Oral Boards and Night Float

Every clerkship has something "special" to look forward to... and by "special" I mean something scary. It's those little things that the prior classes tell stories about; infamous tales of medical student drudgery and potential maltreatment. Some are true, more are not. For Surgery it is the tales of the long hours and the perpetual berating by attendings...

Hey, medical student. What is the difference between dog crap and a medical student?
I don't know.
You don't go out of your way to step on dog crap... (insert hearty laughter). Also, dog crap does not say "thank you" after you step on it.
Wow, I am having a great time here! Thank you! I wish you would tell me that joke 4 to 5 times per day.

No, that wasn't from an actual encounter, but these jokes make for good YouTube videos (Med Student vs. General Surgery). I personally didn't hear any crass jabs thrown my way, but I certainly wish I would have. And why not? My parents tell me they walked to school barefoot in the snow as children, uphill both ways. I have to at least be able to tell my kids that I got a little hazing down the road.

Obstetrics and Gynecology is no different. I heard plenty about the torturous hours on Gyn-Onc and spillage of bodily fluids (although no one fully warned me about the placenta...). But for us here in Asheville, we had two new gauntlets to look forward to: the oral boards and a week of night float.

First, the oral exam. Standardized tests you can BS. You can study how the questions are asked, and sometimes even know exactly which questions are going to be asked. Two or three answers can generally be eliminated before even fully looking at the question stem. It is possible to do very well on these exams, even with a knowledge base that is just so-so. Not the case with an oral test. This is where the attending truly finds out if you know what you're talking about. You can't "recognize" the answer from five choices in front of you. You either know it or you don't. That's why I have to respect this type of test. No bullshitting.

The one thing I was warned about before the exam began was that my preceptor has a perfect poker face. Whether you're right or wrong, you're gonna get nothing from her. So be confident, and keep answering questions until you can't anymore. And eventually that will happen, and that's the point. Every trail of questioning will lead to something you can't answer. That's why everyone thinks they do poorly on the exam, because you only remember the wrong choices you make, not the right ones. So when we got to the review portion of the exam, I thought I had been toasted... although we all did just fine.

Second tribulation, night float. One of the weeks on OB/GYN is completely nocturnal. Starting from Sunday night at 5:45pm, we worked 5 straight 14 hour night shifts. Rounding with the AM team first, we then picked up the patients for the evening through early morn. The service seemed to be a bit quieter, especially since there were fewer staff and no scheduled surgeries, but anything can happen at night. Anything. The random patient that was told to go to the hospital at 1400 for labor will show up at two in the morning, water broken and baby halfway out. As an added bonus, our last night (or "day") finished with 4 hours of lecture from 8am to 12pm. The only positive from this is that it kept me awake long enough so I could flip back to a "normal" human schedule. Even then, I went to bed at 3pm, woke up at midnight, and started reading for my 12 hour day shift that Saturday. It's like switching time zones. This is what I signed up for though, so I better get used to it.

A couple keys to surviving this... first, black out the room. Per Blake Pemberton's suggestion, I taped multiple black garbage bags to the windows to make my bedroom pitch black. It was a cave. There was no way to tell the sun was shining so brightly just outside. I also changed my clock so the "AM/PM" button didn't light up. That way when I went to bed at around 9am, I thought it could have been 9pm. When I woke up at 5pm, I might as well have been waking up at 5am like I did on Gyn-Onc or Labor and Delivery. Tricking your mind is crucial. Blake even suggested that sunglasses should be worn each morning on your drive home. Don't let your eyes see the light!

Night float was actually quite a bit of fun though. I got to do more at night than any regular shift (and I got my first birth! See The Miracle of Life). And every morning after breakfast we watched the sun slowly rise above the Asheville skyline during rounds...

Which makes it all worth it.