Internal Medicine 2: Infectious Disease

Note: no knitting content on this post. I forgot to publish this a while back, so all of my knitting was updated in other posts.

This month (May), I am on ID, or Infectious Disease. It is definitely an interesting change of pace from last month's Internal Medicine clerkship. Instead of getting up at 6am to go to the hospital for short rounds, I am getting up at 6am, but staying home to handwrite notes for 4 hours before heading to the hospital and rounding on the patients. This is my first specialty rotation, and it is definitely very different. While we still want to make sure the patient is alive and stable, our entire focus is on the patient's infection. It doesn't matter if the patient has heart disease or diabetes. We are here to focus on treating the patient's infections. The only labs we really care about are those that are affected by the medications we are prescribing, and those that reflect the patient's infection: white count, viral load, temperature, etc.

The days are hard, but we are learning so much. I had forgotten so many of the medications from second year, and this had been a good review of antibiotics. I am so happy with our team. We have a good group of people, and I know that I can trust them to have my back. Our days are pretty long, from 6am to usually 5pm, but the last two or three hours are usually lectures by our attending physician, a renowned infectious disease specialist, and we are usually happy to spend as much time as we can with him. We conduct the lectures in the doctor's lounge, and that way we are able to get some water and much-needed refreshments. Oh, and go to the bathroom. I am so thankful for my kidneys and bladder. They take so much abuse, as it is frowned upon to go to the bathroom on rounds. Especially since we never know which route the doctor wishes to take that day, and sometimes you'd be late to the presentation of your own patient. That is REALLY frowned upon, needless to say. I am learning so much and feel privileged to be on this rotation, since it is a very popular and hard to get rotation. I look forward to learning the rest of this month.

Knitdown lockdown, Neurology, and Boards, oh My!

WARNING: Super long post! Long Rant about life-stuff in the beginning, lots of knitting content at the end. 

August has been extremely hectic as I am running around finishing quite a few tasks at the sme time. I was at a medical boards review class all of last month in Kansas, which was both necessary but also an annoyance. Everything that I had been doing had to be put on hold, and I lived in a hotel room for a month, studying from 7am to 9pm every day, eating hot dogs from the hotel and anything I could cook in a rice cooker. (Note: actually quite a lot of things can be cooked in a rice cooker.) It was nice in a way, to just shut myself in with a select few other students and teachers, and limit my outside contact for the most part to just a few letters and emails to my family and phone calls every night to my parents. My brother has been undergoing his Beast training at West Point at the same time, and in some ways my life paralleled his, except that all of my training was for mental endurance.

This month started out relatively slow as I started my Neurology rotation with an esteemed physician. He was on vacation for the first week of the rotation, so I was able to get used to the policies and procedures in his office, work on my residency applications, and do quite a bit of boards studying as well. This week, on the other hand, was extremely hectic. There were some days where I was at the office for 12 hours. There were some days where the office manager gave me time limitations, down to the minute of when and where I should be meeting with the physician versus seeing the patient. There were some days when I got home at 7pm (after starting the day at the office at 7am) and could barely keep my eyes open to do one block of questions and would sadly look at my notes and not have the energy or mental capacity to record my incorrect answers. On Friday, as I left, the office manager warned us that next week was likely to be the same. 

As mentioned before, I am taking my second set of medical boards at the end of the month, which also contributes to the craziness. The clerkship is crazy enough on its own, with the stern and sarcastic "operations manager", the highly critical attending physician, and the plethora of medical students, medical assistance, nurses, and physician assistance all vying for time and attention with the physician and trying to see a large amount of patients all at the same time, but add to that trying to study and memorize facts and do questions. In addition, I am also applying for residencies at this time, which makes things even just a bit more hectic. However, I know that these times are only as challenging as I can handle, and I am getting everything done, as much as I can. I know that these are the times when I grow, both as a person and as a future physician. I am learning to handle multiple tasks, and memorize complicated lists of patients and their health information, as well as learning, memorizing, and remembering facts and numbers and information that will be pertinent to the board exams. I know that this is going to help me in the future. I know this. I know I can handle this. It doesn't make the days suck any less. I am grateful that I have the opportunity to pursue my passion, and have the resources on hand to do all of these things at once. It it still hard work. I will get through it. Knowing that doesn't make it any easier, though. 

<Knitting content starts here> I have done some knitting and finished a couple of things, since I have been traveling quite a bit. I finally finished my Parrot socks, which are MCN socks out of Polly wants a Cracker colorway by TurtlePurl Yarns. They are so soft and squishy and overall wonderful. It was my stress knitting for most of the time I was in Kansas, just a row here and there, from the airport to the hotel and one or two rows before bed. I'm quite pleased with how they turned out: almost matchy-matchy.

While I was in Kansas, I also started my rainbow mitts, which are with the Running Mitts pattern by Heather of the Fiberista Files/Highland Handmades podcast and yarn by Leading Men Fiber Arts in the OMG Squee! Colorway. I finished these on the plane ride home, next to a hilarious and large Kansas family who were going to a drill team competition and had never been on a plane before. I loved their enthusiasm.

Works in Progress: I have the second of my Pebble Beach shawls still in the works, but since it is laceweight, it is becoming somewhat of a slog. I'm about 75% done, but I think I'll put it off until after boards because we are not getting along.  In addition, I had started my Jaala Spiro Diamonds Lace shawl with Knit Circus yarns, but a mistake somewhere in the beginning is making everything one stitch off. I don't think I have the mental capacity to deal with lace right now, so it is also going in the "after boards" pile to think about its behavior. 

New Things: When I got home from Kansas, I was in somewhat of a dither. I shouldn't be starting things, but at the same time, with Stash Dash going on, I wanted to start and knit all of the things. I tried to put myself under Knit-Down Lock-down, meaning not knit anything for the month of boards. That didn't work. I was miserable, and couldn't concentrated on studying, my mind going a mile a minute but unable to focus on my work. So I compromised, and worked on a few things here and there.  Most of what I started are things with lots of stockinette or garter, things that I can mostly not think about and knit while I study. This is what I have been working on, off and on: 

1. Book Woman Jacket: I have been eyeing this pattern for a long time from the Stitching in the Stacks book, and I figured I should start working on them now, if I am going to be going to all of the cold places this winter (Maine, Michigan, etc. More on that later.) I'm knitting this out of Eco+ Wool instead of the called for Aran weight because I have a ton of this wool and because with my loose gauge, I actually get gauge with Eco. 

2. Socks for Jay: I have been promising my brother Jay socks from the Simple Socks Poste yarn in the Ravenclaw/Cleverness colorway for about 6 months. There is a bit of a backlog on socks, so I figured since I finished a pair, I might as well start these for him. It'll take some time to finish, but since he's probably not going to be able to wear them in the army, he can have them as his Christmas present. It will be my go-to sock on the needles for a while, since he has enormous feet.

3. Trickle Shawl: I am doing this partially for the Palkal/AYNKal, but also because I have been wanting to use this baby alpaca yarn for so long and never know what to do with it. It's baby alpaca, it's special, I think to myself. I need to save it for later, I think. But at the same time, with the countdown to graduation and residency less than 1 year away, I'm starting Operation Knit All the Stash and not caring about saving the stash. 

I think that covers it all, for the most part. Hope everyone is staying cool in the summer heat, and all is going well! I'll try to check in again soon! 

Best, 

~Z

Internal Medicine 1, OMM socks, and Residency stuff

March and April have gone by in a blur of conferences, night shift calls, OMM treatments, and Internal Medicine woes. Fortunately for my knitting, all of this meant lots of travel time, stress, and anxiety, which lead to some of my best knitting. I'll talk first about the med school stuff, and then about the knitting.

In March, I attended my first Convocation, the annual convention for OMM physicians and students. I thoroughly enjoyed myself, and learned so much. I was also happy to see some of my friends from other schools, and got to catch up on their lives, as well as meet up with some of my friends from first and second year of medical school, as we have not seen each other in months. In addition, I TA'd 6 OMM classes, and found myself lacking in the ability to communicate effectively. I also experienced my first bout of cynicism. I am usually such a positive person, that it was strange to think that I didn't want to believe in the best in people all of the time. However, I felt like I didn't quite try as hard as I could have in teaching some of the students, as they probably would not want to actually do this in the future. However, I quickly corrected my thinking. Who knows who will end up doing OMM in the future? Just because the students don't know it very well or like it well right now does not mean that in one or two years, they might not have a change of heart, and the more confident they are in their skills now, the more likely they will want to do OMM on their patients in the future. 

It was with great trepidation and sadness that I finished my OMM clerkship, as I knew that I would not have as easy or happy of a time in April, during my first Internal Medicine inpatient clerkship. I was right. Internal Medicine has been the most challenge clerkship I've had as of yet. Everyday, I felt like I was drowning, or treading in deep water with the fear that if I were to stop for one moment, I would drowned. I didn't know what to do when I went in, and even now, I feel like I don't know what I am doing. I HAVE, however, gotten better at doing History and Physical exams, as well as developing my skills of differential diagnoses, assessments, and have some idea of plans of action, though I still need to work on that. I wish we had classes on how much fluids to give and when, and what to do for patients at what time. I suppose that is what I am here to learn. I have learned so much about thinking on my feet, and asking patients questions to develop my differential diagnoses. I am so grateful to the interns and residents who were patient with me and helped me to learn. I do wish that I was able to do more, but at the same time, I was so tired and grumpy and unhappy all the time that I know I don't want to be there for residency. They had such a negative attitude towards OMM. In addition, I felt like I was on display and being tested all of the time, on topics I had no idea about. I know that with time, and lots of studying, I will know all of the answers, but I just hate feeling stupid and ignorant all of the time. 

<Knitting stuff starts here!> In terms of knitting, I knit quite a lot during the last two months. In March, I decided to make a hat to coordinate with my Balsam Hollow shawl, out of the Leading Men Fiber Arts Anne with an E colorway yarn, from the little skein in the big wool kit, as I had half a skein left. I had purchased two Alana Dakos books on Amazon, Coastal Knits and Botanical Knits 1, and I ended up making the Rustling Leaves Beret. However, I ran out of yarn with only a little to go, and ended up having to supplement with Elle Rae yarn.

Next, I wanted to make something for my mom to wear when she went to China, so I dug out some yarn that I had wanted to use for a long time, Prism Yarn Merino Mia in the Orchard colorway, and I made Kristen Belleheumer's Palindrome scarf.

I also wanted to make a hat for my grandmother, who is still in China, so I made a second Rustling Leaves Beret, this time in Knitcircus's Acrobat yarn, in the Root Bear colorway. 

In the second week of March, I attended Convocation, and I decided that I wanted Convo Socks. There were a LOT of lectures going on, and I wanted to attend them and stay awake. Therefore, I started some socks, just plain vanilla socks that would not take too much attention but would be occupying enough that I would not fall asleep. They are in the Neeley's Knits Sock yarn in the Jack color way. 

I cast on the socks during my first day of Convo, and I finished the socks yesterday, at the last OMM Children's Clinic with Dr. Galin that we will ever have. It was very appropriate that these were my first OMM socks.

Next, I started my Grapes and Wine Shawl. I started the shawl with handspun from my knit-night friend Keena, who sells her handspun as Happy Handspun on Etsy. She had brought some of her handspun to share/sell months ago, and I finally got to cast it on. I used the pattern Brandywine from Romi Hill, and it was beautiful. Unfortunately, I ran out of yarn with 5 rows to go, so I ended up using some of my very first handspun. It was actually very nice, as I wasn't sure what I was going to use my handspun for, and this was perfect.

Finally, I also finished a headband. This was a really quick knit, as my friend Carmen from med school wanted a headband/earwarmer for her audition rotations in Michigan. She's never lived outside of California and Nevada, and needed something for the winter. I cast on one day at the hospital when we had a lot of downtime, and finished binding off this morning. 

Despite the title, I think I'm going to sign off now as this is a much longer post than I was expecting. I've had a great time these last two months, despite all the anxiety (more on that in the next post.) I've expanded my knitting repertoire, and learn many new medical skills. 

Love and hugs, 

~Z

Gearing up for Family Med exam, and some thoughts

There is less time for crafting and the like as I gear up my studying for the end-of-service exam for Family Med. This exam is notorious for being all-encompassing, and  it pulls questions from pyschiatry, pediatrics, and OB/GYN, as befitting the scope of the field. This means it is a much bigger pain to study for than other exams, like surgery or any of the above mentioned fields. It is also more pressure on me to do well on this exam, as it is one of the fields I am considering entering, and I want to make sure I don't fail this exam!

Here are some notes about knitting, and the rest will be thoughts on Family Med clinic encounters.

<Knitting notes>

I finished my shawl! It's the Balsam Hollow shawl from the Little Skein in the Big Wool Anne of Green Gables kit, with Leading Men Fiber Arts yarn in the Anne with an E colorway. It was actually a quick knit, everything considering. My dad had a slight medical mishap last week, so I sat in the quick care waiting room with him and got a LOT of knitting done. I was so happy to finish it, and just in time for our unusually cold Sunday morning hike!

I am using the rest of the yarn to make a matching hat. More on that in the next post!

I also bought several tincanknits books during their BOGO sale last week, and I'm getting ready to cast on a gramps cardigan for a friend's new baby out of Tink yarn.

<end knitting notes here!>

On a different thought, we encountered a patient this past week who presented with a spotty past medical history, and stated that she was anemic and instructed to take iron pills. Being a medical student, I wanted to investigate her anemia further, when the preceptor asked her why she had been anemic, and the patient stated that she had only recently had a job, and before that, she she didn't really have money for food. I was a bit taken aback, as the clinic where I am working this month is in one of the wealthiest areas in the city, in the same mile block as Whole Foods and several high-end yoga studios. The family medicine book that I was reading about anemias actually stated that "all adults in the US are unlikely to have nutritional deficiency-derived anemia" and to "rule this out as a possible cause." But in this day and age, when the American economy is still slowly recovering, and some (like my patient), are only working part-time for minimum wage, they are unable to afford good nutrition, it is still possible in America to be nutritionally deficient. In the age of cheap fast food, they'd be able to meet the daily caloric requirements, but most likely it is not nutritional in nature. It is sobering to encounter first-hand that there really is still poverty and hunger in America, the Land of Plenty. 

I saw three patients this week that made me nervous and thoughtful at the same time. Two of them were a couple, who came on separate conditions, and were both physicians nearing retirement who recently move to the area. The husband was the new director of one of the largest healthcare programs in the area. The third patient was a nurse, one who manages eight different clinics. I was shaking as I conducted my H&P. I wanted to be thorough and do a good job, yet I didn't want to make any mistakes or go too slowly. I didn't know if they might be judging my clinical abilities. I was happy that they were nice and let me conduct my exam, but I was definitely afraid and extremely nervous. On the same hand, it was also somewhat sobering and thought-provoking, that these "important" people of the healthcare industry were given the same medical care and treatment as those who could not afford to eat dinner properly. Medicine truly is the great equalizer, especially in America.

As I finish my second month of Family Med, I am truly humbled by the amount of knowledge I have gained in the last two months, from my preceptors and my patients. I have been so lucky to be able to have so much access to knowledge and medical information and patients, and I am so thankful to the patients for being patient with me as I fumbled to do their history and physicals. Family medicine has been the most stressful and most fun rotation. Now, on to OMM month! 

Yarn, knitting, and Superbowl, oh my!

I am not usually a Super Bowl watcher, but I am doing the Pigskin park knitalong, and it has increased my interest in football. So, this Sunday, this is what I will be doing:

That's right, SUPERBOWL BINGO. Because I might just earn myself some yarn. :) 

New WIPs, FOs, and some Family Medicine thoughts

I'm mid-way through my first month of Family Medicine, and while it has been interesting, it has also been a LOT of work, mentally and physically. Thus, I haven't been online as much. (At least, on Blogger. Ravelry is another thing all together.That's phone-time.) But here are some mid-family-medicine-month thoughts, and knitting progress:

<Med school/non-knitting notes> Family Medicine is a LOT of work. Orthopedic Surgery was a lot of work, but it was different: I was mostly assisting the surgeon in the cases, so I just needed to anticipate the tools they'd need in the surgeries, and try not to tremble too much when retracting fascia back for a long time. However, in Family Medicine, I am basically seeing patients on my own. My preceptor sees a TON of patients, so we start right at 7am in rounds at the hospital, then start at the office by 7:40 or 8am, and then see about 20-30 patients in the course of 4 hours. It is insane, but it also has allowed me more autonomy. I go into the rooms on my own, introduce myself as a student doctor, and then ask the patient if it would be okay for me to take their blood pressure and ask them a few questions before the doctor comes in. I reassure them that the doctor would be coming in afterwards, but that I am there to learn and also that it would speed things along. Then, I go through a do an H&P, ask about medications and allergies, and then do a physical exam. I try my best with the assessment and plan, and then ask if they have any concerns. Usually, I can get through most of the exam before the physician comes in. It's mentally tiring to do what I've never done before, but little by little I am able to get through more of it, which is encouraging.Sometimes, I even get to do a little bit of counseling, like today, when I counseled a patient with severe sleep apnea to start wearing his mask more often, as it is most likely the cause of his erectile dysfunction, leg swelling, and headaches. By the end of the visit, he was promising me that he would wear his mask. I don't know if he will actually do it, but it is encouraging to know that I can make some sort of difference just by taking the time to listen to him and talking with him. I know that I need to study more and study harder so that I will be able to make more accurate diagnoses, but I love what I do right now. </notes>

Now, for the knitting: I was a bad med student and knit all the afternoons after work last week, so I have quite a few finished objects! I finally finished my Felici Socks, which I worked on during my first ever knitting circle (more on that in the next post). They were finished just in time, too, as I needed my US 1.5 circular needles for the Knitting Through the Loops knit-a-long, which is another new thing for me. I am trying to be more adventurous and try new things, so this has been one of those experiences. Anyways, here is a pic of the Felici Socks, knit from KnitPicks Felici in the Sorbet colorway:

I ended up doing two different heels, since I wanted to try different heels. These were my first afterthought heels, which I think I don't like as much as the traditional hell flap and gusset socks, as it is harder for me to do the math on the length of the foot. Both of these socks ended up being a bit bigger than I anticipated. I did a Lara Neel Fork in the Road/thumb-joint hat top heel on the right, and a modified Sox Therapist Fish Lips Kiss Heel on the left. Both of these socks were knit cuff down.

I also finished my Chunky Socks, which were knit from some Ella Rae yarn I got on discount from Tuesday Morning. They are 100% wool, which is nice. I did a Sweet Tomato Heel on one, and I can't remember how I did the other heel. Truly. I can't. Both of these socks were knit toe-up, and these were my first toe up socks. I did do them magic loop, but I did them one at a time, as my needles were not long enough for two at a time. 

Finally, WIPs: 

I finished the first sock of my brother's Baronial socks, which, after much urging and bribing, he modeled it for me: 

I'm still working on the second sock, also knit toe-up, but it is hard to knit a sock when the foot I need to fit is never around to try it. 

My other WIP is also for my brother (See the pattern? I finish my own socks and my brother's socks are WIPS. Mostly his own fault, How can I knit if he won't try them on as I am going?) These are stash-busters, and my first pair of deliberate striped socks:

It has definitely been an interested few weeks, and I can't wait to see what else I can learn this year!

Socks, Socks, and More Socks!

Hello 2015!
I hope everyone had a good holiday season. Mine was filled with studying for the Surgery COMAT, and getting my knitted gifts ready! I had more finished objects than I had expected, which was quite nice. I finished the prayer scarf for the Alice's Embrace, as well as socks for my brother, and a pair of socks for myself. I was lucky that my brother was in China for a couple of weeks during the holidays, so I could finish his socks after the Christmas holiday and still gift them to him for "Christmas" without spending too much of my studying time on them.

I have started on my rotation in Family Medicine this month, which will go for two months. It's been fun, hectic, and somewhat nerve-wracking all at the same time. On one hand, I've thoroughly enjoyed being at this location because I am familiar with the office, as both of my parents and myself used to go to this family doctor. In addition, I am VERY interested in family medicine as a potential career choice, so it is nice to be able to get to see and do this rotation under the tutelage of a family friend. On the other hand, it is somewhat frustrating because I am still a third year student, and there is a LOT that I don't know, so I can't do as much as I want, and I don't want to disappoint or look bad in front of the doctor that I've known for a long time. Finally, there are so many patients in the morning that we barely get to breathe! I know that it is typical for primary care of any sort, especially since the passage of the ACA, but it is magnified even more here, as the doctor is a very well-established physician in town, and he has a LOT of patients to start with, even before ACA. 

I have a LOT of WIPs, most of which are socks. I have been on a sock kick lately, as my knitting awareness realizes how many different kinds of socks there are out there, and since I bought both Big Foot Knits and Sock Architecture during the Knitmore Girls Podcast's 25 days of enabling (There was a discount for books from Cooperative Press.) It's been fun, but sometimes my hands feel like doing something else besides fiddling with fingering weight yarns, so I've also been working on a chunky cowl. But still, all I can think of is socks, socks, and more socks! It's almost-instant gratification, to go in 2 days from balls of yarn to something to keep my feet warm. Actually, this morning, I took a hit to my ego when I decided that I wanted to wear my chunky socks today. I had 2 rows to go and the bindoff, so I put the finished one on one foot, and was furiously working on the other one. The room was really cold, and my foot was freezing when I finished it and realized I had, in my haste, bound it too tightly. I was forced to put on a different sock to keep my foot warm while I frogged the rows back and redid the bind off in a more stretchy manner.

I've decided that this year, my word is LEARN. I want to learn more about medicine, more about OMM, and more about knitting. I want to learn as much as I can, and explore the paths that can only open once you've gained knowledge.