I could begin this post with some grand retrospective statement like “time flies on wings of lightening.” But this retrospective isn’t meant to be sentimental. It’s one blunt wife’s take on year three at Arrowhead Regional Medical Center.

The most important point I want to make is that this was, without a doubt, the best decision for us. Everyone is different and has different priorities. However, if I could do it over we would come here again in a heartbeat.

It’s been a year since we left Grenada and embarked on the clinical years adventure. As a clinical clerk suddenly, the stories that shape your day-to-day lives involve real people with very private diagnoses and real pain. I will not be writing about those stories, even obliquely. The third year med student’s experience is also shaped by hospital/SGU bureaucracies and ineptitudes, which can be different for every student. So that is neither fair nor wise to blog about.

But St. George’s University alumni are nothing if not helpful to those following in later classes. So here goes the wifey’s perspective of year three at Arrowhead Regional Medical Center.

Hopefully this helps others who will be coming in the months and years ahead.

The Time Commitment Overview:

Let’s not sugar coat this. Your spouse is going to be a doctor. Did you really expect him or her to have anything close to the equivalent of the free time of the average working professional? Nope. Doctors work a lot of hours, residents work a little more and clinical clerks have to put in their time too. C’est la vie. Some rotations here allow for more free time, while others suck the life out of you. With each rotation there are also opportunities to take extra shifts, swap with other students, get in on an interesting procedure or just go home. In the end, you can be the gunner student or the guy who goes home when the work is done.

Hospital Overview:

Arrowhead Regional Medical Center is a San Bernardino County Hospital. This means you will see funky stuff from patients who have no health insurance. Expect to pick up a decent amount of spanish during your time here. You will smell awkward bodily fluids, you will see people who have not bathed in a while and many of the things you treat could have been avoided with exercise and ditching the cigarettes, meth, marijuana, crack, alcohol and Big Macs. In Internal Med. surgery and family medicine it can be long days of seeing rough stuff. But you didn’t become a doctor to help people who are well, did you?

This leads me to one of Arrowhead’s big pros: the groups are generally smaller so you get plenty of face time with doctors. Forming good relationships with your peers is important regardless, but you will also be asking these people for letters of recommendation…

So here’s the breakdown by rotation:

Internal Med:

How many hours worked?

64 hours a week was the max and 40 was the minimum. The average day started at 7 a.m. and ended … whenever. Sometimes as early as noon and many other times past midnight. Plenty of over-night on-call days tossed in there as well.

Daily responsibilities?

Follow residents and attendings, write up notes on people, patient interviews, study and lots of thinking through diagnoses.

What’s it like managing home life: dinners, date nights, family home evening, etc …

It takes a decent amount of flexibility. I don’t think we would have dinner at the same time every night, but David would send me a text letting me know his ETA. Date nights were often improptu, but that fits us well anyway.

Attire: 

Dress shirts, suit pants, ditch the tie and get some comfy broken-in dress shoes. On call nights you can wear scrubs, but don’t go out and buy a bunch! The hospital prefers that you wear theirs so you can look like everyone else.

My take:

Internal Med was an adjustment, especially as a first rotation after moving here. Both you and your spouse get tossed in head first. He is suddenly diagnosing and you are suddenly in a new place, alone and adjusting. Just breathe, take it one day at a time and do everything you can to get involved in the community. It is crucial that you find your own thing and get involved in it, be it work, service, church or family.

Surgery:

How many hours worked?

79 per week was the max, 35 was the minimum (study week). The average day started at 4 a.m. and ended between 3 and 6 in the afternoon. You generally have one over-night shift per week.

Daily responsibilities?

Ohhh and ahhh while surgeons do their thing. Oh, and help on a few procedures. Your level of involvement on a surgery depends on the case, who you are working with and your level of inherent skill. These are the days when you wished you had sutured more pork in Grenada. Pre-op and post-op follow ups are also high on the duties list.

What’s it like managing home life: dinners, date nights, family home evening, etc …

This rotation was harder due to the hours worked, overnight shifts and need to sleep whenever possible. The schedule seemed a little more predictable than internal med, but still required a lot of flexibility.

Attire: 

Scrubs and tennis!

My take:

Surgery is also a rough rotation time-wise. The hardest part is if your spouse does not like it. Dave came home at the end of the day beaming like he had just left Disneyland, so we were great. But spending that much time on something that you don’t enjoy can take a toll on your spouse and create a grumpy gus. Surgery (ironically enough) also requires a thick skin. You might run into the horror stories of surgeons tossing a tray in a manic fit, or you might just have to get used to a healthy dose of swearing and ego. Like I said, Dave loved it so we have no complaints.

Pediatrics:

How many hours worked?

50 per week was the max, 39 was the minimum. The weekdays were pretty 8-5 hours with a few call weekends tossed in.

Daily responsibilities?

Tell mommy that her kid’s sniffle was just a cold and not cancer. The peds people are also in charge of the newborns, which was kind of cool. They did the well-baby checks on all the newborns. Kids cases (up to age 18) were also on their to-do list. Although, to be honest most of the really severe (aka interesting) cases went to Loma Linda University Medical Center, so there wasn’t a ton to do all the time. Be prepared to possibly see (and report) potential child abuse as well.

Attire: 

Dress up in your white coat and some comfy shoes. I might be wrong, but I think there were some days he could wear scrubs too …

My take:

This rotation felt more consistent and scheduled, like we finally got to breathe after IM and Surgery. Depending on how many beds were filled, there was time to study built into that 8-5 day as well. However, because most Peds cases were sent to Loma Linda you didn’t get a good grasp of the specialty here. We will be doing an away rotation at another hospital for pediatrics for two reasons. First, there is an accreditation issue so you have to do a peds elective somewhere else anyway. Second, it would be great to finish feeling really knowledgable about the specialty.

OB/GYN:

How many hours worked?

54 per week was the max, 35 was the minimum. There was no such thing as an average day here. Sometimes he was there by 5 a.m. other days he went in at 9 a.m. There were for sure many long days including on-call nights.

Daily responsibilities?

First day you might have to tell a 300 Lb. woman (who speaks no english) to mount the stirrups for a vaginal exam. Luckily you will have a chaperone at each of these encounters who might know a little more about both vaginal exams and spanish than you do. But be prepared to be tossed in head-first and become a pro at the vaginal exam. The medical students do the bulk of the work in this department as there are very few residents and attendings. However, it is pretty cool being able to catch a baby or see a C-section. If the resident has met their quota for deliveries, then you might get to catch the child. If not, the resident will be doing it. Sometimes it is hard to get long stretches of undivided attention from the attending.

What’s it like managing home life: dinners, date nights, family home evening, etc …

This was a time sucker as well. But by this time we were used to it. Be prepared to be flexible.

Attire: 

Dress up with white coat for clinic days (most of the time) and scrubs and tennis in the O.R.

My take:

Although a steep learning curve, we enjoyed this rotation and David is even considering it as an option now. You get a lot of really good experience right off the batt and his favorable opinion might be due in part to some interesting cases he got to be in on.

Family Medicine:

How many hours worked?

60 per week was the max, 50 was the minimum. Days were 12 hours at least. It was either 8 a.m. – 8 p.m. or 8 p.m. – 8 a.m. But there was some variability tossed in there.

Daily responsibilities?

Doing lots of patient interviews and writing up lots of notes on these patients. It was very similar to Internal Med, however you could see any age in this rotation. The amount of work you have to do depends on how many people are in that rotation at the time. David drew the short straw and was only one of two people in his group. Other classes might have four, five or more people to divide the work among. If this is the case, you will have plenty of down time.

Attire: 

Dress professionally unless you are on night call.

My take:

Family was a hard one for us. It won’t be for everyone. A few lucky kids get to go to the Fontana clinic. You must request that early because it is a sweet deal. Those hours are pretty well 8-5 with a two-hour lunch. Chill. We were looking forward to this one because we were told that there would be plenty of down time to study – aka: you can’t go home but you don’t have anything to do. But don’t count on it.

Psychiatry:

How many hours worked?

Well, with only two weeks under our belt it is hard to say. But so far the most has been 28 per week and the least was 17 hours. All weekends off. With at-hospital study time built in, a 9-5 is what you can expect.

Daily responsibilities?

Hang out with doctors as they interview psych patients, sit in on in-hospital court sessions determining competency and sometimes interview patients yourself.

What’s it like managing home life: dinners, date nights, family home evening, etc …

He is always home! Plenty of study time is needed though, so don’t plan a vacation for this one. Think of it as the third term of 3rd year clinicals.

Attire: 

Professional attire and white coat.

My take:

There will be plenty of interesting cases, action and interesting things to study here. However, the hours are very relaxed. Will share more as the rotation progresses!