Day 5: The Good, the Bad, and the Ugly

Let me first start of by saying, that what I have just been through in the last 4 days cannot truly be described in words, but I will try. Needless to say, the last 48 hours, have been some of the most stressful I've ever felt.

Let me just give you a brief background. My first rotation is CCU/ICU- it’s a combined rotation- cardiac critical care, and Intensive care, put together. Not the ideal rotation to start, but no complaints. On top of that, the senior residents assigned to us (me and 2 other 1^st years) are 4 days from graduating. So your lucky that you can even see them for 5 minutes sometimes. So a good majority of the time, you are left alone, depending on your senior. In my case, I got real “lucky”. I was put with another second year resident, who is about to graduate to 3^rd year. At first I thought it was a blessing. But not really. The guy is like a superstar resident. When he is given a patient, he quickly goes to the computer reviews basically the entire medical history of the patient (including ct’s, xray, cultures, ultrasound, surgery history, the labs and how the correlate for possible the last 3-4 days. And etc..) and writes it down on 1 sheet, which is filled with any lab you can think of. After he writes it down (Oh yeah and the 15 meds the patient is on) and 5 minute later he throws it away. And when the attending ask him questions about the patient, he talk like he’s given a lecture. He knows every single detail about the patient. And by that time he has consulted with like 3 doctors on the case, all this within a really short time. When we do rounds me and the other 1^st years and another 2^nd year are all carrying notes and patient binders, and this guy just has his hands folded behind his back, and knows the patients, like the back of his hand. I was just amazed. It’s a mixed blessing because I was like “damn, I want to be just like this guy!” But damn I think I need to read a little more…lol….

It was on Thursday that I practically saw him rescue a guy that was given to him by another 2^nd year resident. I will call this superresident clark or superman. the patient was called into him and afterwards, I then saw him go to action. First of, I was able to follow him a bit, because I came in at 6am and tried to do my notes, because I wanted to see what this super resident was doing. Once the patient was giving to him, he went directly to the computer and started bringing up his labs. He saw the current days labs, wrote them down. Then he saw wbc were down and went and retrieved the last 3 days of wbc. Then he also followed the patients last 4 labs (the pt. has HIV,hep c, liver failure, not compliance with meds, history of toxo,CABG )and the ABG’s. When he looked at the ABG, he noticed a mixed syndrome. He had respiratory alkalosis with metabolic acidosis, he was hyponatremic 119, and his T4 count was 2!!!!! Can you believe that ! 2 cell count!!! His co2 was like 60, and he turn to me and said “this patient is about to code and crash, we need to get him to the ICU now!” And now for the ugly. When he called downstairs to the medical floor “nobody” seemed to care. The nurses says they had no order to bring the patient to ICU, and that they had to run it through their floor manager. He didn’t get much from them, so he told the ICU staff about his patient and they were like “what? Your bringing who here? We haven’t heard about this. Were not gonna get him” basically this guy was going down and this nurses were just interested in fighting which room he would go into. They were not able to get any lab work today because his veins had collapse and without a PT, PTT levels nobody in the ICU will put in a central. (I learned this from superman). Basically he told the nurses that why bring him here , because he couldn’t put in the central. So basically superman, thought for one second before calling the cardiovascular interventional radiologist personally (who was just about to leave for the day) and asked him if he could put in the central line with ultrasound guidance. But even before he could do this, the patient had to be brought to the radio unit. And finally a caring nurse said “ok, I’ll get him, if nobody wants to go “ So she told her supervisor, they started moving and she went down to get the patient as a favor for superman. While I’ll this was going on, I was just in amazement. One, because nobody really cared about a patient who is probably moments from dying and who is chronically ill, and secondly because this superman was fighting for this guy, who he had never even met. He was fighting with 2 floors of nursing staff and calling 4 doctors and TELLING them what to do. He called them so that they would give him the ok. He was very confident, stern, but remained human at least. He was stern with the nurses and was determined to get the patient to ICU to do something about it. He didn’t take no for an answer, when asked what was wrong with the patient, he recited all the labs and his defense of what he was doing. After about 30 minutes the patient was brought to ICU, superman calculated the ventilator settings and put the patient on the respirator. He was thinking it was pcp pneumonia and MAI but he was going to check with infectious disease first. He was also thinking legionella because of the hyponatremia. He started a sepsis working up and the patient was ok for now.

Now comes the bad. The following day he signs of duty after being on call, and leaves the patient to me!!! I was like what? He left me “alone” with the patient . I wasn’t completely alone, but might as well have been because, the other seniors had no clue of his history. And that’s what has cause my stress in the last 48 hours. Yesterday , the head of the infectious department (whose patient this happens to be) asked my about the patient, and I was fumbling my notes of the patient in front of him, and couldn’t answer his questions. You should have seen his face, I think he wanted to stab me if he could. If he had any non-earthly power, I think he would have banned me to mars !! Man I was nervous… That’s not even the start of it. He was not their today and I had the patient all the myself again TODAY !!! In the entire ICU CCU it was one 3^nd year senior and 3 first years . She was like “whatda hell? I’m alone with these guys!!” I figured this was happened so I went early at 6am to the hospital to try to learn all the history of the patient and try to find out what the heck was going on. When I was in the unit. I put my face down and prayed “God help me with this”. I told myself “ok, lets think this through you can do this” So this was around 7 am. By 11am they guy was almost crashing !!! His ABG were horrible. I was looking at his labs and there were 2 attendings standing outside. I told myself “you’re the doctor, do something about this” I went and checked his levels. I noticed in the cxray he had bi lateral effusions, he was not breathing to good. He was getting dehydrated. When I told this to the cardiologist, he was like just stop the IV normal saline because your fluid overloading him. I was like (respectfully) “If I take him off liquids I think that might exacerbate his pre-renal state” He paused and look at me. I told him “He is pre-renal, his bun is 63 and creatine is 24.” He then kinda studdred and was like “ok, talk to nephrology” I then spoke to the pulmonary specialist who agreed with me. He said call the renal and get the ok to stop the iv saline and will go 20 mg lasix 1 time. I got on the phone with renal (after I spent 10 minutes looking for the number) and spoke to renal over the phone. We were able to get the ok. And we gave him the lasix. I though this would take care of the problem. Until suddenly I walked into his room 1 hour later and his respiration was at 40!!! I was like whatdahell !!! I looked outside the room and nobody was their!! I didn’t know what to do. I said to myself "I think this guy probably need to be intubated again" (he had been token of the respirator a few hours ago.) I went and spoke to the 2^nd year senior and she was like “what? Who are you talking about?” I paced back and forth for about a minute, and guess what happen. Just at that moment. My beeper buzzed. I looked at the number I called it back, and guess who it was? SUPERMAN !!! He was like “get a vital capacity on that guy. Call respiratory they will do it.” I also went and told him about the last ABG’s. He then told me “check his vital capacity, and if its ok, then continue with the oxygen” I paged respiratory. They came and checked his vital capacity which was 0.07 !!! (that’s bad) and his nif was -15 (that’s really bad) I didn’t panic much because superman had told me to call the pulmonary attending who had left 2 hours ago. I called him and he said to put him on BPAP . I went to the respiratory guys (who were giving me dirty looks) and I told him were going to do BPAP. 1 hour later he was on BIPAP and stable and I was on my way home thanking God and my lucky stars. I wanted to kill superman !!!! I couldn’t believe he left me alone with this guy. I didn’t even do my note, I was to busy trying to figure out what the heck was going on. I wrote my notes at the end and left around 1pm.

Man what a relief, when the patient was put back on bipap. I was already thinking of the next match or maybe another career, but I prayed told myself “you’re the doctor do something!!" and luckily everything turned out "ok.”

Geesh man, they don’t teach this stuff in the books!!! Man I thought I knew medicine. But one thing is reading and another is having people you can rely on. I guess that would be the good-Having individuals who are willing to help and sacrifice for others. Individuals fighting for the sick and those in need.

God Bless friends. Pray for me.

Dr.Mike

Day 1: Residency Begins ! (and part of day 2)

Well I finished my OFFICIAL first day of residency. I left the apartment at 6:15am and got home 6:43pm. Not bad I guess for my first day..lol…. wow the day seem to fly…. I don’t even think I ate much lunch…..

Not even sure where to begin. I arrived “early: at the hospital. ( I think I’ll go in even a but more earlier tomorrow..lol) Well the day started pretty fast. We had morning report in my area, and the senior residents went through a list of about 11 patience in like 44 seconds….. Me and my fellow 1^st years were just looking at each other saying silently “whatdahell?” Boy these guys were fast. I don’t know if they were trying to impresses us, or they had a plane to catch. But needless to say it was over even before it started. Then it was a rush to do the notes, and examine the patients. You will not believe tthis. My first Patient I saw, the first patient I examined, the first patient I touched . Died. I just couldn’t believe it she was an elderly woman around her 80’s that had a cerebral hemorrhage, and within 10 minutes of touching I met the patients family members, who were standing outside to pay their last respect. I introduced myself to the siblings, and I was kind of speechless. I couldn’t believe it. I didn’t even have time to soak it in. MY senior was already dragging me to see the next patient. But even before I did that. The program director came up to show us a new computer program, for sign out. She even asked “how’s it going?” I said “its been good. The first patient I saw passed away.” She was like “Oh my God.” I don’t know if she had a meeting with the residents or something, but we were all limited to like 2 patients that day. And to writing about 2 notes . Which almost took the ENTIRE DAY!!!! I’m sure I’ll be laughing at it one of these days but. The note took the entire day. I think we all got confused with the Planning of the note. We were like “wait a second do I have to treat this patients HTN or CHF” (which he/she probably is already being treatmented) Glad it took me two days to find out that most patients already have a protocol, and you norally continue the regiments as long as it does not interfere with her condition. I friend of mines called me. He was their at 7am and got home 8:30pm!!!! He did 5 notes!!!

Lol… I think these resident were like… what da heck? My resident told me today (I started writing this yesterday. While I’m writing this to you, its actually the second day) “You tell me all you did yesterday was 1 note??” I was like “afterI did the note I spend 3 hours trying to figure out the computer system” Then he was like “didn’t you take time to read the notes that I did?” I was like “I read part of them..”

Honestly, who can understand doctors handwriting? Its like these guys just vomit words on a page. Like they don’t want no one to read what they write. Its probably even sloppier in my hospital because they do most computer orders. SO the notes are mainly for the attending to read. (who barely even reads them)

Tomorrow I’m going to try another system out. I’ll try to go in around 5am too…lol. Hopefully I can get 4 notes done by 8am.

I wish I could write to you more. But its 7pm and I need to read up on some COPD treatments and ventilator treatments and protocols.

My senior asked me today “are you having fun?” I told him “I’m in heaven…..This is what we were born to do.”

He laughed.

God bless

DR.Mike

p.s I will write longer update on sunday. Not on call this week.

ThankyouGodforResidency.com !!!

I got my own website today !!! That links to this blog. Please share it with your friends that are struggling with matching. Give them hope!!!

http://thankyougodforResidency.com

For those that struggle to Match

hi guys

I know that a couple of people know me here. I'm basically an IMG with low scores that was blessed enough to have gotten a residency in internal medicine. (pre-matched) I decided to blog about my experiences, but I wanted to also expand the blog to others that have also been blessed.

If you feel God has blessed you in a special way towards getting residency please email me your stories and I will post them on my blog. Your stories can help others that are struggling to get residency.

For now I rather hear from people with low scores and barely a "chance" of getting residency.

I know I have been accused of being fake, but I have met a lot of people with stories similar to my self that have also been blessed. Now I want to post these stories as lasting testimonies of the goodness of GOD. anyone that has spoken to me knows that i don't endorse ANY SITE. I don't endorse any of those clinical sites. Because the second I do, I know that people will not believe me. But i still feel that people should hear my story, and if it gives even ONE person a bit of hope and a bit of peace, then everything I have been through was not in vain.

Please give hope to others and encourage them with stories of triumph and blessings from the lord.

Please email me your stories to: themadmike31@gmail.com
put in the subject : MY story


For others that have emailed me, sorry that I have not responded. There are so many emails. Please give me time.

this is my BLOG:

http://thankyougodforresidency.blogspot.com/

Don't give up. Don't talk Defeat. Keep your head up.

lean on God...

Onward !!!!!! Remember the greater good. helping those that suffer. changing to better that lives of those around us. Thats what medicine is !! Purpose.....

Dr.Mike

Last day of Orientation : GOT MY BEEPER ! (pic)

I Got my beeper today !!!! Here are the pics. I wish I could tell you how it feels. I'm just blessed. It feels good to accomplish even this little, after so much hard work.















I PASSED ACLS !!!!!!

Orientation: ACLS, Step 3 nightmare, and a bit of Peace

Ok, first of sorry for not posting a lot of updates. It’s been a pretty hectic week. I had a lot of things this week. We had the orientation and also had to get certified in ACLS. It wasn’t your typical acls for us, because one of the program heads was taking the course with us!!!! Can u believe that? He was one of the doctors that gave interviews to some of us. SO we were under a lot pressure not to fail !! You should have seen our group in the course. Its like we had a final coming up. We stayed up studying late at night the ACLS course manual and videos. We even stayed longer at the ACLS center trying to get the megacode right. The test was 25 questions and luckily was easy. (THANK GOD)

Anyways I spend the whole week filling out paper work . Going to meetings. Getting the health insurance details worked out. We even had a residency meet and greet for our families. A lot of the new residents. Bought their families. I brought my wife. It was a good meeting I introduced my wife to some of the program heads and the chief residents. Overall was a good meeting. We met all the spouses of the new residents. I was happy I brought my wife, because she is also an IMG and it was good for her to meet the department heads. They even asked her if she had ECFMG certificate yet, so that they can interview her, which must have been really nice to her. A lot of programs these days do that. They will accommodate couples in residency. And hopefully she will get that. She is hard working and good with people. I’m sure a lot of people think that it might be a but un-fair. I was speaking to one of the other residents about this, but the reality is that a lot of programs are swamped with application 2000-3000 applicants, and its hard to find the right person for the program. I get a sense that these programs will take a chance with someone that they might know, than someone that is not familiar with them. I remember interviewing in a program in texas. And the doctor interview was surprised that I even applied their, because the majority of residents there are through hook-ups or friends and family members of the residents of the program. So a lot of residency programs keep it in the family. That’s just the nature of the system. That’s the way it works.

Also, had a step 3 NIGHTMARE!!!!!!!!!!!!!!

I took the exam after 5 months of studying and on the second day the ELECTRICITY WENT OUT !!!!!! The computers just shut off. It came back an hour later. And as I began the block of questions, it went out AGAIN!!!!!!!!!!! And I lost the entire 2^nd day of the exam. I couldn’t believe it. I was shocked. I had planned to take step 3 before residency, so that I wouldn’t have to worry about it, but it seems like I’m going to have to take it again. I called the usmle board and they said I can retake it. But being that I’m not even going to have the time, I’m just going to have to retake it again soon. Maybe I might take it in January.

I called the board and they said that they would grade me on the blocks that I had completed, but in the end I still needed the rest of the exam, so they offered me a retake.

Let me tell you. I was in a deep deep anguish. Everything that I had been planning was down the tube. I couldn’t even sleep at night, I was so stressed. I have never failed any of my boards, but it felt like a failed. I understood a little more of what some people that fail experience. It’s painful. It hurts deep inside. You feel like a failure. Truly something I would not wish on anyone. Not knowing what to do about my stress I decided to take up this matter in prayer. When I got out of orientation on Friday, I went to the park by my apartment, and sat in my car in the parking lot alone. Trying to pray and meditate on the situation. I even stopped in Barnes and nobles and picked up a book called “You can if you think you can” by Vincent Peale. It’s basically a positive thinking book, but it’s also God centered. Reading the first chapter of the book really helped me. Basically the chapter said “ITS ALWAYS TO Soon to QUIT” and “Don’t give up !!” and “NEVER TALK DEFEAT” . Sometimes we have to fight for what we want. We cannot give up. Certain things are worth fighting for, and being a doctor is one of them. WE need to fight on. When the going gets tough, the tough get going. That, and also the idea that you are NOT ALONE. God is with us to carry us through these tough times. Lean on God. Lean on Jesus. He is their to give us strength in our weakness. When I doubt the future or difficulties all I have to do is look at myself in the mirror and look where I am. I have residency. It is a miracle. A true miracle. I’m living my answered prayer. I don’t need to doubt God. If there is trouble up ahead, then let it come!! MY God is there to carry me.

Although life has its happy moments and sunny days, it also has days filled with storms and stressful situations. But when the tough times come, who do u turn to? Where do u go? When a car needs repairs, it goes to the car shop. When your heart is broken, where do u go? Who do u turn too? Even though you are surrounded by people, doesn’t life seem lonely sometimes? Who do you turn to when know one around you understands what your going through? May I suggest Jesus. (psalms 23) IN GOD you will find peace for your soul. In God is where I find my rest. You can go ahead and try other things to try to repair the pain you feel in your heart, but when you have tried everything you can and it still doesn’t work. I suggest you get on your knees and open your heart to jesus. You call on his name. And you will find rest in your heart.

I start residency in 48 hours. There will be long hours and frustration and pain. BUT I say, Let it come. LET IT COME ! My God is their for me. And if life’s troubles forces me to knees, then I say let it come. There is no better place to be then on your knees talking and walking with God. I’m ready.

LETS DO THIS !!!!

GOD IS WITH ME !!!!!

God be with You

Dr. mike

Start of Orientation: Met the new residents (interns) today

Well today was the first day of orientation. (The official first day.) Although we start rotating officially next week. It was really interesting to meet the other resident that I’ll probably be working with for the next 3 years. There a really great group of people. I was surprised how friendly all of them were . Out of the 9 I say about 8 or 9 of them were really friendly. The only one that was not, was the oldest resident. But I suspect he feels strange being around such a young group. But overall he was nice. He was just serious.

But its really nice to know they hired good group of people. It was interesting to find out what exactly they did to get here. Today the program director welcomed us and she said that they received 1700 applications. (I later learned from the chief resident that they interview 350 people, and they offered about 5 pre-matches and they matched 4 in the match. They only went through the first 6 people on there match list. Usually programs match about 50-100 applicants depending on the spots. ) SO needless, to say I felt very lucky and blessed. I was surprised at the background of some of the new residents. About 3 of them already did residency back home, and 2 of them were chief residents, and even had they own clinics back home. ( 1 of them was from south korea, and another one from another “far “ country..lol.. I don’t remember.) I know one of them was a house officer in UK for a year. The rest of did research in the states. One of the guys did research at john Hopkins, the other from Michigan state, and etc. Others graduated recently from Ross university, and others were surgical assistants. So overall a very diverse group. Honestly, I tell you. It seemed strange, but it didn’t seem that anyone stood out. They were all IMG’s and only one of them graduated recently. I get the sense that they hired almost a big portion of their decision, based on the personalities of the people. Meaning they hired a REALLY REALLY NICE NICE group of people. I mean everyone is a real joy. Which is strange. I would expect some of them to be arrogant pr_cks. But they were not. Kinda strange… its hard to explain… but that’s the sense I got. Some of them graduated about 15 yrs ago!!!! Lol……

Anyways, it was nice to know that most of them were nervous like me. But we spoke to the 2^nd years and chief residents, who were really nice. IT was just 1 big happy family. I was ready to take our some marshmellows and build a fire so we can all hold hands and sing kumbyya…lol…

Overall a good and exciting day…. I really look forward to starting soon…… GOD is good.

mike

2 weeks till Residency Begins !!!

Well I went today to the hospital to observe for a few hours before I start. I have orientation on monday. the orientation last a whole week. I was really impressed with the program. The residents really seem close. I was expecting a group of competitive people. But they were all nice and willing to answer any questions I had. They all told me to "go home!!, what the heck you doing here?" They advise me to get some rest, because I'm gonna need. I took their advice at went home at 1pm.

I tagged along pgy1 resident (first year). She was really busy. she had about 12 patients. I got their at 7:30. I had a feeling she was there probably 7am or earlier !! wow, i was surprised. (kindof) I think I slowed her down a bit, but she understood. She was trying to write her notes fast.

I finally understood what they mean when they say 1sy year is the toughest. the interns are the ones that do almost ALL the notes and writing. So thats what takes up most of your. The second years watch over the interns (1st years), but the interns does everything.

But I can't complain. Its to be expected. Thats what we are here for. We need to start somewhere. Theres nothing wrong in hard work... anyways, of to take a break before next weeks orientation..... wish me luck...

God bless you all............ you can do it!!!!!!!!

Pain and Disapointment Meets Hope (part one)

If you ever failed a USMLE exam or failed to enter residency then you know the feeling. You know the disappointment. You the know the pain. You feel like a failure. All the hard work , and all the years spend trying to become a doctor seems like a waste. Most of all, the questions and inquiries by your family members wondering what happened. The constant annoyance of having to answer to them and letting them know that you failed again, or that your plan didn't work out. Maybe you even resort to not being completely honest of the situation, just so that you can avoid the pain of having to tell your parents , friends or spouse that it will be another year with out a job. Another year trying to figure out what went wrong.

I know how it feels, because I ‘ve been through this THREE times. And each time it doesn't get any easier. Pain is there, and its real. And it hurts. Its hard for someone outside of medicine to understand truly what we have been through. But I'm writing this to let you know that there is hope. You can keep your head up.

What has always giving me peace and hope is knowing and believing that God is always there for me. It is what brings me comfort. Not everyone even believes in God. I'm just someone that chooses to believe in him. But that choice to believe gets stronger the more I'm given energy to keep going. God has never let me down. I feel I was meant to be an example for many people. I truly believe I was placed on this planet to make a lasting difference in people lives..

(to be continued)

Welcome to my Blog!!

Hi

Welcome to my blog. If you don't know my story please click on one of the links on the RIGHT. For those that don't know. I'm an IMG (international Medical Graduate) who has been appyling to residency for 3 years unsuccessfully, until recently- with prayers and Hard work was given a pre-match Spot at an Internal medicine Residency Program. With regular scores on the USMLE and and 5 year graduation date. I was blessed to be given the opportunity...

I felt like starting this blog as a testimony to the Goodness of God and Jesus Christ my savior.