ONE. MORE. WEEK.

This is it y’all!

I’m heading into my final week of third-year rotations!!

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I’m finally going to be taking my eighth and final Shelf exam this Friday, and I couldn’t be more ready to get it over with. It’s taking everything in me to get through all the material that I need to study in order to perform adequately on the exam, especially since the Emergency Medicine exam is one that can test me on just about anything. So yeah, you already know that there’s no way I’m going to know everything I need to know for this exam. If there’s one thing I learned about Shelf exams this year, it’s that the questions on the test are a total crapshoot. There’s pretty much no telling what’s coming at you once you hit “Start Exam” and enter into the 2-hour-and-45-minute time crunch that you’re given to complete the 110 questions. It’s annoying as hell. But regardless, I’m gonna put my best effort into it and deal with whatever score I manage to squeeze from it. Unlike other rotations though, I also have a 30-minute oral exam that I have to complete the morning of my Shelf. So I have the glorious opportunity to prepare for that too. Lucky me. Hopefully that ends up helping out my overall grade as opposed to hurting me!

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Before I get to finish off my third year and move on to fourth year like I so desperately want to, I have to work two more ED shifts tomorrow and Tuesday as well as participate in a Pediatrics Simulation Lab and finish writing up this required case report about a patient that I helped treat a couple of weeks ago. This is all after having completed a Peds ED shift today just prior to typing this post.

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Now don’t get me wrong, I actually do like this rotation and the people I’ve worked with in it have been some of the best and nicest that I’ve worked with all year long. Plus, both the didactic and the on-the-job teaching I’ve had the opportunity to receive while in this rotation has been phenomenal. I feel like I’ve learned an incredible amount of information in these past three weeks and like I’ve been treated as a true member of the healthcare team while working my shifts. And I can’t forget about the fact that I’ve gotten the chance to see some pretty crazy things happen to patients while on my shifts. But even with all that said, I’ve recently come to find that I’ve become quite exhausted with this school year overall. It has been getting harder for me to will myself to get things done and to engage myself in the rotation at times. There have been also times where I just completely forgoed studying and found something else to do with the limited time that I have. For a second, I had thought I was starting to perhaps experience some early signs of burnout…but I don’t think that’s really what it is. I think it’s moreso that now that I know what field of medicine I want to go into, I’m just itching to start working in that field specifically. I have most of my fourth-year schedule locked in already, and I have a fantastic start to the year with my first four blocks being Step 2 prep (🙃🙃🙃), the Victory Junction Pediatric Summer Camp, Neonatal ICU and the Pediatric Hematology/Oncology Acting Internship. And not only am I excited about my schedule, I’m also thrilled about the fact that I don’t have any exams to prepare for in most of my blocks next year!!

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That’s literally one of the best parts of fourth year; I’ll be able to fully immerse myself in the rotations and study the material that I want to study in the fashion that I want to do so without having to worry about getting through a certain number of questions and memorizing buzzwords and whatnot. I can read research articles to my heart’s desire, I can spend my “study time” reading up on as many patients as I want, I can fully engage with my patients without having to worry about setting time aside to study questions and when I get home I don’t have to spend most of my waking hours studying for Shelf exams! It’s going to be wonderful, I already know it lol. These, plus more, are the reasons as to why I am itching to finish up this Emergency Medicine rotation and to start off my last year of medical school. I’m really glad that this rotation is designed the way it is though, because having great people to work with in such a collegiate environment has made it easier for me to engage myself and learn, no matter how much I would like to fast forward time. However, I did enjoy the two Peds ED shifts that I’ve worked in, so Peds Emergency Medicine is definitely a possible career path for me in the future!

This past week was straight. I don’t really feel like typing anymore, especially since I have a lot of other stuff to do…so I’ll keep it brief. I worked three ED shifts throughout the week, participated in an Airway Lab where my classmates and I got hands-on learning about managing airways in patients, and attended the annual Scholar’s Brunch yesterday morning where I met one of the people that one of my scholarships was named after. It turns out that she was one of the previous Deans for Student Inclusion and Diversity at the medical school! We had some great conversation over some delicious food and I was able to take in the moment to appreciate the fact that I was in a room full of freakin’ millionaires. Like, I was meeting people whose family members had buildings around the medical center named after them! Wild bruh. Just wild. I was also featured in a video that was shown during the brunch (Here’s the link to it), so maybe some of those donors will remember my face and decide to help me pay off some more of my six-digit debt! 😅🙏🏿

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Aight, I’m done typing. Y’all be sure to have a fantastic week! 😄

“Happiness is not something you postpone for the future; it is something you design for the present.” – Jim Rohn

– Black Man, M.D.

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.