Day 65 : My First Four months as a PGY1

First of, let me say that I apologize for not regularly updating the blog. I'm now in my fourth block . I have so much to write about and tell you guys about. It’s just amazing looking back just four months ago. It’s amazing how much you pick up and learn in a short period of time. We started 4 months ago on call nights- supervised by senior residents. And just 4 days ago, I started night float (which means I'm oncall covering "ALL" the hospital beds except the ICU) by myself!! If I find myself with challenges I can page one of the seniors, who probably isn't too happy because they are covering the intensive care unit; which presents with its form of problems. Just last night, I had a patient who an RRT was called (rapid response call) because of change in mental status and hypoglycemia. The house physician called me while I was doing admission in the ER. About 2 hours after that I was at the telemetry unit, where the patient was, and she again started having change in mental status. I went to her room- calm !! (I really wasn't nervous. Its amazing) she was disoriented, we got vitals on her, rechecked her blood sugar on her right arm , and it came back 140. She still didn't seem right so we gave d5w 50 ampule. One of the nurses suggested we retake the blood sugar again (finger stick) and it was 50!!! amazing 2 separate readings, with the same machine. Anyways, I put her on a d5w drip at a rate of about 80ml/hr with frequent blood sugar checks q3hrs. She had received too much of the novolog that night, so i guess it kept bringing down her sugar. The point of all this that I'm saying is that, 4 months ago, I didn't even know who to give an aspirin to!! I mean, when you first start, you are a bit nervous, and you hesitate to do things. But its amazing how fast God allows me to pick up things. Just 2 night ago, I was called for a patient that was receiving dialysis and had episode of vomiting coffee ground, I took orthostatics measurements, put him on H+H q6h, BMP-stat, abdominal x-ray (rule out free air) since he complained of abdominal pain with sever burning type pain) gave give IV nexium 40mg bid. It’s amazing how it all comes to you, but I learn a lot by seeing the attendings day in and out and how they manage medical conditions and problems. I just tend to remember exactly everything these guys do, and I just copy them! A lot of the medical conditions, you see over and over again. CHF,COPD, MI,Chronic renal insufficincy...etc.. you see the same things so much that you become an “expert’ at treating them. And every day you learn something. until one day, you find yourself alone and taking "care" of entire floors by yourself!!! ( Like I was last night.) Truly amazing. I'm very grateful to God for all that he has allowed me to learn. But, let me tell you, some nights are just very stressful. We had guy last night that came in with chs exacerbation and troponin of 12.32 !!!!! The guy was DM and wasn't even complaining of any pain. We put a heparin non-weight based protocol on him, and we upgraded him to the unit. HE had severe pitting edema 4+. We gave him Lasix 40mg BID, ASA 81mg, and b blocker, ekgQ8H etc. One of the most helpful aspects off it is that the team at night works very well together. We usually just call each other on the cell phones, its easier than just paging and waiting for call backs. Its works well and we get along. Not all of the residents get along, but for the most part they do. Yesterday was pretty bad, two of the seniors were arguing because one of them didn't respond to a call in the ICU. One of the 2nd year residencts (nice guy that came from mount sinai/ny) was doing admission for MI in the ER. And there was a page over head in the ICU and pages for him, for a patient he was covering. He didn't respond and was arguing with the other senior about answering the call. The senior went to the bed side, and the problem was solved. But there was a lof of tension between them. There was a complaint filed on the resident by the nursing staff. And what was even more shocking, I learned that this 2nd year mount sinai resident was DEMOTED yesterday !!! to 1st year. It seems like he hasn't been able to adjust to our hospital. He came from new york sinai, where I guess the system is a bit diferent. That and other reasons, he was placed as a 1st year again!! I felt really bad for him. He was really upset. We suspect that he might leave. He is a smart guy too. He got 90 on his boards, but somehow, he has not been able to get it. He hasn't adopted to the hospital routines.He takes 2-3 hours to do admission, and is not really helpful in the morning with rounds when we see the patient. He is vey nice but seems kind of lost. He will come around hopefully and will be ok.

I have so much to say. I'm learning so much about medicine-the good side and bad side to it. The hardest thing for me has been handling the emotional tiredness. It seems like the problems build up sometimes, and at the end of the day you feel wasted and tired. It really drains your energy. But thank God for his mercy and strength.
On a personal note, I'm kind of going through some personal turmoil. Its hard, because I can’t find someone to talk with it about. I've been trying more and more to get closer to God. I just find myself distracted,so that I haven't had time to spend time meditating on the things of GOD. Its great to be a doctor, but its even greater to be closer to God and Jesus. But day in and day out, I feel myself distracted. I come home and I'm so tried , I don't pray as I should and I find myself just drained. I'm trying to find rest for my soul but haven’t found it completely at times. Its hard, but God is merciful to me.
I understand my life better. Just yesterday a friend of mines called me because he met a guy that had 88 on step 1, 84 on step2, 86 on step 3, had done observation, research, had also been working as medical assistant, and also had h1 visa (I think), and he has not been able to get residency. And here I am with step 1 score of 78, step2 score of 79, and I have a internal medicine spot-CATEGORICAL !! Its just truly amazing to me. I really don't deserve it. I don't know why GOd is so good to me. I just wish I can give more of myself to him. I struggle so much. I only want to do the will of God, and I'm willing and trying to go where ever he sends me. I don’t take credit for anything. I believe that I scored low grades on my boards because it was the only way that God was going to demonstrate his power to me. Sometimes when you accomplish certain things you tend to take credit for most of it. But when the impossible happens (like it did to me) you begin to see the goodness of God you begin to see the grace of God. And it is good. I truly believe I was meant to be here. And I pray that I continue to learn, and to dedicate time in serving other people. In trying to help those that suffer. I really don't care about the money. Money is the last thing on my mind. I would be a doctor even if there was not a salary involved. I think that doctors shouldn’t make as much as they do. Because for them it becomes an economically profession, instead of a soul profession. We are here to help those that suffer. Not help our pockets. Happiness in life comes from loving god and Loving others, and seriving those that are in need- In giving hope to the hopeless. In trying to relieve someone suffering. But one thing is for sure- Medicine has its limits. I have seen it myself personally. Their are patients that I say daily, that are terminally ill. And medicine can't do anyhting for them. How do u heal a broken heart? How do you heal a broken spirit?

When you have no inner strength to go on with the trauma of life, where do you go? what do u do? I have spoken to people who are at there last moments of life, I have told them that they are not alone. GOd is with them. No one understands what there going through, except someone all powerful and all knowing being that sees into the hearts of others. God can heal a broken heart. He can comfort anyone-even those with terminally illness and dying of irreversible processes. Jesus has come to heal the broken hearted, and that is my message to those patient sI see who are in despair, and in need of healing their inner spirit. Medicine has its limits, and I have learned that painfully-seeing the death of those around me. I have spoken to those who are dying, and I believe I have brought them a bit of hope and a bit of comfort. I presented the idea that they are not alone, and that what has happen to them is not fair, and God will make it up to them in the world to come. He will provided. He will ammend. Perhaps not in this life, but in the life to come. Death is not the final journey, but only the begining.
I know alot of people will not agree with my religious views. I'm sure some might be even atheist, and that is fine. I'm not trying to get into s debate. But I believe a spiritual problem needs a spiritual solution. A broken heart needs healing (and I'm not talking cardiology) when life hurts and ambien, xanax, morphine, pca pumps can't relieve your pain, what do you do? where do you go? When you feel that life is crashing on you and you don't have a place to turn where do you go ? what do you do? perhaps you do drugs, drink alcohol and get high to relieve your pain, but what do you do afterwards? How do you heal your heart my friend? This is not about getting into debates about the existence of God. This is about healing your heart. Perhaps your in pain right now. You have failed your exams. You have failed getting to residency. You have failed over and over again. And your heart hurts. Now what do you do about it? You need a solution. And what is it? I believe the solution to your pain-the remedy for your heart is GOd. And I believe jesus provides a pathway to God. He is the way to forming a personal relationship with GOd. When jesus was here on this earth, in the first sermon he ever preached he stood up in front of a crowd and said " The Spirit of the LORD is upon Me…..he has sent Me to heal the brokenhearted" (luke 4:18). This passage represents the essence of what Jesus came to do. He came to heal your broken hearts. He came to help you to struggle with life and your problems. At this time of need, You don't need theories or proof of evolutionary changes, you need to heal the pain that you feel in your heart. You need relief from the stress that is over bearing you at moments. You need relief form the pain of life. And why not test GOD? why not fall at the feet of Jesus in all honest and pray for help? You have nothing to lose. And you know what, If God doesn't help, then there is no GOD. And the bible is false. The bible promises are true and so are the words of jesus. Jesus promises to heal your broken heart and help you to bear the pain of life. He doesn't promise absence of problems. He is a Sheppard guiding you through the valley of death. But he doesn’t eliminate the valley of death or problems. You will not find one passage in the bible that says that God will take away all your problems. But you will find hundreds where he offers his grace and HIS peace, and he doesn't require your obedience for his grace. GOd has been so good to me . I'm living proof of his goodness. I'm not a perfect person. I have alot of faults I commit errors, but God still offers his grace, he still offers strength, and he gives it to me free. I don't need evolutionary arguments to believe in GOd. What I need is solution to my problems. I need strength and peace in my life. And Jesus gives me that. It’s all the proof I need that God is real and that he is with me. Peace is real. My residency spot is real .My 78 and 79 on step one and a pool of thousand with higher scores and perhaps better qualifications are real. But nothing can stand in the way of Gods goodness and guidance. I only pray and hope that you find peace in your life. Make it your goal in life to serve others, Make it your goal to help relieve the sufferings of others. True happiness lies here. True happiness is a phone call away to God on your knees, through jesus christ.

Take care my freind. DOn't give up. Work hard, Try your best and Lean on God through jesus. Good luck this year in the match and future matches if that is the case.
YOu are not ALone.

God Bless you
Dr.Mike


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