A Day in the Life: Pediatrics Clinic

Although at some point I’ll post a review of the rotation as a whole, I thought I’d share what a day looks like for me when I’m in primary care clinic as a resident pediatrician! Let me know in the comments what questions you have or what you’d like me to talk about in my review later!

06:30: wake up and feed my diva dog who demands his kibble be mixed with water and wet food. He’s a great and affectionate alarm clock and it’s pretty difficult to snooze. Pour coffee into my body and try to put on enough mascara and concealer to not look like death.

07:32: leave to make sure I get a good parking spot at work.

07:44: actually leave, will not get a great spot but will show up exactly on time.

08:00: morning report starts, which is often a case-based session led by one of the chiefs, an attending/fellow/resident, or, on occasion, me!

09:00: head up to clinic and look at the list for my morning preceptor. Check any labs or imaging I ordered recently and call families as needed to give results. Find a patient to see and let my preceptor know where I’m headed!

  • typically I run the whole visit at this point in my training as “the” doctor, with attending backup. It’s a great way to learn to be efficient and pick up tips on things to improve, but always with the knowledge that when I don’t know something I have an immediate support.
  • I don’t usually give SOAP style presentations anymore since they take up a lot of time. Especially with well child checks, I’ll let my preceptor know what the parents’ concerns were, what the child’s concerns were, what my concerns were, and then my plan, but otherwise report only the most pertinent positives and negatives.
  • What’s really fun is when either a) my preceptor checks on the patient after I’m completely done just to “bless” the encounter, or b) my preceptor goes with me into every visit and watches me see every patient on the schedule. The first is fun because it really feels like it’s my own clinic, and the second is fun because I get real-time feedback from an experienced pediatrician, with actual time constraints on the appointment that I’ll have in real life as an attending.

12:00: wrap up my last encounter, then head down to grab lunch to take to noon conference. This tends to be a bit more didactic and is likely to be a lecture from an attending. Sometimes we also use this hour for housestaff meetings or ethics conferences.

13:00: at this point I have a few possibilities: go back to clinic (usually with a different preceptor), drive to my own continuity clinic at an FQHC a few blocks away, head to a seminar for my leadership program, or find a quiet space to get some work done on my quality improvement project. Occasionally I get the afternoon off to read which I sometimes do from home in order to spend more time with Auggie! (Not that he’s spoiled…)

18:00: clinic ends and I go home to make dinner and study! I like reading from Nelson’s or Peds in Review about something I saw that day. I also usually have at least two books going so I’ll spend some time reading, and I have to admit that most nights I turn the TV on for a while too, mostly for some noise.

That’s pretty much it! What would you like more details about?

 

Step 1 Studying

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This is one of my most requested topics through instagram DMs. I’m writing this down as a stream-of-consciousness once so that I can send this link to anyone who asks for it… but I don’t want to talk about it a lot more than that! Everyone’s step 1 experience is tortuous in its own special way, and although I’m very hopeful that mine was one of the worst so that I can console myself into believing that not every single doctor out there is as traumatized by this exam as I was, I’m fairly certain this is wishful thinking.

One disclaimer is that I knew I wanted to do something primary-care related, and since the average step 1 score for ob/gyn (which I was thinking about at the time) was somewhere around 226 vs. neurosurgery at 244, there was a lot more cushion and a lot less pressure on me to go nuts aiming for a 280. If I’d changed my mind later to doing something more competitive, there were certainly other aspects of my application that in combination with the score I did end up receiving would have likely made me successful candidate in any specialty, but my approach was definitely an “I don’t want any roadblocks to residency but more than enough seems superfluous” one and that might not be the very comfortable for someone who knows ahead of time they need a high score.

Another disclaimer is that this is not a post about how to approach the exam as an IMG. I get that question from a lot of instagrammers as well and honestly, I don’t have expertise in that area and would feel bad trying to give advice about it!

So, now that I’ve written disclaimers that are probably a lot longer than the actual content of how I studied, here it is:

  1. Do well in medical school. This doesn’t necessarily mean make 100s on every exam, but it means studying like someone’s life depends on it, because at some point someone’s life will probably depend on how hard you studied in medical school. This also has the benefit of making step 1 studying a review rather than a crash course in all of medicine, which would be physically impossible to do.
  2. Pathoma. Either get this or Goljan’s and stick with it. You can use it during the preclinical years, but definitely pay more attention to your lecturers in real life since just knowing the pathology is not the only key to success as a physician.
  3. First Aid. Obviously. I would advise against buying this as a first year and maybe not even until the second semester of MS2 if you’re at a school that still has 4 preclinical semesters. Over-annotating will be wholly counterproductive and you’ll seriously get lost in the woods if your whole book is covered in something you just knew would be helpful when you started reviewing. It won’t be. My favorite tip for this book was to get it unbound and 3-hole-punched so you could put it into separate binders. One small section at a time somehow feels one million times less intimidating than the entire thousand-page volume. Also see bonus #11 for disposal techniques.
  4. UWorld. UWorld UWorld UWorld. If you know everything in all of the answer explanations, you probably will score beyond your wildest dreams.
  5. Strategize timing. I know most people probably can’t do this one, but for me it worked really, really well. I had built up some elective time during MS1/MS2 (thank you Spanish and alternative medicine) that meant I had a LOT of free time in MS4, so I moved my first MS3 rotation into MS4 and took an extra 6 weeks of at the end of MS2. I finished a couple of projects I’d been working on, went on vacation with my family, did MS3 orientation with the rest of my class, and then started studying. I only studied for about 3 weeks in total before taking another 3 weeks off. It was a little weird seeing the rest of my classmates get started on the wards, but in hindsight is now absolutely a decision I’d make over and over again to protect my mental health.
  6. Find a a good study spot. I went home to my parents’ house and let my mom drive me to my undergrad library every morning when she went her work nearby. This meant I couldn’t call it quits early if I was getting bored of studying since I had no way to get home. I had the perfect study carroll and the librarians all started bringing me coffee and giving words of encouragement because they’d literally never seen anyone study so hard. #UNCWproblems
  7. Flashcard study walks! I know all of the pharmacology that I know only because I took pre-made flashcards of drugs on short walks 2-3 times per day. Thankfully the campus where I was studying was really safe/car-free so it worked out pretty well that I could walk and read at the same time. After a certain point my body just needed to stand up, but I am the type of person who needs studying momentum and even a 15 minute break can derail my train of thought, so this was a good happy medium. It felt like a “break” to me but I would advise using this technique with caution if you are of the mindset that a real break entails actually stopping studying.
  8. Take evenings off. If you have already studied 9 hours in the library all day, how productive is your brain actually going to be at home? Just enjoy time with family or friends and try not to think about anything important.
  9. Let loved ones know you’re not feeling like yourself. This was key – despite the relatively low-stakes nature of my exam prep and the overall way I approached the test, I was beside myself with fear 99.9% of my waking hours, and that manifested itself as me not being totally emotionally stable. Now, looking back, I know my strategy paid off and I shouldn’t have been as anxious as I was, but one of the best things I did for myself was to surround myself with support and to let them know that this was at least somewhat par for the course, since at the time I would have probably crumbled if it wasn’t for my parents. There was one night the week of my exam where I freaked out to the point of a panic attack, sobbing and practically screaming that I “knew nothing,” so my mom literally turned every single page of First Aid saying “do you know something about what’s on this page?” and when I answered yes, she wrote something down and at the end did some really phony math that demonstrated I knew 98% of everything in First Aid. Obviously I didn’t, but I needed that morale boost and I think everyone could use that kind of cheerleader who doesn’t judge you or ask questions but just helps during the hell that is step 1.
  10. Don’t study the day before the test! I think this is pretty obvious, but relax and just try to remember how to breathe. My mom came to the rescue again with this one… she found a friend with a yacht and got me invited to spend the afternoon and evening on the water so that I literally could not get access to my books no matter how hard I tried.
  11. Bonus: shoot First Aid. My dad took me to a shooting range after the test was over and I unloaded 15 rounds into the front cover. This was incredibly cathartic and though I usually do not condone gun use now as a pediatrician, I would make a special exception for anyone wanting to exact revenge on an inanimate object such as First Aid, as long as it’s done with adequate eye and ear protection and safe shooting technique and environment.

I guess step number 12 would be to almost immediately start studying for step 2, which I found much more pleasant and actually applicable to real life as a physician. I can do a separate post about it later, but for now check out OnlineMedEd which is what I used and loved. It helped boost not just my numerical score (average step 2 CK is much higher at baseline) but my actual percentile. It also helped me look good on the wards!

That’s pretty much it. Writing this all down actually brought back a strange amount of emotion… so glad I don’t ever really have to think about this again!

Being a dog mom in residency

At the start of my fourth year of medical school, I decided I really wanted a dog. I’d been thinking about it for a long time in a very serious way, but kept putting it off because I thought medical training and being a decent dog parent couldn’t mix. However, I did see several of my friends successfully finding ways to do it, and started dog sitting for some of them and even for a few of the residents at UNC. I loved it! So I made up my mind and thought where there’s a will there’s a way.

I started scrolling through petfinder and adoptapet to try to find the perfect pup. I wanted something very small (knowing full well that yes absolutely I would be that girl carrying a dog in a handbag), a boy, poodle mix, and young. I told my roommate I was thinking of making this big decision and she thankfully got on board with the idea very quickly and started helping me search. One Thursday morning while I was on an incredibly dull rotation that often meant I saw one or maybe two patients a day, this cute dog named “Rascal” showed up on my computer screen and I knew I had to have him. Having taken all of two days of excused absences in medical school to date at that point, I decided I would take a mental health day and go adopt a puppy. I met a stranger in a Dollar General parking lot about an hour and a half away from Chapel Hill, where I was living at the time.

((I didn’t tell my parents the details of what I’d done until much later because common sense would tell you that meeting a random stranger off the internet to accept a cute but unpredictable puppy in the middle of nowhere North Carolina would not be a good idea, but, you know, all’s well that ends well.))

He was very stinky so I immediately gave him a bath when we got home, and invited a steady stream of friends over the next few days to come visit him. What I did not really think out particularly well ahead of time was what to do when I was on 24 hour call and when I was heading out for week-long treks to interview at different residency programs. Thankfully my roommate and my parents were all very generous and willing to help out, but things definitely weren’t easy and I probably would have done at least a couple things differently with hindsight being 20/20.

I thought maybe I’d share a few things that I’ve learned with readers who are in med school or residency or some other time-consuming career about how to keep a dog alive and happy!

  1. Adopt a dog who is small, exceptionally cute, and nondestructive. I know it’s hard to predict an exact dog’s behavior (especially if you do what I did and make a very hasty decision), but it has been much easier for me to find co-residents and friends and attendings even who volunteer to help take care of him because he’s little and low-maintenance. The people even in my program who have big and more rambunctious dogs have had more difficulty.
  2. Puppy school. This is important. We just went to Petsmart and signed up for as many classes as we could and honestly had a lot of fun learning tricks and manners! Auggie made a ton of friends and came home exhausted after class.
  3. Potty pads are a very good idea. So are apartments with hardwood floors, because even though my sweet boy’s ability to go to the pad every time is actually astounding, his aim is not. But in all seriousness this has been one of our saving graces to have him potty trained because I’m not panicking at the end of a 14 hour day thinking omg he hasn’t peed all day!! He has and he is fine.
  4. Do not adopt a dog immediately before traipsing around the country for 15 different job interviews while on a q4 28 hour call rotation. You will not be home and you will miss your dog. The second half of the fourth year of med school (when all of that is over!) is a much easier time to work on potty training and learning to sleep through the night.
  5. If you’re in a stage of life where 24 hour calls in the hospital are a thing, find several people you trust to take care of your angel (which is made easier I think if you have followed tip #1). He will be fine (in fact, will probably have a blast while he’s hanging out with his dog friends) but you will really, really miss him. Just a heads up.
  6. Don’t let the fear of how difficult it might be stop you from adopting your new best friend! You won’t regret having a furry (well-behaved, quiet, adorable) new member of your family.

Let me know in the comments if you have other questions about being a dog mom in residency? And if you already have a furry best friend, tell me about them!

The Devil in the White City

Let me just preface this by saying I loved this book, but largely because it gave me so much history about Chicago and the way Chicago shaped the world, so if you’re not super into Chicago like I am you may not find it quite as interesting. But who doesn’t want to know why we use AC current? Or how Central Park and the Columbian exposition were similar (hint: landscape architecture)? No one! Second preface that I’m going to use a lot of parentheses and ramble a little bit…

Most of this book is set about 2 miles from where I live and work, in a community area called Englewood. Before the Great Migration and white flight in the 20th century, it was a part of town inhabited by largely German and Irish workers who staffed the Union Stock Yard (the nice name for a large hog slaughterhouse) and was home to a young doctor named Herman Webster Mudgett who called himself H.H. Holmes, and turned out to be America’s first serial killer. He’s the “devil” in the book, and the “white city” is the Columbian World’s Fair that took place in nearby Jackson Park. (It is nicknamed the white city because everything was painted white.)

(There is a hospital in Jackson park now that lacks pediatric support in its emergency room and we get a lot of interesting transfers from them. There is another hospital, La Rabida, where U Chicago residents rotate that is actually on the fair grounds. It is an absolutely gorgeous hospital and the views of the lake from that particular spot are a clear indicator of why the designers of the fair chose that location.)

The book goes back and forth between Holmes’ rather creepy and horrifying process of seducing and sometimes killing young women and the autobiography of Daniel Burnham, the leading architect for the world’s fair, and his much more pleasant but kind of stressful process of trying to get the fair ready in time. He succeeds, but not without a lot of roadblocks in the way. This is the section of the book I found to be less of a page-turner and more of an “oh wow that is an interesting factoid I will probably randomly share with too many people at some point, better go look up the back story so I can bore them with extra detail!” so it took me a little longer to get through these sections.

(As another aside, I have always liked knowing random facts about stuff, but the random trivia items I know are usually too obscure to be any good for bar trivia. People who invite me to trivia nights find themselves quite disappointed that the girl who has a random fact for every situation is actually really bad at naming movies and 90s bands. Like I know a lot about Pink Floyd stuff from the late 70s but nothing about Dark Side of the Moon or The Wall, which is the exact opposite of what normal people know. Anyway. Back to the point of this post.)

Some random fun facts I learned from the book:

  1. Walt Disney’s dad was involved in the exposition design and this is thought to have contributed to Walt’s idea for the Magic Kingdom!
  2. A few of my co-residents live in a building where Al Capone carried out most of his business in Chicago and was later a brothel. Technically Al Capone was at the Lexington Hotel and the new condos are called the Lex, but still. This was also the site that the fair’s opening day parade started before making its way south to Jackson Park.
  3. Our train system was originally called “Alley L” because it traveled over alleys. Now it’s just “the L” which is short for “elevated.”
  4. The guy who designed the landscape architecture also did Central Park and Vanderbilt estate.
  5. Frank Lloyd Wright got fired during the design process of some of the exposition’s buildings.
  6. Westinghouse significantly underbid GE for the contract to light the fair and suggested AC current (what we use now) over DC current (the less efficient standard of the time) and incandescent bulbs.
  7. Shredded wheat cereal was introduced at the fair.
  8. October 12 became Columbus day because it was the dedication day of the fair, not because it had been such a thing for the 400 preceding years.
  9. Midways and Ferris wheels are now well-established staples of every fair and carnival because of this fair. The Midway Plaisance is a road I drive on regularly now as part of the U Chicago campus!
  10. I think a lot of people know this one, but it’s a good one. Chicago isn’t the Windy City because it’s actually windy, although it is. It was because when Chicago architects and socialites were lobbying for the fair to be held in Chicago and not in an east coast city like New York, their “big talk” was considered “windy” by NYC editors.

That seems like enough fun facts. Have you read this book? Anyone else morbidly fascinated by serial killer stories?!

Blue Apron Review

A few months ago I decided to try a food-delivery service and after a lot of googling to find out which one would be best, I decided to check out Blue Apron! I’m interested in trying some others like Hello Fresh or Purple Carrot, but for now I’m really happy with my first choice. It’s definitely not something I see myself sticking with long term since it’s kind of on the pricey side for what you get, but it’s a ton of fun for now.

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The packaging:

The box is standard corrugated cardboard, but has a nice lift-up lid that opens and closes neatly. Inside is an aluminum cooler bag with two huge ice packs that consistently arrive quite frozen, even on a hot summer day. I have had the unfortunate experience of one of the ice bags rupturing and damaging the cardboard, but even so the food stayed fresh so it wasn’t a huge deal. The food from all three meals are mixed together haphazardly, but everything is individually packaged and the little “knick knacks” of each meal are collected together, along with little pamphlets that include nutritional information, which has been thoughtfully balanced by dietitians.

The food quality:

Everything is really fresh! It’s all stuff I would hand pick from the grocery store, and I am super picky when it comes to visual appeal of my produce. They do send an overabundance of garlic which I find a bit odd.

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The recipes:

I am not a good cook at all so I usually make at least one mistake in the recipes… like putting the wrong vegetable into an empanada or putting the whole portion of an ingredient somewhere I was only supposed to use half. So far it hasn’t been a big deal, but the recipes are definitely complex enough that if you’re a total novice like me, mistakes will probably happen! They also seriously underestimate the amount of time it will take me to actually do the cooking. Again, not a big deal because I find cooking to be pretty fun and therapeutic. I’m also learning a lot of cooking techniques and that’s been really nice too. As an aside, the recipes come on nice, 8×11 cardstock that you can keep and use again.

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The actual taste:

So far, I have seriously really enjoyed every meal I have tried! I think my favorite might have been the vegetable tartines with cucumber salad on the side. It was probably because there was a recipe included for amazing garlic sourdough toast that I will absolutely make again, but I also really liked the salad that was an elevated take on something my mom made for me a lot when I was growing up.

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Overall impression:

For $9.99 a pop (really, $6.67 since 2 servings is actually 3 for me), the amount of work it takes to prepare each meal is a little exorbitant, especially considering I could buy a frozen Amy’s or SweetEarth meal for less that $5 for a similar and way-lower-hassle amount of food. The ability to skip weeks and cancel at any time is helpful, and it’s purely from an enjoyment standpoint that I keep getting meals delivered. It’s definitely worth a try, particularly if you have a discount code!

This is not a sponsored post.

I’m Back!

Hi!

I know a lot of you from instagram have been wondering over the last year or two where my old blog went! I decided at the end of medical school to take a break from writing publicly as I started residency just because I wanted my online presence to be a little more subtle and grown up than it had been before. I have noticed that I really miss the creative outlet and wanted to start fresh, so here I am! Over time I’m hoping to migrate some of the more useful content onto this site, but I want this blog to have a more professional feel to it with less pictures in bathroom mirrors and more content that is actually meaningful and potentially with some educational value. Please let me know what sorts of things you’d like to read about, as I know there are a plethora of medical blogs and I want this to actually be worth reading in a sea of other writings.

I’ll put the disclaimer here and other places on the blog that any sort of patient care stories I share will have been changed and combined with other stories to make sure I’m HIPAA compliant and protecting the identities of the little humans I take care of. The essence of the what I write I hope will still capture the emotions and realities of being a resident physician, but if you know me in real life, just be aware that the things you know to be true about my life in person may not be always represented the same way in writing.

Welcome to my blog!