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.

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.

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.