Oct 27, 2008

Found it!

The fundus, at long last, the holy grail of physical diagnosis. SO much easier once you've dilated a patient's pupils rather than just blinding your boyfriend for an hour until his pupils are so constricted that he looks like he's OD'd on heroin in your clumsy efforts to visualize the back of his eye.

I know, med school's sexy, eh?

Also, a tip, when you actually manage to correctly manipulate the ophthalmoscope and the fundus suddenly comes brightly into view, try not to exclaim "oh!" as if you've just seen a magic trick. It confuses the patients, who are led to believe that we know what we're doing.

Opthalmology rotation today, and far cooler than I was expecting, since I'm not usually a big eye person and don't really know much about eyes. We did a full patient history, watched some eye charts, but then go to watch a series of eye exams on people who actually had things wrong with their eyes that we could observe, rather than just peering into the face of our clinical skills buddies for a preset period of time, and then lying our asses off about actually seeing something.

Today we had a traumatic cataract and glaucoma in the same patient, someone with diabetes, some more cataract formation, an infection that was causing the edges of the iris to look black and ragged. Interesting stuff.

This also marks our last hospital visit, though I'm hoping to reschedule one of my bus-associated truancies (though still my fault) because I was really disappointed to miss the surgery rotation. I likey the cutty.

Oct 26, 2008

It doesn't matter...

where you do your rotations. According to the school. I mean, people have families and stuff, but ultimately, doesn't matter.

At least according to a meeting we went to today and in why it was okay to totally not tell the Global Scholars students that they can't do New Jersey rotations and may not be able to get licensing in CA or NJ.

So if rotations and reputations are a lot of reasons people choose this school, could one also say that it matters equally little whether you choose to go to SGU or AUC, SABA, or Ross, except for the whole hundred grand less thing?

I'm guessing they wouldn't like that assertion. So maybe take the concerns with where we're going to live and pay to work for the next year with a wee tad more respect and quit putting all the administrative mishandling off on the students. Because that's the obnoxious part. Yes, students bitch a lot, and this is part of running a high school, college, or graduate school. Yes, many hardened professors and administrators start to get sick of hearing a lot of lame excuses or being blamed for stuff students do, and I sympathize, though sympathize a little less as that whole dynamic is part of the job description. For instance, as a doctor, I suspect I'm going to have to deal with a lot of sick people.

Part of that job dynamic should involve being *aware* of the legitimate stresses and complaints manifested in the student body. First of all, even petty obnoxious stuff is still a catastrophe in that person's mind, and even if someone has brought consequences onto themselves, that is still a person's life, even if it's annoying you.

Secondly, if over 65% of the class has a beef with you over a specific issue at a specific period of time, maybe it's you. And maybe that 65% plus would be somewhat eased if you didn't keep flipping glib responses at them over how either their concerns or irrelevant or that they should have maintained the academic responsibility of being one step ahead of the next administrative screw up. It's sort of like being under the perpetual control of the snotty guy at the airline desk that tells you it's your fault they lost your luggage because you should never check baggage that you actually need.

To center back on the clinicals thing, the whole "Well we COULD just take out letting you put down your preferences and send you anywhere" thing? Not cool. I appreciate that it's frustrating to have the class mad at you, and I sympathize that it's becoming pretty bloody frequent this term since the class has a lot of reasons to be mad, but totally not the right response. Not knowing where you're going to live in addition to the other stressors, particularly for those who have families, *is* a big deal. Particularly in the economy we're heading back to.

This Cincinnati analogy kept coming up too. Apparently people who go to med school in Cincinnati have to do their rotations in Cincinnati. Maybe some Cincinnati students can back me up, but I feel like it'd be accurate to say that they know that when they enter medical school, and, if they entered medical school with the assumption they were going to get rotations in Cincinnati, and then their school told them they were shipping them to California in their last term of basic sciences because fifty of them actually hadn't been cleared for Cincinnati because the school hadn't cleared it before making the claim, and that it wasn't a big deal, those students would be super-mega-pissed. But correct me if I'm wrong. Cincinnati medical students may just be an enviably laid back lot.

Regardless of what residency programs think, advertising SGU based on its great rotation spots and telling students they have a good likelihood of getting them so they're likely to be able to be near their families, and then not being able to follow through *is* a big deal. We all got the great advertising package about the wonders of SGU, and it's time for the excuses to stop and the results to start. STOP minimizing our concerns.

On the plus side, they finally got Angel working after only being down for the majority of the weekend. Fortunately, I already had my course materials downloaded because I expect this sort of thing. Sucks to be those fourth termers with their exams tomorrow though! Hope they didn't need any revision on their slides.

Oct 24, 2008

In med school too long

I actually know what all these mean:

Thank you, Amateur Transplants

Yup, getting to be that time again...

Oct 22, 2008

Oh wait...

Renal lectures are up on Sonic. I'd say that makes all right in the world, but I've just discovered that I need to know 8 billion anti-cancer drugs. I've got the brilliant idea of combining them into one giant super drug, call it Cancer-Ex, and go home. The pill will be a little large but you can dissolve it into pink beer.


in the flesh.

This term has me on an emotional roller coaster that's hard to adequately express because my mood towards it is changing so rapidly as are my approaches to attempt to stave off a bad attitude.

While my nature is generally sarcastic and cynical (as is anyone who read over a hundred issues of the Babysitter's Club as a child), my overall attitude is one I try to generally be happy (being sarcastic makes me happy), try not to let little things get to me beyond the surface irritation, thus I enjoy making fun of things without being too hard-hit by them, with a few notable exceptions that are pretty dramatically splashed onto this blog.

I've also let myself get cases of the deep-blue-funks which made the overall decently-run second term a complete misery for me while I enjoyed the "rabid monkeys made my schedule" fourth term largely by avoiding anything that wasn't mandatory and keeping chipper that this would be the hardest term in basic sciences and I was enjoying most of the material.

Flash forward to my current state of affairs where I am desperately seeking a positive attitude so that I do not waste my last couple months on this tropical island wallowing around feeling sorry for myself. This is difficult because there are a number of negative factors that are making the term a bit of a hell, while not allowing me to sink too deeply because there are a bunch of goods, and the goods are frequently rather spectacular goods, which just gives me that whole unstable bipolar feeling that I never know if I'm going to cry or dance around.

This is all being exacerbated by my having an absolutely *galloping* case of senioritis, thus I don't feel like doing anything, go for long periods of doing absolutely nothing but procrastinating, then followed by marathon study sessions, all the while kind of resenting that they're making me do this whole med school thing when I'm supposed to be relaxing on the beach, doing hashes, going scuba diving, playing guitar, seeing monkeys, island hopping, and all the other impossible goals I hoped to get in before leaving for good. Like it's third term or something.

Oh, to get onto the good... I've been chronicling this little battle with the pathophys department for a while, which was constituting a lot of the "bad". Long story short: chancellor letter, huge and surprising response, big open forum where we got listened to by all the department heads and the deans, some initial changes made that were promising, and continue to look promising, but cautious optimism.

This took a slight down-swing with hearing the reports to the fourth termers, though their 5/6th might be worse than ours, in that they were told a couple of times that they'd need to bring back all their books and notes (unrealistic and sucktastic, but at least announced), but that the current term (ours) had a bunch of complaints because no one told us we would have to think critically so they should be prepared for that for the next term.

So that was kind of pissy. "Well, we can't tell the 5/6th termers this because they'd completely destroy us in a debate over it by citing our lack of organization and preparation while citing the past pathology course as requiring integration and the BSCE1 as being a test of our recall from other classes, but we just wanted to let you fourthies know that unlike your special-ed upperclassmen, who have made it to the near-end of their second year of medical school without being able to arrive at any conclusion that wasn't drawn out in capital letters on something shiny for them, you're actually going to have to use your brains next term, so be prepared."


Lest I withhold credit where credit is due, they are reinstituting a curve based on the actual class averages and standard deviations, per an announcement on Angel! Woo hoo!!!! And though NONE of the renal Sonic Foundry lectures have been posted, the notes for heme, GI and renal were on time, and they changed up the way the BSFCR was run, as they indicated they would while getting the objectives up in advance, as they also said they would, so while I have no idea how this is going to play out on the upcoming exam, I'm going to go ahead and give the administration credit for following through on this one, and make it generally known that if you do feel like your education is taking an inexcusable hit, politely express that, and you never know what can happen. While I'm not wildly appreciative of the announcement to fourth term, it was made to fourth term, and so long as they're fixing the problems that are plaguing this term and are aware of the problem, I'm going to go ahead and give them a pass on saying anything they like. I mean, I'm going to completely make fun of it, but that's all part of the "not a deep hurt" part of above.

In Clinical Skills, they continue to demonstrate that though there is a ton of disorganization, you generally don't have to go any higher than the department heads (or sometimes the tutors) to get a response, and the disorganization seems regretted and inadvertent. And as I've said all along, attitude goes a *long* way with me. If you point out a problem and someones says "I'm really sorry for the inconvenience and we're working to do _________ to fix it.", I will readily let a whole lot of stuff go. Today, during our morning session, one of the students in my group pointed out that our patient write up grades hadn't been posted yet, which is important so we know what we can fix for the next ones, and they were up by this afternoon, and the reception of the request was apologetic and active rather than defensive. Pretty impressive.

The department is also fairly accommodating to students in situations that are directly the student's fault (totally guilty), and I haven't really seen any of their instructors or directors be overtly nasty, gripey, or unprofessional. Usually they're extremely friendly, helpful, and eager to add on stuff that'll benefit us. I'm not giving a pass on the organization, because it is a problem, but knowing you can actually talk to them and they'll respond nicely is honestly one of the high points of my experience with the school. I'm not sure what that says about me or the school, but there you go.

Pharm. Pharm is the definition of ambivalence for me, as I've mentioned before because I maintain that it is well run, but I hate this class probably more than any other and it is taking up a huge portion of my time, which means I'm spending a huge amount of time focusing on a subject that is difficult, heavy, high yield, and mindnumbing. So it's a lot like being forced to spend 2-8 hours of your day eating liver. It's good for you; it may be made well by champion chefs and butchers, but it's still going to ruin your day.

Clinic. The clinic is driving me nuts. 90 minutes minimum to renew prescriptions, only to have it dragged on for a week or two weeks or whatever the on-duty feels like giving me and having the pharmacy frequently out of what I need, while the mail from home isn't reliably making it. Not a great use of time. Also an added stress I don't need hitting right at the end.

Social... another big source of ambivalence. I'm finding more and more that I like a huge number of the students at this school, and have established close friendships with a number of them and I'm deeply enjoying being around them. My boyfriend is being completely awesome, per usual, and since we're both incarcerated in the study hall a lot, it means I get to spend more time with him.

BUT... (there's always a but)... I am becoming more and more acutely aware that though I'm extremely excited to get done with basic sciences and begin the next stage of my life, I am also going to lose the close contact with my fellow convicts and we're all going to get scattered to the wind. Many of us will likely end up at the same hospitals, and there's internet connections, but it's not the same, and I'm going to miss that. Some of my closest friendships have been made on this island, and I'm going to be abandoning that to have a close relationship with my step 1 videos. I'm going to miss running into a ton of people I know and like on campus, at the beach, at the market, and the whole closeness of the campus. Yes, this also creates a fishbowl here, but it can be a pretty comforting one, and soon, it's going to be back to the scary real world, having lost the ability to hold conversations with people that aren't Caribbean medical students. "Hey, how are you doing? So... who's running for president? Did you catch the last season of that show that ended three years ago? Don't you hate it when you're trying to watch an episode of House, but the channel feed keeps switching between the Colorado and New York feed so you can't tell when it's on? It's about as reliable as the egg supply at IGA. Wanna go get a Carib? How many EC do they go for at that bar on the corner? As long as they're not blasting soca, know what I mean? No?"

Also, there's the scenery. I love the scenery in the states too, don't get me wrong, but even after nearly two years, I frequently look around and am taken in by the surreality of essentially living in a Windows screensaver. Though I probably go to the beach and dive way less frequently than I did in California (and no, I didn't live near the beach), the fact that it is so close is something I'm always aware of.

So it's a whole weird thing. I'm having to do "next stage of life" things like register for the USMLE, which was always this huge looming someday off in the distance thing and now it's a 700$ charge on my credit card and I'm having to choose date periods and get photos made for my ID. I'm having to figure out what I'm doing for rotations, when I'm starting them, and how I'm handling the period in between rather than just continuing on the island, paying my rent. I'm dealing with what I'm going to do with all my stuff, people are touring my apartment, and it's a huge change.

I'm going to get to see my family again. I'm going to get to have seasons again. My clothes are going to last longer and can be varied. I'm going to get to have fast food and cheap meat and ethnic cuisine, and trips to the grocery store, and quick pick ups of anything I need as close as the local love/hate Walmart. I'll be able to drive. I won't need to book a boat or a plane to anywhere outside of an 11X22 mile radius.

So it's all... blah, mixed up inside me. And making it hard to study. As is the suddenly rescheduled meeting at 5 tonight.

To change gears abruptly (much like my moods at any given second), I guess I'll Sandblast-talk, since that's an actual event rather than some diary description of my overall feelings.

Since I wasn't behind in school enough, I chose to hit the last Sandblast for me (hopefully), which had a Halloween theme, making it particularly appealing because I love Autumn and Halloween, and they don't really do either here. I had to grab and orange AND black t-shirt since they not only had the whole Halloween thing going for them, but chose to mesh it with a Dark Knight Heath-Ledger-as-Joker pumpkin "Why so serious" motto that just upped the awesome. Well done, designers.

For a change, I actually got there close to when it opened rather than sleeping late and not getting there until they were half out of beer thing that I normally do. I also chose to maintain a steady state of alcohol in my bloodstream rather than gorging myself on it first thing, falling over, and being done for the evening by 5 PM. Muchhhh smarter. Makes for rougher mornings though.

I had promised Ashley a beer pong partner, so we first cruised the area a bit, grabbed our mugs, a well-made cocktail from the bar, hit the food tent and relaxed on the beach for a bit. Refilled a bit later on inexplicably pink beer. We attempted to figure this one out for a while, but it turns out, pink was supposed to be red for *blood* beer. While it ended up looking like we were drinking the run off from an eviscerated Care Bear, it's probably better off that there was not a sufficient amount of red food coloring to turn the beer *really* red or the clinic probably would have had a run on it the next morning the likes of which has never been seen.

So beer pong started up and we wandered over, and promptly watched a couple vet students run the table to a degree that it was surprising they were still standing.

To our credit, we got them down to the last cup to sudden death, and that is *quite* an accomplishment, but sadly, they got it in for the win. Much shame. Ran into Jay and Jordan, hung out with them for a while, and got a full thing of beer dumped over me by two guys who were "fighting or are they wrestling, I'm not sure, let's just move". Fortunately, you wear disposable clothes to Sandblast.

Ran into Grace and Dem and headed down to the Owl to watch the game. Good chicken wings there but unfortunately, only crab racing on Monday nights, which I still haven't seen. Some pool, some jeopardy, a good night swim, then home to preen for Bananas, which I ended up leaving with Grace and Dem at around 5 in the morning. Gods.

If this seems excessive, this is pretty much "just another Sandblast". One thing about medical school is that it destroys your sanity *and* your liver.

So now I'm paying the price and attempting to catch up pharm... which will leave me catching up renal in pathophys, which inexplicably puts me in the same place as everyone who either studied for the entirety of last weekend OR spent the entire weekend drinking. It's like the entire class procrastinates together and always seems the same number of lectures behind. See why I love these guys?

Oct 19, 2008

Fully Sandblasted

And infinitely behind as a result, though I got a few hours in at Taylor today. Sorry for no updates for a while, but I'm out of ambien, which is making me a very cranky and addled Ishie, indeed. And I'm due to report for surgery rotation in the nasty hour of the morning and hope like hell when I get back I'll be able to get in rather than having my apartment manager bang on the door to show my apartment when I have the Do Not Disturb sign up for the third consecutive business day in a row. Gods man, I sleep DAYS. And have since I got here. This should surprise no one. More later and nighty night.

Oct 9, 2008

Better Start

Though wrong class.

Clinical Skills is canceling our lab sessions during finals week AND canceling one of the case reviews so we can instead review physical diagnosis. This is not only helpful for the OSCE, but also helpful in my *not* ineptly manhandling the knee of a guy with a meniscus tear who I doubt was appreciating the fumbling.

In the other classes, so far, notes are not only on time... they're EARLY. I'm getting the vapors just thinking about it.

We had the mega-meeting, and holy crap, was it ever a mega meeting. The course directors from ALL the courses were there, as were the deans, as were about 150 people, two mics in the aisle for us, and from the line of students talking at the mic, we went 30-40 minutes over what was planned.


Way way beyond what I could have ever hoped for, so I'm being optimistic, because it seems like some good people are listening, and also, so far, no one's threatened to kick me out of school and set me adrift on a flaming rowboat saturated in shark pheromones, so that's good news.

Will things be made perfect? Absolutely not. Will this term end in such a way that we can't all look back and say "that would have been made easier by _________". Will the first floor library computers ever boot up in under an hour, cease to crash, remove the necessity to reinstall the network printer and office ever time you try to print an objective sheet? I fear not. BUT, as I've said before, I think there's a change for the positive, and I'm also really really proud of my class and our response. I think the meeting went well; people expressed themselves professionally, and it didn't devolve into the sort of heated yelling match that occurs in... well, most houses of government, but you get my drift.

In the meantime? 600th hash!! Pictures pending. It celebrated the occasion by raining for the better part of the day and stopped right before the hash, which made the trail a mudbath. I have honestly scrubbed my socks in the sink three times with detergent (putting those in a communal washing machine would be ruder than I could possibly be) and you can only just tell they're white. When I got back from the hash, I tiptoed across my foyer shedding as little nastiness as possible to keep my housekeeper from killing me, and stepped directly into the shower with all my clothes on, including my shoes.

Yeah, have you ever been *that* muddy? It also reached the stage where I stopped trying not to fall because I wasn't going to get any muddier, which makes the passage easier.

We were also the last group getting in, so everyone was worried about us, which was sweet, and we had a guy in back coming behind us to make sure no one got lost along the way, and by the time we got back, there were two guys with flashlights coming in from the back, so it's great that they really watch for people so no one gets stuck in the rainforest overnight.

In two stunning displays of brilliance on my part, I both took the false trail AND had such tunnel vision that I missed the 'turnaround X' on the false trail and had to be chased down before I wandered off a cliff at dusk, AND at one point, somehow mistook white flowers for shredded paper, missed an extremely obvious turn in the trail, and strode directly into razor grass, which is aptly named.

The thing about razor grass is that not only does it cut you, it sticks to you, which means that attempting to pull it off then cuts up your hands, so you're forced to make the decision "do I want to just leave this thing draped on my shoulders while it continues to saw into me, or do I want to grab it with my fingers, which have tons more nerve endings?" Decisions decisions.

That one got met with our patient guide asking me, genuinely mystified, "Why did you do that?" My response was "because I'm kind of an idiot." He refrained from saying "only kind of"?

There were some steep slippery portions of the trail that required a rope to get up or down. I thought with my underdeveloped chicken biceps that it would consist of me getting down two steps and then falling forty feet backwards into a tree, but it wasn't half as hard as it looked (the rest of the trail was) and about three times as fun.

The hash did mean getting to devirginate Lori, Krash, and David. Woo hoo! But we got back too late to drench them in beer and give them a certificate, so next time.

Well, bedtime. I need to ingest a lot of GI tomorrow so I can figure exactly what I'm contracting from my water supply. The paranoia I've held onto since parasitology not-so-coincidentally evaporated when I ran out of filters, but I'm not dead yet, and so far nothing I've experienced physiologically this term could be described as "explosive", so I'm putting it in the "win" column.

Oct 4, 2008

Good start

As I've posted before, there's been some major uproar regarding the current 5/6 term stuff, and I think for good reason. I'm still in favor of instituting the old grading scale and to open up more lines of communication, BUT...

Notes for GI, which starts on Monday, were already in the lecture hall, facilitating pre-study for the industrious folks, and ensuring even the lazy people (like me) that they will be able to follow along in lecture.

Either the physio people had another place to go or they were on an off week because we got booked use of the path lab today versus the last session where we didn't have a room and got booted back to the lecture hall. While I complained about the path lab in fourth term because the A/C was not keeping up with how incredibly loud and overcrowded it was, it seems to work decently for its purposes, plus nothing makes you appreciate the path lab more than trying to conduct a discussion group by yelling down a row in Bell Hall before having to go in front of a lecture theater with a microphone to present to 150 of your classmates on 10 minutes notice. Stage fright much? So I think this format works much better. I was actually able to interact with my group and the projection of the cases on the screen means everyone can see them and contribute equally.

I don't know about the "think on your own first" format to BSFCR, but the fact that they've changed it and are now posting the enabling objectives the Monday before is a big plus and a strong indication that someone's listening. I also like the one case per set of questions format to having the exact same case with two groups presenting 8 different things, which gets repetitive without being helpful and takes forever. Much appreciated.

The list of "question types" at the end of BSFCR session. YES. That is the sort of thing we need.

The agreement to post the BSFCR cases on Angel. THANK YOU.

The addition of the points to both pathophys and BSFCR grades. This was definitely necessary and I really believe we need a consistent standard for the future, but leaving the average at 64 really would have been unacceptable.

There is an open forum to discuss the problems of this term with the department heads on Monday. That is a HUGE step forward. I don't know what will come of the discussion, but the willingness for this meeting to happen is definitely encouraging. Thank you to the SGA for meeting to convey the students' expressed desire for an open forum and thank you to the heads and deans for agreeing to meet.

The GI objectives, which were posted early, had a change that was posted on Angel, and the announcement was made along with an apology for the inconvenience. While this doesn't seem like a big deal, for me, it really is. Part of what has really gotten on my wick previously is a feeling that any inconvenience, even minor, that the students suffered was somehow our faults, and informing us of it was a favor. A "sorry guys" goes a long way, at least for me.

Though this has absolutely nothing to do with the pathophys or BSFCR classes, my freaking sixth term loan check arrived on schedule. Trumpets and fanfare, people!


This doesn't mean all is sunshine and rainbows, of course. And I know there's going to be obnoxious problems that persist right until the end, because there's been things about every term that I think could have really been changed to the benefit of the students, but I felt this one needed special address, and it seems like the problem is being taken seriously. So long as students are able to have a voice if the going gets tough enough, I'm willing to take difficulties (though will certainly whine about it) if there's an effort to fix gross malfunctions in the system. It's only when I felt that the departments were completely unaccountable for any action with no capacity for a change to occur in our better that I honestly had started to regret coming and not pursuing a different route to doctorhood, and while that sounds extreme, that's honestly how I was starting to feel.

Let's hope this is a new beginning for all of us.