The last couple weeks of Sub-I have gone much more smoothly than the first few. Although that first sink or swim call definitely contributed to that-if you can learn to admit and manage 5 patients in one day, then an occasional admit every other day doesnt have quite the same terror inducing power.

And I realized I have neglected to tell you any patient stories from SubI…now this is again because of the aforementioned busyness and studying, not because I havent had any interesting patients. Here are a few brief summaries of the folks I have had the *dubious* pleasure of treating during the last month

1)A 50 yr old man who was brought to the paramedics following a grand mal seizure. He had a history of seizures 10 years previous for which he took dilantin, but had since become noncompliant with meds. His history was additionally signficant for Crohns disease and a blood clot in the brain necessitating a right craniotomy. What is a craniotomy?


That’s right, it’s zombie bait surgery…your skull is cut open and the most delicious parts of the brain (or the one causing the problem, whatever) are removed. As you can imagine, this can occasionally lead to an indented sort of look for the patient. Luckily (or not) for our patient, he had no knowledge his sull looked caved in, or even that he had undergone a craniotomy, as the piece of brain removed from him had something to do with his short term memory, as per the family’s description. Oh and btw, he was postictal (the state of confusion following a seizure) and wandering naked about the ER when I first went down to attempt an interview him.

We loaded him with dilantin, an anti-seizure medication for while he was in the hospital, but he refused to take it saying he hadnt had a seizure in 10 years and didnt need it, nevermind the one he was brought in for. Until, that is, his mother came him and told him he was taking it because her and the doctor said so. To which he immediately agreed. I guess no one ever gets over being scared of their parents

Assesment/Plan: EEG negative for current seizure activity, MRI declined, pt sent home with dilantin and a stern lecture from his mother.

2) A 56 year old cocaine abuser in for chest pain radiating to the shoulder. That’s right its everyones favorite rule out ACS (acute coronary syndrome). His history was significant for hypertension and heart failure, not to mention the cocaine abuse which can precipitate heart attacks through vasospasms. His social history revealed that patient abused cocaine while his girlfriend used heroin. How long do you suppose they’ve been together? 17 years. Wow perhaps the marriage counselors are missing a key therapy here.

Assesment/Plan: Three sets of cardiac enzymes negative, no EKG changes, a beta blocker to decrease afterload on the heart and a negative stress test showed our gentleman was not in fact having a heart attack, just the standard cocaine buzz. Discharged home with the admonition that coke is for drinking not snorting. Wonder how long til we see the girlfriend

3) a 29 year old mixed martial arts fighter with multiple MRSA abcesses including a rectal one. While his choice of career could lead to abscess potential, the sheer number and the fact that they were all colonized with MRSA (a drug resistant bacteria usually only accquired in the hospital) he was a rather interesting case whose etiology we never quite figured out. But the real kicker is that I am a pretty big fan of UFC and all those fighting leagues…so while this fine fellow was not technically one of MY patient, but rather on my team, I would just pop in and chat over his fight record and techniques with him. He’s still a small time fighter and not one I have followed, but it was still the closest I have come to meeting a sports star I actually gave half a damn about.

Assessment/Plan: You really think I am going to tell a man who beats people up for a living to do anything? We pumped him full of antibiotics and set him loose on particularly difficult staff members

Of course there were a whole grab-bag of other ill folks, with seizures, diabetes, abuse, and the usual hospital culprits, but like any good med student I know that both audiences and attendings tend to stop listening after the 3rd patient, so I will leave you with that thought.

Exciting!

I just got my first featured entry in GRAND ROUNDS! Now before you get confused, no that does not mean featured on Xanga…I am nowhere near that popular, nor am I am member of the evil xanga clique ;-P

Instead, grand rounds is a weekly best of the medical blogosphere hosted on rotating sites by various medbloggers, including doctors, nurses, and of course the almostdoctors, us med students. Not only is it a pretty good way to keep abreast of the latest in health happenings, but its almost like a mini medical support group-no matter how bad or crazy things can get, there is an entire internet full of people out there who have been through the exact same thing, and can help to keep it all in perspective.

Here is the entry of mine that was featured, about my first day of Sub-I
and two others that I really liked

The scalpels edge talks about how its hard to ever admit to making a mistake in medicine
Vitummedicinus shows us what med school would look like if written up as a job application

Dont worry fellow xangans, I am not neglecting you to go gallivanting off with my new blogring-but sometimes its nice to confer with people I have more in common with than, “yeah i remember higschool being crazy like that” Or maybe its because all you young whippersnappers are just better writers than me, and I need the comfortable illegiblitiy of the medical world

cheers!

almost dr J

Mrs W, a 63 year old woman was cooking in her kitchen when she slipped and fell, fracturing her right hip. She was admitted to the medical floor due to her history of end stage renal disease on dialysis, hypertension, and diabetes. A surgical consult was placed, and Mrs W underwent a successful open reduction internal fixation for her hip, and the plan was to discharge her after she recovered from surgery.

On post op day 3, Mrs W seemed slightly altered when I went in to see her on pre-rounds. While she was normally responsive, she was doing nothing but grunting in response to my questions. I asked her if she could understand and she grunted mm-hmm. I followed it up by asking how her pain was, and she grunted something uninteligible. On reporting these finding to my senior resident, we ordered a CT scan of her head, because we were worried about a stroke. We made sure she was on anticoagulation, and signed her out to the on call team

The next morning, I was running late on writing my notes before morning report. Went in to speak with Mrs W but she was still sleeping, so I just skipped it, figuring I would go back and see if her status had improved later, once her labs and vitals were up on the computer.

Then I ran into the on call team during morning report, who informed me that my patient had died during the night. She was found unresponsive, a code was called, but she was unable to be revived, and likely had been dead when she was discovered by the nurse.

The family did not want an autopsy, but our suspicion was a massive thromboembolism (blood clot).

Could this have been prevented? Was everything done that could have been done? I guess I will never know.

-Almost Dr J

I was warned time and again by my doctors, by my med school friends and even on occasion, by myself-medicine is a lot of paperwork. However, it is only during the nearly completed first week of my sub-internship that I have realized how much.

During my 3rd year medicine clerkship my responsibilities were basically limited too seeing the patient and writing the H&P. I had to follow lab values, of course, and write daily progress notes. But after that was completed, the remainder of my day could be spent studying for the SHELF exam (an end of rotation exam in whatever discipline you are rotating through). It was like being part of a big dramatic production where you go to rehearsals and learn your lines but never actually see or realize the existence of the tech crew who actually gets everything done

Now for just a single patient (and mind you I cap at 6 patients and will usually be carrying around 4 at any given time) I not only have to do the intial admission note, but also the floor admission orders, medicatio and dvt prophylaxis orders, constant phone calls to social work, home health, any other team being consulted on the patient, antimicrobial orders, daily tpn orders for patients on parenteral (food by direct tube to your insides) nutrition and a host of other things on a day-to-day basis. Then, when I can finally get rid of a patient, I still have reams of paper worth of discharge forms to fill out to make sure the patient gets all the proper meds and follow ups. After all, I cant send someone home on an intravenous medication if they dont have a home health nurse or friendly neighborhood heroin user to help them inject their veins. Little details like that. Not to mention those damn dictations which suck up about an hour or more of time AFTER my work is done for the day.

Now despite my whining, all this is actually a good thing. Sure I am being worked, and quite hard, but no more so than I will be during my intern year. And while classmates at other sites finish each day by 2pm and only carry 1-2 patients, I will be vastly more prepared and knowledgable when the time comes that I have to handle all this by myself.

I have also begun to really be more on top of my patients and in one sense care about them more than I could third year. During the clerkship, I was mostly concerned with grades and amassing minutiae of medical knowledge. Now I am concerned that I have done everything I need to do for my patients at any given moment, and that I know them in and out should i be asked by an attending or consultant whats going on. Somewhere along the way i magically began being able to spew out med lists and dosages, lab values, and other things that I would have previously had to run to a computer and look up or say “i dont know”

And while I still say I dont know on rounds, about half the time is now just from sheer intimidation or self doubt that my first instinct is wrong. On further reflection i often DO know the answer, i just cant reason it out in the five seconds time I am asked-but i get to eventually.

All in all, not bad for a first week.

Whew…apparently the Sub, in sub-I stands for subjugated. But I am getting ahead of myself…

For those of you unfamilar to the med school meat grinder, The Subinternship, or SubI for short is the one rotation that all 4th year med students are required to go through, in comparison to the remainder of the year, which we pretty much plan ourselves. It is a month spent acting like a real honest to goodness licensed intern on the medical floor, with the caveat that any orders we write still must be cosigned.

My team consists of two senior residents, three sub-I’s aside from myself, and one medical student.I flew back in to Chicago on Sunday. Monday (my first day) I was on call..trial by fire learning at its finest. Our team caps at 6 patients each, and since it was the first day, me and one other subi decided to split the call, so we only admitted 3 patients each. And when i say admitted, I dont mean 3rd year med student admitted, where all you are basically responsible for is the history and physical. No sirree, we also get introduced to the wonderful world of medical paperwork, writing admissions and orders.

Not too worry, laypeople. The final say on what orders are actually carried out is dependent on the senior resident. Other than that though, the patients I admit are mine-I am responsible for following them during their hospital stay, writing the daily notes, ordering consults, ensuring all tests are performed and the results followed up on…its just like being a big boy real doctor.

Following the call, we presented our patients in morning rounds, and just like the real interns our post call day, which is supposed to end at 1:00PM due to those workweek regulations in fact ended somewhere around 4PM. The post-post-call day is short call, meaning we still admit patients until 4PM, then we sign out and it becomes the on-call teams problem responsibility.

One of the things that is new to me is the sacred important necessary duty of dictating any patients who have been discharged. This entails punching a special code into the phone and then summarizing the patients hospital entire hospital stay, including admit diagnosis, discharge diagnosis, all treatment given, any and all procedures done, and of course the history and physical along with any significant developments. It doesnt sound that difficult until you think about how some patients remain in the hospital for weeks on end and SOMEBODY has to dictate that.

The dictation reports eventually get transcribed and placed in the electronic medical records so for any future admissions the other doctors will know what went down, and if the admission is for a similar problem, they can see how effective the previous treatment was. Whoever actually transcribes the dictation though must have had a grand old time listening to mine though. It was filled with such pearls as

“44 year old woman admitted with diagnoses of chestpain for 4 days and, oh wait, I mean this is almost drj dictating the discharge report…”

“MRI of the brain was performed without contrast and the uh erm brain scan came back negative”

and the best, after dictating the whole history and course treatment then thinking I forgot to say something, rewinding and dictating the whole thing again on the principle that it would record over and realizing that in fact it didnt-” Oh wait, I totally didnt need to say this…nuts”

Hopefully future dictations (and there will be future ones) will go somewhat smoother, but all in all, not bad for a first couple of days. On call again Saturday, and according to the schedule this month, it looks like I get a total of 3 whole days off! w00t!

Future posting may be sporadic for a while, given my responsibilities, my attempt to finish up and submit my residency applications, and studying for the Step2 ck.

-Almost Dr J

I would GREATLY appreciate your feedback on my personal statement for internal medicine. This is only a first draft, so any criticism on it is helpful. That is to say, if you read this at all, please leave a comment with your thoughts on how it could be improved or even just the gestalt you get from it. That said, here we go

—

I have always loved detective stories.
The trained observer arriving at the scene of the crime, unable to
prevent the incident, but possibly capable of unraveling the mystery.
How one seemingly innocuous clue, one insignificant detail becomes
the linchpin to the whole case. How nothing more than wits and
determination transform a rather ordinary Joe into the framework of
an extraordinary adventure.

The trained physician, much like the
trained detective must learn to use all of his senses above and
beyond the normal. We auscultate heart and lungs, We peer both
superficially with our eyes, and deeply with our machines, we smell
illness from lesions, we feel irregularities in bone structure or
rectal tone, and back in the day, some even used to taste urine,
though that is one mystery I am personally glad to leave unsolved.

When I began my third year of medical
school, I was the Watson to the hospital’s Holmes. I could only
observe in astonishment as the resident or attending would piece
together unrelated symptoms and complaints into a diagnosis, often
within minutes, while i struggled to come to a conclusion with the
same basic information.

Like Watson though, as time wore on, I
began to follow the reasoning and even pick up on clues myself.
During my rotation in internal medicine, my team had a patient who
had presented with a sudden onset of fever beginning one week
earlier, myalgia and abdominal pain. While all initial signs pointed
to influenza, my history revealed that the patient had recently
traveled to Venezuela to visit family. That piece of knowledge helped
lead my team to discover the real culprit was dengue fever, and the
patient quickly recovered. The thrill in solving the case stuck with
me, and with each successive patient my ability to create
differentials and perform the clinical reasoning process improves.

Internal medicine holds the greatest
appeal to me as a field due to its sheer variety. The internist is
the doctor’s doctor, the archetype conjured by the word a figure who
through careful questioning teases out the problem and then provides
the solution. The internist not only helps to identify the main
problem, but often coordinates care between different teams such as
surgery or social work. Additionally, the number of sub-specialties
available provide near-limitless opportunity for the physician
looking for a further challenge.

In all my successive rotations, it was
the skills and abilities from my internal medicine rotation that I
turned to first. Each rotation had something new to offer me, but it
was against internal medicine that they were all measured.

Sir Arthur Conan Doyle began his career
in medicine, only later to utilize his talents in creating the worlds
greatest detective. Interest in his stories helped to stoke my own
interest in medicine as the ultimate mystery. A story is nothing more
than a predefined beginning and end. With graduation, one chapter
ends. But as for this character, many mysteries remain to be solved.

—

So there you have it…i eagerly await your thoughts

-Almost Dr J

Moving right along down the choose your own adventure posts, today’s question comes from Dare2BDifferent, who asks: “What’s the most awkward thing that’s ever happened to you involving your work?”

Oh jeez, I almost dont even know where to start with this one. The very first time I had to perform a rectal exam and got farted on? The first time I had to perform a vaginal exam on a none-too-hygenic female? That time in family medicine where due to the young age of a mother i mistook her child for her sister?

The truth is, medicine is a pretty awkward field. People are constantly coming to you with things that are embarassing, disgusting, pitiful, humorous, or some hodgepodge of all of the above. Nor is it just in a hospital setting either…people find out you are a doctor (or in my case, an almost-doctor) and suddenly feel it is perfectly alright to whip out that mole that has been bothering them, or tell you about that horrible diarrhea they have been having lately.

And sometimes the awkwardness is a result of your own actions. There was about a two year period where I simply lost the ability to carry on a conversation that DIDNT involve medicine. And you would probably not be surprised to find out how little people want to talk about the sick, the elderly, the vomiting, the bleeding, and the whole gamut of med school experiences when they are not actually in the field seeing it firsthand. All of which would lead to awkward pauses in the conversation until I could resort to…so, how about them local sports team, eh? Or recent celebrity scandal-that wacky a-lister.

So trying to narrow down the multitude of awkward experiences that I have gone through in just a day, let alone the last 4 years is a pretty tall order. Despite that, there IS one particular instance that stands out in my mind as being incredibly awkward and uncomfortable.

In the beginning of my third year, my very first rotation and clinical experience in the trenches ever was internal medicine. Being fresh out of USMLE step 1 (shudder) and anxious to make an impression in whatever way I could, I made my senior resident aware of the fact that I could speak spanish relatively fluently. On the whole, this came in rather helpful, since rather than having to call and wait for a translator, I simply accompanied the resident to whatever patient she was interviewing and did the majority of the workup myself. It was a great way to both improve and accquire my medical spanish.

On one particular call though, my ability was definitely overestimated somewhat as I accompanied my senior resident to see Mr M. Mr M was rather well known to the hospital as he had been in and out with liver problems, kidney problems, blood problems…you name it, he had probably had it. Unfortunately, on this particular occasion, Mr M.’s test results indicated that he had finally reached complete kidney failure…endgame, if you will.

Oh yeah, and Mr M-spanish speaking only. So my senior resident pages me from studying to come talk to a patient with her. I arrive in the room and begin translating, only to realize about three sentences in that I am basically telling this man I met not one week ago that he is going to die. By the fourth sentence, I also realize that I lack the proper vocabulary to explain this to him in any kind of compassionate manner.

So before digging myself in to any trouble I cant get out of, I pardon myself and explain to my resident that this particular bit of linguistic acrobatics is going to be beyond my ability, and we will need to call for a hospital translator. Which we do, but all the while Mr M is waiting patiently to find out the end of what I was in the midst of telling him about the significance of his current test results.

The translator arrived and resumed from where we left off, and all the while I stand there in the corner with the resident, not speaking, just listening and watching as Mr M finally grasps what is going on. A silent observer, invisible to the resident who doesnt need me any longer, the translator who is telling the patient his options, and the patient himself who has long sinced cease to notice me amidst his own concerns.

One of my earliest experiences in clinical medicine, and certainly one that has and will continue to remain with me-I certainly wont be able to avoid similar circumstances, but I have done everything I can since to ensure that if I am caught at a loss for words again, it wont be due to my own inability, and it wont be in midsentence to the patient. Hardly the most amusing awkward medical story, but certainly one of the most important ones.

-Almost Dr J

Todays Choose your own adventure post topic is from Greek Physique, who asks “How frustrating does the endless cycle of rotations get?”

For those of you unfamiliar with medical school, third and fourth year consist of rotations. Med students spend approximately 6-8 weeks at a time in each of the core specialties (e.g. medicine, surgery, obstetrics, pediatrics) in various hospitals and during 4th year 4 weeks at a time in electives scheduled to the students own preference (gastroenterology, ophthalmology, etc.)

This can get a little disorienting as during the first week in any new rotation you are trying to learn the ins and outs of the hospital, the specialty, the area, your team and any number of variables. Compounding this confusion during the longer rotations is that the residents/attendings change each month as residency still includes rotations. For some, it can feel like by the time you finally learn what you are doing, and appear competent, you have to move on to somewhere else

Like anything else, this has its ups and downs. There were a few rotations I out and out hated (ER/Neurology). Knowing that they would be over relatively soon made suffering through them easier, even if time occasionally dragged out to infinity countind down the days.

Other rotations, such as OB/Gyn and Psychology, i knew I had no interest in, so these brief rotations would be my only exposure to the field, giving me a chance to learn without the pressure of looming years of the same monotonous work ahead of me. These made for some of the best learning experiences, even if they were not my favorite rotations, because I really made an effort to learn all I could, knowing I was unlikely to get another chance where i would be so able to ask questions and make mistakes

And finally for the rotations I was interested in as possible career choices (medicine/surgery/pediatrics) It gave me just long enough to see what I liked and didnt like about each specialty, and to see if I could mentally prepare myself for the long road ahead. At the end of the rotation I can think back and still remember how some rotations seemed to fly by and others drag, and that knowledge helped to limit my choices down to what specialty i would be applying for for my residency.

So in short, I didnt find the endless cycle of rotation particularly frustrating, because it ends up being a rather unique experience in the lives of medical students/doctors. Sure, your entire environment changes every couple months, but it also makes you fresher in your knowledge of certain fields when entering into others, and it also creates some intangible bond with other students and residents as you all had to ride this carousel of modern medical training before being allowed into the big kids world of healthcare rollercoasters. Though I may disagree with the emphasis placed on certain specialties over others, I wouldnt change the rotation education system for all those incoming students-its part of what being a med student is all about.

-Almost Dr J

This is the first of the choose your own adventure posts, wherein I answer questions YOU have asked about what it is like going through medical school

This is in response to TheBlackSpiderman, who asked “Do you wear your scrubs outside of work – and if so, does it aid in picking up women?

—

Prior to entering med school, I had a lot of preconceived notions about what it was going to be like. I think it is fairly safe to say that most people have an archetypal image of the med student, head down in an anatomy book somewhere in the back corner of a coffee shop, and of course wearing scrubs.

For two years before going to med school, I worked as an opthalmic technician, and my daily uniform was scrubs. I absolutely loved them…they were comfortable, they came in a variety of colors, and they made me feel like a grown up, an honest to goodness part of the medical profession. A vain egotistical part of me secretly harbored the hope that people who saw me walking around outside of work wearing scrubs would think I was on my way somewhere important to save lives, a surgeon in transit. For one of my birthdays, a girlfriend purchased me a pair of scrubs with my name embroidered in, and i would wear it even on days I had off…going to class just to be seen, like others would wear an armani suit or a louis vitton bag.

As I have gotten older, (and deeper into the medical profession) I have come to see how naive and foolish those earlier ideas were. I would wander around thinking people might confuse me for a doctor. That girls would see the scrubs and think oh, medical student let me go up and get to know that charming, handsome gentleman.

Turns out, not so much. You know what people think when they see a med student? Debt. Mountains of it. Not quite the sexy turn on you thought, is it? You know what I think when I see scrubs outside of a hospital setting? Not surgeon-anyone in a hospital operating room does not leave the building wearing scrubs as they are usually disgusting, covered in blood, bone, and whatever other germs were floating around. Instead I am thinking an exhausted resident on call, or maybe an ER doc, and they wear scrubs that are twice as gross as anyone else because wearing suits and ties in an emergency setting is just ludicrous.

As I come closer and closer to crossing the line between almost doctor j and actual doctor j, I could care less who sees me wearing what. It has little to nothing to do with the work i actually do, outside of being comfortable for long hours on call. It has been said clothes make the man. Well its about time this man starts making the clothes. But not in a literal sense, i would hate to put all those child laborers out of work.

I just cant seem to do anything right.

The last few workdays, I have slowly been giving myself a complex. A brief history: prior to entering medical school, I worked as an ophthalmic technician for my ophthalmologist. An amazing doctor, he has definetly been a huge influence in my decision to apply for ophto myself. However, while he made a great doctor and influence, he could occasionally be a difficult person to work for. Mostly due to the minimal positive feedback he gave out

He assigned me various tasks in addition to my tech duties in order to beef up my med school application. Which is great…but he always just assumed I knew without any prior experience how to write a case report, or do some complicated technical procedure, and then when I didnt, there would usually be once chance to fix any mistakes and then he would just go and take care of whatever the task was himself.

It got to be very stressful going to work for a time because even though i KNEW there was no reason I should have a given piece of knowledge, whenever i didnt, I would beat myself up over it.

Now at no point was I ever insulted, or put down. Comments usually were along the lines of, “wait, you NEVER learned this?” or “This is inappropriate format for a medical journal, you need to rewrite it..” Which seems great until you realize that at no point was the “how” or where do i learn that answered, even when i explicitly asked.

Well, the solution to that problem was to stop asking questions and basically teach myself how to do something in one chance or not at all, since if I failed the one attempt, the opportunity would be retracted. Which is not the most terrible of solutions. However it made me on the whole much less inclined to ask questions, and much more self conscious about anything i couldnt do right on my first try.

Along came medical school, and with my habits rather firmly set from this experience (along with several others) I tended to be one of those people who sits toward the back of the class and is rarely heard from. At least academically anyway. Not because I was a bad student, but because my habits simpyl made me less inclined to ask for help, since i was usually not expecting to receive any. Which actually got me through my first two years pretty well.

Well as I have mentioned in other posts about third year, one of the well known trial by fire rituals med students have to eventually go through is known as “pimping” wherein an attending or someone else in a position of authority higher than yours tests your medical knowledge on the spot. I did not do well with pimping, as my style of learning tended to be researching things I did not know on my own. I eventually learned how to ask questions of peers, coworkers, nurses and residents again, getting through third year and occasionally even surviving the pimping as my body of knowledge grew.

And then we come to this rotation, where I am pimped not just by the attending, to which i have become accustomed, but I am often pimped in front of the patient. Which adds a whole other layer of pressure. Imagine you have just been introduced as a graduating medical student, and now you are being asked to come up with differentials, treatments and plans in front of someone with NO MEDICAL KNOWLEDGE while someone with INSANE MEDICAL KNOWLEDGE judges your attempt to respond with something coherent in about 10 seconds or less?

In most cases, this leads to epic fail. Not because I wouldnt be able to reason out the answer, but doing so in the ridiculosly limited alloted time leads to me throwing out usually the first couple things that pop into mind. Now lets say that 50% of the time this answer is correct. (that is a generous estimate, but moving on)

Even when i hit the nail on the head, the doctor either moves on to successive questions until i am stumped, or simply takes the response, completes the patient exam and moves on. No, good job, thats correct, or really achknowledgment at all. Soon as I get something wrong however, it is a “well there is a resound case of i’m not sure” or “you really need to look that up”

Again, no blatant putdowns. Now i am not saying i need a pat on the head and a treat everytime i do something correctly. But an occasional realization that I do not have the same knowledge in the field as someone who has been practicing 20+ years, nor should i would be nice. I hate doubting myself, and when the only time i am ever given advice is when i do something wrong or cant figure something out, it makes me that much more insecure about trying to give answers in the future, which in turn appears as more hesitation indicating i dont know an answer which leads to more negative feedback. It’s a vicious cycle

The point of this whole little emo-fest i have been having here?

I still like opthalmology. I am still learning a pretty decent amount. I am pretty sure I made a mistake in choosing to do this rotation at this location just because i wanted to get in one more optho audition rotation before interview season. I will be very glad when the rotation ends and I can go back home to chicago, LA, or wherever.

I originally sat down to write about what I saw in the office today, and this just happened to come out. So i will postpone weekend adventures and what i saw til another post, as right now i really just need to grab a drink and desperately try to get enough studying done so i am prepared for anything that might be asked of me tomorrow.

Sometimes, I really dislike my private, keep to myself nature.

-Almost Dr J