Thank You God For Residency

Day 964: Last Day of Residency !!

2011-07-12T21:31:00.017-04:00

It has been a long time since I wrote in the blog, and I apologize for that. I meant to every day, but it was hard for me. In fact as I write this down its 24 hours since I finished my residency. Normally most residents finish July 1st, but because of some events over the year, I had to make up some lost day and clinic hours. I know that many of you have been following my journey throughout the years and from the bottom of my heart I appreciate your patience. I hope the time I spent here sharing my experiences and views helped lift you up from time to time.

Many things have changed throughout my final year in residency. I lot of trying times and heart ache. One was the farewell of all my the seniors and residents I spent my first two years with. I put my heart out on the line with many of them, and to see them go was very difficult. Also, my father passed away a few months ago. But not all has been sober. I have a new baby boy in my Life !! He was born in October 2011. He is the most wonderful thing I've ever seen.

I'll try to recall some experiences of my third year with many of you. Today I'm still trying to get use to the fact that I finished my residency. I wish that I would enjoy it more, but the stress of starting to work has come fast. In fact, the final 6 months of this year, I have spent trying to get my papers and license in order. There is this process called FCVS, in which you hand in all your paper work and medical school records and they keep it in their database throughout your life, so as to avoid having to ask your old medical school for records, however the process takes an extreme amount of time, if your an IMG. I studied overseas, so my school took months and months to send the paper work. In fact, I still haven't received all my paper work. Instead, I chose to apply directly to the state that I will be staying in: NJ !!

Its difficult to explain how I feel, right now. Its like a marathoner at the end of a long race. There is a sense of personal satisfaction, but also a deep sense of tiredness. You are trying to soak in the moment, and at the same time you just want to sleep for a week. But then again you can't, because you are soon starting a "real" job.

I've decided to work as a Hospitalist the coming year or two. I won't give all the reasons behind my decision now, but it seems to be a growing field in medicine. It offers you a decent salary and also time to spend off to enjoy other things. The trend seems to be working 7 days on and 7 days off. The salary ranges anywhere from $150,000-220,000 with or without bonuses. There are a lot of factors that go into the salary that ill talk about as time goes by. (maybe it might help those of you who are in your last year) Looking for work was a bit of a surprise, and I'll share my experiences. I went on many interviews and I would say that 95% of them were positive, and practically every place I interviewed offered me the position. I'm not sure that says a lot about my qualifications, as it says for the shortage of Hospitalist that are desperately needed in the hospitals. The majority of my class mates became hospitalist and decided to practice out of the state. Only 1 or 2 were interested in fellowships. I think the majority of us just wanted to start working and move on with life.

My last day at the hospital was also one of the saddest. I went to the resident lounge to see it for the last time. I went to open my locker and I found that it had already been replaced with someones name (new 1st year). I was upset for a few seconds, until I realized that its a part of life. I still remember my first day in the resident lounge. I saw three of the graduating senior residents emptying there locker. they seemed in a bit of a hurry and not extremely happy, but then again I was so happy and excited that I didn't dwell on their demeanor much.

Tomorrow I'm heading over to my new hospital. I have to sign bank papers and insurance papers. And I also need a physical and PPD testing etc...

Overall its a new start and new beginning in my life. I wish I could enjoy that it was the last day of residency, but there is a new start and a new beginning coming.

However, my main reason for coming here to write a blog was to give thanks to the person that has helped me the most: God and the people he placed in my life to get me to this point. If not for God there would be no me, and there wouldn't be days like today. I think he placed many people in my walk of life that helped me to get to this point and to give praise to him.

No matter what happens in my life: the heart ached, the triumphs or the let downs, God's goodness has been one constant in my life. I have always felt the loving hand of God around me. A father and a positive friend. Always there to help me and guide me through the toughest times in life. I felt that I neeeded to share my experiences with trying to get residency; with trying to do what seems impossible for many of you: getting residency in the states. I feel that it was truly a miracle of God, and no one will ever take that away from me. I hope in this long journey that I have at least helped one person to feel good about themselves. My only wish was to give someone who reads this hope where there is no hope. To give someone struggling to get residency and finish there career a bit of sun light in the darkness that they might have experienced. I'm not smarter of better than any of you. Whatever blessing nad luck came my way, it was meant for the greater good. It was for a higher purpose. If my measly example can give one of you a ray of hope and can help those struggling with challenges, then every pain that I have felt in life is worth it.

GOd has freely Given, now I only wish to freely give to whoever I can.

Maybe you stumbled along this blog now or before, and you have been struggling to get residency. You feel despair. Your unsure of the future and all you see is darkness and fear. Well, I'm here to tell you to NOT GIVE UP. There is light at the end of the tunnel or there is calmness at the end of the storm. Sometimes that storm last a long time, and many of you have spent months and years in it, but there is a solution and there is a comfort. There are people out there that understand what your going through. I understand the despair and disappointment. And I would tell you friend to take heart. And when you feel alone or that there is no one that understand you, be of good cheer. God is there for you. Jesus and his holy spirit is there to comfort you. Tonight, alone in your room as you lay on your bed or as you drive to work or to the library, open your heart to God. Talk to him as you would a friend, and he will comfort you in your struggle.

Many years ago during a world war, a prisoner was dragged by a security guard to the bathrooms and was throne on the floor of toilets and was told to clean them with his bear hands. As this prisoner lay there humiliated and forced to do the unthinkable, the guard mockingly asked him "where is your God?" The prisoner from the floor looked up to him and said "He is Here with me."

And so in your room now where you read this. In your despair for residency and trying to accomplish the things you most want in life, GOD and Jesus is there with you. Its a very strange thing to explain, But he is there with you. We don't know why bad things happen to good people, but rest assured God is there with you. Even though you walk through the shadows of heart ache and death in this world he is there with you. Crying with you..... (psalms 23)

God Bless all of you...... May God give you peace and happiness in your life.

Don't Give up !! You can DO it !! Believe in Yourself . Work as Hard as you can, and let the chips land where they may...

Love

Dr.Mike

If God had mercy on my life, why would he not do the same for you?

Some messages of Hope for you:

Day 564 My personal Experience with the Scramble and Advice

2010-03-07T00:44:00.012-05:00

With several Days remaining till the match and the scramble, I decided to help. I have been through the scramble twice. I will go point by point.I think it could possibly help many of you.

1.Avoid Paying for Scramble services

There is a simply reason for why you shouldn't pay for a scramble service which basically automatically send off your cv and paper work to 100 program instantly, and that is because on scramble day you need to call EACH And EVERY program you are applying to ! Randomly sending it to a bulk of programs seems like no harm, but there are several problems with it.

* Many of these pay services email programs automatically. Majority of
programs suggest NOT sending emails. There is way too many emails to
read. These program only have several hours to fill their
spots, and they are not going to review all these emails, it just
takes too much time. They rather have paper work in their arms.
* These services send these random faxes and emails to programs that you
might not qualify for. IT raises your expectations. You shouldn't be
faxing programs that you do not qualify for. Don't waste your time and
energy.
* Too Expensive.

2. Get an extra friend to HELP you CALL PROGRAMS WHEN THE Scramble STARTS !!!!

As soon as the empty spot list is open in the National Match Registry. have an extra one or two friends on hand that will help you to start calling programs to ask them if you can send your papers. and whether you qualify or not. This is the most important thing to do on scramble day!! you need an extra one or two phone lines.
the secretary will tell you "yes your qualify, and please send your papers." This is perhaps the most important point, because they hear your voice over the phone and will be inclined to view your application. Or they will tell you "sorry we filled the spot" Don't take it too heart, move to the next number. You will hear many rejections that day. Don't waste time hang up and call the next. (I was fortunate to have my wife with me in the scramble twice. She was the greatest help!)

3. Speak Clear English over the phone when calling Program

When these programs hear that you are an IMG, they might think that you don't speak English. So many times when we called, the secretary was so surprised that I spoke English. Speak slow and take your time.If you are not good at English, just take your time speaking.

4. Have A fax at home or Use an online Fax Service (if you can afford it)

This might be hard for some, but you can fax your OWN papers to the programs, after you get off the phone with them. If you cannot afford a fax, then try to use an online fax service if you can afford it. You need to upload the papers to the fax service online, and then after speaking with the program send the fax. I personally don't have any experience with them, but its optional.I always used the fax machine,and it worked almost all the time.

5. The night before the scramble Be prepared with a List of who you will Call

The scramble is the day after the Match. There is no time to waste. start making a list of the programs you qualify for and get ready to call them. If you want review last years unmatched if you want an idea of the programs that will be possibly open. Right it in a neat paper. Make copies and hand them to your friend, and start calling. check the Match schedule site for the time of when the scramble day starts.

6.Be prepared for possible phone interviews

There will be programs that might give you an interview over the phone. be ready and speak slowly. Offer to travel to them for a live interview if you are in the same state !! They will love to see you go personally. (this is highly optional)

7. Prepare all the paper work you are going to send over the fax.

8. If you are in the same state as program,Let them KNOW you are in the same state few miles away!!

And let them know that if they are going to offer live interviews, that you are available to go the SAME DAY! I experienced this once. I was in the same state of the program I called, and they told me to go over for a live interview. IN fact going there changed my life. (following the link of my story on the bottom)

9.Put your ego aside. Call ALL THE PROGRAMS and specialties you Qualify for.

This is not the time to be picky. You need to call all the programs you qualify for. The name of the game now is to get any spot you can!! Put your pride and ego aside. Open all your doors.

10.Use 2 laptops and Have a good internet Connection

Make sure you internet is working.If you have too, tell your friend to bring there laptops to your house to help you.

11. Clear your house for the day. Make your house scramble central. Tell anyone in your house that is not going to help to leave you alone. You don't need any distractions.

12. PRAY the night before the Scramble.

perhaps you might not feel like it, and your heart is broken and you feel lost. This is the proper time to humble yourself and get on your knees and pray to GOD. I don't care if you are religious or not. This is no time for debates. you need help, and GOd can Help you. In the darkness moments of our lives, I really believe that God is there for us. come what may. It is difficult to get through these times, and you might not have the mental energy and strength to even go through the scramble. I still remember the night before the scramble. I had checked my email on match day and read the email that simply said "you did not Match" It was one of the lowest points in my life. It is very painful And many of you reading these will experience this. And from someone that went through 3 three matches and 2 scramble, I can tell you that don't lose hope. Life will hurt sometimes. there is days that shouldn't happen. But being that they do and you can't avoid it, you need someway of getting through it. God will not abandon you. he will carry you and help you get through the scramble, whether it works or not, you would have at least have the strength to get through the 24 hours. If you don't believe in GOd, it doesn't matter. God believes in you. He will help anyone that ask. God doesn't judge you. He will help the worst persons of all of us. Without merit. God will give you hope. you have nothing to lose. Try GOD.

A simple prayer or conversation as you would have with a friend. lock yourself in your room the night before the scramble and talk to God as if he was standing next to you. He will listen.He will help.

I hope this has helped many of you.

Good luck !!!!

God Bless. jesus loves you

Dr.Mike

You can do it!!!!

MY match Experience & how it changed My life
(http://http://thankyougodforresidency.blogspot.com/2008_08_01_archive.html)

Day 560 Tips from a Program director

2010-03-05T05:37:00.008-05:00

It was around 1:15pm in the afternoon when I over heard a conversation from two faculty members in the clinic. Interestingly enough, they were talking about this years match, and about the thousand applications they had just received. The conversation I heard went like this.

Attending: "there are so many applications, and they are all qualified. It so hard to just settle on a few."

program director: "I known what you mean. What I like to do is look over several important points in the CV. I don't really look over the transcript much, as I like to look at a few things. For instance, I like to look at how many letters of recommendation this person has. A lot of times you see someone that has accomplished so much, but only has 1 letter of recommendation. I would like to think that they have met more than one person in their life that can talk about what they have accomplished and what type of person they are. Also when it comes to the letter of recommendation. I like to see long letters of recommendation. I want someone that is talking and writing something meaningful about the application. I also pay some attention to the personal statement. I try to find something that makes them stand out in the personal statement. I want to see something different. Some new experience that I have not heard about. In general also, I like to sometimes see a long CV. I want to see what exactly they have been doing all this time."

I stood there really trying to grasp everything they were saying. I was actually in the room and they saw me there. They really didn't seem to mind that I was there standing. I really found these few tips helpful. I have spoken to this program director last year. You can find our other conversation following this link (http://thankyougodforresidency.blogspot.com/2008/10/dr-mikes-getting-into-residency-for-img.html)

I hope this helps someone. Good Luck this year. You can do it!!!!

God Bless

Dr.Mike

Day 546 Acing your Residency Interview

2010-03-05T05:25:00.007-05:00

I found the following article from an expert on residency interviews. She is a consultant for medical and residency program admissions.

************************************************

Most residency applicants have not found themselves in the interviewee seat since they applied to medical school. Well, the residency interview is somewhat different from the medical school interview. Because you have now nearly graduated from medical school (for the traditional applicant), no one is trying to assess your commitment to medicine; rather, they are specifically evaluating your commitment to the specialty to which you are applying. They also are evaluating your ability to perform well as a resident and if you will be a good fit for their program. This article will provide some tips to help you succeed, whether you are applying to residency this interview season or in the future.

Clearly articulate your interest in the specialty to which you are applying.
Residency program directors must be convinced that you have a genuine interest in the specialty and a clear understanding of what it means to practice in that specialty. They also want to know that you are motivated and that you will work hard to become an outstanding clinician. The question “why THIS specialty” will undoubtedly come up at every interview, and your answer to this question must be clear and well thought out. Don’t just say the obvious, but try for a response that will set you apart from other applicants. For example, as the associate program director in emergency medicine (EM), when I asked the question, “why EM,” I heard this response more times than I can count: “Well, I liked everything in medical school and I enjoy caring for high acuity patients so EM was an easy choice.” A more memorable response was, “I have been interested in EM ever since I was a patient in the ED during my second year of medical school. As I watched what was going on during that roughly six hour visit, I realized that the emergency physician who cared for me represented the type of doctor I hoped to become: someone who could manage anything that came through the door, was kind and compassionate and cared for a diverse group of patients. My time in the ED as a patient really made it clear that EM was the ideal specialty for me.” You should also try to substantiate your answer by using examples from your rotations in that specialty to illustrate what you like about it.

Be personable, energetic and communicative.
A large part of your residency interview will focus on the evaluation of your interpersonal skills, including not only how well you communicate but your demeanor, enthusiasm, compassion and general attitude. These skills are important not only because any physician, regardless of specialty, must be an effective communicator, but also because program directors are seeking applicants who will be pleasant to have in their program. You will be spending three to five intensive years in this program so interviewers try to match with people who will be a joy to train. To assess an applicant’s ability to communicate, many program directors ask them to describe an interesting case. International medical graduates (IMGs) who are not US citizens are most likely to be asked this question.

Have a clear idea of what you want to convey during your interview.
Why is this important? Many residency interviewers have little interviewing experience and simply do not know the best questions to ask or what information they should obtain. Your interviewer is your advocate on the residency admissions committee, but he or she can present the committee only the information you provide. If interviewers fail to ask you pertinent questions because of a lack of experience, their presentations in support of your candidacy may be weak. So, it is your job as a residency applicant to be proactive; tell them specifically why you are interested in the specialty, what you have done to explore this interest and what makes you a unique applicant.

Be sure to bring up “red flags.”
These red flags include board failures or major gaps in time. Even if such topics do not come up during your interview, they will likely be discussed in behind-the-scenes discussions, and you are sunk if your interviewer does not have a defense for you because the issues were not addressed.

Project a good image.
No, you won’t be evaluated on your attire, but you must appear to be mature, professional and well-balanced. This means you should have good posture, make eye contact with everyone whom you meet, speak clearly and articulately and convey confidence but without any hint of arrogance. Your interviewers are also trying to rule out any underlying psychopathology; a program’s worst nightmare is to have a resident who might have a personality disorder, a hidden substance abuse problem or a tendency to cause trouble.

Have a sense of why you will be a good fit for the program.
It is important to have as much information about the program before you interview. Sometimes this information is easy to find on websites but, if not, you can also learn about programs at dinners or events the night before the interview day (if offered) and at presentations during the interview day itself. While it is important to be authentic during your interview day (most seasoned interviewers can sense if someone is misrepresenting himself or herself), you can tailor your responses to become a better “fit” for the program. If a program is largely community based, for example, you don’t want to emphasize that you hope to become a physician scientist in the future. In contrast, for the large academic program that boasts residents’ scholarly pursuits, you would want to highlight your past academic achievements and mention that you might consider an academic career.

Be friendly and respectful towards the residency coordinator and residents.
Residency coordinators and the residents you meet have tremendous influence in this process. The residency coordinator who has a negative impression of someone often will mention this to the program director. By the same token, residents’ opinions of applicants are also taken in to consideration, especially when they are extremely positive or negative.

Be prepared for specific questions if you are an IMG.
The IMG who is a United States citizen likely will be asked about his decision to go abroad for medical school. When I do mock interviews with residency applicants, I find that most clients initially give this type of answer: “I wanted a different experience and to learn about a new culture.” When I ask for the “real” reason, they reveal the truth: “I couldn’t get into a US school because…. After doing research, I realized I could do well by going to XXX medical school.” I encourage applicants to always tell the whole truth. The IMG who is not a US citizen should be able to discuss why he decided to pursue residency training in the US and his path to residency. As discussed above, most non-US citizen IMGs will be asked to talk about an interesting case.

In summary, remember that most residency interviews are directed and conversational. In my work with clients I find that some interviews are becoming shockingly brief – some clients tell me that interviews last only 10 to 15 minutes. Depending on the program and the specialty, you will have at least two interviews but may have up to five or six. Usually, the more interviews you have, the shorter each individual interview will be. On average, though, an interview will last 20 minutes. This brevity makes it important to have a clear idea of what you would like to talk about on interview day. Also be prepared to talk about the same topics repeatedly since most interviewers are trying to ascertain the same general information.

Here are some topics that you should be prepared to discuss at your residency interview:

* Tell me about yourself.
* Why XXX specialty?
* Where do you see yourself in the future?
* Why do you want to come to this program?
* Tell me about an interesting case.
* Tell me about your rotations in XXX specialty.
* Tell me about your greatest strength and weakness.
* What are some issues in health care today and how will they impact this specialty?
* What are the negative aspects of practicing this specialty?

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

Day 543: Life quote

2010-02-13T21:34:00.001-05:00

“The weak can never forgive. Forgiveness is the attribute of the strong.". -Mahatma Gandhi

Day 540: For those Waiting For Residency,Match, and Hope

2010-02-10T06:54:00.017-05:00

Someone once said that if you treat a man as he is, he stays as he is. But if you inspire someone; if you believe in them; if you see more than they see; if you treat him how he ought to be; then he becomes what he ought to be. I hope that in the coming match and coming year I can pass to you what was given to me. We can only give what we have received in life. And what I can give you is words of hope. Words of belief and words that were once told to me. When you look back in life you will never forget the individuals that inspired you and that have made you believe that you can be so much more in life. I can only tell you friend to don't give up on your dreams. Life may seem unfair and unjust at this point in your life, but don't give up. There are people that believe in you. I believe in you. God believes in you. The final chapter of your life has not been written yet. Sometimes your heart hurts. It is unfair and makes no sense, but just remember you are not alone in your struggle. Many people in these forums and I understand what you are going through.

Throughout your walk and journey towards residency or towards the next chapter of your life. Don't forget what really matters in life. Sometimes the greatest things you need in life are right next to you. They are found in the people that surround you and love. They are found in the smile of your children. It is found in the warm embrace of the person you love the most in this world, be it whom it may be.

You are not alone. Don't give up.Keep your head up. I felt that I had to say that to someone reading this at this moment. Perhaps you needed a pause in your life and reflection. Perhaps circumstances causes you to look again at your life and question where you are or ought to be. Sometimes in life you get everything you want but not what you NEED.

Spending months and months surrounded by people sick and dying has only made me appreciate the smaller things in life. Has made me love my wife more and more each day.

Take time today to spend time with the person you love the most.Call them. Email them. Send them a message. Tell them thank you for their patience. Tell them how much you appreciate them. Life is so fast and short. Don't let the struggle to residency and match take time from spending with the people you love. Sometimes in life you will find strength to keep moving in life by the people that surround you.

Although life is filled with difficulty and heart ache, it is also filled with special people and special moments. It is these moments that give you strength when you can no longer walk or run....

If by any chance you are someone that is far away from home, stuck in a part of the united stated living by yourself and feeling alone right now, I'm here to tell you that you are not alone. There is someone that sees your tears and weary heart. I believe that person is God, and through his son jesus Can give you the strength to carry on with your life.

Don't give up. You can do it. When all is says and done at the end of the day ask yourself only one question "Did I do everything in my power? Did I try with all my heart and soul?" If you answer yes to this, then you have already succeeded in life. What you want in life and in accomplishing a task is to give it all your heart and soul, and whatever happens be as it may. If it is written for you to be a doctor or a plumber, just know that you have not failed in life. Failing is not trying. Let God and destiny take you where it may....

There is a country song called "the weary kind" (found at this end of this message) In the chorus of the song there is a part that says "pick up your crazy heart and give it one more try..." Perhaps this year I pray that you could pick up your heart, and you give the match or residency one more try. But this time around you give it all. And "let the cards fall" where it may.

Measure your success not by the materials that you possess, but by the people that surround you, and by the moments you have spend life in love...

God be with you friend... Jesus Loves you....Keep your head up.....best of Wishes..
I believe in you...jesus believes in you.... if you need a friend you can talk to him like one...he is only phone call away through honest and sincere prayer....

God Bless.

Dr.Mike (pgy2)

Don't give up my friend.... God Believes in you.......

Day 538: Good Cop. Bad Cop

2010-02-06T12:00:00.010-05:00

I still remember when I visited a program for a residency interview and one of the invited interviewers asked the program director- "In all your years here as program director, what makes a good resident? who were your most memorable residents, and why were they special? What made them stand out amongst the rest?" He stood quiet for a few seconds and then responded by saying "I have been program director almost 20 years, and when I look back at all the residents I have ever had, the really great residents where the ones that truly cared about their patients. They always where asking why things were happening and were always trying to find a solution. Their were many times I asked residents what certain things were happening in their patients, and many of them never bothered finding answers or maybe never really cared that much."

At the time I never really could appreciate or understand these words, but I did yesterday. We had a patient that was admitted to the unit for abdominal pain and had developed a doudenal perforation, and she then became septic and had DIC (disseminated Intravascular coagulation). She had been placed on pressors for her hyotension and was getting antibiotics and frequent platelet and blood tranfusions for her condition. I also believe that she coded one time. On of these special residents had been involved on her care the entire time at her stay in the unit. She had been working vigorously with her for almost 2 weeks. The code status had not been fully adjusted and there was no agreement because the POA was a 21 year old nephew. So whether or not they should have gone as far as they did, could have been debated. The patient yesterday seem to be in her final stages of battle with sepsis. She had been on levophed and "maxed" out (according to the ICU attending, there really is no max on levophed you can go higher with the doctors approval.)The fact that they went higher on the levophed also caused more vaso-constriction on her hands and feet, and she had been developing gangrene on her hands and feet. In the morning the intensivess had passed by to see her progress, and he was told that her direct billirubin had been going up to 20 (it was believed that maybe it was caused by the tpn, so it was stopped.) They had done a hida scan and had showed that the bile duct was being obstructed. GI had seen her and did not suggest any surgery or further testing at the time except a liver ct. The intensive said that I think its time to let her go. Within the next 3o minutes he called the family to give them the bad news. The resident that had been working trying to keep her alive also tried to contact the family. The family was not yet fully responsive and wanted a few more hours to think about it. In the afternoon the family had passed by and as I walked into the unit around 4:30pm this senior resident told me "I made her comfort measure."

I turned to her and said "you did the right thing." She only smiled and started walking to visit the patient room again.

I stood around till 5pm because I needed sign out, and I was on call. She then told me "I'm going to go into room and I'm going to do the terminal extubation." The family members came out of the room, and she went into the room with 1 nurse and the respiratory tech. It took about 10 minutes when she finally came out of the room. She turn to me and said "I did it."

She then walked over to the vital signs monitor to check on the vitals signs of the patient she just terminally extubated. It was amazing to see that within 1-2 minutes her heart rate when slowly down. 80...70...60....50...20...0. Then next to go was her heart monitor. Slowly it flat lined. I stood their quietly observing her reaction. She stood their staring at the monitor quiet with her hands folded and one arm over her mouth. She seem to be thinking about the moment. She turned around and started walking back to the resident room. I met her half way and told her "you know... you did everything you could. She was lucky to have you as her doctor. You did the best anyone could. She couldn't have lived longer with nay resident, but you." She looked at me and stared down at the floor. I think she wanted to cry but she felt shy. I put my hand around her shoulders and gave her a short hug. She sign off the other patients she had in the unit, and I told her "you can go home now."

As I walked out of the resident room thinking about all that had happened and as I was about to walk out of the unit, I turned around to look back at the patient room. I could see this resident going back into the room and I could hear her tell the nurse "we can get them the funeral numbers if you need them. Let me help you."

It was passed 5 pm and she was signed off duty. But I know she was staying longer, and she did...

On my way driving home I thought about what I had just seen. I was glad that I was their to witness what I had seen. It was good to see someone who cared. Someone who had fought for someone else. She had earnestly tried everything she could and you could see. It is good too see "bad" and "good" physicians. Its good to see people who care and don;t care. You learn what you shouldn't be and what you should be.

Looking back on what I had experienced, I knew that I would always have a clear picture in my mind off what makes one doctor stand out above the rest; about what makes a human being a special one. It is healthy to have good passions, it is even better to have passions directed towards helping others. It is not really what you know, but how much you are willing to help someone. Even with limited knowledge, someone who is fighting for the life of someone, will find answers.

God Bless.

Dr.Mike

Day 530 : ZZZZZzzzzzz.....

2010-02-06T09:12:00.020-05:00

Well I just had the busiest night in almost 2 years in the hospital, and I think we broke the record for the most unit/ccu admissions in one night. IT was about 8 unit admissions. I have started the night float, and my night began around 7pm. It usually starts around 8pm, but a friend of mines called and asked if I could go in early. I got there at 7pm and right away a friend of mines called me to do a unit admission. He was originally suppose to do it, but since it was close to 715 and they usually take around 2 hours, I did him the favor. Anyways, so I head out to go do the admission, and it was for multiple drug overdose. Apparently, this 19 year old girl had take 4 full bottles of medication wellbutrin, propronalol, and 2 other pschy meds. IT seemed like she had a long history of mental disorders. I spoke with the e.r physician and the nurse, and she was found in the room lying on her bed very lethargic. When she came into the E.R. she had a generalized tonic clonic seizure and she had been intubated. It seemed like a pretty straight forward unit admission that we get in the E.R. As I was approaching the bed of the patient the nurse hands me the paper work and he also says, oh yeah and by the way she is the daughter of one the members of the senate or governors office of the state. I was like "huh?" I got a little bit nervous. I try to play it off like it wasn't a big thing. "Ok...no problem." I proceeded to the bed side and when I arrived there, the pt was intubated, and I didn't see any of her parents. I went back to the nurse and asked if he knew where the parents were. HE went outside to get them so I could speak to them. Geesh, I don't know why I was so nervous. I was breathing a little heavy, I guess because its someone who is "famous". Most of the people and including the e.r. attending seemed paranoid too. Anyways I met with the "member of congress or senate" No noe knew if it was for sure. They seemed very pleasant and concerned about what had been going on. I told this individual that poison control had been called and she was receiving all the appropriate medications. Her vitals were stable and her oxygenation had been wnl. She was on fiO2 of about 40percent and her saturation was about 95%. She seemed comfortable. According to poison control because of the propranolol overdose, they had place a lipid infusion. It was a very rare recommendation. The director of poison control had to be called because he had not seen it in 20 years. The fact that she was also on this lipid infusion also meant that it was binding to her propofol and versed, so she was very arousable. I had to discuss with pharmacy for another agents that we could use. In the end we dscided to give her boluses of ativan and fentanyl as the last resort. After speaking with the parents, I went over to the internet, because I didn't recognize this supposed member of congress. I checked the states website and It WASN't the senator or governor who I had spoken too. (later on the following 2 days I found out that it was an official from one of the "local districts" or possible state "assembly".) Anyways, regardless of who it was, I was a bit scared I guess. Whenever you are around a person of "power", I guess you think twice about what you did, and you want to do a good job. They even labeled her a vip, and gave her the best available room. Well after I finished this admission, I went over to try to get the sign out from the ccu resident. I called his cell phone and he said that I better come sign out to him in ccu. I didn't like the sound of that, but I went anyways..lol. When I got there, everything "seemed" in order except for the patient in bed 8 whose heart rate was in the 180-190's. She was also in the middle of dialysis when it was going on. It was probably only my second time having to personally deal with it my self. (We see it a lot on the floors but the cardiologist always handles it.) It seemed like svt on the monitor we got a 12 lead ekg that showed svy at 160. We had given her multiple bolus doses of lopressor and cardizem, but she was still running 160. So we decided to give her adenosine 6mg IVx1 which didn't break it. We were looking at the moinitor to see if we can see the underlying rythym. We gave her 12mg adenosine push and at first we didnt see any change, but then in about 2o seconds we saw the underlying a.fib or a.flutter. Me and the other resident were so happy !! We then decided to call cardiology to let them know what we had done. The suggested cardizem drip. So we started it, and no heparin drip. Anyways so I got the sign out of all the ccu patients. As soon as I got back to the lounge the other senior resident on the floor told me he had a unit sign out. I told him about the one I had done. He also gave me a floor admission with the intern. As I was going down to do the unit admission, I get a call from the ccu "hey doctor, you know the lady in bed 8 she is still tachy at around 170" I then hung up the phone and went to the bedside. She was still in svt. I really didn't want to call the cardiologist, but I had no choice to wake them up, it was not too late. He recommended to use digoxin 250IVx1 and then digoxin 125mcg uvx1 after that and also place her on lopressor 2 mg IV q4h. AND, he also added "you know you can cardiovert her if her bp drops." I answered "sure...I will do it" SO I hang up the phone and told the nurse the plan. One of the head nurses asked me about the cardioversion. And I told her "he said we can cardiovert if we have to." She looked at me puzzeled "don't the cardiologist have to be at the bedside to do this?" I told her "off course, but I guess if they trust you, they might allow you to do it, lets hope that we don't have to do it." (I have seen it done in a more controlled environment in minor or, and not normally at the bed side)

Right around this time, I got another call for another unit admission. I went down to the E.r and it was for chf exacerbation for a patient on bipap. I went to see her and she seemed more or less comfortable. On the bipap she was saturating 94%. Right around the time I was examining her, the patient in the next bed started having a seizure (she was the other unit admission my friend had just done.) She was also in the middle of dialysis. I told them to give her ativan IVx1 and repeated it twice, and to call anesthesiology for possible intubation. I called my friend on the cellphone "hey, you know that pt you just admitted? she is having a seizure, you might have to come and intubate her." Sure enough he came down in a few minuted and they intubated her. Right around this time, the E.r attending tells my friend "by the way, there are 5 floor admissions." My friend looks at me and says "can you believe this guy? I think he is going home and just wants to clear all his work?"

Anyways, we grab charts and distribute the admission between us three (me, him and the intern) About 2hours into the last admission, my friend calls me and tells me "sorry mike, there is another unit admission." I try to finish up the last admission, and head over to the other unit admission. It was a female patient going to the unit for STEMI, she had st elevations on v2-v6 and she wanted to signout AMA. I get to the bedside and she tells me "I'm not staying, I'm going home. I don't have anything." I told her "you don't have anything besides a possible heart attack." AT this time her son. who is sitting next to her says "she ain't got nothing !" I look at him a bit confused and say "I'm telling her exactly how I would say to my mother. If you were my mother I wouldn't let you go home." So I convince her to stay till the morning-which it was. Just when I was finishing this admission, the intern calls me on the cell phone "hey I just wanted to let you know that I'm not letting a patient go AMA. He is not fully oriented, and I told the nurses." I said fine and hung-up the phone. A few minutes go by and I heard an alarm go off in the hospital speakers "ALERT CODE GREY, ALERT CODE GREY." I don't think twice about it, I told myself that it was probably the alcoholic patient he had just called me about. So I finish with the stemi admission, and head back to the lounge to see if I could get a break, when the intern calls me and says "hey, do you think you can take a look at this guy. he seems to be oriented but i'm not sure." just around this time the other senior resident meets me on my way to the floor. When we arrive, this patient is on 4 point lock restraints and a body net. I turn to the intern and say "this guy is in full blown DT's and needs to be upgraded to the unit and started on IV benzo's. I almost intubated the guy, but we decided to give him a chance. We started boluses of vallium and made the upgrade to the unit.

It must have been around 5am in the morning when I called the cardiologist for the STEMI admission. He sounded half asleep and said "did you check the last ekg?" I fumbled my words and said something strange, and he said "those are not new, she has thos from previous ekg's." I proceeded to apologize and also told him about ccu bed 8 "by the way she is still in the 160's. Her bp is stable, so we havent cardioverted yet." He muffled ok and went back to sleep. At around this time I got a call from the other senior who had been called to another unit admission, and he wanted my help to do it faster. So i went down with him so we can finish it up. I don't remember exactly what it was, I was half asleep, but we finished it anyways.

Overall we had about 7-8 unit admissions (including upgrades) 15 floor admissions, one code grey, one intubation, one seizure,one SVT, one hour sign out to am team and one half angry cardiologist. All in all, not too bad.

Off to sleep.....

God bless
Dr.Mike

p.s the svt was cardioverted in the am with anesthesiology and after TEE to rule out thrombus.

Day 518 Most Amazing Email I Have Ever Read

2010-01-03T02:48:00.013-05:00

I wanted to start including some special written stories and thoughts that I have been wanting to write about over the years. I wanted it to be about hope and helping those deal with the difficulties in life. Here is an example of one of the most amazing emails I have read online. It was in a response to a very popular youtube vidoes- "the Hug campaign." Below is th eletter the video will follow.

****************************************************
Date: 2009/8/6
Subject: I know you don’t know me, But…
To: juan@juanmann.com

Juan-

Your campaign has changed a lot of people’s worlds and has lit a fire in so many people’s heart; including mine.

Although I have never been hugged by you personally, I can still feel the warmth in my heart that has been inspired by you.

My life and how you changed it:
Growing up for me was very difficult. My mother and my father were drug addicts trying to raise a family. The only memories I have from my early childhood are dark. My mother would start her day off using, and same for my father, and trying to remember what happened the day before. My mother was very abusive to my father and I didn’t know anything different. I learned 911 before I could spell my own name, tie my shoes, or blow a bubble. I had to learn quickly what to do when situations got bad; take my little sister in her room and tuck her in, sneak into the kitchen, dial those three number’s and just leave the phone in the living room and go back to be with my little sister. I had to expeirence my mother stabbing my father, throwing her car keys into my dad’s eye, and watch my dad just lay there bloody and helpless.

One day, my father just picked my sister and me up from daycare, and we were pulling into the driveway… My mother’s car was still on and the front door was wide open. My dad rushed inside to find blood all over the walls and my mother sitting in the corner crying. She had tryed to commit suicide. After she was “okay”, she left. Two weeks later, my father had been served with divorce papers. He immdiatly called my mom’s friend’s house and asked to speak to my mother. She was drunk, spun, and coked out… My father asked her to come say her good byes to the family, and that’s the last time I ever saw her.

In 2006, 10 years later… My father had quit doing hard core drugs, but remained a pot head and a drunk, but he got me started in all that mess.
My dad, sister, my best friend and I were at a theme park close to home when my dad got a phone call from a strange number. They verifyed his name and told him they needed him to identify a body that had been found via emailed pictures. My dad didn’t tell us what was going on and made us rush home. He ran to the computer and broke down crying. It was my mother.
It turns out that when my mother left, she became a stripper and moved to Tennessee, where she later became a prostitute…. She was at a party at near a lake with her “friends”. She passed out from alcohol poisening when someone shot her up 3times beyond the lethal limit of cocaine. She died instantly and everyone left her there only to be found a month later. Her body was so far gone that she remained a “Jane Doe” for another month. The only way anyone could identify her was by her tattoo of my father’s name.

Since then, I have struggled with bi-polar disorder, severe anxiety, post dramatic stress disorder, and a very bad substance abuse problem. I hadn’t really smiled since the day at the theme park. I was begining to believe that happieness was only in my dreams. That is until I saw the Free Hugs campaigne. I saw the sparkel in the eyes of the people getting hugs, and I began to feel this overwhelming sensation of pure happieness rush in me.

I am now a year sober, in my first year of college, and an active “member” of the free hugs campaigne. And I finally know what I want to do with my life, I want to send that same overwhelming feeling of joy to other’s that are going through hard times, and as I help them, I am helping myself discover what I once thought was only in my dreams. I thank you for helping me smile again… There is not a big enough way to ever repay you for saving my heart so I could save other’s. You are truely amazing.

hug,
X.

God Bless
Dr.Mike

P.s Do something positive Today. Tell someone you believe in them. Tell them not to give up and to keep fighting for the good things in life...

Day 515: Crap !

2009-12-28T18:55:00.011-05:00

wow...well not sure where to start. It was around 4:30pm and I was about to sign out my patients on the floor, when the nurse on my bed 5 came into the resident room and said "the sister of bed 5 is here to talk to you." As I walked towards bed 5, I couldn't help but be glad to be able to talk to her. I had been talking to her daily about her brother and giving her updates and she seemed to be on board and was always cooperative and friendly. (I didn't know what I was in for.) As I walked over the room I can see a mature woman in her 50's outside the room crying and being held by the father of the patient. I had seen him before daily at the bed side, and always spoke to him daily. I went up to her briefly, but I sensed that she wasn't who I was talking to over the phone. So I then proceeded to go into the room. I walked in and the mother was at the right head of the bed, and the sister was at the left side of the head of the bed. She had her hand on her brothers head, and she was rubbing it and telling him how much she loved him and how much she cared for me. (He had been intubated in the ER for airway protection after he was found to be in delerium tremens and was extremely aggressive- pulling out iv lines and almost hitting the nurses. He also got a case aspiration pnuemonia and was in ARDS. He had been on the vent 13+days and was a candidate for Tracheostomy if we are not able to wean him the next 2 days.)

After she spend a few minutes "talking" with her brother she came over to me and I introduced myself. We spoke a bit and updated her on his progress. Then all the sudden the intensives/pulmonologist walked into the room to see how he was doing. (we had been trying to wean him off the vent and he came to see how he was doing) He walked in without greeting us and went up to the vent.I followed him to see what he would say. He looked down on the patient and said. He doesn't look like he will be weaned, his stomach is assisting his breathing, and just walked out of the room. The daughter asked me who was that, and I said that he was one of the pulmonologist that was on the case. (I got a sense she didn't like him very much. He is usually straight forward talking and is not friendly with everyone, but he is probably the best intensive pulmonary attending in the area. He has a "super surgeon" type personality- overly confident,aggressive and cocky, which would be the personality you need to be an intensive care specialist) We stepped out of the room and she spoke to me at the outside of the room.

She said "so how many years have you been practicing medicine?" the question caught me off gaurd. I said "I'm a 2nd year resident. I have been one for 1 year and a half." She kind of look perplexed and said "And what were you doing before that?" I said "I was in medical school before that." Probably not the best answer to her question, but I didn't want to lie to her.

She then said "And why is it that every time I talk to you, all I hear is- maybe,possibly, most likely, hopefully?" I didn't know whether to laugh or to argue back, so I decided to stay quiet. She seemed a bit angry. "And who was that doctor that walked in? I don't appreciate and like his bed side manner.He just walked in and was not very polite." I told her "he is one of the pulmonary specialist and intensive doctors working with us. He is one of the doctors on the team." "well you know what, I want to talk to him." At this point, I knew things were about to get worst. The pulmonary attending was sitting right behind us and was on the phone. As soon as he got of the phone and continued to write a note he was writing she came up to him and said "HI. I would like to talk to you. what is your name and number?" He looked over her and said "ok" she then continued and said "and you know I don't like your bed side manner. I want you to stand when you talk to me!" At this point the other residents had walked into the area and I looked over to one of the seniors and she stared back at me as if saying what the heck happen here?. He stood up as if he was about to kill someone, but remained calm. "who are you ?" He said to her "This is my brother you are talking care off." He said "I'm not his doctor. He is not my patient I just came here, I was covering for the other pulmonologist who is on vacation. I saw him today for the first time" She then looked at me, I tried to become invisible, but it didn't work! She responded "What?" he then said, realizing what he had just said "I'm the pulmonary doctor for today and I know what has been going on with him and I'm taking care of him for the next couple of days."

"do you think he is getting the right care here? how long have you been a doctor here? He stood quiet 2 seconds then said "I've been a doctor here since 2001. I wasn't aware of who you were so when You approached me the way you did I was taken back. But I can tell you that he is getting all the proper care. If you feel he is not getting the proper care you can always transfer him, but I don't think you should."

He then went on to tell her what he thought about his prognosis and the fact that he might need possible tracheostomy. She then asked a few more questions and seemed to be calm for the moment. I was going to walk away and run to my bat-mobile plane to fly home, but I realized I hadn't signed out yet to the resident on call, so I decided to stay. I then went over to the sister and tried to calm her down. I told her "I think that you would feel comfortable if you spoke to the primary care doctor, he would help you with any of your concerns,. And anything you need please don't hesitate to call us." She seemed a bit more calm, and then ran-walked over to the on-call resident to sign out.

I signed out and then got in my car and drove off.... I felt as if though I had just dogged a bullet, but this wasn't the matrix, and I still have him for another week. I'll let you know how it turns out. If I write another blog, you will know that everything turned out ok.

God Bless you
Dr.mike

i.e. I found out that the sister is bipolar. The mom told us. Well i guess that could explain a few things.

Day 500: Pouring rain in the Intensive Care Unit

2009-12-10T17:18:00.017-05:00

Sometimes it seems like when it rains, it sometimes pours.... today was no exception. It was one of those days. It's been a long time since I felt the way I do now. When I was an intern their was days where I felt my entire spirit and mind drained. Drained by the stress and activities of the days. The days when you drive home crying and feeling as if you just got run over by a truck of stress and being over worked.

I'm back where it all started- the intensive care unit. This time around, I'm no longer an intern, but the senior. I'm forced now to supervise and watch over the interns very carefully. However, their was this one patient we have, who happens to be the son of one of the nurses we have in the hospital, and his son has been in the unit for 4 weeks. He has a rare genetic disorder and has been in and out of multi-organ failure. He is also on dialysis daily and CHF with ejection fraction 15%. (His heart is hardly working.) He was intubated originally for a large infiltrate and collapsed lung. He was in ARDS but got out of it. HE is on mechanical ventilation and has been having difficulty getting weaned off the ventilator. Every time we shut off the sedation so that we could extubate, he starts to get tachypnic and tachycardic and starts geting agitated. It has really been a struggle. I guess what makes this case different is that it is the son of one of the nurses we work closely with. So you kind of pay extra attention to detailed. We have even seen him sleeping in the empty unit bed next to his room.

Today was a bad day. Are plan was to try to wean him off the ventilator today, and as a last resort if he didn't tolerate weaning then immediately do a possible tracheotomy and possibly peg tube or even yet let him go entirely and let nature take its course.

We started around 3 pm. We had the trauma surgeons and the pulmonologist in the room along with 5 more people and at first we took at the tube. The anesthesiologist place another tube in his trachea just in case it would close do to a stricture. He initially seemed to be doing well. But then trouble started. He started to have a lot of secretions. he seemed very "wet" he was getting tachycardic and tachypnic. hr 140 and np 160/110. His respiration was around 37. His saturation was 92%. We left him like this for 5 minutes while we waited for his father to come.

WE were surrounding the bed when his father walked in. He immediately went to the left side of the bed. He grabbed his head and kissed him on the cheek. His eyes were all red and slightly watery. (he is a stocky man. He is very muscular not the type you would think would be this emotional, but yet again this is his son.) Seeing all this was really took a lot of us back. I stood their silently trying to figure out what to do. The intensivist was their (one of the top in the region). he turned to me and ask "you think he will make it?" I just stood there not really sure what to say. He went up to him and started listening to his lung and observing him.
you can hear the crackles across the room. IS sounded like a lot of gurgling sound. They kept on suctioning him, but he still had it. He then turn to me and said not good. I wasn't sure what that would mean. A few minutes later I came back into the room and he was close to the nurse talking to him and had his hand over his shoulder and he said "I'm sorry. we tried everything we could." I still wasn't fully sure what would happen next, till I saw the anesthesiologist saying "pass me the tubs" They were re-intubating him again and they were saying that they will put do a tracheotomy on Monday. The reason this was really big news was that the family was thinking that is might not be a good idea. He would have a trach and be stomach pegged for nutrition and maybe on full restraints so that he could not pull out the tubes. He would literally be a "prisoner" tied on a bed. And add dialysis possibly every day. It would be like slow torture. As I stood thinking about all this. I looked at the back of the room. And the nurse was in tears crying and hugging the father. He was sobbing. I turned away and gave him his privacy. I stood out side the door. I could feel all the energy in my mind and spirit leaving me, as I stood their looking at the anesthesiologist re-intubating the 20yr old kid.

The intensivist came out of the room and said "put him back on the same ventilator settings... we will see what we do on monday." I placed the orders in and I walked down the unit floor. As I walked away I met up with my friend who seemed to be upset. He turned to me and said "I can't believe the schedule they have me on this weekend. I don't know why the chief gave me the schedule she did this month." I turned to him trying to be polite. In my mind I was like "are you kidding me? your complaining about a schedule? did you just see what just happen to that 19yr kid in bed 5." I turned to him and didn't say nothing. I pointed at the schedule and told him "if its any consolation, I have an extra three days more than you, and i'm on call 2 more weekends days extra than you." He kind of stayed quiet after I said this. He got the sense I was feeling tired and drained.

I told him I was leaving earlier and I signed out the other 2 patients that I had. Along with the last hour and several other patients and situations throughout the day, I felt so tired and drained. It was tough to see this type of suffering. Its a very hard thing ti get use to. Specially when you form bond with certain patients and their parents.

I drove home in about 30 minutes . I even gave superman a call over the phone. He graduated and is working as a hospitalist in Florida. I still call him when i need help. eh gave me ideas and told me not to give up. It was nice to hear those words. he told me to try to do more dialysis before extubation monday and try to limit the fluids as much as you can. even if you have to change the in antibiotics to po and limit any fluids you can. It was nice hearing his willingness to keep going. I will try to do what he recommended.

I went up stairs and sat tied on my couch. My wife came into the room from work. I asked her how she was feeling. She said "is was a bad day, I'm so tired. (she works in a busy clinic in the city) I turned to her and simply said "I know what you mean."

God Bless

Dr.Mike

Day 491 Discovering the Goodness of Life

2009-12-06T19:29:00.024-05:00

Well its been a long since I last wrote, and I'm really sorry about it. I know a lot of you follow the blog. I have blog entries that I have written but have not been able to upload them and edit them. I promise to log them all in the coming 2 weeks. I'm about to start my UNIT rotation tomorrow. It will be throughout the month of December. As i'm writing this, it is the last day of my short 2 week vacation.

Overall the year as gone surprisingly fast. Already it is December, and we are in the 7th block. Already there are people coming in for an interviews and tours. I have not been in the hospital while they have been going on, because I was on night float before vacation.

The new interns have been adapting well to the program. And are slowly coming into their own. Slowly they are gaining more confidence and learning the practical aspect of medicine. A few of them are very cocky and proud, but they are good people. you can't help sometimes to be proud and you feel good when you start practicing medicine. One day while you are on the floors, it will kick into to you. And you realize that its not as hard as people make it out to be. And you learn the practical aspects of what you really need to help people.

On another note, I just have not been feeling myself. I have not been able to fully enjoy myself this year. A part of me feels something is missing in my life. I have spent some much time and so many years trying to get here. I think a lot of you understand what I mean. The countless hours studying to no end. Constant disappointments and surrounded by people that just don't understand what you are going through- having to takes these exams over and over again, sometimes to no avail. It use to seem that there was no light at the end of the tunnel. You read these experiences daily in the forums. Countless people frustrated and in tears over their plight. And can say that i understand a great deal of them and you.

I use to wake up in the morning not caring, not smiling, pondering the unforeseen future. It seems as though the impossible would never happen. Its as if you are walking in a circle over and over again.

I went through the match about 3 times, and each time it seemed more pointless and meaning less. Countless of times I use to sit at my table in the room, staring into the blank walls. Motionless and with no emotion. You become numb to the situation. You get to the point of surrendering. you get to the point where you just say "I'm gonna try and do everything I can, and if it doesn't work out, then so be it."

I'm not saying that we all go through this experience like this. A lot of us are fortunate to have the support from people will love and our families, but even then deep down inside you realize that they don't really understand fully what you are going through.

And one day the time will come. All your hopes and dreams seem to come true. You go on interviews over and over again. never expecting and always hoping. And then finally a good email !! Not the ones from ecfmg that simple crush your dreams in a two line sentence, but the email-the one offering you a positions in residency. It seems that for a while the sun is always shining. even in the raining days you still can see the sun, well at least a part of it. Almost every problem seems minuscule compared to what you have just tackled. And yes as time passes by and you receive what you have always wanted, it seems as though something is missing.. you look around yourself. you see that you are surrounded by people you love and care about it. You help them with their problems. You live the life you have wanted and yet their seems like something is missing in your heart.

Cold play in one of their songs "fix you" says sometimes in life " you get what you want but not what you need.". And think that's exactly what happens to many of people that attain things they have been fighting for their entire lives. Be it a career or position. May material possessions or relationships. you see it all the time in holly wood. The super rich with everything anyone could "want" out of life. And they are some of the most unhappy people you see. Sigmund Freud was once ask who did he prefer to treat "the rich or the poor?" he responded by saying "the rich, because they understand that money cannot solve all your problems." Perhaps this comment might ring true for many of us. We spend our life chasing material things, but maybe their is more to life than wealth, power and positions. Don't get me wrong. I think what we do with our lives is special. We need to dedicate our lives for a higher purpose in service of others, but what i'm talking about perhaps takes it a step further.

I can only speak of what I'm experiencing now. I feel that something is missing in my life. I think I have reached a peak, and yet it seems I'm still not thinking clearly. Its as if I'm not complete yet. I have been thinking about it for weeks and hours at a time. I have tried to put it off and tried to take my mind off of it. But I still feel a hole in my heart. An empty space.

There are certain people that attain tremendous wealth, and when they reach to that level and realize that they are still not happy. they panic. They are perplexed. They don't understand how they could have what everyone wants and what everyone thinks will make them happy. And yet when they have all these things and they are still not fully happy, they go into s state of depression or denial. many of them reach out to different things to try to relieve the feeling. More expensive homes, more vacations, more exotic gifts and spending, more dating, more of "everything". And yet at the end of the day, while they lie their on their bed staring into the dark ceiling of their bedroom they can't help but still notice that emptiness inside. Its what I have been feeling now for a while. I didn't want to share it, but then I thought it would not be truthful and I wanted it be part of my written journey throughout residency. I guess that's why I haven't updated the blog recently.

Furthermore, as I looked back on my experience and present moment. I analyzed and pondered over my life daily and I realized what I had been missing. It was a spiritual hole in my heart. I wanting for something deep and spiritual which i haven't obtained. A deeper inner emptiness that God once filled in my life. Its a separation with God that hurts. Its the same feeling you get when you haven't been home in a long time. Its also the same feeling you get when you are away from your love ones for a long time. When they are not with you. You feel empty. You are not the same. Your time and happiness is not complete. Its the best way that I can describe to you what i'm feeling and what I have been going through.

I've come to realize that their is a higher level of being in life. One that you don;t often discover, since we spend our lives chasing our dreams.. Chasing positions and people. We rarely get what we want in life. And sometimes when we do get it, we realize that there is more to life that what we expected. Their is a higher level of happiness found in other things than what we were chasing. It could probably take someone a long time to discover. It has taken me all my life, since trying to become a doctor is usually a lifetimes work. But overall my life has been a blessings. the lessons I have learned have not been easy, but sometimes that's how we learn them- the hard way. But the knowledge and realizations of these truths are probably worth a lot more than anything that possibly life could offer. A deep spiritual peace and love cannot be purchased. I hope that in time I could unlock its secrets. I hope that god can fill the emptiness in my soul. I pray that God has mercy on my soul and shows me his way. I hope i can learn to know him better like I once did. I think I have been to distracted by the things in life. And I have separated myself from all the goodness of God.

Let us hope in the coming weeks and new year that my happiness may one day be complete.

I wish you the best in the coming match. Congratulations to those that have gotten interview and have gone on them. Don't give up. keep your head....

God bless

Dr.Mike

Day 445 Tips For those That are Frustrated & Anxious About 2009 Match !

2009-09-22T10:56:00.029-04:00

I wanted to take this time to give you a brief update of whats going on. sorry that I haven't updated the Blog recently. I have been away from the hospital, doing an Outside Elective in a Cancer Hospital. But I wanted to take this time to address those that have recently applied to the 2009-2010 match that opened on september 1. I wanted to address those that have applied and offer some tips that have helped me in the past. I went through the match about three times, so I understand what many of you are going through. Their are a lot of questions that you might have , and I will try to address them here.

The biggest question I think You all have is:

I just sent out my applicatioons through eras, is there anything I could do now? or How can I get some sleep from the anxiety from waiting on the replies of the programs? or Now what? or How often should I check my email? or Should I call the programs? There are a few things that you can do to ensure that you have done enough to better your chances in this years match.

1. Even thought you have sent your applications, call all the programs again if you can and ask them their criteria and confirm that they recieved our application. (you should have done this initially but it is never too late) It helps sometimes to call these programs, and you get a human voice on the other line. once the secretary tells you the qualifications, tell her that you will sent or have sent the application, and thanked them very much. You just never know if someone on the other line might like you. The secretary at my program screens the applicants all the time. If they hear a friendly voice over the phone, they just at least might take another look at your file.

2. When you recieve rejections from a program, just double check to make sure you didnt make any mistakes. I had some rejectuions in the past because my letters of recomendations were missing on a few applicants. If you made this mistake call them and let them know yrou updating the eras.

3. If you have recently published or recenlty started a clinical externship, send the progam an email letting them know you are starting this and you wanted to let the program be aware. I know a few residents in my program, that had recently published a paper after the eras deadlin and she emailed the program letting them know of this NEW occurance, and she was granted an extra 2 interviews. Programs like to see that you are always improving your CV. But you need to let them know this. A brief short polite message, don't over do it.

4. Find ANY contacts you think you might have. Put your ego aside, and start asking EVERYONE you know who might be involoved in a residency program. Put your ego aside, you never know where it will take you. I got an extra 2 interviews this way. Ask them if they can help you out in ANY capacity.

5. If you have family memebers thos are nurses, janitors or cooks in a hospital, call them and ask them if they can "pick" you up an application for the residency program. A lot of these hospital workers have been in hospitl 10 plus years, you never know hwo they might know. hospitals like keeping it in the family. they don;t necessarily have to be doctors.

6.Go back and Review all the programs that you didnt apply , and see if their are some that you can apply ONLY after calling them directly to see if you qualify.

7.Check your SPAM in the email, I got send an interview once in my spam box !!!

8.make sure you read rejection emails correctly. They wil sometimes tell you what you missed or that your application is incorrect.

9.Value the interviews that you get. Even if it just one. Dress well, talk slow and BE YOUR Self. DOn't try to act like someone you are not. ANd treat everyone you meet with respect. Even the Hospital janitors on the day of interview. And try to learn the names of the people that are interviewing you.

10. And last but not least. try to relax!!! At this point you have done almost everything you can. What more can you do? What matters at the end off all this process is not necessarily an interview or a spot in residency. It is knowing deep down in your heart and sould that you gave it everything you can. that famous "Leave it all on the court" syaing rings true. You have done everything you can. You have spent years preparing for this. Now it is up to destiny it is up to chance, call it whatever you want. what matters in life is that you do everything possibel to achieve your drreams. you have buiklt the boat now just wait for the wind to push you away as destiny sees fit. Your life and mones are all written. I believe you have a destiny. You were meant to read this. You were meant o be where you are now.

You are probably very scared and frustrated. you have borrowed cash to paply to these programs, or you have maxed out yur credit cards. What more can you do? Nothing is the response. You have done everything. you are not a failure. you have achieved alot to get to this point. Passing your usmle. Working 10 years in graud schools. Now it is time for fate to take over. Your job is finished. You do not control the residency porgram directors mind. You cannot force anyone to give you a position. You have odne everything possible. The rejection letters will come. And they will hurt every time you see them. But don't lose heart and don't give up. It doesn't mean you are a failure. It only means that your time in that hopsital was not meant for right now.

If you are reading this you have alrready succeeded in life. You have walked the long journey. you have made it. you have achieved your ecfmg certificate. be proud of that and look back at your life if you doubt your successes. Being a doctor is not the ultimate fulfilment of your life, it is simply a part of it. Living life to its fullest and Livign life as a positive human being that is true success. Loving those that surround you, wether good or bad, that is true success and achievement in life. that has value. At the end of the day ask yourself "Is there more that I could have done? Was their no stone that I did not turn?" If you answer is no, then rest in peace my friend. You are a winnewr in life already. You have not given up. You journey has already begun since the day you started and ended medical school. time spent learning klnowloedge that helps others, is never a waste.

What you do in life doesnt define you. WHo you surround yourself with and who you choose th=o soent your life with, this is what defines your life. True hapiniess uin life is found from living those around you and loving God. sigmund frued was once asked who he preferred to treat "the rich or the poor?" Sigmund freud answered
" I rather treat the rich, because they understand that money can't solve all their problems."

You are now at a crossroads in life. You feel like what will happen in the next few months will determine your future. I would say that it is onlyt partly true. the future is hidding from all of us. Know one can see into the mysteries of the future. Your life has meaning and you were meant for great things in this world. YOu have already succeeded in life. Succeeded in accoplishing medical school. What happens now will happen. Call it fate, or call it guiding by GOd. As a spiritual person I believe are Lifes are guiding by God. And although we still have problems in life and although sometimes its painful and doesnt make sense, I beleive god is their to GOd us through the good times and Especially the BAD ones.

Be at peace today. You have done all that you can. Their is no more you can do but be patient and Let Life and God lead your life. Ifin the next few weeks you feel heart ack and you feel lost, rememeber you will always have a friend. You are not alone in this world. You don't have to bear disapointment alone. God cares for you. Jesus Loves you. Keep your head up. he will walk with you through thises trying times. ALthough their is no explanation for why you did not get the interview you wanted, or the hospital you tried so hard to get accepted too, know that youa re not alone in your pain. GOd sees the heart he can help you bear the pain you feel.

don't Give up !! You can do it !! you are doing it!!

God Bless & good Luck

Dr.Mike

***********************************************
"I asked"

I asked for Strength...
And God gave me Difficulties to make me strong.

I asked for Wisdom...
And God gave me Problems to solve.

I asked for Prosperity...
And God gave me Brain and Brawn to work.

I asked for Courage...
And God gave me Danger to overcome.

I asked for Love...
And God gave me Troubled people to help.

I asked for Favors...
And God gave me Opportunities.

I received nothing I wanted...
I received everything I needed!

**********************************************

Day 435 Dying Awake !!!

2009-09-22T10:39:00.009-04:00

Geesh I just finished having a tough morning. I was up all night watching movies, and it must have been about 2am when I told myself "I have to get up at 6:15 am, so I might as well stay up for 4 more hours then go to the hospital." I think I took at 20 minute nap at 6 am. I got up got dressed and went to the hospital. I went to morning rounds at the Cancer hospital, and couldnt keep my eys open. I kept of falling asleep. I didn' want to seem disrespectful, so I tried my hardest to keep my eyes open. I was even trying to pinch myself in the hands and trying to cause my self pain so I could stay awake. this went on for abotu an hour. I wanted to go out of the room to splash some water on my face, but as I was about to stand up to go to the bathroom, the chief of the department walks in and so does the program ditrector and about 4 other attendnings for a 2 hour administrative meeting !!! As I was siting down on the round table, the secretary hands me a white sheet with the administrative agenda for the meeting. It was basically a bunch of mumbo jumbo and paper work. If that was bad enough, the program director site in front of me, and the chief of the department sits to my right. I told myself in my mind "I'm dead !" I can barely stay awake, how the heck am I going to get through this meeting?" It must have been the most painfull 2 hours of my life. I found tic tacs in my pocket so I could take it and try to get some sugar in my blood. (I think I had Twenty tic tacs.)I was having a mini heart attack. I couldn't even rest my head on my hands and try to cover my eyes as I pretend to write somoething, because the chief was lateral to me and he would see my eyes if I doze off. It was bad. Thats th elast time I try to stay awake. I've never been so happy to leave a room after that.

They say that einstien hated to sleep. He felt that it was a waste of time. IT's been rumored that he slept 3-4 hours a night. I think I'm going to go home and sleep 16 hours. Lesson learned.

Seems like the lessons we remeber the most come from of some type of extreme emotions- wether good or bad ones. Why is that? I wish I could write about it, but I'm just so tired.....zzzzzzzzzzzzz.......zzzzzzzzz....... BRB... Time for nap....zzzzzzzz..................ergvae[aw3335444r...43543

God Bless

Dr.Mike

This guy has the right idea !!

Day Day 399 life lessons from Valentino

2009-08-25T00:43:00.032-04:00

The Italian designer Valentino was once asked "what do women want?" Valentino smiled and said "Its simple. They want to be beautiful."

I'm sure more than half the men in the world would not know how to answer this question. Its a question that some have tried to explain in books and books across the centuries...lol Its surprising the answers that you learn about when asked the right question. I think we should all take moments of our lives to answer some of life's "simple" questions.

If someone was to ask you today "what do you want?" what would your response be? Being that this is a blog mostly read by inspiring doctors and those struggling to match, it might not be surprising if you answered "I want to be a doctor, I want to get residency" But I think the question can go a bit deeper than that. I think deep down inside what we all want is to be happy-It is possibly the single reason as to why you are doing what you are doing. Studying and trying to be a doctor and trying to get residency is your goal and it is what you feel will make you happy. Even though I would partially agree with this, I would say that happiness goes beyond residency, and goes beyond wanting to be a doctor. I think true happiness and long lasting happiness goes beyond what you dedicate your life too. I was reading a book called life lessons by Elizabeth Ross, and in that book she talks about the single most important desire of those that are in their final hours of life. And the thing they most cling to. The thing they most want and appreciate is Love. AT the end of it all. At the end of our working days and at the end of retirement. When you look back at your life, and you look back to see what was really important in life, it was the relationships you formed with others. It was the special bonds you had. It was the special moments you spent with the persons you loved most in this world. Certain moments in life are defined by the people you choose to spend your life with.

You might feel that you have failed in your quest called life. You have struggled year after year trying to get residency only to have your hopes and dreams crushed by a single email from eras stating "You did not match." 4 or 5 words that have changed your life in more ways than one. Even now while you read this you are somewhere in a hospital doing an observationship, or your in a university or office trying to do clinical work or doing research. you have spent countless hours on forums trying to learn about what more you can do to better your situation. THe countless questions from family members that mean well, but do not simply understand what you are going through. Friends and family members that don't see your broken heart. They don't see the countless hours you have spent crying at the thought of your future. But I'm here to tell you that the purpose in life is bigger than what we sometimes imagine it to be. Maybe happiness can be found in the simpler things that surround you. Although what you do in life is important, it doesn't define who you are as a person. The meaning of life is more deeper that you think. What is truly important and special in life is closer than you have ever imagined. The more hours I have spent in my residency (almost 100 hours a week) the more I long to go home and spent time with the person I love the most in this world-my wife. I'm not the only one that feels this way (residents in my program all enjoy their time out of the hospital).

The more time you are around death and people that die, the more you understand how fragile and short life could be. And although you want to help others and make a difference in the lives of those around you, you also need to find special time for you to always get the most out of life. Continue to work around for the things you want out of life, but don't forget the most important thing-love. It is what can bring happiness to your life. Its is what many of us our truly searching for. Love can give happiness and it helps you to bear the struggles of life. You will find strength to carry the burdens of this life in the people that surround you. It is found in the time you spend with your loved ones. It is found with the time you spend with your friends. Don't let the true meaning of life pass you by.

But what if you are alone in this world? What if you are someone that doesn't have a family or someone that has been rejected by others and you feel abandoned by someone you once loved. What if you are someone that is "alone". Maybe your someone that searches through their cell phones, and looks through the list of friends without having someone you can truly talk to. No one that can understand you. I would tell you that your not alone my friend.

The heart and pain you feel in your heart. The hours spent in darkness. The hours you have spent in hopelessness. And the feelings that no one understands you. All of these emotions has maybe let you to believe that you can't take it anymore. The struggle to match and ge residency is too much to bear. Your heart is broken. You have no one to go to. I would tell you that there is someone you can go to. In fact, only someone that could see inside your heart. Only someone that can see your thoughts and see your emotions can truly understand what you are going through. In fact it would have to be a person with supernatural abilities and almighty powerful to be able to do that. And I believe that person is God. God can help you in your pain. Life can be a trauma sometimes, and it can be unbearable at times. But don't lose hope. God can help you. He can give you the strength you need to deal with the burdens of life. With the struggles that make u cry.

A story is told of a boy a couple of years back that decided that he wanted to have a puppy. he started to have a paper route in his community so that he can save enough money to purchase a puppy. One day on his way to the paper route. He found a sign in front of a farm that read "Puppies for sale $25" The boy was ecstatic and went to the farmer to inquire about the puppies. As the boy spoke to the farmer, the farmer turned around and whistled the puppies to come out. The boy lay on the ground and was greeted by three small cute puppies that played and licked his face. As a few minutes pass the boy noticed that there was one more puppy walking out of the barn The puppy was very fragile and limping. He could barely walk. The boy asked the farmer "who is that?" To which the farmer responded "that is the run of the litter. Today I'm going to take him to the back of the yarn and shoot him. he is a burden to every one. Can barely walk. he would have to be carried every where he goes. He is useless." TO which the boy enthusiastically said "I want the puppy!" The farmer said "that one? you sure? nobody wants that one." The boy at this point stood up and walked towards the farmer. He was limping. HE got closed to the farmer and lifted up his pants on his bad leg to chow wooden stints he had. He had been diagnosed with polio as a child and was handicapped. The boy turned to the farmer and said "He is gonna need someone that understands. And I understand."

My friend God understands you. Jesus loves you. God loves you. God can help you bear with life. He can heal your heart. Search for God and he will find you. he will not abandon you. You can dial God anytime and anywhere by deep and honest prayer. Talk to God as if you were talking to a friend. In the darkness of your room where ever you are. In the middle of a class room in your mind. In the middle of the day. where ever you are reading this. take a moment to pray to GOd and talk to him as a friend. Open you heart. Ask him to help you bear with these tough timse. Help him to help you see the goodness life has to offer. Your troubles might not go away, but God can help you to bear them. The difficulties and Bad things that happen to us have no explanations sometimes. Countless time people try to blame GOd for all that happens in this world. The bad things that have happened to you should not have happened. And their is no explanation for now of why they did. Life is unfair sometimes. God never promised that we would not have problems, but what he has promised IS Help. HE has promised to give you his peace. You are not alone. You don't have to tread life alone. You are loved. You are wanted. Don't give up. GOd is a friend. Yours. God can bring light in your darkness. You don't have to tread life alone and in fear. God will guide you through the storms. God will cry with you. He will not abandon you.

Good luck in these years match. Keep doing everything you can. What you do in life Doesnt define you. The people that surround you in life is what defines your life. True meaning in life is found in loving God and loving those around you. When you need strength and meaning in life remember these two things.

God bless

Dr.Mike

Day 381 In trouble with the Program Director

2009-08-09T20:07:00.009-04:00

It was around 7:40 in the morning and we had just finished sign out when the program director approached me and said "I need to talk to you." I wasn't sure what I had done, but I was a bit nervous. I told her "Am I in trouble?" She smiled and said "no." We walked into her office and she closed the door and said "what is going on with Dr.ONC ? When we do rounds it seems like he is never prepared. Why is it that you know more about the patient than he does. Also...He is also always joking around, its like he is not taking it seriously. I wanted to tell you because you have a way with people and I wanted you to tell him to be a bit more serious and to talk to him about it." I told her "I have spoken to him about it. he is a great guy. We are trying to work with him, to take things more seriously. A lot of the interns are being spoiled by us, but we are trying to get them to learn to be more independent and confident." It was a short conversation and I left her office in search of Dr.ONC.

He was in one of the floors and in a patients room when I went up to him and told him "Listen I have to talk to you its important" He saw the look on my face and knew that it was serious. We went into a private room in the floor. I sat down and told him "I wanted to talk to you because I wanted you to know what was going on. Someone in the top office called me in to talk to you about certain things. They just wanted me to talk to you about how you are with the patients. Remember that you are in care of about 10 patients daily, but the way our attendings know how we are with patients is during the times when we round on our patients and how we manage them." At this point he cut me off and said "you know then I'm leaving that's it. If they don't like the way I am, then I'm leaving." I told him, "hold on, its not like that. Remember, part of this is about adapting to people and situations. Nobody knows how to be a resident in 4 weeks. I had the same issues when I started. I didn't know how to do a lot of things, but in time I learned, and so will you. And this will happen anyplace you go. Wherever you go , you will have to adapt to people and situations. Its about adjusting. You are a good resident. We tell you these things to help you, not to harm you.This is good advice, its not judgmental." He kind of relaxed a little bit. He seemed a bit upset. I told him "when it comes to the teaching patients just remember to always have a plan. always have an idea about what we are doing for this patient. When the attending comes to round tell him what is today's plan and what we are going to do." He shook he head and said ok, but I think he was still hurt.

I tried to tell him in a nice way of what was told to me. The program director is not the first person that has told me about him. There have been other residents complaining about him. they say that he fools around a lot. He ask a lot of stupid questions and comments. I think its pretty judgmental of some residents, but then again,its always been like that. A lot of times you have to be more serious and hold back the stupid questions you might have, and ask a person privately that you trust will not make fun of you. Some residents have told me that they remind them of the resident that was kicked out before.(http://thankyougodforresidency.blogspot.com/2009/04/day-resident-with-usmle-scores-98-99.html) I don't Think Dr.Onc is on the same level as the other intern that got kicked out. I'm going to be working with him closely. I'll let you guys know what happens.

On the other hand, the other interns are coming along. Some of them are still trying to adapt and get use to the system. We have been criticized by some of the 3rd years, because we are doing a lot of the admissions for them. A lot of times we do all the orders and they are simply just doing the physical and none of the planning. I started to give the interns more time by themselves during the admissions. I'm letting them talk to the patients by themselves and get the history and physical. Overall its been a good rotation. I'm having a lot of fun. I will let you guys know what happens.

God bless

Dr.Mike

Day 370: First Day with the Interns: Introducing Dr.Harvard

2009-07-08T18:04:00.005-04:00

Wow what a day- I would say that today was my official first day working with the interns. I couldn't believe what I stepped into today.

SO basically I decided to go in a bit early to the hospital, since it was my first day, and I wanted to get to know the patients better. I went to the sign out "early". I don't really think it was early because the interns are already their doing the notes. We can usually catch up quickly because you are use to a lot of the clinical scenarios. The problems started when the chief resident called me to take pictures of all the Residents !!! I knew this was not a good way to start because the intern would be left alone and they might feel overwhelmed and get upset. Anyways I went to her office and took the picture of most of the residents, by the time I came back I found the intern. I don't know him very well, but I was about too. Out of all the 10 new interns he and another intern (female) are very overly aggressive. He is aggressive and assertive in another way. He tries to show off that he knows everything, but is still really not sure. I think he wants to prove that he knows a lot, but he is still lost, like we ALL Are when we start. It doesn't matter how much research or your credentials, but everyone is lost and scared in the beginning. And it can be a disadvantage if you are not scared and willing to take direction. He tries to do too much too early, and doesn't really know everything. He still not sure what the consultants are saying, and he doesn't completely know how to do work ups, but he tries to. Its good to see him motivated but he needs to slow down.

I went with him to see one of the patients that we were rounding with. It was the first time I saw the patient, but he tried to kind of show of to me that he knew the patient more than I did. It kind of threw me back a bit. I was caught off guard. Its sometimes not a good idea to show people who think that know everything that you are not sure of something. A lot of times when you start residency you will see that you are more comfortable working with some people than others. You don't want them to put you down. Or they think they know everything, and you don't feel like asking them. Some people are arrogant and tend to reflect a lot of people in their lives. Some of the greatest people I ever met in life were the most humblest and approachable. I enjoyed spending time with them and learning from them. I think that's why I liked so much the third years that left, I loved learning from them and they were very teachable. Most of them were very helpful and I appreciate them for that.

Its too early to tell but hopefully he will turn around.

So basically when I met Dr.Harvard (he did some research at Harvard, so I will call him this.) I spent the entire morning running around and trying to learn about all the patients as fast as I can , before Dr. Harvard "hurts" someone. It was a fast scramble. My wife was calling me all morning and i didn't have time to respond to her.

I tried to be patient and not fight with him. I have a basic rule in residency, don't argue or fight with ANY resident. A lot of people are stressed out, and you might need their help. You will be working with them very very very closely and 80-100 hours week. And you need to get along with them !! SO holding your tongue will profit you in the long run.

Well by 12 o'clock I was patient ans tried to help him out. He was post call, and I wanted to help him leave early. I did about 2 notes for him. (they are allowed only 5) Anyways, so I went to the noon conference and I sat next to my friend- another second year. He told me that he had just completed an admission. I asked him who he did it with. He told me it was with Dr. Harvard. I smiled and turned away. I saw the look on his face. Later on during the day I text him asking him how his admission with Dr. Harvard was. He text me back "lol". I guess he knew what I was talking about. We later met up and talked about it. Seems like he did an admission with Dr.Harvard and he found out how Dr.Harvard was. I told him "I guess Dr.Harvard is ready to do unit admissions and nuero surgery at the same time." He laughed and said that the other female was the same way. (we will call her DR.ICU - since she was a previously an ICU attending 9 years AGO !!) They both are pretty much giving us orders...lol.

Anyways around 1pm. I text superman (who is now doing an infectious disease fellowship) and I text him this- "sorry for fighting and arguing with you as an intern. Now I know what its like.lol. Presidente!" He text me back laughing and I responded back that it was pay back for me. I guess it shows how life is circular and what goes around sometimes goes around.

Anyways, if that wasn't amazing enough. You will b surprised how the day ended. It was around 2pm. And I saw Dr.Harvard still doing notes. I understand what it is to be post call and doing notes. I told him to go home and sleep and not to worry about it. As I went to see another patient of ours and saw him running back to get more charts. I told him "Hi... DR.Harvard I made 2 of your patients non-teaching so don;t worry about them." His eyes lighted up like a Christmas tree and he then grabbed my hand and kissed them !!!! He told me "thank you thank you" in his broken english. I was a bit taken back. I told him "don't worry about it. Its ok"

WOW... can you believe that !!! Not often in life you get thanked by someone with them kissing your hand. I was a bit taken back, but then again I understand his stress and emotion. You feel so overwhelmed some times as an intern. If you are not crying at least once a week, then you are not doing a good job!! I'm serious you feel over whelmed sometimes. Its part of your body adjusting to the times and the work. In 8 months they will be laughing at this. Its not a negative to have a lot of work and situations to deal with. The more you do , the more you get use to it, and it becomes routine.

All in all, it was a great and tough day. I loved teaching the other resident I worked with, after DR.Harvard left. It was a good day. I'm on-call 30 hours with them tomorrow. I'll let you know how it goes.

God Bless
Dr.mike

Day 369 1st day as a Senior (PGY2)

2009-07-06T22:21:00.005-04:00

Well the day we all wished for finally came. good bye to the intern year and hello to the senior. Today was my first day as a senior or second year. I wish I had more to write of what happened that day, but I was in elective, so I didn't get to see what was going on. I spent the day with the radiologist. I got to speak to some of my fellow 2nd years. They seem to be more relaxed. The interns seemed to be doing the running around. the only thing we are stressed with about now, is doing the unit admissions. (the intensive care admissions) Its tough because we don't really know what to expect, and a lot of times the patients are sick with multiple problems, its a lot of fun , but very stressful. So that is what is mostly of the minds of the second years. And on top of that you are running the codes and RRT beeper and AOD...lol. Its just a higher level of responsibility. And supervising the interns.

I kind of dread going back to the unit, because of the experience I have had their in the past. My issue with them has always been the ICU nurses which are very combative at times and tend to give you an attitude. A lot of it stems from the stress, and other of it stems from the fact that they expect you to know everything. they seem to get frustrated when you don't have a fast answer for them. I really try to be as nice as I can, but I get the sense that sometimes they read this the wrong way. they see you very nice and approachable, so you have to be more serious and more assertive. Its hard for me because I tend to have a temper if I'm pushed far enough. sO I try to not get angry and try to stay calm and patient. I think you get more out of people when you are nice to them. Pray for me to have patience.

On another note, it seems that everything has changed. the seniors that left are no longer weith us. Its seems like something is missing. the mood has changed. the climate is not what it is. I was trying to put my finger on what it was, and I realized that the third years were no longer with us. they were like family to us. A lot of them were dependable, and always their if you need it. It was a relaly great group.

but I guess thats part of life. No matter where you go and where you are times will change. the people that surround you will not always be their. I told myself that it would never be as good as it was last year simply because the people will be different.

Its sad part of life when you lose people you care about. I think that happiness sometimes is a measure of the people that surround you. Surround yourself with great and loving people, and it will have an influence you on your life. Granted people are not perfect and they have imperfections, but overall their presence brings brightness to the dullness of life.

I hope now to start dedicating more time to studying for my step 3 and hoping to start soon my elective that's coming up in palliative medicine.

I hope all of you are well. I hope and pray that you find individuals that will bring a bit of happiness to your life. And remember, don't go looking to far for something special in your life. the most special things in out lives are found by the people that surround you. It is found in spending a brief couple of moments with the people you love most in this worild. A son or daughter, a wife or husband , a mother or a father, or an old friend. This is the essence of happiness. It eludes us sometimes, bacause our minds are too fixed in our careers, but never forget this trasure that you might hvae in your home and Life.

God Bless

Dr.Mike

Day 359 Last Day as an Intern !!!

2009-06-30T20:34:00.012-04:00

Well it finally came. My last day as an intern!! I just can’t believe it has already been a year. Its truly amazing. I had a really stressful week. I was in the hospital 7 days straight. My on call schedule was something like this:

June 14th Sunday on-call 7am-8pm
June 17th Wednesday on-call 7am-8pm
June 19th Friday Graduation 7am -11pm
June 20th Saturday on-call 730am-8am (24hours)
June 22th Monday On-call 7-8pm
June 23rd Tuesday Presentation

I was basically in the hospital 9/10 days !!! Geesh I was exhausted. Thank goodness I’m on vacation now!!! It Was an activity filled week. We had the senior’s graduation ceremony that we were planning on Friday. I had several things I needed to do for the ceremony. Me and another 2nd year planned award plaques and I had to purchase 2 separate Award plaques that I had to custom order online for about $160 dollars. I had searched about 50 different sites, but I was able to get to only one I thought was good. We had made a collection for the cash with the other residents and the rest of the cash, I had to put in. The 2nd year gave me extra cash to cover a few of the cost. I had also spent the last 4 weeks editing a special video presentation for the graduating class. It was so exhausting to do, but I was able to do it. We included the video as part of a graduation gift bag. I almost got in big trouble on Friday the day of the ceremony. It was around 3pm when one of the program secretaries called me to her office. She sat me down and said “I need to talk to you.” She said it so serious. I got so nervous. I must have done something really bad I thought. She went on “You know a lot of people don’t know a lot of what has happen. And you don’t know a lot of what has happen. I saw the presentation that you did. And I hate to ask you, but you have to take one picture out.” She then went on to tell me how that person had had a turbulent relationship with her and the other staff members and the program director now, and she would appreciate it if I would take out the picture from the presentation.” I was relieved to hear her say that, I thought that I had done something awful or injured a patient. She was so serious, her tone was so different. She told me that it’s the program directors night, and I shouldn’t spoil it for her bringing back pass memories of relationships. Well I said no problem ran to my computer which I had in the car and edited the picture that was on my computer. I had to do it fast, because the graduation party was about to start. I went back and edited the picture, and went back to her and told her that I had taken it out. I also told her to tell the program director indirectly, that I had taken the photo out, but that the video show had to be played with my computer since it’s the final edit. Well it seemed like the problem was avoided and I left the hospital around 5:00pm to go set up the presentation. The program director was going to meet me there.
Well It seemed that everything was going to plan until I plugged in my computer to the sound system they had their and realized that I didn’t have the power cord of the lab top. My face turned white and cold. My wife was there and she looked at me and asked what was wrong. I told her “I forgot the power cord of my computer. I need the power cord! I can’t play the video show from any other computer. I gave my word to the program director and I didn’t want to make her feel bad…” I was in a state of panic. My wife said “take it easy. I’ll go back and get the cord for you. Don’t worry.” At this time the program director walked in and she asked if everything was ok, I turned to her and said. I “I think so, except for the fact that I forgot the cord for my computer, but don’t worry my wife went to get it.” Her face changed and she seemed a bit worried. Luckily for me, I had backed up the power point presentation on my flash drive and tried to load it to another computer that was there. I spend the next 10 minutes trying to edit the show as best as I could. And by God’s grace I was able to fix it. I went over to the program director and told her everything is fine. She seemed relieved. (the power point was the presentation I had been working on for about 4 weeks. It was a tribute with pictures we took over the year of all the events in the program.)
Well needless to say the night went out without a flaw. My wife came back with my cord, but I didn’t need it, but the program director was glad to see he had made the effort. The night went rather well. They gave out awards and resident awards – award for hardest working residents, nursing staff favorite resident etc.. I didn’t win any awards but probably came close. The program director publically thanked me and my friend for all our hard work this year.

The high point of the night was when I got to present the program director and associate program director the $160 plaques we got them. It was memorable because they didn’t know we were going to do that. The 3rd years had gotten their awards, and me and the 2nd year resident stood up and presented the awards to them. They were really surprised! You should have seen the look on their faces. After the award ceremony the residents danced and we took pictures, and really had a good time.

I was really glad for my wife, she was able to meet the program directors and staff-Which was really good for her, because she wants to start residency soon. When it comes time to applying and she will at least be “guaranteed” an interview.
After this award ceremony I spent the next weekend on call and studying for my mortality and morbidity conference I was holding with SUPERMAN ! Can you believe it? And it had to do with the code we both ran on the patient who they found the ETT in the esophagus. I think none of the seniors wanted to do it, so they put it on me to do it. I spent the entire weekend studying for it. It was pretty fun. I learned a lot of good stuff. I tried to do my presentation design almost similar to how the ACP doctors I saw in ACP. When they talk about certain points, they always refer to journal articles. So the majority of what I said on my presentation was from articles and journals. It was a lot of fun.
I almost forgot. The New interns are here !! and they look nervous !! just like we did 1 year ago. They look like they are going to crap their pants. Lol. Hard to believe 1 year ago we were in their exact shoes. They have been in the hospital about a week doing orientation. They seem to be a stronger group academically. 2 or 3 of them are surgeons (eye & colon). A few of them have phd’s and have had publications-Pretty impressive. However impressive it is, it really doesn’t prepare you for what they are about to go through.
I still remember having the first meeting with the chief and him telling us “on day one we start right away. It’s like the military. You are thrown into the fire.” I didn’t realize what that meant until the first day I was on call and got paged by the telemetry nurses 60 times.
Overall, it was a good and exciting year. I’m Glad some of you have followed my journey reading this blog. I hope and pray that one day you can begin your residency journey. I also hope that you find true meaning in your lives. What we do doesn’t define us. What we do is an extension of what we have inside. I hope that you find happiness in purpose in your career- Whether that involves having residency or not. I believe happiness comes from doing what you are meant in life. You have a purpose. And I hope you can discover that. I Hope and pray God grants you the strength and will to carry on in your long journey to finish with your career.

God Bless you and your family. Keep on working hard. Don’t Give up ! You can do it! Anything worth in this world comes through hard work and determination. Find strength amongst people that lift your life up. And when you can’t find peace in your life. When you feel the clouds of darkness surrounding you, when you feel alone and unsure of your life, look to God. He will life you up. Jesus can bring peace to your life. He can give you strength and the patience you need to carry on. Goodluck

God Bless
Dr.Mike

Day 346 My battle with Superman

2009-06-25T15:08:00.008-04:00

It happened when we were on-call a few nights ago. It was the first time I have worked with him in about 7 months, since I first had my Unit rotation with him (you can read about it here: http://thankyougodforresidency.blogspot.com/2008/06/day-5-good-bad-and-ugly.html). It's kind of strange but he is probably one of the only residents that I actually have NOT talked much with him the last few months. I have spend a lot of times with the other residents and have built a good relationships, but he has to be the one that I'm least closest to. He is a nice guy. A bit serious on most occasions. I get the sense he wants to maintain a slight distance amongst himself and the interns. A sense that he is the teacher and we are the students. Its the same odd feeling you feel when your hanging out with a teacher or attending. You don't really feel like letting your "hair down". You conversation is reserved and you are not as open. I personally like joking around and having laugh with most of the residents, and some attendings, but with some people you just feel like you have to be reserved. Anyways, so thats how I act sometimes when I'm around superman. He is the "teacher" and I'm a "student"..lol. But its still a good relationship. I have no ill will towards him. He is very knowledgeable and helpful. He is always ready to review something with the interns.

So I was on-call with him. He was covering the floor and He called me for an admission. I went to the ER to do the admission, and in the middle of the admission a code blue was called in the ct scan room. I have to say that I really was looking forward to doing the code with him. I wanted to see how his approach to running a code was. At the sound of the code blue alarm we ran to the ct scan room. It was a female patient that was getting a ct scan, they were working her up for PE. There was a controlled mayhem that followed. Nursing screaming, radiologist tech screaming and anesthesiologist trying to in-tubate while everyone was screaming around him. The code had started in the ct scan room to the dismay of the CT tech who was like "can you guys take this outside?" It must have been less than 2 minutes, when the anesthesiologist said "Ok we got it, lets take an xray and move her out." Superman agreed and told everyone to take it outside. The respiratory tech started bagging the patient and we slowly worked ourselves out of the ct scan room and headed towards another empty room about 1 minute away. When we arrive at the second room the code was still continuing , and it was my turn to do the chest compressions (its usually about the only thing the interns are allowed to do) I started the chest compression. When I place my hands over the sternum and started compressing, it felt as though her ribs or sternum were a bit cracked. I remember feeling a chest similar to that a few months ago when I was running one of my first codes. The chest wall was very frail. I tried not to compress too hard while I did the compression. Superman saw how I was doing the compressions and yelled loudly "Hey do those compressions harder." I started to do it it a little deeper and faster. About 15 seconds of trying and superman was like "look that's not how you do it" and he came over and tried to show me how to do the compressions. Its not that I didn't mind him showing me how he did compressions, but it was the way he did it. And yelled in front of all the other nurses and techs. (by the way this was not my first,second,third or fifth or tenth time doing chest compressions....) He then told one of the critical care techs to take over the chest compressions. Less than 1 minute into doing the chest compressions superman yells "good chest compressions. Very good." He kind of said it really while I was next to him. It was really irritating. It felt as if he was trying to rub it in my face. Maybe he wasn't doing it on purpose, but it made me really upset. This was probably not the time to try to "teach me" how to do chest compressions.

Anyways I didn't say anything and the code kept on running. About 6 minutes into the code. He asked for a pulse. I tried to feel for it but didn't feel one. Superman came over and "felt" one in the carotids. He said we had a pulse and proceeded to cal of the code. "Her rhythm was sinus tach. (no afib or flutter). The code was over for now and I went to look for a phone, because an attending was waiting to get in contact with me. I went back to the E.R. to call the attending. And the female that we had coded was brought back to the E.r. While I was in the E.R about 8 minutes. Another code blue was called again. (Codes in the E.R are run by the E.R doctors and not the residents. I went to find the room in the E.R that the code was being run, because I figured it was superman running the code. I found the bed number and sure enough superman was their running the code. All in all it must have been at least 40 minutes all together that this female was being coded. While he was running the code and one of the techs was doing compressions, superman again said while he was next to me "keep those compressions going. " He then turn to me again and said "you see that's how you do it." I turned to him and said "no, that's not how you do it. He is doing the compression way to hard (this guy must have weighed about 260 lbs and the female was about 140lbs.) He is doing the compressions too hard and she probably has cracked ribs and is going to lose all the negative intrathoracic pressure your trying to preserve." I didn't say it too loudly. But he kind of stayed quiet when I responded the way I did. Anyway, another 20 minutes passed and he decided to call of the code. Even after trying to rule out tamponade (which he had the Head of E.R do a bed side sonogram). Cold was called, and the team was dispersed. I have to be honest with you. I was extremely pissed. I thought it was really inappropriate for superman to start giving me lectures on cpr in front of the entire code team.

I waited for some time to pass by and when I saw him sitting down at a desk I told him. "You know, that's not how you do chest compressions. You are gonna crack ribs and cause lose of pressure. DO you remember ICU bed 13? The guy with hydronephrosis? We coded him 1 hour and a half. (me and another resident doing the chest compressions), and we brought him back. You don't need to do he-man compressions on someone. Thats not the standard." (later when I got home I even read more on the AHA guidelines about chest compression which need to be 1 1/2 -2 inches. I also remembered one of the lectures of critical care telling us in a lecture to make sure you try and not break the ribs and you lose pressure and air. When I first heard this few months ago, because I felt that I had broken some ribs on a patient I had done cpr on. If you read on the net and some specialist they will say that breaking ribs is better than not doing any at all. But ideally you want to make sure you try no to break the ribs.) Anyways superman said "i know. I know." and didn't say anything again. I didn't want to keep on, because it wasn't the place for it, but I was just so upset at the way he was acting or by his approach.

Anyways fast forward a week later, and I saw superman approach me at the resident lounge. He said "guess what?" I said "what?" he said "its your turn to do an M+M (morbidity +mortality) conference." I said "on whom." He said "remember that lady we coded? come here sit down, and check out this xray?" I sat down and he opened the xray from the computer system. I looked at the xray and coudnt really see anything. He pointed to the trachea, and said "you see the Et tube that was placed, looked at it? You see, its in the ESOPHAGUS!!!" I was like "wow.. your telling me the anesthiologist put the tube in wrong place? and nobody caught that? Wasn't the xray read by someone in the E.R? " He was like "yup, one of the experienced staff E.r Docs read it during the code, and it was wrong!!" I was a bit in shock. Looking back her stomach was a bit distended. But because of the chaos, no one bother to check the breath sounds from the Et tube placement.

Looking back, it really was a chaotic night. Seemed that everything went wrong, and sometimes goes wrong. Looking back I'm sure there was a lot of things that could have been done, that was not. Overall one of the toughest nights I've seen in a while. Me and superman are still friends though his approach might not be ideal, but he tries to do the best he can for his patients.

Gd Bless

Dr.Mike

Day 342 Almost Euthanasized a patient Today !!!

2009-06-17T14:59:00.009-04:00

It happened in the afternoon. The case manager on the floor called me and she told me under the phone if I could increase the morphine on a PCA drip that a patient who was in comfort measure (basically end of life care) I didn't really think about what she was asking me to do until it was too late. I wrote down the name of the room and went to visit the patient. An elderly gentleman about 80yrs old. Non-verbal and lying comfortably in one of the rooms on the general medical floor. I was surprised to see how relaxed and calm he was. I thought it was strange that she wanted me to increase the morphine. Anyways, I went over to the computer, and increased the morphine by 1mg on the pca pump. As I walked away to go to another floor. The nurse assigned to the patient came up to me and said "Can I talk to you." She seemed a bit upset. She then said "listen, I understand what you are doing. But I just wanted to tell you that I can't. And I'll tell you why." At this point she began to quietly cry. "I have a problem with this situation because I was the person who gave my husband the last does of morphine while he was dying. And I just can't do it anymore. I just can't.." She said the last words with difficulties as the tears ran down here face. Not even half way into the conversation I realized what I almost did. "I almost euthanasized this guy!!" I told myself in my mind. I told the nurse "I agree with you. And we will not go up on the pca dose." I'm gonna d/c the order and just put him back on his previous. Don't even touch it, leave it alone" I told her. She thanked me and walked away. As soon I walked the corner near the elevator, I looked behind me to make sure no one was behind me, and I "ran" to the nearest computer I could find to take off the order!

After all this, I took a step back to take a breath and went to the lounge. I couldn't believe what I almost did. I could have gotten in huge trouble. I can't believe I didn't realized why the case management was pushing for more morphine. The hospital has been flooded with full beds, and they are trying to discharge as much patients as they can. It seem like this guy was just in their way. I'm Glad an angel was looking at for me that day. I'm glad the nurse was smart enough to challenge the order. Glad I didn't break the Law !! Yet alone get kicked out of residency !!

Sometimes as an intern you make mistakes but some are harder to correct. The hardest of which is death!!!! I still remember running to my seniors in the unit when the patients were literally crashing before me!! I was scared out of my mind. Thank God for good team work.

God Bless

Dr.Mike

Day 339 End of the Year Update

2009-06-10T13:40:00.006-04:00

Its been a while since I last updated the blog. I wanted to let you guys know what has been happening. I have about 2-3 weeks left in the year before we become 2nd years. Its amazing how fast time flies. I remember just yesterday spending my first night on call and spending my first weeks in the unit. I'm really glad you guys have been following the blog. I hope it has helped all of you who read it. If I have not answered all your emails please give me time. I will respond to all of them. I hope that you have walked away after reading my journey to first year with some insights into residency and the match. I have tried to post information that you can use to help you better in this years match that is coming up. Whenever there is information that helps those to get into programs I try to post it here.

I'm finishing my last 2 weeks in the general medical Medicine floor. I just finished the night float system (on-call 8pm-8am 2 weeks in a row.) I was surprised how smoothly it went. The nurses didn't seem to bother much. Most if not all of the calls where handled smoothly. I had good seniors with me. I did most of the admissions with little or no supervision. I also got to spend my night float one week with superman !!! (check out day 5 of the blog : http://thankyougodforresidency.blogspot.com/2008/06/day-5-good-bad-and-ugly.html)
Some of you might remember him from previous post. I really had a good night float with him. We had a good time reviewing some protocols and debating everything and anything. I spent an entire night arguing whether to use xopenex or albuterol on a asthma exacerbation admission that I did. He had stated that albuterol was preferred over xopenex. I didn't completely believe him, but was kind of irritated by the way he asked me about it. he kind of scolded me for placing her on xopenex. I was so annoyed I spent an hour on the internet comparing journals and articles on both of them and found conflicting information. I found articles stating that xopenex was sometimes preferred for cost because it might diminish the number of hospital stays. I showed him the articles to his surprise and we had a loud discussion about it. lol. I came of a little upset while we argued because I was annoyed that he was trying to lecture me on admitting an asthma exacerbation which we have done 100 times. Anyways overall it was a good night float. A lot of other stuff happened throughout the night float and I'll post it later.

The resident graduation is in 10 days and I'm preparing some slide show presentation which is taking me a long time to do. I have been sorting out from a group of pictures. I was also up late last night ordering some special award plaques that we wanted to give to the program director and associate program director for all their help this year. It came out about 160$ but we will try to collect money from the residents to see if they can chip in.

I also have vacation coming up. There is a group of residents that are going to the Bahamas, but me and my wife might go to Dominican Republic. I sure miss Dominican republic. We spent 6-7 years their when we were back in school. IT is a great country to relax and have fun. It was difficult when we were there, but we really miss it a lot. We lived near 27 de Febrero and went to an English/Spanish speaking school called Unibe. I'm sure a lot of you know the school. (you can pretty much find all the unibe students on facebook these days). We want to go to D.R. but the price is so expensive. I think a ticket is like 1000$ per person. We want to go to bavaro resorts that we are very familiar with.

Other happenings with my life : we have had several tragedies hit some of the residents and people that I know. One of the residents husband was found to have cancer (stage 3-4) and another residents dad passed away from cancer 3 days ago. They took some time off to deal with these difficult situations. Our prayers go out to them and their families. Its been very difficult for them. A lot of times in life you complain of problems and difficulties, only to see someone else have a bigger and more serious one. It was very devastating for us to hear the news. Specially when she also has 2 small kids with them. You hate to see people you love and care about it pain. I pray that they will be able to bear all these trying times.

I'm on call today till 8pm. I'm a little exhausted. I hope I can give a betetr update. I have blog inserts that I have finished I just have to upload them I will upload it this week.

Make sure you guys check out this blog has a lot of helpful material:
http://www.usmletomd.com/tips4match/

Take care guys. I need to take a short nap. I'm beat......

God bless

Dr.Mike

Day 334 Helicopters,Cops and Xanax

2009-06-01T05:53:00.011-04:00

9:46 pm Man I'm tired. I'm on call the second Saturday in a row. I wanted to write about what has been going on in the hospital but I can't right now. I feel a bit drained. There is this resident that has been asking me for help to do his power point, and I guess he has never used it before, and I have been helping him even with the little time I have free this week. I hope I get some time of next week when I go to ACP in Philadelphia. (which the program is paying for !!! weee!!!) But anyways. Man I'm tired. By the way my friend called me from the parking lot before he left. He is a second year resident. He wanted me to come out and watch the helicopter on the roof. I was like "huh? helicopter?" He said "yeah you can see it hanging from the roof come and take a pic!!" I was like "this is not a joke right?" he said " no, no man... its for real. If you are coming I'm turning around." So I took my camera and I went outside the hospital lobby. And sure enough there was a helicopter on the roof. Boy my friend was excited. Not sure if he had ever seen anything like that. But he was a "kid in a candy store" happy. It got really cool when the helicopter starting moving the tail and started to speed up. And as it was taking off my friend said "you know what this means right?" I was like "what?" He said "that's means someones got a unit admission!! " He started laughing. It was a cool site to see.

Other than that the floor has been ok. I saw a patient of mines that has been pretty "un-popular" here with the staff. I remember seeing her about 2-3 weeks ago in the general medical floor. She had come in for sinusitis/ recurrent and was staying in the GMF floor, and she was giving the nurses a really hard time. I wasn't sure what they met till I went to talk to her. I think she spoke to me almost an hour. I was trying to "escape" but I tried to be understand and listen to her as long as I could. She seemed very anxious, and I have learned that sometimes anxious people just need to be heard. She when on to tell me how she thinks there is a conspiracy against her. The last 2-3 hospitals she has been to have been really bad. I think she said she was going to call her congressman. She said that she was also kicked out of R__ W___ hospital too, but that the fault was mostly the nurses. But when I saw her she was upset because they were being "racist" towards her. The African American nurses were treating her bad she said. And also her neighbor in the bed next to her had her family over last night which was about 20 of them (according to her) and she really felt a bit uncomfortable, even though she has no problem with black people. She has a lot of black friends. She says that while she was lying in her bed, there was a little girl just staring at her, and it made her really uncomfortable. She said it got so bad she even called the cops!! I was like "what, you called the cops?" She said "yup, I sure did. You can't treat people like this. What kind of country do we live in? These people are just racist." That has to be one of the first I have heard of patients calling cops from the hospital at the bed side. It didn't take too long talking to her to make me realize that she has some anxiety issues. I tried to listen as much as I can. I told her I would get the patient advocate to come and see her. The following day I saw the attending who she was under. He told me "Hey, Dr. Mike did you make MS.___ non teaching?" I smiled and laughed and told him "her? no....lol. I wouldn't do that to you. By the way, you know she called the cops yesterday right?" His eyes widened and he seemed shocked, he said "what ? are you serious?" I said "no..I just wanted to tell you. She called the cops and they came here, so if I were you I would be careful." I left the room, but I got the sense he was a bit worried. He is one for the attendings that try to avoid any legal issues or situations like this. Who can blame him? The next morning on sunday, I actually saw him come in to personally discharge her. I think thats the first sunday I've ever seen him in the hospital. I laughed when I saw him. I think he looked at me and smiled back.

Well fast forward to today , and here she was again. Guess what ? she was a patient of Dr. DEvil !!! (http://thankyougodforresidency.blogspot.com/2008/08/across-your-time-in-wards-and-floors.html) out of all people!!! I saw her this morning and she was in a state of mild panic. She seemed very upset and was angry.I said "what happen?" She said "last night was horrible. I had the doctor come in and he basically screamed at me and told me that my asthma is triggered by my anxiety, and I told him that was not possible." She then asked me to give her a second because she was upset now, and she was having a hard time breathing. I tried to "explain" to her that maybe the stress of the situation might be causing your body to react differently and it might cause you to breath differently. She said she doubts that it was from the anxiety, but that while she spoke to me she felt a little better. I told her I would give her some more respiratory treatment, incentive spirometry and mucomyst. She said ok and she agreed to try to relax. I told her if she had any problems that she could call me. Surprisingly she hasn't called the entire day.

10:12 gonna try to get some rest. Have to wake up at 4am to do some notes. and tomorrow that resident is coming to my house to finish up the power point at 7pm!!! amazing huh...... geesh must be nice to sleep and have a day off........

God BLess
Dr.MIke

Day 320 A Message to Those of you with stress and Pain

2009-05-26T05:30:00.022-04:00

There are many of you out there that are struggling to match over the years. And there are those that are scared and nervous about applying this year. This is a small message of Hope to uplift you and give you strength to keep going.

"PEOPLE NEED THE LORD" song by STEVE GREEN

Everyday they pass me by,
I can see it in their eyes.
Empty people filled with care,
Headed who knows where?

On they go through private pain,
Living fear to fear.
Laughter hides their silent cries,
Only Jesus hears.

People need the Lord, people need the Lord.
At the end of broken dreams, He's the open door.
People need the Lord, people need the Lord.
When will we realize, people need the Lord?

We are called to take His light
To a world where wrong seems right.
What could be too great a cost
For sharing Life with one who's lost?

Through His love our hearts can feel
All the grief they bear.
They must hear the Words of Life
Only we can share.

People need the Lord, people need the Lord
At the end of broken dreams, He's the open door.
People need the Lord, people need the Lord.
When will we realize that we must give our lives,
For peo-ple need the Lord.

People need the Lord.

Another Good Song in Spanish though. "Paz en La Tormenta"
Peace in the Storm

The Greatest Story ever Told (part One)

The Greatest Story Ever Told (Part Two)

God BLess

Dr.Mike

Steps To Christ (Free Download,PDF)
http://www.sdagreymouth.org.nz/PDFs/Steps-to-Christ.pdf

Why Does God Allow Suffering? (video)
http://www.discoveries08.org/episode-4-high-quality

Purchase this song here 1$(99 centz) :
http://mp3.rhapsody.com/steve-green/people-need-the-lord/people-need-the-lord

Day 315 How do I Kill my Beeper ?

2009-05-15T18:35:00.020-04:00

Every few times a week the following happens to interns. I would have to say that it happens maybe 1-2 times a week. There is a time during the week where you start getting paged non stop by the nurses and attendings and you are bound to make 1 person un-happy. Its like a juggling act. It gets very hectic to say the least. I will tell you a true scenario of one of those moments.

I would say it started at around 3:30pm

3:31 page 1: "Hi Dr. I just letting you know pt in 205b is upset and want to sign out AMA. Can you come and talk to him?

3:33 Phone call from other intern. "Hey you know that guy in 205b he was in a.fib before but I repeated EKG and he is in sinus now. See if you have a chance to talk with the cardiologist who wanted me to start dig. I gave you a copy of the EKG show it to him if you have a chance . bye"

3:34 Paged again. "hi Dr. can you sign the med rec on the patient you are discharging. Thanks."

3:35 I start walking to the telemetry to see the pt that wants to leave.

3:36 arrive at telemetry. I walk over to the room 205b. Start talking to pt to see what it the situation. While I try to find out why he wants to leave I get another page and 3 cellular phone calls from intern that left.

3:42 I polite interrupt my conversation with the pt. to answer page and phone calls.

3:43 page from e.r wondering if pt can go without monitor for a test.

3:46 As I walk back to try to talk to pt , the nurse taking care of 205b comes up to me and says "did you talk to him? I think he has psych issues. By the way that's the cardiologist behind you. We have been paging him all day. He is an A#$% H_le. "

3:47 I 'm kind of relieved to know that he is an A H_le so that way I can avoid him as best as I can. I wait till he goes to the other room. I answer phone from intern. "You wont believe this. I brought the wrong papers to my appointment. Did you bring papers to your appointment?" I polite say no, but I tell him to call me back if he needs anything.

3:49 I stand a few seconds out side the doctors room deciding whether to talk to the "psycho" attending. I say to myself , let me do it for the pt. I swallow my pride. and show him the EKG. He rarely looks up and says fine. I tell him pt wants to sign out AMA. He says good and keeps writing another note.

3:53 I'm on the phone with the attending of 205b to let him know pt wants to sign out AMA. attending tells me he has psych history. I better check with psych to see if they will clear him to leave AMA.

3:56 I'm on the phone with crisis. "we will try to send someone out to you. But they left for the day. the evening psych might be able to help. the Family resident is standing next to me. "I think I saw him in the other floors."

3:58 I get phone call from my friend again . "Hey sorry to bother you man. Yeah I have to come back and do this again. I didn't bring the paper work. I came for nothing. " (I guess i'll be covering for him again for the third time!)

4:02 I'm walking around the floors to see where the psychiatrist is to ask him about pt. I find him and he tells me that the guy is delusional.

4:04 paged by nurse. whats the story with the 205. I tell her he cant sign out. "Strap him if you have to. do the soft restraints. but better to tell him that psych will come to see him, to see if he can be discharged."

4:06 paged by er again about septic pt. You guys coming to help with the med rec?

4:08 I get to e.r I walk over to nurses station. "there is family members of septic patients that want to talk to me. Nurses supervisor comes up to me and tell me that I should sit down and review 20 medications to see if she is getting the right ones. Other senior comes up to me and ask me about siging line of site of pt that was admitted in the e.r. in the morning for polysubstance abuse. While I sit down to discuss the meds on the septic pt. Other intern stand next to me to sign out his list of patients. I get beeped as I sit down to review septic pts meds. "hi sorry you have and admission. where r u ?" I tell her I'm in e.r

4:10 I read in the progress notes of septic pt that vanco and cancidas were d/c. I go to the computer and delete vaco and cancidas and mistakenly delete 15 other meds !! Now I have to input them before I go to next admission. I sit down and try to do as much of the meds in the computer as I can. another beep comes in from amu to tell me to replace a low magnesium on a pt. As I finish up the list of meds. I realize that the admission I got is from an attending that enjoys having a 1 hour admission talk over the phone. he even wants to know when his patients had the 5th bowel movement when they were 9 yrs old and what color was it. And whats her favorite beverage? what does she eat for lunch? Is she a vegetarian? better check vit b 12.

4:14 I get to bedside of pt that I'm doing admission. the cardiologist is their. I hear something about a murmur. diastolic or something like that. I talk with the cardiologist for a few seconds we did cath on her 5 years ago. Her 2 d echo has worsen. she might need replacement. look up and study indications for valve replacement in asymptomatic pts. I agree to give him a short review later.

418 I sit down with the senior. She is kind of looking at me with a puppy face. you ok? you seem tired. I start looking up labs of patients.. I ask her if she knows the story? she says nothing much just systolic murmur. Maybe some abdominal pain. But she tells me better get orthostatic vitals on her before I call attending. Or try to do a rectal. But she will probably refuse.

420 I walk over to lady who refuses rectal. She denies any abdominal pain on palpitations.

423 "psycho" attending calls back and basically questions every single order that we wanted to do. I say black he says white. I say orange he says apples. I give a brief history of what she told me. He goes into 5 minute story of what he knows about her. Since he's been taking care of her for 110 years and by the way he saw her this morning in the office and last week and had dinner at her has on Saturday. So I finish taking down the orders for the admission. Completely exhausted and upset that I had to end the night talking with this arrogant attending. TO calm myself down I google quotes on patience and wisdom. I find some that make me laugh .

"You are educated when you have the ability to listen to almost anything without losing your temper or self-confidence."
Robert Frost

Patience is something you admire in the driver behind you, but not in one ahead.
Author: Bill Mcglashen

Patience is the greatest of all virtues.: Cato the Elder (234 BC - 149 BC)

"One moment of patience may ward off great disaster. One moment of impatience may ruin a whole life."
Chinese Proverb

4:30 the storm of pages stops for now. After reading quotes on patience, I realize how little I have. I tell myself that its unrealistic to expect all doctors to be the same. There is one bad apple in 100 Its a fact of life and residency. II guess its me that lacks understanding and patience.

SO much for qoutes.

7:30pm 3o minutes to go before I go home. I'm tired

God Bless

Dr.Mike

Day 310 The Sad Side of learning

2009-05-12T20:18:00.017-04:00

It was around 530pm in the afternoon and I was on call in the telemetry unit. I had just finished doing an admission when there was a code blue alarm called. "CODE BLUE CCU.... CODE BLUE CCU.." I dropped everything I was doing and ran to the unit. I arrive in about 1 minute and found that there was a patient intubated whose heart rate was in the 190's. When I walked into the room there were 2 seniors (a second and third year.) As I walked into the room,the second year turned to me and said "there is a pulse and she is breathing." There were a group of nurses with the crash cart and respiratory techs standing by. In about another minute or so, the other intern arrived at the room. The other senior turned to us and said "you guys can leave, there is no code blue." The other intern left the room to go back to the e.r. I decided that I wanted to stay to see what they were going to do. I had a page to my beeper and I left to room eager to go back to see how they would handle the situation. As I was on the phone answer a routine call from the floors, I turned to the other intern who was stepping out and said "look at the monitor. She is at 190. You should stick around. When we are seniors, we are going to have to deal with situations like this."

As we were about to start heading back the the unit room, I suddenly hear a group of people clapping or cheering. It seem to be coming from the room where the code blue had been called. I went back to the room to see what was going on, and I see the heart rate at 86. It seems that they had given adenosine 6mg IV x1 and the rate had taken a dramatic dropped. The nurses were so excited and other techs, that they were cheering and clapping about the sudden drop in HR. I felt it was a bit strange. I've never seen people clapping in the middle of a code or a possible code. Over the next 2 minutes her HR when up again. She has a narrow irregular rate Tachycardia. SHe was not in V Tach or V Fib. They gave another adenosine 6mg IVx1 and it broke again. The crowd in the room was less jovial but were a bit relieved that it had gone down. I think the next step was giving adenosine 12mg IVx1 or if she went into V FiB or V tach possible shock?

Anyways, as I walked back to the E.R I thought about what had just happened. I was also excited to have seen what had just happened. I told the intern, "see how much you can learn from these situations. You will rarely forget them. " But the more I thought about it, the more I became a bit sad at what happened. Or at least that fact that some medicine you learn -which is exciting- comes by way of someone else 's misery or misfortune.

I'm not sure if you have been in the middle of a code where people are clapping and cheering with excitement, but it seemed a bit odd.

There is joy in helping people. There is joy in learning something that can better the lives of those around you. There is a sense of deep great emotional fulfillment in medically helping someone that is suffering from diseases. There is a deep joy in giving hope to those that are hopeless, and bringing some light to the darkness of someones life.

Today I went to see a patient in the surgical trauma unit that had a R MCA Stenosis and R internal Carotid occlusion. He is schedule tomorrow possibly for a stenting by the neurosurgeon. As I spoke to him today morning, he seemed a bit nervous. He is a very analytical person. He is an accountant and even writes down and takes note when we do rounds on him. He has 20 questions each time, and is a very well informed individual. We spoke about quitting smoking and possible what was going to happen. As I was about to leave, I had the feeling that I had to say what I was about to tell him. I said " you know MR. Smith. Sometimes certain situations happen in our lives that make us take a step back and make us question what is really important in life. This situation that you are going through might make you look at your life in a different way. You might start to appreciate and realize what is really important in life. Your family your friends. But also you need to remember one thing. Right now you are surrounded by people that care and love you very much. But no one. No one can possible understand fully what you are going through. No one can see your mind and heart. It would have to take someone that is all powerful and knowing to do that. And I believe that someone is God. He is here with you in the darkness moments of your life. He can give you the strength and peace in life to deal with the situation you are going through. He will not abandon you. He is here with you. I don't know how much of a spiritual person you are, but I felt that I had to tell you this. I can sum up my entire life and spiritual walk with one story I heard a long time ago. There was a man in a prison and he was taken to the bathroom by the guard. He grabbed him and threw him down on the toilet and said "clean the toilet with your hands." As the prisoner stood there humiliated and cleaning the toilet with his bare hands, the soldier turned to him and said "where is your GOD?.... Where is your God?" The prisoner looked up to him and said "He is here with me." Sometimes life seems unfair, and it is. Life hurts and you don't understand what you are going through but always remember that God is with you. He will not abandon you. How many times people tell you "where is your GOD?" or How can this happen to you? When you are asked this remember to tell them that God is with you. He will walk with you in these difficult times." I almost had tears in my eyes. And he stared at me. His eyes were wide open. He was very quiet. I turned to him and said "I just that you had to hear that." He turned to me and said "thank you very much for that. I hope that you can come by tomorrow. I turned to him and said "sure.I will see you tomorrow. Good luck tomorrow." I shook is hand and left the room.

I can't describe to you completely how I felt. I felt this deep spiritual strength and satisfaction. It was like an spiritual high. I felt that I had to say those things. He seemed scared and I wanted to give him a bit of hope and a bit of peace. I pray to God that he will have some tomorrow when he undergoes the operation.

I too hope that you have found strength from the difficulties you are facing now in your life. IN your struggle to match and and your struggle to keep going. Keep your head up. God is with you. He will not abandon you. Jesus Loves you very much. Don't give up lean on God for strength. He knows the desire of your heart. Talk and pray to him as you would a friend. He will not forsake you.

God Bless

Dr.Mike

(click on the Below Image)

Day 304 Sixteen Memorable moments of My First year in Residency

2009-05-05T10:40:00.033-04:00

Here they are, 16 of them :

16. It happened on my third day of residency. I was called by the nurse to see a patient on the ventilator who was de-saturating. I was being yelled at by the respiratory techs while they asked me what I wanted to do. I was speechless and helpless partly because I had no Idea what to do. You don't learn ventilator management in medical school. I did only what I could do. I got on the phone and scared the living hell out of my senior. I called him and basically almost "cried" to him on the phone....lol. He was in the middle of doing 2 admissions and he came 5 minutes later running. I remember driving home that day scared as hell. I was in a state of quiet shock.

15. I remember the first time I sat down and saw the seniors sign out to each other in the Unit. They ran down about 20 patients in about 5 minutes. Me and the interns were looking at each other saying. "what da hell?".

14. The first patient I ever saw and examined died about 10 minutes later.

13. I still remember when I was back in south New jersey. Living in a 1 room studio with my wife. (We were doing clinical externships in the area.) I remember that I was sitting on the tablei on my computer and my wife stood up and said "you got a pre-match!" I saidd "huh?.... what? Are you kidding me?" She said "look come over and read it." I went over the read the email and it was true. I couldn't believe. "I told you I had a good interview, but I didn't think it was that good...wow." I was so happy. My wife called her mother who was on the phone crying. I called my mom but she wasn't there, so I called my Dad. In fact I called anyone I could think of.It really was amazing.

12. I remember my first day of residency. I sat in the car around 620am and as I drove out of the parking lot. I remember telling myself. "this is truly amazing. I never thought this day would come.

11. I remember when I first pulled into the hospital. I called my mother and told her "you will not believe where I'm at?" She said "where?" I told her I was in the parking lot of the doctors in the hospital. She was like "wow.."

10. I remember when I first woke up to go to residency and my wife had ironed my pants and shirt. And she had woke up early in the morning and I think she made me breakfast and wished me a good day. She was so happy. I later came home that night and she had made me a cake. She is the greatest.

9. I remember the first time I had to do cpr on a patient. The code ran about 20 minutes. After it was over and I left the room. I stopped and looked back and said "I know her." It was a patient who I had talked to about God and hope about 72 hours ago. She had metastatic breast cancer. I rememeber talking to her and telling her "you know. Know one understand what you are going through. Only someone that could see inside your heart and see inside your mind can truly understand what you are going through. And I believe that person is God. He can help you. He will not abandon you. He is with you in these heart times. Lean on God he will help you bear with the difficulties of Life." Who would have known that in 72 hours I would be coding her and she was dying.

8. I remember the chief resident standing up in front of the conference room and telling all the first years "Be ready on day 1. Its gonna start and it will be fast." I really didn't understand what that meant until 3 days later.

7. I remember my first night on call. I was handed about 3 sign outs with 40 patients. I was so scared. And right before I left the floor to go to the lounge for a sec. One of the first year must have seen the expression on my face. He was like "you want me to stay with you? You ok? Come lets talk about it. anything you need let me know." He made me feel at ease. He is really a great Guy. I love him so much. I think he later called me back and asked if I wanted some pizza that he would order for me.

6. I remember finishing my first night on call. Another first year asked me how was my first night on call? I turned to him and said "it was like a medical buffet, and everybody was hungry!" LOL. He smiled and laughed.

5. I will never forget How Dr.Devil went on a rampage in the Unit my first week. (http://thankyougodforresidency.blogspot.com/2008/08/across-your-time-in-wards-and-floors.html) I think ever since that I have been very cautious in approaching attendings. I try to give them their space-especially the Angry ones, and latch on to the ones that are open-minded and love to teach. I remember meeting some extremely humble and approachable attending 's after Dr.Devil and telling myself "what planet do these guys come from?"

4. I never forget the day I realized that all the residents were all equal but the only difference was the experiences they had had. There are a lot of smart and hard working residents, but the only difference is the real life medical situations they have dealt with. Those that had experienced a lot of difficult situations were very prepared and good Doctors.

3. I never forgot how good it felt talking and trying to give hope to those that were dying from a terminal disease . I tried to tell them all that they were not alone. They did not have to deal with this pain by themselves. God was with them. He was going to make up all the badness that they have gone through in life.

2. I never forgot the time that all hell broke lose in the program. http://thankyougodforresidency.blogspot.com/2008/12/day-166-this-is-spartaaaaa.html

Ever since that happened. I have tried to mind my own business and try to work with everyone peacefully.

1. Most of all I remember coming home late from work one night. And sitting in my car. I looked up to my second story apartment. My wife was home and the lights were on. I knew that she had gotten home early and was preparing dinner for me. I remember how good it felt realizing that after 13 years of being with her I still wanted to come home. And I was happy to be there.

Overall I have been very blessed by what God has given me. I only hope that I can give to others the grace and goodness that he has shown me. The good things that happen to us in life, happen so we can share them with others. God gives us purpose so that we can use that purpose to change this world we live in. If God has given me residency, it is only so that I can help others achieve it to. It is to give those who wer ein my same shoes hope. Hope that their lives have purpose and meaning. God will not abandon you. You are not alone in your struggle to finish your careers. Jesus loves you very much. He will guide your path in this long journey you have started. Don't give up. Lean on God for strength.

God Bless

Dr.Mike

"life is not about the moments we breathe

but about the moments

that take our breath away."

Day 302 Drowning

2009-05-03T06:27:00.023-04:00

It's 630am in the morning. I just finished another 24 hr call. (This is the 3rd Saturday in the last 4 weeks) I'm a bit exhausted, but I wanted to write down the events of last night. It was a very busy night and very stressful at some points. I was called by a nurse at around 11pm because a patient was desaturating on the floor. She was an elderly lady with chf and pneumonia. I was told over the phone by the nurse that she really didn't look good. I was a bit surprised to hear about it because I was the only resident on the telemetry floor. The admission was done by the other intern and he didn't let me know she was going tho the AMU. What followed next I will never forget.

I went to the telemetry unit to see here. She was extremely anxious, and was saying that she coudn't breath. I check the pulse oximetry and she was at around 80% !! She was about 85yrs old and her code status was AND without intubation. They had her on a non-re breather mask with 100% oxygen. I called respiratory and ordered the usually ABG, EKG, Xray,CMx2. The respiratory tech came and was getting the ABG, and in the meanwhile I called the attending to let her know what was going on. It turns out she was aware that she was really sick and that the family wanted to make possibly comfort measures. I returned to the room, and then all hell broke lose. The patient was now really anxious, she was crying softly and saying "I can't breath !!! HELP ME !! HELP!" I tried to stay calm. I looked at the respiratory tech who had been trying to get the ABG for about 10 minutes (possibly even more). I told him forget the ABG lets put her on high flow oxygen and if we have to we can use bipap. He left the room and went to get the high flow system. I then look over to the lady and she was on the non-re breather mask and she talked slowly and weakly lifts her hands up and try to pull of the facial mask. I try to calm her down. I examined her and even without my stethoscope I could hear the rales. (I had also seen the previous xray of the chest. She has pretty bad CHF , effusion and infiltrate. The xray looked pretty awful!) I loaded her with another does of lasix 40mg IVx1. While we are waiting for the respiratory tech to get the supplies, I try to calm the lady, but then she is starting to cry a bit and keeps looking at me and the nurse "HELP me please... I can't breath." I grabbed her hand and tried to reassure her "WE are going to give you something to breath better. WE are going to give you another mask so you can breath better...ok.." I don't think it help much. She was kicking her legs out and kept on saying "help me..help me." It was so horrible. I got the sense that she probably felt like she was drowning, since she was in CHF and had very bad infiltrates. (She didn't have any severe plueral effusions, in which case she probably would have needed a thoracic tap. I doubt the attending would have agreed to it.) For a minute I wasn't sure what to do. (I didn't want to give her ativan and sedate her.) By this point the other first year had arrived in the room (he had done the admission) He seemed a bit worried. I ordered some respiratory treatments in the meanwhile. I then thought about giving her morphine -for the anxiety properties and for its dilatory properties. I told the nurse to give her 2mg IV morphine, which I placed in the system. By this time about 15minutes passed and we still couldn't find the respiratory tech. The nurse manager walked in, and was upset. "Where is the respiratory tech? He never gets the ABG. He always passes it on to somebody." She went back to the station and started paging the tech. I went back to the room and was trying to comfort the patient. She kept anxiously saying "I can't breath with this mask." We checked the mask to make sure it was working properly. I got the sense that she didn't like how the mask made her feel. I think she felt as if it was suffocating her. And she was acting as if she was "drowning". I tried to stay calm. It wasn't the first time I have seen someone de-saturating and having troubles breathing. And they tend to be a bit lethargic and non responsive. But this is the first time I had someone yelling "PLEASE HELP ME! PLEASE!" While she was on the non-rebreather mask her saturation still was low about 80 percent and fluctuating. Since she kept fighting the mask, we tried to give her Oxygen by nasal canula, but her saturation dropped to about 70%. I wish I could describe to you situation better so that you can get a sense of how this lady was softly screaming and in distress.

A few minutes passed, and finally the respiratory tech appeared with the 100% high flow oxygen system. I told him "lets try the high flow, and if she doesn't improve we can always put her on bipap" He agreed and put her on the high flow system. Its high flow oxygen, but its with a longer nasal tube and has 100 percent high flow oxygen. I didn't want to do bipap yet. I think if she would have seen the bipap mask she would have been extremely agitated. We placed her on the system, and her saturation started to go up around 90%. I check back her meds,and she was on morpine 1mg IV q2h prn. I told the nurse to give her the morphine every two hours so that she can calm down. In about 20 minutes my prayers were answered. ( I had been praying in my head) She was sating around 95 %. And was not acting up. She was calm. It seemed the morphine was having its affect and the high flow really helped. When I saw the situation had calmed, I took a step back and went to the lounge to take a short break and get a cup of water. I felt so relieved. It felt as if I had run a short marathon. I checked back on her in about 30 minutes and she was sleeping comfortably in the room and saturation was 100%. I spoke to the tech to try to titrate down the oxygen, since she was on 100%. He brought it down around 95% and was going down slowly. I also put her on respiratory treatments to help her breath better. (We tried to previous also give her respiratory treatments, but her saturation dropped 80%. )

I hope I tried to explain the situation as best as I could. I'm really glad we were able to help her. Even if its just to help her breath a bit more and so that she won't feel like she is drowning.

Hard to believe how going through scenarios like this you learn to stay calm and try to do certain things to help the patient. If you read my first experience with a similar situation I had in the
Intensive Care unit my first week of residency!! (Day 5 http://thankyougodforresidency.blogspot.com/2008/06/day-5-good-bad-and-ugly.html) They say the long term memory is instilled in you when you have vivid experiences of them. The more unpredictable and different the situation is, the more you remember it. Some of the most stressful moments I have had, have also been the most educational.

For those that are starting residency soon. Work hard and be a good active participant in your residency. Stay close to a senior you can talk medicine with. You will have seniors that you don't feel comfortable asking certain things because you don't want to seem stupid. But find the seniors that are patient and are able to help you out in any situation. You will see that the more situations you encounter, the more you will feel comfortable.

It's 8:30 in am now, I'm gonna try to get some rest.

God Bless

Dr.Mike

Day 298 The last Song

2009-04-25T11:50:00.013-04:00

Well today was clearly not the ideal day. Where sometimes it feels good to come to the hospital to try to make a difference and help some people, occasional you have a day like I just had. The day started and ended on the same note. At 745am I received sign out and my first beeper page was the medical floor where I was called to pronounce someone's passing. I jotted down the room number and proceed towards the floor.
Its not the ideal way to start the day but it is expected. When I arrived at the room I was shocked to learn that it was one of my patients that I had on the previous day. He had throat cancer that was non operable and had a trach that was constantly bleeding. The family was consulted through the years to provide hospice for the patient, but the wife refused. She insisted that everything be done. It really was a shock to me. I didn't take it well. He was alert yesterday when I rounded on him. I'm only talking about it because I just can't forget it. I can't forget how his wife fought for him. She just didn't want to let him go. She was constantly at his side. She use to sleep in the bed next too him. The nurses hated that, but they had no choice. He seemed to be out of control with the nurses and was more calm when his wife was in the room. I still remember a few days ago when a particular smell was coming from the room- It was coming from the trach site that was infested with the metastatic cancer. The room smelled awful. The nurses had changed the sheets but the smell was tough. The only person in the room with him was his wife. I remember finding her sleeping with the bed covers over her face.

When I talked to her, I honestly felt she was neurotic and kind of pushy. But then I took a step back and tried to place myself in her shoes. I realized that its difficult to let go of people we love in this life. And it should be. It should not be something easy. We should all fight long and hard for the people we love, because we love them and cant live without them. Sometimes your judgment can get clouded and you might need time letting go, but for some its difficult and
it should be understood.

At the end of my life . I only hope and pray that someone is by my side praying and fighting for me and she was for him.

The entire situation wiped a part of me that day.

And the day ended with me pronouncing another person at night. I was called to the room for a gentleman that was recently admitted about 2 hours ago! When the nurse paged me she told me
to come pronounce, but that there were family members their. I kind of hesitated a little bit. (Its always difficult to pronounce a patient in front of their family especially when you don't know the history much.) I went to the chart immediately and read a bit of the story. He has severe heart failure. When I walked into the room I was surprised to only see 1 person standing in the room below the bedside. Her eyes were all red and full of tears. She had her hands clench together with a napkin. When I saw the patient he seemed extremely pale. I know from history that he had bleeding but family refused transfusion. I pronounced him dead at 945pm. I walked over and hugged the person in the room and told her how sorry I was for her lost. I stood their to talk to her wondering who she was. In our conversation I realized that she was his wife. She said something like "well after 45 years of marriage.." Wow that seemed like a long time i thought. She also said "and he just sang happy birthday to my son downstairs 2 hours ago." I said my good byes again and talked to her about funeral arrangements and she thanked me. I walked away and left the room. As I was leaving the room I could hear her walk to the bedside and start to moan & cry. I really didn't know what to think. I was just in shock again. Wasn't he just singing happy birthday to his son? and now he is dead? It really took a tole on me. I was pretty much drained and the night is not even over.

The more I spend around people that lose their lives to disease and sickness. The more I see the frailty of life, the more I realize how special each waking moment is. Elisabeth Kubler-Ross
(Swiss-born psychiatrist and the author of the groundbreaking book On Death and Dying where she first discussed what is now known as the Kübler-Ross model.) once said that the more you study death, the more you realize how precious life truly is. You learn that you have to live life to its fullest. You have to value as much of the time you have here on this earth. You have to appreciate the time you spent with your family and friends. And the more time I spend in the hospital and experiencing moments like today, the more I realize all of what I just said.

My wife send me a text a few days ago. "is it ok if I spend the weekend with my parents.?" I text her back and said "enjoy your family. This is what life is all about."

God Bless

Dr.Mike

Day 334 Cops, Xanax, and Helicopters

2009-04-24T15:43:00.008-04:00

9:46 pm Man I'm tired. I'm on call the second Saturday in a row. I wanted to write about what has been going on in the hospital but I can't right now. I feel a bit drained. There is this resident that has been asking me for help to do his power point, and I guess he has never used it before, and I have been helping him even with the little time I have free this week. I hope I get some time of next week when I go to ACP in Philadelphia. (which the program is paying for !!! weee!!!) But anyways. Man I'm tired. By the way my friend called me from the parking lot before he left. He is a second year resident. He wanted me to come out and watch the helicopter on the roof. I was like "huh? helicopter?" He said "yeah you can see it hanging from the roof come and take a pic!!" I was like "this is not a joke right?" he said " no, no man... its for real. If you are coming I'm turning around." So I took my camera and I went outside the hospital lobby. And sure enough there was a helicopter on the roof. Boy my friend was excited. Not sure if he had ever seen anything like that. But he was a "kid in a candy store" happy. It got really cool when the helicopter starting moving the tail and started to speed up. And as it was taking off my friend said "you know what this means right?" I was like "what?" He said "that's means someones got a unit admission!! " He started laughing. It was a cool site to see.

Other than that the floor has been ok. I saw a patient of mines that has been pretty "un-popular" here with the staff. I remember seeing her about 2-3 weeks ago in the general medical floor. She had come in for sinusitis/ recurrent and was staying in the GMF floor, and she was giving the nurses a really hard time. I wasn't sure what they met till I went to talk to her. I think she spoke to me almost an hour. I was trying to "escape" but I tried to be understand and listen to her as long as I could. She seemed very anxious, and I have learned that sometimes anxious people just need to be heard. She when on to tell me how she thinks there is a conspiracy against her. The last 2-3 hospitals she has been to have been really bad. I think she said she was going to call her congressman. She said that she was also kicked out of R__ W___ hospital too, but that the fault was mostly the nurses. But when I saw her she was upset because they were being "racist" towards her. The African American nurses were treating her bad she said. And also her neighbor in the bed next to her had her family over last night which was about 20 of them (according to her) and she really felt a bit uncomfortable, even though she has no problem with black people. She has a lot of black friends. She says that while she was lying in her bed, there was a little girl just staring at her, and it made her really uncomfortable. She said it got so bad she even called the cops!! I was like "what, you called the cops?" She said "yup, I sure did. You can't treat people like this. What kind of country do we live in? These people are just racist." That has to be one of the first I have heard of patients calling cops from the hospital at the bed side. It didn't take too long talking to her to make me realize that she has some anxiety issues. I tried to listen as much as I can. I told her I would get the patient advocate to come and see her. The following day I saw the attending who she was under. He told me "Hey, Dr. Mike did you make MS.___ non teaching?" I smiled and laughed and told him "her? no....lol. I wouldn't do that to you. By the way, you know she called the cops yesterday right?" His eyes widened and he seemed shocked, he said "what ? are you serious?" I said "no..I just wanted to tell you. She called the cops and they came here, so if I were you I would be careful." I left the room, but I got the sense he was a bit worried. He is one for the attendings that try to avoid any legal issues or situations like this. Who can blame him? The next morning on sunday, I actually saw him come in to personally discharge her. I think thats the first sunday I've ever seen him in the hospital. I laughed when I saw him. I think he looked at me and smiled back.

Well fast forward to today , and here she was again. Guess what ? she was a patient of Dr. DEvil !!! (dr.DEvil http://thankyougodforresidency.blogspot.com/2008/08/across-your-time-in-wards-and-floors.html) out of all people!!! I saw her this morning and she was in a state of mild panic. She seemed very upset and was angry.I said "what happen?" She said "last night was horrible. I had the doctor come in and he basically screamed at me and told me that my asthma is triggered by my anxiety, and I told him that was not possible." She then asked me to give her a second because she was upset now, and she was having a hard time breathing. I tried to "explain" to her that maybe the stress of the situation might be causing your body to react differently and it might cause you to breath differently. She said she doubts that it was from the anxiety, but that while she spoke to me she felt a little better. I told her I would give her some more respiratory treatment, incentive spirometry and mucomyst. She said ok and she agreed to try to relax. I told her if she had any problems that she could call me. Surprisingly she hasn't called the entire day.

10:12 gonna try to get some rest. Have to wake up at 4am to do some notes. and tomorrow that resident is coming to my house to finish up the power point at 7pm!!! amazing huh...... geesh must be nice to sleep and have a day off........

God BLess
Dr.MIke

Day 295 Resident with Usmle Scores 98 & 99 Gets kicked out !!

2009-04-24T15:39:00.016-04:00

I suspect that the situation I'm gonna talk about is one that doesn't happen often. You might here about someone with 99's on their boards not getting residency (which is most of the time due to visa issues) but you never heard of one of them get kicked out of a residency program. Well lets talk about one of that is no longer part of my program. I will give him a false name to preserve anonymity. We'll call him Dr.Jack. So it so happens that jack was a replacement second year for a spot in the second year that was open due to the fact that one of the 2nd years got sick. He had been a recent first year from a program in Manhattan. (It was one of the mount Sinai hospitals) I spent a great deal with him, so I knew him well compared to the other residents, but as it turns out, not too well. It must have been 3-4 weeks of him starting the program that trouble started to arise. I still remember clearly the day all "Hell" broke lose. It must have been around 6 pm at night and I was taking a break in the resident lounge when we heard in the over head microphone of the hospital: "Paging Dr. Jack. Dr. Jack Please pick up line 8765". Being the intern and newbie, I didn't think anything of it, but in the next 30 minutes there was about to be an explosion. I was sitting at the computer and writing some orders when the door of the lounge opened and it was jack. Jack seem to be his cheerful self. I got along with him well. I said "hi "and kept doing my work. 5 minutes passed and I heard screaming from another second year resident. She was pretty upset. I didn't understand everything she was saying because she was speaking arabic to him. But she was really upset! They were in a room and there was one more 3rd year resident in the room with them. When the door opened all three of them were in the middle of the lounge and they were going at it!

"I told you ... why didn't you pick up? why didn't you go to the unit when they were calling u?" she said to him. He responded "I told you I was in the E.R. I didn't hear the page and I was taking care of someone that was having an MI. How can I be blamed for this?" . She responded back "You are not suppose to do this! If the unit is calling you , then you must go. You cannot behave like this!" I learned later on that their was a critical patient in the unit that needed a resident to evaluate (knowing the unit, it must have been someone desaturating or someone in an acute rhythm that needed help.) In other words, a pretty critical situation. I also learned that you shouldn't have your name called out loud in the speaker. It basically means that you are not being reached by your pager, or that you are not returning calls to you. So most of the residents cringe if they hear their name pronounced over head. And it seems that our friend jack never heard the page. It also turns out that the admission he was doing was of a patient who had been having chest pain, but was stable. Troponin might have been mildly elevated, but a person who was not in any critical state. (We have tons a patients each day that come in for chest pain. They are closely monitored for 24-48hrs and most get stress testing and cardiac cath.) Anyways, that was what they were talking about, but they were really screaming and arguing. He didn't feel like he did anything wrong. I still remember raising her hand and pointing to his face and screaming in arabic something pretty bad. I remember him just looking at her and kind of surprised. She left the lounge and he stayed their kind of perplexed. He stayed talking with the other senior. Wow, was she pissed! I've never seen her so upset. I remember him speaking to me after this had happened. He had told me that he wasn't going to leave the patient.

The next few days it seemed like most of the second years really didn't like working with him and were complaining to the program director all the time. And it only got worse. It turns out that nurses were complaining about him -that he didn't call back and that he didn't handle their problems, and didn't order the medications they asked him to. An attending also complained that he had been a bit flirtatious and un-profesional. Looking back I still remember the moment. It was in the E.r and we were doing an admission, and he was discussing the case with the attending. At the start of the conversation it went something like this "HI how r u?.... You remember me? Its Dr.Jack. We had good time last time Remember? (he's talking about the last time he had discussed a case with her)" It sounded a bit strange when he said it, but I didn't think anything of it. But turns out that attending had complained to the medical office about that conversation. Depending how you look at it, it can be seen as some type of harassment? I had also heard that he had given his phone number to one of the nurses. (I was their when he gave it to her. I found it awkward, but then again he was a very friendly guy, Always laughing and telling jokes.)

Over all, I think the seniors expected him to get use to how the hospital runs in a short period of time. This is a small community hospital, but the patient load is heavy and their is a lot of work to do. I don' think he ever adjusted to it. And it kind of hurt him. People had to pick up the pace for him, and were having to work extra and were not happy with it. SO even if he might have made small mistakes, they were exaggerated a bit. I still remember being in the E.r and hearing on of the cardiologist on the phone complaining about him to the administration because he was to slow. They were doing cardiology rounds, and he had spent about 2 hour on one patient! And these cardiologist had 30 patients to see!! I also remember him talking a lot about religion and arguing about it with the residents. He was deeply religious. He spoke very softly to me. I considered him a good friend. I still remember doing a 3-hour cellulitis admission with him one time, and him talking the attending to sleep over the phone while he gave a 30 minute admission call over the phone at 3 am in the morning. I can still remember him speaking into the phone "Hello?...Hello?.... are you there?...hello?" But perhaps the most amazing story I heard about him was when he fought with the program director. He was in her office, and she had been trying to work with him and explain the situation, when he grabbed her by the side of her arm and said "don't worry about me, my god will provide for me."
It turns out that Dr. Jack was a very spiritual person. I had endless private conversations with him about religion. He use to walk to attendings and start kind of preaching to them. I thought it was a bit strange, but then again he was a strange guy. I heard he also had problems with the chief resident who was trying to help him with the situation he was in. They had paged him for an admission and never went to the admission and blamed the chief for never getting paged for the admission.

I'll never forget the last time I saw him. It was 730am in the morning and their was sign out. And like usual, whoever was overnight, signs out to the morning team and we distributed the work. I sat down and started handing out patients and then I cam to a name on the bottom of my sheet. It said DR. Jack Pgy-1. They had demoted him to first year again as a trial basis to catch up with the system. I still remember the look on his face when I called his name out loud in front of the group. I said "Dr. Jack? Ok these are your patients for today." He seemed embarrassed and upset. That was the last time I saw him. Later that day around 6pm I heard that he had been escorted out of the hospital with security . I felt bad when I heard that it had occurred. I was told later on that he had been arguing with a nurse in the telemetry and he had grabbed her the wrong way, and their was a complaint of harassment placed on him. After he had left the program I spoke to one of the first years who told me that he had seen that he had scored a 98 and 99 on his boards and 97 step 3. I was kind of shocked. He said that he had been working with him on applying to other programs and had seen his cv. To this day we were all in shock when we had heard that he had scored so high. Some believe that he probably stole someones grade, but I believe that he just wasn't use to the system we had here. It was a change for him and the work that he had been doing in his previous hospital was not as intense as it was here. I later found out that he had gone to a VA Program his first year, where there were a lot of patients, and where you don't do a lot of admissions the first year. (We have been doing admissions from day 1 here.) Over all, it was a very sad situation. He was a warm fellow that was poorly understood. I wish him the best. I have tried to call him a few times, but he never picked up his phone. I hope he was able to find another program. IT might be difficult if the previous program calls here for references.

I believe that it is important to have good grades. Knowledge comes by reading, but it also comes by doing. Most of the residents here have learned there medicine at the bed side. Next to a patient. This is how you perfect your medicine. I will try to call him today . I'll let you guys know what happens.

God bless

DR. Mike

"I hear and I forget. I see and I remember. I do and I understand." - Confucius

Day 286 Trouble in Paradise

2009-04-23T21:25:00.008-04:00

I have thought about writing this for a long time. The reason I haven't is because I wanted to be positive as much as I can, but I realized that this experience would be incomplete, and I would be living a lie if everything I wrote always seemed positive. Although I talk about my program with a lot of positivity and joy. There are also un-pleasant moments and situations that arise occasionally, and I believe its just part of life and residency, and its something I'm having a hard time adjusting to. I recently had a meeting with the program director and one of her assistants to go over the yearbook which we were planning. (I had already made a video and placed it on youtube, but it was taking down because of the soundtrack.) As I sat their collecting my thoughts, one of the administrative directors sat down next to me and said "you know what has happened this year, has never happened before. This year all of you guys seem to really get a long. We have never had such a tight group here. It's really amazing" By this time the director was sitting next to me and was hearing the conversation. I turned to her and said "I know what you mean, we were even discussing this a few weeks ago, and we were saying that people should pay to be in our residency." They both laughed.

My friends -there's trouble in paradise. I guess it was naive of me to believe that this place is perfect, but then that would not be reality. People are people. They have emotions and they can be quite mean. They have their bad days and their good days. No one is morally perfect. For instance, I was kind of shocked when I first found out that one of the first years in the program tried to kick out one of my best friends whose a first year. She was covering for my friend one Sunday, and he had not given her a proper sign out (it might have been in-complete) and because of it she had a bad day and had to do a lot of "extra" work. Well, instead of talking it over amongst us, she went to the chief resident and had a 1 hour meeting about him and wanting to get him in trouble with the program director and hospital. The meeting was an hour because the chief was trying to convince her not to complain about my friend and not get him fired! Whats shocking about all this is that we are all first years and in the same group. We have all been through a lot. We should be working with each other instead of going up against each other. To top it all off, she even complained about me. She was complaining to the other residents that I'm late a lot of times. I couldn't believe she did not discuss this with me, but instead went to the other residents and was talking about it. I still talk to her, and I still get along with her. Many of the interns and seniors are careful when they spent time with her because they know that she is capable to complain to the highest office if something goes wrong. There are probably many small examples of situations that has developed in the past this year, but I don't think its relevant to describe them all. (I have written about a few of them and will post them.) Even today, I asked one of the seniors to help one of the interns on Sunday (because I 'm leaving for a wedding of one of my best friends in the program). The covering intern is pretty much covering all the floors 2 hours, and I spoke to the senior and asked them if it was ok to help him out so he will not get over whelmed 2 hours. I didn't think it was anything. And I have gotten along with her pretty good the entire year. But when I asked her, she put this face like "This damn interns. We are seniors and shouldn't be doing this." It really took me back. I felt very awkward. Its like if you have every felt like you are in the wrong place- like walking in to the ladies room by accident- you just put you head down try to apologize and walk away. Her entire demeanor changed. She seemed very upset. And if she tried to cover it up she really didn't do a good job. There are 2 seniors on this Sunday, and I got the same reaction from the other senior when I asked her too. She has this face like "these damn interns." But in all fairness, I can almost understand them. I'm not going to go into details, but the seniors before us were living a nightmare based on all the stories I heard. I heard people were very abrasive to one another. There was a lot of infighting. People wanted to leave the program. Senior residents were not helpful for the most part. It was a very cold place. (I'll post about it in the future) SO the seniors that we have now look at the environment and are in shocked of how much has changed. People are working better with each other. Helping each other out more. It feels like we are all a family. But like any family, none is perfect. We all have faults. There is trouble in paradise after all. On the other hand, a small part of me kind of hurts a bit. Hurts because of the realization that even in this place we cannot have complete happiness and harmony. We are all after all part of this world. We are in a hospital where people are sick and dying day in and day out. There are human beings in pain. There are people that suffer and are angry. We laugh but we also cry. We love but we also fight. We bless and we also hurt. Just a small part of me wanting to be part of something that was bigger than anything. Bigger than me and any place. I wanted to be part of a place untainted by the evilness of this world. I wanted to belong to a group of like minded individuals that are solly concerned about others and not themselves.

I was in a bus one day. And there was an individual that was handing out this small little papers that read "How to have eternal Life" She must have been a missionary and she was handing it out to everyone. As she went towards the back, she handed it to one guy who gave her back the paper and said "Eternal Life? No thanxs! I have enough problems as it is. I don't want to live with my problems for ever. I don't want to have bills the rest of my life. Theirs just to many problems in life to live with them for ever." The missionary looked at him and was confused. She told him "this is not to live on this earth for ever. This is to live in heaven for ever." The man smiled and said "ok." and took the paper. I Still love and care about the residents that I work with. We are like a big family with occasional problems. We have faults and we have to accept them. I pray to God that I can accept mines and other peoples.
GOd BLess

Dr.Mike

Day 280 Best Day in Residency !!!!!!

2009-04-18T17:27:00.006-04:00

Today was perhaps one of the best days in my residency. After almost a year I finally saw the attending that gave me my first interview here!! The attending that helped me to get one of the spots in the program. It happened while we were in noon conference at 12 pm. I didn't even recognize her. I helped her set up the slide show presentation. Then she turned on the slide show, and her name was on the slide show presentation. I was in a state of quiet shock. I can feel my heart racing fast. I was so elated, (nice word huh? elated? ..lol) I was really happy inside. lol. I thought to myself "I have been looking to thank her an entire year. I turned to one of the 1st years sitting next to me "Thats the attending that gave me the interview." I can almost remember what the interview was like. I remember being in the waiting room. When it was my turn to interview I left the waiting office and saw the Male attending; who seem very cheerful and easy going, I almost regretted not having him for one second, but that all changed when I first saw her. She seem very soft spoken and nice. I remember walking into her office and saying "so how is everything going? Busy day?" She was surprised I think when I asked her this, shesmiled and said "Yeah its pretty busy. Its a lot of work." And we sat down and we started the interview. Needless to say it was one of the best interviews I had ever had. I had about 10-12 offers when I applied that year (2008) This was my second interview. MY first had been at Jamaica hospitla in queens (another memorable interview. I even cried in that interview. They also send me letter stating they would rank me high, but no pre-match). This was my second interview. I never forgot how calm she was and well spoken. She had a nice soft demeanor to her and was very educated, spoke in soft sentences. I really tried to control my emotions and tried to rise to her level. I read a lot of interview books that said you should adapt to the person that interviews you. Try to relate to them on a common level. We really had a good talk. When I left the room and went down stairs, my wife was waiting for me. I told her "wow, that was a good interview" She was like "it was?" I said "that was probably best interview I ever had." ( I had gone to 16 interviews the last 2 years.) Even if I didn't get the spot I would still say it was the best interview I have had. Everything just seem to "click". She asked me during the interview if I had plans to stay in the area. It was a strange question. No one had ever asked me that befor. I told her I would definitely like to stay in the are. I never thought anything of it. But 2 days later I received a pre-match offer in the mail. I went the next day to sign and cancelled my other 9 interviwews. TO this day I framed that letter of the offer -it sits in the office in my apartment. I later came back to the office and wrote her a thank you email. I wanted to buy her a Tiffany gift pen (silver) but the quality was bad(I still plan on buying her something.). I was expecting to see her when I started residency. But that was her last few days their at the program. GO figure. lol. Fate ? Maybe.

Any ways, I was really excited to see her!!! I waited till the lecture finished and till everyone left the room. I think she was kind of surprised to see me. She had a plate of food in her hand. I went up to her and told her "I'm not sure if you remember me. I interviewed here with you last year?" she said "Yeah I remember you. How is it going?" I smiled and said "its been going really good. I just wanted to tell you that I have been looking to talk to you for the last year. They told me you are no longer here, but at the sleep center. " she said "yeah I work at H___ sleep center." I then said "I just wanted to tell you that I wish you all the goodness of Life. From the bottom of my heart. I wish you all the happiness that is possible on earth. You are a very great and special person. I never forgot our conversation. And I wanted to thank you once again from the bottom of my heart. (I think I had few tears in my eyes.)" She was a bit surprised when I said this. She smiled and said "Your welcome." I told her "you really are a special person. Thank you very much. Thank you for giving me this opportunity." I tried not to say too much. I didn't want to scare her. lol. That's what my wife says of me sometimes when I'm grateful to some people. I shook her hand and put my hand on her arm and looked at her and said "thank you." I turned around and as I was walking out she added "Do you like it here?" I turned around and with a smile on my face, and watery eyes "I love it here." I left the room and didn't look back. I wanted her to eat her food. (She still had the plate of food on her hands.) I didn't want to say anything else. It was the end of another great, but short interview. I wanted to remember it like that. overall one of the best days I've ever had here.

God Bless

Dr. Mike

Day 272 He Died

2009-04-12T19:24:00.007-04:00

It must have been around 2pm and their I was crying in front of the program director. It was hard to control my emotions. I didn't know who to talk to once I had found out the news. One of the most well known teaching patients that I had taken care off had past away. He was well known to the teaching staff and residents. I was in shock to find out about him today from one of the residents. It was very painful and heart breaking news. I felt as though a friend had passed away. (I also wrote about him in for my blog a few weeks ago.)

Ironically the attending and I were the last doctors he saw in our hospital. When I found out about it I was in the middle of doing an admission. I tried to hold back my emotion. I wanted to go up stairs and talk to the attending that I had seen with him the last day he was here. It was strange, but I felt that I had to apologize to the attending. I had to say I was sorry. Sorry that I had not done enough. Sorry That I let him down. Sorry that this had to happen. It was strange but I had seen him at noon conference and he had seemed a bit down. I didn't think anything about it, but looking back I think he had found out the news about what had happen, and he might have taken it a bit hard. Or at least he was saddened by what had happen. When I went down the hallway and approached his office- which is right across the program directors office- I had a change of mind and decided to visit the program director. I think I needed someone who was a bit more emotional, not saying that he was not, but I figured that the program director might be more inclined to listen and I decided to first go to see her.

I went to the program director office door and waited for someone who was in her office to leave and she saw me and said "hi mike, anything I can do for you? " I kind of put my head down and told her "I'm not sure if you heard, but N___ L___ died today at R__ W___ hospital. I just found out about it now.....and...... I just wanted to say..... ( started having a bit of tears) We tried everything we can to help him. Me and doctor G___ tried everything, and he just didn't let us help him. We tried...(crying)" She stood up from her chair and closed the door behind us. She said "Mike, don't cry.... you did everything you could. Here have a seat." I sat down at a small round table she has in her office. I sat their and told her "we tried...we tried.." She stared at me a little and with a smile said "you know its OK to have a connection with your patient, we try to do the best we can, and that's all you can do. Its good that you care. Its good that you want to help." My nose started running a bit. She stood up and went to get some tissue paper for me. When she came back we spoke only a few seconds more. I said "thank you for the talk and sorry for interrupting you." She said "no, any time, any time you can come by, don't worry." I stood up and thanked her and left the office. When I stepped out, I went to visit the other attending across her office, but he wasn't in the office. I only saw the secretary and I said hi to her. I figured today when I get home that I would email the attending the brief blog I did about the patient and the situation. I think he would appreciate what I wrote about him and the situation. I'm going to email him now.

God Bless

Dr.Mike

why does God allows evil?
http://www.discoveries08.org/episode-4-high-quality

Day 261 Caught in the Act

2009-04-10T22:07:00.009-04:00

Well It was a pretty surprising day today. It was around 2 pm in the afternoon and a patient
had to be discharged and I needed a prescription signed by an attending. The chief resident was
not around, so I went up to the program directors office. I walked into her office and asked her for the paper signed. There was another staff member in the office. She had a strange look in her face, and she was about to say something. But the secretary told her bye and she didn't say what she wanted to. I asked her for the script and right before I was about to leave the room she said "I wanted to thank you for what you wrote." I was like "huh?" she said "I got a letter from the President of the hospital, and I wanted to thank you for what you wrote." I was trying to play it off, and I said "what ?" with a smile. She said "It really meant a lot to me and I wanted to thank you from the bottom of my heart." It seem like she was about to cry. I kind of had the same feeling. It was just real appreciation for the chance she gave me and how good she has been with us. I said something like "I think you deserve it and you are special......etc" It was probably a lame response. But I was speechless I didn't know what to do. I just put my head down. About two weeks ago I decided to write the president and vice president of the hospital (which she probably doesn't know yet.) telling them about her. Telling them that we as residents really apprecited all she has done for us. I will post the letter at the end of this. I'm not sure where I got the idea from, but I figured it would be a nice thing to do. I figured she would really like it.

I have been writing to some of the residents private letters thanking them for all their help that
they have giving me. I have been very surprised by their response. Some of them said they even cried when they read my letters. Since it got such a good response I figured I would keep on writing them. Its amazing the response people get when you tell them how special you think they are.

I guess its a nice feeling to know that someone cares about you, and looks up to you. All in all, a good day. I was a bit embarrassed after she told me that she knew it was me. I had signed the letter pgy1 Internal Medicine. I figured she might not figure it was me, but I guess I got caught. I wanted to keep it anonymous. After I left her office. I had to return in 5 minutes again to ask her for something. I felt a bit wierd. lol. I had to walk down with her so she could sign some papers. As I walked down the hallway with her I turned to her and asked "so how is work going?" She smile and said "work is pretty good, especially with residents like you." I smiled and turned my head and Laughing I told her "I still don't know what your talking about."

God Bless you

Dr.Mike

Below is the letter I sent:

Dr. ________
Vice President, Medical Affairs

I’m writing this personal letter to you because I’m aware that you like to be informed about important patient issues and Health Care practices at ______. I’m a first year Internal Medicine resident that was hired in 2008. And I’m writing this letter on behalf of Dr. ________ (IM program Director) because I feel that you should be aware of the great job she is doing as program director.

I just wanted to say how grateful me and the other residents are with all the hard work that she has done in the program. There have been a lot of positive changes ever since she became program director and we as residents have felt it. For many of us, ______ is our second home, and we feel very honored to be part of your system and Hospital. Dr. _____ as been a huge blessing to this program and hospital. Not only does her leadership inspire us all but she she has a great deal of patience and human qualities that make her stand out from anyone I’ve ever met. Her demeanor and approach with us is a welcomed change.

She has put together a great team of residents. Her hard work and positive reinforcement makes motivates us daily to be better physicians and persons.

We have all been giving a special privilege in out lives. We have been placed in this planet to make a difference in the lives of those that surround us. Our meaning and existence in life is found in trying to relieves the human suffering that surrounds us. Our meaning It is found in providing quality health care to everyone we can. We all have a purpose. And we could not achieve our life goals without individuals like Dr. _____.

She is like a bright ray of sun on a cloudy day. She is a star amongst the sky. She is part of our lives and our mission on this earth.

I write this letter just so that you would be made aware of the impact she is having at _____. She is to be highly commending for building such a strong health team who sole purpose is to provide the uttomost medical health care at ____.

We also wanted to also say thank you to you. Thank you for Dr. _____ and her Staff. Thank you for giving us the chance to be part of ____. If we have changed lives, if we have help even one person to live life a bit better, if we have helped one person to be able to spent a few more hours of his life we the people he/she loves the most in this world, then all the struggle and difficulties we have faced in life was worth it.

Thank you in advance for your time

PGY 1

Internal Medicine

p.s. (feel free to share this letter)

Another email sent to a resident:

Hi _____

I was really Glad to hear that you won the award no one deserves it better than you. It was really good news to my heart. I can't think of anyone that deserves it more than you. I know that you went through a lot of difficult time last year, amd I think this is God's way of him showing you his goodness. A lof times we ask for strength, and God allows us to be stronger with the trials we face in life. The difficult situations you had last year only helped to make you stronger and to show you God's grace.

Always remember that happiness not only comes from receiving what you want, but also comes from making a positive difference in someones life. And you have and will continue to make a positive difference in all of our lives.

Your passion and goodness inspires us all the time. Very rare in life do people have the opportunity to do what they like and love. I feel that you have been blessed with the desire to better yourself, and others. In all the dark moments of your life God was always with you and did not abandon you. I think now maybe you see that even more.

I wish you the best. Your happiness is my happiness. Your joy my joy. It's good to see people overcome and better themselves. Its good to see the happy moments in the life of someone you care about.

Good luck.
I look forward to working with you the rest of the year.

God Bless

Dr. Mike

Day 253 Almost Died Today !!!

2009-04-07T19:18:00.007-04:00

I almost DIED today. It happen in the e.r when I was called to do an admission. I was in the small resident room writing the orders when I heard the voice of what seemed to come from a young person who screamed "Stop!..... everyone stop!......put everything down now. I'm not playing!" It seemed like he was right outside the door, and he was! He kept on screaming. It sounded like he had a gun or a bomb. I wasnt sure what to do. I figured maybe when he passed by the room that I could just ignore him. For ONCE in my life I wasn't nosy and didn't want to know what was happening. Their were 2 attendings in the room and boy they were scared!! One of them was a female and other was a male attending. I'm sure one of them peed in their pants, but I couldn't smell it. The female attending went to immediately close the door, but she kind of hesitated- not wanting to stick out her head.

I remember thinking "that's it I'm dead..." I really didn't have anytime to think. I stood there frozen (there were no exits in the room. Its like a little closet with 2 computers where we do the admissions.) I was just in a slight state of shock. The scream got close and closer and sure enough there passed a young man being carried by 8 cops and security gaurds and he was screaming like he was on fire "do you see what their doing to me? Let me go? Somebody
HELP!!!"

Boy I was happy to see him! Well you know what I mean. Wow! I was happy to be alive! I laughed. I told the attending' s "I thought he had a bomb and that we were dead." They didn't smile much at that. And for the SECOND time in my life I didn't even bother finding out why he was their. I didn't think it would make much of a story. The fact that I was alive was enough of a story!!

The Er shows on television sometimes shows the crazy stuff I've seen HERE!!! I still remember one of my earlier admissions. I was walking into the e.r with one of the senior residents, and as I walked out of the nurses station. There was a naked woman lying in front of us face down on the floor. And it seemed like nobody noticed or even cared. The senior resident looked at me and she kind of was like "whats going on here? who is this?" While she said this, a few people walked by as if not noticing anything. As we walked closer we could hear one of the nurses walk up to her and say "come one get up. We already told you , that you can't go home." There was a male nurse that tried to cover her up. She smelled like alcohol. And we just kept walking. It was surreal.

I still remember my conversation with an E.R nurse. We were discussing the crisis room- its a place that these types of patients go to when they are hysterical. Its a special room with a camera thats monitored by 2 people. As I walked by the room, he smiled at me and said "Don't walk into that room" I looked at the room and it was empty.

I asked him "why?" He said smiling "trust me, you don't want to go in their."

I think I understand him now.

God bless
DR.Mike

Day 240 A Message of Hope to those who Didn't Match : Metagame yourself into Residency

2009-03-19T18:31:00.025-04:00

The word metagame means to play or follow a certain game against the rules, or against the normal strategy that one normally takes when confronting a game or situation.(http://en.wikipedia.org/wiki/Metagame) I would like to apply it to getting a medical residency. There are thousands that struggle with this very "game" of getting residency. There are many strategies posted on the internet and thousands are trying them. Some more successful than others. I would like to talk about some out of the box ideas that are very different, but I believed might be a different approach that will help some in finding their elusive residency. I will propose a few ideas.

Metagame strategy #1 Observership

A lot has been said about observerships. The majority of people believe that they are a waste of time, simply because you are just observing and not "doing" any hands on clinical practice. I would have to disagree with some of these well meaning indivduals. I believe that there is a small chance <10% that it might work. IF it is "correctly" done. For the most part you should enroll in an observation where your chances of getting in are "very" good. Meaning that, you at least fulfill their requirements. There is no sense to doing an observation in a hospital where you might not have a chance of getting in. I'm sure the percentage of you succeeding in getting residency would be less than 3%. I'm not completely dismissing it, because there is a possibility, but it is just very slim. The reason that I'm talking about observationships, is because there are about 3 people in my residency program that did just that!!!! They rotated here about 3-6 months and they met other residents and were very liked my the program director, and they were able to be invited to join the program (categorical too!!) So I believe that it worked, but I believe that they were very lucky. I'm sure no one can argue against that. But reality can argue against any theory that you might have about observationships.

Now it worked for them because they basically found "CONTACTS". They met someone that really liked them, and were invited for interviews and were given a spot. Its a 1/100 chance but
it worked!! NOw, I know that its hard for some people who are foreigners to speak the language, or maybe you are not that friendly of a person, or your flat out not a brown nose. But this isnt about that, this is about meta gaming your self into residency. You have to try something outside the box. I work with these people DAILY. Its a reality. SO its an option you may consider, but it has to be done correctly-AT a hospital that you are applying to, and also on more than one!! The guy that got one of the spots, he had done about 3-4 observationshps!!! already.... and he only had one interview, and that was form this program that he got accepted!! lol... Now that my friends is amazing. But who is to say you can't be that lucky? You will be surprised who you meet at the observationships, or who you can get a letter of recommendation from. So don't rule out observations entirely.

Metagaming strategy #2 clinical Externships

Well a lot has been said about this. You can read it on any forum or any website. There are a lot of companies offering you help in getting us clinical externships. And I would agree with most of them that they are a "hoax"- The majority of them are not what you and I are thinking about in terms of clinical experience. You think that a lot of theses are going to put you in a us clinical externship, and that's not possible because you have to be a us student to do a fully accredited externship. So its not what you are expecting. The majority of them are done at outpatient
clinics and doctors office. Now, in terms of metagaming, this is obviously an out of the box thing to do. They do get you recommendations. The majority of residency programs are looking for "recent" us clnical experience. These programs want someone who is adapted to the us hospital system, and who is aware of how us hopsitals "work". What is important is that whatever office you go to you ask the attending if you can go to the hospital to do rounds with him.
So maybe you can get exposure to it. And you can write that into your cv. It might not sound like much, but it is an idea. We are talking outside the box. Now, the best place to actually do this can be debated. Some say that you don't need
a service if you can convince a doctor at a local office to do that then you can work in his office for free. But I would suggest getting student insurance and then that way he might allow you to to go to the office and you have liability insurance on you. Student insurance cost about 1000$ dollars I think. SO its an option.

Wether they help or not is purely based on where, when and who you do this with? WHat if you were to do a "rotation" at the office of one
of the attendings you are applying for residency too? would that help? I think it would. One of the female residents here in the program was working as a medical assistant, and she use to see the vice president of this hospital!!! Amazing... I was shocked when she said it. She even got recommendation from him. ..lol.... Not bad- recommendation from vice president of hospital
your applying to. That is metagaming your self into residency.

Metagaming #3 Research

A lot has been said about whether or not research matters. and I think a lot of it depends on which program you are applying to. The majority of programs don't put a great deal of importance on it, but others do. I might be kind of bias because I spend 7 months doing clinical research in Columbia University. In fact, the best recommendation I received was from one from a brilliant professor their that I worked with (she had 2 PhD's and a masters). The recommendation she gave me was 2 pages long SINGLE SPACED. We really worked great together. She was a brilliant person and very humble. I truly believe she was instrumental in me getting residency. Why? her RECOMMENDATION was amazing!! On top of it, she is a writer,
so she really expresses her self really really good. lol (not sure that's grammatically correct to say but...lol.) It really maked you stand out of a crowd of applications. I think 3 sentences of true love and appreciating for someone, is worth more than an encyclopedia of facts about someone. Its important to have many recommendation, but if you have one recommendation from someone that has true love and apprecition for you, it will show in their letters.

I think the bottom line with research is that you can use it to build contacts recommendation and to built your CV. But the bulk of your time she be spent trying to build your clinical skills.

Metagaming #4 LOR

I spoke about it previously in the paragrapher before. Try to get LOR from people that KNOW YOU and that LIKE YOU !! Most of the LOR that programs read are positive. I mean, its not gonna be a letter of hate. The program is expecting them to be good. But you want yours to stand out. Maybe the letter is from somoe one that works at the hospital your applying to. Maybe its from a resident at the program or an attending. Maybe its from the vice-president of the hospital!! This is out side the box thinking. don't forget substance. IT matters a lot.
True appreciation and love will stand out, and this goes back to finding contacts and building relationships. Its a very important part of it. Don't miss improving these letters. If you see a letter form an attending that could use some work, tell them if they could write you another
one. I mean, you have to be political about it, but tell them if they mind just giving more detail to your qualities and strength. A lot of attending's are very busy in their work life, so be humble about it and grateful.

Metagaming #5 Dialing God For help

Last but not least, is the MOST important part on this journey to residency. This tip is above all else. If you have not believed anything I have said, believe this one. If you have not paid attention to anything written here, pay attention to this one. I will try to speak to you truthfully and as if you were standing right in front of me.

No one. NO one can truly understand what you are going through right now. No one can completely understand the heart ache that you feel. No one. No one has seen all the tears you have shed at night and throughout the day. You might have friends and family members and people in these forums trying to make you feel better, but no one truly understands what you are going through. And these are good people. they care about you. They want you to feel better.
They want you to achieve something in life. But that doesn't rid the fact that they do not see your heart ache, and your pain.

Only, and ONLY someone that could see Inside your heart. Only someone that could see inside your mind and your thoughts can truly and deeply understand you. And only someone all powerful with supernatural forces and strength can do this. And I believe that person is God. I believe that person is Jesus. God can give you strength in this moment of uncertainty and pain.
GOd can relieve your pain. IT might not be completely eliminated, but God can help you bare the pain. A lot of atheist exist in this world because they have never understood what the bibles says about pain and suffering. God never said that you would not have pain in this world, in fact he said "in this life you will have trouble" John 16:33 (http://www.biblegateway.com/passage/?search=John+16:33) But he has ALSO said "I will be with YOU.
I will walk with you in your pain. We will walk this trauma of life together. I can see your pain, I can feel what you feel. I can give you peace and strength to carry on."

Let us not spent time arguing and debating whether God exist or not. Your tears and pain don't have time for this. Time is passing bye and the heart ache that you feel is real. And I believe
that God is real. He has promised to help you bear with the trying times that you are having now. What would it cost to put a bit of faith in God? He has promised to give you peace. And if he doesn't, then there is no God, because God doesn't break his promises. He has declared himself the good Shepard. Psalm 23 (http://www.biblegateway.com/passage/?search=psalm%2023) He has said he will walk through the valley of death. The valley of shame and disappointment. IT might not make sense how a powerful God would even allow such things to happen to you, but he has offered his help to you. I had gone through the match 3 times and have been rejected countless times. Yet God has grace and was wiling to help me in my life. If it was to be in residency or not.

I have been through the heartache of not having gone through the match. I know the heart and the pain. It is real and its not a theory or joke. Pain is real. But God's peace is also real. And he offers to give us peace in our time in suffering through Jesus. Through his son. God offers you help in your life. he offers you help in becoming a doctor or not. DO not feel that you have
wasted your time all these years in school. God can help you. Meaning and fulfillment in life comes from doing the things on this earth that we were meant to do. If it is meant for you to have residency or if its meant in doing something else. Take time now in your room alone, or later today to talk to God as you were a friend. Dial up God for help by honest sincere prayer. He will answer you in one way or the other.be honest and open about your feelings.. Lean on him when it seems unbearable to keep on applying over and over in the match, year after year.
don't give up.

You are not alone. You have not wasted your time. Lean on God. Lean on Jesus. he cares for you. He has seen what you have seen. And offers in help to you.

God can give you peace. He can do the impossible. He can change your life. he can give you strength to carry on. My life is a testimony to his grace. My residency is a testament to the power of God. Its not simply having residency, but it is seeing the power of God in my life that helps me to bear living, and that helps me to carry on. God can and will bring meaning to your life. And he will if you give him a chance. Test him. Seek him it will come to pass.

I don't mean to "throw" around religion and didn't intend to throw it in anyone's face. This is simply ideas that have helped me. These are situations and feelings that I do based on what I have experienced. God has been good to me. And I can only try to help as many people as I can, and as many people that will believe.

I wish you all Good luck in the scramble and in Life.

God Bless you.

Jesus Loves you. He cares..... He cares.

Dr.Mike

Day 215: HAPPY NEW YEAR !!!!

2009-01-26T14:14:00.007-05:00

Well its the begining of a new year. 2008 was really my year. I was blessed to finally have gotten a residency spot after trying and suffering for so long. MOst of you already know my story, if not, just check on the links and their's a blog I made explaining it. I'm very grateful to God for all the goodness he has shown me. Every morning on my way to the hospital I throw a prayer in my mind thanking him for all his goodness and blessings. There was a lot of darkness in my life and he has poured out his blessings on me. I still have difficulties and trials, but they are
different from the ones you are going through, and especially different if you still don't have residency. Not only has God blessed me with getting residency but he has also giving me a great and caring wife who I love and who I owe a great deal to. I will right about her in a separate Blog.

Well a lot has happened since I last blogged. I tol you about the hurricane that erupted in the residency program.there was a lot of people hurt and feelings were hurt and their was a lot of misunderstanding, but I have good new to report, that all is well now!! I told you that their was a misunderstanding between a group of residents (including me!!) and the program director and staff. Well I really felt bad about what happened and I went home that day and decided to right the program director a letter. I spend a few hours composing and editing it. This is what I wrote to her:

Dear Dr. ______

I wanted to write this personal letter to you so that you would know how I feel about the discussion that has been going on. I first want to say that I really appreciate everything you do for us. I would also say that all the residents appreciate all the work you have done. You are very special and dear to us. A lot of times we don't hear or find out how others truly feel about us, but I thought that you should know how we feel about you. I have only been in your program a short time , but I have heard nothing but praise about all that you have done in the program.All your hard work and dedication is appreciated and well known. Many, if not all of the senior residents who havebeen in the program a long time always shower you with praise whenever your name comes up in a conversation. Many ofthe senior residents believe the program has changed significantly since you took it over and are very happy withall the changes.. And you deserve all the credit.

I believe that the goodness that we do in our life is carried on for eternity. The goodness and love that you showered on me , I will give to others and they they will give to someone else. Your kindness and thoughtfulness are appreciated and we carry them to those whom we come in contact.

When all is said and done, and our lives are finished, when we look back what we will rememebr will be moments.Moments in which we touched and better the lives of those around us.When I look back on my life years from now I will rememebr the moments that you made special, and the moments of the lives that you made better by your presence.

You have touched our lives in a special way. And we love you for it.

Residency is a one in a life time experience, and it is our fortune to share that experience with you. I believe that the goodness and greatness that we acheive in life is a measure of the individuals that surround us, and we are fortunate to be surround by you. We can bare the trauma and pain that sometimes life offers when we our sorounded we people that lift us up. And you truly lift us all. You make the enormous stress that we are on bareable. You have made our lives on this earth easier to live with, and we appreciate you greatly for this, and love you for it.
I think you needed to hear this. I have been meaning towrite this note to you.

Perhaps a small part of goodness came from all these stressful times. Difficult situations have a way of showing different sides of people. Although they might show the bad parts of people, they can also show the good. Bad times can also show you who is by your side and who will not abandom you. And I want to say that we are on your side. We are with you, and we would not
have it anyway.The program that you have built is very special, because you are special. You cannot give someone what you have not recieved, and you have a lot of goodness and love that we have recieved, and we thank you for that and appreciate it.

good luck the rest of the year.

with Love

Dr. _______

Let me tell you guys, man I was praying this letter helped calm the situation. the day I gave it to her was on thursday- my clinic day, I I was heading out of thehospital to go to clinic when I ran into a second year resident. SHe looked at me and said "mike, what did you do?" I was like "listen this entire thing got way out of hand. Can you beleive that their upset with me and the other residents. But can you believe me? I hate fighting and arguing with people." She was like "I'm gonna go talk to her about it" I then told her "I went home and wrote her a long letter,and I'm probably gonna see her when i come back from clinic". she was like "ok, I'm gonna go talk to her."

Well that same day I went to clinic. And man was I nervous. I had a sense or maybe I just made it up in my head that everyone knew about the arguments we had. I was nervous all day in the clinic. then about 1 hour and a half later I got a call from the second year. She was like "I spoke to her and she was really happy about your letter. She said she spent an hour reading it twice she was so happy. And I also told her you meant no harm and that you wanted to stop the fighting that wad going on etc...." I was so relieved to hear this. Man I was glad it at least helped to quench all the bitterness. Looking back on it. I think the program director was in a lot of stress and had a lot of problems to deal with this year, and it was her first year as program director and with the ACGME accreditation of the program in limbo this year. But thank that is all behind us. the following day I went in to her office and spoke to her and she was find. Looking back I realized that there was a lot of stress, but also I realized that this open door policy that administration has with residents is a good and bad thing. SOmetimes you have a good relationship with people and you feel like they are yoru friends, so you talk to them about your problems and letthem know your frustration, but a lot of times that back fires, because the program director is stressed as it it,and the chief resident is also stress because he is hearing ten complaints a day. SO you can imagine the sitatuion.Every second the chief is hearing from a resident, but the reason that is is or WAS this way in this program, isbacause you gain a comfort level with people. you view them as friends and friendly people, so it back fires when it gets too much. needless to say after all these problems I decided for now just to lay back and saty quiet. I don't plan on ever complaining or talking to the chief about any concerns or problems until maybe the next chief resident comes a long. I just think sometimes its better just to stay quiet and just listen and not raise y oru voice to much, beacsue people just misunderstand you. I think this feeling has spread to the other resident. Most of them realy don't say anything or complain, and now it will be even more quieter. I also plan- when I go back to the hospital (on vacation month of january)- to right a letter to the vice-president and president of the hospital complementing the program director for the extrordinary work she has done in the program. I will sign in only as resident to keep it private.

All in all, it still a good program, i just thnk the stress of the sitaution was just too much and people were hurt. But I think all is well now..lol. At least I'll hope. I'll let you guys know is I received retribution. About my program - it was in probabtion for some citation from the ACGME, but we had the site visit and it went really good! I think we will recieve 3-4 years accreditation easily. It was really stressful but was a great meeting. The way it works was that. the residents all nominated who they wanted to represent them in the ACGME meeting. We all voted privately and 12 people out of the 30 residents were chosen. 4 from each year. And I was one of them! Then this 12 are chosen to have a special sit down with the acgme person and she ask us questions about the program. the reason this program had trouble last year, was because the previous residents were not happy with the program and were complaining to the site visitor. Can you believe how thises people were that they were complaing to the site visitor about hte program? The bad part of that was that they almost sunk themselves. I don't think its wise. They are bashing the program they represent. When they graduate they are graduates of that program. If You put down the program and training , then you are putting yourself down, because youwere part of it. If you build a bad reputation of the hospital then you are part of that reputation. Last year because if the bad visit, the residency program was given about 17 citations, one that also said the resident lounge of the program was poor...lol. Can you believe that was a citation? ANyways, this time around was completly different, we laid it on nice and thick and sweet !! When the visitor asked me what I like about the program I said something like

"In life to do something special, you need to be sorounded by special people. We laugh we cry and we pray together here. We are a family. This place and program is very special to us."

The site visitor was impressed. she was like "wow". lol. anyways was really good and went very well. We were all happy. Anyways, we also had a christmas party with all the staff and residents it went very well (I hae pics and videos I wish I can post but I can't because I want to remain private for now). I also made a special slide presentation for the residents and program. I put music in it. It was very nice. At the end of it people were crying and so was I. I though it illustrated the heart of the program. I tried to capture the moments.

Last month was also bitter sweet for me because one of the attendings I loved left the program. Because of the economy her husband had returned to his country and she had to also. I made a tribute to her on the slide show and people were crying, but that was nothing compared to what happen when we through her a party- a farewell. Some chosen people stood up and made comments, i didn't want to stand up, but something told me to stand up because I would never again have the chance. I don't remember exactly what I said because I started crying as I was talking. You see this attending was really helpful to meet at the start of residency. I was really nervous and had no idea what I was doing, but she took me aside and said

"I see a lof of potential in you. You are going to make a great doctor one day. Forget about the notes worry more about the patient."

and I tell you these few words changed my life. And I said a lot of nice things about her. I started cryig and so did the other residents and doctors it was bitter sweet. We bought her a gift to take with her. This is the letter that I wrote to her:

Jaunuary 5, 2009

Dear Dr.____

Writing this letter to you is bitter sweet. On the one hand it’s a good thing to thank you for all the
goodness they have shown to me, but on the other hand it is painfully hard to say good bye to you. I’m not sure if I could have told you all this in person because it just hurts too much. I wanted to thank you for the few words of encouragement you gave me at the start of the residency year. You don’t know how much I appreciated your positive words.

Very seldom in life do you meet people that choose to care and people that choose to be positive. The world cries today for lack of people that help it or lift it up like you do. You will never know how those few words of encouragement meant to me. A little goodness goes a long way. And thank you for showing it to me.

I wanted to thank you from the bottom of heart. Thank you very much for taking the time. Thank you for caring. You didn’t have to, but you did, and I’m very grateful. In these difficult times and life we all need to meet people that life us up. People that give us the strength to carry on, and you are that person for all of us. You are like the lone star that lights the darkness.
It’s the small unexpected things that you do in life that have a lasting effect. Just a bit of caring and a bit of wanting to help make’s a profound difference. And I think you have made that difference at capital health. And the effects of your goodness will be seen for a long time.

We have all been fortunate to have met you.

Thank you for everything. Thank you for believing in Us.

I believe God uses you to help better the lives of those around you. And you have better our lives by your presence.You will always be remembered. You are the greatest. May God bless you wherever you Go. You and your family.

Thank You…
You will never be forgotten.

With Love

Dr.M____

Overall was a nice day. but was very painful to see someone that helped me out so much leave. What I told the residents that day in her farewell meeting is what I would tell you. IN Life-God places special people in your path that help you to achieve what your purpose in life. God uses them to bring light to your life. By their words and caringness they tell you things that inspire you to grow and to become someone. They motivate you and change you. Their presence is a blessing to everyoen around them. THey are like the sunshine that is needed on a cold day.
They life up instead of destroying. Its important in life to be sorounded by positive people. a lot of times in life you need uplifting and a few people you meet will do that. I'm been fortunate to be sourounded by only a FEW, but that is ok. Not everyone believes what you believe. THis world had a lot of negative people, but it also has positive ones. I advice you in this trying times of your life, while you struggle to get somewhere in life, suround yourself with positive people. even if you only have 1 or 2 people. Stay cose to them. Talk to them. they will lift you up. I'm blessed especially to have a great wife who has helped me tremendously, she is a gift sent from God to
me. she helps me out a lot. With out her help and strength I would not be.

Good luck to those in the match. Don't give up. Keep trying. Your primary goal in life is "not" to be a doctor. Yur primary goal in life is to better the lives of those around you, be it in medicine or somethingelse. NEVER think that your life has no meaning or is not worth it, if you dont become a doctor. You are meant to do good in this world. And God will guide you in doing that. He can make the impossible possible. He can lighten yoru darkness. He has given u his son Jesus who is our strength and light on this world. Lean on Jesus when do going gets tough. Don't give up. study hard. Good Bless you.

Jesus loves you

Dr.Mike

p.s Download free copy of one of My favorite books
"Desire of Ages" Here: http://www.highfields.org.au/desireofages/

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Day 166 THIS IS SPARTAAAAA !!!

2008-12-10T15:28:00.005-05:00

Wow, what a day, or shall I say morning. Today I was post call after being in the unit and we ended up getting into an emotional noon conference. Geesh, it got a bit “ugly” kind of. Basically yesterday while we were in the unit one of the rounding attending suggested to us that we should have a physician advocate. It all started when I saw him log on to his computer from the icu floor. He has a program which was gotomypc. He was able to log on to his computer in the office. We were all standing their and we were pretty surprised. (we are not giving email access in the hospital for security reasons since someone downloaded a virus to the hospital main frame, but we have hospital email) he asked us “why you guys can’t check your emails?” We were like, not really. He then kind of laughed at us and said “man, you guys are getting cheated!” He said it in a joking way. It didn’t seem to come of mean spirited to me. He was like “you guys should have a physician advocate. We told him we have the chief resident, and he said that we needed someone who is independent. An outsider to fight for you- someone who is not linked to the admisinstration.” Well the seniors felt it sounded like a good idea. Anyways, we didn’t think anything of it. The seniors said they were going to discuss it amongst themselves. And yesterday at the noon conference one of the seniors brought it up to the chief resident. Right away the tone of the chief change.- I’ve known for some time now, and it looked like he was pissed. He answered to the senior “why what happen? What do you need now?” the senior right away just stayed quiet. We then told him that the idea was to have an independent outsider that would go to the administration with complaints without fearing retribution. It didn’t seem like it was a problem to me. But, man the chief took it personal. I think he took it to mean that he wasn’t doing his job. The guys was kind of pissed. It was debated for a few minutes, and he went on to defend some of the fundings that the program had given us. Anyways, it didn’t seem like it went to well with the chief resident, and I thought that it was over, but then today, the program director was at noon conference! Damn, felt like I was in a soap opera. So much emotion. Needless to say she was pissed. She was like “ok, so why is it that you guys want a physician advocate?” Man her tone sounded pretty pissed off. It was like she was sayng “Ok… now what are you guys complaining about?” A bit of background on this. She has been working really hard and has been under a lot of stress this year. This is her first time in as program director, and has had to deal with a lot of issues and drama. ( I think I wrote about this previously. A lot of the first years wanted to leave the program) Anways, seems like she was pissed off at the unit residents. The seniors and me!! or she was pissed off mostly with the attending who was “feeding” us these suggestion. I was in shock. I was thinking to myself “what da hell?” How did I get involved in all is?” even one of the assistant directors was like “this is really bad. Its pretty disrespectful. There were even people that went to the program director nd had suggested to her to make changes to the program etc..” and she went on to say that its unacceptable. This is not the way you do it. One of the seniors was their, and she was trying to explain the conversation, but it really was not well received. The program director was obviously emotionally hurt. I think she definitely took it the wrong way. I don’t think anyone meant any disrespect to her or the chief resident. I even try to explain they those in the unit love the program and always defend the program. We feel they were doing a good job. Anyways, I can’t believe I somehow got in the middle of all this. I’m really dumbfounded for words. She said at the end she just wanted to clarify everything. One of the other seniors try to cool the situation and told her that it wasn’t meant in any harm.. It was only a suggestion to help everyone out, and burden the load. Anyways, man I’m still in shock. I tried to talk afterwards with the chief, but it seemed like he was still pissed off. Too!!
Man, and I thought I knew people pretty well, but I guess we are all human after all. We all have flaws and feelings get hurt. I think from this second on, I’m just going to mind my business, stay low- key. And do my “time”. It’s tough trying to please everyone in the program. Must be a very stressful job. I will try to find the time to talk to her and thank her for all that she does in the program. I think I’ll write her a personal letter through email. But today was the last day I get involved in hospital politics. I’ll let someone else deal with it. Don’t want to be in fights or hurt relationships with people.
God bless. Got to get some rest.
For those still going through interviews- good luck !!
Dr. Mike

Day 152 : Frustrated Interns, E.R and Residency Life

2008-12-10T15:20:00.003-05:00

Well it’s been a while since my last update. I’m real sorry for that. The last few post have been about some tips helping those trying to get residency. I have also updated the site so it could be a bit easier to navigate through it. I also updated my story (link) If there are some wondering how I was able to get residency please click on my links. I also have a picture of my pre-match contract that I included in one of the links. I will post copies of my usmle score for those that might not believe my experience.

A lot has been going on since my last update. I’m rotating right now in the Emergency room. ( It’s one of the easier and lighter rotations. ) There are a few ER attending, but I choose which one to work with so it really makes life for the intern better. I basically work with the helpful and nice doctors, lol. I shy away from the more “aggressive” ones. It also helps that I’m doing the rotation with another of the senior residents which is very helpful, and she covers me.

A lot has been going on that I haven’t told you guys, and I will try to be as specific as I can without naming names. Over the last few months I had discovered that some of the first years had wanted to leave. I wrote a blog about it, but I have not been able to locate on my computer to post it. I was pretty devastated when I found out. I even met up with my counselor, and I even cried about it to him. Me and another 1st year resident have been trying to find out who wants to leave and if there is anything that we could do about it. It seems like a lot of them have been upset with a few things in the program. One of them being that they don’t have a lot of time to study, that the attending don’t round consistently, that they are looking for fellowship, and this hospital doesn’t have it. Basically what a few of them were complaining about it the fact that it is not a university program. I can understand some of their frustrations, but I still don’t understand what they expected when they came to see the program. This is not Harvard. We are not the university of Penn. Anyone can see that it is a community hospital. But this doesn’t mean that it’s an inferior program. We have a steady inflow of patients and a lot of opportunity to learn a lot. We take care of a large patient community, and this gives you a lot of opportunity to learn. There are 2 ways to learn medicine. You can passively learn it by reading a book , or you can actively learn it treating and caring for patients. I understand you need to read, but the majority of medicine that you will learn will come from actively being involved in the care of people. Well anyways, I went through a pretty bad stretch of 2 weeks when I found out they wanted to leave. I told the program director and the assistant program director that I would advice them to hand out contracts earlier, so that they at least know who is leaving and then we can look for someone to replace them. Well, this happened about 2 months ago. In the last few weeks I don’t think a lot of them are leaving. One of the reasons is that if you go to a university program they will have to repeat the 1st year and that is pretty devastating. I will keep you posted on what happens.

During the last weeks the program has begun to interview candidates. They are giving about 100 interviews for about 9-10 spots. What is different this year is that they are not giving any pre-match offers yet. They are going to wait until they interview everyone before deciding. I see about 3 of the interview candidates pass by the wards when we are working. I just look at them in amazement and think about my situation and think about the interviews that I had to go to. It’s pretty amazing that I’m here. It truly is a miracle. I spoke with the program director and she said that she can’t believe how any great candidates she has. I remember telling her to be careful who you choose and those that want fellowship. (Because a lot of people complain in the program about their not being any fellowship and they have been talking about leaving). It’s a sad reality. I know it might not sound fair to a lot of people. But programs are interested in people that don’t want to leave the program. They want to invest their time in someone who will be with them for a long time. One of the seniors told me that the previous program director was hiring an older “crowd” of residents because they were less likely to leave. Our batch of interns is the first group that are “young”. Don’t get me wrong they graduated a long time ago, but they are younger than the current residents ! Its been pretty stressful for the program directors. They plan on maybe giving early contracts, so that they will at least know, if any of the residents want to leave, and so they can start interviewing for new residents. I’l l keep you guys posted on what happens.

All in all, I know that a lot of you are going through a pretty tough time now. Its pretty stressful. You are going on interviews and desperately trying to get a spot. But hang in their!! You can do it!! Keep doing what you have to. I have tried to help a few of you. If you guys need my help. You can email me at themadmike31@gmail.com . I have responded to some of you. I will respond to most of you, just be patient. I know that some times people ask where I did my externship, but I don’t like to promote any program in general. I don’t post it publically because I will be accused of being a fake. This blog is a testimony of my life. A testimony of the goodness of God and his grace. I don’t deserve any of the blessings that I have received. I’m grateful for all the goodness that God has given me. And if I can help even one person to better their lives, and to have a bit of peace, then all my struggle would have been worth it.

I never mean to brag about my situation, because I know a lot of people are trying to get residency. I only talk about my situation because I believe that it can happen to you, if its God’s will. I have posted a few tips, and you can look back at the archive.

Overall , residency life has been pretty good. Most of the interns have become pretty comfortable managing all the problems were faced with. Medicine is repetition. And the more patients you treat, the more your able to manage. After 100 chest pains, you kind of get comfortable with it. That’s just one example. The patients will change, but the basics will remain. You will see this when you start residency. At first you will be nervous as heck, but as time goes by you will adjust.

Have to run guys.

God bless

Dr.Mike

Day 86 Dr. Mike’s Getting into Residency For IMG Tip # 3 My conversation with a Program director

2008-10-07T18:57:00.011-04:00

Well I decided to write some other tips that might help some people now. But these are just some things that I have learned directly from the internal medicine office at my program. I happened to walk in on the secretary while she was recieving the applications that you guys send in applying. I asked her about how much applications she had recieved at that point, and she said they had received about 1000, and this was just 2-3 weeks into the match. I asked her how did she screen the applicants? She said that well at first she looks at wether the appicants have visa's or not and she automatically deletes them, and sends a sorry response. AUtomatically !! can you believe this? I was
like wow, she doesn't even look at their scores or experience. It is posted in the website and she says that people still send applications hoping to get in, but they have certain restrictions, and they abide by them. So after she screens these people, the pool that are left, are divided among the attending physicians. If there are around 600 applicants, the attendings look at who they want to give an interview, and they give out about 300 interviews. I asked her if she had other cut offs, and she said that sometimes they do cut offs if you have a lot of attempts at the boards. So that too might be put into consideration. She said then you are given an interview, and not always with the person that read your cv. I remember that I had my interview with one of the doctors that actually chose me out of the hundreds of final applicants. This was purely luck, as the people granted interviews are just distributed to the people giving the interview that day.

I also spoke with one of the associate program directors and I asked him how does he decide wether to choose a particular person or not? He said that it is not an easy task, but he tries to find someone that will be willing to handle the work, and someone that is commited to theprogram. He says that a lot of time when he discusses night floats and on call schedules, that he sees the looks on the applicants faces-their looks of shock, when they find out how much work it is. They basically are looking for someone that is willing to do the work. Someone that will work hard and not leave the program. Its trying to find the person that will be commited to the program. A lot of times,people will interview and will have no desire in the program. They are just their, to be their. They don't really care about the spot. Its in their long list of interviews they recieved. The program directors will pick up on this. And you have to be honest with yourself. If you interview at a program and you really don't want to be their. just remember, you will be there 100 hours a week. ALmost everyday. Trust me,I'm here now!! I like my program. but I see some residents that complain, and are not happy, and it affects them. SO be honest with yourself. THe best program is the one that accepts you!! At least thats how I look at it. The human body doesn't change across the border. what matter is your desire to learn and your hard work and determination.

On a personal level I can tell you (And this from someone that scored 78 and 79 on my steps) Programs are more worried about your ability to take care of patients and your recet clinical experience. They want someone that is comfortable with patients, and that is willing to work
hard. There are a lot of people with high scores, so that CAN'T be the deciding factor. Its your desire and your people skills that comes across to them, that willl help them and you.We are in the "business" of taking care of people. This is what matters the most-LIfe. The life and well being of the patient is above all.

I hope you guys well in the interviews. Pray a lot. be yourselfs. Be honest. And have fun, if you mess up at the interview, just remember

their will be others.
LEan on God when life gets hard. The darkest moments of your life can be the brightest. Let God and Jesus light shine on you.

God Bless
Dr.Mike

Day 75 Dr. Mike’s Getting into Residency For IMG Tip # 2 THE INTERVIEW

2008-09-23T11:05:00.007-04:00

I decided to share my experiences in interviews to help those that are going to the interviews now. I went throught the match 3 times and interviewed a lot of places. And I wanted to share some tips that I think will be usefull to you when you go to your interviews.

1. Know the hospital You apply to!!
A lot of times you will recieve interviews to programs that you really don't know anything about. You are simply so happy to get the interview that you rarely even took time to figure out any iformation abotu it. This can present with a problem for you because when you go to the interview the program direct you will ask you what it is you like about the program, and you want to be able to look like you want to be there and that you are motivated to be there. SPend the night before reading on the website about the hospital, you might find questions you have about the program, and ask them when youa re 1 to 1 in the interview, and it shows that you are interested in them. The prorgrams will pick up on your level of interest. If you are interested in the program, then you will ask questions about it. Ask about its reserach opportunities and its didactic programs. Just show them, that you at least know where you are interviewing!! I can't tell you how many times I got stuck in the interviews, when the person interviewing me asked me if I had questioons about the program, it was almost a strange silence.

2. Know the Person your interviewing !!

this is easier said than done. I rememeber asking the FAMily practice director that was interviewing me if he was a cardiologis? lol... It was a stupid question, but it cam out of my mouth after I saw him giving a talk to one of the residents about an ekg. Geesh, was I stupid to ask him that. I didn't get the position obviously, but I saw the look on his face. he was in disbelief. A lot of these individuals have pictures in the website. Learn them memorize them. Don't do what I did!!

3.Base your interview on the personality of the person interviewing you

BAsically what this means is that, if you are interviewing a person you suspect is serious, then you be serious. If its a person you suspect is very go lucky joy joy, then loosen down a little bit. But not too down. If they want to talk sports, talk sports !! Let them lead the interview. Don't go over board either. Be professional, but adapt to the person. Don't be fake either. Just relate to the person. be yourself. and if you screw up the interview don;t worry, you will have others and in time you will get better. Interview yoru friends or strangers. Practice with other people. Good luck.

4. Find out wether they willa sk you questions? medical.

There are websites out there that tell you what time of interviews each program has. you will find it on forums. You don't have to study for them, but keep it in mind so if they do ask questions, you are at least 'prepared" for it. Take an educated guess and try to reason it. and if you get it wrong don;t worry. Your not expected to know everything. Its just a process. They know your grades, and they know more or less yoru academic background. Don't worry too much.

5. Dress appropriate.

Men wear suits and females also. I remember when I saw this one female come to an interview in her pajamas!! I couldn't believe it. It was pretty shocking. Dress to impress. Nothing to flashy. Serious clothe for serious times.

6. Be on time!

GO there a day earlier if you have to. Don't take a chance on something happening to you. a lot of programs will provide hotel if you ask them.

7. Be yourself

Most important. Be yourself. Don't try to be somoene you are not. YOu can tell a fake person a mile away. They have been doing this for years. Practice with yoru friends and family.

8. If you don't know good english what do you do?

PRACTICE PRACTICE with your friends with mock interviews, and talk slowly. When you speak slower you are able to understand a lot more.

9. Buy a book on interviews and visit websites with tips!!1

You be surprised how much you learn from reading these things. And lot of them are free!!!! google.. residency interview tips !!

10.MOst important!

Pray and have faith in yourself. You are being led towards your destiny. GOD is with you. Get up early in the morning. Kneel down on your bed, and pray to GOD to give you patience and calmness. He will provide and help you. The program is interested in you. Just be yourself, and have a good time. They want to just get to know you in a short time. Don't try to be fake. Be yourself. Lean on GOd when you feel overwhelmed.

GOOD LUCK !!!!

DR.MIKE

Day 65 : My First Four months as a PGY1

2008-09-18T11:55:00.015-04:00

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

WHo is Jesus? (free online video 50+languages)
http://www.jesusfilm.org/languages/

Day 41 A message to those who Didn't Match

2008-08-03T17:26:00.020-04:00

I can still remember the day following the scramble. It was perhaps one of the most disappointing days of my life. Seemed like all the hard work, all the sweat ,blood, and tears that I had gone through for so many years was all one big waste. Your also left kind of confused and dazed. Your really not sure what just happen. In my second match I had gone to about 9-10 interviewes and had even traveled out of the state. So I was expecting to match. When I received the email from the eras simplying stating: You did not Match, I was almost numb. I coudn't believe it. I just stood there sitting at my computer quiet. Not sure what to do. It was early in the morning too when I found out, and I didn't even have time to think about it much because the scramble was to start soon. So me and my wife stood up all night and day trying to figure out which hospitals we were going to call. The scramble came and went. And it was perhaps one of the toughest days of my life, but however, not all was a waste. The day of the scramble I was invited for one interview at a hospital. I had called them during the scramble, and they had wanted to see me. So me and my wife got dresses and took the car, and went to go see the program. They interviewed me for a few hours. And i think they almost were about to choose me, but at the end it was a NO. I still remember like it was yesterday. It must have been around 7pm at night. My wife was waiting for me in the hallway. The program director saw me and my wife at the end of the night. She said I will call you tomorrow. I had a feeling I didn't get it, but I sensed that she didn't want to tell me right their. And just as we were walking out of the center she said " you know we really debated giving you the spot. We just wished that you had more clinical experience. We have one girl here that had done some clinical externship. you should really look into that. "

Those few words changed my life. After that the next few days. I sat and spoke to my wife and told her "can you believe how close we got. They were gonna take me...unreal.. Now what do we do? I think we have to find one for those externiships. There really is no way out of this." My wife did some snooping around and I did the externship. 8 months later, by God's grace I was signing a pre-match offer. Now, before you run off to those extership places. Let me just tell you that this is my story. Every one is unique, and every program is unique. I was definetly blessed this year when I was able to pre-match. But I don't really credit myself. Their are a few ways to get into residence and I just chose one of them. I'm a big believer in God. I believe that it was my destiny to be a doctor. And if it is your destiny, then nothing will stand in your way. I believe that if it is really your purpose to be a doctor, then you will become a doctor. We all have a path and a destiny. If being a doctor is what you are meant to be, then nothing will stop it. Offcourse this implies that perhaps no all of us are meant to be doctors. However, this doesn't mean you failed at life, or that you are less of a person. You didn't waste all thise years in medical school. Your life can still have purpose and meaning. True happiness and purpose comes from God and comes from spending a life in the service of others. It comes from allowing to be led by God. Wether that means being a doctor or something else. I've only ever wanted to do the will of GOd. I believe that jesus guides my path. And if he does, he will take me to a peacefull place and a happy life. Wether that life is spent being a doctor in care of others or being a janitor. I believed that- I will work the hardest I could, and at the end of all the hard work and effort- if being a doctor is what I'm meant to be, then it will happen. If it doesn't happen, then something else will. Something else that will also give your life purpose and meaning. How else can you
explain some people facing impossible odds, with low scores, hardly a contact, but yet getting a spot. Someone once emailed me and asked, "if it was God's will, then why did you keep on trying. when do u stop trying?" and my response, is what I'm telling you now. I was going to try everything I can, and work the hardest I can. If after all the hardwork, it results in me getting residency- great, if not, then I'll move to do something else that is meaningful and would give my life purpose.

If you have failed year after year getting into residency, then fix your mistakes. try to correct your weaknesses. After you do all that, if it happens that you don't get residency,it doesn't mean you are a failure. At the end of the day you want to go out and give it your all. Give it all you got. If you don't succeed it doesn't mean your a failure. It means that there is another purpose and another meaning out their in the world for you. all your hard work, was not a waste. The knowledge that your learned can still be used in bringing hope and help to others around you. For now, don't give up! Tell yourself "ok, lets do this!! Let me give it all that I have all that I can will." And if you find yourself in pain and hurt, just remeber that you are not alone. God is there with you. YOu only have to call on the name of Jesus. He is their for you. He is their to comfort you.
The pain that life gives can not be eliminated by trying to forget about it, or by trying to intoxicate yourself with something. the bible says that jesus came to heal the broken hearted. Let God mend your broken heart. Fall on the face of Jesus. He will give you life meaning and purpose and will give you the strength to carry on. Only someone that can read your thoughts and "look" inside your heart can truly understand what you are going through. Perhaps that person is God. Perhaps that person is Jesus. God can give you peace. Peace that is not like the worlds. Lean on God and he will guide you. If you are meant to be a Doctor than ask GOD for guidance and strength. If you don't believe in GOd much, or you really don't believe anything I'm saying then thats fine. But what do you have to lose. God calls those who are in pain and who are weary to come to him. He doesn't judgde. Even is you don't have much faith in God, what does it cost to go to your room and close your door, and get and your knees and pray to GOd and ask for hel and peace. Ask him to help you to deal with this pain you feel of not being a Doctor. The pain you feel that you have failed by not getting residency. OPen your heart. jesus wil not judge you. God can give you peace. He can give you the yearnings of your heart. Keep you head up. You can do this. I say all this because, God has given me peace. When the impossible becomes possible and you start seeing the workings of God in your heart, then your heart will be filled with belief in Jesus and God. Belief that your special and that God hears you. Don't give up my friend !! you can do it!! Study hard keep your head up. Lean on GOd. Jesus Loves you.

God can freely give you Peace. just ask him too.

You are NOT ALone!

Dr.Mike

Day 21: First Year Resident Drops out

2008-08-03T16:13:00.005-04:00

Well today while we were rounding, the chief resident came and met us, and told us that one of the first years had dropped out, and that their was a spot open. Within the same hour of her droppping out, there were already people calling and asking for interviews. I couldn't believe it. We were shocked. she had come from another country and had already done her residency. It was kinda shocking. She was very timid and shy, and she never really spoke to any of us. So no one really knows what happen. One guess was that she had a problem with the language. When the nurses would cal her, she would tell them to please page the senior. At least that is what someone said. She also had some trouble at home. She was a single mother raising a teenager. And that is never easy. So I hope that she is ok. It must have been really devastating for her. You spend your entire life to get here. And then you are not able to finish. Its really tough. ANyways hopefully she will be ok. THe program said that they are going to go back to their match list and choose the next few persons on the list. This year they pre-matched about 5 of us and use the match for like 3 of us. Out of the list of 50 people on their list, seems the program only used the first 6. So the list is very long. drmike

New replacement Resident

Well As fast as the word went out that their was a free spot. They were able to fill it up. They chose a person (male) that had already done an observation at the hospital. Boy that guy was happy. He said that last year he had only gotten 1 interview, and that was from this program that he did an observation with. Geesh, its almost unreal. But seems like some people are very lucky and blessed. MOst programs do not accept observership these days, and bad news is that some states NOW,only allow actively enrolled students to do observership. This will cause a lot of IMG's to not be able to do observership. I think they said it has to do with legal issues and stuff. NOt sure, but when i heard that you have to be a student to do observership, I couldn't believe. Its not fair. In the hospital there are like 3 students that I have seen that are doing rotations. This hospital that I'm doing residency also is keen on people doing research. The guy that got residency went and did some reasearch and had a publication, so that was also a key that helped him get the spot. I suspect that it was only a minor point. It was already around the 2-3rd week, and the program realy needed someone that knew the hospital. It really helps to have someone that knows the hospital, because their really is no time to teach someone where everything is. The program wnated someone that was ready to go, and he was it. Before you run off to do observation, remember, each hospital is different. SOme programs, don't want observationship, or research. SO don't think this sitaution applies to every program. Programs, are very particular, and others are not. Its your reponsibility, to find out what the program you are applying to wants. Sorry for the short update. BYe
GOd bless
Dr.Mike

Day 19: Dr. Devil

2008-08-03T16:07:00.006-04:00

Across your time in the wards and floors you will most likely meet people you will seldom remember, and others you will NEVER FORGET !!! ( lol). Let me introduce you to Dr.Devil (not his real name. But thats what I will call him) He is one of the Attendings in the hospital. He is an infectious disease specialist. He is one of the most feared and disliked doctors in the hospital. Yet he is probably the most loved doctor according to the patients. Basically this guy treats all the interns and residency like crap when he wants to, but treats the patients like they were his own children. Ironically he is one of the most beloved doctor accoring to the patients I have spoken too. Let me tell you how I met Dr.Devil. It must have been my first week in the wards, and I was my happy and excited self. I was introducing myself to every attending I saw, and waving and greeting all the staff and nurses when I saw them. I was like a little kid in the candy store-Happy that I was fullfiling my dream. Needless to say, I think some of the nurses smelled blood, when they saw me. (lol) I was like a lamb put in the lions den. I guess I was too friendly with the nurses and some doctors. I think the nurses when they saw me were like "who the hell is this happy go lucky young doctor? Damn, he is annoying as hell". Needless to say it didn't take long for me to realize that you have to be a nice person, but you have to be serious and assertive, or SOME nurses will step all over you, and not take you serious. I think I even had nurses that started giving me orders! lol. Anyways, back to Dr.Devil. So here I was, Dr. marry poppins, "singing" down the hallways of the ICU, when I met Dr.Devil. He was called into an Infectious disease consult into one of the patients I was 'in-charge" off. I notice that he had pick up the chart and I immediately went over, and introduced myself,. He just looked at me and walked away. I didn't think anything of it, but I has a sense I was going to be in trouble the next 5 minutes. He then started reading the charts and turn to me and asked what was the O2 sat on the patient. I had a bunch of papers in my pocket with some labs that I had written out, and I took out my crumbled stack of papers in front of him and started muffling through them. All I could say was "UMM.. UMM". While I was going through this paper, and while my heart began to panic, I notice the expression on his face changed. MY goodness you should have seen it, if he had any magical powers, I think he would have thrown a bolt of lightening and torched me on the spot. I kinda felt like he was about to stab me. I have never seen anyways so pissed off, and this was without him even saying a word!!! (Lol) Man, while all this was going on. One of the senior residents looked over, and saw my expression, and since she was the senior on the floor she came real fast and started talking to the doctor in attempts to stop him from blowing out my brains and stabbing me with his pen. Man I have never been so nervous. I didn't know some of the labs by memory, and was kind of scared. Thank God for the senior that covered my back. She told him "I will check the chart. I will look at the labs, give me one second." By the way he was also chewing gum. And man, was he chewing it hard...lol.. Anyways I stood right behind him and the senior and I tried to find a hiding place but couldn't, and he left the ward a few minutes later. I was saved by the senior. I will never forget this senior’a help, and she didn't even seem to friendly either. But since that day I was thanking her every minute. Anyways, fast foward a week later, and then I saw Dr. Devil again. He was on the case of this other patient, who had been seriously sick, and no one really knew what was going on for her. I was on call again. It was Saturday. But this patient was actually HIS PATIENT !! I still remember when I saw him this second time. I almost crapped in my pants. I was going to walk away, but my senior grabbed me and said, lets go talk to DR. Devil. Boy, if this guy had known what he was gettinghimself into. It just happen that, this day, DR. Devil was REALLY in a bad mood. He started looking to the chart and started screaming "do you guys know what the hell you are doing?" He said at my senior (3rd year) "What the hell are you people doing? what do you think this is? nigeria? This is not how you practice medicine !" (the senior just a happen to be african american by the way) Man, you should have seen the seniors face, and the nurse that was standing next to me, when he said it, and it was the way he said it. "What do you think this is? africa? " Man, I was shocked. He then went on to sift through the chart and insult the orders that had been given. He even insulted his own note, without even knowing it..lol he was like "why is this patient on anti-biotics? oh, you don't know... ok.." So he then went on and wrote in the chart stop all antibiotics: due to the fact no one knows what the hell she is on them for. After he got up from this trashing of me and my friends and the medical staff, he went to another patient that he had on the other side, and he took her off her antibiotics too and he also took another patient of their antibiotics. Basically, anyone that was on the floor that day, he took off anti-biotics. Man this guy was on a tear. He then asked my friend "who is covering the ICU? My friend said it was Dr.Tina (fake name) He then said, "well call tina and tell her that I'm coming !! and get ready !!" While all this was going on I went to the phone on called Dr.tina. When I told her that Dr.Devil was looking for her she was like "what?.. huh? he's looking for me.... ummm...ummmm.." She was like "are you sure?" (lol) I was like "yeah he's right here he wants to see you. She was like "ok" (she said it with a really sad voice by the way. After I hung up with her, my senior went up to me and said "you didn't call dr.tina did you?" I was like "umm.. yeah. I'm sorry. I didn't mean too" He put his eyes down a bit, he looked worried and said "its ok, lets go" So we went over to the ICU. By this time I was walking 5 steps behind. Trying to stay out of the fire. When he walked into the ICU, Dr.tina was their holding her papers looking very nervous. I told myself 'man, this girl is gonna get killed." however, due to my surprise dr.devil sensed the fear in her, and decided to take it easy an her, being that he already released his fury on the other senior, who looked like he just ran the new york marathon. Anyways, the rounds ended, and Dr.devil took off. Later that day, my friend spent the next few hours in shock and disbelief. He was like "he never ever talked to me like that. I have known him for years, and he never treats me like that. he treats everyone else like that, but never me." (lol) I was like "well it was your turn today." Ever since that day I just stay away from most attendings. I give them space and try not to smother or be overly friendly. But this story doesn't end here. you should see Dr.Devil with the patients!! It’s like he's an angel sent from GOD. He puts his hand on their shoulders and counsels them as they were his own kids. He spoke to one of the patients who was their for alcohol intoxication "what the hell all you doing. Your gonna hurt yourself. Look at your self, you don't want to live like this. We are here to help. you have to clean up your life. You have a sickness and its not your fault. I want to help you and you have to let me help you." when he talks to the patients, they are almost crying because they feel relief. I couldn't believe it, when I saw it. I was shocked. And for the next few weeks when I hear his name from patients its nothing but praise. They LOVE this guy!! Seriously. He probably has more patients that any attending in the hospital. Overall, it was amazing to see the contrast. I guess in the end, all the matters is how you treat your patients. But I don't know if I could work along side my peers and treat them like garbage. I rather treat people as I would like to be treated.
God BLess
Dr.Mike

BIg Update Coming!

2008-07-24T18:32:00.008-04:00

First of all, let me just apologize for the lack of updates, I've been really really busy...lol... I have so much to write, and I barely have any free time, so I'm gonna try and give a few updates about whats been going on. Please bare with me. I will post the following very soon.

Updates:

Dr. Devil
1st year resident Drops out!
New replacement residents coming in !
finished my ICU rotation !!
What I learned My first week of residency
Welcome to the real world !
Dr.Mike Getting Residency tip # 2
What to do after you don't match

I will work on posting the above. been working 80-90 plus hours 6 days a week..lol..
God Bless you

Dr.Mike

You are not alone, Jesus loves you.

Day 10: You are not Alone

2008-07-06T19:02:00.007-04:00

In one of the chapters of the ICU book, it starts of by saying that “many people believe that intensive care is about saving lives, when in realty it is about relieving suffering”. I think most young interns and doctors start their career with this idea in mind-saving lives, yet the reality is that we tend mostly to treat suffering. It didn't take long for me to learn this painful truth. No matter how much you care. No matter how much medicine you know. Know matter how much effort you put into caring for someone. The truth is that you can't save everyone. Starting in the Icu as my first rotation has been a blessing and a curse. It’s been a curse because it painfully wakes you up to the reality that sometimes theirs not much I can do. You witness the utter depts of suffering. In my first week I witness a woman who had slit her wrist 4 times and had gone into multiorgan failure and ultimately death. I've seen a few drug overdoses and alcohol withdrawls, leading to coma. Yet amongs all this human tragedy there are a few doctors that are willing to give everything they have for the sake of the patient. Doctors that dont give up. There are superman and woman in all hospitals. They are few, but you will find them. When I first came to this hospital for an interview, I asked the program director "who were the residents that stood out? In all his 15 yrs experience, who were the residents that stood far above the rest?" He responded by saying "the best residents I've seen are the ones that truly care about their patience. They are curious as to the "why" of something that happens to their patient, and they are wiling to go that extra mile to find out what’s going on." It didn't take long to notice these words in my hospital. I learned it by watching superman (superman is nickname I gave to another resident. See previous post) in action and going the extra mile.
Its a blessing and a curse to be sourrounded by good doctors because you want to be just like them. You want to be caring. You want to do everything you can for your patients. You want to have "all" the answers, and bring them back from sudden death. Yet you realize your limitations. You quickly learn that what you read in a book takes skill to apply it to real life. You lack experience, but your desire is their. And its painful to not be able to execute or treat critical patients instantly. You want to help, but you just "can't". However, its difficult to be able to properly treat a patient with multi organ failure and other critical conditions properly when you have only been a resident for 8 days. But the desire burns inside you-the desire to want to do something- but the painful realty that you can't.
Now more than ever, I believe that some of us are destined to be Doctors- with so many exams to pass and so many years of studying and struggle and with applying to a program with 2000-3000 applicants and only 9 spots up for grabs (a chance of less than 1%). Getting into residency for many of us is FATE. I believe it’s my destiny. I was put here for a purpose. By God's grace I was put exactly where I'm at , to make a difference in someone's life. We are here to change people's lives. And even if we are to help someone in their suffering, even for a brief moment, and even if we were to make someone's life on this earth a bit easier for someone to live, then all our years of studying would have been worth it.
There was one patient that I saw- a 60 yr old F that was in the ICU for CHF exacerbation and renal failure-she has about 5 different doctors and specialist. I saw her once and introduced myself to her. I told her I was one of the residents in this floor taking care of her. We spoke for a while and at the end of our conversation she says she was thankful to God for everything. The second she mentioned God, I realized she was abeliever. Before I left I turned to her and said. "I just want to tell you that you are not alone. Sometimes life hurts. It’s painful. You are surrounded by people yet you still fell alone. You still feel pain and sadness, but you are not alone. God is with you. Only someone that can read your mind, and look into your heart can truly understand what you are going through. God is with you. Remember that. He is just a thought away." She stared at me, and almost started to cry. But she was very happy. She agreed with me. The next day I walked into her room again, her daughter was their and she said “my mom can't stop talking about you. She said you are the greatest doctor” I put my head down and said "no,no" She also wanted to know if I have a business card. I guess she didn’t know I only started my career 7 days ago. I didn’t do much. I didn't cure her renal failure or heart failure. There isn't much "anyone" can do. But what we can do is give her comfort. Give her Hope. Hope in the fact that she is not alone. The pain and fear she can get rid of if she puts her faith in God and Jesus. It really felt good that she was smiling after I spoke to her. Even for a moment, if it made gave her a bit of strength and hope in dealing with her pain, all the struggle I have had mad eme realize that it was worth it.

Jesus Loves you
Dr.Mike

Dr. Mike’s Getting into Residency For IMG Tip # 1

2008-07-06T18:59:00.006-04:00

Over the last few weeks a lot of people have emailed asking for help getting into residency. They are from all parts of the worlds and their scores range from 75 all the way to 95. Seems that a lot of people struggle with getting into residency. And I’m someone that understands most of these individuals. I have gone through 3 matches and 2 scrambles and was finally able to match successfully. And I’ll try to give a series of tips for those that need help and guidance.
Let me first start of by saying that getting residency is a game. And you have to play the game correctly. For those that are born in this country and go to medical school in the USA its less of a game and the struggles does not compare to what an IMG goes through. But it is a game for IMG’s. And just like a game, you have to apply by some rules. Now, there are a lot of strategies when you approach applying for the match, and I’m not claiming to have to only correct way, but this was the approach that worked for me.
What Programs do I apply to?
My first tip is probably the most important one, and this is how do you decide which programs to choose and apply to. This is perhaps the most important piece in the match. It is the bases for everything. And there are people that just don’t apply correctly to programs. When I first applied to the match (my scores being 78 on step 1 and 79 on step 2)I found a lot of programs that had a minimum of 80 cutoff. I didn’t think anything of it. I figured I got 79, it should be enough. But I was WRONG. A lot of these programs are serious when it comes to cut off. I didn’t believe them until I actually called the programs during my 3rd match. From the conversation with these program directors, I can tell you to take those cut offs seriously . If the program cut off is 85 and you have 82, don’t apply save your money and apply somewhere else. If you really like the program and still and still want to apply. Call them and talk to the directors. The point is that you need to take those cut offs seriously. You need to do the research on the programs you are applying to, and call EVERYONE OF THEM!! and you ask them whats their cut off.
I used a website that is not too costly and find programs that you qualify for based on your scores and based on wether you have us experience or not. It was http://www.matcharesident.com/. I don’t like endorsing any site, and I’m not saying you have to choose them, it was only the one I used. If you don’t have money to join this site, you can go search eras per state and per specialty and CALL ALL OF THEM!! I’m serious about calling them, don’t apply to any program that you don’t personally talk to !! Don’t lose money applying to programs that you don’t fully qualify for !!
And let me just tell you now, be careful with those IMG friendly list that you find on the internet. The entire “world” is applying to those programs. In my second match I applied for Harlem hospital. Because I wasn’t able to get to their fax machine, I drove to the hospital myself. I handed my application to the secretary who told me she couldn’t take it because it was paper, but then she also said don’t bother we have received 4000 !!! applications for 9 spots !!!! I was shocked out of my mind. I couldn’t believe so many people applying to the same hospital. And the reason for that is because everyone applies to the SAME PLACE and that only means your chances of matching is a lot less… under 0.5% probably. If you don’t believe what I’m saying call the programs and ask them, and they will tell you. Be smart, play the game and first search the programs that you qualify for and call them, and then apply to them. And think outside the box. Don’t apply to the hospitals that everyone is applying to . It is only lowering your chances. And If you have to end up in the middle of the US in residency- surrounded by farms- who cares. You’re a doctor !!
I will post more tips soon. Good luck. You can do it!! Keep your head up!!
God Bless you.
Dr.Mike