The end of the world as we know it
by fiona
Third year starts soon. In a month. The third year of medical school, affectionately known as "hell" to those who survive it, is the most intense, stressful, and exhausting phase in one's medical education. It is the year in which one leaves the comfortable confines of the lecture hall, home for the first two years, and ventures into the strange and mysterious world of the clinical clerkships. One spends hour upon hour in the hospital or "on the wards". One enters into a lifestyle filled with such phrases as "on call" and "post-call" and "pre-round" and "getting pimped." One aschews book learning for the infinitely more educational experience of actually interacting with patients and then being randomly and sunjectively graded on the ability to spew forth random bits of obscure, irrelevant medical knowledge when put in the spotlight in front of a large group of people (this, my friends, is what is known as "pimping.")
Of course, this to me is all the stuff of legends. Pure myth. Stories whispered in hushed tones in sterile hallways. I have yet to experience any of it. But that will soon change.
We were recently told of the track in which we will be operating throughout the course of our third year. The track you are on determines the order in which you do your clinical rotations. And there is a lot of strategizing that goes into this. And with strategy comes a huge amount of conflicting information. Start out hard. Start out easy. Take Medicine (internal medicine) first so you are fresh. Take medicine last so you know what you are doing. Take medicine in the middle so you are not burned out. Take OBGYN late so the residents will let you catch babies. If you did path, try to take Surgery early because that's what you will know the most about. But not too early. And then add to this the strategizing required to end up on the same track as your path buddies: If you put down track G as your second choice and I don't include it at all, but put down tracks A and B as my third and fourth, then we should all end up with track F...
Well, it worked. I got placed with my team in track F. The one that starts with Peds (pediatrics, fairly challenging, some call), is followed by surgery (intense hours, very hard) and has medicine in the middle, split by a week-long respite. Nice. I think. In the end it probably won't matter.
Last friday a couple pathology residents sat down with us to give us some informal advice about getting through third year in one piece.
How To Get Through Third Year in One Piece:
1. Accept the fact that you will not be getting honors. This will make everything much easier.
2. Never make your fellow students look bad.
3. If one of your fellow students intentionally makes you look bad, make them suffer. Do not back them up. Do not help them out.
4. Never be late. Its one of the only things you can control, and one of the only things anyone actually remembers.
5. Do not overtly kiss up to the residents. Most of them will see right through it (see item number 2).
6. Always have a pen.
7. Consider taking a sick day every rotation, though you might get penalized for it.
8. Never ask to leave early. But if someone tells you to leave early, immediately do so with no questions asked.
Items 1 and 4 are going to be very difficult for me. But, weird as it may sound, I am kind of looking forward to diving in. I think it will be fun. In a mind-numbing, soul-crushing kind of way.
Posted on May 31, 2005 | Comments (3)
Dear scalpel, please do not slip
by fiona
I have left the suprisingly slow world of autopsy for the more glamorous, fast paced whirlwind that is surgical pathology. The hosptital autopsy service saw last month a grand total of only 4 cases, a considerable drop from the 20 or so that I have seen on previous rotations. Not that people aren't dying. I guess they are not dying mysteriously. Which is good, I guess.
Unfortunately, all of the 4 autopsies that I did last month were on children under the age of 5. Cutting open a baby is, needless to say, a very intense experience tinged with sadness and awe and a profound sense of the extreme harshness of the world. It is easy to get quite cavalier about performing autopsies on adults, especially after you have witnessed many. But a baby. They are so unbelievably adorable, even in death. Their big old heads, their wide eyes, their little baby fingers. And the knowledge that a parent is somewhere nearby, completely devastated, struck down by the impossibile horribleness of what has just happened to their child.
We do our fair share of autopsies on fetuses, who have died in utetero for a variety of reasons. But this is never as bad. Its the ones from like 5 months old and up that are the worst.
Mike and I would joke about it, with that laughing-about-death humor that is usually always funny, in spite of, or perhaps because of, the intensity of the subject. "Did you cut up any dead babies today, honey?" he would ask me. "Sure did, sweety!" That reminds me of one of the only three jokes that I know. You guys remember Dead Baby Jokes? I think it must have been a national phenomenon in the early 90's. Here goes: What's the difference between a truck full of bowling balls and a truck full of dead babies? You can unload one with a pitchfork.
Oh boy. I am so going to hell.
But I have left that world for good (last autopsy rotation ever) and am now doing my last Surg Path rotation. Surgical pathology, home of biopsies, tumor resections, and surgical consults. Good bye, dead children ... hello hepatitis C.
The other day, at about 2 in the afternoon, I found myself in the position of dissecting a chunk of fresh liver that was infected with both hepatitis B and hepatitis C. Both are intense blood and fluid-borne pathogens, and Hep B is one of the worst contagious viruses that a person could accquire, as it is likely to cause severe, progressive liver damage and comes with a high risk of developing liver cancer (hepatocellular carcinoma). I have been vaccinated against the B, but the C would still suck, as it is no stroll in the park either. Anyhow, so I am double-gloved and arm-guarded and aproned and cutting on this piece of liver with a very sharp scalpel, attempting to shave off small slices so I can freeze them for fast sectioning. The surgeons are waiting in the OR for the results. And this is something that is very hard to do without holding and balancing the liver with my fingers - the forceps are just not giving me the maneuverability that I need. And all the while I'm thinking ... I have not cut myself all year ... please do not let this be the time...
... steady, steady kind scalpel.
Posted on May 14, 2005 | Comments (2)
Who asks the questions?
by fiona
A few months ago I told the story of the crotchety old pathologists who attend the thursday morning autopsy conferences and whose sole purpose in coming seems to be attempting to trip up the presenter by asking them incredibly random, obscure questions. In one such presentation, when I posed a rhetorical question to the audience, one of the dudes said to me, "I ASK THE QUESTIONS!" in a very condescending tone.
Since then, that has been a running joke among my path friends. "Hey, do you know what time the lecture starts?" "Fiona, I ASK THE QUESTIONS!" "What restaurant are we meeting at?" "Hey, I ASK THE QUESTIONS. Is that not clear?" Patty and Tracy recently presented me with this amazing t-shirt. Now there will be no more confusion.
Posted on May 12, 2005 | Comments (4)
I remember when I was strong
by fiona
I have decided to start working out. Lately I have been remeniscing about my rowing days, when I got up at 4:30 in the morning to spend the pre-dawn period straining against a weather-beaten oar, pushing through the cold and the exhaustion and the blisters, pushing every muscle in my body, striving to find that perfect, peaceful synchrony. Back then I was strong. I had muscles. My back, which now looks like a pile of bones with fat hanging off it, once was firm and defined and powerful. I had strong arms that could do things with purpose, not the shoddy sticks with pre-old lady flab that I'm sporting today. And I had legs that, when pushed against the footholds in a boat, displayed actual musculature. I mean, muscles. Plus rowing was the only sport I was ever good at, so I have a right to be nostalgic.
So I have decided to start working out. I can't handle the getting up at 4:30am voluntarily (I will have to do it next year, but that will be against both my will and my better judgement), so rowing is, for the time being, out. But in addition to riding my bike up the hill, I want to get some arms again, find my back, feel strong.
Yesterday I went to the weight room in the OHSU fitness center for the first time ever. I kind of wandered around aimlessly for a while, trying to conjure up memories of weight machines I had used in my rowin' days, while all the while trying to pretend that I belonged there, that I knew what I was doing. I have forgetten how much of a guy zone weight rooms usually are. Such a man vibe in there - it hit me instantly. Large bulky dudes straining against crazy leg presses, grunting as they bench pressed what appeared to be 4,000 lbs of iron, entangling themselves in metal to do those intense sideways situps. Not that I felt unwelcome, but its just a different feel, you know? A room full of guys pumping iron. And then there was me.
Yes, I think I will move that weight down from 180 to 40lbs, please. Excellent.
So here's what I did: lat pull, rowing pull, push up thing, triceps thing, leg extensor, and back guy. I tried this machine to "blast my abs" (as ritchey would say), but it felt very unsatisfying, so I dropped it from my intense iron-pumping muscle-making routine. Does it still count as pumping iron if you are only using machines? My vote is yes. Also - since I have completely forgotten how to lift weights - do I do 3 sets of 10 reps? Of 15? Do I sit at a machine until I'm done with all my sets? Or do I do a cycle? (That's another thing about the man vibe weight room - nobody was in there with a walkman or anything, and nobody was talking to eachother, so it was just this silent room full of bulky grunting dudes (plus fiona) all sitting on their machines between grunting sessions and starting at eachother.) Also, is there any way in hell that I am going to stick with my plan of 3 days of weight training a week? Attempting something comparable to an "old college try" comes to mind.
I am going to become so unbelievably buff.
Posted on May 4, 2005 | Comments (9)
JFK MD
by fiona
Last Friday I had the priviledge of attending a History of Medicine lecture in my old second year lecture hall. Actually, the main purpose of attending this lecture was to partake in the free lunch that was prominently displayed on the event flyers. Maybe a pizza, perhaps a nice pasta salad, per chance a fine collection of mini-quiches (the medical student devotes much of her or his free time to the scavenging of free food). However, as this talk was not funded by a pharmaceutical giant, the food was scant and had completely disappeared by the time I got there. Of course, had there been ample food provided by a pharmaceutical giant, I would obviously have not eaten it in protest. Well... no. Obviously not.
But the topic of the talk genuintely intersted me, so I stayed despite my rumbles of hunger. "John F. Kennedy's Failed Back Syndrome." A guy was presenting on the effects that JFK's constant back problems had on his presidency. Now, JFK also had a lot of other health problems, including Addison's disease, but he got the most trouble from his constant back pain. Apparently this pain, and the treatments that he employed to treat the pain, had a lot of impact on his personal, public, and political life.
For example, there is this theory that had JFK not been wearing his back braces, he would not have received the second, fatal shot on that fateful day in Dallas. Apparently, as his back condition worsened, he used both a lumbar support girdle and 12-feet of ace bandage wrap to support his back. All this support, according to some theorists, was perhaps a little too supportive, as it did not allow him to slump to the ground after getting the first shot in the neck. The lecturer did a frame-by-frame analysis of some home video footage of the assassination, to show that while some other guy in the car got down on the ground after getting shot, Kennedy bascially sat bolt upright the whole time. Interesting.
Also interesting was the insight into how JFK's back problems affected his love life. Poor Jackie O. One of his many lovers wrote an autobiography and stated that "kennedy was accustomed to being the pommel horse, allowing the women to be the gymnasts" or something like that. Poor, poor Jackie O.
But here is the most fascinating thing: Did you know that the Personal Physician to the President during JFK's presidency was.... A WOMAN?!? Its true! I had no idea. Dr. Janet Travell was named to this post by kennedy himself in 1960. She was the first woman to hold it, and after the assassination, continued on as personal physician to Lyndon Johnson. Crazy, huh? A lady? In the white house? Making important health decisions that could potentially affect the national security of the United States of America? And in 1960 to boot. Who knew?
She sounds like a pretty awesome dame, and I have instant respect for any woman who graduated from medical school in 1926. Especially if she managed to do so at the top of her class. She is also affectionately known as the Mother of Myofascial-Trigger Point Knowldege. But just to her friends. Janet Travell is my new hero.
Posted on May 2, 2005 | Comments (4)
Ultimate Boyfriend
by fiona
For those of you who do not yet know (and shame on you for not knowing - what are you, asleep?), Mike's amazing reality blog project The Ultimate Blogger is officially underway. Along with ultimate co-fonders Steve and Jona, he is making internet history. Right now. It is being made. Right now.
I would also like to congratulate my dear friend Ritchey for being named as one of the 12 contestants for said blog competition. Ritchey, even if you do not go home with the title of Ultimate Blogger (which, obviously, you will), you can rest assured at already having won a much more important and eminently impressive title; that of Ultimate Frogger. (please insert awesome cool nice lady friend for frogger)
Posted on May 2, 2005 | Comments (9)