Hola, como se siente?
I finished up geriatrics in September in Chicago and was supposed to start an ER elective at hospital I once was an ER tech in for October. In a strange turn of events, I found out last minute that my rotation was at a non-ACGME site so with 2 business days and a weekend, I had to find new rotation to start Monday. If not, I’d have to sit out a month or travel back to NY in order to graduate on time.
So after tons of phone-calls, emails and prayers, I finally ended up on a family practice rotation here in Chicago in a Spanish-only clinic. At first, my school and the hospital were reluctant to let me start the rotation, reluctant meaning they flat out wouldn’t let me. I took 4 years of high school Spanish and while in NY, participate in a language exchange group, yet my Spanish isn’t quite up to par. So out of desperation determination, I begged to do the rotation in hopes that I would pick up. I have good comprehension since Spanish is similar to Tagalog and Italian, but my conversational medical Spanish is not very good.
Armed with my Medical Spanish dictionary that I picked up at Barnes & Noble on the way into my first day, I struggled through talking with patients on my first day, eventually involving the MA’s to help translate. For the past week and a half, I have been reading through this dictionary, doing Rosetta Stone and forcing myself to remember my vocabulary. I tell all of my Spanish-speaking patients, “Entiendo mucho pero hablo un poquito de Espanol. Asi que hableme despacio por favor.” which means “I understand a lot but I speak a little Spanish. So please speak slowly.” My patients’ seem excited that I’m trying to learn and speak their language. It’s amazing how much I picked up and now and doing full interviews with patients and families, and slowly on the road to being fluent!
So this month began as a stressful mess, but has turned into a great opportunity for me to learn more about family practice and to become more bilingual, an important advantage for the future.
Yesterday was my last day as an MS III. I’ve been doing my last three rotations, Ob/Gyn, Surgery and Internal Medicine here for the past 7 months, so as far as hospitals go, this place feels most like home. I was both excited and sad about leaving, since I’ve grown so used to the comfort of this place, familiar places and even frequent patients. It is strange that my 5 am alarm clock alarms with requisite, repeated snooze will not be set for the next few weeks. And yet, I could not get myself to sleep in this morning. I said my goodbyes and thank you’s to my residents, attendings, nurses, housekeeping, even the chef in the cafeteria and the cashiers in the hospital diner. I’ve come to know so many people here, and it’s sad that they won’t be part of my everyday. It’s part of moving on and forward, yet I always get a little nostalgic. I’ve had a really great experience. Everyone was so friendly and kind. It is incredible how much I have learned so much this past year and how much more comfortable and easier things seem. I’m excited and anxious about starting my 4th year electives. I will be bouncing back and forth from California, Chicago, possibly Florida and New York for rotations. It is nerve-wrecking yet really exciting to be traveling here and there in search of some unknown future. I’m not sure where I want to live nor am I really tied to a specific city, so the possibilities seem endless. I have to say I really do love New York. But.. Before then, I will be back on lockdown for the next few months studying for step 2.
Day after hand surgery (for a displaced scaphoid fracture on my right dominant hand) writing progress notes as a lefty.
My last surgery call awaiting the next trauma after a superbly busy and exhausting night.
Yet another take on figuring out how to choose a medical specialty.
Planning out my 4th year and trying to figure out what I want to be when I grow up.
Discover Magazine Vital Signs: Education All Around
Interesting new Vital Signs article on women’s health, medical students and misconceptions about pain.
I have known the evenings, mornings, afternoons,
I have measured out my life with coffee spoons.
T.S. Eliot, “The Lovesong of J. Alfred Prufrock”
This is my favorite poem. I’m having a cup of coffee before heading in for my night shift tonight in Ob/Gyn and was reminded of this line. Sometimes I feel like days are measured out in coffee spoons while in medical school or clerkships, and surely in residency.
On Ob/Gyn and planning life…
While in pediatrics, initially I was pretty horrified by labor and delivery. Now, 2 weeks into Ob/Gyn, my perspective has totally changed…it really is quite miraculous. It’s pretty exciting to see how happy parents are when you present their newborns to them.
I’ve spent a week in gynecology OR, a weekend call in L&D and now a week in Ob/Gyn outpatient clinic. It’s been incredibly interesting so far but I’m still not sure if it’s for me. It’s not reassuring when most Ob/Gyn docs that I’ve spoken to either recommend not to go into Ob/Gyn or wish they hadn’t gone into the field, mostly based on the politics, malpractice, etc. I was really surprised that I loved the surgical aspect of this rotation. I never really thought I would like OR, but the gyn surgeries were fascinating but I know that I don’t think I could commit to the back-breaking hours of surgery. I finally broke down and bought those hideous doctor clogs since my feet and lower back would really hurt at the end of a long day. I’d fine myself stretching in yoga poses in the locker room post surgery. I have surgery for my next 12 week rotation and I know many surgeries can go on for hours. I really might need to lift more weights for all the retracting I have in store for me in the next few months!
I am also in the middle of planning my 4th year electives. It’s exciting and nerve-wrecking to plan out a year in advance that ideally sets you up for your residency after. I essentially have to decide potentially where I’d like to live someday and my potential job, and hope that I am planned accordingly. I’m still up in the air about what I want field I want to go into, and I can only really cross off the ones I know I definitely don’t like.
Any advice?
Unfortunately, there are no snow days in medicine. A view from my front steps headed into work at 5:30 am. And it’s still snowing!
On medical clerkships
Now that I am 6 months into my clerkship, I feel like I have some bits of wisdom to pass on as I continue to be a sponge for learning everything I possibly can. My advice after 6 months:
1. Eat when you can, you never know how busy it will get on the floor or in clinic and being hungry can make you tired, cranky and unpleasant to be around.
2. Don’t complain. Everyone around you has probably gone through what you are going through or are going through it at the same time. Complaining becomes annoying and a real downer. You don’t want to be the Debbie Downer in the group.
3. Get to know your patients. Not just the lists of things to ask but really get to know them and they will remember you and cooperate with your care. Try to understand your patients and it will help to know where they are coming from, or at least try to come to an understanding WITH your patients.
4. Don’t be late. Ever. As my brother would say, “If you’re not early, you’re late.” And if you are late, be accountable and professional. Don’t just show up late and think no one notices, they may not say anything but they notice.
5. Be nice. And not fake nice. Patients, med students, attendings, residents, nurses, techs, aids, etc. can see through your saccharin-ness (my favorite word for being fake sweet).
6. Always look for ways to improve yourself. They know we don’t know everything or forgot most things, but I try to continue to look for ways to know more.
7. Be open to other options. Maybe you know you want surgery but don’t totally dismiss every rotation. I’ve seen other students proclaim they want to be a surgeon and blow off all their other rotations as not as important and get bit in the ass for it. To me, every rotation is important, especially if you are not certain about what you want to do.
8. Enjoy the time you have off. Seriously, time off is your time to sleep, explore and do fun stuff. Take advantage of time off.
9. Don’t take out your frustrations, stress, sleep deprivation and crankiness out on those you care about. It’s easy to project onto your friends and loved ones, but they don’t deserve to be crapped on if you were crapped on. They are your support system and won’t support you if all they get is the cranky, unpleasant version of you.
10. Exercise. I’m trying to keep to a regular schedule and it’s tough but it really helps to balance you.
11. When you see something really interesting, go home and learn everything you can about it. I’m not just talking about rare zebra diseases but common illnesses, learn about it since you’ll see it over and over again and you should know about it. And after you read it, re-visit it the topic again since you’ll forget stuff.
12. Look nice. As my aunt, a retired physician, told me, “Even if you are tired and having slept for 36 hours, don’t look tired. Fix your hair, put on lipstick. No one wants to see you looking exhausted.”
13.Take advantage of free food. Go to Grand Rounds of course to learn, but make sure you get there early to get lunch too.
14. If you don’t know, ask. My residents and attendings kept telling us, there are no stupid questions. 99% of the time, this is true. If you really don’t know or can’t find the answer on your smartphone, just ask.
15. Be professional and introduce yourself or you will just be called “medical student.” They may forget your name or may still just call you medical student but it’s good to try.
16. Be concise when you present patients. Provide good details but have a good format and cut out the anecdotal crap.
17. Take care of yourself. Take vitamins or Emergen-C or something. I was sick for about 3 weeks during my pediatrics rotations. Kids will cough in your face and throw up on your shoes. Protect yourself!
18. Make sure your white coat is clean, before someone tells you it needs to be cleaned. It looks gross and gets smelly when you don’t wash it. Try not to roll it up in a ball in your locker since you look like a wrinkled mess.
19. Utilize apps on your smart phone. I love some of the Iphone apps and they are really helpful for quick reference.
20. Have fun. It really goes by fast.
….
To write prescriptions is easy, but to come to an understanding with people is hard.
-Franz Kafka in A Country Doctor
In the start of my first rotations of my 3rd year of medical school, a wise psychiatrist gave us this story to read and discuss. Some of the medical students blew it off as nonsensical ranting but for me, it had incredible insight into practicing medicine especially since it was written in 1919. Kafka had amazing foresight about medicine and perhaps what the future of medicine may entail, if you can dig through the heavy symbolism and analyze his carefully, meticulously chosen words.
I was excited to read the short story that I had read years before medical school. It’s interesting how different stories are when re-read in a different context, time and level of maturity. I was also excited as a former English major to read fiction for a change. I would definitely pass this story on to other medical students as it was passed on to me.
NY Times article on Caribbean med students in NY
Here’s the article related to my previous post.
Caribbean Medical Students in NY
As an SGU student, I have worked alongside SUNY Downstate, NYU, NYCOM, and Ross students during the past 6 months in my rotations through psych, general medicine (geriatrics, cardiology, endocrinology) and pediatrics. We are all grilled with questions each day from attendings and residents. We have all worked long and difficult shifts, saw dozens of patients with complicated medical problems and learned quickly how to do procedures (“See one, do one, teach one” standard practice in medical training). I have felt as adequately trained, prepared and knowledgeable as my colleagues both from Caribbean and US medical schools.
And here I thought this was an old school disease…
I just finished up in pediatrics’ clinic for the week when I found this interesting case. I picked up the chart and read the chief complaint: “Rash all over body.”
I entered the patient room to meet an adorable 5-year old girl, presenting with a rash for 1 day, 2 days prior to rash, the patient had a sore throat and low-grade fever. Her mother was there providing history, telling that “Oh, she complains a lot so her throat is probably not that sore and she’s making it up.” I examined her and found this flesh-colored, papular (bumpy) rash on her face, neck, arms, chest and legs. No nausea, no vomiting, no trouble breathing, no diarrhea, no runny nose, asthma. Lots of no’s, a rash and a sore throat that her mom says isn’t real. She has no history of allergies, but she did recently try peanut butter for the first time.
Finally, I look inside her throat despite her mother telling me that her throat isn’t really sore and she’s just complaining. I find a mess, so to speak…Tonsillar erythema, patchy exudates and redness all over.
But her rash is peculiar, it’s rough-feeling but not very red. It doesn’t look like hives (urticaria) or an allergic reaction. It’s nothing that I’ve ever seen before in my short stint in pediatrics or while working in ER.
So I go to the lounge to present to my attending doctor. On the way there, I pick up the first pediatric dermatology book I can find and start scanning rashes and rashes related to sore throats. Suddenly, it makes sense… Scarlet fever! Except the picture looks nothing like what I saw in this little girl. The picture is of this pale white boy with a desquamating, peeling red rash all over his body and in my room I have a very dark-skinned black girl with bumpy skin.
I talk it over with my attending and after seeing her, we determine that this young girl likely has scarlet fever with a presentation of a sandpaper-like rash on exam. Apparently in dark skinned children, this rash appears flesh-colored and rough. Most textbooks show the desquamating version since it’s more impressive to photograph. Unless you have children’s tactile dermatology book (which I can’t imagine would be the most entertaining book for a kid), most books won’t have the insert where you tell what it actually feels like.
When you hear scarlet fever, I thought more that the child would look reddish. I thought of the Step 1 buzzwords like strawberry tongue and desquamating rash. With rashes and any derm issue, it is important to know how they may present on various skin tones. For example, it is difficult to see a reddish rash on someone with very dark skin. Hence, physical exam and really feeling what the rash feels like (that means actually touching it) is critical.
So quick review, scarlet fever is caused by Group A Streptococcus (Strep pyogenes) infection. It a pretty rare illness, but it is seen. Bacteremia associated with GAS pharyngitis is an uncommon occurrence; even with scarlet fever, it occurs in only 0.3 percent of febrile patients.
To me, scarlet fever sounds like age-old disease from Oregon Trail times. But, like dysentary, scarlet fever is still seen in kids today. Except we won’t be hunting buffalo with rifles (shooting at a very slow pace) and we won’t have to make life-changing decisions about fording streams!
"Take the world apart and figure out how it works." - Built to Spill, 1994.
