first vacation, almost 1/2 done w/ PGY-1

Sitting at the oakland aiport waiting for the connection to Portland after spending some qt with the family in San Diego. Always good to see my parents and my brother-- it was nice to actually see sun. Between early hours of work, long days, daylight savings, I really haven't seen or noticed any sun in Portland lately... kind of depressing. Even in New York, one will see sun, even if its a bit colder. On top of not seeing the sun, it has been cold these days in PDX, with light snow right before I left. So San Diego was a welcome respite if only temporarily. Not thinking about ekgs, and cxr's also a welcome break; though now I'm afraid I'll forget everything I've learned.

Between posts I was in the midst of a busy 2 months of ward + ICU which was a great experience for me. Good people to work with and interesting patients. Definitely learning to make decisions on my own and getting a bit more efficient. One piece of feedback that I keep getting is how my quote unquote "laidback" nature can prevent me from demonstrating medical knowledge. Not really sure how it connects, but I've heard it a couple times from attendings I respect, so there's something to them; or at least something to take from them. Which brings me to the dilemma-- how do I address it. I probably have gone through life with the same nature and personality-- in fact i value it as a strength. Im not a yeller; I see myself as a leader, but leading through example and my work, not necessarily by showing off that I know the mechanism of action of aspirin, or by talking loudly: which appear to be the possible ways to improve upon these concerns. I say this because in asking about how I can improve, one comment was that I should read more, as I might have lacked knowledge; another suggestion was to be more decisive in decisions-- even if its the wrong decision/answer. To me, it seems like it means that for me to be a good resident (not nec a good doctor, though it stands to reason that a good resident makes a good doctor), it is important to be able to demonstrate knowledge to others. But how does one do this if one is again quote unquote "laid back." (which by the way I am not a fan of this characterization of me)

In thinking about this, I look to other mentors and physicians and their personalities. It seems to me that those physicians who do well, are respected fall broadly into two categories. Those who are "laid back," "soft-spoken," etc etc and do well are those who are geniuses-- they're the the ones who got a phd, published the mechanism of action for aspirin; they're the doctors that everyone holds is high regard because they're "nice," "calm and collected," and brilliant. Then there are those good doctors that people respect who are loud, intimidating, but decisive-- they are necessarily genius' but they do their homework, read up and then show it off by talking big and acting tough; and those doctors get respect too, because they often have larger than life personality, are somewhat obnoxious, but exude confidence and make the right decisions more often than not. Then there are the cross overs between personality and knowledge, so those who are obnoxious, loud and cocky AND who are brilliant... so what about the doctor who is calm and collected, but not necesarily a mensa member?

Its way too simplistic a model for categorizing physicians, but it is a starting point as someone who will hopefully be an attending in the next couple years. And for the pgy-1 who is not that sure of their decision making, and who knows himself well enough to know he isn't a genius (and not delusional enough to think that he is-- though am I shortchanging myself by thinking this?), and fits the "calm and collected," mode (or the "laid back" bs), striving to show others that I know something is the goal of the next half year... or forever...

suggestions welcome. (i'll be reading and memorizing harrisons)
Channy.

2 mos goes by fast...

Wow- how fast can the summer go? its now raining on a oft-daily basis, and the weather has got a little chillier tinge to it. The summer sun is fighting off the 9 months of rain that will soon encompass the sleepy town of Portland. In the meantime, I finished ER month, and about to finish Ambulatory month.

1. My cousins from our cousins in the north, canada, graced me with their presence for a beautiful NW weekend. How coincidental that Viv and Gord decided to come down on a little gettaway the same weekend that Winnie and her girlfriends decided to have a fun trip to Portland. Both emailed me about their plans without knowing what the other was doing. In anycase, good food (the screen door is amazing), good company, and the Mt. Tabor Soap Box derby day later, the weekend was a blast. Its the best part about moving back to the West Coast- Family.

2. Next big event was MFNW. 4 days of wide variety of music. from the weird to the standard. Kyle and I had ambulatory month- which mean basically we were free to catch any show we wanted at any of the venues around PDX. Checked out wonder ballroom in NE for Washed Out and Phantogram; then Crystal Ballroom for Panda Bear (yawner btw). Friday night college buddy andy came into town and we hit up the bars, then okkervil river at crystal ballroom, then some random warehouse party in god knows where, having to hitch hike home with a girl from Berkeley no less..... Saturday Brady came in and the wknd is too much of a blur btw Decemberists, the Walkmen, and the National, seeing Nick and pregnant Libby, and eating good food... well you get the picture......a fun wknd had by all. i think??

first month over.

The first month of internship is over. VA wards came and went. Have to say, it wasn't as bad as it could have been. Highlights of the month include having a great resident, co-intern, and med students, capped by a fun day out at The Oregon Brew Fest down by the waterfront (don't ask how we all were able to not be at the hospital, but we had no patients that day anyway). Pretty cool huh. I don't rememebr too much of brew fest just because there were so many different types of beer-- the highlights were probably trying the beer with 0 hops, the espresso beer, the acai berry beer, and pomegranate beer. I'm more of a PBR man myself, but hey, beer is beer. Beer fest was followed by a final 30 hour call which I think was particularly brutal, and everyone just was too tired to think. My resident fell asleep on me presenting a patient (yes, apparently i put people to sleep), and we were all just happy to be over with the month, basically just ran out of the hospital post call...

Pretty much every week in the summer is some kind of festival is going on. There was an international beer festival, then the oregon brew fest, and this weekend is some type of eating festival. Then a bunch of music festivals throughout. This is summer in the NW, so it makes sense everyone is taking advantage of the good weather before, gulp, the rain comes.

As for now, I'm on to Emergency Room at the VA. Pretty standard ER, with acute and non-acute/urgent care patients. Obviously, its not going to be Kings County/Downstate (aka gun shot wounds and motorcycle accidents), but going to a shift work type of schedule will be a good change. I remember really liking ER as a med student, and did an elective with my friend Brady in the ER which was pretty interesting, and ER clerkship with Inna, Tyler, and Tassalo! (the austrian/german visiting student) was also pretty fun. However, when you have to do it as a job and for real, its just not the same. Maybe you just have to really like the people you work with. Not having to do a full workup/problem list is also a nice change, though i'm so used to doing that, that i'm definitely the slowest person there. I think I had a pt in an acute bed for 5-6 hours and didn't do one single intervention (no labs, no xray, etc). Because I had no idea what was going on with him. Finally, he looked minimally dehydrated so he got IV fluids. I think at County I would have been flogged for that. The nurses definitely gave me shit for that, but whatever.

Free Weekend

Since the last post, I had my first out of town visitor. Jake was in town for business in Eugene, and was able to hang out last Friday and Sunday. I guess Plowman came a while back, but that was before I was moved in, so Jake takes the prize for first guest (as he so mentioned). Jake and I went to Stanford together and even though he's been in Nashville for a good chunk of years, I've managed to see him every once in a while. Glad to see that my move to Portland hasn't changed that dynamic. Caught up with a quick tour of the city (which basically means, walking to Powell's- oh and in case you are wondering "whoa my boss is naked" is in stock at Powell's, which is pretty good considering that the book is only distributed online), happy hour at Jakes (where else would we go) before heading to Eugene. On his way back, capped off a great visit with a run down the riverside and bridges, then with burgers and beers at Bridgeport brewery.

Had this weekend free. Our service is light at the moment, and co-intern and I are starting to get the hang of the VA, so the sr and the attg decided it was cool for us and the med students to take the wknd off... so finally put the last piece of furniture together. Some pics need to be hung, but here are a few pics below for those curious. Its a studio type of place in the Pearl district. However, even my studio is probably bigger than most peoples 1-2 br in new york. I'm also 1 of 60 units in the building, which is a lot bigger than the Henry st building that has 10 units total. I definitely miss how I was able to get to know and see all my neighbors in the Brooklyn apt- here, i'm lucky if I see 1 person. But its a newer type of place, nice kitchen, garbage disposal and in unit laundry, so its easily the nicest place I've rented in my life. We'll see if by the end of the year, I can still afford it. And if you're wondering what the "next year in jerusalem" pic is, thats in lobby of the building, which is pretty random. Jake says that what all the Jews say when they reunite, I guess I can see that. What doesn't necessarily make sense is that the building's name is The McKenzie, which doesn't sound that Jewish. Whatever.

The weekend was spent being fairly lazy, besides putting together particle board, went to the portland international beer festival, held a couple blocks from where I live, and which is apparently nothing compared to the Oregon beer festival happening next weekend... theme here in portland is beer btw. Today, hiked with some co-interns Angel's Rest, a trail off the Columbia River Gorge. Its pretty amazing that in 20-25 minutes by car, one can get out of civilization and into the woods.

I will say that ensuring long weekends are productive and maximized is harder work than one would think. You never know who's free that weekend, and you're so tired from the week before that its easy to just recover your sleep.

the entry way into the apt

.the largest kitchen i've ever had

kitchen/living room

brooklyn love (thanks todd).

post-call

I should be asleep at this point, 11:30pm, because I have to work tomorrow by 7 AM, which means waking up by 6 or so to make a 6:30 bus to the VA. However, today was post-call day, which meant I was out at 12pm, got home and passed out until 8pm tonight. Unintentional, but necessary after the night I experienced, with many issues popping up with the cross-cover patients, and getting 4 admissions relatively late in the game. There is nothing like getting paged as a starting intern for a cross-cover patient whose heart has stopped beating for 5 seconds and being asked what to do. I mean, I was still in school but 1 month ago...

Yesterday was our first call with the current team. Our new resident, my co-intern, me, and two eager medical students. Its amazing to see the students in this situation and know that barely 1 year ago, I was in their same shoes, eager to help out and trying to impress their resident and attending. Its exciting to be in that position to be a role model and try to teach the students. Unfortunately, not sure how much I am teaching them at this point!

Long call, like life, is made up of slow parts of the day, when there are no patients being admitted, rounds are done, and notes completed, you are messing around with the team-- to 30 minutes before call ends and you end up with a bunch of new patients. At least thats how it seemed yesterday. Going from thinking we'd be out of here and going home to sleep, to being lucky to get 1.5 hours of sleep is a sharp mental hurdle to get over. The worst is when you don't have a call room key and you're left pondering if sleeping in the car is the best option. Or when you have a patient that is on 50 medications and you have to go through them 1 by 1. But we got through it, and now I'm still up typing. In 4 days, the cycle will repeat itself, and I'll be hoping to go faster. and get some sleep. Still wondering how we fit in reading and studying as an intern.. thats for another night.

Starting Internship

Hello from PDX (Portland)!

This year is a big year for me. For one, I turned big 3-0. Two, I graduated medical school. Three, I made the move back to the west coast from New York to Portland, Oregon to start internship. I still sometimes wonder if I made the right choice, moving back west. New York became home to me in many respects and while I am originally from California, I have spent the majority of my adult life on the East Coast. I've moved around a lot, but leaving New York was probably the hardest thing to actually do when the time came. I've been blessed to have such great family and friends to help me through it, especially my cousin Viv who came out this May to visit and give me outside insight to the big move, and to my friend Andy who helped me pack up the apt as I made my way out of town this June.

So one piece of advice my cousins husband, who happens to be a newly minted attending physician, imparted to me prior to starting internship was to pick up a new hobby. I'm hoping to keep up this diary this year. With my geographic isolation and relative newness to Portland fresh in my mind, I am hoping to keep in touch via this site. Everyone has ideas and thoughts about how medical internship year goes. The goal is to see if I can reflect on my experience through this means, and stay relatively sane. And not break HIPAA in the process.

So here it goes...