It had to happen eventually: "That sounds like something I read on a blog once."

When I'm hanging out with med friends, as much as we may try to avoid it, every conversation turns to school somehow... some gross thing we saw, some cool clinic case, or general hatred or love for certain professors. (The professor who approached me and told me he reads my blog fits into the latter category, of course).

The other day I was at a classmate's house having some incredible steak, and for some unknown reason, the conversation turned to our cadavers.

We were talking about the nature of our cadavers and how some of the ones with high BMIs are really hard to dissect... some of them you're cutting through the skin and you cut and there's fat, so you go deeper and there's more fat, and you go really deep and you're in the muscle, and so you go back and realize that there isn't any distinction really between the fat and the muscle like there is on the really nice cadavers; instead, on the more fatty ones it's more of a gradient and the fat and muscle is all mixed together, making learning the muscles of the thigh and buttock a much different experience than if you had a different cadaver.

Anyway, a girl who's also in my class piped up that on some of the cadavers, at room temperature the fat is mostly liquid, and this requires suction to get rid of the extra liquid.

"Mine's a lot like that," I said. "It seems like every lab I'm suctioning the fluid... the dead human body fluid... mine had so much I ended up with it dripping all over my leg once."

At this point, my buddy's brother, piped up. He's not in medical school but is interested in going; otherwise he probably wouldn't be able to stand hanging out with med students and listening to their med chatter. He was apparently interested - not grossed out - by my story. "How did that happen?" he asked me.

I explained the story that I've written here before under the heading of Great Moments in Anatomy Lab, where I had proceeded upon a course of actions that resulted in DHBF (Dead Human Body Fluid) dripping down my leg.


This is where things started getting weird. Not dead body weird, but, well, read on.

After I told him the story of how I ended up with DHBF dripping down my scrubs pants, he looked at me and said, "That's funny, there's this medical blog I read, some medical student somewhere in the Carribean - the exact same thing happened to him."

I knew right away where this conversation was going to end up.

"Vitum writes a blog," said his brother. "Maybe you read it there."

"No," he replied, "this one I read was from a student in the Carribean, I think. The exact same thing happened to him - he ended up with DHBF all over his leg."

Either somebody is plagiarizing my blog, I thought, or he's referring to my story. "Yeah, I think that's my blog," I said.

"No, no," he insisted, "I really think this was some medical student in the Carribean that wrote the story."

I loaded up my blog on my mobile phone's web browser and said, "Read this."

Before he read it, he said, "Okay, okay, the story I read on this blog ended up saying the guy was upset that he had cadaver juice running down his leg, but the worst part was that this was the second time it had happened."

Which is exactly the premise of my story.

I handed him my mobile phone and stood back, watching it sink in.

He finished reading and looked up. "Weird... so that's you... well, I've read a fair bit of your blog. I had no idea."

I thought it was funny but he seemed a bit weirded out. Ten minutes later he was still talking about how weird it was that he'd been reading my blog all along, and he knew me, yet didn't know I was the author.

I did warn him I'd be writing about this. Still, I hope that reading about himself here won't be too weird.

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Why Rural Docs have to leave town if they want a vacation

I've written a few posts already about how medicine has started to take over my life. Apparently, it doesn't necessarily end once you've become a doctor.

A doc at a rural conference I went to told me that in order for them to take a day off, they need to literally leave town.

Why? They explained as follows.

One day, early in their career in the town, the doctor was enjoying a vacation day with his family. The phone rang, and the doctor picked it up. "Doctor, I need your help please."

The doctor explained, "Sorry, today is my day off," and made a mental note to not pick up the phone during his next day off.


The next time he had a day off and the phone rang, he decided he'd let the machine get it, just in case it might have something to do with work. Sure enough, the message started out, "Doctor, I need your help..."

Shortly after, the phone rang again. It was the same number. Another message was left:


"Doctor, please pick up the phone, I know you're home, we can see your car in the driveway."

And that's why doctors in a small town need to leave if they want a break from work. Yep, medicine can take over your life.

If you want to know more about what it's like being a rural doctor, check out this brief article, recently published in the Canadian Journal of Rural Medicine: You Know You're a Rural Resident When... Selected highlights:

• You've delivered a baby in a canoe
• You've eaten a Canada goose.
• You've body checked your preceptor during a hockey game.

Read the rest...

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Top 10 List: Foods that Med School has ruined

Not for the faint of heart...

I've written more than once about medical school taking over my life, but now, I'm about to demonstrate another, entirely new and different, way that being a medical student is invading every aspect of my daily existence.

In the words of the evil resident, pathologists love food anologies. Thanks to pathologists who drew the analogies, and who provided photos that in many cases didn't need an analogy to be verbalized in order to cause irreprable harm, I now have trouble eating some foods.

Without further ado, here is the list of foods that are hard to eat now, and why, thanks to medical school.

Actually, there will be further ado, a warning that certain individuals may find the following quite disturbing. If you fall into that camp, I don't mind you choosing to not read this post, so long as you shower me with empathy anyways.

(You're lucky I provided a warning, by the way. I didn't give my sister a warning before I took her on a tour of my school's pathology museum. She lasted about 6 seconds. Bless her soul.)

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1. Lasagna
An anatomic specimen of an athersclerotic aorta seen in pathology lab bore a stunning resemblance.

2. Cocktail shrimp
A procedure called "Transurethral Resection of the Prostate" (TURP!), where they shove a large, narrow .... up male patient's... nevermind ... results in tiny "cores" of the prostate gland being removed. When collected on a surgical towel and photographed, they look like shrimp. In case any student failed to make the visual association, the professor was kind enough to draw our attention to it.

3. Popcorn
Fortunately, my mind has blocked out this reference. Must have been too traumatic. I only remember that it was mentioned in a pathology lecture.

4. Tomato Juice
Duh.

5. Cream Cheese
Doesn't help that the actual term to describe many pus-esque exudates is "cheesy."

6. Pulled Pork
Frighteningly stunning resemblance to certain human muscles that have been thorougly examined by anatomy students.

7. Beef Jerky
Frighteningly stunning resemblance to human abdominal muscles that have been drying out in a body bag for several months.

8. Sheep Brain
Though I enjoyed this delicacy before medical school, it just reminds me way too much of human brains now. (Okay, just kidding. I never ate sheep brain.)

9. Fettucini
One word: Tapeworms. Actually, it technically wasn't medical school that ruined this - I found this one on a blog post.

10. Cream of Broccoli Soup
Turns out this was the food that my body donor had chosen as her last meal. Please don't ask me how I know. As sad as it is gross.

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Even on my summer break...It's taking over my life.

The thing about medicine is that once you're in it, it's pretty hard to get away from it.

I started this blog over a year ago (and clearly forgot to celebrate its anniversary with fanfare of any sort), and evidently even at that tender naïve age I was aware of that fact. Enamored, actually, you could probably say. I knew that it would happen, and I was actually excited about living every moment enriched by my training in the medical sciences, making a difference in people's lives everywhere I went, breathing and living a life of medicine. I even used that phrase to name my blog.

Boy, was I delusional.

Okay, it's not that big a deal...yet. But it is happening. Here's a story to show how medicine has pretty much taken over my thoughts and day-to-day existence.

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On the plane on the way to a much-appreciated vacation last week, I got up to use the restr (those little rooms far too small to be called 'restrooms') and, wouldn't you know it, I ended up getting trapped by the beverage cart. The stewardesses had apparently taken the lighting of the final "Restroom Occupied" light as their signal to block the aisle with their large metal goodie-carts-on-wheels. They hid their glee well behind their powdered faces, perfectly poofed hair, and polyester neckerchiefs, but I could tell they were pleased with themselves and their strategic timing.


This left me stranded in their little lair at the back of the airship. I thought about popping the emergency door to get back at them (those slides look like a blast), or raiding the "Buy-on-board" cabinets when they weren't looking and stuffing my pockets with tiny liquor bottles and crusty sandwiches, or even worse, tampering with the smoke detector, but was prevented by the presence of another passenger back there, so instead I decided to talk to him instead.

"Stranded back here as well?" I asked him.

"No, actually, I've actually got arthritis and am just kindof moving around a bit so I don't get too stiff."

I replied, "How long have you had arthritis?"

"Are you currently on any medication for your arthritis?"

"Are there any factors that make your arthritis worse or better?"

"Are you frightened in any way by your arthritis?"

"Does the pain wake you up at night?"

"On a scale of 1 to 10, where 10 is the feeling of getting your eyeballs and fingernails ripped out by tiny monkeys and having scorpions invade and subsequently sting every orifice, how bad is the pain?"

And, remembering the latest research, I made sure not to tell him about my experiences with arthritis.

Actually, I didn't say any of those things. But in all seriousness, all of those questions did flood my mind, as if I was back in my OSCE again and had to think quick of something to ask him.

So, instead of carrying on a normal conversation, I was forced to wait for the storm of questions in my mind to quell, and in that time I only managed to blurt out something awkward like "Oh, that's good."

I then got to stand there uncomfortably with him while realizing that I apparently can't carry on a conversation without my med school training trying to take over.

Oh well, it's not like something like this won't happen again. In fact, it has happened to me before. And wait until I provide the list of foods I have trouble eating now, thanks to medical school.

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Fumbling with the Tools of the Trade: Empathetic Statements

"... So I pulled out this empathy comment in front of a patient at my Family Practice class on Wednesday. I figured I hadn't used one in a while. I tried hard to mean it but I guess I didn't really, and so soon after I started saying it I began hoping the patient wouldn't catch me. It was slightly misplaced, and a little bit out of context. I felt really phony and I hated myself for it for a brief few seconds..."

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I sometimes feel a little awkward using my new set of tools of the trade.

I'm not talking about the otoscope, or the opthalmascope, or the stethoscope, or the rectoscope (I can't wait!), or the tongue blade (apparently the technical term for 'tongue depressor'; the public caught on and started using the medical term 'tongue depressor,' so 'they' had to change the medical term to something more scientific and dangerous sounding. "Tongue blade should suffice," said the men in the white coats in the dimly-lit strategic medical equipment naming room.) Yeah, I'm all thumbs with all those tools still (as is my classmate who inflicted great pain on me whilst using one of the above scopes in a Clinical Skills learning session), but those aren't exactly the tools I'm referring to.

The 'tools' I'm referring to are the tools we learned during Communications Skills class, or "We Have A Past History Of Taking Crap for Our Graduates Being Socially Awkward And Insensitive To Patients So We Will Mandate That All Of Our Medical Students Take This Class On How To Talk To Patients Without a) Them Thinking The Doctor Hates Them, b) Them Thinking That They Will Sue The Doctor, Or Worse Still, c) That They Should Stop Donating Money To The Medical School From Which The Doctor Graduated." (That's the course title. Look it up.)

These 'Tools' are the Sit Down, the Get Consent or Die a Painful Immediate Death, and the most difficult to master secret ancient ninja maneuver, the Empathetic Statement.

The first two are pretty easy. "Sit down to create the impression of spending more time with the patient," we were told. Funny, I figured I'd just create that impression by spending more time with my patients. Shows how much I know. Moving on.

The second tool, Get Consent or Die a Painful Immediate Death, is pretty self explanatory and consists of making sure that the patient is willing to be interviewed by me. I have to get permission to talk to the people and I still don't even examine them on my own yet. Even if I screw this one up, my Medical School has covered their legal bases by layering - the patients are told when they book their appointment that medical students will be there, there is a "This Doctor is Teaching Medical Students" slash "Go Easy on the Medical Students, We Can't Have Them Quit On Us This Far In" certificate in the waiting room, the doctor asks them if it's OK to be questioned by a rookie, and finally I, the Medical Student of whom the patients have heard so much and are by now wondering why they have to be so sure they want to talk to me, ask them if it's OK.

(On a bit of a side note, in case there aren't enough side notes already, there are patients who decline to have their appointment on Wednesday afternoon once they find out that there are medical students in the office then. I'm collecting names so that I can decline to treat them or their children in the future. Just kidding, there are still some things that I don't mind putting off seeing in real patients until I've had a chance to be trained with standardized patients. You may recall what I'm referring to.)

Back to the tools. While the first two could be mastered by any layman, the final one, the Empathetic Statement, has pretty much become one of those things that haunts you even when you've punched your clock and have left work. It's awkward to wield, and takes a while to master, and at times you just close your eyes and hope it's working and you're not just embarrassing yourself, but when it is effective, man is it a deadly blow. It's kindof a secret weapon of new doctors, too, so don't tell anyone I told you this, we're sworn to confidentiality (which is why I'm sworn to anonymity)... I'll tell you, but I just don't want you, in your next doctor's appointment, to start wondering if a doctor is genuinely nice, or they have had to receive training on being nice to patients and are whipping out a full blown Empathetic Statement assault on you. Assume the former.

So I pulled out this empathy comment in front of a patient at my Family Practice class on Wednesday. I figured I hadn't used one in a while so I should get some more experience. I tried hard to mean it but I guess I didn't really, and so soon after I started saying it I began hoping the patient wouldn't catch me. I was interviewing this patient about her painful urination, now on my list of afflictions that I hope to treat rarely and acquire never, and I then chose to pull out an Empathetic Statement. It was slightly misplaced, and a little bit out of context. I felt really phony and I hated myself for it for a brief few seconds. If she wasn't so busy trying to make sense of my questions while I asked her to describe her pain in terms of its location, intensity, nature, character, mood, demeanor and favourite food and color, she might have noticed that my Empathetic Statement, "That must've been difficult," isn't exactly the most ideal interviewer response to "But the pain got better when I drank cranberry juice."

Okay, it wasn't actually that bad. I think what actually happened was that she told me that the pain was worse than ever before and I said that it must have been difficult. But I still felt phony saying it. This is what I'm talking about when I say that work stays with you even after you punch out. You see, it's rough when I do say something like "That must've been really frustrating!" spontaneously, even in normal conversations, because I feel like people - especially if the conversation is with someone in my class - they think I'm just pulling that out of my ass(ignment book for Communications Skills class). We joke around enough with FIFE (ie. Classmate approaches me and tells me they locked their keys in their car; I respond, "Awwww, how is this affecting your functioning? What are your fears?") so it's logical for them to think that I'm pulling out an Empathetic Statement because we were taught to, and not because I actually mean it.

Fortunately it doesn't usually go that bad. I have never actually gotten in trouble or accused of brash falsehood when I have used an empathetic statement, genuine or not. But I still hope this will stop being so awkward soon, and that when I actually do mean the statement, or even on those rare times that I don't and am just trying hard to be a bit more human, that my efforts will be appreciated nonetheless.

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