I started orientation on Thursday, June 18th. The first day was the longest. i had to listen to several people throughout the day about all kinds of stuff. Plus listen to a 1.5 hour lecture on performing a newborn exam and other pediatric stuff. The cool thing is they give you a handbook that they made on peds. So it has everything you need and it's in alphabetical order. It tells you what to do and what labs to order. My day ended at 4pm which is pretty good.
The previous evening, there was a social where I met the interns, chiefs, and faculty at the program director's home. It was nice to meet them all and it turned out that I knew more interns that I originally had thought. There's 14 of us total. It turns out that I ran into some of them during interview season. It was funny that some of us were at the same interviews at different locations.
On Friday, it was more paperwork. But it was much more laid back because it was at Human Resources and we learned about different benefits the hospital offers. They have cell phone discounts. For example, if I have AT&T, I get 24% off my monthly bill. Pretty cool, huh? After much research with all the different discounts they offered through Verizon and Sprint and AT&T, I decided to stay with my parents family plan with T-mobile. It's only $12 per month for me to be added on that plan. I spent a lot of time researching all the smartphones and plans and ultimately decided to hold off on it for now. I don't want the iphone. I love the palm pre (but it's too new and lacks a lot of the software I need, but great operating system and multitask ability).
I also looked into gym membership. There's an awesome gym next door to the hospital and for employees, it's $28 per month. So I will be getting that. Everyday, they've been feeding us catered food for breakfast and lunch. As well as dessert and chocolates and snacks. So I will definitely need to hit the gym soon. But I can't really complain about the food. It's been awesome. - and remember, I'm a picky eater.
Friday evening was a social at a resident's home for just the residents. So I got to meet the 2nd and 3rd years and soon to be graduates from the program.
I then had the weekend off. But my weekend did not go without stress. Why? Because I had a PALS course starting on Monday and I didn't really prepare for it. I didn't think it would be coming so soon. So I read a little and worried a lot. Monday was BLS for child and infant followed by some advanced life support (ALS). They really want us to know BLS really well and pass it before proceeding to ALS. We had to perform CPR perfectly. I had to repeat infant CPR because I forgot to lift the infant's chin when I listened to it's airway for breathing. They even time you to make sure you listen between 5-10 seconds. If you listen for too short or too long, you have to get retested. The booklet came with the fold up card which abbreviated the steps on what to do with arrhythmias, shock, respiratory problems. I was getting really worried about Tuesday because that's when we are tested on the megacode which can be a combination of the 3. btw, this was not like ACLS at school. I found out that normally each person is individually tested to lead the megacode and must pass it. But we each got to lead a couple of practice scenarios which was good. I got nervous and would blank out on what to do. But each time I practiced, I got to more confident. They also said, you can only fail either the written or the megacode once and then you get a second chance. But you can't fail both. So I was really worried. I passed the written, but I did have to repeat the megacode. I forgot to check the rhythm on the monitor before starting CPR. Overall I passed. Yeah!!!
Today, Wednesday is OSCE day. They said there's no studying involved which is good. They just want to see how you do with simulated patients. I will be doing that this afternoon and the rest of the day I have off.
Wednesday, June 24, 2009
Wednesday, January 14, 2009
Rank Order List starts tomorrow
So I am currently in the process of figuring out what to rank second, third, fourth. I'll probably try out the chart from Iserson's getting into residency book. It'll be interesting to see how each program scores.
So there's a couple of other students on my derm rotation and they are both applying to ophthalmology which actually pre-match tomorrow. They get to know where they end up sometime after midnight, while most everyone else (like me) won't find out 'til late March. I think urology pre-matches as well.
So one resident mentioned that around this time of year, many 4th year students could be expecting phone calls, emails, etc from multiple residency programs. I am starting to notice that now. One was an invitation for a dinner next month, one was a phone call to see if I had any more questions, and one was a nice gift that I received by UPS.
So there's a couple of other students on my derm rotation and they are both applying to ophthalmology which actually pre-match tomorrow. They get to know where they end up sometime after midnight, while most everyone else (like me) won't find out 'til late March. I think urology pre-matches as well.
So one resident mentioned that around this time of year, many 4th year students could be expecting phone calls, emails, etc from multiple residency programs. I am starting to notice that now. One was an invitation for a dinner next month, one was a phone call to see if I had any more questions, and one was a nice gift that I received by UPS.
Tuesday, January 13, 2009
Dermatology
It's 2009! And it feels like 4th year is going downhill - no more exams, residency applications submitted, almost no more interviews. Just a few more rotations, and then graduation. This month is derm. I figured it'll be a good rotation to have to prepare for family medicine. It's been interesting. It's outpatient clinic at the county hospital and clinic is only in the afternoons with optional 1 hour lecture in the AM. I pretty much started seeing patients from day 1 - even though I knew once I left the patient's room, I wouldn't know what to diagnose the patient with. btw, derm has a lot acronyms - and I'm slowly learning one at a time (ex. SK - seborrheic keratosis). After one week, I'm starting to recognize some of the common derm stuff, but I still haven't seen it all. I'm getting better at describing lesions & making good use of my ruler. The interview/exam is VERY focused - probably about 5 minutes long - but I tend to take my time since everyone's busy seeing other patients. I do notice that patients come in for some of the most minor stuff. I'm surprised that they show up to see a derm for it. For example, freezing off a wart. They do biopsies all the time there and since they're short staffed, if my patient needs the biopsy done, I set up the tray. It's actually good to know what equipment I would need and what forms the patient needs to sign and what forms to fill out to send to the pathologist. I'll probably get to do some biopsies during the rest of the rotation. I would like to get comfortable with procedures.
Tuesday, August 26, 2008
My week off....sort of.
I got to relax during my last weekend in Galveston especially since I had no rotation to go to on Monday. It was a lot of fun. btw, this is a picture of my backyard for this past month. There's a row of ducks swimming in the saltwater.
My family and I decided to go fishing and crabbing off the pier. We ended up catching a lot of fish and several large crabs. We don't usually catch much fish most of the time. So it was pretty exciting when we were getting a lot of bites.
The next picture is my sister holding up one of the crabs we caught. It barely fit on the plate. And it was very tasty.
Now I'm back in Houston. And as much as I would like to goof off this week, I have to work on residency apps, study for geriatrics exam, etc, etc.
Tuesday, August 19, 2008
COMLEX step 2 written exam
I just found out that the scores are posted. I took it July 25th. So if you took it before then, it's probably posted. btw, I passed. :)
On death & dying...hospice care
On Monday, I had a good introduction on hospice care at a hospice non-profit company. btw, hospice care is paid for by Medicare. They showed me a 50 minute video called "Pioneers of Hospice" which included the people who started hospice care, hence the title.
Then I visited a young cancer patient (40s) who was diagnosed with stage 4 lung cancer. His major complaint was pain which can be 8/10 often times. He was concerned about a new pain in his side and wanted to know what was causing it, but didn't want to hear the answer "it's because of the cancer." Once a patient enters hospice, we do as much as possible to help relieve pain so that quality of life is improved. We'd give morphine, methadone, etc.
Later that afternoon in family clinic, I saw a patient in her early 50s (which I don't normally see since I'm seeing only geriatrics, but the doctor didn't realize it 'til later.). Her chief complaint were these two huge knot at the tops of her shoulder with muscle tightness and tension headache in the back of her head. The precipitating factor: when her son brings up topics like funeral arrangements. We're treating her with a muscle relaxant and trazodone. But the patient's biggest concern was her son, age 27 with history of 2 strokes and now colon cancer. No one else in the family has cancer. All of his siblings are healthy. He's undergoing chemo now, but there isn't much left that can be done medically. Although, the son has accepted that he doesn't have long to live, the patient (mom) really doesn't want to lose him. The patient says that if you looked at him, you would never think he had cancer. He still plays basketball with friends. But he does limp on his right side because of the stroke.
I haven't really dealt with death personally. Both sides of my grandparents have passed away when I was a teenager, but I only knew one set pretty well when I was a young child. I don't remember them much, so I didn't really grieve.
After clinic, I decided today was a good day to stop procrastinating and start the ethics assignment. It was, after all, about "expressing your feelings" about death of a patient in one of the sample cases. btw, I never enjoyed ethics. I didn't mind listening to interesting cases. But as far as putting in input on what I thought, I was usually a complete blank. I'm not even sure if I completed the assignment correctly, but just tried to follow the instructions as best as I could.
Then I visited a young cancer patient (40s) who was diagnosed with stage 4 lung cancer. His major complaint was pain which can be 8/10 often times. He was concerned about a new pain in his side and wanted to know what was causing it, but didn't want to hear the answer "it's because of the cancer." Once a patient enters hospice, we do as much as possible to help relieve pain so that quality of life is improved. We'd give morphine, methadone, etc.
Later that afternoon in family clinic, I saw a patient in her early 50s (which I don't normally see since I'm seeing only geriatrics, but the doctor didn't realize it 'til later.). Her chief complaint were these two huge knot at the tops of her shoulder with muscle tightness and tension headache in the back of her head. The precipitating factor: when her son brings up topics like funeral arrangements. We're treating her with a muscle relaxant and trazodone. But the patient's biggest concern was her son, age 27 with history of 2 strokes and now colon cancer. No one else in the family has cancer. All of his siblings are healthy. He's undergoing chemo now, but there isn't much left that can be done medically. Although, the son has accepted that he doesn't have long to live, the patient (mom) really doesn't want to lose him. The patient says that if you looked at him, you would never think he had cancer. He still plays basketball with friends. But he does limp on his right side because of the stroke.
I haven't really dealt with death personally. Both sides of my grandparents have passed away when I was a teenager, but I only knew one set pretty well when I was a young child. I don't remember them much, so I didn't really grieve.
After clinic, I decided today was a good day to stop procrastinating and start the ethics assignment. It was, after all, about "expressing your feelings" about death of a patient in one of the sample cases. btw, I never enjoyed ethics. I didn't mind listening to interesting cases. But as far as putting in input on what I thought, I was usually a complete blank. I'm not even sure if I completed the assignment correctly, but just tried to follow the instructions as best as I could.
Wednesday, August 13, 2008
Nursing home care & common sense
So I've been to the nursing home a few times now. And I'm getting more familiar with the whole setup. This nursing home has a SNF, a floor for nursing home patients who require a lot of help and a floor for patients who require less help, and a unit that's for only Alzheimer's patients.
Guess what determines a patient who needs less help. The patient must be able to get to the dining room without any nursing assistance. It doesn't matter how they get there (by walker or wheelchair), as long as they can get there without a nurse.
Some of the patients have a great view of the ocean through their window. It's easy to get distracted and stare at the crashing waves.
So rounding on nursing home patients is like rounding in the hospital, except a bit less formal. You see a lot of PT and OT here. Most or all of the patients in SNF are just here for rehabilitation. We ask the PT/OT how the patients are doing and how much more longer they'll need to stay for treatment. We also manage medications and monitor vitals and find out if patients have any complaints. We see patients on SNF once a week. The nursing home patients are seen atleast once every 60 days unless they have a complaint or the nurses report something wrong with the patient such as hematuria.
I learned that in addition to ordering a urine culture for a patient with hematuria, it wouldn't hurt to order a CBC. This would check to see if patient lost a lot of blood and you can also see if the white count is up.
One patient had a mild, pruritic skin rash over an insulin injection site on her arm. It wasn't infected. The doctor said it was probably eczema. As a side note, she mentioned giving hydrocortisone cream will treat 90% of rashes. Good to know, I thought.
One thing an older, wiser doctor has is good observation. I'm sure I'll develop that skill eventually. But they make it look so easy. When we saw a patient in her room, she was sitting in one of those electric recliners that lifts up at an angle to help you stand up easier from a sitting position. She was lowering it to the sitting position when we walked in. There was also a wheelchair in her room, but no walker. The attending asked the team if she can walk at all. They say she's too weak to use a walker and primarily uses the wheelchair. This doctor's number one concern for any elderly patient is risk for falls. If she's unsteady and tries to walk from the recliner to her wheelchair, she can very likely fall. Also, if she raises her recliner to the standing position, she may lose balance and fall. The doctor said to always picture yourself in the patient's position and see if you're likely to fall, and then do everything possible to keep that from happening. So the doctor recommended that the patient no longer sit on the recliner and that she can only either be on the bed or her wheelchair. She says that you just have to use some common sense when seeing these patients.
Guess what determines a patient who needs less help. The patient must be able to get to the dining room without any nursing assistance. It doesn't matter how they get there (by walker or wheelchair), as long as they can get there without a nurse.
Some of the patients have a great view of the ocean through their window. It's easy to get distracted and stare at the crashing waves.
So rounding on nursing home patients is like rounding in the hospital, except a bit less formal. You see a lot of PT and OT here. Most or all of the patients in SNF are just here for rehabilitation. We ask the PT/OT how the patients are doing and how much more longer they'll need to stay for treatment. We also manage medications and monitor vitals and find out if patients have any complaints. We see patients on SNF once a week. The nursing home patients are seen atleast once every 60 days unless they have a complaint or the nurses report something wrong with the patient such as hematuria.
I learned that in addition to ordering a urine culture for a patient with hematuria, it wouldn't hurt to order a CBC. This would check to see if patient lost a lot of blood and you can also see if the white count is up.
One patient had a mild, pruritic skin rash over an insulin injection site on her arm. It wasn't infected. The doctor said it was probably eczema. As a side note, she mentioned giving hydrocortisone cream will treat 90% of rashes. Good to know, I thought.
One thing an older, wiser doctor has is good observation. I'm sure I'll develop that skill eventually. But they make it look so easy. When we saw a patient in her room, she was sitting in one of those electric recliners that lifts up at an angle to help you stand up easier from a sitting position. She was lowering it to the sitting position when we walked in. There was also a wheelchair in her room, but no walker. The attending asked the team if she can walk at all. They say she's too weak to use a walker and primarily uses the wheelchair. This doctor's number one concern for any elderly patient is risk for falls. If she's unsteady and tries to walk from the recliner to her wheelchair, she can very likely fall. Also, if she raises her recliner to the standing position, she may lose balance and fall. The doctor said to always picture yourself in the patient's position and see if you're likely to fall, and then do everything possible to keep that from happening. So the doctor recommended that the patient no longer sit on the recliner and that she can only either be on the bed or her wheelchair. She says that you just have to use some common sense when seeing these patients.
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