Alright so lets take a crack at this, shall we?

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I am not two dimensional and neither is
my world. Everything around me is constantly jumping out competing
for attention, and the first way most people tend to experience their
world is with their eyes. One of my hobbies is photography, an
incredibly sight oriented art form. And the first and most important lesson in
photography is to focus, in order to best direct the attention of the
audience to where you wish it to be.

My first view of medicine was panoramic, as I tried to take it all in at once. I transported patients in an ER, I did research with a chiropracter, I worked as a technician performing LASIK, anything that would give me a glimpse into the world of health. While my exposure to each field was limited, the one that ultimately most contributed to my development was the time I spent interning for my ophthalmologist.

At first, I thought of it as nothing more than a job like any other. Once I zoomed in however, I noticed how happy everyone seemed to be; The patients returning month after month, either for follow ups or to have their sight corrected; The doctors, performing procedures varying from cataract removal to LASIK; and me, getting to assist in surgeries and developing a relationship with people i still see to this day.

Just before leaving for medical school, I underwent LASIK myself. The procedure left me with a better focus, both literally and metaphorically. As I went through my third year, I enjoyed the majority of my rotations,especially the ones wherein I had more opportunity to interact and follow up with a patient beyond the initialy admission. Despite that, I never seemed to feel that one "ah-ha!" moment, that snapshot that we are all told will come to us when we have found the right field.

Until, that is, I decided to do an ophthalmology rotation near the end of my third year. All of a sudden, everything seemed to come into focus; no matter how many patients I saw, or how complicated they were, I felt confident and the days just seemed to fly by. Like everything had become picture perfect, just waiting for me to step in and complete the shot

It is said that hindsight is always 20/20. While I didnt know it at the time, my early experiences in ophthalmology focused my interest enough to try it again in medical school, only to find that both my desire and enjoyment of the field had been magnified a hundredfold. So I am taking my shot-all that remains is to see what develops.

Well, there you have it. My first attempt at a personal statement for residency, though certainly not my last. I openly invite any and all constructive criticism on this, as it desperately needs to be polished before september rolls around. Feel free to be as harsh as you want, provided it will ultimately lead to something i can improve

Keeping track of multiple patients is tough.

Even with only taking one patient a day, I am still carrying a caseload of around 6-7 patients. And everyone needs a follow up. I have to call pathology to check biopsy results for one, follow up on the egd results of another, make sure the primary team knows our recommendations for a third, and call the morgue to find out what happened to a 4th over the weekend.

And those are just the inpatients! Just because someone is discharged doesnt mean that the paperwork for them ends, oh no. You still have to apprise the attending and primary teams of any labs or procedures carried out while they were here, in case those results necessitate a callback to the hospital.

Not to say that I am not enjoying myself however. My weakest area during my medical rotation was creating a differential and plan, and while I am still far from being perfect (that's why medicine is called "practice" right?) usually i manage to nail all the significant issues on my problem list. Now all I need to do is learn how to speed myself up so it doesnt take me 2 hours to consult, examine, and write the note on a patient. Baby steps, baby steps.

SO what are some of the things I have seen thus far? Well, as always in an attempt to protect patient privacy and not get horrendously sued by HIPAA down the line, here are some of my pts

1. A 43 yr old female with 3 weeks of black watery diarrhea and coffee-ground emesis (both of which indicated a bleed that takes a longer time to traverse the GI system, else it would be red) While we are still waiting on the biopsy results, crohns or ulcerative colitis are both on the differential, as well as an infectious process

2. A 25 year old patient male with a habit of swallowing things. The man is an office supply store unto himself and has been scoped over 20 times to have things removed such as pens, pencils, paperclips, and even a sock. Sadly, one of the paperclips in the past perforated his bowels, necessitating a colostomy bag, so due to his penchant for eating desk supplies, this guy will be pooping out his stomach for life.

3. Hematemesis-this basically means blood in the vomit, and at least in this particular hospital, that reason for consult usually means an alcoholic patient.

My usual day at the hospital is from 8am to about 7pm by the time I leave, so the lack of posting you may have noticed is due mainly to the fact that I get home, eat, play with my puppy, and go to bed without the time to leisurely read or post on xanga like I normally do

Oh yeah, and I still have to write my personal statement. Rhetorically speaking, why do I want to be an ophthalmologist? Somehow, i dont think, "I just do, okay?" is going to be a satisfactory answer. Perhaps checking my backlogs will provide a clue, but even so, I have no "ah-ha!" moment of patient interaction that did it for me. I just feel an affinity for the field, but trying to articulate that or come up with some hokey story for a program director to read is even harder than pulling teeth. At least teeth are obvious. The patients I tend to remember are the ones who amuse me, like the gentleman who popped out his glass eye, or the ones who irritate me, like the woman who tried to argue with me that her eyesight was fine while she was facing the wall.

Ah well, my deadline for a first or second draft is july 25th. If I dont have a personal statement up on here by then, no matter how terrible or poorly written, I expect nothing less than a severe tongue lashing from those of you who read this on any regular basis. Cmon, force me to write something, I know you have it in you. We can all motivate each other! w00000

til then, well, shazbot.

Already one week down in my month of gastroenterology and what have I learned?

First off, that 4th year is way better than 3rd. Not only are all my rotations in things I am definitely interested in, but the amount of responsibility and autonomy I have is increased as well. No longer does my evaluation of and opinionss on a patient amount to so much chattel.

Now when i go in to see a consult for the team I am the only one (at least on my service) following that patient. So while my fellow will still have occasional things to check up on, my word is pretty much taken as authoritative. This means that i even more motivated to do a complete, comprehensive history and physical, compared to before when the constant redundancy and checking up on me meant that if i didnt find something or do something, someone would.

Medical school is structured fairly nicely like that in the sense that each year you are given just a little bit more to handle while still having a safety net. Of coure, the greatest shrinking of my safety net takes places at the end of this year, when I become the one who has to make all the treatment plans and monitor someone instead of just making recommendations to the primary team. Nonetheless, I still have to come up with a diagnosis and plan even now, and for the moment at least i have usually been on the right track if not exactly the same thought processes.

Oh yeah, and I still need to pound out a personal statement even as a draft. Expect a terrible early draft up hopefully soon

Well the break is over.

I made yet another cross country trip with my bro, this time stopping at the likes of The Hobo Museum is Iowa, Carhenge in Nebraska, and Casa Bonita (oh yes, it's real) on the way back.

Visited some old Cali haunts i havent been to in years, like saddle ranch where the AMF's are as big as ever, and Metal Skool, who while their name has changed to Steel Panther, rocks just as hard.

Enjoyed a 4th of July with Chicago friends, went to AX for the first time in 4 years, and added to my toy collection.

All in all, another action packed week in the life of Almost Dr J, and as per the usual, i am promising delayed pic postings.

Tomorrow I begin a month of Gastroenterology. Looks like its back to being a grown up, but the vacay was certainly needed and appreciated

I have two months from this date to get all my application papers in order. Lets see some of that deadline magic kick in, eh? Oh and any residents currently reading this site-1) Congrats, or hang in there, depending on how long you have been a resident ;-P and 2) if you have any step 2 books just laying around, and you wondering how to get rid of them...

Help me help you. *insert effect of light glinting off winning smile*

As for 4th year...well you know what they say

1 for the money
2 for the show
3 to get ready
now go Josh go!
 

In the midst of all the stress of moving, I felt i should take a moment to let people know that I really am enjoying 4th year. 4th year is the breather for medical students, in the sense that we choose all our own courses, and so ideally you are spending the entire year doing not what you HAVE to do, but what you WANT to do, and often in locations where you want to do it. So while I dont have my entire schedule set yet, here is the tentative plan for my final year as a medical student

June 13-25: Essentials of Clinical Reasoning @ Chicago medical school
July 7-Aug 1: Gastroenterology @USC
Aug 1-Sep 8: up in the air due to unforseen circumstances...possibly 2 weeks of optho at UCI
Sep 8-Oct 3: Sub internship @ Mount Sinai chicago
Oct 6-Oct 31: Pediatric Speech Pathology, private clinic
Oct 31: STEP 2 CK....to be followed by crazy partying in West Hollywood, costume not yet decided
Nov 10-28: Ambulatory Care, random clinics around chicago
Dec 1-Dec 26: Online Nutrition, California and wherever I am interviewing
Jan 5-Jan 30: Online Ethics, California and wherever I am interviewing, also MATCH FOR OPTHO
Feb: Undecided
March: Clinical Forensics and MATCH DAY
April, May: Last big travel fling...ideas include Morocco, Egypt, Kenya...the Africa Trip
June: Graduate

So rather than a bunch of international electives, i chose to focus my time on studying for step 2, and doing a couple audition rotations, which will let me finish early enough to take 2 months of traveling and maybe hit up another few continents.

As part of my ECR elective, today I had to watch the new 3rd year students interview a standardized patient, their last such interview before they start seeing real people in the hospital. Afterward, us M4's who have the vast experience of a whole year give them our feedback.

It was both cute and nostalgic watching them do H&P's. I couldnt help wondering if I looked that naive and uncertain when I first began. And I dont doubt that I did. Some of the more notable bloopers included students using the otoscope (ear looker) to do the fundoscopic exam (eye looker), asking if a patient takes glyburide (a diabetic PILL) in both arms, and a few students getting so caught up in nerves that they FORGOT to do a physical exam.

Its hard to imagine that it only took a year from me to go from similar fumbles and faux pas to where I am now, feeling pretty confident in my history taking skills, and even writing assessments and plans. What a difference a day makes, eh? And while thanks to this blog both you and I know my thought process as this transformation slowly took place, actually being able to watch a student at the beginning of the final walk and comparing what I would do differently now, i almost lost the forest for the trees.

A few leftover questions I missed from the choose your own adventure challenge:
Nanumus: Do doctors really write GTFO on charts?

No, but there I have written things like FLK syndrome (funny looking kid), UBI (unexplained beer injury) and a couple others. With the advent of HIPAA, a lot of doctor to doctor slang is slowly going the way of the buffalo, but here is a link to a GINOURMOUS list of british and american medical slang that may still be used at a hospital near you.

Chinchujin: What do you do in the hospital that goes against your principles?

Technically, nothing yet. But i am still on the fence about the abortion issue, and I am a firm believer in letting people die with dignity, which comes dangerously close to euthanasia in the opinions of some. However, I am sure these moral quandaries will become more of an issue as I progress in years.

Ed8e: Something really long about my views on privatized health care versus univeral

I will admit to being a cop out on this one. I dont know anywhere near as much as I should about the differences between the two, and I lack the time right now to properly research it. However some things worht looking into for the controversey value alone are single payer, and franchised or concierge care. Another thing that will have to wait til i am a bit older and actually involved in the business of medicine before i can properly post something.

I think I managed to answer almost everyones question, and hope you enjoyed the choose your own adventure...next game in a few weeks when I am all settled in back in LA. In the meantime, i return you to your regularly unscheduled posting

-Almost Dr J