Neat ER patient

During my rotation at Cook County of Chicago in October-November 2013 I encountered many different patients, I remember one evening I had the following different patients: a  a beautiful young girl, in her low 20s, who was a heroin addict that shot heroin into her legs, she came in with a gigantic abcess on her right buttock with over 80cc of drainage of pus. The same night, a 20s something prisoner came in with a bloody lip, he had blood all over his prison jumpsuit, it looked scary, but it turned out to be just a simple cut. The same night a homeless man was in the ER who needed 26 staples removed from his abdomen, 1 month earlier he had bowel removed for IBD and had an exlap for it. He didn't remove the staples or his Foley catheter because he couldn't get a car to the Emergency Department. That was crazy.

Now, my favorite patient over the course of the rotation was this Asian gentleman in his 80s. He came in on my first overnight at Stroger, around midnight.  

He presented with 1 week of constipation/ no bowel movements and a sensation of bloating.  No nausea or vomiting, no fever or chills.  After our work up in the ED, it was determined he had a large bowel obstruction, and indeed he did. It was MASSIVE.  

His large bowel dilated to a maximum of 12cm! Unbelievable.  The cause of his large bowel obstruction turned out to be sigmoid volvulus. Everyone was afraid, including the surgery team, because usually  an obstruction like this in an eldery patient screams cancer. He turned out to be very lucky. He was taken to the colonoscopy clinic and the obstruction was decompressed.   

That patient, I will never forget. He was just plain fascinating.   

-MD in 14 

1st Residency Interview

It is 12:14 am, I just got done with my first residency interview TODAY, on Friday 11/15, its shortly past midnight, so the post looks like its from Saturday.

Anyways, I interviewed at a school in Kentucky, called Louisville University.  My 1st interview jitters are out.  I felt really good about the interview.

I drive down on Thursday, its about a 5.5hour drive to Louisville, got in around 10pm, and then read about residency in my hotel room (courtesy of the program, which is awesome!) until about 230am. I couldn't get to sleep on time since I am on my ER rotation, so my sleep is all screwed up. I had to wake at 6am,  get dressed and eat, and catch a shuttle to the campus at 7am. It was brutal waking up.

The day went quick too! I was there with one US student, and then 3 IMGs, one from Iraq, Iran, and Egypt. It was cool to see the diversity of our group! I was a bit anxious leading up to the first interview, but thankfully for beta blockers I was not that bad at all! It was interviews with 5 different doctors, the first being the program director. As unreal as this sounds, he is 80 years old. He is a boss. He was very friendly, first he talked about the program for about 5-10 minutes, then he asked me about my birth in Russia, and my thoughts on ban on Russian adoption. He also asked me about my summer orthopedic research project. Easy!

2nd interview: with a resident, a chief resident. He asked, why pathology, "What are you looking for in a pathology program". "What fellowships are you interested in". Again easy.

All the rest went like this too, all asked "Why pathology" and one asked "What is difference and similarity btwn AP and CP?",  and then another asked again "what are you looking for in a program".  Very straight foward questions, no curve balls. It went quick.

Then at noon the five interviewees and the 2 chief residents went for lunch at a nice place called "Mayan", I had a great tasting hamburger.  Then we went back and met some more residents and talked with the director as a group, again very laid back.

I feel like it went well, it was exciting!

-MD in 14

I am a 4th year medical student

It's been so long since I have written anything. Lots has happened, mainly:

1) I successfuly finished my entire 3rd year without failing a rotation or a shelf exam
2) I passed Step 2 CK with a good score
3) I changed my mind from going into Emergency Medicine into Family Medicine

I am currently on a 2 week family medicine rotation, which I just started. I began yesterday. Immediately I knew it was for me. The pace is much better than the ER, I know what people are coming into the office with, and I get a better chance to talk to people.  Yes, some of the stuff may seem run of the mill and somewhat boring, for example a blood pressure check, or a follow up for diabetes. However, just from my first day I have realized it's not about the disease, it's really about the person, and getting to talk to them, so even a mundane Diabetes melitus check up is interesting because of what the patient has to say, their story. I also enjoy sports physicals as mundane as they may be, its neat talking to kids about the sports they are pursuing and seeing the excitement in their face!

I saw about 20 patients yesterday with my family doctor, and not one bit was I stressed out as I was in the ER. I loved the ER, I learned alot, but the schedule, going from morning to nights, to evenings and then back to mornings and re doing that cycle was too much for me. Also, the constant speed and pressure in the ER got old quickly for me. Family is just a better fit for me.

So as of now, I am applying for family medicine programs. I have started my residency application process through a website called ERAS. It is like applying for medical school, you submit all of your information and upload letters of recommendation via this website. Oh and its like medical school because the fees for sending out each application are ridiculously expensive as well!!

-MD in 14

My First Code Blue Experience

My first code blue of 3rd year that I was in and got to see from start to finish was on my neurology rotation. It was a friday night and I was on call, which means I had to stay till about 8:00pm. I was dreading staying, but started studying to use the time wisely. All was quiet until about 6pm the over head system said Code blue 12th floor, Code blue 12th floor. I knew that was us and I  ran to the code blue with my team, my heart pumping. We got there before everyone and got to see the start to end of the code. The process was awesome.

The controlled chaos of 20 people in one room working smoothly to get this guy revived. He had a brain bleed initially for his reason at the hospital. He also had kidney failure and had to get dialysis every day, and he became unresponsive during the procedure. It was cool to see the doctor standing at head of bed coordinationg everyone, telling the nurse to push epi, and to push magnesium, and to push bicarb. They stopped every 2 minutes or so to check for a pulse and a shockable rythm and would do CPR. I almost did chest compressions, but I stepped back and just watched the process. Next time I will do compressions. The guy made it. It was super cool to see the process. It made me realize i really want to do ER. I love Codes!

-MD in 14 

First post of 2013 (3rd Year Impressions)

It has been literally months since I last wrote. My main excuses are I am too tired or I need to study. This is a major lol, since I still find time to play Call of Duty and watch TV for a little every night. Ha ha! Anyways, I am at home today, it is January 2nd 2013. I am cleaning up my papers from my last rotation and getting organized, and opened my "Internal Medicine" notebook to find something I wrote on the first day of the rotation of Internal Medicine. This was my last rotation of 2012. I have done 3 rotations thus far, they are in order, Surgery  (July 2012- Sept 1 2012), Pediatrics (Sept 2012-October 10th 2012 or so)  and then my last rotation was Internal Medicine which lasted until Christmas break.  Anyways, my note I found was:

First Day patient rounds at cook county-
-1 patient with crack/cocaine abuse
-1 heroin user
-1 women just out of jail 1 month ago
-1 man who is currently a prisoner and has possible TB
-2 patients who do not speak a lick of english

I'll never forget that. It was the 2nd half of my internal medicine rotation. I had completed 4 weeks at Rush, and just started Cook County. I had heard it was different and eye opening, but that was far from what I imagined. I have never seen any of those at Rush, besides some non english speaking patients. But, this was crazy. Cook County was eye opening. It was foreign, it was scary that first week.

Then, I got used to the system, but not entirely.  It's mainly poor people who cannot afford healthcare, and many, many prisoners. It was sad because many of the people were in really bad shape by the time they got to the hospital because they let the diseases go for a long time since they cannot afford to pay for anything. The patient that left the biggest impression on me, and it is hard to type this without some tears in my eyes, was a young women, I would say she is more of a girl, she was close to me in age, if I remember right, around 24 or 25. She had blood cancer called leukemia. She had it treated several years ago, but it had come back, and much stronger this time.My team told me that she was not going to make it.

She was going to die, and they said they said it was because no one would treat her, and the treatment available at cook county could not help. She needed a bone marrow transplant, and cook county does not do that operation. I remember the moment I had to go draw her blood one day, and her arms were black and blue from the constant blood draws. They were checking her antibiotic levels since she had something called neutropenic fever. I was the one that went and drew the blood for these levels every day. One day, her mother just broke down in a stream of tears as I was telling A, the patient,  (cant say her real name, so A will have to be it) that I was drawing her blood. So, I put my supplies down and walked over to her, and hugged her. She cried some more, even more heavily. She was spent.

 Her mother had been at A's side every day, almost every hour of the day. I had never seen a time she was not in the room.  I'll never forget that hug. It took all my might not to cry. That hug had an impact on her, and a major impact on me. This woman's daughter was dying in front of her. Every time I went in there she struggled to eat because the cancer had messed up her esophagus. She was also constantly in sweats and always looked  uncomfortable. I am crying as I write this. She's 24 years old and dying. The few times she smiled really made me realized how precious life is.  That is the most profound memory I have at county hospital. It makes me realize how small my problems I have are. This profession really humbles you. I complain about having to study or long hours at the hospital. It is nothing compared to the people we take care of. 

Anyways, rotations have been going well. It's hard, but very cool at the same time. I start neurology next Monday. It will last for one month. I only have 3 rotations left this year, and then I am done in April. It has gone FAST. so fast. I cannot believe I am almost a 4th year. I have really enjoyed it.

-MD in 14