Tower of Druaga: The Aegis of Uruk
Guilty Crown
No. 6 - arguably one of the best anime I've seen, the only fault being that it is so short 

Even on the Surgery rotation, there's time for anime as long as you have some good stimulants around.

It's frightening that sometimes I have to step back and remind myself what month/time of the year it is - time is just hurtling by.  I can't believe I just scheduled my Step 2 CS/CK, as it feels like I crawled out of Step 1 just last week.  Even the Surgery rotation is already half over!  The latter is particularly depressing since I love Surgery and I can't imagine doing anything else with my life.  <3

The post-call aprosexia continues...nothing beats napping and doing whatever the hell I want after 30 hours of being in the OR/ICU/trauma pit.

All I have standing between me and 24-hours-a-day anime watching and manga reading is this damn ridiculous internal medicine shelf exam.  I see the light!

Now, on with your regularly scheduled caffeine-induced palpitations.

Am I depressed enough to drink by myself on a Sunday morning? Or...

Am I too depressed by the thought of drinking by myself to drink by myself on a Sunday morning?

Double depression: when you're so depressed you decide to make it a double. (Actual definition: an acute episode of major depressive disorder superimposed on dysthymia, aka chronic depression).

C – The Money of Soul and Possibility - Control
Persona 4
Tales of the Abyss
Tales of Phantasia
The Legend of the Legendary Heroes

...and I'm rewatching Scrapped Princess as well.  Clearly they're not giving me enough to do on the Neurology service...

...And not one of my patients was an actual stroke patient.  It was pretty much a guarantee that if you were assigned to me, you were not having a stroke.  This worked out better for the guy who ended up with a hemiplegic migraine than for the man whose final diagnosis was metastatic cancer. 

Also, I'm having an identity crisis...Neurology or Neurosurgery?  I've concluded with 95% certainty that I want to do something that involves the brain (the other 5% is split between Emergency Medicine and ID), but now I can't decide between the medical and the surgical.  Don't get me wrong, I love the energy and teamwork of the OR and I tend to get bored if I'm not doing anything with my hands, but the Neurology recruitment speeches I got from the residents this week have me curious about paths to a procedure-driven career in Neurology.  For example, my attending last week was a guy who did a Neurology residency and a Stroke fellowship, plus another fellowship in Interventional Radiology, and now he works half-time seeing patients in Neurology and half-time in the OR doing stenting and whatnot in the Neurosurgery department.  I've also been told that Neuro ICU and epilepsy work are pretty procedure driven, not to mention the Neuro-infectious disease path that would satisfy my ID craving.  

Additionally, I got to experience firsthand the awkwardness of the Neurosugery residents, and I wonder if I could fit in (to be honest, I'd probably rival them in the awkward department though).  The Neurology residents were for the most part "normal" people who seemed very intelligent - except for the one PGY-2 that didn't know that gray matter is on the inside of the spinal cord - and they were exceptionally good at explaining different pathologies.  And, for some reason, all Neurologists smell the same, and not in an unpleasant way...

Crap, just when I thought I had things figured out.

 
"You look like my cousin."

• I always look like someone's relative.

"What are you gonna do to me?  You look about 12 years old."

• Multiply by 2, ma'am.

"Yes, I'm in pain.  The source is right there." [points to husband]

• Does anything make it better or worse?

"Have you even been through college yet?"

• My $40K in student loans reminds me every day that yes, I have.

"Are you sure you're not a doctor?  You're really good."

• Comments like this make my day! : D

"Can I follow up in your clinic?"

• Maybe you can follow-up in my resident's clinic...I do tell these people I'm a med student.

"3rd year, eh?  So you're not through with the ramen-eating part yet?"

• Thanks for reminding me.

[Wake patient up] "Oh no not again!!!"

• Not what again?

"Why is my life falling apart at 40 years old?"

• Uhm...psych consult!

"Can I just do something really quick?" [patient comes over and squeezes my legs] "Ohhh...you have such muscular calves!"

• This was not the first time this has happened.  Maybe I should start wearing pants.

"I've got this sciatic pain...I need to see a urologist."

• Uh, are you sure about that?

I've heard that it's helpful in residency decision-making to establish the pros and cons of each core specialty as you rotate through them, and I thought I'd go ahead and initiate this list now because a) I'll forget the particulars 6 months from now and b) I'm terminally bored reading about small bowel obstruction.

Psychiatry

• Pros: good hours aka time for research, interesting patients with lots of WTF moments, neurophysiology/pathology, interesting research (tie-ins with neurosurgery, etc)
• Cons: the interviews are long (and I frequently daydreamed during them), the overall pace to the day was slow, no procedures - I'm not comfortable with just using medicines and therapy to treat patients, where they may or may not improve

Ob-Gyn

• Pros: labor and delivery drama, surgeries (C-sections, tumor resections, hysterectomies), obstetrics clinic, all the residents/attendings seem nice and are pretty good at teaching
• Cons: gynecology clinic, having to focus on cultural barriers rather than the medicine, more so than in other fields - I'm not so naive as to assume this isn't a problem in all of medicine; spelunking, strange smells, lots of young and stupid patients/people my age that have 5 children/unemployed/getting SSI...uh, so, social dissonance would sum this up pretty well

Internal medicine (so far)

• Pros: needing to know diagnosis and management for just about every form of organ system dysfunction there is, so you're applying a good deal of your 1st/2nd year education; feeling like a "real" doctor, procedures (LP, central line placement, bone marrow biopsy), teaching patients/family something about their disease process in layman's terms
• Cons: litigious patients (yeah, more in 1 week than I ever met on Ob-Gyn...this med student learned to just turn her nametag around), social work, procedure team stealing your procedures, a preponderance of time sitting around putting in orders and checking tests, slow days (compared to what I expected and slower than Ob-Gyn), Dr. Cranky Resident - at first I thought it was just on call day and post-call day, but then I realized...he's cranky all the time! Thus, I have named him Dr. Cranky Resident...which is ok in the end because he brings us sugary nutriment

1. How to shut up, keep a straight face, and keep your head down.  Attendings (and patients) can smell fear, while you are left smelling...er, other things.
2. Spanish.  So much that I propose renaming the OB-GYN rotation to "Crash Course Medical Spanish."
3. Mental techniques and phrases you can repeat to yourself in order to instill confidence.  On one occasion, I overheard the chief of the department saying to my intern (concerning C-sections) - "just imagine that you're the only one there, and it's up to you to get the baby out."  Some of the residents had certain phrases they would repeat to us, like "be strong, be wrong," when it seemed like we were skirting the fine line between saying something brilliant and royally sticking our collective feet in shit.

As I'm sure I mentioned before, it was a good rotation with plenty of education built in.  Now I'm on Internal Medicine, and I find myself getting a little bored (and subsequently lazy) at times.  I don't know where I got the idea, but I expected the Medicine rotation to be more fast-paced than it is in reality.  The only way I save myself from ennui is by taking on craptons of patients and just about every short call patient that I can steal from my fellow students, but of course that leads to anxiety overload during pre-rounding and rounds because "holy shit I have to see all these people and I'm working on not writing stuff down while talking to them/doing their physical and craaaaaaaaaaap I don't have time to surf UpToDate for things to beef up my assessment and plan and oh jaysus I can't believe I just told my attending to 'make sure the blood is coming from the rectum and not the vagina' on my LGIB patient."  It usually ends up ok, except for the one day the attending decided to round at 7am instead of 9am...but that time, no one, including the residents, had seen their patients.  We christened rounds on such occasions as Discovery Rounds - where you go in the room with the entire team and "discover" if the patient's still breathing or not.  At this point, we're 2 weeks in and the trials and travails of OB-triage seem like a distant memory...however, I don't think I'll miss the smell of someone pooping during childbirth (I'm sure I don't need to inform you that, as the person delivering the baby, I'm practically in the line of fire of such things).   

So it's been a long 3 weeks sucked into the black hole of OB-GYN, but I have recently emerged at the event horizon because Specials (aka vacation) week is nigh!  I have conflicting feelings about this specialty since I thought I was going to loathe the entire 6 weeks of the rotation, but the last few weeks of speculums and lochia have been surprisingly tolerable even with 13-14 hour days (and then going home to study).  Obstetrics was fun because I never knew when I'd get called for delivery, and pregnant ladies are so cute and hopeful (even if they're a grand multipara already)!  I really enjoyed seeing my pregnant patients in prenatal clinic - doing their ultrasounds and fetal heart tones, seeing their faces light up with joy when they heard/saw their baby - taking care of them in OB triage, assisting in their delivery, and then following up with them on morning rounds and in gynecology clinic.  Gynecology wasn't my favorite (I've had several patients pee on me during exams and ask "have you done this before??? You look about 12 years old" in clinic), but the surgeries are really cool.  Gyn-oncology is potentially depressing because a lot of them are late-FIGO stage and have multiple comorbidities, but I find cancer fascinating and the patients are adorable.  All I've got left is Specials (where I learn colposcopy, level II diagnostic ultrasounds, genetic counseling) and night float, and then it will be shelf exam time yet again! 

Speaking of which, I finally found out that the psychiatry rotation was a success!  YES.  That shelf was comprised of way too much medicine for someone with virtually no experience in medicine...maybe I did bend over but I did NOT enjoy it.  Also, my attending told me that I'm "possibly the only student I've ever seen successfully take notes and retain eye contact when interviewing patients" during my clinical exam today...I give working in the PES (psychiatric ER) all the credit for developing that particular skill - you don't ever want to take your eyes off of those patients!

Now off to hastily cobble together a presentation on endometrial cancer staging...I wanted to sleep more than anything else yesterday since our attending had us round forever while concurrently pimping us to death.  Buh. 

Complicated romance, amazing music, bombastic explosions...just a few of the reasons why my shelf studying has been derailed by Macross Frontier.