ndab Ah Yes, Medical School: April 2006

Sunday, April 30, 2006

Puss. (Boots Sold Separately)

First, let me put forward the fact that pain is always terrible and everyone has different thresholds for pain. I understand this, respect this, and have seen enough patients during the last nine months to truly appreciate that horrific state of being, where one is crippled with despair, shackled with grief, and weighed down with the diabolically powerful sharpness that rips through ones soul and burns at one's inner being that can only be referred to as "pain".

That said, there's still no excuse for being a pussy.

Case in point, last week I was part-way through a two week rotation in a secondary ER ("secondary" because it is where they send people who shouldn't actually be coming to the ER in the first place, but that's another topic entirely), when I met a middle-aged white male (we'll call him Mr. Ihave Nopenis to maintain his anonymity) of dubious merit and even dubious-er manhood. I talked with him briefly, discovering that he had an infected lesion on his abdomen that was, per his description, exquisitely painful. So painful, in fact, that he hadn't slept in three days, often could not stand up because of the pain, and was utterly debilitated. So debilitated, in fact, that he could not perform his duties at his job as a nurses assistant (I'm not touching that one with a ten foot pole). I lifted his shirt while he winced in pain, discovering a small, 0.5 cm black lesion with a bit of reddness surrounding it. It looked much like an ingrown hair follicle that had become infected, which was, in fact, the final diagnosis as well. I gently touched it (gloves on, of course), and he yelped violently. Look, just give me some pain meds and cut it out. I know what you need to do...I'm a nurse, alright. Just cut it out.

OK, buddy.

A few minutes later Mr. Nopenis was transported to the procedure room for a routine incision and drainage, and when I found him he was already laying down, moaning in pain. When are you going to do this...c'mon already! The ER attending and I washed up, put on some gloves, and started the procedure. It began by placing a sterile drape over the region we were going to cut. Ow! Ow ow ow ow. Then, we cleaned up the lesion with some Beta-dyne. OH MY GOD THAT IS SO COLD AHHHHHH! OWWWWW! At this point, the attending gave me a look, one of those "This guy sucks" looks (likely resembling the look Kevin Federline receives when he encounters...well...anyone). Next, we had to inject the region with lidocaine to numb everything up, you know, for the pain and all. I wielded the syringe that Mr. Nopenis must have seen out of the corner of his eye, because he started hyperventilating and screaming. Oh NO! Ahhhh! I started injecting, first superficial, then deep, while he Oooh-ed and Ahhh-ed, but I made sure to inject everything in rapidly so as to avoid the pain of listening to him moan any longer.

Unfortunately, Nopenis had other thoughts in mind, because an entire minute after we had finished providing the anesthesia, poking around his lesion multiple times to make sure he could not feel anything, he yelped out. Have you finished with the needle yet?!? I responded in the affirmative. Ahhh...SHIT, well why didn't you TELL me?!? Owwwwwww!

Huh?

He began moaning again, screaming in agony every few moments, usually coinciding with when we would make any motion that vaguely resembled one approaching his mild lesion. Interestingly, when I actually made the incision, slicing right through his wound and squeezing hard to express the miniscule amount of pus trapped therein, he was completely and utterly silent, complacent and carefree, as if he couldn't see what was going on and didn't have any cues to scream at.

After cleaning up, we gently removed the sterile gown. Ooooooaaawwwoooooohhhhh!!!

Walking out of the room, I couldn't help but wonder what Mr. Nopenis's deal was. Why was he so sensitive? How could he possibly have felt so much pain at such inappropriate times? What were his real fears, given that he was a nurse who should have known what was going on? How loose was his vagina?

Unforunately, none of these questions were answered then, and they remain a mystery now. Pain is a mysterious entity, crippling to some, a crutch to others, constant and unnerving to many. But for Ihave Nopenis, it is none of these things. Instead, it is merely a means for him to express his inner pussy.

Thursday, April 20, 2006

Personally Revolting

After receiving some initial feedback on my most recent post regarding acing the MCAT, it has come to my attention that there are legions of premeds out there who not only enjoy living vicariously through me, but also wish to follow in my humble, eerily pathetic footsteps every step of the way. Whether it is preparation for the MCAT or choosing the appropriate premed courses, I am clearly the figurehead for a growing cult, a burgeoning mass movement of aspiring physicians who, given all of the nonsense in this blog, frankly should know better. Shame on you people.

Anyways, in another attempt to help those aspiring physicians among you, and to ease the nerves of a certain premed who emailed me from Pennsylvania, I thought I’d touch on what it takes to write the gold-standard Pulitzer prize winning personal statement you’ll need to overcome an application otherwise devoid of Nobel prize winning research, Malaria eradication efforts in Sub-Saharan Africa, and a transcript full of graduate level biochemical physics classes (I guess everyone can’t be like me). What follows is a template to create the stunning essay that will seal your admission to the medical school of your choice*.

The Passion Of The Pre-Med
[FYI, don’t actually title your essay. Unless you choose “Will Put Out: My Life Story” or you’re just a complete douche. In which case, go right ahead.]

Introduction: Were you a refugee from Craptakistan? Did you lose one of your nails in a freakish tire factory explosion? Were you hit by a car during the second week of your freshman year of college, crushing and totaling the car with your body while walking away relatively unscathed (umm...hypothetically speaking, of course)? If you answered yes to any of these questions, or you can come up with an equally tragic/shocking/disturbing/eye-opening sob story of your own, then that is how you must begin your essay. For example, “Walking across the scorching Sub-Saharan desert, carrying four dying children on my back while saving the last drops of water for their disease-ridden mother dragging a fifth child right behind me, I knew that I was within inches of losing my life during this dangerous trek to provide Malaria medications to save an entire tribe of thousands. I also knew, right then and there, that I was meant to become a radiation oncologist.” It pretty much writes itself.

Body: Here is where your journey to becoming a physician really starts to explain itself. Yes, that moment in the Saharan desert may have provided you with your original epiphany, but that alone will not sway admissions reviewers your way. What you need to lay out over the next few paragraphs is how, more specifically, you have acted on this original epiphany in your preparation for medical school. Practically speaking, this means you need to pick out the two or three most stupendously amazing things you’ve ever done since you started college and spend a paragraph talking about how stupendously amazing those things were, and how they were made even more stupendously amazing because you were the person who did them. You should also be sure to mention how these stupendously amazing things will make you an amazingly stupendous doctor.

In other words, no, you didn’t just steal $6,000 from your undergraduate institution to spend a summer pretending to do research while you chatted online with babes for hours on end, silly (not that I would have any idea what that’s about). You devoted your summer to the pursuit of original science research with the hope of making a significant contribution to your field while also honing your research skills so that you could apply them to your future as a groundbreaking researcher in Alzheimer’s disease and other forms of dementia.

No, you didn’t spend a few random afternoons standing around in a hospital while people rushed back and forth in front of you, stopping only to ask you where the bathroom was on occasion. You served valiantly as a hospital volunteer, assisting the aged in all aspects of their hospital care, whether that meant spending hours on end talking with them about their treatment or even, dare I say it, assisting the doctors while they treated these glorious people. And now you are not only acutely aware of what it takes to be a clinical physician, you are also one step closer to being completely prepared for your future as a pediatric thoracic surgeon.

Conclusion: The big finish. The grand finale. The lasting impression you will make on every and all admissions committee members. You need something big, something that hits home, something so profound that it will leave your admissions reviewers in tears, yearning for the moment they can approve your admission to their medical school and sealing their fate as “The Person Who Made Sure The [Now Ridiculously Famous] _____ Attended Our School of Medicine”. Time to make it personal. Very, very personal. In other words, if you don’t make some reference to the profound effect a doctor had on either your health or the health of one of your family members, you’ve bought a one-way ticket to Hollywood Upstairs Medical School (it has been way too long since I’ve made an obscure The Simpsons reference). Here, let me help: “Finally, and perhaps most importantly, I want to pursue a career as a physician because I want to follow in the footsteps of my great-grandmother’s personal assistant’s third cousin, who, while on her death bed after suffering through a shattering trial of cocaine and substance abuse, shared with me the compassionate tale of the physician who sacrificed everything to save her life. This person’s dying words to me, whispered under her breath, were ‘Be like Dr. Nobleheart. Save lives. Use the force. It is your destiny.’ And with that last breath, she passed, but not before providing me with the final dose of inspiration I needed to pursue a career as a cardiothoracicneurobiliaryspinal surgeon, while also pursuing medical research in pediatric oncology.”

I’m all choked up…are you?


P.S. In an effort to provide full disclosure, I should point out that people spend, on average, about 90 seconds reading the essay you are going to slave over for the next three weeks. And after this essay there are these things called “secondaries” where you have to answer even more inane and humiliating questions about yourself in small spaces that people will spend even less time reading. So the only way you can really look bad is if you have a non-functional spell-checker (and you’d be surprized how manny people fall into this categaury).

*Guarantee void in Tennessee. That's two obscure The Simpsons references in one post, in case you're counting.

Wednesday, April 19, 2006

Freak Out: An Insider’s Guide To The MCAT

Looking at my calendar this morning, I couldn’t help but notice that we are in the throes of April, when the sun is shining, the birds are singing, love is in the air (for everyone but me – cue the obligatory “awwwww”), and, most importantly, the matzah has so extensively constipated my intestines that I am confident my next bowel movement will be in September, 2010.

However, after thinking back for a moment on the Aprils that have come and gone, I couldn’t help but remember that it was only a few short years ago that one fateful April day became one of the defining days of my college career: the day I took the dreaded MCAT. With that somber memory in mind, and knowing full well that I am on what can only be described as the biggest joke of a rotation right now (affording me so much free time that I have had the opportunity to dissect and laugh at each and every circumcision comment that was sent my way – by the way, that Godwin's Law thing was fascinating – and also providing me with absolutely nothing entertaining to share in the form of news methods of self-humiliation), I thought I would provide a few pointers to those eager beavers among you who are about to take the defining standardized test of their college careers. Not that there’s any pressure or anything.

1. Don’t Take It – Seriously, have you read nothing I’ve written here? You don’t even have to know anything to take the LSAT or the GMAT. Christ, people, c’mon now.

2. Stamina – Perhaps the most challenging part of this test is simply staying awake. “But Fake Doctor,” you’re no doubt thinking, “how could one possibly fall asleep during the biggest test of his or her life?!?” Actually, it’s pretty easy. On test day you’ve probably amassed a maximum of 5 hours of sleep (or even less, if, say your mom found a place near the testing center for you and friend to stay the night before that was a cross between the Bates Motel and your average inner-city crackhouse…hypothetically speaking, of course), you’ve had to think your way through all sorts of inane questions, and you’ve had to deal with all sorts of douche bags saying things like “I just aced the physics section!” during the lunch break. Honestly, it’s a miracle people don’t end it all right then and there. Seriously though, if you can just figure out a way to stay awake to the point that you are marginally functional during that last section, you’ll be more likely to get questions right that other people who are succumbing to their fatigue will be missing. Options include eating a moderately sized meal during lunch, taking many practice tests so that it all becomes routine, and the occasional amphetamines. Can you believe I made it through an entire section about “Stamina” and didn't make even one stupid sex joke? Me neither.

3. Blowing In The Wind – One beautiful thing about the MCAT is that, unlike its medical school equivalent (USMLE Step 1), you don’t really have to know much of anything to do well. Seriously. Hell, I’m the poster child for this statement. I promise you that 60% of the answers to the test are actually in those atrocious paragraphs they give you to read, and that you literally do not have to know a single fact about organic chemistry to get a lot of organic chemistry questions right. The test makers don’t care if you memorized every way a bonobo has sex on page 689 of your 4,000 page life sciences book; they want to know if you can reason through a paragraph that describes the mating patterns and interpret the pointless population chart they give you, knowing full well you should have never seen this chart before in your life before shelling out hundreds of dollars to take this test in the first place.

4. No Biggie – One stint on the admissions committee has taught me that, contrary to the belief of every premed out there, MCAT scores really are not that big of a deal. Which is not to say that you are sitting pretty if you tallied up a 25, but there are people out there who think that getting a 45 is vastly superior to being an interesting, well-rounded person who can carry on a conversation (or at least construct complete sentences on occasion) but had a less stellar MCAT score. To be honest, I had a negative impression of the person who’s application had an almost perfect MCAT score before the interview even started, if only because I would assume that this person earned that score by locking him or herself up in a room for 4 years of college to study rather than actually developing as a human being. And I’m sad to say that I was, more often than not, correct with these assessments. The MCAT is used to weed people out, but after that initial screening it becomes quite possibly the least important part of a person’s application. The most important? Well I can’t give away every secret, silly! (Here’s a hint though: it rhymes with “imbibe” and involves giving me money).

5. No Problem, Ess'ay - I believe there is still an essay portion to this exam, and I am pretty sure it is still graded on a letter scale (whereas everything else is graded with numbers). This pretty much assures that, as was the case on the admissions committee I was in last year, no adult faculty member will have any clue whatsoever on how to interpret the score you get on this, so all you have to do is refrain from drawing a stick figure and you'll be fine. In fact, you could probably throw in a paragraph discussing the fourteen linguistic origins of the name "Suri" (Hindu for "publicity stunt", Arabic for "MI-3 arrives in theaters this May!", and Swahili for "My daddy is a closeted homosexual") and no one would notice. I promise.

6. Good Times – Look at you, you’ve just taken what is up to this point in your academic career the most notoriously painful standardized test known to mankind…what are you going to do now? The answer to this question better be damn well be “Get shitfaced!”, or else you’re not going to get into medical school. Period. Call it the Fake Doctor Jinx if you need to. After finishing the test, I literally walked out the door, down to the nearest liquor store, bought a (multitude of) 40(‘s), and proceeded to get wasted on the train ride back to campus with a few equally celebratory friends. I expect each and every one of you aspiring medical students to do the same, and I expect each and every one of you to tell your equivalent post-MCAT-drinking story to your interviewer (which, should I rejoin the admissions committee this fall, may or may not be me).

I hope these pointers helped, and I hope those of you about to take this test do well. So well, in fact, that you build up enough confidence to take the LSAT or GMAT on a whim and apply elsewhere. Can I get an amen? Amen!

Wednesday, April 05, 2006

NSWTHAMIGTDWML-O-Meter Update

At around this time, all third year medical students are supposed to seriously start thinking about their future careers because the preliminary fourth year schedules are due. The same fourth year schedules that you set up in the field(s) you are going to enter so that you can kiss enough ass in order to get good letters of recommendation. However, the fact that I have absolutely, positively no clue whatsoever what I want to do with my life (and whether that even involves being a practicing doctor at this point) poses a serious problem. With that set-up in mind, I invite you into my brain, to experience a little taste of the thought process going through my riddled, neurotic, strangely attractive Jewish self as I tried to fill out this schedule a couple of days ago:


OK I've put this off for two months time to get going and crap what am I going to do let me see here's dermatology really chill great pay no that's gross hate skin ok general surgery no all pricks can't deal but they get all the women so maybe umm no bad idea I'm too neurotic here pediatrics love kids they love me but not in that way dude that's disgusting $80,000 a year after all this no way can't do pediatrics parents whining all the time kids screaming painful. OK so far...nothing. Shit. First do internal medicine then do hematology-oncology no that's depressing but it's profound but it's sad you don't do procedures it's six years might as well do surgery if in school that long how about orthopedics no not a jock good pay tough training I have no research what's the point don't even care ob/gyn good times on ob but don't like gyn the smell oh the smell it's so awful some times fish tacos yuck do internal medicine then gastroenterology get to scope no don't like shit maybe urology get procedures good life all penis all the time no thanks good pay fuck don't think I want to be down there all the time head and neck surgery no way small spaces will mess things up no research crap crap how about dermatology no I hate skin...


Right. This could be a problem. I hope the updated NSWTHAMIGTDWML-O-Meter reflects this, and I hope I figure out something real soon. For the wealthy women out there (Natalie?), that something definitely includes marrying rich. Just thought I'd throw that out there

No Snip For You

I receive a diverse set of emails, comments, and suggestions, some of which are good, some are bad, and most thoughtful in some way, shape, or form. But once in a blue moon I receive something so asinine, so irreparably foolish, that I must without hesitation (i.e. waiting for me to get off my lazy ass and writing another Ask The Fake Doctor segment) reply. The winner of my inaugural "Bitch, You're Retarded" Award goes to someone who sent me a comment so ridiculous and upsetting that I actually threw up in my mouth.

The backstory is as follows. After someone linked my circumcision story to an anti-circumcision forum recently, I started receiving comments and emails from people voicing their disgust for my actions. Which is totally fine, as everyone is entitled to their opinion and I am glad they feel comfortable telling me I'm an awful person in so many creative ways (but just in case anyone is wondering, I'm a Jew, so my boys - assuming I ever meet any Jewish girls desperate enough to sleep with me - will be getting snipped). However, among the barrage of hate mail I received was this gem, which bears repeating only to demonstrate how dangerous arrogance and ignorance are in combination:

Aren't you a disgusting piece of shit. Wow. Hopefully one day someone will tie you down and do something as painful. Hell, more painful. You deserve it. As does everyone who has ever had their son or daughter circumcised. At least female circumcision is not as harmful as male circumcision. Not that either should be allowed, but you'd think that they'd do it to girls instead. At least it's not as painful or as damaging.

OK, maybe I am disgusting and a piece of shit, and maybe someone will tie me down one day and do something as painful. Actually, I was watching this porn once and...wait nevermind this is supposed to be serious. Female circumcision not as harmful? Excuse me? What? You might find a legion of women in Africa who take issue with this assessment. Don't believe me? Let's see what the World Health Organization has to say about female circumcision:

Immediate complications include severe pain, shock, haemorrhage, urine retention, ulceration of the genital region and injury to adjacent tissue. Haemorrhage and infection can cause death. More recently, concern has arisen about possible transmission of the human immunodeficiency virus (HIV) due to the use of one instrument in multiple operations, but this has not been the subject of detailed research. Long-term consequences include cysts and abscesses, keloid scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse) and sexual dysfunction and difficulties with childbirth. Psychosexual and psychological health: Genital mutilation may leave a lasting mark on the life and mind of the woman who has undergone it. In the longer term, women may suffer feelings of incompleteness, anxiety and depression.

Hmm...and what say you, Amensty International?

[Testimonial] I was genitally mutilated with a blunt penknife.

Maybe male circumcision is evil, maybe not, but discussing it in the same breath as female circumcision or attempting to compare the two is simply wrong, and I have my circumcised penis sans all of the surrounding horror to prove it. Ignorance alone is nothing to be proud of, but most people are ignorant about many things (myself obviously included). However, when you pair ignorance with a stunning dose of arrogance you get statements like this, statements that are sensationalistic, false, and potentially deadly. In other words...

Bitch, you're retarded.