Chronic care – saw some patients. Two hours of lecture on prescription writing – aka write legibly and pay attention. The real elephant in the room though was of course we received our Step 1 scores today. All of us looked up our scores differently. I wouldn’t open the email until I was back at my house all alone where others opened theirs while driving to work in the morning! I definitely would have crashed. I came out of the 8 hour nonsense test last month feeling horrible, worried about passing, and upset that I had wasted two years of my life. Anyways today, I’m sitting at my couch, finally alone and able to just think of this one thing. I had to calm down, slow my breathing, pray, and remind myself again and again that I’d given my all and that I could do nothing more. I opened it, heart pounding, sweating, feeling some chest pain (probably in need of a little nitroglycerin), and almost cried from relief. I passed and even beat my original goal. The beautiful thing about my score is that I’m not limited. Most residency programs have a cutoff and I’m above what I need for anything I’ve considered. So excited and happy, but most of all relieved. No more golgi apparatus or endoplasmic reticulum or IL-8 or any of the things that only matter to researchers for the rest of my life! Haha well unless I go into research but at the moment, that is HIGHLY doubtful! Some of the best students (intelligence, compassion, and just pure doctoring skills) I know did not do as well as expected. Clearly the test doesn’t demonstrate some of the most important qualities. I’m just disappointed that we’re judged on test scores that really don’t matter in the grand scheme of things. Regardless, I can finally look back at this monster of a test for which we spent two years preparing, raise my hands, and say, “I did it.”
“But I will trust in you, O Lord. I say, ‘You are my God.’ My times are in your hands.”
Today was really exciting and full of new procedures. I did a pap smear, placed sutures and removed an epidermoid cyst for the first time. Well, I guess I should say I did my first sutures on a living person… I guess I’ve already practiced suturing on cadavers and pig’s feet. Regardless, everything turned out good. Just as I was leaving to go to dinner with some good friends, I got a call that someone had just sliced up their finger so I went back in got a kit prepared and practiced sewing. Who would’ve thought med school would make me into a seamstress? The good news is we saved the finger, the bad news is I showed up very late for dinner. But when you show up in scrubs and have a cool picture, all is forgiven. Man, what a fun day though, the patients were excellent, outside of one who amused us greatly by leaving just when we arrived to his room! Haha what can you do? We’re in an “almost” free clinic, people aren’t going to be seen as soon as they walk in the door and if they’d like to leave then so be it. We treat everyone we can as best as possible. I met a lovely older patient from Chile, where I learned to speak Spanish, and it was just incredible to finally hear someone with what is in my mind the correct accent. It was clear and crisp and I was just happy that I understood everything. She was trying to set me up with her daughter but I kinda feel there is probably a law against that… Granted, I definitely need to look that up and see, just in case!
Family Med – Rural Clinic
Today I met my favorite patients yet. They were two young Venezuelans who came to America fleeing the brutal treatment of the government against the opposition party (more specifically, the murders of their family and friends). As a side note, it’s amazing how much is going on in the world that I’ve never heard about. It just makes me wonder why sirens, megaphones, CNN, and social media aren’t blaring out the harsh realities that so many face day in and day out in our world. I hope the reason for this lack of information is totally political because my alternate theory, that we just don’t care about the suffering of others, would reveal something terrifying about how our country has decayed. Regardless, medically, the young man presented to the clinic for a bad case of onychomycosis (aka nail fungus) of the great toe that had unfortunately become infected. At first we didn’t think it was infected but then it started oozing yellow liquid and we quickly had a change in opinion… this guy was in need of some solid antibiotics right away. I loved that he was so excited when I told him he was still allowed to work as long as he covered the nail. Already in this clinic, I’ve seen that the majority of immigrants work wherever and however they can; it’s refreshing to see people give their all. The girl that was with him laughed at my Spanish and sat me down and taught me to say words correctly. The Audacity! Haha but really, I was so appreciative because they just smiled at my mistakes, slowed things down and simplified their words as best they could, and helped me to get better. Outside of that, I gave a few knee injections, saw Grave’s disease for the first time, and learned more about calming angry patients. All in all, an excellent day finished with a long run and a glass of wonderful wine.
Today I did my first punch biopsy which was surprisingly simple. If you’ve ever made Christmas cookies, you can do one of these. I thought I saw a Kaposi’s Sarcoma which is basically a skin cancer that’s really only seen in AIDS patients. I’ve only ever seen the like in pictures, but man it looked exactly like that. We won’t know the results for a while but I’ll keep you posted. There’s always a fun patient and today was no different. We had a middle aged white guy who was taking Percocet, Soma, AND Methadone! Those are three highly abused drugs, and Soma, a muscle relaxant, doesn’t really help anything according to most doctors I’ve spoken with. They say it’s just a worthless drug fraught with abuse. Whoever prescribed all of these meds to this guy (it was a pain management doctor who I won’t name) should lose their license in both Dr. Leonidas’ and my opinion. He described a terrible shooting arm pain with movement that went, I’m not making this up, straight across from the medial to lateral mid humerus… He was totally jacked (and was trying to convince me to give him extra testosterone despite elevated testosterone labs), had no pain on palpation, no decreased grip strength, no decreased range of motion, and not even a flinch when in “8/10 pain” (even with just a few days of posts I hope you can see my appreciation for the pain scale). He had to wear a neck brace at night and a back brace throughout the day which I highly suspect came off immediately upon leaving the office. What’s amazing about him is that he actually expected us to give him more meds and was angry when we wouldn’t. Clearly he had no problems (other than abusing multiple drugs), was on much much stronger meds than I would ever have prescribed in the first place, and was lying through his teeth to get more. It’s just sad to see someone who has nothing wrong taking up the time slot in the day for someone that legitimately needs help.
Today we practiced IV caths by jabbing each other with needles again and again. I thought it was fantastic. It was a great way to learn and nice to know that we were going through extra pain so our patients wouldn’t have to. I, being the one least phased by needles on account of growing up with them all around (don’t worry, nothing illegal haha) in addition to having tunnels for veins, was the volunteer for anyone who was struggling to get them in. Basically, we had lots of fun and laughs as people totally missed veins and gained a new appreciation for the nurses and techs that are able to insert IV caths with ease. I, too, failed on my first attempt. Thankfully though, with some quick needlework and manipulation I was able to get it in without having to pull the needle out and restart. I always figured I would get it right away though and was shocked when I didn’t see the flash of blood immediately. Next time, I’ll get it perfect (probably not but will try!). Following this we had one of those riveting three hour lectures where a doctor who didn’t grow up with a computer teaches us how to open excel documents and how to right click… Not kidding. All you can do is laugh and move on. We then worked on projects and dermatology slides for a couple hours. After that, went home, watched Dr. Dustyn Williams. Dustyn is basically the up and coming Goljan (known by all young docs and residents, a legend for the basic sciences) for rotations and Step 2/3. Third year is just about time management and caring about people. Work hard and learn throughout the day, get a work out and something fun in, see/talk to the people you care about, study, wake up and do it again (and find time to write a blog post!). Tomorrow, I start seeing all my patients on my own! Hurray!
Family Med Rotation
Cancer, cancer, cancer. That was the name of the game today. Two probable prostate cancers (one of which had a PSA of 287!!! Normal is less than 4.0), hepatocellular carcinoma where the patient decided not to show for his appointment with the oncologist following a biopsy, and a prolactinoma (typically benign, hormone producing tumor in the sella turcica). One of the men with prostate cancer just stopped seeing his oncologist years ago when he didn’t like chemo and is now showing up to us because he isn’t doing well… Who would’ve thought? It’s tough to see that this guy isn’t likely to make it just because he wouldn’t go through with treatments when it could actually be treated. We had a few train wrecks to start the morning but then this 47 year old black male came in for a diabetes follow up. He had gained a considerable amount of weight and his HbA1c had spiked. I figured this would be the typical interaction we have with a DM (diabetes mellitus) patient where we just beg them to exercise, diet a little, and do the things that everyone knows to do. But this man shocked me by saying, “Look doc, I’ve been really struggling with my weight. I know what I’m supposed to do, and I’ve done it before. Is there any way I can come in and see you once a month just so I can have some more accountability?” I just sat there stunned; this is exactly the type of patient that people go into primary care to see. Of course I get irritated with patients when I see them eating and lounging themselves to death, but when someone is really willing to try, I’m going to do everything I possibly can and then some to help them.
Day 1 – Family Med
Never would have guessed I’d like my first day so much. My preceptor’s a solid young doc fresh out of residency that has a great perspective on patients and medicine and just seems to want to help people. I’ll call him Dr. Leonidas throughout this rotation (not his actual name of course). Who would’ve thought on the first day of my first rotation I’d be doing pelvic exams and the like? Already have multiple interesting patient interactions but the one that stood out was a white 50 year old lady that came in with fibromyalgia AND rheumatoid arthritis AND multiple car accidents resulting in neck pain AND a heart murmur AND mental slowness AND excruciating right lower abdomen pain for one month… Needless to say, she had a high pain tolerance and rated the pain as a 7 on a ten point scale while in no apparent discomfort (nor any sweating, elevated HR/breathing). I love patients like this, you realize that it’s all just a mental thing but it’s still real to them (I should point out that the heart murmur was very real and she gets a nice visit to cardio) and so you’ve got to figure out how to treat them without giving drugs with abuse potential. What’s really irritating though is when they use these “pains” to collect disability and then sit at home smoking multiple packs a day and watching TV… haha and then get mad at you for running late despite offering free (or almost free) services. So besides that we had a young black male with a full set of gold grillz coming in with orchitis (swollen testicle) and discharge after multiple unprotected sexual encounters with multiple partners… not in multiple weeks. What really “stood out” about him was, well, let’s just say we later had a laugh as we asked the nurse what was going on before we got in the room if you catch my drift. Well, hopefully my stories were entertaining for you today. To sum it all up, my first day of my third year of med school taught me a valuable lesson: a glass of red wine, walk on the beach, and romantic dinner with extra virgin olive oil and French vanilla candles in a dimly lit room do more than a pill ever could.