sanguinemare

November 6, 2017

“Someday, one of your patients might be me. So study hard!”

Filed under: "Me" updates,Med School and the MSTP,MS-3 — sanguinemare @ 3:15 pm
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Today, I happened to be off shift (I’m doing my Emergency Medicine elective right now), so after lectures this morning, I went to the Military Medicine Interest Group’s talk on Navy Medicine.  A DNP (doctor of nursing practice) told us a little of his experiences in the Navy and in Iraq, and showed up some pictures about the medical set-up and such they had there.  But what really stuck with me was what he closed the talk with, which I’ve put as the title of this post: “Someday, one of your patients might be me.  So study hard!”

I think as a medical student, you do sometimes lose sight of the bigger picture a little bit while you are trying to learn what you need to medically relating to whatever service you’re on, and meanwhile also navigate the hierarchical structure without overstepping your boundaries (since different attendings and residents have different levels of interest in teaching/interacting with med students, and in some services, you have a lot more turnover in who you’re interacting with than others.  For example, on Emergency Medicine, it’s almost a new resident and/or attending every single shift.)  It’s not really that one doesn’t think about the patients themselves, but I think partly because we aren’t allowed to do a lot of the aspects of actually doing anything for the patient directly (putting in orders for medications, consults, etc, or even writing notes on some services), sometimes one can feel somewhat impotent and not very useful, either to the patients or the residents/attendings for whom one is supposed to be helping on a team.

I think that’s the biggest issue I’m having right now in EM actually, which is that since we’re often not allowed to do much, depending on who we’re working with that day, and particularly when all the rooms are already full by the beginning of the shift with work-ups mostly done and just waiting for a room, I’ve felt like I’ve done the least out of any service I’ve been on so far.  The residents are nice and say that me seeing a patient and giving a quick H+P actually is useful, but sometimes it’s hard to see whether I’m making any difference in that situation (though I have definitely helped push to get some psych patients admitted for suicide ideation and other issues when they seem they might have otherwise been written off… and in part that’s because our hospital seems constantly overflowing with people with psych needs – something I could write a whole entire post about in itself).  Suffice to say that it’s sometimes difficult to be motivated to even learn more when one feels like they aren’t really able to contribute.  But the quote from the end of today’s talk was a good reminder.  We’re training to be doctors who will be the ones actually responsible for people’s lives someday.   And as a physician, people will look to us for answers, and we’ll be the ones making the important decisions for their healthcare and ability to live good quality lives.  So it’s important to forge ahead, study hard, and learn as much as we can, so that when we are someday on our own, we will know enough to take good care of our patients.

Also, my apologies for the sporadic updates – most of the rest of my surgical rotation (through mid-October) basically left me so exhausted by the time I’d get back that I’d literally get back to my place, get in a quick shower, and decide to get in a “quick nap”… and then end up waking up sometime around 10pm-12am being very disoriented, decide whether or not I’m hungry enough to get something to eat, and then plopping right back to sleep.  So I pretty much actually did not start studying for the surgery shelf exam until literally 2 weeks before the test.  Thank goodness I had medicine before surgery because otherwise I probably really would have failed that.  (They say the surgery shelf is mostly medicine and not surgery.  They are absolutely correct.  In fact, even though they say there’s a lot of trauma and GI on the test, there was basically almost nothing relating to almost anything I saw on either of my three services I rotated on surgery, which included trauma surgery, orthopedics trauma, and acute care surgery (mostly appendix issues, gallbladder issues, or small bowel obstruction).  Sigh.)  I did, however, do a little more digging to understand the shelf scoring system because I also really felt like I failed this shelf if we were going by raw score standards too, but still somehow managed to pass.  So apparently the shelf score is actually not a raw score, but based on how students have done on the test in the past.  Here are some of the NBME’s answers about shelf scoring from the AAMC in 2013.  Additionally, here’s an explanation by benwhite, who is a physician in Texas according to his website, which I found helpful.  Luckily, I don’t have a shelf to study for during this current elective, so it’ll be a good time to catch up on all those USMLE medicine questions I never got around to!  (And to also finally get my eyes examined… I developed some strange eye infection during my first week or so of surgery, and it’s continued to reoccur throughout the last 2-3 months, even after stopping use of my hard contacts.  Finally got a time scheduled with an ophthalmologist today for Thursday, so hopefully we can finally get to the bottom of it!  This is the one time I hope my symptoms will still persist until then instead of being in one of its minor remission stages so they can figure it out, haha.)  Wish me luck!

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August 24, 2017

Be curious, and listen to their stories

I think if there’s anything that I’ve learned so far in the wards, it’s that you really never know what someone has been through unless you ask.

Case in point: Today, I found out that one of my attendings not only used to be a competitive football player (which I’d found out a couple days ago when I first met him… before I knew he was an attending by the way…), but had also served (and still is serving) as a surgeon in the Air Force for 16 years in Special Operations.  If I remember correctly, apparently, the former makes him one of only about 80 surgeons serving about 350,000 soldiers in the Air Force, while the latter category puts him in a group of even fewer surgeons, who actually travel with the soldiers and do emergency surgeries wherever they are in the field (as opposed to serving in a military base).  He also did his residency at a military hospital where there were no surgical specialty residents, which meant that there were no ENT, orthopedics, neurosurgery, etc residents, so they had to basically learn how to do every single type of surgery, which is awesome (I really really wish we had more of those programs!).  He has been deployed multiple times overseas, and he shared some of what it was like to work in those conditions.  What they had to work with was whatever they could carry on their backs, and he showed me some pictures of what he did in the field with the limited equipment they had (including craniotomies, which is basically cutting open the skull to release pressure!).  We also talked about how there (and even now sometimes), if someone’s about to die, sterilization is not of concern.  They just go at it with whatever they have in the quickest way possible, and sometimes even use things in succession from one patient to the next in times of crises.  It’s kind of shocking to hear/think about now, in our world of antiseptic cleanliness, to not even use a flame to sterilize instruments before use.  But it totally makes sense too, in that context.  “Sure, they might get an infection later, but we’re saving life and limbs out there!  They might get an infection, but at least they’re alive.”  Good point.

In my mind, the term “doctor” has always evoked two images – that of a family/local physician, who treats everyone and everything, and thus essentially is the best primary care/internist there is… or that of a surgeon on the battlefield, with the wounded all around, desperately fighting to save lives.  The latter is what he has lived through, which is amazing.  And he loves it.  I did have to ask, as this is something I have often wondered/felt it would keep haunting me if I attempted to go that route – “How do you deal with having people die in your hands?  Do you ever worry that something you did caused the death of the patient, or caused them even more misery before they die anyway?”  His answer was practical in its simplicity: “Well, if they die, they were going to die anyway.  Or they’ve already died, and we’re trying to resuscitate them.  You can’t do anything worse to them than what is already happening, which is death.”  Well, guess I can’t really argue against that one.

All of this I never would have known if I’d just assumed he was like any other resident/attending when I met him.  Granted, he’s a pretty big/strong guy, and has multiple tattoos, which I guess isn’t the most stereotypical picture of a surgeon, but still.

There are many other cases like that too, but with patients.  While I was at the VA last month for the 2nd half of my IM rotation, I learned about one man’s time in the Navy, where he spent 10 years at sea and lost two wives in the process (he was supposed to spend 4 years at sea and 4 on shore, but he got the short end of the stick and somehow was never given shore duty), and also got cancer, which they think may be secondary to his being on Christmas Island during the atomic bomb testing.  He said they’d been ordered to literally run under the cloud that formed after detonation for as long as they could, which is a pretty crazy breach of human ethics I would think.  But anyway, he also humorously recounted his first trip to Fiji, where 19 year old him was pretty shocked at the sight of the women at the time, who had rushed up to the boats in their native dress, which was topless.

Another veteran told me about how he was fully deaf in one ear and only had 30% hearing left in his other because they blew a cannon right over his head, and that his team of ~32 was able to rescue a whole platoon of about 85 people out alive during the Korean war without losing a single person… but when he got back, the US government lost his record, so he never got any recognition for it.  His story was pretty crazy too – he then ended up smoking and drinking for 42 years, “drunk for the last 14 years”, due to depression from all that happened during his 8 years of service in Korea. Then he had a seizure due to drinking too much on the day before he planned to suicide (by dynamite in a mine shaft, no less) but he says God found him, and he quit both cold turkey and hasn’t been tempted to try again since.  Amazing.  He was also the one who told me “I’m glad it’s you” when I was about to leave after taking his H&P (history and physical exam), and when I stopped and looked at him questioningly, he elaborated with “you’re very thorough, and you seem to really know what you’re doing.”  While I certainly don’t think was an accurate statement for me haha, it was still a very nice sentiment, which I thanked him for.  I ended up having the day off the next day, which is when he got discharged, so I never did get to see him again after rounds or to say bye.  But I hope he healed up and that he continues to do well.

There was another vet, who everyone kept saying was “just crazy/psychotic” because he would talk a lot and seemed fixated on certain ideas.  I went to talk with him, and it does seem like he has anxiety and probably OCD, but I also learned that his PTSD came because he had served in Russia back in the day, when they were on a secret mission I think.  He had been riding around the perimeter with the captain to hear the scout reports, and were on the way back when they found the troops burning in their tents.  He and the Captain rushed in and attempted to save them, but they couldn’t save a single one.  He still remembers it vividly, and feels great guilt over it, but it seems like he hasn’t really told anyone else about it.  I suggested that he find someone to talk to about his experiences to help him through that and his anger issues with his mother, who he clearly loves very much, but gets frustrated by because she no longer treats him like her trusted, beloved son after he blacked out from drinking too much 13 years ago (likely due to his unresolved PTSD and other issues) and never listens to him anymore.  He says he cries after he yells at her and she leaves, and was almost in tears while telling me, but he says he can’t help getting frustrated when they talk regardless.

So many people I think really just need people in their lives to just listen.  No degree is even necessary for that.  Just listening to someone and not judging them can help so much I feel.  But unfortunately in this world, so few people truly have time for that.  Which, I guess, is one of the few blessings, and privileges, we can give/get to our patients as medical students.  The gift of time, as well as an ear to hear, and perhaps even a shoulder to lean/cry on.  Which brings me to my last example – a patient who wasn’t even mine to take care of, but was on our team’s service.

This was a man almost my own age who had been brought in for an overdose on cocaine and probably methamphetamine.  He had been found on the street, yelling at a policeman, and was brought in.  He had multiple lacerations on his arms, and when he had first come in the previous afternoon, the upper level resident I was working with had said “don’t bother” seeing him, I think perhaps because she felt it was a simple case to manage medically and I wouldn’t really learn anything.  However, on rounds the next morning, after some questioning by our attending (during which I found out he’d also apparently re-activated his Hep C), he muttered a few things that I found troubling – that it happened because he “was around people he shouldn’t be around,” that he didn’t want to get treated for Hep C because he had no money since his fiduciary wasn’t giving him his payments so “it’s ok, I’ll just clear it on my own, like last time,” he knew he “shouldn’t be doing this, because every time it happens, I just end up shooting up and having a lot of sex…” and when we then questioned him then how he got the money for the drugs, he said something that sounded like “well, I kinda just you know, sell myself I guess.”  The picture I was getting from this hurt my heart, and so when I found out he was going to get transferred that afternoon to a different service, I made it a point to visit him to try to get to know him a bit more before I had to go to class, hoping I could maybe help him somehow.  At first, he was very reluctant to talk, but when I mentioned his potential transfer and how I might not see him again, I think he realized I cared and at least stopped acting like he wanted me to go away.  I didn’t get all that more out of him, but I did find out that he served in Iraq, and I think he had a very hard time and hasn’t been able to talk to anyone about it.  When asked why he did the drugs, he said “I just don’t want to be me.”  When asked what he meant by that, he just shrugged defeatedly and responded “I don’t know. I just.. hate myself. I don’t want to be me. That’s all.”  I also asked why he was moving states to begin with, as I’d noticed that in his notes, and he said “I was trying to get away from people I shouldn’t be around.  But I’m starting to realize it doesn’t matter, because you can find them anywhere.”  I also tried to advise him to find someone to speak to about all of this, even if it was hard at first, because everything he’s going through is not something that someone can carry alone, and his current trajectory was not good, and he knew it too.

Through this, it was so painfully clear that he wasn’t a drug addict and engaging in these behaviors for the fun of it or even maybe for the physiological high.  He obviously wanted to stop but didn’t know how… because the whole reason he fell into it in the first place was because he was depressed and trying to numb his pain (in fact, his file has a “suicide risk” warning flag that pops up when you open it), and he couldn’t see any way out of his darkness.  I could say a lot here about my now much stronger feelings regarding drug dealers who prey on this type of person, but that’s a rant for another time.  Overall, I just thought his whole story was heartbreaking, and I actually ended up almost breaking down in that room after I said some encouraging words to him that I could tell almost made him cry, and then when I got upstairs to our team room (which was thankfully empty), I just let it all out.  Here was a life that still had so much potential, and yet he was stuck in this dark place all alone, and even we, who are supposed to be health providers, are not able to do what needs to be done to help him, because of the way the system is set up.  He was just going to get discharged after he cleared the drugs, but if there’s no one to talk with him and follow up with him, he’s just going to end up the same way and end up back in the hospital and the cycle will continue, or worse, one day he might overdose and die.  I sincerely hope that is not the case, and that hopefully my words, or someone’s words, will have a good impact and change his life around – perhaps that he will find God as well, like the second vet I mentioned, and be able to see that his life does have worth, meaning, and life.  But regardless, my heart breaks for him and where he is right now, and for everyone who is in a similar situation.  And for all of our vets, who go through so much for our sake’s.

The sense I get from healthcare providers about the VA is often frustration with the system, jadedness about both caregivers and patients, and a kind of resignation, that the patients are all “a certain type.”  And yes, that’s generally true – there is a lot of substance use/abuse in this population, which leads to many of them having heart, lung, and/or kidney issues, and many of course have PTSD or other psychological issues (and amputations).  But really, who can blame them, given what they’ve been through and how (some of them) have been treated when they come back?  It’s a very isolating experience, and for the most part, we as a society are not well-trained in helping people through that.   So don’t be that healthcare person who just writes off a patient because of their addiction or psych issues.  Be the one who listens – the one who learns about the hidden stories.  Everyone has struggles and life experiences that you would never know if you just judge who they seem to be today.  Be curious.  Ask questions.  Spend time.  And just listen, with an open, non-judgmental, and loving heart.  You just might learn something – and in return, you just might end up giving a greater gift of healing to these people than any of the medicines and procedures we’re taught about can reach.

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In completely unrelated news, I also found out my Shelf exam score today for my last rotation and… I passed!  I didn’t get high enough to get honors, but honestly, that test was so unexpected and random in the questions asked (very few on cardio, pulm, and renal, and a lot more than expected on trauma, skin, heme/immunology/inflammation and other random facts) that it was the first test I walked out of actually concerned I might have failed, so I’m thankful that I made it :).

August 3, 2017

Ear irrigation and Dix-Hallpike Maneuver and Updates

Today was an interesting day!  Surprisingly mostly because of clinic rather than what’s been going on in the in-patient setting.   So much a bit of background – I’ve switched over to the VA for the month on a different team, and we go to clinic once a week as well to experience what things are like at the outpatient setting.  The first time last week was a little hectic – my preceptor had just come back from a week of vacation and had a lot of catching up to do, so it was a bit of a whirlwind.

Today at clinic though, I actually felt like I was able to participate in the healthcare a bit, which was nice – I am starting to realize I would like to be able to do procedures/work with my hands at least a little with the patients.  Currently in the in-patient setting, I feel like my role has mostly just been talking to people (either patients, other team members, or making phone calls) and looking things up on the internet, but it’s mostly theoretical/medical management, and not as much hands-on.  But today during a routine check-up at the clinic, I got to help out with an ear irrigation due to earwax plugging up of ears leading to decreased hearing (and the patient was actually more comfortable when I did it I think), which was something I’d always heard about but never saw in real life.  Basically, she added drops into one ear (5-10) to soften the wax, then plugged it up with cotton and turned the head over to repeat on the other side.  Then they prepared a spray bottle with lukewarm water, attaching a small, flexible tubing to the end, and then removed the cotton, put the tubing into the ear, and gently spray into the ear until the earwax/dissolved debris runs out (don’t forget to put towels below and use a container to catch the water!).  Also don’t spray too hard, or it’ll 1) be painful for the patient and 2) it’ll spray all over you when it comes back out!

I also finally got to see how to do the Dix-Hallpike maneuver in person!  The latter was pretty exciting to me (even though the move actually turned out to be quite simple) because I’d had a patient with unexplained vertigo last month at the hospital that I thought might have BPPV, but since I didn’t know how to do it and no one on my team had done it before either, I wasn’t sure if I should try it, especially since she was so dizzy at baseline.  But now I know!  Essentially the person sits on the bed, turns their torso to a 45 degree angle, and they are supported down to the bed straight down in that manner (without turning their torso back to a supine position), to see whether they get dizzy.  As an aside, I did end up trying the Epley maneuver on that previous patient to try to improve her symptoms, but it was hard to tell which side was worse for her, and I don’t think it did anything much but make her more dizzy… :\  The one thing that did seem to help though, was talking to her and listening to her – she’d had a lot of really sad things happen to her children/family over the last few months, including deaths, stroke, diagnoses of cancer etc, and so talking with her and praying with her on the last day of her stay I think did much better than anything else we’d done for her during her stay.  I’m grateful I had that opportunity.  May God watch over and comfort that family.

June 30, 2017

Week 1 of clerkships, and a little bit about the dissertation submission process

Today marks the end of my 1st week back to medical school, as a 3rd year student on the wards.  (Is it more grammatically correct to say “in the wards” or “on the wards”?  Hmm…) It’s been a pretty crazy ride so far, and I have to say, post-call day was pretty brutal.

So just to walk you through my week, I’ve basically been waking up around 6am this week to make it in on time at 7am (and I’m fortunate that my commute is about a <10 min walk) to be able to look up what happened to my patient overnight, check in with them, and get my thoughts organized before we round at 9am.  Generally I’ve been staying until around 4:30-5pm, sometimes just to go over my notes for the day.  On call day (Wednesday this week – it happens every 5 days), I got in at around the same time, but stayed until ~9pm, and post-call day, I had to wake up at ~4am to get in at 5am to prep for rounding at 7am to go over the patients the night shift team needed to pass over to us.  I still got out around 4:30pm that day.  So as you can imagine, that’s been pretty rough.

After I get back, I’ve been working on revising and sending out our manuscript the first couple nights to a new journal, and then yesterday I got an e-mail about minor edits for my dissertation, so I spent a couple hours fixing that on post-call night (after first taking a nap for a couple of hours), and finally got the final acceptance for that this morning.  Whoo hoo!  That also means I haven’t had any time to study/catch-up yet though, so I’ve been doing pretty poorly in terms of answering questions from the attending/residents.  It’s to the point where our attending didn’t even bother asking me questions when he went over antibiotics with us this afternoon, which is pretty much when you know you’re in bad shape. Sigh.

Anyway, also just wanted to give a brief overview of the dissertation submission process, (at least at our school) since I haven’t had a chance to yet, and did just happen to finish that today.  Basically, ~2 weeks before the PhD defense, you’re supposed to submit your dissertation to all of your committee members.  They review the file, and depending on the department, they’ll either give you feedback before your defense, or after.  My department does that after for some reason, so I didn’t see any edits until after my defense.  Then, you have 10 business days (aka 2 weeks) to make all the edits your committee requires, which can be either minor or extensive, depending.  Mine were pretty minor for the most part, luckily, but since I’m somewhat of a perfectionist, I also went back and fixed wording, added citations, fixed figures, etc.  That last one took an extremely long time to figure out because Microsoft Word for some reason was not converting pictures right, so I tried asking for help, and that person didn’t get back to me until the day before it was due (and actually they made one thing worse and didn’t fix any of the issues at all), so it was quite a bit of a panic there at the end.  Extremely fortunately for me, I was supposed to meet up with a computer engineer friend for lunch that last day, and he finally figured out the rather crude, but effective, method of print-screening the figures really large on a big monitor and copy-pasting into Word.  So there’s a tip for you, if you ever have issues with importing images into Word!

Anyway, after finally submitting it, then we wait until the graduate school looks over it and sends an e-mail with any formatting or other issues that need to be fixed.  I got that e-mail yesterday, made my revisions (and went through everything again with a fine-toothed comb to check for (many) spacing errors and typos), sent it in, and got the e-mail back this morning saying it was officially accepted.  Apparently sometimes that last step can go back and forth for a bit – another MSTP who went back a rotation before me and is now on the same rotation as me said it took him a couple weeks of going back and forth with the graduate school before it got accepted, but I think he also didn’t realize that some of his changes threw off other formatting, so maybe that’s why it took longer.  But anyway, there you have it!  That’s the dissertation submission process in a nutshell.   And it’s past my bedtime nowadays, so goodnight!

June 26, 2017

First Day Back to Clinics

Filed under: Med School and the MSTP,MS-3 — sanguinemare @ 7:07 pm
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Thoughts and impressions about my first day starting back as an MS-3 student on the wards (on Internal Medicine):

Orientation:

Orientation was pretty chill, but unfortunately less informative than I would have liked, in regards to say… what my actual schedule was going to be like (which, if nothing else, I was hoping we’d at least get some sort of understandable schedule.  Someone even had to ask what call/post-call meant, because there was no explanation of the hours or caps or anything in the actual orientation.  FYI, I’m still not actually sure what it entails, but from what my MSTP friend told me yesterday at retreat and somewhat from orientation today, I gather that there’s something called a “short call”, which goes from ~7am-12pm, with a cap of 4 new patients.  “Long call”, means 12pm – 8pm or so (which is when night shift gets there), with a cap of 8 new patients (and takes over if the short call team caps).  Except here’s where I get a little confused, since my interns mentioned that on our call day, we also start rounding at 7am, which also means we need to get there around 5am.  So, not really sure on that… and then “post-call” is apparently the day after long call, where we also have to be in to present by 7am.  So basically post-call days are probably going to be the worst in terms of sleep deprivation and such (but even then, as med students, we don’t have it nearly as bad as the interns).

The other 3rd years on this rotation seem pretty chill though, which is nice.  Also got to see an old acquaintance who used to be a year above me, went to Harvard for his PhD, then came back to 3rd year here, so that was nostalgic.  Apparently he’s been back since January.

The team:

We have a pretty full team – 1 PGY-3 (3rd year resident), 2 PGY-1’s (interns), 1 4th year, and 2 3rd years.  It’s good I guess so the work is split more, but it also means so that we are down 1 computer in our team room, which worked out ok today because I still didn’t have computer access yet, but will be kind of a problem later.  I ended up having to grab a “COW” (computer on wheels) after I was finally able to get access to the online system this afternoon, and that was a bit tricky to use because it was kind of cumbersome/blocked a large part of the room, happened to have a broken lever so wasn’t height-adjustable, and just wasn’t great to have to use overall.  Actually now that I think about it, I’m probably going to have to use another one tomorrow, since it sounds like everyone else is planning to get there super early, and I’m only planning to get in around 7am (one of the interns said we just needed to be ready by 8am, but it sounds like the 4th year wants to be in IM so is going to get there really early, and the other 3rd year also seems like he’s going to wake up early), so the computers will likely be all taken up by the time I get there. Ah well.

In terms of the people, our group seems pretty nice and friendly.  It’s apparently almost everyone’s first time though, which makes for an interesting dynamic.  This is the interns’ first rotation, the first AI for the 4th year, obviously the first rotation for me, and the upper level resident’s first time on this service.  The only one whose first time it isn’t is my co-3rd year, and it’s only his 2nd rotation.  So far though, other than the interns and 4th year all looking extremely tired (which is actually rather concerning…) everyone seems pretty friendly.  It’s also kind of interesting because our upper level is actually someone from my class haha.  So that was fun.  (And thankfully he’s super nice and really wants to teach people, so I’m glad it was him).  Our attending seems pretty laid back as well, but we’ll see.  He actually invited us to his place for a party on Saturday this morning haha!

My mental status after today:

Wow.  I am so lost, and know absolutely nothing.  We saw a patient with bullae and the only thing I could think of was “epidermolysis bullosa,” but when the attending asked us the most likely cause, I had no idea.  The other med student didn’t skip a beat, and said “antibodies”, and I had no idea what he even meant.  (And now that I’ve looked up EB, which is apparently usually genetically based, I’m pretty sure that wasn’t even correct…)  And what with all my access being limited and everything else, I was essentially completely useless on the team today.  I have a LOT to learn.  Which is why I need to buy the UWorld Qbank tonight and start doing some questions right away haha.  It’s going to be tough to get back up to speed in such a short time, but I’m going to do my best.  I also need to submit our manuscript which got rejected over the weekend to another journal, and still need to re-draft another manuscript and edit some other files, as well as read up on my patient tonight.  Yikes.  Now I know why everyone says 3rd year is really tough (aside from intern year).  There’s really no time to waste on any unnecessary things.  Well, I guess it just means it’s time for me to finally learn to be efficient with my time!  Wish me luck!

August 31, 2016

Publishing and Reviews

Oh man, I can’t believe it’s been almost an entire YEAR since I last published here!  I’m so sorry… there’s been a lot going on, and also I’m fairly certain I’ve been actually depressed for the last year or so and only very recently started perking up a bit (like literally a couple weeks ago) so that’s probably part of the reason… PhD life and its ups and (mostly, at least in my case) downs, an unexpected and lengthy authorship battle… etc etc… so it was hard to find anything positive to write about, and/or to summon enough energy/brainpower to write about anything at length in general.  But that’s fodder for another post.

Today what I’m going to write about (briefly) is publishing!  Yay, publishing… the currency and lifeblood of the academic.  In case you weren’t aware, basically what, where, and how much you publish is an important factor for your career, mainly because all the people/agencies with money (institutions looking to hire you, government/other organizations looking to award grants) use it as a kind of surrogate measure of your scientific worth when evaluating whether or not to hire you/give you money.  In a way, it’s like judging you based on your contribution to society’s advancement, which I guess is fair, especially if you’re using, say, government funds to help your research. Where it gets a little tricky however, is when you get into the question of where the articles are being published, and whether quantity > quality, and that’s different for everyone.  There’s a whole discussion to be had about the Impact Factor of journals (which itself has some controversy based on how it is determined), but that might have to wait for another time.  In terms of quantity vs quality, from what I gather, I think (a very big emphasis on “think”) the general consensus is that quality is of course important, but publishing regularly (at least every year or so, even if it’s only a review paper) is highly desired because it shows consistency. Which is bad news for someone like me, who hasn’t even had a single (first author) publication yet, and it’s already my 4th/last year in the program (hopefully anyway), heh.

At any rate, after you submit your paper for publication, assuming it isn’t rejected outright, it goes to a couple reviewers.  These are usually other scientists, usually in a related field of study, but sometimes not.  They review the paper and help the editors of the journals determine whether the paper is ready to be either 1) accepted as is, 2) accepted with revisions, or 3) rejected.  The first two options are obviously preferred 😛 but if it needs to be revised, the manuscript authors need to address all the reviews (either by doing more experiments or rebutting with explanations why they don’t need to), and resubmit.  This process I hear can take anywhere up to a few weeks to a few months!  I just submitted my first PhD-related paper a couple weeks ago, so will try to update on how that process goes after I hear back.  It is currently in the “under review” status (so at least that means it wasn’t rejected outright, hopefully!)

Anyway, what actually prompted this post was that I got an e-mail from the director of the pre-doctoral training fellowship I’m currently on as a follow-up to a discussion we had about hosting a seminar for all the trainees to learn how to review a paper (something we will all be called to do as scientists in the future).  It was quite an amusing article on how to review papers by Greg Gibson, who apparently was a section editor for PLoS Genetics for 10 years, which exemplifies the type of feedback that was often receive from these things… and really, now that I think about it, it must be pretty difficult to have to constantly make executive decisions as an editor as to whose review gets the most weight if they are this scattered, haha!  But anyway, just wanted to re-post that all here for you guys in case you’re curious how these things work.

Until next time!  (Which will hopefully be less than a year from now! ^.^||)

October 8, 2015

Antibacterial Soap is not Better than Regular Soap… and learning from death

So, fun fact of the day: according to our MSTP seminar speaker tonight, apparently the FDA agrees that “antibacterial” soap is not any more effective at preventing disease transmission than regular soap, assuming both are used to wash hands properly!  Did not know that.  And to back that up, here’s an article straight off the FDA site that speaks about that, from 2013.

He also described a painful experience he had had as a clinician, where he did a procedure on a patient, and that patient ended up dying, even though he had done everything technically right.  This, in itself, was one of his lessons – that you can be technically right, but mess up intellectually.  Because, as it turns out, after that, they did a retrospective study, and apparently that patient was at high risk for bleeding out after that procedure, as they’d had a bone marrow transplant before that.  That wasn’t known at the time, but it cost that patient their life.  There are two lessons I learned from this:

The first, which is rather scary and sobering, is that as a doctor, we’re all going to make mistakes at some point.  Mistakes that may even cost people their lives.  And some of them, like the case here, won’t really be our “fault”, in the sense that it wasn’t anything that could be prevented at the time due to lack of knowledge, but in hindsight, for whatever reason – new research coming out, a new technique our clinic/hospital was not aware of, etc… we’ll realize that our decision at that point in time was what directly or indirectly, caused harm to the patient.  To be quite honest, that scares me quite a lot.  I don’t know if I can handle that. I think that would tear me apart from the inside.  And yet… if no one makes those decisions… even more people may come to harm.  It’s a tough job.  I guess time will tell.  I just pray that over the course of my career, I will be fortunate enough not to do anything so bad that it costs a life or cripples someone the rest of their time on earth.

The 2nd is that even in one’s darkest moments/worst mistakes, something good can come of it.  In this case, research that probably has saved at least a few lives since.  He recognized that maybe there was something about this patient that made them susceptible to the procedure, even though he did nothing wrong, and they went back and looked at records and realized this predisposition, and published a paper on it.  So now, anyone encountering this type of patient before this procedure will know that it is a high risk thing to do in these people, so they may be much more cautious about ordering that test to be done.  So even when making mistakes, analyzing it and building off of it may lead to research that helps others in the future.  And I guess that’s how we have to look at it, in order to keep moving forward, lest we crumble from the guilt and sadness of those we were unable to help.

July 20, 2015

This about sums up how I feel about research right now

Filed under: Med School and the MSTP — sanguinemare @ 11:04 am

Other than the sentient animals panel, since I’ve made it a point not to work with animals, pretty much all of these are spot on.

June 18, 2015

Learning Communities, Lead Mentors Interviews, and Moving Forward

I am actually pretty excited about the changes happening in our medical school regarding Learning Communities and just the overall culture here.  Learning Communities (LC) are in some ways the med school equivalent of Harry Potter Houses, in a sense – every class upon entering the school gets divided into one of these communities, and then stay with that community for the rest of their time here.

Having been here for starting on 5 years now, with LC’s having started 2 years prior to my entrance to the school, I’ve been able to see it evolve from something that people didn’t care much for and that was seen as just a small social thing, to one that finally, seem to be something people enjoy and that reps are proud to be reps for.  The first years this year in particular seem to really like the system and feel more connected to faculty and each other.  We are also finally going to have funded positions for lead mentors this year!  It’s actually a really big step for us, because not having the resources was one major reason we believe it was hard for mentors to come to events (since they didn’t have protected time) and for students to be regularly engaged with their mentors.  So as part of the LC executive board members at our school, I’ve been helping to sit in on some of the Lead Mentor interviews.  And I have to say, I’m pretty freaking excited about a lot of the ones I’ve seen so far.  They seem very motivated and eager to help students in learning to deal with the realities of a physician lifestyle, including all the hard conversations, life events, and other things that students might have to go through during medical school and beyond.  They’re also often good listeners and very open in sharing their own experiences, which I think will be invaluable for students to hear as they’re going through med school.

One example was a professor who talked about how difficult it was for him to transition into the clinical years after so many years of schooling through college and the first two years of doing very well on tests.  Another today shared about the experience of seeing a fellow medical student pass away right in front of him during a party after a med school test – that student was apparently sitting at the bar when his eyes rolled up and he fell over backwards, never to wake again.  And then they all had to start the next module the very next day.  How do you cope?  Or another experience of a friend whose father had pancreatic cancer and was dying, but that friend saying things like “I hope he doesn’t pass away this week, because we have a final at the end of the week”… which reminded me of one of my own anatomy lab groupmates, whose father passed away during medical school, and he was gone for a while.  We never really got a chance to talk or mourn with him about it, besides checking if he was doing ok a few weeks later when he reappeared in lab.  Or the father of a family friend of one of my growth group members, who she would always ask us to pray for along with her friend, the daughter, who was stressed out because she had a test on top of her dad’s health situation.  It was always a weird dynamic to me, that she would ask us to pray for her friend’s stress because of the test rather than the health of her dad being a main concern, but I guess part of that was this underlying message some people take from med school that grades are everything.  And they’re not, or at least, they shouldn’t be.  Learning the material and understanding how to better take care of a patient should be the main thing, not getting a certain score on a test.

Anyway, I digress.

My main point is I’m really glad that it sounds like we have so many attendings and faculty at our school willing, and really desiring, to get to know the students better, and to guide them through medical school with wisdom gleaned from experience, and to foster a healthier viewpoint of medical school as a whole.  I’m also glad we have a fairly diverse population in such a small group of people in terms of age, sex, race, experience, and specialty (the Emergency Department in particular has been outstanding in presenting applicants, and major props to their Department Chair for signing off on so many of their staff to encourage participation in this!)  Really looking forward to seeing how LC’s grow in the next few years with such dedicated mentors, and how the school’s culture as a whole… or dare I hope, the culture of medicine in general… will change.  I know it’s already starting with all the emphasis on holistic admissions and patient-centered care, but with this new rise in awareness of health and wellness in the physicians and those training-to-be, I am hopeful that we will train up a generation of doctors who are more compassionate, in addition to knowledgeable, than some of their current counterparts, and that they can become proper role models to the patients that they work with in terms of both health and happiness.

March 17, 2015

Match Week

Filed under: Med School and the MSTP — sanguinemare @ 3:44 pm
Tags: , , , ,

My classmates with whom I entered medical school with are graduating this year.  Match Day is coming up at the end of the week, and it’s a highly charged atmosphere.  Yesterday was apparently when people found out whether they matched or not period, and my Facebook newsfeed was blown up with a ton of posts, both from med school friends here and around the country, about how happy and excited people were to have matched (though they won’t find out where they will end up until the Match Day Ceremony on Friday).  Lots of congratulatory statements and likes were passed around on Facebook – so much that a couple people posted in our private class page with memes to the effect haha.  It’s kind of a surreal feeling – that we’ve all been here for four years already, and that people who I still think of as classmates have gone through so much training already and are going to be official doctors soon.  To them, as well as to those who are unfortunate enough to be in SOAP (where one ends up in the week-long, stressful process of desperately trying to find a place to do residency at on of the remaining spots after finding out they did not match on Monday), I wish the best of luck.

In case you’d like to know a bit more about The Match, which is arguably the most important day of a medical student (even more-so than graduation day), here is one article that explains the gist of the process and how it’s become so much more competitive over the years, and if you’re interested, here’s another rather angry article about how The Match is not the best way to get into residency, from a graduating medical student last year, presumably after her own match.  It is true that the cost burden of the current system is quite high for seniors – at a recent talk, people mentioned how the average one spends on applications and the residency trail may be somewhere around $11,000, if I remember the number correctly, which is kind of on the ridiculous side.

In a way, it’s interesting that the concept of the Match is made such a big deal of over here, because that is standard practice in Asian countries (or at least for sure in Taiwan and I think China as well) all throughout every major school transition (elementary to middle school, middle school to high school, high school to college, etc), but in America, where one’s individual choices leads to the promised land, I guess this is one of the few times one feels so very out of control of one’s life and future. I understand that feeling, especially when studying for Step 1 (and in the aftermath), when it finally hit me that one test score could determine my entire future career in a way that is not really readily alterable.  It’s a scary thought.

So in light of all of that, my sincere congratulations to all of my classmates and the graduating class of 2015 that have matched!  I’m glad you will be able to become the kind of doctor that you aspire to be. 🙂

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