March 2006 Archives

This is actually Mike sneaking into Fiona's blog to wish her a HAPPY BIRTHDAY!

I just opened a box of crispy cream doughnuts that I found in the trash, just in case.

I have the worst ring around the collar on my white coat that the world has ever known. Honestly, its horrible.

I vandalized a poster in the VA elevator last night by writing "Killer!" in a little speech bubble over a clip art illustration of two businessmen enthusiastically high fiving eachother. I do not regret this.

I recently heard a story about how a medical student's stethescope got caught in her senior resident's open fly during the end-of-rotation evalutaion. She leaned over to pick up a cup of coffee, and then got stuck with her head close to his open-flied crotch. And she couldn't remove the stethescope ear-piece from his fly because that would involve putting her hand there, so there was this akward, prolonged fumbly situation, followed by him storming off and saying "you fail!" This is the single best medical student story I have ever heard.

The single worst medical story I have ever heard has me as its protagonist. It goes as follows: tomorrow I have to take overnight call. This is the last call night of the rotation. It is also an extra call, one more than everyone else has to take, because I was also assigned the the very first call night on the first day of the rotation. Tomorrow is the worst possible night for overnight call, because we have the huge national Internal Medicine exam (known as the "shelf") on Friday, and no time off to study. Also, tomorrow is my birthday.

This is why i am rooting through the trash looking for uneaten doughnuts.

This is an entry that I originally wrote a couple of weeks ago while sitting in a tea-shop. Unfortunately, my laptop shut down, as it is wont to do whenever I am downloading or saving anything, purchasing anything online, or otherwise working on anything important that is due the next day. A frequent phrase in my vocabulary of late has been "my computer is totally f*cking me right now." And as the F-word figured prominently in a recent medical school experiences, I thought I might recount my lost tea-shop entry here....

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You know you are emotionally done with a rotation when you swear at your senior resident.

This happened on call last night, when, in a moment of sleep-deprived, sugar-high giddiness, I literally yelled "Fuck you, Ray!" to my resident. My senior resident. Who is grading me. The motive, I assure you, was fully honorable. He gave away one of the major plot points of Brokeback Mountain, a movie I have not seen but am planning to. I have not seen even a single movie that was nominated for any kind of award this year, an indication of my pathetic hermetic existance. It was bad enough having to spend Oscar night at the hospital, but to have the story given away? Clearly unacceptable. This would not go unreprimanded, and, in the heat of the moment, I felt the duty fell on my shoulders.

As my resident is cool, I think his response to my highly unorthadox verbal abuse was to laugh and then high-five me. In medicine, you are somtimes rewarded for showing "gumption." Apparently, yelling the F-word in a hospital at 10 pm on a sunday night sometimes falls under the gumption category. As does flat out disagreeing with your senior resident during rounds, which is something that I also did this morning. "Given that the patient is so tenuous right now, I would definitely feel uncomfortable not giving antibiotics," my resident says. "Come on, he's not THAT tenuous," says I, with bewildering, undeserved confidence. Sometimes you have to just go with your gut, and my gut tends to tell me to sent patients home without appropriate treatment.

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This whole story, apart from demonstrating that I have a potty-mouth, mainly serves to illustrate the deeply seated heirarchy of medicine. The fact that I found it blog-worthy that i disagreed with a resident, who is probably not much older than me, is pretty interesting. But you have to understand, medicine is made up of a classic chain of command, with medical students on the bottom. The way bottom.

What was also fascinating about this whole blogging in the hippy tea shop experience, was that sitting across from me in the hippy tea shop were two students of a medical field (i will assume nursing because i didn't recognize any of their text books) who were going over, outloud, the steps of a female gynecologic exam. They were reading the steps outloud from the book, and not in their best indoor library voices either. Things like "begin by spreading the labia minora and ispecting the vaginal entrance..." I actually wrote that exact phrase down, along with many other similarly amusing phrases, because what they were saying was so stunningly audible to the entire population of the tea shop. Plus, do you really need to read that business outloud? In clear, resonant voices? Does that help you? Not that you need to be ashamed of the female anatomy, but for pete's sake. It is a wee bit distracting. Folks be tryin to get their study on.

"Observe the color of the labia..." No joke.

You can learn alot from the second heart sound. The dub of the perpetual lub-dub rhythm. If you listen closely, you can hear it split into two separate sounds when a healthy person breathes in, corresponding to the closure of the aortic, then pulmonic valves. This sound can also do other things, and a staggering amount of information can be gleaned from whether there is wide splitting, fixed splitting, reversed splitting, or fusion of the different components of the second heart sound. Things like valvular abnormalities, bundle branch blocks, Wolf-Parkinson-White syndrome with left ventricular pre-excitation - you know, stuff like that.

I had an assignment to report on all the subtle nuances of the second heart sound on monday morning. And, the diligent medical student that I am, I made a long, complicated, but extremely well-organized list on the white board in the conference room. We're talking diagrams. We're talking different colors for the different valves. We're talking complex organizational style. (Caveat: I am not normally such a gunner, but I was on call in the hospital, waiting for a patient, and had nothing else to do).

As a final touch, I wrote "DO NOT ERASE 3/5/06" in red with a circle around it. Merely as a precaution. This was the whiteboard that had the same thing written on it for the past 2 weeks and which was clearly rarely used by anyone. But what did I see when I came back to the ward on monday morning? My entire presentation had been erased, only to be replaced with a diagram of a breast.

A giant boob.

And we're not even talking complicated breast anatomy. We are talking about the most simplified diagram imaginable, consisting of a giant boob with three ducts drawn carelessly in blue. The kind of diagram that would clearly not be helpful, unless one desperately needed to illustrate the fact that breasts contain ducts. You don't need to draw that on the board! You can just say it outloud! I can't even begin to imagine the thought process on that one. "Well, Dr. Burke, as you know breasts make milk... wait, this is far too complicated for words alone.. let me just illustrate this for you... what's this?.. a complicated diagram deliniating the phsyiology of cardiac valve closure and the possible etiologies of variability in S2?... this clearly does not look important, nor does it appear to have any indication of when it was placed upon this writing board... i'll just... there we go... all gone!"

Perfect. I did my presentation without any visuals, and it was fine, but very very boring.

The worst thing about this story is, I have a patient right now who actually has reversed splitting of his second heart sound. And when asked about it, I totally fumbled and messed stuff up. I blame Family Medicine.