As a rotating intern, I spent time on the general surgical service. Traditionally, off-service interns are granted minimal responsibilities on the surgical service; they are akin to glorified medical students with M.D’s. Most of the rotators intend to become radiologists, dermatologists, or ophthalmologists. The administration is aware of the circumstances, and usually schedules accordingly. When I reflect back to my stint, however, this was certainly not the case. Somehow I was promoted to a level I was probably underqualified for, at least part of the time. Perhaps it was because I had mentioned to the team that Mehmet Oz once lectured to us about incorporating flaxseed into our daily meals.  Or maybe there was simply a shortage of bodies on service. Mind you, while some ophthalmologists spend a year in surgical internship, the only experience I had to draw from was one rotation as a third year medical student. Most of my time as a student was spent changing wound dressings. Here are a few notable instances that I was subjected to:

10. Consulted on 12 surgical cases while covering a service of 58 patients while on call. (A new pager battery died in a matter of 10hrs)

9. Incised, drained, and packed thigh abscesses on the floor. (I read a blog on how to perform the procedure beforehand)

8. Closed up subcuticulars in several inguinal hernias and lumpectomies.

7. Ate 10 chocolate chip cookies and drank 3 20-oz Powerades for dinner.

6. Served as first-assist in a laparoscopic J-tube placement on a woman with peritoneal mets–the case started at 8pm and ran 3hrs. I read a website how-to guide on the general progression of the operation. My responsibilities were minimal–just holding the camera at awkward positions, keeping the field clear, and working the 2nd alligator and dolphins.

5. Diagnosed an acute appy in the ED (cool!), but had to assist in the case at 4am. (I watched a video from some website in India beforehand to figure out where to put the trocars)

4. Replaced a G-tube that had fallen out of a floor patient (with guidance from a nurse and the instruction manual).

3. Placed a G-tube via endoscopy (with supervision from attending)

2. Hand wrote 16 progress notes in one morning.

1. Performed 50% of a lumpectomy including sentinel node biopsy and tagging. (Attending thought I was a surgical resident and did not listen when I explained that I was a non-surgical intern; I did however prepare for the case extensively beforehand)

The experience, while harrowing at the time, was actually extremely gratifying afterwards. Now that it’s over, I suppose that I’ve added to my adventures of residency.

* Note: In no way should the aforementioned anecdotes be construed as a reflection of those parties involved. Ophthosurgery and its authors hold no responsibilities to any parties mentioned on this website. Ophthosurgery is not liable for the use or interpretation of any content found on this website. See disclaimer for more details.

medicine work

As part of my internship requirements, I work in the emergency room triaging patients. The shifts range from 10-12hrs apiece, and it’s surprisingly tolerable. Since I am not an EM categorical resident, I don’t have to triage the trauma patients. That leaves a medley of typical ED presentations along with some less common issues. These include COPD exacerbations, pneumonias, GI bleeders, HIVers, and obstipations. The best part about the ED is that all I have to do is determine whether a patient needs to be admitted or sent home. At the end of the shift, I sign out any pending labs and issues to the next resident, and I leave. No more worries. Since there are always patients waiting to be seen, the shift doesn’t drag along.

The attendings also seem content with their work–several of them noted that the best part of their job is that they rarely exceed 50, even 40 hrs a week! That leaves adequate time outside of the hospital to stay sane. Not bad.

medicine work

typical Anki screenshot

I finally managed to register for the USMLE Step 3 after going through all the hoops that the NY State Department dishes out for physicians. Now the only thing left is to learn the material for the test. The test itself is a two-day exam with clinical scenarios relating to general medicine. It’s run by the National Board of medical examiners, but is actually administered by the folks at Prometric. (I’ve taken MSCE’s and IBM AIX licensure exams by them in the past, as well as Step 1/2 exams).

I haven’t decided how to prepare for the exam. I haven’t purchased any books yet, nor have I the urge to. The exam itself was $690, and the NY State Dept charged me $735 to make sure I’m not a villian.  What a rip.

However, since I’m not necessarily in the mood to do any group studying, I might try to use some spaced-repetition software to help some of the material sink in my head.  Read more…

computing usmle, work

I’m working on night float this week for the Heme-Onc service. This means that I take all admissions coming in, and manage the floor patients. The one perk of this job is not having to write progress notes in the morning. The flip side is that you have to deal with otherwise stable patients who go berserk at night. Aside from my pager going nuts occasionally, the hospital itself is relatively quiet.

medical resident work area

Read more…

medicine coca-cola, medicine, work