hello internet

After a long hiatus, my life has regained a sense of connectedness. And if you think I am being poetic and symbolic, I am not. For the past 5 weeks I have basically been without computer access, and this has left me with a strange sense of isolation and dependence and subacute unease. I was helped through it by the generosity of friends, and the understanding of neglected email contacts.

Now, hopefully, my computer will no longer be effing me, and I can regain my position next to the outlet at the Wireless Internet Coffee Shop, so ubiquitous in NW PDX.

I just finished my rotation in Family Medicine. At a clinic without internet access. If you can believe that. Apart from this glaring fault, I had a very good time, learning tons about musculoskeletal complaints, sports injuries, testosterone deficiency, and the common cold. Family medicine docs are my hero, in a way. I could not do what they do. Seeing patient after patient all day long, every day, getting to know them year after year, treating the common, diagnosing the uncommon, attempting to ease the suffering associated with chronic medical problems, trying in vein to convince people to get off their asses and lose weight, managing the teetering slope of diabetic blood sugar control . This is one of the most important jobs. But it doesn't hold enough excitement for me, unfortunately. The times when I was truly engrossed in patient care issues in the clinic was when there was an active decision to be made. A decision that would have serious consequences. Usually these decisions centered around when to send people to the hospital. The little kid with crackles in his right lung, the feverish woman with an advancing rash... this is when I temporarily ceased to feel the weighty pull of the clock slowly dragging me through the day.

I like the challenge associated with making these decisions. But I am not yet good at making them. How many times has my preceptor asked me "what would you do next?" If we even make it past the blank stare portion of my response, what follows is often "I would do nothing," or "I think this is probably viral and I would not give antibiotics," or something that attempts to imply that I have given it a great deal of thought in the preceding 7.5 seconds. And many times the response to my treatment plan starts out with "actually..." or "well...," Which usually translates as "the correct answer is the exact opposite of what you just said, but nice try."

One of my fondest recent memories (please note the sarcasm dripping thickly off of the word "fondest") was the Observed Clinical Skills Exam, which, against all logic, is referred to by the incorrect abbreviation "OSCE". Whoever said that medical students were behelden to the laws of grammar and pronunciation was sorely mistaken. Anyhow, this is a 4 hour test of sorts that consists of filmed interactions with patient actors. You are given a task such as Explain to the patient the results of her abnormal pap smear or Convince the patient to stop smoking or Tell the girl with meningitis that you need to stick a needle into her spinal canal. On the Read a very long and complicated medical history in 30 seconds and then perform an abdominal exam Station, I found myself telling the patient, who had just been seen by 10 other medical students, that I thought he had acute pancreatitis and I wanted to get a CT scan of his belly and possibly admit him to the hospital. This, I was soon to discover, might have been a wee bit of overkill. Everyone else had apparently diagnosed some form of simple gastritis and started with a trial of proton pump inhibitors. The grader said "you are the first person today who has even mentioned pancreatitis." Ok. Hmm.

But maybe my way of thinking about things is good. Maybe that means that I have a good framework for making such decisions. I just need to learn how to make them correctly. I hope that class is offered 4th year.