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.