Fun Times

I hauled my butt out of bed this morning to show up at lecture at 8:00am. Too bad the lecturer apparently did not--so we spent about 20 minutes watching a Hulu Family Guy episode on the giant projection screen.

Yay, med school!

MGR

On Tuesday, I was (in a way) fully initiated into the profession of medicine.

I performed my first rectal exam.

Granted, it was done on a standardized patient--an actor who is trained to teach us how to do these things, in exchange for a hefty paycheck (after all--would you expose all your naughty parts to random kids to poke around on for free?). The good news: my SP was the veritable definition of professionalism and kept things quick and to the point--and, best of all, he lowered his gown when he was talking, rather than just letting it all hang out for us to stare at as he explained. Much less awkward than I thought it would be. The bad news: No matter what you do, however, there is still a very surreal element when you're sitting there with gloved hands, face to face with a stranger's nether regions, and being told that "you can press harder--it really doesn't hurt." Oh, the fun times.

The rectal part of the exam was actually the easiest part. The hardest was not laughing when we very suddenly switched from small talk to the SP just up and raising his gown to expose himself to us like nothing else was going on and this wasn't weird at all. The very worst part was that my partner (they send us in to learn the exam in twos) had to do this exam on her birthday. Happy birthday! Now stick your finger up this guy's ass.

All in all though, it's kind of nice to have the whole thing over with--I have to do the pelvic exam sometime second semester, but I'm not too worried about that because I've at least seen them done before. Unfortunately, it is now block week (tests on Friday), and so I will probably disappear for at least a while--but you never know. Maybe I'll get bored enough with studying to use blogging as an out.

Long Day

Yesterday, I left my house at 7:15 in the morning and got home at 10:00 at night. I'm not on call, I'm not even working in a hospital yet--but those almost 15 hours contained almost no studying whatsoever. I started out with two hours of lecture, followed by two hours of studying in the library, followed by an almost 6 hour shift in the pediatric ER doing the research thing.

Last Friday, my ER shift was slooooooooooooooooo.....w. I think there were a max of 18 kids on the list for the day (list = kids on their way, in the waiting room, or in an actual room being treated). Yesterday, the hospital gods got back at me by placing no fewer than 45 kids on the board at any one time. While this doesn't automatically increase my workload per se, since my duties really only include sitting and watching for kids to come up on the list with a complaint that might fit the studies we're doing currently, it sure did make things much more hectic. First of all, more kids overall means more kids with the right symptoms, which of course means more getting up, finding the doctor, talking to the doctor and/or nurse to see if they qualify, and finally heading back to my room because no one with abdominal pain is ever actually getting worked up for appendicitis.

In addition to the "normal" duties, I'm also helping another doctor with a more specific project where I get to give surveys to parents to see how they liked their ER experience. That in and of itself doesn't sound so horrible, except that it involves a lot more than you think--finding kids with appropriate diagnoses, finding all of their doctors to see if they're going home or getting admitted, randomizing, getting all the paperwork together, giving them the survey (which of course includes explaining it), filing all the paperwork, etc.

It used to be that ER shifts were basically study hall to sit around and get work done. Not so much any more. At least it's interesting, though--I do get to actually see and do more this way.

After running around like a chicken with my head cut off during the ER shift, I left early and headed straight for my new clinic. Background info: at my school, there are 4 clinics run by second-years (with physician preceptors, of course) that serve the indigent population for free in exchange for allowing us to tinker around and practice being doctors on you. We figure out who gets to work in which clinic and when by a lottery, which happened last spring. My lottery number was unfortunately very high, so I didn't get the clinic I wanted, and ended up being signed up for the very last rotation available in the spring. Sunday night, however, a friend of mine who helps direct the clinic I *really* wanted in the first place (because it serves a lot more kids) called me up to tell me that a spot had opened in her clinic starting Monday and would I like to work there instead for the next 8 weeks?

Obviously, I couldn't say no...so now I get to work in the clinic I wanted each Monday for the next 7 weeks (with weeks off for tests). And while this is all well and good, going straight from the ER to the clinic, where I remained form 6-9:30, made for a very, very long day even if I did see some rather interesting people. Highlights included a teenage girl for a checkup, a teenage guy for a physical, and an older gentleman who had bad allergies.

Now, unfortunately, I'm stuck today and tomorrow playing mad dash to catch up on all the work I should've gotten done yesterday, but didn't. Maybe I'll come up for air sometime in the next few days.

Frustration

So I was planning on writing my next post about how I actually find pathology interesting and rather fun (at least, in med school relative terms), or about the awesome time I had at my local drug/alcohol abuse shelter preceptorship last week, or about my 3 hours on rounds for my general preceptorship yesterday, but then this morning I got so mad that I just gave up.

In our pathology course, we have these lovely little group activities about once a week called TBLs. The TBLs are essentially set up to be group sessions wherein the entire class gets together in an auditorium (in groups) and various cases are presented by the professor. Along with the cases are questions that are supposed to relate the cases to what we're learning in class. We answer the questions on our own, then discuss with a group, then answer again. Supposedly, we learn how to apply basic knowledge to a more clinical setting this way.

This is all a fine and dandy proposition IF the questions posted have anything to do with a) what we've learned or b) legitimate clinical medicine. Unfortunately, thus far the professors have proven that really, what we need to know to do well is what they're thinking--it's a test on how well you can read the teacher's mind. We had a case today in which a good 10 symptoms and labs pointed to a diagnosis of Hemolytic Uremic Syndrome (I could explain, but if you go google it I'm sure you'll find something satisfactory). Literally, EVERYTHING about the case pointed that way--but the answer was not HUS, it was actually TTP (another blood disease)--and the only thing we were supposed to use to come to this conclusion was the fact that the lady was confused upon arrival. Supposedly, confusion = neurologic symptoms and HUS only affects the kidney. This is, of course, after they tell you that the main lab used to confirm TTP was negative. But oh--you should know that it could be a false negative, and the fact that she had any neurologic symptoms means it can't be HUS.

Wait. WHAT???

It's not just frustrating because the questions and answers are asinine. It's not just frustrating because I'm 100% positive that, were the exact same question on the boards, the answer would be HUS. It's frustrating because I know there will be questions on our exam that look like this, and I'll probably fail even though I know my pathology cold just because I can't read what the professor was thinking when they wrote the question. Ugh. It's awful.

In lay terms, it's kind of like having a question like this:

A normally healthy 25 yo male trapeze artist arrives in your ER after a tragic circus accident in which the blindfolded knife-thrower got startled by the elephant and lost control of the blade, which ended up 6 inches deep into the trapeze artist's aorta. Your patient's labs show massive blood loss, low serum iron, tachycardia and hypotension as well as neutrophilia. As he gasps for air, he informs you that he also was recently on tour in Africa, bitten by a mosquito, and later developed a high fever. His family history is significant for males who all died young due to massive bleeding after insignificant accidents, as well as beta-thalassemia and sickle cell disease, and his PMH is significant for allergic rhinitis and asthma, for which he takes Zyrtec. As a child, he had leukemia that was treated with radiation therapy and resolved.

What killed this patient?

a) Massive blood loss due to knife wound
b) Inappropriate clotting due to hemophilia
c) hepatic failure resulting from portal hypertension due to his splenomegaly from sickle cell-related hemolytic anemia
d) malaria
e) Histoplasmosis
f) aplastic anemia due to the radiation therapy he received as a child
g) None of the above--he was faking and just has a case of the sniffles--could you please refill his allegra?

Answer: E, histoplasmosis. You see, histoplasmosis is mostly spread by breathing in spores from bird droppings--the elephant in question lives right next to the birdcage in the circus animals' cage room. Said elephant stepped in the bird poop and the trapeze artist breathed in the spores a few weeks ago and contracted the infection in his lungs. Untreated, he has now developed a massive pneumonia, which killed him. Knife wound notwithstanding.

Space Filler

Yikes but it's been a while.

The problem with school is that there are lots of stories to tell--but the insane level of work required prevents me from having the time and energy in the evenings to do much anything other than collapse and watch How I Met Your Mother (which is my new obsession, by the way--everyone should watch that show. D and I can't get enough.)

I promise I'll fill in with lots of exciting stories shortly--hopefully by the end of the day (and maybe more than once!)--but for now I really need to learn about congenital immunodeficiencies.