I've only been able to post photos on this site lately - it's just been so hard to find the time to write anything. It is, however, my last weekend call (for this rotation), as I have a golden weekend for my last weekend next week. I've got lots of stuff to catch up on at home, but will try to finish up the whole "choosing my medical specialty" story soon. Enjoy the weekend guys!

Tags: residency

Just need to get to tomorrow. Whew, I am pretty tired.

Tags: residency

I logged 79 work hours last week (from Sunday through Saturday) and I can't remember if I logged all my hours doing dictations at home. I haven't had a day off since I started this rotation last Monday and won't get one until Sunday. I generally get to work by 6am and leave somewhere between 6 and 6:30 at night. And call is from 6am until about noon the following day (which is what I did this weekend).

Logistically, this means I leave before anyone get up up in the morning (while it is still pitch black outside), and get home in time to (hopefully) have dinner with the family, play with the kids for a bit and then help put them to bed. Fortunately, they have been going to bed a little bit later during the summer (closer to 9pm) which leaves me a little bit more time with them in the evenings. Of course, this makes it harder on my husband who has to get them up for school in the morning so that he can make it to work on time (It'd be great to have a nanny and daycare, wouldn't it?). So this means after 9pm, we've got dinnertime clean up, and then whatever dictations I need to do, and then try to get to bed at a reasonable hour so i can be up early in the morning to do it all again. What usually happens though is that I am so exhausted at 9pm, that I fall asleep in the kids room (sometimes I lay on a mat in there when they go to bed) and get up at 2 or 3am, freak out about all the work I have to finish and then stay up until it's time to go back to work.

It's weird how there is this "rule" of working a maximum of 80 hours a week, and then seeing how everyone really has to try hard to stay under these limits (I've definitely gone over before). Overworking is certainly not limited to the field of medicine but I have to say it is much too common for my taste. The other thing I think people don't always recognize is that when I am at work, I am pretty much working the whole time I am there. There really aren't many breaks or periods of downtime unless I consciously remember and force myself to a) eat something or b) sit down and take a break. And that is assuming there is enough lull in the workload to dare try it. My pager always seems to go off the second I walk into a restroom.

Tags: residency

So I'm almost done with my first week of one of the tougher ward months of my intern year, and I am pretty tired. Unfortunately, my first day off won't be until next Sunday (also the first day I will actually be with my kids when they wake up in the morning). Sigh.

Tags: residency

I really enjoyed my general surgery and ob/gyn rotations, as well as my pediatrics rotation. In fact, for the most part (and with the exception of internal medicine), I pretty much liked all of my rotations. Read more

Tags: school, me

Okay, so I am post-call on my very last day of my critical care rotation and wow, was that a crazy month. I was just telling one of my good friends the other day that I don't even think I could describe how busy I have been (both at work and at home) because I don't think anyone would believe me. I know most medical students and residents have had days where you are so busy you forget to do essential things like eat lunch or even go to the bathroom, but I have to say that on this month, that was the norm. I think I was in fluid homeostasis, neither drinking any water nor needing to pee either, which is crazy. I'm trying to hydrate myself now.

I don't know how many of you have experience with buying a property (we don't) but slap that on top of everything that is happening this month, and it's beyond chaos. I started intern year, my husband finished his fellowship (he took three days off - we really needed the money) and started a new job. We're about to close escrow and I haven't even started packing yet. I had to sneak away to the call room for five minutes before evening sign-out so I could call the movers and book a date.

For those of you who are wondering how we could even afford to buy a place, we did the physician home loan program from Bank of America (no/low down, no mortgage insurance fees (at the cost of higher interest), student loans not included in your debt-to-loan ratio). Considering we have a negative net worth of several hundreds of thousands of dollars, it's a miracle that anyone would give us a home loan in this economy.

Anyhow, I'll be starting a much less intense rotation on Monday, although we will be starting what I hope will be the last move we undergo in a long while. Hopefully we can be settled before my next block at the end of August, which will be another chaotic month. Intern count: four weeks down, only 48 more to go.

I'll be back soon to finish writing about choosing my medical specialty. I have to dictate my off-service summaries.

Tags: residency

Okay, so not only did I not get a wink of sleep on my last call night, but I didn't even get to go the call room. Only a few more days until this block is done, and only one more call night on this rotation - hooray! This month has been so crazy.

Tags: residency

Today I left my call only about three to four hours earlier than when I would have normally left for the day on a regular workday. Funny how when you really think about it, post-call days don't really give you that much time to catch up on sleep compared to just working through through the whole day. I'll take what I can get, but it's pretty rough to say the least. Of course, people have been doing this for many years in medicine (why?), so I've really got nothing to complain about, right? It still amazes me that the medical field is such a hypocritical one in that it basically doesn't practice what it preaches. Take care of your health, but don't model after me. If I can contribute anything to the field of medicine as a whole when I am done with this whole process, I hope it will be to be the best physician I can to my patients, AND to change the practice in such a way that it allows for physicians to be human as well. And I won't even go into what I'd like to contribute in terms of my personal life. What a crazy profession.

Tags: residency

Yesterday was my first day off (that wasn't a post-call day) since I started residency, and boy was I ready for a break. Because of the holiday, I was fortunate enough to have two consecutive days off. Unfortunately, I am on call again tomorrow and will likely have at least 6 brand new critical care patients in addition to my own to pre-round on. It's nice to have a break, but it makes it tough to catch up on everything that has happened when you go back to work.

In any case, I am now halfway done with this rotation and after tomorrow's call, I will be more than halfway done with the calls for this month, thank goodness.

Tags: residency

So, to the meat of the matter, and the whole reason why I started this post. How did I end up choosing? Well, I thought about each rotation I had done and eliminated ones that I either didn’t like, or didn’t like enough to make my top five list. Read more

Tags: school, me

So I have been on call twice now since starting residency, and I have to say it's definitely a challenge. In many ways, I think being totally busy all night might actually make it easier than being sporadically busy at times spaced out just so there is no way you can actually get to lie down and rest for a few minutes. I really think that this system has to change - it's really not good for anyone to have sleep-deprived doctors presenting information, placing orders, and signing out critical information to other people. But that's a project that'll have to wait for now.

Now that there is a 30 consecutive hour rule (you technically have to go home after 30 hours), it's probably a lot easier than it could be. But still, the other day I was thinking that in one overnight call, I was putting in 75% of what is considered to be a normal workweek by traditional standards. And while I had similar calls as a medical student, it was never as busy as it is now (the pager never stops these days). It's nearly impossible to keep up, since there are so many people who need you to do something all at the same time.

It really hit me around midnight of my first call (when I had been at work for 18 hours), when I felt like I was still feeling okay, but that I still had twelve more hours to go. I've found that I really start to tire out right around pre-rounding time, when I am supposed to working fast to finish my notes and collect all the tiny bits of information needed to present on rounds. It's particularly difficult since it is often the first time I can sit down (at a computer), and then the fatigue totally hits me.

To put things in perspective, my first month is on a critical care unit. As a med student, we only carried one or two patients on our critical care months, since these patients are often very sick with lots of complicated things going on. Well, talk about abrupt transition. Somehow, between being a medical student and intern (really only a matter of days), the workload progressed from two patients to up to eight or even ten critical care patients, which is definitely a challenge to say the least. I keep going in earlier and earlier to pre-round, since it's becoming harder and harder to get everything done by the time we round in the morning.

Anyhow, I've got a few things to work on before going to bed (there is a lot of logging of patients, procedures, dictating, etc.) so I better stop now. I'll keep trying to post as much as I can (but probably not on call or post-call days).

Tags: residency

This was just a few minutes after we piled into the car after graduation. Kind of how I'll feel post-call. Actually, it's how I feel right now pre-call.

Tags: school, A, M

All work and no play makes graduation a dull day.

Tags: M, me, school

I decided to join his lab and worked part-time in his lab over the next year and a half or so (while I was a full time preclinical student) on a project that involved microarrays and immunohistochemistry. Read more

Tags: school, me

We finally got around to downloading photos off the camera and here's one from graduation a little while ago. It was a long day for everyone, especially the kids. But it's official now. My preschooler called me Dr. Mommy the other day. I don't think I'll ever get used to being called Dr. anything.

Intern year has actually started (orientation at least) and I am on call my very first day and whole first weekend. This is a q4 month, which kind of stinks, so we'll see if I can keep these posts up.

Tags: grandparents, J, A, M, me, school

The obstetrics and gynecology rotation has historically not been very popular at my school, and based on what I have heard from students at other schools, it’s not very popular in general. Read more

Tags: school

Four lovely letters that I read this morning in regards to my USMLE Step 2 CS score. I know it sounds ridiculous to many people when I say I was truly worried about that score - I can think of so many things that I thought I could have done better during that exam. I can now say with a fair amount of confidence that it really must be an easy test to pass, given how I felt about my performance.

Tags: school

This is a serious life-threatening obstetric complication that is believe to be related to pre-eclampsia. It is important to note that this syndrome can sometimes not present until after delivery. The pathophysiology is not well understood but a serious complication is consumption of coagulation factors, which can lead to disseminated intravascular coagulation (DIC). As in pre-eclampsia, the only effective treatment is delivery of the baby.

Hemolytic anemia, Elevated Liver enzymes, Low Platelets

I emailed the Chair of the Department of Surgery. In my email, I wrote about how I was trying to decide what field to go into and that I might be interested in surgery or a surgical field. Fortunately, he was very enthusiastic about medical students who were interested in surgery and agreed to meet with me to discuss options. Read more

Tags: school, me

I thought this month would be rather leisurely. I could take it easy, read some fiction, lounge around reading and listening to my Spanish language CDs. And, of course, finish my research projects. I can't recall the last time I was ever able to just sit back and relax without worrying about the million things we had to do. Hawaii was nice in that we couldn't do any work while we were there, but it was definitely hard work to vacation with the kids.

Is it at all what I thought it would be? Nope. It's going to be a mad dash to the finish line. My husband, who is finishing his fellowship, has been burning the midnight oil every night for the last 5 weeks, and has got three more to go. My orientation for residency starts really soon, and we got a lot of paperwork, busywork, and reading to do beforehand, which I think is kind of a bummer. I mean, can't they just wait until we start? And I'm still trying to work out the whole kindergarten and school district stuff.

It'll be really nice to just start residency, since we could really use the financial support. My brother lamented to me the other day about how he and his wife have to live on one income while she's in business school. I pointed out to him that not only does he make twice as much as my husband does as a fellow, but they don't have children yet and don't live in one of the most expensive cities in the country. We've been living with this modest salary for several years. She'll be done in two. He gets some sympathy, but not much.

In any case, I hope I'll still be able to post and update. I've got more about what field I've picked, as well as some thoughts about my ob/gyn rotation (which I really enjoyed). Hopefully, this chaos will all settle down soon and we can go right back to a nice comfy routine. While I am a resident. Riiiight.

Tags: school, me

Not long ago, I was chatting with a good friend of mine (who is going to be a co-resident with me - hooray!) and we were discussing how these last few weeks are very weird. I commented that I felt like I was going off to war or into hiding or something, and she agreed, saying it was like she was dying. I mean, I am basically trying to squeeze into the next few weeks everything I think I can do before starting residency. Everything I have put off during medical school and when the kids were born - going to the dentist, drycleaning, getting the kitchen knives sharpened (that was a task I've been wanting to do for years), stocking up on food and supplies, and much more. My friend agreed, saying she's been makings lists for others to remember to do when she's not around.

I really hope that we'll be able to retain some semblance of a normal life, since I am pretty much depending on it. There certainly will be our fair share of hospital cafeteria family dinners (or if I can prepare beforehand, picnic dinners on the grass just outside the hospital), but I definitely do want to see my family more than what is anecdotally believed to be the available time for a personal life. I certainly hope it's not worse than my busier rotations in medical school - those were hard to endure for even two months at a time, and I was fortunately able to squeeze in lighter months or even breaks in between.

Needless to say, I'm feeling pretty nervous.

Tags: me, school

Sorry I've been so slow to post lately. I have just been incredibly busy trying to get things squared away before starting intern year in just a few weeks. Plus, there's that small matter of graduation, which I have barely thought about and is just around the corner. Frankly, I'm not much for ceremonies, and I've got so many things going on right now that it is at the bottom of my list of things to worry about. Although I guess I should figure out the whole gown/rehearsal/schedule stuff before I forget.

To make things even more complicated (and what has really been tying up all my time) is that we are now thinking about buying a home. Despite all the media about home prices plummeting, it's a fantastic time for us to consider buying. Around here, homes usually get dozens of bids (and most get more than asking price) but now, there are fewer bidders for the same number of homes, so we have a chance at a reasonable price. And interestingly, home prices have not decreased in this part of California (they just haven't been increasing as much as they usually do). Prices around here are crazy, really crazy. Imagine "crazy" and then at least double that price, maybe triple that price. That's how much you'd pay for an old, dinky house around here. We can't afford a detached, single-family house (and if we don't get in the market soon, we may never be able to), so we are looking at townhomes and condominiums. Is it worth living here? Who knows, but we're at least stuck here for a few more years and it's not smart for us to keep throwing away money into renting (especially if we can try to buy), not to mention take advantage of the tax shelter we'd be getting.

With my older son starting kindergarten next year (we think), we're trying to figure out which school district we'd like to live in so we won't have to move too much and he can make longtime friends. The problem is that the school systems are very complex (not to mention oversubscribed and underfunded) and for the first time, we are actually considering private school as an option (which is totally not something we ever thought we'd do). But I can totally see why people send their kids to private school now. And I'll write more later about all this. I've literally gone from zero to at least 80% in terms of researching homes, schools, and the tax code in the last week. My brains hurts from all the number crunching and decision-making, but I think it'll be worth it. It might be a whirlwind in the next few months, but nothing we're not used to by now. Thank goodness I have these few weeks to work this out.

So between trying to make decisions about schools and whether or not to purchase (we've never owned a property before), there's that other little matter regarding financing. Apparently it is quite difficult to get a loan nowadays (there are unique loans for physicians that we are looking into, but they of course have higher rates), and of course we don't have much equity or fluid assets at the moment. But at least we can probably qualify for a physician loan. Otherwise, how do you tell a bank Um, we don't have much for a down, and we don't have any assets - in fact, we have hundreds of thousands of dollars of school loans, but please loan us several hundreds of thousands of dollars. With this physician loan (low/no down, no PMI, up to $1 million), we will have massive monthly payments for the first little while, but once we build up some equity, we can refinance and bring that down. And if we sit tight and don't move for a few years (which I'd love - student life has resulted in five moves in the last five years, four with at least one child), we'll have a nice springboard to purchase the next home (which would otherwise be impossible).

It's all very crazy right now, and it's going to be even crazier once I start (I'll be sure to post about moving in the middle of my intern year). Nothing has been set in stone yet, but I am chin deep in the middle of the chaos right now and will be sure to update once it's a bit less crazy.

Tags: me, website

If you missed the previous sections, you can read the whole thing here.

Figuring I just needed to dive in and try something, I decided to take a stab (no pun intended) at the world of surgery. As a pre-clinical medical student, I never really heard many positive things about surgery – the field is widely portrayed in a very negative way. Read more

Tags: school, me

Here's the next section I wrote about how I ended up choosing my medical specialty (I'll get to the end soon):

As part of my neuroendocrine research, I learned how to do some stereotactic microsurgery (brain and vascular), which I loved. It was very calming to spend a whole afternoon performing these surgeries, and I really enjoyed trying to come up with ways to improve the procedures and help with recovery of my tiny rodent patients. Read more

Tags: school, me

Last week, I went to the Occupational Health office at the hospital I will be starting at for residency, in order to complete my pre-hire physical (asked my height and weight, checked my vision and blood pressure), and get blood drawn for tuberculosis testing. I called back to see if the results were back so I could have them sign off on my checklist, and this is what happened:

Me: Hi, I wanted to check on my lab results for my new-resident physical and TB lab test.

Nurse: Um, hold on a sec.

Me: Okay.

Nurse: Oh, did the lab call you?

Me: No.

Nurse: Oh, they didn't? Well, we do not have the results of the test because the tube broke. You need to come in and have blood drawn again.

Me: You're kidding me!

Nurse: No, I'm sorry I am not. The lab should have called you. Please come in Monday through Thursday...

Me: (interrupting - hey, I was miffed) You're not open tomorrow?

Nurse: No, please come in Monday through Thursday to have it redrawn.

Me: What time can I come in until?

Nurse: 4:30pm.

Well, I better get going. I'll have to hurry if I want to go stand in line to pick up a new lab slip and then head over to the lab again where I will wait another 30 minutes for an available phlebotomist to draw more blood. Boo. What a wasted afternoon.

Tags: health

Felty syndrome is characterized by the triad of chronic rheumatoid arthritis, splenomegaly, and granulocytopenia. Patients frequently have high titers of rheumatoid factor, and may also have subcutaneous nodules.

Although many patients are asymptomatic, some develop serious and life-threatening infections secondary to granulocytopenia.

I had plans to see if I could take USMLE Step 3 before starting residency. It turns out that you have to have graduated from medical school before registering for the exam. In any case, I guess I will consider taking it during an elective month during intern year, or (preferably not) during a vacation. Too bad, since I was hoping to get it over with as soon as possible (it's taken over two days!).

Tags: school

I started as a math major in college, but switched to neurobiology and behavior in my junior year when I started feeling like I wanted to study something a little more broad, particularly in development and biology. Read more

Tags: school, me

I’ve been meaning to write some more about how I chose my field in medicine, and what residency I’ll be starting in June, but I’ve been a little hesitant to start, since it’s a long story and I don’t think I’ve got enough time or patience to sit down and spend hours and hours writing about it. To solve that problem, I’ve decided to just start writing from the beginning and will continue in installments if I don’t get to finish in one post. Read more

Tags: me, school

Now that I am finished with rotations, I have a fairly flexible schedule. But even though I should feel more relaxed, it almost seems as though I have more to do! I think it has to do with the fact that during rotations, I put off anything that isn't urgent or immediate. That list grows pretty quickly and of course, when I finally address it, it's impossible to manage.

Here's a short list of what I did yesterday:
1. Researched kindergarten options (more to come on this soon). Sounds early right? Believe me, it isn't. It's a very complicated situation in our area.
2. Spoke with a mortgage lender. We're curious to see if we are eligible for any special first-time homebuyer physician loans. This is in part related to #1.
3. Called our local AAA life insurance agent to discuss options and quotes. At my school's financial aid exit interview, I was reminded about the importance of life insurance for those who have children or other dependents. When our first was born, I remember thinking it would probably be a good idea to buy some. Seeing as how I am more than 3 years behind schedule, I figured I should take care of this before I start intern year. Looks like we'll be picking up some term insurance.
4. Shopped for dress shirts and ties for my husband online. Now that he'll be a real attending, he should probably look the part.
5. Made 3 dozen chocolate-chip cookies for my kids' preschool teachers in appreciation for all their hard work this week. It's the NAEYC Week of the Young Child and they've packed the week full of fun activities for the kids. More to come on this soon.
6. Finally finished my intern biography and survey (due today) as well as formatted a photo to send for their files. I have yet to read and sign my contract but I can get to that tomorrow.
7. Updated the website.
8. Purchased some travel insurance (again, through AAA) for our upcoming vacation. I usually don't buy into these things, but with all the airline bankruptcies and the ridiculous policy of specifically not covering strollers and carseats in their usual luggage damage protection, I figured $60 was not a terrible price to pay to make sure we were covered. Schedule delays, lost luggage, and health coverage were included too.
9. Three loads of regular laundry, and then the bath rugs as well (minor potty accident).
10. Collected some outgrown baby and maternity work clothing to pass on to a good friend.

There were a bunch of things I didn't get to yesterday, but are on deck for today:
1. Research, research, research!
2. Read through my residency contract, sign it, and mail it in.
3. Make a huge macaroni casserole for the daycare potluck tomorrow.
4. Organize my school loans (including undergrad) so I know who all my lenders are and what the repayment will be.
5. On a related note, fill out the paperwork to defer my subsidized loans while I am an intern.

There are more, but I should probably stop writing these lists and work on #4 and then start #3 so I can be ready in time for dinner.

Tags: M, school, safety, daycare, travel, website

Temporary blindness in one visual field. Often described as similar to "pulling down of a shade." Seen in TIAs (transient ischemic attacks).

Well, I took USMLE Step 2 CS, and now all I have to do is wait two months to make sure I passed (gosh, I really hope I passed). I think I did. I hope I did, since it'd be pretty awful to have to take that again. But it is hard not to think about all the stuff I forgot to ask or do during the physical exam. Plus I think my encounter notes were messy, which is really weird since I usually have pretty decent handwriting. But the combination of the rushing, and the bad ball point pen on the hard clipboard made for a very uncomfortable writing experience. I should have typed my notes instead. I'm going to try not to think about it until I get my score report (basically a pass/fail statement). Most people pass, which puts the odds in my favor. However, that also means that failing the test would be really horrible.

The morning of the exam, some other medical students and I had a bit of a scare. The testing center was on the 13th floor of a high rise (ominous?) and we waited for a set of elevators that would take us there. After waiting for quite some time, someone suggested we get on one of the limited elevators that only go up to the tenth floor, and then walk the last three. Seemed reasonable enough. right? Well, we got to the tenth floor and walked up the stairs only to find that we were locked in the stairwell. I should have seen it coming, since that has happened to me in the hospital before. In any case, we were eventually "rescued" and made it to the testing center just in time (they would probably have waited, since there were so many of us). They knew the elevator had been acting up, so it wasn't a big deal. But it definitely added another element of excitement and stress to the day!

Tags: school

I am about to go to bed, but I just spent the last hour or so going through the USMLE Step 2 CS website, reading (for the first time) the details about how the exam is going to be given. I probably should have looked at this stuff sooner, but I figured it was going to be the same as the ones we have at school (it pretty much is).

In any case, I am also printing out documents needed for my short trip (scheduling permit, maps, etc.) and just in case, I emailed them to myself. I'd hate to find myself without them the morning of the exam and have no way of getting them again. My email client refreshed and the "new email" notice showed up and I thought to myself Hmm, I wonder who the heck could be emailing me at this hour? It was my own email - duh! I'm such a dork. Anyhow, that probably a good sign that I should go to sleep!

Tags: me, school

I am taking USMLE Step 2 CS next week, which is a full-day clinical exam, where medical students see 12 (I think) standardized patients with a variety of problems and have to take appropriate histories, do focused physical exams, and then write up a note with a plan. We only get 15 minutes to see each patient, and 10 minutes to write (or type) a note. Most physicians get more than 15 minutes to see a new patient, so it's a bit of a time crunch. Also, it's kind of stressful because you know you have to ask certain questions to get credit for the test, and perform certain parts of the physical exam as well. And then the standardized patient also scores your professionalism and demeanor, as well as ability to communicate.

Most students pass the exam, and there has been a lot of talk about how unnecessary this $1000 exam is, if nearly everyone passes it. Some people say it's mostly aimed at the international medical graduates (they have lower passing rates), others say it's just a money-maker. Whatever the reason, it's expensive (it's only offered in certain cities, so most of us have to buy plane tickets, rent a car, and stay at a hotel) and stressful (at least for me - I have a lot of test anxiety).

Now that my critical care month is over, I am supposed to be studying for this exam. However, I've mostly spent the beginning of this week catching up on everything that I put off during last month. And I've got a ton of things to do regarding residency (as well as planning our lives during that busy time). We've got lots of surveys to fill out, schedules to pick - it all seems to be happening so fast! It seems like Match Day wasn't that long ago. I think it's because I haven't really had a chance to relax or reflect over the last few weeks. Between the intense rotation, Match Day, and the funeral I went to, I just haven't had a chance to sit and think or absorb any of the events that have happened.

In any case, I am trying to send in my schedule preferences (it's hard to plan through June of 2009, when no one else has their schedule planned that far in advance). And I have to resist the urge to sort and organize things, so I can sit down and study for this exam. It's been a little while since I've performed all the components of a complete physical exam. I suppose I can deal with the rest after next week, even though I've got tons planned already (research to finish, books to sell, even some much-delayed unpacking). Whew!

Despite the fact that most people pass, I am still pretty nervous about this exam. It is an unrealistic environment. No matter what anyone says, to me it is quite different having a standardized patient vs. a real one. It's hard not to obsess about the points you need to hit or what you might be forgetting when you are with a standardized patient (as well as worrying about whether your hands are cold, if you washed your hands, or if you appropriately draped the patient). I know many excellent students who have made uncharacteristic blunders during similar exams we have here at school. One time, a friend of mine sent a patient home who may have had an ectopic pregnancy (it was the first exam, and she was pretty nervous). Another friend of mine performed a full neurologic exam on someone who came in with respiratory symptoms. I hope my brain can function adequately because I know I'll be nervous and so pretty much all the planning will go out the window and I'll be on auto-pilot (I just hope that auto-pilot is ready!). I guess I better go study!

Tags: me, school

I know it's been a while since I've posted one of these (sorry about that!).

This is classically defined as a fall in systolic blood pressure >10mm Hg on inspiration, which is an exaggeration of the normal response. Classically seen in pericarditis.

Here's a related mnemonic from First Aid:
PERICarditis
Pulsus paradoxus
ECG changes (PR-segment depression in precordial leads, low voltage, diffuse ST segment elevation)
Rub (friction)
Increased JVP
Chest pain

If anyone is interested, USMLE Consult is offering $30 off 3-month subscriptions to Step 1 and Step 2 CK Question Bank and Scorrelators from now until April 30. Enter and activate promo code FCBK$30 at purchase to redeem.


Tags: school

Well, it's official - I matched at my first choice residency program. Matthew helped me open the envelope, which took what seemed like 5 minutes (especially after he dropped it)! I'll be at a great academic center in California.

More details about what I applied into to come very soon, I promise!

Tags: school, me, M

Adding on to a long list of safety concerns regarding products from China, now heparin may have been affected too. I wonder how many more of these news releases it will take before we do something about it? It's terrible how money is often the root of all things corrupt, and healthcare is no exception.

Tags: safety

Interesting, at least in my opinion. Post-call, I had a fat email inbox waiting for me at home, and one of them was a link to the NBME site, where I found out that I passed Step 2 CK. Thank goodness! I have a lot of anxiety when it comes to taking big exams, and this was one of those where you don't walk out of it feeling like you knew for sure if you passed or not. Eight one-hour blocks, with 45 minutes to use as break time between blocks or as a larger lunch break. So if you took 5 minutes between each section, you would have almost used up all your break time (and the clock starts ticking as soon as you finish each section). It was pretty tiring, and by the end of the exam, I was pretty much just clicking answer choices to get them over with (my reading speed had also slowed by the end of the day, so I was more pressed for time in the later blocks). In any case, I am really glad to have that over with. I still have Step 2 CS (the day-long practical exam). And I think Step 3 (during intern year) is taken over two days! With all the test anxiety I get, you'd think I would have picked a profession where you aren't taking major exams every couple of years!

Tags: me

Yesterday, we got an email to tell us whether or not we matched at one of our ranked residency programs. We didn't find out where (that's on Thursday), only if we did (I did). We've gotten a string of emails recently with alarming subjects, like Scramble Advisory (someone probably chuckled to themselves when they sent that one out to thousands of nervous graduating seniors). The "Scramble" is the stressful process you go through if you didn't match at one of your ranked programs, and you essentially try to pick up an unmatched spot, possibly in an entirely different specialty. In any case, lots of people are on edge this week, since we're going to find out where we spend the next several years. I'll keep my fingers crossed.

Two more weeks of critical care and then I am done with rotations! Hooray! Then I have several weeks to finish writing up some research projects I've had on the backburner for quite some time. But at least I'll be on a flexible schedule and won't have to get up at the crack of dawn (at least not until mid-June). Or unless the boys do.

Tags: school

I'm post-call again, but this time I got out at 12:30pm, a big improvement from last time (I realize it's only about 1.5 hours more, but when you are tired, every minute counts). I even had a chance to have lunch with Jason at one of the cafeterias at the medical school, something we hardly ever get to do.

I'm really looking forward to seeing the kids today, since I haven't seen them (awake) since Tuesday night. I did talk to them on the phone last night, which was really cute. When I am a resident, I plan to iChat with them when I am on call, and even have them meet me at the hospital on quiet weekend calls. We can have lunch or dinner or just play in the courtyards. This is all theoretical, of course. I'll find a way to make it work.

Oh, and remember that patient I had to write a transfer summary for on my last call? They weren't transferred on Saturday, and instead moved to the floor only yesterday (and a new transfer summary had to be written). It did make it a bit easier to have done it already, since I could just add an addendum to it, but I would have preferred to have written it after having a reasonable night's rest.

Tags: J, A, school

If I have a free morning, what I really want to do is drop the kids off at daycare and then come home, have a bowl of cereal and maybe fold some laundry while I catch up on months of recorded television shows on our Tivo. Then I might catch up on email, and post something to this site. And then study for a few hours. If I am feeling really indulgent, I could take a nap.

This never happens. I hardly ever have a free morning, for starters. But let's just say it's a rare occasion. Realistically, what happens is I throw in load after load of laundry, letting the clean clothes pile up into baskets in the hallway, and wolf down a bowl of cereal while I try to catch up on my studies. Why not take a break? Well, I've learned that I can pretty much be called at any time during the day because someone has a fever, fell down, or has pinkeye. Especially during the winter months. I can live with unfolded laundry. I will fail my exams (not to mention be a terrible physician) if I don't study.

Prior to any major exam I've taken since the kids were born, someone always gets sick in the few days beforehand. It happened before Step 1 and Step 2, as well as several shelf exams. This is stressful to say the least, but what's it taught me is to try not to procrastinate, especially when it comes to studying.

Tags: health, school

I'm going to refrain from writing too much lest I start ranting about how people have no respect for other people's time. I am post-call today, and did not leave the hospital until 2:11 pm this afternoon, after having to request that I be excused because I was post-call (and over the hour limit). And not before my resident asked that I write a transfer note for a patient being moved tomorrow, and sign out to the resident on the team who would accept the transfer (even though that resident probably wasn't going to be the one accepting the patient tomorrow). Which explains why they haven't paged me back. Anyhow, no respect for time is what I am saying.

I'm mostly annoyed because I have a schedule to follow this afternoon. I was supposed to get home at 12:30pm, take a shower and a quick nap until 1:30pm, after which I'd start prepping a pork roast that takes at 2.5 hours to cook (during which time I would catch up on email and perhaps take another nap), and then go run an errand between 4 and 5pm (a pre-scheduled appointment which also happens to double as a favor for a friend, who is also on a critical care month and is very busy as well).

I've now started the roast, and am now catching up on email and busy work (got a notice to apply to graduate), and I'll take a quick shower before running out the door again at 5pm. No nap. Oh well.

I know I am being overly dramatic, but it's been a rough day. Plus two patients died. So really, I'll stop complaining, because their families have had one of the worst days ever. But I can't help but reiterate the importance of having respect for other people's time.

Tags: school

I've been a bit slow about posting lately - it's sort of chaotic right now. I've mostly just been posting photos of the boys (mainly because I know my mom checks the site every day). J is finishing his last (full) week of call as a fellow (thank goodness), and I am cramming for boards. I do realize that all I need to do is pass, but when you've only got a few hours each night to study (and realize that you are exhausted during those hours), it can be a challenge, especially if you're like me, and hate walking into stuff feeling unprepared. Studying on Sunday nights is particularly difficult after an active weekend with the kids.