Year 3 in review

Well I didn't do too well on keeping up with the blog. Needless to say, my 3rd year of medical school went by like a blur! Much faster than 2nd year at least! After surgery, I had a great family medicine rotation with Dr. Jack Hawks, who was an AZCOM grad himself. He ran a great office, and I was able to learn much about patient management with him. The downside was the same drawback from all civilian family medicine- there wasn't that much diversity. There was not much peds at all, no OB and very little GYN. There was some sports med, but it was small. Mostly it was adult ambulatory medicine. Lots of HTN, DM, and cholesterol, with flu/colds mixed in. I did learn a great deal about pharmacology, and different management strategies for common cases. There was also drug rep lunches every day, which is a huge perk for civilian medicine! Dr. Hawks was a great doc, and I did like his style of practice. He was very laid back and easily identified with the patient.

In February, I was on OBGYN at Maricopa Medical Center. I am so glad that I did my OB training here, as it was very hands on and lots of opportunities. A huge majority of the patients were from Mexico, and most did not have great OB prenatal care. I was able to do 2 weeks of the "mole shift," or night float. My day started at 6pm and I was on all night and got off at 8am. Then I got to make the 40 minute drive home, and sleep for about 5 hours before going back in. Over those 2 weeks I slept in our closet because it was dark and quiet, especially when Meghan ran her preschool twice a week. But the service was good, and like I said, I was afforded great hands-on training. I got along well with the chief resident and most of the residents. However, I noticed that the morale wasn't all that great there. Maybe it was just the residency, or maybe it's OBGYN in general, but there was a little backbiting too. I also spent a week in clinic, doing mostly prenatal care, with some colposcopy mixed in. And I spent a week on GYN surgery, where I was seeing a lot of hysterectomy and D&C cases. I loved what I did there, and I gained a great appreciation and fondness of the field, particularly the obstetric side. There's something magical about the birthing process, and I was able to share in the joy of the family, and create more enthusiasm in them by sharing my own experiences as a parent! However, I don't think that I could exclusively do OBGYN. It's easy to burn out on, with all the call and long hours. Plus, I do enjoy diversity in my day-to-day schedule.

March was a fun month, as I did my outpatient pediatrics rotation in the greatest place on the planet, Cedar City, Utah! I figured Utah would be a great place to do peds, as there are so many kids per capita! I was at Color Country Pediatrics w/ Dr. Burrows. I was amazed at how much I saw there, for a smaller community. I also came while it was still flu/strep/croup season, so I became quite familiar with a upper respiratory infections. I also saw some more rare conditions, such as histiocytosis, fragile X syndrome, and a cephalohematoma. Megs and the kids came up for 2 weeks. We crammed into the small 1 bedroom apartment that was given to us by the rural health education center who coordinated the rotation. The funniest part about the apartment was that the hallway from the living room to the bedroom doubled as the kitchen. On one side was the sink and dishwasher and on the other was the fridge and microwave. Classic. But it was fun for the kids because it snowed quite a few times while we were there. So they had fun playing in the snow quite a bit. They also really like discovery park!We also got to see some old friends. We really missed seeing Cordelle and Wendy, and Emily and Chris. It was awesome to see Scott Bauman and the women's gymnastics team, too! It was a great month. Especially because during this time, Meghan found out that she was pregnant once more with child number 3! We were so excited!

Then we returned back to AZ for April and I had my ward based Pediatrics rotation at Phoenix Children's Hospital. Let me just saw that that is one of the coolest hospitals ever! All the staff seem to be much happier there than in other hosiptals! The walls are all colorful, there are massive toy trains that go around open gardens. Best of all, the food was awesome, and as a student, I got a card with $1000 limit for the month!! But inpatient peds was a very different experience than outpatient peds. These kids were really sick, very seriously so in some instances. I saw everything from a little one year old with E. coli meningitis, to a 16 year old elite soccer player with extrapulmonary coccidiomycosis. There were obscure things like rat bite fever, to complications of more common cases like mastoiditits. Plus, I got to really work well with the residents, which I really enjoyed. I learned a great deal over this month and it made a huge impression on me. Peds is one of my favorite disciplines of medicine, and I frequently tell people that if I wasn't in the military and I wasn't exposed to the vast diversity that military family medicine had to offer, I would likely go into civilian pediatrics. I was very rewarding, but at times, very sad.

Then I moved on to my final rotation of the year- Internal Medicine at the VA hospital. Despite mixed reviews from some of my classmates, I had a great experience. It was challenging for me, but I got a lot out of it. It was a stark contrast to PCH, as all the walls were white, the hospital was bland, and the staff was not nearly as enthusiastic! That being said, the residents were very helpful, and I was able to see a good bit of pathology. I did see a lot of COPD, along with diverticulitis/osis. Of course, there were trips to the ER for chest pain cases, and many more people had complications regarding their coronary artery disease. I did see a cool Ace inhibitor induced angioedema. My favorite patient was a 61 yo male presenting with cocaine intoxication. After a huge drug binge, he realized her needed help (probably ran out and had no more money), so drove down to check himself into the hospital. He managed to make it to the hospital, but her ended up crashing his car into the flagpole outside the ER! We took care of him, got him cleaned up and after a few days, he was doing well. He said he wanted to check into a program and return to family up north to get away from influences and start fresh. He came back in the next day with repeat overdose. Found out he sold everything he had to get that extra fix. How sad it was.

After the rotation, we had a week of classes, simulated patient cases, and a comprehensive exam. Then I flew out to Philly to take my level 2 performance exam, which tests clinical skills. Each examinee has 12 simulate encounters. We had 12 minutes in with the patient then had 9 minutes to write a soap note. They were very anal in the testing center, and I was rebuked multiple times for showing too much enthusiasm or smiling, or some other means that could be construed as communicating. It went pretty well, though, and it was fun because there were 5 other students from my school that took the test at the same time.

Then it was back to AZ, where I had a few weeks to study for my level 2 written board exams. I studied quite a bit and felt pretty comfortable with what was going on. I walked out of the exam feeling relatively well. However, when I got my results, it was not what I had hoped. In fact, it was lower than my level 1 score. Sure, I passed, but it was not what would be considered a strong score. I was pretty down for a couple days. But Meghan really came through and picked me up. She is always such a great support for me, and she lit a fire inside of me, and convinced me that I will go out into my audition rotations and show them the kind of doctor that I will be, and that I will not let a number define who I become. I'm so lucky to have her in my life.

Also during this time, we had the kids in swimming lessons, so I enjoyed taking them to swimming nearly every day while I was off. Braylei was also involved in many things such as her city gymnastics class and dance class. Meghan also finished her preschool classes in May, and she decided not to teach again for the fall, as she is due at the end of October. And so we got Braylei in another in home preschool. Meghan will still be teaching piano, however. And little Tayscen is just a hoot! He is so full of energy and he can entertain himself for hours if he needed too! I love that little guy!

Onward To Spring Quarter!

Whoa! I guess I haven't posted in awhile! I've been in a super flurry of events as of late! Let me give a brief rundown of all that's been going on! First, finals week was like none other! It was absolutely insane! Through the first week, I ended up doing really well on my OMM exams, getting solid A's on both the written and practical portions. However, my intro to clinical medicine final didn't go as smoothly. Typically, Dr. Schwartz asks pretty surface (albeit sometimes obscure) questions, but apparently he was really mad that hardly anyone went to his lectures on the morning before one of our killer Anatomy/Histology/Embryology block tests, so he had a ton of questions on that information. Fair, I suppose, but pretty stupid. It's a good thing I had a hefty cushion in that class. Then, as for the real finals week...it went okay. I didn't sleep a lot, but I manages fairly well. I received my best test score in Physiology of the whole quarter on the final. Then the Anatomy/Histology/Embryology block came pretty hard. I received my best grade of the previous two quarters in Histo and Embryo, but at the cost of Anatomy, which was a sub-par score for my anatomy standards. But it didn't bring my average down too much. Next was Human Behavior, which was a typical crapshoot human behavior test. Psychiatrists, go figure. The last final was Biochemistry, my arch nemesis. However, this exam's material was very interesting to me, as it dealt mostly with human nutrition, and of special interest, nutrition during pregnancy, and infant nutrition. I did pretty well, earning my best score from the past two quarters in that class! It was a good thing that was the last final, because we were all looking pretty ragged by the end! The best part was that we had a week off!

My "Spring Break" flew by so fast! I was able to enjoy most of it by just being with Meghan and Braylei, my two favorite people in the world! Bryalei just cracks me up! She is so clever and smart. She has also fallen in love with the movie Cars. I probably watched it 20 times over this past week! She mainly likes the racing scenes, but loses interest during the middle. It's hilarious because she'll point to the TV and say "Ideo" and "Carsh!" She is getting even better at her animal sounds, recognizing both when she sees a picture and by name. We've also been including her in helping out. She'll go put things away, or hand something to Meghan or myself. It's really unbelievable how fast she is growing. She also will point to Meghan's tiny little stomach when we ask her where the baby is, or where her brother is.

Alas, the week has come and gone. And now Spring quarter is upon me. I am excited to be done with Anatomy, histology, embryology, and biochemistry. Now we start neuroscience immunology and our early clinical experience preceptorships! I guess I'll find more details out tomorrow at orientation! 11 more weeks until summer vacation!

Treading Water!!

Wow! This has been one long week! Probably because I haven't slept very much, but I am nearing the end of this treacherous testing stretch! Biochem went okay on Monday, the OMM quiz wasn't too bad, the Anatomy and Histology tests were pretty tough, but hopefully I did well enough to get by. My Physiology group presentation Friday went well, although the other groups took too long and, as we were the last group to present, did not have a great deal of time. Unfortunately, the Physiology test did not get moved like I was hoping. The class liaisons presented a good case to the Physiology department chair, and they had it arranged to switch the Wednesday biochemistry workshop to Monday so that the phys test could be Monday at 8am. However, AZCOM has this really lame "unwritten" rule that states that for a change like that to take place, the class has to unanimously vote in favor of this change. And there were two people (out of 150) who did not want the test to be changed! Apparently, they wanted to just get it over with so they could have a week off. But there is no reasoning with them, as these are confidential votes, and they are most likely those students where everything comes pretty easy to them and aren't concerned with those of us who need a little more time because we actually have lives outside of school. Oh well. After tomorrow, we have our OMM written final next Monday, the practical final Wednesday, and our Intro to Clinical Med final Thursday. Then we hit finals week! Yea!
Braylei meanwhile is feeling much better and has returned to her usual hilarious self. I wish that I got to see her more. And those days when I do its only for a half hour or so before she goes to bed. I hope that she understands. Meghan is doing well, and is the most incredible person I know. She is so supportive of me and does so much. I admire her so much for her selflessness in putting aside her own wants and needs to take care of our family. She is a true inspiration and I am eternally grateful for her!
I hope everyone is doing fabulous and I wish an awesome week ahead upon all!

Pouring it on

Sorry it's been awhile since I posted, but school has been absolutely nuts! I got through midterms okay, albeit a very crazy time! The day after MLK brought a 6:30 am Gross Anatomy test on the Lower Extremity, then Wednesday was a Osteopathic Manipulative Medicine quiz, Thursday was my midterm in Intro to Clinical Medicine, Friday brought a midterm in Human Behavior, then we got to rebound with a Physiology test on Monday morning on Cardiac Physiology. Now I am facing perhaps an even bigger challenge with a Biochemistry test Monday morning, then an OMM quiz Wednesday, Head/Neck exams in both Anatomy and Histology on Thursday, then Physiology the following Monday! It's really hard to balance studying time when there are so many tests back to back! I guess that med school for you!

Meanwhile, Braylei has gotten pretty sick, currently battling both an ear infection and pneumonia. We have had some long nights, and for Meghan, some very long days. Braylei's vocabulary is soaring! She is learning new words every day, her cognitive skills are really developing, as she is getting so good at basic problem solving, and she is all over the place.

Meghan's been very busy as the Young Women's President in our ward. They just had their New Beginnings, for which she invested a lot of time. She also just had her second OB checkup and we are happy to say that we are having a boy!!!! I'm so excited! Plus, the ultrasound revealed a high placenta, so as of now there is no placenta previa as was with Braylei, and there are no other current signs of a high risk pregnancy! So we are praying that her conditions will stay this positive!

Hopefully I will get through this set of tests, especially Biochem tomorrow!

The Wonderful World of Coagulation!

Every time I have a break from school, it is so hard to get back into the swing of things. This time, though, I do not have a choice, as our first Biochemistry exam is tomorrow! It is really unbelievable how much information they cram into such a small amount of time! A test over lectures 1-10 and workshops 1-3 doesn't sound like a ton, but the breadth of the material is really incredible. Especially deep are the first 3 lectures on the inflammatory response to injury and the coagulation/healing process. At first I thought, "oh, no big deal." I remembered covering that in my undergraduate athletic training classes. I can still vividly recall my professor Ben Davidson spitting out terms like prostaglandins and neutrophils, but it came across like a magical process! We have learned every step of the way, a the systematic process by which blood clots are formed and resolved. The same thing with my athletic training pharmacology class. In undergrad, it was just knowing names and what they did. I knew COX-2 inhibitors like aspirin, ibuprofen, vioxx and celebrex, but now I know what they do and how they do it! The more I learn, the more I see the interrelation of all things, and although very complicated, the up and down regulations of these processes really testify to me that we are divine creations. It really is amazing!

I have put in a tons of time in my studies, but there is still more that I would like to cover before the 8am test! Then I can look forward to a patient simulated male invasive (rectal) exam! Doesn't that sound spectacular? I hope Midwestern is paying these people well! That means yet another late night here, but at least that gives me plenty of time to study for my 3 exams next week!

Sundays are really nice for me. Establishing that I will keep the Sabbath day holy and not study was at first a trial, but now it is a huge blessing. Sure, I get up super early on Mondays to prepare for my tests, but I love spending time with my family and being able to take care of church responsibilities. I stayed home from church today since Braylei was not feeling too well and Meghan was teaching a lesson in Young Women's. I will take every opportunity to spend time with Braylei since I hardly get to see her during the week. She is really getting so clever and smart. Her beautiful personality is coming out and she reminds me more of Meghan every day! My family truly lights up my life and I wouldn't trade anything for that.

The Importance of Elvis' Pelvis

Another week has come and gone. A week and a half is what separates me from Christmas break. However, in that period of time I will face an onslaught of tasks! In Anatomy and Histology, we are fully immersed in the Pelvis and Perineum unit, which has been an excellent learning experience, as my athletic training background didn't hit a whole lot on urogenital systems, reproductive organs, and everyone's favorite, the rectum! We have both tests next Monday, the 18th at 6:30am!!!! It's unbelievable how early that is, but that afternoon, I two patient simulation clinical exams as well. I have a heart and lungs exam in the afternoon, then from 6:30-9pm I will conduct a female pelvic exam. Now this is a great opportunity to have real clinical experience so early on, but it is amazing to me that they can get people to sign up to be patients for this. I personally have never undergone a female pelvic exam (seeing that I'm a dude), but having 5 extremely nervous 1st year med students examining a very sensitive area is not exactly comparative to the excitement of standing in line for a PS3! So next Monday needless to say will be long and tiring, as I have no breaks throughout the morning, day or night! And I can't relax after that because we have our first and biggest Physiology test on Wednesday morning, which is worth 25% of our quarter grade! This week will be crazy because of all the preparation needed for the heinousness of what I have just described. I also have an Head, Eyes, Ears, Nose, Neck and Throat (HEENNT) exam to conduct tomorrow, a quiz for osteopathic manual medicine (OMM) Wednesday, and a case presentation for our Physiology workshop on Friday.

As I mentioned earlier, studying a topic day and night really sets the subject in your subconscious. Mix that with a lack of sleep and trying to maintain sanity and you will find yourself in my position. I swear, I had a dream about a mutant uterus that was chasing me, not unlike those scenes from war of the worlds, only the ovaries were firing flesh-eating oocytes at me! I may be going crazy, but the female reproductive system is a "hostile environment," biologically at least. Also, after seeing so many illustrations of the uterus, a particular coronal section (cut in half view) looks scarily like the logo for the Chicago Bulls! Hmm. The more I say, the more I think I'm going mad!!

On a less traumatic note, we started manipulation techniques in OMM on Wednesday. I was pleased to find a good deal of success even on my first tries! Now that we have done so much diagnosis and theory, it makes sense of what we are trying to do, as well as the detriment that can be caused by those "who know not what they do." I look forward to practicing these techniques a lot, and will be a great tool for me as a physician.

On the home front, Meghan and Braylei give me the strength to keep going day in and day out. They light up my life and I am so thankful for them and their beautiful spirits. Braylei just cracks me up! She is such a funny little girl! She has been talking non-stop and is everywhere. She always has a smile on her face and is very affectionate. Meghan, meanwhile, is one whom I am in absolute awe. She amazes me. She is such an incredible mother and wife. In addition, she is making a fabulous Young Women's President in our church ward. She has been so understanding of the demands of my education and is very supportive. In what time we do have with each other I absolutely cherish. We occasionally get to watch a Phoenix Suns game or maybe a movie, but her support means everything to me.

Well, hopefully I will survive this week and I will post again then!

Back at the Park!

Today we met at the park with my parents, along with my sister Suzi, her husband John, and their daughter Elizabeth (who live in California)! We had a good visit! Braylei has been really starting to walk more and more over the past few days! For the past few months, she would take a couple steps here or there, but she preferred crawling. The past couple days has been a different story! She has been walking across the living room, back and forth between Meghan and I, and she'll just stand up on her own and walk somewhere! It's really fun to watch! But it was good to visit with my parents and Suzi & John. Elizabeth has grown a lot since I last saw her. Braylei was perfectly content playing in the sand most of the time, and enjoyed grabbing a handful of sand and dumping into her Grandpa Schroeder's hands!

Trip to the Zoo!

On Wednesday, we took Braylei to the Zoo! She, as usual, loved it, and we tried to see some different exhibits this time around. She absolutely loved the tortoises! She also really liked seeing the babbons, especially as we were there at feeding time! We also saw the largest rodent in the world, the capybara! The Phoenix Zoo is a great place with not only great exhibits, but it is very interactive, great for kids, and features great themed areas like the jungle! On the trip home, both Meghan and Braylei were out! While my girls were napping, I was able to visit my former co-workers at Mezona Orthopaedic Physical & Hand Therapy. It was great to get to see everyone again. I learned so much while working there and a wonderful work to be in. I miss them all a lot.

If anyone is interested in learning more about the largest living rodent, the capybara, please visit the Smithsonian National Zoological Park at this link!

Feeding the Ducks!

On Tuesday afternoon we took Braylei to Freestone park to feed the ducks! It was so much fun! There were many different varieties of waterfowl, and there were a lot of duck around us! Braylei enjoyed watching Meghan and I throw the bread to the ducks, but she wasn't quite so charitable with the bread we gave her to throw, she would eat every piece we gave to her! We also were able to play on the playground for a little while, which she loved tremendously!