Rotation 4: Internal Medicine

Oh IM. Both a blessing and a curse. Universally known to be one of the more intense rotations, both in terms of hours, caseload, complexity, you name it. I worked incredibly hard during these 8 weeks, and learned an incredible amount. And I think I came very far, even achieving one of my goals which was to present (mostly) from memory during rounds. Win!

I really really liked the intellectual challenges and the way I was pushed during this rotation. I totally believe in tough love. But did I love the rotation? I'm not so sure. It was my last rotation before the holidays and I was thinking I might have been burned out (was literally counting down to vacation, like I had a countdown on my whiteboard which I updated on the daily !!), but then again I wasn't waking up every morning excited like I had been on some other rotations (cough, Peds, cough). You could say we had an "I love you but I'm not in love with you" type of relationship.

The most striking moment for me was that I lost my very first patient on this rotation. Sure, patients had died before, but they hadn't been patients I had been *directly* caring for. This was hard. I started taking care of her as soon as she was admitted. Seeing her getting weaker and weaker as the days went by was hard in itself, especially when she kept conveying how uncomfortable it was. We had many conversations with the family, and it was hard seeing how everyone was in a different place regarding accepting her condition. I was so impressed by how my senior resident led those meetings. Death and dying is definitely something I struggle with. I hope I can be even moderately as good as he was handling those discussions. And just like that, by the end of the week she was gone. I was actually watching the monitor as it flatlined. Her family surrounded her and everyone was crying. That was so hard for me to see too. I had to excuse myself to the bathroom and cry in there for some time. It was an experience and I hope I'm stronger for it.

This beauty had case discussion with us students every Wednesday morning. MD stands for Medical Dog-tor. Ha!

Appropriate. Also it was Halloween.

Finagled a 36-hour trip home for Thanksgiving to see all these kiddos! Promptly got sick for 2 weeks afterwards. So worth it.

Running into classmates in the cafeteria. Yes, there is a pizza slice in there. Somewhere.

After my IM shelf, I was blessed with Winter Break. Like 2 whole weeks off?!? With the prospect that I had maybe only 2 more weekends to work during the 3rd year because I so smartly front-loaded my schedule? It's like Christmas morning! Literally.

Med school friend A and I drove down home (well, he drove. I annoyed him). We talked. We sang 90s songs. We stopped by Merced to check out the Hmong New Year Festival. Cool stuff.

Hmong Festival food. If only I could remember the names of these.

Annual Christmas brunch with the high school BFFs.

OMG it snowed in LA! JK.

Peace out, IM. It was real.

Rotation 1: Surgery

I started off third year with Surgery. It wasn't my original choice, but I convinced myself that it would be a good idea to get a hard rotation out of the way early on. I knew there wasn't a huge chance I would choose surgery as a career so it would function as way to get familiarized with the hospital and be comfortable seeing patients, charting, and just figuring out what 3rd year is like.

Ready with my clogs and pager. Please page me! (Please don't.)

I had one month of cardiothoracic surgery and one month of general surgery. I ended up liking the rotation a lot, especially general surgery. CT had some really cool surgeries, but I felt like I grasped general surgery much better. CT was especially challenging with regards to management as most of the patients are in the ICU. Although I did get to see open heart surgeries, LVAD placements (don't cut the LVAD wire! (loyal Grey's Anatomy fan reference there), lung removals, and esophagectomies (yep, pretty much get rid of the esophagus due to the cancer eroding it. I got to hold the stomach up while it got stapled). General had more "bread-and-butter" cases that I thought were more within my scope - bunch of hernia repairs and gallbladder removals; I also scrubbed in on plenty of colorectal cases which are so complicated! I got to do plenty in the OR too: suturing, being in charge of the camera during laparoscopic procedures, putting in Foleys, retracting, etc!

"Practicing."

The hours sure are long, but the days go by so quickly. The one really hard thing is carving out time to study. There just isn't enough time after you come home and eat because you have to be in bed soon after that in order to wake up at 4am! I did okay on the shelf exam, but not great, so I will be adjusting some study strategies for my next rotation.

End of rotation assessment:
I didn't expect to like surgery as much as I did. However, I found that I enjoyed reading up about patients' conditions and their management much more than being in the OR. I also think the structure of the rotation prepared me well for the rest of the year. It was definitely cool for 8 weeks, but I find myself more intrigued by the medicine than the procedure. Good effort though, Surgery!

Fam came up after my shelf and we went to Tahoe for the weekend!

Lottery

3rd year is right around the corner! Pretty soon, we will be done with our pre-clinical curriculum, go off to study for and take Step 1 of our boards, and then we will officially be in the clinical half of the med school years. Third year is reserved for the core clinical rotations. Since everyone can't obviously be on the same rotation at the same time, schools have various ways of scheduling students. Some schools simply hand students schedules. Other schools have a few set schedules they have students rank and then assign accordingly. Our school is a little different. ;)

We have a Lottery system of choosing your clerkship schedule. Everyone gets to pick a number out of a hat and then based on your number, you choose one rotation at a time. The starting point changes with each round, of course. Anyway, you don't have to go in any particular order (e.g. you can schedule your third rotation before your first) and are free to choose any order you like, so long as there is an open spot. Now, see where it gets stressful? What if what you want isn't open, you ask? Well, you can't take it and have to figure something else out!

Over winter break, I came up with like 17 permutations for schedules I would be okay with. Which was a complete waste of time, haha. You really end up making decisions on the fly, because your strategy needs to change based on how other people are choosing their rotations. If it looks like one of the rotations is filling up, you choose it that particular round to avoid losing it. Regardless, about 1/4 of the class will end up getting locked out of their last rotation pick just because the spaces have filled up. There might be spaces open for other rotations, but they are not the one you need.

Of course, I figured with my luck, I was bound to get locked out. And I did! Good thing I'm consistent. I had picked every rotation except Pediatrics for my second rotation. What happens when you get locked out is, each person has to go through their schedule and adjust accordingly to fill in whatever is open. This might mean that you have to tear apart your entire schedule. Luckily, the person before me dropped Pediatrics as her second rotation when she was adjusting her schedule, and I swooped right in. Didn't need to adjust my schedule after all!

Behold, my 3rd year schedule (8 weeks each):

Surgery
Pediatrics
Psychiatry
Medicine
Ob/Gyn
Family

It isn't what I originally wanted, but it's close enough. I'm excited and terrified.

Prepping the night before.

The school decorated our room as Super Heroes! 

My lottery number.

Won a Starbucks gift card as well! 

Post-lottery celebrations.