Two More Weeks of Beach

I've found a place in queens, bought the plane tickets, and begun packing. This latest chapter of my education in Miami is drawing to a close, and even though I didn't plan to come here in February, I'm already missing it. I'm sure NYC'll be plenty of fun, but it won't have South Beach, my apartment won't have its own washer-dryer, and the winter's going to be reallly cold. However, I'll have scheduled and completed my cores back to back - something not many of my classmates are doing. That'll definitely make things easier when it comes to buckling down for the second set of boards.

I've heard a lot of complaining about some of the clinical spots we have in NYC, but I've sort of resolved that my real education will come during my fourth year electives and sub-internships. While I've enjoyed this internal medicine rotation, it hasn't quite been the juggernaut I'd expected - a small fraction of my time is spent actually in the ICU. Ross had told me that it'd be the Mount Sinai internal medicine core, but that's not the truth - the core is through Miami Beach Community Centers, which have an business relationship with Mt. Sinai. Thus, while I initially expected to be following very ill patients on the floors for 3 months, I've spent much of that time in an outpatient clinic, another chunk of time being fairly useless in the ER, and that aforementioned small fraction shadowing docs in the ICU. It frustrates me because I don't actually fell like I'm useful - I know how to do a fraction of the things the nurses do every day, much less what the doctors do, but most importantly, I am not learning those things. I'm studying on my own, but there isn't enough hands-on experience, and, in hindsight, I don't think I'd recommend this particular clerkship to anyone.

Many of my colleagues love the ER because that's what they want to go into - however I side with the ER docs themselves in feeling that perhaps it's too early. As third year students, we don't really know enough to be helpful or get the most out of our time in the ER, such that it's almost a waste for everyone involved - a waste for the docs, because we're slowing them down instead of being useful, and a waste for us, because we could be learning or practicing something.

I know that the majority of what I learn for my career will be from my years of internship and residency, but I can't help but be annoyed that things are working out as they are. I'm reading through my texts and review texts, trying to figure out what should be important; mostly, though, I'm casting a wide net and hoping to dredge up the morsels and tidbits that'll show up on the Next Big Test. Hopefully, between Davidson's Principles and Practice of Medicine, Step-up to Medicine, and The Washington Manual of Medical Therapeutics 33rd ed, I'm getting what I need. I know that, more than likely, I've a firm grasp of what I'll need for the test, but, believe it or not, that's a small comfort when, in those rare moments in the ICU, I feel less than useless.

This was a quiet weekend, all brooding aside. Nicole scratched the back bumper of our little rented Hyundai and, rather than deal with the hassle of insurance and the rental company, we're quietly taking care of it at a little body shop on the beach. Thus, we stayed in all weekend, but I can't for the life of me figure out why we didn't go to the beach. We went jogging yesterday and I diagnosed myself as having shin-splints for the first time in my life. Chalking it up to an improper stride, though, I iced my leg, took some ibuprofen, and went jogging again today - ever the masochist. I did, however, manage to do the teeniest bit of research for my case presentation on Thursday (on nutrition) - the alarming thing is that I still have yet to acquire a suitable case (or any case, for that matter) to present. I'd like to do one from the ICU - something interesting, like total parenteral nutrition - but I'll settle for some interesting case from the ER tomorrow, if I must. I also managed to finally finished Gene Wolfe's Litany of the Long Sun and Sam Shem's The House of God. I've been working on that damn Long Sun book since I stepped on the plan in February, but things got in the way. Now I get to tear into Ken Follet's Pillars of the Earth, and it had better live up to expectations.

Upstream

I've got another month left in my internal medicine rotation, and I've got to find housing for psychiatry. I'm still enjoying this - on the one hand, the ICU and the cath lab are places I could sit around all day, soaking everything up. On the other hand, I'd like to be able to actually do something, but I don't really know enough to do anything. All of my learning up until this point was directed at an outpatient setting. My OB rotation was a blessing, because I got to do so much.

I've decided that, during my fourth year clerkships, I'm going to spend a lot of time in the ICU.

Everything kind of hinges on surgery then, doesn't it? I'm eagerly anticipating the madness.

I second the wishes of my current attending; I wish there were 48 hours in every day. I almost wish that this was all done so I could just throw myself into something, rather than trying to cover things broadly. However, I still feel, sometimes, as if I don't know anything useful.

I went on a run today, down to Southpoint along the Boardwalk. This has, over the past few months, become my favorite route - it's a little over 5 miles round trip between the beach and Ocean Drive. I'd gotten about a quarter of the way when it started to rain, and by the time I was halfway done, it was torrential. I was sloshing through ankle-deep water at several points, and ducking under random awnings to listen for thunder at others. This, I shall miss.