Sunday, September 25, 2011

Residency Interview - The First

Just coming off of night shifts, I had a difficult time falling asleep and the anxiety of an interview the next day didn't make things any better. In total I think I may have slept four hours before my alarm sounded at 3am.

St. Barnabas Hospital

I shuffled about my morning activities while the world around me still slept and the crickets chirped. It had been a while since I knotted a tie, but this morning it went on with no problem. I was out the door by 4am and on the road for an early morning cruise to New York. My destination, St. Barnabas Hospital in the Bronx, roughly three hours away. Traffic was nonexistent and the morning fog was the worst obstacle. The hurried feel of New York was obvious as I approached the hospital with people mulling about and a full ambulance bay. I had arrived for my first residency interview.

I was fascinated by the inherent antiquity of the buildings, it gave a sense of being well established in the community. The only person in a suit, I stood out like a sore thumb among those in scrubs and street clothes as I walked the campus. It was apparent that I was there on official business. Shortly after finding the morning meeting place, the faculty lectures and student case reports consumed the early hours of this program introduction. These were followed by a tour of the emergency department and hospital before grabbing lunch that was provided for Employee Appreciation Day.

While it was difficult to digest lunch due to the building anxiety, we conversed with residents and other interviewees about the program. One by one we made our way into the "hot seat" for our personal interviews in front of a panel made up of two residents and two faculty members. The questions were focused around the program and my submitted application, both of which I felt comfortable discussing. I was then given time to ask about the program and before I knew it, we were shaking hands and parting ways. It was a breath of fresh air to have my first interview behind me. I definitely enjoyed the experience and look forward to more like it as I explore the world of emergency medicine residencies.

Question of the Week
You have diagnosed a patient with a terminal illness or must give grave news. How would you share this new information with your patient?

Suggested Consideration

Sunday, September 18, 2011

Night Shift

As I drove home in the early hours of the morning, I was greeted by rays of sunshine peeking through the clouds and flittering on the surface of the harbor waters. Where many people cringe at the thought of staying awake all night to fulfill a work related responsibility, this was my reward for making it through another evening at the hospital.

Call of Duty

The night shift happens when most of the community should be sleeping, yet somehow the hospital emergency department seems to stay lively at all hours. It amazes me sometimes what people will present with at three in the morning; a nagging cough, an ankle injury from the day before or chronic pains that could have been treated during the day at a clinicians office. On the other hand there are those that tend to celebrate the evening hours with brawls, imbibing their favorite alcoholic beverages or driving who knows where at that sleepy hour. So without fail, the emergency room staff assemble to assuage their complaints and injuries. In all honesty, it is not always easy to remain stoic about their complaints as a good laugh helps us stay awake and it just seems uncanny that someone would rather be at the hospital than in their own bed sleeping. Nonetheless, there will be someone there to meet the responsibility of caring for the night owls of the world in that time of need.

Of course there are true emergencies that present to the ED on occasion. The hum-drum feeling can quickly become pell-mell as resources are combined to make a difference for the people that need them most. In a coordinated effort treatment is rendered to expedite the care of the individual in question while the ankle sprains and hang nails take a back seat to the action. The night shift seems to be a different breed of caffeine guzzlers and adrenaline junkies, but when the night has come to an end, everyone scatters to catch up on their sleep and enjoy the serenity of the quiet morning hours before the rest of the world makes their morning commute.

Question of the Week
A 17 year old female is brought to the emergency department by her sister because of pruritic symptoms around her fingers and toes that is worse at night. On exam there are visible excoriations from repetitive scratching. The patient has been living in a women's shelter for several months. She has no past medical history, is not on medication and has no known allergies. A biopsy is taken from the intertriginous space between her fingers. What is the name of the organism responsible for causing her problem?

A. Herpes simplex type I
B. Staphylococcus aureus
C. Sarcoptes scabiei
D. Candida albicans
E. Streptococcus

Answer & Explanation

Sunday, September 11, 2011

A Time for Celebration

Last week may have marked the last exam of my official educational career...assuming I passed. While I can think of no more depressing way of spending my 30th birthday than sitting for a medical school board exam on a rainy day in a foreign city, the celebration of being done was thoroughly enjoyable even if it was only a modest party for one.

Moving Right Along

All I could think was, "finally this exam is done." It has plagued me for so long trying to concentrate on rotations and applying to residency programs. With any luck I will have passed and can move on to worrying about interviews and the upcoming match. It seems like just yesterday one of the upperclassmen was telling me how fast medical school would go by. Of course at the time I couldn't believe the semester would ever come to an end. And now, looking back, we have been so busy that I barely noticed the elapsed time. Although we have not quite reached the summit of this experience, it is definitely in site and attainable at this point.

Reflecting on 30 years seems rather farcical and I wonder if the 20 some years of education has really paid its dividends. Does that mean that medicine can be considered my second career? At this point, I think I am ready to move on to career mode and at least realize a little of the benefits from all of this training even if that means more responsibility. But I am getting ahead of myself. I have yet to be officially told the examination was a success and I still have interviews to attend. Now, more than ever, is the time to sprint to the finish and focus on keeping my game face. There will be more time to celebrate later, but it was nice to pit-stop for a moment and feel human again.

Question of the Week
A 25 year old medical student who was PPD-negative when starting medical school tests PPD-positive after her first ward rotation. As her physician, what is your first step in managing this patient?

A. Repeat the PPD
B. Check her liver function
C. Obtain a sputum sample for culture
D. Order a chest roentgenogram
E. Order a urine culture

Answer & Explanation

Sunday, September 4, 2011

Special Occasions

Some 2,500 miles away, my grandparents will be getting up in a few hours to go about their daily activities including opening their email and finding this delivered to their inbox. They just celebrated a wedding anniversary and today is Grandma's birthday. I want to dedicate this post to them as they have been so supportive throughout the years and especially during medical school.


The first chapter of my career in medicine started on their basement stairs when I was just a child. As the story goes, I am almost done with another chapter in this never ending book. In days, I will be taking another board exam and in weeks I will be starting interviews for residency. Like their significant milestone anniversaries, I am trudging past a few of my own, making small advancements that bring me steps closer to a goal I've had for so long. My grandparents have been there every step of the way, cheering me on, following my progress and feeding the cereal craved fiend inside. If I ever needed something, they were the first to offer a helping hand and always graciously generous when meeting those needs. It's too bad they are already taken, because I think everybody could benefit from the best grandparents in the world.

Through retrospective analysis, I have come to realize one of my weaknesses over the years. In short I have become a "yes" man. When a person requests my services, I have the hardest time turning them away and do what I can to provide for their need. Now I think I know where that comes from. So, Grandma and Grandpa, I want to thank you for all your support, for giving selflessly to see me succeed and for having the best cereal and treat stash I could ever imagine. You two are fantastic and I love you for who you have been in my life and the lives of others. Thank you for your examples of what genuinely caring people can do in this world. I hope you had a wonderful wedding anniversary and Grandma, HAPPY BIRTHDAY! I love you both and thank you for being such an integral part of who and where I am.

Question of the Week
A medical student writes a blog about his fantastic grandparents who are celebrating some incredible moments in life. Which of the following is true about this dedicated, hard working couple?

A. They are celebrating their 62nd wedding anniversary
B. Crossword puzzles are no match for them
C. They are the best grandparents ever
D. They still know how to have a good time
E. All of the above

Answer & Explanation

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