December 24, 2007

Merry Chrismakwanzanukkah

Driving by the OHSU emergency room today, I thought back to three years ago, when I shadowed an OHSU ER doc on Christmas Eve. Being in a hospital during the holidays is a very unique and interesting experience. The hospital staff seems to work together a little better, and those who have to give up their holidays with their families to roam the wards seem to understand the sacrifices each other had to make in order to care for patients. There's a certain soldier mentality to it, and the bond between staff seems to be a little more palpable around Christmas time. And inevitably, the holidays are some of the busiest days of the year.

During my shadowing experience, I saw a gunshot victim do into v-fib (ventricular fibrillation), bleed out and die on the table. I saw the doc have to tell a diabetic that they would have to amputate his legs. I saw countless people come in trying to score their pill of choice. Difficult experiences in medicine are always difficult, but seem to hit a little closer to home in the holidays. It's not coincidence that suicide rate is at its highest around Christmas. Christmas, for all its warm and fuzzy intentions, can often be an isolating time for those who don't have the family and friends to share it with that most of us do. Tragedy on Christmas has the unfortunate effect of bringing us back to reality, and a hospital around Christmas time is full of tragedy. To put a bit of an exclamation on the sights I saw, I left OHSU that Christmas eve three years ago and went directly to another hospital, where a friend's mother was in intensive care after having a stroke behind the wheel of her car. No one thinks they would ever have to spend Christmas in a hospital - until they do.

Be safe this year everyone. Take a moment and really appreciate the blessings you have. And have a merry Christmas!

December 16, 2007

Dear Journal,

Christmas break. A time to sleep, I mean, reflect.

As I write this, I started med school exactly 100 days ago. It's really hard to quantify the change I've undergone in that time, but its really fascinating for me to think about it. I've been challenged more then I've ever been before: academically, socially, emotionally. I've developed an incredible capacity to absorb information, beyond what I ever thought was physically possible. I've witnessed medical miracles, children given life who in the past would have left behind grieving parents and a book full of "what if's." I've witnessed tragedy, people who I was talking to one moment and who slipped into death moments later as their heart quivered inside their chest. I've learned the power of the scalpel to flesh, the power of a pill. I've learned the subtlety of disease heard through a stethoscope, the devastating effects of a cancer that spreads to every reach of the body. I've experienced the thrill of putting someone back together with a needle and thread. I've learned I currently suck at putting someone back together with needle and thread.

I recently went back and read my med school application, skimming through all the points I spilled to schools about "why I want be a doctor" and "what I know about the medical field." It was amazing how much I was wrong about things. Medicine is definitely one of those fields that is difficult to "get" until you are in it. I remember back in August coming into school being afraid that once I learned what being a physician is all about that I would find it wasn't really for me. I think its a danger that we all face entering medical school, and there are stories of people who find out once they're in that they don't really want to be doctors.

Luckily, I've found myself more committed then ever to my career choice. Medicine is highly romanticized in our society and on our televisions, and I'm glad that after that glossy veneer was taken off that I still like what I see. But my visions and thoughts of who I will be when I finally move to practice on my own have definitely been shaped and shifted by the past 100 days. I think most of us come to realize we will not be those shining saviors riding into work every day curing disease with the touch of our stethoscopes. Real daily medicine is a lot more mundane then that. But there's still a thrill in it (and there still is the thrill of that truly miraculous cure every once and a while).

They say the changes you undergo in medical school only get swifter the longer you are in it. If I've experienced this much in only 100 days, I cannot even begin to predict what the next 100 (or 1000, yes I will sadly be in school that long) will be like. The time has been flying by, but the next 3.5 years still seems like a truly insurmountable climb. Luckily, I've learned that I can function much better if I break things down to much smaller pieces to chew on. The next week ain't bad and the next day is definitely do-able.

I think above all, I'm looking forward to continually gaining more skills in what I do. While being the wide-eyed new med student who looks at everything with wonder has been fun, I'm truly in my element in the realm of competency. It makes me frustrated to get pimped in clinic or the OR and to not know the answer. But I know I have to have patience, because such a large breadth of knowledge and such a radical transformation of my person can't come overnight.

Here's to the next 100 days.

December 6, 2007

Jiffy Lube Hospital.

My car has a bad belt at the moment.

Which means it makes this awesome squeaking sound when the engine idles at a stop light.
(Which gets me plenty of looks from the ladies when driving downtown - 'Yeah baby, wassup? I'm ass-load in debt and my car is broken. But I'm gonna be a doctor! Wanna hop in?')

Since my life as a med student is a combination of incredible busy-ness and incredible laziness (for example, today I went to four straight hours of lecture, a presentation from a cardiothoracic surgeon, came home, passed out face down in my bed with my clothes and coat still on cause I felt like it, drooled on my pillow, woke up 20 minutes later in said drool, went to the gym, studied for four hours, and am now home effectively wasting my evening), I haven't been able to get my car in to get the sound checked out. But while idling at an unusually long stop light today and listening to the musical tones coming from under my car's hood, I had an incredible flash of insight.

Mechanics = Doctors. Or Doctors = Mechanics. Whatever.

The key is that there is an eerie amount of similarity between how a mechanic tackles a problem with a car and a doctor tackles a problem with you. Being the massive nerd that I am (contrary to my reputation), I just had to take the analogy further. So without further ado, here's the SOAP note for my car.

For those of you not in the know, a SOAP note stands for subjective, objective, assessment, plan - it's a specific method of writing notes in a patient chart used in health care to track patient history, progress, and future planning. There are specific sections to be covered in a specific order with a specific type of language - its one of those "medicine things" you never knew about until you get on the wards and realize you don't know jack. I'll break this one down for y'all.

ID/CC (Identifying Information/Chief Complaint): Patient is a black '00 Nissan Sentra XE Sedan who presents with an irregular squeaking sound deep to the hood which began unexpectedly three weeks ago. Patient reports squeaking as high pitched and inconsistent and occurs when engine is idle but ceases when engages in acceleration. Patient has not noted any worsening of squeaking since it began. Patient is concerned and annoyed by squeaking but has reported no other more significant symptoms.

PMH (Past Medical History): Patient reports no serious mechanical work done prior to the initiation of squeaking. Patient has no history of serious accidents. Patient has had routine maintenance performed at appropriate times throughout lifetime.

FamHx (Family History): '00 Nissan Sentra Sedans have a history of surge and hesitation, engine clatter, and transmission failure. Patient believes both parents exhibited symptoms of engine starter squeal and 5th gear popout.

SocHx (Social History): Patient reports aggressive but not reckless driving style. Frequently takes corners at above average speed. Does not drive while intoxicated. Undergoes frequent oil changes.

ROS (Review of Systems): No reported decrease in power of acceleration or performance in day to day driving.

Meds (Medications): Patient reports usage of regular unleaded gasoline.

Vitals: Engine idles @ 750rpm. Gas mileage 24mpg. Radiator temp 170 deg. F

Physical Exam: Car appears clean and functioning well. Mild stratching and denting of fender observed. No abnormal smell noted from engine. Consistent shrill squeak emanating from drive belt. Sound ceases upon depression of accelerator.

Labs: Couldn't think of a good analogy for a blood panel or CT scan. So sue me, its almost christmas break.

Patient is a black '00 Nissan Sentra XE Sedan who presents with an irregular squeaking sound deep to the hood.

For the problem of the engine-focused shrill sound, the likely cause is misalignment of the drive belt. The following are recommended:
-Further tests performed on engine performance to rule out deeper issues.
-Replacement of drive belt.
-Further followup for reckless driving habits.

So there you have it, a SOAP note. These things are the bane of the medical students existence, making for long tedious hours of paperwork as we learn how to effectively write one, but to tie my analogy full circle, I'm sure mechanics would go through the exact same sequence when a car is brought in for service. They ask the customer what the problem with the car seems to be (chief complaint), whether the car has had any serious problems before (past medical history). They begin service with an idea of common problems for that make and model of car (past family history). They ask the customer a few specific questions about the nature of the problem (review of systems). They examine the car and run appropriate tests to find the problem (physical exam and labs). They then draw up what the problem is and what they need to do to fix it (assessment and plan).

So there ya go. Your doctor tackles your abdominal pain the same way your mechanic tackles your RAV4's windshield wiper problem.

November 25, 2007

What Would You Do If I Didn't Have A Scanner?

I've discovered a funny little quirk in my studying habits.

I draw a lot. See Exhibit A, a page of the notes I made while studying for this last exam.

I can't simply look at a picture and memorize the information but if I sketch out said picture in my own lame rendition for some reason it sticks. Besides this being the source of endless ridicule by my friends in class ("where are your cute little drawings!?") it's also given me a great opportunity to look back at my growth as an artist over these past four months. Here are some of the highlights:

Lonely Platelet.

A social examination of the under appreciated existence of clotting factors.


It's true that smiling utilizes more muscles and burns more calories than frowning.

The Knee

A Football Player's Worst Enemy

The Indifferent Gonad

Because at one point of development, we all had the same private parts!


An examination of color and the anterior triangles of the neck.


I went through an impressionistic stage during our study of the genitalia. I think it was a coping mechanism.

Your Pelvic Girdle

Because without it, you'd poop out your insides!


Nothing better to spur reflection on life and death than a lateral diagramatic view of the skull!

I am sure as I continue to find myself in medical school my artistic style will continue to evolve in turn.

Not much else to say right now - the last month was constant tests (and thus hell). When you spend all day and night every day studying for almost a month straight it leaves little time for things like "reflection" or "personal growth." Thanksgiving break has been a much needed break and now three weeks to push through to Christmas. The year has been flying by. I think that's a good sign - must mean I'm enjoying myself. So really, in the spirit of this post, I think there's only one real way to explain what I've been up to the past month. If you recall in an earlier post - I have a little something called The Place My Medical Knowledge Goes To Die (which has subsequently been renamed The Place My Medical Knowledge Goes To Die Until I Need To Resurrect Every Last Drop Of It Before The Boards Next Year).

My brain on October 2nd, 2007:

My brain on November 25th, 2007:


November 11, 2007

I Enjoy VH1 Celebreality TV.

There's different types of tired. There's just-had-a-crazy-intense-workout tired (which I actually enjoy). There's running-on-too-little-sleep tired (which I definitely don't enjoy). There's an emotionally drained tired. There's a been-running-around-all-day tired.

Right now I'm feeling a wholly different kind of tired. My brain is tired.

I am currently about to start the second week of a three week gauntlet where we have an exam each week. As I have already covered, preparing for a medical school exam is like preparing for 4 college exams in the same day - it's a week long process that requires a great deal of time and energy investment.

My previous strategy for surviving these draining cram-and-purge periods was by mailing in the week of school after the test. Not studying much (ok, at all). Maybe catching up on study objectives for a couple hours max on saturday. It worked well, gave my brain a nice break, gave me a chance to hit the gym, and when it came time to get back to work I was more than happy to jump right in. I really liked mailing it in.

I took my final GIE exam last week, a grueling exam on 3 weeks of material that was easily our most difficult challenge yet. This week I have a cumulative exam for our Principles of Clinical Medicine class. Next week is our first exam for our new Cell Structure and Function curriculum. Basically this requires me to be in full balls-to-the-wall study mode for 4 weeks straight. I can now understand why Pheidippides fell over dead after his sprint from Marathon to Athens.

So what's it like to be brain tired? Pretty easy to describe actually. Motivation? You lack any of it. Sense of humor? Well lets just say I have no problem perpetuating my blonde hair stereotype at the moment. A little slow on the uptake. Energy? Good luck, even on the back end of halloween and its copious amounts of candy lying about - no sugar high can touch my fatigue. Quad venti caramel low fat peppermint mocha latte extra hot? Please, I'm not even sure a line of coke could move my flatline.

Thankfully, at the end of the tunnel is a four day break for thanksgiving where I get to mail it in and not feel guilty about it. I think someone on our med school curriculum board has a soul. And if there's one undeniable truth, its that I will eat my weight in stuffing, park my butt on the couch, and have the most amazing nap of my life. Just got to get there first. Anyone got any coke?

November 5, 2007

Practice makes good enough.

“I had never done this surgery before,” my preceptor said as he pointed to the MRI on the screen. “I read about it in a journal. Didn’t turn out quite as well as I hoped. But next time I’ll read up on it some more and hope for better.”

As all things in life, practice makes perfect. Medicine uniquely requires one to practice on people. To further complicate things, medicine is always changing. Always improving. Of course, nothing in medicine is ever introduced without extensive testing to guarantee the safety of the people we treat. But eventually, every doctor has to make the jump and attempt that new treatment or new procedure. What happens to those first patients? Their results may be “not quite as well as we hoped.” Our patients unfortunately have to be the guinea pigs.

Even though I was not present for the conversation between my preceptor and his patient prior to the surgery, I can imagine somewhat how it may have transpired. He would have sat the patient down - explained all options. That a current surgery may exist which can help them. That he does not have experience with that surgery. Of course, many people put a great deal of trust in their physicians. When my preceptor explained “I have never done this surgery before,” many would likely hear “but I have done many surgeries like this before” as an unspoken affirmation. How close is that to the truth? How much does previous experience translate to future success?

Ultimately, I believe it is simply a matter of trust in the checks and balances in a system designed for change. As medical students, we bumble around learning the foundations of medicine that will help us function as the physicians of the future. In residency, we learn the skills and instincts that will help us succeed in the field we have chosen. New drugs and techniques are put through extensive trials. Surgeons travel to observe new procedures and read about them in journals. And ultimately it is all overseen by “experience.” Medical students are aided and corrected by the residents they work under. Residents are taught and covered by the attendings of their program. Surgeons learn from their peers who have pioneered and practiced new procedures. Drugs are tested and scrutinized by those involved and educated in their design and effects.

It may not be the best system, but it seems to be one that works. But with all things new, there are guinea pigs. Unfortunately in medicine, the guinea pigs are people, with the physician possessing only an instruction manual and trust in his or her skills and instincts to go on. This means people with "not quite good enough" results (which in reality in some cases means difficulties they will have to live with the rest of their lives). The best we can do is educate and hope for the best. Because it is ultimately about change, and change, as history has taught, is good for medicine. And good for the patient.

October 28, 2007

Meet: Your Brain.

Everyone is fascinated with the brain. I spent the majority of my childhood obsessed with neurosurgery. The brain truly is one of those last frontiers in medicine where we still don't understand much about why it does the things it does. As my preceptor said the other day... "don't believe anything they tell you in your classes. everything between your ears is a black box."

This week we took a bone saw to the skulls of our bodies and took out the brain. Anatomy has had its fair share of awe inspiring moments. Taking out the heart. Looking in the knee. Dissecting out the sciatic nerve (its as thick as your thumb!) But the brain definitely takes the cake.

The first thing that really struck me was just how heavy it was. They say your brain weighs around 4 pounds. That doesn't sound like much, but when you hold it in your hands in has some real heft to it. Maybe its the philosopher in me, but I found it really fascinating to hold the organ that has allowed the great mind's over the course of history to make some of the incredible revelations they have. Those 4 pounds have produced Plato's Republic, Shakespeare's Macbeth, Bentham's Utilitarianism. Really cool to think about.

So what does your brain actually look like? Really, about what you would expect it to. I think that was really fascinating. The brain always seems like one of those magical mystical things but it really is just as you expect it to be.

It's also amazing the things you find out about your cadaver as you work on them. The death certificate said our person died of a heart attack but we noticed he had a massive brain bleed which wiped out the whole left half of his cerebrum. Basically, he most likely died of a stroke and not a heart attack. All in all in doesn't matter, but its interesting to think of how many people out there whose cause of death was incorrectly pronounced.

Anyways, enough procrastinating for one night. Back to the grind.

October 16, 2007


In the words of Seargeant Nicholas Angel from the incredible movie (seriously, see this movie) Hot Fuzz: "shit just got real."

Today marked the first day of our last block of GIE. At this point, we're seasoned medical students. We've become study machines, busting through our lecture hours every morning and meticulously working the dissection of the day in cadaver lab after. Until today. Today, our dissection lab gained 30 new members.

No, my medical school didn't suddenly decide to expand its medical school class from 120 to 150 two months into the year. But today, we removed the shrouds on the faces of our cadavers and began dissection of the head and neck.

Up to this point, the heads of our bodies have been wrapped in a cloth shroud. Besides serving a practical purpose (it prevents dessication of the skin while we worked elsewhere on the body), the purpose of the shroud was the help us rookie medical students adjust to the experience of taking apart another human body in less dramatic circumstances. When looking down at your body or looking around the room, you saw the project for the day. A shoulder. A lung. A foot. Until today. Today if you looked around you saw faces.

Today we weren't working on a body. We were working someone's mother. Someone's grandfather. Someone's child. Suddenly there weren't 30 bodies in the lab. There were 30 people. It really helped tie full circle that the hours we've toiled in the lab really were to give us an opportunity to gain perspective on the human body in order to help... real people. It's really easy to lose that perspective in medicine. In a few days, the skin will be gone from the faces, and we'll be back to working on bodies again. But part of me wishes that didn't happen. As eerie as it is, having those 30 extra people in the lab really is a profound reminder of what we're really here to do. Medical school isn't really about the tests. Or the board scores. Or the letters of recommendation. It's really about the adjustment of learning how to work on and work with people. Because that's what its really all about. You learn the nitty gritty of how to "doctor" in your specific field in residency. Medical school isn't going to make you a great doctor, but its going to give you the tools to start becoming one. Seeing those faces really reminded me of that, just as we all were settled into a routine, trucking along thinking we were hot shit first years who got everything down.

I guess, when it comes down to it, medical school (well, medicine in general) is a series of humbling experiences strung together. Even today, I saw a patient who completely fractured his leg apart two years ago. They tried a cast. Didn't heal. They tried plating the bone. Didn't heal. They tried a rod. Didn't heal. The surgeon I'm working under has exhausted all the options of treatment that he knows of and the patient is now considering amputation of the lower leg because at least he'll be able to walk with a prosthetic. Needless to say, the surgeon is effectively... humbled. I feel for him. And for the patient. Because I'm humbled today too.

Just when you think you have something figured out, you realize you're standing on the tip of the iceberg. But it also gives endless challenges as opportunity to grow and learn. To become better. And I like that. Because what's ultimately going to get you farthest in medicine to isn't knowing everything, but always being reminded that you don't.

October 8, 2007

What's That Spell!?! PROCRASTINATE!

I should be studying right now, but like all things in life, there are some things more important than school and one of those things is procrastinating.

Each classroom gains its own dynamic - an ebb and flow of personalities that can make your experience in that class either a joy or hell on earth. Luckily my experience in GIE has landed somewhere in the middle, but since I'm the type of sit back and enjoy lecture rather than furiously scribble down notes, its given me an opportunity to observe some of the idiosyncracies of our lecture hall at this time. Since we're over halfway done with the class and things will soon be changing, I thought this would be a great chance to give you all a look into the what its like to sit in a 160 person medical school lecture hall at god awful times in the morning digesting a truly evil amount of information.

Thus I present... my lecture hall and all that makes it wonderful.

Exhibit A. The Girl Who Sleeps. In my day, I have known many people with an incredible knack for being able to fall asleep anywhere at any time. But of my lord this girl takes the cake, sets the record, and is so far ahead she'll never be caught. 15 second between slides? 15 seconds of REM sleep please! 10 minute break? Why that's enough time to fit a dream or two in! I do not know what makes this girl so perpetually tired, but I am continually impressed at her ability to fall asleep faster than a narcoleptic who's 24 hours behind on their meds.

Exbihit B. The PAs. One day we will work together, since PAs are an essential and soon to become even more important component of our medical infrastructure. But for now... the line is drawn in the sand. There must be no mingling of MDs and PAs under any circumstances. The must be no acknowledgement of PAs by MDs. The PAs must always score higher than the MDs on exam. These are the rules of lecture hall.

Exhibit C. The kids. Adding further dynamic to our lecture hall, we have the pleasure of taking GIE with 7 radiology students. Radiology is a major offered through Portland State University, which means these 19 year olds have the exquisite *cough* pleasure of taking a medical school class with our future leaders of america... I mean future incompetant doctors of america. They resort to cowering in the back row, pretending they don't have to live through such a hell and hoping not to be seen.

Exhibit D. Death to All Who Come Here. These are the achievers of the group. Front row seats please, so I can digest directly from the mouth and not from the microphone all the wonderful insights into medicine our lecturers impart on us on a daily basis. The hierarchy of these seats have been established from the first day. Do not venture into this area and take someone's seat under the penalty of death.

Exhibit E. I didn't put in an E. This serves as further proof I am losing my mind.

Exhibit F. The Computer. Technology is a wonderful thing. Except when lecturers do not know how to use it. There is a guaranteed 15 technical difficulties per week in lecture hall. In case of said technical difficulties, count of some individual from Exhibit D (Death To All Who Come Here Zone) to run up eagerly to help. Because we must learn. We. Must. Learn.

Exhibit G. The Giant Projection Screen. This thing is like 80" big. It puts most MTV Cribs theater rooms to shame. That being said, count on at least 80% of all lectures to have slides with text and diagrams too small read, even on such a behemoth monstronsity.

Exhibit H. You're Late. This space on the stairs is reserved for those special individuals who arrive late. Seats taken? Tough luck. You are cursed to sit on your hard ass for an hour with your binder awkwardly on your lap until break. I think we should invest in pillows for zone H. I might be late on purpose if that was the case.

Exhibit I. Smelly Food Zone. People filter in and out of this zone but one thing is constant... the smell. I think it is required for someone to sit in this zone and open up their wonderful tupperware container of sliced eggs lain all over their tuna sandwhich. Yum.

Exhibit J. Dr. Feelgood. Dr. Feelgood is a general surgeon who helps out in anatomy lab. One caveat... Dr. Feelgood has been banned from the OR for being too old and senile. As a result, Dr. Feelgood uses lecture hall to flex his surgical prowess, challenging all guest lecturers that he knows just as much about the procedures on their specialty and they do. Oh, Dr. Feelgood. I hear Old Country Kitchen has continental breakfast all morning long.

The Star. Me. I do not move... My zone is my happy place.

So there you have it. Welcome to lecture hall.

October 2, 2007

The Table In The Corner

I apologize for not posting for a while, but well, we've been studying the colon, rectum, and anal canal and I figured I would spare you all the pleasantries of my expeditions into our body's most... aromatic regions. That being said, getting to hear the word "anal" in lecture 200 times a day has still not ceased to be humorous in any way.

We have now moved onto genitalia, so I think I will spare you all some details now as well. Though it has been pretty funny to observe certain classmates of mine who are just now being exposed to many details of female anatomy which I have a hunch they had a very vague (if no) idea of before now.

We have just finished block II of our GIE block. Which means I am now officially halfway done with our cadaveric dissection. Studying for med school tests is hell. Between lab and my neighborhood 23rd Starbucks, I believe I put in around 25 hours of studying with my nose to the grindstone (often a very smelly grindstone) this weekend. That being said, one of the most satisfying moments in medical school is finishing an exam, and when you get home, unloading all that information from your binder because you know longer need to know it. I know, this is sad that this is now a highlight of my life, but I take my perks where I can get them. On that note, I now introduce you to...

The place where my medical knowledge goes to die.

Only a couple inches of paperwork in here now, but by the end of the year, this baby will be full of things I have (somewhat) successfully crammed into my head, regurgitated onto paper for 4 hours, then subsequently purged from my memory over a beer (or several) the night following.

On a completely unrelated note, I am continually amazed by the caliber of physicians that my medical school has in their hospital. Since my last post, I have met a surgeon who is helping pioneer a surgery that is going to replace microfracture, a surgeon who is considered one of the premiere pediatric cardiac surgeons in the nations if not world, a surgeon who is trained to operate using one of only 8 robotics units on the entire west coast. Yes I said robots. The hospital has a robot which performs surgery - a truly exciting field which I have a hunch people are going to see continue to expand over the coming years.

I am also continually amazed at how generous and gracious some of the patients are at a teaching institution. Last week our group was learning how to identify a variety of heart and lung sounds indicating various pathologies. Our small group leader took us out onto the wards to visit several of his patients, including one individual I'll call Stan. Stan had just been diagnosed with highly developed COPD (Chronic Obstructive Pulmonary Disease), an incurable condition which could end his life as soon as two weeks later. I know many people who would be in know mood to even interact with other people after receiving such news, especially bumbling loud curious first year medical students. But Stan simply wanted us to learn, and let each of us listen to all areas of his lungs for the distinctive crackling sound telling of COPD. Why? "If you can learn from me, maybe you can save someone's life one day, or at least prolong it." I am amazed at Stan's generosity and strength, and that even with the end of his life very near in sight, he simply wanted to give as much as he had to offer until the very end.

Not much else to report for now - though I am pleading with several physicians for as much OR time as possible so I am sure I will have some interesting stories soon.

BTW... over 300 hits on the site. That's awesome. Thanks to all of you who check in every once and a while!

September 18, 2007

The Waiting Room

It's one of the things people hate most about going to the doctor's office: waiting. You show up 15 minutes early for your appointment, spend 15 minutes filling out paperwork, another 30 minutes waiting reading your National Geographic from 2001, then you get called back. Progress! This will all be over soon!

You get to the back room, talk with the PA/RN for a few, then bam, another 30 minutes of waiting in a cold room, except this time they don't even give you the common decency of a 6 year old magazine. Bastards. Finally, an hour and a half after first arriving, a knock! The doctor enters, time for them to listen intently to your story, give guidance, immediately offer a remedy that will cure all ails, and you leave engaged in laughter and smiles. Except instead, the doctor talks to you for 5 minutes, doesn't seem to really listen, then slaps a piece of paper in your hand and send you on your way.

Today, I'd like to tackle two issues: why all that damn waiting? and also, why all that damn waiting for such little face time?

First... all that damn waiting.

Most people are under the impression (as I was for a long time) that when a doctor is in clinic, he is making his way around in a big circle through the clinic, seeing a patient, finishing, moving to next patient, finishing, etc. The reason the doctor is late either because of a difficult patient or because he's just slow. I will now in the longest run on sentence ever attempt to capsulize what a doctor is ACTUALLY doing while you're waiting.

While you are waiting, the doctor is following up on tests run on patients earlier in the day, receiving requests for referrals on more patients, requesting referrals to other physicians, receiving phone calls from patients with questions, receiving phone calls from fellow physicians with questions, receiving phone calls from hospital/clinic staff with questions, receiving phone calls from the press asking questions (yes, this happens), attempting to finish up out-patient notes on all the patients they have seen before you, reading up on the few assorted difficult cases of the day, getting paged incessantly for any variety of reasons, seeing the patient(s) before you on the day's appointment list, and attempting to preview your chart as you are in the waiting room.

Ok, I may have squeezed an ounce of sympathy out of that hardened heart of yours, but it truly is impressive to see the multitasking the physicians I've been around pull off on a daily basis.

Now... why so little face time?

At the beginning of the day, the doctor previews his or her appointments scheduled for the day. They know you're coming up. While you are waiting in the room, they are looking through your chart. If you're a follow up for surgery or something of the sort, they are looking at any x-rays/MRIs/CT scans that you may have on file. They are reading notes from previous physicians if you are a referral. Generally, they have a pretty good idea of what is going on before they even step foot in your room.

In medicine, we have what we call a differential diagnosis, which is basically to say, a list of things we may think be going on with you in order of decreasing likelihood. As we gather more information, certain things move up and down the list.

Even if the doctor is not quite sure of what is going on as they knock on your door, they already have a few ideas. That is when they begin to ask you questions about the symptoms to add to their differential diagnosis. Most doctors have it nailed what's wrong with you within a period of 5 questions. Yes, they are that good, or rather have so much experience that when a certain set of responses come from the patient, well, one doctor described the diagnosis as "a trigger finger reflex - you just KNOW." So while you're still hashing out the how the only reason you were even AT the picnic where you broke your ankle was because your ex wife's brother who you thought was a nice guy was sneaking around with your mother and you were there to break his jaw but had a change of heart because the children were around but that's when you tripped over the dog, which your ex-wife got in the divorce, that bitch, your doctor has already clearly figured out what's wrong, already has a plan of treatment, and is smiling and nodding because he likes dogs and has an ex-wife as well so he can relate.

This is the conundrum of the doctor visit. Your doctor wants to stay and hear about your embarrassingly promiscuous mother, but the phone calls for referrals, about referrals, from patients, from doctors, from press, from staff, the pages, the emails, the charts, the difficult patients are all backing up outside that little room you two are in. And while your doctor loves talking about picnics with you (they really do), they don't NEED to hear about it because they already know exactly what is wrong with you and how they want to treat it.

So you end up waiting 90 minutes for 5 minutes of face time. Is there a better way to do this? I have no idea. But there's two things that your doctor truly appreciates. (1) That you are a good patient, because these are a lot more rare than you'd expect and (2) That you might be willing to let him move on to the next person because you two have gotten you to where you need to be, because that extra time you free up will be sorely needed for dealing with those patients in which things are difficult.

They call it the rule of 20/80. 80% of your patients will be a joy to work with, with a clear and present problem and realistic expectations of how that problem will fix itself with treatment. But the other 20% of the patients will be a pain in the arse, and those 20% will suck 80% of your time. So while you are waiting in your room, your doctor may be next door trying (hoping) to make a patient understand that no, he may never be ABLE to be a wildfire firefighter again because he was in a motorcycle accident where he broke 28 bones in his body, split his pelvis in two, and has enough screws and plates in him to put together a piece of ikea furniture (true story). But hoping the patient could at least lower his expectations a little bit, simply because when they peeled him off the asphalt they had to shock his heart 3 times and put him into a coma for 3 weeks, so its honestly a miracle that person is even sitting there to begin with.

I don't know where I am going with this. All that is apparent to me is that inside every doctor is this war. They want to spend as much time with a patient as the patient truly wants, but simply, physically, cannot. How much personal connection do you balance with necessary brevity? Because when the doctor has to sink that 80% of their time into those 20% category of patients, ultimately, it's not just you who ends up waiting, it's the doctor - waiting to finish for the day with all those phone calls, pages, emails, and cases. And waiting to go home for the day.

September 10, 2007

Welcome to the jungle.

My name is no longer MedZag. My name is #5814.

In respect of privacy (and to keep the gunners of the class from gloating so much their heads explode), my medical school assigns each individual a designated exam number. As soon as test day comes, you cease to exist as a person, and you rematerialize as this number.

#5814 will be the barometer of my medical school success for the next two years. That being said... med school exams are not nearly as bad as advertised (yet). I show up to school at noon today to take the bitch down, run into the token hyperventilating classmates (God rest your souls) and head on down to the lab. Contrary to popular belief, identifying 50 different structures on 25 different cadavers ain't so bad. Granted it sucks, and your brain works hard, but in the grand scheme of intellectual effort I think there's 6 levels of effort: (1) Can do it while watching Rock of Love. (2) Can do it while watching MythBusters. (3) Can do it sans television with music. (4) Can do it. (5) Kinda difficult. (6) F*cking impossible.

For the exam, I grade (out of 150 questions) 20 as a (1) 10 as a (2) 45 as a (3) 70 as a (4) 5 as a (5) and 0 as a (6).

End score: Reasonable. Big bad medical school exams are big, not really bad. But totally doable. End verdict comes Wednesday (and Monday).

Maybe my good feelings of the day come down to my playlist from the morning. I woke up, listened to some Eye of the Tiger, and went of my way. I should really attest my entire medical school career so far to 80's rock bands.

On a totally unrelated note, Portland has begun to be invaded by Vespas. The annoying whine of what used to be a uniquely European phenomenon now has penetrated (ha, penetrate) the culture of the dear state of Oregon. And it really doesn't work for our poor town, the damn things just seem so out of place. It's like Seattle, WA and Florence, Italy got together for a hot and steamy night after a crazzzzzy time at some bar (what bar Seattle and Florence would both hang out at, I have no idea) and Portland, OR was the "accident" that popped up 6 weeks later. I just hope Florence took the news well. Yes, I am making Seattle the woman in this analogy. Or perhaps a better analogy would be when two attractive celebrities get together and make a baby and you go "damn, that's gonna be one good looking baby" and the end product ends up looking something like this. Thank you, Portland.

Another random musing... one of the doctors who leads our PCM (Principles of Clinical Medicine) looks and acts exactly like JD from Scrubs, give or take 20 years. I find it truly hilarious, though I think my group thinks I'm a little weird for laughing a lot more than I'm supposed to. But what else am I supposed to do when all I can think about is a correlary Dr. Cox rant going through my head all throughout small group.

September 6, 2007

Private Snowflake.

I've never really had a problem with tests in my life. Not because they haven't been difficult, I've had my fair share of those. But I've never been the type to stress out before tests (or study for them). Get in, get out, quick f*ckin' about.

Enter medical school. Our first exam of the year looms at the end of the weekend, a 4 hour behemoth called "GIE Exam 1." I just battled my way through the first level of medical school, now I gotta beat the boss. And you know the funny thing? I'm not stressing too much. Oh, I have enough of apprehension in me to keep me in the library all weekend, but (and I can't believe I'm saying this), the material doesn't seem "that bad." Just 3 weeks ago, I got my 2 inch syllabus, and my jaw dropped 20 inches. Now, it all seems damn reasonable. A continual evolution of me, I guess. That being said...

Preparing for an exam in medical school is like preparing for war.

Studying for it is an intensive endeavor. Packing my bag in the morning is like preparing to go on a week long recon mission. I need my manuals (books), water to stay hydrated, source of energy, source of caffeine, radio (ipod). Throw it all on your back and trudge off for 12 hours.

The exam is close to 4 hours long. For comparison, the LSAT is close to four hours long. I am taking an LSAT I only had 2 1/2 weeks to prepare for.

The exam is split into two parts. The first half is multiple choice based on lecture material and the questions are framed to be like what we'll see when we take the United States Medical Licensing Exam (USMLE) Step 1 following our second year. I haven't taken a multiple choice test since my lower division sociology class at Gonzaga (upper division profs considered them "too easy"), but wouldn't you know, I'm taking them in medical school. The second half of the exam is the lab practical. The day before the exam, the lab professors and 4th year students go through each of our dissections. They grade the dissections, and choose structures from each group's cadaver that are good representations of what things SHOULD look like (or, as our course director says, "we're really superficial, we choose things that look pretty"). For the lab practical, you enter the lab and start at a station. In front of you is a cadaver, and in this cadaver are tiny metal pins. At the tip of these pins could be a variety of structures. The filum terminale of the spinal cord, the recurrent branch of the median nerve, the extensor carpi radialis brevis muscle, the thoracolumbar fascia. If its a muscle, you might not be asked the name, but will be asked where it originates, or where it inserts, or what it does, or what nerve innervates it. Obviously, this is a very daunting task with no Word Bank to help you out. You have 60 seconds to identify the pins, pick their names out of thin air, and move on to the next station, where a whole new set of pins await you. At least we get to stand.

Obviously, this sounds like a really fun way to spend a Monday (sarcasm). I've been trying to put my finger on why I'm not FLIPPING SH*T about this exam, and I've yet to find a good reason why not. Maybe its because I'm a person the world needs most (thank you Gonzaga). Maybe it's my ego. Or maybe my brain is really just running that well after years of lack of use (and abuse, likely). I think above all the main emotion I'm feeling going into the exam is simply... curiosity. These will be the things that judge my progress for the next two years, and I just want to get the first one out of the way to see whether my study strategies have been working so far.

So, we'll see how it goes. The class is going out to happy hour after the exam, and I'll either be celebrating or drowning my sorrows. The nice thing is all you need to do is pass. As they say, "P's get MDs."

August 29, 2007

Just call me Kobayashi.

My brain feels like it has been in a hot dog eating contest.

Now bear with my analogy. Hot dogs are like medical knowledge. I love hot dogs (as I love medicine). If I am feeling particularly adventurous at a bbq, I might polish off 4 or 5 hot dogs in an afternoon. But after I am full, hot dogs aren't as fun anymore. The winner of this year's competitive hot dog eating contest ate 66 hot dogs. It goes without saying, this is not an enjoyable experience, regards of how much you love hot dogs.

Med school is like a daily competitive eating contest and my brain is feeling like it was just forced to compete in said competition and had to wolf down 66 medical-knowledge hot dogs. Just when your brain thinks its full, that you can't POSSIBLY study more or retain more information, you simply force yourself to. It goes without saying, this takes a lot of the fun out of hot dogs (or medicine).

So what keeps people eating those hot dogs, pushing past levels of discomfort or pain? It could be competitive desire, to be the very best hot dog eater in the world. It could be personal motivation to prove the human body is capable of much more than one could ever expect. It could be that someone just really, really loves hot dogs, though I am sure this is certainly a diagnosable bizarre and rare psychological condition.

Similar things motivate med school students. Eventually, studying medicine is like eating too many hot dogs. No matter how much you love medicine, eventually you go into information overload and learning it isn't fun anymore (just as eating too many hot dogs makes you feel sick). So what forces us to keep studying, as fatigued as we are and as sick as we feel?

Competitive Desire. Nearly everyone gets into medical school because they are competitive. These are the people who take personal offense to a B, scoff at a C, and only like A's if they don't have a - next to them. These are the people who enjoy setting the curve. I admit I am somewhat competitive, especially self-competitive, because I certainly enjoy the feeling of being the best at something. The feeling of success is like an endorphin shot for me. It's only natural.

To Be The Best. Almost everyone goes to medical school because they want to help people. No one is naive enough to not acknowledge that the special privileges and the gifts of healing that doctors are afforded are largely afforded due to their extensive knowledge on medicine. And yes, it is easier to hit the books with a little voice in the back of your head telling you that one day, someone's life might be saved by the extra effort you put in now.

However, there is one predominant motivator to always study more.


Success in medical school is almost always correlated to time invested in studying. No one gets through medical school by simply being smart. But its a lot like treading water. Hours spent studying doesn't let you fly, it simply lets you keep your head above water. Slack off a little and all of a second you're breathing water. Considering medical school is a VERY expensive endeavor (I will be $200,000 in debt by the end), failure is simply not an option.

So we study.

Now I should note, just like the competitive eater, there is a training process and your body adapts to the rigors you put it through. In a couple months, the continual studying will not seem nearly as exhausting. Just as a competitive eater's stomach becomes more elastic and can distend to much larger sizes, my brain will become able to retain increasing quantities of information with more comfort. It's a lot like training for a marathon. Right now I just finished my first week of training. My body is sore, I'm tired, I don't think I'll ever be able to run 26 miles. But with time and effort, you can mold yourself into a marathon rider. I'm molding myself into a medical student.

It's also worth noting that no matter how many hot dogs I am forced to eat... I still like hot dogs. All the studying sucks, but the good thing is it doesn't make me love medicine less. It's a weird feeling, loving medicine and sometimes loathing it, but its a feeling that all in the medical field experience.

Some other things of note that have happened lately:

I got my faculty advisor/mentor... and he's a pediatric cardiac surgeon (one of only TWO at my school). Booya! I met him today and I have a feeling this is going to be a great experience. He's young (38), and was a straight-from-college med student as well. When I told him of my interest in congenital heart surgery, his first reaction was "well lets get you into the OR!" He also helped dispel a lot of stereotypes about pediatric cardiac surgery. While he's on call every other night, he hardly ever has to come into the hospital. He has a healthy marriage and a 4 month old baby. He doesn't seem worn out. It's was a very positive experience overall. And I'm sure I'll flip at my first chance to see a Norwood procedure or Fontan procedure.

I also got my first preceptorship assignment. I get to work with an orthopaedic trauma surgeon. I'm glad I got to start on a surgery rotation and I'm sure there will be some crazy things I get to see.

All in all, things are starting to fall into place. I'm beginning to run out of hours in a day, but I guess above all, I just need to keep eating those hot dogs.

August 25, 2007


I preface this post by saying I have the utmost respect and appreciation for those that chose to donate their bodies to science so that we may learn from them. Any humor is not meant as disrespect to them or the very unique and powerful experience they have afforded us.

They say that the dissection of the human body is an important transition in medical school to the treatment of actual living, breathing patients.

I can see why.

The preserved cadaver walks this fine line between being something distinctly human and being some distinctly not. The formalin preservation process cross links proteins in the body. It makes skin feel almost rubbery. It makes joints difficult to manipulate. It distends the belly. But for all of that, it remains very, very human.

To run a scalpel through human flesh is a very powerful experience. It gives you a great appreciation for how fragile we are. But it also gives you a great appreciation of how well we are put together. Believe me, separating skin from your underlying muscle is a VERY difficult endeavor. Of our group of four, we often had two of us pulling with all our strength (yes, its that tough) while someone incised beneath. Everything is attached to everything. While we were instructed to use primarily blunt dissection to perform most of our dissection, the scalpel turned out to be our truest friend.

Funny anecdote though. Apparently there's a way that everyone holds scissors, then there's a different way that surgeons hold scissors. You have your thumb and ring finger in the scissor islets. You use your middle finger for guidance and place the index finger on top of the blade for greater control. Strangely enough, I've held scissors like that my entire life. Guess some things are meant to be.

Yesterday we got to use the bone saw to cut into the spine. The anatomy lab was like shop class. Power saws going everywhere, smoke rising up, hammers and chisels at work. And this is not a unique phenomenon to anatomy class. A lot of medicine is a lot more crude and brutal than people realize. Just last night a trauma surgeon was telling me about a time when a man came in impaled by rebar. They had to take it out of him using... a diamond cutter and monkey wrench. Guy turned out fine.

I guess that's the part of medicine that starts to get indoctrinated in anatomy lab. Working with the human body is a lot more brutal, aggressive, and messy then people realize. But thats part of what makes it so elegant, and what makes people so resilient.

Perhaps the coolest part of anatomy lab is to see the physical manifestations of pathologies. It's one thing to see a person die of spinal meningitis on the outside, where vitals slowly plummet and the person passes. It's a completely different experience to physically look at that person's spinal cord and actually see white growths of Staphylococcus pneumoniae all over it. You can read the story of the lives and last days of the people we dissect. Our cadaver died of a sudden massive myocardial infarction (heart attack). When we dissect his aorta, it will likely be sclerotic due to heart disease. His liver will tell us if he drank. His lungs will tell us if he smoked (and speaking of which, don't smoke. If you do, quit. You have no idea the ravages smoking leaves on the human body). We may find hip replacements. We may find previous surgical work.

It's a very personal experience. And really makes you marvel at medicine these days and our wealth of knowledge we have acquired.

Luckily, it'll be a while before I cut into a living person. But when that day comes, I know one of the cornerstones of what will give me the confidence to place a razor blade to another person's skin will be these days spent in the anatomy lab.

August 22, 2007

Gettin' toasty in here

So we've started to hit stride in the academic side of this whole medical school bit, and let me tell you, the stories of the wealth of information you are "afforded" are far from exagerrated. We received our first packet of material we are required to know for GIE (Gross Anatomy, Imaging, Embryology), and well, see for yourself:

My first impression was that "that isn't too bad for the whole 11 week GIE block" only to be informed by a classmate that it isn't the whole block, but rather for the first exam... two weeks from now. Boy did I feel like a dumbass.

So yes, 2" of material for 12 days of lecture. I was trying to find some comparison to undergrad, and I think the most accurate equivalent I could draw is that every day of lecture in med school covers about as much material as a whole week of lecture for an upper division biology course at GU. So we're covering the equivalent of 5 weeks of material a week.

To make matters... interesting... the information in the syllabus is highly condensed (see below). There is very little background on concepts, which means I'm often in a textbook looking up the background to the sentence I'm currently covering in my packet.

A very different style of studying which can leave you feeling scatterbrained. No more neat chapters in one textbook to skim before class. I feel the real barometer will be that first test, but some MS2s I talked to said it can take most of the entire first year to figure out your most effective and efficient studying regimen. The idea of floundering around in the library for 7 months before finally hitting stride isn't appealing, but I've been lucky to be pretty adaptive.

For all the crazy amount of material I'm being fed, it strangely doesn't feel overwhelming. I've been able to grasp everything conceptually, and above all...


To be learning things that, in their own small way, will help me save someone's life someday... well it makes it a lot easier to throw the books into the bag and wander down to the library. And this is coming from the guy who went to the GU library TWICE in all four years of college.

I'm also really digging the integrated curriculum. Having embryology alongside gross anatomy is really awesome for me, considering I want to do some form of pediatric surgery, and pediatric surgery deals a lot with teratology (children born with malformed/deformed structures or organs) and this helps really hammer home the relation between development and structure.

Anyways, first day of cadaver dissection tomorrow. I'm sure another post will be following soon. For now you'll find me here:

August 15, 2007

Stay tuned for a preview of next week's episode of 24!

It's amazing how much you can start to change over the course of 48 hours.

48 hours ago I couldn't believe I was sitting in orientation in medical school. It's a very surreal feeling being exactly where you've been striving for your entire life.

48 hours later, I'm actually starting to feel like a medical student. I haven't made a single incision in a cadaver yet, haven't seen a single patient, but this week has already started to lay into me the gravity and excitement of the road I'm embarking down. There's been a lot done the past years to humanize doctors, which I think is a good thing, but this week has reinforced to me that medicine truly is a special profession and special calling.

The environment is VERY supportive and rankings and honors are not done on a bell curve. As such, if everyone in the class scores above 90, everyone in the class gets honors. Very cool, and tends to cut out a lot of the competition that seems to permeate medical school.

In a traditional med school format, the first two years are spent loaded with classes necessary to give you all you need to pass your United States Medical Licensing Exam (USMLE) Step 1. You might have a preceptorship, but its primarily in a shadowing format, following around a given physician. Your third and four year are spent in several week long blocks of clinical rotations in the different disciplines of medicine, eventually reaching electives where you are allowed to pursue experiences in tune with your specialization of choice.

My school (though not just my school) does things very differently. The curriculum is integrated, so instead of being loaded up with hours of lecture each day and exams pretty much every week, multiple disciplines are integrated into one "block" (our first block is a combination of gross anatomy, imaging, and embryology). As a result, lecture only takes up the morning, and you only have one exam to look forward to (typically every 3 weeks). This frees up time for what makes my school pretty innovative in my mind: their combination of preceptorship and PCM (Principles of Clinical Medicine).

PCM is a class focused on teaching you the skills to succeed in a clinical environment, focusing on performing the requisite physical exams, proper communication with patients, etc. This PCM is then coupled with a preceptor physician. At my school, one year is spent in 3 rotations of primary care, and the other is spent in 3 rotations of specialties of interest. I find out next Tuesday which block I will be completing this year, though I'm really hoping for specialty rotations this year. Since after your first block you can personally request physicians as preceptors, I'd have the opportunity the really look into the different areas of pediatric surgery I'm interested in.

Since your preceptorship is matched with PCM, MS1s and MS2s are given a much greater deal of responsibility in their preceptor rotations. Thus, I'll have the opportunity to scrub in for surgeries, treat and assist patients, participate (or not since my medical knowledge is basically zilch first year) in rounds, and generally do all the cool stuff I've dreamed of. So not only will I be out on the wards in two weeks, I will actually be DOING things on the wards in two weeks. In fact, the joke around my school is that you're almost loaded with too much responsibility at first, but I'd rather be thrown into the clinical fray right away instead of having to wait two years.

Tomorrow is the white coat ceremony, where we receive our coats "in recognition of our achievements which have granted us the privilege to study medicine." Perhaps a bit melodramatic, but I think that will really solidify the feelings I've had from the first week.

If this much can come in 48 hours, it really will be interesting to see how I feel after 2 weeks, or 2 months for that matter. One thing is sure, I'll be on my way.

August 13, 2007

Cause if I did, I wouldn't be a Toys-R-Us kid

So the first day of medical school has come and passed. I tried to keep expectations to a minimum, since generally expectations on the first day of anything tend to disappoint. Overall, I believe it really went well. I was curious to see how things turn out when you put a bunch of accomplished, motivated, type A personalities in a room together and let them get to work. Definitely fun to watch. Funny how everyone slips into a script when attempting to meet new people though. On the first day of undergraduate, things tended to progress like:

"Hi! My name is InsecureFroshZag!" (I was so young. *sniff*)
"Where are you from?"
"What high school did you go to?"
"What are you majoring in?"
"What dorm are you living in?"
*awkward silence*

In med school, its good to know things are totally different.

"Hi! My name is MedZag!"
"Where are you from?"
"Where did you go to undergraduate?"
"What was your major?"
"Where are you living?"
"What area of medicine are you thinking of going into?"
*awkward silence*

Ok maybe not.

Some people seemed intent on getting every name of every person in a room then moving on. For me... I'm horrible with names. Like pathetically, classic blonde spacey with names. So I'm taking my time. There's only 120 of us, so I'll get there eventually. Newfound respect for my professors who learn and relearn names every 4 months though. Props to professors. I'm the youngest person I've met so far (the class' average age is 26), so there's a bit of life experience gap compared to most of my peers, but I know in a month when we're knee deep in gross anatomy its going to matter a lot less whether you're right out of undergrad or are married with a child.

Besides, I hope there's more I can relate to with my classmates than simply the fact that we all happen to be at the same medical school together. Overall, some good conversations on a wide variety of subjects.

If med school was all like today (which it unfortunately isn't), well, sign me up for that Mayo residency. One word: lines. Wait in line to get your white coat size. Wait in line to get your class catalog picture taken. Wait in line then wait in line some more to get your ID badge. An obvious hassle, but also a good opportunity to chat it up with those stuck around you.

Overall, it was a pretty typical first day stuff. Good introduction to the history of the school, rundown of curriculum, all that jazz. My school seems to have things right (*chest thump*). Early exposure to patients (I'll see my first one by the end of August), curriculum focusing on understanding and diagnosing disease, lots of practice of clinical skills. We'll see if the actual thing stands up to the structure they trumpet to you in the beginning. Above all, right now is difficult because you can tell everyone is anxious to jump right in and get to work and it's going to be a more gradual introduction. Email addresses: later in the week. Big siblings: later in the week. Social events: later in the week But, the more I think about it, the more I like it this way. Set a solid foundation. Build up.

Today we set the cornerstone. We'll see whether I end up building an outhouse or nice gated villa. I just hope it ends up something with a view.

August 11, 2007

But I can't swim!

So I came up with a really good analogy for this post in my head while out for a run yesterday... and then subsequently completely forgot it. Hope this doesn't stay true in med school.

Speaking of which... MSI orientation begins in approximately 41 1/2 hours. There are many "typical" feelings that students experience as they get ready to start medical school. Some examples:

"Oh my god what if I'm not smart enough!"
"Oh my god what if I don't really want to be a doctor!"
"Oh my god what if my classmates suck!"
"Oh my god how am I going to be able to study enough!"
"Oh my god how will I be able to maintain even a semblance of a social life!"
"Oh my god what will I do if I fail!"

These are typical feelings experienced going into medical school. I've never considered myself typical. But I've come to realize in the past 48 hours...


I'm typical.

I've handled things pretty well so far, mainly due to my low key SoCal bloodline and my healthy ego. But in the past couple days, in has crept the apprehension, the worry, the nervousness, the dread. I have to keep telling myself that this is all normal. It will pass soon enough. I AM smart enough to cut it, and cut it well. I really DO want to be a doctor. My classmates will NOT be a bunch of bookhead drones who will simply nod at my sarcastic sense of humor. I WON'T become a nerd hermit (nerd hermit... sounds like an animal. I'll work on this one).

However, we all have ways of coping. I have been coping by milking every precious moment out of my last few days of freedom by doing everything I always wanted to do... like sky diving, and renting a stretch hummer, and doing a line of coke off of a stripper's back.

Ok, not really.

But the consecutive nights of going out on the town have taken a healthy bite out of my checking account... and given me a healthy peace of mind.

I think I'm ready. Ok, I know I'm ready, but part of me doesn't want to believe it. Guess I don't have a choice. Time to stop swimming in the shallows and jump into the deep end.

Welcome to medical school.

August 6, 2007

Because I Want To Help People!

Being a person who's going to med school, there's one question nearly all of us have fielded for years. We've heard it in at med school admissions interviews, from grandma at thanksgiving, from that cute brunette at the bar, in conversations with undergrad professors.

"What made you want to be a doctor?"

"Why medicine?"

"Why do you want to be a doctor?"

There's a certain way to answer this question during med school interviews. You're supposed to say because its intellectually stimulating. Because you want to be a lifelong learner. Because you want to operate in a prestigious field. Because you are fascinated by the human body. Under no circumstances are you to say it's because you want to help people (ironically, I actually used this in my interviews and my interviewer at one said it was refreshing... REFRESHING! to hear a prospective med school student say he wanted to go into medicine to help people. Ah, medicine!).

When talking to pretty much anyone else... you always say what made you want to be a doctor was to help people (especially if you're talking to that cute brunette). Grandma doesn't want to hear about your "intellectually stimulating-shmimulating" crap.

For me, it was none of those things which first made me want to be a doctor. It wasn't because I popped out of the womb all altruistic and empathetic and scoring 35s on my mock MCATs.

For all of you to see, I will now unveil what made me first want to be a doctor.

...drumroll please...

August 7th, 1989 I received my Fischer Price Medical Bag for my 4th birthday. And the rest is history. Oh sure, eventually (not too much later actually) I knew I wanted to help people, and that vibed with medicine. In high school I knew I'd be a lifelong learner, and that vibed with medicine. I learned I loved challenges, and that vibed with medicine.

But it was all really that bag. From that day on I was all about the doctor-ness. While moving the other day I recently rediscovered this bag and went about examining its treasurers.

The Stethoscope:
3M Littmann Canary Blue/Baby Blue vs. Welch Allyn Firetruck Red/Classic Blue

From day one I had two stethoscopes in my bag. Deep down, I believe its because 3m Littmann and Welch Allyn both knew that one day they would be competing for my loyalties.

Unfortunately, neither carry stethoscopes in Canary Yellow/Baby Blue or Firetruck Red/Classic Blue anymore. I had to settle for Black/Brushed Steel. Maybe one day I can work with some reps to get some poppin' color back on the line.

Sexy Grown-Up MedZag Stethoscope (Welch Allyn Elite)

The Sphygmomanometer:
Yes, I owned a sphygmomanometer at age 4. That means I owned one on average of 20 years before my med school classmates. Does this make me a gunner? It's open to debate.

It's worth noting, however, that even though I've owned a sphygmomanometer for 18 years now, I still have no idea how the f@*k to pronounce the word.

The Rest:Tons of stuff in this bag. At my med school, they recommend a student collect the following items before starting their clinical rotations: stethoscope, otoscope, sphygmomanometer, opthalmoscope, reflex hammer, and tuning fork. Of those items, I had 4 in my bag at age 4. The two I was missing, the opthalmoscope and tuning fork, I compensated with bandaids, a thermometer, and THREE syringes. So you could make the case that I was ready for clinical rotations from the day I received the bag. And ready for a crash code, since those three syringes are obviously filled with epi, atropine, and magnesium sulfate.

I'm considering taking the bag for a spin out in the bars here sometime soon. After all, next time I get asked "so why did you want to become a doctor?" (and it WILL happen soon), I figure it will be much easier to hold up the bag than launch into a rhetoric on my inherent altruistic nature.

Besides, it makes a great accessory. The cute brunette will appreciate that.

July 30, 2007

Color Me An Idiot

Big news today when supreme court chief justice John Roberts went down at his vacation home with a sudden unexpected seizure. Since I spent the first dozen years of my life really interested neurology, I checked up on the actual medical diagnosis of his condition.

Ruled: benign idiopathic seizure

Being the classically bored pre-medical student that I am, I bust out Stedman's Medical Dictionary to look up the proper definition of "idiopathic."

Denoting a disease of unknown cause. Less commonly referred to as idiopathetic.

Idiopathetic. Sometimes I love the english language. Only a term denoting an unanswerable question of diagnosis contains reference to both the words "idiot" and "pathetic."

July 26, 2007

My Shoulder Named Dr. Orthopod

It's that calm before the storm. Med school orientation starts in 18 days. I have a place to live and a bed to sleep in. I'm about as organized as I am going to be before the madness begins. I'm in a city at least hours away from mostly everyone from my regular social group. Which gives me a lot of time to do absolutely nothing. My time hasn't been this unoccupied in years and its given me a lot of time to reflect.

Medicine is one of the most paradoxical professions out there. Medical school self-selects for individuals who ooze empathy, a desire to do good and help others. That empathy is subsequently systematically destroyed under the notion that it is only by being objectively detached from those one treats that you can decide what is best for them. I keep wondering what kind of doctor I'm going to be. Am I going to be the type who will be able to look into the eyes of a patient and explain we've done all that we can but they will die and be able to connect on a level that I can actually continue to make a difference in their care beyond the point of drugs and tests? Or will I be the type to switch into a systematic "I'm sorry" routine, give the hands two squirts of sanitizer on the way out the door, then drop the chart into its wall mount and move on to "patient #2 is presenting with..." Only time will tell.

I think most medical school students still, despite all our hours of clinical experience, ER shadowing, and hospital volunteering, hold a great deal of naïtivity and delusions of grandeur about being a physician. And I think thats a good thing. Medicine is an issue of ultimate trust between patient and doctor. Doctors take ownership of their patients' bodies, and patients are oddly at ease with it. Just today at physical therapy, I referred to my shoulder as my orthopedic surgeon's "good work." Not my shoulder repaired by my orthopedic surgeon. My shoulder, property of my orthopedic surgeon. His sutures will dissolve in a few months. The anchoring screws in a few more. But it will ever be his handiwork. In a perhaps overly dramatic statement, if it weren't for him, a part of me would be broken, and now its fixed.

I think with that sort of responsibility the physician owes more to the patient then to be completely detached. And I think starting down the path to the doctor-I'm -going-to-be that its good to have some of those childhood visions about being a doctor, riding off on his horse into the sick and diseased and waving his staff of asclepius in the face of death (I know, I had a dorky childhood). Because I think too many doctors these days treat the disease and not the person. But I've seen enough physicians who are exceptions, who treat their patients kindly, humanely, empathetically, and intelligently, to know that it doesn't have to be like that. I know my medical school class can be 120 for 120 in producing empathetic, caring doctors. Odds are it will be much lower then that, because the culture of medicine is structured to beat that childhood pipe dream out of you - to emotionally protect you, to "make you a better doctor." But I think you need to have that childhood doctor-in-shining-armor inside you in the beginning, because you never know how long it will stick around or when it might pop up again. It might be at the end of a 48 hour shift when I'm an intern. It might be 7 years later as an attending. But the important thing is, you might just find yourself treating people again, instead of "patient #2 presenting with..."

I wonder what kind of doctor I'm going to be. I hope I'm one who treats sick people and not sickness.

And turn out looking like McDreamy. With the wit of Perry Cox. Yeah, that'll do just fine. But mainly the sick people part.

"Because it is particularly in cases of catastrophic or incurable illnesses that the role of the physician is more, not less, important, let me suggest that the fewer the therapeutic options available, the greater your involvement with the patient should be. When there is no cure, there is still much to be done to alleviate suffering."

July 25, 2007

Hi, my name is MedZag and I'm going to be a...

first year medical school student.

I've always loved telling stories. In my 21 years, I like to think I've collected a solid repertoire of anecdotes to fill my head during those boring moments (like, say, a night in a bar with eskimos). I've wanted to be a doctor since that day in 1991 when my mom bought me that Fischer Price doctors bag of instruments (which I still have - which happens to say a lot about me as a person). So I'm hoping this blog gets to be as much a chronicle of my personal journey through medical school for my own recollection years down the road as much as it an entertaining read for any of my friends sympathetic enough to read it as well. It might give a little insight to those of you who are curious into how our medical curriculum and training steal the humanity and soul out of our future doctors... and why this may be a good thing. It might just serve as a personal ego stroke to myself from time to time to remind myself that what I'm doing actually is pretty cool and that all the hours of personal isolation spent studying and the verbal abuse from the powers that be are worth it.

I've always loved telling stories. Hopefully you'll enjoy listening.