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.

Culinary Adventures

My second rotation was a little more flexible, especially during my outpatient weeks! So of course I had to eat my way through it.

Most important meal of the day.

Impromptu contest at the Fourth of July Last Minute BBQ hosted by K.

I was finally able to attend the CA State Fair! It was already over before I moved up to Sacramento my first year, and I didn't get a chance to go during second year, though I really cannot recall why. I was extremely excited to go this year and was looking forward to it a soon as third year began. Luckily, the fair coincided with my outpatient month so I was fortunate to have the extra time. Third year has actually been really great so far. I'm finding that I am actually spending *more* time with classmates, going out and enjoying the things Sactown has to offer. I think a lot of us are putting in the extra effort to get together because 1) we don't get to see each other as often now that we are spread out among different rotations and different sites and 2) it's a wonderful way to catch up and compare notes about how things are going.

Anyway, as evidenced below, I ate way too much, and people are willing to deep-fry anything and everything. Case in point: deep-fried snickers, nutella, cheesecake (what the...?). It's glorious.

Fried fried fried. Also, dragon!

German chocolate cake (L) and banana creme pie (R).

Summer pasta with beef ragu and garlic bread. 

But now I'm back

Well, it's been a while. I feel like I've been less inclined to write and more likely to amass pictures that I want to post. This will probably ring even more true as boards study time inches closer and closer. We are already on Block 4 aka Pathophysiology aka the last block of pre-clinicals! Block 3 was all neuro and psych and totally up my alley. And as the new class started, it really sunk in that we are not the babies of the school anymore. Eek!

Orientation week party for the new kids on the block.

Med school is really hard.

Like really hard. Like so much so that your MS3 friends will bring you treats from their vacation.

In other news, my good friend L from like preschool (seriously) is getting married!!! I'm a little bummed that I won't be able to attend the wedding. It's on the East Coast and it would be nearly impossible with my class schedule. :(

BUT, I was able to attend the bridal shower, which was so much fun! And here are the cupcakes to prove it.

September Break Fun:

Chicken katsu.

Restaurant by my house that I did not know existed. 

Brunch with the fam.

Shakshuka for the win. 

And hot cocoa. Of course. 

I like to eat.

July (thus far)

Pizza night extravaganza with Year 1 Anatomy group!

K and I have an unhealthy relationship with colored pens.

Fam bam came up for a few days and wanted to do touristy things. Exhibit A: Sacramento River cruise.

Projected the World Cup finals at our lecture hall at school! Oh snap. 

Congrats to Germany! By the time the next WC rolls around I'll be finishing my intern year, ha!

This is what happens when you have neuroanatomy lab with clay. Brain modeling or professor modeling? ;)
All credit goes to the group that so expertly made this.

Harry Potter trivia night! Medical Muggles: Wingardium Mediosa placed a respectable 4th out of 46 teams.

On to MS2

Today is the first day of summer - the season, I mean. It's also the penultimate day of our "summer" break. These last six weeks have just flown by. I guess that was partly my fault since I split up my break. I did a two week "mini" psych clerkship where I followed around psychiatrists on the consult service in the mornings and outpatient clinics in the afternoons. Since I was going to be around, I figured I might as well be at clinic as much as I could as well. This meant the timing of things would be a little tricky. I ended up going home for 2 weeks after finals, then coming back up for a couple of weeks, and going home again for another 2 weeks.

I did learn a lot doing the summer program, though. My attending wanted to make me feel like I was part of the team so she had me do an oral presentation on the neurocircuitry of OCD and also present a paper for journal club. It was pretty cool being challenged at the level of an MS3. It makes me less nervous about the transition to third year. Anyway, psychiatry is definitely a tough field to go into. It's not necessarily physically demanding, but very much so mentally and emotionally. I really really liked being on the consult service though. It's a nice mix of medicine and psychiatry since these patients are usually brought in for a medical condition and need to be evaluated for an underlying psych issue or develop something throughout the course of their inpatient stay.

The rest of break was a mix of being sick right after finals, hanging out with friends, and eating a lot as usual.

Life lesson learned: I like inpatient much much more than outpatient - at least for psych.
Movies seen: 3 (X-Men, The Fault in Our Stars, 22 Jump Street)
Books read: 6
Binge-watched: alllllll of Sherlock and Game of Thrones season 4

The Fault in Our Stars was amazing. Amazing. Amazing. It's such a charming story and I bawled all throughout the book and movie. I'm a sap for YA lit. I tore through the Maze Runner series during the break. The movie comes out in September. Cannot wait. In the meantime, it's 12 weeks of Brain and Behavior and as many World Cup matches we can watch on the huge screens in our lecture halls.

Wet burrito at CaCao.

Traditional post-finals Porto's outing  with med school friend A. So happy!

Mmmmm cappuccino mousse.

Baked my brother brownies and a cake made with turmeric as soon as I got home. What a spoiled brat.

My brother's all-time favorite food. My grandmother made this for him even though it's blazing hot. It's yogurt-mint stew with meat/wheat balls and chicken.

Move night with high school friends. Those on the left are roasted strawberry-balsamic reduction-greek yogurt popsicles. The ones on the left are margarita mix-greek yogurt popsicles. 

I decided to chop off my hair for new beginnings. Wish me luck with Year 2!

Honduras trip

aka How I spent my Spring Break aka "Remember that time we almost died in Honduras?"

Spring break was a few weeks ago and I spent it doing a medical mission trip in Honduras. How I got involved was totally accidental, too. I recall receiving a mass email from the organization heading the trip, but didn't give it much thought. There would be some lunchtime presentation discussing it sometime during the middle of Block 1 so we'd probably get some reminder. But, it had completely slipped my mind until anatomy partner K brought it up. We went to the talk together and I was hooked.

I had never done something like this before and that was a huge factor in me wanting to go. Some friends had gone during undergrad, but it hadn't interested me much before. Now, I felt like I would actually be part of a team since I have an entire (!) few months of medical school under my belt. It would be an amazing opportunity to travel to Central America (haven't been!) and also get to know my fellow classmates better. If there is one thing I learned while on my senior class trip to Armenia, it's that trips like that tend to bring people closer together (or the opposite, but let's think positively!).

So I signed up. And then I learned Honduras has the #1 highest murder rate in the world. Oh joy. Well, there was no backing out now. I convinced myself that being in a group setting is not the same as being some random tourist and I also made sure to neglect to tell my mother that statistic. Ha! (As to the second "aka" above, that was a running joke between one of my roommates and me during our bus rides to the various clinic sites. Speed + steep mountains = palpitations for yours truly.)

Our team was composed of physicians, dentists, nurses, pharmacists, us MS1s, a couple of MS4s, and two undergrads. We had had biweekly gatherings prior to the trip to prepare and get to know each other better. And in Honduras, we met up with Honduran physicians and dentists, along with some translators too, to round out the group. Here we go!

DAY 1
We literally left the first day of Spring Break, in the wee hours of the morning, and returned in the wee hours of the morning on the last day. This year we would be traveling to Santa Barbara, a new location from previous years that is about a 4 hour bus ride from the capital of Tegucigalpa. And we couldn't even fly out of Sacramento. So we took a 2 hour bus ride to San Francisco, 5 hour flight to El Salvador, 30 minute flight to Tegucigalpa, and...spent the night there to avoid having an even longer travel day. To our delight, there was WiFi in the hotel.

We finally made it to Honduras! Photo credit: A

View from our hotel room in Tegucigalpa.

View from hotel balcony.

DAY 2
Bus ride to Santa Barbara. With a pit stop at Wendy's for lunch. Seriously.

Leaving Tegucigalpa for Santa Barbara.

Homes damaged by a mudslide. 

The streets of Siguatepeque. Photo credit: Z

DAY 3
Today was our first day in clinic and we set up in a school in the Santa Rita area. I was assigned to Lentes for the day - doing eye exams and providing prescription glasses. I was a little glad I wasn't in Medicine on the first day so I could brush up on my Spanish before tackling patient histories. I can't believe how much I've forgotten in just a few years. I need to try and practice more often. We ended up seeing a little under 300 patients today, which is fewer than the average day, but also pretty decent for a first day.

The Lentes team! Photo credit: Z

What I learned while in Central America.

DAY 4
Pharmacy day in Guacamaya! Drugs, drugs, and more drugs. Most of my day was spent counting pills, writing instructions in Spanish, and deciphering the hieroglyphics that is some prescriptions. I vow to write as legibly as possible when I'm grown up and an MD.

DAY 5
Free day! The original plan was to go see the Mayan ruins at Copan, but when people heard it was a 4 hour bus ride (meaning 8 hours in the bus roundtrip), they weren't so enthused anymore. I really really really wanted to see them and I'm so glad our team leaders were able to work things out so that whoever wanted to see the ruins could go while the rest could take a free day to shop or relax or whatever. I mean, c'mon, these are architectural goldmines. Could even be a once-in-a-lifetime experience. No competition.

Traffic.

Photo credit: Z

U-C-L-A. Bruins at the ruins ;)

DAY 6
My Medicine day in Sapote! I was pretty excited to work with our team leader, and kind of got a little shock when he said, "Well, you're the doctor, I'm just here to translate if need be or if you have any questions." Oh dear, I wasn't prepared for that. Glad A and I tag-teamed on a few patients so that between the two of us we could gather a more or less decent history. And then we had to come up with diagnoses and treatment plans so it was kind of cool pretending to know what we were doing. Fake it till you make it, right? Highlight of my day: diagnosing a UTI from an interview I did (alone! in Spanish!) and knowing to prescribe TMP-SMX! It helped that we had had Quiz 5 which covered all of this right before the trip. ;)

DAY 7
Don't remember the town but we passed by Lake Yojoa on the way. Was supposed to finish up Medicine today but due to some team members falling sick, I covered Pharmacy. Which wasn't so bad since I had some more responsibilities so I felt less like a human counter and more like I actually know why I'm giving certain meds to people. We saw a record number of nearly 500 patients today, bringing our weeklong total to over 1600 patients! We also broke the record for number of patients seen for this trip ever and had four clinic days only instead of the usual five. Yay team!

DAY 8
Time to go back to Tegucigalpa. We stopped midway in Siguatepeque to shop shop shop. I managed to buy a few souvenirs and would have liked to buy some more, but I ran out of cash and chickened out on using my card. I really wanted to save that for absolute emergencies and not risk falling victim to identity theft. I had let the bank know exactly when I would be out of the country but was still wary about using my card. But oh well, still got some nice canvas painting for my parents, some small woven baskets and wooden jewelry boxes, and a very interesting gift for the brother. ;)

Laka Yojoa. Photo credit: Z

Painting of Lake Yojoa for my parents. Any resemblance?

More goodies.

DAY 9
Back to the USA! I was ready to leave, but also reluctant. It was nice living in a bubble and being with my classmates practically 24/7 - every night we played Banangrams and Mafia. We bonded and our team really meshed well together. I really miss our adventures already. From geckos in our bathroom to tortillas, refried beans, and plantains at every meal, this was such a wonderful experience, especially since it involved global health. What I'm really surprised about is that I didn't get sick at all. Usually when I travel, I'm the one in my family who gets sick while everyone else is just super. Just plain old good luck I guess. And finally to round out our adventures, as soon as we took off from El Salvador, the oxygen masks dropped in the row in front of us. Funny! But really, it was an unforgettable trip and I'm so thankful for our fundraising efforts - almost every single member of our team was able to cover all their costs. Amazing!

Pupusas during our layover in El Salvador.