Out of the Forest

Second semester done.  Boards looming.  No longer walking into the forest.  Running terrified out of it.

That's Pure Hell

Another week in the record books; another system completed.  Today marked the final exam of the reproductive system.  I'm relieved and quite tired.  Sleep beckons but I've got a story to tell...

This Is Probably Going To Sting.  I Mean Really, Really Sting.  Badly.

This week, all the students did a male genital exam.  This consists of doing a physical inspection of the genitals, palpating the testicles for masses, feeling for hernias with the old "turn your head and cough" maneuver, and the prostate exam.  For these male and female genital exams, the school hires "patients" who are compensated for their time in helping further our education.  Let's just say that these folks come from various walks of life: some are dedicated to helping us learn, others are on tough times and need the money.  Regardless, it's a pretty unique thing and, for sure, is one hell of a tough way to make some money.

When it was my turn to go, I was grouped with two other students and a preceptor who would oversee the process.  We walked into the room and saw our patient: a young man in an exam gown, a little nervous looking. He was pretty fit and looked like he'd seen some scrapes in his life as evidenced by some visible scars and plenty of tattoos that covered his arms.  He reminded me a little of a down-on-his-luck Manny Pacquiao.  Behind us on the counter was a box of gloves, a few tubes of Surgi-Lube, and a paper towel with a huge mound of gel (similar to what you might see when you're preparing to insert a catheter).

After a little chat, the exams began.  The first student started out, asked the patient about his health history, did a fine job with the exam, and was cruising with no hiccups until it was time to do the digital rectal exam.  He grabbed a tube of lube from the counter and fumbled with it a little while trying to get it on his fingers.  To make matters worse, the patient wouldn't quite bend over far enough on the table to allow for a easy exam.  (Honestly, can't say I'd blame him.)  Undeterred, [student 1] continued and the patient did his best.  Prostate examined, hands washed, sighs of relief sighed.

The next student moves in to the repeat the exam and, as expected, sort of built on the what we've just seen by incorporating feedback in real time, if you will.  He was very precise in his exam and his technique.  When it came time for the prostate portion, he turned to the preceptor and asked if he should just use the lube on the paper towel.  The preceptor gave his approval and the student easily got his finger lubed up and ready for the exam.  He asked the patient to bend over and, confidently, began the exam.  As he conducted his exam, [student 2] asked the patient to relax and tried to reassure him.

As I stood there with the first student, I noticed that the patient's toes had curled under his feet, and that his hands had clenched the table, and that his arms were quivering.  Truly, his feel had curled up so damned much that I though [student 2] was going to be wearing Dorothy's ruby slippers.  We looked at each other for a split second and the first student asked the patient if he was uncomfortable or if he was doing okay.

"I think ... it's ... alcohol," the patient said through gritted teeth.

Everyone in the room gasped and blanched, including the second student who, by the way, immediately ended the exam.  We all leaned over the paper towel on the counter and smelled the mound of hand sanitizer on it.  It was never lube!  Someone had prepped a bunch of hand gel and left it by the lube ... while we were doing prostate exams.  Needless to say, we apologized profusely and asked if he needed some time to go wash up or if he was still in pain.  He said that he was fine and that we should continue.

"Holy crap, this dude is prison strong!" I said in my mind as I gloved up.

I will admit that it's a hell of a thing knowing that you're batting cleanup and having to do another exam on a patient who's just had a bolus of Purell introduced into his rectum.  During the genital exam and hernia check, I talked with the patient while explaining what I was doing on the exam.  When I asked him about the prior hernia that he mentioned, he pulled up his gown to show me the scars on his chest from the repair of a surgical hernia after he'd been shot.  "Shot," as in "with a gun."

"Damn," I thought, "[student 2] is gonna get his ass killed tonight."

When I got to the prostate check, I made sure to grab the tube of the lubricant and apply a liberal amount.  I did the exam, discarded my gloves, and, with the other students, thanked the gentleman profusely for his time and involvement in our education. We offered our most sincere apologies and left the room.  He mentioned that it was like something from SNL and told us his nickname as we were leaving.

After our debriefing session with the preceptor, the three of us students walked, shell-shocked, back to our study carrells.  [Student 2] remarked about how I charmed the guy and how we were best buddies by the end of the exam.

"It wasn't that hard, really.  All I had to do was not put a handful of Purell in his ass and we were buds."

It really is the simple things, isn't it?

Dr. D.R.E.

Class continues to progress.  Board exams relentlessly approach.  In a few months, I'll be in the hospital on rotations.  This journey seems so far from where it was when I quit work some years back and began this endeavor.  As I'm in the midst of what is the craziest bit of studying that I've experienced, I've not written very much lately.  Do, however, feel free to check out Scholarly Photos, a photo blog that I've created to provide some creative outlet in lieu of writing.  (See the links to the right; you'll know the one.)  I look forward to posting more regularly in the near future.  In the meantime, please accept the following yarn as a down payment on future posts.  
-- The Scholar


Yesterday, I shadowed a doc at an Urgent Care clinic.  In the past, I have been stunned at the variety of things that I've seen, amazed at her prowess in diagnosing and treating, and thrilled at what I've seen.  Late in the day, we saw a patient who presented with prostatitis.  We took a history, did a physical exam, and asked him for urine.  The doctor got a gown for him and asked him to change into it because we'd need to do a rectal exam.  Pretty cool, I thought, as I walked out of the room.

A few minutes passed and, during a break, she asked me if I'd done a rectal exam.  She asked if I wanted to do this one.  I let her know that I'd never done one but I'd love the opportunity as it would be a great learning experience.  As we went back into the room, I was pretty amped from the adrenalin and anxiety.  Like a hawk, I watched everything she was doing.  She asked the patient if he'd allow the student to do the procedure as a learning experience and he consented.  Immediately, I threw on some gloves and was overcome by a sudden urge to roll my freaking sleeves up as far as I could get them.  Seriously, if I was wearing a muscle shirt, the sleeves still wouldn't have been up high enough.  No worries, I was going in!

The doc gave me another quick demonstration which I pantomimed in the air.  I can only imagine the look on the patient's face as he overheard me repeating everything; poor guy must've been mortified.  Next, the doc and I tried to put a dollop of lubricant on my finger.  Turns out, the tube of KY was nearly empty.  Honestly, it was like fighting to get the last bit of toothpaste out of tube that should've been thrown out a week ago or, more specifically, exactly like someone nervously trying to get adequate lube on their finger before doing their first rectal exam on a patient.  Once successfully prepared, I approached the "entry zone," began the exam, and did my best to act out her instructions, being careful to try to listen with my fingers for any abnormalities.

After, I ditched my gloves, maintained my professionalism while I left the room, and, grinning, washed my hands as furiously as Lady MacBeth.

In addition to that patient, I helped suture a hand laceration, removed an embedded foreign body from someone's eye, did a few physicals, practiced OMM on two patients (a respiratory case and a shoulder rehab), and saw a bunch of sick kids.

My day was awesome.

I.  Love. Medicine.

New Neighbor, Same Old Crazy

So much to share, so much has happened. First, however, the most recent gem...

Several months ago, my crazy upstairs neighbor moved away.  Since then, things have been, frankly, far less crazy.  Don't get me wrong, it's a good thing.  In fact, it's a great thing.  The new tenant is a pretty nice guy.  He's an older gent who's renting the apartment while he's in town for some continuing education courses related to his job.  In start contrast to the previous tenant, Batshit McCrazy, he's a friendly, "with-it" kind of guy.  On numerous occasions, we had conversations outside.  He's got a knack for remembering who the hell I am and what it is that I do.  To top it off, he remembers Winning Run and a bit about her as well.  I suppose that he's just a nice guy who enjoys conversation.  Anyway, it's a nice change from the previous who, each time she met you, seemed happy to be meeting you for the first time.

Last week, on the eve of the President's Day weekend, I was packing my car to head to Seattle to see Winning Run.  As I'm putting the last bag inside, I see him walking across the parking lot toward his apartment and say "hello."  We begin to talk.  After a short while, the conversation drifts toward current events and to the upheaval in Egypt and other countries in the vicinity.

"It's pretty crazy what's going on over there, right?," I asked.

"Yeah," he said.  "It's a mess.  We need to watch out."

"Tell me about it.  Oil prices are going to go through the roof," I offered.

"Uh huh.  We need to be aware of what we're doing; they're watching," he explained.

"Yeah, we use too much oil.  I guess the government does need to watch out.  We need to wean ourselves off of it, don't we?," I offered.

He looked a little puzzled. "Government?  No, man, the UFOs are watching us."

[Silence.]

"Huh?," I asked, unsure of how we moved so quickly from unrest in the Middle East to extraterrestrial monitoring of our affairs.

"Yeah, they're out there," he exclaimed while pointed toward the horizon.  "I seen 'em flying.  I know planes and what I've seen are not planes."

"Okaaayyyy," I said while trying to put on my best poker face.

"It's started back in World War II when we built the bomb and brought all the Nazis over to work on the space program.  We had the power of death, the bomb.  They started watching."

"Really," I said, moving toward my door.

"I've got friends who work for nuclear power plants.  Sometimes the guards will go outside and see their ships hovering outside.  Sometimes they shut the plants down, just turn 'em off, to let us know they're watching us."

"Guess we'd better behave, then," I told him.  I wished him and good evening and ducked into my living room.  "Well, that got effing crazy really, really fast," I said to the emptiness.

My favorite part of the conversation was how he looked at me like I was the crazy one for suggesting that the government, not aliens, were watching us.  Priceless.  And completely, utterly wacko. 

Long live Batshit Crazy McGillicutty..

Maybe It Isn't Really About The Baseball

A few weeks back, I commented to my classmate that I'd noticed a bunch of young guys in the town wearing Atlanta Braves apparel.  Being so far from home, when someone sports a hat or jacket from my hometown team, it's my first impulse to shout "Go Braves!" at them, or at the very least, to introduce myself and chat with them.  Hell, Winning Run and I did the same to some people in Seattle who were decked out in UGA gear one Saturday in the fall.  They were pretty friendly.  For some reason, however, I've been hesitant to do the same with the folks I've seen around town here.  "I'm pretty sure that these guys aren't baseball fans," I mentioned to my buddy.

Which brings me to today's lecture about gangs...
During what was an informative lecture about gangs that included several cringe-inducing security camera videos of homicides and assaults, I connected a few dots.  (Those dots, by the way, were not about why we were having this particular gang discussion as part of our medical school education. It was informative, engrossing, terrifying, and heartbreaking but lacked the ties to medicine that I would've preferred.) A local faction of major gang sometimes leaves graffiti tags using a three letter abbreviation or numerical equivalent. The officer giving the lecture mentioned these numbers. Immediately, I recognized them as an area code from the Atlanta area.  Then, I made the leap to Atlanta apparel.  When I asked the officer about this connection between the "area code" and MLB clothes and hats, he responded as if it were a novel idea to him.  "I guess they could be doing that.  It fits.  We'll look into it," he told me enthusiastically.  "Considering that I've seen more Braves gear out here than I did back in Atlanta, that might be a good idea," I said.  Then I returned to my seat and planned what I would say to the crowd when the mayor inevitably presents me with the key to the city.

In other news, I'm glad that when I saw the first of these cats, I didn't start yelling and doing the Braves chop ... or running through my pitch signs.  They might not be as nostalgic as I am for the Sid Bream slide.

Twenty Eleven

To ATL and Back

Best Christmas Card Ever

Winning Run and I never got it together enough to send out holiday cards this year.  We aiming for a "Happy New Year" card.  That's our plan.  She did, however, give me a fantastic Christmas card that incorporated a photo of a snowman I made for her and recent events.  Photo and card below...

The rare 4-globe snowman.

Winning Run's hand-drawn card, for the win.

Southern Snowpacalypse 2010

Early on the 25th, Winning Run and I hopped a flight back to ATL.  Our original 6am departure had been canceled by Delta supposedly for the weather but, in my opinion, to consolidate less than full flights into ones more profitable.  The people watching on the flight was pretty good.  The "My Love" lady whose children sat across the aisle from us was priceless.  We overheard her say "Now I can't sit with you, my loves, because I have to sit with daddy.  You stay here and behave, my loves.  Mommy will check on you."  Then, she waddled four rows up and wedged herself into a middle seat with her husband, leaving her 8 and 4 year old kids alone to do as they chose.  To their credit, the kids were pretty good.  As a result, "My Love" lady visited only a few times during the flight but each visit was a precious Christmas gift to Winning Run and me.  At one point, she stood in the aisle bent over her brood, her ass inches from my face, and started doing hip stretches.  I managed to cry a single tear and whisper toward Winning Run: "God bless us all, every one."

When we touched down in ATL, snow was falling and, I'm certain, all the milk, bread, batteries, and kerosene in the city was in very short supply.  Thanks to the Duke's expert driving, we made it to Winning Run's family Christmas dinner and gift exchange extravaganza.  Their place was coated in about 3 inches or so of wet snow.  News outlets reported that it was the first White Christmas in Atlanta since the 1880s, I think.  The evening was great but traveling from SEA to ATL was quite tiring.  When I turned in to bed that night, I fumbled in the dark looking for the bedroom light switch.  When turning on the light, I was greeted by a doll lying on the bed, staring at me, peering deep into my soul.  Although it was my mother-in-law's dear childhood plaything, the damned thing scared me.  Even worse, I awoke during the night and it was on top of me, eyes glowing red, whispering a Latin incantation; I peed the bed, fought it off of me, and went outside to sleep the remainder of the night in the snow.

The SoulCatcher 5000

A few days later, we went to visit my parents and share some time with them.  While there, I did a bunch of OMM treatment on my mom and it seemed to help her out; guess I'm learning something.  :)  We even managed to catch up with a bunch of friends and share some beers at a local watering hole back home.  It was too brief visit but I'm glad we went.  Sometimes, just being around those people who really know you can be a great boost for the spirit.

Winning Run's Fist vs. the Mouth of a Teenager with Braces*

*The following story has been invented to add intrigue to the details surrounding Winning Run's accident.  It is not true.  For the true story, you'll need to hear it from Winning Run herself.

The other night on the bus back from the Picasso exhibit, some rough looking teenager on the bus kept mouthing of at us.  Really harassing us.  We moved seats a few times to get away but the kid just kept it up.  After an eternity, we reached our stop.  As we were exiting the bus, the punk reached at Winning Run's bag.  Naturally, she jerked away and the punk started swinging at her.  She clocked the idiot in the mouth but the punk's braces cut her hand.

We made a quick to the ER and got her stitched up.  Meeting with a hand specialist later today to ensure that no tendon damage occurred.  Personally, I don't think it did.

And now, some action shots from the hospital...

 Pre-stitches.

 Irrigating the wound.

 

Post-stitches. Yum.

3 Semesters In and All is Well

Late last week, I wrapped up my third semester of medical school.  In retrospect, it's pretty hard to believe that it's gone by so quickly.  Actually, some weeks last what feels like months, hours become says, fifteen minutes is enough time to accomplish so much.  Other weeks, however, fly by so quickly that I seem to move in slow motion while everything speeds by me.  So, there's that.  Time is elastic; it moves quickly and slowly but rarely constantly.

Next semester begins in January and brings with it a maddening push through remaining subject matter, toward the boards.  Then, in July, I'll begin rotations in the hospital.  Insane.

For now, however, I'm going to enjoy a few days under the same roof as my wife, studying less than I should.

It's a Little Less Funny Today

In 1982, after each episode of "Police Squad" aired, I'd get on the phone and call my grandmother, "Bamba," to discuss it, relive it, and laugh about it even more.  At this point, I don't even remember all of the gags on the show but I'm not sure that it matters.  (They've been recycled time and again through all of the "Naked Gun" films, anyway.) I do remember the two of us in hysterics about the shootout between some miscellaneous hood and Frank Drebin, each taking cover behind trashcans no more than two feet apart. That scene really killed us; I mean it just brought us down, made us laugh until we cried.

So, I guess I owe those memories to a short-lived television show starring Leslie Nielsen.  The measly six episode run allowed a 9-year-old kid to get on the phone with his grams and to just laugh it up, to be fans, to be lovers of slapstick, goofy comedy.

Thanks, Mr. Nielsen. Rest in peace.

Hands Off The Chic-Fil-A

As I was getting into bed some time after Winning Run had gone to sleep, she announced in a whispered voice "I just invented a game called 'Hands Off the Chic-Fil-A.'"
"That sounds pretty interesting," I told her.
"Yeah.  I'm not exactly sure of the rules, though," she replied.
"Well, I can think of two of them," I offered.
And, with that brief exchange, she was back off into her dream, a magical land full of games played with delicious Chic-Fil-A sandwiches.

So Long To Pinky, Here Comes The Thumb.

...and it's nearly December.  Seriously, I cannot cannot cannot believe how quickly the time has flown since the semester started.  We've completed Cardiovascular, Respiratory, Renal, Hematology/Oncology, and looking to wrap up GI in the next few weeks. Here's a very, very brief recap of some of the goings-on since my crazy-assed neighbor decided to rappel from her balcony on Christmas lights...

I'm a Professional Twice Over

For Halloween, several of us decided to dress as the cast of Arrested Development.  The "costume contest" took place during a pot-luck luncheon at school prior to an interactive session.  I went as Tobias Funke.  Initially, I dressed in cords, a funky shirt, and Birkenstocks but quickly stripped down to "never nude" attire.

David Cross as Tobias Funke

from "Arrested Development"

After winning the costume contest, I attended class in costume.  I must say that being mostly naked in class (and being called on to stand and answer a question) was as near as I'll get to realizing the recurring nightmare of being in class naked.  My wife was so proud, she cried tears of "joy" as she tried to remove her wedding ring.

The Best Week of Medical School I've Experienced

As part of our clinical skills training, we worked an emergency case on a simulated patient or Sim Man.  The whole thing was pretty intense as, despite our efforts, it desaturated and was transported to the ICU after we intubated it.  Still, I walked away from it thrilled to be a medical student and anticipating the applied practice of medicine instead of the didactics.  Later that week, I passed my tests with flying colors.  Generally, I felt pretty good about myself and my performance as a student which, based on how the semester has gone thus far, has been a pretty fleeting feeling for most of my classmates.

Snow-Drive

A couple of weeks ago, I went to Seattle to visit Winning Run and accompany her to a dinner party hosted by a coworker friend.  I applaud wonderful food and great conversation but, shit, dinner parties should be fun and not so damned serious or pretentious.  At first, I thought we wandered into some sort of liberalism pissing contest that delved in and out of "foodie-ism" which, by all accounts, can be equally pretentious.  Luckily, libations seemed to loosen everyone up, make the gang more approachable, and the conversation a little more organic and natural.

The next day, at Dick's Drive-In, Bill Gates pulled into the parking lot and stood in line behind us.  This is the absolute, honest truth.  We noticed him, confirmed that it was him, and decided to just let him have a little peace.  Plus, I was convinced that had I attempted to speak to him and shake his hand, a sniper would've taken me out on the spot.

Once again, I was reminded that I'm no longer in the southeast with my drive back from Seattle.  I had to go by chains for my car to get over the pass and had an amazingly terrifying drive (for me).  After getting over Snoqualmie Pass, the rest of my drive was spent in blinding snowfall with accumulation on the road.  In the silence of my car, I kept repeating part of a Samuel Jackson monologue from "Pulp Fiction," telling myself aloud that I was like a little Fonzie:  "And what's Fonzie like?" "He's cool?" "That's right, he's cool."
On successfully making it back, I noticed that my ass had been clinched so tight that I'd drawn up my seat into a permanent cone, an inverse vortex, a physical sign of my stress.

Thanksgiving

Winning Run made it in on Thanksgiving morning.  That afternoon, we had dinner with several classmates and their families.  In all, it was pretty fun and nice to be away from the books for a little bit.  Now, it's just a downhill slide to holiday break before the uphill climb to the work of next semester, boards, and rotations. Yippee.

Batshit Crazy McGillicutty Escapes A Wintry Grave*

*By a "wintry grave," of course, I mean that temps are expected to dip overnight into the mid-30s.

Preface: I now live in an old apartment with a crazy-assed landlord and, other than the two other medical students I have as neighbors, a motley assortment of peculiar tenants. My upstairs neighbor, who's name I cannot remember -- and never will because the rules of decorum dictate that far too much time has passed to ask her (a misdelivered parcel is my best hope for insight) -- anyway, whenever I see this neighbor, she always asks if she's making too much noise. I politely tell her not to worry because I'm not home too much, that I'm often on campus studying. We share a little polite, if awkward, laughter because, truthfully, she's exceptionally loud and she knows it and because I feel too bad about forgetting her name to be honest and tell her that I think she should practice her godforsaken Irish dance at a time later than 5:30am. After the awkward laughter that trails into an even more awkward silence, she'll ask a little bit about medical school, about Winning Run, about my dog. Wash, rinse, and repeat the exchange almost verbatim the next time we bump into one another which is typically about every two weeks. The last few times we've spoken, I think she's been especially sauced as she's been a little more emphatic than normal (and slurring her words a little) about being sorry for the noise. I've been a little shorter with her because, well, it's a charade with which I've grown tired. For the love of all things holy, you make noise; it's a crappy old apartment, it goes with the territory, so, when you see me, please just smile and say "hello" or nothing at all. In summary: she's kinda* crazy (by "kinda" I mean "without a doubt, full-on, batshit crazy"), a semi-cougar, a lush with a boyfriend, a live-in daughter, and sometimes a granddaughter, who does laundry every day, and loves, loves, loves Irish dancing or clogging or jumping jacks at all hours of the day.

So, with the back-story complete, let's step back in time to an hour ago...

I was in my office with my headphones on and the door shut trying to settle into a study groove for the evening. As the temp has been getting pretty brisk overnight, I'd been closing the doors and using a space heater to warm the rooms instead of turning on all the baseboard heaters. So, I was in the office doing my thing and hanging out with Dylan who's with me while Winning Run wraps a major deadline on her project. All of a sudden, Dylan freaked, got really agitated, paced, and kept staring from me to the door and back. When I took off my headphones, I heard someone pounding on my door. It wasn't the forceful pounding knock of an authority figure but something, I don't know, a little crazier but just as urgent.

On taking a few steps into the hall, I heard a voice pleading for help, for me to open the door. Naturally, my adrenaline went through the roof. Then, I realized that it was from my back door and not the front like I'd expected. It was a woman's voice; my upstairs neighbor, I thought. As I pulled back the vertical blinds, I was a little freaked out by what I might see. To my surprise, I saw my neighbor in her sock feet, jeans, a fleece standing there beating on my sliding door, still pleading for me to open it.

I cautiously opened the door a little.

"Oh thank God," she said. "I've been locked out on my deck for two hours. I'm freezing, I can't feel my feet."

"What? You've been locked on your balcony?," I asked. "How'd that happen?"

"I went outside without my phone or my keys and I got locked out. I've been out there for two hours. I'm so cold. I was yelling for help and throwing stuff down to get your attention."

"I've been in my office on the other side of the apartment, with my headphones on studying. I thought you were just moving furniture or something."

"I was throwing all sorts of stuff down and yelling for help."

"How'd you get down?," I asked.

"I through about throwing some concrete through my sliding glass door but I ended up using my Christmas lights to do a MacGyver and climb down."

"What?" I leaned forward to look past her and, sure enough, a single strand of Christmas lights hung there limply, a remnant of a seemingly festive escape. "You climbed down on that?"

"Yes. Oh my God, I'm so cold. I can't feel my feet. I think I have frostbite."

"I'm pretty sure that you're gonna be okay," I offered. "I think that, for frostbite, it's got to be pretty cold, like below freezing."

"Really?"

"Yeah, you'll probably make it," I assured her. "Now, how the hell did you get locked out by the sliding glass door? It's got a thumb latch on the inside."

"I don't know, it just locked me out. Can I use your phone to call someone to bring me my keys?"

"Sure."

I got my phone and let her make a couple of calls. Her lifeline tonight (other than the Christmas lights) was her recently (like a few hours ago) ex-boyfriend. I offered to make her some tea to help her warm back up but she declined.

"You must think I'm crazy. I mean, really, who does this?"

I pondered my response for a minute.  "Ahhhhh...well, I'm just happy you didn't hurt yourself when you climbed down." (Why, yes; yes, I do think you are a big bowl of crazy.)

"I'm sorry to interrupt you. Just go back and study and I'll just stay here until he comes with my keys."

"Thanks but I'm just gonna stay here with you until he comes."  There was absolutely no chance in hell that I was going to go in the other room and leave her unattended.  Who knows what I would've found when I returned?  Hell, she probably would've managed to get herself inextricably wedged in the over-sized chair in my living room or to simultaneously shatter all of my picture frames.  So, I stayed in the room, maintained a safe distance, and opened the front blinds so that we could see when her spare key arrived.

"So, what do you do?," she asked. "I notice that sometimes, you're dressed in medical clothes."

Luckily, her near-fatal frostbite prevented her from seeing the look of disbelief on my face as this was a topic that we'd covered many, many times before. I had a sneaking suspicion what was on the horizon but I chose to play along.

"I'm a student at the medical school here," I told her.

"What are you studying to be?," she asked and she didn't mean what specialty.

"A doctor," I said.

"Oh, that's great."

"Yeah," I replied.

"I hope I don't make too much noise upstairs," she said.

"It's okay," I lied.

My goal was to get her the hell out of my apartment as fast as I could. Luckily, after ten or fifteen minutes of this, her newly "former" boyfriend arrived with her key. As I was going to open the front door for her, I turned to see her yell thanks and bolt right back out my sliding door, stumbling and nearly falling on her way out.

"What the hell just happened?," I asked the newly silent room.

And that, my friends, is why you should not do drugs or drink.

Stress Stress Stress Burnout Burnout Burnout

A blink of an eye and November is nearly upon us. Among other things, med school has been great for really making time elastic: in some cases you can do a world of things in fifteen minutes; in others, months rush past unnoticed. So it is. I'm closer to the end of this semester than I am to the beginning of it.

Honestly, I have no idea where the time went. Quite literally, I feel like my face has been shoved in a book since the semester started, frantically trying to coax the words from the page and into my memory. Anyway, it's now October. Post-season baseball. College football. Crisp, cool mornings with amazing amber light that makes you miss your grandparents, miss being a kid.

Tomorrow, I'll take the last test in our renal system and, in doing so, try to illustrate that I know a little bit about renal tumors, treating hypertension, acid-base disorders, identifying stones, proteinuria, and maneuvering the choppy waters of anti-hypertensive medications. (These among other things.)

I feel like a stranger to myself, to my family, and my close friends. This weekend, I'll head to Seattle to see Winning Run and try to be a normal cat for a few days. Perhaps in jest, a classmate sent the warning signs of burnout to the class. Rather than run down the litany of signs, it should have a single requirement: second-year medical student. Seems about right.

Back to the grind...

You're Talking About a Song?

In a brief respite from studying for my upcoming Renal exam, some friends and I went to hear one of our classmates perform a local venue.  We grabbed some drinks and a spot and listened to her set with a ton of students from the 1st year class.  We were chatting with one of the 1st year students when, randomly, he asked if we liked masturbation.

"Sure, man, I'm all for it," I said. My friend SJ piped up that she was also a fan.

"Yeah, it's a pretty good song," he replied.

"Oh, you're talking about a song..."

"Yeah, 'Masturbation' is one of her songs," he offered.

"Don't know it," I admitted. "Never heard it."

He looked a little perplexed but said, "You'll know it's the song when you hear something really uptempo."

"And you'll know it's the other if my hand is in my pants," I said.

He looked like he was about to say something else before he thought better of it and just turned around.  Conversation over.  What can I say, I'm a winner.

Aside from that comedic gem, nothing else is happening or has happened other than a ton of studying.  Tomorrow is my first exam covering the renal system.  I have tons of stuff to get through in advance of the test.  As I didn't see Winning Run over the weekend, one of the little bits of joy has been getting Hipstamatic for my phone.  Here are a few shots:

 The view from my desk.

A car hit the house across the street in the middle of the night.

Hops field at sunset.

Sunset from my apartment.  Mt. Adams is in the distance.

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.