I’m an Intern Now!

August 30, 2012

Now that I’m a few months into my intern year, things are starting to settle into a rhythm. I’ve been in the emergency room, on a rural medicine rotation about an hour from home, and now on OB/Gyn. From here, I move on to orthopedics, internal medicine, and anesthesia. I’ve gotten into a semi-regular exercise routine, and I’m hoping to stick to it for the foreseeable future. I’ve been able to visit Emily three times since starting my internship. Some weeks go by quicker than others, but it’s still rough. I’m working on getting in touch with residency directors out in St. Louis to increase my chances of matching there next year.

In other news, I’ve begun writing for Medscape again! With Match Game wrapped up, I was asked to keep my own blog on the site. I’m an Intern Now operates similarly to Match Game, but I’ll have weekly posts (rather than biweekly) about anything and everything related to a traditional internship year at my local community hospital. I’m hoping to keep it fun, helpful, and lighthearted. The first post went up a few days ago, and I’ve got a few more waiting in the wings for the coming weeks. Please keep an eye on it and send any feedback you have my way.

Match Game Archive

August 30, 2012

Medscape’s Match Game Blog
January 2011 – June 2012

When I Grow Up (1.19.11)
An introduction to the Match Game blog

Surviving the Match with Your Relationship Intact (2.1.11)
A personal story about surviving the match with a significant other

Doing Well on Rotations, Step 1: Stay Conscious (2.15.11)
A humorous anecdote about my first day of third year

The Atypical Medical Student (2.21.11)
A quick summary of my path to medical school

What If I Don’t Match? (2.28.11)
Preemptive Consolation for the Worst-Case Scenario

Misconceptions About Family Medicine (3.9.11)

Rotation Selection Desperation (3.16.11)
Be proactive with your electives!

Studying for 3rd Year Shelf Exams (3.30.11)
Advice for Shelf Studying

Attending to Your Attendings (4.13.11)
Quick tips on interacting with attending physicians

Attending Do’s and Don’ts (5.3.11)
Pet peeves from 3rd year

Clinical Skills 101: Building Rapport (5.18.11)
Relating to patients and their families

Step 2 PE Review and a Brief ERAS Introduction (6.1.11)

How I Chose Pediatrics (6.14.11)

Dealing with Dropped Rotations (6.29.11)

Sacrifices for a Medical Career (7.19.11)

COMLEX Step 2: Done! (8.10.11)

(Trying To) Write My Personal Statement (8.24.11)

Confession Time: Deciding to Change Residencies (9.4.11)
Why I switched from pediatrics to emergency medicine

Finding the Right Internship (9.19.11)
Considering an extra year of training

Trying to Plan for the Unexpected (10.3.11)
Reactions to my wife’s fellowship match

Being Honest With Residency Directors (10.18.11)

Submitting My Dean’s Letter Request (11.7.11)

With A Few Interviews Under My Belt (11.29.11)

Match Panic Sets In (1.5.12)

Taking the COMLEX Level 2 PE Exam (1.19.12)

Rank List Submitted and Certified! (2.2.12)

Good Luck in Tomorrow’s Osteopathic Match! (2.12.12)

And Now We Wait (2.23.12)

Patient Perspective (3.3.12)
My Personal Experience with a Laparoscopic Cholecystectomy

Congratulations, New Residents! (3.16.12)

Preparing for Graduation (3.25.12)

Following Your Own Medical Advice (4.1.12)

Avoiding Cynicism in the ER (4.19.12)

Graduation Cold Feet (5.4.12)

Realizing How Lucky I Am (5.24.12)

It’s Been a Good Run, Match Gamers (6.9.12)

The Next Chapter

June 20, 2012

I realize that it’s been a while since I’ve posted anything of worth here. It’s been a hectic time for me. Medical school graduation has come and gone, and while I’m thrilled to be done with that chapter of my life, the commencement ceremony was fairly anticlimactic. My traditional intern year begins soon, and I’ve got orientation activities for the next couple of weeks. Maybe once that’s over and I start seeing patients again, it won’t feel as weird introducing myself as Dr. Fishman.

My time writing for Medscape’s Match Game blog has also come to a close as well. It was an amazing privilege to work for such a great site and with such awesome fellow medical students. Hopefully, this won’t be the end of my writing there. Keep an eye out for more. In the meantime, I’m working on a full archive post of everything I’ve written for Match Game. I’ll try to get that up as soon as I can.

I’m hoping to keep DoctorFishypants better populated in the coming months. Since most of my day-to-day life in medicine is covered elsewhere online, I’m going to try to use this site for more essays or long-form writing about anything from medicine to my increasingly expensive love affair with video games. I’ll try to keep it interesting, even for those of you who don’t know anything about medicine or don’t obsess over the next Super Mario Bros. game.

Tuna Fishman

March 17, 2012

My wife and I have always wanted a puppy, but neither of us were allowed to when we were growing up. Our parents aren’t huge fans of pets. Now that we’re married and off on our own, we decided it was finally time to adopt. We drove to our local shelter and met a 3 month old terrier mix puppy in need of a home. The folks at the shelter named him Murphy, but we thought Tuna Fishman would be more fitting. He’s scrappy, and he can be a handful at times, but he’s a ton of fun.


Patient Perspective

March 4, 2012

I’ve spent a fair amount of time in the ER, and I’d like to think I haven’t already become jaded or cynical. But I’ll reluctantly admit that I’ve rolled my eyes once or twice when a young, healthy patient strolls into the ER at 4AM complaining of intense pain that couldn’t wait until morning for an office visit.

A few weeks ago, I reluctantly became that patient. At about 11PM, I started having gnawing abdominal cramps. By 3AM, the pain had moved to my right upper quadrant and I was writhing in bed, unable to find a comfortable position. Tylenol didn’t help. The pain was in the right spot to be my gallbladder, but I wasn’t nauseous and I don’t exactly fit the traditional patient profile of someone with cholecystitis. My wife called off of work for the next morning and took me to the emergency room. I didn’t know what else to do.

When you’ve spent the past four years thinking from the physician’s perspective, becoming the patient is an odd experience. You know what to expect, but you don’t know what’s going on from one minute to the next. You find yourself trying to help the nurses, but there really isn’t anything you can do besides give a thorough history and be a good pin cushion. Unfortunately, most hospitals don’t keep an ultrasound tech on hand past midnight these days. By the time I left the ER, I was given some Zofran and a recommendation to follow up as an outpatient. I’m not really sure I expected much more than that when I came in.

The next morning, I called the family physician that I was on rotation with. She thought I should get the ultrasound, and I agreed. At that point, I had an inkling that I’d be getting my gallbladder taken out the next day. The exam showed acute cholecystitis, and I went straight back to the emergency room. This time, I had to wait nearly 3 hours to be seen by a physician. When you’re working in the ER on a busy night, it’s not uncommon (or unreasonable) to see patients with non-life threatening conditions wait extended periods before being treated. When you’re a patient in that same ER who’s sitting in the waiting room with no medication for your pain, that’s another story.

Fortunately, the ER wait was the worst thing about my experience in the hospital. Once I got up to my room for the night, it was almost as if I were staying in a nice hotel for the weekend. The only thing I had to do was wake up in the morning, answer a few questions, take a nice medication-induced nap, rest again, and go home. Everyone in the hospital from the transport team to the nurses and physicians were incredibly friendly and helpful. Having attentive nurses made me feel so much better as a patient because it compensated for my feelings of helplessness (or rather, futility) lying in a hospital bed.

As I was wheeled into the operating room the next morning, my wife was more nervous than I was. We’d both scrubbed in on quite a few laparoscopic cholecystectomies, and we both knew what to expect, but I was actually excited to finally experience everything as a patient. I know it sounds weird, but I wanted to know what it felt like to be put under with anesthesia and to wake up groggy and loopy. I wanted to know what the different pain medications we hand out so freely to patients actually do to your body. And I wanted to know what sutures and dermabond feel like. Now that I’ve experienced all those things, I’ll know what to tell my future patients to expect. I’ve gained more respect for my future colleagues, more appreciation for everything that the nursing team does for their patients, and, perhaps most importantly, more empathy for my patients.


Osteopathic Match Results

February 23, 2012

Because of the hectic schedule during my fourth year of medical school and trying to get everything ready for graduation, I haven’t been able to keep this site updated as often as I’d like. If you’d like to keep closer tabs on me and see what I’ve been up to lately, Medscape’s Match Game Blog is a good place to start. I’ve been posting there on a weekly basis for a couple of years now.

To get caught up and make a long story short, I decided that I want to go into emergency medicine instead of pediatrics. The whole process of how I came to the decision is documented in a few posts on Match Game, beginning here. Unfortunately, the decision complicates things a bit. My wife recently matched for a neonatology fellowship in St. Louis, Missouri. Had I stayed with pediatrics, it would’ve been easier for me to land a residency there. As it turns out, though, there are only two emergency medicine residencies in the state, both of which are allopathic, not osteopathic.

So instead of applying for a residency spot directly from medical school, I applied (and matched into) a one-year traditional rotating internship at home in Cleveland at the hospital where I did the majority of my third and fourth year clinical rotations. It means I’ll have to to the entire match process over again next year, and it’s yet another year spent in a different city than my wife. But it’ll improve my application for emergency medicine and make it more likely that I’ll land a spot out in St. Louis.

That’s about it for now. Graduation is coming up in June. It really can’t come fast enough!

Why I Play, Continued

December 4, 2011

Last week, a young man came through the emergency department complaining of intractable nausea and vomiting for two days. He was severely dehydrated, dizzy, and lightheaded because he hadn’t been able to keep any food or drink down for some time. The first things you think about in your differential for an otherwise healthy-appearing 30-year-old guy with nausea and vomiting are the flu or a simple viral gastroenteritis. Fairly routine.

Talking with the patient and getting a better idea of his medical history revealed that just a few months earlier he had undergone a complete resection of a craniopharyngioma. These tumors are usually benign masses that grow near the pituitary gland in the brain. The term benign can be somewhat misleading, however, because the growing brain mass can cause increased intracranial pressure, disrupt function of the pituitary gland, and damage the optic nerve simply because of its location in the brain. These changes lead to symptoms like nausea, vomiting, balance issues, hormone imbalances, and problems with vision. Craniopharyngiomas rarely metastasize, which is why they are usually designated as benign.

With this new information, the next step in figuring out what was going on was to get a CT scan of the patient’s head to make sure the tumor was completely gone. We also had some imaging of his abdomen done in case we could find anything there that might be causing his nausea and vomiting. When the results came back, it was my job to tell my patient what we found. I sat down next to his bed, and he looked at me already knowing what I was going to say. He started to tear up before I started talking. The reason he’d been so sick is because his brain tumor that was resected less than six months ago had come back. I also told him that we found a new lesion in his liver. I explained that he still had a number of options. There’s surgery, chemotherapy, and radiation. The lesion in his liver might be nothing at all. You try to stay positive in situations like these, but it’s very difficult not to focus on the negative, and it’s more difficult to maintain your composure with a tearful patient.

I like working in the emergency department because, most of the time, you’re able to see a problem, fix it, and send your patient on his or her way. Unfortunately, sometimes all you can do is give them a little more information than they had coming in and refer them to someone who might be able to help.

That night, I went home and unwound much like I usually do. Video games help me relax by taking me somewhere completely fantastical and so out of touch with reality that I forget what went on at work. I played one of my favorite franchises, Assassin’s Creed. It’s a historical science fiction series about a war between the order of Assassins and the Knights Templar. The games are set in various time periods and locales ranging from the Crusades in Jerusalem to Renaissance Italy and 14th century Constantinople. As an assassin, you are tasked with ridding your cities of the oppressive Templar regimes by any means necessary.

Typically, the games reward you for stealth and strategy more than wanton destruction. But that’s not how I played that night. That night, I was brazen with my attacks. I cut paths of murder and destruction from one end of the city to the other with no goal or objective, no in-game reward to reap. It was cathartic.

Video games get a lot of flack for their consequence-free destruction or violence – and in many cases, rightfully so. Without the proper maturity, the desensitization they cause can be dangerous. Sometimes, though, it’s precisely this desensitization that I play for. When the horrible things that happen on a daily basis in medicine can be blocked out, even momentarily, it makes the impact, the care, and the life of even a single patient that much more important. That’s why I play.


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