la la la

it don't mean a thing, if it ain't got that swing

time capsule June 9, 2008

Filed under: school — sp @ 11:06 pm

Saturday, I graduated from medical school.  Sunday, I moved 400 miles.  Today, I showed up at my new residency for my employee health screening/physical.  There’s been so much craziness over the last few days, that I’ve barely had a moment to process all these big changes in my life.

When I returned my gown after the grad ceremony, I was handed a manila envelope.   “Health clearance records and stuff,” the staffperson said.  That’s nice of them, I thought, knowing that we all had so much else on our minds besides digging up records for our residency programs.  I tossed it in the back of the car with my graduation cap, and immediately forgot about it as I reverted to stressing about coordinating lunch and family and finishing my packing.

I brought the manila envelope with me to the hospital today for my physical, and pulled out copies of my diploma, health clearance records from four years ago when I entered medical school, a reminder about the medical school alumni association, etc.  It wasn’t until later, as I was putting these papers back into the manila envelope that I realized there was something else in the envelope, something smaller that had escaped my notice.  I pulled out a small note-card sized envelope and thought, oh it must be a congratulations or goodbye card from the school staff…   I then realized that it was MY handwriting on the front that had addressed it to “Sharon Pham, c/o 2008”.

I opened it up to find a note written to me, by me, four years ago:

Oct 2, 2004

You’re an MD!  As a premed in college the road seemed endless, but now you’re there.  Hopefully you’ve enjoyed the journey and retained the idealism and passion that motivated you to take this path.  When you started med school you had a number of interests – peds hem/onc, health policy, underserved communities, teaching – and these may have changed or strengthened.  You also had (or have) a boyfriend of 2 yrs who you could see yourself growing old with.  Hopefully you’ll continue to have wonderful people in your life and enjoy a good balance of professional and personal lives.  Never forget where you’ve been as you head into new and exciting parts of your life.

<3,  SP

I nearly cried when I read this (and am in fact crying right now as I copy my note for this post).  When we were given 10 minutes at our first-year retreat to do this exercise, I had no idea what to write and no clue what the next four years would hold for me.  And yet, I managed to write the perfect note for me.  For future med school graduate me who has survived four years of some of the highest highs and some of the lowest lows, and has questioned her career choice a hundred or so times (and questioned her sanity a million times), and has met some amazing people along the way (patients, attendings, classmates), and and who, by the way, still has that boyfriend (now 6 yrs and counting).

At our retreat four years ago, I had no idea how valuable this exercise would turn out to be, and now I’m so thankful that someone told me to write this letter to myself.  I hope the rest of my classmates find their notes an equally pleasant (and poignant) surprise.

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the devil wears prada December 16, 2007

Filed under: school — sp @ 12:55 am

i just finished two of the most painful weeks of my medical school career, which is rather impressive considering that i’d already survived 3rd year.  if you have talked to me at all in the last couple weeks you’ve already heard me complain.

the first shock of the rotation was the prospect of having to do H&Ps after finishing rounds at 5 pm.  the typical workday ended about 7 or 8 pm, and i kept asking myself why i was working AI hours.  okay, so i had long hours.  not the ideal 4th year elective, but i like working in the hospital anyway, so it’d be okay, right?

apparently not if your attending is someone whose mere mention draws instantaneous shudders and looks of pity for the poor students under her tutelage.  or someone who one of my classmates cleverly compared to meryl streep’s character from The Devil Wears Prada.

i will refrain from retelling all the stories of medical student mistreatment endured these past 2 weeks (culture of medicine –> build a thick skin), but here are a few gems:

“it’s like pulling teeth” – in reference to my constantly interrupted presentation (interrupted by who?)

“what medical school do you guys go to?” – rhetorical question she posed after realizing our pharmacology was weak

“i’m not sure if you’re getting anything out of rounds” – because we’re just dumb idiots sitting there silently and not understanding anything.

and there’s so much much more.

she definitely beats the previous holder of the title of Snidest Unnecessary Comments

surgery attending to the intern: “you’re not a medical student anymore, you know”

 

small moments to hold onto March 8, 2007

Filed under: school — sp @ 11:03 pm

it’s week 2 of my medicine rotation and things have been looking pretty bleak.  the transition from psych to internal medicine has been rough.  on psych, i could rely on common sense and recognition of basic patterns of psych pathology.  on IM i’m expected to spout knowledge of all kinds of details from kidney physiology to the management protocol for new onset atrial fibrillation at any moment, and to keep an eye on my patients’ 10+ problems and 20+ medications.  i’ve been feeling like a fish out of water everyday for the past 1.5 weeks.

however, there have been a few rays of light:  

  • a patient telling me “you have good bedside manner”  🙂
  • putting in a femoral line (!) today

 hmm i think i need more moments on this list if i’m going to survive…

 

real-life lesson in psychiatry February 13, 2007

Filed under: school — sp @ 5:07 pm

so I’m on week 7 of my psych rotation.  and though i’m definitely ready for it to be over, i feel like i’ve learned a lot of useful skills, especially for my medicine rotation.  [our pt needs a psych consult?  quick, check his ammonia, TSH, LFTs, B12, folate, RPR, and head CT and give him Zydis!]

i haven’t written too much about my experiences partly because i try to avoid talking about patients and mostly because the amount of craziness out there is so crazy, that it feels like crazy is the norm and rather unremarkable.  “Your patient wants to hang himself?  Well mine cut off his arm because the voices told him to.”  “Your patient calls you retarded?  Today is the first day mine didn’t threaten to kill me.”

however, last week, i had the most interesting [i.e. upsetting] real-life experience in psychiatry, mostly because it involved not a patient, who i expect to have poor coping skills, but our very own IOR (instructor of record).

you see, we have these logbooks for each rotation that theoretically provide some semblance of standardization of each student’s highly variable learning experience.  this is rotation #4 and we’re pretty used to the logbooks. 

but psych is a little different. 

in psych, one of our skills to get signed off on is “Assess the role of one’s own feelings as one is assessing a mental illness.”  probably in my own passive-aggressive rebellion against the lameness of that “skill,” I had chosen not to ask my resident to sign it.

still, i had 43/56 signed by week 6, and technically we only need 45 by the end of the rotation.  it seemed that most of my classmates were similarly finished/almost finished with their logbooks.  so it was quite the surprise when our IOR walked into class last week expressing his disappointment with our logbook progress.  it seems that he was perturbed that among other things, many of us had not assessed the role of our feelings in assessing patients’ mental illnesses, to which i wanted to scream “hello, i think we do this with every patient!?”  also, many of us had not seen patients with delirium, which you really only see if you’re on the consult service at the hospital.  and down the list he went, naming each particular skill we were lacking as a group.

the best part about this ONE HOUR discussion admonishment session was his passive-aggressive, anxiety-inducing tone.  in his own words, “i’m not saying it’s your fault, but this isn’t right.”  whoa.

naturally, most of us became defensive, and tried to point out that some of us simply had not gotten signatures for skills already accomplished or that some of us hesitated to sign off a skill for which we felt we hadn’t quite met the expectations.  and so the IOR “tried to help” by clarifying what qualified as a clinical encounter.

per the IOR, a clinical encounter was one in which “the student has a potentially affectively arousing experience in a relational context.”  there he went again, using that same unwieldy abstract phrase – AFFECTIVELY AROUSING – that he’d tried to use the first day of the rotation.  for the next hour, he repeated “affectively arousing” another 5 times maybe, and each time i wanted to scream, but instead tried my best not to roll my eyes.  if that’s not countertransference, i don’t know what is.

several of my classmates were not as successful in hiding their feelings, and voiced their frustration with the meaninglessness of this 1 hour discussion admonishment session, but to no avail. he just kept going on and on about affective arousal and the logbook.

the next day, we discovered e-mails addressed to each of us and our current attendings.

Dear Dr. ATTENDING and MED STUDENT,

I believe MED STUDENT’s work on the psychiatry clerkship is at least adequate. However, I am concerned because she is still missing important clinical experiences. Although she is not alone in this, I would like her and her current attending and resident to work together to ensure that she has the following clinical experiences:

1) MISSING LOGBOOK EXPERIENCE

2) MISSING LOGBOOK EXPERIENCE 

I would appreciate the student and resident or attending discussing these experiences in order further consolidate their educational value.

Here is my latest attempt to briefly define the following key term: “being involved in clinical care” means that the student has a potentially affectively arousing experience in a relational context. The ideal “relational context” is a student interacting with a real patient. A student watching someone else is adequate. In some instances, an in-depth discussion between attending and student will suffice. “In depth” suggests that the relational context (attending and student) includes affective and relationship-based learning in addition to facts and concepts.

Thank you for your ongoing effort and time in working to ensure that clerkship students get adequate clinical experience so that they can master the clerkship’s learning objectives and become competent UCDSOM graduates.

OCPD INSTRUCTOR, MD
P.S. MED STUDENT will also be participating in Seminar Case Discussions to address experience deficits in BLAH BLAH and BLAH BLAH BLAH.

and this… this… there’s not much to say about the above email except that he is seriously OCPD and thankfully the attendings and residents on our team seemed to realize the same thing.

and so from this real-life lession in psych i learned

  1. OCPD people are not fun to be around
  2. although you might feel like you’re always being watched by the psych residents/attending, at least you can count on them to understand the personality issues of other faculty.
  3. there is NO WAY i’m going into psychiatry

p.s.  yes, i too am a little OCPD, but hopefully nowhere near as bad as our IOR.

 

reasons not to go into medicine December 3, 2006

Filed under: school — sp @ 12:03 am

i’m not sure this link will work for non-ucd people, but this was our school’s sad attempt at encouraging physician well-being.  i don’t know about my classmates, but for me, all this video did was verbalize all the frustrations and worries that i already have.

the video was followed by a small group session, but instead of talking about all of the issues brought up by the video, the session was focused on a simulated encounter of confronting a “colleague” with a drug problem.

 

rescue me October 1, 2006

Filed under: school — sp @ 2:14 pm

i had written a nice long post but it somehow got erased.   today i am on my weekend shift of pediatric wards.  suffice it to say that things are S L O W (i.e. i am doing nothing) and i can’t believe i woke up at 5:30 this morning for this.

*sigh*  5 hours to go…

 

tired is… September 22, 2006

Filed under: pearls,school — sp @ 6:47 pm

[on surgery]  …collapsing in bed and sleeping for 3 hrs without any thought of eating at the end of a grueling 14 hr day devoid of any kind of sustenance other than coffee.

[on newborn nursery]  …wondering for the briefest moment whether it would be possible to eat while lying in bed and coming to the sad conclusion that no, you cannot multitask eating while sleeping.