You're excited to get off clinic early not because it gives you an afternoon off, but because it gives you more time to study.
What's That Spell!?! PROCRASTINATE!
OCTOBER 8, 2007
I should be studying right now, but like all things in life, there are some things more important than school and one of those things is procrastinating.
Each classroom gains its own dynamic - an ebb and flow of personalities that can make your experience in that class either a joy or hell on earth. Luckily my experience in GIE has landed somewhere in the middle, but since I'm the type of sit back and enjoy lecture rather than furiously scribble down notes, its given me an opportunity to observe some of the idiosyncracies of our lecture hall at this time. Since we're over halfway done with the class and things will soon be changing, I thought this would be a great chance to give you all a look into the what its like to sit in a 160 person medical school lecture hall at god awful times in the morning digesting a truly evil amount of information.
Thus I present... my lecture hall and all that makes it wonderful.
Exhibit A. The Girl Who Sleeps. In my day, I have known many people with an incredible knack for being able to fall asleep anywhere at any time. But of my lord this girl takes the cake, sets the record, and is so far ahead she'll never be caught. 15 second between slides? 15 seconds of REM sleep please! 10 minute break? Why that's enough time to fit a dream or two in! I do not know what makes this girl so perpetually tired, but I am continually impressed at her ability to fall asleep faster than a narcoleptic who's 24 hours behind on their meds.
Exbihit B. The PAs. One day we will work together, since PAs are an essential and soon to become even more important component of our medical infrastructure. But for now... the line is drawn in the sand. There must be no mingling of MDs and PAs under any circumstances. The must be no acknowledgement of PAs by MDs. The PAs must always score higher than the MDs on exam. These are the rules of lecture hall.
Exhibit C. The kids. Adding further dynamic to our lecture hall, we have the pleasure of taking GIE with 7 radiology students. Radiology is a major offered through Portland State University, which means these 19 year olds have the exquisite *cough* pleasure of taking a medical school class with our future leaders of america... I mean future incompetant doctors of america. They resort to cowering in the back row, pretending they don't have to live through such a hell and hoping not to be seen.
Exhibit D. Death to All Who Come Here. These are the achievers of the group. Front row seats please, so I can digest directly from the mouth and not from the microphone all the wonderful insights into medicine our lecturers impart on us on a daily basis. The hierarchy of these seats have been established from the first day. Do not venture into this area and take someone's seat under the penalty of death.
Exhibit E. I didn't put in an E. This serves as further proof I am losing my mind.
Exhibit F. The Computer. Technology is a wonderful thing. Except when lecturers do not know how to use it. There is a guaranteed 15 technical difficulties per week in lecture hall. In case of said technical difficulties, count of some individual from Exhibit D (Death To All Who Come Here Zone) to run up eagerly to help. Because we must learn. We. Must. Learn.
Exhibit G. The Giant Projection Screen. This thing is like 80" big. It puts most MTV Cribs theater rooms to shame. That being said, count on at least 80% of all lectures to have slides with text and diagrams too small read, even on such a behemoth monstronsity.
Exhibit H. You're Late. This space on the stairs is reserved for those special individuals who arrive late. Seats taken? Tough luck. You are cursed to sit on your hard ass for an hour with your binder awkwardly on your lap until break. I think we should invest in pillows for zone H. I might be late on purpose if that was the case.
Exhibit I. Smelly Food Zone. People filter in and out of this zone but one thing is constant... the smell. I think it is required for someone to sit in this zone and open up their wonderful tupperware container of sliced eggs lain all over their tuna sandwhich. Yum.
Exhibit J. Dr. Feelgood. Dr. Feelgood is a general surgeon who helps out in anatomy lab. One caveat... Dr. Feelgood has been banned from the OR for being too old and senile. As a result, Dr. Feelgood uses lecture hall to flex his surgical prowess, challenging all guest lecturers that he knows just as much about the procedures on their specialty and they do. Oh, Dr. Feelgood. I hear Old Country Kitchen has continental breakfast all morning long.
The Star. Me. I do not move... My zone is my happy place.
So there you have it. Welcome to lecture hall.
Ruminations on idiotitis.
Probably one of my favorite structures in the human body is the uvula. Maybe it comes from my childhood love of stalactites (nerd alert!), but there's something endearing about that little ball of mucosa hanging suspended from the back of your throat.
Little, that is, until it gets infected.
In one of the more bizarre medical presentations I have ever been around, a patient came in 3 days after having his uvula pierced. That's right, he pierced his uvula. Even more amazing, this sort of thing actually came up with a google image search.
Exhibit A:
On examination, his uvula had swollen nearly to the size of a golf ball and was at risk of closing off his airway. And stuck in the middle of it, like a hula hoop around John Daly, was his newly acquired uvula bling.
We checked his epiglottis, and that seemed to be golden, so he wasn't at immediate risk of asphyxiation and this was almost certainly a case of a non-sterile piercing. The #1 etiology of bacterial uvulitis is group A strep, but since this was due to direct trauma by an instrument we weren't sure what it was, so we took a culture and put him on some amoxicillin and told him to follow up in 3 days. But as a parting gift, the PCP also gave him an epi pen and told him to inject his uvula if he felt like he could no longer breathe, and that should buy him time to get to an ED.
Yup. If he felt like he couldn't breathe, and was panicking, he was supposed to take this pen, put it him his mouth, and inject the back of his throat. His eyes got pretty big as the doc told him that one. If he was looking for a little "badass factor" with his new throat ornament, I think he got a little more than he bargained for. But hey, every guy on a certain level has to wish he could do his own little personal re-enactment of the scene in The Rock where Nicholas Cage injects himself to save his life. I should have given him some green flares for dramatic effect.
Fievel Goes to Medical School.
Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday. Study, study, study, study, study, study, study.
I'm used to being swamped in medical school, but the stakes are definitely raised in MS2. Blink and suddenly you are 8 lectures behind. It requires a higher degree of vigilance towards a continual level of effort than MS1.
It's like running on a treadmill. Or a rat wheel. Stop for a second and the ground goes out from under you, and I recently had a pretty dramatic faceplant to remind me of that fact. The days are definitely blending together. It's already October. Daylight is getting to be a more precious commodity.
The advantage of being in my second year is that I'm used to this. The feeling of the rat race is a familiar one. But it still feels like you're doing a whole lot of running and not getting anywhere.
Since there's been a lot of pirate mentions lately
SEPTEMBER 19, 2008
It would be a disservice if I didn't mention that today, September 19th, is national Talk Like A Pirate Day.
Under the "Pirate Fun & Games" tab at TalkLikeAPirate.com you can print out your own Pirate Party Kit for your office, ward, classroom, construction site, clinic, wherever.
Also note, since this is a medical blog, the venerable Pirate Medicine: Pestilence and Pain During the Golden Age of Piracy.
Ahoy!
UPDATE:
MedZag's Classmate YELLING at Last Lecturer Of Day (11:55PM): "Arrrrrrrr, good day to ye matey. I be havin a question for ye, what be the effects of me rum on me collecting tubules? Can it be causin' me hyponatremia-rrrrr?"
This is the life of a medical student.
I think a little bit of me died inside.
Ischemic Motivation Disease.
SEPTEMBER 8, 2008
So the first week of MS2 is now officially down the tubes. I responded to the school year starting up again by putting off studying for as long as physically possible, but just as a crack addict needs his... crack, a medical student needs his studying, and the multicolor highlighters are now out in force. The first day of the year went pretty much exactly like I expected. After the fun of seeing everyone wore off (read: 30 minutes), the day felt just like any other day of medical school.
So, (I can see you pre-meds and MS1s rabidly foaming at the mouth) how is MS2 compared to MS1?
One of my more famous (or Follies infamous) posts was my ruminations on competitive eating. Yeah, MS1 is a lot like putting down a ton of hot dogs. After a while, you ask yourself why you ever liked hot dogs because, after all, its made of all the discarded parts of a cow. Who would ever want to eat that? But you eat and eat and eat, because there's nothing to do but eat. And summer break begins with you seriously overweight with a glossly flaccid stomach. But after a while you forget why you hated hot dogs, and are at a BBQ, and slowly creep towards that hot dog bun. Because part of you misses the hot dogs, as sick as the thought of eating one makes you.
Well, thankfully, MS2 is nothing like eating hot dogs. You're done with the days of all the leftover cow parts. Instead, MS2 is like a nice, juicy, delicious steak. The lecturers don't talk down to you (as much), the majority of the information thrown at your brain is rooted in some form of the actual clinical practice of medicine (aka the succulent hip, not the leftovers), and hell, you're a competitive hot dog eater, putting down a steak should be fun compared to hot dogs. After all, eating steak is an enjoyable experience.
Enjoyable at first, that is, until you realize the steak is 72oz. And steak sits in the stomach a lot heavier than hot dogs. And steak is all that is on the menu for the next 8 months. You're a competitive eater, so you know how to eat, but this is different. More tasty, but more challenging.
So yeah, MS2 is a lot more enjoyable than MS1. Instead of being forced to memorize a bunch of information a PhD would rarely find useful, the information is much more tailored and relevant to the practice of medicine. Instead of stumbling around in the dark looking for the fastest way to cram as many drug names, half-lives, metabolic pathways, and enzyme topographical maps into your brain, you're talking about how said drugs are actually being used to treat disease, how errant pathways manifest themselves symptomatically, and what current literature says about treatment strategies. But there's no getting around the fact that this is still medical school. And you're a MS2 now, the information comes faster. I already feel behind. We already have an exam in a week. My favorite neighborhood baristas already know that I am back at it. I already haven't talked to many of my friends since class started. It's still a crapload of information, and its still not going to be fun some of the time. But you can take heart in the fact that it is better information.
Ironically, as I stuffed myself with steak yesterday, cracking my syllabus for the first time this year to get my eat on, one of the first topics I had to study was... coronary artery disease. I think I feel heartburn coming on.
As an added note, Med11 (appropriately named the Pill Hill Pirates... arrrrrrgh) took the title in the first inaugural PA/MD kickball tournament yesterday, in an epic 14-13 title game which came down to a gut wrenching bottom of the 9th defensive slugfest. You have never seen a competitive kickball game until you throw a bunch of anal type A personalities together and tell them to go at it. Trust me.
Arrrrrgghh.
The time honored tradition of walking the plank. Per wikipedia:
Walking the plank is a phrase that describes a form of murder or torture that was practiced by pirates, mutineers and other rogue seafarers. It involved the victim being forced to walk off the end of a wooden plank or beam extended over the side of a ship, thereby falling into the water to drown, often into the vicinity of sharks.
I'm standing on the plank right now. The sharks circle, they can smell blood. A stick pokes me in the back, spurring me to take a step further.
Yup, my times as a full-fledged (not just a fake) MS2 start up tomorrow. I am on the end of the proverbial summer plank and in 18 precious hours my life will once again consist of sink or swim time amongst the sharks.
The start of MS2 feels very different from MS1. There are some pluses. You know you can handle medical school just fine, you already feel like you're starting to establish a fund of knowledge, you have your study habits and know they work.
The drawback of knowing the ropes is that you... know the ropes. I know that my days will consist of endlessly staring at information. I know about all the work and time required. I know that the speed of information gets ramped up second year. I know there's this small little test looming in the distance called Hurricane USMLE. Surprisingly, these things do not make me anxious. Really, anxious would be one of the words farthest from how I would describe how I feel right now. Rather they just make me apathetic.
Waking up tomorrow and heading to class will feel just like another day of med school. All the wide eyed fluffy optimism of first year is gone, and now begins the trudge, through second year, through Step 1, through 3rd year, never ceasing.
Of course, part of me is still excited to get started again. My liver will appreciate the break. And, frankly, I really enjoyed my times as an MS1 and kind of went to medical school for the purpose of learning medicine, so it's my own damn fault that they expect you to learn stuff every once and a while.
But saying goodbye to the last summer break of your life is not easy. So goodbye, sleeping in 5 days a week. Goodbye, drinking on Wednesday-though-Saturdays. Goodbye, completely unregimented schedules. Goodbye, 2:00am bar close. Goodbye outdoor all day festivals.
But it's time to do this thing.
August Cruisin'
AUGUST 18, 2008
As I said before, sorry for the lull in posting lately. My main blogging computer crunched its last bit of binary and croaked and the repair/upgrade process has been a bit time-consuming to say the least (that's the tough part about building your own computers... crap, think I just let a bit of the inner nerd slip out).
So things have been putzing along at a fairly uninteresting rate these days. I would say it's the "lull of summer" but frankly I love this lull and academics will have a difficult time wrenching it from my grasp 2 weeks from now when class starts up again. Ok, I'll probably end up giving it up right away while whimpering and screaming "please! no! somebody!" but such is the immovable march of time.
So I've been filling my time with what is turning out to be an entertaining pastime - selling all my old undergrad textbooks on half.com. 2 sales already in the past 12 hours, who would have known there'd be such a market for 2 edition/4 year old hardcovers? But the best part about it all hasn't been the money. I know, funny.
The best part has been the old papers I have found hastily folded and stuffed into the bindings, a relic of my past (lack of) study habits and aversion to binders and organizing. College (and alcohol) will do that to you. Here's some of my favorites:
My how far we've come.
This was found in my old Biology 101 textbook. Yes, I was once tested on whether I knew and understood the terms "genetic variation" and "natural selection." There's two things that stuck out to me about the study guide.
One is just how much my scientific thinkbank has been expanded these past 5-6 years (despite my damnedest efforts to prevent it). There are thousands of words in my daily vocabulary now that were not there a couple years ago (or the gross majority a year ago). It reminds me of last summer. Last summer, I came into medical school missing a pre-req (*collective pre-med gasp*). Yup, apparently "statistics" isn't "math" enough for medical school, so at the last minute (1.5 months prior to matriculation) I had to pick up a science class at PSU to prove I was worthy of attending medical school. After talking to the dean's office, it turns out it could be any math class BUT statistics, so I flipped the course catalog to the MATH section and picked the closest freaking thing to the number 100. End result, MedZag, a cumme laude college graduate and accepted medical student, ends up enrolled in Math 107: Introduction to Algebra. With high school students. It actually turned out to be a lot of fun, since I hadn't taken algebra since I was 13 years old. Because algebra is one of the few classes growing up that I actually got a D on a test in. After many more years of math, geometry, pre-cal, calculus 1 & 2, statistics, to come back to that same subject I struggled with and to notice how easy, how fundamental it all seemed at that point of my academic career was really something. Call it "evolution." Now if only I could go back and retake BIO101 instead of having to look forward to "Circulation 201."
Second is that it's far too easy for us in medicine to assume our patients can understand what we are trying to educate them on when in actuality they may feel like we're speaking in a weird cross of latin and idiot. I've already been accused of speaking in "doctorese" when talking to my non-medicine friends about some of the crazy shit I see, but I cannot begin to fathom how you could explain to a newly-diagnosed cancer patient the difference between small cell and non-small cell lung cancer when they may barely understand what DNA is let alone mitosis, genetic variation, and natural selection/genetic evolution. These are words and understandings I gained with a college education, which seems so far in the past at this point of my training, but it is humbling to acknowledge that many patients I will see in the time of my practice who were never granted such an opportunity. The art of conveying "doctorese" in "crap-the-everyone-else-can-understandese" can take a career to perfect. And as not even in the "career" part of my life yet, I know I suck at it.
My how far we haven't come.
If the previous page I found was a testament to how much you can learn over the years, this one is a testament to all the crap you forget. Little bugs like Rickettsia and Salmonella and "Stephylococcus" (yeah I noticed that) were words I crammed into my noggin back in the day... and then subsequently completely forgot about. When I came across this page, I was honestly surprised, because the information had completely and utterly slipped out of my brain, namely because I never had to use it again in the remainder of my college career. After a thorough spanking in micro my MS1, these words are now common parts of my daily vernacular, but it points to what you forget so readily, even after learning something, if you never use it or apply it to your knowledge the rest of your life.
That's the frustrating part about the first two years of medical school, especially first year. You pound all these useless facts into your brain, in order to pass your next test, and in sacrifice to the almighty Step I, only to know you will lose the majority of it in the remainder of your career unless you use it in your daily practice. It seems utterly inefficient, and for all intents and purposes, it is.
I leave you with a page that isn't my own, but is a piece of looseleaf left in my undergrad biochem book from the previous owner to myself:
Wellspring of life
Superfluous as self
I am none than a
pH of 7.4 balanced (wow)
by paying the bills
and filling
up the car with gas.
Unleaded's already $2.09.
We're drinking up
commercialism in a tank
of thick black wine. (wow)
Drunk with the soldiers
pressed in the huddle
east where the sun rises
to another lonely day.
Seeing only the tops of our
heads. No one basks in the sun.
We bask in our lower office.
No one looks up into
the asky anymore, face greeting the rays.
Only the very young and even
their baby faces are
turned to the luminescent screen.
(They play virtual tag.)
Ah, undergrad bio majors. Gas for $2.09 a gallon? You got to be f*cking me. Black wine? More like black franzia.