MS-III
Friday, July 30, 2004
One Month Down
I've turned in my scrubs and pager.
I've handed over my name badge and parking tag.
My month of Internal/Infernal medicine at JPSH hospital is over. I must say, it was nothing like I expected. Medicine is actually an intellectual pursuit. As a nurse working on a med/surg floor, I thought I knew a lot about the care of patients in the hospital. I'd see orders written by a physician (who never spent more than 15 minutes on the floor seeing his 7 patients) and would often wonder why he would order x, y, or z for this patient when they OBVIOUSLY needed w.
I've learned the error of my ways this past month. Medicine physicians really care for their patients (for the most part - there are always exceptions). The few minutes they spend with the patient in the morning on rounds is nothing compared to the amount of time spent discussing the case with consultants, other colleagues and reading about the newest treatments available for such-and-such disease. I was blown away!
Overall, I can say I've really enjoyed medicine thus far. JPSH hospital, while the largest hospital in Tarrant County (and the only county hospital), is still home to some very intelligent and caring physicians. The patient load is tremendous, but still the physicians spend the necessary time with each patient to understand his complaint and to discuss the best treatment. They are also willing to spend as much time as needed with a patient to completely understand his/her social/family issues. I don't know how many wonderful social workers I've worked with in the past month whose sole goal is to help patients find funding for their healthcare. What a system.
Would I go to JPS again? Absolutely! My team was great. Drs. H (my resident), S, McC, and G (my interns) were an absolute blast to hang out with. We'd spend hours post-call at Snookies talking and bull-sh!tting until we were too tired to do so any longer. Dr. C (my supposed main attending) is a great teacher and physician. Dr. K (another attending) is very intelligent. Dr. C2 is probably the smartest person I've ever met (even though we had some personality conflicts), and Dr. R is an eminent Infectious disease specialist (and he knows it).
My only complaints about his rotation are that we changed attendings every 3-5 days, so no plan of care was ever safe from the ravages of another attending's whims. We were also left open to the new attending's wrath when we hadn't been managing said patient "his" way. The only other complaint I had is that this rotation was in July, when the interns are green and still wanting to do every procedure themselves. I was not allowed to do anything except H&Ps, admission orders, and daily rounds. No procedures at all. Sad, but I understand why.
That's it.. everything else was perfect. Now, we'll just have to wait and see how my evaluation comes out of this. Tell the truth, I don't even know who will write my evaluation - one of my 4 attendings? Or Dr. Hein? Time will tell.....
Next month is medicine at O with Dr. C. I've heard good things - if you work hard.
Ok, that's all for now. I need to go read some medicine - I have to learn about vertigo.
more to come... ¶ 9:59 PM 0 comments
I've handed over my name badge and parking tag.
My month of Internal/Infernal medicine at JPSH hospital is over. I must say, it was nothing like I expected. Medicine is actually an intellectual pursuit. As a nurse working on a med/surg floor, I thought I knew a lot about the care of patients in the hospital. I'd see orders written by a physician (who never spent more than 15 minutes on the floor seeing his 7 patients) and would often wonder why he would order x, y, or z for this patient when they OBVIOUSLY needed w.
I've learned the error of my ways this past month. Medicine physicians really care for their patients (for the most part - there are always exceptions). The few minutes they spend with the patient in the morning on rounds is nothing compared to the amount of time spent discussing the case with consultants, other colleagues and reading about the newest treatments available for such-and-such disease. I was blown away!
Overall, I can say I've really enjoyed medicine thus far. JPSH hospital, while the largest hospital in Tarrant County (and the only county hospital), is still home to some very intelligent and caring physicians. The patient load is tremendous, but still the physicians spend the necessary time with each patient to understand his complaint and to discuss the best treatment. They are also willing to spend as much time as needed with a patient to completely understand his/her social/family issues. I don't know how many wonderful social workers I've worked with in the past month whose sole goal is to help patients find funding for their healthcare. What a system.
Would I go to JPS again? Absolutely! My team was great. Drs. H (my resident), S, McC, and G (my interns) were an absolute blast to hang out with. We'd spend hours post-call at Snookies talking and bull-sh!tting until we were too tired to do so any longer. Dr. C (my supposed main attending) is a great teacher and physician. Dr. K (another attending) is very intelligent. Dr. C2 is probably the smartest person I've ever met (even though we had some personality conflicts), and Dr. R is an eminent Infectious disease specialist (and he knows it).
My only complaints about his rotation are that we changed attendings every 3-5 days, so no plan of care was ever safe from the ravages of another attending's whims. We were also left open to the new attending's wrath when we hadn't been managing said patient "his" way. The only other complaint I had is that this rotation was in July, when the interns are green and still wanting to do every procedure themselves. I was not allowed to do anything except H&Ps, admission orders, and daily rounds. No procedures at all. Sad, but I understand why.
That's it.. everything else was perfect. Now, we'll just have to wait and see how my evaluation comes out of this. Tell the truth, I don't even know who will write my evaluation - one of my 4 attendings? Or Dr. Hein? Time will tell.....
Next month is medicine at O with Dr. C. I've heard good things - if you work hard.
Ok, that's all for now. I need to go read some medicine - I have to learn about vertigo.
more to come... ¶ 9:59 PM 0 comments
Wednesday, July 28, 2004
It's My Life - The Rest of the Story
Previously on "It's my life...." read the other post - it's too long for me to reiterate.
Ok, so now we're in August of 1994 - has it really been 10 years? That's crazy. Anyway, I'm moving into a dorm room in McConnell hall and meeting roughly 400 people I've never seen in my life for the first time. Not that that's a bad thing - just unusual (for me). So I get all of my things into my dorm room and meet up with a few of the people I remember from the preview/interview days. We begin our friendship.
Roughly a week later, we begin classes. My first class was a general biology class - along with about 100 other students. I'd never been in a class so large! I'd always been in classes of about 15-30, so this was just unfathomable. Culture shock in the extreme. I also attended several other classes - chemistry, english literature, etc.
So, I'm taking classes and all the while trying to adjust to life on a very large college campus. I think the year I started, they said about 25,000 students attended UNT.
Being away from home in such a big city, I became a little lax in my studying and class attendance. As a result, my second semester GPA was 2.19. Not quite failing, but I made a lot of C's that semester. Realizing what was happening, I started studying a lot harder, actually going to class (most of the time) and came out of TAMS with a 2.98 cumulative GPA and 65 hours. Not such a stellar performance from someone as bright as I consider myself to be.
I really enjoyed my experiences at TAMS. While some days I wish I had paid more attention, gone straight the whole time and made better grades, I'm also glad that I had fun while I had the chance. There was a time when I cursed myself almost every day (i.e. while I was applying to medical schools with a 3.29 GPA because of those 65 wasted hours); now that I have a couple more years under my belt, I realize it didn't really matter (I got into medical school anyway) and I don't know what I'd do without those experiences. I'd probably be a lot more boring, if anything. I think I grew a lot at TAMS as a person and intellectually (even if it isn't reflected in my grades). I found out who I am and where I want to go with my life - the kind of person I want to be.
So, in 1996, I graduated from TAMS and was all set to go to Baylor University on a partial scholarship. However, that was not to be my fate, as you shall see.
In late July, 1996, I attended an "orientation" session at Baylor - the purpose was to introduce the new students to the campus and get them registered for classes and let them intermingle with each other a bit. This turned out to be perhaps the best thing that ever happened to me. While at Baylor, I found out what the school is really like - the people that attend school there, the faculty, everything. I also learned that I REALLY didn't like it there and I would NOT fit in. So I withdrew from that school that day.
Of course, now it is July, school starts in late August and I now have nowhere to attend college! I was thinking "OH CRAP! This isn't good." Fortunately for me, I was able to basically walk in at my hometown school and start taking classes there. Also fortunately for me, while attending BFE-University I had the priveledge of working with perhaps the most knowledgeable pre-medical advisor in the history of pre-medical advisors: Dr. A.B. We had multiple very long and serious discussions about my future medical career. It was his idea for me to pursue a career in nursing while finishing up my premedical requirements.
According to Dr. B., this would serve several purposes
1. It would give me time to bring up my GPA, which at the time was sitting at a less-than-stellar 2.98
2. It would give me much-needed experience in the medical field
3. I would have a viable backup plan in case my plans of medical school were to fail
4. I would have a good job in the meantime, even if my plans of entering medical school were realized.
And so, during my first year of classes at BFE-U, I applied and gained entry into their school of nursing. Meanwhile, I continued to take pre-medical courses as well as the pre-requisites for nursing school, which consisted of anatomy and physiology, nursing microbiology (I took the regular version), statistics, and some basic english stuff I didn't CLEP out of because I was too lazy to take the test. All of which I made A's in, so I have a 4.0 GPA for that year. Yippee, I'm going in the right direction.
During the summer prior to my second year of school at BFE-U (1997), I entered the nursing program. I was one of 4 guys in the program - only 2 of us were heterosexual. Right away, I saw the odds were in our favor.
As classes started to wind up, I realized that nursing school was not anything I expected it to be. We were taught nothing medical at all. It was all "nursing theory" and "history" about Florence Nightingale, the "mother of nursing." I'm sure what Ms. Nightingale did was very important, but do I think it has anything to do with the medical or even the nursing professions? No. It was brainwashing - plain and simple. We were made to memorize and recite dates and events just like we were in high school. The tests were just about as bad. Nothing concrete, no medical or even nursing facts - completely subjective stuff about what, according to so-and-so's theory of basic needs, would be the most important to address first? And nevermind the care-plans and physicals we had to write up. Even in medical school a complete history and physical is not 10 typed pages. It was ridiculous. Nothing real, only busy work. Of course, I looked at it as hoops: I'd decided long ago that everything we do is only jumping through hoops to get to our goals... school, the MCAT, applications, interviews, medical school, board exams, residency applications, etc, etc, etc. It is all hoops to get to our final goal of becoming a physician. Even then we'll have hoops - certification exams, licensure, CME requirements.. it never ends. It's all just hoops.
Finally, after 2 years go by, I graduate from nursing school. By this time (1999) , I'm so jaded with nursing school, I decide I'm not going to pursue a bachelor's degree in it. If I HAVE to have a bachelor's, I'll get it in computer science or something. So I get a job as a Graduate Nurse at a local hospital and wait to take the nursing board exams - the NCLEX. That was a joke. Don't ever let any nurse tell you different or lie to you about how hard they studied. It was a complete and total joke. I thought our nursing school exams were ridiculous - they were written just like the NCLEX questions. The teachers at school were only preparing us for the NCLEX all along! So I passed the first time, with no problems. Shortly after this time, I also got married. Another mistake. It has since been corrected.
So I start working as a Registered Nurse on a Medical/Surgical floor at Shannon Medical Center in San Angelo, Tx. At first, it was kind of cool - going to work. After a while, I really got tired of seeing the same patients day after day after day after day after day every time I came in to work. Even after I'd had some time off, the same patients. I felt like an underpaid babysitter - I knew I had to get out. So I start looking around for another job. I apply to the emergency department downstairs and am refused - twice. So, I applly to the ED across town at the other hospital in town - and get a part time position. I begin working there "part time" 40 hours a week. After a month, they decide they want to make me full time and I get to tell the nursing supervisor on the Med/Surg floor just what I think of her and her unit. I'd been waiting for that for almost a year.
Don't think that everything about nursing school and nursing in general is bad - it's not. The money is great if you work it right (if not, you get paid peanuts), you can't really beat the hours, the job market is insane (have you ever heard of the nursing shortage?), and the work (in certain areas) is very cool. I just wasn't meant to be a med/surg nurse - or a ward nurse in general, I think. Of course, this may have been only this one unit - there were some extenuating circumstances going on as well as what is listed above - nothing is ever black-and-white. I may have been perfectly happy on another unit or in another hospital.
Working in the Emergency Department as a nurse is about as close to what I envision true nursing to be as one can get. When people talk about the healthcare "team," this is what they are talking about. Nurses working alongside physicians working alongside respiratory, etc. Everyone works toward a common, forseeable goal. And everyone works hard. None of the shirking responsibility I was always experiencing on the floors. If something doesn't get done, a person can have a bad outcome - not necessarily die, but they might be in the department longer than they need to, etc. Believe me, the physicians and nurses want as few people in the waiting room as possible - so if your treatment takes too long, they start to get edgy.
During this time, I finished up my prerequisites for medical school and took the MCAT. I also decided I wanted to do some travelling before I started school again. I started looking into travel nursing positions. After a few months I landed a position in Philadelphia at Presby. Presby is a nice little "community" hospital right on the cusp of West Philly - not too good a place to be caught late at night, but if you continue down Market for about 10 more blocks, it's a whole lot less good - if you know what I mean.
In May of 2001, we move up to Philadelphia and I started working at Presby. What I didn't realize when I took the job is that Presby is a teaching institution affiliated with the University of Pennsylvania. Very cool, indeed. For 6 months, I got to hang out with residents and medical students, pick their brains and even teach them a little. I also made some of the best friends of my life. Presby was a very cool place and I would love to go back there some day as an attending physician. I really became interested in perhaps pursuing an academic position after going to Presby.
During September of 2001, a group of freaks from the middle east decided to drive a bunch of planes into a few buildings around the nation. I got called in to work that day and spent 12 hours working on a disaster call. That was a bad day in Philadelphia. Everyone was scared and panicked. Noone knew what would happen next and we saw probably more than three times our usual volume that day because everyone in the surrounding neighborhood was freaked. To tell the truth, so were we. The following day, myself and a group of nurses from Presby volunteered to go up to NYC to help, but were refused. They said they already had more help than they could use - which was a good thing.
Of course, during this time, I was interviewing for medical school. I had an interview at XYZ medical school I think the week after September 11th. That was not a fun time to be in the airports. I also had a few other interviews I had to fly out for over the ensuing months, but standing in line for 6 hours the week after 9/11 trying to catch a flight to LMNOP state was not fun. The others were cake-walks in comparison.
I finished my assignment in Philadelphia in December of 2001 and we drove back to LMNOP to enjoy Christmas with my family before starting my next assignment. Why did I choose to come to QRS? I was all but told during my interview that would be accepted at ABC and I loved the school so much I decided to come here and anticipate matriculation in the fall. I took a travel position and worked there for 7 months until school started.
Since then, I have been in medical school.
And that is basically my life up until this point. I'll write more about the intervening time in future entries and tell all about my first 2 years of medical school - and of course I'll be writing about my current experiences as well.
I hope you've enjoyed my life story. Not the best, nor the brightest, but all mine.
more to come...
posted 28 July 2004, Wednesday
A visitor made this comment,
I knew I wanted to become a doctor, however I did really badly on my second year of undergrad were I lost completely my self-confidence and onward my grade kept dropping to the point of C average. I just barely graduated; I could not even pursuit a Master degree, as most programs require at least a B average. I went right into the work force, because of financial necessities, but I find my self everyday, thinking about only if I chosen an easier undergrad program I could have had a good GPA and could have gone to med school. Now I am afraid if I drop everything and go back to school, how about if I can’t do well again. I don’t have the self-confidence, motivation, but it’s still my dream to become a doctor, I almost 29 yrs. I don’t see myself going back to school for at least few years, because of financial obligations. As a result of this I feel completely hopeless. I guest the reason why I am writing to you is that your store really inspires me and I just want to know how you stayed focus and motivated. Thank you, and sorry for my bad English.
Udona
comment added :: 9th December 2004, 11:49 GMT-06
DeLaughterDO made this comment,
Udona,
Thanks for sharing your story with us! I understand what it can feel like to be worried you cannot realize your dreams - hell, I STILL sometimes feel that way and I'm in med school (some days it just doesn't feel REAL).
What can I tell you about motivation? Probably nothing you don't already know in your heart of hearts. Becoming a physician is your dream. If you want it badly enough and every day you ache for it, you'll find a way.
The first step is always the hardest. Once you're out of school and in the workplace, it can be VERY scary to return to school and have to quit working (especially since you become dependent on that income). Could you possibly take an evening class or two to try to get back into the practice of studying?
Do you have someone close to you that is supportive of your dream? I know that is often the most helpful when you are having difficulty believing in yourself... to have your own personal cheerleader, if you will. They can help you through the harder times when you only want to sit down and give up.
First and foremost - I think you need to look seriously into yourself and decide if medicine is something you really, truly want. It's not an easy road; if you are easily discouraged, it might not be for you. You have to be tough-minded and goal-oriented.
I wish you luck in your journey. I think you can do it if you truly want to. Age is not a reason to give up on your dreams. I am 28 now.. We have several people in our class over 40! You're much younger than that...
Look into your heart and follow your dreams! ¶ 9:04 PM 0 comments
Ok, so now we're in August of 1994 - has it really been 10 years? That's crazy. Anyway, I'm moving into a dorm room in McConnell hall and meeting roughly 400 people I've never seen in my life for the first time. Not that that's a bad thing - just unusual (for me). So I get all of my things into my dorm room and meet up with a few of the people I remember from the preview/interview days. We begin our friendship.
Roughly a week later, we begin classes. My first class was a general biology class - along with about 100 other students. I'd never been in a class so large! I'd always been in classes of about 15-30, so this was just unfathomable. Culture shock in the extreme. I also attended several other classes - chemistry, english literature, etc.
So, I'm taking classes and all the while trying to adjust to life on a very large college campus. I think the year I started, they said about 25,000 students attended UNT.
Being away from home in such a big city, I became a little lax in my studying and class attendance. As a result, my second semester GPA was 2.19. Not quite failing, but I made a lot of C's that semester. Realizing what was happening, I started studying a lot harder, actually going to class (most of the time) and came out of TAMS with a 2.98 cumulative GPA and 65 hours. Not such a stellar performance from someone as bright as I consider myself to be.
I really enjoyed my experiences at TAMS. While some days I wish I had paid more attention, gone straight the whole time and made better grades, I'm also glad that I had fun while I had the chance. There was a time when I cursed myself almost every day (i.e. while I was applying to medical schools with a 3.29 GPA because of those 65 wasted hours); now that I have a couple more years under my belt, I realize it didn't really matter (I got into medical school anyway) and I don't know what I'd do without those experiences. I'd probably be a lot more boring, if anything. I think I grew a lot at TAMS as a person and intellectually (even if it isn't reflected in my grades). I found out who I am and where I want to go with my life - the kind of person I want to be.
So, in 1996, I graduated from TAMS and was all set to go to Baylor University on a partial scholarship. However, that was not to be my fate, as you shall see.
In late July, 1996, I attended an "orientation" session at Baylor - the purpose was to introduce the new students to the campus and get them registered for classes and let them intermingle with each other a bit. This turned out to be perhaps the best thing that ever happened to me. While at Baylor, I found out what the school is really like - the people that attend school there, the faculty, everything. I also learned that I REALLY didn't like it there and I would NOT fit in. So I withdrew from that school that day.
Of course, now it is July, school starts in late August and I now have nowhere to attend college! I was thinking "OH CRAP! This isn't good." Fortunately for me, I was able to basically walk in at my hometown school and start taking classes there. Also fortunately for me, while attending BFE-University I had the priveledge of working with perhaps the most knowledgeable pre-medical advisor in the history of pre-medical advisors: Dr. A.B. We had multiple very long and serious discussions about my future medical career. It was his idea for me to pursue a career in nursing while finishing up my premedical requirements.
According to Dr. B., this would serve several purposes
1. It would give me time to bring up my GPA, which at the time was sitting at a less-than-stellar 2.98
2. It would give me much-needed experience in the medical field
3. I would have a viable backup plan in case my plans of medical school were to fail
4. I would have a good job in the meantime, even if my plans of entering medical school were realized.
And so, during my first year of classes at BFE-U, I applied and gained entry into their school of nursing. Meanwhile, I continued to take pre-medical courses as well as the pre-requisites for nursing school, which consisted of anatomy and physiology, nursing microbiology (I took the regular version), statistics, and some basic english stuff I didn't CLEP out of because I was too lazy to take the test. All of which I made A's in, so I have a 4.0 GPA for that year. Yippee, I'm going in the right direction.
During the summer prior to my second year of school at BFE-U (1997), I entered the nursing program. I was one of 4 guys in the program - only 2 of us were heterosexual. Right away, I saw the odds were in our favor.
As classes started to wind up, I realized that nursing school was not anything I expected it to be. We were taught nothing medical at all. It was all "nursing theory" and "history" about Florence Nightingale, the "mother of nursing." I'm sure what Ms. Nightingale did was very important, but do I think it has anything to do with the medical or even the nursing professions? No. It was brainwashing - plain and simple. We were made to memorize and recite dates and events just like we were in high school. The tests were just about as bad. Nothing concrete, no medical or even nursing facts - completely subjective stuff about what, according to so-and-so's theory of basic needs, would be the most important to address first? And nevermind the care-plans and physicals we had to write up. Even in medical school a complete history and physical is not 10 typed pages. It was ridiculous. Nothing real, only busy work. Of course, I looked at it as hoops: I'd decided long ago that everything we do is only jumping through hoops to get to our goals... school, the MCAT, applications, interviews, medical school, board exams, residency applications, etc, etc, etc. It is all hoops to get to our final goal of becoming a physician. Even then we'll have hoops - certification exams, licensure, CME requirements.. it never ends. It's all just hoops.
Finally, after 2 years go by, I graduate from nursing school. By this time (1999) , I'm so jaded with nursing school, I decide I'm not going to pursue a bachelor's degree in it. If I HAVE to have a bachelor's, I'll get it in computer science or something. So I get a job as a Graduate Nurse at a local hospital and wait to take the nursing board exams - the NCLEX. That was a joke. Don't ever let any nurse tell you different or lie to you about how hard they studied. It was a complete and total joke. I thought our nursing school exams were ridiculous - they were written just like the NCLEX questions. The teachers at school were only preparing us for the NCLEX all along! So I passed the first time, with no problems. Shortly after this time, I also got married. Another mistake. It has since been corrected.
So I start working as a Registered Nurse on a Medical/Surgical floor at Shannon Medical Center in San Angelo, Tx. At first, it was kind of cool - going to work. After a while, I really got tired of seeing the same patients day after day after day after day after day every time I came in to work. Even after I'd had some time off, the same patients. I felt like an underpaid babysitter - I knew I had to get out. So I start looking around for another job. I apply to the emergency department downstairs and am refused - twice. So, I applly to the ED across town at the other hospital in town - and get a part time position. I begin working there "part time" 40 hours a week. After a month, they decide they want to make me full time and I get to tell the nursing supervisor on the Med/Surg floor just what I think of her and her unit. I'd been waiting for that for almost a year.
Don't think that everything about nursing school and nursing in general is bad - it's not. The money is great if you work it right (if not, you get paid peanuts), you can't really beat the hours, the job market is insane (have you ever heard of the nursing shortage?), and the work (in certain areas) is very cool. I just wasn't meant to be a med/surg nurse - or a ward nurse in general, I think. Of course, this may have been only this one unit - there were some extenuating circumstances going on as well as what is listed above - nothing is ever black-and-white. I may have been perfectly happy on another unit or in another hospital.
Working in the Emergency Department as a nurse is about as close to what I envision true nursing to be as one can get. When people talk about the healthcare "team," this is what they are talking about. Nurses working alongside physicians working alongside respiratory, etc. Everyone works toward a common, forseeable goal. And everyone works hard. None of the shirking responsibility I was always experiencing on the floors. If something doesn't get done, a person can have a bad outcome - not necessarily die, but they might be in the department longer than they need to, etc. Believe me, the physicians and nurses want as few people in the waiting room as possible - so if your treatment takes too long, they start to get edgy.
During this time, I finished up my prerequisites for medical school and took the MCAT. I also decided I wanted to do some travelling before I started school again. I started looking into travel nursing positions. After a few months I landed a position in Philadelphia at Presby. Presby is a nice little "community" hospital right on the cusp of West Philly - not too good a place to be caught late at night, but if you continue down Market for about 10 more blocks, it's a whole lot less good - if you know what I mean.
In May of 2001, we move up to Philadelphia and I started working at Presby. What I didn't realize when I took the job is that Presby is a teaching institution affiliated with the University of Pennsylvania. Very cool, indeed. For 6 months, I got to hang out with residents and medical students, pick their brains and even teach them a little. I also made some of the best friends of my life. Presby was a very cool place and I would love to go back there some day as an attending physician. I really became interested in perhaps pursuing an academic position after going to Presby.
During September of 2001, a group of freaks from the middle east decided to drive a bunch of planes into a few buildings around the nation. I got called in to work that day and spent 12 hours working on a disaster call. That was a bad day in Philadelphia. Everyone was scared and panicked. Noone knew what would happen next and we saw probably more than three times our usual volume that day because everyone in the surrounding neighborhood was freaked. To tell the truth, so were we. The following day, myself and a group of nurses from Presby volunteered to go up to NYC to help, but were refused. They said they already had more help than they could use - which was a good thing.
Of course, during this time, I was interviewing for medical school. I had an interview at XYZ medical school I think the week after September 11th. That was not a fun time to be in the airports. I also had a few other interviews I had to fly out for over the ensuing months, but standing in line for 6 hours the week after 9/11 trying to catch a flight to LMNOP state was not fun. The others were cake-walks in comparison.
I finished my assignment in Philadelphia in December of 2001 and we drove back to LMNOP to enjoy Christmas with my family before starting my next assignment. Why did I choose to come to QRS? I was all but told during my interview that would be accepted at ABC and I loved the school so much I decided to come here and anticipate matriculation in the fall. I took a travel position and worked there for 7 months until school started.
Since then, I have been in medical school.
And that is basically my life up until this point. I'll write more about the intervening time in future entries and tell all about my first 2 years of medical school - and of course I'll be writing about my current experiences as well.
I hope you've enjoyed my life story. Not the best, nor the brightest, but all mine.
more to come...
posted 28 July 2004, Wednesday
A visitor made this comment,
I knew I wanted to become a doctor, however I did really badly on my second year of undergrad were I lost completely my self-confidence and onward my grade kept dropping to the point of C average. I just barely graduated; I could not even pursuit a Master degree, as most programs require at least a B average. I went right into the work force, because of financial necessities, but I find my self everyday, thinking about only if I chosen an easier undergrad program I could have had a good GPA and could have gone to med school. Now I am afraid if I drop everything and go back to school, how about if I can’t do well again. I don’t have the self-confidence, motivation, but it’s still my dream to become a doctor, I almost 29 yrs. I don’t see myself going back to school for at least few years, because of financial obligations. As a result of this I feel completely hopeless. I guest the reason why I am writing to you is that your store really inspires me and I just want to know how you stayed focus and motivated. Thank you, and sorry for my bad English.
Udona
comment added :: 9th December 2004, 11:49 GMT-06
DeLaughterDO made this comment,
Udona,
Thanks for sharing your story with us! I understand what it can feel like to be worried you cannot realize your dreams - hell, I STILL sometimes feel that way and I'm in med school (some days it just doesn't feel REAL).
What can I tell you about motivation? Probably nothing you don't already know in your heart of hearts. Becoming a physician is your dream. If you want it badly enough and every day you ache for it, you'll find a way.
The first step is always the hardest. Once you're out of school and in the workplace, it can be VERY scary to return to school and have to quit working (especially since you become dependent on that income). Could you possibly take an evening class or two to try to get back into the practice of studying?
Do you have someone close to you that is supportive of your dream? I know that is often the most helpful when you are having difficulty believing in yourself... to have your own personal cheerleader, if you will. They can help you through the harder times when you only want to sit down and give up.
First and foremost - I think you need to look seriously into yourself and decide if medicine is something you really, truly want. It's not an easy road; if you are easily discouraged, it might not be for you. You have to be tough-minded and goal-oriented.
I wish you luck in your journey. I think you can do it if you truly want to. Age is not a reason to give up on your dreams. I am 28 now.. We have several people in our class over 40! You're much younger than that...
Look into your heart and follow your dreams! ¶ 9:04 PM 0 comments
Monday, July 26, 2004
It's My Life
Well, I suppose I should tell my story as well... mine may be a two-part mini-series though... anyone know a producer from TNT? I could be on TV!
I was born in 1977 in BFE - a little military retirement town of around 80,000 at the time. My parents were both military brats that met each other in high school while their respective fathers were stationed at the military base as teachers of some sort or another. My mother was 17 when I was born - that makes her 43 now. You figure out my age.
She dropped out of high school and my father got a job at a steel plant as a welder. I think we were living with my grandparents at the time.
Over the course of the next few years, my family got up on its own feet: my mother completed her GED, my father went to work with my grandfather in the family landscaping business. In 1981, my sister was born. My mother was working at Ethicon as a channel swedger. Yes, the same Ethicon that makes all the wonderful suture with which you sew up the drunken brawlers that come into your ED at 0200. She basically ran the machine that crimped the needle onto the suture. Not the most glorious job, but it paid well.
Shortly before my sister was born, we moved out into a little "suburb" of BFE called Orient. Technically, not a suburb, but the closest thing that BFE is ever likely to have. This used to be a huge ranch that was broken up into lots and sold. I don't think I ever knew the reason why.
Regardless, my budding family had its own piece of land, a house, and a chance at life. I was almost 4 by now.
As I grew, I inevitably entered school. I went to the catholic school in BFE. First Holy Angels and after 3rd grade, the second campus - Sacred Heart. I was never really one to follow rules. When we were supposed to be napping, I wanted to do anything but nap. When we were to sit quietly, I wanted to fidget and make noise. I never really did very well on my Behavior marks... This set the stage for a lot of things to come, I think. One thing I have always been serious about, however, is learning. As long as I can remember, I've taken my education very seriously. When I was a young child, I wanted to know how to write, so I made my mother teach me to write. I'll always remember my poor 1st grade teacher reprimanding me for wanting to write in cursive on my Big Chief pads instead of those dopey print letters. I liked the way cursive looked better. Now I print almost everything because my handwriting is so horrid.
Off the tangent now.
In 5th grade, I was transferred to public school in a very small town - if I had stayed to graduate, I would have graduated in a class of 19. I don't know if public school was good for me or not - I've never really decided. There are distinct pros and cons: I could curse out loud at school and not get put in detention for a week (pro and con - I had a mouth like a sailor by the end of the first 6 weeks of my 5th grade year); my education was very much slowed (con); football (pro); track (con); you see where this is going. By far the most important factor to me was that I now had to push myself that much harder to make damn sure I kept learning. This has always proven a benefit to me, especially now that I am in medical school and the only thing driving me is my ambition.
Life goes on for a while; I never really fit in with the public school crowd. You know how it is: small town, a new kid comes in during 5th grade and totally upsets the status quo because he is smart. I really think a lot of the way I got treated was because of jealousy and bitterness. Of course, I wasn't related to the entire town either.
While I'm in 9th grade, my father hears about this program at the University of North Texas called the Texas Academy of Mathematics and Science (TAMS) on the local news. He brings this up to me and I decide that I'd like some more information about it. So, we contact TAMS and they send me an information packet. Long story short, this is a program in which 200 high school juniors are taken out of their high school and complete it at UNT, all the while accumulating college credits. Sounded almost too good to be true - only it is for real. I decide to apply, which requires the SAT and some other documentation from your current high school - transcripts, etc. If you pass the initial look-over, you are invited for an interview, during which time you talk with an administrator, a professor you will probably see in one of your classes, and the staff head-shrinker to determine if you (at 15 or 16) are emotionally stable enough to leave home and endure "college life." You are also given several more exams during the interview day. Apparently, I made the grade, because I was one of the chosen 200 that year in 1994.
And so in late august, I was moving out of my house and into McConnell hall on the UNT campus. What a trip that was!
ok.. it's 0100 and I need to go to bed so I can be at the hospital at 0600 for pre-rounds.
next week on "my life," read about my experiences as a 16 year old on a college campus, how I almost ruined any chance I had of ever gaining admission into medical school, how dumb chance and lady luck saved me from certain doom, and more!
to be continued....... ¶ 11:04 PM 0 comments
I was born in 1977 in BFE - a little military retirement town of around 80,000 at the time. My parents were both military brats that met each other in high school while their respective fathers were stationed at the military base as teachers of some sort or another. My mother was 17 when I was born - that makes her 43 now. You figure out my age.
She dropped out of high school and my father got a job at a steel plant as a welder. I think we were living with my grandparents at the time.
Over the course of the next few years, my family got up on its own feet: my mother completed her GED, my father went to work with my grandfather in the family landscaping business. In 1981, my sister was born. My mother was working at Ethicon as a channel swedger. Yes, the same Ethicon that makes all the wonderful suture with which you sew up the drunken brawlers that come into your ED at 0200. She basically ran the machine that crimped the needle onto the suture. Not the most glorious job, but it paid well.
Shortly before my sister was born, we moved out into a little "suburb" of BFE called Orient. Technically, not a suburb, but the closest thing that BFE is ever likely to have. This used to be a huge ranch that was broken up into lots and sold. I don't think I ever knew the reason why.
Regardless, my budding family had its own piece of land, a house, and a chance at life. I was almost 4 by now.
As I grew, I inevitably entered school. I went to the catholic school in BFE. First Holy Angels and after 3rd grade, the second campus - Sacred Heart. I was never really one to follow rules. When we were supposed to be napping, I wanted to do anything but nap. When we were to sit quietly, I wanted to fidget and make noise. I never really did very well on my Behavior marks... This set the stage for a lot of things to come, I think. One thing I have always been serious about, however, is learning. As long as I can remember, I've taken my education very seriously. When I was a young child, I wanted to know how to write, so I made my mother teach me to write. I'll always remember my poor 1st grade teacher reprimanding me for wanting to write in cursive on my Big Chief pads instead of those dopey print letters. I liked the way cursive looked better. Now I print almost everything because my handwriting is so horrid.
Off the tangent now.
In 5th grade, I was transferred to public school in a very small town - if I had stayed to graduate, I would have graduated in a class of 19. I don't know if public school was good for me or not - I've never really decided. There are distinct pros and cons: I could curse out loud at school and not get put in detention for a week (pro and con - I had a mouth like a sailor by the end of the first 6 weeks of my 5th grade year); my education was very much slowed (con); football (pro); track (con); you see where this is going. By far the most important factor to me was that I now had to push myself that much harder to make damn sure I kept learning. This has always proven a benefit to me, especially now that I am in medical school and the only thing driving me is my ambition.
Life goes on for a while; I never really fit in with the public school crowd. You know how it is: small town, a new kid comes in during 5th grade and totally upsets the status quo because he is smart. I really think a lot of the way I got treated was because of jealousy and bitterness. Of course, I wasn't related to the entire town either.
While I'm in 9th grade, my father hears about this program at the University of North Texas called the Texas Academy of Mathematics and Science (TAMS) on the local news. He brings this up to me and I decide that I'd like some more information about it. So, we contact TAMS and they send me an information packet. Long story short, this is a program in which 200 high school juniors are taken out of their high school and complete it at UNT, all the while accumulating college credits. Sounded almost too good to be true - only it is for real. I decide to apply, which requires the SAT and some other documentation from your current high school - transcripts, etc. If you pass the initial look-over, you are invited for an interview, during which time you talk with an administrator, a professor you will probably see in one of your classes, and the staff head-shrinker to determine if you (at 15 or 16) are emotionally stable enough to leave home and endure "college life." You are also given several more exams during the interview day. Apparently, I made the grade, because I was one of the chosen 200 that year in 1994.
And so in late august, I was moving out of my house and into McConnell hall on the UNT campus. What a trip that was!
ok.. it's 0100 and I need to go to bed so I can be at the hospital at 0600 for pre-rounds.
next week on "my life," read about my experiences as a 16 year old on a college campus, how I almost ruined any chance I had of ever gaining admission into medical school, how dumb chance and lady luck saved me from certain doom, and more!
to be continued....... ¶ 11:04 PM 0 comments
On Call
I'm on call tonite at JPSH hospital. i've been up since 0800 yesterday. It's now 0220... That's a lot of hours, and I have many more to go before the night is over.
Actually, so far I've really enjoyed my time here at JPSH. I have a really good team - we all get along crazy well and I feel like I've learned a lot. When I first started, I was pretty much clueless about how to manage a patient with almost any complaint when it came to inpatient management. Now, I am seeing patients, writing H&Ps and admission orders and following the patient in the hospital, calling consults, etc. Not too bad for a lowly 3rd year medical student. My team gives me a lot of autonomy as well - that is really cool, since I learn better when I an just thrown out and have to figure it out. Of course, I know that I can get back up if I need it. That's the beauty of being a medical student. I can practice "on my own," but if I need anything, all I have to do is yell.
Tonite has been our slowest call yet. We've only taken 8 or 9 hits (aka admissions). Usually we're pretty close to our max of 15 by now. Of course, the night is still young. We've been hanging out and acting crazy all nite. It's really pretty sad, but it's a REALLY good thing that we don't have any girls on our team - we would so get in trouble... we'd all be out of medicine so fast we'd wonder what hit us. But it's fun being "just us guys."
Tonite, the only patient I've seen is a cardiac patient. He has had 2 MIs in the past as well as a CVA. He was at a convenience store when he began to experience a sharp chest pain in his left chest. This lasted about 2 minutes and resolved without any intervention. He went home and took his ASA and ImDur. he then reported to the ED. He denies any N/V/palpitations/radiation, but he said he was short of breath and lightheaded. Given his extensive cardiovascular history and a significant family history, he was admitted to telemetry to R/O MI. His first set of enzymes were negative and his second is pending.
An interesting thing with this person is that he was hypertensive when he presented to the ED. They gave him some metoprolol IV to try to bring his pressure down and he went into RBBB. This passed after several minutes and he reverted to NSR. Very strange indeed. I've never heard of something like that occuring w/ a Beta Blocker. Too bad I wasn't there to see it. The EKG is pretty impressive, though. The first EKG the ED did has NSR w/ inferior T wave inversions, and then the second shows bigger-than-life RBBB. I'm all like "holy crap! WTF is that?" Very strange indeed.
Another patient we got called on was a consult from OB. This is a 57 y.o. BF in OB for c/o vaginal bleeding for the past 6 weeks and anemia. OB consulted our team because they wanted us to evaluate her for other causes of anemia. First thing that goes through my head is "duh, she's anemic because she's bleeding..." But, of course, it could feasibly be something else. So we go see her. She is very pleasant, but pale. She says that about 6 weeks ago, she began having heavy vaginal bleeding w/ clotting and frequent lower abdominal cramps. She said her LNMP was last july (2003) and she had been amenorrheic since. Suddenly she begain bleeding profusely w/ clots. Shortly thereafter, she began feeling very tired, getting dyspneic w/ minimal exertion and just all around not feeling well. She came to ABC and was admitted and transfused w/ 3 units of PRBCs. They did an ultrasound and found a 16x9cm fibroid tumor in her uterus. They discharged her on hormones and told her to follow up with her OB/Gyn. That was 2 weeks ago. She has not seen her OB/Gyn, nor has she stopped bleeding. She is now symptomatic again and back in the hospital. And Medicine B is on the case.
I see her and there is NOTHING wrong w/ this lady aside from the fact that she is anemic. The only abnormality she has on exam is a f'ing HUGE mass in her suprapubic area. I'm assuming it's this 16x9cm mass in her uterus. It's freaking enormous... 16x9 = ~7x4 inches. That's a big-assed fibroid. And here I'm thinking, "Why are you guys consulting medicine to find another source for this anemia.. you've got a freaking 28 square inch reason RIGHT HERE!!" These people never freaking cease to amaze me.
Anyway, that's all for now. I'll update again later. ¶ 12:35 AM 0 comments
Actually, so far I've really enjoyed my time here at JPSH. I have a really good team - we all get along crazy well and I feel like I've learned a lot. When I first started, I was pretty much clueless about how to manage a patient with almost any complaint when it came to inpatient management. Now, I am seeing patients, writing H&Ps and admission orders and following the patient in the hospital, calling consults, etc. Not too bad for a lowly 3rd year medical student. My team gives me a lot of autonomy as well - that is really cool, since I learn better when I an just thrown out and have to figure it out. Of course, I know that I can get back up if I need it. That's the beauty of being a medical student. I can practice "on my own," but if I need anything, all I have to do is yell.
Tonite has been our slowest call yet. We've only taken 8 or 9 hits (aka admissions). Usually we're pretty close to our max of 15 by now. Of course, the night is still young. We've been hanging out and acting crazy all nite. It's really pretty sad, but it's a REALLY good thing that we don't have any girls on our team - we would so get in trouble... we'd all be out of medicine so fast we'd wonder what hit us. But it's fun being "just us guys."
Tonite, the only patient I've seen is a cardiac patient. He has had 2 MIs in the past as well as a CVA. He was at a convenience store when he began to experience a sharp chest pain in his left chest. This lasted about 2 minutes and resolved without any intervention. He went home and took his ASA and ImDur. he then reported to the ED. He denies any N/V/palpitations/radiation, but he said he was short of breath and lightheaded. Given his extensive cardiovascular history and a significant family history, he was admitted to telemetry to R/O MI. His first set of enzymes were negative and his second is pending.
An interesting thing with this person is that he was hypertensive when he presented to the ED. They gave him some metoprolol IV to try to bring his pressure down and he went into RBBB. This passed after several minutes and he reverted to NSR. Very strange indeed. I've never heard of something like that occuring w/ a Beta Blocker. Too bad I wasn't there to see it. The EKG is pretty impressive, though. The first EKG the ED did has NSR w/ inferior T wave inversions, and then the second shows bigger-than-life RBBB. I'm all like "holy crap! WTF is that?" Very strange indeed.
Another patient we got called on was a consult from OB. This is a 57 y.o. BF in OB for c/o vaginal bleeding for the past 6 weeks and anemia. OB consulted our team because they wanted us to evaluate her for other causes of anemia. First thing that goes through my head is "duh, she's anemic because she's bleeding..." But, of course, it could feasibly be something else. So we go see her. She is very pleasant, but pale. She says that about 6 weeks ago, she began having heavy vaginal bleeding w/ clotting and frequent lower abdominal cramps. She said her LNMP was last july (2003) and she had been amenorrheic since. Suddenly she begain bleeding profusely w/ clots. Shortly thereafter, she began feeling very tired, getting dyspneic w/ minimal exertion and just all around not feeling well. She came to ABC and was admitted and transfused w/ 3 units of PRBCs. They did an ultrasound and found a 16x9cm fibroid tumor in her uterus. They discharged her on hormones and told her to follow up with her OB/Gyn. That was 2 weeks ago. She has not seen her OB/Gyn, nor has she stopped bleeding. She is now symptomatic again and back in the hospital. And Medicine B is on the case.
I see her and there is NOTHING wrong w/ this lady aside from the fact that she is anemic. The only abnormality she has on exam is a f'ing HUGE mass in her suprapubic area. I'm assuming it's this 16x9cm mass in her uterus. It's freaking enormous... 16x9 = ~7x4 inches. That's a big-assed fibroid. And here I'm thinking, "Why are you guys consulting medicine to find another source for this anemia.. you've got a freaking 28 square inch reason RIGHT HERE!!" These people never freaking cease to amaze me.
Anyway, that's all for now. I'll update again later. ¶ 12:35 AM 0 comments
Tuesday, July 20, 2004
Fatties of the world, unite!
====================================================
Medicare to Cover Obesity as a Disease, U.S. Says
WASHINGTON (Reuters) Jul 16 - In a policy shift that could affect millions of Americans, obesity treatments may be covered under Medicare and Medicaid, Health and Human Services Secretary Tommy Thompson said on Thursday.
State and federal health insurance plans for the poor and elderly currently do not consider obesity itself a disease, though some conditions linked to obesity are covered.
However, Thompson said if an obesity treatment could be proved to improve the health of a Medicare recipient, it would be covered.
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely," he said in a statement.
"Treating obesity-related illnesses and complications adds billions of dollars to the nation's health care costs," he added in testimony to the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education.
"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions."
The Department of Health and Human Services said a first step would be a look at obesity surgery like gastric bypass.
HHS said in a statement it did not expect the new policy to have any immediate impact, as the Center for Medicare and Medicaid services would have to review any claim.
"We encourage and we're expecting requests to review scientific evidence evaluating the benefits of a range of treatments for obesity in the Medicare population," said CMS Chief Medical Officer Dr. Sean Tunis.
"As a first step, we expect to convene our Medicare Coverage Advisory Committee in the fall to evaluate the evidence on obesity-related surgical procedures that may reduce the risk of heart disease and other illnesses."
========================================================
Ok.. whoever came up with this stupid idea should be shot, I swear it. Obesity is now considered a DISEASE? No... obesity is someone that ate too much food and didn't exercise. This is going to open up a whole can of worms in our medical and justice systems. Now, patients are going to see their doctors and DEMAND bariatric surgery - 99.9% of patients can't even say bariatric, much less understand the risks involved in such a surgery. Are they smoking crack?
This decision will also open up new doors for fatties to sue physicians. I thought we were trying to decrease the number of malpractice lawsuits in this country. I can see it now - "500 pound fattie sues doctor over his fat ass - more at 11." Why do people refuse to take responsibility for their own actions? What is it about this country and about humankind that makes everyone so quick to blame someone else for their problems?
I guess it's something in our culture. Oh wait, we have no culture because we have people from like 5000 countries here - and none of them speak English (that's another rant altogether).
So, what do we do? Reverse this decision, for one. I don't want my tax dollars to go to some fattie's surgery or depression medications because they won't get off their ass and exercise and not eat McDonalds. If you're going to eat McDonalds, at least WALK to the damn store! Then you would have burned 15 of the 150000 calories you are about to ingest.
Another thing - why do people order 2 double cheese burgers, xtra large fries and a DIET COKE. Oh yeah.. that's going to make a HUGE impact in your daily caloric intake.. why don't you just order a big freaking cup of the grease they use to cook those damn fries?
Stupid people... get off your ass and lose the weight. And if you refuse, don't expect anyone else to do it for you because your fat ass is your own CHOICE. Obesity isn't a disease - it's a choice. You chose to eat all that food. You chose to not exercise.
And I choose to refuse to believe that obesity is a disease.
more to come...
¶ 7:37 AM 0 comments
Medicare to Cover Obesity as a Disease, U.S. Says
WASHINGTON (Reuters) Jul 16 - In a policy shift that could affect millions of Americans, obesity treatments may be covered under Medicare and Medicaid, Health and Human Services Secretary Tommy Thompson said on Thursday.
State and federal health insurance plans for the poor and elderly currently do not consider obesity itself a disease, though some conditions linked to obesity are covered.
However, Thompson said if an obesity treatment could be proved to improve the health of a Medicare recipient, it would be covered.
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely," he said in a statement.
"Treating obesity-related illnesses and complications adds billions of dollars to the nation's health care costs," he added in testimony to the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education.
"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions."
The Department of Health and Human Services said a first step would be a look at obesity surgery like gastric bypass.
HHS said in a statement it did not expect the new policy to have any immediate impact, as the Center for Medicare and Medicaid services would have to review any claim.
"We encourage and we're expecting requests to review scientific evidence evaluating the benefits of a range of treatments for obesity in the Medicare population," said CMS Chief Medical Officer Dr. Sean Tunis.
"As a first step, we expect to convene our Medicare Coverage Advisory Committee in the fall to evaluate the evidence on obesity-related surgical procedures that may reduce the risk of heart disease and other illnesses."
========================================================
Ok.. whoever came up with this stupid idea should be shot, I swear it. Obesity is now considered a DISEASE? No... obesity is someone that ate too much food and didn't exercise. This is going to open up a whole can of worms in our medical and justice systems. Now, patients are going to see their doctors and DEMAND bariatric surgery - 99.9% of patients can't even say bariatric, much less understand the risks involved in such a surgery. Are they smoking crack?
This decision will also open up new doors for fatties to sue physicians. I thought we were trying to decrease the number of malpractice lawsuits in this country. I can see it now - "500 pound fattie sues doctor over his fat ass - more at 11." Why do people refuse to take responsibility for their own actions? What is it about this country and about humankind that makes everyone so quick to blame someone else for their problems?
I guess it's something in our culture. Oh wait, we have no culture because we have people from like 5000 countries here - and none of them speak English (that's another rant altogether).
So, what do we do? Reverse this decision, for one. I don't want my tax dollars to go to some fattie's surgery or depression medications because they won't get off their ass and exercise and not eat McDonalds. If you're going to eat McDonalds, at least WALK to the damn store! Then you would have burned 15 of the 150000 calories you are about to ingest.
Another thing - why do people order 2 double cheese burgers, xtra large fries and a DIET COKE. Oh yeah.. that's going to make a HUGE impact in your daily caloric intake.. why don't you just order a big freaking cup of the grease they use to cook those damn fries?
Stupid people... get off your ass and lose the weight. And if you refuse, don't expect anyone else to do it for you because your fat ass is your own CHOICE. Obesity isn't a disease - it's a choice. You chose to eat all that food. You chose to not exercise.
And I choose to refuse to believe that obesity is a disease.
more to come...
¶ 7:37 AM 0 comments
Monday, July 19, 2004
Monday...
Damn, I hate mondays.
I woke up at 0430 so I could help Ashleigh get all her stuff ready to leave. That sucked (both the getting up so damn early and having Ashleigh leave). Then on top of that, I couldn't go back to sleep afterwards and so I laid in bed tossing and turning. Finally I gave up and got dressed and went up to the hospital.
While rounding on my patients, I kept having trouble getting my thoughts together. I don't know why. I figured I was just tired or something.
That is, of course, until I met up with the rest of the team and saw they were all that way.
"F'ing Monday" syndrome (FMS):
¶ 11:29 AM 0 comments
I woke up at 0430 so I could help Ashleigh get all her stuff ready to leave. That sucked (both the getting up so damn early and having Ashleigh leave). Then on top of that, I couldn't go back to sleep afterwards and so I laid in bed tossing and turning. Finally I gave up and got dressed and went up to the hospital.
While rounding on my patients, I kept having trouble getting my thoughts together. I don't know why. I figured I was just tired or something.
That is, of course, until I met up with the rest of the team and saw they were all that way.
"F'ing Monday" syndrome (FMS):
This is a complex of symptoms resulting from being on call the previous weekend and not getting any damn rest. Its signs and symptoms include:
- inability to render thoughts verbally (Post call aphasia)
- inability to walk upright
- anorexia, nausea, vomiting, flatulence, and diarrhea (from the shitty hospital/McDonalds food you ate while on call)
- excessive daytime sleepiness (EDS - secondary to overexhaustion and not really knowing whether it is day or night)
- apathy (the "I'm too f'ing tired to give a shit" complex)
- inability to read/write (alexia w/ agraphia)
- excessive crudeness/sick jokes/giggling at said sick jokes (post call delirium)
Of course, I wasn't quite as bad off as some of the other guys - I don't know if they got as much sleep as I did on call. It's scary when the student is the most alert person on the team. That can mean things get very BAD very fast.
Fortunately, I think Dr. K noticed that we weren't really into rounding today, so we saw a few patients and then ended up finishing it up as table rounds. Of course, he had to get to clinic as well, but I don't really think that has anything to do with it.
So I'm off tomorrow. That'll be cool. I don't know what I should do with myself.
more to come...
¶ 11:29 AM 0 comments
Sunday, July 18, 2004
Post call babbling
Well, I'm home from my third night on call. It was actually everything I'd hoped for.
¶ 9:25 AM 0 comments
- Not too busy
- I got to sleep
- I still got a pretty cool patient
What more could a guy want? I mean hell - I got 3 hours of sleep last night. I'm not even tired now. Of course, who knows what happens when I sit down for a while after I eat --> COMA
About my patient (I've decided I'm going to start posting some stuff about them w/o identifiers so I don't break any HIPAA/Confidentiality laws):
He is 77 years old. He came in to the ED yesterday morning after 3 weeks of progressively worsening dizziness with occasional syncope (which has the longest freaking differential list ever). What finally brought him in was that he had a bad episode while cooking, became dyspneic and passed out in the kitchen for like 5 minutes. He denies any seizure activity, incontinence, post-ictal state, chest pain, headache. So here I am, I'm talking to this guy (who looks pretty healthy aside from some bad teeth.. more on that later) and trying to figure out what is wrong with him.
Now I have to go on my soap box.
If ever you are going to be admitted into the hospital, don't come to this hospital. The ED staff are idiots - at least when it comes to getting patients ready for admission. For example - I admitted a lady on my first call with H&H of 4.4/17. Obviously she's bleeding from somewhere, but the ED did not do a stool guiac. WTF? Another patient was admitted with a GI bleed, no stool guiac - WTF again? How do you diagnose someone with a GI bleed w/o a guiac? Can it even be done? My point is, if you have someone with a test that is begging to be done (like a CT Head in someone with syncope), please do it so I don't have to.
I'm off my soapbox now. And I ordered a CT head w/o contrast.
As I'm talking to this fellow, it turns out he has pretty extensive cardiac history (but no cardiac enzymes in the ED - another WTF?) and has had an MI and 4 way bypass grafts. He's also had 2 strokes (but with very little residual effects beside a slight problem with cerebellar function and some weakness on the right - 4/5) and has chewed/smoked cigars for 60 years. His teeth are so brown and ground down I was surprised to see any teeth left.
Anyway, he's a really nice guy though and he's been admitted for 23 hour observation which will probably be changed to a full admission before it's over. He's getting a CT head and carotid doppler. His EKG was relatively normal and chest xray showed some increased density on the left lower lung field, but nothing that really declared itself. We're thinking about a Holter monitor for 24 hours to see if maybe he's having any arrhythmias that are causing this syncope.
Ok, so the morning came and I saw all my other patients and went to rounds at 0700 (which would be ungodly early except that I was already at the hospital and dressed, so I didn't have to wake up too damn early - 0600). Actually was able to stay awake during post-call rounds - I was impressed. Usually I'm dropping off before 20 minutes have passed. I'm sure it doesn't look good, but I can't help myself. I don't think I'm gone for long, just nod and wake up again. We finished table rounds and were free to go finish our scut and then go home.. so here I am. Since I can't write orders or anything, it makes my life easier than not.
So, I think this afternoon we're going to have lunch with Ashleigh's parents. They're having hamburgers and all the dressings. This will be the first time I've not eaten something just thrown together in like 2 weeks. Home cookin' - ain't it great?
more to come...
¶ 9:25 AM 0 comments
Friday, July 16, 2004
Ashleigh's coming home!
I just got home from the hospital and called Ashleigh because she is supposed to work only a half day today. When she answered her cellphone, we talked for a couple of minutes and I asked where she was (I heard a lot of noise in the background). SHE SAID SHE IS ON THE WAY HOME!! I am so excited. Of course, I'm on call tomorrow night, but hopefully it will be quiet and I can get some sleep so I can stay up on sunday and hang out with her... I'm so excited!
Anyway, work was work. It was nice to be off early today. I like Dr. K - he's smart and he rounds fast, so we can get our stuff done and be out of there at a decent hour. Pretty sweet in my book. That way I can get home and do other stuff (like waste time on here and SDN). And study - some.
I just haven't felt very motivated to study lately. I'm just having fun taking care of my patients and reading about their problems. I'm hoping that will get me through most of it.
I had to give a presentation on Infective Endocarditis today. So yesterday I spent most of the day after getting done at the hospital doing research about IE. I had no idea how detailed he wanted it, so I think I went overboard (especially compared to the interns that were also presenting.) My take was I'm getting graded for this and they aren't, so I have to do more than them anyway or I'll get screwed in the end. So I did. The thing that kind of pissed me off was that afterI finished, all Dr. K said was "Good Job."
Of course, he didn't have to add anything to my presentation like he did the others - so I guess I should be proud of that.
more to come...
¶ 10:44 AM 0 comments
Anyway, work was work. It was nice to be off early today. I like Dr. K - he's smart and he rounds fast, so we can get our stuff done and be out of there at a decent hour. Pretty sweet in my book. That way I can get home and do other stuff (like waste time on here and SDN). And study - some.
I just haven't felt very motivated to study lately. I'm just having fun taking care of my patients and reading about their problems. I'm hoping that will get me through most of it.
I had to give a presentation on Infective Endocarditis today. So yesterday I spent most of the day after getting done at the hospital doing research about IE. I had no idea how detailed he wanted it, so I think I went overboard (especially compared to the interns that were also presenting.) My take was I'm getting graded for this and they aren't, so I have to do more than them anyway or I'll get screwed in the end. So I did. The thing that kind of pissed me off was that afterI finished, all Dr. K said was "Good Job."
Of course, he didn't have to add anything to my presentation like he did the others - so I guess I should be proud of that.
more to come...
¶ 10:44 AM 0 comments
Wednesday, July 14, 2004
Call night #2
Well, I've just had my second ever post call shower. It was quite an accomplishment! I've never had a post call shower quite like it; nor, I would venture to guess, will I ever have another like it.
Enough of the stupidity, right? Sorry, I'm just a bit tired... I was at the hospital for almost 24 hours without sleep. I think you can cut me a little slack.
The night went well. I saw 2 patients. I was going to see a third, but he decided to leave AMA before I got there. So far, I don't think I've made any egregious errors. At least noone has told me anything of the sort. It was long and busy, but we got a lot done and now it's just wait until everything comes back.
Must. sleep. now.
more to come.... ¶ 10:07 AM 0 comments
Enough of the stupidity, right? Sorry, I'm just a bit tired... I was at the hospital for almost 24 hours without sleep. I think you can cut me a little slack.
The night went well. I saw 2 patients. I was going to see a third, but he decided to leave AMA before I got there. So far, I don't think I've made any egregious errors. At least noone has told me anything of the sort. It was long and busy, but we got a lot done and now it's just wait until everything comes back.
Must. sleep. now.
more to come.... ¶ 10:07 AM 0 comments
Monday, July 12, 2004
Back after a few days
Ok, so it's been 4 days since I posted anything... I had call and then slept for an entire day - so that's 2, then I went to spend some time with Ashleigh - that's another day, and I can't remember what happened to the other day.. oh wait.. that's today. Ok...
Everything is going really well - I think. All the residents tell me I'm doing well, so I'm taking their word for it. I'm really enjoying Internal Medicine. Of course, I've heard that people that go into EM generally like EVERYTHING anyway.. so it's not altogether surprising.
I had Sunday off, so that was the day I went to visit Ashleigh. We had a nice day.. that's just a very long drive to make twice in one day. It's over 3 hours each way - so about 7 hours in the car all told.
Today I went and visited my patient and picked up a bounce-back we discharged the other day. She is a sweet lady that has CHF. I think she'll be an interesting case.
Of course, there is my other patient - the medical conundrum. We can't manage to find anything wrong with her, except that she is bleeding from somewhere. No source yet, though. She came into the ED on last friday with h/h 4.4/17.. that's BAD. We gave her 4 units of blood and she came up to 7/24 or so... not as much as we expected for the amount of blood we gave. She should be closer to 10/30... it's a mystery.
anyway, I have call again tomorrow night... have to sleep so I can be ready for the long hours.
more to come....
¶ 11:33 PM 0 comments
Everything is going really well - I think. All the residents tell me I'm doing well, so I'm taking their word for it. I'm really enjoying Internal Medicine. Of course, I've heard that people that go into EM generally like EVERYTHING anyway.. so it's not altogether surprising.
I had Sunday off, so that was the day I went to visit Ashleigh. We had a nice day.. that's just a very long drive to make twice in one day. It's over 3 hours each way - so about 7 hours in the car all told.
Today I went and visited my patient and picked up a bounce-back we discharged the other day. She is a sweet lady that has CHF. I think she'll be an interesting case.
Of course, there is my other patient - the medical conundrum. We can't manage to find anything wrong with her, except that she is bleeding from somewhere. No source yet, though. She came into the ED on last friday with h/h 4.4/17.. that's BAD. We gave her 4 units of blood and she came up to 7/24 or so... not as much as we expected for the amount of blood we gave. She should be closer to 10/30... it's a mystery.
anyway, I have call again tomorrow night... have to sleep so I can be ready for the long hours.
more to come....
¶ 11:33 PM 0 comments
Thursday, July 08, 2004
More Int Med
Day 3 done and into the log book. Busy day today. One of our interns was off and we changed over to a different attending, Dr. C. He's an Infectious Disease doc that works over at the HIV clinic. He's pretty cool and is so intelligent it's scary. This guy is really quick on the uptake.
Anyway, to the hospital this morning, checked in on my patient, talked to the intern, wrote a note, blah blah blah. Did some scutwork for one of the 'terns and then went up to rounds.
Once I joined the rest of the team (minus Dr. G), the resident pulls me aside and asks me to go see a couple of Dr. G's patients he hadn't been up to see.. this with rounds about to start in 5 minutes. Oh well, off I go again.
These two patients were fine, but some of the ordering from the previous day got botched up and so I had to put out those fires and get the stuff ordered - stat. It all should have been done yesterday. Ah, the wonders of county hospitals. Once that was all taken care of, I went to see these patients, both of whom looked really good. I paged the resident to find out where they were and re-joined the team. Finally meet the new attending.
So, we continue with rounds, which takes forever since Dr. C knows nothing about any of the patients on the service. Basically, it's like re-admitting everyone - presentation and all... what a mess. Anyway, we basically go on a discharging spree. I think we discharged 8-10 patients today. The old attending, Dr. R, was keeping a lot of people in the hospital for somewhat petty reasons. Dr. C basically says, "let's get all these people outta here!" So, our census goes down by half. Much fun tomorrow night when we're on call. 15 patient cap.. just remember that. 15 patient cap.
I'm really enjoying myself so far. My team is really laid back and seems to get along really well. We're all quirky in or own little way. I just wish I knew more about patient management. Oh well, off to read so I can learn something about patient management, right??
more to come...
¶ 4:12 PM 0 comments
Anyway, to the hospital this morning, checked in on my patient, talked to the intern, wrote a note, blah blah blah. Did some scutwork for one of the 'terns and then went up to rounds.
Once I joined the rest of the team (minus Dr. G), the resident pulls me aside and asks me to go see a couple of Dr. G's patients he hadn't been up to see.. this with rounds about to start in 5 minutes. Oh well, off I go again.
These two patients were fine, but some of the ordering from the previous day got botched up and so I had to put out those fires and get the stuff ordered - stat. It all should have been done yesterday. Ah, the wonders of county hospitals. Once that was all taken care of, I went to see these patients, both of whom looked really good. I paged the resident to find out where they were and re-joined the team. Finally meet the new attending.
So, we continue with rounds, which takes forever since Dr. C knows nothing about any of the patients on the service. Basically, it's like re-admitting everyone - presentation and all... what a mess. Anyway, we basically go on a discharging spree. I think we discharged 8-10 patients today. The old attending, Dr. R, was keeping a lot of people in the hospital for somewhat petty reasons. Dr. C basically says, "let's get all these people outta here!" So, our census goes down by half. Much fun tomorrow night when we're on call. 15 patient cap.. just remember that. 15 patient cap.
I'm really enjoying myself so far. My team is really laid back and seems to get along really well. We're all quirky in or own little way. I just wish I knew more about patient management. Oh well, off to read so I can learn something about patient management, right??
more to come...
¶ 4:12 PM 0 comments
Wednesday, July 07, 2004
Internal Medicine, Day 2
Well, I'm done with day 2. So far, so good. This morning after I wrote the last entry, I went up to the hospital, read through my patient's chart and went in to talk with my patient. Fortunately, he had a good night and had no complaints or requests (except that he would like to go home). I then performed a short exam. I then paged the intern and started writing information down for rounds. Dr. M (the intern for the patient) arrived and I presented to him and we talked about what needed to be done for the patient for the day. Afterwards, we went upstairs for rounds.
Rounds took forever. We started shortly after 0930 and didn't finish until after 1300. I didn't think we would ever get done. There was a lot of teaching during rounds, however, if you can understand what Dr. R is talking about. He's a little old and sometimes he goes into these long stories that just don't end about something completely unrelated to the case (as far as I understand it, anyway). Maybe that's just a problem with my knowledge base.
After rounds, I went back to tie up some loose ends with my patient. He has had an echocardiogram ordered for 2 days that is still not done, so I got that sorted out. He also was waiting on a stress test that apparently never got ordered. So that was also taken care of. Then I paged Dr. M again and went to meet him on the 11th floor.
There, he showed me how to access records on the computer and print out labs, etc on my patients. Now I'll have some information on my patients in the mornings. Cool.
After that, I called the rest of my team to make sure they didn't need anything and left. Came home, finished up some work for the departmental exam in IM and started doing this.
Exciting day, huh? I'm sure it'll be plenty exciting after friday (first call day).
more to come...
¶ 3:18 PM 0 comments
Rounds took forever. We started shortly after 0930 and didn't finish until after 1300. I didn't think we would ever get done. There was a lot of teaching during rounds, however, if you can understand what Dr. R is talking about. He's a little old and sometimes he goes into these long stories that just don't end about something completely unrelated to the case (as far as I understand it, anyway). Maybe that's just a problem with my knowledge base.
After rounds, I went back to tie up some loose ends with my patient. He has had an echocardiogram ordered for 2 days that is still not done, so I got that sorted out. He also was waiting on a stress test that apparently never got ordered. So that was also taken care of. Then I paged Dr. M again and went to meet him on the 11th floor.
There, he showed me how to access records on the computer and print out labs, etc on my patients. Now I'll have some information on my patients in the mornings. Cool.
After that, I called the rest of my team to make sure they didn't need anything and left. Came home, finished up some work for the departmental exam in IM and started doing this.
Exciting day, huh? I'm sure it'll be plenty exciting after friday (first call day).
more to come...
¶ 3:18 PM 0 comments
Internal Medicine, Day 1
Ok, quick note, then I have to leave for the hospital. Yesterday was day 1. We all went up to the hospital and got our name badges made, parking decals, etc. Then I joined my team. They had call the night before, so they were pretty tired. I'm glad we started on a tuesday - I wouldn't have wanted to start with call my first night.
I caught them in the middle of attending rounds. I introduced myself and then we set about running all over the hospital and seeing patients they had admitted the day/night before. It seems as though they were very busy the previous night.
After rounds were over, we went to the doctor's lounge and "ran the sheet." This is where all the interns sit down with the resident and go over what is left to be done for the day. Since they were all post-call, they were all falling asleep by this time - it was after noon.
Once everything was done there, the interns went about taking care of what was left and they told me to go home... I was home by 1400. Not too bad for day 1. They assigned me a patient they admitted yesterday, so I have to go see him this morning. I'm supposed to meet one of my interns at his room ~0830 and he'll show me the ropes as far as paperwork, computer login, etc.
that's all for now.. more to come....
¶ 5:32 AM 0 comments
I caught them in the middle of attending rounds. I introduced myself and then we set about running all over the hospital and seeing patients they had admitted the day/night before. It seems as though they were very busy the previous night.
After rounds were over, we went to the doctor's lounge and "ran the sheet." This is where all the interns sit down with the resident and go over what is left to be done for the day. Since they were all post-call, they were all falling asleep by this time - it was after noon.
Once everything was done there, the interns went about taking care of what was left and they told me to go home... I was home by 1400. Not too bad for day 1. They assigned me a patient they admitted yesterday, so I have to go see him this morning. I'm supposed to meet one of my interns at his room ~0830 and he'll show me the ropes as far as paperwork, computer login, etc.
that's all for now.. more to come....
¶ 5:32 AM 0 comments
Monday, July 05, 2004
Intro to Internal Medicine
Well, this morning we had our introduction to our Internal medicine clerkship - our first rotation of the year. I'm very excited. Most of my class is now in the clinics, but since the hospital at which I am to rotate considers today a holiday, I don't start until tomorrow. Hooray for me!
Of course, I'm still helping Ashleigh move all of her stuff for her 2 month rotation in Family Medicine there. She will be living in a hospital room for 2 months (and then 2 more months over the next 2 years as well) and she is absolutely thrilled about it, let me tell you!
Today has gone well - I learned that I will be on call every 4th night or so at LMNOP hospital, but I shouldn't have to work more than 30 hours straight.. a good thing, I think. Of course, after 24, what's the difference? But I should be very busy. I ordered a pager today (hopefully to arrive by the end of the week), so I'll have a means to be reached over the next year while I'm at clinic/hospital. Should prove easier than my cell phone - I don't want a bunch of residents to have my cell #.
Overall, I'm very excited. I should have fun, and hopefully learn a lot. Hopefully, I'll have time to do all this reading as well - we have 2 exams at the end of the 2 months that count for 50% of our grade. That makes it really easy to get carried away and spend all your time with your patients and not read what you're assigned. Just have to remember to read a couple hours a day so I can stay on top of things.
Well, off to help Ashleigh with her packing.
more to come...
¶ 10:33 AM 0 comments
Of course, I'm still helping Ashleigh move all of her stuff for her 2 month rotation in Family Medicine there. She will be living in a hospital room for 2 months (and then 2 more months over the next 2 years as well) and she is absolutely thrilled about it, let me tell you!
Today has gone well - I learned that I will be on call every 4th night or so at LMNOP hospital, but I shouldn't have to work more than 30 hours straight.. a good thing, I think. Of course, after 24, what's the difference? But I should be very busy. I ordered a pager today (hopefully to arrive by the end of the week), so I'll have a means to be reached over the next year while I'm at clinic/hospital. Should prove easier than my cell phone - I don't want a bunch of residents to have my cell #.
Overall, I'm very excited. I should have fun, and hopefully learn a lot. Hopefully, I'll have time to do all this reading as well - we have 2 exams at the end of the 2 months that count for 50% of our grade. That makes it really easy to get carried away and spend all your time with your patients and not read what you're assigned. Just have to remember to read a couple hours a day so I can stay on top of things.
Well, off to help Ashleigh with her packing.
more to come...
¶ 10:33 AM 0 comments
Friday, July 02, 2004
Future of the Osteopathic Internship
Letters on future of the Osteopathic Internship
This is a couple of letters written by faculty of West Virginia School of Osteopathic Medicine. While they make some good points (the first one) and somewhat reinforces my idea of the need to dually accredit more programs (AOA/ACGME) to accomodate the growing number of osteopathic school graduates, they do not really tell the whole story.
The first letter, "Future of the Osteopathic Internship," tells of the osteopathic philosophy of generalist first, specialist later. While this is a noble goal (and just so you know, I will probably complete an osteopathic internship), I think it is somewhat outdated. Most residency programs train a physician in a number of fields included in the traditional internship (OB/GYN, Family medicine, Int Med, Surg, Peds) in their first year of postgraduate training anyway, so why the need for an additional year of "generalist" training. It has been postulated that this is still an AOA requirement to ensure the few "Osteopathic" hospitals that remain that they will have a renewable source of cheap labor. This is definitely a possibility. Another hypothesis involves something akin to brainwashing. Proponents say that by the time you are done with this internship, you are so deeply indoctrinated into the ways of osteopathy that you would never dare to leave its arms.
I have a tendency to take a third view, somewhat comprised of the others, but still unique. If the AOA requires an osteopathic internship for licensure (and the 5 key states of PA, FL, WV, OK, and MI do as well), then students who wish to either practice in one of these 5 states or be recognized in the future by their accrediting body are forced to obtain this training. This, of course, ensures cheap labor for the struggling osteopathic hospitals. It also gives the training physicians a year to pressure the intern to stay in their program or at least go to another osteopathic program. Finally, it makes finding placement in an allopathic (ACGME) residency after the internship more difficult. Let me explain:
1) There are several residency programs that will not consider any applicant with prior training, no matter what. This takes this number out of the possible training pool.
2) The rigors of the internship year are not conducive to application to residency programs and residency interviews. This further encourages the resident to stay at the current institution or go to another nearby institution.
3) The aforementioned rigors of the intern year are such that not many would want to repeat them; something which is a distinct possibility if the student goes to an ACGME residency after their intern year - most ACGME residencies do not recognize an AOA traditional rotating internship and will require the student to start over again at the bottom of the barrel.
4) Money. The Centers of Medicare and Medicaid (CMS or whatever) has decided how many years each specialty should take to train. Therefore, if a resident starts one residency and decides to go to another specialty mid-training, there is the distinct possibility that the residency program would get decreased funding for the last 1-2 years of the resident's training. This is another hurdle that an osteopathic resident must overcome - convincing the residency program to take a loss on their training in order to attend their institution. In today's age of medical cutbacks and shortfalls, this is a very hard case to argue. This, again, makes it difficult for an osteopathic resident to make the transition from osteopathic internship to ACGME residency.
All of these factors add up to make life difficult for the osteopathic resident/student. While they may want to follow their osteopathic roots and complete the osteopathic internship, their post-internship choices are decidedly limited. This is unfortunate, for I find myself in this position.
more to come... ¶ 4:44 PM 0 comments
This is a couple of letters written by faculty of West Virginia School of Osteopathic Medicine. While they make some good points (the first one) and somewhat reinforces my idea of the need to dually accredit more programs (AOA/ACGME) to accomodate the growing number of osteopathic school graduates, they do not really tell the whole story.
The first letter, "Future of the Osteopathic Internship," tells of the osteopathic philosophy of generalist first, specialist later. While this is a noble goal (and just so you know, I will probably complete an osteopathic internship), I think it is somewhat outdated. Most residency programs train a physician in a number of fields included in the traditional internship (OB/GYN, Family medicine, Int Med, Surg, Peds) in their first year of postgraduate training anyway, so why the need for an additional year of "generalist" training. It has been postulated that this is still an AOA requirement to ensure the few "Osteopathic" hospitals that remain that they will have a renewable source of cheap labor. This is definitely a possibility. Another hypothesis involves something akin to brainwashing. Proponents say that by the time you are done with this internship, you are so deeply indoctrinated into the ways of osteopathy that you would never dare to leave its arms.
I have a tendency to take a third view, somewhat comprised of the others, but still unique. If the AOA requires an osteopathic internship for licensure (and the 5 key states of PA, FL, WV, OK, and MI do as well), then students who wish to either practice in one of these 5 states or be recognized in the future by their accrediting body are forced to obtain this training. This, of course, ensures cheap labor for the struggling osteopathic hospitals. It also gives the training physicians a year to pressure the intern to stay in their program or at least go to another osteopathic program. Finally, it makes finding placement in an allopathic (ACGME) residency after the internship more difficult. Let me explain:
1) There are several residency programs that will not consider any applicant with prior training, no matter what. This takes this number out of the possible training pool.
2) The rigors of the internship year are not conducive to application to residency programs and residency interviews. This further encourages the resident to stay at the current institution or go to another nearby institution.
3) The aforementioned rigors of the intern year are such that not many would want to repeat them; something which is a distinct possibility if the student goes to an ACGME residency after their intern year - most ACGME residencies do not recognize an AOA traditional rotating internship and will require the student to start over again at the bottom of the barrel.
4) Money. The Centers of Medicare and Medicaid (CMS or whatever) has decided how many years each specialty should take to train. Therefore, if a resident starts one residency and decides to go to another specialty mid-training, there is the distinct possibility that the residency program would get decreased funding for the last 1-2 years of the resident's training. This is another hurdle that an osteopathic resident must overcome - convincing the residency program to take a loss on their training in order to attend their institution. In today's age of medical cutbacks and shortfalls, this is a very hard case to argue. This, again, makes it difficult for an osteopathic resident to make the transition from osteopathic internship to ACGME residency.
All of these factors add up to make life difficult for the osteopathic resident/student. While they may want to follow their osteopathic roots and complete the osteopathic internship, their post-internship choices are decidedly limited. This is unfortunate, for I find myself in this position.
more to come... ¶ 4:44 PM 0 comments
Thursday, July 01, 2004
Growing pains
Ok, I guess I'm just having difficulties with the system, but so far in 2 days, I've had to retype 3 different entries. I guess it's just growing pains. Hopefully this will not continue for too long.
Today was a complete and total waste of time. First of all, I woke up at 0700 (ish) and then had my first class of the day at 0800. It was all about OSHA guidelines, standard precautions and infectious diseases. Nothing I didn't already know, aside from a list of the reportable diseases in the state of Texas.
Next was an incredibly boring lecture about how to use the I.T. system at the hospital across the street.
Then was patient confidentiality. Again, nothing much that I didn't know. Everything that was said was either so basic or something an idiot should know. Don't share health information with your newspaper boy, duh.
Next was a curriculum meeting. Basically, a bunch of students had lunch with the dean of medical education or something and told the faculty/staff what we thought was wrong with our curriculum. Not that anything we say will make a damn bit of difference.
After lunch, was a riveting session about documentation by a NURSE. Ok, not to sound crass or anything (especially since I am a nurse), but nursing documentation is nothing like physician documentation. Nurses write about how much crap a person left in the bowl, not about what their CVP or EF is. Give me a break.
Finally, we finished with a coma-inducing session about analyzing and critically thinking about medical literature. OH MY GOD.. I seriously could not stay awake for the life of me. I think I was placed into a coma by my subconscious to protect my fragile little mind. Repression has its uses.
Anyway, so that was pretty much my day. Much fun, huh? And now I'm going to drive Ashleigh to Lewisville to pick up her car. That is a complete cluster fuck as well. I'll tell you about it sometime...
more to come...
¶ 1:37 PM 0 comments
Today was a complete and total waste of time. First of all, I woke up at 0700 (ish) and then had my first class of the day at 0800. It was all about OSHA guidelines, standard precautions and infectious diseases. Nothing I didn't already know, aside from a list of the reportable diseases in the state of Texas.
Next was an incredibly boring lecture about how to use the I.T. system at the hospital across the street.
Then was patient confidentiality. Again, nothing much that I didn't know. Everything that was said was either so basic or something an idiot should know. Don't share health information with your newspaper boy, duh.
Next was a curriculum meeting. Basically, a bunch of students had lunch with the dean of medical education or something and told the faculty/staff what we thought was wrong with our curriculum. Not that anything we say will make a damn bit of difference.
After lunch, was a riveting session about documentation by a NURSE. Ok, not to sound crass or anything (especially since I am a nurse), but nursing documentation is nothing like physician documentation. Nurses write about how much crap a person left in the bowl, not about what their CVP or EF is. Give me a break.
Finally, we finished with a coma-inducing session about analyzing and critically thinking about medical literature. OH MY GOD.. I seriously could not stay awake for the life of me. I think I was placed into a coma by my subconscious to protect my fragile little mind. Repression has its uses.
Anyway, so that was pretty much my day. Much fun, huh? And now I'm going to drive Ashleigh to Lewisville to pick up her car. That is a complete cluster fuck as well. I'll tell you about it sometime...
more to come...
¶ 1:37 PM 0 comments
