Surviving and Thriving: Completing Transitional Year of Internal Medicine and Beginning Anesthesiology Residency with Matt Mclean MD

Episode Transcript
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Speaker 1 (00:07):
Hello everybody and welcome to the Off White Coat
podcast.
Today I'm bringing you one ofmy good friends back from St
George's.
He's been on this episodebefore, but it's been a year.
He's finished up his first yearof residency and now he's here
to share with us.
So, everybody, matt McLean,how's it going, buddy?

Speaker 2 (00:25):
What's up guys?
Hey Jordan, thanks for havingme back.
You know it felt like just ayear ago.
You know I was just starting aninternship.
Now I'm done and it's just awhirlwind of emotions and I'm
glad to be back and hang outwith you because it's been a
while.

Speaker 1 (00:40):
Yeah, dude, oh no.
You got to tell me all yourstories about intern year.
Now that I'm going into it, yougot to share with me some tips.

Speaker 2 (00:47):
Yeah, 100%.
I got everybody listening,everyone listening today.
Don't worry, I'll give you allthe do's and do nots of intern
year.

Speaker 1 (00:56):
It's funny that they call it an intern when you still
get paid In the business world,and any other time that there's
an intern I feel like theydon't get paid or whatever.
But in medicine we always haveour own terms.
You're getting paid $1,000 lessthan the other person but we're
all an intern.

Speaker 2 (01:14):
Yeah, exactly.

Speaker 1 (01:19):
But yeah, so give us a breakdown, because I know last
time you were excited and youhad let us know that you matched
, and you matched anesthesiology, correct?

Speaker 2 (01:28):
Yep.

Speaker 1 (01:29):
But you have to.
A lot of people don't realizethat when you do that you have
to actually do an intern year ininternal medicine and then you
can actually do your three Ithink it's three years of your
specific anesthesiologyresidency.
So kind of just give everybodya breakdown of what you had to
do to get into that residencyspot to begin with, because you

(01:54):
had to switch hospitals andeverything.
So just give us a little break.

Speaker 2 (01:58):
Yeah, so you almost had it because it's a little bit
.
It's a little different fromwhat you explained.
But basically with anesthesiathere's the categorical programs
where you can do all four yearsof the same hospital.
You know my old roommate, carlMiller.
He matched the categorical spotin SUNY Upstate so he's doing
all four years there.

(02:18):
Meanwhile, the program that Ireally I put number one on my
list, st Joe's Medical Center inPatterson, new Jersey.
I really wanted to go there.
I rotated there, I love theattendings, the residents there
and it's really close to home.
So I ranked it number one.
But they're not a categoricalprogram.
They were known as what we callan advanced program.
I'm not really sure why theycall it an advanced program,

(02:40):
because it doesn't feel as it.
You know it doesn't feel likethat.
But essentially when you'reapplying, you basically you'll
have your rank list and thatwill consist of both your
categorical and advancedprograms, all of your anesthesia
programs.
But they're going to have aseparate rank list called a
supplemental rank list andthat's just going to say if I

(03:03):
match an advanced program now Ialso need to rank and match into
a first year spot.
Now that first year spot caneither be an internal medicine
prelim year, which I just did.
It could also be a preliminarysurgical intern year, which some
people can do, and then there's, you know, transitional years

(03:25):
and things like that.
That I can't really speak tobecause I haven't really done
them, but there's many differentoptions on what you can do with
that first year and you knowit's just weird because each
program differs.
So you know, I'm talking withsome of my incoming class and it
seems like right off the batwe've already had some different

(03:46):
experiences.
So it's kind of interesting andI can't wait to meet them.

Speaker 1 (03:49):
You know, just yeah, yeah, it's very weird to even
with all the different aspectsof medicine, like where you have
prelim surge and the surgerylike they kind of want it's
prelim surge, and then you're incategorical, but in other
specialties there's a wholeadvanced and then other other
programs don't have any of that,and so you really have to know

(04:14):
the ins and outs, which isreally difficult if you're not
going through it all.
And so, yeah, you've got to.
It's very, very exciting,though, that I can't imagine
someone going prelim surge andthen doing all that up into
their antecedent, like you know,like you're not going to be a
surgeon, but you're having to doall that scutwork.

(04:35):
I'm glad.

Speaker 2 (04:35):
I'm a scutwork yeah.
That's what I only applied forinternal medicine prelims.
So I didn't do.
I didn't apply for any surgicalprelims or any.
I didn't really know much abouttransitional years, so, where
they call them TY's, I didn'treally apply for any of those,
you know, because there's somany programs out there.
So for anesthesia I applied to,like all of them in the country

(04:58):
, but when it came to myinternal medicine prelims I only
applied to the New Jersey andNew York area, since I knew I
wanted to stay in, you know,near home, you know.

Speaker 1 (05:08):
Yeah, and that's something I guess we need to
explain too is that when you'redoing the match process and
we've kind of talked about it onthis podcast, a little bit
about, like how all that worksbut you have to apply to the
programs you want for anesthesia, get into those programs, and
then you also simultaneously,right, have to apply prelim IM

(05:30):
to make sure you get into one ofthose as well, so that you can
have both of those covered bythe time it goes correct.

Speaker 2 (05:39):
Yeah, that's right.
You know, like, like Imentioned there's, there would
be two, there would be two ranklists for your anesthesia and
your supplemental.
Now, if you had all categoricalanesthesia programs, then you
wouldn't, you wouldn't reallyneed that first, that
supplemental list, because then,like Carl Miller, you could
just do all four years at thesame spot.
No, no problems at all.

(06:00):
But you know, then some peoplerun into situations where maybe
they only match advancedanesthesia position and they
don't have a first year position, or the opposite, where they
match a first year position andthey don't match anesthesia, in
which case they would have toreapply for anesthesia the
following year.

Speaker 1 (06:19):
Yeah, exactly, but that was to say it's super
ballsy to just go okay, I'm justgoing to do categorical and not
provide my.
I mean, people are.
When you're doing this wholematch process, it's
nerve-wracking, as it is likeyou're putting out as many
fillers as possible and soyou're going to have to apply to
essentially everything.

(06:40):
So it's just crazy.
So you have to pay for all ofyour prelim.
Do you have to pay for theapplications for the prelim, im
and anesthesia?

Speaker 2 (06:50):
Absolutely yeah.
So it gets expensive.
So you know, with anesthesia Iknew that was like my number one
and only I knew that's what Iwanted to do.
So I didn't want to.
I didn't care about the moneyin that aspect.
I applied to all the programs,but with prelims.
I figured you know there's alot more programs.
So that's why I kind ofnarrowed it down to like a

(07:13):
regional area.
So you kind of need to, whenthinking about ranking or
thinking about where you want toapply, when you're getting
ready to that point you got tothink how competitive am I?
You know, what type ofspecialty am I getting into?
You know you, sometimes you dohave to consider what med school

(07:33):
you go to, like you know for us, like we'll SGU, you know
students, you know some.
Some states, some regions aremore IMG-friendly than others.
But in this case I said, look,I'm going to put all my cards on
the table applied to everysingle program.
And even though I did, it'sactually crazy.
I only got interviews on theEast Coast, I didn't get

(07:55):
anything on in the Midwest andnothing in the Pacific Coast.
So it's like it's a gamble.
But at the end of the day, ifyou really want to get to the
nitty gritty and you want tosave money.
You're really going to have tofigure out those, those kind of
concepts.
How competitive is my specialty?
What are my scores like?
How you know how competitive amI?
And you know what region do Ipreferably want to live in?

(08:21):
But usually it's kind of atrade off.
It's either I rather want to bein a very competitive specialty
and I don't care where I wantto be.
You kind of you don't get both.
You know what I mean.
Yeah, you can either pick yourlocation or pick how competitive
you want to be.

Speaker 1 (08:36):
So exactly, yeah, you don't.
I just buzz, I can't just belike, oh okay, I'm going to have
this program and they're justgoing to fall all over me,
because whenever match day comes, you're ranking this program
and like, and they say it, Iread this book or whatever.
Or when I was going through theapplication process and it said

(08:59):
60% of all programs lie to theapplicant about where they are
on the rank list.
So even if you're just socertain, pre-enduring the
interview process, which youdon't even know, you put out all
these applications and sendthem to all these programs
because you want it on day oneand then they let you know if

(09:20):
you get an interview.
So, hem forbid, you only pick,you know, in New Jersey and you
don't get an interview rightaway.
Then you start putting outapplications in other places.
Well, you, you don't have it onday one now, you just wasted.
So it.
It's a weird role we have toplay, like in medicine, where

(09:40):
we're just like, especiallyduring the match, like no wonder
it's so stressful becauseyou're having to, just like all
the timelines are all set andyou have to have everything in
and it's really just a game yougot to play.
So it's better to know the gamethan to assume that you are the
best player at it.

Speaker 2 (09:57):
Exactly.
And so all the listeners outthere you know, especially if
you're like, coming at the endof your third year, start of
your fourth year, I got to sayit might seem like an expensive
year but it's all relative, youknow.
You got to just throw whateverto the wall and see what sticks
and don't worry about the moneyright now.
Everything sounds like a lotright now but in time, you know,

(10:21):
you'll pay everything off andyou'll you know you'll make a
decent salary.
So I guess what I'm trying tosay is just try to keep a pretty
broad sense of you know.
If you really want this certainspecialty apply everywhere, you
know, and if you don't get thelocation you're in, then you

(10:41):
have to make a decision.
But you'll be okay.
Just try to put your name outthere, you know, out into the
universe, and hopefullysomething will happen.

Speaker 1 (10:51):
You got to, I did the same thing.
I shot very wide or cast a verywide net, and that was the
whole point of that was for oneto get my name out there,
because I didn't know whatprograms there were going to
want me.
And I was actually relativelysurprised in the fact that a lot
of the programs because I didmy training either up North or

(11:14):
Superdown South, like in Miami,and not in Georgia, not in
Mississippi where I'm at, not insome of these other Southern
places, and so I put thosebecause those were like
obviously closer.
But I mean, I think I only gotone specialty or one interview
in Georgia at all, but I got alot of other Southern states

(11:38):
that wanted me to, you know, orwanted me to interview there.
So it was you can't predict itat all Like I thought for sure,
the one place that was rightnear my hometown.
I was like, oh yeah, no chance,there's even, or there's got to
be a chance, we have a personthere that's speaking for me,
blah, blah, blah.

(11:58):
And then that didn't work out.
But then there was all theseother better programs, because I
cast a wider net and it allowedme to pick the one that I
actually really liked instead ofnarrowing it down because we
don't know.
You don't really know.
First off, if you're a medicalstudent, you don't know how

(12:20):
they're going to treat.
You may have done a rotationand you've seen kind of the
inside, being a house officerand everything, and you can
speak more to this too Likepeople are treating you
differently than the medicalstudents significantly, and
there's a whole different roleand there's a whole another bag
of tricks that you gotta have.
So, yeah, you gotta really justplay the game.

Speaker 2 (12:45):
Yep 100% 100%.

Speaker 1 (12:48):
So, but walk us through.
So you've officially finishedthat first year of residency.
How was it, mike?

Speaker 2 (12:57):
It was a whirlwind of it's one hell of experience,
let me put it that way.
So I finished my internalmedicine pre-lingure at Jersey
Shore University Medical Center,which is part of, like, the
Hackensack Meridian Network, ifanyone isn't from the New Jersey
, new York area.
What I really loved about thisplace is that the people there

(13:22):
were very welcoming andaccepting, and I'm not even just
talking about the residents,but I'm talking about the
attendings, the nurses, all thestaff.
It was very welcomingexperience.
I started day one, july 1st, inthe ICU.
I think we remembered that wewere speaking about that last
time we were here and I was soscared it was my first day at

(13:43):
you know, june 30th, I'm gettingsign out for the following
morning, on July 1st, and myhands shaking while I take sign
out and you know, first thing inthe morning I came in super
early, 4 or 4 30 in the morning,and I go to one of the
patient's rooms and you know hehad OptiFlow on and everything
like that, and I'm, you know, oh, good morning sir, how are you
doing?
And he's like, oh, chest pain.

(14:04):
And I'm like freaking out, like, oh, my God, you know it.
Just it all hits you at once.
But you gotta just realize thatI mean different programs.
You know it can depend on howsupportive they can be.
But you gotta at firstdefinitely look to your seniors.
Don't necessarily depend onthem for everything.

(14:25):
Try to, like you know, figurestuff out on your own, because
that's how you learn.
But look to them becausethey've probably been in a very
similar situation from you andmaybe they won't fix your
problem, but they'll tell youwhat to do and they can and they
can help you kind of.
So you don't need a panic, youknow.
So I was blessed in that aspectand once I started in ICU, I

(14:47):
actually loved it.
I don't.
Icu was actually one of myfavorite rotations.
Everything else kind of seemeddownhill from there and I was
like, okay, cool, after you dolike ICU, after you do your
little, your night floatrotation, what have you?
You kind of feel like all right, the majority of everything I
can kind of handle.
And then floors, depending onwhere you're at, it, is a lot of

(15:10):
social work.
A lot of people are like I needto study, I need to do this, I
need to do that.
I think the best way.
My first attending told me dayone of ICU.
He said, my expectations for youare very low.
I don't care about how much youknow, I just want you to learn
the process, learn the routineand just get to know how the

(15:32):
hospital kind of functions andyou kind of feel like you have
an idea at med school as amedical student on rotations,
but it really becomes differentin residency.
So take it easy.
Don't go crazy doing questionson your world and looking stuff
up on you know, online med ed,because a lot of it it's just

(15:53):
gonna come down to kind of likestreet smarts and I don't mean
it like so informally, but a lotof it is kind of how do I get
through these hospital problems?
How who do I talk to, like youknow, about certain issues like
that and not so much about themedicine.
You know the medicine is kindof like a lot of it you're gonna

(16:16):
know already and if you don't,you can quickly look that up.
So I would just say you knowit's gonna take a little bit of
time to get that like runningstart, but you should be good to
go after that.

Speaker 1 (16:29):
That's the whole beauty of it is that most of it
is you've been learning themedicine.
You've seen it.
There's gonna be some smallcases, I'm sure I mean every
time I've ever been in anyrotation I've seen something
that I wasn't very comfortablewith, and then you keep seeing

(16:51):
it over and over and over again.
But eventually the biggestproblem is not gonna be the just
you not knowing enough.
It's gonna be like what you'redo when things get really sour,
or who you go to, or, and sothat's what I'm hoping that I

(17:12):
can navigate well whenever myyou know, in the upcoming year,
because you know you gotta make,you gotta endear yourself to
the nurses, you gotta do allthis other stuff so that you
don't get left out to dry.
Yeah, and so we will.
We shall see on that one.

Speaker 2 (17:32):
Yeah, and on the same token too, you know, especially
with internal medicine again, Ican't really speak to surgical
prelims as much or transitionalyears but in internal medicine
prelim you're gonna be speakingwith a lot of different
consultants, especially in thefloors and in the ICU.
The consultants always comes in.
They always write theirprogress notes.

(17:53):
You kind of follow along aboutthe recommendations and if you
have a question, sometimes youdon't need to look it up, you
can just ask them.
They're part of the medicalteam and they're providing their
treatment and theirrecommendations.
So you can ask them wait, whyare we doing this?
Blah, blah, you know, andobviously introduce yourself.
That's like the number onething you need to do as an

(18:14):
intern.
Like some of the nurses, theywould have like a bad impression
of certain interns if they juststarted putting into orders and
doing things without evenintroducing themselves.
So you know, make sure I wouldalways have, you know, some gum
on me or something like thataround during rounds, things
like that hey, you want a pieceof gum?
Oh, what's your name?

(18:35):
I'm Matt, things like that.
Yeah, it's like it doesn't needto be so formal.

Speaker 1 (18:39):
Like hi, I am Dr McClain you know just be like
hey, I'm.

Speaker 2 (18:41):
Matt, you want a piece of gum?
Blah, blah, let's talk, how areyou doing.
And then they, when they getthat good first impression of
you, that's like an excellentrunning head start Because they
a lot of the times it's likesometimes, like the nurses, are
no more than what's going onwith the attending sometimes,
because they'll come to you andbe like hey, matt, you should

(19:04):
check this or you should maybereplenish that or something like
that.
But if they don't like you,they're not gonna remind you and
they can make you look bad.
So yeah, I definitely think youknow it's the first thing in
the morning, even if you'retired 4 or 4.30 in the morning,
whenever it's time you get there, just be like hey, good morning
, you know, I'm Matt, blah, blah, blah.
And then from there people willtalk and they'll be like oh

(19:27):
yeah, that's like the reallynice intern, you know, and
that's how you want to be known.

Speaker 1 (19:31):
Yeah, that's a great piece of advice, because and
they always say, endure yourselfas a nurse, but you don't
realize how much they will talkto once you're not there.
Like everybody will continue todiscuss your performance
whenever you're not standingthere.
And the last thing you want isfor the attending to be like

(19:54):
well, I mean, I think he'spretty competent, and then a
nurse go no, he's not, I've beendoing whatever, or there's been
these issues, and then theywill definitely believe exactly
what was just said to them overanything that you've done.
And so the last thing you wantis and I mean I would too if I

(20:16):
was the attending I would trustthe.
You know like, just becauseyou're showing me something,
it's all the other people aroundyou that are gonna attest to
your leadership or how well youtreat other people.
And if they go oh, he's nice.
That means the world for them.
They go, okay, cool.
Like he'll make it then Like,instead of them talking bad

(20:37):
about you so.

Speaker 2 (20:38):
Yeah, and you know, sometimes the nurses always got
your back.
They've seen, you know so manydifferent things.
You know they've been in thefield for you know some are just
starting out, some been fordecades, so they've seen a lot
and they can really help you out.
But on the same token, let'syou know, sometimes you will get

(21:00):
pages and the nurses likereally questioning you, like you
know, hey, why are we doingthis?
Are you sure we wanna be doingthat?
Or something like that.
Sometimes you don't getdefensive.
You know a lot of people likeyes, like they'll just like yes,
we're doing this, that's final,we talked about it in rounds.
Blah, blah, blah.
Just be like what kind ofquestions do you have about it?
And maybe you don't need togive them a lecture on it.

(21:22):
Just be like yeah, this is thereasoning while we're doing this
, that and the other.
Once they have the reasoning,they'll feel comfortable with
you making more decisions in thefuture.
And then I'm like, okay, cool,he knows he's able to
communicate his thoughts, asopposed to just saying, yeah,
the attending told me to do it,or that's what we talked about
in rounds.
Cause then they're gonna feellike, oh, he's just like the
messenger about what we're doing, but not can't give me the

(21:46):
explanation itself herself.

Speaker 1 (21:48):
And it's amazing how just asking somebody without
saying this is how it is, butyou just asking somebody, even
when you're speaking to patientsand stuff like that too, like
what is your concern withwhatever's going on?
Like, just please, because itmay not be.
Because sometimes we think waytoo hot, technical, and I know

(22:11):
I'm a victim of this where ifsomebody's questioning something
that's going on, I'm like, look, I know, you know, that's this,
this, this, and they're like,well, I don't care about any of
that.
It's actually the fact that hecan't pay for it or whatever.
You know, it's like it hasnothing to do with that.
But if you start going on thispreset rant about things because

(22:34):
you think you're right, youalmost prove yourself wrong.
And so asking somebody what istheir concern or what, why, oh
yeah, like what, what would beyour concern about this To a
nurse or the patient or anything, and they they might just be
like they might prove that itmay be a teachable moment where

(22:54):
you could help them and honestly, it could just be a way to
endure yourself and not turnaround and look, you know, like
foolish, like they could besomething.

Speaker 2 (23:03):
Exactly, and it doesn't need to be in a
patronizing manner either.
It's not like well, I learnedthis, this, and it's not.
It doesn't need to be like that.
Just be like oh yeah, we'redoing this because this and this
and that.
So it doesn't need to feel likeI'm like superior to you.
You know we're all in ittogether, so we don't need to.
I think it's not even just whatyou say, but the how you say it

(23:24):
.
And you know sometimes, youknow maybe in the middle of the
night you're on night float,maybe you're a little cranky,
but just try to keep in mindthat they're also awake too, so
they're also probably equally ascranky.
And again, you know you got towork as a team and that's how
it's gonna work.
It's gonna work out well.

Speaker 1 (23:43):
That's the one thing I've learned about being married
is, even if I'm in a rough spot, if I start acting cranky, that
level that MB can get over me.
If I'm rude, she can be worse.
No, she can't.
It's the same way in a hospitalLike.
If I'm like passive aggressive,I know for a fact that there is

(24:04):
no like.
Mine is super low level anyway.
And so if somebody upset, I'mlike, oh man, dude, I messed up
there.
I shouldn't have even pokedthat there.
But yeah, so then, dude, so I'mglad you made it through, you
survived.
Are you happy to be switchingto the new hospital?

Speaker 2 (24:26):
Because now, you have to do a whole.
You have to move, yeah.
So, luckily enough, I you know,when I gave my vacation
preferences to the chiefresidents last year before I
started, I kind of anticipatedthat I was gonna have to move.
So I kind of told them look, Iwould prefer to have a few weeks
of vacation in June or towardsthe end of the year, just so I

(24:48):
can move.
I know it's not really a farmove it's about an hour from
Neptune, new Jersey, to, youknow, st Joseph's in Patterson,
but I'm living near there, soit's not that far.
But I knew that I was movingfrom like a small studio and now
moving into a house.
I'm actually moving back intothe house I grew up in.
I'm just gonna rent from my mom.

(25:09):
So it's kind of a nicesituation.

Speaker 1 (25:15):
And it feels like it up to you Coming for that rent
dude.

Speaker 2 (25:18):
Yeah, right, yeah I know my mom's in North Carolina,
so I'll have the house tomyself, which is nice.
But again, you know it's ahouse, so I'm gonna have a lot
of responsibility.
That's why nothing's really puttogether right now.
And you know, but hopefully ifwe ever have another podcast
together, it shouldn't look alot better my mic set up and
everything.

Speaker 1 (25:38):
You gotta ask the I guess it's not the renter.
What do you call the personthat owns the house?
Whatever you gotta, hang someclothes and stuff.

Speaker 2 (25:50):
Yeah, yeah, yeah, so, yeah, exactly right.
So it definitely feels reallynice and, again, I really
enjoyed my year at Jersey Shore.
But you know, I know kind oflike my personality and I know I
would not be the best fit forinternal medicine for the rest
of my life.
So I'm glad to finally be done,done with the progress notes

(26:15):
and the discharge summaries andpre-rounding and all that stuff,
you know, and you know it'sgreat is that I'm still not that
far.
So I'm still friends with allof my co-residents and I've been
trying to like organize alittle barbecue here in my
backyard.
So it's cool.
You know, even when you move on, you still make connections

(26:37):
that last a lifetime, you know.

Speaker 1 (26:39):
Yeah, dude, it's, I've had that.
You're like, ah, finally I canshake off like all the internal
medicine.
And I mean I'm glad that you'refinally.
I mean because essentially youwere dead set on anesthesia.
That's the weird thing about it, is you?
You're like I want to do onething and they're like, okay,
cool, well, to do this, you'vegot to do this for a year.

(27:02):
And you're like, oh, okay, thisis totally not the job I'm
signing up for, but I'll giveyou good insight on how the
whole hospital and everythingworks and it's you know you're
getting to speak to all theseconsultants, which I guess we
didn't really talk much on.
But it is amazing, theconsultants like reading a book

(27:22):
and then asking somebody who'sbeen practicing for 30 years
they are way better at whetherit's reading X-rays or reading
CTs and all that like imaging,just understanding the concept,
like they've been doing it waylonger they could they knock it
out, no problem, and you'lllearn way more than you ever
would just dissecting a book.

(27:43):
But the yeah, just I know thatthere's importance to it, but
you've got to be living largenow getting to go in and finally
now you're it's funny becauseyou were an intern but now
you're technically starting offyour first anesthesia.

Speaker 2 (28:01):
Yeah, so, like when I was like a medical student, I
would ask someone like theanesthesia residents.
I'm like, oh, what year are you?
And they're like, oh, what doyou mean?
Like I'm a PGY3CA2.
And I'm like, oh, what doesthat mean?
You know?
But so exactly.
So now I'm going to be a PGY2post grad year two, but I'll be
a CA1, clinical anesthesia one.

(28:21):
So you know, they just keepadding all that.
So my last year would be aPGY4CA3, unless I do fellowship,
you know.
So that's kind of how it works.
And you know a lot of peoplethink you know a lot of these
first year spots are kind of thesame, but it really depends on,
like, like I mentioned, thedifferent types and location and

(28:44):
things like that.
I was just talking with myincoming class and they seem, we
seem like we've had differentexperiences to like.
Take my old roommate, carlMiller, for example, like I said
, that he's doing a categoricalprogram at SUNY Upstate.
I think he mentioned he gotabout three, three months of
anesthesia in his first year.

(29:04):
I got zero days of anesthesiain my first year.
So that's a huge differenceright off the bat.
And you know other people, youknow they're doing way more
floors like I did.
I would have to think about it,but I think I did about maybe
four or five months of floors.
Some people might think that'sa lot, some people will think

(29:26):
that's a little bit right.
I didn't have much electivetime.
I practically had no electivetime.
One thing that I really wishwould change, because for
anesthesia, prelimbs wererequired to do, even if we're at
a categorical or not, I thinkit just by the ACGME, I believe

(29:47):
we need one month of emergencymedicine, which is what you're
doing right.
But again, that changes byprogram.
And what I mean is, for example, here at Hackensack, maine,
there's that actual emergencymedicine residency program.
When I was a med student Iwould see that anesthesia, you
know, first year with theemergency medicine residents and

(30:09):
they worked pretty cohesivelytogether.
But at George Shore for exampleand I'm not saying this to like
point fingers or, you know,blame anybody, I'm just like
giving examples of somedifferent you know discrepancies
in programs at George Shore,but still part of Hackensack
Emergency Network, there isn'tan emergency medicine residency

(30:30):
program there.
So I and the other anesthesia,you know, internal medicine
prelimbs we would be withattendings directly and every
day is a different attending andthey all had different
expectations.
Some of us some of them wantedto wanted us to be like third
year medical students getting anHPI and this and that and the

(30:52):
other.
The other ones were like hey,just go practice your lines, go,
do you know, profile, whatever.
So it didn't feel as cohesiveand structured as I would say,
for example, hackensack, maine,where you're working with
residents.
So it seems like you knowwhat's the word, you know.

(31:13):
It worked better, yeah, yeahthe.

Speaker 1 (31:17):
It's weird how each hospital for one is drastically
different, and one can be very,very beneficial for your
learning and then the other onemay like what you're saying,
like you're there for anesthesiaand actually you know the
anesthesia sometimes plays avery critical role in the

(31:40):
emergency room.
Like sometimes you have to comedown to come to like you could
be doing that role, but insteadyou're because there is whether
it is like there's not a wholeprogram set up for teaching
students, and that's probablywhat it is Like, because they
know they have emergencyresidents and all that.
They've got that whole programset up.

(32:00):
They can go ahead and justallow the anesthesia people to
do whatever they want.
I know that that's the way Imiss to be to like there's a lot
of people rotating in the ER,as it is, along with the ER
residents.
So it's more like, okay, we'lljust get our residents to do
like the, the ER stuff, and thenyou can just do whatever.

(32:23):
But if it's not that way, thenthey're expecting you to just do
, well, essentially what theresident would do if they
weren't there.

Speaker 2 (32:34):
So you'll get like different experiences and I'm
not trying to change anything,but I think that you know
anesthesia prevails.
At least they should have like arotation of just lines, whether
that's ultrasound guided, ibs,a lines, central lines Because a
lot of the times I feel reallycomfortable with intubations

(32:55):
During this year I got tointubate during codes, during
rapid responses I feel verycomfortable in that aspect I
don't feel comfortable in lines,and the reason why is because a
lot of the times when you'rethe intern and during the day
you're writing notes, you'retalking to consultants and
nurses, you're talking withfamilies and then maybe you're
on long call Now you got thephone, people are paging you the

(33:17):
last last thing you have timefor is to gown up, you know, get
, get all the materials ready,sterilize, you know, and get
ready to do a central line.
That might take maybe, if you'renot, you know, experienced with
it might take upwards half anhour, 45 minutes, you know, and
people are paging you and thingslike that.
So I I felt like it would notbe appropriate for me to do that

(33:41):
and usually my seniors would bethe ones that you know.
They would have more time toget their hands on skills while
I'm kind of answering the pagesand things like that.
So I think that you know if, ifa program offers some elective
time, I definitely think ifthere's any way that you can do
lines and you're going intoanesthesia, that that's
definitely very beneficial youknow, yeah, and it could just

(34:05):
even be that the attendings inthe ER or in these other places,
they don't realize the, andit's no insult to them.

Speaker 1 (34:16):
They just might not understand like how and like how
you would learn anesthesia,like how you what you're
comfortable with, what you needto practice to be a good one to
begin with, and so they're just.
You know, that's like if you,if I go into an eighth grade,
you know social science, socialstudies class, I'm like I don't

(34:37):
know what you need to studyright now.
You know, I don't even know.

Speaker 2 (34:40):
Yeah, exactly.

Speaker 1 (34:42):
So even though I did that class and I know
essentially what, I wouldn'tknow where you're, where they're
supposed to begin.
So I think that, yeah, like Ithink at least all be more aware
now that you're saying, that ifthere is, if I have that
opportunity, I definitely willtry to think about that because

(35:05):
the because if you're prelimanesthesia and they might just
see as prelim IM, they may noteven do as anesthesia.

Speaker 2 (35:13):
Mm, hmm.

Speaker 1 (35:14):
That they are.
You're just an IM guy that'scoming down there.
They're not even paying anyattention, and so you've got
this.
Yeah, like I don't know thebest way to solve that one, but
the.
I think that it would bedefinitely conducive to your
education to, because that'swhen you were an ER resident and

(35:34):
you go to the ER, they're justgoing into bay as much as
possible, like that's all weneed you do, we don't need to do
anything else.
Yeah because that's what you'regoing to do when your job comes.
You're not going to put lines,and so it should be the
reciprocal should be back.
You're giving back.

Speaker 2 (35:52):
Exactly, yeah, yeah, and so I guess that's.

Speaker 1 (35:55):
I mean that's I guess that's just something you got
to be aware of is that and youdo an IM to?
There's a lot of like that wasthe one of the reasons I didn't
like my IM rotation is that I amrotations because I was just I
was just doing paperwork andstuff and I didn't do.
There was a whole month, onetime where I was doing and I did
like one radio stick orsomething.

(36:16):
I did nothing else beyond thatand I was just running around
the whole time like gettinggetting information, bringing it
back to typing nodes, you know,calling somebody if they need
it, and you're just running.
I mean it's a lot to run thathospital and I understand it.
Yeah, as far as me and you,we'd like to be more hands on.

(36:37):
We want to do.
That's why we signed up for thethe gift, exactly, exactly.

Speaker 2 (36:43):
Yep and so I wonder if there's a better way.

Speaker 1 (36:47):
But being prelims are when you're running.
I mean you get your hands onthat.
You would be.
You would be dead.
Yeah, I don't know if that'sthe best way either.

Speaker 2 (36:58):
Yeah, exactly, but yeah, so I was.
I was gonna, you know, move onto the next you know piece of
advice going into intern year,which I would definitely say is,
you know, organization andefficiency, because I try to be
very organized but sometimes youknow things can get really busy

(37:22):
really quick and then nothinggets done.
So what I did, you know, to behonest, when I was kind of
driving down there to kind ofmove in, I would kind of listen
to like YouTube videos to justkind of hear like different
pieces of advice to stayorganized.
So I probably wouldn'trecommend getting those med

(37:43):
student kind of H&P books.
I don't think that wouldnecessarily work, but I
definitely think, you know colorcoded pens work, different kind
of ways of getting your to dolists.
I feel like when you print out,let's say, like your for
internal medicine, you print outthe list of patients and you
put like a little square on onecall, like little squares on one

(38:07):
column of things to do and thenput a line through it with
different colors, just to keepmake sure that you don't forget,
because a lot of the times withinterns the seniors are not
going to remind you you're goingto be, you know on rounds
you're going to go over exactlywhat's going on, what the case
is, and they'll expect you to bekeeping tabs on what we're

(38:29):
talking about.
And then when you run the listlater in the afternoon it's like
hey, did you call this personto be?
Did we get follow up on thisand that?
So the best way I would thinkis color coded pens, make sure
that your list is updated andthen try to make it neat, not
too much extra, becausesometimes I'll come with a big
one liner maybe jot down someimportant stuff.

(38:52):
You don't need to write thewhole HPI on your list, you just
need to know the most.
You know important thingsbecause you can always just sign
into the computer and look at.
The other additional thing, andthe other big thing I think is
definitely like a portable phonecharger, especially for long
call.
They didn't give us someprograms give you like a phone.

(39:13):
They only gave us a phone forlike CCU and like certain
rotations, and so to the mostpart we would get pages through
an app on our phone called zipit, so it'd be our personal
phone.
So if your phone's almost deadand you can't just leave your
phone on the charger and go to apatient's room.

(39:34):
We need to keep it on you.
And again, I'm not, I'm notsponsored.
I don't have any particularrecommendations, but any.
You know.
If you read the reviews, seeyou know good, portable charger,
that might work for you.
But yeah, those probably thetwo main things.
I think is definitely portablecharger, go into color coded

(39:55):
pens and a good system to writedown your follow ups and follow
up on them.

Speaker 1 (40:02):
When you have your color coordinated pen
coordinated pens, do you havethe little like where there's?
Like a red, a blue and a yellow.

Speaker 2 (40:09):
I think those work the best because you don't want
to have five different pens inyour pocket.
But if you have like one ofthose good ones, or you can just
change it to red, to blue, togreen, to those.
I think they work great and youcan make your own system
exactly oh, green meanscompleted or blue means
completed, whatever works foryou.
But just so you don't forgetanything, because sometimes when

(40:31):
you're on long call and theshort call interns says hey,
follow up on this, that and theother oh crap, I didn't follow
up on this H and H now have torush, do it.
You know, maybe write that inred, you know, so it stands out
a little more.
Just so, you know.

Speaker 1 (40:47):
So nothing gets, you know, missed on, you know and
yeah, yeah, and you don'trealize to like, and for anybody
that's listening, this is Someof this work.
You have it in your mind thatyou're going to do it.
You immediately make a call andthen it doesn't work out.
You leave a voicemail.
Now you're just waiting for thevoicemail to go through and

(41:09):
then to call you back.
So it's like I understand itactually makes perfect sense,
like where you could make, likeyou know, like I'm halfway
through this task because, like,sometimes you see it again,
you're like, oh, I've made thatcall now and it's just a lot to
remember all at once.
And then other people arecalling you and you're still
waiting.
And if those people don't evercall and you forget to call them

(41:30):
back, then you just you'resitting there looking like an
idiot when everybody startsasking like what happened?
And so, yeah, I think the colorcoordinated pens is great.
I will say, when you weretalking about the portable
charger too, I've gone on justlike Google and Google like top

(41:53):
portable chargers or whatever,and there's so many reviews and
everything where they listed allout Maybe don't click the first
one, which would probably be anad, but like, sort through it
and find where they're rankingthem and there's because what
you want to, I found ones like.
When I moved to Grenada I gotone that was kind of hefty but

(42:13):
it lasted for like four days andit could charge anything, but
you wouldn't want to take thaton shift with you.
It was, it was bigger.
So you want to find one that'skind of portable, that you can
shove in your pocket, in yourscrub pocket or whatever, and
then also be able to yeah, thatI can't.

(42:34):
I didn't even think about theportable charger because I
forget how many times they callyour personal.

Speaker 2 (42:39):
They don't.
I mean, maybe your programmight give you an actual phone.
Again, there's too manyprograms out there and there's
so many different differences,so you just need to make sure
that you're ready, you know,because maybe you might hear
from your friend oh yeah, theygive us this, that and the other
, and you're, you know you'reexpecting that, but just try to
not expect anything and then beprepared in that type of

(43:01):
situation.

Speaker 1 (43:02):
Yeah, my phone stays about to die.
I mean, it's probably about todie as we speak, so I definitely
understand.
Yeah, that's a very good one,are you?
Are you excited to meet, likeyour new co-residents?
Because, like you were saying,like there's all these different

(43:23):
backgrounds.

Speaker 2 (43:24):
Yeah.

Speaker 1 (43:25):
And so.
But now you're all going tocome in and be like fresh in the
pot.
Yeah, exactly.

Speaker 2 (43:30):
Like my class at Jersey Shore.
There's a 30 PGY ones.
Now we're going where I'm goingnow in St Joe's there's only
eight of us of the incoming CAones.
So it's pretty cool.
I mean, I love, I still love,my, my, my PGY one class at
Jersey Shore.
We still have group chats, likeI mentioned.

(43:50):
We still talk and stuff likethat.
And even the new CA one classwe have kind of a group chat,
even though we didn't meeteverybody in person, but we're
kind of like you know talkingabout, you know when we should
meet up and and hang out and getto know each other and stuff,
you know, like T-shirt time.
Yeah, exactly Right.

Speaker 1 (44:09):
Jersey Shore.

Speaker 2 (44:11):
Oh yeah, jersey Shore reference, but yeah, no, we
were like thinking about gettinglike matching.
You know what it is,patagonia's or whatever you know
.

Speaker 1 (44:19):
Oh, dude, I could have sworn you were talking
about getting matching tattoos.
I was like.
I was like, yeah, no, like this.

Speaker 2 (44:26):
You know some some of the classes do that.
Really I like no one reallywears those white coats.
You know some of them do.
But some of those hospitals arecold and sometimes those
Patagonia's or North facesreally keep you warm.
The resident.

Speaker 1 (44:41):
Resident got to success.
You're going to need aPatagonia or some kind of light
fleece.
Yeah, the name that says you'rea doctor on it still.
Yeah, I found that people don't.
Even if you're wearing like awhite coat, people don't assume
you're the resident at all Like.
But if you're wearing a lightjacket and your scrubs as even
as a medical student like,people would be like oh, are you

(45:03):
the resident?
And I'm like yeah, no, no, no,no, no, no, no.
That's down there.

Speaker 2 (45:06):
Exactly.
They kind of have like animpression of you when you're
wearing your white coat.
They're like, oh, look at thisguy.

Speaker 1 (45:12):
Yeah, exactly.

Speaker 2 (45:15):
But everyone wears one on day one, it's no issue.
I just thought that it was ahassle to keep clean.
You know I didn't have time togo to the dry cleaners.
You know a lot of the times I'mrunning from here to there.
I don't want to lose it.
So I just I to be.
Personally, I never wore it.
But I have a question for you.
What do you think is for?
I don't know anything aboutemergency medicine, like the

(45:36):
residency program, but do theylike break you up into rotations
?
How does that work?

Speaker 1 (45:41):
Yeah, so they definitely do that.
So we have there's like 16 ofus going into this program and
we all start differently.
Now there's going to be acouple of people and the first
month we actually do this wholeand that's why I had a little
bit of free time that we coulddo this episode we have this
first month where we essentiallyjust do skills training, like

(46:02):
we're not thrown into the fire,but then after that we're going
to split up to where you've.
I think we've got MQ,cardiology and I think trauma is
second year.
So maybe it's not then, butthere is, yeah, you essentially
do rotations throughout thehospital and I think but I'll

(46:25):
start in the ER and we'll.
You'll have like three or fourmonths in the ER and then the
rest of that whole year is goingto be in different parts of the
hospital, which is funnybecause you have the three years
as an emergency resident andthe first year, you know most of
it, you're in a different areaof the hospital.

(46:47):
Anyway, you're not even in theER.
Yeah, you're getting trainingthroughout that whole process
with it, but it's justinteresting.
And then they.
So we will like well, we'll doessentially the same thing with
IAM, like where you bouncearound and do rotations, and I
think anesthesiology is a firstyear rotation, yeah, and then

(47:11):
we'll.
But I'm kind of excited toofficially start in the ER One,
because it I will be.
It will give me a for one, achance to get to understand how
the system works and that's likewhere I'm going to be.
But also the expectations willbe at an all time low, like if
you have, if you had to do allthe other rotations first and

(47:33):
then you went to the ER by monthsix.
They're, they're expecting,they're like what are you doing?
You know, like this is thefirst time I've ever been down
here.

Speaker 2 (47:43):
Yeah, yeah, so, yeah.
So it's almost a blessing whenyou get to start where you kind
of want to be, because then youknow you're going to get a
little bit of extra help, alittle bit more lenient, and you
know all the, all, the, the,the flak won't be be put on you
all the time.

Speaker 1 (48:02):
I mean it's still be tough, but you'll have a little
bit more cushion you know, yeah,they will know that this is the
first time that the interns arethere.
Like, yeah, there's a funny.
My mom actually sent me thiscause my mom's a ER doctor and
she said there was a like a memeor GIF or whatever and it was

(48:25):
Drake singing the song.
What is it?
Oh my God?
Now I'm going to blank out, butit was centrally, you know,
like, uh, like for no newfriends or whatever he's like.
I don't see anybody that Irecognize, you know.

Speaker 2 (48:43):
Oh yeah, who did it?
No, yeah, I just saw this.
Yeah, yeah.

Speaker 1 (48:48):
And uh, yeah, yeah, I'm trying to.
Now the song is coming to mebut I'm not going to butcher it
for everybody listening for meto sing it.
But yeah, he's like.

Speaker 2 (48:57):
I know way too many people here right now that I
didn't know last year.
Who the heck?
Yeah, yeah, exactly, dude, yeah.

Speaker 1 (49:07):
It's um, when everybody starts piling into the
hospital, they're going to knowthat it's the you know
everybody's new.
But after a while, you know,people are going to start
expecting you to be the doctor,yep.
And so at least at thatbeginning point like there's,
they understand that there'sgoing to be problems with the
system.
But if you start havingproblems with the system and

(49:28):
like month eight and stuff.
People are going to have wayless leniency for it.

Speaker 2 (49:32):
I think like the way you should do it is like kind of
take on more responsibility onyour own and not let someone
give it to you, if that makessense.
Like some people, like I wasrunning codes towards the mid to
end of my intern year, usuallyin the beginning of the year.
Honestly, the expectation for,at least for Jersey Shore was,

(49:56):
you know, the interns would bethe ones that are doing
compressions, the ones callingfamilies, you know, the ones
writing the transition care noteif they're going to ICU doing
those types of responsibilities,and the seniors would be the
ones, you know, uh, leading thecode call, you know, talking to
the fellow and things like that.
But they should, your seniorsshouldn't be having to ask you

(50:18):
to do more things as the yearprogresses.
You need to be like, willing tobe like all right now I want, I
feel comfortable.
Obviously, if you do not feelcomfortable doing something,
don't and you know, don't justjump in and do that.
But I'm saying, kind of take ona little bit more
responsibility, start acting asif you're going to become the
senior, because you are in a fewmonths, you know what I mean.

(50:40):
Um, at least here and my programaround March.
That's kind of the time wherethe third year is we're kind of
coaching the second years on howto run rapid responses and
things like that, you know, andeveryone was kind of moving up a
little bit right.
So, as long as you kind of havethat mentality, uh, let me, let

(51:01):
me, let me learn how to do this, let me take it a little bit
more, as opposed to let me justcontinue to do what I'm doing
until someone tells me to dothat.
You know what I mean, becausethen it's going to be kind of a
rude awakening because you'regoing to be burnt out and things
like that, and you're not goingto feel like, uh, like I feel
like I'm rambling a little bit.
But my point is, um, that, justbe willing to, you know, uh,

(51:28):
get comfortable beinguncomfortable throughout the
whole year.

Speaker 1 (51:33):
No, that's good advice.
I, the one thing like I think Ihave going for me is, for one, I
like being uncomfortable that'sthe awkward business about it.
But the my mom is a ER doctorand so even though people are
going to give me like, oh hey,we only expect this much of you,

(51:55):
like I feel like I know what Iexpected myself and that is to
be better than her, and that's apretty big uh, and I don't even
know if I'll make it there, butI'm sure it's hell going to try
.
And so I know that I'm going toprobably be a little bit
difficult in the regard,especially on myself to be

(52:17):
getting this stuff and gettingit well, because I guess I've
kind of always been that way.
But so I'm hoping that I amable to follow that advice and
cause I want to yeah, I don't, Idon't want it to be I want to
go ahead and knock it all outand be way more prepared for my

(52:38):
second year before that evencomes.
And then dad, on top of youknow, going into my third year,
because, yeah, I mean to behonest, like she's kind of a,
you know a, she's a rock starwhen it comes to being an ER
doctor.
But I I'm also kind of like acompetitive person where I see

(53:02):
all the time and stuff and thenthey just like I can't be worse,
so I gotta be, at least evenbetter.
And that's it.
So it's a.
At least I have that.
It's probably not a good thing.
It's probably like a lot ofSettler, a lot of pressure put
on me for no reason, but we'regonna see where I get the land,
where I land after it.

Speaker 2 (53:22):
Yeah, they're all.
All takes time, all takes time.
I guess that's you know, that'spart of the process yeah, yeah,
yeah, and that's a.

Speaker 1 (53:29):
That's a good thing, even for, like, medical students
coming up and and Stuff likethat.
Like you they say dress For thejob that you want.
Like if you want to do ananesthesia or you want to do a
certain specialty, like get inthere and try to do and like
focus on what that.
Like show people that you Wantto do it and get in there and

(53:49):
try to act like you are onethose people, because you'll be
there very quickly and I don'tknow.
I feel like that's alwaysworked out in my favor, like if
I tried to Get in that role Forwhatever rotation or whatever I
was doing.

Speaker 2 (54:06):
Yeah, yeah, I totally feel it.
Now I was gonna tell you now myfavorite rotation that I had
this year and a lot of peopleprobably wouldn't expect it.
My favorite rotation was nightfloat.
Now some some hospitals they dohave 24 hour call.
Luckily enough, at my programthere wasn't 24 hour calls, so

(54:30):
you were either you know days,whether short call, or long call
, long call meaning aroundfinishing around 7 pm.
And then there's nights wherewe just work seven to seven.
It sounded like a lot but itreally.
It was six days, six nights on,two nights off, and what I

(54:51):
loved about nights is One.
I really hate typing.
So no progress notes, right.
No pre-rounding.
It's not like if to wake upearly and pre-round and get
ready for rounds, get all yournotes done, you don't need to
wake up and call all theseconsultants and blah, blah, blah
and all this.
You know other stuff.
You're kind of and you alsohave a little bit more autonomy
to you get the sign out, youknow what to follow up on.

(55:14):
You kind, when you get pagesand you encounter problems, you
can kind of think about them onyour own If you really need to.
You always have seniors outthere to help you, but you kind
of feel a little bit moreautonomous and you have more
time to do lines, you know, getsome procedures done too, and
you have more experience withlike rapid responses and codes

(55:36):
and things like that.
So I felt like a little bitmore of like what I wanted to do
as opposed to, you know, kindof sitting and you have a lot of
down pound too.
So you know you got to stayawake, so you, whether that's
you know reading something orplaying cards or something like
that, just to keep you awake.
So it's a good time to likebond with your co-residents and,

(55:58):
you know, get to know thempretty well.

Speaker 1 (56:00):
Yeah, dude.
So wait, when you say nightflow, you mean just that that
six on a or two days off everynight, coming in at 7 p.

Speaker 2 (56:11):
Yeah, six nights, two nights off again.
This is just at this program.
I don't know how they do it atother programs and it was.
We got signed out at 7 pm andwe would sign out at 7 am, with
some exceptions Because there'sone team that covers a smaller
hospitalist team, but they'realso in the ICU and CCU.

(56:32):
Obviously they have a senior,so they're kind of covering
three teams with a little extrahelp from the seniors.
But it's nice because thenyou're kind of in the unit for
the most of the night.
You get to encounter a lot ofICU related problems.
You see how the senior responseto them Maybe if it's a very
serious situation, they got acall, the MICU, that you know

(56:55):
the poem fellow Poemker fellowor the cardio fellow see their
thought process and you'rereally figuring things out.
You know watching them,observing them and figuring
things out together.
So I feel like a lot oflearning happens at night.
But you have to be, you have tobe awakened, recepted, for you
know, if you're saying, oh, I'mtired, I'm tired, I just want to

(57:16):
just answer my pages and followup what I have to, then you're
probably not going to get asmuch out of it as you know You'd
want.
But if you're kind of engaged,you know and and ready to see,
you know what, what happensthroughout the night, then Then
then I think you know it willwork out.
Like I said, I started with amonth of ICU and then I went

(57:38):
right into a month of nights andby so, by the end of August, I
felt like I saw 90% of what Ineeded to see in those two
months and I felt like all right, cool.
And then I went in.
When I went into floors, I waslike oh wow, so I'm just really
like these people don't seem assick, you know.
I like I know how to fix this,you know, and it becomes a lot

(58:00):
of more social work issues andthings like that, which you
would have to learn.
But, yeah, nights, definitelylook forward to it, don't.
Don't like you know, sigh, orlike I have to do it.
I think it'll be a good time,don't sleep on it, pun intended.
Don't sleep on it.
That's a great way to put it.

Speaker 1 (58:16):
So, besides just staying up, is there any other
challenges that come with beingthat night shift doctor as
opposed to Working the day?
Like I know, you don't have todo the progress notes, but are
there specific challenges thatcome with being in the night
flow?

Speaker 2 (58:32):
Oh yeah, 100%, and so like, probably one of the
biggest challenges that I had isLike when you're the admitting
team, I again I keep saying thisover and over that I don't know
how all the other hospitalsoperate, but on my hospital

(58:53):
Different teams would have adifferent night where they would
be admitting new patients, fromthe ER to the to the you know
floors, and Some days you'rejust getting blown up with a lot
of admissions.
You got to keep on on top of itbecause those are new patients.
No one signed them out to youor like you are kind of getting

(59:13):
signed out to them, but you haveto be prepared to remember
everything kind of what's goingon and be ready to sign that out
to the dating and you andthere's a lot of things that can
all happen at once, whether, oh, this person lost IV access and
the nurses want you to do Oldshun guided IV, but then another
person shall leave AMA Anotherperson you know the rates

(59:36):
uncontrolled in the 140s andthey want you at bedside.
So you know it becomes a littlebit just because you're one
person and you need to be at amultiple different places at one
time.
So you're definitely gonna havethose nights where you're just
like, oh my god, like I need thephone to stop ringing.
But for the most part, you knowit's pretty, it's pretty good as

(59:58):
long as you stay on top of it.
You know, keep, follow, whatyou need to follow up.
And and Don't, don't sleep.
Yeah, I don't know if you're.
If you're sleeping, I don'tthink you're gonna have a good
time.
We're gonna wake up drowsy whenyou really are needed and
you're not gonna be able tothink yeah, yeah, I completely
agree like get your rest in,don't?

Speaker 1 (01:00:21):
Some people come into night shifts and they think,
okay, well, I'll probably justnews, and I know some people
that are surgeons, like you justhaven't left the hospital, so
please take your rest when youcan dude.
But the yeah, the Best thingabout Night shift for one is the
camaraderie.
But did you ever find out thatthere was like a lack of this

(01:00:46):
Specialists, like a cardiologist?
There's usually a ton of themat the hospital during the day,
but was there ever a situationwhere you just didn't have Like
specific specialists there atthe time?

Speaker 2 (01:00:58):
Um, sometimes I would call, you know, like the cardio
fellow Maybe he would be in agrumpy mood, maybe not so much,
but usually they're very helpfuland just say, like, run it by
them, like, hey, you know, I gotthis person in AFib, rvr, this
is what I did already, this istheir past medical history.
Like, what would you recommendin the situation?

(01:01:19):
Something like that.
Or, you know, if it's thatserious, that you're in a really
bad predicament and you're notreally sure what you need, you
know Need to do, talk to yoursenior or just call rapid
response if you really thinkthat the patient is, you know,
in a detrimental, downward statewhere you're really worried

(01:01:40):
about them.
Because then when you have arapid response, then you have
everybody come in there toassess them and, and you know,
come up with with solutionsquickly.
And at those times you canalways call the on call the free
for the consultant.

(01:02:00):
You can call, like, thecardiologist service and they
can page them.
But make sure to ask them aquestion that you don't know the
answer to.
You don't want to be answeringAsking questions that you kind
of you know the answer to, butyou just wanted to confirm with
them or something like thatbecause you know you really want

(01:02:21):
to be.
It has to be succinct.
Let's put it that way.
You need to be like this isthis is what's going on.
Obviously, give them aone-liner and this is my
question, right?
Not like, oh, I was thinkingabout this, but what about that?
Just want to be like I got thisissue.
This is what's going on.

(01:02:42):
I'm reaching out to you.
What do I do need to right,especially at nighttime?

Speaker 1 (01:02:45):
they so, exactly as I say, especially at nighttime,
because and now we'll be goingto teaching hospitals, so
they'll have either resident,like a cardio fellow or somebody
there that has Is doingsomething.
But, like, I can attest thisbecause my mom, she I've
mentioned it already that she'sa ER doctor, but she works at a

(01:03:05):
hospital and it's you know, it'snot necessarily the biggest,
and At nighttime too she prefersto work during the day, because
at nighttime, when you call anysurgeon or any of those people
they may, they're more lesslikely to be in-house, and so

(01:03:27):
you've got to call them, wakethem up, get them over there,
and so it better be important,or better be important, and if
it's in the I'm.

Speaker 2 (01:03:34):
Most people are like oh yeah, I'll sure I'm in the
hospital, I'll swing back down,I'll swing by.

Speaker 1 (01:03:38):
They come with a smile on their face and then
they're like oh no, it's nothing, don't worry about it.
Yeah, nighttime you callsomebody and you get them out of
bed and they come and it's notan emergency.
You will be caught for sure.
Yeah, and, and don't take it toheart.

Speaker 2 (01:03:53):
if they're upset, you know like they're obviously not
personally upset with you,they're just quite being tired.
I get that way too, you knowwhat I mean out of bed.
Yeah, yeah, like I had a badsituation one time where One of
the patients that I had had adeal of FOI AVM in her stomach.
She's ICU downgrade and thebleed was stable and then all of

(01:04:18):
a sudden of course it alwayshappens at nighttime she just
starts vomiting large amounthuman, human temesis and I'm
freaking out.
I'm like, oh my god, is thispatient gonna just exanquinate
in front of me?
Like I'm Petrified first thingI do.
I jump on, call GI and they'rejust kind of like, yeah, mess,
you know, do transfusionprotocol, blah, blah, blah,

(01:04:40):
don't worry about it, we'll bethere, you know.
Like they were kind of like,yeah, we saw this many times
before and I'm like freaking out.
So it's not like they weretrying to be rude, it's just
they.
Again, you're gonna find a lotof people that has encountered
this problem You've had before.
You seeing this problem is notthe first time.

(01:05:02):
It's happened.

Speaker 1 (01:05:02):
Yeah, you know but when you, when someone's
vomiting blood, you're like whoadude, yeah, like oh my god,
yeah, then just just go back toyour basics.

Speaker 2 (01:05:09):
You know your ABCs, you know things like that,
things that you know that youcan do.
Obviously, you're not gonna beable to fix this AVM per se, but
you can stabilize the patientso that when the specialists
come in they are ready to dowhat they got to do and they'll
get it done.

Speaker 1 (01:05:28):
Do you have any tricks for staying up and being
interested?
Because the I think the thingthat kills me is when there's
like I can go all night.
But if there's a low, like ifthere's a three hour low where
I'm sitting there like you know,twiddling my thumbs and you
know I got my feet rested up andthen all of a sudden an
emergency happens, I'm like whoa, whoa, whoa, you caught me

(01:05:48):
slipping a little.
Do you have a trick?
I kind of keep your mind stillgoing.
I guess it also depends on thechemistry of, like, the people
you're with.

Speaker 2 (01:05:58):
I had like really, really good chemistry with my
coworkers.
We played monopoly deal, whichis like a little car game.
It's really competitive, reallyfun, quick to learn and it's
like a fast game.
That kind of kept us awake.
Sometimes, if it's really, youknow, dull, we don't have that
many follow-ups coming up.
Sometimes in the residentlounge we'd actually just like

(01:06:22):
connect Xbox and watch Netflixfor a little while and have
obviously have our pages andeverything nearby, you know,
right next to us.
So it's like if you getsomething pause, you know answer
it.
It's not like really likeneglecting, but anything that
you know will definitely keepyou awake.
You know some people read books.
Other people might, you know,get hired from, get more tired

(01:06:44):
from reading the books.
That's what I was saying.
Yeah, so like whatever youthink works best for you and
even just like talking like this, you know if you have like a
good you know co residents thatyou really vibe with and just
like you know chatting in aboutyour interest and things like
that and really like connecting.
Like when you're in thisconversation you typically don't

(01:07:07):
get like too tired and thenmaybe you get a rapid response.
You're up, you're like joggingover to that room and now you're
like all right, I'm awake againbecause I just kind of had to
like get up and move around andthings like that Look forward to
lunchtime at like two in themorning, you know.
So, those things, those thingskind of help you stay awake as
well.

Speaker 1 (01:07:27):
Yeah, that's what.
That's one of the things Iactually I enjoy nights One.
I usually am up later at nightanyway, so it allows me to
justify that.
But I love the conversationthat switches around like one or
two.
Everybody starts acting eitherreal goofy, yeah, or you know,

(01:07:48):
and I start doing it myself andyou're just trying to bypass the
next five hours and it just itcan be a lot more fun than when
it's the middle of the day andyou're afraid that you know
administration is going to walkdownstairs or something Exactly.

Speaker 2 (01:08:08):
Yeah, I had some of like the most fun times on that.
It's just, you know, hangingout and you know, after like the
first few nights you just getso accustomed to it like I don't
know, I'm just a very like goodsleeper.
Doesn't matter, it's noisy, ifit's light outside I will sleep,
so they would.
I would literally routinelylike fall asleep at like 8, 8,
30am, wake up right like righton the dot like 535, 45pm, like

(01:08:34):
like nothing, and then the wholenight after a while I was wide
awake, I wasn't tired at all.
So it's just goes like firstfew days to that, maybe first
week or so, where you're reallytrying to switch that schedule.
That's the toughest, but afterthat it really it really comes,
comes easy, nice.

Speaker 1 (01:08:53):
Yeah, I'm curious too about has went and it.
I'm curious too about the factthat when you have a night shift
working team, most of theactual staff nurses, techs, all
that are night shift workers.
Now they may fluctuate a littlebit, but most of the time they
are the night shift people andthen there's a day shift people

(01:09:18):
and all of the in-between, withyou doing different rotations in
different parts of the hospital.
Then you're in nights, thenyou're in days.
How did you bridge the gap ofintroductions and being part of
the team?
I mean, I guess you said withthe gum, but did you have a good
way of getting part and tobeing a part of team when you're

(01:09:40):
constantly the new person inevery rotation?

Speaker 2 (01:09:43):
Yeah, especially with nights too, like I mentioned,
you're not really roundingunless you're in the ICU really
getting to know those patientsbecause you really have to keep
a close eye on them.
But when you're on generalfloors on nights there's just
way too many rooms, buildingsand staff for you to learn

(01:10:05):
everyone.
So after a few months andyou've been around the block,
different rotations theyrecognize you.
You have small conversation butsometimes it's impossible to
know everyone.
But at least if you make thatgood impression they'll remember
you.
They'll be like oh, I rememberyou.
You're like the tall one, I hada nice conversation with you,

(01:10:28):
even if they don't remember yourname, they don't remember
anything about you.
Or if you return their pagesand you're very kind to them,
they'll remember that too.
And always when I'm writingsupplemental note regarding an
important page I got, I alwayssay was kindly informed by RN.
So instead of just saying RNpage about this, when you say

(01:10:49):
was kindly informed and theyread that, they're like wow,
okay, I wasn't annoying him andhe actually took to what I said
and he really listened to me.
So and then they look at yournames and notes and things like
that.
So when your name is kind ofout there and notes and pages
and things like that and theyput a name to a face.

(01:11:10):
I think that's probably thebest way to get people to know
you.
So when you speak, when youwrite, just kind of try not to
be passive, aggressive ever andjust be like a friendly person.

Speaker 1 (01:11:22):
That's good advice, dude, yeah, and so I guess I
just really because I'm curiousalso.
I mean, I know that this is alittle off topic, but because
you were talking about how yousleep and you, how did you
manage your time when youweren't in the hospital?
Because I know you do this.

(01:11:43):
You have your own YouTubechannel.
I don't know if you were evenable to do those videos over the
past year, but you do a lot ofother things and then you also
have this heavy responsibilityto the hospital, so how did you
manage that time?

Speaker 2 (01:11:56):
Yeah, yeah, that's a great question.
To be honest, I put a lot of iton the back burner.
Typically I work six days,maybe get one or two days off,
depending what rotation like Imentioned, six nights to one, or
if you're on days on floors,it's six days, one day off
either Saturday or Sunday.
I see you as the exception.

(01:12:18):
You have a little moreflexibility, but a lot of the
times that one day off I hadduring the week I would just be
doing laundry, cleaning, grocerystore things like that, seeing
my girlfriend, seeing my family,things like that.
But I haven't had much time forthe YouTube channel.

(01:12:38):
Maybe I'm going to have maybelike one video this past year.
I'm not like throwing it away.
Hopefully with more time if Iever get more time, I'm
definitely more likely to postmore fun stuff, because it's
good to definitely have hobbiesoutside of medicine.
But yeah, I got to say I thinkintern year is probably going to

(01:13:00):
be the one year where you'rereally going to have to
sacrifice some of the thingsthat you just enjoy.
I love college football.
A lot of the games I couldn'treally watch.
Maybe I would just like try topull it up on Google, check some
of the scores, but I reallycouldn't watch it and enjoy it
like I used to.
And that's not forever.

(01:13:21):
Hopefully, with time maybe it'sjust intern year.
That's really difficult, butjust got to prioritize what
matters most and, again, beefficient in and out of the
hospital.
If you get your stuff done outof the hospital quickly and
efficiently, then you might havemore time to do other stuff.

Speaker 1 (01:13:41):
Yeah, I think that for one, it's just about the
managing and now I'm about to gothrough it.
But I mean it's expected thatyou had to put some stuff on the
bad burner, like.
This is supposed to be one ofthe toughest years, so I think
you'll have more free timecoming up.
That's kind of the one reasonwe had to knock this bad boy out

(01:14:02):
now is because we both had thisweird gap where we aren't being
swarmed with, and also, notonly did you have all the other
stuff that you were just talkingabout, you had to study for
step three, which is a test thatyou had to do, and a bunch of
other things and you did thatright.

Speaker 2 (01:14:22):
Yeah, I took step three in April.
A lot of people tell me, takeit before you start your intern
year.
I really think it's situational.
It depends on what you're doing.
If you're an internal medicineand you really want to go into a
very competitive fellowshipwhether that's GI, cardiology,
pulmonary, what have you yeah,maybe you definitely want to

(01:14:44):
study really hard, maybe give itthat the way, something like
that, or you want to take itdown the road and get some
clinical experience in your belt.
But for anesthesia, really, wejust really need a passing score
.
It doesn't really matter asmuch exactly the score.
So for me, I probably shouldhave studied more than I did.

(01:15:08):
But you do what you can.
You don't kill yourself over it.
And I passed and I was OK.
That's it.
Moving on, that's all about.
Yeah, your patients are yournumber one responsibility.
Your scores, all that is allsecondary.

(01:15:30):
So make sure that you're fit.
Like I said, make sure you'reefficient in the hospital.
So if you do want to get a goodstep three score, make sure
that you make time for it.
That's not conflicting witheverything else.
And make sure you sleep.
Get as much of sleep as you can.
Don't feel guilty about it, youknow, because you won't be able
to work well if you're sleepdeprived.

Speaker 1 (01:15:50):
Yeah, and I think the fact that, like I know, people
really are very concerned withtheir test scores, like I know
that it's essentially what gotus to where we are and it's been
a big part of all of our livesfor so much, so it's hard to
take a step back from that.
But I think that you're, youknow, like you're the people

(01:16:15):
that are going to reach out foryou in your residency and if,
like, let's say, you're lookingto get into a fellowship, I'm
sure that they are going toconsider your step three.
But at the end of the stepthree, like there's no other
tests like that are that besidesthe boards?
And so you, they're going to gooff your this is at least what
I've heard is they're going togo off, like the people that are

(01:16:36):
reaching out for you and theirevaluations of you and all that
other stuff, before they'regoing to just look at a solo
test score, like it would havebeen in metal.
You know, coming from medicalschool.

Speaker 2 (01:16:50):
Yeah, yeah, no, I totally feel that.
And again like, for example, ifyou're going into certain
specialties, whether thatsurgery like I know anesthesia
has their own tests.
Like I think I'm going to havemy anesthesia basics at the end
of this upcoming year, so youknow, I'll take it all with a

(01:17:12):
grain of salt.
You're you're sorry about that.
You're you're going to begetting tested for the rest of
your life.
That's the type of career thatwe've entered in.
So don't, don't take exams soabrasively.
Just, you know, as long asyou're working hard and learning
in the hospital, everythingelse should, once you get to the

(01:17:34):
point where you're at residency, unless you're really really
trying to do a very competitivefellowship, I think what really
matters most is just making sureyou're doing a good job day in
and day out, and everything elsewill come with time.

Speaker 1 (01:17:47):
Yeah, man, well that's.
I'm so glad that you were ableto like share all of your like
tips and everything, and I knowthat that you're going to do
great in this next year and soI'm like excited you're finally
going to get all the year youknow, your actual skill set
ready for actually doinganesthesia.

Speaker 2 (01:18:10):
So, yeah, I'm excited and I got to.
I got to give a congratulationsto you too.
Man, like I, I didn't take aminute to sit down and say
congratulations.
You matched, like that's a bigthing.
I know we haven't talked muchin this past year because you've
been getting your applicationsready and your interviews.
I'm in my internship, my internyear and all that stuff.

(01:18:30):
So you know, I think it's it's.
We're always focused on what weneed to do next, but we never
just sit down and bask and justsay like, wow, we did it, you
know.
So congratulations to you, toJordan, you know, I know you're
going to do an excellent job.
And again, you know, you don'tneed to know everything on day

(01:18:52):
one.
You don't just take in themoment.
Make sure you, you know, make,make as many connections as
possible and and with time,you're going to start feeling
really confident.
By the end of your first yearyou're going to be feeling
you're on the right path, 100percent.

Speaker 1 (01:19:10):
Dude.
Well, thank you so much.
I really appreciate it, and I,speaking of getting behind and
everything, I forgot to tell youhave a birthday, so oh yeah
thank you so much I literallyjust thought.
I thought about it right beforewe got on, and then I thought
about it at one point and then Iliterally just almost forgot
about it again, dude, so yeah,no, it's all right.

Speaker 2 (01:19:29):
Yeah, my birthday is just this past weekend, 28.
Now I'm getting closer to 30.

Speaker 1 (01:19:34):
I mean I did once you .
Once it hits you, your kneesare going to start hurting.

Speaker 2 (01:19:38):
Oh yeah, my knees hurt already.
I'm feeling it.

Speaker 1 (01:19:42):
Well, dude, thank you so much for coming on.
Everybody go check out.
It's Matt's man cave, right?

Speaker 2 (01:19:47):
McLean's man cave.
Or McLean's man cave, yeah, likeM clean M C L E A N McLean's
man cave.
It's on YouTube.
I don't post that often.
I hopefully will as time moveson to have more free time.
I'm finally, you know, movingto the house, maybe have a
little studio, have a little bitmore time.
I just talk about anything fun.

(01:20:08):
I like Star Wars, anime, videogames, college football,
anything you know.
I get with a millennial typefeel to it and if you just like
nice vibes and with maybe atouch of medicine here and there
, you know, come, come, take alisten.
Yeah, and that's about it.

Speaker 1 (01:20:26):
No, you're great and it's going to.
Yeah, everybody go check thatout.
We're so glad that you're ableto give us a little bit of your
time.
I know you've been super busythis year, so thanks so much,
matt.

Speaker 2 (01:20:36):
Yeah, and guys, don't forget to, you know, like the
podcast subscribe to, you know,Off White Coat, this man, dr
Abney, you know, he really putseverything out there.
I, you know it's crazy how hegets these podcasts off so
consistently and I really got tolike applaud you on that
because, like, I can't even stayon top of my stuff and he's

(01:20:59):
really doing it for you guys,you know, because residency, you
know, it's really kind of likesomething where you're an
experience that you're goingthrough, but he's kind of
bringing you along with it withhim and showing all the amazing
faces along the way.
But he's doing it for you.
So, you know, definitely showyour support to this guy and I

(01:21:23):
can't wait to see what, what,what continues on with this
podcast.

Speaker 1 (01:21:27):
Dude, I appreciate it so much.
Yeah, I literally I started itso that we could get everybody
into residency and now that wedid it, I was like, oh no, I
created a beast.
I can't stop myself.

Speaker 2 (01:21:36):
Yeah, yeah, but now you know.
Now you know exactly what totell people because you made it.
You're in.

Speaker 1 (01:21:42):
Yeah, yeah, exactly.
But, dude, thank you so muchand we enjoyed it, so we'll see
you next time.

Speaker 2 (01:21:49):
Yeah, until next time , guys, everyone take care.

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