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.

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.

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.

Holy crap; I'm a fourth year

AIIIIIIIIEEEEEEEEEEE

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.

Life's little truths

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

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...

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.

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).
Bed.

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.

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.

Surgical call...

sucked.

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.

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.

Asthma

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!

Justifications for violence

I have a nice long blog out there waiting for you people, but it's put on hold because of the above, and the recurrence of a virus I've been fighting off solidly for three days and off and on for a week has made a sick and cowardly surge that severed my connection briefly, so I will, be brief...

I prefer to live in a civilized society where people settle things with discourse, and barring that, insults against the opponent's mother. That being said, the unique creators of Internet Security 2010 virus need to be hauled out of their mothers' basements by an angry mob of syphilitic wolverines, otherwise known as the closest thing to women these f*tards are ever going to get, have a team of angry medical students rip their naughty bits asunder with lemon-tipped dull scalpels, and then get beaten to death with the same buggy Dell computers they've rendered useless in their relentless pursuit of my credit card information before having their corpses spit on with smug satisfaction by all the mac users saying "Oh, our computers don't get viruses".

I'm reasonably sure that if I can televise the demise of the Internet Security 2010 virus assembly crew, I will make enough off the proceeds to buy an insanity plea AND a sparkling new Macbook.

So, off to sleep so I can head off to another day of working with children. Let that one roll around in your heads for a while.

Children and zebras...

Okay, for those of you who watch House (hopefully all of you), you've heard the medical cliché "If you hear hoofbeats, think horses, not zebras" which pretty much summarizes the syndrome medical students have where we want to diagnose people who have diabetes as being infected with a silver-bellied Peruvian brainworm. And the only reason we have this syndrome is because we've been infected with a silver-bellied Peruvian brainworm.

Thing about kids is they have zebras. Obviously I can't go into strategic detail because HIPAA doesn't have a clause to make exceptions in privacy settings for crap I think is cool... though they totally should, but since starting peds a week ago, I've probably seen 4 kids that have syndromes that were filed in medical school under "Why do I have to learn about stuff that only affects 1 in 40,000 people?" Oh, because those 40,000 people are more likely to go to the hospital than others, and when they're kids, they're still ironing out the details of how to manage the condition, so bam, hospital.

And then there's the kid who has, at present, stumped everyone on the floor, required consult by a specialist whose contribution included not having seen a case like this in umpteen years of practice and that if we had any thoughts, we should feel free to input them because f- if they know. So they're running more tests.

What I'm liking about peds is that in peds so far, they seem way more interested in puzzling out what they're dealing with. I don't know if it's because they like kids, like medicine, or just watch as much House as I do, but it's refreshing. And the stuff they're dealing with is frequently really interesting, which helps.

Then there's the seventeen thousand babies with bronchiolitis. But then those kids don't tend to present with the spectrum of baggage adults have so their cases are fairly straightforward. They're also far less inclined to yell at me for taking too long during an examination before demanding drugs.

And so far exams on kids hasn't been too bad. The sort of expectation of crying helps, but then they don't really hold grudges, and they're easy to placate afterward. And what's wrong usually shows up as what's wrong rather than oh, these skin lesions are from an untreated fungal infection, and there's existing diabetic peripheral neuropathy and blah blah blah.

Of course, the fact that kids are being less difficult than I expected means it sucks when they get really sick, so that can be a stone cold bummer.

And I'll talk briefly about the staff... while I can't count myself as being someone described by anyone as "someone that loves kids", the people that choose to go into pediatrics seem to, which seems to instill a refreshing position in them of being patient advocates, so I think we all get slightly less cynical as a result of it.

Though no worries; surgery will beat it straight back into us.

And lest anyone think I've gone soft on path for peds, recall that one of the reasons I'm liking the crap out of peds (minus the hours) is because I get to see weird stuff, which is not really the motivation most parents want their pediatrician to have.

New Year; New Rotation

Greetings people-recently-incarcerated-on and people-recently-freed-from Grenada! And all you other lovelies as well.

I just started my pediatrics rotation which is screwing me up by being way more difficult than I thought, while having attentive and interested attendings and residents, which makes me actually want to try hard at it, despite my love of things that are dead and jammed under a microscope, while this rotation has an abundance of loud squirmy pink things. That all have bronchiolitis. I'm giving myself about 3 days before I'll inevitably catch the upper respiratory tract grown-up version of it from the little tykes.

But now, it's my fabulous roomie's birthday, so yet again, I'm off.

Hope you're all having a wonderful new year!