An internal medicine resident's journey through public health, island living, medical school, clerkship rotations, internship, residency, travel medicine and life... with many pit stops, detours and distractions along the way.
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Robin Williams tribute brunch at Stony Brook PCMH clinic!

One of my regular patients called in to reschedule her appointment. I didn’t get to speak to her but she told the clerk, “Tell her I love her and I’ll see her soon!l

Made my day especially before my 24 hour call tomorrow.

Clinic Mexican Fiesta plus JNC8 review.

After this past week as MAR (Medical Admitting Resident), this was an especially good (re-)read.

"We recognize the empty souls behind your tired eyes as you admit the 105 year old dementia patient with, yep, weakness. Your tenth admit for weakness in 12 hours. We know that the average age of all your admissions is somewhere around 85. We hear your souls die a little when we say, “the family wants to put him in a nursing home and says he’s more confused than normal.”

But we know it hurts in other ways. It hurts when you have those days. Those days when you have all the same patient. Eight chest pain work-ups. Six Xanax overdoses. Nine TIA’s. Seven syncopes. And a partridge in a pear tree. The thing is, we see them before you do, and we understand. We just realized, early in our career, that two hours of anything was more than enough. You have them for days. Bless your hearts!

We also feel for you when it comes down to the patient dumping contest. You know, the ancient hip fracture with 26 meds whom the orthopedist says, “have the hospitalist admit them, we’ll consult.” The GI bleed, of whom the gastroenterologist says, “have the hospitalist admit her, we’ll consult.” The nosebleed on Coumadin dodged by ENT and gifted to your capable hands. The post-op cellulitis, the post-partum pneumonia, the vague abdominal pain. “Have the hospitalist admit them.” The very words must haunt your nightmares, as assorted specialties leave the annoying work, the admission orders, sliding scales, pain meds, dispositions, social planning and midnight phone-calls … to you!”

Best surprise for the MAR after transporting MICU patients. #bribesarewelcome #teamBisawesome #bestideasinmedicine (at Stony Brook Hospital Emergency Room)

Board review on a rainy day… And so it begins.

“You have to have a burning, unending desire, to put yourself”

So well put.

As a SGU grad, I am grateful for this second chance to fulfill a life long dream. And it has only made me work harder. I love what I do!

"Regardless of our age, gender, or student loan debt, doctors have all taken an oath. An oath promising to value and respect human life, do no harm, maintain confidentiality and ultimately do what is best for patients and our community.

So the next time a young doctor walks into the room, give her the benefit of the doubt. She may be 20-something, driving a 2000 Toyota, with half of her paycheck paying off student loan debt. If you look hard enough you may see the “age lines” she and the next generation of young doctors acquired through the many sleepless nights and delayed gratification invested in taking care of you and your loved ones.”

-Dr. Aunna Pourang, Family Medicine from www.kevinmd.com

Great read. I feel like people often have very misconstrued notions about what it’s like to be a doctor these days. I’m not complaining, but the reality is often very different than what people believe.

"I know I raise my game when I work with residents and students. They make me better — even now, after all these years.

I can’t prove it: clinical expertise doesn’t lend itself easily to objective measurement, much less controlled trials. (If I could prove it, I would ask patients to give informed consent for admission to the nonteaching service.) But I know it as surely as I remember Mrs. J. in Chicago, whose severe pernicious anemia explained her dyspnea until my intern heard the diastolic rumble I had missed; and Mr. R. in Manhattan, whose raging illness stumped me cold until my resident taught me about familial Mediterranean fever; and Mrs. K. in Rochester, whose near-fatal drug addiction remained undiscovered until my medical student made the effort to bond with her family. Patients’ stories are clinicians’ lifeblood and conscience; they make us who we are. Shouldn’t I tell Mrs. A. who I am? How my student doctors can help her, too?”

-Brendan M. Reilly, M.D.
N Engl J Med 2014; 371:293-295July 24, 2014DOI: 10.1056/NEJMp1405709


There are many times that I have seen patients that do not want to see students. I disagree, I would rather be on a teaching service, so that you have more eyes on you. Attendings “step up their game” when they have to teach. And for me, teaching someone else reassures me that I know what I am talking about. It’s true, medical students are naive and residents, the same. But in training, you are forced to think of differential diagnoses that one may forget about or not think about.

saidnoresidentever:

"Being under VA "sky lights" for 12 hours is just like being outside on a summer day." - said no resident ever.

Heart tracings as Neil Armstrong and Buzz Aldrin first walked on the moon on July 21, 1969, nearly 45 years ago while Michael Collins piloted Apollo 11. You can sense their excitement!

EVA = Extravehicular activity.
Credit to my dear friend and cardiology fellow, Naveed, for sharing this.

Missouri Governor Jay Nixon has signed into a law a bill that makes it legal for medical students who have not yet completed a year of residency to work as “assistant physicians” within the state, delivering primary care services with 10 percent of their work reviewed by a physician.

I disagree with this. Residency is invaluable in teaching people how to be doctors. Looking back to myself as a 4th year medical student and now as a resident, it’s amazing to see how much I have learned while under supervision. Practicing medicine without a residency is scary and likely dangerous. 

2. W61.12XA: Struck by macaw, initial encounter. ​

The 16 most absurd ICD-10
Codes.

Birds are terrifying. They have such an advantage over us. Flight.

Enroute to temple of the moon #peru #machupicchu

Know your bacterial infections