Category: Medical

This morning was pretty exciting. It was a relatively slow morning in the ED, perhaps surprising day after 4th of July which is notorious for hand-related firework injuries, but then again any of those probably would have come in overnight. But because it was slow I was able to work on a firework-unrelated hand injury; I got to sew up the fingers of a young lad who works as junior arborist and accidentally grabbed a live hedger blade. It was a pretty gnarly injury. Lacerations along all 4 fingers, some of them going down to the tendon, but the tendons were all intact. He still had good strength and function, so no need for a plastic surgeon apparently. He was wearing a thick leather glove when it happened and I can only imagine what would have happened if he wasn’t. The lacerations were not very neat so it took of thought as to how best to re-approximate the wound edges and took us all of 4 hours to finish the the whole thing, but in the end I think it looked pretty good. Ended up putting a total of 26 stitches. He was a good sport with the whole think. Putting in sutures is definitely an activity I’ve come to enjoy and one I hope I’ll have space to do in my future practice.

The rest of the day was pretty unremarkable, but good overall. Wasn’t bored and got to see some bread and butter cases.

After a week in the ED, definitely feeling a bit more comfortable with the flow. I feel like I’m being treated like an intern by the attendings and staff, probably in part because the new interns just started late last week so some people do actually think I’m a first year resident. There was a new senior resident today, a fresh 2nd year, so similar to last week he was kinda hands-off so I got to work more directly with the attendings. The good part of that is I feel more independent and like a true sub-I, the bad part is if I say something dumb the attending will know I’m dumb without it being filtered through a resident. Though so far it’s been going ok. Today was pretty standard in terms of the cases I saw, nothing too interesting from a medical standpoint. I had to interrogate someone’s implantable cardioverter-defibrillator (ICD; I had to figure out how to do this first). I also had a patient with suicidal thoughts which I haven’t had since my psych rotation and as well as an individual with body lice which I hadn’t seen since I was working with Doctors Without Walls. The days go by fast and there is a certain satisfaction about doing acute interventions to make someone better in the ED. At the same time, there’s a lot of cases where we aren’t actually solving people’s issues, just getting them stable enough to find someone who can help them. Pluses and minuses, but overall I’m having a good time.

I had to work with some new residents today so workflow was a bit different, but the good part was I got more facetime with the attendings, the bad part was I got more facetime with the attendings. It’s just more nerve wracking than presenting to the residents, and I definitely embarrassed myself multiple times today by suggesting stupid or outlandish things to add to the differential while forgetting to include some of the most obvious ones. At the same time I think I did a decent job of proposing appropriate plans and following up on work up for patient to expedite their dispo. Also definitely getting a better handle on the notes. Also I did an ultrasound by myself to confirm a pregnancy and got told that my Spanish is really good by a patient.

Got to be back in a primary care clinic this morning which was kinda nice. It was nice to talk about health maintenance and more quality of life issues rather than people racking up bills $2342 because they had a bit of diarrhea. I was back in the ED in the afternoon/ evening, and what’s nice is it’s still a brand new experience every day. Today we had an older gentleman who just arrive in the country not too long ago but has been having nausea and vomiting ever since. Interestingly his daughter was a doctor and after the work up, seems like they got more than they bargained for in terms of diagnosis.

Anyway so far still digging the variety. No procedures today, but hopefully tomorrow, and maybe something that is not pasta for lunch.

It turns out I’m a black cloud. Today there was a bomb threat at a government facility (not that there was a increase in patients because of this) and a train derailment. Only 2 patients from the derailment showed up to our ED, but the department was definitely a-buzz with excitement/ activity in anticipation for a potential influx of patients. It was good we only got 2 though because we had plenty enough to deal with (and according to my resident yesterday was pretty quiet). I got to do a thoracentesis and we also pulled a fishhook out of a kids cheek. The thora was kinda exciting and satisfying, but I also had to manually pull out the fluid with a syringe (no vacuum bottle) which was kinda tedious, but the guy was very thankful which is always a good feeling.

Still getting used to ED note writing, I feel like I never got a formal run down, and it almost feels like it doesn’t really matter what I right ’cause the resident is going to write is own note anyway, but it’s good practice. Also have the time when I’m talking to attendings its hard to tell if they are testing me or if they actually want to know what I think about a case. It’s likely both, but it just has different vibes than what I’m used to.

Maybe it’s a misnomer to title all these as FM ED. Technically, this is all just FM inpatient, but it’s being split into 2 weeks of ED and 2 weeks of like wards. But to make it more confusing during these first 2 weeks I’m also spending time in the Urgent Care clinic and the normal primary care/ continuity clinic. Today I was in Urgent Care which was my first exposure to working UC as a student. It was kinda a nice blend of ED and primary care in that it’s single-problem, but there is some opportunity to do more patient education and create follow-up (just not with the UC). Note writing is also relatively simple and focused.

One of my attending today gave me some pretty high praise and I was feeling good cause I was kinda nailing my patient encounters from getting the history, to doing a focused physical, and creating assessments and plans (albeit for relatively straightforward cases), including a case of likely EBV/ mono. There was a rising 2nd year resident who was also working his first shift in the UC and I felt like I was at least keeping up with him.

Later in the afternoon we had “core conference” but today it was more of a promotion ceremony for the incoming residents, rising 2nd years, and graduating 3rd year residents. There was lot of good wisdom being thrown around. One of the things that kinda stuck with me mostly cause I thought it was kinda sweet and sounded fun was one of the residents talking about how their experience in this residency felt like “running a hospital with your friends,” and I just thought that was a nice sentiment.

I’m definitely feeling more and more like a 4th year medical student. Today was my first day rotating through the emergency department and they really had me hit the ground running. I had to employ so many skills that I learned at different points during medical school over the course of my 11 hour shift (I got off a bit early today). I had to do point-of-care ultrasounds by myself, stitch up some guys gnarly facial lacerations, and irrigate someone’s bloody bladder. I got to tell someone they weren’t having a heart attack and I had to tell another person that they likely had cancer. While I was feeling a bit nervous doing all this stuff, once I got started it all came back pretty quickly and definitely was a bit of a confidence boost, like hey I’ve actually learned some stuff and grown over this past year (which is kinda cool because I was at this same site almost exactly a year ago).

While it was a long and busy day, it actually flew by decently quickly. I was constantly doing something and ED note-writing was relatively quick and straightforward (plus they didn’t have me write so many notes today on my first day).

At least with my first taste of it, I’m kinda liking the buzz of the ED and the pace of it. What is a bit hard for me to get used to is seeing the patient and then sending them off, either home or admitting them to the hospital and not really following them in what happens next. I feel like this is something I can get used to but we will see how I feel by the end of these 2 weeks in the ED.

I’ve been pretty bad about keeping up with these since after my month hiatus for board studying, and this lack of posting is in no way indicative my experience on Pediatric Infectious Disease. To be honest, I went into it not really expecting much. I mostly chose it because I have a mild interest, wanted to see what the specialty was about, and they offered it at a hospital close to my current residence.

I actually really enjoyed my time on it. Things I like were:

• The thought process. One of my fears about specializing is that I will miss problem solving for patient’s other active problems. While this was kind of the case and was apparent in my impressions/ assessments, I did feel like we had to do pretty extensive differential production and work-up/through these complex or mysterious ID cases. We had to think about all the systems (because microbes can go anywhere), but we didn’t have to manage every part of the patient.
• HIV clinic. I didn’t realize that the Peds ID doctors were the primaries at the HIV clinic in this specific community and they have a pretty extensive patient base. They see kids and adults which appealed to my orientation towards Med-Peds and definitely opened up ID as a potential specialty if I end up doing Med-Peds that would allow me to do inpatient work and longitudinal outpatient care. Plus I got to learn so much about the current state of HIV care locally and around and world as well as the stigma that has illogically persisted around HIV.
• The hours. Even though most days I got in at around 6:30 AM and left at 5:00 PM, I wasn’t feeling super drained at the end of the day. My work was varied and I felt like I had the time to think about things and also do a lot of meaningful learning. And probably as an attending I wouldn’t have to be in so early.

Things I didn’t like so much:

• Had to sort of ignore other things. I touched on this above and yes in some cases this was a good thing, but also I’m just a curious/ nosy person and I want to know why certain non-ID related things are going on, but my attendings kinda steered me away from that, at least for the purposes of this rotation.
• Isolation. This may be a med student specific perspective thing, but I didn’t have a team of residents to really work with, it was just me and my attending for that given week. My attendings were lovely, very nice and patient and liked to teach, but you know as a student its always nice to have people who are closer to you in terms of training to kinda give you the more relevant tips and tricks of just survival.

Anyways, all that said I had a really positive experience and will definitely be keeping ID in my back pocket as a possible specialty down the road.

Tomorrow I start on inpatient family medicine which I think will be pretty important in terms of me deciding what residency I will ultimately apply into.

I started off the day pretty confused. I was accepted into this rotation pretty late, as in 2 weeks before it started and actually wasn’t even officially accepted until the Friday before with the last correspondence of whether or not I would be allowed in the hospital being equivocal. Fortunately, it all worked out and I was able to get my badge and everything, but didn’t have any instructions on where to go after that. So I wondered around and found the resident work-up. Meekly badged in and explained my situation with my saddest puppy dog eyes. They said they would try to help me out. I got some info about who the attend on service was. Eventually I went to the GME office once it opened and someone there was able to contact the ID attending. Lucky for me he turned out to be one of nicest guys ever. Very helpful, good teacher, super patient. It was overall a good introduction into ID and back into hospital medicine after my hiatus studying for Step 2.

At the end of the day I met the attending who will be taking over tomorrow and he tells me to go ahead and see all the patients in the morning and the text him when I’m done so we can round. It feels like a pretty intense return, but also not surprising at this point in my training, but also at the same time I’m excited to see patients on my own again.

The reason I chose to do this rotation this early on was so I could get a sense of whether or not there is any possibility of me wanting to pursue this in the future, thus informing what residencies I would apply to. I can confidently say that after these 4 weeks I have not ruled pediatric cardiology out of the equation. Between this rotation and last, I think one more definitive things that has come out is that I definitely want to have some component of working with kids. If I had to choose between only working with kids and only working with adults, I would drop adults in a heartbeat. I feel like there’s a path from my current trajectory that is pretty well defined to a possible future in congenital heart disease, but as I’ve mentioned I still have a lot of training to go through before I need to make that decision.

All in all, I’m just super glad I got to have this opportunity and I’m excited to see where things go.