The First Day of a Long Year

I just wanted to commemorate my FIRST day in the wards with a special post. Today marks the first time that I have:

1) written an order
2) written an H&P that will actually go into a patient's file
3) been paged regarding an order


The transition from the classroom to the clinic is jarring no matter how wonderfully UCSF tries to soften the blow through FPC and Transitional Clerkship (which was excellent). I remember that right after a brief morning session, I began to follow Blue Team around on Rounds and they began discussing this baby with hyperbilirubinemia and debating things like hereditary spherocytosis, osmotic fragility test, Coombs test, etc. Suddenly, I had a moment of clarity lined slightly by surprise, delight, and terror. My first thought was, "Oh shit, this stuff actually matters." Two years of medical school have already passed, may they stand me in good stead.

Craig, you stole my post!

Lying awake this morning, I was thinking about writing the same thing as Craig....about the balance of power between nurses and doctors and how doctors can only write orders and are not allowed to touch the medications, while nurses are the only ones who can "push" the meds.

Moreover, nurses usually perform phlebotomies (blood draw from veins), but if the patient is a "hard stick," the butterfly needle may end up in the doctor's hands (MD's are also the least experienced phlebotomists!). What's even more interesting is that only doctors are allowed to draw blood from arteries...why is that?

if I don't return your calls

Third year is starting! Please forgive me if I don't return your calls/emails/smoke signals/pigeons...I will be in the hospital...a guppy in the healthcare ocean learning how to survive. This is your warning!

Block 1: Pediatrics
Block 2: Medicine
Block 3: Family Medicine
Block 4: Surgery
Block 5: Ob-Gyn
Block 6: Psych/Neurology

I will continue to blog, worry not. See you next May! =p

Chagrin

Funny thing: the closer we get to starting third year...the less sure I am about what I'm interested in. Suddenly everything feels more like an open book than ever before, and I don't know what I want to do or even where I'm going to live!

Boards Recap

USMLE Step 1 Tips:

1) Essential texts:
- BRS Pathology
- BRS Physiology
- First Aid (started at UCSF!)
- Microbiology Made Ridiculously Simple

2) Other great books:
- Basic Immunology (by Abbas, faculty at UCSF, he made us buy it)
- Neuroanatomy by Blumenfeld
- Neuroanatomy Made Ridiculously Simple
- For detailed biochemistry...Voet & Voet (from Paul)

There is an ocean of review books for pharmacology, gross anatomy, biochemistry, embryology from various series (First Aid has a review of the study resources), but I just relied on First Aid to tell me the important points.

3) Read BRS Pathology with Google Images and Wikipedia nearby...invaluable.

4) The age-old dilemma: Kaplan QBank or USMLE World? A classmate and I bought both qbanks and switched off taking tests on either one...so as someone who has tried both...choose USMLE World because it's cheaper, has more realistic/harder questions, and the testing format looks EXACTLY like the real test with identical buttons, etc.

5) Goljan lectures are entertaining and enlightening and good for those few minutes of the day when you want to be productive without reading.

6) There is a free NBME Practice Test online.

7) Watching "House MD" on DVD as a "break" actually HELPED! Suddenly, tuberous sclerosis doesn't seem so foreign and you get to practice making differentials and seeing weird "zebras" dramatized onscreen.

8) Teaching MS1's (like in MSP) really helps you review material and remember it better.


Overall, I would agree with Craig's evaluation of Step 1...there were more behavioral science and experimental data analysis questions than I expected. Some questions were tricky...some were plain inscrutable (an oxymoron), and others were freebies. :)

Honestly, this might get me tarred and feathered, but I had a lot of fun studying for the boards. It was stimulating to learn new things (there's an ick factor tie between Google imaging STD's and various dermatological lesions) and having unstructured time to eat and play. I slept at 12, woke up at 9, studied for the most of the day in coffee shops, classrooms, or at home...went wine tasting, attended a mnemonics "party," ate meals at restaurants, and it was really only the last 4 days when I started freaking out (ehhh, probably not an endorsement, but there ya go).

Paul and I began studying in earnest around March 6 after formal classes ended, we finished BRS Pathology and Physiology in 9 days and then slowed down when we started reading First Aid in 5 days (read it several times, it's incredibly dense and every word is actually important). Then we started practice questions on Kaplan QBank and USMLE World while reviewing material in various sources.

Overall, I am fairly happy with my score, but of course it's my nature to entertain the nagging feeling that maybe I could have studied harder. Studying was a good experience, however, and I just have to admit that my brain and personality have mellowed with age. :)

Inside HEADSSS

Before today, I had never seen the effects of a gunshot wound before, much less a self-inflicted one. I was unsure that the bullet would be easily visualized on the x-ray, but the outline was clearer than a rabies virus capsule. It's true what they say about the identities white opaque things on CT: blood, bone, bullet, or "bontrast" (contrast).

Medicine loves acronyms and mnemonics. Give a poorly spelled and nonsensical acronym that serves as a mnemonic to any medical student and they will write it down and regurgitate it back to you like a highly trained machine. We like crazy sentences and mnemonics full of sexual innuendo. For example, for the brachial plexus, we have "SMI LPM MARMU" and "Randy Travis Drinks Cold Beers." Okay, there was no sexual innuendo. To the untrained eye.

For an assessment of a teenager's psychosocial history, we use HEADSSS (my pet peeve is when they add multiple "invisible" repeats of a letter in the mnemonic), which stands for "Home, Education, Activities, Drugs/Alcohol, Sexual History, Suicidality, and Safety." I underestimated how important HEADSSS can be as a "tool" to cover the basics until my patient was an adolescent with a self-inflicted gunshot wound. Suddenly, the mnemonic was a way to get inside his HEAD(SSS).

>_<

Today was the first day of Third Year (we're in a 2-week buffer known as Transitional Clerkship) and the rubber has clearly hit the road.

We had class 9-12 pm and then orientation at SFGH (for my group) in the afternoon. Around 10:30 am, the speaker asked if there were any questions and one student asked if we could take a break.

"A break?" the speaker asked blankly, as if to say, what's that?

It was a sign that we've become MS3's...no more touchy feely breaks or administrative coddling! Running down the hallway eating a salad at SFGH today also made me realize that life is going to be a lot more hectic.

Hopefully these 2 weeks will be productive and organizational for me...I've already experienced a few administrative snafu's mostly from being so distracted last month.

Coming back to UCSF for lecture makes me feel like a stranger...the lecture hall was repainted and recarpeted and there were new metal benches outside the nursing building. UCSF does seem to continually change. :)

Taiwan!

Look, Ma, No Cisplatin!

Took Step 1 (gulp) the first week of April and then flew home to LA to take a family trip to Taiwan. The four kids in our family took the coolest picture with a DNA sculpture! Next week begins our orientation for the wards. :)

one year ago

Written exactly one year ago today on this blog:

"I woke up at noon today (surprise), worked a little bit on odds and ends before grabbing lunch at the Canvas Gallery with my favorite girl, Kim, around 1:30 p.m.

It was a meal that strangely focused on the theme of endings (at least for me it did)...the Canvas Gallery closing, a long weekend slowly ending, a year gone by in the blink of an eye. Kim (my favorite partner in the metaphysical journey known as life) mentioned how a year is both a long and a short amount of time, and how so many things can happen within the space of 12 months and yet how it's paradoxically not a very long time at all. We talked about daylight savings time and how Kim was upset about losing an hour to talk to her friend in Germany due to daylight savings. It makes me realize that time = love, even more than time = money.

This seemed especially poignant today, because it was the first anniversary of a friend's death, a gifted friend from high school who was preparing to take over my job at Stanford last year before passing away unexpectedly while whitewater rafting in Peru over spring break. Time is a strange beast, and it feels like the most precious thing in the world.

We squander it."

Double Dog Dare You