The Week

A thought

2012-01-10T10:29:00.007-06:00

Over the course of the past few years of school I have thought hard and tried to be as honest and non-biased as I can while I wade through the mess and waste that is health care in the U.S.. There have been times where I ask myself a question and try to figure out the why/how of it as it pertains to health care. I think over time medical students see and hear a lot of things and begin to shape their view of humanity based on people who are sick. It may not look fair on the outside, but I don't know of a better way to see people for who they really are. The "right to healthcare" debate is always on the table and there are a lot of people who SEEM to deserve and need it and above all else, APPRECIATE it. But in my experience more who don't.

As a physician you sometimes know more about someone than anyone else and you see them with their guards down. It can go both ways though and isn't always negative. For example, I have seen "gangbangers" teardrop tattoo and all, crying because they are in pain. They may want to cut my throat on the streets but in the hospital they are just as needy as the next person. In fact, one of the most humbling things I have had to do was wipe the butt of a 50 year old prisoner with gang tattoos who had lost control of his bowel and bladder. Twice. He turned out to be one of the most appreciative patients I have ever had and would be so grateful anyone came to see how he was doing.

You see people at their worst in the hospital. People in denial, people who have put things off for too long because of one reason or another, people who find out their 4 year old child has a brain tumor, people who find out they will die...soon. People who have no option but to let down the wall they have had for so long in order to ask for help. It can be very interesting at times. But it always gets me thinking. Here is one thought that has been heavy on my mind at times.

Why do we not take better care of the resources we give away?

As a society we have chosen to provide health care through medicaid and medicare and through our emergency rooms. Right or wrong, we are doing it. Why aren't there stipulations to free things? For instance shouldn't we say "We are giving you this resource for free, but in order to make sure it is used for its intended purpose to the best of its capabilities, you can't smoke, do drugs, commit a crime or have more children than you can afford which is zero due to the fact that you are needing this resource"? And before you start with the "freedom to have children" argument, watch a meth addicted newborn go into withdrawals only to die a few days later. Or listen to someone have to choose between medicine for their baby or food or electricity.

I think the notion is that these resources are permanent cures. Is that what they are intended for? It isn't a green-eyed-blue-eyed situation, it is a fat-skinny situation meaning being the recipient of some free government resource doesn't have to be long-term. But have we created a system and mindset that makes it long-term? If medicaid weren't looked at as a long-term solution, it wouldn't be a "can't have babies" argument, it would be "can't have babies right now" argument. Can we as a society do a better job of "helping" those in need? Should there be some form of reciprocity instead of just a one-way freebie? Always open to thoughts and comments as I am no 'expert' unless I fool you into thinking I am.

Too Long

2011-12-16T12:19:00.002-06:00

It has been too long since I have updated this blog. Over a year. Don't know who actually makes it here anymore. I have been struggling between throwing up a few short posts or waiting until I had something I liked before posting. Maybe I put too much thought into posts and maybe that will have to change if I continue to use this as an avenue to do whatever I am doing on here. I have learned and seen a huge amount. There have been so many things I have wanted to write but just haven't had/made the time to update this. I hope to get things moving again with more writings very soon. Medicine is changing in a lot of ways right now and my life will be transitioning hopefully from student to resident in the next 7 months. Things will hopefully be settling down for me and I will be able to get some thoughts/observations down on this blog. I hope to be a place some students can come to learn about medical school, rotations, the match, applying to residency and most importantly keeping a positive outlook on classmates by anonymously making fun of them online. I promise I will have a more traditional update by Jan 15. Hopefully sooner.

Pa-pa-pa-poker face

2010-09-15T11:35:00.002-05:00

Just got done with rotation number one, psychiatry. In-patient. Lock-down floor. Veteran's hospital. It is a shame some rotations are not longer than 4 weeks. I felt like I was just getting the hang of things when it was time to leave. It is interesting what specialties medical schools choose to make a requirement and which ones they do not. Four weeks is not long enough for someone to decide they want to do something for the rest of their life in my opinion. Some thoughts:

-The employees of the hospital dubbed their electronic health record, "the best in the world" and I am surprised if that is as good as it gets. It is my first run-in with an EHR, but I had many suggestions for improving it. While it may improve time when compared to paper charts, it is by no means fast. It still took time to gather the information needed to be caught up on the patients' current care, diseases, medications, labs, vitals and any other pertinent information. I know most of it has to do with the fact that it is my first rotation and I have no idea what I am doing. What I did like was that we could see any visit the patient made to any VA hospital in the country. That was clutch.

-The hours were nice. Essentially 8-4:30 every day, but the call for residents was every 4-5 days which isn't the greatest. I still had to get there early to navigate the EHR so the hours for me seemed longer than they should. Still, the hours were very nice and precise. I foolishly tried to meet with a secretary to get some papers filled out at 4:15 on a Friday. Struggled to find someone who could tell me, "Don't ever try to get anything done at 4:00 on a Friday." Thanks chief.

-I was blessed with an amazing attending, and wonderful resident and an awesome staff to work with. Everyone was very laid back and helpful. My resident was constantly making sure I was not overwhelmed or stressed out which I appreciated but never crossed the line to treating me like a baby. In med school we constantly hear the horror stories of attendings who are rude and residents who make you feel like a piece of crap. Not this rotation. Call me "weak" or "soft," but I know I will not do well in certain situations with certain personalities. Sorry for all the residents who have a resentment towards students, puppies and laughing children because somewhere along the way you got a massive chip on your shoulder. I am convinced that residents and attendings can be pleasant, thoughtful and respectful and still be wonderful teachers and mentors. The snide comments, standoffish teaching approach and temper tantrums will never help me. For instance, a resident on another team was constantly grouchy, passive aggressive, and rude to everyone, especially his students. I was helping one of his students navigate the EHR, the floor, the procedures, etc. during his first day and after five minutes the resident privately asked me if his student was getting it yet in the most condescending tone. Getting it yet? Getting what yet exactly? Yeah buddy, he has the whole "doctor" thing mastered in five minutes. He actually just left to apply for Harvard faculty. I am willing to give people the benefit of the doubt a few times, but at some point you cross the line from "bad day syndrome" (my new addition to the DSM-IV) to "I want to kick you down stairs" jerk.

-I loath gunners. Direct quote from another student: "When the attending was asking me questions, I thought it was because she didn't know the answer." Seriously? You really thought that the attending uses medical students as her ~~wikipedia~~ medical reference. The trained and licensed physician wanted you to enlighten her on medical practice protocols during your first rotation. The more and more time goes on I realize most gunners just flat out don't get it. He doesn't understand what just came out of his mouth enough to understand how absurd it is. This same student also decided it would be a good idea during rounds to point out that another student forgot to check his patient's labs. My hat goes off to the attending who corrected this guy by simply stating "It is bad form to take over another student's patients and correct them. Nobody likes it." There needs to be more attendings like that. This guy is a nice guy, it is almost as if he doesn't think through actions and things that come out of his mouth. Glad he wasn't on my team.

-There were underlying themes to mental illness. This by no means is a attempt at politics or judgement, but the patterns are clear. Combat experience, drugs, broken families and abuse jack people up. All political and religious beliefs aside, I have a huge appreciation for the sacrifice military men and women make for us. The illnesses that can come from a result of serving not only mess the servicemen up, but can destroy their family's lives as well. I was saddened at many of the people's lives as a result of their service commitment.

-The human mind is so sensitive. There is so much unknown about mental illness and the brain and I am amazed at seeing some of the sicknesses first hand. Reading about schizophrenia is one thing, but seeing a person believe people are going to try and kill him to the point his heart is racing is eye-opening to say the least. Hearing voices that are so real to them that if they cover their ears, the volume of the voices diminishes. I feel like there is such a fine line between our brains and the brains of the mentally-ill. I often wondered if someone were to really listen for voices (I mean really listen and try to convince yourself you can hear them) what might happen. Or if something really bad/traumatic were to happen to me, would my coping mechanisms be enough to keep me sane?

-There were really odd situations. Like the guy who kept peeing himself and attempted to play the dementia card, and the stroke victim card at the same time. Was he demented, was he a stroke victim, we couldn't figure out what he was trying to have us believe. After extensive metabolic tests which came back negative we did physical exams and mental aptitude tests. Once the tests came back severely different in the matter of 4 hours, we were pretty sure he was faking it. Why? I have no idea. Maybe he doesn't want to go home. I have no idea but were were extremely confident nothing urgent was wrong with him so we discharged him. There were many people who came to the floor to avoid being homeless and facing legal issues. Utter the magic phrase = ~~"New England Clam Chowder"~~ "I want to kill myself" and you are in. The cycle of people coming in at the middle of the month when they run out of money and then ~~miraculously~~ getting better near the first of the month when their disability/service check/welfare check was due to be delivered was like clockwork.

-Another odd situation was a gentleman who had antisocial personality disorder. My attending stated he would pass a lie detector test because he legitimately doesn't have feelings of remorse. He could look you in the eye and lie to you and have no problem with it ever. This same gentleman was caught selling drugs from the patient floor on the ward. Nice.

-I had to figure out techniques for not laughing. Pretty much worked on my poker face for a month. It is seriously hard to do in certain situations. I did not want to be unprofessional or insensitive, but at times it was really hard to not laugh as some things patients said and did. How do you not laugh when advising a grown man that masturbating on the ward is probably not a proactive approach to get himself discharged. And dude, I know you were not "dry" down there so don't try to play it off that you were "moisturizing." As close as I came to laughing at times, I never cracked. I was also accused of the following:

Having a second wife and three current girlfriends. After all, the patient's lawyers had been following me for the past 6 months.
Changing my name repeatedly
Having a small device to make the patient fall over when she was talking to me. She had my attending search my pockets.
Putting thoughts into a patients' head
Starting rumors that a female patient had a penis. Seriously how do you not laugh when a conversation goes like this:

Me: "Good morning Ms. X, how are you feeling today."

Ms. X: "Not good, you started a rumor I have a penis and I don't!"

I had to learn to anticipate odd comments so they wouldn't come as such a surprise and at times had to bite the inside of my mouth so I wouldn't smile. Worked pretty well.

Overall it was a perfect first rotation. I got comfortable interviewing real patients and had plenty of time to do interviews. By not being in a office setting I didn't feel the need to rush through patients. I can't say that I am sold on psychiatry. I felt at times there was not enough procedural action. It was a very interesting field, but I am not sure it would be the best fit for me as a career.

Next rotation: Family Medicine

P.S. Don't be afraid to click some ads

How does it taste?

2010-08-17T12:43:00.002-05:00

I am so sick of the word 'boards' I could puke. USMLE this, boards that, First Aid, etc. Med students have the tendancy of incessantly harping on one topic after another. It's like the flavor of the week. You want to know who bought pogs, pokemon cards, magic cards, yoyos, silly bandz and whatever else the middle school craze is? Future med students.

So let's get to the meaning of the title, the meat and potatoes if you will. Get it? I used a title referring to eating and then used 'meat and potatoes' to refer to it. Get it? Unfortunately what I am asking is how socialized medicine tastes. You know, the health care is a right not a privilege mantra. What's that you say? Obama-care hasn't started yet? Hmmmmmm.....Imagine the following interaction:

Week: Want some bread?

You: It has been in the pantry a long time, how does it look?

Week: Looks ok.

You take a big bite and start chewing...

Week: Ooops, I don't think I quite looked over it as best I could, there is a spot. I am sorry, I shouldn't have just assumed it was ok by looking at only one side of it. It doesn't seem to have spread to the area where your piece is from, but there is mold on the loaf, look.

I flip over the loaf and there, almost mocking you, is a dark green and white mold spot...
You, being the clever person you are realize that mold is microscopic and the fact that it is visible tells you the mold has spread and affected every piece of the loaf...You now have the option. If you are me, you go by taste and smell. I would keep eating. However, you have the option of spitting it out or swallowing. As you spit it out (you softie, you) you say you wish you had a crystal ball to see how it would have ended up if you kept chewing. Would you have puked, had diarrhea or died? Too bad you don't have that crystal ball...

Now imagine I forced you to eat it. It looks ok, but you aren't to sure. But as I am forcing you to eat it I am assuring you that it will be ok. Do you trust me? Did I meticulously look at every part of that bread to assure it was mold free? Could I possibly look at every square millimeter? Would it be ok if you just got a little sick? What about if you died?

Now imagine that the loaf of bread represents Obama-care. The loaf may look good, even perfect to some, but is it? While we may not have the choice, do you want to eat it? Should we take some time to thoroughly look it over? It may be one of the most important loafs of bread we consume. If only we had the crystal balls.............

Crystal Ball #1
Crystal Ball #2

Doesn't look so good does it, eh?

Can't see, Can't (stop) Pee, Can't Climb a Tree

2010-06-05T10:13:00.007-05:00

No, I don't have Reiter's. Let me explain...

How do you do it? Those of you who spend your work day ~~shopping~~ being productive in front of a computer. My 20/10 vision is in serious jeopardy as I have spent the last 2 months in front of a computer for 13 hours per day. Might as well be staring at a light bulb. Plus the screen was greasy and blurry from all the first-years putting their grubby mitts on it so everything was out of focus. My eyes are slowly regaining their strength, but spending that much time in front of a screen seems unhealthy for my eyes. Hey, maybe all those people who have the screen darkeners are ahead of the curve, just like Shape-Ups, Toddler Leashes and SARS masks. I am seriously surprised no one has won a lawsuit over getting hazard pay for computer work. Not that I would have their back on that one, I am just surprised no one has try to sue. Hey, maybe the next watered down computer Steve Jobs waves in front of your face and convinces you that you need will have some high tech screen that won't hurt your eyes. Seriously, have you watched the videos of him at conferences? I am convinced he could pull one of those old car phones out of a box and everyone would cheer and yell like he just cured cancer. They are programmed to do that. The press kisses Jobs' ass worse than a plastic surgery gunner. Maybe they are afraid he will unleash a police raid on them like he did this guy. What can the iPad do that other computers can't? I love my mac and avoid PC's like I do other med students, but I still don't need another $500 piece of equipment just because I want to flick not click through my pictures. Besides, they are way to secretive about their products and leave too many questions. Dude is like a walking Lost episode.

I have consumed more coffee in the past 8 weeks than the rest of my life combined. The day I took my boards, I got a computer with a very sensitive mouse. Shaky Hands + Coffee makes clicking answers Carnival-Game-Hard. I was waiting for the balloon to inflate or a carney to pop out and convince me I needed to upgrade to a bigger stuffed animal. Felt like I had to pee every 5 minutes for a few days after the test. I don't know how you religious coffee drinkers get any work done. Maybe that's the point, always going to the bathroom to ~~shop on your iPhone and update your facebook~~ pee. Didn't get any withdrawal headaches so I must not have used for long enough.

My wrist hurts. I never thought I would say this, but I think I had the beginnings of carpal tunnel syndrome. I feel like I need a wrist brace next time I go bowling. What exactly do the bowler wrist braces do? Anyways, about week 5 of my 8 week final push I started having wrist pain and a little numbness. So I switched the buttons on the mouse and used my left hand. I almost filed workers' comp, but that only works if you are making money. Day of the test, my forearm was all tight. Kind of pathetic when you think about it, not to mention the risk of a DVT from all that sitting. Seriously, med school is dangerous. Compound that with a school in the ghetto and it makes for an episode comparable to Deadliest Catch.

I've got a few weeks before I start the circus that will be rotations. Can't wait to tell you some of the stories. I know there will be some gems from some of my colleagues' mouths as well as some patients. I can just see it now, med student answering a question the resident couldn't, the brown-nosing, the putting down/proving wrong other fellow med students. I just need to remember to take deep breaths and remember I have a fragile wrist from boards studying...

Boo Hoo!!

2010-05-28T18:54:00.003-05:00

Overheard today during the 40 minute break I had halfway through my 8 hour licensing exam at the local testing center.

Non-Med Student "How long is my test?"

Test Center Rep "1 to 2 and a half hours."

Non-Med Student "Awww you're shi**ing me."

Let's say it all together...."Awwwwwwww boo hoo."

Updates next week. I promise...

Do I know you?

2009-10-31T14:57:00.011-05:00

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

2009-08-15T12:42:00.003-05:00

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

2009-07-10T20:27:00.005-05:00

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

2009-04-28T09:18:00.006-05:00

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

2009-03-30T15:09:00.007-05:00

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

2009-03-13T20:57:00.005-05:00

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?

2009-02-24T16:36:00.000-06:00

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

2009-01-29T13:41:00.005-06:00

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

2009-01-21T10:00:00.001-06:00

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...

2009-01-12T12:40:00.000-06:00

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.

You can sit here if you want to

2008-12-26T02:24:00.001-06:00

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...

2008-12-12T16:00:00.001-06:00

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?

2008-12-03T17:44:00.000-06:00

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!

2008-11-24T12:09:00.000-06:00

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

2008-11-22T15:13:00.000-06:00

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

2008-11-14T12:18:00.004-06:00

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

2008-11-11T14:51:00.002-06:00

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

2008-11-03T13:56:00.004-06:00

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

2008-10-27T18:47:00.007-05:00

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

2008-10-26T12:17:00.003-05:00

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

2008-10-18T16:15:00.009-05:00

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

2008-10-10T16:03:00.005-05:00

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"

2008-10-03T15:40:00.013-05:00

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

2008-10-02T19:34:00.003-05:00

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

2008-09-26T16:53:00.003-05:00

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?

2008-09-20T09:48:00.004-05:00

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

2008-09-19T15:09:00.006-05:00

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

2008-09-15T19:53:00.002-05:00

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!)

2008-09-11T20:28:00.007-05:00

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

2008-09-09T19:19:00.004-05:00

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'

2008-09-02T16:40:00.009-05:00

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.

2008-08-31T16:02:00.001-05:00

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?

Mosunday(TM pending)

2008-08-29T15:16:00.012-05:00

So every week, around Thursday, they put out the packets for the following week. Well this classmate and I were staring at the papers and wondering where Monday's handout was. We were looking all through them and then she suddenly exclaimed "oh yeah, we don't have school on Monday." To me, though, there is no 'Monday' as people call it, only Mosundays(TM pending), a horrible fused Monday and Sunday. Work with me here. Every morning I wake up, it feels like a Monday. I know there is a full day of work and worse yet, there are 4 more days of work. Then at about 12pm, something changes about the day. It turns into that early Sunday evening feeling when you know that you still have 5 days ahead of you. Your stomach starts to knot and you get instantly sad that the 'weekend' is over. I don't feel like "oh, phew, Monday is almost over." No, I feel like, "Awww crap, tomorrow IS Monday." Then it repeats every day. Dang you Mosunday!! (TM pending)

This week was filled with two labs (micro and clinical skills). Learned about range of motion and gram stains. Lecture was pharmacology and immunology heavy. I just about fell out of my chair when the immunology 'professor' told us it was his last lecture of the section. Instead of 'professor' I think his name should be 'reader of many confusing power points'. He has yet to teach me something. 3 more immunology-less weeks. Pharmacology is interesting. There is a lot more behind drugs and dosing than I thought. We haven't started to learn the drugs yet, and I am sure it will be difficult at first. I am getting sick of the microbiology lectures. I am not happy with the amount of bacteria, parasites, and fungi that we have to 'memorize'. I use 'memorize' loosely because at this point I feel like it goes in one ear and out the other. I know I will not fully memorize a lot of things until I start to use it in a clinical setting or with a system. That is just how I work. You can tell me that IL-1 is a pro-inflammitory cytokine, but unless you show me in a setting, I will not learn it. (I looked that up)

I am looking forward to musculoskeletal, which is 3 weeks away. I know it will be more challenging, but I also know that it will not seem so scattered. I have begun to get frustrated with some things and procedures. I want to keep a positive attitude, but there are some things I do not agree with so far. The biggest is the immunology professor.

Did you ever wonder how elementary teachers have to go through all sorts of training and schooling to learn how to teach, but as soon as someone gets their PhD, they are all of a sudden experts on teaching? Why? I am not saying that there are not good teachers that have a PhD, but I am saying that I feel that if I am paying for an education, I would like the person standing up in front of me to know teaching styles and how to cater to each student, etc. ANYONE can read a powerpoint that was copied and pasted out of some book. NOT everyone can teach. I know this is medical school and we are grown ups, but I would like more bang for my buck in certain subjects. We shouldn't be walking out of a lecture more confused than ever. And I am sure I am not the only one who feels that way (some people are talking about getting a petition going). His first language is not English, so he doesn't even form complete sentences. Last I checked, I am not at a foreign medical school. Maybe I should just pay part of the tuition and when they ask me where the rest is I will tell them they will get it as soon as I start being taught immunology by someone other than myself.

I learned in football that if you do not do your job, you do not play. That doesn't mean that the coach doesn't like you as a person, he just doesn't like the way you play. Plain and simple. Either you produce results or you watch someone else who can. The same rule should apply to education, especially if it is paid for. If other professors have to post handouts from when they taught your subject because you are confusing students, it is time to go. There are other things you can do with the PhD and M.D. combo. You have had two years to prove yourself.

You don't have to outrun the bear, just your friend.

2008-08-25T12:57:00.005-05:00

So, today was my first "quiz" of medical school and by "quiz" I mean test because no quiz is 76 questions long. I had gotten to talking with a friend of mine over the weekend about failure and being the bottom of the class and how with grades it creates a somewhat competitive atmosphere, thus embracing the gunner lifestyle. (but it also doesn't allow you to coast through med school at a "passing" level, which I appreciate). We were also talking about how the tests are graded on a curve and I said that heaven forbid it is one of us who is LAST in the class. Someone has to be. To which he replied "you don't have to outrun the bear, just your friend." After I stopped laughing, I began to think in my head about who I was "faster" than. You, you, you, maybe not you, you, etc. Yeah, I am competitive, I'll admit it. I want to get a good residency in a specialty I am excited about and if that means that I have to do research behind your back or rub shoulders with the right person, so be it. I am not saying I will trip you while running, or even not help you if you need to get up into my tree, just don't sit on my branch because there is only room for one of us. "Seat's taken" These are facts. This isn't for my ego, but for a family I will have one day and a job I have to happily show up to. The application process was hard enough. Thinking about someone in "my" seat at a better school wasn't easy to swallow. Especially coupled with affirmative action, but that's a topic for a different discussion (I do believe I am in the right place though). That doesn't mean I am not a nice person or will try to make you look bad, I just know my weaknesses and if I can't run faster than you, I better be able to climb a tree faster than you or know a better way out of the woods.

There is one thing I try to keep telling myself when I get stressed about the mental aptitude of my classmates. "If they were THAT smart, they would be at Harvard."

So today I have an opportunity to go do some volunteering. The CMDA is serving 500 homeless people some dinner. I will be going to that and getting grounded. All this medical school is overwhelming at times and it will be nice to do something for someone else. Isn't that why I am here???

Also, for the record, in regards to my ethical question. I voted to tell the mother the results and give her the option to come clean before I spilled the beans. She is the only one who already knows or has some suspicion (could have been quite a party) that the son isn't her husband's. I also said this because if I were the husband, I would want to hear it from my wife, not some doctor I do not know. I factored MY feelings into the equation, which is probably not a good idea. "Do unto others" right? Unless you are running from a bear...(just kidding)

P.R.O.D.-the new club on campus

2008-08-22T20:08:00.015-05:00

Ok, so week two is done. I am actually leaving school an hour earlier than I had planned. Why, you might ask? (I pretty much sat here for the last five minutes trying to come up with a witty response, but I could not.) I guess that kind of tells you why I am leaving early. I feel like if I try to learn/read/stare/listen to another thing I will forget the way home, which would result in me A)sleeping at school B)sleeping under a bridge C)hanging out with someone in the area who might rob me or D)all of the above. Which brings me to my next point.

I had an epiphany last night. Why on earth would someone try to rob a medical student? We are actually some of the most indebted students around. We are the outlier to the bell curve of debt, and I am talking the numbers in the red. If anyone should be doing the robbing, it should be US! In fact, maybe I can get that club approved here on campus. P.R.O.D. Proactive Rapid Olbigation Dispursement. That doesn't sound so bad.

So this week was filled with 1 clinical lecture, 1 embryology lecture, 6 microbiology lectures, 2 histology, 5 immunology, 2 physiology, 1 bioethics, and 3 pathology lectures. Then 3 labs. The pathology professor is good. He wants us to learn and is quite entertaining. He shows some interesting slides as well as MANY that elicit an "ooooo" or "ouch" response. We also spent 2 hours in a room looking at x-rays and other various scans, which brings me to my specialty hierarchy. As you may have noticed, I have added Aerospace Medicine and dropped some down a little bit. I think Aerospace medicine would be very interesting. I have read a few articles on it and will try to learn more about it when I can.

Finally, I added a small question below. I am interested in what my small handful of readers think about the medical ethics question that was presented in class to us. (PLEASE TYPE YOUR ANSWER IN AS A COMMENT IF YOU WISH TO DO SO.) I think it is really interesting stuff. Makes you think hard. Oh, and YES there is a "correct" answer, which led me to ask the following question during our discussion this week. "What makes the ethics board so special that they get to decide what is the ethical thing to do?I mean, you could have ten ethics boards from ten hospitals all give different decisions, right?" I wasn't trying to be a smart-ass, just trying to figure out how there could be one right answer.

THE QUESTION:

This situation came up in a major transplant program which does more kidney transplants than anyone in the U.S. In brief: An adult son who was willing to be a live kidney donor for his father is found in testing that he is not biologically related to his father. Neither the father nor the son appear to know this. Should they be told? If so, what should be said, by whom, to whom-and why? If not, why not- and what should be disclosed?

If only we had a parking garage on campus...

2008-08-20T20:06:00.004-05:00

Just to give you a feel.......(straight out of the security department)

August 19, 2008

On Monday afternoon, August 18, 2008 at around 4:30 P.M., a student was robbed by force across the street from the University on the corner of Woodland and Independence Blvd. The student observed the suspect yelling and cussing at everyone in the vicinity and even struck a car with his fist as it passed. She started trying to avoid the suspect but, he singled her out and concentrated his aggression solely toward her. He first tried to punch her and grab for her purse all the time yelling obscenities and asking for money. The student was able to get her cell phone out and was trying to call for help when the suspect grabbed the phone and hit her in the arm. He gathered his belonging and left in the direction of Seven-Eleven. The student continued on to the University where the robbery was reported to first security and later Kansas City Police. The robbery is currently under investigation.

UPDATE : 8/19/08: The suspect in the robbery of our student is in police custody. Her property has been recovered.

August 20, 2008

On Tuesday, August 19, 2008 a student's vehicle was broken into while parked in the lot across from Smith Hall at the corner of Highland and Independence. Entry was gained by damaging the lock cylinder on the driver’s side door. A large amount of property was taken from the vehicle including electronic, power tools and medical equipment. Video surveillance revealed the suspect entered the parking lot in a car and parked close to the victim’s vehicle at about 10:00 A.M. and gained entry to the vehicle in less than 30 seconds. The suspect remained in the vehicle for about 6 minutes and exited making one trip to his car. He back out of his parking space, made one circle around the parking lot, and left the area. The total time on campus was less than 11 minutes. The suspect vehicle is a small gray or silver 2 door compact car with a sunroof and spoiler. There is no indication as to what led the suspect to single out this particular vehicle, but one theory could be a GPS mount left on the dash or windshield of the vehicle. Attached is a link to an internet article entitled, “GPS Theft on the Rise- Windshield Mounts Tip off Thieves” (http://www.gpsmagazine.com/2007/09/gps_thefts_rise.php). Another theory is the suspect may have had good luck gaining entry to a particular type of vehicle in the past. Reports have been filed with PD and video evidence is made available to them.

It's Not THAT Bad!!

2008-08-15T16:48:00.005-05:00

So some of those special people in my life have been wondering about the new phase in my life and what is going on, how are things, etc. So, I decided to start this blog. That being said, this is not a substitute for a phone call or personal e-mail. I have thought long and hard and I feel this will help ease some of my "broodings" if you will. It has also allowed me to put my thoughts on paper which can be very therapeutic, even if nobody reads them. My goal right now is a minimum of once a week, but there may be some more posts as I see fit. I will try to keep this as anonymous as I can as I never know who is watching. I have heard that my school can sometimes be a bit like "big brother". I may end up putting up pictures though, so who knows. This first post is very long. Sorry, but I am just setting the scene for you. So here goes:

My neighborhood:

Used to be the Italian mob stomping grounds years ago. They have all moved out of the area, but the woman who runs the pizza place in my building is straight out of Italy, so I am sure mob-remnants still exist. A car ride to school takes approx 6 minutes, a bike ride 11.5. I had started the week out riding my bike to school, only later to find out that the hookers and thugs come out near my school after 7pm. They were yelling at me as I rode home one night so as of right now I will no longer be attempting the "dodge-a-hooker and avoid robbery" ride home. Maybe I will find a new route at a later date, or if I could lighten my load (currently two bags with a laptop and cell phone in one) I think I could bike faster than anyone can run if need be. All I know is the security guards on campus pack heat, and it isn't because the med students like to party. Plus on the drive to school today there was a man throwing gang signs at cars while standing in the middle of the street. I'll pass on the "share-a-ride" option with him.

My APT:

A nice brick, studio apartment above a coffee shop. I am on the end so that is nice and I do have someone above me. I have decided not to get cable right now as I think it might be a huge distractor or an unused expense. I am not here to get caught up on "So you think you can dance" and "Maury", I am here to go to medical school.

My Class:

There is a wide range of students from all walks of life. Heavily Caucasian. 2 black students, three middle east students, and maybe three or four asian students. I have talked with some people about how this might be where the victims (I use that term loosely) of Affirmative Action end up as some public schools still use Affirmative Action. I could go deeper here, but I will save it for a different post. I have met some nice people. My goal with medical school was to make at least one friend that was close enough with me to be in my wedding one day so we will see.

This week was my re-introduction to:

Taking notes
Paying attention when someone is talking even though I want to fall asleep REALLY badly
Three-ring binders
Professors
Students
Backpacks
The library

Some new things I have experienced this week:

Studying weeks before a test and the same day the info is presented to me
Gunners
Being inside studying or in class for the day's daylight hours
Not getting the mail/taking out the trash/doing laundry because I won't have the time until tomorrow or the weekend
The feeling the term "I think socialized medicine is a good thing" brings to my stomach

I understand that there are some words, such as gunner, that I may use which may be foreign. The definition can be seen on the right hand column of this page, as well as many other fun things. If you would like to, click one of the ads in the upper right corner of the page and let the page load, whatever it is. I don't know how much they will give me for having them, but every little bit counts. And if you think about it, have everyone you know do it as well. Heck, maybe I can pay for medical school. (Ok, maybe not, but I will keep you updated on the first check when and if it arrives). Go ahead and do it now, I will wait...............

My typical day goes something like this:

8am - 12pm Lecture

12-1pm Lunch (unless they bring in a guest lecturer or a club is meeting)

1-5pm Lab or study time

5-9/10 Study

I hate to say it, but I didn't even study like this for finals week in undergrad. The hardest part right now is the volume of information. We got about a semester's worth of cell biology in two days. I have a three-ring binder (3") full of the week's notes. The main point I have heard over and over again is to stay on top of it. It isn't so much the difficulty right now, but more the volume that is the challenge. Here has been my plan (because I learned a physician always needs a plan):

Find a place to study without distractions:

cell phone off, shades closed, no foot traffic. The school has a building that has small "offices" where you can study without any interruption. This is my new home.

2. Review and condense the day's notes:

Four lectures a day and one hour per lecture = 4 hours minimum study time. There are 3 points that come from each lecture (2 questions worth 0.5 and two one point questions on the final) so I have concentrated on the main points only. I have tried to get the big ideas. It's no use spending a lot of hours on one idea if it only will yield 3 points. I have found myself skimming over details (nervously) that I do not think are important. There is just no way to get it all in.

3. On the weekend, condense the notes for each lecture even further and make flash cards so studying for the final and boards will be easier.

Other things added to my Mon-Fri life:

good diet
exercise (daily)(starts tomorrow)(no, seriously)

I know I am not the smartest person in class, but I feel that I do have an advantage. While a lot of students wait to make personal connections with residency programs for their second, third but mostly fourth years, I plan on making a few of them this year...EARLY. I would love to walk into a rotation or clerkship somewhere and have them already know me by name. A list of specialties I am interested in can be seen on the right hand column and I will update that as well as the other things on a regular basis. I plan on meeting with a few people to get their advice in the specialty. I have heard over and over again that if a residency program likes you and knows you want to go there, they will take you even if you don't have as strong of scores as some other applicants have. I know the specialties I am interested in are all very competitive, but I know that if I make the right connections and work hard enough, I will strengthen my chances to get the residency I want. If you know someone who knows someone, who might be able to help me or introduce me to someone who can help me, please do not hesitate to let me know. I'll appreciate and need any help I can get.

And now for a weekly thing that I used to do on a daily basis for my parents (I am not known as a "talker"), best and worst. I will also add frustration.

Best: Realizing that this is it. Medical school. I do not think it has fully sunk in, but this is like starting a career in a company and being at the bottom. A long way to go, but I am on the track I need to be on. A side caveat was that Whole Foods carries the Red Baron Classic Crust Mexican Style Supreme Pizza...my all-time favorite.

Worst: I have found myself wondering about other students. What they are doing, how much they are studying, if they are putting more time in, or are learning better than me. I wonder about techniques, if I am doing it all correctly, etc. I guess that will come with time, but the sooner the better. I don't want to be stuck after Christmas still trying to figure out the best way to study. On that same note, a part of me doesn't want to feel like I have to compete with them, but at the same time it would feel great to be a member of the top 10% or so.

Frustrating: There are some professors with some HEAVY accents. Some of the terms I have been hearing are hard enough to understand, but when you add a heavy Russian accent on top, its like hearing spanish with a southern accent. Plus, this professor in particular just read his notes. No explanation or help bringing the pieces together. It was like he dumped all the parts to an Ikea desk on the floor and took away the picture and directions. I can piece it together but there will be mistakes and a lot of time consumed. So there will be these subjects I will need to teach myself.

There you have it... Feel free to comment. I am still trying to figure this all out but this will have to do for now.