Wednesday, December 17, 2008

I've had this in my head for 48 hours straight.

Knowing my life I'm going to be asked about rectal carcinoma in my oral exam today and will be unable to stop myself from saying (not for the faint of heart):

It will be an experience not unlike the time I accidentally wore sequined shoes to an Ivy League medical school interview.

Monday, December 15, 2008

Shelving the Shelf

One of the most difficult things about buckling down to study for an exam, besides "not wanting to" and, my personal favorite, "crippling self-destructive tendencies," is when the exam in question is widely characterized as ridiculous, non-representative and altogether impossible to predict. Classmate upon classmate who took the surgery shelf (a timed, nationally standardized final exam of sorts which are administered at the conclusion of each rotation) has relayed their feeling of utter defeat following this exam. And again when the results arrived.

I do have one Meddie Friend who rocked the socks of her surgery shelf, but she also kicks all sorts of ass in general. I reiterate, she kicks ass. That is where she and I largely differ.

Evidently the surgery exam focuses primarily on the medical management of surgical patients which by and large is NOT what I gave my attention to these past twelve weeks. When we weren't being scutted out (e.g. "Here, run this blood to the lab," or "Hey, can you write discharge summaries for the 28 patients on our service? Today?" or "So would you mind stopping by my apartment to take my dog around the block? Here're my keys.") we as medical students were expected to be in the OR to serve as retractors and mute sounding boards for surgeons' misplaced disappointment in their lives.

Standing there watching a ten hour Whipple, willing my ankles not to roll so I wouldn't accidentally drop the small intestine into the area the surgeon was focused on, it was hard to feel I was learning about medical management. The hierarchy of medicine and the staggering capacity for arrogance within human emotion? Sure, I learned plenty about all that. But how this patient was worked up and the different approaches to evaluating their presentation? Not so much touched on, at all, ever, even though we had plenty of quality time standing there and standing there and standing there.

Now, I suppose that's where the responsible med student would make it a point to go home and read up on pancreatic neoplasms (one of the main indications for performing a Whipple), but, Dude. I've been standing in an OR for ten hours (WITH ONLY ONE PEE BREAK) and was probably awake by 4:30a this morning with the expectation of waking up that early again tomorrow. I want to go home and mainline cheese cubes before collapsing into bed.

The even more responsible med student, perhaps even the good med student, would have read about all that pancreas stuff the night BEFORE the operation. In my world that's made difficult by all the persuasive excuses my incredibly imaginative internal monologue produces railing against that possibility: You need your sleep for the big procedure tomorrow! It will probably be cancelled! Someone will surely want to scrub into the case and relieve you of its infamous horror! I bet an agent will hear you whistling Christmas tunes en route to the hospital tomorrow morning and immediately enlist your talents for the Radio City Music Hall Spectacular!

So, yes, whine-ity whine whine whine. Bottom line, I have little to no motivation to bust my buns studying for an exam I am anticipating to be a medical quagmire.

Had I learned medicine the first time around, you know, at any point in the previous two years or during my 12 week internal medicine rotation this year, I may not feel so resigned to mediocrity... or if I had any modicum of motivation I might be able to use the defeateds' complaints to better equip myself for the showdown... but that would be what the good, responsible, kick ass medical student would do. And if we've learned anything about anything, we all know that that med student I am not.

Five more days. Let's see what we can do.

Friday, December 12, 2008

Harmony. Jo-Ann.

The other day we had a seminar that attempted to introduce us to what happens when a patient leaves the hospital. Specifically, elderly, chronically ill patients. Where do they go when we're done patching them up? Back home? Rehab? The curb?

One of the essential skills the lecturer highlighted was performing a functional assessment in order to determine just what our geriatric charge can or can't do for themselves. Part of that includes testing their hearing. Makes sense.

The lecturer went on to say that when older people are hard of hearing, it really isn't helpful to start shouting at them. Not only do you up the HIPAA ante of broadcasting their health status, but raising your voice tends to elevate vocal pitch. This is troublesome since higher tones are the first to go as human hearing degenerates, so even though you're louder, you may not be any more intelligible.

The lecturer suggested instead of yelling into the patient's face we, especially us women, consider lowering our voice.

The rest of the seminar was lost on me. All I could do was imagine interviewing my patients in this voice (heard between 1:17-1:20):

Wednesday, December 10, 2008

When the Bough Breaks

Yesterday I was gloriously excused for a few hours from my (minimal)(laughable)(let's face it, largely fake) responsibilities in the neurosurgery OR for a good ole fashioned GYN appointment. Anymore when I see a physician for any reason I find myself in an odd position: I'm the patient. It seems spending the past six months on the other side of the drop sheet has afforded me new insights into my own health care. Specifically, I am now determined never to be sick or require medical attention ever. Ever ever ever. I don't want to be in a hospital EVERRRRR, MY GOD. And doctors on the whole frankly freak my shit out. But! The root of these notions are stories for a different HIPAA laced day.

So anyway, the times when I do have to suck it up and go to the doctor I find myself surveying things with a short white coat sized grain of salt (AKA I can probably convince you I know what's going on while having absolutely no idea).

My doc's waiting room is arranged such that a whole host of chairs forms a U shape facing a central wall. On said central wall there are four or five large bulletin boards teeming with pinned up baby face snapshots, all staring out with empty baby stares in a kind of an eerie way, eliciting a creepy feeling from passerby not unlike the spook I imagine supermarket employees get walking down the Gerber food aisle after the customers have gone home.

I couldn't help but... question... the decor from a, I suppose, social sensitivity standpoint.   I mean, really? Baby faces? Obviously they are the cooing mugs of past deliveries, but... they're the successful deliveries.

Am I being  a freak thinking that such a display might alienate or off put patients who came in uncertain about their pregnancy? Or even less politically/socially/religiously charged, an infertile patient coming in for consultation? Or the patient who comes in for an anatomy ultrasound and learns the fetus has been lost?

I just... I don't know... was surprised.

Some of you I'm sure will commence eye rolling, but others will maybe understand  why I think doctors can be a little too focused on the science sometimes. Detrimentally so.