FRANKIE SAY RELAX.

My name is Naveen :) 24. SSOM Second Year Med Student. "Dreams don't work unless you do."

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Totally missing my fun in the sun ☀️

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Take advantage of the days when you feel yourself

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3 weeks into OBGYN

tips I win with: 

- carry lube in your pocket

- ask nurses to teach you things (small talk is not the most effective way to break the ice, asking them to teach you a skill is the way to go.) 

- be hands on with the patient (help with draping, dressing, comforting, etc)

- speak when appropriate! read the room.

- read Case Files regularly (stuff comes up more often than you may think), look up stuff when someone mentions something (it will keep you in the loop even if they’re not talking directly to you), Uptodate everything!

- figure out where things are, seriously. (I’ve had a lot of trouble with this one, naturally lol)

- watch people do things and learn from watching and next time be the first to reach for the sheet or the tool (or anything) so they know you know.

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”Hi! I'm currently applying to med schools and I'm strongly considering Loyola! Would you mind telling me what you like and dislike about it? Stuff like location, classmates, proximity to downtown Chicago, clinical sites, things like that? Thanks!”

location: If you live close to school (within 10 mins) you’ll be in the burbs basically and about a 20 minute drive from downtown. First year I had a ton more free time and energy to head downtown...I turned into a homebody lolol. However, lots of students live downtown and commute! So if downtown Chi is definitely your thing, then you can easily make that happen.

clinical sites: Majority of during 3rd year is at Loyola’s hospital which is great because it’s home turf and a great hospital. But we also have the VA and a mental health hospital next door to the main hospital so those three together offer a very diverse experience. There are also a ton of outpatient sites that are in different suburbs and different parts of the city. So overall, you will DEFINITELY get to see a variety of patients.

classmates: so I say this to everyone, but I feel like med school is like the adult version of high school...which can be both really great and really awful lol. No matter which school you go to, you’ll find people you jive with and others not so much. That being said, I think Loyola does a great job recruiting diverse people from all walks of life. Diverse in their backgrounds, identities, education, experiences, everything! And the majority of my class truly wants nothing more than to make the world a better place and I’m SOOO thankful to be a part of the Loyola community.

curriculum: I really liked how our school structured our curriculum. We did all hard science/anatomy/physio/imuuno during first year and then all the path and pharm second year. So we got to revisit organ systems as opposed to seeing them only once in all of two years. I also really loved that they started us off easy during first year. It made the transition much smoother (even though I didn’t appreciate that enough during first year).

opportunities: You can literally do ANYTHING your heart desires here!!! Research? yes. Ministry? yes. Community service? yes. Sports? yes. Gym 2x a day? yes. Study 90% of the time? yes. ALL YES EVERYTHING! of course this was maybe 1% of the things you could do here, but you get the point. Opportunities at Loyola are endless, it’s just up to you to go for it! And you’ll have so much support to do whatever you want through administration/faculty/classmates.

dislikes: not much to be honest! sure there are small detail-y things, but anyone can find anything to complain about! But there are absolutely no dealbreakers in my opinion.

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💕💕👵🏽👩🏽

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Obstetrics and Gynecology Advice

So I finished my Ob/Gyn rotation last week, and here’s some take aways that I found valuable. Take this with a grain of salt. I’m just a wee third year medical student:

Before the Rotation:

1. I studied a few things beforehand, and several residents/attendings said that it showed during the first couple of weeks of the rotation. Know fetal heart tracing basics and why they happen (baseline HR, variability, accels, decels). Know what G’s and P’s are (TPAL!). Review pre-eclampsia. You’ll learn more about this on the rotation, but if you’re at a larger urban hospital like I am, you’ll see a lot of this.

2. Watch a video of a baby being born and a c-section if you have no idea what you’re getting yourself into. If you haven’t taken surgery yet, and really want to be prepared, watch a video of a subcuticular suture. I closed more skin on this rotation than I did on general surgery.

3. Sleep and grocery shop because lol who knows when you’ll get the chance later.

Labor and Delivery

1. Follow your residents EVERYWHERE. You will get left behind if you don’t.

2. Offer to get an H&P on as many triage patients as you can, especially if it’s a labor rule-out. At my hospital, we weren’t allowed to go into rooms of laboring patients we hadn’t met before. So try to meet as many as you can, so you can get more deliveries! Don’t just expect to be handed deliveries. You have to earn it.

3. Ask to do as much as you can. Whether it’s cervix checks or presentation ultrasounds, there’s lots of smaller hands-on stuff that the resident can do in a few seconds and will forget to include you on if you don’t ask.

4. Some people might not agree with me on this, but if you’re interested in Ob/Gyn and have to do night shifts, don’t sleep if you can help it. See above, if you are asleep, there are tons of small things the residents do throughout the night that they won’t wake you up for. Also, there were a couple of times people rolled in by ambulance at 10cm and pushed a baby out in a few minutes. You don’t want to miss this. Be included in as much as you can! Plus, you can always study during slower nights.

5. C-sections are so much fun! Wear the knee high boots, and grab that suction because you’re going to need it. Eat something beforehand and don’t forget to bend your knees.

6. You’ll see lots of body fluids. Practice your poker face and don’t scowl when things get weird.

Clinic

1. Don’t forget the OB and GYN histories. For OB, get the full G’s and P’s. Don’t forget to ask about miscarriages and abortions. Ask about any pregnancy complications (i.e. hypertension, diabetes, preterm delivery) and mode of delivery. For GYN, ask about last menstrual period, how heavy they are, how regular they are, and how long they last. Then, ask about birth control/condom usage, history of STI’s (list them off because sometimes people don’t know), and pap smears (any abnormal ones?). Finally, ask about sexual activity (men/women/both, multiple partners, etc.). This seems like a lot to ask, but if you don’t ask, many people won’t tell!

2. Be comfortable with speculum exams. For God’s sake, don’t tell patients to “spread your legs”. Ask them to let their knees fall to the sides. Tell them to expect your touch and downward pressure. Insert the speculum ALL the way and open, the cervix will 9 times out of 10 pop into view from there. Make sure you close the speculum while taking it out.

3. Know what tests need to be ordered when for each OB visit throughout pregnancy. Know the types of spontaneous abortions and what can be expectantly managed. Know the work up for infertility. Know when colposcopy and LEEP are generally indicated. Know when endometrial biopsies are indicated.

4. Talk to every patient about birth control if they aren’t already on it and aren’t trying to get pregnant! Maybe this is something I’m just passionate about, but no one is going to fault you if during your presentation for a patient with a vulvar lesion or vaginal discharge you say “…oh by the way, she’s interested in trying a Nexplanon”.

Gynecologic Surgery

1. I only had a week of this but know your anatomy. Know layers of the abdominal wall, parts of the fallopian tube, and uterine ligaments.

2. Fibroids and abnormal uterine bleeding. Learn this. Know the types of fibroids and when you treat abnormal uterine bleeding with surgery.

3. Sleeping patients are the best time to practice speculum and bimanual exams.

Shelf Exam

1. I don’t know my score yet, but I studied sooo much for this one. I read BluePrints, did all the UWise/UWorld questions x1, and all the questions I got wrong x1.

2. Honestly, I love the ACOG committee opinions and practice bulletins. Ask your resident to use their account if you don’t have one. If you only choose a couple to read, the hypertension/pre-eclampsia and gestational diabetes ones are great.

3. Just work hard, and it will all be ok! After taking the shelf, I realized that I saw so many of the clinical vignettes in real life, which was pretty cool.

4. Some things I wish I studied more were STI’s and antibiotics, breast disease, and stages of labor.

I probably have a lot more advice, so if you have questions, just ask! These are just some things that helped me along the way.

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Basics for the Wards: Ob note

**NOTE: The field of ob-gyn is geared toward people with uteruses, and the things that can happen with ‘female anatomy’. In this post, the most common ob-gyn patient is a person with a uterus who identifies as a woman and that is the language used. I understand that not everyone with a uterus is a woman, and that not every woman has a uterus. Trans and nonbinary folks do come to ob’s for care, and I would hope all healthcare providers will respect every patient’s preferred pronouns and identity.  

This post has been mostly written by Baby Dragon (future ob-gyn extraordinaire) over my feeble attempt.

In Ob-gyn there is a lot: from routine ob-gyn notes to specifically ob/L&D notes. This post we’re going to cover how to write a note for a pregnant patient.

HPI: What brings her in today? Is it a routine prenatal visit? Is there a problem? When talking to your pregnant patients, Big four are vaginal bleeding, loss of fluid, contractions, and fetal movement. Ask every time. Even if they’re probably not feeling movement because it’s impossible (and therefore gas.) Even if it’s obviously dehydration-induced contractions. Every time. Ask about a dating ultrasound. If it’s a first visit, figuring out last menstrual period (LMP) is fine but not specific. Other things you can ask if you have time: any nausea/vomiting, how is her appetite, how is her energy, how is she sleeping, and if she is doing any physical activity.  Ex: Ms. Smith is a 25 yo who presents to clinic to confirm intrauterine pregnancy. Her last menstrual period was 8 weeks ago, home pregnancy test was positive three weeks ago. She has had nausea/vomiting every day for the last 2 weeks, crackers and ginger ale help. She would like some medication for the nausea. She has not had any spotting or abdominal/pelvic pain.

PMH/PSH: If this is a first visit, ask about medical conditions that can affect the management of her pregnancy like diabetes, hypertension, seizures, etc. Ask how many times she has been pregnant and how many living children she has had. If the number of pregnancies and the number of living children do not match, you need to find out why. This can be a sensitive subject for many women, for some they have had multiple miscarriages or a stillbirth and those lost pregnancies still hurt; some have had abortions and may feel fear of being judged for their choices.

You need extended Gs and Ps. G3P1102 = gravida, 1 term birth, 1 preterm birth, 2 living children. Previous pregnancy complications, explicitly high blood pressure, and diabetes. Were her previous deliveries vaginal or C-section, and if C-section, why. If baby went home with mom/why not. Vaccination history, especially Tdap, Hep B, flu, Rhogam in this and previous pregnancies. Rubella and varicella we get from titers so that’s fine to ignore. Ex: She is a G2P0, she has had one elective D&C at age 20. She is up to date on her vaccinations.

Meds: MAKE SURE YOU FIND OUT ALL MEDICINES, PRESCRIPTION AND OVER THE COUNTER, THAT SHE IS TAKING! So many meds are immediately off the table when a patient becomes pregnant- ibuprofen, decongestants, warfarin, many diabetes and hypertension meds, most psych meds. Be sure to emphasize the importance of taking prenatal vitamins- if she is struggling with nausea, suggest taking them at a time of day when she isn’t nauseous like right before bed. There are gummy prenatals, or if the pill is solid and too big she can break it in half (I break my prenatals in half and take them at night because the iron and fish oil made my morning nausea 100x worse) Ex: She takes Clartitin and prenatal vitamins.

Allergies: What is she allergic to and what happens? Ex: She has seasonal allergies, no known drug allergies.

FH: For family history, on top of the other things, be sure to ask about family pregnancy history. Any history of birth defects or genetic diseases in her or the father’s families? Ex: Family history is significant for maternal uncle with cystic fibrosis. Father of the baby has no significant family history that she is aware of.

SH: Who does she live with? What does she do for a living? Smoking, alcohol, and substance use history is crucial here because they are all known to negatively impact the baby. Not only are we worried about fetal health, but maternal, too. Saying something is bad for baby is fine, but “also we don’t want you to get a blood clot in your lungs that won’t let you breathe” is important.  Ex: She lives with her boyfriend of 3 years who is the father of the baby, she works as a secretary for a CEO, she does not use tobacco, alcohol, or illicit substances.

ROS: Always do a thorough head to toe review of systems.

Physical exam: Do a brief focused physical exam and you CANNOT do invasive exams by yourself. That is not even an option. You cannot do it, it’s illegal, end of sentence. If the uterus is palpable, specify where: it’s not in the pelvis anymore if you can feel it, so is it “at the umbilicus, 2cm below, 4 cm above” or not at all. Fundal height, when measured, is done for IUGR screening. Always remember why you’re doing a step when reporting the results. Formal U/S findings are separate from physical exam, like labs, since we get those from reports. Dopplers are fine in this section. Ex: Cranial nerves grossly intact, regular S1/S2 with no murmurs, lungs clear bilaterally with no wheezes, belly soft and nontender with active bowel sounds, skin clear of lesions, pelvic exam showed normal vagina and cervix with no lesions, uterus is firm and enlarged in the pelvis.

Assessment/plan: Always ask about postpartum plans. Breastfeeding, contraception, circumcision, pediatrician. Contraception especially is key, because many states and insurance plans require tubal papers signed 30 days before delivery for postpartum tubals, and LARC can require pre-auth as well. These things need to be documented extensively. It’s also a good opportunity for students to do patient education, which is rare in preggo-land. Ex: This is a healthy 25 yo G2P0000 who presents to establish pregnancy, confirmed single fetus dated by ultrasound at 8 weeks. She is having nausea/vomiting and fatigue. Told patient to take a single 25mg unisom and 75mg vitamin B6 before bedtime through the first trimester for her nausea. Followup in 4 weeks unless patient experiences bleeding or pain, will discuss contraception and breastfeeding at the next visit.

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“Destroy the idea that you have to be constantly working or grinding in order to be successful. Embrace the concept that rest, recovery, and reflection are essential parts of the progress towards a successful and ultimately happy life.”

— @yourbigsisnissi (via astound)

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Our second white coat ceremony + first day of M3 year!

It’s orientation week of M3 year and it’s filled with nervousness, excitement, and hope. I keep fluctuating between being too eager to start and scared out of my mind. Post coming up about my first rotation- OBGYN! 

 On another note, our first day also included the tree blessing ceremony for a classmate who passed away last year and a memorial for another classmate who passed away last week. To say the least we felt their absence but their spirit was ever present. Both ceremonies were beautiful and I believe they’re both in better places without pain and with the love of God. I pray for their eternal peace and hope that they will continue to stay with us in spirit and guide us towards becoming the doctors the world deserves. 

 We miss you both dearly and I vow to work hard not just for myself, but also in the honor of the both of you.

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It wasn’t Toro Toro, Bolivia....but still plenty of sun and O2 ☀️🌿 (at Starved Rock State Park)

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I know I just called you dude but I’m trying to flirt with you

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Eid Mubarak tumblr fam 💕

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Step Reflections

Now that I’ve taken step, and before I’ve gotten my results, here are some reflections I’ve had relating back to second year. I may edit this as I reflect some more, until then, feel free to ask me anything! 

What I would have kept the same: 

My extracurriculars - they gave me the motivation and encouragement to make me feel like I was still relevant. It gave my life as an M2 more purpose and drive. It forced me to not slack off on studying because I had major time constraints. 

My effort throughout the year to become more and more okay with being selfish. Everyone is right, if there’s a year to be selfish, it’s second year. It’s draining and exhausting and even when second year is done, you still have to do dedicated! Throughout the year I pushed myself to learn how to say no and how to put what I wanted and needed first. It helped me a lot during dedicated because by the time dedicated rolled around, all the guilt I had for not being able to please everyone and do everything, was gone. By the time dedicated came, I was incredibly comfortable with doing just ME. Some people are already okay with that right off the bat, but for someone like me, it took time to develop that. 

Starting UWorld during second semester. I wasn’t super on top of it, but I definitely used focused blocks to help me study for exams and I’m really glad I did. I think by the time second semester rolled around I was more comfortable with path and medicine so doing the questions was more beneficial for me. I don’t know if starting it during first semester would have helped me (I don’t think it would have hurt), but given that I didn’t even do the Rx questions I bought, who knows if the extra UWorld time would have even happened.

Doing Pathoma throughout the year. It not only helped me during the year, but since I had already done Pathoma so thoroughly once, doing it during dedicated was MUCH better. 

Didn’t let step stress take over my life until dedicated. I was adamant with myself about not letting step ruin my life all year long. That was the best decision I made. I of course stressed A TON during dedicated but I’m so happy that I didn’t let it get to me during the year. I had more than enough stresses already without step being one of them. Second year courses are hard!!!

What I would have changed:

I really do wish I had mastered more material from coursework. My last block exam was my best one and that’s the stuff that I really felt strongest in (of course it helped that it was the most recent, but I truly think I just learned it better too.) It’s so hard to study new stuff during dedicated. And especially hard to re-memorize/learn when you have a shaky foundation. 

I wish I had been better at Sketchy Micro throughout the year. There’s a learning curve, and I think I took too long figuring it out. (and that’s okay too)

I wish I had actually used the Rx questions I bought. Lolol. 

I wish I had given First Aid more of a chance. Well, I wish I had made enough time to actually give it a chance. (...parts of me really does wish I had factored it in more, but I just don’t know where I would have found the time without burning myself out.)

[dankmemesreasonforliving]

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guys, the deed is done

OMG