Evaluating Our Professors

I'm done my finals and it's great to finally be relaxing at home.

I'll use some of my free time to add a few long overdue posts to this blog. Until then, I'll just make this one comment.

Right now, I'm filling out evaluations of the courses that we took. I am very liberal with the positive feedback wherever it is warranted, but at the same time it's a nice feeling telling the course directors what changes need to be made, especially when they have told us some of the things they have improved in the past due to student comments. Hopefully they change some more stuff.

My favourite comment I've left so far:

"While Dr. M is a nice individual, she has trouble relating the information to students who do not know it well. Also, her lecture slides lack professionalism as they are written in cartoon font."

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My Tribute to Our Med School's Finals

Question 4,281

The "second signal concept" refers to the process by which a T cell is activated through two signals, allowing the Tcell to complete its normal duties of the immunological system, the system also referred to as Host Defense, by which the host fights off pathogens using acquired immunity, also known as specific immunity eg. receiving a vaccination, and natural immunity, which encompasses the physical barriers to infections that do not require previous exposure to the antigen (eg. mucous production). Which of THE following isn't NOT false?

A. Effector cells of the immune system called B cells exist in two subtypes, B-1 and B-2. B cell activation is dependent on three things: antigen bound to the B cell, the presence of cytokines from a Th cell - specifically a Th2 cell, and contact with the T cell including an interaction between a CD40 receptor and a CD40 ligand.

B. An electron micrograph of a plasma cell USUALLY IN MOST SITUATIONS shows large amounts of rough endoplasmic reticulum (RER) in the cell's cytoplasm. Rough endoplasmic reticulum can be considered part of the cell's cytoplasm but not the cell's cytosol; it is different from smooth endoplasmic reticulum (SER) which is similar but identical to RER, and performs slightly different functions, as SER is more highly expressed in steroid-secreting cells.

C. Another term for Macrophages is ALWAYS "histicytes."

D. The optional lecture on Complement was WRITTEN by Dr. Alex Blackstone, whose e-mail address is blackstone@pathology.medschool.ca.

E. The quantity theory of money IS shown by the Equation of Exchange, MV = PQ, which is used to show how fast money circulates in the economy and can be considered an accounting measure.

F. Naive B cells do not produce IgG; instead of not producing IgG, they also don't not produce IgD and IgM, until the binding of T cells with B cells with Antigen, when the B cells stop not producing IgG but don't not stop producing IgD.

G. This is just an additional TRUE statement to throw you off and increase your reading time of the question.

Remember, only 60 seconds per question. You've already used up about 120. You better hurry up. What's the answer?????


(Scroll down for correct answer).

.
.
.
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Correct answer: D.
Dr. Alex Blackstone's e-mail address is ablackstone@pathology.medschool.ca, not blackstone@pathology.medschool.ca.

General feedback:

A. Wasn't covered in our notes. Therefore it must be known for the exam.
B. is histology. of course that is a separate subject and wasn't directly covered on the exam, but it is similar to immunology so it's fair game. And it's frikkin long, just to eat up more of your time. B is true - the "USUALLY IN MOST SITUATIONS" is there just to exclude exceptions such as a blurry EM.
C. also wasn't covered in our notes but it was mentioned in the lecture once.
E. may not SEEM to have anything to do with immunology, but immunologists make money so they should know stuff like that. And it's true, so it isn't not not the correct answer.
F. Enjoy figuring out the double negatives, but it's true.
G. A reference to the GRATUITOUS use of CAPITALIZED words in the TEST QUESTIONS.

Oh, and none of them really have that much to do with the question stem.

Now you should have a good idea of how I felt the final went yesterday.....

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What the heck do you mean, balance? I'm too busy studying.

A common question that I've gotten from pre-meds is, "Is there a lot of work in med school?" Let me give some sort of an answer to that question.

During the semester, it was awesome. Great fun. I loved it; the people are awesome, the coursework is increasingly interesting, and there wasn't much required work to hand in so there was plenty of free time for socializing.

And then it dawned on us that finals were so close that they were staring us in the face. Oh, how things have changed.

My life for the past 13 days or so has consisted of me waking up, going to school to meet up with some friends in a study room, unpacking all my books, studying for my entire time awake, and then going home and going to bed.

Exceptions to this wake-to-sleep study time include breaks for writing the two lab finals I've already written (histology & anatomy), and eating and toileting and sanity brakes (most of which involve doing anything other than studying to keep our mind sane, during which we usually end up doing crazy things and don't look very sane at all). I also took a day off to go on a paramedic ride-along, and an evening off when I called my friend and said "I need to do something other than study" and we hung out instead. And I had to go pick up milk at a 7-eleven once because none of the grocery stores are open at the ghastly hour I end up driving home every night.

There are also random breaks when I wonder if I if this is all worth it. If I should have become a paramedic / burger flipper / graphic designer / any other profession. There are times when I feel like I don't deserve to wear my brand new hoodie with my school's initials and "MEDICINE" plastered across the front until I at least pass this final. Times when I wonder how embarrassing it will be for me to have to re-take a year if I fail this semester. Times when I listen to a classmate confide in me that his relationship is on the rocks because his girlfriend never sees him anymore. "It will be really sad if med school causes me to lose my girlfriend." I agree. My heart goes out to him.

This study frenzy and sudden lack of social life isn't because I did have a social life during the semester and maybe I didn't keep up as much as some of the more keener folk in my class. I know that because even those who have been studying every day throughout the semester are still stressing and approaching this final wondering if they'll make it.

The exams themselves will be exhausting. Our two finals this week will be pushing 300 questions. We will be given a massive question booklet and an answer booklet with enough blank circles on each of its several pages to make it look like it's been riddled with bullets. Over the course of three hours, we will decide which of those circles we feel should be filled in.

When we are finished our last final, we'll go to the class holiday party. There, I will realize that it's four days until Christmas and I haven't even thought about Christmas shopping yet, let alone enjoyed the progression of the holiday season towards Christmas day. The only reason I knew it was holiday season was because Tim Horton's and Starbucks, where I've been partaking in caffiene infusions lately, have seasonal cups and flavourings.

Other than the MCAT (I shudder every time I even say that word), I have never studied so much for such a huge test, and I have never studied for one test for so many hours and so many straight days. In undergrad, if I studied one single day like this for any one of my examsI would have been more than ready. Here, I am merely hoping to get by with something more respectable than just a 'pass.'

Of course, there's still that echo in my mind that "everybody passes" and "it will be fine." But that's from people who studied more than I have for these tests and have also put them well behind themselves. Easy for them to say.

I'm not sure when I traded in my life for this. I guess this is when I'm supposed to take a step back and think about the reasons I signed up in the first place.


So this is med school.

This is what I fought so hard to be able to do.


And it's only the first term.

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It's study time.

Dang, there's a lot of stuff to know for finals...

I've got tons of things I can't wait to write about here. I'm actually making a list. But our class dynamic has now undergone a sort of a change as it's starting to hit home for everybody all that stuff they say about how hard med school is (despite my previous impression). Even for the more laid-back people in my class, it's study time like never before. For the first time in...ever, I'm spending almost the entirety of my time outside of class with my nose in the books.

Thanks so much to all of those of you who read this blog and those who have told me you check for updates on a regular basis. I look forward to writing a lot here over my Christmas break, and who knows - perhaps the odd post during finals as a form of procrastination. I'm excited for when I get the chance to write lots more stuff here along the lines of what inspired me to start this blog in the first place - interesting stories from clinic, and more about how they teach people to become doctors. Until then, I strongly encourage you to check out the other blogs I've linked to in the column on the right. Perhaps they're more balanced than I and are updating during this season.

And keep the comments coming!

- vm

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Milestone: First Dinner Paid For by a Pharmaceutical Company

I went to a Resident's Research night the other night at a fancy business club downtown. I was attracted by the possibility of the free cocktails, the free gourmet dinner, the experience of seeing this fancy club for free, and not one bit by the free research speech in between.

We arrived, suitably conforming to the club's dress code, and were pointed to a conference hall in the public area of the club. I never did get to see the private member's area with the billiards tables and the swimming pool and the brandy and stacks of the Wall Street Journal. Strike 1.

After that, the first thing we noticed is that there was a price list beside the bar. By "Cocktails 6:30 - 7:00" on the invitation, they meant "Cash Bar 6:30 - 7:00." BIG difference. Strike 2.

At the end of the speech, though, which was mostly out of my league (but it kept my attention because the resident spoke so fast) they served a fabulous and delicious three-course dinner with all the wine we could drink. Outstanding. Reset the count; 0 balls, 0 strikes.

And the best part: right before they served it, they told us that a pharmaceutical company was paying for the dinner. I had been wondering how long it would be before I was getting food from the drug companies; my time had come. I have pretty much arrived. (And I don't feel coerced one bit: to be honest, other than mentioning the name once, they did a bad job of making an impression. I can't even remember the name of the drug company. That makes it OK, then, doesn't it?)

It was well worth going just for the (free) dinner, but the best part happened after dinner. Two young psychiatrists came and sat down at the table where I was sitting with about five other first-years from my class. They told us a lot about psychiatry, answered our naïve questions ("Do you have a couch?" - answer: only about 3 shrinks in the entire metropolitan area use couches), and joked around with us, and gave us some great advice.

Before I get to the advice, let me make this clear: I know absolutely nothing about psychiatry, and in fact, in all seriousness, I am a little bit frightened by the thought of being around psychotic patients. Okay, I know that statement is laden with ignorance and so forth. Go ahead and make your judgments... Strike 1, against me... but hear me out:

Despite my ignorance, I am really interested in actually overcoming my ignorance and getting to know what the profession is like (reset the count against me, 0 balls, 0 strikes). I got the doc's contact info and I'm looking forward to shadowing them in the near future to get a handle on what they really do.

All that being said, however, the most valuable part of the entire evening was the advice that the psychiatrists gave us. I'll leave you with that; it should be helpful to anyone trying to figure out what specialty they should enter.

"No matter what fascinates you now, it is going to become routine after you do it day in and day out. So, when you're in a rotation or shadowing, take a close look at the residents in that field, and see if their level of happiness, their lifestyle, the things outside of what they do for work, jive with what you're hoping for in your career. If they don't, then look for another specialty."

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The Impending Lawsuits, part 2

I've got a bit to add to my previous post entitled "The Impending Lawsuits."

I received a comment from one of my tutor group leaders in the journal I was writing for our class on the phycian's role in dealing with individual patients and soceity as a whole (yes, a journal... yes, a touchy-feely class... no, I haven't gotten anything out of it).

I wrote in that journal about getting sued, since apparently that has been on my mind lately, and he responded:

"Most doctors go through their entire career without getting sued once."

As well, in Canada, doctors are legally represented by the Canadian Medical Protective Association (CMPA) which provides legal services for physicians who are being sued.

A doctor whom I spoke with told me:

"the lawyers provided by the CMPA are outstanding. However, while this is good for physicians, sometimes it gets to a point where it puts patients at a disadvantage; I've seen patients who have had legitimate cases, but couldn't afford lawyers at the same calibre of the CMPA's, and therefore weren't able to successfully defend their case."

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Medicine has its perks... even for med students!

I went to a Rural Medicine club meeting tonight because they were giving away food (and I am indeed curious as to whether I'd be interested in rural medicine).

Not only were the speakers hilarious and the meeting very interesting, I also walked away as one of 9 winners of a free trip to a Rural Medicine conference, including flight, accomodation, food, and conference entrance fee.

Awesome.

My friend made fun of me when I was folding my ballot entry. My mom showed me some special technique and told me that it would help me win contests (she didn't tell me that it would get me made fun of). I never really believed her, but today my ballot was the first entry drawn. Thanks, Mom!

I love medicine!

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Addition to Top 10 list: Things that make me feel like I'm becoming a doctor (as of First Year)

I have to add one more item to this list (the original ten can be found here).

11. Getting a stack of twenty brochures about talking to your doctor along with a medical journal.
Received twenty brochures in the mail today. I guess they assume that by being a member of the association and receiving their journal, I must be a physician. Nope. So, I'm not sure what I'm supposed to do with them; if I were a GP I'd probably put them in my office waiting room, but as a medical student, well, who knows. Any suggestions?

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Brain Surgery

Today I watched brain surgery. It was incredible. I'll finish this post later, and tell you all about it.

**Update 6/1/07
The promised post can (finally) be found here.

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The Impending Lawsuits

We've just started receiving lectures on the legality and ethics of medicine, and already we're all very aware that we are all going to get sued, inevitably, and soon.

One of my tutors, a family practitioner, told me that of all his friends in plastic surgery, each and every one of them has at least one pending lawsuit at all times. If one gets settled, there's always another one that is ongoing.

So every time I've heard of a doctor getting sued, I've started taking a mental note as to what they did, so that I won't do it. Here are a few of the mental notes I've collected.

• If a patient needs blood to save their life, and they're carrying a Jehovah's Witness card saying "no blood," don't give it to them.
  
• If you're putting in a central line and you put the needle in the wrong place, pull it out before adjusting the angle; moving it around inside will cause it to damage important nerve tissue.
  
• If you have gotten a patient to sign a consent form, it doesn't mean they've given consent. They can still pull their consent after they've signed the form, and the verbal dissent is what's legally binding.
  
• If someone tells you "Come help, someone is having seizures," don't reply, "Bring them here." If they're a reasonable distance away, failure to attend is professional misconduct.
  
• Don't diagnose things outside your office for your friends. Bad, bad, bad. If you do, don't forget to say, "If it gets worse, go see a doctor."

So you can understand why a post about lawsuits on a blog that I read and enjoy is one that I will undoubtedly read and remember.

EDIT (11/23) - Follow-up to this post here

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"Don't Ask Shit Questions": To FIFE or not to FIFE

Another med school first.

I'm about to tell you about the first time that I was sworn at by a patient.

I've heard patients swearing at doctors before, but never at me. This was a wholly new and wonderful experience and I am taking it as though I have reached new depth in my irreversible spiral of being sucked into the health care profession, complete with its highs and lows, the latter of which can include being sworn at, among other things.

I'm happy to recount this saga. Unfortunately, it does not come without a lengthy, but hopefully entertaining, prologue.

Prologue

In our medical school we're taking a course on how to interview patients. Sure, most of it is common sense, but in the day and age where doctors are taking hits on having poor bedside manner, the logic behind this can be understood. I have seen, and have heard first-hand accounts, of physicians such as a surgeon who would enter a patient's room, remove the surgery bandage, look at the wound, write in the chart, and leave, without so much as a word to the patient. Yeah, these cases are in the minority, but there are enough of them for the medical schools to start teaching doctors how to be compassionate and how to talk to patients and show empathy and feeling.

So, someone somewhere in medical school curriculum development land decided that there were not enough acronyms for med students to remember and separate them from the general public untrained in medical expertise other than through what they see in ER and Grey's Anatomy, and thus invented "FIFE."

The students in my class have taken very dearly to this acronym, and instead of talking about "asking a patient the FIFE questions" or "using FIFE," my classmates have taken towards stating it in terms of "FIFEing the patient." "In this interview I'll be sure to FIFE my patient," I have heard often, or in further abuses of the loose resemblance of the term another word in the English language, some students will say "FIFE your patient! FIFE them until you can't FIFE any more," or "I definitely FIFEd the _ out of my volunteer patient." No disrespect is meant to the patients, just to the dude who thought that "FIFE" would be a safe word to give to young men and women early in their medical training.

Even our faculty tutors sometimes use this term in a way that could possibly be phrased more gently. A medical student at my school was practicing interviewing a volunteer patient in our communication skills class, and called a "time out" because she didn't know what to ask. "Did you FIFE your patient?" the tutor asked. The patient, with a look of surprise and horror on his face, exclaimed, "'FIFE?!' You're going to FIFE me? What do you mean FIFE?!!"

If you don't know what this means, you're probably wondering by now what the heck I'm talking about. You are not alone, and I have chosen to enlighten you. FIFE stands for Feelings & Fears / Ideas & Impressions / Function / Expectations, and are headings for a number of questions that doctors can ask patients about their illness to determine where the patient is coming from.

For example:
F: "Do you have any specific fears or concerns?"
I: "What do you think might be causing this illness?"
F: "How is this illness affecting your daily functioning?"
E: "What are you expecting from this visit to the doctor?"

You get the idea.

Some doctors don't use these guidelines, some doctors do. Some avoid even the idea of it. A girl in my class told me that her clinic preceptor pretty much used "the anti-FIFE" - don't ask any questions about their feelings because there just isn't enough time if we're going to fit in 6 patients per hour.

In some cases, though, the FIFE questions can be very helpful. To demonstrate this, the course directors brought a standardized patient (an actor portraying a patient with an illness) who complained of wheezing and chest tightness. Questioning the class made it clear that we were all ready to assume that proper treatment would be along the lines of doing a lung test and prescribing asthma puffers; however, FIFE produced valuable additional information that would not have been discovered otherwise. The best example came upon asking the E portion of FIFE ("What are you expecting from this visit to the doctor?"). The patient revealed that she knew of friends and family that had suffered from heart conditions, and she wanted a heart test to rule out this possibility. Us budding physicians hadn't considered that the patient might have been hoping for this, so FIFE prevailed and we were all immediately and wholly convinced as to its efficacy and even stopped making fun of it just a little bit.

Saga

With that introduction I can now move in to the saga of my being sworn at.

I was in my third week of Family Practice clinic and was sent to a room to interview a patient. I walked into the room to see a gentleman in his late thirties peering out the window through the blinds. I wasn't sure how to approach this odd situation, so after composing myself I asked, "What are you looking at?"

"My car. I don't want my car to get towed," he said hurriedly.

He turned around to reveal a gentleman in his late thirties, I'm guessing blue collar, with blond spiked hair, an earring, and a large tattoo on his back and neck. He was the type of guy you might see get out of a beat-up pick up truck at a bar to have a few beers, watch a hockey game, and yell at the TV with his buddies.

I respected his implication that time was of the essence so I decided to proceed a bit more quickly, without asking about his family and hobbies and the like. I introduced myself as a medical student and asked if it was okay for me to interview him; he almost cut me off: "Yeah, yeah, do whatever you need to do, that's fine with me."

I proceeded ask him about the chest pain that had brought him in, and the typical questions about how long, how painful, and the like. "It hurts like hell," he said. I asked, "On a scale of 1 to 10, where 10 is the worst pain you ever experienced, how bad is it?" He replied, "Well, I have gout, and that is horrible pain. Compared to that, this would be like a 1. But this hurts like hell." I tried to figure out what that meant while I scribbled notes on my clipboard.

Once I had gotten a good idea of his pain, admittedly a bit flustered that I was thrown off my normal questioning routine by trying to rush the interview, I realized that I was running out of questions.

Without skipping a beat or showing any signs of distress, I immediately resorted to FIFE. I had the good sense to not ask this man about his feelings, and instead asked what he thought was causing the pain.

"My smoking, for sure."

Score one for FIFE.

I reached into my trusty FIFE question kit and carefully selected another question to present to him.

"What do you hope to achieve by coming in today?" I asked.

He stared at me.

"Um," I rephrased, "what are your expectations for this visit to the doctor?"

He looked at me as if I had just grown a third ear.

"I want to know what it is. I want to know what the fuck it is. Make the fucking pain go away."

And then the fateful blow:

"I just want to know what the pain is. Don't ask me any of your shit questions."

"Shit" questions?! I was devastated. I thought I had been armed with the tools of interviewing by my infallible supervisors, and yet here I had gone and agitated a patient to the point of cussing. How dare he call FIFE "shit questions"!!! FIFE had failed me. And it only went downhill from there.

I tried not to look too flustered and tried to wrap up as fast as I could. I asked if he wanted a flu shot, then I asked if he was taking any medications. He mentioned a drug for his gout, then looked at me and said,

"Dr. Milton knows about all my conditions. I've talked with him about all that already. My history is not your fucking business. Do what you need to do with this, and ask me nothing else."

Again trying not to act too flustered, and sensing something less than appreciation for my efforts, I ended the interview, and told him, "You know, I usually come back in with Dr. Milton, but if you prefer the doctor can just see you on his own."

His response was not what I expected.

"Oh, no, no, that's fine, I don't care if you're here."

A bit confused, and a lot flustered, I left and presented the case to the physician quickly, and hoped that this paradoxical patient would stop trying to test my limits. The doctor came in, diagnosed the illness, and wrote down a prescription. As the doctor was finishing up, he told me to take the patient's blood pressure.

I realized I had subconsciously edged my way as far as possible away from this patient and had my back against the wall, and so upon being asked to take his blood pressure I slowly made my way towards this man that I realized I had been distancing myself from.

He didn't make it easy for me, either. As soon as I put the blood pressure cuff on his arm and had inflated it with a single pump...he freaked out. He jumped and pulled his arm away.

"What the hell!?" he shouted.

I was pretty much at my wit's end, and shocked and confused as to why this guy was reacting this way to the very minor pressure that a blood pressure cuff exerts after only one squeeze of the bulb. I looked up at him in surprise.

"Just kidding," he said.

What the heck!? I'm not sure if there was something not right in this patient's head. My classmate suggested he might be bipolar. Either way, he was enough to make me seriously wonder about his sanity.

Postlude

(Any story with a prologue must have a postlude. It's just good Englishing, and I am a huge proponent of doing grammar correct.)

So that was my first experience being sworn at by a patient, and I can probably expect it to happen again. Fortunately, in the grand scheme of cusses that patients can direct towards their health care providers, this was very mild. At least he didn't start swinging at me or anything; heck, he didn't really even swear at me, just around me. And I couldn't wait to tell my interviewing class small-group tutor what the patient had said about FIFE.

I'll definitely be more selective about when I choose to pull out the "shit questions."

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Top 10 list: Things that make me feel like I'm becoming a doctor (as of First Year)

EDIT (11/21): I had to add a number 11. Find it here.

I kindof had to make this list to convince myself that I'm actually in med school. Like I've mentioned before, our first semester is a lot of just basic biology, things I learned in undergrad (biochem, physiology, etc.), so I can't help but feel that I'm still just taking more biology classes. Until I get to third year, where I report to the hospital every day (and on weekends...and I am given evening shifts...And I'm put on call...) it still seems kindof like school, still. Hopefully this changes a bit in January when we start going through the body organ systems, block by block. Until then, I have this list to go by:

10. Got my second issue of the CMAJ today
It always makes me feel like a member of the profession.

9. Calculating IV infusion rates
Finally, there is an applicable use for algebra and natural log calculations. Boy, was I rusty on those for a while, though!

8. Getting my ID tags
I wear these a bit too often, my excuse being because they're on the same retractable carrier as my bus pass. The third-years make fun of me.

7. Being allowed to shadow doctors in the area
It's hard to arrange this when you're a pre-med!! I've already shadowed an ER doc back home, an ER doc here, and going to shadow a surgeon next Monday.

6. Learning how to interview actor patients in my interviewing class

5. Interviewing real patients in the family practice clinic

4. Getting sworn at by a patient in the family practice clinic for asking questions I was told to ask in my interviewing class
I'll definitely tell this story soon!! EDIT (11/20): This post is now available here. (Title will be: "Don't ask shit questions" - To FIFE or not to FIFE. Another time, though; I'm keeping busy and don't have the time right now).

3. Cadaver lab
Partly because I get to wear scrubs, and partly because this was something I envisioned doing when I got to medical school, since not many people get this privilege.

2. Giving injections
This isn't #1 because some of my friends who were in nursing when I took my undergrad were giving injections way before me, so I was jealous of them and when I got to do it I only felt like I was caught up to them.

1. Getting my stethoscope
The excitement of this has started to wear off, but the day I got it I felt like I was pretty much ready to graduate and be called "Doctor". Don't laugh. Small things amuse small minds. And when you pay that much for something, you may as well appreciate it.

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Clinical Experience: High and Low

Just got back from another great day at my Family Practice preceptor's clinic.

High: Gave my first IM injections today! We walked in and our doc said, "The flu shots have arrived. You're going to immunize me." After a quick briefing, myself, my clinic partner, and I went around the circle giving each other shots. It was kindof bonding, in an endearing sort of way, kindof like drug addicts? ok, probably not. We did use clean needles, of course. I lucked out because I was the only one who got stuck by someone who had done it before; I injected my partner and she injected the doc.

High runner-up: Our doc is great as far as clearing out his clinic so we can get lots of experience and have lots of time with patients. While my clinic partner was in a room interviewing a patient, he had nothing to do for a few mins, so him and I had a really good chat about choosing specialties. I wanted to know more about what radiology is about, since I ranked high on that in an online matching-test toy thingy; I wasn't sure if it was more than just looking at films all day. He told me that the field of interventional radiology involves lots of procedures (yay) but it can be difficult to get into (boo).

Low: I watched our amazing preceptor get a needle stick today. He stabbed his thumb after immunizing an elderly woman who was already in a population at risk for Hep B. "Ow," he said, after he tried to throw out the needle, missed the sharps container, and picked it up again. I feared the worst, and after we left the room, I asked him, "did you just get a needle stick?!" His response: "yep..." I know this is a hazard of the occupation, and took a deep breath and was ready to watch him go through the post-stick procedure, pictured him going to the ER and the like.

What did he actually do about it?

Nothing.

"It didn't draw blood, I just pricked myself a little bit."

Wow. I was shocked. Talk about getting desensitized after years of working in the profession... but hey, he's the doc...

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The Sacrifices I Make for Your Health...

Not even two months into med school and they're already subjecting us to self-torture.

First, we weren't allowed to eat anything for the last ten hours. That was rough enough.

And now we've got to stick a needle into our fingers six times over the next two hours. For the more unfortunate people such as my lab partner, who apparently is some sort of mutant demon reptile and doesn't have any of hat substance we humans call "blood" (a requirement necessary for this lab), she is forced to poke herself many more times (and with much more force).

At least we got something to drink for free. That cheered me up, until I read the label and realized that this supercharged Minute Maid is actually "Glucose Tolerance Beverage" and cointains 75 grams of glucose in just a little bottle. It's so sweet that they have explained to us that we must drink it within five minutes...not a simple task, considering that I now have a massive headrush and the entire room is spinning.

My lab partner got off to a slow start after poking herself several times, unsuccessfuly, and was caught by the instructor chugging the radioactive-looking beverage well after everyone else had downed theirs. "Get it down, already!" he said in his British accent. "You must be a cheap drunk." She did not take well to that comment. (Her friend at our lab bench swore he was right, though).

We've been told to 'bring some studying' or something because all we're really doing is sitting here, poking, and the like. Fortunately this is taken place in the computer lab, so I can at least blog.

Apparently after these two hours we'll have learned something about fasting glucose levels or something like that. All that I've learned is that I'll have a bit more empathy towards my future diabetic patients.

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Best Day So Far.

Why was today the best day so far in my medical education?

Two reasons.

The first, and minor reason - it was my first day in the doctor's clinic for our family practice class. We go four times this semester to a clinic and shadow the doc, watch procedures, and depending on the preceptor, do some procedures, interview patients, and the like. Today, however, was a bit more watching than doing; I took a lot of BP's and was advised to bring my own watch next time. The watching involved seeing a man's scrotum, a breast exam on an elderly lady, a rectal exam, and the like...oh, the glamour of family practice. From here on in, though, I've been promised the chance to give lots of flu shots - once the vaccine arrives in a couple weeks.

The second, and better reason, I GOT MY STETHOSCOPE TODAY!!! And my otoscope and opthalmascope kit. Wearing my own stethoscope today in clinic around my neck, and starting to feel more like a real doctor, is definitely worth the $800 I shelled out for them. It even came with a CD of heart sounds. And, as much as I'd love to hear more, I've got this CD to listen to!!!

Only kidding. I'm not that nerdy. I'm just doing homework.

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The Dreaded Inevitable: First Patient Death

This week's Grand Rounds is great, as usual. I don't have the time to read all the posts I want to, as usual. For some reason, though, long after I should have been in bed, I went through some of the posts.

I quickly realized that this GR holds two posts on the same topic: two separate med students, Ali Tabatabaey and Jenn, tell of the first time a patient of theirs has died.

It was hard to not feel my eyes getting wet as I read those, one after another. I've heard and read so many accounts of physicians, on blogs and in medical journals and textbooks, about how they simply do not forget their first patient death.

I won't forget the first time I learned about this. I read it on Incidental Finding's blog the summer before I started med school. He wrote, "The first patient of mine that died, in my 3rd year of medical school, I can recreate her history and physical exam from memory. If I sat down for 10 minutes, I could probably come up with her medication list as well." He titled that post, "One is too much."

It's something that will happen to me, inevitably. And it will stay with me until the day I die. As vital a part of my education it will be, I can't help but feel that I want to put it off as long as possible.

-----

I'm adding to this post after I initially wrote it, just to note that there are already emotionally heart-wrenching things I've experienced in medicine that will be with me forever.

I won't forget the sight I saw when I walked into an OR while I was in Nigeria to find a stilborn infant, fully formed but seemingly asleep, laying abandoned in a kidney pan as the surgeons closed up his mother.

And, when I was shadowing an ER doc, I experienced a truck driver dealing with the devestating realization that - even though it was an accident - he had ended human life.

Tonight, after writing this post, I tried to fall asleep, but couldn't, because in my head, I could still hear that man crying.

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The most intensively studied medical devices - ever

"I think it's safe to say that these medical devices are the most intensively studied medical devices in medical history."

What was the person who said this talking about?

  The heart stent?

    The ventilator, perhaps?

      Or maybe the latex glove?

None of the above. According to Supriya Sharma of Health Canada's therapeutic products directorate, the silicon gel breast implant fits the above description. Canada is finally de-regulating the use of these well-researched devices after nixing their use in 1992.

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Post-ER-shadowing Advice

[Formerly a part of the post Back in the hospital: ER shadowing]

Advice I got from the MSIII at the hospital:

• Enjoy first and second year! Go to all the social events. After hearing this, I went and signed up for the ski trip and the killer Halloween party that the med class has a reputation for. Both sold out shortly thereafter.

Advice I got from the ER doc I shadowed a couple months ago, and was reiterated by my own personal experience:

• If you're working in a clinic, get a box of disposable pens without lids, and carry two or three with you. Yeah, you'll be writing lots and may want to get a pricey pen for that reason, but you'll go through it so fast it won't be worth it with all the time for refilling. Also, if you use disposables, you can chuck them in the garbage when they run out, and use another one from your lab coat pocket. Finally, make sure they don't have lids; you won't have the time to be uncapping and capping all shift long. Efficient ER docs use their lab coat pockets to always have their own scissors (they can go missing easily in the ER) and tongue depressors.

And my final piece of advice, from the R1:

• When you're saying goodbye to a doc you've been shadowing, don't tell them, "Well, it's about time I head out, I don't want to be late for the pub." Apparently it's better to say that you're going to be working on a research project or something. The doc found my comment pretty funny and announced to all the nurses, "This student would rather drink beer than experience clinical medicine!" He seemed pretty amused, though, and commented that he was disappointed that he wasn't responsible for filling out an evaluation for me or anything like that. In retrospect, I probably could've made a better impression by omitting that info.

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Back in the hospital: ER shadowing

School is great so far, but the general basic biology review that comprises our first term is a bit slow and lacking in clinical experience.

Things will brighten up when I get my stethoscope / otoscope / opthalmascope next Tuesday. Also that day, I start my first of four experiences in a family physician's office, which is going to add an exciting element to my medical education.

The doctor I'll be shadowing seems pretty cool, and excited to have us, which is nice. He sent me an e-mail that got me really excited. Part of that e-mail:

In my office, you will be doing more than just talking. I expect you to do limited physical examinations under my supervision. So yes, bring all your instruments. You will also have a chance to do some minor procedures, like giving shots or taking out sutures. In another word, you have to work. Flu shot season is coming up. Hopefully you will be an expert in giving shots by the time you leave.

I hope you will have a good experience and at the same time, have some fun. Books can be very boring.

That's all you need to tell a med student to get them very excited. As well, his practice is about 60% Chinese, "so polish up your Cantonese." And, I don't have to wear a tie. Nice.

Though I'm required to get that experience, I'm still trying to get some more exposure to the specialties I'm most interested in right now, namely, OR and ER. I finally have had enough of trying to smother my itch for clinical exposure and signed up to shadow an ER doc for a couple hours yesterday. Our school has a comprehensive online list of about 100-150 local docs in all sorts of specialties who are happy to have med students to shadow them, so I looked one up, and yesterday found myself wandering towards the big city hospital a short walk away.

I haven't been orientated to that hospital, or any hospital here for that matter, so I wandered in through the paramedic ER entrance, put on my short lab coat in a hallway and wandered over to meet the doc.

The doc I was following looks EXACTLY like a younger, shorter, blond Greg Kinnear. I kept doing double takes all night. He was great to shadow; it was pretty busy and he also had a R1 (first-year resident) and a MSIII (third-year medical student) following him around, but he was happy to have me there.

It's only the second ER I've ever shadowed in, too, so it was neat comparing the two places. This big city hospital had all sorts of neat stuff: a very belligerent HIV+ homeless individual who got drunk on rubbing alcohol and bumped his head and subsequently cussed out the doctor at full volume when the doc tried to get info about his HIV condition; a lady with alpha-1 antitrypsin, sepsis, lung transplant (alpha1 is one of the few conditions we've actually learned something about so far); a 50-year-old Fijian gentleman who had recently had a SEXTUPLE bypass (never heard of that before)!

It was also my first experience with actual teaching-hospital-attending-doc pimping, something I had only heard about to date in the medical blogosphere. The doc asked me a few medical questions, which I wasn't expecting. Fortunately, one of the ones he asked me (why do we give thiamine when we give glucose?) was something I learned this week in class. He seemed almost surprised that I knew the answer.

I enjoyed seeing what the MSIII does, as well. It'll be exciting to finally be on the floors and doing medicine and interviewing patients and doing procedures. He did a great job of presenting cases to the attending; I wonder how some of the people in my class will end up when it comes time for them to coherently present cases. At this point, at least, they don't seem nearly as confident...or competent...as he was.

[Formerly the first half of a longer post; second half can be found at the post Post-ER-Shadowing Advice]

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Learn from someone else's mistake #2: The Day my Sense of Humour Died

I told my last med school joke today.

So much for my mark for "Professionalism" for this block of case-based learning.

We were given a case and on one sheet, the information provided said that "vital signs were normal." Then, on the next sheet, the respiratory rate and heart rate were elevated. One person in our group said, "I thought we were told that the vitals were normal!"

My fateful response: "Don't trust nurses."

Ha, ha. I though it was funny. Most of the people laughed, too, and realized that I WAS JOKING, and that comment is NOT exemplary of what I feel about nurses.

Please let me provide context (perhaps my first mistake; I made my comment in the first session with a new group, so they probably didn't realize that I try really hard to respect everybody and every profession and every member of the health care team).

• I know from personal experience, and I strongly believe that nurses are an important and valuable part of the health care team and play hugely significant and essential roles. Without them, hospitals wouldn't function.
• I know that nurses can be a doctor/med student's worst enemy or best friend
• I have several good friends who are currently nursing students, or just became nurses. Heck, I read nursing blogs, I dated a nurse once, I have friends whose moms are nurses, and my mom's a nurse, too.
• I wouldn't wish anything bad upon a nurse and plan to treat them with the respect and admiration they deserve.
• my only exception: when there is incompetence or danger to a patient, then I have no tolerance (but this goes for anyone working in a hospital)

Anyways...the tutor asked me to repeat what I had said. I told him I was joking, and he went on a rant about how his wife is a nurse, how nurses are important part of a team, how what I said wasn't funny, and on and on and on. When he finished talking and I had turned red enough and sunk deep enough into my chair, I blubbered out an apology.

Serves me right - when we were laying out ground rules for this case-based learning block, I offered, "Be willing to give and accept constructive criticism." I didn't expect to have to accept some so soon. The funnier part was that, according to our case, it wasn't a nurse who presented the vitals - it was a paramedic.

Figures. Don't trust param.... i mean, nevermind! ONLY KIDDING! man, I really haven't learned my lesson. (Oh dear, do I have to make it clear that I love paramedics now, too?! okay here goes: that's what I originally wanted to do with my life, and a former paramedic in my class drove me to school today :) )

The tutor did say he was sorry for singling me out and later apologized again, and I had a chance to try to redeem myself and say what I really feel about nurses and that my flippant comment wasn't what I really believe. Good thing it was in a small-group session with only 8 other people.

I definitely am much more aware that I need to be careful with my jokes, because usually they don't emphasize the amount of respect I usually have. Also because this isn't the first time I could've been more tactful. Maybe it was my enjoyment of other blogs where med humour abounds that led me to say things like that...regardless of where it came from, from now on I'll keep it to the written word.

Wish me well in beating down my sense of humour. Class clown, signing out.

**Postscript (10/24/06)**
Our tutor has lightened up a bit; I think perhaps he feels bad for reaming me out. I've noticed a distinct - almost forced - effort on his part to laugh at all the (very sterile and non-offensive) jokes I've made since then.

**Post-Postscript (07/24/07)**
Since I've linked to this post I read it again. Fortunately I've learned from this (and I know better now, thanks Captain Constructive Criticism below who called me an ass). In my review for the block my tutor made mention that I shouldn't be too careful lest I lose my 'endearing' sense of humour.

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Top 10 list: Things you don't want to hear in the cadaver lab

Our group got a little carried away with our lab the other day, in a good way. Tasked to find the part where the thoracic duct drains into the bloodstream, as well as perhaps the vagus nerve and its branch the recurrent laryngeal nerve, instead of being one of the first groups done - our usual reputation - we chose to be thorough.
It was worth it, too. We learned so much. We impressed even the lab instructors. And we were really into it. So into it, in fact, that at the end of it, my lab partner told me he might have been a little too close to resting his chin on an exposed surface of the cadaver while peering in at the details of the mediastinum. So close, in fact, that the #2 on the list below was actually said to me. (I wish I could give him the coveted #1 spot...but you'll probably agree that the premier location has been rightfully assigned.)

And so, amidst this outstanding level of learning which will undoubtedly make us better clinicians due to our increased level of knowledge thanks to our body donor, was born the idea for the latest Top 10 list, Things You Don't Want to Hear in the Cadaver Lab. I encourage you to not read on should you be sensitive or assume that humour in the cadaver lab is unconditionally synonymous of a lack of respect. That being said, the list lies below, complete with colour commentary.

10. "Um, you got me in the eye with that splatter."
Actually heard.

9. "Um, you got me in the mouth with that splatter."
Actually heard. Not by me, fortunately. But it's a horror story that still looms from last year's class. Maybe I'll tell it in its entirety sometime.

8. "It happens."
The anatomy prof's actual response to a student uttering number 10 to him, said while he kept chiseling at the vertebrae without so much as looking up.

7. "Hey! That looks like pulled pork!"
Actually heard. I haven't eaten pulled pork...or spare ribs...since.

6. "OUCH"
Bad enough if it's a student saying this. The person who suggested this as an addition to this list, though, was thinking, 'what if the cadaver...' - - - nevermind. That being said, one person in my group did get the cadaver's hand caught in their lab coat last time...it was somewhat eerie how the cadaver apparently 'grabbed' her, with enough force to undo a button on her lab coat...

5. "Let me just tug a bit on this spermatic cord."
Actually heard. Fortunately, the prof was not referring to a body part other than the spermatic cord.

4. "This might make you a bit squeamish..."
Actually heard. The prof was right. Whenever the scalpel meanders over to the inguinal area, brace yourself.

3. While putting a foot into the body cavity: "I'm going to jump right in, swim down the aorta, and take a look. No, it's okay - I saw this on the Magic Schoolbus once."
This one didn't happen. Fortunately.

2. "Do I have a piece of pleura in my teeth?"
Actually heard.

1. "Grandma?!"
...upon removal of the bags on the cadaver's heads. I wouldn't wish this upon anyone.

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First Midterm response: Conflicting advice from the second-years

Apparently by not giving us take-home work in the first five weeks (in my naïvety, I actually wrote a post entitled "Med School is So Slack") our school was giving us lots of time to prepare for the first midterm.

I should have taken advantage of that time.

After the midterm, our school gives us an Exam Review Session. When time is up, we hand in our answer sheet and test booklet; then everyone goes into the same lecture hall where we sign out our exam booklet and a sheet of paper with the correct answers. If you were bright enough to mark your answers in the test booklet you can find out how many you got wrong; the point of the session is not only to find out how you did but they want us to learn from our mistakes, so they encourage us to discuss questions in small-group format. If we're not satisfied with a correct answer, we can go to a 'master test booklet' and voice our concerns; "it only takes one comment for a question to be investigated." There were actually one or two questions on the midterm that everyone was convinced that the provided answer was incorrect.

All that to say that barring the administration changing around the correct answers / the values of some questions, I know how I did. I didn't fail. I passed. Not by a whole lot, though. I was a little surprised, especially since the second-years were offering advice along the lines of, "Don't be afraid of the first midterm - it's SO easy! EVERYONE gets like 85!" I shouldn't have listened to them.

Okay, it's only pass/fail, and it is worth only like 3 percent of our term mark, and because of those factors combined, in the days preceding I didn't take it that seriously and probably could have studied a lot more. But I'm the type of person who needs pressure deadlines for motivation, and frankly, there was not a lot of pressure with this midterm.

Because this midterm isn't worth a lot, I'm not tearing up or traumatized from not doing better than everybody else in the class. In fact, my inferiority complex is telling me that I am lucky to even be in med school, so I should expect to get ranked at the bottom of the class (those thoughts are always accompanied by that little voice in my head, "You can't fail med school!")

However, this test was really beneficial. It will change the way I study from now on in. All of the second-years before me told me, "Keep up with the work," and unlike their comments about the midterm, I should have taken this advice more seriously. I'll pass on that advice to aspiring medistudents. I plan to devote more of my evening and weekend time to reviewing the preceding week's content. I'd rather study all throughout the semester than cram all at once before the test; apparently, the second method doesn't get you really good marks, as I found out.

I know I didn't give it my all for this midterm, and I'm not too worried beacuse I could have done better if I sacrificed spending the preceding thanksgiving weekend for studying instead of hanging out with friends & family. From now on, if I fail a test, I'll have to go to the committee designed to help students, and then take a remedial exam. I'd rather not partake in that sort of thing. I'll definitely be taking the tests a bit more seriously from now on.

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Some advice for future cadaver dissectors: Smell

Or, What I Have Learned Thus Far through Observation, Experience, or Trial and Error

Sorry for all the cadaver-related posts; that's all I've done so far that's really 'doctor-ish.'

Anyways, as far as cadaver lab advice goes, here's what I have to offer so far (I can forsee myself adding to this list in the future),

Today's entry is on Smell. On the way out of lab, I was chatting with a fellow classmate, who commented to me that the excitement of anatomy lab is starting to wear off, due in large part to the odours thereof.

As I learned while witnessing an autopsy a few years back, and through my now more frequent cadaver experiences throughout my medical education, I can assure you that the odours of a cadaver lab, and the changerooms preceeding entrance to said lab, are like none other. Though our school uses the chemical Infutrace to neutralize the formaldehyde odour (breaking the formaldehyde down into an alcohol), as can be expected, the inside of what was a long time ago a living, breathing person does not exude the most pleasant odour in the world.

To make it worse, some of the bodies are less well-preserved than the others, and in addition to organs being dark and crumbly, as can be expected, there is an increased intensity of questionable aromas which grace the nasal passages.

There are some strategies available to combat this unpleasant aspect of anatomical education.

• Lip Treatment. Spread a swath of Vapo-Rub or similar menthol lotion on your upper lip before entering lab. By the time this odour has faded, you will have mostly adjusted to the smell.
  
• Hand Protection. While the gloves are the obvious universal means of maintaining a healthy barrier between one's hands and the items those hands are caressing, they can - IF used properly - play a crucial role in odour protection. In my zest to appear macho or non-squeamish during my past anatomy lab experiences, I used to only wear one pair of latex gloves; however, I was unwitingly exposing my hands to a great amount of odours, many of which were retained for hours after leaving lab and even making numerous visits to the sink.
  
  I have since learned that this amount can be significantly reduced, shouldst one use the Vitum Medicinus patented double-glove technique. Instead of simply using two layers of Latex gloves, avail yourself of the nitrile gloves, but make use of these underneath a pair of latex gloves. This specific arrangement serves a number of purposes.
  
  First, I have found the nitrile gloves to be effective in odour-penetration preventance when used in conjunction with latex.
  
  Second, limited direct exposure to latex is a good thing; more and more people are developing hypersensitivities each and every day, and God knows we'll be exposed to plenty of latex throughout the course of our medical careers.
  
  And third, while the nitrile gloves should be closest to the skin, an overlying layer of latex glove will allow the gloves to fit tighter to the hand, improving grip, accuracy, and dexterity.

Although the preceding exhaustive and unquestionably useful description will undoubtedly lead you to believe that I an expert on odour control in the cadaver lab, I will make this honest confession; I have actually a lot more yet to experience as far as the anatomy lab is concerned. We haven't yet dissected deep into the abdominal cavity. That being mentioned, I'll confide in you that I am not looking forward to dozens of individuals using their scalpels to penetrate the membraneous containers that the good Lord intended never to be opened - let alone months after the spirt has left the body - due to the odorous nature of their contents.

Indeed, the worst is yet to come.

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A Pair of Warnings for Medical Students to Heed

• You'll come across them. Old folks who, try as you might to explain there's nothing wrong with them, they'll continue to pop up in your clinic. We call them Gomers. It stands for, Get Out Of My Emergency Room.
  - from House of God, I believe. The person I know reading this book told me, "I'm not sure if I can recommend it to you." Read the online reviews at the provided link and see what I mean...it's pretty intense.
  
• There are two types of patients that you can tell right away are crazy:
  First - the people who wear headphones. Old-school headphones. Usually crazy.
  Second - the people with a tooth-to-tattoo ratio of less than 1. If they have 29 tattoos and 28 teeth...crazy. If they have 3 tattoos and 2 teeth...crazy.
  - from the doc acting as a preceptor for my buddy's elective.

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In Loving Memory of our Cadavers

"My mother never liked to waste anything."

So, he told me, that's why his mother wanted medical students to be able to learn from her body.

"She never threw anything out, really. And even when she was dying, she didn't want to be buried or cremated. She thought that was a waste. And she never liked to waste anything."

I don't usually leave a memorial service really impacted by the things that were said.

Then again, I don't usually go to memorial services for people whose bodies I have seen fully exposed internally and externally, for people whose organs I have held in my hands, people who have taught me so much more than some teachers ever could. What a fascinating and unusual experience.

Among a couple choir songs, a piano performance and a candlelight procession, there were a few reflections and readings of poems. One of the student speakers talked about the courage that the body donors showed by giving their "most personal possession" to us. We med students often discuss whether or not we think we could donate our bodies, knowing what is done to them - even though they are treated with the utmost respect (as I mentioned earlier), and what we do is done all the time in routine autopsies, it is still so generous of them to grant amateurs the opportunity to learn so much from them.

Another speaker said the following:

When I study their eyes, I wonder about the things they saw.
When I their arms, I wonder about the people whose lives they touched.
When I study their hearts, I wonder about the people they loved.

I can relate. I thought I'd get desensitized, and I have in a sense, it's not like the first day where I didn't know what to expect. But still, each week in anatomy lab I spend a good part of the time there overwhelmed by the fact that this isn't a "specimen" but a person.

I wish more of the students in our class showed up. Of a few hundred first- and second-year students, only about 30 showed up, and half of them were directly involved. Being there, and actually talking to the families was a great experience. It makes the donors more human. The only identifying characteristic to date is that my cadaver is the one on table 32.

Even before today I know I will never forget what I've already learned from my cadaver, which is already in a quanitity much greater than any anatomy book has ever taught me. By going to this service, I developed a whole new level of respect and gratitude for the body donors. Even though I knew they were people who lived lives and had loved ones cry at their deaths, I had never seen the people who they lived their lives with, nor watched their loved ones cry. Until today.

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"She was dying, and he didn't even look at her."

"I was watching my wife die over the course of those nine months. Our family doctor sent us to see a specialist. Without even doing a physical to see the her ribs jutting out of her back, he told me that 'women typically lose weight during their menstural period.' I was shocked. She was dying, she was as skinny as a corpse, her brain wasn't functioning properly, and he tried to tell me it was her menstrual period. He didn't even look at her."

That happened almost thirty years ago, and still, my patient's husband talks as if this happened last week. Today I had to go to the home of a patient who had volunteered to discuss their chronic condition, part of a rather interesting assignment meant to get me thinking about the impact of a chronic condition on a patient's life and family.

Unfortunately, the husband is still convinced that the only reason his wife was eventually diagnosed or received treatment is because he reamed out the doctor.

Not every story like that has a happy ending. But this one did. Once they diagnosed the disease, although that was a nine-month process, they gave her one injection and other than the low body weight, she was completely normal the next day. Today, one pill per day is all she needs to live a completely normal life, and if she didn't tell you about her disorder, you wouldn't even know it existed.

If only all diseases had outcomes like that...

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"Um, is this your first time examining a woman there?" "Hell no!"

I gave in.

I know I said I was going to sit out the Maternity Hands-On night, but I didn't go just for the vaginal exams (and what if I did, anyways? I'm going to be a doctor, I need to get experience, nothing weird about that? right? why do I feel as though I have to justify this?) I went for two reasons: 1. I was there anyways for a meeting of the Emergency Medicine club, and 2. free pizza!

I'm glad I went, too. Not only did I get elected to a position in the ER club, but this was probably one of my most practical and interesting events since starting med school. Hopefully it's a taste of things to come in January when we stop the cirruculum of undergrad review and get into the doctory stuff.

I delivered a baby, determined how dilated a woman's cervix was, and felt for the position of a baby inside a woman's stomach!

Had I known the first two of those would be on fake silicone models, I wouldn't have been so shy about attending. Mind you, I was clearly not the only shy one. Even though there was a great turnout - almost a quarter of our class showed up - the men in the group were far fewer in number.

It was interesting, too, learning how much an experienced physician can tell from an exam; how the baby is lying / presenting, etc. Someday I'll be that good - someday at the end of my OB/GYN rotation, and it will probably all go downhill from there.

And the best part? If a woman ever asks me while I'm conducting the above procedures, "Is this the first time you've ever done this?", I can emphatically and truthfully say, "Hell, no!"

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The P=MD discussion, furthered

Before leaving the states, I wondered at all the rumors I heard coming from the Caribbean. Do they study on the beach? Do their professors sip cocktails with little umbrellas in them during the exams? Are they really learning medicine in a Third World Country?
Yes, the rumors were true.

That's a direct quote from the Rumours Were True blog. If I can't come up with anything interesting to post, why not post a reciprocal courtesy link to someone else? Especially if I apparently had something to do with their posts! In case that intro isn't interesting enough, Topher of RWT was kind enough to further a discussion I initiated about pass/fail medical school marking.

Judging by the apparent popularity of this discussion, perhaps I'll muse about PBL (Problem-Based Learning or Case-Based Learning) here sometime in the near future.

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Extraeducational Patient Encounter

I felt like a real doctor today for a brief moment.

When I was switching buses on my daily commute home, I saw someone waiting for the bus whom I recognized - a woman who had been a patient of mine!

Okay, I'm not a doctor yet. Not even close. And in actuality, all my "patients" to date are either cadavers or fake - hired actors.

The one I fortuitously saw on the street today fell into the latter category, in case you were wondering.

Even though my feeling as though I am a doctor lasted for less than a measurable time quantity, it was kindof neat. I know that happens to doctors all the time, running into patients of theirs. My friend's dad is a GP in a small town, and it happens to him. It must be nice for doctors having these little reminders that they've made a difference in somebody's life, every time they bump into them. Or perhaps they're more like reminders of what a nightmare the patient was and how stressful the doctor's practice is.

Maybe I'm just stretching for ways to feel like I'm becoming a real doctor, since I don't get that feeling very much in class. All our classes so far are a repeat of fairly simple concepts we learned in undergrad, or even worse, high school. I've learned how cells divide about six or seven hundred times already, and that meiosis happens in the somatic cells and mitosis in the germ cells (don't freak out, I'm on it, that was a little joke for you science people out there). It seems like it's going to be like this for the rest of the first term, too, since it's designed to catch up the people who, unlike myself, do not come from a science background.

There's just enough new information that I have decided to heed the words of pretty much any second year I've talked to: "Don't get behind! Stay on top of the material." So my days of little to no homework are gone; I've started making work for myself, namely, reading and studying the notes, so that when study time for our midterm comes up in a few weeks I won't feel too pressured. But still, that midterm's only worth 5% of our grade...so how much pressure can that be?

That being said, you can probably understand how it's a relief to study things that are more clinically related, like our small group session on hypertension today. Though the second half of the first-year curriculum promises to be a lot more work, my friends in second year say it's a lot more clinically relevant and a lot more interesting. I think I'd rather have lots of interesting work to do than be bored reviewing things I've already gone over.

I have a feeling that I'm going to regret saying that someday.

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