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.)