Chumbawamba

Morning!





Quick side note, did you know that above titled band were a bunch or anarchists? Unusual to a billboard top 100 hit, granted it was the 90s. Rage against establishment indeed.



I am writing to you from the AICU at Geisinger Medical Center. An awesome hospital which may or may not be the most wired hospital in the nation. I, I, have my own computer & mobile workstation. I guess having a fleet of 3 helicopters outside brings in the money. TUG machines are just rubbing it in (http://www.aethon.com/spotlight/video.php)



First, to business! I must answer your questions.


Match season is underway! Let the forehead pimples rise up! Residency applications are perhaps the most stress inducing part of medical school. Naturally your first couple of tests are up there on the stress meter but a.) deciding on what your career will be b.) deciding which programs will educate you the best c.) wondering if you are even qualified for these programs will all wrack your brain to the "nth" degree.


Applications start by obtaining your ERAS information. ERAS, Electronic Residency Application Service, serves as a middleman between you and every allopathic and osteopathic program director in the USA. You are tasked with inputing your most current CV ( I HIGHLY RECOMMEND YOU KEEP A CV/RESUME COMPLETELY UPDATED, nothing sucks more than opening your last one titles RCM 3-15-03!). This information is pretty standard but included any awards you have won in undergrad, graduate or medical school, research you have done, and organizations you have been a part of or led. This is where volunteering (for me) and participation in student government (not me) come in handy. I included everything from undergraduate to present.


(I was tempted to put in my perfet attendance from kindergarten, showing that in my young age my love of learning/knowledge was formed, but i think it was mostly for the daily naps and oreos with milk!)


You must also put in a personal statement. This is designed to show why you want a particular field (EM for me), why you are the perfect fit, what you plan to do with your education and goals for blah blah blah.


It is the most uncomfortable essay you will ever write.


You are basically whoring yourself out to professional programs. You will go over every word, every phrase, every possible meaning of every sentence just to delete the document and start again. Most personal statements are tailored to the specialty you are applying, so if you apply to IM/EM you will need a PS directed towards that compared to OB/GYN or Family. You will also need to upload a photo (Not a passport photo) and at least 3 Letter of Rec. You can submit your application with <3 but some residencies will not consider your application complete unless you have three.

The timeline goes as follows:

July 15th - ERAS opens, you can start inputting your info and if you are a gunner, submit too
Sept 1st - Unofficial deadline to submit, you need to submit to get interviews, most programs don;t look until after sepetember 1st anyway, but I know many classmates you submitted on July 15th. I am not one of those people.
Nov 1st - You need to register for the match. There are two (2) matches. The allopathic and osteopathic. Depending on what programs you want you can chose one or both. Caveat - The osteopathic match happens in February, with the allopathic in March. The match is a legally binding contract, herego, you cannot match in the osteopathic match and still be eligible for the allopathic a month later. You can put all your eggs into one basket and go allopathic but remember, you will be competing against foreign medical grads, allopathic students and other osteopathic students for spots.
Decemberish - After you interview at potential locations, you submit a "Rank List" to the match, basically identifying your top choices. Residency programs also submit a list of possible candidates as well. This leads us to..
February/March - THE MATCH. You and your classmates head to the bar and await an e-mail from the match service. All you receive is an email saying you matched, or you didn't. A week will pass before you know the program. Yay Stress! If you don't match you undergo what is called "the scramble." Residency programs don;t fill up on the first day, so the week after the match applicants are frantically calling programs with vacancies, doing phone interviews and ultimately trying to scramble into a program. After that is done, its relax until july 1st, when you become scared shitless because now you have responsibility.

Where am I in all of this?

I have applied to 20 programs going as far west as Chicago, South as Virginia, as North as Boston. I have received 2 oppporunities to interview so far. I am dedicated to EM with a Critical Care or Sports Med fellowship at the end of residency. My first choice is New York Methodist hospital in Brooklyn, NY. I know many graduates from that program and they are all excelllent emergency medicine attendings.


DOtogo: Better clinical rotations between Truro, NYCOM, PCOM?

- I can only speak for NYCOM on this one. I know we have over 20 affiliated hospitals with more programs being added every month. The NYCOMEC (NYCOM Education Consortium) works long and hard to help hospitals accept not only DO programs but NYCOM students. I chose NYCOM over UNECOM for the NYC hospitals and area. Although cost of living was significantly cheaper in Biddeford, ME than Long Island. Go with your gut, the main question is what school will give you the best clinical education for 3rd and 4th year.

(I'm pretty sure that answer said nothing of value, sorry)

Done any rotations in the midwest?

- No, I am an eastern seaboard kind of guy who likes all 4 seasons, lacks natural disasters (earthquake and hurricaine were fun!) and is a hotbed for hockey. Oh, and my gf is from NYC area and would like to stay around the tri-state area.


As I said at the introduction, I am curretnly in Critical care. My next rotation takes me to the city of brotherly love for EM - Toxicology. I will be writing more about 3rd year and more musings about 4th year. Also, fun stories about patients in the ED. Fantastic!

Whoop Whoop,


Zoidberg

Long days turn into long nights

Good News Everyone!

I'm back.

Wish I had kept up with this. My eyes are currently too tired to stare at this screen any longer. Future posts forthcoming detailing the rest of my third year and addressing what questions I can.

See you tomorrow.

Whoop Whoop,

Zoidberg

Creative Conversational Skills Required...

Psychiatry

I am at the end of my first 3rd year rotation, Psychiatry. Psychiatry is an opportunistic, albeit interesting specialty. Opportunistic in the sense that it is truly a rotation where a little interest can go a long way in terms of exposure. Now, I did my rotation in the Bronx. Obviously an under-served population. In the hospital I worked at there are 2 locked psych inpatient units and a locked detox unit. You also have the opportunity to work in the "consult" division, in which you spend your days trolling the medical floors responding to requests made for a psychiatric evaluation. I'll explain the different parts.

Locked Psych Unit

Ahh, the truly crazed. At our hospital, the psych unit is not what modern cinema has not made it out to be. This is not "awakenings" at all and only 1 room in the entire unit that has padded walls. The patients admitted to this unit are truly a mixed bag. there are schizophrenics who have been non compliant with medication for many years, the depressed that soon realize their depression, however serious in my naive eyes, is nothing compared to the gentleman next door who cant help but masturbate every waking moment, to the bipolar population with manic phases that intrigue you for hours on end.

The big 5 diagnoses in the Bronx are Schizophrenia, Bipolar, Major Depressive Disorder (MDD), Anti-Social Personality disorder and Borderline Personality disorder.

A quick word about schizo. IT IS NOT MULTIPLE PERSONALITIES.

Clear enough? Let's move on...

The inpatients are a mixed bag of the big three (schizo, bipolar, MDD). The schizophrenics are paranoid, prone to hallucinations, delusional, and if you are real lucky, a bit of all three. They are fine to talk to and most do not pose any violent threat to me or my fellow students, but they have impulse control issues and there have been multiple orthopaedic consults for swollen/sore hands. Some patients will be eager to talk, some will be dismissive, and some will invite you to their wedding. It's all very interesting when you figure out the trigger to their delusions or paranoia and watch them vividly describe their rationale for being admitted to the ward. Reasons vary from "jealous of my potential rap producer career," to "I came to volunteer my services and decided to stay." All in all, a very fun group who if they would just take a shower/medications/change their shirt we would be happy to discharge them and make room for the next patient.

A word on the delusional patient.

Never ever take part in or encourage a delusion. Simply acknowledge to the patient that the delusion exists and you know about it. Taking part only encourages the patient and may reinforce to the patient that the delusion is true. Even if he promises to pay you $60K if you let him off the unit.

The bipolar patients are interesting. The are usually well controlled with their medications but when they decompensate its a crapshoot. At points they will go on and on about the gas chambers to baseball statistics to Al Sharpton's politics to global warming, all seemingly without hesitation. Next week they simply stare out the window and you cannot get the time of day.

The MDD patients are the shortest house guests of the unit. I guess seeing an obese, geriatric, African woman lift up her mu-mu all day gives the incentive to think about all the positive, clothed activities one can do outside the hospital in the sunlight, and not sit alone at home have PTSD like flashbacks about the above mentioned scenario.

Most patients are generally pleasant, some have anger issues and may walk around shouting "Holocaust, Holocaust, Holocaust" for no reason but generally you are in no danger.

Detox

Psychiatry's role in detox is to help out the patients who tend to self medicate their bipolar/schizophrenia with alcohol and cocaine. I don't know why we bother interviewing them. They all want their anti-depressants and anti-psychotics which if they had been taking them instead of selling them, they wouldn't need the drugs in the first place. The interesting part in interviewing these patients is their own knowledge of modern pharmacology, its poetic and ironic. They know dosages and brand/generic names, some even know what they can an cannot take due to their hepatitis C, and yet none can simply open the bottle and follow the direction on how to take the medication.

I hate detox. I don't know why, maybe reading about drug addicts and their constant scheming for a fix has jaded my views of them. Addiction medicine is a serious specialty and I sure do applaud those who day after day deal with people experiencing withdrawal. I just feel no sympathy/empathy for the gentleman with a history of 55+ detox admissions and his 8-10 bags of heroin/day and 150 bucks of cocaine/day and four 40oz. of cobra/day. Seriously, that was the exact line I wrote in my consult. When he told me I couldn't help but laugh and shake his hand, for this gentleman had the system figured out. He saves up money from medicaid or whatever, maybe works on an odd job or two, or hustle's, lives on the street to not pay rent and binges after 2 weeks. He then comes to the hospital, gets "three hots and a cot," a shower and leaves in 4 days.

Rinse and Repeat...x55

Consult

This was the bulk of my experience. Medical consults are amazing because you get to see the various pathologies the the hospital has to offer without all the rounding. I got to see trauma victims on their 3rd day post accident. Doing a depression screen on a little old lady with no prior medical issues who just experienced a Left leg below knee amputation via NYC taxi cab really strains your interview skills. I mean, no shit she's depressed, do I really need to ask her if she has suicidal thoughts? Visual hallucinations? It's really numbing trying to interview her about her mental health when all you want to do is give her a hug.

A bonus is being in the emergency department. At the hospital there is no official psych ED, just a bunch a beds called the "bullpen." (Seriously, I need you dear readers to find a better name than "bullpen." Go with an hyperbole, perhaps a pun, maybe an alliteration, I know you have a linguistic talent to come up with a term endearing to and labeling the psychiatric patient in the ED.) The ED is fun because you interview psychotic patients in their acute phase, or manics, or drug addicts that simply don't understand that when you smoke PCP, you hallucinate. It's not rocket science, it's common sense.

"You say you saw a spotted dog running around the ceiling, right after you speed-balled? amazing"

The ED is also probably the most dangerous place, seeing that those who are truly decompensating get brought in and placed in a bed not 5 feet from you. They are paranoid, angry and irritable which proves a dangerous combination. I have been hit and swung at, but a keen eye and a proactive doctor/nurse with a dose of haldol, ativan and benadryl usually save the day.

All in all, psychiatry is fun. I was fortunate to deal primarily with consults to the medical/surgical floors and not spend a great deal of time with the same inpatients. Variety is truly the spice of life and in psychiatry, if you play your cards right, you'll have a fun, easy and interesting rotation.

Until next time...

Whoop Whoop,

Zoidberg