Deal or No Deal Casting, Part 3 May 13, 2008

Can you believe it? There is actually a PART 3!!  See Part 1  and Part 2 if you have no clue what I’m talking about.

 

So I got home from my second day of Medicine orientation and I have a phone call from an “Unknown” number.  I decide to pick it up anyway and the woman introduces herself as one of the people from the syndicated version of Deal or No Deal!  Apparently she called me earlier, but I didn’t get the voicemail.  I was (and still am) SHOCKED to hear it was Deal or No Deal on the line, especially since they said it could take up to 5 months to hear back from them!

She continues to tell me that they want me to be one of the contestants.  The syndicated version is set up a bit differently, but basically I will be on TV as one of the models and will have a good shot at being picked randomly to play for the cash!!  Of course I would have loved to be picked for the primetime TV version as the one and only contestant, but I’m still super excited.  I mean I have a shot at winning money that could pay off my >$100,000 of student loans, or pay for my graduation trip, or all my residency interviews, or buy me a car, or something.

The only bad news is that it is filming on a random Tuesday. Yes. The middle of the week.  On top of that, if I can’t make this specific taping then my audition tape goes back into the general pool again!  However, it was perfect timing because tomorrow is my first day to join the Medicine team and I can tell them off bat that I need the day off.  I will work every single weekday and weekend of my 4 weeks at that site for the opportunity to have that day off.  I just have to be sure it’s not a day my team is admitting or a post call day where I would be expected to present that day.  I think I have a chance at being granted the day off!!  I’ll update you soon

My Last MS3 Rotation! May 12, 2008

Today I had orientation for my LAST rotation as a third year medical student.  I must say that I have mixed feelings about giving up this title.  I mean, it shows that you reached a landmark of getting through the first 2 years in the classroom and boards, but at the same time you have no clinical experience.  It doesn’t have the same expectations of the sub-I/4th year med student.  It’s scary to believe that in just 8 weeks, I’ll be busting my ass to pretend I’m an intern and also help out the new third year students start to find their way on the wards.

As far as this rotation, all of the residents and attendings know that this is our last rotation of the year.  That means the expectations are high.  It’s not going to be enough to just work hard, but I’ll have to prove that I actually learned something over the past 10 months.  On top of it all, it’s inpatient Internal Medicine, which means I have plenty of pimping ahead in the next 8 weeks.  I really am a bit nervous because I haven’t looked at some of those weird diagnoses, or even all the diagnostic/treatment details of the more common inpatient medical complaints.  I really hope that this is a great preparation for step 2 and I go out with a bang!!

No More Neuro May 9, 2008

So I just finished with the Neuro shelf… no need for beta-blockers today!!  I felt that this test was a lot more straight forward than the Psych shelf.  I either knew it, marked the answer and moved on or if I didn’t know it, could do some deductive reasoning.  The shelf still didn’t get too into the specific drug effects, but had a couple of good pharm questions about treating trigeminal neuralgia, or recognizing phenytoin toxicity.  There were some stroke questions, but not nearly all the localization that I had hoped for… just 1 for locating the vessel involved in a homonymous hemianopsia and a few vertebrobasilar symptoms.  The only one that I am upset about was a vitamin deficiency question that if I had not rushed through, I could’ve gotten correct.  It was about question #95, so by that point I was getting a lil tired.

 

Anyways… results should be back in the next few weeks.  Hopefully I’m in the running for honors!  We shall see…

Psych Shelf Done… Neuro Here I Come! May 5, 2008

This is a pretty intense week for me.  I just finished the psychiatry shelf exam and I have the Neuro shelf coming up on Friday.  Man, one is enough…

 

As for the Psych shelf, what can I say?  I had plenty of time to study, but did not necessarily “crack down” on the books until the past week or so.  I read Blueprints Psychiatry a few times, read the Pscyh section in First Aid for USMLE Step 2 CK, created a chart of all the major psychiatric disorders, personality disorders, and defense mechanisms.  I was warned that it was a test that you can’t study for, but I was determined to study it and conquer.

 

However, I’m not quite sure how it went for me.  After all of my studying about psychiatry, I’m pretty convinced that I may need to take a beta-blocker for text anxiety.  I mean seriously, it’s like I study so hard for the test and want to do well on it that I get anxious that I’ll mess it up the day of the test.  It was so bad today that after 1 hour, I had only gotten through 30 questions!!! That’s only 30% of the test in 50% of the time.  So of course I’m freaking out for the remaining hour, concerned that I may not finish.  Anyhow, I guess I got frustrated because I feel that I have all this knowledge that they didn’t even touch upon.  I mean they barely got into the drug side effects… I mean I wanted them to get into the nitty gritty because I know it!  They were more into panic attack, adjustment disorder, bereavement, MDD, conduct disorder, oppositional defiant disorder, ADHD, etc.  I mean I know all of these diagnoses, but there are little subtlties, such as only listing 4 characteristics of depression and not the full 5.  I’m not sure if I was being anal about it, but that’s the whole reason they created that DSM was to have some type of standardization of psychiatric symptoms leading to a diagnosis.  There were a few “medical” questions that could look like mood disorder or psyhosis, or required you to decide the next step in managment.

 

Alright… I’m done complaining about it.  We’ll see how it goes when I get my score in a few weeks!

Meeting With “Important People” May 1, 2008

As I come closer to this whole residency application process, I have realized that it is important for me to get to know people in the field.  People, i.e. 4th years that recently matched, recommended contacting the different department chairs and such in order to start putting your name out there.  Our school has several hospitals including the University Hospital, 2 county hospitals, and a private hospital for students to do their rotations in OB/GYN.  Of the 4 locations, there are actually 3 distinct residency programs.  In the past 2 months, I have met with the Chair of OB/GYN, the Residency Program Director, and the Clerkship Chair at the county location.  I met with the Residency Program Director of the private hospital and with the Chair of OB/GYN at our University.  The Chair at my school revealed to me that they ranked only 21 students for 7 spots.  They got their top 5 choices and their #8 and #9.  Sadly, #20 and #21 didn’t match anywhere because they were too selective and didn’t apply widely enough.  Man, that’s intense, but I’m happy he shared that info with me!

 

Back to the meetings… I guess that’s quite a few, but I want to get my name out there! However, I’m not sure how much of this really matters.  I mean I feel good getting out there and talking to these people, asking for their advice, and also asking about the program, but I’m sure alot of students do it.  I guess I’m just confused on how to make sure that these important people even remember our interactions???  The Chair from my school offered to write me a letter and to call the program that I desire most, but I guess I don’t feel all that deserving considering I’ve only talked with him via email a few times, and just officially met him in person for the first time today.  I mean, I’ll take what I can get, but I suppose that all of these meetings feel a bit forced and I hate all the “politics” of this whole application process.  What happened to the simple good grades, leadership, and community service that got me into medical school?

Interesting Ultrasound Findings April 29, 2008

Today was by far the best day that I have had at my preceptor.  (Side note: during our 3rd year we have a preceptor that we shadow 8 afternoons per half of the year.  The first half I did pediatric orthopedics, this half maternal-fetal medicine, which is a specialty of OB/GYN).  I must say that in the past weeks I have learned alot about doing a great fetal anatomic survey, and really did not see any anomalies.  The most interesting thing had been twins.

 

Not today!  So the first patient that I see has a didelphys uterus!  That means that she has 2 uteri and happens to be prenant in one of them (more info: http://www.emedicine.com/Radio/topic738.htm).  So the next few cases were interesting medically, but a bit more sad.  The next patient had gone through ovulation induction and subsequent IVF.  She ultimately ended up being pregnant with triplets.  Sounds great… but unfortunately by the time of her visit, one already had intrauterine demise.  Then as we are ultrasounding the second triplet, we discover a distended bladder and kidneys.  The infant likely has some bladder outlet obstruction leading to those physical findings.  On top of that, it had a small diaphragmatic hernia.  Interestingly, these are two of the findings in Trisomy 13.   The patient decided it would be best to do a reduction of this pregnancy with KCl.  Sadly, she went from triplets to a singlet in only a short matter of time.

 

The next patient had a past history of 3 c-sections.  This puts one at an increased risk for abnormal placentation.  The first abnormality that she has is a complete placenta previa, which means lots of third trimester bleeding and no chance of a vaginal delivery (which wasn’t too likely anyhow considering she’d had 3 c/s).  Anyhow, it was also found that the patient has placenta accreta, which is when the placenta invades the uterine wall and starts getting into the myometrium.  She also had an area of placenta increta, in which the placenta invades the thickness of the myometrium.  It is possible that it could invade beyond the outer serosa of the uterus, called placenta percreta.  So we had to tell this woman that she will likely bleed alot during this c-section, and it will require a hysterectomy.  She didn’t take the news so well, and it was hard to see this level of emotion.

 

The last patient had a similar finding to the second patient, but more severe.  Upon doing the ultrasound, we noticed that the heart was on the right side of the chest, when the normal anatomic position is on the left.  Initially we thought it could be dextrocardia (read the basics: http://en.wikipedia.org/wiki/Dextrocardia), but concluded this couldn’t be the case because the apex of the heart was still facing left.  Further investigation of the heart also revealed a large ventricular septal defect, which basically means there is a hole between the left and right side of the heart that doesn’t belong.  We go on to the abdomen and see a normal sized liver, but there is no other content in the abdomen.  All of the bowel was in the chest.  This fetus had a large left sided diaphragmatic hernia that was pushing the heart to the right.  As you can imagine the lungs are not going to develop correctly and this baby would be in for alot of surgeries.  They also decided to terminate.

 

So while today was full of fascinating ultrasound findings, it opened my eyes to the reality that life is a gift.  It also made me remember that while I chose OB/GYN for all of the happy and exciting moments, there will be times of great suffering and grief in my future patients.  To end on a good note: he finally let me do a simple ultrasound on one of the patients!  The lady was pregnant with twins and I located the beating heart in both of them and pointed it out to the mother.  According to the people there, he never lets anybody do the ultrasound!! I guess I may be doing something right.

Graduation Checklist April 25, 2008

This was sent to me via email by our Dean’s Office:

Graduation Requirment Checklist- Class of 2009 REV DATE: 4/24/2008

In order to graduate you need to complete the following:

·       -Pass USMLE Step1

o               Take prior to starting third year

o               Pass prior to starting fourth year

·       -Satisfactory completion of Clinical Foundations.

·       -48 weeks of required clerkships

·       -Satisfactory completion of Doctoring 3.

·       -Satisfactory completion of the Longitudinal Radiology clerkship

·       -Satisfactory completion of the Clinical Performance Examination (CPX).

·       -Satisfactory completion of College Foundations

·       -Mandatory Graduation Check appointment by December 19, 2008.

·       -Pass USMLE Step 2 CK (Clinical Knowledge)

o              Register by November 1, 2008

o              Take by December 31, 2008

·       -Pass USMLE Step 2 CS (Clinical Skills)

o              Register NOW

o              Take by December 31, 2008

·       -Complete 30 Weeks of Elective Coursework

o              21 weeks elective coursework (100, 200, 300, 400, 600, 700, 800 level coursework)

o              3 consecutive weeks of 300 level Subinternship from Handbook of Courses

o              3 consecutive weeks of 400 level Subinternship from Handbook of Courses

o              3 consecutive weeks of 300 level subinternship or 400 level Subinternship from Handbook of Courses

·      -Satisfactory completion of College Requirements (April 3, 2009)

·      -Attend Scholarship Day on Friday March 19, 2009.  Everyone is required to attend.

     -Completing the AAMC Graduation Questionnaire (GQ).  You will receive additional information regarding this item in February/March.

Scary!

Not So Bored With Mania April 24, 2008

So yesterday I started taking care of this patient with her first episode of mania.  She presented with disorganized and racing thought, grandiosity, decreased need for sleep, elevated mood, hyperreligiosity, and increased goal directed activity.  What is fascinating is the patient reports this is the best that she has ever felt in her life and the family is the one that noticed that she was not her usual self.  In addition, she denied having any past history of depression, but when talking to her family they report a long history of depressive episodes.  Ultimately we gave her a diagnosis of Bipolar I (mania and major depression), which she goes in and out of accepting.  She may have some personality disorder stuff (OCPD), but that can’t be diagnosed on the inpatient setting.  Anyhow, it is now my job to help this patient understand her diagnosis (versus what society and media portrays it as) and help her to realize that she needs treatment.  But how do you convince someone that is feeling on top of the world that they need medications?!  It’s such a paradox because you are trying to reason with someone that really has a brain disease and their capacity may not be there.

 

If you are interested, check out the NAMI (National Alliance of Mental Illness, www.nami.org) definition of bipolar.  Is it what you thought?

Bipolar Disorder

What is bipolar disorder?

Deal or No Deal Casting, Part 2 April 23, 2008

Yesterday was such an exciting day!  I show up to the studio about 15 minutes early and there are already about 15 people in front of me in line.  I guess I learned my first Hollywood lesson.  A closed/private casting call doesn’t mean that it is just you, it just means that it’s not the open call with 1000’s of people where you have to wait for 10 hours to be seen.  Anyways, right at 4pm they bring in the whole group, about 50 of us.  We walk into a small studio where there are a bunch of chairs set up and a blue screen with a silver case on a stand, and a video camera in front of it.  We walk into the room and one by one they take a digital photo of us holding our paper “slate” with our name, phone number, and height.

Now on to the audition…. This guy stands up and tells us a couple of ground rules: be excited, no hands in your pocket, don’t spend your whole time talking about all the reasons you love Deal or No Deal, yada yada yada.  Then one by one we go up in front of the camera.  The first guy broke all of the aforementioned rules, was horribly depressive and ended up leaving the audition early since I’m sure he knew there was no way they would put him on the show.  There were also some really personable people before me, so that uped the ante so to speak.  You could tell those that were doing well were the ones that had a good back and forth dialogue with the casting director.  Finally, it was my turn.  But first, you have to see the outfit I wore in honor of Mardi Gras (remember I went to undergrad in New Orleans).  It was a combo of purple, green, and gold, CrAZy huh!?

 

I get up in front of the camera, tell them my name, where I’m from, how old I am, and that I was a third year medical student.  The first thing that the casting director says is, “Wait, I thought medical students were supposed to be smart?“  I was so excited, because my outfit did its job of sparking conversation.  I joked about not revealing how I got the beads, but I did get them from Mardi Gras.  Then, I threw in that I had plenty more at home, and the whole crowd started laughing!  I proceeded to talk to him about my undergrad, the balance between school and the party life in New Orleans, and of course that I managed to be graduate with a perfect 4.0 GPA.  Once again the crowd cheered.  So then we talked about me having a nickname breifly.   As expected the conversation turned to my career and he asked, “Why medicine?”  I went on to discuss my desire and how I wanted to be like my grandma (who is a child Psychiatrist) and mentioned, in what other field can you meet someone and they almost immediately trust you to talk about their most intimate problems (that got a lone cheer). 

So this is when it got weird. 

Deal or No Deal Casting April 21, 2008

Well the title almost says it all, but I’ll give a little background before I get to the conclusion. So during Spring Break, my boyfriend and I decided to take his parents to see an episode of the hit game show Deal or No Deal. We got there as instructed at 2pm and they told us the morning taping was going too long and to return at 3:30pm. So we were a little annoyed, but figured we could go grab some ice cream to kill some time. So we return at 3:30pm and are escorted into this large holding studio. We literally sat there for TWO HOURS before the stage manager (who knows what his title was, I know nothing about that), came out and told us that the afternoon show was canceled. So you know I was pissed that I’d basically wasted 3.5 hours of my afternoon doing nothing! A couple of us decided we would complain and see what could be done. At that point we were told the Casting Department was going to come out and talk to anyone that wanted to be a potential candidate for the syndicated version of the show. I get in line… yes, I was first in line, and the lady gives me her business card and a half sheet of paper with instructions to email her 2 photos, and a paragraph about myself. Since I was waiting so long, I probably wasn’t (okay, I know I wasn’t) my normal excited bubbly self when I introduced myself. My boyfriend basically told me that I blew it and there was no way I’d hear back from her (they wrote down all of our names by the way). So, my boyfriend and his parents also gave their information and we got VIP passes for the taping the next morning. We decided to give it a shot and had an amazing time at the taping!! The only thing is that we were literally there from 9am - 2:15pm just to tape a one hour episode. The only way I would go back is as a contestant! Here are some pix that I snuck in from over the edge of my purse: