http://www.urbanhonking.com/medschool/ en Copyright 2008 Thu, 02 Aug 2007 10:54:26 -0800 http://www.sixapart.com/movabletype/ http://www.rssboard.org/rss-specification ]]> http://www.urbanhonking.com/medschool/2007/08/a-long-night.html http://www.urbanhonking.com/medschool/2007/08/a-long-night.html Thu, 02 Aug 2007 10:54:26 -0800 The 35W bridge over the Mississippi river in downtown Minneapolis just collapsed. It just broke and fell into the river, bringing all of the rush hour traffic down with it. When my brother called me to let me know - a "heads up" on my shift tonight - I thought he was kidding. But then I saw the images on tv - mammoth slabs of highway asphault lying across the river, slanted up onto the land with shapes resembling cars, semis, a school bus scattered over their surfaces. The semi was on fire. There were cars in the river. From a helicopter-scale distance it was an eerily calm image, without much movement except for the clamor of the newscasters. and then I got the following pages: "get to HCMC NOW" and " Level 3 Incident - report to ED" I threw on some scrubs, jumped on my bike and came in, running into the ED in a sweat. My first patient was on the top of the bridge, running from his car, and rode the bridge down as it collapsed. We will see how the evening unfolds. http://www.urbanhonking.com/medschool/2007/08/level-3-incident.html http://www.urbanhonking.com/medschool/2007/08/level-3-incident.html Wed, 01 Aug 2007 18:02:38 -0800 I have the day off! I have the day off! After a particularly brutal string of 12 hour shifts, I have not only 1 day off, but the entire weekend. And I got to sleep in and it is a beautiful day and I got to play guitar hero for the first time last night. Turns out, guitar hero is very very fun. My first 2 weeks of internship have already come and gone, a fact which is utterly incomprehensible to me. This fast-forward time vortex that I seem to have stepped into - triggered I think by merely setting foot in the emergency department - is fueled by a combination of long hours and constant activity and a near total lack of free time. This is an exageration, but for the first week I did work noon to midnight every day except thursday, my day off, when I had to be there from 6:30 am til noon for conference. I felt like I when I wasn't literally in the hospital I was either sleeping, studying, or getting ready to go back to the hospital. But once I am there, it is totally fun. And stressful, and weird, and hard to keep everything together. Because now that I am the "primary medical provider" for all of my patients, I am responsible for writing all the orders and all the prescriptions and fully documenting everything and admiting patients and calling for consults... etc. And when you combine this with my inherent slowness and newbie inefficiency, things take a while. But, boy do I have some stories. For example... Two words sum up my first shift as an intern: penile laceration. Welcome to your new life as a doctor, now stitch up that man's penis. And then on my second shift (or maybe my third - who can keep track): there was the very pleasant gentleman who was spewing blood from his tracheostomy site - the hole in the neck that people who have had their larynxes removed breathe through. Everytime he coughed blood would spurt out of his neck and land on the underside of his chin, and then drip down onto his shirt. At one point he got lost on the way back from the bathroom and was wandering around the department with blood coming out of the gaping hole in his neck, using his robotic voice-amplifier device to ask people if they could help him. Just the nicest man. And then I was working on the night of July 4th from 6 until 2am. There was a noticeable lull, a palpable calm before the storm, followed by an influx of drunk people who had injured themselves in a variety of very un-humerous ways. I got to reduce a guy's dislocated ankle, put a bunch of plaster splints on, and try to track down the man with the bloody face who had removed his c-collar and left the department, presumably to attempt his own brand of vigilante justice. Then, at 3:30 in the morning, I got a security escort to the resident library, where I took advantage of the new plush leather sofa. I slept for a couple hours, and then made my way to the conference room where I was scheduled to lead the intern reading group in a discussion of lacerations to the scalp, face, lip, nose, hands, and feet. As you can see, my life is exactly like Grey's Anatomy! I have already slept with 3 of my attendings and have been yelled at repeatedly by the stern and sassy senior resident, who, beneath it all, really has my best interest at heart. Also I am living in a house with all of the other interns and we accidentally see eachother naked all of the time and then learn valuable life lessons while competing with eachother for who can deliver the conjoined twins from the 14 year old amish transexual with three uteruses and a fatal brain tumor who just got impaled by a streetlight. Also, everyone is in love with me. Being a doctor is awesome! http://www.urbanhonking.com/medschool/2007/07/just-like-greys-anatomy.html http://www.urbanhonking.com/medschool/2007/07/just-like-greys-anatomy.html Fri, 06 Jul 2007 10:57:56 -0800 Tonight is my last night of freedom. One could argue that I haven't technically been "free" for years, but one could also argue that being a 4th year medical student is much much easier than being a 1st year resident. In fact, I will argue this right now by stating that being an intern (a 1st year resident) will be approximately one million times harder than being a medical student. Now perhaps I am being unfair and pessimistic, because by "harder" I simply mean more responsibility, more pressure, more stress, vastly more time at the hospital, less sleep, less free time, and more ability to be sued for messing up... so its not really all that bad when you stop to think about it. To be honest, I will also be getting paid for the first time since I can remember. But this might be the last night when I will be able to calmly eat lime basil sorbet at Sebastian Joes (my current activity) and then plan on calmly making dinner and watching a movie, without being oppressively exhausted. So I am going to enjoy this lime basil sorbet, gol darn it. Tomorrow I have my first shift in the emergency room, which equates to my first official day as a resident and the first time I will introduce myself to a patient as "doctor." Hopefully, I will not start squeeling with uncomfortable laughter when that happens. My first month finds me on the emergency orthopedic service, which means that I will be focusing on musculoskeletal complaints such as fractures and dislocations and chronic low back pain that must be immediately resolved by narcotic pain killers. It also means that I will be working 12 hour shifts for many days a week. For example, every day next week except thursday I work the noon to midnight shift. And then thursday I have to come back in at 6:30am for conference. Lets just say there will be lots of learning taking place in this upcoming week, starting tomorrow. Lots and lots of learning. Last week we finished our orientation, which consisted of 2 days of computer training, 2 days of Advanced Cardiac Life Support (ACLS) training, 1 day of watching videos about patient safety and airways, and 1 day of signing documents, peeing in a cup for drug testing, and getting fit tested for respirators, which involved a bunch of new residents wandering around a room with enormous masks over their heads trying to see if they could taste a saccharine solution while bending over, moving their heads around, and reciting prose. It was like a roomful of hazmat astronauts alternately doing calesthenics and reading educational literature. Very early in the morning. But now hopefully I won't get tuberculosis if I wear my little correctly-sized mask. In the ACLS course I got to learn how to defibrillate (CLEAR!) and manage various flavors of cardiorespitory arrest. There is a very good chance, however, that I will retain precisely none of that knowledge in an actual arrest situation. "Doctor, the patient is in V-fib, what should we do?" "Boy, I don't know. Probably call a doctor or something." A real doctor. In spite of all my recent training, and my years of medical education, I'm not sure that anything would be able to prepare me adequately for what will happen tomorrow. People use sayings like "diving in" and "trial by fire" and "the shit hitting the fan" as approximations of what will happen when I walk in tomorrow in my scrubs and long white coat, my pager newly affixed to my waist, from which it will be symbolically inseparable for the next three years. We were told to always carry it everywhere, even while off. We were also told to never get sick. Or more precisely, to never call in sick. So. Tomorrow. http://www.urbanhonking.com/medschool/2007/06/here-we-go.html http://www.urbanhonking.com/medschool/2007/06/here-we-go.html Sun, 24 Jun 2007 18:06:42 -0800 I haven't written about this experience yet, mostly because I haven't had the time, but partly because I wasn't sure if I could do justice to what was probably one of the most intense things to happen to me in recent memory. "Intense" has become such a meaningless word, but that's what it was. Intense. Last Monday night I went to bed pleasantly exhausted after a lovely bike around the lakes, a get together with my new intern peeps (who, by the way, are very awesome) and a downtown minneapolis roof-top viewing of Litte Miss Sunshine. Nice way to end the day. Then I was awoken at 2:10 in the morning by the horrific sound of breaks screaching followed by a heavy metal crunch. The kind of gut-wrenching, univerally identifiable sound that you recognize, even in your sleep, as an awful awful car crash. Which is what it was. Kind of. My first thought was that, based on the sound of the impact, there was a good chance that somebody was really hurt. And that if so, there was an even better chance that I would be the most qualified person to help. I threw on some clothes, took a seemingly endless amount of time to find my sandals, and ran outside of my building. A very large crowd of people were gathered around a car, and wedged under the front of the car was a young man, unconscious, bleeding from his head. All I could do was verify that 911 had been called, and ensure that he was breathing and had a pulse, which he was. Apparently this guy had been attempting to stop someone from stealing his car, which he had left running while he walked his sister to her apartment. He ended up halfway inside of the drivers side window being drug down the street, smashed against cars, and eventually flung under a parked car. He did not look good. At all. Within a couple minutes the ambulence was there, and they were able to pry the car up, strap him to a board, and take him away to HCMC, where my colleagues attended to him. But as I walked back to my apartment, literally shaking, I could not stop analyzing my role in the whole thing. I went over the scenario again and again in my head. Was there anything else I should have done? Why didn't I take charge of the situation? Why didn't I remember that I was a doctor? I announced to people that I was a medical student. I literally forgot that I was a doctor. There was one moment when I didn't find a pulse in his left arm, and had the instantaneous thought that I was going to have to do something- NOW. Fortunately, he had a very strong pulse in his right arm, so I deferred on my plan to command the help of the crowd to extract him from his position under the car in order to begin CPR. But I think I would have done it without hesitation if I needed to. I think I would have. The whole experience left me shaken and, for some reason, kind of disappointed in myself. I sat on my balcony with a beer for a long while, until all the police vehicles had departed, trying to come to terms with what had just happened. What an amazing welcome to Minneapolis, I thought. Seriously, I move here one week ago and already someone almost dies in a car jacking outside of my apartment? What an incredible introduction to Emergency Medicine. Regardless of whether or not my response to the situation was ideal, it confirmed for me that I am going into the right field. Inspite of the chaos of the situation, of my own insecurity about my abilities, it felt right for me to be there, kneeling on the road, feeling the pulse of someone who, on an incredibly basic human level, just needed a doctor. Someday I hope that doctor will be me. http://www.urbanhonking.com/medschool/2007/06/last-monday-night.html http://www.urbanhonking.com/medschool/2007/06/last-monday-night.html Sun, 24 Jun 2007 17:39:40 -0800
Graduation Speech (the actual title of my speech) "Thank you, Mary. Thank you Dr. Keenan and Dean Richardson and Dr. Loriaux. Thank you to all the deans and faculty hooders and ushers. And on behalf of the class of 2007, I'd like to sincerely thank all of our family and friends for joining us on this momentous day - quite possibly the most momentous day of our careers to date. And to the class of 2007, my colleagues and friends - Congratulations! ... Congratulations. I recently returned from a trip to Australia on a transoceanic flight from sydney to LA. And on the 13 hour flight, as I was contemplating an appropriate way to summarize our collective medical journey with an appropriately moving symbolic metaphor... for some reason, all I could think of was the television show Lost. which coincidentally also begins with trans-oceanic flight from syndey to LA. Lost, you know... a bunch of strangers from all different backgrounds embark on a long slow journey (ie medical school), they survive a horrific plane crash (whcih could be the boards, or the match, or our surgery rotation- however you want to look at it) and then some of them (the ones that don't die horrible painful deaths) up on a mysterious tropical island (aka residency) having to face all sorts of eerie terrors and jungle smoke monsters.... yada yada yada. And so apparently, after 4 years of medical school and a 1 year pathology student fellowship I am only capable of thinking in terms of TV analogies. I don't know what that says about OHSU. Perhaps a more appropriate, and much more reasonable analogy would be a story, say, about climbing a mountain. For example, one of the residents that I worked with in the emergency department recently climbed Mt. Everest. He literally climbed Mt. Everest. Unfortunately, I don't have a story like that. Instead i'd like to share with a you a brief story about not climbing The summer after our first year at OHSU, when many of my illustrious colleagues did things like pursue research opportunities, or go on medical rescue missions in poverty-stricken nations, or invent life-saving medical techniques or cure cancer ... i decided to go on vacation. So I traveled around Australia with my sister, and found myself, one clear day, looking up at a staggeringly enormous bright red rock, towering out of the middle of the outback desert. Ayers rock. which is a geologic marvel, once thought to be the largest single piece of rock in the world. Its amazing. According to the aboriginal people it is Uluru, a sacred place where they have gathered worshiped for thousands of years. And because it is sacred, they do not climb it. And they ask the tourists not to climb it. There's this picture I took, with this sign that says "please do not climb" and behind, a long line of white tourists clambering up the side, using the metal spikes that have been driven into the rock to make their way. And I thought to myself, why? Why is everyone climbing it? For the sense of accomplishment? For the amazing view? Perhaps for the obligatory "I climbed ayer's rock t-shirt?" I think our tendency to want to climb to the top of things means something. Medical school is a kind of climb. Completing medical school at OHSU is indeed a fantastic accomplishment, indicative of a climb that was mentally, physically, and emotionally challenging. It is an accomplishment that we should all be truly proud of - one that probably does deserve a really nice t-shirt. But we need to continue to ask ourselves: why did we do this? Why did we embark on this journey? For the sense of accomplishment? For the view that we can get from the top of our new-found positions in society? For the satisfaction of a contribution to the greater good? Each of us has our own reasons for pursuing a career in medicine. Maybe, as for Sir William Osler, it was a calling. "The practice of medicine is an art, not a trade," he said. "A calling, not a business; a calling in which your heart will be exercised equally with your head." But along with this calling comes leadership, and with leadership comes responsibility. And choices. We owe it to ourselves and to those who have helped us in our education thus far, to be conscious of our actions, of our great effect on others, of our power, really. So my charge to you is "Don't just get in line. Think about where you are climbing to, and why." In case you were wondering, my sister and I did not climb Ayers rock. Instead, we hiked around it and then had lunch. And now, on behalf of the class of 2007, I would like to say thank you. Thank you to OHSU, for allowing us these opportunities. Thank you to the deans for guiding our way. A great thank you to all those in the dean's office without whom we would have wandered away in confusion years ago. Thank you to all of our teachers and mentors. To the wonderful and talented faculty of OHSU, our esteemed attendings, who taught us so very much. To our residents and interns, who quite possibly taught us even more. Survival skills. And thank you to our other teachers, our nurses, who often displayed the patience of angels. I would also like this opportunity to thank the those who taught us the most of all, and yet who are not on the payroll: our patients. And, to all OHSU pts, on behalf of the class of 2007 I would like to say thank you, and also that we are really... really.. sorry. Sorry for waking you up every morning at 4:45 to ask you if you've passed gas, sorry for our cold and tentative hands, for our awkward and repeated questioning, for our incompetent and pinchy pelvic exams... Sorry for having a roomful of total strangers stare and then prod at various exposed parts of your naked body, and then stand around you and talk in incomprehensible acronyms about things like Ranson's criteria and EtOH and hepatic encephalopathy. We're very sorry for telling you things that later turned out to be completely untrue. For all these things, and many more, dear patients, we aplogize and we thank you. Last, and most important of all, thank you to all of you. To our loved ones, our families and friends, our parents and children, our significant others... for all of your support and encouragement and unending patience on behalf of the OHSU school of medicine class of 2007 I would like to express our deepest gratitude. Thank you so very much. And to my fellow classmates and colleagues, I wish to all of you the best of luck, wherever your paths may take you, whatever climbs or non-climbs lie ahead. And as we all scatter across the country to begin our respective residencies, I would like to leave you with a reminder from one of our great teachers, who shares the stage with me today. In the inspirational words of Dr. Marc Gosselin, "the d-dimer is the devil's asshole." Thank you."]]> http://www.urbanhonking.com/medschool/2007/06/leave-em-with-a-swear.html http://www.urbanhonking.com/medschool/2007/06/leave-em-with-a-swear.html Sat, 23 Jun 2007 13:54:05 -0800 I know, I know. You're thinking: wait just a minute - this blog is called Adventures in Medical School, and yet its author just recently graduated from medical school, which by definition excludes her from the category of medical student... something is just not adding up. Seriously, what gives? Or in the words of my favorite new phrase, DOES NOT COMPUTE (which clearly must be said in a robot voice). Well, if you are confused by this change, you have a right to be. This small inconsistency is representative of an enormous transition in my life; actually, several enormous transitions all happening simultaneously. The transition from medical student to doctor. (DOCTOR!!) The transition from living in Portland to living in Minneapolis. From being on mental vacation to starting residency. The tragic transition from spending time with people I love in portland to ... not spending time with them. But spending time with new people, some of whom I love. From rain to oppressive heat and humidity and mosquitoes. From rivers to lakes, mountains to prarie, big evergreens to smaller trees that drop things on you (I guess these would be called "leaves"). I originally had an elaborate plan to do an entire blog redesign that would correspond with graduation. Running titles during my jam session with mike and steve included "Adventures in Medicine," "Adventures in Residency," and some other likely much better ones that would be authored by "Doctor Fiona, Medical Doctor." However, given my incredible list of things to do around the time of graduation - a list that included but was not limited to graduating, writing the graduation speech, taking boards, preparing program for and attending awards ceremony, welcoming and spending time with family, packing up apartment, saying goodbye - well, it just didn't happen. Ok? It just didn't. In the mean time, suggestions for new blog title are welcome. It strikes me that I haven't really allowed myself an appropriate blog-time emotional response to the fact that I actually graduated from medical school and was awarded the title of MD. Which, when I stop to think about it, has realy been the primary goal of my life to date. So, regardless of how funny it sounds to me and how weird it makes me feel... I AM A DOCTOR! Barely, but still. Oh my god. Graduation was really nice. And very momentous. It was actually technically a hooding ceremony, in which our doctoral hoods were bestowed upon us individually on stage. They called us up one by one, we kneeled down on an ornate padded stool with a rickety hand-rail (which we were told repeatedly not to use because it would break) and then two faculty members draped the fancy velvet-like hood, that badge of academia, over our shoulders. I was prohibited from fully savoring the full significance of this moment by the knowledge that I still had to give a speech - a speech that, by the way, I had showed to no-one. And also the knowledge that I had to sit on stage, right in front, in full view of the hundreds and hundreds of people in attendence, for the duration of the entire ceremony. And let me tell you, the combination of thick black polyester gown and bright stage lights is not necessarily wholly enjoyable. Its weird what you think about when you are up on stage. For example, the whole time that I was up there I couldn't stop thinking about the amalgamation of bandaids and corn pads that I affixed to the back of my heels to prevent my vintage size 12 patent leather pumps from eating through my skin and severing my achiles tendons. And I was worried that this sticky "flesh-colored" contraption was hanging out from the back of my shoes, visible to everyone but me. But checking would entail lifting up my gown and leaning over at an odd and very conspicuous angle... this is what I thought about. In between bouts of paralyzing nervousness about walking to the podium. That and the fact that I had to go to the bathroom really bad. But I gave my speech, and people laughed when I wanted them to (sometimes more than I expected them to - I think everyone was hopped up on a weird mixture of nostalgia and adrenaline). And the things that I was worried about - namely tripping and hitting my head on the podium and losing consciousness - did not happen. So I think that can be counted as a success. And then, inexplicably, I was given a very fancy gold-headed cane (a prestigious award and an enormous honor that I hope to some day be able to live up to). But it was nevertheless a cane, which one can't help but incorporate into various vaudeville-esque tap dance numbers. Couldn't be helped. It was probably the proudest day of my entire life, and I was so glad that so many wonderful people were there to share it with me. My lovely family (including my awesome aunt from Australia), my beautiful friends, my incredible boyfriend. It was amazing. And now I have to worry about what comes next. ie, Residency. ie, actually being a doctor. http://www.urbanhonking.com/medschool/2007/06/adventures-in.html http://www.urbanhonking.com/medschool/2007/06/adventures-in.html Sat, 23 Jun 2007 12:20:08 -0800 I AM SO GLAD THAT ITS OVER. The Clinical Skills exam was quite possibly one of the oddest experiences of my life. It was an all-day stress fest that was not only fraught with anxiety, but also suprisingly full of humor. It was actually incredibly hilarious, but no-one else seemed to get the joke. For one, my day was spent surrounded by senior medical students and foreign medical grads (often who had practiced for years in other countries and were now pursuing licensure in the US), all dressed in white coats, and all completely serious at all times. I arrived half an hour early and expected to feel this sense of in-the-trenches comradery with my fellow examinees. But I walked in to the lobby of this corporate skyrise in El Segundo, California and ecountered a group of solemn folks who not only barely made eye contact, but seemed wholly uninterested in engaging in any kind of shared human interaction. My questions of "so, are you guys here for the exam...?" met with long pauses, and then one solitary, "yes." Didn't anyone tell them this exam was about communication skills? There was this one amazing moment when we were all herded into the freight elevator in the back of the building because the regular elevators weren't working. (There was a lot of white-coat herding that happened that day). I was one of the last in line to arrive, and when I turned the corner I was faced with about 20 doctor types packed shoulder-to-shoulder into the frieght elevator, all wearing white coats, all facing forward, all standing there in silence. "Ha!" I exclaimed aloud at the sight, which was quite reminiscant of a cattle car, or an elaborate joke punchline. That was also met with silence. The day was extremely regimented, with designated holding rooms and lots of lining up according to assigned number. Everyone was wearing a white coat with a number pinned to the left lapel and left upper arm, and that became our identity for the day. The main event took place in a very long, wide hallway with 12 exam rooms on each side. In each exam room was a standardized patient, a highly trained actor playing the role of a patient with a specific illness. We were all guided to stand in front of an exam room, and wait for the announcement that the examinees could begin the "patient encounter," which meant rapidly opening the info sheet that contained a brief summary of the patient, scribbling a few notes, and then knocking and entering the room. 24 people in white coats, lined up along both sides of a long hallway, all standing in front of a numbered door, just staring at the door in silence until the announcement came. Like a starting gait. Very humorous image. And when the bell rang, we all jumped into action. 15 minutes to interview and examine the patient, 10 minutes back in the hallway to write the note. Top 5 diagnoses, in order of most to least likely, top 5 next tests/ exams to order. And then on to the next one.. then the next one... and the next. It made for an exhausting day, but one that went faster than I had expected. And the time spent with each patient seemed to go buy faster than I had expected as well. I tended to get rushed at the end, and probably missed some key examination points. There were things that I didn't think of until the second that I left the room, likely diagnoses that I then couldn't confirm with history. Lots of stupid omissions. A very weird interaction with a patient who was intentionally being very difficult. Anyway... DONE. Assuming that I don't have to re-take it. Afterward I was so drained that, even though Andrew generously offered to take me out to ice cream and a movie, all I could say was, "I think I have to lie down." Fortunately, once I woke up from an incredibly restorative nap, I spent my last evening in LA with my good friends Ritchey, Andrew, and Starr laughing so hard for hours and hours about the deconstruction of modern slang. "Literally." http://www.urbanhonking.com/medschool/2007/06/a-herd-of-white-coats.html http://www.urbanhonking.com/medschool/2007/06/a-herd-of-white-coats.html Wed, 06 Jun 2007 14:11:53 -0800 Last night I was sitting on the creaky wood floor in the bedroom of my new apartment in Minneapolis, slowly screwing my new IKEA bed together, piece by "medium brown"-finished piece. I had dug my stereo - the one I got for my 16th birthday - out of the cat carrier box I had packed it in to make the epic two-day drive across the country from Portland. I sat there on the floor, screwdriver in hand, beer at my side, listening to my new local radio station as a thunderstorm raged outside. For the first time in years I basked in that electric ethereal glow of an early evening thunderstorm and thought, "this is where I am going to live." And I felt pretty good about it. Until I realized that I was missing the central "midbeam" for my new medium brown Malm bed frame, which was apparently not included in the 3 different boxes that contained the other parts of the bedframe, nor was it indicated on these boxes that another crucial - nay, indispensible - part of the bedframe was also required. This necesitated a very long and annoying trip to IKEA in the midst of an early evening thunderstorm, which, needless to say, killed my moment. But the whole experience allowed me to utter the phrase, "I am really sore from the hours of screwing I did last night." I figure that makes it all worthwhile. That was yesterday. Yesterday I was in Minnesota moving boxes up three flights of back stairs, purchasing an awesome red formica and chrome table and chair set, wrestling with the construction of my first actual new bed ever(!), and then, steeped in dried sweat, drinking microbrews with some old and new friends. And then there's today. Today I am in Los Angeles. I am sitting in a coffee shop where I am supposed to be studying for my boards. Which brings me to tomorrow. Tomorrow I am scheduled to take the Clinical Skills portion of the United States Medical Licensing Exam, Step 2. I am in LA instead of sitting in front of a computer screen at a prometric testing in portland because this exam is only given in a few testing centers in the country, and this was the closest (and the one in a city that I had friends to visit). The Clinical Skills exam is a "hands-on exam that tests the examinee's clinical communication skills through his or her ability to gather information from standardized patients, perform a physical examination, communicate the findings to the patient, and write a student note." In other words I will spend 8 hours tomorrow interviewing and performing physical exams on patient actors who are highly trained not only to portray specific medical conditions, but then to judge me on my every move. My every move will also be videotaped for review by a professional physician judge at a later date. And since I graduate from medical school in literally 5 days, I sure hope I pass. Being tested on your interactions with "standardized patients" brings up all sorts of interesting issues. Simple things like greeting a person become part of a complicated assessment of your professionalism, emapthy, and cultural sensitivity. For example, according to the study guide book that I have been occasionally looking at: - "Remain consistently aware of words you are using during this and all phases of the interview; it is often disquieting to patients if physicians use too informal or personal statements, e.g., "How are you?" or "I am pleased to meet you." - "If a patient offers to shake your hand, returning the gesture is often appropriate. For cultural reaasons, it is better to not offer the handshake because not all patients are comfortable with this form of greeting." Or how about this: - " If the patient becomes teary... gently gaze at the patient with a compassionate expression in your eyes. It is permissible to convey supportiveness by resting your hand for one second gently on the patient's shoulder or upper arm (not the leg or hand, and do not pat)." One mississippi... and release. Empathy officially given and recieved. Check. This whole testing process is so interesting. Obviously there are certain qualities that everyone looks for in their doctor - but these qualities are very hard to test for in a standardized manner. But the USMLE is giving it a go. It is safe to say that this is a very unique time in my life. And by unique I do mean stressful and crazy and emotionally, mentally, and physically demanding in a total-life-upheaval kind of way. But its also a pretty amazing and important and exciting transition in my life, when I stop to think about it. Things accomplished in past two months: - finished last class in medical school - went to australia - managed to return from australia without crashing onto a deserted jungle island - purchased car for first time ever- enormous white 1993 toyota camry wagon, aka "Gigantor." - packed new car full of belongings and drove it to minnesota (aided by little bro and the admiral) - reunited with family and friends - looked for and found apartment in new home town of minneapolis - looked for and found local co-op, dive bar, coffee shop/art house, ice cream shop, thrift store, and hippy organic juice bar and herbal tea emporium - purchased new couch at aforementioned thrift store and lugged it up three flights of stairs (aided so graciously by mom and bud) - purchased incredible table and chair set and assembled bed - studied on the flight from minneapolis to LA Things to accomplish in next week: - take and pass USMLE Step 2 CK exam - finish program for AOA induction ceremony - write graduation speech (I really really need to get on this one) - plan graduation party - graduate from medical school - pack up remaineder of random stuff strewn about half-empty apartment - say goodbye to everyone that I know and love in portland - try not to sob too hard on the plane back to minneapolis Sounds do-able, right? http://www.urbanhonking.com/medschool/2007/06/yesterday-today-tomorrow.html http://www.urbanhonking.com/medschool/2007/06/yesterday-today-tomorrow.html Sun, 03 Jun 2007 15:39:19 -0800 For the past few nights I have been plagued with insomnia. It came upon me gradually, night upon night of sleep that was a little more long in coming, a little more restless when it came, bit by bit more tenuous and elusive. It culminated last night in a fitful period of desperate sleeplessness that lasted from 2 am til after 7 am. Now, I know that there are many bad things that can happen to a person. I recently saw the Last King of Scotland. I read two hundred pages of The Kite Runner last night, which filled my mind with images of horrible loss and desperation and suffering. (that probably didn't help the cause of me trying to find sleep). I know that me getting less than 2 hours of sleep falls pretty low on the list of Horrible Things Human Beings Have Been Forced to Endure. Nevertheless, insomnia is an awful thing. You know that feeling when you are so exhausted, craving sleep more than anything else in the world, and yet for some reason it continues to escape you? And the fact that you cannot sleep begins to dominate your thoughts, filling you with a frustration that is physically tangible and ultimately incredibly counterproductive? That. If you are me, you read, you try to convince yourself to fall asleep with the light on, you try lying there and counting forwards and backwards, you read some more, you cry a little, you move to the couch, you try to convince your cat to give you a back massage (which he often does when you lie on your stomach), and your cat responds by repeatedly scratching at the front door and then scampering all over the apartment. You see light beginning to creep through the windows, and hear the sounds of the neighborhood awakening: the recycling truck and its horrible explosive crashing, the sounds of traffic, of alarm clocks going off, of showers turning on, of the downstairs neighbors talking, of someone softly singing. And each sound is a jarring, cruel reminder of the fact that you are STILL not asleep. It feels like you are in the midst of an epic internal battle... but against who? The clock? Your own mind? The injustice of human existence? The inevitable passage of time? I finally drifted off for a couple of hours, comforted I think by my own resignation to my sleepless fate, and the soothing arms of a very kind man who had to get up and go to work. I have waged the war of insomnia before. Once in a while, usually during periods of great stress or emotional upheaval, often the night before anything remotely important, sleeplessness will rear its ugly bastard head. Like when I was studying for Step 1 of the medical boards. So why has it come back to visit me? Well, I guess I am done with medical school. My last little rotation had an anti-climactic end last friday, and now I am faced only with planning for the future. Packing, selling books, buying a car, trying to get more loans to buy a car, filling out employment paperwork, planning a last-minute trip to Australia (!!!).... now that's all I have to worry about. That and the pressure to enjoy my last days in portland, and the pressure I put on myself to be productive, which is promptly followed by the deep dissatisfaction I feel when I am not. - - - - - - Today I am in a daze. Have you ever noticed how sleeplessness makes things go slightly wrong? Maybe its clumsiness and thoughtlessness from the lack of the mysterious rejuvenation that sleep brings, but I swear that stuff has gone disproportionately wrong these past few days. My front brake cable snapping yesterday, my new bike light breaking without warning, my library pin number not working and the line to fix it shockingly long, the guy at the coffee shop not putting enough loose-leaf tea in my tea bag, me forgetting my laptop power cord (ok - that one was my fault). And today. Check this out. Two hours after I fell asleep I was awakened by a phone call, which, in a state of incredible confusion, I mistakenly answered. And then I was prevented from returning to my dearest sweetest loveliest sleep by the sudden intrusion of a very loud noise. Someone appeared to be power-washing the floor directly above my head in the apartment above me with a machine that was likely developed to clean mortar debris from soviet tanks. And when the incessant hissing and churning sound moved on to a floor that was not directly above my head, it was replaced by the sound of steady dripping. I got out of bed to explore and found that a brown liquid was leaking through my kitchen ceiling and into the light fixture. Very soon, this brown liquid completely filled the light fixture, casting a sickly murky glow when I inadvertently turned the light switch on (and quickly off again). Then this brown liquid began to overflow, creating a very surreal fountain that cascaded in splatters from my ceiling to the floor below, soaking through my kitchen rug, pooling along the base of my cabinets. I honestly thought I might be dreaming. If not dreaming, then in the middle of perhaps the funniest and most well-executed joke of all time. Good one, Universe. Soon after that there were strange men with ladders in my kitchen as well. I tried to drink my tea and eat my oatmeal like a normal person who got a normal amount of sleep while the nice man fixed the brown liquid kitchen fountain. Seeking solace, more caffeine, and a quiet, non-leaking place to compose my muddled thoughts, I left my apartment and found my way to one of my favorite coffee shops. Literally less than 10 minutes after I sat down (a mere hour ago) A PARADE OF SMALL CHILDREN descended upon the same coffee shop. This seemed like an even funnier joke than the one with the brown water pouring out of my kitchen light. For a while they were standing outside the window near where i am seated (guided there by the hands of satan himself), cupping their little pre-adolescent hands to the window, making gregarious faces, chanting to eachother, occasionally banging on the glass. One of them did a funny little dance in her oversized rubber rainboots. Then they all came inside, wearing little fluorescent name tags, inexplicably on some sort of coffee shop tour. They were relatively well-behaved for a group of thirty 6-10 year olds, and they were of course appropriately supervised. But I thought it the most perfect and beautiful practical joke ever designed that the place that I went to to escape the weird chaos in my apartment, after a brutally sleepless night, was promptly overrun by literally dozens of energetic little children on the world's first and only coffee-shop tour for montesorri students. Touche, Universe. You have really outdone yourself this time. http://www.urbanhonking.com/medschool/2007/04/when-the-universe-plays-a-hila.html http://www.urbanhonking.com/medschool/2007/04/when-the-universe-plays-a-hila.html Fri, 13 Apr 2007 16:29:19 -0800 lecture series. The topic was "Superfoods: 14 Foods that will Change Your Life" and it was given by Steve Pratt, MD, an ophthamologist who wrote a book with a similar title and who (as he often reminded us) has been a guest consultant on Oprah. Now, I'm not usually in the habit of plugging books (especially new york times best seller books that don't need my help), but I can feel comfortable in the act of putting in a plug for nutritional education. Dr. Pratt's investigations into how nutrition can help prevent eye diseases like macular degeneration progressed over the years to how certain foods can prevent other chronic diseases. He compiled a list of foods that, because of their high concentrations of various beneficial compounds (anti-oxidants, carotenoids, lycopene, omega-3-fatty acids, etc), their scientifically demonstrated beneficial health effects, and their use by various human cultures for countless millennia, he thinks that everyone should try to eat. It was a very good talk (I will forgive the good Dr. Pratt for his deplorable enunciation). I was even thinking of buying the book, but I settled for just writing down a list of the "superfoods." Dear reader, so that you may lead long and healthy lives without spending money on fad books, here is the list: 1. Beans 2. Blueberries 3. Broccoli 4. Oats 5. Oranges 6. Pumpkin 7. Wild Salmon (specifically wild Alaskan sockeye. Never farmed) 8. Soy 9. Spinach 10. Tea (especially green tea) 11. Tomatoes 12. Turkey 13. Walnuts 14. Yogurt 15. Dark Chocolate (the audience literally cheered when he got to this slide) 16. Apples 17. Avocado 18. Spices - cinnamon, black pepper, tumeric (he takes a 1g tumeric pill every day) 19. Extra virgin olive oil 20. Garlic 21. Onions 22. Honey (ideally dark, buckwheat honey) 23. Kiwi 24. Pomegranate 25. Dried fruits (especially tart cherries) There were lots of things that I liked about the talk, and this list. For one, it confirmed a lot of my notions on good foods to eat (I was able to feel very self-congratulatory about eating oat bran every day and about my recent dinner of chickpeas and swiss chard). It reminded me how important nutrition is in human health, and how incredibly little we learn about it in medical school. It was also nice to get this information from a practicing MD who had put years of study into peer-reviewed scientific literature, and it was nice that these decades of research have confirmed what most people know deep down (and what naturopaths have been telling everyone for years): that eating whole fruits, vegetables, and grains is very very good for you. It was also nice to get the following piece of data: Blueberries have been shown to reduce the neurological effects of the radiation from space travel. I repeat, space travel. With that in mind, Alex and I biked home and made a delicious desert of yogurt, oats, toasted walnuts, honey, and, of course, blueberries. You never know when you might be forced to board a rocket ship and travel through the endless infinity of space, incurring all sorts of neurological damage. I just want to be prepared.]]> http://www.urbanhonking.com/medschool/2007/04/superfoods.html http://www.urbanhonking.com/medschool/2007/04/superfoods.html Fri, 13 Apr 2007 16:11:30 -0800 Morbidity and Mortality Weekly Report” on two recent cases of fatal colchicine toxicity that we are going to submit later this week to the CDC. Then later I will be able to say, “Oh yeah, that was the time when I submitted that MMWR report to the CDC” and people will say “Wow, you must be really motivated and not at all lazy” and I will reply “My point exactly.” Later this week I might just do some research on pediatric Visine ingestions. Why? Because that’s just the kind of person I am. (And because they told me to).]]> http://www.urbanhonking.com/medschool/2007/04/back-to-tox.html http://www.urbanhonking.com/medschool/2007/04/back-to-tox.html Thu, 05 Apr 2007 12:04:18 -0800 That was the moment. The moment that my future became definite, the reality of my departure from the people I love in Portland dropping like concrete from the little printed words on that weightless piece of paper. At the same time, the excitement about that same future began to set in. What a moment! Congratulations to all my friends and colleagues who lived through their own future-defining moments at around the same time. My friend Tracy, who is applauding in the picture, had just found out that she got her first choice program in pediatrics and will also be leaving Portland. There were others who were not so happy - many tears were shed yesterday, and not all of them out of joy. Fortunately, we were able to leave the frenzied masses and enjoy a much deserved drink at a cafe in a location far, far from campus. A bloody mary never tasted so good (which is why I had another one - that one tasted pretty good too.) The rest of the day was dedicated to celebrating my birthday. I treated myself to a wonderful massage, which, after the two drinks and the general surrealness of the day's events, put me into an altered mental state that I remedied with a walk and a nice nap. Alex took me out for an absolutely delicious dinner. I finished off the night with a little bit of disinhibited karaoke with some of my favorite people in the world. People who I will miss dearly. Fortunately, most of them left before I decided, in a moment of ill-advised disinhibition induced by one too many amaretto sours, to sing Milli Vanilli's "Blame it on the Rain." That, and not the realization of my impeding departure, was definitely the low point of the day. For everyone involved.]]> http://www.urbanhonking.com/medschool/2007/03/the-match-part-5-match-day.html http://www.urbanhonking.com/medschool/2007/03/the-match-part-5-match-day.html Fri, 16 Mar 2007 16:30:22 -0800 Tomorrow is the day! Tomorrow morning at 10 am, I open an envelope that tells me where I will be spending the next three years of my life, if not more. Its weird that it is already decided. There are some people who find this period of uncertainty unbearable. For some reason I don't really mind not knowing. Because knowing makes everything final, it means decisions must be made and actions must be taken. It means finally planning for the future instead of simply enjoying the present. It means I might be leaving. But its cool. Its cool. I'm actually excited. Oh yeah, and not only is it Match Day tomorrow, but it is also my birthday! I'm not joking. March 15th. Good one, God! You really zinged me this year! Most memorable birthday ever. http://www.urbanhonking.com/medschool/2007/03/the-match-part-4-tomorrow.html http://www.urbanhonking.com/medschool/2007/03/the-match-part-4-tomorrow.html Wed, 14 Mar 2007 22:00:24 -0800 lawsuit was actually brought against the NRMP by a group of residents in 2002. They argued, I assume unsuccessfully, that the match system is "anti-competitive and thus a violation of anti-trust laws." Doctors and doctoring organization rallied against the lawsuit, claiming that the Match "levels the playing field. It makes everything fair. … Before the Match, there were deals made under the table. People were picked based on who they knew. If you destroy the Match, you're going to Neanderthal times." I guess I don't want to go to Neanderthal times, if you put it that way. Anyway, right now I am waiting for some giant computer in some basement somewhere to make a lot of beeping and whirring noises and spit out a slip of paper with my name and my match result on it. This large, cold-war era computing mainframe machine, which is probably called something like the Mr. Matchatron 4000, looks like this: Nickname: the Winds of Destiny When Mr. Matchatron 4000 prints out my piece of paper, it will say my name in its slow, cold, metallic voice. Fee-oh- na. It will probably mispronounce my last name. But its words will be final.]]> http://www.urbanhonking.com/medschool/2007/03/the-match-part-3-scrambled-egg.html http://www.urbanhonking.com/medschool/2007/03/the-match-part-3-scrambled-egg.html Tue, 13 Mar 2007 20:10:55 -0800