4th year schedule!

So I technically had 1 more month of third year after my Family Medicine shelf, but it ended up being my elective block so doesn't count! Historically, all 3rd year rotations have been 8 weeks long, however this year, the school restructured the FM rotation to be 4 weeks, with the remainder of the rotation being spread out over the entire 3rd year with a longitudinal primary care clinic we were assigned to. Although I wasn't too thrilled about this option at first, I ended up really loving it, because I could hone my skills throughout the entire year, work with a preceptor directly for an entire year, and practice FM throughout the entire year before even starting my dedicated rotation.

I also had a few options for my elective block. Originally I wanted to do Neurology, however once it became clear I was most likely going into Pediatrics, I decided to postpone Neuro during 4th year, with the intention of taking the Child Neuro elective instead. I figured this would be much more relevant to my chosen field, and we really don't have much exposure to child neurology anyway so it would be good to gain those skills before residency. That left me with either PM&R or Diagnostic Radiology. Again, I wanted to leave PM&R for later, also because I didn't think I would want to do an entire month of it (a 2-week option is also available for fourth years). That left with the logical choice of Rads. Something I feel a little weak in. Four weeks would surely allow me to gain a better appreciation for imaging, improve those skills, and be relevant for Step 2 studying. Hooray!

It was also flexible enough for me to continue polishing my culinary skills.

Homemade cornbread for my Doctoring 3 group (see recipe at bottom)

Homemade chocolate chip cookies for my preceptor on my last day of longitudinal clinic. Love my Williams-Sonoma Baking Book for all its deliciousness.

Pork and beans dinner during my elective block.

Paint Nite at school. Mine is the worst-looking one (top left).

As for picking my 4th year schedule, it was back to undergrad methods for that, where you try to add a class and then if there is room it will be offered to you. Kinda miss how these last 3 years, I just had my schedule handed to me. So many permutations! In the end, I'm really proud of how my schedule came out. I was able to fit in pretty much everything I wanted, and met all the school requirements as well. Behold, my schedule:

MONTH OFF for Step 2 CK
PICU Acting Internship
Child Neurology elective
Peds Wards Acting Internship
SUMMER BREAK / Step 2 CS
PM&R (2 weeks)
Clinical Pathology (2 weeks)
Anesthesiology
Doctoring 4 Special Studies Module
MONTH OFF for interviews
WINTER BREAK
Dermatology
EKG Reading didactic (2 weeks)
ENT outpatient only (2 weeks)
Emergency Medicine Acting Internship
MATCH
SPRING QUARTER OFF

I feel like this year will fly on by! 10 more months of school left and I'm done!

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Golden Sweet Cornbread (from allrecipes.com)

1 cup all-purpose flour
1 cup yellow cornmeal
2/3 cup white sugar
1 teaspoon salt
3 1/2 teaspoons baking powder
1 egg
1 cup milk*
1/3 cup vegetable oil

*I have also tried this recipe with almond milk instead and it works just as well.

-Preheat oven to 400 degrees.
-Spray a 9-inch round cake pan (can also use a square or rectangular pan)
-Combine flour, cornmeal, sugar, salt, baking powder.
-Stir in egg, milk, oil until well combined.
-Pour into pan and bake for 20-25 minutes.

Rotation 6: Family Medicine

I purposely scheduled Family Medicine as my last rotation for a few reasons. I definitely did not want to have anything "intense" as my last rotation, aka no Surgery or IM. I also had heard that Family is a myriad of IM, Peds, and Ob/Gyn and I wanted to have already had those rotations so that I could better understand Family Med, especially since it's an outpatient rotation and you don't have too much time to come up with diagnoses and plans. I also figured it would reinforce everything I had learned so far, and be a good review before starting Step 2 CK studying (more on that later...).

I was in a Kaiser setting during my rotation, which marked my 4th (!!) time working at KP - the others being during Peds outpatient, half of IM, and Gyn/Onc. I like the Kaiser system just fine. I used to be a KP patient back in the day and everything was incredibly easy to schedule, access, and cheap! The KP FM docs I worked with were really great. And they make a point of talking to you about career plans, offering advice about where to go, the pros and cons of different systems, etc. That was really refreshing.

Surprisingly (sort of?), the hardest part of the rotation was removing ingrown toenails! I know I'm not a procedure-friendly person, but I usually have no problems with blood or goriness. Open heart surgeries did not phase me, suturing up lacerations in the ER did not phase, but this was something else! Actually, watching it was much worse than me actually performing it. I guess when I'm the one removing the nail, I'm focused on what's going on, what to do next, etc., so it takes my mind off of what is really happening. But if I never have to remove another ingrown nail for the rest of my life, I'd be okay with that. Ha!

The weekend after the shelf also coincided with Easter, so I flew home for some much needed time off.

Yes, those are chux. Made clean-up a cinch.

And guess what?! That was my LAST SHELF EVER! 3rd year flew by so fast! Yes, I technically have one more month left, but it's my elective block, so it doesn't really count as 3rd year! I cannot believe it. Sometimes I think it was the hardest, most grueling year ever. Other times, I think it wasn't so bad, and I truly did enjoy it. It's remarkable how far you can come in just under 1 year. I used to be terrified of starting 3rd year, because as a career student it's easy to get used to the classroom environment. You are in control, you know your schedule and what's expected of you, and you do it. I wasn't sure how to handle the pressures of 3rd year, not knowing what's expected of you, or having different expectations from different attendings. I didn't know how I could learn what is needed or expected to be known without having a set syllabus or curriculum to guide me. But you know what? You take charge of your learning, you research the available resources, choose what's best for you, and set your own curriculum plan. And you truly do learn so much just from your patients and reading up on what's going on. UpToDate and Wikipedia are still my BFFs though, let's be real.

Rotation 5: Ob/Gyn

As you can tell, I am trying to bust out as many posts as possible this weekend in order to stay in real-time and before I start my AI next week. More on that later of course...

Rotation 5! There is a light at the end of the tunnel. We are seasoned 3rd years at this point, on the last stretch to the end. After a 2 week hiatus, it's back to the wards...on Ob/Gyn. I could easily say it was the lowest on my list coming into med school. And so I was terrified I would fall in love with it and have a panic attack about how I was going to spin a residency application showing my interest.

I started off on the Obstetrics part of the rotation. Babies babies babies. So cute. It took me back to my Newborn Nursery days. If anything, Labor and Delivery reinforced:

1) how I don't like being in the OR. Sorry, C-sections.
2) how I gravitate towards the baby versus the mother. Sorry, adults.

I also like a little structure to my days. L&D is anything but. Yes, there are scheduled C-sections. However at any given time you might have zero laboring mothers to all laboring mothers. It ebbs and flows. Which makes me antsy.

I surprisingly liked my Gynecology month much more. Well, not my Oncology weeks, because, well, there is OR time, You know. But I really liked Gynecology clinics and especially the Ob/Gyn longitudinal clinic I was assigned to. I loved seeing the pregnant ladies, measuring their bellies, listening for the baby's heart, counseling them about what to expect next. It was also really cool that I got to see a couple of moms twice over the course of my month there!! Which is really interesting, because longitudinal care isn't necessarily one of my main interests (prefer the high acuity patients).

I liked Ob/Gyn for the reason that it was very niche and I felt I got good learning because of that. I was able to focus on the subject and really read up on things. But it's not something I would pursue. I don't think anything surgical is my style. I much prefer the medicine of things.

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 3: Psychiatry

I had intentionally placed Psychiatry as my 3rd rotation. As you may (or may not) have known, I was seriously considering pursuing Psychiatry when I started medical school. The usual advice is to place what you are considering 4th or 5th in your schedule so that you are not a newbie 3rd year and can impress, but are not so far along your year that you are burned out. I wasn't keen on placing it 4th because I thought I might get burned out since it was around the holidays and I also didn't want to have too many inpatient rotations back to back. I didn't want it 5th because I feared it might be a little late in the year just in case I changed my mind. I wanted to really have a sense of what I wanted to do before Christmas. And so 3rd rotation it was.

I was nervous going in. I really wanted to like it, to validate that this was what I was meant to do. I didn't want to have a panic attack, thinking all my future plans would be unraveling if I decided this wasn't what I wanted to. I had 1 month of inpatient and 1 month of outpatient to get a good idea of the field.

I started on inpatient at the county treatment center. Brutal honesty here: I was so so anxious that first week there. It's a locked unit and I was nervous for so many reasons. 1) Most of the patients are psychotic. 2) I didn't want to drop my key at any point and have it picked up by someone else. 3) I didn't want to get hurt - we actually had to take a mini self-defense class the day before we started just in case. And they gave us lanyards that break apart if someone tries to choke you. All of this was making for a very jumpy T. Which wasn't a feeling I was liking. It was definitely a difficult environment and so unlike my previous rotations. People don't just get better over the course of a few days in the hospital. Some patients had been there for months or even years! The hero complex in me wanted to fix everyone quickly, but that would not apply here. However, I slowly adapted to my surroundings and everyday became easier and easier. There were some moments that were certainly scary - such as when a patient got attacked by another patient right in front of me, or when a patient I didn't know kept approaching me and I yelled for staff because I wasn't sure what they wanted, or when a patient I had been taking care of suddenly yelled that he didn't want to see me again and refused to talk to me anymore. It was quite an experience, and I'm grateful that I did it, but I wasn't sure if this was something I wanted to do for the rest of my life.

Lunch at the treatment center! I got a meal card and everything. Only $2 for this whole thing.

But before I started on my outpatient month, med school friend F and I attended a Psychiatry conference in SoCal. It was a really great weekend and I learned a lot, especially about delirium tremens and new treatment strategies for that. The place wasn't too shabby, either. What do you think?

Eggs benedict aka my favorite breakfast ever.

I told myself I wouldn't make any decisions until my outpatient month was over. But looking back, I think I enjoyed inpatient more than outpatient. In general, I think I thrive much more in the inpatient setting. I like the structure, and the acuity of the patients. Something was missing for me in outpatient psychiatry. I think I wanted to have the role of the psychologist or case worker rather than the psychiatrist in that setting.

In my heart, I knew that the decision had already been made for me. I didn't think this was the right career path for me. I didn't love even though I really really really wanted to. I felt guilty for so many reasons. I had told people this was what I was going to do. I had been the president of the Psychiatry club at school! I had mentors who had taken the time to talk to me, guide me, give me advice over the last 2+ years. I felt like I would be letting them down, that they would somehow be disappointed with me for diverging from this path. I also wasn't sure whether I liked Pediatrics so much because it was right after Surgery or whether I truly truly liked it. I was so concerned I even scheduled a meeting with one of our deans who also dispenses career advice. I think I just needed someone to hear out my thoughts even though I knew what I wanted. It was nice that he validated my concerns and offered his thoughts that I was making the right decision, especially given that I was still thinking about Peds months after that rotation had ended. That felt nice to hear and eased my worries a bit.

So that's that. Sorry Psychiatry. I really really wanted to like you. I leave you with this: one interesting assignment we had for the rotation was to attend a local AA or NA meeting and then write a reflection about it. Here are a few excerpts from my piece:

My first thought while perusing the Internet, looking for a meeting to attend, was: Wow! I had no idea there were so many meetings that occur on a weekly basis just here. There were so many to choose from, I figured they would be small, intimate sessions – perhaps 15 or 20 people at a time. My second surprise was when I walked into one and there were at least 50, if not more, people there. There were professionally-dressed people, people who brought along their kids or spouses, people who had never attended a meeting before, and people who had been attending for longer than I’ve been alive. Some had been sober for years, others for days. Some had relapsed. It’s humbling to think that there are so many people who struggle with this and we would not even know it when passing them by on the street or working by them side-by-side. It was immediately clear to me that this was a safe place for them to come to, not only to maintain their sobriety, but also be able to check-in about things and gain and give support to others who have walked a similar path.

....

Many of the attendees who spoke and shared their experiences relayed that they do not think it is possible to overcome this addiction without a sponsor, and that sponsor is preferably someone who is in recovery themselves. I completely understood this statement and it resonated with me for many reasons, not least of all because of being in medical student. Most of the time, I find it difficult to share some of my experiences and feelings regarding school with friends or family who are not in the healthcare field. Somewhere along the line, things get “lost in translation.” While it’s helpful and wonderful to have supportive people around, it’s truly significant when that person can also serve as a “mentor” figure, one who has already gone through similar experiences and can provide advice, share coping strategies, and offer encouragement.   

Sac adventures aka Psychation Part 1

Hello. Is this blog dead? Probably. Actually, I think I'm going it resurrect it. I suppose an 8-month hiatus isn't so bad, considering it was during the most grueling year of medical school, but this was also meant to be a cathartic outlet for me and I shouldn't keep neglecting it, even when I'm busy busy busy. New goals for 4th year. I cannot believe I'm already an MS4. (More on that later.)

Anyway, Rotation 3 was Psychiatry, and I definitely had more time on my hands than before (weekends off! whaaaaat). Cue some adventures such as going to the Crocker Art Museum. I love going to museums, and cannot believe I hadn't been to the Crocker yet. When med school friend F signed us up for a free session there, I finally got my chance. It was a group of us touring the museum's newest collection for about an hour, discussing how we felt about the art pieces (for an art therapy/pain management research project), and then we were free to explore the rest of the museum for the day (FOR FREE!). What a steal! Glad I got my art fix in.

Since I also had plenty of time on my hands, I decided to take an elective class as well. Yep. Elective during 3rd year of med school. I had actually meant to take this class last year, but it conflicted with another commitment I had, so I was excited to take it this year since most of the sessions were during my Psych rotation so I knew my evenings would be free. It was a "Healthy Living Fit" class, divided into Nutrition, Exercise, and Mindfulness modules. The nutrition portion really introduced me to some things I hadn't thought of before and encouraged me to swap out certain things in my diet. For example, I rarely buy ice cream now (shocking). Though I will definitely eat it once in a while, just not like on the daily at home. I also swapped out cow's milk for almond milk instead, and started using almond butter. I also tried to incorporate more protein in the form of beans instead of meats, although that is still a work in progress. I always thought I was a healthy eater, even though I need help with portion-control, but logging my food intake made me realize that my fat content is way more than I realized, at the expense of my protein content. Things to think about.

Free weekends = treat yourself

Conveniently have a fridge magnet to remind me which foods are better choices and which aren't. Why are chocolate chip cookies under "extremely limited consumption?" 

Apple Hill

One thing I've been meaning to do while living in NorCal is go apple picking. I've never gone fruit picking before and it seems like such a cool and interesting thing to do. Last year a few of us did go to Apple Hill (about a 45 minute drive from our med school), but we missed the apple picking season and it was already time for pumpkins. We did enjoy our day, but it was still a fail in that we came back empty-handed. This year, we made sure to double check when apple picking season starts (Labor Day weekend!) and when the best time to go is. And I am happy to report that our mission was successful.

Apple-caramel crisp (top), blackberry cream pie (L), and pumpkin pie (R).

Granny smith and gala mostly.

I thought this seemed really peaceful. And the logs on the side were a nice touch.

So excited.