ndab Ah Yes, Medical School: December 2003

Saturday, December 27, 2003

Merry #$%@# Christmas

Perhaps given the fact that I am Jewish, it is only fitting that this Christmas season is filled with misery for me. In this case, misery is in the form of a leaky pipe that decided to burst Christmas Eve. This did not result in immediate flood-age; rather, the dripping began slowly and was only audible if one carefully listened by the wall. Which I did not do. So I left for home for a few hours, only to return and hear a loud, consistent thud emanating from my room. I entered, only to find a large pool of water right by my dresser, and a disgustingly yellow ceiling above it. That's just fucking great. I called the manager, but of course she wasn't there because she is just a useless human being and a complete waste of space. Maybe I'm being too harsh...actually no I'm not. Hearing other tenants make fun of her in the elevator taught me that she is just terrible.

Anyways, one drip became two, which became four. I put out buckets, called the interim manager, and sat there. Eventually I got a call back and was told that someone would be coming tomorrow. One Chinese Water Torture day later, the plumber arrived. And promptly cut out a two foot long chunk of my ceiling. Did I mention the ceilings were old and made with asbestos? And that there was steam coming out of this hole for hours? And when I asked the guy about when they were going to fix it, he responded with a "Oh, maybe January 8th or later,"? The great thing is, I know my manager is going to show up someday and want to charge me a billion dollars to fix the carpets that I had obviously ruined and the hole that I had obviously punched into the wall, and that the pictures I took of this disaster will somehow not be sufficient to prove otherwise for her sake.


Saturday, December 20, 2003

Learning Is Fun! And So Is Unnecessarily Hurting People!

Before I get to the nasty stuff I saw during my preceptor visit yesterday, I would just like to add something to my previous bitch-fest. As much as I enjoyed ripping my school, I have to say that I impressed myself (along with the doctors I was following around) yesterday with how much I have actually learned in just four months. Almost every patient we saw had something that I was completely comfortable with: diabetic ketoacidosis, COPD, heart failure, etc. Granted, these are pretty common things, but, as one doc said, most first year medical students wouldn't have the slightest clue about such things because they don't get to learn about them until second year, much less the detailed knowledge of pathophysiology and treatment options that I brought to the table. Awwwwwwwww Shiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiit.

Anyways, the amusing stuff from yesterday is as follows:

One patient I got to learn about is jovially referred to by the doctors on the ward as "Magpile". This monstrously large woman was brought into the ER with a whole mess of problems, not the least of which was the fact that there were MAGGOTS on parts of her body that she was completely unaware of. Umm. Yea. That is just awful.

Later on, doc decides that one patient needs an arterial blood gas test done. Then looks up at me and says "Oh, you're doing it." That's just great. Turns out that this test involves taking a big needle and sticking it down someone's wrist at a 45 degree angle, hoping to hit an artery (they are buried deeper than veins). Needless to say, this does not hurt at all. Naturally, I hit a vein the first time around and had to repoke him. Then I missed again. And again. And again. What made me feel a little better was the fact that the doctor couldn't do it either, but that could have been because the swelling was so much after my attempts that it was just not gonna happen. Yay trial and error!

Next, doc decides that I should just keep on trying and has me follow a nurse around to start an IV on someone. Unfortunately, as the nurse would later tell me, it is as if this woman has no veins, so we spend about 20 minutes just trying to find one on her body in the first place. Did I mention that she was going through menopause and was experiencing hot flashes while I was trying to poke her? Or that she knew I didn't have the slightest fucking clue what I was doing and was belittling me the whole time? Or that the nurse pointed to what she claimed was a vein but was to me nothing? Yea you can guess what happened next. I fucked that up. Heh. Actually, I made the right hole, just didn't direct the needle completely in the right way, which required nurse assistance. Well, I'll take any sort of silver lining at this point. And no "I can't find the hole!" jokes, please.

So what is the moral of this story? If you happen to be at the Kaiser I'm at one day and just so happen to see a dashing young medical student handsomly walking around and offering to stick you with a needle, just say no.

Thursday, December 18, 2003

A Sense of Entitlement

Now that finals are over (pass, baby, it’s all about the pass), I feel a need to vent on something one of the heads of our cardio/renal/respiratory block said as a grand finale on the final day of lecture. He got up in front of everyone and went off on this grandiose speech, talking about the virtues of medicine and all this fuzzy crap. That alone would have made for a rather benign and quasi-inspiring speech. Yet, if that were the case, I’d have nothing to be pissed off about. To conclude his speech, the doctor began discussing the notion of entitlement. He seemed rather worked up about this topic and how we, as doctors, are only entitled to taking care of our patients and learning everything we can for their sake. In a dramatic pose, he concluded, “You are entitled to NOTHING else,” and he stormed off to a rousing ovation. I’m sure it didn’t quite go down like that, but that is the gist of what was going on.

The subtext of these comments was very clear: after spending eight weeks of listening to or reading what must have been hundreds (thousands?) of complaints from anal premeds (they may technically be medical students, but they’re not fooling anyone) about the class, this doctor felt the need to give a quick lecture on what we are really entitled to. He felt that students were complaining about the most ridiculous things – if lecture notes weren’t posted a week in advance, if someone didn’t appreciate a non-offensive joke that was made in class, etc – and that we should stop being such pussies, sack up and learn to deal with these minor inconveniences and just learn everything we can, blah blah blah. He mentioned how the clerical people work all night to prepare copies of notes for us and about how everyone is working so hard on our behalf. On that point, I think he is absolutely right. There are individuals in our class who probably gripe about the most asinine things and come across as whiny little bitches who want to be spoon-fed everything, and if I had to listen to them all the time I’d want to impart a lesson regarding entitlement, too.

However, now that the doctor has brought up the topic of entitlement, I feel a need to respond (to whom, you ask? To my loyal readers, of course!). Before I begin, I should note that I have never complained about anything to official medical school people, much less the moronic stuff that people in our class complain about. In fact, my only conversation with this doctor went as follows:

Me: Wouldn’t mitral regurgitation have a diastolic murmur that starts in the beginning of diastole and not an end-diastolic murmur?
--I point to the screen--
Doctor: Umm, EDM stands for early diastolic murmur.
(Needless to say, I did not make much of any impression with this guy.)

All that aside, the doctor’s argument is fundamentally flawed. Yes, when I am a practicing doctor, I am only entitled to learning all there is to know to treat my patients. That is a noble statement that I hope to fulfill during my career. However, I am not a doctor. I can’t even pretend to be one. I can’t really even take a freaking blood pressure right. Given that, I am going to go off bitching as medical student paying tuition to support this guy's salary, be forewarned, because as a medical STUDENT who is paying a fee for a service, my sense of entitlement is not as he perceives it to be:

First let me say that I understand that this is a new curriculum where things aren’t totally set. Lecture notes might not be ready far in advanced because they are being made for the first time in this format. There is some fudging of the schedule now and then. Some of the lectures or labs might not be all that useful or clear. I’m ok with all this – it’s all brand new, so there’s bound to be mistakes. And in this facet of the game, I think they’re doing a pretty good job of things overall.

However, as a medical student paying thousands of dollars in tuition to this university, I feel like I am entitled certain things. For example, two weeks before this last set of exams, neither I nor anyone else in my class had any clue how we were going to be evaluated. Take home finals? Anatomy practical? Three hour in class test? Clinical skills test? All we got was a shrug from the professors and a hint of interdepartmental squabbling as to what is the most important thing to test us on (the anatomy guys literally had verbal arguments with the block chairs about including an anatomy test after our whopping three sessions of anatomy over eight weeks). Umm, guys? You’ve had six fucking years to figure this out. This isn’t one lecture or one lab. This is the entire evaluation system on which it is decided whether we ultimately graduate, what residency we go off to, etc., and it’d be nice if we had a clue about what we should be focusing on before we went into it. Do I spend my time trying to learn the anatomy that was so poorly presented in the first place? Do I try to make sense of the many heart sounds? Should I learn how to do a complete physical on my own to make up for the pathetic attempt they made to teach us? I wasn’t sure, and they didn’t really elucidate it all until about a week before the exam. I’m not paying thousands of dollars so that they can loaf on something this basic and fundamental to the medical education process and leave everyone of us just wondering how to spend our time.

A sense of entitlement?
You’re damn right.

Last week I had a chance to view the schedule for the next block. To my dismay, it turns out that I will be in school from 10-5, Monday through Friday. The problem, you wonder? Well, part of my decision to choose a medical school hinged on whether the given school provided a more flexible schedule that would allow for outside pursuits. This meant so much to me that I asked our lady in charge of the new curriculum TWICE (once during the revisit day, and once via email) to confirm that the schedule at our school would follow the lesser classtime/more independent learning plan that most medical schools are leaning towards. Both times she assured me that this was the case, and our schedule for the first two blocks lived up to it (mostly). However, this new schedule demonstrates to me that she really has no say in the matter – the block chairs can do whatever the hell they want, and because of that I am going to be in school all day, every day rather than being able to pursue the “extra” things that got me into medical school in the first place. This is especially unnerving because the word is that the block after this one has super hardcore chairs that will see this and have no problem extending school from 8-5. I specifically wanted to avoid this, as I do not learn best being in class all day – there is a fundamental split in medical schools in this regard, and I made a point to avoid the ones that teach this way. I’m mad at this because I could be having a guaranteed independent learning schedule at a certain school in Boston right about now, and I honestly believe that is where I would be if I knew that our schedule was turning out to be this way. This amounts to them blatantly lying to me. Twice. Needless to say, I am less than thrilled.

A sense of entitlement?
You’re damn right.

Have you ever had to sit in lecture and observe what is going on, only to realize that the people up there talking to you have no idea what you know or any clue of how their talk has anything to do with what we are learning? I would say that, on average, two to three lectures per week fit in this category. Now I said before that I am ok with things being a little rocky since it is a new curriculum, yadda yadda yadda. But at some point you have just got to wonder whether they really have ANY clue what the fuck is going on. They’ve had six fucking years to get their act together, and I do not get the impression they really have it. The odd part is that the new curriculum cut out some lectures, etc., but for the most part just rearranged lectures that were already being given in a different order so we see pathology the first year. So then why the hell, after six years of planning, is this so complicated? Why do we have hours of our lives taken away by someone talking about esoteric research thing that is totally irrelevant to what we are supposed to be learning? Why do we not get a schedule for the following week sometimes? Is it because they don’t even know themselves what the hell we are doing the next week? It sure as shit seems that way. Why is the poor office worker up late at night Xeroxing for us, as the doctor so dramatically portrayed in his grand speech? Because he and the other people in charge of our education don’t have THEIR fucking act together in the first place, and any complaints they receive from us are in essence a reflection of their own failure to demonstrate that they can plan an eight week class with six years of notice. For my thousands of dollars, I do not expect perfection or anything even close to it, but I do expect a certain basic level of organization or structure.

A sense of entitlement?
You’re damn right.

Ahh I feel much better.
The funny thing is, I think they are doing a great job overall - but just because you are a self-proclaimed brilliant doctor does mean you can get up on stage and demean us on a groundless and flawed argument.

Wednesday, December 03, 2003

If Darwin Only Knew...

In previous editions I have commented on the ridiculous heights people will go to make their presence felt in class (see Hypertalkers). However, having spent even more time in lecture, I can't help but feel like I've observed an evolution into different species of talkers. It is rather remarkable, I think. And really fucking annoying too. So without delay, I present to you the nightmare that is the Question-Asker Evolution Process. (As a disclaimer, I realize upfront how incredibly dorky this makes me appear, but honestly, if you spent your day trying to learn about nerdy science stuff it just becomes a lameass part of you).

It all began with a simple raising of the hand, a simple four months ago. From this initial promise of life spewed forth a mass of churning, ugly, indistinguishable questions from indistinguishable question-askers. However, as a result of environmental influences, these people have changed, morphed, and evolved into their present, differentiated conditions. I give you now a catalog of the predominant types:

Emptus Brainus - You know who this is. Approximately every five minutes, this particular species will raise his or her hand. Not out of a desire to annoy or show off, but rather because this person simply does not get it. By it, I mean anything the lecturer is saying. For example, a slide on "Four causes of Pulmonary Edema" might be followed immediately with a "So which are the four causes of pulmonary edema?" Or a slide stating "The active site is very nonspecific, so that MANY molecules can fit in it" with a picture of six different things fitting is followed with a "Does that mean these types of proteins can fit six different molecules only?". It is not long before a "Can you help me tie my shoes?" or "Why is my tinkle yellow?" question will appear in class. It makes you wonder how this person made it this far? I mean seriously, how the hell does someone like this get into medical school? Do you really want this type being YOUR doctor? I sure as shit don't. This raises the question: how does one know how to avoid such creatures of idiocy? Sadly, I am dumbfounded as to a useful screening process, but I am open to any and all suggestions.

KA (abbreviation for Knowit Allus) - Why the unnecessary and confusing abbreviation, you ask? Well, that is a major method for identifying this class of jacka-umm-question asker. No matter the lecture, this person insists on demonstrating his or her outside knowledge (most likely as a result of working as an EMT or other related health profession, but this could also apply to a law student who spent three years as a para-legal, etc.) by asking a question that is over almost everyone's head and by inserting as many complicated abbreviations as possible. A typical exchange might go as follows:

Professor - "...so that is a typical acid-base case."
KA - "Would you want to administer the epi or naravac before or after getting the ABG, or is that contraindicated by an increased PMI?"

OK seriously, what the fuck are you saying? We have only been in school for 4 months, asshole. The great thing is that, despite all this previous knowledge, KI AUs are likely of below-average intelligence and are merely compensating for this insecurity by trying to make everyone else feel inferior while they still aren't familiar with the medical-specific lingo this person has had years to master. As a result, when they choose to make questions that are more like suggestions (like the above example), they are more than likely blatantly wrong. An exchange today between a professor and a KA resulted in the professor saying "Well, actually, that would most likely kill the patient." There is justice in this world.

Ripoffus Cockus - Perhaps the most deadly question-asker, this person is known for asking questions in the most violent way possible. No matter what the topic, where there is a question about aortic stenosis, lung volumes, or when tomorrows handouts will be available, the subtext is always clear: ANSWER THIS FUCKING QUESTION RIGHT NOW OR I WILL GO UP THERE AND RIP YOUR COCK OFF. There is a sense of urgency to this question asking that is unparalled in the modern world. It is advised to proceed with caution around these people and always let them ask as many questions as they want.

Toolus Maximus - This particular species sadly does not even realize he or she belongs to the Question-Asker class. Instead, this person basks in a false sense of coolness, faking a sense of idiocy by choosing to raise his or her hand and say something that makes him or her sound dumb to look cool. You all know what I mean. For example, after a series of post-class annoncements are made, this person will undoubtedly follow with a "Everyone! I'd just like to announce that I have no more announcements-HAHAH" despite having heard that joke be made multiple times in the past with little or no success (perhaps even done by this person previously) - this person will also be thinking he or she is the funniest man alive and will laughin your face until you laugh with him or her. Oh please shut the fuck up. The beautiful irony is that this person is only demonstrating how BIG of an idiot he or she is anyways, and, more importantly, how this idiot personifies all that is "Tool"-ness (a word that evades definition but is so important and all-encompassing - perhaps I will go into what really defines a tool some other time).

Offus Highwayus- Perhaps a sufferer of ADD as a child, this type can often be found pulling questions out of thin air, totally blind to the fact that such questions are completely and utterly irrelevent and wholly detrimental to the learning process of the class. Beyond that, they are really fucking annoying too. Interestingly, the questions are often KA-like and way beyond the scope of the class, and suggest that there is a recent common ancestor between these two species. To these people I repeat these immortal words from a brilliant immunology professor: "Jeez, what's with these detailed intense science questions? You guys are in medical school, not grad school. Lets stay on the highway..."

Makus Sensus - Shockingly, one group has evolved that does ask questions that are clear, relevant, and not long-winded. Atheists beware: The evolution of this group ironically provides true evidence for the presence of a higher being and true divine intervention, for no one thought this would ever be possible a few months ago...

There are many other forms, but this is enough for now...

(Well, I've gone and done it. I am now the biggest dork of all time. But I did manage to procrastinate for a solid 30 minutes.)