So What Do You Do?

I have just returned from nearly three weeks of travel, touring several countries in South America. It was a great trip and I regret not being able to travel longer.

While I still have no medical anecdotes to report, some interesting moments did occur during my trip as a result of me being in medical school. Because I am essentially done with medical school -- graduation is next month, but my classes/clerkships ended last month -- when people asked me what I did, I simply told people I was a doctor. My responses weren't far from the truth at all ... I said I had just finished with medical school and I would be starting internship very soon.

(Interestingly, Americans were intrigued by newly-minted doctors, while foreigners were not.)

Inevitably they would start asking follow-up questions such as what specialty I had chosen, why I went into medicine, and other related topics. These conversations were amusing and enjoyable at first, however, I quickly grew tired of them. After the first few of these conversations I knew exactly what question(s) people would ask next, and all my answers were canned.

I therefore came up with an alternative response to the question "What do you do?" I just told people I was in "healthcare". That usually elicited a response similar to "Oh that's a good field" ... and then the conversation usually ended.

It was great. With this wise choice of words, I evaded that repetitive conversation. It worked great the rest of the trip ... although one woman pried a little by asking "What do you do in healthcare?" to which I responded "I work in a hospital."

It is funny how certain things in medicine are so exciting initially, but whose novelty wears off quickly. Other examples include wearing my white coat (I was so excited the first time I wore it but now I can't stand wearing that short white coat) and having a pager (my first page was exciting, while every single one thereafter was annoying). I can only assume more of these situations will arise in the future, and so I should just accept them now.

Hello from Argentina

Hola again!

 

I am writing you all from near the bottom of the earth. While I entered Argentina through Buenos Aires -- which is a great and lively city -- we then flew further down south, to the Patagonia region of this country ... which, if you refer to a map, approaches the bottom of the globe. I am probably upside down compared to most of you (at least those in the US)!

 

Patagonia offers LOTS of amazing scenery and some of the planet´s greatest outdoor sites. Mountains, glaciers, towers of granite, fjords, it has it all. It is also quite cold here, which is unfortunate since I wasn´t expecting to take this excursion and thus only packed beach clothing. Not wise, but a little 0.4 degree Celsius never killed anyone, right? (OK, it probably does.)

 

Until next time, chau!

 

Greetings from South America

Buenos dias!

 

I am writing from the nice beaches of Uruguay. This particular city is where many people in South America -- as well as some Americans -- flock to when it gets hot. It is actually fall here (we are in the southern hemisphere) so the masses of people are no longer here, but with Easter weekend approaching there should be a ton of people visiting for the next few days.

 

Uruguay is an impressively modern country, with great internet connections, fancy stores, and drinkable water. If it weren´t so far from America, I might consider buying a second home here ... and with prices starting in the $80s for a small apartment, you gotta consider it!

 

Anyway, we´ll be here for a few more days and then move on to another country. Till then, adios!

 

P.S. I wish I had taken Spanish in high school. French, unfortunately, is a totally useless language for journeys such as this (as well as practicing medicine in California!)

No More Medical School

My rotations finished two weeks ago, meaning I am done with medical school. Since graduation is still months away (end of May) that also means I have nothing to do until then. Unfortunately, this weblog will probably suffer temporarily as I have nothing medically-related to report. Fortunately for me, though, this means I have almost three months to play around.

Which reminds me ... I should start packing soon for my trip to South America tomorrow.

Post-Match Day Thoughts

Now that Match Day is well in the past, I thought I would share some thoughts regarding that entire experience.

When I think about it, that was truly the worst experience I have ever experienced -- at least the worse experience I have participated in voluntarily. Not the overall residency application process, but just Match Day itself.

There is something unusually stressful about this day ... whether it is knowing about Match Day from the very day you enter medical school, or realizing that Match Day is a more significant event than graduation, or just realizing that the envelope you are holding in your hand, once opened, will declare where you will be forced to stay for the next several years of your life (for better or worse) ... whatever the reason, it is enough to turn the sane insane.

What the contents of the envelope reveal is an entirely different story. It is difficult enough waiting for Match Day to arrive, but finding out where on your rank list you were assigned is potentially much more difficult. Unfortunately I tend to set my heart things, and when they don't happen I get demoralized. The same thing occured here -- I was set on my #1 choice and had been planning my short-term future around it; and so when I opened the envelope and saw I was off to #2, I was devastated. It made that day pretty tough when responding to all the people who asked me "Are you happy?"

Anyway, there is a first time for everything ... and luckily this will be its last time too.

Today

So, 15,252,514 minutes ago ...

or, 10,592 days ago ...

or, 1508 weeks ago ...

or, 29 years ago ...

I guess I was born.

Damn.

This is the last year of my 20s. Next year I will be 30, and next thing I know I'll have osteoporosis and be going to sleep at 5pm.

Match Day

Matched to my #2 ... not bad, not bad.

Still in southern California (new city, however).

More to come, most likely.

Seattle Grace Hospital

So I found myself in Seattle Grace Hospital today. For those who aren't in the know, this hospital is the setting of my favorite TV show Grey's Anatomy.

I was invited to give a talk at a VA hospital in the valley ("the valley" is an area about 30 minutes north of LA), and when I arrived I immediately noticed a motorized golf cart labeled with "Grey's Anatomy" driving around the lot. Once I was inside the hospital, there was one section of the top floor filled with camera crews, lighting, screens, and other filming gear. After looking around a bit, I saw that well-known breezeway seen in almost every episode, the concrete pathway leading up to the hospital, and a lot of SGH signs on windows and floormats! I love getting behind-the-scenes and seeing film sets, so I was pretty excited.

(Hm, considering how much I hate this show, I sure talk about it a lot.)

Unmatch Day

Today is a moderately important day. It is known as "Unmatch Day", the day when all applicants find out if -- but not where -- they have matched to a residency program. It is particularly important for people applying to competitive residencies since there is a good chance they might go unmatched.

For someone like me, however, who is applying to internal medicine, which isn't as competitive (except at top-ranked institutions), it isn't as much of a big deal. Having said that, I was up all night tossing and turning, having nightmares about the worst-case scenario of not matching and getting the dreaded email in the morning.

Lucky for me I received this lonely little one-liner in my inbox this morning:

Congratulations! You have matched.

It was a nice relief. It is also kind of strange when I think about it actually, because this email essentially indicates a job offer. It confirms that I have a job awaiting me in July ... salary and all, as a doctor, no less! That's a little frightening and intimidating.

Now all I have to do it last until Thursday ... which is easier said than done.

Less than One Week Until Match Day

The big day is quickly approaching. It wasn't until last Thursday -- exactly one week before Match Day -- that I began getting anxious just thinking about the match. I am fine as long as I don't think about it (which is most of the day), however if I think about it my mind quickly works itself up into a state of mild anxiety and stress ... not very pleasant.

I just want Match Day to come and go without having to actually go through it ... in other words, I want to know where I match without having to experience the actual moment where I open the envelope and face what's written inside.

Grand Rounds 3:24 is Up

I don't like tooting my own horn (or, for that matter, using that phrase), but that latest Grand Rounds is up at GruntDoc. I mention this because one of my posts is included ... so go check it out!

Scrubs vs. Grey's Anatomy

Abortion. Euthanasia. Stem cells.

These are famous examples of some of medicine's oldest and greatest debates. There is no shortage of passionate people on each side arguing their position, and unfortunately there will likely never be a solution that satisfies both sides.

The times are changing, however, and a new debate is emerging, one that involves medical TV shows. Yes I'm speaking of Scrubs and Grey's Anatomy, both of which have huge and loyal followings. Is it Scrubs, the quirky single-camera show about the life of three residents and a nurse, or is it Grey's Anatomy, the new medical drama about a group of surgical interns?

Never fear, Axis is here to help settle this debate. I will attempt to evaluate this dilemma by using several objective criteria to answer modern medicine's ultimate question once and for all.

Medical Accuracy
Let's start with the easy one. The medicine that takes place on Scrubs is nearly dead-on. Internists diagnose and surgeons operate. Classic stereotypes are explained (e.g. surgeons as knife-wielding morons, ob/gyn's as sorority girls, etc.), inside secrets about medicine are revealed, and the emotional aspects of medicine are well conveyed . On the other hand, in Grey's Anatomy surgeons deliver babies and neurosurgeons do abdominal procedures. Most interestingly, the interns have hours of free time on their hands. Point goes to: Scrubs

The Girls
Elliot and Carla on Scrubs are both fairly attractive and well-fed. On Grey's, while Katherine Heigl is hot (albeit whiny), Ellen Pompeo is so skinny she looks like an ashen grey skeleton ... and Sandra Oh looks like a catcher's mitt with eyes. Point: Scrubs

Attendings
You can't beat Dr. Cox: who else can turn a word with two syllables into six? Who can come up with a new girls name every 10 minutes? In fairness, Dr. McDreamy is unusually popular, both on- and off-screen. Point: tie

Chiefs of Service
This is a tough one. On Scrubs, Dr. Kelso is a scowling money-driven Chief of Medicine who makes everyone's life miserable (especially for Ted, that poor attorney). On Grey's, the chief is Dr. Webber, a big guy who simply plays a generic "stern black man". Point: tie

Humor
Scrubs is overflowing with quirky humor (my personal favorite) while Grey's has none (quirky or otherwise). Point: Scrubs

Drama
But what Grey's lacks in humor, it more than makes up in drama. Grey's Anatomy is not so much a medical TV show but rather a soap opera that happens to take place in a hospital. Medicine is occasionally practiced, but only if an intern can hook up with an attending in the process. The winner here is clear-cut. Point: Grey's Anatomy.

Timeline
Characters in Scrubs progress nicely each year, from intern to junior resident to senior resident, etc. In Grey's, the characters apparently are so dumb that they are still interns after three years. Point: Scrubs

And the winner is: Scrubs.

There you have it peoples, objective proof that you may safely avoid watching TV on Wednesday nights. Anyway, it's time to watch Scrubs ... seeing how it's the better show.

The Flu

I think I have the flu. I woke up three days ago unable to move a muscle and have since been clinging on to life by a delicate thread. I wish it was just a severe cold, but I guess I have the classic flu symptoms: fever, chills, muscle aches, cough, headache, and fatigue. I'm a mess. I also don't think I've ever slept as much as I have in the past few days, with that first day setting the record: only 3 hours of the day when I wasn't asleep!

I should just be thankful that I'm on a rotation where I can afford to take a few days off without serious repercussion. Speaking of this ID rotation, I should also be thankful that I only have the flu, and not one of the many nasty infections I've encountered the past few weeks. Would much rather have influenza than salmonella or cryptococcal meningitis. (But then again, with the way I easily scare, I keep fearing that I have the bird flu).

Anyway, back to the grind (meaning get out of bed, drink juice, take temperature, get back into bed.)

1 Month Until Match Day

Title says it all. One month -- exactly 4 weeks -- till we find out where we go for residency. I am really looking forward to Match Day ... except that once the day arrives and it's time to open the envelope, I know that anxiety will overpower me, and I won't be able to do it.

Apparently there is also a big breakfast for us that morning (this is probably common to all schools). I don't know about other people, but I will likely be a little too nervous to keep any food down. We shall see.

Rank List

It's in. Today I submitted my rank order list, which is the next step of this residency application process. Even though the deadline to submit our finalized rank order list is February 21, it was recommended that we submit approximately one week early to avoid overloading the apparently frail servers that become unresponsive the night of the deadline.

My rank list consisted of very few programs and thus was fairly easy for me to create, in that it was easy for me to determine which program I liked best, second best, and so on. It did, however, get me thinking about the programs' end and how they need to rank a large number of applicants. The average internal medicine program interviews 200-300 applicants for about 30 available spots. Assuming they rank most of those applicants -- or even if you don't make that assumption -- that is a lot of people to rank.

Furthermore I cannot imagine how they differentiate their applicants, in particular the ones that are similar. I had minor difficulty deciding my #3 and #4 spots; now imagine a program trying to decide which of their 200 applicants gets what rank. Can they fairly or accurately tell the difference between their #56 applicant and their #57? Differentiating that many applicants seems nearly impossible. I haven't a clue how they do it, especially in internal medicine where the interview -- a seemingly important component of their evaluation of us -- is useless. No hard-hitting questions, no difficult questions, no nothing; just casual chatting. (I suppose this weeds out the social idiots, but really, how many people does that eliminate?)

Anyway, the process is now completely out of my hands and controlled only by the magic that is the matching algorithm. Nothing to do but wait.

For a reminder of how the residency application process works, re-read this post.

Happy Valentine's Day (every day is the 14th)!

First Time With a Foley

Read this post by keagirl on her blog, UroStream. It is a great and entertaining description of her first time placing a Foley catheter in a patient. The reason I link to it is because this was exactly what happened to me too the first time I tried placing a Foley. I was obviously very embarassed, and my resident who was with me at the time instructing me, was thankfully being very patient ... although I could tell she was feeling slightly sorry for my girlfriend.

Anyway, I was going to write about this experience myself at one point, but I procrastinated and keagirl unknowingly beat me to it. Maybe it's for the better, as she probably describes it better than I could.

Ensuring Professional Behavior

It's late at night right now, and I just got home from hanging out all night with people from school. We were at a bar, and something on everyone's mind was DUI ... or more precisely how to avoid getting one.

See, today we had a (outrageously long and boring) session on medical licensure, and to make sure this topic was properly shoved down our throats, three middlemen representatives from the Medical Board of California made an appearance to talk to us. In addition to describing their mundane job in great detail (i.e. sifting through thousands of applications a year), they spent lots of explaining how we had to make absolutely sure we were being truthful when reporting any prior offenses ... including but not limited to reckless driving, DUI, and running red lights.

Needless to say many students were a little shocked that these offenses, no matter how distant, would have to be reported, lest their application for a license be denied.

So whereas before, people were not overly scared to get a DUI (they were, but everyone has had a friend at one point who got one), now everyone was just a little more careful with their drinking and driving ... to make sure their behavior now doesn't jeopardize their future career.

That was a lot of words. To sum up: now we're really afraid to get a DUI.

Working Too Hard

Shoot me now. I just can't do it. I am now back in the hospital for an infectious diseases (ID) rotation, and it is killing me alive. After 2 1/2 months of easy rotations where I never worked past 10am, I now have to work normal hours (aka, a full day). Since these past few rotations were all some version of radiology, I also never had to deal with patients ... it was just me, the radiologist, and a dark room. So not only do I have to work long hours but I have to see patients too. A shame, because I think I've forgotten most of my history-taking and physical exam skills. Luckily the first few patients assigned to me were all intubated, making things much easier.

Furthermore, this is a consult service ... meaning that we get our patients when other services/specialties consult us (i.e. ask for our assistance). This also means that we do not round on our patients until the afternoon -- as opposed to the morning -- which for some reason is the tradition with consultation services.

As a result I have to get to the hospital at 8am, catch up with my patient, which takes less than an hour, and then entertain myself until early afternoon. At that point we proceed to round for about 3-4 hours. Yes, hours. (Rounds could easily be shortened, but our attending is the type who responds to a question with a 10-minute story.) As 5pm approaches I really do want to shoot myself. It is precisely nonsense such as this -- endless rounding, endless talking -- that turns people away from internal medicine.

Relatedly, this is quite reminiscent of my dreadful Neurology days.

At times like this I really wish I were going into surgery, where rounds are brief and focused. Unfortunately I have to look forward to 3 more years of this.

One Year Anniversary

I just realized that today marks the one-year anniversary of this blog (you might even call it my one-year bloggiversary). No one is more surprised that myself that this weblog has lasted so long, and I am glad it has. The few blogs I have tried to maintain over the years have all died after a few posts, so for me to write fairly consistently for a year is unprecedented for me.

Anyway, thanks for whoever reads my blog, and I'll try to keep up the posts.

Boards Done, Radiology Done

I took my USMLE Step 2 board exam today. It was much like Step 1 (the board exam that really matters), but more clinically oriented. I dedicated one month of semi-serious studying and that was it. It was a 9-hour test, which is damn long. I haven't sat down and focused all my attention on one thing for a long time (since Step 1, actually) and that made it very tough. More importantly, having taken this test signifies the last test I will take in medical school.

Today also marks the end of my radiology rotation ... more accurately, radiology rotations. After having spent December in neuroradiology and this month in radiology, my "radi-holiday" is now over. I definitely did not learn much over the past 2 months, but I have to admit I'll miss the radiologist lifestyle. Gone are my 1-hour "work" days. The rest of my school year still won't be rigorous, since I only have two more months of rotations, one of which is a research month.

Relatedly, I am also starting to understand part of the reason why internship is so stressful and difficult. After going through the fourth year of medical school, the last half of which is spent mostly doing nothing, it must be a rude awakening to be thrust full-time into the hospital again. Going from slacking to 80-hour work weeks, no free weekends, and a call schedule can't be pleasant for anyone. It is a good thing no one expects much from interns. I hope.

2 Months Until Match Day

I just realized today that Match Day is two months from now. The big day that dictates where I'll work and live for the next few years is no longer in the distant future ... it's just a matter of months now.

Interview season is also winding down, which means the next step in this residency application process is to create and submit the "rank order list", the ranked list of programs you are interested in. (Where did the time go? I swear, I was just a first year med student recently.)

As the big day gets closer and closer, I also get getting lazier and lazier. Fourth year of medical school really is like senior year of high school. I have been on most of my interviews and so I'm tired from all the travelling. I also have lots of free time but can't find motivation to do anything too productive. I am still in Radiology, which is a joke, in terms of time commitment; simultaneously I am trying to study for Step 2 (the next step of the national boards), which I am taking at the end of this month but not having much luck with my attention span. Life is so slow that I watched American Idol last night (making me realize that Seattle is full of freaks ... a shame, since I love that city).

That's it. Not much else going on in this so-called life.

Happy New Year and I'm Back

Happy new year everyone!

I know it is a little belated, but I've been busy trying to settle down now that I have returned from my trip abroad. I'm glad to be back, although the trip was lots of fun.

My plane rides, however, were not enjoyable. I first flew 5 hours to Frankfurt, Germany, which was not too bad since at the airport I sat and drank a great beer (Licher). Excellent taste while being served at the perfect temperature (not too cold). Ze germans really know how to brew and serve beer. Even better, this beer was for breakfast ... but don't worry, I balanced it out with a healthy bowl of yogurt and muesli (dubbed "The Fitness Breakfast" in their menu). Great combination. Not a bad way to start off the 5am hour.

I should also mention that at Frankfurt's security checkpoint, I was thoroughly "inspected" (felt up). That guy was poking and rubbing his hand in places that even girls haven't visited. Not at all enjoyable, even with a crowd of people watching me squirm with each new body part being examined.

My next flight -- back to California -- was over 11 hours. Think about that. Think about what you typically do in 11 hours. There is only so much sleeping, reading, watching movies (You, Me, and Dupree), and eating you can do when on a plane before you go stir-crazy, or get a PE. Needless to say, I was very excited when we touched ground, especially since I have a new-found appreciation for life.

In any case, I'm back. The plan for this month: radiology. Yes, last month was neuroradiology, and now it's plain old radiology. After one week, I have realized my schedule will be nearly the same as before. Instead of starting at 9am, however, I start at 8am ... which just means my day is done at 9am. Not too shabby!

Near Death Experience

I've ever been so scared in my life.

Still here in the Middle East, we decided to take a trip to another city within the country, and so went to a travel agency to buy our tickets. Now in the US, this wouldn't a big deal at all ... just book whatever flight was available or cheap and you'd be set. Unfortunately, here you have to watch out because some flights are aboard the infamous Tupolev planes.

If you're not familiar with Tupolev, read here and here. In short, Tupolevs are Russian-made airplanes that are notorious for crashing. They drop out of the sky like flies. All you have to do is look at one the wrong way and it'll crash.

Anyway we reserved flights that weren't on the dangerous airplane, and we thought that was that. However, on the day of departure, we were boarding the plane when a crew member stopped me to and told me to check in my little carry-on bag. I asked him why, and he said "these Tupolev planes are very small."

Um ... what?

My mom and I immediately faced each other and saw the shock in each other's eyes. We asked the guy to repeat, and he again confirmed that it was the airplane we didn't want -- the one aircraft we went to great lengths to avoid, the one aircraft that determined our travel plans for this little trip, and the one aircraft that prompted us to stay an extra night at that city (to avoid Tupolev flights).

The crew member tried calming us down, and for the most part he did, until I stepped foot on the plane ... and saw all the signs were written in Russian. Not calming. Neither was the fact that this plane was incredibly small, half-filled with broken parts (seats, floor boards, overhead compartments, etc.), and smelled like gasoline. I'm no rocket scientician, but I am pretty sure airplanes shouldn't smell like gas.

Luckily -- thankfully -- our flight was uneventful and we arrived safely. We were flying to the holiest city in the country, so it would have taken one mean God to bring down that flight. (Ironically/coincidentally/unfortunately, we were flying to the same city mentioned in the article above.)

I know this isn't much of a medical post, but I guess it does loosely touch upon some medical ethics ... namely, end of life issues.

Hello from the Middle East

Greetings from abroad! Yup, that's where I am these days. I came
across an internet cafe and thought I'd drop a quick note.

It is very cold and snowy here. (So to answer the burning question in
your minds: no, the Middle East isn't just sand dunes and deserts.) I
actually love snow, especially since it's a huge change from Southern
California. I am also eating a lot, shopping a lot, visiting people a
lot, and thinking about medicine not at all.

Unfortunately internet access is pretty difficult to come by (not in
the entire country, but just in the neighborhood I am staying) so
another post might not occur until my return home.

Till then ... happy christmas and holidays!

Leaving the Country

Dearest readers, I am leaving tomorrow for a 2-week family trip out of the country. The region of the world we are travelling to (mentioned frequently in the news these days) has unreliable internet connections, so I doubt I can post from there ... but never fear, I'll be back soon.

Merry Christmas!

Interview Thoughts and Random Thoughts

Now that my first round of interviews is over, I have a little time to breathe (and focus on my hard days of work on neuroradiology). Here are some recent thoughts I've collected. First, the post-interview thoughts:

• I wear a suit to all my interviews, as is expected. My suit is kept neatly pressed all the time, and on the mornings of my interviews I sometimes even walk around the house without pants (a la Seinfeld) while getting ready so that they don't get wrinkled unnecessarily early in the day. Also, I make sure my belts are tied, shoes are polished, and ties are straight. In other words, I make sure I look slick.
  
  Well on one interview a few weeks back, I was interviewing with the program director and sitting directly across from him with no desk between us. I may not have had the world's greatest answers, but at least, I felt, I looked damn good. Of course, nothing ever goes perfectly for me ... because afterwards I went to the bathroom, only to realize my fly had been open the entire time. Man, so close!
  


• I've noticed a mildly interesting association between gender and subspecialty choice. At some point during the interview day when all the interviewees are together in one room, we will be asked in what, if anything, we plan to sub-specialize. The trend I've noticed is that girls are interested in pulmonary medicine while guys are interested in cardiology. (And during the tour at my second interview, these two guy interviewees suddenly disagreed on a minor point about cardiology. They went back and forth a few times and then started geeking out -- they began bickering loudly over this useless point, drawing the attention of everyone in the tour. Not wanting to get caught up in this extraordinarily embarassing show, I quickly dropped back to the girls and starting showing newfound interest in the lung.)
  


• Updates from my night at Days Inn (aka, my night in the ghetto motel). The night actually improved: I figured out how to connect the light switches to the lamps; I got the bathroom light working after flipping the switch on and off about ten times; and most importantly, I was able to jerry-rig (gerry-rig? Jerry-rig?) the curtains so that I had some privacy (I used the clip on my hospital name badge to connect both of the thick curtains to each other so that they covered the majority of the window). However, the best part of the night -- which I failed to mention in my original post -- is that the hotel offered FREE wireless internet. That amenity more than redeemed Days Inn in my eyes.
  

Here are some other random thoughts collected as of late:

• I was at the farmer's market one morning last weekend, standing in front of one of the vegetable stands. This stand had a big box of fava beans, and upon seeing them I told my girlfriend "Ha, some people would die if they ate these", referring to favaism, seen in some G6PD patients (causing their red blood cells to lyse open). Some woman next to us overheard me say this and immediately began asking me "what? why? why?" and freaking out. Not wanting to get into the details with her, I just mumbled something about allergies and walked away.
  


• Financial aid disbursements haven't arrived yet, and tuition is due soon ... because I got a bill from my school for $21,000! That is a lot of money. Paying off my student loans will take a looong 30 years. (My blog entry on the day I finish paying it off will probably be my happiest one ever.)
  


• I finally found out that I passed the USMLE Step 2 CS. I still grumble over the $1000 I had to cough up to prove them I know how to speak English.
  

Acute Intermittent Porphyria

I swear the gods are sending me a message.

I think they want me to know about a disease known as acute intermittent porphyria. Why? Because this disease has been thrown in my face non-stop lately. The first -- and last -- time I encountered this entity was when I was studying for the boards. I learned it, took the test, and promptly forgot about it. I assumed I would never hear about it again.

Well the people up above would differ. In just the past week alone, acute intermittent porphyria was brought to my attention FOUR separate times. The first time was during my first interview, where a video providing an overview of the program showed a group of residents discussing a case, one of which had porphyria on the differential. It caught my attention, but only enough to think, "oh yeah, I forgot that existed."

The next time was on the show House, a medical show I occasionally watch, in which porphyria was the cause of the main patient's illness. After this episode I thought "OK, I guess I shouldn't forget remember this disease". Shortly afterwards I was watching an rerun episode of Scrubs, which I watch religiously, and one of their patient's abdominal pain was due to porphyria. This time I figured I had better remember it, having seen it twice in a row now. And finally, on my last interview one of the girls in the group (an extremely annoying one, too) said her previous interviewer pimped her by asking her to name the enzyme deficiency in acute intermittent porphyria.

What is up with this? Why, all of a sudden, am I having this obscure disease pop up everywhere I turn? I feel like Mother Nature is trying to indicate that one of my family members will get this disease ... or at the very least, one of my patients will.

In any case, it's safe to say this disease is permanently ingrained in my head.

In case you're wondering, acute intermittend porphyria is one of the porphyrias, which are a group of disorders caused by abnormalities in the production of hemoglobin (the molecule that carries oxygen in your red blood cells). It usually presents with acute abdominal pain, generally in young women. And the deficient enzyme is porphobilinogen deaminase.

I can't believe I looked this up.

Night Before an Interview

I am sitting here in a motel in San Diego, the night before a residency interview tomorrow. The program recommended this motel as it is the most accomodating one in the area. Accomodating as it may be (in terms of free shuttles and discounts to interviewees), it is no 5-star motel.

It was nighttime when I entered my room for the first time, and immediately none of the light switches worked. After I wandered around in the dark turning on lamps manually, I noticed that the one (large) window in this room was covered only by a curtain that was thin and see-through. I moved to pull the thicker curtains that were bunched up at the side of the window, but I realized that there was no track for them, and so they weren't able to be pulled across the window ... which means that with all the lights on in this room, people from the outside have an easy and clear view of what I'm doing in here. Which also makes me worry in this sketchy neighborhood that's only 50 feet from the freeway.

To top it off, the bathroom light doesn't work, so if I want to take care of business, it'll be in the dark. Luckily I know where all my boy parts are.

So again ... I'm sitting here in a motel in the middle of the San Diego boonies, unable to relieve myself, and probably being watched from the outside by some freak. Talk about the sacrifices one makes to become a doctor.

Neuroradiology Rotation

Neuroradiology is just radiology of the brain and spine. Now that we're all on the same page ... what's up with this field?

I have been on this rotation for 5 days and have worked a total of 8 hours ... and by "worked" I mean sat in a chair and listened to the radiologists talk to each other. I show up (although I guarantee they wouldn't notice if I was absent) and listen to the attending and resident read films. All I do is I sit behind them and try to stay awake. Every once in awhile I provide my two cents, but only on non-medical topics (e.g. the war in Iraq, the Daily Show, or combinations of the two). I feel like I'm in high school again, shadowing doctors and contributing nothing.

With that said, I love this rotation! In case you missed it, I've been on this rotation for 5 days and have only worked 8 hours! That's less than 2 hours a day. I don't know if my interactions with these radiologists are representative of their profession, but if so, I'm entering the wrong field. Why work 10 hours a day when you can work 2 (and make more money too)? Working 2 hours per day is something with which I have absolutely no problem. I am really curious what the radiologists do the rest of their day, though ... procedures? scans? Either brain and spine scans are easy to read or there aren't that many performed each day.

Either way, I don't know ... and for once, I don't care. I'm enjoying my free time.

Thanksgiving Travel

It being Thanksgiving and all, I have come home to Northern California for several days. Normally I drive, but since I will only be gone for 3 nights I decided instead to fly here. (Yes, I was just here last week for my sub-I.)

My flight was scheduled for 9pm, and I figured I should be at the airport at 8pm. But after hearing about a big-rig flipping over on the 405 freeway and clogging up traffic for miles, and also every news station reporting unusually long lines at airports, I chose to leave for the airport even earlier ... as in, I left for the airport at 6pm (and it normally takes about 30 minutes to reach the airport).

Not only did I not hit traffic, but I flew through the security line. It also helped that I wasn't checking in luggage and that I printed my boarding pass at home. So I ended up at my gate at 6:45pm. For a 9pm flight. Talk about unnecessary precautions.

To top things off, I was also an idiot. I sat in line at Gate 7 (since Southwest seats on a first-come-first-served basis) until 9pm, reading, staring, twiddling my thumbs, when I realized how strange it was that we hadn't boarded yet. I then heard an announcement overhead saying, "Passenger Axis, please come to the counter". Not sure if that was really my name I heard (even though I have a distinctive last name) I waited, and sure enough they announced it again. I went to the counter and the woman said that I should board the plane at Gate 7 now, as my flight was about to take off. I looked up and noticed that I was actually at Gate 6. I had been sitting for 2 hours in front of Gate 6!

I rushed onto the plane and noticed the plane was full of passengers ... with luggage packed away, seated, and listening to the flight attendant explain where the exit rows were. So apparently I single-handedly held up the entire flight for a few minutes. How many people can do that (non-violently, at least)?

Anyway, I'm home for Thanksgiving now. Will be flying back to Southern California in a few days. Enjoy your turkeys everybody!

Next Rotation

Tomorrow will be the start of my next rotation: neuroradiology. As far as I can tell, this simply means radiology of the head.

I (as well as many other students) schedule this rotation during the winter months in anticipation of being absent during interview season, since this rotation is supposed to be very easy and not at all time-consuming. Regular radiology is supposed to be an easy rotation, where you work only several hours per day ... and neuroradiology supposedly makes radiology look like hard work.

I am definitely looking forward to the free time, to say the least ...

Back to SoCal

Subject says it all.

The sub-I is over (it actually ended Saturday when I was post-call) and I am driving back to southern California tomorrow. The month went very quickly, and I cannot believe I am heading back already. Now let's see if this month of work has gained me anything ... in terms of earning me an interview at this program (I doubt it).

In any case, will be writing next from sunny southern California ... till then.

Call Room Funk

I'm on call right now. It's 1:30 in the morning, and I'm about to take a little nap in this call room. All I want is some sleep, but unfortunately this call room smells like ass. Seriously, no seriously. It smells like a homeless person lived here for a week and left. Either that or someone took a piss in here.

This ain't fair ...

Random Thoughts

• Residency interview offers are finally starting to trickle in. I have a few offers from some of the programs I have slightly less interest in, but they are interviews nonetheless. I'm still waiting around for some of the big guns to get back to me (with good news, I hope).


• I'm quickly getting tired of people who only talk about their kids. I completely understand the excitement of fatherhood and motherhood, and I fully expect to have kids in the future myself, but the behavior of these new parents is just irritating. As long as a topic relates remotely to their kids or children in general (e.g. Halloween) they jump at the opportunity to bring up pictures and stories of their children. So now, to prevent them from dominating conversations, I have started showing pictures of my dog to everyone.


• Being on call q4 (medical speak for "every 4 nights") is not as bad as I thought it would be. Granted it's no breeze either, since there are only 2 days where I am neither on- or post-call, but I'm holding up better than I expected. I have been lucky, however, to get about 2 hours of sleep per call night. It is also easier knowing that this schedule will end soon ... which scares me a little since I know fully well that the bulk of next year will involve such a call schedule.


• On a related note, my time here is almost up. Three weeks down, one to go. Funny how my first week here seemed to drag on, as I was learning the ins and outs of this new hospital and system, and now all of a sudden I have only one week to go before I return to Southern California.


• In other news: being up here is definitely clearing my head of the friend situation from back home. The flip side is that whenever I receive a phone call or text message from friend I get even more excited than normal, which I'll admit is probably not a healthy sign. Case in point: I woke up at 3am recently to the sound of my phone receiving a text message -- from her -- which made me so excited I couldn't fall asleep afterwards.


• P.S. Go see Borat!

The Drip

I got the drip.

I've actually had it for about a month now, and I am upset because it's been a LONG time since I've had it. It is really starting to irritate me now, too ... I wake up and the drip is there, during the day it's there, and it's actually the worst at nighttime. Its green color doesn't excite me much, either.

I don't know where I got it from, but it probably doesn't help that I work in the hospital. I was borderline sick before, but since starting this rotation it's become full-blown ... so I probably picked it up from someone here. If only I knew who ...

Anyway, I finally decided to stop with the over-the-counter stuff and go to the doctor today, who prescribed some sprays and such. I expect results by tomorrow morning!

(By the way, I'm referring to the post-nasal drip.)

Drowning in Estrogen

Attending: female.
Resident: female.
Intern: female.
Me: not so much.

This is a first for me, where my entire team is composed of girls (women?) I have been on many teams where the majority of the team was female, but never where I am the only guy.

I definitely have no problem with this, it is just new for me. The team is just as efficient and competent as any team I've ever been on, but it definitely has a different air to it than when guys are the majority. Everyone instinctively responds with "ohhh" (with sympathetic tone) when a patient says something touching. They all bust out with "he's so cuuuuuute!" after interacting with our little old man patient. And they all show pictures of their children to each other.

Luckily the fellow that rounds with us for our unit (ICU) patients is a guy, so there is a little burst of testosterone for a few minutes each morning. (The interesting thing is that I did not even notice this all-female aspect of my team until he brought it up one morning!)

Anyway, not complaining ... just reporting.

Grey's Anatomy

I have been watching a lot of the TV show Grey's Anatomy on DVD here since I don't have television (but luckily I do have internet).

But what is up with this show? These "general surgery" residents do everything ... they're not just general surgeons, but they deliver babies, they do prostatectomies, they do it all. The cardiothoracic surgeons remove abdominal tumors, the neurosurgeons do heart surgery ... what don't they do?

Well for one, they don't listen to DNR/DNI orders (such as the Asian girl intern who goes about coding a DNR patient like there was no tomorrow), as well as many other orders from their attendings. What kind of intern goes behind their attending's back and second guesses their clinical decisions? I cannot even imagine in real life what would happen to that lowly intern if they were to defy an attending in that way.

Also, at what program do most interns sleep with their attendings? Perhaps I should go there for training ... I do like Seattle, afterall.

And finally, come to think of it, this show is on its 3rd season ... and what kind of interns remain interns for 3 years?

Anyway, time for the next episode.

(I know these post-call posts are lame, but in my delirious state of mind they're pretty damn entertaining.)

50 Posts

I am post-call and thus a little tired right now, but I just realized that my weblog just broke 50 posts! Might not sound like much, but when I first started this little endeavor -- while I was hoping for many and frequent posts -- I was afraid it would fizzle out after a few posts. But surprisingly I have found enough time, motivation, and topics to write about.

So thank you to everyone who reads this blog, and the few of you who have even linked to it -- I really appreciate it and am flattered.

Time to sleep ...

Updates from the Subinternship

Hello from Northern California.

Well this rotation is keeping me a lot busier than I expected! Apparently it is a subinternship, which means I am being treated as if I'm an intern ... meaning that I have (near) complete control of my patients, I take overnight call with the team and admit about several new patients, and I am also the first one that's paged in the middle of the night when there is a problem with the patient. Some of these are responsibilities I'm used to, but others are completely new duties for me (such as putting myself down for first page on the admission orders).

Plus, they hit me hard and they hit me fast ... I was on call my second day, as I was still slightly shaken up over struggling to learn my way around the hospital, learn their electronic medical system, and just get a feel for the overall culture. (At least I got to sleep for about 1 1/2 hours.)

Anyway, I am pulling pretty long hours so I have very little time for leisure activities. So much for going to the gym and hanging out with family/friends for the remainder of this rotation. My schedule consists of going to work at 6am, coming home, eating, squeezing in some reading, and then going to sleep. Repeat x 28 days. On the bright side, the residents and faculty here are extremely sharp and knowledgeable, and I am learning a lot. I am also getting an appreciation for what next year (i.e. internship) will feel like.

This is a program I really would like to go to for residency, so I'm willing to endure all of this ... but I get a total of 4 days off (today being one of them), so I won't complain too much.

In the meantime, expect posts and comment replies only on my days off ... so until then, goodbye.

P.S. There are noontime talks here nearly everyday, and the first one I attended was one about the influence of the pharmaceutical industry on medical industry. A very interesting talk ... and very timely!

Away Rotation

I leave today for a month-long rotation in northern California. I will be at a fairly top-notch medical center, working with their housestaff and students, which is a slightly intimidating thought. Then again I will be working in the CCU (Cardiac Care Unit), and when it comes to cardiology I am rock solid ... so I don't worry much.

Northern California is home for me, so I look forward to spending the little free time I have with family and friends. It should be a good month, especially since I think I need to get away from this area to get me away from a certain distraction that has been clouding my thoughts (and sleep) for the past several weeks. Maybe the physical distance will help clear my head.

Anyway, stay tuned for posting from the Bay Area!

Pharmaceutical Sales Reps

I just came across an interesting article in the New York Times entitled Drug Makers Pay for Lunch as They Pitch, describing how pharmaceutical sales reps frequently bring lunch and other meals to doctors' offices in a not-so-subtle effort to pitch their drugs. They resort to providing meals because recent laws have restricted them from offering the fancy gifts that they used to give in the past, such as free vacations, golfing trips, or tickets to sports events.

Anyone that has spent at least a full day in a hospital or doctor's office knows just how true this article rings. You cannot go one day without having a drug rep -- usually an attractive (or wannabe attractive) woman -- prance in with several large containers of food and plenty of drug-related information. Their objective is straightforward: soften you up with goodies and simultaneously slip in information about their drug. They are the missionaries of the medical world ... but instead of "Here, take some Bible with your hot meal" it's more like "As long as you’re eating, let me tell you about this drug.” Their hope, obviously, is that their drug will be the only one you consider if and when you need it at some point in the future.

Careful observation of these reps will often reveal some pathetic behavior. Since drug reps often come in pairs, one will do the talking, schmoozing, and chat-chitting with the doctors; meanwhile their partner is at your disposal, slaving away by preparing fresh food in front of you: Belgian waffles, ice cream sundaes, fresh fruit smoothies, you name it. It is a little sad seeing a grown man or woman in a fancy suit serving milk shakes in Dixie cups. Silly as their behavior is, however, their goal of the bottom line is serious.

Even more amusing is when they refer to a published study that touts their drug's efficacy over a rival drug (conveniently, they are usually pulling out a hard copy of the article and handing it to you.) I don't think they are fooling many people, since most people know these studies were funded by the drug maker, and the results are necessarily skewed. The frightening part is that many people are probably not aware of this financial connection.

The only reason drug reps and their tactics continue to exist is that drug makers have done studies showing the powerful impact of surrounding doctors by simple items that bear the drug names (some people say the only true science that drug companies study is marketing.) They conclude that if even one in every X people (5, 10, 100, etc.) remembers their drug name, it’s a success.

Attending physicians or those with private practices aren't the only targets, but so are the doctors of tomorrow: residents. It is a genius strategy … bombard them with your drug while they are still impressionable and they will likely remember your product once they are practicing on their own. What hungry overworked resident wouldn't pick a fresh hot meal over a repulsive cafeteria meal, even if it means tolerating a short blurb about the latest anti-hypertensive

My personal opinion is that reps should be forbidden from giving any sort of free gifts to doctors ... or if that isn't possible, doctors should not be allowed to accept such items. It was refreshing to hear that Stanford University recently instituted such a rule for its medical centers, by forbidding any of their doctors from accepting even the simplest of free gifts from reps.

Some people claim that drug reps do some good by bringing free samples for doctors to give out to their patients, which is particularly helpful for poorer patients. But the very reason medications have such high prices in the first place is because they include the costs of marketing, including drug rep salaries. So it's kind of like a drug rep bringing a few free paper towels to clean up spilled milk … but only after they had intentionally knocked over the cup of milk themselves.

In the end, as tough as it might be, I hope more medical centers will follow in Stanford’s footsteps. (Until then, you can find me writing with my Zoloft pen on my Rocephin notepad while I drink from my Prevacid cup).

Randoms

Random thoughts ... some related to medicine, some not.

• I just ate spinach -- not raw spinach, but spinach that was on a frozen pizza. If a week goes by and I still haven't written, consider me dead. (Actually let's make it two weeks ... I'm feeling a little lazy these days.) I am also a few big steps closer to colon cancer. A friend recently brought over a huge 2-pound log of meat to my place to BBQ, and we ended finishing it all off. Not bad for two skinny people. Unfortunately, I'm still suffering from too much meat in my system.
  


• Costco sent me a free Gilette Fusion razor in the mail. In case you haven't seen its TV commercials, the Fusion is the monster razor with 5 blades (for the bulk of your shaving) as well as a single blade on the other side (for tricky areas) . I had a pretty good shave with it -- but nothing better than my previous Mach 3 -- but I have to say, the attachment that holds the 5 blades in place is pretty damn big. I feel like I'm running a vaccuum cleaner across my face.
  
  (Relatedly, I just got myself another one too. On our apartment complex's mailbox there was a free blade (again, from Costco) addressed to a former tenant, and the new tenant scribbed "Does Not Live Here, Return to Sender" on it. So I felt free to take it for myself, since these blades are so expensive.


• I had a scotch neat this weekend ... my first "neat" drink. Not so neat considering my throat was burning the entire 2 hours it took me to finish it. I guess this really is an adult drink. I'll try again in 10 years.


• I am suffering from a nasty cold right now. I don't know whether I picked up from "the community" or from the doc that I'm working with right now, one who coughs so violently and frequently, I swear I think I see alveoli shooting out of his mouth every few minutes. That plague is the last thing I need right now, especially since psychologically I don't handle getting sick well.
  


• In other news: I went to a dinner at someone's place last night, and the friend was there. We ended up hanging out together till well past midnight, which was really enjoyable. But then when I went to bed I couldn't sleep at all during the night, as I was thinking about her. My mind is a mess now ... this ain't healthy.
  

Advice for USMLE Step 2 CS

I just took the USMLE Step 2 CS today (see previous post). It was a long and tiring day going from station to station and putting on the same enthusiastic act ... 12 times over.

So, dear readers, for your benefit I have put together a list of how to prepare for the Step 2 CS. Read on ...

STANDARD ADVICE:

Get First Aid
If you've dealt with standardized patients before for school, the test is not very difficult. However, you should be familiar with the large variety of possible chief complaints the patients will present with and the possible diagnoses you could give them. I recommend getting First Aid for the USMLE Step 2 CS to prepare; it is a thin book and has many practice cases to review for the appropriate questions to ask, the physicals to perform, and sample patient notes. Just spend four or five days reading through this book and you'll likely do well.


WHAT THEY DON'T TELL YOU:

Take the 405
(This is specifically for the LA testing center.) To reach the center, I had to drive on the (in)famous 405 freeway. I never take this freeway, and so with everything people have told me about the horrendously slow traffic, to arrive there at 8am I decided to leave home at 7am. I don't know if these aforementioned people were hallucinating, but there was no traffic on this freeway. None! I got to the center at 7:20am, and spent the remainder of the time sitting in my car, in the dark, 2 stories underground, counting down the minutes. Do yourself a favor and don't arrive too early.

Bring your own food
(I'm kind of a picky eater, so this might be particular just to me.) The testing center does provide you with "lunch", but in reality what they provide are some gross looking pre-made sandwiches. I swear, they must have spent only $50 total on that meal ... for all 24 people. Do yourself another favor and bring your own lunch.

Beta-block with bananas
While I don't get full-blown test anxiety, on big test days my stomach usually does some pretty crazy internal gymnastics. I heard that eating bananas helps musicians with performance anxiety. I thought it might be an old-wives tale, but they followed up by saying bananas have beta-blockers. Hm, now that's something I could get behind. So I went and bought bananas last night, and ate a boatload of them throughout today. I don't know if it was the bananas or the placebo effect, but I actually didn't feel too bad. (Note: after searching the web, there seems to be confusion as to whether this effect is due to beta-blockade or high amounts of potassium.) Either way, I ate so much potassium, it was coming outta my assium ...

Bring parking money
The cheap USMLE bastards have no problem charging you $1000 for this test (not to mention the airfare and hotel costs some poor people have to pay to travel cross-country to reach the testing center). Then, they stick it to you again and make you pay $8.75 for parking. Come on, that's just low. I'd rather they simply make the test fee $1009 and let us have "free" parking. Keep the change.


INSIDER TIPS:

Don't eat Thai food the night before
I love Thai food. I eat lots of it. I've even been to Thailand and tolerated the food just fine. But, there's something about eating Thai food the night before important events that makes me regret it. I thought my system could easily handle the Thai noodles I ate last night, but I was mistaken. The moment I came within eyeshot of the testing center, I experienced some ... um, unusual ... "GI symptoms". I don't know what it is about Thai food, but somehow it's spicier on the way out than on the way in. This made for a stressful morning, as a few times I had to cut in front of people in line for the bathroom in order to make it.

Lock the bathroom door
Continuing with the bathroom theme, please lock the door to the bathroom when you use it. While we were all sitting quietly in the waiting room before the test began, a woman went into one of the bathrooms. Maybe it was because she was foreign, but for some reason she forgot to lock the bathroom door. A few minutes later another guy got up to use the bathroom. He walked to the same bathroom door, opened it, and then jumped back yelling "I'm sorry!" It was great! But the reason I bring this up is because I replayed this scene in my head during one of my patient encounters, making me laugh at an inappropriate time. So spare your fellow examinees potential embarassment and lock your bathroom door.

Go easy on the tongue depressor.
I suppose this one was my fault. I was doing a physical exam on a patient who was supposedly in lots of pain, making her very subdued and quiet. At one point I used a tongue depressor to push down her tongue. I guess I pushed down a little too hard, because she then gagged, started laughing, and worked quickly to correct her behavior. I really don't think I pushed down that hard, but whatever its cause, it was funny watching her break out of her role for a minute.

If all else fails ...
If for some reason you completely forget what to ask or do next, rest assured you can’t go wrong if you do one of the following: 1) wash your hands, 2) drape the patient, or 3) ask “Do you have any questions?” I feel the only thing the USMLE people care about is the patient and their safety, modesty, and input. So, if you’re hot on the trail of asking the patient about hematuria and you freeze up ... simply drape them (if they are already draped, take off the sheet and just re-drape them). If you’re auscultating the heart and forget the next heart sound location ... just walk over the sink and wash your hands. Don’t know how to respond to a patient who says, “Doc I’m scared, what do I have?” ... just say “I see. So do you have any questions?” What you lack in content will be more than made up by professionalism.

That's it. If even one of these suggestions helps you, I'll consider them a success.

Oh Yeah, Step 2 CS

If it's not one thing, it's another ...

Just when I thought I would have nothing to do the next few weeks, I realized I have the next part of my board exams coming up on Monday. It's the USMLE Step 2 CS, which is a day-long clinical exam where there are 12 encounters with standardized patients. You have to take a focused history, do the appropriate physical exams, tell the patient your impression, and then write a progress note on them. (You also have to drape the patients and wash your hands a lot.)

This exam is a recently added component to the Step 2, originally for foreign medical graduates only, but apparently various people complained and now all of us have to take it.

Apparently this is an easy exam for American students, and my medical school has been teaching and reinforcing these clinical skills non-stop over the past 3 years, so I really have nothing to worry about. However, I still don't like walking into any sort of test unprepared, so I am spending an hour or two per day with a review book familiarizing myself with the type of cases commonly encountered ... nothing intense like the Step 1, though.

Anyway, I never have as much free time as I think I do ...

Neurology Notes

Some neuro-related thoughts collected over the past four weeks:

• On the very first day of our neuro unit, I counted down exactly how many days of the 4-week clerkship I would have to work (taking into account weekends, lecture days, and a few school functions). The final count: 12. Only 12 working days out of 4 weeks! Most people in the "real world" would laugh at such a schedule. I, however, barely lasted those 12.
  


• We had a random lecture one day about neuroimmunology ... 2 topics I couldn't despise more. I don't even know what neuroimmunology. I really do not know what puts me to sleep quicker, talking about the cerebral cortex or T-cells. Actually, a topic that does put me to sleep even quicker is anything related to a uterus. There's the triple threat: a lecture on gynecologic neuroimmunology.


• My dog doesn't have reflexes. I tried tapping her knees with my reflex hammer to elicit a response, but I didn't see any movement. Who knows if I was doing it correctly, though, since she kept trying to sniff the hammer. Come to think of it ... I don't know if she even has knees.


• Speaking of reflexes, I need some better ones for myself. I just learned the hard way why one should load silverware into the dishwasher with the sharp sides pointed down. As I was emptying the dishwasher, I was stabbed by a fork ... and I now have 4 holes in my thumb. All in a straight line.


• Neurology rounds are possibly the most boring event ever ... and not just in a hospital, either. One day our attending, while we all stood around and observed, interrogated an obstinate patient for over 30 minutes about a seizure he had had ... it was unbelievably painful since there are only so many ways to ask "what happened during the seizure?". And he ended the whole encounter by pleading with the patient to tell a dirty joke (to evaluate a part of the brain involved with the sense of humor), which the patient refused to do. I wanted to kick both my attending and the patient.


• No more left-sided weakness, right-sided weakness, dysarthria, fasciculations, fibrillations, nerve conduction studies, EMGs, pain and temperature sensation, or two-point discrimination!
  

Neurology is Over!

I just took the neuro exam (aka, the shelf exam. or is it Shelf? SHELF?), which signifies the much-awaited end to my monthlong neurology clerkship. The shelf went as smoothly as all other shelfs (i.e. it didn't), but that is OK as long as I don't have to retake that exam.

I did learn a few things in this rotation:

1. There are rounds more boring than medicine rounds.
2. We still can't do much for stroke patients, despite advances in medicine and technology. Unfortunately if you get a (ischemic) stroke, much of what we can offer is supportive care and rehab.
   
3. There is a good chance I might have MS (multiple sclerosis). But I'd rather not think about that too much.

Anyway, with luck I can retire my tuning fork and reflex hammer for good now.

And actually, now that I think about it, this test was also the last exam I will ever have to take in medical school. Nice.

Neuro Exam

Much as I despite this rotation, I still have to take this Friday's test seriously ... and being forced to work until Thursday doesn't leave me much free time. So posting will resume then. Hopefully.

Nurse Power

I am always on the lookout for tips and tricks to make my intern year -- next year -- easier and less stressful. I am observing others around me, trying to learn how to deal with commonly-encountered problems (e.g. a patient's middle-of-the-night temperature spike) so that when I face these same problems as an intern, I'll be ready.

I am also learning how to treat (and not treat) nurses.

As the ones that maintain true continuity of patient care, nurses have the power to make doctors' lives very easy, but just as easily can make their lives miserable. I got a rare and behind-the-scenes glimpse into the mindset of a nurse who was exercising this power. I was chatting with one of the nurses on our floor -- a nurse who is very feisty but stubborn -- and she began telling me her views on all the interns. The conversation then turned to one specific intern who this nurse hated. I admit, from my limited interactions with this intern, that she was not entirely pleasant to work with, but I learned from the nurse that the intern was particularly rude to her recently.

In fact, the incident she described was one when the intern was on call and began barking out orders in a condescending manner at one point in the night. After that encounter, and for the rest of the entire night, the nurse made a point of paging the intern with every order that was written in order to "double check" them. Needless to say the intern didn't get much sleep, much to the nurse's amusement.

I haven't taken many overnight calls (only ~10) in my brief medical career, but I quickly learned to appreciate sleep the few moments I did get ... and after this conversation, I definitely don't want a vengeful nurse ruining those few minutes of shut-eye.

So, yes, lesson learned. I will not be rude to you nurses.

The Natural History of Blogs

It never fails. I had to stop reading yet another blog because it became lame.

I am not going to get into a deep discussion about blogs and their impact (since I swear, there have more articles written analyzing blogs than there were analyzing 9/11), but in my experience most blogs have the same natural history. It starts with me somehow discovering a blog I find interesting and then reading it conscientiously. This lasts a few weeks or months until some dramatic event occurs in the blogger's life ... something major with either their job, health, social situation, or whatever.

At that point the blog degenerates. The collection of well-written posts revolving around a single theme turns into a bunch of entries describing random events in the blogger's personal life. The focus of the blog is nearly always lost, because that dramatic event usually disrupted the original motivation for the blog. Then the blog starts to suck.

The most prominent example I can think of is Opinionistas, a blog written by a young New York attorney who was highly dissatisfied with her job in a big city law firm. Her blog did an entertaining job of describing the ridiculousness of life inside a large law firm. She eventually "outted" herself, and once her anonymity was lost so was her ability to write posts with any unified topic. Now -- or rather, last time I checked -- she just writes about whatever crosses her mind, and it is not that interesting.

Anyway, the reason I discuss any of this is because I just had to yank two blogs from my "Medical Blogs I Read" (since you know, making it onto my blogroll is so competitive.) I don't read that many blogs in the first place, medical or otherwise, so whenever one fizzles out, my online reading list takes a big hit.

This fate befalls all blogs I encounter, so I hope it doesn't happen to mine. But don't worry ... as long as I don't get kicked out of med school, Axis will be here for you.

West Coast - East Coast

Many months ago I sent in applications to two different medical schools to do a month-long visiting rotation at each (one for his month and next month). While both are prestigious schools, one is in California and one on the east coast ... and what a difference a coast makes.

The California school informed within a week that they scheduled me in to the block I wanted.

Snooty East Coast School didn't get back to me after one month, two months, or even four months. I sent countless emails and made many phone calls to their registrar's office, all of which yielded no response. I even had an old advisor of mine (who is faculty there) send personal emails to the clerkship director, which, again, was fruitless.

After another month I finally got in touch with their registrar ... who not only acted like she had no idea who I was (despite my 5+ voicemails), but who still didn't know if they could accomodate me. It turned out that she had been unable to get in touch with the clerkship director (or his secretary). She certainly didn't feel the same sense of urgency I did, as this month was quickly approaching and I still didn't know if I needed to buy a $500 cross-country plane ticket.

The week before my theoretical start date arrived I gave them one last call, only to get lip from the registrar herself, saying how she had no idea how to get in touch with the clerkship director and that he was probably on summer vacation for all she knew. I was shocked to hear her getting angry with me ... and then she had the f'ing nerve to shrug me off with a "you might have better luck in the spring"!

So I was stuck with an empty month-long block that I need to fill, simply because of a sketchy clerkship director who didn't realize that students' schedules are on the line.

Topping off this story, the California school just recently contacted me, asking if I had a preference as to what attending I would like to be on a team with. What love!

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In other news: I went out with some people last night, including the friend from the previous post. This situation is getting a little torturous for me, since nothing can happen because it would set up a triangle.

To sum up: California is great, and I'm a little conflicted.