I survived Step 1.
It still seems surreal to say it. That the seemingly insurmountable task that has been hovering over my head for such a long time is now over and done. In the past.
All that remains is the aftermath. My First Aid binder with pages ripped through their 3 hole punches, hanging out like a dog's tongue after chasing one too many frisbees. Dead highlighters on my desk. Sheets full of self-made diagrams and flowcharts. Sentences underlined in red with "QUESTION!" written next to them. My Goljan book, with its binding cracked down the middle and the second half of the "Hepatobiliary and Pancreatic Disorders" chapter hastily scotch taped back in. 3,400 QBank questions tucked somewhere in my cranium. 2,400 notecards sitting no longer of use on my laptop.
I'll post more about my experiences with my progress doing questions, taking NBMEs, and the like when I get my actual score back and know how accurately it actually projected how I'd do. But I thought I'd talk a bit about the experience of the test. My actual test day went pretty well. My immune system made one last rally and with my prophylactic DayQuil in hand I kept the congestion and runny nose at bay throughout the day. I arrived for the test a half hour early, and found myself starting the exam early at 7:40am. All those hours doing questions paid off and I found my stamina was good enough that I could bang out two hours of question blocks at a time between breaks. Time goes VERY quickly while you're taking the test. You find yourself so focused on each question that blocks can seem to fly by, and hours of the day silently tick away. Before I knew it, block 7 rolled around and I clicked that final "End Block" button and half-assed my way through the survey at the end.
What does it feel like when you step out of the testing center? It's a strange combination of exhaustion, exhilaration, and denial. It didn't sink in for almost two days that I was done. That there was no more studying to do. The day itself almost felt like just a long day of doing USMLEWorld, as the interface, pacing, and question prompts were all so similar.
But it does finally sink in. And its a great feeling when its over. The sheer amount of concentrated will it takes to study endlessly, day after day without reprieve, was honestly something I wasn't sure I had in me. Its a time filled with highs and lows. Lots of lows. Frustrations, and sometimes despair. You realize you have gone days without talking to another human being, and find yourself unable to engage in normal conversation when you do. You become robotic in your routine. Wake up, study. Eat only because you have to. Study. Sleep. Repeat.
I think if I had to sum up the entire experience it would be: I would never want to repeat it. But I'm damn glad I went through it. And now its time to sleep.
So after all this hubbub, after everything of the first two years of medical school inevitably being tied to this day, I take Step 1 tomorrow.
I tried reviewing pharm today. My brain wouldn't cooperate. Took my last diagnostic yesterday, it said I'm right where I want to be.
Still sick, but what can I say? Life sucks, then you die.
Game face.
6:00am - MedZag awakens for another day of relentless Step 1 studying. Man, he feels tired today.
11:00am - MedZag has to blow his nose.
11:15am - MedZag has to blow his nose, again.
11:30am - MedZag is noticing he sure is blowing his nose a lot today, and as he is noticing this, collapses into a fit of sneezing.
4:00pm - MedZag notices an insidious onset of headache, sore throat, and myalgias.
Well, crap. Of all weeks, of all days, my body chose 3 days before the boards to get sick. I know not who the culprit is: adenovirus, coronavirus, rhinovirus, or friends. I do know that this blows. No pun intended.
I've loaded up on the antioxidants and am pushing the fluids. We'll see if my immune system can muster one last Spartan defense before the big day.
And with that, I'm off to bed.
Has it really already been two weeks? That just blows me away. Really, for as exhausting and monotonous all this board studying is, the hours and days fly by. Probably because every day feels the same.
I'm in the final stretch, I take Step 1 a week from Saturday, so I really only have 7 days left of studying. Which is probably a good thing, because my mental stamina is fading faster than your libido after starting an SSRI. I've been doing 100 questions + full explanations every morning, which normally lasts me from 8am-noonish. I then take a lunch break and have grandiose plans for the rest of the afternoon, but generally can only really buckle down and really concentrate another 4 hours before the caffeine-induced diuresis and pressure sores on my ass proceed to tell me I need a change of scenery. I go home, telling myself I'm going to "finish", and proceed to "study" till late. By "study" I mean have something open in front of me and distractedly "look" at it while not retaining anything. This has not bode well on me making any progress on any of the items on my steadily growing "You're Behind On This, Get Your Ass In Gear" List.
I'm starting to notice some holes in my study schedule. For example, I only gave myself 1 day to learn micro for the first time, instead of the 652 days required to memorize all the necessary info as I am quickly realizing. But finding time to plug in additional micro studying when I barely have the mental stamina to slog through 80% of the stuff I'm supposed to study for the day has not proven humanly possible. I'm still trying to figure out how I'm going to remedy this. Without the use of illicit substances.
At least it seems like all the effort has started to pay off, as my QBank blocks have finally started to climb over the last 3-4 days. Of course, each one feels like a fluke to me, and I still expect every next block to come back and give me a big fat 40% in my face, but so far it seems I've been able to stave that off. I think I've hit that quasi steady state where any additional info I learn is desperately trying to offset all the information slowly leaking out of the back of my head. We'll see. A week is hardly any time but a ton of time at the same time.And only during Step 1 time does that seem like a good sentence to end on.
So I had all these "stay balanced" things planned into my study schedule. Gym time, free time in the evenings, all that wonderful stuff. Unfortunately, I think my schedule was a bit too ambitious and as a result those days I was supposed to be done at 6pm are more like 10pm and gym time has been forsaken to make up on lost sleep. But what other choice do I have, really? If I don't get through the material now, I won't ever... and the thought of going into the test having NOT finished a subject scares the crap out of me.
So much for balance.
I was ambitious, I mean, masochistic enough to believe I could get through all of neuro today. I did it... but it took me 10 hours. On a Friday night.
Questions continue to oscillate up and down for me. I'll do a pretty good number on a subject and think I have it hammered down then drop 15% in the same subject a day later. But the fluctuations are getting less dramatic and my scores are slowly trending up, even if it doesn't feel like it. I created an excel spreadsheet with a graph and trendline to prove it to myself. Yes, its gotten to that point. Today was a down day for questions. That coupled with the sadistic enterprise that was neuro and the fact that its Friday but I hardly noticed since it was just like any other day made for a pretty down day for me. I have heard of medical students being reduced to tears during board studying. If I was one of those more sensitive types, today probably would have been one of those days. Instead, I did what any testosterone-fueled male would do... and raged. I have developed a habit of verbally abusing my QBank when reviewing questions. OH! ALL I NEEDED TO KNOW IS THAT tRNA HAS 94 NUCLEOTIDES AND ENDS IN CCAGGG ON THE 3' END! THANKS USMLEWORLD! YOU'RE A GREAT HELP! I've also developed a habit of talking to myself when studying now. That's a new symptom.
14 more days...
The Step 1 gods show no mercy or remorse. This is the forecast for the next week:
This was apparently a holiday weekend. The people I saw out walking and enjoying this wonderful weather sure seemed like they were having a lot of fun. Me, I had fun grinding my ischial tuberosities into my chair slogging through my first couple full days.
I tried to come up with some witty or insightful analogy for what studying for Step 1 is like. But all I could come up with is what everyone will tell you:
It sucks.
Now, this is the type of studying I could really enjoy if I was, say, reclining on a beach with a mojito with a 3 month deadline. It is after all a sort of review, and it's somewhat satisfying when you have those "oh! I remember that!" moments. But the short deadline and the long days add enough displeasure and stress to more than amply offset any enjoyment I may derive out of this process.
Questions are trending up for me. My goal is to get through all the organ systems this week then spend the next two weeks on a meticulous review of each subject/system. Renal and GI are up tomorrow. We'll see how my next NBME looks this coming weekend.
So today I started my Step 1 prep. I purposely scheduled myself a "light" day to ease into things, and even that was pretty exhausting. This is going to be a lot of fun!!!! < /sarcasm >
Anyways, here's my next 3 Weeks of Death™:
Well, to survive the first two years, all you need to do is memorize this information in 74 weeks:
5 wood and manatee for comparison. Manatee may or may not be to scale. Tape measure reads just over 4 feet tall (1.21 meters) tall.
Done with second year. Wooo.
So I have my final exam of second year on Thursday. While there is a certain degree of surreality to typing that (part of my brain still feels like its 2008... or 2007 for that matter), I am definitely looking forward to leaving the brain-desiccating monotony of the pre-clinical years behind. If finally hit me as I was sitting down to study today after lecture how close I am to being done with second year. And my brain thought: cool.
A couple posts ago, I talked about my plans for studying for Step 1 up until the end of class and my intensive 3 week period (namely: not studying, but simply "pre"-studying). Well, that was going well, until chatter around the lecture hall started slowly switching to boards, then becoming predominantly about boards, eventually becoming the all encompassing obsessive fixation of the class. The lecture hall soon became riddled with micro note cards, flow charts of the nephron, acid-base tables, and clotting cascades. And frankly, I am not a strong man. I hate feeling like I'm not doing something I should be (one of the many reasons I do not study in the school library). So I've acquiesced and started doing more QBank questions to at least give myself the illusion that I am trying harder. The results have looked something like this:
... I think if you ran a linear regression on that it'd have a negative slope. But the main thing that is so maddening is the up-and-down nature of it all. One night I'm feeling like the work is starting to pay off. The next... certain doom. I took a second NBME and I'm up 15 points from my previous score. Yeah! Still 40 points from my goal. Crap. It's finally starting to sink in what a bear of an exam Step 1 is going to be. Sure, everyone "knows" that but there's a difference between watching Twister on your DVD player and standing in the middle of a field as a F5 tornado descends on you.
So that's is where I am at. Less than 48 hours away from having to regurgitate my last syllabus. Either destined to pass or fail Step 1. Can MedZag make the final push and make up those 40 points to preserve his future career? Or is he just a cocky jackass for thinking he could accomplish so much in such little time, destined to practice primary care in Disappointment, KY? Stay tuned.
A couple years ago, when I was recovering from a shoulder surgery, I watched every single episode of Scrubs in chronological order. Yes, I'm that big of a Scrubs geek.
So it was sad to see the show end last night after 8 seasons on the air. I always insisted it was the most accurate medical show on TV, and people often stared at me with crazy eyes for suggesting a slapstick comedy show could do such a thing. But I still feel like no other show really got at the deeper drama and emotional aspect of a hospital than Scrubs did. And its medical terminology was always spot on.
So farewell, Scrubs. And thanks-for-everything-five.
And yes, I can finally tell after all these years that the xray is backwards. Either that or the joke is on us and we're looking at a perfect example of situs inversus.
So I've been hesitant to really talk about board prep here for a number of reasons. 
Medical students are an odd sort with all sorts of unwritten social rules and idiosyncrasies, and there's a narrow line to be tread between being known as a "nice guy who works hard" and a "gunner." Frankly I think everyone in medical school studies more than they let on, but never honestly discusses it, for fear of being labeled the frightful "g word", except for the select few who are so neurotic that despite their best efforts its simply painfully obvious.
But I know several MS1s at my med school read this, as well as assorted students elsewhere in this wild world (Hi Malaysia! Say hi to Indonesia for me). And I think both board experiences and board advice on the internet tends to be skewed to come from the neurotic minority versus the gross majority of students. I've seen and heard enough through the med student grapevine to know I'm (probably) not in that neurotic minority so I thought I'd give my personal plan.
My Advice For Before You Begin Board Review:
-Do not start studying for the boards before you get into medical school. Do not start studying for the boards during MS1. If you're so distraught over an exam that is over a year away and simply, absolutely, must do something, buy First Aid for the USMLE Step 1 and read through relevant sections as you progress through the subject in your classes. I bought FA last year with the intention of doing something like this, but ended up not even touching it and don't feel like it was any loss.
-Likewise, do not study for the boards the summer after MS1. Anything you DO learn will be long dispersed and displaced by second year classes and its essentially lost work. Besides, the gross majority of Step 1 is based the pathophysiology you learn as a MS2. If you haven't learned it yet, board review books will be pretty much useless to you.
-I'd recommend to "start" doing something the early spring of your second year. For me, this was as simple as getting a study plan together and making sure I had all the relevant materials on hand or ordered. I also 3-hole-punched my First Aid. That was a big accomplishment.
-Everyone studies differently. Everyone learns/reads/memorizes/poops at different speeds. Get a good sense of how you study and how fast you study compared to your peers so when you're creating a plan of attack you know how to tweak your schedule (which will most likely be based on someone else's schedule you run across) to fit you as a person.
-Medical students stress out wayyyyyyyyyyyyy too much about this test. I am as guilty of this as anyone else. Acknowledge you're stressed out, and wrangle your Type A personality down a bit. Stress is useless. And counterproductive.
-If you put in the work like everyone else, you'll pass. Step 1 is not an IQ test, and except for the exceptional few amongst the exceptional few, your success is largely dependent on the time you put in. I say this not to make you exclaim "OMG! THAT MEANS I HAVE TO STUDY FOR 6 MONTHS TO GET A 290 AND MATCH INTO DERMATOLOGIC RADIATION PLASTIC NEUROSURGERY!" but to make you realize that if you study as much as everyone else, you'll pass. If you are really shooting for a killer score, you're going to have to put in more work, but you are not stupid and you don't need 10 weeks to pass.
What I've Done/Am In The Process of Doing:
I've allotted 3 weeks to study for Step 1. Until then, I'm trying to muster up some R&R so my motivation tank is full going into that 3 week period. That being said, I am a medical student. I have a festering Type A personality. So I've assembled a few things to accomplish prior to that period to make me feel like I'm doing something and keep the stress level down. Note that the things I am doing now are not directly studying for the test per-se, but rather making sure I got concepts solidified, sources consolidated, and am becoming familiar with material so that I will have an easier time studying during that 3 week period.
-Read through 
Goljan's Rapid Review of Pathology while listening to his audio lecture (Do not ask me how to get them. Ask Frankie over there. Yeah, the guy sitting at the bar with the mean dragon tattoo on his arm) and annotating things into the book.
-Do the questions in the Robbin's Review of Pathology question book. For questions I miss, I make sure the key concept I was wrong on is in my First Aid. If it isn't, I write it in. 1 sentence max per concept.
-Read through BRS Physiology and do the questions in the book to make sure I gots my key physiology concepts dowwwwnnn. Extrapolate on concepts in First Aid that are vague.
-Review my biochemistry /immunology/cell biology/genetics. You know, all the nitty gritty stuff you're in all-too-much of a hurry to forget when you learn it.
-Skim through Clinical Microbiology Made Ridiculously Simple to jog my memory of some of the more useful mnemonics in it.
-In the couple weeks just before I really have to buck up, plan to start doing some questions on USMLEWorld/QBank to get myself more experience with the question format and system. No more than 48 questions at a time. Missed questions go into First Aid like above.
I started doing these things about 3 months before I take my Step 1 (~2 months before I really buckle down and study). But I must point out that I have done them in order to de-stress, not add stress. So I've been doing a couple, and only a couple, hours a week at maximum.
These are also what I am doing. I know people who have been doing QBank for months. Others have had their First Aid open next to them all year in class. Others have done flash cards for pharm and micro. And still others plan to do nothing until its time for them to really bite the bullet. All of these strategies have worked for others in the past. The key is finding a level of effort anywhere between 0 and 100 that you feel like is helping you.
My final schedule for the 3 weeks+ to come soon.
So yeah, pigs are taking over the world. Or at least the news feeds and the stock options for Prestige Ameritech and their surgical masks. Everyone's heard about this swine flu deal which frankly strikes me as a cross between Y2K and the bird flu scare. But science will not be deterred! Science will overcome! Science will... uhmmm... compose?
Some dude, Stephan Zielinski (I knew a Stephan and a Zielinski in high school, wonder if they married) transcribed the amino acid sequence for hemagglutinin 1 (aka the "H1" of H1N1 influenza) into a music sequence. In his own words:
"Each beat corresponds to one amino acid, and the piece is in 3/4 time, so each six measures would correspond to five turns around the alpha structure. (I’m weaseling because I haven’t the foggiest idea how the protein actually gets folded.) Amino acids with side chains that are neither aromatic not aliphatic control the piano and organ: the nine non-hydrophobics the piano, and the four hydrophobics the organ. The three amino acids with aliphatic side chains control the low synthesizer, while the four with aromatics control the percussion."
LISTEN TO IT HERE
It's strangely beautiful, in a child-with-Lennox-Gastaut-playing-your-keyboard-from-the-early-90's sort of way.
I've come to find that blogging (wow, its hurts me to type that)
about medical school during the first two years eventually loses its momentum and eventually reaches this steady state. In the beginning, everything is cool and interesting "WOW! MED SCHOOL TESTS! WOW! ANATOMY! WOW! DONE WITH FIRST YEAR! Hahaha I'm a quarter of a doctor! If you have 4 of us stand together we make a whole doctor! Hahaha!" But really, the life of a medical student during the pre-clinical years is about as interesting as stale bread. After the excitement wears off, you realize that even though the subjects change, your life stays pretty much the same, and after a while you run out of things to say about it, because at its core its a perverse form of Groundhog day (minus anything nearly as humorous as a young Bill Murray). And frankly, that's definitely had an impact in my absence from posting these past 54 (wow) days. Neuroscience was a bear of a class, spring break was an opportunity to recover, and I finally decided since I have this "little" test called Step 1 coming up in 7 weeks that I should probably start doing some review for, so facetious things like blogging have unfortunately fallen by the wayside, especially when I don't feel like I have anything interesting to say. Do interesting things still happen? Probably. But you tend to notice them less because you have an exam coming up on Wednesday or you've had a swamped week and have been ignoring your significant other or the weather is nice outside and you just want to go catch some rays.
A couple of highlights of the past 2 months:
-I learned some stuff.
-I did my first pelvic exam, and successfully found the cervix on the first try. It's the little victories that get you through the day.
-The "Prostate exams performed" ticker has quietly climbed up to 1.
-I have amassed 1472.8 miles driving to and from my preceptorship this year, and have only 56 miles to go until I never return to that far away land.
Currently I am suffering from a bad case of what has affectionately been termed "2nd yearitis" (inflammation of the 2nd year?), otherwise known as a completely and utter apathy towards everything involving the pre-clinical years of medical school. We're currently slogging through our "Human Growth and Development" class which is roughly the equivalent of "Gynecology Gynecology and Gynecology," and 4 more exams, a book report (yes, a book report), and an OSCE separate me from being blissfully done with the monotony of the first two years of medical school. And frankly, I cannot wait for it to be over.
At the beginning of medical school, the clinical aspect of things can often be trepidating. And the lecture hall is a refuge of sorts, where you engage in an activity you've been doing for pretty much all of your life... that your long-term memory tells you anyways. Namely: class, note-taking, studying, ad nauseum. Regurgitate, rinse, and repeat. Sure the material is at an enormous volume, but studying is studying and its not really any different in med school, so its a comforting activity compared to trying to do a history and physical on another human being when you can barely tell a uvula from a vuvla. But along the way of the first two years, it's been my experience that something switches. You start to gain a certain level of competency in the clinical setting and start to find the intellectual engagement from patient problems instead of focusing on not f*cking up enough to let the patient and your superiors know what an idiot you are. And once that happens, its all over, because the lecture hall becomes a place where you're forced to sit, absorb, and later upchuck banal facts and minutiae that have often have no context or application to your actual fund of medical knowledge. And the clinical side becomes the place where the really interesting things happen.
It's in a way analogous to the "senioritis" of high school, when you feel like the trivial things that high school involves are
behind you, and you can't wait to get to college and start the next stage of your life, but you're forced to gut out another few months or weeks of the same old crap just to graduate. Likewise, I've been slogging through the staging of prostatic cancer and whether a mature Graffian follicle has a single or multilaminar layer to its antral chamber. I could care less about this stuff, but am forced to go through it for the sake of crossing the finish line. Even though all the while my eyes are set on June, when I'm out of the classroom and into the real action. Sure, third year and beyond involves its own set of aggravations and monotonous activities, but they're different aggravations and monotonous activities.
And there's sure to be more interesting stories for a medical student blog than "woke up, went to class, ate lunch, studied, ran, studied some more, made dinner, watched True Life: My Life Is Boring, went to bed."
Today marks the 56th day in a row that I have been studying "Neuroscience & Behavior."
Yes, I attend medical school at one of those places with that fancy pants "integrated curriculum" that's all the rage with the youngins these days. Which means that instead of having individual "classes," we have "one class," with a loose association of various subjects all tied together under one common umbrella. Kinda like a family reunion where everyone shows up, including Uncle Frank with his 5th wife he met last month in Tijuana.
So I am on my 56th day of studying "Neuroscience & Behavior." 56 days of neuroanatomy, CNS pharmacology, CNS pathology, CNS trauma, neurology, psychiatry (definitely the Uncle Frank of the group), and everything else about the brain. The integrated curriculum is nice is some respects. Studying for one class is much easier than juggling multiple. Having to prepare for one test instead of a test week is nice. The integrated subjects of the integrated curriculum can sometimes be pretty integrated, which allows you to make some interesting and useful connections between material (or so called... integration of knowledge).
But there is one dramatic drawback to integrated curriculum... the debilitating and inevitable subject burnout that comes at the end of each class.
I have been reading about the brain for damn near two straight months. Imagine doing anything every single day for 2 months. Eating plain spaghetti without meat sauce. Every day. Coming home from work to watch the same episode of Family Guy. Every day. Wearing the same black t-shirt. Every day.
As such, I am 3 days removed from kissing NSB's sweet ass goodbye, but instead of being motivated to boot its neuropil-filled derriere out the rear screen door I am instead motivated to do absolutely. no. studying. It sounds like a recipe for success to me.
The next class? Simply titled: Blood. Who knows who is going to show up to THAT family reunion?
Your notes sometimes look like this:
And other times look like this:
I have come to realize medical school is like juggling a bunch of eggs.
In the beginning you start with a couple eggs. Like any beginning juggler, you kind of fumble around a bit. Maybe you break some eggs, but eventually you start to get the hang of it. Before you know it, you're juggling those couple of eggs and thinking "This is NIIIICCCEEE!!!"
But med school doesn't applaud your newfound juggling skillz. Med school gives you a snarky face and adds another egg. You get the hang of 4 eggs? Try 5. 5 becoming a breeze? Try 6. As you progress through your training, the eggs may change. The "biochem exam" egg becomes the "OB/Gyn shelf" egg. The "research for residency" egg may become a "giving a talk to colleagues at regional conference" egg. The "I just failed that test" egg becomes a "I just lost that patient" egg. But the more skilled you become, the more eggs there are, until you become a proficient and masterful physician/juggler. Then you retire.
Why juggling? Because it requires constant attention. Why eggs? Eggs are fragile. One of the all too familiar feelings as a medical student are those moments when your concentration lapses and you break an egg. Could be not getting enough sleep. Stress getting to you. Failing an exam. Getting out of shape. The analogy applies to many if not all walks of life. But man, med school sometimes sure feels like a lot of eggs sometime.
Of course, its not all doom and gloom. When you're on a roll juggling those eggs, then hell, it can be damn fun. Makes you kinda feel like this guy:
I guess that's why I haven't been posting as much lately. Second year threw a bunch of new eggs at me and I had to ditch one to make things more manageable. But things are back on the up and up and I'm back to cruisin' down the highway with the top down and the wind in my hair. So I'm adding another egg back in.
And hey, if I break one, I can always make scrambled eggs.
The following words were uttered from my mouth this past Thursday:
"I hate this so much it makes me miss 'renal'."
Yes, neuroscience, neuroanatomy, neuropilates, all that neuro- junk has officially crawled itself to the top of the Super Aggro Crag that is my 'Most Hated' list. Maybe that's because I've spent the past 3 days straight cramming for an exam I spent the previous week and a half being a piece of crap preparing for. But I'd rather pawn off my irresponsibility on the subject matter. I was at Macaroni Grill last night and all I could think to draw on my paper tablecloth with my Roasted Pepper Red crayon was a f#@cking diagram of the cerebral cortex (complete with labels!). I am so much better then that.
Exam tomorrow. I will feel so much better when I purge myself of this information all over that scantron sheet.
Until then, I defer to Bobby Boucher.
Mama says that alligators are ornery 'cause they got all them teeth but no toothbrush.
...
Somethin's wrong with his medulla oblongata.
Every once and a while you have an afternoon where everything feels right. Got dressed for clinic and found a $10 bill in my pocket (yes, a $20 would have been just way too cliche). Clinic was efficient, with straightforward visits, even the narcotic patients (I swear to f'in god this is not made up). Traffic on the drive home didn't matter because I was catching up on the phone with an old friend I haven't talked to in 8 months. Got home to watch the alma mater win a classic college ballgame in overtime. Cracked a beer to celebrate and it was the perfect combination of "chilled" and "icy."
If only days like that could come more often, I'd probably be a little (ok, a lot) more sane.
Speaking of clinic, today marked the first time I have seen a patient in 35 days. Between my final and winter break, I had damn near forgotten what I was supposed to even do with one. But today was a nice lukewarm wading pool for me to get my feet wet in again. Saw a cellulitis patient whose entire right arm was much larger, redder, and hotter than his left one. Drained the wound to give him relief, gave him a boost of IM antibiotics, a scrip, and his arm should be feeling immensely better within 48 hours. Saw a patient with textbook bacterial sinusitis. A patient with a URI who simply needed reassurance about his new-onset hearing problems. Yup, your tympanic membranes are full of serous fluid and bulging sir, start popping those decongestants. Saw a 2 year old with a 6 month history of constipation. Natural methods had proven ineffective so far and it was time to actually see what we could get going with laxatives. You could tangibly feel the relief from the parents when we handed them the prescription, as if they now had a tool they could use to fight their kid's suffering. And yeah, even the narc patient, a pleasant 70 year old woman with a history of loading up a bit too much on her oxy. She was in a nursing home now, and the pyoderma gangrenosum on her leg was causing her a great deal of pain, oh doctor please, can't you give me more to help this go away? Turns out the nursing home... wasn't giving her any oxy period on a clerical error. Well that was an easy fix. Between histories and physicals, I didn't even have to think and ponder about "what to do next?" - it was all so straightforward it came naturally. This after 35 days. Unreal.
Dare I say, I actually enjoyed myself for an entire afternoon in family practice?
Hahaha. That's silly.And yes, I chose the fruitiest picture possible for this post on purpose.
Turns out the winter storm referenced in my previous post was simply a little foreplay from Mother Nature until she unleashed the full-on kama sutra of arctic chill on my little niche of the world (see right). 
As a result, I abandoned Siberia, I mean, my apartment, and have been sleeping on various couches of various houses I have broken into over the past 10 days. Having no internet access for nearly 2 weeks, being sans car, sans bed, and sans normalcy has been equal parts entertaining and maddening. The Great Thaw has finally come, and with it my migration home, just in time for me to hop on a plane tomorrow for Vegas and New Years. I don't really know what the point of this post is except to justify my hiatus. I was hoping to post some thoughts over break but that will have to come after my return from Sin City and the hangover subsides.
Until then - Vegas, baby. Vegas!
