MudPhud Adventures

Woah

2009-06-06T08:14:00.000-07:00

I start residency orientation a week from Monday.

What else can I say? It just feels so huge. It is still not real that I graduated and am an actual medical doctor. Perhaps this is because I certainly do not have the knowledge or experience required to be a medical doctor. Which makes it all the more terrifying that in one week I will be expected to do the job of a medical doctor.

It's funny, looking back, at how stressed out I was about rotations and exams and stuff. I mean, those were grades--that's all. And starting in a few weeks, I will have ACTUAL LIVE PATIENTS for whom I am ordering tests and treatments and medications. Before, I could fail an exam. Now, I could FREAKING KILL SOMEONE.

Now, all of you in medicine know that this isn't exactly 100% true. There are layers and layers of supervision and oversight designed expressly to prevent me, as an intern, from killing someone. But just because I can look down from the high wire and see the net doesn't make me feel all that much better about being up there. I mean, I could fall onto the net, then bounce off of it and land directly in the mouth of a hungry lion. I could fall right into the sole location of a gap in the net. The whole damn net could break, my skull along with it. I will be way the hell up there, and having a net below you is not equal to being on nice, solid ground.

What brought this panic on is the info I just got about taking my PALS (Pediatric Advanced Life Support) class, a two day long affair you have to spend some time studying for ahead of time. And, suddenly, it occurred to me that, holy cow, I might very well end up in a position where instead of hovering against the wall or, at most, being the bag mask girl during a code, I might be expected to actually run the code on a kid. And then I broke out in a cold sweat.

I know that this will pass, and that after a few months of trial by fire I will feel more sure of myself, and less scared. But I kind of hope that the fear never completely goes away; that I never feel totally confident in my abilities. It's a price I have to pay to be the best physician I can. It's the way to keep me on my toes, keep me reading, keep me trying to be better every day. Fear, my constant companion.

(Quick side note: Since I started medical school, every day I find it harder to understand doctors who have a huge ego. Nothing, nothing has made me feel more humble, more naive, less knowledgeable, less confident than studying medicine. And because of its nature, I can't imagine ever feeling differently. Just because you are an excellent swimmer doesn't mean you can just dive in swim across the ocean, no matter how long you train.)

In any case, I leave you with the advice that all those in the medical profession already know: for God's sake, don't get sick in July.

M.D. -> Patient -> Mommy -> Resident

2009-05-17T11:54:00.001-07:00

Weird transitions to be happening so very closely together.
.
A little over a week ago I graduated. The big one. THE graduation. The Grandaddy I've been working towards for eight long years.

Less than two days later, I was admitted into the hospital where I had been a student, into one of the rooms where I had delivered a baby as a medical student, to have a baby of my own.

About 13 hours after that, I became a mother.

My head is spinning. Doing this baby thing is completely overwhelming. Obviously I have tremendous support (which is the main reason I'm still alive) but still--insane.

Again I am faced with the same issues I was when Mr. Dr. Dr. VonB got sick. I know too much, and too little. Though I'm going into a peds prelim year in four weeks, there is so very much I don't know about healthy infants. Sadly, I know way more about sick infants, the result being that I have been one of "those" mothers, the ones who drive pediatricians crazy; wondering about every single little thing incessantly. Is she breathing too hard during this feeding (subtext: could she have a congenital heart defect)? What's up with her peeling skin and nails (subtext: could she have some kind of weird genetic connective tissue disorder)? Why is she so pale (subtext: could she have a red blood cell disorder? (real answer: because you and your hubby are dairy white, crazypants...))? You know. Crazy.

Being in the hospital was strange, too. All of a sudden, instead of the medical student dealing with a frustrated patient waiting hours to be discharged, I was the frustrated patient. Instead of fielding 1000 paranoid questions about a new baby, I was the one hurling them out there.

Having not been in the hospital in forever, I had forgotten how horrible it is being woken up every 10 minutes. At one point, when my husband was taking care of the baby so I could have the first nap I'd had in almost two days, I started counting: in 1 hour we had EIGHT people knock on our door to come in and examine me, examine the baby, tell us about the new study they'd like to enroll us in, offer to clean the room, examine me again... I was ready to die. The hospital is such a HORRIBLE place to try and get any rest or recuperation. And the worst part is that when you do want to see someone, they don't show up. Ever. The lactation nurse came by once, and I was anxious to meet one more time before we left, but of course she was two hours late and I was therefore discharged before I could see her. The attending came right in the middle of my nap, but when we were ready to be discharged (and I mean, REALLY ready), it took her three hours to get the orders in. Ugh. Things to remember when I'm back on the other side.

Speaking of which, that's right around the corner. I feel I have forgotten everything I've ever learned, and it's freaking me out. I have two weeks of orientation and then I'm fresh meat on the wards (though starting with a very easy rotation).

My other problem is that I never imagined I would be one of those women who finds herself crushed thinking about leaving her child to go back to work. I'm not heartless; I assumed it would be difficult. But I can't put into words how hard it is to think about now. I am 150% sure at least part of it is the hormones and the sleep deprivation, but still. This is going to be a doozy. Strangely, at the same time, I'm excited to be a real doc. It's remarkably difficult.

Well, baby is stirring and calling for the cow (me). At her next nap I am going to try to get some reviewing in, but I'm not holding out much hope. Lately whenever I'm not actually standing or walking I tend to fall asleep, and this time I don't think that even the fear of being an intern will be enough to keep me awake while reading about strep throat.

Graduation cometh

2009-05-08T16:49:00.000-07:00

Well, this is it. Time's up. Graduation is tomorrow.

Last night we had our mudphud program graduation party. Today we had graduation rehearsal, so I got to hear them call my name, then say, "VonB, Doctor of Medicine and Doctor of Philosophy", then I walked across the stage so they could put the crazy hood on me. Then I sat back down.

I have to tell you--so far, this whole thing has been strangely and unsettlingly anticlimactic. Maybe it will be different when everyone has on their robes and hats, and the bleachers are full of friends and family cheering. Maybe it will be different when I have a program that has my name in it. I don't know. For now it's all just surreal and, well, tiring.

Little VonB has not made her appearance. I can't wear the dress I bought for graduation, both because I can't go without support hose now (by the way, 3+ edema is VERY uncomfortable; I have a whole new level of sympathy for patients who have it) and because I can't get my feet into any shoes besides sneakers. She's due on Sunday, and I am lucky enough to have an OB who understands that I am eminently beginning residency and was happy to schedule an induction on Monday should the tike continue to be stubborn.

So, it is looking like I will be able to waddle across the stage tomorrow after all. But like I said--it isn't as exciting as I thought it would be, somehow. I find myself not really hoping that Little VonB holds out until after graduation, but feeling more indifferent. It's like when I had my dissertation defense. Then, I blamed it on not having a graduation. But I see now it's not that at all. Maybe it's because I've been doing this thing so long, it feels much more like a job than anything else. Maybe it's because endings are often anticlimactic. Maybe it's my crazy hormones. I'm sure it will dawn on me soon and I will feel all kinds of emotions. But for now, I mostly feel: meh.

I admit, have been feeling sort of nostalgic and sad; a lot of it is for the friends who are moving away, but some of it is for my MSTP program itself. It's been like a family to me for so long. I've invested a lot in it, made a lot of changes I'm proud of. I hope I've left it a little better than it was before. And it isn't like I won't be around and able to check in from time to time. It's just... well, I won't be part of that group anymore. I'll be in a new group.

I think that's part of it, too. I'm excited to meet the new interns and get to know all of the residents I hadn't met before--but I'm nervous, too. And kind of tired just thinking about it. Although basically everyone would describe me as an extrovert, I'm shy in my own way. I'm also not good with change (I guess most people aren't, but still). Also, like when I started medical school, I'm hesitant to get too attached to a new set of people I will be leaving so soon. However, I always regretted not making more friends in my original medical school class, so maybe this is my chance for a do-over.

On the other hand, as we recently discussed over on OldMDGirl's blog, it can be hard making friends with people who are so much younger than you, with such different life experiences. Maybe residency will level some of that out. Hmm. Not holding my breath, but still hopeful.

Now I'm just rambling, which is my cue to sign off. When next I post, I will be VonB, M.D., Ph.D. For reals.

Weird.

Residency, husband, baby, nervous breakdown

2009-04-28T14:11:00.000-07:00

Old MD Girl recently posted her thoughts on "The Good Life", specifically the musings about it she had heard from a male lecturer. It got me thinking a lot about my experiences so far and what I am facing down when it comes to being a mudphud, married to another mudphud, looking down the barrel of us both being interns and then residents, with a baby on the way and hopes for at least one more in the future.

Like Old MD Girl, I have also been privy to the musings of many a physician or practicing mudphud when it comes to "lifestyle", "goals", "balancing career and family", etc. The striking thing is how differently this is talked about by males vs females.

I do hate to generalize and certainly hate to generalize based on gender--Lord knows I resent it when anyone else does--but I would be lying if I said there wasn't a persistent difference in my experience. So far, without fail, when a man is talking all about how "you CAN have it all", how he has a thriving practice, two grants, and three great kids, he says it all has to do with balance and good decisions and careful planning. I always ask these men: "What does your wife do?" And so far, without fail, they look slightly abashed as they answer, "she stays at home with the kids." Aha. So she's the one running the parts of your life that aren't lab or patients; she's the one that makes sure that when you are at home you get Quality Time with the Family, because she's already done the laundry and the cooking and the shopping and the cleaning and the paying the bills and... well, you get my point.

When women mudphuds or physician-scientists talk about Life Balance, they almost always say you can't really have it all, that something has to give. They talk about hiring help; nannies, cooks, maids, whatever you need to get through. They talk about having to cut back hours sometimes, and finding lots of good after-school programs; about working part time if you have to, and having a very supportive spouse (interestingly, they always bring this up without me having to ask. So far, none of the men have).

There was one exception to this. We heard from a couple who were both physician scientists and had a young child. I'm sure they are perfectly lovely and accomplished people but please believe me of understatement when I say that after hearing their presentation on "balancing" professional and private life, my husband and I wanted to shoot ourselves. Their system went something like this: one would go in to to work around 4am while the other kept the baby until the nanny arrived; then they would both work all day; then the one who went in at 4am would come home around 6 or 7pm and relieve the nanny, while the other would stay at work until around midnight. The one who stayed at home would work from there, writing grants. Sometimes, they said maybe once a week, they would both be home and have dinner together--although this meant one would have to go back to work until 1 or 2am.

Horrible, horrible, horrible, we thought. There must be another way. I don't know about you, readers, but I can't live like that. As I said when I was interviewing for residency and was repeatedly asked why I couldn't expand my geographical area and just live away from my husband for three years: I married him for a reason. I like having him around, and honestly being apart for three years is not an option I am willing to consider. Sorry; life is too short not to be with the ones you love.

Likewise, I can't imagine never seeing my children. I have no delusions that I will not see my daughter as much as I'd like this coming year; however, I can manage because it is a temporary situation. The couple described above intended to keep up such a schedule for at least three years until their fellowships were completed (and hinted it would be many more before their labs were established enough they could give up such a schedule).

I'm sorry, but since when did becoming a doc mirror entering the priesthood? Is it reasonable to expect us to give up any chance at having a life outside of work? Although we both love our chosen fields, my husband and I picked ophthalmology and dermatology partially because we knew those areas gave us the best shot at being able to be fully functional mudphuds--patients and research--without guaranteeing that we would suck at one or the other (or both), and without having years of never seeing each other or our children. Had one or both of us chosen medicine, followed by a fellowship, it's hard to image a way to escape the misery of the docs described above.

I feel there has to be a better way to do things. I worry that by asking so much sacrifice, the most talented people are being driven away from medicine and research, and particularly those fields where they are most needed (primary care, etc.). And the sacrifices seem to only get bigger as time goes on--more debt upon graduation, more hours spent on billing and insurance, more days on the phone with some random dude who has a bachelor's in rhetoric and communications and is trying to tell you how to treat your patient, more years working such long hours that you don't have anything to give at the end of the day to research, much less your family.

We are going to have to face the fact that we would have more, happier, better doctors if we didn't abuse them so. I read that Obama is struggling to find the best way to address the current and growingly alarming doctor shortage. How about allowing them to have a decent quality of life? More debt forgiveness for those who go into primary care; more flexible schedules and hours (which would often mean hiring more docs); more autonomy from the HMOs in how they treat their patients.

Well, I've gotten off topic, but I'm sure you get the gist. I wonder--I hope--my hubby and I are doing the right thing. Most days, I feel pretty confident that our kids will be fine in daycare. We'll have time for them and for each other, and hopefully won't suck at patient care or research. I'm hoping that we CAN "have it all". I'm pretty sure I will need a maid, though, since I'm unlucky enough not to have a stay-at-home spouse running the rest of my life. To those of you who do, I salute you. Just be sure to thank him or her the next time you're bragging about successful you are.

T minus 18 days until MD

2009-04-21T10:01:00.000-07:00

Crazy, no?

It's extra strange to me because I have been so completely focused on other things--lab, getting my medical license (pain in the ASS), doing the mounds of paperwork required to be a resident, getting ready for the baby (YIKES), the foils of pregnancy (being essentially handicapped with various ailments, frequent doctor visits, etc etc), and importantly the hubby's PET scan which is at the end of the week--that I haven't thought much at all about the fact that I am about to graduate and be a student no more. It's a mind scrambler.

In other news, I passed Step 2 CS, which is good, because it means that no one at the NMBE has to get a whupping from me. What a lame experience that was.

My internship starts June 15th, which is more than a week sooner than I had hoped. Mainly I am sad to have less "maternity leave"/time to recover from childbirth and attempt to build up a supply of pumped milk. By the way, though I have seen lactation nurses teach new moms how to pump I am not relishing the thought of having to pump myself.

Which actually kind of explains my whole take on this pregnancy/childbirth thing. I've seen a third degree tear up close and personal, as well as lots of C sections, births gone awry, or even those that go okay but still leave mental scars for those who had to witness them. Having seen so much from the medical end of things must alter how you view the experience, but I can't say, having only had the experience from this point of view. It's also weird because I am reading books about Lamaze, approaches to laboring, etc., most of which are pretty darn anti-medicine; however, clearly I am NOT so much with the anti-medicine. But apparently I am pretty susceptible to suggestion because I keep finding myself thinking, "Yeah! Why DO they make laboring women do that?!" It's very strange.

And even though all the books try to make you feel guilty about having any drugs, I am totally getting an epidural. Why? Because I've seen what happens to first time moms who don't, and... well, no thanks.

In any case, that's all for now. The countdown to labor and--gasp!--graduation is ON. Hopefully I will labor early enough to be able to go to graduation. It's going to be a close shave, as I am due the day after graduation. I think I would be pretty bummed to miss graduation; after all, this is a big end to a looooooooong road, and I feel I've earned hearing my name and walking across the stage. I guess there are more important things, but damn. Come a little early, girl, and let your momma have her day in the sun!

Now I'm back to all those chores and errands which somehow seem to take up WAY less time when you are working than when you are on vacation. How does that always happen?

What Capstone Taught Me

2009-03-23T17:32:00.000-07:00

-First, I am even more scared to get sued than I was before. I don't think that is what they were going for with their "Don't worry, you can avoid getting sued" talk.

-By the way, malpractice insurance is frickin' expensive.

-Also, it now seems inevitable that I, or someone I know, will develop a drug or alcohol problem. If it is someone I know, I will be forced to report that person to the Medical Licensing Board and potentially ruin their lives.

-Say what you will about the MD/PhD pathway (Lord knows I have), but at least I am not well into six figures in debt like my classmates, who will have to work just as hard as me (who am I kidding, I'm going in to Derm... they will have to work harder) and be much poorer for a looooooooong time.

-Docs sure do seem to get the s*** end of the stick.

-I figured it would be awful to have to tell the family of a patient that their loved one might die because I screwed up; standardized patient family members have helped me realize that "awful" is the understatement of the year.

-Sometimes, there are patients who have had bad health care experiences who have a lot of valuable things to say. And sometimes, there are patients you want to smack because they clearly think they understand what happened to them, but in reality they got most of their information from qacks and you have to listen to their ridiculous nonsensical ramblings about how awful doctors are.

-Apparently--and this TOTALLY blew my mind--it's a bad idea to have sex with one of your patients, especially if that patient has borderline personality disorder. Holy Cow! I am so glad I sat through an hour long lecture to learn this gem, because otherwise I might have gotten into real trouble!

-Residency is hard. No, seriously.

-You won't have time to take care of yourself, but you owe it to yourself and your patients to take care of yourself. Whatever that means.

-Finally and most importantly: I am completely done with medical school. Holy 8 year training program completion, Batman!

Dr. VonB is a lucky, lucky girl

2009-03-20T04:43:00.000-07:00

Well, I am still in shock, but I have managed to get everything I hoped for. Yesterday I found out that I matched into my top choices for preliminary year (pediatrics) and my advanced year (dermatology)!
Match day was kind of bitter sweet. Lots of friends leaving, lots staying; lots got what they wanted, some were disappointed. I was a lucky one, getting what I wanted, sticking around. I'm sure I will be even more excited as days go on, but for now I'm kind of still in stunned disbelief.
Here's the thing: I can't tell you how excited I am about dermatology!! I love, love, LOVE it. It is just about perfect for me. I've said it before, but I get to do everything I love. Great diagnostic work, surgery, and kickass immunology. Plus, my daughter will probably even know what I look like!
As for intern year, I am also very excited, but nervous. It's such a huge leap, going from not doing anything without four levels of permission to basically being able to make decisions on my own. Also: the hours. Scary. And even scarier... Capstone has given me a very clear understanding of just how much stuff I've already managed to forget in just a few months. But I'm not thinking about that now. Right now all I'm thinking about is packing for a short, weekend getaway with my hubby which we have been looking forward to for months. :)
For those of you out there who matched, I hope you are as happy as I am. For those with the match still ahead... sitting on this side of things, I can tell you that keeping up with that hard work and studying does pay off! Hang in there! And enjoy the first day of spring.

Changing gears, Step 2 CS, and OHMYGOD MATCH DAY

2009-03-05T09:49:00.000-08:00

Well, clearly I have not been 100% on top of updating this thing, which is probably appropriate since things will be moving on soon. I have been trying to decide if I will blog about this next great phase in my training--moving from being a student to being a resident--and I'm undecided. With a baby on the way and a husband who will also be an intern, there may not be time. On the other hand, Lord knows I always have lots to say.

These days things have become considerably more peaceful. It's nice, but almost frightening--I feel as though I keep waiting for the other shoe to drop. My husband has completed chemotherapy. He gets his port out soon and in another couple of months will have his follow-up PET scan. Waiting for that is certainly a source of anxiety; I try not to think about it, and to just rejoice in seeing him slowly return to his old self. Another huge source of anxiety, which was finding appropriate child care for next year, is now gone. We found a wonderful situation which we both feel great about, with the tiny exception that it will take MY ENTIRE RESIDENT SALARY to pay for it. That's right, folks. My. Entire. Salary. Repeat after me: MD/PhD training is worth it... MD/PhD training is worth it... MD/PhD training is worth it...

The following year we will probably be able to use considerably cheaper child care, but for now this is really the only way that we can both do our jobs. I keep reminding myself that this is still an investment, and that one way or another we will be able to survive on one resident's salary. Hey, it isn't really that different than what we did before, so I guess we'll be okay.

The big YIKES on the horizon right now is: MATCH DAY. Yipe. I think that a week from Monday is when we learn if we matched or not; official Match Day, where we learn where we will be, is March 19th. Now, I know that a lot of MS4s out there are feeling anxiety about this, but allow me to put it in perspective for you: I applied to dermatology. And ranked two programs. TWO. It is the height of madness, but luckily, I have to say that the PET is scarier, so there you go. In any case, hopefully I will at least have a prelim spot for next year, and if I am a REALLY lucky girl, I will have a place to call derm home after that. One way or another it will be nice to know for sure.

I also took Step 2 CS. I don't want them coming after me so I won't say anything about it except that I expected it to be really stupid, and it exceeded those expectations like a champ. I have never been forced to do anything that was such a racket, so pointless and aggravating, in medical school or graduate school, and those of you have done either or both know that is saying something. I urge anyone with the power to do so eliminate this charade, this rip-off disguised as an exam. Everyone knows you make us do it for the money. Why give us that final slap in the face after we've crawled through the sewer tunnel to graduation? I'll say no more.

These days I am all done with rotations, and am back in my dissertation lab for a while to help out with progressing my old project. Going back to research, changing gears again, is a strange experience. It's both harder and easier than I thought it would be to come back to it. My main issue right now is fatigue. It's hard to focus, hard to care as much as I did when I was here almost two years ago. I'm trying, but it ain't easy. It's also interesting to see how my perspective has changed with just a few years of clinical work under my belt. It's a good thing, and it makes me more certain that in the end I've done the right thing with the MD/PhD. A nice place to be.

No other big insights here for now. I have a Capstone course coming up, and my forecast for that is Stupid with occasional chance of Helpfulness. It sounds like most medical schools have these, so I might post a little something there. Also expect a triumphant or tragic post regarding match results. And wherever you are, whatever stage you are in, I wish you godspeed in your endeavors. We all have it pretty tough no matter where you are in this drawn out hot mess of physician-scientist-dom. Hang in there. I can honestly say that things keep getting cooler with each passing year.

No, I do not have any more #@*$&! questions about the program, or anything else

2009-01-28T08:05:00.000-08:00

Interview season has come to a close for me. My interview season was relatively very short and painless; with my husband having a spot at a nearby university for residency, I only applied locally. Let's not talk about what that means for my matching chances, especially given that I am attempting to match in dermatology. We will pretend that this is NOT the scariest thing ever, and move on. Very well.

In any case, I only had five total interviews, and had to travel for exactly zero of them. Given how ecstatic I am that I am all done, I have to wonder--how do people DO this? Most people have 10-25 interviews, all over the country. I was ready to stab myself in the eye after just five. Plus, I actually liked all of the places I interviewed, which makes it even less painful.

However, there is something weird about interviewing only where you have done rotations. It leaves a lot more blank space where there would have been questions, and as anyone who has gone through interviews can tell you, there is already a lot of blank space where they expect questions that don't exist. After you've gone through two or three lectures about the place and met with residents and faculty both formally and informally, there just aren't. Any. More. Questions. But yet they ask, at some point during every individual interview: "Any questions for me? Anything you'd like to know about the program?"

It is especially tough for derm interviews, where you have to meet with essentially ALL of the faculty individually, typically at least 10 or more people. It's nice in these situations to have a Blue Ribbon Pony of a question all picked out that you can parade in front of any faculty member, especially if you care about the answer. My personal Pony was: "What do you see as the most important goals for the future of (fill in name of residency program here)?" Interviewers love this question, and it gives a lot of helpful information to you, too.

That is my one useful tip for today. I have been heavily engaged in recruiting for our MD/PhD program, which is fun but busy and stressful. It is also very weird to have just finished being on the interviewee side of things, and then being on the interviewer(-ish) side of things. Now I have been chained in the garage by my husband to help him sort through the mind-boggling amount of ridiculous crap we have in there. It's nice, but now I need a nap.

I had something else to say, but it's gone now. Will post more when brain working again. Unless I inadvertently put said brain in one of the to-donate boxes in the garage... hmmmm....

It's not just good things that must come to and end

2009-01-02T18:01:00.000-08:00

Bye, bye, 2008. Please be sure to let the door hit you in the ass on your way out.

This year has had a few nice points for us, but overall, it can go straight to hell. I have a very optimistic eye trained on 2009, and that eye is looking through the laser sight of a powerful rifle, so you'd better watch your step, 2009. It's time to pony up and be good to us.

In other news, I'm all done, and it couldn't have come a day too soon. PICU was definitely the most difficult rotation of medical school for me. I would like to say that unconditionally, without the qualifier of what was going on in my personal life during that time, but I can't. After all, to be fair, the second most difficult rotation was probably OB/Gyn, due not in small part I'm sure to the fact that I had a miscarriage right smack dab in the middle of it (stupid 2008). So, clearly, personal issues cannot be put aside here.

However, I must say that even without the whole husband with cancer thing and the being pregnant thing, PICU is amazingly difficult. I have a whole new level of respect and awe for critical care physicians, particularly those in PICU. There is a new dimension added to critical care when you have children involved.

It's very feast or famine; my first week, we mostly had kids that needed a lot of very careful care but would almost certainly be okay. Then we had weeks where we lost three patients and an additional 30% of our service was about to die.

It blindsides you. There's the kid who comes in with headaches and is found to have terminal brain cancer; the kid who was totally healthy until infection led to meningitis led to stroke; the kid who came in for a simple, common operation and died three days later from massive cardiovascular collapse. I couldn't put it aside like I could with older adults. Losing patients has always hit me hard, but this was something new. The grief of parents of young children is somehow much harder to bear than the grief of adult children of elderly patients.

Then, you add in my current personal situations. Having to go see a family awaiting biopsy results for their child's brain mass every day, for days and days, without having an answer for them--and then having to deliver bad news--was heart wrenching. I had just waited for those results for my husband, and it was the longest and most horrible two weeks of my life (and we got relatively good news at the end). We still have scary waits--PET scan results, blood culture results, etc. etc.--and every minute still kills me.

I was waiting to have our 20 week ultrasound during the majority of the rotation, and seeing a parade of tragic lethal congenial malformations being desperately, and unsuccessfully, treated kept in fresh in my mind just how many things can go wrong with a baby. I went from being excited about the scan to being terrified. Luckily, everything looked great. It didn't stop my obsessive worry, but it took it down a few decibels.

Intellectually, it was always challenging. These are the most complicated patients around, with multiple life-threatening medical issues balanced against each other like a house of cards; every day you were trying to shift one of the bottom cards without having the whole thing collapse. I never felt that I developed a good grasp of the sickest patients. Yet, looking back, I am somewhat disappointed that I couldn't find within myself the usual regret to be moving on from something before I felt I really understood it. When I finished the rotation, I felt nothing but relief.

I was exhausted, in every sense of the word. At one point my husband spiked his first fever--luckily, he was not neutropenic (Go Go Gadget Neupogen!) but it was still terrifying. Having to be away from him so much was really agony, worse than it had been since his diagnosis, if that's possible.

What got me through it was 1) my deep, deep desire to never, ever, ever ever ever have to go back and do it again; 2) my husband's constant encouragement; and 3) my fantastic residents. Thanks a bunch guys--literally couldn't have done it without you.

And now I'm done, done, done. Though I'm technically on vacation it doesn't feel like it; at least, not yet. Hubby got very very sick a few weeks ago and we had to postpone his chemo. It was the worst week since after we got rolling on the treatments. I was terrified. He had high fevers, night sweats--it was a perfect example of how horrible it is to be newly minted MD when something like this goes down. We knew every possible bad thing that could be going on, but we both lack the practical experience to offset those fears with less frightening possibilities. The one thing I hadn't thought of was relapse, and when the doc pointed out that possibility, I well nigh had a meltdown. There were several nights I just laid in bed next to his sleeping, sweat-drenched form and cried. But he got much better, and today the doc informed us he thinks it is much, much more likely to have been a virus than anything else; sometimes, a little reassurance is magical.

We also found out that one of our doggies has a cancerous mass--can you believe that @)%&@? She has to go back in for a wider excision, and get an ultrasound of her spleen to see if there are any mets. This is the kind of tumor that if her spleen is clear, she will almost certainly be fine; if she has mets to her spleen, she's a goner. So, that has certainly added to my current Climate of Frenzied Panic.

Once I finished, I had about eight metric tons of random life chores to get done, the holidays, the family in town, blah, blah, blah... and I have a solid week of interviews starting Monday.

So, vacation, but not really. Looking ahead I think things will become substantially more sane towards the end of the month, but I've been saying crap like that for a while. Hubby only has three more treatments, then a PET, and if that sucker's clean, it will be the best thing ever (of course we have to await the 3 month PET...). The doggie gets her scan next week and if that looks good it will be a big relief (and if not... LALALA, I CAN'T HEAR YOU!). End of Feb I have to take--and pass, unless I want to cough up an additional thousand clams--Step 2 CS. Then comes the rank list and match. Baby looks awesome, still kickin' me with a vengeance.

So that's it for now. The long update. I am thinking of some ideas for future posts, perhaps about interviewing and ranking, exciting stuff like that. Until then I hope everyone had a wonderful, safe, happy and healthy Holidays, and that you remembered all of the wonderful things you have in your life. They are too precious and delicate not to be treasured.

Except for 2008. That sucker can go into concrete shoes at the bottom of the Hudson.

PICU

2008-11-26T15:57:00.000-08:00

HOLYMOTHEROFGOD...

PICU is like all the hard rotations I've had so far, but put together all at once, at 10x the speed, in a foreign language. And with more sad stories.

Remember waaaaaaaaaaay back when I posted this about not understanding medical abbreviations and jargon? Well, I look back on that post and laugh, it's so second-nature to me now. But PICU is like starting right back there. Most of the time I just either stare vapidly or, when that gets old, I nod. But I have no idea what people are talking about at least 30%, and probably more like 50% of the time.

I picked up a highly recommended book about the rotation which I will be reading in between bites of turkey. At least I get Thanksgiving off, which is good, because I need to sleep for at least 24 hours straight. I will let you know if said reading helps me understand what the #$(*& is going on in that place.

Until then, happy Thanksgiving!

'Round and 'Round

2008-11-21T10:50:00.000-08:00

A random brief post about rounds... some new 3rd years have asked, so here is what to expect:

SURGERY ROUNDS
Start time: 6am
End time: 6:15am
What to know about your patients: If they have eaten, pooed, or started bleeding from any orifice
What to present about your patients: If they are still alive
How many seconds attendings usually listen to your presentation: 0 (To be fair, they are not usually present.)

PEDIATRICS ROUNDS
Start time: 8 or 9am
End time: 11am
What to know about your patients: Medical stuff plus their birth history, growth and development history, grade in school, favorite subject, teacher's name, pets, names of pets, stuffed animal's name, symptoms expressed by stuffed animal (if present)
What to present about your patients: Significant overnight events, abnormal vitals, lab results
How many seconds attendings usually listen to your presentation: Usually to the whole thing (!), unless the attending is a cardiologist, in which case, 5

PSYCHIATRY ROUNDS
Start time: Between 10am and whenever everyone feels emotionally ready to round
End time: Depends directly on the quantity of both the patients themselves and the amount of crazy present in each individual patient
What to know about your patients: If they still think that you are an alien and they are communicating with the reincarnation of Elvis through a transmitter in their teeth
What to present about your patients: If they fought off the 8pm dose of Haldol
How many seconds attendings usually listen to your presentation: Often the whole thing, while nodding thoughtfully

MEDICINE ROUNDS:
Start time: 8am
End time: 5pm (on a short day)
What to know about your patients: Every health issue or experience that has happened to the patient and the patient's relatives or close acquaintances from when they were in the womb until now.
What to present about your patients: Any overnight event, including what time patient turned over, all vitals including trends in vitals since admission or possibly before, lab results for patient and patient's first degree relatives, or as much of this as you can get in before someone on the team interrupts you
How many seconds attendings usually listen to your presentation: They may pretend to listen for up to 60, but often not well enough to avoid asking you a series of questions which were answered in the first 60 seconds of your already given presentation

Like a 12 step program

2008-11-16T05:10:00.000-08:00

One day at a time. And so time has moved along, and for the most part, been good to us.

My husband had his PET scan, and it was good news. He still has enlarged nodes, though they are smaller, and none of them took up the label, so they consider the therapy a success. 6 months of chemo instead of 8, and most likely no radiation needed (thank God). I finally feel like I can breathe again.

On the bad side, chemo sucks so much. I guess I have realized how caviler we are with prescribing things for our patients, how quickly we are to dismiss them as "not too bad", when really they are pretty horrible and life-changing. To be fair, we were basically warned pretty accurately about the chemo, but there are parts of it that were downplayed to a ridiculous degree. For example, Mr. Dr. Dr. VonB had to get a central port, which they really blew off as not a big deal. In fact, the VIR (vascular interventional radiology) guys who did it didn't even prescribe pain medicines, they told him that Tylanol would be more than sufficient. What a joke! He was absolutely miserable for at least three days after that procedure, unable to sleep, unable to be comfortable, and in lots of pain. It was so much worse than his lymph node biopsy that he was using the pain medicine they'd given him for that (which he used once right after his surgery, and then had gotten by fine with Tylanol).

It's still a struggle to try to find something that doesn't make chemo so horrible. He just feels awful for 4-5 days after each treatment (and each one is getting a little worse). We keep switching around his medicines to help treat the nausea but most of them make him feel bad too. It is indecribably sucky to watch your partner suffer like this and be completely powerless to do anything.

In other news... OldMDGirl was actually right, though not about what my worst nightmare is. I found out the day after my husband's official diagnosis that I'm pregnant. It isn't that I'm not happy, it's just... nice timing, right? The first trimester was just... well, it was pretty miserable. I was worried about the baby, worried about my husband, worried about how much I was worrying (anyone else catch the study published right around that time linking maternal stress in the first trimester with schizophrenia in the child?), and oh yeah, yacking every single day while trying to continue rotations. Good. Times.

But things are better now. We got the Happy PET Scan News, the scary 1st trimester is behind me, along with the yacking, and I'm 5 short weeks from being essentially done with medical school. I took and passed Step 2, and surprisingly managed to to better than OK, which really blew my mind. I am done with my AI in three days (well, almost four, since one of those days is a call day) and it was pretty good even though I reaaaaaaaaaaalllllllllly didn't want to be working. Then I have four weeks of PICU and I'm outta there. Well, there's this crazy two week long course we all have to take in March. Oh, and I have to drive to FREAKING ATLANTA to take the Biggest Rip-Off in Existence (aka Step 2 CS) in February. But other than that... done.

And did I mention the baby is due the day after graduation? I don't care if I have to wheel myself, in labor, across the stage... I WILL ATTEND GRADUATION AND BE HANDED MY FREAKING DEGREE AND BE HOODED AND ALL THAT. This little munchkin is either going to have to be a little early, or a little late. Hear that, munchkin?

Anyway, that is a quick update of stuff here. I had actually meant to write more about the AI and what that's like, but I will have to do that another time. Here's a preview: overall, it's pretty awesome.

Until then... thanks so much for all of your thoughts, prayers and well-wishes. For those of you in graduate or medical school, keep the faith, because I am proof that even with random hideous life curve-balls, you do eventually get through it and move on.

Not supposed to happen

2008-10-12T10:19:00.000-07:00

Here it is.

My husband has cancer.

Though we've known now for almost 2 months it is still blowing my mind. The worst part was the two weeks of waiting for a diagnosis. See, he woke up one morning and his armpit was sore. He was worried it might be something bad (always the optimist, that hubby of mine), and I made fun of him and told him he'd over-used his arm. A week later he called me from the kitchen.

"Hey, honey... wanna check this out?"

I sighed and put down my book.

"Look at this," he said, holding down the collar of his shirt.

On left side of his neck, right above the collarbone, was visibly swollen compared to the right. My stomach dropped.

"Feel this," he said, pushing around with is fingers.

I was almost shaking as I did to my husband what I've done to probably hundreds of patients--palpated for lymph nodes.

I've never felt a left supraclavicular node on a person before, but I've answered lots of test questions about what a firm, non-tender node in this area usually means: cancer. And there it was. A firm, non-tender left supraclavicular node.

On my husband.

My heart started pounding.

Strangely, at this point, he got more optimistic, while I began sinking into despair. "Maybe I have a weird infection," he said. "I've been taking care of a lot of dudes with TB, maybe I have that."

"Maybe," I said. I didn't mean it.

"Or Cat Scratch Fever."

"Yeah, maybe."

I wanted to go to the doctor right away, but this was a Friday afternoon, so we had to wait until Monday. We were there when the office opened Monday, but as he was a new patient, they wouldn't see him until Tuesday. Those days were awful, but they weren't anything compared to what was coming. Tuesday morning the resident examined him and said he probably had an infection. A trial of antibiotics, he said.

"I'm worried about cancer," I said, trying to sound like I was wondering if it would rain or not. "Specifically, lymphoma or testicular cancer."

The resident shrugged. "Well, we could do a chest x-ray just to be sure."

"Great," I said. "Thanks."

The report came back showing a mediastinal mass, a large one. Just like how, though most people might have blown it off, I knew that his node was bad news, I knew what this meant. I had been sort of rooting for testicular cancer, something that had a pretty darn good prognosis. But a mediastinal mass meant lymphoma, and that was the kind of diagnosis that could carry less than a 50% 5-year survival rate.

It was another week and a half of CTs and lymph node biopsies before we had a diagnosis. Each test looked more like the diagnosis was lymphoma, and it was more wide-spread than we had realized. The problem is that there are lots of types, and some are pretty OK, prognosis-wise, and some are horrific. So I tried to hope, but it was hard, knowing that it was more likely he had a horrific kind (they are more common) than a pretty OK kind.

And that's what life was: hoping for the least horrible kind of cancer.

Finally, we got a diagnosis. Hodgkin's Disease. It was the best diagnosis I could have hoped for given what we knew. His labs came back--again, the best labs we could have hoped for, given his stage. They started Chemo the following week.

I never even really had much time to think. How did this happen? He's 31 years old! Healthy! Never smoked, excersises, eats well, hardly ever drinks, and then only one or two beers. This isn't right. It isn't fair. I take care of people all stinking day who have abused their bodies maliciously for 50, 60, 70 years, and they are still hanging around, complaining that they cough (You're kidding, Mr. 100-pack-years? You COUGH??).

I'd find myself thinking a lot when I had to tell people, "My husband has lymphoma." Husband doesn't really say it. It's not right. It doesn't mean to everyone what it means to me. I wanted to say, "The love of my life, my best friend, my soul mate I never thought I would find, has cancer. He could die. And I'm supposed to keep showing up to clinic, keep doing laundry, keep eating and sleeping like any of it matters."

I would overhear people talking about their problems and want to cry. "My wife got in a fender-bender, my computer died, and I lost my wallet," I heard one person lament. "Could my life get any worse?"

For your sake, buddy, I thought--I hope not.

That's all I can write for now. Things are going as well as can be expected. He's tolerating the chemo okay. Having to watch him go through so many horrible procedures, tests and therapies is torture. Waiting for his PET scan, where we find out if his cancer is responding to the chemo, is hell.

But I am still doing my rotations (on his insistence... he always makes me do the right thing). I am studying for Step 2, which I take in two weeks--just days before his PET scan. I'm still going to clinic, and doing laundry, and eating and sleeping, because I guess that stuff does matter, somehow.

Just not as much as it used to.

Life throws Dr. VonB a big ol' curve ball to the face

2008-09-14T18:42:00.000-07:00

You know, I casually throw around words like "survive" around a lot on this blog. It seems kind of silly now.

Unfortunately I can't tell you a lot about this curve ball except that it is basically one of my worst nightmares come true, and I probably won't be writing much for a while.

In the future I may, however, be in a position to talk more about real survival, and being on the other side of medical care.

Until then... keep believing in wondrous advancements in medicine. For those of you in med school/grad school/mudphud adventures, keep believing in what you do. It matters, and it changes people's lives.

Thanks for reading, everyone, and please send Mrs. Dr. and Mr. Dr. VonB all the positive vibes you can spare. I'm off to face my nightmare.

It's graduate school that sucks; not research

2008-08-24T13:24:00.000-07:00

Yes, I honestly believe that. Research does not suck like graduate school does. Here's why:

1. Hordes of minions. This is something I've been looking forward to since before I came back to school. I worked for a biotech company for a while, and I went from being a minion to having my own minions. I can't begin to tell you how awesome it is to do research when you have your own minions. All that drudgery, all those banal things you hate can be tasked to other, often more capable, people. You can focus on the best things about research: thinking about data. Coming up with theories. Designing experiments to test those theories. Communicating your ideas to others. Personally, I also really enjoy writing grants and papers, as that really boils down to doing all of the above. In any case, this one is easy: in grad school you are a minion; in research, you get to command minions.

2. Having some small measure of power over your own destiny. I've always felt that, in graduate school, you have all of the responsibility, but none of the power. You are expected to produce, but all you can bring to bear is your own blood, sweat and tears. Others control everything: lab space. Equipment. Supplies. Manpower other than your own. You have to wait for your boss to edit stuff, which can take years. Wait for him or her to submit papers. Ask permission from your committee. Obviously, some of these requirements make lots of sense; after all, you're only learning. However, as a very take-charge person it was a relentlessly frustrating situation for me to be expected to produce, on a schedule, but have so little ability to ensure that could happen. Now, I am not so naive to think that at some point you are magically no longer beholden to anyone; no matter how high you climb you can't just do whatever you want (ahem, recent NIEHS Director badness). But, no one, and I mean no one has a more deranged power-to-responsibility ration than a graduate student. As a full fledged MD/PhD, at least you get a little leverage and a little say in your own little lab-verse.

3. Did I mention minions?

4. You can have a life outside of the lab. In my ideal career, at least, I will also have clinic, and patients. I won't live and die chained to my bench. I will be able to be out, teaching, seeing patients, speaking, hearing talks, going to conferences. Yes, I got to do some of this in graduate school, but I think that when you are a PI this whole new world of freedom opens up for you--I can't wait.

5. Minions.

Okay, I'm sure there are more, but for now I must return to the luxurious weekend. I have but a few precious hours to do whatever I want (I've been reading fun books like a madwoman--it feels like forever since I've read fiction) and I'm going to dive right in, baby. Also, I am already working hard to secure my horde, and I have a pile of applications to go through.

Whatcha, whatcha, whatcha want?

2008-08-13T04:29:00.001-07:00

You've survived almost EIGHT YEARS of intensive schooling and, dare I add, intermittent torture. You are possibly mildly in debt, or at least way behind saving for retirement. Most of your friends make more money than you, and ALL of them have more spare time. BUT, up ahead, you see a light... blazing more brightly with each passing day: graduation.

What's next? Disneyland? Rampage of revenge? Huddling in a ball and crying for days as though you just survived a plane crash? Perhaps. But the biggest question for most mudphuds is:

What the heck am I gonna do with the five years of employment I have before I retire?

It's very fun to see where your friends end up. Some you expect, some come out of left field. It's even more interesting to hear why they choose what they choose.

For me, it's peds because they are a lot of acutely ill patients that you can actually make almost or completely better. And it's derm because, well, dermatology is the awesomest thing ever.

A lot of people think of derm as lots of acne. I think that in some private practice settings that's true. But what I want to do--academic derm--is very different. There is a huge variety in patients and conditions, lots of research, surgery... it's heaven. I love that people come from hours and hours away to see you, and that often you are able to help them when numerous previous doctors have not been able to. I love seeing them come back better, and happy. Also, don't discount how horrible some of these conditions can be. I have seen many patients that are physically debilitated, and that isn't including the ones who don't date because of embarrassment.

Anyway, enough about my choice. The thing is to figure out yours. From what I've seen you need to answer an important question:

Do you want to do research? It seems a lot of mudphuds end up burned out on research. It's very sad. I can't blame them, but I wish we could figure out why this happens. I mean, yes, graduate school is often hellacious. But a lot of what makes it so is intrinsic to graduate school and not research in general. In any case, be honest with yourself, and decide if it's for you. I think it's important to choose this before you settle on a specialty, because some are much more amenable to research than others. It's good to find an example--someone who is in your field of interest who is doing what you would like to do, and--this is important--doing it well.

For me, I was trying to decide between peds rheum and derm, and what it came down to was research. Peds rheum is a very under served specialty, and the clinical aspects would always be so demanding that doing research would be very difficult. And here's the thing: research is hard enough without adding extra crap.

Anyway, those are my nonsensical ramblings. Now that I've chosen my field my full-time job is arranging meetings to try to be admitted to said field, and it's time to get back to that. Please share your thoughts on field selection below, and with luck your 4th year schedule will allow you, as mine has, to mull these things over at some length. And also to have days where you don't have to change out of your pj's.

Entry for Most Disturbing, Strange, Offensive, and Yet Amusing Patient Quote Ever Contest

2008-08-04T09:02:00.001-07:00

(it's a very specific contest)

From a pretty old, gnarled southern dude, said to me for reasons that, even on very careful and repeated reflection, are still not clear:

"There's two things a man lies about. The gas mileage of his truck, and how many women he's bent over."

Huh.

Any other entires out there?

Dumbass Medical Student Move

2008-07-30T17:25:00.000-07:00

Okay, so I'm in this low-end procedures room, helping to do an excisional biopsy. I'm the non-scrubbed in person, grabbing non-sterile things, moving the table up and down, etc. etc. Then I offer to adjust the procedure light, the one on the arm. Now, the OR lights I am used to having a handle in the middle--which hardly ever actually positions the light the way you want--and very nice handles on the sides. So, first I try the handle in the middle. Then, making the ridiculous assumption without actually looking that this piece of crap light has the same side handles, I grab the side where the other handles usually are, firmly, to swing it around.
All I can say is I am damn lucky that I was wearing gloves, because even then I manged to burn the living @(*$%& out of my thumb, which I planted directly on one of the exposed bulbs. Then, being that there was a (conscious) patient and three residents trying to close up a giant wound about six inches from me , I had to pretend I hadn't just done that and it didn't hurt like a sonofabitch and I wasn't really, really embarrassed. I don't know how I managed to casually finish adjusting the light, pull off my gloves, and examine the giant blister on my thumb.
I quietly excused myself, taking my glove with me, to curse under my breath and find an ice machine and create a makeshift ice pack.

Which brings me to my next point: latex-free gloves are not very waterproof, and the only thing more embarrassing than burning your thumb on the overhead light during a procedure is dripping water from your makeshift ice pack onto the patient and the electrocautery plate during the procedure.

And I thought being a 4th year meant most of my bonehead moments were behind me...

Final side note: my favorite personal 3rd year bonehead moment was when, on my first day in the OR (actually, my first day of 3rd year!), the scrub nurse asked what size glove I wear (you have to know what size surgery glove you wear so they can pull the sterile gloves out for you). I said, I don't know, it's my first day. She said, hey, why don't you go next door to the other OR and ask Cindy to give you the glove sizer? I--and the other medical student--said, oh, okay! Sure! And like the pair of gullible brand new 3rd years that we were, went next door and asked for the glove sizer.

Well. The entire OR just looked at us like we rode in on goats. Then the circulating nurse kind of smiled and said, oh, yeah, the glove sizer. No, I think that's back in the other OR.

I'd like to say that we knew before the moment that we walked back into our OR and the ENTIRE OR--scrub nurse, circulating nurse, intern, resident, attending... hell, I think the anesthesiologists--were laughing heartily, that we had been had. But we didn't.

And they say doctors don't have a sense of humor. No one, of course, says that medical students aren't boneheads most of the time.

'Cause we are.

Okay, I am, anyway.

Whole New Scene

2008-07-21T15:14:00.000-07:00

Well, today was my first day of 4th year medical school. It was great, and also scary. It was great to say out loud, "I'm a 4th year." It was scary to have people assume that somehow that means I know what I'm doing.

It's also great and scary because I'm no longer at my home base. I am doing a rotation at a somewhat nearby (also, major rival) school. In a field, which I love and want to enter, which I have not done, ever. With my limited, one-day experience, I have to say it has been pretty great. It's always scary for me to try completely new things, but I'm trying to focus on the positive, exciting parts of trying completely new things. Like, for example, it's nice to have new things to suck at, when all the other things I suck at start to get old.

No, but really, everyone was very nice today, and I think I am going to have a good month, which is followed by a super awesome two more weeks off. So, overall, I'm very pleased. Except...

Well, here's the thing I can't stop thinking about.

Vacation was awesome. You know what I really liked about it? The part where I don't have to do anything. It is actually making me feel kind of conflicted. Like, shouldn't I have been more excited to get back to things? Shouldn't I have at least been less depressed to be done with my vacation?

Here's the thing. I think that whole "Do for a living what you would do for free" thing is real nice in theory, but it hardly ever works out like that. I think that finding that job is like winning the lottery. I think that you are pretty damn lucky if you don't hate your job, and even luckier if you sort of like it.

I don't know... how many people do you know who would keep their job if they won the lottery? I'd like to say that I would, but I don't know that I would. I am trying to chalk some of this up to the fact that we are still not really moved in yet. The place is a mess, which I hate, but I hit a wall, and with the hubby on night float I'm not sure how much more I can do. I'm telling myself that if we can just make it through this damn night float that things will be better. And that's a whole separate post... how many times I've said that over the past 7 years of training. "If I can just make it through (insert whatever phase I'm in at the point), things will be better". But there's always something new.

But those are thoughts for another day. Today it is time to start some reading, and here's another reason to cheer: I'm reading to try and look like less of an idiot, but NOT FOR A SHELF EXAM. If that's not a reason to embrace novelty, I don't know what is.

My ERAS, my tormentor

2008-07-09T05:56:00.000-07:00

Dude. Just when you think that the Parade of Menial, Banal Tasks that No One Should Ever Have to Do that is medical school is tapering off, they drop the bomb.

ERAS, which stands for... um, hang on, I have to look this one up... Electronic Residency Application Service... wow. That basically explains it. Nice job with the naming, residency people! Anyway, it's nice that it's electronic and all, except that the interface is slowly driving me insane.

They have boxes for everything--and I mean EVERYTHING. Now, normally I am a big fan of having boxes to fill in. That's just the kind of person I am. I color inside the lines, and I like to fill in forms. (Caveat: they have to be well-designed forms. I hate when I have to write outside of existing boxes on a form.) I know--I sound like a load of fun at parties, huh?

Anyway, I have spent hours thus far copying my CV into this ridiculous form. It's totally out of control. It is rigid, very detailed, and wants to know everything about everything I've done since I graduated from high school, which for me is 15 years ago*. Actually, I'm not totally sure they don't want to know about stuff I did in high school.

Look, ERAS, I don't remember what month that abstract I was on in 1997 came out, and PubMed doesn't either. But ERAS doesn't care, and won't save it unless I lie. I am being forced to lie by a stupid web-based application.

In any case I am TOTALLY sick of myself right now. I'm sick of my publications, my research experience, my teaching experience, and basically every other experience I've had. I'm sick of estimating how many hours a week I spend doing ANYTHING.

I will end this with a piece of advice. This is for everyone, but especially for mudphuds:
ALWAYS KEEP A CONTINUALLY UPDATED CV.

My husband did not do this, and his ERAS experience was exponentially more painful than mine, meaning that it almost killed him.

So, go forth and update your CV. Put EVERYTHING on there. You'll thank me later.

*I know. I'm old. Tell me something I don't know.

Hey, wait, didn't I use to have a husband around here somewhere?

2008-07-04T20:48:00.000-07:00

So. We moved. Right now it feels like we relocated to the inner circle of hell, but I'm pretty sure that's just because I hate moving and unpacking and repacking and recycling zillions of those tiny little foam peanuts which get everywhere and under furniture and stuck in your dogs' fur and fly around when you try to sweep them up and eventually require you to set fire to your new home just to get rid of them.

There are a lot of things I still can't find, including my husband. I'm pretty sure I wrapped him very carefully in bubble wrap and put him in Styrofoam molds and labeled the box "HUSBAND--LIVING ROOM", but I thought that about the accent lamp that goes in the guest room, and that's nowhere to be found, either.

Okay, I didn't lose him in the move. He started internship this week, and his first month is night float. That means that he gets home around 9am, at which time he eats and stumbles to bed to pass out, sometimes still wearing his scrubs, then a few hours later he's up and out the door. It's so weird. Most of my time with him these days is on the phone during his commute. Turns out that Bluetooth headset was the perfect graduation gift for him.

In any case, I'm thankful to have so much stuff to keep me occupied while he's always away. I have about 2K years of unpacking and settling in to do. I have a few more rooms to paint. And, just so I don't forget that I'm still in medical school, I have a bunch of residency application stuff to do, a personal statement to write, my packet of random stupid crap to turn in for my last rotation, and some studying to prepare for my next rotation. How am I supposed to fit all of that around my Arrested Development marathon?

Well, it's time for me to turn in--I have a big day tomorrow, getting my VERY PROFESSIONAL (=black suit, white shirt, understated makeup) picture taken for my residency applications, and before I go to bed I have to practice my "I'm a serious, professional doctor but still fun to work with" expressions in the mirror. But first, time to page my hubby a kiss goodnight.

Medicine vs Peds

2008-07-01T04:35:00.000-07:00

The main reason people will give you for choosing medicine over peds is, "I can't stand dealing with the obnoxious parents."

Here's the thing I don't get: when you go into medicine, the parents are your obnoxious patients.

Medicine was, in fact, more fun than I thought it would be. However, I discovered a not-so-pleasing fact about myself, which is that I don't enjoy taking care of people as much when what I am doing is trying to re-arrange the deck chairs on the Titanic. AND, the reason the Titanic is sinking is that the captain repeatedly and intentionally rammed it into every iceberg in sight, despite being told each time that if he did that again he was gonna sink the sucker.

It felt like 90% of our patients were in the hospital secondary to one of three reasons (and often a combination of all three):
1. Years of drug abuse (tobacco, alcohol, heroin, crack--I also include the HIV or hepatitis they contracted because they were using dirty needles).
2. Years of eating everything within reach (and never getting off the couch).
3. Years of either not going to the doctor or flatly ignoring everything doctors have told them.

Actually, now that I think about it, I think that you could combine 1 and 2 given that for many people food seems to be an addiction akin to any other drug.

In any case, I find it hard to enjoy taking care of these patients. It isn't that I don't feel empathy and pity for them. I do. I took care of a lot of people right at the moment that it occurs to them that they have thrown away their entire lives. That is not a happy moment. I suppose it's good that I can be there for them, but what am I supposed to say? You're right, you have thrown away your life, and now you're dying, and there's nothing we can really do about it. But buck up! It's sunny outside!

The thing is, I'm sure that they have horrible, sad life stories. I've heard a lot of them. My problem isn't that I can't find any compassion in myself. My problem is that I have what my dad calls "a strong bias towards action". I don't like to deal with problems that have no solution. I'm not proud of that, but I can't pretend that it isn't true. When I find a problem, my natural instinct--no, my need--is to solve it.

And, for most of these people, that can't be done. The best you can hope for is maybe postponing their eminent death for a short while, or making it more comfortable. Which, actually, I feel is a very honorable mission. It's just not my mission.

To survive in medicine, you have to have a mission. You have to have something that makes you excited and fulfilled. Because Lord knows you don't get money, or leisure time. You don't often get kudos either. When you do, it definitely feels great--but if you rely on those, that's a one-way ticket to Burnout Town.

Anyway, I like Peds because the proportions are reversed. 90% of the patients did nothing do themselves to get sick or hurt. 90% of them will get better and lead normal lives. They have problems which you can diagnose, treat, and solve. Yes, parents can be annoying. But as I said, I'd rather have them as parents than as my patients.

And the Angels Sang...

2008-06-30T05:58:00.000-07:00

As I FINISHED 3RD YEAR OF MEDICAL SCHOOL.

I cannot wrap my mind properly around that concept. I am just starting a nice, long vacation, but I had to go out of town immediately after taking my shelf test, so it isn't really real that I don't have to go back to work as soon as I get home. And beyond that, it isn't real that I don't have any more shelf exams, and that the pressure is generally much lower in almost every way.

But not to fear. I will still have plenty of things to complain about, because what I DO have starting me in the face is:
1. My university's clinical skills exam (standardized patients)
2. Step 2 CK (step 2 of the boards, the written part)
3. Step 2 CS (step 2 of the boards, the standardized patient part)
4. And most terrifyingly... RESIDENCY APPLICATIONS, INTERVIEWS and MATCHING!!

In any case, I will try to gather my thoughts about 3rd year as I max it and relax it. Too bad I have about three months worth of real life work which has accumulated over my past few rotations. Until then, may you know the joy of a well-earned vacation and the satisfaction of using it to catch up on Little House on the Prairie episodes. Oh, Pa...

Longest rotation ever.

2008-06-21T05:34:00.000-07:00

I have one more week--actually, less than a week--of 3rd year. And it couldn't come too soon.

I am SO TIRED. The hours on this rotation have been nuttypants. Let's put aside that I am taking q2 call.

No, let's NOT put that aside. q2 call is cruel and unusual punishment for a 3rd year student just trying to pass the medicine shelf test.

In any case, I am working ALL the hours, and trying to study on top of it.

But that's okay... I'm counting down... one... more... week...

BOOM.

2008-06-04T17:47:00.000-07:00

(If you don't get the title, hop on the bus to Philly and rent the awesomest show in quite some time).

Anyway, we got our 4th year schedules. And although I could choose to gripe about how I asked for a month off to study for Step 2 CK (Clinical Knowledge) and they totally ignored me, I will instead choose to focus on how I got all my other requests and importantly WILL BE COMPLETELY DONE WITH 4TH YEAR BY DEC 21.

Flipping. Awesome.

The Ecstasy and The Agony

2008-05-30T12:45:00.000-07:00

THE ECSTASY
Today I finished my general medicine rotation and took our school's mid-medicine written exam, my second-to-last exam of 3rd year. It wasn't too bad--statistics, concepts, EKGs and CXRs. I'm pretty sure I got everything right but I'm usually surprised by just how dumb I can be on exams. The most important thing about this is that I now have only have ONE test left in all of 3rd year, and it's a biggie... the Medicine Shelf Test. Which transitions us nicely to:

THE AGONY
Of course, there's the looming Medicine Shelf. There is also another month of medicine (I do have high hopes that it will be good). However, NOTHING compares to this horrible, crippling pain in my lower back. I am seriously walking like a 100-year-old. It is SO pathetic. Plus I'm in pain basically 100% of the time. This has been going on for three or four days now and it is flipping killing me. Yesterday I tried to stand up from a chair, had a giant spasm and almost FELL DOWN in front of my whole team. I was going to try to get a lot done this weekend since I have it off, but now I'm considering drugging the bajesus out of myself and finally getting some relief/sleep (which I have not had since this started). Also--walk rounds=usually painful; walk rounds when your back is one giant spasm=unbearable. It's like every second takes an hour, and you WANT to be concentrating on learning whatever the attending is talking about, but instead all you can focus on is trying not to throw up or a fantasy about finding a dark room to lay down in and cry or how much you wish someone would take pity on you and just kill you already.
Is it just me? OldMDGirl, you too claim to be old--do you ever have this problem?

In any case I am taking my broken self and money I don't have down to get a professional to address this problem right now. Those of you reading in other states--let me know when my screams of pain reach your time zone.

Until then, cherish your youth. For you too will someday become whiny, old and pathetic.

Hell hath no torture

2008-05-25T07:16:00.001-07:00

like 8 full patient write-ups which have to include ridiculous level of detail including a full neuro and rectal exam in every patient and a minimum 1 pg long discussion with references.

In fact, I'm pretty sure there's a special level of hell reserved for people who smack their food and drive in the far left lane going the same speed as the car next to them where all you do, day in and day out, is patient write-ups.

I've done six, but it feels like a bazillion.

Side note: Maybe it's just me, but doing a rectal exam in every patient kind of feels like assault.

so... close...

2008-05-24T05:34:00.000-07:00

Well, I only have 4.5 weeks left of 3rd year medical school. And it's totally blowing my mind.

Medicine is the rollercoaster of 3rd year squared. You have days where you panic because you are convinced that when you become an intern--something that is terrifyingly close to happening--you are certain to kill patient after patient. Then you have days where you just seem to know what is going on, where the attending likes every patient plan you have, where they basically just sign your orders as they are and you think hey, you might be able to do this after all.

So, on the one hand I am SO excited to be almost done with 3rd year. I have a written exam on Friday about EKGs, x-rays and--*shudder*--statistics. Then, in a little less than 5 weeks, the medicine shelf test. My very... last... shelf test. Holy moley.

Medicine is a lot more fun than I thought... and it is also a lot harder. Which is saying something, because I expected it to be hard. I guess I expected it to be hard like an 80's move montage where the main character does lots of hard work set to peppy music over the course of about 30 seconds. Whereas instead it mostly involves rounding for 5 hours a day, doing a bunch of scut for another 5 hours, rounding some more, and coming home to read and study for another 2 hours or so. Maybe if we had a guy follow us around with a boombox on rounds, playing some peppy 80's music, that would be better.

Hm... maybe I'll bring that up at the next team meeting. I'm thinking "Working for the Weekend", or maybe "Danger Zone". Ohh...what's that song from the Karate Kid? You know, "You're the BEST! Around! Nothin's ever gonna keep you down!"

Yes. That should make rounds go faster.

Things don't just appear in your colon.

2008-05-20T12:28:00.000-07:00

They can only get there two ways: from the top, or from the bottom.

You can tell me you have no idea how they got there.

But I'll know you're lying.

Okay, Jerkheads

2008-05-14T17:59:00.000-07:00

Listen very carefully.

Are you listening?

Good.

STOP. F'ING. SMOKING. YOU. IDIOTS.

I am tired of helping doctors try to save your stupid ass from 80 pack years of retardation. I am tired of pretending that I'm not silently passing judgment on your decision to use your money to buy cigarettes instead of your medications. I get that you can't undo the past, but when you TURN OFF YOUR FRICKING OXYGEN TO SMOKE YOUR TWO PACKS A DAY I WANT TO STRANGLE YOU.

That is all.

O Medicine, why dost thou bludgeon me?

2008-05-09T14:17:00.000-07:00

Okay. I have done a lot of flipping out on this blog. But nothing--nothing--has prepared me for the amount of flipping out that is about to commence.

I was so damn cocky. I have studied and worked very, very hard over the course of this year, partially because I want to get into a very competitive speciality, partially because of THE FEAR (that old friend to all mudphuds returning to the clinic after a prolonged absence), partially because, and call me crazy, but I want to be a good doctor. In any case, I felt that I was really doing well and getting more than the gist of 3rd year. I mean, I'm practically DONE, right? I've done all my rotations except medicine. I felt like I at least mostly knew the basics of what was going on.

Until now.

Right now the main thing I'm feeling is YIKES. Because I. Don't. Know. Crap.

The things I don't know fall into many categories:

1. Things I Thought I Knew But Clearly Don't Know: Antibiotic coverage, diabetes.
2. Things I Thought I At Least Sort of Knew But Know Nothing About: EKGs, VERY basic labs and their meaning.
3. Things I Knew I Didn't Know And Thought I Had More Time to Learn Before Looking Like an Idiot: Basically everything else.

Add to this that the entire week has been crammed full of graduation events for my husband. I'm very proud of him, but couldn't he have picked a more convenient time to graduate?!?! In any case, that's all for now. I'm sure you recognize the pattern by now, of me starting something new->freaking out->posting about said freakout->going into crazy study mode->chilling out slightly->getting close to the shelf test->freaking out again and more robustly->taking shelf->posting about how tolerable or terrifying the shelf test was->moving on to the next freakout. So, I will go now to partake in crazy study mode. I'll see you when I'm approaching chilling out slightly!!!

Five down, one to go

2008-05-02T12:04:00.000-07:00

So awesome holy wow! I just finished my psych shelf. HUZZAH! It was not that bad. I mean, I don't know that I tore it up or anything, but I am 99% sure I passed (knock on wood).

The craziest thing ever is that I only have one shelf test left. I can't really wrap my mind around it. I mean, two months left of 3rd year!! Wow. I only have seven months total of coursework left in medical school. That means that I will be unleashed on an unwitting patient population in a frighteningly short period of time. Hmmm... that feeling of anxiety which went away when I finished the test is beginning to come back...

In any case, psych was a great rotation. The hours are great. The people were nice. The subject was interesting. But I think that the best thing about the rotation was how included they made us feel. I had a role, which was actually meaningful and useful. After lots of rotations where you are basically a shadow of a shadow, it is such a nice change of pace to feel like people want you to be there, and that you help them out.

Anyway, I have a bazillion things to do... more on that a little later... but for now, just a deep breath, and reminding myself... five down, one to go.

WOOHOO!!!

2008-04-27T17:43:00.001-07:00

I did not fail the neurology shelf exam!! HURRAH!!

It was my lowest raw shelf score ever, but I still beat the mean by a decent margin. I'm not sure how I pulled that one off, but DAMN.

Psych ward continues to be amusing/scary/sad. At least the hours on psych are nice and cushy, although I do have call this week. In any case, the shelf is on Friday and other than continuing to get all of the stupid drugs mixed up in my head (the names, actions, and side effects of the drugs, not the actual drugs, unfortunately) I am feeling pretty okay about it. Also, this is my second to last shelf test EVER!! Wow.

WOW!

Okay, back to studying. There's nothing like studying crazy people on a Sunday night...

The interesting thing about delusions...

2008-04-16T18:12:00.000-07:00

No matter how crazy they are, most patients just sort of assume that you believe them.

I was worried about how I would respond if someone busted out with something really nuts and one of those "You gotta believe me, doc!" sort of rants you see in the movies. But really, it's been more like "It's that cat. The one that can smell you and hunt you down and suck out your soul. It's comin' for me."

It is WEIRD.

It is also kind of disturbing how profoundly your mind can betray you. One dude can't even draw a clock anymore; he was totally fine three days ago. It's amazing what a little acute renal failure and oxycodone can do to your brain.

Okay, I have to get back to memorizing the psych dictionary. That's mostly what you are tested on for the psych shelf; it's the DSM criteria, which are basically just long, complicated definitions. You know, stuff like the patient has X if they have 2 from column A and 3 from column B. Which makes for a lot of memorization, since column A and column B are usually not too short and fairly complex. There are also a lot of sister diagnoses, meaning that A is just like B except with (or without) symptom whatever. It is interesting, at least.

So far I only have one diagnosis: generalized anxiety disorder. I keep reminding myself that I am just a little too high functioning to truly have a disorder, but I definitely have most of the symptoms:
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). CHECK!
B. The person finds it difficult to control the worry. CHECK!
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
-restlessness or feeling keyed up or on edge CHECK!
-being easily fatigued CHECK!
-difficulty concentrating or mind going blank MEGACHECK!!
-irritability Ask my husband!
-muscle tension OH LORD YES!
-sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Okay, not this one... KIDDING! ABSOLUTELY!
D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in a Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder. Okay, I may be a little afraid of being embarrassed on rounds, does that count?
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder. Not as far as I know...
F. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. THIS is the one that saves me. I don't think I can say that this one is true.

So there you are. I'm one step away from a psychiatric diagnosis. How come I can't get my hands on any of the good meds?!?

Bi-Polar Bear

2008-04-11T16:27:00.000-07:00

("This looks like a job for Bi-Polar Bear!!! But I just can't get out of bed this month..." For those of you who are not familiar with The Tick, I suggest you clickity click and find out what you are missing).

Anyway, friends and neighbors, I have come to realize that some of you are angels straight from heaven, and some of you hate me and wish I would just go ahead and knock myself off so you wouldn't have to deal with me anymore. Of course I haven't had thoughts of killing myself, but if someone doesn't stop this pain, what choice do I have? Would you want to live with pain like this? No, that would be it. You can't put me on the Crisis unit for saying that, can you? I'm not saying I am going to kill myself. It's just that if I wanted to, you couldn't stop me. Why should I stick around here? Even my father wouldn't care; he 's always said I'm a loser. Now how am I supposed to feel about that? You know, if I could just get a little something to take the edge off... no, not that, only lorazepam really works... no, 2mg isn't enough, I'll need more like 10 or 15mg to really help... seriously, they haven't been giving me my home medicines and now I haven't slept for four days! Just don't give up on me. You understand me. That other doc who was in here, I don't know what his problem was, but it was like he wouldn't listen. Or he thought I was crazy, or something--just made me feel terrible. But not you, I'm so blessed to have you, you are the one who is really going to be able to help me. You are so wonderful, God sent you, and... what? What do you mean you won't give me 15mg of lorazepam? You're just like all of those other doctors, aren't you? Where is that other doctor, the nice one, the one who actually listened? Send him back in here, and don't bother coming back, okay?

OK! Now, those of you who have not had psych or the delightful experience of interacting with numerous patients probably feel confused and blindsided. Everyone else got to the second or third line and a neon sign in their head lit up, and that sign flashed BORDERLINE! BORDERLINE! BORDERLINE!

Believe me, it is just as fun as it sounds to interact with Borderline patients. By which I mean, it is no fun at all. It is one of the most frustrating things that exists in medicine, although what makes it so hard sometimes varies from person to person. For me, it's hard because most of these patients have had lots of bad things happen to them--some just because, some self-inflicted in some respect--and they are in a lot of pain but have no idea how to get themselves out of it. Also, Borderline patients tend to be master manipulators, they push your buttons, good or bad, they make it REALLY hard to take care of them, either because they are not telling the truth, alienating the team, disobeying orders, etc etc.

Also, a tip for those of you just starting into the clinical world: At least half of the patients who tell you they are "bipolar" actually have Borderline Personality Disorder. Probably more like 80%. Unless you are on psych, and then you probably will be lucky enough to see truly bipolar patients in a manic phase ("No weapon forged will prevail against me!!"--not a Tick quote, an actual patient quote). You'll secretly wish you could feel like them for just a little while.

Quick side note: I've learned that just because someone thinks that a white van full of Navy SEALS is following them around and then jumping out of the van to chase them with bicycles doesn't mean they have paranoid schizophrenia. Apparently it can also mean that they have been taking 16-30 pills of dextromethorphan at a time for the past five years or so (along with several other street drugs, of course).

Anyway, I'm off to learn about more psych, so I can find a few more frightening diagnoses which almost apply to me. Also, I think I see a white van outside.

Holy Mother of God

2008-04-04T08:50:00.000-07:00

Today, for the first time, I left a shelf exam thinking, "Wow, it is entirely possible that I failed that exam."

The neuro shelf exam was horrible. HORRIBLE. Maybe it is partially due to how little I enjoy the subject, but it was brutal.

It's going to be a tense few weeks waiting to hear about THAT sucker.

And now to totally cleanse the palate of the mind and prepare myself for a weekend of working to catch up on life requirements and starting a whole new rotation! Hurrah!

But first, excuse me while I curl up into a ball in the corner, rocking and mumbling to myself.... there's no place like home... there's no place like home...

Hoping for that magic spark of panic

2008-04-03T05:37:00.001-07:00

Otherwise, how will I ever find the motivation to study more neurology today?

I already blew hours of time yesterday which I could have used to study, but no. What has happened to me? I used to whine and complain but I would eventually study, and study big time. Now it seems the thrill is gone.

Maybe it's burnout. Maybe it's just neurology. Or maybe its... shudder... neuroanatomy.

In any case it will be all over tomorrow, when I take my third-to-last shelf exam, leaving only psych and medicine to conquer before I reach the promised land of 4th year.

So, what did I think of neurology? Well, the people (residents/attendings) were almost unanimously extremely nice. Okay, but how did I like neurology?

They were very, very nice.

You know, like the classic example from When Harry Met Sally, when Harry points out that saying a woman has a good personality only means she's unattractive if "she has a good personality" is the answer to the question, "What does she look like?"

Neurology is interesting in theory, but it goes against one of my core traits, something my dad calls "a strong bias towards action". I want to DO stuff to patients that makes them better. In neurology, it just seems like you do stuff to patients just to better define all of the stuff you can't really fix. Plus, there is something deeply and spiritually disturbing about seeing patients who are now different people because of a 1cm-wide change in their brain.

Plus--and please believe me of understatement when I say this--neurology easily ties rheumatology for the coveted Specialty With the Most Crazy Patients award.

And no, I'm not forgetting psychiatry.

In any case, like it or no, it's time for me to do the age-old medical student ritual of cramming what feels like millions of anti-convulsant drugs and their various uses into my brain for the exam so that I can immediately forget them for the tenth time.

Next post: the never-ending cycle of Relearning and Reforgetting: the Cornerstone of Medical Education.

Graham Crackers of Despair

2008-03-17T15:32:00.000-07:00

Those of you who have been on inpatient services know exactly what I'm talking about.

You see, on inpatient services, there are many, many times where for whatever reason you will go for hours on end with no access to food. Be it call, or rounds which last all day (I wish I were kidding), or some procedure which lasts an hour longer than it should forcing you to run down the hall to the next disaster, there always seems to be something. And in these times your only hope for avoiding a hypglycemic coma is ducking into the supply rooms and grabbing the snacks they have set aside for patients.

I'm not saying this is a proud moment, but desperate times call for... well, frankly, they call for stealing food from sick people.

Anyway, when pilfering from the supply closet, your choices are scant, by which I mean your choice is to eat one of the graham crackers in the packet or to eat both of the graham crackers in the packet.

Now, I have nothing against the graham cracker in principle. They are handy little snacks. They are sweet, yet you can convince yourself that they are marginally good for you because they seem to have pieces of grain or some kind of grass in them. They go great with peanut butter and chamomile tea.

However, there are only so many times you can stuff graham crackers into your mouth while running down the hall wondering if you managed to get all of the influenza off of your hands from the patient you just examined while trying to prevent the gag reflex which may be due to the smell memory of the wound you just debrided or may be because you haven't slept in 30 hours, lamenting the fact that some protein might make your hands stop shaking but for now all you can eat is another... damn... graham cracker... before you totally lose it.

But Despair, you ask? Isn't "despair" a little dramatic? I mean, you're getting to eat, aren't you?

Well, the next time you see someone in a white coat walking down the hospital hall eating a graham cracker, take a look at their face. You will see Despair. Because, for most of us in white coats, the graham cracker has come to symbolize all that is crappy and unrelenting about our chosen profession.

Plus, they aren't even the kind with cinnamon-sugar on top.

Random Observations from the Clinics

2008-03-07T18:56:00.001-08:00

1. The cervix can be significantly more difficult to find than you might think. It can be very wily, that cervix.

2. Also, it usually smells weird.

3. Speaking of smelling weird, the hands-down worst smell there is in medicine is the smell of an anerobic infection. It isn't exactly bad in the classic sense, it's just that it awakens something very primal in your brain which tells you to run away, or maybe yak.

4. Crazy people can be very funny, but they can also be scary. However, most of the time, they're just confusing.

5. If you're reading a magazine, you are NOT in 10 out of 10 pain.

6. Okay, in fact, if you are doing anything other than writhing and crying, you are not in 10 out of 10 pain. So it doesn't impress me that you say you are. It makes me not believe you.

7. The more medications someone tells you they are allergic to, the more likely it is that they have a personality disorder. If one of the medications they are "allergic" to is a mood stabilizer or antipsychotic, the likelihood increases 100 fold.

8. Related Public Service Announcement: "Messes up my bowels" is NOT an allergy. Antibiotics do that to everyone. Likewise, just because a certain narcotic makes you "sick on my stomach" or "real weird" does not mean you are allergic to it. It means you are responding fairly normally to the medication. It does NOT mean you need darvocet.

9. Also, if someone says the following phrase: "(Fill in name of powerful narcotic) doesn't even touch my pain", then you can be 95% sure they are drug-seeking. It is phenomenal, and phenomenally depressing, how accurate this observation is.

10. "I got the sugar and my blood is high" is southern for "I have type 2 diabetes and high blood pressure".

Grad vs Med: The Smackdown--UPDATE

2008-02-24T14:12:00.000-08:00

First, a confession: I totally love tracking my blog visit stats. It is geeky and sad (yet not nearly the geekiest or saddest thing I have done in the past week) but there it is. My favorite is seeing what kind of Google searches bring readers to my blog.

One that keeps popping up is a phrase along the lines of "Which is harder, graduate school or medical school?". I find this very interesting. I mean, first of all, who are the people searching for this phrase? Are they trying to decide between going to medical school or going to graduate school? (By the way, if you happen to be one of these individuals, my feeling is PLEASE FOR THE LOVE OF GOD SAVE YOURSELF and GO TO MEDICAL SCHOOL.) Or are they MD/PhD students trying to see what the future holds? Maybe they're in some kind of smackdown themselves, where they are either med or grad students and the other type of student is trying to tell them that they have it easy.

Anyway, I re-read my original post, and it got me to thinking. I had said that grad school was more difficult by a hair. But now, with many of my psychological scars from grad school healing, and fresh ones from 3rd year springing up on an almost daily basis, I dunno. I guess I see them as more evenly matched now.

This tells me one thing: whichever you're doing is going to get extra points in the "ouch" column, because you're doing it right then. I think that the original analogies I wrote about there still hold pretty well, except I see now that, at least in 3rd year, there is less of a roadmap to success than in 1st or 2nd year med school. They tell you the things you can do to do well, but sometimes there are extra secret things you can do that no one tells you about. And sometimes, the things you can do to be great for one attending or team will really annoy the crap out of the next attending or team that you work with. True anecdotal example: One day, I got chastised for just starting to scrub in to a surgery without asking first. Two days later I got yelled at for asking if I should scrub in. I mean, at least in grad school they just don't tell you anything, which I guess is somewhat more helpful than telling you the wrong thing. Although I will note that it's really sad that those seem to be the two choices.

Also, 3rd year has really worn me down. It took longer for graduate school to wear me down; I think in the hitting a wall department it took 3rd year 8 months to accomplish what it took grad school 2.5 years to do. Now, I'm not sure if that would be the case if I hadn't been in school for six years before starting this one (and eight years older than many classmates); maybe those fresh-faced classmates of mine don't feel the same, never having tasted the triumph of making a plump salary in the real world for a few years (before becoming really, really poor), or the defeat of, well, most of graduate school.

So, I have to say that the Smackdown is now officially a tie in my book. In the interest of full disclosure I have to say that that opinion is in the minority among my MD/PhD friends, most of whom fully endorse the "Grad school is way worse" stance. I can see their viewpoint, and must also confess that there are some personal reasons why this year has been possibly more stressful for me (although everyone has their own cross to bear). I think that next year, when I have vast spans of time completely off, things may be different, but for now, I am still trying to wrap my head around the concept of a real vacation.

Holy cow. I'm on vacation. Wait a minute! I'm on vacation! I'm going to go do something vacation-y, relaxing, or fun, like...

Hm. I can't seem to remember what people do to relax or have fun. Maybe I can look it up on eMedicine. (Okay, I just looked "fun" up on eMedicine, and the first hit is "Substance Abuse". Who says doctors don't know how to party?!?)

Another One Bites the Dust

2008-02-22T16:01:00.000-08:00

Well, I'm all done with my eighth month of 3rd year; my sixth rotation. Holy Awesome Awesomeness!
How was the exam? Flippin' hard. It was a written exam and they really pulled some tough ones on us. Ugh. But now I get a small vacation! Joy!
So. Medicine. It is tough. I am glad I had this outpatient medicine rotation before my inpatient medicine rotation; hopefully it will give me a boost and make me somewhat less spastic and retarded. I don't know. I'm not holding my breath. I did get to see some really interesting patients, and I love coming up with differentials. So in that sense, I actually kind of enjoyed it.
I have neurology next, and just spoke to a friend who told me that the national mean on the neuro shelf test has been around 35%. My feelings on this: !!!!!!!!!!!!!!!!!!!!!!
I may have to spend some of my rotation reviewing neuroanatomy, as I remember only two things about neuroanatomy: Jack and shit. And Jack left town.
NOT looking forward to it.
I guess it will be good to learn this stuff... maybe.
Anyway, I am going to go ahead and close off this basically pointless post. I may try to gather some of my thoughts and get some meaningful posts in over these couple of weeks. Later suckers! I hope you have something good going on, and hang in there!

It's About That Time

2008-02-12T15:49:00.000-08:00

You have probably been asking yourself: "Self, I wonder how long it will be until Dr. VonB decides she has been in 3rd year long enough to begin giving out often obvious advice in her know-it-all way?" Well, the answer is: right about now.

So, first off, a brief run-down of outpatient medicine. As with any rotation, the quality and overall suckitude (or, if you're lucky, the lack thereof) depends entirely on your preceptor. I am at our University's outpatient clinic and it is definitely higher pressure than most of my classmates seem to be experiencing. On the other hand, I think I have learned a ton, which brings me to my first official piece of advice about 3rd year medical school (or maybe I'm deluding myself, and I've already given out a bunch of advice, but as with most things these days I don't remember it):

OFFICIAL PIECE OF 3RD YEAR ADVICE #1: You get out what you put in.

I mean this in a few ways.

SUBADVICE 1A. Read every day. This may sound 1) oblivious and/or 2) like a pain in the ass, but either way, it is key to success in 3rd year. Most rotations have a lot more reading than you expect, and if you put it off it creeps up on you and kicks your everloving butt. I was told to pick your review book, divide the number of pages by the number of days in the rotation minus about 5 days, and read that number of pages every single day. Your residents and, if you are lucky, your attending, will notice, and importantly you will get more out of what you see in the clinic. Also, do not underestimate the shelf exams. Those who underestimate the shelf exams end up curled up in a small ball, crying, in a corner. And no one wants that.

SUBADVICE 1B. Be enthusiastic. Sometimes you may have to pretend, but if you came to medical school for the right reasons, that won't be too often. Most days you get to see at least one really cool thing. And the best thing about being enthusiastic is that most supervisors will give you more cool stuff to do if you follow pieces of subadvice 1A and 1B, which makes both easier to follow.

SUBADVICE 1C. Do a good job. I know how dumb that sounds, and yet I am consistently amazed at how many of my fellow classmates fail to do this every single day. And here's the thing: doing a good job is something within the grasp of just about every even semi-normal person, because all I mean by doing a good job is stuff like: show up when they tell you; if they tell you to look something up, look it up; try not to make the same mistake a bunch of times in a row; etc. It is NOT THAT HARD. Just try. Even a little.

Basically what I am getting at here is the fabled Cycle of Awesomeness. How this works is that the more you read, and try, and are enthusiastic, the more people trust you and teach you and let you do stuff, which makes you read more and try harder and be even more enthusiastic, etc etc, until you feel like you are actually getting close to be a realio, trulio doctor. And it. Is. AWESOME.

Also, before I forget, one thing you MUST have in your white coat pocket: Sabatine's Pocket Medicine. I cannot begin to describe the awesomeness of this book. If you are a student buy it IMMEDIATELY. No real need for it on surgical rotations or possibly stuff like psych, but it is stunningly useful on any vaguely medicine related rotation.

Okay, I need to follow my own SUBADVICE 1A and get to reading. I am about halfway through this rotation, and ahead lies neurology, psychology, and inpatient medicine. Then I will be an honest-to-God 4TH YEAR MEDICAL STUDENT! HURRAH!

In the meantime, keep an eye out for the crazy patient who came back to clinic with a knife today because we wouldn't give him percocet. Good times!

There's a first time for everything

2008-02-02T06:29:00.000-08:00

Old MD Girl tagged me with this meme, and given that I have a ton of homework to do it only seemed natural to fill it out.

In 2008:

1. Will you be looking for a new job?
Job? What's a job? You mean people do things other than study? And they make more than $5/hr? Holy Cow, I gotta look into that...

2. Will you be looking for a new relationship?
I have to admit that I'm getting sick of my relationship with Blueprints. I'm thinking of having a torrid affair with Case Files.

3. New house?
God, I hope so. 1275 square feet is no way to live, especially with a husband who is morally opposed to throwing anything away, ever.

4. What will you do differently in 08?
Well, right now, I can't do much differently, but in the not-to-distant future my life will cease to revolve around evaluations and shelf scores. So, in short, I will become an actual human again, with feelings and interests outside of medicine, assuming there are such things.

5. New Years resolution?
Old MD Girl said: "Talk about things other than work." YES! Me too!! Any ideas on what else there is to talk about? I got nothin'.

6. What will you NOT be doing in 08?
I will not be seeing "Remember the Spartans". I promise. (Side note: remember when parody movies used to be awesome? Like Airplane? I miss those days.)

7. Any trips planned?
I trip all the time, but I rarely plan it. I blame my shoes.

8. Wedding?
An awesome family wedding coming up soon. Another good friend getting married later this year; frighteningly, most everyone else I know is married. When did this happen?!?

9. Major things on your calendar?
Husband graduates (GRADUATES!! From EVERYTHING!!) in May. Starts residency in June.

10. What can't you wait for?
To match into the residency of my choice (knock on wood) and to GRADUATE! Also, it may be time to start having tiny humans of our own...

11. What would you like to see happen differently?
In keeping with number 5 above, I would like to have things to talk about other than work.

12. What about yourself will you be changing?
Again, Old MD Girl and I are on the same page... I have gained some confidence in the last 7 months of clinical rotations, but I'm not quite where I need to be yet. Also I have to start working out before people confuse me with Jabba the Hutt.

13. What happened in 07 that you didn't think would ever happen?
I aced the surgery shelf test (I know! I couldn't believe it either!) and published my second dissertation paper... JOY!

14. Will you be nicer to the people you care about?
Mainly I plan on being nicer to people I don't give a shit about. It throws them off.

15. Will you dress differently this year than you did in 07?
Not unless I don't keep my plan as detailed in number 12 and I have to start buying Jabba the Hutt Wear.

16. Will you start or quit drinking?
A wise man once said: "I don't need to drink to have a good time. I need to drink to stop the voices in my head."

17. Will you better your relationship with your family?
I am basically happy with how things are now. The only thing which could improve would be if I had more time, which I won't, so I guess not.

18. Will you be nice to people you don't know?
No, as per my new policy, I have to figure out if I care about them or not before I can be nice to anyone.

19. Do you expect '08 to be a good year for you?
I am pretty sure it will be awesome.

20. How much did you change from this time last year till now?
A lot. I think I am more confident in most of what I do, even if I still have plenty of insecurity. I also learned an extraordinary amount, AND I'm a "Dr." now.

21. Do you plan on having a child?
I plan on having a child mow my lawn.

22. What are your plans for new year's eve?
We watched Aliens for the 293,393,595,391th time, and it was awesome.

23. Will you have someone to kiss at midnight?
We didn't realize when midnight happened, because Ridley was fighting the Queen Alien in the big robo-loader.

24. One wish for 08?
A big, fat raise. I want to know what it's like to live the life of the fat cats making minimum wage.

I tag Heidolicious and nosugrefneb. Now send me something else before I have to resort to doing my assignments.

Words you don't want to hear while working at a free clinc

2008-01-30T19:23:00.000-08:00

"They said I had the syphilis on my brain."

Big Deal, I'm Very Professional

2008-01-27T15:48:00.000-08:00

As you probably know, a huge portion of your grades in 3rd year medical school are based on evaluations. Everyone evaluates you; the interns, the residents, the fellows, the attendings--I've even had a rotation where a nurse coordinator evaluated me. Sometimes, it's nice to get evaluated, because it gives you an ego boost, plus some constructive things to work on. Sometimes it's crappy to get evaluated, because they give you a mediocre review for no apparent reason with nothing constructive (or even non-constructive) to work on.

For example, a friend of mine, who is brilliant plus a super great and hard-working guy with good social skills, got a very average evaluation from one of his attendings; you know, a "meets expectations" kind of thing. The attending told him, "You've been great, but I expect you to be great." So, my friend asked the attending, "What else could I have done to get an excellent evaluation?" And he said, "Nothing, really. Like I said, I expect you to be great, so you met my expectations." Awesome motivator, no?

The other kind of evaluation you can get is super lame because you are forced to get it from someone who basically works with you for five minutes. This happens often, because as a 3rd year medical student, you typically work almost exclusively with interns and residents, but you are required to get a certain number of evaluations from attendings, so you are forced to feel like a total wonk asking a bigwig to evaluate you when they couldn't say for sure that you don't work for food services.

Alright, I've gotten off topic here. What I wanted to write about were another type of evaluation that we have to do at our school: "Professionalism Evaluations". Believe me, they are as stupid as they sound.

Essentially, they are to try and make sure that you aren't some kind of a deranged weirdo with bad personal hygiene who is liable to get everyone on the team sued. The biggest reason that I think these are stupid is that they clearly don't work, as evidenced by a student I worked with a few rotations ago who was so wildly inappropriate that his "unprofessional behavior" actually crossed the line into felony (sadly, I am not kidding) and yet he is, as far as I know, still a student here.

However, they are terribly amusing to read. Whereas most evaluations are set up so that the boxes for "Best Ever Student Whom I Would Be Proud To Call Son/Daughter" are on the far right, and the boxes for "Should Consider Alternative Life Choice, Like Prison" are on the far left. However, on the Professionalism Evaluations, the good boxes--the only ones you want checked--are in the middle, and to either side there is badness to opposite extremes.

For example, one middle box is something like "Personal Appearance is Professional", and to the far left is "Looks like Pigpen From The Peanuts, with the Dirt Swirls and Everything" and to the far right is "Looks Like a Ho". Another is something like "Displays Appropriate Empathy", with "Spit on No Fewer than Three Patients" to the left and "Often Attempts to Hump Patients" to the right.

This setup has led to some hilarious, although unfortunate, evals where the attending, not having the time to read the ten zillionth eval form thrust at them by a 3rd year, tries to do the nice thing and check all the way down the right hand side--normally the side of honors, now the side of Axis II Personality Disorders.

In any case, it is clear that at some point some big, important committee told my school that professionalism is a Big Deal and they needed a Formal System in Place to Evaluate the Living *#$& out of us. Well, hats off to you, there, University. I could only be happier if you started evaluating how well I endure being evaluated.

Oh, wait... you already do that.

We Only Come Out at Night

2008-01-25T05:25:00.001-08:00

So, I finished my week of night shifts and in five hours I have my OB/Gyn shelf exam. My take on nights: I hate nights. I'm too old for that crap. I'm exhausted, and cranky, and I've had a headache for three days. I realize that some nights are inevitable pretty much no matter what you do these days, but ugh. Most other fields, at least around here, have a night float system where you only have to do a week or so of nights at a time, and for surprisingly few weeks per year. On OB you spend months on nights. Months. And speaking of OB, I have one word for you about "NSVDs" (normal spontaneous vaginal deliveries--OB/Gyns flippin' LOVE their acronyms). Here is that word.
UggggghhhhhhhhhewwwwwwwyyeeeeeeeOOOOOOUUUUUUUCCCCCCHHHHHHHH-
uuuuhhhhGROSS!

Ok, so, OB/Gyn. I have to say that it was my least favorite rotation so far. Now, I do also want to say that around here, OB/Gyns sort of had a reputation for being awful to work with as a medical student, but I have to say I found the opposite. Everyone (okay, with a few scary exceptions) was fantastic and really interested in teaching. It's just that I don't like the rotation. The hours are awful, and just through luck of the draw I was on during one of the more depressing months in history, patient-wise. You know, pregnant moms being diagnosed with metastatic cancer and being given 2-6 months to live, moms miscarrying a second trimester multiple gestation after trying for 10 years to conceive, stuff like that. Wrist-slitting.

Also, at least half of the patients speak Spanish, and I do not speak Spanish. Well, I sort of do, but kind of like Tonto if he were drunk. (Me student. Me no talk large in Spanish. Tall pain is having you where? You have water from your (indecipherable)? Big water or little water?)

Okay, it is time for me to go study for the shelf exam even though I am getting hives just thinking about it. But I will post again soon and I already know exactly what I would like to rant a little about: a little something our school likes to call "Professionalism Evaluations". In the immortal words of Ron Burgundy, "Big deal! I'm very professional!"

Operation: Vajayjay

2008-01-12T18:05:00.000-08:00

Just a few quick things:

1. My head is spinning. I am reading at a pace which is exceeding my ability to retain information. Sadly I do not have the option of slowing down if I wish to get through the reading before the shelf test.

2. I do not like the OR. I especially do not like the OR when I don't scrub in but instead stand on two stacked stools for hours and hours so I can catch an occasional glimpse of sheets/piles of random tissue and 34,234 clamps over the shoulders of three doctors crammed in between some poor woman's legs. Plus it's freezing.

3. If I never see another hoohoo, it will be much too soon, and I haven't even done labor & delivery yet. That goes for cervixes (cervi?) too.

4. As it turns out I got really lucky in that not only was Doc Mamma right and they can't make me work Thurs night before the shelf, but we also have a required holiday (I'm not kidding, it's required--we aren't techically allowed to be in the hospital) that Monday, so I will only have to do three nights instead of five. This almost makes up for me having my night shift week last.

Okay, as per usual, time to get back to reading. The great thing about this rotation is that you never know what fantastic thing you get to learn about next. Incontinence? Prolapse? Disgusting STDs? All of the horrible things that can happen to you before, during, and after childbirth? I'm so happy to be a woman! With complex parts that apparently fail all the time! Haha!!! By the way, I just learned that leakage which occurs while laughing is a sign of stress incontinence. Not that I have that problem.

Yet.

OB/Gyn, Thy Name is Terror

2008-01-02T18:09:00.000-08:00

AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH

Okay, I feel much better now. Today I started my OB/Gyn rotation, and although everyone I've met has been very to excessively nice, I am petrified. You see, our rotation is already only four weeks long, but we started two days late due to the holiday so it is even shorter. And my God, have you looked at OB/Gyn Blueprints lately? It's a kagillion pages long!!!

(PS: You might wonder why I didn't go ahead and start studying over break. This is an excellent question, and I would love to answer it, but calls to the decision-making regions of my brain were not immediately returned.)

There's more: the way the rotation is set up here, we don't have call for three of the weeks, but one of the weeks is all OB night shift (5pm-7am). And my nights week, as luck would have it, is the week of the shelf test. What this means is that I have two and a half weeks to learn enough OB/Gyn to pass the shelf test. Then I have to find a way to keep it in my brain as it (my brain) is scrambled due to a completely jacked up sleep pattern in the days leading up to the exam. Mix this in with the long hours of this rotation, and you have one trembling, sweating Dr. VonB.

Anyway, I have to get back to reading, for super duper serious. I will write more if I can stop my screaming, which, honestly, is really making it hard to read.

The Final Countdown

2007-12-20T15:47:00.000-08:00

The minutes are ticking away... the 11th hour approaches, a time for fear (shelf test!) and celebration (vacation!!).

Today I had my oral/written exam portion of the peds rotation, and tomorrow morning is the shelf test. Therefore, this entry will be short so I can get back to alternately freaking out and succumbing to complete apathy.

First, my take. Peds: I liked it. I actually liked it a whole lot. I can't see myself as a general outpatient pediatrician, but that doesn't surprise me, because I think that general outpatient anything would bore me beyond tears and into the realm of automatic weaponry. However, I could see loving inpatient peds or specialty peds (depending on the specialty). I'm not sure that I'll end up doing it, but it gets a big thumbs up in by book. The oral and written exam were not too bad, although I am somewhat (between a little and gosh-darn) irked that I missed a question about immunizations and I'm still not sure why; they even provided the immunization chart, I'm sure with the thought "Now even severely handicapped students can get this question right!". So really it's a mix of feeling like an idiot and feeling like a major idiot since I still don't understand why I got it wrong. But whatever.

As for the shelf, I am in the same place I always seem to be the night before these things. I want to care; I try to care; there are fleeting moments where I actually do mange to care; but mostly, no. I am tired, and tired, and oh yeah, tired, and I don't want to study this stuff any more. I want to take the test now and be done. (Or--better idea--not take the test at all.)

Sadly, as is so often the case with the MD/PhD program, there is no rest for the weary. I must trudge ahead and try to study... at least pretend to study... maybe pretend to try to study. I'm still trying to work that out. Okay... here I go... books out... where's my pen... okay...

Oh, hey! A Christmas Story is on!!

Happy Holidays everyone, and try to enjoy your vacation as much as I plan to, which is a lot.

Sludging

2007-12-04T17:36:00.001-08:00

Sludging is something I was just reading about, and it struck me that this is the perfect term to describe what is going on with the information I am currently attempting to cram into my brain.

In medicine, sludging refers to what happens when you have hyperviscosity syndrome--that is, your blood gets thick (usually from too many red blood cells) and forms "sludge" in vessels which supply your most vital organs: for some of us, the brain; for others, not so much. But it is essentially like what happens in sewer pipes when goo causes a back-up of unfathomable grossness right into your bathroom, only this happens inside your body.

Ew, indeed.

But, I was trying to find the words to describe my current knowledge of pediatrics, and sludging is the absolute perfect term. I read, and read, and read, and if I still have the ability to retain saliva in my mouth, I read some more. I listen to residents and attending as they hurl information at me like jai alai players on speed, and I try to pack it all into my poor brain, but what I have now is simply sludge.

Brain sludge is very dangerous, because not only is it useless, but it precludes adding new, non-sludge knowledge. It gums up the works. It's driving me mad.

And just to accentuate the horror, I must update my previous post and say that I was wrong about the FIVE cases. The actual required number--REQUIRED--is t-e-n. TEN. 10. X.

I have manged to finish ten, and I can promise you one thing: I am much dumber for it. On the bright side, I have even less pride. But not to worry: the sludge is slowly spreading through my brain and I have it on good authority that it will soon reach the part which retains the memories of the cases that I... hmm. I'm sorry. What was I saying?

ChumpWork

2007-11-29T16:54:00.001-08:00

Dude. Make it stop.

Just when I thought I was out of the woods, homework-wise, they drop the frickin' A-bomb of busywork on me.

I can sum up my misery in four words: Stupid, online, required cases.

Ugh. Apparently, many med schools around the country use them. You log on to a web site and are led through a web of lameness like a small blind child, and are occasionally forced to answer a multiple choice answer or (shudder) type a response in a box. The web site says that the cases should take about 40 min to complete; I've been taking 20-30min each, which is still 20-30min each of my life I will never get back. We are required to complete at least 5.

FIVE.

But that's not the worst of it. They set it up so that you are required to complete at least 5, but that just gets you a pass. To get a high pass or honors you have to complete more LOTS, LOTS more. And although it only accounts for 5% of your total grade (WHY do they insist on acting like your 3rd year grades are objective by assigning things percentages and numbers? It is a total lie. I may talk about this in a future post...) you just know that if you decide to slack and only do the minimum that you would miss a good grade by 2.5% and the you'd just die.

Anyway, the cases go something like this. You open the page and it has a picture of a scary person who as far as you know just broke out of prison. They say,

"Hello. My name is Dr. Doverschlogenmarchowitz. Today we'll be seeing little Timmy, a 4 year old who insists on traveling everywhere by hopping on one leg and has a history of explosive diarrhea. Why don't you go in and introduce yourself?"

Then you click on the next page button and it has a picture of Timmy, and it asks you some kind of question mildly related to the situation, like:

"Explosive diarrhea can stem from many causes, such as watching reality television. Which ONE of the following is the least medically accurate television program?
A. Grey's Anatomy
B. ER
C. House
D. Diagnosis: Sexy!: The Search for the Hottest Doc in America"

Then you are forced to click on questions for the patient and read their answers and it goes on and on and oh my God it is horrible.

Anyway, I could mock them all night, but really I'd like to finish another one of these stinkbombs so I can go to sleep. By the way, in the interest of full disclosure, I would like to state that I know that at least one of my classmates, an otherwise totally sane human, has stated that he believes these cases are helpful. For this person I would like to suggest haldol. For Timmy, I suggest laying off America's Most Smartest Model.

Student, evaluate thyself

2007-11-17T10:22:00.000-08:00

First of all, WHEW.

I'm done with inpatient pediatrics. One more month left in this rotation, which is a week of newborn nursery and three weeks of outpatient clinics. But the tough stuff is the inpatient, with longer hours, call and weekends.

So, how was it? Well, I am totally beat, but I really like peds for a bunch of reasons I won't go into here. In fact my liking of it is such a majority that it is easier to say what I don't like about it, which is:
1. Crazy adolescent patients
2. Crazy parents
3. 1 and 2 (they often go together)
4. Extremely depressing patients, such as victims of child abuse (shaken baby syndrome being possibly the most depressing) and those with profound CP and mental retardation

Still, even with the above, I could see myself really enjoying pediatrics. Because the vast majority of time, even in bad situations 1-4, you still leave feeling like you managed to help, even in the smallest way.

But that is not what I would like to talk about today. Today I would like to discuss (with my keyboard and my three readers) the idea of self-evaluation.

Most rotations do this in some respect, but peds does it more formally than others I've had so far. At the half-way point they give you a long questionnaire which you fill out in what is supposed to be an intensely self-searching and honest manner, and then you go over it with one of the attendings.

Now, as an oftentimes exorbitantly introspective (and, okay, insecure) person, I found this process both redundant and depressing. Basically, it allowed me to write down all the shortcomings I have been acutely aware of since day one on the wards, while at the same time introducing new and disturbing facets of inadequacy which I may now ruminate over at my leisure. When I finished the forms, and was feeling even more disappointing than usual, I started questioning the utility of this form of review. The way I see it, there are Three Main Classes of Student, and self-evaluation fails each of them, albeit for different reasons:

-The Egotistical Jackass: This is the person who sees most everything as beneath them and their superior level of function. The self-evaluation fails here because the egotistical jackass will never consciously acknowledge that they have room for improvement; if they do it tends to be something inane like "I will try not to make the other students as jealous of my awesomeness." (You think I am lying, but there are definitely students like this out there. Sometimes they actually are pretty good, and sometimes not. Sometimes their ego is kind of endearing, and sometimes it makes you want to tie their vulnerable appendages to your car bumper and drive off.)
-The Oblivious and Often Inappropriate Nutbar: Again, it is surprising how many there are. Most of these people, in my opinion, simply lack introspective prowesses. They say and do ridiculous things and don't seem to understand why they are wildly inappropriate. Example: one of my fellow students, who is so strange and inappropriate that it would not surprise me in the least to learn that he is actually a humanoid robot shell operated by alien beings, actually started pimping us, our interns and our senior resident in the middle of rounds. By name. As in, "(Senior Resident's name), why don't you tell us some metabolic derangements you might see with this disease." It would have been even funnier if it wasn't so sad. Asking them to figure out how they can improve is like asking an cow to derive the equations of motion.
-The Paranoid, Insecure Self-Torturer: I think I fall into this category, and I think the result of self-evaluation for most of us is as I described above. The last thing we need is more stuff to beat ourselves up about.

I think the main goal of this self-evaluation stuff is to come up with an "action plan"; that is, a way to address the areas you think need to be improved. Again, in light of the Three Major Types of Student, I think this step is not useful. The egotistical jackass has not come up with anything reasonable to improve, so it's kind of a moot point there. The Oblivious and Often Inappropriate Nutbar... well, it's best not to delve deeper into their psyche. And the Paranoid, Insecure Self-Torturer formulates about 20 action plans for their perceived areas of weakness every single day on their way home, so to ask them to do it formally is to risk pushing them into Generalized Insecurity Paralysis (GIP) which I think we can all agree is counter-productive.

All that being said, my session was somewhat helpful for me. For instance, my attending moved several areas of self-perceived weakness into the "strengths" category, which was honestly a load off of my mind. Example: my knowledge base. I always feel behind my peers, so having an attending tell me that wasn't true was frankly a load off of my mind. She also did point out that some things I perceived as deficits in my presentations were actually not an issue, but that my lack of confidence was; and as I had not realized my insecurity was so apparent, that was a helpful observation.

So, med school bigwigs, on behalf of my other equally though differently dysfunctional classmates, just tell us what we are good at, and what we suck at, so we can go back to being in denial, or insane, or self-deprecating. Thank you, and I hope I've given you a plan for improvement.

Like Being in the Ring with Mike Tyson

2007-11-04T05:45:00.001-08:00

That is what it's like on the wards for a 3rd year medical student.

You step into the ring and KAPOW!!! You're reeling, you try to shake it off, but before you can JABJABJAB! BODY BLOW! You hit the canvas, they're counting, you stagger to your feet and KABLAM!! Lights out.

What I mean here is, it's tough on the wards for people like me, still trying to figure out what the hell is going on. As soon as you recover from one mistake, you make a complete ass of yourself in front of your team and possibly trip over an IV on your way out. One time I dropped something on a patient's leg, right where she had just had a skin graft. She cried. It was horrible.

Dumbass Moment 1: Presentations during rounds
I swear to God, it doesn't seem to matter what time I get to the hospital to prepare, how much reading I do about my patient, how carefully I write out what I need to say. I cannot seem to get through a single presentation without making some mistake. I wish I could say that I make a new and different mistake every time, but sadly, that is not the case. There is a set of mistakes that I make over and over and over again, forcing the attending to ask things like "So why is this patient here?" and "Are you sure their heart exam was normal? Because that child has a murmur you can hear from Mars." In addition, I'm generally spastic and strange throughout most of my presentations (see "Medical Tourette's" below). You are supposed to go in a very specific order, and sometimes I'll make it the whole way through the presentation, but then people are still looking at me, so I'll just kind of yell "LASIX 30mg PO BID" for no reason.
Yesterday I presented a new patient. I had a particularly bad day the day before, so I worked very hard to shake it off and make it my best presentation, and when I finished, I felt great... for about two seconds. Then a fellow pointed out that I had said "lungs clear to auscultation, except for some scattered wheezes". That's like saying "patient is doing well, except that he is dead". Last week I was actually given a very complex patient to follow, but after one horrible crash-and-burn presentation they switched me to a patient just saying overnight after a percutaneous cath. It was like "There, there. Give mommy the power tool. Here is a nice soft plastic block with rounded edges."

Dumbass Moment 2: Totally off-base answer to pimping question
This happens to me a lot. They'll ask something like, "What is something in your differential diagnosis for lower abdominal pain?" And I'll just blurt out "CHEST TOAD!" It's like I have Medical Tourette's. I say completely idiotic things, and I say them loudly. It's horrible.

Dumbass Moment 3: Flubbing the Interview/Exam in Front of a Patient
I have done this plenty, but my favorite example is actually something a fellow medical student said. He was interviewing a patient's mom about her daughter's vomiting, and he actually said, "Any pets? How about a beaver?"

These are just a few examples of classic Ward Dumbass Moments. There are many more. What makes is hard is that these are inevitably scattered throughout every single day, and you have to find a way to immediately recover from the humiliation and shame so that you can go back to making the next mistake. It's very exhausting. So far Mike hasn't gone for my ear, but I'm sure it's just a matter of time.

FanTASTIC

2007-10-28T08:49:00.000-07:00

Now playing on Lifetime Movie Network:
(I swear this is true):

"Baby Monitor: Sound of Fear"

I sure wish I had more time to kill... this post would be followed by a review.

Back to clinic... now how do I use this stethamathingy again?

2007-10-21T06:09:00.001-07:00

I start Pediatrics tomorrow morning after having a super fantastic three week vacation, and I have to say, I'm pretty nervous. I feel like I have actually forgotten stuff, as weird as that sounds. It's amazing how quickly that pile of information starts to drift away.

I have high hopes for this rotation... I think I will really enjoy it, if I can somehow get back into the constantly working mode I was in before. For the rest of the year, my longest vacation will be one week, and I hate to say it but I think that is for the best. My poor brain needs as much help as it can get.

In other news it looks like I am going to have to have an upper endoscopy, and this brings up something I've been thinking about: how much harder it is to be sick or to be a patient when you've seen the behind-the-scenes action. I know for a fact I would not be one tenth as freaked out at the prospect of an upper endoscopy if I hadn't seen one done. But I have. And I am totally dreading it.

The other part of this is that I know all of the Really Bad Things they have to rule out. You start to be able to look at yourself from the outside, as if you were just one of your patients. It is not a good place to be, believe me. Anyway, I am hoping to get this over with as soon as possible and I will write all about it. After all, it's important to remember that the people we treat are no different than us. They need compassion, understanding, and most of all, Versed.

Lots of Versed.

Hopefully, all I'll write about is how I can't remember a thing about the upper endoscopy. In the meantime, I have to go get started on some reading. You see, unlike most of my classmates, I don't remember jack about EKGs or electrolytes or acid-base balance, so I have to relearn these things in addition to learning all of the other mounds of stuff for this rotation. So off I go, to read about bundle branch block and dream of being the person with the huge camera being stuffed down my throat... and an IV full of Versed.

MD/PhDs are people, too

2007-10-06T11:28:00.000-07:00

A theme has emerged lately, and I've been thinking about it a lot.

The first incident was a comment made by a higher-up my husband was meeting with to discuss his then upcoming residency applications. Now, I know I'm biased, but my husband kicks just about all the academic ass there is (it ain't braggin' if it's true). The guy is just amazing. Reduce him to numbers, and he's amazing; look at his personal recommendations from all kinds of people, and he's amazing. He basically lacks chinks in his application armor. Yes, his armor is chinkless. It's actually quite exasperating, following a guy like that through the program. But that's a discussion for another day.

Anyway, the doc he met with was very nice and supportive and was going through my hubby's app with him, making various suggestions about how to present things, etc. The really interesting thing came when they started talking about letters of recommendation. You are only allowed so many, so they usually advise you to chose the authors carefully. My husband had a long list of impressive people who said they would be happy to write him a great letter (did I mention exasperating?) and was asking the doc's advice on which would be best to include. Here is what they guy said.

"It's important, since you are an MD/PhD, to have a letter which says you can interact well with patients and staff. People tend to think of MD/PhDs as lab geeks who lack social skills."

We both thought that was interesting, but mostly just funny. I mean, at least in our program, there are tons of really cool people who have sufficient to superfluous social skills. Yes, there are definitely individuals whose social abilities are roughly equivalent to, say, Michael Myers, but I know quite a few straight MD students who are the same. I don't think the percentages are any different; if anything, I'd argue that there are more functional MD/PhDs. So, I had decided that that particular doc had maybe had some unfortunate run-ins with socially handicapped mudphuds, and was therefore unfairly biased.

Then, just a few weeks after that, I was hanging out with my family medicine preceptor and another doc in his practice, and one asked the other about something, I can't even remember what, but something about the disease I studied for my PhD. The other doc didn't know, but I did, so I started explaining how we thought things worked and a little about my research. This started some teasing on their part which continued throughout the remainder of my rotation, and the gist of the teasing was: Boy, you sure are a science nerd! I thought it was odd, since the "science" they teased me about knowing was the basis of medicine, but whatever.
Additional thoughts on this were:
1. I know I probably do qualify as a science nerd, and
2. I did actually like both of the docs quite a bit, but...
3. HEY!
Perhaps I wouldn't have even remembered all of this, except for the real corker, which was that at the end of the rotation when my preceptor was evaluating me, he told me how amazed he was that I was maybe the best med student he had ever had when it came to interacting with patients and staff, "even though you're an MD/PhD."

Okay... WHAT?

And possibly, HEY!

I don't get it. What do people see us as? Giant albino cave-dwelling mutants with a crippling stutter? Or maybe we can only carry on conversations if the topic is meiosis in fruit flies? Allow me to re-emphasise that some of the weirdest, least socially functional people I have ever met are either 1. doctors or 2. training to be doctors. Are there total freakish, socially inept dorks in research? Does the pope wear a funny hat? Of course there are. But let he who is without dorkiness cast the first stone, docs.

It also kind of scares me that there are doctors out there that think of science as "nerdy". HELLO! You're a flippin' doctor, man! Have you really divorced medicine from science to the point where you can feel like a varsity jock compared to the nerdling members of the Chemistry Club? Give me a break.

I will not even go into how they actually said that it was a good thing I was already married, because being a female "super smart science nerd" is not appealing to men.

Excuse me for a moment of stunned silence.

Okay, I'm back. Anyway, in my thinking about this, I've been wondering: Is our program an exception? Are most MD/PhD's social bulls in the china shop of medicine? Are we really that much geekier than regular doctors? I mean, we can't be more socially inept than most surgeons, right? If I had a nickel for every time I saw a surgeon make a patient cry, I'd have--let's see--at least 25 cents... which, okay, is not a lot, but let's not forget I haven't been in the clinic very much. What if I told you that once, after the very empathetic move of breaking the news that a patient had cancer by reading it directly from the chart to her, a surgeon I worked with was distracted by the crying of the patient, paused the reading aloud mid-sentence, looked up from the chart and said (clearly irritated), "Can I go on?"

I mean, we can't be worse than that, can we?

In closing, I would like to say that I know lots of super great mudphuds, and we are not mutants, thank you very much, and we may be smart and enjoy learning but there is no need to assume that we are all weirdo loser geeks who never talk to normal people. Now if you'll excuse me, I need to go catalog my Star Wars figurines.

Sprechen Sie AWESOME?

2007-10-01T06:59:00.000-07:00

So the hubby and I decided that we've earned it, and goshdarnit, we're going to Europe.

We have been talking about it for a while, but were too busy to really plan it. So when we started looking at tickets and there were some good deals to Germany, we decided, what the hell. Let's do it.

I am SO EXCITED, and am in the throes of planning right now. My husband is currently studying for Step 2 of the boards, which he takes soon, and then we're outta here. The great news for him is that after this exam the pressure is basically off for a good long while; he has interviews, which should be fun, and lots of months without any required stuff to do. So, for the first time in literally years, I get to spend some time with my husband where neither of us have anything--no publications or dissertations to work on, no applications to finish or big exams to study for--that we have to do. We can read fun books, travel, and talk. It's pretty stunning.

In other news, I am two months away from being half way through 3rd year. Unreal. The main survival technique I've learned for not just getting through, but doing well in 3rd year is: Study every day, for at least 1 hour. More is good, but less gets dicey. It is definitely hard to do after a loooooooong day in the hospital or clinic, but it is what has to happen. It is also rewarding to start occasionally knowing things when attendings pimp you.

Okay, I have to get back to tracking down a room in Munich, and trying to relearn cardiology before I start my next rotation. Such is the life of a medical student...

I can't complain.

Vacation, all I ever wanted!

2007-09-28T13:12:00.000-07:00

What could be truer than the truths sung by the immortal GoGos?

I am done, done, DONE for THREE WHOLE WEEKS!!! At the risk of sounding Texan, YEEEEEEHAAAAAAAAAA!

I'm sitting here, on a Monday, in my pj's, with not a study book in sight. It's amazing.

The weird thing is that after a weekend full of playing catch-up for chores and errands, I'm not sure what to do with myself. I still have lots I need to do--for example, I can't see my desk due to the enormous pile of papers and mail and books covering it. Also, there are no fewer than two closets in our house which, if they are opened, would bury the poor hapless individual under a pile of random junk. Also, I need to get my hair cut (you know you're in bad shape when your hair looks bad even in a ponytail). But where's the studying? Where's the stress, and the fear? The frustration?

Hmmm. Strangely absent.

Anyway, due to our not so regularly scheduled vacation, I don't have a lot to ramble or rant about today. However we have something brewing on the back burner which may result in some awesomeness shortly. I'll keep you posted. And in the meantime, Dr. VonB abides.

Deep breath, deep breath, deep breath, deep breath, ok, breathe normally.

2007-09-23T14:03:00.000-07:00

If you read the title, you've just experienced what it's like to have me perform a physical exam on you. Just envision me listening to each side of your back on the bottom, then each side on the top, then to your chest. I've done it so much that I catch myself doing it like a zombie sometimes.

Which is good, because it's important to get a rhythm going with the physical exam. This is for several reasons:
Reason 1: You don't want the patient to suspect you don't really know what you're doing.
Reason 2: You usually feel like a giant wonk, so it's easy to get flustered, which also tends to result in some patient uncertainty. If you have a system you tend not to get flustered, unless they have a really obscene tattoo or something (not that uncommon).
Reason 3: It's amazing how easy it is to forget to check things that you should be checking. For example, if someone has a URI (upper respiratory infection), you should listen to the lungs, and then often we throw in a heart listen for free, 'cause we're in the neighborhood, then you are supposed to look in their ears, their throat, and their nose (Believe me, it's as gross as it sounds. I used to always worry when the doctor looked in my nose that it was gross and embarrassing, and as it turns out, I was right. It is gross and embarrassing.). But for at least the first two weeks I would be looking in the ears, trying so hard to see something, anything, and I would get focused on that and inevitably forget to look in either the throat or the nose. If I had my rhythm down then, I wouldn't have had that problem.

The neuro exam is even worse, 'cause there's a bazillion things you are technically supposed to check, but most doctors only check about a million of them, but you don't always know which ones the doctor you're working with thinks are important enough to do. Then there's the abdominal exam, which sucks on 1) fat people, 2) people who currently have abdominal pain, or 3) both (this accounts for most of the patients I saw). It sucks because you feel really strange pushing around on this GIANT stomach and moving it around (I am not exaggerating), and you feel really bad pushing on it and making them cry out in pain (also not exaggerating).

Anyway I was thinking about the physical exam because I took that stupid Family Medicine test on Friday, the videotape one (see last post), and it sucked gluteus. It was actually four patients, and I think I did so badly that I am expecting a call any day now from the medical school advising me to go into a field more suited to my particular style of physical exam, such as herding cattle or mud wrestling. I guess I can at least be glad it's over, and I get about two months to sweat about my grade since it takes forever to get it back. This coming week I have a nice, short, relaxed rotation, followed by three weeks of vacation bliss. There will be painting of my grandmother's house, yes, but there will also be sleeping. And beer.

I'll be back when I have something interesting to say about resuscitating people. In the meantime, if you see me coming with a stethoscope, run the other way.

I have a fever... and sadly the cure is not more cowbell

2007-09-16T12:39:00.000-07:00

This will totally shock those of you that know me personally, but I have a wicked head cold.

It was just a matter of time. I've been seeing about five to ten sick kids a day for three weeks. About 75% of them have some type of nasty virus which affects the respiratory tract, while the other 25% have some type of nasty virus which affects the intestinal tract; so, I guess if I was going to catch a virus, I'd rather have this one.

Anyway the main thing that is bad about it is that I have two choices: 1) feel totally spaced out due to the virus or 2) feel totally spaced out due to the only medicines which give me even minor relief from the virus. I've been alternating between the two and I can't decide which leads to more productive studying. Every time I pick up the pills it's like, "Well, would I rather have my main insight into diabetes be "uhhhhhhhhhhhhwha?" or would I rather have it be 'uggggggSNORTuuurhhhhhhh'?"

This whole event has made me much more nervous about having my pediatric rotation in Nov/Dec. From what I've heard, peds during this particular period becomes like a frickin' flea market of RSV (respiratory syncytial virus, a super nasty respiratory tract infection), rotavirus (Severe diarrhea and vomiting! Yay!), and various other unappealing and highly contagious infections. Hopefully my pathetic excuse for an immune system (that's right, immune system--you heard me. I called you pathetic. If you want some respect, take a moment and contemplate why you go into full red alert over dust mite poop but roll out the frickin' red carpet for Mr. Nasty Flu) will manage to scrape together enough sense among its billion cells or so to remember whatever I have now and keep me from getting it again. But I'm not holding my breath. Which is good, because it's not easy to breathe when your nose is completely blocked off and draining into your throat, choking you. Stupid virus.

Anyway, otherwise, things are going well. I feel pretty good about studying for Family Medicine because it's kind of like a sneak preview for the rest of the year: peds, medicine, OB/Gyn, psych--it's all here. Just laying good ground work for everything that's ahead. It's great! (Psst: does that stuff sound convincing to you? 'Cause it's not really making studying sound any better to me. Stupid hypertension drugs!!) My husband just got his residency applications submitted, which is a load off his mind and mine, plus I don't have to listen to him whine about them anymore. He finishes his current rotation Friday, after which he will be free to be my personal servant until Christmas. Just kidding. Kind of. Actually, he will have to study for Step 2 of the boards, and then he will have residency interviews and stuff, but I trust that there will be lots of servitude blended in. Right, honey?

As for me, I have one more week of Family Medicine--my exam is on Friday. The exam, as I mentioned, consists of a multiple-choice test, a videotaped interview and exam on an actor playing a patient, and a brief written/oral exam. Allow me to express my feelings about this exam: YIPE. I mean, videotape? Ugh. My theory is that all the doctors get together and have a big party, and show bloopers from people's exams where they inadvertently poke the actor in the eye or knock him unconscious with a reflex hammer and then sit down on the floor and cry. In any case, I will try to update the blog with details of that super fun experience once I am done.

The following week I have a one week course where you learn about acute care--mostly resuscitation stuff. Then I get a glorious vacation before starting peds. I can't wait... I can almost smell the vomit now.

How about filling this prescription for STOP EATING

2007-09-11T13:03:00.000-07:00

A few confessions right up front: I am not a skinny person. I never have been. And, I love food. A bunch. Finally, I am not athletic. I've always been one of those stereotypical nerdy kids who likes school and has asthma and tries for the cool hairdo but falls sadly short.

However, I have a rule. If my pants start to get tight, I institute THE diet, the most fantastic diet in the world. There are two parts to this diet.
Part 1: Eat less.
Part 2: Exercise more.

Amazingly, it works every time. I think about that two part diet a lot. I first heard this precise diet from a doctor I worked with my first year of medical school. He is an amazing doctor. He trained in India and could diagnose twenty diseases just by looking at a patient's hands. We would see tons (no pun intended) of patients come through his practice who were not only overweight but have diabetes and countless other health problems. Some of them would enthusiastically tell the doc about whatever new crazy diet they were trying; all liquid, no carbs, only carbs, only foods that start with the letter z, whatever. And he would always close his eyes and shake his head and say, "It is good you are trying to losing weight. But there is only one way to lose weight, and that is to eat less and exercise more."

The best part is that 99% of the time the patient would look at him like he was nuts.

It's a simple concept, people. I didn't say easy; it is, however, undeniably simple. Every single day in Family medicine we would see patients who were easily 100lbs over their ideal weight, and, shockingly, they would have all kinds of problems. Doc, my knee hurts. Doc, my lower back hurts. Doc, my heart's bad. And oh, by the way, I smoke 2 packs a day.

I am not minimizing the problems of all those people in the US who are overweight. As I said, I struggle with it myself. It is very difficult living in the US today, with mounds of delicious, tasty, and horribly bad-for-you-food not only available but in your face constantly, day in and day out. Lots of them have all kinds of other difficult psychological and social issues which I am very fortunate not to have to shoulder. But, OH MY GOD, people, STOP. EATING. And, occasionally, consider moving your ass.

It gets very frustrating. Even besides the fact that I want to do clinical research, I know now that I could not go into primary care. I don't think I could spend every day overlooking the major problems in people's lives and trying, usually in vain, to treat the results of those problems. Yes, this is an overly simplified view of primary care, and yes, there are truckloads of amazing doctors who do manage to change people's life every day. But, in my experience, even those doctors will admit that they are happy if they reach even 10% of their patients.

I think the truth is that Americans take things for granted. Their wealth, their lifestyle, and as I have learned, their health. Most patients want to abuse their bodies for 40 or 50 years and then get a pill to make it all better.

I salute all those doctors who are happy with 10%. I am in awe of them. I can't do it.

I need to go work out.

Cough, cough, fever

2007-09-09T08:19:00.000-07:00

Kind of like duck, duck, goose, only with more mucous. That pretty much sums up Family Medicine.

Actually, I like it. I don't know that it is for me, for a lifetime, but for now it's good. There's a lot of variety, and good practice for general and focused H&Ps (history and physical). My preceptor is very very nice. I do have to admit that, unfortunately, I feel that the slope of my learning curve has really leveled out. That could be because I'm studying way less than I was on Surgery. Why? Well, first, the textbook we are supposed to use pretty much blows. Also, in contrast to Surgery, with Family, you don't have The Fear.

The Fear is very important, and it isn't just about the Socratic method, pimping, or angry, angry surgeons yelling at you. It's also about having a lot of patients who might just die on you if you don't figure out what is going on and how to fix it. It gives the whole thing a sense of urgency that frankly is lacking in Family Medicine, an urgency you can use very well to fuel your studying.

Don't get me wrong, there is a ton to learn--for example, I'm trying to remember at least three major medications and what they're used for (I try not to set my standards too high). There is a ton of breadth, but not a lot of depth, and I think that works against my disposition a little bit. Anyway, writing about this has made me feel that I should really go and get some studying done. So I will. That's a very, very important thing to remember in 3rd year: when you get the urge to study, for whatever reason, run with it. Just remember to put down the scissors.

And we're back

2007-09-07T23:34:00.000-07:00

Family medicine is a lot busier than I expected it to be.

First of all, I have to commute a little more than an hour each way (that's more than two hours of driving per day, for those of you who are math-challenged). Then, there's the homework.

Yes, that's right. All of a sudden you're like a frickin' 5th grader, with homework.

They try to dress it up; they're "presentations" and "research summaries", but honestly, that just makes it more insulting. In my opinion, it's time to stop this ridiculous crap. There's already a big exam at the end of the rotation (written and verbal). Plus--and I hope I'm not understating this here--I feel that if the motivation to NOT KILL PEOPLE isn't enough to make someone learn of their own volition, then I don't see how homework is going to do it.

Let me learn on my own. I am NOT a 5th grader. I don't need your damn homework. I can learn all by myself, just like I brush my teeth without being told and wear matching socks without you picking them out (well, most of the time).

My other gripe (Yes!! There's more!!) is that a big part of being a doctor (okay, a GOOD doctor) is to be what they like to call a "self-directed learner". This means--stick with me here, because this is a startling and complex idea--that if you don't know something, you look it up. Radical concept, huh? Well, they tell you that it's time that you become a "self-directed learner", and in some rotations (coughSURGERYcough) if you don't do that you are a dead doornail, while in others, I'm talking to you, FAMILY, they make you do stupid. Frickin. Homework.

The cherry on top: I won't be able to say for sure until after the exam, but my hunch is that these homework assignments are not going to be super helpful on the exam. I mean, I think that they are overall theoretically important things, but the kind of things that I could have learned on my own in about one third or less of the time it took me to put it together into homework.

There is another part to this that I have to confess. One of my biggest pet peeves--other than having homework at the age of 32 and the song "American Pie"--is a little something I like to call "forced audience participation". I bet you know exactly what I'm taking about. It can happen anywhere, from a "Hey, let's put those hands together!! I can't hear you!" to "Where is everyone from?" to what I am experiencing now: "What kinds of psychosocial issues do you think we should consider in this patient?". Ironically, I don't really mind the more Socratic surgery method, where they direct a question to one particular audience member (usually warmly and personally, as in "that guy back there in the blue shirt who isn't paying attention"). But when they ask this very subjective, open-ended question, and just sit there, silently, waiting for someone to speak up, which finally someone does, but inevitably doesn't give exactly the answer the person wants, so they say something inane like "Um, yes, okay, but what else?", I just want to punch their face in.

Wow, okay, I've really woven all over the blog road here. Let me wrap up and we'll come back to some of these hard-hitting issues--plus the things I LIKE about Family Medicine--after a brief commercial break. Seriously, I will try to post again this weekend. In the meantime, keep on keepin' on, people, and let me hear you put those hands together!!

To sleep, perchance to, well, sleep

2007-08-23T14:14:00.001-07:00

Today was my last clinical day of surgery; tomorrow is the surgery shelf exam. My feelings can be summarized by combining the traditional "zzzzzzzzzzz", indicating sleep or sleepiness, and the "ARRRGGGGGGGGGGGHHHHHHHHH" of fear/frustration, thusly forming the new compound expression:
zzzzzzzARRRGGGGGHHHHHHzzzzzzzzzz,
which is the rallying cry of 3rd year surgery clerkship students everywhere.

I was on call last night, and after two solid weeks of madness it really took a toll. I was able to leave the hospital early today but have found that I'm not doing very well with the last-minute studying. But I'm looking on the bright side: I'm too exhausted to panic.

I'm pretty sure I will be able to pass the shelf and therefore the rotation (knock on a forest full of wood). Unfortunately, though it is uncool to acknowledge that you are "gunning" for honors, these things do matter, especially if you are strongly considering a very competitive subspeciality, which I am. So, passing is not really enough. I'm trying to give myself a break since this is my first rotation back and I have, by careful calculation, ZERO knowledge of minor things such as, I dunno, ANY DRUGS AT ALL, but I can't allow myself to be complacent about being behind my classmates. I'm trying hard, but right now I'm not sure it is enough.

Also, much to my chagrin, I've found that osmosis learning does NOT occur after falling asleep on your book, which I have done more in the past few weeks than in the entirety of my life up until now. In addition, I have found that I've become stupider as the rotation wears on. I'm not sure if this is due to the previous "topping off" phenomenon I wrote about before, or the exhaustion, or hearing slightly different versions of "the next appropriate step of management" from three different books and ten different people, but it is definitely true.

In any case this will be over, for better or for worse, tomorrow before noon. I move on to family medicine next which will be AWESOME in terms of hours (closer to 9 to 5 than the 5 to 9 of surgery) but is a continuation of the brain-stuffing I've been attempting with mixed results. I am going to try to get caught up on my drugs (learning, not taking) and general medical knowledge, but also on remembing what my husband looks like. I miss him, a lot. Also I miss fun, and sleeping. And my dogs. And sleeping.

I am going to sign out before this becomes any more rambling... not surprising given that I wrote it more to have something to do other than study and not so much because I have something specific or interesting to say. My positive thought for the post is easy: tomorrow I'm done with surgery, considered by most to be the most difficult rotation of 3rd year. What have I learned?
1. Waking up any time after 5am is "sleeping in".
2. Caffeine can be your best friend, but use her wisely; she is a bitch-goddess who does not take either abandonment or abuse lightly.
3. Surgeons are crazy.
4. Papillary is the most common type of thyroid cancer.
5. I can't remember the fifth thing, 'cause my brain is full.

Okay, that's all for now. In closing, always rememzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

On second thought, no post today.

2007-08-14T17:16:00.001-07:00

I was about to write a quick but scathing post about my horrific day and my generally abysmal outlook on the entirety of my medical education when I noticed my previous post. Let's just say that given my current state of mind I don't think anything I could write today would be in keeping with my new resolution, so I am going to take tonight to cool off and hopefully have a more reasonable outlook tomorrow.

Positive thought for the day: Today, despite persistent thoughts to the contrary, I did not harm myself or others. At least not physically.

To the best of my knowledge.

So far.

Super happy shiny fun time!

2007-08-12T09:48:00.000-07:00

In flipping back through my previous posts, a subtle, yet persistent, theme emerged: bitching.

Yes, if I had to rename this blog, it would have to be called: "The Incessant and Unrelenting Bitchfest: A Tale of Two Degrees."

I'm sorry about that, for two main reasons. First--and you are never going to believe me about this one--I am basically a positive person. (I know! After reading my previous posts, it surprised me too!!) I'm not depressive, am only mildly moody (I like to think I experience the least possible amount of moodiness possible for a girl). I tend to be an optimistic, glass-half-full kind of person. And second, overall, I didn't hate graduate school, and third year medical school is basically awesome. Painful and terrifying and sad and really, really hard, but awesome.

So why so much bitching?

Honestly, I'm not 100% sure. I think a lot of it is that there are a whole lot of things about this career path that are extremely stressful, frustrating, challenging, etc. etc., and at some point my husband, family and friends get really sick of hearing about it, and tell me to knock it off, already! and I still have some venting to do, and, hey!, blog. Another part of it is that--and this is especially true of the grad school stuff--once you crawl out of a pit of despair, you want to put orange cones and CAUTION! tape and stuff around it, so other people don't fall into it, too. (Unless you are a certain person I am having to interact with a lot lately, in which case if you happen to fall into a pit with tigers and spikes and poisonous snakes I would laugh and laugh, and maybe throw rocks).

In any case I have resolved to try and always include something positive in every single one of my posts. Even if all I can manage is "Today I continue to successfully turn oxygen into carbon dioxide", my God, it'll be in there.

Currently, I am working on a list of "Everything you ever wanted to know about the surgical rotation, asked about, and were yelled at by a nurse." Expect it after I shake off my 30 hour shift. Until then, remember: fluffy bunnies are happy and cute!! Yay!

Ow... my brain

2007-08-09T18:06:00.000-07:00

You know how there are signs at the gas station that tell you not to "top off" your tank? Well, I think I've topped off my brain.

It seems that no matter how much reading or studying I do there is actually MORE that I don't know. It's like when you are packing up your house and you spend two days putting stuff in boxes but somehow now there is still the same amount of stuff unpacked, so you pack more frantically, and now there is EVEN MORE STUFF UNPACKED THAN WHEN YOU STARTED PACKING AHHHHHHHHHHH.

Lately I don't know if I have any more boxes upstairs, if you know what I mean.

I have to admit, it's all pretty interesting. With as much studying as I've been doing, none of it has been nearly as painful as other stages of this process. Basically everything I'm trying to learn now is clinical, it's about taking care of people, and I really like that. Also, it's amazing actually seeing diseases and syndromes that somewhere along the line you convinced yourself existed only in books. It's amazing seeing how the new innovations in care over the last few years are actually being used to save people's lives, and seeing what new things are on the horizon.

I could go on and on, but I can feel details about primary hyperparathyroidism leaking out of my ears as I type, and I need that for tomorrow, when I'm on overnight call. Overnight call is often a prime time for pimping, because it is even funnier when medical students not only don't know the answer, but we cry. If you come up with any new innovations in brain drain plugs, definitely let me know, if I can remember why I needed it.

I don't know where time is, but it ain't on my side

2007-08-06T15:44:00.000-07:00

Okay, this is going to be short. Why? Check out the title.

How in God's name to surgeons do this?!? It is NUTS. I mean, I haven't even had hours that were that bad and I feel like I'm barely scraping by. To be fair, I do have to do a whole truckload of reading and studying and other random busywork stuff when I'm not in the hospital, but still. Interns have it a lot worse, hour-wise. To give you a more specific idea of the hours I'm talking about, I have been spending 12-16 hours a day, an average of 6 days a week in the hospital. Then I need another 1-3 hours of studying time each day. My schedule has me working the next 13 days straight; then I get one day off, then work six more days. Then the exam. Included within those spans are two nights of all-night call where I could get five hours of sleep or zero sleep.

Also, I have to take the shelf test in less than three weeks, and that is freaking me out. The shelf test is a big, really hard, national exam you take at the end of each clinical clerkship--so, two weeks from Friday, I'll be taking the surgery shelf. Lots of people say it's the hardest one, but I don't listen to them. I listen to my brain, which is shrieking: AHHHHHHHH, we will never pass this exam!!!!!!!!!!!!!!!!!!

Okay, in any case, I have to go get some work done so I can get more than six hours of sleep tonight. Your final random thought: don't you think that Daniel Radcliffe always wears WAY too much blush in interviews?

You say Mudphud, I say Sucker

2007-07-28T06:07:00.001-07:00

I'm old.

Like, really old. Seriously. I'm a third year medical student who is usually the same age as the youngest attendings. ATTENDINGS.

Brief side note: if you don't know the whole medical hierarchy, here's how it goes, in ascending order:
3rd year medical students
4th year medical students/acting interns (AIs)
Cockroaches
Interns (although in some services the interns are treated worse than the medical students, and in all services they work a lot harder)
Food service employees
Residents (ranked from 1st year to whatever the last year of that particular residency is, usually called the "senior resident")
Chief Resident (usually in the final year of residency, but sometimes it adds an extra year of residency to be chief resident)
Fellows (depending on if whatever you are doing is a fellowship)
Anyone who brings people good coffee
Attendings (have finished all of their training)
Friends of the Chief who want to see what medicine is like
Chief (head of the department)

Anyway. My point here is that I am usually being taught and generally bossed around by people who are up to seven years younger than me. Which is usually okay, other than all those whippersnappers making a racket, and sometimes I develop the strong urge to knit and put my hair up in a bun. So far they at least have the courtesy to act surprised upon learning my age, which is inevitably followed by the question: so what have you been up to (insinuated addition: "for all those years")?

There are two parts to this answer. Part one: I spent four pretty awesome years working in biopharmaceutical research, traveling, and having a total blast with tons of fantastic people after college. I needed the time to decide what to do with my life and although I sometimes wish I was four years younger now (then again, who doesn't??), I needed that time and I don't regret it one iota.
Part two: I spent four years as everyone's bitch getting a PhD which I now pray will pay off in some small way in the future and will not mean I have missed my chance to have kids or have a career which lasts for more than five years before retirement.

I know that sounds kinda bitter, and I don't really mean it that way exactly. It's just that I think a lot of us Mudphuds start feeling this way when we go back to 3rd year. We are all at least four or five years older, four or five years more jaded and tired and frustrated, and more importantly we have forgotten most of what we tried so hard to learn in the first few years of medical school. We finish our dissertations and show up to 3rd year like middle aged, haggard marathon runners staggering over the finish line, only to find another starting line, populated with these fresh-faced young people who have just gotten a full night's sleep and tons of carb loading. They just took their boards and it is all still fresh in their minds; they are still at an age where they can stay up all night and still remember where they live the next morning.

I haven't quite made up my mind about the abuse issue; that is, does having just gone through four to five years of consistent abuse make it easier to be abused for another three to five years, or is it better to go into it fresh? Maybe it is both, but speaking for myself, it isn't always easy to be treated like scum having just finished the scumfest of all scumfests. I know that medicine is a whole different field and basically everyone in the hospital, including the janitors, know more about medicine than I do, but come on! Didn't I just do this? As they say, it's déjà vu all over again.

Back to my original point. When I tell these younger bosses of mine that I have a PhD, most of them act impressed. They say really aggravating things, like, "Wow!" and "That's great!".

Is it? Is it really?

I dunno. I have been told over and over that I will be glad I did this, and in fact I do think I want to do clinical research, but right now, feeling old and behind and lost, I have to wonder.

And that's not even getting in to the thoughts I sometimes have about what I'd be doing with my six figures a year if I had gone straight into programming after college...

Pretend I didn't say that.

Finding words to say the worst

2007-07-26T19:20:00.000-07:00

Today I met a completely disarming 6 year old girl. She was sweet and giggly, and very cute even though she lost all of her hair during her chemo and radiation. You could see how big her smile was even before she took off the mask she has to wear whenever she is out in the world, to keep her from getting sick. She has no immune system, you see--she, and her family, are waiting to see if the one she had transplanted into her is going to take.

She was referred to our clinic by her pediatric oncologist because they noticed that one of her eyes was occasionally drifting to the side, almost imperceptibly. My resident was concerned that they hadn't corrected this yet at the age of 6, because if you don't correct those sorts of disorders by age 7 they become almost impossible to fix. Even as he was telling me this I could tell there was something else he was worried about.

One of the worst things about being a doctor is knowing the bad signs. I knew as soon as I watched her pupil react to the swinging flashlight test that things were not okay, that they were a lot worse than we had at first feared. As we completed the eye exam, it was pretty clear that this little girl was blind in her right eye.

How do you tell her and her mother this? They did not come in today because they noticed something was wrong with her eye. They came in for a check up, and after her initial diagnosis, initial chemo and remission, then her relapse, more aggressive treatment, and bone marrow transplant, they thought things were just going to get easier from here. In fact, it was probably the radiation and chemotherapy that did it; the same things that probably saved her life took her right eye as payment.

As the resident went to call the referring doctor, the little girl's mom asked me what we thought. What was wrong? Why was it wrong? What was she seeing in that eye--were things fuzzy? Blurry?

I didn't know what to say. I thought she had seen that when we covered up her daughter's left eye, she couldn't see anything. I didn't know how to tell her she was blind in that eye--that she didn't see fuzzy things; she might--might--see a little light when you shined it right in that eye.

Luckily for me my resident came back, and he carefully explained everything, ending it by saying that the little girl could do whatever she wanted, that this would not hold her back in life at all. I added that just last week we did a check up on a physician who had been blind in one eye since birth. The mom didn't cry; she didn't really even look sad. She looked... the closest I can say is that she looked like a solider. She just put her arm around her daughter and said, "Okay."

And I find myself thinking about them tonight. Did the little girl understand what we were saying? Does she know that she won't ever see out of that eye again? Is her mom crying in her bed tonight?

I doubt it. They are much braver than I, and more thankful for everything they have. She has 20/20 vision in her left eye, and for now, that's enough.

Sweet dreams are made of this

2007-07-22T08:33:00.000-07:00

Okay. The stress dreams have got to stop.

Just a sampling of the nightmares I've had in the past few weeks:

Dream One: I was operating with two residents, and we didn't really know what we were doing, and one of them made a mistake and the patient died, right there in my arms while I was trying to save her, and then the resident who killed her starting threatening that if I told anyone there would be big trouble... possibly another murder...

Dream Two: They tell me to do a procedure I have never done or even SEEN, one I don't really know how to do even in theory. But I have to do it, so I start by cutting into this fully conscious dude's scalp with a scalpel, and then I realize, horribly, that I didn't sterilize the area, and I'm not scrubbed in or even wearing gloves, so I try to play it cool but it's too late to use the betadine now, and one of the surgeons calls me over to tell me that I'm not cut out for medicine, that I'm a truly horrible student, not just because I just started cutting without any anesthetic or betadine or scrubbing but also because I keep scratching my leg, and even as she is telling me this I realize I'm scratching my damn leg, and they're telling me I'm no good, and the guy is bleeding, etc etc etc...

This is just a small sampling; there have been many, many other dreams (there are lots, since I've been having at least one, and usually several, per night). So what does it all mean?

It means that 3rd year is scary as hell. It's amazing, and great, and exhilarating, and definitely totally, completely terrifying. If you have never experienced it, the closest I can come to explaining it is to envision that you are on a jetliner, and all of the crew has passed out, and they grab you and plop you in front of the controls and say, "It's up to you to land this plane! The lives of you and everyone on it depend on you!" Then they slam the cockpit door and it's just you and the controls, the millions and millions of controls and blinking lights and switches with no labels. This analogy only works if you have never even set a toe inside a cockpit before.

Alright, enough of my melodrama. The irony in all of this is that they basically never ask you to do anything that matters (which, perhaps, makes it all the worse when you do it ineptly). I have to get some decent studying in since I spent most of yesterday reading the new Harry Potter book (it was AWESOME), and then get some sleep to prepare for my last week of reprieve before my general surgery month. Until then, may you dream of sunsets and waterfalls and butterfiles, none of which need a central line.

Two weeks down, six to go

2007-07-13T14:52:00.000-07:00

So. Surgery.
What can you say?

I've had a fairly easy time so far, as surgery goes. The hours have been very reasonable (for surgery) and the people have been very nice (not just for surgery, but nice by any standard... with maybe one or two exceptions). I'm switching services now though, so things may get considerably more crazy.

So far I've seen some remarkable things. Today I saw a brain. It was just out there, with the skull about 60% removed. It pulsated with every heartbeat. I've seen surgeons drill holes through skulls and noses, bedsores that go to the bone, and tubes threaded through the tear ducts. I've smelled some smells I thought never could exist. I've put staples and stitches into people and taken them out, helped take and place skin grafts, and retracted for 34098213487.3 hours. So, now, at this one quarter-way point, what do I think of surgery?

In short, I have a great deal of respect for surgeons, and for the field of surgery. These people are cool cucumbers, and I salute them. They totally could have made it on the prairie.

From a medical student perspective, however, surgery is very challenging. They don't have much time to tell you what is going on, what you should be doing, etc. It's very scary, actually.

First of all, they engage in something called "pimping". Pimping is when they put you on the spot and ask you questions in front of a big group of people. Pimping is a very frightening experience, even when they are nice and don't really give you a hard time when you get the answers wrong. So far I have been really bad at this process. Even answers that I know fall right out of my head when they ask me in front of lots of other people, and most of the answers I didn't know in the first place.

Also, the OR is a very stressful place to be. It functions in a very regimented way, but that way varies depending on the people running the OR. Some are nice when you don't do things their way; others yell at you. It's hard to remember all the musts and mustn'ts.

Plus, sometimes you almost pass out. This happened to me. It was actually the first time I ever scrubbed in, on a breast reconstruction. I'm not 100% sure what happened, but I think it was a combo of sweating under hot lights and about 50 pounds of occlusive, non-breathing clothing, awkward posture, and the Bovie. The Bovie is an electrocautery device that they use to essentially burn through tissue and it emits all of this horrible smoke. It smells frickin' awful, especially when they are cutting through fat. Anyway I was about to pass out face down on the patient (not recommended) when I fessed up. They were nice as they told me to get out and get a drink of water. It was still embarrassing.

Anyway, there is more to my rambling, but for now I need to get some sleep. I will try to write some more random thoughts tomorrow. Until then, remember this: when they get out the Bovie, always ask for suction. You can suck up the smoke; it really cuts down on the passing out.

Ho. Lee. Lord.

2007-07-05T14:14:00.000-07:00

Okay, people. I'm not sure what to write, because I can only think of maybe three people who would want to hear about the stuff I've seen in the past few days. I'm on surgery--plastics, to be exact--and let's just say we aren't just doing breast reductions and tummy tucks (abdominoplasty). I have seen one of each, however, and let me tell you what:
1. Do not ever have a breast reduction, even if your wabambas are the size of two dwarfs clinging to your chest.
2. If Weight Watchers wanted to become really effective, it would make all of its new clients watch a tummy tuck. Ask yourself: do I want that cupcake bad enough to have a whole Office Depot worth of staples in my body?

Anyway, plastics does lots of other things; hand surgeries, facial reconstructions after car accidents, skin grafts for burn patients, debridement of wounds, etc. My thoughts are as follows. First, do not ever get into a car accident. Second, never set yourself on fire. Third, don't get a giant wound.

I don't mean to be flippant; these surgeons are AMAZING, and the work they do is quite often miraculous. But seeing these patients and what they have to go through makes me thankful every second that I am not sick or injured.

Anyway, the hours haven't been awful. Sure, I'm getting up at the crack of dawn, but the patient load has been pretty light so we've been finishing pretty early. Of course, I pass out pretty early, and have been having to do a lot of reading; in fact, all I've done this week is work, drive, shower, study, and sleep. Occasionally, just to mix things up, I eat.

So far, I really like patient care, if I can get past my fear and confusion and frustration and ignorance and constantly being in the way and not knowing what I'm supposed to be doing or when or to whom. It is slowly getting better, though, and I'm definitely pretty excited to go in every morning, despite the fact that even God isn't up yet.

I need to go study, but I will leave you with this thought: did you know cheese slicers aren't just for cheese?

The early bird gets the nausea when she brushes her teeth

2007-07-01T02:41:00.000-07:00

I've been pushing back my "wake up" time for the past few days so that today, the day before I start surgery, I got up at 5:30am. I'm guessing that, normally, I will have to get up no later than 5am, and probably earlier, depending on how short I can make my morning routine. I think that 4:45am will be a normal time, with the occasional 4am.

UGH.

That's one thing you can say for graduate school: there is hardly ever a reason why you would have to be in lab at a specific time, much less an early one. I mean, some people have lab meeting once a week in the morning, or journal club, but the earliest time for either of these things that I've ever heard is 8:30am. In fact, I had a journal club that was at 9am on Fridays, and I can't tell you how often I was late to that thing (or slept through it entirely).

I did go through a phase where I got in to lab at 7am or 7:30am because my husband was on pediatrics and would drop me off on his way to the hospital. Once I got used to that, it wasn't really that bad; in fact, I got to the point where I would basically wake up spontaneously most mornings. But, somehow, I don't see how that will happen for 4:45am.

What I can see happening is the following:
1. Nausea.
2. Self pity.
3. Occasionally dragging myself out of bed, slowly and painfully getting ready, and being about to leave the house, when my alarm goes off and I realize I am still in bed and it was all a dream and now I have to do it again.

But that's okay. I only have to do it for a couple of weeks, and then I get a two week break from ridiculous mornings when I switch to a service with less crappy hours. But after that, I have four weeks on another service which will start just as early, if not earlier.

So, six weeks. I can do this. Six weeks of getting up in the dark (but I can see the sun come up on my way to work!) and dry heaving when I brush my teeth (maybe I can lose a few pounds!) and being dressed and in the hospital a full three hours before I would normally even consider opening my eyes (but I get to wear scrubs sometimes, which is just like pajamas!!). As you can see, I'm trying to listen to that little, positive voice in my head, but at this hour, it doesn't always make a lot of sense (breakdancing chicken!).

I will try to post a short update after my first few days, but you might not hear from me for a little while. My schedule is packed with pushing my snooze button.

The Drama of Grad School (Rodent Reinactment)

2007-06-21T17:54:00.000-07:00

Click below to see how to respond to the question, "How's the dissertation going?" Be sure to always have a tape recorder handy for the music, a very important thematic element.

Diagnose me, student doctor!

2007-06-19T17:16:00.001-07:00

One really tough thing about being a medical student is that everyone thinks you know lots of stuff and can help them out with any number of medical and diagnostic conundrums. It isn't that I mind answering questions; at least I wouldn't, if I actually knew the answers. That's the problem. At my stage, you don't know much of anything practical. The first two years are basic science, physiology, and the like. There isn't all that much medicine (Surprise! You came to medical school to learn medicine, but first, here are two hideous and painful years of genetics and biochemistry!).

You do learn some medicine; but as I said, what is really lacking is "practical" part. You see, the medicine you learn is the kind of stuff that would scare the living bejeezus out of people if you told them about it. What they mostly teach you are worst case scenarios, I suppose to prevent you from missing those and causing someone to die later on when you are actually doing medicine stuff. For example, the fact that a headache is just a headache in 99% of cases isn't really emphasized very much in the first two years. Rather, you learn about meningitis, epidural hemorrhage, West Nile virus, tumors, and a slew of other horrible things that it could be. We are taught that even something as innocuous as a runny nose could be—and again, it isn't as though this is likely, even if you have recently sustained a major head injury—cerebrospinal fluid leaking out of your brain. Do you see how this type of knowledge might be a problem when trying to council people about the possible cause of their typically completely benign symptoms? “Well, Aunt Molly, your abdominal pain could be that ten day old tuna you ate, or you could have a bowel torsion leading to ischemia which requires surgical removal of your colon so that for the rest of your life you will be pooping into a bag.” I therefore try to refrain from doing this, unless my last birthday gift from the person was less than satisfactory.

Of course, as I said, the alternative to knowing the most horrible possibility is simply not knowing any possibility. This is also very common. But your loved ones seem so confident in your abilities, so certain you will know the answer, so trusting, that it is hard not to just make something up on the spot. It’s important to make up a name that is complex enough that the loved one will not remember it, and then follow that up by telling them that they should talk to their doctor about it. You know: “Hmmm. That sounds like it could be superiomedial recurrent extraclavicular uvulitis. You should probably talk to your doctor about that.”

In any case, remember that most of what medical students know is worse than knowing nothing. Don’t ask for their opinion of anything, except maybe pizza toppings. In the meantime, I’d be happy to give you my opinions on what that strange rash might be. I’d have to go with leprosy.

Hello! You look familiar… are we married?

2007-06-17T11:51:00.000-07:00

Being in a program like this one can be a strain on all kinds of relationships. Your parents don’t really understand what you’re doing, or why you don’t know yet if you will have to work over Christmas. Things between the mudphud and his or her spouse/partner is even worse: The mudphud partner is exhausted, stressed, emotional, and has almost no spare time and no control over his or her life. The partner is lonely, bored, frustrated, and tired of hearing the mudphud constantly bitch about stuff. I know all about this from both sides, since my husband is also an MD/PhD student. I haven’t decided if being married to another crazy person like me makes things easier or harder. I’m pretty sure it’s both.

On one hand, we have all of the negatives associated with this mess times two. Both of us have very demanding schedules with long hours that we can’t control. Both of us have to study even when we get to be at home. We have both been through a major episode of clinical depression, aka “graduate school”.

On the other hand, we at least understand why the other has to do these things. I think all mudphud or medical spouses kind of understand. But the more I do this the more I believe it’s kind of like being at war with someone. It’s impossible to really, truly understand what it’s like unless you’ve been through it yourself.

There is another interesting wrinkle to this for me, which is having a front row seat to the madness to come. My husband is a year ahead of me in the program, so I get to watch the events—and the effects of those events—before they happen to me. I knew that finishing grad school, writing my dissertation, etc, would be hard. After watching my hubby go through it, I redefined my expectations of “hard”. Knowing exactly what I’m in for this coming year is good and bad. There is less mystery and I have the advantage of his survival tips and gems. On the other hand, I know things that other students at my level seem to not understand yet. For example, at our last class meeting, one of my classmates asked how many weekends we were going to have to work on surgery; another asked who they had to speak to to make sure they could leave by a certain time every day. I was almost the only one to laugh.

Anyway, the absolute hardest part of all of this is not getting to see very much of your spouse. My husband is my best friend and I love spending time with him—that is, after all, why I married the guy. It’s been hard all year, but now that I have lots of time and he has basically none, it is much worse. In a few weeks I won’t have much of a chance to think about it, but sadly he will have quite a bit of free time next year, and it will be my turn to be totally slammed. We will basically alternate this way—one of us AWOL, the other with a reasonable amount of time—for the next three or four years. Then, God willing, we’ll have more time and say-so about our schedules. At least we will have time off together, for the first time in a few years, for the holidays this year. And in a week we get a whole week off together! It’s the small victories you savor in this business.

I’ve been writing this while waiting for him to finish a question set. He’s studying hard for his last shelf exam (very difficult exams at the end of each rotation), but I have gotten to see a little of him this weekend, which has been great. He’s ready to take a break now, so off I go. I’ve learned that these past few years; be flexible, and you might just remember what your spouse looks like.

Studyin' again... naturally

2007-06-16T09:57:00.000-07:00

When you're in medical school, you--by necessity--get used to studying a lot. I did my fair share in first and second year, but I was probably in the bottom third of the class in terms of hours logged. I'm not proud of it, and in fact, if I could, I would go back and kick up the hours I spent (not enough to push me into the top third, but a healthy middle of the middle third). In any case, what is done is done, and all I can do now is learn from my regrets.

By, for example, starting some proactive studying now, while I have lots and lots of spare time, before I start surgery and become overwhelmed with the hours. I have done a little bit, but nothing close to the one hour a day deal I had with myself before I started vacation. What the hell is my problem? It's not like I have anything pressing other than moving the laundry into the dryer before it mildews. It could be any number of things:
1. I'm scared to start studying again in earnest, because it will make me realize how much I've forgotten and made me even more nervous about starting back.
2. My brain reasons that starting too early will just be a waste of time since I will forget the stuff before I start.
3. I'm still recovering from graduate school trauma.
4. I'm a pathetic loser.

I think number four there has the edge. I mean, they all have merit, but it's number four that cuts to the heart of things. Some people think that insane individuals like me, who have chosen years and years (and years and years) of schooling like to study, or have a crazy robust work ethic, or whatever, but I am living proof that that is not always the case. However, once again, my recent fascination with LHotP has shown me the light. Yesterday's episode featured Pa working four jobs, seven days a week (including the Lord's day, as Ma repeatedly reminds him), from before dawn until after sunset, and then continuing to stack giant bags of grain despite four broken ribs, all so he wouldn't lose the farm. As I watched him sweat and wince and stagger and fall (all in a very manly fashion, of course), it occurred to me that picking up a book and doing something with my brain for one stupid hour out of the day is not such a big deal. So now, I go to read. For real. Seriously. Right after I take a little nap.

The four most important decisions of graduate school

2007-06-14T18:25:00.000-07:00

Yes, there are lots of chump-traps you need to dodge to survive. But in essence, there are four decisions which will determine the bulk of your misery or happiness (okay, I'm not positive that one can truly be happy in graduate school, so let's say.... not-misery) in graduate school. Here they are, in order.

1. Make sure you really want to go to graduate school. This sounds silly, but I can't tell you how many students I ran in to who had not actually thought about this decision very much. Some did it because they were done with college and didn't really want to get a "real" job. Some did it because they did an undergraduate research project and kind of liked it. Some didn't know what else to do, and some like the idea of research and science but don't yet realize they hate the day-to-day. By my estimate, about half of these people drop out of graduate school, and the other half don't quit, usually for the same bad reasons they decided to come. Then they end up doing something totally different, usually after languishing for years. These days graduate schools are trying to limit entry of these people by requiring at least a year of post-undergraduate research, but sometimes that isn't enough. It's up to the individual to really understand what research is like; how political and grueling and repetitive and sometimes empty it can be, how much reading and writing and 'rithmetic is involved, etc etc. Make sure you understand these things, plus what kind of careers and pay is available to you if and when you get that degree. Make sure you are really happy with at least two of the options.

2. Choose the right department. Don't make this decision based purely on the subject matter. Know important things such as the nature of the preliminary (or qualifying) examination, class and teaching requirements, graduation requirements, reputation, pay, etc., all of which can sometimes vary widely from department to department. If you are an MD/PhD it is very important to learn how each department you're considering has treated mudphuds in the past, because believe me, this can vary wildly too. Often, if you like a particular primary investigator (PI, the person who would be your mentor/boss), and the project you are interested in is related to another field with a department which is a better fit for you, the PI will consider getting a joint appointment so you can have your cake and eat it, too.

3. Choose the right PI/lab. I've mentioned this in the past, but it is very, very, very important to find a PI whose style and personality is a good fit for you. For example, if you are a normal, balanced person, you would not want to work for a Yankees fan, since they all have strong tendencies towards evil. Don't work for a control freak if you are a control freak. Don't work for a slacker if you are a slacker. It's kind of like finding someone to marry, someone who will balance out all of your crazy parts, and whose crazy parts you can in turn balance out. Also it is better if you don't want to stab them with any handy object, blunt or sharp, after speaking with them for short periods of time. As I said, the other people in lab can be a good measure of this. Ask yourself: Do these people look despondent? Depressed? Are all the windows nailed down to prevent further suicide attempts? Are they angry? Drooling? Does their skin show signs of having seen even a few seconds of sunlight in the past year? These are important things to know. Also, ask about people who have recently left the lab. Did they do so in a tight, wrap-around coat and a white van, escorted by men with tranquilizer guns? Or did they move on in a normal span of time to a respectable position at a respectable institution (not the kind of institution the white van was going to)? Also: do you hate them?

4. Choose the right project. I learned this one the hard way. It might seem all shiny and flashy and awesome to start a new project, but this is the kiss of graduate school death in 95% of cases. Read that sentence again, because you, like dumb ol' me, will almost definitely be lured into this crap. You have to remember: It almost never works out for you. Who it works out for is the graduate student who follows you. And what are you, Mother Theresa? No, you will never graduate with that kind of altruistic attitude. What you need to find is some other poor Mother Theresa sap senior student who was tricked into starting such a project and is leaving and is ready to hand it to you with the four or five years of crappy, monotonous leg work all done. You might have to be co-author on the first paper (maybe), but believe me, it is almost always worth it. Also, the PI should be able to outline for you what sort of stuff will be included in your first paper in a decent amount of detail, and it should make sense to you and stand up to some hearty questions.

So there you are. The four main decision tree branches leading to graduate school success. Just try not to fall out of the tree, and you'll be all set.

The MD/PhD Journey: Welcome to the bottom of a new ladder!

2007-06-13T13:49:00.000-07:00

One of the most difficult things about the MD/PhD training program is that every time you start to get good at something, you have to switch to something totally different. It’s not that there is never any overlap, but you are usually a stone’s throw away from square one, if not smack in the middle of it. Also, if you were starting to gain any kind of clout, you slide immediately back to whipping boy/girl.

The first is when you start medical school. Almost all medical students are starting something totally new, in a new language. It isn’t until you take Step 1 of the Board Examination at the end of second year medical school that you begin to feel like you know something—however meager—about medicine. It took two years of hard work, but you know something. At this point most medical students proceed on to third year, which in a lot of ways is a step down again, since it is very clinical and different from the classroom learning of years one and two. Also, although it is building on the foundation laid during the first two years, there is an enormous amount of new material to learn. This is also prime whipping boy/girl time, as you are the lowest man on the totem pole in the hospital (although some would argue that interns have it worse, and in a lot of ways this is true). However, you proceed with your classmates, so you at least have peer support. And that foundation of knowledge is still fresh and strong to learn the new stuff.

At this stage, MD/PhD students go to graduate school instead of clinic. This means that you start completely over. New classes, a totally different set of things to know, new (and often strange) people, etc. It isn’t until you are finishing up that you feel you are just beginning to learn the field you have chosen for your PhD. You have become attached to a new set of people who you have to leave again, and you have had plenty of time to forget all of that nice foundation you spent two years building up. You’re starting 3^rd year with a group of people who are largely strangers, most of whom are 4-8 years younger than you (whippersnappers!!). If you are lucky, there might be a few other MD/PhDs returning with you to 3^rd year, and if you are really lucky, you might like some of them, but it is unlikely you will have any rotations with them. You start completely over—again.

I’ve been told that there is not quite as much attrition in the medical knowledge as you fear; that it comes back faster and better than you expect. I hope that is true, but it still feels like I’m starting over for the third time in six years. But at least I get to stick with the clinical stuff for a while—probably about six years—before starting back in lab. Also, even then, I will still be doing clinical stuff, so in a way, I’m finally starting the job I’ll have the rest of my life. The one I've been working towards most of my life. Finally. There will be other ways in the coming years in which I'll be starting at the bottom of new ladders, but at least they will be ladders above the ones I’ve been climbing so far, and not on totally different walls, if you get my meaning. It’s a good feeling.

TODAY ON LITTLE HOUSE: Carolyn goes through menopause, becomes despondent, and fears Charles will no longer love her. Instead, they get remarried. Is there any issue this show doesn’t tackle?!?

"I did absolutely nothing, and it was everything I dreamed it could be."

2007-06-11T10:14:00.000-07:00

So, I’m on vacation (hence the lack of posts). It hasn’t hit me yet that I am totally done in lab, but it feels awful nice to not be there. Yesterday I was painting a (very pathetic) picture when my phone rang. It was a friend of mine who is still trying to finish up, with a technical question about an experiment. I put down my paintbrush and answered his question, and he asked how things were.

Awesome. Things are awesome.

The time is going by frighteningly fast, but it is great. A few days ago I didn’t even change out of my pajamas until 3pm. Pathetic, you say? Definitely. But I’ve really been able to catch up on my Little House.

Let me tell you what: the shit always goes down on the prairie. One of my best friends, Andrea, and I realized this some years ago. We didn’t notice it so much when we were kids watching the show, but as an adult it can really put things in perspective. Have a rough day at work? I’ll bet it wasn’t as bad as the time that Pa got run over by the giant, one-ton milling wheel. Got stuck in traffic? Not as bad as the time that Mary, newly blind, got into a really bad stagecoach accident, was stranded for days with her also blind husband trapped under the coach, and almost died in the open plains. Missed your favorite TV show? At least you didn’t lose your baby and your best friend, mother of two young children, in a boarding school fire.

I haven’t just been sitting around watching LHotP. I’ve engaged in other highly impressive activities, such as going to the grocery store and occasionally showering. I’ve had a really good friend visiting so we’ve been hanging out and that forces me to put on real clothes, but I’m going back to the PJ’s when he leaves on Wednesday.

I worry sometimes that this lifestyle is spoiling me, and it will make it all the more painful when, in a few weeks, I have to get up at 4am, work for 15 hours, come home and eat whatever is in the fridge while studying for several hours, and then pass out, hopefully in or near the bed. On the other hand, maybe it will get me nice and rested up.

I sure will miss Little House, though. I might have to check in now and again, when I really feel sorry for myself, and see what kind of horrible plague has descended on the people of Walnut Grove, or who died in a tragic barn raising accident. It will help me remember that they, too, have to get up at 4am, but I'd take walking around an air conditioned hospital over slaving in scorched fields any day.

Graduate skill set number 2,304: Evaluating yourself

2007-06-07T06:08:00.001-07:00

Every now and then, a grad student is lucky enough to have a mentor that will praise him or her on a regular basis. This is so rare that I have never heard of it happening. Usually, as a grad student, you are only praised once in a blue moon. And I'm not talking about mediocre or plain bad grad students, and I'm not being picky about what I call "praise", or requiring that kudos be lavished for the tiniest or most simple tasks, such as mearly showing (although sometimes this would have been very helpful). No--for the sake of this argument, let's give praise this definition:
When you are doing an exceptional job, or accomplish something impressive, you are bestowed with the following words: "Good job."
Even with this measly definition of praise, it doesn't happen very often. In fact, it wasn't until after my defense that some members of my committee very slid some really quality praise into our conversations. They did it almost sneakily, as if afraid that I would notice that they praised me. And we certainly couldn't have that.
I vividly recall when a particularly no-nonsense, kind of gruff bigwig told me one day, almost off-handedly, that I was a very good grad student, and he thought I would be a great researcher. I was so surprised that I said something like, "Wow, it's nice to hear that. We don't really get positive reinforcement like that."
He looked at me strangely and said, "You shouldn't need it."
I thought about those words for a long time. On one hand, it's true. We should be able to get to a point in our training where we know if we are doing a good job; we shouldn't need to hear it from anyone else. On the other hand--and I think this gets to the core of why grad school is so hard--we are beginners. Students. Just starting out. But they never really treat you like that. No, the way they approach training is to throw you in with both hands, and turn and walk away. A lot of the time they don't even stick around to see if you sink or swim; they might come back a few years later and see if there's a body to fish out of the pool, but that's about it. It's not as though they lavish you with praise early on and wean you off of it over time. No, in most cases, if they run into you later, they'll say, "Hey--way to get out of that pool without drowning."
So, if you are a mentor with access to grad students (they're easy to spot; just look for the most haggard, depressed people in the halls), I implore you: throw a little kindness their way. If they are doing a great job, would it kill you to let them know about it? In my experience, one morsel of praise can sustain a downtrodden student for months.
In the meantime, we will have to develop the ability to evaluate and praise ourselves. This task is almost insurmountably difficult, at least for me. If you're an insecure person (me!), it's tough to be fair with yourself. If you're an overly confident person (I know lots!), it's tough to be fair with yourself. But, with practice, and importantly, some caring, honest friends, you might be able to get to the point where you look yourself in the mirror after a particularly trying day and say to yourself:
Boy, you sure did screw the pooch on that one.

ATM, PDQ, ASAP FBI

2007-06-04T17:38:00.000-07:00

I start my surgical rotation July 2^nd. To prepare for this, I have begun the following regimen:

I have my husband wake me up at random intervals throughout the night, and if I do not immediately and accurately recite the Gettysburg Address, he beats me with a sock full of nickels.
Sometimes, when I get out of my car, I slam my fingers in the door on purpose.
I’m slowly weaning myself off of coffee so that when I start it will be potent enough to keep me conscious.
I’m reading some of the study books for the surgical rotation.

It’s that last one that is really the problem. You see, doctors record patient information in the form of “notes”, and since doctors are usually too busy to even sign their full name (ever noticed that if your doctor’s name is, say, William Slatherington, his signature looks like Wie Saaa?), they have invented a lot of shorthand to write these notes. As a medical student I need to be able to (1) read, (2) understand, and (3) write this medical shorthand. So far this is not going very well, in the same way that the maiden voyage of the Titanic did not go very well.

How bad can it be? Well, friend, allow me to slide a little taste of confusion your way, in the form of this ACTUAL EXCERPT which I totally swear I am not making up. Seriously, I am copying this verbatim.

55 yo WM admitted for perforated PU, HD#3, POD#2 s/p Graham patch, NPO, abx=Ancef D#1/5, Flagyl D#1/5, central line D#1

D5 ½ NS @ 80cc/hr, JP output->15cc-12 hr total

PE: Gen: WD/WN male in NAD, A&O x 3.

CV: RRR, nl S1/S2, no M/R/G

Chest: CTAB, no W/R/R

Fantastic!!! Now, if you are a layperson, I know what you’re thinking. You’re thinking that since I have had two years of medical education that I can understand at least part of that mess. Allow me to correct you. My general reaction to the above string of letters and numbers is an abbreviation that I do know, one that you may be familiar with: WTF?

It’s kind of like reading personal ads from hell. I am slightly heartened that I managed to correctly guess what about three of the above letter strings stood for. Three. After two flippin’ years of medical school. Other than that it looks like one of the subway signs in New York.

I just wanted to fill you in on how things are going (Great! Just great! Haha!), and now, if you don’t mind, I’ll return to my regularly scheduled panic attack which was already in progress.

Moving out of lab; aka, What IS that?

2007-06-03T07:51:00.000-07:00

Today is my last experiment, and tomorrow I develop it, analyze it, and leave lab for good.
Leaving a lab is sort of like leaving an apartment you've lived in for four years. Instead of food in the fridge, you have reagents and solutions in several fridges as well as up to five freezers of different temperatures. Going through these can be kind of depressing, since I wrote the date on them, and some of them date from 2003. 2003, for God's sake!!! There are also emergency supplies (such as a real necessity for research, aspirin) stashed around, a lots of random things with crazy memories attached to them.
Case in point: We have a small troll doll--the kind with the crazy hair--that has been our lab mascot for years. It dates from a time when I was on my way back from another facility about 20 miles away at 1am, having just finished an impressively boring 6 hour experiment. I realized I was starving, which made sense, because I had last eaten at lunch. So, I stopped at McD's and got a happy meal. Inside was this crazy troll doll and I thought, you know, this is the perfect mascot for our lab. Why? Because things like this make a lot of sense at 1am.
There's also the white mouse stuffed animal that one of my best friends left on my desk when I found out my mom had breast cancer. My giant microbe collection (don't laugh--they're awesome!), my Wonder Woman pez dispenser, green tea, and my Far Side cartoons... you know, the random crap that got me through the day.
Packing these things up gives me the finish I didn't get--it is graduation from grad school. Am I happy? Ecstatic. But a little sad. It's hard to leave something you've been doing for four years. I'll really miss the people. Okay, some of the people. Some of them I'm hoping to see soon, and some of them I'm hoping to see in prison, or perhaps cornered by bears.
The weird thing is that I don't really have a place for this stuff any more. Where does it go now? In a box, I suppose, with the rest of the souviners from previous stages of my life.
Except the troll. That stays, because I had to leave a few people behind that are going to need a mascot.

The anti-climactic finish to the hardest climb of my life

2007-05-29T14:07:00.000-07:00

I never thought I could sleep this much. I've been clocking about 10 hours most nights. It's shameful. You'd think that I would have too much pride to try and squeeze in a nap after a night's sleep like that, but you'd be wrong.
The countdown to no more lab is three days, but I haven't needed to go in for the past few days. I have one small experiment left.
It's kind of funny. Finishing grad school has all the markings of any other grad school activity. Poorly defined but required duties to complete. Lots of deadlines, some of which don't have dates associated with them, some of which are firm, some of which are not, none of which are labeled as such. And when you finally complete all of the duties, meet all of the deadlines... nothing. Okay, there's one thing: other scientists jokingly call you "doctor" and sometimes ask "What are you still doing here?", which is a question you ask yourself every five minutes when you are back in lab. But most graduate students don't "walk the line" (participate in a graduation ceremony). You aren't handed a diploma. You do have a public defense where you present your work, and some people treat that as a graduation, but it isn't. After that is done, you still have your private defense, and after that, you have to (sometimes) make changes to your dissertation as requested by your committee, and then you have to get the darn thing formatted for acceptance by the graduate school (this particular chore is one of the most confusing things you will run up against). Once you have filed for graduation, defended, submitted your dissertation, had it accepted, paid a bunch of money to get bound copies of it (these people are sly and merciless; it is impossible for the weakened grad student who has spent four years or more putting together their dissertation to resist paying any absurd amount of money to have a bound copy), then you are often still not done. There are papers to submit, revise, and submit again. There are almost always more experiments to do (you soon run out of fingers to count the one last experiments your boss/committee/journal reviewers are asking you to do). Almost always, you go right back to doing what you did leading up to the defense. Most mornings I wake up and go in to lab and wonder if I finished at all.
But I did.
Holy Lord, I did--can you believe it??
And come Monday, my "last" day in lab, maybe it will sink in...
Until I get an e-mail from my boss asking me to re-format the paper, or find a protocol, or maybe do just one more experiment...

Surviving Graduate School, Pt 3: Constant Dripping Hollows Out a Stone

2007-05-28T07:57:00.000-07:00

OK! You've avoided being a chump, and are master of your own destiny. Now what?

One of the most difficult parts of graduate school is finding the determination to trudge on when your project is in the crapper. Don't underestimate how hard it is to show up and do experiments over and over when nothing is working. I think this is one of the ways in which graduate school as han edge in difficulty over medical school. There is constant pressure and obvious consequences in medical school for not making progress and forging ahead; the things you need to learn are laid out in front of you, and if you don't learn them, you will fail your class. In graduate school, there are rarely actual consequences to having spans of months where no progress at all is made on your project. Which can be good, because sometimes it is out of your hands; sometimes, no matter how hard you work or how many hours you put in, there will be nothing to show for it. However, the lack of consequences can really undermine your work ethic. It's a constant struggle to find ways to motivate yourself.

There are two steps to getting things done, if you think about it. Sadly, they aren't always as easy as they sound.

Step 1: Show up
Sometimes you will wake up in the morning, lay in bed, and think about how you are so sick of trying things that don't work, how you're sick of lab and graduate school and you just need a break. You'll probably find that your brain can be very persuasive those mornings--it will have very convincing and reasonable sounding arguements as to why it would be okay for you to just take the day off. This is one of the many reasons to try and find a lab which has people you enjoy being with. Finding one or more people to work next to that you like can make the difference between just barely scraping by and actually thriving. There were many days when the only thing that got me out of bed and into lab was knowing that at least I would see my friends, and they could give me a pep talk.
There are other tools also. Self bribery can be very helpful. Depending on the lab you join, there may be plenty of motivation--in the form of having your boss berate you for hours--to at least show up. Side note: some bosses don't even notice if you don't show up for a few days. You should decide if this would be good for you or bad for you. I know it sounds nice now, but it can be helpful to know that you will be missed if you don't show, because sometimes things are so rough that even awesome labmates won't help.
Of course, showing up isn't enough. Once you get in to lab, it's time for:

Step 2: Do actual work
First, briefly congratulate yourself for shaking off those two weeks of long hours and hard work that went into the garbage yesterday. Now it's time to get down to business. This may not be as easy as it sounds.
You see, there is this kind of quicksand that can form in labs. Chances are that at any one time there are at least two people for whom things aren't going well. And in the days of computers, and heading out to lunch, there are about ten million ways in which you can be technically in lab but not actually doing anything. You may be able to escape this temptation normally, but having someone else around that is as frustrated, as tired, as disillusioned and as unmotivated as you forms slacker quicksand that is well nigh impossible to escape. Watch for this quicksand, and avoid it if you can.
There are two sayings that really helped me pull out of this quicksand. The first is the title of this entry: constant dripping hollows out a stone. I liked to say this to myself as I got up to start repeat number one billion of an experiment I didn't want to do in the first place. The other is: you can't till a field by turning it over in your mind. Another trap is thinking, and planning, and thinking, and planning, but never just doing your experiments. At some point you have to just get up and do it.
Because the truth is--and you have probably noticed this as a theme so far--that only you can get yourself through grad school to your degree, and you do that by trudging on.

Surviving Graduate School, Part 2: Be the Captian of Your Own Ship

2007-05-25T09:37:00.000-07:00

This sounds fairly self-explanatory, and it is. However, for some reasons, scores of graduate students everywhere are floating around randomly on bobbing, captain-less ships. Or, they are sailing towards a slave port, because they have allowed their ship to be captained by someone else (it is important to assume, until proven otherwise, that everyone around you is looking to sell you into slavery).

Actually, in many ways, this is my philosophy of life: life is not just stuff that happens to you. It’s what you do to stuff, if you get my meaning. I’m not a terribly patient person, so I was lucky enough to learn early in the grad school process that it is important to take initiative if you ever want to escape. Because it is highly unlikely that anyone else is going to push you to check things off of your list and eventually graduate.

Find out what you need to do and when. Have conversations with your boss about what he or she expects from you. In short, be proactive. As a side note, I also learned this the hard way back a million years ago when I was working in the real world. I was horribly underpaid, and when I found out that I was making less than new people with less experience, I was very, very angry. I even started looking for another job, but as it turned out, all I had to do was to go to my boss and say “I deserve to make X amount of money.” He agreed, and my salary was increased by about 70%. Basically, very often people will give you as little and take as much as they can get away with. I don’t mean this as cynically as it sounds, but it’s usually true to some degree. If you are good at your job and are being mistreated you need to be your own advocate and stand up for yourself. This is definitely true in grad school too.

So get out there and steer, people! Your ship’s a-waitin’, and if it helps, I have an eye patch and a parrot you can borrow.

Surviving Graduate School (And Possibly Even Getting Your Degree), Part 1

2007-05-24T11:53:00.000-07:00

Foreword

First of all, a word as to what I wish to accomplish with these next entries. If you are reading this, I figure you are 1) considering graduate school; 2) in graduate school; 3) know someone struggling through graduate school; or 4) incredibly bored. Hopefully I will address things which will be helpful, or at least amusing, for all of you. That is my main goal. My secondary goal is to have a hobby which prevents me from having fantasies of slipping into a coma—not a serious coma, mind you, but one like in the soap operas, where you wake up feeling refreshed and with no loss of mental or physical function—while I finish up my own graduate degree. I hope it will give me a sense of accomplishment, passing on what I have learned; a sense of accomplishment that is simply unattainable by writing or defending my dissertation. This may sound strange, but I think you’ll understand what I mean after reading some of what I have to say. Some of these lessons may even be useful in the non-graduate school “real world”. However, I have completely lost touch with the real world, and therefore I can’t say for sure.

When I started Graduate School—what seems like a kazillion years ago—I had no idea what was in store for me. I had done quite a bit of scientific research and felt I was pretty good at it; I had learned the ups and downs and ins and outs in the way that you can only learn by being in a lab for years. This worked for me and against me, as I will detail if I remember to. Herein you will find tips, tricks, and warnings which are based upon my experiences and the experiences of other grad students (friends of mine) and are therefore only opinions and suggestions. We therefore make no guarantees, even though we are TOTALLY right and you would be a complete chump not to take heed.

PART 1: DON’T BE A CHUMP

This should be your mantra in graduate school. Don’t be a chump. And I think you will find (sometimes in retrospect, unfortunately) that there are a metric crapload of times that you will be prepped for prime chumpitude in graduate school. Here are just a few.

Potential Chump Situation #1: Becoming involved in a poorly thought out research project which has little or no chance of resulting in meaningful progress for you.

Warning Sign: Whoever is trying to get you involved in this mess is very enthusiastic, vaguely pushy, stands a lot to gain, but probably won’t have to put forth much more effort than you will; says things like “This could get us a quick/easy publication.”

Upon further inspection: This project will take up oodles of your time, but will not be part of your dissertation. There are two exceptions: first, if you are guaranteed authorship for a set amount of work, regardless of the outcome, and feel you can finish the said work in one week or less, it may be worth it. Second, if doing it would put the other person in your debt, and you think you can later use this to your advantage, consider it.

How not to be a chump: First, define all the details—specifics about the experiment and specifics about the authorship. If the deal is no good for you, just say no. This is a very important theme you will see throughout these pages: sometimes you have to say no. If you are no good at saying no, learning how to do so now will save you time and sanity. In fact, this is a good time for…

Potential Chump Situation #2: Not saying no to things you should say no to.

Warning Sign: Your boss (and basically everyone else) not only comes to you for everything, but sends others to you, too.

Upon further inspection: You have become a doormat. Sometimes people don’t even ask you to do stuff anymore, they just tell you to. I’m talking training others, organizing stuff, picking up other people’s slack, and so on.

How not to be a chump: In this area, all grad students have to be somewhat of a chump. You will have to do things that aren’t your job, and if you are any good, you will have to do more of this than other, stupider people around you. So in a way, it’s kind of a complement. The trick here is to find where to draw that line in the sand. Being fairly Machiavellian myself, I tend to ask myself the following question before doing just about anything for anyone: “Will this, somehow and at some point, be helpful to me?” Be sure to ask this inside your head. For some reason, people tend to think you are a jerk if you ask it out loud.

Potential Chump Situation #3: Waiting around for someone else to be the captain of your ship.

Warning Sign: You don’t know what you need to do to graduate.

Upon further inspection: You’re waiting for your boss to tell you to take your prelims, to form your committee, to write your papers, and to generally lead your life.

How not to be a chump: Surprisingly, the way out of this one is: be the captain of your own ship. I will talk more about this in Part 2 of Surviving Graduate School, coming soon to a blog near you.

Paging Dr. Idiot...

2007-05-23T17:15:00.001-07:00

I'm having this really terrifying experience over and over again, now that I'm starting to get back into the clinic. Basically someone mentions a medical finding or fact, or sometimes asks me a question about medicine, and one of three things happens:

1. My brain drops into my feet and I can't form real words, just words like "whosywhatsis" or "thingy", which are not traditionally accepted medical terms.
2. The initials of the answer pop into my head, but nothing more (for example, if the answer is "pyogenic granuloma", what my brain comes up with is "P. G."). This is not even a little helpful, and I'm pretty sure my brain is intentionally taunting me.
3. I come up with something that is kind of similar--for example, a related disease which would appear on the same page of a medical textbook as the correct disease, but is not actually the correct disease. You might think that isn't too bad, I'm in the ballpark and all, but it is true that close only counts in horseshoes and hand grenades. Not so much in medicine. For some reason, they always want you to be actually right, not just kinda right. What makes this much worse is that I think my answer is actually correct.

They say that all the stuff you learned in 1st and 2nd year medical school will come back to you. I'm clinging to that idea like a ramora. Other than the creeping suspicion that I am a medical idiot, things are going well. Lab stuff has wound way down and I'm trying to do some studying. Notice I say trying.

I'll try to post some stuff I wrote a little while ago about graduate school tomorrow. In the meantime, if you're looking for medical information which is incorrect in one of three idiotic ways, drop me a line!!

Grad vs Med: The Smackdown

2007-05-22T10:29:00.000-07:00

A lot of people have been asking me about school lately. My graduate school peers have asked how medical school is different, the doctors I've been working with have been asking about the PhD. Really, both groups mostly want to know which is "harder". Right now, I am leaning towards graduate school being the more difficult of the two by a hair, but that may be because it's what I've been doing for four years. I've come up with two metaphors to explain the differences between the two training paths; the first struck me within in the first year of graduate school after finishing two years of medical school, and the other has been very recent, having been developed after the struggle to publish and graduate.

NUMBER ONE--THE GYM METAPHOR:
Graduate school is like strenuous cross training; medical school is like doing 2000 right biceps curls. They're both hard, but for different reasons.
I can see now, looking back, that I was still smarting from the butt-kicking that is first and second year medical school. And the point of the metaphor still holds; that is, the first two years of medical school are grueling and involve very little thinking and a whole truckload of memorization, and graduate school is also grueling but because there is a lot of thinking and reading (and doing experiments, sometimes over and over).
But over these past few years I have developed a sort of fondness for med school. For one thing, I had WAY more free time. For another, there was a great deal of structure, which brings us to--

NUMBER TWO--THE DRUGGED AND LEFT FOR DEAD METAPHOR:
Imagine you are sleeping in your bed, and suddenly wake with the feeling someone is in the room. You open your eyes in time to see masked men chloroform you back into unconsciousness. When you next awaken, you are in a completely unfamiliar and uninhabited jungle, with no apparent trails, paths, or indication of where you might be. Next to you, you find a map and compass with a note: "500 miles to civilization. Good luck, and watch out for the tigers." This is medical school. Graduate school is the same, only when you wake up you are naked and they didn't leave you squat.
Clearly, when I came up with this metaphor, I was feeling the angst of the complete lack of structure which is rampant in graduate school. I am the kind of person who likes to make lists and cross things off. (Confession: I have also been known to add something to the list which I have already done so I can immediately cross it off. I know there are more of you out there: don't deny it.) People like me are bound to feel some angst in graduate school where everything tends to be "fuzzy", including expectations and deadlines. This drives me absolutely nuts. Being someone who enjoys a good rant, I'm sure I will be writing much more about the trials and tribulations of graduate school in the future.

For now, I have to say that the Grad vs Med smackdown is not over. It's the 6th round, and both contestents are reeling on their feet, but no clear winner has emerged. Stay tuned...

Never say never.

2007-05-20T13:51:00.001-07:00

I have been saying for two years that I would not start a blog, which is actually a bit strange; one of my primary hobbies is talking, and back before my career path completely eclipsed the rest of my life, I wrote a great deal. However, over the past few months I have been toying around with the idea of starting a blog about my career path/education, and a few days ago, one of my best friends suggested she might actually read such a thing, so here I am.

So what is this crazy career path which, in my somewhat damaged mind, is worthy of yet another blog in a vast sea of blogs? I am a "mudphud": an MD/PhD student. We are a crazy lot, and gluttons for punishment. I am currently 6 years into an 8 year program. The length of the program can vary according to the duration of the PhD. Medical school is fixed at 4 years.

The structure can vary somewhat from school to school, but the "traditional" structure of the MD/PhD program is as follows:
-Medical school years 1 and 2 (Year 1 is mostly basic science, physiology, anatomy, etc., and year 2 is slightly more clinical, but still almost all of these years is classroom learing)
-Graduate school (the PhD portion--this usually takes four years, but often takes five; some lucky souls escape in three; it depends on the department, the project, and the lead scientist)
-Medical school years 3 and 4 (Both are clinical years spent mostly in the hospital)

Having just completed my PhD, I am about to return to finish the last two years of medical school. I have been writing some essays about surviving graduate school over the past year, so I will post some of that here. I'll also be trying to post some of my experiences on the hospital wards. 3rd year medical school is an enormous transition even for medical students proceeding from 2nd year, but for me, who has spent the last four years in a lab obtaining a PhD, it is kind of like switching from the swimming portion of a triathlon to the cycling portion. I'm pretty sure I'll need training wheels.

I hope my foibles during these experiences, past and present, will be amusing to read about (feel free to laugh at me as well as with me) and I will try to be as honest as possible about my experiences. So please, join me, will you? Especially if you are looking for a perfectly innocent way to avoid doing anything productive, even if only for a few minutes.