beau

best!

Indecision, indecision

I've been thinking lately about what I might want to do career-wise.  I think all the good feedback I've gotten on internal has gone to my head and now I'm wondering whether a meds-peds combined residency (4 years) might be better than family medicine (3 years).  I'm torn, because although family medicine is less time, it includes a broader variety of things-- including surgical procedures and obstetrics/gynecology.  But I keep wondering if family is less time and more things, won't I necessarily not learn them as well?  I think the bottom line is if I see myself practicing in a clinic somewhere or in a hospital somewhere-- but I really don't know.  Obviously I have some time to think about it, but I just don't know.

So I was doing some looking at residencies. . . There are so many options.  I feel overwhelmed just thinking about finding the time to sort them all out and decide where to apply.  And I can't imagine doubling those prospects by including med-peds programs. :-p
In my search I came across this, too:

 http://globalhealtheducation.org/resources/Pages/QAGuidance.aspx

• What do you want to do in IH? —  Do you see yourself primarily working as a "practitioner" or as a "change agent?" Practitioners spend most of their time working one-on-one with patients, while change agents work primarily to change the attitudes, behaviors and practices of organizations or groups of individuals? In real life most persons working in IH combine elements of both roles but where you are on the continuum between one extreme and the other will have important implications for your postbasic training program.

Ugh another decision point.  I want to be a change agent, but I feel like the best way to change someone is on a personal level.  BOTH BOTH BOTH I WANT TO DO EVERYTHING!  How do I pick?

In unrelated news, I have a date on Saturday with a guy I met online.  We'll see how that goes.  Any of you loyal readers out there itching for more information (also perhaps why this falls under an entry called "indecision, indecision") will just have to find me on the phone or in person or on gchat to find that out.  Don't worry, it will be in public, I won't leave my drink unattended, and I might even bring along a friend-spy to sit in the background and make sure I don't get abducted.

Blah I need to study but I want to go to bed and to know where I'm going to spend the next 5 years and then the rest of my life.  But that would take all the fun out of it, wouldn't it?

Creative outlet

I wish I had the time to do little creative things like take lots of pictures, or paint something or make etsy things, or read for pleasure.  I think there are probably some other obstacles to doing these things well (with the exception of reading, I'm marginal at best).  And technically, on this rotation at least, I can find the hours to do those things, but when I have free time I mostly want to spend it with the people I love, and getting all the people I love to paint or read or create together is sort of difficult.  Sometimes I have time to myself and I think about reading, but then I think about the shelf and how I really might be able to honor this rotation, and how I ought to study, and so then I figure I have to study in that rare moment when the mood strikes me to do so.  So I haven't read more than about a paragraph for pleasure since the beginning of school.

Don't get me wrong, I love what I'm doing, and I think it's worth it and I have made the right choice.  But I'm not sure I was quite so aware of some of the things I was putting on hold or de-prioritizing when I made this choice.

Another interesting thing is the gender dynamic and all the varieties of manifestations that can take in medicine.  But I think that's another post for another day, or maybe for never.  We'll see.

Seriously, I have to email someone to get permission to attend my grandfather's funeral?  This is perverse.  I know I sound angry but in usual fashion I am mostly just sad.  This makes me really hate medicine.

Month one, down

Lessons learned from my first month of hospital service--very stream of consciousness and also call-centric given that I am now post call.

1.  Hospital air (especially elevators) is super greasy and hell on my complexion.  I don't care how weird it feels, I am taking a shower on overnight call.  Ugh.

2.  Overnight call is hell on my dark eye circles and my ability to avoid the side effects of caffeine.  But when done right (I know I will disagree with this at some point, probably very soon), it is pretty freaking fun.

3.  Things to pack for overnight call:
toothbrush
toothpaste
shampoo
soap
(towel provided by hospital)
phone charger
sense of adventure
courage
curiosity
liquid caffeine
snacks
reading material

4.  I have reason to be confident!  I stumbled around this whole month never really knowing what to expect and generally feeling wholly inadequate.  Of course, every attending and every rotation is way way different, and I am pretty much wholly inadequate to practice medicine at this point, but there is hope. :)  My evaluations (the subjective part I was most most nervous about) came back very positive, as good as I really could have hoped for, and still (following the trend in my life) much better than I feel like I deserve.  I think this will give me the confidence I need to move forward and say, good gracious I have a lot to learn, but gosh darnit I do know part of this sometimes.  I'm sure that sounds like a very mediocre statement, but I feel like it is a giant leap ahead from the knot of anxiety that was my first month of orientation to life outside the classroom.

5.  After a while, giving rectal exams is still awkward, but it loses its awkward novelty.

6.  Thank God for approachable patients/interns/residents/attendings/nurses/custodial staff.  Every single person in that freaking hospital is a part of making me a better person.

7. Despite my upgraded aggressiveness from pre-debate days, I need to be more aggressive.  This is sort of tied up with taking personal responsibility for the patient and not depending on the resident or the EMR protocol or the consult team or even the nurses to do my job.  Obviously I can't and shouldn't do everything, but as the doctor the ultimate responsibility for whether or not something happens for a patient falls on me.  So I've got to step it up and follow through and do my least favorite thing to do and politely harass the appropriate people or do the work myself when something needs to be done (wow what a run-on!).

8. Medical ethics is so much more interesting and so much more difficult to get right in real patients than in classes.  That goes for medicine too.

9. Plan fun evenings for the day before your day off, not the day of, so you can sleep in.

That's it for now, but a lot better outlook than the last note I think!

Things at the hospital have picked up now, and I have a lot of observations about how debate is surprisingly helpful on rounds and life and my interesting patient, but the more pressing problem is this newfound loneliness.

It's just like when I was in Nepal, except only on my 36 hours off and not an every day kind of lonely.  I have plenty of things I could/should do. . . dishes piled up, laundry piled up, studying, other books to read, a future to plan.  But I am too tired for that, I just want to hang out with my friends, and get a little energy back.  But at the moment they're all tied up-- off in coupleland on a double date, out of town, don't live here (MEWPPP), on a rotation that is so busy I dare not ask for their free time because I know they want to be recovering from their 3 hours of sleep for a week straight, or still at the hospital. 

I feel like nothing quite is the same as that emptiness of looking so forward to time off to spend with people and finding yourself alone.  In a big house, with nobody there.

I think these things are going to be remedied soon. . . 1) I will be so tired I will just sleep instead. 2) My friends won't be out of town. 3)Two new roommates will be moving in.  4) The couples will break up?  Just kidding, not a remedy.

If there are any readers out there I promise I really am enjoying life I'd say 85% of the time, don't worry about this.  I just need to get it out.

Day 1 of the rest of my life

So, I know this was originally my Cameroon-y retro-blog, and that sort of fell to the wayside.  Maybe someday I will pick it up again, but for right now it's going to be my place to let out whatever's on my mind, I think.  I don't really think I have any readers and pretty much I am planning to write just to get things off my mind.

Today was the orientation for my internal medicine clerkship.  While I have already been "oriented" to third year (last Friday) and now theoretically have been oriented to this rotation, I have never utterly felt more thoroughly disoriented in my life.  The clerkship director and the chief resident got up and sort of overviewed our responsibilities as med students and what happens on the rotation, and while I understood the words that they said, somehow at the end of it all I still have no clue exactly what I'm going to be doing every day.  I know it involves seeing patients and H&Ps and presenting, and in theory I know what that means, but in practice I have no idea of the moment to moment actuality of it all.  I don't think I've ever felt more lost before, or hopefully will again. . . It's overwhelming because not only do I not know much of anything about practical medicine, but I also really don't know any of the nuts and bolts of the system I'll be working in.

Our orientation let out at around 10:30 today, and suddenly I was left with a whole day of empty space.  I went to the library and played around a little with the eCare system so I can at least find my patients' charts and open them. . . maybe.  Still haven't figured out exactly how to look at an actual image, but I can see the report so I guess that will have to do for the moment.  It was nice because as I fiddled with the program some of the nervousness melted away into  routine and I'm hoping that will continue as the rotation goes on.

Tomorrow is another pretty light day, from the looks of things although at some point my team for the month is supposed to get together and talk about our responsibilities/patient assignments.  Thankfully I'm on a team with Will Fuller, someone I'm already pretty good friends with, and someone who I think has a good deal of clinical experience already.  Our first day of call is Friday, which is crazy. I don't really know what to expect but I'm on short call (til 8 pm) and Will and Stephanie are overnight.  Then on Tuesday is my first overnight call, and I'm the only MSIII on that one.  But hopefully I'll have some idea of what I'm doing by then.

In the pile of other miscellaneous stressors. . . Still waiting for Step I scores.  In theory we're not supposed to even imagine we'll get them til next Wednesday but in actuality I just can't keep myself from checking almost every day.  I alternate between wondering if I failed or aced it.  I know there's no reason to worry at this point, what's done is done, but it would just be so embarrassing not to mention disruptive and horrible to have to quit rotations to study and take it again.  And I'm so far removed I can't even begin to properly speculate (if I ever even could).  Please just tell me I passed, please please.

Also my financial aid is nowhere to be found and my landlord is on vacation and we have to basically do a new lease even though I'm just staying on another year.  Not a huge problem yet, I can make it another month I think but it would be nice to have some money in my hand or at least know that some is headed my way eventually.  Ugh.

I know God knows what he's doing, that he got me this far and that he'll get me through this, and that millions?  at least a whole lot of people have done this exact same thing before and made it through.  I know that I signed up for this and this is what I want to do for the rest of my life, and there's so many people who want so badly to be in my position right now.  But it's just so scary.

I was trying to calm myself down on my way to the orientation this morning, walking across campus in my white coat, planning on getting there 15 minutes early so there's no way I can be late.  A guy stopped and asked me for directions and I about had a heart attack.  This is going to be an interesting year.