getting there... @chris-vera - Tumblr Blog

Approaching the end

It's been a few months since last time I was on here. I've been using the time to relax, refresh my studies, and take care of some other things as the inevitable end of my academic career approaches its final leg. The interview trail ended early this year, right at the end of January. Since then it's been a waiting game for match results to come out. This week is the week! Monday I found out that I matched somewhere, which was sort of anti-climactic, because I don't know to which program I matched into. Friday is the day that garners the most excitement (or disappointment), because that is when we all find out, nationwide, where we will be going to spend the next few years of our training as newly minted physicians. It's exciting just to know that the next chapter is about to begin. With relation to my studies for my Masters in public health, I concluded one of the largest hurdles, which had to do with a 200 hour internship. I finished that at the local county hospital, having to do with care delivery (patient centered medical home). There is still some work to be done on that front, including creation of a poster and an all day long poster presentation, but the brunt of the work is complete. The penultimate obligation to this degree is a comprehensive exam next week, which will test everything I've ever learned about health management policy through the UNTHSC School of Public Health. Following that, I'll just need to complete the very last course I'm taking (health economics) and its final exam, and then my MPH degree will be complete! Good times.

The Interview Trail

Making my rounds across the state, visiting the most probable locations that my family and I would like to end up. Thus far I have visited Denison, Conroe, Dallas, and Galveston Texas. Several more cities laid out in the near future. The adventure is fun, the food has been great, and meeting students from Texas pursuing Family Medicine has been cool as well. I've yet to go on an interview that doesn't feature students from my own class, TCOM 2015!

This past weekend, I was put up in the San Luis Resort in Galveston, TX. I wish I didn't have just a single night in that fantastic hotel. Hands down the best accommodations that any entity has ever hooked me up with!

Fourth year of medical school is going strong, all is well. Currently gearing up for the interview trail. Thus far I've been on two interviews in pursuit of a family medicine residency in this great state, with some other applications in places like California, Washington, Oklahoma, and Tennessee. Montanta or Wyoming may make their way onto the list, as I think I would love the wilderness featured in those two states.

I am definitely underway on my fourth and final year of medical school. The transition really wasn't all that glorious, as I had spent most of the entire summer revising my knowledge base. However, I am now full-on into an outpatient neurology rotation. Although I'm learning some tricks of the trade for developing an expedient neurological exam, the heavier process of learning comes in the form of very good debate and conversation on the current political landscape of healthcare, and the business of medicine in general. It does give me pause to consider the future of my profession, and how very little I know (or can prognosticate) of the changes that are forthcoming. These past few weeks certainly have been a great opportunity for thought-exercising, and I’ve come across some pretty good articles here and there in different journals. As if that alone weren't enough, the second to last public health class of mine that I am required to take this semester is on Health Politics and Policy. More information soon to follow.

#year iv

Round 2 (Level 2)

My third year of medical school is effectively over and I’m in the throes of a two week break between our 3rd and 4th year. I wish I could tell you I’m doing something outstanding with this time off, but the dreary truth is that I’m reading and revising everything I know about medicine for yet another demonstration, by means of an 8 hour exam, of my current level of competence and understanding of disease processes and the management and treatment of those ailments. I’ll be back in a few weeks to write of my academic exploits.

#third year #comlex

My third year experience is coming to an end, and with that, there are a lot of moving pieces. In the interim, I've been pretty busy with numerous projects going on:

Family trip to Austin

Appointment to University Board of Regents

Primary Care Partnership rotation (4 weeks in a sports medicine clinic that also does osteopathic manipulative medicine)

Recipient of two scholarships for future family medicine practicioners

Meeting University executives and preparing for a meeting with JPS Executives for a big announcement later this month

Gearing up for my daughter's 4th birthday

COMLEX Level-II Cognitive Evaluation this summer (second series of medical licensing examination)

Finalizing schedule for my 4th and final year of medical school

So those are some of the major issues. There is also a lot of writing of personal statements and CV refresh to support the opening season of ERAS 2015. So these days have been nice and busy, just the way I like it.

It's nearing 9pm at night, and I get further along with my medical studies, and as my children get older, and as my wife becomes more pregnant, it is becoming incredibly difficult to get everyone down to sleep at a decent hour to provide a mere hour at the end of the day to read and revise my studies. One of these days, I'm going to lose the evening entirely and will have to rely on the silence of the morning, or getting things done during the day.

Supreme court cases and other items

This evening I had the task of conducting a presentation in my school of public health course (public health law). The case my partner and I discussed was in determining whether or not citizen's had a right to die. Specifically, we were looking at the issue of physician-assisted suicide, and how the Supreme Court (and one state court) have decided on this matter. The presentation we conducted lasted about 25 minutes, and we talked about the current states that permit physician-assisted suicide (Oregon, Washington, Vermont, and Montana) and how these states came about making it a legal process. I thought we gave a pretty solid performance, though I did stumble a tiny bit when commenting on the steps that Oregon goes through to prescribe drugs to its citizens.

Another case that was discussed was euthanasia, and whether or not that should be permissible by law. In the US, it is absolutely illegal. Current countries that do offer euthanasia include Belgium, Luxembourg, and the Netherlands. It was a good presentation as well.

I find that I am generally in favor of physician-assisted suicide. So long as states are able to legislate safeguards, and prevent potential abuse. Having reviewed the way several states administer physician-assisted suicide, I'd have to say Oregon seems to have a model program in their state. The exercise, which included a written paper and our 30 minute presentation, was a very good exercise in investigating the law and the varied attempts at determing whether or not such a right can be inferred from the constitution. Largely, it cannot, but because healthcare in general is the states' responsibility (i.e. not explicitly defined as a federal government obligation in the U.S. Constitution), this issue resides at the state level.

#sph #public health law

More time spent at JPS, and I dig it.

This past week, began yet another rotation -- Psychiatry. This last chapter in my third year of education will feature quick, 4-week long introductions to the remainder of medicine that I'll survey as a medical student. What remains is psychiatry, osteopathic manipulative medicine (OMM), and a 4-week primary care practice experience, which I've chosen to do with a family medicine physician specializing in sports medicine and OMM. What follows then is the final chapter of a years long journey into my last year of medical school. I like to describe 4th year as a choose-your-own-adventure read, where the first semester is largely designed with the intent of preparing me to excel in the specialty that I'm after. If I hadn't mentioned it before, I'm after a career in primary care, largely centered around either family medicine or internal medicine, with some degree of emergency medicine involved in there, if I can so design it. The primary care aspect is shaped by my philosophy for the continuity of care and wishing to influence long-term behavior and choices of those who wish to build a partnership with me as a physician. The emergency medicine aspect is the result of spending the first portion of my adult life as a Hospital Corpsman in the US Navy and frequenting one too many locales where emergent care had to be delivered quite frequently, along with a healthy dose of emergency medicine training in a high-speed environment. My calm demeanor further lends support to a high-pressure environment where being cool and collected facilitates 'smooth operating', so to speak.

So these next few weeks will be spent trying to jockey for an elective rotation at places that I wouldn't mind spending the next few years of my life. This is going to be a pretty neat prelude to the next chapter.

#Year III #residency

In the nursery now

This week will be spent at JPS Health Network here in Fort Worth, going over all the things that a budding physician needs to now about the first hours, days, and weeks of a new person's life. This morning I was able to perform an exam on an hour old infant that estimates the gestational age of a newborn by weeks. Yesterday, I was in on two deliveries, one a spontaneous vaginal delivery, the other a Cesarean section. For both, I observed the attention paid to the child once she or he makes their exit. Just weeks ago, I was on the other side of the action, delivering the babies, and on this side of the fence, we're more focused on examination of the child. Very neat experience.

#Year III #paediatrics

Working with children

Moving through clinical rotations, and now I'm working with children in my paediatric core rotation. I always said to myself that I really like my own children, I just don't know how much I'm going to like other people's children. As it turns out, I don't mind it so much at all. In fact, I think having kids gives me somewhat of an edge, in that I can better read kids who are similarly aged to my own children a little bit better. Today I was able to get a little girl to smile who was tired and sour from having been to multiple appointments earlier in the day. And she had such a pleasant smile.

My role these days is more of listening to the parents and elucidating the 'chief complaint' or what brings them in to the clinic. I've also been exposed to many different partental styles and how this variability in parenthood works out for families. It certainly is a nice change of pace from the long hours on the obstetrical wards.

#Year III #paediatrics

Preparing for the exam(s)

Sunday night. For the greater part of these past 5 weeks, I've been putting a lot of focus into the public health courses that I've signed up for. That's right, course with an 's' to convey plurality. Whether that was a good idea or not is likely topic for another post. The upside to taking two courses this semester is that one of them, an online course, will be finished up here in a few weeks. The downside, is that I may be trying to do too many things at once. We'll see how that works out for me here in about 6 weeks time. But, now here I am, at the virtual end of my obstetrics & gynaecology rotation and I've hit the books hard (somewhat) this weekend. I have to write two exams later this week for OB/GYN. One that is put on by the department at my school, and factored into my overall core rotation performance. The other one, at the end of the week, arguably the more important, is the shelf exam by which my OB/GYN knowledge is compared with other students nationwide. So only now, have I begun preparing for these exams in earnest. And yet, here I am writing....

#obgyn #shelf exam #Year III

The transition

It's 2am here at the house on a Saturday night. Normally, I'd be awake in 2-3 hours from now, but since I'll be exploring the night shift for this next week, I've begun a nocturnal transition to reset my clocks and make for a more pleasurable experience in labour & delivery. I'll go in later today, around 6pm.

I've managed to go for a run this evening, as well as make a trip for errands to the local 24 hour shop. I've just taken a small break in between writing assignments for a public health course I'm taking this semester. After sending this, I'll resume reading through another text for more public health information. And I will probably read standing up so as to not get too comfortable.

#night shift

Observing mothers

Sitting here at the local tertiary care center in Fort Worth and watching and waiting for expectant mothers. I was reminiscing of some time that I spent here on this very ward with my wife a little over a year and a half ago as we awaited the arrival of our son Dominic. What was rather neat was placing an intravenous catheter in a woman's hand in the very same room where we were stationed for a small amount of time during Cinco de Mayo of 2012. From quasi-patient to quasi-provider.

#obgyn

One year closer

The long rotations have since ended for this first semester of my third year of medical school. I've had now, about two weeks off to do as I please (only after completing other tasks assigned from my lovely wife), and it's been great. Took on a few non-medical books to keep my mind occupied and have increased the amount of time spent running or swimming. Maybe there is a triathlon out there beckoning next summer...

My finance course ended strong through the school of public health, and I will be taking on a bigger load this upcoming semester. There are definitely going to be a lot of moving parts this upcoming Spring, with shorter, more frequent rotations through psych, pediatrics, OB/GYN, primary care, OMM, as well as a trip to Philly to demonstrate my clinical exam skills. And then at the end of it all, the summer has in store for me another licensing examination, which will be immediately followed by elective and audition rotations as I begin my fourth and final year of medical training and subsequent journey along the interview trail...

This is about the tempo that I usually like things to move along. Looking forward to the shift into the new year.

#Year III #new year

Surgical oncology

Pending the short Thanksgiving holiday, I have just finished off a quick two weeks following a sub-specialty surgeon, who dealt specifically with tumours and the like. I have witnessed the most awesome surgeries yet while following this young physician. I never really anticipated holding organs in my hand that were part of a living organism. Cadavers, sure, did that in the first year of medical school. The operating table certainly provided a more intense review of anatomy. And if the mere exposure wasn't enough, time in the surgical suite was made all the more spectacular when being thoroughly pimped regarding blood supply to said organs and their pattern of venous return. Let's not also forget obscure anatomical trivia that only a seasoned resident could possibly know.

In January I start an OB/GYN core rotation. I have selected, and hope to be granted another tour through the world of neoplasm - gynaecological oncology. Let's see if this story continues.

#Year III #surgery

Cutting to the chase....

Cue cheesy title to describe current adventures in surgery.

Things are going reasonably well for surgery. It's not really something that I dreamt of doing as a grown up, but it has certainly been very cool to be in the operating room trying not to mess anything up. The coolest thing I've seen thus far was a laparoscopic cholecystectomy. I'm sure to the surgeons doing the procedure, it was probably routine. But, having never seen what the inside of someone's abdomen looks like when it's expanded with CO2 to visualise the internal structures, I was pretty amazed. How the surgeons used the equipment for the procedure, I could see where good eye-hand coordination/dexterity (the same that might be developed and fine tuned playing video games) would be a useful skill to have.

#Year III #surgery #med student

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