The Exam

Just in case you were wondering, I've decided that I'm going to sit for my board exams in September. I've already paid the fees, and I *do* still have 2 months and 21 days left to study.

I decided that I would wait and see how I felt after the practice exams that my department was nice enough to organize for us this week. I didn't have high hopes, as I've done all of two months of emergency medicine in the past year and the last time I was in the emerg here was 11 months ago. That's a long time to be out of the swing of things. 

Well... I wish I could say that I aced the practice exams and that my confidence is back. But no. In fact, I failed two of the four orals. In one of them, I practically killed a patient. 

So why am I still thinking of writing the exam? Well for starters, I did really well on the written. And my strength is usually the oral. I'm good at thinking on my feet, less good at retaining minutiae that I don't use every day. So if I already have a pretty good base of knowledge for the written, that helps a lot. As for the oral... well, I sucked. I won't sugar-coat it. But one that I passed I managed to get through with very little knowledge simply by thinking my way through it, and the two that I didn't pass were for incredibly STUPID mistakes on my part. Things that when I'm actually confronted with the situation, I always think to do.

If you're curious, I forgot to ask about Viagra use before giving a cardiac patient nitro, and had to watch helplessly as his pressure bottomed out in spite of fluid bolus after fluid bolus. Finally I conceded defeat after starting him on two different pressors and crystalloids. Gah. The other case I failed because I didn't examine the scrotum of a young boy with RLQ pain and vomiting. I ruled out appendix and missed a testicular torsion.  Again, stupid mistake that I would never make in real life. Grr.

Basically it all went down in a way that made me realize that once I'm back in the emerg and getting back in the EM frame of mind, it will all be second nature. I *can* do this. 

Hearing that PGY-3 EM candidates have over a 90% pass rate made me feel better as well. Heh.

One more week until I'm back in emerg. It's been forever. I can't wait!

Adventures in Sitemeter

Every now and then I like to browse through the Sitemeter link at the bottom of my blog to see how people have stumbled across me. Today I'm laughing my ass off at some of the Google searches that have lead people to Tales From the Emergency Room and Beyond. 

My favorite? "Unrecognizable penis"

My husband's favorite? "Married to a doctor sucks"

Love it.

Introducing...

I've added a cool new blog to my blogroll called Mothers in Medicine. I poked around their site and found I could identify with an awful lot of what they're going through over there. I still find it hard to wrap my head around the fact that I'm somebody's 'mother'. Odd. But I am, so I might as well get used to the idea before the Bean actually starts calling me that. 

My Own Personal Hell

Remember my earlier post about being WAY too emotionally involved where children are concerned these days?

Have I ever mentioned how much teeth skeeve me out? 

So guess which emerg resident, currently rotating through anesthesia, got stuck in the pediatric dental room THREE TIMES already in the past two weeks?

Gack. I get goosebumps just thinking about it. 

Crap. Crap, Crap, Crap.

There are now exactly 3 months left until the emergency medicine board exam. I sent in my registration and payment ($2300!!!) a few weeks ago.

And now I am panicking.

This is not an easy exam. Right now, I haven't actually been in the emerg since last fall. And I've only done 8 weeks of emerg in my PGY-3 year. I will have completed only another 8 weeks by the time the exam rolls around. 

I've been actively studying since March. I didn't get nearly as much studying done as I'd hoped during mat leave (no big surprise), and it's been going VERY slowly since then. I have covered 1/6th of the material I need to. And there are things I'm definitely going to need to review more than once. 

My life consists of this: I wake up. I go to work. I come home from work. I play with the kidlet for a couple of hours until his bedtime. I put kidlet to bed. I study until I go to bed. I sleep (getting up with Bean overnight) and repeat the whole thing the next day. There is literally NO time for anything else. I don't watch TV. I don't read. I can't even go for a run without thinking that I'm wasting valuable study time. I am wondering if this life is actually sustainable for the next 3 months. 

Downside to not writing it this year? I'm not sure. I'd still be able to work without it. I'd have to check with the chief of staff here if they'd be willing to hire me without it, but I don't think it will be a problem. It would mean having it hang over my head another year. Mr. Couz thinks that it will be harder to write once I'm out of the study zone and in the real world, but I can't imagine it would be anything but easier once I've been out working for awhile on top of studying the theoretical side. I can't really think of any other drawbacks.

Downside to writing it this year? Having to push myself to the max to prepare for the next 3 months. Having to come up with the money to write it. The very real possibility of failing it on my first go-around, which will leave me in the same position as not writing it at all only $2300 poorer, and significantly humiliated. 

Gah. I need to talk to my program director. 

Gah.

I've now been back at work for 6 weeks, and there are two arguments I NEVER want to have again as long as I live:

1. That all emerg docs are not inferior clinicians who just triage people and refer everything without doing any actual medical management

2. That having my baby delivered by a midwife was NOT a stupid, irresponsible decision

Seriously, people. Just let it go.

Hmm. Didn't See THIS One Coming.

One of my strengths in emergency medicine is my ability to have empathy without getting emotionally involved. I'm not made of stone or anything, but I have never had the breakdowns that my friends and colleagues have. I don't fault them for it... if anything, watching their totally normal reactions to horrible situations (stillborn babies, terminally ill children, victims of abuse, etc.) has made me wonder if I'm the one who is defective in some way. I've been involved in many a traumatic situation, but when the staff involved are offered the chance to debrief and get counseling I've never felt the need. My husband is a wonderful ear for my complaints and shoulder for support, and I've never needed to look further. One of my first shifts here involved a code on a perfectly healthy toddler. She died. I appreciated how tragic it was, but it didn't affect me deeper than that in spite of the fact that I was pregnant and hormonal at the time.

Then I had the Bean.

It was like flipping a switch. My ability to stay impartial and unaffected has been completely lost. Having to reduce a trampoline-induced displaced fracture on a child nearly had me in tears of sympathy my first week back at work. Hearing another person's account of a case of child abuse that had presented to emerg made me so nauseous I thought I was going to throw up in the middle of an academic session. Today, just putting a 1 year old (who looked strikingly like my own kidlet) under anesthetic for a minor surgery had me choked up-- the child's confusion and tears, his agitation when he woke up in recovery, the anguish and helplessness on his mother's face as she rocked him before giving him up to the anesthesiologist-- I just couldn't stop thinking of my own son and how hard it would be to watch him be taken away by strangers and waking up confused and in pain afterwards.

I wonder if this happens to men.