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.

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. 

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.

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.

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