Pathology ends tomorrow after two exams (in house mid-term and an NBME shelf)...I'm counting down the minutes (approximately 960 as of midnight).
It's been a struggle and I have some issues with how the course was run. Overall, I feel like I have a fairly solid basis for taking on the boards successfully in about 46 days...but that's another issue...I still have to make it out of this semester in one academic piece.
Catch ya on the flip side.
Showing posts with label Avoiding Robbins. Show all posts
Showing posts with label Avoiding Robbins. Show all posts
5.07.2008
4.22.2008
Progress...
Part of the reason that I've been writing less is that I've been running a bit more and doing other outside funtime activities. That has provided me with a whole bunch of good feeling endorphins, incremental gains in fitness and a dose of sanity that nothing else has been able to provide to this point. I feel better, I've cut back on coffee consumption, I'm sleeping a bit better and I have a good excuse not to study. And the dress slacks fit better now too...which is always a plus.
I took my longest run in a while this weekend -5.3 miles- which felt great and I put in my first structured speed work since high school. I think the hardest part about getting back into running is that I'm still getting used to the fact that I'm a beginner again. I can't expect my body to pound out a decent pace like I used to, and it takes a bit of mental work to realign my perceived effort level with the paces/times that I'm putting up. So far the heart rate monitor is helping out with that aspect, I know where my lactate threshold is and where I need to put my heart rate to match my perceived effort, my feet just fall in line with the rest...kind of a cool quasi-physiological way to approach things. I'm also taking time to rest, which is helping out alot with the aches that plagued me for a lot of my earlier self-directed running.
I cobbled together a half-marathon training schedule that takes me up to the race in October. I'm almost sticking to it, except when exam weeks get in the way. I just hope that Surgery doesn't completely kill my hopes of finishing the race...but we'll see!
******************
I'm getting into the home stretch with classes, and starting to get all wound up for the boards in June. The nice weather is making it increasingly difficult to lock myself in the library with my good ol' pal Robbins, but I've been fairly good thus far.
Looking back on the first two years of medical school, it's been rough. It's not that the material is difficult to understand. It's the frame of reference that's been killing me all along. I'm an active learner. I learn by doing and seeing, not by staring at piles of notes and pages of readings. There is no way to actively learn pathology or biochem or any of the pre-clinical material, really. Seeing patients with their diseases makes the material stick more than the books do. It's just been the pure grunt work of slogging through the material until enough of it sticks, and that's led to some disappointing performances for me...like all of them. I've never felt less confident about what I'm doing in my life, and to have to live with that lack of confidence is draining.
Two weeks of torture left though, then a week of reading period/exams and then it's time for me to study for the boards. I'm looking foward to board studying, because I have a schedule that I'm going to stick to and it should be plenty to get a decent score on the step 1's. I'll probably continue to sneak in a post or two a week, updating about running/studying/life in general.
I took my longest run in a while this weekend -5.3 miles- which felt great and I put in my first structured speed work since high school. I think the hardest part about getting back into running is that I'm still getting used to the fact that I'm a beginner again. I can't expect my body to pound out a decent pace like I used to, and it takes a bit of mental work to realign my perceived effort level with the paces/times that I'm putting up. So far the heart rate monitor is helping out with that aspect, I know where my lactate threshold is and where I need to put my heart rate to match my perceived effort, my feet just fall in line with the rest...kind of a cool quasi-physiological way to approach things. I'm also taking time to rest, which is helping out alot with the aches that plagued me for a lot of my earlier self-directed running.
I cobbled together a half-marathon training schedule that takes me up to the race in October. I'm almost sticking to it, except when exam weeks get in the way. I just hope that Surgery doesn't completely kill my hopes of finishing the race...but we'll see!
******************
I'm getting into the home stretch with classes, and starting to get all wound up for the boards in June. The nice weather is making it increasingly difficult to lock myself in the library with my good ol' pal Robbins, but I've been fairly good thus far.
Looking back on the first two years of medical school, it's been rough. It's not that the material is difficult to understand. It's the frame of reference that's been killing me all along. I'm an active learner. I learn by doing and seeing, not by staring at piles of notes and pages of readings. There is no way to actively learn pathology or biochem or any of the pre-clinical material, really. Seeing patients with their diseases makes the material stick more than the books do. It's just been the pure grunt work of slogging through the material until enough of it sticks, and that's led to some disappointing performances for me...like all of them. I've never felt less confident about what I'm doing in my life, and to have to live with that lack of confidence is draining.
Two weeks of torture left though, then a week of reading period/exams and then it's time for me to study for the boards. I'm looking foward to board studying, because I have a schedule that I'm going to stick to and it should be plenty to get a decent score on the step 1's. I'll probably continue to sneak in a post or two a week, updating about running/studying/life in general.
4.12.2008
Quotes from the rectum
Ok so I have to share this one with everyone, despite how disturbing it is to me. So I had my standard male genitourinary and rectal exam a few weeks ago, and I just keep relaying one quote to everyone that asks how it went.
So we finished up the awkward exam of the male genitals (junk or twig and two berries if you will) and perenium (the taint or grundle for the anatomically disinclined). I've plucked this guys spermatic cords about 5 times and have had my finger up into his inguinal canal to feel his hernia...crossing all sorts of boundaries that I've never crossed with another man's junk, with minimal public display of discomfort. The patient/actor/educator turns around to the three of us males in the room and says:
"Hold up your hands."
We oblige. Pointing to the large-handed former football player, he deadpan says "Ok, you've got the biggest fingers, you're going to go first and open me up."
Great way to make things comfortable and welcoming for all with that visual aid...whilst I insert my fingers into your rectum...ugh.
Thanks for that again. I'll definitely be rushing to do my requisite 10 observed rectals on my surgery rotation in July after that experience.
So we finished up the awkward exam of the male genitals (junk or twig and two berries if you will) and perenium (the taint or grundle for the anatomically disinclined). I've plucked this guys spermatic cords about 5 times and have had my finger up into his inguinal canal to feel his hernia...crossing all sorts of boundaries that I've never crossed with another man's junk, with minimal public display of discomfort. The patient/actor/educator turns around to the three of us males in the room and says:
"Hold up your hands."
We oblige. Pointing to the large-handed former football player, he deadpan says "Ok, you've got the biggest fingers, you're going to go first and open me up."
Great way to make things comfortable and welcoming for all with that visual aid...whilst I insert my fingers into your rectum...ugh.
Thanks for that again. I'll definitely be rushing to do my requisite 10 observed rectals on my surgery rotation in July after that experience.
Lack of blogging motivation
So I've kind of been out of ideas for writing lately, and for that I apologize to anyone who still regularly checks in. I've been running away from school for the past two weekends since my renal path exam and the rest of my free time is being eaten up by a stupid group project.
I'm not quite sure why as a 24 year old medical student I'm still assigned group work. Honestly, I am quite capable of working with a group to complete an assignment as well as doing it independently. I think that group science report that I did in elementary school proved that skill set. But here I am again, trying to coordinate 7 other classmates to create a paper that will live up to the nit-picky expectations of the course director. I've realized that I naturally gravitate to these types of positions where I take on the burden of getting a group of people to pull in the same direction, and usually I do ok with them. Hopefully, we can get a decent grade out of this project for all of us, I've certainly done my share. Especially with rewriting the sections assigned to the the one member of the group that struggles to write a coherent paragraph. I figured the 5 non-native english speakers would be the dead weight in the writing department, but they actually write quite well...it was one of the two native speakers that gave me trouble...figures.
******************
So I got out to my favorite spot on earth this afternoon again: Fenway Park.
There's just something about the hustle and bustle around the ball park that makes me feel invigorated. Once I'm through the ticket gates, I like to immediately descend from the overly comercialized and family friendly Yawkey Way into the dimly bowels of the stadium that has stood there, almost unchanged since 1912. It almost feels like I'm traveling back in time amidst the smokey aroma of sausage on the grill and the white noise of 37,000 people vibrating through the concrete structure. Each descent brings back floods of memories of dozens of visits before, all rushing back at once. It's similar to what I imagine seeing your life flash before your eyes is like, but you can do it whenever you like for the price of admission. There's the usual, comfortable ritual of procuring the correct overpriced mass produced American lager for my dad in appreciation for the tickets he preennially provides, of walking down the ramp past the same souvenir vendor that's always there with the same old overpriced stuff, past the nacho/pretzel and hot dog/sausage, Papa Gino's, Beer/Peanut and Ice cream stands (yes, in that exact order). Waving to the same beer guy that's always there with some clever remark while he happily pours his brews in the corner by the entrance up to our section. It's a ritual that always feels familiar and yet always exciting and new...like nothing else I've ever experienced. If you've been to Fenway and sat on the third base side of the stadium, you probably know what I mean...it's the least renovated portion of the ball park and instead of feeling like a dump, which is what I'm sure many people would think, it feels like I'm walking back into an earlier time where nothing else matters except for enjoying the home team playing the classic american game.
For me, the real magic begins as soon as I emerge from the musty underbelly of the beast into the light and fresh air and echoing sounds of the park. I like to look up at the skyline over the right field wall and scan the outfield and just take a few seconds to absorb the atmosphere, and it instantly takes me back to the first few times that I visited the stadium back in the 80's and sat on my dad's lap and ate cotton candy and watched Wade Boggs (one of my favorite childhood players) play his heart out at third base and be the RBI machine that he was. It's a great feeling. The world could be collapsing around me (as it indeed it often seems to be these days), but I wouldn't really care if I had my butt in one of those cramped old seats. It really is a special place for me and holds hundreds of amazing memories that make me feel at peace and at home.
It's quite a stark and welcome contrast to my other life in New York, where I constantly feel out of place and like something is looming over me waiting to rend my soul to it's very roots. I wish I could better express what it is that I feel in words, but it's one of those intangibles that just nags at the periphery of my consciousness. Like when you walk into a room and absolutely know that something is out of place but you're not even sure what it is or why you have that feeling, but it's there nonetheless. I guess that I just don't feel at home there in NY and it adversely affects everything I do and weighs me down. I guess that strikes at the heart of the reason that I started writing this blog in the first place...to get over that feeling of living in a place that I will never be comfortable enough to call home.
I've come to realize over the past two years that discomfort is the place where I have to learn to be comfortable through many experiences (see "Notes from the Vagina"). However, making that leap from conceptualization to actualization is more difficult than it appears on the surface.
So that's a little bit about where I'm coming from in my life at this point, and it only took 3 overpriced, mass produced American lagers at my favorite place on earth to bring it out...hopefully I'll have something less touchy-feely to write about next time, but here's where my flow of consciousness went tonight.
Peace out girl scout...
I'm not quite sure why as a 24 year old medical student I'm still assigned group work. Honestly, I am quite capable of working with a group to complete an assignment as well as doing it independently. I think that group science report that I did in elementary school proved that skill set. But here I am again, trying to coordinate 7 other classmates to create a paper that will live up to the nit-picky expectations of the course director. I've realized that I naturally gravitate to these types of positions where I take on the burden of getting a group of people to pull in the same direction, and usually I do ok with them. Hopefully, we can get a decent grade out of this project for all of us, I've certainly done my share. Especially with rewriting the sections assigned to the the one member of the group that struggles to write a coherent paragraph. I figured the 5 non-native english speakers would be the dead weight in the writing department, but they actually write quite well...it was one of the two native speakers that gave me trouble...figures.
******************
So I got out to my favorite spot on earth this afternoon again: Fenway Park.
There's just something about the hustle and bustle around the ball park that makes me feel invigorated. Once I'm through the ticket gates, I like to immediately descend from the overly comercialized and family friendly Yawkey Way into the dimly bowels of the stadium that has stood there, almost unchanged since 1912. It almost feels like I'm traveling back in time amidst the smokey aroma of sausage on the grill and the white noise of 37,000 people vibrating through the concrete structure. Each descent brings back floods of memories of dozens of visits before, all rushing back at once. It's similar to what I imagine seeing your life flash before your eyes is like, but you can do it whenever you like for the price of admission. There's the usual, comfortable ritual of procuring the correct overpriced mass produced American lager for my dad in appreciation for the tickets he preennially provides, of walking down the ramp past the same souvenir vendor that's always there with the same old overpriced stuff, past the nacho/pretzel and hot dog/sausage, Papa Gino's, Beer/Peanut and Ice cream stands (yes, in that exact order). Waving to the same beer guy that's always there with some clever remark while he happily pours his brews in the corner by the entrance up to our section. It's a ritual that always feels familiar and yet always exciting and new...like nothing else I've ever experienced. If you've been to Fenway and sat on the third base side of the stadium, you probably know what I mean...it's the least renovated portion of the ball park and instead of feeling like a dump, which is what I'm sure many people would think, it feels like I'm walking back into an earlier time where nothing else matters except for enjoying the home team playing the classic american game.
For me, the real magic begins as soon as I emerge from the musty underbelly of the beast into the light and fresh air and echoing sounds of the park. I like to look up at the skyline over the right field wall and scan the outfield and just take a few seconds to absorb the atmosphere, and it instantly takes me back to the first few times that I visited the stadium back in the 80's and sat on my dad's lap and ate cotton candy and watched Wade Boggs (one of my favorite childhood players) play his heart out at third base and be the RBI machine that he was. It's a great feeling. The world could be collapsing around me (as it indeed it often seems to be these days), but I wouldn't really care if I had my butt in one of those cramped old seats. It really is a special place for me and holds hundreds of amazing memories that make me feel at peace and at home.
It's quite a stark and welcome contrast to my other life in New York, where I constantly feel out of place and like something is looming over me waiting to rend my soul to it's very roots. I wish I could better express what it is that I feel in words, but it's one of those intangibles that just nags at the periphery of my consciousness. Like when you walk into a room and absolutely know that something is out of place but you're not even sure what it is or why you have that feeling, but it's there nonetheless. I guess that I just don't feel at home there in NY and it adversely affects everything I do and weighs me down. I guess that strikes at the heart of the reason that I started writing this blog in the first place...to get over that feeling of living in a place that I will never be comfortable enough to call home.
I've come to realize over the past two years that discomfort is the place where I have to learn to be comfortable through many experiences (see "Notes from the Vagina"). However, making that leap from conceptualization to actualization is more difficult than it appears on the surface.
So that's a little bit about where I'm coming from in my life at this point, and it only took 3 overpriced, mass produced American lagers at my favorite place on earth to bring it out...hopefully I'll have something less touchy-feely to write about next time, but here's where my flow of consciousness went tonight.
Peace out girl scout...
4.04.2008
Renal Failure...
I'm having a little trouble walking after that exam.
The combination of being flustered and under prepared for the depth of material was infuriating. I felt completely lost for about half the questions, which should get me into the "I should still be able to pass the course" range. It was renal, hepatobiliary and GI with clinical correlations and lab correlations. I could have had Robbins and Cecil open on my desk with a boarded pathologist, a nephrologist and a gastroenterologist sitting next to me for the exam whispering answers into my ear and I probably still would have struggled.
Good job course director, you have crushed my will to continue on in medicine yet again...off to to nice and easy pharm exam and then to crawl into a bottle of something alcoholic until Monday.
The combination of being flustered and under prepared for the depth of material was infuriating. I felt completely lost for about half the questions, which should get me into the "I should still be able to pass the course" range. It was renal, hepatobiliary and GI with clinical correlations and lab correlations. I could have had Robbins and Cecil open on my desk with a boarded pathologist, a nephrologist and a gastroenterologist sitting next to me for the exam whispering answers into my ear and I probably still would have struggled.
Good job course director, you have crushed my will to continue on in medicine yet again...off to to nice and easy pharm exam and then to crawl into a bottle of something alcoholic until Monday.
Ode to a Kidney...
Oh Kidney, you rend the joy within my soul.You do so much, so elegantly, without complaint.
Yet I cannot fathom the depths of your pathology.
Your glomeruli confound me.
Your tubules vex my very soul.
Your electrolytes confuse the living shit out of me.
In short kidney, you make me want to curl up into the fetal position...
I suffer from neophrogenic anxiety and acute interstitial glomerulo-I-FREAKING-HATE THE-KIDNEY-itis.
3.28.2008
New Side Bar Items
I'm going to add a few new side bar items:
-A count down until I take the boards
-A link to my Runner's world workout log for anyone that might want to follow along with that progress.
-A count down until I take the boards
-A link to my Runner's world workout log for anyone that might want to follow along with that progress.
Goals and Expectations
Most people think of their new year's resolutions in December/January and break them by February. Since I'm an amazing procrastinator, I've set a few new goals for myself over the next few months:
- Finish out the year on a strong note (ie stop slacking off!!!)
- Carry that momentum through studying for the boards (June 23rd...yikes)
- Do above average on the boards (220-230 range)
- Keep running a couple times a week to maintain sanity/health
- Go into 3rd year with a positive attitude, especially with our school's "academic mecca" surgical clerkship in July as my first rotation
- Come out with a decent grade and something positive from the experience to set the tone for familyvacation medicine and the rest of the year
- Finish a half marathon with girlfriend in October
- Help my brother do some work on his new house this summer and stay in better touch with him
- Overcome the relentless beer potomania that arises with every path study session
I'll let you know how they go.
- Finish out the year on a strong note (ie stop slacking off!!!)
- Carry that momentum through studying for the boards (June 23rd...yikes)
- Do above average on the boards (220-230 range)
- Keep running a couple times a week to maintain sanity/health
- Go into 3rd year with a positive attitude, especially with our school's "academic mecca" surgical clerkship in July as my first rotation
- Come out with a decent grade and something positive from the experience to set the tone for family
- Finish a half marathon with girlfriend in October
- Help my brother do some work on his new house this summer and stay in better touch with him
- Overcome the relentless beer potomania that arises with every path study session
I'll let you know how they go.
3.26.2008
Post Match
With all of this Post-Match hoopla, I'm feeling pretty good about things. My school matched a bunch to MA based EM residencies, so I'm pretty pumped about my prospects of getting back up to the Boston area.
The downside of being a second year is that everything seems so far away when you have the rest of path, step 1, a year of mandatory clerkships, Step 2, aways, ERAS, and interviews to get through. Looking behind me though, I'm almost done with Pre-clinical. I just have a few more pre-clinical requisites to get through include my Male GU exam this weekend/the second time I have to put a finger into someone's rectum for a check mark.
I'll probably be away from the blog for another 2 weeks since we have exams coming up and I'm behind as usual...
The downside of being a second year is that everything seems so far away when you have the rest of path, step 1, a year of mandatory clerkships, Step 2, aways, ERAS, and interviews to get through. Looking behind me though, I'm almost done with Pre-clinical. I just have a few more pre-clinical requisites to get through include my Male GU exam this weekend/the second time I have to put a finger into someone's rectum for a check mark.
I'll probably be away from the blog for another 2 weeks since we have exams coming up and I'm behind as usual...
3.23.2008
Spring break
Carrying my clothes back into my building from my car, I ran into a couple of my classmates.
Bostonian: Hey guys, what's happening?
Guy: Back to hell
My thoughts exactly...
Bostonian: Hey guys, what's happening?
Guy: Back to hell
My thoughts exactly...
3.09.2008
Clinical Competence
We arrived at the Morchand Center For Clinical Competence at about 11 am and had a nice little introduction of how the exam will run. The basic rules are that you get an hour to elicit a full H&P from an actor in 1 hour. Every move and every word are recorded on videotape for your school and you have 15 minutes of review/critique at the end. Three sections on the grading- History, Physical and Patient Interaction. The administrator kept calling it "an experience". Oh and was it ever.
There is a big cloud of mystery that hangs over the Morchand center at my school. Mostly it is talked about with a tone anxiety and whispered rumor. I've heard stories of people failing for pretending to give immunizations, I've heard of people failing for not taking it serious enough, I've heard of people completely freezing and forgetting large chunks of the history...there's a lot of rumors. My roomate got reamed for being "excessively happy and not respecting the patient" the day before I went. Not exactly the comforting aura of puppy dogs and rainbows like you'd expect.
Having done one full H&P on my own, and briefly practicing over the past few days, I was somewhat worried about the physical. I knew that I was solid on the history and patient interaction, but I haven't quite gotten the complete physical synthesized to the point where it flows. I had planned to spend about 2o minutes with the complete medical history and then move to the physical for the remainder, and I hit around 25 minutes...not too bad. What killed me was the neuro exam. It's so long, and my oncologist preceptor kept telling us that we didn't need to know the complete neuro exam no matter how much we asked to go over/practice it. Guess what Doc...we needed it. So I didn't finish my neuro exam or get a chance to wrap up the session...but the rest of everything went fine.
My patient was actually quite friendly and cooperative with me, and even managed to joke around with me despite having unstable angina. I was somewhat unsettled when I went over to the sink to wash my hands ended up staring directly into a camera mounted on the wall. I made sure to give the camera guy a little wink, so maybe that will show up on my eval. The most interesting part of the feedback came from the patient who told me what it was like to be my patient...and it was all pretty positive. I guess those empathy classes worked.
Overall I think it boosted my confidence in communication and showed me what I have to work on in the physical: PRACTICING!
There is a big cloud of mystery that hangs over the Morchand center at my school. Mostly it is talked about with a tone anxiety and whispered rumor. I've heard stories of people failing for pretending to give immunizations, I've heard of people failing for not taking it serious enough, I've heard of people completely freezing and forgetting large chunks of the history...there's a lot of rumors. My roomate got reamed for being "excessively happy and not respecting the patient" the day before I went. Not exactly the comforting aura of puppy dogs and rainbows like you'd expect.
Having done one full H&P on my own, and briefly practicing over the past few days, I was somewhat worried about the physical. I knew that I was solid on the history and patient interaction, but I haven't quite gotten the complete physical synthesized to the point where it flows. I had planned to spend about 2o minutes with the complete medical history and then move to the physical for the remainder, and I hit around 25 minutes...not too bad. What killed me was the neuro exam. It's so long, and my oncologist preceptor kept telling us that we didn't need to know the complete neuro exam no matter how much we asked to go over/practice it. Guess what Doc...we needed it. So I didn't finish my neuro exam or get a chance to wrap up the session...but the rest of everything went fine.
My patient was actually quite friendly and cooperative with me, and even managed to joke around with me despite having unstable angina. I was somewhat unsettled when I went over to the sink to wash my hands ended up staring directly into a camera mounted on the wall. I made sure to give the camera guy a little wink, so maybe that will show up on my eval. The most interesting part of the feedback came from the patient who told me what it was like to be my patient...and it was all pretty positive. I guess those empathy classes worked.
Overall I think it boosted my confidence in communication and showed me what I have to work on in the physical: PRACTICING!
3.05.2008
Work out wagon
The combination of my pathology class, every patient that I've seen with diabetes thus far and a few of the MI's I saw over the summer have prompted me to get back on the workout wagon. Oh yeah, and the indignity of pannus retraction that I've seen on a few occasions. I fell off that wagon about 6 weeks into first year with the advent of "oh-crap-I-have-to-study" as one of the dominant emotions in my life. I've done some on and off running since then, but I've been feeling increasingly like crap, not had the energy to get out of bed, put on some apple shaped weight and generally become less than the healthy person that I once was. Seeing fatty streaks, atherosclerosis and ruptured plaques was pretty much like when I watched "Scared Straight" 20 years later back in the day...3 months later and I'm finally getting off my arse to do something about it.
The last time I self-coached myself through a half-marathon, I ended up needing 3 months of PT and a year of rest before I could run without pain. So, I bought myself a nifty heart rate monitor (Suunto t4) that has an interesting physiologically based training effect measurement that it uses to schedule in workouts and emphasizes not over training. Anyway, I'll occasionally be posting about running/working out with this infernal machine strapped to me as catharsis from time to time, so bear with my lameness. I'll probably put it away come time for my surgery rotation (I mean lose the majority of my rights as a human being) anyway.
The last time I self-coached myself through a half-marathon, I ended up needing 3 months of PT and a year of rest before I could run without pain. So, I bought myself a nifty heart rate monitor (Suunto t4) that has an interesting physiologically based training effect measurement that it uses to schedule in workouts and emphasizes not over training. Anyway, I'll occasionally be posting about running/working out with this infernal machine strapped to me as catharsis from time to time, so bear with my lameness. I'll probably put it away come time for my surgery rotation (I mean lose the majority of my rights as a human being) anyway.
2.28.2008
Autopsy
My phone rang at 9:02 AM and pulled me from my 4th snooze cycle of the morning. Guess what, it was my group's turn to observe an autopsy...at 10:30 AM. So we gathered our group up and trudged through the frigid NY morning to the ME's office. After a very brief history of what had happened and what we were expected to record and write up, we entered the morgue...the other worldly place that you see on CSI or Law and Order.
Now being a second year medical student, you're not really used to seeing naked dead people on a slab. You're not used to the smells of a dead body. You've maybe seen a handful of patients, most of them semi-clad and in pretty good shape, all things considered. Sure you saw your cadaver in anatomy and hacked it to bits over the course of 4 months, but that guy was drained of bodily fluids and smelled pleasantly of fixitive and fabric softener (we used a mix of Downy and water to keep things moist). However, this was a living, breathing human being not more than 8 hours ago, and now he's D-E-A-D in front of you, on a slab, still kind of warmish. It was kind of an eerie feeling to be standing there looking at a complete stranger dead in front of you. You almost feel that you should be mourning the passing of this poor soul, or comforting a family member. But it's just you, the dead body and some creepy guy holding a HUGE scalpel.
So you take it all in stride and begin looking at the outward appearance of the body. Standard things like height, weight, eye color, pupil diameter, scars/identifying marks, lividity, just a general survey of what's going on with him. Then that creepy dude in a surgical gown and face shield comes in an makes the standard Y-shaped incision in about 2 seconds. He then dissects the layers of flesh and muscle from the rib cage so he can make a merciless series of cuts through the ribs and clavicles with his little reciprocating bone saw, being sure to shred the subclavian vessels thereby pouring about 2 pints of blood into the now open body cavity. Seeing this can make even the manliest of men feel queasy and I watched one of my group members run out the door to get some fresh air. Blood has never bothered me too much, and my first cup of coffee had put me in a good place gastrically so I just stood there about 2 feet from the body taking notes. Elapsed time: 5 minutes.
Once the chest cavity is opened, the tech goes about systematically removing each organ piece by piece, recording the weight of every organ. Then, one by one, the organs are dissected by the pathologist and sliced serially to see if there is any pathology happening. Every detail is carefully organized, noted and dictated. It's a tedious process, but a necessary one when you have no prior medical history to go on and are essentially screening for EVERYTHING that could possibly go wrong with a person who suddenly dropped dead in front of their family. I actually saw that it is possible to access every bodily cavity with a strong arm and a 16-gauge needle...I was floored. Samples of every bodily fluid imaginable are sent for analysis and toxicology. Several tissues are also sent for toxicology.
Total time to completely turn a body inside out and look at every organ thoroughly: 90 minutes. It was basically anatomy on speed, with a whole lot more gore and stench. If you think that you learned a little too much about your cadaver in Anatomy lab, I can tell you what my autopsy patient had for dinner a few hours before he died (rice and black beans). I highly recommend that everyone see an autopsy at least once in their medical training as it will give you a perspective on pathology that you've never experienced before. It will also make you think that being a pathologist might be cool for about 30 seconds. But then you get a whiff of the contents of the small intestines and you realize that you really don't want to eat very much for the rest of the day.
Now being a second year medical student, you're not really used to seeing naked dead people on a slab. You're not used to the smells of a dead body. You've maybe seen a handful of patients, most of them semi-clad and in pretty good shape, all things considered. Sure you saw your cadaver in anatomy and hacked it to bits over the course of 4 months, but that guy was drained of bodily fluids and smelled pleasantly of fixitive and fabric softener (we used a mix of Downy and water to keep things moist). However, this was a living, breathing human being not more than 8 hours ago, and now he's D-E-A-D in front of you, on a slab, still kind of warmish. It was kind of an eerie feeling to be standing there looking at a complete stranger dead in front of you. You almost feel that you should be mourning the passing of this poor soul, or comforting a family member. But it's just you, the dead body and some creepy guy holding a HUGE scalpel.
So you take it all in stride and begin looking at the outward appearance of the body. Standard things like height, weight, eye color, pupil diameter, scars/identifying marks, lividity, just a general survey of what's going on with him. Then that creepy dude in a surgical gown and face shield comes in an makes the standard Y-shaped incision in about 2 seconds. He then dissects the layers of flesh and muscle from the rib cage so he can make a merciless series of cuts through the ribs and clavicles with his little reciprocating bone saw, being sure to shred the subclavian vessels thereby pouring about 2 pints of blood into the now open body cavity. Seeing this can make even the manliest of men feel queasy and I watched one of my group members run out the door to get some fresh air. Blood has never bothered me too much, and my first cup of coffee had put me in a good place gastrically so I just stood there about 2 feet from the body taking notes. Elapsed time: 5 minutes.
Once the chest cavity is opened, the tech goes about systematically removing each organ piece by piece, recording the weight of every organ. Then, one by one, the organs are dissected by the pathologist and sliced serially to see if there is any pathology happening. Every detail is carefully organized, noted and dictated. It's a tedious process, but a necessary one when you have no prior medical history to go on and are essentially screening for EVERYTHING that could possibly go wrong with a person who suddenly dropped dead in front of their family. I actually saw that it is possible to access every bodily cavity with a strong arm and a 16-gauge needle...I was floored. Samples of every bodily fluid imaginable are sent for analysis and toxicology. Several tissues are also sent for toxicology.
Total time to completely turn a body inside out and look at every organ thoroughly: 90 minutes. It was basically anatomy on speed, with a whole lot more gore and stench. If you think that you learned a little too much about your cadaver in Anatomy lab, I can tell you what my autopsy patient had for dinner a few hours before he died (rice and black beans). I highly recommend that everyone see an autopsy at least once in their medical training as it will give you a perspective on pathology that you've never experienced before. It will also make you think that being a pathologist might be cool for about 30 seconds. But then you get a whiff of the contents of the small intestines and you realize that you really don't want to eat very much for the rest of the day.
2.26.2008
Forgetting Learned Helplessness
Behavioral scientists developed an animal model for depression. The model works on the premise that if you repeatedly expose an animal to a noxious stimulus that it can not escape from, the animal will become desensitized to the pain and basically become depressed. Usually it's performed with rats on an electrified grid. It is called the "Learned Helplessness" model. Many medical school professors have deemed it necessary to move these experiments into human trials...more specifically, they're trying their methods on us, the medical students.
This is my informal declaration to the investigators:
Over the past 18 months, I have been provided so much noxious stimulus in the form of crushing debt, sleep deprivation, impossibly difficult exams, stupid busy-work assignments, painfully boring lectures, and excruciatingly drawn out small group exercises that I have achieved a level of Learned Helplessness the likes of which I have never experienced. I actually hit the bottom of that depression before the end of last semester. I pretty much had given up hope of ever being more than mediocre. I was doubting whether I was worthy of the admission that my institution had even given me. I wondered if I would even want to go back to this grind. I even looked into transferring back home, but the chances were slim given that my application would basically state "I am a miserable med student 3 hours away from everyone he cares about, unable to strike a balance between the demands of medical school and the desire to put the pieces of the former life that I had built up over the past 24 years back into shape."
I took my winter break to look long and hard at what was happening to me. I realized that I had pretty much just reached the end of my wits focusing on how miserable I was and that was distracting me from everything at school. Instead of focusing on studying, I was thinking about being unhappy which lead to some very inefficient studying. Instead of going to lecture, I was laying in bed thinking about how much lecture sucked. Instead of focusing on doing my best, I was focusing on how I hard everything was. I looked around at my classmates and several of them were going through the same thing that I was. I told myself that things had to change this semester, that I had to make more room for the things outside of medical school because all of my free time is going away in a few short months when I hit the wards. I told myself that I have to make my study time as efficient as I could.
So I've been working at it. I've been diligent about paying attention to my girlfriend. I've been good about calling and talking to my parents and brothers and friends whenever I still have the time. I've even managed to fit in a few days of skiing in here and there. I put myself ahead of the curve on my last set of exams instead of on the back side of it. I almost feel like I'm back on track, or have I just learned to forget my helplessness?
This is my informal declaration to the investigators:
Over the past 18 months, I have been provided so much noxious stimulus in the form of crushing debt, sleep deprivation, impossibly difficult exams, stupid busy-work assignments, painfully boring lectures, and excruciatingly drawn out small group exercises that I have achieved a level of Learned Helplessness the likes of which I have never experienced. I actually hit the bottom of that depression before the end of last semester. I pretty much had given up hope of ever being more than mediocre. I was doubting whether I was worthy of the admission that my institution had even given me. I wondered if I would even want to go back to this grind. I even looked into transferring back home, but the chances were slim given that my application would basically state "I am a miserable med student 3 hours away from everyone he cares about, unable to strike a balance between the demands of medical school and the desire to put the pieces of the former life that I had built up over the past 24 years back into shape."
I took my winter break to look long and hard at what was happening to me. I realized that I had pretty much just reached the end of my wits focusing on how miserable I was and that was distracting me from everything at school. Instead of focusing on studying, I was thinking about being unhappy which lead to some very inefficient studying. Instead of going to lecture, I was laying in bed thinking about how much lecture sucked. Instead of focusing on doing my best, I was focusing on how I hard everything was. I looked around at my classmates and several of them were going through the same thing that I was. I told myself that things had to change this semester, that I had to make more room for the things outside of medical school because all of my free time is going away in a few short months when I hit the wards. I told myself that I have to make my study time as efficient as I could.
So I've been working at it. I've been diligent about paying attention to my girlfriend. I've been good about calling and talking to my parents and brothers and friends whenever I still have the time. I've even managed to fit in a few days of skiing in here and there. I put myself ahead of the curve on my last set of exams instead of on the back side of it. I almost feel like I'm back on track, or have I just learned to forget my helplessness?
2.14.2008
Someone else understands!!!
My dad sent this to me. I'm about 97% this artist ran into me on the train...kind of scary. My favorite part of the picture is the kid in the lower right hand corner giving the proverbial "stink eye." I've seen it a couple hundred times just for wearing a hat or T-shirt around...even I'm not stupid enough to wear my jersey on the subway. (I don't want to get the curse of A-Rod on it). Anyway, I found it buried in my inbox and had to post it as it captures so much of what I've experienced over the past year and a half...over 6 million people disdaining my mere existence.
Back to Back exams tomorrow. Pharm and Path...should be fun. I'll get some substance back into my posts next week.
PS- Happy Pitchers and Catchers
2.13.2008
REM rebound
So the pharm textbooks describe a phenomenon called "Rebound REM" when using sleep aids. I actually have experienced it a few times over the past few days...it's basically really, really vivid day dreaming...with my eyes closed...sitting in front of Robbins.
Needless to say, I'm pretty tired and have since stopped with the sleep aids because of the fog they put me in for the morning hours and the time spent staring off into nothingness.
Needless to say, I'm pretty tired and have since stopped with the sleep aids because of the fog they put me in for the morning hours and the time spent staring off into nothingness.
2.10.2008
Pats were screwed?
So I was wasting a little bit of time on the interweb this evening after a nice day of pharm in the library and stumbled upon this poorly made video:
http://www.i-am-bored.com/bored_link.cfm?link_id=27384
It basically shows in excruciating detail how the Giants were given an extra 50 seconds of time over the final 1:30 of the game due to errant stoppages and mysterious, unannounced clock resettings. Pretty interesting stuff.
http://www.i-am-bored.com/bored_link.cfm?link_id=27384
It basically shows in excruciating detail how the Giants were given an extra 50 seconds of time over the final 1:30 of the game due to errant stoppages and mysterious, unannounced clock resettings. Pretty interesting stuff.
2.09.2008
Better living through pharmacology!
I've been destroying my sleep architecture for years with alarm clocks, caffeine abuse and late nights writing blogs/studying/partying/goofing off. It's pretty sad when I look back and consider that the majority of my waking hours are regulated by caffeine. But it's a necessary and acceptable evil in my world.
To make matters worse, I'm now having trouble falling asleep. So after reading Pharm all day, I've decided to chemically regulate my sleep habits with a touch of diphenyhydramine and some melatonin. I doubt that the melatonin will do anything since there's no proof that it even crosses the BBB, but the diphenyhydramine is definitely kicking in now so I'm gonna go catch some Z's.
To make matters worse, I'm now having trouble falling asleep. So after reading Pharm all day, I've decided to chemically regulate my sleep habits with a touch of diphenyhydramine and some melatonin. I doubt that the melatonin will do anything since there's no proof that it even crosses the BBB, but the diphenyhydramine is definitely kicking in now so I'm gonna go catch some Z's.
2.08.2008
Now with More Patient Wisdom in every box!
Another Wednesday, another happy Oncological encounter, Now with more patient wisdom:
For better or for worse, patients in the VA hospital are of a fairly unique breed. They don't resent medical students, they don't say "No Residents! I only want to be treated by attending physicians." They sit there and patiently tolerate our awkwardly in-depth histories and our bumbling attempts at physical examination. Not only are they amazing folks, they also feel the need to leave us with deep, meaning full comments on the experience of being a patient.
Enter Patient Biker Dude. CC: Itchiness, headaches, dizziness. Preceptor knows the patient and tells us to skip the history.
OncoDoc: "Bostonian, do the physical. Other guy, do the physical afterwards"
Bostonian: "His spleen seems to be enlarged"
OncoDoc: "We'll discuss that after Other guy has his turn"
Biker Dude's spleen is literally the size of a regulation NBA basketball!!! He actually has a long-standing polycythemia secondary to some kind of neoplasm, platelet count is about half a million, he's been having all kinds of CNS disturbances lately so he came in to get checked out. So we're shooting the breeze while he has his therapeutic phlebotomy (read: BLOOD LETTING!!! Literally dumping 450 ml of this guy's blood into a giant glass bottle. I thought they stopped doing that in 1800's). Biker dude is telling us how we have to be able to read patients and interact with them in kind. He tells us that he will only come to see my preceptor, 45 miles away from his home, because the oncologist closer VA tried to remove several hundred ml of blood therapeutically with a 10 ml syringe (Sticking the patient multiple times until the patient said that he'd had enough), gave him the "run around" with scheduling appointments and spoke down to the patient on numerous occasions. The way Biker Dude sees it, without veterans there would be no VA hospital and this doc wouldn't have a job, so why is he being treated like crap? Towards the end of the chat this gem comes out:
Biker Dude: "...and I don't like to be treated like a N*****!!!"
Bostonian and other medical student: Being the polite, east-coaster medical student gentlemen that we are, we pick our jaws up off of the floor, smile and nod and wish him good luck. Preceptor doesn't even bat an eye while typing up the chart.
Biker Dude: Walking out the door, placing his western-style hat on, raises his hand without turning around "Best of luck to you fellas, God Bless!"
OncoDoc: (Thick Indian Accent) "You see, this patient does not like being talked down to. Always treat your patients with respect!"
Nothing like a good racial slur followed by a hearty blessing to warm your heart...
**********************************************
Then there was the patient with a history of alcohol abuse who couldn't remember how he got HepC and was surprised when told he had a mass in his liver. I'm guessing that it wasnt the only memory missing from that time in his life. He tells us that he read some patient education material saying that most people with HepC don't even know that they have it.
Normally, I have a little bit of trouble finding the liver edge, but this guy had a nice firm cirrhotic liver sticking down 2 cm below the ribcage, he must have been a hard drinker back in the day. Favorite quote from him:
"These things just keep sneaking up on me..."
He must have missed the part of pamphlet where they said "you've got a significantly increased chance of hepatoma with HepC, which is only exacerbated with heavy alcohol abuse." Lucky guy caught it pretty early. His last sonogram was negative a few months ago, but this one caught it.
**********************************************
Then there was a sweet old man getting his chemo for a fairly involved pancreatic cancer, optimistic as all get out that he's going to beat this thing. He was chomping at the bit to look at the graph of his tumor marker levels (CA19-9 I believe) which wasn't scheduled until 2 month from now. Damn near broke my heart. He kept on telling us that we were very brave for going into the medical field, that it took a special person to be able to look into the eyes of a patient and honestly tell them exactly what is going on. It felt like trying to hold a straight face after being kicked in the gut.
His infusion pump signaled that his chemo treatment had finished, he smacked his lips and said "Good to the last drop." His optimism was very heart warming, yet it was still a sad interaction knowing his prognosis.
**********************************************
Every day that I go through this routine, I wonder when my emotions are going to stop being dragged into the process. I vacillate between abject horror at how poorly these patients are being treated (both medically and socially) by so many of their private physicians, laughter with the patients at the funny moments, sad when my patients are crying, solemn as I recuperate after a mere 3 hours of precepting. I haven't really had a problem putting on the professional mask when the white coat goes on in front of the patient, it's when the white coat comes off and I have to go back to the library that I start rehashing and actually dealing with my feelings. I don' think I could do this for the rest of my career without developing a serious substance abuse problem.
I'm finding that the work of an oncologist is a labor of frustration, of integrating all of the loose pieces of the patient's fragmented medical care, of attending to the emotional, spiritual and medical needs of the patient, and of patiently waiting for the disease process to respond. I'm not a patient enough person to deal with that kind of waiting for results and that level of craptastic discontinuity of patient care.
For better or for worse, patients in the VA hospital are of a fairly unique breed. They don't resent medical students, they don't say "No Residents! I only want to be treated by attending physicians." They sit there and patiently tolerate our awkwardly in-depth histories and our bumbling attempts at physical examination. Not only are they amazing folks, they also feel the need to leave us with deep, meaning full comments on the experience of being a patient.
Enter Patient Biker Dude. CC: Itchiness, headaches, dizziness. Preceptor knows the patient and tells us to skip the history.
OncoDoc: "Bostonian, do the physical. Other guy, do the physical afterwards"
Bostonian: "His spleen seems to be enlarged"
OncoDoc: "We'll discuss that after Other guy has his turn"
Biker Dude's spleen is literally the size of a regulation NBA basketball!!! He actually has a long-standing polycythemia secondary to some kind of neoplasm, platelet count is about half a million, he's been having all kinds of CNS disturbances lately so he came in to get checked out. So we're shooting the breeze while he has his therapeutic phlebotomy (read: BLOOD LETTING!!! Literally dumping 450 ml of this guy's blood into a giant glass bottle. I thought they stopped doing that in 1800's). Biker dude is telling us how we have to be able to read patients and interact with them in kind. He tells us that he will only come to see my preceptor, 45 miles away from his home, because the oncologist closer VA tried to remove several hundred ml of blood therapeutically with a 10 ml syringe (Sticking the patient multiple times until the patient said that he'd had enough), gave him the "run around" with scheduling appointments and spoke down to the patient on numerous occasions. The way Biker Dude sees it, without veterans there would be no VA hospital and this doc wouldn't have a job, so why is he being treated like crap? Towards the end of the chat this gem comes out:
Biker Dude: "...and I don't like to be treated like a N*****!!!"
Bostonian and other medical student: Being the polite, east-coaster medical student gentlemen that we are, we pick our jaws up off of the floor, smile and nod and wish him good luck. Preceptor doesn't even bat an eye while typing up the chart.
Biker Dude: Walking out the door, placing his western-style hat on, raises his hand without turning around "Best of luck to you fellas, God Bless!"
OncoDoc: (Thick Indian Accent) "You see, this patient does not like being talked down to. Always treat your patients with respect!"
Nothing like a good racial slur followed by a hearty blessing to warm your heart...
**********************************************
Then there was the patient with a history of alcohol abuse who couldn't remember how he got HepC and was surprised when told he had a mass in his liver. I'm guessing that it wasnt the only memory missing from that time in his life. He tells us that he read some patient education material saying that most people with HepC don't even know that they have it.
Normally, I have a little bit of trouble finding the liver edge, but this guy had a nice firm cirrhotic liver sticking down 2 cm below the ribcage, he must have been a hard drinker back in the day. Favorite quote from him:
"These things just keep sneaking up on me..."
He must have missed the part of pamphlet where they said "you've got a significantly increased chance of hepatoma with HepC, which is only exacerbated with heavy alcohol abuse." Lucky guy caught it pretty early. His last sonogram was negative a few months ago, but this one caught it.
**********************************************
Then there was a sweet old man getting his chemo for a fairly involved pancreatic cancer, optimistic as all get out that he's going to beat this thing. He was chomping at the bit to look at the graph of his tumor marker levels (CA19-9 I believe) which wasn't scheduled until 2 month from now. Damn near broke my heart. He kept on telling us that we were very brave for going into the medical field, that it took a special person to be able to look into the eyes of a patient and honestly tell them exactly what is going on. It felt like trying to hold a straight face after being kicked in the gut.
His infusion pump signaled that his chemo treatment had finished, he smacked his lips and said "Good to the last drop." His optimism was very heart warming, yet it was still a sad interaction knowing his prognosis.
**********************************************
Every day that I go through this routine, I wonder when my emotions are going to stop being dragged into the process. I vacillate between abject horror at how poorly these patients are being treated (both medically and socially) by so many of their private physicians, laughter with the patients at the funny moments, sad when my patients are crying, solemn as I recuperate after a mere 3 hours of precepting. I haven't really had a problem putting on the professional mask when the white coat goes on in front of the patient, it's when the white coat comes off and I have to go back to the library that I start rehashing and actually dealing with my feelings. I don' think I could do this for the rest of my career without developing a serious substance abuse problem.
I'm finding that the work of an oncologist is a labor of frustration, of integrating all of the loose pieces of the patient's fragmented medical care, of attending to the emotional, spiritual and medical needs of the patient, and of patiently waiting for the disease process to respond. I'm not a patient enough person to deal with that kind of waiting for results and that level of craptastic discontinuity of patient care.
Reason # 57 why medical school sucks
18-24 inches of light, fluffy, west-coast style powder fell over the Green Mountains of VT in the past 24 hours. I studied CNS pharmacology. I could be spending a weekend (like that guy) with my brother or my girlfriend skiing some of the BEST SNOW CONDITIONS EVER, but instead I'll be chillin in the library with Robbins, Cecil, Golijan and Katzung getting ready for my exams. Stupid priorities...Stupid expensive medical education...Stupid Bostonian for making responsible life decisions.
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