Learning things the hard way

I spent this weekend in Miami visiting my boyfriend. But the journey getting there was full of L’s (losses)! I felt like I just couldn’t catch a break. After a series of unfortunate events, I missed my original flight and spent the next few hours trecking all over the airport trying to find another flight out. My airline didn’t have any other flights for the night so I was checking with other airlines. I’ve never missed a flight before so I felt like such a failure, like really irresponsible. And of course I’m thinking about study time lost while I’m getting my cardio in for the day/week. After many rejections and more money spent I finally reached my destination 6 hours later. I will never miss another flight in my life I’ll tell you that much.

And THEN on the way back, nobody told me that if you don’t fly on your airline out, they don’t save your return flight. So when I got to the airport for my return flight at 9am, I found that out the hard way. So I had to get yet another flight, but they still put me on standby for that flight. I was one person away from making standby -_-. Thankfully, Leslie hadn’t left the airport yet (he was taking a nap) and was able to pick me back up with no issue. Ended up leaving on a 5pm flight. I enjoyed the extra time but since I was now eating into my Sunday work day, I had to spend much of it studying. So, this weekend ended up being a heck of a lot more expensive than planned, but still worth every penny.

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I took a lesson from it all though, which is why I decided to write about it instead of suppress my misfortune. You simply cannot plan everything out to the T, that’s not how life works. And when things don’t go as planned, it’s all about your attitude and how you respond that makes the difference. At first I was so frustrated and teary-eyed but I had to pull myself together and remind myself that I couldn’t change my circumstances; I just had to keep it moving with the current situation. Dwelling on the past would do nothing for me. I tried as best I could to keep my thoughts positive (emphasis on try). When you’re already in a tough spot, negativity will only add fuel to the flames that are consuming you. I’ve learned these lessons before, but I was definitely reminded of them this weekend.

Many are the plans in the mind of a man, but it is the purpose of the LORD that will stand. -Proverbs


Praise God for journey mercies though because I made it back in town safely. I’m 10 days out from my shelf exam for Family Medicine and currently not feeling very comfortable with the material, so please extend your prayers to me and my brain!

Have a wonderful week!

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How you can make a difference as a medical student on rotations

We play a small but mighty role in the lives of our patients!

It can be pretty hard sometimes to find your place as a member of the “team” while you’re on your rotations. Speaking from experience, it’s hard to feel like I’m making much of a difference. After feeling good about the patient encounter and presenting everything to the attending (including the correct diagnosis for the patient), they come in and ask all the same questions and do all the same physical exam! Of course I understand why, but I can’t help but feel a little undermined at times. If you’re in a big hospital on a team with interns and residents then you might feel even more useless, because the students in training do all of the real work. I remember feeling lost in the shadows my time on a hospitalist team. Technically I was following my own patients and would present on them, but after rounds I was pretty out of the loop, unless I forced myself into it (and I didn’t want to be that girl). So it can be pretty frustrating. But rest assured, there are ways that you can impact your patients unlike any other person, as well as make a huge difference for your care team.

We’re eager and fresh in this new environment. We haven’t been jaded by the system and we only want to do the best by our patients. Our hearts tug when we hear bad news; we give people the benefit of the doubt; we believe it when they say they’re taking their medicine. This is such a meaningful thing that patients actually notice! There’s a difference in the way a medical student talks to them versus an attending. We show them the compassion, care, and empathy that they truly need and sometimes don’t get. There are times we can do more for them than all of the medications and tests that the residents are ordering. We have the time to sit with them and get to know them more personally. This especially goes if you don’t have to write notes after your patient encounter. More practically, there are many things you can do to be a rockstar team member: print rounding reports, gather new data on patients, do extra research on topics you or the residents may be pimped on, etc.

I’ll always remember on my OB/GYN rotation, there was a patient whose child had to be transported to another hospital while she had to stay to recover. It was so hard for her to be separated from her child. I came in during pre-rounds and was a soundboard for her to express her feelings. I told her that she was going to be a wonderful mom and that the time would soon come for her to be reunited with her child. I stopped in again later in the day, and as she was being discharged, she thanked me so much for being her rock as she waited for the go-ahead to leave the hospital. And she gave me the biggest hug. She said people just came in and out of her room all day and no one cared what she was going through. In that moment I felt like I did more for her than any of the nurses or even my attending–who really just signed her discharge papers.

So just remember that even though you might not have access to the computer record to look up patient info, or you might be the third person to take the same patient history, you really can make all the difference in a patient’s life. Our worth as medical students is unfortunately defined by how good our oral presentations and differential diagnoses are. But our worth as physicians is really in the connections we make with patients and in the rapport we build with them. That’s what makes all the difference. While learning to be good clinicians, we are also learning to be good doctors.

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Have a wonderful week! Subscribe on your way out if you haven’t already!

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Life and Death

A week of palliative care has shown me a lot

I’ve spent a week on my palliative care rotation and boy has it been heavy. Palliative care is focused on quality of life and relief of symptoms, especially towards the end of life. I’m assigned to a nursing home, so not only am I exposed to end of life issues, but I’ve been able to learn about geriatric/elder patient care in general. I did a puzzle with a 94 year-old in occupational therapy and I saw a patient around the same age in her last days of life. It’s been quite the ride.

Earlier in the week I was part of a very delicate conversation concerning one of our patients nearing the end of life. It was a team meeting with the patient’s son and grandson. Our medical director asked questions like “how do you envision a good death for the patient?” and “what are your goals for the end of life?” They were trying to think about what the patient would want, as he could no longer speak for himself. Such a delicate time for the family.

Dealing so much with death and end of life has actually made me reflect a lot on life and how we all want to life full lives. And even at old age, after living a full life, death can still come suddenly to a family. There’s never really any way to prepare for that conversation. But it’s a reminder to live each day to the fullest and take advantage of all the ways you can make a difference in people’s lives. To pursue your passions and not put a hold on your goals for life. Because at the end, we aren’t all going to be blessed with the opportunity to plan out how we or our loved ones will leave the world.

As a future physician it’s nerve-racking to think that I’ll have to have these kind of conversations with patients and their families as soon as my first year out of school. So I’m happy to be getting the small exposure I am now so that maybe when I’m more important I’ll be able to guide a family through such a vulnerable time as this.


One more week of palliative care, then Family Medicine. Stay tuned. I’m excited for the week ahead!

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What you need to know about the OBGYN rotation

My pearls to help you be successful on the OBGYN clerkship & Shelf exam

Day 1: Approach the OBGYN physician with caution

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Most docs in the OB field are generalized to be “catty”, which of course isn’t true everywhere. But if you think about it—the long hours, being on call, constantly feeling like you’re on demand–you can imagine how that can wear on your attitude some days. So, careful as you come in with your beaming smile and radiant energy because you may not be met with the same thing. You’re likely coming off of a full nights sleep while your doc or resident was on call last night. So, use your social cues and gage the situation. Look for ways to help your people out or help the staff to do anything that makes the day run smoother. The staff will love you, and your attending will notice how much they love you.

It’s not all about the deliveries!

The first thing people say to me when I tell them I’m on OBGYN is so you’re delivering lots of babies huh? Of course delivering babies is a big part of the field (especially financially), but as a student if you go into the rotation thinking you’re only going to be popping babies out left and right, you’ll be highly disappointed. And there is so much to learn in those 12-24 hours leading up to the delivery–managing the patients labor, tracking the rate of cervical dilations, monitoring the status of the fetus, making sure mom is comfortable and gets her epidural on time, etc. The birth itself is a bloody climax to it all. So whenever you spend your time on L&D, I advise you to work closely with & learn from the nurses (or possibly junior residents) who are likely the ones keeping a close eye on everything. In my experience working in a smaller town, the nurses manage the patients all the way until about 60 seconds before the baby is ready to see the world. So I really gained a TON of knowledge and clinical experience by following patients with the nurses, much of which helped me on the Shelf exam. And to answer the question, yes I caught my fair share of babies.

You need to know ASEPSIS

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OBGYN is a surgical specialty and you spend quite a bit of your time in the operating room (at least I did). Pay special attention to your ASEPSIS training and if you aren’t getting it right before the rotation, watch some YouTube videos to help you refresh. Save yourself the embarrassment & potential scolding depending on where you rotate. I think the most common way you’d mess up (from personal experience and from what I’ve been told) is moving the surgical light with your sterile hands, so be extra careful there. Luckily I rotated at a site where the staff and doctors were chill and didn’t take pleasure in making med students cry, so when I messed up it wasn’t the end of the world.

On surgery days, learn as much about the patients as possible

Watching/assisting with procedures is awesome, but unfortunately won’t get you very far in the numbers game as a third year medical student. Take time to read each patients chart before the surgery in order to understand how they got to this point. Then go ask them questions if you can before they get all doped up. How old are they? What were their major symptoms? What things did they try before hand? If you’re doing an operative laparoscopy (op-lap), think about some things you might see based on the patients symptoms. Especially cases like dilation & curettages, LEEP and cone biopsies–learning about the patients getting these procedures can help you in your studies when a clinical vignette is asking you about the infamous “next step in management.”

SHELF advice–The name of the game is management and risk factors

What is the diagnosis? What is the next step in management? What is the greatest risk factor for this patients condition? are a few of the most common question stems you will encounter in your shelf prep. So start early nailing these things down as you study different conditions. If I could go back, I would have kept a few sheets of paper where I drew out flow charts for the management of different conditions. It gets so confusing when you follow different protocol based on age or weeks gestation or stage of cancer or grade of lesion. I found myself second guessing a lot of those types of things, even on my exam.

 math study learning exam studying GIFThe resources I used were the Beckman’s textbook, Online MedEd, UWise, UWorld, PreTest, and I read some of Case Files in the last weeks. Each of those resources were solid, but honestly PreTest really wasn’t doing it for me like it did during Pediatrics. Like in Peds, I watched all of the OME videos up front and took digital notes on them as my foundation. As I did questions and learned more, I added those notes into the structure I already had. Our school had a reading schedule for us to get through the Beckman’s text along with the associated APGO YouTube videos and UWise quizzes. I was able to keep up with that consistently. I did PreTest in the first 3 weeks by waking up early in the morning or doing questions at night when I finished the readings and Uwise. But like I sad, it’s really not something to be pressed about. I did UWorld in the 4th and 5th week and did NBMEs/UWise comprehensive exams in the last week. Lastly, you want to always have something on you to study at all times. There is down time on L&D and in between surgeries that you can use to get some of your work done, especially if you have long hours.

Nearing the end of the rotation, I had this unsettling feeling in me that no matter how much I studied, I would still be iffy on those management questions. I just felt like there was no way for me to just memorize it all (I’m horrible at memorizing things if you didn’t know). I could only really remember the things that related to patients that I worked with. That’s why I said if I could go back I’d have created something as I went and used that to review/memorize in crunch time. But hey, I did my best, which is all I can ask of myself, so we’ll see how those results come out!


I hope this is helpful to someone. If you’ve been through it and have other things to add about OBGYN, feel free to drop them in the comments!

Also, S U B S C R I B E !

New rotation, new location–one week down!

Update on OB, life, and embarrassing moments from the week

First week of OB has been awesome! It started out with me being in the wrong place for orientation, which is exactly the type of thing that I would do. People think I’m really smart but in reality I don’t have much common sense. Everything ended up working out though of course. Anyways, being in a rural area as the only student with my preceptor and no residents means that I get to see all the patients and scrub in/assist with all the surgeries. I work with different preceptors throughout my time here which I personally enjoy because I learn even more. And I live right across from the hospital and 2 mins from the surgery center/clinic, which is so great for my sleep, and car. And there’s free breakfast and lunch in the doctors lounge, which I have access to! So I can’t complain.

My first day was GYN clinic which was full of women young and old with all sorts of things going on. From annual physical exams to possible ectopic pregnancies to infertility, I met so many school requirements in just one day. Coincidentally, I watched my preceptor insert an IUD (intrauterine device for contraception) in clinic, and after we finished she trained me on inserting it using a model. Then the next day I was working with a different preceptor doing GYN surgery and there’s a woman also getting the same IUD (under anesthesia)! Literally my the doctor just gave me the IUD and said “OK you’re gonna put this in.” I was praising God in my head that I had just learned about it the day before so I was able to do it with confidence. I worked with the same physician the rest of the week and not only do I scrub in each time, but she lets me operate the camera when she’s doing laparoscopies and she even let me do part (a very small part, she’s not crazy) of a D&C (dilation and curettage). Anything I want to do I just ask! Thursday morning I was in L&D (labor & delivery). I was in my first C-section and all I can say is WOW. I was just blown away. I might have even forgotten to blink. It was weird though because we were talking to mom casually meanwhile I’m looking at her insides. I was thinking if only you knew what was going on on the other side of this drape… The rest of that day was OB clinic which was pretty un-stimulating for the most part bc it’s just monthly check ups and labs. The girl we were supposed to deliver from L&D decided that her cervix wasn’t going to dilate till 8pm so I missed that chance. My preceptor just had me read and present all the fetal heart tracings so I got pretty good at those, and I watched ultrasounds, which I’ll eventually have to do as an assignment. Then Fridays are apparently office OR days so I was back there again–saw stage 4 endometriosis which was pretty gross and so cool at the same time, also sad bc it was preventing the patient from getting pregnant.

I’ve been able to stay on top of my studies without losing sleep also which I’m proud of. We have assigned readings, videos, and online quizzes to do and I also try to squeeze PreTest questions in as well. As for other parts of my life, I got 2 workouts in this week–we’ll shoot for 3 this week. I haven’t explored the city much outside of going out to dinner with my roomie. I got lots of great news this week including winning this scholarship I applied for back in June! And also, my birthday is coming up on Wednesday! So over the weekend I had a brunch with some of my college and med school friends and had so much fun! My parents also took me out for breakfast so I appreciated that very much.

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All in all I’m having a blast to far, and I’m excited to see what this week has in store! Being me, I’ve already racked up my share of embarrassing moments in just 4 days and I’ll tell the top 3 stories for your entertainment pleasure…

Pass the Scissors:
So I’m with my preceptor the first day in the OR and the nurse tells me to get ready to pass the surgeon the scissors–simple enough. Up until this moment I had never passed a surgeon anything so I didn’t know there was a special format. So it took me like 3 repositions and the nurse kept saying “no not like that, turn it the other way”. I just felt like an idiot! Then after the procedure my preceptor showed me the proper way to pass instruments, and she was nice about it so I didn’t mind.

Scrub:
I got fully scrubbed in then I touched the overhead light without the sterile cover thing and then everyone just looked at me like yeeeeeeah you’re not touching anything this time.

A way with words:
This nurse in L&D was asking me about the size of a patient (who was having her c-section that morning) and I didn’t know exactly how to describe her. She specifically wanted to know about her body size. But what I said was she’s like your size…like with her arms and stuff. And honestly she did have similar body size as the nurse in terms of arms and shoulder breadth. But I quickly realized that I basically just told that nurse that she was the same size as a lady giving birth that morning. I think I severed any possibility of a future relationship with her.


Hope you enjoyed the read! If you did, take the next step and S U B S C R I B E today!

Have a wonderful week,

Ijeoma

Experience is the best teacher

Peds experience, my Shelf prep, and what’s next for me

6 weeks of Pediatrics blew by so fast! I learned so much and really put myself out there. Clinically, it was fantastic because I had a perfect blend of outpatient (2 weeks) and inpatient (2 weeks) experience along with nursery (1 week) and subspecialty (Heme-Onc, 1 week). Personally though, I’ve been feeling more unlike myself. Once inpatient started, I lost touch with just about everything. My days were on average from 6:30-5 and I’d be pretty pooped by the end and wanted to use the little energy I had to study for my Shelf exam*. I felt like I couldn’t even sacrifice the time to go to the gym, which is so unlike me! The gym clothes I kept in the car eventually got thrown to the back seat so I wouldn’t have to think about them lol. Eventually I hit a low point of true exhaustion, which was inevitable honestly with my level of sleep deprivation. I feel like because this was my first rotation and first Shelf exam, I just had to give it my all. And it’s in a primary care specialty (and I want to do PC) so I just wanted to shine. Even when I started newborn nursery I had so much more time on my hands, but I still spent it studying because at that point I was 2 weeks out from the Shelf and I was going to be in Miami the weekend before so I felt pressure to really grind it out to keep the study guilt away. And by the grace of God I made it through! And now I’m ready to start my OB-GYN rotation in rural Tifton, GA. I’ll get into more logistic detail of my Peds rotation at the end (and my Shelf prep!), really just for other med students who wanna know. I won’t be mad if you just scroll down to the end.

One highlight of Peds was in the nursery helping a mom breastfeed her newborn after I had spent some time with our lactation consultant. It was just really cool to translate those techniques I had learned to another mom. Another highlight was seeing a patient I took care of in outpatient my first week again in the Heme-onc clinic in my last week! It was actually the little girl I mentioned in my last post. A low point was getting pimped** on diabetes my first week on inpatient and not being able to come up with the answers. I felt so embarrassed because I remember it was something simple but I was just so nervous I couldn’t think, I could just stand there and sweat lol. I bounced back though so issok! Another notable moment that was a high and low was putting in an NG (nasogastric) tube in a kid. It was a cool “procedure” to do, but the kid was so miserable that I was pretty traumatized. I’ll probably never forget his screaming and the look from his parents like “wtf are y’all doing to my son.”


Finding balance in third year is so much different from first and second year. Whoever has the secret needs to let ya girl know because I’m still trying to figure it out! It’s so much easier when you just have 4 hours of lecture material to get through and you can control your schedule however you want. I was just a full time student. Now I feel like I have TWO full time jobs! I really love working with patients all day and not being in class; thinking about them gets me out of bed in the morning. And then I come home and everything shifts and it’s like I have to start my night job *eye rolling emoji*. But I will say that I definitely learned from my experience and will make a conscious effort this next rotation to be more balanced so I can be just as happy at home as I am at work. Actually, that in itself will be its own challenge because the house I’m going to be living in is basically from the 1800s (exaggerating, but its supposedly old and dingy). I’m just going down there with an open mind and my usual positive attitude and we’ll see how it goes. Luckily I have Verizon, so even though I’ll be in the middle of nowhere, at least I know I’ll have service! I’m excited though, to get out of my comfort zone and embrace a totally different setting than I’m used to. That’s really the reason I chose (yes I did this to myself) to go rural for a couple of my rotations.


Back to Peds though: I just wanted to break down the day-to-day and also my Shelf prep for other students with Peds in their future or wanting to compare (and also for me to refer back to later tbh). I started with outpatient, which ran just like any clinic. I worked with different preceptors each morning and afternoon, which had it’s pros and cons, both having to do with learning different styles and preferences. We saw patients ourselves and had to write the notes on each patient–again, pros and cons. It’s a great skill to learn, but you wanna also see more patients so you can learn more. Inpatient was rough with the 6:30am handoff from the night team. Afterwards you had a sliver of time to research any new admissions you picked up and go pre-round on your patients before morning report and rounds began soon after. The first week rounds took about 2-2.5 hours. The second week it was 3-3.5 hours just about everyday (comfortable shoes are a must!). We had different attendings each week, so more different styles. I probably learned the most shelf-wise from inpatient because of the exposure to so many complex patients. Newborn nursery was about the same–7am to research patients and do pre rounds. I became numb to babies crying once you un-swaddle them to do your exam. You also learn to be gentle with your language because moms don’t want to hear anything that sounds even remotely negative about their baby. Lastly, Heme-Onc clinic ran like outpatient primary care did. I saw patients on my own then with the attending. You learn a lot about chemotherapy regimens and anemias. There are sad cases and also really cool survivors stories too. One day I sat with my attending as she cried for one of her patients. It takes a special person to work with that population of kids. Overall though, it was a pretty dope experience.

I started Shelf studying on day 1 with Online Med Ed videos, which I created my own notes on, and a chunk of Pre-Test questions daily. There’s ~900 Qs to get through between PT and UWorld so I pushed myself to get through them all + my missed questions, which I was able to do. I added Q bank notes to the relevant OME sections. Once I started realizing what my weak areas were, I supplemented with those chapters in BRS. I originally wanted to read the whole BRS but for me that was just unrealistic. I’m a reader, but I need to read something multiple times, so I wouldn’t have fully benefited from reading that whole book, especially if I started in early in the rotation. You gotta know yourself. The notes I had by the end were pretty golden. I went through the Emma Holiday review twice in the week leading up to the shelf (one time was on a drive from Atl). In the end I definitely felt prepared going into the exam. A lot of questions still stumped me and threw me for a loop, which I expected from speaking to other 4th years, but I definitely did my best and really put my all into preparing, so we’ll see how it turns out!


Ok I’m done rambling now! Hopefully I figure this whole balance thing out soon so I don’t have this much time between posts. I’m still human though, still learning and growing, Experience is the best teacher..

Much love & thanks for supporting me. Next stop, Tifton!

The LORD is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge

– Psalm 18:2

*National exam students take at the end of each rotation. At our school, we have to make a certain score cut off to be eligible for an A in the rotation.
**being asked questions on the spot

Done with boards and on to the wards!

Pediatrics rotation off to a good start!

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Week one (well, the three days that it was) in the wards is under my belt! I’m in Pediatrics now, and I’m just loving all the babies and kids because they’re so cute–even when they’re sick lol. It’s summer time and I’m on out-patient service right now so I’m doing my fair share of regular check ups and have seen a lot of bread and butter Peds diagnoses. No crazy genetic abnormalities have come my way yet. What’s funny is that I see the patients before the doctor does, so the parents ask me all these questions about how their kid is doing and if they’re doing the right things as parents and in my head I’m like you really don’t want me to be answering your questions. But between social smiles, rolling over, and pincer grasps, I’m slowly building my knowledge of baby milestones and the do’s and don’t’s of parenting. The only semi-embarrassing thing that’s happened to me was when I was trying to look in this kids ear and the stupid plastic tip thing kept falling off! It took me like 3 times to get it to twist on right and me and the patients mom just started laughing. But that’s just the kind of stuff I’d expect to happen to me lol. I’ve also gotten lost in the hospital like 5 times before I finally figured out where the heck I was going. Now I have my one route in and one route out and I’m sticking to them.

The days go by so fast and I don’t even feel like I’m working half the time! But I’m constantly being evaluated, so I have to show face at all times because I never want to look like I’m just going through the motions. I’m realizing what people were talking about before when they would talk about the hospital hierarchy of attendings, residents, everyone else, and then med students at the bottom lol. But I definitely know my place, and just keep it pushing when my patients get taken away from me #notbitter. All in all I love pediatrics and I mean I know it’s only 3 days in, but it’s definitely got a place on my career differential. I saw this 2 year old girl on Friday and she just loved me so much that she started crying as I left the room, I was so touched! And I also get a lot of encouragement from the minority parents I work with. They love seeing a young black woman in a white coat. I feel like I’m automatically a role model for their kids.

The worst part of my days is when I come home and have to study and do questions for the rest of the night. I literally feel like I’m studying for STEP again. I have a new schedule, a journal for questions, videos to watch, etc. Like it never ends!!!! That’s the only depressing thing, just realizing that this is how my life is going to be until 4th year. They don’t tell you this stuff before you decide to do medicine. But I’m in too deep now, so oh well, just gotta keep grinding! It’ll all be worth it. Honestly I really am blessed to be where I’m at.

Also side note, my white coat weighs like 10 pounds! I keep a foldable clipboard, stethoscope, pens, chap stick (major key), and 3 granola/protein bars in my secret inside pocket haha (another major key). Look, I’m not about to play myself or get caught slippin’! Trust and believe that.

So I have one more week of out-patient, then I start in-patient service where I have to report at 6:30am *upside down smiley face emoji* so we’ll see if this happy-go-lucky attitude holds up! I’ll keep y’all posted on life in the hospital! Wishing everyone a wonderful week.