Strawberry Swing

Her eyes started across the sparse hospital room into eternity, my presence unacknowledged. I introduced myself as a student from neurology, and explained that we were asked to assess her situation by the main team caring for her. I scanned her 78 year-old frame for any signs of trauma or external manifestations of disease. She laid motionless, angular with knees drawn into her body. Her illness was hidden from my inspection, but I knew having read her history that she was wracked by severe Alzheimer's Disease. She did not blink and she did not speak, rather her mouth remained half open, hoarse gurgling sounds streaming forth with every exhalation. I continued speaking in a calming tone as I examined her, knowing that her mind did not register a word I was saying. In retrospect, my unnecessary one-way conversation was almost certainly to calm my own nerves. After all, inflicting pain in a hospital should always come after the civilities.

The neuro exam is often difficult for patients to endure. For high functioning patients the low-level cognitive function tests and repetitive movements must seem mere child's play, while those with true neurological deficits must experience a great deal of frustration when faced with the reality that motions and sensations that were previously second nature can now be impossible. Even more difficult is the exam conducted on a comatose or severely demented patient, who is entirely unable to cooperate or verbalize sensations, cognitive ability, or fluency or comprehension of language. This forces the examiner to become a physical exam instrument, testing sensation in all limbs by compressing nailbeds to inflict pain and monitoring for a response. More often than not, at this point of the exam I find myself wincing in sympathetic pain as I press down fiercely on the patient's nailbed with the metal handle of my reflex hammer. More often than not, the patient is so obtunded that they do not even flinch with the inflicted pain.

After thanking the patient for her cooperation, despite her inability to utter a single syllable during the entire exam, I left the room to report my findings to my resident and attending physician. I "presented" the case to the entire team as we stood outside her room, the time-honored manner in which physicians learn to transmit a patient's story to each other in a thorough and logical manner. Soon our patient was being wheeled back into her room, cutting a swath through the crowd of white coats. Following closely was an elderly man, slightly overweight and walking with a strong gait. He appeared well enough to play 18 holes of golf more days than not. As he waited outside of the room while our patient was being transferred back into her bed, it became obvious to me that this was the woman's husband that was mentioned in her chart. The chart indicated that he cared for his wife in their home, only getting respite twice a week for a few hours. Even skimming our patient's story and having a crude understanding of the severity of her disease before seeing her for myself, I quickly understood that the care of his wife was a huge undertaking. I remember feeling a vague sense of admiration when learning that she lived at home, yet I couldn't suppress the feeling that maybe he really did not fully understand just how advanced her condition was.

My preconceptions were blown away with one look at his face. The care, love, and concern that he showed for his wife, who must have been a frail shell of her former self, was enough to rend my heart. I struggled to finish my presentation of his wife's case in the impartial and highly scientific manner that is encouraged in the medical field, regardless of the specialty, fully aware that he stood mere yards away, listening to every word. It was obvious that his world was hanging on my assessment of the situation. I continued spouting medical terminology as I fumbled for a reason why his wife's Alzheimer's had worsened overnight, but for him I had no words.

Upon finishing my presentation, I watched as my attending ushered him into the patient's room, asking questions along the way about recent events and changes that might have led to her current state. Wounded, I stared at my shuffling feet as I tailed behind the team, dreading the moment when I would finally have to look up and see this strong man coaxing his wife to speak words that would never come.

The Longest Mile

When I was in high school I ran cross country. Poorly. To make things even worse, I was one of those cross country runners that the other runners hated, namely the person who was running only to train for another sport that they were much more interested in. In my case, I was a 6'5" basketball player whose only purpose for running was to show dedication to his coach's advice to run in an effort to make varsity as an underclassman. I had little to no stamina, only a moderate amount of sheer determination, and exercise-induced asthma. On the other hand, as I was a veritable behemoth when it came to the prototypical running physique, at least I had a long stride. Needless to say, when it came down to it I was the epitome of average.

Cross country was probably one of the most physically and mentally exhausting things I've ever done. I wanted to quit during the first mile of every race I ever ran, and imagined a myriad of scenarios in which I used my asthma as a crutch to get out of finishing the race. My lungs would be burning, my legs were lead weights, and I would be struggling along with the pack while the more skilled runners whizzed past us, all while my mind worked fervently to betray my efforts. With each race I was convinced that this would be the one when I would finally succumb to these deep desires to just give up on this cross country insanity.

One race stands out in my mind as the turning point when I realized that I would never be able to just give in. Each season teams from around the region in our conference would travel from town to town, usually running on golf courses or courses running through large parks. It was considered an honor for your town to have a course with which to host a race. The small town of 4,000 at which I was a freshman was one such town, and boasted one of the most challenging courses in the conference, filled with large hills, abrupt changes in direction, and was ran as a continuous circuit, with no repeated laps. This made it even more difficult, as it was impossible to scout the course out during the first lap and make any moves on "easier" parts of the course during subsequent laps.

Our team had been instructed to work even harder heading into this race, as we wanted to put on a good show for our fans at home, which in cross country mostly consisted of close friends, family, and significant others. I complied with this coaching stratagem, as I was certainly not going to go out of my way to look like a slacker in front of my friends. However, about a week before the race I became ill with what, at the time, was my semiannual respiratory infection. These infections seemed to come on each winter and spring and lasted almost a month each time, worsened by my asthma. I was always able to continue competing in sports, however my stamina was usually diminished somewhat and I coughed like a maniac, often forcing referees to ask me during the game whether I was okay to continue playing.

So naturally, I was extremely excited to be running our heinous home course in front of my close friends, feeling like crap and in a sport for which I had no actual affinity. I barely remember the thoughts racing through my head during the actual race. I do remember feeling somewhat delirious during much of it, and wondering if I was simply going to collapse. Oddly enough, the thought of actually quitting the race of my own volition never passed my mind. It wasn't so much that I was determined to finish, rather my mental state was such that I'm not sure my brain actually registered that it was a possibility. I had been reduced to primitive reflexes. Evidently one of those reflexes has something to do with running like a dying chicken (which, I've been told, summarizes my running style). In the end, I crossed the finish line glassy-eyed and diaphoretic with a finishing time slightly off my average for a 3 mile race and as my friend who worked as our team assistant ran over to congratulate me, I doubled over and threw up. Looking back, I think that day marks the first day I actually felt proud of running cross country, because it was the first time in the sport I overcame an obstacle that months before I would have said was impossible.

I'm now exactly one week away from finishing my 3rd year of medical school, which is the first year spent entirely in the clinical setting. Over the last year I've worked with infants suffering from terminal brain damage in palliative care, incredibly warm military veterans with newly diagnosed cancer, psychiatric patients who will likely never receive the care that they need simply due to the American health care system, and an incredible number of patients with a nebulous distrust of health care professionals and a nearly infectious negative attitude. I've worked long hours shoulder to shoulder with some of the most caring physicians a patient could hope to work with, and also with some of the most jaded, cynical, and nearly inhuman health care professionals treating patient and junior colleague alike with nothing but distrust and disdain. I've found my personality and attitudes morphing into the dominant culture of every branch of medicine in which I've rotated and in the end I've said and done things that I'm not proud of and wonder just how firm my self-identity really is. As I approach residency, one year away at this point, with the stresses placed on a new physician and the hours necessary for our training, I wonder if I will even be able to keep tabs on who I am and will have any control over who I will become. Will I be just another one of those overworked physicians whose patients are convinced don't listen to or care about them?

I guess my cross country story entered my mind today because I type this as an exhausted medical student. Not someone looking for assurance, sympathy, or misplaced compliments. Rather as someone who often feels delirious as he tries to understand not only the medical concepts that he is inundated with on a daily basis, but also the ethical and interpersonal ramifications of the health care system in which he struggles. As I limp away from my third year of medical school I find myself utterly confused as to just who I am to become in this profession. I can only hope that much like the aforementioned race my mind can slip into a primal autopilot and emerge on the other side of this training proud of the results.

Don't Call It a Comeback

So, it's been a while. How have you been? Me, not too bad. Turns out the first board exam is as hard as everyone says, and that studying 12 hrs a day, 6 days a week for 5 weeks leading up to the exam is not great fun. Turns out good friends can get you through it, though.

Oh, 3rd year of medical school? Good times, long hours. You get to experience a little bit of everything in medicine, which is great. The only problem is that as soon as you feel a small amount of comfort in one specialty it's time to rotate to the next one, where you can feel like an idiot again for a few weeks. No worries though, as long as you have an idea of how to act professional, a good sense of humor, and don't take yourself too seriously, you'll get by. Things get even better towards the end of the year when you finally decide on a specialty and can (potentially) relax about grades and settle into learning aspects of each field for the sake of your future career.

You always thought I would do ortho, huh? Well I actually decided on pediatrics (probably a subspecialty in the field that will allow me to do hospital work). As much as I would enjoy the money and lifestyle that comes with some other specialties I was considering (interventional cardiology, I'm looking at you!) I couldn't overlook the fact that taking care of kids during my first few months on the wards was the most rewarding experience I had all year. The other nice thing is that even the sickest kid whines less than the average adult patient. Parents? Yeah, they can be a little challenging, but you can tell even the less-than-ideal ones love their kids and are usually trying to be better parents. Sometimes mental illness or poverty just get in the way of that ideal. And sure, working with child abuse will be tough, but we all know it happens and I'd rather be the guy trying his best to defend those that can't defend themselves than just look the other way and try to protect myself from the ugly reality of it all.

So there you go, all caught up. I'm finishing up the last 2 wks of my 3rd year and am looking forward to what, by all accounts, should be a cush 4th year full of electives, residency interviews, and vacation months. I'll try to do a little better with staying in touch in the future...

Thanksgiving

5 adults, 2 children: ages 6 and 2. 2 bedrooms, 2 bathrooms, and 1000 square feet. That, in short, is how my Thanksgiving weekend is being spent as my wife's family has descended upon our apartment for the holiday. The quarters may be cramped, but I've become an expert not only at keeping my niece and nephew occupied while the other adults cook (turns out my huge bag of Star Wars figures, a true testament to my geekiness, is worth its weight in gold) but also to hop across my apartment like a one-legged chicken navigating a minefield as I search for spots on the carpet that are not littered with sharp toys that are sure to give me tetanus.

I'm sure that a great many of you, despite loving your families as much as I love mine, are experiencing a "fight or flight" response to the description above. Just another aspect of the paradox that is the human experience--we crave social interaction and time with family, but at the same time even the most social of us needs space to ourselves and an opportunity to have some privacy. I struggle with this just as much as anyone else, perhaps more so as I often really enjoy time to myself, but I've found that some of the survival skills I've developed during my year and a half in medical school can be applied to this situation successfully.

Case in point: last night, after finishing the post-turkey dinner dishes, I managed to find a stretch of carpet near the entryway to our apartment that was completely barren. I proceeded to toss a kid's DVD into the trusty player to occupy the kiddos and then stretched myself out on that spot, closing my eyes and soaking in the calm. 15 minutes later, I felt completely recharged and ready to play "Uncle JungleGym" for another few hours.

Having been removed from my classes and studies for a whole 48 hours I was able to put aside the negative feelings I often have about school (my own little defense mechanism) and appreciate one of the small benefits that I've gained through my medical education. Namely, the ability to find a little peace in a field that is constantly bombarding you with things you should be learning, things you should be studying, things you should be doing to prepare yourself for the next stage of your career. Sometimes you just need to listen to that little voice in your head, the one that often gets drowned out by your professors, friends, and spouse, and realize that the most valuable thing you can do for anyone is to take a moment for yourself.

I hope everyone has a very Happy Thanksgiving, and is able to find at least one of these moments to let themselves just "stretch out."

To Whomever It May Concern

Today we finished our ethics class in which we covered controversial topics like stem cell research, abortion, and physician-assisted suicide. I found the whole experience fairly intolerable, which surprised me until I found time to reflect on the reasons for my allergic reaction to learning ethics in med school.

First, I have found this year that I am really indignant when my school makes attendance of any class mandatory. So, of course, I was quite miserable every week during our mandatory discussion groups for the ethics course. I found this time, as well as the lectures, to be time that I wished was spent with my Robbins Pathology text or my microbiology notes. The "soft" courses in our curriculum (ethics, psych, clinical exam) have been deemed to be unworthy of my time by the academic defense mechanisms I have erected to cope with the insane amount of material which we are expected to master this year. Couple this ongoing anxiety with the impending doom of our Step 1 licensing exam this summer, and I find myself intolerant of any time wasted. Except time spent writing in this blog, of course!

The tendency of these courses to portray the "ideal" physician and putting forth the idea that said "ideal" physician can only act in certain ways is also a huge turn-off for me. I am sure there are plenty of great physicians that "feel their patient's pain" and "explore feelings and ever-changing goals of treatment" with their patients, but I am just as sure that there are physicians that simply don't have time to spend on these diversions that provide excellent care for their patients by focusing on other strengths. Medicine is far too complicated an endeavor to master simply by following a few "touchy-feely" rules, and I feel insulted when it is portrayed to us as such.

That being said, I think that a poem I wrote a few years ago touches on my conflicted feelings about ethics in medicine--in particular, that hazy line between aggressive treatment with the idea of curing an illness and palliative care in which the goal is to comfort the patient while they die naturally. I would love to hear what kind of reaction any of you have to this poem, or even your ideas about the role of the physician in the dying process and Western civilization's eternal fight against mortality. And, you know, if the poem is just way too obtuse for anyone but me to understand, feel free to let me know that too. No comment is unwelcome.

To Whomever It May Concern
Deaf men bang drums, bleeding hands
protest the primal rhythm.
The blind turn leaden eyes to the sky,
stone synapses flare to life.
An alcoholic, fire in his veins, defiant
stands before his essence, a genetic jury.
You wouldn’t understand.

You couldn’t understand
a fish joyfully embracing the sandy shore,
his best breath, his last.
Or the bulimic refusing herself from within.
A hunger artist painting a visceral desert.
The beauty of a falling eagle,
blanketed by warm vertigo.
That empyrean pull, fatal.

Not you,
you wrote the rules in blood.
You’ve got your millennial plan,
an ivory covenant delivered on death.
No, you couldn’t understand.

Grand Rounds 3.09 is up!

Another excellent edition of Grand Rounds (a weekly collection of the best writing in medical blogs) brought to us by Doctor Anonymous is up here. I was lucky enough to have my entry "An Unwilling Consultant" mentioned this week, and I urge everyone to check out some great writing by other medical bloggers.

To those visiting the Bad Doctor for the first time from Grand Rounds: welcome! I hope you check back often and feel free to leave feedback or topics you would like to see me write about.

Thanks again to Dr. A for his hard work on Grand Rounds. It's a job well done!

This is what happens when you are studying for two weeks straight while self-medicating with Dayquil

My fellow medical students, throw off the chains that bind you! It is time to focus not on the differences amongst us--not our chosen specialties of interest, nor our percentile ranking in the class and chances at AOA nomination. We must look beyond our membership in various interest groups and our attendance record in lectures. Indeed, even our stance on nationalized health care must be put aside in this Time of Greatness. For we stand on the threshold of change.

Those that oppress us would that we spend every weekend of the impending year locked in the library, awash in the ignorant minutiae of propaganda-laden binders distributed to us by the bourgeoisie. No more I say! No more shall we sit idly by while they test us like mindless animals regurgitating triviality after triviality! Throw off the chains and follow your great leader to the promised land! A land of clinical relevance, a land of absolutely no required attendance functions, a land of shared responsibility for education during the day, and shared adult beverages at night! Most importantly, a land with only 5 human development lectures per year and absolutely no touchy-feely humanities classes!

As your fearless leader, long ago I promised these things and more, and your ruler and his Knights of Vanquishing fought long and hard to secure these basic rights of man. Alas, the enemy hides behind the infrastructure of a society intent on marginalizing those who seek to serve humanity's ill. They bludgeon us with board exams, subjective grading, unfathomable student loans, and endless hours of residency in which we earn less than the hourly minimum wage. Only together can we hope to transform the ripples that your valiant leader has made in the Sea of Time into great Tides of Change!

I ask you all to dust off your Netters and grab your Pocket Robbins. Holster your stethoscope (you can leave your diagnostic kits behind-those will be available in exam rooms when we need them) and clean and press your short white coats, for they will be the uniform of the People's Army. Muster your courage, my dear friends, and follow me to freedom!!! For I am no longer your ruler. I stand before you now, a Man of the People!

Making my first Grand Rounds

Just wanted to give my readers a heads-up to my inclusion this week in Grand Rounds over at topher's site, the rumors were true. For those not in the know, Grand Rounds is a weekly selection of the web's best medical blogging, so I definitely feel honored by being included. I urge you all to check this week's edition out and read great medical stories from some excellent bloggers.

An Unwilling Consultant

Two weeks ago we learned that my wife's 96 year-old Grandmother was in the final stages of kidney failure--a terminal condition. I only knew her for a short time, but it is really difficult to overstate the life that this woman led. She was mother to 13 children who all turned out to be wonderful people, and grandmother to 36 grandkids, 36 great-grandkids, and 1 great-great-grandchild. She was very independent, and lived alone until the age of 94, attending mass at the Catholic church down the road every morning. Perhaps most telling was the love and respect that her family had for her. I often joked with my wife when we saw her at the immense family weddings that she loved to frequent that she looked like a Polish "Godfather" with all of the people that visited her while she sat comfortably in her chair, receiving each family member in turn and treating every one of them like the only person on earth she would like to speak to at that moment. I don't throw compliments around lightly, but she was truly a stunning woman.

You can imagine the turmoil that her imminent passing threw my wife's family into. Of course they all knew that sooner or later her body would fail at her age (or, as she liked to say, her body would go "kaput") but I'm not sure they could imagine a life without her, or their immense family without her as the matriarch. The family that I had joined only a year previous was on the cusp of great change, and I soon found myself thrust into the situation, honored and more than a little terrified, as I found those I love looking to me for medical knowledge for the first time.

We received word of Grandmother's condition on the eve of my nephew's 6th birthday party. The whole family had made the 400 mile weekend journey to a small town in Michigan to attend, but the celebration was completely overshadowed by the phone call late Friday night about their grandmother's kidney failure. The next morning my father-in-law decided that he should make the trip back to Wisconsin early to be at his mother's side. While he was packing up his van and waiting for my mother-in-law to say her goodbyes, I found myself alone in the doorway with him, completely at a loss for what to say in such a time. Unsurprisingly the "touchy-feely" empathy classes at my school had failed me. With concern on his face, he said to me, "I guess they found a blood clot in her kidney. They said there was nothing they could do to help it heal."

I immediately found myself searching through my long forgotten knowledge of renal physiology and cursing the fact that I had not yet had renal pathology this year. I was not surprised that she had thrown a clot to the renal artery, as she was suffering from a heart condition that left her at great risk for an embolus. Fighting a feeling of disgust for my dispassionate medical evaluation of the situation, I simply replied "I understand."

"I guess her doctor said she probably had about 7 days..." he continued, clearly hoping for me to fill in the missing pieces of the story. I felt relief that this was a topic that I had at least a basic understanding of, having given a presentation this year about dialysis discontinuation and the stages of the subsequent death by renal failure.

I replied, "I've read that in a situation like this it can go anywhere from 5-10 days usually. I would say that's a pretty fair estimate. The good news is that for most of that time she'll be conscious and able to visit with you guys. Probably during the last two days or so she'll start slipping away peacefully. She really shouldn't feel any pain." I timidly placed my hand on his broad shoulder, trying to provide some degree of comfort.

I knew this was a bold prediction to make for a mere second year student. Part of me trusted the references I had researched on renal failure. I also knew the palliative care nurses that were tending to his mother would be experienced in renal failure, and would be capable of easing any discomfort she might feel during the week. Most importantly, the human side of me, maybe the part that has yet to be claimed by the ofttimes dispassionate profession of medicine, knew that this was what he needed to hear right now. To him, at that one moment, I was an insider source on the secrets of human life and death, and my juvenile opinion held the weight of the world. I can say with all honesty that I did not relish that position, and do not look forward to facing it again in the future.

Grandmother died 9 days later, surrounded by her family, who had kept a vigil at her bedside throughout the week. Her final wish to pass on a Sunday was granted. In fact, she died the day before her 73rd wedding anniversary to her husband who had passed 9 years prior, and the family took comfort in the thought that they would once again be able to share a "first dance" together.

By all accounts, she felt no pain.

Interviews with Wolves

It's that magical time of year again, interview season at medical schools across the country! For those unfamiliar with the archaic system that is the medical school application process, I'll try to provide a quick summary. Essentially all med schools require applicants to take certain classes to be eligible, then all applicants take a standardized exam called the *name deleted to protect would-be applicants from themselves*. Then, typically following their junior year of undergrad, applicants submit a standardized "primary" application to any school of their choosing through a national computer program. This includes a personal statement that is invariably embarrassing and chock-full of half-truths, a list of impressive-sounding extracurriculars and awards, and your transcript and standardized test score. Did I mention that submitting the primary application and taking that test costs buckets of money? Ok, good.

At this point, the schools check out your goods along with thousands of other applicants. Then they choose a subset of applicants to further query in a "secondary" application with school-specific questions and requested information, including a small photo of yourself (which I'm sure are treated by the admissions personnel with nothing but respect and never, ever become running jokes in the office). This is largely a huge pain in the applicant's ass, which is undoubtedly the only reason to make these mandatory. I feel I should mention in passing that the schools all charge an additional fee (which averages to about $75 or so) to consider these secondary applications when you turn them in. Oh, and most successful applicants apply to anywhere between 12-15 schools, with some crazies applying to over 40 of the 120 or so schools across the country.

The schools' admissions committees then review each applicant individually, and if their review is favorable they will invite them for an interview at the school. This requires the applicant to travel to the school while taking time away from work or their senior year of undergrad to spend a full day learning about the school via tours, Q&A sessions, and countless powerpoint presentations. The applicant is responsible for the airfare, the business attire required at the interview, and usually lodging costs, all for a chance at the coveted role of MEDICAL STUDENT. Did I mention that medical school tuition usually leaves graduating physicians with over $200,000 in debt? But let me be fairhanded in this tale: the medical school is kind enough to provide lunch during the interview day. Although chances are your nerves will be far too rattled to actually allow you to enjoy a meal. Life can be such a cruel, cruel mistress.

Now that my 2,000 word introduction is finished, I would like to share with you the story of my medical school interview. This was actually my third interview as I had previously applied unsuccessfully two years prior. Turns out that schools are not as amused as one might think when applicants show up in a high school counselor-style sweater and khakis rather than the traditional business garb, even if said applicant is tall, dark, and disarmingly handsome. Who knew?

So I sat, facing a random door in a large office space full of bustling admissions personnel and fellow applicants running like the proverbial headless chicken to find their next interview. I had already completed one interview with a 3rd year medical student at this particular school. He had been a little cool in his demeanor, but I soon broke through his shell, as I am a master of communication. It turns out (and at the time I had no idea that this is a scientific law even more bulletproof than evolutionary or germ theory) that medical students like feeling superior. So all I had to do was ask a question about his opinions on different curriculum choices or the grading system at the school, and wait for his answer. At this point I eagerly lapped it up like manna in the desert, making sure he felt like a medical student demigod. After 10 minutes or so of this game, we spent the rest of the interview discussing the bars that he and his fellow students frequented when they were not studying their brains out. It went well.

Alas, I had spent my karmic capital on that half-hour of glory, yet I sat before the door of judgment completely clueless. All I knew was that I was about to be interviewed by Dr. X who was a faculty physician subspecializing in gastroenterology. Entering the interview, I knew that my acceptance was waiting for me. I was entitled to it, like Michael Jordan was assured his sixth NBA Championship. As the clock struck 3, I knocked gently on the door and slowly turned the door handle. I entered the tiny room, scanning it with my eyes before settling on my interviewer, his desk, and the lonely chair that sat across from him. He was a stout old man, bespectacled and adorned in the traditional long white coat that marked him as that rarest of creatures, a physician. He looked up from what I assumed was my applicant file, and gave me a penetrating glare. I took my first step into the room and he opened his mouth and shot forth a verbal volley the likes of which I had not been privy to since my years of living at home with a teenaged sister.

"From your application photo, I expected you to be a lot uglier. You looked fat."

I stopped in my tracks, midstride on my way to the seat and spent a millisecond weighing my options. I could either launch myself over the desk like the physical specimen that I am and teach him just how much physical punishment my "fat ass" could inflict, or I could take my seat like a civilized young man and forget he had made such a comment, hoping that it was merely his geriatric senility peaking through. The first in a long line of regrets in my medical career, I chose the latter.

The interview proceeded in much the same manner. I was forced to defend every choice made during my undergraduate career (who would have thought that minoring in English could have offended someone) and explain the evolutionary biology research I helped with in excruciating detail before having my role dismissed with the wave of a hand. I found myself attacked for any opinion or insight I tried to offer, even in my own preferences in employment (no, I did not strip for a living). I had made the statement in my application that I really enjoyed interpersonal interactions and developing long-term relationships (one of those half-truths I was telling you about) and had intimated without sounding entirely committed that I might enjoy a career in primary care with its psychiatric component. Now, being a specialist, this evidently enraged my interviewer. He repeated over and over again that a huge part of his job was developing relationships with patients and treating them psychiatrically. Fair enough, he knows what medicine is like more than me. I told him as much, but then added in a not-so-rare moment of Bad Doctor stubbornness "I'm sure you do all that, but a primary care physician is going to have more responsibility to treat their patients psychiatrically and socially due to the nature of the office visits and the illnesses that they present with." I probably would have been better off telling him that Perry Mason was a filthy commie.

Later, I found my race up for debate. Looking thoughtfully at the pile of papers that so perfectly summarized my 23 years of life's work sitting before him, Dr. X. stated, "You know, by looking at your application, I would have thought you were Native American. Do you think that a trick like that is going to help you get accepted?"

A little background might help place this ludicrous notion into context. I had attended a high school in a town near a tribal community college. Now this community college was open to anyone of any race, and it just so happened that my high school had an agreement with this college to get students college credit for advanced classes. I had earned some credits in this manner, and as instructed in the applications had listed all of my college credits and the official name of the college at which it was earned. The only other mention of Native Americans or their culture in my application was in my transcript where I had taken a Dakota Literature class to finish off my English minor. The class had exactly three Native Americans attending it out of at least 20 students. Most importantly, in the race section of the application, I had clearly marked "caucasian." I guess he forgot to check that minor section before accusing me of race camouflage. Needless to say, I was mortified.

Finally it was time for the interview to end. I maintained the plastered-on smile that I had so heroically kept up throughout the interrogation and answered him when he asked whether I was going to make the 8 hour cross-state drive back to my hometown that night. "Yes," I meekly replied, "I am really looking forward to seeing some of the autumn leaf changes during the drive." Now, I ask that you look past the inherent lameness of my response and instead focus on his assertion that, "It's going to be much too dark out there to see anything. You'll probably have a really boring drive." At this point, I had had just about enough of his crap. I was exasperated, and without thinking blurted out, "Then I guess I'll just have to settle on playing chicken with the deer that try crossing the highway." He looked at me as if he would rather see me in his headlights than in his clinic as a student. Knowing when to cut my losses, I got up from my chair, thrust my hand toward him abruptly and lied straight to his face: "Thanks for your time. It's been really enjoyable." With that, I tucked my tail between my legs and ran and ran.

Needless to say, this is the school at which I earned my first acceptance, and also the school which I attend. Some may be shocked that I actually accepted a spot at the school after such an interview experience, but they would be missing that this is truly the final move that will checkmate my opponent in our battle of wits. I plan on taking a gastroenterology elective during my 4th year, when my MD is pretty much wrapped up. I'm going to seek out the kind, old man that interviewed me, shake his hand and thank him for all he did for me and my career. Then, I am going to watch him keel over in disbelief.

In closing, let me summarize this story for you in one sentence: Beware medical school interviews with people who have dedicated their professional lives to sticking probes up people's asses.

So this is second year?

Last year as a lowly M1, I often found myself discussing how much better the second year in med school must be with my friends. Usually these conversations (perhaps better described as hallucinatory delusions) took place during a supper break in the middle of a marathon 14 hour study day at the library. Often we would put in days like these in the week leading up to our block exams, in which we took a test on every subject that we are studying within the span of 3 days. Pretty intense, and at the time we thought that there was no way second year could be more time-intensive than that. What's more, in second year you learn about the disease processes that can occur in the body, and all the bacteria and viruses that can cause illness. We wistfully imagined, at the time, that second year would be full of interesting lectures, and purposeful studying. Oh, the follies of youth.

Recently I read medical school described as "a roller coaster at the fair that has just burst into flames as it careens off the track into a crowd of school children, while all you can do is run around in circles flailing your arms and crying for your mother." I find more and more everyday that this is an appropriate comparison, on some level. Many med students complain about the amount of time they put into their studies, or the social activities they have to forsake to get through their classes, however I find the whole experience difficult for entirely different reasons. Don't get me wrong, nobody enjoys studying all day, and the busy work that is always added to the curriculum is no walk in the park, but I really think that the most difficult aspect of medical education, for me, has been the siphoning away of my interest in biology and my increasing inability to empathize with others.

Forcefeeding yourself molecular pathway after pathway, and disease names that, interestingly enough, all seem to include identical symptomatology is enough to make anyone wish that they had stayed as far away from the biological sciences as possible. This is what medical school does to you. You are so bogged down in detail and the "alphabet and number soup" that constitutes modern biological nomenclature, that it becomes impossible to even remember why you might EVER use such detailed information in the care of patients. This is only reinforced when a community physician visits to give a more clinically oriented lecture (which occurs maybe once a month) and details exactly how much of these details you will never need to know in practice, unless you are specializing in that area. Don't get me wrong, I'm just as nerdy as any other med student as far as being interested in gaining knowledge and learning for the sake of learning, but perhaps the most frustrating aspect of the whole ordeal is that the vast majority of us are completely unable to recall these details and concepts when asked about them later. You cram your head full of material for the next exam, and then within a week you purge it all out in favor of the new details you need to learn. There is almost zero long-term retention involved, which leads one to wonder if the object of the first two years of medical school is less to learn about the basic science behind medicine and more about how to work yourself like a dog.

As I mentioned previously, my ability to empathize with others has also been shot in the foot during the past year and a half. I'm not sure whether I have already started to see the difficulties in other people's lives as a by-product of their own actions (e.g. an overweight 55 year old man whose diet consists of junk food and alcohol wondering why he has cardiovascular disease) or if I am suffering from some kind of "messiah complex" where I compare the hardships in others lives and find them wanting compared to the frustration in mine. Either way, it's not a very healthy problem for me to have at this stage of the game, and I am really dreading to see how things will change when I reach the clinics next year. I always swore that I wouldn't become that emotionally removed doctor that we have all met, but in the end it might be better than resorting to the judgment and resentment that some physicians (especially in their training years) have towards their patient and the field in which they work.

/Psychiatric Self-Evaluation

Immunology Exam Imminent

We've learned a book's worth of immunology material in the past three weeks, and will thankfully have the opportunity today to unload that material on an exam, so that the next cycle of med school binge and purge can begin again. On this momentous occassion, I thought I would share an excellent motivator tool I found.

Update: Credit for this picture goes to Kat. You can visit her excellent blog about her life in medical school at http://inked-caduceus.livejournal.com/

How to Disappear Completely

Sleep is nigh, so I will keep this short. Just wanted to apologize to anyone out there that actually reads this blog for my absence during these past few months. It turns out that three months of freedom during the summer after your first year of medical school makes even the most obsessive-compulsive med student completely forget anything remotely related to school. In fact, for the past twelve weeks I was quite content to disappear entirely from my whole school network (save my job working in a research lab there, which was great for some extra cash). Who would have thought that nine months of anatomy, physiology, and neuroscience classes could make one want to lay low like they had just robbed three banks in four days?

That being said, now that 2nd year is upon us, I hope to keep this page a little more updated. My classmates and I are actually going to have contact with real live patients (saying things like that always makes me feel a little guilty...it's like they're zoo animals or something) and I hope that this will lead to more interesting posts than whatever test I have coming up and my innate ability to draw every detail in my school's library by memory. But, that is neither here nor there. If anyone reading this blog has burning questions about medical school, life as a married student, or even how a 6'5" guy can wear a short white coat and look even remotely professional, just leave me a comment with suggestions on blog topics and I would be more than happy to write an entry on whatever your little hearts desire. Until then, I retire to my restful slumber with my mind chock-full of useless immunology facts.

P.S- I always thought that the material in second year (pathology, microbiology, pharmacology) was inherently going to be more interesting than that taught in first year. Boy was I wrong.

So we meet again, Mr. Brain

Short post, as time is of the essence.

Tomorrow, neuroscience and I will finally throw down, once and for all. I have less than a 2% cushion to keep my current grade heading into the cumulative final, and it's time to find out which one of us is a real man. Neuroscience may have all those fancy anatomical structures and scientific theory backing it up, but does it have the cajones to knock me out when it counts?

Tomorrow, we find out.

Oh, and I really need some sleep

That Time Again...

Well, the sun is finally shining and Milwaukee is finally heating up beyond the freezing point. That's right, spring has sprung, and that can only mean one thing...time to bury ourselves in the library studying for spring finals! That's right, while everyone else is busy shaking off their cabin fever by doing all sorts of ridiculous things outdoors, I and my 205 cohorts will be busy busting our humps trying to "re"learn about 800 pages of Neuroscience notes, roughly 1000 pages of physiology notes, and thankfully less than 10 lectures worth of material for our Cell & Tissue Biology test (which is the only non-cumulative exam). These tests run throughout next week, and as you might have guessed that means we are busy this week in the lecture hall, learning brand spankin' new material to cover on these exams in addition to the myriad details we learned once up a time earlier this semester.

I have strategically declined to attend these lectures, as they will not only suck up 4 productive morning hours of studying, but also tend to leave me feeling deflated and overwhelmed before I even start my real studying for the day. At this time of the semester, caring for your own psyche and avoiding stress is probably just as important for your performance on the Finals as 12 hours of studying a day. Luckily, I have made it about halfway through my first pass of the cumulative material and even the oldest stuff seems to be coming back pretty well, which is a good sign. If nothing else, at least I can probably avoid completely stressing out over the exams (like I did for at least one exam last semester). I'm also pretty well removed from any grade cut-offs in 2 of the 3 classes, which means that I would really have to screw things up to move down a grade. Overall, it just means that I can continue with my general study strategy (which consists of putting in a lot of time and reading through the notes in their entirety at least 2-3 times in the days leading up to an exam) and hope for the same results I've had previously.

It's late, and I should really be reading up on acid/base balance. I'll try to make sure to update as the week goes on, if nothing else than to pretend that I am communicating somewhat with the world during the next two intense weeks.