John was once the manager of a construction company, and was the man to go to get things done. He supervised numerous employees, and had great organizational abilities. At home, he was a family man with good values. However, five years ago, John suffered an aneurysm rupture in his anterior cerebral artery in his brain. It led to bleeding and subsequent damage to the frontal lobe, the part of the brain known to control our ability to judge what’s good and bad, to reason, and to control our impulses. Ever since then, nothing was the same for John nor his family. John didn’t become paralyzed or lose the ability to speak like many stroke patients do. In fact, he was quite active and spoke fluently and quite a lot. John, however, was a different person, and the man his wife and family knew is no longer there.

Ever since the incident, John became very uninhibited as if he no longer cared about what he said anymore or how people perceived him. During our encounter, John was restless, excited, and happy, but he often blurted out very inappropriate comments, sometimes offensive or politically incorrect. Despite being at a medical office for his condition, he often spoke off-topic and joked around a lot. His attention was short, and his memory was spotty. According to his wife, he no longer feels the need to brush his teeth, shower, and do other daily routine activities unless he’s told to do so, and his wife finds herself managing him as if he were a child needing to be told everything that needs to be done. This is quite unexpected from a man who was once managing a large company and raising a family with children. Today, he no longer works, and is being taken care of by his loving wife who never forgot the man who he was.

I’ve seen many patients who had strokes during my rotation in Neurology. Of those who survive, some people may lose their ability to walk, while others may lose their sight. But my encounter with John made me realize that the most heart-breaking for me to see are those who lose their personalities, which makes us who we are.

UF Shands Medical Center

Hi Folks,

A big hello from sunny Gainesville Florida! At last, I have completed my last core rotation, which was surgery in London, and am now finishing off my medical education with a few more elective rotations. I’ve decided to do Neurology, Nephrology, and Cardiology (4 weeks each) at the University of Florida’s Shands Hospital because I heard great things about the training here from former AUC students who have been there. Gainesville was also an ideal place for me to do rotations because I wanted to spend some time with family. My brother Jimmy and his family live here in town. He is a well-known wedding photographer here in Gainesville, and was also the one who took our engagement photos. Also in the news, my wife Irene recently found a job as a PA in her hometown of Valdosta, less than 2 hours away north of here. She is working at a pulmonology clinic, and I am very proud of her. Again, we will be long distance for the next three months, but at least we’ll be relatively close to each other, and able to see each other on the weekends.

Setting up elective rotations at hospitals like UF Shands is not as easy as setting up rotations at the main AUC-affiliated hospitals like Bronx-Lebanon or Nassau, which your clinical advisor can easily do for you. Instead, you’d have to set it up yourself. It took me some time to figure out the process, and so I’d like to share with you the steps that I took to do it. Hopefully this would help some AUC students who would be interested in coming to UF Shands for elective rotations.

According to the Florida state statute, students of non-LCME schools (which includes AUC) can only do rotations at Floridian institutions that have an affiliation or agreement with their schools. As of 2013, AUC has agreements with the following institutes in Florida:

• Center for Haitian Studies (Miami)
• Cleveland Clinic (Weston)
• University of Florida/Shands Medical Center (Gainesville)
• Bayfront Medical Center (St. Petersburg)
• Tallahassee Memorial Hospital (Tallahassee)
• Orlando Regional hospital (Orlando)
• Medical Examiner’s Office (Browards County)

Unlike the other institutions in Florida, in order to do rotations at UF Shands, AUC students need to first get approval from a faculty member who would agree to sponsor them and evaluate them.

STEP-BY-STEP GUIDE FOR AUC STUDENTS

1. Figure out which rotations at UF you would like to do. Not all rotations will be available to AUC students at all times, since UF students take first pick over visiting medical students. You can check out the available options here.
2. Email the secretary or the rotation director of the field you are interested in rotating (preferably the secretary). In the email, introduce yourself, tell them your interest in the rotation, the dates you are interested in, and ask them to contact the Associate Dean for Student Affairs, Dr. Patrick Duff, for final approval. It’s very common to not hear back from them via email. In this case, be persistent! If you don’t hear back from them in a week, I’d suggest calling them directly over the telephone.
3. Once they approve of you, forward that email to Rita Ford at the Office of Student Affairs and Registration. Make sure to introduce yourself to Rita too! She’s a nice lady. Rita: ritaford@ufl.edu and (352) 273-7977
4. Once Rita receives the approval email, she will email you a packet of documents that must be completed and sent back to her. Make sure the secretary and Rita have you down on their schedule on the exact dates of your rotation. Make sure Rita knows the exact course name for the rotation. You can look up the course name here.
5. Fill in as much information as you can on the package, and then send it all to your clinical advisor at AUC. He/She will then fill out the rest of the documents. Have your clinical advisor send all the completed documents to Rita. Make sure your AUC clinical advisor have your UF rotations on your official AUC clinical schedule as well.
6. Go to the Application Fee Page and pay the $25 application processing fee. Go to the Weekly Rotation Fee Page and prepay the $800 per week ($3200 for a 4-week rotation) for the elective. You’ll have to pay this upon approval of the rotation and no less than 7 days before the start of the rotation. Since AUC has an agreement with UF, the hefty rotation fee will be covered by AUC tuition, and AUC will reimburse you the money at the end of the rotation. When you pay for the elective, make sure to save the receipt (like print-screen the receipt page, or save the confirmation email)!! You will need this document in order to get reimbursed by AUC!
7. Once Rita receives all your paperwork, she will let you know that you are good to go. Let your AUC advisor know that you are good to go as well.
8. Get ready for the move! You can find some housing information here. In the meantime, you can complete the HIPAA training online. Once you have completed the training, print the confidentiality statement and bring it with you signed to Gainesville to give to Rita.
9. Move to Gainesville!
10. On the first day, go to Rita’s office. She will give you a brief orientation about your stay at UF. Bring with you $16.25 to pay for the Gator One photo ID. If your rotation requires you to go to the SOuth Tower of the hospital, you will also need to bring $20 for a deposite on a key fob that will give you access there.
11. Rita will take you to go meet your attending or his secretary, and from there you will start your rotation.

SAMPLE CONTACT LETTER

Dear Mr./Mrs. _________,

REIMBURSEMENT

AUC will reimburse for affiliated clinical sites like UF Shands. While other hospitals may just invoice the school, for UF Shands, you’ll have to pay the rotation fees upfront before the start of the rotation. After the rotation ends, ask your AUC clinical advisor to send you a reimbursement form. Fill out the reimbursement form and send it to your advisor along with the completed rotation evaluation and receipt of your rotation fees. AUC will then write you a check to reimburse you.

CONTACT INFORMATION

To set up rotations, here are some of the people to contact. However, to find an updated list, consult the links I have above.

• Office of Student Affairs and Registration: Ms. Rita Ford; ritaford@ufl.edu; (352) 273-7977
• Neurology: Ms. Deborah Kahakua; deborah.kahakua@neurology.ufl.edu; (352) 273-590.
• Nephrology: Ms. Jamie Sims; Jamie.Sims@medicine.ufl.edu; (352) 273-8821.
• Cardiology: Ms. Mimi Jolicoeur; Mireille.Jolicoeur@medicine.ufl.edu; 352-273-9079.

Operation Theater during the 19th Century

In the mornings when I arrive at the operation theaters, I see a list of different surgeries happening that day. There may be a cholecystectomy in one room, or a knee replacement surgery in another, a thyroidectomy happening now, or a brain biopsy scheduled in a few hours. If I hadn’t seen a particular surgery before, I can decide to scrub in and see it. Almost all the surgeons I have met in the operation theaters thus far have been very nice and welcoming in having a medical student walk in to see them work.

In my experience these past two months so far, the name “operation theater” lives up quite to its name. Going to the surgical theater is a lot like going to a movie theater and picking out which show to see. As I don’t watch a lot of movies nowadays, coming to the operation theater is my way of seeing something new and intriguing on my surgery rotation. Should I first see the long epic drama of the femoral-popliteal bypass graft or the short but graphic action blockbuster of the below knee amputation? Or perhaps I’m in the mood for a mystery flick: the exploratory laparotomy.

Old Operation Theatre Museum in London. Photo by Mike Peel.

It’s no accident that in the UK, what we Americans call the “operation room” is what the British call the “operation theatre.” Historically in the 19th century, surgeries in England were performed on a stage surrounded by an audience of spectators who were curious to watch. This was before the development of modern sterilization techniques, anaesthesia, or even sterile surgical gloves, and the surgeons of the day would perform the procedures in their street clothes with just a white apron to shield them from blood stains. They would have to work quickly and swiftly to minimize the duration of pain on patients who are often fully awake. Although all of this dramatic showmanship and spectator seating have since been done away with with the development of modern standards of hygiene and privacy, the term “theater” still lingers today in the UK in reference to the “operation room.”  Today, if you come to London for clinical rotations, you can still visit some of the world’s oldest surviving operation theaters, now converted into museums.

I’m grateful to be doing my surgery rotation in the UK, one of the historical centers of surgery. Several of the major players in the history of modern surgery were British, like Joseph Lister, who pioneered the use of antiseptics in surgery in the mid 1800s, or Lawson Tait, often considered the father of gynecological surgery. At Queen’s Hospital, the hours have been reasonable and curriculum very flexible, and most attendings like teaching students. You could easily walk into a surgical theater, ask if you could observe or follow the doctor, and most doctors would be more than happy to have you observe and participate. Because of this, I’ve seen quite a variety of surgeries in diverse specialties, such as ortho/trauma, gyne, ENT, GI, vascular, and neurosurgery. I’ve also spent time in anaesthesiology, seeing the “other side” of the patient during surgery, as well as a day in the endoscopy clinic because I hadn’t had the chance to see one before in my previous rotations. The educational opportunities abound here. Being a student here is like being handed a special ticket (which I have to say we do pay a lot for) for unlimited showings at a movie theater. It’s up to us as to how to make use of that ticket.

Laparoscopic surgical tools

“I want to see your basketball dunking skills” my attending said to me, handing me the laparoscopic surgical tools that stuck halfway out of our patient’s abdomen. I was hesitant. I had never done anything like this before. I’ve always been used to using my hands, and trusting my fingers to directly carry out my commands seemingly without thought. But with laparoscopic surgery, my hands are now these pronged rods, speared deep beneath the abdominal walls of our patient. I had to reprogram the way I understood hand control, moving these new hands that I can now only see indirectly on a TV screen. A big move of the rod to the left is actually a small move to the right, and pulling the trigger made the pinchers on the end of the rod grab things.

With only a few seconds to adjust to these new controls, I looked at the monitor in front of me and gave my best shot at hand-eye coordination. I grabbed the newly resected gallbladder and “dunked” it into a storage bag to be pulled out of the abdomen on the first try. I had just assisted in my first cholecystectomy.

Manually maneuvering laparoscopic tools with my eyes fixed to a screen felt surprisingly a lot like controlling the moves of a player on a video game with a joystick or game controller, something I never really did much growing up. It’s impressive (and beautiful) what these doctors can do with these toy-like tools, performing intricate procedures that save people’s lives. This experience made me realize that perhaps there is a useful skill to be developed in those who play a lot of video games, which I had always considered a waste of time growing up. Perhaps some of these video gamers grow up to become the great surgeons of tomorrow. Just a thought.

Every day, I’m getting more and more used to this rotation and this place. In terms of rotation, these first few weeks have been really cool… I got to scrub in and assist in an open abdominal aortic aneurysm repair, extended hemicolectomy (where they take out part of the colon due to tumor), cholecystectomies (where they take out the gallbladder), a few foot amputations, countless hernia repairs, lipoma excisions, and many other surgeries, both vascular (which is my attending’s specialty) and general. In the next few weeks, I’ll be rotating with other specialties as well, like ortho and GI, so I will hopefully get a broader experience in surgery.

My “basketball dunking” experience really wasn’t much in comparison to what my attending does every day in the OR, but it was the highlight of my week.

Now that we both know that she has passed,  and we both are finally here together in Romford, we can now take a deep breath and spend our time in the UK relieved. I think it’s now a good time to share with you all our new home for the next 2.5 months!

Romford is located in the northeastern part of London. Historically, it was well-known as a market city, with its historic Romford Market. Today, the market continues to flourish and along with shopping centers, department stores, and pedestrian shopping streets, Romford is a shopper’s Eden.

As for Irene and I,  we are living in Swan Housing where most AUC students stay during our rotations at Queen’s Hospital. It’s a fairly new complex, built in 2009, and within 10 minute walking distance from both the hospital and the shopping areas, making it a very comfortable and convenient place to live. They rent out suites of 4, studios, 1-bedroom apartments, and 2-bedroom apartments. Because Irene was going to be joining me in living in Romford throughout most of my rotation, I decided to book for a 1-bedroom apartment, completely furnished and stocked, and I’m really happy about that.

I go into the hospital on most days at around 9am, and come home around 5pm or so, depending on the day. If it’s a busy day in the OR or on the ward (like whenever my team is on call), then sometimes I may stay at the hospital until 8pm. On other days when things may be going slow, I may come home earlier to study. While I’m at the hospital, Irene has been busy with quite a lot of tasks. First, she has been getting groceries and cooking. As we live close to the hospital, I often walk home for lunch, and it’s nice to be able to come back to tasty, home-cooked meals, and not to mention, much more affordable than what I could get at the hospital cafeteria, even with the student/staff discount. As London is a great jumping point to other parts of England and Europe, Irene also has been researching and organizing trips that we would like to take during my weekends off from the hospital. Thus far, we have Paris and Brussels on the bucket list, as well as some other places in the UK like Oxford and Cambridge (yes, I’m in love with academia). Irene has also been preparing clinical cases so that she can act as a standardized patient for me to practice on. Everyday, we’ve been doing 2 cases  from First Aid Step 2 cs book, and it is really good practice. It reminds me of playing make-believe doctor and patient as kids and it’s educational for both of us.

I’m really happy that Irene is finally here with me in Romford. Living here has been a lot easier with her around. I look forward to the rest of our stay together here in Romford, as we build memories together during this unique part of our lives.

Romford, my home for the next three months.

So I’m finally here in Romford, and a week into my surgical training. Romford is a great place, with lots of shopping streets, malls, and markets, and of course, that marvelous British accent. Most of us AUC students live just down the street from the hospital, in fairly new accomodations, and within short walking distance from these lively commercial areas.  I also just signed up for a gym that’s right across the street. Despite all of these convenient amenities, comforts, and exciting new adventure possibilities of living in a new country, I haven’t been feeling all too excited this time around, and not enjoying it as much as I wished I could. One thing is missing… my wife.

Before we got married, Irene and I had done long distance for quite a long time. When I was in St. Maarten, she was in Miami. We would visit each other during the breaks, and sometimes even during the school year. We had Skype, and we were only an hour time difference from each other. Long distance relationships seemed so easy back then. However, once I left the island, we immediately got married, found a home for the two of us and meow meow, and moved in together. She is my best roommate, and I quickly grew to become so used to living with her everyday. It felt right. I eventually did most of my rotations in Miami (with a few short rotations elsewhere), and after a year and a few months of living together in our home in Miami, she graduated and I moved onto my current rotation in Romford. We moved out of our Miami home, our first home together as a married couple. Although I have a new temporary home now in Romford, I feel homeless without Irene here.

Perhaps its because I haven’t had as much chance to talk to my wife as she is studying to take her PA national certification exam (PANCE) next week. I’m worrying a lot for her. Perhaps it’s the time zone difference, culture shock, or cold, dry climate I’m not used to. Perhaps its the stress of adjusting to my new rotation and attending I’m working with. Or perhaps its because I have so many things on my mind, like my upcoming step 2 cs exam, surgery shelf exam, step 2 ck exam, elective rotations I’m trying to schedule myself, finding time to study, saving money amid an ever-accumulating debt, finding time to exercise and stay healthy, and worrying how Irene is going to pass the time while I’m at the hospital when she comes to visit next week.

I usually love exploring new places, but at the moment, I’m not really in the mood. In the meantime, I’ve been distracting myself from my homesickness by studying more, until I fall asleep, and staying at the hospital longer than usual. Last night (Friday), I chose to stay at the hospital to help out my resident until 8pm, and today I went into the hospital to scrub into some surgeries, even though it’s a weekend. Among all the things I’m not used to in this new place, seeing patients is the one thing I’m comfortable doing here so far, and it helps me connect with what I’m used to back home.

I can’t wait until Irene comes next weekend, after she finishes her big licensing exam. I hope she does well, and whatever the outcome is, I’m still really proud of her anyway. The alignment of our paths is uncertain for the next few months after this rotation. Perhaps we’ll be thrown into long distance again depending on where she finds a job, and where I eventually schedule the rest of my rotations. For the time being when she comes next week until we leave London together in April, we’ll have to hold onto our shared sense of home together while we still have a chance.

Irene and I at Momi Ramen in Miami

So I’m back in Miami, and this month, I’m taking my first break since my wedding last March! I had decided to take this month off to help Irene and I move out of Miami, sell our furniture, attend Irene’s graduation ceremony next week (she graduates from PA school!), properly spend Christmas with family, attend a belated memorial service for Irene’s late beloved uncle at the end of this month, and study for the Step 2 board exams, which I plan on taking next spring.

I thought I would really enjoy this break (who doesn’t?), but after not even a week into this break, I’ve learned something profound about myself… I not only like, but actually prefer to be in the hospital working. Sitting in my apartment in Miami right now, it feels so strange not going into the hospital and seeing patients. I no longer get the feeling of accomplishment after a busy, productive day that I did when I was running around in the hospital, or the feeling that I’ve contributed something to someone else’s life. Those are amazing feelings one doesn’t really get with sitting at a desk reading board review books and selling off furniture pieces on craigslist at ultra bargain prices. I actually miss being at the hospital right now, and I’ve surprised myself with this revelation. Perhaps my attitudes may change in the future, especially when Irene and I have kids and start a family, but at least for right now, it makes me happy to know that I’m going into the right career path

My next rotation will be 12 weeks of Surgery, which I’ll start in January at Queen’s/Romford Hospital in London (yes, I’m going back!). I hear so many great things about this rotation from my classmates: the attendings love teaching students, you see a lot, and the working hours are much nicer than the surgery rotations in the US, which often requires students to be at the hospital by 4-5am. In the UK, in contrast, you just go at 9am. In the UK, they also give students much more opportunity to learn to do procedures. One of my friends who went to Romford for her surgery rotation got to do an appendectomy by herself with the doctor verbally guiding her way through the procedure. She told me that rotation was one of the best experiences she’s had in medical school, and convinced me to go. It’s also nice that AUC will help pay for my flight. On top of that, Irene will be able to join me later on after she takes her PANCE exam (Physician Assistant National Certifying Exam), and together we can experience living in the UK, and perhaps take a few excursions to visit other countries on the weekends as well. It will be my last core rotation, after which I’ll have four more electives before I’ll be done with everything. I’m really looking forward to returning to the hospital after this break!

Nassau University Medical Center

An elective rotation in Endocrinology was something I knew I always wanted to do during clinicals because as an aspiring primary care physician, I knew I would be seeing lots of patients with diabetes, hyperthyroidism, hypothyroidism, and other hormone diseases. After four weeks, I am so happy to have been able to finally do it, and with an excellent team of attendings and fellows as well. The endocrinology elective rotation at Nassau University Medical Center (NUMC) has been one of my favorite rotations that I have done.

NUMC is located in East Meadow, New York, on Long Island, about an hour away from New York City by car without traffic. Although I’ve only done this one rotation at NUMC, it has given me a really good impression of NUMC as a place to do clinical rotations. I felt my days were fulfilling and I did a lot of useful work, like seeing new consults and following patients on my own. I felt the attendings also give a lot of feedback and find every opportunity to teach as well, and I felt like I was constantly learning something. The hours were a little bit longer than most rotations that I’ve done (ranging from 8-4 on a short day to 7-7 on a busy day) , but I didn’t care, since I didn’t feel like I was wasting any time. Also, there are so many benefits of working in a team of attendings, residents, and fellows, something that I never got in Miami. As future practitioners in US hospitals, its important to understand this hierachy, power, and roles within the medical team, and to experience it at least once before residency.

Typical Day:

During this rotation, we get a good balance between inpatient and outpatient, as well as the practical and the educational experiences. Every morning, I come in around 7am or 8am (depending on the day) to see the 3-4 patients that I am following (pre-rounding). I talk to them, see how they’ve been doing since I last saw them the day before, and do a physical exam. I then record my findings on a progress note. Afterwards around 8am or 9am (depending on the day), I head to the outpatient clinic on the 6th floor of the hospital. In the clinic, we focus on different things on different days:

On Monday mornings, the clinic is usually reserved for patients who have suspicious thyroid nodules and need Fine-Needle Biopsies. The fellow typically perform the biopsies, while I usually help press buttons to capture ultrasound images of the fine needles and nodules.

On Tuesday mornings at 9am, we have Diabetes Clinic, in which we see mostly diabetic patients. Typically the nurse would come into the residents’ room and start stacking up a pile of paperwork of the patients that are ready to be seen. The residents and students would then grab the patient files, find an empty room to see the patient, and call the patient in. I would see the patient, check his/her labs and documents on the computer, do a physical exam, and write my findings on the progress note. I would then ask the patient to wait in the room while I return to the resident’s room and present my findings to the attending. After discussing the case, we would then both go back into the examination room to see the patient together.

On Wednesday mornings at 8am, we typically have Journal Club in which students, residents, and fellows are assigned journal articles about endocrinology to present and discuss with the group. This weekly event keeps us up to date with the medical literature, helps us build critical reading skills, and educates us. Journal club is followed by “Nuclear Medicine” educational session in which the fellow presents and discusses a case, and we see the patient as well as the nuclear imaging of the case.

On Thursday mornings at 9am, we have Thyroid Clinic, in which we see mostly hyper and hypothyroid patients.

On Friday mornings, we have Endocrinology Grand Rounds at 8am, in which residents, fellows, or attendings would give a talk about a certain endocrine topic they have been researching.  After Grand Rounds end at 9am, we start clinic, and see a mix of different endocrine patients.

Every afternoon, after clinic is over (around 1-2pm, depending on how busy it is), I usually take 30 minutes off to eat lunch in the hospital cafeteria, during which the fellow may or may not ask me to see a new consult before the afternoon inpatient rounds with the attending. Endocrine consults are ordered by other doctors for patients who may or may not have been admitted to the hospital for the endocrine problems (and often it’s not). For example, I’ve done consults on patients who were admitted to the hospital for fractured leg who also happened to have diabetes. I’ve also done consults on psych patients in the psych ward who happen to have found to have high parathyroid hormone levels, etc. If there is a new consult to see, I usually go by myself to wherever the patient is located at the hospital. I would then introduce myself, talk to them (if they are conscious), see why they were admitted to the hospital, and find out more about their endocrine conditions. I’d do a physical exam, and then write a detailed account of my findings on the consult (pink) sheets.

The last event of the day is usually rounds, which may begin at 3pm or so (it’s not a set time). With the attending, fellows, residents, and students, we first discuss all the patients we are following, including new consults. Usually, there’s 12-13 patients. After deciding who we need to go see, we go see the patients, assess their progress, and decide on the management of the patient. Always be prepared to answer what your assessment and plan for the patient is. We finish rounds at around 6 or 7pm.

Sometimes it’s not too busy and we get done early, and if the fellow is not as busy, he/she would often sit with me one-on-one and give me a lecture about different topics, like hypothyroidism, diabetes drugs, etc. The attending may also sometimes assign me certain topics to read up on in the library before going home, and ask me questions about them the next morning.

SCHEDULE SUMMARY:

Monday: Pre-rounds –> Biopsy in the clinic –> Lunch/Consults –> Rounds

Tuesday: Pre-rounds –> Clinic –> Lunch/Consults –> Rounds

Wednesday: Pre-rounds –> Journal Club –> Nuclear Medicine –> Lunch/Consults –> Rounds

Thursday: Pre-rounds –> Clinic –> Lunch/Consults –> Rounds

Friday: Pre-rounds –> Grand rounds –> Clinic –> Lunch/Consults –> Rounds

View from the hospital

Who Do We Work With?

There are usually 4 attendings during the morning clinics. However, usually only one of the attendings lead the afternoon rounds. There are two fellows we work with (the junior and senior fellows). We also occasionally work with one resident and/or another medical student. Besides other AUC students, Stony Brook University and NYCOM medical students also rotate there with us.

How Are We Graded?

As endocrinology is an elective, there is no Shelf Exam we have to pass in order to pass the rotation. Your grade is completely dependent on the faculty evaluation. Nassau uses electronic evaluation forms, and therefore it’s not necessary to print out an eval sheet to give your attendings, like it is at other clinical sites. And of course like all other rotations at AUC, make sure to fill out the case logs.

What Types of Cases Do We See?

Because it’s endocrinology, we see all sorts of hormonal diseases. By far the most common one we see is Diabetes mellitus type II. Following this, we also see lots of hypothyroidism and hyperthyroidism. By the end, we get a good sense of the management of Diabetes, which really just involves the same few drugs, tweaking the dose here and there, and doing trial and error to see what’s best for the patient. Here are some of the other types of conditions I have seen in the last 4 weeks: hypoparathyroidism, osteoporosis, VIPoma, amnorrhea secondary to methadone, hypogonadotropic hypogonadism, hypertrophic osteodystrophy, hypokalemic periodic paralysis.

Conclusion

Endocrinology at NUMC is a really good rotation, and I felt I learned a lot from it. My days felt busy, but productive, which is what I love. The attendings are nice, and put their time and effort into teaching. Although I’ve only done one rotation at NUMC, from what I see, I feel this hospital is a really good learning environment, and I’d definitely recommend it. Plus, there are lots of AUC students everywhere here… and that’s always a plus .

80 yo WF c PMH NIDDM x10yrs, HTN, c/o HA. Ø N/V/CP/SOB/Abd pain. PE: AAOx3, NAD, PERRLA, EOMI, MMM, Ø JVD, S1 S2, HRRR, LCTA, Abd NT/ND, BPPP. VS: 98.3° 150/80 80 18…

About three years ago, I wrote a post titled “Second Language” in which I talked about how learning medicine comes with learning an entirely new set of vocabulary, like a second language. Now, after 11 months of seeing patients, writing progress notes, H&P’s, and consult notes, I’ve picked up another language that builds upon the language of medicine: medical abbreviations.

A year ago, I probably would not have been able to read the above statement, but now it’s second nature to me. Abbreviations continue to be used today by people in the medical field because it lets us write our findings faster, especially if we are pressed with time with many other patients to see. It’s also useful because it makes reading faster as well. Instead of reading “extraocular movements intact,” we could simply and briefly glance at EOMI and know exactly what it means. Ironically, however, over time the abbreviation itself becomes more intuitive to me than what it actually stands for. When I see “PERRLA” now, I instantly know what it means. But when you ask me what it actually stands for letter-by-letter, I’d have to pause for a few seconds to think about it.

While medical abbreviations has its advantages, it also has its disadvantages such as misinterpretation, especially when doctors write with their cursive Chinese calligraphic handwriting that they are so famous for. U’s can be confused with 0′s. IU’s can be confused with IV’s. Because of this, many hospital have discouraged the use of certain abbreviations like QD, QOD, U, IU, MS, and MgSO4, and have a set of approved abbreviations for current use.

Medicine really is a world of its own, with its own culture, knowledge, system, laws, traditions, ethics, practices, and of course, language. The longer we are immersed in it, the more we find ourselves expressing ourselves through it. I’ve heard residents talk like this before: “They’re showing the movie q3 hours. We should go ahead and buy tickets times 2 for the next showing.” I haven’t gotten to that level yet, but perhaps one day I may and not even realize it.

Translation:

The patient is an 80-year old white female with a past medical history of non-insulin dependent diabetes mellitus for 10 years and hypertension who complains of headache. She denies nausea, vomiting, chest pain, shortness of breath, or abdominal pain. Physical exam shows that she is alert and oriented to person, time, and place. She is not in acute distress. Her pupils are equal, round, and reactive to light and accomodation, and extraocular movements are intact. She has moist, mucous membranes, and has no jugular venous distension. Her S1 S2 sounds are present and her heart has regular rate and rhythm. Her lungs are clear to auscultation, her abdomen is non-tender and non-distended, and her bilateral pedal pulses are present. Her vital signs show a temperature of 98.3 degrees, blood pressure of 150/80, pulse of 80, and respiratory rate of 18.