ndab Ah Yes, Medical School: July 2005

Tuesday, July 26, 2005

Close Talker

When asked to describe my classmates by family and friends outside of medical school, I usually am quick to reply with a one word answer: freakshows. However, when pressed to give more specific examples, I am often at a loss to explain this phenomenon, only because it takes a certain amount of time spent with these people before one can really appreaciate the freakshow nature of a typical medical student class, much less the collection of freaks in my class. I've tried to document some of the highlights in this blog, but I still don't think it does my class justice. Luckily, during ophthalmology clinic today, I was put in a situation that will, for the moment, rank right up there with the FCMA "tight" episode as one of my shining examples of why you should be afraid when you go to the doctor.

For my second week of my outpatient surgery clerkship, this week being ophthalmology, I was paired with another medical student and had to report early this morning to the county hospital to work all day. She was a very frail Asian woman, already married and someone so exceedingly benign I honestly didn't know she was around for most of the first two years of medical school. Very quiet, very bland, very...umm...just not noticeable. Needless to say, we weren't exactly close friends. Instead, we were on a very comfortable "How are you today?" conversational relationship, and that's how I presumed this relationship would remain during this week. I was to discover that, as in many things in my life, I was completely and utterly wrong.

Our resident gathered us into a small room that morning and explained that we should practice looking into each other's eyes with the ophthalmoscope (the thing we use to shine a light the eye to look at the retina) for a while before we tried it on real patients, because this is actually a pretty tricky skill that takes a lot of practice. If you've ever been to the doctor, you know what this is - the doctor takes a light and shines it directly into your eye, coming very very very close to your face as he approaches your eye and leaves the light there for a few seconds before repeating the same test with the other eye:

Anyways, the resident leaves, and it's just me and her in the room. I offer to volunteer my eyes first, and she attempts the exam on my eyes. And fails pretty badly at it. I try on her and fail as well. We go back and forth a few times, failing miserably at trying to see the optic disc, which is the goal of this exam. Since I had been up since 5 AM, I was pretty oblivious to the fact that this failure might actually be a bad thing, and simply chalked it up to inexperience, which in actuality is all it was. After all, one of the residents stated that it takes potentially hundreds of practice attempts before this skill becomes second nature.

Yet, after a few more rounds of failure, my collegue begins to do the exam on me but stops abruptly. She starts talking really fast about how disappointed in herself she is that she cannot get this, how she doesn't understand why she is failing at this, and so on. I try to calm her down by a) just using my naturally sexy and soothing voice and b) reminding her what the resident just told us 20 minutes ago about how this was a difficult skill and many people with years of experience are still poor at it. She then begins freaking out about how she is right eye dominant and doesn't know how she will ever use her left eye to visualize the other eye. Her talking gets more and more rapid as she begins this mini-panic attack. Then, I notice that the hand that is holding the ophthalmoscope is shaking violently. Just to remind you, it's literally just me and her in a room. No one is evaluating us. No patients are getting upset. We had just been lectured to about how we aren't expected to get the hang of this for a while, and how this is all just for practice. Despite all this, she was completely freaking out. (You may be thinking to yourself, "Well duh, she's just nervous because for this exam she gets right to within kissing distance of your sensuous lips, you devilishly handsome young man you"...and you'd be right. But that still doesn't explain the hand shaking.) She continues to freak out, lamenting that her friend who had this rotation last week was amazing at this skill by the end of the week. My attempts to remind her that today was, in fact, Tuesday and not Friday, meaning that she had three more days to practice, were subsequently ignored, and she continued to melt away in a pool of panic and despair.

However, if having a panic attack in a non-threatening situation that has no bearing on grades, one's future career, someone's life, etc. were the sole criteria for being a hall of fame medical school freakshow, then I'd say about half the class would qualify. My jittery medical school friend, who's hand was again shaking furiously at this point, would take it one step further. First, she tried to control herself and stop tears from rolling down her face (I am not joking). She managed to get her hand to stop shaking and then decided that she needed a latex glove to help stabilize things. (You may be thinking, "What the fuck would a glove do? Someone give this girl an enema or something to remove the rod firmly entrenched in her ass"...and, again, you'd be right. But urology was last week and I'd had my fill of the rectum for the time being.) She finds a glove, puts it on, controls the shaking, and proceeds, for about the 10th time now, to approach my face with her ophthalmoscope. She then begins talking extremely rapidly. What follows was quickly uttered to me while her face was almost pressed right up against mine, about a half an inch away, her latex-laden hand pressed against my check, and her hand shakily shining a light right in my eye. Keep in mind that I a) just learned her name two weeks ago, b) have spoken to her about three times for a cumulative total of about ten minutes over the last two years, c) am pretty sure she is of the Bible Thumper persuasion (i.e. no sex until marriage...and even probably none for a while after that), and, d) already just had a nervous breakdown right in front of me over something exceedingly retarded:

"So ya it's good that I put on this glove I think it will help steady my hand OH! so my friend wanted to have sex with this guy and she really wanted him bad like REALLY bad but she has this latex allergy but she got the guy to her apartment and she put the condom on him anyways and then they had a lot a lot of pretty intense sex but then she had this allergic response to the latex condom that she put on him and she got a rash all over and I had to take her to the ER and I told her not to have sex with that guy but she just had to so you know it's good to know if you have a latex allergy so if you're having sex with someone you should know to have sex with other condoms."

In the dictionary, somewhere buried in one of the definitions for the word "restraint", there should be a picture of me, sitting in that chair, a half an inch away from this girl's face, not exploding in a fit of thunderous laughter. I literally almost died holding it all in. I'm sure you could draw any number of lessons from this story, such as understanding priorities, when something is actually worth stressing over, and what kinds of conversations are just not socially acceptable in certain situations, but instead I'm going to leave you with perhaps the most important thing you should take away from this: if you or your partner are allergic to latex condoms, please find some other form of contraception.

(cue music)
The more you know...

Friday, July 22, 2005

Basic Training

Let me begin by stating that I have nothing but the utmost respect for our nation's veterans. In fact, despite most staff experiences at the VA, I really enjoyed talking to the veterans I met this week while working at the urology clinic in the VA near my medical school. However, I noticed something rather peculiar about a select few of these veterans that I think is worth addressing, because it is obvious that this core element of humanity has been left out of the basic training manual they all surely received upon joining the armed forces and is likely representative of the American patient population as a whole. What do I mean? Well, some patients seem like they would be model patients. They arrive at the clinic an hour before their appointment. They have a printout of all their medications, scheduled doctors appointments, and recent labs. They are dressed up, often wearing nice slacks and a dress shirt. Very professional, very punctual. Surely, these are the model soldiers and model patients.

However, they seemed to have forgotten or never been taught one small element of the common morning routine one must go through before facing the day.

And by that I mean taking a fucking shower.

My first patient this morning, dressed in fine slacks and a polo shirt, arrived smelling so bad I could feel the odor getting stronger as he approached my office as it literally burned my nostrils. After sitting him down and taking a deep breath, I reluctantly closed the door and did my history and physical while breathing exclusively through my mouth. It got so bad in this small room I actually had to cut the physical a little short and jump outside, only because I needed a breath of fresh air because I was getting light-headed.

However, upon exiting the room I noticed that his trail of odor still lingered outside, and all I saw when I left my exam room was the angry faces of the receptionist and his co-worker demanding that I close the door. I then quickly presented my information to the attending physician while fighting back an acute onset of nausea, generated a plan that would (unfortunately) require my patient doing further tests in the clinic, took a deep breath and jumped into my room, giving the patient all the information in one long exhale so as to avoid what would be the inevitably violent penetration of his bodily aroma through me. It eventually got so bad in there I actually started tearing at the eyes before I sent him out to the waiting room because he needed to drink water before doing a test. Of course, as I walked him to the water fountain, all of the other patients moved away. One guy in a wheelchair gave me the evil eye for bringing Stinkmaster E anywhere near him. This was the literally the worst thing ever.

Luckily for me, this story does have a happy ending, at least for me. While waiting for the results, I saw another patient and during that time this first guy's results came in and he was seen by another doctor (who conveniently had a cold and couldn't smell a thing), thus saving me the misery of having to be in close contact with that guy for any more time. But you are surely on the edge of your seat wondering how I knew that had even happened? After finishing up with my second patient, I walked out and noticed Stinky McGee had disappeared, which led to this exchange with the receptionist:

Me: Uhh...where did my patient go, Mr. _____?
Receptionist: Hmm...I don't remember that name. Do you have hi-
Me: Uhh...he was the guy that smelled.
Receptionist: OH! Lord. That guy. Ya Dr. ____ saw him already and sent him home. Thank the Lord Jesus Christ our Savior.

What have we learned here? Well, it turns out that doctors are actually people, just like everyone else. And just because we spend a lot of our time knee deep in shit, piss, and any other assortment of bodily fluids does not mean you, as the patient, don't have a responsibility to at least show us a little decency and common courtesy to take a shower or put on some deoderant before you show up. Because if you don't and start saying things like "Doc, just tell me, how sick am I?", all you're going to get is a response like "Man I don't fucking know, all I can think about is that you smell worse Michael Jordan's jockstrap. I can't even remember my own name anymore."

P.S. On a totally unrelated note, I discovered this week that I look damn good in my scrubs-white coat combo. Laaaaaaaaaaaadies!

Monday, July 18, 2005

Mind, Body, Anus: A Probing of Rectal Philosophy

When you think of grand explorations in human thought that test the boundaries of our cognitive limits as a species, you might imagine things like Newton sitting by the apple tree and gaining the insight to describe gravity, or Einstein thinking furiously about stars travelling through space while scribbling down equations.. Perhaps you conjure up images of Aristotle or Socrates expounding on core philosophical theories in Ancient Greece, or the nameless NASA rocket scientists working tirelessly to guide the space shuttle to the moon.

Given these classic and idealized settings, it came as no surprise to me that my grand insight into one of the worlds classic philosophical problems came while I was shoving my finger up an elderly man's asshole.

(You may be familiar with the Mind-Body problem, as described and philosophized heavily by Descartes. Briefly*, this philosophical area explores whether there is a separation between our conscious mind and the body that it is associated with. Descartes held that there was a separation between Mind and Body, whereas much of the subsequent philosophical arguments attempted [rather successfuly, as far as I can recall] to demonstrate that Descartes' arguments were a bunch of poo, pun intended. But anyways, if you are actually curious, read more here.)

This being my second rectal exam of the afternoon of my first full day on the wards as a third year medical student, the novelty of it all had worn off (rather quickly I might add) and I was getting tired of coming into such close contact with wet and juicy excrement. I carefully rubbed the KY jelly over the glove area covering my pointer finger and quickly inserted said finger into an elderly gentleman's asshole. The warmth of his rectum heated my finger, easily the most disgusting part of the exam for me, while the brown stains started spreading over my latex glove. Then, suddenly, I had a quick succession of thoughts, which shall henceforth be known as the Rectal Corollary to the Mind-Body Problem:

1. This is fucking disgusting.
2. My finger is warm and surrounded by shit.
3. If only I could cut off my finger, I would no longer feel this sensation of shit.
4. I cannot cut off my finger because I am a pussy.
5. If only I could figure out a way for this finger to no longer be a part of me, I would no longer feel this sensation of shit.
6. If only I could convince myself that the finger inside that man's asshole was not mine, but someone else's, I would no longer feel this sensation of shit.
7. If only I could convince myself that the finger, and all the sensations being brought to me courtesy of it's placement, was all in fact a delusion of the Mind and that the finger was not actually represented in my Mind even if it was a part of my Body, then I would no longer feel this sensation of shit.
8. When placed in a truly horrible situation, I could will myself to believe anything if doing so would get me out of the horrible sensation.
9. A rectal exam is that horrible.
10. If only I could will myself to believe that my finger was not actually a part of me, my essence, my Mind, then I would no longer feel this sensation of shit.
11. Given that I am in a situation that horrible, I can will myself to believe that my finger is no longer a part of me, and therefore I no longer feel this sensation of shit.

With this simple progression of thought, I managed to separate my Mind, which believed itself to be in such a horrible situation it was ready to accept any form of delusion to extricate itself from said situation, from my Body, part of which was currently driving up the Hershey Highway without a map. And with that, everything fell into place, the prostate was felt, the finger was pulled out, and my Mind was off somewhere else, daydreaming about Natalie Portman and trying to figure out just how awful my Penis to Vagina viewing ratio was now that I had examined about 10 penises that morning and afternoon (to any ladies out there who would like to help me adjust this ratio, please let me know).

However, philosophy is not that simple and my argument is likely filled with a vast array of holes that need to be addressed (feel free to tear it apart - but please be nice, this post is less about philosophy as it is about...ass). Despite this, I first walked away from the patient preparing my Nobel speech, having just conqured an age-old philosophical question. However, I noticed something funny. When removed from that stressful situation, I found that the finger, that was part of my Body but no longer part of my Mind, kept following my around. Turns out, it was still attached to the rest of my body. And my Mind couldn't deal with that. Crap. Literally.

It took only another rectal exam for me to then realize that I had forgotten the key part of the Rectal Corollary, which in fact demonstrated that the Mind and Body cannot be separate, at least when it comes to rectal exams:

12. The powers of delusion are temporary at best.
13. The sickening sensation of heat emanating from a finger that has been up someone's butthole lasts indefinitely.
14. Given the factor of time, the Mind cannot forever ignore the sensation of heat coming from the finger (the Body), thus reestablishing the connection that it tried so hard to destroy.

Well, folks, there it is. Three rectal exams into my third year, and I have already proven that the Mind cannot be separated from the Body. Give me two more days to discover the cure for the common cold, and in one week I'm sure I'll have explained why I can't find a nice, good-looking, single Jewish girl. That is, if I have time to spare when I'm not washing my hands excessively. Seriously, it's been four hours and I can still feel the warmth. I think I'm going to throw up.

It may occur to you that I forgot one final step, which would read something like "14. I am the biggest loser of all time for even wasting 30 minutes writing this up". And you'd be right. But one thing I'm learning about medical school is that we all have ways of coping with the craziness we are thrown into on a daily basis, and mine just happens to be thinking about utterly absurd stuff like this. And if you have a problem with that, find someone you don't really know and stick your finger up his or her butt, leave your finger in there for a couple of seconds, poke around in there, pull your finger out, and then think long and hard about how you are going to look at yourself in the mirror in the following morning.

*It is really hard to encapsulate this area of philosophy in a sentence or two, as it has filled volumes and volumes of books over the course of the last few centuries. And, lets face it, it's not like I remember a whole lot about it despite taking a whole bunch of philosophy classes as an undergraduate. I would like to thank my $120,000 private school undergraduate education for making that previous sentence possible.

Thursday, July 14, 2005

Well Played II

Perhaps it is something about me and three weeks worth of clinical orientation, but I've managed to set myself up for some pretty easy chances for friends to make me look like a moron (yes, this is what substitutes for supportive friendships among medical school classmates...and yes, I actually have friends). Case in point, Well Played. I thought I'd bring this topic up again because yesterday, during our head and neck physical exam module, I managed to pull off this feat yet again.

We were wrapping up the session when the doctor, a skilled practitioner with about 40 years of clinical experience, offered to check any of us out if we thought we had any problems worth addressing. Seeing this as a prime opportunity to get free health care, I decided to speak up. Why? Because, as has often been noted here, I am a jackass:

Me: Actually I have something I was hoping you'd look at.
Doc: OK sure what do you want me to do?
Me: Well I have this ear wax problem...I make a TON of it.
Doc: OK well sit in the chair and I'll check it out. If there's enough I'll try to extract it.
Me: Ya last time I was at my preceptor's office and he took a look in there and pulled out this HUGE wad of wax. It was enormous.
Friend 1: Oh my lord that is really disgusting.
Doc: That's ok, people think that having a lot of ear wax is a sign of poor hygeine, when in fact it is a genetically predetermined trait that one has no control over. [Editor's note: I am not making this up to make myself seem less disgusting, and if any ladies find excessive ear wax attractive, let me know.]
Friend 2: How much did they take out of you?
Me: Oh a ton. Actually it was so huge he put it all out on a paper towel for me too see and he wrote "YUM" on it as a joke. He said it was the most he'd seen...
Friend 2: Seriously that's gross.
Me: ...but I was so impressed with it that I took a picture of it with my camera phone.
Friend 1: You're kidding right?
Me: Nope, I just wish my camera wasn't messed up at the time because it came out all fuzzy.
Friend 1: OK, seriously, this is why you don't have a girlfriend.

Ouch. Once again, well played. But of course, I recognize that I set myself up for something like that, because some things just don't need to be shared...

...that said, you didn't seriously think I'd write all that and not actually post the picture, right?

In case you're curious, the wad of wax on that paper was roughly an inch wide, and that was all from just one of my ears.
Next week: Urology Clerkship. Something entertaining might come out of a week of fondling testicles and doing rectal exams. Just a hunch.

Monday, July 11, 2005

And Hello To You, Too

There are certain social graces that you do not really appreciate, or even notice, until they are obviously absent from normal social discourse. For example, imagine if you were talking to someone for a while, and at the conclusion of the conversation you did not say "bye" or any variation of that word, but instead just got up and left. The person left behind would undoubtedly feel a bit cheated and confused at the way this conversation ended.

This idea is what was racing through my otherwise sleep-deprived mind during the first day of surgery clerkship orientation this morning. After a brief talk from one of the OR nurses about general etiquette, one of the main surgeons walked into the lecture hall to greet us, give us some introductory comments about surgery, and give us some insight into what we were getting ourselves into for the next twelve (yes, twelve) weeks. Well, at least that's what I was expecting.

Instead, this is a paraphrase of our introduction to surgery:

My name is Dr. _____ and I am one of the directors for the surgery clerkship at this hospital. Over the past few years I have noticed that your predecessors have missed required lectures, failed to attend required outpatient surgery commitments, and have otherwise skipped out on certain activities that are a required part of passing this clerkship. Let me say this strongly: if you do not complete all of these requirements, you will fail the course. Furthermore, I should add that the textbooks are required and you must read them thoroughly. Personally, I'd recommend that you read through both textbooks [about 400 pages per book] twice through during your free time in this week-long orientation.

A "hello" would have been nice.

Thursday, July 07, 2005

Spike Collar Sold Separately

My medical school is big on ceremonies. The White Coat Ceremony, to mark our entrance into the medical profession, make us feel like we are real doctors from day one, and allow us to wander around town looking official and impressing women with our doctor garb when we, in fact, know nothing. The Cadaver Memorial Ceremony, to give us a chance to reflect on the year that was anatomy, how much we did (or did not) learn, and how far down into hell we were going to go for making fun of any sexual organ irregularities in the donated bodies we cut open. The Second Year Banquet, held before the second year is actually over and before any of us have taken the boards, marking the moment we...umm...ehh…accomplished… uhh…nothing. The Professionalism Ceremony, held at the end of my current round of clinical skills orientations today that required us to literally reaffirm the vows of “humanism” as future doctors that we first took in the White Coat Ceremony two years earlier, bringing new meaning to the term “married to my job”.

Given this penchant for ceremonies, I found it odd that my school forgot to commemorate perhaps the most defining moment of our entry into the medical profession with a ceremony of its own. For what, you ask? Please ask. C’mon, just play along. Ask. OK fine whatever, I’m going to ramble on anyways:

This past Friday we had the privilege to shell out $120 (per year) to receive our very own…(cue drumroll)…shiny…slightly used…encased...


Yes, from this moment on until we decide to retire or become dermatologists, we will be slaves to these pagers and the people at the other end of the page who desire our presence or attention at ungodly hours of the night, in the most horrid of conditions, and under the most extreme amount of stress. While it may seem unfathomable to you that I am able to contain my excitement over finally receiving this key accessory to make my fake doctor costume complete, I am stunningly able to do so nonetheless.

It is with this defining moment in mind that I propose a new ceremony to be added to the clinical foundations/orientation portion of our third year curriculum: The “Is This Thing Really Supposed To Go Off At 3AM?” Pager Ceremony Extravaganza. In it, we can have naive third year medical students file into an auditorium, get in alphabetical order, and proceed to walk to the front of the class, where the ceremonial rituals begin. Rather than be fitted for a white coat to be placed over their shoulder by one of the deans of the medical school, a lá the White Coat Ceremony, students must walk past a series of pictures depicting their families, friends, the beach, and so on, only to have someone throw these pictures into a growing bonfire on stage. They are then verbally harassed by various superiors, and given that as third year medical students we are literally at the bottom of the food chain in the hospital, this cast of characters includes attending physicians, chief residents, residents, interns, fourth years, nurses, physician assistants, biostaticians, respiratory therapists, pharmacists, pharmacy residents, pharmacy interns, pharmacy techs, candy stripers, janitors, volunteers, the patients themselves, their families, friends, distant cousins, and, finally, the homeless people who live down the street. Lastly, each student receives their pager, which is firmly bolted to their waist. They then must listen to the annoying ring of the pager while receiving the words of wisdom that were given to me this afternoon, by the chief of surgery at the hospital I will be working at, regarding pagers:

“I firmly believe that everyone has a predetermined number of pages they can receive in a lifetime, and once you pass that limit, you die.”

With that, the ceremony is complete.

This post is in honor of the page I just received from a friend that startled me so much (because I wasn’t expecting anything) that I almost fell backwards out of my chair.


(Note to self: stop being so overdramatic for next post.)