Category: Medical

My first day in clinic. I started the day in pediatric cardiology clinic which felt like another full circle moment because this was the first place I shadowed during medical school. It felt good to be back in a clinical setting and seeing patients, and in cards especially seeing some interesting conditions, getting to look at echoes, and only having to focus on one condition. I impressed my attending because after we went back in together to see a patient, the patient who normally is not cooperative with any type of exam, motioned for me to listen to her heart again (probably just ’cause she’s just getting older, but still was gratifying).

Then in the afternoon I had my first continuity clinic patient, a newborn. It’s always fun to work with the wee babes and (usually) the families. I did have to learn and do all the stuff real doctors have to do though beyond writing the note; doing the med rec, doing the visit charge, etc.

It’ll be a pretty stark transition when I start in the MICU next week which I’m actually looking forward to, but for now I’m just going to enjoy the coming weekend for my brothers wedding.

I couldn’t have asked for a better way to start my residency training. I was scheduled for community outreach all day which involved going to a local organization for “Questions for a Doctor” in the morning, and then in the afternoon we went to a local high school for an on-site “mobile” clinic to do sports physical for students. The opportunity to be out in the community and bring healthcare to people who may otherwise have limited access is a big reason why I wanted to be in this program. This morning I had some really great conversations with people in a setting that they feel comfortable and on their terms, answered some question, and got some advice on how to be a better doctor. This was my first time engaging with people and also doing clinical work as an MD, I even signed my first sports physical which was exactly as exciting as it sounds. While these kind of community-based activities are not going to be as frequent as I would like since I still need to become an expert at regular medicine, it was hugely motivating as I go into tomorrow to see my very first patients in clinic.

It’s been a while since last wrote anything on here despite this being probably the most eventful 3 months of my life. I matched into my first choice residency program, I finally went to Japan, I finally built a pizza oven with my dad, graduated medical school, and tomorrow is my first day official day as a resident loose in the world. Luckily for the world I’m on a weird +1 week this first week and in Med-Peds we can have a day of community engagement and so that is what I have tomorrow. It feels fitting though because involvement in the community is one of the big reasons I wanted to stay here at this program. And then Thursday I have my very first clinic patient. I am very excited to finally start after all this time since match day. Hopefully I can keep up this enthusiasm. But yes that is all for now.

I’ve been pretty bad about staying up to date with this, and in general using my time after getting out of the hospital to do any kind of meaningful reflection which I feel like has taken a toll on me in various ways that are hard to quantify.

The rest of my MICU rotation was pretty good though. I actually liked the overall operation of the ICU. I liked the complexity of patients that came through and management of drips and vents, while still having to pay attention to the standard internal medicine things like blood sugars and electrolytes. I expected to be more dissatisfied with the aspect of not getting to see patients to discharge, but in most cases there was a sense of completion. Either the patient was stabilized enough to transfer to the lower acuity floors or to another hospital, or even in some cases be discharged directly from the ICU (in some cases they were basically stable enough to go home from the ICU after being super sick but stayed a few more days on the floor for monitoring or other reasons, or in the other unfortunate case they would pass while in the ICU. It is a lot of training though, but it does seem like something I could be interested in in the future.

This experience also makes me curious about the pediatric ICU, the things I’ll see and the types of conversations I’ll have.

I was able to actively participate during a code today for the first time today (I know it only took all of Med School). It was pretty different from all the Mock and Sim codes I’ve done or the BLS/ ACLS training I’ve done, but understandable so. I was recruited to do chest compressions, though I wasn’t the first one so I didn’t experience the rib cracking. It was a bit more tiring than the Mock codes I’ve done and definitely a lot scarier with an actual life on the line. The defibrillator/ heart monitor wasn’t hooked up correctly at first or didn’t have good contact or something based on the signal, so it kept saying “push harder” which definitely added to the stress. It hard to maintain a steady pace without actively thinking about my rate. And at the same time I was trying to listen to everything else going on so I could learn. It was only 3 minutes but it felt like a long time and a short time at the same time. After my round of compressions we checked a rhythm and got a pulse (or as we say return of spontaneous circulation or ROSC). Was it my excellent compressions or was it the meds he was getting who’s to say??? Let’s just say it’s good we were in a room full of seasoned professionals.

At the end I wasn’t sure how I felt, or how I thought I was supposed to feel. I feel like there were maybe less emotions than I was expecting given this was my first real code. The only prominent emotion was excitement which feels wrong. Of course I felt bad for the patient and it is terrible that this happened, but at the same with him being sedated through the whole thing there was no emotional feedback to go off of, and everyone around me was super professional and if not stoic or in some cases kidding around with each other. So that was the emotional energy that I was feeding off of I guess. Still feels a bit weird, but only because I feel like it should. A man almost died in front of my eyes. If anything the person who was at the forefront of my mind was the patient’s mother who had constantly been at bedside and was in the room when they decided to intubate which eventually led to a code (she was out of the room when they lost the pulse thankfully). I was constantly trying to think of the right words to say to her if I were the one to tell her what was going on, what happened, or what might’ve happened if it came to that. I kept drawing blanks beside the basics and cliches, so definitely something I need to work on, and then be able to do it in Spanish.

Otherwise it was a pretty standard day, besides me coming back in from the weekend and us starting with a new attending who seems pretty badass.

It was an eventful day. I got to help out a bit with an emergent chest tube for a pneumothorax which I never had seen before. Though the circumstance under which this occurred were not ideal (there was a breakdown in communication that lead to rapid worsening of the patient’s existing pneumothorax which we were already treating). Today was also my last day with the attending who has been on since I started in the ICU. I liked him a lot as an attending, he was super patient and encouraging with all of us and really made it a point to teach and also give us autonomy with out patients. Being my last day working with him we did feedback. He said I did a good job and was surprised that this was my first ICU rotation and said I was working at the level of a first or second year resident, which felt good even though he was probably being generous. That said I do think I’ve come a long way from where I once was. I definitely have a lot more confidence than I did a year ago. Whether that confidence is proportional to growth in my clinical ability is a whole other story.

This was an interview for a program that I was not particularly interested, especially after the “social event” the night prior, just given that I felt like it didn’t vibe with the culture. But I actually really enjoyed this interview as well. The program has a lot of the things I’m looking for and most of the people I was able to talk to today definitely passed the vibe check. Definitely will keep this one in mind.

A lot of residents were off today so I kinda was helping pick up some of the slack as best I could as a medical student. And since I was gone the yesterday and both my patients were downgraded I had to pick up all new patient, and I also took on one of the news as a third. So far I’ve enjoyed my time on ICU. It’s a good mix of pure, broad scope medicine with also the action and drama and procedures of high acuity and the sentimentality and care of interacting with patients and families around sensitive topics.

My first residency interview was today. It was for my home institution’s program which was a good one to start with. My thought was that I would be able to get past some of the earlier interview cycle jitters with a program that I know relatively well and know a good amount of the faculty and residents. I was still super nervous. Last night I had pre-Disneyland-like insomnia, but fortunately did get decent sleep and woke up pretty refreshed and with time to do my usual morning routine. Overall the interview went pretty well I thought. Everyone I spoke with I have spoken to and/ or worked with before, except the one person who did my community member interview. It was also good to get a more formal presentation on the program and the experience reiterated in my mind how much the culture and environment of the program match with my own values and philosophies toward medicine. Part of my really wants to stay because I this program is almost exactly what I’m looking for. Another part of me wants to venture off for a new experience (not that residency in and of itself won’t be a new experience). I guess I’ll have to see if any other programs can compete.