Merry Christmas

I scraped by my ass by my latest path exam...apparently I was supposed to prepare for a clinical cardiology exam instead of a cardiovascular pathology exam. That wasn't what the syllabus or the previous year's exams said, but such is life. I still passed the class...but this P=MD after weeks of studying my butt off is just sucking the life out of me. I don't know what I'm doing wrong but it's quite disheartening to study your face off for 3 weeks straight and walk out of an exam to find out you're barely pass the class because of your awesomely half-assed performance. Regardless, I'm still class of 2010

Fortunately, I've got the next two weeks off to get my head on straight, re-evaluate what I'm doing wrong and set up a plan to get me through step 1 and into third year with my sanity and relationships in tact. Oh yeah, I get to spend time with my family and non-medical friends too!!! Merry Christmas to all, and I'll be back in the new year

Take care,
Bostonian

I've lost that lovin' feelin'...

(Cue Anthony Edwards: "I hate it when he does that!")

For about the umpteenth time this year, I've lost that lovin' feelin' that I had when I was a pre-med, came again for about the first 3 weeks of medical school, and then again for the first few weeks of this year after my fun EM internship. Whenever I walk over to the library, I feel the life being drained out of me. Whenever I look at Robbins, I'm told I get what has been described as "a really pathetic look" on my face.

So I am pondering:

Why is it that the entire medical education process is built around separating us from the things and people that we care about and totally immersing ourselves in the material? I spent 22 years of my life focused on becoming a well-rounded individual with interests outside of medicine, with relationships beyond the walls of my educational institution, with emotions, creative energy, compassion and a decent credit rating. Hell, I even ran a half marathon at one point at sub-8 minute mile pace.

But all of that is gone now, at age 24. I gave myself away the second I put on that short white coat and signed away my first master promissory note. I can rattle off obscure medical facts with out blinking, but I can't have a normal conversation with friends from high school. I can talk to a schizophrenic and elicit the history of his life, but I can barely hold a 10 minute phone conversation with my mom or my girlfriend without long silences. I know the intricate workings of the human body and mind, but I'm losing touch with my own soul.

I suppose that if this was the former USSR circa-1965 and my parents and local government officials had determined that I would be a physician from the age of 3 because I was good at the knock off Soviet version of Operation, this total dedication of my life's energy to Mother Medicine would be a bit more palatable. But, I guess that physicians are made and not born... and hundreds of thousands have gone through this training process and come out alive and with their minds somewhat in tact.

5 days...until freedom, sleep and feeling like myself again.

Under Pressure...

::Cue Queen::
Dun dun dun dundundun dun...
Dun dun dun dundundun dun...

8 mere days left until winter break...3 cumulative exams to go...
I can't wait!!!

I'll post again soon!

Holy Crap!

More than 1000 views of this page, many of which are not my own!

Thanks for reading my drivel, if it gets your through your day, more power to you.

If you come here to anonymously spy on my suffering, there's plenty more coming up you're a sick person and should probably seek professional help, you sadist you.

Seriously, thanks for reading

BinNY

Demotivation

I know that it's perfectly natural to go through up and down periods within medical school, but I swear that I swing back and forth faster than a bipolar crack addict.

This morning, I had a great amount of difficulty dragging my sorry ass out of bed to study. I walk through the cold over to school, and as soon as I get through the front door I can feel my shoulders sag and my posture slouching and the joy being dragged out of me as I head into the library for a little bit of light reading (Viruses...hooray). 20 ounces of black coffee couldn't even get my sorry butt motivated.

Later this same day, I head to a mandatory small group session with one of the fourth year students and I almost enjoyed interacting with my small group in yet another extremely inefficient clinical correlation exercise...the leader actually managed to get a discussion going and some interesting tidbits were addressed and some of her knowledge was thrown down and the session actually ran itself instead of morphing into mandatory lecture time like usual. I finally felt like I was actually learning something that might be clinically relevant in my career, instead of staggering through endless lists of cell markers, random correlations pulled from pubmed and obscure diseases that have an incidence of 1:10,000 in a tiny corner of Bulawayo province of Zimbabwe.

Then again tonight, I head on back over to the library with my dinner and my virus reading, same life-sucking feeling, same slouching posture, same falling asleep in the pages of my book out of sheer disgust. I try chewing gum...still can't concentrate. I try taking a dinner break...still can't concentrate. I try commiserating with some of my study buddies...can't focus. Finally after about 6 hours of on and off productivity, (consisting of 2 class transcripts, phone calls to mom and the girlfriend, an hour of screwing around with classmates, 30 minutes of dinner, and at least 6 bathroom breaks) I threw in the towel and headed for home, defeated by viruses and my own demotivation.

All I can do is remind myself of a few things:

• 903 days until graduation.
  
• 1.5 years finished, $117,000 spent on school
  
• 7 months until I am released onto the wards and Step 1 and the end of this pointless suffering in the bowels of the library.
  
• Most importantly, 2 weeks until Winter Break: sleeping in, skiing, family and friends around, no Robbins, no Murray, my dog, and contact with the real world outside of my personal hell. Basically, I get the things that matter in my life back firmly in my possession for 2 entire weeks (probably for the last time until 4th year, but I'll face that realization later on...with a healthy dose of angst and scotch)
  

The Debt Card

So I've noticed a couple debt postings over the past week, so I'm hopping on the bandwagon too. I just received my bill for the spring semester of year 2: I now owed something on the order of $117,000. I've never even seen $1000 in cash, I can picture $100, but I cannot fathom owing that much money without having seen more than 10% of it hit my bank account at one time.

To bring that down to my level, I've come up with some nice equivalents to help myself out. Please stick with me until you find an equivalence that hits home:

• A Mercedes Benz SL550 with every option possible- $120,000
• A house somewhere in the mid west
• A Fender Stratocaster owned and played by Jimi Hendrix himself
• A 36' YACHT
• 75 Karats of Diamonds attached to a platinum necklace
  
• Over 9 pounds of solid gold at the current price of $795.20/oz.
  
• 80 years eating 4 items off the dollar menu at Wendy's every day

Now, lets keep in mind that I've wracked up this debt over the course of the past two years, so about $57,500/year. It would probably seem that I could live a cushy lifestyle on that. However, subtracting out tuition, books, car, health insurance, rent and everything else, I'm left with about $10,000 for the incidentals of daily living. It would be amazing if that just included food, gas, girlfriend, and fun, but I'm also stuck paying for professional clothing, books, mandatory medical equipment, mandatory exam fees, professional association fees, ...all on just over $27 dollars a day.

I am currently projected to have something on the order of $260,000 in debt after medical school. Sure it's "good debt" but really, I'm going to have to enter a fairly lucrative and short residency to actually be able to pay it off in a reasonable amount of time. My repayment plan calculator says that I'll be paying $3,000 a month at 6.8% for the next 10 years and that I will actually end up paying on the order of $360,000 when all is said and done. 6 digits of interest...great. At that rate, I'll be 26 when I get my MD, 29 by the time that I enter repayment after deferring for residency and 39 by the time that I finish repayment. Something to think about when you're filling out your AMCAS while watching Scrubs/Gray's Anatomy and thinking how awesome your life is going to be.

Medical Education Philosophy Rant

Forest or trees?
Looking back on the last exam block, it seems that there is something inherently wrong with the way that I am being educated. I get the joy of trying to cram 3-500 pages of material into my brain and regurgitating it in the form of trivia questions and little black circles. How many of those circles I bubble in correctly corresponds to my grade, which in the context of the performance of 200 of my peers determines a small portion of where I will be allowed to work in the future and what I will be allowed to specialize in. It's an asinine process where I'm not really retaining a whole lot of material that matters. Instead I'm focusing on memorizing which CD's are expressed in which developmental stages of which WBC cancers...and it will have VERY little to do with the rest of my career from here on out. I'd assume that the forest was more important than the trees, but apparently we're going to examine every cell of every tree in the forest.

Multiple guess/Alphabet soup
Loosely thrown into the mix is an attempt to get interaction from members of the class in small group sessions. Unfortunately, these sessions turn into more of a lecture than a discussion/problem solving exercize. My concern comes when I'm actually going to have to make diagnoses and see patients and interact with other physicians. Will I see the patterns, will I know what tests to order, will I even know what to look for when it's not presented in a multiple choice format. It's not as if people are going to present with the choice of ABCD or E with me able to bubble in the correct choice with only the price of my grade on the line. These will be people's lives, and I don't even know how to make a differential diagnosis work or even what should be listed together. But I can tell you the different markers on the different flavors of Non-hodgkins lymphoma...what is more important in your future physician: performance on a multiple-choice exam or knowing how to diagnose a patient??? I saw an article from AAMC that the Step 1 is being re-thought.

I think what has bothered me most about my very expensive education thus far is that I could have learned most of the material with about 6 books and a ticket to Body Worlds at the Museum of Science...

Re-dienchanted again...

I pretty much have the non-hormonal, non-gonadal, medical education-based version of PMS these days. I'm deeming the acronym NHNGMEB-PMS. At my lovely institution, epidemic NHNGMEB-PMS seems to flair up every 6 weeks with intense spasms of anxiety, grouchiness, eating crappy food, not sleeping well, excessive caffeine consumption and excessive distractability. I think it's spread by the special human body louse that lives inside every copy of Robbins. The natural reservior seems to be restricted to second year medical students. There's another variant that affects first year medical students to a similar degree, but the etiology and timing is slightly different. I'm sure it happens other places with different frequencies.

Anyway, it's just about exam time again and I've been studying diligently for the past several weeks, I've even been ahead of the game at a few points. Now that I'm getting closer to exam time and taking some practice exams...they're not looking so hot. I don't actually know what I am doing wrong, or how many more lines of Robbins I could memorize and randomly recall at the whim of a very convoluted "All of the following, except" type multiple choice question. That combined with one of the hardest sections in Path (Blood cell disorders and Cancer) is not making for a very rewarding studying experience.

Such is life here however, I'll do what I can, but it's not going to be pretty getting these exams back. I wasn't exactly in the running for AOA in this lifetime, but I'd at-least like to be riding high on the curve (i.e. not failing miserably). Putting a positive twist on it: maybe having to know this level of detail now will make the USMLE's seem a little bit easier????

I'm off to bury my face in some Micro...and boost my ego a little by not miserably failing a practice exam...I'll post after the exam.

The List Shortens...Heme/Onc

Heme/Onc

To begin, any subject that has enough detail to make a pathologist complain about the amount of detail automatically turns me off. I think I read "but that is beyond the scope of this text" four times in the most detail oriented sections of that damed tome of Path. Robbins and Cotran basically wave the white flag of surrender.

Hematopathology is the detail masochists' dream subject. There are officially 2-bagillion distinctly individual pathologies of blood cells recognized in Robbins, each coupled with it's own set of complications, prognostic indicators and cytogenetic/molecular nuisances and uninformative name. Then there's the verbal diarrhea explaining the difference between the cell types, the uninformative naming schemes, the treatments, the lab value changes...and my head just exploded. Oh, and everyone of these damned patients presents as being tired and having lost weight.

And then there is oncology. God bless the person that can go to work every day and tell at least one person that they have cancer. I swear that half of Robbins is devoted to neoplasms of each organ system, and the equivalent to watching a Fox special "When good cells go bad". I'm going to leave it at that out of respect to the people that toil to keep those pesky neoplasms at bay...it's something that I never could do day in and day out.

The list shortens...OB/GYN

As I take my little whirlwind tour of potential medical specialties in Pathology and Microbiology, I have knocked off about half a dozen specialties from my list if possible career choices. I'll make this a regular installment for your reading pleasure.

Disclaimer: If you are interested in any of the fields that I mention or are currently working in aforementioned specialty or potentially grading me/evaluating me in anyway, please understand that this is nothing more than my somewhat twisted justification for not going into your field. I respect you for doing what I never could. Please don't mess up my life over my poor attempts at humor.

OB/GYN-
Between my microbiology lectures on STD's and a couple of less-than-pleasant encounters with some purulent cervices, genital warts, fungal infections and unpleasant/irresponsible pregnant mothers-to-be I couldn't run away fast enough from this specialty.

"But what about bringing a beautiful new life into the world?"

Listen. I've seen the TLC series about making the baby or whatever (while switching between "Mythbusters" on Discovery and Sportscenter). The horribly violent act of bringing a human child onto this Earth is utterly horrifying to me. You couldn't pay me enough to be on the business end of a hormonally imbalanced woman passing an 6-12 pound bowling ball of a HUMAN BEING through a slightly elastic tunnel that is roughly the size of a roll of dimes in its relaxed state. At 3 AM. On Christmas Eve. In a blizzard.

The female body may have taken millions of years to become a baby producing machine, but the female mind/consciousness has been evolving away from that role over the past century or so. I am not getting in the middle of that argument or spending the rest of my career catching the equivalent of a vaseline-covered football worth a couple million dollars as it flies out of an angry vagina that's being torn to shreds.

"But there's plenty of fun surgical procedures without the long surgery residency!"

Yeah, but there's also cutting into an oriented x 3 mother that is anesthetized from T12 down, sewing back together that now septic birth canal, being sued because I wasn't gifted with Randy Moss' hands, being sued because mom died of DIC or being sued because some baby I delivered as a resident didn't become MENSA material because I may have made a mistake, at 3AM, on Christmas Eve, in a blizzard.

OB/GYN...you are the weakest link...GOODBYE!

Professional Organizations

Just a warning for all of you med students/physicians out there.

So you just started medical school, you're sensory overloaded, strapped for cash and looking for any free thing that you can get. Your friendly AMSA rep runs up to you and says "Sign up and get a free Netter's!" and your gut reaction is GREAT! You get your Netters for free and a fancy little card showing you your benefits of joining AMSA shows up a few weeks later. Take a little look at what you're signing up for.

Here's the mission statement:The American Medical Student Association is committed to improving health care and healthcare delivery to all people; promoting active improvement in medical education; involving its members in the social, moral and ethical obligations of the profession of medicine; assisting in the improvement and understanding of world health problems; contributing to the welfare of medical students, interns, residents and post-MD/DO trainees; and advancing the profession of medicine

I'd like to point out how the second to last concern of the group is contributing to the welfare of medical students. Funny thing is that their associated lender is part of the probe by NY AG into the predatory lending practices...Good job AMSA...good job.

Parallel Universe

Sometimes when I'm dealing with other medical students, I feel like I'm entering a parallel universe where human interaction and expression of emotion has become some weird hybrid of what it should be. Granted, I was born and raised in New England which makes me a bit emotionally stunted, thereby warping my perspective slightly. But I digress...

Seriously though, a production is made out of every little happening. Case in point: I tried to go out to dinner with my room mates last night...a simple task in my former life. But here in the Twilight Zone, the roommates disagree on time and no compromise can be reached. This leads to other grievances being aired, crossing of arms/stamping of feet, awkwardly silent rides to the restaurant, awkward silences over dinner, and general discomfort for the Bostonian in the middle of all of this. Oh and the temper tantrums...don't forget those.

I've noticed that this toddler/kindergarten level of maturity also extends thorough a good portion of my class and it's frustrating to think that I will have to cater to these types of personalities for the rest of my career. Hooray future doctors of America!!!

SOX WIN

Obligatory post...sorry. I love this piscture of Pap...

Overall, this year was probably the best years of baseball that I can remember, but the World Series was kind of bittersweet. Do I miss Shaugnessy's Curse of the Bambino? NO! But there is something missing in my soul...it's that potent longing that only a lifetime of being a lovable loser can bring. 86 years of disappointment no longer tug at my heart strings. Billy Buckner letting the ball through his legs in the '86 series doesn't make me quite as angry. Falling to the Tribe in '95 and '98 and losing to the Yanks in '99 are just distant memories from my adolescence. The heartbreak of the 2003 game 7, 11th inning ALCS loss that forged my love of the Sox no longer makes the bile rise in my throat. 2004 put all of those things to rest. The fatalist Sox fan is gone from my soul.

There was no elation this year for me, just satisfaction and a lot of hope for the next few years. With the young core of players that have come up through the farm system, a passionate owner that cares about his fans and team, competent management at the helm and another red banner hanging over Yawkee Way for me to look up at, I am satisfied.

Getting my groove back

So a funny thing has happened over the past two weeks. After my last post, I found myself battling some of the same feelings that I had addressed: Med school sucking, wondering why I would ever put myself through this, wondering what my motivation in all of this is, etc. The motivation problem is what has come to the forefront of my mind as of late. I just can't seem to come up with a single concrete answer other than the $94,000 that I've racked up in debt over the past year and a half.

Is it for my family? No, my parents are proud of me no matter what. Is it for my kids? No, I probably wont have them for a while thanks to the inter-state relationship that I'm in for the foreseeable future. Am I doing this for me then???

At one point, somewhere back in the application process, I was doing this for me, to give myself a solid career where I wouldn't just be a cog in the wheel of industry like my father and brothers, merely making a product to make a paycheck. I would much rather a career where I could look back at the end of every week of work and see that the hours of my life that I am investing into my career had a positive impact on the lives of others...and be compensated for my skills and time.

Well, I wish the naive younger version of me had known the sacrifices he'd be making in the near future for that fulfilling career and decent paycheck. I look at other people my age that are traveling the world in their free time, keeping themselves healthy at the gym, starting their marriages, starting their families, broadening their social networks, finding their niches in careers and generally living life.

And then I look in the mirror and see my life, filled with sitting in front of a couple of books, in a small group discussing that pile of books or in an auditorium listening to the highlights of those books. No impact on other people, nothing but the same 200 faces day in and day out, the same books day in day out, nothing to look back on at the end of the week to say to myself "wow, I actually contributed to humanity today."

I think the lack of a rewarding feeling in the pursuit that I spend the majority of my time in is the worst part of this whole process. I'm literally working my butt off, spending weeks of my life glued to a chair for nothing but a number on a piece of paper...ok so couple of numbers (Exams, USMLE, Clinical Evals and shelf exams, Deans letter, interviews and the actual match). My life for the next 3 years is lined up for me and I feel like a cog, just what I wanted to avoid... pointless, unrelenting, unrewarding toil.

Like I've said a couple of times now: It's hard to look past all of this to the actual practice of medicine when your head is burried in the pages of a book and won't be coming out for some time now.

Advice about med school blowing hard...

I received a comment on one of my older posts commenting that the writer had found me by Googling the phrase "Med school blows." In the absolute lack of anything else to write about, I'm gonna throw down some knowledge/experiences...be prepared for awesomeness!!!

So you've spent the last 5-10 years of your life working towards this moment: getting into medical school. Now that you're here you think it sucks and you might have made the biggest, most expensive mistake of your life? Yeah, welcome to the club Anonymous. Many medical students have what I like to call an "Oh Shit" moment once they get into the day to day slog of medical school. I had one of those moments myself about 3 weeks into school for my first set of exams, and look at me I survived it!

It's VERY easy to get caught up in the feeling of "THIS STUFF BLOWS A GOAT" especially around exam time. It's even easier when you've just left a fairly easy job where you worked 40 hours a week, drank your paycheck away and really had very few cares when the clock hit 5PM. The transition was rough for me anyway. I imagine you have just come to the painful realization that you didn't want to study Anatomy and Histology. To be completely honest, you're going to realize that you don't really want to study Biochem, Physio, Neuro, Psych, Path, Pharm, Micro or Ethics either. So that begs the question why you signed up to be tortured for the next 4 years of your life whilst paying out of your ass for it?

Well it took me almost the entire first year of school to figure this one out. You'd figure someone who made it this far would be bright enough to conjure a silver lining somewhere in the midst of the shit-storm. Well, after a particularly rough final set of exams for Neuro, including a mini-board that was actually my worst exam performance in medical school, I did some soul searching. As with any good Irish fellow, my soul searching included copious amounts of whiskey and beer. I find that they help to slow down my brain to the point where instead of just making decisions based on the immediate situation, I take time to evaluate the entirety of the situation...it may sound like BS, but it works for me.

I looked at the big picture: Was this truly what I wanted? What am I doing here? What would I be doing otherwise? Why don't twinkies go bad for 40 years? Where did I put that bottle of scotch? You know, the important global questions.

I came up with a few very important answers that changed how I look at things:

1.) Medical School is not truly what I wanted out of life. Anyone who want's that is just plain SICK. What I wanted was to have a nice easy life where everything comes to me with minimal effort and I don't have to work very hard at all to get where I want, and I want oompa-loompas to bring me candy while I swim in a river of chocolate. That sort of life is not a possibility for me since my parents are neither wealthy nor willing to let me waste my life like that (and oompa-loompas aren't real either...sadly).

Short of that, what do I want out of life? I want to pay back my loans, to have a medium sized family and a good dog that will actually listen to me off the leash, to leave a lasting impression on a few of the people that I encounter in life and a job that changes on a daily basis and is somewhat unscripted so that I don't get too bored with it. In short, I want to look back on my life 45-50 years from now on my death bed and be able to say "Damn, that was a good life!" How can I have all of that? By going through with this beast.

2.) I am here at school to learn to be a physician. Physicians are not born, they are not pampered into existence. They are nearly ordinary people, broken down to a steaming pile of humanity by medical school, and then rebuilt into a slightly less steaming pile of humanity that is then baked by the heat of residency, forged by the flame of fellowship, and then made to crumble by the weight of debt, malpractice insurance, and CME obligations.

In other words, the training process sucks. It was designed by a bunch of single geeks at JHU with no aspirations outside of medicine. It always has sucked. It will suck more for the people that come after me...but it's not what the reality of your medical practice will be. If you can just look past the mountains of stuff that you have to learn in order to be certified competent by the NBME as a physician, you can then be tortured by a state liscencing board and allowed to pass and live your life how you want and take your career/life whereever you choose! I know it's tough when you're staring at Netter trying to memorize the Brachial Plexus (Roots, Trunks Divisions, Cords), but there is more to medicine than rote memorization.

3.) If I weren't here, I would probably be sitting in some analytical chemistry lab at some Ginormous Pharmaceutical Company in Connecticut (which shall remain nameless) pushing samples of the latest batch of "old-wrinkly-penis de-wrinkling" pills into a GC/MS while slowly growing my pension and counting down the days until I could retire. I could get married, pop out 1.5 kids, buy a modestly sized house in a modest neighbor hood, sending my kids to modest schools, living a modest life as quality inspection monitor number 1234 of 2000. There could be no imaginable fate worse than that for me. So whatever cool ideas that you've concocted in your exhausted, sleep-deprived mind as an excuse to quit, make them seem mundane and temper them with the fact that you'd have to pay for them somehow and the act of paying for them would take more time than the fun you'd actually have.

4.) Twinkies, Cockroaches and Dick Cheney will be the only things to survive the next nuclear holocaust. Hostess designed them as the perfect food, and well they did a little bit too good of a job. By the way, the bakery where the twinkie was originally created was torn down and replaced with a Nordstrom/Neiman Marcus. Hows that for progress??? Yeah, I got to visit (was dragged into) the Tiffany's that stands where the loading docks once were with the girlfriend a couple weekends ago...the place got a slightly different feel to it these days. I digress...

So anyway, Anonymous here's my advice, all wrapped up in a nice package:

-The first year of Medical School is not what the rest of your life will be like. You're studying random medically-related trivia at this point. Next year, you'll learn more medically relevant trivia, but it's when the good stuff your learned first year goes bad, which makes it slightly more interesting, like a Fox special. Third year, you lose all of your freedoms by becoming the lowest ranked person in the hospital...but you get to see patients and tell their stories to everyone else and pretend to be a doctor. Fourth year, they let you think you've learned something and allow you some freedom to sleep to choose what you do. Then depending on your specialty you get paid too little to work too much in residency for a few to several years. Finally, when all that's over, you can get a real job and have President Hillary Clinton (in her second term) signing your paycheck. (Or you can join the rebel forces and strike out on your own in private practice.) (Or you can avoid the whole ordeal and do a few fellowships and wait for the next fix.)

-It doesn't get better, you just learn to accept the crap they pile upon you more easily.
-You'll slowly realize that you will indeed, some day, need this knowledge to figure out what the hell is wrong with someone. That is why you're studying it after all.
-As much as this profession sucks, someone has to do it...it might as well be you doing it.

My suggestions
for the short term:
Go back and read the lies in your personal statement and secondaries, realize how naive you were. Laugh at yourself for not thinking this through better a year ago. Have a beer or 3. Write "I will not commit to 7 years of torture without thinking it through ever again" on a white board 50 times for emphasis. Pass out, wake up and remember the previous night from the white board, laugh because it's so true.

Medium Term:
Schedule a day to shadow in the ED of your school's affiliated hospital, put on your short white coat of indignation and listen to the patients' stories about why they're there, listen to the doctors' story about why they show up there day after day. Schedule a day in the Pediatric Oncology ward, read stories to the kids, play with them, talk to the doctors and nurses about why they go back to that floor day after day after day. Go to Hospice for a day, go to psych for a day. Lather, Rinse, Repeat with anyone else in the hospital.

Longer term
Go back to your room. Sit by yourself in the quiet and listen to why you're there. Write it down on your blog, read it whenever you're feeling like all of this isn't worth it. If you can't hear anything, you're not listening hard enough. If you honestly can't find one redeeming reason deep down in your soul to grab on to that makes all of this worth it, give up your spot, give as much of your loans back as you can, and get the hell out of dodge before you've bought a house that you'll never live in. Being miserable for the rest of your life is not worth a couple letters after your name.


What's the point?
Remember who you were, learn who you'll be, do something about it...that's all there is to it.

Best of luck
~Bostonian

Back in the saddle...

Well, I've had a busy past few weeks that have completely derailed my blogging. Between a transcontinental flight, baseball and barely surviving my path exam, I've been somewhat distracted. However, stay tuned for more regular updates to the drama that is my life. I'm going to try to mix in some different styles of writing other than just ranting about how much reading about/being tested on the pathological happenings of the human body sucks the life out of you. Stay tuned...
~Bostonian

PS- As much joy as I feel at the downfall of the Yankees, I also feel a great deal of empathy for Joe Torre and the position that he has been forced into by account of the maniacal George Steinbrenner III threats/whims. To quote Seinfeld: The man fires people like it's a bodily function

P=MD?

Well, I actually managed to survive and pass both of my exams. Path was probably the most angst-inducing exam that I have ever been subjected to. 3 hours, 168 questions. I'd say for about 20%, the extent of my knowledge of the subject was covered in the question and the answers were just flat out beyond what I had absorbed from the readings.

Micro was mercifully fair, except for the level of depth we were expected to know about fungi...which I neglected to cram into my already over-full brain. Overall, last friday was a rough go at it for me and I'll need to severely modify my exam preparation techniques if I'm going to make it out of this year alive. I questioned my worthiness as a medical student a few times, and even pondered a career in the fast food industry for a few minutes. But I survived, with only a few gray hairs to show for it.

A tribute...

Sometimes, when I am in the middle of my struggles against the evil forces of Robbins and the Pathology department, I like to take a moment out to appreciate the little things that make life worth living:

Today I salute the "GREAT ONE" at Dunkin' Donuts. Whoever decided that one person could consume 24 ounces of coffee in one sitting before it got cold was absolutely brilliant...because I am one of those people. When someone sees you drinking one of these, they know you mean business. I personally give everyone that

For those of you who aren't familiar with this glorious sight, it is a styrofoam cup that stands about 9 inches tall, yet is still fits snugly into your hand for convenient quaffing. It's not one of those $5 whimpy, Type-II-diabetes-with-a-side-of-atherosclerosis-and-metabolic-syndrome Starsucks beverages...oh no no. This is 24 oz of pure, black liquid studying fuel, literally the equivalent of drinking a 6 cup pot of coffee (400 mg of caffeine). If you need anything else to wake you up for the day, you're probably dead already.

The numbers

Total days as a med student: 409
Days left as a med student: 970
Med School induced grey hairs: ~20 on the head and 1 in the beard
Exams this Friday: 2
Pages of Robbins read: around 350-400
Months until Step 1: 9
Months until the wards: 10
Debt accumulated so far: $122,000
Approximate debt left to accumulate: $140,000
Approximate loan payments: $3000/mo for the rest of my natural life
Non-medical friends that I talk to on a regular basis: 2 (one of whom is pre-med)

Hours of sleep last night: 5
Sleep debt this week: 12 hours
Cups of coffee consumed today: 1 (22 0z DD "Great One"=1 cup in my world)
Carcinogens in coffee: aproximately 200 (Robbins and Cotran PBD 7th ed., page 446)
Home cooked meals this week: 1
Purchased meals this week: too many
Hours of exercise this week: 0
Days off of the end of my life due to this week: 365

Beers to be consumed after exams: 6+
Hepatocytes and neurons lost to binge drinking: THOUSANDS, thank you hepatic regeneration! (Robbins and Cotran PBD, 7th ed., chapter 2)

Nice Hit...

This singular play made my weekend...thank you Eric Hinske. 9 games to clinch the AL East.

Schil and the Rocket tomorrow for the rubber game. I don't know if anyone has seen this, but here's a hilarious video that some folks from MA made about the Rocket, called Rocket 2057 and it's probably one of the most clever shots taken at the Yanks ever. Hopefully, the 45 year old Clemens will show up feeling like he's "throwing with a piece of wood," (to use a quote of his from last week), cash his million dollar check for the 4 innings he'll last, and head on back to see his family in Texas.

On another note, I've be hitting the books like Hinske hit Posada this afternoon. I should be able to get through everything once by the end of this week giving me a week of pure review/memorizing/test prep...perhaps I'll make it through the first set of exams with some semblance of my sanity intact...who knows though. After the exams, things get better though (only things getting me through the next 2 weeks):
Now-9/27: Study Face off, complete mandatory stuff, sleep a little in between.
9/28: Exam marathon...Immuno and Path...on the same day.
9/29: Sox game at Fenway with the 'rents and girlfriend.
10/5-10/8: ACEP/EMRA Conference in Seattle since it's the last time that I'll be able to go before turning in my ERAS. Dragging girlfriend along for the trip since no one from school wanted to go with me to check out the Med Student weekend stuff and hang out in a new city for a few days with the .
10/9: Catch up on all the Robbins that I've been avoiding

I'll see what I can pull together for posts between now and the exams. It'll probably scattered random exams suck type posts and whatever else spills out onto the screen in the midst of my downward spiral of caffeine abuse, sleep deprivation and exam PMS (yes, men have it too). There'll be good stuff coming up in a few weeks including an ACEP review and an In praise of Fenway post. Until then, Stay tuned

-Bostonian

I'm not an angry person by nature, but...

Blowing a 7-2 lead in the top of the 8th....with two of the best relief pitchers of 2007.

I COULD HEAR MY OWN PULSE. I WAS CURSING, I WAS THROWING STUFF, I WAS CALLING MY COLLEGE FRIENDS TO SCREAM INTO THE PHONE, I WOULD CALL MY FATHER TO MAKE SURE HE'S ALIVE IF HE WEREN'T OUT OF THE COUNTRY WITH MY MOM FOR THEIR ANNIVERSARY.

Oh well...it's just a game. I'm going to get so much crap on Monday

::shakes his lowered head in disgust and anticipation of the 100 or so yanks fans consoling him as he walks into class on Monday::

Maybe the three other Sox fans will have a support group meeting Sunday night to discuss methods of anger management and self-defense.

Instead of cursing here, I'll hearken back a few weeks to one of my favorite anecdotal encounters that defines medical school for me:

I'm in the Micro department office picking up my course packet, I greet the secretary very graciously as I would any other day. From behind me I hear the distinct Brooklyn accent of my course director:

Course Director: ...how dare he wear that David Ortiz t-shirt into my department office...

Great...here we go again...be nice, he's a faculty member and ultimately will be placing your grade onto your transcript. Don't look too weak either, because then he'll know that you're kissing ass. Deep breath, and turn...

Me: Good morning Dr. X
Course Director: Good morning. Why are you wearing that around my office? What's your Name?
Me: My name's Bostonian. I'm from Boston so like half my wardrobe consists of 'these things'. Really though, I'm wearing a Dominican Republic shirt. Who could hate David Ortiz...he's such a happy person and the most clutch hitter of all time!!!

until this season...stupid torn meniscus...

Course Director: Well I have to agree with you there...

YES!!!!!!!! BOSTONIAN: 1, DR. X: 0

Course Director: I can understand where you're coming from. Actually my son is a Sox fan, he grew up one just to spite me. My first faculty position was in MA and he spent his formitive years watching the Sox. We watched Fiske wishing that home run fair in '86, and...

All I heard at that point was seagulls. --OK, so I was imitating Fiske waving his hit fair past Peske's Pole. For those of you who aren't familiar with it, I'm flailing arms like a moron in front of my Micro course director in the middle of the department office, several secretaries/faculty members stare in disgust and confusion. If I weren't 3 years old at that time it would be probably one of the single best moments of my entire life. Hell, even as it is, I've seen the highlight played at least 500 times, and I sit there every time holding my breath watching that hit bend fair by about 10 inches from the foul pole. Composing myself...

Me: I'm sorry for your loss. Do you still speak to your son?
Course Director: Occasionally. You must have been nervous after the Yanks swept you last week, eh?
Me: Not really, considering that the yanks just dropped 2 of 3 to the D-Rays.

Damn I'm good, BOSTONIAN: 2, DR. X: 0. It is taking every ounce of my self restraint not to throw down the flagrant fist pump of victory in the middle of this guy's office.

Course Director: Alright Mr. Bostonian, have a nice morning.

BOSTONIAN: 0, DR. X: 100...damn it

Me: You too Dr. X

Great...way to alienate yourself from the faculty...ASS

GO SOX....here goes my weekend

I know I'm probably asking for trouble by posting this...but 5.5 games up on the Yanks, 11 games to clinch the AL East and I'm nervous. I'm nervous because the Sox have had anemic offense all of August, and it just started waking up against TAMPA BAY. I'm nervous because the Yanks swept us in 3 last time. I'm nervous because I will again be venturing out into NYC tonight wearing Sox paraphernalia just to remind every New Yorkers that I see that there's a game on tonight and it's deciding the AL east. Hopefully the offense will show up tonight too!

AHEAD on Robbins reading, behind in everything else, and probably going to stay that way today...

Second year...

I'm not sure if this is how things are at every school, but second year has been a farcical experience to date. Here's you're syllabus, here's the extremely shallow intro lecture that doesn't even scratch the surface of the topics you need for the exam, here's the summary lecture that basically recapitulates the intro lecture, here's the clinical correlations group discussion problems that are far too in depth for you to possibly glean from the reading and thanks for that $40k in tuition.

I know, I know...first I whine that there's too much class, now I'm whining that there's not enough. You're missing my point...effective lecture beats the pathetic excuse that we're asked to sit through any day. What I have a problem with is that the LCME is making all of medicine "self taught" to make us "life-long learners". Wonderful. How is paying an exorbitant amount of money to sit around reading, highlighting, memorizing and rereading hundreds of pages of Robbins going to make me a life long learner? I could buy myself a Kaczynski style hut in the woods of Montana and hole up there with my Robbins, my Lippencot pharm, my Parham immuno and my Clinical micro made rediculously simple books, 500 highlighters and the syllabi and get just as much done without the bothersome distractions of food, electricity or human interaction. I understand that medicine is progressing at an amazingly fast rate, so instead of updating your lecture series, I get the JOY of teaching myself the molecular nuances of every pathological condition that have all been illucidated in the last 10 years. But I digress...

Ok, so I'm expected to teach myself all of pathology, micro and pharm...cool. I've accepted that. So why am I still giving the school $40k for tuition? Well, they need me to come and discuss the readings, facilitated via a case study format, with my classmates. Sounds wonderful in theory, right? In practice, it is basically 20 of us sitting in a room going through a list of questions with either, a) a path resident who covers WAYYYYYYYYYY too much detail or b) a pathologist that they pulled back from the brink of death to moderate our small group. Kind of like the Crypt Keeper from Tale from the Crypt, but better groomed.

The other students in my group just sit there with blank stares hurriedly taking notes on everything that is said and not contributing to the discussion at all because they're afraid to answer a question incorrectly. We sit around for 2 hours, with the better part of an hour consumed by silence...it drives me up a wall. I throw out wrong answer after wrong answer and in the lovely Socratic method, the doctor just keeps telling me I'm wrong and waiting for someone else to answer correctly.

My favorite example: Young lady presenting with granulomatous lesions in her hilar and mediastinal nodes, SOB, the whole 9 yards infering sarcoidosis...what's the differential?

Lets see, you have to rule out EVERYTHING ELSE before you can call it sarcoidosis...so I start listing things and getting shut down. Silence. Something else, shot down. Silence. Look around at one of the girls that I know studies alot and is way up on her stuff and try to drag the answer out of her brain with Jedi mind control power...silence. IT IS DRIVING ME INSANE. One more try...shot down. Meek voice from the smart girl says "Sarcoidosis...?"CORRECT DING, DING, DING, praise showered on her. Excuse me if I am mistaken, but isn't a differential diagnosis a COMPREHENSIVE LIST OF EVERYTHING THAT MIGHT BE WRONG WITH THE PATIENT. Yet I get shot down at everything I mention...it just makes me feel stupid...better get used to it, because third year isn't much better from the stories that I hear.

Anyway I'll bring this tirade to a close with the following thought:
Dearest LCME,
If you want me to become a life long learner, aren't you responsible for building up my strong foundation now so that I can actually pass your classes, get through school and get to the point of having to educate myself??? I'm paying for an education, not to be tossed a 1500 page book to memorize minutae from while I flounder in your mandatory group sessions. Thanks for your consideration, and I look foward to your reply
~Bostonian

Boston discount...

As most of you probably know by now, I'm a Bostonian stuck in my own little slice of hell known as New York for the next 3 or so years...(PLEASE UMASS TAKE ME FOR RESIDENCY!!!!!!!!!) From time to time (3-4 days a week) I'll make the unforgivable folly of wearing one of my Red Sox shirts out into public which usually unleashes a tirade of steaming vitriolic hatred upon me from the locals. Latest episode happened today:

Walking into school to print something out. A crowd of the big wigs is walking by including the dean of the ENTIRE MEDICAL COLLEGE!
Dean of School: RED SOX? (shakes head in disapproval walking away)
Me: Sorry Dean, I'm from Boston, it's in my blood.
Dean of School: (Mutters something to his colleagues, they all smirk and look at me)
Me: (to self) Great, there goes my dean's letter.

It's around 11 and instead of going to my intro to nutrition class, I'm out with my roomates running some errands. I hadn't had breakfast yet, so I decide to run into a deli to grab a quick sandwich while my roomate is getting gas.

Deli owner: How ya doin'?
Me: Fine, how are you?
Deli owner: (Stoping dead in the midst of stocking the drink refrigerator) YOU KNOW YOU'RE AWFUL BALLSY WEARING THAT RED SOX SHIRT AROUND HERE
Me: Yeah yeah, born into it man...sorry. I'll have a turkey, lettuce and tomato with cheddar.
Deli owner: (GLARING AT ME WITH HATRED) Mayo?
Me: (Beaming back to spite him) Yeah

So I basically stare at the guy for the next few minutes while he's making my sandwich to make sure that I don't get any special sauce

Deli owner's son: HEY DAD, should I give him the Boston Discount?
Me: Very funny...
Deli owner's son: That'll be 50 bucks (register says $7.42)

I even left the guy a tip for the little ray of sunshine he stamped out of my day. The sandwich, by the way, was pretty good!

9/11 Obligatory Post....

I woke up this morning and saw what day it was. I checked the headlines of the Boston Globe and NY Times...and had to scroll down to find anything mentioning it. It's sad that only 6 years after the most massive loss of human life on US soil, the mention of the event has become a trite headline, almost to the point of a cliche. Luckily, when I clicked over to my favorite Red Sox blog, and the author had posted a list of all the passengers who died on the 4 flights and some nice tribute graphics.

It is truly a sad day now that we have stopped mourning the loss of so many of our fellow citizens as a nation. We have forgotten.

10th Circle of Hell...

So I was diligently reading Robbins this past Wedsneday evening at one of my favorite local cafe's when I receive a call from my roomate with the offer of a spare baseball ticket for that night's game. My first instinct, as I would assume most med students who are Sox fans living in NY, was "Thank you, but no thank you, I should be studying."

After much protest from him, I hung up the phone and continued the internal monologue trying to justify my decision: "I don't like the Yankees. I don't have any remote interest in going to Yankee stadium. I vehemently protest supporting the Yankees in any way, shape or form and just knowing that my ticket revinue and beer money would be going to support Steinbrenner's overflowing coffers would turn my stomach and undermine the foundations of my very being. I can't go. Plus look at what a good and diligent student I'm being, I'm caffeinated and could probably go till 1AM if I keep going at this pace. God, I hate the Yankees. "

So about 25 seconds later I call my roomate back and tell him I'll go...

Problem though: I'm wearing one of my many Red Sox t-shirts (my closet kinda resembles Jimmy Fallon's in Fever Pitch) and I don't have time to go home and change and catch the train to make it to the stadium on time...crap. So now I have to:

1. sit on the subway
2. wait around outside the stadium for his friend to show up with the tickets (right next to the 30 or so bars teeming with thousands of intoxicated, pinstriped, ignorant zealots)
   
3. get past security (presumably Yankee fans)
   
4. buy a $9 beer (from a lady wearing pinstripes)
   
5. walk up to the 3rd tier of the stadium (past 40,000 pinstripe wearing Yankee-lovers)
   
6. buy a $12 beer
   
7. and get to the seats
   

All with out being killed over my t-shirt. Yes, roomate's girlfriend you make a good point, I could turn my shirt inside out...but what self-respecting, mildly intelligent, somewhat good looking Bostonian living in NY would do that? Not me. So I proudly strode into the gates of the 10th circle of my own personal hell, without incident. Mind you, this is in the state where I cant even go into Bed Bath and Beyond without getting heckled by 60 year old women.

We get to the seats, I've got my second beer in hand, and we've basically got the row to ourselves. About middle of the third inning, Corporate Lawyer Guy rolls up in his suit and $200 shoes with his good non-lawyer buddy and family in tow. He sees me in my shirt and his eyes light up with that demonic rage that can be traced back to February of 1919 when the Yanks stopped dwelling in the basement of the AL east when Babe Ruth's contract was sold to them. The first words out of his mouth: "Your in my seat." You thought it was going to be something about the sox didn't you? IT'S MY STORY, I will build the tension as I please. He didn't even notice my t-shirt because what moron would wear the t-shirt of a team that wasn't even playing in the game that he's watching. It's like wearing a Metallica t-shirt to the Symphony or white after Labor day...just so so very wrong to do, even if it's unintentional.

Anyway, we moved over and everything was fine. It took Lawyer Guy an entire three minutes to start ripping on the Sox with his buddy...it was some completely baseball ignorant. I overheard it and casually mentioned something to the effect of "You're completely and utterly wrong", at which point we begin a somewhat passionate, though civilized discussion of the finer points of Sox v. Yanks this year. He actually was somewhat knowledgable about the game and didn't bring up 86 years once, so he nearly won back the respect that his shoes lost him.

The game was somewhat of a blow out so it was somewhat boring (A-Rod did his two HR in one inning thing...yawn). I did have a few more beers $12 24 oz hineys in preparation for the train ride home though, which I assumed would be some fun as 50,000 pinstripe-wearing lemmings were all heading to the same train station after the game.

It was fun. I was heckled by several intoxicated Yankee lovers on the train. I got into a "spirited discussion" of how well the Yankees and Sox have been playing this year with one fellow in particular. I don't recall all of what was said, however my voice and blood pressure were both slightly elevated in frustration over the number of times he mentioned 26 rings and the sweep of last weekend. It was later described by Roomate's Girlfriend to others as "Bostonian nearly died last night. I kind of was afraid for his life."

Got home alive despite my best efforts to anger everyone on the train, sent out a few emails, passed out.

Pages of Robbins not read that night: 40ish

Feeling OLD, update

The combination of moving my little brother into college at Northeastern (as a frosh) and hanging out with some family friends at the beach who are entering their last year of college, has made this Bostonian feel very old. It seems like just yesterday that I moved into college and met so many of my good friends, finally grew up outside of my parents' sphere of influence, drank my first beer, met the love of my life and all the wonderfulness that comes with going to college. And now my 6 year younger brother is getting to do the same thing.

I remember holding him in the hospital when he was born...now he'll be an adult. I just feel old. No wonder my mom cries so much...
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Good news is that I got my final Day in on Nauset Beach (Robbins and Cotran came along) for the year. It was a beautiful day, the water was warm (60ish) and it was nice to see the actual sun and some non-med school folks for a couple hours. Although, I may be the first person in history to actually get a Robbins tan (consisting of a rectangular, book-shaped pale spot across my lap, beyond the normal shorts tan).
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Anyway, I'm still working on a write up of my backpacking trip experiences in my spare time, so stay tuned for that...it's completely non-medically related though. I'm still about 60-80 pages back in Robbins, so priorities need to be met first...I'll get to writing soon enough. Until next time
~Bostonian in NY

(PS...7 games up in the East after being swept by the Yanks doesn't look too bad at all. Especially when the yanks lose 2 of 3 to the D-Rays and continue their slide against the Mariners which simultaneously drags them closer to playoff elimination in both the AL east and wildcard races. I love Baseball in September...too bad I only have one more Fenway game left before October.)

Despite my being 60 or so pages behind in Robbins reading, there's always a little time to focus on baseball in August...especially when I'm stuck in this hellhole of Yankee-fandom 8 games up going into a 3-game series. Here are a couple stories that have warmed my heart while living here over the past year:

The Old Lady
Time stuck in Yankee Country: 36 Hours, give or take. Location: Bed Bath and Beyond for apartment supplies. I'm walking down the aisle, standing amongst the tea pots because I don't even have the means to boil water in my apartment as of yet, when all of a sudden I hear this angry voice with that accent that makes every hair on my neck bristle, "You know you better be careful around here."

"Why's that ma'am?"

"You're going to get yourself hurt wearing that kind of shirt around here."

Looking down I notice that I'm wearing my Bronson Arroyo shirt that I picked up for $5 after he got traded. I thought to myself -Great...and old lady just threatened to beat me up for wearing a Bronson Arroyo shirt in the middle of BB&B. At that time Arroyo was about 10-2 with an ERA under 3, and the Sox were in their skid, but still up 1.5 games at that point. To make things better, it was still about 3 weeks before the second comming of the Boston Massacre where the Sox dropped a 5 game homestand which essentially was the dagger in their playoff hopes.

Thinking quickly I retorted "Ma'am, I'm from the Boston area and just moved here yesterday. Bronson Arroyo, who isn't even on the Red Sox anymore, is one of my favorite pitchers who is currently leading the NL in wins and ERA. If anyone wants to beat the crap out of me over Arroyo, they need to seriously get a life. Enjoy the rest of your shopping" With that I
turned and walked away.

Random other Sox-hating events
Generally when I go to a bar, I'm still carded at the door despite the fact that I look like a 30 year old at the ripe old age of 24. Most NY bouncers see the Massachusetts license and give me grief about being from Boston/the Sox.

I also have Red Sox license plates. They were doing random safety checks on one of the roads near campus, and so the officer makes me stop and says with a dead-pan, straight face "Son, I may have to write you a ticket for those plates that you have there." I said: "See you in Traffic Court," with a smile, and he cracked a smirk.

In the ED
Patient: So where are you from?
Me: Boston
Patient: So why don't you have one of those stupid accents that they always have? (through her own thick Long Island/Queens accent)
Me: My parents taught me how to speak properly as a child...

Edit: at the time of this post the Sox are only up 7 games on the Yank-me's based upon Damon's 2 Run HR...Run support for Matsuzaka could have been better...especially if Manny hadn't strained his back.

Sorry

Path is hitting me harder than I thought it would and I'm still trying to figure out how much of Robbins I need to memorize to survive. Good stuff is on it's way at some point though
~Bostonian

Back on campus...

So after a nice little 2 week hiatus away from the computer and the hell that is NY state, I'm back for the next 10 months or so. Stay tuned for some good non-medically related stuff

Commenwealth Care...

(For what it's worth, I'm a moderate in that sort of skeptical and cynical liberal sort of way)

One of the family friends asked me what I thought of the Massachusetts Mandatory Health Insurance bill the other day. I went on about how it's somewhat of a good thing because it ensures that patients are covered by SOME sort of insurance plan that reimburses at a rate somewhat higher than medicare/medicaid, it ensures that patients are taking SOME responsibility for their health care instead of just "showing up to the Emergency Room" when they need care (like W suggests), and it forced insurance providers to offer affordable coverage in Massachusetts.

Granted the downsides are that there aren't enough PCP's to cover the 130,000 new enrollees, and the $35/month premium for people with incomes 1.5-2x the federal poverty limit isn't going to put a dent in the cost associated with their increased consumption of health care. With that lack of funding will probably come a medicare-like reduction in the reimbursement schedule and a burden on the state coffers and ultimately increased taxes, resulting in physicians fleeing the state.

But at least it's something: Preventative care (for what it's worth) will be delivered, theoretically driving down overall costs of acute care later on, and perhaps the increased health care demand will drive the legislature to make Massachusetts a more attractive place to practice medicine with loan-repayment incentives and momentarily increased rates of reimbursement (even if we are paying out the ass for the programs with our tax dollars). It's an experiment in trying to sustain a viable health care delivery system that's not 100% government funded and places the responsibility upon employers and patients.

Only time will tell if it will work...

Back to Massachusetts...

Whenever I find myself on the way home, I usually get that Guster song stuck in my head for about an hour of my three hour escape...pretty random but it gets me through the hell that is driving through Connecticut. No matter what time of day it is, there is traffic going through every city (especially Hartford...why is their a 3 mile backup at 10 PM???) in the state...it drives me nuts.

Since the last post, I helped the newly-minted first year students move in and get oriented at school. The poor bastards have no idea what they're in for. It seems like just yesterday that I was one of those bright-eyed optimists who thought they were going to be saving the world right out of the gate. It was nice because the orientation committee this year was realistic in their advice and made sure to not overstate how awesome medical school is (unlike the folks that oriented us who wanted us to believe that everyone is bestest friends, studying is fun, anatomy is hardest course and other sunshine-filled facts).

Since then, I've been at home in MA, which is why my blogging has been on the DL for a few days. I've mostly been savoring some family time while I've been here. I did go down the cape for the weekend to one of my favorite places on earth (Nauset Beach), consumed some of my favorite beverage (Samuel Adams Summer Ale) with some family friends. I also turned 24 which is a lack-luster birthday because I can't do anything new (like rent a car or sign up for my AARP card). None-the-less my brothers took me out for some sushi and the Simpsons movie which was pretty awesome of them and a good time was had by all. And I got to see my dog, which is my favorite part of coming home (next to the home cooked meals, free laundry, and absence of anything Med School related)

Since I have about 2 weeks of freedom until the second year of my imprisonment begins, I have a fairly full social calendar of non-medically related events:
8/9: Back to NY for the weekend
8/10: Human Guinea Pig for $150...it's a pretty cool study, and mostly involves me laying still and being stabbed with needles and it will pay for some of my latest REI shopping spree (Daddy needed some new Gore-tex, white gas and backpacking socks)
8/11-12: Camping with med students...which ought to be interesting as most of them are not exactly what I would call "outdoorsy" in even the remotest sense of the word...but it's at a camp site and therefore somewhat of a controlled environment with access to toilets...it'll be ok.
8/13-17: Fly fishing, backpacking (3 nights on the Long Trail) and generalized relationship time in Vermont with the Girlfriend where we pretend that our doctoral (JD and MD) educations haven't interfered with our lives at all (I can see the therapy bills now).
8/18: Fenway with the fam for Sox vs. Angels
8/19: Back to NY, clean/stow gear, buy food/beer, upload schedule onto Treo, put books into backpack
8/20: Classes begin...huzzah (sarcastic tone used here).
8/21: Whiny posts recommence

A med student rekindled

Truth be told, I have not been a fan of medical school to date. I haven't enjoyed the hours of lecture on scientific minutiae, the exams focused on the obscure corners of said scientific minutiae covered in lecture, the people who spent endless hours memorizing the aforementioned corners of scientific minutiae without having anything else in life to talk about, and generally the solitary nature of the pre-clinical years of medical school. When it comes down to it, I have been downright frustrated about not learning any actual MEDICINE in MEDICAL SCHOOL!!!

But I digress. The past few weeks in the ED have somewhat rekindled my willingness to slog through another 12 months of studying before being thrown to the wolves on the wards third year. I think it was actually being immersed in the thick of the ED chaos that did it for me...seeing sick patients, seeing what the doctors do and how the department runs, seeing medicine in one of it's few remaining purer forms medicine where someone is sick (kind of, most of the time) and we supply the healing (or call in a consult from someone who knows what to do).

Honestly, I have never felt as at home in a hospital as in an emergency department. There are no pissing matches between the EM physicians, there are no patients that have been hopelessly "circling the drain" for months on end in one of the beds sucking the resources from other patients, just people who feel that they need emergency care for anything from poison ivy to shortness of breath in a guy with spontaneous pneumothorax diagnosed 30+ years ago to the lady that collapsed with a sudden "worst headache of her life to the guy with a complex medical history of liver failure, diabetes, CHF, COPD, and a case of "the Clap" flaring up since he bought that hooker in Vegas. It is the ultimate renaissance profession, where you get to know a little about a lot of illnesses, do procedures and coordinate with every service in the hospital to get people the help they need...and I think I'm in love with it.


Furthermore, outside of the confines of the stuffy auditorium, it is nice to see my limited knowledge coming into practice...well the random tidbits that I was pimped on by every service the saw me looking over their shoulder anyway. It was nice to expand the pile of notes into the practical realm FINALLY!!! It almost makes that $60k tuition worth it...:)

Holding another man's junk

I put in my first male Foley Catheter today.

Hopefully it will be one of the few times in my life that I'll be instructed to "firmly grasp" another man's junk in my left hand, and whilst applying proper tension to the member hear the softly spoken words "retract the foreskin...around the frenulum...very good, you're doing great..." coming from another man standing next to me.

Ramming a large diameter rubber hose into the bladder of another man through the business end his firmly grasped one-eyed trouser snake was actually a lot less scaring than I would have thought. No referred pain, no serious psychological trauma...just another tool added to the medical toolkit.

SMA

Spinal Muscular Atrophy is a genetic deletion of the gene Survival Motor Neuron 1 that causes degradation of motor neurons that is present in 1 of 6000 live births. There are 4 forms of the disease 1 being the earliest onset and most severe, 4 being adult onset and the most mild. Symptoms generally present as muscle weakness, decreased muscle tone, respiratory problems, failure to thrive, etc. Also known as Floppy Baby Syndrome.

There was a baby in the ED yesterday with type 1 SMA and that description does not do the disease justice...it is just sad to see a helpless little human struggling to breathe, struggling to exist.

Child abusers suck

I've never understood how child abusers live with themselves. About once a month or so, you'll see some teenage parent who microwaves their child, or something like that on CNN or the evening news. I've seen at least 3 CPS workups being done in the last month. The most heart rending case that I've seen came in yesterday, where a 6 month old girl was submerged scalding water leaving her with burns over 40% of her body, including her head, arms and the front of her torso...

There's a special place in hell for someone that would do that to a child.

ED summer in review

I've been pretty lazy about blogging lately, mostly due to the pile of good books on my desk, some traveling, and needing to catch up on my summer research project. Not to mention that the the monotony of being a newly minted second year medical student "working" in the ED doesn't exactly make for exciting blogging. As my six weeks in the ED come to a close, I'd like to share a few of the many things that I have learned while either holding up the wall for 6-8 hours of a shift, running around doing scut for the understaffed, overworked nurses or just sitting around thinking about trying to fall asleep after a night shift.

1. I learned nothing in first year of medical school
Seriously. $60,000, hundreds of class hours, hundreds of study hours...and I'm still completely useless. You could drop dead in front of me, and I'd be standing there with my thumbs up my ass. I wouldn't know where to begin beyond what I already know from my long-expired EMT-B certification (ABC's, bleeding=bad, stablized c-spine=good, call paramedics).

Feeling useless is the most frustrating situation that I can be in. Being paid to stand in the corner and observe for the summer is about the equivalent of Chinese Water torture. I can't wait until third year when I can be made to perform useless tasks for nothing more than the benefit of my education...at least I'd be doing SOMETHING. One of my least favorite attendings said that my experiences this summer would be "valuable" in the future because I would be "used to being around very sick people." I contend that (since he dumped me off with the NP in fast track instead of teaching me anything) the past six weeks were pretty close to worthless because I barely know any patholgy/pathophys. I've learned about as much about medicine this summer as a 4 year old learns about zoology from a day at the zoo.

2. Your attending/resident can make or break your learning experience I've had the chance to work with pretty much every attending in the department, as well as a few of the residents and interns rotating through. I loosely define "working with them" as following them around for my shift. The individual responses of the physicians vary between mild annoyance to completely ignoring the fact that I am there. There were 7 of about 15 EM physicians that were willing to acknowledge my presence, and about 3 of those that actually took time to explain ANYTHING that they were doing (the physician who organized the program has yet to acknowledge me). I mean honestly, how long does it take to explain what the lab results indicate as you're typing up your note...30 seconds? 45 seconds? How about explaining what pertinent information you gleaned from the history as we're walking back to the nurses station? I understand you're busy, but treat me like the somewhat intelligent human that I am, not like part of the wall.

To be fair, there are a few of the attendings who are very good about explaining what they are doing, and the tidbits of knowledge they dropped have been extremely helpful in understanding what's happening with patients, why we're using certain treatments over others, etc.

3. Nurses are amazing resources
The nurses in the ED have been wonderfully patient with me. I mean sure, I'm a complete annoyance who barely knows how to stand out of the way, but they figured out that med students (surprise, surprise) learn pretty quickly and come in handy as an extra body for procedures that generally suck. But then there's those times when the floodgates have been opened and there's patients in every stretcher in every room (most afternoons) when I actually get to help out and move the meat along. Yeah, I may be doing scut, but atleast it's something.

4. Night Shifts aren't all that bad
Sure it's dark when you show up at the door of the ED and light when you leave. Sure you know that every normal human being is comfortably nestled in their bed at home asleep, while you're pounding that next cup of coffee. Sure the crazies, the drunks, and the drug seekers are the only people that roll into the waiting room at 2AM...and that lady with poison ivy who's getting really itchy again. But there's a certain cohesiveness of the night staff that I haven't experienced during the day. It seems to come out of the feeling that "this really sucks for all of us, there's no one else who's awake right now so we have no backup...just whoever is in the department and the residents up stairs." That feeling is pretty much all that gets you through the night, especially around 4-5am when you've been awake for about 30 hours and that little forced nap before your shift just didn't cut it. You know it's morning when those urgent Urology and Plastics consults that got called in at 3AM start showing up. There's really no words to describe the feeling that I have when those Ambulance bay slide doors open at 7:30 AM, the sun hits my retinas full force sending pain shooting all the way back into my visual cortex and seeing all of the hundreds of people streaming into work. It feels like "HA, we made it through another night without all of you...good luck with the mess we left behind."

5. Wear you freaking helmet
If I see one more helmetless moron falling off his motorcycle, flipping his ATV while holding his 5 year-old helmetless daughter or riding his bicycle without a helmet that rolls up in the ED with a GCS of 8, I think I'm going to flip. For the love all that is good and holy, wear your frigging helmet. It may not look cool at the time, but it certainly looks better than that depressed skull fracture you're sporting or that fancy respirator that's breathing for you since the blood and edema currently compressing your brain stem is making you unable to sustain your own life.

And while you're at it, it would be great if you could also not drive into that tree with your minivan full of children after 10 beers, drive your motorcycle like a maniac only to be clipped by that car your just cut off at 70 MPH, and please don't hit pedestrians any more...their bodies aren't really made to stand up to your 25 MPH attempt to nudge them along in the crosswalk. Don't even get me started on power tool safety.

ED Quote of the night: Why dating is a bad idea...

I got stuck running some scut for the nurses the other night (drawing blood, taking vitals) on a particularly busy night. One of the murses (who I thought was gay) pulls me to the side and asks if I can talk to patients yet...

Me: Yes
RN: Good, I want you to go talk to this lovely young lady and then report back to me on why dating is bad. She's really cute...if it wasn't for the shame I would bring my family I would [naughty things]
Me: Ok...

So I go ahead and do my history taking thing...

Fairly gorgeous 21 y.o., 9/10 backpain for 3 days. Ran out of opiate of choice and needs more but isn't medically insured since her employment was terminated due to inability to perform her job due to backpain. Also treated for anxiety d/o with three different meds.

I report back to the murse:
Me: Dating is a bad idea because most beautiful women are insane.
RN: (Pointing to the meds on triage sheet) Very good, you're learning quickly. You take care of me, and I take care of you... (wink)

NY Rant

Being from Boston, I am fairly accustomed to impatient people, an arcane public transportation system and the far-too-early closure of said transit system. I had a little adventure that took the cake in pain-in-the-ass transit in the Big Apple. Here's the time table:

11:31 PM- Flight lands at JFK
11:41- Pick up mandatorally checked baggage (so that I could bring shaving cream, deodorant and toothpaste on to my friends wedding in San Francisco)
11:45- Arrive at the "Air Train" station (dedicated train that loops around JFK and goes to 2 separate subway stations. Sign says that the train is going to both stations subway...which is not possible
11:53- First train arrives, without the sign changing
11:55- Leave the first train at the next stop, attendant announces that the train is indeed going to the wrong station
12:07- Next train arrives. Sign says it's going to my station, attendant says it's going to the other station. Impatient people flood off of train, train looses power at the station for two minutes and then leaves.
12:19- Next train arrives, sign and attendant agree that this is the train that I (and 200 angry New Yorkers) want to be on. Cram into car, listen to some guy's story (that contained more 4 lettered F-words than I've ever heard in a minute long rant).
12:31- Arrive at desired station, buy MTA card for exorbitant fee ($5 for a 2 mile ride)
12:32- Discover that the inbound side of the station is under construction so both trains are running on the outbound side of the station every 20 minutes or so.
12:40- First train arrives...no indication of which way it's going...I guess it's the wrong way.
12:53- Next train arrives going the other way...no indication of which way it's going... I guess it's the right way. Fortunately they don't make the announcement UNTIL THE DOORS ARE CLOSED.
1:38- Arrive at 53rd and Lexington...15 minutes to get onto the 6 train and down to Grand central
1:43- No train...10 minutes to go, no train
1:45- No train...7 minutes to get on the next train, get to my train at Grand central...not gonna happen. Attendant says the next train is about 10 minutes away...
1:46- Run up to the corner of Lexington, grab a cab and offer a huge tip if he can get me to Grand Central in 5 minutes...
1:50- Arrive at Grand Central, drop $10 for the cabbie's valiant land speed record attempt.
1:52- Run to platform 23, hop on the train, take a deep breath
2:43- Get off train, get picked up by my friend.
3:00- HOME...bed after 10+ hours of traveling.

It's times like 1:46 in the morning in the middle of the NYC subway system feeling completely stranded that I miss Boston. 2 years, 10 months, and 17 days until I leave the Empire State.

Quote of the Day: Absconding...

After a wonderful hour in the Adult ED, I was politely asked by the attending to hang out in fast track with the NP. Actually the conversation went something to the effect of:

Attending: "Who are you?"
Me: "My name is Bostonian, I'm a second year Med Student."
Attending: "What are you doing here?"
Me: "Observing you today."
Attending: "So following me around all day?"
Me: "Yep..."
Attending: "Yeah... That's not going to work for me. Go talk to the fast track Nurse..."

Usually, I feel pretty useless because the physicians basically ignore the fact that we summer students exist. Fortunately, the nurses are my saving grace and they actually allow me to do some of their scut, which is nice for the time being. I'd rather do stupid go-for errands than hold up the wall for 8 hours.

Anyway, second patient that I talk to has a pretty out-there triage sheet claiming that he's being abused by another person. The NP picks up that the guy is pretty out there, so he pulls me aside and has me make sure to ask the guy if his abuser is here now because he's a presumed psychotic patient.

Me: "So, why'd you come in today sir?"
Patient: putting his fingers really close to my face "There's writing in there, in the nail beds, do you see it?"
Me: "It must be pretty small because I can't. I heard someone hurt your elbow, how did that happen?"
Patient: "This guy comes in and puts me out with narcotic sedation and does things to me. See the smiley face he put on my elbow?"

You probably get how the rest of that interview went...delusions and he appeared to be lost in his own world (hallucinating? not that he would admit to it)

Long story short, at the mention of seeing a psychiatrist the grossly psychotic patient took off to the parking lot with a nurse and security in hot pursuit. When he reached his car, he took off at a high rate of speed across the front lawn of the hospital, swerving at the nurse and security guard

...never a dull moment

Depressing week in the ED

There were a disproportionately high number of horrible cases that I've seen in the past week...to the point where even the attendings were getting a bit down.

• It started with the 18 yo girl who fell while riding her bike without a helmet and had multiple depressed skull fractures. When I left that night she was in rough shape, but I never actually found out what happened to her.
  
• Two days ago a 47 year old woman came in who had collapsed at home after the worst headache of her life. She died while she was in the OR having her dual ruptured aneurysms clipped. She left behind her 4 year old daughter and a teenage son
  
• Then there was a 41 year old woman that had an MI that died (I wasn't there for that one).
  
• And last night, there was a healthy 36 year old man that collapsed while playing hockey. He was stabilized and sent up to the cath lab, which showed a 100% occlusion of his LEV. 2 stents were placed and the guy appeared stable after a few hours in the CCU. Then about 3AM we heard the code called overhead, and found out shortly afterward that he didn't make it. He left behind a 4 month pregnant wife, and both of his parents.
  

Now, I'm not one of those med students that was planning on spending half of his career in aclinic in Sudan ridding the continent of AIDS, but I'm finding that I still have a sliver of the starry-eyed optimist that I once was. It's mostly because I'm not all that far removed from my own pre-med misconception of medicine as a land of sunshine and puppy dogs. I go into the ED most shifts expecting the majority of the patients that come through the doors to leave happily or healthily, or at least to be somewhat cordial to us since we are refilling their narcotic stash and pumping them full of opiates. However, I've gotten a cold dose of reality over the past few shifts: not everyone gets better, people die, people lie and some really crazy shit happens in the ED (including a guy apparently threatening to go home and return with his pistol because he was "mistreated" before he walked out the door).

The sad part of it all is, that medical admission committees expect us to be deluded in our interviews and applications. They want us to paint our own grandiose pictures of serving the under served and curing sick patients who are always compliant. Meanwhile, the majority of us have no idea what we were getting into, and walk into the hospital to have our sunny dispositions squelched by hostile or non-compliant or really sick patients that not very much can be done for.

ED quote of the night

17 yo male walks into Boondocks Regional Hospital ED after flipping his ATV at high speed and hitting several fixed objects including a mailbox and a few trees. Transferred to our ED in good spirits, but in a little bit of pain. Head/C-spine and Spinal CT's reveal multiple vertebral body fractures along the entire spine and a crush fracture to L5...

Trauma Attenting: "I'm going to have to do a rectal exam, you're going to feel some pressure around your rectum."
ED Attending: "He's going to put his finger in your butt to check for bleeding."
...finger inserted...
Patient: "AHHH, doctor you've touched me like no one else ever has."
Trauma: "I certainly hope so."
Patient: "I have to take a dump."

A crying shame...

18 yo female in bicycle vs asphault and trees. Not wearing helmet, resulting multiple depressed skull fractures. GCS of 8 at the community hospital ED, given a quick CT workup and intubated, flown into our ED for further care.

She had probably just graduated high school, may have even been headed off to college. She had the best years of her life ahead of her. And now, because she didn't want to wear a helmet, she'll be lucky if she ever has the capacity to breathe on her own, let alone live a normal life...

ED quote of the day:

80 something year old woman, mistakenly sent from nursing home to Trauma Center ED for psych evaluation when she should have been sent to Psych ED. Completely lucid, displaying no signs of dementia...

Patient: Overly detailed story about how some other guy was getting in her personal space... "I don't like it when other people push me around, so I told him "You pick up that towel or I'll punch you in the face". So he stomped on the towel to spite me, and so I punched him in the face.

To the patients (and families) who yell at the ED staff

I don't really understand what is with patients who feel the need to yell at the ED nurses and Docs. I'm really just a fly on the wall, so I miss most of the flak, but watching it go down is probably one of the most annoying parts of my day...hence it inspired the following compiled synopsis of interactions with that lovely family that came in today:

Yes, ma'am, we know that your c-spine collar is very uncomfortable and that it doesn't allow you to watch your stories or look around the room for your call button, which we conveniently located directly next to your head. Fortunately for us, your voice was shrill enough carry over all the noise of the over-crowded ED all the way to the nursing station at the other end of the hall. Screaming "Help me, I'm dyin', I'm dyin', I can't breathe" at the top of your lungs, really communicated the urgency of your situation. Unfortunately, I don't think waiting room was able to hear you though the sold oak fire doors.

What's that? Yes, we need to keep that collar on because we haven't been able to look at your spine with the CT machine yet. No, it's not choking you, that's your panic attack that's making it hard to breathe. Apparently not being able to breath doesn't stop you from screaming at the top of your lungs...I think you're breathing fine, please just breathe deeply. Yes, we know that your neck hurts, that's why we need to keep the collar on and look at your spine with the CT machine. Yes, I know that you've been here for 45 minutes, but we have several other people that need to have their heads and necks imaged with the CT machine too, we're waiting until they're finished. Because they were here hours before you and they waited their turn.

Oh that's nice, you're son's here to visit you...what's that? You want your mother to get her CT scan and to go home as soon as possible. Funny, that's what we want too. However, there are sicker patients, like the lady with the sudden onset of the worst headache of her life and the man who came in 2 hours before your mother with his head split open from the fall that he took when he fainted at work. There's no need to raise your voice, sir. We're getting her through as fast as we can, sir, but there are patients with life-threatening injuries that we must deal with immediately because they could DIE. Your mother is sitting up now watching Days of Our Lives and laughing with your brother and aunt...oh that's your grandmother, I'm sorry. Regardless, we just need to be sure that there was no damage to her head, neck or spine before we let her go. So you don't sue us, that's why.

We're doing the best we can, sir, we've got patients in every bed in the department. Listen, yelling at me and the nurses isn't going to get your mother out of here any faster. In fact, it's taking time away from the nurses and ultimately delaying your mothers care and discharge. She should be going to CT in the next hour or so. No we need to get a radiologist to read the scan, that will take some time, but your mother should be out of here in 2-3 hours. We're also waiting on the labs we sent up earlier, and then we need to figure out where your mom needs to go after her scan comes back.

Sir, the nurses can hear you cursing about them, the work station isn't soundproof and you're standing 3 feet away in the middle of the hall way. Yes we know you said it, you're the only one with a Rastafarian accent in earshot of us. You're also the only one shooting menacing glares at the nursing station...besides that psych patient, but he can't help it. Do you really kiss your mother with that mouth???

...2 hours later...

Yes we're glad your mother is fine too. Have a nice day.

ED quote of the night

Middle aged woman, presenting with swollen right foot.

Attending: So, that looks like a bite of some sort.
Patient's Mom: Does it look more like a snake bite or a spider bite to you? I can't tell the difference.
Patient: I think it's a snake bite.
Attending: I'm can't quite tell, but it's more likely to be a spider bite around here.
Pt: I definitely think it's a snake bite. I've been bitten by snakes a bunch of times before. You know, normal snakes like pythons. I barely felt those.
Attending: (deadpan with a hint of sarcasm) Can I ask why you've been bitten by snakes more than once???