tired

medicine is so tiring. i rounded for 5 hours today post call. so many new patients. I kept having this raging internal debate in my head as we went over patient after patient- am i more sleepy, or more hungry?

especially tiring when you're running around like a headless chicken and you feel like you're getting in the way more than you contribute. it's exhausting being so stupid and incompetent.

i guess i just have to take it on faith that eventually... i'll get there. but i feel so stupid compared to our subi's. who seem so stupid compared to our interns. who seem so stupid compared to our residents. who seem like total dumbshits compared to our attendings. maybe i've just had two extra fabulous attendings.

all of that knowledge to accumulate... sometimes you just think, fuck it, what's the point. it's like after two years of busting your ass and all of your rapidly disintegrating knowledge base isn't worth jack shit.

i'm lost in a sea of trade names i have to pick up, dosing levels, abbreviations... all that crap. then having to remember patient names and doctor names and nurses names.

i find it all very exhausting. there's not enough victories in medicine. so many dumbasses putting themselves into the hospital for the nth time because they can't stop drinking. so many f'ing drug addicts. it's like every patient we need to start a goddamn withdrawal protocol.

and then you finally have the people who don't want to be sick. it makes you sad when despite all of the smiles and time spent and the caring and wanting to help you realize there's nothing you can do. that you spent a week and a half working towards a diagnosis and being there 3 hours late answering questions... and when you finally get a diagnosis you realize your patient can't get the fucking curative surgery anyway because they don't have any health insurance. you feel like you're doing a good job and then shit like that just ruins your day.

i wish there were more victories. More curing instead of discharging people a little less sick than they came in.

I watch my attending everday and how awesome and patient she is with everyone and I'm just amazed. how much she cares and how she might be the nicest person i've ever freakin met. i wish i could be that caring. because honestly sometimes i just want to slap some of our patients.

she's probably just faking it. she probably goes home and clubs her dogs or something.

I find myself leaning more and more towards doing radiology. And it feels so dirty and cheap.

i think my problem is i'm a lazy overachiever. i'm always willing to put the work it... but i hate myself as i do it. I care too much about my patients... or maybe my grade, who knows... but then i go home and whine about how tired it made me. i wish i could either just embrace the laziness or be an earnest hard worker.

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i need to stop whining. randy pausch died. :( i need to be more positivbe.

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peace

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Song of the Week - M.I.A. - Paper Planes (Remix Feat. Bun B & Rich Boy)

I Felt Like a Doctor Today

As a med student on rotations with theoretically zero authority, nothing feels better than spotting an error in logic or medications, or coming up with a different diagnosis that results in a tangible change in medical management.

nothing is more vindicating than showing the powers that be above you that you were there to catch screwups which they with the md behind their signatures are ultimately responsible for. me, a lowly msiii.

sure, maybe it was my poor h&p that led us in the wrong direction. yeah, in fact that's exactly what it was... but who's counting?

i mean, if i hadn't caught my own fuckup, where would they be? shit up the creek without a diagnosis, that's where.

the key is making the error under your unsuspecting first attending. then catching the error after hours and then calling up your brand new second attending who's taking over the case and now thinks, 'damn, this kid is dilligent'

score!

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I sent in another one of my H&P writeups to my preceptorship last friday and i got back an email today from him which said only the following:
"Suboptimal, Gerlad. See comments"

ouch! that kinda really hurt my feelings...

it's okay though because i purposely set my writeup standards low so i can trend upwards. i even turned it in 2 days later than the other two in my group. still it was a little harsh.

i don't understand why they expect us to write 50 freaking pages up in grand detail when in reality all of the real docs write 2 sentences in ineligible chickenscratch. get real.

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On the other hand i met with my (first) attending today for an evaluation-vs-self-evaluation session. Self evaluation is a very tricky business. You always want to underestimate yourself. But then again you don't want to be so thoroughly convincing in the explanation area that they agree with your score assessments. I gave myself all satisfactorys except for motivation, which i put as excellent. I think it worked as he upgraded my grade for every category and kept the excellent for motivation. score! i almost shed a tear in my pants when he told me my knowledge base was definitely above average.

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I'm having this inner battle to decide how much I care/should care. On the one hand, I spend a lot of extra time in the hospital in talking to and caring for my patients. I'm usually there on average over an hour or two later than my counterpart. Not sure why that is but it always ends up that way somehow.

On the other hand, I'm consciously aware of the fact that I spend way too much fucking time in the hospital. Going back to make sure their pain meds got ordered like you asked (they were). Annoying the tired ent doc to make sure your less than sane patient's ridiculous request gets made like you ridiculously promised. Spending extra time with my patients to answer their questions and make small talk and letting them know someone kinda cares while I glance at the clock and realize I don't have any time for reading again tonight. Which begs the question- do you really care if you resent/hate the fact that you care?

Sure it makes the patient feel better (maybe) or the attendings residents realize your dedication (doubtful they notice). But then again most of the time I come home look at the clock, think about how tired i am and conclude it probably wasn't worth the extra effort.

Third year is freaking tiring. Or medicine in general. This whole business is like a mirage. People always just keep telling you to temporarily self-sacrifice and that there's light at the end of the tunnel. but then you look around at all of the doctors and they're all still self-sacrificing and miserable and how many are all that happy.

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Yesterday me and the subi tracked down the source of the popsicles we saw our chf patient snacking on. it looked so good i almost sntached it from him. I had been obsessing about the damn thing for the last week. now I'm determined to smuggle a popsicle every day until i make back my 65k. nice too because it's freaking hot up in hurr.

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in other news step 1 is my bitch afterall.

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Song of the Week - Leona Lewis - Run.mp3

One Week

I've come to the realization that I kind of suck at this. I am bumbling around like a headless chicken and I feel like I am mostly just getting in the way.

I think my main problem is my very-short-term memory. I've always been more of a conceptual person and when it comes to remembering names, numbers etc I tend to forget crap like that within seconds of being told.

I will go to a computer, read up on a couple of lab values, write them down, have it straight in my mind what I want to say and what the relevance of each value is, but as soon as I have to report to anyone my findings I lose track of what I wanted to say, I forget key points and I talk all jumbled and garbled. I'll have one or two simple questions I want to ask a patient but after getting through the small talk I'll forget what they were.

I think I'm just not very good at following directions or ordered tasks. If I give myself or someone else gives me a couple of tasks to do I have to keep reminding myself what the next task and I'm terribly inefficient.

I'm not very good at doing evaluating physical signs (still mostly going through the motions), I can't keep up with all of the clinical jargon and drug regiments and crap flying left and right...

I think my only real strength is my understanding of organ system pathophysiology. The only problem is, when someone asks me a question directly I turn into a complete freaking moron- my mind blanks out. I was asked how to identify a-fib at the bedside (DUH- irregular irregular rhythm) and for some reason I started reasoning out heart block instead. god I felt like such a tool.

When he asks someone else or asks the group a question, I can almost always come up with good answers first but Im too timid to blurt out answers until there's a silence. I'm always coming up with very intelligent questions but I very rarely ask them on rounds because there's so many patients to get through and I don't want to annoy our interns.

So basically I think to any objective observer I'm performing about average or below. I'm most definitely not standing out.

Dammit, this has to change. I need to figure out a way to get myself, my thoughts and my huge overfreaking crowded pockets organized. I need to stop staying up so late for no good reasons and showing up tired without enough time to keep myself from panicking collecting data during prerounds. I need to start reading like a fiend. I probably need to stop blogging...

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So far I don't like 3rd year all that much. Too tiring and I feel like I don't learn much in a day. People are too busy to teach you stuff and it's mostly learning through osmosis, which is pretty inefficient. Talking to patients is fun and all but you don't learn much medicine from them. I get home and I'm tired and I soo don't feel like opening up a book so I end up watching more episodes of how i met your mother or something.

And everyone is so busy. You can only hang out with people for like 30 minute intervals. Don't even bother asking any surgery friends to hang out, their bedtime is like 8:30 pm.

Ok maybe if I stop whining I can actually get some reading in today. Hopefully I can turn a corner this week. It's probably better this way... don't want to set the bar high, you start off slow so they can see more improvement.

still alive

survived my 2nd full day. hmmmm what to say.

gina if you are as busy as our interns then god bless you. i find it pretty amazing how much responsibility they give interns that are fresh out of chilling and vacationing all of 4th year.

rounds i think are my favorite part of the day. i just hope i get better at keeping straight patients. i often can't focus for the 20 or so seconds of a presentation and so by the time i finish telling myself "focus" i've missed the chief complaint and i'm trying to piece the story together from the family and past medical history. that and i space out pretty often. i find it pretty amazing how attentive the attendings are to keep track of so many freaking patients down to the little details. even the interns who are doing all of that plus a shitload of gruntwork.

i hope that is something that comes with time. as it is people's symptoms all seem to blend together in my head as we go from one patient to another.

rounding is fun because i still have all of this step1 stuff fresh in my head and when it comes to getting pimped on useless pathophysiology (2nd messengers etc) I can answer a heck of a lot more than the interns and our senior resident... who are fatigued and riddled with actual useful knowledge. and happily, i am smarter than my teammate. I hold myself back and always let the residents answer first though because they told us during orientation not to be the annoying knowitall.

the frustrating thing is that my step1 knowledge is disappearing at an alarming rate (almost zero recollection of drugs already after 2 weeks) and i suck suck suck suck at presenting.

i really need softer shoes.. my feet are killing me!

maybe it's just my school but nobody seems to want to give me any scutwork... outside of my two patients... which is pretty nice, i think. i really thought i would get used more.

of course that's probably because i am ass-slow and i'm so afraid of messing up i keep asking for micromanagement and it is twice as fast for them to do scutwork without me.

medicine is kind of sad. i spent two hours today talking to an adopted patient because i wanted to get to know this person better instead of presenting on people i've never really spent time with, which is what i've been doing. this person ended up crying to me several times. the sad thing is i'm probably the only person that's really taken the time to talk to this person.

not that that makes me a saint, really who the f else has the time. when i am an intern will i care about anything more than discharging patients and lightening the workload and getting some sleep? will i take the time when i am on call with 30 other patients to find out if said patient really has the diseases on her chart, to figure out some way to reduce her 14 different medications? heck no. will i distrust and assume half of my patients are drug seeking addicts? probably.

hopefully i've neutered all of that to be a hippaa non-violation. i would write more but i've got to read up on freaking ekg's

oh yeah my schedule! 6 days a week unless we have call saturday, in which case i have zero days off! "Sunday is a reading day, we expect you to devote a significant portion of the day to reading"... wtf!!! i don't even have lunches off bc of damn noon conferences.

i miss second year. when classes were optional and i could go a whole week without shaving... :(

oh yeah if you IM me and i ignore you, it's because i'm stealing off of my neighbor's shoddy ass connection which keeps disconnecting. i didn't pay my dsl bill during step1 madness and they freakin cut my line. gonna take a week to get it back up... those fuckers.

iphone app store coming out tomorrow!!!

Long Ass Update

Whoa. I just vacuumed my apartment for the first time in... don't ask.

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Step1 was... an experience. I ate a hugeass burrito the night before and I think it delayed the absorption of my zolpidem because I couldn't fall asleep for a good 5 hours. Even after upping my dose to a full pill from my usual half pill. I guess I should have read the captialized bolded "TAKE ON AN EMPTY STOMACH" part of the instructions more carefully.

Anyway it was a horrible, horrible 5 hours. Between my anger and the paranoia of having my sleeping pills kick in during the middle of the test I was wide awake and freaking out. I tried sleep relaxation techniques I read about online, I called my mom and had her tell me stories for an hour, I tried reverse reverse psychology, I tried... um yeah. I tried everything. I would get to about 90% asleep and then I would think "hey i'm almost asleep" and wake right up again.

How did it go, I honestly have no freaking clue. My goal prior to the exam was to stay within $100 bucks (silly $5/point bet we made last year) of my friend whom I can all but guarantee will get a 260+ score. 240 = happy, 245 ecstatic, 250 worth selling my soul for. 500 hours and 2 nbmes and 2000 questions later I even got delusional and started dreaming of beating my friend, because of the psychopaths on sdn projecting usmleworld scores.

The test itself... one of the most godawful experiences of my life. No excuses on the sleep, I got a solid 4 hours of sleep in under the influence, 4 hours more than I had for the mcat. I brought a whole bunch of caffeine with me too but I was so amped up I think an extra caffeine boost might have killed me. I felt like I had malignant hypertension throughout the whole 8 hours. I thought I was gonna leave the test center with a buffalo hump from all of the stress.

I literally spent 15 minutes on the 4 minute tutorial (usually you try to finish fast to save your break time) because I was too afraid to click on the "Done" button to start the test. The first 10 minutes of the exam were the absolute worst. I kept thinking "omg, this counts, omg omg omg this counts, focus gerlad focus, omg i can't focus omg if i get this wrong my score it counts, focus dammit focus" over and over again. I had to reread the first 8 or so questions about 10 or so times before I finally calmed down.

The rest was a blur. Eight hours is way way way too fucking long for an exam of that magnitude. But whatever I've done it so every poor bastard that comes after me should suffer it too hehehe.

It was not fun. I think I would have done a lot better if I was more relaxed and wasn't second guessing myself so much. I felt so off of my game because of the pressure. The hard questions I felt panicked on and even the easy questions I had to double-think and reread because I would think "are they really asking such a simple question?" (the qbanks rarely ask gimmes so it was a changeup) As a result I was constantly time-rushed to finish and didn't get a full relook on all of my marked questions which is usually my bread and butter for getting separation. I've found that usually when I'm not sure my gut is more often right the second time around.

It wouldn't have been so bad if during hour 5 the bitch to my right hadn't literally begun coughing up her lungs. It started as a regular cough and then I think she aspirated something and started to choke. It was SO FREAKING LOUD I couldn't hear myself think and I started getting so pissed off. Read 5 words, anticipate loud ass cough... read 8 more words, anticipate cough. FINALLY she walks out of the test center but by that time the vicious cycle of my pscyhoticness had grown exponentially and I had to give myself a timeout and the end of the block to walk around the building and calm myself down. I know I wasn't the only one pissed off because I could hear other people getting annoyed and sighing really loudly. I felt sorry for the girl but I also kind of wanted her to choke to death so that I could get some peace and quiet.

I even complained to the test moderators after my walk but the desk chick just gave me attitude and said "unfortunately we can't make her stop coughing". Yeah, I freaking know that. I didn't expect them to do anything I was just hoping for a sympathy "I'm sorry." My freaking life is on the line and some chick taking some meaningless mail-in finger-painting certification exam is coughing into my right ear!!!

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aight i had to step away from the keyboard because i started reliving the moment.

Anyway, i really thought i would leave the test center feeling some semblance of happiness. I felt annoyed more than anything. I mean, after 6 fucking weeks of straight studying... and that was it? Just some dinky little printout with a stamp on it. I wanted like a hi-five or something. It just felt so frustrating. All of that work... and you leave feeling like they tested you on everything that you didn't study. It felt like a wasted 6 weeks. I wish I had gone to Hawaii.

I keep telling myself everyone feels that way, including the hardcore gunners on sdn but it doesn't seem to help. Then I looked up a bunch of hard questions I remembered, realized I got most of them wrong and that REALLY didn't help. Especially the antimalarial side effect question which is not in ANY standard resource and I TOLD MYSELF to play it safe and go with the 'quine' drug which I knew 90% of people would pick based on the name but I decided to go for the glory on a bad false memory and got it wrong.

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So in summary, how did it go? My best answer- it's fucking over. My new expectations are just to prepare to be disappointed on the 16th. I think it's a defense mechanism to reverse psychologize myself into keeping an ounce of optimism. dammit I just don't want to be in the midwest no mo.

The aftermath was pretty anticlimatic. People kept telling me to go get wasted or whatever afterwards but there wasn't anyone to celebrate with. Everyone was either done and out of town or still studying. Which was probably good because I didn't much feel like celebrating.

So instead I did something really really gay. My friend had some friends in town for some conference so we went and got sushi at a "really good" restaurant (in the midwest that means shitty and overpriced). Then being the only male in the group i was "dragged" along to see Sex in the City the Movie. First I made them swear not to tell anyone this was how I celebrated being boards-done or that I happen to know all of the character names. I thought it was pretty hilarious actually, a lot better than I thought it would be. But then again, my brain was pretty fried. And at least it was free.

I'm really surprised more guys weren't jumping to see this movie when it first came out. The girl-guy ratio was ridiculous. And what is better than 200 wannabe samanthas leaving a theater with sluttiness = feminism thoughts in their head.

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I had a mini 10 year high school reunion last thursday. Goddamn I'm old. I didn't really want to see anyone (never kept in touch with hs friends) but they asked me and rearranged it around my vacation (real thing is august 2nd, which I can't make) so i guess i had to go.

I was so much smarter than everyone at my craptastic high school, I guess I just expected to have something more to show after 10 years. Coming out of high school I really thought I would discover something big or start a company, or have millions of dollars or otherwise have made a mark in the world. Instead it was like "hey, what's up, yeah i'm still in school and 100k in debt." Damn you stanford for humbling me.

It was actually pretty fun though and a real trip seeing people after so long.

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So anyway tomorrow begins my first day as an MSIII.

To be perfectly honest, I am scurred out of my FREAKIN MIND. For all of my bitching I never appreciated how awesome preclinical years were. Didn't have to go to class if I didn't want to. Didn't have to stand on my feet all of the time. I could stay up as late as I wanted to. No pagers. I could be late all of the time. Now I have to always be early and pretend to be happy all of the time. And according to ruth, i need to show cleavage.

Objectively the first two years sucked cock but dammit, after two years, that's what I'm good at. I always joke about it but deep down inside I have this real fear that I will actually turn out to be one of "those" people who are only good at answering multiple choice questions. For one thing I'm really shitty at remembering names and all of my preceptorship patients started to blend together after a week. Not good signs.

Another part of me is excited about what lies ahead. I've come to the conclusion that I'm just not a very good person anymore. I've always sort of assumed I was a good person but then I sat down one day and tried to come up with reasons why. I couldn't come up with much.

I've been at this stage in my life where I'm pretty much just dead weight. I can't help out my family anymore. I don't contribute to society. I do nothing. The only quantifiable good I do is the occasional buck to the homeless dude on the freeway exit. I guess I'm just a sucker for guys with 1 arm, I want to help them acquire booze.

Other than that, what? I always try to help people out at school and I like teaching people stuff. But those are just selfish ways of getting people to like me and me wanting to feel smart... I always say bless you. I'm polite and I hold the door open for people. But I also get pissed off when people don't say thank you in return. I courtesy jog crossing the street in front of cars. I wave after I cut people off. I smile at people in hallways. I feel bad when bad things happen to good people and vice versa. I feel guilty for being lazy. And that's it. That's all I can come up with.

On the other hand I swear a lot, I constantly talk shit about people I dislike, i want to kick certain persons in the face and there's almost nothing too tasteless for me to joke about. Doing the tally makes me realize I've never really been a very good person. I'm just another dude who isn't outright evil. But at least when I made money or had someone to take care of, at least I felt productve. Now I just sit around studying, procrastinating and accumulating debt.

I guess I'm holding out hope that I'm going to discover some sort of passion for helping people or something, but I'm so damn cynical these days I'm not sure I see it happening. The last few weeks I've been very seriously considering just selling out completely and doing radiology and it really really bothers me.

I got into this stupid field because someone once convinced me that I was patient, that I had a good heart, and that I would be a great doctor someday. And I was sure that I wanted to help people when I got into this. But these days half the time I feel like it's just not worth the trouble.

I've been trying to decide how hard I want to try this upcoming year. I've turned into such a gunner over the course of the last year. I feel like I was more laid back first year, even if my grades weren't as pristine. What's the point... what does it all add up to. So I get into a competitive residency and then what? When does it end... I'm just so tired of having to compete.

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damn this was a long ass blog entry. I think I was inspired after watching some 21 episodes of "How I met your Mother" today, which my brother got me hooked on. OG blogger Doogie Howser (Barney) might just be the most hilarious sitcom character ever invented (even better than the seinfeld characters as individuals). I highly recommend it.