eating struggles

i’ve really been struggling with my eating on internal medicine rotation.

For 1, we have free lunch every day. that really should be a big hurray for someone taking out loans, but i really don’t like the gigantic meals they give complete with soda, cookies, and chips. It’s really hard to resist when EVERYONE ELSE is eating it!

for 2, we are on call every 4 days, that means everyone else is eating like shit all day e’erday. Donuts, pigs in a blanket, COSTCO sized cheetos/chips, cookies, etc. etc. ALL OVER THE TABLE. And my team mates are snacking ALL DAY on these shitty junk food! it’s also hard to resist!

I guess that just means I need to have better self control...not only am I not liking the weight gain, my body is also rebelling by popping out pimples every single call day! I know the pimples is a result from EATING and not stress because I also had a bunch of pimples whilst on vacation in SF. Naturally, i eat indulgently on vacation, but my body also hated it. If i’m getting pimples on vacation, that means it’s coming from the FOOD! I obviously have no stress on vacation.

garghhh.

at the same time, I feel so bad about wanting to be skinny when I’m seeing so many patients sick with liver failure, heart attacks, cancer, etc. etc.

What I thought about Ob-Gyn

overall, i actually kind of enjoyed the rotation to my surprise! I kind of like the OR (though I will NEVER go into a surgical specialty in 21039201938 yrs, but that’s a story for another time), so i had a decent time on obgyn . kind of.

the nature of the work

– OB is a lot of fun, generally very fast paced, sometimes shit goes down very quickly. for example, sometimes during labor the woman needs to be RUSHED to the OR to do an emergent c-section.

– Gyn I thought was boring. it was abnormal uterine bleeding ALL DAY EVERY DAY. got boring after awhile.

– as far as the treatment, I thought that was also kind of boring. there wasn’t that much variety. everything on OB is treated by c section for the most part, and everything on gyn is treated by giving oral contraceptives (i.e. really bad period cramps, excessive bleeding, etc.)

– i LOVED seeing the babies though. And of course having the privilege of being involved in one of the most important moments in the family’s lives. my favorite part is always seeing the reaction/expression of the mom and dad.

– i actually really really enjoyed uro-gyn. however, i don’t like uro-gyn enough to endure 4 yrs of obgyn hell just to do that. Plus, urogyn is super competitive, no guarantee i’ll get the fellowship

– i also thought reproductive endocrinology stuff was pretty interesting. once again, don’t like it enough to go thru 4 yrs of obgyn. it’s also a super competitive fellowship

– ob-gyn has a mixture of internal medicine AND surgery. so that may be appealing to some.

– for those who want to do oncology surgery but ALSO want to take care of patients, gyn onc is really your best and only option. people in surgical oncology aren’t very involved in taking care of patients, while oncologists are the opposite- take care of patients but no surgical procedures except maybe spinal taps.

 

lifestyle/hours

– MAN OH MAN. i was surprised how hard even the ATTENDINGS WORKED! gee whiz, it’s a super shitty deal if you ask me

– gyn lifestyle i think is okay, but ob seems like it sucks pretty hard

 

the people

– i was not a fan of the people. most ob-gyn folks i encountered were MEAN. and sorry but, it never surprised me which people decided to go into obgyn. a lot of them were people i found rather unpleasant. but key word is a lot. of course there are still some very lovely pleasant ppl who go into obgyn, but IMO they are kind of rare. maybe i just didn’t mesh with them? but i think most people will agree with you that they hated the ppl on obgyn

 

my tips for OB-GYN rotation

OB

– ask about the BABY status, method of future contraception, and whether they’re breastfeeding. 

– ask about lochia.

– discharge goals for c-section are same as normal surgery: peeing, tolerating PO, no signs of infection/endometritis/fever, ambulating, passed gas.

-learn about fetal heat tracings early on for OB. this includes baseline, level of variability, accels/early or late decels, and how to calculate montevideo units. also know what sufficient power for contraction means (200 montevideo units).

– in your note don’t forget to mention the IUPC (intrauterine pressure catheter) if in place, what method of delivery you anticipate, position of fetus (cephalic or breech), station baby is at, what percent cervix effacement.

– prenatally: always mention fundal height (measured from pubic symphysis) and fetal heart rate (via doppler).

– volunteer to do the 2 hour progress notes for patients in labor. i think the residents will appreciate this as it’s usually quite crazy in the labor and delivery unit.

DON’T PULL ON THE CORD TOO HARD or else you might invert the uterus. that will cause MASSIVE hemorrhage and is considered an emergency.

 

GYN

– abnormal uterine bleeding ALL DAY E’ERDAY. this is probs the majority of what you’ll see, so know the differential diagnosis for it well!

– regarding pelvic exam- you don’t actually push the speculum in the downwards direction that much, only slightly. ***also do NOT push the labia majora from the top, THAT IS WHERE THE CLITORIS IS! so do it from the bottom.

– always ask about menstrual history- this includes age of menarche, number of days, length of cycle, how many pads per day, any pain/dysmenorrhea

 

literally the worst people i’ve ever encountered

ughhhhhh so freaking frustrating working in a team sometimes!!!!!!

now, i’m not talking about isolated projects at school or work. i’m talking about having to spend 6 days a week for 4 WEEKS, 12 hours/day usually, sometimes 32 hours nonstop with the same two people. so yea. it can suck big time. most of the time though, it’s not a big deal because i am a pretty easy going person and get along with most people.

…but i cannot even begin to describe how freaking frustrated i am with my current team mates!!!!! let’s call one C and one M.

i knew that our entire med school class hates C. i didn’t know why and felt bad for him so actually went out of my way to be nice to him. But, he is insufferable and now i finally understand where the rest of our class is coming from.

he likes to say things in very condescending ways to make me look stupid EVEN THOUGH HE IS THE DUMB ONE. ex: for a patient case, the first line was “x year old female comes in with muscle weakness, what’s on the differential?”

C goes neisseria gonorrhea. I ask, septic arthritis wouldn’t call muscle weakness would it?  (the answer is no). he then responds in the douschiest way possible: “YOU’RE MISSING THE POINT, WE’RE TALKING ABOUT THE DIFFERENTIAL HERE.”

at this point, I’m on the verge of slapping him. Not only is he a dousche for saying it in a condescending way, HE ISN’T EVEN RIGHT!! SEPTIC ARTHRITIS DOESN’T CAUSE MUSCLE WEAKNESS. I am perfectly aware that we were talking about the differential diagnosis here, but excuse me C, you are the dumb one so STFU. but, for the record, i was still nice to him and didn’t make a deal out of it.

2nd example. he walks in huffing and puffing so i teasingly say, wow someones out of shape. his response? “how hard you breathe isn’t a function of how out of shape you are, it’s a function of how much lactic acid you make.

he was trying to make me look dumb again, yet what he was saying was something a 2nd grader would know- OF COURSE you’ll be more more out breath WHEN YOU’RE MORE OUT OF SHAPE, WHY DO YOU HAVE THE INTELLIGENCE OF A ROCK? sorry, i am not usually mean, but i am INFURIATED because he said it in such a condescending way when he is stupid, i just can’t….

aside from these 2 perhaps benign examples, he tries to do it in front of our ATTENDING PHYSICIAN AND RESIDENTS. i seriously want to slap the shit out of C. I have been perfectly nice and professional with him, but time after time my patience is tried and he’s pushed me over the edge. from now, no more chit chat and i’m only going to interact with him if need be.

meanwhile, my other team mate M isn’t any better whatsoever. we all have our formal write-up due on fri but we were only informed 2 days beforehand about the due date. yea, that sucks, but of course it still needs to be done, so thurs i was up for 32 hours because I had patients to see as well as the write up to do. well, guess what, THIS FUCKING D-BAG slept for like 6 hours on our call night instead of working on his paper, and then because he didn’t finish his paper, HE WANTED C AND I TO TURN OUR PAPERS IN LATE BECAUSE IF WE TURNED IT IN ON TIME IT WOULD BE “THROWING HIM UNDER THE BUS.” WWWTTTTFFFFFFFFF. Who the FUCK DOES THAT?????????? 1Q9832UJ4982U348923748923ª•¶¡™ºª•£ªº™¡38

C and I accommodated for M by turning out papers late this time, but i didn’t stay up all night to work on my paper just to come as a bad student to my attending. we both could’ve finished it, i did so by staying up and M chose not to by sleeping for 6 hours. This is the first time i’ve done this for someone, and i guarantee it will also be the last. if he is immature enough to believe that me turning my paper in ON TIME is to sabotage him? then there’s no point of reasoning with him. I AM turning my paper on time next time, and if he says otherwise? well then for lack of a better phrase, he can go fuck himself.

I can’t decide if that incident with M was worse, or the fact that M is a manipulating and conniving piece of shit. He lied to me and told me everyone on your team in third yr rotations gets the same grade as you, so it doesn’t make sense to try to look good in comparison to your team mates. well, what he told me was NOT TRUE. he was trying to bring me down because i am the only one on our team presenting literature to our superiors- he’s trying to get me to stop looking good in comparison to him so he fucking LIES and make up shit.

…but i guess there are always going to be shitty people like that in the world, and there’s nothing you can do about it. nonetheless, i am baffled how shitty these people are. and sorry for the foul language.

that’s the end of my rant. if you’ve read this far, thanks for listening? reading?

one of those days

today was one of those days where I just needed to break down and cry.

Trying to work hard and learn as much as I can, please my residents and attendings all day long, while maintaining friendly work relationships with my team mates is emotionally draining! …so I came home and cried today.

 

sometimes I cry because a cocaine addict patient tells me about his shame, guilt, feelings of worthless and habit of self isolation- all which resonates with me strongly, because it sounds EXACTLY like all the things I’ve felt while being depressed.

 

sometimes I cry because I want to work hard but also want to be liked by my classmates…and it’s often a fine line. and trying to do it jussstttttt right, walking on egg shells all day, is jut so so emotionally tiring.

 

sometimes I cry because I’m physically EXHAUSTED having to be on call a lot- that’s staying up for 28 hours straight every 4 days.

 

sometimes I cry because a patient who was COMPLETELY functional, after experiencing a seizure, they have all the symptoms of a stroke patient, i.e. needs to wear a diaper and help for everything. But, that’s not even the worst part. The part that gets me the most, is that since the doctors can’t offer any medication that will reverse the brain damage in this seizure patient, all they are able to offer is empathy and care. Yet, the doctors and residents don’t give a shit. All they want to do is get the patient out as soon as possible. THE LEAST YOU CAN DO IS SETUP A NEUROLOGY CONSULT AND REFER THEM TO A PHYSICAL THERAPIST AND SPEECH THERAPIST, YET YOU DON’T- INSTEAD YOU REFER THEM TO THEIR PCP SO THEY HAVE TO GO THROUGH A BAZILLION TIMES GREATER HASSLE TO GET SOME CARE. so fucking frustrating!!!!!!!!!!!! But, i’m just a med student, what can i do? my job is to be the resident’s bitch, not advisor.

 

sometimes I cry because I only get a pass in clinic, or I get asked a bazillion questions I don’t know by the residents, or my classmates know a lot more than me….and I get worried that I’ll be a terrible doctor….so I go home and cry.

 

sometimes I cry because I worry about whether I’m going to match anywhere for emergency medicine, when this is all I want to do.

 

so, lots of crying in med school so far. I just try to let it ALL OUT and just bawl if I need to, wipe away the tears, listen to some music or take a nap to relax, then get back to it….because med school is what I want to do.

 

so, I’ve done my crying to do, now I’m getting back to it..

shaming in med school

there’s this terrible culture of shaming in med school that doesn’t make much sense: shaming those who work hard.

people generally get quite annoyed with people who spend a lot of effort in the clinic, such as staying late, looking up the newest research that could benefit your patient, etc….AND IT DOESN’T MAKE SENSE. Shouldn’t this type of behavior be praised instead?

though there is admittedly a fine line between hard working and sucking up, i’m constantly tip toeing around others to work hard but not TOO hard. this AM specifically, i was shat on by my team mates for bringing a few papers showing findings that some chemo drugs cause seizures and other encephalopathies (since my patient had some unexplainable seizure that started worsening within the last yr all the sudden after being seizure free for 15 years). I REALLY WAS GENUINELY CURIOUS about my patient, not trying to impress the attending. but, even IF my motivation was only just to impress the attending, WHY DOES IT MATTER if i’m studying up on my patient and he/she may benefit from it?????

so annoying.

end rant.

Things to do on your psychiatry rotation

I wanted to document some things I learned in hopes that it will be helpful to other med students.

– ALWAYS do a suicide risk assessment. That doesn’t just mean “do you feel like killing yourself?” Other questions that also need to be asked include “are you occupied with thoughts of death?” and “do you ever wish you were dead?” as well as whether they have any plans, means, previous attempts.

-Antipsychotics drug side effects are things you want to be very wary of. For example, check thyroid function and kidney function, etc. if they are taking lithium.

– Anti-convulsants are often used as antipsychotics/mood stabilizers.  that information was new to me and confused me a little.

– Assess cognitive function for kids with behavioral problems. they may be refusing to do their homework because they think it’s hard and get frustrated with the level of difficulty.

– Psych emphasizes heavily on the social history. that means if they’re working and what they do, where they live, whom they live with, who they rely on for their social support system, etc.

– Specifically ask about marijuana. Though weed is technically considered a “recreational drug,” many patients do not put it in the drug category and will say no when asked whether they do any drugs. Thus, it’s important to specifically ask whether they smoke weed.

 Taking the substance use history. A thorough history includes: when they first used the substance, how frequently and how much they’re using, their most recent substance use, their longest period of sobriety and when that was, what caused the relapse, the purpose of using the substance (while this seems trivial, it is important to know if they self medicate their depression for alcohol or other reasons), and if they’ve gotten into any legal trouble relate to the substance use. Regarding street drugs, you ask how much money they spend on it.

– Don’t just take their word for it, ask specific symptoms. many people “think” they’re depressed or bipolar, but when further questioned about the specific symptoms they experience, it meets none of the DSM criteria.

– Other parts of the history include any past history of brain injury, seizures. also try to ask about physical/verbal/sexual abuse, childhood milestones, family history of mental illnesses.

– Depression and bipolar disorders are two of the most common mental illnesses you’ll likely see, so read up a lot on those.

– Make the interview conversational instead of having a list to complete for the history taking. While it is still important to get a full history, it doesn’t have to go in a particular order. Try to make the conversation flow naturally. For example, when they say they do xyz drugs, you can easily transition from “how much do you spend on drugs” to “what do you do for a living or how do you pay for the drugs?”

– You don’t actually formally conduct a mental status exam during the interview, it’s mostly just based on your observation- so not even the “where are you, what are you here for, etc.” to test for whether they’re alert and oriented to person time place. Also, most of the time you don’t do the cognitive function exam to assess their immediate/recent/remote memory unless relevant (e.g. they’re old, had previous brain injury). At least for me, I initially thought you did that on EVERYone.

– Learn the terminology early on. i think it’d be extremely beneficial to learn these terms even before you start the rotation or during the first few days, there aren’t THAT many of them anyway. I’m talking about terminology you use for the mental status exam such as: tangentiality, circumstantiality, thought blocking, etc.

– IN DELIRIUM, THE MOST IMPORTANT THING IS NOT BEING ORIENTED TO PERSON/TIME/PLACE. THAT is the super important thing for distinguishing it from psychosis.

– Child development stages may be worthwhile to review before the shelf. At least on my shelf exam, they asked about it and i totally wasn’t expecting it.

– Autonomic status is a helpful feature for distinguishing diff types of drug withdrawals. Specifically, alcohol and benzodiazapene withdrawal cause autonomic instability and can be lethal, which is much different than opiate withdrawal.

Finally, one last tip: try to enjoy it and not hate on it so much. It’s really the best time to work on your interviewing skills and empathy.