IM Sub-I: Short Call A

This morning I saw three patients (a fourth one was supposed to leave, but she ended up staying because she had "grossly bloody stools" and we wanted to have GI look her over) and had plenty of time to kill before rounds. It turned out morning report was at 8 a.m. instead of the usual 9 a.m., but I missed the memo b/c I wasn't in the computer system (the drawback of being a visiting med student). Erin, one of the chief residents, added me to the list at my request, so next time I won't miss morning report (hopefully). My noncompliant patient was supposed to get an MRI yesterday, but he turned it down for the third time b/c he was claustrophobic and insisted on getting complete sedation before submitting to the MRI. Since his blood cultures were clean and his white count was falling, we decided to forgo the MRI; chances are he doesn't have osteomyelitis. Today was Short Call A, so Greg had to admit 4 patients to our service before noon (and he got all four in before morning report b/c they were "hand-offs.") Tomorrow is Zack's birthday so he asked to take the day off, but then we hit a rut: tomorrow is Short Stay B, when we admit 4 patients in the afternoon, and Yan has clinic in the afternoon, leaving our team without an intern to help admit patients. Zack looked really upset and said he'd cancel his birthday plans, but Greg said no and suggested that Zack find someone to cover for him. That definitely would have sucked if Zack had to come to work tomorrow after making all these plans (family was driving to Texas to see him, apparently), so I hope it worked out. For the rest of the afternoon (until about 3:00 pm) I helped Yan with writing prescriptions and transfer orders, getting to know more about her in the process. We managed to finish early while An and Zack were still working on their patients. One of An's patients, a bipolar guy with DKA, was supposed to go home today, but he didn't want to b/c he didn't feel as though his "psych" issues were treated. We had gotten a psych consult and they'd cleared him for discharge (the only adjustment they made was increasing his Lamictal) and he didn't think that was enough. "How can you discharge me without knowing if the medicine works?" he asked. "I don't like this. I really don't like this. This hospital is gonna get sued." Later on he threatened to commit suicide if he was discharged, and his death would be on his hands, so we had no choice but to let him stay. *sigh* He'd better not pull the same stunt tomorrow; every team caps at 19 patients and we currently have 16. We need to get some of these patients out of the hospital, soon. When I got home, I met Beth, the girl who's renting the room next to mine. She seems pretty nice so far, and I've already said I'd bring back some Odwalla drinks that I can get for free in the physician's dining room for the two of us to enjoy =) Nothing like bonding over drinks =P

IM Sub-I: Still learning

I got to the hospital at 6 a.m. to preround on all my patients. I saved my noncompliant patient for last (after what happened yesterday I was dreading seeing him), but when I went to his room he was in a much better mood. For starters, he's eating the ADA diet like he's supposed to, and his white count went down so the antibiotics are working well for his cellulitis. He was more agreeable to letting me check his wound this morning than yesterday, when he flat-out refused to let me examine him. He said that the reason he was being so stubborn about not getting Accuchecks was because he was afraid of needles (namely, the pain that needles cause) and that no one listened to him when he tried to tell them. We were in the middle of discussing which fruits were good or bad for diabetics to eat when Greg came in. He told the patient that he was doing very well, but that they still had to check his sugars regularly. Well, the patient didn't take that too well and said, "I'm getting angry again." Greg pretended that he had a page and said, "I'll let the two of you to talk." After he left, my patient growled, "He always does that when I try to talk to him. Can I get another doctor?" I said no, explaining that he was assigned to our team and that the doctors meant well and just wanted to help him get better. At any rate, I probably spent 20-30 minutes just talking to him, but I think he needed someone to talk to. He got a psych consult later in the day and was diagnosed with mixed narcissistic and borderline personality disorder. It's easy to see the borderline in him; the way he's nice to me and mean to Greg and Dr. C is a classic example of splitting.

I messed up in my presentation of my cancer patient today; I was going through all the details of how she got diagnosed with gallbladder cancer when Dr. C interrupted and said, "Ok, so she's already been diagnosed? Then just get to the point and say so." Damn. *sigh* Even though I'm a fourth year, I feel somewhat inferior to An b/c she's already been here a month and knows how everything in the hospital works. Not to mention she's on good terms with everyone on the team (especially the guys) and even has their cell phone numbers so that she can call them directly instead of paging them. On top of that, she's the perfect third-year medical student. It's almost like she wants me to look stupid. Of course, maybe I'm just paranoid. >_< Hopefully things will get better; it's only day 3 after all.

IM Sub I: First Call

Today was my first day on call, and despite going to bed at 11:30 pm with the intent to wake up at 6:20 am, I woke up at 5:00 a.m. instead. *sigh* Still not used to this place, I guess. I was assigned two patients to round on this morning: one was a sweet, compliant lady with a lumbar abscess, and another was a disgruntled, non-compliant diabetic with cellulitis. He has refused to eat his diabetic diet and says he just won't eat until he gets a regular diet (even though it's against the law to grant his request), and he flat-out refused to let me examine him. *sigh* He had the exact same cellulitis problem the last time he was here last week (and he'd left AMA); I think everyone on the team is hoping he'll leave AMA again b/c he's flat-out rude to everybody. Heck, I'm dreading having to see him tomorrow. He said he didn't want to see any doctors for the rest of the day, and since I'm not a doctor yet, Greg says it's my job to bargain with him to be compliant (even though he'd refused to sign Greg's contract to "stop being an asshole" earlier). *sigh* Yan said that she never had difficult patients in China, but that's because in Asia, doctors are well respected. My first patient got me out of a lecture on chest xrays; I had to write an acceptance note for an ICU patient coming to our service. A nearby intern was shocked that Greg would give a med student such a complicated case (this guy's been in the hospital for 5 weeks secondary to complications of a perfed bowel), but when she found out I was an AI and not a third year she said that was okay. Then I had a 3 hr break during which I surfed the net, slept, or ate dinner before I got my second admit of the night. This lady had a cholecystectomy for abdominal pain that never resolved and began draining dark bilious fluid, so another hospital did a CT scan and found tumors in her lung. Biopsy revealed metastatic giant cell tumor of the gallbladder, which is VERY rare. I felt so horrible for this woman after I learned her diagnosis; when I was talking to her, she said she'd heard that she had tumors in her liver but didn't know how bad it was. I don't think she was under the impression that this would kill her, and gallbladder cancer is highly fatal =( I was done by 9:00 pm and allowed to leave, but I stuck around until An finished presenting her patient b/c it'd look bad if the AI went home before the med student. I'm supposed to be acting like an intern here, after all.

IM Sub-I: First Day

This morning I reported to the Professional Office Building at the hospital for a quick HIPAA orientation before getting my badge and parking permit. There, I was pleasantly surprised to see Liza, who's doing a cardiology sub-I here. Nice to see a familiar (and friendly) face.

There are five medicine teams, and I was assigned to the Blue Team. The attending is Dr. C; he asked me about my school and where I did my medicine rotations. I met the rest of the team in the ER: Greg, a 2nd year; Zack, a transitional intern; Yan, a medicine intern; and An, a third year who's been on the team for the past month. Later I asked one of the chief residents what was expected of me, and she said that she expects AIs (students doing an acting internship) to step up to the plate and act like interns. In other words, third years would have to answer to me. Good to know. I've been paired with Yan, and after she taught me how to use the computer system, she said I could go to the library and study unless I get paged. Ummm...study what? I didn't exactly bring any prep books with me. Instead I familiarized myself with the two patients I'll be following starting tomorrow. I also explored the hospital and found the medical library, which was located in a different building and is a long walk away from the hospital (via walkways, of course). An saw me wasting time in the foyer and suggested that if I had nothing to do, I should just go home. I called Yan and asked if I could leave (2 hrs early), and she said ok. In those two hours, I drove to the campus and browsed through the Co-op, buying a $5 T-shirt in the process in order to get my ticket validated. There's a parking garage for the Co-op now, which was a good move; the old parking lots were way too small.

Call is q5, and it follows in this sequence: Pre-Call, Call, Post-Call, Short Call A, and Short Call B, before it starts all over again. Short calls take place either from 8-12 or 12-4 pm; i.e. yesterday my team was on Short Call B and picked up 4 pts, including a bounceback. On a call day, shifts are staggered so that one intern comes in the morning and rounds on all the patients, then the other intern comes later at noon. Since I'm with Yan, I'll come early in the morning to help her pre-round. Due to a limited number of overnight call rooms, students don't stay past 10:00 pm; that means An and I can get a decent night's sleep every night. Not that I'm complaining.

Back in Austin

My parents and I drove to Austin yesterday morning to check on the house where I'd be staying for the next four weeks. When we arrived, I was dismayed to see that the house, which was currently undergoing renovation, still had buckets of paint stacked along the walls and no carpet on the floor, just concrete. I did NOT want to spend my first night in Austin alone in a place like that, and fortunately my friends Alyssa and Andrew let me stay at their place. After getting over the initial shock and spending a day in the company of friends, I went back to the house and worked on making it more homey (namely, filling the fridge with food) I start work tomorrow; hopefully I won't be on call on my first day.

Remembering Randy Pausch

Randy Pausch, 1960-2008

For those of you who don't know, this man wrote a book called "The Last Lecture" (which I haven't read yet but plan to once I have time to read for fun) and also gave a really inspirational speech (available on YouTube) on how to live life to the fullest. At the time he gave his last lecture, he'd been diagnosed with metastatic pancreatic cancer and was given 3-6 months to live, and he ended up living for almost a year after his initial diagnosis. He kept a blog on his health and progress, which I'd been following faithfully for about six months. In his entries, he always posted his blood pressure, his creatinine levels (to show how his kidneys were doing), and more importantly, his CA 19-9 count. As the months passed by, his CA 19-9 ranged from about less than 100 to over 1000, but ever the optimist, he said that by the time it was over, his CA 19-9 would probably be close to 4000. I always looked forward to reading his blog, just to know if he was doing all right, but when a month passed without an entry (the last one I read was in June, when he said chemo wasn't working and he was considering other options) I had a nagging fear that his health had taken a downhill turn. =/ His blog has been taken off the internet, but I know I will never forget the things he shared with the rest of the world in the last year of his life. This man really did live life to the fullest, and I hope I can do the same.

COMLEX Step 2 CE: Done

Overall, I thought the COMLEX was a lot easier than the USMLE. Most of the questions were short and fairly straightforward (almost to the point of being ridiculous), and the OMM questions weren't too bad. I don't know if I should be worried that I went through the CE so fast; it took me about 6 hrs to take the COMLEX Step 1 as well. Oh well, it doesn't matter now. Bottom line, I am done! =)

Chew on this...

My mom bought these in Taiwan =) They're not ALL for me, though. My sister gets half, and there'll still be enough left over for me to enjoy for months =D

USMLE Step 2 CK Reflections

*THUD*

That's the sound of my head hitting the table after I finished the USMLE Step 2 late this afternoon. It was a long day. Got to the testing site around 7:45 a.m. (Fallon was already there), didn't enter the actual room with the computers until 8:25. The first few sections were all right; I'd taken a full-length Kaplan test last week so I was able to pace myself and finish each section with at least five minutes to spare for double-checking. Everything went to hell after lunch; one chicken panini sandwich drew all the blood from my brain to my gut so I kept dozing off during the test =/ At one point, I clicked "Take a break" after one section (the good thing is they have breaks after every section) and just leaned back in my chair and closed my eyes for a few minutes. My patience started wearing thin around the 7th section, and I was sooo glad when I finished at around 5:15 pm. These tests are just way too long.

So, what's on USMLE Step 2? Everything. I got a lot of peds and IM, but the rest of it (obgyn, psych, surgery, statistics, trauma) was also fair game. I definitely answered more statistics questions right on this exam than I did on Step 1 (learned my lesson the hard way), so I hope I got some points from there. At any rate, it's done. Now I just need to review some OMM for the COMLEX II.

Balancing Act

Can someone tell me how I'm supposed to do 100+ questions a day, reread review books for Step 2, and work on my personal statement all at the same time?!

On second thought, don't answer that.

One year and counting

Let the dream begin is officially one year old now =) Now, the last promised entry: (yes, it's sappy)

Why did you choose "kawaranaikimochi" as your blog address? Where did it come from, and what does it mean?

Japanese:

Kawaranai mono nado nani hitotsu nakutemo
Kawaranai kimochi nakushita kunai

English:

Even without those permanent things in life
My unchanging feelings will never disappear

I named my blog "Let the dream begin" after my love for Phantom of the Opera; for the address of the blog, I needed something more original that hasn't been used before. After a few tries (my first few choices were rejected b/c someone already took those names), I decided to turn to my favorite anime and manga: Bleach, for inspiration. Anyone knows me also knows that I'm a huge Bleach fan; chances are that during second year, if you could see my computer screen, you'd occasionally see me reading the manga or watching the anime online instead of listening to lecture. It's such a good series; in fact, Bleach is so popular in Japan that a group of people turned the anime into a live musical called "Rock Bleach Musical." Many thought the idea of a Bleach musical was ridiculous, but hey, I love musicals. =) The song above, titled "Kawaranai Kimochi," was performed in the first "Rock Bleach Musical," which was so received that it was followed by five sequels, two of which aired this past spring. I think I'd just started watching the musicals around summer of 2007 (when this blog was created), and because I liked that one song so much, I decided to use it as my blog address.

"Kawaranai Kimochi" can be loosely translated from Japanese to English into "unchanging feelings" or "unchanging emotions," whichever you prefer. It is, first and foremost, a song about friendship. The line above said, "My unchanging feelings will never disappear," which to me is the perfect way of describing friends for life. Just as night turns into morning, friends enter and exit our lives, sometimes never to be seen again. Despite that, I believe that there are some friends who make such a great impact in our lives that even if we don't speak for months or years at a time, they will always be friends because of the memories we share. Another line from "Kawaranai Kimochi:"

These important memories, these important feelings
I don't want to lose them, no matter what my future holds

After this year, we'll all go our separate ways, and it's impossible to say when we'll meet again. Despite that, I still believe that as long as we hold the memories of our friends close to our hearts, then our feelings of friendship will never change. My feelings certainly haven't.

Happy 4th of July!

Let your mind start a journey through a strange new world...

One year ago on this day, I drove down to Corpus Christi for my first rotation of third year: pediatrics. Now that was a memorable rotation. Who can ever forget Cafe Driscoll, hanging out with the Corpus Crew, the death of little AJ (for Elizabeth and me), and riding in the same car as Amy? I entered medical school thinking I was going to be a pediatrician; Driscoll (and also family practice) taught me that as much as I love kids, I don't want to spend the rest of my life treating them. And now, one of the entries I promised:

Where did "Let the dream begin" come from?

Let the dream begin,
Let your darker side give in
To the power of the music that I write...
The power of the music of the night

This is an excerpt from the song "Music of the Night" from Andrew Lloyd Webber's Phantom of the Opera, my long-time favorite musical. I first heard the original Broadway soundtrack in its entirety when I was around 13 or 14, and I totally fell in love with it. Who wouldn't love hearing Raoul sing, "All I Ask of You" to Christine, where he promises to love her and protect her? To this day I still think it's one of the most romantic songs ever. =) I've listened to the soundtrack so many times that I know all the words to almost every song by heart (except for "Masquerade" and "Prima Donna" b/c there's too many people singing in those), and I was so happy when I got to play "Selections from Phantom of the Opera" in high school. I practiced those pieces so much that I can still play them from memory to this day (just not as well as I used to). "Music of the Night" is one of my favorites; it's my ringtone for text messages as well =) Even more importantly, Phantom of the Opera introduced me to the world of musicals in general, and now I love musicals. I got to see Miss Saigon on Broadway and Phantom of the Opera (of course) in college. I want to see Avenue Q this month downtown, but I probably won't b/c of boards. Oh well.

So why "Let the dream begin?" Because when I first started this blog, we were leaving behind the familiar world of classrooms and textbooks for a brand new world of clinical rotations. Here's another excerpt from "Music of the Night:"

Let your mind start a journey through a strange, new world!
Leave all thoughts of the world you knew before!
Let your soul take you where you long to be!
Only then can you belong to me...

Just as the Phantom tries to persuade Christine to leave her old life behind to be with him, we all had to leave a part of ourselves behind when we entered 3rd year and took one step closer to fulfilling our goals of becoming doctors. We can't be those innocent, naive, wide-eyed first and second year students playing doctor in Clin Med anymore. We have to start taking more responsibility because one day, we'll be the ones giving orders and trying to help people other than ourselves. And when we graduate, this will no longer be a dream, but our reality.