"By the Road to the Contagious Hospital..."

I'm sad to say that this will be my last post on this blog.  Orientation finishes today, and tomorrow is my first day on the floors in the hospital in my new role as physician.

I even have an ID badge that tells people who I am!  It's very official-looking, isn't it?  Looking at it, someone might even mistake me for someone who actually knows something.

is this real life?

All joking aside though, I am so ready to start.  Being a medical student was amazing, but I can't wait to finally be able to introduce myself to patients and say "Hi, I'm your doctor."  It still feels fake - even after four years of studying and practicing, I don't feel like I know enough about anything to treat anyone.  This year is going to be an incredibly steep learning curve (I feel like even that is a HUGE understatement).

Any new beginning is scary - in medicine or in anything!  I've gone through so many new beginnings throughout medical school (every new rotation, hospital, attending) that I should be used to these first-day jitters by now.  But I do feel like I'm as prepared as I probably can be (or actually, should I have re-read Step Up to Medicine? Or all of Harrison's? Oh no! What if everyone else did that?), and I'm sure I will be well-supported by my co-interns, my senior residents, the attendings, the nurses, and the program administration.  All that's really left to do is just jump in!



Hopefully I'll continue writing in some capacity, and I hope you buy my book when I write it one day (just kidding? kind of?).  Thank you for sharing my journey with me, and always feel free to email me with anything at mdwalksintobar@gmail.com.

Tanzania and The End of an Era

I apologize for my lack of recent posting, but as you should already know (Vacation Post 1), I have trouble writing when it's not a form of procrastination for something else.  So let me bring you up to speed:


After match day, I had a couple other electives at UH, and then I went to Tanzania for just over three weeks.  One blog post cannot even begin to do that trip justice, but I'll do my best.  I went with the program Work the World in Arusha, and I cannot recommend them enough.  It was not cheap, but it was incredibly well-run, safe, fun, and gave me an incredible experience at Mt. Meru Regional Hospital.

I spent two weeks in the general medicine department, and I learned an amazing amount in my time there.  The Tanzanian doctors were great to work with, and I got a lot of hands-on experience.  I learned how to make do with very limited supplies (probably the most valuable thing I learned), I learned about typhoid and malaria and HIV and TB, and I learned so much about the amazing Tanzanian and Massai patients.

the female ward (pics taken and posted with permission)

families waiting for visiting hours outside the ward

mzungu Dominic learning on rounds

But enough about medicine - in those two weeks, I also got to visit St. Jude's, an amazing school for gifted but poor Tanzanian children; help out at two orphanages (Neema House and Paradiso); take a traditional Tanzanian cooking class; drink Konyagi; and go on a three-day safari to the Serengeti and to the Ngorongoro Crater with a fellow medical student on my program.  We had a fantastic time, and saw all of the Big Five + some extras (like my personal favorite, the zebras).

the beautiful Serengeti

Sarah and I in our jeep!

zebras are cool.

And after the program, I climbed Kilimanjaro.  It was very rainy, very very difficult, and I definitely got altitude sickness (which involved some vomit, and a lot of me trying to convince myself in the middle of the night that I had pulmonary edema... I didn't).

I (slowly) made it to the top with the help of my amazing guide Nicholaus and the rest of the crew.  I cried on the first night because I was alone in a tent and I was wet and muddy and there was a giant spider and I don't like ANY of those things and I was like, "WHAT am I doing here?!" but after that first night, don't worry, I got more and more miserable the higher and wetter I got.  But I was really good at faking smiles for pictures whenever the rain briefly stopped...

only day 2 - not too miserable yet

but views like this made it worth it (I guess)

Uhuru peak.  Phew. 5,895 m (19,341 feet) high!

I suppose it was worth it because now I can say I climbed Kilimanjaro!  And that's pretty cool.  But I'm oh so glad it's over.  :)

Kilimanjaro beer > Kilimanjaro mountain

Once I returned to the US, there was that minor thing called medical school graduation, and officially this blog is a misnomer because I am no longer a medical student, but Dr. Elena Welt, MD.  After graduation, I packed up my apartment, had to say good-bye to my awesome roomie of FOUR years, and now I live in DC!

My amazing parents without whom I couldn't have done any of the things I've done.

A new, exciting phase of my life is beginning.  Eek!!

Residency Matching Algorithm (Also, I Matched!)

I am so so excited to report that I matched to my #1 program on my list, Georgetown (Go Hoyas)!!!!!!  I loved everything about the program, and I’m excited to try out DC!

For those who haven’t been lucky enough to hear my many explanations on how the match works, here’s an article my brother sent me that pretty succinctly explains how the process works: algorithm.

But what I found MORE interesting about that article is that the two people who developed this algorithm (Dr. Shapley who invented it and Dr. Roth who later modified it to fit the NRMP’s needs) won the 2012 Nobel Prize in Economics for their work!!

Dr. Shapley (with Dr. Gale) created an algorithm in the 1960’s to solve the “stable marriage” problem – which, in a very simplified way, is this: if there is a list of men and women, how do you match them up (note: this does not take into account same-sex marriages) so that there are no “unstable matches” in which all involved would have been happier in a different match? 

They solved this using "deferred acceptance," meaning that there would be multiple rounds of matches in which individuals would select a second option/mate (and then a third, etc.) if their most preferred option rejected them.

However, this was obviously stupid as that is not how marriage or people work.  So while the mathematics world was thrilled (maybe?), everyone else just went about living their lives as usual.

…I swear I’m going somewhere with this.

While it may not be how romance works, it turns out that it can be how residency works!  In fact, when the NRMP (National Resident Match Program) was established by med students in the 1950s (because getting into a residency was PuRe cHaOs before that), it turns out that’s exactly what they were using without even realizing it. 

In the 1980’s, Dr. Roth showed that the NRMP actually was using the Gale-Shapley algorithm, and he then went on to revamp the process in 1995 to favor the match based on applicants’ lists rather than programs’ list (after much controversy and student protest basically forced their hand).

So.  The moral of the story here is that if you are creating something with absolutely no real-world application, just hold on another 40-50 years, and maybe someone else will come up with a use for it and YOU TOO could win a Nobel Prize.

No, the real moral of the story is I’m going to be an internal medicine resident at Georgetown next year! Yay!

more sources not already linked: Nobel Prize, NRMP, Nobel explanation (this one really explains the general algorithm quite well)

The Light at the End of the Tunnel

Boy, have I missed being here!  So many things I could have said about the polar vortex - wait, what's that you say?  There's another one coming this week?  Oh, phew.  I would hate it for it to be warm and nice and having nothing to complain about...


So at 9:00 tomorrow night, our rank lists are due, and the programs' lists are also due.  So now it is (literally) just a waiting game to find out where the universe will place us for the next few years.  Although for the big computer who makes our matches (I imagine the Sorting Hat + the ENIAC), this is really his one time of year to shine.

Finally the majority of our fourth year responsibilities are over.  We did our away rotations, we took Step 2 (both parts of it), we did our Acting Internship, we sent in our applications, we bought a suit, we traveled all over the place for interviews, we outgrew our suit, we sent 6,000 thank you notes (ONLY 6,000 you say? You must have forgotten some people!!), and we finally certified our rank list.

The hard part of medical school is over.  We can finally see the light at the end of this four-year tunnel.  We worked so hard to get to this point, and the light is finally here!  But wait... There's something off about that light.... Something sinister seems to be lurking behind it...

(in case embedding chooses not to work, click here)

Ohhhh right!  After we graduate, we have to be interns!!  This false sense of vacation and freedom we have is really just to lull us into a reverie until the angler fish (residency) EATS US and we fall right back to the bottom of the food chain to enter what will be one of the most challenging (and rewarding? yes? please..?) years of our lives.

Click here for the best thing you'll ever watch about the angler fish, I promise.  Feminism fo' life!

Welcome!

Hello there, and welcome to my blog if you've never checked it out before!  Feel free to look around, and click back through all my old posts to see my full journey from a scared first year to a slightly-less-scared fourth year medical student.  On the off-chance that you don't have hours to waste reading about me (although that just seems impossible), below are links to my favorite posts from each school year so you can get a small sample.

I'm going to be taking a brief hiatus on new posts, so this will have to satisfy for now.  And of course feel free to continue following my updates on twitter (@elenawelt) and continue to check back here for my return!


Where it All Began:
Welcome to My Blog

First Year:
Funkmaster Flex and the Future of Medical Education
Muggle Medicine or Magic?
Studying and My Bed

Second Year:
 Med Student Stereotypes
Jewish Housewives' Disease
Pop Quiz

Third and Fourth Year:
Adventures in Nomenclature: APGAR
The Best Way to Study
What I Learned in the Peds ED
Elena's Parking Space Theorum

Nostalgia

It took me awhile to see it, but I truly love being in University Hospital in Newark.  After spending so much time here over the past four years, I've realized it's started to feel like home.  I only recognize how comfortable I am here when I rotate at other hospitals.  There's a learning curve at every new hospital - the computer system, where everything is, the people.  Sometimes I spend a month at other hospitals and am in awe at how luxurious it feels - you mean you just order a lab and it automatically gets done?  Free lunch every day (ok, that only happened for me once)?  Carpeting in the hallways?  But I've just never been able to feel as comfortable at another hospital as I do at UH, no matter how amazing other hospital experiences have been (and I have had really fantastic experiences all over the place).

It's like vacation.  I love going away and staying in a hotel - who doesn't?  I mean, how great can it get - someone cleans up after you every single day, you could (probably?) drown in the fluffiness of the comforter, breakfast is included and set out for you each morning.  But no matter how luxurious my vacation may feel, I'm always ready to come home at the end.  There's just something so much more comfortable about sleeping in your own bed, perusing your own refrigerator (even if you know it's empty since you haven't gone food shopping), using your own bathroom products.


At UH, I love being able to wave hello to everyone in the hallways because I know the attendings and the security guards and the nurses and the other students.  I like being able to volunteer to run things down to the lab because I actually know where the lab is.  I like knowing that no matter what time of day I'm in the cafeteria, I'll be able to find someone to sit with.

(cheesy, but oh so true)

Maybe I'm just getting nostalgic because I can finally count the months left of medical school on my fingers.  Or maybe it's a little sad that I can describe a hospital as home.  And I know if I spend as much time in another hospital system, I'll get equally attached.  But whether I end up here for residency, or a program close by, or a program far away, I'll always think of University Hospital as my first "home" of my medical career.

Pearls of Wisdom from the ICU

Doing drugs is bad.  Doing drugs in 90 degree heat is really really bad.

Thanks?

Nurse: Ah, you get to go home soon right?  You look tired.

Me: I literally just got here 10 minutes ago.

but thanks for noticing

Step 2 CK Is Over!!

Party Time!  Excellent!

but I am le tired.

Elena's Parking Space Theorum

Back in elementary school I had a teacher who told me not to worry (my pretty little head)* about math but just focus on the things I was naturally good at like reading and writing.  I've always had a bit of a complex about math since then, but LOOK AT ME NOW, I just invented a mathematical theorem:

*note: I added that condescending part myself, but that's definitely what her tone implied.


How much your life stinks on any given day is inversely proportional to how good a parking spot you get at the hospital.



It's true, here are some examples:

• You get to the hospital at 5am for surgery rotation: parking spot right next to the door.

• You're on outpatient and you don't have to be there till 8 or (gasp!) 9: forget it, you're parking on Mars... if you're lucky.

• You're on call on Sunday: park annnnnywhere you like.

• You take a study/research month, and mosey in around 11 for a quick meeting: don't even bother driving, take the train.

• You're on night float and get to the hospital at 7pm after everyone's left: park inside the ER for all we care.

So in summary:  Life Happiness = 1/Parking Spot + B 

where B includes other factors such as weather, fun dinner plans, an upcoming exam, world events, etc.



And that, my friends, is Math Made Easy by Elena.

Best Summer Vacation Ever

I took my last exam of third year on Friday, had some amaaaaaazing time off, and then fourth year starts today!  I can't wait to see everyone, and see how they spent their summer vacation - traveling, volunteering, research? 

Lucky for me, I am actually using June as a study month for Step 2 CK.  For those that thought Step 1 was the end of it - well, nope.  It (literally) never ends.  So even though I wan to do really well and will be studying pretty intensely all month, 3 months of medicine were definitely exhausting, and I am pretty happy not to be jumping immediately into another month of intensity on the wards.  That can wait until July. :)

Quotes from an Internal Medicine Attending

"Everyone sees medicine through the anoscope* of their own specialty."




*[anoscope: it's better than a rectoscope]

Breaking Up with a Med Student

When normal people break up, there's a certain amount of time afterwards where you are insufferable because every little thing reminds you of your significant other and you just have to tell everyone about it.  "This song makes me so sad, we used to listen to it all the time" [most popular song on the radio].  "This is that the ice cream place we passed once and almost thought about going into."   "We're right near where his brother used to live!"  Friend's response to all of the above:  "Oh ...sorry?"

And of course long after you stop being annoying, little things still remind you of him, catching you off guard way too long after the breakup than you probably care to admit.  For normal people, the trigger could be a commercial you laughed at together, a friend suggesting a restaurant the two of you always ate at, a politician you made fun of, a dessert you shared - whatever it is, you see the trigger and your heart rate speeds up a tiny bit, or you get sadly nostalgic for a moment, and then you move on.

When two med students date and break up, it's a little bit of a different story.  I was recently reading a Wikipedia article peer-reviewed article about cutaneous conditions, and one of the pictures on the side was of Norwegian scabies (don't look it up, it's gross) and I kid you not, my heart totally skipped a beat.  I'm not sure what it says about me, or him, or the relationship in general, but Norweigan scabies (and Surinam toads - definitely don't look those up either) are always going to be my trigger.  Fortunately these are things that don't ((often)) come up in everyday conversation.

Pretty Much the Same Thing

Patient: You bite your nails?
Me: Unfortunately, yeah.  It's my nervous habit.
Patient: Well, we all got our addictions.  You and your nails, me and my heroin.
Doctor: ::shakes head::

Personal Statement

Writing a personal statement for residency applications is not that fun, even for someone who loves to write as much as I do.  A friend of mine brought up an excellent point about it.  "For the love of God.  I want to be a [insert specialty here].  Why do I need to write an essay about it?  Doesn't my thousands of dollars of tuition loans speak for themselves?"

And seriously.  A one page essay talking about why we want to be a doctor?  We just finished medical school and we're now applying to residency... what else would we want to do?  Who is out there that doesn't believe us?  (And for those smarties out there going into pharmaceuticals or consulting or something, they wouldn't be writing this essay in the first place because they're not applying to residency!)  Am I wrong?



[Note: Residency directors, don't read this post!  But if you already did... I really really really want to be a doctor, pretty please with a cherry on top.]

Why It's Impossible to Memorize Anything Ever

So I'm studying the skin chapter in Step Up to Medicine, and I get to the disorder called lichen planus.  No big deal, the book tells me just to remember the 4 P's: pruritic, polygonal, purple, flat-topped papules.  I can forgive them for the last one (I can call it papule (comma) flat-topped, like a last name (comma) first name sort of thing). 

But now fast-forward two pages later (aka three facebook breaks and two youtube videos later), and I get to basal cell carcinoma.  OK, no biggy, the book says it's classic appearance can easily be remembered by the 3 P's: pearly, pink, papule.

. . . .

I'm sorry but that is too many P's in too short a time!  How am I supposed to remember which are the 4 P's and which are the 3 P's, and which one goes with which?  Where is the mnemonic for that??

Beer Potomania!

Guyssssss, who's coming to this awesome fun event with me?!??!?

Coming Summer 2013 to an open field outside of a city near you!  With music by all your favorite bands and food trucks from all your favorite restaurants!  Tickets priced only just outside of your comfort zone for how much you want to spend in one weekend!

Just kidding, it's a disease name (drinking all beer and eating no food means lots of free water intake but not enough solutes which causes hyponatremia).  But come on, doesn't it sound like a really fun outdoor beer-tasting festival?  And admit it, doesn't part of you sort of wish it was?

Oh you meant SURGERY?

Me: Have you ever had any surgeries?
Patient: Nope.
Me: Have you ever had any eye problems?
Patient: Yeah, I just had cataract surgery last week.
Me:

Scrubs

I was talking with some friends on internal medicine the other day and complaining (naturally, because what other type of conversation is there?) about the traffic that morning, and another friend on surgery was like, "Really? At 5 this morning, 280 was totally clear."  It got me thinking about the pros and cons about the different rotations. 

In terms of call schedule and hours, surgery is obviously the worst (helloooo 5 am).  But you got the best parking spots, it took you half the time to get to the hospital, and you got to wear scrubs every. single. day.  Ob/gyn was the second worst (helloooo night float), but you also got to wear scrubs every day - except for your week of outpatient clinic when your hours were 9-5 but you had to dress professionally.

Now for internal medicine, there are no overnights.  But you are on call every fourth day (weekends included) which more or less means you stay till 8pm and admit all the new patients for the day.  You are expected to dress professionally in the hospital, but on your call days you are allowed to wear scrubs. 


...Is anyone else sensing a pattern here?  Being allowed to wear scrubs is obviously a consolation prize for having a crappy day.  And it's totally effective!  "Sorry you have to be at the hospital for all of the daylight hours, but at least you get to wear pajamas!"  #Winning!

consolation prize

By the end of surgery, I was so excited to put on real clothes again - it was like a full two months of never wearing pants without a drawstring, and that can get depressing.  But now that I have to dress up almost every day, getting to wear scrubs and sneakers makes call days so so much more bearable.

More Technical Talk

A patient not too much older than me had been having erectile dysfunction, and his testosterone level was in the normal but low range, and he asked the doctor if he should be prescribed some testosterone. 

Doctor: Testosterone doesn't help with your erection but it does with the dirty talk, the dirty thoughts - if you know what I mean.
Patient: You mean sex drive?
Doctor: Sure, yeah, that.

The doctor was also trying to convince him to lose weight (more fat tissue --> more estrogen --> negative feedback on LH/FSH --> less testosterone) and told him if he lost 30 pounds he would become an unstoppable animal, and that girls would start calling him "The Animal."


...Meanwhile, I sat awkwardly in the corner typing the patient's vitals into the EMR.