You know you're in med school when... (V)

Your notes sometimes look like this:

And other times look like this:

Scrambled Eggs.

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.

Dear kidney, I love you.

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.

The day that will never happen again.

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.

Christmas... Break?

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!

MedZag gets beatdown by Old Man Winter.

oh hai. Apologies for going on hiatus for two weeks. Haven't had much to post for the last while, but we've currently been slammed with a nice winter storm the past two days which has effectively put me on house arrest. For those of you who have no idea where I go to med school... that pinpoints my location down to pretty much 30 of the 50 states. For those of you who know where I go to med school... you know what I'm talking about. We actually got a snow day yesterday, which I never thought I'd see in med school.

You know, in med school we like to talk about all the things we gain in our training. Experience, knowledge, insight, competency, warm fuzzies, giant egos, all that shmooze. But I also have been reflecting lately on the things I've lost in med school. No, not my virginity, or my sense of humor (completely). But I have lost a great deal of patience (thankfully no patients yet). Not to toot my own flute, but I used to be a pretty darn patient person in my younger life. But one of the constants in medicine is the feeling that there is never enough hours in a day. And I've been deluged with that feeling every day for a while now. Between trying to keep up on studying, trying to maintain my sanity, trying to make it to meetings and talks I find interesting, and trying to maintain a semblance of a six pack, I find it amazing I have found time to even poop or sleep. Lately I've noticed myself become exasperated by activities, PBL sessions, and lectures which I feel like are a waste of time. I haven't developed overt road rage yet, but have formed a habit of yelling expletives at slow drivers (which breed like rabbits in this state) in front of me regularly when driving alone.

But it all came to a head this week. Now normally I have quite the active routine. I go to the gym, go study at different coffee shops, basically get away from my apartment, which is too close to campus and frankly claustrophobic.

Damn you freezing temperatures. I've been stuck at home for only 2 days now, and have already resorted to cleaning my apartment (!), organizing my DVDs, and even studying at home, a near impossibility for me normally. I am going insane.

Speaking of studying, we're currently mucking through endocrinology, which I have come to disdain nearly as much as the kidney. I do not state that lightly. But unlike the kidney, I actually somewhat enjoy the pathophysiology of the subject, I have just come to disdain the manner in which it is conveyed to us. For example, some of the bullshit lectures we have been fed in the past 3 weeks:
12/02 - Nutrition in Diabetes
12/05 - Nutrition Assesment
12/08 - Weight Loss
12/05 - Nutrition and Disease
12/06 - Women Nutrition
12/06 - Pediatric Nutrition

There are three main thoughts I have come to from our course direction. (1) Endocrinologists are glorified nutritionists. (2) Why am I spending $180,000 for this degree when I could get a bachelor's degree in nutrition for $60,000 (and its online!!!) (3) Why the **** are 20% of our endocrine lectures on nutrition?

Look, I know eating healthy is all puppy dogs and ice cream for your body. And the health care burden would be reduced substantially if people learned to eat better. But last I checked, med school was supposed to teach me what I needed to know to practice medicine. And there's only one thing you need to know about nutrition as a practicing physician. And that may or not begin with a "c" and end with an "-onsult nutritionist."

For comparison, we have spent 8% of our time on thyroid disorders. Ah, med school.

A long December.

Man, time flies when you're having fun. And by having fun I mean really busy. But with four days off for turkey day I got to fit a little bit of fun in for good measure. Ok a lot of fun.

But as they say, all good things must come to an end and so this week we jump headfirst into our endocrinology block. It still feels like September to me, so the fact that we are barreling headfirst towards 2009 is equal parts disconcerting and exciting. Cardiovascular, renal, pulmonary, gastroenterology, the march through the body and everything that goes wrong in is continues. But a brief break also allowed for a bit of that "reflection" crap that I hear about all the time in our Principles of Clinical Medicine class.

MS2 is has turned out to be quite a comfortable year. You establish your system of studying during your first year, after a certain degree of flailing, and I've found I've been able to stick to that system with only some minor tweaks through my second year. I'm a tactile learner so I like to write a lot of information down, which has proven to be a larger pain in the ass this year with the larger volume of info that gets thrown our way, but it hasn't been enough of an annoyance to force me to change things up yet. The next step will come after the new year when I have to teach myself how to do worthwhile board prep in conjunction to my classes, but I'm sure I'll figure it out. Or I won't, and I'll fail Step 1 and end up in family practice. Either way, I'm sure it will be interesting. I was one of those douchebags that was able to skate through the majority of my academic career without too much effort, and that included the MCAT, so I'm curious to see how this next major standardized test will go when for all intents and purposes your score is an almost direct reflection on the effort you make into preparing.

But so far, MS2 has been a comfortable year. If MS1 is a futon, MS2 is a nice padded fabric couch (and MS3 is sleeping on a wood board over a ravine). Medical school is as much about learning the language of medicine as it is the facts that you cram down your throat, and its definitely the year when things begin to come into a more complete picture. The days tend to blend together the more comfortable you become, but I don't necessarily think that's a bad thing. In fact it may be a sign that I'm continuing to enjoy myself in this masochistic path to a career that I've chosen. I don't know if there's much more to say about it. After a while, the first two years of medical school become a certain form of Groundhog Day. Wake up, go to lecture, fit in some fitness, study. Wake up, go to lecture, fit in some fitness, study. It's like watching the proverbial lawn grow on your brain. It may be nice to host a block party on in the end, but no one is going to make any movies about how it got there. So I feel there isn't much to say about the second year of med school in regards to the academic side of it all. It's just more of the same. More learning. More growth. Of grass. On your frontal lobe.

Oh, and since this is MedZag's blog... go Zags. 5-0, with 3 impressive victories over Okie State, Maryland, and Tennessee over the break. #5 in the nation. Good time to be a Gonzaga fan. I'll be in Seattle for the UConn game the day after my next exam doing my best PremedZag impression. Which may or may not involve copious amounts of a liquid that affects your... endocrine system.