Merry Christmas!!!

So it has finally come.....that day that you spend hours in traffic for.....that day you baked thousands of sugar cookies for (and spent days frosting).....that day you have to see certain relatives because if you don't, you will hear about it for the next 364 days.....that DAY where you tear through bright colored and fancy paper to say "Gee thanks, I always wanted one" when in reality you had never seen or wanted anything remotely like it......its CHRISTMAS DAY!!!!

I have been up since 6am and since I can't open any presents until mom and fur get out of bed (it could be 11am before that happens) I have been busy doing none other than USMLE World questions!! The life of a soon to be doctor....not even a holiday can prevent me from learning!! Although, I have realized that doing questions while surrounded by cookies is not a very good idea. I have devised a way whereby when I answer a question correct I get to eat a cookie....my percentage of correct questions has increased dramatically, but my sleek figure is taking a huge hit right now!!

So, how has my vacation been since I have been home?? I have seen a hockey game, had dinner at a sports bar with friends, met Kevin (who does not like me at all), eaten pizza 2x, seen my uncle dave (who can now stop bugging me on facebook :), had coffee at Dunkin Donuts with an old friend who provided me lots of material for writing a book, made sugar cookies, eaten sugar cookies and peanut butter cookies, and jelly cookies, and brownies.....and watched Law and Order SVU marathons as well as all 6 of the Star Wars movies on TV.

And now onto today, where I get to open presents from Santa....watch christmas movies....eat lots of food....maybe go to the movies....and see my sister's band play at the Electric Company later tonight. Busy day....but looking forward to it!!!!

Merry Christmas!!!!! Have a safe and happy holiday! :)

Bye bye pediatrics!!

Today was my last day of peds....wow, did it go extremely fast. These 6 week rotations are great!

This week I had my oral exam, my presentation, and my written exam. Overall, I feel everything went really well. So, what did I like the best about peds?? I liked the nursery...these little ones do cry, but if you stick a pacifer dunked in sugar water in their mouths they are happy. I also got to do a circumsicion which was a great experience! The ED was great too. I liked having the opportunity to get a patient, ask questions, figure out what is going on and present to the attending. But, I also like emergency so I may be biased. Seeing a seizure patient and some fractures were great. Seeing a hundred kids with fever and stuffy nose got a little "routine". The floor wasn't too bad, but like everything in rotations, it all depends on your residents. We were lucky as this months batch of residents were all pretty good. They were knowledgeable, fun, and best of all, they liked to teach/explain. The teaching attending on the floor this month was phenomenal as well. It was a joy to listen to her. Overall, the attendings at Coney Island are all helpful and also love to share/teach. I feel like this program is one of the best that I have rotated at so far.

So, I am all packed and ready to head out bright and early tomorrow morning to catch the Maple Leaf home!!! Can't wait to see my family, my puppies, my friends...and just relax a little. I do have some work to do, but at least I won't be in a rush to complete it. When I get back in 2 weeks, I start Ob/gyn.....hopefully the rotation goes as quickly as pediatrics did!!

I hope everyone has a great night!!!! :)

Emergency....parade....being hit on??

I just ended week 3 of pediatrics, and my first week in the pediatric emergency department. So far, the ED is going okay. The morning is very boring because there are no patients. So, I basically bring a book and read. Usually about 11am, it starts to pick up. We get the routine patients: sore throat, stuffy nose, fever. And then we get some interesting ones: 15 year old who was dunking, fell, and subluxated the radius/ulna. His wrist/forearm was shaped like an "S". Very cool, for me of course, he was screaming in pain. I got to interview the 1 year old with Kawasaki's disease. I missed actually seeing it in the ED because the patient came in the evening. Apparently, the signs/symptoms were very apparent. By the time I saw the child Friday morning, only a hint of those remained.

Of course, Friday was extremely busy in the ED (day after Thanksgiving and many kids have it off). The day started off slow, but by 1pm, the waiting area was packed. I had the pleasure of doing my first psych eval/interview on a 17 year old who "wanted to see a psychiatrist". This particular patient had a history of bipolar, cutting, and suicidal thoughts. During my interview the following exchange occurred:

Patient: Are you single?

Me: (trying to refocus the interview): I am more interested in talking about why you are here.

Patient: I don't mean to offend you....I just think you are F*****G hot!

Me: So, when was the last time you though about suicide

Patient: I really think you are F******G attractive!

Me: (Just standing there, waiting for an answer to my previous questions)

Patient: Who knew I would be so into a doctor?

At this point I decided that interviewing the mother may be more beneficial in obtaining answers to my questions. Eventually, the patient answered my questions but not without referencing "my attactiveness".

Around 3:30pm, we received a 15 year old female who had 2 seizures at home. The resident and myself were about to collect blood work when she seized. I had seen a absence seizure before during internal, but never a generalized clonic seizure. For almost 5-6 minutes, this poor girl was shaking, eyes rolled back in her head, and some muscles fixed/rigid. We tried to pry her jaw open with a jaw-thrust to keep her from biting her tongue. We applied oxygen, and tried to suction her mouth. After the episode she remained unconscious. We quickly collected urine samples and blood samples. By this time it was 5:30pm, and the attending said that she was just waiting on CT scan so I could go home. I felt so sorry for the girl, but inside, I was ecstatic! This whole episode reinforced my desire to become an Emergency Physician (not that I really needed it: I got more than enough reinforcement from my surgery and medicine clerkships).

So, I have one more week in the emergency department and then 2 weeks on the floor, and then pediatrics will officially be done. 6 weeks flies by so much faster than 12 weeks :)

Lets briefly talk about thanksgiving. I decided not to go home and stay in NYC. So, I got up early (4:30am) and headed down to the Macy's Parade. I got a great spot on 57th and 7th. I waited there for 3 hours, but it was well worth it. The parade live was so much better than on TV. I never knew that the handlers of all the balloons chant the name of their balloon as they walk in the parade.

So, as the handlers of Spider-man walked by they were all chanting "Spidey", "Spidey", "Spidey" in unison. I heard "Kermit", "Buzz", "Kitty" (as in hello kitty), "Dough boy", and many more. In addition, everyone in the parade was so happy and nice, yelling out "Happy Thanksgiving", throwing confetti, and high fiving people along the route. I had a great time and I am so happy I went!!

After the parade, I took the subway down to Chelsea and watched the movie New Moon. It was okay. I think you needed to read the books before watching the movie to fully appreciate what was going on because they left alot out. I then ate my dinner at the Malibu diner. I had Turkey, mashed potatoes, carrots/peas, stuffing, salad, bread, pumpkin pie, and a glass of wine - all for $21.95!! YUMMY! After dinner, I walked around the city for a while and then headed home. Overall, a very adventurous and fun day!

I hope everyone had a great thanksgiving, and if you shopped on black friday, I hope you survived!! I will be home in 3 weeks!! Take care.

End of internal, hockey fun, start of peds and whatever else I decide to throw in!

So it has been a wild and crazy 2 weeks and I have lots to catch you up on. Lets start with:

My last week of internal medicine.....what to say but FINALLY!!! I could not wait for this to be over. I have come to the conclusion that internal is not for me. I really felt that many times our patients were not getting better. We had a few successes.....but not nearly as many failures. Overall, medicine is just management.....try to get the patient well enough to discharge them home or to a nursing home so that in a week or so they will return again. Overall, my last week flew by and soon it was friday and I was saying goodbye and heading out to:

The Yankee ticker tape parade!!! I decided since I was getting out early I was going to head down to lower manhatten to see if I could catch a glimpse of any of the World Series Champs. Wow, was it packed!!! There were so many people all wearing their yankee blue (i actually was one of the few not wearing anything remotely yankee). I managed to crawl up onto a firetruck parked on a side street, but because there were about 40 other people on top of the truck I couldn't see anything but the tops of the floats. I may have caught a glimpse of one Yankee but I honestly couldn't tell you who. I quickly decided that I had had enough and tried to embark back to Brooklyn to find that most of the subways were shut down because of the parade. So, I had to walk about 15 minutes to another station closer to the brooklyn bridge. Not all was lost...on the way home I picked up some lunch sushi:

Back at my place I pounded said sushi and then headed out to Penn Station to catch my train. I was headed to Albany to see Mit, Dy, Laura, Sacco and the rest of the CNY wrecks in a hockey tournament. Unfortunately, they lost all of their games but I had a great time. I got to hang out at Roberta's house and eat some great lasagna and of course spend a gorgeous Sunday afternoon outside stacking wood. After, we had pizza, wings, and ice cream (I had a peanut butter sundae....yummy!!!). Then, I headed back on the train to NYC. Arrived at 12am at Penn Station, pushed my way through thousands of Bruce Springsteen fans (of course there had to be a concert at Madison Square Garden on this night), hopped the Q train to Brooklyn, and was in bed by 1am:

For my early wake-up call at 5am!! It was my first day of Pediatrics and I was looking forward to it. Although I know that I am not interested in Peds as a profession, I am aware that if I do go into Emergency Medicine I will have to deal with kids all the time. So, I decided to try and learn as much as I can during this rotation. I found out early Monday morning that I am in the nursery all this week, except for wednesday because its Veteran's Day and I get it off:

The nursery actually is not bad at all. Most of the babies are only a few days old. They cry and little but not much, and if they cry too much you just stick a pacifier of sugar water in their mouths and they quite right down. I got to examine babies, I did a few heel sticks for blood draws, I saw 2 lumbar punctures (to rule out meningitis), I did a circumcision (and a fine job I must say!!!), and of course, I got to watch a few live births and C-sections because we are in the room to take care of the baby once it is delivered. I got to rub some nasty white stuff off, listen to a newborn's heart (murmur and all), and suction the mouth and nose. I wasn't expecting to like the nursery as much as I did.....overall I had a really great time and a great experience:

Saturday was Ishie's b-day and she wanted to celebrate at the Bohemian Beer Garden in Queens. I had never taken the N train to Astoria before and what a long ride from Brooklyn (over an hour). The beer garden was awesome although we didn't get a chance to go outside because it was raining. It is a Czech restaurant and bar. We ordered a few pitchers of Czech beer and I had some potato pierogies and sauerkraut along with an apple strudel for dessert (all very good). I only stayed for 3 hours because I had to head home early....I had call today and I didn't want to be overly tired:

Call went well today. I got there at 7am, we had signout of all the patients to my team, we did rounds on all the patients and soon it was 10am. I helped the intern write a few progress notes and discharge summaries. I then helped the senior and intern with a delivery; natural with no pain meds.....OUCH!!!! And was she screaming!! I took a history from a new admission for my first write-up, and then the Senior resident sent my home. I got home about 3pm. I decided to go for a run in the park since it was gorgeous out today and I didn't want to miss a day like this, especially since it is almost December and the weather will turn very cold soon!

So tomorrow starts Week #2 in Pediatrics. I am in the outpatient clinic all week. I hear it is very busy for the doctors anyway. I mostly get to follow and observe. I love having these little 6 week rotations because they go by so quickly!!!!

I hope everyone has a great week. Hopefully I won't go 2 more weeks until my next update.....of course, you all know me by now :) :) Take care!!!

Adventures in Rainy Halloween!

Happy Halloween!!!! Yesterday night was a blast. Some friends and I decided to dress up as characters from Alice in Wonderland. I was the white rabbit.









Ishie was Alice.












Daniel was the Mad Hatter.
Matt was the Catepillar.

Chelsea was the Queen of Hearts.









We were joined by a bunch of other "characters" in what was our first Halloween in NYC!!!


* There are a few more pics of people I don't have yet!!

We all headed out to the NYC parade thinking how fun it would be to walk in our costumes and also to see everyone else dressed up. Unfortunately....it started to pour. Being wet, cold, and needing some adult beverages plus a bathroom stop, we all decided to head back to Brooklyn. Only to find out that the train we took to Manhatten was not returning back to Brooklyn (crappy MTA and their construction). Our attempts at hailing 3 taxi's also failed miserably. So, we ran through the rain to city hall to board another subway and finally made it back to Brooklyn Heights where we ate some yummy backed ziti and pumpkin pies courtesy of Chelsea!! Then the few remaining brave ones headed out for a drink at a local bar.

Overall it was an adventurous night. At least I can say that I was at the Halloween parade in NYC, standing in line for 45 minutes waiting to march, only to be spoiled by rain!!! Typical NYC...you always have in mind what may happen, but it always turns into something else!!!

Happy Halloween everyone!!! Take care.

Exams finished.....2 more weeks of internal to go!

Today marked my second, and last exam in Internal Medicine. I had my oral exam with the Director of the program. We only see him once.....for 15 minutes....for the oral. And its worth 20% of our grade. So, I studied extremely hard because I really wanted to impress him. Did I impress??? Not to sure. But I did get a "you did a good job" at the end and a handshake to go with it, so hopefully he was impressed!

Last week we had the written exam. I didn't even try to impress on that one. In fact, I didn't study at all. I figured if this exam was like any of the others from our school, it would be full of grammatical mistakes with questions written in one language and translated into english and answer choices that range from obscure....to maybe this fits....to none of these are even correct! I was not disappointed in my assumptions. I always seem to walk out of an SGU test thinking "I hope to god that the adminstration of another medical school never sees this test".

I did get some good news from our current residents. They love me!!! They said I was one of the hardest working students they have had, I always seem prepared, and I have been a tremendous help to them. They both gave me an excellent evaluation.

Well, I only have 2 weeks left....actually I have exactly 8 days. I found out today that we have next Tuesday off. Apparently voting in NYC is a holiday. I'll be voting for my favorite beer on that day!!

I hope everyone has a great night. :)

Happy Tyrant Day!!

Today was kind of nice. I had a day off due to Columbus Day, although I have to admit, I hate this holiday. In fact, I don't think it should be a holiday at all in the United States considering Columbus didn't even set foot in North America. I will give him credit for setting out across a vast ocean to "explore". But we all know he wasn't the first to find the new land. Leif Erikson did it years before him.....and the Native Americans hundreds of years before both of them. I remember growing up and being told in school that Christopher Columbus was this great explorer who was told the world was flat and therefore he could not get to the Asian continent but persisted in his dream. Funny thing is.....it is all crap!!! Search wikipedia about Christopher Columbus and you will find that he was not a great explorer at all. He was ruthless, mean-spirited, and incredibly selfish. At that time, many scholars, explorers, and mapmakers did not believe the world was flat...in fact, they knew it to be round. What they disputed was Columbus' calculations of how far he had to travel west to reach Asia (he was about 20,000km off!) and if not for his dumb luck in running into another land he would have perished at sea. His discovery led to thousands of people being killed, raped, or sold into slavery. He was even arrested for his crimes against humanity by the Spanish government (but later pardoned).

Of course, then I wondered why we are called "America". Turns out we are named after Amerigo Vespucci, another explorer of sorts. Although, he didn't really find anything new. A german mapmaker named Martin Waldseemuller was the first to create a map in 1507 with the new lands. For some strange reason he picked Amerigo to honor. Funny thing is that about 5 years later, this mapmaker had second thoughts about the naming and tried desperately to change it with no luck.

Now why do we celebrate Columbus Day anyway?? Leave that up to FDR. During the depression he wanted to create a national holiday in October in order to give workers a day off. He came up with this one. Of course today, many states don't celebrate this holiday. And some have changed it to suit there needs. Hawaii celebrates "Explorer Day" to kind of honor all. South Dakota calls it "Native American Day". Tennesee moves the day to the friday after thanksgiving to give all an extended vacation (I like this one :) In Illinois, school districts move the holiday to December 23rd.

And here in New York, well we have the day off. And apparently there was a huge parade down 5th avenue today to celebrate Columbus (i missed that one). Instead, I spent the day doing a little studying, some laundry, grocery shopping, and relaxing :)

Everyone have a great day!

A very amazing end to the week!

Wow, the past few days have been amazing....and interesting. Its really sad to know it is ending. Hopefully next week brings more excitement. Lets recap:

On Thursday we were assigned to our new floor, new residents, and new attending. The new floor is the same old sick patients. My new residents are great. I have one PGY-3 and one PGY-1 (intern). The intern is still learning and seems a bit overwhelmed so far. But our PGY-3 knows his shit. Very smart guy and loves to teach. He is so interactive which is great for me. In addition, our attending is AWESOME!!! We get to spend the whole morning with her, almost 3-4 hours. She loves students.....loves teaching more. And in 2 days, I have learned more on the floors with her than at any other time during this rotation. She requires alot from us: we have to divide patients up, know their history in the hospital, know the current problems, devise a plan of management, and continue our follow-up until their discharge. In addition, we have daily reading assignments on important medical topics (we covered pericarditis and pericardial effusions on friday). I feel like part of a team and its a great feeling. The only downside....being at the hospital at 6am to accomplish all of the above. But it is okay....I have the pleasure of being with this attending for the next 4 weeks and I am going to take full advantage.

So on friday, a fellow student was having a b-day extravaganza at a sushi bar called Aishya. For $40 it was all you can eat and drink. The sushi was not limited to cheap rolls. All rolls were included and I took full advantage by ordering some of the expensive ones. For the drinking portion, it was sake bombs. I had never had one before. Basically you are given beer and sake. You pour a little beer into your glass and then place your chopsticks flat on the top of the glass. You pour some sake into a small cup and then balance this cup on your chopsticks. Then, you pound the table....sake falls into beer....and you chug. I had four of these before the food even came and I was SOOOOO DRUNK! Then I ate....had some more to drink (although I just drank sake...no beer)....ate some more and drank some more. 2 hours later we were headed to union square to a bar to continue the celebration. I had one glass of water and decided to head home. It was 11pm! But I couldn't keep my eyes open. And did I mention I was really drunk. So, I was at home and in bed by 11:35pm on a friday. And I did wake up saturday morning with a slight hangover :) Only slight though......

Saturday night was my first ever Brandi Carlile concert at the Beacon Theater. I have listened to her music for a few years now and she has an amazing voice. My good friend Kate has been telling me that she is even more amazing live and she was absolutely correct. Seeing Brandi Carlile live was a great experience. I got to the theater around 7:45 and watched her opening act, Katie Herzig. I had heard the name before but never really heard the music. She was good...just not my style of music....much more happy, peppy country music. But still good. And then Brandi Carlile performed and I was blown away. Not only by her voice, but her entire stage performance. She is a great performer. Her band was equally fun to watch. I am so happy I saw the show and I really can't wait to see her again when she plays in NYC. If you have the opportunity to hear her music please do. You will not be disappointed.

While at the concert, my friend Daniel texted me to see if I wanted to see Lady Gaga. I respectfully declined knowing I was getting the better show :)

So, that is my last 3 days in review. The prior 4 days were not very exciting except for Heroes....very exciting!!! And Grey's is doing a pretty decent job this year too! Today is a major study day because this week I am on call both Monday and Friday. Have to do my write-ups for my preceptor now so I don't get behind.

Which reminds me. Pink is playing tomorrow night at Madison Square Garden. I absolutely love Pink. I really wanted to go but then found out I was on call. I guess it is just as well considering I would have had to pay $150 for a ticket. NYC is just so damn expensive. Hopefully someday in the future I can see her live again. Her shows are fantastic as well.

Take care everyone!!

Week #6....check!

One more week of internal medicine down. It seems forever ago that I started. But, time has flown by just a little bit more these past 2 weeks, I think mostly because our residents are trusting us more and more each day and allowing us to do more and more. Unfortunately, this is our last week with this resident crew. Next week, we switch resident teams, floors, attendings and call nights. Good thing I didn't buy that $150 Pink concert ticket for October 5th. I may be on call that night :) So, here is a recap of the last week, starting with last weekend!!

Mit and Roberta came down to the city....YAY!!! Morgan, a friend from Roberta's work, flew in from Australia. He had a hotel room at the New Yorker, so Mit and Roberta came to hang out in the city on Saturday. We had brunch at Friend of the Farmer, which was excellent. We then strolled along the East River, headed to central park, sat on a bench and "people watched", headed back to the hotel room, got ready for a night out, had Mexican food at a restaurant in the lower east side, headed to the slipper room for a burlesque show. As always, the slipper room didn't disappoint me!! It was a great night, and I'm so happy that Mit and Roberta came down. And of course, it was really nice to meet Morgan.

So, on Monday started Week #6. As always we had some interesting patients. Lots of "chest pain" and "shortness of breath". I loved the patient who complained about SOB but refused to quit smoking cigarrettes or smoking crack/snorting cocaine. Her response was "how the hell does that have anything to do with my asthma?" I give our attending lots of credit for trying to explain it to her but she still didn't get it. I'm sure we will be seeing her again soon. I was on call Tuesday night and we had 1 very interesting case. A woman who just gave birth the week before came in with shortness of breath, difficulty breathing, and heart palpitations. It turns out she had these symptoms during her last month of pregnancy as well. The diagnosis: pregnancy induced dilated cardiomyopathy. Fortunately for her, it is reversible. The other interesting case was assigned to our floor on Thursday. 22 year old female with tremors, sweating, palpitations, anxiety. One look at her neck gave the diagnosis away....she had a huge thyroid. Blood samples were sent to test for antibodies but everyone is in agreement that it is probably Grave's Disease. The good thing for her is that it is completely treatable as long as she is compliant with medication. The hard part will be the next few months of trying to figure out what her medication dosage should be.

I also had 2 preceptor meeting this week. My preceptor is very good. Not only is he Director of Pulmonology at the hospital, but he is a walking textbook of everything!!! Which makes my meetings with him interesting since I never know what he will ask. The interesting thing is this, every meeting with him he makes a comment about how me and the other student there are dumb. He will make a reference to our IQs and then laugh. Or, he will flat out tell us we are dumb and laugh. I can't figure out if he is really joking or if he is really serious. I think me and the other student do very well with our presentations and answering questions. I feel like pulling in some other students from our program for our meeting and asking the doctor to talk to them. I think in a few moments he would realize that we are intelligent students. I was hopefully planning on asking for a letter of recommendation from this doctor, but not i'm not too sure. My other option was seeing if he would be my preceptor for my medicine sub I elective in 4th year....working my butt off....and hopefully getting a letter then.

Which reminds me, on Tuesday we had a meeting with a current 4th year student about next year....signing up for Step 2....scheduling electives....etc. I have been busy trying to plan my 4th year as to what I will take and when. After 12 weeks of surgery and 6 weeks of medicine, my heart still belongs to Emergency Medicine. I'm sure that won't change after peds, Obgyn, and Psych. I have decided that I want to do a rotation in Emergency at Maimo and one at Methodist. Hopefully I can get them both in before September. For the rest of my electives I am thinking about Neurology, Cardiology, Anesthesia, Peds Emercency, PICU, Family Medicine, Radiology, and Dermatology. If I have extra time available, I may also try Ortho and MICU. Of course, a 2 week course in U/S would be great also. You are probably asking why family medicine?? Well, in order to practice in California or Texas a student must do that elective. I don't want to lose any future opportunities in any state. I'm still trying to plan out my timeline and I'm just hoping everything works out. Of course I will keep you updated!!

Well, I have lots to do today in terms of studying and paper writing. Next saturday I am seeing Brandi Carlisle in concert. And, if I'm not on call 10/5, I will try to land some Pink tickets. So I have to get as much work as possible done between now and then. Take care everyone.

Weekend fun

This weekend was alot of fun!!! It started with Amanda asking me if I would like to attend a Yankee's game on saturday. She happened to have some tickets, and since I had not yet set foot inside the new Yankee stadium, I eagerly said YES!!! So, at 10am saturday morning I made my way to 161st in the bronx.


Very nice stadium!! Inside was even nicer....

Me, posing it up!!

DEREK!!!!

The game....unfortunately, they lost to the Orioles 7-2.

After the game, Amanda and Dy and the peeps they came down with (already forgot their names) had to leave to drive back. So, I hopped on the 4 train and headed down to midtown. Once there, I ran into a street festival. They sell t-shirts, and jewelry, and lots of food. I got a chicken burrito for dinner.....it was very good. Then, on a whim I decided I wanted to see the movie District 9. I have wanted to see it for the last few weeks, but just haven't had the time. I headed to Times Square to Regal. Very good movie. At first I didn't know what was going on. It was shot almost as a documentary, but then the movie picked up and surprisingly, was a little gory. But overall, I thought it was very good. Great special effects. And, an original story!!! During the movie, my tummy didn't feel too good.....damn street chicken burrito. So, after the movie, I headed back home and to bed.

I got up this morning, made some coffee and sat down at my computer to see what events were happening today. NYC.gov has this nice section entitled "events". I found out today was HarborFest.....a celebration of the Dutch settling the city. So, I decided to get ready and head on out there to see what it was about. I jumped on the Q and headed to Times Square, and then walked over to the West Side pier off of 44th St. I grabbed a brochure and headed out on the Water taxi to Battery Park...

Aren't I cute?? :) The guy on the water taxi was hounding me to take my pic......Harbor Fest was all over the city. They had events back at the Pier off of 44th st. Events off of Chistopher St. Events at Battery Park. Events on Governor's Island. Events near the Brooklyn Bride. Many of the events were free. They even offered free bicycle rentals to use on the Hudson boardwalk, but I decided to enjoy the day and walk. So, I walked around Battery Park, enjoyed some Dutch music, had some lunch and then headed back to the Pier for the Oyster and Wine fest. I didn't have any Oysters....just some wine. And, there was also a craft beer judging event there. 12 breweries from Lake Placid to NYC took part (remember, Henry Hudson sailed from NYC to Lake Champlain). They had to enter a beer that would have been brewed 400 years ago. The winner was Brooklyn Brewery with their District 2 beer. After the judging, they had a beer tasting......very good!! Other pictured highlights include:

The city.....sky looks very dark at 11:30am....but by the afternoon, it was blue skies with gorgeous sunny hotness.

This is the "Half Moon"...the ship that Henry Hudson used to sail up the Hudson river. I'm not sure if this is the real ship, or a replica.

This is some Dutch ship....I am really bad remembering people names, how the hell am I going to remember a ship's name I couldn't pronounce. Apparently this was the first ship built in New York by the Dutch in 1614.....this is not a replica...it is the original boat. Behind it is the USS Intrepid. And as I told you, the sky is blue now!!!

At 3:30pm.....after a wine and a few beers at the tasting.....I decided to head to Madison Square Garden to see the NY Liberty play their final home game of the season against the Washington Mystics. As I was standing in line waiting to buy a ticket, this woman comes up to me and the people standing beside me and says "Do you want free tickets?" Apparently she was with the Liberty and she was randomly selecting people to give tickets to. So, I thanked her and headed to my seat.......

Unlike the yankees, the Liberty won!! It was a great game and I am so glad that I decided to go....and that it was free!!! Thanks NY Liberty!!!! I will be sure to go to games next season and pay!!

On the way home, I stopped in Union Square and had Taco Bell. I was really craving a chicken taco!! I also had some nachos supreme.....hey, i walked alot today okay so I can afford the calories!!

Well, that is the end to my weekend. I had a great time.....saw alot....did alot....walked alot!!! Tomorrow starts week 5 of Internal Medicine, and I am on call. Hopefully, we get an interesting case. I hope everyone had a great weekend. Take care.

Click the box medicine

So today was the start of week #4 for Internal Medicine. I can officially say that I am bored out of my mind. I do, however, feel the utmost joy when our residents do or say something so incredibly dumb that you know the attending just wants to slap them silly. Here was last weeks funny moment:

Residents: There is no urine coming out of the foley.
Attending: So, what is your next step?
Residents: Ultrasound of the kidneys....there may be something there.
Attending: (Looking rather annoyed). Don't you want to check the foley first?
Residents: (Dumb looks on there face).
Attending: (Looking more annoyed). Don't you think there could be a blockage or maybe it is in the vagina instead of the urethra???
Residents: (Still with dumb looks on their faces....and not saying anything).
Attending: DID YOU CHECK??
Residents: Uh........................no.
Attending: Go check!!!

This is of course one of many instances where I have come to find out that some residents just lack some common sense. I can see this coming from the intern, but not the second year resident (both of which were part of the conversation above). My friend today put it rather nicely when he stated that the residents practice click the box medicine. Patient presents with this, then it must be this (check). Patient complains of this, then it must be that (check). There is no thinking involved which can lead to some disastrous consequences. The one thing I have learned in medicine is that I do not want to be a click the box doctor!!!

So, this past weekend I decided to travel home to visit. It was my sister's birthday and she wanted to go to the State Fair. I hadn't been to the state fair in 3 years so I was excited. It only took about 1 hour to realize nothing had changed. All the vendors.....all the food....all the rides....all the games....all exactly the same. Even with that, I had a great time. I got chocolate milk for $0.25/each.....I rode the ferris wheel....I saw the horse pull....I had some wine....I ate corn on the cob, a hot dog, a hamburger, a twist with chocolate spinkles, 6 chocolate covered strawberries, a root beer float, a few of my brother's fries, a bite of my mom's roasted prime rib sandwich, a few cubes of NY cheese, a couple of nachos, and lots of water!!! And of course, I walked around all day long and I was exhausted when I got home....passed right out!!! So, going home for the labor day weekend was a great idea.....that, and if I had stayed here in Brooklyn, I would have been in the heart of the weekend long Caribbean festival...and I have already experienced that once!!!! Happy Birthday Randi!!! Everyone have a great night!

Week #2 of Internal Medicine

Well, today started off the 2nd week of IM. My first week was okay. Started off a little slow because its a new rotation and we are getting to know our residents and what is expected, and of course they are getting to know us! The first day of IM was also my first call night which involved me doing alot of sitting around in the ED and reading. So far, alot of internal medicine, at least for us students, is sitting around. Occasionally there is a blood draw, or ekg, or IV line to put in and of course we get volunteered for that. I really don't mind because it gives me something to do. But a vast majority of the time, I am either searching endlessly on Uptodate.com for diseases and treatments, or I am sitting in a corner of Tower 3E reading in my medicine book. After the hectic schedule of surgery, I was looking forward to more time to learn and comprehend. However, I have a feeling that by week 6, this will all be very boring.

Our call schedule is q4 with no weekends, which meant that I was also on call Friday as well. That night was a little more interesting. I did many blood draws, an ABG, and an ekg. I also saw a male patient with liver cirrhosis, hep c, external hemorrhoids, and 2 very large and in charge scrotal hernias. He has had these for over 20 years and currently it looks like 2 medium sized soccer balls dangling between his legs. He says it is painful and uncomfortable to walk.....ya think?? Unfortunately, he can't have surgery because his liver is so bad.

The last patient before I left on friday came in with a severe asthma attack. She had a superimposed upper respiratory infection. We tried several courses of albuterol and solumedrol with no relief so she had to be intubated. She told us she has had this happen in the past, 3 times, and she also said her last one was very painful so she requested to be "put out" for this one. Unfortunately, it didn't go as planned. Ativan and propofol was pushed IV and the intubation was very difficult. Turns out, the IV was infiltrated and most of the medication ended up in her arm. They re-established an IV (2 of them) and was able to get her sedated enough to put the endotracheal tube in. However, she started fighting and trying to remove it, so they had to restrain her. I felt bad because she was in obvious pain and distress. I left around 9pm to come home, but I found out today that she did manage to self extubate herself around 11 pm which didn't make the anesthesiologist too pleased.

Today was a rather mundane day, or better yet, an average IM day. I get to the hospital around 7am. I proceed to check the vitals, labs, and radiology reports of our assigned patients. Then we (my 2 residents, a fellow student and myself) do a mini round on all of the patients. At 8:30, the attending shows up and they again go over and round on all the patients. At 10am, we have morning report where we hear of some of the admits from the night before. I have come to find out that IM doctors love to hear themselves talk!! They will debate tiny details for 20 minutes, or at least until they have exhausted every possibility and then they move on. At noon, we have lecture which is good and bad. Good because it gets lecture over with at a decent hour. Bad because it is during lunch and I find myself dozing off. Today was especially bad....the topic was Anion Gap. Very boring.......and easy to fall asleep to!!

The afternoon was really slow until family members of one of our patients showed up and started screaming at the doctors. They were upset, but for good reason. Their father had been in the hospital for 3 days and his condition was worsening. They were also questioning why he was being treated for alcohol detox (for DTs) when he doesn't drink. The daughter was yelling questions and yet none of the doctors were giving her any answers, or if they were, they were not explaining themselves very well at all. Then they walked out of the room with no explanation and she became even more upset. I really couldn't bite my tongue any longer, so I did something I probably shouldn't have, but I answered all of her questions. I explained to her that her father was brought into the hospital by the police department who found him wandering around on a highway very confused and agitated. He could not give us a proper history of what had happened and he showed signs of altered mental status. Because of this, the initial treatment was to rule out the life threatening things that cause altered mental status.....trauma, bleed in the brain, alcohol withdrawal, etc. They started to treat him for DTs and he was responding to the treatment. The doctors were unaware that he had early onset dementia/alzheimers due to boxing injuries sustained for over 30 years and also did not know that he only spoke spanish. I was able to get some more history from the daughter as well as her father's normal baseline which I then passed on to my senior resident. The doctors then began to suspect a possible infectious cause and started the workup for that. I spent 2 hours with the daughter answering all of her questions and helping her to understand. She was very grateful and at one point said "How come you are spending your time to explain this to us when we can't get straight answers out of any of the other doctors". I told her it was because I was a medical student who had more time to devote to answering her questions. She thanked me for helping her and told me that she was sure I would make a great doctor which was a very nice complement.

Of course, it then got me thinking. She was right. All of the other doctors present took no time in explaining anything to her. They just said "Well, we are going to start antibiotics and get a repeat CT and we will go from there." But nothing was explained as to why or even what they were looking for. It made me wonder if being in medicine had caused them to be this careless in dealing with the patient/family or if this is just how they normally deal with things. Up until the point i started to talk to this woman, she was screaming that she was going to sue the hospital for malpractice and have the tv cameras down there. But once I talked with her and explained, she was fine...no threats....she just wanted the best care for her father and she felt like she wasn't getting it or any explanations as to what was being done to treat her father. As a doctor, you can be sure that if it was your family member, you would want the same thing....and in fact demand it. But I feel that many doctors don't step back to see this. And it becomes very costly in the end, because then you are not only dealing with a sick patient but a a very agitated, upset, and angry family whose only option, they feel, is a lawsuit. I can only hope that through my training and beyond I am able to keep my ability to communicate with patients and family members. And to recognize that I may not know all of the answers to every question, but I can do my very best to help find the answers.

I hope everyone has a good night. Take care.

Bye bye surgery!!!

Today was officially my last day for surgery at Coney Island. :) :) I am so happy to be done with this rotation. There are things I will miss, and things that I definitely won't miss. Overall, I thought the rotation was good. We did learn alot, and being a community hospital, we as students were allowed to do so many things (iv's, blood draws, NG tubes, sutures, I&Ds). I was fortunate to have some great residents (especially on call) that were willing to share their knowledge and teach. I was also exposed to some great attending who really care about surgery, their patients, and students. A word of advice for any future Coney Island surgery students: if you really want to learn and be a doer, then this is a great rotation. If you want to hang back and slack, then this is a great rotation too! Basically, its what you put into it!!

Now to recap the week: I was on call sunday night...my last one. I spent it with Scott because he had switched with Brian the week before. It was surprisingly uneventful. No trauma....no surgery....no major issues. Of course we did have one minor issue. A gentleman came in with an abscess near his anus. We had to incise and drain it. This was a major WOW on all fronts. First, he practically jumped off the table when the needle with lidocaine touched him. Then, when it was opened up and draining the stench was nasty....picture the distinct smell of infection laced with pooh. My nose was burning! Then, the inside of the abscess had to be swabbed to break up any loculations, and this poor guy was screaming and crying. Not just screaming, but whaling!!! The others in the ED must have thought he was giving birth or something. I felt really bad for him because you could just tell it was extremely painful.

This week I was in urology and wow did I quickly find out that the land of pee pee was not for me. By tuesday I wanted the week to be over with. I did get to see a few interesting surgeries: circumcision, revision of circumcision, cystoureteroscopy, stent placement, and laser stone removal (which interestingly looked like a game of asteroids on the screen). But overall I found urology to be boring and uneventful.

On wednesday, we had our oral presentations. We started at 8am and ended at 1pm. I asked to go first, just to get it over with. I did mine on Traumatic Aortic Injury. We had 12 minutes to present our topic (and we could not go over for risk of a penalty to our grade). Tuesday night I finished my slides and began to practice presenting when I quickly realized that my talk was well over 30 minutes long. So the process of editing began (good thing I never went into movies). I had trimmed so much out that I was afraid my topic would be boring. So, in order to put some interesting things back, I decided that talking really, really fast would be a good thing :0 Overall, my presentation went really, really well. Dr. L (our preceptor) really liked it and said I hit all of the important points within the allotted time.

Then on thursday, we had our exit interview with Dr. L. He had nothing but great things to say about me. Things like I was very knowledgeable, I used good judgement...I was really good with patients.....and that he thought very highly of me and expected great things. Those were all very nice things to hear, especially from someone who I really looked up to as being a great doctor, surgeon, and preceptor. I found out my written exam grade (the ridiculous SGU written exam which was more like an internal medicine exam than a surgery exam). I received an A, which really makes me think they curved the grades. I won't get my final surgery grade for a few weeks, but I'm hoping that I get an A overall.

Well, I start internal medicine on monday. This is where the real medicine is :) At least now I will have more of an idea as to all the things I don't know, or can't recall/remember from the first 2 years of medical school! This weekend I am just chilling out and relaxing. I may do something fun, but then again I may not. And having the choice is great!!! Everyone have a great night. I will fill you all in on my first day on Monday! :)

It has been too long....

Since my last post! Of course, that is nothing new :)

Well, surgery is almost over. 1 more week to go. And I will be spending that week in "pee-pee land". At least that is what the urologists refer to themselves as. Am I looking forward to it...maybe. I guess it all depends on what I get to do and see.

I have call tomorrow. I have to go in at 8am, so I decided today would be a free day of walking around and exploring brooklyn. I took the B16 bus to Bay Ridge, walked around a bit. Saw GI Joe the movie (which was very action packed). Took the B63 bus to cobble hill. Walked around a bit. Then headed home. I was gone from 9am until 6:30pm. Long day, and my feet are extremely tired. But, it was a gorgeous day outside and I saw alot, so the day was not wasted!

This past week, we had our written and oral examination for surgery. The written was a typical SGU test....one with no relevance to what we are actually doing NOW...which is surgery. I felt I was taking an internal medicine test for the entire 2.5 hours. I had to rely on lots of stored medical knowledge from Grenada in order to answer some of the questions. Whether I got them right is another matter. The oral was better, although I quickly realized that from the moment my preceptor said "You have 15 minutes", my downfall began. I was too worried about not having enough time so I was rushing through the exam, trying to spit-fire all of my answers. I received a B+ on my oral. And I have an A average for all of my write-ups submitted over the last 12 weeks. I'm hoping that my presentation, which is wednesday, will be good enough to bump my overall course grade to an A. I'm presenting on traumatic aortic injury.

Last weekend I traveled home for Sacco's wedding. I arrived late thursday night after my flight was delayed by an hour. On friday I had lunch with Laura and some of her co-workers. I went out to dinner with my family (minus my sister because she was working). After dinner I headed to Mit's for a beer and some chatting. On saturday I had alot to do. Running around in the morning, giving the dogs a bath. I missed the wedding ceremony because of all of these little things, but I did not miss the reception which was very nice. Sacco looked beautiful, as did the hockey team!!!

After the reception, Laura and I met up with Dy and Amanda at the Electric Company, stayed until closing, went to Denny's, then passed out at 3:30am. My flight was supposed to leave on Sunday at 4:30pm, but Jet Blue cancelled it. Any other time I would have been excited except I brought only one medical book with me to study from, with the rest of my books and notes at my apartment in Brooklyn. I figured I would be home early on Sunday and could do some studying. No such luck. My flight was changed until Monday at 12:30pm. So, I watched Law and Order marathons and Discovery Health on day and night on Sunday.

And that is the re-cap of the last 2 weeks!!

Okay, it's 8pm and I'm off to bed. Everyone have a great night. Talk to you soon!

Just another sunday....

I realize i haven't posted here in a while, so I decided to do some updating today. Why haven't I posted you ask? Well, nothing exciting has come my way at Coney Island. My last two call nights were very uncharacteriscally boring: not alot of consults, and no emergency surgeries. I basically read.....and ate.....and talked. Although on wednesday I did have the pleasure to finally palpate the spleen. Normally, it is not palpable but in this particular gentleman it was as big as the liver. He has a disease called polycythemia vera (disorder where too many red blood cells are made), which causes congestion within the spleen and an increase in size.

Last week in surgery was the dreaded "Specialty Clinic" week. A few clinics at Coney Island are run well, and are a pleasure to attend and participate in (Plastics, ENT, Breast, Ortho). The rest are disorganized and unenjoyable. It makes it hard for the patients....and for us to be there. By the end, I am exhausted, frustrated, and mentally sapped. It would be hard to explain how this all occurs. I think it is a combination of which doctor/doctors are at the clinic, which patient charts you pick up, what language the patient speaks, what paperwork you need to fill out (booking for a surgery can be long and uneventful), etc. All I can say is I never have to set foot in a surgery clinic at Coney Island ever again!! :)

So yesterday I had lots of plans and a very fun day/night. I got up early (6am), had breakfast, did some reading, went for my hair appointment, went tanning, walked around Park Slope looking for a dress, ate a bagel w/cream cheese toasted, headed to Macy's in manhatten to find a dress, spent 4 hours in Macy's, found a dress on sale, bought it, proceeded to walk around trying to find a decently priced bar for dinner, stumbled upon The Rodeo Bar and Grill on 27th and 2nd, it was Happy hour so I ordered a margarita, also ordered a burger and fries, started talking to the guy next to me who is attending Hunter College for Physical Therapy, had a beer, continued talking, had another beer, went to the bathroom where I stumbled upon 2 girls who were out with their husbands and having a bad time, got invited to hang out with those girls for the night at there hotel, went back to the bar for more talk with PT man, felt a little drunk, recognized that PT man wanted to continue the night at a bar up the street, paid my tab and politely left the bar, walked 15 minutes back to 34th street (actually stumbled along), sat at a table at 34th street people watching for a while, think I fell asleep while people watching, got on the Q train at 11:04pm heading back to Brooklyn, walked into my apartment at 11:37pm, brushed my teeth, stripped down to my nakey suit, had 2 full glasses of water with some advil, passed out until this morning at 8am!

Today was also eventful although not as much as yesterday: Woke up with a slight headache :), had coffee and breakfast, played a little on the internet, went to do my laundry, had a turkey/roasted red pepper pannini and a skinny latte for lunch, did some grocery shopping, came home, watched some Sex and the City, did a little reading for surgery, made dinner (spaghetti with turkey meatballs and bread/butter), sat down to write my blog!

In closing, tomorrow I start 2 weeks of Surgical ICU. I have to be there at 6am, which means I am back up at 4am every morning. Tonight I have decided to take a break, watch a movie, and relax. I am so looking forward to Thursday. I'm heading home for Sacco's wedding this weekend. Can't wait to see family, friends, and of course....MY PUPPIES!!!!

Everyone have a great night! :)

One more week of surgery done....as well as one more call night

Well, week #7 is done. I spent the entire week in Orthopedics. I had a really, really great time. Bones are fun, especially when they are broken and shattered and you get to use various tools that one could find in Lowe's or Home Depot to fix your patients. This week I saw a total knee replacement, a total hip replacement, a hardware change of an infected hip replacement, and the start of an I and D on a knee (incision and drainage). In clinic, I saw multiple patients for follow-up on broken bones. I also got to experience (several times) the following: the patient with severe arthritis in the knee who is experiencing difficulties in walking and excruciating pain, yet does not want the only treatment option, surgery. As explained by the doctor, there is nothing else but a knee replacement, yet the patients refuse. One of these patients happened to see Dr. H, who proceeded to say "Okay, well continue to take ibuprofen and come back to see me in 3 months. Hopefully, by that time you will be in such excruciating pain that you will consent to the surgery instead of wasting my time here in clinic." I also had a rather hilarious experience with Dr. W and a 79 year old woman. While looking at her X-ray of the titanium rod that was placed in her femur, the woman says "Wow, that is a big rod in me!!" Dr. W broke out in hysterical laughter as did I :)

My call night was friday. It started off really, really slow but picked up around 11pm. I had the pleasure of seeing a 12 year old boy with abdominal pain. It was my first time examining anyone under the age of 18. I asked all of my relevant questions about history to the parents and then examined the patient. Soon after, I had my diagnosis...Acute Appendicitis. Of course, I had my differentials too (gastroenteritis, Meckel's diverticulitis, testicular torsion, cystitis, pyelonephritis). A ct scan was ordered and because there was what appeared to be an abscess, surgery was not performed. I did get to present this patient as well as my findings to my preceptor the next morning. I did fairly well, except I did forget to perform a few tests to rule out my differentials. But overall, my presenting skills were pretty good :)

Yesterday I slept all day :). Today I did laundry and ran in the park. And, for the first time in my life, I went tanning.....in a tanning bed. It was interesting. Only 10 minutes. It got really hot under the lamps. I decided to go completely naked, because I had that option and if you know me you know that naky-ness should be my middle name! Why am I tanning?? Well, I have a wedding to go to in August, and my date is a tan-a-holic. She looks like she walked off a beach....year round!! So as to not look pasty white next to her in any photos, I decided that i must do some tanning. If I wasn't spending so much time in the hospital, I would try to lay out. But that is not an option, so fake and bake I must. Hopefully, I get a nice color!!

Okay, time to do some studying. This week I do anesthesia. Hopefully, I get to intubate someone!! Everyone have a great night!

Call #7....in all its 4th of July glory!

I spent the prior week wondering what my night call on July 4th would be? Nice day + beach + lots of drinking + lots of food + lots of people out and about = drunks, fights, MVAs, and sunburns!!

Saturday started off okay. I spent the first part of the day in SICU managing the sick patients plus helping out on some of the floor patients. I flushed an NG tube, helped the nursing staff change bedding on the 450+ pound patient, changed the dressing on a diabetics amputated foot, changed the dressing on a lower limb fasciotomy (for compartment syndrome following AAA surgery), etc. I also had some down time away from patients where I read all about breast pathology and surgical techniques for fixing said pathology.

By late afternoon, the ER started to pick up so I headed down there with my resident. First up, pneumothorax take 2 guy. He was a young 28 year old man who was involved in an altercation on tuesday and was stabbed. He went to another hospital, was treated for the stab wound and a pneumothorax that had developed. On friday, they took out his chest tube and sent him home. On saturday, he was in our ER with difficulty breathing and alot of pain. Turns out the pneumo was not resolved. So, we had to place another chest tube and since this young gentleman had already had one placed a few days back, he was well informed of the intense amount of pain he was about to feel!!

Next up, 87 year old male from nursing home in respiratory arrest. By the time I was assigned this patient, he was already intubated making the interview process a tad bit hard. My only source was a good physical exam and the nursing home notes which were not detailed at all. My senior resident managed to get a hold of the gentleman's nephew who was of even less help than the nursing home. We stabilized him and sent him to SICU.

During this time the red shirt brigade started piling up. You are asking "what the hell is that?" Well, its a wall of stretchers with patients all wearing a red shirt and handcuffed to the bed. These are all drunk patients who are too intoxicated to be released. They put red shirts on them so they are easy to spot in case they escape. Of course, everytime you walk past them they scream (in a slurred, slowed speech) "Doctor, doctor!!!" And once one starts yelling it, they all start yelling.

An older gentleman came in with really bad chest and abdomen pain. On CT exam, he had a aortic dissection that started at the distal end of the arch of the aorta and traveled down to the common iliacs. Unfortunately for him there was no vascular surgeon on call this particular night so he was immediately transferred to Maimo for treatment.

Our last patient was an 80 year old female who was experiencing some abdominal pain. On CT scan she had an internal hernia (a section of small bowel was protruding through another section of small bowel). We had to rush her immediately to surgery for an exploratory laparotomy. Once the doctors reached the small bowel, they realized she had an ischemic bowel and a portion of the small intestines was dead. So, I got to see my first small bowel resection. 2 feet of distal jejunum and proximal ileum was removed. Then the ends were stapled and sutured back together again. Unfortunately for this patient, her outcome was not that good. While closing the incision her blood pressure suddenly dropped to 35/28 and her heart rate shot up to 130 beats/minute. A central line was placed in the patients jugular and we pumped her full of fluids. That coupled with levophed brought her blood pressure back up but she is currently in SICU in very bad shape. The doctor thinks she may have suffered a pulmonary embolus while on the table (she had a history of prior DVTs).

I scrubbed in for the above surgery, and it started at 2:15am. It didn't finish until almost 5am and I slept for about 30 minutes in a chair. I was exhausted when I got home at 9am, so what did I do??? I walked around Union Square with Dy and Amanda!!! Around 2pm, after extreme exhaustion, I took the subway home and at 3pm I crawled into bed and didn't wake until 4am this morning!!!

These call nights are so tiring!! I hope everyone's 4th of July was as exciting as mine!! Take care.

Who knew the rectum was so much fun?

Today I was in clinic all day. And since it is my last week of Surgery II, I decided to try rectal clinic instead of Post Op. I had heard (from other students) that the Rectal surgeon on Coney Island is very good....and very quizzical when it comes to students. He not only pimps....he super pimps. He treats you as a resident in rectal surgery and fires question after question after question at you until your brain starts screaming STOP!!!! But, that is what made this clinic so much fun for me. Because he made me think....hard. And after only 2 hours, I felt like I learned and accomplished so much. So, let me briefly review the wonderful world of the rectum.

The first patient was an older male who was diagnosed with Carcinoid tumor of the colon that was resected. The doctor brought up his most recent labs which showed an elevated 5-HIAA. This is a marker for Serotonin, which is released from this kind of tumor. First question to me, what does this mean for this patient? My response: metastasis to a distant site. Good (first one down), now what sites are commonly involved? My response: liver and lungs. Very good (now I was feeling a bit cocky), now what 2 radiology studies, 5 blood tests, 3 clinical signs and one very important test will you order? OUCH!!! I got about half right, which isn't bad for my first try. By the way, the answers according to this doctor are: Radiology: CT scan, Octreotide Scan; Blood tests: 5-HIAA, Liver function tests, Serotonin, Chromogranin A, CEA; Clinical signs: Flushing, sweating, diarrhea; Important test: Colonoscopy.

The next few patients all had hemorroids, either internal or external. The external ones were easy to find...just spread the buttocks apart and you can easily see them. The internal ones were more tricky. A speculum type of device was placed in the rectum and slowly removed to show the presence of any internal hemorroids. I also got the wonderul opportunity to perform digital rectal exams on all of these patients.

On two of the patients I had the opportunity to perform a sigmoidoscopy. This is a device that allows you to see the mucosa of the rectum. And by blowing up a little balloon on one end, you can advance the device further into the rectum to the sigmoid colon, which is the most distal portion of the colon. Of course, I ran into a bit of a problem on the last patient. I tried to advance the scope and I ran into a big wall of pooh which allowed me absolutely no visibility. I had to retract the scope and the doctor informed the patient that he would need to come back again to have the procedure, but this time taking an enema prior to the appointment.

Overall this was one of the most challenging clinics I had ever attended and for a few moments I thought to myself "Hey, I could totally be a colo-rectal surgeon!!" :)

New things I learned on call.......

I had call last night (5 down, 7 more to go) and I learned some interesting things:

- Never try to interview a patient at 1:30am
- I never want to experience a chest tube placement
- I never want to live in a nursing home
- I am going to write a book entitled "Hernia repair: 101 Ways"

Because our night was very busy, our team did not get around to catching up with consults until almost midnight. At 1 am, my resident sent me to interview a patient on the floor with an abscess on her shoulder. So, I proceeded into the patient's room, turned on the overhead light and had the following conversation:

Me: Ms. BL, I'm sorry to wake you but I'm from surgery. I'm here to ask you about the problem you are having with your shoulder.

Ms. BL: WHAT??? You woke me up to ask me about pain. What the hell is wrong with you!!! I'm not talking to you now....get out of my room.....come back tomorrow morning!

So, I proceeded back down to SICU where I told my resident to please never send me to a patient's room again after midnight unless it was an emergency.

I fully recognize that sleep is very important for any person, especially those recovering from sickness or surgery. However, it is rare in the hospital setting to get any decent sleep at all. Nurses...doctors....therapists.....are constantly coming in and out at all hours of the day. I sometimes wonder if patients would recover faster with more sleep (interesting study idea).

Now on to the chest tube.....OUCH!! It started off okay, with some local anesthetic, 2mg of IV morphine and a small incision, but then the patient was having some pain and the resident was having a hard time getting into the chest wall. So, the senior resident turns to the patient and says "This is going to hurt", then proceeds to jab a blunt instrument extremely forceful into this guys chest and into his pleural cavity. All we heard was a loud "Pshhhhhhh" like if you opened a can of soda, and the patient started screaming in pain (although the word screaming does not do justice in fully describing what came out of this guys mouth)....and the screaming lasted for about 10 minutes after this fairly traumatic event. My first chest tube placement made me quickly realize that I never, ever want to go through that procedure....and, in the unfortunate circumstance that I do, I want to be completely knocked out.

While we were placing the chest tube, the paramedics bring in an 80-something year old female resident of a nursing home with a very visible, pulsatile abdominal mass. My senior resident asks the paramedics if she is responsive. The paramedics reply "The patient has been unresponsive for 2 days." What?? 2 days?? They go on to explain to my senior resident that that is the history the nursing home provided. 2 days?? That seems a little extreme to me. Who in their right mind would allow an elderly patient to be unresponsive for that amount of time. Can you say lawsuit??

Other than that, I also scrubbed in on 3 hernia cases, all involving the right inguinal region, and all of them completely different from each other. By the end of the 3rd surgery I realized several key things: the presentation (extent, location, etc) of the hernia can influence the surgery (where to cut, how long to make the incision, etc); each surgeon has their own way of starting a hernia, repairing a hernia, and closing a hernia (using a multitude of differing instruments, meshing, plugs, sutures, etc). I also quickly realized that I can easily pick out the layers of the hernia until they cut open the hernia sack.....then everything gets boggled up and I have no idea what layer is what (I only hope the surgeon knows ;)

Well, it is officially time for bed. Tomorrow is another OR day. Hopefully, I get the chance to see something new (please not another hernia :). Everyone have a good night.

No sleep = severe crankiness

I have been blessed to recognize, since early on in my life, that sleep is a very big priority for me. I try to get at least 7 hours of good sleep a night. 8 hours is the very best, allowing me to perform at my maximum intellectual level. So what happens when I am on call and the resident sends me to bed at 4:30am and I have to get up at 6am for morning rounds??? Lets just say I am not very pretty (in any sense of that word).

Example: during morning rounds the Chief resident pointed to me and asked me a question. It took me a whole 10 seconds (of complete silence and everyone staring at me) to realize first, that he was pointing to me. I said "are you directing the question to me?" and he said "Yes". And then, after pausing for another 5 seconds, I said "What was the question you asked?" He then gave up and pointed to another student which I was entirely happy about. The funny thing about this whole conversation.....the Chief was also on call with me last night and was fully aware that my sleep was non-existent (as was his), so why he even thought of pointing to me in the first place was something I contemplated for almost 10 minutes after this whole exchange (which of course led me to miss the presentation of the patients in rooms 225A, 225B, 226A, and 226B). So, to start a list of sleep deprived issues...so far I have decrease in responsiveness, confusion, pre-occupation on things that are not relevant at that specific time....oh, and lateness, considering rounds started at 6am, and I arrived at 6:24. Although I could also classify that as an inappropriate behavior and non-caring attitude considering the fact that while I was in the call room staring at my watch thinking to myself that I'm late, I was also saying "I don't really give a shit, I was on call last night!!!" Of course if you truly know me, you realize that none of the above really even come close to describing me, which leads me to the conclusion that without sleep, I am a totally different person. So the moral of my story....sleep is very important for me!!

Last night we had alot of surgeries.....a small bowel obstruction, an abdominal bleed on a patient who had surgery to remove the gall bladder 3 days ago, and an appendectomy. I got to scrub in on the last case which started at 2:15am. The funny part....putting the foley catheter in. I asked the nurse if I could do it...she said yes, but insisted on "watching me". So, I put my sterile gloves on, cleansed the area and proceeded to place the catheter. The nurse then says "Are you sure you aren't in the vagina?" In my mind the answer to that was "If you knew me, you wouldn't have to ask me THAT question!!!" but what came out of my mouth instead was "I am positive I am in the urethra." Sure enough, urine was seen in the catheter tube (damn I know my anatomy :)

I also got to place some stitches in the patient. I used a subcuticular stitch: the stitch is placed just below skin level ( in the dermis) and is continued throughout the lesion. When finished, tension can be placed on the ends to bring the skin edges together. No visible suture marks are seen. I am still working on my surgeon's knot for tying purposes so I didn't have a chance to do that. But I'm confident I will have it down by next call!!

Well, that is it for tonight. I have breast clinic all day tomorrow and then Head and neck on friday. I hope everyone has a great night!

Week 3 done....

Wow, I am really proud of myself. Not because I have successfully completed my third week of surgery. No. More important is that I have kept up blogging with my incredibly crazy and hectic schedule!!

So, as mentioned above, today was the end of week 3 and of Surgery I. On monday, I start Surgery II. I'm looking forward to breast, rectal, and head/neck. Hopefully, I get to see some great surgeries and more importantly, I hope the surgeons are willing to teach us (because I am so willing to learn).

Let me recap this past week. I did make it into the OR on several occasions this week. I saw a carpal tunnel release, multiple phlebectomies (to remove varicose veins), but by far the best procedure is what I saw on Thursday. A debridement and skin graft on a diabetic patient. This patient had a partial foot amputation. They needed to trasplant skin from his thigh to his foot, hoping that the new skin will take and therefore relieve him of a stumpy red foot with no skin. The grafting was interesting. The plastic surgeon informed us that they use a similar device that the cow hide industry uses to shave off the epidermal layer of skin. It looks like a giant metal razor. Then the skin is place on a platform with lots of holes and is pressed in another machine. This makes the skin come out looking almost like an accordian, with the purpose being to allow the skin to stretch more so less skin needs to be harvested. By far the most stomach turning moment was when the surgeons had to debride the patients foot. They needed to rid the foot of any non-viable skin/tissue thereby allowing the new skin to be grafted to healthy, blood rich tissue. Basically, they scraped the foot with tools; and the blood and tissue that flowed off the table and onto the floor made the OR look like a horror film. I swear it looked like a gallon of blood on the floor!! It was both gross and interesting at the same time. If not for the surgical mask covering my face, everyone in the room probably would have seen my mouth wide open and fixed (as if the wide eyes didn't give me away)!! Overall, the surgery was a success and now we get to follow the patient to see if the grafting took and if someday he will be able to walk.

Other than that, I had call on Wednesday night. Only one trauma: an 18 year old patient who was hit by a car crossing the street to school. His head hit the windshield and he had a huge hematoma on the top of his head, but other than that, no injuries - he is very lucky. We kept him overnight to evaluate his mental status. We had lots of consults all night long, and the night was officially annointed Bleed Night. Everyone was bleeding...consults for upper GI bleed....consults for lower GI bleed....even a consult for epistaxis (nose bleed). I have never seen so much blood come out of any oriffice before. The only plus of the whole night was I got to perform my first rectal exam.....and then, about 20 minutes later, I got to do another :)

Overall, call went well although I was exhausted thursday night and basically just came home and slept. I have also found that call night messes royally with my circadian rhythm. I found it incredibly difficult to wake my ass up this morning. But once I was up, I was okay. The best part....lecture was cancelled today so I was out of the hospital by 3:15pm!!! I came home, ran in the park for 45 minutes, ate dinner...and now, I am just relaxing with a Caribe and waiting for the Penguins to hoist the trophy!!!! GO PENS!!!

Everyone have a wonderful night!

2 weeks down.....10 to go!

Tomorrow starts week #3 of surgery, and my last week of Surg I. I should explain a little on how this surgery rotation is set up. In 12 weeks we do the following:
3 weeks of Surgery I: comprised of general, vascular, plastics
3 weeks of Surgery II: comprised of general, rectal, breast, Head and neck
1 week each of: Orthopedics, Anesthesia, Specialty clinic, Urology
2 weeks of Surgical ICU

After this week I move into Surgery II. Of course Surgery I and II have the most time committment since we have to be at the hospital at 6am. To do that I have to get up at 4am so I can make my 5:05am Q train to Coney Island. If we are not on call, we are able to leave after lecture at 5pm, and then I usually get home around 6-6:30pm, where I have dinner, check some email and then get into bed by 8pm to rinse, lather and repeat again!!

Of course, a call day means a 36 hours stay in the hospital. For instance, I have call Wednesday night which means I go in at 6am on Wednesday and I get out of the hospital on Thursday at 5pm!! Very, very long night and day. Its actually not all that bad if you are able to sleep a little, but even then the night of post call, you just crawl into bed at 6pm and go to sleep :)

So how is surgery going so far?? Its okay....I have found that there are good days and bad days and it really all depends on who you are working with that particular day. If you have a great attending/resident, your day is awesome in that you are able to learn so much. If you have an attending/resident that just doesn't seem to care about you/doesn't want to teach you anything, then its a pretty shitty day. I will say this....the residents work hard and are on call every 3rd night. I don't know how they do it and quite honestly, that schedule alone turns me off from being a surgeon. I love medicine and it will be a big part of who I am....but, there is also so much more to me than that and I have so many other things that I love and want to do.

So, for the next 10 weeks I will learn as much as I can about surgery. Because I know that after August 14th, I will probably never be in an operating room again. I hope everyone has a great night. Take care!

LOBECTOMY!!!

This morning I had the excellent opportunity to scrub in with Dr. S and see a right middle/lower lobectomy. This female patient was diagnosed with a carcinoid tumor.

So last night I prepared for this surgery by digging out my old anatomy books and looking up the relevant physical structures. In terms of cutting into the thoracic cavity, I reviewed which structures would be cut (skin layers, subcutaneous fat, muscles, intercostal space). I then reviewed the lung anatomy, artery and vein supply, the trachea, the lymphatics and other structures nearby (heart being the biggest). This morning I arrived early to look into the history of my patient. 57 year old female with 40 year history of smoking tobacco (and some occasional crack). I looked up her chest CT scan and saw where the tumor was localized (right posterior lower/middle lobe). And I was all prepared to answer any question that Dr. S asked me right?

Well, I got the first one; "What muscle is this that I am cutting through?" My answer: Latissimus Dorsi! Correct!!!! And I got the next question right; "What is that muscle's nerve supply? Long Thoracic Nerve! Correct!! But then it was downhill, because the next question was "Do you know the history of the first lobectomy/pneumonectomy?? And I said No. And so began Dr. S's hour long explanation into the history and its importance. I actually enjoyed it tremendously because it gave you an appreciation for how this procedure developed. So now I know that the first pneumonectomy was performed in 1933 by Dr. Graham on a Dentist from Pittsburgh who traveled to Barnes Hospital in St. Louis to have the procedure done. And I should mention that the Dentist was a smoker.....and so was Dr. Graham!!!

By the way, for those who can stomach it....the following University of Michigan video is very similar to the procedure I saw. Enjoy!!!
http://anatomy.med.umich.edu/surgical_videos/pneumonectomy.html

Have a great night!

1st week of surgery done!!!

Well, my first week of surgery at Coney Island Hospital is done. That also included my first call night which was Friday. So far, it is going well. There is alot to know and learn and I am trying to keep up with all of it. We are asked questions constantly and if the answer is not known, then we here the following "Go home and read about it". It seems everything ends with those words. Unfortunately for me, I can read it a hundred times and it doesn't stick, but if I do it then I'm fine. So I try to keep my ears open and volunteer for everything I can just so I can learn better.

Here is a quick re-cap of my week: In SICU (surgery intensive care unit), we saw some patients get better and others that did not. We have 2 patients on the medical floors with diabetes that need amputations. One is scheduled for next week, the other is still waiting on insurance to cover the procedure. I had clinic this week; vascular and ulcer, surgery I, plastics. All went okay. I am still trying to learn the computer system which has been a little frustrating at times but I'm hoping I figure it out by the end of the rotation. I was assigned one patient who came in for small bowel obstruction. She was in SICU. Fortunately, she has not needed surgery. When I left yesterday morning she was feeling much better and they were thinking of discharging her. Also, we were scheduled clinics (suture, respiratory, scrub training) and we had 2 lectures...one on aneurysms and the other on acute appendicitis (which was very beneficial to me considering my first case on call was just that).

Call was okay. The night started off slow and there wasn't much to do. Our resident sent us to the call room around midnight. I slept a little, then I got up at 3:30am just in time for the action. A young 27 year old came to the hospital with pain in his abdomen. After talking with him, and after a CT scan he was told he had appendicitis and his appendix needed to be removed that morning in surgery. Because it was our case, we got to go into surgery and watch. They did the procedure laparascopic. Before the surgery though, we did have one trauma. A 29 year old male who was drinking went swimming with his girlfriend and drowned. Everything was tried to no avail. He died 45 minutes after arriving to the ER.

In terms of procedures, well only one was learning this past week. Before doing the surgery in the ER a foley catheter had to be inserted. I got to do it....actually I volunteered to do it. So now, I can put one in anytime!!!

The only downside to surgery is the tiredness. I was fine pretty much all week. I was going to bed early and eating healthy. Even call was not bad. It has been the 2 days after call that has been kicking my ass. I got home yesterday morning at 10am and slept until 5pm, then had dinner and watched a movie, then slept from 9pm until 7am this morning and for some strange reason.....I'm still tired. And I absolutely hate that feeling. So, that is the only bad part to this rotation. Hopefully I adjust as the weeks move on.

Okay, I have to go and do laundry. I hope everyone has a great day!!! Stay tuned for week #2!