Gonorrhea!!!!

Gonorrhea!!!

I have my clinical skills exam this weekend, which should be fairly interesting. It's being held at the Morchand center, made famous by an episode of Seinfeld, you all know the one
Student #1: And are you experiencing any discomfort? Kramer: Just a little burning during urination. Student #1: Okay, any other pain? Kramer: The haunting memories of lost love. May I? (signals to Mickey) Lights? (Mickey turns down the lights and Kramer lights a cigar) Our eyes met across the crowded hat store. I, a customer, and she a coquettish haberdasher. Oh, I pursued and she withdrew, then she pursued and I withdrew, and so we danced. I burned for her, much like the burning during urination that I would experience soon afterwards.

Student 1: GONORRHEA!!!

Anyway, there's a a 100% chance that it will be nothing like that scene, but it should still be interesting...I'll make sure to report back. I survived my GYN exam with minimal emotional trauma. The ladies that ran the session were great and even though I was forced to desexualize the vagina, which was not an easy feat for me, they made it a very professional and educational experience. I am still afraid of the cervix though...it's one of the scariest organs that I've encountered.
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Failure to Communicate

I've written a string of posts relating to my adventures through my oncologist preceptor's practice, and I think my experience came to an apex today. My classmate and I were telling our preceptor about what we thought we needed in terms of getting ready for our clinical skills practical and how we would both like to run through a H&P today to make sure we have everything down before the exam. So our first two patients were follow up visits, the first a schitzophrenic who was so gorked out on anti-psychotics that he cannot communicate and the second was a patient that we had already dealt with in the past who needed some theraputic phlebotomy.

Patients 3 and 4 didn't show, so we went out to the floor to do a consultation. We get to the patient's bedside, and my preceptor tells me to go ahead and do the H&P. Slight problem, the patient HAS NO LARYNX and has a GAPING TRACHEOSTOMY FISTULA without one of the tubes that you usually see. (PS-Don't smoke.) Ok...how to communicate with a man who cannot speak...

Bostonian: How long have you been hospitalized?
Patient: Gurgle gurgle gurgle... (mouths November)
(this is going to be easy)

I took about as complete of a history as I could have, got a general idea of what was going on in terms of what needed to be done and did as painless a physical as I could, because they poor guy was wasting away and had several exquisitely tender points on his body. I've never seen such a pitiful site. The skin was just hanging off of his leg bones, he had no muscle mass left just bones with some skin hung on them. Pretty sad. It was also my first physical on someone in bed...not my ideal way to practice, but a good experience none-the-less.

To make things even more happy, it turns out that he was MRSA positive and the only notation was in his chart, the nurses didn't mention it, there was no warning about contact precautions...nothing. So if I disappear from the interweb, it's because I'm hospitalized with MRSA pneumonia

Third Year's Shaping Up

I've gotten my assigned rotations for next year and it was exactly how I planned it! It's nice to be able to look at this list and see the light at the end of the tunnel:
Second year
Classes end May 13th
Step 1's on June 21st

Third year
Orientation- June 27th- July 1
Surgery- July & August (I'll probably spend the entire summer in the air conditioning)
Family Med- September (light schedule...maybe I'll sneak in a couple Sox games!)
Neuro- October (Perhaps a light schedule...playoff tickets with the Fam/GF?)
Peds-November & December (A moderate schedule, maybe I'll get some shopping done before break?)

-Winter break-

OB/GYN- Jan-Feb (I'll be nice and rested, so I don't kill anyone)
Psych- Feb-Mar (I'll need to be medicated after above rotation)
Elective- (2wks Anesthesia/Rehab requirement or EM...not sure yet) March
Medicine- April-Mid June (Maybe it will help my step 2's?)


Fourth year...
Apps, aways and then the slide until match day...graduate May 2010.

Only 804 days to go.

The year of the Boards

Happy 2008! Ok, so it's January 3rd, but I haven't really been in the mood/had anything to write about until today. It's hard to find something to write about when you're sleeping 10 hours a night and catching up with the family and friends that are still close to home. It's been nice but far from entertaining to read about. I feel like my time off has helped me get my head on straight again and get my life back into perspective. I finally feel balanced again, which should last all of 3 weeks, but at least I'll have that going into one of the busiest/most challenging semesters of my life thus far.

Anyway, I finally got around to ordering all of my Step 1 materials, registering for the exam and laying out a schedule (over $1000 later). Here's my current plan of attack:

• Mandatory mock board in April at school and taking a look at where I stand after that
  
• The free NBME exam the day after classes end to give me an idea of what I am weak in to guide me in my overall studying.
  
• 6 weeks of studying with 1 integrated catch-up/Qbank day per week to allow for some level of flexibility/sanity/mixing it up.
• A goal of doing 50-100 random Q-Bank questions per night with explanations to get into the groove of answering questions
• 1 timed NBME exam per week to show me where I stand (in place of the Qbank/catch up day) for the final 4 weeks leading up to the exam
• 2 days of focused review based on Qbank/NBME indicated weaknesses right before the exam

Hopefully, that will be good enough to get me a 230, but my confidence in my academic abilities has been pretty much crushed over the past semester in Path since I rode on the back side of the curve for most of the semester. I'm a SD above average in all of my small group sessions, but I'm just not testing well and I'm not exactly sure how to remedy it.

I've taken a look at how I studied for the exams thus far and it looks like I'm getting bogged down in all of the nitty-gritty details and losing sight of the big important themes. Putting off studying for way too long between exams hasn't helped either. If I stay on top of my stuff and incorporate Rapid Review/BRS/First Aid as a frame work to fill in the nit-picky details from Robbins and Cecil, I should be able to kick myself over to the other side of the curve. Between that and doing questions before the exams, I should start doing better. But only time will tell

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.

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