Mixed Feelings

My time in Lubbock is rapidly coming to a close — I only have four more days of left of actual medical school.  On Thursday, I will finish my last day in the Cardiac ICU, then I will go to the Student Affairs office and drop off my ID and scrub card, and then go pick up a rental van to prepare for my move back to DFW.  E (somehow Ellen lost the last four letters of her name while I was away) will fly out Friday morning to drive my car back home and I will leave Lubbock behind for good.

I know that I should feel really excited about finishing school and getting home (and of course I do), but I also feel a little sad about leaving West Texas and the friends I have made here behind.  Last night my FMAT friends took me out to dinner to say farewell.  I cherish them all and am privileged to have come to know them.  Each of them will make great contributions as family doctors and I will miss the opportunity to share the residency experience with them.  I have come to appreciate the friendly nature of the people and the less than frantic pace of life here in West Texas.  I believe that God nudges us in certain directions for good reasons and I am thankful that he nudged me to Texas Tech to spend the last three years.

That being said, I also am extremely grateful that He has nudged me back to DFW to continue my journey.  I will get ten days “off” between the end of medical school and the start of my residency.  I use quotation marks because, starting the day after I return, E and I are moving from our home of twenty years to a home closer to both her work and to the hospital.  Nevertheless, we plan on taking some time to visit some local museums like a couple of tourists on vacation.  I hope to be able to find some time to reconnect with the people I left behind and I look forward to forging new friendships in my new residency.

Looking back on it all, I am amazed by how quickly the three years passed and how much I learned during that time.  The fact remains that I have so much more to learn over the next three years of residency before I will be ready to practice medicine.  I only hope that the good Lord will open up some space in my cluttered brain for all the knowledge I need to acquire.

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We Are Going Home Toto!

March 30, 2014 4 comments

To all of you who took the time to read my musings over the past nearly three years, I apologize for failing to keep my blog updated.  That being said, I will offer a recap of my third year to date.  As an overview, I have enjoyed my clinical year greatly.  Unlike the first two years where most of the learning is done abstractly through lectures and reading, the bulk of the learning from the clinical year(s) is done at the patient’s bedside.  Now when you learn something, you have a person to attach that knowledge to, which makes it extremely easy to remember.

The third year is divided into six eight week rotations consisting of Family Medicine, Internal Medicine, Psychiatry, OB/GYN, Surgery and Pediatrics.  In my case, I completed my family medicine rotation in my second year (save for the final exam with I took in November of my third year),  which left me with only five of the standard rotations to complete.  Internal medicine was the first and hardest rotation for me.  IM used to a twelve week rotation and the IM folks are still miffed about being cut down to eight weeks.  Their solution is to  try to cram twelve weeks of material and work into eight weeks.  The result is that you work six days a week and are told constantly that all of your free time need to be dedicated to reading.  The result is an exhausting, but rewarding, eight weeks.  I learned a lot during that time and between family medicine and IM was able to build a strong base for my next rotations.

Psychiatry followed IM for me, which was a blessing.  The cornerstone of Psych is the ability to establish rapport with the patient and to be able to gather relevant information.  That is in my wheelhouse and I found that I flourished in such an environment.  In fact, I gave some real thought to whether I should practice psychiatry.  After much soul-searching, I came to the conclusion that psychiatry was too narrow for me and that too much of the field was about throwing some pills at a problem and seeing what happened.  Instead, I decided to build a base of knowledge about psychiatric issues that I could use in my family medicine practice.

My next rotation was OB/GYN.  As I told my wife during that experience, I saw enough hoohaws during that rotation to last a lifetime.  Seriously though, I learned a lot during that rotation and got to deliver some babies, which made it a worthwhile experience.  I never had a moment where I thought that I should consider doing OB/GYN exclusively, but I will consider incorporating some aspects of it into my FM practice.

Next came surgery, which I was dreading.  Looking back upon it, I think that I dreaded it partly because I feared that the personalities of the surgeons would mirror the personalities of the hardcore litigators that I left behind, and partly because I would be learning about things that I would never use in that I knew that I would not become a surgeon.  In the end, the experience was much better than I expected.  For the most part, the personalities of the physicians were not as advertised.  I found a wide variety of interesting and talented people who were eager to teach.  Indeed, the director of the rotation was one of the most delightful men I have ever had the pleasure to meet.  Even though I came in with low expectations, somewhere along the way I learned a lot and ended up finishing second in the rotation.  The only major downside was that the hours of standing in place caused my right leg to become very painful due to an issue with my lateral femoral cutaneous nerve, which has caused me to start wearing suspenders (like I needed anything else to set me apart from my younger classmates).

I am now halfway through my last eight week rotation, Pediatrics.  What is not to love about pediatrics?  I get to work with kids all day, and not all of them are sick.  Indeed, many are perfectly healthy having just been born, or coming in for well-checks and routine follow ups.  It has been a wonderful way to wrap up my traditional rotations.

I still have two four-week rotations to complete before I leave, but I think that I will save discussion of those for a later date because I fear that I have buried the lead.  As the title of this post reveals, I will be going home.  Although Tech’s FMAT program is designed to feed directly into it own FM residency program, the school supported me in my quest to place into a program in the Dallas are so that I could return home to my family.  The process was a difficult one inasmuch as I likely was the only third year medical student in the country applying for a residency spot, which raised a number of logistical issues.  I plan on writing in the future in more depth on how the process worked, but for now I will just say that I was blessed with having two interviews in the Dallas area and one here in Lubbock as a safety valve.  Both of the Dallas area interviews were with excellent programs and both went well.  In the end, I had to rank the programs in the order of my preference and I ended up ranking the Baylor Garland Family Medicine program as my top choice.  A little over a week ago I attended Tech’s Match Day ceremony in which the senior class simultaneously each opened an envelope revealing the program with which they matched.  My envelope contained the name “Baylor Garland Family Medicine” and I was ecstatic.  I get to go home, and to a program that fits me quite well to boot.  In his speech after the envelopes were opened, the Dean of the medical school said that I had made history in a good way by being the first FMAT student to be placed in a residency program outside of Tech, which he sees as a validation of the FMAT program that he pioneered.  Although that was all very flattering, the only thing that really mattered to me was that I am going home. Praise God.

Thank you for sharing my journey with me.  I plan on writing more on the residency selection process and on the pressure packed final eight weeks of my stay in Lubbock.  Stay tuned.

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Finished With Year Two

It is hard to believe, but I returned home today and am finished with my second year (and then some).  The qualifier relates to the fact that I have also completed my Family Medicine rotation along with geriatrics and palliative care.  Because of the accelerated program, I am now two-thirds of the way through medical school.  As I sit here writing this I find myself a little run tired from the two-year grind, but excited as I look forward to what is ahead.  And what lies ahead?  I am glad you asked.

On June 25th I take the Step 1 exam.  It is a seven hour exam covering everything we learned (or were supposed to learn) over the past two years, down to minute factoids.  I have been studying for the exam over the past several weeks and have complete 2,200 practice questions.  I start an online review course next week and plan on studying full-time up to the exam itself  My grade on the exam is important because I plan on applying this coming fall for residencies in Dallas and will be competing against students who are in their fourth year of medical school.  I feel that it is important to have a good score to even the playing field a bit.

After the Step exam, on July 6th, Harry and Laura will be getting married in San Antonio.  From there I will return to Lubbock to start my six clinical rotations on July 8th.  My rotation schedule is Internal Medicine, Psychiatry, OB-GYN, Surgery, Pediatrics, and Critical Care.  I am excited about the clinical phase of my schooling, especially after having such a good experience with my Family Medicine rotation.  It will be good to get to see patients again.

I promised myself that I would take a few days off from studying, but I can already see that doing so will be difficult.  I have a huge stack of materials I need to comb through to refresh my memory and am tempted to pick up some notes and skim through a bit.  I will try to fight off the urge a little longer and enjoy this beautiful day.

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Post Test Glomerulous Excitis

February 18, 2013 5 comments

Today we had an exam on the renal unit of our pathophysiology block.  I thought that the block was not very well taught.  It might just be that the subject matter is not conducive to presenting the material in a cogent manner, but I suspect that it has more to do with the shotgun approach of the lecturers, spewing out material and details, leaving it up to us to try to make sense out of it.  I must admit that I struggled getting a handle on the material.  I think that part of the problem was that the names were so cumbersome, like Post Streptococcal Glomerulonephritis, Membranous Proliferative Glomerulonephritis, Segmental Focal Glomerulosclerosis, and the like.  I studied hard all weekend and finally settled on a blend of memory palace, acronyms, and sheer brut strength memorization of seemingly never-ending facts.

I went into the test willing to accept a low grade knowing that I had two decent test grades in the bank from the first two units.  The test started off swimmingly as I worked my way through the first twenty or so questions confident that I knew the answers.  I got bogged down in the middle of the test, however, as the questions became more complex and my confidence waned.  In fact, I ran across a few questions that led me to wonder whether I had slept through a lecture or two because they seemed totally alien to what I had studied.  The last twenty questions, however, finished off as the first twenty had begun, with me being confident of my answers.  I then submitted my test for grading and waited to see my results.  The computer told me that I had answered sixty-eight right.  I was happy to see that, but I could not remember how many questions were on the test.  I knew it was in the seventies, but that was all.  When I walked out, I ran into the block director and I asked him how many questions were on the exam and he told me seventy-one.  I was elated because that meant that I had only missed three, giving me a ninety-six (rounding up of course).  If memory serves correctly, that is my best score in medical school and on a test that I was feeling quite shaky about.  The block director then told me about the four random questions that had been thrown in by the curriculum director, questions that had not come from the lectures.  These were the questions that had me scratching me head during the test.  That made me feel even better about missing only three.

I was elated about doing well on the test, but I had no one to share it with.  I take the tests rather quickly and usually do not hang around for the test review where you can see what you got wrong and challenge questions that you think were inaccurate or unfair.  My friends, however, take the full time on the test and stick around for the review, meaning that I would have to hung around for about an hour to talk to anybody.  As happy as I was, I was not about to hang around the school for an extra hour.  Instead, I came home to share this with you.  Thank you for putting up with me as I gloat.  I try not to do it often and, frankly, my goal here is not to gloat.  Rather, it is to share the excitement I feel for getting lucky on a test that was much easier than the material it was examining.

I did have a particular interest in the renal block.  Although diabetes was the ultimate culprit in my mother’s early death, the failure of her kidneys and her rejection of her transplanted kidney was the driving force behind her suffering and ultimate demise.  I think that my personal interest in the material helped me in my studying and in getting a good result.  Hopefully, I will be able to use what I have learned to help others in my mother’s position to avoid or, at least, put off the terrible effects of diabetic nephropathy.

On a final note, I want to update a couple of things from my last post.  As you may have been able to surmise, I did not come down with pneumonia after taking a face-full of pneumonia-ridden sputum during my hospital service.  After service was over, I continued to follow my patients’ progress by logging on daily to the electronic medical records to read their progress notes.  Sadly, the pneumonia patient for whom I had cared declined steadily and died the following week.  She was an elderly lady with serious underlying medical conditions, but I was sad to learn of her passing.  According to the notes, she chose to have the ventilator removed and she passed in the presence of her family who had gathered to read from the Bible and to sing around her.  When it is all said and done, that does not sound like too bad of a way to go when one’s time is up.

Wow, way to tamp down a really good mood, John.  Sorry about that.  Perhaps it is beneficial, however, to temper excitement over an abstract number with real life perspective.  I think that I will take a nice walk now before turning my sights to gastrointestinal concerns (meaning the subject matter of the next block, not dinner).

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Hospital Service

January 30, 2013 1 comment

Monday I finished my second round of hospital service for my family medicine rotation. In order to give us a better feel of true hospital service, they assigned us to five consecutive days on the floor instead of the Tuesday/Thursday for a month schedule we had in the fall. The downside of the consecutive days is that I missed three days of classes during that time. I was able to catch up with the taped lectures, however, so it worked out alright. The best part about this round was that I got to follow two patients closely for the five days. One of them I got to see in the emergency room first and then follow her on the floor. The continuity of care aspect of the experience was fantastic.
I learned a tremendous amount in the five-day period. The most important thing I learned was how much more I have to learn before I can consider myself to be anywhere near competent. Another important lesson I learned was to be vigilant in protecting myself. One morning I was focused hard on listening for bowel sounds on a pneumonia patient when the patient let loose a productive cough right in my face. I am now suffering from what is referred to in the field of biostatistics as “informational bias.” In other words, because I got a face full of pneumonia charged sputum, I now perceive every bit of tiredness and every sniffle and cough as the beginning of a raging course of pneumonia. In truth, I am just being paranoid and am not likely to become ill given my existing state of good health. In the future, however, I will be much more careful how I position myself when examining a patient with an infectious condition.
I learned much about the politics of medicine during these five days. I also ran into a few medical legal traps along the way. The biggest such trap is how to deal with the issue of chest pain. Once documented, chest pain is presumed to be angina, or a heart attack, until proven otherwise. This triggers many tests and procedures in order to keep the lawyers away in case something bad does happen. Because of this, doctors have to be careful how they ask about chest pain and how they document the response. It is something that I will have to master sooner rather than later. Those damn lawyers screw up everything!
I would write more, but I just felt a tickle in my throat, so I have to go take some vitamin C and gargle for a while to tamp down the plague of bacteria fulminating in my throat.  One way or another, the bug is in my head.  Hopefully, it stays out of my lungs.

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Halfway Home

December 31, 2012 5 comments

Upon completing my final exam in Multisystems Disorders on December 21st, I marked the halfway point in my journey to becoming an M.D.  I have one more semester of classwork to go followed by one year of clinical rotations.  Thanks to the accelerated Family Medicine tract, I will not have to complete the fourth year of rotations before getting my degree.  At first blush I have trouble believing that I am halfway done, but looking back at all the work and miles put in, it seems about right.

The next semester looks daunting.  It starts off with systems disorders, which covers everything that can go wrong with organ systems, system by system, starting with cardiovascular.  I am continuing my Family Medicine rotation along with geriatrics and palliative care as I did the past semester.  The daunting part starts with the fact that, in the last week of January, I am on hospital service twelve hours a day for five days straight, meaning that I will miss three days of lectures in a block where the test is only going to cover seven days of lectures total.  Fortunately the administration responded to my concerns and have provided me with audio from last year’s lectures of the material I will be missing, which will allow me to get a head start on the material.  The daunting part continues with the looming spectre of the dreaded Step One exam, a comprehensive day-long examination covering the first two years’ worth of material.  All medical students across the country must pass Step One in order to continue on with medical school.  I will be taking the exam in June and need to start reviewing now in order to be fully prepared.

The holidays have been a wonderful break from the drudgery of school.  It was especially nice to have Dad and Kay join us from our Christmas Day feast of prime rib and yorkshire pudding.  Now that the kids our grown, our focus has been on enjoying one another’s company instead of gift giving and the shift has been very nice indeed.  I know that my family time will shrink as I enter rotations and then residency, which makes the time we do get to spend together all the more sweet.  As I write this post, the hours are winding down on 2012.  To everyone reading this, I pray for a blessed, prosperous, and healthy 2013

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Eggs For Dinner

October 30, 2012 5 comments

Yesterday was the start of a new block, Multisystems Disorders and Cancer, which is basically the launch of pathology. Up until now the focus of our classes has been on the normal functioning of the body. From here on out we focus on how things go wrong, such as disease and injury. After a grueling twelve weeks of Neuroanatomy followed by the most ridiculous final ever, we started the new block with a scheduled six hours of lecture with an hour lunch break of a sales pitch for a review class for the end of the year Step 1 exam, designed to scare our pants off.  Mission accomplished.
On the way back to the apartment (or the bungalow as E likes to call it), I ran to Walmart to pick up some things. In the parking lot my cart shook so much that the carton of eggs dropped from the top to the bottom. When I got back to the bungalow and started putting the groceries away I discovered that a number of eggs had broken in the mishap. My usual reaction to such misfortune, especially when feeling stress, is to act out in frustration, not unlike a petulant child or a cornered politician. Yesterday, however, my reaction was completely different. Looking at the broken eggs I immediately thought, “eggs for dinner!” I got out the pan, turned on the stove top and salvaged the broken eggs by cooking them for dinner. Later, as I sat eating my eggs, I thought about what had just happened. It is never too late to have a moment of growth in maturity. I have decided to take this otherwise insignificant moment in my life and try to integrate it into my approach toward unfortunate events in the future. From here on out, whenever I am faced with something unfortunate that would have soured my mood in the past, I will now try to figure out how to make “eggs for dinner” out of it. I know that I will not always be able to accommodate such events in the same fashion I was able to turn the broken eggs into an acceptable meal, but maybe just making the effort to find a positive solution will help me handle them in a more balanced and mature manner.
As I write this, I just realized that I am awaiting my grade from the Neuroanatomy final exam, which was the most ridiculous test I have taken in recent memory. Hopefully, I will not be looking at ways to make eggs for dinner out of a disastrous score, but I am prepared to try if that should happen. I know that some of you might be thinking, “what is so great about eggs for dinner?” It is not that the eggs were great. It is that eggs for dinner was an acceptable solution to the problem. And besides that, because I had eggs for dinner, now I get to have ribs for breakfast!  Yum.

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