Exploration's Sake, Learning's Sake (and re-discovering Foursquare)

The original intent of this post was to photo-document my adventures during Columbus Day in October. I thought (and still think) that the idea of "exploring" Dayton on Columbus Day was a clever play on words during the holiday. With an entire day of freedom, I plotted out a few goals to structure my time, namely breakfast at Butter Cafe, lunch at Smokin' BBQ, and dinner/trivia night at The Pub. How I would arrive at each goal, though, was up in the air, an adventure waiting to happen.

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[An overview of my travels (all on foot) through Dayton on Columbus Day, courtesy of Google Maps]

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Like any good Asian, I took a lot of pictures as I wandered the streets of Dayton, but trying to post them all with individual commentary proved to be too tedious and made the post look too cluttered. There were some particularly nice shots that I wanted to share though.

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[E: Pausing in the middle of the street and looking back north up Main St.]

[F: A beautiful shot of the rising sun amongst clouds over Route 35.]

[G: There was something tragic(?)/ironic(?) about seeing a Salvation Army store boarded up. This was the first time on my journey that I realized how blind I've been during the hustle and bustle of residency. I've passed this building countless times, driving to and from work/errands/social gatherings, and never noticed it until I took the time on Columbus Day to slow down my life and simply walk down the street.]

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[K: A post-breakfast walk through Woodland Cemetary and Arboretum, with stops at the grave of the Wright Brothers and a view of the Dayton cityscape. There was also a pretty cool Civil War portion of the cemetary.]

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It was during breakfast at Butter Cafe that I started cultivating the thought behind this post. You see, I used to be an avid Foursquare user when it first came out. The thought of racking up purely symbolic points against other friends was enough motivation for me to "check in" at even the most mundane locations. After receiving a few purely symbolic badges, the novelty of the game soon wore off. In hindsight, I think the purely symbolic nature of Foursquare points just wasn't worth the effort it took to maintain my place on the ever-changing leaderboard. However, during Columbus Day, I opened up my Foursquare app and on a whim tapped the "Explore" button for the first time. This was a new feature that was introduced a few updates ago, and one that I simply hadn't paid much attention to until that day while I was sipping my hot cup of coffee, waiting for my delicious Bacon, Avacodo & Tomato Omelette.

Turns out, that decision helped add to my itinerary that day! Through Foursquare's "Explore" feature I found a section specifically dedicated to tourist-y sites (How appropriate!), which led me to find the Stewart Street Bridge. Not only that, on my way to visit the bridge I discovered Dayton's Vietnam Veterans Memorial Park, and from the park I discovered the Point of Peace. 

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[M, N, O: One unexpected find after another, after another.]

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This string of happy surprises has led to a change in attitude. Other possible titles for this post might have been "Meta-Exploration" and "Explorations in Exploring." This is because on Columbus Day, I learned to explore for exploration's sake. I learned to forget about collecting artificial points and simply enjoy the journey. Since that marathon of a day, I've come to enjoy walking whenever I can. If anything, the freedom of movement that comes with being a pedestrian gives me the chance to see streets I might not otherwise commute on, and from a perspective I might not otherwise appreciate. Just today, for example, walking to get dinner from the Oregon District led me to the Dayton courthouse plaza, and on a whim deciding to take out my Thai 9 udon soup and sushi to Riverscape helped me stumble across the Riverscape Metropark Ice Rink (which I didn't even know existed).

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[Christmas tree and ice skating. December has arrived.]

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I'm hoping to extend this spirit of exploration into my academic life also. I'm halfway done with my Emergency Medicine block, and have three more Internal Medicine blocks left. Although I would obviously prefer to be working psychiatry cases, having a spirit of exploration has helped me get the most out of these Internal Medicine months. (At the same time, assessing patients with acute mental status change and seeing what I think was my first case of serotonin syndrome has kept the rotation relevant.) Even if it isn't related to psychiatry, knowledge is still knowledge, and I've come to appreciate learning for learning's sake, in the hopes that happy surprises keep coming my way.

On that note, explore away!

Glad to survive, ready to thrive

Looking back at my blog, I guess I had a couple of months where I was able to post and stay up to date. Unfortunately, September was quite the whirlwind. For a couple of weeks, I was carrying upwards of eight or nine patients at a time; at one point, I even had ten patients on my census (that was the day I worked from 7 AM to almost 8:30 PM; if I remember correctly, dinner consisted of sharing the chips, pretzels, and cookies that were at the nurses station that night). The quantity of patients was only exacerbated by the difficulty of treating some of them. There was a day when two of my patients got into a physical altercation because one of them called me a racial slur while the other felt a need to defend my honor, and in a completely unrelated incident a third patient (in the process of being treated for mania) ended up taking off his T-shirt and roaming the halls verbally threatening staff and patients alike. Fortunately, as I was told by my colleagues, the workload on inpatient psychiatry always seems to come in waves, and it appears that this most recent wave has passed with my census last week averaging just two or three patients. In some ways, I'm grateful to have gone through the gauntlet of September. There's no way I want to have ten patients again, but at least I now know I can handle the situation.

There isn't much else to report, I suppose. I learned on Friday that tomorrow is Columbus Day, which (being a federal holiday) means a day off at the VA. That pleasant surprise opens up a day of possibilities ranging from trying the culinary offerings of Dayton to simply staying at home. Looking ahead, there are only two more weeks left on this inpatient psychiatry rotation. I move onto four weeks of Child and Adolescent Psychiatry, which is all outpatient, which means a more predictable schedule, which means possible visits to Ann Arbor and a definite visit to California for a wedding.

That's about it for now. Not much in the way of deep insightful musings I'm afraid, but getting back into the swing of blogging makes me feel better. For a second I was afraid I hadn't written anything during the entire four months of inpatient psychiatry and was glad to realize I had actually checked in during August. It's been less than two months since that post, but it sure feels like it's been longer. In the process of thinking of a title for this post, I thought "Surviving September" had a nice ring to it, mostly because it was how I felt during most of the month, but now I'm ready to move from surviving to thriving. I guess you could say I'm already on my way. I know that one of these days I will re-read this post, remember the wave that was September, and be glad of how far I've come. Glad to be back, and thanks for reading!


[College football: one of the ways I survived September]

Tales from the Life Domestic

Well, another month passed, time for another blog post. I'm beginning to realize at this point that I've made the transition from student life to "real world" life. Perhaps most of my colleagues were already in the midst of this transition during medical school, living on their own in apartments, cooking their own food, etc. For my part, having lived in the co-op environment of Phi Rho Sigma during three of the four years of med school, having had most of my meals prepared by Chef Amy at Phi Rho during all four years of med school, and having lived the dorm/fraternity house life at Stanford before med school, I guess I was a little behind on the whole "growing up" thing. I must say, though, I'm quite proud of how I've adapted.

First, there was moving into my new apartment:

[Note to self: queen-sized box spring does not fit inside my car]
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[Boxed furniture = greatest invention ever. This bellhop cart is holding four chairs, a desk, a coffee table, and half of a dining table.]
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Complete with before and after photos:

[Living room: before and after]
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[Bedroom: before and after (yes, I realize the bed is still messy)]
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[The IKEA box graveyard. Rest in peace, cardboard and foam.]
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[The finish touch on my housework: a memory corkboard.]
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Then there was the whole learning-how-to-transform-materials-from-raw-products-to-edible-sustenance process.

[My starting point: milk, salami, cheese, and Oikos Greek yogurt. In other words, I had nowhere to go but up in terms of my culinary prowess.]
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To start with, some familiar favorites:

[Fried dumplings, i.e. Chinese comfort food. Déjà vu, perhaps?]
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[Smiley face breakfast, for branching out from my usual scrambled egg routine.]
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After a couple of weeks, I had exhausted my repertoire of microwavable/boilable/pasta-ble foods. That's when I made an amazing discovery. Did you know there's a whole Network dedicated to Food? And did you know that on the website of this "Food Network" are troves of "recipes," i.e. easy-to-follow steps for delicious meals, complete with lists of ingredients and cooking instructions? This discovery has since opened a floodgate of inner Emeril.

[Yes, that is a side salad. Yes, I did feel less guilty eating this delicious, delicious chicken.]
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Followed by Perfect French Toast:

[Oui!]
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And finally, some baking (recipes courtesy of Anne Hoekstra):

[Banana bread and banana espresso muffins.]

All in all, not a bad way to live the domestic life, if I do say so myself. Now if you'll excuse me, dinner beckons.

Another year older

Usually I associate the phrase "Another year older" with birthdays. In this case though, it came to mind during this past Fourth of July, and not necessarily because it was America's birthday.

Let me back up a bit. The entire month of June was taken up by residency orientation. Most residencies don't start orientation until mid-June, but my Air Force connection required two extra weeks of military-specific sessions (mostly used to establish military payroll and health insurance...very important...). This was followed by two weeks of orientation through the civilian program where I will be doing most of my work. [Because it's a common question, I'll explain what it means for me to be a "military resident." For all intents and purposes, I'm the same as the civilian residents in the Wright State University psychiatry department. I go through the same rotations at the same locations. In fact, everybody in the program works at some point at Wright Patterson Air Force Base. The only difference is I signed a contract with the Air Force, not Wright State University, and therefore receive my salary and benefits through the military.]
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[In keeping with the trend of my medical friends posting pictures of their shiny new residency ID cards, here's the sign I had to hold up for my resident photo directory mug shot.]
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But enough with the boring bureaucratic info. The point of that tangent was to say that June was all orientation, and my first day of work as a physician was July 3. Because I'm working at the VA inpatient psychiatry unit, this first day of work was promptly followed by a day off to celebrate the federal holiday of Independence Day. (God Bless America, and God Bless the VA Spa.) This gave me the opportunity to watch fireworks with my co-intern, Gib, at the local park. As we were watching the display, it occurred to me that exactly one year ago, I had arrived in Dayton to start the first of two away rotations at the Air Force psychiatry programs (one at Wright Patt and the other at Lackland AFB in San Antonio, Texas). In fact, I went back into my blog archives and pulled out the post I wrote at that time: http://lukeli.posterous.com/that-lovin-feeling
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[Reposting the photo of fireworks from July 4th, 2011, taken with my iPhone 3G]
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[Now upgraded to video of fireworks from July 4th, 2012, taken with my iPhone 4S]
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Rereading that post helped me remember the excitement I had as an M4 taking the first step toward becoming a psychiatry resident. This is in contrast to my first week as an intern, which I guess was an understandable whirlwind of adjustment. At times, I felt like I was at a loss for how to formulate plans on my patients, almost as if I were simply grabbing onto my attending's coat tails and hanging on while he explained what we were going to do for the day. (This is slightly hyperbolic because we don't wear white coats on inpatient psychiatry.)

However, I think the second week of work was a great improvement. Part of the change is simply decreased patient load. (At one point, our census was 22 patients out of a max 25. I think I was carrying 5 or 6 patients on my second day of work.) The other part was drawing on my training from Michigan. It helped that I was familiar with the VA computer system from my time in Ann Arbor, but more than the technology though, I started remembering the habits I had formed during medical school. I've come to realize that looking up literature and practice guidelines has become second nature to me, which reassures me that, yes, I do "know what I am doing." I also took comfort in the little teaching moments I've had with the M3 on my team. As interns we work with medical students, which brings back memories of another post I wrote last year: http://lukeli.posterous.com/med-school-360 (a post where, interestingly enough, I also said "I knew what I was doing"). Helping the medical student calculate the QTc interval on a patient's EKG prior to starting an antipsychotic (turns out, psychiatrists are still expected to know a bit of medicine) was a satisfying reminder that I can do work and still teach at the same time. Perhaps that's the Michigan Difference.
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[Tattoo #2 on my left shoulder blade, to commemorate my Michigan training. It's the Rod of Asclepius, the symbol of medicine, with a head of the snake sporting the winged helmet design as a subtle tribute to the University of Michigan. Designed and inked by Carrie Hoekstra of Temple Tattoo in Holland, Michigan.]
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All of this is to say that the transition to residency is going as well as can be expected so far. I might just make it out the other end, a few years older and (with a bit of luck) a few years wiser.

Aspiring

Yes, I've been delinquent in keeping this blog updated. There's been quite a lot of happenings, the most significant one being my graduation from med school! No less significant, though, being my birthday in April as well as my imminent transition to Dayton. In fact, since my last post, I have found a sweet apartment in downtown Dayton and the Air Force has moved a majority of my household goods from my room. (I am literally living out of a suitcase since my clothes drawers are on their way to Ohio.)

Some highlights from the past couple of months:

[Graduating in-house Phi Rho-ers enjoying gelato!]

[Free birthday show at the Ann Arbor Comedy Showcase!]

[Skeet shooting...]

[...and BBQ at Dr. Brzezinski's house!]

[Phi Rho Senior Dinner!]

[Graduation, with the Honduras crew!]

[Diploma, custom-framed with Michigan-blue matting!]

These images give me pause to reflect on how my time in Michigan has impacted me. I've had countless memories of good times, but there has been an even deeper change in the way I view the world. (Folks who were at Phi Rho Senior Dinner will have heard this message already, but it is elaborated and more coherently written down below.)

The best way to explain what I mean comes from a TED talk entitled "Building the Musical Muscle." The speaker is Dr. Charles Limb, an ENT surgeon who explains that although cochlear implants have come a long way in helping patients with speech and language, the devices are unable to help patients differentiate between a trumpet and a violin. What's more, he drives home the point that this is unacceptable. He goes on to say that he and his colleagues actually have an obligation to help patients appreciate music. The theme of the talk was that our duty as physicians is not simply to restore basic function, but to restore beauty.

This message has struck a major chord with me (no pun intended). Oftentimes the main goal in med school and residency is to learn how to remove disease, but there is so much more to the human experience than being functional. The world was not made for living, it was made for thriving. As physicians, we should help patients see the world as it was meant to be, not simply a world devoid of pain but a world infused with happiness.

If I am to take anything away from my time at Michigan, it won't just be the education I received, the innumerable facts and skills I had to learn. Instead, the most important thing I have gained is the sense of joy I've had outside of the classroom. Were there difficult times along the way? Of course. Any of my close confidants know that I had personal struggles alongside personal triumphs. And I do not doubt that there will be similar struggles in the future. But the time I've spent with these friends, the little moments in life (going to late-night movie outings, satisfying a sudden urge for ice cream), the big moments in life (celebrating birthdays, engagements, weddings), they all have given me a glimpse of the human condition at its best, and it is a vision worth aspiring to, both during my residency and beyond.

Checking off my Michigan bucket list

Apologies for the long delay in blogging. However, I hope that the title of this post says it all. I've been spending the last two months really trying to take advantage of all that Ann Arbor and Michigan has to offer before I head off to Dayton, Ohio for my psychiatry residency. Having a Hospice/Palliative Care elective last month really made me appreciate whatever amount of time I am given in life and at Michigan in particular. In fact, trolling Dayton craigslist and mapping out potential apartment locations on a custom Google Map has been a bittersweet reminder that I'll be moving soon. In the meantime, though, I'm really grateful for all the fun things that have happened since my last post:
  1. Ann Arbor Restaurant Week: eating at the Melting Pot and Jolly Pumpkin for the first time
  2. Detroit auto show with Phi Rho peeps
  3. Skiing at Crystal Mountain with Steph, Eunice, Paul, and Joe
  4. Performing with Auscultations at the Biorhythms Winter Show 2012
  5. Having a lead role in the 94th Annual Galens Smoker: Thrombin Hood and His Merry Meds! (Corollary: performing in the objectively best Stud Dance of all time)
  6. Galens Banquet
    • Taking part in the first annual M4 Matchelor Party (paintball followed by suits and dinner in Detroit)

    [#3: dinner at the Crystal Mountain lodge. From left to right: Paul, me, Eunice, Steph, Joe]

    [#4: Auscultations debuting two new songs, Mariah Carey's "You'll Always Be My Baby" and OneRepublic's "Secrets." Kudos to Jess Bloom and Peter Park for outstanding solos!]

    [#5: the 2012 Galens Smoker! Photos and Stud Dance video by request only ;-)]

    [#6: Wojcik, me, and Kimball at Galens Banquet]

    [#7a: Matchelor Party 2012 - paintball...]

    [#7b: ...followed by suits and dinner at Fishbone's at Greektown Casino in Detroit. Dang, we clean up well.]

    So much time has gone by, and so much fun has been had, it's hard to believe that graduation is only two months away! There's still plenty to look forward to also:
    • Match Day 2012 is coming this Friday! Although I already know where I will be going next year, it will still be exciting to share this day with my other med school friends. Plus, Match Day party that night!
    • The first ever Auscultations concert this Sunday!
    • The Michigan Pops Orchestra presents: Pops in Peril!
    • Season 2 of Game of Thrones!
    • My birthday!
    • Annual Tulip Festival in Holland, Michigan! And a potential second tattoo idea taking shape!
    Stay thirsty, my friends...

    One step closer

    Happy New Year!


    [Can I still say that?]

    Winter Break has come and gone. Going back home was pretty standard fare. My family's Christmas Eve party featured relatives playing Maj, my cousins and me playing Words with Friends, and everybody enjoying traditional Chinese food. The highlight of Christmas Day was going to a performance by my mom's dance group at the Global Winter Wonderland in Santa Clara. After the festivities, my family and I went on our annual ski trip to Reno. In addition to skiing, we enjoyed a performance of ZzyZyx (no, that's not a typo), bowling, and a screening of the movie Moneyball. Plus, I won $50 at poker! The other exciting venture during break was going to the Fiesta Bowl with the Stanford Marching Band. Although it was a heartbreaking 38-41 OT loss to Oklahoma State, the trip was a great time reconnecting with old friends and reliving the days of Rocking the F*** Out™.


    [Hitting the slopes in Reno!]

    The most exciting piece of news, though, happened before Winter Break even started: I matched into the Air Force psychiatry residency program in Dayton, Ohio! I'm very excited to be staying within driving distance of many close friends in Ann Arbor, and the program itself offered a good balance of psychotherapy and psychopharmacology training. Once the snow clears up in the spring, I'll have to start looking for housing. In terms of the rest of the year, I'm looking forward to my fourth month of vacation as well as my remaining rotations (Hospice/Palliative Care, ID Consults, Clinical Anesthesiology), with graduation in May! Time passes by much too quickly.

    Unspoken communication: thoughts on music, Watson, and medicine

    Hooray, a new blog post less than three weeks after the last one! Guess I'm slowly making progress. My days have been filled with lots of holiday cheer lately. I went home for Thanksgiving and joined the Stanford Band as an Old Fart for the Notre Dame game that weekend. This past weekend was also the 85th annual Galens Tag Days, where medical students stand out in the Michigan cold with red ponchos and buckets to collect money for Mott Children's Hospital and other organizations benefiting the children of Washtenaw County. This year Auscultations tagged as a group during Friday's Midnight Madness event on Main Street, singing Christmas carols and selections from our repertoire. It's not too late to help, so please visit the Galens website to make a donation: http://www.umich.edu/~galens/tagdays.shtml

    [Singing John Mayer's "Heartbreak Warfare"]

    As part of the Christmas spirit, I recently attended a performance of Handel's "Messiah" at Hill Auditorium with Clay, Joanna, and Steph. For anyone who has never seen "Messiah" live, hearing four soloists accompanied by an orchestra and full choir is absolutely astounding, and singing the Hallelujah chorus is a staple of the Christmas season.

    [What I hope to be singing when my Air Force match results are released on December 14.]

    During the concert, I started noticing aspects of the music that went beyond the notes being played. There was an incredible amount of unspoken beauty that could only be appreciated during a live performance. After all, what really drives us to go to concerts in the first place? As audio technology continues to improve, electronically synthesized MIDI files could conceivably mimic the pitches, tones, and dynamic changes that we hear. Even an artist's CDs and music videos aren't enough for his fans who pay good money to see him on stage. Watching "Messiah," I realized that I enjoyed watching the musicians subtly interact with each other. The violin player's entrance wasn't just determined by his sheet music; he was also watching the vocalist finish her solo before drawing his bow across his strings. Members of the choir bobbed their heads from side-to-side while they ran up and down strings of notes. There were even times when I wished I didn't understand the English lyrics to the piece; I found that I got distracted sometimes when the words of a verse were repeated multiple times, albeit to different notes. Although the Bible verses were indeed inspiring when put to music, the significance of the piece was not exclusively in the strict meaning of the words, but also in the way a singer's body prepared itself to carry through an impressive arpeggio.

    I see parallels between this type of nonverbal communication in music and the type in medicine. It's a type of communication that can't be picked up very easily by a machine, despite what IBM might have you think.

    [The 30-second commercial.]

    [The 2-minute commercial.]

    I can appreciate the statement in the 2-minute commercial (about 22 second in) about how Watson will never replace a trained doctor or nurse. If Watson were to be used in healthcare, its role would still be based on human-human communication. Doctors would need to know what data to input into Watson, data that would have to be generated by taking patient histories. Theoretically, the process of taking patient histories could also be computerized. I was once asked the following question on a med school interview: "With all the advances in artificial intelligence, with websites that allow users to type in symptoms and receive a list of possible diagnoses alongside the corresponding treatment, what will be the role of physicians in the future?" At the time I probably bumbled through the question. I was expecting the interviewer to ask me to elaborate on my CV, not delve into an existential discussion.

    Past drama aside, I now know that taking a patient history is more than just going down an algorithmic decision tree. Patients don't present cases; they tell stories. As in all stories, certain sections can be emphasized, and some can be downplayed. For a machine whose basis of interaction is rooted in digital black-or-white choices of yes-or-no/1-or-0, Watson's interaction with the analog world of unspoken communication might be too limited to generate its own diagnoses. I find it hard to imagine Watson being able to differentiate between a patient confidently denying a symptom and a patient whose initial denial is actually a sign to continue further down that line of questioning. Just like that violin player taking his cue from the soloist, I plan to take cues from my patients to help determine how best to pursue a diagnosis and arrive at a plan.

    Leveling up

    Wow, time really flies when you finish all your M4 requirements. Since my last post, I completed my Medicine Sub-I and my Neurosurgery ICU rotation. Just yesterday, I completed the last set of quiz questions for Advanced Medical Therapeutics (AMT), the required M4 online course, and since my AMT project requirements are done, I am essentially done for the year (minus three electives in February, March, and April). I don't even need to go on any interviews for the time being; since the Air Force match results are released on December 14 and since I would have to withdraw from the civilian match anyways if I got into an Air Force program, all of my civilian interviews are scheduled for January. Bottom line: I'm living the good life, working out regularly, keeping up with my TV shows. Heck, I might even start blogging on a more regular basis.

    [Part of the good life: fried frog legs at the Dexter Pub. Nomnomnomnomnom.]

    As the end of medical school approaches, enjoyment of M4 year is also coupled with the realization that I'll be starting residency soon. This is both exciting and daunting. Exciting because my Sub-I rotation gave me a taste of the satisfaction that comes with being a (relatively) independent doctor with (nearly) full patient responsibilities. Daunting because I know my current level of knowledge isn't going to cut it for much longer. Right now, I bask in the admiration of underclassmen who marvel at my understanding of psychiatry (admittedly a bit narcissistic), but having the time to attend various psychiatry talks and to watch various online psychiatry lectures also helps keep me grounded by showing me just how much more there is to learn.

    I'm not even talking about the prospect of essentially memorizing the DSM (I imagine that will naturally come about with more clinical exposure and more clinical practice); I'm talking about the need to add depth to my knowledge. The stereotype of psychiatry is that it's a field of hand-waving medicine ("we give you this pill and you magically stop hearing voices"). What is becoming more apparent, though, are the advances that are beginning to shed a light on the pathophysiology of psychiatric disease. All throughout med school, we had a cursory introduction to the receptors, neurotransmitters, etc. that are involved in mental illness, but I have to admit that those topics took a backseat to learning the patterns of symptoms that make up a diagnosis or the broad categories of medications used (SSRIs, TCAs, typical antipsychotics, atypical antipsychotics).

    No more. To quote Dean Wooliscroft in this year's State of the School address: "The status quo will not continue." As a resident, and even more so as an attending, I will have to have a better understanding of neuroanatomy, various brain circuits, and how psychiatric medications exert their therapeutic effects. It will no longer be good enough to simply recognize a particular class of medications; I will need to start differentiating between members of the same class, to distinguish their particular properties, in order to be able to justify prescribing one over the other.

    With these thoughts in mind, I particularly appreciated a recent post from "Insights on Residency Training," the JournalWatch blog run by chief residents in family and internal medicine. The author was reflecting on how the nature of learning changes, from pre-med to med school to residency. I was a bit relieved to see some of my current habits already matching with some of her suggestions ("Look up answers to your questions, not just subjects you are instructed to read about." "Start some sort of filing system for helpful articles or handouts." "Register for free e-mail alerts from Journal Watch."). What really stuck out, though, was this piece of advice: "We are all naturally curious people who want to be the best doctors we can be. We cannot help but learn. We should have a bit more faith in the process and trust that when we’re spit out the other end of residency, we will have acquired enough knowledge to be good doctors."

    [In the end, there's no magic mushroom to level up my knowledge. Just have to keep gaining experience points.]

    Med School 360

    Ho geez, wow, I guess it's time to blog again. Yikes. In my defense, I have been on an Internal Medicine Sub-internship (i.e. Sub-I) for the past month. That's a rotation where an M4 student acts like an independent intern, a sort of practice run before actual internship begins. Part of being a Sub-I is also having the schedule and workload of an intern, hence my absence. But enough excuses. How have I been? Thanks for asking.

    The Air Force psychiatry rotation at San Antonio went well. I finally met other M4s on the HPSP scholarship who were applying to psych. It was exciting to meet future colleagues of mine. Even if we don't match in the same program, it's a small Air Force, so we'll probably bump into each other and work together eventually. Some highlights from Texas:
    • Visiting the San Antonio Riverwalk. Pretty touristy, but it was still fun to listen to an acoustic soloist rendition of "Drunken Lullabies" and "Come Together" at Waxy O'Conner's. (I wonder if there's any relation to Ann Arbor's Conner O'Neill's...)
    • Traveling to Houston for a weekend, visiting Martin Duncan and Sandy Williams.
    • Making the 560-mile total round trip to an In-N-Out Burger in Fort Worth, Texas. I discovered this on a whim, messing around with my In-N-Out iPhone app while in Texas. Turns out there's actually quite a few branches in the Dallas area.
    • Returning to Michigan in uniform and avoiding annoying baggage fees at the airport.

    [Rental car during a 4-week psychiatry rotation: $820; Gas for a 560-mile total round trip: $56; Double-double with grilled onions, Animal-Style fries, and a medium Sweet Tea: $8.71; Medium-sized In-N-Out Burger Texas T-shirt: $10.28; Ending an away rotation in Texas with some California lovin': Priceless]

    And of course, as mentioned above, I came back to my Medicine Sub-I at the VA. There was a poetic sense of homecoming, particularly because my very first clinical rotation of M3 year was Medicine at the VA. Not only that, but for this Sub-I I was assigned to the same team I was on during M3 year (Gold Team), and my senior resident for the first few days of the Sub-I was the intern I worked with during M3 year. Talk about taking a 360. At the same time, I was really amazed by how far I had come in a year. Although I am nowhere near senior resident level in terms of my knowledge base, it turns out that over the course of M3 year I had learned enough to be fairly independent in my work. Sure, I still needed to have my orders co-signed, but in the simplest terms, I felt "I knew what I was doing." Maybe not 100%, maybe for example there were diagnoses on a patient's differential that I wouldn't have considered unless my senior offered the possibilities, but for the most part I loved the feeling of getting into a groove. Having full control of my patients and running the show without working through an intern actually helped me remember daily plans and helped me keep track of orders better.

    What's more, these past two rotations gave me the opportunity to teach and mentor M3s. In San Antonio I gave a teaching session on the differential diagnosis for psychosis, and at the VA I gave a similar but more medically-oriented presentation to the M3s on the work-up and management of altered mental status. I had alluded to these opportunities in my last blog post, and it was exciting to actually get to pass on pearls of knowledge. Although I may have come full circle during this last month, it's pretty obvious that my circle of experience has expanded considerably. What an awesome feeling.

    [The components of a psychiatric history & physical. Whoops, just realized I forgot to include the Biopsychosocial formulation during this talk. Luke's teaching career, still a work in progress.]