Boggle

Another post that I wrote and never published. Either I thought I had more to say, or I'm really bad at the follow through.

What is with people who think that refusing treatment for their medical problems somehow makes them healthier? It doesn't make you healthy, it only makes you sick and stupid. Happy thoughts about puppies and rainbows won't cure the raging skin infection you have on your foot. And neither will ocean water, btw.  I had a patient today decline to take a short course of oral antibiotics to treat the not insignificant cellulitis on his foot because, and I quote, "my yoga teacher said that those antibiotics will cause bone thinning." Yes, because taking two weeks worth of Duricef is going to give you osteoporosis...at the age of 24. It's not that I'm opposed to not taking medications, because I would gladly never pop another pill for the rest of my life. But if there's something seriously wrong with me, then sign me up. Bring on the drugs!
Maybe it's because I have a better knowledge base about medicine and health to know what is serious and what isn't, but it boggles my mind when patients play the either-or game with their health. Why is the anecdotal threat of "bone thinning" worse than your skin infection that could progress to septic arthritis, which according to all my vast medical knowledge is dangerous, hard to treat, and hurts like a bitch? Why is the ability to proclaim that your family is proudly crunchy and anti-Western medicine and just generally more awesome than everyone else more important than giving your kid an asthma inhaler so he can properly oxygenate his body?

It's patients like these that make me want to go into forensic pathology. Their patients don't say stupid things...or say anything at all.

Here's What I Learned In Pediatrics:

aka: A post that I wrote and never published, probably because I wasn't done learning! Or because I have a short attention span and forgot it existed. So here you go.

1. It is surprisingly difficult to make a kid open their mouth when they don't want to. They have little piranha jaws and I don't want my fingers to be their next meal.

2. There is just a never-ending supply of screams.

3. If I ever want to have kids, then I needed to get married yesterday. Old mothers=Down's syndrome. Old fathers=Autism. There is no winning either way. I love Autistic kids, but what I love more is sending them home with their parents. From the way they scream, you'd think my stethoscope had been dipped in molten lava or something. It sounds callous, but I'm being completely serious. The possibility of having a kid with Autism is so scary that it makes me just want to skip the whole genetic lottery of having children altogether because its heartbreaking to watch those families in the office and know that they never get a break from it.

4. Hyperbaric oxygen therapy can cure any ailment if you have enough money. Diabetic ulcers? Definitely. Cerebral Palsy? Yep. Autism? There's no proven evidence, you say. Oh well, why not? Arthritis? Who knows, but we're not going to say no if you want to fork over $100 every day for two weeks to lay in a glass coffin while the magic oxygen rushes around you.

5. Fanny packs are making a comeback, heaven help us.

6. All doctors are assholes. This is what my attending told me at least once a day. I didn't quite have the guts to ask her what that makes her then.

And All God's People Said AMEN!

In the psych ward, every morning we have group. We go around, one by one, and share our name and our goal for the day. Group is its own special brand of torture that involves giving actively psychotic people a platform in which to espouse their crazy theories and delusions in lieu of just stating their damn name and goal.

My goals, by the way, are always something lame like getting my oil changed or actually studying instead of spending four hours playing spider solitaire or working out. The nursing students that show up always try to outdo each other with increasingly stupid existentialist goals like accepting myself and others, finding my inner peace, making a new friend. Kill me.

My absolute favorite goal ever came today. This patient I like to refer to as Santa shared his name and his goal. Now, everyone's goal is to get out the hospital and go home, but that's not really in their control so they have to come up with another goal. So he said his goal was to relax today. The staff member leading the group asked what he was going to do to relax. His answer: have sex. The staff member, after he stopped laughing, politely informed Santa that this goal was for today, not just in general, and there will be no sex in the mental hospital thankyouverymuch. Santa just nodded and said, "Huh, I thought that was allowed under certain conditions."

Hmm. I don't even want to imagine what those conditions might be.

Today's group was more akin to a church service than a group meeting. In the psych ward, religion spreads like mass hysteria did in Salem, Massachusetts. Last week, only one guy had a Bible, from which he would quote long (made up) passages intermingled with very inventive strings of curse words. Then a couple more people took up Christianity. But that must have gotten old fast because today everyone was Muslim. Half the group said "Allah Akbar" before they introduced themselves.

Then the church service began. Some lady shared with us a five minute ramble on what God wanted her to do with her life. An old demented lady started singing hymns and praising Jesus like they do on those televised services on TV and everybody joined in. And, lo, there was dancing and shouting to the heavens. And all we were missing was someone speaking in tongues and a giant snake.

Dream

Last night I had a nightmare that I was involuntarily committed to the psych ward. And then I missed the morning shower time, and they wouldn't let me shower in the psych ward. I had to be dirty the rest of the day. In the psych ward. Did I mention that I was stuck in the psych ward?

I'm still recovering.

Last week, the veteran psych medical students (from another school) left for greener (less insane) pastures, only to be replaced by two new medical students who get to suffer along with me. Unfortunately, this makes me the veteran student. You know how dogs can smell fear? Well, psych ward patients can smell when you're the only person who knows what's going on.

For some reason all the normal nurses on the floor were out today, or they all took lunch at the same time (jerks), which left me with two new nurses that had no idea what was going on. And my two new medical students (both of whom had those big anime eyes by the time the day was over). And some resident on ambulatory that was being forced to spend the morning on the psych ward. She wouldn't take off her white coat (no one wears white coats in psych, the better to not freak out the patients. Also, no one wears stethoscopes, the better to not get strangled with.) and she wouldn't do anything but refill her coffee cup.

I was trying to hide behind a bunch of charts and stay out of everyone's line of sight, but the nurses station is a square in the middle of the unit, with glass walls all around it. Basically, it's like a big fish tank. Or, probably more accurately, like one of those cages people lock themselves in to look at shark. So hiding is impossible.

In the span of two minutes, one patient came up and asked for a piece of paper. Everybody ignored her, so she (naturally) started chanting "Paper! Paper! Paper!" until somebody got some for her. Then she asked for a pen (It's like the psych version of "If You Give A Mouse A Cookie). The patients aren't allowed to have pens, I'm assuming so that they can't fashion it into some sort of shiv and injure themselves or others. They are allowed to have little golf pencils, which I can't see are any safer than pens, but, whatever. I'm not going to argue with crazy. So I tell the patient she can't have a pen, just as the new nurse hands her a pen. Of course The patient grabs it and runs off back to her room. That's going to end well, but not my problem, cause I'm just the student! Whee!

Then another patient tells me that the patient phone says it needs to be recharged but she needs to make a call rightthisveryminute but she can't make a phone call because it might die in the middle of her conversation and that would be the end of the world but it is of the upmost of importance that she make her call so what am I going to do about? Oh and also, she needs to talk to the doctor right now because she has this handy list of everything she's every felt after taking each dose of each medication she's currently taking and she wants to go over that with the doctor right now, but no one will get the doctor for her and she's upset that the doctor won't let her out because she's not crazy and she feels very unsafe with all the crazy people in here, and she REALLY NEEDS TO MAKE A PHONE CALL BUT THE PHONE MIGHT DIE!!!!!!!!!!!!

I suggested that she practice my new favorite stress relieving technique of deep breathing. She handed me the phone and told me that she'd be just right over there, waiting for the phone, and practicing her breathing. And then she sat down two feet away from me and proceeded to stare intently at the phone.

Then her friend rolls up in his wheelchair, using his legs to maneuver it (the same legs that last week he refused to move, instead using his hands to pull himself around on the floor) and he tries to tell me he wants to use the phone, except he doesn't really speak, at least not coherently. So manic girl from last minute interrupts and tells me what he wants because, naturally, she can understand him perfectly (I'm betting on psychotic telepathy). Guess what? He wants to use the broken phone too. Oh, and he doesn't know the number of the person he's trying to call.

Why me?

Then I went to exercise group where we did some aerobics that were guaranteed to get the blood pumping. I'm pretty sure my heart rate never got about 75, but it was possibly the most fun I've had on this rotation yet. I was raising the roof to Frank Sinatra, good times. Or at least good times, until the leg lifts portion of the workout, which is when the crazy penises started coming out. This old guy in a wheel chair with only an untied hospital gown on was sitting right across from me. Let's just say that I have seen more than my fare share of naked people on this rotation and it has left me to wonder why it is that we can involuntarily commit someone (meaning they are here against their will) to the psych ward but we cannot involuntarily put underwear on them?

A Whole Bucket O' Crazy

I've been on psychiatry for the last two weeks. And the best thing that I can say about this rotation is that there are only 7 days 17 hours and 13 minutes left until it's over.

I thought I was going to like this rotation, I even thought at one point that I might want to be a psychiatrist. Especially one that studied serial killers, which just goes to show that there's something wrong with my brain. Or that I'd watched too much Criminal Minds. The jury is still out. But it didn't really take more than about 20 minutes at the inpatient psych ward for me to realize that if I wanted to retain the little sanity that I still possessed, I needed to get out of there.

I've been struggling with anxiety for a long time, anxiety that has been getting progressively worse for the past year. Anxiety that, at times, makes me feel like I'm going crazy, that my body is going to explode any minute into a million little pieces. Anxiety that makes me check the locks on my car door 3 times before I can walk away, that convinces me that the whole world is going wrong and it's just better to stay inside my house, in my bed, where it's safe. Anxiety is a bitch.

Suffice it to say, on my own, on a typical day, I feel like I have a precarious hold on my own sanity. And then I had to get locked in a mental hospital with 25 psychotic people. I need to take some mental health leave from my mental health rotation. Oh the irony.

About three seconds after I'd walked onto the ward, on my first day, I was greeted by Jose, the longest standing resident, a chronic schizophrenic, whose baseline involves a lot of imaginary friends and a compulsion to converse with them in unrecognizable Spanish. Jose, recognizing that I was fresh meat, beelined over to me and said hello by dancing for me (with his untied hospital gown fluttering in the wind) and then rubbing my bare arms muttering "soft." Awesome.

Funnily enough, he's been my favorite patient so far. He just left a couple of days ago, and I was sad to see him go. He'd follow me around and sing me new songs each day while he slow danced with no one. We'd talk, too. If you can call him mumbling something in "Spanish" (which the translator said doesn't even amount to real words) and then me talking back in English (mostly requesting new songs).  And then he'd wink at me and walk away.

The real problem with the psych ward is, surprisingly enough, not the patients. It's the staff, or maybe the system, I don't know. Psych patients are hard to deal with. They have so many weird quirks, they're agitated, they're compulsive, they're brains are just plain not working right, and that makes them hard to deal with. Hard enough for a month that I can't imagine how the staff deals with them day in, day out for years.

The staff doesn't really seem to like the patients, and one of the doctors doesn't even look at her patients when they come to her office to be evaluated. The patients are often combative (you'd be too if someone locked you up in a creepy building where everything smells like week-old cafeteria food and your roommate talks to the walls). For whatever reason, the staff argues with the patients! One day the doctor spent 5 minutes arguing with a schizophrenic that "God helps those who help themselves" is actually in the Bible. The patient was right (It's not) and the doctor was wrong, but he just couldn't let it go. And all I could think was, why are we arguing with crazy? Doesn't that make us crazy too?

So I just sit in these meetings where everyone is talking at once and no one is listening (my mother calls this "Too many chiefs and not enough Indians," otherwise known as "Welcome to my extended family.") and there is so much passive-aggression (and sometimes just plain old aggression) and paranoia ("How come you're lookin' at me? Make her stop strarin' at me.) that it takes everything within me not to have a heart attack.

I don't do uncontrolled chaos well, and these meetings are like a field day for my anxiety. It's like my anxiety has just taken PCP and is now throwing chairs around the room and beating it's chest like Tarzan all while yelling "I'm the King of the World!" at the top of it's lungs (Because obviously that's what happens when someone's on PCP, just go with it). So in order to not have to voluntarily commit myself to the ward along with my patients, I sit in these meetings and do my breathing exercises while thinking about tranquil imagery like unicorns prancing in a meadow of wildflowers underneath a rainbow. It works surprisingly well, but then again, so does making finger guns and pointing them at my forehead when no one is looking.

Needless to say, I like to minimize my time there whenever possible. I show up late and leave early and talk to the least amount of patients possible. This might make me a bad medical student, but I'd like to think it's making me a better human being because I am not in the staff room rocking myself in the fetal position while mentally calculating how many Xanax is too many Xanax.

7 days 16 hours 34 minutes 17 seconds. Not that I'm counting or anything.

OB/GYN

I'm currently on my OB/Gyn rotation. I don't want to say this too loudly, but I actually really like this rotation. I've always said that there was no way in hell that I'd do OB. For some demented reason, we used to watch A Baby Story on TLC during lunch in college. I'm not sure why we did that because I was always about 4 seconds away from losing my Baja Bingham quesadilla.

I very much prefer the OB part to the Gyn part because babies are much cuter than vaginas, even when they're all covered in ick and are screaming bloody murder. So who knows, maybe I'll end up as an OB and I'll finally get an excuse to use my Gone With the Wind material (I don't know nothin' 'bout birthin' babies!)

C-sections are crazy. They make this 6 inch incision on your abdomen and cut through all the tissue until they hit the uterus. They rupture the membranes carefully with the scalpel and this big gush of blood and amniotic fluid comes gushing out in a mini tidal wave.  Meanwhile the assisting physician keeps one eye on the tummy and the other on my skin color to see if I'm going to pass out or throw up while reminding me that if I feel sick to please puke away from the sterile field. I'm too preoccupied with figuring out how they're going to get that 8 pound baby out of that tiny hole to feel sick. A little foot pops out of the incision, because this is a breech delievery. The obstetritian grabs hold, fishes around for the other foot inside, grabs it too and then just begins to yank. Hard. All I can think is thank goodness that mom and dad are safely behind the blue curtain because this guy is going to rip this brand new baby's head off trying to get it out of it's little cocoon and why did you not just make a longer incision? I'd rather have a bigger scar than a baby missing a limb or two. Jeeze.

Vaginal deliveries are better, as long as mom got an epidural, otherwise the screaming is not okay.

Blowing the lid off the vagina.
Vaginas are weird. I'm just saying. I would consider being an OB/GYN if it weren't for the gyn part. The OB part is great because at least at the end of all the blood, guts, and a million pelvic exams, you get a cool prize. My attending doesn't see a lot of OB patients anymore, which is a pity, because I love those visits. They're my favorite ones because if its early enough in the pregnancy I don't have to stick my fingers in a stranger's hoo-ha and poke around and we all come out winners. Instead, I get to feel a pregnant belly for a baby head and then I get to use the fetal heart monitor to hunt around for the heart beat and we all stand around for a minute listening to the pitter-patter of a healthy baby heart and everyone is happy.
In gyn appointments I listen to 80 year old women ramble about how they're sure that cyst "down there" is actually a tick that's been causing her foot cramps. And I have to hear the word "discharge" which is something I never want to talk about. And if I have to hear the phrase "You're due for your yearly mammo" one more time, I might have to scream. Mammo sounds like some sort of maternal summo wrestler or a hippo or something. Although, these patients are more likely to bring me cookies for some reason, and I like cookies. So I can't completely look a gift horse in the mouth, or a gift hippo, as the case may be.

Why NJ is weird:

1. You are not legally allowed to pump your own gas.
2. People like to key your car when it has out-of-state license plates because they're dicks.
3. The mall has a kiosk that sells fruits and vegetables.
4. An inordinate number of people wear fanny packs, and they're not tourists.
5. I just saw someone in the mall bathroom wearing stir-up pants. Dear God, the Eighties, they are back.

Pediatrics

Here was my day yesterday:

1: Dad comes in at 5:40 pm for his 5:15 emergency add-on visit with his son:

"Your son has asthma. He's going to need to start using this albuterol pump to get his asthma under control."

"Albuterol? Are you sure? My wife isn't going to like this. She's not really okay with our kids taking medication."

WTF?!  "Yes I'm sure, he's wheezing in every lobe of his lungs, everytime he coughs he can't catch his breath and his oxygen saturation is low. He's not getting enough oxygen into his lungs."

"And that's serious?"

"Yes, not being able to breathe is serious."

"Well, I guess we can we'll try that medication. At least for a little bit."


2. Mom and 1 year-old baby are here for a well-baby visit. Mom pulls out a sheet of questions. Oh goodie.

"Is it okay for my baby to play with toys?

"Is it okay that he poops four times a day?"

"He gets three meals a day. Am I feeding him too much?"

"He's starting to walk. Should I be letting him do that?"


3. Mom to her 4 year-old girl here for booster vaccines:

Mom "You're going to get lots of shots today! Are you scared? You should be scared. It's going to hurt. A lot."

Kid: ear-piercing screams

4. Mom to 6 year-old who won't stop playing with the scale out in the hallway:

"If you don't start behaving right now, I swear I will leave you here with the doctor. How would you like that?"

Me (internally): I'm guessing your kid wouldn't mind that as much as you might think...

Is pediatrics over yet? The kids are cute, but the parents are going to be the death of me.

It's September 12th and everything is back to normal around here. Everyone seems to have recovered from the whole "Let's love everyone extra" of yesterday, which is kind of a relief because all the niceness was starting to freak me out. People in the grocery store kept striking up conversations with me. They even voluntarily moved their carts out of the middle of the aisle so I could get through , which might seem like common courtesy in any other part of the country, but here is like an act of God if you don't have to resort to pushing their cart with yours first. It was all very Invasion of the Body Snatchers.

Don't get me wrong, I think that sentiment is great, but it seems a little phoney when it only applies to one day of the year (man, this makes me sound like the hippy I desperately wanted to be in high school).

I knew everything was back to the status quo today when a transit bus decided to cut me off in rush hour traffic because he couldn't be bothered to check his mirrors before all 20 feet of him changed lanes. I was so happy that everyone was back to being rude again that I forgot to honk.

The empty lot next to my house has this stray cat and I want to adopt it. I keep asking if he wants to come home with me, but I think he's shy. He'd really come in handy this winter because my landlord has started bringing up the M-word and I don't really want to have to move out because Mickey's little cousins are coming to visit.

What I really want is one of those hairless cats that look like Voldemort. It sounds like the perfect pet because A: it's a cat, which means that it has no use for you as long as you make the food appear on a regular basis (ie, perfect for a med student) and B: because it's hypoallergenic and C: they just look hilarious. I did a little research on hairless cats last month during my radiology rotation because, let's be honest, what else was there to do. Sadly, hairless cats are the insecure sorority girls of the cat world. In other words, high maintenance. Because they have no hair, you have to bathe and moisturize them with special hairless cat soap multiple times a week. If I wanted to put in that much effort, I'd get a kid. The death of a dream...

See you in your nightmares...

9/11

I haven’t been here long, but New York City, I think, is one of those places that you either love or hate, and it doesn’t take too long to decide your position. There’s something undeniably special about the city that is hard to put into words. Despite the insane housing prices, the eye-watering smell on garbage day, never ending traffic, and the evil known as toll roads, there’s just something about this place that makes me want to stay here forever. It’s sad to know that I never got a chance to meet this city before it lost its innocence. 

9/11 is different here, more real, less theoretical. For everyone here, whether you were here 10 years ago or not.

It's a different kind of loss, and a different kind of mourning, to live here now. To know that as I drive across the Pulaski Skyway, headed home from the hospital, with Manhattan's skyline in front of me, that I've never known that view the way it was meant to be. With the Twin Towers, the tallest in the bunch, watching over their shorter companions. 

I wasn't planning on going down to Ground Zero today, given the possible terrorist threat, but this year might be the only chance I have to be there for an anniversary and it just felt wrong to sit at home and read about it on CNN when I'm a 20 minute bus ride away. 

So I went. I'm not sure exactly what I was expecting. More crying and less Asian tourists flashing the peace sign to their cameras, I guess. 

In high school, I went to the Oklahoma City Bombing memorial six or seven years after the bombing occurred. Even though I wasn't there on the anniversary of the event, the sense of loss was still palpable. 

But Ground Zero felt a little more like Times Square than a memorial. Leave it to America to turn the most devastating tragedy in its history, at least of this century, into a tourist trap. There were people everywhere selling red ribbons, and programs, a small American flags. The obligatory nut-jobs were there waving their end-of-the-world signs in the air and yelling about evils of a capitalist economy. And there were thousands of people posing for pictures in front of the new WTC building in between talking about where they're going for dinner and asking that fireman passing by if he'll pose with them.

And all I could think was, ''Ten years ago, thousands of people died here. Just a few hours ago, their families came and read their names aloud in remembrance and cried over their names etched into the new memorial. And across there street, behind the mesh fence, there is still a gaping hole in the Earth. How can you even smile, much less laugh here, today?"

I didn't stay very long at Ground Zero. I walked downtown toward the end of the island where Battery Park sits. Flags of Heroes, American Flags with the names of everyone who gave their lives on 9/11 making up the Stars and Stripes, were erected all over the park's grounds, one for each person who died. 3000 flags.

 

As I walked back to the WTC subway stop, I passed this Irish pub that, ten years ago, would have sat in the shadow of the Towers. Outside there were FDNY firemen (and women), all in uniform, milling around. The atmosphere was reminiscent of a class reunion, and it was obvious that for many of them, this is the only day of the year they get to see one another. The older generation of firemen, the ones who were most likely there that day were shepherding little clusters of younger guys who probably in middle school a decade ago. There was more celebration among the FDNY than there was a block away among the tourists. And here, unlike with the tourists, the mood felt right. Here, you get the sense that the right to smile and laugh has been hard won. Because life goes on. Even if a small part of all of us has been left ten years in the past. 

Walking past that pub was the most fitting book end to whole the day. It just felt right that a day that started in tears for what our country has lost, that was followed by unease of walking around Manhattan and seeing policemen carrying automatic weapons, ended with a display of human resiliency and hope. 

I'd like to take back everything I said about Hurricane Irene being a dud. Turns out, while Jersey City was spared, a lot of inland areas of New Jersey are underwater. Of course, these places happen to be right next to where my new pediatrics rotation is. The part of the highway I have to take to get to the suburbs flooded and collapsed. Who knew that could happen?

On a normal day, it takes nearly forever (or 45 minutes) to get out there. Yesterday it took me an hour and half to get there and two hours to get home! Because that major highway is closed for the foreseeable future, all the other highways are overloaded. On my drive home, I ended up taking 6 different highways to get home because everytime Judy the GPS found me a new route home, the road would be closed. She finally diverted me onto a toll road that only had two ticket lanes going. Guess who had to sit in line for 30 minutes because her EZ Pass is still sitting on her desk?

I took the wrong route home yesterday, which I realized about 4 seconds after I got on the highway onramp and it was too late to turn around. I kept telling myself that the other route must be equally bad because the thought that I more than doubled my commute was going to make my head explode. Sure enough, I took the other highway today. 40 minutes. Needless to say, Hurricane Irene is officially dead to me.

Also, I'd like to break up with Pediatrics. I like kids and all, but mostly when they're happy and cute. They're so much less cute when they scream. And yesterday, they all screamed. All. Day. Long.

Kill me.

I think my problem is that I like control and calm. Pediatrics is uncontrolled chaos. There's just way too much yelling and crying and crazy moms threatening to leave their crying kids with the doctor if they don't behave. Don't even joke about that. I will walk out of here and never come back if you leave that screaming kid alone with me.

My attending's practice attracts a lot of autistic kids, whom I normally love because they're quirky and socially awkward and way too smart for their own good. Autism plus doctor's office equals full-on Linda Blair nightmare because on the whole, autistic kids don't like to be touched and here's this stranger sticking point objects into their ears and nose. Oh the torture. For everyone involved.

It's just a matter of time before I come down with some sort of fluminant upper respiratory Strep-fluenza-croup infection because kids are big walking fomites.

The bright side is sometimes I get to hold babies, and discuss favorite Michael Jackson songs with 8 year-olds, and watch my attending give the sex talk to embarrassed 16 year-olds. Oh, and I have a 5 day weekend.

Jersey City vs. Hurricane Irene

That was the most disappointing hurricane ever! Now I'm pissed that I subjected myself to torture at the hands of Walmart on Friday. All for nothing.

It rained off and on pretty much all of Saturday. I spent the day over at a friend's house watching movies and killing time until the hurricane started. We decided to venture out for dinner because nothing was happening, so we ate at this Irish pub that was having hurricane drink specials. I've come to the conclusion that we should have fake hurricanes all the time because no one was out on the roads, we found street parking on the weekend (a certifiable miracle), and they suspended all the parking laws until Monday so you could park basically anywhere.

The storm started in earnest around 11 pm and by that time it was pouring and the wind was picking up. My cousin called me in a panic, wanting to know if I was prepared. He's lived through two hurricanes in Florida, and he was, needless to say, unimpressed when I told him that not only was I not boarding up the windows and filling the bathtub with ice water, but I wasn't even at home. He kind of freaked me out a little with all his disaster talk, so my friend filled the bathtub with water (not because we were going to need it, but to shut me up). Needless to say, we never lost power. The Dish even worked through most of the hurricane, which has to be some act of God because I had one of those my senior year in college and we lost all reception anytime the sky even thought about sending rain.

The storm was over by 10 this morning and I ventured home. I was expecting to see at least some damage from the storm, a few tree limbs down, anything to prove that we'd been through a hurricane.

Leaves

Lame

I'm seriously disappointed that Hurricane Irene did not bring her A game, because how can I say I survived a hurricane when I've been through worse thunderstorms in the middle of the country? And now I have no choice but to go to work on Monday. Thanks a lot, Irene.

I miss predictable Midwestern weather patterns. Not to say that tornados are predictable, because they're not, which is what can make them so devastating, but at least I was comfortable with Missouri's weather. I know what to do when the tornado sirens go off (if you're a true Missourian, that means going outside to look at the sky before maybe going down to the basement). This whole Hurricane Irene deal is not okay. 

My anxiety manifests itself in a excessive preoccupation with natural disasters (and also the ability to convince myself that I have all sorts of rare medical conditions), mainly because my brain is hard-wired to go directly to the worst-cast scenario for everything. So weather phenomena are like a field day for my nerves. 

When I was little, I used to be deathly afraid of tsunamis whenever it would rain. Yes, I lived in Missouri, possibly the most land-locked state in the US. Completely logical, I know. So whenever it rained my dad would make me go get the mail from the mailbox at the end of the driveway. I'm going to pretend that he was doing it for my own good, helping me get over my completely irrational fear, but I'm pretty sure it was mostly just entertaining to watch me work up the nerve to leave the porch and then race down the driveway and back before the 20 foot tidal waves got me. Thanks, Dad. 

I've spent most of the day checking the Weather Channel's website for updates on the impending doom. New Jersey is officially in a state of emergency. They're preparing to evacuate prisons. When they start evacuating the criminals, that's when you know it's serious. The problem with all of this is I don't know what to do in event of a hurricane. The Weather Channel is offering helpful advice like:

    

        Please begin to think about and act on your hurricane preparations. Now is the time.

Thanks for that. Real helpful, there. 

I went to the store Friday after work to buy supplies because I figured bottled water and a flashlight might save me the Hurricane. So I went to Walmart...and now I'm going to need therapy. There were so many people there that the police were directing traffic in and out of its parking lot. Although they really should have been inside because there were so many people you could hardly move. I figured that most people would be there buying the basics like canned food, water, bread, etc, but the people of Northern Jersey seem to be approaching a possible future without electricity and running water like it's a 4th of July BBQ. Every cart seems to be full of chips and cookies and hamburgers, sandwich meat, cheese...most of which require the electricity to still work in order for it to stay edible. Or maybe it's just they haven't worked out this whole electricity concept yet. 

I passed more than one person who decided that the threat of extensive flooding made this weekend the perfect time to buy that new flat screen, HD tv they'd been eyeing. 

I went straight back to the bottled water section, hoping that there'd be some left. 

Not so much

By 4pm on Friday there wasn't a bottle of water, a battery, a flashlight, or a generator to be had in New Jersey. So instead I just bought some non-perishable food, like pretzel M&Ms, you know, the essentials.
The storm isn't supposed to hit until late Saturday night, so last night I went out with a bunch of other med students to celebrate the end of our rotations.

I got an email from our program director about the Hurricane yesterday, telling us to "use your best judgement" on whether to go to work on Monday. I start my Pediatrics rotation, where apparently the attending doesn't actually let you talk to the mini-humans. What do you think the chances are that I can use my "best judgement" to claim emotional distress from the Hurricane and not go in?

Today was my last day on Radiology. I had my attending fill out my evaluation yesterday because I never know when he's actually going to be around. He wished me luck on my next rotation and told me to keep in touch (which is funny since I can guarantee that he has no idea what my name is). I told him that I still had one day left on the rotation and that I'd be in the next day. The radiologists were all shocked that I was going to actually come back. Apparently, once their evaluations are signed, students rarely return.

He should not have told me that because the temptation was almost too great. Especially early this morning, when I'd hit the snooze button three times too many. I decided to go in anyway, at least until noon (yeah, grueling, I know) and then I'd go home and take the exam that I didn't study for and call it a day.

Of course, all of the interesting patients waited until my last day to show up. The minute I walked in the door until the moment I left hours later, we went from one procedure after another and I didn't have to identify a single anatomic structure on a CT. We spent the last three hours of my work day in the CT room watching my attending basically invent a procedure on a patient that desperately needed a catheter placed but had no accessible peripheral veins. He was all pumped about this, but the other radiologist looked slightly less enthusiastic about it. So did the patient for that matter.

At least for me, radiology is almost always as dull as dishwater. I spent the last two weeks sitting in a dark room looking at abdominal CTs and chest x-rays, being lulled to sleep by radiologists quietly repeating the date 15 times into their handheld dictaphones. Today it was as if the circus had come to town. Half of the surgery department, all of the radiology department, an anesthesia resident, the CT techs, my resident and I are all crammed into this space smaller than my freshman dorm room, all of us peering at a computer monitor to watch the progress of a 12 cm needle as it got closer and closer to its intended target.

The radiology tech, this high strung older man who looks like he belongs at the North Pole helping Santa make toys for good little boys and girls, is running around about to blow a fuse because every attending in the room is trying to tell him what to do. The patient is screaming everytime the radiologist tries to draw on his skin with a marker. The department director is hovering around making sure all the T's are crossed and I's are dotted so the department doesn't get sued when the procedure doesn't work.

And my resident and I just keep saying to each other "Why hasn't every day been like this?"

The leg bone is connected to the foot bone...

I'm currently on my two week radiology rotation. The first day I stayed until lunch and then went home. Obviously I am such a gunner. I would put in more effort, except my attending thinks medical student equates more with secretary than, you know, student.

The other day I was observing him put in a fluoroscopy- guided PICC line (a central catheter designed for long-term medication administration) on a patient. This involves having everyone in the room wearing the lead shield aprons. So he's got this 50 lb apron on with a sterile gown over it. His phone rings and it's still clipped to his belt. Instead of just letting it go to voicemail, he asks me to get it. So I have to go digging around under all this stuff without breaking sterile and grab his phone from his pants. I can't decide who was sexually harassed in this situation, me or him?

Then I have to answer the phone like I'm his secretary. But here's the problem: the person on the other end has an accent and he's talking a mile a minute and I can't understand a single word he's saying. He wants to talk to my attending but I'm scared to interrupt him because he is currently trying to float a catheter up a vein in the patient's arm and into the superior vena cava, which I'm guessing takes some amount of concentration. I eventually just gave up trying to figure out what the caller wanted and told him my attending would call back when he was done.

Later that day we're doing the same procedure on another patient. As soon as my attending was sterile, his phone rings. I made the other med student get it.

The Google

I've just discovered this Stats application on Blogger. Who knew that it kept a record of all the Google searches that have lead people to my blog. The best one?

"Who let me into medical school?"

I don't know, but I think the same thing at least once a day.

Completely not okay

Seriously. It is way too hot. Although I totally deserve this because the Midwest has been having this kind of heat for the last couple of weeks while I've been going on about how nice it's been here with the 80 degree weather and the lack of humidity. 

Now it's so hot that staying outside one more second that I possibly have to makes me feel like killing anyone standing in the way of my air conditioned apartment, which is basically every stupid driver within a three mile radius. 

On a more medically related note, I had a patient yesterday who had a probable yeast infection. It didn't sound like it to me, but she was adamant that it was. The problem was she doesn't want him to do a swab, nor does she want him to even look down there. My attending tells her that the standard practice is to take a vaginal swab and culture it to confirm the diagnosis. The patient decides she wants the medication that treats a yeast infection instead. He tells her that he could prescribe it to her, but if it gets worse and she ends up in the ER, then they're going to do one there, and they're going to be pissed at him for not doing a culture. 

So she turns and looks at me and asks if I can do the swab since I'm female. Obviously I'm a much better actress than I give myself credit for because this woman must not realize that I have no idea what I'm doing! I want to tell her that somedays I can't even get the little plastic covers to stay on the otoscope when I'm trying to look into people's ears. I refrain imparting this bit of information

I, of course, am all for it because that'll be the closest I will get to anything even remotely resembling a procedure all month, but, alas, in the end she decided to just go with empirical antibiotic therapy.

Not that this is even a remotely complicated or dangerous procedure, but still. Two months ago I was sitting on my couch memorizing all the components of MEN syndrome and now the nurse keeps introducing me as "the doctor student," which makes me sound more competent than I truly am.

I think somebody needs to reexamine her priorities if she'd rather have the medical student do anything to her instead of the real doctor. Some guy in an ER once let me suture his face back together after I informed both him and the attending that I had never sutured anything before. I guess I should be glad that these people have some kind of inordinate faith in me because I sure as hell wouldn't. But to each his/her own, I guess.

The Doctor Is In

     I'm two weeks into my very first rotation. Family Medicine. Among the myriad of medical-ish things I've learned thus far, mostly I have learned that I'm not cut out for general medicine. Don't get me wrong, I'm loving this rotation, but I suspect that a good portion of that is due to the fact that I am no longer sitting in class (or sitting on my couch, as the case may be) and instead am finally seeing patients and practicing my doctor skillz. Really, proctology is better than the first two years of medical school.

    I enjoy talking to patients and listening to their stories, actually much more than I would have thought, given my misanthropic tendencies. I regret not being able to follow up on their progress, partially because I'm curious to know how the story ends medically, but mostly because I want to know how it turns out for them. Was this patient's fatigue caused by chronic Lyme? Was this kids unexplained weight loss just a simple parasitic infection, or something more worrisome? Will my patient every get his crippling anxiety under control so she get back to making her art? I guess the not knowing how the story ends is all part of being a medical student, even a resident. At the end of the month we move up and out, onto something new.

    I also like that 90% of the patients are more than happy to extend their visit by 10 minutes to allow the bumbling medical student a chance to see them before the real doctor comes in. I love when they wish me good luck in my journey of becoming a doctor. I get the sense that it's not a bother when I ask them a hundred questions only to have my attending ask them again five minutes later. There's almost a sense of pride that they were able to contribute to my education and to the future of the medical community.

    Here's what I don't enjoy: sore throats, ear pain, high blood pressure, and tick bites. These things are boring. Even the tick bites, which at least hold the promise of some kind of cool infectious disease (but rarely do). I cannot imagine spending the rest of my medical career treating these things. Thank goodness there are people that love treating these medical problems, because general practitioners are sorely needed. I don't want medicine to ever become boring, I want to wake up every day excited to go to work. I figure that's the least I can ask out of medicine after paying with my blood, sweat, tears, and about $200,000. If I'm already bored by the prospect of seeing another inflamed pharynx two weeks in, I won't be able to hack it for the rest of my natural life.

     So Family Medicine is looking like a no. But who knows, I still have another 6 weeks of it to change my mind. Maybe I'll get to diagnose someone with Ebola this week. Or at least get somebody with a positive strep test so I can put them on antibiotics.

     Best part of the rotation so far? (Besides having lunch provided by the drug reps every day) I saw a college student last week who came in complaining of a sore throat, a runny nose, and a cough. I did an H&P (history and physical) and was just about to leave the room to present to my attending when the patient asked me, "In your professional opinion, what's wrong with me?"

     Ha! My professional opinion! That is so cute. I wanted to say, "Can't you tell I've only been doing this  2 weeks and I have no professional opinion?" The only thing I've become professional at is saying "I don't know, but I'll look it up" whenever I'm asked a question. But half of being a medical student, I think, is pretending that you know what you're doing even when you have less than no clue, so I told her that I thought it was a virus, but that I was on my way to get the real professional.

NYC take II

I've been trying to find a church around here, but the general impression that I'm getting of New Jersey is that they don't really like Protestantism. Or English speaking Protestants, at any rate. I was hoping that I'd be able to find a church within walking distance of my apartment, because walking to church sounds so quaint, and it means that I don't have to move my car.

Unfortunately the churches within walking distance are all 1) Catholic or 2) Protestant in Spanish or Arabic  or something equally as un-English (unhelpful, considering that I took French for 5 years and seemed to have retained only the ability to say my name and ask where the library is).

I found a church about 10 minutes away that looked decent so I went this morning. Or I tried to go. I swear. There wasn't a parking lot, so I spent 20 minutes trying to find street parking, but all the non-resident-only parking was full (of course).

So I apologized to God and decided that I'd go worship at the Church of American Consumerism instead, otherwise known as Wal-Mart. I plugged the address into my GPS and took off. I got about a mile down this highway-ish road that suddenly split off into two roads, but Judy the GPS didn't really think it was necessary to warn me that I needed to be in the far left lane on this 6 lane interchange thing. Needless to say, I was not in the left lane, or anywhere near it, and I ended up in the toll lane for the Lincoln Tunnel into NYC.

I sat in the stupid toll lane traffic trying to decide whether or not I was going to cry. The problem with not knowing where you're going in New Jersey, is that making mistakes is expensive. So I got to pay $8 for the privilege of driving under the Hudson River for two miles and ending up in Manhattan. I sat in traffic (at noon on a Sunday, seriously?) for 15 minutes until I could get myself back to the Lincoln Tunnel and back to Jersey. But, hey, I can now say that I drove in NYC and I didn't die, in fact, I mostly just sat at a complete stop and looked at all the really tall buildings.

And I won't be skipping church next week, that's for sure.

Toto, I don't think we're in Kansas any more...

I went into New York city today and walked around. I've never been before, and NYC looms so large in my mind as the biggest, brightest city on earth that it was almost a letdown to realize it is basically like every other big city I've visited. Almost...

Right out of the subway tunnel, there was a huge farmer's market and tons of people milling around in the amazing weather. Little old men were challenging passersby to play them in chess. A woman was sitting on the ground telling fortunes and reading tarot cards.

I walked around Greenwich Village, which has some of the most beautiful, old architecture. I love taking photos of old buildings, and I would have, had I not forgotten my camera. I'm clearly awesome at being a tourist. The camera on my phone had to be sacrificed in order to conserve the pathetic battery, because Judy the GPS needs a lot of energy to live and I never know where I am.

I also went to the Strand, the home to 18 miles of books, which made my inner nerd happy. And my outer nerd.

I met up with a couple of other Kirksville survivors and a couple of their friends for dinner and drinks. Everyone at the table, excluding myself and my roommate, graduated from KU, which meant the night quickly dissolved into arguments over whose state was responsible for the border skirmishes during the Civil War. Again with the nerdiness. There was also a lot of Rock Chalk Jayhawk chanting going on. I threw in an MIZ-ZOU chant, but really I have no school spirit, I was just feeling outnumbered.

So that is how the only picture I took on my first excursion into NYC ended up representing the Midwest...

The Enemy

I made it to New Jersey alive. My parents and I drove all my stuff here in a two day trip that was exactly like The Griswald Family Vacation if the Griswalds drove 16 hours in one day and were only allowed to stop 4 times.
When we made it to my apartment, my dad took one look around and immediately started campaigning for residencies as far away from the East Coast as possible. Well not quite, because that would mean the West coast, which is almost as bad.

I think the thing I was most worried about was going to be the driving. My roommate told me about the unofficial motto of New Jersey drivers, which is: one foot on the break, the other foot on the gas, one hand on the wheel, and the other hand flipping of the other drivers. I can safely say that this is a pretty accurate description.

New Jersey drivers (and I'm assuming most East Coast drivers) are like dogs: they can smell your fear. If you hesitate for even a fraction of a second and they'll start biting your heels  honking and using the shoulder to speed around you because your license plate says Missouri and obviously you are completely inept at life.

This works out well seeing as how I have no idea where I'm going. Other than attempting to drive in a large city while missing the gene that carries directional skills, driving here isn't too bad (granted I haven't actually been out during rush hour, so I'm holding judgement). People here are good drivers and they just kind of go, which in some ways makes it easier to drive here than St. Louis, where everybody must own stock in break pads given how much they enjoy using them.

The real problem here is parking. I park on the street outside my apartment and the street sweeper comes through four times a week and everyone has to go out and move their car from 10 to Noon . It sounds easy enough except I keep forgetting which side of the street has to move.

Yesterday I went out to check on my car only to see that it was the only one left on its side of the street. Not a good sign. So I run in and get my keys. When I went back out to move my car the meter maid that drives in front of the street sweeper, like the harbinger of death, was heading down the street. I made it to my car and drove off just as she pulled up to give me a ticket! Take that New Jersey Transit Authority. The good news is that this won't be an issue when I finally start working. The bad news is the first day I'm post call and I'm trying to sleep during the day I'm going to get a ticket.

Here's the other problem related to parking. I cannot parallel park. The only time I have successfully parallel parked was in the Drivers Ed car in high school. And that was only because there was a football player in the passenger seat telling me exactly what to do. I even failed that section of the driving test and the crazy DMV lady still passed me!

The people here are like parallel parking wizards. They can park in spaces that leave about 6 inches between each bumper. I don't even understand how they can pull out of spaces like that. I mostly just drive around until I can find a place where I can just pull straight in. I went to the library the other day, and after 10 minutes of driving around, it became very apparent that if I ever wanted to stop driving I was going to have to parallel park. So I drove around until there wasn't anyone driving up behind me because I did not need the extra pressure of some impatient person behind me (it's like vehicular performance anxiety). It took me 5 minutes and a 60-point turn to get into the space, but I finally made it.

Pictoral Evidence

I was still about 18 inches away from the curb. I got out of my car and there was this guy sitting on his porch laughing at me. Glad I could provide some entertainment for your smoke break, dude.

Do you think there are driving schools that offer remedial parallel parking?

9 Days or I'm not sure I even remember my name anymore

   I'm moving to New Jersey in less than a month. And I take my first Boards in 9 days. Holy crap. My apartment is basically in boxes and I wear the same clothes multiple days in a row mainly because they happen to be the ones on the floor closest to my bed. Today was the first time I had been outside my front door for a reason that did not include MORE CAFFEINE in three days. I also thought today was Wednesday for about 5 hours until I opened my computer and realized that it's actually Wednesday + 2.

   I wake up in the middle of the night because I've forgotten the most common type of thyroid cancer (papillary) and then I can't fall back asleep until I get up, find my First Aid (the all-knowing study guide of Step 1) and look it up. Then I do the same thing about an hour later because I've forgotten the name of that drug that turns people into smurfs (Amiodarone). Obviously I'm not smart enough to just sleep with the damn book next to me so I wouldn't have to get up 15 times. And why haven't I been sleeping with it under my pillow for the last two weeks?!

   If you're reading this, so, basically, my mother, you know me, which means you know I'm neurotic and this shouldn't surprise you. I have slept with the notes for every medical school test under my pillow the night before. You know, just in the off chance that osmosis works on more than just water. I had better not fail the Boards because I just jinked the dirt. Thankfully, I still have 9 more nights to make up for that lapse in judgement.

Everyone in my class is starting to drift off to their new cities, two or three at a time. The prevailing sentiment is along the lines of "Get me out of this hellhole." I don't disagree, mainly because this place is a pretend town, with the budgetary licensing for 150 blinking stoplights but only 1 snowplow. Also there are no Targets and way too many coffee shops that close at 5 pm.

But I'm also going to miss this place because small towns are weird, and I like weird.
Here's what I'm going to miss:

-Windchimes made out of coat hangers and Natty Lite cans (I'm still mad at myself for not taking a picture with my phone)

-Barbeque grills on house roofs (again with the pictures)

-Driving behind a truck pulling a small wooden house behind it. (and again. Seriously, what is wrong with me.)

-Awkwardly seeing my professor at the grocery store in the middle of the day, knowing that we're both skipping school.

- A place where the townies' idea of a good time is hanging out at the Kum 'n' Go gas station, sitting on the hood of the car with your friends, smoking a cigarette and listening to the radio blasting out of your open windows.

- A place where they name the gas stations Kum 'n' Go.

-Being able to go home and see my parents without involving aerial deathtraps. Moving half way across the county means I actually have to get in a plane alone. During landing and takeoff, I tend to spazz out, with visions of fiery crashes dancing in my head. I don't think people enjoy having random strangers holding their hand in a bone-crushing grip. On the other hand, some day I'm going to be on a plane when their flight attendant asks if there's a doctor on board, and it's going to be awesome. It's the little joys in life... Also moving far away means that I'm no longer three hours from home and can't go visit my parents just because.

-Going to the gun range to shoot my old class notes. This is what happens when a good portion of your classmates are on military scholarship, own enough firepower to take over Russia, and have a lot of residual hatred toward Anatomy.

-Rednecks, because, seriously, how ridiculous are they? This town is so full of them that the electric billboard outside of the pharmacy here posts helpful tips on personal hygiene that involve things like wearing deodorant showering daily. I might be losing the rednecks but I'm gaining the "Jersey Shore" type people that I suspect are running rampant around NJ. They must be the East Coast equivalent of rednecks, right?

-The Blue Bunny Ice Cream golf cart: Kirksville is way to weird to have an ice cream truck. Instead we have some woman with an old golf cart retrofitted to hold a small freezer, which she drives up and down the streets. It's the Pinocchio of ice cream carts: "I'm real. I'm a real ice cream truck!"

All in all, I'm excited to be going somewhere new, experiencing a different part of America, all while hopefully not driving into a pothole the size of the state. It's been fun Kirksville. See you in a year.

My compost pile hurts to much to title this

Man, I never update this anymore (I think this is exactly how I started my last post 2 months ago). Once again, it's  because the only thing I do is study for the Boards. I better pass these suckers because this much studying has to be akin to Chinese water torture. And why do I need to know the clinical presentations of von Hipple Lindau syndrome and Neurofibromatosis when I'll probably never see a case of either of these ever. Why can't they ask me things like "What is diabetes?" or "What virus causes Influenza?" You know, useful things.

In other news, I found a place to live in New Jersey! And I don't have to pay $1 million a month to live there either. I was worried that I'd never find a place and I'd end up like Callie on the first season of Grey's Anatomy, living in an on call room at the hospital. But, I have a place to keep my belongings while I work, so all is well. Now if I could only figure out how to magically transport all my stuff across the country so I don't actually have to rent a U-Haul...

At the end of every year here we have to do OMS testing. OMS testing serves a couple purposes. 1. It's the school's way of checking to make sure that they're not sending a bunch of socially inept idiots out into the world. 2. It's a fun way for them to combine time-wasting and torture together in a 3-hour package.

We repeat this morality test every year while they track the progress of our moral reasoning. Apparently studies have shown that residents score progressively worse on these tests as residency beats the soul out of them. Our school is apparently trying to provide a little prophylaxis that. I'm fairly certain I'm getting more amoral each time we take the test. By 4th year, they just might not graduate me because I think that Joe should go all Robin Hood on the rich guy in town to feed his starving family while all the other families try to make tree bark soup. Seriously, I could be memorizing the 7 most common causes of hypercalcemia and I'm ranking how important I think Joe's tree-bark soup recipe is to my moral judgement of his predicament. I wish I was joking, but I'm really not.

Then we have a really long afternoon of playing doctor with "patients" hired from the community to pretend they have an STD or intermittent claudication of the right calf or something. This is always a fun time full of trying to remember the 16 special tests I'm supposed to perform on the leg or trying to decide whether the fact that I can't get this patient's patellar reflex is A) because I'm incompetent, B) because his character is supposed to have an absent reflex, or C) because the actor actually has an absent reflex. It's mentally exhausting.

Last year's cases were relatively simple, usually along the lines of, "Doc, the outside part of my elbow hurts." Hmm. Sounds like  lateral epicondylitis. Let me pretend to do some tests while you pretend your arm really hurts.

This year, not so much. This time my cases were more like, "Hey Doc, I'm really tired and I coughed once a couple months ago. What'd you think is wrong with me?" Do you know how many diseases can make you feel tired? Basically every single one.

I know that this is more like real-life medicine, but I'm not a real-life doctor yet. My brain feels like one of those really nasty compost piles, full of all sorts of random pieces of medical knowledge that I don't actually know how to put together. Except hopefully my brain smells better. Trying to remember to ask and do everything about a simple diagnosis is one thing. Trying to ask about about risk factors and symptoms of lung cancer, heart disease, leukemia, lymphoma, tuberculosis, old age, walking pneumonia, etc, is a monumental task still. However, it was kind of a nice surprise to realize that, while my brain kind of felt like it might combust from trying to organize the most likely differential diagnosis, I could actually come up with a differential diagnosis. Meaning, there weren't just a bunch of bees buzzing around my skull while I yammered out random questions hoping to stumble into a diagnosis. It's not a bad feeling to realize that I actually know a thing or two.

Here's the good news: I actually know what I'm doing about 10% of the time, which is up from about 2% this time last year. Here's the bad news: there's still that other 90% to deal with. That, and I forgot to ask about anemia. Dang it.

Dermatology, or "The class to which I'm most likely to lose my lunch"

I haven't posted here in forever. Mainly because who wants to hear about how I sit on my couch 8 hours a day and look at pictures of colons and cancers (Of shoes--and ships--and sealing-wax--Of cabbages--and kings).


But here are a couple random observations from my dermatology notes: 

1. A little political commentary with our fascinating discussion on Rosacea...

2. The first two years of medical school are all about staying as far away from patients as humanly possible. The point is to learn, in theory, everything there is to know about medicine in the classroom (or on my couch, since I no longer actually go to class). In an effort to keep all their students from dying of sheer boredom, professors like to put lots of pictures into the PowerPoint's. It's all well and good until you have 1500 slides to memorize for a final, at least 16 of which are pictures of freckles. Seriously? If I needed  that many pictorial reminders of what freckles looked like, should I still be in med school? 

Fun medical fact of the day: the medical term for freckles is ephelides. My new favorite medical term, along with dysdiadochokinesis.

There are bazillions of pictures on the Internet that doctors have taken of their patients' weird-ass disease manifestation. I'm not exactly clear on how it doesn't violate HIPAA to put these pictures on the Internet. Maybe that's why they do this...

Because obviously those creepy black ovals over the patient's eyes totally protect his right to privacy. Now he just looks like a demon with really bad acne. But at least his identity is safe.


Here's some free medical advise from me to you: when the doctor comes in waving around a camera, and an expression on his face akin to that of someone who's just won the lottery: Say no. Because as soon as you leave he's going to call all his other doctor friends over to brag about whatever rare medical phenomenon he just witnessed. And then he's going to upload it onto Google.

Also, I feel the burning need to share that I wasted way too much time today reading all the insane things that Charlie Sheen has been saying. The man is bat-shit crazy. His narcissistic personality defect is overshadowing the crisis in the Middle East, which is just pathetic. If he truly is only "high on Charlie Sheen" as he so eloquently put, then maybe he should take one for the good of humanity and call his dealer.