I am having a lot of inner turmoil these days. I was (smartly) advised to blog about these feelings so I can look back on them one day and (hopefully) be reassured that I thought out my situation well and made the right choice. Long post ahead, be warned.
1. My 4th year schedule is due on the 25th of this month. This is VERY soon. In order to fill this out, I need to have picked a specialty pretty definitively. At this point, I am deciding between Pediatrics, Psychiatry, and Emergency (ED). The problem I am having with this is threefold:
A. I do not have my ED experience until my elective in March. On paper, I think it sounds great (predictable hours, no being on call, shift work, easy to do part-time, exciting, no need to stay late or follow up on patients). In practice, I've got nothin to go off of, and won't until March. This doesn't help me when a decision must be made in about a week.
B. I am on Psych right now, and I am having a mini conflict about it. I went into this year with Psych at the top of my list. Now, after one week of child psych and 3 days of inpatient adult psych, I am not sure how much I like it. I knew the thing that would draw me to Psych was the theraputic part; I did not want to be a "medication manager" and ignore the patient's psyche. All I have seen is medication management. This may be the environment that I am in, but I'm not convinced that it is. I also feel like it is incredible subjective; one patient may be diagnosed OCD by one doctor and ADHD by another and be put on completely different meds even if the diagnosis was agreed on. I do not know how I would ever know that I was doing a good job or was doing it right. Also, EVERYONE gets diagnosed with something. Obviously they are at a psychiatrist because it is causing them distress, but it is discouraging. Lastly, most of these patients will not really get better, and it can be a lot of trying to convince someone to change something about themselves that they do not think is a problem. In short, like banging your head against a wall while trying to convince it that it is really a pillow. This was a long rant about Psych, but I am frustrated by these feeling because I really thought I would love it and while I like parts of it, I do not think I love it.
C. I got the score back from the Peds exam I took in December...not too hot. I passed, no problem, but it was actually worse than my Internal Medicine score, which is VERY surprising. I know one exam is not everything, but it is very discouraging...how can I believe that Peds is the right choice for me if I do poorly on it? Based on the above two worries, it would be logical to put my stock in Peds, schedule my 4th year for that, and just be done with it. I know it makes me really happy, I know that I miss being around the kiddos, I know that there are a lot of other positives about it, but this exam thing is seriously throwing me off. I should wait until I get my clinical evaluation from my supervisors back and see what that said (since what I actually do with the kids counts way more than some silly test), but unfortunately it will probably be months before I get that back. Again, not helpful when my schedule is due in a week.
2. Apart from not knowing what I want to do, I am having problems with the logistical aspects of the scheduling. There is a lot of strategy involved. For example, if I am interested in doing a Peds residency at a particular hospital, it is advised that I do a "sub-internship" there during Nov, Dec, or Jan. A "sub-i" is where I will act like an intern (interns are in their first year of residency) so that the program can evaluate me and decide if they would want me to be an intern/resident with them. It is basically an audition. So I need to be strategic about when I do my sub-i, and I also need to decide how many hospitals I want to try to do it at as well as at which hospitals. So not only do I need some idea of WHAT I want to do, but WHERE I want to do it at. How in the WORLD am I supposed to know this?!? How am I supposed to know which programs are good and which are not and which are too good for me to ever get into? How am I supposed to know even what CITY I want to live in if I haven't even ever been there? Apart from the strategy is scheduling sub-i's, there is also leaving time to interview, scheduling easier/more flexible rotations during interview season, choosing what other rotations I want to do, trying to find a research project/mentor, etc.
3. I am coming up on Step 2 of my licensing exams. Now, it feels like I just took Step 1 (which I did, last June), and I am DREADING going through that studying process again (the schedule is much the same...multiple weeks straight of studying 10+hours per day). Step 2 is divided into two parts: Clinical Knowledge (CK)- the multiple choice exam, and Clinical Skills (CS)- the practical part. There is strategy about how and when you take these exams as well. I think I have decided to take them both in the same month, which I hope goes well...just get them over with. There is a lot of scheduling involved, as CS is only offered in 5 cities and I have to travel to take it, and I need to schedule time off from rotations to study for CK. I do not want to study again and do poorly or only as well as I did on Step 1. To help me with my residency applications, I need to do better on Step 2 (particularly CK), and I'm scared that I can't do any better than I did on Step 1.
Clearly I have a lot on my plate right now and trying to stay organized and on top of the rotation I'm currently on while trying to figure out the rest of my life is very, very taxing. I have made probably 25 lists in the past week of things I need to do, people I need to email/call, things I need to study, things I need to check on for my patients, etc. I guess I have learned that about myself...when I get stressed, I write lists. It is a little pathologic (I'm probably looking at it like that because I'm on Psych!), but I don't know how else to feel like I have any handle on everything that is going on.
This has been long enough. There is more, I'm sure, but that is all for now.
1.14.2010
12.05.2009
Delayed
Well, now that I've been on Peds for a month, I figured I should write something about it...
I L-O-V-E it!
My first three weeks I was on inpatient in the hospital and I think I have decided that the hospital is the place for me. I get SO bored in clinic...most of the patients are healthy, they do NOT need to be at the doctor. I understand the importance of being healthy and staying healthy, and especially for kids I understand "well checks", but they are the most boring things ever. People in the hospital need you. They are sick and there are usually a lot of things that need to be done for them. Things can change very quickly, and I like that. Keeps me on my toes.
Aside from being in the clinic right now, overall I am obsessed. The kiddos put me in such a good mood. I was getting so frustrated with the adults that caused a lot of their own problems and were not willing to fix them 70% of the time. The vast majority of the time, parents are trying to do what's best for their kids, and if you explain to them what they have to do most of them will do it. Most kids had nothing to do with the problems that they are having, and if they did (ex. they swallowed a penny) it is still pretty cute and funny, not frustrating and annoying.
My time has not been perfect: I had one patient "code" (not a true code since she still had a pulse...just "insufficient respiratory effort") twice in 1 week, some teenagers that were just whiners, and some pretty sad social situations to deal with, but just walking into the room with a kid I smile. Since I was considering psych, ED, or neuro, I can still do those but just with a peds concentration. OB doesn't have a peds specialty, but other than that all this experience does is sort of focus me to doing PEDS neuro or CHILD psych, etc. Unless I become a general pediatrician...then all bets are off.
This is a shocking development for me...I was CERTAIN going into this year that I did not want to do peds. This started to change on Family when I got so excited to see all of the kids every time. This rotation helped confirm that for me. I am not committing to peds (or anything else!) at this point, but it definately excites me!
I L-O-V-E it!
My first three weeks I was on inpatient in the hospital and I think I have decided that the hospital is the place for me. I get SO bored in clinic...most of the patients are healthy, they do NOT need to be at the doctor. I understand the importance of being healthy and staying healthy, and especially for kids I understand "well checks", but they are the most boring things ever. People in the hospital need you. They are sick and there are usually a lot of things that need to be done for them. Things can change very quickly, and I like that. Keeps me on my toes.
Aside from being in the clinic right now, overall I am obsessed. The kiddos put me in such a good mood. I was getting so frustrated with the adults that caused a lot of their own problems and were not willing to fix them 70% of the time. The vast majority of the time, parents are trying to do what's best for their kids, and if you explain to them what they have to do most of them will do it. Most kids had nothing to do with the problems that they are having, and if they did (ex. they swallowed a penny) it is still pretty cute and funny, not frustrating and annoying.
My time has not been perfect: I had one patient "code" (not a true code since she still had a pulse...just "insufficient respiratory effort") twice in 1 week, some teenagers that were just whiners, and some pretty sad social situations to deal with, but just walking into the room with a kid I smile. Since I was considering psych, ED, or neuro, I can still do those but just with a peds concentration. OB doesn't have a peds specialty, but other than that all this experience does is sort of focus me to doing PEDS neuro or CHILD psych, etc. Unless I become a general pediatrician...then all bets are off.
This is a shocking development for me...I was CERTAIN going into this year that I did not want to do peds. This started to change on Family when I got so excited to see all of the kids every time. This rotation helped confirm that for me. I am not committing to peds (or anything else!) at this point, but it definately excites me!
10.18.2009
Bland
Not too much exciting going on here...I was sick all of last week except Friday, when I went in and shadowed the OB/Gyn Nurse Practitioner. I had never seen a pregnant person as a patient before, so it was a great experience. Almost everyone we saw had something going on with them, like preterm labor or intrauterine fetal growth retardation, so that made it even more interesting. The only drawback was that since I was still a little sick and had no idea what I was doing, the experience was strictly shadowing; I didn't get to do anything on my own and didn't get to touch almost any of the patients (by the end of the day I did get to find the fundal height and fetal heartbeats on 2 women). I'm excited to see more! Other than that, boring week (sick), low-key weekend...not much to say! Ready to get back to work tomorrow. And to go back to the Primal Hour workout with D...yikes!
10.14.2009
Hooray!
1. When I called in to work this morning to say that I was not going to be able to come in, the person I talked with informed me that the physician I am working with has taken off til Monday! The physician later called me and said that she arranged with the Nurse Practitioner for me to work with her if I am feeling better before Monday. I am sure I will at least go in on Friday, tomorrow is questionable.
2. I found out that I did pretty well on my Internal Medicine Shelf exam that I took about 3 weeks ago...actually, WAY better than I thought I did! I thought there was a good chance I failed it and would have to retake it, but I was WELL above failing. NO CLUE how that happened, but I'm thankful! I may have done well enough to Honor the block if my clinical evaluations were good enough- to honor, I had to have done at or above the mean on the Shelf. I'm not sure what the mean is this year (it fluctuates), but I'm pretty close so we'll see if it was enough! My goal has been to get Honors in my clinical evaluations in all the blocks, and I didn't really think that I might Honor a complete block, especially Medicine, so this is pretty exciting! I find out my grade in 3-5 weeks. We'll see!
2. I found out that I did pretty well on my Internal Medicine Shelf exam that I took about 3 weeks ago...actually, WAY better than I thought I did! I thought there was a good chance I failed it and would have to retake it, but I was WELL above failing. NO CLUE how that happened, but I'm thankful! I may have done well enough to Honor the block if my clinical evaluations were good enough- to honor, I had to have done at or above the mean on the Shelf. I'm not sure what the mean is this year (it fluctuates), but I'm pretty close so we'll see if it was enough! My goal has been to get Honors in my clinical evaluations in all the blocks, and I didn't really think that I might Honor a complete block, especially Medicine, so this is pretty exciting! I find out my grade in 3-5 weeks. We'll see!
10.13.2009
Sick
So I lasted exactly 5 days in the FCM clinic before I got sick. That's pretty sad! I showed up to work on Monday feeling a little tickle in my throat, and the physician I am working with showed up feeling the exact same way. By 10am she had decided to take the afternoon and the next day off, and I was SO thankful because I was feeling much worse by that time. I was supposed to have lecture on Tuesday afternoon, but I was definately coughing and runny nose-ing all over the place and didn't want my classmates to get sick. I don't have a fever (I have been checking like every 3 hours), which is really good, but I am definately still sick. When I called in about lecture, the doctor said that if I am symptomatic I should definately NOT go into the clinic. Hmm...I'm thinking that might mean another day off tomorrow. Particularly because the physician I work with is pregnant...even though it sounds like she had exactly what I have, I do not want to be around her if she is feeling better and I am still feeling sick. Pretty sure we both caught it from the same kids that were in the clinic on Friday (4 kids in 1 exam room all hacking up their lungs and crawling all over me...yikes!). Hopefully I will catch most mild illnesses before I get onto Peds in a month so I'm immune by then! I'm NEVER sick so this is hard for me. I'm just glad there's no fever or else I would really be a baby and probably call my mom! Not really, but it would be pretty close. While I won't mind another day off, it is hard to miss even a couple of days when my rotation is only 5 weeks (or 25 work days) long...I don't want to miss out on anything! But the patients come first, and if I am putting them at risk for getting sick just by seeing me, that's not right. We'll see how I feel in the morning!
10.11.2009
Expansion
One week done with my FCM rotation. I actually like it more than I thought I would, which truthfully isn't that surprising. I didn't think I would like it, but had a feeling I would like it more than I thought I would, so I'm not surprised that I actually do like it, but it is weird. If that makes sense! I have been seeing 12ish patients a day, which is a LOT more than I have ever seen before. I am getting pretty speedy and usually have a pretty good idea about what is going on with the patients (and my ideas are actually usually right!), so it is encouraging. I have seen a number of kids ranging from 2 days to 15 years old, and I (VERY surprisingly) LOVE them. Now, they have all been very well behaved and cooperative, no crying or clinging to mom, so that is unusual, but I am very surprised to learn that I like working with them. I especially like working with teenagers, which I already knew. All in all, it was a good week; busy, productive, and educational.
D and I went to a Primal Hour workout with a trainer earlier this week...no weights, no boxing bags, just using your own body weight and a tire (like from a car) to run around or balance on. It was SO hard! I was sore the day after, but 2 days after I literally was dying! My feet and calves hurt SO bad! It was wonderful! I definately think we are going to go back; the class is twice a week at a time when we can both go. Since it is really fun as well as really hard, I think I will actually go and enjoy it, so it is definately worth the price. I'm excited for the next one!
Lastly, I heard from C around the middle of the week. He told me that his grandpa died and so "everything is on hold and family is flying in". Now, I have no idea why he needed to tell me that; the only thing I can think of is that he wanted to let me know that I might not be hearing from him for a few days and that that was the reason so I wouldn't be upset. I think that is a good thing...? So I guess since the funeral was this weekend I should expect to hear from him this week maybe? Not sure, all I know is I would like to hang out with him again, so I hope he calls, but I'm not exactly waiting around for it. We'll see!
D and I went to a Primal Hour workout with a trainer earlier this week...no weights, no boxing bags, just using your own body weight and a tire (like from a car) to run around or balance on. It was SO hard! I was sore the day after, but 2 days after I literally was dying! My feet and calves hurt SO bad! It was wonderful! I definately think we are going to go back; the class is twice a week at a time when we can both go. Since it is really fun as well as really hard, I think I will actually go and enjoy it, so it is definately worth the price. I'm excited for the next one!
Lastly, I heard from C around the middle of the week. He told me that his grandpa died and so "everything is on hold and family is flying in". Now, I have no idea why he needed to tell me that; the only thing I can think of is that he wanted to let me know that I might not be hearing from him for a few days and that that was the reason so I wouldn't be upset. I think that is a good thing...? So I guess since the funeral was this weekend I should expect to hear from him this week maybe? Not sure, all I know is I would like to hang out with him again, so I hope he calls, but I'm not exactly waiting around for it. We'll see!
10.05.2009
New
And it begins again! I am now on my Family and Community Medicine (FCM) rotation. I am working at an outpatient clinic that serves a number of underserved populations (illegal immigrants, refugees, poor, etc.). I just spent a couple hours there this afternoon to get oriented, and it was actually really fun! It is a very busy clinic, so I will need to move quick, and I'm sure I'll see a TON of patients scared about "pig flu", but I think I will enjoy it. The doctor I worked with today is very nice, and there are no residents or interns or other medical students which means lots of teaching time for me! Hopefully I can impress them!
I was able to get down to Tucson this weekend to see some friends from school who I have not been able to see for the past 10 weeks. It was really great to catch up with them; I am definately not going to let 10 weeks go by again without seeing them!
Lastly, I think my dates with C have come to an end. I didn't hear from him all last week and when I finally did it was "I think you're a sweetheart, but I don't know how compatible our lifestyles are. I want to take you out again, but I don't think going out drinking with me on the weekends is a good idea". So I'm not too sure what that exactly means; if he calls again and wants to go out, I definately would, but I think I have him pegged as a non-committal typical single 20-something. It has nothing to do with me...that is just his attitude right now, and if that's working for him then that's totally fine. I really hope we can be friends though, since I really do like hanging out with him and having someone outside of medicine to do things with!
That's all...hopefully I'll have plenty of time on FCM to do other things and blog about them!
I was able to get down to Tucson this weekend to see some friends from school who I have not been able to see for the past 10 weeks. It was really great to catch up with them; I am definately not going to let 10 weeks go by again without seeing them!
Lastly, I think my dates with C have come to an end. I didn't hear from him all last week and when I finally did it was "I think you're a sweetheart, but I don't know how compatible our lifestyles are. I want to take you out again, but I don't think going out drinking with me on the weekends is a good idea". So I'm not too sure what that exactly means; if he calls again and wants to go out, I definately would, but I think I have him pegged as a non-committal typical single 20-something. It has nothing to do with me...that is just his attitude right now, and if that's working for him then that's totally fine. I really hope we can be friends though, since I really do like hanging out with him and having someone outside of medicine to do things with!
That's all...hopefully I'll have plenty of time on FCM to do other things and blog about them!
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