Cardiology Update

Cardiology at Chicago Memorial Hospital has been a pretty intense challenge thus far!! We only meet for a few hours a day, but a lot is packed into those days. I knew going into this that my knowledge of EKGs could use some improvement, and I have been given a crash course in EKGs. Apparently not one to baby us, the attending gives all of about thirty seconds to review and EKG, which has really made me realize how much sharpening I need! I have gone home every day reviewing the days topics and researching the homework assignments, and some of it is starting to make a little more sense. Some of it is going to take a little more review. But that is why I chose this rotation at this point in my schedule. I knew that going into my USMLE Step 2 CK there would be plenty of cardiac cases, and an intense Cardiology elective would only benefit me. During the Basic Sciences part of my curriculum EKGs were certainly introduced, but mostly the theory behind them. Very little was discussed regarding the interpretation of them. Obviously that is of equal or importance to the theory. Until this week I hadn't received much instruction in it.  

We have also reviewed a lot of echocardiograms, which I have had zero experience with. That has been an equal challenge as well!

It has been an interesting experience and odd feeling thus far being scheduled for electives and as an MS4. It means I've come a long way, and am on the "downhill" slope to my MD. It's a little overwhelming to think of everything that I've forced myself to do over the last few years!!

Quote of the Day

“Power always thinks it has a great soul and vast views beyond the comprehension of the weak; and that it is doing God's service when it is violating all his laws.” ~ John Adams

Cardiology Day 1

Today was my first day back in rotations after a four week break. I was ready to get back to work and have something to do each day, as the last few days of my break I thought I was tempted to start counting my teeth I was so bored at times. You'd think time off would be great, but it isn't as great when everybody else is busy at work or at the hospital. I have very few jobless friends or friends who work late shifts.

So today I made my way to my new hospital for the next few months, Chicago Memorial Hospital. Aficionados of The Fugitive will get my reference. Because I was a new student, I had to endure the lovely New Student Orientation. Which is basically the hospital playing CYA. Concomitant with my first day was the new group of Core Rotation track students at Chicago Memorial Hospital. This was me last year at Chicago Hope Hospital. All the white coats were pristine. All the students had a deer-in-headlights expression, and they all sat stone-stiff. There was a smaller group of students like me, MS4s scheduled for electives, relegated to the back corner. We were much more relaxed, and didn't have to be told to dive for the doughnuts. If I'm being completely honest the whole thing made me a bit cranky, too. Much of the discussion was oriented toward the third years, and not that I think I'm too good to be instructed, but I wanted to be on the floor with my preceptor, not listening to yet another pseudo-inspiration speech about the practice of medicine.

I quickly reflected on everything I'd done in the past year and wondered if I too looked this green when I began my rotations. I also wondered if, like the previous year, the Chicago Hope and Chicago Memorial Hospital students would ever mix. The two hospitals are less than two miles apart and I don't think we ever mixed at parties or student get togethers, which to me is a bit sad. Perhaps I can do something about that in the coming months.

From this Morning's Tribune

"On the West Side in the Humboldt Park neighborhood, a 23-year-old man walking his dog was shot about 2:30 a.m.

He was taken from the Xx00 block of West Blah Street to Level 1 Hospital with wounds to his back and right arm. His dog was not injured."

Thank goodness his dog wasn't injured.

Stop and Smell the Flowers

Tonight at the gym I was about 15 minutes into a 45 minute run, fiddling with my headphones when a small lady next to me started up a conversation. I'd never had that happen to me at the gym, nor am I usually in a chatty mood when I know I'm about to sweat out 6 miles. But I figured why not at least answer her question and be friendly. What harm? I had seen her in there before, doing her thing. I turned off my Richard Marx/Whitney Houston/Spice Girls playlist and We ended up having about a fifteen minute conversation, and it was quite pleasant. I didn't feel encumbered, or out of my zone without my frantic music. It was an unexpected, yet pleasant encounter. We talked about quite a few things: her grandchild, bagels, iPhones, and credit cards. When she was done she smiled and went about her way. Smell the flowers folks.

Wake Up, Weatherman

This time last year in Chicago it was almost 80 degrees. Today it is 24. 

"There is no such thing as bad weather, only bad clothing." ~ Norwegian proverb

Time off...for studying

I've been finished with more cores for the better part of two weeks now. I have about two weeks to go. In the mean time, this past week I had my USMLE Step 2 CS (Clinical Skills). Basically, this is an all day test whereby prospective medical students are given ten to eleven cases over the course of the day, and work them up. Doesn't sound much different from the last year of my life, right?

I practiced for over a week, a couple hours a day with another student who is due to take it some time within the next week as well. We started by practicing our interview questioning format, what pertinent exams to conduct, and then stressing differentials. The first few days we weren't too focused on timing, but that ramped up later. Examinees have 15 minutes to gain a history and do a physical, and then ten minutes to type it up with relevant exams. By the end of the study session, it was clear that we were going to be ok time-wise for the H&P, but ten minutes sounds like a lot, but really isn't for typing out all that information, especially when you are character limited to 950 characters (why not 1000???). 

In preparation for test day I had determined that 30-45 seconds of outlining would save me a lot of time and keep me on track in the room. So, when practicing, after getting the demographic data, I wrote out my plan and order. It looked something like this:

This helped me immensely. For starters, it ensured that I interviewed every patient the same, that way nothing would get left out, I would stay on track and in a rhythm that was practiced and somewhat second nature, and it did indeed give me a reminder when I summarized as I looked through because once or twice I forgot to ask a question. It's very easy to get taken off on a tangent. 

For the Review of Systems (ROS) section I would simply do a head-to-toe questionnaire and only write down something if it was relevant. Same for the PE. If it was normal, I didn't write anything on the paper and saved it for my standard spiel in the note, eg: CV: Regular rate and rhythm, +S1/S2, no murmurs, clicks, or ejection sounds. You might note in the upper right corner I have DDX, or differential diagnoses. For any given presentation, I jotted down a few things that I wanted to keep in mind, and/or quickly rule out or in. Not to blow my own horn, but usually one of my differentials was correct, though it's really not that difficult when somebody comes in complaining of chest pain that you write down MI, PE, pericarditis, costochondritis, and aortic aneurysm. Boom. One of those IS going to be the answer, and if it's not, then you've eliminated all the immediately fatal problems, and nobody is going to yell at you for ruling any of those out.

On test day, I had originally planned to just take CTA to the testing center and then go straight to the airport (I was to visit friends in New York). However, a giant fly landed in my chardonnay when friends who had already taken the exam noted that there was nowhere to place my overstuffed suitcase. Which meant that I now would have to drive to the test site. Lovely. I had thoroughly enjoyed not needed the pain in the rear that is my car. I don't mind driving, and I like my car. Just figuring out where to put it while I do my business is always an aggravation. But I really didn't have much choice with the timing of my flights and Friday afternoon Chicago traffic. So long story short (too late) I ended up driving to the test center. I was annoyed because I was faced with having to park my car at the airport, and pay no less than $6.50/day, for four days. Not cheap considering the CTA would've gotten me there for $2.50. After taking the test, I realized I had just enough time to get home, and turn around and get on the bus (that would go right back down the road I just slogged) to get to the airport. So I tried to book it. I checked my email, boom, my flight was delayed at least two hours. Perfect, so I endured a mind-numbing slog into the city on the Kennedy. Chicago is one of the few cities where there can be just as much traffic going into the city as out of it. 

All in all, I get to O'Hare, only to sit around for three hours while a slight dusting wreaks havoc on New York City's airports. How annoying!! Needless to say I slept quite well that night.