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Posts Tagged ‘medical school’

Tomorrow is my last day of medical school.

 

Ok, I don’t actually graduate until December, but as of tomorrow I will have completed all of the requirements for graduation from my school (because of my PhD I am half a year out of sync with the majority of my classmates).  I had initially planned to schedule a few more electives (might as well get as much hands on experience while I am still covered by liability insurance!), but interviews for residency programs have rapidly filled my schedule.

 

In the next couple of months I’ll be travelling around the country interviewing at various residency programs.  Many new doctors restrict themselves to geographic location when they apply to residency (the next phase in medical education- “Graduate Medical Education”), choosing to apply to programs in areas they are familiar with, have connections to, or where they have family.  I am applying widely- generally (though not exclusively) at academic programs, and with little thought to geography.  I’m fortunate to have friends in many of the places I’m applying (I actually think that visiting with friends when I travel to interviews is going to be one of the major perks of interview season), though certainly not all of them (any friends in Rochester Minnesota I’m not aware of?).

 

The “matching” process that graduating medical students (and some who have already graduated) go through seems rather odd to many people outside the medical community.  While I apply to and interview at many programs, ultimately I do not accept or reject a job offer from a residency program.  Medical students and residency programs enter into a system known as “the match”.  Through this process students apply to programs using an online application, programs offer interview invitations to selected students, students interview, and at the end of the day (or February 26th 2014 at 9pm EST if you’re being specific) medical students submit a “rank list” stating their preferences for residency.  Residency programs make similar rank lists, and using an algorithm a computer program determines our fates.  Putting student’s preferences first, the system determines where graduates will be headed for their internship in June or July.

 

March 17, 2014 is the start of “Match week” for my peers and me.  On that Monday we will get an email telling us if we “matched”.  There won’t be any specifics (you don’t find out where you matched until that Friday- “Match Day”), but that Monday marks a day when most med students around the country breathe a massive and collective sigh of relief.  On that day, Facebook is flooded by waves of status updates informing friends and family that “I’ll have a job in July!”, and “I’ll finally be making money” (though arguably not that much as a PGY1 (post graduate year 1).

 

Of course, a small minority of students will get emails that Monday informing them that they have not matched.  In the past these individuals have then “scrambled” for open positions, though now the system has been formalized into a process known as the SOAP (Supplemental Offer and Acceptance Program).  I won’t elaborate, but no student wants to use SOAP.

 

I’ve written before about speed dating for medical students, but then I was talking about the rapid-fire clinical rotations that medical students take in third year.  The interview process is also a “speed dating for medical students” experience, culminating with an arranged marriage of sorts.  While some students opt to do “away rotations” at programs they are very interested in for residency, you can’t possibly do rotations everywhere you hope to interview.  Spending a month at a hospital tells you a lot about the program you would be joining as a resident, but it can be hard to get a real sense of a program in just one day (or half a day, as the case may be).  Some programs offer dinners with residents, or extra time visiting a program, but it is truly a “speed-dating” experience.

 

These “speed dates” are important, since they determine how you choose where you hope to spend at least the next year of your life.  Some new doctors must do a “transition year” before heading off to their specialty of choice, but most new docs are interviewing for positions at hospitals where they will be based for anywhere from 3-7 years (residency training length varies with specialty.).

 

So that’s what I’ll be up to for the next few months- speed dating my way around the country. I’ve been invited to give a talk for the evolutionary medicine program when I’m out interviewing at UCLA, which should be fun, and I’m looking forward to visiting with friends and seeing the sights as I travel around the country.  I’m excited to visit lots of different hospitals and see what different programs have to offer.  Hopefully, when this round of speed dating comes to a close, I’ll have figured out how I want to write my dance card, and hopefully the programs I like find the feelings to be mutual.  If not, I guess there’s always a future in bovine obstetrics!

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I have been a zombie today.

I’ve wanted to write this post all day, but I’ve been spinning my wheels, unable to find the focus to sit and write.

I know where my inability to focus comes from. It’s the same thing that’s been causing my insatiable hunger and serious sweet-tooth.

I had a night shift on Thursday night.

The health industry is notoriously unhealthy. Even during the best of times the medical community tends to get things wrong with seminars on preventative health being coupled with breakfasts that consist of pastries, margarine to schmear on bagels, and fat-free non-dairy creamer to opacify a foul smelling substance that masquerades as coffee.

Practicing medicine is not easy on the body.  Being a doctor is stressful and, of course, spending your days around people who are sick makes you prone to getting sick yourself.  Lack of sleep is another big problem.

Of all the clerkships that medical students rotate through, the surgical ones- surgery and obstetrics/gynecology- have the worst hours. Depending on a school’s program, this is where students first get to experience the joys (by which I mean terrors) of 24+ hour call and “night float”.

At my school, the surgery clerkship has maintained the traditional call schedule (you work a day and then when you’re on call you stay for the night and finally go home the next morning when you are “post call”), while the ob/gyn clerkship has adopted a “night float” schedule for students, where we switch from day service to night service for a few days running during the clerkship.  These two clerkships were separated by 8 months in my schedule, so it’s perhaps hard to accurately compare them.  Nonetheless, I’d like to write about my experience with these two notoriously rough clerkships.

Surgery…

My school still follows a traditional call schedule for students on the surgery clerkship: every 4th or 5th day we would be “on call” after our normal day in the hospital. For the first half of this clerkship I was at a hospital 45 minutes away from my apartment. I was up between 4:25 and 4:30 each morning to be in the hospital by 5:30 to round on my patients before we “ran the list” as a team shortly after 6 and then headed to the OR for the day.

My problems on this clerkship started early. I had just come off my psychiatry clerkship where I’d been enjoying the psyche hours of 9-4… surgery hours were a big change. I couldn’t convince myself to eat breakfast before 4:30 and instead started my mornings with 1 or 2 double-shot espressos before heading to the hospital. The hospital to which I was assigned doesn’t have great quarters for medical students on surgery, so I was left to share a miniscule locker with 3 other students.  We barely had space to store our clothes, let alone space for real food. While there was a residents’ lounge, it was adorned with a large sign warning “Med students- do not leave your shit here”, and we didn’t have access to a fridge or a microwave. Lunch was a hit-or-miss occurrence, and the general mantra for med students during a surgery rotation is “eat when you can, you don’t know when you’ll have the opportunity next.”

Here’s a classic from Whatshouldwecallmedschool

During that first month I subsisted on my morning espressos and my best attempts at healthy snacks- unsweetened banana chips, jerky, nuts, and 85% chocolate. In the evenings I’d eat a proper dinner before putting myself to bed before 9 on most nights. I occasionally managed to make it to the gym, but I tended to feel rather weak and pathetic when I managed to get in a workout. Every 4th or 5th night I was on call, and instead of heading home around 5pm as per usual, I would grab dinner in the hospital cafeteria and see patients in the emergency department and go to the OR for emergency cases.  At some point during the evening (usually between 11pm and 1am) the night resident would tell the med students to retreat to our on-call room for some sleep, promising to page us if anything interesting came through. For me, at that hospital, I was never paged during the night.

My second month of surgery was on the trauma team at our university hospital, which is a level 1 trauma center.  Start time was similar at this hospital, but I was now 25 minutes closer, giving me 25 more blissful minutes of sleep. Also, at school we have a students’ lounge with a fridge and microwave, and I was able to start eating real lunches again. I also had realized that going to the gym in my stressed and sleep-deprived state was doing me no favors so I put my gym membership on hold.  Our call schedule was similar on trauma service, but unlike the general surgery service at a community hospital, the trauma team at our inner-city hospital was constantly getting paged in the wee-hours of the morning. I don’t think I ever got more than 2 hours of sleep when I was on call, and was always woken by the screams of the pager rather than the dulcet tones of my cell phone’s alarm (I occasionally hear a pager with the same ring-tone as the trauma pager and it still sends chills down my spine).

At the first hospital, after being on call, we were usually dismissed after we “ran the list”- frequently being on the way home shortly after 7am. On trauma we would run the list, go to radiology rounds, and then physically round on our patients as a team before being sent home.  Alas, our list of patients grew malignantly during my month of trauma and at one point we had over 30 patients, with some on each floor of the hospital. After a night on trauma I would usually find myself driving home after over 30 hours in the hospital (sometimes with no sleep) willing myself to get home safely (I really didn’t want to end up in the trauma bay as a patient- nothing like the fear of having your classmates cut your clothes off with shears to keep you awake!).

It’s amazing what lack of sleep does… I remember being asked a simple question one post-call morning on rounds and completely drawing a total blank. The funny thing was, it was a simple question that I actually felt very strongly about (Why do so many of our hospitalized patients have messed up electrolyte levels? We do it to them by flooding them with fluids!). Also, despite eating a lot less than I usually do, I definitely put on weight during my surgery clerkship.

Eight months later, as I faced the prospect of another notoriously rough clerkship (ob/gyn), I prepared myself a bit better.  While I was again stationed at the hospital 45 minutes from my apartment, this time I made sure that I ate breakfast before starting each day. I had also weaned myself completely off coffee before the start of the clerkship and never drank more than a single double-shot espresso each morning. I also preemptively put my gym-membership on hold.

We didn’t have call on ob/gyn and instead had a brief stint of “night float”, where we were in the hospital from 7pm-9am for a number of days consecutively.  This is a more realistic experience of life as an intern (with current intern rules), and has the advantage of allowing you to “switch over” from days to nights. I did a bit of research and when I switched over to nights I did a combination of fasting and napping that saw me switch over easily.

During ob/gyn I didn’t have much of a social life- I was going to bed between 8:30 and 9:30 most nights and most of my time was spent in the hospital or sleeping, but all things considered I think I held up very well.  I’ve long liked ending showers with a brief cold-water rinse (I think of it as a healthy bit of hormesis), but during surgery I lost the ability to tolerate cold showers.  Actually the worst part of being “post call” was the dreadful, inescapable cold that would come over me early on the post-call morning.  I’ve always been a warm-handed person, but on surgery I developed cold hands on a regular basis. While my hands weren’t always warm, I didn’t develop terrible chills on ob/gyn.

Med school is, of course, a learning experience, and a big part of the experience is learning what your body can handle and what it can’t (and what you need to do to keep yourself healthy, happy, and sane).  I’m not looking forward to the rough hours of residency, but I know the importance of prioritizing sleep, food, and socialization and I’m learning how to balance these things to keep myself well.

Alas, just after celebrating my successful navigation of ob/gyn (at least on the “feeling good” front, I’m still waiting for grades to be posted), I was knocked almost flat by a night shift on my current EMS elective.  While a night shift is not *required* during this elective it is strongly recommended, and I went out with the night crew on Thursday night to get an idea of what night-life on an ambulance in a rough inner-city is like (short answer- it does not disappoint).  While I was out with a great team and saw some pretty interesting things, I’ve been suffering the consequences since.  On Friday morning I had an insatiable appetite and was battling sugar-cravings (something I don’t usually have) for the rest of the day. Even after getting 11 hours of sleep last night I was still pretty groggy and fairly useless most of today.

There are no more night-shift in my foreseeable future (though I know we’ll meet again during my Emergency Medicine clerkship) and I’m confident that with another good night’s sleep I’ll be back to normal, but this has been a good reminder of just how brutal sleep deprivation can be.  My time with EMS (though only brief) has also reminded me that being in the health profession is often not a healthy practice. The people I’ve been working with sometimes risk their lives to save a stranger, but they also risk their health on a daily basis by living a lifestyle for which our bodies are ill-suited.

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