The drive to Tyler yesterday was fairly uneventful. Lisa and I are sharing a cabin while the others get cabins to themselves. On top of that, the UTHSC-Tyler is located on the outskirts of Tyler and literally in the middle of nowhere. It takes 15 minutes to actually drive into the town to get to the nearest grocery store or Chick-fil-A, as well as the UT-Tyler undergraduate campus. We're allowed to join the gym there for $25 so Lisa and I went there to get passes as an incentive to work out during our stay here.
Today was mostly orientation, as we learned MediTech (which was the same EMR used at Methodist so we've all seen it before) and toured the hospital. We also got a respiratory FIT test to make sure our "duckbill" masks were securely over our faces before we could see TB patients later on. They do this by making us wear a hood over our heads and then spraying saccharine into the hood, and if we taste the saccharine, we needed to start over. I tasted saccharine after one squirt. Kate and Amber lasted a bit longer, and Lisa made it all the way to the "walk in place" step before she tasted it. The tester lamented that this was the first time he had four people fail (Danny was late), but the second time around we all passed. After orientation, Jen came over to around dinnertime. Longview's not too far from Tyler so that made the visit possible.
Monday, March 30, 2009
Friday, March 27, 2009
Heme/Onc: Breast Day (Last Day!)
| My last morning at the Center started out slow; I followed Sandy for about two patients before she "disappeared" (took her purse and went somewhere), so Dr. BR suggested that I follow Dr. RY, the breast cancer specialist of the group. I'd been wanting to work with her for sometime but never asked b/c she seemed so busy; Dr. RY is pretty famous in this part of town for her focus on breast cancer and women's health. As it turned out, she was also an excellent teacher and wanted me to learn everything I could about breast cancer in this one day I spent with her. For each breast cancer patient who came in, she asked me to do a breast exam right after she did (with the patient's permission, of course), and each patient was drastically different from the other. One woman had a unilateral mastectomy so I got to feel both the normal breast and the scarred tissue where the other breast used to be. Another woman had bilateral expanders s/p mastectomy on both sides, and those felt pretty firm (though I couldn't find the port where the saline is injected to make the expanders larger). Yet another woman had bilateral implants, and I was immediately stunned by how cool they felt to the touch. I recalled reading an article where a man wrote how he initially freaked out when he found out his girlfriend's breasts "weren't real," and now I understood what he meant. They just don't feel the same. We had one new patient, and Dr. RY spent an entire hour going over her medical history, diagnosis, and treatment options. Her explanations were such that an ordinary woman with no medical training could understand what was going on, so even if this was my first day of the heme-onc rotation and I knew nothing about breast cancer therapy, I could understand the way the drugs worked. The new patient had a rather small cancer that was removed by lumpectomy, but it was also grade II and lymphatic invasion, which is concerning for future recurrence. She was, however, very Type A and did not want chemo if it wasn't necessary (since the tumor had been removed with clean margins), opting for radiation only. Everyone has their own way of doing things. What impressed me the most about Dr. RY was her rapport with her patients. She sees only breast cancer patients (earlier today she and Dr. BR were trying to compare who had "crazier" patients), presumably all female (haven't seen a male breast cancer patient yet), and she builds relationships with them, woman to woman. There was one couple with whom she regularly joined in prayer at the end of the visit, and today she and Joi (her scribe) invited me to join them. The five of us then joined hands as Dr. RY thanked God for blessing our patient with good health, and I admired her for being able to pray with her patients on request. That's not something I myself would be comfortable with. Joi, after learning I played the violin, told me about a concert she attended in which the musician played a harp and described it as some of the most beautiful music she ever heard. I agreed; words can't describe what a harp sounds like when performed well. At the end of the day, I thanked Dr. BR, Dr. RY, and Helena for having me at the Center and they wished me all the best. I was sad to go; everyone at the Center had made me feel welcome, especially Drs. RP, MR, LM, and BR (with whom I probably spent the most time). As for my thoughts toward heme-onc, it really is a fascinating field and I can easily see myself going into heme/onc if not for the fact that I'm not a huge fan of research. We'll see what happens. |
Thursday, March 26, 2009
Heme/Onc: The Crazy Patient
The clinic was strangely empty today b/c there were only 3-4 physicians present at any given time; both NPs were out for the day. I worked with Dr. BR as usual, and when we saw how packed his schedule was, I offered to see some of his patients for him so then he'd only have to do a quickie on them. It worked well enough in the morning; I got to follow up on a lady I saw two weeks ago who went gambling in Oklahoma despite having a low white count (that wasn't about to stop her, and she earned $700) but there were still a few "crazy" patients that we had to see together. At one point Dr. MS (whom I've only seen twice before since I'm never at the Center on Thursdays) told Dr. BR there was someone she wanted him to meet, but that "someone" turned out to be one of the crazy patients. "Want to be my boyfriend?" she asked. I was around the corner so I didn't see the look on Dr. BR's face, but nearby the MAs were trying to hide their laughter. "I got a boyfriend," the patient continued. "He's a n*****." 
Now I was the one trying not to laugh as Dr. BR tried to tell her not to use that term (though it's apparently more acceptable if African Americans use that term on each other), and she asked if he was trying to get rid of her. By the time Dr. BR finally got away from that patient, he looked pretty beat up and Dr. MS was laughing. "When you said you wanted me to meet someone, I thought you meant someone young and good looking!" he said. Dr. MS just smiled and said, "I think she's going to transfer her care to you." Hopefully not.
One of the patients we saw was actually a man I saw in Weatherford with Dr. RP weeks ago; I remembered him b/c he and his wife live in Mansfield but were willing to travel a long way to Weatherford just to see Dr. RP. He was in horrible shape; his wife said he'd only had a few cups of jello in the span of one week and was so weak that he could barely lift his head (or himself off the floor when he fell). Fortunately all parties agreed that he needed to be hospitalized immediately and arrangements were made for him to go to Harris. Hopefully the waiting room will be empty so he'll get admitted immediately. I have to admit, I miss ER sometimes.
Dr. BR still had 2 patients to see at 12:15 but sent me upstairs to grab some food. Today's menu was Panera Bread, and as soon as the social worker saw me (she knew I was Dr. BR's student), she asked where Dr. BR was. I said he was still working, and she said that after yesterday's fiasco (we got up to the lounge at 12:45 to find almost no food left), she saved him a plate. I didn't think she needed to worry yet since there was still plenty of food to go around. Scott joked, "Tell Dr. BR he's such a girl, being so high maintenance." I later passed the message along, and Dr. BR retorted that obviously Scott doesn't know what it's like to go hungry since he's gained a lot of weight recently. LOL. That's one thing I love about the dynamic at the Center; everyone jokes around a lot yet gets along well. I don't know how many times Dr. BR has teased the NPs for "being old," since they have children his age, but Dr. LM gets a few insults in now and then as well.
Now I was the one trying not to laugh as Dr. BR tried to tell her not to use that term (though it's apparently more acceptable if African Americans use that term on each other), and she asked if he was trying to get rid of her. By the time Dr. BR finally got away from that patient, he looked pretty beat up and Dr. MS was laughing. "When you said you wanted me to meet someone, I thought you meant someone young and good looking!" he said. Dr. MS just smiled and said, "I think she's going to transfer her care to you." Hopefully not.One of the patients we saw was actually a man I saw in Weatherford with Dr. RP weeks ago; I remembered him b/c he and his wife live in Mansfield but were willing to travel a long way to Weatherford just to see Dr. RP. He was in horrible shape; his wife said he'd only had a few cups of jello in the span of one week and was so weak that he could barely lift his head (or himself off the floor when he fell). Fortunately all parties agreed that he needed to be hospitalized immediately and arrangements were made for him to go to Harris. Hopefully the waiting room will be empty so he'll get admitted immediately. I have to admit, I miss ER sometimes.
Dr. BR still had 2 patients to see at 12:15 but sent me upstairs to grab some food. Today's menu was Panera Bread, and as soon as the social worker saw me (she knew I was Dr. BR's student), she asked where Dr. BR was. I said he was still working, and she said that after yesterday's fiasco (we got up to the lounge at 12:45 to find almost no food left), she saved him a plate. I didn't think she needed to worry yet since there was still plenty of food to go around. Scott joked, "Tell Dr. BR he's such a girl, being so high maintenance." I later passed the message along, and Dr. BR retorted that obviously Scott doesn't know what it's like to go hungry since he's gained a lot of weight recently. LOL. That's one thing I love about the dynamic at the Center; everyone jokes around a lot yet gets along well. I don't know how many times Dr. BR has teased the NPs for "being old," since they have children his age, but Dr. LM gets a few insults in now and then as well.
Wednesday, March 25, 2009
Heme/Onc: Difficult patients
This morning I paired up with Dr. BR, but before we saw any patients I got to listen as Helena and Dr. RY discussed a "horrible" patient who turned up the drip on her Taxol (?) chemo so that she could finish a 3 hr treatment in just 15-30 minutes. "Did she not realize that she could have died from that?" said Dr. RY. Apparently this is not the first time this woman acted up though; there were stories being exchanged about her left and right for a while. We saw our pancreatic cancer lady again (fortunately she didn't bring any vases or flowers; the flowers she gave Dr. BR yesterday have all dried up but are still pretty), and then we got a patient that really made Dr. BR groan.
Mr. C was a 78-year-old former lawyer with head and neck cancer that has metastasized to his facial nerves and given him a right face droop, and one side of his vocal cords is paralyzed so that his speech is really soft and hoarse. Now he has trouble swallowing and will need a PEG tube for nourishment, which he is not too keen about. He and his wife were reportedly "angry" about the delay in treatment that led to his present symptoms when in fact he was the one who wavered between surgery and Cyberknife (he was afraid surgery guaranteed his facial nerve paralysis, and he "fired" the neurosurgeon b/c the neurosurgeon was pushing for surgery), and now he didn't want the PEG tube. He described having a PEG tube like being a "cadaver with blood flowing," which made no sense. Dr. BR patiently explained that many people have continued to lead fulfilling lives s/p PEG tube insertion and that it was not the end of the world. Even after the 20-30 minute discussion, however, the patient wasn't convinced, and his wife later contacted Dr. BJ, his previous oncologist (the former president of the Center who retired earlier this year) "just to talk" about their frustrations. *sigh* It was funny when Dr. BJ forgot which doctors worked which days; he said, "Guess that happens when you don't have a regular schedule." This was, of course, referring to the fact that he was retired, and the other doctors were quick to tell him to leave the workroom (for rubbing it in)
I got to follow Dr. LM in the afternoon and got pimped on CML and even the AML: M3. He asked me what the translocation of AML: M3 (aka APL) was, and thank goodness for Dr. Barone's lectures; I remembered the 15:17. Dr. LM looked impressed and said I was on a roll, and I later shared the story of the 15-17 year old teenager wandering in the "trans" district of some street looking for some DIC and hopping in a black sudan. The stain was "Sudan black" so Helena and Dr. LM didn't get that part at first, but they both got the DIC part down, hehe.
Mr. C was a 78-year-old former lawyer with head and neck cancer that has metastasized to his facial nerves and given him a right face droop, and one side of his vocal cords is paralyzed so that his speech is really soft and hoarse. Now he has trouble swallowing and will need a PEG tube for nourishment, which he is not too keen about. He and his wife were reportedly "angry" about the delay in treatment that led to his present symptoms when in fact he was the one who wavered between surgery and Cyberknife (he was afraid surgery guaranteed his facial nerve paralysis, and he "fired" the neurosurgeon b/c the neurosurgeon was pushing for surgery), and now he didn't want the PEG tube. He described having a PEG tube like being a "cadaver with blood flowing," which made no sense. Dr. BR patiently explained that many people have continued to lead fulfilling lives s/p PEG tube insertion and that it was not the end of the world. Even after the 20-30 minute discussion, however, the patient wasn't convinced, and his wife later contacted Dr. BJ, his previous oncologist (the former president of the Center who retired earlier this year) "just to talk" about their frustrations. *sigh* It was funny when Dr. BJ forgot which doctors worked which days; he said, "Guess that happens when you don't have a regular schedule." This was, of course, referring to the fact that he was retired, and the other doctors were quick to tell him to leave the workroom (for rubbing it in)
I got to follow Dr. LM in the afternoon and got pimped on CML and even the AML: M3. He asked me what the translocation of AML: M3 (aka APL) was, and thank goodness for Dr. Barone's lectures; I remembered the 15:17. Dr. LM looked impressed and said I was on a roll, and I later shared the story of the 15-17 year old teenager wandering in the "trans" district of some street looking for some DIC and hopping in a black sudan. The stain was "Sudan black" so Helena and Dr. LM didn't get that part at first, but they both got the DIC part down, hehe.
Tuesday, March 24, 2009
Heme/Onc: Tumor Board patient
This entire week I'm at the Center downtown, and I spent yesterday and today working with Dr. MR. He's one of the heme/oncs who seems to like having a student around b/c he can teach while we're in the patient's room. Sometimes, however, he talks as though the patient isn't there and uses a lot of medical terminology which has the patient feeling (and looking) left-out and confused. With him around, I'm introduced as Dr. ____, which feels anticlimatic b/c in less than 2 months I will be Dr. ____. It's a scary, yet exciting thought. Tumor Board was this morning, and as expected, Dr. MR had me present our patient from last week. I hit the important points and then asked the other oncologists whether they'd treat my lung cancer patient, who is not a surgical candidate, with radiation only or radiation plus chemo. His mets were in three isolated regions, so they COULD be hit by radiation only, but the chances of micrometastases was also high. Ultimately, the doctors thought that a combination of both chemo and radiation would give the patient the best shot at survival (aside from CAD, he's a pretty healthy 78-year-old). Afterwards Dr. MR said I did a good job in presenting our patient, and I was happy to hear it. Now if only Dr. RP could have seen me; that could have helped my grade. But he'll learn about it if he asks the other doctors for feedback.
We saw our patient and his (neurotic) wife later this afternoon, and when Dr. MR brought up the topic of chemotherapy, they looked surprised. "We met with Dr. L (the radiation oncologist) earlier this morning, and he didn't say anything about chemotherapy," said the wife. "We thought he only needed radiation." This led to about 5-10 minutes of confusion as Dr. MR tried to explain where we were coming from while the wife was indignant over hearing two different things from two doctors. "I don't think we should have chemo," the wife said, and Dr. MR, obviously wanting to avoid an argument, said that we could try radiation first and if that doesn't work, then consider the chemo. The wife seemed satisfied with this, and so did the patient. But when they left, Dr. MR shook his head. We had another patient come in whose wife was in late-stage dementia, and Dr. MR commented that he would rather be dead than in that state. Not the first time I've heard comments like that from doctors.
I told Dr. MR that I'd matched in Philadelphia. He didn't respond to the name "Drexel" but as soon as I said "Hahnemann University Hospital" he knew exactly which program I was talking about (HUH didn't merge with Drexel until a few years ago). "That's an excellent teaching hospital," he said. "You'll learn a lot there." The other doctors overheard us talking about Philadelphia so I told them I matched there, and they offered their congrats. Dr. BR offered to get in touch with some of his friends up there and ask them about places to live in Philly for me, which I thought was nice of him. "City of Brotherly Love," he said. Dr. MR added, "Just be sure you get off at the right stop at the subway," meaning that Philly can be dangerous. Yes, I know.
We saw our patient and his (neurotic) wife later this afternoon, and when Dr. MR brought up the topic of chemotherapy, they looked surprised. "We met with Dr. L (the radiation oncologist) earlier this morning, and he didn't say anything about chemotherapy," said the wife. "We thought he only needed radiation." This led to about 5-10 minutes of confusion as Dr. MR tried to explain where we were coming from while the wife was indignant over hearing two different things from two doctors. "I don't think we should have chemo," the wife said, and Dr. MR, obviously wanting to avoid an argument, said that we could try radiation first and if that doesn't work, then consider the chemo. The wife seemed satisfied with this, and so did the patient. But when they left, Dr. MR shook his head. We had another patient come in whose wife was in late-stage dementia, and Dr. MR commented that he would rather be dead than in that state. Not the first time I've heard comments like that from doctors.
I told Dr. MR that I'd matched in Philadelphia. He didn't respond to the name "Drexel" but as soon as I said "Hahnemann University Hospital" he knew exactly which program I was talking about (HUH didn't merge with Drexel until a few years ago). "That's an excellent teaching hospital," he said. "You'll learn a lot there." The other doctors overheard us talking about Philadelphia so I told them I matched there, and they offered their congrats. Dr. BR offered to get in touch with some of his friends up there and ask them about places to live in Philly for me, which I thought was nice of him. "City of Brotherly Love," he said. Dr. MR added, "Just be sure you get off at the right stop at the subway," meaning that Philly can be dangerous. Yes, I know.
Friday, March 20, 2009
Heme/Onc: After the Match
This morning I brought the TCOM 2009 residency list that Dr. D sent out for Dr. RP to see. He seemed concerned by the low number of IM applicants (about 15), whereas we had about 8 psych and 16 ER, among others. I think our class has a lot of specialty representation this year, including one psych/neuro (Matt) and one FP/psych (unknown). Only Clark matched at JPS for family medicine, which was a big surprise since I know a lot of FP classmates had interviewed there and ranked it pretty high. Dr. RP then voiced his opinion that JPS was not DO friendly. I definitely got that impression from the surgeons, but not so much in FP and ob-gyn. I wouldn't know about psych since I didn't do my rotation there, but Jacob and Aaron matched so there should be less discrimination psych-wise. Dr. RP said that when he first came to work at Harris, the people up there tried everything in their power to get him kicked out b/c he was a DO, never mind that he was a former chief fellow at MD Anderson with excellent credentials. *sigh* I hope I don't have that problem in the future.
The last day at this clinic was fairly uneventful until our last patient was seen (SCLC patient with 3 sons with her; at least she has a good support system) and Dr. RP reminded me that I had to play my violin for the clinic in order to get an A (joking). So I played a few tunes from "Canon in D," "Spring" from Vivaldi's Four Seasons, and "West Side Story." Dr. RP also found some sheet music from "Schindler's List" that I was able to sightread, and he said there was something nice about hearing music live. I think so too =)
After work I stopped by the Poly Clinic to see Dr. RR, my family medicine preceptor who'd written one of my LORs. I hadn't seen him in almost a year, and he looked like he had more white hairs than before, but he recognized me almost immediately. I told him where I matched and he said I deserved to go where I wanted to go. I said, "I have to thank you as well. The school said your letter was the best of the bunch." (which was true). Dr. RR brushed it off, saying that I was a good student who worked hard. He said that when he started his internship at JPS, he was paged almost as soon as he walked into the door b/c his team was on call that night. Wow. I hope my first day of work isn't like that =P
The last day at this clinic was fairly uneventful until our last patient was seen (SCLC patient with 3 sons with her; at least she has a good support system) and Dr. RP reminded me that I had to play my violin for the clinic in order to get an A (joking). So I played a few tunes from "Canon in D," "Spring" from Vivaldi's Four Seasons, and "West Side Story." Dr. RP also found some sheet music from "Schindler's List" that I was able to sightread, and he said there was something nice about hearing music live. I think so too =)
After work I stopped by the Poly Clinic to see Dr. RR, my family medicine preceptor who'd written one of my LORs. I hadn't seen him in almost a year, and he looked like he had more white hairs than before, but he recognized me almost immediately. I told him where I matched and he said I deserved to go where I wanted to go. I said, "I have to thank you as well. The school said your letter was the best of the bunch." (which was true). Dr. RR brushed it off, saying that I was a good student who worked hard. He said that when he started his internship at JPS, he was paged almost as soon as he walked into the door b/c his team was on call that night. Wow. I hope my first day of work isn't like that =P
Thursday, March 19, 2009
Match Day
We were given the opportunity to call the school at 10:40 a.m. today to find out where we matched, but I was determined to do things the old fashioned way and wait until noon to check my match status online. I wanted to see the name of my future residency program with my own eyes; just hearing it over the phone wouldn't be enough to convince me of anything. The morning was pretty slow (at one point we had a 1 hr break between patients) so Dr. RP, Shandy, Martha, and I chatted about places to visit in Colorado (Shandy's going on vacation there in June with her family), music (Dr. RP's mother-in-law teaches piano), and American Idol. I mentioned that I couldn't watch American Idol b/c it makes my ears bleed (the problem with having perfect pitch), and Shandy asked if I played any instrument. I said I played the violin, and she said I should bring it tomorrow and play for everyone. "It'll get you an A if you do," joked Dr. RP, so I agreed. Even if my grade wasn't at stake I would have done it =P
At 11:55 a.m. I checked my email and got the following:
I was not surprised to learn that I'd matched at Drexel; I had my best interviews there and had a pretty good feeling that I'd probably end up at Philadelphia. With that, I told Dr. RP and the others where I got accepted and then called my mom and sister to tell them the news. At first my mom didn't know where Drexel was, but when I said Philadelphia, she said, "Oh! Your dad likes that program, too!" I was relieved that my parents were happy with where I ended up; they've been to Philadelphia before and think it's a nice city to live in.
Dr. RP let me take the rest of the afternoon off so I could meet "the gang" for lunch at Cousin's. Everyone was smiling and happy that this whole waiting game was over. Then of course we went to Blue Mesa to find out where everyone else was going. It was the first time most of our class has been together in over a year, and it didn't matter whether we knew each other well or not, everyone was conversational and asking where each other ended up. Even Dr. D stopped by briefly to offer his congratulations. It was a nice way to celebrate our achievement, and everyone there was smiling and happy. That's all that matters =)
At 11:55 a.m. I checked my email and got the following:
Drexel Univ COM/Hahnemann Univ Hosp-PA
I was not surprised to learn that I'd matched at Drexel; I had my best interviews there and had a pretty good feeling that I'd probably end up at Philadelphia. With that, I told Dr. RP and the others where I got accepted and then called my mom and sister to tell them the news. At first my mom didn't know where Drexel was, but when I said Philadelphia, she said, "Oh! Your dad likes that program, too!" I was relieved that my parents were happy with where I ended up; they've been to Philadelphia before and think it's a nice city to live in.Dr. RP let me take the rest of the afternoon off so I could meet "the gang" for lunch at Cousin's. Everyone was smiling and happy that this whole waiting game was over. Then of course we went to Blue Mesa to find out where everyone else was going. It was the first time most of our class has been together in over a year, and it didn't matter whether we knew each other well or not, everyone was conversational and asking where each other ended up. Even Dr. D stopped by briefly to offer his congratulations. It was a nice way to celebrate our achievement, and everyone there was smiling and happy. That's all that matters =)
Wednesday, March 18, 2009
Heme/Onc: Counting Down
These last two days in FW have passed by pretty quickly. Yesterday during Tumor Board (which was nearly empty b/c half the doctors are out on spring break with their kids) I was asked to give differentials for a man with a "ring-enhancing lesion" in his head, and later one of the doctors suggested that I present a case at Tumor Board next week. Fortunately we came across a case that seems present-worthy: a 78 year old man with resected lung cancer presents with a new mass along his incision site. Also saw my first new breast cancer patient today. The woman was in her mid 50s and had a 6 cm mass in her right breast. To be fair, she never suspected that she had cancer b/c she'd had lipomas in the past and assumed that her breast mass was also a lipoma. It wasn't until a neighbor of hers got diagnosed with breast cancer that she became concerned, but right now, 6 cm is way too large for a lumpectomy. She had two options: mastectomy followed by chemo, or neo-adjuvant chemo in hopes of shrinking the tumor followed by lumpectomy/mastectomy. The patient didn't really understand her treatment options and what the difference between chemo first or second meant, so we referred her to a surgeon to assess the tumor size and see whether s/he is willing to remove the breast or let the oncologists try to shrink the tumor first. Her ER/PR/Her2 results had not come in yet, so the doctor was able to spare her from being overwhelmed with that additional info.
Match Day's tomorrow, and I can't stop wondering where I'm going to end up for the next 3 years or so. Chicago? Denver? Philly? LA? DC? San Antonio? Austin? Cleveland? Lots of choices, and all in different cities so I could end up anywhere. Guess I'll find out tomorrow. In the meantime, this was a video we watched at the office today that made everyone laugh their heads off. And people wonder what we do when we're not working. ;)
Match Day's tomorrow, and I can't stop wondering where I'm going to end up for the next 3 years or so. Chicago? Denver? Philly? LA? DC? San Antonio? Austin? Cleveland? Lots of choices, and all in different cities so I could end up anywhere. Guess I'll find out tomorrow. In the meantime, this was a video we watched at the office today that made everyone laugh their heads off. And people wonder what we do when we're not working. ;)
Monday, March 16, 2009
Heme/Onc: "Black" Monday
What was supposed to be a stressful morning turned out to be pretty good when I got the email saying that I'd matched =) And it looks like all my friends matched, so congratulations to everyone! I'm not going to jump on the bandwagon and post "I matched!" on Facebook, though, because while I'm glad to know I have a position waiting for me, I don't think I'll really be able to be happy and celebrate until I find out where. So I'll save that news for Thursday.
One of the techs made lunch for the entire clinic today, and she really outdid herself and made a true Southern meal: cornbread, chicken dumplings, purple hull peas, and jambalaya. Shandy was shocked when I told her I'd never had purple hull peas before and said she could eat an entire pot of them. I've never been a huge fan of peas, but you know what? These peas were good. Dr. RP commented that I wouldn't be able to get a good Southern meal like this at any of the places I applied to, which is probably true. But it was still delicious.
I saw several familiar faces in the office today. One was a guy with metastatic lung cancer who's almost completely lost his voice due to recurrent laryngeal nerve paralysis. Another was the colon cancer patient who didn't want chemo and ended up in the hospital with a 3 cm cerebellar brain met; interestingly enough, he asked Dr. RP if cancer could ever be cured. Dr. RP said that there were thousands of people doing cancer research every day in hopes of a cure, but afterwards he wondered why this patient would ask such a thing when he didn't want chemo even though it could have cured him (and now it's too late).
One of the techs made lunch for the entire clinic today, and she really outdid herself and made a true Southern meal: cornbread, chicken dumplings, purple hull peas, and jambalaya. Shandy was shocked when I told her I'd never had purple hull peas before and said she could eat an entire pot of them. I've never been a huge fan of peas, but you know what? These peas were good. Dr. RP commented that I wouldn't be able to get a good Southern meal like this at any of the places I applied to, which is probably true. But it was still delicious.
I saw several familiar faces in the office today. One was a guy with metastatic lung cancer who's almost completely lost his voice due to recurrent laryngeal nerve paralysis. Another was the colon cancer patient who didn't want chemo and ended up in the hospital with a 3 cm cerebellar brain met; interestingly enough, he asked Dr. RP if cancer could ever be cured. Dr. RP said that there were thousands of people doing cancer research every day in hopes of a cure, but afterwards he wondered why this patient would ask such a thing when he didn't want chemo even though it could have cured him (and now it's too late).
Saturday, March 14, 2009
Friday, March 13, 2009
Heme/Onc: Bad Medicine
We had one new patient this afternoon: a 44-year-old man with metastatic rectal cancer. He was a "self-referral," which isn't the norm (most new patients are referred by their PCPs or surgeons), but we soon got the whole story. He's originally from Weatherford and was diagnosed with his cancer six weeks ago after experiencing increasing fatigue (among other symptoms), and he was referred to the other cancer center in town (Dr. RP calls them "rivals.") The oncologist he was referred to was relatively young, having finished her fellowship just 2-3 years ago, and she insisted that he get a PET scan in several weeks before seeing her again. Dissatisfied with the slow pace, he went down to MD Anderson for a 2nd opinion, but he didn't like the way he was treated there. And in the meantime, he got no treatment ever since he saw that young oncologist except for the PET scan, and that's a six week delay in treatment. Dr. RP, on the other hand, immediately got the ball rolling and made plans for him to schedule surgery to get a port put in so he could start chemo next week.
I'd read in the PET report that the patient had diffuse mets to the liver, but I had no idea how diffuse until Dr. RP let me palpate his abdomen. His liver was HUGE. It felt so hard that I couldn't tell if I was palpating rib or liver, extending into the LUQ of the abdomen. On top of that, if you ran your finger along the skin above the liver, you could just FEEL the nodular mets on his liver. Amazing. Dr. RP called it a "med student liver" because even a med student could tell that it was abnormal. And his CEA was off the charts: over 22,000 whereas a normal CEA is less than 6. Fortunately the patient was a pretty good sport about the whole thing. He was willing to try chemo if it would give him a shot at living longer, but if there was nothing more to be done, then he was fine with it. He also made no secret of his disgust toward MD Anderson and said that he didn't feel comfortable with his first oncologist, and that's why he brought himself here (where Dr. RP has more experience).
After the patient left and we retired to the physician work room, Dr. RP shook his head. "This is bad medicine," he said. "If he'd seen me six weeks ago, I would have gotten him started on chemo immediately or enrolled him in a clinical trial. Why would you wait to treat someone with metastatic cancer? He probably has WEEKS to live at most now." The scribe asked what the other oncologist was waiting for in delaying treatment, "Someone to tell her what to do?" Again, a jab at her relative inexperience. I asked if the patient's family could file a suit against the other oncologist for delaying treatment, and Dr. RP said something like that would never make it to court. In his dictation, however, Dr. RP made a point of reporting that the patient did not feel comfortable getting treated at "the other place" and even went to MD Anderson for better care (never mind that he got a DVT during the drive to Houston) when all this time he could have just stayed in town. *sigh* The lesson here: if a patient has advanced cancer, don't hesitate to treat.
I'd read in the PET report that the patient had diffuse mets to the liver, but I had no idea how diffuse until Dr. RP let me palpate his abdomen. His liver was HUGE. It felt so hard that I couldn't tell if I was palpating rib or liver, extending into the LUQ of the abdomen. On top of that, if you ran your finger along the skin above the liver, you could just FEEL the nodular mets on his liver. Amazing. Dr. RP called it a "med student liver" because even a med student could tell that it was abnormal. And his CEA was off the charts: over 22,000 whereas a normal CEA is less than 6. Fortunately the patient was a pretty good sport about the whole thing. He was willing to try chemo if it would give him a shot at living longer, but if there was nothing more to be done, then he was fine with it. He also made no secret of his disgust toward MD Anderson and said that he didn't feel comfortable with his first oncologist, and that's why he brought himself here (where Dr. RP has more experience).
After the patient left and we retired to the physician work room, Dr. RP shook his head. "This is bad medicine," he said. "If he'd seen me six weeks ago, I would have gotten him started on chemo immediately or enrolled him in a clinical trial. Why would you wait to treat someone with metastatic cancer? He probably has WEEKS to live at most now." The scribe asked what the other oncologist was waiting for in delaying treatment, "Someone to tell her what to do?" Again, a jab at her relative inexperience. I asked if the patient's family could file a suit against the other oncologist for delaying treatment, and Dr. RP said something like that would never make it to court. In his dictation, however, Dr. RP made a point of reporting that the patient did not feel comfortable getting treated at "the other place" and even went to MD Anderson for better care (never mind that he got a DVT during the drive to Houston) when all this time he could have just stayed in town. *sigh* The lesson here: if a patient has advanced cancer, don't hesitate to treat.
Thursday, March 12, 2009
Heme/Onc: When Treatment Fails...
It was back to Weatherford today, and one of the patients we saw was the patient who wanted to try oleander extract to improve his chances of survival (from pancreatic cancer). Despite Dr. RP showing him an article showing that phase I trials of oleander had no effect on survival, the patient insisted on trying it, even though it would cost $1300 a month. Dr. RP said it was his choice what he chose to do. We later read online that oleander can be cardiotoxic, and Dr. RP said that if he ends up dying of a heart attack, well, he made his own choice.
We got a call from another patient we saw on Monday, a man with untreated colorectal cancer (his choice) who presented with vision changes and now has big-time nausea and vomiting. We suspected that he had brain mets and Dr. RP made plans to admit him to the hospital. As it turned out, he did have mets to the cerebellum, and Dr. RP later told him (I wasn't there to see it) that if he didn't get radiation treatments to shrink the brain mets, he'd have less than one month to life. Fortunately the patient was willing to give radiation a try.
We also had two separate bladder patients come in for follow-up to learn that their cancer has spread. One man had mets to his adrenal gland; it was inoperable, and 2nd round chemo was his best chance of longer survival. There was no talk of "how much time is left;" his wife was visibly numb and there was no way she was ready to hear how much time her husband had to live. The second patient (also a man) took the news bravely while his wife quietly cried and wiped her eyes. It was probably the worst news you can get. Both men endured aggressive chemotherapy for their bladder cancer in hopes of a cure, and now their disease has metastasized and who knows if 2nd round chemo will work. But the important thing is that they're not giving up yet.
We got a call from another patient we saw on Monday, a man with untreated colorectal cancer (his choice) who presented with vision changes and now has big-time nausea and vomiting. We suspected that he had brain mets and Dr. RP made plans to admit him to the hospital. As it turned out, he did have mets to the cerebellum, and Dr. RP later told him (I wasn't there to see it) that if he didn't get radiation treatments to shrink the brain mets, he'd have less than one month to life. Fortunately the patient was willing to give radiation a try.
We also had two separate bladder patients come in for follow-up to learn that their cancer has spread. One man had mets to his adrenal gland; it was inoperable, and 2nd round chemo was his best chance of longer survival. There was no talk of "how much time is left;" his wife was visibly numb and there was no way she was ready to hear how much time her husband had to live. The second patient (also a man) took the news bravely while his wife quietly cried and wiped her eyes. It was probably the worst news you can get. Both men endured aggressive chemotherapy for their bladder cancer in hopes of a cure, and now their disease has metastasized and who knows if 2nd round chemo will work. But the important thing is that they're not giving up yet.
Wednesday, March 11, 2009
Heme/Onc: Downtown Clinic
During Tumor Board yesterday, one of the oncologists put me on the spot by describing a patient with a history of pancytopenia with an 8:14 translocation, now presenting with fever, diarrhea, and new-onset HTN, and asking me to give a differential diagnosis. Fortunately I remembered that 8:14 = Burkitt's lymphoma (if you recall the trick we learned during path review for Step 1), so my differentials were Burkitt's lymphoma, carcinoid (primary DDx), and pheochromocytoma. More than one oncologist later told me I'd done well, so I'm glad I didn't come off as a total idiot.
When Dr. RP isn't around (he has admin duties when we're downtown) I get bounced around amongst the other attendings, though I'm usually with NP Sandy and Drs BR and LM. A patient we saw last week with a combined lung cancer and mantle cell lymphoma (both very bad cancers to have) also returned with his wife and son; the pathology slides from his previous hospital had not arrived yet. His son (whom Dr. BR described as extremely passive aggressive) then wondered if we should go ahead and redo the biopsy if the slides never arrive. "I mean, maybe they made a mistake. Maybe if you check again, you'll see that there isn't cancer there," he said. We knew he was grasping at any shred of hope that his father didn't have a 1-year death sentence looming over his head, but if we were to rebiopsy his swollen lymph node, we might as well do another thoracentesis to see if he really had lung cancer.
I was with Sandy when I saw a really sad case of a man with small cell lung cancer with "destructive" bony mets to the ribs and pelvis. His wife reported that he hadn't been able to keep anything down for 9 days. 2 weeks ago he was 152 points, but now he weighed only 132. Pretty frightening. Then, right in front of us, he threw up a lime-green puddle on the ground; looked like scrambled eggs and Gatorade. Sandy made arrangements for them to go upstairs and get a fluid infusion, but privately she said that at this stage, the patient would be better off in hospice care. She later talked to the couple about it, and they agreed. *sigh* Really, really sad. Later on I got to interview a new patient with a finding of "elevated platelets" and presented to Dr. LM, one of the hematologists. He said I did a good HPI and said he thinks I'm well prepared for intern year =) Sure hope so; it's always good to be thorough. Dr. LM also likes to pimp so I need to brush up on my anemia workup knowledge.
When Dr. RP isn't around (he has admin duties when we're downtown) I get bounced around amongst the other attendings, though I'm usually with NP Sandy and Drs BR and LM. A patient we saw last week with a combined lung cancer and mantle cell lymphoma (both very bad cancers to have) also returned with his wife and son; the pathology slides from his previous hospital had not arrived yet. His son (whom Dr. BR described as extremely passive aggressive) then wondered if we should go ahead and redo the biopsy if the slides never arrive. "I mean, maybe they made a mistake. Maybe if you check again, you'll see that there isn't cancer there," he said. We knew he was grasping at any shred of hope that his father didn't have a 1-year death sentence looming over his head, but if we were to rebiopsy his swollen lymph node, we might as well do another thoracentesis to see if he really had lung cancer.
I was with Sandy when I saw a really sad case of a man with small cell lung cancer with "destructive" bony mets to the ribs and pelvis. His wife reported that he hadn't been able to keep anything down for 9 days. 2 weeks ago he was 152 points, but now he weighed only 132. Pretty frightening. Then, right in front of us, he threw up a lime-green puddle on the ground; looked like scrambled eggs and Gatorade. Sandy made arrangements for them to go upstairs and get a fluid infusion, but privately she said that at this stage, the patient would be better off in hospice care. She later talked to the couple about it, and they agreed. *sigh* Really, really sad. Later on I got to interview a new patient with a finding of "elevated platelets" and presented to Dr. LM, one of the hematologists. He said I did a good HPI and said he thinks I'm well prepared for intern year =) Sure hope so; it's always good to be thorough. Dr. LM also likes to pimp so I need to brush up on my anemia workup knowledge.
Monday, March 9, 2009
Heme/Onc: When Patients Are Dying
A few interesting cases today. One of our patients complained of having itchy "bug bites" that looked like huge zits and were very vesicular. My first thought was "shingles" but these were scattered on her back and limbs didn't follow a dermatome pattern. Still, I wasn't too far off; Dr. RP said she had disseminated varicella which, if untreated, could be very deadly to an immunocompromised patient. "Looks like chicken pox, right?" he said to me, and I had to tell him that I'd never seen chicken pox before (all the kids these days are vaccinated). Now I know.
Another patient who saw us after lunch the 59 year old lady with Stage IV lung cancer who had come last week to be told that her cancer was progressing. We'd given her a week to decide whether to proceed with chemo or enter hospice care, and she gave her answer: "I don't think I can go through with [chemo]." It was, Dr. RP and I agreed, the best choice for her since she was already weak, frail, and in constant pain from bone mets; the last thing she needed was chemo that may or may not prolong her life and make her suffer. Dr. RP gave the patient a hug before he left the room and told her that it was a pleasure taking care of her these last several months, and she and her son thanked him in return. Interestingly enough, Dr. RP had just showed me an article about how patients perceive abandonment by their physicians towards the end of life, and I was glad that he didn't fit the stereotype of most doctors featured in that article.
Another lung cancer patient came with complaints of chest pain, but went ahead to his chemo treatment. During the treatment, one of the nurses came to us and said, "Did you know he's having a stabbing pain behind his eye?" No, because he didn't tell us about it, and after some discussion Dr. RP called the ER and told them to expect our patient. One of our last patients was a colon cancer patient who refused all chemotherapy and was "letting nature run its course." We were following his CEA (which has risen from 3 to 7 to 24 over time), and when asked how he was doing, his reply: "Terrible." He's been suffering from nausea and vomiting more often than usual, and on top of that he has double vision when he tilts his head a certain way. Two words for that: brain mets.
Dr. RP had a few patients in the hospital that he wasn't about to round on before clinic hours, so we went to the hospital after clinic ended. There were three consults: one for a woman with a large lump in her breast (likely cystic, according to Dr. RP, after he read the oncologist's note), and two for patients with anemia (iron deficiency vs vitamin B12 deficiency vs anemia of chronic disease). Our last patient in the ICU was a 77 year old man who was found to have early renal cell carcinoma AND stage III lung cancer at the same time; he already had a curative kidney resection but his lung cancer was another story. He was hospitalized for pneumonia but his condition has gone downhill ever since, starting with a spontaneous pneumothorax. When we saw him, I thought he looked close to death. His breaths were slow but gasping, his mouth was open, and to me his pinnae looked relaxed. "He looks terrible," said Dr. RP, who was genuinely surprised and upset that this man's condition had worsened so quickly. "I'd hoped to give him at least another year." He then told me that this patient was an Army veteran with the mentality to match; he followed all medical orders given to him (i.e. showed up on time for his treatments, took medications as directed). And now it looked as though he wouldn't survive the night, all because he developed pneumonia. *sigh* Very sad.
Another patient who saw us after lunch the 59 year old lady with Stage IV lung cancer who had come last week to be told that her cancer was progressing. We'd given her a week to decide whether to proceed with chemo or enter hospice care, and she gave her answer: "I don't think I can go through with [chemo]." It was, Dr. RP and I agreed, the best choice for her since she was already weak, frail, and in constant pain from bone mets; the last thing she needed was chemo that may or may not prolong her life and make her suffer. Dr. RP gave the patient a hug before he left the room and told her that it was a pleasure taking care of her these last several months, and she and her son thanked him in return. Interestingly enough, Dr. RP had just showed me an article about how patients perceive abandonment by their physicians towards the end of life, and I was glad that he didn't fit the stereotype of most doctors featured in that article.
Another lung cancer patient came with complaints of chest pain, but went ahead to his chemo treatment. During the treatment, one of the nurses came to us and said, "Did you know he's having a stabbing pain behind his eye?" No, because he didn't tell us about it, and after some discussion Dr. RP called the ER and told them to expect our patient. One of our last patients was a colon cancer patient who refused all chemotherapy and was "letting nature run its course." We were following his CEA (which has risen from 3 to 7 to 24 over time), and when asked how he was doing, his reply: "Terrible." He's been suffering from nausea and vomiting more often than usual, and on top of that he has double vision when he tilts his head a certain way. Two words for that: brain mets.
Dr. RP had a few patients in the hospital that he wasn't about to round on before clinic hours, so we went to the hospital after clinic ended. There were three consults: one for a woman with a large lump in her breast (likely cystic, according to Dr. RP, after he read the oncologist's note), and two for patients with anemia (iron deficiency vs vitamin B12 deficiency vs anemia of chronic disease). Our last patient in the ICU was a 77 year old man who was found to have early renal cell carcinoma AND stage III lung cancer at the same time; he already had a curative kidney resection but his lung cancer was another story. He was hospitalized for pneumonia but his condition has gone downhill ever since, starting with a spontaneous pneumothorax. When we saw him, I thought he looked close to death. His breaths were slow but gasping, his mouth was open, and to me his pinnae looked relaxed. "He looks terrible," said Dr. RP, who was genuinely surprised and upset that this man's condition had worsened so quickly. "I'd hoped to give him at least another year." He then told me that this patient was an Army veteran with the mentality to match; he followed all medical orders given to him (i.e. showed up on time for his treatments, took medications as directed). And now it looked as though he wouldn't survive the night, all because he developed pneumonia. *sigh* Very sad.
Friday, March 6, 2009
Heme/Onc: First Week Overview
So I finished my first week of heme/onc, and so far it seems like a pretty good rotation. I'll definitely learn a lot for sure b/c I'm working with an excellent doctor, Dr. P. He splits his time between the cancer clinics in Weatherford and Fort Worth, and so will I. On Tuesdays we have Tumor Board, where all the hematologists and oncologists in the practice (along with PAs, NPs, and nurses) get together and discuss difficult cases they've seen. I've seen three patients so far that'll be presented at next week's tumor board, and there was one patient with mesothelioma that was presented at the tumor board at Plaza (yes, I attend those as well). I was really sad for the mesothelioma patient; he's not even 50 yet and has a wife and daughter just slightly younger than me, and though he remained calm throughout our discussion, he ended up having to comfort his wife when she started crying. *sigh* Cancer really does destroy lives.
There are all kinds of cancer patients, but a few stand out more than others. One is a 59 year old woman with Stage IV lung cancer with bony mets who was recently told that her cancer was spreading despite aggressive chemo treatment. Another woman, despite being 63, was in complete denial of her diagnosis (renal cell carcinoma) and regressed to a childlike state whenever she answered questions. Her speech would become high-pitched and extremely pressured as she insisted that she was fine, and beside her, her husband couldn't stop smacking his lips. Tardive dyskinesia, anyone? We all agreed she had some serious unresolved psych issues. Yet another patient with pancreatic cancer was insistent on trying an alternative medication called Anvirzel that's derived from the oleander (a poisonous plant) instead of chemo, and despite our telling him that oleander isn't FDA approved and that he shouldn't take it without a physician to monitor his progress, he feels it's his only shot at buying himself more time (he's 75). He then asked why Dr. RP wouldn't monitor his progress, but Dr. RP, being a PhD as well, wouldn't do it b/c there's not enough publications or proof that Anvirzel is truly safe, just a few patient testimonies scattered throughout the internet claiming it works. We'll have to talk to him again next week; I doubt his mind will have changed. And on the other spectrum, I've met some really sweet patients with positive attitudes about staying in remission. And if I could choose the type of cancer to have, I'd definitely choose breast.
There are all kinds of cancer patients, but a few stand out more than others. One is a 59 year old woman with Stage IV lung cancer with bony mets who was recently told that her cancer was spreading despite aggressive chemo treatment. Another woman, despite being 63, was in complete denial of her diagnosis (renal cell carcinoma) and regressed to a childlike state whenever she answered questions. Her speech would become high-pitched and extremely pressured as she insisted that she was fine, and beside her, her husband couldn't stop smacking his lips. Tardive dyskinesia, anyone? We all agreed she had some serious unresolved psych issues. Yet another patient with pancreatic cancer was insistent on trying an alternative medication called Anvirzel that's derived from the oleander (a poisonous plant) instead of chemo, and despite our telling him that oleander isn't FDA approved and that he shouldn't take it without a physician to monitor his progress, he feels it's his only shot at buying himself more time (he's 75). He then asked why Dr. RP wouldn't monitor his progress, but Dr. RP, being a PhD as well, wouldn't do it b/c there's not enough publications or proof that Anvirzel is truly safe, just a few patient testimonies scattered throughout the internet claiming it works. We'll have to talk to him again next week; I doubt his mind will have changed. And on the other spectrum, I've met some really sweet patients with positive attitudes about staying in remission. And if I could choose the type of cancer to have, I'd definitely choose breast.
Sunday, March 1, 2009
A Note to My Readers...
I’m sure those of you who are faithful readers may have noticed that I no longer update every day. At best, I post multiple entries in one day once I feel like getting around to putting them up. To tell the truth, I’ve begun to lose interest in this blog and have thought more than once about “putting the pen down."
Let me explain. Creating this blog was never my idea to begin with. Several friends started blogs at the beginning of third year with the intent of describing what rotations were like so that we could share our experiences throughout the year, and they wanted me to do the same. I was against the idea at first, but in the end I agreed b/c I thought it wouldn’t hurt. I had hoped that our blogs would keep us connected since we wouldn’t see each other much during third year.
In the beginning I really did like the idea of having a blog to share with friends. I enjoyed writing about my rotation experiences at the end of the day and posting them online so my friends, whom I could no longer see on a regular basis, could know what I was doing. But that has changed. Nearly 2 years and over 370 posts later, I am the only one who still writes on a regular basis. The other blogs have pretty much died out except for a few sporadic updates; I rarely even visit those sites anymore because I know they haven’t been updated. This whole blogging business has become way too one-sided for my liking. Unless I see you or chat with you online, I have no idea what you’ve done all year, yet my life is practically an open book. Where’s the fairness in that? That's hardly what you'd call "sharing." Why should you know everything about me when I know so little about you? How about telling me what you’ve been doing for a change? You can easily read my blog and know all about the Geriatrics rotation, but don’t you think I’d be interested in reading someone's perspective about the Pulm rotation at UT-Tyler, considering I’ll be going there in April? It’d be nice to know a little more of what to expect. Looking back, I think I've been way too wordy and generous in my blogging. I'm starting to regret writing about my interview experiences; you know where I interviewed, so if on Match Day I say I got into a program that you never heard of, you’ll know I had to scramble.
I've kept a private journal since I was twelve because I needed a place where I could fully express myself, and I can’t do that here. I’ve already set myself up for potential trouble by using the real names of classmates and the initials of attendings in my posts; anyone who was really bored could find who these people are. I can’t even be too opinionated for fear of offending anyone. I love writing, but lately I’ve been feeling really hindered and even disillusioned when it comes to writing in this blog. The rest of you, for the most part, have stopped updating your blogs, and I see no reason why I shouldn’t do the same. I don't know when I started feeling like this. Residency is looming in the near future, and by then I expect that I’ll have even less time and desire to write about what’s going on.
Still, I don’t like leaving things unfinished, and to be fair I will continue to update my blog until graduation. After that, who knows. I haven’t decided yet. I have no desire to be the next scutmonkey. Should I continue to write, I will not be blogging about my residency experiences on a regular basis, just a few updates now and then to let you know I’m still alive. That is my choice, and I’m standing by it. Thank you for being supportive readers these last 2 years, and I hope that despite this rant, you’ll continue to see this through to the end.
Let me explain. Creating this blog was never my idea to begin with. Several friends started blogs at the beginning of third year with the intent of describing what rotations were like so that we could share our experiences throughout the year, and they wanted me to do the same. I was against the idea at first, but in the end I agreed b/c I thought it wouldn’t hurt. I had hoped that our blogs would keep us connected since we wouldn’t see each other much during third year.
In the beginning I really did like the idea of having a blog to share with friends. I enjoyed writing about my rotation experiences at the end of the day and posting them online so my friends, whom I could no longer see on a regular basis, could know what I was doing. But that has changed. Nearly 2 years and over 370 posts later, I am the only one who still writes on a regular basis. The other blogs have pretty much died out except for a few sporadic updates; I rarely even visit those sites anymore because I know they haven’t been updated. This whole blogging business has become way too one-sided for my liking. Unless I see you or chat with you online, I have no idea what you’ve done all year, yet my life is practically an open book. Where’s the fairness in that? That's hardly what you'd call "sharing." Why should you know everything about me when I know so little about you? How about telling me what you’ve been doing for a change? You can easily read my blog and know all about the Geriatrics rotation, but don’t you think I’d be interested in reading someone's perspective about the Pulm rotation at UT-Tyler, considering I’ll be going there in April? It’d be nice to know a little more of what to expect. Looking back, I think I've been way too wordy and generous in my blogging. I'm starting to regret writing about my interview experiences; you know where I interviewed, so if on Match Day I say I got into a program that you never heard of, you’ll know I had to scramble.
I've kept a private journal since I was twelve because I needed a place where I could fully express myself, and I can’t do that here. I’ve already set myself up for potential trouble by using the real names of classmates and the initials of attendings in my posts; anyone who was really bored could find who these people are. I can’t even be too opinionated for fear of offending anyone. I love writing, but lately I’ve been feeling really hindered and even disillusioned when it comes to writing in this blog. The rest of you, for the most part, have stopped updating your blogs, and I see no reason why I shouldn’t do the same. I don't know when I started feeling like this. Residency is looming in the near future, and by then I expect that I’ll have even less time and desire to write about what’s going on.
Still, I don’t like leaving things unfinished, and to be fair I will continue to update my blog until graduation. After that, who knows. I haven’t decided yet. I have no desire to be the next scutmonkey. Should I continue to write, I will not be blogging about my residency experiences on a regular basis, just a few updates now and then to let you know I’m still alive. That is my choice, and I’m standing by it. Thank you for being supportive readers these last 2 years, and I hope that despite this rant, you’ll continue to see this through to the end.
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