September 19, 2008

Since there's been a lot of pirate mentions lately

It would be a disservice if I didn't mention that today, September 19th, is national Talk Like A Pirate Day.

Under the "Pirate Fun & Games" tab at you can print out your own Pirate Party Kit for your office, ward, classroom, construction site, clinic, wherever.

Also note, since this is a medical blog, the venerable Pirate Medicine: Pestilence and Pain During the Golden Age of Piracy.


MedZag's Classmate YELLING at Last Lecturer Of Day (11:55PM): "Arrrrrrrr, good day to ye matey. I be havin a question for ye, what be the effects of me rum on me collecting tubules? Can it be causin' me hyponatremia-rrrrr?"

This is the life of a medical student.

I think a little bit of me died inside.

September 18, 2008

Maybe I should convince myself I'm going to win the lottery.

Another story from preceptorship. A patient came to clinic last year convinced he had lung cancer. He was a previous smoker (1 pack/day for 10 years), but had no symptoms, no family history, no other risk factors, in his 40s, nada, zip, zilch. So the doc ordered a blood panel, guy was healthy as a horse, and sent him on his way. He couldn't even elucidate why the patient was suddenly convinced he had cancer.

Got a call from radiology at the local community hospital this week. The guy had presented to the ED with acute chest pain. Chest xray revealed multiple metastases in his lungs.

As the french say: déveine.

Say ah.

Patient is a 12 year old boy with a sore throat. Neighbor boy had strep throat the week before and the patient was exposed at a birthday party. Mom brings him in wondering if he has strep.

History includes a 12 hour fever (no thermometer used) two days prior which disappeared overnight. No headaches, chills, or malaise. Chief complaint is odynophagia. No mucous drip, stuffy nose, ear pain, or cough. Patient is afebrile and on examination has no tonsillar exudate, no erythema of the posterior pharynx. Tympanic membranes clear bilaterally. Only remarkable finding was petechiae of the soft palate.

Preceptor: "Mr. MedZag, what would you say is the likelihood of this child having strep?"

MedZag: "I'd say 20-30%. The fever course was too short, currently afebrile, no tosillar exudate or enlarged lymph nodes."

Preceptor: "WRONG! With the presence of petechiae on the soft palate, I would place his likelihood at over 80%. I might make you print the antibiotics prescription."

Fast forward 15 minutes. Strep test comes back... negative. Score one for the medical student.

The CENTOR score is criteria used to evaulate the pre-test risk of GABHS phayngitis. The patient is given a point for filling any of the following criteria:
:: Febrile (Temp >100F)
:: No cough
:: Swollen anterior lymph nodes
:: Tonsillar exudate/swelling
:: Age 3-14

Little Billy scored a 3 on the CENTOR score, which puts his pre-test probability at... drumroll please... 28-35%. Hey, 5% off ain't bad.

September 11, 2008

This blog will remain 100% apolitical (for now)...

...but this is funny.

Besides, it wouldn't be a chronicling of my memoirs if I didn't have at least one post documenting this ridiculous campaign season.

September 8, 2008

Ischemic Motivation Disease.

So the first week of MS2 is now officially down the tubes. I responded to the school year starting up again by putting off studying for as long as physically possible, but just as a crack addict needs his... crack, a medical student needs his studying, and the multicolor highlighters are now out in force. The first day of the year went pretty much exactly like I expected. After the fun of seeing everyone wore off (read: 30 minutes), the day felt just like any other day of medical school.

So, (I can see you pre-meds and MS1s rabidly foaming at the mouth) how is MS2 compared to MS1?

One of my more famous (or Follies infamous) posts was my ruminations on competitive eating. Yeah, MS1 is a lot like putting down a ton of hot dogs. After a while, you ask yourself why you ever liked hot dogs because, after all, its made of all the discarded parts of a cow. Who would ever want to eat that? But you eat and eat and eat, because there's nothing to do but eat. And summer break begins with you seriously overweight with a glossly flaccid stomach. But after a while you forget why you hated hot dogs, and are at a BBQ, and slowly creep towards that hot dog bun. Because part of you misses the hot dogs, as sick as the thought of eating one makes you.

Well, thankfully, MS2 is nothing like eating hot dogs. You're done with the days of all the leftover cow parts. Instead, MS2 is like a nice, juicy, delicious steak. The lecturers don't talk down to you (as much), the majority of the information thrown at your brain is rooted in some form of the actual clinical practice of medicine (aka the succulent hip, not the leftovers), and hell, you're a competitive hot dog eater, putting down a steak should be fun compared to hot dogs. After all, eating steak is an enjoyable experience.

Enjoyable at first, that is, until you realize the steak is 72oz. And steak sits in the stomach a lot heavier than hot dogs. And steak is all that is on the menu for the next 8 months. You're a competitive eater, so you know how to eat, but this is different. More tasty, but more challenging.

So yeah, MS2 is a lot more enjoyable than MS1. Instead of being forced to memorize a bunch of information a PhD would rarely find useful, the information is much more tailored and relevant to the practice of medicine. Instead of stumbling around in the dark looking for the fastest way to cram as many drug names, half-lives, metabolic pathways, and enzyme topographical maps into your brain, you're talking about how said drugs are actually being used to treat disease, how errant pathways manifest themselves symptomatically, and what current literature says about treatment strategies. But there's no getting around the fact that this is still medical school. And you're a MS2 now, the information comes faster. I already feel behind. We already have an exam in a week. My favorite neighborhood baristas already know that I am back at it. I already haven't talked to many of my friends since class started. It's still a crapload of information, and its still not going to be fun some of the time. But you can take heart in the fact that it is better information.

Ironically, as I stuffed myself with steak yesterday, cracking my syllabus for the first time this year to get my eat on, one of the first topics I had to study was... coronary artery disease. I think I feel heartburn coming on.

As an added note, Med11 (appropriately named the Pill Hill Pirates... arrrrrrgh) took the title in the first inaugural PA/MD kickball tournament yesterday, in an epic 14-13 title game which came down to a gut wrenching bottom of the 9th defensive slugfest. You have never seen a competitive kickball game until you throw a bunch of anal type A personalities together and tell them to go at it. Trust me.

September 1, 2008


The time honored tradition of walking the plank. Per wikipedia:

Walking the plank is a phrase that describes a form of murder or torture that was practiced by pirates, mutineers and other rogue seafarers. It involved the victim being forced to walk off the end of a wooden plank or beam extended over the side of a ship, thereby falling into the water to drown, often into the vicinity of sharks.

I'm standing on the plank right now. The sharks circle, they can smell blood. A stick pokes me in the back, spurring me to take a step further.

Yup, my times as a full-fledged (not just a fake) MS2 start up tomorrow. I am on the end of the proverbial summer plank and in 18 precious hours my life will once again consist of sink or swim time amongst the sharks.

The start of MS2 feels very different from MS1. There are some pluses. You know you can handle medical school just fine, you already feel like you're starting to establish a fund of knowledge, you have your study habits and know they work.

The drawback of knowing the ropes is that you... know the ropes. I know that my days will consist of endlessly staring at information. I know about all the work and time required. I know that the speed of information gets ramped up second year. I know there's this small little test looming in the distance called Hurricane USMLE. Surprisingly, these things do not make me anxious. Really, anxious would be one of the words farthest from how I would describe how I feel right now. Rather they just make me apathetic.

Waking up tomorrow and heading to class will feel just like another day of med school. All the wide eyed fluffy optimism of first year is gone, and now begins the trudge, through second year, through Step 1, through 3rd year, never ceasing.

Of course, part of me is still excited to get started again. My liver will appreciate the break. And, frankly, I really enjoyed my times as an MS1 and kind of went to medical school for the purpose of learning medicine, so it's my own damn fault that they expect you to learn stuff every once and a while.

But saying goodbye to the last summer break of your life is not easy. So goodbye, sleeping in 5 days a week. Goodbye, drinking on Wednesday-though-Saturdays. Goodbye, completely unregimented schedules. Goodbye, 2:00am bar close. Goodbye outdoor all day festivals.

But it's time to do this thing.