Me. It's all about me here.

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NY, United States
My name is Daren. I currently attend LECOM in Bradenton, FL. This is currently my 4th year of med school. I created this blog to post my thoughts about medical school. And because I rock. Boom. So please, come make yourself at home and enjoy my musings. If you are easily offended by things (ie sarcasm, being politically incorrect, etc) then I suggest you evacuate the immediate vicinity :)

Monday, July 29, 2013

On Pediatrics

A most wondrous Monday morning to you all. I hope your weekend was relaxing. I hope you had fun. I hope you had something delicious to eat/drink at least twice. Ok whatever....


I'm in somewhat of a foul mood... not sure why. It may have something to do with waking up at 5am. I forgot to change my alarm for this morning (I don't have to be in the hospital til 8:30am) and was rudely awakened. Anyway, I just had my Honey Bunches of Oats (tropical flavors :D) and I'm ok now. I might have to pop a starbucks double shot energy though.... and I really want applewood smoked bacon right now... mmmmmm.....


So I'm gonna write a small spiel about pediatrics. Let me start by saying I love kids. They are hilarious and the funnest little buggers ever. They whine and cry and puke and pee yet if you know how to turn on their brains, they are the best learners out there. They pick up on things you don't even realize. Anyway, I did my peds rotation through Sisters Hospital in NY. It's an outpatient clinic so no cool hospitalizations for me. But the hours aren't bad: essentially 8am-5pm every day on average. I think my Mondays were longer and I had Thursdays off. Which was awesome. The doc was super chill, very old school pediatrician. We saw kids from 2 days old to 22 year olds. He would have you observe the H&P the first week, then after that you do everything, including writing the note. He would watch in the room but essentially let you do it all. Come to the physical, he might listen to the heart and lungs, but again, you do it all. Which I think is the best way to learn. I had a lot of fun on this rotation. We kept busy most of the time but sometimes you get cancellations and you have like a 45 min block of downtime. I used those opportunities to study for the shelf exam. We didn't see anything super crazy. Your typical viral URI's, viral gastroenteritis (we put a lot of people on the BRAT diet), otitis media, scabies, head lice, mono, vaccines, warts, strep throat, and standard checkups/sports physicals. Not bad.

I was surprised I didn't get sick at all during the rotation. I got sick during Ob/gyn though... ugh that's a whole different experience that I don't know if I'll be posting about because my choice of words may cause this blog to become R rated.... anyway, Peds... when kids get sick, treat the parents because a lot of times, kids are sick because they are stressed. Parents: don't stress out your kids to the point where they get sick. Or you may deserve a hearty flogging.













Sunday, July 14, 2013

On Psychiatry

A most invigorating and marvelous morning to all. Actually, it's kinda crappy right now. AC broke yesterday and it's pretty close to 80°F inside. Not appreciating that. Especially since I have to wait until Monday to get it fixed. Ugh. There is no curse in Entish, Elvish, or the tongues of Men bad enough for such treachery.

Those who know me personally know my thoughts on psychiatry. But I am not here to parlay semantics or opinions on the matter. My time in psychiatry was brief, albeit somewhat interesting. I was at Manatee Glens in Bradenton. I found the hours there promising (maybe 10am-1 or 2pm) and I did not have to do much. Ideal. We interviewed new consults in the morning, waited for the attending to show up (chatting with the case manager in the meantime), and did lightning-style rounds with him. And that was pretty much it. No weekends. I was there with some of my classmates, which made being in a nuthouse slightly more tolerable. I did see some pretty cool cases. Disorganized schizo, paranoid schizo, manic depressives, bipolars, depression, etc... I felt bad for these people. Not because much of it was their own doing in poor choices, but because of their utter hopelessness and despair that no medication or counsel can repent. It was profound to see these beings in their state. 

Speaking of psych, is anyone else as sick of hearing about the Zimmerman case as I am? Seriously, whenever something happens that makes the public media, everyone suddenly becomes an expert in the topic and thinks their opinions are law. It's sad, really. Here's a synopsis of the case:
1. We don't know what really happened.
2. People think they know what really happened.
3. Even if people don't know what happened, they convince themselves that certain justices should be taken.
4. #3 is based on pure emotion and bias.
5. People are now flipping out because their opinion on the outcome of the case is not to their liking.
6. People forget that they were not present at the crime scene or the court.
7. Stuff like this happens all the time. Climb out of your baby crib and welcome to the real world.

Anyway, I'm hungry. Enough about psychiatry, petty politics, and social media. Time to make breakfast. Boom.

Saturday, July 6, 2013

On Internal Medicine

Well, a very happy morning to all. I feel pretty great this morning. Woke up at 10am, got some Tropical Honey Bunches of Oats, and now here we are. What's going through my mind right now? How I'm actually in my 4th year of medical school. And how I actually have a weekend off after my first week of audition rotations. Amazing. When I heard about this daunting concept of basically auditioning for a residency, I had no idea what to expect? Do they work you like a resident? Do they expect you to know as much as a resident? Are they going to pimp you incessantly? Do you have to work all weekends and holidays?

Nope. At least, not in this rotation. I actually went and asked the senior fellow (I'm on cardiology at Largo Medical Center) if they wanted any help over the weekend and he said "Dude, let the residents suffer. Go enjoy yourself this weekend." Fine by me haha. I'm really digging this team. The residents, fellows, and attending are really chill and very happy to teach. It's amazing how good coworkers can bring any experience up a few notches.

Anyway, I feel like talking about Internal Medicine. Specifically, my experiences when on the IM service. I did IM mainly at 3 locations: United Memorial Medical Center in Batavia, Sisters of Charity in Buffalo, and Mercy South Buffalo. UMMC is a small hospital and the internists are part of the hospitalist service. So they basically do shifts (7-7). That's pretty cool since you don't have to deal with anything when you're off shift. This was actually one of my favorite rotations because there are no IM residents. You work one on one with the attending and they let you do a lot. They enjoy teaching and are happy to answer whatever questions you might have. It's a small hospital so everyone works in a fairly tight-knit group. Everyone knows one another and people are very friendly. There are PAs who work with the hospitalists and they are so chill. 

SOCH and Mercy are a little different. The hospitals themselves are much larger and there are many more employees. It's not uncommon to find yourself lost in some random hallway you've never been to even after a couple weeks in. There is a residency program at SOCH (both hospitals basically run under SOCH and you apply to residency through SOCH, but you might rotate and do a month or however long at Mercy) and having done rotations there, I must admit the IM program is very good and enticed me for a while. They have regular didactics  and meetings, which are rather annoying, but the actual service is awesome. You have a lot on your plate, with residents taking up to 10 patients each, but it's good training and I feel like many New England residencies are pretty hardcore like that. I think that explains a lot... anyway, I'll describe a typical day in SOCH or Mercy:

We usually arrive around 6am to round on patients. As a student, they let you take up to 3 patients, but I've taken 4 or 5 a number of occasions, especially if you end up with a bunch of boring patients (like asthma exacerbations or cellulitis). I like keeping busy because my brain starts meandering with boring things. So you check up on your peeps and write up the note, then go over your patients with the corresponding resident to make sure your note is hunky dory, then sometimes there is a meeting called morning report, which usually is some sort of case presentation by a resident and/or a lecture on a specific topic by a resident, attending, or student. I'm not a person who gets much out of being talked to or lectured so to me, it's kind of a waste of time. Not to mention a lot of times, morning report is at 7am and come on, who is really going to pay attention when your coffee hasn't even kicked in yet? I digress. If there's no morning report, you do your thing until the attending comes around and starts rounding. Some attendings are great and do table rounds and only do bedside rounds on new patients or if a patient has something interesting to show to the team. Other attendings want to to bedside for every pt on the list and that can sometimes take forever. But, overall, you get a lot of pt interaction and experience taking H&P's. After a while it gets old though. If you ask, you might get the opportunity to do admissions with the residents or attendings in the ER and that's always more fun. I like doing admissions because you actually have to do a full H&P and come up with the diagnosis and plan. Early on in 3rd year, that was difficult because you obviously don't know enough about pt management to come up with a good plan, but you talk to the docs and learn about how to manage pts and soon you get the hang of it. I think probably 2 weeks into my very first rotation (which was UMMC), the attending felt comfortable sending me to the ER to do admissions on my own and discussing the plan with me after I'm done.

You always hear about the deathly hours associated with IM. I feel like most of the time, it's worth it. As an internist (this goes for FP to), you're a jack of all trades. You see the majority of the inpatients. You have to be comfortable in dealing with and treating all kinds of patients, from the young to the old, from a simple cellulitis to a train wreck in the ICU. You're going to deal with malingering drug seekers, psychotic bitches who have unrealistic expectations about everything, fibromyalgia pts who can't ever get comfortable and who freak the nurses out because they have "pain". So the more you deal with this type of thing, the easier it becomes.

I'm choosing to go the IM route because IM is not organ/system specific. You need to know all of it. The body is a unit. The body heals itself (if you give it the right conditions). And as a physician, your job is to entertain the patient and give them the right conditions so they can heal themselves.