You tube, I tube, we all tube!

Happy Sunday everyone!!

I hope you all had an exciting weekend – or at least more so than me. Let’s just say I did NOT get my share of vitamin D these last couple of days.

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So while I was inside admitting patients from the ER, I was also doing something else. I was writing my personal statement. THEY ARE THE WORST.

If you guys remember, when I first introduced myself, I mentioned that I was applying to fellowship this year. The masochist that I am, I’ve decided to apply to pulmonary/critical care. Why would I choose pulm/crit? Why would I choose a field with murderous hours and constant pages? Why would I choose a field that requires not just a knowledge of pulmonology or critical care but an understanding of the human body at its core?

Because pulm/crit is the best subspecialty there is and nothing else measures up.

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Ok ok don’t get me wrong, all the specialties are important. Truly they are. I just happen to like pulm/crit the best :p

It took me FOREVER (it is now 1 AM!!!!) but I finally finished the personal statement (PS). I can promise I said more than ‘Pulm/crit is the best subspecialty ever!!!’ I would share the PS with you all but it is still pretty rough and not ready for public consumption. In that case, I thought I would talk a little bit about pulm/crit and what I love about it.

 

In all reality, pulm/crit gets an unfair rep. Like I mentioned earlier, it’s a general opinion you work long hours without much return (aka the green stuff). Plus it’s damn hard.

 

 

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There will be soooo many days when you want to do the exact same thing. Run and never look back. And you’ll hear it from a lot of people – that if you want to subspecialize, there are so many other choices with a cushy salary and better lifestyle. But if you love it the way I do, you’ll never be happy doing anything else. Plus I’ve found there’s not as many female pulm/crit docs out there and to that, I say – who run the world?

So, I’ve compiled a list of characteristics that I think define a pulm/crit doc. If you’ve got these/this is what you envision yourself doing, this just might be the field for you. Welcome to the world of CXRs, PFTs and SIRS – wait I mean SOFA. I should have just said welcome to the world of acronyms but then again you knew that when you became an MD/DO :p

Characteristics of a pulm/crit physician:

  1. They like to be busy. Whether it’s on the floors or in the ICU, there’s usually very little downtime.
  2. They like the science behind it all. Whether or not we want to admit, that one pathway out of the hundreds you learned in biochem comes back to bite you in pulm/crit. If you slept through physiology in med school, this may not be the field for you.
  3. They like internal medicine. Some specialties tend to be so organ-specific, they tend to lose focus on what’s happening with the rest of the body. Pulm/crit docs, especially in the ICU, have to have a solid understanding of how the human body as a whole works because, let’s face it – your lungs aren’t sitting in Timbuktu while the rest of your body is in the USA.
  4. They enjoy procedures. I like working with my hands but there’s no way I could stand for one spot in a cold OR wearing those masks for hours at a time. If there’s any surgery residents reading this – how do you keep your mask from fogging up? My face ends up doing acrobatics to get rid of the condensation which invariably leads to the most inopportune itches which leads to me becoming nonsterile which leads to me getting yelled at by the scrub tech and being told to sit outside like a bad student. Not that this actually happened to me but I get PTSD even thinking about my surgery rotation. So, doing central lines/intubations is my consolation prize – one that I’m more than happy to accept.
  5. They don’t ALWAYS enjoy talking to their patients. Let me tell you – it is such a relief not having to do a ROS on any of your ventilated patients in the ICU. You know those patients that have 13 point positive ROS? Yeah none of that in the ICU. Plus you get to be Sherlock Holmes and actually use your skills to diagnose/treat your patient that is on a ventilator, non-responsive and has no family present.
  6. They love controlled chaos. When I started residency, I used to think the ICU was just like the ER and I began to question if critical care was for me. I’m not someone who can handle a billion different people in one room, shouting orders left and right while in the next room another patient is screaming her lungs out for pain medicine and at the same time the overhead is going off, shouting out a code blue. That is what I like to call complete and utter chaos. A lot of people like that environment and they flourish in it, case in point ER residents. What I realized once I did my first ICU rotation, is that while chaos does happen, it’s in a controlled environment. Things move smoother and calmer. There is an innate understanding between you and your nurses – they’re already anticipating orders before you give them. You stabilize one patient and you just move right along to the next patient that’s crashing. Within the chaos, there is a sense of order.
  7. Lastly – while every physician plays an important role, I feel strongly that pulm/crit docs are really there for the patients that can’t help themselves. And that’s why I became a doctor in the first place – I’ve been so privileged to be given what I have, it’s only natural that I give back. And how better to do that than to be one of the first faces your patient sees when that tube comes out or he/she wakes up. One of my favorite phrases to say is ‘You’re too healthy for the ICU’.

 

Ok guys this is me right now.

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Yep. Just like that. ‘Night everyone and see ya on the flip side!

 

Welcome!

Anyone out there?

Well, for those of you who may be reading…hi! My name is Priyanka and I’m a soon-to-be third-year internal medicine resident who decided it was about time I take all my thoughts about medicine, pop culture, how to lose weight, life in general, and put it to paper. Oops – put it to a webpage. Sorry I forgot we’re much more advanced now than those Neanderthals.

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Good question, guys. There’s lots of reasons:

  1. The things you see and hear in a hospital are too good to be true.
  2. Shared experiences.
  3. To inspire and be inspired.
  4. I gotta study for boards. And what better way to study than to bounce ideas off one another?

 

Now that we’ve gotten the pesky  intro stuff out of the way: Welcome.

I wanted to take today and welcome not just whoever may be reading this, but those thousands of people who will be elevated from mere medical students to INTERNS on July 1st.

Welcome to the world of residency, my friends.

Welcome to the world of motivation, inspiration and altruism. Where you wake up every day knowing this was what you were meant to do.

And welcome to the world of the hungry, the tired, the poor. And I’m not talking about the patients.

Wait, what? Hold the phones. Did she just say this was a world of hungry, tired and poor people? And if she’s not talking about the patients, then she can only mean us – the brand new interns?! WHAT DID WE GET OURSELVES INTO???

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Hold on, everyone. Before a worldwide Code Brown happens, let me explain.

You’ve worked hard all your life. Did well in high school, college, got accepted to medical school. You stayed the extra hour at the hospital or did  100 more questions in Uworld than you needed to but you got the golden ticket. In March, you received an email saying Congratulations you have matched! All your dreams came true and July 1st, you know you’re going to walk into Podunk Hospital as the best damn intern there ever was, ready to save the world with one touch of your Littman stethoscope.

 

Well, you’re wrong.

 

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This is a photo of my co-residents and I at the annual intern welcome party with our program director. There I am, cheesing hard in the gray on the bottom R (L to you non-medical people – I tell you, doing medicine has screwed up my L and R more than you know).

Each one of us thought we were going to walk into work on July 1st with all the answers, just like the rest of you. I mean, come on, we were DOCTORS now. We ruled the world – no one could stop us. We quickly learned, some sooner than others, this was the farthest thing from the truth.

As medical students, our duties were limited. We were solely there to learn, to observe, to absorb. It was enough to come into the hospital at 7 AM and leave at 4 PM knowing you had seen your 2 patients for the day, written satisfactory notes and presented just well enough so your residents didn’t have to add anything extra and not too well so the residents didn’t start singling you out for extra work. As medical students, your responsibility was to yourself. Let’s be honest – you’re all paying for your education, whether it’s now or years down the road as loan repayments. But if you didn’t want to get anything out of your time as a medical student, then that was a choice you made. It was enough to know the patient’s labs and symptoms but not know what to do with it. As a medical student, it was enough to be passive. Because, really, the only person you were making a difference with was you.

As an intern, this all changes. It’s not all about you anymore. Now you’re responsible for another human life. At times, you may be responsible for another 80 human lives. Point is, you become the least important person.

So when I say:

Welcome to the world of the hungry – you don’t eat so your patient can get the medications he/she needs

Welcome to the world of the tired – you don’t sleep so your patient can get the proper discharge planning

Welcome to the world of the poor – you don’t wallow in luxury so your patients can get the benefit of the time and energy you put into their care

As an intern, you are hungry, tired and poor because of the very thing that made you want to be a physician in the first place. That desire to help another person, to do right by your fellow men and women is still there.

And don’t get me wrong, it will be difficult. Your sense of altruism will be tested now more than ever. But this is when those who cannot help themselves need you the most. Even at your hungriest, your most fatigued and your poorest, you can still offer your patients what they cannot give themselves. Hope, empathy and a chance to feel better.

Come July 1st, I can guarantee no one is going to walk into Podunk Hospital and BE the best damn intern the world ever saw. But what I can also guarantee by the end of your residency training is a ton of self-reflection, intellectual growth and hopefully you walking out of Podunk Hospital as the best damn physician the world ever saw.

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So, now you’re all sitting there, saying ‘Well she explained herself but that still makes me want to shit my pants’.

It’s okay, we’ve all done it. And to keep any more unsuspecting interns from having these unfortunate accidents, I’ve compiled a list of tips, tricks and advice that helped me survive my first day as an intern and residency since then. I promise – they’ll help you too.

  1. Be excited. This is what you wanted to do, right? You will be tested day in and day out but it’s important to remember why you’re here in the first place.
  2. Smile. The last thing a sick patient wants to see is your irritated face at having to get up at 5 AM or to hear about all the extra work you have to do, when all they really want is to feel better. Plus the nurses will be less likely to throw out your coffee.
  3. Be prepared. Remember when I talked about responsibility? Well this is what I meant. Knowing your patient’s symptoms, what their Creatinine was or how they sounded on exam in order to impress your residents and attending was enough when you were a medical student. Now, it actually matters, because you knowing whether or not your patient has AKI could easily become a life-or-death situation.
  4. Budget yourself. Internship and residency is really a time where you learn a lot about yourself and how you operate. Your intern year is going to be demanding so why not make it easier on yourself? If you know you’re a little slower, wake up half-hour earlier. If you know you’ll finish your work too quickly, bring a copy of Washington Manual with you and brush up.
  5. Orders first, notes second. This is pretty self-explanatory. You can write a beautiful note but if you haven’t given the orders to make that note a reality, none of it matters.
  6. Listen. As doctors, we love to talk. Well maybe not if you’re a surgeon…or a pathologist. But for those of who do like the spoken word, talking is great. Listening is better. Your patients will provide you with valuable information if you just listen. Plus some of them have very unique stories to tell. And it’s not just your patients, it’s your colleagues, your support staff. We all come from different walks of life and those shared experiences are what makes us better people.
  7. Lean on each other. It’s okay to struggle. You’re not the only one. And when it gets too much to handle? There is help available. Don’t be shy, use them. No one is meant to do this alone.
  8. You want action? Go to the frontline. The best way to learn is getting your hands dirty. Need I say more?
  9. Ask questions. Remember, this is about your education too. How else are you going to expand your knowledge base? Yes, dumb questions do exist. But there is no such thing as a useless question. And trust me, that dumb question you just asked? All twenty of your co-interns were thinking the exact same thing. Some of the residents, too.
  10. Read something every day. This is probably going to be the hardest part of your job. After working for twelve hours, who wants to open a book, much less lift their own pinky finger? The only thing you think about is whether to eat or sleep or do both. I get it. I’m not asking you to open up Harrison’s and read a chapter every night. An attending once told me ‘read for 15 minutes a day and you’ll do fine’. It’s true. Spend fifteen minutes on UpToDate or Washington Manual reading on the conditions you dealt with during the day. You’ll become a better clinician.
  11. Don’t forget about yourself. Yeah yeah I know I gave you guys such a long spiel on putting your patients’ needs before your own. It’s a fact of life you’re going to experience those things as an intern – there have been multiple instances where I wouldn’t have eaten for over 12 hours because I was so busy. But that doesn’t mean you don’t take care of yourself. You are important as well. Take that day off to recharge. Stay active. Just because you only get time to eat a small bite, make that small bite count.
  12. Have fun. July 1st marks the beginning of the rest of your life. Walk into Podunk Hospital with your Littman stethoscope and while you won’t BE the best damn intern there ever was, you’re going to BECOME the best damn physician the world ever saw.

 

Thanks for tuning in, everyone! See ya on the flip side 🙂