ndab Ah Yes, Medical School: October 2006

Wednesday, October 25, 2006

ID for ID

Among the multitude of aspects that is frustrating about medicine, one of the main areas of concern centers around an excruciatingly painful task requiring scores of mental aptitude, quick analysis, and the extremes of dedication to achieve and thrive in. You know, learning stuff. Since it has been well established that learning is boring, and since all I am really expected to do on my Infectious Disease rotation is learn stuff (as there are no procedures or tasks to master), I thought I'd ease the pain and make learning fun. And by fun I mean a way for me to kill an hour writing this up instead of learning stuff.

With fun in mind, I made a game for you all to play: What will follow are five infectious disease topics, followed by the pictures of five celebrities they most resemble in a jumbled order. (Despite my obscenely large C-level Internet celebrity status, I’m not one of the celebrities depicted. After all, I don’t even have a Wikipedia entry made about me, so I can’t be that famous. Yet.) Your task is to try to match the disease with the appropriate celebrity, and then compare your results with the solutions I have provided below. And before you even begin to ask, the answer to your question is: yes, I do in fact have no life whatsoever. Enjoy!

1. Diabetic foot ulcer
2. Ebola virus
3. Herpes Encephalitis
4. C. difficile colitis

1. Madonna

2. The Bush White House
3. Tom Cruise
4. Mel Gibson
5. Kim Jong Il

1. Diabetic foot ulcer - Proving that your toe does taste like chicken, the diabetic foot ulcer presents itself as an appetizing feature of infectious disease. Interestingly, this soft tissue infection often starts as a simple little prick, say from a nail or some other sharp object, that grows into a massive infiltration because the diabetic patient cannot feel his or her feet and does not even realize that a raging infection is taking place. And speaking of little pricks, if you matched this topic with Kim Jong Il, you are correct! But only because President Bush is not little. Answer: Kim Jong Il

2. Ebola virus - It's elusive. It's dangerous. It is one of the most deadly things in the universe. It was featured as a fearsome killing machine in a movie starring Rene Russo (more frightening, now that I think about it, than Rene's plastic surgeon). And it is currently only found in Africa, snatching up defenseless children across the land and causing almost unheard of societal damage. Yikes. Answer: Madonna

3. Herpes encephalitis - This little guy is something I have absolutely no personal knowledge of whatsoever. It's called herpes, and (I've been told that) it can lead to some pretty gnarly, painful lesions on your genitalia and/or lips (depicted to your right). What you may not know is that, rarely, it can cause something called "herpes encephalitis" (that just sounds bad, ya?) when the virus that causes this disease gets into your brain tissue, which basically makes patients suffering from this condition act completely insane and do utterly irrational things, like jump up and down like a monkey on national television or attempt to convince other people that you are not gay by getting an actress to artificially inseminate herself with alien sperm while telling everyone that you impregnated her. Answer: Tom Cruise

4. Clostridium difficile colitis - The unique thing about this type of colitis and the subsequent raging diarrhea that ensues is that one only gets this specific type of diarrhea after being treated with antibiotics for another disease. So even when you think you are helping someone by giving antibiotics, you might actually be causing this monstrosity to be unleashed on your patient's colon, toilet bowl, and wall (but only if the spray is forceful enough). And nothing makes me think of steaming, watery, foul-smelling putrid mounds of shit more than anti-Semetic raging alcoholic wastes of space. And by the way, Braveheart was totally overrated. Prick. Answer: Mel Gibson

5. Definitely one of the hottest topics among fear-mongerers today, MRSA (methicillin resistant staphylococcus aureus) represents the latest in drug-resistant infectious organisms. Basically what happened was the medical establishment was careless in its initial approach to this bug, blasting it away with unnecessary heavy-duty antibiotics at inappropriate times, but not being judicious in its planning and approach to long-term management of the disease and not ensuring that patients completed the required course. Some would even argue that many of these infections were not actually real infections at all, but were only contaminants in blood or skin cultures, and should not have been attacked with antibiotics in the first place. Remaining bugs started acquiring resistance to these antibiotics, first appearing rarely and then disseminating rapidly, spreading out from the hospital setting into the big communities, killing the weak, and developing into a quagmire that is quickly spiraling out of control. It is now at the point where there are extremely few antibiotics left to treat this bug, options that are often decidedly toxic to humans and that represent a tragic strain on the fabric of society. Even worse, the medical establishment has absolutely no good exit strategy for how to deal with this ferocious force. Gosh, I feel like I’ve heard this story before, I just can’t remember when or where. Answer: The Bush White House

Monday, October 09, 2006

Spiraling Out Of Control

Some time ago, I made a decision that went catastrophically bad. Those of you who know me on a personal level might be thinking that the decision I am referring to involves going to Supercuts today, having subsequently seen me sporting my new look that not only allows me to fulfill my dream of using my forehead as advertising space, but also allows me to look like a complete and utter douche bag for the next month. Assholes. However, the decision I am actually referring to is one slightly grander, one that most of you might predict. If you guessed “Go to medical school”, then congratulations, you can read. Given how this has turned out (see Ah Yes, Medical School, Years 1-4), you might imagine that I have approached my decision to choose a specialty with more than a little trepidation. After all, if I can mess up a life choice this badly once, there really isn’t all that much to stop me from doing so again. (Just in case you haven’t figured this out for yourself yet, I should remind you that optimism does not exactly go hand-in-hand with Jewish guilt.)

Fortunately, the one difference between the circumstances surrounding that last decision and this one is that I now have you, my loyal band of trusted readers, to help guide me in my decision making process. Sifting through my fan mail from time to time (OK, OK, fine. I sit here and hit refresh every two minutes waiting for something - naked pictures - to keep me entertained.), I have received a plethora of useful and useless bits of wisdom geared towards helping me with my decision. One tool that I have received multiple times is this moderately humorous and moderately truthful flowchart. After thorough examination of this chart, I can’t help but feel frustrated by its lack of utility. There are multiple things wrong with this chart, such as the lack of a broader range of specialties covered or the spelling of "pediatrics" (damn British), but the one thing that stuck out in my mind was that this flowchart presented things in a two-dimensional space but did not indicate whether there was any directional component as one traversed the chart. In other words, I didn’t feel like I was going anywhere in this chart, but I knew damn well where I was going in real life - towards that charming, beautiful locale known as the shit house. Then, suddenly, it hit me like the hand of a congressman on a 16 year old boy’s bare buttocks (sorry, too easy). Why make a simple flow-chart when, in fact, a shame spiral would work much nicer? With that in mind, I have created the Medical Specialty Shame Spiral, and I hope you take a ride down with me…

Medical Specialty Shame Spiral

Much like the original flowchart, this shame spiral assumes you begin as a medical student, depicted by the skillfully drawn figure created by none other than yours truly. You hop on the shame spiral and spin around, still idealistic about your career choice, but are almost immediately confronted by the first branch point.

Branch Point 1: Crazy or Really Fucking Crazy
One subtle error in the original flow chart is that it makes this ridiculous assumption that a medical student can, in fact, be sane. Wrong. The separating factor is actually whether one is simply crazy, with quirks, tendencies towards masochism, and a sprinkle of OCD, or whether one is out of one’s fucking mind. The 25 hour studiers in a 24 hour day. The “I scrub in on every single case in this entire hospital at the same time” pricks. The people who ask me about my stance about whether it is socially acceptable to serve drinks at a dinner party (Don’t ask. Actually, let me ask you all. Is there a debate? How could anyone debate this? What the fuck is wrong with these people? Have a drink for Christ’s sake. Lord knows I needed one after talking to this nut.). These people aren’t just crazy, they’re crazy motherfuckers. Thus they are likely to become the future neurosurgeons, plastic surgeons, cardiothoracic surgeons, and even orthopedic surgeons (notice a trend here?) of the future, as well as becoming the first group to bypass the rest of the shame spiral and go directly to taking it from The Man. Oh, and don’t think I forgot about the psychiatrists. They are so fucking crazy they don’t even fit in the shame spiral.

Only crazy, you find yourself still spinning around this spiral of shame, having likely discovered the merits of drinking alcohol by yourself, and you now make your way to the shame spiral branch point 2.

Branch Point 2: Fascinated By Genitalia or Disturbingly Fascinated By Genitalia
Everyone is fascinated by genitalia. Right? It’s not just me? Right? Hello? Hi mom! But the real nuts are just a little too fascinated by it (Get it? Nuts? How am I not getting paid for this?), so much so that they would devote their professional careers, likely spanning 40 years and thousands of hours of their lives, knee deep in whichever set of genitalia they prefer. Why do I feel like I should have saved my Mark Foley jokes for this section? Oh well. Welcome, Ob/Gyn and Urology, you have just taken a dive off the shame spiral and can now go directly to taking it from The Man. And no, I’m not putting Adolescent Medicine here. Pervert.

Having survived the next stop, you are creeping further down in shame and are now taking shots of Popov and chugging Natty Light, you haven’t shaved in a week, and you look ready to start calling former girlfriends or boyfriends. Not looking good, but we’ve arrived at our next stop.

Branch Point 3: People or No People
Some people are people persons but other people are personally putrid at purporting to interact with, palpate, percuss, and personify people. Just in case you’re keeping score, The Fake Doctor Is A Big Loser is in the lead with 23094823098. Simply put, there are people that somehow manage to make it through a medical school interview process without having the slightest ability to communicate with your average Joe, or even your average Xiao, Neeraj, or Yitzhak. I’m still not entirely sure how that happens, but fortunately there is a place for these people in the medical profession. It’s called the basement. Yes, where better to hide the freaks and spazzes in your medical school class than in the one place where they will never see another living soul? I see no other reason why Pathology and Radiology are always in the dungeons of every hospital I’ve been to thus far. Oh, and you might as well throw in Anesthesia, and give them extra points for actually taking pleasure in making people incommunicable.

You’re still spinning down this spiral of shame, having graduated from liquors to painkillers. It’s getting ugly here, folks. Britney Spears ugly. And speaking of ugly, we’re at our next branch point.

Branch Point 4: Gross or No Gross
Much like staring at any recent photograph of Nicole Ritchie, some people are just better at dealing with gross and scary things than others. I am not one of those people. Call me a pussy if you’d like (and believe me, you wouldn’t be the first), but I can think of a lot of things I’d rather be touching and smelling than someone’s bowels, skin crusts, or diabetic foot ulcers (for a list of such things, please see Branch Point 2 – like you didn’t see that one coming). So that means no general surgery, no dermatology, no vascular surgery. Ah, hell. No ophthalmology (eyes are gross to poke), head and neck surgery (except for this), or colorectal surgery either. Sorry, but that’s just not how I roll, although that’s how these people roll…right off the shame spiral and directly into The Man’s fortress of doom.

Heavily sedated on painkillers, still binging on alcohol, you are sinking further down the shame spiral and have now resorted to watching the VH1 Flavor of Love marathon for the last 3 days straight on repeat courtesy of TiVo. Flava Flaaaaaaaaaaaaaav!

Branch Point 5: Baggage or No Baggage
It’s bad enough having to deal with the patient. But when the patient comes with excess baggage in the form of obnoxious, irritating, sometimes homicidally painful parents, then that pain becomes sheer agony. Don’t get me wrong, I love kids. Anyone who knows me personally knows of the things I’ve done on behalf of children (apologies for how horribly sketch that sounds). But I’d rather be the meat in a Hastert-Foley sandwich than deal with their freaking parents all day long, whining about little Johnny’s runny nose at 3 A.M. Also, last time I checked, it’s not fun making kids cry. Peace out, pediatrics and family medicine. I thought we had something together, but then again, Krazy thought the same thing about Flava Flav, too. I hope someone besides me finds that obscure reference amusing.

You have reached the bottom of the shame spiral, done every narcotic known to mankind and Paris Hilton, and are passed out on the floor of the bathroom, covered in your own filth. Not that that’s a bad thing. Why isn’t this on the cover of your medical school’s brochure, you ask? I do not have the answer.

Branch Point 6: OK Fine, It’s Not Technically A Branch
Well, there’s one thing left*. The one thing so generic, so bland, that just about anyone could pick it, shrug one’s shoulders, and just continue on this same shame spiral for at least a few more years before actually committing to anything: Internal Medicine. Ta da! Why choose a specialty now when you can put it off another 3 years? At least that’s what I figured as I clicked Internal Medicine on my application (That, and something along the lines of "Please let someone offer me big bucks to write my memoirs" ...Desperatelosersayswhat? What?) .

Of course, that still doesn’t stop you (or me) from sliding directly into The Man’s filthy lair, but by now you’ve probably figured out that The Man is nothing more than your own future medical self, proving once and for all that if you do decide to go to medical school, you’re really only screwing yourself.

*There’s actually more than one thing left. Like Nuclear Medicine. Or Radiation Oncology. That doesn’t change the fact that you’re a total asshole for wanting to point that out.