Tuesday, June 25, 2013

Trauma Surgery

      I must keep repeating that to myself because otherwise I will keep thinking that it is a joke. I am starting my intern year on trauma surgery. At the city hospital that the residents in my program rotate at.  In an area of NYC where people apparently love to shoot and stab each other in the month of July. Why July you ask? Don't worry, I asked that very question today. The answer is actually very simple. People shoot each other more in July because of the good weather. Personally, I can think of so many other things to do in good weather. Trauma surgery. They gave the anesthesia prelim trauma surgery to start? Does that seem reasonable to you? Am I being crazy? I wish I could review what I know for this rotation, but I never rotated through trauma in the first  place. They didn't have trauma surgery at the hospital where I did my third year surgery rotation. HELP!
     By the way, surgery bootcamp was not too bad. It was actually kind of fun. We learned to put a foley in a hot dog, an IV in a fake arm, and an NG tube down a mannequin. It was fun meeting the other interns, and it was especially good to know that they do not feel much more confident than me. It was also comforting to learn that I am not way behind with regard to my surgical skills like I thought I would be (not that I have any skills, but most of the other interns don't either). Trauma surgery-so much for easing into my surgery year. Should be interesting! 

Monday, June 24, 2013

Surgery Intern Boot Camp

      Sorry about the posting delay. I have been trying to savor my last few days of vacation until I become a "real person." I put "real person" in quotes because I am not entirely sure that residents in general, or surgery residents in particular, can be classified in that manner. As a medical student, I always thought of a resident as a super human alien hybrid that possessed limitless amounts of knowledge and could exist on less than 5 hours of sleep a night. I do not know how to be one of those people. Will it happen over time?
      Today was the house staff orientation for the hospital I am working at. It consisted of a lot of speeches, a mask fit test (to make sure we will be protected from tuberculosis if we encounter a patient with it), ID pictures, and videos on infection control. Residents from every department had to attend, so it was pretty much a mad house. Tomorrow was supposed to be orientation for the surgery department. I was ready for a repeat of today. Lots of speeches by surgeons and lots of paperwork. I was comfortable with the thought. However, at approximately 3:21 this afternoon, we all received an email that our surgery orientation scheduled for tomorrow has been changed to "Surgery Intern Boot Camp."
      I am not a big exerciser, which is very unfortunate. In fact, I didn't exercise during my first 3 years of medical school. I admire the people who make it a part of their daily lives, as routine as "brushing their teeth." With me, it always becomes such a big production. I get home from my rotation, have a snack, then proceed to spend the next few hours avoiding/dreading the gym. When I finally get up the stamina to go, I stay around 30 minutes. Then I come back, hydrate, shower, and blow dry my hair. By the time I am finished, 30 minutes of exercising has turned into a 3 hour ordeal. Did I mention that the gym is IN MY BUILDING? I really have NO excuse not to go.
      Midway through my surgery rotation 3rd year, however, I had a defining, quite embarrassing, moment in which I decided that exercising would be a MANDATORY part of my life. I was on call with one of the interns one evening. It was midnight, the intern had been paged 911, and we were on the first floor where the ORs were located. The patient was on the 8th floor, so naturally, instead of waiting for the ridiculously slow elevator, the intern started running up the stairs. She was a great doctor who genuinely cared for her patients, so it was understandable that she left me huffing, puffing, and half-alive on the landing of the 5th floor. When I finally composed myself and made it up to the 8th floor, the patient was actually fine, but the intern thought my lack of stamina was extremely funny. "I almost killed my med student," she kept telling everyone. The next week I started walking on a treadmill. WALKING. Easing myself into an exercise routine. My big point is, if I had started one of those crazy bootcamp workout classes after not working out for so long, I would probably have collapsed after 5 minutes.
      I have no idea what "Surgery Bootcamp" actually is, and maybe it would have been better if I was expecting it, but it certainly does not sound like they are easing us in. The last time I actually rotated through surgery was in December of my 3rd year, so it has been quite some time. I would be lying if I said that I was not scared. I hope they are not expecting us to know too much. Anyway, I am optimistic. Or at least, I am storing my fears in the back of my mind. I am hoping it will be a bonding experience, and am definitely looking forward to meeting the other surgery residents. So, here is to an easy day at intern bootcamp. I will let you all know how it goes, but please cross your fingers that I do not fall on my face. Thanks!

Friday, June 14, 2013

The New England Journal of Medicine

     Sometimes people (residents, attendings) speak to you (a medical student) in passing, and end up saying something so unintentionally profound, it sticks with you forever. At the same time, I am sure that they (busy, important individuals) probably do not remember what they said a mere 5 minutes after they say it. When I was on my internal medicine Sub-I, one of the interns gave me some sage advice. He said that the best doctors he knew in any field read constantly. Not only do they keep themselves up to date with regard to what is going on in their field, they keep themselves reasonably up to date with news from other fields. This is because a patient on a surgery floor, for example, might very well be on a psych medication, and thus, the surgeon should have an understanding of the newest psychiatric medications and how they act in the body and interact with other medications.
     He said that the easiest way to keep up with new information would be to order the New England Journal of Medicine, which has the most up to date studies in every field. The New England Journal of Medicine is the oldest continuously published medical journal in the world, and publishes editorials, papers on original research, review articles, correspondence, case reports, as well as a section called "Images in Clinical Medicine." He also advised all of the medical students to order a physical copy instead of/in addition to an email copy or copy for the ipad. He said that it is easy to skip over an email, but people are more likely to read something it if it is in front of their face or lying around their home.
      Additionally, a subscription to the New England Journal of Medicine costs a lot more to purchase as an attending physician than as a resident or a medical student. As an attending, it costs $169 a year, but as a student/resident, it only costs $69 a year. In my opinion, that is a small price to pay to keep myself updated and informed in an effort to be the best doctor I possibly can for my patients. Besides, I really look forward to receiving my copy each week. I am just as excited to see my new copy in the mail as I am to see my People magazine. So, I am passing this advice on to all of you. I may not remember much from my internal medicine Sub-I, but I will always remember this resident and his advice. Hopefully, I can pass on some useful information to the medical students that I will work with in the future too.

Monday, June 10, 2013

Amanda's Healthy Snack Guide for Residents, Medical Students, and Busy People in General

      It took me less than a week on my surgery rotation as a med student to realize that eating, sleeping, and using the bathroom are necessities of the weak. Just kidding! I DID realize, however, that there was not a lot of time to run down to the coffee shop or cafeteria for a meal, let alone a snack, and that there was no way that I was going to disappear to do so. I did not want to be the medical student that the residents could not find when they actually needed me (probably to do something that they themselves did not want to do, but still, they needed me). I had to bring my food, or I had to starve. Disclaimer: This advice generally applies to those rotating/working at hospitals in the NYC area, and not hospitals in other areas of the country that have a Starbucks in the lobby and a Whole Foods next door (clearly I am jealous of the individuals at the particular hospital I am speaking of). Anyway, I am not the type that can function all day on two meals alone, so I absolutely had to bring snacks to the hospital with me.
      My snack requirements were fairly simple. The snack had to be portable, healthy, not processed or full of sugar (that would make me hungrier and defeat the purpose), filling, nutritious, and require minimal effort on my behalf to bring everyday. As I said, SIMPLE, EASY requirements. Essentially, they had to be grab and go snacks. Below you will find my list of favorites:

1.) Mini packs of olives: These olives are dry-packed, European style, and full of heart-healthy monosaturated fats to keep you full between meals. You can order them online at: Olive Snack Pack.

Nutrition: 50 calories, 6 grams of fat, 1 gram of fiber, 0.5 grams of protein.



2.) Mini packs of pistachios: I prefer pistachio packs to other nut packs because they take longer to eat, and have fewer calories per ounce. They are also packed with good fats to keep you full, as well as a decent amount of protein and fiber, making them the perfect grab and go snack. These are readily available in stores, but you can also order mini packs here: Pistachios.

Nutrition: 120-130 calories (depends on the brand), 9 grams of fat, 2 grams of fiber, 4 grams of protein.


3.) Mini Kind Bars: A great snack to curb hunger between meals (especially if you feel that the 200 calorie full-sized bar is too high of a calorie price tag for a snack). It is also full of good fat, protein, fiber, and tastes amazing. I have not found one flavor that I do not like. They are all natural and the perfect midday pick me up. They sell these in many stores, but to make your lives easier, you can also buy them online here: Mini Kind Bars.

Nutrition: 110 calories, 7 grams of fat, 2 grams of fiber, 2 grams of protein.




4.) Already sliced organic apples + individual 90 calorie pack of almond butter: Clearly I am too lazy to slice apples myself, which is why I am so obsessed with these delicious pre-sliced apples from Trader Joe's (you can buy sliced apples at pretty much any supermarket if you do not have a Trader Joe's near you). There are SO many things that you can do with them, but snack wise, I like to bring them in a ziplock bag and eat them with a perfectly portioned pack of almond butter (perfect for me, because I love it and will eat the entire jar if I do not control myself). This snack is filling, full of fiber, healthy fats, and vitamins to help you make it through your day. You can purchase the individual packs of almond butter here: Almond Butter.

Nutrition for the apples: 1.5 cups is 80 calories, 0 grams of fat, 2 grams of fiber, 0 grams of protein.
Nutrition for the almond butter: 90 calories, 7.5 grams of fat, 1.5 grams of fiber, 3 grams of protein.

              

5.) Baby Carrots: I love any type of pre-sliced/tiny vegetables (again, I am lazy and won't even take the time to slice them myself) and carrots are the easiest to buy in miniature. They are crunchy, filling, full of fiber, and antioxidants. I put them in a zip log back and pair them with a mini hummus or mini light ranch dip to make the perfect snack.

Nutrition: 3 oz are 35 calories, 0 grams of fat, 2 grams of fiber, 1 gram of protein.



6.) Mini packs of hummus : (the two brands I have seen that offer this are Sabra and Tribe-I prefer Tribe)- I absolutely love hummus, but once again, if I am left with an open container, I will eat the entire thing, and it is no longer a healthy snack. Because of this, these pre-portioned packs are perfect for me, and perfect to throw into my bag to bring with me to work to eat with my carrots. Hummus is rich in protein, monosaturated fat, omega 3 fatty acids, and contains a substantial amount of B6, manganese, copper, folic acid, as well as multiple amino acids.

Nutrition: (for the Tribe brand) 130 calories, 9 grams of fat, 2 grams of fiber, 4 grams of protein.


7.) Mini packs of light ranch dip: Another perfect thing to bring to eat with my sliced veggies. The brand I use is T. Marzetti, and it can be found in certain supermarkets. Clearly, I am not a plain vegetable type of girl. The pack is low calorie, pre-portioned, and makes the perfect grab and go snack for work.

Nutrition: 90 calories, 7 grams of fat, 0 grams of fiber, 1 gram of protein.



8.) String Cheese: It can be light, full-fat, whichever you prefer. I eat both types. String cheese is portable, full of protein, good fat, and is fun to eat. It can easily be thrown into your bag without too much thought, making it the perfect work snack. There is not really one brand that I prefer, and the light vs. full fat varieties typically only vary by about 10 calories and 2-3 grams of fat.

Nutrition: (For Stringsters Reduced Fat) 70 calories, 4 grams of fat, 0 grams of fiber, 8 grams of protein,

Wednesday, June 5, 2013

Greece

      I am back!!! I had an amazing trip, but honestly I am always SO happy to come home after traveling. I think that everybody has a threshold (the amount of time they can be away before they start to miss their family, friends, home, etc.) for vacation, and once they hit it all they can think about is home. I believe mine is about 7-10 days. That is a good thing, I guess, because I do not know when I will have more than 7 days off in a row for the next 4 years. On another note......everyone warned me that I would go crazy with all of the time off before residency, and that by the time July rolled around I would be bored out of my mind and ready to jump back into the hospital routine. I am sad to report that I am LOVING this time off. I still have about 3 weeks to go before orientation, but I do not feel compelled to work yet. Maybe this will change in 3 weeks? I hope so- because soon I will not have a choice. I think I would actually enjoy a few more months of vacation before I begin. Oh well.
     Anyway, Greece was amazing! It was definitely worth the nine month wait. First, we were told not to spend more than a day in Athens, and that was sage advice. Seeing the ruins and the acropolis was great, but there is nothing else to really do there. The islands, on the other hand, were spectacular. Breathtaking. There is no other way to really describe them. We went to Mykonos first, aka party central, and we stayed at a resort the entire time. We did not engage in the crazy party culture. We also went to Santorini, which was so beautiful, not only because of the views, but because all of the buildings were literally built on a cliff. The sunsets were probably the most dramatic and stunning displays that I will ever see in my entire life.....as if they were painted by an artist. Santorini also has a black beach, a red beach, and a white beach, all remnants of multiple volcanic eruptions (the volacono is STILL active), which were really cool and unusual to see.
     The food was delicious- everything was super fresh. Also-in case you were wondering, they do specify "Greek salad" and "Greek yogurt" on the menus there. I kind of figured since we were in Greece it would simply be called "salad," but then I realized that since they did offer different types of salads and yogurts on the menus, they had to be specific to avoid confusion. I still wonder if they call the chocolate in Belgium "Belgium chocolate," or just chocolate. I am pretty sure they do not call the food in China "Chinese food." I will probably have to wait a few years to find out, because I will be remaining in the U.S. for the foreseeable future. Unless any of you know and can help me out?
      The WORST part of vacation is coming home (even though I was ready) and dealing with all of the minor things that I have neglected for the past two weeks. I will be enjoying a fun-filled day of food shopping and other errands. FYI, you will never do as much paperwork in your life as you will after you match at a residency program. On the bright side, there is a seven hour time difference between Greece and the U.S., (Greece is 7 hours ahead), so I was up very early to begin to conquer my long to-do list. I have such great things to post about in the next few weeks, so standby for some new posts soon. I hope your summer is off to a fabulous start.
     
                                            Mykonos

                                            Santorini