The 85-Hour School Week

Hello there, friends and relations! I'm still coming to you live from Queens, New York. Well, nearly alive. Perhaps only mostly dead. I'm pretty sure Miracle Max could formulate something that would get me back in action.

Let me tell you a little about my first week in clinical rotations. Assigned to the OB/GYN department at Jamaica Hospital Medical Center for the first of what will eventually be 78 weeks of clinical training, I found myself on the corner of Jamaica Avenue and the Van Wyck Expressway this Monday morning not entirely sure what I was getting into. After all...OB/GYN? Babies? Mothers? Lots and lots of pain and screaming? Yikes!

We started the week with some paperwork and a bit of a tour of the Hospital campus. There aren't that many buildings, and the OB/GYN service is largely confined to one floor of one building. Unfortunately, as you may know, all hospital areas look very similar to each other, so it becomes very easy to get lost. It has taken me about a week just to find my way around, but I got the hang of the place after I managed to get my fingerprint scan working for the door locks (the doors lock to prevent code pinks, i.e., baby-thefts). Mondays are "education days" for the OB/GYN residents, and so we medical students spent most of the day hanging around listening to lectures, reviewing an article, getting fed (hurrah!), and just kind of getting to know each other. There are 8 medical students on OB/GYN right now, 4 from Ross University, and 4 from St. George's University. There is some mild competition between the two groups, but it's all healthy and not devious or underhanded. Med students tend to be competitive by nature, and a little competition to encourage extra diligence isn't a bad thing.

The bad thing about Monday: we received out schedule for the rotation. Every weekday, we report at 6:30 am and we work until our shift ends about 12 hours later. We typically have weekends off. However, to throw a wrench into the schedule, we are on 24-hour call every 4 days (q4, in medical vernacular), with a day off after your call day. That includes weekdays and weekends, so if you have call on Sunday, you arrive Sunday morning at 6:30, work for 24 hours, and then leave Monday morning at 6:30, getting Monday "off." It just so happens that we began call on Wednesdays, and my first call was on Saturday, so I had a 6-day, approximately 85-hour school week this week. Try it yourself, kids, and see how you like it.

In addition, the failure of the iPhone's alarm clock since the New Year and the general disarray ("General Disarray!" Salute!) of the New York Metropolitan Transit Authority have caused me some troubles with punctuality. I crashed with my good friend and college roommate Danny Wiederkehr for a full week and a half in his apartment in Stuyvesant Town, Manhattan, and the commute via public transit was on the order of 75-90 minutes. So, that's 12-13 hours at the hospital, 2.5-3 hours commuting each day, and we start to get into crunch time for my sleep. Today, I moved from Danny's apartment (thank you a million times over again, Danny!!!) to a place nearer the hospital, in Queens. I look forward to briefer commutes and a little extra time to get some sleep or food or whatever it is I used to get before I got to New York.

I'll send some more about the nuts and bolts of the rotation itself later this week. I'm post-call today, and I'm pretty tired, but I think I'd like to post each day that I'm post-call, so I'll be back in 4 days. Until then, take care!

Renaissance

Greetings, happy campers! This post follows a long delay in posting, which seems to happen to me after every time I post. I appear only to have the stamina and fortitude to post once every 4 months, on average. Ah, well, take what you can get.

I'm coming to you live from New York City - Queens, actually. Following my 16 months on the island of Dominica, and 3 months in Miami, Florida, I spent a blissful 5 months at home in Panama City, Florida, preparing for and taking the US Medical Licensing Exam (Step 1), and then waiting for my clinical rotations to begin. The test went very well, for those of you that had not heard, and I nearly achieved my personal, if slightly unrealistic, goal for the exam. Following the receipt of my score, I languished in self-satisfaction as I awaited my first clinical assignment.

Lo and behold, I received the assignment on December 16th: Obstetrics & Gynecology at Jamaica Hospital Medical Center in Queens, New York, to begin on January 3rd of 2011. Doing the math for you, that left me 18 days to report to New York for vulgar vulvar duty. In addition, due to the holiday interceding between my assignment notification and start date, there has been a significant amount of confusion and consternation just in getting up here and being ready for work on the 3rd. Add in the inclement weather the Northeast has been hit with recently, and I had a recipe for disaster. Fortunately, good friend and former Notre Dame roomie of mine Danny Wiederkehr lives in New York and has allowed me to crash at his place for a short time while I locate and secure slightly more permanent living arrangements.

New York, thus far, has not failed to disappoint - cold temps, gruff cabbies, delicious accents, dirty subways, and even a subway prophet who preached at no one in particular.

That's all I've got for you, now, campers. I'll let you know how the first week of OB/GYN goes. Until then, take care!

Practice Dummy

Sticking to my plan of shorter, more frequent updates (I know...for now...)

Fun week this week. On Thursday, I volunteered to assist the Behavioral Science department as they test the 3rd semester students on their patient interview skills. Basically, we're handed a "script" of our chief complaints as patients, plus a bunch of past medical history and family history data. The 3rd semester students come in and interview us as if we were real patients coming to their office/hospital for the first time. There's a professor in the room with us to grade the 3rd semester students on their skills and give them feedback. After months (and months) of doing bookwork, taking tests, etc., it was nice to be in a setting where you can see the outcome of all of this. In addition, while I was acting like a patient, I was learning what I should be asking as a physician, especially as a prep for when I have to do this next semester. That reminds me: I need to copy down some thoughts before I forget them and the river of time sweeps me along.

Yesterday, I participated in a Neuroscience study that is examining the efficacy of simulator usage on medical training. Unfortunately, I was not placed into the group that got to play with the plastic "dummy patients," and I got put into a "reflection" group. I was concerned that this exercise would be a boring conversation, but I was completely wrong. The gentleman running the group was an emergency physician, and as soon as we were assembled and ready to go, he ran through a case with us: "You have a 52-year-old patient that's brought into the ER by EMTs, who report that he has a pulse of 50 bpm, O2 sats in the 80s, BP of 150 over 96...what do you want to do?" And we have to quickly ask the right questions and decide how to go about treating the patient: his O2 sats are way too low and he's registering below 8 on the Glasgow Coma Scale, so we have to intubate him; he's seizing, so we have to administer anticonvulsive medication (all we know about thus far is phenytoin); etc. The session was fast-paced, and the physician running the group was very demanding, asking us tons of questions. If we waffled, he'd keep grilling us. Lots of fun, and hopefully another good indicator of the work we'll get to do in the future.

Also, on Tuesday, I took a break from class with a friend from Bermuda named Janaya. We went to the capital of Dominica, Roseau, to watch a cricket match between Bangladesh and the West Indies. It was a ton of fun, and well worth having to make up a couple of skipped classes to go (all of our classes are videotaped and put on the web, so we can watch them at our leisure, although it's unwise to get behind). I didn't know anything about cricket beforehand, but this was a once-in-a-lifetime opportunity for me, and even for the locals here. It was the first international cricket match hosted by Dominica, so there was a national holiday declared to exhort the locals to come to the match! I'll have to check and see if there have been enough improvements to the network to allow me to post photos on the blog. If not, I'll add 'em to Facebook and my me.com account.

I admit that I made a bit of an ass of myself, though. Useful reminder for the future: if you get confused about which side of the body the spleen is on (it's on the left side, fyi, unless all of your viscera are backward, which is extremely rare), PLEASE don't correct someone loudly in the middle of a crowded room, like I did. You WILL feel stupid, and people WILL stare at you like your head has turned into a Mr. Potato-Head. Forewarned is forearmed, people.

Until next time, take care of yourselves and each other!

Upon Reflection

I know it's been forever since I updated my blog. This will be a very brief update for everyone.

I plan on doing more frequent blog posts, with briefer descriptions of what I've been up to. I will probably give you some more meat-and-potatoes type blogs, with some of the classes I take each week, which labs/ICMs I'm doing, etc. There will be less emote-a-posting about how things "are going."

I got some good advice tonight about monitoring my online "presence," and how important it is to maintain a proper online persona in the event that it is misused to profile me as I prepare for residency positions, employment positions, and the like. It isn't that I was unaware that such use of people's online postings took place, but I was reminded of how seriously many things can be taken once they've been put on the web.

To wit, I've also taken a look at my Facebook and Twitter accounts. I'm revamping my entire online image, and the dust might be shaking things up soon.

I hope everyone is doing well. I'm about 4 weeks from returning to Florida for my 2-week break between semesters 2 and 3, and I can't wait to see everyone! Take care!

Med School, Part Deux

Here comes Semester Two.

I had a great break for the past three weeks. There was a ton to do, and I accomplished all of it except for a visit to Sweet Dreams, BW3s for trivia, and a 64-team Mario Kart tournament.

Thanks to all of my friends and family for making it such a great time. List of goals attained on this break:

- "Choir practice" with the Bay High Science Department

- PJ party at the Enclave

- Coram's after dark

- Spaghetti Carbonara

- Family Reunion

- The Red Bar

- Walsingham/Edmondson wedding (I caught neither the garter nor the bouquet)

- El Presidentes for Cinco de Mayo

- Batting cages

- Mini-golf

- Midnight movies

- Destin shopping

- Scene it x 100

What's on tap for next break:

- Orlando, including seeing Mike "Family" Jones and Mark "Crooner" Jenkins, O.A.R. at Hard Rock, Pete's Specials at Pat O's, and CHIPOTLE. I'm looking forward to it.

For now, it's game time. OOSE.

Practically Relevant

Since Notre Dame's hockey team lost to Bemidji State in the opening round and my NCAA tournament bracket fell apart completely when Louisville lost to Michigan State earlier today, I've found myself with not enough to do (except study). So...time for another round of blogtopia! Today's topic: the DPS Practical Exam!

One of the 5 courses I'm taking right now is called Doctor, Patient, & Society I. When I first arrived at Ross, I thought this could be a great course. Young doctors need to learn how to interact with their patients from the get-go, and this course could be a great vehicle for that.

Unfortunately, the course has not really met my expectations. No methodology is being taught in it. It seems as though we're supposed to know how to accomplish certain parts of the doctor-patient relationship by the end of the semester, but there hasn't been an adequate level of instruction on how to actually handle those parts. For instance, one of the first things med students should learn to do is be able to sit down with a patient and take a history of their present illness (HPI). Essentially, you find out what the patient's chief complaint is, and ask all the questions you need in order to be able to come up with a few options for the diagnosis. For instance, if a patient comes in complaining of lethargy or fatigue, the differential diagnosis is extensive: anemia, myasthenia gravis, hypothyroidism, diabetes, cancer, major depression, etc. But by asking certain questions, the student should be able to rule out certain disorders - if the patient has had no weight loss, then cancer is less likely; if the patient doesn't have any problems performing light tasks like combing their hair, then myasthenia gravis is less likely. The HPI is only one part of a complete report on a patient, but it's the easiest thing to learn.

We haven't really learned anything about it, though. More than that, we haven't even been given a breakdown of what information belongs in each component of the complete report. Regardless, we have to go in tomorrow and "take" an HPI, based on a chief complaint we're told about (in advance). The chief complaint we're covering is fatigue/tiredness, so I admit that my example wasn't just chosen at random.

Get this, though: instead of interacting with a human being, we have to make up a conversation that we might have with a patient. Tomorrow, I'm going to sit down in a crowded classroom in front of two blank sheets of paper, and write out a script for an imaginary HPI. Here's how mine starts:

I (Interviewer): Good afternoon. I'm Dr. Palfrey (extends hand).

P (Patient): (shakes hand weakly) Hello, doc. My name's J.J. Johnson.

I: Nice to meet you, Mr Johnson. Can I take your jacket?

P: Actually, it's pretty cold in here. Do I have to take it off?

I: You can keep it on for now while I ask you a few questions, but you'll have to remove it when we come to the physical exam. I'll turn up the temperature a bit for you.

P: Thanks.

I: So, what brings you to see me today?

ET CETERA

To ruin the ending...I decided that my deceased jazz trombonist has Hashimoto's thyroiditis.

Tune in for more medical wackiness next time, folks! Take care!

Addendum: Quick shout-out to Jessi...thanks for the comment! I missed you guys on St. Patty's Day, too. Sadly, I did not visit the bar for a beer. I didn't even wear green. What's worse: no one pinched me for not wearing green! And let's get it out here in the open - I believe that Jessi's bracket selection (accurately named "Jessi's Gonna Win") is a LOCK to win the Yahoo.com group's bracket competition. If and when it does, I will pay homage to your basketball tournament prediction prowess on this very site! Meanwhile, Andrew's "Let's Go Duke" and my own "I Like the Irish in the NIT" will have drifted so far off the radar that we will have to drink many beers to overcome the sadness that will set in shortly after your assured victory. ;-) Arrivederci, Fiero!

(Looks at watch) Wow! Look at the date!

Let's get caught up, friends and relations.

It's been a full month since I last posted. As you might have expected, time seems to evaporate during medical school. Since February 15th, I took two practical exams and another Mini. I'll quickly describe the practicals, for those of you interested in the minutiae of actually being a medical student.

The first practical exam was based on our lab for Histology. Typical Histology courses will have laboratory components where students will look at tissue slides through microscopes, learning tissue type characteristics as well as techniques for preparing tissues for visualization and how to use the microscopes to examine the tissue samples. At Ross, with so many students, the decision was made long ago to eschew the microscopes in favor of essentially having lab via lecture. So we meet in the lecture hall, and the slides that we would have looked at are projected onto screens and plasma TVs for us to view. We're not getting the "feel" of using microscopes, but we also don't have to deal with the pain of keeping up with them, so I don't feel too bad about doing Histo lab this way. The one thing I think we're really missing out on is slide preparation, because I've never really done much of this, but we won't be doing much of that type of gruntwork as physicians.

Our practical exam for Histology involved us going into the same lecture hall and answering multiple choice (up to 10 options, A-J) questions based on slides that would be projected onto screens/TVs that were changed roughly every minute. In, out, and largely done for the day. I'll do another post on PBL, which was the only scheduled activity I had for that day.

Meanwhile, let's talk about Gross Anatomy lab. I've already posted several times about the Anatomy lab - mostly about how bad I am at it! Like I've already said, we're broken into groups, and the groups each have a cadaver to work on, and the groups trade off dissection days. We recently (this was after the practical, but it's illustrative) did our dissections of the lower limb. Group B started on a Tuesday by dissecting the anterior and medial thigh. My group (C) did a dissection two days later of the gluteal region, then A did the posterior thigh and popliteal fossa on the following Tuesday, etc. We always work on the same body we start with.

The Anatomy practical exam involves opening up all the cadavers. The professors tag one or two structures on each body and ask us to identify things like muscles, arteries, veins, nerves, some aspects of bones, and some connective tissue structures (e.g., the dura mater overlaying the spinal cord). All the questions are multiple choice (A-E), and we answer them as we walk up and down the rows of lab tables in a serpentine fashion, pausing at each body to answer a question. There is usually a tag/question on one side for me to answer, and a tag/question on the other side for someone ahead of me to answer. They can also ask us secondary-level questions based on tagged structures (e.g., what function would be lost if the tagged nerve were severed?). Finally, there is a small radiography component to the lab, so there will be several x-rays on computer screens, with a question added to the side (e.g., which of the structures in this MRI corresponds to the initiator of arm abduction?). There is a "bell" that rings roughly every 40 seconds, telling us to move to the next station/question. With so many students, they have to move quickly to get everyone tested in the same afternoon.

I did pretty well on both of the practical exams, although not as well as I wanted to do. If I do a little analysis of my performance, I come up with one strong belief: Timed tests are ok. Timed questions are not. When we take our full lecture-based exams, we're given a total time based on a given amount of time per question (75 seconds, I think). When I'm in this situation, I handle it very well. I can beat up on the easier questions and answer them in 10-15 seconds, saving a considerable amount of time to focus on the toughies. For each the first two lecture-based exams, I went through the whole test, answered the questions I knew, skipped the ones I didn't, then went back to the questions I skipped, answered them, and went through the whole test a second time to check my answers. I ended up getting out about an hour early each time, and performed well each time. During the practical, I can't beat up on the easy questions in order to move on to the toughies. As a result, my performance on the toughies suffered. I'm going to have to figure out a way to maximize my performance on toughies despite restricted time per each question. I can probably do this easily with the Histo practical: our questions are in a big stapled document, so if I beat up on an easy question, I can read the next question before time starts. The Anatomy practical will be more difficult, as the questions are kept at the stations. I can look ahead to some of the radiographs, and maybe take a look at the tagged structure on the other side of the bodies ahead, but I certainly don't want the proctors to think I'm cheating or acting inappropriately in any manner. Please post any comments with other recommendations.

As a general kind of update, I've got straight A's thus far (woohoo!), and I'm doing my best to stay motivated. I'm really looking forward to the two-week break I'm getting in April, though. I need to take and post some more pictures of the school, especially the classroom where our lectures are held, and the Anatomy laboratory. Hopefully, I'll take care of that this week! 

Quick shoutout to Adam Loverro. Adam was my roommate at Notre Dame during our freshman and sophomore years, and it was his message to me on Facebook that gave me enough of a kick in the rear to put up a new post. I had kind of let the blog sit around for a while, but I'll try to keep up a little bit better for those of you that follow it. As always, questions are welcome, as I run out of stuff to talk about unless prompted! Take care, everyone!

Gotta Hand It to You

Feeling much better after Saturday evening's dissection of the hand went off pretty well.  Gotta stop complaining, and just get in there.

Give 'er!

Give 'er!

The title is a shout-out to Canada. Oh, and to Vijay from my anatomy lab group.

So, some quick news: lots of studying in the weeks leading up to my first exam paid off. I ended up with A's in all subjects! Unfortunately, I didn't have a lot of time to celebrate - we have two lab practical exams in the two-week period following the first written exam. However, I did celebrate a little bit. I joined a bunch of schoolmates at a local "club" on the beach in Portsmouth called The Purple Turtle. At one point, I needed a walk to clear my head, so I walked along the beach, and was offered marijuana by at least two locals (a third local was unintelligible). I declined, and got the hell out of there. It was time for bed.

I took the Histology practical exam Friday morning, which didn't go as well. I nailed the cell biology part of the exam, but a lot of the light microscopy slides were difficult to distinguish. I'm pretty sure that I'll be taking a small hit in the grade because of the practical, but not too much.

This weekend is almost completely devoted to anatomy lab. We have a practical exam coming up on Thursday, so all of the first and second semester students have flooded the lab to go over the cadavers. The practical exam will make use of nearly every body in the lab, so it doesn't help just to know the details of your table's specimen. Students are going from table to table, looking them over from head to toe to make sure they are familiar with the anatomy of the bodies in general, rather than the specific anatomy of their own body. Unfortunately, this flood is preventing me and my group from finishing up our dissection of the hand.

Speaking of which, I really need to vent. I'm so frustrated with gross lab. I'm not good at this. In fact, I would go so far as to say I'm bad at this. I know the theoretical anatomy cold, and if you handed me a copy of Netter's Atlas of Human Anatomy without any labels, I'd be able to label everything there. When I try to dig around and find structures in the real thing, though, I end up cutting through things I shouldn't, horribly dismantling structures that need to be left intact. This even happens when we're being extra-cautious, because it will take us forever to do something, and then when we get tired of making zero progress, we'll try to move a little more aggressively, and BOOM! goes the dynamite - the patient's axillary artery has been severed, and he's dead on the table (again). Thursday, I was trying to get underneath the palmar fascia and aponeurosis - the stuff covering the muscles, vessels, and bones of the palm/hand. And as soon as I make a small incision, I see that I've cut an important vessel: the superficial palmar arch, something we were supposed to find, clean up, and keep intact.

Surgery may be off the table, which is a shame, because I really enjoy anatomy and I thought that surgery would be a great way to pursue it. But not if I do to patients what I've done to the cadaver.

I promise that I'll post a little more about the island stuff soon. I have a three-day weekend next week, and I'm planning on going out to the Cabrits, taking a bunch of pictures. That'll be more fun for everyone, blogger and reader alike. Until then, take care, and Happy Valentines' Day!

First Test: Vanquished?

Friends and relations!

Long time no blog. Actually, that's kind of a ridiculous statement, considering that when I first began my blog years ago, I never wrote a second post. Instead, I deleted the whole thing to start this puppy. So what if it's been around two weeks since my last post? I'm doing great here! Stop complaining!

Monday, February 9th, I took my first test in medical school, and I thought it would be a good opportunity to give some insight into the testing that takes place at Ross University.

I'm taking the following courses this semester: Gross Anatomy I; Biochemistry I; Physiology I; Developmental and Microscopic Anatomy I (really, it's Histology); and Doctor, Patient, and Society I. All of the courses are lecture-based, but there is a minor lab component to Histology, and a big lab component to Gross Anatomy. When we take exams for all of these courses, we take big block exams with questions from each class. So the test I took on Monday featured 14 questions from DPS, 22 from Anatomy, 36 from Histology, and 44 from Biochem. Actually, that only adds up to 116, whereas there were 117 multiple choice questions on the exam. Oh, well, you get the idea. The exam began at 1 pm and we had about 2.5 hours to finish. All of this is designed to mimic the licensing exams that we'll have to take after we finish our coursework at different points in medical school (I'll leave off explaining all of that until I get there). We'll have 3 of these "Minis" as they're known here, and then a cumulative comprehensive Final Exam in the last week of the semester. Additionally, we will have at least two lab practical exams for each of the lab components, the first of which is on Friday the 13th, in Histology.

I was pretty nervous about the exam as it approached. I had been studying every day this semester, and as this weekend came and went, my motivation declined a little. I just didn't feel like I could learn any more than I already had. I went through a lot of practice questions to identify any trouble areas, but mostly I just tried to get my mental state right for the test. I finished the test early after answering everything and checking my answers, and I feel pretty good about how I performed. We'll get our grades for the exam sometime this week. If you see me back in Panama City in two weeks, you'll know that it did not go well. Actually, if you never hear from me again, you'll know that it went really badly.

After the exam, the SGA here threw a party down on the beach, and there was a party at a local club. I went out and woke up feeling ragged today. I don't think I'll repeat THAT part of the post-exam performance in the future (and my tortured brain thanks me).

Send me any questions you might have. I want to do a quick post on where I'm actually living and student residences later this week, with pictures for my me.com web gallery. Until then, take care!