Back in when I did my MICU rotation in August 2011, I had the same three patients throughout the entire month. One was a cirrhotic guy who had a massive GI bleed my second day of MICU but survived and had the best mental status I'd ever seen in any ESLD patient. Another was an alcoholic who literally drank up until she had a massive variceal bleed and ended up in the MICU with end stage liver failure. We ended up making her condition worse by getting her a G-tube (the ascites kept leaking around it) and putting her on colistin when she had a resistent bug growing in her blood (killed her kidneys and put her on CVVHD) The third was a large 400 lb guy who initially presented with a fall, developed a COPD exacerbation and refused BiPAP, ended up getting intubated and developing a buttload of complications like MRSA bacteremia, necrotic bowel s/p exp lap (which, given his girth, did not heal well). The three of them were like seesaws throughout my entire month of MICU. One day, the cirrhotic guy would crump while the others seemed to be headed in the right direction. One day, the alcoholic woman felt well enough to flip everyone off and tolerate trach collar; the following day she had to go back on the vent due to new sepsis. One night my COPD guy accidentally fell out of bed despite being on a vent and hooked up to numerous IVs (we still aren't sure how that happened), dislodging his Hickman and bleeding all over the ground (heparin drip). I had high hopes that one of them would make it out of the MICU before I did, but they were still there on my last day.
My two ESLD patients ended up dying, though the alcoholic woman was at least able to make it out of the hospital to hospice. The COPD guy walked into my clinic today, and to see him awake, walking, and talking was amazing. When I think back to how he was in the MICU, how he required monster doses of sedation (until we discovered Risperdal) to keep him from bucking the vent and reopening the barely-healing wound from his ex lap, how he developed ARF and needed CVVHD (which was, fortunately, temporary), how his abdomen grew a highly resistant bug that later became septic, there were times when we thought he wouldn't make it. He told me himself that he had no memory of those 2-3 months he'd spent in the ICU (probably a good thing), and that he was extremely grateful to be able to walk and talk again (he'd required a trach and PEG). His abdomen has healed, though the granulation tissue still looked a bit friable. I was surprised he hadn't followed up with surgery and told him to call them for an appointment. One of my friends who had him on the floors (when he drank the water used to swab his mouth while still NPO on a PEG tube) called him a giant POS, but I was just happy he survived. Considering all the people I've seen die in the MICU, he was one of the lucky ones.
There
Wednesday, February 22, 2012
Monday, February 20, 2012
Looking Ahead
Wow...it's been a long time since I've written on this blog. Kind of sad, considering how from age 11 to 22 I wrote (yes, WROTE, not typed) journal entries almost every day detailing life from elementary school through college. In med school I switched from writing to blogging, but my entries throughout residency have been minimal at best. Years from now, I'm going to go through my old journal entries and lament that I barely have any entries documenting my residency years. Part of it was that I was afraid that anything I put on here would become a HIPAA violation, especially now that I was a practicing physician. I may try to write a bit more later on.
The biggest thing I had to deal with last summer was not matching into heme-onc fellowship and wondering what my next path would be. The question I had to ask myself was, "How much do I want to be an oncologist?" I had always been interested in oncology even as an undergrad (cell/molecular bio major learning about carcinogenesis, targeted gene therapies, etc.), but my reasons became more personal in med school. My mother was diagnosed with breast cancer during my first year of med school (few people knew outside of my family, as we wanted to keep it private, but she has now been in remission for 5+ years) I also remembered telling my orchestra director several days before she died of colon cancer that someday I hoped to be an oncologist and help people like her. I had high hopes for myself, thinking that my background and personal experiences would help me get into a heme/onc fellowship. Finding out I didn't match was a huge slap in the face (or, as I told my friends later on, a big fat "F*** you."), and I wondered what went wrong. My reaction on Match Day was not normal either; the ones who didn't match pretty much sulked all day; I smiled and looked on the bright side: at least I can move back to Texas! That got me thinking: maybe the people at the programs could tell I didn't want to be on the East Coast bad enough. Maybe my real goal all this time was to come back to Texas. One door closed, but another one opened.
My chief residents still sent me emails whenever they heard of any heme-onc fellowship openings, but by then I'd already decided that I no longer wanted to pursue a fellowship. I'd never been a huge fan of research, and the idea of spending time and money to reapply was something I no longer wanted. And while I personally feel I'm more suited for clinic, I liked the acute care setting better and decided to apply for hospitalist positions in Texas. I worked on my CV, looked up job opportunities on PracticeMatch.com (and browsed through those endless emails from recruiters for opportunities to practice in Texas), then applied to positions that sounded interesting. I ended up getting 3 interviews, 1 in Dallas, 1 in Austin, 1 in Round Rock.
I went to those interviews in early February and immediately noticed how different applying for a position is than applying for residency for fellowship. I didn't have to do anything to sell myself. My first interview in Dallas didn't feel like an interview at all. One of the attendings showed me around the hospital (1000+ beds!), and then we had lunch with the other partners. I asked a lot of questions, but not once did the interviewers (it was very informal) ask me anything about myself. I was prepared to list my strengths and weaknesses, say why I was applying to their program, but instead, they did all the talking. Clearly they needed me more than I needed them. I knew if I went to this program, I'd be expected to work hard.
My interviews in Austin went pretty well. I had a brief info session with the president of the company, then drove to the hospital where they needed to hire more physicians. The schedule here was Monday through Friday with every 3rd weekend on call, but work hours were flexible (you can leave once all your work is done). I also found that I had a good rapport with the attendings there; there was a good vibe amongst us that was reminiscent to what I felt at my Drexel interview 3 years ago (and helped me decide to rank them high on my list). It was in the 60s and beautiful in Austin that day. After my interview I dropped my luggage off at the hotel and then walked around Town Lake (now called Lady Bird Lake). I also got to meet up with Dina for dinner; we went to Uchi, which was AMAZING.
My Round Rock interview also went well. The doctors here have a 12-on 9-off schedule where they only rounded on the first 5 days, did rounds/admissions the weekend, and then only admitted the remaining 5 days. It was an ideal schedule for someone who needed a lot of free time (i.e. family with kids), and I found myself really liking this program as well. It was, however, a smaller program (6 physicians working per day), and I didn't have that same rapport with the attendings that I did in Austin. I liked all three of the programs pretty well, and I dreaded having to make a decision between them if I should get multiple offers (which, of course, was better than having no offer at all!)
Both Austin and Round Rock offered me contracts within a week of my interviews. I was shocked by the fast turnaround; how was it that I failed to impress anyone during my heme-onc interviews, yet with medicine they actually wanted me to work with them? It felt good to be sought after, for once. Deciding between the two programs was a huge challenge because they were so different from each other in terms of workload, salary, and call schedule. In the end, I decided on the program in Austin. They are a well established hospitalist group in Austin and provide care to different hospitals and rehab centers throughout the city. They are looking to hire a total of 5 new doctors this fall; I would be the 4th. And assuming the other new hires are MDs, I would be the first DO in the practice. And for me, that would be a huge accomplishment, showing that DOs can (and should) be able to practice wherever they want, and how they want.
Looking back for the past seven years, I can hardly believe it's finally come to this. My parents had tried their hardest to talk me out of medical school (and TCOM, once they found out it was a DO school and were fed lies about how DOs face great discrimination in the medical field), fearing that I would someday be doomed to practice medicine in a small town because no one would want to hire me. Fortunately I've proved them wrong, and now they couldn't be more proud =) I'm proud to be where I am =)
The biggest thing I had to deal with last summer was not matching into heme-onc fellowship and wondering what my next path would be. The question I had to ask myself was, "How much do I want to be an oncologist?" I had always been interested in oncology even as an undergrad (cell/molecular bio major learning about carcinogenesis, targeted gene therapies, etc.), but my reasons became more personal in med school. My mother was diagnosed with breast cancer during my first year of med school (few people knew outside of my family, as we wanted to keep it private, but she has now been in remission for 5+ years) I also remembered telling my orchestra director several days before she died of colon cancer that someday I hoped to be an oncologist and help people like her. I had high hopes for myself, thinking that my background and personal experiences would help me get into a heme/onc fellowship. Finding out I didn't match was a huge slap in the face (or, as I told my friends later on, a big fat "F*** you."), and I wondered what went wrong. My reaction on Match Day was not normal either; the ones who didn't match pretty much sulked all day; I smiled and looked on the bright side: at least I can move back to Texas! That got me thinking: maybe the people at the programs could tell I didn't want to be on the East Coast bad enough. Maybe my real goal all this time was to come back to Texas. One door closed, but another one opened.
My chief residents still sent me emails whenever they heard of any heme-onc fellowship openings, but by then I'd already decided that I no longer wanted to pursue a fellowship. I'd never been a huge fan of research, and the idea of spending time and money to reapply was something I no longer wanted. And while I personally feel I'm more suited for clinic, I liked the acute care setting better and decided to apply for hospitalist positions in Texas. I worked on my CV, looked up job opportunities on PracticeMatch.com (and browsed through those endless emails from recruiters for opportunities to practice in Texas), then applied to positions that sounded interesting. I ended up getting 3 interviews, 1 in Dallas, 1 in Austin, 1 in Round Rock.
I went to those interviews in early February and immediately noticed how different applying for a position is than applying for residency for fellowship. I didn't have to do anything to sell myself. My first interview in Dallas didn't feel like an interview at all. One of the attendings showed me around the hospital (1000+ beds!), and then we had lunch with the other partners. I asked a lot of questions, but not once did the interviewers (it was very informal) ask me anything about myself. I was prepared to list my strengths and weaknesses, say why I was applying to their program, but instead, they did all the talking. Clearly they needed me more than I needed them. I knew if I went to this program, I'd be expected to work hard.
My interviews in Austin went pretty well. I had a brief info session with the president of the company, then drove to the hospital where they needed to hire more physicians. The schedule here was Monday through Friday with every 3rd weekend on call, but work hours were flexible (you can leave once all your work is done). I also found that I had a good rapport with the attendings there; there was a good vibe amongst us that was reminiscent to what I felt at my Drexel interview 3 years ago (and helped me decide to rank them high on my list). It was in the 60s and beautiful in Austin that day. After my interview I dropped my luggage off at the hotel and then walked around Town Lake (now called Lady Bird Lake). I also got to meet up with Dina for dinner; we went to Uchi, which was AMAZING.
My Round Rock interview also went well. The doctors here have a 12-on 9-off schedule where they only rounded on the first 5 days, did rounds/admissions the weekend, and then only admitted the remaining 5 days. It was an ideal schedule for someone who needed a lot of free time (i.e. family with kids), and I found myself really liking this program as well. It was, however, a smaller program (6 physicians working per day), and I didn't have that same rapport with the attendings that I did in Austin. I liked all three of the programs pretty well, and I dreaded having to make a decision between them if I should get multiple offers (which, of course, was better than having no offer at all!)
Both Austin and Round Rock offered me contracts within a week of my interviews. I was shocked by the fast turnaround; how was it that I failed to impress anyone during my heme-onc interviews, yet with medicine they actually wanted me to work with them? It felt good to be sought after, for once. Deciding between the two programs was a huge challenge because they were so different from each other in terms of workload, salary, and call schedule. In the end, I decided on the program in Austin. They are a well established hospitalist group in Austin and provide care to different hospitals and rehab centers throughout the city. They are looking to hire a total of 5 new doctors this fall; I would be the 4th. And assuming the other new hires are MDs, I would be the first DO in the practice. And for me, that would be a huge accomplishment, showing that DOs can (and should) be able to practice wherever they want, and how they want.
Looking back for the past seven years, I can hardly believe it's finally come to this. My parents had tried their hardest to talk me out of medical school (and TCOM, once they found out it was a DO school and were fed lies about how DOs face great discrimination in the medical field), fearing that I would someday be doomed to practice medicine in a small town because no one would want to hire me. Fortunately I've proved them wrong, and now they couldn't be more proud =) I'm proud to be where I am =)
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