Recapping

I know, I know....its been forever. I have tried to sit down and write--several times---but I had so many different things to say and they would have been so many different blog entries. So instead I'm compiling everything into one huge cluster. Its not so different as my life! :)

Interviews: I am done with interviewing! I actually finished a few weeks ago. It was exhausting, but pieces of it was really fun. Here are some memories from that experience:
*I flew 5 different airlines, set foot in 12 different cities in a period of 2 months--all while doing an anatomy and an ED rotation (ok the schedule was flexible---but it still was a rotation!)
* Interviewing with up to 6 different people for fifteen to twenty minutes at a time---which felt more like speed dating than anything.
* Meeting the biggest gunner of each interview, and just hoping their number one didn't match mine.
* Having a residency director respond to my comment that I like classical music (I listen to it when I study) that he doesn't because it makes him feel depressed. And then he mentioned that he is probably just someone who is more apt to feel depressed anyway.
* Being asked where I am going next year aka what is my number one pick---ILLEGAL QUESTION---at several of my interviews and me just smiling away with a big "I dunno response."
* Being asked about 150 times if I had any other questions about the program.

Working in the Peds Ed for the past month has been interesting as well:
* A father knew the first day of his 16yr old daughters last menstrual period.
* The same 16 yr old girl replied to my question about being sexually active (I kicked the dad out by this point) as "Oh, Its been ages since I did that." When? I asked. 3 weeks prior to her dysuria. I didn't realize teenagers had such awful dry spells.
* I walked into the room of a 20something mom bringing her 2 year old son in because of an abscess. He was sucking on a starburst. Only she hadn't unwrapped it for him so he was also chewing on the paper.
*After waiting for 45 minutes to be seen, taking the history and doing the physical of a kiddo with asthma, the mom tells me she really doesn't want to be in the ED anymore. She'd rather just take her kiddo home.
* I have seen more "viral syndrome" URIs (aka colds) than I thought possible while working in the ED.

I've also been working on the yearbook for my medical school class. Its been sorta tiring, but fun to revisit everything we've been through and all the fun times we had. Motivating medical students to do something, though, its a challenge that I didn't appreciate until this task....

I am heading international next week. I will be gone for 6 weeks! I am doing an OB rotation in Nepal---its going to be amazing but I would be lying if I said that I wasn't a bit nervous as well. I hope to write at least one entry while I'm there, but we will see what sort of access to Internet I will have!!

Which means I have to make my rank list. It is due Feb25th. AGHH!

4th year = decision time

We were told that 4th year was the best year of medical school. We were lied to.



Don't get me wrong---I've had a lot of fun this year, and definitely enjoyed not having exams after the end of every rotation. But undoubtedly there is this HUGE pressure to make big decisions---something I've never been fond of.



Flashback to senior year high school----I could not decide where to go to undergrad. So much so, that I almost took a year off in order to prolong the decision making process. What ended up happening? I signed up for the Unv. of Denver on the last day acceptances were due---and secretly hoped my letter got lost in the mail so I'd have to take the year off. Good choice? It took a year before I fell in love with Denver, but once I did, I was so happy I ended up there.



Now to present time. I actually joked a couple days ago how I will be in Nepal (whohoo!) when our ranking list is due. And how Internet may not be so great out there, so maybe I wont get my rank list in and then I'll have to take a year off.



For some reason I'm seeing a pattern.

you know it

You know you're an emergency resident wanna-be when after you run a half marathon and then jump on a plane to get to an interview, your main worry in life is getting a DVT.

thought for the day

A medical students LEAST favorite question in the whole wide world:

"Do you have any questions for me?"

I wonder if I could throw that question back to the director as my question........

My right hook

One would think after my interviews I would have quickly written a response to my last posting, but to be completely honest, my final interview sorta hit me hard and I wasn't quite sure what to think.

My standard question to the directors is "How are the residents evaluated?" Its a an easy way to get the program director to chat away and I can think of a follow up question, or we can move on.

Well at my final interview, I think this program director took this question the wrong way. He gave me the quick run down, told me that I will do just fine in residency, and then quickly shot me a question that to this day I'm still thinking about. He asked me if I beat myself up.

The question seems innocent enough. Just say no and move on. But I paused. Because the truth is---to a point, I do beat myself up. I don't want to say my family was particularly hard on me, but when you grow up with work-alcoholic parents, your options are to rebel and be a slacker or follow in their footsteps. I clearly chose the later.

So after the pause, I attempted to explain this. I fumbled. I came across sounding like I'm super competitive which, I guess I am, but truthfully, I'm only competing against myself. The program director finally saved me and said, "Listen, we all appreciate excellence."

And that's when I shut up.

Interview season!

www.glasbergen.com

This week I start my first rounds of interviews. I had hoped that I could have started the interview process with a program that I wasn't hanging my life on getting into, but that is just how things go.

So in order to put my best foot forward (is it my left or right?) I've been practicing. A LOT.
I've been caught talking about myself while running along the canal. But thinking back to the really weird faces that I passed--- it is possible that I was yelling since I always listen to Boston's "More than a Feeling!" full blast while practicing (and running). It has been my theme song for fourth year---I wrote my entire personal statement while listening to this song over, and over, and over, and over (angela--you know what I'm talking about!).

I found an excellent website with practice questions. So today, on my final day off, I found an awesome coffee shop and tackled them. I was quite surprised to find the potential questions I might get asked:

* Tell me a joke.
* Teach me something non-medical in five minutes.*
* Besides medicine, how else are you intellectual?
* Present to me a patient you seen in the past, as if we were in the clinic.
* Ask yourself a question, and then answer it.

And of course the infamous: do you have any questions for me?

Now maybe these don't seem so bad just reading them over, but imagine if you just introduced yourself and the program director asks (or demands) a joke! I know that my head will go completely blank under the pressure. My plan? I'll just giggle a lot.

*I'm gonna teach that program director how to swim---that'll get him/her out of her comfort zone! I'll just have to bring a small kiddie pool....

Politics

It is election day!! Go vote!

But I have to say neither candidate has a really good handle on the health care issue. And just cuz health care is sorta my life I wanted to bring up some facts that we went over yesterday in class...

Why people go to the ED:
- they have a true emergency
- they are traveling to that city and get sick
- lack of alternative access: uninsured, no PCP appointment available, PCP closed
- societal outcasts: homeless, illegal immigrants,etc
- drug seekers

Average cost of an EM visit: $383
Average cost of a PCP visit: $60
(although this is not comparing apples to apples---most people who visit the ED are generally sicker, although 55% of the 90 million ED visits were deemed unnecessary in 1996)

Number uninsured:
- 47 million uninsured

Who pays for the uninsured?
- The insured. Premiums and such don't just cover the individual needs. We're all paying for everyone to get medical help. The money has to come from some where

Why is this important?
--if the insured are paying for everyone else---wouldn't we all want everyone to be insured and then no one would be paying extra??

Just some food for thought!

My Favorite Day!

It's the most wonderful time of the year!!!

Happy Halloween!

If you're looking for a spoooookkkkyy flick---try The Strangers! Its the scariest thing I've seen in a long while.

Med student informs attendings and isn't beaten down!

Being back in the ED again, and being sincerely happy about it, definitely makes me a bit more confident about the whole EM/Peds thing again--cuz I have to say---there are days that I very much miss the OR. And being on the Peds side for the past few months got me thinking that maybe Peds was more my thing, but after one shift downstairs, I realized my heart is totally into the ED thing too.

I am currently doing my first, and only, away rotation. It is pretty interesting to see how the ED works here compared to back home. Firstly, for all lacerations: the nurses numb up and scrub them out for you. This lets me get other work done like calling surgery or pediatrics, or discharging someone. Secondly, I never have to look up a single number to page someone---I just tell one of the three secretaries that I need to talk to Dr. C and they take care of it---within ten minutes I'm getting paged overhead that he is on the line waiting. Lastly, people here are ridiculously friendly.

Last night I had a sick kiddo. In the ED the main purpose is to decide who is "sick" and who is "not sick." I have to say as a second year I thought everyone was considered "sick"---I mean why else would they have gone to the ED?? Now I think I finally have it down. So this kidddo had a fever of 104, hadn't eaten/drank anything all day, was tachycardic and tachypnic and just looked out of it. I was worried. So we started an IV, got cultures from her urine and blood and gave her Tylenol and Motrin. She perked up after the second bolus and I felt much better. Her urine came back with a UTI and we decided we were gonna send her home, but my attending really wanted me to talk to her pediatrician prior to sending her home. Of course the parents had no idea which Dr. F it was in town (there were 3 by the same last name) so I had to do some serious searching.

Around 10:30pm I was pretty sure that I narrowed it down to the correct doc. I was nervous to page this doc late at night just to do a "let you know" conversation, but it was important. So I dialed away. She responded about 10 minutes later and was amazing. She was completely appreciative that I informed her. I couldn't believe it. I hung up the phone with a smile on my face. And that's when I started thinking---I hadn't called a single consult so far that resulted in someone getting nasty or being rude---people here were happy to help out! What an amazing concept---we were all on the same side --trying to do best by the patient. And that's when I started thinking, maybe I could live here.

tying up the PICU

I finished my rotation and at PICU--- I know I didn't report much on it, ok like nothing really on it, so I am gonna sum it up here!

It was intense. And as a close peds mentor told me---you have to be deranged to like it.
Call me deranged!

Because I liked it enough that I actually applied to a pediatric program. Who woulda thought?!?! I was able to cardiovert a stable arrhythmia twice, I did my first LP on a kid, and I saw more central lines placed that I believe I could now do one on my own. I took care of a ventilated congenital cardiac kiddo---balancing lasix and fluids carefully. I took care of a very sad head bleed teenager---she was in the bed of the truck when it rolled over. I managed a very dehydrated kiddo (sodium=170!) and normalized her sodium carefully. All in all--I learned a ton but I also experienced awful things.

My second to last day we had 3 children die. It was probably one of the worst days of my medical school career. (I had a hanging death of a college student while on trauma which now is in second place) The first death occurred around 9am: it was a previously healthy 6 year old who had a T&A (tonsil and adenoid removal) the previous day. At 4am, mom gave him hydrocodone and by 8am he was blue and not breathing. We coded him for 90 minutes. And just before we were about to call it, someone found a pulse. So we put him on a epinephrine drip to allow mom & dad to say goodbye. It was so sad. By the time it was all settled it was around noon. I grabbed a quick lunch and then was told there was a 2 month old boy coming in coding. He was sleeping on the couch with dad and dad woke up and he wasn't breathing. We coded him for 60 minutes, but he did not make it. The final death was a cardiac kid who went to surgery. I came up from the ED after the 2 month old didn't make it to find out that the cardiac kid died while in surgery.

I pretty much cried all day. But it got me thinking which is "better"---having a sudden situation, where your child passed away suddenly and out of the blue, or having a chronically sick child and them passing away in a high risk situation---aka surgery---but a situation that you believe will save their life. I am not sure which one "wins."