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. 

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.

Do I Even Belong Here?

Royal Tenenbaum: That's just not right, damn it.  You used to be a genius.

Margot Tenenbaum: No I didn't.

Royal Tenenbaum: Well, anyway, that's what they used to say.

From Wes Anderson's "The Royal Tenenbaums"

Another tough week in the bag and I am damned sure not going to be earning honors in any of my classes.  If I can't improve my performance, the only thing I'll be earning is a bus ticket back home.  What the hell, man, I'm not even halfway through the semester and I'm feeling like I'm running on empty, on fumes.  I'm burned out and tired of not passing exams.

Shit, I'm tempted to host a coloring exam where all anyone has to do is take a single crayon and color in a giant rectangle.  That's it, just fill in a rectangle with a crayon and, hell, just stay mostly in the lines.  Do it and you pass.  Bingo.  A+.  Honors.  Ticker-tape parade.  Confetti.  Bells.  Whistles.  Bullshit.

Last week, during a four day weekend.  I took about 8 hours to myself excluding the hours I slept, of course.  On average, I've been getting about 5 and a half hours of sleep a night.  I've lived in a study room on campus, coming to my apartment only to sleep.  I knew that yesterday's exams would be a challenge.  Hell, no matter how you approach it, Neuroscience is tough stuff; it's amazing but tough.  Immunology, too.  And OMM.  And Pharmacology.  All told, though, I didn't expect another "O-fer" day.  "O-fer" as in I was zero for four on passing anything.  Here's the best part:  I was absolutely sure that I was going to rock my Pharmacology exam.  Absolutely effing positive.  When I'd answered all the questions, I clicked the proceed button, saw that I'd failed miserably, and felt my countenance morph from a smarmy, shit-eating grin to a stunned, distant look of shock.

I hate working my ass off and feeling like I'm just spinning my wheels and getting nowhere.  Still, I keep attempting to get up, dust myself off, and dive back into the fray.  That being said, it sure would be nice to have some sort of a win in the near future; I hate feeling like a big bag o' fail.

A Meanness In This World

Nothing quite like preparing for a session on the "internal male genitalia" and "bladder and urethra" and, fifteen minutes before class, finding out that they changed the order of the topics.  And, more importantly, that today will be an interactive session in which you're expected to stand and deliver your differential diagnosis if called to do so.  Super.

And, just for the hell of it, let's add to that the development of the brain and frakking cranial nerves for Friday's test block.  And, some immunology.  And, for the surprise of the week, Pharmacology. We're having our first exam for a class two days after we have the first class.

Grrr.

You've Got Mono!

I just got out of an essay exam in Microbiology.  Essentially, we were given an infectious condition and expected to identify the causative agent, describe the etiology of the causative agent, discuss the pathology of the condition, identify transmission methods, describe hallmark symptoms, describe any pertinent incidence/fatality rates, and discuss treatment options.  All of this in a pseudo-cohesive essay per condition, within an hour.

Our prof had given us a list of five possibilities:  bacterial pneumonia, bacterial diarrhea, burn wound infections, infectious mononucleosis, and urinary tract infections.  Of these five, two would be drawn from a hat at test time. We'd write a third essay on a condition of our choice that was not included in the original five.

So, as the week has drawn on, everyone has been busy trying to learn everything for all the conditions, some of which have what seems like a gajillion causative agents.  (Google some of the causes of bacterial diarrhea; there are seven serotypes of Escherichia coli alone.)  A few days ago, I started asking people what their wish list would be for the exam.  Most everyone, would say either bacterial pneumonia or diarrhea and infectious mononucleosis.  Mono is caused by the Epstein-Barr virus and, compared to the others, is easier to quickly understand and memorize key points.  As the rigors of the week continued to mount (we have two tests tomorrow and finals next week), people became more hopeful that we'd all get mono.

"I don't know ... I really hope we get mono!," someone would tell me.

"Yeah, that'd be pretty sweet," I'd concur.

Today, everyone made the final push on studying for it.  Like most exams, the room was buzzing with nervous tension in the minutes before the test.  One of our classmates picked the topics from a jar.  We were on pins an needles as our prof, unfolded the first one and announced that one of the topics would be bacterial pneumonia.  Everyone sighed.  In my gut, I knew that we'd be getting Urinary Tract Infections.

His hand rattled around in the jar for what seemed an eternity before he drew out a folded yellow slip and handed it to the prof.

"Your.  Next. Topic. Is. Infectious Mononucleosis!"

No shit, the room erupted with yells and applause.  All 75 of us were cheering and carrying on like we'd just won the lottery. It was ridiculous.  Hell, I personally was pumping my fist and screaming "Mono!!! Yeahhhhh!!!" without being at all sarcastic or ironic.  For five minutes after the cacophony settled, I sat there with my eyes closed laughing silently.  I smiled and chuckled during the entire thing.  Afterward, I headed to a conference room and laughed about it with a classmate until I cried.  Instead of studying for Histology and Anatomy, I'm writing this because it still kills me.  Damn, I wish I had it on video.  Classic.  Absolute classic.

That's what it's like to be a medical student:  the absolute effing highlight of my day involved cheering with joyful abandon for mono.  Honestly, it felt like my team won the big game on the final play with no time left.