Saving Lives and Stamping out Disease

OBGYN at the WIZ with Placenta Recipes!

I am currently in the OBGYN course of my Surgery block and in the few short days that I have been at the Wiz, I have experienced a great deal of INTERESTING patient care experiences.  Among these experiences was the introduction of placental recipes into the a person's diet.  Yes, people eat placenta.   While I have not partaken of such cannibalistic  fare, here are some recipes for all to enjoy. Got your own recipe involving birth remains?  Share it in the comments! 

Video

Placenta Cocktail:
1/4 cup raw placenta
8oz V-8 juice
2 ice cubes
1/2 cup carrot.
Blend at high speed for 10 seconds

Placenta Lasagna:
Use your favorite Lasagna recipe and substitute this mixture for one layer of cheese.
In 2 tbl. olive oil, quickly saute meat of 3/4 placenta, ground or minced; plus 2 sliced cloves of garlic, 1/2 tsp. oregano, 1/2 diced onion & 2 tbl. tomato paste, or 1 whole tomato.

Placenta Spaghetti:
Cut meat of 3/4 placenta into bite size pieces, then brown quickly in 1 tbl. butter plus 1 tbl. oil.
Then add 1 large can tomato puree, 2 cans crushed pear tomatoes, 1 onion, 2 cloves of garlic, 1 tbl. molasses, 1 bay leaf, 1 tbl. rosemary, 1 tsp. ea. of salt, honey, oregano, basil, and fennel.
Simmer 1 1/2 hours.

Placenta Stew:
Meat of 3/4 placenta in bite size chunks, 1 potato (cubed), 1/4 cup fresh parsley, 2 carrots, 3 ribs celery, 1 zucchini, 1 large tomato, 1 small onion.
Dredge meat in 1 tbl. flour mixed with 1 tsp. salt, 1/2 tsp. paprika, pinch of cloves, pinch of pepper, 6-8 crushed coriander seeds.
Saute meat in 2 tbl. oil, then add vegetables (cut up) and 4-5 cups of water.
Bring to full boil, then simmer for 1 hour.

Placenta Pizza:
Grind placenta.
Saute in 2 tbl. olive oil with 4 garlic cloves, then add 1/4 tsp. fennel, 1/4 tsp. pepper, 1/4 tsp. paprika, 1/4 tsp. salt, 1/2 tsp. oregano, 1/4 tsp. thyme, and 1/4 cup of wine.
Allow to stand for 30 minutes, then use with your favorite home made pizza recipe.
It's a fine placenta sausage topping.

Placenta Roast:

INGREDIENTS:

1 to 3 lb. placenta no more than 3 days old
1 large onion
1 large green or red pepper (green will add color to the presentation)
1 cup tomato sauce
1 sleeve of saltine crackers
1 tsp crab or shrimp seasoning
1 tsp black pepper
1 tsp white pepper
1 clove garlic (roasted and minced)


DIRECTIONS:

Preheat oven to 350 degrees.

Chop onion and green or red pepper in small cubes. Place in large bowl. Crush saltines into crumbs and add to onion and pepper cubes.

COMBINE IN LARGE BOWL:

Placenta, seafood seasoning, pepper, garlic, and tomato sauce. Place into aluminum loaf pan. Cover and bake for 1 and 1/2 hours, occasionally pouring off excess liquid. Retain liquid for gravy base if desired.

Spicy Australian Placenta

* 250 grams of fresh human placenta, chopped into fine strips (about half of the placenta from a 6.6 pound baby, or 1/3 from a 9.9 pound baby)
* 1 onion
* 2 cloves of garlic, chopped.
* 1 tablespoon of olive oil
* rosemary
* salt
* pepper
* cumin
* rice noodles
* red chile
* Shallots

1. Cook onion in olive oil until it is transparent.
2. Add chopped garlic.
3. Toss in placenta.
4. Cook quickly.
5. Add a dash of fresh rosemary and 1/2 teaspoon of cumin.
6. Add a pinch of salt and ground pepper to taste.
7. Place on a bed of rice noodles and garnish with thin slices of red capsicum and shallots.



Placenta with Broccoli
* 1/3 cup chopped fresh human placenta
* 2/3 cup chopped broccoli
* 2 egg whites
* 1/8 t thyme
* oil for frying

1. Wash the placenta well, in a colander, then shake it to drain. (it will still leak juices)
2. Stir the egg whites with a fork until they are without lumps.
3. Mix all ingredients well, squishing them by hand.
4. Add a decent amount of oil to a suitable frying pan.
5. Set a burner to high heat, and put the pan on it.
6. Start frying, stirring as if stir-frying or scrambling an egg.
7. The small amount of liquid (seeping from the placenta, plus the egg whites) will come to a boil. You might turn down the heat slightly at this point.
8. Let the liquid boil away and/or solidify onto the broccoli and placenta.
9. When it looks yummy, serve it.

Technorati Tags: medical school, placenta, recipes

Communication in Medicine - How Not to Be a Dick.

The world of medicine is a strange one, filled with strange people doing strange things, usually because someone did something...  well strange.  Where else in society is it acceptable to cut others with knives and shoot them full of drugs(Amsterdam and Tijuana excluded of course)? It is only logical that this world would have its own language and communication style.  Here is a glimpse into the bizarre world of communication in medicine and how not to be a dick poor communicator while you are in it.

STRANGE WORDS
We have strange words in medicine.  They were created to make us sound a lot smarter and to shorten things up. For example, the current mainstay procedure for the correction of an inflamed gallbladder is a laparoscopic cholecystectomy.  It shortens up significantly the following: "Poking holes in the patient sticking cameras and scissors in there, then yanking the little bastard sick gallbladder out.  It saves time, but apparently not enough time.  They are often referred to as lap-chole's.  This is, of course, much shorter.  The logical conclusion will be that we are eventually going to call them LCs or perhaps just make clicks and whistles. There are other words we throw around that will frequently leave normal people looking at us like we have two heads (polycephaly).  Dyspepsia is not in fact a painful soft drink, it is indigestion. Pleurisy is not a condition that means having more than one of something, it is the inflammation of the lining of the lungs.  My favorite is pachycephalic which means "thick skulled" or "thick headed" I am surprised that this is not a term used to describe members of the medical community.  Throwing around strange words in front of people without explaining them is not the sign of a good communicator.  Often, physicians forget that everyone does not have the same fund of knowledge that they do and will entirely confuse a patient.  If you are a patient, ask them what they are talking about.  They obviously need to explain things better.   If you are a health care provider and continue to assault patients with medical lingo despite reading this, you are likely a dick poor communicator.

STRANGE ABBREVIATIONS
Only in a special group of people would "PT OOB TID" make any sense. It stands for Patient Out of Bed Three Times Daily and is not, an anagram for anything else.  (I now wonder how many people are looking to see what words can be made from those letters)  FOOSH is not a type of nerf toy, rather it stands for "Fall on Outstretched Hand". PERRL is not a programming language or the precious stone found in an oyster, it is "Pupils Equal Round and Reactive to Light".  It is no wonder many patients get confused when we discuss their care in front of them.  It is my opinion that any discussion of a patient's care done in front of the patient should be done in a language that they can understand.  Does this always happen?  Nope.

STRANGE MEDICAL SLANG
Truthfully this is my favorite because it shows the creativity of health care workers.  There are many "Codes" in the hospital.  While a "Code Blue" means cardiac and/or respiratory arrest, CODE BROWN means poop.  "Frequent Fliers" are not passengers on airplanes; rather they are patients who frequent medical establishments with irritating regularity.  Vitamin "A" and "H" are code for ativan and haldol. ART (Assuming Room Temperature)  and FTD (Fixing To Die) are slang for patients who are dying.  There are a whole host of similar and even more humorous creations in existence and none of them should be used in front of patients or on any form of documentation.  They are often rude, unprofessional, and not conducive to providing appropriate care.  These are also exceptionally unpleasant things to have to explain in court if you should have to testify regarding a patient.  "Your Honor the T:T ratio is certainly not the Tattoo to Tooth ratio, rather it is ......."  Have I seen these used in front of patients?  Yes.  Have I seen them used on documentation?  Yes.  If you routinely use these slang terms around patients you will quickly lose their respect as well as the respect of others.  You are also likely a dick poor communicator.

STRANGE PATTERNS OF COMMUNICATION

Medical personnel have odd patterns of communication.  Where else can two people be carrying on a conversation and stop, midsentence, and leave to do something.  Seriously, watch sometime.  It is great for people with ADD (like me) who can switch thoughts and tasks instantly and without thought (not that I think much).  For those who actually like fully communicating thoughts and information, it can be very painful to get used to.  Physicians in hospitals also have serious timing issues.  Were you to go to someone's home, a hotel, or tent at 5:30 in the morning, wake them up, and ask them a multitude of questions about their pain, condition, and general well-being you would likely be cursed at, beaten, or shot.  There is a fair amount of confusion among physicians regarding this.  It is a practice that has been perpetuated for years and leads to multiple rounding on patients because "they just weren't mentating".  Perhaps if patients were awake when doctors interacted with them, better results would be obtained.  Of course this is likely not true for anesthesiologists who tend to like to have sleeping patients.  Finally, there is inter-professional communication.  This includes but not limited to physician-physician, physician-nurse, and physician-student communication.  Excellent docs are ones that can effectively communicate their thoughts to others and see that they are carried out to the best interest of the patient.  Other professions feel empowered to do their jobs and are a part of the team.  Students feel like they are making a difference and learn a great deal more. It was once explained to me that learning that involves an emotional response leads to better retention.  That response can be positive or negative, it is just easier and faster to elicit a negative one.  It takes time and thought to make the experience positive and there are a significant number of physicians who have a problem with this.  While the majority of docs are, at least, fair communicators, the real stinkers leave a lasting, if not painful, impression. The "praise in public, criticize in private" method is a good model.  Publicly dressing down interns, nurses, and others trying to provide care is not good communication.  If you are one of these individuals, I highly recommend you recognize the behavior and take steps to correct it.  If not, you are probably a dick poor communicator.

Enjoy these links to interesting medical slang!

http://slangrn.com/

http://www.womenshealthmag.com/node/2560

http://www.cracked.com/article_16302_8-medical-terms-your-doctor-uses-insult-you.html

Professionalism

Professionalism is a loaded term that is often used to describe businessmen, doctors, lawyers, and people who tend to wear suits a lot.  The dictionary defines it as "the conduct, aims, or qualities that characterize or mark a profession or a professional person" and "the following of a profession (as athletics) for gain or livelihood".  A profession, itself, is defined as "a: a calling requiring specialized knowledge and often long and intensive academic preparation b: a principal calling, vocation, or employment c: the whole body of persons engaged in a calling".   Suffice it to say that those of us engaged in the practice of medicine are, indeed, professionals.  We spend more time in school than any other group and command a body of knowledge that is so staggering that we have developed specialties to deal with their delicate intricacies.  In my time participating in the health care system, I have had the fortune of seeing  many professionals practicing their art that truly  give medicine it's noble image.

There is a significant number of people out there who vilify physicians as greedy opportunists who only are in the profession to make a buck.  While I agree that there are always some bad apples, the overwhelming majority of doctors are exactly the opposite.  .

Here are the Top 10 Qualities of a Great Medical Professional according to www.medicalschools.com.
1. Has a Good Bedside Manner: A great medical professional has a good bedside manner and makes patients feel comfortable and at ease during exams and treatments.

• The vast majority of physicians that I have encountered have made a very concerted effort to put patients at ease.  Patients are able to take a more active role in their care when they are comfortable with their doctor and physicians certainly recognize that.
  

2. Has a Sense of Empathy: A great medical professional has a strong sense of empathy and understands what it is to feel pain and suffering. They are supportive and have a genuine interest in improving a patient's well-being.

• Physicians are constantly putting themselves in the place of their patients and trying to evaluate what is best for those they are caring for.  Sometimes this is hard because there are some really painful situations and it is possible to get a little too close and lose objectivity.
  

3. Has Great Communication Skills: A great medical professional has excellent communication skills. They can explain complicated medical terminology in laymen's terms to the average patient. They also have excellent listening skills and take the time to understand what a patient's needs are.

• Doctors take great pains not to use jargon so that their patients will understand their instructions and explanations.  Timing plays a big role too.  More than once we have rounded a second or third time on a patient to make sure that they were awake enough to participate in their care.
  

4. Has Sharp Problem Solving Skills: A great medical professional has excellent problem solving skills and can quickly determine solutions to problems. Working in health care, by definition, involves solving problems of the human body.

• Physicians thrive on their ability to solve problems both great and small.  If they can't figure it out, they have the ability to find someone who will.  The human body is a very complex organism and presents a number of challenges.  I have had the good fortune to see both medicine and surgery teams work in collaboration to solve strange and unusual issues.
  

5. Is Always Very Thorough: A great medical professional is always very thorough in their work. They recognize that the smallest oversight can have grave consequences and therefore are sure to cover all the bases in everything they do.

• Modern physicians are thorough, sometimes to a fault.  Often they will order extra tests, repeat exams, and collaborate with other doctors on cases that trouble them.  They are always concerned with missing something.  Not just in regard to liability, doctors are terribly worried that they will miss something and their patients will suffer needlesslty or, worse, suffer harm.  I've seen doctors reduced to tears when they have made a mistake.
  

6. Offers Support for Patient Decisions: A great medical professional acts as a partner with a patient in treatment decisions and understands that ultimately, all decisions lie in the hands of the patient. They offer full support of patient decisions.

• I have seen this be very hard for some physicians when they believe that the patient is making the wrong decision.  I have also seen every single one of them identify the patient, accept their decision, and support them in their care. 
  

7. Offers Time to Patients: A great medical professional spends adequate time with their patients and never rushes through an exam during a busy day. They give each patient enough time to make a proper diagnosis or to offer a thorough treatment

• This is harder today for high volume services, but I see doctors doing their best every day to see that their patients get the best care possible.  Often, this means that the doctor in question misses out on things like bathroom breaks, lunch, dinner, and family time.
  

8. Possesses Significant Knowledge: A great medical professional has extensive knowledge of the human body and its ailments. They are not afraid to admit when they do not know something and will either research it or refer a patient to someone better qualified.

• Physicians are required to have a tremendous body of knowledge and they use it every day.  They also recognize that there are others with more knowledge in certain areas.  In the emergency department I have seen this most of all.  There is a tremendous symphony of multidisciplinary collaboration that renders the absolute finest care possible.
  

9. Possesses Strong Sense of Ethics: A great medical professional has a strong sense of ethics and never compromises their integrity or values.

• Physicians have a tremendous responsibility to their patients and their profession.  They consistently keep private an overwhelming amount of confidential information.  They put their patients needs above their own with incredible frequency.  It is in cases like the Michael Jackson death that we see where a physician has failed in this sense.  Of all the excellent doctors in the world, it only takes one to make us all look bad.
  

10. Pursues Continuing Education: A great medical professional recognizes that the medical field is full of new research and developments, and they stay on top of everything new in the field. They read research journals and take training classes to stay current.

• Doctors are always learning.  They incorporate new ideas and techniques from colleagues, journals,conferences,  and personal experimentation.  Many states require continuing education but many doctors routinely exceed the minimum standards by leaps and bounds.

No other vocation in the world has such a wide dynamic to their profession.  I would argue that if professionalism were defined in terms of responsibility and sheer number of qualities that it incorporates, physicians are the most professional professionals of all.



Technorati Tags: physician, professional, professionalism, medical school

USMLE Step 1 Scores Released

USMLE Step 1 Curve Explaination.

After weeks of stress, nausea, and second-guessing, we finally got our scores for USMLE Step 1.  I took mine a couple months ago and it only took them 6 weeks to get the results of their computerized exam.  For $500 per exam, I would think that they would have more than a Commodore 64 crunching the numbers.  The national average was 221 +/- 6 points.  Overall, I am ok with my results.  Sure, I would love to have done better, but I never planned to be a rocket surgeon. With my painfully average score, I am freed from that choice.

Technorati Tags: USMLE Step 1, curve, USMLE, step 1, medicine

Plastic Surgery Wrap-Up

After 4 weeks, I am finally finished with plastic surgery and have completed exactly 2 elective cosmetic procedures.  Neither of these were boob-jobs.  I feel really comfortable with skin grafts, wound care, the basics of hand surgery, and flap theory.  I had the privilege of helping several women regain their breasts after a mastectomy and help put hands back together.    I assisted in helping rebuild half of a man's head and doing a lot of suturing.   Plastics is a lot more than cosmetics and deserves a great deal more respect than it gets in the general population. The majority of the physicians I worked with spend a crazy number of hours providing life-changing surgeries to very needy people.  I respect them a great deal.  I also recognize that surgery is not a lifestyle that I am ever interested in.  It demands more time away from a family than I can abide by and it is both physically and mentally draining.  I am very thankful for those who choose it as their profession so I do not have to.  They truly earn their money at the end of the day.

Let's share some nuggets of wisdom from the plastic surgery rotation.

#1 Every single day in clinic there will be someone who tries to scam free breast augmentation / abdominoplasty and/or  breast lift.  They will try to coerce the surgeons into insurance fraud.  They will make a passionate plea and give examples of friends who were successful at their scams.  These people are politely shot down and provided with an elective cosmetic price list.  (surprisingly it really isn't as expensive as you would believe)

#2 People in Indianapolis (and likely many other major urban areas) get shot in the hand a lot.  This always occurs while minding their own business, before/after bible study, and visiting a grandmother is usually involved.  It is always "some dude" that does it every time.  In greater than 50% of these cases they will have been shot previously.  This proves several things:
A.  People in Indy need a lot more target practice.
B.  Never mind your own business
C.  Never shoot someone with a caliber of bullet that is not start with at least a .4  or has magnum in the name.
D.  There are a lot of grandmothers that live near dudes that like to shoot people.  Avoid grandma at all costs.... your life may depend on it.
E.  Some Dude is an asshole

#3  Plastic surgery is an art.  It requires a great deal of skill, vision, and artistry.   There are different kinds of artists.  One is a sculptor chiseling David from marble.  Another is a large, hairy, bearded man with no shirt that cuts large logs into bears.  Plastic surgeons should strive to be the former rather than the latter.

#4  Many people (physicians included... yes they are people too) have a magical belief that plastic surgery is a mysterious cabal of flesh crafters that can create super-physiological results.  This is totally untrue.  A substantial amount of the modern view of plastics is based on a totally ridiculous fantasy perpetuated by the media.  A cursory review of what plastic surgeons do will prove this.  Yes, it is highly skilled.  No, it is not at all magic.

#5 Fasciotomies when done well can save limbs.   Fasciotomies done poorly make the initial surgeon look like Hannibal Lecter and piss off plastic surgeons when they have to cover them with skin grafts unnecessarily.  I never ever ever ever ever want a fasciotomy.....   ever...


Now it is on to anesthesia....  the land of milk and honey (diprivan and fentanyl).  

Technorati Tags: plastic surgery, medical school, indianapolis

Going off the DIEP End - Plastic Surgery in Medical School

I have to be honest, I didn't choose plastic surgery as my first surgical sub-specialty.  I wanted the trauma service.  I had plastic surgery ranked 3rd out of 3.  Truthfully, I put it because I thought it would be great as far as hours go and full of boob jobs and lipo.  Essentially, I thought it was going to be easy.  I was quite far from the truth. 

Plastic surgery is much more than cosmetics. Here's a typical day:
4:45 am   wake up SSS
5:30 leave for the hospital
6am  rounds
6:30 lecture/rounds
7:30  finish rounds/go to M&M  or grand rounds or Or
8:00/8:30  OR time / Clinic Time
See new consults on the floor
See consults in the ER
More OR time
See new consults on the floor
See consults in the ER
More OR time
9-10pm  leave

Notice there isn't any lunch in there....  and that goes into some nuggets of wisdom I picked up there
Rule #1  Eat When You Can
You will never be paged and told that you haven't eaten that day and should get a bite.
Rule #2  Sleep When You Can
You will never be paged and told that you haven't slept that day and should get a nap in.
Rule #3 Never F**K with the Pancreas
Seriously, it is like frozen cottage cheese and there is rarely a good outcome.


I have seen some amazing things.  I can't tell you how many skin grafts we have done.  I think I could do them on my own now. They are surprisingly easy to do.  Flaps are AMAZING and very time consuming.

Observations
Good Nurses Keep Medical Machine In Motion.  Bad Nurses Keep Patients in the Hospital Longer and Make Doctors Angry.
Coming from a background in Nursing, I am very sympathetic toward nurses.  I will cut them a lot of slack and do my very best to work with them as a team in the care of patients.  Stupid or lazy nurses, however, seriously piss me off.  There has yet to be a day were I have not discovered serious neglect on the part of the nursing staff for at least one patient.  Skin assessment is exceptionally lacking.  I also used to wonder why orders were written:  ACCURATE I&Os.  I no longer wonder why.   Some nurses have obviously made them up.  While many of my colleagues and I would hemorrhage from the eyes at the thought of doing such a thing, others have demonstrated that they have no such feelings.

Good Surgical Techs are Worth Their Weight in Gold.  Bad Surgical Techs are Worse Than Doing it all on Your Own.
When the techs are actively engaged in the surgery, there is a harmonious flow of instruments and the procedure is both efficient and expedient.   When they stand there staring off into space with their thumbs up their asses (which does in fact break the sterile field) and are uncertain what their instruments are, the symphony that is the surgery comes to a grinding halt.  Fortunately, the vast majority of surgical techs that I have worked with are exceptiopnally skilled professionals.  The 1% that were not made....  an impression.

Flaps Are Amazing
I had the good fortune to participate in a DIEP flap proceedure.  There is an excellent write up of the proceedure at www.microsurgeon.org/diep.html that explains the basics.  We were able to reconstruct the breast of a woman the same day that she had her mastectomy.  She was very pleased with the result and it was exceptionaly rewarding.  I suppose you could call it a "boob job"  but it is unlike anything I have ever had the honor of participating in. 

Many Old School Docs think Many New Docs are Whiners
There have been extensive discussions about the 80 hour week that was mandated for residents.  The consensus of the older staff docs is that it is crap, and that anyone for it is more or less a whiner and a sissy that supports a shorter work week.  It is anathema to speak in favor of better working conditions in front of the attendings.  When they are out of the room, however, the true feelings are shared.  FYI today is the first day that I have not violated the 10 hours between shifts rule this week.

Sutures are Fun
Most medical students are either retractor bitch or suture cutting bitch.   Also you will never retract in the correct spot with the appropriate amount of tension and your suture tails will be slightly too long or too short.  Once you accept this you can move on to actully being useful.  If you show that you are reasonably competent, you can do a surprising number of things.  Interestingly enough, I have managed to convince the fellows and attendings that I am marginally intelligent and that there is a low probability that I will kill or disfigure our patients.  Suturing is a lot like mowing grass, you can really tell that you have done something when you are done and it is very satisfying. 


More to come as I decompress from the previous 2 weeks of material.






Technorati Tags: medical school, plastic surgery, demotivator

Bad Blogger - No Biscuit

My bookworm, Helio.  Sadly, he was eaten shortly after this was taken.
(Not  by me... a bird did it)

It's been awhile since I've blogged.  Sadly, it was not due to some vacation in a tropical paradise or that I had inherited a substantial amount of cash.  I was actually studying.  Yes, I really was. Let's do a IUSM Year 2 Semester 2 After Action Report!

Systemic Pathology
Everything I needed to know for pathology was covered in General Pathology.  I would have been quite happy skipping systemic path.  I can't say that I got a lot out of it except more mileage on my car.  The shelf exam was ok.  I think that we could have covered the material in a much better way.  When I am a pathology director I guess I can make those changes.  Since I have no intention of EVER doing that, I suppose the status quo is going to have to stay.  On the bright side I do know that Blasto has broad based buds and that everyone in Indiana has histoplasmosis.

Pharmacology
In all, I have to say that pharmacology was a good course.  We covered a lot of material that I saw on the USMLE Step 1.  Unfortunately, after 7 hours everything gets fuzzy.  There were some  guest lecturers that weren't so hot, but we survived.  Dr. DiMicco taught us a lot, but he did manage to hide one frightening fact. His evil twin is Charles Manson.

Seriously, I doubt Dr. DiMicco ever knew Sharon Tate.  He's a good guy.

Introduction to Clinical Medicine
We learned the basic clinical exam multiple times over the year.  Sadly some people didn't get to apply it enough.  The fake OSCE was good practice, but I think it would be more beneficial for students to watch actual physicians perform the full head to toe on real patients as well as the medical students themselves.  Actually being examined by a professional would demontrate what the maneuvers actually feel like as well as build empathy for the patients themselves.  On the bright side, some people actually got to see a vagina in real life.  Welcome to the big boys club guys.  Also, now you have no excuse to stare at a V in an panicked sweat  trying to find the appropriate orifice to put the catheter.  Nurses now have every right to laugh at you.  


USMLE Step 1
I wish I had tossed the First Aid Book and done nothing but Goljian and Q-Bank.  I think I would have gotten a lot more for my time.  I also wish that I had written down the correct date and planned accordingly.  Oops...  The first 4 hours of the exam were pretty decent.  I felt alright.  The last three were generated by a sadist who peeked into my brain to find all the things that I do not know or like about the human body.  There is no reason to have 5 questions on hypothalamic nuclei in a row.   SERIOUSLY.  I vote now that all physicians dealing with neuro or neuro surgery get an immediate 10% pay increase so I don't have to ever deal with that crap again...  EVER...  I'm not concerned about passing.  I just want to get a decent score so I don't end up in Elk Snout Island doing an FP residency that was rejected by every other physician on the planet. 

When The Going Gets Tough, The Tough Kill Hookers... or Not

When life gives you lemons... or perhaps words that exist only in old versions of certain obsolete radiology texts written by your radiology professor... make lemonade!  If this works for you, it is a great thing.  Personally, the whole Pollyanna thing gets old.  I like optimism, but I'm old enough now to have seen that rainbows don't end with pot of gold, they end at Jo-Ann Fabric... and I have proof.

Personally I'll take my chances against scurvy and drink my kool-aid.  Stress relief comes in all forms.  Some people choose to embrace the suckiness and push themselves harder (often burning out or developing mental health issues).  Other people turn to drugs, alcohol, or self abuse.  While I enjoy self abuse, crossfit gives me enough to get by.  Drugs and alcohol have become entirely too expensive and tobacco kills you too damn fast.  Still others seem to skate by without so much as a ripple in their fascade.  These guys tend to kill hookers on craigslist when they finally crack. 

What do I do?  I bottle feed baby animals and cuddle small furry creatures.  Yep....  I bet you won't find that in the DSM-IV.  It has fewer fatal outcomes, you don't have to go on meds, and no dead hookers.  Sometimes medical school sucks. Actually it sucks more than sometimes, but we can all survive if we just find the right coping mechanisms.

Feeding my baby bunny "Tula"

The Whistle

In light of recent events at our hospital and at the medical school which I attend,  we had a discussion about personal safety.  Later in the evening, my son had some questions for my wife.  When my wife told me about it, I had to share it.  Here is their conversation:

Nick and I sat down in the van to go shopping, and Nick found a little plastic whistle that I was recently given at work and asked where I got it. I explained that, recently, there have been several incidents of bad people in the parking lots and garages at work. I told him the story of a co-worker who had his vehicle broken into while he was in the process of getting his belongings out of it. I explained how my co-worker hit the would-be thief and held him there until hospital security could show up and arrest him. Nick was concerned that I shouldn’t walk in the garage by myself, and I assured him that I was always very careful and always left work with other people who were walking with me. That was when I explained that the Managers at the Hospital gave all of us whistles. We were to carry them in case a “bad guy” bothered us while we were walking to our cars we could whistle for help. I asked him what he thought. His response went something like this:
Nick: Well, I don’t know, I guess it might be a good idea.
Christi: What do you mean by “Might Be”?
Nick: Actually, I don’t think it’s a very good idea, I don’t think it will help you.
Christi: Why not?
Nick: How can the security guards hear the whistles in the big garage?
Christi: They can hear the whistles if they are close, but there usually aren’t any security guards in the garage.
Nick: There aren’t?
Christi: No, not always, they just drive through the garage every hour or so to check for problems. But, the whistle wouldn’t necessarily only be to call security guards. What if you were visiting a friend in the hospital and you parked your car in the garage and were walking inside when you heard someone blowing a whistle? What would you do?
Nick: Well, I’d see if I could find where the whistle sounds were coming from and see if I could help the person, if they needed help.
Christi: OK. Do you think most people would do that?
Nick: No
Christi: Why not?
Nick: I don’t think most people would think that was their job or their responsibility.
Christi: Really?
Nick: Yeah, I don’t think they would help.
Christi: So do you think the whistle is a good idea?
Nick: No, I don’t think it will help you if you get hurt by someone,….. It’s just a nice free whistle.

At 9 years old, this little sheepdog pup has more thoughtfulness and insight than many grown men I have known. 

With that I give you my solution.

Clerkship Schedules Released!

BRING FORTH THE CLERKSHIP SCHEDULE!!!

COURSENUMBER	TITLE	START	STOP
INTERSESSION		6/17/09
93AN690	SURGICAL SPECIALTY/ANESTHESIA	6/18/09	7/21/09
93SG690	SURGERY CLERKSHIP	7/22/09	8/25/09
93GO690	OBSTETRICS AND GYNECOLOGY	8/26/09	10/2/09
INTERSESSION		10/6/09
VACATION		10/30/09
93YF690	FAMILY MEDICINE CLERKSHIP	11/2/09	11/25/09
93KI690	PEDIATRICS CLERKSHIP	11/30/09	1/29/10
INTERSESSION		2/1/10
93PS690	PSYCHIATRIC CLERKSHIP	2/2/10	2/26/10
93NR690	CORE CLKSHP-NEUROSENSORY	3/1/10	3/26/10
INTERSESSION		3/29/10
93MI690	MEDICINE CLERKSHIP	3/30/10	5/21/10

Clerkships were announced today and I am pretty happy with my results.  I really wanted to do surgery first and I got that.  The vacation month isn't super, but it beats a sharp stick in the eye.  Immediately after the announcement a flurry of trading emails were released by those who got hosed on their assignments.  I know it has to suck to be a student at a center and then get bounced around in 3rd year. Sorry guys.  Now we get to fill out a bunch more forms to request the facilities that we go to this summer.  It is going to be terrible trying to decide among the fine facilities here in Indianapolis. Truthfully, this is a terrible pain in the ass.  I don't know why this has to be so painful, but the powers that be make it so.  I would think that with the vast resources we have available that a simple interface would be available to make choices from a single screen.  Sadly, it is not so.  But don't worry gentle readers, baby ducks will make it all better.