Psychiatry intern year is half psychiatry, and half “off service” rotations, usually a mix of Internal Medicine and Neurology. My program offers us the option of doing some Pediatrics rotations, either pediatric inpatient or pediatric neurology, and I decided that if I was considering doing the Child and Adolescent Psychiatry fellowship, perhaps I should have a better foundation of pediatric medicine than just what I got in medical school.
So my Intern year is a little bit more intense than most of my co-Interns. Usually you have two or three off service “ward” months, two months of neurology, and then another two or three somewhat lighter medicine related months like Medicine Consults or Emergency Medicine. And when you start Off Service instead of on psychiatry, you get a total of seven months (month = a four week block) of off service rotations instead of six. Since I opted to start Off Service, and I wanted to do some pediatrics, I (and one other intern) have two adult medicine ward months, three pediatric ward months, one adult neurology month, and one pediatric neurology month (which I’m on right now and it is a very welcome break). And in addition to having three weeks of night float for Psychiatry this year, I also have three weeks of Pediatrics night float.
I’m mostly glad I chose this, because it’s Intern year. This is essentially my last chance to explore other fields in a hands on way, so I should take advantage of all the learning opportunities I can. I’m a bit apprehensive about January/February/March though, because it will be winter, and I will have adult medicine, followed by two months of pediatrics, all months during which I can’t take vacation. It’s going to be an intense 12 weeks and you bet I’m buying a happy light because I’ll likely only be seeing the sun through my patients’ windows. I’m really excited about April, because I will be back on Psychiatry, and I’ll be on psychiatry for good.
So starting Off Service is a bit rough, because I’m finally a doctor and that’s exciting and awesome! But wait, this isn’t the kind of medicine I signed up for!
Thankfully, we have didactics from 1pm to 5pm every Thursday afternoon, and except for my medicine month at the beginning, and when I was on night float for a week, I’ve been able to make it over. It’s been a nice weekly trip to my “home base,” and it helps keep me grounded.
I feel kind of guilty for whining about having five ward months, when pediatric and medicine interns have so many more, but they also enjoy it (or so I’ve been told). I definitely don’t hate my ward months – sometimes they are actually fun, and they’re always very rewarding – but there’s something missing for me.
Fitbit flex + mandatory duty hours logging = lots of fun data to play with.
12 days of work in a row for a total of 134.5hrs (today’s my first day off since I started; we get one day off every seven, averaged over four weeks). Past seven days stats = 81.5hrs at work, and 6.5hrs average actual sleep per night. Apparently I need to enforce my bedtime better, and maybe invest in blackout curtains, but I think intern year is off to a good start (Internal Medicine at the VA), and I have a better handle on CPRS (the VA EMR system) so my hours should improve from here on out.
Now if I just didn’t feel silly wearing a blue rubber wristband at work, I could see if I need to make myself take the stairs more often.
One week ago, I graduated from medical school! =D It was an amazing weekend, not just because I’m finally, officially a doctor, but because my entire immediate family, some extended family, and some of my closest friends were all there celebrating with me.
I have a handful more weeks before I start Residency (I’ll be starting off service on Medicine, Pediatrics, or Neurology. No idea which yet!), and I’m doing my best to achieve maximum rest and enjoyment. I’m between leases at the moment, so I’m traveling around the US until I actually start my lease and move to Seattle.
All those years of trying to embrace minimalist culture, and the more recent months of realizing that all but one of the options on my rank list meant a cross country move, finally paid off. This was by far the smoothest move out process I have ever been through. I did it mainly on my own (with occasional important help from people, like my friends who came to my graduation carrying my orchids to Seattle for me), but I didn’t feel overwhelmed like I did when I left New Haven by myself. I sold all the furniture I wanted to sell, donated the rest, and even found a sublettor to take over my studio for the end of my lease! I forgot to pack up my tea cabinet (yes, I had an entire little cabinet dedicated to tea), and I left behind a little tea set from China that I was going to give to the daughter of a couple of friends, but I did everything else!
Moving in might be another story, but I’m optimistic that it will go well! While I did a ton of de-cluttering, I’m still hanging out to a bit more “junk” than I really need, but I have a little over a week after I move in before Residency starts, and I’m planning to completely unpack (and get things dry cleaned and tailored, register to vote, get my new driver’s license, get new plates for my car, etc) and be all set up by the time Orientation rolls around. We’ll see how well that goes!
It’s going to take a while for the novelty of being a doctor to wear off, by the way. For example, I just realized I can refer to this as “my doctor blog” now, which is easier to type and say than “my med school blog.” =D
Last week was my first week of Dermatology (and the start of my last rotation! Just three more weeks and I’m officially done with medical school!), and by the end of it, I couldn’t help but think of the movie “My Big Fat Greek Wedding,” because of how often patients were told to put vaseline on various bumps and rashes and ulcers. Vaseline and steroids, I guess, would be the two most common recommendations I’ve seen.
It’s been a fun, laid back rotation though! By the end of it I should be able to treat basic acne and eczema on my own, and tell people when they really should have that mole looked at.
If anyone has any ideas for how I can sleep better for the next 16 nights until Match Day, I’d love to hear it! Lists are in, and the only thing standing between me and knowing where I’m living for the next three to five years is, well, I’m not entirely sure why it takes three weeks, but it does.
I thought it’d improve, but tonight I went to bed later and woke up even earlier! It’s normal for me to have trouble sleeping a night or two before big change, but nearly three weeks away? Sigh. It feels like I’m on a surgery rotation, except I’m on a fairly light outpatient gynecology rotation.
4:41am is an unacceptable wake up time when my alarm goes off at 6am. I’m going to try going back to sleep. (I started this post last night and figured I might as well finish it while catching myself in the act).
(You’re going to have to put up with these countdown posts for a few more months. Sorry!)
It’s one hundred days till my graduation! What amazes me is not that it’s so close, but rather, how normal it seems that I’m going to be a doctor in three months. Four years ago, I still wasn’t even sure I was going to get into medical school; I hadn’t yet received my first of three acceptances. Once I did get in, I suffered from a touch of “Impostor’s Syndrome,” and was worried that I’d gotten in by accident, that I was going to struggle through medical school, and maybe not fail out, but that I would have taken up a spot that should have gone to some more deserving person.
The year during my application cycle, I read several medical student and resident blogs, and I strongly suspected that I was going to struggle with the first two years (I was a psychology major and only took a few biology class in college), but that I was going to thrive in my clinical years. At the same time, I worried that maybe I was going to start my third year clerkships and realize that actually, I hate this, and I’ve just wasted two years of studying and ~$120K to realize that.
The real attitude change happened after my pre-clinical years. Passing Step 1 (and not just passing, but actually doing okay), and then finishing third year, finally resulted in my feeling like Yes, I deserve to be here, and more importantly, Yes, I can build a satisfying career in medicine.
Third year was hard. I worked long hours, always felt like I needed to be studying more (and was usually right about that), and even though I was in the hospital all day, I often felt useless and confused about my role on the team. And every time I finally figured things out and bonded with my team, it was time to move on to a new rotation. And yet it was amazing in its own way. I got to help deliver babies, and sew and staple and glue people’s skin (and muscle, and connective tissue) back together. I got to drain fluid out of someone’s knee, and stick foley cathers up several urethras. I got to do a lot of things that I will either never do again, or will only do during my intern year. I’ve built the extensively broad foundation of medical knowledge that all doctors start off with, and soon I’m about to begin specializing in the field that I’ll be practicing in for many, many years to come.
I remember meeting fourth year medical students when I was a first year and being in awe. Even as a third year, fourth years seemed amazing. How did they know the answer to that question?! They’re only a year ahead of me; how is the knowledge gap so vast? Fourth years seemed so wise, knowing everything from the common causes of fever after surgery, to where to get the better free coffee in the hospital (like the 7th floor patient family lounge and the neurosurgery ICU).
And I have to admit, I do feel a lot more confident these days. I figure out my place on my teams much faster, and I know how I can help. I worked hard throughout third year, and that hard work culminated in an excellent, not just okay, Step 2 CK score, and good letters of recommendation that landed me interviews at several schools I would be very happy to match at.
I remember starting medical school and thinking about how proud of myself I’m going to feel on my graduation day, and yeah, I already do feel proud. Pride is often regarded as a bad thing, and it certainly can be, but right now I’m going to bask in this sense of accomplishment. My education has only just begun, but it has begun, and I’m glad it’s going to continue. Residency is going to be its own challenge, and it’s not going to be the happiest, most relaxed days of my life, but it’s going to be meaningful, and I feel like overall I like my life best when I’m really working toward something.
I went to a special grand rounds in the pediatrics department yesterday, and the topic was “My First Death.” It was a panel of five people, plus the doctor in charge of the pediatric palliative care service in the children’s hospital. Each of the five told a story of their first patient death in their current roles, and then the floor was open to questions, or for other people to share their experiences. I’m not an easy crier, but I admit I came close to tearing up at least once or twice.
The idea of my own death still terrifies and confuses me on some level, but at the same time I am very aware of the inevitability of death, and of the extended process both dying and grieving can become. It’s interesting to me how little we talk about death in the US. When I lived in Ghana, I was confronted with death more often, but these days I think if I wasn’t in medicine, it’d be fairly easy for me to only think about it on a very superficial level.
I feel a little self conscious sometimes when talking to people outside of my family and classmates, especially on my more bleak rotations. I feel like it’s inappropriate for me to share what I’ve been going through and thinking about, like finally writing up my advance directives and assigning at least one or two medical powers of attorney, or how interesting it is to see the variety of people who are the ones standing by someone during their most trying and difficult times (sometimes not even family or romantic partners, but people whose lives have become intertwined in unusual ways), or when the death or illness of a child precipitates the end of a marriage, was the divorce inevitable someday or would they have stayed together otherwise?
I worry that speaking my mind is being a Debbie Downer, that people don’t want to hear about these things. That the stories that I find almost uplifting in a bittersweet way, like the attending who told the fellow to stop CPR so that the baby could spend the last moments of its very brief life being held instead of being pounded upon, will simply be depressing.
What was my first death as a medical student, by the way? It depends on how you define it. Was it the patient in the Emergency Department that my resident wanted me to try CPR on (I don’t remember why exactly I didn’t “get a turn”) but who everyone was just waiting to pronounce dead? Or was it the patient I followed my entire four weeks on the general Internal Medicine rotation who we had nothing left to offer and were sending home with hospice? (Or the one I had for two days who we also had nothing left to offer and also sent home with hospice? He probably actually died first).
I’ve never had a patient die in front of me, but I’ve known quite a few patients, quite a few people, adults and children both, who either died soon after I met them, or who I know will die within another year or two.
I don’t have a specific point to this post. I think that mostly I’m wondering how much it’s okay for me to talk about these things, because they’re on my mind often, and dying, death, and grieving, are all a big part of living, as much as we really don’t want them to be.