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.

Stroke of Misfortune

Last week was absolutely one of the busiest weeks I’ve had in a while.

It was my first week of Neurology and I was on the Stroke service helping to care for patients who were suffering from symptoms concerning for, well you know, stroke. My classmate and I were put to work right away as soon as we came in at 6 A.M. for our first shift on Tuesday morning. (Monday was reserved for Neurology Orientation, where we were told what to expect from the rotation and what was expected of us. We were also given free Chick-Fil-A lunch and reflex hammers to borrow, which was nice. 😊) From then on, we were expected to closely follow the patients that were assigned to us (I was assigned about 7 or so patients throughout the week), pick up new patients as they came in, think through their problems & try to come up with solutions to them, try our best to read their MRI and CT scans, follow through with the tasks assigned to us by the residents on the team, go to the required lectures that the attending physicians were giving to us, and some other things I can’t think of off the top of my head. Sure, most of this stuff are things that I’ve already been doing in other rotations and aren’t new to me.

But the fact that I had been thrown in a very busy service in a specialty that I hadn’t had much exposure to ever since Step Study Period made it harder to keep up with everything I had to do. It didn’t help that the last time I had conducted a full Neurology exam was well over a year ago. 😅 My multiple gaps of knowledge were exposed by the questions that I was peppered with by my attending, who also was gracious enough to fill those same gaps with very valuable information regarding strokes and how to efficiently assess brain imaging. In addition, I saw firsthand how debilitating brain damage could be, how it can completely change how a person functions physicially and mentally, the unbelievable findings that can be elicited on a physical exam and how much it could affect the families of the patients who were suffering from the damage. I definitely learned a lot last week from the medical team and the patients on that service, and with all the tasks that I had to complete for my patients (who were all really friendly!), I really felt like an indispensible part of the team! Okaaayyy, I’m stretching it with indispensible. But I sure did feel useful!

On the other hand though, I barely had any time to study new neuro material. Clinical duties and attending lectures are heavily stressed on this rotation, so I was ending my shifts around 5 PM or so, and getting back home pretty tired. I got some studying in and reviewed the conditions that my patients had but then before I knew it, it was time for me to go to bed in order to start the process all over again the next day. It was like the inpatient units of Internal Medicine all over again…except that I’m more than halfway done with third-year at this point and it’s really freakin’ cold outside at 5:30 in the morning these days. I did do some studying of the lecture material this past couple days for this quiz we have tomorrow that is worth 30% of our grade. 😂😂😂 I had to laugh because I’ve never heard of a quiz being worth so much of someone’s grade before. It’s wild as hell…but it’s also not supposed to be a tough quiz. Plus, we have to complete a bedside clinical exam at some point during our rotation and we actually have the option to subsitute that grade for our quiz grade if we would like to. And the clinical bedside exam isn’t known to be a hard thing to do great on in this rotation. So hopefully, this 30% will work heavily in my favor and not the other way around!

By the way, y’all remember the Clinical Practice Exam I talked to you about back in my Back To Basics post in October? You know, the CPX where I had to zip through 6 patients in 15-minute intervals and write up clinic notes on them on the spot? Well I know I had said that I thought that I did alright on it and that my performance was far from perfect. I FINALLY got my evaluation back from it and turns out that my evaluators thought the same thing! Well, except for the “doing alright” part. They absolutely agreed that my overall performance was far from perfect. As a matter of fact, they believed that it was so far from it that it was “Less Than Satisfactory”.

Oh My God Omg GIF

Well damn! Less than satisfactory though?!? Can’t say that I was expecting that kind of feedback. On the documentation side, they seemed to think my history-taking and physical examination skills were okay, but they did NOT seem to like what they saw when it came to my diagnoses and workup plans.

Frustrated Denzel Washington GIF

As for my actual encounters with the standardized patients, they weren’t big fans of my history-taking and my physical examination skills.

Confused Tituss Burgess GIF by The Late Late Show with James Corden

Confused? Yeah, me too. But hey on the bright side, I scored above average on my communication and interpersonal skills, so I did something right!! But overall, I didn’t do as well as they would have liked for me to do, so now I need to set up an appointment with the director of this clinical skills course in order to review my performance. Thankfully, it doesn’t have any impact on any of my grades and I’m glad that my flaws are being exposed now so that I have more than enough time to fix them before my second Clinical Practice Examination and Step 2 Clinical Skills comes about. And by looking at the averages and ranges of the class scores, I’m absolutely certain that I’m not the only one who’s performance was viewed as less than satisfactory. Plus, it was the first time that any one of us ever had a clinical exam in that format. Regardless though, it’s annoying as hell that I’m not considered up to par clinically. Looks like I still got a lot of work to do before Step 2 Clinical Skills rolls around.

Jon Stewart Queue GIF

Well, that’s all I got for you today! I start outpatient clinic tomorrow at 8 A.M., which means I get to sleep in this week! Yay me! And after my night shift on Thursday night, I’m free for winter break!! TURN UUUPPPP!!!

Have a marvelous week and continue to enjoy the glory of the holiday season!

“You don’t need to be perfect to inspire others. Let people get inspired by how you deal with your imperfection.” – Wilson Kanadi

– Black Man, M.D.

Perspectives.

There was so much emotion around me.

Laughs.

Screams.

Tears.

Jumps of joy.

Hugs.

Kisses. 

It was the day that all medical students across the nation work tirelessly for; a day that determines our future and indisputably seals our fate. Match Day. The fourth years all around me had matched in various specialties in a number of schools around the nation. Most of them matched in the specialty they desired and matched to a school that was within the top 3 choices on their list. It was fantastic to witness all of my 4th year friends finally receive the opportunity to become something that they’ve put an insane amount of hours towards; something that very few people in the world get a chance to be; something that gives them the incredible ability to heal;

A physician.

I was at the Match Day ceremony for maybe 30 minutes max, but all I needed was 5 minutes to fully absorb the magnitude of what was happening around me. In those 5 minutes, I saw with my own eyes what the result of this taxing medical school life will be. In three short years, I’ll be celebrating with my class about our incredible achievement and the fact that our hard work will allow us to secure a stable job & lifestyle that we can keep for the rest of our lives. It was definitely reassuring to witness with my own eyes the light that is waiting for me at the end of this challenging journey. Sure, we all are going to be worked off our ass during our residencies, but at least we’ll be getting paid doing what we love right?

Now that I’m here talking about my future, I’m reminded of what lies ahead of me between now and Match Day of 2019. Second year classes, the USMLE Step 1 Exam *rolling my eyes*, my clinical years where I’m literally paying the school to work me, etc. It looks like an uphill battle…but getting in this position from college was an uphill battle in itself and I’m here aren’t I? I’ve also heard multiple times from different people about how things just get worse from first-year…as well as how much things get better from here. I guess it’s just a matter of perspective. Hell, I’m just happy to be here. I personally plan on maintaining the positive attitude that has gotten me this far. Call me naive if you want, but at least I’m content. 😁

Speaking of being content, I was recently elected to serve on the Ophthalmology Interest Group E-board here as well as on the SNMA E-board as the Community Service Co-Chair! I’m looking forward to working in those positions because both of those organizations have a considerable amount of value to me. They’ll also give me something to do that doesn’t involve me studying for the exams that never stop coming, which I really appreciate. So there’s that.

There’s one more thing I want to add. We’ve been learning all about stroke this past week in class and one of our professors actually had a stroke patient come in to talk to us about what life is like after having one. He had suffered from one a few years ago while doing the simple task of walking a dog with his loved one. Because of his stroke, he can’t see anything in his right visual field, he had to attend physical therapy for an extended period of time in order to relearn how to walk, he’s had to relearn his alphabet and how to do simple math, and he has to concentrate extra hard to process information in a regular conversation. However, he was pretty upbeat and willing to talk and joke around with us about his perspective with the disability. It was a very fascinating conversation. He really helped to put a human face on a topic that we’ve been laboring over for the past week and I feel that he also helped to inspire a number of us in the class to continue working hard towards understanding the intricacies of the brain. It’s scary to think about how sudden a stroke can present itself…it makes me want to get a CT scan of my head and look for any abnormalities. Someone once told me that med school can turn you into a hypochondriac…I’m finally starting to see what they meant by that. 😰

Alright, that’s all of my reflections for today. Go on and have a stupendous week!

Oh yeah, shoutout to all the upsets that have occurred since March Madness started. Y’all never fail to destroy the brackets I work so hard to perfect. 😊😊😊😊😊😊😊😊😊😊😊😊

If you don’t go after what you want, you’ll never have it. If you don’t ask, the answer is always no. If you don’t step forward, you’re always in the same place. – Nora Roberts

– Black Man, M.D.