MKSAP

So MKSAP 17 has taken over my life for the last two months. In the end, I got through reading all the MKSAP 17 books and just finished all the print questions (about 6 months after Dr. Russell told us to be done). So 1200 questions done, and over a 1000 more in digital form. It's been a total grind, but I feel like I'm getting close. I just need to finish these last two weeks strong and I know I'll be ready. Considering how little effort I put into my in-service exam (showed up pissed on my day off, took it with the utmost speed, left at noon) and still managed a "board passing" score, I think I'll be alright. Then again, my new job sort of depends on me passing, so I shouldn't be too cocky.

I'm also trying to figure out how I stack up with my practice questions score in terms of the real thing. I've been told that 60-65% on MKSAP questions should be enough to comfortably pass the real thing. I'm at that point now and I'm starting to feel ready. And since I'm a stats geek, here is my breakdown:

	A	B	C	D
1	SUBJECT	TOTAL	WRONG	PERCENTAGE
2	GI/Hepatology	96	23	0.7604166667
3	Rheum	96	35	0.6354166667
4	Cardiovasc	120	29	0.7583333333
5	Neuro	96	35	0.6354166667
6	Heme	78	28	0.641025641
7	Onc	71	28	0.6056338028
8	Gen Med	168	49	0.7083333333
9	Pulm/CC	103	22	0.786407767
10	Derm	72	18	0.75
11	Nephro	108	23	0.787037037
12	ID	108	45	0.5833333333
13	Endo	84	32	0.619047619
14
15	TOTAL	1200	367	0.6941666667

So a few thoughts:

Rheum: never did a rotation, hate all rheum related stuff
Neuro: No complaints, only did neuro ICU and not a fan
Heme/Onc: Three rotations and this is what happens!?
Gen Med: Much improved from my in-service exams, but I hate memorizing vaccination schedules
Pulm/CC: I like it, so no surprise there
Nephro: I guess I still appreciate the physiology
Endo: Even with TWO years of secondary clinic, ouch!
Derm: If it's dry, make it wet; if it's wet, make it dry.

I still have a ton of digital questions to complete, but I think I'm close to getting to where I want to be and the overall right should be enough to push me through with ease.

Three more weeks. August 25th, I'm coming for you.

Sharks Eulogy 2016

Well, this was a strange year to be a Sharks fan. Another year of Marleau and Thornton with promises that this was a "different" team and to not let the past dictate the future. With Deboer at the helm and Martin in the net, I felt like I could buy into the idea.

Round 1 against the Kings. The same team that came back from an 0-3 deficit to beat the Sharks a year prior. Sharks win the first two games on the road, what a feeling! Were they truly different? Then the Kings win game 3 and I figure it's the same old team. The Sharks come back and win again, making the series 3-1. In game 5, they go up 3-0! But then the Kings come storming back to tie it 3-3 going into the third. Somehow, the Sharks prevail and demolish their nemesis 6-3 and win the series 4-1. This was a magnificent feeling.

Round 2 against the Preds. Sharks do well against them in the past, which I try not to think about. The series is back and forth, including two brutal OT losses on the road, which are usually back breakers. But the Sharks bounce back each time and win the next one, with Martin playing better each time.

Round 3 and the Blues are next, arguably the best team in the West, having just beaten the Stars. This series is a thriller, but thE sharks dominate and finish in 6. Is this happening, are they really going to the Cup!?

The reality sets in that the Sharks, who have been playing with house money, are going to the Stanley Cup Finals! They'll be playing the Pens, who defeated the Presidents-winning Caps on the way over. The experts predict the Sharks should win based on size and desire.

So I talk to Tim and we make the leap. Game 5 in Pittsburgh, we'll be there.

The series begins. The Pens are FAST! They capitalize on the rush and really keep the Sharks pinned in all game 1, taking a 2-0 lead, but the Sharks fight back and tie it 2-2. In the end, Ponino gets a late goal and the Pens get game 1 and then game 2 in OT. The Sharks need to come back strong at home. And they do, with a great OT winner. But the Pens get game 4 and go up 3-1 in the series.

We talked about it and sell the game 5 tickets for game 7. The G5 tickets go for a profit and end up trading equally for G7. We need the Sharks to get the series back. The Sharks prevail in G5 (now I wish I were there!) and send it back to San Jose. But the Pens are too much in G6 and win the Cup.

Heartbroken.

I wanted to write down my thoughts on their their miraculous run. And even though the exceeded expectations, I feel let down they didn't win the Cup. I've seen how hard it is for teams to make it that far, and they were so close. I agree that Crosby gets away with a lot, but he got it done. And the Pens were deep enough to make it happen. Martin was absolutely unreal and I'm glad we have such a fantastic goaltender for the future. Pavs, for his amazing playoff run, couldn't get it done in the finals. I'm convinced he was hurt, just based on his skating and shooting all series, but he was also too slow to keep up with the Pens. Couture looked amazing and I'm excited to watch him continue his success. I read about his DVT and thigh hemorrhage scare; he gone through a lot and persevered. Hertl going down also didn't help, since we lost a top winger. Thornton is still a world-class passer. And Burns should have won the Norris.

I hope they'll get there again. I believe they have the right pieces in place to make a run for a year ot two more. Thornton is still dominant, but Marleau has lost a step. If Marleau can accept a 3rd line position, I think they can do a lot.

So that ends the season. Is it October yet?

The VAG bug

I had my first VAG experience with a hand-me-down from my brother in the form of a 2000 Jetta 2.0. That car lasted me through most of my med school rotations. It was underpowered and didn't exactly have the best handling, but it drove well enough and my wife liked it. After I found out that I was moving from California, I handed it off to my wife's brother. Not sure what happened, but I guess it had transmission issues after I gave it to him. So he sold it and I took the cash.

I moved to Philly and decided that I needed something AWD for the winter, but I wanted another German sedan. I searched and searched, finally finding the perfect B5 A4. It was an 1.8T, single-owner, had just been traded in the night before. I saw it posted on CL and was the first person there that morning. I picked up it and immediately found a mechanic who did the timing belt, transmission service, and various other known issues. It was a great car and I had many plans for it. I even picked up a sweet pair of 16" BBS rims for it. I was going for tasteful mods, but keep it close to stock. At 105K, it decided to throw a piston through the oil pan. So I sold it a week later for parts, swearing I'd never buy another one of these God-awful, unreliable machines again. 

A year later, I picked up another car. This time, it was a Nissan Patherfinder. It has 200K miles on it, and was a complete tank. I knew there was nothing winter could throw at me. Once again, I let my mechanic do all the preventative work on it. In the mean time, he gave me one of his All-Roads to drive while he worked on it. And then it happened again, I wanted another Audi.

So more searching on CL and finally I found another one. This time it was a B6 with 140K, single-owner, had a little neglect, but had "good bones" to build on. We both went to go see it that morning, I made an offer, and drove it home that afternoon. I drove it straight to his shop, which is where it's been for the last two weeks. I haven't driven it more than 50 miles, and the mod bug has already kicked in. And the list grows:

1. Gates performance timing belt kit
2. DDMtuning 55W 4500K HID lights
3. Centric premium rotors and Powerstop Evolution Z17 ceramic pads (front and rear)
4. Nitto NT850+ 235/45/17 tires

So I'm happy to be back, looking forward to the future. The first order of business is a tune-up. Then Stage 1 or 1+

Fatherhood

On June 21st, my life changed forever. There is not much to describe the birth of a child. It is an exciting, horrifying, and nerve-wracking experience. There are late nights, very early morning, lots of diaper changes and bottle feedings. No matter what one does in life, it is incredibly humbling. You see this being, who is entirely dependent on you, and you can't help but want to give him or her everything you have. This is the concept of unconditional love.

It was a period of huge adjustment. Thankfully, I was put on a light rotation, which allowed me to spend time at home and be available on the weekends. The highlight was being able to go back to California for Eid and spend time with family. Now with my own family, I'm starting to see my priorities. No matter how bad work can be, I know who is waiting at home, and that is all the matters.

For the time being, I'll be on my own. ICU starts tomorrow and I won't be around much. And when I am, I'll be exhausted. We figured it wouldn't be good to have two babies at home. So I'll be in Philly with the family stays in California and maintains the help they'll need for the next few weeks. I find myself missing them more and more. I also find my life to be a little boring without them here. I caught up on Game of Thrones and watched a lot of Twitch, but I found myself trying to go outside to keep from going stir-crazy.

I finally got back into playing some hockey this week. On Friday, I made it out to a roller hockey rink in the suburbs. There was a decent amount of players, but there was a lack of goalies. I also found myself really taking a step back in skating. I didn't want to hockey stop and I missed being able to use my edges. I felt slow, and was slipping on my wheels while trying to accelerate. This morning, I made it out to ice pick-up and I actually felt more comfortable. I was able to move and stop without issue. I'll guess I'll be switching to ice permanently.


I also ordered a bunch of new hockey gear, thanks to Hockey Giant and Hockey Tron. I'll be awaiting my new toys in the mail very soon, which includes a great deal on a new APX2.

Spring Time

Four months since my last post. Seems like a lot has happened in the mean time. We moved to a new apartment with a gym, doorman, and central air. Didn't know how important these luxuries were until I finally have them. It's a joy to order a ton of shit online and not have to worry about who is going to pick it up. Ordered an XBox, well worth it, not sure if I'll have time to enjoy it in the future, but it works for now.

Finished my three weeks of triage, which made me an angry person. Don't know how I'm going to do it again next year, but I'll have to fight through. I was a glorified secretary working at the pleasure of the ED and flow center. I felt powerless and had no real back-up throughout.

Weather is finally warming up, which means festival and garden time. These six months are the best in the city and with the new addition (iA), we're excited to do a lot of exploring. There is going to be a serious lack of sleep and a lot of stress, but I'm excited to take on the challenge. Making the crib was one of the "real" moments so far. I'm looking forward to more in the future.

Giving Thanks

The highlight of last month, was going back to California and enjoying a week at home. It was a rejuvenating experience, spending time with family and seeing how much my nieces and nephews have grown up. They are like little people now. Eating good food always helps in the process. Leaving a snowy and 38F afternoon in Philly to arrive to 65F and sunny California also helped the process. Another reason to get back when I'm done here.

The next question is what to do next. The options for fellowship are appealing, but need to be balanced with the pain of going through another 2-3 years of training. I go back and forth about whether this to take a hospitalist job or look for something more. I guess time will tell.

Now it is time to prepare for Winter. The weather is cooling. The heaters have been plugged in. The jackets have come out of the closet. Thankfully, the new windows have prevented the apartment from becoming an ice box like last year. At least the sticker shock of the heater bill might be a little less this year. We've also started the process of finding a new apartment, preferably with 2 bedrooms and a gym (although I'm not sure if it changes my poor gym habits). It's expensive to keep living in Center City, but it's also hard to give up the location. We might have to fork over a little extra get what we want for the next year.

I'll also look forward to the weeks of elective and vacation I have lined up for the next couple of months. I feel my seasonal affective disorder kicking in, so being outside the hospital will help with the depression. I pulled off two long ICU months; I feel like I deserve the time off. Funny how I become just as lazy as the rotation I'm on, I need to work on a little more self-motivation during this time off.

Perspective and Loss

This week, our residency found out some shocking news: a colleague took his own life.

This was sudden and sad. I had worked with the intern his first month of residency. This was my first experience as a senior resident. I was determined to take all the good qualities from my previous residents and sad all the bad ones along the way. This was my moment to be in charge and pass along all the information I had received along the way. I was excited and nervous. The first week was a whirlwind, I don't remember much. It was scary being responsible. And one of my interns was struggling. I knew how he felt and I wanted to be there as much as a could, but I was juggling my responsibilities to the students, attendings, consultants, and patients. I spent extra time talking to him to let him know that it was a steep learning curve and he'd be alright; the first six months are all about surviving. He had a tough time and he struggled, but in my head I figured it was intern jitters and he'd be okay. Eventually, he had a moment where it was too much and took some time off. I respected that, some times I felt the same.

And on Friday I found out the news. He had taken his own life.

Could I have done more? Could I have reached out after the rotation to find out how he was doing? I feel like I could have, not sure if I could have made a difference. Either way, puts a lot into perspective; we can always walk away from it if push came to shove. Sometimes, we don't know what our limit is and when we go too far, it feels like there is no way out. From what I heard, he had been getting help and was considering switching out a specialty with less day-to-day stress, but maybe it was too little too late. Hopefully, his pain is gone.

I hope his family will find some comfort in his pain being gone, but the pain continues for those who have to live with it.

Licensed!

It finally happened. Took Step 3 about three weeks ago and found out I passed. It's a nice feeling to finally be done with those exams. Now it's time to start board studying. Well, maybe a quick break beforehand is due. Doing my first week back at Abington. Pace is nice, but patients are about equally sick, but are old-sick not drug-alcohol-sick like at Hahnemann. Keeps one on their toes. Lucky that my intern happens to be self-sufficient. He is a medicine transfer after 2 years of a surgery residency. Technically, he outranks me. He also did those years at Abington, so he knows his way around the computers and the hospital.

Finally picked up a new ride. Got a 2001 Audi A4 for a steal! Had to put a little work into it, but I think it is well worth it. I can see where the German fascination comes in. Even this old, lowly car has a bite on the road. The handling is crisp and makes the driving experience much more interactive. The fun part is having a turbo and AWD at the helm. I could get used to this set up. I was lucky enough to stumble upon an awesome mechanic to take care of the car too. He's a former Audi master tech who is now doing part-time jobs while he takes care of his two sons. I almost envy him when he's under the hood working on it. So far, completed the timing belt and water pump, various PCV valves and hosing, transmission fluid. Next up is a new radiator and heater core flush. Either way, he agrees the car is in very good condition and that I really came out ahead on the price of the car, SCORE! I already bought a pair of HID lights to drop in. Next will be new speakers and a new radio head unit with bluetooth. The upgrade bug has hit hard. I'm hoping for a set of Audi rims along the way too. I'll be thinking twice about lower the car because I've seen what the East coast roads and Winter have done to various cars around here. Don't see a lot of lowered Civics surviving the Winter. I'm hoping the AWD gets me through all that junk this year.

New windows in the apartment and I can already tell the difference. The coolness stays in the apartment, which means less A/C needed. More importantly, this should also translate into more heat during the Wintertime, which is going to be huge. No more incessant heater running day and night to keep the place above 60F. We might actually be warm in the apartment this time around.

Wife is home. Not a bad day.

Being a Mentor

Today, I had my first "resident" moment. In the middle of pre-rounds, while seeing all the patients with my interns, I had one stop and break down. He told me that he had no idea what was going on and he couldn't keep it together. I understood that the patient was complicated, but he was stable and improving from our treatment. I calmly put my hand on his shoulder and explained to him that feeling overwhelmed happens to all interns and that he had nothing to worry about because we all went through it. I explained to his that I was his back-up and I'd be there to guide him and help him along the process. I felt for him because I know I've felt the same way multiple times last year even if I did not express it. He calmed down, was able to keep it together and proceeded through the day. I checked in on him repeatedly and worked our way through patients he that felt prepared to take care of them. If someone hadn't done the same for me, I would be where I am today. In that, medicine is an interesting profession. You learn an infinite amount of information, but none of it counts unless you pass it down to the people who come up behind you. Mentoring is a fundamental process of residency and I feel like I got my first taste of it.

I had a lot of people say that I was pretty calm as an intern, but I always felt that it was on the surface, and I could break down at any moment. It lead to sleepless nights and a lot of anxiety. I am thankful to think that I'm starting to get past those moments and I'm starting to work my way towards being a real physician. It's exciting to see how far I've come. I don't think I'm close to be where I need to, but I am confident to know that I'm getting better and more confident through each step of the process. My wife was right all along, she usually is.

I'm thankful that I have an attending who is a recent graduate, so he understands what it is like being in training. He is patient, educational, and cool, which is all that is needed in a good teacher. I hope to mimic those qualities in the people that I work with.

This is also a reminder that I was lucky to grow up with parents who are mentors and have infinite patience. Without their teachings, I'm not sure I could hold it together or be able to teach a struggling person at the cost of my own work to be done.

Year Two

Three weeks of vacation went by way too quickly. By the time it was over, I had no idea where the time went. I felt like I just got into California before I was packing my bags again. We had a blast and it was well worth it. We both agree that we felt young at home, borrow the family car, living in our old rooms, and generally feeling reliant. For now, our "adult" lives are here in Philly. Spending time with family, eating really well, and generally having a relaxing and awesome time made it all worth it.

One of the highlights was making it to MLG Anaheim. The dedication included leaving NorCal at 4am to make it to Anaheim for the opening at 10am. We were up 21 hours that first day. We ended up at Morton's Steakhouse for dinner and enjoyed an awesome strip steak. I met HerO and Rotterdam, which were my personal highlights. Watching Trap win the finals was also a nice little bonus. It was fun to see the players in action and walk amongst them.

So three weeks of vacation wraps up, and now the real work begins. Now I start as a senior resident, making decisions for the team, dividing the responsibilities and taking care of the patients. Seems like a lot of work and I'm not sure exactly what I'm getting into, but I'll try my best and see if I can get it all done. Dictations are extra work for this year, so we'll see how much time that adds to my day. Overall, I'm exciting and nervous for the next step (sounds like intern year all over again).

Final Stretch

I've completed my last service month as an intern. It was a very busy three weeks thanks to an incredibly lazy resident, who did little to nothing while there. In a cruel joke, I was pulled to cover the same service, only to find out that the resident was in clinic, so I covered the capped service on my own, which felt about the same. Now it's two weeks of research and get ready for vacation. I was lucky enough to have Q and family come into town last week. We showed them around Philly, tried to hit up all the major tourist attractions, and eat at our favorite place, Han Dynasty. We'll make any excuse to go.

After wrapping up this week, it'll be a week of relaxation in Cabo and then two weeks in California in a much needed vacation and family catch-up time. If everything goes as planned, M and I will be making a trip down to Anaheim for MLG for some offline Starcraft action.

The wife started her new job this week, which has her traveling 45 minutes away to Trenton. She gets her own office and a sweet new title. I think she's pretty happy, but getting stuck in traffic today might make her a little more weary about her commute. Overall, we're excited for the new transition.

The weather has warmed and people have come out of hibernation. Now I know why East Coasters push so hard to be outside when the weather is nice. You gotta take advantage when you can.

Wind Down

The final weeks of intern year are coming to a close. The reality of being a senior resident is starting to settle in. Talking to other seconds years, they common theme seems to be that the transition from intern to senior is tougher then med student to intern. I'm having a hard time fathoming this, but it just might be true. Even more responsibility, even more to know, and more people looking to you to make a decision. With the new format of 2 interns and 1 resident, that means there been less hands on and even more managerial responsibilities. Granted, it will be with fresh medical students. Those little doe-eyed youth have no idea what they are about to experience. Now there will be two. And since I'll most likely be starting on a general medicine service, I'll be in the middle of it. Help us all.

This might be my moment to vent about my incredibly lazy senior resident. This is the guy who comes in on the first day of service to let me know that I'm almost a senior resident and that I should be able to handle the service on my own. Translation: I'm really lazy and I'm probably not going to do a lot of work, but I'm going to pretend that this is a "learning" experience of the intern. And he has lived up to his reputation. He will only write the notes demanded of him by law. He presents none of the patients, so in the end, I still have to look up all the information so I know what's going on. He takes off for hours at a time. He makes "suggestions", expecting me to put in the orders and follow-up with the consultants. He sits back during rounds, with his little smug smile, while sitting back silently throughout the process. Put it this way, when he has clinic, the service is essentially the same; I'll still do all the work. He doesn't have a malignant personality that some other residents have, but the laziness is brutal. Two more weeks. I'll have to remind myself to not be such a self-righteous prick when I'm in that position. The saving grace is that I'm at Abington, where the consultants are happy, the radiology images get done promptly, and the social workers actually get patients out. Bless private practice medicine.

Winner Take All

I took my 30 minute nap so that I could stay up for this. Either the Sharks are going to the second round or they cement their position as the "choke artists" the ignorant hockey "fan" believes they are. I would love for them to move on. I've allotted two hours of precious sleep for this. They better deliver. They are on home ice, so there's that.

I'm back on floor service, which means another 24 days as an intern with intern duties before I can finally move up in the world. Finally feel like I might know what's going on, but can still feel overwhelming at times. It does feel cool to walk into an unknown situation and make an assessment and plan. Not always right, but that's where experience kicks in. 9 months into my career, seems like a short period of time.

Life in QHD

One week with the new laptop and I'm really digging the new features. The thing is light as hell, has great build quality (feels rock solid), super quick with the 4th gen i5, and generally amazing. Did I mention the QHD touch screen? I never knew how much as I was missing out on until now. It's nice having four times the pixel density compared to my lovely 4 year old laptop. Images are unreal. I have enough resolution to have side by side windows open and see everything in person. The only drawback so far has been the keyboard. Even though it is a Levono, which means it's coming from good pedigree, the thin chassis makes for a less smooth feedback and feel. It will probably take a little getting used to. I didn't know how good I had it before I suppose.

It's a blessing to have weekends off. I finally have had a chance to explore Philly and the surroundings. I finally get to play hockey. It's a little rough in the mornings, since it starts at 7am, but it is well worth it. Beating the goalie top corner on a wrister and then five hole on a breakaway makes also helps to ease the lack of sleep. Always take a few shifts to get my skating legs back, but feels good to be out there. Wish I could play more, but scheduling the time is not going to happen soon.

The crowning foodie achievement occurred yesterday in the form of Del Frisco. I've never paid that much for a steak before. It was worth every penny. The experience was unreal. The atmosphere was great, the service was outstanding, and the meat was sweet, tender bliss. I've had a taste of the good life and now I want more.

Sugars: TID AC And QHS

As my intern year winds down, I finally have a rotation to sit back and think back on the last few months. It's been a whirlwind of physical and emotional battles, and small victories along the way. Intern year is about perseverance. I hope I'll never have to go through that again. The odd part is getting through each month and wondering how I ever knew enough to get through the month prior. The perpetual nature of this feeling means I'll probably never know enough. Coming off my last HUH DoD service means I can finally use my brain again. The low was getting 30 pages in 3 hours. Good luck trying to write 10 notes, look up labs and vitals, and round on patients while getting a page every 6 minutes in the morning. That last sign out was a great pleasure.

For the last two weeks, I've been rotating through endocrinology. The majority of the service is diabetes management, but you get some of the interesting ones along the way (pancreatic insufficiency, hypopituitaryism, hypothyroidism), which helps to change things up. Not having a primary service is also a nice little perk. Another advantage of a light service is the ability to study for Step 3. I hadn't touched a book in probably 4-6 months, so it feels good to actually read something and not feel like a complete loss.

After a long search for the right ultrabook, I finally ordered my laptop. I had high expectations (1080p+ screen, 13" format, up to date graphics and processor, under 3.5lb, and under an 1" in size, and under $1200). I almost pulled the trigger a few times (Ativ Pro 9 and Aspire S7), but I settled on the Lenovo Yoga 2 Pro 13. Long name, amazing results. Now I must wait patiently for it's arrival. It will be sad to retire the Probook 5310m. I'll miss the amazing keyboard. I'll miss the rock solid feel. I won't miss that fact that it turns into an inferno when I watch Twitch or Netflix streams on it. On a side note, Twitch on 1800p screen is an enticing thought.

6 Months

As I approach the six month mark of my intern year, I must reflect on the half year of my life. Intern year is all about getting it done. You are the lowest person on the totem pole who is actually responsible. I didn't know how easy I had it as a medical student. No matter what you did, it usually couldn't be your fault. Interns have it a much worse. Probably the most frustrating thing is getting the details right and finding all the wrong turns that come along the way. No asks how long it took or what hoops it took to get there, they just want results. But as you get better, you grow a little more confident after surmounting each obstacle.

I'm finally winding down my final week of heart failure. Some of the hype about the service has lived up to reality, but most of it has not. The one attending with the worst reputation has a bit of a shtick, but it's still a pain to deal with. Not sure I'm getting the learning I was looking for, but at least it is tolerable. Although I was lied to about the census. I was promised 2-3 patients and light afternoons. I have been disappointed. Thankfully, I have an awesome senior who takes care of business and always there to back me up. I couldn't ask for more.

Everyone month I complete, I wonder how a managed to finished the last. From what I've done, the more knowledge I gain, the more I learn that I don't know. It's a humbling process. Most of it is learning on the job, since it's a little tough to read while getting through 14-hour shifts. It's an exhausting process. Many times I feel like I'm going through the motions, but once in awhile, you'll make a connection and you'll help someone. That makes it worth it. Those victories are small and infrequent, but the battles help fight through the war.

Just have to get through two more shifts and I'll be ready to start my week off for Winter block. It couldn't come faster. I had a vacation three weeks ago and I'm ready for another one. Next up is a month of nights. Gotta get through a few more weeks and coast my way out of here.

And on a heart failure note. Take your meds and stop eating so much salt!

14 Hours

The first month was about getting adjusted. I started on a heme/onc floor at Abington, the private hospital North of Philly. Thanks to a good senior, I learned to manage a census: rounding on patients, writing notes, putting in orders, rounding with attendings, putting in consults, following up labs and imaging, and fielding nursing calls all the while. By the end, I finally felt like I could pull it off so long as I had a few lucky breaks.

After a week of night float, I'm in full survival mode. The key is getting a decent sign out, following up on basis labs, answering the relentless pages, putting out fires, and praying for everything to get done for the 60 patients you have to manage for 14 hours. I don't think it gets much more brutal than this (I could be wrong, of course).

The first night was especially memorable, as it was my first time on the Hahnemann floors. I didn't even know where sign-out was, which was a bad sign. I got slammed with signouts and nursing calls. On top of that, I had a sick patient, which I didn't know what to do. For one thing, the patients are much sicker at Hahnemann; everyone is end-stage kidney/heart/liver disease. They're all one step away from disaster. Not exactly the kind of knowledge that makes you feel comfortable. I was scared of the pager, the patients, and everything around me. I don't know how, but by day 4, I was figuring things out and actually felt a little bit in control.

They say intern year is the toughest. The responsibilities change dramatically, but you're knowledge is still that of a fourth year med student. It's an abrupt wake-up call. At this point, you're not trying to swim, just treading to stay above water.

My fire last night was a girl with a very high potassium. The issue is that you can get a lethal heart arrhythmia without treatment. I didn't find her in her room. I talked to the nurse who told me she was visiting someone on another floor. So I went down and asked the nurses there, but no one had seen her. I even paged her on the overhead speaker. The whole time she was outside smoking and hanging out for 2 hours. In the end, she only got half the treatment she needed, but it was enough to hold her over until the morning.

Only 3 more weeks of this craziness.

East Coast Living

So the next stage begins. I've been in Philadelphia for two weeks and have so far enjoyed the process. I live in South Philly, in an older, but safe neighborhood and close to the Broad Street SEPTA train, which makes my commute to Hahnemann about 20 minutes door-to-door. One of the things I was not prepared for was the torrential downpour that arrived on the first morning of orientation and then the thunderstorm warning two days later. Also, I moved in with the antics of Drunk Dave pounding on the window of a house a few doors.

I've had a chance to meet people in my class and everyone seems pretty nice. There are a couple of unmatched prelims who think they're hardcore. I'm not sure where they decided this was okay considering the circumstances in which they arrived at HUH. Oh well, they'll learn soon enough.

My original plan was to get here without a car for a couple of months, but having a rotation at an outside hospital makes that a little difficult. So in the end, I shipped one of the cars over to be able to make my trips to Abington during the first month. The other advantage is that I sent my hockey stuff over, so I'll be able to start playing soon. Considering I was looking up hockey leagues in Philadelphia even before I found a place to live, it was probably the best plan I made.

I also have noticed how much I've grown from my bachelor days. Living with two single guys has made me appreciate the importance of cleanliness throughout the home. I'm hoping I can impart some of my habits, but we'll see about that.

Today was BLS/ACLS certification, which was a little nerve-wracking. I was able to get through the course with no major hiccups, but thinking about doing it for real is a scary thought. I'm hoping I won't blank from the adrenaline. Time will tell.

Last Weeks in the West

As I slowly wind down my time in Central California, I think about the fond memories of this place. The long, early hours at KMC playing the role of incompetent medical student. It was fun while it lasted, but now it is time to move on. Some of me will miss this place. Mainly, the ice and roller rink. Actually, that just might be the only thing. It will be tough to be in Philly on my own for a few months, but I'll try to make the best of it while I transition into my first real physician role (and first paying job in almost 30 years).

Before I go, there is a trip to Yosemite in the works for this coming weekend. We rented out an awesome house on the water outside the park with 5 bedrooms and a pool table. I'm really looking forward to using it when we get in. It will be nice to have some unadulterated time with my family before I go.

In more current news, my students are wrapping up their finals this weeks, so that means longer, more frantic hours. I've had to sacrifice my time (and one hockey game), but I do like teaching and I feel like I'm helping them out, so it's probably worth it in the long run for both parties. I'm sure they're looking forward to Summer and sleeping in.

EuroTrip

We made it back safe and sound! Two weeks in Europe was an awesome experience. I finally lived my dream of seeing the Colosseum in person. It was breath-taking! The best part was taking the extended tour into the subterranean level and up to the third ring. Seeing the Roman Forum and the Pantheon helped round out the experience. In Turkey, I was blown away by the architecture of the Ottoman empire. The Grand Bazaar was a great places full of color and life. It was a reminder of a magnificent past and a sad reality of how far the Islamic world has fallen from it's once great roots. Turkey is a model country as it blends East and West seamlessly (which makes sense based on it's location), but I think other Islamic countries have a lot to learn from their Turkish counterparts. You could see the mingling of their conservative and liberal citizens with no issues or difficulty.

The final leg in St. Maarten was a nice finish to the trip. There was a lot of relaxing and enjoying the beach. It was an odd sensation going back, but coming as a tourist makes all the difference. Sadly, I never made it back to campus, but maybe that would be a reason to go back in the future. I did make it to Thai Savanh and the crepe place, so there was some major nostalgia going on.

In the end, I am glad to be headed home again. It's crazy to think that I only have 3 more weeks until residency starts. I'm nervous and excited to see what the future will be like. Thankfully, I'm moving to a new location with a dwelling secured (which was the mistake I made moving to St. Maarten); I don't plan on doing that ever again.