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.

The Soak

So after a few months, it was time to clean my hockey stuff. Previously, I soaked my stuff in a warm bath with a cup of bleach. This was great in getting rid of the smell and cleaning my stuff, but it ended up destroying the palms of my gloves, which was a costly replacement. After a little more research, I decided upon a borax wash. Apparently, it is advertised as a laundry detergent enhancer and all-around light cleaner. Here's the stuff:

http://www.20muleteamlaundry.com/

So I made my way to Walmart, picked up a box of borax, and dropped a cup of the powder into a half tub of warm water. I put my stuff in, let it soak for a bout 20 minutes with a few check-ups to push everything around, and rinsed it all off. I was weary about my hockey gloves, so I left them out. I might try them next time. After a rinsing, I left them hanging to drip out.

As of now, they are post-soaking and outside to dry. Initial impressions are that the smell is gone and the foam and cloth seems to have held up. Apparently, borax is easier on clothing than bleach. It forms hydrogen peroxide in water, which is a nice little anti-microbial. If this works out as planned, I think I'll have a new routine to keep everything shiny and fresh without the concern for ruining all my pads.

In other news, my flight is booked for Philadelphia. The one nice thing is that Virgin America has four direct SFO-PHL flights a day, so we should be able to travel nicely between coasts. This is mark my second flight with Virgin. The last one was a few months after they started the airline; I hope they fixed the in-flight entertainment system.

Leisure Update

Let's see, it's been about 3 months since I finished up at KMC. For entertainment, I took up ice hockey (best choice ever!), began planning for our Eurpean vacation, and decided to start studying for Step 3. Including my tutor, I've managed to keep myself busy. The next step will be getting ready for intern year.

In world news, we have the Boston Marathon bombing. Such a despicable act and those who did this should suffer severely. Targeting innocent civilians is abhorrent, whether done by domestic or international terrorists and we can come together to seek justice against them.

Seems like time is going by more quickly than I thought. I was under the impression that the 6 month break would last forever, but I underestimated the reality. Maybe it was a long time, but all I know is that we are halfway through April, will be gone for 2 weeks in May, and I start after the first week of June. Where did it all go?

Next Chapter: City of Brotherly Love

The news is out, I'm headed to Drexel University for residency. This is has been an exciting and nerve-wracking revelation. Parts of me (small parts) will miss Bakersfield. Mainly, we'll miss the easy access to our families in Northern California and friends in LA. It will be nice to live in a new, exciting place, but there will be a lot of logistics in our transplant. Cars and furniture will need to be moved quickly and efficiently. I went to a couple of websites to get estimates, gave them my email and phone number, and ended up with 15 phone calls the next day. I felt like such a sucker for ending up on a contact list, when I pride myself on my well-protected internet life. So now I've been doing damage control to try to get off each company's list.

In other news, I had a provoking dream last night. The gist of it being that I was living in Philadelphia, had to catch the train, ended up on the track with a large crowd of commuters, watched a woman get hit by the train, and watched her partner weep next to her body. It was startling enough to wake me up, which is a rare occurrence. I tried to settle my mind again after to sleep, but it was too late and I was up at that point.

So back to the future. I have to be in Philadelphia by June 10th to start orientation, which is about 2 weeks before I start. With the wife working, this makes it difficult move everything at that time, so she'll be sticking around until she can find something that works for her and we can move all of out belongings to PA and start the next chapter.

I am happy for all those who have "matched" this year, we had a lot of good results and I'm happy for all my classmates. We all worked pretty hard for this and it feels good to finally be back in the game and moving on. I think the stigma of being an IMG will slowly fade as residency starts and I think the future is bright, iA.

Graduation

The time has finally come. I finished medical school. Seems kind of odd saying it, doesn't seem like it's real. Interviews all are done, so there is really nothing left (save the Match) before residency. There will be a lot of laying around, mixed with a couple of new hobbies (including learning to play ice hockey), and finding some sort of part-time job to keep me entertained.

So now I get to reflect back on medical school. I would say it was not as bad as I thought it would be (or some people made it out to be). I think learning was a matter of handling volume. Frankly, differential equations are tough as shit (and I still don't understand them), but I never felt the same about basic sciences. My clinical years were relatively benign. I had a bad time in surgery, I think are non-surgeons do and I hated the hours of OB/GYN, but overall I made it through relatively. And there was the horrible psych resident, but again it was only 3 weeks and I think I'm stronger for it. I've learned (thanks to my father) that one will always encounter difficult people who will never like you. The trick is stop trying to appease them and learn to by diplomatic while getting your work done. I would it was good advice. Seems odd being done, but I'm not sure if I feel any more knowledgeable from the say I started. Maybe I know more things about medicine, but I still don't think I would be able to take care of a patient. Seems scary since this will be asked of me starting in July. The keys will be accepting my ignorance, focusing on learning, and turning to others for help.

The other tough part was learning that I have very limited marketable skills. I'm applying for the same jobs I did before medical school. I have no certifications, so I can't do any nursing duties. I can't even be a medical assistant. I could possibly do front office work, but I'm not looking for a full-time job. So in the end, it's back to tutoring positions.

So major steps are occupying my time for the next six months, planning on vacation out of the country, finding out where I'll be headed in July, and starting my medical career.