Monday, April 11, 2011

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.