Dec 26, 2010

Good news

My dad got discharged from the hospital on Christmas Eve; he's doing much better, sounds really positive, and is making all those lifestyle changes the majority of my patients refused to consider, so that's a huge load off my shoulders, and I get to go see him in a couple of days before burning back to NYC just in time to conscientiously avoid Times Square for New Years.

Speaking of Times Square, I was there today, because I was trying to score Broadway tickets but gave up because they're expensive even on discount, and more importantly, scoring those tickets would have involved standing in an outside line during that whole blizzard thing we're having today.

Because on my mom's time off work, I spent a great deal of it either interviewing or lying in my house in a useless deep depression prior to Christmas, I decided we'd go out today to Midtown 'in the snow', maybe ice skate a little, and do it up. "In the snow" is quite different than "in a blizzard". Today while... let's say... fording a path through Rockefeller Center to see the tree, the wind and temperatures were such that my scarf actually froze through solid. I also had the same little faux-fur lined hood black parka that *everyone* in NYC owns, and that caked with snow and froze too.

It was a good reminder that though I typically avoid Midtown, I actually do like Grand Central Station a lot, which is where we ducked for cover for a while to "see the holiday decorations and eat", by which I mean "get out of the 40 mile per hour blinding snow, and was that thunder and lightning, holy crap get inside".

Christmas was nice; my mom came along with two of my friends and I cooked a massive feast thanks to a generous contribution of fake talent both from, plus Yoshie taking on my roommate's usual role of following me around the kitchen cleaning dishes and trying to keep me from lighting stuff on fire.

The menu:
Spinach salad with mandarin oranges, dried cranberries, red onions, balsamic vinegarette and feta.
Rosemary lamb chops with balsalmic reduction
Yams with sugar and orange peel stuffed inside a shelled orange and coated in a caramel pecan sauce
Cashew broccoli
Ice cream sandwiches from Bierkraft (they're amazing; I can't top them)

This is probably more detail than anyone wants, but my cooking usually amounts to searing a steak or boiling ramen water, so I was pretty pleased with myself. Plenty of Christmas movies, wine, beer, and eggnog too. Traditional route.

Christmas in NYC reminds me of why it's going to be so hard to leave NYC. Well, currently, it would be difficult because I'm snowed in, but yesterday, we managed to procure lamb chops, eggnog, and beer on Christmas Day. On Christmas Eve, I was able to snag gourmet macaroons at night. I'm spoiled completely rotten. I kept saying the adage while I was cooking of "If I screw this up, we can get take out." How can I live elsewhere?

I'm off rotations right now for interviews and the holidays but start up again after New Year's. The whole reality of not being a medical student anymore after April keeps hitting me intermittently.

Dec 19, 2010

A pause, not one that refreshes

I was out earlier screwing around with my friends, eating one raw oyster from a good oyster bar because they were too expensive to order more, drinking, waiting two hours so that we could have fries at the Breslin, and getting mysteriously screwed out of the hot chocolate we'd planned on.

We're goofing about baby names due to one of the party having a bun in the oven, and that became the conversation as my roommate and I did our nightly home stuff... in the kitchen:

"I knew a girl that wanted to name her baby Diamond Katana. I begged her to have her tubes tied."
"Oh, that's pretty."

My phone rings and it's my dad, and sounds bad on the phone and I'm punchdrunk and slaphappy at this point and I say "TELL me you are not flaking out of coming down here on Christmas".

At which point, I get to feel like a complete asshole because the man's just had his first heart attack, is in the CCU, and he's scared, and no one's telling him things, and he really wanted to see me. For that last part, he sounded like he was crying, and I never see my dad cry. People barely even see me cry.

I'm split in two. I'm that family member calling the desk and wondering about prognosis, and if I were able to be at the hospital right now, I'd be the one looming around. Since I'm not there, I'm the bastard family member just leaving someone in their hour of need. "Daughter," they'll say. "Hasn't seen the guy in over a year. Bet now all of the sudden, she starts threatening litigation and all other manner of crap. What a scumbag".

The split was my first year medical school split. My maybe I can help even though I can't do anything. My maybe having the knowledge of what exactly happened will secure it in my mind so I know... well, I don't fucking know, how worried I should be?

So my first questions to my dad are who his doctor is, if I can speak to him, what was the quality of the heart attack. I call the charge nurse, apologize for bothering him, explain that I'm a medical student, so he'll dish me the dirt... STEMi, for starters. Shit. 100% occlusion of the left anterior descending artery. (roommate's response: that means he must have crazy collateral circulation) (Me: way to make lemonade out of those lemons). Stint in place, thrombolytics pushed within 90 minutes, standard stuff. Watching him in the CCU. Quick, med student. What's the most common cause of death within 24 hours of a heart attack? Arrhythmia. What complication arises within 3-5 days? When will the patient be able to return to physical activity? I'm getting pimped by my own fucking subconscious.

Through that din, which without the personal involvement, is similar to my normal mental din, is the thought that I don't want my daddy to die. I don't want him to miss Christmas. I want him to come to NYC so I can take him to nice places to eat, maybe a show on Broadway, show him the tree at Rockefeller Center, because turista nonsense or not, it is beautiful, and skate for him at the same center, because he always wanted me to when I was a kid and I couldn't. I want him back to NYC in June, when it's not horrendously cold, so he can see me graduate, become a doctor for the rest of my life, everything I've worked for, and I want him to be embarrassing me from the audience by yelling my real name too loudly when I walk across the stage.

Med student me knows that while this period is critical, it is also frequently survived. People live years and years post heart attack with little incident. A scare tactic to really motivate you for your diet. I know all this because I've seen all this. I've disinterestedly draped a stethoscope over all this. "You're stable, sir. Please relax. Turn your phone off. You're in the CCU. No, I cannot talk to your daughter right now to tell her everything's fine. I'm a doctor. I'm busy."

But for now, Dartmouth looms, as do a bunch of important travel decisions. I really really want to just go back to before that phone call.


Nov 22, 2010

Hopping along the interview trail...

My five year plan? Fellowship. Maybe two. Ten year plan? Good question. Should have an anwer to it. Don't. Why did I go to a good undergraduate program, excel in it, and then head to the Caribbean? No money for AMCAS stuff at the time. Do I want to go back to place-of-birth? Don't care. Am I applying to other specialties? No. What brings me to _______? You agreed to interview me. Why pathology? I love it. How long pathology? I dunno. It became apparent once I realized "medical science geek" was an actual job. Usually you don't find that kind of career specificity outside of "chocolate taster in a stripper factory". What did you learn during your pathology rotations? That gout is waaaay less disgusting under a microscope. Tell me about your research. Apparently, it's weird enough to gross out people that do this for a living. Do you have any questions for us? I've been stalking your program on the internet, but I'm still going to ask about your board pass rates. How many other programs have you applied to? Many. I mean, only yours. What are you looking for in a program? One that will hire me. Please note that I am, in fact, wearing a suit. This should adequately convince you that I totally don't spend the vast majority of my life wearing running shorts, tank tops, and penguin holiday socks (my feet get cold).

This is a brief summary of interviewing... that, plus becoming intimately acquainted with every form of public transportation ever conceived by man. And I'm sure with my upcoming air transit necessity, I'm going to become intimately acquainted with some TSA agents. Blah blah blah, relevant news. I'm actually trying to read the New York Times right now because there's a free app for it, I have a lot of downtime on trains, and I'm running out of ways to launch angry birds at pigs.

I've been running down my NYC "to do" list. I cheered for a friend in the NY marathon (that's the closest I'm going to get to running one, guys), had a fabulicious birthday weekend in Atlantic City, got smushed in the Greenwich Halloween parade while appropriately dressed as a bedbug, saw dancers reenact multiple seasons of Dr. Who, all while getting my hospital rotations on and obsessively checking my student email account every 16 seconds for the remote possibility of an interview. I've gone from fastidiously trying to impress attendings with my intrinsic knowledge of their field to trying not to get them too pissed off by missing too many days for interviews. I've come to accurately read the expression on their faces as they start to explain patient management algorithms to me, remember that I'm going into pathology, and trail off hopelessly as I lean forward and nod politely. I'm fighting the dregs of senioritis while being more aggressively 'scheduled' than I have perhaps ever been. I've developed a term for this period of my life known as exhaustilerating.

Nov 19, 2010


Oh Harvard; you and I could have been so close. I mean, I know I'm from the wrong side of the tracks; I've been around, and if your parents had ever found out, there'd have been hell to pay... I mean, I'm a shark; you're a jet. I'm not even a shark... I'm a goldfish, but baby, we could have made something work in the end. When the love is there.

But I get it. You want to be left alone. No more 3 AM phone calls from the bar begging you to reconsider. No more violated restraining orders. No more facebook friending Yale and asking about you to see how you're doing. It's okay. I just hope... one day we can be friends... you know, maybe when fellowship season rolls along in a few years. Hey, I'm just throwing it out there. That's cool. Love ya.

Oct 26, 2010

More Hijinks

So, there's often talk about us medical types being impossible to talk to by anyone not specifically ensconced in our field, because we're dorks with god complexes who can't fathom anyone not being interested in our "most disgusting/disturbing digital rectal exam" stories at dinner.

In an attempt to derail myself (usually unsuccessfully) from this white coated stereotype, I'm trying to get an appreciate of the arts. It still makes me insufferable, but a different kind of insufferable, and that's all I'm going for.

One of our friends is a dancer, thus has known about this adaptation of the usually mind-numbing (sorry) Swan Lake. After confirming that would would be able to get the cheap nosebleed seats (last student loan ever!), we made a Wednesday of it.

The reinterpretation looks something like this:

As far as art, an interesting adaptation bringing swans more into their actual role as aggressive nasty creatures rather than the ballet's traditional role, which has them as fluffy females helplessly waiting on a handsome price.

As far as my own perspective, replacing tutu clad ballerinas with hard bodied males wearing nothing but feathered capri pants and extended guyliner wins two enthusiastic thumbs up.

Because I like emotional whiplash, Thursday we headed to the Oktoburlesk celebration at our local Gowanus dive bar. They also featured an accordion/alpine horn player and I did something I referred to as "polka" but to the untrained eye, probably looks more like spastically hopping around on one foot while wearing heels. No sprained ankle this time.

Also, sometime in the weeks before, I finally managed to get the tickets to the Daily Show. That's have been on my New York bucket list since I got here. With Sam Harris as a special guest, which gets me street cred for something. Now, onto the Colbert Report. And yes, when Jon Stewart walked out, I screamed and clapped like a Jonas Brothers fangirl. Yes, he is that hot (and short) in person. We had a guy warming up the crowd that was fantastic, and we all got free audiobooks, which was an unexpected bonus, plus directions to the Jon Stewart-approved BYOB Thai restaurant we later attended.

Oh, the life of a fourth year would be sweet if I wasn't about to eat about two grand worth of airfare. On that note, I'm still really thrilled about how interviews are coming, and I get to go to New Orleans, which is always exciting, made more exciting by going in the dead of NY winter.

Speaking of fourth year, I'm actually enjoying Family Medicine more than I expected. Though it will hardly divert me from my desired route back to microscope-hugging, it's the closest I've come to feeling like a real doctor because it has all the associated doctor framework. I thought Internal Medicine would feel that way, but IM seems to be more constructed from existential angst and despair. Outpatient clinics get the have patient, check patient's wellness, provisionally diagnose patient, possibly refer patient to specialist. Follow patient's progress. Check on patient in a week to a month to gauge problem list. Doctoring. I enjoy it a lot; I'm just not sure I'll enjoy it in twenty years, nor will I enjoy the absolute necessity of setting up my own practice for it, failing miserably because I have no business sense, and waiting tables at Applebee's (I'm your server, DR. Ishie) due to my inability to run a practice.

Oh yeah, and I like pathology a heck of a lot.

Oct 15, 2010

In other news...

I forgot in my last blog, but remember that tornado I told you guys about um... last month? Well, this last week we had an unexpected torrential hailstorm that dropped about an inch of quarter-sized ice pellets onto our porch. WTF is going on in Brooklyn?

Oct 13, 2010

Success is... expensive

Hi all, it's your regularly absentee blogger again, stumbling from the hours-crunch of "trying to have a night job" to "partying for fourth year". Plus there's the whole: "I don't want residency directors to figure out who I am, spend the next week reading this blog from start to finish because they have nothing else to do and then figure I'm too unprofessional to ever give a job in a desirable location, ie, the place in the middle of the Venn diagram that encompasses "places close to a large body of water" with "places where cockroaches can't fly". Or something.

But my title... I'm getting interviews! Wahoo!!! In many different places!! Wahoo! Where I have to fly to... um.. wahoo... during scheduled clinical rotations... hmmm... hope they don't mind that... in the middle of the holiday season... ooh... off my last loan check, which is supposed to last me until July... ergh... hurk.

No, it's exciting though. It really is. I'm actually applying for a job as a doctor. Which is really frigging bizarre, and I feel like the gap between my position and the residents is shrinking. When I started my third year rotations, I was scared of interns. Little things keep emphasizing to me that it's next year. Before next season clears up this season's story arc on True Blood? Doctor. Before my lease is up? Doctor. Half the stuff I receive through my school account is addressed to "Doctor", because, eh, close enough. I even played the doctor card to get my stuff back at one point, because I figure if an airline loses belongings that have a stethoscope and a white coat in them, it's fair game.

And it's a title change thing. Since I'm fundamentally afraid of marriage, I never really thought about the Miss/Ms/Mrs transition, but once I get this degree, I get "Dr" before my last name for the rest of my life, even if I spend the rest of my life selling Amway. It's extremely weird.

Meanwhile, I spent yesterday in conference, teaching me a number of things.

1. Trapping medical students in conference while you spend an hour talking about the hospital's financial restructuring has become an obsolete form of torture due to the invention of the internet phone. I never got a chance to read Crime and Punishment in high school, and it's actually pretty darn good. My colleagues seem to equally be enjoying video games, Facebook, email, and a USMLE question prep app. The residents, similarly occupied. Seriously, no one cares.
2. Despite being in conference, "I just came in for ______ and these expletives want to get all up in my expletive" is a far more common primary patient complaint than I would have expected. All I ask for in my doctor is that he not lecture me about biological clocks when I tell him I've never been pregnant. I'm easy that way.
3. Why must every conference room either be as hot as the surface of the sun or as cold as a meat locker?

One the plus side, drug company visit during conference plus radiology company visit during clinic today meant free lunches *two days in a row*. To a penniless interview-scheduling med student, this is the frigging moneyload. I also got to work with my favorite surgeon despite being out in other-Brooklyn and not being in a surgical rotation. Sweet.

Roommate and I are having an October horror-month. Paranormal Activity is freaking scary. And no, I don't believe in the paranormal, and my current favorite show has a serial killer as a protagonist. Still freaking scary.

Update: it is both wonderful and unfortunate (calorie and money-wise) that I live near the food mecca of the universe. Half the places roomie and I regularly frequent seem to be featured on the Food Network. This is going to make it very difficult to leave NYC.

Sep 21, 2010

Blow me away...

For the uninitiated, that there below is Brooklyn. More specifically, it's near the part of Brooklyn *I live in*.

And that, over on yonder screen, is a frigging tornado.

I try not to ask for much, guys... I mean, some school-love every now and then, a pat on the back from an attending, unchecked wealth and power... what I'm saying is I'm an ask-not sort of gal.

But I don't think it's asking too much to ask *tornadoes* to stay out of my hood.

I lived in California; I accepted that earthquakes are part of the package.
I lived in North Carolina; I accepted that hurricanes are part of the package.
I lived in Grenada; I accepted that hurricanes are part of the package though we inexplicably got an earthquake too. Maybe it's me.
I live in Brooklyn, I accept crime, the warm smell of dog piss on the streets in the summer, and the potential to freeze to death in the winter if you can't find a cab. My point is, TORNADOES ARE NOT PART OF THE EQUATION.

And in truth, tornadoes are rarely the part of any of my equations because they scare the crap out of me.

So basically, while I was passing hours on call down at Coney, just as I was let out (of course), I hear what I had believed to be a truck backing into a loading dock. Turns out that was just the thunder. When I get home to my street, the front of one building is off, there's tree wreckage everywhere, the fence has been blown up the street, and my walls had dirt streaked on them because the wind kicked up the dust from the screens. Whoa.

In other news, I'm doing my medicine sub internship right now, which is a rough commute, topped by trying to get a job at night, topped by scheduling residency interviews (it's that time, kids!), which leaves me no time to do laundry.

On the residency front, I kicked out 57 applications for that field that I love and am just waiting for my letters of recommendation to be scanned in so that my application can finally be complete. Huzzah! I've heard back from three programs so far, two offering interviews, and one stating they will schedule and interview for me when my LORs come back in, so I'm calling that one a half interview.

Sep 2, 2010

Tales from the Crypt...

Day 1:

Ishie: Ooh, an autopsy in the basement! What a wonderful learning experience!

PA: You two go down and label the cassettes. We'll be down soon.

(an hour passes)

(morgue phone rings)

Other med student: Um... hello?


Just kidding.

Voice: Oh... are you guys still down there? We're doing the autopsy tomorrow.

Day 2

Ishie: Ooh, an autopsy in the basement! What a wonderful learning experience!

(PA unlocks door. Grenada sized roach runs across floor.)

Ishie: AHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!

(Other med student smashes roach. Roach flips on back in center of floor)

PA: So, you won't need too much protection for this one... just a gown, gloves and shoe covers... you can come get them...

(Ishie remains pinned against far wall with arms crossed across chest. PA looks at her and looks at roach)

PA: You're a pathologist!!

Ishie: I'm not an entomologist!!

(PA sighs, takes broom and shoves roach through drain in floor.)

PA: They come up through it; I push them back through it.

Ishie: AHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!

Aug 27, 2010

Personal Statement Blues...

So that whole application season thing is coming up again and like most of the red tape involved in becoming a doctor, it's a headache.

I've never had too much trouble writing, and it used to be the normal way I occupied my free time before I discovered beer, boys, and youtube...

Where I do have trouble is selling myself. I have no particular idea how to actually convey to others that I have qualities worth hiring without sounding like a tool or downplaying myself to such a degree that I can't even figure out why anyone would hire me.

I also find my best writing comes out of either humor or anger or a combination of both, neither of which are qualities befitting a personal statement. Hire me because when stuff sucks, I'll make cracks about your program that make the other residents laugh. But rest assured, it'll be at your expense.

I also have trouble conveying why I love something, because while I can write a dissertation in iambic pentameter about why I hate something (war, construction workers jackhammering outside my apartment at 11 PM, Nicolas Cage), my general way of describing something I like is that it's "awesome".

So, this means my most natural personal statement would read... "Pathology is so so awesome. I love seeing what the problem is under a microscope because it's the closest anyone will ever come to a diagnosis. I'm fine with bodies since they complain far less than living people and I love genetics and microbiology, even though anyone with half a conscience shouldn't trust me with the former. I did a couple pathology rotations and they were awesome. I used to work at the Donated Body Program and that was super awesome too. They let me play with bones a lot and I got to do forensic research no one will ever be interested in. You should hire me because I think pathology is as awesome as you guys probably do. Peace. PS, I've never seen a single episode of CSI so please don't think I'm trying to jump on the bandwagon. -Ish"

Less than convincing... immature, unprofessional, all those lovely qualities I embody, but you're not supposed to put them a personal statement.

Instead, I currently have something that is pleasantly wishy washy and sounds insincere even though it isn't. I didn't have any one event that led to my pursuing pathology. I didn't have a beloved grandfather who just would have been saved if some go-getter had diagnosed his _____ correctly. I wasn't on a plane where a passenger collapsed and someone screamed for a pathologist, and they ran up, did a biopsy and the patient lived to see another day.

When I was a girl scout, I wanted to diagnose labs instead of people. When I was 13, after abandoning my dreams of marine biology because I get so seasick I envy the dead, I wanted to be a virologist. Probably due initially to Dustin Hoffman. Then when I was a candy striper, I got sick of wheeling patients around and providing comfort around day four and spent the rest of my time there organizing slides in the path lab because it made me happy even though I had no idea what anything was. I found fourth term WAY more fun than second term because I like path and hate physio. I'm a lifer. But expressing that in any form either sounds like I'm lying or like I'm severely socially maladjusted.

Pathology makes me content. I don't run home with awesome stories largely because no one would be remotely interested in what makes my day fantastic, and my best shareable stories from it tend to be disgusting enough to significantly limit my audience. People are excited by stories about gunshot wounds and CPR... hell, I am, and I've run home enthusiastic when they've happened in my other rotations... but once that adrenaline wears off, I'm left with... what? Surgery was cool until it wasn't. Once the excitement of a case wore off, I wasn't left feeling content; I was left feeling bored and frequently frustrated. No answers and no diagnoses. When I'm doing mind numbing number crunching in the gross lab and entering standard templates into the computer, I feel a general sense of peace and satisfaction in the downtime that I have not found anywhere else. Why is that so hard to commit to paper?

Aug 16, 2010

Oh right, the test...

This sort of thing gets weirder and weirder that farther you get in medical school, once stress gives way to apathy and exhaustion.

I got a Wii!! At long last! I can lately join the awesome gaming generation as my treat for finishing that 9 hour beast of an exam. I also had friends take me out to Chip Shop the next night so I could cram some deep fried Reese's and a few English pints. I'm not even sure which is worse for you, but I'll post from the hospital over whether my heart's failing before my liver is.

The exam... boy howdy is it long. Like LONG. Like kind of over any stress you were experiencing and "I wonder how many points I'd lose if I just went and saw a movie in the middle of this nonsense" long. The questions are long. The whole test time is long. The fact that you get 45 minutes of the day to do anything you need to do and it takes 5-10 minutes to sign in and out means it's long and you're hungry. Or dyspeptic from trying to swallow an entire peanut butter sandwich and then trying to shove it a sufficient distance down your esophagus by pouring Red Bull on it and hoping the bubbles will dissolve some of it. Hell, the stuff tastes like battery acid anyway; it should make some headway.

I took it afternoon until night, as I mentioned, which was awesome, though I closed out the place, and lo and behold the place is right across the hall from the offices for Air Jamaica, which is nice because I guess if you do badly enough, they can send you straight back to Grenada without ever letting you set foot on New York soil again.

To be fair, the people at the testing center were really nice, very chill, and the temperature was good. I was able to bring my own foam earplugs (call ahead and ask your center) which is great, because the silencers provided are identical to the ones that they use at shooting ranges which makes them heavy and tight on your skull. Good for drowning out the .45 in the next booth. Overkill when you're trying to think while drowning out the keyboard sounds in the next booth.

Despite the preventative measures, I would recommend taking as many breaks as feasible. Get water, go to the bathroom, cram some calories and get back in. Stretch your back and legs, make a Home Alone face in the mirror, chuckle to yourself and go for round 2, 3, 4, 5, 6, 7, or 8.

Don't overthink the questions because they give you a lot to overthink. If it seems right, just pick it. If you're clueless, pick the most likely (eliminate the obviously wrong) and move on, mark it later.

Getting in and out is starting to encroach on the airport's turf for security overkill. I had to get frisked before going back into the testing center each time, and though she did the job right in front of the security camera, I have a feeling the girl responsible for feeling me up felt as ridiculous about it as I did. That made me feel better about the whole thing. They didn't make me take my shoes off though.

Looking back, I don't really know what I would have done differently studying-wise. It seems like any moment I didn't have my head buried in UWORLD questions was a wasted one. There were still a lot of wishy washy weird judgment call questions, but I don't think any resource could really get you ready for them.

How do I think I did? Geeze, I have no idea. I think I passed, but once I'm getting below an 80 on a test (which I'm guessing I did on this one), I have *no* clue how I do. My mom's set on 261, which I think is about as probable as my riding into a residency at UCSF on the back of a unicorn, but it's a nice thought.

Also, with the exception of recalling some questions almost in entirety (though I was better about that on Step 1), I get massive testing amnesia. I go in... I vaguely remember things like "Oh, block three was really sticking it to me" and "Oh crap; out of time" and "AAAHHHHH MATH!!!" and then I walk out nine hours later feeling puzzled, brain-enema'd and occasionally vurping up bits of Red Bull. I wonder what happened. I go home, watch Futurama and go to sleep. I party the next day and then I sleep solidly for the two after that. Not hungover; not wildly stressed; just completely mentally erased.

So there you have it folks. Taking Step 2 CK is like getting roofied, waking up hours later with a hangover and your kidney missing and the only clue left behind is a note someone's written in lipstick on the mirror and it says "Your testing session for USMLE Step 2 Clinical Knowledge has ended. Thank you for participating in the United States Medical Licensing Examination. Close. (follow the white rabbit)"

And you're just surprised you can still read.

Aug 10, 2010

Oh, it's here

With considerably less holy crapping than the first... but time will tell.

I'm taking the Step 2 CK later today, so naturally that will be followed by probably very little helpful information since the USMLE wranglers have me so paranoid that if I say to a friend something like "Whew!! Should have studied more epidemiology!" (that's just an example; I swear I haven't taken it yet!! Don't kill me!), I'm convinced I'll hear the opening to Ride of the Valkyries and black helicopters will swoop down, whisk me away and strange men will waterboard me... or feed me okra or something. And the last thing anyone will ever hear of me will be an email from my clinical coordinator saying "You STILL haven't written your personal statement?"

Aug 6, 2010

Bored now...

The problem with being an intrinsic night owl the second you're deprived of an attending who would take you not showing up at a rotation until 3 PM somewhat amiss, is that you start studying late thus your study breaks come around... oh, say, now, rather than at a time where you can spend them doing anything fun.

So my Step 2 CK is in four days, and I'm trying to stay motivated, which is difficult because as noted above, I'm bored. I seem to have weaned myself off the crippling levels of stress that kept my blog so um... colorful... through my early med school days, but losing that overwhelming anxiety is also killing my drive to do things like study straight through for 48 hour blocks. That's probably a good thing. I also live in NYC with an awesome roommate, which means at any given time (even now), I *could* be forgoing this study thing entirely and replacing it with whatever the heck I want. Live music, transvestite burlesque shows, 2 AM cupcake delivery, microbrewery sampling.

But whine whine, that all ends on Tuesday and then I have some relaxation. By relaxation I mean, do a case write up in the hopes of squeezing a last minute publication under the wire, write my personal statement, and upload all my crap to ERAS because I'm a horrendous procrastinator that can only focus on one task at a time. Sometimes not even one.

Oh, though speaking of awesome NYC stuff plus night owl stuff, I'm actually taking my exam starting at 1 PM, because holy crap, that was an option. That means instead of spending the first three hours of the exam feeling shaky, exhausted, and smelling of Red Bull and fear, I can sleep until my normal hour, stroll to the testing site grabbing some tasty lunch treat along the way and be at my best when I'm actually at my best. Granted this will leave me strolling Brooklyn after dark, but for the luxury of sleeping in on board exams day, I will gladly sacrifice a maxed credit card or three to the urban jungle.

What else... I'm still in maximum amounts of love with my phone and it's letting me play with Wikipedia with enough speed and dexterity that I can study in places that aren't "in front of my computer where I'm getting foot drop from having plastic-chair ass".

That seems like a good place to end.

Jul 28, 2010

Too true

Hello all, I'm in USMLE study hell again though I'm taking a little bit of a turn from last year's Step 1 hell and making my current experience less hell and more "I don't have to be at the hospital! PARTY!!!!" Weirdly, it seems to be working pretty well though the actual exam will tell, but stress has always been my big killer on exams and enjoying life is making the gears run smoother. Plus I spent a great deal of this last year transferring a number of hospital lunch breaks into UWorld time at the library because sometimes that cafeteria pizza is just so gnarly that it's better to cram a granola bar and surf a computer.

Due to that tendency, I actually completed all 2200+ questions on USMLE World last night after a year long subscription to that brain-ripping, ego-destroying program, which felt a bit like this:

Of course, the actual test still comes at the end of this, which is sort of like defeating Mario Brothers only to discover that King Koopa is real and lives in your bathroom.

Speaking of random youtube videos, I chased this link thinking it was an actual tutorial on heart sounds because I suck at them and the brand new audio feature I experienced on Step 1 emphasized that to me. I admit, I loled.

And yeah, that's pretty much what I did on Step 1.

Anything else? NYC (as well as a great deal of the rest of the country) spent the last couple weeks being miserably unbearably hot. Like a good medical student, I chose to attempt to run Prospect Park on a day where the heat index was 105, which fortunately, at a mile and a half, my body saved me the hospital trip by crapping out on me entirely and made it difficult to even walk home. If my life were a USMLE World question stem, it would have read:

"A 29-year-old female with no documented medical problems is brought into the Emergency Department unresponsive, seizing, and with a body temperature of 109. She had previously been running in an unshaded section of the park despite an actual weather alert advising against doing exactly that. Despite aggressive management, she codes. What is the physiological mechanism behind her cause of death?"

If you picked anything regarding temperature regulation mechanisms or denaturing proteins, you're wrong. The answer is "mind-blowing stupidity". It's actually a more common cause of death than the usual statistics indicate.

So I consoled myself at my favorite bar with True Blood because damn, I'm hooked on that show and I don't get HBO at home because I'm cheap. Sookie.

Jul 12, 2010

Ways to make a good impression...

1. Come early
2. Don't leave until you're told to go. This may periodically involve staring at your attending an hour past leaving time like a dog waiting to be fed.
3. Ask questions at appropriate times
4. Don't write vitriolic, misspelled, profanity-laden hate mail to your entire department

Wait, what?

Yeah, so apparently some resident thought it'd be a swell idea to do number 4. Now, I grew up in a beautiful world where the internet was increasingly providing a veil of anonymity to flame warriors and Thundercats fanfiction authors, but how dumb can you possibly be? The resident pool within a department is not *that* large... you are in a group of people that has gotten to know you over years, including your mannerisms when you're at your worst (2 am post-scut) and your personal idioms, and if that isn't enough to protect you, blasting nearly everyone else in the department including your colleagues is probably going to narrow the suspect pool to the cat not mentioned in the letter. Not rocket science. Or brain surgery. Or garbage collection.

And yes, I realize the irony of pointing this out in a blog... but I've also been relatively cautious not to email said blog to any of my superiors with "RE: YOU SUK AND SO DOS EVERYONE YOU LUV" in the subject line. Plus I'm relatively sure most of my superiors already know exactly who I am and thus can avoid my application letters with impunity. I'm also hoping someone with a love of sarcasm and path-geeks will embrace me into his/her grasp and give me a job with the caveat that I'm not allowed to talk to others without a handler. Which I think is fair.

What else... ummm... I'm studying for that pesky exam that comes after Step 1 and before Step 3. I have 10 percent of the questions on UWorld left to do and am finally beating the clock by a fair margin while skimming the questions going "blah blah blah useless" and then reading the last line. I think after you do the first 1800 questions, you just stop caring, so I think I'm going to avoid my pre Step 1 anhedonia, but time will tell. The increased time on UWorld is also giving me an appreciated bit of quality time with my iTunes playlist so I'm discovering some new bands, by which I mean "bands that have been occupying my hard drive for half a decade".

I've been studying with a friend at various locales in the interim to try and mix it up. We had a conversation at an Asian fusion place (tres chic) about preventative screening measures because I'm useless at it, so we really know how to live it up. This is sort of a running theme from my "stercobilin in the line for the Finding Nemo ride" from a few years ago.

This is my last week of heme/onc, which I've really enjoyed despite having kind of a soul-crushing day that will make me more appreciative of being on the other side of the microscope.

I'm also learning that while I don't particularly care for Spongebob despite being a cartoon focused adult, he is absolutely hypnotizing to children. Like forget Lidocaine; the second they hear "He lives in a pineapple under the...", you are effectively dead to them.

I've also learned that I can be puked on without moving my hand or relaxing my grasp, which was a useful little piece of information about myself I had not previously been privileged with. Oh, the little bits of medical school that aren't in the brochure.

Summer got a little miserable so I've been basking in finally having an A/C and occasionally venturing out to hit concerts in Prospect Park or wander off to see True Blood in a place with both HBO and and cheap nachos. I drew the line at Twilight though. Shirtless werewolves? No thank you. Shirtless werewolves with extremely gratuitous violence? Shakespearean.

I also joined the Apple cult of iPhone because I'm a weak weak person and I'm too destructive to be affected by the network problems because everything I own already requires a case lest I spill stuff on it. Just ask my (miraculously still working) laptop, which survived the great Grenadian cornflake barrage of 2008.

Jun 23, 2010

Oh well whatever nevermind

Against all odds, my bag was recovered today AND the people on the phone through AA's lost luggage line were nice and polite. I had pretty much kissed off seeing my stuff again and also figured I'd have to get and finish a residency and hire a lawyer before I'd see any compensation.

I also sacrificed another year of my life to get a new phone. It's shiny. I'm getting used to having manual keys to type again.

In even more unbelievable news, today I... comforted a child. Somewhat successfully. I feel like now I should be in a CS advertisement jumping up in the air and high fiving something, since my usual response to human suffering is profound and visibly awkward discomfort. Maybe that studying paid off.

Jun 22, 2010

Luggage gone again...

Hmmm... brief synopsis that will be elaborated on later because my days up until yesterday were spent studying for Step 2 CS, flying to Houston to take my CS, and then hanging with family in Houston, and since then I've been alternately trying to figure out how to get my luggage back and how to get my insurance to give me a new phone since mine's broken. Which makes getting luggage back more fun...

So... CS: stressful, but not as stressful as I was expecting considering forced human interaction with people who are judging me is where I excel least (hello pathology!). Can't detail too much on the exam because they threaten us with death or something equally bad like not being allowed to take CK or something. Wait...

Also, practicing for CS is not only a good idea, but fun. I got to treat my boyfriend for 'lady bits problems' and discovered a crashing deficit in my bedside manner when I was practicing on my friend... you see, the chief complaint that was yelled to me (our version of the doorway information) was "fatigue". I open my door and there is my friend sitting there with my silk robe on backwards and her eye blacked out with makeup. After my first staccato burst of laughter, I extend my hand and find both of her arms similarly darkened.

So my response to the investigation of domestic violence is to laugh uncontrollably for 15 minutes while attempting to conduct an interview and being completely unable to look at the patient's face. FAIL.

Seeing family: Awesome! My little cousins are people now. They're also more polite than I am and address me by name and title, whereas I usually get people's attention by either saying "Hey!" or more frequently, by wandering obliviously down the street attached to my ipod until someone who wants my attention has to physically grab me.

The littlest one also wants to be a doctor because she wants to give shots, and asked if I brought any. Which is absolutely not weird. The older one shares my Wii addiction and my unnatural love of the show Avatar: the Last Airbender. I'll add in that my love of True Blood fills out my diet with enough mindless sex and violence that it justifies my addition to a Nick toons show, thus I maintain my legal status as a grown-up. My big cousins plied me with wine and explained the whole oil crisis since as a proper medical student, I have absolutely no idea what's going on in the outside world at any time and my grasp of the BP situation involved a vague depression and pictures of dead pelicans.

In other news, hi guys!

My aunt and uncle took me to a little place called Spring which I liked and reminded me of Woodstock, if someone turned the thermostat up 20 degrees. I also ate BBQ with gusto since it tends to be of not fantastic quality and prohibitively expensive in NYC. I also got to make multiple car trips to the store which is a convenience I had not realized how badly I missed until I was tucked safely and comfortably in the backseat of an air conditioned ride rather than rammed up against a hobo and a busker with my food for the next week determined by how much upper body stength I have (spoiler: none).

I shopped before I left and I shopped while I was in Texas. This is relevant because it allows me to say that pretty much *everything* lost in my carry-on luggage was brand spanking new. And I very rarely shop for clothes, so it was a particularly harsh blow.

I've had luggage lost so many times that by the time I flew to NYC for my current stay, my luggage was labeled all over with Sharpie marker with my contact information, had ribbons tied on the handles, and was wrapped in fluorescent duct tape. I'm not making that up. Since flying now carries the added fun of a 25 dollar fee and I'm tired of losing my shit, I put everything in carry on. Including my stethoscope, white coat, PD kit, and all that fun stuff (that I needed today!). So imagine my surprise when as I went through the gate to my flight, my carry on (fortunately not my purse) as well as most other people's was marked "Valet" and stuck in the side of the plane. Since I never planned on letting that bag leave my sight, it wasn't well labeled.

So naturally, as soon as I got to Dallas, someone grabbed my bag instead of his and apparently disappeared off the face of the planet, leaving his bag with me, which I promptly turned over to lost luggage in Dallas because I'm a moron unfamiliar with the art of blackmail. Best part is... since it was never formally 'checked', I can't actually prove I ever had it. So I may be out the possibly ~800 dollars worth of stuff in that bag that was of a cost and emotional value which they recommend you don't check... *which is why I didn't*.

I put all of that aside to go out to watch True Blood at a bar with my friends last night, cause you know, you gotta prioritize, at which point my phone went from "almost dead" to "dead". So I end up having to call others so they can call my voicemail to listen to my messages to determine whether my bag's been found.


But whatever. I started pediatric heme/onc today and it's pretty cool, features an insanely nice nurse, plus nothing minimizes an extraordinarily aggravating couple of days like seeing 6 year old cancer patients. It's hard to even stay really pissed off. "I'm having the worst day with my luggage and my phone and I had to circle LGA for an hour and..." "My hair fell out but they gave me this great wig. Can I watch Ratatouille during my chemo sessions?" "Uhhh.. have a cookie." "I can't; I'm NPO."

Oh, in that direction, while practicing for the CS, the First Aid gives you these often off-the-wall 'patient questions' that are designed to throw you off guard to determine your response to being put on the spot. They range from "am I going to die?" to "What does 'ultrasound' mean"? They dispense with the normal answers of "No" and "it's a test" in favor of a paragraph of feel-good that I found rather silly.

Until today. Had a "Will I be able to make the trip" question that sounded like it was lifted directly out of the pages of the First Aid, and then not one but two "Why does she keep complaining of being cold and shivering when her temperature is so high?" that wasn't in First Aid, but should have been. Hopefully the practice paid off for something, because I felt like I could give pretty good answers and empathized well. And even for real empathy. Also, heme/onc moms seem to be a relatively forgiving lot and are used to medical students asking them a crap-ton of questions they've answered seventeen billion times, so it worked.

Jun 10, 2010

When is an emergency not an emergency?

Naturally, the second I have a week off, I revert to my midnight owl schedule, which put me at my prime study hour just in time to hear annoying jangling outside my window for long enough that I finally looked out it.

In time to see one of our friendly neighborhood street rats brandish his giant novelty-sized bike-lock pruning shears, put them away, and ride off on his newly found prize.

Bah... so I uttered an ineffective "Hey!" out the window, tempted to run him down swatting him in the head like our falafel guy did when someone tried to jack a bike out of our apartment (love you, Mohammad, seriously, and your shwarma is the frigging bomb), but by the time I got jeans on and went outside, he was already ineffectively weaving up the street...

Leaving me with a dilemma... this is not my bicycle thus I can't really identify it or prove it isn't this kid's (though the shears might), and the perpetrator is currently escaping with slim odds, I would think, that someone is going to pull up and catch him by the time I run upstairs and call the police.

So who do you call? The last time 911 and I had a friendly chat, it was for a three year old that was sans a heartbeat, which tends to be the level of emergency I do not want getting preempted for bike theft. So I called 311, due to their effectiveness at shutting up noisy buttholes at my friends' place, but then they promptly forwarded me to 911, who seemed interested but vaguely confused as to why I was calling them. Then they called me back three times to get a better description, so I guess they care after all. But if you see a blurb in the paper about some high strung female who called 911 due to seeing a kid with bike clips outside her apartment, don't blame me. I called information.

Jun 7, 2010

Another test already?

But I just took the Step 1 like... oh, over a year ago. But still.

I'm going to take the Step 2 CS in about a week and a half. This is a really different exam than all the others in that it costs nearly twice as frigging much and I actually have to play doctor with actors rather than banging out multiple choice questions on a computer screen.

The problem with this exam is that it has a really high pass rate, which sounds like a good thing, but that ends up serving to make you feel really bad if you're in that 10 percent that fails it, and given my proclivity to blurt out nerdy inappropriate jokes when I'm stressed, that just has "train wreck" written all over it.

Nah, but it's all good. It's an opportunity to go to Houston and finally see family again! Huzzah! And I'm actually really excited about that. So fake patients do your worst. Actually, don't. Be nice to me so I can play with my cousins.

Because I don't want to blow off the exam and I was being creative with my scheduling, I now have a week off post-pathology rotation, which I'm going to dedicate to practicing and studying for the test so I can enjoy my Texas time. I'm also going to enjoy the opportunity to sleep in and *not* have a 45 minute train ride each morning.

Not that I can really bitch about my last rotation. It was pretty awesome, everyone was nice to me; everyone showed me around; I got to see all the labs, and since path is a heavy laboratory specialty, the staff offset my expected cost of eating disgusting overpriced hospital food by bringing goodies in damn near every day. In unrelated news, I'm upping my run-time in Prospect Park despite the stifling humidity because I refuse to buy new jeans to accommodate an expanding posterior surface.

I started getting confident with the microscope, which makes me happy. I'm not confident with diagnosing what's on the microscope (though now I can find H. pylori!) but I can swap those lenses out and zoom in on problem areas with ease. I got to see an autopsy, which kept me hovering near the back room like a vulture for half the day because I didn't want them to start without me. I stayed late a lot largely because I wanted to make a good impression on the denizens of my future career, but also because I had access to my own microscope, a computer, and air conditioning.

Speaking of that last one, I caved. I can't do another summer, particularly with all New Yorkers talking about how mild the last one I suffered through was. Home Depot was having an online sale and now I'm just checking the order status every five minutes to see if they shipped my A/C yet. I'm giddy with the anticipation. Especially with a late summer several-week study session for the Step 2 CK (the computer exam), I'm going to be sweating enough from the mental beating UWorld gives me; I don't need to add constant sticky heat and sleeping on ice packs.

Being in the specialty of my dreams didn't keep me from recreating though... I went stereotype NYC for Memorial Day by escaping the city on a camping trip up to the Adirondacks, which was phenomenal and refreshed my desire to apply to residency in some more rural locations to get my nature vibe back. I also went with the most prepared camper in the world, who not only brings the stuff I forget (like flashlights, maps, tent poles, and similar little stuff) but a tournament beer pong table, an air mattress that is larger and more comfortable than my actual (bunk) bed, and three dogs.

The weekend before that was Jersey pool party weekend... Now this weekend was... uhhh... let's just say it involved Williamsburg, Zombie Hut, an insane hunt for pommes frites, and dozing off in our deck's new pool at 4 AM. And by pool, I mean "We now have a plastic kiddie pool on our porch that we fill from the sink." Looking at that plus the 6 and a half foot plastic mannequin standing vigilant over it, my roommmate muttered something to the effect of "We are such hipster trash." Heh.

May 10, 2010

As soon as it was over...

it begins again!

Except this time, I'm chasing the specialty that I want... ah, the beginning of fourth year. It seems like not too long ago (Friday), I was a lowly third year, new in the ways of the world before a new day dawned (Saturday) and all the wisdom of the profession was passed down to me.

Or something. Plus I went to Fat Cat so that Lori and I had a contest over who could suck more at pool. Then my boyfriend stepped up and was gracious enough to not destroy me immediately.

Whenever I feel like I don't know enough in medicine and I'm not studying enough and I'm dumb and stupid and I'll never be a real doctor, I need to play pool, because holy crap, I can cram decent knowledge into my brain when I have to, but I have the hand-eye coordination of a brain damaged rhesus monkey. Another good reason not to go into surgery. My real life scratch on the eight ball could have me jamming a kelly clamp into someone's hypothalamus, and I'm told the hospital's insurance company frowns on that.

But I started my pathology rotation at a new hospital! The path part was cool, but I'm discovering a few things... I'd say that being at a new hospital is like being the new kid in school, except it's more like being the new kid in school if you started in the middle of summer vacation. The crop of third year clinicals don't start at that hospital for another one or two weeks and most of my now fourth year colleagues were smart enough to give themselves a break now, so I was virtually the only medical student wandering around this giant hospital, and the only one in my rotation.

I'm also discovering that while I love love love looking at slides while attendings teach me (!!!), I need some damn Bonine or something because I was getting seasick. I actually had to close my eyes a few times while we were reviewing pap smear slides because I had that icky feeling I got when I went up the windy road to Fish Friday. Is there any way to man up your middle ear? That's pathetic.

The attendings are really nice so far, and they already know that I'm almost certain I want to go into their profession. This lays on the extra pressure of my being the only student *and* I don't have the "I don't need to know this" excuse, because even if it is too high tech for the boards, I'm going to need it in the long run.

I'm already mourning the loss of our free meal passes at my old hospital too. I was bone dead tired this morning so ran down to the cafeteria to pay for my coffee... later pay for my lunch... the horror! After nearly a year of running to the grocery store virtually never, the first thing I did on my way home was stop and get portable lunches. Momma needs rent money, and that is not going to go to paying 8 dollars a day for crappy hospital food.

May 8, 2010

Holy crap; I'm a fourth year


Seriously, wow... when I first came to Grenada, I was staring at second termers in awe because they were... wait for it, almost a year into medical school! Now, with the completion of my surgery written exam, I'm officially done with third year. Like donezo. Like applying for a residency this year. Like going to have "MD" after my name in a year. Like... actually will be able to draw a paycheck rather than just hemorrhaging Citibank's money in the hopes they'll never cut me off.

I'm not sure if I'm going to feel more ready to be a doctor in a year. I think I expected some sort of transition through medical school where I felt like a doctor at the end of it, or near the end of it, but instead it's just sort of an insidious thing that creeps in while you remain petrified that you have no real doctoring skills and feel just as inept as you did after your freshman year of high school. But I find it harder and harder to have totally un-medicine related discussions. I have a bunch of interests, but stuff creeps in... there's analogies... "man, this song is so bad, I'd rather hold retraction for a whipple on a 450 lb patient than listen to it again"... ya know, normal stuff.

I also have moments of "Hey the training paid off clarity" when I'm in clinic and a patient begins to describe a symptom, and I can rattle off all the other symptoms they're about to say in my head because I know what they have. Then some friend or family asks me some extremely simple question (So why do you get that stitch in your side when you run?) and I just look at them blankly and wonder where all my money (by which I mean Citibank's) is going.

Bahhhhh but no more surgery! No more third year! Conceivably I don't have to be on call again unless I schedule a rotation that requires on call time. I'm "studying for CS" and "taking a month off for interviews" and the rest of the fourth year lexicon. I'm pass/fail for the next year. Weird. I'll be the highest level of short white coat in the hospital, which still has me outranked by... everyone except the third years.

Naturally, this even required celebration, meaning that pretty much immediately after the exam, we migrated en masse to a student's rooftop to do what carless medical students do when they celebrate... To give you some idea of the day I've had, we got out of the exam around 11 AM and I just got home, albeit the last hour was largely influenced by the F train's insistence on sucking. Three trains and a shuttle later, that I wound up getting off in... let's just say a part of town where I didn't feel snuggly and warm standing by myself on a corner in a bright red dress, so I caved and took a taxi. The horror.

Oh, which reminds me of my latest pet peeve. Everyone has GPS. I even have a GPS and I don't have a car. WHY have the last 12 taxis I've gotten into (and having me get into a taxi is relatively rare) asked me how to get to my location? And it doesn't matter where. "Brooklyn Bridge please." "Oh, how do you get there?" "Um... drive downhill until you hit water; I don't frigging know." To me the city is a series of completely disconnected epicenters around subway stops. I have no idea how to logically connect them, and certainly not within the framework of legal traffic patterns. And every minute you sit in a cab (like frantically pulling up the directions on your phone), you're paying. I'm also not a fan of the phenomenon of getting a cab in Brooklyn and having them waffle, refuse to take you, or try to charge more if you're going to another place in Brooklyn. Manhattan is amply served by subways. Areas of Brooklyn, less so. Just drive me to my destination and shut up. I'm not paying you forty dollars to take me to Manhattan slower than the subway takes to get there. Except the F train.

Monday I start my official pathology rotation (rather than the unofficial one I was making out of surgery), and I'm excited. My first rotation of fourth year! Celebration will continue through the weekend, so long as mother nature doesn't conspire to ruin it.

Apr 28, 2010

Life's little truths

This isn't mine, but I wish it were...

Apr 21, 2010

It's drawing near...

The end of surgery! (and third year)

Surgery's kind of a mixed bag in that we have a pretty slack rotation as far as surgery rotations go, but apparently an even *more* slackass group, so we keep getting in massive amounts of trouble with no conceivable way to end it since as the slackers keep slacking, eventually everyone sort of gets a "f- it; why am I doing the scutwork of two people when you're at home doing nothing" sort of attitude which compounds the slacking which compounds the trouble.

I feel the students' guide to slacking is to not slack in ways that screw over other students or sticks them with excessive amounts of work in your absence. Otherwise, slack at your own risk. If not, the whole group dynamic changes and people get angry, bitter, and defensive. I feel a lot of this is also a function of simply having too many students on this rotation. The statistical likelihood of shameless slackery goes up simply with the number of people, plus since there is an overflow of students that lessens the workload, it creates an impression that you can do *nothing* and others will pick up the slack. This is partially true, but creates a tremendous amount of resentment.

If you are going to slack, the worst way to do it is the slack-and-schmooze. This is a brilliant technique wherein your colleagues are left with thankless scutwork while you flash the glistening smile at the attendings of someone that's racked up an adequate amount of sleep. To be fair, this technique seems to frequently pay off gradewise (leading to a similar phenomenon observed in residents), but your classmates will want to kill you even more than if you were the simple shameless slacker that could not be less interested in ________ rotation, and has no problem showing it. Be advised.

Lest anyone get the idea that I'm claiming to be a good little worker bee when half this blog has been dedicated to my various non-medicine related exploits, I'm not. I tend to refer to myself as a lazy buttmunch with frequency, but moderation people; jesus.

Anyway, so that's that bit. Otherwise, surgery's mixed on its own because as a lazy buttmunch, I detest long hours, and in particular, early mornings, which surgery has in abundance. I'm also fidgety and get hot easily, both of which are not fantastic qualities when you're scrubbed into surgery leaning over a heated air cushion and not allowed to touch your face. On the other hand, you get to do what I generally associate with "medicine" such as "Hear patient's complaint. Use prohibitively expensive education (or Wikipedia) to diagnose complaint. Remove complaint. Hope removal of complaint doesn't lead to minor complications such as wound site irritation or massive blood loss. Discharge happier patient sans complaint. Make bed of money and roll around in it."

Okay, not that last part. For anyone reading this that thinks becoming an MD is an efficient, effective way to make money, that is the same logic as deciding to get a piece of cake by working your way up at Duncan Hines starting as a janitor and eventually buying stock in the company fifteen years later so you can sell it to buy cake.

I'm also finding kind of a mixed bag on the whole surgeon personality thing, which I was initially warned about and expected to be far worse than it was. I've found surgery people more prone to tantrums than your average other-doc and during conference, they're absolutely brutal to each other, but they also seem to possess far less soul-crushing existential angst than other branches of medicine indicating a certain level of happiness. On an individual basis too, I've found most of them to be fairly friendly and nice to students (with a few rather drastic exceptions). So that's cool. Procedures are also interesting. I'm also learning a surprising amount of real medicine because diagnosis is key when screwing up leads to the definitive "uh oh" moment of opening the wrong thing. So they aren't the mindless scalpel jockeys of legend either.

Surgery possesses some amazing gadgetry too, even at county hospital level, which I assume is largely around based on surgeon-tantrums so maybe they have a purpose. For every engineering inconvenience in the human body, there is a tool that's made to deal with it. Wanna remove a section of cancerous bowel and snap the healthy ends back together in such a way that gets you out in time for lunch AND keeps the patient from having to carry their waste in a bag for the rest of their life? There's an app for that. Wanna see where that obstruction is without having to saw through that large important artery? No problemo. So far the only drawback other than the huge cost of manufacturing the most specific articles on the planet (this tool is made to see around gallbladders!) is that then you have to learn the names of all of it. Or if you're a med student, the suture scissors, since that's generally what your tool is. And we take it seriously too.

I'm on ENT now, which is particularly nice, and am almost comfortable enough with the staff to ask them to clean my ears, since after a few patients and the standard procedures of doing a standard ear exam on people without significant symptoms, going "hmm", and still pulling out giant disgusting gobs of crap, I'm paranoid. Though I suspect the root of my gradual hearing loss is far more likely embedded in the fact that I'm in physical and emotional connection with my ipod every second that I'm not at the hospital or asleep, as it protects me from having to talk to people on the subway.

ENT is also proving more interesting than I expected. Lots of allergies and sinus infections naturally, but also some crazy frigging tumors.

Still, pathology calls. There was some downtime in SICU last week that coincided with helping out in the gross lab and an autopsy so I got to make productive use of the time and got to practice some suturing where I can't do damage, which enhances my confidence greatly. When I wasn't fixing the computer.

Lemme just take this opportunity to again rail at frigging virus makers, since the SICU computer got hit with an almost exact variant of the virus I had, which is the only reason I knew half where to start with it having dedicated an entire Saturday to it previously (thanks, jackasses!). So not only are they stealing your credit card information, they're also trying to hinder medical care to your loved ones. Please remember that the next time you happen to catch yourself in a dark alley with one of them.

Speaking of peaceful hippie love, I went to Woodstock and the nearby lighthouse this past weekend so I could give my mom an urban escape for her birthday. I would highly recommend that for anyone who needs a break. What I would not recommend is what I did last year, which is using Woodstock as a staging ground to get lost in the Catskills at night, but I managed to refrain from doing so this time around.

Bedtime. Tonsillectomy in the morning, so I can finally see what was done to me as a child...

Apr 8, 2010

Anesthesia is sweet...

Though I suck at pulmonary physiology and pharmacology, so I think I'll keep on towards path. Plus path makes me really gloriously happy, which causes me (and others) to doubt my sanity.

So in surgery, we have several weeks of 6 AM rising and cranky residents interrupted by anesthesia, which seems to be a specialty that was licked into existence by unicorns. They leave early; they're chill (getting to sleep does that to you) and given the long periods where there is virtually nothing to do, they enjoy talking and teaching, and periodically, dismissing med students to take long lunches mid surgery, because hey, what the hell.

We still tend to have late lectures, which has often left me several hours at the hospital, forced to do something productive like (gasp) study for Step 2. I actually have a date for the CS, which I decided to take in Houston so I could finally see my family again, to whom I've been a distant memory since before I left for Grenada. I'm also studying for the CK, whose date is "sometime in August", doing the delicate balance between giving myself time off to study and rock boards while being well aware through the entire time that our loan distribution is contingent on our actual enrollment in rotations, so eek. Studying or working, I still need rent, people!

But I'm being oddly productive lately because I've started to run out of creative ways to procrastinate. I'm trying to save money by not... oh, going out to bars and overpaying for drinks, but I still like to get out of the house, so I'm running a ton, including a 6.7 mile double loop through Prospect Park today. So my days are largely consumed by working, studying, and exercising. I'm so ashamed.

It's also gotten hot recently, rather abruptly, so we went from snow on the ground to "Holy crap, it's time for me to buy an air conditioner" weather, which is actually really fantastic. I hit the Brooklyn Botanic Gardens last weekend where everything is threatening to bloom, the cherry trees are all opening up and I feel a strange emotion that was probably, oh, licked on by unicorns. I also got Easter off at the last minute when I was *supposed* to be working a 24 hour call by myself, so I'm feeling pretty good. Except my last run is leaving me acutely aware of what "lactic acidosis" feels like.

In other school news, through anesthesia, I finally got in on my first fresh frozen specimen. This and autopsies are really the only thing most pathologists are on "call" for. Essentially, you're in a surgery and you need the results on something to decide how to proceed. In this case, it was lymph node. The pathologist flash freezes it, shaves off pieces in something that looks remarkably like a miniature deli slicer, throws it through the H&E stain, and in minutes, determines whether it's malignant or not. This determines whether the surgeon will close up the patient or perform a multi-hour axillary dissection. While they were dissecting out, I was doing mature things like shifting from foot to foot excitedly and going "When they take it out, do you mind if I follow it to the lab? Pathologists are also a cool lot who seem unused to students giving half a crap about what they do, so ours readily explained it to me while moving at the speed of sound. And I got to run the papers back to the room with the results. I resisted kicking the door open like Batman and shouting "CLOSE HER UP, DOC! IT'S BENIGN!" but only just.

Also, I'm such a dork that finally seeing the H&E staining process was like meeting a rock star. "Oh my gosh... I've heard about you since histology... I love your work in the gallbladder. I never thought I'd actually see you in person. Can I have your autograph?"

Yeah, so I think it's official. It's even so official that I've stopped giving the flip-flop craven med school response of "Oh, I'm keeping my options open, but I really like surgery" and just blurt out "I like pathology". This usually invites a sort of "Um... oh. Well, someone needs to do it!" response, or the haters, who just think I want sweet hours so I can occupy my time making babies, or something. The rest just go with the general assumption that I wasn't hugged enough as a child.

Mar 22, 2010

So I'm on teams now...

Which may explain a thing or two... the skinny, before having to get to bed late (the horror)...

6 AM to 5-6PM.
Run in the park.
Watch Inuyasha (I know it's marketed to 8 year old Japanese girls; I can't help it).

Oh, and there was the sake bombing Saturday night, but ya know...

This week I have two straight weeks of teams with a Saturday call in the middle. I would be more pissed off about it (though I've been griping about it for a while now), but we're only on call every 9 days versus the every 3-4 days at some hospitals, so it's hard to be *too* upset, and I got this last beautiful weekend off AND was post call on Friday, so kind of a three day weekend.

Weirdly, the difference between a good surgery and a bad surgery lies in the people you're with. First two lap choles, awesome, I am a camera-holding goddess; circulating nurse being nice; good procedures. Exact same procedure; different doc; I am worthless at everything, the OR nurse hates students, and any med student holding a camera is trying to make some hideous Cloverfield/Blair Witch crossover. I also almost got kicked in the head by the patient. Fun for all.

Also, while I'm on the hardest team now, I like the chief and have scrubbed in with him before and he (gasp) likes to teach. Let's see what tomorrow brings.

Mar 5, 2010

Anti Powerpoint Rebellion

Though apparently I'm late on the bandwagon and there's already a group of anti-establishment Luddites that have taken this position, but I'm over PowerPoint. This hit me last night.

I'm not saying PowerPoint doesn't have its uses, like all three of them. As someone that's infatuated with pathology, you need PowerPoint (or some kind of visual projection device) to teach it. Diagrams are also useful, particularly in surgery, where they tend to do procedures that connect stuff to other stuff you wouldn't necessarily expect, and you kind of need a diagram representation of what GI anatomy looks like after you've put in Tivo and a hot tub. Or something. So yeah, if you need something that isn't "words", hooray for PowerPoint.

I was kind of indifferent to PowerPoint for a long time. I laughed when people put in the "funny" slide or the unnecessary slide effect, as you're supposed to, and the really bad PowerPoint presentations stand out as really bad PowerPoint presentations, so I hadn't really chalked them up to the program, but to people's inability to understand the concept of margins, grammar, or choosing colors that don't provoke seizures, and that's valid.

But two things happened yesterday. One, it was conference day, which pretty much means around 7 hours of PowerPoint. Some lecturers are good; some are not. But I realized that the second they dimmed the lights to put up the projections, I had a Pavlovian reaction. I pulled out my Surgical Recall to study.

So essentially, I don't mind PowerPoint because it offers me the opportunity for self-directed study unmolested without the distraction of an engaging or novel lecture. And books tend to be more significantly higher yield, probably because they're not in PowerPoint format. And they're in normal English because the authors presumably have not been doing language gymnastics to avoid direct plagiarism. And I realized the only way to actually pull me OUT of reading my book is to have a lecturer that is either distractingly good or distractingly bad. But most fall under the "okay" line of droning information that is already on their slides with topics they know well, but are no longer capable of presenting in an interesting fashion.

Then I watched one of the really good, extremely knowledgeable residents get the crap pimped out of her on topics that were already later addressed in her presentation, which in fairness, wasn't bad. But you have no flexibility in the direction you're going with PowerPoint because it's already on the slides. And then if the attendings toss you in another direction by ripping you apart with questions, you're still left having to come back to your presentation and plod through slides they may have just explained to make a point, at which point you just kind of stare blankly at the screen, glance at the audience, say "uhhh" and then flip quickly past an hour's work, most of which probably consisted of spacing out the bullets and changing the fonts. Your audience is bored, you've lost your mojo, and more importantly, an hour of your life you will never ever get back.

Everyone thinks about the bad PowerPoint lectures because they're hilarious. But then I thought long and hard about the last GOOD lectures I've had. I've had plenty of perfectly functional decent lectures, including by other students, even when I was forced to pay attention, because text on screen is still text with information, even if it's a wildly inefficient way to get it.

But even this rotation, the GOOD lectures? Half of them were rounding with attendings. The SICU chief who kept vividly maiming our patients when we strayed in the wrong direction: "After spending four hours convincing Anesthesia to actually let you do this procedure, the patient codes on the table. They're resuscitated AGAIN. Systolic pressure is 50". "Uhhh... well, I'd order..." "40." "I'd explore the..." "30." "AHHHHHHH!!!" "Patient begins pouring feces out of the incision site." "AHHHHH!!! Is that a real thing???? Yes?? AHHHHHHHHH!!!"

The lectures with our attending that tells dirty jokes and pimps us... the impromptu question reviews, even when I think they aren't going to be relevant because they're surgical resident question reviews and I haven't studied adrenal anatomy in 8 months. Almost none have used PowerPoint. The ones that do have either been almost exclusively image-oriented or the speaker has barely referenced them and flips through them in the middle of an interesting lecture because a PowerPoint presentation was required or he doesn't have a pen that writes well on the back of his hand. (I'd make one of many easy cracks at Sarah Palin here, but since I totally do that too, I can't.)

And why do the funny effects or that humorous cartoon, or the serene picture of the beach entertain us? Because PowerPoint lectures are so mindnumbing that we need the emotional break from wanting to kill ourselves.

Which finally brings me to my second point. I had to present an excruciating article for surgery today and was up late doing it (because I was late in a lecture and spent a good part of the day listening to an attending bitch and moan about medical students not 'being around' because we're unreasonably 'post 24 hour weekend call' or 'in mandatory conference'). The article was almost exclusively statistical analysis on other statistical values about a topic that wasn't really easy when you stripped it to the original condition, and because I'm not a statistician (nor am I good at arithmetic), I had to Wiki half the terms in the freaking thing.

So I *finally* was able to understand the article, its point, and the original topic it addressed, and interpret the numbers.

But THEN I *still* had the task of taking all the information I had in my head AND the organization and logical follow through, and then turn it into a deadpan samey boring ass PowerPoint presentation despite having no idea which way the attendings would direct it. Plus doing PowerPoints gives me complete mental constipation while I struggle to elaborate on bullet points without reading text off the slide like the listeners are illiterate children rather than board certified freaking surgeons. In addition, the article was virtually incapable of being made interesting by anyone nor to anyone, and the only way you can make it less interesting is by taking all those statistics and copying them onto a PowerPoint slide.

So I kind of rebelled. I put together like 5 slides with the main points on them (particularly since the entire point of the article is summarized neatly in the title and the entire paper is merely justifying why they aren't full of crap) and just talked about it, summarizing the key findings without blasting numbers on a screen at 7 in the morning, and pretty much ignored my own slides. I think I was stuttering a bit because I'd gotten four hours of sleep and was presenting to a group of attendings without the mental crutch, but no one seemed pissed, so who knows.

Feb 21, 2010

Surgical call...


How can I be on surgical call for over 24 hours, two of which we were allowed to sleep, be busy for most of the night, and not see any... surgeries? Honestly, I barely know what was wrong with half the patients, though I certainly know what their labs were. OB-Gyn call could suck in that it was long and hard and you got scutted a lot and you were the definitive vitals/labs bitch, but all that stuff was punctuated with somewhere between 1 and 7 deliveries/c-sections a night which they insisted students be in on, so calling it "OB Call" was as advertised.

But guys, seriously. It's called "COMPUTERIZED CHARTING". For the love of all that is good and beautiful in this world, institute a program with more patient-organizing power than Office 97. That goes for about three quarters of the hospitals in this city. Why progress notes are still being scrawled illegibly on easily lost or damaged charts that have to be fought over by all the attendings, residents, medical students, and nurses who need them at the exact same critical times escapes me. And med lists... freaking... list every single medication a patient is *currently on*, changes to medication with date/time, and electronically attach that data to the patient's name. And to add an extra stage of programming that could be done by a precocious 12 year old with a Warcraft habit and his own 4chan meme, throw up a caution if any drug is prescribed to which a patient has an allergy or if there's a hazardous drug interaction. No, have some on the paper copy of the medlists, some on the computer, some in a different part of the chart (which you often can't check because the nurses, who have to dispense the medications, understandably need that chart as much if not more than you do), confirm by occasionally having medical students check to see what's in the IVs. WTF?

I know this *can* be done, because it *has* been done. Not only is the lack of electronic charting really irritating to medical students (and everyone else) that then has to dedicate hours and hours to rewriting information that is in one place into other places (if they can read it) or hilariously, *typing* information from one excel list to another, but it's unnecessarily hazardous.

Anyway. On the plus side, all the people in surgery I've met so far since I've been on surgery have been really nice, which has been an unexpected surprise. Surgical staff is not commonly associated with uh... social grace, or a particular love of our grimy, wound-contaminating, instrument-dropping ilk so not getting yelled at has been a bonus and I really like the main attending we've been introduced to, so not all bad.

And early in the night, the resident was showing us some bedside procedures which I didn't get in internal medicine, which I think is where I was supposed to. I got to drop an NG tube in ED (which was awesome), but last night I did get to listen for the gurgle to ensure proper placement, which was loud enough to be startling, so I'm finally getting some use out of my stethoscope beyond putting it on a patient's chest, listening intently, frowning, and then lying when the attending asks me if I can hear the murmur. At least I always remember to have the earpieces in.

Feb 10, 2010

Another rotation rolls toward a close

And it's a snow day! It's hard to believe that in two years, I went from this:

to this:

Pretty sweet, eh? Makes me feel bad every time I'm a whiny-butt, which is often.

So the blizzard of the century or whatnot finally hit us after bathing the rest of the east coast in it, and so far, it hasn't been too bad. The salters and plows were out almost instantly, my subway was still running, and it was way less of a pain in the ass than the one that hit right before Christmas. It was also nice that it hit *today* rather than destroying the weekend, as they were expecting, which meant instead of getting stranded in Manhattan, I was peacefully in the pediatric ED discovering that while getting a nail jammed into a foot only causes minimal tears in a child, that tetanus shot that follows it is an act of hideousness Mother Nature herself couldn't concoct. To be fair, those things do burn.

The NYC population seems to have responded to the storm by whipping out garbage can lids, cardboard boxes, and anything else remotely flat and sledding down hills on them, so I suppose the winter horror isn't affecting the public morale too badly. I was way more responsible after work and responded by tossing snowballs at my colleague and then pushing her into the snow after she refrained from doing so to me because she thought I might have a laptop in my backpack (I didn't). It's this level of maturity that's going to make me such a good doctor.

But alas, not all can be snow play since I have my oral exam for peds tomorrow and my written exam on Friday. Then I get three glorious days of reckless winter merriment before surgery begins and my life effectively ends in a blaze of retractor-holding, 4 AM-rising joy.

Jan 27, 2010


You thought "asthma" was going to have to do with pediatrics, eh? Well no. I'll get to that in a minute...

But first, for why you come to my blog... Ishie's 30 second movie review of things everyone else has already seen.... Casino Royale!

First impression: Not bad
Second impression: I'm calling sissy. Not for your average movie hero, obviously, but for James Frigging Bond. Sean Connery would have killed everyone Venice had ever loved before the archvillain got one of his socks off. Being tied naked to a chair helplessly before you and your disposable ladyfriend are rescued just isn't in the cards. Even if the aces are.
Third impression, and hence my title: Asthma is one of the least badass illnesses an archvillain could have, possibly topped only by fecal incontinence and a lisp. Even tied naked to a chair, if my tormentor had to take a drag off his inhaler every five seconds before punctuating his threats with inspiratory wheezing, I'd probably start laughing too.

Anyway, there hasn't been much to report in the hospital scene lately because I've spent very little of this last week at the hospital and even less of it seeing children. We have a 'study week' in pediatrics, which is one of the best ideas ever, and finally poses a solution to that endless dilemma medical students have where they're expected to be constantly as the hospital seeing patients, but also expected to study sufficiently to know all the enzymes in a kid that can break (hint: all of them). Essentially, last week, I studied. Which isn't exciting to report on, though I loved it and got a ton of crap done.

Oh, except Monday we actually got off thanks to our heroic clinical coordinator pushing for our holiday time, so Monday, I spent less time "studying" and more time "in a cabin in the snow playing bumper pool and visiting microbreweries." But the rest of the week, I studied.

And this is the point I was at in my post before where the puppetmasters in partial control of my computer decided it was shutdown time.

A little aside on this whole virus thing... I've finally gotten to a point where I'm not tech-unsavvy, which is probably why my computer isn't a smoking pile of plastic (yet), though honestly, this one's been living on borrowed time since I spilled half a bowl of cereal on it in Grenada (d'oh!) a couple years ago. Essentially, this virus keeps reviving itself for the last week, but I've been gradually winning battles if not wars. It managed to disable my ability to restart Windows in safe mode and defaulted to the blue screen of death (*(&(*&!!!) when I attempted it, disabled my internet connection at one point, deleted the essential files for my spyware and malware programs so they wouldn't work, and when I'd restored my internet, defaulted all my google search links to its evil little fake webpages. It also bugged up system restore, infiltrated my registry and a bunch of other stuff that quite frankly, could usually be only be accomplished by Sean Connery's James Bond. If I weren't so earth-shatterly pissed off about the whole thing, I'd be impressed. Fortunately, some experience with the interweb plus an internet phone when my computer *really* went off the rails has proved useful, providing such clues as re-downloading and renaming all the executable files of my antivirus/antimalware so the devil program can't find and snuff them. It's like a witness protection program for bits of code.

To get an idea of this thing's general effect on my life, despite the fact that my downtime tends to consist of either drinking or vegetating, I instead got to spend 7 hours of my Saturday testing how many times my computer could survive a cold boot without the processor grinding to a halt.

But babies. Cute little pink babies. My week's actually been going well. Last week I got a lot done on the study horizon, but could get absolutely nothing accomplished in any other venue. My loan status was unknown/pending, which is something that's had me on edge and driving everyone I know crazy for the last FIVE WEEKS. This one's not actually on the school, but on a medical bill of which I was unaware that got stuck on my credit report like ten minutes before I had to submit my loan application, so I did a lot of runaround, talked to the original billers and found that my insurance hadn't gone through, so resubmitted paid the extra, and was assured they'd take it off. Which they did. So when I called them to go "Uh homies? This shiz is still on my credit report as an open collection", and the lady very nicely told me that it was taken off and I could get a letter from them stating it, but that it could take as long as 30 days for the credit reporting bureaus to take it off.

So my opening statement to people asking how I was doing for that thirty days (which was past tuition due date for my session) was "Oh ya know... probably going to get kicked out of school."

I was also getting blocked at a prescription refill for yet another insurance related reason, and could not figure out for the life of me whose problem it was.

I was also trying to reclaim a locker from someone that put a lock on my locker, removed my nametag from it, and then removed all the notes the clinical coordinator put on it telling him/her to get the crap off and the lock off.

So that was Friday.

Tuesday.... my loan has been approved and dispersed and I'm waiting on the check, my prescription was worked out, and the lock got cut off my locker! And I beat my record time for jogging the 3.35 mile Prospect Park loop by a minute. It's a good time.

Oh, now that I'm back in baby land, I can tell you medical stuff again. I spent the first two days in the newborn nursery. This is a mixed bag...

Pros: the kids are healthy and happy and usually people are glad to see them. You don't see any sick ones because the second a kid even starts to breathe funny, they're shipped upstairs.
-nice doctors
-nice nurses
-scrubs and no white coat. It's a twofer.
Cons: Newborns are squicky. I'm sorry. I know they get cute when they're two, but they're not now.
-Babies scream. A lot. One baby screaming sets off the others. This has been proved by science to be one of the most annoying noises possible. Long exposure to high decibels of baby-scream has caused people's brains to explode out of their heads with some regularity. It's science, people.
-You have to check a lot of things on babies, because they're new to the world, and like a car built by blind people with ADD, you need to do checks most people don't expect. Two of these checks are disturbing. In one, you get to determine whether a boy baby's dropped both his sinkers down, and in the other, you have to make sure the baby's butt is properly connected to the outside world.

If you think there's expensive exhaustive medical instruments for doing those checks, guess again. It involves medical students having to cradle baby testicles and then, worse, peek inside the rear end to make sure there's a hole there, because *sometimes there isn't*. Yes, imperforate anus, possibly a candidate for one of the disorders the next James Bond villain can have!

After nursery this week, we have different specialty clinics each day. Yesterday was child advocacy clinic (re: child abuse) which was really interesting and the only two cases we saw had a minimum of soul crushery, so that was nice. The stories the director told though, geeze. People are freaks.

Today was pediatric heme/onc, which like child advocacy clinic, was way less depressing than I expected. The attending was really cool and let us interview the two kids that came in for check ups. Since peds heme/onc is an area with a lot of path, they had a monster microscope in the back with a ton of slides so at downtime, I asked if I could play with it and was promptly tied up with playing with iron deficiency slides for the next hour while trying not to break them. Damn 100X lens!

As I was back in the lab, I was overhearing a patient interview, significant in that it concluded with a ton of people making a ruckus in the hall. I poked my head out in time to see a pretty blond woman accompanied by a guy in a giant fox suit lean over to the last patient and say "Do YOU like basketball???" to which the child responded "Um... no?"

See, moments like *that* are when I love children. Not when I'm having to examine their nether regions. So the woman, undeterred, said "Well, you will!!!!"

Apparently we had a visit from the Nets. As an Ovarian American, I had no idea who the heck they were, but they were passing out signed baseball hats and we got a picture with the mascot, so cool. Unfortunately I don't think they realized that despite the potential for changing some frowns to smiles in a place called "Pediatric Heme/Onc", all the sick kids were downstairs and we had two kids, both of whom were perfectly fine and only in there for ten minutes for a follow up visit. And one of them doesn't like basketball.

Well, good night!