It blows my mind that a healthy woman with NO prior health history, on NO medications, who had a baby 5 months ago, could spontaneously develop a dangerous liver abscess from a severe infection. This world is a crazy place.
Luckily, she will be okay. She was my last patient at the JMP! Which is another thing that blows my mind. I can't quite realize that three years have gone by. I am no longer that fresh-faced young person just starting anatomy. Three years older, and dubiously wiser, and slightly sadder, and definitely happier, all at the same time. I've learned a lot, and not all of it has been from a textbook.
1. It's good to be important, but it's more important to be good.
2. A sense of humor will preserve you.
3. Never scoff at love in any form.
4. Remember what it feels like to be sick. Everyone in the hospital feels like that times ten.
5. Be grateful. As often as possible.
That's all the sentimental nonsense I got for now. It's a mellow sunshiny afternoon here after days of rain, and our big clinical exam is tomorrow! I'm a little tired so I may take a quick nap before studying my physical exam stuff. We each get six patients: 20 min. for physical exam, 8 min. written exam, 7 min. feedback from each examiner. They grade you on above, at, or below competency, and there's some magical algorithm to tell them whether you've passed or not. Sigh.
Life is crazy right now. There is too much to remember. I miss B something fierce. I try not to dwell on the fact that I don't really get to see family, hang out with friends, catch up with old friends, or have lots of fun right now. But I'm probably contagious anyway, given this vague pro-dromal feeling, so perhaps it's a blessing in disguise.
I'm listening to The Great River from the LOTR soundtrack, which is beautiful. Wouldn't it be fun to be Howard Shore and compose all the music that went with that movie? Although maybe it would be more fun to be in the orchestra or the choir. Hmm. Either way, it's pretty fabulous stuff.
Saturday, February 27, 2010
Thursday, February 25, 2010
The Post Triumphant!!
I have an announcement to make! After 48 hours of incredibly hard work and very little sleep:
A new thesis comes into the worldTo prevent the spread of germs (mine to you), visitors are very welcome after April 2nd.
Wednesday, February 24, 2010
We're Not Alone
And, as proof that others have felt this way since time began (or at least since the first world war):
Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.
Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.
Surely some revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spiritus Mundi
Troubles my sight: a waste of desert sand;
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Wind shadows of the indignant desert birds.
The darkness drops again but now I know
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?
(Yeats, The Second Coming)
Things Fall Apart
The book by Chinua Achebe describes a man who watches in dismay as his way of life becomes obsolete. The analogy is a pretty good one for 3rd year at the JMP. The first two years, you mosey along, doing PBL like it's a hobby, thinking to yourself how fun medical school has turned out to be. You don't actually bother to remember much from the first year, and you remember a little more from the second. Third year, you begin to realize ways in which some of the common myths passed around the JMP are actually hurting some of its type A procrastinators (hmm, I wonder if I fall into this category).
First, I'm exhausted so please take this post, if you happen to be reading it at the moment, with a grain of salt.
To reiterate: please take this post with a grain of salt. None of these generalizations are subscribed to by everyone, professors and students, in the JMP -- in fact, I think only a few individuals actually believe them. But they have somehow become acceptable to say. I debunk them below.
Top Ten Myths Passed Around the JMP
1. "Don't worry now -- after all, the boards/thesis/exams/wards are a long way away. The best preparation is lots of fun and sleep." This is not true. I cannot even tell you how many times people (including professors) brushed me off instead of helping me find the tools to really learn and make myself a better student. Now, in my 3rd year, I find myself having to correct mid-course. Sleep is important, obviously. But so is taking your work seriously! You're not paying $30,000/year to scrape by.
2. "Oh, whatever -- I barely studied. Who cares, anyway? Screw it." This attitude is addictive. I know I've gotten sucked into it. But really, people? This is not middle school, it's medical school. I realize they both begin with M. But you're still too cool for school?
3. "You'll never know everything, so don't worry about it. Just enjoy it the first time around, it'll be back." Yes, but if you never take the time to understand it when it's fresh and exciting, it'll always be a mystery and eventually you'll develop a mental block, whether it's EKGs, ABG's, or other acronyms that scare you. Better advice would be, "There is a lot to learn, but don't feel anxious. Just take it one step at a time and focus on the task at hand."
4. "Medicine keeps changing. Don't bother to memorize anything." This is something I've heard again and again and again, and truly it does students a disservice. Memorization helps you remember things so that you can understand them the second time around. And glycolysis hasn't changed in my lifetime (or yours, either)! Anatomy? Still the same (evolution isn't that fast). Normal vital signs? Very crucial. So ditch the hippie attitude. It is important and we do need to know it by heart. When it changes, we'll have a basis to understand the change.
5. "In PBL, students call the shots and can learn whatever they want, however they want to learn it." Again, not true. There are standards, they are simply not published. So please, please ditch this myth and the passive-aggressiveness it generates. If you want us to learn something specific, don't use the unit exam to tell us this -- just tell us! Believe me, we won't be offended or crippled by a little spoon-feeding now and then. Getting angry at us when we don't want to 'challenge ourselves' is a failure to recognize a cry for academic, or personal, help. All together, now: 1, 2, 3...HELP!
6. "This is great preparation for the real world." No, this is the real world. I've said this before, and I'll say it again. You don't tell a 5-year-old that learning to write is super easy, so why are they stressing? You don't tell them that a playground fight is no big deal. No, you help them with their writing, even if it takes you three hours, and you clean the wounds from the fight while trying to figure out what's going on with your kids. Here's a secret: medical students are just 5-year-olds who are older. So please accept the fact that for us, life is actually difficult, the demands on our time are perhaps more than we have the skills to deal with, and that yes -- when we're 50 it might be easier for us, but we're still LEARNING. That's why it's called school. So please be patient instead of dismissive when we're stressed or overwhelmed. Of course, that is never an excuse for us to act mean or rude. But realize we're learning more than how to use an iphone app. Some of us are still learning how to keep ourselves clean and clothed.
7. "We have an integrated curriculum." No, we have three arms of the curriculum -- clinical skills, master's thesis, and PBL. They are all vying for our attention (which is very flattering, by the way). They're all useful and exciting. However, they are not integrated. Each arm rarely can describe what's going on with the other two. All of them tend to demand a lot of time and effort. Please don't pretend that you've integrated the curriculum -- you've presented the curriculum to your students, who are integrating it in their studies. But we may as well be taking three entirely different classes in three different departments on three different campuses, because that's how much logistical coordination and effort is required to pull it off. And THAT'S OK. But let's be honest.
8. "We know what you're going through." I appreciate this as what it's meant to be -- a genuine expression of empathy. However, rarely does someone use this when they actually know what I'm going through. Unless you have individually met with a student and figured out how they learn, their academic history, what their home life is like, their level of fatigue, their morals and values, and their other commitments -- then no, you have very little idea of what they're going through. This just sounds dismissive. See #6, above.
9. "Everyone needs a therapist." No. Everyone needs more sleep. Everyone needs food and water and shelter from precipitation in freezing weather. But everyone does not need a therapist. If YOU need a therapist, that's absolutely fine. I like therapists. Hell, I even let them use my bathroom! (That was a joke. Joke. Joke.) But my point is, please, please, please stop telling me I need a therapist. If I've offended you, I'm sorry. Otherwise -- huh? Stress is okay. Sadness is normal. If I feel like I'm sliding, I'll go to a therapist. But it's just rude to assume you know what someone else needs unless you're deliberately trying to stage an intervention. I realize the point of this is to emphasize that MANY medical students go through depression or have other mental health needs, and I think that needs recognition. I just don't need to find a therapist myself to recognize that others might want one! I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. Ahhhh.
10. "If a student doesn't do well on this exam/thesis/final/oral/preceptorship, it must be that there's something wrong in the student's personal life." This is actually not a bad assumption for a professor to make, but it would be a lot easier if they also understood something else: I care about your subject very much. I do not deliberately want to blow it off. But I'm juggling, and sometimes, I cannot prioritize your subject/ball. Sometimes your subject/ball will drop on the ground. I will pick it up, dust it off, and continue to juggle. But until I'm a master juggler, balls are gonna drop. If it belonged to you, I'm truly sorry and will try to do better. But it's really not personal -- it's not about you, and it's not about my personal life. It's purely about my juggling ability.
Wow, that was cathartic. Okay, back to my real life. Which right now involves an emergency nap (we had an exam this morning).
P.S. I just want to say that you rock. That's right, YOU -- mom, dad, brother, friend, partner, unsung professor who really gets it, loved-one-in-some capacity -- you are people I care about, look up to, and try to do well for. Thank you for being there.
First, I'm exhausted so please take this post, if you happen to be reading it at the moment, with a grain of salt.
To reiterate: please take this post with a grain of salt. None of these generalizations are subscribed to by everyone, professors and students, in the JMP -- in fact, I think only a few individuals actually believe them. But they have somehow become acceptable to say. I debunk them below.
Top Ten Myths Passed Around the JMP
1. "Don't worry now -- after all, the boards/thesis/exams/wards are a long way away. The best preparation is lots of fun and sleep." This is not true. I cannot even tell you how many times people (including professors) brushed me off instead of helping me find the tools to really learn and make myself a better student. Now, in my 3rd year, I find myself having to correct mid-course. Sleep is important, obviously. But so is taking your work seriously! You're not paying $30,000/year to scrape by.
2. "Oh, whatever -- I barely studied. Who cares, anyway? Screw it." This attitude is addictive. I know I've gotten sucked into it. But really, people? This is not middle school, it's medical school. I realize they both begin with M. But you're still too cool for school?
3. "You'll never know everything, so don't worry about it. Just enjoy it the first time around, it'll be back." Yes, but if you never take the time to understand it when it's fresh and exciting, it'll always be a mystery and eventually you'll develop a mental block, whether it's EKGs, ABG's, or other acronyms that scare you. Better advice would be, "There is a lot to learn, but don't feel anxious. Just take it one step at a time and focus on the task at hand."
4. "Medicine keeps changing. Don't bother to memorize anything." This is something I've heard again and again and again, and truly it does students a disservice. Memorization helps you remember things so that you can understand them the second time around. And glycolysis hasn't changed in my lifetime (or yours, either)! Anatomy? Still the same (evolution isn't that fast). Normal vital signs? Very crucial. So ditch the hippie attitude. It is important and we do need to know it by heart. When it changes, we'll have a basis to understand the change.
5. "In PBL, students call the shots and can learn whatever they want, however they want to learn it." Again, not true. There are standards, they are simply not published. So please, please ditch this myth and the passive-aggressiveness it generates. If you want us to learn something specific, don't use the unit exam to tell us this -- just tell us! Believe me, we won't be offended or crippled by a little spoon-feeding now and then. Getting angry at us when we don't want to 'challenge ourselves' is a failure to recognize a cry for academic, or personal, help. All together, now: 1, 2, 3...HELP!
6. "This is great preparation for the real world." No, this is the real world. I've said this before, and I'll say it again. You don't tell a 5-year-old that learning to write is super easy, so why are they stressing? You don't tell them that a playground fight is no big deal. No, you help them with their writing, even if it takes you three hours, and you clean the wounds from the fight while trying to figure out what's going on with your kids. Here's a secret: medical students are just 5-year-olds who are older. So please accept the fact that for us, life is actually difficult, the demands on our time are perhaps more than we have the skills to deal with, and that yes -- when we're 50 it might be easier for us, but we're still LEARNING. That's why it's called school. So please be patient instead of dismissive when we're stressed or overwhelmed. Of course, that is never an excuse for us to act mean or rude. But realize we're learning more than how to use an iphone app. Some of us are still learning how to keep ourselves clean and clothed.
7. "We have an integrated curriculum." No, we have three arms of the curriculum -- clinical skills, master's thesis, and PBL. They are all vying for our attention (which is very flattering, by the way). They're all useful and exciting. However, they are not integrated. Each arm rarely can describe what's going on with the other two. All of them tend to demand a lot of time and effort. Please don't pretend that you've integrated the curriculum -- you've presented the curriculum to your students, who are integrating it in their studies. But we may as well be taking three entirely different classes in three different departments on three different campuses, because that's how much logistical coordination and effort is required to pull it off. And THAT'S OK. But let's be honest.
8. "We know what you're going through." I appreciate this as what it's meant to be -- a genuine expression of empathy. However, rarely does someone use this when they actually know what I'm going through. Unless you have individually met with a student and figured out how they learn, their academic history, what their home life is like, their level of fatigue, their morals and values, and their other commitments -- then no, you have very little idea of what they're going through. This just sounds dismissive. See #6, above.
9. "Everyone needs a therapist." No. Everyone needs more sleep. Everyone needs food and water and shelter from precipitation in freezing weather. But everyone does not need a therapist. If YOU need a therapist, that's absolutely fine. I like therapists. Hell, I even let them use my bathroom! (That was a joke. Joke. Joke.) But my point is, please, please, please stop telling me I need a therapist. If I've offended you, I'm sorry. Otherwise -- huh? Stress is okay. Sadness is normal. If I feel like I'm sliding, I'll go to a therapist. But it's just rude to assume you know what someone else needs unless you're deliberately trying to stage an intervention. I realize the point of this is to emphasize that MANY medical students go through depression or have other mental health needs, and I think that needs recognition. I just don't need to find a therapist myself to recognize that others might want one! I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. Ahhhh.
10. "If a student doesn't do well on this exam/thesis/final/oral/preceptorship, it must be that there's something wrong in the student's personal life." This is actually not a bad assumption for a professor to make, but it would be a lot easier if they also understood something else: I care about your subject very much. I do not deliberately want to blow it off. But I'm juggling, and sometimes, I cannot prioritize your subject/ball. Sometimes your subject/ball will drop on the ground. I will pick it up, dust it off, and continue to juggle. But until I'm a master juggler, balls are gonna drop. If it belonged to you, I'm truly sorry and will try to do better. But it's really not personal -- it's not about you, and it's not about my personal life. It's purely about my juggling ability.
Wow, that was cathartic. Okay, back to my real life. Which right now involves an emergency nap (we had an exam this morning).
P.S. I just want to say that you rock. That's right, YOU -- mom, dad, brother, friend, partner, unsung professor who really gets it, loved-one-in-some capacity -- you are people I care about, look up to, and try to do well for. Thank you for being there.
Thursday, February 18, 2010
You know you're a lucky lady when...
...your brother initiates a dinner-rescue-plan whereby he spends twenty minutes convincing you he means it when he offers to drive an hour out and an hour back JUST to have dinner because he knows you're stressed out from studying and you refused to drive out anywhere.
...your mom hears of the plan and comes along, bringing soup for your freezer.
...and a jacket from your dad, who bought you one as a surprise (thanks! it's awesome!)
...you go out to dinner with them, and your mom and brother are charming, listen to your inane and nerdy stories, gently tell you about what's happening in the real world, and then your brother picks up the tab.
...the cat is so happy to see them that she bounces around like a kitten, even though she's 12.
...you have them to go home to once the boards are over.
Sigh. Warm. Fuzz.
...your friends buy you frozen yogurt and invite you to a party
...your fiance thinks you have every right to vent, even if you really don't
...your classmates share study resources with one another and truly wish each other well
...your cousin doesn't need stitches after all! :)
...your friends find romance and it makes them happy, thereby making you happy
...people come home from abroad and leave you a voice mail
I could go on for ages. This counting blessings thing gets addictive.
...your mom hears of the plan and comes along, bringing soup for your freezer.
...and a jacket from your dad, who bought you one as a surprise (thanks! it's awesome!)
...you go out to dinner with them, and your mom and brother are charming, listen to your inane and nerdy stories, gently tell you about what's happening in the real world, and then your brother picks up the tab.
...the cat is so happy to see them that she bounces around like a kitten, even though she's 12.
...you have them to go home to once the boards are over.
Sigh. Warm. Fuzz.
...your friends buy you frozen yogurt and invite you to a party
...your fiance thinks you have every right to vent, even if you really don't
...your classmates share study resources with one another and truly wish each other well
...your cousin doesn't need stitches after all! :)
...your friends find romance and it makes them happy, thereby making you happy
...people come home from abroad and leave you a voice mail
I could go on for ages. This counting blessings thing gets addictive.
Tuesday, February 16, 2010
Running (out of excuses not to run)...
Wow, I'm prolific right now. I don't even know why. Today I went for my first run in a long time -- I think since I went running with B when I was visiting him. And it felt GOOD! I got a mild runner's high going in maybe the first five minutes, and then I kept it up for pretty much the whole half hour. And it was beautiful, the sun was slanting in over the bay, and people were out and about, and I just had fun. So many adorable dogs, it was an animal lover's paradise this afternoon. And perhaps the best part was that when I got home feeling all glowy and athletic, I saw the sun setting out of the window and that was spectacular, too.
Thanks for finding this place, Mom and Mashi!! You both rock big-time.
Um, so why don't I do this more often?
Thanks for finding this place, Mom and Mashi!! You both rock big-time.
Um, so why don't I do this more often?
Musings on V-Day
This Sunday was Valentine's day, and I didn't get to see B, but we had already celebrated the weekend before. I got him the first season of Chuck, which is apparently no longer online, and he took me out for a champagne brunch! Yum. It was right after symposium AND the medical school formal, so that was a wonderful chance to relax together before the boards/law school resumed control of our lives. I don't think it's cool that people kept bugging him about coming to see me specifically for V-day -- poor guy! We already celebrated together. Yeesh, leave him alone. My mom, however, flew out to see my dad in Tokyo for Valentine's Day! Aww, cute parents.
I don't think Valentine's Day should be a Hallmark (tm or whatever) holiday, with lots of commercial stuff, but I think it is a nice idea. I think it's nice that the we care enough about love to set aside one day out of the year, one day when you are allowed, even expected, to spend time with your partner. And if you're single, I think the point of Valentine's day is to enjoy yourself, just remembering who you are and the talents you bring to the world, maybe appreciating the gifts you've been given. Showing yourself some serious love!
My favorite single Valentine's Day has always been (surprise surprise) a cup of tea, a cat, and a good book. There was one time people made anti-Valentine's Day cards at my high school because they were single (and again in college), but somehow it seemed too -- unhappy to be making cards against love, or against yourself for being single, or against the world for not providing someone... I don't know. My mom is an optimist and it's a trait I greatly admire. Life is too short to be cynical and too long to stay angry, you know?
Eve Ensler did the V-day monologues to reclaim Valentine's Day, in part. I think they're very powerful for women who aren't aware of their sexuality, or don't feel they can own up to it properly. But on the other hand, I think our society is a little too obsessed with sexuality. Somehow, the content of your character gets lost by the wayside.
Anyway, so back to the cup of tea, cat, and good book (I wasn't single this year, but I was far from my valentine, and from my non-furry family members): One of my favorite series of all time is Anne of Green Gables by L.M. Montgomery. By the standards of the day, Anne was very liberated -- but she just did her own thing and lived by example. Kind of like my grandparents and my parents, come to think of it.
This is a V-day-appropriate verse from Locksley Hall by Lord Alfred Tennyson that LM Montgomery quotes from a lot:
Love took up the glass of Time, and turn'd it in his glowing hands;
Every moment, lightly shaken, ran itself in golden sands.
Love took up the harp of Life, and smote on all the chords with might:
Smote the chord of Self, that, trembling, pass'd in music out of sight.
Many a morning on the moorland did we hear the copses ring
And her whisper throng'd my pulses with the fulness of the Spring.
Many an evening by the waters did we watch the stately ships,
And our spirits rush'd together at the touching of the lips.
I don't think Valentine's Day should be a Hallmark (tm or whatever) holiday, with lots of commercial stuff, but I think it is a nice idea. I think it's nice that the we care enough about love to set aside one day out of the year, one day when you are allowed, even expected, to spend time with your partner. And if you're single, I think the point of Valentine's day is to enjoy yourself, just remembering who you are and the talents you bring to the world, maybe appreciating the gifts you've been given. Showing yourself some serious love!
My favorite single Valentine's Day has always been (surprise surprise) a cup of tea, a cat, and a good book. There was one time people made anti-Valentine's Day cards at my high school because they were single (and again in college), but somehow it seemed too -- unhappy to be making cards against love, or against yourself for being single, or against the world for not providing someone... I don't know. My mom is an optimist and it's a trait I greatly admire. Life is too short to be cynical and too long to stay angry, you know?
Eve Ensler did the V-day monologues to reclaim Valentine's Day, in part. I think they're very powerful for women who aren't aware of their sexuality, or don't feel they can own up to it properly. But on the other hand, I think our society is a little too obsessed with sexuality. Somehow, the content of your character gets lost by the wayside.
Anyway, so back to the cup of tea, cat, and good book (I wasn't single this year, but I was far from my valentine, and from my non-furry family members): One of my favorite series of all time is Anne of Green Gables by L.M. Montgomery. By the standards of the day, Anne was very liberated -- but she just did her own thing and lived by example. Kind of like my grandparents and my parents, come to think of it.
This is a V-day-appropriate verse from Locksley Hall by Lord Alfred Tennyson that LM Montgomery quotes from a lot:
Love took up the glass of Time, and turn'd it in his glowing hands;
Every moment, lightly shaken, ran itself in golden sands.
Love took up the harp of Life, and smote on all the chords with might:
Smote the chord of Self, that, trembling, pass'd in music out of sight.
Many a morning on the moorland did we hear the copses ring
And her whisper throng'd my pulses with the fulness of the Spring.
Many an evening by the waters did we watch the stately ships,
And our spirits rush'd together at the touching of the lips.
I think the fourth line is especially powerful. Is losing yourself in the music a good thing? I hope so! I think if it's your ego, it must be :)
How can I help you?
I'm going to try to express what bugs me so much about our clinical preceptorships. It's not just visiting a new hospital every semester and getting taught by another new doctor whom you'll only meet three times. I like the patient visits a lot, and I like hearing people's stories and practicing physical exam and seeing how the whole hospital/clinic/ER works, but...still. I hesitate. Here's what happened this morning:
She was pretty stoic about her condition. After years of working as a health worker herself, she was hospitalized by sudden and severe back issues that left her in a wheelchair for life. In addition, she is obese and diabetic. She has fungal infections in the folds of her skin, which had opened the pathway for bacterial infection. She has had several severe cellulitis infections (skin infections that turn red, make you swell up, and spread rapidly). Luckily, her partner seems to be supportive but there are, as she pointed out, limits.
She agreed to speak with me, told me her health history, and then gave me her story. She knew all of her medications, trade name and generic, with dosages and also what they do -- which I think is an unmatched feat (among the patients I've seen). But as she spoke to me, I got this overwhelming sense of -- what are you going to do? Like she was testing me, and wanted me to 'practice' on her, but also that she was fed up.
So what did I do? Given that we didn't have to do the whole exam for our last two patient visits, and that my preceptor was waiting, I opted to do a focused H&P (meaning the problem at hand, any relevant history -- which is often extensive, and then pick one system to examine). With her, obviously, it was skin. I wanted to do the neuro exam, too, which is much more extensive and involves cranial nerves, motor, sensory, and mental status -- but I had a feeling she had had it. I asked if her feet hurt, and she said yes, but I could touch them. And I was thinking -- why am I here? To practice? I can't help you -- I don't have the knowledge. I can do a neuro exam, but you don't need one. You need to go home. I got this overwhelming sense of shame, making someone go through the paces -- and there was no interest from her about what they were teaching us, etc, which you often get if you examine healthcare workers. So I think she was humoring me, and I did the basics and ran -- well, not quite, but spent almost as much time on her labs (40 minutes) as with her (70 minutes).
Wimpy? Dumb? Good idea? Bad idea? I mean, obviously, I can't and won't when I'm on the wards -- but on the wards, I'll have a function that goes beyond putting people out for the sake of my own learning.
She said to me, "This is not how I envisioned living at 5X years old. It's not much fun having to show your boobies to everyone (common site of fungal infections). I don't want to visit the hospital again for another 7 years." My preceptor seemed to think that much of it stemmed from carrying extra weight -- probably around 100 lbs. But the fundamental question I wanted to ask this brave, somewhat fed-up, and talented historian was, "I'm not even on the wards yet. So how can I help you?"
And the painful answer is, I can't. I can just learn from you in order to help someone else. And none of my professors have given me a truly good justification for why one patient (who has 'volunteered,' but often is simply doing it as a favor to their doctor) should go through an hour or two of crap for me.
I mean, some patients really enjoy teaching. They enjoy interacting with a medical student, they like telling their stories, they don't mind someone spending an extra hour with them. But inevitably, as a student, you are called upon to examine and interview people who don't really get much out of it. And unlike when you're on the wards or when you're a physician, you can't say, "I know this is annoying/embarrassing/painful, but I'm really trying to help you." Because you're not trying to help them! You're just trying to get to the point where you could.
She was pretty stoic about her condition. After years of working as a health worker herself, she was hospitalized by sudden and severe back issues that left her in a wheelchair for life. In addition, she is obese and diabetic. She has fungal infections in the folds of her skin, which had opened the pathway for bacterial infection. She has had several severe cellulitis infections (skin infections that turn red, make you swell up, and spread rapidly). Luckily, her partner seems to be supportive but there are, as she pointed out, limits.
She agreed to speak with me, told me her health history, and then gave me her story. She knew all of her medications, trade name and generic, with dosages and also what they do -- which I think is an unmatched feat (among the patients I've seen). But as she spoke to me, I got this overwhelming sense of -- what are you going to do? Like she was testing me, and wanted me to 'practice' on her, but also that she was fed up.
So what did I do? Given that we didn't have to do the whole exam for our last two patient visits, and that my preceptor was waiting, I opted to do a focused H&P (meaning the problem at hand, any relevant history -- which is often extensive, and then pick one system to examine). With her, obviously, it was skin. I wanted to do the neuro exam, too, which is much more extensive and involves cranial nerves, motor, sensory, and mental status -- but I had a feeling she had had it. I asked if her feet hurt, and she said yes, but I could touch them. And I was thinking -- why am I here? To practice? I can't help you -- I don't have the knowledge. I can do a neuro exam, but you don't need one. You need to go home. I got this overwhelming sense of shame, making someone go through the paces -- and there was no interest from her about what they were teaching us, etc, which you often get if you examine healthcare workers. So I think she was humoring me, and I did the basics and ran -- well, not quite, but spent almost as much time on her labs (40 minutes) as with her (70 minutes).
Wimpy? Dumb? Good idea? Bad idea? I mean, obviously, I can't and won't when I'm on the wards -- but on the wards, I'll have a function that goes beyond putting people out for the sake of my own learning.
She said to me, "This is not how I envisioned living at 5X years old. It's not much fun having to show your boobies to everyone (common site of fungal infections). I don't want to visit the hospital again for another 7 years." My preceptor seemed to think that much of it stemmed from carrying extra weight -- probably around 100 lbs. But the fundamental question I wanted to ask this brave, somewhat fed-up, and talented historian was, "I'm not even on the wards yet. So how can I help you?"
And the painful answer is, I can't. I can just learn from you in order to help someone else. And none of my professors have given me a truly good justification for why one patient (who has 'volunteered,' but often is simply doing it as a favor to their doctor) should go through an hour or two of crap for me.
I mean, some patients really enjoy teaching. They enjoy interacting with a medical student, they like telling their stories, they don't mind someone spending an extra hour with them. But inevitably, as a student, you are called upon to examine and interview people who don't really get much out of it. And unlike when you're on the wards or when you're a physician, you can't say, "I know this is annoying/embarrassing/painful, but I'm really trying to help you." Because you're not trying to help them! You're just trying to get to the point where you could.
Telefund DID kiss my ass
So I called the Telefund call center closest to me, in Santa Barbara. And explained the problem. And got a patient response. And the person offered to take me off the list and fix the problem without arguing.
I no longer think Telefund, the progressive call center company, can kiss my ass.
I'm just happy that they did.
Thank you, Telefund. My check is in the mail.
I no longer think Telefund, the progressive call center company, can kiss my ass.
I'm just happy that they did.
Thank you, Telefund. My check is in the mail.
Telefund can kiss my ass
Who calls at 5 am? And at 10 pm? And every two hours in between? Telefund.
Who, when I pick up the phone and tell them the problem and ask to be taken off the list, gets testy with me and gives me lip and demand that I stay on the line while asking for a $75 annual renewal for the DNC? Telefund.
Who do I hope will be written up my his supervisor when his call is "monitored for quality purposes?" The not-so-nice-man at Telefund.
And who makes me ashamed to be a member of the DNC who may perhaps NOT renew her membership, due to the DNC's poor taste in call company contractors? Telefund.
Telefund, kiss my ass. That's the only way you'll see a dime.
Who, when I pick up the phone and tell them the problem and ask to be taken off the list, gets testy with me and gives me lip and demand that I stay on the line while asking for a $75 annual renewal for the DNC? Telefund.
Who do I hope will be written up my his supervisor when his call is "monitored for quality purposes?" The not-so-nice-man at Telefund.
And who makes me ashamed to be a member of the DNC who may perhaps NOT renew her membership, due to the DNC's poor taste in call company contractors? Telefund.
Telefund, kiss my ass. That's the only way you'll see a dime.
Monday, February 8, 2010
Finally Figured it Out
Lately, my parents (who are dear, sweet people) have been less sympathetic about my overwhelming stress and less encouraging about my work than they used to be. I have finally figured out why.
They are sick of hearing me whine. It's been twenty-five years, and they're getting tired of it. They're happy to help with editing/money/food, but I think they may have reached the end of their respective venting tolerances. Their reactions now tend to be more along the lines of "so get off the phone and go do your work," than "oh, poor thing."
Wait -- what? You expect me to grow up and take responsibility for my life? I should acknowledge that I knew what I was getting myself into? Those that dance will pay the piper? Bed to lie in, etc? You want me to deal with stress without being cranky to those around me and acting like I'm at the center of the universe? You (gasp) want your own lives?
Oh. That's actually kind of reasonable. Darn.
I guess that's what cats are for.
They are sick of hearing me whine. It's been twenty-five years, and they're getting tired of it. They're happy to help with editing/money/food, but I think they may have reached the end of their respective venting tolerances. Their reactions now tend to be more along the lines of "so get off the phone and go do your work," than "oh, poor thing."
Wait -- what? You expect me to grow up and take responsibility for my life? I should acknowledge that I knew what I was getting myself into? Those that dance will pay the piper? Bed to lie in, etc? You want me to deal with stress without being cranky to those around me and acting like I'm at the center of the universe? You (gasp) want your own lives?
Oh. That's actually kind of reasonable. Darn.
I guess that's what cats are for.
Full Plate, but Dessert Before Dinner
So here I am with post-symposium guilt, feeling like I've eaten dessert before dinner. For a week, it was mainly symposium stuff, which was super fun because it was single-minded. And now I have to get back to all the other stuff. I just got off the phone with mom, who obviously had no idea what all this 'other stuff' was. In case you are similarly in the dark, let me show you:
2/1: Get last thesis comments, prepare for admissions, Admissions committee mtg 6-9 pm
2/2: Preceptorship 9-12 noon, Study for CS exam tomorrow, Pelvic Exam 5:30-7:30
2/3: Practice presentation for prof, 12 -1 pm, Clinical Skills Exam, 2-5 pm, Practice for prof, 5-6
2/4: Make changes and practice, Give practice presentation 12 noon, make final changes until 2 am
2/5: Symposium, 8-6 pm
2/6: Sleep till 1:30 (after going to bed at 10 pm) from exhaustion. Go to dinner and a party.
2/7: Paper on the Krebs cycle due; struggle to understand carbohydrate, fat, and fed/fasting metabolism all day long. Fail. Eat more cooked food (not cereal). Work on thesis revisions.
2/8: Class 8:30-12 noon. Sleep from 12 to 3:30 pm. Work on thesis revisions.
2/9: Preceptorship 8:30-1 pm
When you combine medical school, clinical skills, a thesis symposium, admissions, and an actual thesis...you have chaos in a jar.
Our professors like to tell us, "It's great practice for the real world!" Okay, first, this is the real world. It's not like the world gets more real as you progress from your twenties to your fifties. It gets harder, but hopefully you've spend the interim decades, you know, learning. Try telling a preschooler that writing cursive is easy, why don't they just do it already? And playground fights are very real when you are four.
I don't NEED practice for the REAL world. Okay? I'll deal with my career when I'm ready to be a physician. I don't need to PRACTICE being CRAZY. There's PLENTY of time for that LATER. And the world that we're living in is VERY real. Believe me, this kind of intricate chaos doesn't happen in dream states.
I mean honestly, has any physician ever said, "You know, my life is so crazy. I wish I had PRACTICED this earlier?" No, they wish they had spent more medical school weekends sleeping.
2/1: Get last thesis comments, prepare for admissions, Admissions committee mtg 6-9 pm
2/2: Preceptorship 9-12 noon, Study for CS exam tomorrow, Pelvic Exam 5:30-7:30
2/3: Practice presentation for prof, 12 -1 pm, Clinical Skills Exam, 2-5 pm, Practice for prof, 5-6
2/4: Make changes and practice, Give practice presentation 12 noon, make final changes until 2 am
2/5: Symposium, 8-6 pm
2/6: Sleep till 1:30 (after going to bed at 10 pm) from exhaustion. Go to dinner and a party.
2/7: Paper on the Krebs cycle due; struggle to understand carbohydrate, fat, and fed/fasting metabolism all day long. Fail. Eat more cooked food (not cereal). Work on thesis revisions.
2/8: Class 8:30-12 noon. Sleep from 12 to 3:30 pm. Work on thesis revisions.
2/9: Preceptorship 8:30-1 pm
When you combine medical school, clinical skills, a thesis symposium, admissions, and an actual thesis...you have chaos in a jar.
Our professors like to tell us, "It's great practice for the real world!" Okay, first, this is the real world. It's not like the world gets more real as you progress from your twenties to your fifties. It gets harder, but hopefully you've spend the interim decades, you know, learning. Try telling a preschooler that writing cursive is easy, why don't they just do it already? And playground fights are very real when you are four.
I don't NEED practice for the REAL world. Okay? I'll deal with my career when I'm ready to be a physician. I don't need to PRACTICE being CRAZY. There's PLENTY of time for that LATER. And the world that we're living in is VERY real. Believe me, this kind of intricate chaos doesn't happen in dream states.
I mean honestly, has any physician ever said, "You know, my life is so crazy. I wish I had PRACTICED this earlier?" No, they wish they had spent more medical school weekends sleeping.
Saturday, February 6, 2010
Research Rocks the House at Symposium 2010
The symposium was fabulous! I don't know whether the audience actually enjoyed it, but I sincerely hope they did. I am SO PROUD of my classmates for doing their research, putting their talks together, and making 10 hours fly by. I arrived for the first panel and stayed till the last (which was when I was going). I thought I'd be really nervous, but seeing so many friendly faces in the audience helped tremendously. I wish I could bottle that euphoric feeling from right afterwards and drink it when I'm feeling down, cause wow. It felt GOOD.
It was so exciting and uplifting and fun. It was totally a dream come true! So much so that I can't write about it in the first person without bawling. So, this is what I wish had been written about it in the San Francisco Chronicle:
February 5th, 2010, Berkeley, CA.
The medical community sat up and took notice as the 15 stars of the Joint Medical Program (JMP) class of 2010 presented their research talks during the all-day symposium at UC Berkeley yesterday. Dr. Coco Auerswald, the head of the Master's program at the JMP, hosted the symposium, which was coordinated by the masterful Jessea Greenman of the JMP staff. Topics ranging from violence to God to STD transmission gave audience members a reason to stay for the 10 hours of sequential talks, as did the fabulous breakfast, lunch, and wine-and-cheese reception organized by the JMP's Mary Rita Algazzali.
The morning began with a 'violence' panel, in which three members of the class presented work about released prisoners' health outcomes, a violence-recidivism intervention for inner city youth, and how residential segregation relates to violent injury. These young investigators took the slight computer glitches in stride, which were in any case soon dealt with by Nina Green, the JMP technology whiz.
Following this, an entire panel was devoted to the single payer debate concerning national healthcare, which drew the audience into a compelling argument about moral intuition and how people come to decisions about policy.
A coffee break gave everyone enough energy to delve into the complex issues the third panelists tackled with their projects, including the use of race in pharmacogenetics, the relationhips between social integration and mortality, immunization coverage in the Native American population, and how Vietnamese-American youth prefer to access healthcare.
After lunch, which was filling, tidy (for those in suits), and delicious, we heard about sex and God at the same time, with a rousing discussion of cervical cancer prevention, concurrent sexual partnerships in Mozambique and their effects of HIV transmission, and how religiosity influences prenatal depression in Appalachia (pronounce it right or she'll throw an 'apple atcha').
More coffee, and then the last round of talks for the day: arsenic poisoning prevention in Bangladesh, participant observation from a residential student program in a retirement community, a sociological analysis of the free clinic movement and Big Pharma, and the finale -- how community ambassadors can force the public sector to do its job while providing immigrant seniors with health services.
The Joint Medical Program should be proud of its graduating class. The future looks bright for our country as these young professionals begin to make their mark in the world. We wish them all the best as they move on to their clinical medicine years (or nurse midwifery, in one case), and will follow their careers with interest.
It was so exciting and uplifting and fun. It was totally a dream come true! So much so that I can't write about it in the first person without bawling. So, this is what I wish had been written about it in the San Francisco Chronicle:
February 5th, 2010, Berkeley, CA.
The medical community sat up and took notice as the 15 stars of the Joint Medical Program (JMP) class of 2010 presented their research talks during the all-day symposium at UC Berkeley yesterday. Dr. Coco Auerswald, the head of the Master's program at the JMP, hosted the symposium, which was coordinated by the masterful Jessea Greenman of the JMP staff. Topics ranging from violence to God to STD transmission gave audience members a reason to stay for the 10 hours of sequential talks, as did the fabulous breakfast, lunch, and wine-and-cheese reception organized by the JMP's Mary Rita Algazzali.
The morning began with a 'violence' panel, in which three members of the class presented work about released prisoners' health outcomes, a violence-recidivism intervention for inner city youth, and how residential segregation relates to violent injury. These young investigators took the slight computer glitches in stride, which were in any case soon dealt with by Nina Green, the JMP technology whiz.
Following this, an entire panel was devoted to the single payer debate concerning national healthcare, which drew the audience into a compelling argument about moral intuition and how people come to decisions about policy.
A coffee break gave everyone enough energy to delve into the complex issues the third panelists tackled with their projects, including the use of race in pharmacogenetics, the relationhips between social integration and mortality, immunization coverage in the Native American population, and how Vietnamese-American youth prefer to access healthcare.
After lunch, which was filling, tidy (for those in suits), and delicious, we heard about sex and God at the same time, with a rousing discussion of cervical cancer prevention, concurrent sexual partnerships in Mozambique and their effects of HIV transmission, and how religiosity influences prenatal depression in Appalachia (pronounce it right or she'll throw an 'apple atcha').
More coffee, and then the last round of talks for the day: arsenic poisoning prevention in Bangladesh, participant observation from a residential student program in a retirement community, a sociological analysis of the free clinic movement and Big Pharma, and the finale -- how community ambassadors can force the public sector to do its job while providing immigrant seniors with health services.
The Joint Medical Program should be proud of its graduating class. The future looks bright for our country as these young professionals begin to make their mark in the world. We wish them all the best as they move on to their clinical medicine years (or nurse midwifery, in one case), and will follow their careers with interest.
Wednesday, February 3, 2010
Eating Humble Pie
I forgot something. Because I'm in this longitudinal track for our clinical core rotations, I don't have to do the lottery to see where I'll be for which rotation. The lottery which is, of course, due this Friday. My classmates have to do it. I do not have to do it. I lose at misery poker :) And this is why I have been eating humble pie this morning.
No more venting. More sleep, more work, more learning, more showers.
I'm a lucky, fortunate, and grateful person!
Oh, and the cat likes honey nut cheerio-flavored milk -- ???
No more venting. More sleep, more work, more learning, more showers.
I'm a lucky, fortunate, and grateful person!
Oh, and the cat likes honey nut cheerio-flavored milk -- ???
Tuesday, February 2, 2010
A Day in the Life, or 'I Am De Niyavich'
Disclosure: this is a venting post. Don't read if you're not in the mood!
Two good but intense things happened today. I saw two patients, one in the morning and one in the evening. The morning was a 'real' patient who may or may not ever walk again due to infection. And this was particularly awful because the patient didn't understand how serious the illness really was, what the implications were for paraplegia, etc. And I wasn't supposed to say anything. Sigh. The second was a medical model educator, who taught me (and three of my classmates) how to do the OB/GYN exam along with our professor. It was a really, really good way to learn it. Our model/educator is incredibly good at knowing whether you're doing it right, and how to fix it, and how to relax while clumsy medical students examine your nether regions. But it is pretty intense to be doing an OB/GYN exam, or watching one, for three hours straight.
Those two things were quite medically amazing, and I learned a lot and I'm glad for them (patient suffering notwithstanding). However, they were emotionally demanding, and on top of them, all the small things in the day kept tripping me up -- starting this morning, when I literally tripped on my way to preceptorship and almost fell down the stairs. Other stupid things kept happening. My hairspray had no nozzle and I broke one of my favorite headbands. I thought our OB exam started half an hour later than it actually did and was late to a pelvic exam, which is very bad form and incredibly humiliating because it's so disrespectful (thankfully no scolding or parking ticket as vengeance for my error). Luckily, I think I did all right during the exam itself. I didn't eat a square meal till 9 pm, for various reasons. I haven't paid my bills or taken care of my cat today. There are dishes in the sink driving me nuts. The recycling bins are overflowing and need to be taken out. Plus a million important emails are sitting in my inbox, undealt-with. I need about twenty hours of sleep tonight.
And tomorrow is going to be so hectic. In the morning, I have to practice my complete research talk for the head of our thesis department (which is not done yet), and then I have a clinical skills exam where I get to do the entire physical exam in an hour from memory. Yikes. Add to this a still-undone thesis (!), a patient write-up, a paper due for class on Monday, and the actual research presentation this Friday, and you have just a little stress.
Oh, yeah, and the boards. I should probably start thinking about those. Too bad school is getting in the way of the boards, huh?
I keep telling myself to breathe. Air is necessary. Air is necessary.
But as they say,
"When you're cold, don't expect sympathy from someone who's warm."
- Aleksandr Solzhenitsyn
So, my friends, rest assured: this pity party is officially over.
Okay? Okay:
One.
Two.
Three...
GO!
Two good but intense things happened today. I saw two patients, one in the morning and one in the evening. The morning was a 'real' patient who may or may not ever walk again due to infection. And this was particularly awful because the patient didn't understand how serious the illness really was, what the implications were for paraplegia, etc. And I wasn't supposed to say anything. Sigh. The second was a medical model educator, who taught me (and three of my classmates) how to do the OB/GYN exam along with our professor. It was a really, really good way to learn it. Our model/educator is incredibly good at knowing whether you're doing it right, and how to fix it, and how to relax while clumsy medical students examine your nether regions. But it is pretty intense to be doing an OB/GYN exam, or watching one, for three hours straight.
Those two things were quite medically amazing, and I learned a lot and I'm glad for them (patient suffering notwithstanding). However, they were emotionally demanding, and on top of them, all the small things in the day kept tripping me up -- starting this morning, when I literally tripped on my way to preceptorship and almost fell down the stairs. Other stupid things kept happening. My hairspray had no nozzle and I broke one of my favorite headbands. I thought our OB exam started half an hour later than it actually did and was late to a pelvic exam, which is very bad form and incredibly humiliating because it's so disrespectful (thankfully no scolding or parking ticket as vengeance for my error). Luckily, I think I did all right during the exam itself. I didn't eat a square meal till 9 pm, for various reasons. I haven't paid my bills or taken care of my cat today. There are dishes in the sink driving me nuts. The recycling bins are overflowing and need to be taken out. Plus a million important emails are sitting in my inbox, undealt-with. I need about twenty hours of sleep tonight.
And tomorrow is going to be so hectic. In the morning, I have to practice my complete research talk for the head of our thesis department (which is not done yet), and then I have a clinical skills exam where I get to do the entire physical exam in an hour from memory. Yikes. Add to this a still-undone thesis (!), a patient write-up, a paper due for class on Monday, and the actual research presentation this Friday, and you have just a little stress.
Oh, yeah, and the boards. I should probably start thinking about those. Too bad school is getting in the way of the boards, huh?
I keep telling myself to breathe. Air is necessary. Air is necessary.
But as they say,
"When you're cold, don't expect sympathy from someone who's warm."
- Aleksandr Solzhenitsyn
So, my friends, rest assured: this pity party is officially over.
Okay? Okay:
One.
Two.
Three...
GO!
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