I know....it's been ages since my last post. Pictures from the rodeo and shots of the beach are both forthcoming, however I'll wait for a more stable internet connection before I post them. I got through a pleasant bouquet of books – enough to hold me for a while (Barbara Kingsolver’s The Poisonwood Bible, Denni Lehanes’ Shutter Island, Diane setterfield’s The Thirteenth Tale, Stepehen Erikson’s Gardens of the Moon, and Randy Alcorn’s Safely Home). Now, I’m easing my way through Gene Wolf’s Litany of the Long Sun, and am as happy as a kid in a candy store.
Well. For the third time in my life, I have - without really expecting it or wanting it - been sucked back to Miami. The first time was for MERP - Ross' medical education review program. That time didn't particularly bother me; I was just thrilled to be starting on my medical education. I knew that my journey would take me to “a land behind God’s face”, as my mother would say – the nowehere-island of Dominica. After 16 months there, I’d applied to remain on the island for my 5th semester. The word on the street was that 5th semester on the island afforded much more time to study for step 1. Much to my chagrin, I was repatriated (I blogged about that vexation). However, it all turned out for the best; 5th was fun, and the Kaplan course I took helped me to rock Step 1.
Now – Ross has most of its clinical spots in New York. They’re scattered around NYC, and so this is where I thought I’d be for my clerkships. I looked into making sure I was applying for programs that would be accredited in Texas, and began to look into housing. Once my scores came in, I submitted them along with the myriad bits of facts and desiderata composing required paperwork. I don’t know if it was the Christmas and New Year’s holidays, but both my and Nicole’s submissions were lost to some abysmal inbox in Ross’ central offices, such that a little too much time passed, and we called in to make sure they’d received everything. When I finally spoke to the administration, I was told that, if I still wanted to go to NYC, I wouldn’t be able to start until March 29th. This was back in early January, and I was severly nonplussed; not only did I just not want to wait that long, there was a time-limit to the length of my vacation, after which I’d incur the relentless wrath of Sallie Mae – my student lender. I essentially had no choice, and would have to start again. There were two options – the family practice residency in my hometown, and Miami.
I’d have loved to have stayed in Harlingen – I’d worked for the family practice residency program during the summer after my freshman year of undergrad. They needed someone to update their patient information databases, and once that was done, I was fortunate enough to be allowed to shadow the docs and residents a few hours a week, as well as participating in Summer Medical Institute – their program for medical students who came down and helped the residents and attendings run their door-to-door medical clinics, as well as free medical clinics in Mexico. I had a blast doing that, and apparently made quite an impression – even though they don’t allow FMGs to do clerkships, they’d make an exception for me – just not for Nicole.
And so I prepared to return to Miami. This really frustrated me – after leaving the last time, I’d decided that I don’t like this city. Despite the fact that I have a significant support system down here, with family on both Mom and Dad’s side spread out over Dade County, I didn’t like the city. I didn’t like the self-important, superficial, arrogant attitudes that seemed to be everywhere. I didn’t like how people drove as if right-of-way was determined by the price of one’s car. I didn’t like being forced to speak another language in my own country because the people I was speaking with gave me dirty looks if I spoke to them in English (oddly enough, though most folks in Harlingen are bilingual, the attitude is entirely different – I guess we’re just more polite). So I wasn’t happy to be sent back, but deep down I knew that it wasn’t so terrible – I’d gotten family practice, OBGYN, internal medicine, and psychiatry scheduled back-to- back right from the get-go, which, based on the feedback I’m getting from my classmates, seems to be a blessing; a lot of people have huge gaps in their schedules. Also, Nicole and I were scheduled for the same rotations, so that made the whole transition much easier. She was thrilled that things went so smoothly, and I grudgingly joined her in the planning. The only snag in getting here is that my bags took a later flight out of Charlotte (it seems to happen whenever I fly in to meet Nicole somewhere; when I went to visit her in Spokane after we first started dating, my bags decided to stay somewhere in Milwaukee. I stepped off the plane without my winter clothes into Washington’s first serious blizzard of the year. Fortunately for me, her father loaned me a coat until my luggage and I were reunited.)
Seems like I just can’t get away from this place, but it more and more reasons why I should be grateful manifest daily. This isn’t a particularly gentle winter for the northeast, and after hearing how many hundreds of flights have been cancelled and how many feet of snow have burdened the roads, I think I can admit that I’m in a good place. I don’t believe in strings of coincidences – of course they’re possible, but I think it’s simpler than chance. Inopportune events befall everyone from time to time, but if I get wrapped up in a string of unpleasant calamities, it’s always my fault – generally I was too lazy and didn’t plan well enough (Hopefully I’ve gotten that out of my system). However, when a string of blessings encircle me, I can’t help but know that it’s the Hand of God preserving me and ushering me away from some other calamity. I guess this is the case with my seemingly inextricable linkage with this city; I can’t get away, but it’s been for nothing but good.
This time, I’m living on South Beach. No, seriously - I’m talking Miami Ink, Ocean Avenue, art-deco South Beach – and I love it. The feel is entirely different from down-town Miami; the pace of life seems to be a bit more even, and on this little island at least, though we’re bogged down with constructions as they prepare improvements for tourist season, the drivers are downright polite (such is not the case back on the mainland. The nerve of some people). There seems to be a bit more money down here, but it’s a bit more low-key, folks don’t flaunt it and aren’t arrogant like they are across the bridge. It’s surprising that we found a place at the price that we did, but I think it’s because (1) the building is a bit older and, (2) I think the owner’s paid off the apartment. Shockingly, this is the cheapest I’ve ever paid for rent in Miami – and I’m on the beach! I jog along the boardwalk, my route taking me between the ocean and Ocean Avenue, what with her posh bistros and exotic cars. Know that “punchdub” game, where, if the advertising campaigns are to be believed, you’re supposed to punch someone in the arm if you see a Volkswagen of some type? Nicole and I only play that with Bentleys.
Anyway, 2 weeks ago, I began my family practice rotation at the Miami Jewish Home and Hospital, under the program run by the Center for Haitian studies, in conjunction with Jackson’s residency programs. The family practice clerkship is 6 weeks, and ours is broken up into three sections – the first two weeks of which are at MJHH. It’s a “home and hospital for the aged”, and, initially I was thrilled to be starting with the geriatric part of family – that way I could get it over with. It’s been a few months since I studied hardcore, but it wasn’t that difficult to get back into the swing of things – the required text is atrocious, but we’ve got online access to Harrison’s, so I can’t complain too much. Anyway, this was a nice rotation to begin with – we showed up to the clinic every day at around 9, and then either sat in with a cardiologist, neurologist, ENT doc, pulmonologist, dermatologist, endocrinologist, or wound clinic. We worked with several docs throughout the two weeks who had us examining, writing-up progress notes for, and following up on various patients. The experience was so varied, because these docs weren’t run-of-the-mill family practitioners; they were experts in their respective fields. The previous medical director (who’d just stepped down, claiming that he was getting too old to get dragged out of bed in the middle of the night) had been a 35 year arm-doc who’d published over 200 papers. We saw a lot of dementia, but I guess that should be expected; the median age was somewhere around 85. It wasn’t until the end of the first week that I felt comfortable in my own skin again, with the stethoscope around my neck and short, white coat draped over my shoulders – and by then, I’d come, much to my surprise, to be genuinely enjoying myself.
It was unexpected – I’d walk through the halls and see patients I’d examined; I recalled notes from their charts and specifics about their disease processes like you’d remember something about your friend when you bumped into them unexpectedly. I saw things change – people healed, and people got worse. Patients remembered my name, and their faces lit up when they saw me. I got to know the nurses (I’ve always gotten along well with nurses), and perhaps because of this, I think I got a little special treatment. One thing I had a whole lot of fun doing was the wound-clinic – many of these geriatric patients are quite literally losing their mind and are bed-bound. Overworked nurses are just treading water trying to take care of everyone and turn them every two hours, and so bed sores happen – they’re unavoidable; if old hearts and lungs fail, old skin fails too. Add to that the significant diabetic population, and wound-clinic was never slow-moving. While it was great examining and interviewing patients, and reporting to the attending physicians or just following them around listening, I much preferred working with my hands. Within a few minutes of watching my first wound cleaning and dressing, I was assisting, and by the end of that first session, I was doing it myself and the nurses were assisting me. It was gratifying, because people came in with a problem, and I improved it. I’m not going to treat wounds for the rest of my life, but this reaffirms for me my conviction that I’m going to have to do something with my hands.
Towards the end of our two weeks, JCAHO descended upon MJHH, and, like magic, the docs were no longer available. This slowed some of our plans, because I was unable to go and follow-up with some patients I’d wanted to see, but it all worked out. I had a great time, and felt that all of the docs (some of whom also teach at UM) were fantastic. On Friday, after dropping off some required paperwork, Nicole and I drove out to our next station – a free clinic for homeless and low-income folks. It was hell to find (thanks sprint GPS….), but once we got there, I was pleased to hear from the staff that the medical students were pretty much given free reign; we interview the patients, examine them, and formulate a plan, which we then present to the attending physician. This autonomous, hands-on approach feels to be just what I need – I’m not yet 100% confident in some physical exam things, having done the lion’s share of my practicing on healthy medical students – and this is where the rubber meets the road. This is grass-roots medicine, without fancy diagnostics and expensive equipment; this is a sick, person, myself, and my understanding of the disease process. I’m looking forward to this because, unlike the wealthy MJHH, the people I will see starting on Monday have no other options, and I will do what I can to make them well.
My OBGYN rotation is next – it’ll be fun, but it will also be a significantly different philosophy of medicine than I’m accustomed to…being a man. There’ll be a lot to learn, but what I’m really looking forward to is doing my internal medicine rotation at Mount Sinai – 3 months of nose-to-the-grindstone medicine. At some point, every doc I’ve ever met in my life has asked me what type of medicine I want to go into. I guess some folks just know where they belong. Since Dad’s an interventional cardiologist, that’s the type of medicine I’m most familiar with, and it would be tempting to just hang my hat on that, however, there’s so much out there; medicine develops and changes every day. Thus, when people ask me what I want to do, I tell them about my background, but also that since I’m perched on the beginning edge of my clinical education, I haven’t had enough experience to close the door on anything (I do, however, refrain from relating that I don’t think either family medicine or psych are for me). Nevertheless, in my admittedly limited experience, I’ve come to believe that doctors who have either completed an internal medicine residency or a pathology residency have the greatest fund of knowledge with which to understand the disease process – and so, I’m excited that I’m going to do my internal medicine rotation as such a well-known, well-established institution. It’s also a bit of coming-full-circle; you see, all those years ago in medical school, my father also completed his internal medicine rotation at the very same Mount Sinai Medical Center.
I’m definitely keeping my options open. I may fall in love with surgery. I guess we’ll just have to see.
