Gila Monster Spit

So I started studying again tonight after essentially taking a two week bender minus the OSCE and the BSCE2, which are two exams that matter but don't matter but the first one matters more but is still Clinical Skills but the second one is 7 hours and makes you feel like a complete moron that has wasted the last two years, so blah.

But tonight I finally broke down and dug into the antidiabetes lectures for pharm, since that class requires three times the study of pathophys while being half the units because words I'm unfamiliar with (like thiazolidinediones, and no, I didn't make that one up) go straight in one ear and out the other.

But what did stick, and will probably be the *only* thing that sticks from pharm before I'm forced to cram it all back in for the USMLE, is that there's a diabetes drug made from the salivary gland of Gila monsters, which is one of the most random things I can imagine other than that whole "don't freeze your polar bear meat" from parasit.

It also leaves a number of questions... such as... what on earth was the scientist smoking when he decided to try that one out? How many other lizards got screened. Did he go straight to lizards or was there a whole move up the phylogenetic tree before he honed in on that *specific lizard*.

Also... if I get bitten by a Gila monster, and I'm diabetic, will I be half-okay?

Also... this kind of makes a weird conservation argument. Never drive anything to extinction that might treat a disease with some improbable part of its anatomy. Next up... wombat gonads cure struma ovarii. You heard it here first.

Oh yeah, those test things and the whole birthday thing...

Pathophys, despite woefully understudying it this time around, turned out well. That nice busty curve helps a lot.

Pharm would be discouraging in studying twice as hard for this exam as I did for the last one and only boosting my grade by four points until I realized that they threw out 15 questions on the last exam, so I actually boosted my grade by 19 points... that makes me feel better at night.

OSCE: No results, and I suck at reading chest X-rays that don't have anything glaringly obviously wrong with them. I'm also bad at reporting EKGs when the diagnosis seems to be "Patient's heart exploded". "Oh good, ST elevation in 6 leads, ST depression in two leads, one lead is inexplicably missing from this read out, dicrotic R waves, spiking T waves, sawtooth P waves... I mean, did this guy's thorax crack open and an alien spewed out of there? WTF? And 10 minutes to read it and report it."

This is when the more practical types ask me what I'd do when I'm a real doctor, and this is when I even MORE practically answer "panic and page the attending".

The OSCE was well run though, I have to admit. The patients were also super nice. You get feedback from them after 7 minutes (during which I ran out of time on... oh, all of them), and while the clinical tutors were more "Um, you completely neglected to do X" (appropriately), the patients were like "I would feel very comfortable with you as my doctor, and I really felt like you empathized with what I was telling you" etc, so wahoo to fake patients.

Actually, most of the fake patients (and real ones) we've gotten since first term have been really cool. The OSCE chick that was doing rotator cuff syndrome actually locked her muscles when you hit a certain point on the rotation, such that I could feel it tense, so she's not only kind, but a decent actor.

We also had a really good actor last term that had aches and pains related to her husband's recent death, and she was recalling the story well enough, that it half choked me up.

Prior, as mentioned, was the BSCE2. Whoda thought the Carnitine transporter was so important? Not me! I have *no* idea how I did on that one. I needed a 52 to pass, and don't really need to pass, so the fact that I was actually pushing to know the answers rather than bailing after half an hour out of 8 is a testament to just how anal retentive I am. Huzzah.

So we had the whole "drag ishie out to Stuart's Wednesday night as the clock hits midnight on when her birthday starts" that I mentioned (and loved) and the wrestling ON my birthday that still has my arms covered in bruises.

Friday was my birthday at Prickly Bay and it was absolutely spectacular. All hail the Barbie Cake!



Christine found the candle at IGA and built the rest of the cake around it to create me an absolute Anti-Ishie cake that was not only delicious in taste but delicious in irony. A bunch of people showed at Prickly Bay, we had pizza, the band came on and they were great, I have awesome friends, and I got to dance in the rain. Dave's coming to visit me in the US next term, which is my (very awesome) birthday poster, and Krash made me a big poster that she got a bunch of people in the BSFCR class to sign, so it's all been good. People have still been wishing me a happy birthday a week later, which is highly cool, and I've been getting well wishes from my Annex Peeps rolling in, so I feel very and completely loved.

Then it was Banana's, then, I believe, a night swim at the beach, because I don't learn. And plus night time shark jokes never get old.

Next morning was the Sauteurs hash! Woot! And total mudhash it was, and more cuts and bruises to add to my wrestling injuries. I've been wanting to go to Sauteurs forever, and I finally got to see that beautiful beach. Hung out with Grace and Dem for it and managed to score some cheap and great BBQ chicken, nutmeg ice cream, and beer before booking it back onto the bus... for the Unity Ball, which I was needed for pouring wine and champagne, which I pictured as occurring behind some sort of a bar with a shelf behind me. Ha.

I got home, climbed into the shower with my clothes on (again) to avoid carnage, and quickly realized I would not be able to wear a skirt because my legs and arms were torn up, so I figured, nice long sleeved shirt and slacks, no worries, just working.

Whoa. Not only was everyone dressed up like senior prom, but everyone was getting drunk and fast. While there were a ton of nice people who were giving me no problem, and Grace was dropping me homemade gingerbread over the tops of people's heads like she was feeding a fish, there were also a ton of people YELLING that we're too slow, that we're out of the wrong wines, that we generally suck, one great guy grabbing me and squawking "Don't you wish your boyfriend was a freak like me!!!" approximately 6 feet away from my *actual* boyfriend, and then barring that, they just ran into the back to grab our dwindling wine bottles.

Oh, and someone threw a beer bottle down the stairs, and the bar areas were so soaked in alcohol it was hard to walk. I dunno, I wasn't up for the mood of it and was underdressed, so I felt the majority feeling irritated, a little embarrassed, and toward the end where it started turning ugly, like I wanted to chew my arm off to get out of there. But I saw some of my friends and they all looked great.

So it's *definitely* studying time. Or sleeping time, as the case may be. Night!

What a week!

Extreme highs, some good sized lows, but mostly highs, an awesome birthday, a ergh bartending at the Unity Ball (I know I'm a crap bartender, guys but when you yell at people and then run in the back and steal wine bottles, that makes you a complete asshole, flat out), some great quality time with my boyfriend, an 8 hour mindcrushing exam followed the DAY after by my clinical skills major final exam with the fun of trying to get to it in the middle of it, in nice clothes, in a rainstorm. Ew.

More details later. I'm exhausted!

That post-exam bliss

I absolutely love the time after an exam has passed. That first week before panic has set in for how behind I am when I can still live like I'm on vacation.

Exams went decently, though no clinical skills grade yet. I'm not sure if they're planning on failing half the class (likely not) or how they're going to handle the fact that a great number of us aren't doing well in a class that used to be one of the no prob classes (probably when it was in St. Vincent's). They seem like a fair lot though. We have our OSCE exam next Tuesday which will be a large determinant in how grades go.

So what's been going on? Friday was the pharm exam. While being horrible, it wasn't half as horrible as the last one, probably because I took the "memorize the drugs" approach this time rather than the "read and understand" approach I took last time, which, given the nature of a class where the goal is to memorize drugs, was probably a stupid move.

I've progressively gone from acute panic attacks first term to "Oh my god I just don't care anymore", which has proven to be the better route. I'm also learning to sleep before exams. Thursday night, I was kind of in that place where I really didn't want to study anymore and was majorly tired of it, but was cranky in that sort of child throwing a tantrum (hence the video) way rather than some deep penetrating sort of fear. You know that stage where you're like "I COULD spend the next hour doing worm flashcards, but I so do not feel like it, but I still have six hours until bed time and can't justify spending it watching Scrubs reruns"?

So Friday night was the celebration of Krash's birthday, so we headed to Aquarium for a very nice dinner, Wayne sang to her, and it was all great fun. Saturday was my day for catching up sleep and bumming around doing nothing. Sunday was early rising for a cruise around the island, some hardcore waves up snorkeling, a BBQ off Sandy Island, a powerful rainstorm over some amazing rock formations, and great company, great rum punch. Dinner with Dave and then movie night with Krash, with popcorn and pie, plus Without a Paddle and Oceans 11, neither of which I've seen because I've been living in a cave.

Today was brief responsibility in the form of a surprisingly useful meeting on the boards and attaining a residency. Then that quickly gave way to a girls night at Ocean Grill, which is one of my favorite restaurants. Lori was showing Grenada to her visiting family, so we piled six people into a rented car and took off for St. George's. More wining and dining. And beering and pizzaing at Prickly Bay this coming Friday. What medical school?

That impression given to her family also makes me realize the lucky parts of living here again. Sailing, enjoying the beaches and general Caribbean life. Funny stories about the stuff we do in our precious free time. I realize I've had more 'recreation events' in the last two years than at any time in my life because we work so hard. So rather than having those blissful unemployed days of doing very little but playing Bloodrayne 2 for weeks, I'm Sandblasting or turtle watching or hashing or sailing (or sleeping in and watching tv, but you know).

Message of the day on the general meeting: THE STEP ONE IS THE MORE IMPORTANT EXAM YOU WILL EVER TAKE IN YOUR LIFE. FOR THE LOVE OF GOD, DO NOT SCREW THIS UP.

Eek. Message received. Also, although I've seen the "choose a specialty flow chart" before, it always cracks me up and was a great mood lightener to the meeting, as were the appropriately placed jokes in the speakers' routines ("No one told me we had a second exam!!!!" If there were only one exam, they wouldn't call it the Step 1. They'd just call it the Step.").

So that was good. Most of our "so you're gonna be a doctor" meetings are completely useless. I contemplating skipping this one in tradition with my general nature as a truant, but decided to stick it out and was glad I did.

Time to write a case report.

Tomorrow

So Ishie, how do you feel about taking a pharm exam tomorrow?




This video is alternately subtitled "So, you've decided to go into peds! Welcome to the rest of your life!"


In other news, half the school and I decided to inexplicably and spontaneously wander out in a hellacious rainstorm to IGA on a Thursday, in my case, because I was out of EVERYTHING including toothpaste, and in their cases... I think because they knew I was out of EVERYTHING and wanted to inconvenience me by virtue of occupying my corner of space at the same time when I'm irritable due to having an exam tomorrow. The plus side is that IGA was equally inexplicably stocked with everything (which never happens on a Thursday; they even had my coveted eggs!), so I went on a buying spree while trying to simultaneously listen to my ipod, read pharmacology flashcards, and juggle 5000 pounds of crap that's bad for me (and asparagus!).

What exams?

Yeah, I'm just not able to work up any enthusiasm for this next set, per the norm for this term. Mainly, I just want to go diving.

Oh, for those who didn't make it through the whole pumpkin video, that band is Beasts and Superbeasts. I found the video just by typing "Spooky Halloween" or something into YouTube on a procrastination break, but that song grew on me so I looked them up. Not bad. Definitely not bad.

Incidentally, males castrated before puberty never develop benign prostatic hyperplasia in later life, so I guess the message is, uh... have your kids spayed or neutered?

In med school too long

I actually know what all these mean:



Thank you, Amateur Transplants

Yup, getting to be that time again...

Geeze where do I begin?

I went from having really nothing to say but "camped at Taylor Hall; made doe-eyes at boyfriend; tried to find source of study for pathophys; periodically mimed the First Aid book eating my head. Highlighted every line of pulmonary physiology in the BRS Physio since it all seemed important. Thought I was doing well at studying pharm but totally wasn't. Watched Red Dwarf. Slept." to having a ton going on where I don't know where to start. As frequently seems to occur.

Midterms! Aiiiiieeeeeeeeeeee.... oh, was that ever an exercise in humility. Weirdly, the exam I had the most problem with at a philosophical level is the one I'm pretty sure I did the best on with all the added hoopla (not that it justifies anything), while I'm thinking I didn't do half as well in Clinical Skills as I thought (damn you, Hashimoto's thyroiditis!), and I have no idea what I got in pharm, but I'm kind of hoping it's in the double digits. Gods.

Taking the pharm exam made me realize two things:
1: I'm VERY bad at drugs. I knew this from biochem when I was going through my flashcards while my dad was visiting, and he was reading me off the answer for the mechanism of neomycin without looking at the card because I'd missed it so many times.
2: When I learn drugs, it's kind of like I have this new deck of playing cards in my head where each suite represents a drug class and I know what order they're in. Taking a pharm exam is kind of like taking that deck of cards and playing 52 card pickup. And I just look at the fluttering mess on the floor and go "Uh oh." So... new study approach for me, I think.

In the wake of midterms, I pretty much spent the rest of Friday in full on bender-mode, starting with George's party, featuring great company, great rum punch, great food, great pinata. Then the Beauty and the Geek party which had some really innovative costumes by my colleagues. Then Banana's, largely to steal Dem's french fries.

Then spent the rest of the weekend recovering from Friday by lounging on various beaches and making a two and a half week overdue trip to Spiceland Mall to buy food, since my on campus studies have caused me to subsist off food from Pearl's, which means I've hit my upper limit for intestinal parasites.

Saturday, La Sagesse was characteristically gorgeous and the weather went from looking like it was going to rain us out to being really nice. We had a wonderful lunch at the restaurant there, went for a long swim, and got eaten by ants on the beach. Oh, though word of advice since this applied to all of us, myself included... don't go out for a long night of drinking and reveling, get four to five hours of sleep and then jump into a cab for a lengthy ride along fast tight curves. Glurgh.

Sunday, initially dive planned, but still recovering, so lounged at Grand Anse. The beach was nice, but apparently the storm that missed us hit it, and the water was kind of eerie. There was a dead eel washed up on the beach which some brave girl, as everyone watched her in awe, picked it up by its rotting dead tail and hauled it over to the garbage can so people wouldn't have to deal with it. REALLY nice of her.

The seascape though, save for a couple flying gernards (woo hoo!) seemed oddly dead. The coral was pretty brown, and then Lori and I swam through a patch where there were bubbles on the surface and we couldn't see anything, but then started feeling itchy and then actively stingy and we were like "okay, time to go", so I have no idea what that was about and it's never happened before. I'm wondering if we swam through the remains of a boat propeller-hit jellyfish. I had some spots when we got out, but quickly faded, and drying off to a diminishing sun made it all worthwhile. As did not having to study.

Last night was Dark Knight night, since Lori and I seem to be the last people on earth who haven't seen it, so we made a night of it with Dave. Awww, RIP Heath Ledger. Much as I love Batman, I've always thought most of its villains weren't half as scary as Batman himself, but that is the kind of Joker that makes you want to sleep with the lights on. Sorry Jack Nicholson; you'll always have the Shining.

In the meantime, the surge of response to the whole pathophys thing has been awesome and you guys are absolutely fantastic!! It looks like we may get some changes too: Our note packet was printed and there for lecture (Yes, I went; stop the presses, though three buses passing me made it a thirty minutes late for first lecture thing), they seem to be shifting the setup of the Friday classes AND have already posted the objectives, they're having a meeting, and stuff's happening. Wahoo!

We just started the hematology unit which so far seems to be recycling path. Hematology is one of the nastiest parts of path due to having to be able to read a CBC in 75 seconds and pull a diagnosis out of it, but so far it's review, which is good, because eventually if I study myeloid derivations enough, it may stick in my head like the frigging female menstrual cycle finally did. You'd think, that being female, it would not take me FIVE SEPARATE medical school classes to learn when the progesterone rises, but I'm slow like that. Some stuff goes in once and stays there until I'm dead and other stuff that other people have gotten a year ago, when they're reviewing it in class, I'm going "dammit. Still don't know it." And I go back to my original source or the internet (Wiggers Diagram, I'm looking in your direction) and I redraw it, and I read all the parts of it out loud, and I see if I can redraw it from memory, and state all the parts, and feel secure, and know it on the exam, and promptly forget it entirely until it comes up again.

To backtrack a bit, I had my anesthesia rotation this morning, which I thought would be really boring (ewww, pulmonary phys), but was really interesting, particularly when first the Bovie died, and then the entire power shut off three times until the OR was running on the backup generator. The doctors were great, let us close in on a hernia operation, and showed us everything. They're also a very calm lot, moving effectively and deliberately, but not panicky as the anesthesia cart is screaming over its sudden power cut, the lights have gone out (hooray for windows), and the patient is open. Noooo problem. Continue putting hernia back in, no reason for alarm, sewn up, with awesome response to being put under.

They let us in pretty close without screwing up the sterile field, and were very willing and ready to answer our questions. So far all the docs have been like that, so I've been impressed, as I've mentioned, with the rotations, and find them to be a really cool experience that's giving us not only a taste of a lot of different areas of medicine, but also of the whole "medical experience in another country". Some stuff is utterly the same, while other stuff is mystifyingly different.

Got home from the selective to wash up since I knew I had a nice dinner after lecture, but found I had no water. I haven't found that this happens to me all that frequently, but when it does, it tends to hit at inconvenient times. Same with internet access. I'll have NO problems with internet access for weeks when I'm screwing around watching youtube videos while trying not to study, but the second I try to download some small group assignment that's due the next day? Total connection meltdown.

In other news, FANTASTIC dinner with Dave tonight where he was, per usual, being a perfect gentleman, and is gradually breaking me into Merlot, which is usually up with Cab on the "List of the only two wines I have trouble choking down", but I've been really enjoying it lately. What can I say; I'm a wino!

Beautiful

"Some Drugs Create Awesome Knockers" for the drugs that can cause gynecomastia (think Bob from Fight Club) may be the best mnemonic to ever exist, and that includes all the really dirty ones from anatomy.

In other news, I thought that "qiss and qiq 'til you're siq of sqs" (kiss and kick 'til you're sick of sex) was an incredibly stupid one until I reviewed the intro pharm lectures and discovered that I needed it to keep my head from exploding, and I certainly can't think of a better one in the time allotted.

I think I'm losing it. My head is full of "SAFE Moms Take Really Good Care" and "buy AT 30; CELL at 50" until all the information (which there still isn't enough of) is threatening to fall out.

I've spent the last unfathomable length of time holed up in Taylor Hall studying with my hair progressively messier and my t-shirts progressively dorkier (today's even has a math pun) and despite feeling like I know absolutely nothing about pharmacology, there are times in med school, and this is one of them, where you cram so much for an exam that you feel like if you bump your head against something, there's just going to be a flood of notebook pages coming out of your skull.

But if med school has taught me nothing else (which is possible), it's that there are two types of people:
1: Those that feel intense stress during exams, and in an unconscious attempt to escape- jerk, twitch, and bounce their legs uncontrollably. This is the "flight" response.
2: Those that feel intense stress during exams, and in an unconscious attempt to confront their antagonist (the test), want to jam a pencil into the necks of the people in Group 1. This is the "fight" response.

We're dead...

dead da dead dead dead

Pharm exam tomorrow and everyone's pretty much expressing the same sentiment: too much material; too little time; nothing is sticking.

Can't say the department is lacking in effort though; but this leading-up week has been so hellish with the pathophys exam that we all find ourselves painfully behind in a difficult and new topic. Oh, and there was that CS exam on Wednesday, which seemed primarily as a distraction from people trying desperately to study for pharm.

So pretty much, I'm living for the weekend. Par-tay.

Helpful hints for life

If you see a child born with ambiguous genitalia, just tell the parents to give it an androgynous name and don't tell anyone until the karyotype comes back.

I arrived at Taylor Hall this morning at 10:30. I just got home. Break for lunch; "break" for tutorial EKG lecture. Finally understand pulmonary physiology and it only took a year longer than it was supposed to. Brain full of lungs and ovaries. Send help.

Last one up!

Man oh man... my last exam of fourth term is in 11 hours, and do I ever *not* have the impetus to study for it.

This week was started off by the last path exam, as mentioned, and in it being the last came one of the biggest feelings of relief of my natural class. The boogeyman of SGU is no more. Well, hopefully. It was pointed out to me that they're not going to post the grades until Friday at 4. Now, they usually don't post until the Friday afterward, ostensibly so you aren't distracted for your other exams.

So then why, 4 PM? Hmm... Friday before everyone leaves, post the scores at the end of the day, most people leaving this weekend, so there's no way anyone can contest anything. Clever, path department. And fairly typical of them.

I had my CPD lab exam on Wednesday and got the super duper nice examiner with the half-compliant, barely awake patient. And no, that wasn't his "condition"; that was actually the way he was. He also didn't have deep tendon reflexes, which is disheartening when you're trying to perform them for an examination, until the examiner informs you of this, and lets you beat on her with a reflex hammer.

But she was really sweet. Complimented me on my kit; asked me really fair questions, didn't do that "insane amount of pressure and criticizing your every move" thing which some of them do, and it really screws up people's mojo.

So that was good. But it still is hard to get up the effort to study for the written. Instead, I'm so overwhelmed by the fact that in a week I'm going to be in Berlin that it's hard to focus on anything else. I'm examed out. I'm tired of filling in scantrons, tired of my student ID number, tired of standard issue #2 mechanical pencils, and wish to increase my etOH content.

On the plus side, the frequency of exams is starting to reduce the catastrophizing I did previously upon their arrival. It's easy to completely freak out when you're in your first term ever of medical school, each exam is worth roughly 50% of your grade, and you haven't figured out yet whether you're smart enough to be in med school. By the end of fourth term, it's almost an "Oh my god, I don't care anymore" sort of vibe. "Let me drop a letter grade because I can't focus for an hour. It's all the same."

More and more, people are planning less for the exam itself, and more for how they're going to schedule their packing around the festivities planned for ending 5 and a half months of pretty hard work.

The lack of nutrition is probably also contributing. After discovering my milk had gone bad, I had dry frosted flakes for breakfast and then at dinner, discovered a packet of chicken flavored top ramen hiding behind my IGA shopping bags, so didn't have to go hungry. And I can't go to the store because there's too little time, yet I somehow have a ton of food that I don't have the base ingredients for. I could have an 8 course fine dining dinner if only I had that cup of milk, or that one egg or those two tablespoons of butter.

Pretty collegey, eh? Now... to endocrine or not to endocrine. That is the question...

No more path!!!

Wahhooooooooooooooo!!!!!!!!!!

Well, barring some horrid mishap, but no more path!!!!!! Test over! Now, to attempt to focus on CPD for the next week, which is no easy feat, and then no more fourth term!!!

As for the third path exam... not as bad as it could have been considering a lot of the rumors surrounding it. It's not typically considered as horrid as the second exam, but a lot of people have said it tends to be just as hard, or the like.

Though renal. Holy holy crap was there ever a lot of renal. Epic renal. Renal renal renal renal and again with the renal! You wouldn't see more renal if you shoved your head inside a kidney.

A visual metaphor

Or one hopes, at any rate. We're scrappy, we're tired, but we're still flying.

The end of fourth term is basically an exercise in stamina. Everyone's left, the island kind of forgets about us, places are closed early or have limited selections, our friends regale us with tales of their summers, and all the while, we go "Just four more exams. Just three more exams. Just 9 more days. Just x more hours." Most people have forgone the thought of an "A" for a hope of getting out alive; everyone has a grim look about them, and this term has explained to me just why, in first term, all the upper termers always looked so much older. Not by way of wrinkles or physical age, but just kind of a weariness that doesn't necessarily bely unhappiness (though sometimes it does), but utter exhaustion.

In the meantime, I'm trying to maintain the impetus to study, while what I *really* want to do varies back and forth between wanting to lie on my bed tucked under the comforter with the A/C on and the lights off and plan for the fact that I'm going to be in Berlin in less than two weeks, focus on hostels, plan my day trips, and pretty much do everything *except* study path and physical diagnosis. I'm in that period where I want an extra week to offset my laziness, but know I wouldn't do anything with it anyway, while at the same time, want it all to be over now, hell to the consequences so I can go get my Boston and Europe on.

The list of things I have to do before leaving grows longer as well. Clean, empty the fridge, pack, arrange my rent and stuff for while I'm gone, get the taxi, order the Eurail pass, clean more of my clothes, wonder if I've got enough and the right kind of food to make it until the end game. Tip my housekeeper. Plan plan plan. But that gets in the way of study study.

Yesterday, after determining yet again, that I don't have TB (woo hoo! They got the tests in!), I managed to rebirth the renal packet so that I feel pretty confident in it. Today's task is endocrine. Tomorrow and Sunday will be male, bone, and CNS, and forensics will be part 'attended lecture' and part 'spent four years in a morgue'.

It's been raining since last night, so the sky is gray, which I love. It's kind of a hard mix between wet and dry season. During dry season, it's hot all the time, the weather never changes, everything gets dusty, and all that lush jungle foliage surrounding you dies. There's no crabs around, the lizard populations wane, and it's just not as fun. On the other hand, during wet season, you can easily get drenched by unpredictable torrential downpours and while you get the crabs and lizards back, they bring with them the roaches and ants. What to do; what to do? But I welcome back wet season so long as it doesn't delay my plane.

Hang in there comrades; we're almost out.

My steam runneth outeth

And such-eth.

Arrrrrgggghhhh, the final stretch is the worst. On the plus side, the last CNS lecture closer was not only by a prof I like, but was 16 minutes long just to tie stuff up, which meant when I saw the length on Sonic I did my little happy dance.

Not really sure why seeing the length on Sonic affects my mood as if I'm tied in for each one until the bitter end, yet when I see 42 minute lectures, I cheer, and when I see 58 minute lecture ones, I groan, as if this somehow affects the amount of information I need to get or decreases my study time. I think, because the conclusion of each feels like progress, and that progress gets closer, as I tally down my "how many lectures I'm behind" count.

Now, I'm determining if the forensic path lectures next week will be the first time I've regularly attended lecture since midway through second term.

In my struggle to continue my streak of procrastination to increase panic mode as we close in, I did some laundry today, though it may have been a good thing, since my normal pre-exam mode thing is to leave it all until I am COMPLETELY out of clothes a day or two before the exam, which of course means I can't do laundry, and of course DOES mean having to sit the exams in my least gnarly pair of scrubs. Coming back from laundry, I saw two guys from my complex taking pictures of what I initially thought, was the pick up truck parked on our lawn. Turns out it was the bull NEXT to the pick up truck, who had wandered into our front yard to munch on the bushes and grass, so to prolong my attempts to not study, I tried to feed him a branch and he licked my hand, but rejected my offering. Picky bulls.

If I ever do get near one of those Looney Tunes style mean scary bulls, I am going to get killed to an extent that will make the coroner vomit. I just don't have the sense to be scared of the things because they look like... well... cows. And cows just don't look scary. Or fast. I'm sure those will be my final thoughts when one outruns me and sticks its horn into my skull.

Speaking of random violence, I saw the last half of 300. It was educational. First, I learned that while it's awesome to watch guys in leather speedos fight, it doesn't make for wildly effective battle protection. Second, I learned that Persians are easier to kill than stormtroopers, and a fair number of them that actually planned ahead and donned armor still managed to get slashed to bits with minimal effort by guys in leather speedos. I'm not sure who to be more embarrassed for. The Persian faction *did* demonstrate some poor planning by piercing everything though. As anyone with hoops or a belly ring that's been to a rock concert knows, this is extremely hazardous, and grows more so when your enemy likes to fight in close combat.

Nutrition final

Well, that sucked.

And not sucked in a "gee, that was hard" sort of way. Sucked in a sort of poorly written, convoluted answers, tons of random memorized numbers, misdirection in the lectures, fairly deviant from the lecture objectives, sort of way.

Instead of focusing on the objectives, key concepts, and the like, instead we were tested on such critical things as being able to rearrange calories and kilojoules (which fortunately, I can do), memorize exact protein intakes, and a few cases, analyze a patient who's history promised complexity for which none was given. Example, how you assess and recommend for someone's vitamin D status depends largely on how much time they spend outside, their skin color, and their location, ie, you are going to give a different recommendation to a Caucasian bike messenger in San Diego than you are to a dark-skinned African-American woman who works the hospital night shift in Northern Missouri.

So that was really irritating. And now, I get to suck it up, lament the time I spent studying for that waste of a class when I could have been studying for path, which I now have two weeks to get caught up in, and prep for my PD quiz today, which also would have been time better spent.

Sad part is that in nutrition, I actually watched all the lectures, stayed pretty up on the material, and read all the lecture notes pretty carefully while taking notes, despite the fact that it was boring the crap out of me and making me long for the fascination of endocrine pathology, and I feel pretty much like it was for nothing.

Turtles!

But first, a brief synopsis of midterms:



Anyway, so in celebration of 4, count em, FOUR exams in a week, one of which was the dreaded second path exam, and the other was the micro final, we did what any reasonable people would do: packed into a couple buses with these guys to drive 90 minutes north, eat some chicken, drink some beer, and see some freaking turtles!!! Woot!!!!

So we got to do this "usually only see it on the Discovery Channel" thing where we headed to the beach at night under close supervision to see the leatherback sea turtles lay eggs, AND in an unexpected bonus, get to see some of the previously laid hatchlings toddle their way toward the water.

Whoa... I mean, words cannot describe the level of awesome. They had 9 turtles on the beach when they called us from dinner at Bathway Beach (after we'd made the necessary stop at Food Fair before leaving the campus area to stockpile beer for the occasion), and after giving the "no flashes, no flashlights, no messing with the turtles, etc" talk and we followed our guide to one of the laying females, which I had previously known were large, but did not quite have an impression of HOW large. On the way, we saw two little itty bitty turtles making their way to the beach and had to be very careful in our steps because they warned us that there were enough hatchlings on the beach that they didn't want us to accidentally crush one.

So we get to what they consider to be a "small" female, as in having my first mistake it for a permanent rock structure, gathered in behind her, as she kicked out a sand hole, and got to stroke her shell as she laid the numerous eggs. Then, we were off to see two MORE turtles that were simultaneously covering their egg-laying holes with giant flipper kicks, one of which, the guide explained, was going to need to have her nest moved because it was too close to the water. We already knew we weren't supposed to go around to the front end of these massive animals because it disturbs their laying, so we were all huddling back like good tourists when both turtles turned around in their retreat back to the water, and the biggest one came right near us and made a grunting sound as we attempted not to make any sudden movements and I giggled giddily by the sheer awesomeness of the experience.

So it was just flat incredible. And then I prattled all the way home because I was so excited.

CMV, why do you hate me?

Nope, definitely not a fan of the CMV. I mean, being immunocompetent and everything, it definitely beats out lots and lots of other things for diseases in the category of "stuff I'd rather have than staph aureus in my brain", but as far as learning about it, it's one of those sneaky bastards that causes everything, and when you're studying it in immunocompromised, like everything else in immunocompromised, pretty much everything is attributable to it. It's the sarcoidosis of micro.

On the other end of the spectrum, we have those pathogens which I've long lamented that only have one or two symptoms, but happen to share that feature with 5000 other things exactly like them that some scientist at some point was interested in enough to go "Hey, these two things that cause self-limiting coughs have different molecular structures. Let us create new viral families, genera, and species for them so that students' lives may be made more difficult for it."

Then, there's those horrendous organisms that cause terrible things but I love them, because they have incredibly specific risk factors and symptoms: 'a guy into home canning develops paralys.." "Botulism! Next question!"

I did get a big form of entertainment on the bioterrorism lecture, which really should have been subtitled "The Murderous Jackass Blooper Reel of Foiled Misbegotten Plots to Bring about Armageddon."

The weird part is there's all this stuff people are TRYING so desperately to do to each other, yet the most deadly outbreaks tend to be associated with the abject stupidity of people that weren't doing it deliberately to begin with. You know "Oops, I had the sewage from the Happy Acres Mad Cow Dairy Farm draining directly into the city water supply. Was that wrong? I checked like three times in 'How Not to Kill off Children and the Elderly for Dummies' and it wasn't listed."

But, gotta know all of it for tomorrow's micro final, which has been blissfully schedule for 1:30 PM at my good hour, which means I actually have a good chance of being half with it when I take it.

This also contrasts sharply to my clinical skills first lab midterm, which is one of the easiest "gimme" points on the planet, to which I did all the vitals and questioning perfectly, drew a complete blank on the rest, and then spent a lot of time gaping blankly, hemming and hawing, and being frustrated. Doh. Fortunately, their grading is on the kind side.

Path... everyone wants to know about path... the dreaded second exam, bane of medical school existence. Did it suck? Absolutely. Was it extremely long and difficult with TONS of irrelevant information that you had to discard, come up with a diagnosis, and then come up with features that clarified that diagnosis so you could pick the right one out of a list of answers that ALL had elements of being correct, but one was 'more' correct than others? Yup.

So why am I not more freaked out, nor was I too bad going in? Reputation. I have heard since the first week of first term how unquestionably terrible the second path exam is, have gotten tons of tips from wonderful people that have taken the class, thus when it came up and was terrible and long, it was just about as terrible and long as I was expecting, and now it's over.

This doesn't mean I did *well* or anything; I honestly have absolutely no idea, since I knew vaguely what virtually every question was talking about, which may be the epitome of "giving me just enough rope to hang myself with", because it allows me to be very easily misled, particularly on an exam where time is such a factor.

And it was too, goodness. I knew that going in, and I was STILL racing the clock. I knew it was going to be a close one when for the first path exam, I was looking at the slides for two seconds before putting my head on my desk to await the next changeover, since I was feeling kind of stress-crappy, and on this one, I was still logicking my way through the question and answer choices when I heard the "next slide" click.

Not that it mattered much. Those slides were... whoa. I'd heard different slides, but same diagnostic features; it just may be a different view of the same sort of specimen. On the first exam, I'd look up, go "Oh, that's nutmeg liver", read the question and go "Uh oh." On the second exam, I'd look up, go "What in hell is that mangled mass of tissue? Was this an incidental finding at a murder scene where the victim got put into a wood chipper?", read the question and go "Oh. That is easily the most undiagnostic least representative view of an aortic dissection I've ever seen. Fortunately, this patient is presenting the way he would if he'd waltzed out of the textbook", and then of course, read the answer choices and go "Uh oh".

Oh, and I owe Kwesi like three beers for LAP scores and I get NONE for pseudomonas. Hmph. Makes me almost think there's something wrong with playing path exam drinking games. Nah...

So who knows and c'est la vie. Now all that's left is to focus on micro and then TRY to pull my aching brain together sufficiently to actually study for the Clinical Skills written exam on Monday.

And then? Turtle watching! Wahoo!!

And an additional good luck to all you anatomy and BSCE takers out there, as well as my microbiology-afflicted brothers and sisters. I'd wish you 6th termers good luck, but I have no idea what your exam schedule is, so I'll just wish you a nonspecific good luck and congratulations.

The feature presentation tonight is:

Places I'd rather be than in a path exam tomorrow!

One more day now

You know that period of studying where you know you still have studying you need to do, but at the same time, you kind of wish it were exam time just so you could be done with the whole mess?

Yup, that's where I am.

What I'm learning in path, besides everything that can go wrong with every part of your body, not that that's any pressure, is that I missed the Sesame Street that was brought to you by the letter "I", because I hate and can't remember every disease that starts with it, specifically those that involve four to five words, the first of which is either "Idiopathic" or "Interstitial". "Idiopathic" is turning into one of those apathetic agnostic things: "Don't know. Don't care."

The weird thing is that idiopathic should be my greatest friend of all, because it means I don't have to learn a buttload of tumor markers and cytokines, but it's not, because it's rarely "Idiopathic heart attack". No, it's like every Greek/Latin derived root word rammed together with "Idiopathic" in front of it. "Oh! That patient has Idiopathic interstitial pulmonary fibromyogenic diverticulosis of the anterior inferior periepicardial medial border. It's found in .005% of 90 year old Papua New Guinean genetically predisposed females somehow secondarily to eating the brains of the nephroxides rubber tree wombat. It presents with malaise and night sweats. As does every other disease that anyone has ever had."

There's a part of me that just wants to write in "TB" and "sarcoidosis" for every answer on the test, because they always screw me up by presenting with a slew of seemingly unrelated symptoms that could easily be confused with absolutely everything else. And your clinical case will be a homeless alcoholic smoker, which means they have EVERYthing. Usually simultaneously.

So to pass the time, instead, I end up developing geeky drinking games with my study partners. I get a beer for Pseudomonas. Kwesi gets a beer for lap scores, and Christine gets a beer for Hodgkin's lymphoma, and possibly for blueberry muffin babies (don't ask). I'd say chug every time you see the word "idiopathic", but then we'd all have alcohol poisoning, aspirate Klebsiella and drown in a sea of our own mucus. You see what I'm dealing with over here?

Yup, I'm still alive

And no, am not going through the slow process of blog abandonment... not until rotations!

What I am doing is preparing for the unmitigated hell that is the upcoming midterm/finals season with the notoriously worst path exam on Tuesday, PD lab midterm on Wednesday, microbio final on Friday, and PD written midterm the following Monday, while the 1st, 2nd, and 5/6th termers are also taking all their final exams.

So if you're asking whether this turns campus into a rampaging boiling mass of stressed out, unwashed, scrubs-clad joyless drones, of which I am one, the answer is "yes". Oh, though I frequently do my stressed out unwashed scrubs-clad joyless drone-essness (it's a word now) in my apartment, since the spontaneous resurrection of my computer despite my dumping milk on it, led to a steady migration back from the library, as did the necessity to study group path.

You can also tell it's exam season from the increasing dreariness of collective skype and facebook away messages as they devolve from quirky status updates to various forms of either the more optimistic forms of "We can do this; good luck everyone; only a little more time now" to the less happy varieties of "Please do not attempt to resuscitate my fetid corpse if you find me because it will be the first peace I've gotten since embarking on this misbegotten career choice" and every variant in between. Ah, spring.

It's also telling that now, virtually my only form of social interaction involves debating over which cytokines are involved in which disease pathologies, and my alone time consists of pacing my apartment with micro flashcards like a caged jaguar... if jaguars did flashcards, I mean.

But despite all this, I'm actually feeling okay right now. I'm not sure if it's exam-optimism (if only) or if I'm finally learning to adapt to the general exam stress and adopt a more live and let scantron approach to life. Or maybe it's because I'm heavily in denial. Or it's that for my study session tonight, I randomly ended up dressed like a pirate by accidentally combining a t-shirt with a skull on it with my "crap, my bangs are too long" bandanna, and pirates make me smile, even if my study buddies probably did think I was about to abandon medical school to pillage swag and drink rum.

Come to think of it...