Saturday, March 7, 2009

Big News!!

Keiko isn't pregnant, but that's not the news.

I did get in the CDC. I actually got the call on Monday morning, amazingly early for my Saturday interview. I am incredibly excited. I am in the tuberculosis division. I can't ask questions to the current tuberculosis CDC fellow because she is investigating an outbreak in Namibia. I can't wait.

This means I will be moving to Atlanta next year. I have no idea what I will do about furniture for 1 year, where we will live, etc., but it's nice to know what will be happening. But mainly I'm just excited!

Thursday, March 5, 2009

Surgery vs medicine, my thoughts on specialty

One of the purposes of the third year of med school is to pick your specialty. The first thing you need to decide is surgery or medicine. Then you could narrow it down after that. Surgery includes anesthesiology and all the specialties of orthopedic, ear-nose-throat, opthalmology, etc. Medicine includes pediatrics, dermatology, psychiatry, etc.

After my 2 weeks in the operating room, I have solidified my rank list of specialties a bit. This was also strengthened by that fact that EVERYONE at the CDC is either a pediatrician or internist.

Summary of my current thoughts on specialty

#1: Pediatrics
Good: I really enjoy kids, they are just cute. And they are not as difficult to deal with as I thought, like hating the doctor and crying every time you enter the room. There are very few people that are faking an illness and less psychiatric components to deal with compared to adults. Even if the parents are crazy and annoying, your patients are the kids, and you are trying to care for them. They tend to come into the hospital really sick and leave quite healthy in a short amount of time. Parents in my experience were very nice and treated the doctors with respect.

Bad: Not as wide variety of illnesses. We study adult medicine for the most part for all of medical school and very little pediatrics. Parents can be terrible, but I haven't run into it or noticed it as much as I expected it. You can't talk to the patients a lot or get the full story from them.

#2: Internal Medicine
Good: An infinite amount of interesting illnesses. They generally generate the most research and have the most money for research. There are more residencies out in medicine. You can talk to the patients, and many are so nice and it's just a pleasure to help them get better, forming a bond of sorts.

Bad: There are lots of psychosocial issues such as homeless people that need a place to sleep, a lot of psychiatric patients including TONS that have headaches/stomach pain due to stress/depression that often never gets solved. Patients are often in the hospital for problems that never get better or are there for weeks because they need nursing home placement.
I'm not very good with elderly patients, I think. I don't enjoy demented patients. They can't tell me what's wrong and are often angry with the doctor for trying to help. I'm not saying they are wrong or bad, but other doctors i know enjoy the humor of the situation, when I just don't.

#3: Emergency Medicine
Good: Emergency medicine sounds really exciting. One of my favorite parts of medicine is hearing the initial story and trying to figure what's wrong so you can solve it. This mainly happens in the ER. You get to talk to patients and form a bond. You also get to do many procedures, like mini-surgeries, so it's a good mix. You can work as little or as much as you want because it is shift work.

Bad:Same as medicine as for the most part. You don't see the same patients twice, except homeless people in the area, etc. I'm not sure if I care about this or not.

Emergency vs infectious disease. These are the 2 specialties I'm interested in. Maybe cardiology too. If I do adults, I have to pick emergency or not while in medical school. If I pick pediatrics, then I have another 3 years or so to decide. At the CDC, there are very few ER docs, but it is a newer specialty.

Wednesday, March 4, 2009

OB-GYN: Student's role in surgery

The student has an interesting role in the operating room.

1. Retracting: this is the most common thing students do. It means you take curved pieces of metal and pull them to keep the incision or where the surgeon is working open. This often means spending 2,3,4 hours and I've heard horror stories of 8-10 hours of you standing there holding retractors, slowly building lactic acid in your muscles. My worst so far was about 4 hours. But was pulling hard to keep a women's introitus (look it up if you want to know what it is, but this is gyn) as wide open as possible.

2. Suction: Sometimes we have the little suction vacuum to get blood or often the smoke from the electrosurgery which can make cuts and stop bleeds from happening by zapping the vessels. Our job is to get the smoke so it doesn't stink the place up.

3. Cutting: We often cut the sutures (surgical sewing thread) once the surgeons are done tying knots.

4. Sewing: And sometimes we even get to sew closed the skin and fat since it one of the simplest parts and harder to mess up.

An interesting job to pay med tens of thousands of dollars in tuition for. Another "rite of passage" for med students.

Monday, March 2, 2009

OB-GYN: Starting in the operating room

I have officially finished my 2 weeks of gynecology surgery. It was my first experience in an operating room (OR). I was scared at first. I knew I was going to screw up. It is interesting that there is a very set method on how to clean yourself and prepare before you start surgery. Some people still start out with the old soap and brush, but these days do the following to become sterile, or so clean that you shouldn't infect the patient getting surgery.
1. Clean underneath your fingernails with a plastic device.
2. Use a special gel to clean your arms and hands.
3. Have an assistant put on a surgery gown, fresh from it's package. Put on the right glove, then the left, then a 2nd right and 2nd left.
4. Can't explain it well, but to tie the gown you do a 360 with one person holding on to a strap of your gown.

You can't have your hands below your belly-button or so, and can't have them above your shoulders. You can't have your hands touch your back or anyone else's back.

I forgot at least 3-4 times. Usually it would be just after I did something and would relax and my hands would fall to my sides (below my belly button) and I would get a friendly or not-so-friendly reminder to keep my hands up. I guess I'll catch on eventually...

Sunday, March 1, 2009

CDC: The interview

I have returned from Atlanta. It was a whirlwind tour, but awesome. The whole thing was paid for, first of all. I flew to Atlanta and with a delayed flight arrived just in time to iron my clothes and gather in the lobby of the hotel.
The first thing I can say is that all the interviewees are nice. Not just nice, but more than half were that kind of super-nice that just kind of emanates from people. In general, people in public health are super nice people. You might think that is obvious, but I remember going to a meeting for medical students around the Chicago area who were interested in working for change to help underserved populations through political activitism. A lot of the kids there were insane. Their language was terrible, just full of curse words, and having faith in a religion was some kind of evil that had to be rooted out. So very different personalities for people working towards a similar goal.
We were given a super nice dinner at supposedly famous restaurant in Atlanta. We met the current fellows working at the CDC. I happened to sit across from the head of the CDC's education department and was learning about how most people end up in the CDC. What I learned was most go through a medicine or pediatrics residency then are trained at the EIS (Epidemic Intelligence Service), a 2 year training period at the CDC. After that, they often join straight up at the CDC. I also found some CDC physicians still hold clinics to keep their skills hones, which is really cool. Some also do infectious disease or cardiology or whatever fellowships before.
We then had a little party with all the applicants and current fellows, where we were able to ask about housing, every day schedules, free time, etc. I've been going to bed at 9pm lately, so that was a little painful, but useful.

The interview: There were originally 59 applications. 18 were invited to interview, with all 18 accepting. There were supposed to be 8 spots, but due to some extra funding, 9 spots are available this year. There were 13 different projects. Since only 8-9 get students as free workers for their team, they were also competing to get students. So we had this process of each project interviewing a student and both of us trying to find out about the other while trying to sell ourselves. It was kind of funny but made both sides really nice, friendly and relaxed interviews.
We were only assigned to 4 projects initially but had 12 open slots. We were allowed to fill the rest or take them to rest. However, the more we interviewed at, the higher chance we had at matching at one of them.
At the end of the whole process, we ranked all the programs, and they all ranked us. They will be trying to match as many 1-to-1 program-students as possible.

Beyond that, we had one interview with the program directors. This was the real "INTERVIEW." Like they asked us "when was a time you had a hard time communicating something? What did you do? What did you learn from it?" This was the interview that decided if we would get in or not, at least to an extent. I'm not sure what would happen if you did terrible in that interview but had programs rank you #1.

I think my interviews went well (me knocking on wood). They were all really interested in my apnea monitor project from undergrad (for those of you who don't know, it went on to win "the biomedical engineering innovation and design award and might be produced) and my HIV-diagnostics project I did in Africa. Not many students there had an MPH or were in the middle of one, which also gave me a step up. But everyone there had a lot of experiences which were pretty amazing so here's for hoping.

I had a lot of projects that I liked. The one that I liked the most was the tuberculosis branch. You often have to travel to different parts of the country and world as there are outbreaks. It sounds very exciting. Another project that was really cool was working on eliminating polio in Nigeria. There were a lot of ones that interested me. Influenza, asthma, heart problems in infants, monitoring infectious at the borders of the US, obesity prevention, etc.

Only half of the students get in. I'll have a nice post if I get in, and if I don't, I'll try and sneak it into a post about something else :)