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.

Break time!

Because we at UCD believe wellness is the key to success, we were blessed with 1 week off after the end of our second rotation. Yaya! I got to go home after a 4 month absence from the city of Angels (the longest I've ever been away). Mostly I did nothing. And by nothing I mean eat too much and hang out with people I hadn't seen in a while. Perfect way to recharge for the rotation ahead.

Got to see my ragamuffins!

First stop: Sprinkles ice cream sundae aka ice cream in between a cupcake. I have to admit, this may have been too much for me.  

Taiwanese Beef Noodle Soup. Perfection! I had never tried this before and it was simply amazing.

Had to treat myself while in the motherland.

On to Psychiatry!

Rotation 2: Pediatrics

After my Surgery shelf exam, I had 2 whole days off before starting my second rotation. I didn't really know what to expect as I've heard really great things about Peds and some not-so-great experiences others have had. Overall, I was happy with my schedule and sites so figured it would be an interesting couple of months and definitely a respite from the OR!

I started off on Newborn Nursery. I basically got to play with babies all day, so I know you are all incredibly jealous. At first, I was very very very careful when examining the babies. After all, they were like 2 HOURS OLD. I would put my stethoscope on them extremely gingerly, so much so that my attending would watch me with a bemused expression on her face. She later assured me that I wouldn't break the babies and I could be a little more confident with the way I was conducting the exams. Ha!

I then had 3 weeks of outpatient. The hours on outpatient are glorious. It's basically 9-5 and I had to be in clinic 3 days out the week! It was such a change from the 13-hour-6-days-a-week schedule I had gotten so used to. It was nice to have the chance to catch up on some life things, like going to the optometrist, taking my car to get serviced, getting my laptop fixed, etc. I really enjoyed outpatient too, which was a little surprising to me. I've always known that I like the inpatient setting more than outpatient - I find the time constraint of appointments a little difficult to manage and I worry after the appointment if I did all that I could for the patient. At least on inpatient services, you can always check in on the patient whenever you want to, get more information, etc. Inpatient cases tend to be more acute as well, which I find exciting. It's like a puzzle you have to solve. And (at least in academic centers) you work in a team, so you feel less isolated and it's more of a learning environment where it's easy to call consults and bounce ideas off others. So when I found myself really enjoying the outpatient part of Peds, I figured it must be because of Peds itself. I told myself I would wait and see how my month of inpatient peds went and then figure out if this is something I want to consider pursuing as a career.

The preceptors I worked with in clinics were also really great about letting me take the reigns and seeing patients on my own rather than simply shadowing. I don't think all of my classmates had the same experience and that's really unfortunate. There's a huge educational benefit to being active participants in patient care so I'm grateful the pediatricians I worked with were willing to do that for me. I also felt I learned a great deal in just a few short weeks. Even though it was summertime, I still saw plenty of sore throat cases, rashes, ear pain, and of course sports physicals. Although some cases were tough and I couldn't get more than one-word answers even though I was trying really hard, other times it was just so easy to build rapport. One kid even gave me his sticker!

After that, I had 4 weeks of inpatient service on the Wards team. Initially, I had requested either the Heme/Onc service (blood disorders and cancer) or Nephrology (kidneys), so I was a little bummed that I had gotten my third choice pick. But it turned out to be the greatest thing ever. I absolutely loved wards so very much. It's the general service so I got to see what you call the "bread and butter" of pediatrics - the typical cases that you manage. Each of my patients had a different issue so I got to experience a variety of things and it turned out to be great not just educationally but also as validation that this might just be the field for me. I loved learning about pediatric conditions, loved interacting with kids and their families, loved working with the various interns, residents, and attendings, and just always felt a sense of happiness. I was happy when I woke up in the morning, exciting to go in to the hospital and experience my day. And I was happy when I came home in the evening, excited about the things I had seen or learned about. Studying pediatrics also did not feel like a chore. At the risk of sounding like a nerd (but we all know I am one, not ashamed to admit so), I would read for hours and not realize how much time had elapsed. From meningitis to botulism to irritable bowel to rashes to cystic fibrosis, I took it all in as a starry-eyed third year student is apt to do.

On our last day of service, the pharmacist brought over samples of the medications we give kids so that we can taste them and experience what it's like. (Before anyone gets bothered, we used the syringes so we were only taking in a few drops.) Let me tell you, most of these are just nasty. I felt bad thinking back on all the times I had to prescribe some of these. I'm sorry, kids! It was for your own good and I'm so glad you got better!

PharmBar.

Shelf day. Peds students have a dress code. 

What a wonderful rotation this was! I'm sad to leave but also excited to see what other surprises third year has in store for me. Check back in 8 months time to see if Peds is the winner.

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.