The Culprit Life

Study, Study, Study

A few friends and I got together at the library today to study pathology and really we ended up organizing all of the leukemias and lymphomas for B and T cells. It was super helpful. Later, Polley and I went to the see the new American Impressionist exhibit in the Tampa Museum of Art downtown. It was good although I’m not very fond of impressionism. In the museum shop we found a cool little kaleidoscope toy that was fashioned onto a wooden panel shaped like a camera. We bought it and held it up to our real cameras for fun. Polley took some really good ones but here are a couple of mine:

Another good path lab today, this time on blood neoplasms: leukemia, lymphoma and the like. In my opinion, they should have less lectures and more labs in this block because only in the labs am I seeing any resemblance to looking at illnesses in the way we will have to look at them in the hospital to make a diagnosis.

After a mandatory small group discussion at school on a disease we will literally never see, I headed home to eat lunch and get ready for my pediatric physical diagnosis session in the hospital. For three hours in the afternoon we were assigned a doctor to follow in groups of five around the pediatric ward of the hospital and then another doctor to show us how to do a newborn exam in the nursery. I had done most of the things they showed us already because my LCE is in pediatrics but it was still a good experience and a feel like I learned quite a bit. One of the kids we saw was a four year old boy admitted to the hospital because he swallowed some rubbing alcohol. Absolutely adorable. He patiently let all five of us plus the doctor listen to his heart and lungs with our stethoscopes. The newborn baby we examined was also adorable and equally tolerant of all six of us prodding and poking around her little body. For the first time, I got a really good feel of the fontanelles (soft spots on the baby’s head). It literally felt like there was a hole someone put in the skull and stuffed with cotton. So weird. It’s a miracle that all that all of that ends up okay in the end.

Well what do you know, the best pathology lecturer we’ve ever had shows up in my path lab today, and sits on my desk no less (awkward). Anyway, the path lab was a good one minus not getting out early like we usually do. I’m starting to like looking at a series of lab results and trying to figure out what’s wrong with the patient. It seems logical to me, kind of like the nephron of the kidney. I like when things are logical. I also like lists. Me and hemepathology are gonna be best friends. As long as it doesn’t stab me in the back on the test.

Another week, another LCE small group discussion, another narrow escape from being drilled by our facilitator on things we’ve never even learned.

Finally, a good pathology lecturer! I thought maybe it would never happen but we actually had a lecturer today who gave us a proper and easy to understand big picture before going into the more specific stuff where she gives good, simple explanations. Not only that but she’s enthusiastic, funny, and you can actually understand her through her accent! Plus it seems like she really cares about us learning the material, not just her research. This doctor is one in a million I think.

In the morning, I examined more toddlers and babies in LCE. The funny thing was, I found most of them to be pretty healthy, and I was right! My doctor didn’t even prescribe anything for a few of them. He took the “let’s just watch them and see how they do approach”. On one hand, I know it must be frustrating being a mother and taking your sick kid in and walking out empty handed but on the other hand it takes a wise and strong pediatrician to know when to NOT give out an antibiotic and stay resolved to act accordingly.
I also realized that you deal with a lot of dermatology in peds. I would say about half the cases I see now have some sort of derm problem associated with them. Rashes, infected bug bites, fungus, congenital lesions. Seriously, kids have a whole lotta skin problems goin on. If you want to go into derm but can’t compete, consider going into pediatrics. It’s on the complete opposite side of the competitive scale and you’ll be able to get your derm fix. Of course that’s assuming you want to go into derm for the actual medicine of it (which is boring to me) and not just of the plush schedule and salary.

Sometimes medical school is just plain boring.
This felt like one of those days.
Study last weeks lecture notes all morning at home, eat lunch, drive to school, attend a clinical problem solving session that was decent but not mind blowing, study pathology with a couple friends, eat some more, study more pathology with friends, print out this week’s notes from the computer lab, drive home, watch two lectures from this morning.

The first clinical problem solving session required seven of us students (being prodded along by two faculty members) to conduct a virtual history and physical on a patient and try to figure out what the underlying problem was. The way it works is we are given nothing but the name, age, and primary complaint of the patient and then we decide what questions to ask and what exams/labs to do in order to make our diagnosis. The faculty members answer our questions with whatever info is written on a sheet that they were given by the people who designed the activity. It’s supposed to help us figure out how to think like doctors in the clinic. It worked pretty well from what I can gather. We have three weeks (with one meeting each week) to fully work the case up and decide on the diagnosis and treatment. One thing I learned about myself (or re-learned) is that I am extremely practical when it comes to diagnosing. Although I value the thoroughness of some of my colleagues, I know in the real world we’ll only have 10 minutes with a patient and not 10 hours so my mind naturally starts to disregard certain theories and pieces of information brought up for discussion. I get impatient when I know we’re holding a microscope over something that is completely inconsequential. I’m looking for horses, not zebras.

And I think in this respect I am developing (or have already developed) a bit of a surgeon’s mindset. Give me the facts, give me what’s relevant, don’t BS me, this patient needs help now not tomorrow. It’s an attitude that seems like it would lead to being susceptible to missing things, but I think I have enough of a respect for the idea of thoroughness to make sure I get a complete picture of the illness and pay respect to the patient’s voice and opinions. I just do it in a more efficient way.

Later when I got home, I edited a short paper Polley had written. It took me 10 minutes which was a lot quicker than I thought. Not because I expected her to be a poor writer (she’s actually fantastic) but because I forgot that I have a knack for reading and writing and consequently proofreading in a limited amount of time. I’m not saying I’m great, and I’m definitely not talking about the stuff on this blog (God knows I consistently write a bunch of rubbish on here) but I do have a bit of skill with the written word. Writing and reading come naturally to me.
Editing her little paper made me realize that all the talent I have in that area is currently going to waste. I can’t remember the last time I wrote or read something I enjoyed. It seems medical education wasn’t designed for the writers of love letters and essays, short stories and screenplays but rather for the writers of physics equations and mathematical postulates, case review studies and laboratory data tables.

I am sculptor in a city of cement, dry and gray.

Studying for pathology today. I’m intentionally avoiding the lecture about leukemia because it is terrifyingly difficult I think. I’ll take those anemia lectures over that any day.

In the morning I started reviewing anemia which is a lot bigger subject than I thought it would be. I recorded vocals for another song in the afternoon. At night I attended the white mass. No, that’s not some laboratory finding; it’s a special church service held for physicians in our area by the Catholic Church. I’m not Catholic but it was an honor to be invited. About nine other med students from my class went and I went as a guest of my LCE doctor who is involved in the Catholic Church. After the service in which one of my class mates handed over her white coat to the priest as symbolic gesture, we had dinner and a local doctor spoke to us on the importance of spirituality in our everyday medical encounters. He showed an interesting photo of a large statue of Jesus in the lobby of a facility at John Hopkins with an inscription about bringing all those who are tired and weary to him. He also spoke about how the Hippocratic Oath has been “modernized” over the years and different med schools have different versions of it that they make their students recite. I’m not sure which version I’ll be asked to swear to after 4th year but I hope it’s one that upholds the sanctity of life.

Looking at my own blood under a light microscope was an interesting experience. We had to identify and count about 50 white blood cells on the smears we made the day before. I spotted 4 eosinophils which is perhaps due to my allergies. Eosinophils are my favorite white blood cell because they are the only one that’s really red and you can always tell if you’ve found one. Is it weird that I have a favorite white blood cell?

In the afternoon I tracked vocals for one song and finished recording the rest of the violin on the EP with Emily. Emily is one heck of violin player, although somewhat bashful of her skills, once you challenge her she generally comes up with something brilliant. I told her to write her own short solo for the opening song and she did it in about five minutes and, more importantly, it was really good and fit really well with the mood of the song. After we finished recording we sat down and listened to most of every song on the record. The main thing I took away from this was that I (with the help of some close friends) have put together a very dynamic set of songs. If you listen to five seconds of a song at the beginning, middle, and end, you might think you just listened to snippets from three very different songs. I think it’s appropriate because the first year of medical school had a lot of emotional ups and downs and the schedule was changing all the time. It put me in a state of flux and I think the EP will reflect that somewhat.

At night I stopped by the Tampa Museum of Art downtown to check out their Art After Dark event. It was kind of lame because half the galleries were blocked off because they were moving things around but they did have a cool photography exhibit from the 80’s on display.

This morning, I spoke with my new career councilor. I switched for a variety of reasons but generally because I felt like I couldn’t relate to my other one as a future physician or as a person and I think this is an important thing to have when you’re dealing with someone who is supposed help you decide what you’re going to do for the rest of your life. My new career counselor seems to be working out much better already. We talked specifically on my mental struggle between pediatrics and surgery and he mentioned a few things that made me think about it differently than I had before. First he said this decision is like deciding who to get married to.

When the subject of doing pediatric surgery came up, I told him that I didn’t think I could do it because I don’t think I could emotionally take having kids die on me, possibly because of a mistake I made. Everyone I had talked to before about that agreed with me and said they could see where I was coming from but this family physician didn’t. He told me it doesn’t matter whether the patient is 7 or 70, it will tear you up inside in a terrible way. He put it like this: if you were driving in a car and you were going to hit someone, would you rather hit a child or the mother of three children? He said that to get me to realize that someone dying has an impact on more people than just that person; you have to think about who depends on that person and who will be hurt by that person’s death. And when you think about it that way, adult death is perhaps even more tragic than children dying.

He said it was good that I was thinking about the different aspects of the different specialties and what I was attracted to most. He said I picked two extremes and that can be really difficult but that there was a way for me to have both the relationship aspect I love and the medical aspect I love combined. Subspecialty.

Towards the end of everything he told me that he heard from me in just that short amount of time more reasons why I wanted to do surgery more than anything else. He said I shouldn’t make my decision on whether to go into something based on if the training is long and hard or not, “after all, you’re in medical school” he reminded me, “you could have done a LOT of other things that were easier than this but you choose to come here because there it something you love about it”. When we finished we agreed that I should go take (or retake) the survey on the professions of medicine website and that I should contact the surgeon who had spoken at my white coat ceremony and ask him for advice.

Now for the fun stuff: venipuncture.

We drove needles into each other’s arms today, most of us, for the first time. I tried to capture the experience on film but that pretty much failed so I got these shots of our tubes filled with the blood we drew from each other instead.

After we watched a brief and somewhat hilarious instructional video from the 80’s, our class headed to the path labs to begin, many of us, like myself, a little worried about jabbing someone in their vein with a needle and being jabbed ourselves with a needle by someone just as inexperienced as ourselves. My one priority was to find a partner that had large veins so it would be easy to guide the needle in. The last thing I wanted was a little girl with veins as thin as hair. Of course while walking to the path lab I realized everyone had already paired up. But I managed to find my friend Asef in the lab to work with. Asef isn’t a big guy but he isn’t a small guy either. “Perfect” I thought.

I thought.

Until it came time to place the turnicate on Asef’s arm and I couldn’t see a thing. Well I saw a little bit of something and felt a little bit of something but not much and when I actually plunged the needle into his skin and pushed the tube into place, nothing came out. Poor Asef. He was a fantastic sport about it through, I guess he’s used to people having a hard time finding his veins. Later, he let me try again and because his other arm was bad too, I used the same arm and the same vein. This time the vein was completely hidden; even the phlebotomist who was trying to help us seemed like she had no idea what to do. But I had to do it. There was no way I was going home without sucking out my first tube of blood from somebody’s arm. And Asef had a great attitude like I said so I decided to go through with it.

Blind.

I couldn’t even really feel any sign of the vein (usually its kind of bouncy/spongy compared to the skin around it).

So when I pushed the needle through the skin and inserted the tube, I was very surprised to find the blood quickly flowing in and eventually filling it. A tiny miracle perhaps. And you can bet I was praying. For Asef’s sake. My mom was a fantastic phlebotomist (by her own accounts) so I hope some of that talent is in me as well. So far, it looks hit or miss.

My other friend Arjun drew my blood. Of course I have enormous veins so he had a buffet to choose from. When he first got under the skin there was no blood but after a small adjustment of his needle the tube was flooded and filled in about 5 seconds.

Afterwards we all made smears of drops of our own blood on glass slides. It only took me three tries to get it right.

Later while watching lectures I noticed that we have another bias apparent in our faculty: malaria. We’ve had about three or four lectures on it now. Three or four. On a disease that we will most likely never see while practicing in this country. I swear, our medical school is trying to train us to be international doctors. I don’t know if they’re teaching it so much because a lot of people have done research on it here or what but I think it’s getting a bit ridiculous. There’s no way that the amount of malaria I’m going to see in the clinic or on my boards validates this kind of focus on it. There are enough human diseases in existence to fill libraries upon libraries and we are given at least three classes on this one that we may never even see? Give me a break. And while you’re at it, give me some of the money back that I paid you for a U.S. medical education.

In the morning I had a meeting with someone who helps coordinate my physical diagnosis course concerning my confusion with the Judeo-Christian Clinic assignment I had. We talked through everything and she was very understanding and receptive to my concerns. She even offered an opportunity for me to do the assignment over again if I wasn’t happy with my grade. When we finished, I thanked her for working with me on an issue that had nothing to do with medical material and everything to do with logistics. I told her I wished that all of the other departments worked as well with students when it came to similar issues. She reminded me that the students are paying the faculty to help them, it is their job to do so, and that we are the customers. That’s a mindset that I have very rarely ever heard a member for the faculty display.

At lunch, my arts and humanities scholarly concentration had a meeting to welcome in some first years who were interested in joining. It was a really pleasant time and we actually made some plans to meet up and talk about some art together. Go figure. Last year I never got the chance to go to any meetings because apparently I wasn’t told about them for some reason which kind of upsets me. Anyways, this time around it seems like all of us will be a lot more in tune with what the others are doing. Our faculty leader suggested we start a blog. I literally laughed at the mention of a blog about art in medical school as I turned to look at my good friend and current first year, Danielle, who returned my laugh because of her awareness of this blog. I’m really kind of blogged out at the moment so I’m hoping the other students can work on that. Our faculty leader also told us we would have the opportunity to meet and talk with (and possibly have dinner with) a few of the more prominent writers/artists in the medical community this year. I’m pretty excited about that.

We had an LCE small group in the afternoon in which I managed to avoid being drilled on gallbladder abnormalities by our faculty group preceptor.
Safe for another week.

My 400th day of medical school. Crazy.

Anyway, LCE was good this morning except for there weren’t many kids to see. The day before apparently they were really packed. I did do a few fun things though. I examined a 2 month old who was one of the healthiest looking babies I had ever seen, minus his little distended belly from his gas. His sister who was about 3 was running around excitedly (probably because she wasn’t the one who needed to see the doctor for once). Eventually she pulled up a stool and kind of leaned on the end of the examining table where I was looking at her brother. I asked her if she wanted to listen too and of course the answer was some excited yelp for joy that could only be interpreted as a yes. I stuck my stethoscope in her ears and placed the diaphragm up to her baby brothers heart. I asked her if she could hear it. She said yes. I said “it’s fast isn’t it?”. She nodded her head.

On my way out she told her mom that I was a nice doctor.

When I came back in the room with my LCE doctor, he examined the infant while I entertained the sister again with my stethoscope flashlight attachment, which she was fascinated by. I made sure I payed enough attention to the doctor to know that I had done everything correctly but I wanted to kind of distract the energetic little girl so her mom and the doctor would get a good chance to talk about her little brother. Eventually, they finished and the mom asked the little girl in front of us to tell us what she wanted to be when she grew up, to which she promptly replied, “A DOCTOR!!!”.

Definitely one of the cutest experiences I’ve ever had.

Later, one of the PAs that works in the clinic took me into an exam room with her to show me a dark, hairy facial lesion on a three year old’s face. The scientific name for the lesion: Giant Hairy Nevus.

No joke.

Seriously? They couldn’t think of anything better than that?

Anyway, it’s a very rare congential abnormality that covered up about half the girl’s face. The amazing thing though was that it used to cover up 2/3 of her face and thanks to some docs that work in plastics I couldn’t even tell that the part they had healed had ever been abnormal. The PA explained it briefly to me. The doctors insert tiny “pillows” under the girls skin and then blow them up with air or something to stretch out the skin. The they cut back the nevus and pull the new skin over the old area. The results are amazing. Unfortunatly the little girl couldn’t finish the procedure quite yet because the pillows were extremely irritating to her and so they had to take them out for now. I think by the time she gets a little older and the doctors have had more time to work on it, she could lead a very normal social life and aquire a good self-esteem. I could tell when I was talking to her she was pretty shy about the whole thing.

Later at night I saw the second to last Quentin Tarantino film on my list: Death Proof. It was a lot longer than I thought. It was originally shown as part of a double feature with a film by Roberto Rodriguez so I thought it would be less than 90 minutes for sure. I was wrong. Tarantino dragged the story out quite a bit (which he tends to do) but he managed to thrill again in the end. Excellent use of action sequences and strong female leads as usual. I was impressed.

I don’t want to speak too soon but I don’t think it was as bad as I thought.

I don’t know if I passed certain courses or didn’t but I feel like for the amount of time I actually had to study I made the most of it.

It felt significantly shorter than the first test, clocking in at 2 hours and 15 minutes.

And there was no anxiety this time either. I felt calm throughout the whole thing, even in light of a great computer malfunction.

Here are the details: It literally took 4 to 5 seconds for anything to happen when I pressed the button to go to the next question. Additionally, almost every time I tried to pick an answer and sometimes when I was adjusting the size of the box of the visual aid, the computer would freeze for several seconds. This may not sound like a big deal but it definitely added up over the course of 108 questions. I seriously think I lost about 10 to 15 minutes of test time because the program froze so many times. And it wasn’t just me, many other people also experienced this problem. When I got to the end of the test I had 10 minutes left so I alerted the staff about the problem but they said they couldn’t do anything for me including add time. I hadn’t asked them earlier because I was afraid of it taking too much time away from my test. So in the end I barely got to look at any of the questions I had made a note to go back and check.

Of course, it’s a really difficult situation because it’s not like they are going to add points back to our tests because we lost some time, and there is no way to go back and give us that time again. So it seems like there is no logical way to rectify the situation. Which translates into quite a few students, including myself, being a screwed over. I’m interested to see how the faculty responds exactly to this. While there are a few people who are sympathetic to our situation, I doubt practically that the faculty as a whole will be able to come up with any kind of way to compensate us.

In the afternoon, I organized some of the tracks for the new album. The recording process is so close to being finished I can taste it.

I feel like I am vaguely familiar with most of the material.

I anticipate a lot of educated guessing, a good deal of “Eeny, meeny, miny, moe”, and a couple confident correct answers.

Here goes nothing.

I have started to triage information that I need to memorize.

Like patients are triaged during a disaster.

Because this is a disaster.

While reviewing four hours worth of dense pathology lecture notes about neoplasia by a lecturer who is just plain terrible, for the first time in a long time, I seriously thought about flying out of town and not telling anyone where I was going.

There is a gargantuan amount of information we have to memorize for this test. I don’t understand how the other people in my class do it. They are machines I think. I ask them of course and this is essentially what they tell me: “I just look at it once and then a second time and usually I’ve got it, if not I’ll read something else about it and then I got it.”

WHAT.

THE.

HECK.

If I could just read something twice and then make A’s and B’s on the test, I’m pretty sure I’d have finished last year with straight A’s, shot a feature film, and recorded a 27 track concept album.

On top of that, the vast majority of them are pretty awesome human beings, kind, and talented in areas outside of what they’re studying.

Seriously. These people are super-human.

There’s no better explanation.

I’m just waiting for Professor X to roll around the corner in his wheelchair. Then all my assumptions will be confirmed.

After several more hours of studying and watching reviews, I started to sense I knew a little something but still I don’t foresee myself having a firm grasp on anything by the time I take the test.

Let me start this by saying that I regard HIV as one of the most important diseases of our time. It is worthwhile to study and beneficial for extending our knowledge base on viral infections as well as helping us manage the care of a specific group of patient’s we will surely encounter in the future.

Today we had a good conference where an patient with HIV spoke to us. It was technically voluntary but our course director strongly encouraged us to go and asked us to attend as a personal favor to him. So I went and was ashamed to find the room significantly not full. An interview with the patient was skillfully interwoven with some brief lecture material presented by an expert HIV doctor. I felt both were high quality and very informative. The patient gave us a rather revealing picture of how HIV affects gay males in the U.S. While not getting into any details, I didn’t completely understand his emotional reasoning or reactions when it came to acquiring the disease but I did feel empathy for him and his condition and the side effects he has experienced from some of the antiviral meds he’s on. I thought it was brave and honorable of him to come and share his story with us. I was just sorry that the room wasn’t full for him.

After the conference, I approached our course director and apologized for my classmates and mentioned that many of them are edgy about the exam and think that two hours in a class, even one that is about a subject relevant to the test material, is somehow not going to help them as much as studying notes on their own. While I totally understand not coming to class because it is less efficient than studying at home, there is something to be said for professionalism. And even with that aside, the people that didn’t attend missed out on a rare and truly meaningful experience with an HIV patient that was without a doubt beneficial to our transformation into compassionate, empathetic, emotionally intelligent physicians.

So now for the nitty gritty, let me state, once again, that I believe HIV is a very important disease to study and that we should be responsible for being familiar with it.

However, I have noticed something that seriously bothers me.

There is clearly a bias toward teaching this disease among our faculty. For reasons that I believe are connected with research interests and perhaps even societal group affiliations (is that vague enough?) I believe we have been OVER-educated about HIV and consequently under-educated about many other illnesses that we will be seeing much more frequently. We’ve probably had about eight contact hours devoted to HIV and HIV related issues in the past two weeks. Meanwhile, we’ve barely learned anything about herpes viruses and hepatitis viruses which are much more common. I understand it’s important but it is ONE disease, and a relatively rare disease in this country at that. Some people may think I’m out of line for making these statements but I really don’t think I am given that many people in the class have expressed these same views to me privately. Additionally, several medical professionals I’ve discussed the issue with outside of our school have validated my view of the matter, affirming the rationality of it and the logical decision making process I postulated had been at play.

I’m just saying what everyone (or nearly everyone) is already thinking.

A conversation while walking through the parking lot, weary discussions in the pathology lab, and very vocal dissension during the TBL in our lecture hall. These moments revealed to me a recent solidarity my class has developed around the now more obvious offenses the administration has committed against us. It’s not so much treachery as a subtle disrobing of the respect our class is entitled to. And people are noticing that we’re nearly naked.

Today was a better day for me personally by many accounts. Perhaps I gained a stronger feeling of camaraderie with the group of people I am sailing across this great ocean of information with while I watched time and time again as a rainbow of answer choice cards were displayed across the room in response to questions in which the parameters were poorly defined and often failed to adhere to the substantially irrelevant set of objectives we were given to prepare ourselves with for the exercise. Maybe I felt a sense of validation when some of the brightest and most well respected students in the class voiced their frustrations with the current set of curricular choices being made to a panel of the very faculty who were responsible.
We called them out on it.
But who’s to say they even listened?

Earlier in the day I met with a psychologist at the HELPS center.
When a psychologist says that you’re “unique” what does it mean?
I would postulate that the answer lies somewhere in between “I am very interested in doing a case study on you” and “I have no idea how to help you”.
Really, the man was nice. His all too obvious advice about using the right side of my brain to build up the left side of my brain aside, he listened to me, invited me to expound on the deep flaws I have discovered in the medical education that exists in this country, and acknowledged, to a certain degree, my academic capabilities. Although there is no doubt in my mind that at some point he wondered what I was doing in medical school. He very nearly said it on one occasion. And yes, while he used his own graduate educational experiences to try to “guide” me like every other well intentioned but ultimately ineffective faculty member has done, I did sense that he was genuinely searching for some way to help me.
In the end of course, he couldn’t.
He told me a few things about myself that we both knew I was already aware of including that I’m not clinical at all, and then referred me to a psychiatrist. As I was walking out he yelled out from his office door that I should at the very least call him to let him know how things worked out for me. I discerned this was more out of an interest in my “unique” mind and consequent situation than a desire to see my personal conflict resolve pleasantly. Scientists are, in general, curious creatures who’s obvious attempts to increase the depth of their obsession with raw information comes at the cost of not possessing any of the social skills needed to accomplish their goal covertly.

Subtly is an art form.

I am overwhelmed.
Yet again.
It stems from the fact that I am extremely behind on studying because my time this test block has been taken up by moving, trying to get my extremely unreliable internet connection to work and with things like physical diagnosis and this ridiculous team based learning session we have tomorrow that wont even be on the test.
I am tired of telling myself that things are going to turn around.
I am tired of lying to myself.
Things are never going to turn around.
I am always going to barely cut it in medicine if I even cut it at all. And no, that’s not a surgery pun, it’s how I feel about my ability handle this tremendous amount of knowledge and pressure that threatens to suffocate me everyday.
Every single day.
I’m sick of looking at pictures online of people living in the places that I want to live in, smiling with the satisfaction that comes with their clean, moderately stressful lifestyle in which they work a 9 to 5 and have the nights and weekends free to do things like ride bikes and go to concerts. They’re never haunted by books filled with symptoms they need to memorize or the faces of patients with diseases that they aren’t even competent enough to pronounce let alone treat.

Generally I consider running a boring and fruitless activity unless there is a soccer ball in front of me. But today I ran outside and got lost on the island I live on. I ran because I couldn’t think of anything else to do. I ran because if I spent one more minute inside in front of a computer or notes from endless powerpoint lectures I was going to spontaneously combust. I ran because I knew when I placed one foot in front of the other that I would actually get somewhere, that I would actually make progress, that I wouldn’t be stuck on this life sucking treadmill on which I am constantly in danger of being sucked under the tread.

Medical school is hell.
It is a hell created specifically for people like me.
People who are default multitaskers, tireless dreamers, hopeless idealists, overly ambitious, and just barely capable of existing in an arena where their fellow human beings function and process information as efficient as supercomputers.
Medicine is a farce of my imagination, a town I dreamed up and believed was real. I’ve spent years asking people how to get there, singing songs of its glory and splendor, pretending that I knew it by sight.
But I will forever be wandering because the medicine I am searching for doesn’t exist. The medicine where people like me make any kind of impact and do anything besides fill a seat in an auditorium. It doesn’t exist. At least not right now.

As terrible as this day became, it started out quite well with a feeling of confidence instilled by another great LCE rotation. I examined a good number of kids by myself and read their symptoms right 95% of the time. Even with a couple of crying children that clung to their mothers as if I had needles poised in both my hands, and would barely let me touch them, I gained a decent sense of what was going on. I saw two dermatological cases as well including a rare, fleshy, scalp lesion called a nevus sebaceous. I left the clinic with a feeling that I had become really comfortable in the shoes of a pediatrician and could hold my own amongst my peers.

But that’s just how medical school is. It’s an unfaithful girlfriend that you’re constantly on the verge of breaking up with but just when you’re ready to let her go she brings you your favorite candy or a picture she’s drawn for you, and she tells you you’re the most important person in her world and that she couldn’t live with out you and she begins to cry. But not a wailing, insensible cry. A cry that’s slow and soft and makes you want to wrap your arms around her and promise her you’ll never leave.

And a few hours later she’s in someone else’s arms.

Drugs and Despair on the Mexican Frontier

Portrait of Trey P. taken by Polley P.

Life and Death on the Mexican Frontier

Portrait of Polley P. taken by Trey P.

Finally got all of these antibiotic names under my belt thanks to some of the most ridiculous drawings I’ve ever made. Think word association to the extreme. Studying quinolones turns into studying an extended analogy about Dr. Quin Medicine Woman including imaginary spin-offs where she fights dinosaurs. Whatever works.

While studying at the law library downtown I discovered just before 5pm that the write up I did for my Judeo Christian Clinic experience the week before had to be turned in as a hard copy to the physical diagnosis office. I had sent it in as an electronic copy because I didn’t notice this information which was apparently explained on a single line of our ten page syllabus. Not only that but I discovered first hand what my friend in the class has been telling me for sometime, that this course has been very unorganized this year. I don’t know the difference between a SOAP note and a history and physical exam write up. I wasn’t even sure which one I was supposed to turn in. Many of the forms and example documents are in folders online that are labeled in a way that you would never be able to find them if you didn’t know they were in there. So now I’m probably going to get points taken off for turning it in late. I really don’t understand the reasoning behind turning in a hard copy. This is the year 2010 people! So I wrote a longish email to the course director explaining how I’m worried about my grade, not because I feel unable to carry out the medical tasks asked of me but because it is extremely difficult to understand the unnecessarily convoluted logistical processes involved with the assignments. Half of med school has turned into figuring out what you need to do and what you need to know at what time.

Whaduya know, my physical diagnosis exam went great!

Due in part to some quick, last minute practice with my buddy Omar.
I only forgot to pull out a table piece for the patient’s legs while I was doing the abdominal exam and a couple other minor things. I seriously wish I could have practiced with the table because maneuvering that was half the battle. I also got brownie points for building good repoirt with the patient. At the beginning of the exam I asked what his favorite music was and then where he grew up. Turns out, he went to the same high school that I shot one of my short films in. That spurred all kinds of talk about how it won some awards and how the patient wanted to shoot some short films of his own. We talked through the whole exam which the 4th year student who was grading me said was a really great thing and something that not a lot of people do.

Of course while I was conversing about short films on the surface, inside I was more like, “okay percuss the lateral side four times and then the other side back and forth, crap I hope she doesn’t notice that I don’t know the exact place I’m supposed to put my finger, I should go pretend to write something down on my check list just so I can have another glance at it, it doesn’t look as bad if I’m writing something down right? stupid table. is this even 45 degrees? screw it, she can’t tell from her angle anyway… etc.”.

I went to an interesting psych group lunch meeting today to hear one of the faculty expound on child parent relationships a bit. Good stuff. Then an LCE group presentation. Then home to prepare for my PD physical exam I have to give tomorrow. I do not feel good about this. Even with wonderful friends who’ll let me practice on them, I’m still seriously rusty.

Newborns. Pink. Warm. Screaming. Squirming. Squinting. Newborns. Complete with tiny mittens so they don’t scratch themselves with their long fingernails. Adorable.

And who got to examine them? Me. And my LCE doctor of course.

Every week he goes to the hospital and as it turns out, this week was the perfect one to bring me along for. One baby was getting phototherapy because of a billirubin problem. One was perfectly normal. One had what’s called a hip click. Part of the exam requires you to grab the baby’s legs and move them around in their hip sockets to make sure they’re in correctly. If you feel it click you know something’s wrong. I felt it click. Usually the baby will be fine because some ortho peds docs will put it in a little harness and it will correct itself. But if you fail to catch the click and they go home, a year later or when they start walking they may need surgery. Which means you can get sued. And even if you did everything correctly, there are still a percentage of hip socket problems that you cannot catch on examination. You can get sued for those too. Awesome.

The last baby had the most interesting problem: aortic valve stenosis. I was really lucky to see it because of all the babies who come out with a cardiac malformation (which is somewhat rare) only 5% have an aortic valve stenosis (which would make it super rare). This baby seemed to be okay though. It had regular and even pulses in all extremities and seemed to be acting normal. The only clear sign was it’s heartbeat. I listened to a previous baby’s heart to make sure I knew what it was supposed to sound like and then I listened to the infant with stenosis. The problem was startlingly evident. Listening to a normal infant is not terribly difficult but you do have to brace yourself for hearing a lot of screaming through a stethoscope which is not fun. But with this baby, in between the normally rapid heart sounds, you could clearly hear the sound of blood being squeezed through the much too narrow opening in the left side of the heart. Fortunately, in mild to moderate cases (like this one) the baby grows up fine. In severe cases the baby needs a valvotomy (surgery). They can even drop dead instantaneously if it is severe enough. My LCE doc ordered a cardiology consult just to be safe. Afterwards he explained to me that it’s difficult when you have to talk to parents in situations like this. He said you have to find the right balance between giving them hope and explaining to them the hard realities of the position the child is in.

Perhaps my favorite part of the day came when I was able to calm down one of the newborns we saw who was crying frantically during the exam. While the doctor talked to her parents, I rubbed her little pink chest with my finger and whispered to her. She stopped crying and squirming and even opened her eyes a bit. The parents noticed I had calmed her and exclaimed that I would make a great pediatrician one day. “Maybe”, I thought, “but it’s going to take a heck of a lot more than me being good with kids”.
I just smiled.

I attempted to meet with a course director today. No luck because a meeting threw off their schedule. Fine by me, I wasn’t looking forward to another 30 minutes of “what do you think went wrong? Well when I was a student… blah blah blah”. I did however meet with a member of the faculty who told me I should schedule an appointment with a group called HELPS for my anxiety. I’ve heard of these people before. They’re generally associated with helping suicidal med school students. That’s a good thing because there are probably more of them than you think. But I figure it can’t hurt to talk to them, it might even help, so I made the appointment.

Moving all day/weekend = no time to study or memorize drugs
Note to all future med students: never move in the middle of the school year if you can help it.
I couldn’t help it.

We were supposed to track cello today but that fell though as well. I would like to record the last two string sessions in the same place as the other ones just for consistency’s sake. Maybe I’m just anal but I think it’s important. Anyway, hopefully we’ll still get the chance. I finished the weeks lectures today but haven’t gotten to really study. It’s almost a waste to watch the pharmacology lectures (even though I like the instructor) because really they’re just a list of drugs you have to memorize. So even though I watched the lectures, the studying of the material is far more important. And that’s the part I haven’t done.

We were supposed to track violin today but that fell though.
In the afternoon I volunteered at the Judeo Christian Clinic. Okay so I didn’t exactly volunteer; it was a mandatory assigned shift that’s part of our physical diagnosis class. And to tell you the truth, I dreaded doing it because I felt very unprepared. But it was actually a pretty good experience, thanks mostly to a 4th year student who was there to help me through everything. My patient was Spanish speaking so the 4th year played interpreter and prodded me along a bit in the direction I should take the physical exam. I learned how to use different risk factors like cholesterol levels and smoking history to calculate the risk for a heart attack. Something interesting I really internalized from the experience was that different population groups view medicine differently and consequently present different challenges for health care workers like myself. I KNEW this before but I hadn’t fully comprehended it I think. Specifically, I learned that in Hispanic culture, people have a significant fear of being addicted to certain medications and so they simply stop taking them even if they are proving to be extremely beneficial to them and even if the medication is not in and of itself addictive. These types of things don’t mean too much on paper but when you see someone sitting and talking with you who embodies this mindset, it’s something you tend not to forget.

Experience is the best teacher.

I watched about eight hours of lecture today, five in a row toward the end. I was on a roll.

I took these photos today of the instruments I own because I had to set them all out anyway in preparation to move. My favorite ones are of the drums. The rest are more for documentation purposes.

I got my exam grades back today. Much sooner than I expected.
They were not good. I definitely have some anxiety issues to work through. Looks like another uphill battle.