How to spend a day preparing for rotations

Alternate title #1: Doing everything you won't have time for later
Alternate title #2: What to do on your day off from your McJob
Alternate title #3: What I did TODAY

1. Read up on the subject, i.e 250 Biggest Mistakes 3rd Year Medical Students Make
   
2. Then don't read up on the subject, as in, read whatever cool non-medical book you've been putting off.
   
3. Laze it up for as long as possible. Guitar Hero helps.
   
4. Work out. You need to build up that physical stamina you lost in exchange for mental stamina with boards. Plus none of your professional clothes fit anymore, fatty fatty two by four.
5. Get totally settled into your place. Getting the stuff out of the box isn't enough, you also need to put it somewhere.
6. Make your bed a comfy piece of heaven, so, like, replace those flat grody pillow you've had for 10 years.
7. Stock up on food at the Safeway or other bulk foods store. As long as its not Walmart. Fascist.
   
8. Call friends and family, or at least Google chat.
9. Work out all the drama. Cellphone...internet...apartment...insurance....husband. Whatever the problem, stop putting it off and fix it now or you never will. Shit, that reminds me, I need to call a dentist, and get new insurance, and overhaul my car, and...gah!
10. Enjoy the feel of the the summer breeze on your face. Soon you'll be stuck inside most of the time and 2 days later its winter.
    

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Blog Rounds 1: Learning to Drool on Command

Glad to see there are still people reading this blog. We all had to take a little break after boards and to finish the end of our second year. Much, much more on that from my POV still to come, stay tuned for a month or two and you'll get the good stuff.

So I read a lot of other blogs, probably way too many. The good ones often leave me thinking about far more than I end up writing in comments, but us three Type B girls often get into good conversations about why these posts appeal to/disgust/inspire/amuse us. I've decided to do some posting on here about why it is that certain posts hit a nerve, and call these posts "Blog Rounds."

I caught this post tonight. It's over on a not uber-popular (read: Michelle Au..yeah you know who I'm talking about) but BEAUTIFULLY written blog, Nobody wears a white coat anymore... The writer is a resident at a hospital in Indiana (my home state!). She is amazingly clear and insightful about what is happening around her, I highly recommend it.

She was writing the other day about a patient of hers that she had just diagnosed with amyloidosis, and despite everyone saying what a "nice" woman this was, the unfairness that she will most likely die soon of this horrible disease.

Here's the excerpt that moved me the most out of all this, bold and italics added for emphasis:

"A has systemic AL-type amyloidosis. It's a horrible disease in which a particular line of cells in the bone marrow is overproduced, yielding an excess of a particular protein, which then simply silts out into the spaces between cells. The only good thing about this disease is that when you stain amyloid with Congo Red and light it up with a polarized microscope, it glows a bright shade of green and looks very pretty. The prognosis is poor, the progression is relentless, and most people who have it die within the year."

The post is much deeper and longer than this. But I think I've just figured out what it is that hit me so hard about it. We're taught in the first two years of med school how to make quick associations that lead us to develop differentials. Any med student entering their third year in the States will quickly, in true Pavlovian nature, shout out "Apple green with Congo Red stain!" if you so much as mutter the phrase amyloidosis anywhere near them. (Go ahead, try it sometime, I dare you. Even if they don't shout it, I can guarantee you that a picture somewhat like the one posted here popped into their minds.)


What is difficult for so many of us to deal with during these first two years, though, is that these aren't just diseases we're dealing with, they're PEOPLE with diseases. These people have lives. They have families. They have hopes and dreams. We came into med school saying that we were here to help PEOPLE, not learn how to knee-jerk diagnose a disease. But that knee-jerk association is necessary to even begin to be able to help them.

Somewhere between the beginning of med school and now, we've, I've, forgotten at times that the people are what matter. It isn't that I think they don't matter, but it's hard to not get caught up in the tornado of memorizing facts and spitting them back out that med school can be.

I'm glad to see it put into perspective that sometime down the line, a few years from the constant onslaught of Scantron tests and lab practicals, this information still came back to her in residency. But it was somehow separate and a tangent to what actually mattered, the patient.

Med Q from the McJob

Is there such a thing as ketchup bottle squirter's thumb?

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LOLcat of Death

NEJM -- A Day in the Life of Oscar the Cat

Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the residents whom he serves.

And Michelle's fave-

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I have Housisms on Facebook

"First, 'Hector does go rug' is a lame anagram. Want a better one for Gregory House? 'Huge ego, sorry.'"

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Quotes from CPR class

(first to set the scene: 8 groups of 3 in a semicircle, working on "manikins", "Staying Alive" quite literally playing in the background.)

"Do we change positions in 2 man CPR or do we just spin the baby around?" -OK that one was me

"Um, my baby's trachea popped out."
"To reinsert, peel his face off and grab it."

"It seems only men pass out in the video, how are we going to deal with boobs?"
"Whats really convenient is that everyone passes out in or near the hospital."

"Do you want the one that is damaged or the one that is lubed up?"

"Aw they dressed him up like a person."

Teacher: "Can you suggest some ways to remember everything you've learned today."
Class: Silence... but everyone thinking, "We just finished boards. I think we can handle remembering 2 breaths and 30 compressions for 2 minutes."
Teacher: "Well, at a party, you could bring it up and go through it with other guests as an icebreaker."
Class: Silence again... but thinking, "Ya, and then get punched for bringing up class while we're trying to get smashed."

Me taking my test, trying to be quiet b/c others are still talking the written portion-
Teacher: So you're in a bathroom with no one else is around, and see someone laying there unresponsive, what would you do?
Me: I would ask them if they are ok.
Teacher: Don't tell me, show me.
Me: But you asked...ok...uh, ma'am are you ok?
Teacher: Right but how would you say it?
Me: Uh, I'd shake her a little and be in her face.
Teacher: But how would you say it?
Me: How? Oh I guess very loudly.
Teacher: YES! You just kinda whispered it.
Me: Ya but we were told to whis...per...anyway, uh, next check breathing.
Teacher: Before that, what would you do?
Me: Nothing if nobody else is around.
Teacher: But you're in a bathroom.
Me: Where you said no one else is around.
Teacher: Well I would still shout just in case.
Me: Ok, I shout for someone to help then. Then I tilt the head, check for breath and there is nothing, so I give 2 breaths.
Teacher: What if that didn't work?
Me: Didn't work? To resuscitate her?
Teacher: No, what if the breaths didn't work?
Me: Like they didn't make the chest rise?
Teacher: Yes, what would you do then?
Me: Well, I would check for a foreign body.
Teacher: There isn't one, what else?
Me: There are a bunch of things I could do if I had the equipment I suppose.
Teacher: No no, what's something YOU could do?
Me: uhhhh....
Teacher: They mentioned it like a 100 times.
Me: uhhhh....oh, readjust the head tilt.
Teacher: YES!
Me: (in my head) AAAAAAAH!

-Michelle

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Dear Male Readers: Doctors don't strip their female patients

An exerpt from an awesome article about being a standardized patient:

Playing Doctor

Like many of the students, Dr. I was baffled by how to assess my
heart and lung function without breaching the fortress of my bra. Most
students, while listening through the stethoscope to my back, simply
worked around the bra. But Dr. I informed me he needed to unsnap it
(no, he didn't use the one-handed technique). Then he stood in front of
me, looked at my gown like a colonel contemplating an incursion, and
struck. He peeled off the top of the gown, dropping it into my lap,
slipped the bra off my shoulder, and left me hanging while he
protractedly listened to my heart. (Dear Male Readers: Doctors don't
strip their female patients.)

I sat there, as the tape ran,
debating whether to stop the exam. Sure he had on a white jacket and
was using a stethoscope, but in reality, Dr. I was no doctor, but just
a pimple-faced kid who'd taken off my bra. My pondering was interrupted
by an abrupt knock on the door. We looked over, and standing there was
the real doctor in charge of the program.

"No breast exam!" she
said firmly to Dr. I. He was left sputtering as she closed the door. I
redid my bra and put on my gown. Dr. I gamely tried to continue, but he
was so shaken he forgot to take my blood pressure, and before he could
get to my reflexes, an announcement over the PA said the time was up.
He had to put down his hammer like a contestant on Top Chef forced to drop the spatula before plating the side dish.

Apparenty at Georgetown they don't practice patient exams until 2nd year. For all I complain about it, this definitely makes me feel more confident in my education. I mean, at least I don't molest my patients. -Michelle

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