Do I know you?

Well we meet again. It has been a long time, I have been busy, but I haven't forgotten you. I think about you often, every time I shake my head after a comment/action/experience one can only have in med school. For instance, just last week someone in a class said "Concierge medicine is unethical." I laugh, roll my eyes and shake it off. Is not cleaning up someone else's trash on the street unethical too? How about eating at a higher-end restaurant while people starve all over the world? Should I just roll over and give up on the hope that I can actually make a decent living in medicine and just go into primary care, lose money by taking only medicare and medicaid patients and feel good about myself because I am not being "unethical"? (I am not implying that you can't make a "decent" living in primary care, just saying it is much harder.) It's ok, because you are one of the youngest people in our class, have never had a job and probably have never payed taxes unless you claimed the birthday money from grandma. Oh, what's that, you didn't? Isn't that unethical?

Oh, and I have a new "guy" similar to this one and this one that I will share with you soon. Hope to see you again really soon. For now, chew on the rest of my list of things to know before med school:

1) Military med students are like Mormons. They are uniformed, polite, and can make a great case for their cause. Medical schools constantly warn you about your mounting debt and the military men and women can see the fear in your eyes. Like an injured succulent bison, you will be picked off from the herd. You will be invited to informational meetings, asked to attend jogs, and even offered to be put in touch with someone. Be careful though, because they know how to keep you interested for years and each carrot they dangle in front of you implores you to stay on the train another stop. You make one nibble on Uncle Sam's teet and pretty soon you are ironing your Temple Garments fatigues and you are monetarily debt free yet you owe Uncle Sam some serious time. It works for some people, but just understand what is going on and think through the temptation.

2) Be prepared for words and phrases to become so hackneyed that they will begin to make you ill. Phrases like "gunner", "boards", "patients don't come in with a multiple choice question", "patients don't come in with a power point", "you learn by doing", "high-yield", "I don't study much", "I am soooo worried about THIS test", the list goes on and on and on. Just know that people will use these phrases with smug superiority masquerading as professionalism in front of others to put you or others down. It is like the guy who waits all night for the perfect set-up to let loose the one-line zinger he learned that day. It is old material that keeps being regurgitated as if it is new material. Kind of like the whole "I'm Rick James!!" skit done by Dave Chappelle before he went crazy. I can't count the number of times I had to listen to someone go through the skit as if they were the writer behind it and I was the first person to hear it. Yeah, I got it, the fingers said slap, you're Rick James, and you need to watch something else.

3) Don't be afraid to defer your admissions another year to do something fun. Really, it's ok to get some life experience if you are fresh out of undergrad. I planned at least one year off of school. Trust me, it will help take the edge off a little bit. Plus it gives you a chance to earn some money and save some money for med school all while getting life experiences. I am amazed at the amount of people in my class who have never had a job. Must be nice.

4) Correlation does not = causation. If this hard to grasp, take this example. Suppose I told you that sleeping with shoes on is strongly correlated with waking up with a headache? It would be easy to say, "well then, sleeping with your shoes on causes you to wake up with a headache." Not so. There is a lurking factor in the form of body shots and Jager Bombs that cause one to wake up with a headache. The fact that they sleep with their shoes on is secondary to being intoxicated. One of my favorite things to do is find the hidden agenda in a speakers talk. Trust me, everyone has an opinion they want you to know in their presentation (especially when you are in medical school) and when you get facts like there are "40 million uninsured people in the U.S." are shoved down your throat, don't trust it just because someone said it. There are lies, damn lies and statistics. Stats thrown at you from some study do no good unless you know how the number was derived which, most of the time, is derived by someone wanting a certain outcome. Be careful. Very careful. If something said is going to make you change your views, do some of your own research. Nothing is worse than uneducated (in terms of life experiences) people forming opinions based on biased or false information who then become too close-minded to change their views when presented with facts. Don't swallow any pill that is handed to you in class. In fact, just the other day I had a speaker tell me that "a majority of doctors believe health care is a right." I have my doubts about whether that is true or not, but either way she was stating an opinion and trying to hide it behind something that slightly resembled a statistic. If you didn't know any better you might fall for it.

5) Do not have a anything on your stethoscope in class. Nothing says "I need attention" more than that. So you worked with children. Great. Take the pink Giraffe off your stethoscope before you shove it in my face. You aren't a children's photographer. It is annoying and awkward, plain and simple.

6) You remember back when you started undergrad? Not day one, but like month three when everyone went home for Thanksgiving, saw some old friends and realized they had gained 15 pounds and then you took a look at yourself and realized you too had gained 15 pounds from all the cafeteria food? If you thought that was bad just wait. Every club on my campus serves pizza for their meetings. Sweets become lunch and a nutritious meal is considered taco bell because they serve rice in their burritos. 8 hours of studying is accompanied by 8 hours of snacks, soda and pizza. The med school 30 beats the pants off of the freshman 15. Trust me, if there is anything you can take from this it needs to be this point. EXERCISE. REGULARLY. Stress relief is so important in med school as is staying healthy. Make a time each day to exercise. No matter what. Just an hour is fine. It is so easy to say "well finals are coming up, I can't spend one minute doing something else other than studying." Bad decision. Excuses are abundant in med school. One hour of exercising isn't going to fail you. Neither will not exercising for that matter. I know that control of my own time only gets worse as the years go by. Pretty soon I will be in rotations and residency and if I don't have the habit of exercising it will be nearly impossible to start. I try to remember that one day I may have to lecture a patient about losing weight. I know they wont think twice about judging me by my appearance and lifestyle. You don't have to be perfect, no one is, just make an effort. Walking up stairs to go to class isn't an effort.

Bonus: Do not take your books into the cadaver lab. Your classmates wont think twice before grabbing your book with their greasy hands. They don't care. Let someone else be the sucker.

Bonus number two: If you have a habit of chewing on your pens, you better stop it. Nothing will elicit a gag reflex faster than when your pen tastes funny, and you then realize it is the same one you had in anatomy lab....except maybe people who update their facebook every ten minutes. Status Update...that spells H-i-s-t-r-i-o-n-i-c P-e-r-s-o-n-a-l-i-t-y D-i-s-o-r-d-e-r. (Let it be known that I made this)

Don't Say I Didn't Warn You Part II

Back again. Sorry for the delay in posts, but I have been too busy hazing the first-years. You know, telling them that all the test questions are from the assigned readings (500+ pages a week) or telling them the library and study halls are for second-year students only. Got to get them freaking out. In all seriousness though, the only hazing going on is the selling of those books WE were foolish enough to buy but never use to this year's incoming class. "Come on, I have reduced the prices on these babies 20%, but disregard the lack of creases in the spine, you NEED this book to survive." This year's incoming class is far worse than mine. I am glad I didn't defer my acceptance a year because this class would have tickled my area postrema more than my class. People were studying BEFORE classes began. Seriously. But to make this short, I have a couple more nuggets for you.

3) Do not have relations with med school classmates. Friendship is fine, but in a world where Paul Revere rides a horse called Texting, you can start one class pure as snow, and by the first break you are on the verge of prostitution. And gentleman, do not be "that guy" who goes after all the first-year females. Just because your own class knows what a tool you are doesn't mean you can fool the first-years for more than a week. Trust me, keep your sexuality outside your medical school. And off craigslist for that matter.

4) Do not go to class. I learned this the hard way. Think about it. Why sit in class hearing something for the first time when you can go over the info twice as fast, picking out concepts you don't understand and have the time to go over those concepts? Plus, when you can then go listen to the lectures at twice the speed, what's there to lose? Seriously, you don't know how much time is wasted with jokes, pauses, and side-stories. I don't pay teachers to tell me where her 4 year old thinks his liver is. The key to med school from the start is time management. Your time is so valuable because of the deluge of information, that to spend too much time on one idea or concept is academic suicide.


5) You have a right to express discontent. Don't let the administration keep you down. Damn the man! No, seriously, don't be afraid to tell someone how upset you are by certain things. You have a right to having power points posted online in the right format, recordings to be done, teachers to be clear about what to expect, etc. You are paying a pretty penny for the education and yes, I believe the school should cater to everyone as best as possible. This is a little different for a state school where uncle sam helps out a bit, but either way, you are paying money for a service, if it isn't what you want, speak up.

6) Some Many of your fellow classmates are socially awkward. I don't mean like middle school dance awkward, you know, guys in one corner and girls in the other. I mean like don't-know-when-to-keep-their-thoughts-to-themselves awkward. For instance they don't have the internal gauge to tell them that what they are thinking in their head isn't something they should tell other people. What sounds like common sense, or constructive criticism to them comes out like smugness or elitist to others. It also seems a lot like they will say something just to one up you. Whether they mean it to be like that, it doesn't matter because they will not be able to know any different. If they start sentences with "I would", drop any sharp objects because you will want to harm them. They are about to tell you how they would do it better than you, but hide it behind critique. Remember, you didn't ask for their feedback. I think that is where it crosses the line. You didn't ask them, yet they will open their mouth anyways. I once had someone "critique" my patient interview by saying "you were blocking the door, I know for me, I don't like when people block my exit." For one, there were two doors to the room so technically I wasn't blocking the exit, Dragnet and besides, not everyone is suffering from PTSD and thinks his doctor is armed and dangerous. Regardless of his lack of observation, he felt it was necessary to open his mouth.

BONUS: Do not call first years "fresh meat". This isn't Dazed and Confused buddy so put down the paddle. There will be no initiation. Ever.

Don't Say I Didn't Warn You Part 1

Alright, so it appears I am 1/4 doctor. Yep, passed all my tests, jumped through all my hoops and didn't kill anyone in the process. I may be able to tell you where the ductus arteriosus is (heart), what the muscles of the rotator cuff are (Supraspinatous, Infraspinatous, Teres Minor and Subscapularis), where the deep tendon reflex for L4 is (patellar tendon), what bug is gram +, coag +, cat + (Staph Aureus) and about 926 mnemonics and acronyms. (Real Texans Drink Cold Beer, Cadavers Are Dead People, MONA, MUDPILES) blah blah blah, but somehow I feel like I know nothing. In fact, if there is anything I do know its that I know nothing. I have such little medical knowledge that I am still insignificant, but I know enough to make me dangerous. Not 007 dangerous but SAW III dangerous.

Having said that, I am here to quell all your fears. Well, any of you who are wondering what to do and what not to do during your first year, or if you are beyond that and want to compare your experiences. I am here to let you know some rules to live by. These are influenced by my experiences, observations, and/or swift judgment. I am no way trying to insult anyone so don't get it twisted. I am guilty of many of these things myself and I am way cooler and better than everyone else not perfect. I am going to stretch this list into a few weeks, so deal with it.

1) Do not listen to people on your interviews, they are lying to you. Remember, they want you to go there as much as you want to be there. If no one was impressed, they wouldn't fill seats, and would be out of a job. Make sure you understand that no school is perfect. After studying for the MCAT, filling out applications and getting interviewed, an acceptance can make you put the blinders on in such a way that you overlook some important details such as how they test, how they teach, and what is expected of you. A lot of it, unfortunately, you will find out once you are there. Just be ready for it. Because your interview was perfect and the campus has a Starbucks in it and you hooked up with a second-year during your interview does not mean that it is the perfect school for you. Make a list of what is important to you (board scores, location, rotation locations, board prep, not getting herpes from that second-year, whatever, etc.) and make your decision off that. This is, of course, assuming you are fortunate enough to have multiple options to choose from. If you don't, take whatever you can get and go for it (except the herpes).

2) Wait to buy books until you absolutely need them. Right now I am looking at a shelf full of books. I can pick out 5 that I have actually used more than once. If I could do it over again I would pick maybe 3 of them to buy. Your school pays teachers to teach you information. They should give you enough in their lectures to do well on tests. It is impossible to read the "assigned reading" for four classes each day and still study without being up all night. Your library should have the books on reserve so use them from the library if you need them. Plus wikipedia is free so use it. Don't be the one who is so excited for school that they buy all the books. Waste of money. Do not show up to orientation week with all the books purchased you little eager-beaver. Pay down your interest, or better yet use it for something fun on the weekends to keep yourself sane.
2b) Don't buy your books from the campus book store. What a joke. eBay, half.com, amazon, 2nd years, etc. have books for a fraction of the cost of your campus book store. It's just another way to suck up your living expenses. Again, use the money for something fun. If you say "but reading med school books is fun" I want to punch you in the face.

Bonus: Unless you like finding flesh and melted human fat all over your stuff, do not bring your anatomy books into the lab. Let someone else ruin their book.

MORE TO COME...

It couldn't B U

Ahh yes, the pressures of med school. So he bet $10,000 the Detroit Lions would win one game in 2008. Who wouldn't take that bet? So he lost and decided to rob and kill to make up for the loss of his semester's living expenses. I wonder what would have happened had he not gotten caught and realized when he was done with residency that his $250,000 of debt with compounding 10% interest had suddenly become a burden. He would have made Jeffery Dahlmer look like Mr. Rodgers... I am still amazed that he was given $1,400 to use for rent. Dude must be selling coke because $1,400 per month is all I get for everything (rent, food, gas, books, clothes etc.). I had to stop collecting magic cards just to make ends meet. I would like to meet with his financial aid counselors.

Well this story got me thinking a little bit. It brings up a few points regarding med students in general. I don't know about BU specifically, but I am sure its largest revenue stream screening process for acceptance is pretty close to other schools, you know, essays, money, essays, money, interview and letter of acceptance for the minorities qualified applicants and rejections for all others. (I realize the craigslist killer was white, he must have been part something. I'm not bitter though, just mad at myself for not checking Native American because technically I am one...) So this brings to question a few things:

1) How accurate is this "screening" process? I mean, how well do they know who we really are? I am speaking about the Hawthorne effect. Basically, everyone improves their productivity and personality, etc. when they are being watched and KNOW they are being watched. They are speaking perfectly and holding doors open for you and acting like they would give you the shirt off their backs, but in the parking lot they are flicking you off and cutting you off. Shoot, if I owned a med school, I would be visiting your hometown and releasing stray puppies near your route home to see if you stopped to pick them up. I would be sending tools from the 909 to hit on your girlfriend in front of you. I would pay the waitress to take as long as possible to give you your food. You would be taking a lie detector test and I would know all your deep dark secrets. I would want to know that you are doing the right thing when no one is looking. Because anyone can put on a smile and act like they love everyone when they know it means the difference between and acceptance and rejection. And my school's reputation would be at stake. I don't need to be known as the school that produces fine doctors but better murderers. Also, you would think that they have the process down to a science. They make it seem like they know the stats and that if you are getting accepted, you will pass. Weird because 6 people have failed out of my school so far (and with them went my "curve assistance"). Unless they knew this and accepted them for their money (which wouldn't surprise me) they missed the signs of those who wouldn't do well in med school, not to mention the murderous profile. Might want to re-examine the qualities of the people you accept. I am glad I am here though, because I would hate to have to do psychological testing along with the essays. And that is next if people like Markoff are getting into schools. To tell you the truth, I am scared that they will make me undergo a psych consult. I can just see it now.......

Dude in suit: Hello Week, I am going to ask you a series of questions. Just answer yes or no. Do you ever feel anxious?
Week: Yes.
Dude in suit: Do you ever feel like an outcast?
Week: Everyone in med school is super strange and I think-
Dude in suit: Yes or no questions week, follow instructions.
Week: Sorry, yes.
Dude in suit: Do you ever feel like you could harm someone?
Week: Well, if someone was trying to rob me or hurt a family member I think I-
Dude in suit: Seriously, yes or no, Week.
Week: Yes.
Dude in suit: Do you ever thinks about killing people?
Week: Well, I worry about making medical errors and killing people all the time. I feel like I know noth-
Dude in suit: Yes or no Week, for the last time.
Week: Well, I guess I would say yes I do think about killing people.
Dude in suit: You sick bastard. Lock him up with the rest of the creepos.

And just like that there would be no one left in med school. Which brings me to my next point.

2) Med students are different. Look, we are socially awkward, that shouldn't come as a surprise to you. Now imagine if I were to tell you that at one time or another the average med student can be described like this:

Smart. Pompous. Clean-cut. Creepy. Weird. Polite. Extreme changes in mood.

Pretty sure you would all agree that on average med students can be described as such. But that is also describing the craigslist killer. Either the profile for a murderer closely coincides with medical students' personalities, or any med student has the ability to break and become the next craigslist killer. How does that sit with you? Kind of makes me wonder if I want any of my tank-mates touching the scalpel...

Speaking of tank-mates, I love the investigative work going on. Here is the description his classmate gave:

"disturbed."

"extreme changes in mood."

"Warm and friendly one day and then brooding and depressed the next."

"He just wasn't right in the head, and I knew it, and probably other people did, too."

"He spoke only when someone else initiated a conversation" adding that he seemed nice but "strange in a dark way."

Wow, you just described 90% of american medical students. We all have to be disturbed to be in med school. To know that we are looking at 10 years of hard work, little pay, little sleep, and little hapiness, yet we still pay thousands to be here is quite disturbing. Add in the looming everyone deserves health care mantra Obama is supporting, and we have to be beyond disturbed to be here.

Extreme changes in mood...huh, I wonder if it had to do with test scores. Monday he is confident he is getting an A and then after taking the test, realizes it is more like an F. Instant depression. I am not impressed by her description, because everyone in my class fits her "profile". Nice going.

One and a half weeks left and I have made it through year one...

Curtain Call

Just got back from spring break. It was much needed and it was used well. I was sincerely dreading the flights though. I used some flight miles I had accumulated and well, they were hard to redeem. I was given a 13 hour travel time one way and another 15 hours returning. The only good part was that for 50% of the flights I had first class. Actually for all of the flights where first class was available, I got it. It was not by choice, but rather by default, but I didn't let anyone know about that. In fact, as soon as I was so graciously allowed to board the plane before the other worldly peons, and made it to my plush seat, I pulled out my laptop and pretended to be on my cell phone on some important business call. I wanted people to believe that I belonged there. I would randomly use words like resource constrained, cash-neutral, interim review, vision statement, and cost-effective. I wanted people to believe I was making money RIGHT THERE on the plane! First leg we were offered some all-you-can-eat snacks and I ate well. It was ok though because on my next layover, I had 8 hours to digest my tasty treats and get ready for the next feeding. Next flight, I was offered a meal. Even the way "ham and cheese on marble rye" rolled off the flight attendant's tongue made it sound luxurious. And you might stick up your nose at airplane food, but not I. In fact, I looooooove airplane food. It had been a while since I had a meal, and I am not sure what makes it taste sooooo good. Well what's better than one ham and cheese on marble rye? Two ham and cheese on marble rye's! Oh yeah, I made a quick lunch room trade (a sammy for a bowl of fruit) with the older gentleman next to me and didn't even have to use any jedi mind tricks to execute it...he wanted the fruit!! I felt like the Kansas City Chiefs after that one-sided trade with the Patriots. Like the US after the Louisiana purchase. Hey, $205,000,000 (after inflation) couldn't even touch the national debt today, but it could buy 1/3 of America. So what if it is the crappiest parts. So the third and final first class leg I got to enjoy was another accident. I wasn't supposed to get home until 9:45pm, but I offered to give up my seat in exchange for $300 voucher, a first class seat AND I got to arrive at 7:30pm instead. They even gave us warm towels to wipe our first-class hands clean before you stuffed our faces yet again. I have to say that despite the 2nd class passengers using our bathroom up front and one person storing their bags in our overhead compartments, I loved the second flight....especially when the flight attendant closed the curtains (ahhh now I can finally rest)! And next time, I am keeping the cloth napkins we get....as a souvenir. Now it's back to the grind.

The big push

Well, I will tell you the reason for my lack of postings.  Nothing new is happening.  At first I was able to make fun introduce you to many classmates of mine, but there are only so many characters.  My day is pretty much filled with diarrhea (which I now know how to spell) constipation, vomit and everything from the mouth to the anus.  Add in a few labs and standardized patient interviews and the mandatory daily work out and you have my life.

GI section is coming to an end (Double entendre alert) and I am pretty sure I have palpated my stomach at least a dozen times this week...just to check the piping.  (No digits were involved though so don't even ask).  The GI section can be summed up in a few words.  Either you can go or you can't.  If you can, check it for blood and worms.  Either you are throwing up or you aren't.  Check it for food and blood.  Done!  Oh, and I now urge you to start checking your stools.  I know it is not fun, but if you never check it, you will not necessarily know when something is wrong until it is too late.  That should be a GI Joe public service announcement.  It would read something like this:

Kid #1:  Hey tommy, you hungry?

Tommy:  Nahhhh!

Kid #1:  Why not, it's your favorite, raw hamburger meat!

Tommy:  I know, it's just that I don't feel quite right.

Kid#1:  What do you mean.

Tommy:  My tummy feels like it is liquid.

Kid#1:  So, eat then.

Tommy:  Every time I eat, it goes through me like OJ through a murder trial.

Kid#1:  How does your food lie?

Tommy:  No, not like that, just really fast and without much difficulty.

Random adult who shouldn't be around kids:  Hey kids, what seems to be the problem?

Tommy:  I have been going to the bathroom a lot and it is very runny.

Random adult who shouldn't be around kids:  Did you notice anything weird about the poop, like color, how often you have been going, how long it has been going on and any other symptoms?

Tommy:  Well, no.

Random adult who shouldn't be around kids:  Well, Tommy, it is always good to check your stools.

Tommy:  My dad has a lot of stools in his work shop at home.

Random adult who shouldn't be around kids:  Hahahaha, not those kind of stools Tommy, the poop kind.

Tommy:  Oh, I get it.  Say, how do you know so much about that stuff?

Random adult who shouldn't be around kids:  Well, they don't call me GI for nothing!!!  Seriously kids, look at your poop every time you go, that way you know if you got worms, bacteria, or just good old rectal bleeding!

"GI Joe!  Now you know, and knowing is half the battle!"

Oh, and I know the answer to the following question that may come up on rotations:

"Hey The Week, you want to untangle this volvulus???"

Response = "Nah, I'm good."

One week until spring break...

So you did a little bit of research did ya?

I know, I know.  It has been a while.  My schedule has been busy and I have started a new study method that does not enable procrastination (i.e. writing in this blog).  It keeps me accountable and it keeps me focused and my grades have been getting better.  Maybe I can improve my "nowhere-to-go-but-up" class ranking.  It is the miracle method.  I am working on a patent for it, but if you are interested I will sell it to you (I have lots and lots of loans to pay off).  Just let me know.

A lot has gone on since the last time I posted.  I feel like I am getting more and more disillusioned to medicine.  The MBA classes certainly don't help with that.  It isn't necessarily a bad thing, BUT it is discouraging.  So I guess it might be a bad thing.  I attended a talk by someone from this organization.  It was severely slanted to the point that he couldn't tell us the downside of a single-payer system.  Wow.  The perfect system has been found.  WRONG.  Check it.  Let's say you are a 60 year old who has taken good care of yourself.  You have eaten well, exercise, etc.  Right now, you have private insurance because you worked for it and spent money on it.  Now lets say you have been having some heart trouble and need a heart surgery.  DONE.  Now lets say you and the rest of the nation are on the single payer insurance plan.  Uncle sam is running the show.  Now you need that same surgery, but guess what, so does a 40 year old man who has eaten his way into his condition while smoking, and on top of that, who didn't have insurance before.  Who gets the surgery?  Uncle sam would say the other dude gets it, but you can try to wait it out until you move up in line.  You see, health care will ALWAYS be rationed in some form.  Right now it is by ability to pay.  Under a single payer system it will be by age, or by wait time (i.e. wait months to years for a treatment/procedure you could have had in days with private insurance).  And don't think Uncle Sam wont stick it to the doctors through payments.  I agree that costs are out of control, but I do not agree a single payer system is the answer.  And neither is cutting physician salaries.

We ended cardiopulmonary and are now 2.5 weeks deep in GI.  This section is nothing special.  In fact, med school itself has been nothing special.  Pretty boring if you ask me, and if it weren't for some of the people in my class I would have no source of entertainment at school.  Take for instance the pissing contest that I witnessed the other week.  Med student A presents research in a very un-humble way to say the least.  Surprised he doesn't want to be called Dr. A already.  I was waiting for him to tell us how much he bench presses, how many beers he can chug, and how many chicks he gets, but he must have run out of time.  So at the end of his talk, he takes questions.  Professor B, who has is all ego as well, approaches the mic.  Apparently Dr. B doesn't take too kindly to student A thinking he is all awesome and stuff when in reality all he did was use trigonometry.  So Dr. B proceeds to ask student A about certain conditions in medicine relating to student A's topic.  When student A cannot answer because student A is student A and not Dr. A, Dr. B shakes his head all the way back to his seat.  I got a good chuckle.  It was indeed unprofessional for Dr. B to do that, but I appreciated him putting student A in his place.  That was the second hardest I have laughed in the last few weeks, second only to this pic which I stumbled upon the other day.  Best ab workout I have gotten in a long time.

Finally, for the answer to the bioethics question from a few posts back.  The answer would be to do NOTHING with the info you have obtained.  Here is why.  Your colleague contacted you and since he was under confidentiality, you could not say anything.  Had you said anything, you would have broken the law by betraying a privileged communication between a lawyer and his client.  It is a fundamental principle of American law that a person must be able to go to a lawyer without fear it will get them into trouble or that the lawyer will betray their secret.  Plus, if you had come forward, you would have lit a chain of events that would have included re-examining every case that examiner would have ever had a part in, inmates demanding to be re-tried and a whole slew of embarrassments for the public defenders and employees, not to mention the ramifications to you.  Politicians don't like to be proved wrong or be embarrassed.  Whether fair or not, that is the right thing to do according to a law school who was asked about said situation.  Crazy world, huh?

Tr-Hip Replacement

It's ok, it's me.  Don't feel like you are cheating on me, it's just like I dyed my hair, or got a little cosmetic surgery.  It's still me on the inside, and that's what counts, right?  For all of you who didn't know what the picture was on the last post, it was a perforated tympanic membrane, aka ruptured eardrum (at least, that's what google promised).  Frequently happens to me when I fly with slight congestion.  See the airlines like to keep the cabin pressurized at a high altitude, approx 8000 feet, something about saving money on gas....penny pinchers if you ask me.  That makes for a terrible descent.  Once the drums blew, it was smooth sailing.  I relate it to finals week.  It's not the taking the test/rupturing eardrum that is bad, that is actually the relieving part.  It is all the pressure leading up to finals week, and you just want it to be over with.  Anyways, enough about me.  

Well this part is about me also, but it is MY blog and MY life and I will do what I want.  (The I's are capitalized too, you just can't tell.  I did press the keys extra hard when I typed them though).  So I have decided to get my MBA while in medical school.  Actually, I am trying out the program right now as my payment isn't due until June.  They have to make sure we pass our classes and all.  We have only had one class so far, but we had a very good discussion about the slight trend in medical tourism.  Our teacher brought up a good question that I would like to share with you.

This can also be asked for standard insurance agencies....

Let's say you worked for a company that is self insured or you had a run of the mill insurance.  You find out you need a hip replacement.  Since your company pays for all your medical expenses, they contact you and ask the following question.  "Mr/Mrs X, your procedure is going to cost $11,000 for us here in the US.  However, it will cost us significantly less in India.  Would you be willing to have your surgery in India if we payed for you and your significant other's flight over there, paid for all the expenses and recovery time, AND gave you $2,000?  Don't worry about the recovery time, we will make sure you get on the plane to come home only when it is safe.  Don't need you getting a DVT on the way back.  Now before you say anything, the hospital you would be sent to has been accredited by the Joint Commission International, which is a branch of a US non-profit agency that has strict requirements for accreditation.  In fact, some would say they are right on par with the US!  We will also pay for any complications, should they arise, once you are back in the states."  They might even follow it up with something cheesy like "Bone Voyage!!!"

Would YOU go to India?  How about for more?  Less????  How about if they gave you your choice of countries, like Costa Rica, Thailand, or Singapore??  Shoot, I would break my OWN femoral neck just to go to some of those places.  Want a vacation?  Just feed your husband McDonald's for a few years and he will need that CABG in that country you always wanted to go to...

Bioethics Part Deux

Check it.  So the above picture has nothing to do with the case I am about to present to you, but it is something I am fortunate of having two of at the moment.  I am so lucky, I know.  I am contemplating changing my color scheme a little bit, so if one morning you come to my web page and have a seizure from the colors, be warned now.

This one is a doozy.  You are a pathologist for the next five minutes.  So, to get in character, hike up your pants, put on white socks under your dress clothes, and only tuck the front of your shirt in.  You are sitting at home one night in your footy pajamas when your phone rings.  It is a friend/colleague of yours who lives in another state.  He says he says he has been asked to be an expert on dog attacks on a legal case and he would like you to take a look at the autopsy photos as a courtesy.  He explains that a man is suing his neighbor.  Apparently the man's 18 month old son got into his neighbor's back yard where the dog attacked and killed him.  His 6 year old brother found him with the boys body in the dogs mouth.  You agree to take a look at some pictures, even though you are eating because as a pathologist, you have a cement stomach.  So you take a look and see deep wounds on the boys neck as well as scratch marks on his forehead.  You, being the awesome pathologist you are, realize that those are not puncture wounds from teeth, but rather from a knife....hmmmmmm.  You seem to be the only one who has caught and has the professional credibility to change this egregious error made by the medical examiner.  Who do you call first and what do you tell them and why?  Answer to be revealed shortly.

And we're back in three, two...

And so we're back.  My prediction was right, there are a few empty seats in the auditorium this time around.  No surprise there, I just hope that one day people aren't asking where I am.  I can honestly say that I had some of the best days of my life while on break (spent time on the beaches of mexico, got engaged, etc.), and I felt horribly when I landed back here, in school world.  I felt like I had just been called into the principal's office after peeking into the girls' locker room.  It was awesome a minute ago, but now it's back to reality.  Opened my apartment door and realized that yes, I am still in medical school, and yes, I have 3.5 more years of this.  I guess it is 1.5 more years of this and 2 years on being in the way of the people who know what they are doing and trying to stay invisible so I do not get pimped in front of my classmates.  Can't wait for that day.  Anatomy is done for this section, so now it is allllll lecture, baby!  SA-WEEEET.  There is only one thing sweeter than that, and it is this job.  Thanks to my future sister for that find.  Too bad I couldn't fulfill their scuba diving requirement as I have a permanently ruptured tympanic membrane.  My other ear sometimes ruptures during plane landings.  Awesome.  Without that, there might just be one more vacant seat in my class.

Not much to write today, but thought I should get the wheels rolling again as it took me all of last week to remember what class I was taking, and how to study, not that I am any good at it.  Looking forward to what semester 2 has to offer in the form of blogging material.  Oh, and tonight is my final class on basic life saving which means that now if you choke, have a heart attack, or cardiac arrest, I might know a thing or two about it and maybe might be able to help.  But then again, after certification I may end up flushing all that info out as that is what seems to happen after tests now, so don't count on me for rescue.