More Confused Than Ever

So I'm more confused than ever. Loving Family Medicine. Loving Emergency Medicine. I have no idea what to do. I start my EM rotation next week... so hopefully that will put things into a little better perspective for me.

Here's my PROS/CONS list thus far

EM PROS:
1. Um, everything? It rocks
2. Shift work, flexible schedule, flexibility to pick up more or less shifts.
3. No "practice" to run
4. Fun, amazing, fast paced
5. Diverse pathology
6. No patient follow-up
7. Can move hospitals/cities easily
8. TRAUMA !!!!!
9. Procedures!!!
10. The residency process is awesome

EM CONS:
1. No patient followup... will that bother me eventually??
2. Will I get tired of shiftwork?
3. Possibly more difficult to practice rurally?
4. Only 1 program in the city I live in... so I may need to move... which I REALLY don't want to do.

FM PROS:
1. Diverse pathology
2. Treating all ages, lots of procedures, managing cards, psych, neuro, etc. cases... essentially everything!
3. Can do a general surgery fellowship
4. Continuity of care
5. Day to day life is pretty damn nice
6. Get to do inpatient medicine and be an intensivist
7. Tons of procedures

FM CONS:
1. Responsible for a practice/ difficult to get away, take vacation, etc
2. Might get tired of routine office visits... URIs and UTIs can get boring
3. I don't think I will enjoy the residency process... with tons of months on wards.


Thoughts from Y'all??

Time Flies....

When you are in med school, apparently. I'm officially a 4th year, folks.

Life is good

Perks of rural medicine... Getting greeted with "morning doc!" at the grocery store by people I've treated ♥

The World As I Know It....

Is totally upsidedown. I love EM. I have always loved EM. And its what I want to do. But.... who knew it? I love family medicine just as much. Enough to switch. Or add. I'm not sure. There are apparently 2 Fam Med/EM dual residency programs. One in Louisiana and one in Delaware. Delaware? Ugh. I'm looking into them. I'm so excited! The last 3 weeks have been BLISS! TONS of procedures. Small rural town. Nice people. OMG. I am so excited about work that I hate the weekends. Seriously. I swear.

Best 2 Days Of Med School Thus Far

I almost didn't write about it because I didn't want to jinx myself... but my first two days in family medicine may have been the best 2 days I've had in medicine thus far. In 2 days I saw 60+ patients. No lie. Me and my attending. Fast paced. Rural. Tons of cool stuff to see. I get to see my own patients. No residents. Its awesome.

Side story... I'm seeing a patient in a room, my attending knocks on the door, and he's like "Can you run in those shoes?" We ended up hauling ass across a huge field to the make it to the hospital to catch a baby from a section.

Incidentally, it also doesn't suck that my attending is 32, single, and uber hot.

Second thoughts....

So I'm having MAJOR doubts about moving. Might call the whole thing off. Yes, one neighbor sucks... but I really hate to leave my place. It's perfect y'all. And if you knew how hard it is to find a "perfect" place here. Ugh. Until I sign a lease aren't I legally entitled to my deposit back?


Update! Got my deposit back. Staying put for now.

Things Are Looking Up

I got a new apartment. Which means I'm moving from my lovely, perfect, historic cottage. But which also means there is no more neighbor boy. Which is good. Really good. Sad, however, very sad to leave my place and my other neighbors. And my neighborhood.

Good news is that my new place is pretty kick ass (almost as kick ass as here... but no jacuzzi tub and no gas range... sad face). It is, however almost 3 times the space and architecturally pretty sexy... and only a few blocks away.

Beat that

Got to see a case of Catel Manzke. Only 26 known cases in the world. Which made it a pretty effing cool day, considering my obsession with peds genetics.

Incidentally....

Just 15 more months until I'm a doctor!!!

Heading out...

to rural country for my family medicine clerkship. 50 mile drive each way... but honestly I'm looking forward to it. Coincidentally, its also the same tiny town I've been driving to at nights to work in the ED for fun... so I think I'm going to like it. A little unnerved, however, that my preceptor is younger than I am. Sigh.

PMI WTF

Here's a little convo that took place today between me and my attending in the PICU on rounds today.

Him: Ella, what is the PMI?

Me: The point of maximum impulse?

Him: No

Me: Hmm. The beat of the heart at the apex?

Him: (sigh of frustration) No. Do you even know where it is?

Me: (worried and thinking I'm crazy) I believe that would be the left anterior mid-clavicular line at the fifth intercostal space.

Him: Absolutely not! Ella, you do realize that if you don't know something as elementary as the PMI, BASIC HUMAN ANATOMY (!), that I will have to fail you on this rotation. Its the FOURTH intercostal space!!!!

Me: (gulp holy shit what am I missing????)

Him: Go look it up.

Me: Yes sir.

Him: ( a few minutes later....) Well......? What does it say?

Me: Um, it says the point of maximum impulse is palpated at the left anterior mid-clavicular line at the fifth intercostal space

Him: LET ME SEE THAT!!!

Then, because he was pissed, he pimped me on a bunch of ridiculous shit that nobody in the group knew.

(now to be fair, though the literature does say the 5th intercostal space... I have also seen it as "between the 4th and the 5th")... but for Christ's sake he threatened to fail me over that! And mind you I have no bad history with the guy... it was only my 2nd day working. First day he said "good job"

Decided.

So even though I've known this all along... I'm officially declaring it again. Emergency Medicine is it. It's me. It's final. Its what want more than anything.

Unfortunately, I want to say in the city I'm in just as much as I want to go into EM. If not more. And there is only one program. Which I happen to love.

Not yet sure how that will play out. I'll keep you posted.

I don't agree

So something happened today that pissed me off. And the more I think about it, the more it makes me mad. So I'm all for patient comfort. And I'm all about minimizing disruptions so that patients can sleep. And treating people like people. And doing whatever is necessary to make patients happy. Within reason. Even if it means I'm inconvenienced.

But I'm on Heme/Onc Peds right now. Which of course we have many patients on long term chemotherapy, study regimens, experimental drugs, etc. And a few have simply decided that they don't want to be bothered by medical students. They refuse to let them in their rooms or talk to them or whatever. Even to the point where some patients have put up "no med student" signs. Needless to say, this really bugs the shit out of me.

Why? Lets put aside for a second the UNGODLY amount of money I'm paying in order to be exposed to patients and for clinical learning. But these people came to a TEACHING hospital. Meaning they are getting the benefit of having an entire team mull over their case every day. They get to be in a research hospital where new and better treatments are being investigated. And where they get the benefit of having free treatment in many cases. But when it comes to returning the favor.... by letting others learn to potentially benefit others... they refuse. Stating that it's too bothersome to have multiple people in the room or multiple questions asked every day.

And what really pisses me off is that many attendings simply adhere to these requests and refuse to let us in. Which burns me even more.

On second thought

So I'm liking peds. A lot. Especially peds genetics. Which I have always liked. But until now I hadn't really seriously considered going into peds. I have to admit I'm tempted by the chill lifestyle, the nice people, patients that actually get better, and playing with babies all day.

But today all of that changed.

I saw a 3 year old for worsening asthma. And sick he was. Definitely in respiratory distress. Breathing hard but he wasn't dying in the next 5 minutes. Maybe a couple more days like this and he'd be toast. But not this minute. My attending admitted him and they sent an ambulance for transport. Ok, no big deal.

Let me tell you, folks, you'd have thought that aliens attacked the White House. People in the clinic were excited. Like really excited. Including the attendings. So I asked... "is this considered a lot of excitement for y'all?" To which I was told, "Yeah!!! Thats the most excitement we've had in years."

Hmmm. Maybe it isn't the place for me.

The babies

are making my ovaries do jumping jacks. which is sooooooo not what i need to be thinking about right now.

god. i'm going to be too old for babies soon. ugh.

Foot in Mouth Disease

Friday my attending is taking me to work a juvenile detention center clinic. And today we were discussing logistics. Where to meet, what to bring, etc. And then he said this.

"Just don't wear anything cute or sexy. What you are wearing right now is perfect."

Um?

ADD worse than me....

Holy smokes. So today I was on Peds ID. Which was pretty cool. But my attending, whew. I mean, she is smart. Really smart. But she talks a million miles an hour and is an ADHD mess!

Example one...

She is on phone call A. On a land line.

Her cell rings. She looks at it, hands her cell phone to me, and says "Can you just tell her I'll call her back?"... as if she totally knew the person.

I say "sure", pick up the phone and say to the woman, "Hi this is Dr So-n-so's phone. She asked me to tell you that she'll call you right back. Is that ok?"

Twenty minutes later after she gets off the phone, she looks at me and says "Well? Who was it?"

I'm like "uh, duh, I thought you knew who it was.... duh...."

Happy Place on Earth

Peds. Who knew med school could be... gasp... fun? No one yelling at you or pimping you or making you get to work early and stay late. Excuses are accepted. You can get time off for a wedding. Seriously. I swear.

Started out on NICU which admittedly was a little boring. But then moved to Well-Baby where I got to play with dozens of happy, healthy, newborns. Now I'm on a variety of clinics, including genetics clinic... which is really cool. And next Friday I'm heading out with one of my attendings for a rural juvenile detention center to run a clinic day.

Yay!

WMFS?

This totally non-politically correct conversation took place between me and one of my attendings regarding a patient who was being difficult about a special supplement that she needed for her infant but didn't want to pay literally pennies for.

ME: What was that all about? We're talking about $2.99.

Attending: Oh, she has WMFS syndrome.

ME: WMFS?

Attending: Yeah. "Where's my free shit?" syndrome. Its rampant in these parts if you haven't noticed.

Yes, unfortunately. I've noticed.

Update

So like I said. Last 2 months has been awful. And I don't want to blog about it. I think I'm starting to feel a little better. Maybe. Hopefully.

To catch you up on the med school aspect of my life, Step One is over. Passed. Yay! Currently on my Peds rotation, which is overall a fun and happy place. Got to do some ED work in a rural area with my favorite attending recently, so that was fun.

Lately I have been contemplating life. A lot. I love being in medicine. But that is about the only thing in my life that seems to be good or that makes any sense at all. And sometimes I wonder if its enough.