So what can I tell you about COVID-19 that you don't already know. Well, I can tell you that it is not only physically demanding, with the donning and doffing of the PPE but it is also emotionally demanding.
As an intensivist, I am in the ICU with these patients. I do not know if they are positive or not until I get the test back, and even then there are patients who are in the hospital for other causes that we still are not sure if they are associated with the virus or not. However, there is a job to do and it needs to be done. But when you get home, that is when the hardship starts.
For the first few days of the pandemic, I was almost living in the basement. I did not want to sleep in the same bed as my wife for fear of transmitting the virus to her. I would strip to my underwear in the garage and then bee line it to the shower. and then go to the basement. However, after much research and information, I did not need to do that. I still had to get right into the shower but I was able to sleep in my bed.
My kids want to give me a welcome home hug but that cannot happen until I am showered and by then, the magic is almost gone. They are back to video games and watching TV.
I am in the Philadelphia area, which is a hot spot. A lot of the younger residents are losing their patience with the nurses but the nurses are now the ones that are losing their patience. Since there is a lack of enough PPE, the residents are not allowed in the rooms unless necessary. It is only the attendings like me. When I hear the nurses go off, I need to calm the whole situation down. Hopefully we are looking at the downslope. But I fear that this is only the beginning, I do believe that there will be a second spike in the winter time. Only this time, we are going to have to deal with both the flu and corona. But by then, hopefully there will be better medications or understanding of the condition. I firmly believe that we just need to provide good supportive care to allow the lungs and the rest of the body to heal from the initial assault. We may be putting people into harms way with treatments that are not proven. Though I have to admit, I did use those in the beginning.
I know a lot of you are struggling with getting your education and potentially being out of work. Or you are riding this out in school. After this, I think there will be more people applying to medical school that before. There is an odd romance that younger people may associate with being on the front lines and being there for people. What does this mean for you? It means that you are going to have more competition for that seat. Where there was once 3 people vying for that seat, there may be closer to 5 or even 6. You will need to ensure that you are making yourselves the most competitive you can. Ensure that your grades are high, make sure that you have a positive attitude towards the MCAT, score well, volunteer. Shadowing for many hours does not impress anyone. Yes, it shows that you have an idea about what the day is like but not really. I have read that people are saying, "I have 500 hours of shadowing...." And what? How does that make you better than the other 4-5 people who want your seat.
Don't fret dear readers, you have something that the younger applicant does not have, maturity. Use it to your advantage. How does being mature make you a better candidate for the school? Think about it, then get back to me.
Tomorrow, back in the ICU.
Sunday, May 3, 2020
Sunday, February 23, 2020
3.5 years as an Attending and New Issues come up
Ladies and Gentleman,
Sorry for my absence. I have been very busy for the last few years. Some updates since my last post.
As you can see from the title of my post, I have completed my training fully. I have not only finished medical school, but I also completed a residency in Internal Medicine and a fellowship in Critical Care Medicine. I have also had the pleasure of passing all of my boards. This means, that for the first time since I can remember, I do not have an exam to study for (at least not for the the next 4 years). My next exam is my recertification in Internal Medicine in 2024. Meaning, I would have been practicing as an Internist for 10 years.
It has been, and continues to be, a long arduous journey. And if you are reading this blog for the first time, let me tell you that the journey was a long one. I started my path to fulfilling my dream in 2003. At that time, I was working full time and had a very young family (only 1 child) and was in the early years of graduate school. My wife and I were waiting for the baby to fall asleep while we were on the porch of the hotel room. I had a 4.0 GPA in graduate school (a far cry from the 2.5 in undergraduate) and had the idea of applying to medical school. I did not want to live with regret and wanted to at least try.
As I said, I have completed my training. I passed my critical care boards in 2018. From start to finish, it took 15 years to complete. You read it right, 15 years. And during that time, I learne a lot about myself and my family. During those 15 years, I was blessed with 4 daughters, 3 presidents, the Great Recession, selling a house, buying 2 new houses, getting in an accident with a deer, celebrating 20 years of marriage, have my marriage not the rocks, having my marriage survive those rocks, present at national meetings, having posters at meetings as a resident, and now attending. And finally, being recommended and accepting the positions of Program Director of the Transitional Year Residency and Director of Osteopathic Education.
As medicine goes, I will continue to keep learning and will be continuing to challenge myself. But now, there will be a new challenge. And this challenge has already started and has been seeing good results. The challenge is to be debt free. There is one thing that I did not expect to suffer from once I became an attending, and this is what I am going to be focusing on here. And that is “Doctoritis”. Will explain in future posts.
Sorry for my absence. I have been very busy for the last few years. Some updates since my last post.
As you can see from the title of my post, I have completed my training fully. I have not only finished medical school, but I also completed a residency in Internal Medicine and a fellowship in Critical Care Medicine. I have also had the pleasure of passing all of my boards. This means, that for the first time since I can remember, I do not have an exam to study for (at least not for the the next 4 years). My next exam is my recertification in Internal Medicine in 2024. Meaning, I would have been practicing as an Internist for 10 years.
It has been, and continues to be, a long arduous journey. And if you are reading this blog for the first time, let me tell you that the journey was a long one. I started my path to fulfilling my dream in 2003. At that time, I was working full time and had a very young family (only 1 child) and was in the early years of graduate school. My wife and I were waiting for the baby to fall asleep while we were on the porch of the hotel room. I had a 4.0 GPA in graduate school (a far cry from the 2.5 in undergraduate) and had the idea of applying to medical school. I did not want to live with regret and wanted to at least try.
As I said, I have completed my training. I passed my critical care boards in 2018. From start to finish, it took 15 years to complete. You read it right, 15 years. And during that time, I learne a lot about myself and my family. During those 15 years, I was blessed with 4 daughters, 3 presidents, the Great Recession, selling a house, buying 2 new houses, getting in an accident with a deer, celebrating 20 years of marriage, have my marriage not the rocks, having my marriage survive those rocks, present at national meetings, having posters at meetings as a resident, and now attending. And finally, being recommended and accepting the positions of Program Director of the Transitional Year Residency and Director of Osteopathic Education.
As medicine goes, I will continue to keep learning and will be continuing to challenge myself. But now, there will be a new challenge. And this challenge has already started and has been seeing good results. The challenge is to be debt free. There is one thing that I did not expect to suffer from once I became an attending, and this is what I am going to be focusing on here. And that is “Doctoritis”. Will explain in future posts.
Monday, August 15, 2016
I cannot believe that it has been about 2 years since my last post. The reason why it has been 2 years is quite compelling, you see, I was completing my training in Critical Care and this past June I finished and I am now an Intensivist, also known as a Specialist in Critical Care.
It took me, 13 years from the time that I came up with the concept of going to medical school to follow a dream to completing my training and becoming an Attending.
I now work for a group that specializes in Intensive Care and I go to 4 hospitals. Not in one day of course, but rather I am credentialed at 4 hospitals and go where I am scheduled to. Two of the hospitals have residents there already and that is great because I enjoy teaching and it keeps me on my toes about the material. The third hospital will be getting residents next year, which hopefully means that I will be on faculty and be involved in the developement of the program. The fourth hospital does not have residents and that is fine.
The days of my sleeping in the hospital because I am on call are pretty much done. I come home every night, which my girls love, but the days that I do work I am on call from home. This can mean multiple phone calls at night or no phone calls at night. Of course, if there is an issue I will go to the hospital but that is usually few and far between.
It feels so nice to be able to wake up in the morning and enjoy going to work. I do nto have that feeling of dread that I used to experience knowing that I was going to work the next day. I don't have stress that I am going to be in work environment that I do not like. The stress that I do have is quite significant though. I mean, it is the stress at the end of the day thinking about the critical patients and wondering if I missed something. Or was I on the right track with my diagnosis, or could I have done something more aggressive, was I too aggressive and the patient was suffering when the best thing was to let them go, did we try to resuscitate long enough and if so, what kind of brain damage is there going to be, will this family or the patient sue me because they did not like the outcome even though the patient was sick beyond bringing them back. All of these thoughts are important because there is an epidemic of physician suicide in this country and these stressors are why.
The practice I joined is great because they are taking over from fellowship and continuing my training. Learning how to really run an ICU, aspects of billing and coding that I was never taught, being a mentor to younger doctors.
At the end of the day, I did not want to live with regret. So I bet, and I hit the jackpot. I put my family through a large financial burden but it is paying off now. In more ways than one. I hope to be able to blod more, but this depends on the schedule. I will also try to Vlog more. Again, depends on the schedule.
It took me, 13 years from the time that I came up with the concept of going to medical school to follow a dream to completing my training and becoming an Attending.
I now work for a group that specializes in Intensive Care and I go to 4 hospitals. Not in one day of course, but rather I am credentialed at 4 hospitals and go where I am scheduled to. Two of the hospitals have residents there already and that is great because I enjoy teaching and it keeps me on my toes about the material. The third hospital will be getting residents next year, which hopefully means that I will be on faculty and be involved in the developement of the program. The fourth hospital does not have residents and that is fine.
The days of my sleeping in the hospital because I am on call are pretty much done. I come home every night, which my girls love, but the days that I do work I am on call from home. This can mean multiple phone calls at night or no phone calls at night. Of course, if there is an issue I will go to the hospital but that is usually few and far between.
It feels so nice to be able to wake up in the morning and enjoy going to work. I do nto have that feeling of dread that I used to experience knowing that I was going to work the next day. I don't have stress that I am going to be in work environment that I do not like. The stress that I do have is quite significant though. I mean, it is the stress at the end of the day thinking about the critical patients and wondering if I missed something. Or was I on the right track with my diagnosis, or could I have done something more aggressive, was I too aggressive and the patient was suffering when the best thing was to let them go, did we try to resuscitate long enough and if so, what kind of brain damage is there going to be, will this family or the patient sue me because they did not like the outcome even though the patient was sick beyond bringing them back. All of these thoughts are important because there is an epidemic of physician suicide in this country and these stressors are why.
The practice I joined is great because they are taking over from fellowship and continuing my training. Learning how to really run an ICU, aspects of billing and coding that I was never taught, being a mentor to younger doctors.
At the end of the day, I did not want to live with regret. So I bet, and I hit the jackpot. I put my family through a large financial burden but it is paying off now. In more ways than one. I hope to be able to blod more, but this depends on the schedule. I will also try to Vlog more. Again, depends on the schedule.
Thursday, January 16, 2014
on the home stretch of Residency
So it has been some time since I last posted. That is because being a 3rd year Medicine Resident is not like being a 4th year medical student where you just want to get what you need done and then shut off.
On the contrary, there is a lot of work that still needs to be done. For starters, I find that the attendings are much more critical of what you are doing. This is because as a senior resident, you have seen enough and have done enough that the bar is set high for you. There are 2nd year residents, interns, and students who are looking to you for answers. And you are being looked at as a leader. Not to mention, if you are trying to get into a fellowship then you have to go through the whole process of applications again and the dreaded personal statement. Now the question is not just why do you want to go into medicine, but why do you want to subspecialize in THIS type of medicine. Then there is the pressure of preparing your CV in the event that you do not match in the specialty of your choice and start looking for a job. Certainly this is much easier for me as I do not have to worry about getting a visa to work in this country, unlike many of my fellow residents.
Did I mention that you also have to start looking to getting your medical license, which is not cheap. And decide if you want to get your DEA license, which is also not very cheap.
All in all, I had applied to 3 programs in South Jersey for Critical Care fellowship. I received 2 interview invites. One was at an established tertiary care facility/trauma center and the other I would be part of their first batch of fellows. While playing the waiting game, I prepared my CV and started the application process for my NJ medical license. Another way that NJ likes to take your money. Well, I received an offer to join the new program in South Jersey. I will be a member of the inaugural class of fellows. How many people can say that they were helping build a program?
I just completed my ICU month, and as a resident who is going into critical care, I felt as if I was being really looked upon. I was able to lead the team. I also became certified in performing lumbar punctures and I am one more line from becoming certified in performing subclavian central lines. This was a very difficult month as we had 2 full units, a total of about 19 patients and 4-6 more in the ED and all were very, very sick.
What is really interesting is that if I did not get into my fellowship then I would have gone into primary care. And when I did get the fellowship, 2 attending physicians had told me that while they are glad that I am following my dream they cannot help but feel that the field of primary care had lost a very good doctor.
I just have to hunker down and prep for boards and really read. Hopefully I will post a little more often, though I cannot promise.
Gabe
On the contrary, there is a lot of work that still needs to be done. For starters, I find that the attendings are much more critical of what you are doing. This is because as a senior resident, you have seen enough and have done enough that the bar is set high for you. There are 2nd year residents, interns, and students who are looking to you for answers. And you are being looked at as a leader. Not to mention, if you are trying to get into a fellowship then you have to go through the whole process of applications again and the dreaded personal statement. Now the question is not just why do you want to go into medicine, but why do you want to subspecialize in THIS type of medicine. Then there is the pressure of preparing your CV in the event that you do not match in the specialty of your choice and start looking for a job. Certainly this is much easier for me as I do not have to worry about getting a visa to work in this country, unlike many of my fellow residents.
Did I mention that you also have to start looking to getting your medical license, which is not cheap. And decide if you want to get your DEA license, which is also not very cheap.
All in all, I had applied to 3 programs in South Jersey for Critical Care fellowship. I received 2 interview invites. One was at an established tertiary care facility/trauma center and the other I would be part of their first batch of fellows. While playing the waiting game, I prepared my CV and started the application process for my NJ medical license. Another way that NJ likes to take your money. Well, I received an offer to join the new program in South Jersey. I will be a member of the inaugural class of fellows. How many people can say that they were helping build a program?
I just completed my ICU month, and as a resident who is going into critical care, I felt as if I was being really looked upon. I was able to lead the team. I also became certified in performing lumbar punctures and I am one more line from becoming certified in performing subclavian central lines. This was a very difficult month as we had 2 full units, a total of about 19 patients and 4-6 more in the ED and all were very, very sick.
What is really interesting is that if I did not get into my fellowship then I would have gone into primary care. And when I did get the fellowship, 2 attending physicians had told me that while they are glad that I am following my dream they cannot help but feel that the field of primary care had lost a very good doctor.
I just have to hunker down and prep for boards and really read. Hopefully I will post a little more often, though I cannot promise.
Gabe
Sunday, June 9, 2013
Sunday, June 2, 2013
PGY-2 almost done
I know that it has been some time since I wrote but I have been up to my head in residency. There are so many things that need to get done, that sometimes I even forget that I have a blog and there are people who are waiting for me to write.
I am at the tail end of my second year of my residency. I have learned a great deal and learned what I really do not know and need to work on. But I have also learned about my strengths. PGY2 is a lot different that the intern year. You are considered a senior resident and there are many more expectations from you than before. For starters, you are the leader of your team. When I am on the general medical floors of hospital, I have 2 interns that report to me directly. It is my responsibility to not only make sure that they write all of their notes but that the patient is being properly taken care of. That the attending physicians have been communicated with and the interns come to me for advice on what should be done next. In addition, I am also responsible to teach the interns. It gets even more complicated when there are medical students as well.
If there is a 3rd year medical student, they typically report to the intern. However, this has been changed and now they report to the resident, me. I need to ensure that they see 2-3 patients, review their notes, cosign the notes and write the orders. In addition, they have to do only 4 admissions per call and I have to go over that entire history and physical with them. Not to mention that medicolegally they cannot write the assessment and plan but I have to do it. Finally teach them. If there is a 4th year medical student, they are considered a sub-intern and have always reported to the resident. These students, being senior medical students have a little more knowledge than the 3rd year but they are still students. I need to give them a larger patient load which means that I have more work to do.
Now most of the time this is not a problem. The issue comes in July when the new interns start. Because these are fresh interns right out of medical school or international medical graduates that are not familiar with how US medicine is run. On top of that being the senior resident all of the discharge dictations have to be done by me. But first I have to review the discharge instructions to make sure that the new interns did not miss anything. Luckily this coming July, I do not have that responsibility.
I have been doing a lot of admissions since I have been the admitting doctor at night and during the day. I have been reading all of the consults and the test results on the patients I have admitted to see if I was correct in my assessments. I have been doing a pretty decent job lately. But it is always a learning process. I am very lucky to be where I am as I get to see many pathologies that I may not have seen anywhere else.
For instance, I was able to see a gentleman with early stage Huntington's Chorea (a virtual death sentence if this is diagnosed), late stage multiple myeloma that is non secretory (very rare), and several incidental findings of renal cancer.
Currently I am preparing to apply to fellowship in critical care medicine. There are 4 programs in the area as we are not moving. If I get into one program, I will be thrilled. If I get into no programs, that is alright too as I will be able to practice medicine either as an internist or a hospitalist.
Hopefully I will have more time to write. In the meantime, come to the old premeds conference this weekend in Washington DC. www.oldpremeds.com
I am at the tail end of my second year of my residency. I have learned a great deal and learned what I really do not know and need to work on. But I have also learned about my strengths. PGY2 is a lot different that the intern year. You are considered a senior resident and there are many more expectations from you than before. For starters, you are the leader of your team. When I am on the general medical floors of hospital, I have 2 interns that report to me directly. It is my responsibility to not only make sure that they write all of their notes but that the patient is being properly taken care of. That the attending physicians have been communicated with and the interns come to me for advice on what should be done next. In addition, I am also responsible to teach the interns. It gets even more complicated when there are medical students as well.
If there is a 3rd year medical student, they typically report to the intern. However, this has been changed and now they report to the resident, me. I need to ensure that they see 2-3 patients, review their notes, cosign the notes and write the orders. In addition, they have to do only 4 admissions per call and I have to go over that entire history and physical with them. Not to mention that medicolegally they cannot write the assessment and plan but I have to do it. Finally teach them. If there is a 4th year medical student, they are considered a sub-intern and have always reported to the resident. These students, being senior medical students have a little more knowledge than the 3rd year but they are still students. I need to give them a larger patient load which means that I have more work to do.
Now most of the time this is not a problem. The issue comes in July when the new interns start. Because these are fresh interns right out of medical school or international medical graduates that are not familiar with how US medicine is run. On top of that being the senior resident all of the discharge dictations have to be done by me. But first I have to review the discharge instructions to make sure that the new interns did not miss anything. Luckily this coming July, I do not have that responsibility.
I have been doing a lot of admissions since I have been the admitting doctor at night and during the day. I have been reading all of the consults and the test results on the patients I have admitted to see if I was correct in my assessments. I have been doing a pretty decent job lately. But it is always a learning process. I am very lucky to be where I am as I get to see many pathologies that I may not have seen anywhere else.
For instance, I was able to see a gentleman with early stage Huntington's Chorea (a virtual death sentence if this is diagnosed), late stage multiple myeloma that is non secretory (very rare), and several incidental findings of renal cancer.
Currently I am preparing to apply to fellowship in critical care medicine. There are 4 programs in the area as we are not moving. If I get into one program, I will be thrilled. If I get into no programs, that is alright too as I will be able to practice medicine either as an internist or a hospitalist.
Hopefully I will have more time to write. In the meantime, come to the old premeds conference this weekend in Washington DC. www.oldpremeds.com
Tuesday, September 25, 2012
Location of the Old Pre Meds 2013 Conference.....
Drum Roll Please...............................
Washington D.C.!!!! Early June. Stay tuned for more information as it comes about.
Washington D.C.!!!! Early June. Stay tuned for more information as it comes about.
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