COMLEX step 3

Yucky ... glad that it's the last one for the ridiculous COMLEX. My goal is to just pass and if I scored high, then it'll be a bonus.

Materials:
First Aid Step 3 - chose this because bad experience with Crush step 2, not a fan of sentences/paragraphs study guides. Need something that is readable and easy to understand.
Combank - used it for step 2 and it was fine, so I stuck with it. signed up for it for a month.

Plan: read the FA book twice and do the Qbank for the month with the goal of getting around 70%.

Note: By the last week before the test, I got really sick of it, so the weekend before I just decided to not do any studying. I even went to the B-Ball game the week before. I guess it's pretty true that for Step 3, you just need a No. 2 pencil. :) I'm not that crazy but I think if I had studied 10-12 hr/day for 2 weeks, it would've been fine. Certainly glad that I'm done.

Test: it's long, 400Qs in 8hrs. There are some ridiculous questions, like anatomy related to OMM (literally muscle insertion and what not) and ethics/medicare/medicaid. Lots of OB and peds and case related. There are certainly a few of pull out of the hat types as well. Generally the format and the feel were similar to Step 2. Ended up with a headache by the end.

As a treat, I went to SalonBlu for eyebrow wax and a short massage. The therapist was good, excellent. She went right for the muscles and got the eyebrows right. Totally coming back for it even though it was a bit pricey.

Update: 12/18 - passed Step 3. Lowest of the 3 but passed with a good cushion. 487/81.
Also as of now, my eyebrows are still in good shape even a month after. Plan on going back 1-2 weeks before going to Taiwan.

Hospitalist

So glad I'm in anesthesia and not end up in internal medicine. ::happy sigh::

The biggest issues I had was that I felt like a social worker/case manager instead of physician. For every patient, it was dealing with where would they go, how would they get meds, insurance issues, who would take care of them and follow up after discharge. There are little medicine involved. Only complicated patients would I feel like that I'm actually practicing medicine.

Other than that, it has been a fairly good month. Reminding me of some basic medicine since I haven't really seen medicine since Jan of my 4th year. It's a good practice and learning to prep for my Step 3.

The funny thing is that there's a fellow for hospitalist. Why would anyone want do 1 yr fellowship in hospitalist medicine? Shouldn't anyone who had finish IM residency should be able to practice hospitalist medicine? Bizzare.

One thing that really irked me was that a patient was transferred from cardiac ICU after MI was ruled out. When I saw the patient, she was breathing really fast and in pain. There was a CT report of pancreatitis vs cholecystitis. Of course, no abx was started, totally unconcerned that it could turn into necrotizing pancreatitis. When I got patient, decided to watch carefully for the night with low threshold to go to MICU. Of course the next AM, disaster struck. Septic picture, change in mental status, respiratory distress. MICU she went. I followed with what happened. She coded and suffered anoxic brain injury. CT read 75% necrotizing pancreatitis. Passed few days later when family withdraw care. Sad. what a disaster from too focused specialties and units/floors.

NBA Nets vs Cavs

I got tix from CCF to the basketball game for $40/pair in the middle seats. Pretty good seats for the price. I figured why not? It would be my first NBA game and it was pretty cheap game. The only problem was who to ask to come with?

My thought was that I don't really know who would be interested in going with me. So I decided to ask one of the guys I met at church that I knew was interested in B-Ball. VL is from Cali and knew several people from my home church. He's very funny too, great sense of humor. So I asked him to come with as friends, no other intention at all.

He ended up asking me if we want to grab a bite to eat before the game as I would be going staright from work. I didn't even think that this might become a date at all. He did paid for the meal and drove me from dinner to game.

From my close girlfriend, this turned into a date, despite me being completely oblivious about it. This was only supposed to be friendly hangout time. Oh well. We shall see what will happen next.

Otherwise, game was fun but the best part was the end that determined the results. I would definitely be up for another one. The weekend after I found out that there were 2 other girls from church that are up for sports game too. Now I've got buddies to go with for the next games.

This turned out weird, probably me being oblivious. Oh well. We shall see what happens the next time I see him.

CV-ICU Part 2

J 54
My week in this unit was slow. Not much going on. People are fairly stable, just keeping an eye out for them and make adjustment as needed. The only issue I had was the fellow that was in the unit. He's Egyptian CTS who is doing critical care training. He was sent up by his dept for extra training. He drove me crazy. He doesn't understand how to use the EPIC and even the nurses from his patients were coming to me for orders and what not. We lovingly call him Dr. "Useless". haha. He really should stick with surgery but at the same time he needs more patient contact time.

J 66
The unit is upstairs and pretty much it's me and the PA/NP. The staff I was with pretty much treated me as a 2nd or 3rd year where he would come in so I can go for breaks/lunch and sometimes around for lines and new admits. It's been interesting. There are times I'm like, I'm not ready to handle the unit by myself. This is the first time where I truly experienced that I am a doc and have the privilege to take care of patients the way that PA/NP couldn't. I'm definitely not ready to run the unit by myself but I'm sure that by the end of 4yrs, I should be able to. I'm glad that they don't just throw us into units and have us run it by ourself. That would be too scary.

Overall, it's been a really good experience with a good fellow, Mike. He pretty let me do what I'm comfortable in and wanting to learn and he would just supervise. Very good teaching, Dr. Boss. (gotta love the last name esp on the unit when we called by last name without dr. in front)

CV-ICU ... part 1 ... hearts

ICU ... much more intense and faster paced. First day was orientation and just hanging around to learn about the patients and the units.

For the last 2 weeks, I've been in what they called the heart units, pretty much all patients have some sort of heart surgeries or are on artificial hearts. These patients wer very sick.

For the 1st week, the unit had more thoracic patients than hearts but it definitely turned around the second week. Heart patients then started rolling in like crazy. All it takes was one day of multiple admissions with several people going nuts with plenty of work for us. It was fun though. My co-resident working on a patient withthe fellow and the NP was busy with other surgeons rounding on their patients and phone calls. So I was pretty much covering for whatever else going on for other patients. It was a definite adrenaline rush.

By now, I have already done multiple central lines, arterial lines and even tried a bronchoscopy. Bronchoscopy, oh my!. It's a video game in medicine

It's been so fun; there are just so much hands on things to do. Really glad that I'm anesthesia. it's tiring and takes up so much of energy, but I really think it's so worthwhile for me. Totally enjoying it.

SalonBlu

I'm in search of a salon here in Cleveland that can give me a Asian layering haircut that I've had from my favorite hairdress in SF. Since I won't be going home as often as I like, I really need one here. My hair is now long enough where once it gets out of shape, it gets annoying and makes me want to chop it all off. I do want to keep my hair long for a while.

So I found this salon from Groupon and was pretty much 50% off with a facial/massage. The salon was quaint, cute and would love to be able to love it and make it my place for next 4 years. Unfortunately, I ended up with Sammy and by the way she was cutting my hair, she's still fairly new and needs more experience. Also I couldn't see how the other 2 hairdressers do since one was doing coloring and the other was styling. Also they don't seem to know what Asian layering style cut means. So I walked out with a fairly uniformed layering, a trim and not much of thinning out as I would have like. Even the bangs was done well. Bangs were cut but there wasn't much of a flow from bangs to the rest of the hair.

I guess this was an okay haircut until it grows out of shape and try another salon. There's a couple that I want to try. I think the next one would Michael Christopher salon.

SalonBlu
Michael Christopher Salon
Laura Lee Aveda Salon (Coventry)
Rosalina's Markfrank (Shaker Hts)
Lucia's Salon

APain

Acute Pain month - "Pain in the butt"
Anyways, it was a fun month. Did lots of regional blocks for surgery and had my first experience ever being on call. It was impressive that they would let me, an intern with practically no experience, to do quite a number of blocks. For the first week, I was pretty much the assistant, setting up, prepping, clean up and doing records. By second week, I was doing some of the easy blocks myself with assistance. It was exhilarating. I have done with and without ultrasound. It's finally something anesthesia related, not just medicine anymore.

Had my first ever call. nerve wrecking but good. The rest of my calls were good. Apparently, I'm one of the residents who has the "white cloud" for calls, meaning that the calls were light, no craziness and able to get good amount of time for sleep. I think I got at least 4 hrs of sleep for every call.

During the month, I was able to see and do some less common blocks. One of them was the axillary nerve block and supraclavicular blocks. Those are usually done by fellows but they were busy or it was beginning of my call, so I ended up doing it. Way cool.

Epidurals are still difficult. I have done a few but it's still difficult being that there are no imaging to see where I'm going with the needle, unlike other regional blocks. It's definitely a good one to learn, but I need more practice.

I can honestly say, I can't wait till I do my anesthesia rotations. :)

Frustrated ... Lesson learned

Never ever agree to cover someone else's call for a couple of hours. Be sure to switch call days if needed.

I stupidly agree to cover for about 4 hours on Labor Day so my colleague can see her husband for the long weekend. Of course, I knew that there was a risk of her flight being delayed but I was not expecting what was about to happened. I was on 24 hr on Sunday already. Even though my call was very quiet not at all busy but still, I was tired and ready to go home and be away from the hospital. I was planning on grocery shopping to stock up for the week and just relax before working again the next day. I would still have majority of the day left when I was to leave at noon.

Of course I got a call around 11am from my colleague that she missed her flight and her connecting flight is delayed until 2:30pm. So I was like fine. But inside, I was thinking how can you miss your flight when you know that someone is covering for you. If I was her, I would not miss the flight cuz then I would feel bad and I wouldn't want something like this happen to me. Be warn. I was being kind in covering, missing a flight is a big no no.

Then when 2:30pm came along, she called saying that she's landed and is currently on her way. So I was expecting her around 3pm since it only takes about 30min from the airport to the hospital. She didn't get in until 4pm and that's when I found out that she went home to her work bag and scrubs and then back to the hospital. How can you not have your work things already in the car when you are fully aware that you would be coming straight from the airport to work to relieve the person who has generously agreed to cover. It was unbelievable. Now that's what I call total irresponsibility. By the time she got in, I was so pissed that I couldn't even make small talk. I had to sign out immediately and leave or else I would've said something mean.

There goes my day and my week in shambles. Lesson: never cover. only swap. be responsible when asking someone to do something for you.

SING CHOW MAI FUN (SINGAPORE FRIED RICE NOODLES/星洲炒米粉)

INGREDIENTS:

2 cloves garlic, minced
1 tablespoon minced ginger
8 dried or fresh shiitake mushrooms
12 ounces of fine dry rice vermicelli (Wai Wai brand recommended)
2 stalks celery, sliced thin
1 medium yellow onion, sliced thin
4 jalapeno peppers, seeded and sliced thin
1 cup bean sprouts, rinsed and drained
8 green onions, root end trimmed, cut into 2-inch pieces
1 pound shrimp, peeled and deveined
1 pound char siu (Chinese barbecued pork), cut into matchsticks
4 tablespoons vegetable oil
3 tablespoons oyster sauce

FOR SAUCE:

3 tablespoons Madras (hot) curry powder
2 cloves garlic, minced
1 tablespoon minced ginger
1 cup chicken broth
4 tablespoons soy sauce
4 teaspoons granlulated sugar
2 teaspoons hot chili paste
2 tablespoons vegetable oil

METHOD:

1) If using dried shiitake mushrooms, soak them in hot water for half an hour. Drain, then cut off the stems. Slice the mushrooms thinly.
2) Put the rice vermicelli in a large bowl and soak in enough hot water to cover, until the noodles are soft (about 8 to 10 minutes). Drain noodles and set aside.
3) Start by heating up 2 tablespoons of oil in a small pan over medium heat. Add the curry powder, the ginger, and the minced garlic, and saute until fragrant. Add the chicken broth, soy sauce, sugar, and chili paste. Stir to combine and then cover and cook for 5 minutes. Remove pan from heat and set aside.
4) Heat 2 tablespoons of oil in a large wok over high heat. Add in the remaining garlic and ginger, and stir-fry until the garlic starts to become golden. Add in the celery, onion, pepper, sprouts, green onions, and mushrooms. Stir-fry for 3 minutes, until the vegetables start to soften. Set the vegetables aside in a bowl.
5) Heat the last 2 tablespoons of oil in the wok over high heat. Add in the shrimp and stir-fry until they start to turn pink on both sides. Add the char siu and toss to combine.
6) Add in the noodles and the vegetables. Pour on the sauce and also add the oyster sauce. Mix the ingredients thoroughly to coat all the noodles and incorporate all the vegetables.
7) Serve hot.

Mee Goreng (Malaysian Spicy Fried Noodles)

Fresh Chinese egg noodles, chili sauce, dark soy, oyster sauce, shao hsing wine and fried shallots are available at Asian markets. Serves 5-6 as part of a family-style meal, 3-4 as a main dish.
INGREDIENTS:

2 cups fresh Chinese egg noodles
2 Tbsp chili sauce (Sriracha), or more to taste
1 tsp dark soy sauce
1 tsp sugar
1/4 tsp salt
3 Tbsp oyster sauce
3 Tbsp ketchup
2 Tbsp vegetable or canola oil
2 eggs
1 tsp minced garlic
1 cup mung bean sprouts, rinsed
1/2 cup shredded cabbage
1/4 lb shrimp, peeled and deveined
1/4 lb boneless chicken breast, cut into 1/2-inch cubes (or leftover shredded cooked chicken)
2 Tbsp shao hsing wine
1/4 tsp white pepper
2 Tbsp scallions, sliced
2 Tbsp fried shallots (available packaged at Asian markets)

METHOD:

Bring a large pot of water to a boil. Cook the noodles for 30 seconds, drain, and rinse with cold water. Set aside.

In a small bowl or measuring cup, combine chili sauce, dark soy, sugar, 1/4 tsp salt, oyster sauce and ketchup. Stir to combine, and set aside.

In a large wok (at least 12 inches in diameter) preheated over high heat, add the oil. Crack the eggs into the wok, stir vigorously until the eggs are lightly scrambled and just set, then add the garlic, noodles, bean sprouts, cabbage, shrimp, chicken, and 3/4 cup water. Stir-fry continuously until noodles are cooked, 3-5 minutes (depending on the heat of your wok), making sure to also cook the chicken and shrimp. Add chili sauce mixture, and keep stirring until well combined. The noodles should begin to get a bit drier (no liquid left in the bottom of the wok). Add shao hsing wine and white pepper, stir to combine, and remove from heat. Garnish with scallions and fried shallots.