The Culprit Life

We had about a 15 minute gross anatomy lab today on the endocrine system. I gripped a kidney tightly in my hand for the first time. I could get used to this.

I attended a pediatric interest group meeting tonight. Currently my preferences are surgery first, pediatrics second, and every other type of medicine a distant third. I really like pediatrics or at least I think I will. Probably because I really like kids. In fact I wish pediatrics was all I wanted to do because it is considerably easier to get a residency in it than in most everything else. Now, the job itself is probably as hard as they come and the emotional impact on the doctors is probably the heaviest of any field. One thing you have to understand about residencies is that the difficulty of getting into a specific one does not in any way equate properly to the difficulty of the actual job.
Looking at the numbers today, I need a little higher USMLE step one score to get into a general surgery residency as opposed to a pediatric one. It’s still a score on par with being average though. The problem is, to be average in medical school is probably one of the most difficult things any human being can accomplish.

I spent most of the day in the communications department editing my match day video on probably the only computer at the medical school capable of completing such a task. I totally forgot that Dr. Ofri was speaking on campus at lunch and so I missed out on what I’m sure would have been a fantastic opportunity to converse with someone who is a veteran in blending medicine and art seamlessly.

Four out of Four

Four photoshoots in three days has been pretty exciting. I was planning on doing a fifth but things didn’t pan out right. The one above is from a shoot I did in the morning with my friend Kristen at Cafe Hey downtown.

A Saturday Night

Another day off, another photoshoot. This time with Sarah Wilson.
Above are some unedited photos I took on my first saturday night off in a long time

The test was pretty difficult. Go figure. But after I got out, I was able to do two photoshoots with my friends Dan and Joyce. I’ve posted a few of the shots here. The rest can be seen on my new photoblog: whopaintedthelion.tumblr.com

Match Day 2010

Okay, so the thing about Match Day is that what you perceive it to be and what it really is are two different things. At least for me.

Here are the facts: 4th year medical students gather with family and friends and the staff of the medical college to open envelopes one by one that will tell them where they are going to spend the next three, five, or six years of their lives. Many have an idea of where they will be going; many don’t. Here is a place where hopes and dreams and visions of the future are either realized, moderately diminished or completely crushed. For over 100 medical students. In front of hundreds of other people.

Sounds like a great set up for an episode of some primetime basic cable drama right?

Wrong.

While all those things above are true, in reality, Match Day is less like an epic televised mini-series and more like a big family barbeque with chicken wings, beer, a lot of infants being carried around, and the occasional rowdy uncle. The dramatically broad spectrum of emotion being felt is not overtly apparent to the casual observer. The fantastic, anxiety driven adventure you expect to find is in fact hidden in the hearts and minds of the students around which the event is centered and perhaps in those of their spouses and close family. On the surface it remains chicken wings and beer.

This is not to diminish the magnitude of the event or its effect on the participants in any way. It is simply an observation. A recognition of the disconnect between expectations and actual atmospheric conditions.

There is no song and dance at Match Day. The show, the only show, is comprised of our associate dean of student affairs calling out names, students coming down, opening envelopes and announcing what city and program they are headed to. Then everyone claps. It’s straight forward really.

The uniqueness of the event lies in its emotional peculiarity. Each student that opens an envelope is opening themselves up to the entire audience (which, thanks to live internet streaming, included people from all over the world). Whether they get exactly what they wanted, their very last choice or something in between, it all comes out in their face and tone of voice when they read that piece of paper. And everyone knows right then and there if you will be charging forward with your lifelong dream in the way (and place) you thought or whether you’ll spend the next five years of your existence in a city you never even wanted to visit. The day before, I pondered to myself, and out loud to my friends in the communications department, if this was the right way to do things. Should we really be placing people in a public arena when such a life changing piece of information is revealed to them? Especially when the content of that information is mostly a result of how well they performed in their primary focus (medical school) over the past four years. In what other profession is this done in? What right do we have to be spectators in a moment where someone could either emerge triumphant as after a tremendous battle or burn like Joan of Arc at the stake of their own calling?

This internal conflict I foresaw myself having on the day before was put mostly to rest by the associate dean’s simple disclosure at the start of the event that some students had opted to find out about their residency privately. So they are not forced to discover their fate in this public manner. They have a choice. But there is peer pressure. What will your fellow classmates think if you decide to open your envelope privately? Will that choice be made out of shame? Out of fear of possible embarrassment? Out of the feeling that you just weren’t good enough to get to where you wanted or needed to go?

I don’t know.
I am only in my first year.
But my guess is that a lot of these things come into play; that there is something much deeper to appreciate about this event then what is seen on the surface.

I’m not saying I agree or disagree with how match day works; I’m just saying it is something that should provoke conversation and a more profound examination of the emotional state of medical students. So I guess in that context, Match Day is a very good thing.

My thanks and my heart goes out to the dozens of students, triumphant and disappointed, who, for a moment in time, allowed me and hundreds of others to be the spectators in their Coliseum.

Today was filled with the usual securities/insecurities that come with winding down your studying for a massive exam, an exam that you didn’t think would be this massive but unfortunately is. No one wants to spend 16 hours at school in one day but as far as 16 hour days go it was bearable. The 8-10 lecture on concentration that it started with though was conducive to anything but concentrating.

I spoke with some of my friends in the communications/art department again about Match Day tomorrow. I will be attending, only for about an hour, and will surely capture some video clips and stills to post in the days ahead.
What is Match Day?
Well, hopefully I will do a decent job explaining that soon enough, but in the shortest, most stoic definition possible: it is the day that 4th year medical students find out which residency program they will be going to.
At USF (and many other colleges) this is done in front of a big crowd with media coverage and the whole bit. Discussing this format today, I became increasingly aware of just how peculiar this circumstance is emotionally for the students involved. I don’t think there exists anything quite comparable to it in our society.
I will write more on this later and probably repeat the same sentiments in a lengthier manner. Now, it’s time to go to bed.

Who am I kidding, it’s time to study. It’s always time to study.

The funny thing about studying in med school is that while you are learning about the body’s different abilities, you instinctively use your own body to demonstrate them. So of course, this whole time I’ve been reading about pulmonary functions I find myself breathing at odd intervals and depths to try and internalize the things written in the books. I don’t know if it’s that technique that’s responsible but I feel like I’m starting to get a hold on this physiology stuff. Okay, realistically, it’s probably that I’ve read the same material now from four different sources and a little of it is starting to sink in. But just like the time when moving my arm or leg around while taking the test during the musculoskeletal block helped me get a couple more questions right, I’d like to think that by simply breathing in the manner described in the viniettes, I’ll have a little better shot at figuring things out.
In related news, I am delusional.

The last of three beautiful days in sunny Florida was spent in class mostly. I skipped out on the physio reviews so I could sit outside in my car with the windows down and enjoy the weather while I read Respiratory Physiology by West. Hands down the best textbook type of book I’ve read through. The explanations are considerably better than any of our physio lectures have had.

And then, in the afternoon, it happened.
THE BEST MEDICAL SCHOOL LECTURE EVER
No exageration.
It started with the doctor (yes a real medical doctor not just a PhD) passing around bags of candy to all of us students and playing a clip of the Simpsons from a VHS tape that we would soon find contained dozens of clips (mostly from funny 80’s movies) that had been crudely edited together. The lecture was on schizophrenia and instead of just talking about all of the different subtypes and symptoms, the doctor played clips from films (and additional Simpsons episodes) that demonstrated the behaviors from his powerpoint. Needless to say, I was impressed. This is exactly how I would like to teach a med school class. Plus, on top of all that, he told hilarious stories about the interactions he has had with his patients through the years.
I’m definitely going to try to meet with him about the new script I’m writing. I had been looking for a doctor to answer a few of my questions and I think he may be just the right one.

Skyyyyy

Yep, another beautiful day spent inside. I don’t think patients really know how much their doctors give up for them. Not that I blame them for it. The only way to really know is to go to medical school yourself. Anyway, I hope they can know somehow. Not so they see me as some kind of martyr or something but just so they can know that the only thing keeping me from running outside on a day like today is my love for them. Because really, I don’t think the sleepless nights on call with your pager going off every five minutes are the worst part of it. I don’t think I’ll miss the sleep nearly as much as I will miss these gorgeous days that seem to pass me by so often.

Here are some behind the scenes shots of Dennis 2

One of the worst parts about being in medical school for me is not being able to enjoy the weather outside when it’s gorgeous like today because you are tied to your computer to study. I think it’s comparable to being locked up in Alcatraz and catching glimpses of San Francisco through the prison bars. It’s days like this that let you know what you’re missing.

Behind the Scenes of Dennis 2

Study Study Study

The meeting went pretty much just as I thought.

In PD, we learned how to do a pulmonary exam. Pretty straight forward stuff.
If you hear “A” when the patient says “E” that’s a bad thing.

How do you put an arterial line in someone who has no pulse?
Well, if you have a line already in that needs to be changed you can use a lead wire to keep your place in the vessel while you switch out catheters. If that doesn’t work (as was the case today in the ICU) you have to go in blind.
Basically, it’s like pin the tail on the donkey except the tail is a needle and the donkey is a human being and the donkey’s butt is a tiny radial artery near the wrist of that human being.
Good luck.
Fortunately, my LCE doctor has been playing this game for the past couple decades so he has a knack for it but even then, nobody ever gets completely used to going in blind and that artery is a little different in everybody. This is how you play: first you stick the patient with the needle just under the skin and then you move the needle in and out in a sort of fan pattern until you hit it. How do you know you’ve hit it? Well, unlike in pin the tail on the donkey where your friends will shout excitedly around you once you’ve succeeded, when you find the artery, the patient’s blood shoots out the back of the needle. Not quite as fun but just as obvious.

At this point, you may be wondering, “why does the patient not have a pulse?”, to which I would reply, I can’t tell you exactly because I’m only a first year medical student who doesn’t understand much and doesn’t want to annoy people by asking the same questions over and over again but generally, the patient is hooked up to two machines, one dialysis like machine that filters the blood and one that helps pump a continuous flow of blood into the heart. Because the flow is continuous there is not pulse like when only our heart is pumping our blood.

On the opposite side of the spectrum, I also saw a patient who’s heart felt like it was about to pop out of his chest it was bounding so extremely. He was on a double bypass machine that basically does the whole work of his heart for him and so the things I felt and heard through my stethoscope were the result of the machine mostly.

The last patient we saw in LCE was an elderly woman who had to get a large amount of fluid taken out of her chest through a needle placed in her back. It’s kind of crazy because you can pop the patient’s lung if you go in to far but they use fluoro imaging to “see” exactly where the fluid has accumulated so you know where to place the needle.

Back at home, I watched a lot of physiology lectures. I can’t count how many. After receiving my grades from the last test this week I realized I’m doing really bad in physio and need to pull off some kind of Christmas miracle to keep my place in the class of 2013. Okay, so it’s not that bad but it is pretty bad. I think I’m gonna do better on this one though and the rest of my classes are looking pretty decent.

Tomorrow I have another useless mandatory meeting with a faculty member about my physio grade who is just going to look at me and tell me they don’t have any answers and ask me what I think is the problem. Staring back at them, in my mind I will say “the problem is that what you are asking of me is humanly impossible, at least it is certainly impossible for a 22 year old who has never taken physiology in his life and who really likes medicine but is quite scared that being married to it for the next 10 years will possible kill his very soul”. But what I will actually say is something like “um… err… well…I think maybe I should do more practice problems??”. Then I will walk out of the office knowing that I have just wasted the past 15 minutes of my life and the faculty member will go back to the part of their work they actually care about not necessarily thinking that they helped me but that they did what was expected of them by the current policy and the rest is up to me to figure out.
Welcome to higher education.

Short Term Nostalgia

This photo was from saturday but I decided to edit it today. It was the only one from this past weekend that I edited except for one of the crane photos that I cropped to a square.

Computer problems suck. Especially when you’re in medical school and have decided to watch all of your lectures online. So after wasting several hours troubleshooting, I got a few lectures done in the library computer lab. At night there was a surgical interest group dinner meeting with a 4th year student panel on the residency process. I didn’t learn too much that I didn’t already know and I even left a little early to finish studying but some of what they were saying got me thinking about the future which nowadays isn’t such a good thing for my mental state. It just reminded me that after 4 years in this prison, I have to spend 5 years working at least 80 hours a week in a city that probably wont be one I want to live in because I wont get my top residency of choice since I’m such a bad student all of a sudden. If I don’t do a general surgery residency, I will be doing something that will leave me less fulfilled and less happy. If I do get a general surgery residency I’m gonna be run into the ground for 5 of what would have been the best years of my life, probably hold off having children, and not make any films. So I can be unhappy throughout the rest of my 20’s or be unhappy for the rest of my 20’s and unfulfilled for the rest of my life. Awesome. Can you say Catch-22?
Just in case there was any doubt, right now, I don’t really feel up to doing this whole doctor thing.

exhausted

Strawberry Festival

Cranes

How To Get A Residency (by M. Tufts)

This how to video was made possible with the help of Joyce Yong and Dan Nguyen.

There was an interesting On Doctoring class this morning on suicide and assistant suicide. Obviously there were varying opinions in our class about when and if it is right to act in that way with a patient. The lecturer was way more liberal about the subject than I thought she would be. She flat out told us that she offs people in the hospital who are gasping for air. That sounds pretty shocking (and it was) except she expressed that she does so out of compassion for the patient and their family who is begging for it. She also made it sound like most doctors do the same frequently. I don’t know. For myself, after reading and watching the material for the class, I can understand where these patients are coming from and why they may want this (especially if they have a disease like ALS). Still, I don’t think I would ever assist in suicide as a doctor. I would provide the maximum amount of palliative care possible, which involves heavy doses of sedatives and pain killers, but I don’t think I could ever provide a patient with a means committing that act directly. It is a grey area for sure though.

I got my new camera in today. It’s the new Canon Rebel T2i. I absolutely love it!
The HD video quality is superb from what I can tell so far and the higher ISO options will definitely give me some more flexibility in shooting stills that I lacked with my xsi. These little blog videos are about get a huge boost in quality for sure.

Also today, I attended a lunchtime surgical interest group meeting where a pediatric neurosurgeon spoke. It was really interesting but it made me feel like I could probably never do pediatric surgery. I just don’t think I could cope with making mistakes while operating on kids or even just losing them for reasons that are out of my control. I don’t think I would be able to sleep at night. Thank God people exist that can do that type of work though. The world is a much better place for their efforts.

Wil and I take entirely different notes for LCE. Mine document types of diseases, normal levels of certain vitals, and generalized treatment plans. Wil’s notebook is filled with and filed by patient name. He keeps track of most of the patients and updates his notes on their conditions each week. It’s interesting, I mean there’s no wrong way to take notes for LCE, I think the main thing is just to gain hospital experience and understand the way things generally work in one, but I think Wil’s notes say something about him as a person/future doctor. He will be very patient oriented. He will be a good, compassionate doctor. No doubt.

In the afternoon, I finally recorded some guitar and vocals for the demo I started in January with Omar. He even came over and recorded his guest vocals at the end. I think it sounds pretty decent but I still need to track bass and some lead guitar.

Just a few people showed up for the USF COM Alternative Film Series screening of Dear Jack tonight. It was still a good time though because we got a more intimate conversation with the doctor from Moffitt who came to answer our questions. He is the most compassionate surgeon I think I’ve ever come across. A stark contrast from my LCE small group facilitator. In short, I want to be just like him, not necessarily practice in his exact field, but handle patient’s the way he does. He told us that in medical school they tell you to not hug the patients and to keep your distance but as soon as he graduated he threw all that out the window. He told us if we looked closely we would see makeup stains all over his white coat (he does breast cancer surgery) and that 90% of what he does could be considered psych.

Tonight’s low turn out though was a reminder to me that everyone in med school has so little time to do anything besides study and that if they aren’t particularly passionate about a certain activity, they probably aren’t going to participate in it. I don’t blame the people who didn’t go or who said they would and then didn’t show up, I totally understand. It just sucks that we don’t have time to expand our views on certain things because we’re always studying. Everyone who came was really glad that they came and felt like they learned something valuable. I wish we were given more time to soak things like this in.
So the decision that this has brought me to is that I will not create anymore outreach type events where I ask people to come to them. People just don’t have time. Even if they want to come they have too many other obligations. I will however continue the film series even with low numbers because I think it’s cool and unique and we have good faculty support to keep it going.

It’s been a good day.
Don’t get me wrong, the test was terrible. It was practically a disaster (at least it felt that way).
But the day was nice. I think maybe it just felt really good to be done with it. To put it behind me no matter how bad I did. I was there from 8am to 3:40pm with about an hour and a half break in between my practical portion and the group test. Just as I thought, the written test was the absolute hardest test I have ever taken. Harder than the MCAT for me. And that’s saying a lot.
Still, at the end of the day, it is a privilege to study/practice medicine. I may sound like I complain a lot but more and more often I find myself going to bed at night feeling grateful for this opportunity.

I am definitely not ready for this test. Still.
This will literally be the hardest test I have ever taken in my entire life.
I feel more unprepared than I ever have before.
That’s all I have to say.