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.

Nbc Fail GIF by Ninja Warrior

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.

Donald Glover Chaos GIF

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!

Cant Stop Dave Chappelle GIF

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.

Dashing Thru Neuro

Shhhh…..do you hear that?

No? Really??

Listen closer…..now I KNOW you can hear them bells ringing!

That’s right! Santa Claus is coming to town!!

santa claus GIF

It’s the most wonderful tiiiiime of the year, where the brisk & chilly winter air (if you live in the Northern Hemisphere) reminds you that you belong indoors with your family drinking some hot cocoa while listening to holiday music and laughing about stories that are being shared, half of which you’ve probably already heard like ten times. Christmas dinner is beginning to be prepared, extended family is arriving, and your parents are telling you to run last-minute errands before Christmas day. Then as Christmas Eve starts drawing closer and closer to an end, the anticipation of Christmas morning overcomes everyone, especially the younger children in the family and everyone in the house entertains one another in a merry fashion. Then Christmas morning arrives and just like magic, there’s a ton of presents under the tree and everyone is all smiles and just happy to be in each other’s company! It’s a wonderful experience every year and being able to see everyone all together happy and healthy is enough of a gift for me every year. I wouldn’t have said this same thing 10+ years ago, back when Christmas meant getting the newest toys and gadgets to entertain myself with. But alas, we all grow and mature and eventually realize the true meaning of Christmas and the holiday season in general!

I love this season as much as anyone else, but I didn’t come here to write up a Christmas novel or memoir. Y’all know the real reason why I’m here. So let me get straight to it.

My experiences at the various outpatient clinics I visited last week were overall positive ones! The atmosphere at the clinics was very calm, laid-back, and educational. The patients that we treated were very nice and appreciative as well. I was at five different clinics throughout the week, most of which were general neurology clinics. So with that said, I ended up seeing several cases of myasthenia gravis, peripheral neuropathy, and headaches. I was even able to witness a case of newly diagnosed ALS, a diagnosis that was not easy for the patient and his family to accept. In addition, I did get the opportunity to observe procedures involving electromyography in one of the clinics, which was pretty cool the first couple of times I saw it. It actually looked quite uncomfortable for the patients, for they were getting pricked by needles in various parts of their body so that we could study the muscle activity in those areas. And it wasn’t a quick procedure either. On average, it took maybe about 20-30 minutes to complete. After the second time around, I had pretty much gotten the gist of the procedure. Hopefully I never need an EMG study done on me. 😅

At some point during the week, my rotation group and I all participated in a coma simulation lab, where we were divided into two different groups by a Neuro ICU attending and were assigned the task of managing a dummy who came into the ER in a comatose state. You know, it’s always funny realizing how much you don’t know when you’re thrown in a situation that you thought you knew how to handle. After managing the ABC’s (airway, breathing, circulation) of the “patient”, my group was at a loss at what to do next. We threw out different ideas and acted on them, but none of us really had a structured plan in place for a situation like this. After exhausting all of the options we could think of as a group, including asking for a CT scan that came back normal, I sure as hell had no idea what to do next. So I just kept sternal rubbing the dummy and calling out “Mr. Jones”! (That’s the name I made up for him on the spot lol.) After both groups had their turn, we critiqued each other and learned some valuable lessons from the attending about managing a comatose patient. It was a cool learning experience and it further proved the point that there is a very clear difference in reading about doing something and actually performing the task in real life. I’m absolutely sure that I’ll get the opportunity to learn more about emergency care later on in the year during my Emergency Medicine rotation.

Speaking of emergency care, I was participating in just that during my night shift last Thursday. Boooyyy, was it busy. Soon after arriving for my shift, we were literally bombarded with pages about the patients that we were covering and about new patients coming into the emergency department. There were several patients who came into the hospital with active strokes and it was fascinating to watch how all the residents in differing specialties worked together in concert in the ED. The neurology residents would perform a patient interview and neuro exam while the patient was being wheeled to the CT scanner, and after being scanned the neurology resident would continue the exam while another neurology resident would assess the CT scan with a neurosurgery resident in order to decide if the patient needed immediate surgery or not. Everything would happen so fast, and all my classmate and I could do is watch and try our best not to get in the way, which we managed to fail at on several occasions. It’s almost impossible to get out of the way in a cramped place like the emergency department, just saying. Apart from answering pages from the ED, we checked on other patients in the hospital who were suffering from other conditions such as seizures and headaches. I definitely learned a lot that night from the awesome residents who were very willing to help us learn things, no matter how busy they were!

The final thing I want to touch on is the mid-rotation feedback session that I had with my clerkship director. It was a very helpful session filled with comments about my strengths and practical feedback that I can utilize in the second half of my rotation when I get back from winter break. I also got my quiz grade back (the one that counted for 30% of my grade) and I must say, I was quite pleased with my score. 😄 The director and I discussed several things, but the main lessons I took from the session included: 1) developing a mindset of thinking in which I’m actively looking to figure out what important lessons and/or techniques I will be taking away from each rotation and 2) focusing my history-taking and neuro physical exam performance on what the patient is complaining most about. She told me that her main goal for me and the other students in this rotation is to have us really learn and appreciate the neuro physical exam so that we are able to use it comfortably in not only our future rotations but also throughout our careers. So guess what I’m going to do? Yup you guessed it; adequately learn and appreciate the neuro physical exam so that I can comfortably use it whenever I feel that it’s necessary to do so!

With two weeks of a solid performance in Neurology behind me and another two weeks of relaxation in front of me, I’m in a fantastic spot mentally, physically and spiritually. I’m planning on this winter break to be an amazing one!

Have a very Merry Christmas and a strong finish to 2017!

“Learn to enjoy every minute of your life. Be happy now. Don’t wait for something outside of yourself to make you happy in the future. Think how really precious is the time you have to spend, whether it’s at work or with your family. Every minute should be enjoyed and savored.” – Earl Nightingale

– Black Man, M.D.

Everyday I’m Hustlin’

My experience in this Pediatrics rotation so far just continues to get better and better. I was on the night shift this past week and I had just as great of a team as I had the previous week! Not only that, the shifts only ran up until midnight, so I’ve had a good amount of time to study (Thank GOD) and get other things done during the day. I probably won’t have as much time to study this upcoming week due to the fact that I’ll be back to working 6AM-5PM shifts, so I really needed this past week to catch up on material that I still don’t feel like I’m caught up on. But on the other hand, I’m sure I’ll have some amazing learning experiences this week because I’ll be helping to care for patients with impairments in their Cardiologic, GI and Nephrologic systems.

 mrw omg john cena savage oh snap GIF

During my time on night shift, my team and I routinely checked in on currently admitted patients on the floors we were covering to make sure that those kids were doing alright. We also frequently went back and forth from our workroom to the Pediatrics Emergency Department to assess and/or admit new patients into the hospital. While in the ED, I helped admit a good number of patients who came in with a wide variety of symptoms that ranged from very benign to extremely serious. I was able to further hone my interviewing skills and to tweak them in a manner that was more amenable to pediatric patients while fully taking in the endlessly busy environment of the ED. Furthermore, I witnessed bad news being delivered to patients on a few occasions and acknowledged not only how the patient’s family took the information but also how the doctor delivering the unfortunate news phrased everything she was saying. Having to deliver news that you know is going to be devastating to a family is tough…but learning how to effectively do so while providing justified hope is an incredible skill to have in your toolkit, and one that I would definitely like to acquire. Overall, my time on Peds night shift was a memorable and enriching experience filled with encounters that will truly be unforgettable.

I’m keeping this post short because I actually have a thousand things to take care of at the moment, which brings me to my final point. As of late, I’ve been asking myself, “Why is it that the further along I get into my medical education, the busier I make myself outside of my studies?” It’s pretty backwards, to tell you the truth lol. You would think that I would participate in more extra-curricular stuff as a first or even second-year student due to the relatively higher amount of free time I had in those years. But I’m finding that I’ve been doing a lot more extra-curricular work this year than I had in years past…or at least it feels like it. Maybe it’s because I’m usually busy in the clinic or the hospital now, so my limited “free time” is spent studying and squeezing in time to fulfill the multiple responsibilites I currently have. Also when I look back, my first-year was a time of adjustment for me…so it was probably better that I stayed focused in my studies. Not having a car back then didn’t make things easier either. But now that I’m a third-year student, I’m a lot more comfortable in taking on multiple responsibilites while fulfilling my role as a medical student. It’s just ironic that I happened to want to become more active in areas that I’m passionate about while at the same time having to deal with an even more demanding workload from school.

 nbc parks and recreation frustrated sigh ron swanson GIF

*Sigh*

Such is life.

Y’all make sure to have a wonderful week! It’s hard to believe that October is already in full swing! AND SHOUTOUT TO THEM CANES FOR BEATING FSWHO IN A DRAMATIC FASHION AT THEIR OWN STADIUM!!!

 sports celebration college football cfb ncaa football GIF

“Whether you think you can or think you can’t, you are right.” Henry Ford

– Black Man, M.D.