Another week is finished! At this point, I am counting down the days to Thanksgiving. We have class tomorrow and Tuesday until noon, and then it's home to family, friends, and food!
This week, we studied Pulmonology. To me, the material seemed pretty straight forward: pneumonias, lung cancer, COPD.. along with a few other smaller diseases. We also had a VERY busy week of extra things on our schedule. Monday, we had pathology lab. Tuesday, I spent the last afternoon at my preceptor's office, but luckily I left a little early. Wednesday, we had a practice history and physical exam. Thursday, we had a seminar on choosing a specialty. And Friday, we had our real history and physical exam (which we were told that our campus is the best the statewide standardized patients have seen)! Needless to say, it was hard to find time to fit in studying.
The seminar on choosing a specialty was actually interesting. Although it didn't help me to actually CHOOSE a specialty, it was more focused on how to prepare for a residency. With the way healthcare is currently going, residency spots are being lost. This means that there are doctors graduating medical school without a job available for them. I find this extremely sad, because we are already in an era of too few physicians. When the new healthcare law has health insurance for every almost every American, the doctor-patient ratio is going to worsen. We need to increase the number of physicians by growing interest and helping the students financially, in my opinion.
Choosing a specialty is one of the hardest decisions we as physicians have to make. The seminar speaker discussed how it is equivalent to the choice of who you are going to marry. Physicians end up regretting their choice, becoming unhappy, and being unable to switch their specialty because of lack of residency spots. At this point, being unsure of what I want to do, I have to do all I can to make sure I am able to get into the specialty I someday choose: this means killing my Step 1 USMLE board exam in May. Currently, I have interests in Neurology and Family Medicine/Internal Medicine. I am hopeful that my clinical rotations next year will help me to make my decision. Right now, however, I am simply trying to stay motivated and study; my motivation has been slightly down with the holidays around the corner.
I'd like to give a small list of things in no particular order that I'm thankful for to end this blog, with Thanksgiving being Thursday! There are many things that people take for granted, but God is blessing us every day.
1. Family.
2. My amazing boyfriend.
3. Friends.
4. Education.
5. Having enough food.
6. Hot showers.
7. A roof over my head.
8. My cat.
9. A working car.
10. Being healthy.
11. Living in the United States.
12. Owning clothes and shoes.
13. Reading a good novel.
14. Hugs.
15. My dogs and cat at my mom's.
16. CHRISTMAS.
17. Being able to see family during the holidays.
18. Sleep.
19. Heaven and prayer.
20. Good movies.
21. Laughter.
22. The beautiful world.
23. Caring people.
24. Having hope and trust.
25. Doctors.
I hope you all have a wonderful Thanksgiving, and don't forget to give thanks EVERY day, not just one day of the year!
Sunday, November 18, 2012
Sunday, November 11, 2012
Breaking Bad News
One more week over. We finished up learning Cardiology, but we also had an experience that most students don't get to experience. On Thursday afternoon, we delivered "bad news" to three of our standardized patients. These SP's are very good actors who pretend to be patients as we play our role of the medical student. We got a little "prep" on Wednesday in order to prepare for this. We were told of 4 things to look into in order to be prepared for Thursday's event. 1. Elderly abuse. 2. Potassium overdose. 3. ALS. 4. Dementia. So on Thursday at 1:30p.m., I was at the school in my professional dress and white coat to talk one-on-one with 3 "patients".
The first patient I had was the elderly abuse case. His wrists had makeup on them to resemble bruises. Talking with him, I realized that even in delicate situations, the most important thing is the patient. While my nerves had been a little shaky prior to beginning, I realized that as I sat in the "office" talking with a man about his living situation with his son, my nerves dissipated. Engaging in conversation with real people can easily make you become comfortable. Even if you are nervous, you must remain calm for the comfort of the patient. We talked about abuse, I presented options, and afterwards, we talked casually as ourselves to give feedback about the encounter.
My next "patient" was an older woman who I had to diagnose with ALS (Lou Gehrig's disease). This encounter felt mostly real to me. I have an interest in neurology, and with this SP, I discussed the prognosis of the disease, treatment options, and realistic expectations regarding her care. I felt oddly connected to the SP as we talked about her wish to travel. During our feedback session, I told her how it was the most comfortable I had felt. Even though delivering bad news is not easy, connecting with the patient is critical in maintaining the doctor-patient relationship and showing empathy and compassion.
The last encounter was THE hardest encounter of all. We had to tell a mother that the ER made an error with her little girl, ending with administering too much potassium via IV and killing her daughter. Starting off with the news that her daughter passed away, the mother expressed shock, then sadness, and finally anger. It was extremely difficult for me in this situation because I had no answers for her. I could not tell her why it had happened or how it had happened. I could only try to comfort her, which in this scenario was most trying, being as I had told her it was the fault of the hospital. I mostly sat in silence while she cried. During the feedback session, I told her how hard it was to be in that circumstance. Luckily, she said that I dealt with it well, taking advantage of the silences and explaining the situation so that she could understand.
Overall, I was told very positive things about my encounters. I was informed that I had great eye contact, showed great sympathy, and explained all situations with great care. After the hour and a half of delivering this set of bad news, I was emotionally exhausted. Even though this encounter was played out by actors and actresses, I am extremely glad for the privilege of "practicing". Many medical students don't get a chance to try it before being thrown into the fire during their clinical years with real patients. Getting the chance now will hopefully make the real encounters more manageable. While delivering bad news will NEVER be easy, I hope that I can show how much I sincerely care and that I will be able to comfort my patients in the future. Whether delivering a bad diagnosis to a patient, telling a family that a loved one died, or helping a patient through a delicate situation, each and every patient deserves attention and compassion from their physician. These two attributes can easily distinguish a great physician from a good one.
The first patient I had was the elderly abuse case. His wrists had makeup on them to resemble bruises. Talking with him, I realized that even in delicate situations, the most important thing is the patient. While my nerves had been a little shaky prior to beginning, I realized that as I sat in the "office" talking with a man about his living situation with his son, my nerves dissipated. Engaging in conversation with real people can easily make you become comfortable. Even if you are nervous, you must remain calm for the comfort of the patient. We talked about abuse, I presented options, and afterwards, we talked casually as ourselves to give feedback about the encounter.
My next "patient" was an older woman who I had to diagnose with ALS (Lou Gehrig's disease). This encounter felt mostly real to me. I have an interest in neurology, and with this SP, I discussed the prognosis of the disease, treatment options, and realistic expectations regarding her care. I felt oddly connected to the SP as we talked about her wish to travel. During our feedback session, I told her how it was the most comfortable I had felt. Even though delivering bad news is not easy, connecting with the patient is critical in maintaining the doctor-patient relationship and showing empathy and compassion.
The last encounter was THE hardest encounter of all. We had to tell a mother that the ER made an error with her little girl, ending with administering too much potassium via IV and killing her daughter. Starting off with the news that her daughter passed away, the mother expressed shock, then sadness, and finally anger. It was extremely difficult for me in this situation because I had no answers for her. I could not tell her why it had happened or how it had happened. I could only try to comfort her, which in this scenario was most trying, being as I had told her it was the fault of the hospital. I mostly sat in silence while she cried. During the feedback session, I told her how hard it was to be in that circumstance. Luckily, she said that I dealt with it well, taking advantage of the silences and explaining the situation so that she could understand.
Overall, I was told very positive things about my encounters. I was informed that I had great eye contact, showed great sympathy, and explained all situations with great care. After the hour and a half of delivering this set of bad news, I was emotionally exhausted. Even though this encounter was played out by actors and actresses, I am extremely glad for the privilege of "practicing". Many medical students don't get a chance to try it before being thrown into the fire during their clinical years with real patients. Getting the chance now will hopefully make the real encounters more manageable. While delivering bad news will NEVER be easy, I hope that I can show how much I sincerely care and that I will be able to comfort my patients in the future. Whether delivering a bad diagnosis to a patient, telling a family that a loved one died, or helping a patient through a delicate situation, each and every patient deserves attention and compassion from their physician. These two attributes can easily distinguish a great physician from a good one.
Friday, November 2, 2012
A Lot of Heart & Novel Ideas
This week was our first week of Cardiology. At our campus, we have no "Step 7" professor, so we only get lectures from outside physicians as they are available. Therefore, we only had an arrhythmia lecture on Monday, and a nuclear medicine lecture today (plus our 3 days of paper cases). Considering we need to learn ALL of cardiology this week and next week, it just is not enough. Most of my classmates have found that the Indianapolis lectures are a good resource (I'm at a regional campus of 25 students in my MS2 class). I've learned about valvular diseases, pericarditis, aortic dissection, and ischemic heart disease. This past summer, I worked with a cardiologist (more specifically, an electrophysiologist). I really enjoyed cardiology, especially the interventional side (stents, pacemakers, etc.). However, the HARDEST part, especially right now, is learning the different heart sounds. I'm not sure I will ever be able to tell them apart! However, it's definitely more fun to be learning the clinical applications now that we have all the basic sciences under our belt.
Besides my boring life of study, not much else has occurred this week. I spent yesterday morning at my preceptor's office. He is an ENT (ear, nose, and throat doc). I think I've learned ENT is not a field for me. Too specialized, too quick, and too boring. He loves surgery; I'm not a huge fan. I would rather be in a field where I am challenged, have to think critically, and come up with crazy differential diagnoses (kind of like a female Dr. House ;)). I also had my Chronic Patient presentation this week. At our campus, we are assigned a chronic patient to follow-up with monthly over a year and a half time frame to learn the progression of chronic disease and establish relationships. Last night, I also talked with other MS2's and MS1's to premed students on our campus about medical school: the application process, undergrad, med school in general, being female in the medical field. Thankfully, today is Friday, and I get to enjoy a little time off with my boyfriend who is coming to visit me! We are going to go see the new Denzel Washington movie.
So when I started this post, it was to begin writing more and become inspired on novel ideas. I have thought of a couple ideas and would gladly accept feedback, comments, or more ideas!
1. Write a series of (at least) 4 books about life as a medical student. It would be a fiction series, centered around a medical student as they progress from 1st year to 4th year (hence the 4 books). There would be truth in the lifestyle of the student and the ordeals, stresses, and achievements of becoming a doctor. There would, however, be some fiction in the life of the character, with more development on the plot. It would probably be a more sincere, heartwarming novel about life. Just a simple idea that needs a lot more growth.
2. A more silly idea: A character (most likely a resident at a hospital) who begins to hear music and other noises while working long hours. No one else hears this noises, and the character is a skeptic who doesn't believe in supernatural things. He becomes convinced he has a brain tumor. When the scan is clean, he is concerned he has a psychiatric disorder (i.e. auditory hallucinations). As the plot develops, something more supernatural WILL be occurring. (This idea, I realize, is more of a mystery; I'm a big fan of Dean Koontz, and I would like it to be similar to his plots.)
Next week, part 2 of Cardiology! We will also be learning how to break bad news to patients.
Besides my boring life of study, not much else has occurred this week. I spent yesterday morning at my preceptor's office. He is an ENT (ear, nose, and throat doc). I think I've learned ENT is not a field for me. Too specialized, too quick, and too boring. He loves surgery; I'm not a huge fan. I would rather be in a field where I am challenged, have to think critically, and come up with crazy differential diagnoses (kind of like a female Dr. House ;)). I also had my Chronic Patient presentation this week. At our campus, we are assigned a chronic patient to follow-up with monthly over a year and a half time frame to learn the progression of chronic disease and establish relationships. Last night, I also talked with other MS2's and MS1's to premed students on our campus about medical school: the application process, undergrad, med school in general, being female in the medical field. Thankfully, today is Friday, and I get to enjoy a little time off with my boyfriend who is coming to visit me! We are going to go see the new Denzel Washington movie.
So when I started this post, it was to begin writing more and become inspired on novel ideas. I have thought of a couple ideas and would gladly accept feedback, comments, or more ideas!
1. Write a series of (at least) 4 books about life as a medical student. It would be a fiction series, centered around a medical student as they progress from 1st year to 4th year (hence the 4 books). There would be truth in the lifestyle of the student and the ordeals, stresses, and achievements of becoming a doctor. There would, however, be some fiction in the life of the character, with more development on the plot. It would probably be a more sincere, heartwarming novel about life. Just a simple idea that needs a lot more growth.
2. A more silly idea: A character (most likely a resident at a hospital) who begins to hear music and other noises while working long hours. No one else hears this noises, and the character is a skeptic who doesn't believe in supernatural things. He becomes convinced he has a brain tumor. When the scan is clean, he is concerned he has a psychiatric disorder (i.e. auditory hallucinations). As the plot develops, something more supernatural WILL be occurring. (This idea, I realize, is more of a mystery; I'm a big fan of Dean Koontz, and I would like it to be similar to his plots.)
Next week, part 2 of Cardiology! We will also be learning how to break bad news to patients.
Saturday, October 27, 2012
An Introduction to My Life
One of my goals in life has always been to write. Ever since middle school, when my English teacher made us do a writing portfolio of short stories and poetry, I have been taken into the world of writing. I love writing poetry, but I've also had a goal to publish a novel someday. Right now, I'm in my second year of medical school at Indiana University School of Medicine. Because of this, I have very little free time. This means my writing has dwindled significantly. I thought starting a blog would inspire me to keep up with my writing - even if it is just simple reflections of my career in medicine. Someday, I'd like to look back on this blog and be able to generate ideas for novels in hopes of getting published. I'm not even sure if anyone will read this, but it seems like a great release and reflection as I go through my medical education experiences. My only regret is that I did not start blogging a year ago, when I started my first year of medical school.
As an MS2, I have now survived Biochemistry, Histology, Anatomy with Radiology and Embryology, Physiology, Neuroscience, Pharmacology, Microbiology, Immunology, and General Pathology courses. On top of these classes we have learned how to take histories and physicals, spent afternoons at preceptor offices, interacted with a chronic patient on a monthly basis, as well as the countless other afternoons and events we fit into our busy lives. I am also a tutor for Anatomy and Neuroscience this year, putting together reviews for first year students to help them in their quest for knowledge. Through it all, my classmates and I have learned, struggled, and grown as individuals and as teammates. At the campus I am located at, we have a curriculum called Problem-Based Learning. Every Monday, Wednesday, and Friday from 8-10, we work in groups to discuss the basic and clinical sciences of a paper case. Many of my classmates dislike this style of learning; however, I must admit that I find it a very important way to incorporate not only physiology and pathology into a clinical-based situation, but also as a way to remember that it's not simply about memorizing pathways, medications, and anatomical structure. We learn to think about differential diagnoses, which tests we would run for a patient, how important the patient's history is, and how we would progress in a case (whether it be cancer, a genetic disorder, or an infectious disease).
It may seem like my life is boring. I go to class from 8-12, spend some afternoons at doctor offices or in the simulation center with standardized patients, and spend the "free" afternoons I have studying until it's time for bed or until I am so exhausted that I just need a break. Okay, I'm not making myself sound more interesting yet. I get it. But I would not change my life for anything in the world. One day, I will be able to talk with patients, give them advice, comfort them when they are ill, and do everything in my possible hands that I can do to guide them and treat them. The struggles I go through now will only end up at the ultimate job - the blessing and privilege of being a physician. Outside of classwork, I am blessed enough to be with family, my boyfriend, and the great friends that I have. This weekend, we had Friday off, and I got to come home and spend time with great people. We spent last night carving pumpkins, eating pizza, and laughing. These more rare moments are times that I could not live without. Support from them is the one thing that helps me get through.
In May, I will be sitting down for an 8-hour exam that will determine my future -- the boards. This test, as we have already been told countless times, is THE test of our entire lives. No big deal, right? Every time someone mentions the boards, I already get a tight, nervous feeling in my chest. Everything we have learned, we must know down to the level of crossed t's and dotted i's. We have to be able to analyze, diagnose, and answer questions, no matter what is thrown at us. I've already spent hundreds of dollars on board prep materials that include lecture videos and thousands of practice questions. It's just a little stressful. But knowing that my classmates are right there with me, that my family and friends support me and encourage me along the way, that as long as I put the time in this year (even if it means having no life, studying 12 hours each day, or having mental breakdowns), I will have the M.D. behind my name in the end.
As we start our last class of the year on Monday - Step 7 "Medicine" - I will continue to write about my experiences, struggles, and accomplishments. Even if no one finds this interesting or worthwhile - to me, it's a catharsis that is definitely worth taking a few minutes out of my week.
As an MS2, I have now survived Biochemistry, Histology, Anatomy with Radiology and Embryology, Physiology, Neuroscience, Pharmacology, Microbiology, Immunology, and General Pathology courses. On top of these classes we have learned how to take histories and physicals, spent afternoons at preceptor offices, interacted with a chronic patient on a monthly basis, as well as the countless other afternoons and events we fit into our busy lives. I am also a tutor for Anatomy and Neuroscience this year, putting together reviews for first year students to help them in their quest for knowledge. Through it all, my classmates and I have learned, struggled, and grown as individuals and as teammates. At the campus I am located at, we have a curriculum called Problem-Based Learning. Every Monday, Wednesday, and Friday from 8-10, we work in groups to discuss the basic and clinical sciences of a paper case. Many of my classmates dislike this style of learning; however, I must admit that I find it a very important way to incorporate not only physiology and pathology into a clinical-based situation, but also as a way to remember that it's not simply about memorizing pathways, medications, and anatomical structure. We learn to think about differential diagnoses, which tests we would run for a patient, how important the patient's history is, and how we would progress in a case (whether it be cancer, a genetic disorder, or an infectious disease).
It may seem like my life is boring. I go to class from 8-12, spend some afternoons at doctor offices or in the simulation center with standardized patients, and spend the "free" afternoons I have studying until it's time for bed or until I am so exhausted that I just need a break. Okay, I'm not making myself sound more interesting yet. I get it. But I would not change my life for anything in the world. One day, I will be able to talk with patients, give them advice, comfort them when they are ill, and do everything in my possible hands that I can do to guide them and treat them. The struggles I go through now will only end up at the ultimate job - the blessing and privilege of being a physician. Outside of classwork, I am blessed enough to be with family, my boyfriend, and the great friends that I have. This weekend, we had Friday off, and I got to come home and spend time with great people. We spent last night carving pumpkins, eating pizza, and laughing. These more rare moments are times that I could not live without. Support from them is the one thing that helps me get through.
In May, I will be sitting down for an 8-hour exam that will determine my future -- the boards. This test, as we have already been told countless times, is THE test of our entire lives. No big deal, right? Every time someone mentions the boards, I already get a tight, nervous feeling in my chest. Everything we have learned, we must know down to the level of crossed t's and dotted i's. We have to be able to analyze, diagnose, and answer questions, no matter what is thrown at us. I've already spent hundreds of dollars on board prep materials that include lecture videos and thousands of practice questions. It's just a little stressful. But knowing that my classmates are right there with me, that my family and friends support me and encourage me along the way, that as long as I put the time in this year (even if it means having no life, studying 12 hours each day, or having mental breakdowns), I will have the M.D. behind my name in the end.
As we start our last class of the year on Monday - Step 7 "Medicine" - I will continue to write about my experiences, struggles, and accomplishments. Even if no one finds this interesting or worthwhile - to me, it's a catharsis that is definitely worth taking a few minutes out of my week.
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