Cleaning up

With a (much) lighter schedule, the Mrs. and I decided we should start getting ready for the baby getting here. The first order of business is to make room for the baby. This means throwing a lot of crap away. Most of the "crap" was notes and folders from undergrad and the first two years of med school. I've somehow felt attached to these notes, even though very little of it is useful to me anymore (really, I don't need to hold on to my History of Jazz notes). But they had to go. And as I was throwing things away, I saw my Calculus 3 notes and flipped through it and I was amazed that at some point in my life I knew how to do triple integrals. Then I thought, holy shit, what a waste of time. I haven't used it since and will probably never use it again. Was it all a waste? I wonder how much of my education is a waste?

Done Surgerizing

As you could probably tell from the frequency of posts in the last 2 months, surgery was not the most leisurely of clinical rotations. But it wasn't too bad. Maybe it is just our school (or just my experience), but the hype over how much work it is and how much pimping is involved is a bit overblown. Yes, it sucks getting up at 4:30 am everyday, but once your there (and awake) most of it isn't "difficult." I rarely got pimped (in fact there was only one time where I may have felt uncomfortable), I was rarely given any scut work and (this may have been a fluke because of some national conferences) I actually had time to read. Still, I quickly decided (after about 4 days) that it's not what I want to do with my life. What I loved about medicine was the opportunity to get a complete mystery and solve it with clues from your history, exam and labs. In surgery (for the most part) that is already done for you. It's a much more get in there and fix the problem kind of job. Don't get me wrong though... most of the surgeries were really cool. There are a lot of clever approaches to fixing otherwise very disabling problems (like making a bladder out of intestines). And there's nothing like cutting apart someone, hacking at bones, chopping up intestines and seeing the person functioning pretty much as normal a few days later. Here are some quick goods and bads:

Goods:
1. Most of the procedures are awesome - something not too many people get to be (somewhat) actively involved in.
2. There actually is thinking involved - surgeons have a lot of thinking on their feet to do when something unexpected happens intraoperatively. It's not just for jocks.
3. Results - for the majority of patients, the surgeries actually work! It's amazing to see the overnight transformation in patients.

Bads:
1. Hours suck - When med students are violating national hour-limit laws, I don't want to know what the residents are doing.
2. Not much to do for the student - unlike medicine where you can follow labs, actively discuss your patient, in surgery the most you get to do is throw a few stitches, hold retractors and get to open your mouth once every half an hour or so. There is a lot of standing around not doing anything, which sucks when you have to get up so early.

Advice:
1. Ask questions, very few people are enough of an asshole to call your question stupid (you'll figure out who those people are and avoid them).
2. Try to do as much as possible, ask (if you actually think you can handle it) if you could do it. This isn't a rotation to be quiet and timid on. You'll have a pretty boring experience if you don't try to actively get involved in whatever the team is doing.
3. Don't kiss ass. This goes for most rotations, but students interested in surgery tend to be the worst. Everyone ends up hating the person (including, I presume, the attending).
4. Don't fret over studying for pimping. Study what is important for your exam, but don't spend hours reading about details of an operation that you'll never think about again. The reputation of pimping is overrated... it is not what you should be worried about.
5. Always have something to read in your pocket. That way you'll read what you need for the day in your downtime, giving you more time to eat and sleep when you get home.
6. Don't volunteer for scut work just because you think it will give you a better grade. It won't and it'll be a complete waste of your time.
7. Have fun. You may never get to experience being in the OR again, so try to make the most of it. This is especially important to remember towards the end, when you're completely burnt out.

Despite the fact that it wasn't too bad... I gotta say, woohoo!! My two (supposedly) most difficult rotations of medical school are behind me. Now I get a relative vacation with 2 weeks of pathology before starting OB/GYN, something I have no interest in, but at least having a baby on the way will somewhat have me caring.


And remember, Jesus is with you... though he'll definitely get yelled at by the scrub nurses

You know you're a racist when...

you have to tell people how many black friends you have.

Here's what a justice of the peace in Louisiana said after refusing to give a mixed couple a marriage license:

"I'm not a racist. I just don't believe in mixing the races that way," Bardwell told the Associated Press on Thursday. "I have piles and piles of black friends. They come to my home, I marry them, they use my bathroom. I treat them just like everyone else."

Wow! He must really not be a racist, if he thinks that black people are clean enough to use his bathroom.

Liberal Swedish Bastards

This happens every year. The Nobel Prize goes to some undeserving person for political reasons. It's all a left-winged conspiracy and a big F-U to George W. Bush. I mean what has Willard Boyle done to deserve the Nobel Prize?? Nothing. Sure he invented the CCD, but isn't it a little premature to be awarding him the Nobel Prize? What do Willard Boyle and the psychotic, and (possible) cat-killer Erwin Schrödinger have in common? They both won the Nobel Prize. Clearly it's a sham.

Every year it's the same... Yoichiro Nambu, Peter Grünberg, John C. Mather, all liberal hacks who have gotten the Nobel prize only because those liberal elitists at the Nobel Foundation want to give a big middle finger to George W. Bush.

Surgery

In medicine, you barely have enough time for TV. In surgery, you barely have enough time to eat and sleep. Not for me.


Although taking this monster out of someone's neck is pretty cool

The end of internal medicine

Well, at least the end of it for me (for now). Wednesday was my last day of the internal medicine rotation and the last two days were the end-of-rotation exams. The rotation itself was actually pretty fun. There was some waiting around not doing anything and there were times when I felt pretty useless. But, overall, I learned a lot, saw a lot of interesting cases (and a lot of not so interesting cases), got to feel like I was the part of a team taking care of people, and got a chance to get to know some interesting people.
Do I want to go into internal medicine? It's hard to say since I only got to experience what life is like for hospitalists. I only saw the specialists tangentially. I wouldn't want to be a hospitalist (things are too hectic and once you see something interesting, you call a specialist). However, from what I saw on the wards, infectious disease and rheumatology appealed to me the most. There is a lot of detective work in both of them and a diagnosis could quickly lead to an effective treatment (Interestingly, these were the two fields that I felt I was the worst at when it came to exam questions). Radiology is still at the top of my list, but going through a more patient-based rotation does make me consider other options. We'll see as the year goes by.

Some advice...
- enjoy your time, at least with my experience, there really wasn't any pimping. There's no reason to feel stressed.
- don't let your first few days' experience set your mood for the rotation. Every time you have a change there is some awkwardness and confusion. It will also take a few days for your team to get warmed up to you. You'll find your place soon.
- don't feel like you have to stay on the wards forever. If someone tells you to leave, leave... it's not a test. You've got a lot of studying to do, and everyone on your team understands that. If nothing is going on, ask if there's anything you can help with, the answer will be "no", and you could leave.
- Spend extra time with your patients. You've got the luxury to actually spend time with your patients. If they're up for it, spend some extra time with them. The more you know about your patient, the better resource you are for the team (plus, the patient will trust you more than the rest of the team, if they've made a connection with you).
- If your school allows it, try to get some experience in a different hospital. It'll give you a better idea of what's constant and what's variable in internal medicine.
- prepare to feel defeated if you're taking the SHELF (nationally standardized) exam. Holy crap the SHELF exam sucks ass. None of my studying prepared me for that test. Even knowing what the exam was like, I don't think I could have effectively studied for it. It is not a good assessment of how much you've learned on the wards. I've never came out of an exam seriously thinking that there's a possibility I could fail until now. Luckily, everyone else in my class felt the same. And from people who have taken it in the past, the results end up being better than you expect.

Now I get a whole weekend off before Surgery starts on Monday. I start with ENT, then have Orthopedic surgery, followed by a month of general surgery.



Old song, but it's been stuck in my head ever since I saw a patient with Wenckebach heart block last month

Informed consent preventing testing?

I recently saw a patient that had pneumocystis pneumonia - an infection that pretty much only occurs in immunodeficient people and is an indication for HIV testing. In many states written consent from the patient is required prior to HIV testing. Consent prior to HIV testing dates from the late 1980's when HIV was a new, stigmatized disease that was essentially a death sentence. States enacted laws to protect patients from health care workers testing them for the deadly disease without them knowing. Now, however, HIV is a treatable disease that, if caught early could allow the patient to live a relatively normal life. The greatest barrier in decrease of HIV-related mortality and the decrease in the spread of HIV is knowledge of HIV status. There was a recent study in the American Journal of Preventive Medicine that showed that states with a written consent law have a decreased rate of HIV testing than those without. And another study showed that the cumbersome requirement for obtaining written consent from the patient has discouraged physicians from performing HIV. I personally think that that HIV should not be singled out as requiring written informed consent prior to testing (I think it continues the stigma associated with HIV). Either all testing for sexually-transmitted or blood-borne infections should require written informed consent or none of them should. But, it's pretty bad that physicians are avoiding the test only because they have to obtain written permission from their patients.