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! :)
Sunday, July 26, 2009
Sunday, July 12, 2009
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!
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!
Monday, July 06, 2009
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.
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.
Tuesday, June 30, 2009
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!!" :)
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!!" :)
Tuesday, June 23, 2009
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.
- 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.
Wednesday, June 17, 2009
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!
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!
Friday, June 12, 2009
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!
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!
Sunday, June 07, 2009
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!
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!
Tuesday, June 02, 2009
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!
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!
Sunday, May 31, 2009
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!
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!
Tuesday, May 26, 2009
First Day of Year 3
Today starts my first day of Year #3 in medical school. I'm starting with surgery!! One of the hardest and most intense due to the call schedule. I'm actually happy that I am doing it first. I'm hoping that my excitement for starting 3rd year will carry me through this rotation :) Plus, I enjoy surgery, so it should be fun. Here is what my schedule looks like for the next year:
Surgery 5/26/09-8/14/09
Medicine 8/17/09-11/6/09
Pediatrics 11/9/09-12/18/09
Ob/Gyn 1/4/10-2/12/10
Psych 2/15/10-3/26/10
Emergency 3/29/10-5/7/10
I am hoping that my blogging will be slightly better than in Grenada. I know, it really has to do with the blogger (that would be me). I just get so caught up I forget but I will try to blog about interesting things on each service.
And of course, I will also blog about the city!!! Speaking of which, this past weekend, Laura came to visit me and we had a nice little adventure. We went to NY Aquarium, Coney Island for some cheap beer, Little Italy and a Pub on Broadway for some not so cheap beer, shopping all around 34th street, Central Park, Prospect Park (Brooklyn), and we ate at 2 cute little places in Park Slope: Ginza, a Japanese Hibachi restaurant, and Fritters, a burger and fries type of place. Both were very good. And lets not forget Bergen Bagels on Monday morning!!!!
Surgery 5/26/09-8/14/09
Medicine 8/17/09-11/6/09
Pediatrics 11/9/09-12/18/09
Ob/Gyn 1/4/10-2/12/10
Psych 2/15/10-3/26/10
Emergency 3/29/10-5/7/10
I am hoping that my blogging will be slightly better than in Grenada. I know, it really has to do with the blogger (that would be me). I just get so caught up I forget but I will try to blog about interesting things on each service.
And of course, I will also blog about the city!!! Speaking of which, this past weekend, Laura came to visit me and we had a nice little adventure. We went to NY Aquarium, Coney Island for some cheap beer, Little Italy and a Pub on Broadway for some not so cheap beer, shopping all around 34th street, Central Park, Prospect Park (Brooklyn), and we ate at 2 cute little places in Park Slope: Ginza, a Japanese Hibachi restaurant, and Fritters, a burger and fries type of place. Both were very good. And lets not forget Bergen Bagels on Monday morning!!!!
Did I mention that Laura kissed Oz!!!! It was so cute! And smelly (he had wicked Tuna breath that was all over the side of Laura's face :)
Alright, I have to get ready for my big day. Need to iron and look my prettiest. Good luck to me!!
Sunday, April 12, 2009
Happy Easter!!
I hope everyone is having a great Easter. In a few short hours I will be munching on Ham, real mashed potatoes, carrots, rolls and later.....cheesecake.....YUMMY!!
Well, I got my test score back. I found out Wednesday March 25th, 3 weeks to the day I took my exam. Before the drumroll begins, let me just say the following: I decided to set a "range" of scores that I would be happy with. My range was 230-240. I knew that if I could land in this range, then no residency that I was interested in would be out of reach. Now to the drumroll: I got a 230!! And I was extremely excited!! Yes it was the minimum of my range, but still within it. Could I have scored higher?? Who really knows. Could I have studied longer and gotten a higher score?? No. As I explained before, I really feel that I studied too much. It does make me wonder would I could have scored had I taken the exam in February when I wanted to. Unfortunately, I will never know, but in the end it doesn't matter. I scored what I wanted and I am very, very happy.
Now that I have my score I am much more relaxed. No crazy dreams about scoring too poorly, or dreams where I did exceptionally well, only to be told I needed to re-take the exam because I performed "too well". It is nice to know that the effort and time you put in was not wasted, and that you achieved something you wanted.
A few of my friends have taken the exam, and some are still waiting to take it. I wish everyone the best of luck with it.
Have a great Easter and I will talk to you all soon! :)
Well, I got my test score back. I found out Wednesday March 25th, 3 weeks to the day I took my exam. Before the drumroll begins, let me just say the following: I decided to set a "range" of scores that I would be happy with. My range was 230-240. I knew that if I could land in this range, then no residency that I was interested in would be out of reach. Now to the drumroll: I got a 230!! And I was extremely excited!! Yes it was the minimum of my range, but still within it. Could I have scored higher?? Who really knows. Could I have studied longer and gotten a higher score?? No. As I explained before, I really feel that I studied too much. It does make me wonder would I could have scored had I taken the exam in February when I wanted to. Unfortunately, I will never know, but in the end it doesn't matter. I scored what I wanted and I am very, very happy.
Now that I have my score I am much more relaxed. No crazy dreams about scoring too poorly, or dreams where I did exceptionally well, only to be told I needed to re-take the exam because I performed "too well". It is nice to know that the effort and time you put in was not wasted, and that you achieved something you wanted.
A few of my friends have taken the exam, and some are still waiting to take it. I wish everyone the best of luck with it.
Have a great Easter and I will talk to you all soon! :)
Thursday, March 19, 2009
Long time no see.....
Good morning!! I was reading Valuemd.com and quickly realized that I have not posted in a while (who would have guessed?). So I decided an update is in order. When I last left all of you, I was about to take my test February 18th. Well, that didn't work out too well. Some personal issues came up and I didn't feel prepared. So, I rescheduled it for March 4th.
To be honest, I wish I would have taken in on the 18th. I figured the extra 2 1/2 weeks would help. It didn't. I think by then I was just too studied out. I couldn't concentrate on learning anything new. I would do a few blocks of questions and then my brain would go blank. It was hard to focus. So, about a week before my test date I decided to do less. I stopped reading First Aid and all my review books. I instead just tried to do as many Uworld questions as possible. I wasn't at all nervous on the days leading up to the test. In fact, test day I wasn't nervous at all.
The test: Not bad. My first two sections were extremely hard. After them, I took a 10 minute break and told myself not to worry. It's okay. I still have 5 more sections. Then I went back in and to my surprise, blocks 3-6 were so easy. I flew through them with hardly any trouble. My last block was medium in comparison, doable definitely. And then I was done. And driving back home to get drunk :)
So here I sit, 2 weeks and 1 day out of my test. Results are released 3-4 weeks after the test. So, next wednesday I may be a happy....or sad. We just have to wait. And of course, I thought studying for the beast was the hardest part. Everyone have a great day!!!
To be honest, I wish I would have taken in on the 18th. I figured the extra 2 1/2 weeks would help. It didn't. I think by then I was just too studied out. I couldn't concentrate on learning anything new. I would do a few blocks of questions and then my brain would go blank. It was hard to focus. So, about a week before my test date I decided to do less. I stopped reading First Aid and all my review books. I instead just tried to do as many Uworld questions as possible. I wasn't at all nervous on the days leading up to the test. In fact, test day I wasn't nervous at all.
The test: Not bad. My first two sections were extremely hard. After them, I took a 10 minute break and told myself not to worry. It's okay. I still have 5 more sections. Then I went back in and to my surprise, blocks 3-6 were so easy. I flew through them with hardly any trouble. My last block was medium in comparison, doable definitely. And then I was done. And driving back home to get drunk :)
So here I sit, 2 weeks and 1 day out of my test. Results are released 3-4 weeks after the test. So, next wednesday I may be a happy....or sad. We just have to wait. And of course, I thought studying for the beast was the hardest part. Everyone have a great day!!!
Wednesday, January 28, 2009
Can't......study.....any.......more.....
I have been studying for too long. How do I know?? Because I start to focus on something important like enzymes in the body that need thiamine as a co-factor, and next thing I know, I'm on the internet looking up thiamine....where does it come from?? What other creatures in this world need thiamine?? Can my cat have thiamine deficiency?? Wait, I need to go check the cat food to see if it is fortified with thiamine. Do mice have thiamine? And this is just with thiamine!! There are other water soluble vitamins needed by our bodies to function properly. And don't get me started with the fat soluble ones!!
So my test date is February 18th. I can't wait for this day. Studying, for the most part, has gone well. There are things I definitely know, and there are things that I quickly forgot. This week has been focused study on those areas I quickly forget. Unfortunately, I can't tell you much about what I'm studying because I have already forgotten.
Today is very snowy and cold in central NY. It is days like this I wish I was in Grenada. But then I remember that I am going for sushi tonight for dinner (it will cost me less than $12 for 3 rolls instead of 1) and then maybe to a movie.....or to walmart.....or wherever else I want to go, and then I don't miss Grenada so much. Did I mention no "hooting or hollering"!! That is a plus :)
Which has me thinking lately. Maybe I will do my residency in a warmer area of the United States. Any suggestions out there as to where?? I'm thinking arizona....maybe south carolina.
Alright, back to studying. Purine salvage deficiencies here I come!!!
So my test date is February 18th. I can't wait for this day. Studying, for the most part, has gone well. There are things I definitely know, and there are things that I quickly forgot. This week has been focused study on those areas I quickly forget. Unfortunately, I can't tell you much about what I'm studying because I have already forgotten.
Today is very snowy and cold in central NY. It is days like this I wish I was in Grenada. But then I remember that I am going for sushi tonight for dinner (it will cost me less than $12 for 3 rolls instead of 1) and then maybe to a movie.....or to walmart.....or wherever else I want to go, and then I don't miss Grenada so much. Did I mention no "hooting or hollering"!! That is a plus :)
Which has me thinking lately. Maybe I will do my residency in a warmer area of the United States. Any suggestions out there as to where?? I'm thinking arizona....maybe south carolina.
Alright, back to studying. Purine salvage deficiencies here I come!!!
Tuesday, January 20, 2009
History is made
I'm supposed to be studying for Step 1, but I had to take a much needed break to watch history. Barack Obama becoming the 44th President of our country. I did not vote for him (mostly because my absentee ballot was not mailed on time), but I am very happy that he was elected and I only hope that he can unite people, to inspire everyone in this great country to be the best, and to make change happen. Good luck Mr. President.
Sunday, December 21, 2008
I'm home!!
I arrived safely yesterday morning at the train station in Utica, NY. And was I excited, not so much to be in Utica, NY but to be in the states and not in Grenada. The flight went well. A little delayed (45 minutes) at the Grenada airport, but smooth flying to JFK. The plane was only 1/2 full, so I had 3 seats to myself. We landed around 1am and I made it through customs really quick. Then it was off to Jamaica station to get the LIRR to Penn Station. Waiting for the train for 7 minutes outside in the cold at 2am was brutal. I couldn't sleep in Penn Station, so I stayed up all night. Then at 7:15am, I boarded the Maple Leaf to Utica, NY and arrived at noon.
First thing was food....I had a chicken and roasted red pepper panini at the Boulevard Diner. Then I came home to play with my puppy (and got rabies kisses!!). Then I just relaxed and watched movies and tv and went to bed really early.
So today I have alot to do. Unpack my summer clothes and pack them away in bins. Get out the little winter clothes I have. See what I need to buy in the next few days. Oh, and study. Let's not forget about the big test I have coming up!!
I hope everyone has a great day. 4 more days until christmas!!!! :)
First thing was food....I had a chicken and roasted red pepper panini at the Boulevard Diner. Then I came home to play with my puppy (and got rabies kisses!!). Then I just relaxed and watched movies and tv and went to bed really early.
So today I have alot to do. Unpack my summer clothes and pack them away in bins. Get out the little winter clothes I have. See what I need to buy in the next few days. Oh, and study. Let's not forget about the big test I have coming up!!
I hope everyone has a great day. 4 more days until christmas!!!! :)
Sunday, December 14, 2008
The end is near...
Tests are over!! I never have to take another test here in Grenada again, and I can say that with confidence because I already have my scores back. A in pathophysiology, B in pharmacology, and in clinical skills....well, they are still working the final grades out but I can't get less than a B (considering that is what the site shows right now). So, overall this term I did fairly well. Considering I was also studying for Step 1 at the same time as the above classes.
Then to old school for a little more drinking....
Friday night: The best party ever, hosted by Sej!! YES I'm in a DRESS!!
Stayed for like 2 minutes (I was really tired and decided to go home and sleep)..
Hash with Ishie....my first and last...I had SO MUCH FUN....
Sushi w/friends and saying goodbye....
So, I have 5 more days of sun to enjoy and then I'll be leaving Grenada. In some ways I will miss it here, but in more ways I am so happy to finally get home!! Take care everyone. See you really soon!
So, the last few days have been crazy and hectic, but REALLY FUN. So lets recap shall we:
Thursday: After pharm, a little celebrating and drinking on campus..
Thursday: After pharm, a little celebrating and drinking on campus..
Then to old school for a little more drinking....Friday night: The best party ever, hosted by Sej!! YES I'm in a DRESS!!Then, back home to change and off to Dr. Groom's for the end of year party....
Stayed for like 2 minutes (I was really tired and decided to go home and sleep)..Saturday: Lunch at BB's....one last crab back experience..
Hash with Ishie....my first and last...I had SO MUCH FUN....Sushi w/friends and saying goodbye....So, I have 5 more days of sun to enjoy and then I'll be leaving Grenada. In some ways I will miss it here, but in more ways I am so happy to finally get home!! Take care everyone. See you really soon! Tuesday, December 02, 2008
Where the hell have I been????
This is something I have heard alot lately. The other is....why have you not posted to your blog since September?? Oh shit....has it been that long?? It has, as I found out about 5 minutes ago. So, there is alot to catch up on and I better type quick considering I have my finals next week and I need to study for those. Here we go:
The first pathophysiology test was horrendous. Averages were really, really low (1/2 the class failed). We had a huge meeting with the directors of the course as well as the other courses, the Dean of Students, the Provost of the school, and so on....after about 2 hours of student complaints we were told the course would be curved.....good thing?? Who knows, all I know is I'm doing just fine and I haven't studied for pathophysiology since this first test and I stopped going to lectures back in September. I have been watching Kaplan videas and doing questions and studying my ass off for Step One. On the second test I did even better. So no worries here.
Speaking of which....Step One. I decided to not take a Kaplan course like many of my fellow students. I couldn't see spending $3,000 on a course for 6 weeks. Not to mention I would have to sit in lecture for 7-8 hours per day for 6 days a week. My attention span would not hold. So, back in July I decided to use this whole semester as my study time. So far its working really well. Once I get back home, I will do some practice tests to judge my weaknesses and strengths and then study my butt off for 6 weeks. I'm hoping to take the test the end of January which is much earlier than most of my friends (who will be taking it in March). I guess I'll have to see how my plan works.
Mit, Marie, Dy, Shelly, and Laura all came to visit me. YAY!!! They all came on November 8th and stayed for a week. I was so excited....its nice when friends or family can come to visit. We had a great time. We went on a hike, and river tubing, and on a sailing trip. And we went to the beach alot!! Here are some pics for you to enjoy:
Did I mention that the boat trip above had all you can drink alcohol. :)
The first pathophysiology test was horrendous. Averages were really, really low (1/2 the class failed). We had a huge meeting with the directors of the course as well as the other courses, the Dean of Students, the Provost of the school, and so on....after about 2 hours of student complaints we were told the course would be curved.....good thing?? Who knows, all I know is I'm doing just fine and I haven't studied for pathophysiology since this first test and I stopped going to lectures back in September. I have been watching Kaplan videas and doing questions and studying my ass off for Step One. On the second test I did even better. So no worries here.
Speaking of which....Step One. I decided to not take a Kaplan course like many of my fellow students. I couldn't see spending $3,000 on a course for 6 weeks. Not to mention I would have to sit in lecture for 7-8 hours per day for 6 days a week. My attention span would not hold. So, back in July I decided to use this whole semester as my study time. So far its working really well. Once I get back home, I will do some practice tests to judge my weaknesses and strengths and then study my butt off for 6 weeks. I'm hoping to take the test the end of January which is much earlier than most of my friends (who will be taking it in March). I guess I'll have to see how my plan works.
Mit, Marie, Dy, Shelly, and Laura all came to visit me. YAY!!! They all came on November 8th and stayed for a week. I was so excited....its nice when friends or family can come to visit. We had a great time. We went on a hike, and river tubing, and on a sailing trip. And we went to the beach alot!! Here are some pics for you to enjoy:
Did I mention that the boat trip above had all you can drink alcohol. :)
My internet is SO slow right now....so, i'll have to end here for now but I promise I will write again soon....and besides I have to post pics of me in a dress!!! What??? A dress?? You heard it....come back for more real soon!! Have a good night!!!
Saturday, September 27, 2008
Beach time!!
So, hell week is over. My last exam was yesterday in pharmacology. It went okay. It is so difficult to study material that has no meaning, at least not now. I'm sure once we get into clinical years, and we see patients with varying degrees of infections, diseases, and such...we will become more familiar as to the standard treatments and drugs of choice. But for now, we must memorize, memorize, and memorize some more and then hope to hell we remember something when trying to answer 3rd and 4th order questions on which drug when given IV causes ototoxicity....or what generation of this family of drugs will treat a Pseudomonas infection...AHHH!!
Also yesterday, our class was graced with our scores from pathophysiology. Lets just say when the class average is 64 (passing grade is 70 don't forget), it says there is definitely something wrong with the class....something we have been bitching and moaning about for 5 weeks. Remember, we are not new here. We are 2nd year medical students and I think by now we have come to know what to expect from our courses. When a class does this poorly it reflects not on us or our learning style, but on the course, professors, and total lack of planning. This is the first year for this supposed revamped and renewed Pathophysiology class...and it totally shows. Not getting handouts or lecture slides in a timely manner (sometimes weeks after the lecture), no clear objectives as to what will be on the test, telling us to post our questions on a class forum and then having no one from the department answer our questions. And then the department posting notes saying please bare with us during this time of adjustment bull****. At least the course director, in an uncharacteristic way, decided to give everyone 20 extra points for the 1st test...so our morale would not be shot for the rest of the course. Why thank you....how generous of you. Now, why don't you FIX THE CLASS!!! Of course, this is a one time shot of extra points and there will be no such curve on the remaining 2 tests. I can't wait to see what those averages look like!!
So last night I watched the debates. McCain really looked good compared to Obama. I'm really sick of questions be asked to Obama and he skirts around them. Just answer the question. What are YOU going to do?? I think the moderator last night asked Obama the same question, re-worded 4x and he still didn't answer it. Right now, I'm leading towards McCain....but, Palin scares me a bit.
Today I am off to the beach to soak up some much needed sun, followed by some lunch sushi. And later tonight I am baking cookies....peanut butter....yummy!! And dinner is meatball subs (something I have been craving for weeks).
Before I go...2 very funny things I have seen this week:
www.nakedclowncalendar.com - this is pretty hysterical if you ask me...i may just get one
http://www.msnbc.msn.com/id/26892950/wid/11915773?GT1=31037 - what is wrong with PETA....this organization is seriously crazy!!
Alright everyone. Have a great weekend and I will update you all soon!! :)
Also yesterday, our class was graced with our scores from pathophysiology. Lets just say when the class average is 64 (passing grade is 70 don't forget), it says there is definitely something wrong with the class....something we have been bitching and moaning about for 5 weeks. Remember, we are not new here. We are 2nd year medical students and I think by now we have come to know what to expect from our courses. When a class does this poorly it reflects not on us or our learning style, but on the course, professors, and total lack of planning. This is the first year for this supposed revamped and renewed Pathophysiology class...and it totally shows. Not getting handouts or lecture slides in a timely manner (sometimes weeks after the lecture), no clear objectives as to what will be on the test, telling us to post our questions on a class forum and then having no one from the department answer our questions. And then the department posting notes saying please bare with us during this time of adjustment bull****. At least the course director, in an uncharacteristic way, decided to give everyone 20 extra points for the 1st test...so our morale would not be shot for the rest of the course. Why thank you....how generous of you. Now, why don't you FIX THE CLASS!!! Of course, this is a one time shot of extra points and there will be no such curve on the remaining 2 tests. I can't wait to see what those averages look like!!
So last night I watched the debates. McCain really looked good compared to Obama. I'm really sick of questions be asked to Obama and he skirts around them. Just answer the question. What are YOU going to do?? I think the moderator last night asked Obama the same question, re-worded 4x and he still didn't answer it. Right now, I'm leading towards McCain....but, Palin scares me a bit.
Today I am off to the beach to soak up some much needed sun, followed by some lunch sushi. And later tonight I am baking cookies....peanut butter....yummy!! And dinner is meatball subs (something I have been craving for weeks).
Before I go...2 very funny things I have seen this week:
www.nakedclowncalendar.com - this is pretty hysterical if you ask me...i may just get one
http://www.msnbc.msn.com/id/26892950/wid/11915773?GT1=31037 - what is wrong with PETA....this organization is seriously crazy!!
Alright everyone. Have a great weekend and I will update you all soon!! :)
Sunday, September 21, 2008
I am at a loss for words, and therefore cannot even come up with a suitable title for this blog.
Tomorrow starts our first found of tests for term 5/6. I have pathophysiology at 1pm. Am I excited? scared? nervous? feeling like I will rock it? NO....none of the above. This is actually the first test in medical school that I have no feelings. And maybe that has alot to do with this department. See, this is an old class with a new look. The school decided to change it up a bit....which is great...change is always good. But in typical SGU fashion, they did it without a plan in place. And because of that, no one knows what to study, where to study from (lecture handouts, books, wikipedia), or really what is going to be on the test. These last 5 weeks have been extraordinary vague and we typically get the following response from the department: "please bare with us and be patient as we are new at this too and we are trying to work out the kinks". Great!! Thanks....and while you are doing that...you are playing with MY FUTURE AS A DOCTOR!! So, needless to say I really don't know what to expect for tomorrow's test. I'm just going to go in and do the best I can and know in the back of my head that I have 2 more tests this semester to make up for this one if I bomb it!! :)
Then wednesday is clinical skills....this class is funny. We have to come in and take a midterm that only counts 8% of our total grade. No, you didn't missread that one.....8%. What a waste of time and not to mention paper. I will definitely not be studying for this one.
No...all my time after pathophysiology.....from monday night until friday at 1pm will be towards pharmacology which happens to be the biggest bear I have encountered in grenada. Now, i hate to memorize with a passion which is why classes like parasitology and microbiology gave me such trouble. This class however, takes the gigantic 5 tier wedding cake. The amount of absolute bull**** and minute details we have to "memorize" and "know" is mind boggling. I thought once we get into the hospital we have PDAs....oh, and those wonderful people that go to school for 5 years straight knowing ONLY medications....hello pharmacists!! So, i will be spending my entire weekend cramming info into my incredibly shrinking cranium only to forget about it next week.
Although I must mention that the season premiere of Grey's is thursday for 2 hours!!! So excited!! I will definitely be taking a much needed break for that.
Alright, well before I go let me fill you in on some of the things that have happened over the last few weeks:
- IGA has no ice cream (bastards)
- IGA has no soy milk (AHHH)
- Union made up of security guards, bus drivers, and other ancillary staff went on strike last week...from my perspective, this was kind of funny (only because I live off campus and have a car)
- My headphones broke (but I learned from term 2 and had a spare pair....i'm too smart!!!)
- I stopped working out for 1 week (tweeked my back)
- OBGYN prof pronounced "centimeters" as "sontimeters" (and she said it ALOT in regards to the dilated cervix and the size of the baby's head....9.5 sontimeters)
- Tom Brady got hurt (BOO FRIGGIN HOO.....little whiner)
- Farewell Yankee stadium (just tonight....how sad)
Alright....i'm off to bed for some sleep before the big day of fun tomorrow. Have a great night.
Tomorrow starts our first found of tests for term 5/6. I have pathophysiology at 1pm. Am I excited? scared? nervous? feeling like I will rock it? NO....none of the above. This is actually the first test in medical school that I have no feelings. And maybe that has alot to do with this department. See, this is an old class with a new look. The school decided to change it up a bit....which is great...change is always good. But in typical SGU fashion, they did it without a plan in place. And because of that, no one knows what to study, where to study from (lecture handouts, books, wikipedia), or really what is going to be on the test. These last 5 weeks have been extraordinary vague and we typically get the following response from the department: "please bare with us and be patient as we are new at this too and we are trying to work out the kinks". Great!! Thanks....and while you are doing that...you are playing with MY FUTURE AS A DOCTOR!! So, needless to say I really don't know what to expect for tomorrow's test. I'm just going to go in and do the best I can and know in the back of my head that I have 2 more tests this semester to make up for this one if I bomb it!! :)
Then wednesday is clinical skills....this class is funny. We have to come in and take a midterm that only counts 8% of our total grade. No, you didn't missread that one.....8%. What a waste of time and not to mention paper. I will definitely not be studying for this one.
No...all my time after pathophysiology.....from monday night until friday at 1pm will be towards pharmacology which happens to be the biggest bear I have encountered in grenada. Now, i hate to memorize with a passion which is why classes like parasitology and microbiology gave me such trouble. This class however, takes the gigantic 5 tier wedding cake. The amount of absolute bull**** and minute details we have to "memorize" and "know" is mind boggling. I thought once we get into the hospital we have PDAs....oh, and those wonderful people that go to school for 5 years straight knowing ONLY medications....hello pharmacists!! So, i will be spending my entire weekend cramming info into my incredibly shrinking cranium only to forget about it next week.
Although I must mention that the season premiere of Grey's is thursday for 2 hours!!! So excited!! I will definitely be taking a much needed break for that.
Alright, well before I go let me fill you in on some of the things that have happened over the last few weeks:
- IGA has no ice cream (bastards)
- IGA has no soy milk (AHHH)
- Union made up of security guards, bus drivers, and other ancillary staff went on strike last week...from my perspective, this was kind of funny (only because I live off campus and have a car)
- My headphones broke (but I learned from term 2 and had a spare pair....i'm too smart!!!)
- I stopped working out for 1 week (tweeked my back)
- OBGYN prof pronounced "centimeters" as "sontimeters" (and she said it ALOT in regards to the dilated cervix and the size of the baby's head....9.5 sontimeters)
- Tom Brady got hurt (BOO FRIGGIN HOO.....little whiner)
- Farewell Yankee stadium (just tonight....how sad)
Alright....i'm off to bed for some sleep before the big day of fun tomorrow. Have a great night.
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