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.

Mile 9363: Countrified 4 - Growing Culture

Above: Nothing beats a tall set of golden arches to greet you on the road. Gilman McDonald's, Exit 283, on Interstate 57 in Illinois.

"I ROAMED THE COUNTRY
SEARCHING FOR ANSWERS TO THINGS
I DID NOT UNDERSTAND."
- Leonardo da Vinci

4:40 PM, Sunday - My friend Don and I were driving back on good old Illinois Interstate 72, after visiting an elective site I'll be attending this upcoming January. I-72 is a four-lane corridor originally designed to connect the mid-sized cities of Springfield, Decatur, and Champaign, Illinois. We got to talking about places that seemed so "perfect," that they were "too good to be true." And for some odd reason, that got me on a mantra to talk about what I liked about Champaign, a city I spent a good 4 years of my life in. To me, it was an example of perfection, but there seemed to be no strings attached to that experience.

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The debate is still hot. Even though it has been just over a year since I've written anything on this topic, it's still something I do think about. I'm still attracted to the sense of urban sophistication that's given in the larger cities like Chicago, but something also pulls me towards the growth and potential in smaller cities found away from metropolitan areas.

I drove down to Champaign this past weekend to spend some time with my good friends Neal & Christine, who I've always wanted to spend time with (more than the 13 hour stop I made last time I was in town in May). On a cold Saturday morning, I whipped down I-57 and made it from the Chicago Area in a very efficient 2.5 hours (without speeding, and with a McDonald's stop for coffee placed in there). When I got into town, seeing a good chunk of people outside at 8:30 AM doing their morning jog on streets made me smile. It was good to see at a metropolitan area of about 100,000+ people (without the students at the University of Illinois) still had that sense of freedom that comes with safety. I soon found myself in the outer rim of the city, entering the "suburb" of Savoy where Neal & Christine live. I smiled when I noticed that when I looked to my left, I saw houses, but on my right, I saw the beauty of endless fields of corn blowing in the wind.

With a lot of smaller cities, especially those home to colleges, there is an investment into downtown areas, to infuse culture, improve the quality of life and to show that these cities have identity. The Champaign-Urbana area has exactly been doing that, and every time I come back, there's something new or something improved about the area. When I first visited the U of I in 2002, I saw the potential in the area, as this was when the improvements were beginning in the cities. And 8 years later, I can see there's something for everyone, with everything from a Weekend Farmer's Market in Urbana to fancy eating in the downtown area of Champaign to summer festivals that complement any social outing quite well.

No, this isn't a post to simply limit my future to be here in Illinois (although I would love to be), but an example of a place I would love to live. I look at other large college towns, like those in Bloomington, IN, Madison, WI, and somehow that "oasis" of urban-ness within miles of rural terrain pulls me to places like those too. From a professional standpoint, the mix of people coming from a city-life and from the rural areas to receive health services makes this an attractive patient base to work with in my future. For me, there's always something about a city that is with vibrant growth that will entice me to live there.

So, although I got some R&R by hanging out with my friends in Champaign, I also got to learn a little more about what I wanted too. And that's what made this past weekend quite awesome.

Mile 8895: Keep on Moving

Above: I do miss the 6 AM rush hour.

ALTHOUGH I MISS INTERNAL MEDICINE,
THE ADVENTURE MUST CONTINUE.

And just like that... it's over. One of the odd ways I've thought about the last 16 weeks is, I've been at the hospital 4 weeks longer than the current interns.

My last 16 weeks at Westlake Hospital were absolutely amazing.

Some of the biggest lessons that I learned during my time in Infectious Disease weren't even in infection (although, with the amount of cellulitis cases that we got called for, I would almost consider myself an expert in cellulitis now). When comparing my 12 weeks on the floors, where we took care of just about every single aspect of our patients, my 4 weeks on infectious disease were simply focused on that. I still remember the first day when I was on "floor mode" - as I liked to term it - and wrote just about every single assessment and plan on the patient I could in my note. I quickly learned that was quite inefficient considering I was on a consulting service. But this is one reason that I couldn't see myself - at this moment - going into a subspecialty; I feel odd treating only one aspect of a patient.

One thing that I really enjoyed was that my Infectious Disease rotation came right after my Internal Medicine rotation and at exactly the same hospital. I knew how the teams worked along with who worked the teams, which not only made the transition easy, but I appreciated how the tables turned. On the floors, my intern would let me know what consults I need to pull, but now the interns were coming to my doctor and me with new consults. I'm going to miss the rhythm I started putting together with the interns, seniors, and students, but I must keep moving...

It was with this program that I appreciated some of the aspects of smaller community programs, getting to know everyone's face, seeing common cases repetitively (i.e. like the cellulitis above), working with tight knit teams, and sometimes seeing patients over and over again. I've been a big fan of the "make a big world a small one" concept, and community-type residency programs attract me in that manner.

For the next 3 weeks, I have them off, but starting in late September begins my Psychiatry rotation at Jackson Park Hospital. But I tell you, I surely am going to miss running up and down those floors.

A huge thank you goes out to the attendings, residents, and students at Westlake.