Boston Drivers

Aaaaaaaaaaaaaaaahhhhhhhhhhhh!!!!!!!!!!!!

My car got out of the shop like three weeks ago. Doesn't look a day over 7 years old. And what happens when I park in the university lot? Some jerk rams the rear bumper this time. Putting a HUGE dent in it. No note, of course. I'd never expect any of these drivers to take any responsibility for their recklessness.

Are Boston drivers, like, born this way or do they actually learn to drive this badly???

I'm Moving?

I've been double posting on my blog here and on the account I have over at LiveJournal. It's all been the same stuff up until now. But I think I'm going to start posting the more personal stuff over at LiveJournal because I can protect certain posts from being read by just anybody. So - if you're inclined to read the more private stuff, just send me a request over at LiveJournal. If you just want to stick with the medicine stuff, then just stay here.

Mikey Gets Some Pointers

I've never done it before. Sensing my hesitation, the chief resident, Joe, gave me some tips on my first time:

Joe: Hey - it's okay, you know. We all go through this.
Mikey: I'm just so afraid of messing up.
Joe: It's so simple. You can't possibly mess it up. Just get in, do your business, then get out.
Mikey: I'm afraid it might hurt.
Joe (taking a look at Mikey's equipment): It's pretty small. The pain should be minimal.
Mikey (skeptically): Well, that kinda makes me feel a little better.
Joe: Don't worry. I'll be with you to watch and make sure everything goes right. Unless...having me observing makes you feel uncomfortable....
Mikey: Uh, no...no. That should be, um, fine.
Joe: Just remember. Don't go in too deep. Don't go too fast. And just remember to not move it around too much. It could get uncomfortable.
Mikey: Got it. How long is this going to take?
Joe: If you do it right, you should be in and out in like 2 minutes.
Mikey: Okay, I think I can handle that.

So I went into the room, shook the man's hand, pulled out my needle, and drained the inflamed bursa on his elbow, which he aggravated by shoveling snow on his driveway. Joe was right. It was pretty easy. Except for the part where I moved around a little and poked the bone. It's pretty amazing - seeing the human body launch from a sitting position, trying to get the head to butt the ceiling.

*******

What I'm listening to right now: Live in Tokyo, Brad Mehldau

Recess is over

Just got out of my Pediatrics exam minutes ago. Now I'm a free man for the next two weeks on SPRING BREAK!!!!

whattodo?whattodo?whattodo?whattodo?whattodo?whattodo?whattodo?

I know! Zzzzzzzzzzzzzzzzzzzzzzzzzz.
Bill Hastings needs to return his penis.

*******

What I'm listening to right now: Anything Goes, Brad Mehldau

Pimp Class

One scary aspect of medical education is the practice of "pimping." It's sort of like approaching a car pileup at 80 miles an hour. Time slows to a crawl. You know that the collision is going to occur, yet there's nothing you can do to avoid it. It's intimidating, but when done correctly, can serve as a valuable teaching tool. Or, it can serve as a means of humiliation. Either way, most of us medical students dread being pimped - it's never comfortable looking like a fool in front of your peers, even when you know that they're watching you, rooting for you, scared that the next question is coming for them.

I recently sat in on a lecture about genetic disease, and the lecturer, "Dr. Gabriel" is known to have these interactive discussions. You can't fall asleep in these classes. Dr. Gabriel likes to go around the room asking question after question:

Dr. Gabriel: What are some findings in a neonate born to a mother with poorly controlled diabetes? You!
Med student #1: ....Hypoglycemia?
Dr. Gabriel: Good! Next?
Med student #2: Macrosomia.
Dr. Gabriel: Next!
Med student #3: The baby is large for gestational age?
Dr. Gabriel: Right. Next?
Mikey: Uh.................
Dr. Gabriel: Nice try. Anyone else? Anyone?...Bueller?...Bueller? How about birth defects? Lesions in the cardiovascular and central nervous systems?

Argh. I dropped the ball the first go-round. Part of the problem with these questions is that 100% of the people in the room know at least one of these complications. Probably 95% at least two complications, et cetera. Most students probably wouldn't be able to name every single characteristic, especially in a topic so broad. We just try to hit the high yield stuff at this point. So anyway, the closer you are to the beginning of the line of people answering a given question, the better your chances are for getting an answer correct. As fate would have it, I did not have this luxury on the next round of questioning. But I had a fighting chance:

Dr. Gabriel: Okay, next question - give me a midline anatomical structure and a developmental abnormality in that structure.
Med student #16 (see, I'm going in reverse now, indicating that Dr Gabriel is starting on the other side of the room): The stomach?
Dr. Gabriel: The stomach isn't really midline. Next!
Med student #15: The head of the pancreas. Annular pancreas. (Ooh, good one).
Med student #14: The mouth. Cleft lip and palate. (Hrm, an easy one.)
Med student #13: The heart's pretty midline, right?
Dr. Gabriel: Are you SURE?????
Med student #13: Um....yes?
Dr. Gabriel: And the abnormality?
Med student #13: ....Ventricular septal defect? (Another easy one off my own list).
Dr. Gabriel: Next?
Med student #12: The brain. Hydrocephalus.
Dr. Gabriel: Wrong! Hydrocephalus is not really a midline abnormality. Think of a midline brain structure.
Med student #11: The corpus callosum? Agenesis. (Yikes, another good one. The list is getting shorter, and my turn is coming. I've got two solid answers, though).
Med student #10: The trachea and esophagus - tracheoesophageal fistula. (Argh. My list is shrinking fast.)
Med student #9: The spine. Spina bifida. (Dammit! One last answer on my list.)
Med student #8: Dammit! He took mine!
Dr. Gabriel: Too bad. You?!

(Well, I'm sorry. But I'm going to have to whip this out.)

Mikey: The penis. Hypospadias.
Dr. Gabriel: Excellent!
Mikey (aside): Sweeeeeeeeeeeeeeeeeeeeeeeeeeet.
Med student #9 (to Mikey): You perv.

Well. Despite now being thought of as some sort of sexual deviant by my peers, I can call this round of questioning a success. Some phrases spring to mind: Grace under pressure, courage under fire, clutch hitter, etc. Will I come through again? Tune in next time when I go through one of my preceptor evaluations.

Dear Diary...

Wow. Third year is coming to a close pretty darn quick. Here are some things on my mind right now:

• I began the year feeling clueless and overwhelmed. I will probably finish the year feeling clueless but aware that that's what Medicine will be about - a career of perpetual learning and relearning and paradigm redrawing. Welcome to perennial studenthood.
• I liked Medicine. I liked Family Medicine. I really like Pediatrics. I really like working with the geriatric population. What to do what to do what to do what to do???? Hmmm...you know, there are some Combined Medicine/Pediatrics Residency programs out there. I know what you're thinking - "Mikey - ENOUGH with the combined degrees already!" I think that much of this attraction to combined degree stuff is rooted in the fact that I can be pretty indecisive. I mean, all those evenings it's been asked of me to decide which restaurant we're going to? Yeah, that's right. I can't decide.
• One thing that stands out with the Pediatrics clerkship is that it has presented me with more ethical questions than any of the other clerkships thus far. Perhaps it's just coincidence. Like - what makes a person a person? Does a baby born with hydranencephaly qualify as a person? I struggled with this. Immensely.

Dr. K: Mike - do you think this baby is a person. And do you think it matters whether you think it's a person?
Mike: Yes, it's a person. And no, it doesn't matter what I think - I should still treat it with as much respect as I would any other patient.
Dr. K: You think the baby is a person, yet you keep on referring to this baby as 'It.'
Mike: Uh, yeah. I guess I'm struggling with this.
Dr. K: No kidding. Why do you think it matters that you're clear on the definition of 'person'?
Mike: Well, because if I'm uncertain about the patient, then that will complicate my decision-making in the course of treatment. And sending uncertain signals to the patient's family in this case could be disastrous.
Dr. K: Precisely. Does this patient feel pain or hunger?
Mike: No.
Dr. K: Will this patient ever develop a personality?
Mike: Uh...no.
Dr. K: Well, then. Where do you think the word 'person' comes from?
Mike: UNCLE!

• The miracle of life. The past few days I've spent with newborn babies - both healthy ones and preemies. It's astounding to realize that just a few minutes ago this little bundle was still inside another person breathing and drinking amniotic fluid. And now I'm standing above them checking their wittle ears and wittle hands and feet and tiny wittle tongues and soft wittle bums as they adapt to the outside world. So dependent, so innocent, yet so lucky when compared to some of the preemies in the neonatal intensive care unit (NICU). Technological advances have made it possible to keep babies alive who have been born at only 24 weeks gestation. This would have been impossible even a decade ago. You wonder if it's worth it, though. A 24-weeker could possibly face so many complications later in life - chronic lung disease, vision disorders, cerebral palsy, to name a few - is it worth it to keep them in the NICU for months in order to face life with such difficulties?
• My cooing and gurgling language is getting better. However, I've found my talent in the newborn nursery. During painful procedures such as drawing blood or putting in intravenous catheters, someone has to keep the baby from fidgeting. One trick is a simple solution of sugar water (sugar molecules will bind to the human opioid receptor and reduce the sensation of pain). The other trick is getting them to concentrate on something else - like food, or making them think that they're getting it. Babies are born with amazing 'suck' capability and if you stick your finger in their mouth, they'll suck on that thing like there's no tomorrow. Thus we come to my natural gift: My Finger. Able to quiet babies for tens of minutes while they're being poked and prodded and jostled and manipulated to no end.

Well, Diary, that's it for now. I'll write to you later.

Mikey (aka "NippleFinger")

What's your type?

I'm leaking this highly secret medical tool to you, the public, because, well, I think it's pretty self-explanatory. Having trouble getting the point across? Problems describing the quality of that ritual performed on the porcelain altar? Well, I'm here to help - some British colleagues of ours decided, To Hell with it, we need some standards! So, to help patients describe their poop, they came up with the "Bristol Stool Scale."

Just so you know, Types 3 and 4 are generally considered normal, although some website out there also said that Type 5's could be okay, too. Personally, I'm not sure about that. The rest of them, well, there's definitely something else going on.

Anyway, I think it's apparent that your water cooler converations are going to be so much easier from now on.

Before:
Stan: Hey, Bob, how's it going?
Bob: Well, Stan - could be better.
Stan: How so?
Bob: Well, I'm having a tough time describing what's going on...
Stan: Say no more. They got these nice little blue pills now...
Bob: No, you got it all wrong...
Stan: Hey, guy, it happens to everyone!
Bob: Nonono - I'm talking about something completely different.
Stan: ???

After:
Stan: Hey, Bob, how's life?
Bob: Could be better, this past week it's all been Type 4's. I'd been passing some AWESOME Type 3's last month, but I'm just out of sorts right now.
Stan: Aw, jeez, man. Are you getting enough fiber lately?

You see? Nice, easy, streamlined descriptions that help grease the passage of conversation. Now go forth and educate the rest of the world. You can thank me (and the Bristol guys) later.