I'm alive!!! It's hard to believe that I am nearly done with my third year of medical school and yet I've barely written about any of it. Whoops. 

Well for starters, I just finished up my month on General Surgery. Which actually turned out to be more Bariatric Surgery, less general. Confession time: I have been DREADING this month since day one. For one, February is a pretty miserable month weather-wise. And for two, Surgery is about as far down on my list as it can possibly be...

...I actually ended up really enjoying this month more than I expected. Not in a "drop-everything-and-become-a-surgeon" way but I did thoroughly appreciate and enjoy learning more about the specialty.

What were your favorite aspects of the rotation?

First of all, I worked with a Bariatric surgeon and his PA who were absolutely fantastic and super nice people! Even though the days were sometimes pretty busy and long, having good people around to laugh with and learn from makes it worth it.

I love the patient population in Bariatrics. Many of our patients have struggled with their weight and health for years and years. They go through a long journey to get to the surgery day - counseling, classes, medical weight loss, etc. I enjoyed hearing their stories and seeing how well people did after surgery. Their lives are forever changed!

Many times, if a Bariatric patient requires surgery down the road for things like hernia repairs, gallbladder issues, etc. we would do those surgeries also so there is a healthy amount of continuity as well as an opportunity to create long-term connections.

What were your least favorite parts of the rotation?

Because the surgeon I was with did mostly Bariatrics, I missed out on seeing more "General" type surgery (including the pre/post-op management) which could negatively affect me for boards. Hopefully I will be able to make up the gap with Internal Medicine and some studying. 

Most surgeries are done laparoscopically now so there wasn't a lot for me to do aside from hold the scope camera and close the incisions at the end. (I did come to enjoy suturing!) It can be really nerve racking because you don't want to move the camera or make things harder for the surgeon. I did get to assist with procedures and even got to place a couple PEG tubes.

Since I enjoyed the patients so much, I enjoyed things more than I expected to. Unlike many med students though, I don't find the actual surgeries all that interesting. Anatomy was never too thrilling for me and working with my hands isn't a high priority either. Generally, I felt more anxiety being in the OR than excitement or ease. Especially if things started to go wrong...

While the hours were much better than typical General Surgery, it's still a pretty unpredictable lifestyle. Also, bariatric patients require a lot of follow up and are susceptible to complications so I felt like the PA and doc were constantly getting pages/phone calls.

What advice would you give for how to do well/survive the rotation?

• Carry healthy snacks in your white coat pocket (protein bars, nuts, etc.) because you never know when you'll get a chance to eat! In general, we were pretty good about getting lunch but there were a few times that lunch just didn't happen.
• Be kind to everyone! Get to know your scrub nurses. Offer to get your own gloves and gowns. If you don't know what to do, where to stand, how to do something, just ask! 
• Know your anatomy! Things look a lot different in a live human than the cadaver you worked on in anatomy lab. I was so thankful I went over some basic anatomy before our first surgery...it shows that you are prepared and interested in learning.  
• Don't get down if you don't know the answer to a question. Most doctors are asking you questions to help you learn or get you thinking, not because they want to embarrass you. Take it as a learning opportunity. If you miss something, just say "I'm sorry, I don't know but I will find out." Then go find out either between surgeries or when you get home. 
• Read on your patients and surgeries for the next day. You don't necessarily need to know how to perform the surgery (you'll be retracting or holding the scope) but you should be familiar with the general steps, anatomy, indications, possible complications, etc.  
• Find ways to be helpful. Sometimes as a medical student, it can feel like you are being less than helpful or in the way. (I think it just comes with that short white coat). Print the patient list for the team before rounds. Be on the lookout for important lab results or imaging studies on your patients. Offer to go round on a patient the doctor was concerned about. 

Did this rotation change what you see yourself specializing in?

If I were single and didn't have geographical restrictions in mind, I MIGHT consider exploring Surgery further. But at the end of the day, I know that my personality and my goals for the future do not mesh well with the surgery lifestyle. That said, there are plenty of hard working, dedicated people who make families and anything else work - to you, I bow down!

This month I gained tremendous respect for the skill set required to be a good surgeon - it's something I'm sure I could cultivate if I truly wanted to but my calling and my heart is somewhere else in medicine. I do feel a little sad that I will probably never get a chance to do surgery again. :(

What resources did you use for studying?

I used First Aid for the Surgery Clerkship & COMBANK question bank. And Dr. Wikipedia + UpToDate. I haven't gotten my COMAT exam grade back yet but I felt pretty good about the exam. 

  

So that's Surgery in a nutshell. Great month but glad to be moving on!

What questions do you have about Surgery? 

Well here I am. Halfway through another rotation - wahoo! I keep psyching (haha) myself out, knowing that I have SO many more rotations ahead of me...

So far Psychiatry has been pretty chill. Definitely a "lighter" rotation, although I find myself getting to the hospital earlier and earlier in order to avoid traffic and to read up on/visit my patients.  Like I said last week, the morning is spent rounding with our attending (we're a group of three students...10 total at this location which isn't usual for most of our rotations) and seeing patients in the various Inpatient wards. Then we split off in the afternoon - this week I was at an Outpatient therapy location just down the street from the hospital. I was able to sit in on Group Therapy, spent a day in the Adolescent Day Therapy, and worked with an amazing outpatient physician as well! I started to learn a little bit about all the different types of therapy - CBT, DBT, psychotherapy, etc. and I definitely want to keep learning. We've talked about everything from shame to self-esteem to finding hope and how to deal with anxiety - topics that are just as important for all of us med students.

I'm just really loving Psych! Sure, I love the lifestyle but I mostly love the patient population and the variety of work. When people come to the hospital, they can be wildly psychotic, manic, or majorly depressed - each one so vastly different from the next. Some are withdrawing from various substances or escaping horrible circumstances (abuse, trauma, homelessness). It's amazing to watch these people get better/stabilize right in front of your eyes over the next few days. Humans are remarkably resilient - especially when their basic needs are being met. For many patients, being in a regulated environment like this is desperately needed - away from all the stressors in their life. They are able to get their required medications, participate in group therapy, interact with others, and start to sort through what brought them to the hospital. It's truly amazing to watch and participate in!

I never realized how much of Psychiatry is done through pure observation and history taking. Unlike other specialties, there aren't a whole lot of tests and procedures one can do. You don't check a lab for depression (although you may look for organic causes like hypothyroidism) and you can't just scan someone's head to diagnose schizophrenia or bipolar (although you can rule out secondary causes of psychosis). A lot of the overall impression of what's going on is based on what the patient says and doesn't say, their body language, their movements/facial expressions, previous history, etc. Collateral information from caregivers, family, friends, nursing staff, etc. is all useful in piecing together the puzzle. I find myself reading a lot of old charts - hence why documentation is so important! 

1.5 more weeks to go but I know this won't be my last psych rotation :)

Whole30

We're steadily moving along in our Whole30 journey this month to the point where I really don't think about it much anymore. Except weekends...weekends are the worst! I just want to go out with friends and not have to worry about things being compliant :/ 2 weeks to go - we can do this!

Workouts

I'm still getting used to this whole "having a job thing"...as silly as that sounds. Going to class/studying all day is just a whole different world with a ton more flexibility, more breaks, etc. So my energy levels on top of doing Whole30 have been decently low. I'm starting to get back to a good place though with enough sleep!

Monday - Crossfit 5-6p
Tuesday - Crossfit 6-7p
Wednesday - Crossfit 5-6p
Thursday - OFF, 20 minute walk with hubby
Friday - OFF
Saturday - Gym - lifting/running
Sunday - Spinning 10:15-11am

So there's my week of workouts. I was really excited I made it to all three Crossfit classes for the week and even tried a new spinning studio with some friends on Sunday morning. I loved it so much I decided to sign up for a 2 week unlimited offer just to try a few more of the classes. I may try to make Sunday morning spinning a new thing for me just to shake things up a bit!

One thing that is lacking from my routine in running. I just haven't felt like doing it lately and I'm not sure if I want to sign up for any more races or not. With my schedule being somewhat unpredictable, I would feel bad to pay for a race and then not be able to go due to being at the hospital. With Fall approaching though (my favorite season to run in) maybe I will get my desire to run back.

And sometimes you gotta treat yo self...to a new workout bag!

Derp. Hello! Just wanted to pop in really quick to recap the past week. My life basically revolves are a small percentage of things: work, making food, eating food, thinking about food, and cleaning up after my food prep. Welcome to the Whole30. 

Chicken sausage, onions, peppers, and roasted potatoes.

Everything is going just fine this time around. Like last time, weekends are pretty much the worst. It's almost sad that my husband and I don't know what to do with ourselves. We could go see a movie...but then I'll want popcorn. We could go out to dinner...but then we'll want some wine or dessert. We could go out with friends...but then I'll want to eat all the things. Whole30 is a social life killer. 

I did meet up with my friends after work on Friday afternoon. Of course they indulged in a deliciously cold adult beverage while I opted for lemon water. They noshed on chips and guac while I loaded up on a delicious unless burger atop greens with a side of broccoli. It was actually pretty tasty so I can't complain :)

See this? This is the other fun part about Whole30. Dishes. (And this is just ONE DAY's worth). Nick and I feel like our kitchen is constantly in a state of being cleaned. We never can get ahead of it! Prepping 95% of our meals certainly takes time (and seems more costly even though it isn't) but it IS going to pay off! And we keep getting better and better at it!

Now that I'm done being a grouch (yes, I've been pretty moody lately), I have to admit that Whole30 is coming at the perfect time for us! We just could NOT get out of our vacation rut. This month is the perfect time to start over. I'm already feeling lighter and more in control again. Getting plenty of nutritious, healthy foods in my system is helping my acne-prone skin clear up and my belly issues calm down. I'm feeling more energetic but I am having some minor cravings for my favorite foods.

My Psychiatry clerkship is going well this month, too. Our schedule is very manageable compared to Emergency Medicine (no overnights) and we're seeing a wide variety of mental illness and conditions. I'm actually pretty interested in Psych - I will definitely be doing an elective or two during my fourth year! Probably in Child & Adolescent Psych or maybe Outpatient. 

Our schedule changes from week to week but our mornings are always spent on Inpatient Psych with our preceptor. Then after lunch, we spend the afternoon in Groups, the Crisis Center, or two different Outpatient psych centers. I love getting to see the different levels of care and how all the team members interact to care for patients - nurses, therapists, mental health counselors, PA/NPs, & docs. 

For this week, I'm at the Outpatient center spending time with the doctors and sitting in on therapy sessions. My goal for this week is to really master the Mental Status Exam and to work on my question bank/review book daily to help prepare for my COMAT exam at the end of the rotation.

I'm also making my public commitment here to not skip out on my workouts this week. I don't know what has gotten into me but I'm back to my old ways again. I've been getting myself all worked up/anxious about going to Crossfit or running and then I talk myself out of it completely. Not happening this week! 

I'm committing to three Crossfit classes and two additional lifting/running sessions this week. There. Now it has to happen! 

Do you ever talk yourself out of workouts? How do you stay accountable?

One rotation down, a whole bunch more to go! Right now I'm wrapping up the end of my very first rotation for third year - Emergency Medicine. Kinda crazy considering most schools don't offer EM until the fourth year. This month was a great way to get exposure to a variety of medical problems - from strokes and MIs to mystery rashes and chronic medical condition exacerbations. The ED is certainly NOT limited to emergency cases! 

Luckily, this rotation hasn't been TOO bad. I worked 13 10 hour shifts and my partner and I were able to create our own schedules as long as we weren't at the ED at the same time. I ended up working a lot of 4p-2a shifts, some 6a-4p, and some 8p-6a. If things happened to get kind of slow or the docs were busy charting, I got to go home a little earlier. Perfect for me because the hospital is about 45 minutes from my house! 

So not a grueling schedule by any means but it was still a hard month, sleep-wise. It's really hard to go from day shift to night shift and back again. I had a LOT of lazy days, especially after overnights, where I would wake up around 10 am and just loaf around all day. I HATE feeling tired and I also hate not having structure.

Even with no other rotations under my belt, I feel like I held my own this month. I was stationed at a community-based ED so it was plenty busy with lots of moderate-acuity patients - TONS of psych/overdoses/withdraws, abscesses/lacerations, abdominal pain, chest pain, etc. It certainly wasn't an academic center in the middle of the city. Usually my day was a mix of seeing patients on my own and following around my doctor. 

Generally, the doc I was assigned to follow around would tell me who they needed me to go see next (so they could go see another patient in the mean time). If possible, I would look at their chart on the computer and look for previous admissions/past medical history. I would introduce myself to the patient/family as a medical student and ask if it was ok to talk with them for a bit before the doctor came to see them. No one ever said "no" and most people were actually very happy to talk with me! The great thing about students is we have plenty of time to chat and are generally a lot less intimidating than the "real" doctors!

Next I would get the history from the patient and/or family. My favorite question to ask is "what made you decide to come to the ER" because it can be very revealing about what could be happening. I'm immediately on my guard if that patient has experienced symptoms abruptly or worse than anything they've had in the past. We do get a lot of patients that shouldn't have come to the ED, for various reasons, but it's important to still make them feel welcome and comfortable. Some people are just scared! 

After taking the history, I do a quick physical exam (I've noticed the ER docs do a VERY focused H&P) and then I explain what I think may be going on and what we will likely do. Then I ask if there is anything I can pass along to the doctors or nurses and explain that the doctor will be in shortly to see them! I then present my findings to my attending and we go see the patient together. Lather, rinse, repeat. Occasionally the PAs grab me for a procedure and let me drain an abscess or close a laceration. 

Gotta practice, right?

Unfortunately, because my computer access is limited, I didn't get a lot of practice writing orders or notes. The docs have scribes so they generally don't write their own notes either. I'm in for a nasty shock when I get to Internal Medicine! 

In between patients, I would look up things I didn't understand or work through this book. My hospital isn't used to having residents or students around so it's been a bit of a learning curve for all of us! Some docs are very comfortable teaching while others just aren't. In those rare cases, I just tried to be as helpful as I could while also following the docs lead (i.e. avoiding interrupting them or asking a million questions that I could easily look up). I filled in gaps by reading Up To Date or another source. I grabbed EKGs and practiced reading them, etc. There are so many way to occupy your time! When possible, I spent a little extra time with my patients and didn't hesitate to grab them a cup of ice water (if allowed!), a blanket, or help a nurse put the patient into a more comfortable position. 

EM has been pretty high on my list of potential specialities for the past couple years so I expected to really enjoy this rotation. And I did enjoy it, just not as much as I would have liked. I'm so glad I had this rotation early, though, so I can start to shift my interests towards Pediatrics and Psych (my secret loves). 

So what did I like? Variety - both in disease presentation and patient population. No two patients look exactly the same, even if it's your fourth "headache" or "flank pain" of the night. It's a tremendous privilege to be there for someone during a vulnerable point in their life. (Almost) no one wants to be in the ER but if you can be a calming force and a good listener, it goes a long way. Also, despite the fast paced/busy nature of the ED, most docs and nurses are pretty laid-back and easy to talk to. Not a lot of ego (that seems to come from the specialists...) and generally willing to help each other out!

As much as I enjoyed this rotation, I don't see EM being my future career. Mostly because I found myself wondering what happened to my patients after they left the ED. I need some follow-up or continuity (although EDs do get their fair share of "frequent flyers"). I'm a patient person and the idea of managing chronic conditions doesn't bother me like I thought it would. There were so many conversations I wanted to have with patients (about nutrition, lifestyle choices, long term treatment alternatives, etc.) that just aren't always possible or appropriate in the ED. So many patients end up coming back again and again - it's heart-breaking. Something about the ED made me feel a little helpless. We could "fix" or help the patient in THAT particular moment but we had little power to do things moving forward. You have to HOPE that your patient has the resources and abilities to get the follow-up they need or to manage their conditions. I'm not completely ruling EM out of the equation since I still have another 4 weeks at a different hospital in December (and possibly January for Pediatric EM).

I'm starting to think Peds, Psych, or Family Med may be more my speed. I know I will still face many of the same challenges in a primary care role (I am dreading the paperwork and insurance red tape) but I know there will be a bigger opportunity to develop long-term relationships. 

In addition to my shift in the ED, I also had the opportunity to do a 10 hour ride along with a local EMS crew. Unfortunately we only got one call the entire day so I was pretty bummed :(. Still, it was pretty neat to see how things work on the other side of emergency care. Our firefighters and EMS crews work SO hard and are amazing at what they do! I had a blast just getting to know them and learning what a typical day is like for them.

Now I just need to take my shelf exam for the end of the rotation and go back to campus for some OMM practice and an ethics session. My next rotation is Psychiatry (starts on Monday) and I CAN'T wait! Psych has always been in the back of my mind but I never really shared my interest with anyone. Mental health is just as important as physical health and I don't feel like it gets the respect or attention it deserves. So excited to see how things work and to start helping people!