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

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

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?

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!

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.

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

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

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.