Friday, May 23, 2008

Post-Step 2 CK Thoughts

*Warning: This is going to be a long post. Also, there won't be any tips on how to ace the Step 2 CK Exam -- I'm not even sure if I passed. If you're "down" with that, read on...*


I’ve been just studying for close to a year now. Doing almost nothing productive with my life (“So what do you do these days?” ... “Umm, I’m currently a bum.”). Just studying. Yes, there were the occasional 24-hour call days at a small hospital near my house or the covering for a physician at a free doctors’ clinic. But this past year, since I finished my internship at the Medical City (TMC) in May 2007, I’ve really only been studying -- for the local Boards, for USMLE Step 1, and most recently for Step 2 CK. I gotta tell you that Starbucks has made a lot of money off of me.

I reflect now on the fact that all that’s about to end in a few months. My life can go in two distinct and separate directions and it most definitely won’t involve just bumming around and studying. Should the whole USMLE thing pan out positively, I will have some interviews in the US come November and will have matched to a US residency program in March 2009. I will have a real job (my first, and with that, my own money) come July 2009. That’s option 1. The second option is when the US residency thing doesn’t work out and I will stay here to train as a resident at TMC, which officially takes in 1st year residents in January. I won’t go into the details that are factored in when I ultimately choose one path over the other but that’s the way things are looking these days. And I really am excited to finally be on the verge of making that decision. Here’s why.

Thanks to kayfish, a senior resident and my former interns’ monitor at TMC, I recently discovered a blog written by the Fake Doctor. I’ve spent almost my entire first Post-Step-2-CK day today just reading his blog right from the beginning, wherein he writes about his med school days (he’s a resident now so he has a new blog and almost 4 years’ worth of entries on this site). I don’t necessarily share all his views on things but I love (but, again, don’t necessarily share) his outlook and cynicism (I just needed that crystal clear. Hehe).

There’s one entry he posted in December 2005, entitled The Fade, that really made me realize how I’ve missed the hospital environment so much. At the same time, he reminded me how much of a whiner I can be while actually in this same hospital environment. I’m sure doctors-in-training everywhere (med students, interns, residents, and even fellows) can understand what he (and I) is (are) talking about. It’s a common thing for trainees to cry out for a “benign duty night” and to sometimes get disgruntled when a patient walks in to the ER with a seemingly harmless condition at 3AM (admit it, doctors reading this!). As clerks, we were upset when we had 8 patients to monitor hourly and your groupmate can sleep through the whole night with not one patient to visit. A nurse pages for you at 2 AM, just when you’ve finished all your paper work and have just also come out of the OR, because you need to read a skin test. Mundane things. Trivialities.

There’s a line in his entry that goes, “‘That's why it was so good?’, she responded quite innocently. ‘I guess I would have figured you'd say something like “I saw an interesting case” or “I met an interesting patient.” ‘“ (how’s that for quotation marks?). This was a friend’s response to him when he said he’d had a “good day” because he got to visit the mall for a few hours during the work day (confusing, but you have to read the linked post in order to get what I’m saying). I realized that in a way, I’ve started to become jaded because of these trivial things, the very thing I set out not to do in the first place (see About Me). It’s like it has snuck up on me, this being jaded thing. It’s really easy to get lost in these trivial things and to forget why I’m here in the first place. But if I’m to really consider these things, most of them (not all, if you’re reading this, Marc) are really integral to our jobs and roles as doctors.

The way Philippine medicine is set up, especially in my experience as an intern in a private hospital, we don’t really get our own patients this early in the game. The residents do, and they have to round on these patients at least once a day, and know their case cover-to-cover. But for us (former!) interns, we see the patient for an IV insertion, and then we’re done. Back in UST, the truly memorable patients to me are those that I admitted and subsequently discharged. They’re the patients that truly stick to my memory because in essence, they really were my patients, under my care. In the fast-paced environment of clerkship and internship, that doesn’t happen a lot (I can count these "memorable patients" in my ten fingers). You admit a patient one night and before you know it, you’re endorsing him to the next guy who’ll take your place in that rotation.

I guess this is my long and winding way of saying that I miss the hospital environment because for almost a year now, I’ve been so drowned in review books and multiple-choice-questions that my jadedness might actually already be eating away at my ideals. The thing is, I don’t know -- and I won't know until I get back to the hospital and see for myself. Only then can I do something about it. I need to start caring for patients again, to admit them and run their labs and see how they progress and feel better with the treatment that I was a part of formulating, and finally to see them discharged improved and stable (although it doesn’t always end up that way).

I happily note that after almost a year of walking into that dark cave of tests and reviewing, I see the end in sight. I’m almost there. I’m finally about to make that important decision and finally move on in my career, and quite possibly, my personal life. I won’t have to make that decision yet, not until August, probably. But I can finally see the proverbial silver lining (did you notice how much cliche' I’ve already injected into this entry?!).

What’s next for me? A trip to the US in June for one final test. It’s going to be a practical exam that’s Pass/Fail and no numerical grade, thank God! Once I get all my scores back, I make my decision. I have a strong feeling how all this will turn out but who knows, God may still have something up His sleeve that will surprise me.

If you’re still reading this, thanks for being interested and lasting this long!

1 comment:

The Fish said...

won't be long now. :)