So I doubt this list has changed much since the last time I played this "game," but the reason I'm doing it again is that now I have a more complete list of medical specialties (this list includes all the possible specialties someone can place into for residency programs). What I did was rank all the specialties from 0 (I could never do) to 5 (I could definitely do), and then put them in order of ranking. The top and bottom of the list didn't change much, but the middle of the list moved around a little. More than half of the specialties are in the 0-2 categories, so for right now, there is a pretty reasonable likelihood that I won't be pursuing any of those paths. That limits my interests, but not too much-- so I think I'm in a good place.
5 pulmonology
5 otolaryngology
5 ophthalmology
5 infectious disease
5 allergy & immunology
4 thoracic surgery
4 general surgery
4 general internal med
4 emergency med
4 anesthesiology
3 preventive med
3 orthopaedic surgery
3 occupational med
3 neurosurgery
3 med oncology
3 hematology
3 cardiology
2 pediatrics
2 pathology
2 neurology
2 nephrology
2 family practice
1 rheumatology
1 radiology
1 radiation oncology
1 psychiatry
1 plastic surgery
1 physical med & rehabilitation
1 obstetrics/gynecology
1 gastroenterology
1 endocrinology
1 dermatology
0 urology
0 nuclear med
0 colon & rectal surgery
0 aerospace med
And for future, future reference: this site has a "competitiveness" scale for residency specialties. Just so I can start freaking out now, 2 out of the 5 specialties that I ranked 5 out of 5 (Ophtho and ENT) are among the 5 most competitive specialties (along with Plastics, Derm and Neurosurg, which I don't care much for). So does that mean I have to turn into a gunner?
Saturday, November 12, 2005
Trauma surgery @ Elmhurst
I'm apparently making a habit of posting to this site only after my week is over. It's almost 8pm on Saturday night, and I am exhausted. I just got back from spending the day shadowing in the Department of Surgery at Elmhurst Hospital in Queens. I got there at 8am, which was just in time for a red trauma call: an HIV+ drug user had been brought in after having been held up at gunpoint and then stabbed in the throat by his neighbor. The patient was being wheeled in as I walked in, so I didn't even have time to change into scrubs. After a tense hour or so, I followed the surgical team on its rounds. The stab patient ended up being fine: I saw them do an angiogram of his aortic arch and great vessels to see if there were any lesions, and I also saw an esophagram. Both came back negative. As I left tonight he was being stitched up, and was going to spend the night in the hospital and probably be discharged in the morning.
I saw a number of other patients that were on the Surgery team's service today, including a 20-week pregant woman with signs of appendicitis (major epigastric and LRQ pain, extremely high white cell count), a Riker's Island inmate with HIV and a severse case of anal warts, a 14yo with appendicitis, a Peruvian man with cholecystitis and a history of appendicitis and peritonitis, a man with MRSA who recently had a left lung lobectomy, a woman who fell off a porcelain sink and had a hugh laceration in her right gluteal region, and a HepB+ Chinese man with esophageal varices caused by portal hypertension (he was bleeding profusely from his mouth, and probably wasn't going to make it through the night). I found the last case to be particularly interesting because of the amount of time that Dr. Laitman spent on collateral sirulation routes in the body, especially between the portal and caval systems. It's one thing to try to memorize the routes of circulation for an Anatomy exam, but it's something else to actually see someone dying from it.
The experience at Elmhurst was really remarkably interesting. I don't think it hit me as something that "I want to do for the rest of my life," so to speak, but I found it to be exhilarating, and on a couple of occasions I found myself thinking: "I think I could do this." This says a lot considering that I've always thought that surgery was something that I wasn't cut out for. It can be intense, but also immensely interesting.
The rest of this past week was about me recovering from my M&C exam on Monday. The exam was alright, which was amazing since I really didn't feel prepared enough for it. They could have definitely made the exam more difficult that it was. I couldn't say whether I beat the curve, but I might have been more or less close. It depends on how other people did. The problem was, though, that since I spent most of last week locked in the library, I started this week low on sleep, and so these past couple of days just seemed to drag on forever. Some things of note this week were: in Anatomy we opened the skull and exposed the brain-- and then ripped it out and exposed the cranial nerves-- and then cracked the frontal bone and popped out the eye; we had our first Belize trip meeting with the people that are actually going on the trip, which was successful; we practiced our history-taking in ASM with a standarized patient (an actress); and on Thursday I gave my first shot, which was 0.5mL of saline, to Milla (which she then reciprocated).
I must say, these weeks have been long. I have been genuinely tired. But it has never been boring. I still have doubts every now and then abut whether I really should be here or not, but I can't ever say that it's not something that's been really interesting so far. I'm having a great time, not considering all the adjustments that I've had a tough time with.
I saw a number of other patients that were on the Surgery team's service today, including a 20-week pregant woman with signs of appendicitis (major epigastric and LRQ pain, extremely high white cell count), a Riker's Island inmate with HIV and a severse case of anal warts, a 14yo with appendicitis, a Peruvian man with cholecystitis and a history of appendicitis and peritonitis, a man with MRSA who recently had a left lung lobectomy, a woman who fell off a porcelain sink and had a hugh laceration in her right gluteal region, and a HepB+ Chinese man with esophageal varices caused by portal hypertension (he was bleeding profusely from his mouth, and probably wasn't going to make it through the night). I found the last case to be particularly interesting because of the amount of time that Dr. Laitman spent on collateral sirulation routes in the body, especially between the portal and caval systems. It's one thing to try to memorize the routes of circulation for an Anatomy exam, but it's something else to actually see someone dying from it.
The experience at Elmhurst was really remarkably interesting. I don't think it hit me as something that "I want to do for the rest of my life," so to speak, but I found it to be exhilarating, and on a couple of occasions I found myself thinking: "I think I could do this." This says a lot considering that I've always thought that surgery was something that I wasn't cut out for. It can be intense, but also immensely interesting.
The rest of this past week was about me recovering from my M&C exam on Monday. The exam was alright, which was amazing since I really didn't feel prepared enough for it. They could have definitely made the exam more difficult that it was. I couldn't say whether I beat the curve, but I might have been more or less close. It depends on how other people did. The problem was, though, that since I spent most of last week locked in the library, I started this week low on sleep, and so these past couple of days just seemed to drag on forever. Some things of note this week were: in Anatomy we opened the skull and exposed the brain-- and then ripped it out and exposed the cranial nerves-- and then cracked the frontal bone and popped out the eye; we had our first Belize trip meeting with the people that are actually going on the trip, which was successful; we practiced our history-taking in ASM with a standarized patient (an actress); and on Thursday I gave my first shot, which was 0.5mL of saline, to Milla (which she then reciprocated).
I must say, these weeks have been long. I have been genuinely tired. But it has never been boring. I still have doubts every now and then abut whether I really should be here or not, but I can't ever say that it's not something that's been really interesting so far. I'm having a great time, not considering all the adjustments that I've had a tough time with.
Friday, November 04, 2005
Hiding out in Levy
I'm sitting in Levy Library as the sun is setting over Central Park, and I was thinking about how this has been a long, long week.
On Wednesday we had a clinical correlate through M&C with a 25 year old girl named Gail who had acute myelogenous leukemia (see more about AML here). She had gone to Emory for college, and knew some of the people from New Rochelle who had gone to Emory (since she was my year in college). She was diagnosed with leukemia her senior year in college, and went through the terrible chemotherapy and treatment. She said she remembered feeling fine at the time of her diagnosis, but being told that she had to go home and be rushed into the hospital for treatment. She shopped for a few doctors in New York while bringing her luggage into the doctor's office, because she fully expected to be admitted as soon as she chose which doctor would treat her. On one night during her treatment she remembered having a 105 degree fever, a 0 neutrophil count (anything below 1000 is considered neutropenic), and a 60/40 blood pressure. Her doctor had called her parents to ask them to come in the night because they thought that Gail might not make it through the night. I imagine that must have been such an incredibly hard thing for her as well as her family to deal with. Gail said, though, that the entire time she was in treatment, she never slept in her hospital room alone: she always had a family member there to look after her. She said that was such an important part of treatment and recovery. Another interesting thing about her case was that she was supposed to start her chemotherapy on September 11, 2001, but after the terrorist attacks Sinai had to push her therapy off indefinitely because there was a question of whether there would be a major strain on the healthcare capabilities of NYC. Because there were so few casualties from the World Trade Center attacks, though, Sinai ended up with a surplus of medical supplies, and Gail's treatment began a week behind schedule.
After Gail we met with another patient through ASM that same afternoon. Nick was a 58 year old male who at one time had been an alcoholic and heavy drug user, but has been sober for more than 20 years. He talked to our small group a little bit about his life and what made him turn to alcohol as well as other drugs (including amphetamines, barbituates, cocaine, and heroin, among others), as well as how it affected his life and what made him seek help. He said that one day he got a letter from a priest he had known while growing up in Greece, inquiring about how Nick was doing, and to write back to say what he had been doing lately. The letter made Nick realize that he had absolutely nothing good or of value going on in his life, and decided to start attending AA meetings to see whether he couldn't change his life around. After going in an out of AA a few times, he made it through the 12-step process, and has been sober ever since. He met his current wife while in AA, which he said has been a great improvement in his life, and has had a job in the NY prison system for the past 15 years or so. It was really interesting to talk to him about alcohol and drug abuse as a disease, and see how difficult it was for him to go through treatment and rehabilitation. I think the students in the small group didn't pass any judgment about Nick, and asked good questions about different aspects of Nick's life. This was an exercise in talking to patients about uncomfortable topics such as sexual and drug histories.
I met with Ann-Gel from the Center for Multicultural and Community Affairs this week to talk about getting in touch with physicians who work in fields that interest me, as well as starting to talk about research plans for next summer. I know that I am interested in somehow structuring a project where I can do part of my work abroad for about a month, and then bring the project back to East Harlem for the rest of the summer. My problem (as I mentioned in a previous post) is that I don't exactly know what field I want to work in, and don't necessarily know where to begin without having had much clinical experience. Ann-Gel was really helpful in giving me some ideas of people I could talk to, and was very serious about getting me organized and working on a gameplan from now until next summer. I'm excited about the prospects of what I am going to do, and I have to keep on telling myself to think about more pressing issues at hand (i.e. my M&C exam that is in 3 days). The CMCA has a scholarship for a few students to do research each summer, and I think it would be great if I had my act together by then to apply for it.
This past Tuesday was the last day of the Extremities section of Gross Anatomy. That meant that this Thursday we started out final section, the Head and Neck. At the beginning of class we took the final wrappings off of our cadaver's head. It was a very surreal--and somewhat disturbing--experience to finally see her face, and to think about her very much as a human being again (not that we didn't think of her that way before, but I guess it is easy to dehumanize a cadaver when looking at such such small parts of her body at a time. Also, the face is by far the most human part of the body). The lab was the most solemn it has been since probably the very first day of dissection, and it involved skinning the cadaver's face and exposing the muscles involved in expression, which seemed like it was something straight out of a horror movie. It was also really interesting that it was virtually impossible to tell what the ethnicity was of our cadaver until we removed the head wrappings-- and then it was very obvious that she was of Asian descent. She was a 78 year old woman who died from COPD and heart problems. One of my suitemates said prior to our lab on Thursday that he was a bit nervous about going through with the lab, and that he had had a dream about uncovering the head wrapping of his cadaver and seeing his own face. Overall, a very surreal experience.
We had a lecture from Dr. Hausman, who is Chief of Hand Surgery at Mt. Sinai, about hand anatomy and how it relates to some of the surgeries he performs. It was a fascinating lecture about how they are able to "harvest" other structures in the body (i.e. toes, tendons in the leg like the plantaris, or the acromion of the scapula) and reconstruct broken or deformed structures in the hand. It was amazing to see that they are able to recreate functions and movements using parts of the body that have absolutely nothing to do with the hand. Every surgery is virtually a completely different surgery, and requires the surgeons to design surgeries based on each case's individual needs. It's just amazing what they can do.
I also went to a talk earlier in the week about post-medical issues such as salaries for different specialties, and how much we can expect to make as physicians. It was a very depressing talk because the panelists gave a number of examples of why we're not going to be making very much money because of overhead costs, declining charges for procedures, and malpractice suits. They said that one of the only ways to make money is to start your own practice, which requires almost more business experience than medical experience. Granted, the panelists were not really involved in things that interest me, but still... it's hard to look at the end of the tunnel and be told that I can only expect to be worked to the bone and receive very little compensation when I get there.
Today was the last day for first-year students to hand in deposits for the Spring Break trip to Belize, and so in a meeting this afternoon we were able to finalize the lists of who will be going to which site (either Orange Walk or San Ignacio), and what their responsibilities will be. I think we have a good group of people going to OW. I'm glad that things have been coming along very smoothly, and I'm getting excited about going on the trip. Hopefully the task of trip preparation and coordination will be fairly smooth since we've got a good network of second-years who went last year and are willing to help us on this year's trip.
This afternoon Christian and I met with the geriatric patient were assigned to through the Seniors as Mentors program in ASM. Her name is Ms. Valentin, and she is a 75 year old Puerto Rican woman who lives a few blocks away from Sinai. She seems to be very nice, though she would much rather watch TV than do anything outdoors, and doesn't seem to want to do too many things. We're going to give her a call sometime next week, and then try to set up a meeting with her sometime in the week after that. Some other students (including Eric) have been through 3 or 4 seniors already, so I guess we have been fortunate to be with someone who is interested in the program.
This post has been long, and now that it's dark outside I think it's time to start on some M&C. I have a feeling that I will be hiding out in this little corner of Levy Library, where people can't find me unless they are looking for me, for many, many hours.
I wanted to close this post with a quote, though:
"The reasonable man adapts himself to the world. The unreasonable man persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George Bernard Shaw
On Wednesday we had a clinical correlate through M&C with a 25 year old girl named Gail who had acute myelogenous leukemia (see more about AML here). She had gone to Emory for college, and knew some of the people from New Rochelle who had gone to Emory (since she was my year in college). She was diagnosed with leukemia her senior year in college, and went through the terrible chemotherapy and treatment. She said she remembered feeling fine at the time of her diagnosis, but being told that she had to go home and be rushed into the hospital for treatment. She shopped for a few doctors in New York while bringing her luggage into the doctor's office, because she fully expected to be admitted as soon as she chose which doctor would treat her. On one night during her treatment she remembered having a 105 degree fever, a 0 neutrophil count (anything below 1000 is considered neutropenic), and a 60/40 blood pressure. Her doctor had called her parents to ask them to come in the night because they thought that Gail might not make it through the night. I imagine that must have been such an incredibly hard thing for her as well as her family to deal with. Gail said, though, that the entire time she was in treatment, she never slept in her hospital room alone: she always had a family member there to look after her. She said that was such an important part of treatment and recovery. Another interesting thing about her case was that she was supposed to start her chemotherapy on September 11, 2001, but after the terrorist attacks Sinai had to push her therapy off indefinitely because there was a question of whether there would be a major strain on the healthcare capabilities of NYC. Because there were so few casualties from the World Trade Center attacks, though, Sinai ended up with a surplus of medical supplies, and Gail's treatment began a week behind schedule.
After Gail we met with another patient through ASM that same afternoon. Nick was a 58 year old male who at one time had been an alcoholic and heavy drug user, but has been sober for more than 20 years. He talked to our small group a little bit about his life and what made him turn to alcohol as well as other drugs (including amphetamines, barbituates, cocaine, and heroin, among others), as well as how it affected his life and what made him seek help. He said that one day he got a letter from a priest he had known while growing up in Greece, inquiring about how Nick was doing, and to write back to say what he had been doing lately. The letter made Nick realize that he had absolutely nothing good or of value going on in his life, and decided to start attending AA meetings to see whether he couldn't change his life around. After going in an out of AA a few times, he made it through the 12-step process, and has been sober ever since. He met his current wife while in AA, which he said has been a great improvement in his life, and has had a job in the NY prison system for the past 15 years or so. It was really interesting to talk to him about alcohol and drug abuse as a disease, and see how difficult it was for him to go through treatment and rehabilitation. I think the students in the small group didn't pass any judgment about Nick, and asked good questions about different aspects of Nick's life. This was an exercise in talking to patients about uncomfortable topics such as sexual and drug histories.
I met with Ann-Gel from the Center for Multicultural and Community Affairs this week to talk about getting in touch with physicians who work in fields that interest me, as well as starting to talk about research plans for next summer. I know that I am interested in somehow structuring a project where I can do part of my work abroad for about a month, and then bring the project back to East Harlem for the rest of the summer. My problem (as I mentioned in a previous post) is that I don't exactly know what field I want to work in, and don't necessarily know where to begin without having had much clinical experience. Ann-Gel was really helpful in giving me some ideas of people I could talk to, and was very serious about getting me organized and working on a gameplan from now until next summer. I'm excited about the prospects of what I am going to do, and I have to keep on telling myself to think about more pressing issues at hand (i.e. my M&C exam that is in 3 days). The CMCA has a scholarship for a few students to do research each summer, and I think it would be great if I had my act together by then to apply for it.
This past Tuesday was the last day of the Extremities section of Gross Anatomy. That meant that this Thursday we started out final section, the Head and Neck. At the beginning of class we took the final wrappings off of our cadaver's head. It was a very surreal--and somewhat disturbing--experience to finally see her face, and to think about her very much as a human being again (not that we didn't think of her that way before, but I guess it is easy to dehumanize a cadaver when looking at such such small parts of her body at a time. Also, the face is by far the most human part of the body). The lab was the most solemn it has been since probably the very first day of dissection, and it involved skinning the cadaver's face and exposing the muscles involved in expression, which seemed like it was something straight out of a horror movie. It was also really interesting that it was virtually impossible to tell what the ethnicity was of our cadaver until we removed the head wrappings-- and then it was very obvious that she was of Asian descent. She was a 78 year old woman who died from COPD and heart problems. One of my suitemates said prior to our lab on Thursday that he was a bit nervous about going through with the lab, and that he had had a dream about uncovering the head wrapping of his cadaver and seeing his own face. Overall, a very surreal experience.
We had a lecture from Dr. Hausman, who is Chief of Hand Surgery at Mt. Sinai, about hand anatomy and how it relates to some of the surgeries he performs. It was a fascinating lecture about how they are able to "harvest" other structures in the body (i.e. toes, tendons in the leg like the plantaris, or the acromion of the scapula) and reconstruct broken or deformed structures in the hand. It was amazing to see that they are able to recreate functions and movements using parts of the body that have absolutely nothing to do with the hand. Every surgery is virtually a completely different surgery, and requires the surgeons to design surgeries based on each case's individual needs. It's just amazing what they can do.
I also went to a talk earlier in the week about post-medical issues such as salaries for different specialties, and how much we can expect to make as physicians. It was a very depressing talk because the panelists gave a number of examples of why we're not going to be making very much money because of overhead costs, declining charges for procedures, and malpractice suits. They said that one of the only ways to make money is to start your own practice, which requires almost more business experience than medical experience. Granted, the panelists were not really involved in things that interest me, but still... it's hard to look at the end of the tunnel and be told that I can only expect to be worked to the bone and receive very little compensation when I get there.
Today was the last day for first-year students to hand in deposits for the Spring Break trip to Belize, and so in a meeting this afternoon we were able to finalize the lists of who will be going to which site (either Orange Walk or San Ignacio), and what their responsibilities will be. I think we have a good group of people going to OW. I'm glad that things have been coming along very smoothly, and I'm getting excited about going on the trip. Hopefully the task of trip preparation and coordination will be fairly smooth since we've got a good network of second-years who went last year and are willing to help us on this year's trip.
This afternoon Christian and I met with the geriatric patient were assigned to through the Seniors as Mentors program in ASM. Her name is Ms. Valentin, and she is a 75 year old Puerto Rican woman who lives a few blocks away from Sinai. She seems to be very nice, though she would much rather watch TV than do anything outdoors, and doesn't seem to want to do too many things. We're going to give her a call sometime next week, and then try to set up a meeting with her sometime in the week after that. Some other students (including Eric) have been through 3 or 4 seniors already, so I guess we have been fortunate to be with someone who is interested in the program.
This post has been long, and now that it's dark outside I think it's time to start on some M&C. I have a feeling that I will be hiding out in this little corner of Levy Library, where people can't find me unless they are looking for me, for many, many hours.
I wanted to close this post with a quote, though:
"The reasonable man adapts himself to the world. The unreasonable man persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George Bernard Shaw
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