Back in the saddle

It is good to be back in action. I worked yesterday and today and saw all kinds of crazy pathology in the emergency department. I walked into the emergency department and felt like I was at home. It is where I belong.

Today I had a patient that was complaining of a strange rash on his palms of his hands and soles of his feet. There are not a lot of diseases that manifest with this kind of rash. Usually it is either Rocky Mountain Spotted Fever or Syphilis. Sometimes scabies can present with marks on the palms but usually scabies presents in the webs of the fingers and toes. I worked the patient up and figured that it was pretty certain he had syphilis.

I ran a couple of syphilis tests and sure enough they all came back positive. We do not see a lot of syphilis anymore because of active use of antibiotics. If we see syphilis at all it usually is primary syphilis which presents as a lesion on the genitals. If the patient goes untreated they can progress to secondary syphilis which presents as a rash, often on the palms and soles. If secondary syphilis goes untreated it can ultimately lead to tertiary syphilis which presents with neurological signs and the patient can go crazy. It is almost unheard of in the modern world to see tertiary syphilis but I imagine it still occurs in certain populations. Even secondary syphilis is fairly rare.

Given the population I am seeing in this emergency department I will see all kinds of rare and weird pathology.

Catch up with Updates

Ok! Maybe it took longer than a month. I have been crazy with my studies and teaching a class to 1st and 2nd year medical students.

I took my exam yesterday. It was the USMLE Step 2CK (CK = clinical skills). This exam is required of all medical students in the USA and is normally taken during your final year of medical school. It covers all the clinical knowledge you are supposed to know by the time you graduate. It is a 10 hour exam and pretty tricky. It gives residency programs a good idea of where each applicant stands as far as their clinical knowledge.

I finished the exam which is a great feeling. I will not have my results for 3 - 6 weeks. It is hard to predict how you did. Everyone leaves the test feeling like they got kick in the gut no matter how well they end up doing on the exam. I will have to wait and see.

I have been studying over the past couple of months and more intensely this past month. I started a rotation at my school where I get credit for helping to teach a class called Essentials of Clinical Reasoning. I teach 1st and 2nd year medical students how to do physical exams on patients. I also write test questions for the exam. I really like doing this and enjoy the interaction with the students and the doctors who actually teach the course. I never really imagined that I would enjoy teaching but I guess I do.

I do not think I will choose a career in academia but you never really escape teaching as a doctor. You always have a student or resident or nurse or someone else asking questions and you end up doing some form of teaching throughout your career. It is convenient that I enjoy it. As a student I always like working with doctors who enjoy teaching because they make the work / rotation so much more interesting and worthwhile. Often you work with a doctor who does not like teaching and then you get the bare minimum of instruction and a lot of learning opportunities are missed.

I have also been busy applying for residency. I have applied for a residency in Emergency Medicine. So I will be an ER doctor. I will write more about this application process and the match in another post. It is worthy of a dedicated post.

My last day of this rotation / course is tomorrow and I will be teaching how to do a neurological exam. It should be fun. Then on Monday I start a rotation at a big teaching hospital in emergency medicine. This rotation will be like a tryout or audition because I have applied there for residency. It should be intense and exciting all in one. I think they see about 2 gunshot wounds / day on average. That makes for a great learning environment. They also will have me manage most of my patients on my own. Basically as a 4th year medical student going into emergency medicine they will treat me like an intern and give me the same responsibilities to see how I perform. Obviously I will have an attending physician watching out for me to answer my questions and to be my safety net. Hopefully I will not need to rely on my attending physician too much.

This rotation will be stressful because it will be like a month long job interview. On the other hand it will give me the opportunity to see if I would want to go there for residency. It is kind of like a test drive for both the residency and the applicant. I am sure I will have a lot to write about.