Wednesday, July 1, 2015

first day of intern year

I kept waking up during the night since I was a little anxious about starting.  I had been doing so much orientation though, that I was mostly over it.

I went to orientation, touched base with my team and chart reviewed a lot of sick patients of mine who had a lot of tests and who we consulted a lot of teams for.  It's so time consuming to chart review everyone while you're answering pages and returning phone calls.  I'm really glad I have a great upper level who has my back and is great support.

I forgot to mention I started the day tired and with diarrhoea.  Then I hadn't eaten from 10pm last night until 1pm today, aside from some candy which helped keep my body from disintegrating.

I'm exhausted and I'm just glad I'm not doing night float right now.

I'm glad today went well overall.  It was pretty challenging and will only become more difficult, but I'm going to strive and stay on top of my game.

Sunday, June 28, 2015

An medical intern's typical day

I spend a lot of time with friends and family dispelling lifestyle myths of medicine.  They're usually pretty shocked when I tell them about the hours we work, how sleep is minimal on call, and the severity of illness we deal with.

My typical day on a medical wards month starts like:

0445: Wake up.  I know I shouldn't really snooze, but I do sometimes.  I probably get up earlier than most because I like to take my time getting ready.

Shower and reluctantly put on my dress trousers, shirt and necktie (ugh, fomite).

Breakfast at this point or not.  I usually am too exhausted from the day before or hardly sleeping that I feel too sick to drink coffee or eat anything.  I entertain the thought of forced eating, but I never go through with it.  I end up feeling weak and dizzy in around 730am.

0545: I'm usually at the hospital at this time, reading up on patients overnight, getting in touch with the night resident and maybe getting a drink of coffee from my thermos.

I try to be as efficient as possible by starting patient notes, pending, then printing out what I have, and filling in information as I go see my patient in their room (how they did overnight, I/Os, pain, ambulation, vomiting/nausea/constitutional symptoms).  If I have enough time, I'll start writing patient notes before rounds.

0800 or 0900: Usually rounds.  Sometimes morning report is at or 9 and the team rounds after.

0900-12: Rounds.  In my opinion, rounding in medicine takes a lot longer than it should.  There are a lot of drawn out discussions that don't really affect patient care.  There's a lot of social work stuff that comes up at the last minute, and there's a lot of calls to be made to consult teams, etc.  Nothing glorious here.

12: Usually noon conference.  We keep getting paged and called but there's nothing we can do about it sometimes unless it's an emergency.

1200-18:00: Patient care, patient notes, calling consults, putting in orders, answering a lot of phone calls and pages.  It could be at any time during the day, but I'm constantly thinking about getting the cardiac arrest page.  I round on my patients on my own again or with the med student just to check up on things and be on the really early side of catching any possible complications/allergic reactions.

I also call family at this time and encourage them to visit and spend time with their hospitalized family member.  Family members are the best advocates for patients and they'll immediately call you if something happens when the nurse is busy taking care of 40 other people.

1800-end: If I'm not on call, I'm signing out my patients to the night person.  I'm glad I'm not cross-covering 80+ patients..

The days get pretty long, but call is always longer.

1800-2300: Study/read/answer texts from my bosses/dinner/squeeze in quality time with loved ones.  Everyday I wish I would have been able to come home to pick up my packages that are now in the closed office, or wish I could've gone to the now closed bank, or had more time to pick up something at the grocery store and cook.

Could be worse, though.

2300 or Later: Fall asleep and most likely have a hospital-related dream.

Tuesday, June 23, 2015

Webinar Registration for Applying to Med School with Lower Stats

Register here for's Med School App Webinar!

I honestly think this will be pretty helpful along with input from your pre-med advisors.

I actually applied without ever having interacted with people in the know, and I think it could've made things a little easier on me and cut some of the anxiety away.

I've known classmates who were combat medics, firemen, teachers, and from other walks of life who happened to have taken time off and not have had the greatest scores out there, but they all made it!

Chase your dreams, everyone & Applying to Medical School With Low Stats: Webinar

Hi everyone,

I'm pretty happy to work with in order to keep in touch with the pre-med readership the further and further I get into residency.

They have shared some webinar information with me:

"Yes, You Can Apply Successfully to Medical School With Low Stats!

Not sure if your MCAT or GPA are high enough to secure you a seat in your top choice med school?
Low scores and med school acceptance aren’t always mutually exclusive!

We’d like to teach you the tips and tricks of creating a medical school application that will get you accepted…even with a low GPA and/or MCAT score!

Don’t let your weaknesses get the best of you. Learn how to highlight your strengths and get accepted during Accepted’s live webinar, Get Accepted to Medical School with Low Stats.

* Who should attend: Medical school applicants with less than stellar stats!

* When: Thursday, June 25, 5:00 PM PT / 8:00 PM ET.

* Presenter: Alicia Nimonkar, medical school admissions expert. Reserve your spot by registering now!

Reserve your spot by registering now!"

Plenty of people have gotten into medical school with average or less than average stats, and a lot of people with very high stats have been rejected.  It's all about applying to the right places and finding a school that has the right fit for you.

Just like for residency applications, you should play up your strengths and communicate what kind of contributions you can make to the training program (eg committee leadership, being able to teach your peers about literature appraisal, etc).

Good luck with your applications!

Saturday, June 20, 2015

Swift Mnemonic #2 Thiazide Mechanism

If you ever have a hard time remembering that thiazide diuretics work at the distal tubule of the nephron, I have this mnemonic.

Thiazides start with "Th-," like in "thunder."  I tie it together by thinking about how on rainy days, you hear "thunder in the distance."

If that helps you remember that thunderous thiazides are out there in the distance, you'll always remember that thiazide diuretics work by inhibiting NaCl update at the distal tubule.

A free and easy way to get better at EKGs

What I started doing in medical school was going on different websites that host EKGs and I would save them on to my hard drive.  I used EKGs that are in the common domain and that are okay to download.

It's pretty fun having your own custom database of EKGs.

There's also a great website called Life In The Fast Lane that I used extensively on my CCU rotation.  It provides so much great information on eponymous EKG signs and is a great source of easily-understood information.


Tuesday, June 16, 2015

Swift Mnemonic #1 Cardiac Drugs

Dobutamine dose: 2-20ug/kilo/minute.  To easily remember, think of how Dobutamine starts with "Do-" and tie that into the word "double," which ties to the number two.  If you speak Spanish, it might be easier to remember how "Dos" means "two" and the starting dose is 2.

Milrinone: 0.375-0.75 ug/kilo/minute.  For milrinone, I think of "military."  A 0.375 caliber round is commonly used in magnum hand guns (although they're not standard issue everywhere).  Think of a 0.375 magnum round.  But remember that in cardiac dosing of inotropic agents, you use micrograms.

Torsemide: 10-100mg/daily.  For "Torsemide" I think of "base ten" or multiples of "ten."

Just quick mnemonics.  I will do more of these if they're useful