Med students aren't the only ones with a sense of humor

In less than a day my first year of medical school will be complete! (hopefully?)

Here is a gem that I didn't catch until the third time through our physiology notes...

b. Stress: Plasma cortisol levels can be increased by numerous factors characterized as stressors, both physical and psychological. Burns, infection, physical restraint, surgery, anxiety, reading the syllabus, and strenuous exercise will all elevate plasma cortisol levels.

Patch Adams

I met Patch Adams on Friday. My school, in typical form, notified us that he would be making an appearance in the atrium of the Children's Hospital a few hours before he was to appear. Only a handful of my classmates were present since it was short notice, and, never forget (oh, if only I could forgot!), one week till the final. Now, Patch Adams was interesting and all of that. Wacky. Dressed as a clown. In fact, he showed up with an entire clown entourage, when he finally did show up. He wrapped most of my classmates in enormous underwear and forced them to lead a parade of children down the hall of the hospital. The only reason I escaped this fate was that during the 45 min wait I stopped caring about meeting Patch Adams, as I had found myself in an enormous, airy, brightly decorated room chock-full of books and toys and children to entertain. I did not know that such a wonderful place existed! (Being a first-year, I've rarely explored the hospital.) First of all, this place is swank. The entire ceiling and outer wall is glass, with a view out over the city and the ocean beyond. It beats the pants off our dimly lit, freezing, burber carpeted library, a.k.a. "The Frozen Wasteland." Second of all, kids! Third of all, toy dinosaurs! Man, I hadn't played with toy dinosaurs in ages. I met a delightful 11-month-old in the process. (Years from now this same child will be coping with a deep-seated clown-fear, with no knowledge of its source.) I don't know about all the clown business, but there is something to be said for making a hospital more cheerful. I know it did wonders for me. Nothing like the sight of kids with bald heads and IVs just being kids to warm the depths of your "oh why the heck did I ever get myself into all this?" first-year med student heart.

Scheduling

One week till our final exam. Yesterday everyone in my class received a delightfully informative email from the new Associate Dean for Curriculum and Evaluation, detailing the "need to know" facts of our test. It included such helpful information as the number of questions (about 2/3 the number there will actually be), what material will be covered from our Doctoring class (including physical diagnosis, which is not included in the written exams), and the overall scope of the exam (both fall and spring semesters! Please fail us now and spare us the pain.) One would think that in 180 years, our college could manage to run a bit more smoothly, or, at the very least, learn to not irritate the crap out of its students.

One more week. One more week. One more week.

The End is Drawing Near...

I think my entire class stopped being able to study when we collectively hit April. The sun is shining, the water is sparkling, the beach is calling... The library is such a cold, desolate place. (It is also, and these two things might be related, the center of my social life.) All of the classes that we thought might be interesting (Physiology? Can't wait to learn how everything we memorized in anatomy actually works! Neuroscience? The inner-workings of the brain are fascinating!) turned out to be indistinguishable from last semester when the dry syllabus notes were stacked and compared. And at this point, no one really believes they will be flunked out. Sure there are the rumors. Did you hear, six people left after the second exam? Four people after the first? Yet no one can name all these people who have left. Mysterious. It could be everyone is just leading me on, saying "Sure, I know what you mean. Can't study an hour without going stir-crazy..." when secretly they are chugging Red Bull, sleeping five hours a night, and logging 15 hours a day at the library. But I doubt it.

Physical Diagnosis

First thing this morning I went to the student bookstore and bought some new toys--a cheap plastic ruler and a reflex hammer. The more items you have to put in the pockets of your short white coat, the less you feel like a sham. Anyhow, my plastic ruler was for estimating jugular venous pressure and my reflex hammer was for percussing because today I had my first physical diagnosis exam! It was about as spectacular as I expected it would be. I managed to briefly forget which of my hands was dominant and therefore capable of operating the valve of a blood pressure cuff. I, and this is a classic mistake, forgot to lower the round rolly-stool that our school puts in the exam rooms to cause us strife, so that it shot out behind me as I sat, losing me a good fifteen professionalism and personal dignity points. I spent a full thirty seconds pulling out the leg extension on the exam table, which had jammed. I was thankful to wash my hands before beginning the exam, not because neglecting to do so would earn me failing marks, but because it allowed me to disguise their clamminess. Despite all this, I think I managed to do my best patient interview yet, as well as bumble through the motions of the exam. I pretend to be a doctor, the actor pretends to be a patient, and it all works out in the end.

I should be asleep now, or studying, as it is test week. But I desperately needed to do something that wasn't studying respiratory physiology this evening, if only for a few moments.

Breast Exam

One of the more glorious parts of a medical education is the use of standardized patients. To make certain that you are fit to interact with real human beings, med schools start you off with actors that you get to "interview" (i.e. they act like they have a medical problem, you act like a doctor who is unaware of the fact that they are perfectly healthy actors, responding to their concerns with the full range of appropriate emotion and empathy that non-theater majors may find difficult to conjure) in front of a group of your peers, a preceptor who may or may not be grading you (or behind a two-way mirror) and, heck, sometimes a videocamera as well. And all of this starts before you have had any pathology or, in the case of Doctoring class last semester, human anatomy. This is the best way to get you "accustomed" to being in the role of a physician. I did the first interview in our Doctoring class, a few weeks into the semester last year. My standardized patient had pancreatic cancer, and it was my job to convince her to agree to conventional treatment. I thought, "Ah, yes, this is an excellent place to start. If they had waited a few months till I had seen a human pancreas, this exercise would have been quite dull."

This semester, Doctoring begins to encorporate aspects of the physical exam. In keeping with the trend of last semester, the first time we get to touch a standardized patient is to perform... a breast exam. Again, well done Doctoring curriculum committee! To begin by examining the ear, nose, and throat might have encouraged students to feel comfortable, even confident, in their interactions with fake patients. Far, far better to leave all those trivial aspects of the physical exam that don't involve nudity untouched until the student is called to perform them on a complete stranger for the first time during our graded exam. Clearly, this class is organized under the assumption that students who are allowed to feel confident in their abilities will only grow lazy.

As for the actual breast exam? Having spent three hours in a tiny exam room watching seven other people thoroughly explain, then perform a breast exam on the same SP I can safely say that I can both perform and teach a breast exam myself (bringing the number of things I know how to do to patients up to about four), and breasts will never be the slightest bit interesting again.

1/8 of an MD

That's right, folks! To all my nonexistent readers worrying themselves to death over my first semester grades, worry no longer! P=MD and I am one-eighth of the way there! (Plus residency. Plus fellowship. But again, quibble quibble.) (P=MD refers to the fact that my med school, like most out there at this point, has adopted a pass/fail grading system.) It was touch-and-go for a bit there during the final. All I could recall of cholesterol synthesis was HMG-CoA reductase, and while it is unarguably an import enzyme, my biochemistry was probably a little on the patchy side if that was all I could remember of a couple weeks of lecture. Additionally I got to one of those anatomy questions that read something like "a person receives a knife wound so many inches deep into the such-and-such intercostal space. what was pierced?" and I thought "Aha! The thorax. I KNEW I forgot to study something."

But here I am, rested from a pleasant winter break and ready to return. What is that sound? Ah, it must be the sweet sound of victory tinkering down from the heavens, to congratulate me on surviving, no excelling at my first semester of medical school.

Though more likely it's the hobos rooting through the garbage again.

Tact

Here is an actual email I received today.

Tomorrow the Department of Cell Biology and Anatomy will be having a luncheon in the elevator lobby on the 6th floor. At the request of the Department, please travel to the Gross Anatomy Lab by taking the elevator to the 5th floor and the stairs (nearest to the lab) up to the 6th floor. Please avoid the main elevator lobby. Thank you for your cooperation in this.

And this is my interpretation.

Students, you literally stink. The repulsiveness of your even transient presence would ruin appetites, and needless to say any food sharing space with you untouchables would be unfit to eat. Stay the hell away from our luncheon. Love, The Department of Cell Biology and Anatomy.

Reality

Notice how I have not written anything since I started school? That was the cold hard grasp of reality seizing the enthusiastic premed. Med school... is hard. (I know, I know. It is shocking.) We have class most mornings from eight till noon, then again in the afternoon on one of the two afternoons a week we aren't scheduled to be in lab till five. In the evenings I read anatomy and biochemistry, either at my carrel in the library, listening to the ambulances and sobbing families, or in the comfort of my own home, listening to the meth addicts screaming from my driveway or the sweet neighborhood kids breaking glass bottles out in the street. That is an exaggeration. The meth addicts usually wait until three in the morning to resolve their drama, when I am (or would have been) asleep. It rarely interferes with studying.

But I survive. I wade through the endless swamp of origins and insertions and aponeuroses and GLUT receptors and cytokines and cultural sensitivity, swatting away the gunners which bite peskily at my exposed skin. I trudge along, daring to hope I will one day reach the estuary of residency and some current will carry me into the sea of medicine, where I'll most likely drown. In debt. Actually, that is not a half-bad overblown analogy. You are a med student. You are struggling along, it isn't pleasant, and every so often the thought comes to mind "Maybe I could just quit." Sure, you could quit. So you stop. Stand there a bit. Maybe turn a circle and fully take in the dark water and drooping, desolate trees surrounding you on all sides. A red-headed woodpecker sounds in the distance.

Which way is the exit?

Or, better yet, you could take a break. Get airlifted out of the swamp, and put back at the mouth next August. Retrudge all you have trudged so far again next year, back to this moment, two tests behind you, one final in front, wondering why, why haven't last week's anatomy grades been posted yet? After all you have been through, is it so much to ask?

Hobbies

I have moved in! Before the next time I move, I vow to give up reading and to begin collecting stuffed animals instead. If this happens soon, I foresee a difficult time passing the boards.

Apartment

The great apartment hunt has been completed! Happily, I will not be living in a refrigerator box and hanging around the back of restaurants for scraps. Though that would make for an interesting blog--The Homeless Med Student. If I could somehow acquire a child in the process I bet it would be worth a book deal, even a movie option.

Amazon

I am ever plagued on Amazon by my browsing/buying history. It started years ago, when I bought one (ONE!) book, Drawing Down the Moon, by Margot Adler. The book is an examination of modern day goddess-worship in the US. I had heard the author on NPR, and her work sounded interesting. Next thing you know, my recommended books list is filled with titles like Morgaine Starburst's Spell Guide for Getting Even with Your Ex, Making Yourself Seem Edgy, and Annoying Your Protestant Parents!.

I have this problem yet again from pricing some textbooks online. I don't actually enjoy reading various anatomy textbooks in my free time. I am only interested in those corresponding to the exact ISBNs I entered into the search bar. If a book has a picture of a prancing, dancing, or otherwise posed skinless human corpse on the cover, it is not what I am casually browsing Amazon in hopes of finding.

Making Plans

I have chosen a medical school. The desire not to go more than $160,000 in debt sure does make that decision a lot easier! Also, you know, all the rejection letters. But I was accepted to a school that I loved when I went for my interview. My next step is going to be finding a place to live. I might be semi-homeless until I get around to that this summer. At this point, I am just thankful to have survived the application process. There is a part of me that looks back on it and wonders why I spent all that time studying for the MCAT (hour after unholy hour), writing the best possible AMCAS essay (should I exploit the illness of someone I love, or one of my own personal hardships?) and researching schools (what level of Fancypants Medical School is right for me?) to then go instate. But I truly enjoyed the time I spent at the school when I interviewed, and I was impressed with all the students and faculty that I met. I think (I hope) that I have made the right decision.

Major Life Decisions

I was born to three doctors. Technically my doctor parents divorced after I was born, then remarried bringing another doctor into the parent collective. But let us not quibble. With genetics and childhood development being what they are, I was doomed to pursue a career in medicine. Some mornings I awake gripped by a fear that I should have become an entrepreneur or a dog handler or a thousand other things I never gave a thought.

But here I am, applying to med school.