Yellow with butterflies

It turns out that if you rotate with the vascular surgery service, you will likely spend some time watching angiograms, which allow you to look at the patient’s blood vessels using some kind of contrast and a CT scanner. It also turns out that a CT scanner uses ionizing radiation, which although it’s not terrible to have small doses and the benefit of the study often outweighs the harm, it’s generally not a good idea to expose yourself to it unnecessarily. Finally, it turns out that when you visit in CVC OR #8 for an angiogram, you get to wear one of the extra sets of lead garments to protect your precious reproductive organs, and all of the smallest ones are yellow, with butterflies. Oh, and did I mention that everyone else will be scrubbed in and covering their lead garments with sterile gowns, while you stand to the side behind a sheet of lead infused glass looking yellow and covered with butterflies? Also, sometimes when you grab an extra thyroid collar from the rack of guest lead garments to protect your neck, it will actually belong to someone named Mary and be embroidered with her name…

Different way of making rural doctors:

This New York Times Article describes a new medical school opening in Salina, Kansas, with 8 students in their first class. In exchange for a debt-free medical education, these students will at least start their careers in rural areas. Although much has been made of an upcoming physician shortage in the US, it is only occasionally mentioned that there is already a grave shortage of physicians practicing in rural areas. Previous approaches to the problem are described in the article:

Some are using incentives like guaranteeing admission or forgiving loans to students who commit to practicing in small communities…Others are recruiting students from rural areas and giving their applications preference, in the hope that they will return after graduating. And a number of schools encourage students to spend one year or more training in rural areas.

I found the emphasis that the article made about being rooted in a community to be particularly insightful. They recognized that when students spend 4+ years training in a city, particularly during formative post-college years, they are likely to develop strong social ties (including finding spouses) to that area. I’ll be interested to follow how this small school in rural Kansas succeeds at training and retaining rural doctors.

Puppy Visit!

Approximately 2 days into my surgery rotation it became clear that I was not going to be able to lavish on Walter the love and attention that he requires. I have been spending 12-17 hours in the hospital (as I think I mentioned in my last post, sorry for the whining), and no matter how many people came over to walk him during the day, that still left him with too much time in his crate alone. I panicked a bit, but then called on the cast of thousands who have volunteered to help with him, and set up some puppy foster care for the month of July. He rotated with each my dad and mom for about a week each, and then came home to me on Tuesday. He’s heading over to Natalie’s house for next week, but his brief visit home has coincided brilliantly with my week of subspecialty urology rotation (read: week of awesome hours).

My family does a great job of wearing him out:

He’ll be spending most of August rotating around (I’ll be e-mailing this week… you know who you are…), but I’m really enjoying having him back…

Biking during Surgery

From Dose of Reality:

While I do sometimes wish it were possible to actually be on my bike in the operating room, as I’d be a lot more comfortable if I were moving around, that is not the subject of this post. Instead, I’m finally admitting publically that although my dedication to physical fitness in general and to cycling in particular is quite strong, spending 13-17 hours/day in the hospital is enough to overcome that dedication. Here is a graph representing my ranking on Bike Journal since the second week of M3 year:You will notice that during outpatient pediatrics there was a pretty good climb, indicating that I was, in general, biking more than the average person on the website. From early June until the end of June I stayed roughly the same, suggesting that I was keeping pace with the cyclists around me on the list, and then the 4th of July weekend showed a substantial spike. This was due to two long rides that led me to rack up nearly 90 miles in a single weekend!

First, on Saturday I rode to Chelsea with Morgan and Yorgos, two new M3 friends who love their bikes and share my love of delicious food. We rode through Dexter and into Chelsea, stopped for an early lunch and some ice cream, and then headed home. This was my first ride on new thinner, higher pressure tires, and it was awesome. We ate at Zou Zou's:

Second, on the Monday holiday Alicia and I reprised a bike ride we did back in 2008 and headed over to St. Clair to bike up the river and have lunch at the Quay Street Brewing Company in Port Huron.

Instead of returning by the same route as we did that time, we followed the entire recommended route for a total of just under 49 miles. It was delightful. On that same ride, my bike odometer turned to 2000 miles:

The following day I started my surgery rotation. This corresponds with the precipitous drop you see on my chart at the top. I did start riding my bike to the hospital last week, but that’s only 1 mile each way. Even on my days off I’m tired enough and have enough errands to run and laundry to do that long rides seem like a distant dream. I suppose it’s worth remembering that the saving grace here is that it’s July, and I dislike being hot and sweaty. My surgery rotation will continue through August, and it should get easier in terms of hours as it gets cooler through the fall. Here’s to a September and October full of long and wonderful rides…

Obviously an oncoming train

From Dose of Reality:

I finished my pediatrics rotation on Friday, and I took my first shelf exam ever. I think that if I had to describe the test in one word it would be “random.” I had expected it to be challenging (which it was), and long (which it wasn’t, at least in my opinion), but I didn’t account for how disconcerting it would be to have all of the questions all jumbled up. All of my textbooks march neatly through the organ systems, and even the cumulative practice questions at the back of Pediatrics Blueprints didn’t seem nearly as random as the exam was. I have no good way to really self-assess my performance on the exam; I definitely didn’t get all of the questions right, but I’m optimistic that I did well enough to pass. I may have also spent a little time in the morning before the exam looking up the remediation policy just in case… Suffice it to say it’s pretty generous – I don’t think this would be the first time on this blog that I gave thanks that it is difficult to fail out of medical school. Once you’re in they really want you to finish, so you get second chances even when you mess stuff up. In any case, I would have to say that even without knowing my grade I would consider my first rotation was a success.I learned a lot about how the hospital works, as well as about how I work as a medical student, and I even learned a bit (I hope!) about pediatrics.

Now I’m enjoying my first switch weekend of M3 year, and while it feels like I’ve emerged from the dark into the beautiful sunlight of July, I know that this coming week is probably one of the bigger trains I’ll face in this tunnel of a year. Big enough to illuminate a whole weekend… I went on a 40 mile bike ride this morning with new med school friends, and have more outdoor fun planned for the rest of the weekend. On Tuesday, I have a full day of surgery orientation, and Wednesday will bring the start of a new rotation: a new schedule, a new set of objectives, and a new group of colleagues and instructors. I think I’ll wait and think about that on Wednesday…

Hello summer…

It’s been warm here, and while it’s cooled down substantially today, the search for all things refreshing has been unending. It seems appropriate to celebrate the official start of summer by sharing something cool and delicious with you. Enter Ashley and her knowledge of many things foreign and fancy. When I had dinner with her last weekend she introduced me to the concept of a shandy, a grown-up Arnold Palmer that is half lemonade and half beer. Apparently it is a dainty lady’s drink in Britain… The combination of Oberon and a really good lemonade was really fantastic and, although many beer lovers are probably judging me right now, I would mix them again in a heartbeat.

Fast forward to this morning, when I was describing this drink to someone else, and couldn’t remember the name. Entering “half lemonade half beer” into Google to try to find it, I discovered not only the Wikipedia page for Shandy, but also a Huffington Post article about cocktails made with beer. Because the lead slide was about a spicy Mexican beer cocktail called a michelada, I was somewhat dubious due to my experience with “Chips and Salsa” Beer:

It was not delicious … I’ve concluded that beer should not be spicy. It is not refreshing to have your drink leave a hot burning taste in your mouth…

Looking past the michelada, however, I’m interested to try the Lambic Sangria recipe from Chow. Let me know what you think of any of these if you try them, as I’m eager to explore new beverage options, as well as dodging bullets when I can.

While I suspect that this new knowledge will not get me out of looking like a little kid (with my Shirley Temple) or like a confirmed member of the ladies who love ladies club (with my beer, which never looks dainty at a wedding or other fancy occasion), I suppose I could at least try to ask for a shandy at my next dressy occasion, and hope it comes in a glass that looks like everyone else’s cocktails. Regardless of any long-term possibilities, I will be making these all summer long!

CSA Weeks 2 and 3

M3 year seems to be getting the better of me in terms of blog posts, but I wanted to share more of the CSA bounty photos… Here is the haul from two weeks ago:

And then this week (minus the strawberries I devoured before taking the photo):

I made a really delicious saag paneer, which was a little complicated but so worth it for the deliciousness.

Also amazing but much simpler is a yogurt chutney that I love, both because it is delicious and because it accommodates almost any greens/herbs left over in the refrigerator and the end of the week.

Yogurt Chutney with Pureed Greens
Adapted from 1,000 Indian Recipes by Neelam Batra

1 teaspoon Chaat Masala (I like the MDH brand, as it contains too many different things for me to make it myself)
4 quarter-sized slices of peeled fresh ginger
3-4 scallions, chopped
1 green chile or a sprinkling of dried ground cayenne
2 cups coarsely chopped fresh herbs in any proportion (I’ve tried cilantro, mint, parsley, dill, basil, peppermint, lemon balm… I've considered adding a little spinach or kale as well...)
2 tablespoons fresh lemon juice
1 teaspoon salt (or to taste)
1/2 teaspoon ground black pepper
1 cup nonfat plain yogurt

In the food processor, mince together the ginger, scallions, and green chile (if you’re using a fresh one). Set aside a few fresh herbs for garnish if you like, and add the rest of the fresh herbs and lemon juice, and process until smooth. Add the chaat masala, salt, pepper, and cayenne (if you’re using dried). Add half the yogurt and blend until smooth. Artfully stir this mixture into the other half of the yogurt, or process the rest of the yogurt into the chutney, depending on how much time you have and how you wish to serve it. Garnish with the fresh herbs if you like.

Enjoy as a dip for vegetables, chips, and breads, as an accent with lentils, or as a side with potatoes. Yum!

Status/post week one

From Dose of Reality:

I started writing this post last week, but couldn’t find the time to finish it until today… I’m finding inpatient to be much more challenging in terms of finding time for everything. The math:

24 hours in a day

- 10-12 hours in the hospital

- 7 hours of sleeping

5-7 hours in which to do everything else

Since “everything else” includes taking care of the dog, eating, bathing, and walking to and from the hospital, there are really only a few short hours in which to fit in studying, exercising, cooking, and maintaining any kind of social life. Given my limited time, I think I may be sticking with the list format blog posts for a while… Lessons learned:

• It can be difficult not to cry on rounds. This is not, as you might have initially imagined, because it is embarrassing not to know the answers to questions posed to you about your patients. Although that is difficult, I got over it pretty quickly when I realized I knew almost nothing. Instead, sometimes on rounds you have to see parents describing how worried they have been about their children’s health. Watching a parent cry during rounds was one of the hardest things I’ve done this year. I’d never met the patient before, and I knew it would have been inappropriate for me to start bawling, but I still had to work pretty hard not to let the tears slip out.


• Scheduling social events for your days off is important. As much as it seems like a great idea to spend the entire day and night catching up on reading and practice questions (which does, in fact, always sound like a great idea), having a really inflexible schedule can be isolating and lonely.


• Mom makes awesome quiche that is delicious when reheated in the hospital. Enough said. Thanks mom!


• Subscribing to a CSA (community supported agriculture) was a great idea. I can count on having produce at home even when I’m too busy to make it to the store. I’ve been making a lot of salad dressings to keep things interesting.


• I have learned the phrase “status/post”, and I like it. It means “after” something has been intervened on, as in, after the play-doh I put in my sister’s nose when we were little was removed, she was “a 3 year-old girl with play-doh in her nose, status/post removal.”

Apologies for the randomness of these insights (?), but I’m starting on nights in a few short hours and have some stuff to finish up before then!

Benny’s Bakery

I wanted to go for a bike ride today and decided that I didn’t need to wait for someone to be available to go with me to visit a delicious attraction outside the city limits. As I was playing around with Gmaps Pedometer (one of the best uses of Google Maps ever), I saw that I could get to Saline, MI (pronounced sal-EEN, not like contact solution) pretty easily. I promptly headed to Yelp to find somewhere to get a snack when I got there. I discovered Benny’s Bakery. I suspected from the reviews that I would be too late to get the highly sought after Saturday hot pretzel, but consoled myself with the prospect of a delicious muffin or doughnut about halfway through my ride.

My route took me through downtown Ann Arbor and scenic Lodi Township, which is “Rooted in Agriculture” according to their website.

Once I arrived in scenic downtown Saline, I quickly found the bakery, complete with a group of older gentlemen chatting about how smoking used to be considered healthy.

I confirmed that I’d missed the pretzels, and instead had a chocolate-glazed doughnut. It was really good! I also had a juice, though in retrospect this was not enough food.

It was around 11:30am (read: lunch time!) and I got back on my bike to head back to Ann Arbor. Around mile 20, still about 5 miles from home, I started to feel icky, and had to get off my bike and eat part of a Clif Bar I had thankfully tucked into my jersey pocket before I left. It was a lot warmer today than I’d planned for, and I probably didn’t have enough water OR food for my ride. Lesson learned, I rehydrated vigorously when I got home, and all was well.

Greens!

Knowing that my schedule would be pretty crazy this year, I signed up to split a CSA share from Tantre Farms with a friend. I have been looking forward to receiving a random assortment of vegetables, and finally, my friends, it has arrived!

This week’s share contained:

• Asparagus
• Radishes
• Spicy Greens Mix (arugula, Kyona/Mizuna, and red and green mustards)
• Spinach
• Tatsoi
• Lettuce
• Kale
• Green Onions
• Oregano
• Fingerling Potatoes
• Cilantro, Chives, and Parsley (which were a bonus from Allison’s garden)

You may be thinking, how does one person eat all of those items in a single week. I am thinking the same thing. I gave some of the spinach to my neighbor upstairs since I had so much, and have been trying to plan my meals around the leaf-heavy share this week. (Apparently the crazy rains have caused the spinach to try to take over the world. I’m just doing my part to keep us all safe from these crazy large plants…) My first creation:

Spinach, boiled fingerling potatoes, and capers with Dijon vinaigrette

Dressing (Feel free to estimate on these proportions… I did…)

• 1/4 cup olive oil
• 1 tablespoon Dijon mustard
• 2 tablespoons red wine vinegar
• 1 clove garlic, minced
• 1/2 teaspoon finely ground Italian seasoning
• 1/4 teaspoon salt
• ground pepper to taste

A wonderful break

This morning was one of the nicest mornings we’ve had in a long time: no rain, not too much sun, heat, or fog, and a beautiful blue sky. Alicia had identified the Tour De Lakes as a promising option for an organized ride, and I wanted to push myself to increase my distance. We signed up for the 31 mile route, and I recruited a new med school friend (!) to join us for the ride. I am feeling good about my training, and am hoping that I can at least maintain where I’m at now. With the ride this morning, my May mileage is 113.5 miles, and all of 2011 is 129.90 miles. True to form, I’ve been tracking my progress on the Bike Journal rankings. There are lots and lots of riders who aren’t riding very much, so every time I log another ride I shoot up in the rankings. While there are folks at the top of the rankings who have already biked over 10,000 miles this year, I know that’s not really reasonable for me. Here is my progress since I started making notes:

Not too shabby…

In any case, the ride this morning ended up being just over 35 miles, and it was my fastest of the season (about 13.5 miles per hour, which is fast for me, but slow for most folks on road bikes). It was really wonderful to just be outside in some nice weather, and I’m keeping my fingers crossed for this to continue!

Cake!

I made a delicious cake for Ruti before she headed out to DC for much of the summer. I used the recipe from Smitten Kitchen without alterations. I’m not skilled enough to mess with real baking; I can alter a muffin recipe, but that doesn’t involve whipping egg whites and yolks separately, and folding a variety of items into said whipped eggs… In any case, it came out beautifully in spite of a few minor cracks in the cake as I rolled it.

As an aside, no, Ruti does not always wear pearls around the house. They look lovely though, don't they? The cake was clearly a special occasion...

Bienvenidas a Cali

Our first day in Cali confirmed what many a guidebook and discussion with Colombian friends had suggested: Cali is a business center. It is a business center that loves salsa, but it is a business center. There aren’t nearly as many conventional tourist attractions in Cali as in other cities we visited, but it had one in particular that was special for us. Alicia was born in Cali, and spent her first 3 months of life in a lovely orphanage there before her parents picked her up and brought her home. This was our first stop:

We had a brief tour with the director, and got to see kids playing and babies napping. The facility itself is really nice, and how has a public school that is attached and serves children in the the local community as well as the resident kids. We saw one baby who looked so much like Alicia’s baby pictures it was a little bit eerie, but we couldn’t take photos of the children, so you’ll have to take my word for it.

After our tour, we headed back to our hotel, which was one of my favorite of the trip, the Posada de San Antonio. It had a really nice courtyard with a fountain, and an incredibly helpful proprietor who helped us get the most out of our visit to the city.

We did walk around later and admired what our guidebook described as the best example of mudejar architecture in Colombia, the Cali cat sculpture (donated by a local artist) and the thought-provoking graffiti.

After about a week of travel, however, we were starting to tire, and we spent more time hanging around in the hotel in Cali than in any other city.

Medellín: Parte 2

More Colombia pictures…

Our last day in Medellín was one of my favorites of the trip. In another feat of public transit, we took the Metro to the end of the line and transferred to the Metro Cable, a system that is like a cross between a ski lift and a train car. The Metro Cable was built to connect the slums on the mountainside to services and jobs in the city center, but it has also proven to be a boon to tourism.

After the first Metro Cable ends near the outskirts of town on the side of the mountain, there is another Metro Cable, the special Cable Arví. It goes directly to a national park, called Parque Arví, where one can hike in the cloud forest (a high elevation rain forest), visit the butterfly house, and ride (?) the zip line (cable-flying, as it’s called in Spanish). The activities in the Colombian national parks are generally run by concession holders, rather than directly by a government entity, so while Parque Arví includes several small villages and a whole lot of inaccessible rain forest, we only visited Piedras Blancas, a smaller area that is developed for ecotourism a short bus ride from the entrance to the park. We’d been told that it was a 50-60 minute shuttle ride, and weren’t sure we’d be able to make it fit with the logistics of flying between cities, so we were pleased to find that it was actually a 15 minute walk/bus ride up the road from the park entrance.

Even before we entered the ecopark, we noticed the flooding. As I mentioned in my last post about the flooding near Medellín, this winter has been the worst in Colombian history. The river running through the park was higher than ever, and large swaths of the usual tourist areas were underwater.

We walked around the mariposario (butterfly house) for a bit, which was thankfully on high enough ground to avoid the flooding, admiring in particular the wide array of chrysalises hanging behind the glass of the laboratory-office area. The staff said that they go out each day and collect both larvae and chrysalises from the forest, and also release many of the butterflies that hatch in the house into the wild. All of the species they raise in the mariposario are native to the cloud forest.

Alicia had had her heart set on trying a zip-line while we were in Colombia, and I didn’t think we were going to be able to do it. When we realized that it was, in fact, available at Piedras Blancas, however, Alicia was thrilled and I agreed that it could be cool. One of the lines was partially underwater, but the other stretched happily across the river, so we did that next. (Sorry the video is sideways... I can't figure out how to change that.)

After a bit more walking around, we headed back into town, ready to pack up and fly to Cali for the third leg of our trip.

Whoa…

From Dose of Reality:

It’s hard to believe that the first real week of M3 year is finished. I’ve already learned an incredible amount, particularly about how to be assertive, and the particular conditions under which I am not good at it. As I was told to anticipate, I feel out of my element most of the time. What I didn’t expect, however, was how calm I feel about not knowing exactly what I’m supposed to do most of the time, and how willing I feel to be put in situations where I don’t know what to do. It’s as though sometime over the weekend of May 7th and 8th a switch flipped in my brain, and I understood the importance of trusting instructors to have a good sense of whether or not I’m ready for something, rather than trying to assess myself. Some examples:

• On my first day, I was terrified to do a well child exam by myself. I still don’t know the answers to a lot of the questions that parents ask, but when my preceptor suggested I go do one, I somewhat numbly agreed, and then went and did it. Lessons One and Two: No one expects you to have all the answers, and 6 month olds are pretty forgiving as you bumble through a physical exam. I was ready enough.
  
• During my first emergency medicine shift the plastic surgery intern asked if I would like to sew a stitch. I have never sewn a stitch on a person before, and was mostly certain that my craftiness would not help much in this arena. Nonetheless, I did it, and did a pretty nice job – turns out it’s not really that hard once the experienced person had closed up the muscle layer and lined everything up. Lesson Three: I don’t know yet how to distinguish between things I don’t know how to do and things I can’t be coached through.

In spite of the fact that things seem to be progressing reasonably well, I can also add an unfortunate Lesson Four to those I mentioned above: I am not good a being assertive when I feel lost, confused, and misguided. I am okay when I am only one or two of those things, but all three are not good. I am trying to volunteer to do new things and put myself out there for learning opportunities, but am also working not to beat myself up about feeling a little shy when I can’t even figure out who to ask where I should be and when!

At the end of this week, I feel more than a bit like Walt looks in this photo:

I’m starting to get the hang of it though, just in time for a complete change of pace next week…

Guatapé y La Piedra

More pictures from Colombia!

We took a short bus trip out from Medellín on our second day in the city. This was our closest encounter with the effects of La Niña, which has made this winter the rainiest in Colombia’s history. We had heard about mudslides in Envigado, a community just outside of Medellín, and about terrible flooding in rural areas around the country, but on this trip we saw sections of mountain highways covered with fallen dirt and trees and even a few places where the road itself had fallen down the mountain, washed away in the heavy rains. Though our bus trip was punctuated by having to get out and walk to another bus on the other side of the broken highway, we made it to La Piedra – The Rock – and hiked to the top.

It was stunningly beautiful.

At La Piedra we made friends with two Colombian travelers and shared a cab into Guatape, as well as lunch and a boat ride. They were outgoing and friendly, and it really made the day much more fun. I’d hoped to see Pablo Escobar’s old house, as well as the spire on the top of the church at the bottom of the lake (when they made the lake, they moved a small town to a new, higher altitude location and flooded the old one), but our guide had his mind made up that we were going to see the waterfall where the water leaves the lake, and shortly after we left shore it started pouring down rain.

Once back on shore, we made our way up to the bus and headed back to Medellín. En route, we admired the "zócalos" on the bottoms of the houses in Guatape:

The rain had washed out a few more roads, so the trip back to Medellín took about three times as long as it should have, but that gave me plenty of time to explain to the woman sitting next to me on the bus that I was, in fact, a girl, despite my short hair, and that no, I was not a Catholic. She magnanimously informed me that she believed that everyone had the right to their own beliefs, but that I was wrong if I didn’t believe in a single God. She proceeded to explain to me how evolution could not have possibly resulted in human beings, and that even if it had, God must have created the monkeys. It was enlightening? At least the time passed quickly…

MSTP7? M3?

From Dose of Reality:

The day has finally arrived. After finishing my dissertation in March, April flew by. I finished up paperwork, did some revisions, and went on vacation, returning home just in time for the start of M3 orientation. I was absolutely terrified, but also thrilled to be moving on. As much as I have enjoyed my doctoral work, I think most of us joined the MSTP because we couldn’t commit to doing just one thing, and I’ve been looking forward to applying my medical knowledge from oh-so-many-years ago!

The hard parts:

• As often as I repeat that I am an M3, I know I’m really an MSTP7, and I don’t know most of my classmates.
• In addition to feeling like an interloper in their class, it’s been 4 years since anyone asked me whether or not clindamycin or bactrim would cover a cutaneous strep infection in addition to possible staph. I don’t remember a lot of stuff.
• My schedule is not my own! I can hardly remember where I’m supposed to be when, because it is different every day, and I have no idea what the coming months will bring.

The exciting and nice parts:

• Everyone is really friendly and seems to appreciate that I’m willing to admit when I don’t know something. (This happens often – I like to think of myself as much-appreciated rather than under-prepared).
• The clinical refresher course and M3 shadowing have helped a lot. I wouldn’t go so far as to describe them as giving me a leg up on my colleagues, but would definitely say that I don’t feel nearly as behind as I would have if I hadn’t had them!
• Starting with pediatrics, and particularly outpatient pediatrics, was a great choice. Happy babies don’t care how long it takes you to pin them down as long as you look in their ears quickly, and it’s hard to stay in any kind of bad mood when someone is gurgling and cooing at you while you listen to their lungs.

Now that I’m officially back in the medical school, I’m planning to post a bit more frequently, and to try to connect what I’ve been doing for the past for years in Public Health with the medicine I’m learning now. You know, just a little something on the side during this most relaxing of years… Wish me luck!

Medellín: Parte 1

I know I’ve been back for more than a week now, but I thought more description and photos from the trip would be appreciated… I’ll post them as I can, following the course of our trip.

Our first day in Medellín was a bit of a bust due to weather and the Botanical Gardens being closed on Mondays, but we nonetheless had a nice time. It was exciting to be in a city with good Metro coverage, particularly as we had to recalculate our plans after discovering that the gardens were closed for maintenance. The elevated stations also provide nice views of the city and the surrounding mountains:

Botero was born in Medellín, so we were fully expecting the plaza of rotund statues outside the Museo de Antioquia, our destination post-garden disappointment. (For those unfamiliar with Colombian geography and cosmology, Medellín is located in the state of Antioquia – pronounced “anti-okie-a” - whose inhabitants are called paísas. They are widely reputed to consider themselves more cosmopolitan and independent than other Colombians.) The museum was really quite nice, featuring not only a large collection of Botero’s work, but also other contemporary artists from Latin American and around the world.

After the museum and a bit of a nap at the hostel, we headed over to a Lonely Planet recommended seafood restaurant. We split an absolutely delicious entree of rice with seafood, and called it a night.

I’m back!

From AMSA On Call

Post #8 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

Yesterday marked the start of my outpatient pediatrics rotation, the first of my third year of medical school, and the end of this series of posts on my transition from doctoral work in the School of Public Health to my third year clerkships. As I interacted with my M3 colleagues during general orientation last week, and pediatrics orientation yesterday morning, I was struck by the overall high level of anxiety. In spite of my perception that everyone (except maybe the other returning MD/PhD students) should be calmer than me because of their more recent completion of things like clinical competency assessments and Step 1 of the USMLE, all of us were talking nervously about seeing real patients, presenting histories and physicals in the inpatient and outpatient setting. Many of us noted with some trepidation that we don’t do any pediatric exams during our first two years of medical school. While I still believe that many of my colleagues were much more prepared than they believed themselves to be, orientation was nonetheless an important reminder that no matter how large or small the period of time between the pre-clinical and the clinical years of medical school, the jump in expectations (both self-imposed and outlined in the ever present learning objectives for each rotation) is daunting. None of us felt truly ready for the challenges that Monday afternoon would bring.

Despite all this, Monday afternoon was great. I can only speak for myself, as I haven’t had much time to debrief with other students, but although I didn’t have all of the answers at my patients’ well-child exams, or ask all of the questions I needed to at sick visits, I made it through and presented what I did know to an understanding and friendly attending. I tried not to hesitate to ask questions and highlight the gaps in my own knowledge. In some ways, I think that doctoral work was great preparation for the wards. Who better, after all, than a PhD student to give a succinct outline of what is known, highlight the gaps, and attempt to make a conclusion anyway? At the same time, I felt myself struggling as I dusted off my medical vocabulary, only to find it a little rusty and perhaps a bit smaller than last time I trotted it out, and I often came up blank as I tried to expand my differential diagnosis.

Looking forward, I see a lot of reading and asking of clarifying questions as my rotation progresses. Just in the past few days I have absorbed a great deal in clinic, and am recognizing the value of applied and practical learning structured around the patients I see. I think my time away will ultimately make me a better doctor, but first, I’ve got to get to studying!

Home!

We made it safely home from Colombia, and I start orientation for my M3 year tomorrow. I’ve started writing some posts about the rest of our days in Medellín and Cali, and will continue to post them as I get a chance. In the flurry of errands I ran today, I picked up the following items:

• A bound copy of my dissertation
• New glasses
• Less than stunningly attractive but wildly comfortable (and wipe-offable) clogs

I’d consider the day a success, and am looking forward to tomorrow and getting a better sense of what I’m in for over the next year…