Congrats, You Aren't Having a Heart Attack

Just walked out of a practical exam in which we are handed a clinical vignette and must tell our attending physician what treatment approach we'd pursue and, afterward, demonstrate a manual medicine technique on our partner.  The scope included cardiopulmonary cases with specific treatments aimed at helping to alleviate a hypersensitive parasympathetic or sympathetic influence on the heart, edema, and cough.

On my second case, I was reading the vignette and avoiding the piercing stare of my attending.  During practicals, he's completely stoic and poker-faced and, frankly, I get a little flustered.  After what seemed like an eternity, I decided that my 14-year-old fictitious patient had a viral infection and had an inhalation dysfunction of the ribs that was impeding the biomechanical aspects of getting full excursion on inspiration.  I stammered my way through my rational about why I thought the patient was medically stable in order to proceed with my course of treatment of the ribs to assist breathing.  I listed a few reasons for why I didn't think he was having a heart attack.  At the end of my list, the attending says "...and he's fourteen." This, of course, is in addition the fact that nothing in the vignette remotely suggested MI.

I turned to my partner and said, "Congratulations, you aren't having a heart attack."

Next stop, big test block tomorrow which marks the end of the respiratory / pulmonary system.  Gonna spend a ton of the night and tomorrow trying to get cancer presentation, genetics, staging, treatment, and microscopic identification into my brain.  (In addition to pulmonary embolism, deep vein thrombosis, occupational pneumoconosis, pharmacological treatment of asthma, various other "bugs and drugs.")  Woo hoo. 

Seven

I'm so much luckier than anyone has a right to be.

"Like melted gold."

Thanks, Winning Run, for taking this crazy ride with me and being the pillar that holds me up.  I absolutely, positively could not do this without your support.  I'm thrilled to be part of the pack.  

Thanks for seven amazing years; I look forward to many more on our adventure together.

It's the New Normal

A couple of weeks ago, as I drove to Seattle to see Winning Run, I phoned a college roommate to catch up with him.  Some years back, he moved away from Atlanta and started a family and pursued his career.  Unsurprisingly, time, distance, and the general pull of life's direction prevented us from talking as much as we should've.  Over the past year, Drewbie has phoned me numerous times and just left voicemails to say something like "Hey buddy, I'm thinking of you.  I know you're working hard; keep it up."  What's uncanny about it, is that he'd always call exactly when I needed most to hear a familiar voice, to get a brief pep talk, to have some unsolicited, unconditional support.  I can't tell you how much these little nudges worked to get me over each hump.

During our conversation, he was telling me about what's been going on in his life with some familial health scares.  As much as I'm overwhelmed by school, in the grand scheme of things, I have absolutely nothing about which to complain; things are pretty much OK with me. 

As we closed our conversation, I told him that I wished we could talk more frequently and that the frequency of our conversations don't reflect my affection for him.  To which he replied something like, "Hey man, I get it: you're in your 'new normal.'  You don't have the time to call.  Your normal is that you don't have time.  That's okay, I get it.  I'm just happy to talk to when we can. When I call, it's just to let you know I'm thinking about you."

Here's to the "new normal" and the practice of deferred gratification.

Sometimes You're a 1998 Mercury Sable ...

... and sometimes you're the fresh hood ornament.  Here's to being the Mercury Sable.

It would've looked better on a Thunderbird.

Tomorrow morning's test quickly approaches.  So far this week, I've managed to maintain my streak of being called on in each interactive session.  The week began with being first out of the gate in a pharmacology session.  You always want to be the first because the first question is typically easier than the subsequent ones and you get to relax for the remainder of the session.  Luckily, I answered the question correctly and proceeded to enjoy the hell out of the remaining hour and fifty-nine minutes of the session while some of my peers anxiously sweated it out.  Today culminated with my incorrect (or, rather, "non-indicated") answer of avoiding spicy and tomato-based foods as the most appropriate follow-up therapy for a particular patient with GERD.  Nice but no cigar.  Well, at the very least, I was thinking of a friend back home and using her to form an empirical plan of action.

Tonight, my plan is to get to bed at a decent hour (11pm? midnight?) and be back on campus at 6am for a final push into the test.  Then, after 70-seconds per question for about 140 questions, I'll be able to relax and do more studying.

La vida pura!

Well, Doctor, If You Must

In light of my less than stellar performance on last week's pharmacology exam, I dropped by to visit my professor to review my study habits and seek guidance.  Not only is he one of the most intelligent people that I've ever encountered (read: freakishly genius) but he's also got an amazingly dry sense of humor that he quickly and deftly displays. 

During our discussion, I told him how I'm studying with others, discussing the mechanism of action of the drugs, picking a prototypical drug in a particular class to learn, and, then, comparing the prototype's half-life, adverse effects, and contraindications with others.  Then, I mentioned that I'm striving to find other materials that would help me to quickly assimilate the information.  Like many other times, the gulf between what I aimed to say and what I said was wide, my friends.  Here's how the exchange occurred:

"So, Dr. _____, I'm really trying to quickly inseminate the information," I say confidently.
[Awkward pause.]
"Well, Doctor, if you must," he says with a half-concealed grin.
"I think I'll just try to learn the material, sir."

Once again, victorious in the ways of oration.

Well ..

Cardiovascular system exam is over.  Based on my previous pharm scores, I was thinking that I'd be able to prescribe Skittles.  Today, I am certain that if I tried to do that, someone would swat the damned things out of my hand and give me a stern look.  So, I'll be limited to making poultices, probably with mustard or eucalyptus. 

"That Sonofabitch Just Might Make It"

It's the week leading up to our second exam and everyone around me is equally haggard.  Last night, I got four hours of sleep and (actually overslept until 5:45).  Tonight, it'll probably be the same.  As I've intimated previously, I think the pace is pretty ridiculous and that the amount of info that's washing over us at any given hour is incomprehensible.  That being said (again), it's effing amazing what actually makes it into your brain, what you can actually learn when pushed.  It has, of course, been a week of peaks and valleys but, thus far, the peaks have been pretty cool.

Epiphany

Last night around midnight, my buddy and I were on campus almost ready to wrap up for the day.  We were reflecting back on a case study exercise that we'd done earlier.  (As a group, you and your peers are given info about a patient and must interview the patient for relevant info to complete a history, determine what lab values and physical exam findings are pertinent, identify areas for further assessment or diagnostic exams, and formulate a plan of action.  Then, you have between 60 and 120 seconds to provide an oral presentation of this information to the attending physician.)  Essentially, these studies are an integration of academic material, clinical scenarios, and the skills of speaking aloud to your peers aka preparation for 3rd year rotations.

So, last night we start talking the day's case.  A while later, we realized that, without any provocation, we'd been thinking and speaking like practicing physicians.  It was pretty cool; a step along the path to reforming my self-image into that of a doctor.

Go Suck It, Digoxin-Induced Hypokalemia.

Two interactive sessions today, both on Heart Failure.  This afternoon, I seemed to do much better on the questions: my rationale seemed to be based on some sort of reality and grasp of key concepts instead of how a third-grader might approach pharmacology.  When I was called on, I stood and correctly answered a question regarding hypokalemia as induced by a drug-regimen.  I went with my gut, stuck to my guns, and didn't look like as much of a clueless dick in front of my peers.
The Scholar: 1, Pharmacology: 248K.
I'm hoping this was my Dave Roberts moment. The crowd goes wild.  (By "crowd," I mean me.)

On To The Next One

" ... Don't be mad 'cause it's all about progression.
Loiterers should be arrested."

'On to the Next One' from Jay-Z's "The Blueprint 3"

Another week, another trove of insurmountable tasks to complete.  I wouldn't quite call them Sisyphean but it definitely feels vaguely similar.  After the last week of doing nothing more than studying, it should come as no surprise that this week is yielding more of the same.  As will next week.  And the week after.  For the foreseeable future.  [Sigh.]  It is, however, pretty damned cool.

Brush That Dirt Off Your Shoulder

One of the major learning experiences of second year, thus far, has been the attempt to become comfortable with standing before your peers and attempting to respond to questions.  You know, a whole "stand and deliver" routine.  In addition to learning the course content, we're being given the opportunity to become more comfortable with failing spectacularly in front of our peers.  This is a task for which I just might earn honors.  What can I say?  Everyone excels at something, right?

We've been given little remote controls called iClickers (the hottest technology of 1999) that we use to respond to questions during class for real-time tallying.  Prior to seeing how your peers respond, though, a student is randomly called to answer the question and, if you're really, really lucky, some follow-ups in front of your peers.  Luckily, I was called on during a Pharmacology session to answer a question involving the selectivity of a Beta-antagonist.  Being the exemplary pharmacology whiz that I am, I punted and guessed something that stuck in my head.  Wrong.  I looked to my peers who whispered the correct answer and called it out.  Wrong again.  I looked to other peers for more choices and tried to follow the prof's coaching. Wrong again.  After what seemed like an hour, I stumbled on the designated response and was allowed to return, licking my wounds to the anonymity of being a less-active participant in the lecture.

I am never going to earn a prescription pad.  Mark my words, I will be forced to "prescribe" Skittles to my patients.  If those don't work, we'll move to either M&Ms or Reese's Pieces.  The options are pretty much unlimited.

This Is War

Not that I'm finished collecting my thoughts about my first year or anything, mind you, but it's day 4 of the 2nd year and I'm feeling like I've been in the trenches for months.  All that bullshit "pie-in-the-sky" thinking that I'd be able to sneak off to see Winning Run in Seattle are teetering on the edge of the sinkhole that is being a med student. 

Seriously.  Day 4.  Monday.  Tuesday.  Wednesday.  Today.

In other news, I feel like I've learned a bunch in these four days.  It is stunning what you can learn when terrified / trying / overwhelmed / sleep-deprived / enjoying it.

More from the front lines, soon.  I promise.

Phound Photos

I finally looked at my SD card from Hawaii and the cross-country drive and stumbled across a few other shots that I like. 

Moon-rise over Manua Kea.

Some photos from the cross-country drive:

Dylan looking at corn fields, 80mph.

Sunset in Nebraska.

 

Dylan at scenic overlook.

Picking burrs off of Dylan's face after he hunted field mice.

How To Fail at Business (Without Really Trying)

A few days ago, we were in the park with Dylan and happened to meet some other dogs for an impromptu dog congress.  Turns out that one of the people there with a dog had a dog walking business.  It also turns out that we're looking for a dog walker to let Dylan out during the day and get him a little exercise.

We met the other dog owners and got a business card from the dog walker.  She seemed nice enough: sort of a hippie-type with plenty of wrist tattoos and unkempt hair.  About two minutes had passed after she gave us her card when we heard her suddenly exclaim:  "Where's my dog?  Have you guys seen my dog?  She was right here a minute ago..."

Everyone around started looking around for her dog and calling for it.

"She's across the street!," the dog-walker announced.  She instructed everyone to refrain from calling her dog.  As she ran across the road to her pooch, she kept telling it to stay there.

Winning Run and I made eye contact and pantomimed our disbelief.  We agreed to promptly lose her card.  She wouldn't be getting our business.

Manifest Destination

Last Thursday, we made it to Seattle after a fun four-day cross-country drive.  If you're ever driving cross-country with a pet, you'll be happy to know that all Motel 6 locations are pet-friendly.  You can, of course, find other places that are nicer and more expensive but it's comforting to know that this ubiquitous chain is there and will take you in for a modest little price.  Depending on where you stop, you might have to contend with their progressive, hard-hitting "No Smoking" campaign designed to stop anyone from even thinking of lighting up in the room.

What deters smoking more than an overturned ashtray with a sticker on the bottom?

Hard to say ... an in-room lighter, maybe?

Mostly, we drove 12-hours a day with exception of the 3rd day when we drove a leisurely 7 hours into Salt Lake to visit Big Mike, my college buddy, and his lady. We took in an outdoor concert, had a great time catching up with the two of them, and enjoyed the break from the highway. The next day, we woke, had breakfast, and pressed on from SLC into Washington.  Along the way, we stopped at a great overlook near Pendleton to drink in the horizon and let Dylan harass some field mice.

After a brief stay at my apartment near campus, Winning Run and I headed to Seattle to prepare for moving her into the apartment.  I knew that she'd like the place but it's pretty cool, if tiny.  A few blocks away is a great park on the shores of Lake Union with great views of downtown, loads of people flying kites, and plenty of seaplane watching.  Compared with the weather we left in Atlanta (100 degrees, 1000% humidity), the climate here is amazing (early morning temp in the 50s, afternoon high in the mid-80s).  Dylan loves it.

More pics:

 A windswept rest area in Wyoming.

Overlook near Pendleton, WA.

Dylan in the morning.

Dylan in the afternoon.

Cool kite at sunset.

All in all, it's pretty nice to be in a big city again.  I love the energy of it and the people in it.  After a year with my wife and dog on the opposite side of the country, I can tell you that having them in the same time zone feels like I've pulled off a coup.  It's freaking amazing.

Next, I'm off to move into my apartment and to hear about Winning Run's first day at hear new job.

Good Morning, America, How Are Ya?

In the immediate aftermath of finishing summer semester and passing my finals, I had little time to revel in the joy of officially becoming a second-year student.  Instead, I had to pack my things, move them out of my apartment, and get them into storage before I left for vacation.  As I abhor moving, it was only natural that I'd be spending the majority of my summer break moving myself into a new apartment, then going home and moving my wife across the country to Seattle. 

After an endless week, I managed to shove the last bits of my things (mostly the remaining 300 rolls of toilet paper from a Costco pack) into the storage bin and get the hell to Seattle onto a plane to Hawaii for a week of R&R with my wife's family.  I cannot explain how amazing it was to actually be in the same place as my wife for more than 48 hours.  Good stuff, indeed.  Two vacation shots:

Moon rise from the Joint Astronomy Center at Mauna Kea.

 

Waterfall at our lodging near Hilo.  

Swimming was great but the water was frigid.

After the vacation, I returned to ATL to help empty our house and, once more, drive across the country.  In case you didn't know, the housing market sucks for sellers and we were beginning to really freak out at the prospect of having an empty unsold house.  A few days before we left, however, we found some tenants for our place...big sigh of relief.  The rest of the time, we spent on the "Winning Run 2010 Farewell Tour" seeing friends, visiting family, and eating and drinking too much. 

We began our drive on the 11 JUL with our dog and hope to be in Seattle by the 15th.  Yesterday, we drove 700 miles and have stopped in central Missouri.

 

 Gateway to the West.

I gotta say that it's pretty damned strange and a little unnerving to be in a motel with your dog.  In good guard dog fashion, he's barked occasionally at strange noises which is followed by pleading cries of "Shh!!!! No bark!!!!" by the two of us.  Guess it's not like the first night in any hotel is ever restful, I suppose.

If You Look Too Far Ahead, You'll Trip Over What's Right Before You

On a short study break but thought I'd recount today's hilarity (so far):

Today, I have three finals:  Genetics, Medical Spanish, and a big ol' Path exam.  I rocked the Genetics one.  For the record, I have a degree in Spanish which makes me feel pretty good about my proficiency. My hubris has been increased by the fact that an overwhelming majority of my classmates are beginning speakers.  I quickly completed my Spanish exam, handed it in, and triumphantly strutted from the room to join my peers in the lobby in post-exam bliss. 

"Congrats on being done," I offered.
"Thanks, man.  You too."
"How'd it go?," I asked.
"Pretty well. I thought that one matching section was a little tough."
Silence.
"What matching section?," I asked.
"The one right before the anatomy terms."
"Come again?," I asked.
"The anatomy terms," he repeated.
"How many versions of the test were there?"
"Just one," he said.
"How many questions were on it?"
"Fifty."
More silence.
"I only did 30; I gotta go," I said as I literally dropped all of my stuff and walked away.

I tore back into the room, quickly explained the depths of my idiocy to the proctor, and did the remaining portion of my exam in five minutes.

Here's hoping that I'm more careful on the keystone exam of the day.

Worth a Thousand Words...

Three days left in the semester and, after, a little freedom* for a few weeks.  Meanwhile, I found another great visual metaphor for med school.



It never gets old.

It Takes an Ocean Not to Break

So, the afterglow of finals was ridiculously short-lived.  A few celebratory drinks were hoisted.  Then, it was off to the races to get to Valdosta, GA for Crazy Greg's (and, by marriage, "Crazy" Meg's) wedding.  Road construction had me miss the red-eye out on Friday night.  After taking the first-flight out on Saturday, I landed in ATL, dove into the car Winning Run had waiting, and sped toward south Georgia.  I arrived with enough time to put on my tux and rush to join the wedding party.  Seattle to Valdosta, GA with thirteen minutes to spare.  That's cutting it too close for comfort.

After the wedding, we hauled back to ATL.  I slept in my bed with my wife for a few hours before hopping a plane back to WA to begin the summer semester.  Now, I'm thoroughly embedded in the work of a few new classes and some remediation work for a few of the old ones.  And, for some reason, I thought that this semester might be a little more relaxing.  Evidently not.

To top off it all off, I came down with a horrible stomach flu shortly after arriving: up at 3am with projectile emissions from both ends for a few days.  Ah, what could be better?

Between all of the running around and stress and loose ends that I'm trying to tie, I've not had a true chance to reflect on the goings on from the year.  When the dust settles, if the dust settles, I share my thoughts.  Until then, some good news:  Winning Run was offered (and accepted) a job at her top choice of Seattle firms.  I'm really proud of her, my rock.

Ahhhh...

Yep, that's about right.

Now, for some celebratory libations and sleep before hopping a plane to GA for Crazy Greg's nuptials.

Well, That's a First....

Three finals left this morning and they're the biggies:
Physiology
Pathology
Gross Anatomy

Last night, got to bed around 1am.  Up at 4 to shower and make the final push. 

So effing stressed about these tests that, five minutes ago, I ran to the bathroom to wretch in the toilet.  WTF?

Living on Coffee and Flowers

Finals are in full effect.  So far this week, I've spent roughly 15 total hours at my apartment.  Rising around 5am, hitting the rack somewhere between 1am and 2am, and spending the hours between buried in books is taxing at the very least.  It sucks.  I'm exhausted.  I've miles to go before tomorrow's exams (and the remaining ones this afternoon).  This shit is medical school, is the best.

From "Conversation 16" by The National:

I think the kids are in trouble
Do not know what all the troubles are for
Give them ice for their fevers
You're the only thing I ever want anymore
Live on coffee and flowers
Try not to wonder what the weather will be
I figured out what we're missing
Tell you miserable things after you are asleep

Standing

Another day, I’ll sleep in a lonely, empty bed.  I won’t hear anyone breathing next to me, won’t move the covers to escape their body heat.  In the morning, I’ll wake at a ridiculous hour and will lumber unsteadily into the shower and let the warm water rouse me.  Standing in the kitchen alone, I’ll drink black coffee and eat eggs on toast.  The only sounds I’ll make will be the rattle of the dish in the metal sink, the resonance of the fork skipping around.  Before turning toward my desk, I'll take another long look out the kitchen window at the gray, wintry sky.  Perfectly, it displays how I feel: vast, uniformly barren, cold.

Still, I’ll take another sip of coffee, shrug my shoulders and sigh to slough off the loneliness, and bear down on another difficult day.  I do this for me.  I do this for us.