Keep On Keeping' On

This week is more of the same. A little OR time, a little clinic, and the new added bonus of a day of colonoscopies! How fun! This morning rounds started extra early and I had three patients to pre-round for so I got to arrive a little after 4:30am. So many fun things. Luckily I actually enjoy surgery for the most part. I do not enjoy contemplating setting my alarm for 3:45am though. Rounds are a little later tomorrow so I can "sleep in" until around 4:30am woo hoo! This is really going to make every other service I'm on for the rest of the M3 year feel like a piece of cake. Next week we have a review day that begins at 6am and instead of being sad that it's so early I literally said that I get to sleep in. Wow, how times change oh so very quickly.

Today in clinic I worked with some undergrads/recent grads who are in a summer program here that includes some shadowing. It was weird to be the one who "knew more" since I am so used to being the absolute bottom of the knowledge totem pole. It was interesting though. Hopefully they didn't think I was an idiot, ha!

Anyways, time for a little bit of studying now that I've had time to wash my hair and do laundry (ahh the luxury, and actually I asked Molly to do my laundry so there's that). Got to get my sleep for those colonoscopies tomorrow. I'm actually interested to see all that they entail. 

Onto the Adults

This week was my first week on my new service, and I was finally forced to see a patient who was allowed to drive, vote, drink, etc. I miss seeing the kids because they are definitely cuter and have a lot fewer problems to juggle, but I know it will be a good experience and I'm pretty sure there is no way through medical school without seeing adults. I spent a day in the main University Hospital OR, three days at the outpatients surgery center, and one day in the Surgical Oncology clinic at the Cancer Center. Most of the cases I saw were for melanoma or breast cancer this week with a few other things here and there. It's weird to think about the fact that almost all of the patients I will be seeing this month have or have had cancer since I'm on the surgical oncology team. Luckily people usually only get surgery if they have a somewhat favorable or potentially favorable prognosis. My day in clinic went quite well too and both notes that I wrote were entered into the patients medical record and signed by the physician without any edits which is great. I am still very exhausted and can basically do nothing other than sit around today because I don't have the energy to do anything. Oh well, just a little over two weeks of clinical responsibilities on surgery and then I'm free to get a normal amount of sleep again! Yay!

Peds Surg Recap

I have been a terrible blogger as of late and I fully acknowledge that. This blog has massively dropped to the wayside as I have had to choose between eating, sleeping, and showering each night for the last four weeks while beginning my journey as an M3. Surgery is a crazy service to start on, thats for sure! Setting my alarm for around 4:10am has become normal (though never easy), and I've been spending almost all of my waking moments in the hospital. I never thought it would be possible to actually get close to an 80 hour work week, but I was oh so wrong. I desperately miss my nights of eight hours of sleep and waking up to sunlight instead of pitch back darkness. Such is the life of a third year med student on the most time intensive rotation we've got. Luckily these past four months were filled with some of the cutest little patients, who make being there a little bit better. Even though most of them are quite sick, I am very glad to have started in the Pediatric Surgery department. The surgeons were great and it was a wonderful experience to learn about all the surgeries necessary for kids that I will never have a chance to see in any other setting.

Some of the patients I have been seeing have had very routine maladies like appendicitis, while others have had some of the rarest disease processes there are. Being at an academic medical center really skews your idea of what people see most often all over the country. For example, I have seen two patients already who are unrelated and who both have a syndrome where there are less than 300 documented cases in the medical literature. That is nuts! Who would've though the rarities could seem so unassumingly common. It is all very interesting and very exhausting at the same time.

So now after the first four weeks I have arrived at our "mini-switch weekend" where we all get two days off in a row before we change surgery services. I will start on Surgical Oncology and Colorectal Surgery on Monday morning, which means I have to venture to the main university hospital and leave the children's hospital behind for now. My walk will at least be a few minutes shorter at least, but I will miss seeing kids all day. For now I am just enjoying getting some sleep and rest for once! Hopefully I can refuel so I am ready to go for another four weeks (well actually only a little more than three due to 4th of July and exams that have been bumped up two days so there are surgeons available to give our oral exam!).


Oh, to update on a comment I made in one of my last posts almost three weeks ago: I did end up getting my wisdom tooth out two weeks ago yesterday. It kind of sucked, but I avoided dry socket completely so I count that as a win. There is still a bit of a weird feeling in my mouth, so thank goodness I only had one to remove!! I don't know how people deal with four. I only had local and a bit of nitrous so there was no post procedure loopiness. There was, however, a lot of fear in eating for a while. I'm past that now and almost back to normal chewing. Hopefully it just continues to get better and better.

Anesthesia Week, Day 1

Today I did my first day of my Anesthesia week. I can't write too much about it due to HIPAA, but it was pretty cool. I got to see some new procedures and I even got to do an intubation. I have a feeling this week will be more shadowing than actually doing things, but it's still very interesting and I'm enjoying it. I'm also enjoying that there are no morning rounds and I get an extra hour of sleep! I even had some daylight when I walked to the hospital this morning, which is a far cry from the utter darkness at 4:45am when I'm walking to surgery rounds. Hard to believe I have to go back to that in just one week! At least surgery is interesting, just very exhausting. I don't think I have a surgeons mentality, but it's neat to get exposed to it all. I'm rambling so I'm signing off now :)

Surgery Week One

I have now finished my first week on Peds Surgery. Needless to say I am absolutely and completely exhausted. On Friday I fell asleep on Molly's floor while talking to her and yesterday I got home a little earlier and took a three hour nap! I'm seeing some interesting procedures and the kids are great, but I am definitely missing my sleep! Today was my day off so I went to Jazzercise this morning and now I get to do laundry, clean, shower, and all that fun stuff I have been neglecting all week. This week I'm on Anesthesia and I get to go in so much later! My schedule may be better but I also need to try to get my wisdom tooth out on Friday, so fun things to look forward to, ugh! 

The end of Japan and M3 Orientation

Okay, so I've been a bad blogger. I am usually very good about updating when I am abroad, but thanks to my dad's "go, go, go" traveling attitude I literally could not do anything other than go to sleep when I got back to the hotel every night! Heres a quick recap of the rest of the trip:

We saw the Japanese macaques on our last morning in Kyoto. It was quite a hike up a mountain, but the views at the end were worth it along with the cuteness of the little monkeys. We took the bullet train from Kyoto to Tokyo, but unfortunately couldn't see Mt. Fuji due to weather. We drug my dad to DisneySea (the second Disney park in Toyko) and went on Tower of Terror and other fun Disney rides. We took a walking tour of the Harajuku district and the Shinjuku district in Tokyo and saw a ton of cool buildings and areas. We had sushi at Sushi Yasuda, which is one of the highest rated restaurants in all of Tokyo! We explored a few other districts of Tokyo, including going to a mega-electronics store! We went to the Robot Restaurant (OMG this was weird). We went to a cat cafe and pet/fed many adorable cats. I went to Disneyland on a national holiday (this timing was a big mistake, who wants to stand in line for Winnie the Pooh for 2.5 hours?). Disney was great, but I had to miss a handful of rides like Thunder Mansion, the Haunted Mansion, and everything in Fantasyland because there was no way I was waiting in line that long. I waited 80 mins for Space Mountain and doing that once was my limit. Thank goodness there were a few rides with a bit shorter lines and Splash Mountain has a single rider line so I got to bypass the 150 minute line there.

On Monday morning in Tokyo I was awoken to two earthquakes about 15 minutes apart of magnitude 4.6 and 6.0. Thank goodness nothing happened and I somewhat used to earthquakes! I took the airport limousine (aka a bus) to the Narita airport and had a pretty uneventful time. I asked the woman at the gate if there were any empty rows, and lucky for me there were! She moved me there and I got a whole row to myself to lay down and sleep. So lucky of me to have that going both directions! It makes international flights so easy. When I arrived in Chicago I went straight through customs thanks to Global Entry (didn't even have to stop at a person!) and got to my gate without problems. The flight to Detroit was also uneventful. When I arrived in Detroit I had to wait over an hour for my sister to get there because she got lost somehow.

Transitioning to Michigan time was not a problem. If anything I want to go to bed early and am waking up a little earlier than normal which is great considering I soon have to wake up at absurd times. We started orientation for M3 year on Tuesday and it went pretty well. It's a bit scary to think that as of Tuesday I will be a part of a patient care team, but I'm sure it will go fine. This weekend is for getting everything in order and catching up on sleep before surgery begins!

Nara

Today was our day to explore the city of Nara, Japan. Nara was briefly the capital of Japan before Kyoto and later Tokyo. It is a smaller city in Japan, but it was a great experience. We began with a delicious breakfast at the Ryokan again and then got ready to leave for the day. Had I known the amount of walking would be so much more than yesterday I would have worn my more comfortable shoes, but I did not, so now my knees and feet are all killing me. Oh well, live and learn. Anyways, back to Nara.

We took the subway train to meet Kazue and then the four of us took a different train for the 40 minutes out to Nara. The train ride was easy and nothing too exciting. We got there without any problems and set off to explore all of the sites within Nara Park. The coolest thing about Nara is that there are literally deer everywhere, and I really mean everywhere. They are very calm and used to people and you can buy deer crackers to feed them straight out of your hand. It was awesome. While at Nara we went to a bunch more temples and shrines and they were all beautiful. The wisteria also happen to be in bloom this week, and they were absolutely amazing to see. I have never seen wisteria before, but I definitely love them already. We wandered around Nara for hours and had a great time seeing the beautiful structures and even saw the biggest Buddha in Japan standing (or sitting rather) around 4 stories tall! The Buddah also sits in the biggest wooden structure in the world. It was all quite impressive. After the shrines and temples we saw a beautiful garden that reminded me of the Japanese Tea Gardens in San Francisco a bit. All in all it was a really nice day, but I was exhausted by the end of it.

After seeing Nara we took the train back to Kyoto and went to the shopping area. They had a ton of bizarre stores along with stores I recognize like Gap, Starbucks, Clarks, etc. It was fun to browse even though we didn't buy anything. We also walked through the market area which was fun to see. My dad and I got fresh squeezed grapefruit juice that was juiced right in the rind with a special machine and served inside the rind with a straw. It was so ridiculous cool and so so yummy! Definitely a highlight even though it was such a small thing.

After strolling through the market we walked home to the Ryokan and had a light snack and chatted/rested for a bit before dinner. Tonight we had dinner here at the Ryokan again and it was very good. A few courses, starting with a sushi style course, then a fish course, a tempura course, and finally dessert. The tempura was my favorite for sure, tough it was all pretty good. Now that dinner is over I am so ready for bed. It may be just 9pm, but I am ready to sleep! It doesn't help that I took a Benadryl just before dinner due to my ritual traveling abroad rash that reared its head today. So its off to sleep! Hope I don't wake up too early. I'm in need of some deep sleeping time!

Wisterias

Largest wooden structure in the world

Enormous Buddha

Garden

In the Garden

Drinking my grapefruit juice 

Exploring Kyoto

This morning began my first full day in Japan. We woke up pretty early since we had fallen asleep by 9:30pm, so we had a slow morning before we had our breakfast come at 8am. Dad had a traditional Japanese breakfast and my mom and I had a western style breakfast that was pretty delicious! After breakfast we met out tour guide Kazue at the Ryokan. Since it was raining we took a taxi to the Kiyomizu Temple to begin our day. Apparently it is one of the most famous and popular temples in all of Japan, and is generally very crowded. Due to the rain we lucked out and we didn't have a bad crowd at all! The special Moon Garden was also open today, and it is only open twice per year for ten days at a time so we lucked out! The garden was quite beautiful, but there were no pictures allowed. We did spend the equivalent of just under $3 to buy some pictures of the garden to take home, which was nice. We spent a good amount of time at the temple area and saw the many shrines and temples on the grounds. It was a really beautiful place, despite the rainy weather.

After the temple we set off to walk around part of Kyoto. We did a little shopping and a LOT of taste testing as we walked by many shops. There were candies, soups, drinks, and so many little things to taste and try along the way. I purchased some tea-bag like soup broth and some spices to make when I get home, as well as some really cool jelly soap and some mango-honey syrup that you can mix with water as a drink or use on desserts! There was so much more I wanted to buy even! We saw some beautiful houses and shops, and even women dressed in traditional kimonos complete with the full white make-up, granted the three girls we saw in full make-up were not Japanese, but from Thailand and Germany! It was a really great walk and I really loved the area. I also discovered this really awesome Kyoto artist that has done a lot of paintings for temples and shops around the city. He has some shops of his own as well, and I was really close to buying a backpack with some beautiful red, black, and gold koi pattern, but as usual I couldn't commit.

Out next stop was lunch, and we went to a noodle place that was really good. We started off with some tea, as we have become very accustomed to here and ordered some tempmusubi, which was basically rice around a tempura shrimp wrapped in a piece of seaweed. It was exactly like Spam musubi, but with tempura shrimp instead of Spam. It was amazing! I then had beef soba for lunch and that was also quite excellent. We chatted for a bit about Japan, and life in general and had a wonderful time.

After lunch we walked down a main street with lots of little shops to the subway station where we took a shuttle to see the Fushimi-Inari Shrine. The shrine is made up of ton of gates and it is so cool and interesting. We had a great time walking around and seeing all the beautiful gates juxtaposed with the bright green foliage. It was quite amazing. Kazume also said a little prayer to at the study shrine for my Step 1 exam, so hope it worked! Kazume left us here as our 6 hours were up, so we explored a bit more and then took the train back to the Ryokan where we rested for a bit. Everytime we get back I swear they have tea and some kind of small treat. It is pretty awesome.

After resting we set out to Gion to find some dinner. It was still pouring, so we all got pretty wet, but we had a nice walk along the river to get there. Oh, and I forgot to say that we did get a reprieve from the rain for much of the middle of the day. Anyways, we ended up eating at a place called Junidanya and I had some of the best tempura I have ever eaten! It was so delicious! All of us liked out respective meals and enjoyed having a real seat and table instead of sitting on the floor. We deeded to take a taxi home from dinner since we didn't feel like getting wet more, and through the language barrier managed to get back to the right place. It helped that we weren't very far away and it was basically a straight shot back!

When we got back I took a lovely shower and now we're just relaxing before getting some sleep. Tomorrow we are taking a trip out to Nara to see some more wonderful things!

Eating breakfast in the room

At the temple looking out at the scenery

The main hall of the temple

A small pagoda on the temple grounds (see in the distance in a pic above)

This Buddha was made from wood collected from the ocean after the tsunami as a tribute to those fallen 

Beef soba noodle lunch

Mom and Dad at the shrine

Me at the shrine

The room at the Ryokan transformed for sleeping

Step 1 DONE and Off to Japan!

I have finally  completed the long and awful test that is the USMLE Step 1. Thankfully I have a few weeks before I have to know how I did on the exam, but it is over, and for that I am thankful.

Now that my endless studying days are behind me I am officially on VACATION!! This morning (or yesterday morning since I crossed the date line, it's confusing) I got up and went to SFO to begin my week trip in Japan. I traveled alone since my parents left the day before me, but everything went smoothly. The plane had a ton of extra seats, so I ended up moving to an empty row where I got to lay down across all three seats! That is an international flight dream come true! Besides sleeping I ate, watched last weeks episode of Glee, and watched four movies (Cloudy with a Chance of Meatballs 2, Cars 2, The Lego Movie, and Cool Runnings. The flight went by quickly and was not bad at all. I got through immigration and customs without any delays or problems at all and met my shuttle from Osaka to Kyoto. The shuttle ride was about two hours and there was plenty of space, but I started getting antsy from sitting so long. I eventually arrived at the Seikoro Ryokan in Kyoto around 5:45pm and met my parents.

Our room at the Ryokan is very traditional and quite adorable. There are no beds, but they set the room up for sleeping at night. We also eat meals in the room on cushions on the floor. It is the full Japanese experience. After arriving we sat for a bit and then my mom and I walked by the river for a few minutes to just get moving after the long flight. We then had Sukiyaki in the room (Japanese hot pot) with miso soup, rice, some various appetizers, and a small dessert of melon and macha green tea and red bean jelly. The jelly wasn't my favorite, but the rest was delicious, especially the hot pot! We are now getting ready to sleep and we have our walking tour of Kyoto tomorrow, most likely in the rain. Hopefully the weather isn't too awful!

Ready to go!

Mom and Dad ready to get some Sukiyaki in the room at the Ryokan

Dad mixing his egg for Saori who was cooking the Sukiyaki

The sukiyaki! So delicious! 

Studying

So for the past four and a half weeks I have pretty much been studying non-stop for Step 1. I had a few days off during the month, but no more than one per week. Boy, did I ever need those for my sanity! Now the test has creeped up on me in a big way and I only have two more study days left. It is both awesome and terrifying. I do not feel that I am ready to do as well as I would like, which is really disappointing. I am pretty confident I can pass, but thats about it. Hopefully things fall into place over the next few days or the test just happens to cover only things I've really gotten down. Either way, I just really hope some miracle happens really. I generally feel good one day and awful the next. Luckily with that pattern test day should be a good one. Fingers crossed!!