Thursday
The homeless clinic was pretty cool because I was able to conduct six new client evals. And the last one was one of the most interesting cases I've seen all month. He had lots of Axis II stuff going on, like Borderline and Histrionic. He wanted an excessive amount of meds, that someone had previously prescribed, and threatened that if he didn't get it he would wind up in jail as a sex offender which would be OK because then he could get some and quiet to finish writing his book. He also had a creepy of saying "sugar" and "honey" to the NP, weird gyrations and some very grandiose expressions. Oh, did I mention he had been in jail because a "kangaroo court" charged him with possession of folding stock tactical weapons? He made for a great finale to my psych rotation.
Friday
Well after a long two hour commute from Herron Island I finally found the community clinic where I worked with a PA all day. It was slower than we expected and a couple patients didn't want me in the room. But I did see a couple STDs, a pre-leukemia anemic patient and general check-ups. The PA and I ended up having a fair amount of time to talk about careers and such as well. The long commutes and Herron Island ferry rides also gave me time for career contemplation.
At this point, rural medicine is sounding pretty good. I've sure gotten positive feedback from Becky, family and all the Docs, NPs, PAs, etc. that I've talked to. It is a bit a of gamble, but what isn't? Finding a community to help with loans and start-up costs while being attractive enough for us and hiring staff may be a bit tricky but there are a lot of opportunities in the Northwest.
Herron Island
Becky and kids sure loved this place. The idea of living in a scenic, quiet place with lots nature around for the kids sure appealed to her. The boys loved exploring the beach with their cousins and soaking most of their clothes every day. They rode bikes, collected shells, hiked around the 1.5 mile wide island and just had a good time. Other than the long commute and my ribs not giving me much sleep on the beds we were provided with, I like it as well.
I can definitely envision being a country Doc driving a short distance to work in my SUV (so I can tow toys and make rural house calls), working for myself with a small staff and then enjoying bike riding, hikes with the dogs, cross country skiing, etc. The kids would miss suburban services like the YMCA and I might have to invest in a pool, but I think they enjoy there their high school years in this kind of environment. Schools though are probably the biggest question at this point.
At this point I need to reevaluate my elective rotation options at the end of the year. I would still like to check out HemeOnc, RadOnc, Rads, etc. but I might be better off with a rural FP rotation (someone who does some of the procedures I'm interested in like C-sections) and another IM rotation (rural if possible).
B-day
Today is Colton's B-day, so it's time for the big event here in WA with all the family and friends. Then packing and the flight back to AZ tomorrow. I'm already trying to mentally prepare for my FP/OMM rotation starting Monday. I think I'm going to need to study a lot more, including many hours of Kaplan Step 2 review lectures and reading Step-up for Medicine. Oh, and I really need to go over all the OMM I've forgotten to!
Saturday, July 29, 2006
Wednesday, July 26, 2006
Last day at Greater Lakes
I spent the morning visit a couple of the adult residences run by Greater Lakes. The way it seems to work is that a client gets picked up and sent to Western State or Puget Sound Mental Health. When they are stable they go to a managed facility like Seely Lake Lodge. Then to a more independent facility with little supervision. Anywhere along the way they can decompensate though and cycle back through the system.
Many clients are long-term patients with medication non-compliance and illicit drug use being the two most common causes. Meth (i.e. crystal meth) seems to be an epidemic around here. WA is by some reports the manufacturing capital of the world for meth, with some reservations in the area have evidence of production in over 25% of the homes!
Meth is just about the worst drug these providers have seen thusfar. It can kill you with the first dose (esp. with pre-existing heart problems). It is almost 100% addictive after the first dose. It is cheap and easy to make. Oh, and it has this wonderful effect of permanently creating psychoses in many users! Want schizophrenia, voices telling you to do stuff or the ability to empathize with vegetable matter? Just use Meth for awhile. Scary stuff for our society, but I'm sure there are newer chemicals just around the corner.
This afternoon I sat in on my first therapy session with an insurance client. Until now, clients have pretty much been Medicare or Medicaid patients. So she was very normal with some relationship issues and anxiety. Not to belittle these very real problems, but they seemed so miniscule compared to the permanently compromised individuals I've been seeing for three weeks now. It was a nice break and a chance to actually provide some input from my own personal experience.
Many clients are long-term patients with medication non-compliance and illicit drug use being the two most common causes. Meth (i.e. crystal meth) seems to be an epidemic around here. WA is by some reports the manufacturing capital of the world for meth, with some reservations in the area have evidence of production in over 25% of the homes!
Meth is just about the worst drug these providers have seen thusfar. It can kill you with the first dose (esp. with pre-existing heart problems). It is almost 100% addictive after the first dose. It is cheap and easy to make. Oh, and it has this wonderful effect of permanently creating psychoses in many users! Want schizophrenia, voices telling you to do stuff or the ability to empathize with vegetable matter? Just use Meth for awhile. Scary stuff for our society, but I'm sure there are newer chemicals just around the corner.
This afternoon I sat in on my first therapy session with an insurance client. Until now, clients have pretty much been Medicare or Medicaid patients. So she was very normal with some relationship issues and anxiety. Not to belittle these very real problems, but they seemed so miniscule compared to the permanently compromised individuals I've been seeing for three weeks now. It was a nice break and a chance to actually provide some input from my own personal experience.
Tuesday, July 25, 2006
Rotation Evals
Monday was pretty straightforward. I got to sit in on couple interesting therapy sessions that gave me some insight into family therapy. I don't feel like I've had much exposure to behavioral or cognitive therapy, but I now understand it better. The day ended early so I got to enjoy a little extra time playing with the boys.
Today was my last day with my official preceptor, Dr. Karakus. We saw some interesting patients, including the most interesting Borderline one I've seen to date. He was hearing "helpful", repeatedly trying to kill himself (but somehow surviving each time) and involved in intense relationships. The Doc and I also had some time to talk about our personal lives, the profession and my decision making process as far as residency goes.
She basically recommended the rural Doc route with some procedures to supplement my income. She doesn't have children, but her thought was that moving during the boys' high school educations wouldn't be too bad. In separate conversations later in the evening my father, brother and mother-in-law all agreed. I just don't know. Going 100% for RadOnc (my fav still) or IM with a fellowship in HemeOnc are still attractive. I sure hope a more solid direction develops over the next few months.
Dr. Karakus gave me top marks on the evaluation of course. I hope we can stay in contact.
Becky, Julie and the boys headed to Heron Island near Gig Harbor to hook up with Paul, Susie and their kids. I hope to meet up with them tomorrow night and Thursday night after work. It's only about an hour from Lakewood including the 7-minute ferry boat ride to the 1.5 mile wide island. Sounds like the place is beautiful and the kids are beachcombing through multiple sets of soaked clothes.
I also learned that my brother and sister got married over the weekend; Dan to his long-term on-again off-again fiance Hiroko and Joanne to "committed" partner and father of three of her four children.
Oh, I tried to do some lap swimming at the YMCA during a break but barely managed 1k yards. I could only kick or breast stroke without pain so bad I caught my breath. I'm pretty convinced that I'm experiencing my first cracked ribs, since bruising or inflammation would have lessened by now. Plus I know my swimming anatomy/biomechanics pretty well. I can't envision anything else producing sharp, focal pain on the costochondral margins of ribs 7, 8 and possibly 9. I still hurt with deep inspiration, valsalva maneuvers, blowing my nose or using my rectus abdominus muscles.
Today was my last day with my official preceptor, Dr. Karakus. We saw some interesting patients, including the most interesting Borderline one I've seen to date. He was hearing "helpful", repeatedly trying to kill himself (but somehow surviving each time) and involved in intense relationships. The Doc and I also had some time to talk about our personal lives, the profession and my decision making process as far as residency goes.
She basically recommended the rural Doc route with some procedures to supplement my income. She doesn't have children, but her thought was that moving during the boys' high school educations wouldn't be too bad. In separate conversations later in the evening my father, brother and mother-in-law all agreed. I just don't know. Going 100% for RadOnc (my fav still) or IM with a fellowship in HemeOnc are still attractive. I sure hope a more solid direction develops over the next few months.
Dr. Karakus gave me top marks on the evaluation of course. I hope we can stay in contact.
Becky, Julie and the boys headed to Heron Island near Gig Harbor to hook up with Paul, Susie and their kids. I hope to meet up with them tomorrow night and Thursday night after work. It's only about an hour from Lakewood including the 7-minute ferry boat ride to the 1.5 mile wide island. Sounds like the place is beautiful and the kids are beachcombing through multiple sets of soaked clothes.
I also learned that my brother and sister got married over the weekend; Dan to his long-term on-again off-again fiance Hiroko and Joanne to "committed" partner and father of three of her four children.
Oh, I tried to do some lap swimming at the YMCA during a break but barely managed 1k yards. I could only kick or breast stroke without pain so bad I caught my breath. I'm pretty convinced that I'm experiencing my first cracked ribs, since bruising or inflammation would have lessened by now. Plus I know my swimming anatomy/biomechanics pretty well. I can't envision anything else producing sharp, focal pain on the costochondral margins of ribs 7, 8 and possibly 9. I still hurt with deep inspiration, valsalva maneuvers, blowing my nose or using my rectus abdominus muscles.
Weekend on Lake Entiat
Lake Entiat is actually the Columbia River damned up in between Wenatchee and Chelan. Becky's older brother owns a vacation home in a planned community there and we were invited for an (almost annual) get together there over the weekend. So after a pretty normal Friday at Greater Lakes Mental Healthcare (and saying goodbye to Po), the boys and I headed to SeaTac to pick up Becky. Then the four of us made the 3 hour drive over the passes.
Saturday the boys had a great time intertubing with their cousins on a huge 4-person hotdog-in-a-bun shaped tube. I goofed around on it with Colton and Kyle and paid the price with a nasty fall at 30mph at we got whipped around a corner. The boys skipped like rocks while I slammed into the 'pavement'. At the time I thought I just had the wind knocked out and some bruises.
Later we did a little cliff jumping. Colton was ready to be a daredevil with his cousin . I felt up to helping him in the current and jumped off a 10-footer with them. But the that little dude then decided to jump off the 20 to 25 foot one! I was too sore for that, so I stayed below for a great view of 7 year old terror.
We then relaxed to some of Dave's great cooking, reading and generally hanging out while the kids played pingpong and video games.
Sunday Dave and I rode about 25 miles with a couple fun hills that proved how out of shape I still am. After breakfast we headed for the boat again and we greeted with some very smooth water. The wake boarding was great, but Colton was disappointed that he only got. He couldn't maintain his balance so he kept falling down until his hands were sore. Becky had almost the exact same experience (and it was her best progress to date to). Connor wasn't feeling well. Chills with the temperature over 105 isn't normal. He was also very disappointed that he was in no shape to keep up with his younger brother and cousin. I managed to get up on the wake board just fine, but Dave and Trish's new Boat's much larger wake was intimidating. After a couple successful toe-side turns I bit it good on my already sore ribs. At this point I starting think cracked ribs was a real possibility.
Kyle and Trish showed us some real wake boarding. Dave took a break from driving and had a bit of fun too. But Katie chose demonstrate knee boarding. By the end, the water was choppy and lunch called. Colton requested a last minute cliff dive and repeated his earlier performance. But not before Kyle tried to demo for him and got injured with a rough landing. Luckily it looked like he would only have a sore back for a day or two.
We ate lunch then napped and relaxed for the rest of the day until it was time to pack up and head back to Lakewood. Not a bad weekend mini-vacation for medical school.
Saturday the boys had a great time intertubing with their cousins on a huge 4-person hotdog-in-a-bun shaped tube. I goofed around on it with Colton and Kyle and paid the price with a nasty fall at 30mph at we got whipped around a corner. The boys skipped like rocks while I slammed into the 'pavement'. At the time I thought I just had the wind knocked out and some bruises.
Later we did a little cliff jumping. Colton was ready to be a daredevil with his cousin . I felt up to helping him in the current and jumped off a 10-footer with them. But the that little dude then decided to jump off the 20 to 25 foot one! I was too sore for that, so I stayed below for a great view of 7 year old terror.
We then relaxed to some of Dave's great cooking, reading and generally hanging out while the kids played pingpong and video games.
Sunday Dave and I rode about 25 miles with a couple fun hills that proved how out of shape I still am. After breakfast we headed for the boat again and we greeted with some very smooth water. The wake boarding was great, but Colton was disappointed that he only got. He couldn't maintain his balance so he kept falling down until his hands were sore. Becky had almost the exact same experience (and it was her best progress to date to). Connor wasn't feeling well. Chills with the temperature over 105 isn't normal. He was also very disappointed that he was in no shape to keep up with his younger brother and cousin. I managed to get up on the wake board just fine, but Dave and Trish's new Boat's much larger wake was intimidating. After a couple successful toe-side turns I bit it good on my already sore ribs. At this point I starting think cracked ribs was a real possibility.
Kyle and Trish showed us some real wake boarding. Dave took a break from driving and had a bit of fun too. But Katie chose demonstrate knee boarding. By the end, the water was choppy and lunch called. Colton requested a last minute cliff dive and repeated his earlier performance. But not before Kyle tried to demo for him and got injured with a rough landing. Luckily it looked like he would only have a sore back for a day or two.
We ate lunch then napped and relaxed for the rest of the day until it was time to pack up and head back to Lakewood. Not a bad weekend mini-vacation for medical school.
Thursday, July 20, 2006
Homeless Clinic
Today was a good today at the homeless clinic Greater Lakes Mental Healthcare is contracted to run (the Psych part). First, I saw one of the clients from last week. This Hispanic guy has symptomatic dilated cardiomyopathy at 42. I thought of Chaga's dz after the meeting last week, so I asked him where he's from. Nicaragua! So I immediately asked the PA I work with how we can order a bleed screen. I may have just made my first save :-).
I also got to run through several evaluations with new patients, including typing in all the notes. The ARNP (nurse practionerer) I'm working with changed a few things and then we agreed on medication plan. Pretty cool. Of there were some hard luck stories, but I hope we are helping them improve their lives.
The afternoon went kinda slow, so I worked with the PA on the medical side of the building and helped unpack and repack a nasty injection site abscess that was drained a couple days ago. I then got to inject lidocaine and cut open a guy's ear that had a large, nasty sebaceous cyst. He had "popped" out most of the gunk, so it was inflamed and refilled with mostly blood. A pretty messy hematoma, but a great experience for me. Looks like I'll be spending my last day of this rotation, next Friday, with the PA. Should be great!
Tomorrow is the last day for me to spend with NP I've been shadowing (the meds team lead) since he's on vacation next week. Hopefully I can get the rest of the week scheduled. Right after work it's off to the airport to pick up Becky. Then it's off to my brother-in-law's vacation house on the Columbia River, actually a portion of it that is damned up so it's basically a large water-ski lake in Eastern Washington.
I also got to run through several evaluations with new patients, including typing in all the notes. The ARNP (nurse practionerer) I'm working with changed a few things and then we agreed on medication plan. Pretty cool. Of there were some hard luck stories, but I hope we are helping them improve their lives.
The afternoon went kinda slow, so I worked with the PA on the medical side of the building and helped unpack and repack a nasty injection site abscess that was drained a couple days ago. I then got to inject lidocaine and cut open a guy's ear that had a large, nasty sebaceous cyst. He had "popped" out most of the gunk, so it was inflamed and refilled with mostly blood. A pretty messy hematoma, but a great experience for me. Looks like I'll be spending my last day of this rotation, next Friday, with the PA. Should be great!
Tomorrow is the last day for me to spend with NP I've been shadowing (the meds team lead) since he's on vacation next week. Hopefully I can get the rest of the week scheduled. Right after work it's off to the airport to pick up Becky. Then it's off to my brother-in-law's vacation house on the Columbia River, actually a portion of it that is damned up so it's basically a large water-ski lake in Eastern Washington.
Wednesday, July 19, 2006
USMLE Score
Last night Becky read my score to me over the phone. It's a decent score, but not quite as high as I hoped. It's high enough to get me into all but most competitive specialties and programs. It's also right about where I thought I'd end up, and interestingly about the same percentile as my GPA.
Given family responsibilities, a lack of recent science coursework and the number of really smart med students out there, I'm pretty happy to be at about the 80% mark. Not surprising, I was strongest on the conceptual stuff like Phys and weakest on the molecular, biochem, micro and immuo sections. The former two aren't taught as in depth at Osteopathic schools and the latter two were just taught horribly at our school. I studied the most in these areas knowing they were weak and memorization of obscure pathways isn't strong suit. But I always seem to do best (even with the least amount of studying) on the conceptual stuff. Once I have the map, table or shape/pattern in my brain, I can manipulate it as well as just about anybody.
Now it's the wait for my COMLEX score. It is no where near as important in my mind, but I need to pass it for my degree and it will be interesting how well the scores correlate.
Given family responsibilities, a lack of recent science coursework and the number of really smart med students out there, I'm pretty happy to be at about the 80% mark. Not surprising, I was strongest on the conceptual stuff like Phys and weakest on the molecular, biochem, micro and immuo sections. The former two aren't taught as in depth at Osteopathic schools and the latter two were just taught horribly at our school. I studied the most in these areas knowing they were weak and memorization of obscure pathways isn't strong suit. But I always seem to do best (even with the least amount of studying) on the conceptual stuff. Once I have the map, table or shape/pattern in my brain, I can manipulate it as well as just about anybody.
Now it's the wait for my COMLEX score. It is no where near as important in my mind, but I need to pass it for my degree and it will be interesting how well the scores correlate.
Experiences in Therapy
Today was fairly interesting. I spent the morning in the injection lab mosting talking with the nurse (a cool guy names Amos) about motorcycles, ATVs and fun outside of work. The weird was how normal these folks are when they stay on their Consta injections every 2 weeks. It's a pretty heavy antipsychotic, so they must need it. But you wouldn't pick them out of any crowd.
The afternoon was my first chance to sit in on some pure therapy sessions and a peds group session for boys 8-9 yrs old. It was nothing like the sterotypical Psychiatrist asking about childhood experiences or freudian analysis. Lots of basic coping skills and relationship tools. My last apt of the evening was with a charming, pretty girl who seemed just like any other teenager on the surface. However, she came from a traffic background and has fetal alcohol syndrome (she looked more like a model than the Path pictures of FAS that I remember). While she can't read or write well, she's made great strides in improving her self-confidence, independance, positive attitude and relationship boundries. You couldn't help but be charmed by her personality and strength of character given what she's been through.
Yesterday, I spent the day mostly talking meds with my Preceptor. Most of the cases were existing clients doing pretty well that needed minor adjustments to meds if anything. We also had a couple evaluations for new clients. These were like peeling the layers off the onion. Broken homes, distrustful relationships with guardians and poor anger management. Both cases ended up being diagnosed with ADHD and started on low dose Strattera. Definitely no quick fixes in most of these cases.
Back to the homeless shelter tomorrow...
The afternoon was my first chance to sit in on some pure therapy sessions and a peds group session for boys 8-9 yrs old. It was nothing like the sterotypical Psychiatrist asking about childhood experiences or freudian analysis. Lots of basic coping skills and relationship tools. My last apt of the evening was with a charming, pretty girl who seemed just like any other teenager on the surface. However, she came from a traffic background and has fetal alcohol syndrome (she looked more like a model than the Path pictures of FAS that I remember). While she can't read or write well, she's made great strides in improving her self-confidence, independance, positive attitude and relationship boundries. You couldn't help but be charmed by her personality and strength of character given what she's been through.
Yesterday, I spent the day mostly talking meds with my Preceptor. Most of the cases were existing clients doing pretty well that needed minor adjustments to meds if anything. We also had a couple evaluations for new clients. These were like peeling the layers off the onion. Broken homes, distrustful relationships with guardians and poor anger management. Both cases ended up being diagnosed with ADHD and started on low dose Strattera. Definitely no quick fixes in most of these cases.
Back to the homeless shelter tomorrow...
Monday, July 17, 2006
On a roll
Two days in a row! Actually not that much interesting happened today, but enough for a quick note.
I saw a real 'cutter' today. Her forearms were covered with more scar tissue than normal skin. One self-mutilation from a few days ago was still open, deep and oozing, but she kept mentioning how nicely it was closing up. Yikes.
I then spent the afternoon visiting several wards at Western State Hospital. That is one bizarre and gigantic place. There are thousands of 'clients' at that place and probably twice as many employees. I have a lot or respect for those people that go into that depressing environment everyday and try to manage that population. I'm realizing that I would rather deal with the terminally ill than the demented and delirious.
On the plus side, most of our clients that were willing to see us were very lucid and alert. A couple should be ready for discharge soon.
I saw a real 'cutter' today. Her forearms were covered with more scar tissue than normal skin. One self-mutilation from a few days ago was still open, deep and oozing, but she kept mentioning how nicely it was closing up. Yikes.
I then spent the afternoon visiting several wards at Western State Hospital. That is one bizarre and gigantic place. There are thousands of 'clients' at that place and probably twice as many employees. I have a lot or respect for those people that go into that depressing environment everyday and try to manage that population. I'm realizing that I would rather deal with the terminally ill than the demented and delirious.
On the plus side, most of our clients that were willing to see us were very lucid and alert. A couple should be ready for discharge soon.
Sunday, July 16, 2006
Psych halfway point
This Psych rotation is so different from what I expected. For starters:
-We have clients (not patients) and providers (not practionerers)
-Psych meds are much more complex than we learned and GPs generally don't do well in this area
-Nurse Practioners handle most of the outpatient Psych meds (I don't think it's just WA either)
-Psychologists handle most of the therapy
-It's 1% housewives seeking valium and 99% IVDAs needing antipsychotics (that's only a slight exaggeration)
-No couches
I only spend one day a week with my psychiatrist 'preceptor' but she's awesome. She's a German neurosurgeon turned psychiatrist after marrying a Turkish neurosurgeon and relocating here since neither one could speak the other's native tongue!
Then I typically spend one day a week with NPs on meds management; one with psychologists on therapy; one at a homeless shelter we're contracted to provide for; and one shadowing our liaison to visit clients at inpatient hospitals after they've been picked up for going off Meds or onto street drugs.
Peds is the most interesting and tragic part I've seen. One young man had a high fever requiring resuscitation that led to seizures at 10 and psychosis later. A family understandibly had the mom in counseling after three of her four kids acquired mental health issues and the father is an uninvolved soldier recently returned from Iraq. Being near Ft. Lewis, we get many less extreme cases related to the war in Iraq. Besides PTSD, soldiers' families frequently have major depression, ADHD and other mental health issues.
Next week I hope to get more directly involved. I'm supposed to spend a day working on wound managment for medicaid clients which will mostly consist of I&Ds on drug injection abscesses. Then I'm going to use my laptop to write my own client notes and scripts since everything here is computerized. Monday I should get to see some really interesting clients committed at Western State just a few miles away. That place is fascinating and scary. It's an old Civil War era Army base the size of some towns converted into one of the country's largest mental hospitals. The hospital has 983 beds! It has a jail for the criminally insane. It even has a farm that inmates used to raise crops on. It also includes a lake and park for the public to use.
The fact that the boys and I have to enjoy the sunny weather, greenery and 75 degree temperature doesn't hurt either :-). Becky is back in Phoenix working and understandably jealous.
This is going to be a great year, regardlesss of the Board scores I get this week. I just love learning with realy patients. Textbooks do not teach the craft of healing.
-We have clients (not patients) and providers (not practionerers)
-Psych meds are much more complex than we learned and GPs generally don't do well in this area
-Nurse Practioners handle most of the outpatient Psych meds (I don't think it's just WA either)
-Psychologists handle most of the therapy
-It's 1% housewives seeking valium and 99% IVDAs needing antipsychotics (that's only a slight exaggeration)
-No couches
I only spend one day a week with my psychiatrist 'preceptor' but she's awesome. She's a German neurosurgeon turned psychiatrist after marrying a Turkish neurosurgeon and relocating here since neither one could speak the other's native tongue!
Then I typically spend one day a week with NPs on meds management; one with psychologists on therapy; one at a homeless shelter we're contracted to provide for; and one shadowing our liaison to visit clients at inpatient hospitals after they've been picked up for going off Meds or onto street drugs.
Peds is the most interesting and tragic part I've seen. One young man had a high fever requiring resuscitation that led to seizures at 10 and psychosis later. A family understandibly had the mom in counseling after three of her four kids acquired mental health issues and the father is an uninvolved soldier recently returned from Iraq. Being near Ft. Lewis, we get many less extreme cases related to the war in Iraq. Besides PTSD, soldiers' families frequently have major depression, ADHD and other mental health issues.
Next week I hope to get more directly involved. I'm supposed to spend a day working on wound managment for medicaid clients which will mostly consist of I&Ds on drug injection abscesses. Then I'm going to use my laptop to write my own client notes and scripts since everything here is computerized. Monday I should get to see some really interesting clients committed at Western State just a few miles away. That place is fascinating and scary. It's an old Civil War era Army base the size of some towns converted into one of the country's largest mental hospitals. The hospital has 983 beds! It has a jail for the criminally insane. It even has a farm that inmates used to raise crops on. It also includes a lake and park for the public to use.
The fact that the boys and I have to enjoy the sunny weather, greenery and 75 degree temperature doesn't hurt either :-). Becky is back in Phoenix working and understandably jealous.
This is going to be a great year, regardlesss of the Board scores I get this week. I just love learning with realy patients. Textbooks do not teach the craft of healing.
Recovery and Orientation
Recovery
I really only had three days to recover before orientation for rotations. While I should have been finishing the Gamma Knife research paper I was writing for a classmate, I couldn't do much of anything medical related.
Playing with my kids and dogs was refreshing. I even read a pleasure book over the weekend and got in some swimming. It just felt so good to never have to worry about Monday and Friday morning finals again. The table in the student lounge that I had lived at for the last few months was now free for the next victim. It had been my favorite study spot for most of the previous two years. And for the last couple of months, most nights I left my garbage and a half dozen books or so on it not so much to claim ownership as to save myself multiple trips to my car.
I also cleaned out the books in my car, three milk crates worth of Boards prep material!
Orientation
Our Clinical Education department is not world class (just trying to be polite). And while the staff works hard for us, orentiation was disorganized and not very beneficial. I skipped several lectures to read Boards & Wards and scope books for rotations. I purchased many from Ebay at steep discounts, but wanted to plan ahead and not end wasting money on bad decisions.
Some lectures on didactics and rotation preparation were pretty good. Especially the ones run by our new Surgery and OB/Gyn dept heads. The ones run by Profs in IM, FM and Peds were generally poor. You'd think that after they've been on the job for 8+ years and had the recent examples set by the newest dept heads they would at least try meet the bar. But no, they seem almost clueless to what students need for rotations.
Moreover, the ClinEd dept has put a bunch of new requirements on us like logging ICD-9 codes of all the patients we see. They don't provide any tools or lists, just a huge new hassle. Ugh!
At least our class gets along very well so we will share rotation objectives, tips, best practices, etc. I've learned far more from classmates and upper classmen than from the oldtime docs in ClinEd.
Finally, it was time to say goodbye to classmates and pack for the drive to first rotation at my mother-in-laws: psychiatry in Lakewood, WA. Becky and I switched driving while the kids slept through the night. We arrived Satuday morning after 24 hours of driving. The Seattle area is so beautiful in the summer!
It's wierd to think that our class won't be back together as a whole until our MSIII finals and MSIV orientation next summer.
I really only had three days to recover before orientation for rotations. While I should have been finishing the Gamma Knife research paper I was writing for a classmate, I couldn't do much of anything medical related.
Playing with my kids and dogs was refreshing. I even read a pleasure book over the weekend and got in some swimming. It just felt so good to never have to worry about Monday and Friday morning finals again. The table in the student lounge that I had lived at for the last few months was now free for the next victim. It had been my favorite study spot for most of the previous two years. And for the last couple of months, most nights I left my garbage and a half dozen books or so on it not so much to claim ownership as to save myself multiple trips to my car.
I also cleaned out the books in my car, three milk crates worth of Boards prep material!
Orientation
Our Clinical Education department is not world class (just trying to be polite). And while the staff works hard for us, orentiation was disorganized and not very beneficial. I skipped several lectures to read Boards & Wards and scope books for rotations. I purchased many from Ebay at steep discounts, but wanted to plan ahead and not end wasting money on bad decisions.
Some lectures on didactics and rotation preparation were pretty good. Especially the ones run by our new Surgery and OB/Gyn dept heads. The ones run by Profs in IM, FM and Peds were generally poor. You'd think that after they've been on the job for 8+ years and had the recent examples set by the newest dept heads they would at least try meet the bar. But no, they seem almost clueless to what students need for rotations.
Moreover, the ClinEd dept has put a bunch of new requirements on us like logging ICD-9 codes of all the patients we see. They don't provide any tools or lists, just a huge new hassle. Ugh!
At least our class gets along very well so we will share rotation objectives, tips, best practices, etc. I've learned far more from classmates and upper classmen than from the oldtime docs in ClinEd.
Finally, it was time to say goodbye to classmates and pack for the drive to first rotation at my mother-in-laws: psychiatry in Lakewood, WA. Becky and I switched driving while the kids slept through the night. We arrived Satuday morning after 24 hours of driving. The Seattle area is so beautiful in the summer!
It's wierd to think that our class won't be back together as a whole until our MSIII finals and MSIV orientation next summer.
Boards
USMLE Step 1
Surprisingly my stress level for the actual USMLE Step 1 on June 12th was pretty low. At that point, I knew I had done the best I could to prepare over the month since classes ended. Sure I could have put in a few more hours or studied more effectively if I had to do it again. But I really lost my motivation. Burnout had overcome my demoralizing schedule.
The test was not what I expected. In fact, along with many classmates, I'm shocked that this is the primary tool used to rank future physicians. It felt like the test was for a PhD in Biochem. The actual medical knowledge tested was incredibly minor. Out of 350 questions (7 blocks of 50 questions) I had less than 25 Pharm questions, a similar number of Micro questions and 25% or so Path questions (vs. the predicted 40%).
My recollection may be biased towards the more difficult questions, but I got tired of the questions that basically included the following stub; "A researcher testing a new drug uses three knockout mice lines to test its efficacy..." Then you had to interpret test results that had nothing to do with knowledge learned in medical school. Luckily I had exercised the day before so I got plenty of rest and a good night's sleep. I can only hope that the test goes like the MCAT where I end up doing better than expected. <Please!>
Afterwards I vegged out on Studentdoctor.net. The match results for RadOnc were very depressing based on the 40+ folks who listed how they matched. I definitely need a good fallback even if I got a decent score.
COMLEX Step 1
I had two days to study for COMLEX after USMLE. However, my motivation was pretty low. I got nowhere near the 12 to 16 hours of studying in I had hoped. I got maybe 10 hours each day consisting of 6 hours of repetitive COMLEX practice questions on Kaplan's Qbank and 4 hours of Pharm and Micro review (which rumor had it were heavily emphasized).
I'm glad I hit those areas, but in the state I was in I don't think that I retained much information. I also didn't prepare as well. I was too burned out to exercise, so I slept horribly the night before. The test started an hour and a half earlier so I didn't get in my two hour "last minute" cram session of buzzwords and formulas. I started with the feeling that I just wanted to get it over.
The test itself was 400 questions in eight hours. I had heard the questions were MUCH more straight forward than USMLE so I expected to finish earlier even with the extra 50 questions. I did have less time pressure than on the USMLE (I actually had time review check-marked questions) but it wasn't as easy as many students reported. I hope that I just had harder questions instead of my being frazzled and/or less prepared. I figure about 50% of the questions were easy whereas friends who took the test earlier put the number closer to 75%. I could very well have scored higher on USMLE than on COMLEX. I'm ok with this as long a) I pass both and b) the USMLE score is over the 85% so the door isn't closed on some specialties.
Scores come out this week. I'm numb and emotionless about it. I know this could be a great week, or a very depressing one. Either way, I can't express how glad I am that those two years are over. I think I'm still in recovery from the stress. It's very de-humanizing and no one gets into medicine to put through it.
Surprisingly my stress level for the actual USMLE Step 1 on June 12th was pretty low. At that point, I knew I had done the best I could to prepare over the month since classes ended. Sure I could have put in a few more hours or studied more effectively if I had to do it again. But I really lost my motivation. Burnout had overcome my demoralizing schedule.
The test was not what I expected. In fact, along with many classmates, I'm shocked that this is the primary tool used to rank future physicians. It felt like the test was for a PhD in Biochem. The actual medical knowledge tested was incredibly minor. Out of 350 questions (7 blocks of 50 questions) I had less than 25 Pharm questions, a similar number of Micro questions and 25% or so Path questions (vs. the predicted 40%).
My recollection may be biased towards the more difficult questions, but I got tired of the questions that basically included the following stub; "A researcher testing a new drug uses three knockout mice lines to test its efficacy..." Then you had to interpret test results that had nothing to do with knowledge learned in medical school. Luckily I had exercised the day before so I got plenty of rest and a good night's sleep. I can only hope that the test goes like the MCAT where I end up doing better than expected. <Please!>
Afterwards I vegged out on Studentdoctor.net. The match results for RadOnc were very depressing based on the 40+ folks who listed how they matched. I definitely need a good fallback even if I got a decent score.
COMLEX Step 1
I had two days to study for COMLEX after USMLE. However, my motivation was pretty low. I got nowhere near the 12 to 16 hours of studying in I had hoped. I got maybe 10 hours each day consisting of 6 hours of repetitive COMLEX practice questions on Kaplan's Qbank and 4 hours of Pharm and Micro review (which rumor had it were heavily emphasized).
I'm glad I hit those areas, but in the state I was in I don't think that I retained much information. I also didn't prepare as well. I was too burned out to exercise, so I slept horribly the night before. The test started an hour and a half earlier so I didn't get in my two hour "last minute" cram session of buzzwords and formulas. I started with the feeling that I just wanted to get it over.
The test itself was 400 questions in eight hours. I had heard the questions were MUCH more straight forward than USMLE so I expected to finish earlier even with the extra 50 questions. I did have less time pressure than on the USMLE (I actually had time review check-marked questions) but it wasn't as easy as many students reported. I hope that I just had harder questions instead of my being frazzled and/or less prepared. I figure about 50% of the questions were easy whereas friends who took the test earlier put the number closer to 75%. I could very well have scored higher on USMLE than on COMLEX. I'm ok with this as long a) I pass both and b) the USMLE score is over the 85% so the door isn't closed on some specialties.
Scores come out this week. I'm numb and emotionless about it. I know this could be a great week, or a very depressing one. Either way, I can't express how glad I am that those two years are over. I think I'm still in recovery from the stress. It's very de-humanizing and no one gets into medicine to put through it.
Didatics are over!!
Well it's been a long time since I last posted. I even forgot my account information and had to spend a while this weekend looking it up. So let me begin by summing up the last six months of MSII. Then, either in this message or following ones, I can cover Boards and my first rotation.
January and February were Hell. Tests constantly and stress levels that are simply unhealthy put most of the class in depression. I pretty didn't care about grades, family or health anymore. I did ok, my lowest quarterly score overall, but only by a couple tenths of a percent. My impressoin of AZCOM and medical school in general hit a new trough.
The forty or so of us who paid to take the Northwest Medical Review course beginning the day after finals had no idea how burned out we'd be. Saturday through Wednesday we sat in class for eight hours a day covering a ton of material. I don't think I was the only one in a stupor.
I begin Spring quarter with a poor attitude towards school, but determined to do my best on Boards. I skipped a lot more class to study on my own and proceeded to work through most of Kaplan's Webprep course. Not having Micro was a relief but it was replaced by a stupid class called OCM that crammed 4 credits into 8 hours a week of lecture for the first half of the quarter. Everyone expected that we'd have a lot more time to study for Boards the last half. We were mistaken.
In the end I got through all of Webprep except the most important subject, Path. I also started onto Goljan's lectures for a second time. By not caring as much, I even got my best grades of the year. However, I had no idea how truly spent I was at the after finals.
I tried to power through Webprep Path and then dive into FirstAid, Step-up and Goljan's high yield notes while doing 100 practice questions per night (and reviews answers) plus 350 over each weekend. I burned out. I took a three day break and didn't finish Kaplan's 2100 question Qbank, let alone questions from NW Medical, Buzzwords, Rapid Review books or the freebies from NBME. The highest yield for me was Goljan's notes, Qbank and the last week of going through FirstAid and StepUp a second time. I wrote a ton of additional notes into StepUp and many of my own notes. Path, Micro and a lot of Biochem really came together over that period.
An then USMLE Step 1 on June 12th...
January and February were Hell. Tests constantly and stress levels that are simply unhealthy put most of the class in depression. I pretty didn't care about grades, family or health anymore. I did ok, my lowest quarterly score overall, but only by a couple tenths of a percent. My impressoin of AZCOM and medical school in general hit a new trough.
The forty or so of us who paid to take the Northwest Medical Review course beginning the day after finals had no idea how burned out we'd be. Saturday through Wednesday we sat in class for eight hours a day covering a ton of material. I don't think I was the only one in a stupor.
I begin Spring quarter with a poor attitude towards school, but determined to do my best on Boards. I skipped a lot more class to study on my own and proceeded to work through most of Kaplan's Webprep course. Not having Micro was a relief but it was replaced by a stupid class called OCM that crammed 4 credits into 8 hours a week of lecture for the first half of the quarter. Everyone expected that we'd have a lot more time to study for Boards the last half. We were mistaken.
In the end I got through all of Webprep except the most important subject, Path. I also started onto Goljan's lectures for a second time. By not caring as much, I even got my best grades of the year. However, I had no idea how truly spent I was at the after finals.
I tried to power through Webprep Path and then dive into FirstAid, Step-up and Goljan's high yield notes while doing 100 practice questions per night (and reviews answers) plus 350 over each weekend. I burned out. I took a three day break and didn't finish Kaplan's 2100 question Qbank, let alone questions from NW Medical, Buzzwords, Rapid Review books or the freebies from NBME. The highest yield for me was Goljan's notes, Qbank and the last week of going through FirstAid and StepUp a second time. I wrote a ton of additional notes into StepUp and many of my own notes. Path, Micro and a lot of Biochem really came together over that period.
An then USMLE Step 1 on June 12th...
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