Chocosseur

Dear Nurse,

I am grateful for you. When the first thing out of your mouth on my first day of a rotation is "We like Chocolate" I laugh. You know how to bring a smile to my face on day one. See, you aren't unique. You are a pattern that is as predictable as a Hollywood marriage. When you say that statement, I know the following truths to be true:

1. When you saw WE you really mean YOU like chocolate

2a. Whenever I see you after day 1 you will say "Hey, where is the Chocolate?"
2b. You will most likely add in some threat, wielding your pseudo-power on my grade. Like you can make or break my evaluation.

3. When the pattern is clear that I will not be bringing you anything, you will make a snide remark about my intelligence and how I don't "get it."

See, I understand. Med students also happen to be quite predictable. This kind of crap may have worked for the other students walking through the door, you know, the merit you think you gain by demanding chocolate from the student on the first day. You have been able to convince students that bringing you chocolate is going to somehow make us better physicians and perhaps even get us a better grade which could ultimately get us into the residency we always wanted. So if the poor souls who end up not matching to a residency had only brought chocolate to the demanding nurse, they would have matched? Spread the word! Well, I am kind in some ways. I want to help you out. Here are some truths from my view:

1. Just because you like something doesn't mean saying it out loud will get you anywhere. This isn't facebook, I don't care if you like this photo, this comment, my location, who I am hanging out with, that I just got done at the dentist, that it's time for GTL, and I definitely don't care if you like chocolate.

2. The best way to get something at the end of a student's rotation is to be nice. Introduce yourself to me. Help me navigate the new work environment. Let me in on the unknown rules (Dr. X likes students to do Y or Never do this in front of Dr. X, he hates it). Always have my back. If I am doing something wrong, correct me quietly. If I should be doing something, correct me quietly. If I keep coming to you with questions or asking for help, it isn't because I am stupid, it is because I trust that you have my back and are watching out for me. And most importantly, it is probably because you are always sweet to me. You may know where object A gets placed because you have worked here 10 years, but I understand that if I put object A in the wrong place, it will make your job harder, so I ask, not out of stupidity, but out of respect. That respect should be mutual. By demanding something day one, you automatically lose that respect. Some respect is earned and some comes with the territory, but that territorial respect is easily lost.

3. Saying that I don't "get it" makes me laugh. It doesn't scare me because I know it is coming. When that comment comes...out loud...in a room full of people, the dialogue always goes something like this:

You: "Where is my chocolate? You must not get how things work around here. You don't get it, do you?"
Me: "Oh, no. I get it. Loud and clear. You like chocolate and you want me to bring you some."
You: "The last student got it. He brought me chocolate."
Me: "Must have been a third-year. They typically fall for the 'get me chocolate or get an F' gag."

I created a nice flow sheet for you below. Feel free to use it as a tool to help you discern which route to take. Glad we could have this talk. Good luck.

A thought

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

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

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?

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

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!!

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?

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

MORE TO COME...

It couldn't B U

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

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

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

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

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

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

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

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

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

"disturbed."

"extreme changes in mood."

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

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

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

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

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

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

Curtain Call

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

The big push

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

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

Kid #1:  Hey tommy, you hungry?

Tommy:  Nahhhh!

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

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

Kid#1:  What do you mean.

Tommy:  My tummy feels like it is liquid.

Kid#1:  So, eat then.

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

Kid#1:  How does your food lie?

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

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

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

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

Tommy:  Well, no.

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

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

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

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

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

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

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

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

Response = "Nah, I'm good."

One week until spring break...

So you did a little bit of research did ya?

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

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

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

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

Tr-Hip Replacement

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

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

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

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

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

Bioethics Part Deux

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

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

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

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

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

You can sit here if you want to

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

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

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

That's the signpost up ahead...

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

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

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

                                     

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

Is anyone here a marine biologist?

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

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

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

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

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