addition, I was so upset that I told Liz I'd rather repeat 5 weeks of colorectal surgery than finish out the last week and a half of Emergency Medicine. Since my acute emotional state has passed, I can say that was not a true statement.

--BLS = Basic Life Support, or typical chest compression/rescue breath CPR. ACLS = Advanced Cardiac Life Support, or running a code when a person has cardiac arrest. ACLS has several different algorithms involving different drugs, which can be very confusing. We'd covered them in class, but the format of our lectures is "interactive discussions," also known as "talking through cases," also known as "ranked absolute last on the list of ways I learn." To my discredit, I didn't put a lot of effort into studying them on my own, since I thought the ACLS class would cover things in a way that was better for me. I was mistaken. Imagine my surprise when, after a brief round of talking through things, we were thrown right into practicing for our mock code exam.

--I bombed my practice code. I was horribly humiliated, and had already been on the verge of tears since seeing all those really sick little kids the night before. I didn't cry, but I really wanted to.

--I managed to pass my real test, but only because I spent the rest of the practice round not listening to what everybody else was doing, but reading the notes I'd managed to write down.

--I'm thinking about starting a campaign for Read-Write Learning Awareness.

--I left ACLS training, not feeling great about myself, and went straight to the adult ED for another shift. It wasn't bad, but I stayed an hour and a half longer than I was supposed to because stuff kept coming up with my patients.

--I woke up Friday morning so tired that I stayed in and skipped the day's first lecture. That definitely helped my mood and energy level, but it didn't stop my classmates from commenting on how sad I looked. Because I was sad, and I have no poker face. I need to work on that.

--I had a true weekend off, and it was glorious. I didn't study as much as I should have, but I got lots of sleep and watched lots of football.

--Sadly, my roommate left for an away rotation over the weekend. Between her aways and my planned months at home, we're not going to see a whole lot of each other until February.

--I had my last ED shift today, out at the community hospital in a smaller town. It was fun! I got to sew up a couple of cuts.

--On the subject of residency apps, I have thirteen interviews scheduled now. Add to the previous list: Vanderbilt (finally!), University of Texas- Austin, Yale, and Emory (oh hello alma mater, nice to hear from you!). Ask anyone, they'll say that thirteen interviews is far too many, but I don't know how I'm going to decide which I'm not going to go on. For now, I can't think about it.

--It's highly likely that the Emergency Medicine final exam is going to demolish me.

Dear Journal,
Feeling listless today. It started this morning, when I tried to make a smoothie out of beef bones, breaking my juicer.

If the above reference, and the entry title, are lost on you, then you NEED to start watching "Glee," or as I call it, "television's greatest gift to humanity in recent memory." You all know how I feel about musicals, especially those set in high schools. This one ups the ante by featuring contemporary pop hits and classic rock standards. To make things even better, it's also really really funny. Just watch it; it won't disappoint.

Moving on to even better things... Tuesday night at trivia, one of the questions required us to name both of the women who attempted to assassinate Gerald Ford. Both of them. Our answer was "Squeaky Fromme and... BUH???" Actually, I said something generic like Susan Williams, because it's always better to put some guess than nothing at all. But still. That was tough. The trivia moderators said that they're trying to make the questions a little tougher, and I'd say they have succeeded. By all reports, it's already the hardest (translation: least lame) bar trivia in town, so I'm not sure why they're trying to make it tougher. But we won, for the second week straight, so if that's tougher trivia, I like it! (During the final wager, I was subject to a little ribbing because, when told to name Shakespeare plays that start with 'T', my first thought was "Titus Andronicus." As opposed to, say, "The Tempest.") We also did the best on the "lightning round" question, netting a total of $70 in house cash for the team. Giddy up.

My emergency medicine rotation is still trucking along. I've only had a grand total of two clinical shifts so far (I'll have had six by the end of the weekend), but I have been to plenty of lectures! Honestly, as much as I whine about the travesty of mandatory lectures as a fourth year, they are for the most part very useful. We've covered things like life-threatening causes of common complaints, management of arrhythmias, and acid-base abnormalities. I can usually appreciate how much I'm learning. Occasionally, however, I zone out in lecture because of a wave of abject terror that I'll actually be responsible for taking care of sick people very, very soon. And sometimes those sick people will have another person inside them! I don't know what I'm getting myself into. But let's not dwell on that.

Since I'm no longer on surgical rotations*, I've been able to start volunteering in the med school admissions office again. (That's the only reason I'm still on campus right now, since lecture ended at 11.) Now I sit down with the interviewees for about ten minutes before they go on their tour, and give them a little talk about the clinical years. I remember when I interviewed, the fourth year seemed so wise and old. I could never imagine myself in that position, getting ready to graduate, confidently saying "I'm going to be a [insert specialty here]." And here I am! It's pretty fun to interact with people who are just starting the process.



*Waking up at 7:10 beats waking up at 4:45, but I miss the OR like gangbusters.

Greetings, readers. As you may know from my facebook status updates, I've been sick recently. I knew it was coming on Saturday, because of incessant, constantly-worsening throat scratchingess. I tried to ward off the imminent badness by drinking a giant green apple slushie from Sonic, with a TheraFlu chaser. You know, soothe the angry throat with cold, soothe the angry throat with hot, sleep it off. It sounded great in theory! Of course, that didn't work. I woke up Sunday morning in the depths of woe: achy, with chest congestion, and febrile to 102.6 F (that's a real fever, folks). I spent most of the day sleeping or just lying in bed. I got up a couple of times to make soup and tea, and at one point I attempted to sit up in my living room and watch "Cars" on the Disney channel. However, that was too difficult a task, so I went back to bed and slept more. Alas, I never found out what happened to Lightning McQueen, though if I had to guess, I'd say he learned the value of teamwork and friendship.

Anyway, late Sunday night my fever finally broke in a disgusting display of human physiology (translation: I sweat buckets), and I gradually started feeling better. But because febrile illness is serious business, I stayed away from the medical center until I passed the "24 hours fever-free" mark. Which meant I missed our Monday lectures, one of which was about EKGs, so I'm still clueless about those!! In all likelihood, this illness was not swine flu, but rather the same thing I get twice each year (as winter becomes spring and again as summer becomes fall). However, it's more fun to blame the cooties floating around the emergency room!!

For those of you playing along at home, I have 9 interviews scheduled so far. In no particular order (actually, in the order I got the invitations):

LSU- New Orleans
University of Washington
Baylor- Houston
Johns Hopkins
LSU- Shreveport
University of Texas, Houston x2 (two affiliated, but separate residency programs)
University of Alabama, Birmingham
Carolinas Medical Center, Charlotte NC

I'll keep you guys posted as things change!

Good morning, world. Today marked my last pre-5am wakeup for, hopefully, a long time. It's also my last day of gyn surgery until, hopefully, intern year. I'm more sad about the latter than the former. I'm not exactly looking forward to my month in the ED, especially since the flu is going to be in full swing. However, it will be nice not to have to pre-round. We've gotten our lecture schedule, an it's pretty impressive. Looks about on par with the amount of lecture we had second year, with the "bonus" of mandatory attendance. Huzzah.

Today I got to watch the repair of a major pelvic organ prolapse, one that was not only ruining the patient's quality of life, but her renal function as well. You see, the "water" of the ureters passes under the "bridge" of the uterine arteries, so uterine prolapse can cause major obstruction of the kidneys. My attending said that this case was the closest thing to a prolapse emergency as you're ever likely to see. So, he fixed it, using a technique so new he had the operation recorded for presentation at a national meeting. With the video camera being held by me, Unsteady McShakerson herself. I just hope the video turns out okay! Anyway, today's operation was only a temporary measure, but it will hopefully improve the patient's quality of life enormously. Not to mention giving her kidneys a chance to heal before going back for the major pelvic reconstruction. All this with a fifty-minute operation that didn't even require general anesthesia!

Still tired as stink, but I'm so excited about being a gynecologist one day, I can hardly stand it.

I was about to post an entry that read simply, "Dear readers, I am tired as stink." But that wouldn't be any fun for you guys to read, now would it? So I'll just fling some random thoughts up here and we'll see how that goes.

First of all, "adjective as stink" is an expression I've started to use more often recently, because a lot of the residents and attendings I'm working with use it. I'm such a verbal sheep. I should blaze my own trail, go my own way (and...song stuck in head). I should start trying to work "like gangbusters" into my vocabulary again.

Another week of urogynecology is drawing to a close. I've seen a ton of vaginal operations, which, as I've said, seem really cool to do. Luckily because there's both a fellow and a resident operating, I get a pretty good view of the operative field over everybody's shoulders. Most of the time. Other times, I was staring at a wall of other people's heads. It was during those times that I got some negative feedback, in the form of exasperated "Come on"s and the like, about my admittedly poor lighting of the field. After that happened a few times, it was only self-control in its purest form that kept me from blurting out, "Wear head lamps, FOR CRYING OUT LOUD." I've seen surgeons wear head lamps for big open cases with everything laid out before them, why wouldn't you wear one when operating in a dark recess of the body? Yet nobody does... I must be missing something. Maybe there's some study comparing the use of head lamps to the use of medical students who can't even see the field, showing that the students are 40% more effective. I don't know. Maybe I'll ask a resident. I'll let you know what I find out.

I have my mock interview coming up with a peds critical care attending-- none of the ob/gyn attendings volunteered to do the mock interviews, and I'm not sure it would be the best idea to practice with them anyway (since, hopefully, I'd be interviewing with them for real at a later date). I almost signed up for a mock interview with one of my former surgery attendings who always pimped the living daylights out of me. I thought that would accurately evoke the feeling of fear and terror that shall surely be present during at least my first interview. However, I'm just not that courageous. Just thinking about a mock interview with that attending has made me tachycardic (current heart rate = 108). Anyway, the attending I will be practicing with is a "tell-it-like-it-is" kind of guy, so I hope to get some accurate feedback about things I need to fix.

As far as real interviews go, I have three scheduled so far. One in New Orleans, one in Houston, and today, I scheduled an interview at Seattle Grace Hospital. Just kidding, Seattle Grace isn't real. But it is in Seattle, and I can't promise I won't blurt out lines of dialogue from "Grey's Anatomy" starting the moment I enter the University of Washington Medical Center. I am, after all, the same person who can't come within twenty miles of the city of Memphis without singing "Walking in Memphis" at the top of my lungs.

One more day before a lovely weekend off!

I created a new Pandora station yesterday. The following is a list of the first ten songs that played:
"Summer of '69" -Bryan Adams
"I Still Haven't Found What I'm Looking For" -U2
"Glory Days" -Bruce Springsteen
"Need You Tonight" -INXS
"Hit Me With Your Best Shot" -Pat Benatar
"King of Pain"- The Police
"Heart of Glass" -Blondie
"I Touch Myself" -The Divinyls
"(I Just) Died in Your Arms" -Cutting Crew
"Brass Pocket" -The Pretenders

I'm about ready to declare this the greatest station I've ever created. It even beats the one that I've been tweaking for years to get only songs that I love. The song seed for this new station?? The entry title probably gave it away, but it's "Bette Davis Eyes" by Kim Carnes. Go ahead, try it out. You can thank me later.

In other news... this past Thursday, the administration held a meeting for my class about residency interviews. There was a panel of program directors for various residencies. They talked about the amount of weight they give the interviews (a lot, duh), questions that commonly trip up applicants ("What have you read lately.." really?), and unspoken "rules" about things like handing out copies of your publications and sending additional correspondence. In short, what I learned is that different program directors expect different things. Like the peds or anesthesia person who said, "Look up your interviewer's CV so you can ask them lots of questions about their research interests!" followed by the radiologist who said "Um, that's lame," and the internist who said "I can spot a brown-noser from miles away." Thanks for the tips guys! All in all, the meeting made me quite a bit more anxious about the interview process. Boooo.

Saturday was, of course, all college football, all day long. Vandy played LSU, causing many people to question my allegiances. I will always cheer for Vandy over LSU, since I am currently a Vanderbilt student (soon to be alum) and have never been an LSU student. No, the summer enrichment classes I took in middle school don't count. Rooting against one's own school is cheap, even when a loss is all but certain. The game was moderately enjoyable, if only because it wasn't the 41-3 blowout that I anticipated. A 23 - 9 loss isn't too terrible! It should be noted that I was the only person in the entire sports bar to do the "Vandy! Vandy! Oh hell yeah!" cheer when we scored our lone touchdown. Whatever, pseudo-fans.

Yesterday, Bette Davis Eyes Radio provided the background music for some serious urogyn studying. I was preparing for today, when I was scheduled to operate with an attending known for being very demanding. I knew the procedure forwards, backwards, and upside down. So of course, I got zero questions. Such is my life. Better to be overprepared than underprepared, I guess. I did get to drive the cystoscope a bit; that was cool.

Chief rounds at 6am tomorrow, that means I need to go to bed right now. Goodnight!!

I forgot to write about seeing Bo Burnham live on August 27! He performed at a local comedy club. Between my ticket and the two-item minimum, I spent about $40, but it was totally worth it. You can forget what I said here. Born in the 90s or not, I'm totally a cougar for Bo. He's tall, he plays music, and he thinks up lines like What's the opposite of ln x? / Duraflame, the unnatural log. Brilliant. Did I mention that he's really tall? Like 6'3". That's pretty good. Also, he handled would-be participants in the audience brilliantly. "We're not going to do a sing-along, okay, because I know it's fun, but trust me I do it better." Overall, good show. Unfortunately I was not willing to wait in line to meet him after the show, because I had to be at the hospital at 5:30 the next morning, or something ridiculous like that.

I forgot to mention that I had to go back to Gyn Oncology tumor conference last week, after moving on to my next rotation. One of the attendings (also the department chair) had wanted me to give an oral presentation as the culmination of my time on the service. Since there wasn't time during my final week, he had me come back to give it. My topic was gestational trophoblastic disease, and I think it went well. Hopefully nobody noticed that I was shaking throughout. Maybe it wasn't as obviously visible as it felt. I've got to get me some propranolol.

I forgot to mention that in addition to submitting my residency application, I also registered for my second licensing exam, also known as Step 2. This one comes in two parts. Clinical Knowledge (or CK) is a computer-based multiple-choice test, much like Step 1 which I took after second year. Clinical Skills (or CS) is already the bane of my existence. It's a full day of standardized patient encounters, in which I'll have to take a history, perform a physical exam, and write a note in which I come up with a differential diagnosis. I've already discussed how awkwardly forced and completely unrealistic standardized patient exercises are. To make things worse, the test is only given in a handful of cities across the country. I signed up for the Houston location, then found out that the family members I plan to stay with live a good 45 minutes from the testing center. Curse you Houston, why must you be so big???? But worst of all, I paid over fifteen hundred dollars for the "privilege" of taking these two exams. It's highway robbery.

I forgot to mention that in addition to paying for the exams, and for my residency application, I had to pay a separate fee to register for "the Match," the process that will actually assign me to a residency. Ridiculous. And all this is happening to thousands of senior medical students across the country, most of whom have already paid tens if not hundreds of thousands in tuition just to get to this point.

Anyway. That explains why my facebook status says I'll be living on saltines and peanut butter for a while.

------
I forgot to mention that college football season began last week! I am pleased that my teams of choice (Vandy, LSU, GA Tech) were all victorious. I went to the Vandy game, which was fun. However, as I was standing there, surrounded by freshmen (seven years my junior) in various states of drunk (ranging from "very" to "extremely"), all I could think was "This smells bad" and "My feet hurt; I should've worn Merrells instead of sneakers." I might be getting a little too old for the student section.

I think that's all. Coming up in future entries: more tales of pelvic surgery!!

I'm not sure why, but I've been pretty homesick for Louisiana lately. The third year resident on my current team is from Natchitoches*, and I kinda want to hang out with her just so I can listen to her talk. "You sound like home" is a creepy and weird thing to say to somebody you just met, right? Also, the fact that a north Louisiana accent makes me homesick is a sign of just how sad a state I'm in.

Y'all can remind me of this homesickness between November 23 and January 31, when I've planned to be at home. Four weeks of that time will be vacation time, for interviewing, and four weeks will be my primary care rotation, with time for interviewing. I'm sure around January 4th or so, I'll be stir crazy from living at home with the parents ("LaKedra, don't you think it's about time you went to bed?") for such an extended period of time.

Speaking of time for interviewing, imagine my surprise when I saw an email titled "Invitation to Interview" in my inbox. I thought that wouldn't happen for a few weeks yet!! Anyway, I responded promptly, as we were taught to do, and have now scheduled my first residency interview. It's with LSU's New Orleans program (hooray Louisiana!!) and it will be in December.

Now, just for fun, I give you a few items from a list I found online.

You know you're from LOUISIANA when...
--You can properly pronounce Lafayette, Bossier Natchitoches*, Opelousas, Shongaloo, Pontchartrain, Ouachita, and you know that New Orleans doesn't have a long "e" sound anywhere in it. (I've never in my life seen the word Shongaloo before tonight, so I won't assume I know how to say that one. I'm Louisianian enough to know better than that.)

--You know whether another Louisianian is from New Orleans, North Louisiana, or South Louisiana as soon as they open their mouth. (True. And if they're from South Louisiana, I know which parish they're from, and/or which side of the Mississippi they grew up on.)

--You sit down to eat boiled crawfish and your host says, "Don't eat the dead ones," and you know what he means. (So, like lobsters, crawfish are boiled live. It's generally thought that the crawfish whose tails aren't tightly curled were dead when they went into the pot.)

--You don't learn until high school that Mardi Gras is not a national holiday. (Try freshman year of college. Try second semester of freshman year of college, when I realized that I actually had to go to organic chemistry on Mardi Gras.)

--You believe that purple, green, and gold look good together. (When the messenger bag I have now bites the dust, my next one WILL be Mardi Gras-colored. That's a promise.)

---------
*It's "NACK-uh-tish."

I submitted my ERAS application last night after trivia. Before clicking 'submit,' I really had to screw my courage to the sticking place. However, I'm not sure exactly why that was. Maybe it was just the multiple warnings that once I clicked submit, under no circumstance would I ever be able to change the "resume" part of my application. Never ever. I hate final warnings like that; they always make me nervous. So I checked, and re-checked, and re-checked. I looked for typos. I tweaked content. I looked for typos again. On my last typo check (after I'd started and aborted the submission process twice), I found two mistakes. Minor ones, probably unnoticeable, but...yikes.

Now that I've submitted the application, the waiting game begins. I applied to 21 programs in all. My list was thought out a little bit more than my med school list, which was largely influenced by the presence of Division I sports. (That's a decision I still stand by, just so you know.) A summary of my applications this time around: 2 in Louisiana, 4 in Texas, 2 in North Carolina, 1 each in Alabama, Georgia (guess which one) and Tennessee (ditto), 6 on the Eastern seaboard, 1 each in Portland, Seattle, Chicago and Pittsburgh. There's a website where I can keep track of which programs have begun to download my stuff, but I won't be hearing back about interviews for several more weeks. So now I wait.

Yesterday was my last pathology conference on Gyn Oncology. We discussed some really interesting cases, for example a squamous cell carcinoma arising from a Bartholin's gland. (That means nothing to you, I know. But it's interesting, trust me.) I presented two patients myself: one with breast cancer metastatic to her ovaries, and one with vulvar cancer. I was subject to some minor pimping about the staging of the latter, but I was armed and ready with information I'd printed out ahead of time. Momma didn't raise no fool.

In other news, as of Monday I was able to review my Dean's Letter and suggest any changes I'd like to have made. I was fine with the content. The only change I asked for were a couple of grammatical errors in my Medicine evaluation, which have been bothering me for about a year now. I have to say, it's kind of sobering to see my entire medical school career summed up in a few pages. Speaking of which, I need to do some serious work on my residency application, also known as ERAS. The most important things I have to do are polish my personal statement and write little blurbs about all my extracurricular activities. Since, you know, I've had oh so much time for extracurriculars. It's like AMCAS all over again, and we all know how much fun I had with that one.

Another sobering thing about the application process is putting together an actual list of programs to apply to. Previously, I could always say, "I could end up anywhere in the country!" I don't normally consider myself adventurous, but there was a certain thrill in thinking that I had a huge number of possibilities when it came to the place I'll end up. Once my application is finalized, those possibilities are limited. Of course, applying to all the programs out there would be ridiculous. According to most people I've talked to, twenty is bordering on ridiculous. But that's the number I set for myself. I'd rather leave myself with more options now. I can always turn down interviews later, if I feel I have too many.

I'm feeling awfully well-rested after having the whole weekend off. I'd gone in to the hospital for twelve days straight!! Things I did on days 8 through 12 included...

--Helped take out the ovaries of a patient who has a BRCA gene mutation. They're known as the Breast Cancer genes, but mutations increase your risk of other cancers, too. I don't know what the specific stats for breast cancer are, but this lady had a 40% chance of getting ovarian cancer at some point in her life. As opposed to the 1-2% chance of a "normal" person. So she got a double mastectomy and had her ovaries taken out to reduce her risk. It was specifically pointed out to me that this was not a prophylactic procedure, but rather risk-reducing, since there's still a chance the patient could get ovarian cancer. My thought is, patients can still get clots on low-dose heparin, but that doesn't stop anyone from calling it DVT prophylaxis. But that is a battle I choose not to fight.

--Helped take out the ovaries of a patient with endometriosis. No cancer, but a combination of body habitus and previous surgical history that classified her operation as "complex pelvic surgery." Many gyn oncologists get referrals for such cases due to their operative expertise. This was a really tough case and lasted about five hours longer than was originally planned.

--Presented a patient at tumor board, along with a quick summary of a paper I'd read.

--We got two new third years on the service. I've been trying to help them out without being that annoying fourth-year who's always dispensing unwanted advice. I thought presenting patients as a third year was nervewracking. It's nothing compared to listening to third years present after being given twenty minutes to practice with them and being told, "They better be good." Every verbal misstep was like a knife in my gut.

--A solid six hours of clinic in one afternoon/evening. I saw mostly followup visits after the various female cancers. One of the attendings lets me go see patients by myself; I like that. And after clinic, that same attending and I realized we'd both gone to Emory, so we spent some time talking about that.

--Took out the ovaries of an 85 year old who'd known she had masses for a while, but hadn't wanted surgery previously. She finally came in for an operation when she started to have pain. Both her ovaries were huge, but the attending felt pretty sure that they looked and felt benign. So they got sent to Pathology for a quick diagnosis, which came back as mostly benign, with some metastatic cells from a GI tract cancer. Yikes. So we inspected her bowels, found the offending tumor, and called in general surgery to do a bowel resection. Actually, my attending asked, "Do we call Colorectal or Surg Onc?" and before I could stop myself I'd said "NOT Colorectal." So Surg Onc it was!!

Direct quote from an email I sent yesterday: "Boom shaka laka, I just helped welcome two bouncing baby girls into the world."

Yesterday, I willingly gave up a day off to hang out at the hospital, in the hopes of getting to do some OB stuff. My reward was a twin c-section. Both babies were breech, and there was a slight possibility of one of them coming out umbilcal cord first (A Very Bad Thing™) had a vaginal birth been attempted. They both did splendidly. Afterward, the GUMP* and I talked about how doing a delivery was much, much happier than spending time on the gyn oncology service.

I'm spending a lot of time with residents who are in their second year or beyond, which means they've had plenty of time to become burnt out. I've been around for multiple bitch sessions, which usually end with one of the residents saying, "Stop, we're going to scare LaKedra away!" It's too late. I'm sucked in. Besides, it's not as if the Medicine residents complained any less.

*When a second-year resident is rotating through the Gyn Oncology service (they do two months at a time), she or he is known is the GUMP**. That stands for Gynecologist Under Maximum Pressure. Basically, it's not a whole lot of fun to be the GUMP. There's no intern on the service, so the second year takes care of all the floor patients. If she's lucky, she gets to operate a couple of times a week. It's like being an intern all over again. If, like the current GUMP, you're on Gyn Oncology during the first two months of second year, it's like being an intern still. When I'm not in the OR or in clinic I'm helping the GUMP with discharges, following up labs, and the like.

**This is not an informal nickname. I once answered the phone with "GYN Oncology," only to have the department chair respond, "I thought I was calling the GUMP office."

...here's another entry about medical school stuff.

Second week on Gyn Onc has been a bit more difficult than the first. On Monday I did a case that didn't leave the OR until almost 9PM. Yesterday, I had clinic all morning, then a case in the afternoon (with the ob/gyn department chair). Because of that case, I was six whole minutes late for the tumor pathology conference at which I was supposed to present a patient. By the time I got there, they had already presented the patient and were discussing her pathology. I have to wonder why they couldn't wait even a few minutes, considering only about a dozen people attend the conference and half of them were still in the OR. It wasn't a big deal, though, since my "presenting the patient" would have only involved reading from the note I'd already put in StarPanel. (I hope they at least noticed that I wrote it!) And I was still able to present the article I'd read for the occasion, if only because I forced my way into the discussion. I might have used the phrase "If I may interject, I found an interesting article..." It's not something I'm proud of, but you just have to do things like that sometimes. You're supposed to gun your sub-I(s), it's the rule.

So this week has gotten off to a pretty hectic start. I think it was pretty obvious that I was Le Tired™ at trivia last night; I almost fell asleep in my fried pickles. .Happily, I got seven hours, forty-eight minutes of sleep last night. That might not seem like anything special, especially to you people who must have eight hours or more every night. But, at baseline, I usually function on six to seven hours. Usually closer to six. Usually more like five to six. Like I'm going to get tonight!!

Percival clearly wasn't happy that I was getting so much sleep, as he decided to have a meowfest early this morning. This has been happening between 4am and 5am with increasing frequency. I don't know what to do with that cat when he's like that. I try to ignore him, but he just goes on forever. I could let him out of my room, but then he'd just go to Liz's door and wake her up. I could throw him out of my window, but that type of action is generally frowned upon. Any tips, cat owners?

Man, when did I start sucking at updating??

My Medicine sub-I ended last Friday, and I spent the following weekend dreading Gyn Onc and seriously doubting my life choices. I really enjoyed Medicine, and could definitely see myself functioning as a Medicine resident. I was even giving some serious thought to which career paths might appeal to me. It's funny, top of the list was pulm/critical care, and we all know how much I hated that rotation when I was a brand new third year and hadn't seen many really sick people before.

Then I started my Gyn Oncology sub-I. Long story short, I'm not doubting my career choice anymore. On day 1, I got to help take care of some hyperthyroidism and some acute renal failure, AND helped remove a big ol' tumor from a woman's body. As my friend Hannah would say, it was the best of both worlds.

On day 3 the team was short on residents, so I scrubbed out of the tumor debulking I was helping with, to go "drive" a hysteroscope (camera used to look inside a uterus). With close supervision from an attending of course. That pretty much made my day. Also day-making was the fact that the staff's scrambling for assistants to help with all the cases ended when the chief said "I'll send my sub-intern." Do you know the feeling of walking into an OR where you are wanted and expected and being waited for so the case can start?? No, you probably don't!! I can't even describe it. I never knew such a thing existed.

Yesterday I scrubbed in on a vaginal hysterectomy. That means the whole operation was done through the vagina. I'm not going to lie, that's no fun as the medical student. I understand that it's the most minimally invasive way to do the operation, which is good for the patient. But I couldn't see jack, and it was uncomfortable to boot. It did seem like it was a pretty cool operation to do, though. Phenomenal surgical powers...itty bitty operating space. I'll have to let you know how cool it is when I actually do one in a few years. For now, I definitely prefer open bellies.

Coming up in my next entry: More stuff about med school! Get excited.

Here's the story of a patient whose case has given me a lot to think about. It was an elderly guy, well into his 80s, who came in with a few months of poor appetite and weight loss. Early lab tests showed that he had some kind of obstruction in his liver. Now, at this point, for me and my colleagues, the question became not "what's wrong?" but "Exactly how widespread is this cancer?" The answer, unfortunately, was "Extremely."

The first morning after the results of the CT scan, I decided that I wouldn't go see this patient by myself. I waited for my resident, and we went in together. This was a good decision, because he was far better than I would have been with answering the family's questions about such things as organ transplantation and stem cell* treatments. I realized that while I knew such things were't options, the patient and his family didn't yet have the frame of reference to know that. I have to remember that sometimes the obvious facts aren't actually obvious at all.

Over the following week, my team tried to help this patient and his family come to terms with the fact that he is dying of widespread cancer. Right before coming into the hospital, this guy was still driving, running his own business, helping his wife around the house, all that stuff. He thought he had a stomach bug that wouldn't go away, and suddenly he has cancer. By the time he was discharged, he and his wife still weren't fully ready to process the situation. What was really difficult for me, as the medical student, was giving them information while trying to let them hang on to their hope for a cure. Part of me really wanted to tell them, "You cannot make plans to go to Mayo and Hopkins for experimental treatments! You need to stay home and enjoy spending time with your family!" But I didn't, and I can only hope that he can process and accept things with time.

(*Re: Stem cells. This appears to be the generic term that people use for "miraculous cure." They often can't articulate just what they want the stem cells to do, they just want them to be used, somehow, to do something, to make everything all better. This case was not the first time I've heard that term thrown around.)

Hello, good readers. My final week on the Morgan service is being broken up by a nice weekday off. That would be today. I really appreciate the time off after working eight straight days (Saturday and Sunday were call/post-call), but I can't help but feel like I'm missing all the action.

Speaking of action, I got all I wanted on Saturday, when one of my patients had a lower GI bleed. Of course, this patient happened to be housed in a part of the hospital that's separate from the main building. By pure dumb luck, I'd gone over to that wing to write my notes, because I knew there'd be no residents over there and I was guaranteed to find an available computer. The administrator types (who I doubt have even crossed paths with a real live patient in years if ever) insist that this wing of the hospital provides a level of care equal to that of the main Medicine and Surgical stepdown floors. They are deceiving themselves and the patients, because in the event a patient declines rapidly, that is a long run. I know, because it took my resident approximately three hours and forty-seven minutes to make that run after I told him I needed help with the patient. Or maybe it just felt that way.

ANYWAY, I was sitting at the computer when I found out my patient had started to poop pure blood. I went to her room, where the charge nurse was saying "When the doctor comes... oh there she is!" I thought, "You are incorrect ma'am, there she is not." But, despite an increase in my overall sphincter tone, I stayed calm and I didn't blank on what to do! ABCs/vitals, a second 18g IV, retrieved a consent form for blood transfusion... And then my resident arrived and I was quite happy to let him take over. The patient ended up not needing any drastic interventions, so in the grand scheme of things it wasn't much of an event. We didn't know that going in, though!

Sorry guys, I am having trouble keeping up with the updates. Taking call every fourth night has been affecting me a little more than I expected. Since I've been spending those nights at the hospital, it's like two of every four days is completely taken up by either hospital stuff or sleeping. Then, for some reason, I'm always even more tired the day after I'm post-call (for example, today!). That means I only have one day of every four in which I feel totally normal. To put it simply, this is kicking my butt. I don't know how people like grorx, who are taking call every third night, are doing it.

That said, with the rotation halfway over, I'm still really enjoying my time on internal medicine. Enjoying it so much that I was briefly thrown into some serious doubt about my career choice. The medicine residents work really hard, and complain a lot (all residents do), but overall they seem to genuinely enjoy what they're doing, and like having students around whom they can also convince to love what they're doing. It's hard not to want to become one of them. I get the feeling that I won't get the same vibe from my next rotation. I could be completely wrong about that, and I hope I am!

I'm already pre-call again tomorrow! Geez Louise.

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!