I'm really not too sure who reads these entries.  I have some sense that I write just to prove I'm alive and doing things with my life (well, to the extent that I do anything at all).  If nothing else, I suppose it'll just be something to look back fondly upon...later in life.  Here's a brief review of this year's academics to date.

Medicine II ("sub-I")
I'll be honest.  I think I've had an awesome fourth year so far.  Most of the "tough" rotations are out of the way, and even through I learned so much throughout the first part of the year, it was seldom actually miserable.  Medicine II, our school's rendition of a traditional medicine sub-I, was actually quite enjoyable.  I've discovered that the quality of a rotation is really almost entirely team and attending dependent.  If your team is good, and your attending is chill, then life is amazing.  Life on Medicine II was awesome.  We had a great team, attending, residents, med students and all.  I requested a specific attending for this rotation, and this was an incredibly good decision in retrospect.  One of the best ever!  Always incredibly supportive and good tempered, and dedicated to both medical student education and patient care.  I feel like we had such an interesting team, with such an amusing mix of personalities.  I was honestly always entertained at rounds, and that's really the best way to spend any rotation.  Even though this was ostensibly our sub-I for the year, our patient load was incredibly low, there was no overnight call, and I actually got out early more days than not (and by early, I mean 1pm)!  Med II confirmed my impression that internal medicine residency is manageable, the ward months at least.  I can do this. 

MICU
I had to work twice as hard on MICU as I did on Medicine II, and put in twice as many hours.  This, too, was a good experience.  I really wanted to front-load my fourth year so that I could level up in terms of clinical knowledge and patient management skills as quickly as possible.  So, I scheduled the most high-yield and clinically practical rotations right up front - Medicine II, MICU, and Infectious Disease.  MICU is another excellent rotation at County.  Yes, long hours - I was in from 7-5 most non-call days, and 7 until 10pm or later on call days, with a Q4 call schedule.  Yes, lots of work, actually.  I was basically juggling patient care responsibilities like an intern, albeit with a smaller number, and having to get all of my stuff co-signed.  But such incredible pathology - so many patients with multiple acute issues, any of which could have been fatal.  Again, excellent teaching from very good attendings.  Great ICU fellow.  And for the most part, a pretty solid team.  I had two distinct experiences on ICU.  I had about 2.5 weeks with a senior that WORKED me, to the extent that I think was taken advantaged of in several ways.  Mostly because we had an incredibly incompetent intern, and thus I had to pick up the slack quite a bit.  I had my remaining 1.5 weeks with an incredibly chill senior, who made me do absolutely nothing, and let me go home early nearly everyday.  I don't think I did anything extraordinary on this rotation, but if nothing else, I am very efficient, and ruthless efficiency is prized over anything else in the MICU, I believe.  Consequently, rightly or wrongly, everyone seemed to think the world of me on this rotation, and I'm grateful I had the opportunity to work with these people.  Again, I'm probably not going into ICU myself, but I can do this. 

Step 2 CK and CS
Well...there's not much to say about these.  I think my time spent studying for CK was adequately summarized in a previous posting.  I could have studied more on CK, I'm sure.  But I think I'll do ok anyways.  And everything that people say about CS is true.  A couple hours of cramming the night before is more than sufficient to secure a pass. 

Infectious Disease
Hmm, so I'm a bit at a loss.  Was my favorite rotation of medical school thus far Medicine II or Infectious Disease?  I'm kind of ashamed of myself for using an adjective as banal and shallow as "awesome" so many times in the same posting, but ID was an incredible rotation in almost every day.  The days were a bit longer than I would have liked, true.  But the teaching was incredible, the residents and fellows were a pleasure to work with, and I feel like I learned or at least solidified so much clinical management information integral to basic internal medicine practice.  Antibiotic management, clinical management of common infectious disease scenarios, management of many uncommon scenarios as well.  Meningitis, pneumonia, endocarditis, TB, HIV, abscesses, osteomyelitis, FUO, UTIs, bacteremia...a lot of bread and butter medicine.  Some more exciting things as well - septic shock, OI's, all of those fun fungal things you learn about in med school but seldom expect to see (cocci, histo, blasto, crypto).  We had patients with H1N1...several that died.  I had multiple patients with necrotizing fasciitis.  There's such amazing pathology on ID, especially at County.  And I can't seem to stop marveling at how NICE everybody was.  The two attendings we had, the two fellows we worked with, and most of the residents.  Everyone was just so NICE.  Rounds, although long and often tedious, were usually actually quite entertaining.  I never felt that anyone was giving me a hard time or expecting more out of me than was reasonable.  I'm sad the month is over.  Again, this was a pleasure. 

Calendar
09/14-10/04 | Rheumatology | UCLA | 3 weeks
10/05-10/25 | MICU | Cedars-Sinai | 3 weeks
10/26-11/22 | Neurology | 4 weeks
11/23-12/04 | Basic Ophthalmology | 2 weeks
12/05-01/17 | Vacation / Interviews | 6 weeks
*12/06 | JLPT Level 1
01/18-02/12 | Clinical Pathology | 4 weeks
02/15-03/14 | Dermatology | JAPAN | 4 weeks
03/15-04/11 | Clinical Radiology | 4 weeks
*03/18 | Match Day!
04/12-05/09 | Away Rotation - TBA | TAIWAN | 4 weeks
*05/16 | Graduation!

It's shocking, right?  I was so miserable in medical school the first couple of years, and perhaps good portions of third year as well (surgery comes to mind).  But now, hey, I can do this.  And I'm looking forward to it.  Bring it on, NRMP!  Let's move on to the next part of life, already. 

I've just finished up my rotation through Infectious Disease, and on Sunday I'm headed off to my friend Brian's place to crash while I go through Clinical Rheumatology at UCLA, followed by ICU at Cedars-Sinai.  S maybe a more academics-oriented post later, if I manage to muster enough energy to ponder that further. 

Recently, I've discovered lang-8 (http://www.lang-8.com), a really rather innovative language learning site where you post entries written in other languages that you're studying, and native speakers of those languages then edit your posts and leave suggestions.  Theoretically you then return the favor by editing posts written by people studying your own native language.  I believe lang-8 was started in Japan, so the site is rather heavily geared toward Japanese and English learners, but other languages (especially Korean and Chinese) seem to be picking up as well.  Thus, it's a very user-driven community, and in practice as well as in theory (at least so far) it works rather well.  The posts I've put on there so far have been thoroughly edited and commented within several hours.  I'm taking the JLPT in December (for kicks, rather than for any tangible need), and accordingly I'm in one of my incredibly rare bouts of motivation to study Japanese in a somewhat serious manner.  So, periodically I will treat all of you to my musings in Japanese.  Well, the "edited" musings at least, which may certainly still contain errors.  But, given the frequency with which I update xanga, perhaps you're more likely to hear from me in Japanese...  =]