You can sit here if you want to

Special thanks to Laurie Edwards over at Chronic Dose for including my post in herGrand Rounds.  She even gave me "the best of the best of" nod with the asterisk award.  Go check out what she is offering over there.  

I apologize for failing to produce a blog the past few days.  I know, it says "the week" yet I didn't live up to the hype like Dan O'Brien circa the 1992 Summer Olympics.  I will have you know I will be repeating my failure next week as I will be down on the beaches of Mexico, taking in the sun and enjoying the Chiclets.  Nothing more gratifying than supporting the Mexican economy via my purchase of flats of tiny packages of gum that produces four seconds of flavor and literally disintegrates in your mouth an hour later.  I do my part.

I am somewhat discouraged going back to school after my vacation.  Not because I don't want to be a doctor anymore, but because there is a good chance that the curve I have been relying heavily upon has changed.  Not the good change, but the kind of change where people talk about you behind your back, you become the "bad boy" and rumors about you and felonies spread like wild fire, but enough about my high school years.  You see, there are certain people who I have been relying upon for helping with the curve, and they may make a decision that will no doubt ripple out to me.  Should they decide that they aren't doing well enough in school and no longer want to be a doctor, they may leave school, destroying the better part of the curve.  Better to get out now than to continue to increase their debt load.  They will have six months to find a new career or school before the bounty hunter shows up.  I will be sorry to see that someone has come this far only to find out that it is not for them and with them went some of the bottom half of the class I was relying upon for an extra boost in my score.  But at least it will free up some more room in the auditorium...

That's the signpost up ahead...

It was only a matter of time.  I figured I wouldn't have a fellow student try to make me look bad until rotations, but here I am, 8 months into my medical career and I got my first taste of a gunner attack.  Of course it had to do with my venipuncture technique on the patient simulators (robots).  Called me out because I wiped the patient's arm with a gloved hand instead of using a bare hand and then gloving up.  (I think I got my error right, but I am not sure.  I forgot if I had a gloved hand or not.  I stopped listening to her when I started to throw up a little in my mouth from her comments.  I tried to think back to when I have had my blood drawn and I am pretty sure the phlebotomist was gloved when she disinfected my arm.)  The third-year who was monitoring the session said it was perfect, but of course this little doll had to open her mouth.  She mentioned something about cross contamination.  Apparently she hasn't learned proper med school etiquette.  If the teacher says I got it right, I got it right, end of story.  If she were a guy I'd give him a left-cross contamination or just kick him down the stairs.  If there is one thing I know in medical school it is that everyone's center of gravity is severely altered due to the 50-pound back-pack people wear.  That's why I use a duffel bag.  That and it's easy to get away from just in case a fellow classmate goes postal.  I can feel the tension in the room as finals close in so I know it could happen.  People are on the verge of breaking.  I will not inflict physical harm on my classmates though as frustrating as they might be because I am compassionate, caring, understanding, and empathetic, at least that's what I told my interviewers at this school.  (Which is true, unless you are a gunner.)

Back to topic.  I asked a phlebotomist in our class the proper technique and it turns out I was right.  Either way,  I still feel ill and violated from it.  I will not go out of my way to make her look bad.  I will let it pass.  Unless I am lucky enough to have her follow me in the anatomy practical in which case I will move every pin I can for her after I write down my answer.  Give her my "contaminated" version of the test.  I am still amazed by some classmates though.  I guess I should expect it by now.  I swear, gunners would go back to med school after graduation just to make everyone look bad.  I feel like the girls of sex and the city in their dating lives...."Are their any NORMAL people in this school?"  Not to date, but to interact with socially so I do not feel like I am living on the set of One flew over the cuckoos nest (see * below).  Should have asked that in my interviews.  Mea Culpa.  Now that I look back on it, I am sure that some schools hired actors to give the campus tours at my interviews because I now know for a fact that there aren't that many normal people in medical school.  My school should consider doing the same.

*While these comments may seem judgemental, I assure you I am well aware of the more probable idea that I am the freak and they are all normal.........

                                     

If this picture means nothing to you, watch the clip below.  It is how I feel sometimes....next stop, the land of shadow and substance, Med School.

Is anyone here a marine biologist?

Back to the grindstone.  Three weeks until the biggest break of the year, but standing in the way of freedom is one test, and four midterms/finals.

So it seems to be commonplace for people to assume that because I am in med school I know everything there is to know about medicine.  It's not their fault, but in case you are reading this, and you still believe that med students are doctors, let me assure you that they are not.  That's why I am in med school.  I know about as much as you do after a full game of Operation.  Ask me anything about musculoskeletal or six weeks of information of cardiopulmonary and I might have some idea of the parts or diseases you are talking about, but ask me anything about reproduction, the brain, skin, and I buckle under the pressure like Miss Teen South Carolina.  Knowing that, I sometimes do not like to admit I am in school in fear of someone asking me a question I know I cannot answer (thus the Seinfeld reference in the title) and me having to face the your-med-school-sucks-stare. So in preparation for the plane rides I took during Thanksgiving, I had some other professions picked out, just in case the flight attendants needed medical assistance.  Sorry but you are better off if I do not touch you.  Just dodging lawsuits.

Leg one of my flight this holiday season:  I am watching Curb Your Enthusiasm on my DVD player, and the guy sitting next to me is watching some sort of porn on his iPod.  No joke.  I was wondering why he was covering the screen with his hands like he caught a leprechaun so naturally I had to make sure the TSA would approve of his viewing choice.  Looked over and caught....well, use your imagination.  Who does that?  What if I had been a child?  Can't it wait until you are off the plane?  Was tempted to lean over and say, "You know, the mile high club only counts if it is with another person."  I had already planned that if we were to converse, that I was going to tell him I was in seminary school.  Just to see.  Funny thing is, he kept looking at MY screen.  Couldn't take his eyes off of it.

Moral of the story:  Curb Your Enthusiasm IS better than porn.  

The return trip can beat porno-flyer.  Just after take-off, dude in front of me turned around and asked, "may I recline my seat, please?"...WHAT???  Who asks that?  If I say no are you going to do it anyways?  Is that lack of 6 degrees going to keep you from dozing off?  Well I am nice, so I said yes.  Who knows, dude could end up being a patient or my attending one day.  Gotta watch my back and karma levels.  I appreciated the gesture though.  Would have made sure he made it off the plane if it went down.  He goes before women and children.  World needs more of those types of people.  Usually right when I am reaching for my Cosmo, and the $15 bottle of water that I bought past the security checkpoint, the joker in front of me reclines their seat.  I get plastic to the skull followed by a face full of SARS-laden magazines.  While I was asleep one time in an airliner, I had a dream I ran into a tree.  Woke up to find my head sandwiched between the tray that I was using for a pillow and the seat in front of me.  That's why I never recline my seat in an airplane.  Don't need to get sued 'cuz I crushed someone's head.  Just dodging lawsuits.

Oh no he di-int!

Oh, yes I did.  Two blogs in two days.  Better productivity then Texas Tech had on Saturday.  It is the holidays and I am a sweetheart so here 'ya go.  See you after T-Giving.

Seeing as the holidays are approaching faster than a gunner can say "teacher, teacher, you forgot to assign us homework!!" I thought I would take this opportunity to assist you folks a little bit should you come across a Hotel.  Once a long, long time ago, a young, stud-riddled group of bellmen (who happen to be the greatest bellmen and co-workers ever and were actually thinking about making a "Bell Hops in Tank Tops" calendar cuz they are so manly) started a blog.  They all make Vin Diesel in Pitch Black look like Clay Aiken.  What started out as sheer entertainment quickly turned into a defunct blog as soon as management pulled the internet from the work-space.  Before the ship went down, they managed to squeeze out the best tipping guide to date (as well as search the internet for info on colon cleansing, UFC, co-workers in bathing suits, you-tube videos of aliens and surf spots, Nascar, beer, reggae music, atheism, Bible Verses, army gear, pictures to photoshop and google every creepy guest they could, to name a few items from memory).  It isn't someone giving their opinion about what they feel is best, but actually advice and guidance straight from the receiver.  Naturally you might be thinking the information is a little biased, like Tom Cruise talking about Scientology in the background of a PETA video, but I assure you, it comes from the heart.  So at my futile attempt to resuscitate the blog (I think they have internet again) I say, Enjoy!!

NOTE TO READER:  If you ever see a bellman loading a cart like the one pictured above, he is a fake.  No self-respecting bellman packs a cart like that.  Maybe a valet, but NOT a bellman.  He is going to put the folding garment bag on the cart, wrinkling the suit.  Plus the golf clubs are resting against the metal which is putting unnecessary strain on the Calvin and Hobbes golf club cover that guest has.  That is what you call a JV job.  Plus I can see the hand prints on the cart.  Someone didn't learn to use bright boy...

Seeing the doctor

I will never look at another doctor visit the same again.  From here on out all doctor visits will be looked at under my "is it good enough for medical school" microscope.  I had to get my final Hep B shot (the school requires it, and besides, I fear Hep B more than Autism so I would have gone for it anyways).  I have not been to the doctor since starting medical school so I immediately started to observe everything.  The way the counter worked (two ladies calling on a single file line), the rules that were posted (no cell phones, extra charge for after hours care, no narcotics after hours), how many doctors they had (11), how many waiting rooms they had (3), etc.  

First of all, I will never attempt to provide reading material in the waiting room.  If you are my patient, entertain yourself.  It agitates me more looking at 50 magazines that all suck then staring at a wall.  One decent magazine would be nice, but instead I get Highlights that already had the Mad Libs done.  So I will not bother to spend money paying for magazines that will not get read by my patients or better yet ones that will agitate them further.  They will bring a book next time.  And there will be a cell phone fee if I have to wait outside a room because you are on the phone.

I also paid attention to how the nurse handled talking with me as well as how the doctor spoke.  Is he using OLDCARTS, or OPPQRSTA, or winging it?  Is he going to pull at my social history a little bit or just give me the shot and be done with it.  For the first time I actually sat in the "interview" chair.  I usually like to sit on the tissue paper, helps me feel sanitary, but this time I went for the textbook doctor visit.  The nurse gave me the shot and then had me wait for the doctor.  I thought about just leaving.  What I came for was done, and there was no need to talk to the doctor, and besides, how stoked would he be to find out that he could go kick back in his office for a few minutes because he didn't have to waist his time talking to me?  Well I stayed, and looked at the dermatome cheat sheet he had on his wall and studied.  Naturally, since he needed a cheat sheet, I figured he must have graduated from Drexel!  HAH!  I realize that it just makes it easier, so I cut him a break.  Chances are I will soon forget them myself anyway.  Then it occurred to me, why am I learning it now if I am allowed to have a cheat sheet on the wall one day?  Better yet, if I have access to wikipedia to diagnose, I am set.  Wikipedia has taught me 99% of the immunology I know.  Well, the patient/doctor interaction went well.  He asked me a few questions and then we talked about medical school a little bit.  He told me about his friend that died from getting Hep B in medical school from a needle stick.  Can't wait for those to start happening.  Then he told me to wait a sec and he would be right back.  For some reason, I got excited.  I thought, "this is it, the day they teach me the doctor handshake or the secret to doing well in medical school or something only doctors know."  I was disappointed when the nurse came by explaining that the doc didn't know I already got my shot and had wanted me to wait to get it.  She didn't tell him that she did that so I ended up waiting an extra 10 minutes.  I would have missed 10 points for a move like that.  I guess I will have to wait until graduation to learn the handshake.  Until then, I will just flash the Harley wave every time I pass a doc in the hallway.  (Couldn't find the clip I wanted, so just deal with it.)

Update: Parents out there really do want out of being a parent

In reference to a previous post found here, where I talked about the safe-haven law in Nebraska:  Front page of cnn.com I found this today.  Apparently they are asking kindly for parents to stop.  Good luck with that.

Flub-otomist

Sunday I looked like a heroin addict.  Yes, friday was our (most of us) first time drawing blood.  (Well, 2nd if you count the one time I was doing research and the german doc and I needed blood, and well we were low on supplies and so we used a belt and butterfly needle and made a mess.  Turns out he didn't know how to draw blood either.  He was more concentrated on learning to be a surgeon than a phlebotomist.  I appreciate that.)  Sad to say it will probably be the last, because every time I have had my blood drawn it has been by a nurse or someone I assume to be a phlebotomist (I was going to link the definition for you, but Princeton decided to define it as someone who practices phlebotomy.  See for yourself.  I guess they like to hoard their knowledge.  Wow, now that the -ist is changed to -y, I understand.)

If I were concerned about not looking like an addict, I probably wouldn't have suggested the student drawing my blood didn't go the easy route and instead, "pick the small vein, you patsy.  One of the few times the other person wont sue you for screwing up, so take advantage."  Either way though it is hard to draw blood with 5 other students watching when they all know you have no idea what you are doing and they all know this is your first time and what not so I won't hold a grudge.  

I couldn't help but question why were were doing this (the only thing I can think of is that in residency and rotations I will be requested to do things outside of my job description which happens to be "stand there and don't kill anyone.")  I mean, as previously hinted to, I have done a fair share of shadowing (one of the many proverbial med school admission "hoops" to jump through.  Seeing as they want you to have some idea about what medicine entails.  If I had listened to the doc I shadowed though I wouldn't be here today, so their plan could have backfired) and the only time I saw a doctor draw blood was that one time where all the nurses passed out and the office manager wasn't available to step in.  I guess it keeps us from having to lie when a patient asks, "is this your first time?" 

Easy Gunner

So here I am, 12 weeks of medical school under my belt and I am going to address one thing today.  I am still amazed by some of my fellow students' need to scrub in after peeing.  Dude, we get it, you have scrubbed in on a few surgeries, big deal.  Yeah it is neat, but you do not need to be peacocking your hand washing skills around like you are Howie Mandel*.  No joke, day one of orientation, first bathroom break, dudes were up to their elbows in suds, scrubbing like they were at a mysophobia convention.  Getting in between the creases, under the nails.  It's cool, bro, the only person who needs to worry about suing you over an infection is you.  Relax, as soon as you grip the door knob on the way out you will already have a nice blanket of bacteria on your arm.  It makes more sense to wash your hands BEFORE peeing anyways, but culture dictates otherwise.  You want to be a surgeon?  Better learn how to not pee on your hands first.

*Mandel has obsessive-compulsive disorder (OCD) and mysophobia (fear of germs) to the point that he does not shake hands with anyone, including enthusiastic contestants on Deal or No Deal, unless he is wearing latex gloves. Instead of shaking contestants' hands when they offer them, Mandel often opts to exchange fist pounds, put his hands on contestants' shoulders, or give an occasional hug.

Pick Your Battles, Moron

It isn't that often that I call people names, but in a class of medical students I am not surprised that many of us have somewhat off-kilter social compasses.  You know, making jokes bout being a 'floppy baby' for halloween (a buzz word in pathology) loud enough for others to hear, talking out loud in the library, repeating 'fecal-oral' every chance you get, being a democrat (I only kid, don't taze me bro).  It is a surprise that they allow some of us to be around naked dead people as much as we are.  Seems like 268 walking liabilities with probes and scalpels to me.  But, I let that all slide.  I am cool like that.  

What I do not understand is how some of my classmates do not know when to keep their mouth shut.  Word around school is that some brilliant one went and complained to a pathology professor.  I could stop there.  Many of you know that you do not voluntarily go and seek out a pathologist to converse.  Like going to rehab to pick up on chicks, you're just asking for trouble.  I mean, pathologists are usually odd, let's be honest.  This one in particular swears he has an extra Y chromosome or something.  So rule number two of med school was breached.  Now I will tell you that this little genius went  to him to complain about how he mentions religion a lot and how offended she was that he mentioned that Muslim women that cover all their skin except their eyes are looking at potential bone disease from lack of Vitamin D from lack of sunlight.  Really?  What offends you?  FACTS?  Or because he said 'Muslim'?  Learn to pick your battles genius.  You want to go petition to change the color of stop signs because RED is offensive and brings negativity also?  Good luck with that.  So now good old path professor pulled his intended test for us and is replacing it with a much harder test for our benefit.  Guaranteed that guy could make a test out where we would all get none right because contrary to what some of my classmates think, we know nothing about diagnosis, recognizing, or treatment of disease.  Rule number one of med school is you don't know crap.  Rule number two is you don't talk to pathologists unless spoken to.  We are first years with undergrad degrees.  Pick your battles.  Go ahead and put the phrase "that offends me" away for a little bit, or at least until I won't be directly affected by your hairpin trigger reactions.  You can't bark up every offensive tree, because if you do, it will be a loooooooong rotation and residency and life.  Path and anatomy practicals thursday.  Pretty sure I now create mnemonics for my grocery lists. 

Study Break

This next week is finals week.  Short post as my time is limited right now.  Somehow the administration has let one of our four finals slip to next tuesday which means the ONE weekend we get in between sections will be consumed with studying for another final.  Awesome.  Hey, one day do you want to tell my children there is no santa too, buzzkill?  I am really tired of anatomy as I have now spent more time around dead people then OJ Simpson.  I have been trying to learn as much as I can for our practical on Thursday, which has forced me to neglect a lot of other material.  I think we are all ready to be done with Musculoskeletal so we can move on.  I think this will be the trend for the rest of med school....always looking forward to the next fix.  

Speaking of the next fix,  special thanks to Frank Drackman MD for his spotlight on The Week.  It can be read here.  The Hideout is a daily read for me between classes and it keeps me laughing when I am not laughing at the gunners.

I now leave you with a great editorial piece:

October 2008
ACEP News
By David F. Baehren, MD

The United States has enjoyed the most successful and enduring form of elected government in the history of mankind. In spite of our political class being populated by some of the most unworthy scoundrels ever to run for office, our system of checks and balances has served our nation well, and we have prospered.

The genius of our founding fathers is evident in their deliberations over the writing of our Declaration of Independence and the Articles of the Constitution.

The signers of the Declaration were accomplished and serious men. Almost all were wealthy, and each had much to lose by signing his name. At the end of the document, they wrote, "We mutually pledge to each other our lives, our fortunes, and our sacred honor." They knew the dangers they faced. Many were hounded by the British and eventually lost family, fortune, and their lives. They died, however, with the thing they cherished most still intact: their sacred honor.

Fast forward to present day, when our politicians and candidates spend more time trying to get and stay elected than they do thinking about the preservation of the republic--a republic for which so many have risked and given their lives. Our current crop of public servants couldn't shine the boots of the likes of John Adams, Samuel Adams, Thomas Jefferson, and Ben Franklin.

An election year seems to bring out the worst in them. The dishonorable pandering that goes on is most vexing. There seems to be little talk about what's best for the country as a whole, and lots of talk about what can be done to please this or that interest group. The latest redistribution-of-wealth scheme disguised as a stimulus package is a very good example of this kind of nonsense.

The biggest prize of all in the pandering game is health care. Some are ready to give it away to all at the expense of the taxpayers. Assuming one believes that expanding the federal health care system would actually help people, it's easy to appeal to voters based on stories of individual hardship. How could anyone deny health care insurance to a working mother of three?

When the poster child approach is used, it becomes difficult to make an argument against a national health plan without sounding heartless. And those who are pushing for national health care are counting on this. A rational person might first ask what kind of coverage would be provided. Would it be like Medicaid, where access to care (except emergency care, of course) is quite limited, and the only guarantee is that nobody will try to collect money after the government pays 30 cents on the dollar?

Would everyone have Medicare, where money gushes like Niagara Falls? (Some of that money actually splashes at the feet of doctors on occasion.) Medicare pays for people who don't recognize a soul or know the year to get dialysis. Ambulances shuttle patients all over creation at $500 a ride--but Medicare won't pay a doctor a reasonable fee to make a house call. Amplify this kind of waste five times, and the budget deficit will soar. The money will dry up quickly, and then the rationing will begin. At first, it will be relatively easy, and we won't dialyze people who don't know what planet they inhabit. Later, choices will become more difficult, and people will wait months for bypass surgery or will be disapproved for hip replacements.

Will we allow people to purchase supplemental insurance and maintain a two-tiered system, or will everyone be forced to live under the same cash-strapped federal system? That's the way it is in Canada. Those with means choose to come to the United States and pay out of pocket when they are put on the waiting list for surgery or chemotherapy, because they are prohibited from buying private insurance.

Americans will demand choice in their health care coverage. Just as people with money abandoned city schools 40 years ago, people will flee the federal health care system. Access to good care will be diminished for those who are stuck in the federal system and will improve for those who can afford the private system. Our elected officials may feel better for having done something to "help" people, but everyone else will be the worse for their efforts. And the very people they set out to help will suffer the most. Just look at the failed public school system of every large city in the country to get a look into the future of health care.

There is more to this than guaranteeing health insurance for a mother of three. The larger debate should surround what's best for the survival of our republic. This is what our founding fathers pledged their honor to. They put the good of the nation ahead of their parochial interests.This is a rare discussion in Washington anymore. Remember, it is our elected representatives who have created the Social Security system but failed to put money aside to pay the tens of millions of people who are about to start collecting from it. These are the numbskulls who gave us EMTALA and demand our servitude (under threat of stiff penalty) without any promise of compensation for our efforts. This is the fiscally irresponsible lot that spends money on useless earmarks while our collective debt soars. I don't have high hopes that any of our candidates or elected representatives will look at the big picture and realize that our Constitution does not guarantee happiness. We have no right to it. We are free only to pursue it. 

Our founding fathers did not believe that pursuing happiness involves sitting on the couch waiting for your federal insurance card. Thomas Jefferson said, "The democracy will cease to exist when you take away from those who are willing to work and give to those who would not." He would not be pleased with our current entitlement state and our punitive tax code. He might even look at our current government in the same way he saw his British oppressors and say that it is his right--it is his duty--to throw off such government, and to provide new guards for our future security. No doubt, today he would be branded as a crazy extremist. Every election provides our nation with a crossroads. For physicians, this is a particularly important one. I fear that the implementation of a national health care system will propel us further down the slippery slope we travel already. 

When the majority sees fit to tax the wealthy minority to pay for something not promised in the Constitution, our republic creeps closer to collapsing into socialism. And then we will be a mere shadow of the great republic forged over 2 centuries past.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu

Or you can share your thoughts here.

Ahhh, yes the BCS

In honor of the BCS, I will soon be changing my specialty hierarchy to a complicated mathematical formula that will in no doubt make it clear which one is right for me.  I hired a math-a-lete to help me.  I will also be giving you a very random, somewhat incoherent post as I have another test tomorrow and this last week was out of control busy.  Felt like I was one the trading floor of wall street, sans the awesome backstreet boy head mic.  

Anatomy lab was filled with phrases like "I hope that wasn't important."  "That looked important."  "I think I found the great saphenous vein."  "No, you found fascia."  "My nose itches."  "You got some juice in my eye." and "maybe we weren't supposed to cut that."  I accidently cut something I shouldn't have (don't worry, even the fellows do that), and instead of alerting my tank mates, and risk getting voted off the island, I tucked it back in and waited for someone else to touch it and pull it out of its intended spot so I could pull the old tommy boy "what'd you do??" line.  Stellar.

Apparently I have been 'tagged' by this woman.  It appears that my job is now to entertain you with 7 'wacky' or unknown facts about myself.

7.  I have owned and actively worn the shoes I am wearing for 5 years.  I hold onto shoes until the soles fall off or they look bad.  Notice I said "or look bad" because I can keep the shoes looking new until the sole comes off.  In fact, my last pair of work shoes I had were spray painted and sharpied to mask the severe discoloration.  It worked.  Wall paper over the hole, baby. (don't hate)

6.  I have had a gun pulled on me (don't ask)

5.  The phrase "I need a bellhop" still brings a sickness to my stomach.  While we are on the subject, so does "I will tip you later", and "Oh, sorry I need to go to the ATM."

4.  I have never done anything wrong/illegal/immoral without getting caught.  (Yep, I suck at crime)

3.  I have never been in a fist fight.  In fact I often think how things would have been different if I had thrown a punch the one chance I had that was warranted.

2.  I have had seven surgeries and I am still convinced that the Kerlan-Jobe doc let his first-day fellow cut on me, but one day that could be me so I won't complain.

1.  I was suspended from pre-school....thats right, pre-school.  (When you're street, you're street.)

Because I was so generous and told everyone who reads my blog to go to their web site, I now 'tag' Frank Drackman MD, the DOA, and Cold Girl Fever (Medicine Girl)    (If you guys do not do this, you will have bad luck for 50 years and John Rocker will become president.)

This week I had a talk from an ED physician, and by ED I mean emergency department.  I wasn't surprised, but I was upset at the fact that he said his group only gets paid 35% of what they bill for.  You can't get that good of a deal buying chiclets from a mexican child on the beaches of San Felipe.  He started to worry some people by saying that his group only gets back 35%, they get a large part of their income taxed, and they still have student loans.   Now, do not take me for a greedy person who has no compassion and does not have a heart, but I wonder how it would change the face of medicine if doctors had no income tax.  Add in teachers, bellmen (had to throw it in there), firemen and policemen to that group and I wonder what would happen.  Just a thought.  Hey, the lawyers will pick up the tab.  A physician I shadowed once told me "you know, a lawyer makes $100,000 a year and people say, 'he must be good and work hard.' but a doctor makes $100,000 a year and people say, 'ah those damn doctors charge too much.'"  Now I know I am not in medicine for the money, and I do believe that some less fortunate people deserve medical care, and I will absolutely be a physician who gives back, but there are a lot of people who take advantage of the system and just ride it out, leaching off of the tax payers.  I could go deeper onto this topic but I have a test tomorrow.  

We did have one person in our class stand up and tell us that she really wants to go work for an insurance company one day.  Kind of like standing up at your  nun orientation and saying you wish to be a stripper one day.  So much for that oath you took at the white coat ceremony about doing everything in your power to get patients better.  I mean you took the seat of someone who actually wanted to treat patients, not actuarial statistics.  I tried to get her kicked out of school, but I couldn't get her to take a swing at me.  They should have kicked her out on principle alone.  Kind of not what we stand for.  I hope this week is not as busy as the last one.  Out.

Safe Haven

First of all, I wanted to thank M.D.O.D. for adding one of my posts to their "Grand Rounds" this week.  I give them full credit for the sudden 300% increase in visitors to my site the past few days.  In a futile attempt at reciprocity I encourage you to head over there and check it out.  They don't hold any punches and I agree with a ton of stuff they talk about, especially when it comes to EMTALA and healthcare in general.  This brings me to the blogs list I have started.  There are a ton of medical blogs out there as well as non-medical blogs that provide me with guidance, support, life-skills, and comfort on a daily basis.  I have started a top list on the right side of the page that I am sure will grow.  Check them out.

For all you parents out there who have at one time or another felt like driving your children to a place far, far away, (pretty sure that gets all of you) there is hope.  You may be saying, "they are 14, too old to abandon," to which I say, "not so fast." GO TO NEBRASKA before it's too late.  Oh, I can just imagine the conversation to pass that law:

Lawmaker #1:  Well, how old is too old for this law?  Lets think about it?

Lawmaker #2:  hmmm...(looking at watch)...the cornhuskers game starts in 5 minutes...

Lawmaker #3:  I know, let's just put 'children' where the age will go, that way we won't have to worry about it.  It's not like some guy will show up with 9 kids and leave them all.

Lawmaker #1 and 2:  Genius!

At least throw in a mandatory vasectomy/hysterectomy if you are going to pass some legal abandonment law.  If a guy can't produce one 'keeper' out of 9 kids, should he be able to try again?  You know what you are getting when you take on the responsibility of children.  (I appreciate the law when it is laid out correctly as it is trying to stop people from leaving their babies in dumpsters to die, etc.)  And yeah, some are more difficult than others and we could try to figure out whose fault nasty children are (parents) by discussing nature vs. nurture until David Blaine stops pulling off "incredible stunts," but I plan on being done with this discussion before I am 40.  [Plus, David Blaine is a crappy tipper.  Dude can change $1 bills into $100's, levitate, resurrect bugs from the dead and pull strings out of his stomach, but the hornswaggler hands over a 3 wadded up $1 bills and expects me to be amazed and dazzled?  Bro, change them into hundies!  But I digress]  I can't go to the fair, pop some balloons, walk around with a giant pink ape all night (or for 14 years for that matter) and then return to the carney and tell him I don't want to carry it around anymore because it is too much of a burden and I didn't realize what I was getting into.  That doesn't fly.  Should have stopped when I won the glass photo of Elvis or after the first three balloons where the toy was small enough for my dog to chew.  Yeah it seems cool at the time and you can't question my dart throwing ability that night  when people would stare and say "wow, he must be good at throwing darts because of the large, stuffed animal on his shoulders!  Wow he is so cool."  And my totally hot girlfriend is naturally impressed, but as soon as I leave the fair, I am just a guy with a giant pink ape on my shoulders and that puts a hamper on my lifestyle.  I do feel badly for the children though, but maybe they called Dad's bluff when he told them they were driving them crazy and he would leave them at the hospital.  "Fine Dad, if I can't watch the Hills or date Mikey, what do I care!"  Maybe 'Dad' doesn't realize that once they get grateful again and realize how nice it is to be home, they can't go back home.

"My oh Myostatin"

Prediction:  If they don't go soft, the Germans will have a male break Phelp's record for the most medals won in approx. 2010-2018.  

For those of you not familiar with Myostatin, let me introduce you to what happens without it.

You can't deny that this mouse is jacked.  The other mice couldn't get that yolked even with the juice.  Myostatin enables fat production and muscle atrophy.  Now, imagine if you weren't able to produce it.  Just so happens that researchers did it in mice.  It also happens that the first recorded human without the gene expression for the hormone is in Germany (documented via scientific literature).  At the age of four, he was holding approx. 7 lbs. straight in front of him in horizontal suspension.  This guy could smack the smirk off of Richard Sandrak's face while curling 50s.  There is no doubt that this little tyke is going to have a great life.  If he ever gets picked on, he will set an example by bending the bully's bike frame into a pretzel.  He will never go to his dad for help with bullies, his dad will come to him.  Fathers, good luck stopping this guy from dating your daughter.  And if by some fluke you have a daughter that cannot produce Myostatin, I say a forced marriage is in order.  You better hope you got some serious bridewealth.  This kid will play every sport imaginable and dominate them all.  Imagine this kid in Pop Warner.  Guy will have college strength in 5th grade.  I would be worried if this child was born in another country, where he might be able to go through life without picking up a sport or 10, but not in Germany.  They are hardcore.  Thing is, even if the kid pigs out on McDonald's daily, he will still be ripped.  With a little education and fitness, he will be unstoppable.  The Germans are prideful and take success seriously.  Not anly that, I wouldn't be surprised to learn that they cloned him to make a whole Olympic squad. Good thing this isn't Berlin, circa 1962, where they might require that parents only produce children sans the Myostatin gene.  The dates above are a range because quite frankly, I wouldn't be surprised to see the Germans cheat a bit to get him there sooner.

Note to Drew Rosenhaus:  Dude, get on this guy before it is too late!

Speaking of football, I just was briefly watching the Kentucky/Alabama game and the announcer said "Looks like they are going to take the penalty and try the field goal from further back.  They say it improves the angle, but I don't see it."  Seriously?  You are a football announcer and you don't see how a field goal from the three yard line on the hash is not as easy as it is from the 8 yard line?  I hope someone was ripping him apart in that little ear thing he wears.  Even Hochuli can make that call. 

Yum

I am not one to brag, but I just found a piece of preserved human flesh on my cell phone.  That's all I have to say about that...

More updates this weekend.

Infraspinatus Envy

Thursday, my lab group exposed the infraspinatus  (among other things), and let me tell you, it is textbook.  No fascia, beautiful striations.  It is even better then the prosection.  Everyone was coming over to look, even the fellows.  If our infraspinatus doesn't get tagged in the anatomy practical, I will be talking to the dean.  

I was convinced that I still had some piece of flesh on me this morning during lecture because I could smell it.  I think I will be smelling it for a long time, piece of flesh or not.  Like my brother once said, "if you smell it, you also taste it."  SWEET!  My group is pretty cool as well.  A lot of people were talking about how everyone at their tank was so serious and no one had a sense of humor (or should I say humerus).  My lab group was joking and laughing.  I could see the sadness in some people's eyes as they looked over at us like we had just beat them in the championship game and it was time for our trophy.  And that was before the infraspinatus was unleashed.

There were a few awkward moments in lectures this week.  The first was when the biochemistry professor asked a student in the front row if the word "invagination" turned him on.  The second was when one of the anatomy professors said to the other, (they are married to each other) in front of the whole class, "thanks for helping me with that, you are definitely getting dessert tonight.

How do you like them apples, gunner?

Before I get to the good stuff, I wanted to say that I am getting really sick of the 'professors' ending all their mid-finals-week-e-mails with "happy studying!"  It is just disgusting.  In fact, some students think it is a good idea to add little 'pick-me-ups' during their messages too.  "Good luck all" or "Have a good weekend" knowing full well that we will be locked inside without seeing the light of day, furiously trying to cram information into our overworked and under-rested brains in the hopes that all of a sudden we will be able to remember said piece of info.  I mean, it is not kosh to say to a person asking for change outside a quiktrip, "happy panhandling!"  Bosses do not say "happy job-hunting" to employees they just fired.  I am all for finding the silver-lining, but don't be ridiculous.  

So the night before every exam, our physiology professor goes onto the chat rooms (no matter how innocent that word is meant to be, there is still something odd about saying chat room) and helps answer any last minute questions we might have.  I was there one night watching questions when I noticed something distracting.  This young buck seemed to always have the first answer to everything.  You know, this kind of activity, but in a chat room!  He was also starting to get a little to friendly with the professor, acting like high school buddies that just met on myspace.  So I did something I do not normally do.  I spoke up in the chat room.  I have to say that I gave myself a high-five.  Normal guy 10, gunner 0.  It felt good.

Professor: And what is the neurotransmitter that activates the post-ganglionic sympathetic receptors? Aug 24, 2008 11:11:09 PM CDT
Professor: receptors should be neurons... Aug 24, 2008 11:11:16 PM CDT
Alpha Gunner: epi Aug 24, 2008 11:11:43 PM CDT
Beta Gunner: norepi? Aug 24, 2008 11:11:45 PM CDT
THE WEEK: ach? Aug 24, 2008 11:11:47 PM CDT
Prefessor: 10 points to THE WEEK... Aug 24, 2008 11:12:04 PM CDT
Confused Gunner: ? Aug 24, 2008 11:12:20 PM CDT
Prefessor: I worded the question differently than I said it in class, which is probably what caught you... Aug 24, 2008 11:12:24 PM CDT

Note to professor:  Do not sugar coat it.  They didn't know the answer...

Speaking of messing with gunners, there is talk amongst some of us about showing up one day in our pressed white coats, with ties and nice shoes and all taking up the first two front rows of seats.  Pretty sure you got to keep the gunners on their toes.  Chris Cocker has nothing on the gunner's potential reaction.  "Leave our seats alone!"

Christmas Is Coming...by Christmas I mean cadavers

So this week was interesting. We had a 'patient panel' on Tuesday which consisted of one patient (No, I wasn't attending class at Drexel, my school makes mistakes too). It was a lecture about obesity from a patient's prospective. I was intrigued to see if the man would change my opinion on obesity, but he didn't. Basically he was a 6' athlete that gained over 180lbs over the course of roughly 5 years and then tried to get it all off in 9 month spurts of exercise and diet. Well that didn't work, so after his daughter begged him for the sake of her unborn children to get a medical procedure to correct it, he finally did. I wanted to ask him questions to test his attempts to lose the weight, but I opted for keeping my mouth shut. I might have asked "Why didn't it work after 9 months of attempting to lose weight? Did you hit a plateau or did you give up?" or "Did you really expect to lose all the weight you gained in five years in 9 months?" I am not ready to stand out like that quite yet. If I was, I would have asked the Surgeon General, in front of a full auditorium a few weeks ago, "How is it that one day I will be on the phone with some 18-year old kid who works for an insurance company, telling me how to treat my patient because what I want to do isn't in the penny-pinching, actuary-produced flow chart that he is using to decide what I can and can't do?" But again, I am not ready to stand out like that quite yet. Those questions will not get me anywhere I am hoping to go. A lot of my thoughts are better kept in my head.

I know what it is like to lose a parent, but I cannot imagine the pain and frustration of watching your parent willingly (these were the patient's words) let him or herself get to the point that they would die a premature death. Three different times he was told that he would die within the year. But still he did nothing. There are so many people out there fighting cancer, and other unfortunate things they cannot control and to see someone who isn't willing to fight to prevent something they can control is disheartening. The people fighting cancer would love for the doctor to tell them, "All you have to do is exercise, and eat right and you will be fine." The patient said he knew what he was doing and he knew what it would take to lose the weight. Every time his daughter would say something, he would just eat more. I felt sorry for him and I am glad he was able to lose weight, surgery or no surgery. I do feel more sorry for the rest of his family though, but I am glad he might one day be able to run around with his grandchildren. He has lost about 80 pounds, but has hit a plateau which he wants to ask his doctors about. The procedure he had is more of a tool then and fix. I think it would also be very frustrating to be his doctor. You tell him, he does nothing, you tell him, he does nothing. It wasn't until he had that moment of clarity (him weighing in at 380 at the doctor's office) that he realized he needed to do something...anything. I can understand that, but that is tough. I have to say that sometimes, as a physician, there will be nothing more I can do. I will have to let fate take its course and at the end of the day just be able to feel confident that I tried my best and did everything I could to right the situation. I think this is definitely one reason I am so drawn to sports medicine. If the patient is an athlete, they will be somewhat healthy already, and they will be willing to to whatever it takes to get back onto the playing field again. I like the sounds of that patient.

We had a clinical didactic and practical exam on Wednesday which was nerve racking. It's one thing to take a multiple choice exam, but to have to answer and perform in front of a physician/observer/grader and mock patient in three minutes is difficult. Either you know it or you don't. There is no help if you draw a blank. They just stare at you and write notes on their paper. We also did some mock interviews. When you are at the doctors office, it seems like it is second nature to them to be able to ask questions, but what I never realized is that it is very awkward. I know it will come with time, but for the first interview, it was challenging.

Yesterday was my first taste of a medical school final exam. It was 4 hours long and I am pretty sure I was looking forward to this moment for the past six weeks. I seriously spent 5 minutes trying to figure out if my calculation of the range was wrong or if the professor didn't proofread his work. I chose for the latter. That is frustrating. We are under a lot of stress and when you have a question and do not give us the right answer, we begin to second guess ourselves. "Wait, I know this is correct. The range is not hard to calculate. But 18 is not there! 19 is. 25 - 7 is 18 not 19. Did he forget to make the 25 a 26? They should take away his preventive medicine title. He can't prevent a mathematical error.(Just kidding) You know, I was told once that the Challenger blew up because of a misplaced comma, but I am pretty sure our teacher was trying to get us to get into the whole grammar thing. Oh wait, I am supposed to be taking a medical school final not an algebra final..." I swear, if I get a 'calculate the mean, mode and range' question on the boards, I am going to ace it. I was more nervous about our clinical didactic and practical exam then I was for the final. I felt that after six weeks of information I couldn't learn much more. I had to use my time to refresh the things I once learned for the previous exams and make sure I had those things down. I didn't sleep much last night, not because I was so worried, but because I was 7 again and Santa was coming in the form of the musculoskeletal section. For the first time this year I hope that things will begin to make sense. Instead of some Russian dude telling me how much he is in love with cytokines, Tumor Necrosis Factor, and IgG (or is he saying IgD? maybe its IgE? I can never understand his accent) I will get to see some cool things. And by cool things I mean the cadavers. I am so grateful that we have this opportunity and I am grateful that someone was willing to donate their body to science.

I had an all-time high of 27 visitors to my blog two days ago. I am hoping that it was because a few of those visitors googled "Drexel University College of Medicine". Hey, one can dream.

Drexel University College of Medicine Thinks I am un-smart

Dear Drexel University College of Medicine,

I got your letter. Thank you for sending it to me. I was eagerly awaiting a phone call from you so it was disappointing to get this version. Even though I am here and going to a medical school already, I pretty much had my life on hold for you. I can finally exhale because I was still packed in anticipation of 'the call' at which point I would have left my life here for you. In my head I imagined 'the call' going something like this:

YOU: "Hello, this is Cheryl A. Hanau, assiciate dean of admissions at Drexel University College of Medicine. I know we have not interviewed you, but we feel we really got to know you by the way you answered our loaded questions such as 'Describe yourself' and 'Tell us about your activities since graduating from college' and 'What are your weaknesses'. I mean, even though we made you keep it under 250 words, essentially feeding us lines we wanted to hear, we feel that was enough to offer you a seat in our class of 2012."

ME: "Wow...uh...that's great, except I already started medical school."

YOU: "So did we, two weeks ago." (Notice the date difference in the letter)

ME: "Ok, great. So should I be there tomorrow? I will spend all night driving, if it means being there, with you."

YOU: "Yes, we are so excited for you to come."

ME: "You sure it isn't because you didn't have enough seats filled to make budget?"

YOU: "Don't be foolish. We got your AMCAS fee and your secondary fee. We have 12,000 applicants per year, which gives us our budget, everything after that is all gravey!"

ME: "So you really do want me there?"

YOU: "You bet!"

ME: "Do you have anywhere I can stay while I find a place to live?"

YOU: "No, in fact you owe us $40,000 by tomorrow. Good luck and welcome!"

ME: "Great! I will be there tomorrow, cash in hand."

YOU: "I like 100s."

Did you really think I was waiting around for you? How stupid do you think I am?  I understand a courtesey letter back when you filled the class, I don't know, maybe in March, but this is just an insult.  Apparently I am too stupid to know that the medical school semester is well under way and that I have about as much of a chance being a part of your class as I do leaving medical school free of debt. Maybe you think that I didn't get into a school anywhere and am just waiting around for something to happen?  I am such a kidder, because the truth is, I gave up on you the moment I had this conversation with one of your staff members back in July, 2007:

ME: "Hi, I looked online, and it says that my application says incomplete, but you cashed my check, which means you have processed my application."

YOU: "Oh yes, I see here [most likely looking at nothing more than a blank piece of paper as my application was already recycled and made into a milk carton at this point] that you are complete. You see, when you send us your application via snail mail, it will never get updated online. [wincing in anticipation of me calling 'SHENANIGANS!!]"

ME: "So you have my application?"

YOU: "Yes."

ME: "And it will never say that my application is complete online?"

YOU: "No. You will receive everything by snail mail, not online."[beginning to snicker]
ME: "So despite what I see online, I can take your word for it?"
YOU: "Yeeeees." [Flashing menacing smile]

I mean call me stupid (oh wait, you already did), but what is the point of having the online status check if it never gets updated? Do you enter through your exits and exit through your entrances as well? Do you make everyone walk backwards on campus, or is it just that way in admissions? Oh well, I hope you enjoyed my $120. I know, in your defense, that not charging people to apply to your school might diminish the respect you gain by making us broke before starting there. I respect that. But I do not understand why you would assume your applicants are this stupid. That's just bad for business. Maybe you just talk down to the rejects, and the people who get in actually get a letter that makes sense. I bet it has big words like confluence and extraordinary. Words I would have to look up before I could make sense of your letter.

I also knew to give up on you back when you started sending me your capitalist propaganda that said, "You might be interested in our school of nursing!" Save it, Drexel. Apparently you didn't read my personal essay that basically laid it out that my dream was to be a doctor and nothing else, whatever it takes. Seriously, this isn't Amazon.com and I am not shopping for books so do not try to sell me more stuff. Maybe your ploy was to make me watch you waste all $120 of my application fee, one postage stamp at a time, by sending those letters. I do not want you to try to guide my life. Do you really think I am stupid enough to think that I had a chance after the whole "we cashed your check, but your application still isn't complete" episode? Apparently you do. Or maybe you felt that I was going to fall for your "maybe you want to do something other than be a doctor" shell game. Yeah, you are right, forget the past four years and all the science I could cram into a semester, I should do something else.  Here is another application fee for you to insult me some more.  Do you maybe have a pyramid scheme I can join as well?

You should be careful, Drexel, because one day I might be in a position where I have to decide whether to hire the Drexel Graduate or someone else. I will think long and hard about how stupid you think I am and probably go with the other candidate, because, let's face it, hiring your graduate might be bad for business.  

Really though, thanks for bringing a smile to my face and allowing me to laugh a little.  When I saw the letter in my mailbox and saw it was from you, I shook my head and smiled.  I picked it up and shoved it between two medical school books I had with me FROM CLASS.  Only Drexel.  Only Drexel.

p.s. I know this pixelated 'signature' isn't really yours. I know you didn't actually put the pen to the paper. You didn't fool me there either. 'A' for effort though.

p.p.s. If I could somehow figure out how to make this post the first google result that pops up when you type in "Drexel University College of Medicine" I would.  Copying and pasting your double descriptive title 1000 times on my blog didn't do the trick.  I tried.  What is a university college anyways?  Your attempt at Jedi mind tricks?  Usually schools settle for X University SCHOOL of medicine.  Abraham Flexnerwould be rolling over in his grave.

Answer to the ethics question and a bonus ethics question (lucky you!)

Alright, ladies and gentlemen, here is the 'answer' to the ethical question. I use the term answer loosely, because in this article it basically says that other institutions have opted for the opposite route. So, this basically means that it is up to each institution to make the decision. So I hope the answer to my board question, should I get one, is any choice. The quotations below were taken from Urology Volume 64 , Issue 3 , Page 590 "Misattributed paternity in a living related donor: To disclose or not to disclose?"Douglas W. Soderdahl, Danny Rabah, Thomas McCune, John Colonna, Roland Frenc, Edwin Robey and Michael D. Fabrizio^,

Arguments for disclosure:

"Arguments for disclosing paternity are these. First, each patient must be treated as an autonomous agent who can make informed decisions, based on all the information available. In this case, the patient has a right to his test results and their interpretation. This allows for true informed consent when the patient is being counseled.

Second, to withhold the information, the physician acts in a paternalistic manner, whereby the doctor makes a value judgment as to how a patient might handle the information. Thus, the perceived potential beneficence and nonmaleficence of how information will be handled is valued above that of patient autonomy. The decision for nondisclosure is based entirely on hypothetical negative outcomes (ie, family break-up), which may or may not come to fruition.[3]

Third, one of the duties of the medical profession is to tell the truth, and although nondisclosure might not be on par with lying, deception, or misrepresentation, it still has ethical consequences. The truth has a tendency to become disclosed eventually and might irrevocably damage the patient-physician relationship when it does.[6] In addition, there might be legal ramifications if the information is discovered in the future under other circumstances.

Fourth, disclosure of the information allows the son to clarify his genetic heritage. His medical family history would not include that of his father or his father's relatives. His future health and life insurance might be affected by this information."

Arguments for non-disclosure:

"Arguments against disclosing paternity were as follows. First, by revealing the paternity information, there is a potential for irrevocable harmful effects on the emotional well-being of each patient and the family unit as a whole. Even though there are no legal or ethical obligations owed to the mother, this information is certainly sensitive to her, and her reaction must be considered as well. Ultimately, the information could prevent the potential transplantation and result in a break-up of the family unit. The “best” result in this case would be a successful transplantation and maintenance of stable family relationships.

Second, by informing both parties of the HLA typing results, one could argue that the physician breaches the confidentiality of each individual's findings. Each patient must give their own informed consent, even though the procedures are intimately related, and there is no absolute right to the other individual's test results even in the context of transplantation.

Third, because the testing was done solely to evaluate donor/recipient compatibility, one could argue that the unsought paternity implications are irrelevant. The son was still a suitable match for his father, and the results would not affect the transplant procedure. In that a similar situation could arise from simple ABO typing, eliminating HLA typing will not prevent situations like ours from occurring."

And what did they do?

"After much deliberation, we elected to inform the father, son, and mother of the results of testing. The paternity implications of the results were presented in as supportive a manner as possible. After a 2-week period requested by us, both patients consented to the procedures and underwent successful operations. At the time of the disclosure and in follow-up, the donor and recipient were both adamant that we did the right thing in informing them of the result and felt that it should always be done. Importantly, the family remains intact."

Here is another question. Is it ethical for the newly promoted Associate Dean for Curricular Affairs to change the long standing rule that states that if something was not presented in lecture, that it wouldn't be on the test?

How about if I tell you that she is also a professor?

How about if I tell you that she is also going to try to pass the rule that it is mandatory to purchase the books for each class?

How about if I told you that she also wrote the book for the class she teaches?

Perhaps a conflict of interest?

Stay tuned for the 2nd year students to take their first test from her. There is talk of a 2nd year student mutiny should she put a question on there that wasn't from lecture. Med school is so exciting. I hope the security guards have their riot gear.

Three and out

Well, we just got the second test results back today.  I will tell you that I am not happy with where I am.  I can do better.  I have not felt that I have been firing on all cylinders.  I feel like a football team that is able to move the ball, but just can't get to the end zone.  I will not settle for a punt or field goal.  [On a side note, when I was injured for football, I was responsible for writing down the result for every play.  Our team was struggling on offense, and it got to the point where I started to misspell 'field' in field goal because I was writing it so many times.  Now I know how you felt coach.]  I am faced with two possible ways out of this predicament.  I can completely throw out the practice plan and start changing things up everyday until I get it right, or I can slightly tweak the plan, while keeping the foundation I have built on.  Either way I suck at studying.  Yeah, I may be hard on myself, but I know no other way.  I could tell myself that I am not last so it is okay, but that would be cheating myself.  Like saying at the end of the loss, "at least we beat them in the second half."  You may be right, but we still lost.  I have yet to find a method that works for me.  I do believe I am on the right track, because the other option for me would be to just read through everything.  I know the notes are good, but just reading will not help me remember because I have been reading them when I review.  People will say what 'works' for them, but that is a relative term.  'Works' as in you are the top of the class, or 'works' as in you are not failing?  I assume the latter.  I do not want to win on a last second play, I want to have my subs in by the start of the fourth quarter.  What I do know is my brain is fried (I actually stopped myself putting dirty dishes into my refrigerator this morning) so there must be something going on inside my head.  Although, on the same token, I feel like I have learned nothing.  Just in one ear and out the other.  There is either severe learning trying to go on, or severe brain damage.  It is a good thing we are not in our neurology section or I would be self diagnosing.  I am already thinking I will develop ankylosing spondylitis, but that is a different topic.  Can't wait for each system so I can figure out what is wrong with me.   

This week is somewhat light and by light I mean I actually recognize some of the words in lecture so I will try to think of ways to do better.  The problem is I am too busy trying to grasp the large picture, and then they ask some detailed question on our test.  It kind of feels like a low blow.  If you spend 20 minutes on one subject and 2 on another, I assume you value the 20 minutes topic.  Either that or you are just wasting my time, and don't get me started on that!!!

Anyways, our section final is next friday along with the clinical final on thursday.  I will have no way to gauge if any new method works for me because the final is cumulative.  I think for now I will do a few things differently, but spend some time this week trying to figure out a game plan so the next time I get the ball I don't go three and out.  Yeah, that post was football themed.  Yeah, I work out.  Yeah, I eat protein.  You wanna wrestle over it?

p.s.  I will be posting the answer to the ethics question soon.

Ode to 'Shout out the answer to the histology slides before anyone else can think guy'

Dear 'Shout out the answer to the histology slides before anyone can think guy'

Congratulations are in order, fine sir. If this were a race, you would have more golds than Michael Phelps. With utter disregard for your fellow classmates, and the speed of Usain Bolt, you shout out what you think is the answer to every histology slide before any of our eyes can bring the image into focus. Even though you are wrong 80% of the time, you make sure none of us have a chance to answer. I can just see it now:

Patient:  "Hi doctor, I think I-"

You:  "Mesenchymal!!!"

Patient:  "What?  No, I need-"

You:  "Dextrocardia!"

Patient:  "No, you aren't-"

You:  "Collagen!!"

Patient:  "I don't underst-"

You:  "Simple cuboidal!!"

Patient:  "...."

You:  "Nodes of ranvier!!!!!!"

Patient:  "I am going to 'raise your hand in lecture guy', at least he talks to me"

Forget using the voice in your head to answer, you choose to use your monster truck ralley voice to provide us with what you think is amazing tissue recognition. Forget if you don't get it right the first time, because one of the next 6 names you yell out are bound to be right. My half-head turns with a rear glance do no good in persuading you to keep quiet, for you seem to have no social barometer that tells you when enough is enough. In fact, you take my half-head turns with a rear glance as a sign of encouragement and keep on going FOR ALL 80 SLIDES! 

I'm about to count out this bucket of loose change, you want to start yelling random numbers in my head while I do it, because that's what this is like.  "17, 32, 45, 98!!"  You are the marathon runner of the lecture and you always bring your A-game. Brett Farve couldn't beat your consistency, which is why I salute you!  (I would give you a high-five, but I am afraid you might talk loudly to me in the library. That's embarrassing, too.)

p.s. Say hi to your friends for me.  You know, 'Drop the f-bombs in front of the kids guy' and 'Kick my seat in the movie theater guy' and 'Rest your car door on mine guy' and 'Talk on your cell phone at socially awkward times guy' and 'Rush to the front of a new line at the grocery store even though you are last in this line guy'. 

$10,368 down the tubes. Thanks.

First of all, I want to thank everyone who is clicking the advertisements in the upper right hand corner.  As of right now I am at $26.06!!  PLEASE CONTINUE TO DO IT.  I really appreciate it.  

The following might seem like whining.  I have learned through the medical school process that there are a lot of people and things I am not going to agree with, and most of the time I will just have to suck it up and move on.  I assure you that should the extremely rare instance when I can do something present itself, I will take full advantage of it.  Until then, I will complain to you about it, so just suck it up and move on.

Dear 'raise your hand in lecture' guy,

$60,000, roughly, is what it costs me to go to school (living expenses included in the number) per year. We go to school about 216 weekdays out of the year. That means every day I attend lecture, I pay $0.20 per minute for the WHOLE day. [Keep in mind that I could factor it in per minute, per lecture, and then the amount would be much more.  I could also add more questions, but it is Labor Day weekend and I am feeling nice.]  So, every time YOU raise YOUR hand and make the 'professor' stop the lecture for five minutes so YOU can ask a question or comment on how YOU have seen/experienced/done something pertaining to lecture, it costs me two dollars. 5 minutes for the time wasted in class and five minutes for the time I have to now spend going over the stuff the 'professor' will consequentially not have time to go over. Add in the compounding interest over 8 years and you now owe me $3.00. It happens AT LEAST 8 times a day (2 per lecture). That is $24 per day, multiplied by 432 (two years), and you get a whopping $10,368.  I didn't notice the 'listen to your classmates 8 times a day' loan on my promissory note.  I don't know about other students, but I would much rather a $10,368 check than to listen to YOU interfere with my learning process.  Oh, and my favorite is when YOU have YOUR hand up for a while and then YOU put it down, at which point the 'professor' calls on YOU and YOU say, "actually you just answered my question." Really? Wow, go figure that a 'professor' is going to back up a statement with clear, concise points. Weird. Pretty sure that unless it is immunology, it will make sense at the end of the lecture and if it doesn't, there is always e-mail or office hours.  In fact, YOU could probably pull out YOUR iPhone and send him a message via e-mail right there!  I also like the one where YOU ask a question and the 'professor' says "That is coming up later in the lecture, you are getting ahead of me." Thanks a lot. I was on the edge of my seat wondering what was next and YOU just ruined it.  I actually had a pool ($10 buy-in) going on the next point in the lecture.  Do YOU want to go ahead and tell me what happens at the end of Harry Potter, too? How about YOU tell me what happened in "so you think you can dance" this week, because I need to clear up some room on my TiVo. I just do not get it. 

There are 2 conditions that should elicit YOUR hand going up in the air during lecture:

1) The student next to YOU is having a medical issue and seeing as YOU are not yet a doctor, YOU cannot help him or her. (Unless YOU are a gunner in which case you would start CPR, draw an i.v. line, and continue quietly taking notes)

2) The 'professor' has stated something that is the exact OPPOSITE of what is on the power point slide.


The fact that YOU did some shadowing somewhere where they used drug 'X' on a patient means nothing to me.  Neither does the fact that they had to get peak and trough levels for him.  Yeah I know it is used, I am learning the protocol, that is why the 'professor' is lecturing on it. Here is a novel idea.  Since YOU are taking a copious amount of notes, why don't YOU continue the trend and WRITE DOWN YOUR QUESTIONS and then E-MAIL THEM TO THE PROFESSOR. It drives me nuts. I have questions during class. Everyone does. I, however, respect everyone who does not have that exact question enough not to disrupt the class. Look, I could have asked "so, what was the antimicrobial solution that the Orthopedic doctor in Germany that I was shadowing squirted in the patient's hip, while doing a metal on metal chromium-cobalt total hip arthroplasty? Oh, by the way, I was holding the leg and some tools and it was so awesome and I am totally sweet and I did things no one else has...etc.etc."   That would not serve in the productivity of the lecture. Save YOUR stories or questions for someone else's borrowed money.  I am a nice guy, but not when you steal from me.  I will remember you when I am forking over an extra $100 per month for ten years to pay your 'question asking' loan.

Sincerely,

Everyone else

p.s.  Can you tutor me in immunology?