Saturday, March 29, 2008

Two Down, One to go
Despite my original good intentions I have fallen into my usual negligent pattern of blog posting. In the meantime I have completed two of the three electives I am kicking off clerkship with.

The first was internal medicine in Kingston. For the first week I did emergency consults for the medical teams because my preceptor was away on vacation. You may ask why, for a two week elective, they would place me with a preceptor that was going to be away for a week. That would be a good question, for which I have no good answer. When she returned I was in "general medicine" clinic with my preceptor for the rest of the time. My preceptor is actually an endocrinologist so almost all of her patients have endocrinology issues. I am horrible at endocrinology; I am taking the experience as a learning opportunity that I would normally avoid at all costs. I also got practice at dictation. A skill that has already served me well and is something that I wouldn't have done unless forced.

All things considered, it wasn't the elective I was hoping for but it turned out to be good preparation for my next elective. I practiced a lot of skills: history, consult notes, orders, dictations, clinic notes, presentations.

My next elective was neurology in Toronto. I had a great experience doing my pre-clerkship elective in neurology in Calgary so I was really looking forward to it. I was apprehensive as well. Neurology became my first choice of specialty after the great experience I had in home town (and my psych experience was less than ideal, but we won't talk about that). Between desperately wanting to impress, I was also a little nervous that this elective live up to my expectations. I didn't want a really disappointing experience to cast me into a sea of self doubt and indecision.

I had a good time. It wasn't as much fun as my previous elective in neurology, mostly because I didn't get to see as many patients as I would like. This is a perennial problem in Toronto, which has a reputation for being overrun with trainees at all levels. Despite not being as hands-on as I would have liked, it was a good elective. I enjoyed clinic and inpatient, and I found all the cases really interesting.

Tomorrow I am off to Winnipeg for two weeks in emergency. I am also really looking forward to this elective. But I a have to opposite problem of my last elective. Emergency has been on my list of possible preferred specialties for awhile, but has dropped down to a distant third behind neurology and medicine. My goal is to learn lots, get a good reference letter and have some fun in emergency. But, if I have a really good time, I will be back to not knowing what I should really be putting my effort towards. I can't be really competitive for both neurology and emergency and I really have to make a final-like decision.

Ahh, the self absorbed second guessing and self doubt of a med student. Where would we be without it?

Monday, March 03, 2008

Clerkship day one
I can't say that I was any kind of rising star today; but all in all I am counting it a success. No one died, no one cried. Aside from a brain freeze here or there (what do you call that area that you tap to look for kidney tenderness??) I think I even managed to look slightly less like an idiot by the end of the day than I did at the beginning. I even had a patient compliment me in front of an attending. I can't remember the name of the attending right now, but regardless. Most importantly, I have a couple things to look up to try to look smart tomorrow. Right now though, I think I have earned a nap.

Sunday, March 02, 2008

New place, new challenges
I made it to Kingston (Ontario, not the sunshine and rum one). I start my first clerkship elective tomorrow. Aside from being generally assigned to Internal Medicine and a mission to the Undergrad medical office to finish paperwork tomorrow morning, I have no idea what I am doing. I don't just mean that there is so much to know that I am assured to look like an idiot, though that is true too. I mean I don't know where I am going, or who I am working with, or what I am doing. In-patient, out-patient, what clinics. It's a huge mystery. Hopefully it is not too much of a disaster and I will have some time to let you know how it is going.

On another note, it is always interesting to see what differences you notice when you travel. I went on a short hike to the grocery store this evening to get some supplies for tomorrow. Two things that struck me right off the bat:

1. the roads here are completely bare of snow and the sidewalks are a mess. It is obvious that it has snowed here a fair amount and, without friendly Alberta chinooks, it has stuck around. While the streets seem to have been plowed by a magic truck that even scoops out the potholes, there is slush and ice and treachery on every side walk. Maybe there are no old ladies to break their hips here, or may be the students that live in the houses just don't care.

2. milk costs twice as much. I am sure there is some fascinating history about farm legislation and price control but geeze, x 2 seems a bit steep.

There is lots of cool things here too, cute old houses, good restaurants, blah, blah; but that is what I have noticed in my 3 hours stay so far.