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| Happy Thanksgiving! Some great times I've been thankful for in the past few months:
  
The botanical gardens and their strange sculptures of curvy women
A poor picture, but it's the Maroon 5/Counting Crows/Augustana concert 
 
I went to this pharmaceutical company dinner (can't even tell you the name of drug, so I guess their strategy didn't really work, it was something for hypertension), and guess who they brought in as a guest speaker? Tony LaRussa! (manager of the Cardinals and was with the A's for a long time before that). I asked him if he still goes back to the Bay Area and he said he has a house in Walnut Creek. I was woefully unprepared, so I took pics w/ my camera phone and had him sign a dollar bill. 
 
Chicago w/ Moo, Po, and Dork!
 
and jumping pictures!
 
Being a tourist w/ Moo
My 15-minute Halloween costume. If there's one valuable thing I learned in college, it's how to make a rockin' ninja mask (right Andrea and Val?). fyi, Vicky is supposed to be a caterpillar (she had like, 4 pairs of socks down her torso), and Zena's got fairy wings.
   
As previously posted by many, Sara Bareilles finally came to town and she was super cool. And Marc Broussard and Raining Jane were also really cool. Raining Jane is from UCLA! People in STL are so weird, The first 50 or 100 people who came in all decided to sit in the seats in the back, and the floor was wide open. So we got first row standing!
 
And the reason why fall is my favorite time of year, especially in STL
Give thanks with a grateful heart...
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| 3RD YEAR IN REVIEW - PART 4 - RADIOLOGY:
1. Radiology is an extremely important part of medicine. It has revolutionized much of the way we currently practice and many up and coming....zzzzzzzzzzzzzzzzzzzz. That about sums up the past month. I've gained a great appreciation for radiologists and everything they have to know, but I don't think a single day went by when it wasn't a fight to keep my eyelids up.
2. Radiologists have to know a crapload about 1) human anatomy, sometimes down to the tubercles on the bones or the sulci of the brain or the branches off a vessel; 2) diseases, because not only do you need to see what's anatomically wrong, but you have to figure out a differential for what could be causing it, everything from inflammation to infection to different tumors to normal aging; 3) physics, to understand what different types of images are highlighting or dampening, when to use different studies, how much radiation a person can afford to get, etc. They also need to have great eyes and attention to detail.
3. On the flip side, I would find it hard to be stuck in a dark room all day, maybe about 0.5% patient contact. It's almost like an office job, sitting in front of a computer all day, moving things from your inbox to your outbox, your butt slowly widening and spreading. I think it was especially tough as a med student because you kind of just sit there while the residents and attendings actually read the films and do the work. It was hit or miss as to how much they tried to teach me and get me involved. There were a few really good attendings that taught me a thing or two, but there were many more days of drifting in and out...of consciousness. But even if I were the one reading the films, I wonder how much it could hold my interest. I mean, how many chest x-rays or knee x-rays or CT scans could I really look at in a row without dying of boredom?
4. Over the 4 weeks, we rotated on 4 different services in radiology, mine being musculoskeletal, interventional, pediatrics, and abdomen. MSK was a lot of osteoarthritis, fractures, and spine surgeries. Interventional had some cool procedures, like TIPS, embolizations, balloon angiography, and gallstone retrievals, but also a million catheters and G tubes. Peds ended up being a lot of chest x-rays for the ICU's and a lot of ortho films, not a lot of CT's or MRI's. Abdomen was kind of boring, a lot of bowel obstruction and CT's looking for nodules or lymphadenopathy. My single most favorite day was on ultrasound, because 1) there was actually patient contact and conversation, 2) it's a dynamic test, so there's always something to look at or find, 3) there were some procedures, like core biopsies and fine needle aspirations, and 4) the attending of the day actually made sure I knew what was going on and what we were looking at. But overall, I don't think I learned very much about radiology or medicine. I still don't know the difference btwn T1 and T2 MRI's, or the differentials for a bone lesion or a solitary pulmonary nodule, or the different types of central venous catheters. Perks of the rotation, however, were the hours (7-4 at most, but often with a few breaks in btwn), no shelf or any exam whatsoever, and only one presentation per week.
5. Radiology would be a good job if you like to help a lot of people very quickly and you don't care much about getting the whole picture or actually solving their problem, and you don't care about talking to patients or getting to know them. However, you do have pretty decent hours and you get paid a crapload. I also realized early on that if I wanted to do a medical mission somewhere, a radiologist is probably one of the least helpful doctors to be, given that many places have no x-ray machines, let alone CT's or MRI's. It might be helpful if you go to another country and teach them radiology, but that's not quite the same. So anyway, the career search continues...
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| 3RD YEAR IN REVIEW - PART 3 - PSYCH:
1. The majority of hospitalized psych patients are what you would imagine: schizophrenics, bipolar manics, some suicidals with depression. Some of the other big players: substance abuse/detox (alcohol, cocaine, opiates, etc), prisoners/forensic patients, and borderline personalities. Some patients had a decent sense of why they were there and why they needed meds and all that. Some did not. My favorite patients: the geriatrics, because they would slowly shuffle around in their hospital outfits and were usually cute and clueless. Least favorite: borderline personalities, because there isn't really a whole lot psychiatrically wrong with them, but they're needy and labile and threaten suicide and never really get better (because you can't really cure a personality). I had a couple of particularly memorably bad borderlines. Easiest patients: people with some history of depression, but something went wrong in the last few days and suddenly they're suicidal. Because you can usually help them come up with a plan to work out their problems, get them some help and meds on the outside, and they're usually pretty compliant and feel better just because now they have some plans to look forward to. Scariest patients: some of the psychotics who really didn't think anything was wrong with them and straight up refused to take their meds and would get violent about it. Most entertaining: some of those same psychotics because they thought up the most random things. One woman believed she was a witch and a robot and had an invisible knife with which she was going to "cut off the resident's meat and feed it back to him." She also punched a nurse in the face and threatened to slit her throat if she came near her with a needle. Another guy was sure the doctors were putting parasites into his brain. This one was kind of interesting, a guy who said he was Jesus and that people didn't believe him because people can't believe that he would actually keep a promise. But you get the picture, a lot of entertaining stories.
2. On MPC: so half of the 3rd years work at Barnes, and half go to Metropolitan Psych Center, which is a state-run facility nearby. So at MPC, we take all the hold prisoners (basically prisoners with a psychotic episode or suicide attempt or whatnot) and forensic patients (people who committed crimes but were not guilty by reason of insanity). Secondly, unlike the rest of BJC which has prohibited drug rep lunches, MPC still allows them. So I had about 2-4 free lunches per week and probably gained a few pounds and a dozen free pens. Thirdly, we happened to have a really awesome team this month. At Barnes, it also seems that most of the attendings are all old guys who are very academic/philosophical/like to talk. Our attending at MPC was this hip, cool, 5-ft tall soccer mom (her ringtone was "Hips Don't Lie") who liked to get things done and taught us a lot. Our senior resident was a crazy blonde who went to med school in the Caribbean and wanted to get things done as soon as possible so that she could go to the gym or the spa or get her hair bleached. Our weekend call shifts were also pretty much a joke. I think I might
hold the record for shortest shift, which started at 8:00 am and I left
at 8:03. We were also lucky in that our residents were fun, cool, and awesome teachers. I definitely learned more on psych than peds or ob/gyn, hands down. I baked cookies on the last day because it was the first time I really felt appreciative to a team that I've worked with. I will miss them a lot more than I will miss the patients.
3. On outpatient psych: Most of our time was spent at the hospital, taking care of the really sick inpatients who needed immediate help. It was also kind of discouraging because so many of them were repeat visitors and never stay compliant on the outside and you know they're going to come back again. But we did spend one day at a regular outpatient clinic, with patients who do take their meds and lead relatively productive lives and take care of themselves. It was nice to know that there are some success stories out there.
4. On child psych: A whole lot of rule out ADHD and autism, but also a little bit of bipolar/depression, Tourette's, OCD, conduct disorder, etc. It's kind of hard with younger kids because they can't really tell you what they're feeling or why, you just have to observe them and how they interact with their parents and stuff like that. And then there are the random things that I didn't see but had to learn about, like bedwetting, night terrors, and separation anxiety. Overall it didn't seem that interesting to me. But we were told by multiple psychiatrists that it's a huge underserved population and you would make a crapload if you go into child psych.
5. ECT: Electroconvulsive therapy= inducing seizures in order to treat really bad depression, mania, psychosis, catatonia, and a few other things. You basically put people to sleep with anesthesia and stick these two rods on their head and pump up the current. It sounds kind of scary, and most of the general public is too freaked out to ever give it a chance, but it's actually the most effective treatment, better than any of the meds. And it's actually pretty safe, you just have a little but of memory loss around the time you get the treatment. So this is my public service announcement, if a doctor ever tells you to consider ECT, it's not a bad idea. It was kind of fun on my end too, because I felt like we were actually doing something. but then again, I didn't really get to see the results afterward, so who knows.
6. On psychiatrists in general: They have a pretty cush life overall, I must say. Even as 2nd year residents, you work from like, 8-2 or 3 on most days, take call once per week, and don't work any weekends. 3rd and 4th year are even better, and you have enough time to moonlight and pay off some loans. On the other hand, you've got to deal with psych patients all the time, which I don't think I could handle. And the majority of your job is pharmacology, prescribing meds and adjusting the dose and looking for side effects.
7. I found out pretty early on that I'm probably not meant to be a psychiatrist, mainly because I don't have very much empathy for the patients. They mostly frustrate me, especially when they have no insight into their illness, and you can't reason with people who don't see reason. It's also sort of discouraging to see people just go through cycles of being in and out of the hospital, either refusing outside services or getting lost in the system or whatever. So not a career calling, but I think it was overall a fun month and I learned a ton and worked with some great people. 
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| and now for a fun post. some of the good times this summer...
free concerts galore! every weekend down by the arch, plus fireworks after every show. and also every week at the botanical gardens. AND free outdoor musicals every week at the Muny, which included Miss Saigon (my fav), The Producers, Fiddler on the Roof, My Fair Lady, and High School Musical (er...).
One Republic! they were really good.
a very weeny picture, but can you guess? it's Boyz II Men! Thousands of people in the humidity (how are they wearing suits?!) testing their memories for the lyrics to "On Bended Knee," "Water Runs Dry," "I'll Make Love to You," and "End of the Road" and belting them at the top of their lungs (myself included). good times.
Ahh, the City Museum. If you ever come to visit me, we are definitely coming here. A massive indoor and outdoor jungle gym filled with slides, caves, cages, and ball pits. The best way for an adult to feel like a kid again (and feel very sore the next day).
BBQ's and picnics in the park! Makes me miss family BBQ's back home. The only thing missing were the marshmallows...mmm...
Well, that was most of my summer in a nutshell. I'm ready for fall!
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| 3RD YEAR IN REVIEW - PART 2 - OB/GYN:
1. By the second day of this rotation, I was already done with it.  I started out on the ambulatory rotation, where doctors see like, 30 patients a day for 15 minutes each and do pelvic exam after pelvic exam. So yes, by day 2, I'd already done enough pelvic exams to last me a lifetime. Then I had to keep doing more. And as crude as it sounds, that part of the body is not pretty. and is always stinky. And I heard more about people's sex lives than I ever cared to know. Not that it's not valid or important, but seriously, i'm the last person that has any advice about that. Our block was split into three 2-week sections of ambulatory/general ob/gyn, labor and delivery, and gyn oncology. So I'm glad that I at least got to see the variety of the field and actually did learn a lot most days.
2. Ambulatory/outpatient block: good hours, but again, seeing patients like crazy left and right. Which I'm sure is not bad once you're competent enough to get through everything, but for a med student is kind of exhausting. For my first week, I don't think I saw a single pregnant patient. They were all well woman exams or gyn problems like a rash or discharge or bleeding or contraception. Then there was one day when I saw a bunch of pregnant patients, the happy excited kind of pregnant patients, and that was a lot more fun. But on that same day, there was a woman who was going through a miscarriage, which was pretty sad. Her HCG levels were dropping (which is pretty definitive for a miscarriage), but we did an ultrasound and you could still see the baby and even its heartbeat. So that kind of sucked, especially for the parents, to see your baby's heartbeat but know that it was going to die very soon.
3. Planned parenthood: This was part of my ambulatory experience, to go to Planned Parenthood once per week. And yes, there were one or two dudes out front with signs and all that. At first I was in the general clinic for well woman exams, STD testing, contraception, etc., which was gross, but not disturbing, if that makes any sense. The second time, I was with the doctors who perform all the abortions. That was hard, probably one of the most disturbing things I've seen yet. I doubt you all want to hear about it in detail, but you can ask me if you're curious. I imagine it's a pretty emotionally traumatizing experience. It was for me and it wasn't even my kid.
4. On childbirth: Seeing childbirth is kind of cool, but it's also pretty gross, as you
can imagine. stuff coming out of every orifice at the same time,
literally. Ladies, I highly advise you to get an epidural. It comes
in handy during the delivery, but also for afterward if there's a tear
that needs to get sewn up (which is often). Most of the time, it was a pretty happy experience. My favorite was to see the big tough dads crying afterward. But there were also the sad and frustrating times. Pregnant women who still did drugs or smoked or drank. Every day, I would say 75% of the patients were under 20 years old. Or patients who were 24 and were on their 5th kid. And sometimes there would be babies just born way too early or babies that had died while still in utero, which sucks because then you have to go through the labor and delivery of basically a corpse. but again, overall happy and exciting and usually nothing goes wrong.
5. On L&D: my first taste of 14-hour days and waking up at 4:30am, walking to work in the dark and walking home in the dark. at least i kind of avoided the gross St. Louis summer. In the beginning, they only let us deliver the placenta, then we slowly got more involved in the actual delivery. By the end, I think I delivered 2 babies basically on my own, which was pretty cool. I also saw a few C-sections, which were also cool, but no less brutal. There's a lot of digging and grabbing and the repair jobs aren't necessarily up to plastic surgery standards. But for all of those cool things I got out of it, I was actually pretty miserable for the first week or so. I think it was a combination of the rough hours and some of the residents that I was working with. There was a lot of paperwork and harping on little details and minor errors that made it not so fun. but the second week was a little more laidback and that helped me enjoy it a lot more.
6. Gyn onc: as opposed to waking up at 4:30, now I had to be at work by 4:30. there were many days where I would come home at 7:30 and have to go to sleep by 8:30 to get a decent amount of sleep and do it all over again. So there was no life outside of work for those 2 weeks. It was my first experience with actually pretty sick patients, some on the brink of death or terminally ill. We would have patients that were there specifically for their cervical or ovarian or uterine cancer, as well as people with a history of cancer but were there for a pneumonia or fever or whatever. As my first experience in the OR (aside from C-sections), I think i enjoyed it a lot. I appreciate the fact that most of the time, you can either solve a problem with surgery or, with cancers, go a long way towards knowing how to treat it. I saw some open abdominal surgeries, some laparoscopics, and there were even some robotic assisted (aka "robotic ass") surgeries. My favorite was an abdominal hysterectomy + a panni, which means taking out a bunch of your stomach fat, almost like a tummy tuck, at the same time. I wouldn't mind one of those. The sad part was, our patient was at least 350 lbs, so our removal of about 20 lbs of fat was like nothing. It basically removed one of many rolls. So I can see why people like gyn onc because you're doing pretty big and pretty life-altering stuff. but there are a lot of times where your best isn't enough, and I think that would be hard to do every day.
7. I will say, though, that 95% of the ob/gyn's are the coolest and nicest doctors i've ever met and i would love to work with them more. the docs on ambulatory and L&D were all fun and nice and pretty chill and very much loved their jobs. then i got to gyn onc, and i swear they all had personality disorders or something. one doctor was totally straight-faced, never smiled even once, never laughed, no inflection in his voice, nothing. he turned out to be a pretty good teacher in the OR though. then this other doctor was large and loud and would make the most random references and jokes. he walked into a room and called the patient's tumor "fugly." the first time i went into a surgery with him, by the second sentence we'd spoken, he decided he was going to call me Heathen from now on. and he proceeded to do just that for the rest of the 3-hour surgery. 
8. For the most part, patients are healthy. Lots of young women with no
other medical problems besides the "fetoma," as one professor put it.
Then there are older patients that may have other medical problems like
hypertension or diabetes or depression, but you're not the one that has
to manage them. So I think i appreciate sort of the focus on a
specific area of a person's health. it's a lot less overwhelming to
learn, too.
9. On being an ob/gyn in general: it is definitely a field where you can make an impact and affect people's health and lives. whether it's making sure someone has a safe and successful pregnancy, or helping a couple with infertility, or treating someone with cancer, it's pretty exciting stuff and you feel like you're making a difference. but there's also the mundane, like well woman exams, and the trying times, like patients with terminal cancer. in general, the two biggest reservations that people have about going into ob/gyn are: 1) the time commitment, like having to go into the hospital at all hours when someone is delivering a baby, and 2) the malpractice insurance, which i believe is the highest out of all the fields, i guess because when you screw up, you've taken away the potential for someone's entire life, which is very costly. There are also a lot of interesting but potentially emotionally draining ethical/personal issues, like abortion, infertility treatment, teenage sex and pregnancy, contraception methods, and end of life issues. So i don't think i could deal with that on a day to day basis.
so i say with a great deal of joy, goodbye to ob/gyn.
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