Life In The Fast Lane

You know, I thought that the switch from Surgery to Family Medicine would be the most drastic turnaround of rotations that I would have all year. And to some extent, it still may be. However, the switch from Family Medicine to Emergency Medicine definitely comes at a close second. Although I knew that Emergency Medicine would be vastly different from clinic life in Family Medicine, I was still a bit frazzled on my first shift at just how fundamentally different it was from my previous rotation. If Family Medicine is like playing Family Feud in a chill environment with Steve Harvey, Emergency Med is like jumping through multiple rings of fire right before leaping on some chains hanging from a ceiling over water and swinging on them in order to get to the other side to do some more ridiculous stunts that you weren’t ready for on American Ninja Warrior.

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Okay I may have made the rings of fire part up, but you get the idea.

All eight hours of that first evening shift on Wednesday was literally wild from start to finish. I probably encountered like 10-15 patients on my own and saw a number of others with my upper-level resident. I thought that having two days to prepare for that shift would get me all ready for it.

It didn’t.

Well okay, I’m being dramatic. I definitely held my own (even with all the crazy things I saw and smelled 😳) and was able to engage with patients and present my findings as well as my differential and plan to the resident and attending. It’s just that I felt like I was making it pretty obvious that it was my first time working in the ED. Because I was trying to be quick with my patient encounters, I would forget to perform a couple of key physical exam maneuvers here and there and would also not think to ask a few key questions with some of my patients. Also, while my presentations were crafted pretty decently, it was clear that I was still in the Family Medicine mindset when it came to presenting patients. I learned quickly just how different presenting patients in the ED was. Because the patients in this environment need high acuity care, you need to frame your mind to rule out devastating diagnoses before working through the diagnoses that don’t require as much acuity to treat.

Also, there’s usually a thousand things going on at the same time as you try to interact with your patients, especially if they have just entered the ED. They usually need to get an EKG and chest x-ray if their symptoms are concerning enough, their airway, breathing and circulation needs to be assessed, their vitals need to be recorded, IV access needs to be obtained, etc, etc, etc. So you can imagine how chaotic the scene can be.

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And then after gathering the patient’s information, you have to find a way to gather your thoughts in this chaotic environment and then present them to your upper-level moments later. So yeah, you can see why I was a bit frazzled on my first night in the ED. I got great feedback overall though and was told that I was doing a good job so far. I was also told about specific things that I could improve on, which I’ve been working on ever since.

I was already showing signs of improvement during my next couple of evening shifts as well as during my required clinical coach session, which all occurred on Friday and Saturday. Outside of a three-hour period on Friday where the ED went berserk with an influx of patients, those shifts were overall calmer than my shift on Wednesday. Because I had begun to familiarize myself with this environment, I was starting to have more fun and I was also getting more proactive at taking advantage of learning opportunites. In addition, the teams that I was working with on both nights were simply fantastic. They really took the time to teach me various concepts and answered any questions that I had about anything concerning this field of medicine. The team members also gave me advice on how to give more effective presentations in the ED, what specific information to gather from patients with various complaints and even complimented my thought process whenever I talked through my differential and plan. In regards to my clinical coach session, it was very helpful and encouraging overall. After interviewing a patient in the ED, performing a physical exam on him and giving a patient presentation to my clinical coach, I was given specific feedback regarding my performance. The feedback was mainly positive and I was told to continue studying chief complaints and connecting what I studied in the text to real-life patients to further improve retention of that information, as well as to continue using my differential to help guide my HPI and physical exam. It’s been awesome to see how much I’ve been improving in such a short amount of time and I’ve been enjoying the huge amount of independence I’ve been given so far. I’m excited to continue this trajectory of improvement as I march through this rotation!

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Outside of my scheduled shifts, I’ve had to attend EM lectures, knock off multiple things on my to-do list and, of course, study. The lectures that I’ve attended have been very educational, interactive and memorable for the most part. There was a specific lecture that stuck with me though, where the physician emphasized how important it was to rearrange the way we thought about assessing and treating patients while on this rotation. He reassured us that we already have the skills necessary to be a successful medical student and that all we need to do now is to futher hone those skills in a way that breeds success in EM. Some of the examples he gave regarding the rearrangement of our thoughts included thinking about the disastrous diagnoses first when encountering patients before backing up and considering other diagnoses, and remembering that labs and imaging modalities should be used to support our thought processes as opposed to being used to make our decisions for us. It was a very well put-together lecture full of useful information that I’ve been sure to implement during my shifts!

And finally, I want to touch on a random yet meaningful lecture that I had the opportunity to attend early on last week. During my off-time, I decided at the last minute to go to a lecutre given by Dr. Deogratias “Deo” Niyizonkiza, who is the Founder and the CEO of Village Health Works in Burundi. During his talk, he touched on his experiences of living in rural Burundi, having to halt his medical school studies and move to America from there due to the horrific genocide and civil war occuring there at the time, suffering from homelessness and depression in New York City, attending both Columbia and Harvard University before continuing his medical education at the Geisel School of Medicine at Dartmouth, and returning to Burundi to help build a medical campus designed to care for the poor in his home country. The absurd conditions in which the people in that country lived in, and still live in to this day, is simply mind-blowing to me. Dr. Deo further illustrated these conditions by showing us multiple pictures of some of the country’s residents. He then showed us the progress that his company has made in the region and how people from neighboring regions come to his medical campus to receive adequate health care. It was a really inspiring talk, to say the least! He also has a book written about his life called Strength In What Remains if you’re interested in learning more about him! I’m glad that I ultimately decided to attend the talk. It really is wild just how drastically different someone’s life can be, simply based on where and when that person was born.

All done! Y’all be sure to have an awesome week and make sure to GO VOTE IN YOUR PRIMARY ELECTIONS!!!

“The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves strong. The amount of work is the same.” – Carlos Castaneda

– Black Man, M.D.

One Last Ride

I had to stop and take a moment this morning to fully take in the fact that my Step 2 CK scheduled exam date is exactly two months from today. TWO MONTHS. I actually didn’t realize how close we were to June, partly because up until about a week ago it had been so damn cold here. But now that it looks like spring is finally here to stay, I’m more acutely aware of how soon summer will be here, which means that I’ll be taking both parts of Step 2 pretty soon as well as starting my fourth-year electives and working on my residency applications.

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Man, that’s a lot to think about right now. I don’t think I’m prepared to be in Step Study Mode yet…it took so much out of me the first time around. But it just has to be done. I just gotta get myself mentally prepared for it. I just really hope that my decision to end my third year on the broad subjects of Family and Emergency Medicine ultimately pays off. 😅

Speaking of which, I’m really about to start my final rotation of third year tomorrow! Emergency Medicine is another four-week rotation and I have a strong feeling that these next four weeks will fly by just as fast as the month in Family Medicine did. I’ve heard only great things about this rotation, including the incredible amount of independence we as students enjoy while rotating in the Emergency Department. At this point in my medical school career, I’m beyond ready to take on patients on my own in order to assess their condition and to come up with a treatment plan for them. I’m looking forward to the wild experiences that I’m sure to come across in the ED, even though the pace is going to be vastly different from the relatively much calmer pace I enjoyed in the clinic this past month. My schedule looks pretty wild though. I have a bunch of evening shifts sprinkled sporadically throughout the month (my weekend days were not spared), a few day shifts, a good number of morning lectures, a couple of clinical coaching experiences, a Saturday overnight shift, and some other things that I’m going to learn more about in orientation tomorrow. I’ve heard that I can change shift days around though, which has been unheard of in other rotations. I might have to go on and look into doing that with some of my shifts, because I have a feeling that I’ll have a couple of time conflicts with other pre-scheduled events…we’ll see though.

As for my most recent shelf exam…I THINK I did okay overall. That mess was pretty challenging, even after all of that preparation I put into it. Even though I was uncertain about more questions than I would have liked, I believe it’s safe to say that it did NOT slap me sideways as I had feared! I finished the exam with some time to spare, allowing me to go over most of the questions that I didn’t feel too sure about. Hopefully I did better on it than I did on my Surgery shelf. That Surgery exam disrespected the hell outta me. Smh. And while I’m on the topic of Surgery, I finally got my rotation grade a couple of days ago. Not gonna lie, I wasn’t impressed with it. I actually was a bit bummed out because I had fallen short of the goal I had set for myself in that rotation, even after all the grueling hours I put into making sure that I performed well. I must say, the shelf exam didn’t really help me reach my goal either. But alas, what’s done is done. I did my best. All I can do is move on and use the lessons I learned along with the feedback I recieved to make me a better medical student and future physician. And besides, I have no desire to be a surgeon. So there’s that.

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I had a few clinic shifts to work leading up to exam day, including a couple of evening shifts. One of them was the Community Care Clinic, where I interviewed and assessed like five or six patients back to back. I definitely got a lot of practice in history-taking, patient presentation and document write-up there. The other shift was at the Delivering Equal Access to Care (DEAC) Free Clinic, where I was paired up with a first-year medical student in order to assess patients together. His main task was to gather a focused history from the patient while mine was to chart the patient and follow-up with any additional questions that I deemed necessary before going on to the physical exam. I was also responsible for presenting the patient to the attending physician. As I worked with the first-year that night, I was suddenly reminded of how far I’ve come as a medical student. I found myself casually using terms that he hadn’t learned yet, asking the patient very focused questions after the student gathered a great history in a style that I remember learning as a first-year, speaking with the attending about various medications and dosages to give to the patient, and teaching the student various things as we worked together through the shift. Although I’ve been aware of my overall growth as a student, I was still quite surprised at how much information I knew while I worked with him, and was even more surprised when the student commended me for being so knowledgeable. It was really cool to be in a position to teach him concepts that are now second-nature to me and to fully appreciate my exponential growth as a student in terms of knowledge base and comfortability in assessing patients.

The last things I’m going to talk about in this post are the two panels that I was invited to be a part of this past week. The first one was a MAPS panel at UNCG, where myself and a few other students from Wake and Duke talked to college students about our experiences in medical school. They were very appreciative of our honesty and that we all came from different backgrounds with different paths to medical school. I always love doing things like this, because seeing us talk about our experiences really helps to motivate them and shows them that they really can achieve whatever goals they set for themselves. Also, it humbles me and allows me to remember what it was like to be a college student striving to get into medical school.

The other panel was at a Narrative Medicine Symposium at Wake Forest yesterday and it involved me talking about how I use narrative medicine in my everyday life as a student in the field of healthcare. I sat on the panel with two other physicians and we all talked about the various ways we cope with the stresses of our lives. I mainly talked about why I started this blog in the first place, how I’ve been able to incorporate it into my everyday life and how I’ve expanded the platform overtime. I also touched on where my love for writing first started, how I’ve had to learn how to navigate writing about my clinical experiences without potentially violating the privacy of the patients that I encountered, and I even shared a few of the posts that I’ve written in the past with the audience! I’m so glad that I was invited to speak on the panel and that I was introduced to the notion of Narrative Medicine. It’s really wild to think about how many opportunities I’ve been able to capitalize on simply because I created this blog! And thanks to the support of each of you, I’ve been able to maintain this platform for as long as I have!

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Alright, I’m done word-vomiting. I’ve had a sort-of chill weekend but now I gotta gear back up and get ready for this last rotation of the school year. I also gotta get in on a couple of conference calls tonight for the SNMA. The grind never stops! I hope that your week is a delightful one! 😄

“If you can dream it, then you can achieve it. You will get all you want in life if you help enough other people get what they want.” – Zig Ziglar 

– Black Man, M.D.

P.S. – If you want to learn more about the disastrous situation in Syria, check out the “Cries From Syria” HBO documentary. I watched it last night and it really shook me. The atrocities happening to the Syrian citizens are absolutely horrendous. Trust me, you’ll learn a lot about the crisis and will also have a better understanding of the implications that their civil war will have on our immediate future. Just to warn you though, the documentary is very graphic.

Way Too Fast

This week flew by so fast man…like I was just in a plane typing up last week’s post. Then I blinked and now here I am typing up this post. I really couldn’t tell you where the time went. However, whenever I’m busy studying for an upcoming exam, time has the cruel tendency to speed up in an exponential fashion. So with that said, it makes sense as to why I feel like the hours in the day have been carelessly flying by. I’ve been getting a TON of necessary studying in via question format and have spent a lot of time reviewing the questions that I’ve answered. If you didn’t already know, there is SOOO much information to review in Family Medicine but because I’ve already seen about 95% of this specialty’s content in all of my previous rotations, it’s really not as overwhelming as it has the potential to be. To put it simply, this rotation is pretty much a crash course of everything that I’ve already learned. This is one of the huge pluses to having this rotation near the end of my third year!

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But even after having said this, I am very well aware of how hard the shelf can potentially be. I’m going to be tested on literally anything that I’ve learned all year long, almost as if it were a mini-Step 2 exam. This is why I’ve already powered through and reviewed 500+ questions, and will continue to power through and review a couple hundred more this week up until exam time on Friday afternoon. This test is NOT about to catch me slipping. If it ends up slapping me sideways anyway, at least I know that I put 100% of my effort in preparing for it. Let’s hope that the outcome is the other way around though lol.

Although I spent the vast majority of my free time this past week studying, I did have the time to participate in some clinical activities. I had an evening shift one night, a few day shifts, and a focused observed patient assessment where I was observed by a clinical coach via video recording as I interacted with a standardized patient. I also had the opportunity to meet with a clinical operations manager in order to learn more about the business side of healthcare and how money influences what goes on in this industry. As a result of this conversation, I got a better understanding of how salary payments are broken down in both an academic setting and a private practice setting, although I still don’t think I could fully explain it to someone else. At the very least, I made a friend who made herself available to me whenever I want to learn more about the financial operations of a hospital or clinic. I’ll surely be hitting her up more in the future!

And last but certainly not least, I’ve had the pleasure of attending the multiple noon conferences that the Family Medicine department hosts. The topics have been some very educational ones, but admittedly the best part of the lectures has been the phenomenal catering. Bruh, the free food that I’ve been able to enjoy in this rotation has been nothing short of spectacular. Like, where else would you get Jason’s Deli, pulled pork & beans with potato salad and grilled chicken, chicken noodle soup, and full house salads all in one week? And those are just the lunches that I can remember at the moment! There have been other awesome dishes that I have taken delightful joy in consuming. I’m definitely going to miss this about this rotation…

Speaking of, I don’t even understand how my time in Family Medicine is already almost up. It honestly wasn’t that long ago that I took my Surgery shelf exam. I’ve had such an awesome time with the residents and attendings here as well as the nurses, the certified medical assistants, and everyone in between. Everyone has been so genuine and kind, which has given me the confidence to take the extra mile to improve upon my history-taking skills as well as my physical exam maneuvers and my presentation technique. For example, I’ve been taking a minimal amount of notes, if any, while in the patient room and then presenting all of my findings to my preceptor from memory. By doing this, I’ve forced myself to not only organize my thoughts in a succinct and presentable fashion in my head but to also be fully engaged with the patient while interviewing him or her. In addition, by presentating information from the dome, I’m learning how to trust myself more and am building the necessary clinical confidence that will help carry me into fourth year and beyond. It’s not an easy thing to do, but I believe that it will help work wonders once I become proficient in this skill. Besides, I feel like this clerkship is a better time to practice something like this than any other time in third year!

Alright I gotta get back to studying like always. This is about to be a very busy week in terms of studying, and my clinic schedule this week isn’t the friendliest relatively speaking (got a couple of evening shifts, a full day of clinic and a half day), but there’s no way in hell I’m going to complain about it, especially if I think about what my days in Surgical Oncology looked like a couple of months ago. Good God.

Thanks for reading and I hope that your week is a fantastic one!

“The successful warrior is the average man, with laser-like focus.” – Bruce Lee

– Black Man, M.D.

P.S. – I was invited to be on a panel during an interdisciplinary symposium taking place at Wake Forest this Saturday titled, “Narrative Medicine: Resilience, Professionalism and Self-Care” because of the fact that I’ve been blogging about my experiences in medical school for almost three years now. The session that I’m going to be serving as a panelist on specifically focuses on how to integrate narrative medicine into one’s life, something that I had already been doing without realizing it! I’m looking forward to sharing my experiences in narrative medicine with the participants of the conference!

Life On The West Side

Bruh…I’m so exhausted.

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Turns out that I did NOT get much sleep at all these past few days while in San Francisco for the SNMA’s Annual Medical Education Conference, and it’s all really starting to hit me at once as I type this post on my flight back to North Carolina. Truthfully, I had a feeling even before I flew out to Cali that I wouldn’t be doing much sleeping once the conference started, so I was prepared for my body to take the hit. That doesn’t really make it any easier to suffer the consequences though lol. What I WAS NOT prepared for was the sudden surge of lower back pain that introduced itself to me at the San Fran airport mere minutes after walking out of the plane that I had spent the previous 5 ½ hours in. I was pretty freakin’ annoyed when the pain hit me and became even more irritated when I eventually realized that I wasn’t going to just walk or stretch this pain off any time soon. It turns out that stretching your body before a long flight is a thing, something that I had never gotten the memo about. So guess who didn’t do his pre-flight stretches? Smh. Sucks that I had to learn this lesson the hard way, but whatever. At least you can learn from my mistake. I seriously can’t wait to get rid of this pain that has been plaguing me this whole trip.

However, even with my inconvenient misfortune, I ended up having a delightful time at AMEC! I got the chance to meet new people and catch up with old friends, some of whom I literally hadn’t seen since last year’s AMEC in Atlanta. I also got the chance to explore some parts of the downtown area in the little free time I had and learned that although San Fran is a diverse city, there are relatively very few black people who actually live in the area. As a matter of fact, I was told by multiple people that the city’s black population had severly decreased over time from 32% to just 3%, which blew my mind. It also blew my mind how expensive the city was. Average gas prices downtown were about $2 more than the prices that I’m typically used to, and I was told that the average looking townhouses that I saw in the area could easily cost over a million dollars each!

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I mean, I knew that this place was one of the most expensive places to live in the country, but that is just ridiculous. The downtown area was really nice though, I must admit.

But it ain’t nice enough for me to be okay with watching my money evaporate just to simply survive there. I also saw an alarming number of homeless people across the downtown area and I believe that the expensive nature of the city has a lot to do with this.

Unlike in Atlanta where I had the freedom to go to multiple sessions at will, I unfortunately wasn’t able to attend as many sessions this time mainly because I was the only medical student from my school in attendance. Because I was the only representative of my school, I spent most of my mornings representing the Wake Forest SNMA chapter at the House of Delegates business sessions. My afternoons were primarily spent attending required sessions tailored for the 2017-2018 National FLP Fellows, performing some community service, perusing the Exhibitors’ Fair where multiple residency programs and medical schools were advertising their respective institutions to pre-meds and medical students, attending regional and leadership transitional meetings, looking for food to eat and wishing that I had time to take a nap (I had finally found some time early Saturday afternoon but I don’t even think that I ever fell all the way asleep…)

There was also a President’s Luncheon that featured Dr. Velma Scantlebury, who was the first Black female transplant surgeon in the United States, and a banquet hosted by the Board of Directors of the SNMA that featured Dr. Zoanne Clack, who is a writer and Executive Producer on Grey’s Anatomy! Both of their speeches were very motivating and made me feel that I could reach incredible heights in my life as long as I continued to work diligently in the things that I’m passionate about. My days usually ended with the nightlife that San Fran had to offer, which was really fun although I was quite surprised at how early things closed down. Enjoying the nightlife events also did not help with my sleep deficiency at all. I’m honestly pretty amazed at how well I was able to function these past few days with the little sleep that I got. My conference experience finally came to a close today after I attended my first Board of Directors meeting, where I was sworn into the position of External Affairs Committee Chairperson. Now I’m flying back to the East Coast, where I’m about to lose the three hours that I had been gifted after flying to Cali. Gotta love that good ol’ jetlag. 😊😊😊

Although most of my week was spent at the conference, I did spend the first couple days of the week at school working in a couple of different clinics. One of the clinics was a community care clinic, where I assisted in treating patients that had no health insurance coverage. In addition, I had the opportunity to sit in on a couple of interesting and interactive discussions that focused on the topics of Exercise Medicine and practicing self-care as a health provider while working to avoid compassion fatigue and depression. I thoroughly enjoyed both of these talks and was also able to take away some great information from them that I’ll surely use in both the present and the future.

Good God this flight is taking forever. I lowkey want to go to sleep, but I also don’t want to not be able to sleep once I get home. I guess I should get some studying done, especially since I didn’t do a lot of that these past few days and my family medicine rotation is already halfway over. In the blink of an eye, it’ll already be time to take my Family Medicine shelf exam. Annnd guess who is currently NOT ready to take that exam?? 👀

I hope that you have had a very Happy Easter Sunday and that your week ends up being an awesome one! 😄

“Opportunities multiply as they are seized.”–Sun Tzu

– Black Man, M.D.

P.S. – Even with the disastrous starts of my March Madness brackets, I surprisingly ended up performing pretty nicely in the group competitions that I’m in! Haha in your face suckas! (Y’all know who you are 😂)