Juggle

The thick skin I’ve built up for more than 20 years seems stripped away. Where did the strong, independent, fierce woman go? She got lost in the hierarchy, in the desire to please, to show that she knows something, to not be the annoying little med student. Make an ass out of myself, it’s ok, learn, go, check labs, make and ass out of myself again. Be aggressive, shut up, ask for help, juggle, juggle more. Determined to do better, put that skin back on, move forward, work harder.

Caught up in stereotypes, I admit to my friends, embarrassed. Writing a note no one will read, trying to find the team, only once does the team try to find me. Talking to a patient who doesn’t know who he is, wanting to sit with him a while.  These things I have learned for sure: 1) hospitals are terrifying places where infections lurk on the hands of a busy resident, and 2) getting old means growing feeble of body or mind, sometimes both – why waste my youth watching my future a thousand times over?  That, perhaps, is why public health calls to me – delay the inevitable for others and by doing so I gain a little more time for myself? Can I learn myself into immortality? Would I want to?

Beating myself up daily, hourly, it all depends on the kindness of the nurses in the morning.  Coming home to an empty apartment, too tired to cook, all the vegetables rot.  Too tired to miss the one I lost. Curl up with a glass of wine and a friend to debrief. Sleep. Do it again. 

MS3

I made it through step 1, and thankfully I won't have to take it again. I'm glad to have that chapter closed. Another has opened, and I hope to post about it with some regularity. I'm aiming to post twice monthly to begin with.

Life measured by exams

The whole year slipped by in 3 and 4 week increments.  Every exam a final, squeezing in life between studying.

I’ve been MIA since kidneys kicked my ass (I’m still really impressed that they actually work).  I’m studying for step 1 now, so I don’t expect to post until later this summer.

My friend just had a baby a few weeks before she was due, a good reminder that life doesn’t stop just because we make a perfect schedule.  Another friend had to put her cat down right before our last exam. We schedule. We study. We’re type A people. But we can’t put life on hold for anything. The most important thing isn’t my score on step 1.  The most important thing is to measure life by the people we share it with.  

Pink toenails

                       “Well, how about the fact that encouraging the choosing of gender identity, rather than suggesting our children become comfortable with the ones that they got at birth, can throw our species into real psychological turmoil—not to mention crowding operating rooms with procedures to grotesquely amputate body parts?”

What is this quote from? Toemageddon made the news last week in ABC, CBS, with most of the controversy stemming from Fox News.  This is not a news story, but I’m not surprised Fox picked it up. It does surprise me, however, that the author of the op ed piece is a psychiatrist, and frankly this is professionally irresponsible.

Medicine isn’t exactly the most liberal profession, but it is our job to remain neutral, non judgemental and do what is best for our patients, even if includes life choices we would not make for ourselves. Controversial examples of this (although it baffles me that these are controversial) include harm reduction with needle exchanges, STI/sex education, methadone centers, and treating transgender patients with hormones.  But this is not a discussion about transgender children.  Pink toenails do not, in any way, make a gay or trans child.

Many things we consider inherently masculine or feminine are solely cultural constructs. Color coding pink to girls is a recent development:  “The Sunday Sentinel in 1914 told American mothers: 'If you like the colour note on the little one's garments, use pink for the boy and blue for the girl, if you are a follower of convention.'” My father was put in dresses as a baby. The Scots wear kilts.

There are, of course, biological differences between the sexes. The prevalence of many diseases differs based on sex, anatomy and reproductive organs are different – but there are overlaps. Skene’s glands are considered to be the female prostate (and are responsible for female ejaculation), clitoromegaly (which can be a symptom of a congenital anomaly or simply be normal variation) can look like a penis.  If you give a female testosterone, as in the treatment of transgendered individuals, facial hair will grow and menstruation will stop. The dichotomy of the sexes isn’t such a binary after all, but a spectrum. 

So this is not a discussion about transgender children, as I said, but there are important points to be made regarding the treatment of transgender people and about their discrimination within medicine.  The idea that letting children of both genders engage in the same activities, like painting toenails will lead to “crowding operating rooms with procedures to grotesquely amputate body parts," especially needs to be addressed:

#1 – transgendered people are, by far, a minority.  (the American Psychological Association estimates 1 in 10,000 male births and 1 in 30,000 female births.) While the cause is likely multifactorial and not well understood as of yet, we are at least 85% sure that it's not due to pink nail polish.

#2 – There is so much discrimination in health care towards transgender individuals, by the time someone presents to the medical community for help in their transition, it is something they have given a whole lot of thought to. Think about the last time you went to your doctor – did you think about what you wanted to say? What you wanted to ask? How much time did you spend on your mental preparation? Multiply that by years of feeling like you exist in the wrong body.  The idea that something like painting one’s toenails can make one transgender in a flash is preposterous. Moreover, that it will cause “crowding [of] operating rooms” is intentional inflammatory hyperbole.

#3 – Calling transgender surgery grotesque amputation of body parts is wholly irresponsible for it adds to the misconceptions and discrimination faced by these individuals.  The more stigma there is against any group of people in society, the more at risk their health is from long-term stressors. Teen suicide related to perceived sexual orientation has been in the news quite a bit recently. Many transgender people and those who treat them see transitioning as medically necessary.   There is a high risk of depression and suicide in transgender youth, especially related to stigma, harassment, and discrimination.  Any healthcare professional who adds to this stigma and discrimination, goes against his or her oath to do no harm. 

I'd rather be...

Since (I hope) I have a future in primary care, I try really hard to convince myself that every subject is important and interesting. But I just cannot get into orthopedics. I find it so, incredibly boring.  Some things I’d rather be doing right now:

-stomping grapes and learning about wine in Napa

-biking in a place with trees and a body of water

-writing for a living (interesting that having MD after one’s name makes it significantly more likely people will listen to you)

-social event planning

-working on an MPH

-cooking

-gardening

-eating plants

-playing with puppies

-snuggling with SO

What you rather be doing today? Or are you one of those lucky people who gets to do what you’d rather be doing?

First Aid quote on the Musculoskeletal section: "The function of muscle is to pull and not to push, except in the case of the genitals and the tongue" -Leonardo da Vinci

Joke of the Day

I appreciate jokes aimed at surgeons, dermatologists and radiologists*, so this one was a winner:

How do you hide a $20 bill from:

            -a radiologist? 

                        tape it on a patient

            -an internist? 

                        tape it under a bandage

            -a plastic surgeon? 

                       you can’t!

*I can take a joke as well as I can dish it.

The light

High potassium states are dangerous because neurons become unable to fire more action potentials. This will stop your heart.

Potassium is used precisely to do this in open-heart surgery and in executions.  What an interesting juxtaposition. 

The light and the dark are within us all. The profession of medicine, especially, has the potential to do tremendous good and tremendous evil. 

Little Monsters

So, I’ve been on vacation.  Away from all things med school. Now I’m back, and it’s time for the 3^rd year clerkship lottery.

Me (whining about clerkship lottery) – “I hate med school”

4^th year friend – “I hate all the drama, it makes us into little monsters.”

It really, really does. “Choosing” our 3^rd year rotations really is a cruel joke. They tell us to rank everything we want most, in our ideal world; location of each rotation and the order in which we want them. So we do, we research, read what students have said in the past, talk to our upper year friends, talk to each other, try to figure out what would be best for us, our goals, our situations. Some people really want to do surgery at our BigCityHospital, some people don’t have cars and can’t drive to affiliated hospitals, some people have kids, etc, etc.

Then they tell us, “well, you probably won’t get what you really want since we re-randomize the class for each choice and there’s no way to tell us the one or two things you really want for next year.”  Lots of whining ensues.  I’d much rather just be given my schedule and not have this illusion of control over it. I’d much rather tell them the one thing I really want (Family Med at a certain location, Medicine first), and get whatever for the rest of it. Don’t make me rank every. single. option.  And they wonder why empathy decreases in medical school. Apparently it will get worse next year.  Actually 2nd and 4th years are the best for empathy.  There has got to be a better way to do this.

Review Sessions

Sometimes upper years throw us reviews. It's like throwing us a post-exam party, but a lot less fun. Except that I usually get a lot out of it - they're sometimes better teachers than our professors.  Except when things like this happen:

Classmate interrupts upper year – “oh we haven’t had the cancer info yet, we have that next block”

Upper year, “Oh really? MOST EVIL LAUGH EVER*"

Terror. I am now filled with it. 

(ok, reality check SR - which is worse: learning about cancer or having cancer? Seriously? At this moment I am not sure...)**

*I don't even know how to make this an onamonapia.  Speaking of onamonapias, enjoy this:

**This moment passed quickly and I am sure I would much rather learn about cancer... sometime I have vastly inappropriate thoughts.  I plan on sharing them with you. I usually realize and acknowledge they're inappropriate, but I think it's a good thing to document the little crazy moments I have in medical school 

Some random goodies

All from professors:

"So, ladies, if you have a boyfriend that won't commit, it's not because he's a jerk - he's a MUTANT! (vasopressin AVPR1 mutant)" 

"Nodular by nature" (on the thyroid)

‎"As everyone knows, when you remove the pineal gland from a patient, they become soulless, flesh-eating zombies. It's very dangerous."

"I love giving lectures on guts and butts - so put your seatbelts on." 

“daily bowel action” 

"through some variety of transvaginal route, she thought she had acquired medical knowledge*” 

My moment of Zen**: 

"I'm not saying that in order to be a physician, you have to have a dirty mind...but it helps."

*wow, this would make med school so much more FUN

**if you don't know that this references The Daily Show, you need to get on that.

Thanks for the reminder

Sometimes, it’s easy to forget what I’m doing here. Four hours of class. Another 3-6 hours going over those lectures, mandatory clinical sessions, hospital visits, and sometimes managing to cook a meal, there’s not much time in the day for reflection.

So it’s really great to have an amazing significant other (SO) to help remind me why I came to medical school in the first place.  SO is a bit younger than I, and thus a little less jaded, although still plenty angry at the state of affairs in the world. My anger at such things has faded into, “well that’s just how it is.”  I still get angry when people are shocked when they hear about homeless kids or drug addicts who are the victims of domestic violence, or a college graduate becoming homeless.  My reaction is, “really? You’re shocked and appalled? Where have you been? These things happen on your doorstep, in your city, on your block, everyday!”  But that anger has faded, and the momentum to do something about these things has slowed. 

Hello? SR? This is why you came to medical school! Social justice! You’re a science nerd who loves the world a little too much, did you forget? Everyone deserves healthcare, because without health, one can’t pursue the life of one’s choosing, and everyone deserves those choices. That’s what I believe, that’s what I want to help provide and fight for in my career.

Thank you, SO, for waking me up.  The boards are looming, scheduling third year, and the prospect of life after med school seems feasible and scary now. Thank you for pulling me back down and reminding me why I came here in the first place. I know you didn’t even mean to. You were simply venting your frustrations about your own efforts to make social change. But I saw myself in your words. I don’t know what the answers are or how we can make meaningful change, but I have to believe our efforts will help someone.  I don’t know how to fix all the systematic problems that lead to poverty, lack of healthcare, discrimination and all the unfair things in life. All we can do is try. I’m so happy you’re someone who tries. Thank you for reminding me that I am too. 

Wonder and other things

I had these moments during first year where I’d be walking down the street in my city thinking about nerves (I’m a med student, ok? I nerd out more than the average person).  Then I’d think about the person I was dating, or my friends, or something else fun and realize that everything we are and feel and do is simply due to ion concentrations and electricity and chemical gradients, receptors, genes, proteins, pathways… and then I’d have a little mind explosion, “OMG that is SO AMAZING!” How beautiful and poetic is it that love equals ion gradients in my brain!  I wasn’t simplifying love or anything else, but I would appreciate the very small in the very complex.

I don’t really have those moments anymore. Or I haven’t for a while. My brain has been too busy with class, studying, othermedschoolnecessities, bills, errands, relationships, eating, fillingbasicneeds and passingexams.

Except, recently, I did have a moment like that – about blood. Holycrap, it works! Your blood carries necessary molecules to your tissues and remains fluid in your arteries and veins. You don’t bleed all over when you get a cut* and your blood doesn’t become a solid mass and cause you to become blue and dead**. That’s amazing! Of course, there are plenty of things that can go wrong and I get to learn all about that fun stuff, but for the most part – it works! It has worked as long as we’ve⁺ had circulatory systems.  Holywow.

Ok, nerdoutexcitement over. Back to the library. 

*Unless you have a bleeding disorder

**Unless you have a coagulopathy

⁺We as in our evolutionary ancestors

Check up

It was just routine. I want to run more and my asthma is preventing me, and the last doctor wasn’t so helpful.  I’ve mentioned before not wanting to be a patient, but I don’t mind going to the PCP.  It was a good reminder of the patient experience. That patients come in with a narrative in mind, things they want to say to their doctor and have their doctor care about (“I’ve never run more than a mile and I want to run 5Ks, isn’t that great?!”).  She went beyond what I came in for and asked about my history in the computer, asked if I had any other questions or concerns, she was good.

The importance of physical exam is interesting. There are a lot of interesting, important things you can pick up on physical exam – but the chances of finding something on an overall healthy person are slim. It is, however, important to the doctor-patient relationship. I knew she wasn’t going to hear me wheeze when she listened to my lungs or find a goiter when she palpated my thyroid, but it still felt reassuring to have my doctor lay her hands on me and check me out.  Isn’t that interesting?

Wednesday Dinners

We were talking about androgen insensitivity disorder, you know, like you do when you're in med school.* 

Friend 1: "Do they have a cervix?"

Friend 2: "No, I think the vagina just ends in a blind pouch. But I'm almost certain the Bartholin's glands are there."

Friend 3: "Well, the vagina's still good for things vaginas are used for."

Friend 2: "Yeah, you can still hide drugs in there."

I love my friends. I really really love them. 

*If you're offened: #1 tough. #2 my friends and I are extremely gay/intersex/trans friendly, so get over it, this is just what med students talk about sometimes.

Uvi-what?

Med school is an exercise in being humble. Most of us have been the best at many things before now. We’ve been in the top of our classes and the leaders of many organizations. We’re used to being smarty-pants-know-it-alls. Not anymore. I’m completely comfortable not being one of the smartest, highest achieving people in my class. I’m surrounded by extremely smart people and the fact that I made it here is enough for me – most of the time.

I’ve mostly gotten over that feeling of, “wow, I didn’t know that, how could I not know that, I must be the dumbest person in med school, they’re going to find out and kick me out.”  Usually, I embrace the fact that it’s all about learning, and if I already knew this stuff, I wouldn’t need to be here.

But sometimes, I still feel dumb.  They throw so many new words at us without explanation, and usually I look them up (on Wikipedia of course), but sometimes I just make erroneous assumptions about what they mean even when it doesn’t make any sense. For example, I thought uveitis was inflammation of the uvula until yesterday. This doesn’t especially make a lot of sense, except that words sound similar – which means nothing in medicine.  I only made the connection yesterday because a professor was naming the symptoms of sarcoidosis and pointed to eyeballs when he said “uveitis.*” So I looked it up later and felt a bit dumb.

I can just imagine having a conversation like this next year with an attending:

“What’s a symptom of Sarcoidosis?”

“Inflammation of the uvula.”

“Sorry, what?”

*Uveitis is inflammation of the middle layer of the eye, the “uvea,” but may refer to anything in the interior of the eye. Thank you Wikipedia.

You should go to the doctor

I identified so strongly with her, which is odd because I don’t have a chronic illness.  It was amazing that a fellow med student would get up there, in front of all of us (in our white coats), and tell us about being a patient. Doctors are not good at being patients. Neither are med students. We are not so good at taking care of ourselves.  Just look here, here, and here.  These example focus mostly on mental health*, but there are plenty of examples of doctors as terrible patients with other diseases like cancer, heart disease, and diabetes.

The class was clearly more interested in asking about this patient/student’s (PS) experience than other patients we’d seen. 

“Has your [illness] affected your career path at all?”

“Um, well I’m going into [a specialty that deals with this illness]”

“When you become a [specialist], do you think you’ll just be your own doctor?”

 The professor cut in here and said sternly, “You should never be your own doctor,” and PS agreed. The student who had asked retorted, “Yeah, but how realistic is that?”

We could taste it – the distain for being a patient. We could feel the desire to control and manage our own disease – imagining ourselves up there.

We also wanted to know how she managed rotations and her chronic illness. Turns out she didn’t control it as well as she would have if she were not in medical school with long days. Wow – what a healthy environment.

PS admitted she didn’t go for her yearly visits to certain specialists, claiming that since she’s had her illness for so long, she knew when something changed. But she’d also admitted that her prodrome to medical crises diminished over the years. And how many of us haven’t noticed subtle changes in our bodies right away?

So why did I identify with her? I could imagine myself up there, saying the same things, ignoring the same guidelines I would use to treat patients.  How many times have I already told my friends, “go to the doctor, go to the doctor” (after asking them a bunch of questions, of course), while putting off my own appointments?  Part of it is that managing anything other than school has gotten increasingly difficult. This includes bills, laundry, doctors’ appointments, cooking food, maintaining friendships**, etc. Another part of it is a refusal to be sick. I don’t have time to be sick (who does, why I am any different?). Another part is that barrier that’s gone up between us (medical professionals) and them (patients). This barrier is necessary in order to do our jobs effectively. It’s a fine line, however. Make that barrier too high and you’ll forget the “them” on the other side are human beings with complex lives, not just complex chemical processes. Don’t build that barrier and you’ll bleed too much for each and every patient and you’ll burn out. 

Also – I know how easily errors can happen, I know how scary hospitals really are. I. Never. Want. To. Be. A. Patient.

*mental health is another topic, and I’m luckily fairily happy as far as med students go.

**I’m pretty good at this, I work hard to take the time to foster my relationships

Politics and Gossip

I’m a part of a big-name organization (BNO) at my school. We were selecting the new members a couple weeks ago, and politics came into play – of course. Of course?

I worked in a hospital before medical school and I was shocked when I figured out there were politics between departments. There was some holiday lunch, and some friends in the same position as I, in a different department, invited us. A couple of us in my department went cheerfully.  When we were pulled aside by some supervisor in their department and reprimanded for eating their (plentiful) food, I was floored. I told my supervisor about it, and she said, “Yeah, that’s why I didn’t go.” Wow, thanks for letting us know… oh wait, no – just throw us to the wolves. Aren’t we all in this for the same thing – better patient care? Why are we fighting about… food? About territory? About departmental identification? About I-don’t-know-what?

Oh, silly-fresh-out-college-me.

I learned politics are a part of every workplace. Sometimes it’s inappropriate and unprofessional.  Sometimes, connections can help you get your foot in the door – but you need to make it to the next step on merit.  No one wants to take unqualified Sue just because so-and-so knows unqualified Sue.  Right?

Med school, for the most part, is filled with extremely professional people. There’s the occasional whiner who talks back to a professor after an exam about an “unfair question,” or the professor who makes some off-color joke, but this is MEDICAL SCHOOL. It’s serious.

I had friends applying for BNO, so did everyone else in BNO. “Check out so-and-so’s interview, I think s/he’d be great.”  These comments gave the rest of us full disclosure and fit into my “connections help you get in the door and get noticed” category. But then – you do how you do in the interview. If you rock it – great – if not, too bad. It was horrifying to me then, when someone who had a terrible interview (that I did not see) got into BNO because of connections (that I do not know) due to conversations (that I did not hear) after the rest of the BNO members had left.

This brings me to my next topic – gossip. I learn a lot about my classmates through gossip. I love hearing gossip. I don’t love sharing gossip. I like to know. People are interesting. Gossip, I realize, has a huge potential to damage people, especially in a professional setting like medical school which is career-centric. So I have my sources I trust, and the few people – mostly unconnected to school – who I trust to talk to. Does this make me a bad person? Unprofessional? It certainly doesn’t make me unique.  It’s not like I would ever act, professionally, on gossip. I can’t do anything about BNO since all I know is by hearsay. I might choose not to be besties with the people involved with what I think is a scandal, but I’ll always be professional with them.

What do you think? What are your stories about politics and gossip in professional settings?

Public Service Announcement

School has been beating me over the head with 4 lectures/day, so instead of write something, I wanted to share this service announcement, as Valentine's Day is coming up:

Things I learn in medical school:

#1 cats have two thyroids
#2 shrinking is not a normal phenomenon

#3 cats have a spiral esophagus

O0wowkthx

Lub dub

Lub-dub. Lub-dub. S1/S2. Systole-diastole. Blood to the body, blood to the ventricles. Lub-dub. Keep it beating. That’s our job. That’s my job. This mechanical organ, this pump made of flesh, keep it going.

Spindle shaped extravasated red blood cells is pathognomonic of Karposi’s Sarcoma.  Will that factoid help me treat patients any better? I can recognize KS without knowing that. Sure, it’s interesting. But how will it benefit my patient? I need to know how to treat my patient in body and mind.  Focus on the drugs. What do they do? What are their side effects? What will be the barriers to having patients take them? What is the best one to give? Tell me that. Test me on that. Tables, tables, more tables. A picture of one person’s dead heart. How will this help me? Tables help me memorize important information. CHF, HTN, AE, d/o, LVH, LBBB, AMI, I’m learning the language. That doesn’t help me help patients. Not yet. It’s like being able to read Hebrew and follow along in the prayer books, but not knowing what I’m reading save for a few words. 

What kind of doctor will I be? Is it at all reflected in the test scores I achieve my first 2 years? I have to learn something. I have to learn a lot. Does doing average on these exams mean I won’t know enough? Does above average mean being a better doctor? What about below average? What if I fail one? Or two? Will I put patients in danger? Or will I, in reality, have a chance to learn it better, in clinic, in a setting where I can see the people I’m helping? I know I will be a good doctor in terms of talking to people, caring about them, and that matters a lot… like alotalot. I just hope I can get enough knowledge into my head so I don’t kill anyone. 

3rd year

So I went to a real hospital for the first time, as a med student. I saw a real patient. I think I’m going to love 3^rd year.  That endorphin release you get when answering a question right is pretty nice. It made me think of the clients I used to work with – the recovering addicts. No wonder they found outdoor movies and spa night so uninteresting; they obliterated their reward pathway (nucleus accumbens!) by overloading it with drug-induced endorphin release.  It made me grateful for the simple endorphin rushes in life. 

So getting questions right feels good. I totally can answer questions confidently, whether or not I have any idea, which the attending seem to appreciate. I can organize data into a coherent presentation. I learn quickly, so the individual variation on what attending prefer will not be much issue.  I actually think I’ve learned something in the past year and a half, so all those things combined will make me a good 3^rd student (I hope).  I really loved the interaction with our preceptor. I forgot how much personalities play into the experience of the healthcare provider. Working at that top-notch hospital before medical school gave me a little window into that. I observed mostly, but I also noticed that the politics and play of personalities.  So much of 3^rd year, it seems, is how personalities fit together. Some students will think their resident is a jerk, and some will like the same person.  It’s not necessarily a good thing, but it’s something I can be good at.

It’s nice to have some decreased anxiety about going to the floors next year. There’s just that pesky step 1 between now and then.  

We Hate Fat People

What more do I love to do at 9am than make fun of fat people? Make fun of fat people in front of an entire medical school class, that’s what! Oh wait, no, that’s not me, that would be my professor. 

Obesity is an important topic, especially as it relates to diabetes, and the medical complications it causes are necessary for us to know – no argument there. There is a clear link between obesity and diabetes – again, no argument.

Now, I have a sense of humor and have been known to say and do completely inappropriate things in the company of friends, but he showed a satirical video clip essentially making fun of the number of fat people in America. Seeing this in a professional setting and hearing the class erupt in laughter was disturbing to me.

The prof augmented it with a few other comments poking fun of fat folk. It was subtle enough, but definitely there.  This is certainly not the first time I’ve heard distain about obesity from physicians and professors.  My upper year friend told me her resident once said of a patient who had lost 40lbs, “wow, she must have been really fat before!” 

Personally, I’m very torn between the sentiments that people should love their bodies no matter their size and the knowledge that obesity takes a toll on one’s body.  I’ve also struggled with weight myself and have been able to lose about 40lbs*.  I recognize the systematic problems that lead to obesity: so-called “food deserts,” poverty, parents working multiple jobs, lack of education, lack of time, living in a time-pressured culture that doesn’t value savoring food, and so on. I also recognize the choices one makes and the need for personal responsibility. But even if we view obesity just like smoking (which I don’t), we don’t make fun of smokers as much as we make fun of fat people.  We counsel them to stop smoking, we have to use motivational interviewing and meet people where they are.  Repeating, “eat well and exercise” and “stop smoking” is like beating our head against a wall – it’s condescending and unhelpful. We need to take it a step further.

Anyway – back to this professor. I tend to give people the benefit of the doubt and assumed he just didn’t give much thought to that part of the presentation (still unprofessional though).  But then, in another lecture, he poked fun at women with hirsutism, and said, “if you have a mustache ladies, please shave them.” Now I just think he’s an ass.

*mostly because I’m a privileged white kid: I was able to love my body at a bigger size, I’m surrounded by healthy people in med school, and I have time and money

You're doing it wrong

Most common cause of hypoparathyroidism: iatrogenic


pseudopseudohypothyroidism*: naming fail. (I swear I'm not making this up). 
*(similar phenotype to pseudohypothyroidism without the same genotype)

Best Quotes from Repro

This was the best unit so far. The teaching was excellent, explicit, and done with a great sense of humor:

"I'm not saying that in order to be a physician, you have to have a dirty mind...but it helps."

“This one is yellow, and the other is extra large” –passing condoms around

“What, you might ask is a fomite? A fomite is anything a patient might put in her vagina.  Like if she douches. Or… what am I thinking of… yes, a vibrator”

Using a story about a trans woman who was the baker at our professor's grocery store, he made the point that everyone seemed to know and not care at all, which is the way it should be. He said, “it made me incredibly happy to eat her rolls, which were quite delicious”

“I loved Barbies when I was growing up – no surprise to anyone” (openly gay professor making the point that his straight male cousin also played Barbies)

Cultural Competency

I am totally on board with the importance of cultural competency in medicine. I used to get very excited about seeing it on the syllabus.  I was an anthropology major, I want to work with underserved populations.  Trust me, I get it – it’s IMPORTANT.  But I know it’s going to be awful. 

Example: this week we had a large group session on cultural competency.  We had to read an article about 1) the importance of spirituality in health, 2) a prospective study on the effectiveness of phone vs. in-person translation and 3) unequal treatment of black Americans in the healthcare system.  These articles were valuable and thought provoking and worth reading and discussing. Except that we didn’t discuss them. We watched a movie about an Afghan man getting lost in translation and not receiving chemotherapy as a result. Also worth discussing. Except that they squashed any meaningful discussion by forcing each group to answer a very specific, often repetitive question.   

In contrast, our small groups are run very well this year. They give us articles like the ones described above, or about the importance of hand washing, minors and gardasil, or cardiovascular risk factors and we have constructive discussion and get to learn from our very amazing, knowledgeable small group leaders.

Anything they do in large groups – “discussions” or lectures are useless and leave me banging my head against the wall, along with the rest of my classmates.  It’s a shame because these are extremely important issues. We need to face our own biases and prejudices and understand the effect of time pressure on obtaining a translator.  These issues will affect our patients’ outcomes. So why do they bollocks it up so badly?  I know these are relatively recent additions to medical education, and they (obviously) haven’t figured out how to teach it yet.  But really? Telling us translation is important and respecting our patients’ culture is important is like telling us that HPV causes cervical cancer.  Most of us know that much at this point, so don’t waste 2 hours telling me that (It leads to days like this).  I can handle something slightly more advanced. 

Pop culture knowledge gaps

This weekend, I was hanging out with some friends and pop culture came up. Something like this happened:


Friend 1: "...it was like that Antoine Dodson video."


Me: "Who's Antoine Dodson?"


All three friends look at me in disbelief, "Where have YOU been?"


Me: "Uhh... in med school."


Friend 3: "Yeah and [SR] doesn't know who David Sedaris is either."

Expiration

“A 65 year old man experienced crushing substernal chest pain, was found to have suffered a myocardial infarction and expired.  The most likely pathogenesis for this…”

Excuse me? He expired? Like milk? Like that slab of steak in the back of the fridge? I guess we all are hunks of meat.  We have a shelf life that maxes out at about 100 years.  A baby born today – “best used by 2110.”

He expired.  I remember that time when the patient I enrolled in our observational study died.  Her lab values were out of wack and I totally missed that little word at the top left of the screen, “expired.” I wouldn’t have known what it meant.  Maybe, “oh, the records expired, no wonder the labs don’t make sense.”  The patient expired.  No, this child died.  She had parents, maybe siblings, friends, people who loved her. 

He expired.  They’re asking me to identify the pathogenesis… what about his family? Did he have children, a spouse, a dog?  How many more questions will I have to read like this in order to learn? How many more expired persons will I need to brush past*?  

*Apparently lots more. I wrote this in August and I've already become desensitized to this kind of language.  Oh, look, there goes that empathy med students loose between 1st and 3rd year.