I switched to General Surgery after a week and a half at Child Psychiatry. For this rotation, I’ll try to give a day-by-day account of how it went down. And I guess I should write that I was assigned to one third year for the whole time. In a sense, I’m discovering what the life of a third-year is like.

Day 1: Didn’t do much today. The third year I was following was assigned to Minor Surgery. So watched as two patients had sebaceous cysts removed from their backs. The cuts were about an inch deep (if I remember correctly). Not much blood and since this was a minor procedure, the patient had only local anesthesia and was awake the entire time.

The attending asked the 3rd year to suture one patient using a particular method. He replied that he had never done that before. But that didn’t stop him because the attending explained it and had the student do it anyway. I wondered what the patient was thinking as he heard this conversation.

Makes me wonder if, should I ever need a major hospital stay, I want to be admitted into a teaching hospital.

Day 2: All the third years had lectures this morning. In the afternoon there was clinic. Apparently it was a very busy day with a lot of patients. Before I left, I got to see two patients with either an attending or the 3rd year I am following.

There was one attending with whom I was absolutely impressed with. She is a surgical oncologist and invited me to come see a patient with her because I didn’t seem to have anything to do at the time. The patient was an elderly gentleman who had colon cancer. She had resected the cancerous part and was now suggesting that he undergo chemotherapy. Chemotherapy was suggested to reduce the risk of the cancer recurring.

The man told us that he had fought in three wars, but this situation scared him. I was so impressed with the “bedside manner” of this attending. She took his hand, explained to him the pros and cons, reassured him, answered all his questions, and then told him that the choice was his to make but that she would not care or love him any less whatever he decided. He remarked that he was glad she was his doctor. He kissed her hand. She hugged the patient’s wife. It was clear that she had cultivated an excellent doctor-patient relationship in which the patient and his wife truly trusted and liked their doctor. I even heard the patient say that he and his wife would adopt the attending.

I can only hope that one day I can have that sort of relationship with the people I treat.

Day 3: My third year was post-call today. I came in for pre-rounds at around 6 AM. We went around with the senior resident and everyone presented to her. An hour later we joined 2 attending surgeons and rounded with them. Apparently everyone was a bit high-strung because the attendings were present. I learned that the attendings normally only round on certain days and the rest of the week the residents and medical students present their patients to the senior resident. So there was a little more stress since no one wanted to mess up or not have an answer for either of the attendings.

Still wondering if I will get in the OR before my time here is up. But then again, I wouldn’t be able to do much…

Well I finished my week and a half at Child Psych. In my last post I wrote a bit about that. I miss being there. My last day was Tuesday. So technically, I’ve been on the General Surgery service for three days now. But I didn’t go in on Wednesday (my third year was sick and told me not to go in). So I missed my first day on Gen Surg.

Yesterday I went and sat through an hour lecture by a neurosurgeon on Intracranial Metastatic Disease. I got to be the designated “next” guy — which means I sat with the keyboard and advanced the powerpoint slides for him. So I definitely didn’t want to fall asleep. At this point I still hadn’t met my third year, but I thought he was sitting in the back of the room (there were less than 15 people). He told me to meet him at the conference room for a lecture, but I hadn’t met him before we got started.

After the lecture I met the third year student I would be following for the next week and a half. He took me to the call room where I dropped off my bag and then we headed to the Minor Surgery section.

I saw a two masses removed from two different patients. I think they were sebaceous cysts, both located on the patients’ backs. The cut was pretty deep. From my point of view it looked like they cut down an inch deep.

Honestly, there was none of the excitement one generally ascribes to time spent on the General Surgery service. I have clinic today later at 1 PM, but I doubt I’ll see anything terribly exciting. I hope I get to scrub in on something next week…

*****

Yesterday, after I got home I found an email from one of the editors at Medscape - The Differential. The Differential is a group blog hosted at Medscape. And, I believe, Medscape is a part of WebMD… or closely associated with it?

Anyways, the email was asking if I would be interested in joining the group blog over there. I’ll let you know what happens with that. I’m considering joining if they offer. Although, from the looks of it, the blogs there are not-at-all anonymous. But then again, this blog isn’t very anonymous either…

I stood at the end of the hallway looking out through the large windows. Outside the sky was gray, the blacktop was damp, and the trees were dripping. It was a stark contrast to the interior. Here, where I stood, the walls were brightly colored, cartoonish faces squinted, frowned, and smiled, and random quotes encouraged readers to share and play nice.

Less than ten feet away from me a doctor was interviewing a patient. I’m not sure how the interview went. I wasn’t paying too much attention. I knew of this patient, though. The young pre-teen had been admitted because she had reported thoughts of killing herself. One might think that this bit of information might be betraying the patient’s identity. But sadly, many of the patients I have been seeing in the child psychiatry unit have/had suicidal ideations.

In a place like this, the patient population seems to have more in common with the dreary weather outside than the bright, cheerful surroundings inside. I’ve spent three days on the unit, and it has been — well, shocking. I have found it all quite interesting. I will definitely not cross Psychiatry off my “list.” But if I had to describe what I’ve seen in one word, that word would be “sad.”

When people hear that I am spending time in the Child Psychiatry unit, I often get asked if they patients look different. Maybe they think these patients have “crazy eyes” or some other telltale sign of craziness. If there are, then I certainly don’t know what the signs are. But to me, these patients look like any other child you might find playing in a schoolyard playground. Except that a number of them are very depressed. And they look sad. But if they were happy, I could picture them laughing and hanging from a jungle gym set or fast and high on a swing set. My point is that visually, these kids wouldn’t stand out if you put them in a lineup with other children.

Abuse is common, though. So are hallucinations — if I can call them that. I’m not sure what the doctors are calling them, but a number of the kids report seeing or hearing things others don’t see or hear. I guess the staff will need to determine if they are truly hallucinations. One patient sees demons at night. Another sees ghosts without any limbs. Others hear voices that tell them to hurt themselves or other people.

When I found out I had been assigned to psychiatry, I thought it would be really fun. I imagined having adult patients telling me outlandish stories that would make me laugh. Then I found out I was assigned to Child Psych. Most of the patients I’ve seen here have made me cringe. Their stories are heart wrenching. It was shocking for me to see some of the things I saw. And as far as the cases of abuse, I wondered, what kind of society do we live in that produces children so mentally damaged by physical, sexual, and emotional abuse?

I have about a week and a half left in Child Psych. I’m sure it’ll be memorable.

I’m really happy. The joy is just crazy. It might even be bordering on giddiness. Today I came out of the two and a half weeks of exams. Previously I posted our final exam schedule. All in all, there were thirteen exams spread out over that time period. Three of those were National Boards Subject Exams, two were practical exams (Anatomy and Neuroscience), and the rest were in-house finals.

So tonight I’m just excited to be done with all my exams. Although I’m wondering if tomorrow that excitement will be replaced with dread. Now I will just have to sit and wait for the scores to come back in.

Tomorrow, we have orientation for the final month of Freshman Ward’s Experience. I found out that I got assigned to Psychiatry for my first two weeks and then Surgery for the final two. I think I rated both of these in the top 5 on my list of preferences. I heard that for the end of the freshman year I would want a relatively easy rotation. So, psychiatry was my pick. Surgery was listed in the top 5 just for me to see what its like in the event I may one day choose to pursue it. But now, I’m a little regretful. People (namely, third years) have been telling me that its tiring and the schedule is hectic. And, as a first year, I probably won’t get much out of it anyways.

Anyways, now that finals are over, and I’m back on the wards, I hope I’ll be able to have some time to write a few more posts about how the year went and things like that. Maybe I’ll even post some of the experiences from these next four weeks seeing actual patients.

Okay, so I’m sitting here about to go to sleep when I get this urge to go check out Twitter.com. So its not a short visit. I already have an account there from way back when I was trying to stay updated on something. Anyhow, I decide to set it up so I can use it with my iPhone (yeah, got one 2 weeks ago).

Well now it works with my phone. So I can text a message and it shows up as an update right here on JeffreyMD.com. So next week as I walk into exams, I’ll twitter a little message like “We who are about to die, salute you” or something like that and it will show up on the right sidebar. Ms. Gross, if you’re reading this, you can be happy I did not forget all of my dates and quotes .

Oh, and it shows up on my facebook status too.

We’ll see if I keep this thing goin or not.

But, what I am saying is that this was a big waste of 20 minutes! I should be sleeping now so that I can wake up early and hit the books before I have to drive home (1.25 hours). As usual, the Friday before exams have no scheduled classes. I’m in a wedding this weekend, so I have to pick up my tuxedo.

Busy weekend.

As you can tell by my writing I’m a bit scatter-brained at the moment… Either that or my brain is not functioning properly because I need sleep!

The patient shook his doctor’s hand in gratitude and said, “Since we are the best of friends, I would not want to insult you by offering payment. But I would like for you to know that I had mentioned you in my will.”

“That is very kind of you,” said the doctor emotionally, and then added, “Can I see that prescription I just gave you? I’d like to make a little change…”

Well I finally reached my 101st post. Unfortunately I can’t celebrate. It’s been really busy lately. I know my monthly post rate has plummeted recently. Hopefully that has an inverse relationship with my exam scores?

Anyways, this is the last week of lectures. I can’t believe the year is almost over. That’s right, it’s the last week of lectures for the first year! So right now I should be studying. The next two and a half weeks will be exams. Some quarter finals and a couple in-house cumulative finals and a few standardized exams. We are required to score in at least the 7th percentile in the standardized exams. And last year, for Physiology, that meant a score of approximately 60%.

Wish me luck. Or pray for me. Whichever you believe in. I’ve included a copy of my exam schedule below for any curious onlookers. (A few blocks are highlighted to indicate a recent change in schedule).

Last week, I attended a Memorial Service at my school. The service was held for all those who had donated their bodies for use in the anatomy labs. There were three schools in attendance (Schools of Medicine, Dentistry, and Allied Health).

A couple of musical numbers were performed by students and a handful of students volunteered to speak and express their appreciation. At the end of the ceremony I looked around and saw some wet eyes. It made me realize that donating one’s body is a sacrifice for the loved ones as well. These friends and relatives never got to bury a coffin. And they won’t. In a few weeks we will have our Gross Anatomy final exams and the school will proceed to cremate the bodies.

I’ve heard that some medical schools have ended anatomy dissections. If I remember correctly, UCSF School of Medicine no longer has students dissect in Anatomy lab. They have models that the students can come and look at.

Personally, I have long thought models are the way to go. I think a whole lot of Anatomy lab is wasted trying to pick away fat and and fascia. But once you get through all the fat and fascia, there are benefits to actually finding the Vagus nerve coursing through the thorax, or the recurrent laryngeal nerve coming through the tracheoesophageal groove. It’s not something easily forgotten after dissecting to find those structures.

So to those who have donated your bodies for science, to those who believed in education enough to sign over yourself, to the families who have waited over a year before getting closure in the form of ashes: Thank You.

I’ve been hearing a lot about these quick-stop clinics staffed by nurse practitioners. I hear about them in the news or read about them online. They seem to be on the east coast or midwest. Or maybe I’m just not paying any attention to them here locally.

As someone going into a medical career, this is somewhat discouraging. I don’t see how a family physician can compete against an NP based solely on costs. It seems like the scope of nursing just keeps getting expanded more and more. I’m sure the nurses are elated about this. And their paychecks continue to rise as they get more specialized.

I don’t think we need to go back to the days were the doctors were kings of their wards and nurses stood whenever one came in the room. But I do think that scope of practice of nurses and doctors cannot overlap too much. Because let’s face it, the nurses will always be able to offer their services at lower costs. And, more often than not, they (nurses) have less debt coming out of school.

Amy from RNCentral.com sent me this post titled 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare. It’s a good read discussing the pros and cons of Wal-Mart entering the health service industry by opening up clinics at their stores.

I know it has been a while since I last wrote. Been a bit busy lately. And in my moments of downtime I’ve found myself doing a different type of writing. I’ve been writing some fiction. Mostly because it’s a bit therapeutic. Anyhow, back to Medical School related matters.

On Friday we had two guest lecturers for our two-hour session of a class called Understanding Your Patient. During the first hour, a professor spoke about understanding cultural differences among our patients. He primarily focused on the latino culture because there is a huge hispanic population in the local area. One thing he mentioned is that in general, the hispanic population would put up very little resistance when talking to a physician. But that does not give any indication that they agree with what you are saying to them.

And that is a very important thing. In this class we have discussed the idea of getting a patient to cooperate and accept the treatment plan. And this applies to everyone, not just the latino community. In order to have the best results, doctors must team up with the patient for a common goal. The idea of white-coat-wearing-doctor dishing out his wisdom on health and a patient obediently following instructions is outdated and just doesn’t work.

During the second hour he gave the time to a local Mexican woman who talked to us about various herbal and traditional remedies the Mexican people use. She told us that many times they turn to those first, because going to see a doctor is just too expensive. She also brought samples of the things she talked about.

I learned that they use a camomile and spearmint tea for a of different things. She shared remedies for many common ailments. There is one treatment, for headaches, that I plan to try. It involves soaking a pinto bean in rubbing alcohol. In the event a headache, the bean is placed on the temples. Supposedly this relieves the pain. I’m quite interested in trying it out. Cause every once in a while, when I don’t drink enough water, I get some pretty annoying headaches.

Anyways, I hope to be able to post with a little more frequency this month.

P.S.
Remember the disclaimer. I’m not offering medical advice on this site. So try that pinto bean thing at your own discretion.