Sandy Hook

As I woke up and got ready for my interview on Friday, I heard on the news about another shooting, but the details were murky. It was not until I was back in the car on the way home that I began to hear the extent of the tragedy. A truly heartening tragedy. I mean, this deranged guy called a bunch of kids in school. Where do we go with this? How do we move forward as a country?

This is a two part effort. It involves gun control and access to mental health services. Maybe people still slip through the cracks, but we need to make a much better effort to try to stop it from happening. Sadly, every time we talk about gun control after a tragedy, the gun lobby comes in to tell us that it's too early and we need to wait a little longer. At this point, I think now is the time.

As far as the mental health, I think there needs to be a better screening process. I think children in school should be screened for mental health issues and gotten the assistance they need. This also means that we need to stop stigmatizing those who need treatment. We need to accept that mental disorders are the same as chronic diseases and should be treated and continued with follow-up. Some might call this government oversight, but I think it is time we start looking into it. This is part of the government's responsibility to protect it's citizens.

The next issue to tackle is gun control. I have mixed feelings about this one. I am not against guns. I had owned guns growing up and still enjoying going to the shooting range with friends. That being said, I think oversight is needed. I propose a couple of things. I think anyone who has been screened for a mental illness should receive not be allowed to own a gun for a period of time (2 years) and then would only be allowed conditionally if they were receiving counseling and were compliant with medications. I think that anyone with schizophrenia should not be allowed to own guns. Period. Finally, all gun owners should have renewable licenses and should have to report to the local law enforcement to determine their mental status and ability to use and maintain a firearm. As far as guns themselves, I think large capacity clips should be banned. No one needs them and those who have committed these atrocities used them. This won't solve our problem, but it will be a start. 

This discussion will continue, but we need to start somewhere.

On a side note, I like that the media has decided to stop focusing on the shooter and start finding out more about the victims and their families. It probably helps that the victims are young children, but I'd like to think that they just want to do the right thing.

Winter is Coming

The title comes from the 80 pages of Game of Thrones I have read so far and the future pages I plan to read on upcoming flights for interviews. I'll get around to watching it... as soon as I can afford HBO.

I've been lucky to be a on a good rotation this month. I've been enjoying a reasonable patient list, a very instructive attending, a chill resident, and social medical students; this is the optimal setup. Interviews are still under way, although I have had a bit of a break until they pick up again in January. It's been tough scheduling, but I think I pulled it off for the most part. It'll involve another trip to the East Coast in the midst of Winter, which will only confirm just how cold it gets out there. Thanks to New York, I actually bought my fist overcoat to survive the cold. Apparently, my H&M jacket just won't cut it when there is real snow and real wind involved. As a Californian, I would have never known.

In other amazing news, I decided to buy new tires. After weeks of fretting (I wish that were a joke), I ended up with the Falken Ziex ZE-612, which happen to be quiet and responsive and exactly what I was looking for. I'm glad I pulled the trigger (even if it drained the bank account), as the winter rains are coming (even in Bakersfield) and I'm not a big fan of hydroplaning.

Resident is close (and far away). Seems like a crazy jump from being a medical student (where you don't real responsibility) and being an intern, where you don't know anything and are actually counted upon to make real decision. Help me! I'll be done in January, with about six months off before I start. I am come to the sad conclusion that I'll have a useless degree. I can't even do nursing work, I have little to no hands-on experience, and no one would hire me as a physician or something that resembles one. I think I'll have to revert back to tutoring and possibly doing research. KMC is rather limited, so I may end up at CSU Bakersfield to keep myself entertained and willing to wake up in the morning. A six month vacation sounds amazing, but I know I'll become bored and slovenly in no time.

The Next Phase

My fourth year of medical school winds down and I'm starting to think about the next step. The applications are over, the interviews are in full swing, and I'm finally wrapping my head around all of it. There will be big changes in the future; new hospital, new staff, new location are all in the cards. There is excitement and frustration in the unknown. I am ready for the next challenge and apprehensive of what it might be.

I'm not sure what it takes to be a good physician. From what I see, they must be able to master the knowledge of medicine, apply it to each unique case, and then be able to work with and communicate to the patients so that both sides can work heal the patient. Sounds straightforward, but I wonder how one puts all these things together. Seems like a great ordeal.

On a personal note, I am looking forward to coming home for Thanksgiving. This is our big celebration. Everyone is invited over for turkey and Dad's kebobs. I'm looking forward to seeing everyone, eating extremely well, and playing board games into the night. Getting a chance to see family always puts things in perspective. No matter what happens, you know you'll have someone to turn to in a time of need. That kind of safety net makes taking a risk that much less scary.

This new Cooler Master Rapid Fire mechanical keyboard is like butter to type on. I'm still adjusting to the increased travel of the, but as I become more adjusted, I know I made the right choice. It's a little loud, which makes bringing the computer back into the room a non-starter. At this point though, it is a worthy investment.

Renal

On my first week of nephrology, and I've been enjoying it so far. Attending is cool, residents are willing to teach, and the students are all reasonable. This is all you can ask for a elective rotation. Sometimes, I see the surgery teams rounding and I cringe. I would not want to be in that situation again. I even enjoy being in the ICU again, which is what medicine will do to you. I'm thinking I picked the right field. Medicine involves a lot of thinking and a little less doing. I can work with that.

Next up is getting a new phone. My HTC Evo 4G has been a trooper, making it the full two years of the contract and still being relevant. Granted, I'm still stuck on gingerbread (CM 7.2), but that is all you can ask for at this point. Right now, the Nexus 4 is at the top of my list. The thought of a fully-functional ICS smartphone with no contract for $300 is rather appealing. I may cave in and go back to another contract, but I'm trying to hold out at this point. One major aspect is getting the parent's upgraded to iPhones, which I'm sure they will be extremely pleased with. Can't argue with a very user-friendly interface. Sprint is crap, so we'll be switching to ATT or Verizon, although I'm leaning towards Verizon right now.

Interview Season

Another post after a long hiatus. Interview season is upon us. Lots of travel and public transportation to get to lots of hospitals I’ve never heard of before. This is my life. So far, New York has been good to me, although they have been through their own trials in the form of Hurricane Sandy. Amazing how quickly this city is back up, although equally amazing to see just how much the storm did to this island.

Currently on the Staten Island Ferry, making my way over to Staten Island University Hospital. Sadly, there was too much fog to catch the Statue of Liberty or Ellis Island, hoping I’ll see it on the way back. Luckily, I made it in before the blizzard kicked in full steam. It’s still falling outside. I was at Jersey Shore Medical Center on Monday: brand new facility, nice attending, happy residents. If it weren’t for the long trips home, I’d be all for it. At the same time, considering I won’t have much time to myself, maybe it’s not such a bad option.

So far, one California program is done. Unfortunately, the East Coast programs are seemingly much better, but the distance is an issue, as well as the East coast support staff. I’ve been brutalized by urban nurses once in the Bronx, not sure I want to walk into that situation again. They say it’ll be done before you know it, but three years still seems like a long time.

Seems odd moving on to the next phase. Felt like I was finally comfortable with all my rotations and now I’ll be in the position of responsibility as an intern, which is both a reward and a challenge. Part of me things it’ll be overwhelming and I wonder if I can handle it. The other part thinks that there are many who have done it before me and many more will come after, so I’m not that special and I’ll be able to finish.

Surgery: Death Rotation

Not sure how I made it through without posting about my surgery experience. Maybe it was the emotional trauma of residents with short fuses, maybe it was the daily 12-14 hour days, maybe it was all the time in the OR just cringing at the possibility that I might be yelled at for just about any offense.

I guess it was not all bad. It had its moments, mind you, but I did survive. 8 weeks of general surgery and 4 weeks of trauma have been enough for me. We'll start with the beginning. I had been fresh out of Psych (thank God!) and was green going into surgery. My only medicine had been my IM rotation (which was rather useless, looking back on it) and I barely knew how to present a patient. There was a lot of learning on the job, but I had a good resident and I was able to pick up a lot from her. So kudos to you, Dr. W, for making surgery reasonable.

Next up was trauma surgery. First day, a fellow student and I get called out for wearing fleeces instead of white coats. I guess it was unprofessional and disrespectful (ironic, since I did not see a single attending wear one in my 3 months there, including the physician scolding us). So not a good tart. But again, I lucked out with a good chief resident and interns. Granted, we got scutted out a lot to follow radiology readings (which made us the ire of the rad department), but I guess that is your job when you rank slightly above the portable urinals in the hospital. Scrambling to see patients and have top-notch presentations in the morning was always nerve-racking. Somehow, we managed.

The final month was a nice little dress-down. Basically called out and told off by the chief resident, and of course, not my fault. Not a planned start. Luckily, the census stayed short and we made it out alive. I hated clinic because I never knew which version of my resident I was going to get.

So there you have it, surgery is done!

Now, it's Step 2 CK studying until June 29th. Wish me luck!

The Epically Horrible Call Day

This was too horrible, it must be told.

It started out like a normal call.  We were asked to come for sign out at 7:30am and then were completely ignored, meaning we could have been there an hour later and we would have been fine.  So then it was off to see patients. I saw four patients and wrote notes (one more than the other student, mind you). We were writing out notes and that is where we came face-to-face with R2. She came into the room, asked if the attending was rounding, and then proceeded to tell us that we should be rounding with them (even though we told her our resident told us to hang out while he finished rounding on his own), so we headed over to see Dr. M, who told her that we were fine and could go back to what we were working on.  I thought that would be the last of it; I was wrong.

We had lunch with the team and Dr. M. R2 got all excited about residents who has been subpoenaed, which she thought meant they were being sued (it does not). When questioned by the attending that she might not know what she was saying, she got flustered enough to leave the table, implying that the attending was lying to her.  Basically, she's crazy.

And then it happened. We were called to see a new patient. I went first, talking to the patient who was irritable and agitated. I was only able to get about half the information I wanted before he walked out of the room, so I wrote my note based on my encounter (which is what I was told to do). I let her see my note. I admit, I did make a mistake in the initial write-up, but the rest had a lot of substance (which is later confirmed by another resident). She took this as her queue to berate me, asking if I just start clinicals or if I had ever done this before. I took it in stride and apologize for my work. She then told me that I hadn't done nearly enough to gain information form the encounter and that I needed to work on my patient interviewing skills.

Now it was her turn. She went to go see the patient and "show" me how it was done. She called the patient into the room. She began talking to him in a baby voice, treating a grown, agitated man like a child. In the end, she got just about nothing and managed to get him to say "I want to fucking punch you in the jaw".  Well done, genius.  She clearly was flustered, trying to hide it, and ordering a bunch of sedatives for the patient she had provoked.

At the point, she told me that I had a lot of work do to and that I needed to stay late to complete the note. She asked if I had "his records", which I did not understand what she meant and asked again what she was saying. She repeated and then finally said from Portal (the hospital software) and when I understood what she meant, I told her I could access it. She then said, next time, just say you can get it instead of not knowing. Basically, she was being a wench.

So then she looked over the other student's note, corrected it, and let him go home. Meanwhile, I was sitting there, note done, while she chatting up the other medical student for 20 minutes before he left. After, she got a page from the ER and had to go down. She called the resident, who she then found out went home. She had an argument with him, made him come from his house back to KMC, and critique my patient note. So I sat there like an idiot for 30 minutes waiting for him to show.

In the meanwhile, she came around to how she was asking and called me on the room phone asking if I was okay. Pathetic.

So the R4 comes (with two MORE years of training than her) and looks over my work. His fixes some typos, cleans up a couple of dates, finishes the plan (which is beyond my scope of knowledge) and tell me that my note was pretty good and he was just doing a lot of it to make it look like he did something.

She comes in later and asks the R4, are we cool, R4? At this point, we both we were completely over her. He stepped out. I packed up stuff and walked out right in front of her, I really didn't feel the need to ask for permission to go home since clearly this is not a rational woman.

And there you have it. The worst call ever (so far).

Kids Everywhere

Finally into my third week of Peds. Although, I've enjoyed my time, there is a lot of it to myself. The first week was focused on Strep throat and middle ear infections, but one can only see so many of those before you get the idea. Since then, it's been a lot of reading and downtime. After a while, even studying is annoying. It has gotten to the point where I now bring my laptop to work and tether my phone for internet. I'm typing this as I sit in the physician's room waiting for another case.

I have three more weeks to go. Next week will be in a new clinic, which will mean a new system and a chance to learn a few new things. Other than that, I'm ready to go back to something where I'm more useful and less of an observer. One can only study so much before the urge to be active kicks in.

In hockey news, we won our first playoff game yesterday. I had two goals to help our team to victory. So far, I've been enjoying my time in this league. The guys are friendly, for the most part, and the level of play on just enough that I have to work hard to effective.

The weekend in the Bay Areas was wonderful. I got to see the whole family, including Khala's from New York and Pakistan. We made it out to SF to a kid's museum, where I think I had as much fun as they did. We had dinner at the in-laws and generally had a good time.

One more wedding this weekend. I'm looking forward to resting and relaxing this weekend. I still need a day of StarCraft to fully decompress.