Mile 14020 + 638.1: Countrified Conversation

Above: Traffic in today's Decatur Rush-Minute.

YOU NEVER KNOW WHO YOU'LL MEET
AT A COFFEEHOUSE.

Ever since I started writing in this blog, I have always written about what I like about smaller communities. My stay in Decatur (about a medium size city) has been defined by amazing patients, great faculty, and a very intensive learning experience. The city perplexed me with not only having two Starbucks locations, but both locations are within 200 feet of each other (one is located within a Target, and there's a freestanding Starbucks right in front).

As I was studying in the freestanding Starbucks this week, I noticed one of the people that walked through the door looked familiar. That person came to sit down at the table next to me. It was then that everything clicked. I saw that person at the hospital and she was in the family of one of the patients that I saw during rounds. I ended up extending my hand out to that person and introducing myself...

"I don't know if you remember me, but I was at the hospital when..."

Her eyes lit up, and one of those looks where everything clicked appeared on her face. Another person related to my patient in the hospital also sat down with her. He shook my hand. Little did I know that just opening up to them would result in a hour in conversation about health care, patient education, and even stories about health care that either discouraged us or inspired us about the field.

Let me tell you, hearing about the healthcare shortage in rural areas meant so much more from people from the areas themselves than the media. I was hearing stories about how much family physicians were critical for care here in Central Illinois, stories about doctors moving out to urban areas for better support, and how much family practice meant a lot to this family. I really appreciated the open honesty and conversation we had.

They asked me what specialty I was considering to go into. When I told them I was strongly considering Family Medicine, the man held out his hand, and as I grabbed it to shake it, he said, "We need people like you here." The woman then said, "Are you coming back here?" I explained my love for Central Illinois (being a part of the alma mater) and told them that I would gladly come back if they let me back in. We all laughed.

Small / Medium sized cities have always caught my interest. Yes, Decatur may not have everything that Chicago has in terms of lifestyle, but the people are who make the difference in experience. It's not every day that one can run into patients at the store or in a coffeehouse, but its a part of the continuum of care: knowing that one can talk to his/her doctor even outside of the hospital is reassuring to our patients and helps build that patient-doctor trust.

(It was awesome to see that my Iced Coffee Property has some actual basis.)

Mile 14020 + 236.4: The Superdoctor

Above: January 2011. With winter approaching, borrowing our AWD Ford Freestyle was appropriate.

ALWAYS GIVE
150%.

With this entry being halfway-written during my time in OB, this entry will have a first-day feel, but it easily relates to my intial experiences in Family Practice.

All first days of my rotations seem to be just about the same. A bunch of students sitting around a room, some knowing one student more than others, with an aura of silence that surrounds the room. A man in a sturdy, well-pressed blue suit walks in. Wearing glasses, and sporting fine (but well groomed) gray hair, the man definitely has a presence. As he looks around at us, we all fall into a bout of silence. As we look up, a friendly smile develops across his face and he welcomed us into OB.

We then knew we would have nothing to worry about.

During that first day, he was an example of a model teacher. Some of the most inspiring doctors that I have observed during my time in clinicals have a degree of charisma, passion, and love for what they do that really inspire me. One of the most inspiring things about him was his concept of the "Superdoctor." A terrific doctor, to him, is a doctor which can only diagnose & treat conditions after they've occurred. However a "Superdoctor" is able to prevent those conditions from occurring in addition to being excellent at diagnosis and treatment. Education of patients and anticipation of sequelae of diseases are absolutely necessary to pull this off (and something that I hope to learn. He said to always give "150%" to your patients; I most certainly believed him.

And this is one of the places I've seen this has been at my Family Medicine Sub-Internship. This is one of the things I really admire about Family Medicine, the time taken to know the patients and where they come from and their lifestyles. I've seen how knowing a patient can contribute to better anticipation of how a disease may progress (i.e. how to adjust a treatment plan for a patient who has been non-compliant int he past). I've also seen attending physicians and doctors set good examples for educating their patients, spending the time to advise them on what else they can do (than just the medication) to help out with their health.

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So, I'm sure you've noticed the mile formatting change above. Well due to winter, I ended up in a more "wintry" car for taking this cross country trip, so while my dad uses my car, I get to use an all-wheel drive car to make sure I stick to the road. So, after 14,020 miles in my Focus, it's time to pull these miles on the Ford Freestyle (the +236.4 and counting miles).

Living in Decatur has actually been pretty cool. With the wide range of patients that come to Decatur as a health center, I've met many patients from kids to adults and the stereotypical Midwestern family to the Amish. However, the patient population has been really receptive to the teaching environment, and not to mention patient. I really, really respect and appreciate that. This week, I participated in the resident clinic seeing patients. Next week, I get to spend some time with the interns on the inpatient floors.

Mile 13624: Final Push

Above: Team "Kentucky Fried" takes one final shot. December 2010.

PUUSSHHH!!!!

Being on call has become a routine for me. Every fifth day during my rotation, my partner and I end up staying 24 hours at the hospital "on call" in the Labor & Delivery Ward. We're responsible for admitting patients in labor, writing their history & physicals and to observe / assist with deliveries. Sounds hectic, but yet over the 6 1/2 calls I have had over the last 6 weeks, there was none more busy than my final day. However, that doesn't mean that the night was tiring beyond measure, as I found the pace of this call exhilarating. I found myself in synchronization with three other nurses saying "push!" to get a mom to finish her delivery and even was treated to a "fourthmeal" along with the nursing staff underneath our attending doctor's tab.

I'll be honest, a quarter pound burger along with a frozen non-alcoholic lemonade sits pretty well when being on call.

However, even after not having busy calls, that night was our "test" to see how much we learned through the deliveries that we had over the calls in the past weeks. And that's something both my partner and I both noticed: we learned a lot simply by observation (and much more than we give our eyes credit for). With the help of our attendings and our past memory, we were able to position the baby's head on its exit from the vaginal canal, deliver placentas, and even coach the mom through her contractions.

I'll admit that it is really invigorating and exciting to do the coaching. I've always seen it on telemagazines and on TV shows, but when actually doing it, it feels quite different. Coaching seems to be one of the most important parts of delivery, as I see how good coaching can result in much more efficient pushing and quick delivery of the baby.

Okay... 10 seconds... Let's go!.... Come on back into it, take a deep breath, give me 10 more seconds... you can do it!

I really loved the OB portion of my rotation. There's always some type of joy associated with delivery, and it brings a type of doctoring where instead of dealing with something that holds back our own lives (the loss of health), OB most of the time brings happiness and its not just to the mother but to the baby's family. This was best seen midday, when one of the nurses yanked my partner and I out of the nursing station simply to do "rounds" consisting of delivering a muffin-top birthday cake and 2 glasses of "fake champagne" (aka sparkling grape juice) to each mom with a newborn that day and singing "Happy Birthday" to each new baby boy and girl. We did 9 newborns that day, and it felt very rewarding.

Even in a world where malpractice could be scary, I can definitely see the light that OBGYN doctors see that motivates them to do their work everyday.

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Forgive me for not writing for the last month. I'll admit the hectic schedule of OB has held back my ability to stop and think and write. However, I was able to see a side of my OBGYN rotation that is more applicable to anyone in every field, and I'm thankful to have an attending that was inspirational as the one I had to show me it. More on that in the next entry.

Mile 12056: First On-Call

Above: Almost a perfect shot on my "adopted sister's" final night in town. Replace that lightbulb, Chicago! November 2010.

SOMETIMES THE UNEXPECTED
JUST HAPPENS.

This week, I began my OBGYN rotation at St. Anthony Hospital in Chicago, IL. There's a group of 10 students working what has been nomered as a q5 schedule. A typical stretch of days include clinic, surgery, more clinic, call, and post-call. Call and Post-Call add up together for a 24 hour time shift from 6:30 AM - 6:30 AM the next day.

And that's exactly what I just went through.

I'll admit that call does have its pros and cons. Let's start with the cons first, because I personally think they won't outweigh the pros. There's less sleep (and odd patterns of it) and an acquired horrible diet (100% fresh pure high-fructose corn syrup in my Crush Orange Soda to start off my day and a nurse offered me chili cheese fries for the night).

Then there's the pros that make call kinda cool: A nifty on-call room (with a comfy bed and a small flat-screen TV). My crush soda (along with the rest of my on-call meals) were taken care of with meal cards. Hanging out with a cool nursing, midwife, and medical staff when there was a long period of downtime. An awesome resident who took the downtime to teach us.

However, the big win of the night occurred early in the morning almost 24 hours after my first call, when my partner shot me a call on my cell phone that woke me out of my trance of sleep in the on-call room. "The doc's here, just wanted to let you know so you won't miss the delivery." So within 10 minutes I was upstairs. I had taken the patient's H&P earlier that night (looked like labor was going to move on smoothly), and hit the sack rather worried about not getting to see a birth that night.

And here I was scrubbed up with the doctor, and the whole experience just went by so quickly. For me as a new medical student, the novelty was definitely there and made every single moment from scrubbing up to catching the baby to waiting for the placenta to come out post-partum exciting. I was glad I had an attending who was willing to trust me to guide me throughout the process. It felt really awesome to participate in the joy with the family & parents that were there.

So here I am, typing up this entry after just ending my shift (a little of editing at home led to a later release). In a discussion I had with my partner in the elevator post-call, we came to an agreement saying that although call is so tiring, a call experience is very rewarding and very cool (although doing too many calls I think makes the novelty wear off). Both my partner and I delivered for the first time today. It totally takes technique and practice, but with the joy brought of making a new boy or girl make it into the world, to me, there can be nothing more motivating to perfect my delivery skills & knowledge as much as I can in the next 6 weeks.

Mile 11942: Exploration - A Prelude to Part III

Above: Michigan Avenue in Chicago has to be one of my favorite streets of all time. September 2010.

IN JANUARY 2011,
WE'RE TRULY HITTING THE ROAD.

Is this something I'm truly excited about? Yes.

With me finishing up psychiatry (roundup ahead), I have two big cores left, OB/GYN and Surgery. Both are at St. Anthony Hospital in Chicago and I begin the OB half this upcoming Monday.

Now that all the bugs have been smoothed out (they were kinked for a little bit), I can tell you that I'm going on an amazing road trip. In May of this year, I went on a road trip that was independent of medicine, just to explore life without limits, and not to be a medical student for a little while. However, beginning in January, I'll be going on the road to do several rotations away from home. It's my time to explore where I might do residencies, different places to work, and even experience what it is to live in a city that's not my own.

(Please don't get me wrong, I love my hometown, the Windy City, to death. I'm just an explorer at heart.)

My current remaining schedule looks like this:
November 2010 - Obstetrics & Gynecology Core at St. Anthony Hospital, Chicago, IL
January 2011 - Family Practice Sub-Internship at Decatur Memorial Hospital, Decatur, IL.
February 2011 - Internal Medicine Sub-Internship at Wilson Medical Center, Johnson City, NY.
March 2011 - Intensive Care Unit at Grant Medical Center, Columbus, OH.
1 week break to take the ever-so-important Step 2 CS on April 1, 2011.
April 2011 - Surgery Core at St. Anthony Hospital, Chicago, IL
Planning 4 week break to take the also very-important Step 2 CK in July 2011.

After then, we're back to an abyss as to what to expect after then. I have about 16 weeks of electives remaining to schedule, as to what they are, we'll see as I have a series of sites I'm looking into and will be putting in my reservations for them soon...

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And now approaching 12,000 miles, I have ended psych. The doctor I round with in the morning and I have seen many things we never have expected to see, everything from people saying that they were "poisoned" to people who have ended up with more money in their pocket after dying. I even met someone from Bedrock (ever Meet the Flinstones?). And as crazy as these stories may seem to some people, doing a psych rotation really has put new perspective on how to look at these patients. To me, with each interview, I was getting onto a roll of taking each interview as a conversation I'd have with someone over breakfast or a cup of coffee. Each patient (from the elderly with dementia to the teenager with schizophrenia) presented with a new challenge, which was something I always welcomed. That's the way I learn: through my challenges.

Although my career interests currently don't involve psychiatry, I value now being able to see how the skills that psychiatric interviewers use to talk to their patients can be used in any setting, and it certainly helps in making any doctor's job easier. Thanks psych for a wonderful six weeks, I loved every moment of it.

So now I'm now a Fourth-Year student (by numbers of weeks of rotations)... If this past year came that fast, well... the next year is going to fly.

Mile 10121: Now You See It

Above: Jack Narz was the host of the 1970s edition of the great game show "Now You See It."

SOMETIMES YOU JUST HAVE TO
SEE THINGS FOR YOURSELF.

As Dr. Psychobabble said, "Psychology is the bestest." Even though, yes, it is a biased opinion (she said so!), this week on the wards, I started seeing how it was the "bestest", exactly as I told you in my last entry. So far, my schedule on the wards has been pretty consistent. Each of my days are faced with an interesting juxtaposition: earlier in my day, I round with a Psychiatrist who is a consultant on the medicine floors, while later in my day I round with a Family Physician who is a consultant on the psychiatric floors. It provides two different perspectives on how to look at a psych patient.

However, to date five things have stood out about psychiatry that have made my first two weeks on the floors enjoyable:

1. Au contraire: psychiatry doesn't just deal with the extremes.
In my last entry, I described some of the more severe cases where my friends were physically "harmed" by a psych patient. However, although there's a chunk of patients that do present with danger, a majority of patients are not like that. Many of the medicine floor patients talk just like their non-psychiatric consult counterparts on the floor. The patients on the psychiatric floor have very cool personalities and backgrounds. Many of them are quite easy to talk to, which leads me to point two.

2. A psych patient is still a person.
During lecture last week, I heard in lecture that the best way to interact with a psychiatric patient is by starting a conversation just like any other in one's non-medical life. I totally enjoy getting away from the standard "conversation conformed to standard history taking" format, and being able to use the interview in another dimension to assess mental function is pretty cool. It was a concept I finally got a hang of this week and am trying to tweak.

3. Sometimes your imagination itself just has to fly.
A few days ago, I heard a patient down the hallway start to sing. Mind you, it wasn't emmy quality, but the few simple notes that the patient was singing were pretty catchy. I ended up looking out the room and saw the patient dancing a semi-two step to the same song. I was very tempted to go out there and dance with him, but I was still getting used to the psych ward. However, that moment really brought a smile to my face.

4. Psychiatry offers some really unique situations.
If I went to a cocktail party, I could actually ask the question, "How many med students does it take to cut a person's ring off?" and answer truthfully six. Our group spent 2 hours switching between each other with a manual ring cutter to cut this patient's ring off. It was grueling, but it was good to see our team pull together with each twist and grip of the ring cutter.

Although this situation could be seen in some other fields (ER for instance), I'll be honest, it was fun to hear our patient sing "Free at Last" when the ring finally came off.

5. A psych rotation offers skills to both future psychiatrists and non-psychiatrists combined.
Every doctor is going to run into psychiatric patients of different sorts throughout their career. Getting an opportunity to see how to interview these patients has been, so far, a great learning experience. To recognize different psychiatric conditions and how to handle them can help aid with not only treatments of the mental conditions but improved understanding of the patient and increased compliance with treatments for their own medical conditions.

I love having an open mind... it makes me enjoy more of what life has to offer. That's what has made me get through 10,000 miles... Here's to 10,000 more!

Mile 9714: Get Psyched!

Above: Meadowbrook Park in Urbana, IL gives visitors a glimpse of the original praries that covered Illinois.

NEVER EVER ASSOCIATE PSYCH WARDS
WITH STRAITJACKETS.

This week, I've started a new round and a new rotation at Jackson Park Hospital in Chicago for Psychiatry. My friends love to tell me stories about things that have happened on the wards when they did their psych rotations. Their stories weren't exactly the most amusing... one got coffee thrown in her face while another put up pictures on Facebook of arm bruises from of a friendly tap from a patient that was all but well... friendly.

Oddly enough, using psych terminology, I think I have a psych ward phobia to get over.

I'm personally determined to use systemic desensitization to getting over it. My first day on the rotation was on Monday, and I'll admit that the adventure was filled with just about every anxiety-producing moment I wanted to just avoid. I kept my eye on the doorway while interviewing patients, I made sure that the door was locked behind me to the nursing station, and I even watched my back to make sure that nobody tried to make a move on me. However, the only way I'll learn and the only way that I face what might happen head on.

After taking on weekend call today, I'm starting to see how Psychiatry, like Peds, takes the concept of medicine and adds its own interesting twist. There's an increased reliance on other people's histories (police, family, nurses), some treatments involve a huge amount of trust in psychology, and blood tests and lab values don't carry as much importance as they do in medicine in pulling a diagnosis (but still can be helpful). And it is for this, just like my previous adventures, I am looking forward to my adventure in psychiatry. There's a reason why psychiatrists enjoy what they do, and I've read about them. However, the only way I'll completely learn and understand is if I see these reasons for myself.

And, that's exactly why I'm keeping my eyes open.