Pop.

So I was running on a nature trail by my place last week. About 1.5 miles in on a particularly brutal downhill stretch, I roll my left foot underneath me. I catch myself and stop, thinking "Oh. Man, that'd really suck to sprain an ankle out here." Run about 50 more feet, and sure enough, roll my RIGHT ankle underneath me, only this time its accompanied with a wonderful 'pop'. I hopped around in circles for a good minute or two and was able to walk it off, and ran the remainder of my 4 miles. Still, a pop is never good, so when I got home I crashed on the couch and kept my leg elevated. Sure enough, by that night it had tightened up considerably and by the next morning I couldn't put my full weight on it.

Of course, my natural curiosity gets the best of me. I hobble over to my bookshelf. Open up Netter's Plate 527. "Ligaments and Tendons of Ankle".

Looking at the mechanism of injury, my foot was plantarflexed and inverted at the time of the pop. Physical exam reveals mild non-pitting edema of the lateral side of the ankle. Palpation produces pain between the lateral maleolus and the calcaneous. No significant loss of range of motion or pain on dorsiflexion. No significant loss of range of motion but pain on plantarflexion. Pain on eversion and inversion of the foot with limited range of motion.

Diagnosis: Likely grade II strain of the calcaneofibular or anterior talofibular ligaments. The pop is worrisome and a less likely but more serious diagnosis of grade III strain is plausible. The fact I can still dorsi and plantarflex my foot and that I was able to continue running post-injury is a good indicator of a less severe injury.

Treatment: The RICE protocol. Rest, Ice, Compression, and Elevation.

... This is what happens when a medical student has nothing to do. I think I need help.

Annnnnnd.... Cut.

I am now officially a MS2.

Pretty wild.

Game. Set. Match.

No med school blog would be complete without a requisite end-of-first-year sappy reflective post. Since I know my friends love reading my entries where I get all gushy and sentimental (Hi Kate!) I figured it would be a disservice to not add my 2 cents to the plethora of bad advice on the internet. With my final exam lurking in 5 days, I figured now would be a great opportunity to procrastinate, put on some Coldplay, mix up a cosmo, and look back at myself 10 months ago (and laugh).

So, without further ago, I now present my 5 pearls of wisdom garnered along the way of the past 290 day endeavor in masochism known endearingly as MS1 (© 2008 for a future book deal, of course):

1. You will fail.
Maybe not literally, if you successfully claw above that 70% line every test, but you will fail. You will study your ass off for an exam and do significantly worse then you expected. You will make an idiot of yourself in front of a patient. You will inevitably do something that makes you turn a color of red so bright it has not existed in the world outside of a Crayola crayon box (see Torch Red).

But there is hope. Luckily, the admissions departments at medical schools do a superb job of selecting perfectionists with abnormally tight external rectal spincters and the moments of failure will become your moments of greatest insight and learning as you sadistically mull over your mess ups. Some of things that I will never forget from MS1 due to my own incompetence include how to feel for the PMI on a well endowed woman (BACK of the hand, do not cup the breast!), the many ways that steroids will destroy your body (that you don't hear about on ESPN), and the fact that the femoral nerve is lateral to the artery (stuttering is not a recommended method of answering a question when pimped). Love the failure, it's good for you.

2. You will have doubts.
Everybody is a happy, fluffy cloud of optimism when they start medical school. Unfortunately, fluffy clouds can quickly become rain clouds (wow, did I really just type that?) There are times when medical school sucks. But it's important to realize that everything in life sucks sometimes and you are not experiencing a phenomenon unique to medical school. Everyone does it differently, but one of the most important things you can do in your medical career has absolutely nothing to do with studying tip & tricks or learning to differentiate rales and ronchi or buying out the pigs feet at Fred Meyer to practice your running line stitch. The most important thing you can do to get ahead is to find something that keeps you happy. Join a pottery group. Train for a half marathon. Go to a strip club. It is those things that will make you a better medical student, since no one likes interacting with a thorny burnt out wad of pessimism all the time.

Best advice I got from a physician this year: "Make sure at least one good thing happens to you every day."

3. You will complain.
Unfortunately, medical students come off as very negative people at times to our friends and loved ones, since one of the most effective and easy ways to let out your stresses involving school is to bitch and complain. I was catching up with a friend the other day and explaining my 10 year roadmap, stating quite truthfully and rather sarcastically that I have 3 more years of medical school where I'm "everyone's bitch," following by 1 year of internship where I am "everyone's bitch... but the medical student," following by x years of residency where I am "everyone's bitch... but the medical student and intern." After finishing all he says to me is "so you wish you didn't go to medical school?" I've loved medical school so far, and don't regret my decision for a second, but can see how that can be lost on others behind the Wall of Bitch.

So, learn the art of complaining. Embrace it as a part of you. But remember when you're done complaining that you are going into a career thats pretty sweet too.

4. Make friends not enemies.
Your classmates are pretty cool people. And thankfully we are kind of self-selecting to be generous and helpful. Same goes for most people you interact with in health care. Your life can either be miserable or awesome depending on how you choose to interact with others. Sure there are bitter and evil classmates, nurses, attendings, information desk receptionists, and patients lurking out there in the shadows, but if you let them make you miserable, they win. [Insert corny Star Wars analogy about the dark side here]. Be nice, it pays off way better then being an asshole.

5. You will love it.
Medical school is really cool. You get to see and do things 95% of the population would never dream of. You get to visualize the human body in ways you never would think possible (tangent: people watching becomes really fascinating when you play the What Disease Do I Have? game). You will be continually challenged and rewarded for your efforts. Yup, most of that crap you rambled on about in your AMCAS personal statement is true.

It even has my skin tone.

I am a medical student. A big, bad learning machine. Well adapted to its environment, with skills honed at survival. That is, until the end of the year workload comes, and bites my fucking head off.

***This post in tribute to the infectious disease block we are currently slogging through, aka "101 things you do not want growing in your body" aka "I am never traveling to anywhere outside of my apartment again"

***This post also in tribute to the 5000 visitor milestone I just passed. That's cool. So are people who visit this lame blog.

***This post also in tribute to the 4 other posts I have started but not finished. I look forward to the day when I have sufficient motivation to finish them. That day is June 14th, or the mythical "summer vacation" I have heard about but lost hope in long ago.

Super Hyphy

So we just started our micro/infectious disease block, and blew through all the fungal infections in 3 lecture hours. Which included such vividly lovely descriptors such as "grainy exudate," "cauliflower-like," and "versicolor lesions."

These lectures are mind-numbingly boring, especially right after an exam. Yet, even in my fungally induced coma, I noticed there seemed to be an unwritten law amongst mycologists. For every disease of the fungus, thou must havest four slides:

Firsteth, thou must haveth a slide that talks about how common this fungal infection is and how important it is that you learn it. (BS)

Secondly, thou must haveth a slide showing a highly advanced form of the fungal infection in attempts to gross out the students. (BS)

Thirdly, thou must haveth a slide talking about Amphotericin B. Complete with requisite "Amphoterrible" joke. And a tiny aside about the azoles and how they are actually the mainstay of treatment. (Not really BS, but redundant)

And fourthly, thou must haveth a slide showing a KOH prep or biopsy slide. (see right)

Now along with every microscopy slide must come the following remark: "If you were a good mycologist, you could differentiate the species based on this slide." There are two things wrong with this statement (I'm big into lists today). One, I am not a good mycologist. Two, I have no desire to ever become a good mycologist. In fact, the odds of even one person from our class of 126 becoming a "good mycologist" are well below .500.

But I digress. Maybe we should be more appreciative of our mycologists. After all, when it comes to deadly systemic fungal infections, there isn't mushroom for error

...

I'm sorry that was in spore taste.

GUNNER!

I'd like to thank Dr. Loriaux and The Follies for a roasting good time last night. It was a lot of fun. And I want to assure my readers, no worries. This blog will always include 100% melodramatics and 100% douchebaggery. I accept no substitutes.

The First Mailbag

Well, this post was supposed to be a mailbag responding to questions for me posed by you, the reader. But since my readers seem to be the creepy type of people who like to watch me and not interact at all (Editors Note: I now know the reason behind this, and think that people missed out on a prime opportunity to bait me into embarrassing questions. I think my anonymous readers are now my favorites), I did a little work and fabricated my own mailbag, gleaned from questions that have popped up in the comments the past 9 months.

"On your surgery rotation, you should, at least once, do a perfect imitation of The Todd from Scrubs."

This is a moment I have dreamed of for a long time, namely because it combines three of my favorite activities, namely: (1) being rediculous (2) wearing scrubs (3) fake tattoos. I will sacrifice 1000 pre-meds before my surgery rotation so that I may draw a cool enough resident to let me do this my 3rd year.

Speaking along those lines, and this is too good to make up, but there is a general surgery resident at our university hospital who wears sleeveless scrubs. Which makes me wonder... can you even BUY sleeveless scrubs? The almighty google says no, which means this resident had to have made his own. At what point did he think this was a good idea? Surely he had to have had a moment before he first put scissors-to-scrubs where he thought "is this fashion forward?" Knowing my luck, I'll probably have to work with this resident during my surgery rotation. Then again, that would give me a prime opportunity to take my Todd impression to the next level. After all, imitation is the highest form of flattery.

"Wow this looks really hard. how do you do it?"

I was going to type out this elaborate response talking about inner strength and resolve and seperating the wheat from the chaff, then I realized that I'd be bullshitting not only you but myself. It's nothing even nearly like that.

You ever watch Fear Factor? Those people do some CRAZY stuff, and they do it all for money. I mean, 95 out of 100 contestants would tell the show host to eff off if they didn't have that money prize to make them compete (note: there's always one person a season I believe has a certifiable psychological disorder and would do it even if the prize was belly button lint). Well, med school is a lot like that. We have this nice enticing prize at the end (doctorhood) and as a result we reduce ourselves to the intellectual equivalent of eating cave spiders, showering in calves blood, and massaging alligator testicles (and, ironically, these comparisons are not that far off of REAL actual experiences we have in medical school!) I think that's what it comes down to... the delayed gratification. Though I guarantee you there's at least one person in my class who is that one crazy person who would do it anyways.

"Wow. That's a lot of drugs. What are your classmates like?"

Now this is a dangerous question, because I know some of my classmates read this blog (788 hits from the Portland metro area. I may check my blog a lot, but I'm not obsessive-compulsive). But there's no way I'd bad mouth my classmates anyways, since they are all great people. But I think one specific scene helps to epitomize the dynamics of my class to a T.

We had a prom. Yes, a med school prom, at a local Irish pub (yes Kells!) which I frequented perhaps a little too much over the summer. At one point, I was standing on the side, watching the dance floor (yes, closet wallflower here) and realized exactly what the scene struck me as. It was a perfect mix of a 6th grade Catholic school dance and and a thirsty thursday dollar beer night down at the local bar. There was this crazy tension between the social awkwardness and the alcohol-induced social lubrication. And one of the most hilarious dance circles I've ever seen in my life. So that's my class, a bunch of drunk 12 year olds.

As a side note, I knew the bartender who was serving drinks at the event and was talking to him for a bit. At one point, he made the observation "you sure are here a lot more than any of your classmates." Yup, that's me. Not just a drunk 12 year old, the drunk 12 year old who's a regular at the down at the local irish pub.

"What happened to you?? have you fallen into the black hole of med school?? no new blog in almost 2 weeks! What's the deal?"

My weeks long absences from posting can be attributed to one of three reasons. First, med school is incredibly busy. 90% of the time, you feel behind on the material, and your schedule is so regimented and scheduled out that when the time comes for me to have "me time" it's midnight, and I have to be up in 6 hours. Especially if you even attempt to do other medically-related things outside of lecture like go to talks or shadow on the wards or in clinic. Second, med school breeds apathy. The times I do have some free evenings, I have an overwhelming urge to do crap like watch trashy reality television or drink a beer or log on to facebook for the 15th time that day. Third, med school sucks every bit of creativity out of my soul. When your life consists of memorizing boatloads of uninteresting facts and enzymes, your brain shifts into this robotic analytical state where things like "humor" are so counter-intuitive that I feel like it would be plain cruel to expose people to the thoughts going through my brain the majority of the time. Trust me, you don't want to hear lame jokes about lame proteins as much as I don't want to type them.

"what's new?"

My shoes are new. I bought them online a couple weeks ago. That is the newest thing in my life. Well, besides the milk in my refrigerator.