(formerly futurekelsoMD)

Slightly less new M.D. s/p suffering through intern year to get to Ophthalmology residency. Now an official PGY-2 finally looking at some eyeballs. Trying to live like James Bond: "Worry is a dividend paid to disaster before it is due."

[dxmedstudent]

People keep pushing me to become a doctor, even if I want to become a radiologic technologist. This makes me really torn inside, because even if a job as a doctor would be more secure than the one of a radtech, I feel that the latter would give me the satisfaction and happiness I need, and my family and others don't seem to understand this. My GP said that her mother made her become a doctor, but that is was worth it in the end because she has an easy life. Should I follow my heart?

Hey friend, I’m sorry to hear that. It’s tough when your family are presuring you into a decidion that you don’t want to make. It’s hard to balance family expectations with what you want. Only you know how much you prefer one thing over another. And only you know whether following your heart would make your life much more difficult with your family. Perhaps you can sit down and really think of the pros and cons for both, and think about whether medicine is something you could enjoy; what are the things you don’t like about it? What worries you most?. Or whether your dream job of being a radiographer is more appealing to you; and why that is. What about it interests you? Is it something that you can explain to your family? Because perhaps if they could see what it means to you, and how you feel it fits you, they might understand better. Or they might not, because people often value the prestige and image of what they think medicine is, rather than the absolute minefield it is in reality. I’ve met loads of people who felt ressured into medicine; both in my biomed degree and whilst in medicine/as a doctor. And ultimately… not everyone pushed into medicine stays there. Some leave when they get a taste for running their own lives; it’s hard to stand up to your parents at 18, but your priorities change when you are 24 or 30. A lot of people drop out, or study different things, or leave medicine once they started working in it. And some choose to stay. Some because it’s convenient, or because they are scared of following their heart. Or because they grew to love medicine. Equally, I know people who went into medicine loving it, and some of them have left, some even regret ever doing it at all. Our hearts are complicated things; the way our studies and job affect our sense of identity, and our happiness can be difficult to understand, and can be painful when they unravel. It is almost impossible to say if any person going in, will still love medicine when they come out. The truth is, there’s no easy answer; I wish there was! It’s really something you’ll have to think over, and then you’ll make the decision you believe is best for you at the time. It might work for the best, or it might not. I wish you all the best in trying to decide; I wish for you to make the best choice for yourself, and find happiness, whatever you decide.

[uptomyeyeballs]

I couldn’t even really read the post because I was so flabbergasted by the fact someone’s doc said they had an easy life like when the hell does that start???

[md-admissions]

So I’m supposed to shadow a pediatrician soon and she keeps pushing back the date and tells me that she only wants me to shadow for 2-4 hours because I will slow her down (true) but after she told me what she does and how she rounds and how long it will take to become a neonatologist. I feel like she is trying to convince me not to become a premed, or maybe she’s trying to be honest. I feel like she’s burnt out and I’m bothering her but I’m so excited to shadow her, am I being ridiculous?

Hi there, anon!

I don’t know this physician but based on what you said, I do not think you are ridiculous when you say she is possibly burnt out and she is perhaps being both tough/honest which comes off quite often as negative. I believe that this physician is trying to be honest with you, but a lot of times, when we as physicians try to be honest with pre-meds or non-medical individuals, it sounds more than a little scary. 

My dad used to do this a lot. He loves being a physician but he’ll be the first to admit its exhausting. Growing up, I felt like he was intentionally trying to scare me or tell me I’d never be good enough to be a doctor whenever I asked him about medicine as a profession. He’d say a lot of the things you brought up: long hours, long training, the daily grind. I used to feel really down whenever he brought up medicine, because I felt like he was always telling me subtly that I’d never be able to do it. Ironically, that backfired pretty hard, as we can all see.

Now that I’m on the other side, I see that a lot of doctors talk about our profession this way. Is this good or bad? It’s both, it goes both ways. Doctors have to find a better way to connect and explain our life to non-doctors. Those who are outside of the profession must be allowed to see the profession for what it is: an expertise, not a service profession. A string of sacrifices in a simultaneously dynamic yet rigid culture that is undergoing massive shifts and struggles. 

This physician sounds like she’s got a lot on her plate. There’s nothing wrong with your excitement. I agree with limiting to shadowing duration to 2-4 hour chunks. As to shadowing tips, you can check out what I’ve written before on the topic here! 

Best,

md-a

[ednursey]

What in the ever loving fuck?

[uptomyeyeballs]

???????????????

Going to go for the eye thing only even though all of it is ridiculous: your pupillary reflex is dependent on your fucking optic nerve (and CN III) function and how much light is being shone in your eyes and some other intraocular things but not how “attentive your brain is” I’m sorry I would like an in depth explanation on how a chiropractic adjustment affects that please

[uptomyeyeballs]

Survived my first (buddy) call night as an Ophtho resident

And not that I even question that I’m in the right specialty but it really confirms it when I’m perfectly fine with bloody eye stuff and half of someone’s corneal epithelium being burned off but the partial degloving I glimpsed on their hand was just blehhhhhhhh

[sandandglass]

Donald Trump gets attacked by an eagle.

This eagle truly represents America. What a majestic symbol.

[lukcskywalkcrs]

It’s only fitting that this gets reblogged today

[rinokami]

This is the only eagle that deserves reblogging on the 4th

[starsinursa]

me, as a kid: i can’t wait til i’m an adult so i can stay up late EVERY NIGHT

me, as an adult, crawling into bed at 6:30 pm: oh thank god

[uptomyeyeballs]

Me: Yeah so apparently someone said I was “soft spoken” in one of my evaluations

Friend:

Me: I know right. 

[captainmdphd-blog]

Tips for the new ‘terns...

Rule #1: Don’t lose yourself in the system.

This is important. Intern year was, by far, the most difficult thing I’ve had to do. This includes cancer, grad school, and medical school. It’s really fucking hard. The hours are long and, often times, inhumane. The patients can be incredibly mean and unappreciative of your time and care. The learning curve is near vertical. This is near impossible to handle alone. Rely on your support system. Try to hold on to at least one non-medicine related activity. Regardless of what the medical education system seems to be saying, remember that you are a person, having a life outside of the hospital doesn’t make you a bad doctor, and you are allowed to put yourself first. YOU SHOULD NOT HAVE TO SACRIFICE YOUR HEALTH FOR THE SAKE OF YOUR PATIENTS. Seek out the support you need. Utilize Jeopardy as needed. This will be a hard year; take care of yourself and take care of your co-interns. Don’t let anyone around you drown, especially if that “anyone” is YOU.

Rule #2: Rely on your upper level residents.

Accept help when it is offered. Ask for help when you need it. This is harder to do than it seems. After four years of pain, you finally have that MD (or DO) behind your name. Your patients and assorted hospital staff are calling your doctor. You feel like you’re supposed to know what you’re doing… but you don’t. THIS IS OKAY. Medical school doesn’t prepare you for this. You are supposed to be stupid. If you came into intern year already knowing how to care for patients then residency would be a moot point. Absorb as much knowledge as possible from your upper levels. Ask all the questions. Quite literally there is no such thing as a stupid question during intern year. If you are drowning and feeling overwhelmed to the point of being unable to accomplish your work, SPEAK UP. No one is perfect, and your upper level may not recognize that you’re drowning. Remember, half of your upper levels were interns just a few hours/days ago. We are all still learning. Make your needs known, and accept our help when it’s offered. Especially early in the year.

Rule #3: Organization is the name of the game.

Your primary objective as an intern is to get shit done. Simple. You can’t do that if you’re disorganized. So, first things first, get yourself a system of organizing your patient-related tasks and stick with it. Write down everything. EVERYTHING. Afternoon urine output check on a heart failure patient? Write it down. Told a patient you’d drop back by his room to clarify some questions? Write it down. Need to remember to write your daily progress note? Write it down. Need to enter in daily labs for tomorrow? Write it down. You get the picture. I personally used the folded side of a printed patient list, but any organization system that prevents tasks from falling between the cracks is golden. Good interns aren’t the ones who know everything. Good interns are the ones who let as little as possible fall through the cracks. Book knowledge, knowing the next step in management? Overrated. That comes with time and repetition. This is how you get there.

Rule #4: Use your med students.

Let’s be honest here. By the time intern year starts, the third years are starting to get into a groove. They’ve been around for a couple of months at least, and, chances are, know way more about logistics of the hospital and the basics of the EMR than you do. The AIs are an even more seasoned source of info. Use these guys to your advantage. Given how useless you feel on any given day as a med student, I found it kind of nice to be able to help the new interns. 

Rule #5: Don’t let anyone rush you into making a non-urgent decision!

This was really hard for me to grasp. I felt like a failure every time I’d get paged about a cross-cover situation that I couldn’t immediately handle. It’s fine, guys. Very few situations require an immediate answer. Take your time. Paged about a patient with hypotension? As long as they’re mentating appropriately, take a few minutes to see where the trend of their blood pressure over the day. Check to see if there’s a recent TTE to determine if they can handle a big IVF bolus. You have time. Don’t let anyone try to pressure you into making an immediate non-critical decision. It’s totally ok to admit that you need to look at the patient’s chart first and you’ll call them back in a few minutes. This isn’t a weakness. This is you practicing good medicine.

Rule #6: Play well with others.

Medicine is a team sport. Your part, while important, it only one piece of a larger whole. You’re going to have a bunch of different, though usually complementary, professions surrounding you in the hospital. Getting along in a team sport is all about appreciating everyone’s POV and contribution. Never, ever, ever dismiss someone’s input. If your nurse is telling you that she is concerned about a patient, ask her why. Try to understand. Don’t just blow her off as being paranoid. This sounds ridiculously basic but, trust me, that reaction is really tempting when you’ve got notes to write and seven other patients who also need your attention. Disagree with a nurse’s request for pain meds, anxiolytics, an ekg, x-ray, etc? Think out loud. Explain your reasoning. One of two things typically happen. One, she already knows everything you’re telling her and just had to pass along the request to get the patient denied from “the doctor”. Two, you teach her something. Beyond nursing, you’ll also be interacting with pharmacists, nutritionists, respiratory therapists, etc. Strike up a conversation with any of these guys and you’ll be AMAZED what all these professions can teach you. Trust me… it’s a lot.

Rule #7: Don’t let bad interactions taint your view of an entire profession.

You’re going to meet asshole nurses. You’re going to meet asshole doctors. You’re going to meet asshole patients. It happens. Difficult as it may be, don’t let one interaction taint your view of an entire population. 

Other Tips and Tricks:

My method of organization (https://tmblr.co/Zzhx1h2M0rPsM)

Paging etiquette (https://tmblr.co/Zzhx1h2N9W0Fn)

Teaching med studs (https://tmblr.co/Zzhx1h2NWra51)

[15-blade]

#1 Tip for new interns

What is my number 1 tip for new interns?

Followthrough. YOU have to be the one to make sure things happen. It is up to you to make sure things happen in the hospital.

Followthrough everything, but especially if it is important. 

You’d like to think that if you order something it magically happens but sadly this isn’t true. Yes, you will be waiting 3 hours for that stat lab if you don’t follow up on it, call the nurse, then the lab to make sure it happens.

If you are waiting on one more x-ray before discharging someone, YOU are the one who has to make sure it happens so the patient can go home.

Yes, you’d like to believe that your colleagues are competent but you need to follow up on everything to make sure. Yes, it’s in the note that the patient is on xyz meds but you need to check to orders to make sure they’re actually ordered for.

A task isn’t done once you’ve done the initiating step, it’s done when it is completed. Yes, you paged to let the primary team know something but until you hear a reply back from them it is not “done.”

I know this because I made all of these mistakes.

New interns: Go forth and make the hospital WERK.

[captainmdphd-blog]

Truth. No. 1 rule of intern year? Get. Shit. Done. That’s it. That’s how you perform well as an intern. Everything else will come with time and practice.

[uptomyeyeballs]

One of the things I finally started doing that really helped me was going through each patient before I left for the day and checking meds, orders, and results against my check list for them. So many times I caught a lab that needed to be ordered or discontinued or med dose that wasn’t changed or a patient wasn’t on DVT prophylaxis. No matter how good you think you did during the day things slip through the cracks and this was my way of filling those cracks in before I left for the night and saving myself grief the next day. Also I’m just super anal and liked to have my orders “cleaned up” as much as possible.

[historical-nonfiction]

When trains were introduced in the U.S, many people believed that that “women’s bodies were not designed to go at 50 miles an hour,” and that their “uteruses would fly out of [their] bodies if they were accelerated to that speed.”

[some-like-it-luke-warm]

I have so much respect for historical women not murdering every man they know

[juststemthings]

my uterus realizing we aren’t having a baby after building up a lining for three weeks:

[nickxdee-deactivated20181221]

current relationship status: sleeping diagonally across my queen size bed

[theoreocat]

[goddess-scarlette]

i needed the full songs worth of this not 15 seconds

[princesstigerbelle]

Always a favorite

[uptomyeyeballs]

I’m sure this is on my blog at least 20 times but can’t stop won’t stop

[surgeonator]

Why did you leave residency and what are you doing now? Do you have debt? Was it scary realizing you wanted to leave?

Why did you leave residency 

this whole blog is about why i left residency so i won’t rehash it here, but this is the short version, this is the professionally edited version, and this is the very long version. 

and what are you doing now? 

by day, i run content and do some product management for an online medical reference / tech company. by evenings and weekends, i enjoy life!

Do you have debt? 

i sure do. and i’ll probably have it for awhile. it’s just another monthly expense to me, like rent. i am financially and emotionally comfortable.

Was it scary realizing you wanted to leave?

not really. it was scarier imagining being stuck in a career i no longer believed in or had a passion for.

[uptomyeyeballs]

There was so much good in the long version but I have to say the thing that will probably stick with me the longest is “one butthole per baby” 😂

[vilus685-deactivated20200321]

me at this point of the year, reacting to any bad news

[uptomyeyeballs]

I hate crying

Honestly. I’m trash at it. I hate the vulnerable feeling of it, the loss of control, and I’m usually left with a monster headache and no relief. I’m much more of a “let’s just joke our way past these emotions” kind of gal. We could spend a lot of time unpacking the whys behind that, but that’s not the story I want to tell. 

Today I cried. Tears rolling down my face as I held the hand of a patient who was getting ready to leave for home with hospice. It’s not the first time I’ve had someone leave for hospice, or have care withdrawn. It’s not the first time I’ve bonded with a patient. But it is the first time I’ve felt this deeply about it. 

I met this patient a couple months ago when she came on my service. She was an instant favorite among all the staff. She is older and has severe medical conditions but was refreshingly spunky and sharp as hell. I’ve never had a patient who was so damn sweet and yet so “with it” and reasonable. The senior resident who had her with me and I worried every day about her tenuous status after her hip surgery. Once we had done everything we could to make her medically stable we sent her off to rehab, hoping not to see her back too soon. 

Two months later I’m back on the same service and she comes back one day after being discharged from the SNF. She was altered on admission but quickly was back to herself after some treatment for her heart failure. She remembered me instantly when most patients half her age won’t remember my name even when I’ve seen them daily for a week straight. I say she was back to herself, but she wasn’t, not completely. Even though we had treated her heart failure and were winning the battle with hypotension and an UTI, she just never felt back to normal. Everyday when I asked how she was feeling, her answer was “not well” and my heart broke for her. Until finally one day she told me she might have “to pull a Barbara Bush.” And that’s when I knew it was time.

We talked to her about hospice and immediately she said she wanted to pursue it. She was tired of fighting. She said she had lived a good life and just didn’t want to deal anymore. Honestly it was the easiest goals of care discussion I’ve ever had. She stole all of my lines. But the usual relief I feel when hospice appropriate patients choose to focus on their quality of life never quite came. I know I was too invested, but I couldn't be completely happy knowing that this beautiful soul won’t be in the world much longer. 

Today was crazy. I had seen her while rounding earlier this morning, but was too busy to make it back up until 30 minutes before she was supposed to leave. I’ve had patients leave the hospital for hospice who I didn’t get to say goodbye to; I knew I couldn’t let her be one of them. I got to her bedside and she immediately grabbed for my hand. Her nurse and the hospice nurse poked their heads in for a moment, but once they realized we were having a moment they left. I’m going to try to quote as much of what she said as I can, just so I can look back on this next time I question why I went into medicine. 

She said that she appreciated everything I had done for her and that I was a wonderful person and my parents should be so proud of me. She said that I was going to be a great physician and that she would miss seeing my smiling face every morning. I told her that I was so grateful to have met her and that I learned so much from her. She said she hoped I had learned to be kind to others, to treat them how I would want to be treated, and that she knows I will because I’m a good person. Then she said “we’ve been through the mill together, haven’t we? Thank you so much for being there for me.” At this point she had to give me her tissues because I had tears rolling down my face and was snotting all over the place. Ironic as I’m usually the one passing out the tissues during tough discussions. Lastly, I told her I wished her the best, wished comfort for her. At this point the hospice nurse came back in, they were ready to take her. I said one last goodbye and left.

This is the one and only time in my life I felt closure and relief after crying. And no one deserved to see me at my most vulnerable more than that woman. 

Rest in Peace. 

[surgeonator]

“Yoga, meditation, and forced wellness modules won’t stop these suicide clusters at NYU and Mount Sinai,” Dr. Wible told Refinery29 in an interview. “The medical system must finally take responsibility for perpetuating the toxic working conditions that destabilize our doctors-in-training and lead to these suicides.”