Wednesday, June 29, 2011

Confession (how I'm spending the summer)

I'm currently studying for step 1. Again. For those of who don't know, the only way one repeats a USMLE step exam again is by failing... so, yes, I failed step 1 my first time taking it in April. All be it, I failed by a very slim margin, but failed none the less. I very aggressively debated the shame vs. potential merits of writing this post, of making my failure so public, settling on the decision that this may help another med student in my position and/or someone out there might have advice for me.

I'm now officially part of the approximately 5% of US medical students who fail the stinking 300 question test of annoying detail. From what I can gather, here is the normal response to failing: 0) Consider dropping out of medical school before reconsidering when calculating the debt already stacked up. 1) Only tell those who NEED to know but hide it from the rest of the world. 2) Cycle through the Kubler-Ross Grief cycle over and over again. 3) Fixate on how this might influence your future: will I be able to match into a residency program? will I match in bumbleville, nowhere in a specialty I don't actually want to be in? what if I never pass this f*ing test? 4) Spend a lot of time, energy, and money reapplying and scheduling the exam, reorganizing your 3rd year clinical rotations, deciding on a study schedule, and motivating to do it all again.

I'm sure this comes as no surprise to anyone, but I'm not normal. I've slowly told those around me in hopes of ensuring that my support system will be well established for this go around. I've also pretty much settled into the stages of anger, more anger, and some acceptance. I'm working on the emotional aspect though, just as I'm working on relearning all the nit picky details about biochemistry and anatomy. I've come back to my parents' house to study this time so that I can limit my distractions, am using a slightly different study strategies, and am integrating context from the medicine clerkship into facts I learned over the first 2 years of med school. I'm trying but it just kind of sucks. I miss my girlfriend, and feel guilty that I'm not around to support her through BAR studying like originally planned. I miss my cat. I'm bummed that I had to pull out of my next clinical rotation. I feel guilty that I had to pull out of speaking at a conference next month in order to keep studying.... and so much more.

However, there is a silver lining to everything right?
-I traded in the awful Southern summer heat and humidity for much milder temperatures
-An opportunity to reacquaint myself with a home, and extended family, I haven't spent much time in since graduating from high school 9 years ago.
-A second pass at all of this info may/will prepare me even more for the pimping to come over the next few years
-An opportunity to increase my score from just passing to much higher (G!d willing!)
-Motivation to apply for year-long research fellowships that could help boost my CV
-After telling my medicine attending, having her strongly respond with: "you must be a really bad test taker because you clearly know your medicine!"
-A solid reminder that I'm in the minority and therefor special. We all need that every now and again, right? (Okay, so this one may be a stretch)

But overall, 3 days in to restudying, the situation just sucks. Oh well. What other option do I have than to pick myself up and keep trekking forward?

Posts will be few and far between as I fall deeper and deeper into the land of step studying but, assuming I can find my way out, I will eventually return.

Monday, June 20, 2011

Beginning of the end

Today marked the beginning of the end for my 2 newly admitted patients and for me. For them, it is the downward slope to the end of their life, presenting with acute decompensation of chronic illness. Comfort care is being established and loved ones are being integrated into the process. Today I had the blessing of spending some quality time with one of these families. The way they are embracing the inevitable is a truly holy spectacle. May we all have such bravery, wisdom, and strength at the end of a well lived life of our dear ones.

For me, it is the end of my medicine clerkship. Today we took the written departmental exam. Tomorrow we take an oral exam on the H&Ps and clinical course of 10 of the patients we followed. Friday we take the medicine shelf exam. I can not believe that 8 weeks are over, and my first 3rd year clerkship is wrapping up! While I am relived to be done with in patient hospital medicine, I will very much miss the incredible teaching and mentoring that I have been privy to. It really is true what they say about medical school: as soon as you get comfortable with the day to day routine it is time to switch it up again.

Here is to hoping that I finish this block on a high note!

Wednesday, June 15, 2011

Doctor x2?

I had an unexpectedly long conversation today with my old md/mph adviser. He is a man who has done amazing things in this world and who's opinion I greatly respect. He planted a seed: I should be going for a phd in health policy. He also told me that I don't need to do it now, but with the track I'm on, I should keep it in mind for the future. He basically gave me a huge complement, a very flattering charge.

Hmmm. The idea does sound appealing. Maybe one day I'll be a doctor, doctor? A MD, PhD, MPH? For now though, I really want to get out of the world and start practicing medicine. It is very much something I can think about when I have more experience under my belt.

Monday, June 13, 2011

First, do no harm.

After only 6 weeks of medicine, I'm pretty sure that we as doctors do harm all the time. We see patient after patient get admitted to the floor for serious conditions (renal failure, heart failure, electrolyte abnormalities, etc.) brought on by the medications we're prescribing for the underlying serious condition already plaguing them. We put patients through painful and costly diagnostic tests to be able to tell them they have metastasized cancer, and that we can't do anything for. Urinary catheters and central IV access become hot zones for infection. The hospital itself breeds nosocomial madness of highly resistant bugs.

There is a lovely old lady who was in amazing health until a few days ago. Then she hit a wall. We treated her and sent her with many new diagnosis, and many more medications. Not even 24 hours later she came back in with the same symptoms. This time she's convinced it is the medication making her sick. I have to say that I am not entirely sure she's wrong.

I'm way to sleepy to make anything of this post currently, and I have a hunch that it's going to be an ongoing conversation as the years [and secrets] of clinical medicine unravel before me. Currently, I just hope that the good we're doing for this lovely lady, and everyone, outweighs the harm that is unintentionally done on the side. I also hope we're learned enough in our practice to properly educate our patients about the risks involved with everything that is done to them and for them.

In the humbling words of my attending: "We will do everything for her/him, but you need to know that there is nothing we can do."

Monday, June 6, 2011

extraneous information

"Oh, and the patient cross-dresses. I found that interesting." said in a very judgmental tone was how the intern decided to end his history & physical summary on a patient this morning in morning report. It took every ounce of self control to not jump across the table and slap him. Really?! What in the world does that piece of information have to do with patient care or his medical condition? Maybe if the patient was trans, it would make sense to enlighten the rest of the medical team that preferred pronouns do not match the medical record. But the way he addressed the matter was extraneous and unnecessary. It belittled the patient into a zoo animal or a freak.

Knowing that I can be hypersensitive, I asked another medical student what she thought about the event. Her response was of equal frustration and also some surprise that I managed to not snap at him. My initial thought was that the power hierarchy means I just need to let the event slide by. However, I'm beginning to think otherwise. If I find a moment alone with him, I may try to gently inform him that the comment lacked a touch of cultural sensitivity, assuming I can figure out a way to do this that fits within the paternalistic medical (& southern) culture in which I reside.