Sneak peak at my upcoming paper:
by fiona
"Multipotential mesenchymal cells that give rise to osseous and chondral cell lines have been demonstrated in animal studies, suggesting that extraskeletal osteochondromas may arise from the differentiation of connective tissue fibroblasts."
Also...
"It has been suggested by some authors that the distinction of extraskeletal osteochondroma as a discrete entity is debatable and that it may lie on a spectrum of post-traumatic ossifying lesions that includes soft tissue chondromas, soft tissue osteomas, and myositis ossificans."
I just wrote this stuff. Blah. Want to go outside.
Posted on June 22, 2005 | Comments (8)
Her spirits were very differently affected, when, to her utter amazement, she saw Mr. Darcy walk into the room.
by fiona
St. Paul, Minnesota has welcomed me back with open arms. I am here, visiting my family, my hometown, and the few residual friends from high school that are nice enough to keep in touch with me. One of those nice friends is getting married on Saturday, and I will play maid to her bride in my sleek black gown and fancy lady shoes.
Must remember to practice walking in fancy lady shoes.
I am reminded how nice a place these Twin Cities are - land of lakes, land of dams and First Ave and soft warm nights. Home to the mighty Mississippi. Home to Grain Belt beer. Home to gangly green prarie trees and buzzing cicadas and constant bird noises. And home to Mall of America, the greatest feat of engineering and sheer human will that this world has ever known.
And home to thunderstorms. One swept across the city today, as I was sitting in a coffee shop window. I looked up from the exciting journal article I was reading about soft tissue osteocartilaginous tumors (does the elusive extraskeletal osteochondroma truly exist, or is it merely an extensively calcified chondroma? I beseach thee) to find that the sky was darkening and the trees were stirring in that particular form of restlessness that does not exist on the west coast. Once inside, I watched as the wave of dark sky rapidly approached, and then - suddenly - the storm hit. The wind arrived first, blasting open the coffee shop door and making the trees writhe, announcing the invevitable arrival of the drenching sheets of rain. Within minutes, the street outside was a river, the sidewalk a lake, and the doorway a waterfall. The window became liquid. Then came the hail. Cars with their lights on (at 2:30 in the afternoon) took refuge under large trees. And then it gradually just faded away.
I love thunderstorms. I miss them so.
Other things that have happened to me here in minnesota include a fancy wine dinner with my dad, a show at 7th St Entry, a night of vodka sours with my brother at a dinkytown bar, and my nephew's jazz camp recital in which dozens of adolescent musicians valiantly attempted improvised solos during multiple painfully long Herbie Hancock numbers.
Also I am re-reading Pride and Prejudice, and once again I am completely absorbed. "In vain I have struggled. It will not do. My feelings will not be repressed. You must allow me to tell you how ardently I admire and love you." God bless you, Mr. Darcy.
Posted on June 20, 2005 | Comments (8)
Word of the Day: Roundsmanship
by fiona
I forgot to mention the hottest of the hot tips that was gleaned from my meeting with my new third year coach. Tom mentioned this as an afterthought, but he said it was the most important thing to remember for all of the next two years: Roundsmanship.
- Roundsmanship: The code of ethics that guides personal interactions during rounds.
- Rounds: the event of going from bed to bed in hospital to check in on the patients that your team is in charge of. This is known as rounding. It happens one or two times a day, from what I can tell. During rounds the resident or medical student presents a patient to the group, which is comprised of medical students, residents, and an attending.
- Attending: the fully acredited doctor (aka all grown up) whose job it is to teach, supervise, and completely belittle the residents and medical students. During rounds, it is the attending's job to make sure that the patient is being properly cared for, to discuss clinical decision making, and to pimp the team on various topics of his or her chosing.
- Pimping: the act of singling out one person of the group and testing their knowledge by asking them a series of intense, difficult questions in front of everyone. Some people have a problem with the term "pimping," as it implies some sort of relationship with prostitution and the denegration of women. I have no idea where it came from, but it is universally used.
- Roundsmanship: The code of ethics that guides personal interactions during rounds. Its like sportsmanship, but for doctors. Medical school is, after all, a competition.
I don't really think that.
Rule #1 of good Roundsmanship: Never make your high-ups look bad. Never ever ever. This kind goes back to the "never make your fellow students look bad" rule that I highlighted earlier, except this one is apparently much more important. Never show up your superiors. If a resident is being pimped and is asked a question that they don't know the answer to and you do, you should never say it. If the resident gives an answer that you know is wrong, you should never point it out. If the attending then turns to you and asks if you know the correct answer, you should not say it, even if you do.
Why? This was a bit shocking to me. It goes against every fiber of my selfish, grade-hungry being. Why not, in this cutthroat world of medicine, where we are pitted against eachother for the attaiment of the illusive Honors, why would I not show my knowledge?? Because, Tom pointed out, the residents grade you. They evaluate you at the end of the service and they can punish you. Do not make them lose face.
Besides, in its purest form, it is simply bad roundsmanship.
Posted on June 7, 2005 | Comments (6)
Secret tips and hot pointers
by fiona
Yesterday Patty and I met with Tom, a pathology resident who was an internist in his former life. The purpose of the meeting: to learn secret pointers and hot tips on how to do a good job as a third year medical student. Basically, how to avoid looking like a moron when interacting with residents and attendings. He went over, in painstaking detail, how he takes a clinical history, what he looks for in a case presentation, and what things to focus on in a physical exam.
The history, he said, is one of the most difficult things in medicine. You will never master the history. "The history will master you," I helpfully chimed in.
The clinical history is something that I have learned about many times, but am not good at actually taking. For example, the last time I volunteered at the Wallace clinic, I saw someone with a cough and forgot to ask if they smoked. Kind of an important question, but i didn't remember to do it because the history is not in my blood yet. It has not yet seeped into my soul and flooded my dreams. That is what next year is for.
The history is divided into several parts that must be addressed in a very specific order. When you present a patient's history to another medical professional, it must be in the exact same format, every time, so that the relevant information can be quickly and effectively communicated. If I may make a poor and inappropriate analogy to music: Its like when you are reading sheet music, and all the things have to be in the customary place - the time signature, the staff, the other stuff - otherwise it would be very difficult to play it with your bassoon.
Here is the order.
- ID - age and sex of the patient, and any relevant identifiers
- Chief Complaint: Why did they come in? (Tom: this should be in the patients own words. It is ok to put "I feel like shit" as a chief complaint. I, of course, immediately imagined reading off a list on graphic obscenities to an attending - i have a feeling some amount of censure is required).
- Reason for Admission - this applies to "in-house" patients only
- History of Present Illness (HPI) - when did the pain start? What kind of pain is it? Leading open ended questions: "Tell me about your diarrhea." Etc etc.
- Past Medical History - any hospitalizations/ medical problems/ major surgeries. Or minor ones, for that matter.
- Medications
- Drug Allergies/ Intolerances
- Family history - have all their primary relatives died of lung cancer at the age of 30? This might be relevant
- Social History - What is that person's life like? Are they a iv drug user that lives on the street? Do they live in a nursing home and get no physical exercise? Are they a marathon runner with a binge drinking problem? Do they have a rare species of python as a pet? Do they sleep every night with their rare python pet curled around their head? These are things that may be important. Figuring out how and why they are important is another issue. For now, that issue is not mine.
- Review of Symptoms (ROS)- This is the part where you quickly try to ask the patient about every single thing that is going on with their body, starting with the general, then skin, and then moving from head to toe. This too has a very specific order that I have a hard time remembering. And the trick is knowing which aspects of the ROS are relevant to and should be included under the HPI.
And then you move on to the physical exam, which has a whole other order and way of presenting it that revolves around a series of unintelligible acronyms. For example: HEENT (head eyes ear nose throat) PERRLA (pupils equally round and reactive to light and accomodation), EOMI (extra-ocular motions intact), RRR (regular rate and rhythm). And on and on. And on.
The moral is, I will need approximately four and a half hours to actually see a patient. Which doesn't account for the roughly 7 hours that I will be need at home to write up that patient before presenting them the following day during rounds. I kind of don't understand how anyone can actually do this. But the gauntlet has been thrown, and, good sir, I ACCEPT THE CHALLANGE!
Posted on June 7, 2005 | Comments (3)
And then I said...!
by fiona
I had the following amazing interaction this afternoon with the former department chair, a noted renal pathologist:
As I was heading out the door of the lab, Dr. H spotted my helmet and said, "are you a motorcyclist?"
- Me: No, I'm a scooterist.
- Noted Pathologist: Oh! Be careful out there.
- Me: Yeah, it can get pretty slick...
- Noted Pathologist: I use to ride a motorcyle. That's a pretty good way to lose some epidermis!
- Me: That's why I got this thing (pointing to leather jacket). Someboyd else's epidermis!
Noted Pathologist: Ha! Epidermis... not to mention sub-q (refering to subcutaneous tissue)!
Ahhh, pathology jokes.
Posted on June 1, 2005 | Comments (2)