Workin’ Day & Night

Man, it has been a STRUGGLE trying to switch my body from my night shift schedule back to my regular daytime schedule.

I finished my last night shift of the week yesterday morning and headed straight for my bed to crash, only to wake up four hours later to get ready for my flight to Pittsburgh. Packing on four hours of sleep is not the best idea, just so you know. I had to force myself to stay awake the rest of the day as I got to the airport, got through security (there was literally nobody in line…it was just me. Had me feeling like some sort of celebrity 😎), ate a pretzel from Auntie Anne’s, flew to Pittsburgh (the view of the city at night is niiiiice), got picked up by some friends from college, went out to dinner with them, came back to their place, did some quick reviewing of the pediatrics residency program at Pittsburgh, FaceTimed my girlfriend and finally got ready to go back to sleep around midnight. I’m glad I decided to go through the torture of staying awake though, because I was knocked out about five seconds after my head hit the pillow lol. Then my stubborn circadian rhythm kicked in and I found myself up and awake in the middle of the night for about an hour for no good reason. I finally crashed once more and woke up much later than I would have liked. It’s all good though, I definitely needed the rest. I just got back from a diversity brunch that the pediatrics program here in Pittsburgh hosted, and will be going to a pre-interview dinner later on this evening that should help prepare me for my interview tomorrow. It should be a great time! 😄

As you can see, my interview season is starting to shift into high gear. After tomorrow’s interview, I have one at VCU next Monday, followed by a flurry of interviews taking place in the following weeks at Emory, Carolinas Medical Center in Charlotte, UNC, Duke, UVA, EVMS, MUSC and the University of Maryland. There’s going to be a lot of money spent on gas and plane tickets, that’s for sure. Good thing I decided to get a new credit card for this season; I’m tryna make some money off of all these expenses lol. It’s going to be fun to get to see all these different programs and to meet all sorts of people, but I also feel like my tank will be on close to empty by the time this interview trail comes to an end. Then I’ll be chillin’ for real!

But before I fully shift into high gear, I have to focus on completing my last week of my rotation at CHOP. It’s crazy that I’ve finally made it to this last week! I’ve experienced a surge of growth and newfound confidence in my clinical skills these past three weeks, a surge that I know will continue as I blaze through this final week. I’m grateful for having been able to rotate through this hospital and am also very grateful that after a five-month long stretch of back-to-back rotations, I’ll FINALLY be enjoying a hard-earned break from clinical responsibilities! I remember looking at my fall semester schedule back in June and being like, “Dang, this is about to be a hell of a ride 😅”. Back then, November had seemed so far away…but look at us now! WE MADE IT!!!

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Before I forget, let me go on and tell you about my week of nights.

First off, it was strange having to be asleep in the daytime and being up all night (reminded me of my long nights during my Ob-Gyn rotation). I really felt like I was missing out on the events going on around me in the world. And at night when I was wide-awake, my phone was pretty much a brick in my pocket because everyone else was fast asleep while I was busy running around the floor admitting patients. It wasn’t like I had a lot of time to be on my phone anyway; I really was busy most of the night every shift. The team consisted of my senior resident, the intern covering the floor, and me. Yeah, just the three of us. Managing a floor that could fill up to a cap of 22 patients.

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If we weren’t managing the care of patients who had already been admitted to the floor, we were working on admitting new patients onto the floor. Most of the time, we would be doing both of those things at the same time. In the rare event that we had some off-time where we weren’t being called for something, we would either be engaging in active learning with our senior resident, reading up on some information that we wanted to learn more about, monitoring our patients’ charts for any changes in their current statuses, or just talking about our respective lives. By the time the morning came around, I would be exhausted. Yet, I would have to stick around a couple extra hours most days to present patients that I helped admit overnight. I honestly don’t even know how I was able to get through those presentations…I sincerely felt like I was babbling nonsense due to fatigue, but I apparently wasn’t because everyone seemed to get the picture I was trying to paint with each of my presentations.

Overall, I actually enjoyed my night shifts! The whole flipping-my-schedule-upside-down thing sucked but once I adjusted to that, I could really begin to appreciate the laid-back, flexible nature of working at night. Oh, and shoutout to the cafeteria being open from 1-4 AM! That was extremely clutch, but it sure was tragic that it was closed from 7:30 PM till 1 AM 😕. I had even more independence at night than I did in the daytime, which is saying a lot because I already felt like I had a ton of independence during my day shifts. I also appreciated the fact that I didn’t have the time constraints that come with pre-rounding and rounding, which allowed me more time to have some touching conversations with my patients, read about things that I found interesting, learn how to be more effective in putting in the correct orders, and write some high-quality notes about the patients I admitted. I also practiced managing multiple patients overnight by splitting the patient list with the overnight intern, meaning that I took responsibility (with oversight of course) of the care of some of the patients on the list. I was really out there feeling like a doctor, and it was pretty cool!

I had a great experience on nights, but it sure does feel good to be back on a regular schedule again. It’s too bad that I won’t get to wear scrubs during the daytime and I’ll be having to wake up real early again, but at least I won’t be messing around with my sleep schedule! Plus, it doesn’t hurt to be looking fresh at the hospital with my bowtie game on 100%!

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That’s it from me today! I hope that you have a fantastic week!

Cheers to my last week of clinical responsibilities in 2018! And Happy Veterans Day! A HUGE THANK YOU to those of you who have served this country!

“The most common way people give up their power is by thinking they don’t have any.” – Alice Walker

– Black Man, M.D.

P.S. – I FINALLY got my absentee ballot the day before Election Day. I had to sacrifice some sleep to get it sent out but it was well worth it, even though the House representative I voted for ended up not winning the election. After my harrowing voting experience, hearing an unsettling amount of horror stories from friends who have tried to vote, and witnessing dangerous levels of corruption and irregularities in the voting system, I’m committed to helping make some very necessary changes in the way elections work in this country. Don’t ask me how I’m going to help make a change, because I don’t know yet…but I’m going to think of something and become more engaged in voter registration and reform in the overall voting system. Hopefully the results of this election will serve to restore some sort of order and sanity in the government. Shoutout to all the elected newcomers to Congress who were inspired to run because they were absolutely sick of the current state of affairs in the country!

P.P.S. – I was able to check out Philly for a bit last Sunday in my severely limited free time! I got to run up the Rocky steps, had brunch at a Lebanese restaurant, had a photo-op with the LOVE structure at Love Park, walked around downtown Philly and visited the Barnes Foundation to look at a ton of original, expensive paintings that I don’t really care about. But it was free to go, and the value of all the art in the museum is estimated to be at about $25 billion, so I had nothing to lose by checking it out!

Evolution.

That extra hour that Daylight Savings gave me today was a glorious gift.

I got to “sleep in” and I still got up at a very reasonable time to take full advantage of my day off!

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It feels great to wake up refreshed and know that you have the full day to do whatever you want with it. My last day off from work was last Sunday, unless you want to count my interview day at CHOP that took place on Tuesday since I didn’t have to work that day either, though I was at the hospital most of the day learning about CHOP and interacting with residents and faculty members. Speaking of, I think interview day went well overall! I got great vibes from the faculty members I interviewed with and it was wonderful to meet both the Residency Program Director as well as the Chair of Pediatrics and Physician-In-Chief of the hospital system. I now have three interviews down, and quite a few more to go! My next one is taking place next Monday in Pittsburgh and just so you know, Pittsburgh and Philly are on OPPOSITE SIDES OF THE STATE. Don’t be a dummy like me and assume that they are close to one another just because they are both cities in Pennsylvania. I had to get a flight because with my tight schedule, I just couldn’t afford to drive 5+ hours to get there and another 5+ hours to get back. SMH. I’ve never been to Pittsburgh before though, so it should be a cool experience!

Back to my second week of my sub-internship at CHOP. I’ve definitely adjusted to the flow of things a lot more since my first couple of days here, and I’ve become more comfortable with my team as time has passed on. With that being said, I’ve come to realize how much this place can humble you. I’ve been consistently challenged to think independently, to provide quality care as the primary “physician” for my patients, and to adjust my performance based on the constant feedback that I’ve been receiving. In these past two weeks, I’ve learned so much not only about medicine and the reality of patient care in an inpatient setting, but also about myself and my strengths and weaknesses. I’ve come to realize that while I may know more than I previously thought I did about certain things, there are also quite a few things that I didn’t know that I didn’t know, if that makes sense.

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I’m starting to consistently think about and do important things that I had only intermittently thought about or done in the past, such as providing discharge criteria for admitted patients, referencing evidence-based research in my patient presentations, committing to specific plans for specific problems that my patients have, prioritizing important tasks to be completed earlier in the day (discharges, consults, etc.), becoming familiar with the dosing and time intervals of medication administration, coordinating care with other members of the healthcare team, giving concise & high-quality handoffs to interns starting their shift, completing concise discharge summaries, putting in orders; the list goes on and on. I’m literally doing intern-level work with the only difference being that I have a lighter patient load than the interns do, I have less experience than they do (it literally takes me twice as long to do just about anything that they do), and I have some additional support from the senior residents on my team.

While my days have been long and exhausting, my learning experience has been spectacular. There’s nothing like throwing yourself into a sub-internship position in a brand-new city at one of the top children’s hospitals in the world. Some may call it insane, but I call it yanking yourself out of your comfort zone and embarking upon a challenging experience that forces you to evolve and become comfortable being uncomfortable. Okay yeah, I admit it’s pretty insane. It’s actually not what I initially asked for when applying to this visiting clerkship program. However, when this was the only option given to me, I ultimately accepted it because I wanted to experience what working at a hospital like CHOP would be like, I wanted to expand my network by meeting brand-new people and mentors, and I wanted to make the most out of my fourth-year of medical school by diversifying my experiences as much as possible. Plus, it is all being paid for, so why not? 🤷🏿‍♂️

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It has been a tough two weeks for sure, but I can literally feel myself becoming a better clinician as a result of this experience. This has definitely been a very necessary experience for my growth, and it’s great to get this insight as to what intern year will most likely look like. Of course now that I’ve started to get into my groove, my schedule is being flipped-turned-upside down and I’m going to be working a week of nights this week, starting tomorrow night.

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I’m not sure how this is going to go, but what I do know is that I’m going to continue to do my best and maximize my learning opportunities during my night shifts! I’ll surely be admitting a ton of patients, which will give me great practice in completing the admission process and writing great H&P (History & Physical) notes. Because the night team is much smaller than the day team, I’ll get the opportunity to get more one-on-one time with my senior resident, which will give me more opportunities to elicit feedback in order to continue improving my skills. Only thing that’s really gonna suck is the fact that my sleep schedule is going to be all screwed up, especially the first couple of days. I’m sitting here trying to plot on how to alter my sleep schedule today knowing damn well that I’m going to be tired on my first night shift, no matter what I try to do to prevent it. My circadian rhythm is just that strong. *Siiiiiiiigh*

On that note, I’m going to go ahead and enjoy my day off! I’m sad that I missed both Howard’s homecoming last weekend and UMiami’s homecoming this weekend due to my rotation schedule…they both looked like a lot of fun. Too bad the ‘Canes aren’t doing so hot this year on the football field. Welp, there’s always next year….😪😪😪

Have an amazing week!

ELECTION DAY IS FINALLY UPON US!!! GO VOTE!!!

“One finds limits by pushing them.” – Herbert Simon

– Black Man, M.D.

The Power of Discussions

That extra hour of sleep was very, very clutch.

But this also means that it’s going to get darker earlier, which is annoying.

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Winter is officially coming. And you know what else is coming?

ELECTION DAY. 😭😭😭😭😭

I don’t want the Obamas to have to leave the White House!! President Obama is the coolest & chillest president we’ve ever had man. I remember watching him the night he got elected into office 8 years ago…I also remember that stunning black & red dress the FLOTUS was wearing that night too lol. I had actually (unnecessarily) recorded President Obama’s whole acceptance speech on my family camera, and I remember thinking to myself: “If he stays in office for 8 years, I’ll be 23 by the time he has to leave! He’s going to be president forever!! YES!!!”

Well.

I’m 23.

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This election season has been an insane one…very truly an insane one. We all know that, so I don’t even need to begin to explain how I feel about it. Just please, please, PLEASE exercise your right to vote if you haven’t already! Let’s keep America on track towards progress, and not rewind ourselves back towards our troubling history.

*Sigh.*

I’m gonna need a couple drinks Tuesday night.

On another note, the SNMA chapter at my school just finished hosting the annual Regional Medical Education Conference! It was an awesome experience, even though I had to miss UMiami’s Homecoming for it 😓. (There’s always next year, right?) Being able to not only watch, but participate in the sessions that I personally helped plan for was a great and rewarding feeling. The conference started off Friday night with registration and a welcome reception where SNMA students from around the region came and mingled with faculty members here at Wake. It was nice to meet some minority residents who worked here at Wake Baptist and to see the Dean again, who I had the pleasure of chatting with the previous night at the Twin City’s Medical Society Mentorship Program reception. I then had a chill night with some of the other medical students, where we played card games and taboo and whatnot lol.

The next morning started off early with a light breakfast at the school, picture-taking, and more registration. We then had a plenary session about Racial Disparities in Receiving Mental Health Care, which was facilitated by Dr. Rahn Bailey, the current Chair of Psychiatry and Behavioral Medicine at the Wake Forest Baptist Medical Center. In his talk, he discussed various issues including the dangers of implicit bias in health providers against minority populations, the fears that people with a lower education level have when it comes to talking with their health providers, the importance of value-based metrics as a future payment method, what the ACA has the potential to do for patients, and the stigma of mental health in the cultures of minority populations, especially in African-American populations. Next came a session involving the topic of Harm Reduction and how it can be used to treat drug addiction. The speaker was a man who had actually dealt with homelessness and drug addiction in his past, but has now been clean for over 10 years due to the powers of harm reduction, which he described as the “middle ground between addiction and sobriety”. He discussed how drug users who participate in harm reduction are 5x more likely to seek help in order to quit as well as how harm reduction works to reduce costs for future potential treatments for people using drugs. He also stressed how important it was to stay patient with patients when trying to wean them off drugs and to try and not get jaded about it, for seeing positive results in patients trying to achieve sobriety can take a very long time.

Following that session was another one based on the importance of Mentorship in Medical Education, where a faculty member from this institution stressed how vital it was to seek out mentors in order to maximize our opportunities in medical school. He also touched on the Twin City Medical Society Mentorship program here, where an advisee is paired with an advisor who is in the field that the advisee is interested in. Soon after that session was one that was based on the topic of Microaggressions, led by one of the co-presidents of the SNMA chapter here. In this session, we participated in an activity where we were presented with a couple of scenarios and chose our own path within the scenario by deciding what we wanted to do after a question was posed to us. It was pretty cool and it opened the floor for us to discuss various instances where we experienced microaggressions from either peers, faculty or other people while living out our lives. Then after that one came a suturing clinic, where I finally learned how to perform a basic suture! My first couple of stitches were rough, but I got a little better as I continued to work on it 😁.

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Next came lunch and a short talk given by a representative from Be The Match where she discussed the importance of signing up for the bone marrow registry and the potential opportunities that we have when it comes to saving a life. (Rest in Peace Tori.) Then came the next session, which was a panel discussion focused on the topic of Gun Violence, Police Brutality and the Mental/Public Health Effects they have on minority populations. I happened to be the moderator of that discussion and thus facilitated the discussion between the three panelists and the audience. We talked about what we as medical students could possibly do when it comes to effectively addressing these issues, the power of the Black Lives Matter movement and the impact that police brutality and gun violence has on the health of the populations they target, just to name a few points. It turned out to be a great conversation overall! After this panel discussion were two more sessions based on Financial Planning for Millennials and Addressing the Health Needs of East Winston-Salem, an area of the city that has a high number of low-income residents. We then all took a bunch of pictures together, checked out the exhibitor’s fair and attended a business meeting for the region to discuss, well, business. By the time that meeting ended, it was 5:00 PM.

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Some of the RMEC Attendees!

But my day wasn’t over just yet.

We all ended up at a country club nearby where we attended a banquet to close out the conference. It was the fancy type of banquet where we had 3 forks, 2 spoons and 2 knives or something like that. Plus, the whole four-course meal was served to us as we sat at our tables. The featured speaker at the banquet was Mr. Cornell P. Wright, who serves as the Executive Director of the North Carolina Office of Minority Health and Health Disparities. He touched on many things in this discussion, a few of which were, of course, the state of minority health in North Carolina, the infuriating truths that the 13th documentary brings up to the surface and the critical importance of health equity for all. He was also a really funny and interactive guy! It was an awesome ending to an awesome conference. I was so tired though, so I was looking forward to crashing in my bed…which I got to do only after hosting a kickback at my apartment complex for the SNMA medical students, which was a great time too. Like I said earlier, that extra hour proved to be REALLY clutch.

Jeez, I didn’t think I was going to write this much about the conference. I have one more unrelated thing I wanna say before closing off this post though. So bear with me!

As you may or may not know, I took my clinical skills exam about a month ago and I felt decent about my performance overall. Turns out my evaluators thought so too for just about every part of the standardized patient encounter…except for the history-taking portion of the encounter.

The freakin’ history-taking portion.

I swear I thought I did okay when it came to taking an HPI, Family/Social/Past Medical History, and Review of Symptoms. It wasn’t perfect, but I didn’t think I was going to get an unsatisfactory with my history-taking. It also didn’t help that the standardized patient was confusing me with her two different conditions (she made it seem like she had three different problems). Boiiiii you shoulda seen my face when I got the email about having to fill out a form requiring me to meet with my coaches in order to work on taking a more effective history.

done steve harvey over it family feud give up

Like, C’MON MAN!!

I’ve been working on this ever since I pretty much got told to do better on taking a history early on in my first year. However, we weren’t given any type of template this time around like in past clinical skills exams, so we had to reason our way through the interview and ask questions we felt were pertinent to the task at hand. I guess I did fine from a first-year med student point-of-view, because I pretty much asked the same open-ended questions that I’ve been taught to ask for the past year. However, the criticism came from the fact that I didn’t ask enough closed-ended questions, which are questions that are meant to pinpoint specific symptoms in order to formulate a working diagnosis in my head. After watching the recording of my encounter and viewing the evaluation form that my evaluators used, I began to realize how apparent the holes in my history-taking were. But even though I passed the exam overall, I still couldn’t really wrap my head around the fact that I really got an unsatisfactory on that part of the exam until I finally met with one of my coaches a couple of days ago to go over it with her.

After viewing the recording of my performance again with her and thoroughly discussing how I did, I truly then began to realize where my true problem lay. It wasn’t that I was necessarily bad at history-taking; I was actually very much calm and in control throughout the whole interview. It’s that, up to this point, I have been thinking of the questions I had to ask as a checklist that I had to fill out, even though I had been fighting to not think of it as that. It’s just that over time, it just became easier to think of it as a checklist as opposed to actually trying to think critically about what was going on with the patient, something I hadn’t even really realized I was doing until I had this discussion with my coach. It was a much-needed learning experience I didn’t realize I needed and that I honestly didn’t even want to accept at first because I had grown comfortable to my style of questioning. It also became vividly apparent to me that we didn’t get a template of questions this time around because we need to be able to critically think about the patient on the spot, something I honestly wasn’t doing well enough. Although I was extremely annoyed when I first got my evaluation back, I’m now very grateful about the feedback I’ve been given, which will work to make me that much better of a physician in the future. I also have a good feeling that there will be many more instances like this as I go about my training in the coming years…so I just can’t ever get too comfortable with anything.

Aiiight, I gotta get back to studying guts and butts, a.k.a. the GI system.

Hope you have an amazing week!

“Be willing to be uncomfortable. Be comfortable being uncomfortable. It may get tough, but it’s a small price to pay for living a dream.” – Peter McWilliams

– Black Man, M.D.