#36: Culture Shock

CC. 2/2. PMHx. Abs. Tx. Abx. qd. subq. DKA. DM. MVA. Sxs.

This is how I write my notes. I speak in the structure of chief complaint (CC), history of present illness (HPI), past medical history (PMHx), and a closing with treatment (Tx). I get a bit annoyed when people don't present things in this structure, even when we don't talk about medicine. I oftentimes want people to present their life problems just like a medical presentation on rounds.

This past Spring Break it took me a few days to become reacclimated with how normal civilized people interact with carefree banter that go nowhere and has no point other than for kicks and giggles. It took me a few days to put away the books even for a day and go have fun without feeling an exorbitant load of guilt.

After being around medicine and medicine people all day, every day for a long period of time, it really takes a long time to adjust. Exiting the medicine world is almost a surreal experience. It's difficult "shut off" the medical personality. Somehow I feel that this is like a Southwest Airlines commercial: want to get away?

Question
How difficult is it for you understand what doctors are saying, especially with jargon?   

#35: Who Wants to Date a Med Student?

Here are some things you should know if you're about to date a med student, especially if you're not a med student:

If you're thinking about dating a 1st year:
1) Postexam bar nights are filled with reckless libation and obscene debauchery.
2) The first few months (3-4) aren't so bad. Your med school significant other will have some free time. Some.
3) Shit hits the fan about 6 months in. Maybe 8 if you're lucky.
4) If you want to bring up a complaint about the relationship, make it high yield: CC and HPI. You will hear "high yield" a whole fucking lot.
5) Unless you can somehow study for about 8 hours per day a week before exams, there really isn't much you can do together as a couple during that week. Well, maybe you two can go pick up a pizza or Chinese. Romantic.

If you're thinking about dating a 2nd year:
1) Don't.
2) Really?
3) What? Still?
4) You crazy.
5) Ok, fine. You really want to know why? Step 1.

Question
I have more or less one week of vacation between 2nd and 3rd year. America is a vast nation of amazing places. Where should I travel to?

#34: I Was Curing Cancer

Hey folks,
I'm sorry for breaking all the hearts of avid fans out there...wherever you are, say Canada and Germany. I still have no idea which one of you in Germany keeps on reading my blog, but danke! During my 2+ months hiatus, I was curing cancer. No big deal, really. It was just a hobby I took up to relax when 2nd year of med school got overwhelming at times.

Anywho, I'm back and will try to bitch and moan and be a sarcastic ass on a more regular basis. I'll even throw in a few deep profound thoughts, but there will be too many daily cathartic moments to share. I can't really be blogging all the time while living my awesome life.

Here's a tidbit of my adventures lately. A good number of my med school friends are on prescription drugs for anxiety, sleep disorders, concentration issues, and other conditions. I'm not saying that this is wrong or frown upon, but it was definitely a shock to hear about it considering every day my friends seem normal and do well in school. They seem fine, cheerful, confident, and well-maintained, but when I got to know them more personally, I was surprised to hear about their situation.

I understand that med school itself is a lot of stress. In addition there are a lot of other stressors in the life of a med student:

1) Relationships (or lack thereof) with significant others. Even dating someone in med school who understands what you're going through can be tough. School takes up a huge chunk of time. Expectations to do well in school forces you at times to prioritize your relationship in the context of school...and that's a huge bummer for your partner. Wining and dining after looking at the 100-200K+ loans kills a bit of your soul each time.

2) Family. Again, some students are and/or were really close to their family, but now feel that they have to prioritize their relationships and time with parents and siblings.We med students always welcome a home cooked meal and laundry service.

3) Food (or lack thereof). Ramen every day for the sake of time and convenience definitely not healthy. Headaches and heart palpitations because of coffee or caffeine pills are not healthy just so you can stay up to learn that alcohol enemas could be a probably reason for alcohol poisoning at frat parties...Again, it's difficult to have the time to cook properly when all med students are basically Type A's who have extremely high expectations for themselves to do well.

4) Classmates. Oh, I seriously want to destroy that classmate who got 97.5% on the Path exam. Still haven't found out who it was (yes, "it"...because no human should do that well).

5) Friends outside of med school. Look, it's nice that you got married, bought a house, and made a baby. Oh wait, you just got a job promotion? Splendid! Want to pay my loans? Want to do rounds at 5AM...after getting home at midnight? I'm sorry that I've declined 3 consecutive invites to parties that, now, you don't even consider inviting me anywhere fun. But, when you're coughing up blood or have a "thing on your thing," you give me a call...at 2AM.

Don't worry, I'll be back again. Soon, I promise.

Question
Are you excited for the return of Community...AND Mad Men? There goes that 97.5% on the upcoming Path exam....

#33: Clinical Joke as a Med Student

As a med student you're bound to be in some hilarious predicaments since you're at the bottom of the totem pole. For example,

Scenario A:
Resident: "I'm going to do a digital rectal exam." - Joke.

Scenario B:
Resident: "You are going to do a digital rectal exam." - Not a joke.

Advice for future med students out there, two words: double gloves.

#32: The Always Chatty Classmates

There's a classmate in my small group who is always chatting with her friend. You can hear them laugh, giggle, whisper, and chatter. I have no problems with being social at school. I find it actually heartwarming considering all the stress.

However, these two never seem to shut up, even when the professor is talking. All the freaking time yap yap yap, teehehe teehehe. I don't give a damn that you bought flight tickets for Spring Break, which types of boots are in this year, or how useless the small group sessions are. To an extent the incessant chatting interferes with how I can focus on what the professor saying, but that isn't my main problem.

What pisses me off is that when the professor calls on them, they don't know what the question is or in which context was the question asked, which wastes time backtracking through the earlier discussion and an explanation of the question. All of this could have been avoided if they would just shut the front door just a few times throughout the small group sessions.

I just want to squeeze in a nap if the small group finishes on time or early. Please, I need my beauty sleep.

#31: What I Wish I Had Known Before Entering Med School - Part 1

1. I should exercise regularly.
2. I should study regularly.
3. Medical jokes never get old.
4. More students are in it for the money than I thought.
5. Med students sleep around...with other med students.
6. Dressing more decently and professionally goes a long way in opening up patients to talk.
7. CAGE questions should only apply to coffee.
8. My index finger gets more play than I do.
9. Loans create nightmares.
10. I am more scared shitless examining patients than I do bombing an exam.

#30: Medical Poetry Slam...Not Really

Aorta tell you I'm quite stressed.
With all this Robbins left I haven't gotten much rest.
Overdosing on Folger's coffee,
I run to the bathroom quite often to pee.
Renal dysfunction, heart palpitations,
please Winter break give me much needed relaxation.

#29: Turkey Day

I would like to thank for all the crappy, painful, exhausting, disappointing, and simply shitty stuff and all the mistakes, the foolishness, and embarrassment that has happened. I want to thank all the people who made those shitty stuff possible. Because without it and without them, I don't think I would be as grateful for all the good stuff, even the tiny good stuff, that has happened. I've learned a lot this past year about what to do, what not to do, who I am, and who I am not. I believe I've grown and become ever so slightly better because of my experiences.

I'm happy and proud to be a medical student. However much I bitch and moan about med school, I am truly happy to wake up each day and learn about what I love, medicine. I don't care if you think that sounds cheesy because I know it's true. Even when I want to shoot my brains out learning about psychiatry or the different Hodgkin's lymphomas, I love what I learn.

I want to thank my parents, my sister, my cousin, my aunt, and other family members. Even when things were rough, they stuck by me, especially my sister. She's awesome.

I love the close friends I have. I can call them up when I'm flustered and stressed out from studying and they would talk to me about random things to get my mind off of med school. I can call them about how to wash wool or how to buy car insurance. One friend in specific actually welcomes me to talk about my med school issues, and that's a great friend right there.

Definitely not last, I'm tremendously thankful for my friendship with my med school buddy, or just simply buddy, Jesse and his wife Jackie. They've taken care of me when I felt like absolute shit because of med school and when I don't feel like shit. Plus, I can fall asleep on their couch when I'm a lazy bastard to walk 2 minutes back to my apartment.

It might not always be awesome every day, but I'm thankful to be where I am and with the best people I can think of and without those who I couldn't care less about. Thanks.

Question
Let's not focus on all the happy puppies moment. What "bad" thing are you actually thankful for? Why?

#28: Oh Lawd

Dear Person Who Got 97FreakingPoint5% on the Pathology Exam,
What are you smoking? Because I want some of that. Have your people contact my people.

Sincerely,
I Can Pay You Handsomely

#27: Dork Alert

Last night I played Risk, only the most awesome board game of all time. Throughout the entire game, instead of thinking about world domination, all I could think was, "How can I metastasize?" Teehehe.

Question
Have I gone off the deep end? 

#26: MD vs. DO, DO vs. MD. Stop it.

I met up with the friend from post #4. Let's call her Mandy (not the real name of course). She's applying to med school right now and was asking about the application process and med school in general. At one point during the conversation, Many asked, "Would you have considered applying to DO schools?" My response, "No. Definitely not." It was not because I do not respect DO schools. It was because of what I believe to be hypocritical to my beliefs of what medicine is about: care for the patient. Let me explain.

This post may be a Pandora's box, but let's open it to discussion. Don't flame me, please.

Hold on, now. Chill out for a minute before you reach for the pitchforks and torches. I understand and know that this whole MD/DO issue has been going on for decades. It's a touchy subject among the professionals, med students, and even pre-meds.

In the States, we have two types of med school: Allopathic and Osteopathic. Allopathic med schools are the ones that grant MD (Doctor of Medicine) degrees. Osteopathic med schools grant DO (Doctor of Osteopathic Medicine) degrees.

First, as an MD student, let me say that I respect DO physicians, students, and interested pre-meds. I wholeheartedly respect what they do, study, and aspire to become. DO colleagues have the same goal as MDs: to serve, treat, and care for patients. Both take the Hippocratic Oath. Both have the same medical responsibilities to patients.

Second, I understand that MD and DO schools have different teaching philosophies as allopathy and osteopathy have different medical philosophies. MD students have to take the USMLE and DO students have to take the COMLEX. DO students also learn Osteopathic Principles and Practices (OPP) and Osteopathic Manipulative Medicine (OMM) and Osteopathic Manipulative Therapy (OMT).

I have absolutely no issue with different degree, different medical philosophies, and different teaching philosophies. Historically, Dr. Still broke away from the MD crowd to establish osteopathic medicine. That's absolutely marvelous in my mind. Hey, Dr. Still clearly had a different medical ideology and he had every right to teach it. Coolios.

With respect to core basic medical science courses and a huge overwhelming majority of clinical courses/rotations, MD and DO students learn the exact same material. The only different is the addition of OMM, OMT, and OPP and the emphasis of osteopathy in other courses at osteopathic schools.

But, the rift between the MD and DO communities has been tense although it is calmer now. I have heard and talked about the disdain one group for the other whether it be about standardized exam scores, application stats, education styles, jealousy, paid grades, residency site competitiveness, whatever. I do not even want to go into comparing the prestige battle about medical schools and residency sites.

What I have a problem with is this: DO students can take the USMLE in addition to COMLEX and apply for allopathic residency positions. However! However, MD students cannot take the COMLEX in addition to USMLE and apply for osteopathic residency positions. Look, I understand that MD students cannot take the COMLEX because they do not have the education in OMM, OMT, and OPP. But, allopathic residency hospitals have extended their welcome to DO graduates. Yet, DO residency hospitals have not reciprocated. I understand that OMM, OMT, and OPP and the osteopathic education in general give another dimension to DO physicians and graduates that the MD counterparts do not have.

Above the disparity in applying for residency, I have a bigger problem with this: Since all physicians, regardless of degree or education, are dedicated to care and treat patients, why can't we all just be doctors? One type. Make one medical doctor degree? If you got osteopathic education and training, then why not make it an additional credentials to the end of your name? There was a report out there that states that DO physicians use OMM/OMT about 5-15% of the time. (Can someone please look for the stats of this?) Do those percentages really make that much of a huge difference to cause a division in the physician community?  

Question
So, here are my concluding questions: If DOs historically wanted a split, then stick with your guns. If DOs now want to work alongside MDs, then reciprocate by opening your residency positions to MDs too. If you got osteopathic education and training, great! You're a physician, too. You're out there to treat and care for patients, too. With the healthcare crisis bubble about to burst, why care if you are DO or MD? Why not just care about being a physician? Why not train as many physicians as possible and put aside the schoolyard tomfoolery? If you got osteopathic skills, use it, and as I suggested, tag on the osteopathic credentials to your embroidered white coat.

Think about the patient, not about which kind of physician you are. Really, like, for real, which of the following sounds better to you if you heard it from a patient?

a) My physician is awesome!
b) My DO/MD physician is awesome!

Since I'm in the MD community, I will honestly admit that I am MD biased. Really, DOs, it is time to open up your residency doors. Or better yet, MDs and DOs, can we all get along? Medicine has advanced a very long way. Heck, even medical education for both allopathy and osteopathy has advanced with all the integrative clinical education in the first two didactic years. We as a community of physicians should too.

#25: Importance of a Physician

This post is not about seeking self-pity or even pity. It's not about being self-absorbed or demanding recognition. Take it as an explanation of part of why I want to become a physician.

We expect our physicians to be smart, charismatic, efficient, understanding, accommodating, prompt, careful, considerate, communicative, accessible, honest, dignified, altruistic, confidential, attentive, dedicated, hardworking, caring, informative, right, proactive...the list goes on. Those are a lot of expectations. It's rightfully so that we expect so much from physicians. And, physicians know this. They took the Hippocratic Oath the moment they graduate from medical school. At my school, I took the Hippocratic Oath at my White Coat Ceremony in my first year.  Physicians understand not only their duty, but their value to their patients.

Why so many expectations? Why are they justified? Because physicians don't necessarily handle things in your life. Physicians handle your life. Not your money, not your car, not your house, not your work, not your schedule. You. Your money can come and go. But, you, you can't. You can't die and come back. (Well, maybe give science and research a few more years...)

Without you, you can't have the things in your life. Imagine not being able to buy a home, marry the person of your dreams, drive your favorite car, read a book on the porch, travel the world, see your parents or kids, talk with your friends, walk, occasionally indulge in your sins and vices, live long enough to see your grandkids, have sex, and all the other little joys of life.

You seek physicians when you're in pain, sick, and/or distressed whether it's because of your volition or of the encouragement of others or when it's your last resort or whenever you want to. Physicians are bound by an oath to treat and care for any patient who seeks them. Now, when I say treat and care, physicians must consider the medical benefits and costs, your personal beliefs and feelings, resources available, and ethical principles. All of this biosocioethical consideration on top of the intellectual demands of figuring out what is medically wrong with you.

The burden of integrating the nuts and bolts of scientific medicine for a diagnosis, the patient's feelings and views, and the physician's own feelings and views can be overwhelming at times. Treatment and care encompass all these factors, which ultimately leads to handling your life. It's not easy. Being a physician is extremely and exorbitantly demanding.

I wouldn't want to be anything else...but, check back with me when I actually have that MD title if I survive the onslaught of 2nd year.

#24: Facepalm

So, this whole to vaccinate or not to vaccinate fiasco. Michelle Bachmann told a possibly false anecdote about a mother whose child became mentally retarded because of a vaccine. Ok, well, not fine. I'm tired of this whole sensationalized crap about anti-vaccination. For Pete's sake, the study linking the measles vaccine with autism was debunked by the medical profession. Heck, some participants even reported of data/observation fabrication, collaborators eventually jumped ship, and the principal investigator of that research had his license revoked.

I understand why, in discrete cases, individuals would object to vaccination. However, I don't understand why people would preach anti-vaccination when a ton of epidemiological data indicate not only has vaccination nearly eradicated several diseases, but also show that not getting vaccinated has increased the incidence of these diseases.

Question
I would like to hear stories of the opposite. Stories of misfortune, regret, and we-told-you-so. Have you ever heard of stories or anecdotes or read literature or news articles about parents who decided not to vaccinate their child(ren) who consequently suffered the same diseases for which they should have been vaccinated?

#23: Open Letter

Dear 2nd Year of Medical School,
First, you've taken tens of thousands of dollars. Second, you've taken away my social life. Third, you've taken away my libido to mate. Would you like my first born too?

Sincerely,
Exhausted MS II

PS: Ladies, the libido thing was a joke. Ladies...?

Question
Have you seen New Girl with Zooey Deschanel? You haven't? Shame on you. 

#22: Pick Up Your Phone and Call

If you have a friend or family member or someone you care about in medical school, please pick up your phone and give them a call. They might not pick up or even return the call in a day or two or three. You might feel that you're intruding or bothering them. You're truly not. They will most likely say, "I'm busy. I have to study" or some variation thereof. They might tell you a horrible event in the clinic or at school. They might break down and express doubts that you may not understand.

Just call anyway.

Question
Did you call?

#21: Unexpected Surprise

Some days, I just need Mumford and Sons to get me through at med school. Other days, it just takes a good looking Senior Resident giving a lecture. Eye candy, you know? But, that's like once every blue moon...

Question
Which type of music or band just gets you through the most banal days?

#20: Still Amazes Me

Scene
Each medical student has graduated undergrad with a bachelor degree (or multiple ones). Some have gotten a Masters or even a Ph.D. degree. Some have done a post-bac program. Some have published scientific research papers. For a huge majority, we're all going to get an medical degree.

But, this still amazes me: it's, its, there, their, they're, your, you're, won't, wont, want, err, air, very, vary. Other notable ones: wit, dat, shouldof, wouldof, couldof, I'mma.

I cringe every time. I'm a hypocritical grammar police, I know.

Question
What is one of your pet peeves?

#19: Spleen

Scene
Last year in the Foundations of Clinical Medicine I class, our class was roughly taught a few physical examination techniques, one of which was how to palpitate for the spleen. To do so, you ask the patient to take a deep breath to push the diaphragm down and consequently push the spleen down past the last rib. Once the patient has taken a deep breath, you push your hand up from the abdomen under the last rib and feel the spleen with your fingers.

I volunteered as the guinea pig for my small group. I thought I was going to be the model for just the professor to demonstrate to the group. I was wrong. I was the model for any other student who wanted to try. It was painful enough to have an experienced professor forcefully push his fingers up against my spleen. It was even more painful to have a handful of students trying over and over and over again. When one student couldn't feel the spleen, the professor encouraged "to push up harder." Apparently, harder meant hard enough to elicit a groan and retraction into the fetal position for me.

Today is the start of FCM II. Cringe.

Question
Which part of a doctor's visit hurts the most?

#18: One of those Blah Days

Scene
Some days, med school just sucks the life out of me. It's all fun and games until I realize I've spent about 6-8 hours studying. My brain is sore. For Immunology, I don't care which cytokine does what. For Path, pretty much every prognosis includes death. Chyeah.

Oh, my butt is numb and my back aches from sitting and hunching over while studying for hours on end. Prognosis? Secondary hypermeducational fukitallitis.

Question
Tell me a happy story of what happened in your life today.

#17: All This Studying

Scene
All this studying has really gotten me out of shape. I feel like as if I have respiratory distress walking up to the 2nd floor mods...which are one floor down from 1st year.

Question
How do you exercise? Do you find it difficult to find the time to exercise?