Sway

I will never be a gastroenterologist.

I love food. I have no problems announcing my bodily functions, especially when my mother calls ("Sorry Mom, can't talk now - need to poop!"). And I can take on the biggest burper you know, and still beat them in a belching contest. My non-medical friends will call me up and tell me all about the color of their stool, alarmed that they might be suffering from some terrible disease (when really it's just a case of Bad Chinese Take-out).

That said, I will never be a gastroenterologist.

This week, in our Physical Exam Skills class, we were reviewing the abdominal exam. Last year when we first did it, we practiced on healthy, relatively young, standardized patients. In other words, all of the things we were testing or looking for came up negative. We were doing all the tests, just for practice.

This year, they actually brought in patients with liver disease, enlarged spleen tips, ascites, and peripheral edema. And it was really cool to actually feel and see all these things we were supposed to look for.

We were on our feet for most of the two hours.

At our last station, I started feeling really weak. It was my turn to do the liver scratch test, and yet, all I wanted to do was sit down. In fact, all my body would allow me to do was sit down. So sit down, I did. But that didn't stop the room from spinning, as my peripheral vision started fading to black. And whoa! Did someone just turn up the heat? I felt like a furnace! Alarmed, I got up and excused myself from the room.

Pulling off my white coat, I said I needed some water (which I probably did), but honestly, I just wanted to get out of there so that my fellow classmates wouldn't see me collapse.

And that's exactly what happened the moment the door closed. Luckily, there was an instructor outside who caught me and pushed me into an exam room where I caught my breath and regained my vision.

I've been in Dance Marathon. In which I successfully stayed awake - while dancing - for a full thirty hours. On my own two feet.

I don't know what happened. But I went home, had some beef, and went to bed.

The next day, feeling much much better (it's funny how a good night's sleep can do that to you), I went to lecture and sat down next to one of my friends.

Arnold
Michelle!! I'm so happy to see you!!

Michelle
Hey you too! Uh, I'm happy to see you too?

Arnold
I mean, what happened yesterday?! You walked out of that room and never came back! And you just left your white coat crumpled up on the ground...

Michelle
Oh, hahaha. Yeah, I wasn't feeling well.

Arnold
I mean, when I saw that, I was like, Wow, Michelle saw that ascites patient and was like, that's it! Forget med school! I'm out of here! And in my head, I saw you throwing your white coat on the floor, sticking it to The Man, and just storming out.

Haha, if only it were that easy.

That said, I still don't know what caused me to black out. Maybe it was the smell, maybe it was the fact that I haven't had any meat in the past two weeks (salad diet, you know), or maybe I'm just overstressed and overtired.

But whatever it was, I know one thing. I will never be a gastroenterologist. And that suits me just fine.


P.S. It's freaking cold here in Chicago. Seriously, my face froze as I walked to class today. That is not cool dude. Not cool at all.

She's so high above me

In med school, we have this lovely little thing called Problem Based Learning (PBL). Theoretically, we have this class right after morning lectures and we're given clinical cases to solve. As a group we identify key facts and learning issues, and then at the next meeting, we come back, make five minute presentations on our topic, and find out new information about Patient X. Unsurprisingly, these cases almost always correlate to what we had just learned that morning. The point of this class is for us to synthesize the material and teach it to our fellow classmates - thus helping us understand the eons of information we end up just memorizing when push comes to shove.

More often than not, PBL turns into a two-hour class of fun and camaraderie, as we make study guides and cheat sheets for the million different diseases we're learning, and spend the first fifteen minutes gossiping about what we did over the weekend.

Oh, and someone always brings food.

It's good stuff.

It's fun, and we all know that it's not as effective as just sitting in the library with our books. Even the preceptors know this. Most of them just sit there looking pretty, and interject only when someone makes a glaringly huge medical mistake like...'pregnancy is a disease state found in men' or 'cholesterol is not related to blood pressure.'

But it's a required class (in fact, it's one of the reasons why our school ranks so high on US News), so we deal with it. We get through it as quickly as possible (goal: 1 hour or less!), and then we all go on our merry library-bound way.

So I'm in a group of seven students. Having been run through the PBL gauntlet, we all know how it goes down. You get the case, you read it, you discuss it, you come up with topics, and then you run home as someone sends out the pertinent information in an email.

Today was our second meeting. And the first thing our preceptor says is, "Well, our scribe had some spelling trouble last week." We all look around, confused - and then laugh nervously as we realize that Richard had misspelled some of the diseases and disorders.

Scary PBL preceptor
So, how do you spell polyhydramnios?

Richard
Uhhhh, P-O-L-Y-H-Y-D-R-

Scary PBL preceptor
[cutting him off]
Right...there is no 'e' sound right?

Richard
Yes, ma'am.

Scary PBL preceptor
You mean, 'No, ma'am.'

Richard
[stuttering]
No, ma'am, I mean, yes ma'am...uhhhhhh.

So then we proceed on with our case, and Bill - this week's scribe - stands up to write down information on the board.

Bill
[writing out 'apperant' instead of 'apparent']
Oh, oops, I spelled that wrong.
[Uses his dress shirt to furiously rub off his spelling mistake and hopes our preceptor didn't notice.]

All
[laughter]

Scary PBL preceptor
Huh. You must have learned spelling from Richard.

All
[dead silence]

The best part though? I think she loves the power she has over us. At the end of the PBL block, each preceptor is supposed to fill out an evaluation form. I like to read my evaluations after a particularly debilitating exam, because the self-esteem boost does wonders. The preceptors always write nice things, because I think they realize that if they didn't, we'd all be dropping out of medical school and wondering if we'd ever be socially and mentally competent to go out into the real world. It's often an afterthought on their part. Most preceptors completely forget about evaluations and do them off the cuff on the last day.

My preceptor though, lines up everyone's evaluation form on the table in front of her. At every single session. And writes down comments constantly. Incessantly.

Michelle
So blah blah blah prenatal screening is important la la la.

Scary PBL preceptor
But, Michelle - what does that all mean?

Michelle
[confused]
Uh, that there was fetal distress in the third trimester?

Scary PBL preceptor
But what does it MEAN?

Michelle
[giving up]
I don't know.

Scary PBL preceptor
Hm. Uh huh.
[writes furiously on Michelle's evaluation sheet]

She does that to everyone. And you know that you're in trouble when it happens. "Melody, did you look into the historical uses of amniocentesis?" "Um, no. I was supposed to look up the pathophysiology of preeclampsia." "Hm. Uh huh."

And that 'hm, uh huh' is always accompanied by furious paper scratching.

I can't wait to see what my evaluation at the end of the unit says.

Something that I already know

I was in the midst of writing today's post, when I got to wondering what I was going to title it...and then went into my old posts to see if I had already used the song title I wanted for this post. Answer, yes.

Then, I realized that this post I was writing? I had written it already. Two years ago.

From March 20, 2006 - Secret.

Nifty, fifty United States

Apparently, third grade geography class failed a couple of us.

Michelle
What are the five states that border Illinois?

Martin
Oh! Kentucky, Indiana, Wisconsin, Iowa, Mich- no, it's MO - MONTANA!

Michelle (aghast)
Montana?!?!

Martin (realizing)
Oh wait! No! MO is Missouri, not Montana!!

...

Later on that day, I'm telling my other geography-challenged friend about this exchange.

Elinor
Wait, what is the abbreviation for Montana then? MO is Missouri, MN is Minnesota, MA is Massachusetts..what the heck is Montana?!

[five minutes later]

Elinor
Ohhh, it's MT. I just wikipedia'ed it. By the way, did you know it's the fourth largest state? But with the 44th largest population in the nation? And that its name is Spanish for mountains? It's north of the Rocky Mountains, which is probably why it's called the Land of Shining Mountains.

Michelle (inner monologue)
Holy crap...this is more information about Montana than I ever wanted to know in my entire life.

Elinor
DUDE. MONTANA BORDERS CANADA. WTF?

[2 minute pause as she Google searches for a map of the US, while I geek out about how much I know about Montana to Martin.]

Martin
4th largest state?! No waaay!! It's like 2nd or something. Look how big it is! Hold on, I'm gonna Wikipedia total area of some of these states.

[30 seconds later]

Martin
DUDE!! DUUUUUUDE!!!!!

Michelle (alarmed)
What's wrong?!

Martin
Alaska is HUGE! HUUUUUUUUUUUUUUUUUUUUGE!

Michelle
I know, it's not drawn to scale on the map.

Martin
But look at it! [as he triumphantly shows me his computer screen of North America] It's enormous!!

Elinor
Omg, it's HUMONGO!

Michelle
Yes, it's the largest state in the nation.

Elinor
What?! I always assumed California was the biggest.

Michelle
...

Elinor
...

Michelle
Uh, there's also Texas.

Elinor
Oh yeah...I guess that state is pretty big too.

Somewhere out there

Let's get out of this town.

Estrellita

Every time I listen to something like this, my fingers itch to play again. I love Joshua Bell (even though I will be the first to admit that he makes some heinous faces as he plays). But I love this. I love the way he plays; it's so smooth, you can't even tell the bow is changing directions. He's making sweet sweet love to that instrument. Seriously.

And I love this piece. It's achingly beautiful.

I miss my violin.

Hanging by a moment

I want to be a pediatrician when I grow up.

I've always known that. The question nowadays is, what kind?

In undergrad, I thought maybe Infectious Diseases. Then I thought, hm maybe ICU. But in the back of my mind, I always thought, hmmm, maybe hematology/oncology.

Maybe it's just because I read all of those trashy "One wish to live" books as a teen. You know what I'm talking about...where the main character is this rebellious goth girl who is forced to do community service at the hospital where she meets this guy dying of terminal cancer and falls in love with him, and learns to live the life she was meant to live. And at the end of the book, you cry buckets as Donovan passes away, with Margaret curled up in the ICU bed with him. And Margaret's dad turns out to be Donovan's doctor, and he sweetly calls her away, telling her she got too involved with the patient...

Yeah, so what if I still remember the character names?

Today during preceptorship, I met Lily, who is my little sister's age. I was sent in to do a full history (chief complaint, history of present illness, past medical history, social history, family history, blah this, blah that), but something about how she was so much younger than the usual patients (and relatable!) made me stray from the the script and start chatting about Gossip Girl (so hot!) and Tila Tequila (so trashy, yet addictive!).

She was a funny kid. And totally adorable, with her big double dimples and bright blue eyes, and blonde peach fuzz hair that was just starting to grow in again.

True story - as we were gossiping about celebrities, she mentioned how she was okay with losing her hair (from getting chemo). "I mean, I figured I was just gonna be bald like Britney Spears, and that's kinda what got me through it. My daddy used to tease me and call me Miss Spears when it first started happening. And I was okay with that. Because she can sing and dance and she has killer abs. But now, I don't want anyone to compare me to Britney, 'cause I don't wanna die."

I laughed. Like I said, she had a good sense of humor. I took some more vitals, and then headed off to present her case to my preceptor.

My preceptor was seeing a different patient at the time, so I walked in, introduced myself, and started listening to random heart sounds. (Okay, maybe not so random, as her heart sounded very textbook.) In the midst of the heart and lung exam, my preceptor's pager went off. Except, this time, it was different from the usual pages that usually interrupt patient visits. Instead of three quick staccatos, there was an arpeggio. Huh, what is that? I wondered through my stethoscope-impaired hearing.

"Excuse me real quick...I need to step outside for just a second," my preceptor said to our patient. Slowly. Calmly.

Our patient was a little surprised. We were, after all, in the middle of the physical exam.

But she nodded obediently as my doctor walked towards the door. I took off my stethoscope, dutifully ready to follow him wherever he went next. As he opened the door, I realized something was going on. There were footsteps - lots of footsteps - coming in our direction, and the overhead loudspeaker was paging my doctor to a patient room. And then I realized.

One of our patients had just coded.

The moment I closed the patient's door behind us, my preceptor took off running. Not wanting to get in the way, I hung back, as a stampede of doctors made their way to the patient, to do whatever they could do to help.

I wasn't quite sure which patient had just coded. Running through the possibilities, I figured it was probably our frail and fragile ninety-one year old and headed towards her room.

And that's when I saw the crowd outside Lily's room.

Holy crap. What did I do?

Five minutes ago, I was talking to a perfectly healthy (minus the whole cancerous tumor thing) teenage girl. And now here she was. With no heart beat.

Thankfully, Lily came back. Turns out she had merely collapsed as a nurse was trying to flush out her port catheter and her heart had stopped as a result. And after the initial scare and stabilizing her, my preceptor was still in there making jokes, "You know, I know you're angry with me because I'm behind schedule and I'm making you wait...but you really have to come up with a better way of getting my attention than a code blue!"

She laughed and agreed, considerably weaker from the excitement and drama that had just played out.

Deciding to let her rest, my preceptor finally let go of her hand, and walked slowly out of the room, glancing back at the room a couple times - as though he were worried that something new might go awry. We headed back to his office to discuss what had just happened, and once we were inside, he started tearing up.

These are the kinds of cases that will make or break you, he said to me. In this field, you get a little hardened and things don't phase you so much when things happen to your elderly patients. They're meant to go sooner or later, and you just want to make them as comfortable as possible. You just want them to leave this life as high-functioning as is possible. But with Lily, it's a little different. No, it's a lot different. If Lily's goes into remission, I will be able to keep going for... for a long time. But if she dies, well... to put it this way, every time I send her blood work off to a lab, or I know a CT scan is supposed to come in for her, Lily's the only patient I can think about until I get the results. And even then - when I get the results, I kind of don't want to see what they are...because there's a chance, a very big chance, that they might be the results I don't want to see. This is a case that will make or break you.

I have a feeling I'm going to get too attached to my patients. But after seeing my preceptor today, I'm thinking that might not be such a bad thing after all.

Killing me softly

I have officially given up French fries and chips for my New Year's resolution.

It just sucks that I have to walk by McDonald's every day to get to class. McDonald's and their freakin' AMAZING fries.

It takes every ounce of willpower for me NOT to go in and order some fries off the dollar menu.

And don't even get me started on Lay's chips. So deliciously good, and so terribly bad for you. I won't be tricked by those giant sunflowers smiling down and telling me to feed. (Even though I have been in the past.)

Goodbye, my two loves of my junk food life.

I'll see you in 2009, baby.

In the meantime, hello breakfast. Show me what you've got.

(I also wanted to try to give up soda again, but after downing two Sunkists in an evening, two days after making up my list of resolutions, I've accepted the fact that I will always be a soda-holic.)

G-L-A-M...

This might be a grossly unfair stereotype, but girls are generally very clean. Very clean and very presentable.

I mean, think about it. We wake up an hour before we have to go anywhere to shower, blow out our hair, style it, and then put on makeup. Some girls won't even leave the house without applying product to their eyelashes. Eyelashes! (I can't do the whole makeup thing because I always end up looking like a painted doll or stabbing myself in the eye and getting mascara on my contacts. It's strange, but very true.)

Our clothes always smell like fresh laundry and besides that one week during finals in undergrad when the laundry room was always fully in use and The GAP was completely out of new panties, we never ever wear dirty underwear. I mean seriously - it's dirty down there. I've heard tales of some boys wearing their boxers inside-out. That's just nasty. I'd rather wear granny panties that go halfway up my chest than wear my dirty underwear again.

Girls are pretty clean people.

So here's the thing.

Why are the women's bathrooms always so dirty?!?!

I mean, I know some bathrooms are inherently dirty. Public malls. Anywhere Britney Spears has been. The beach.

I'm talking about the bathrooms in my med school's library. Where you technically can't come in unless you're a student or an employee of the university. Meaning that we are all highly educated people who value our health and well-being. Meaning we are all people who know how to hold our pee (and our wee - although I've heard horror stories about the boys' bathrooms as well).

I don't understand how there is always pee and toilet paper on the floor. And, at the risk of completely grossing you out, there's sometimes an occasional used tampon out for everyone to see.

Now, this isn't because we don't have a fabulous maintenance staff who do the terribly dirty work of cleaning up after us three times a day. Because we do. We have a fabulous maintenance staff who clean the bathrooms three times a day. Don't ask me how I know. I mean, maybe I know because I've timed my bowel movements to coincide with the bathroom cleanings so that my dress pants have the most optimal chance of not having to step around pee and poo all over the floor. But that would sound obsessive and bathroom stalker-ish. Which isn't me. Maybe.

I just don't get it. Do people wipe their butt and then deliberately throw their used toilet paper on the ground? Maybe people zip up their pants and just forget to flush. Maybe this is how people rebel for having to pay so much for med school tuition. Yeaaaaah!! You want me to pay $50,000 a year for my education?! Take this!!! Yeah. You stick it to The Man.

We have antimicrobial lotion pumps every two steps at the hospital, learn to wash our hands for the full thirty seconds at the beginning of the year (or risk losing points on our Clinical Skills Assessment!), and we know all the steps to creating a sterile environment. And yet, for some odd reason, we can't seem to figure out sewage.

Yes, we are the future doctors of America.

Pop goes the weasel

As a med student, you see everything. The hospital is a crazy place, and no, I'm not talking about crazy sexy hijinks and shenanigans in supply closets a la Grey's Anatomy. I'm talking about the patients.

I shadow an oncologist once every two weeks in Evanston. Just the other day, my preceptor and I walked into a room and the woman immediately proceeded to ask him seemingly random questions. Were you a Boy Scout? Have you had a vasectomy? Are you thinking of getting a vasectomy? Did you camp a lot as a child? (Answers: no, no, uhhhhh, yes?) Her erratic behavior made a lot more sense when we looked at what she had written down as her occupation: 'psychic and humble messenger of supreme beings.'

Anyhow, I'm always a little glad to leave the hospital and head home.

Home.

Where it's nice and normal and comfortable.

I usually get out around 6 or 7. But this week, I was off by 4:30pm!! Excitedly I walked home in the gorgeous almost-Californian-like weather, planning out what I was going to do with my suddenly free afternoon.

So there's this alley way that I sometimes take to get home. It's perfectly safe - well lit and everything, and there's always one or two other people taking the shortcut to their own homes. So on this day, I was walking down this alley, and I saw this man walking in my direction.

For some odd reason, my Spidey sense started to go crazy. And every fiber of my being wanted to turn tail and run away. I looked around and realized that it was just me and him in this alley. Hyper-vigilant, I forced myself to overcome racial stereotypes (yes, he was black), and keep going. Besides, he was on his cell phone, and pretty well groomed in a white oversized sweatshirt and designer jeans. I was just being silly, I told myself.

As he came closer, I overheard his phone conversation. No, man, I dunno! I said I dunno. Hold up, there's a girl here, let me ask her.

I breathed a sigh of relief. Oh, silly me - he just needs directions!

Excuse me...do you know if I can take care of myself around here?

...

...

What?! (I mean, seriously, what does that even mean?) Thinking that he was wondering about how safe the neighborhood was, I said, Uhhh, I guess this is a pretty safe place?

No no, I mean, can I exercise around here?

The gym's a couple of blocks that way.

No, not the gym. Can I masturbate? Jack off to you? Just then, he reached down, and I realized his pants were unbuttoned and unzipped. Cue shock and fear. Quickly figuring out what he was about to do, I immediately started walking away, while adamantly refusing. No, no, no!!

I walked as quickly as I could in my heels and prayed that he wouldn't follow me.

Luckily, he didn't. But as I walked away, he called after me, Please! Just stay for TWO minutes! TWO MINUTES!

My building is half a block from the alley. So, the moment I walked in the door, I told my doormen, who sent security detail in that direction. I don't know if they caught him, but all's well that ends well.

There are some pretty crazy people out there.

And apparently the flasher stereotype is wrong. He wasn't a dirty old man. And he wasn't wearing a long trench coat. And it didn't happen at 2am.

So the message of the story is this: Stay away from alleys, no matter how well-lit it is or how sunny it might be outside. And aways trust your gut. Whether it's telling you to run away or that it's time to eat, it's never ever wrong.

Be safe out there everyone.

You had me from hello

2008 is going to be so much better than 2007. In fact, it's going to be great. I can feel it.

Here's hoping that it just keeps on getting better and better. I'm on cloud nine and heading for space, with my fingers crossed that blogging doesn't jinx anything.