Someone Misses Football Already...

Resident: "His hemoglobin A1C was 14 and-"
Attending: "TWO TOUCHDOWNS!"

I Know I Can't!

Cue to the medicine floor at 9pm.
A nurse notes a patient rifling through the refrigerator at the nurse's station, dumping all the juice boxes into a garbage bag she's taken from the trash can in her room. The nurse watches, agape, as the patient finishes cleaning out the entire fridge, then begins dragging her bag o' goodies down the hall. The nurse finally recovers as the patient is about to enter her room (an easy 30 feet away).
Frozen, RN: "Hey! You can't do that!"
Mrs. Frontal Infarcts: "I know I can't!"
The patient then proceeds to drag her prize into the room and shut the door.
End scene.

This story had a happy ending, however. Shortly afterward, a highly-trained team of professionals was assembled, and the hostage juice boxes of 6-South were successfully extracted.

Playa Haters

"Sir, do you know who shot you?"
"A playa hata...please don't let me die, I just love y'all."

Oh, Hey There

Turns out third year is kinda busy as fuck. People say funny shit to me all the time, I just haven't gotten around to posting it. Mostly cause of the, y'know, being busy-as-fuck. Also the drama of being a 20-something with too many hormones and standards that get a little lower every time I see a bitter single female doc (that would be every time I open my eyes).

I recently declared Ob/Gyn. Why? Because I hate happiness. Just kidding...sort of. I'm thinking about residency pretty much anywhere that isn't the Northeast, but hey, who knows. Looked at a lot of the programs in Texas, but seriously, they pronounce it OB-Gin - like the drink - which utterly disgusts me.

Recently saw a patient in clinic who had helpfully written down his prior surgeries for us. I blinked a few times at this one:

Well, sir, I'm sorry to hear that. I hear it's not the size of the boat, but the motion of the ocean, though, so you've got that going for you.

Really?

There's a girl from my home town who's not a lot older than me (I am quite young, thanks) who is pregnant and engaged to the baby daddy. No big deal, there are at least 10-15 other girls that I went through elementary and middle school with that seem to have done the same. If your child is the ringbearer at your wedding, I'm not gonna judge you.

But the thing with this couple is this isn't their first kid. Or their second. This is baby number three and the oldest is 4 or 5, I think. They've been engaged for a while.

I've seen this a couple times on rotations too. Happens with the hood rats and the white trash girls (my peeps). Here's my question: what's the point? I mean...we all know you guys would've gotten married around baby #2 if this was gonna happen. Stop foolin' yourself.

Photographic Evidence

So here's an example of a typical patient encounter nowadays in what I fondly refer to as "Coochie Clinic"

Me: "So what's brought you in to see us?"
Miss Photogenic: "Well I got this heat rash"

She immediately pulls down the 'dress' that is roughly the size of something that I, at 115 pounds less, would wear as a tank top. I get an eye full of cleavage and it takes about three seconds to identify the ringworm.

Me, with full poker face: "Ah, OK, and have you had any other skin problems?"
Miss Photogenic: "Yeah, I had this spider bite about a month ago, here, I gotta picture!"

As I'm thinking to myself, "Oh shit, I know what spider bite is code for," she grabs her smartphone, clicks around, and then shoves it under my nose. Sure enough, there is a picture of her very large breast lifted up by a hand and a huge ass Staph abscess underneath.

Really, people?

Brain Surgery? Easy. Prepositions? Impossible!

I had a patient last week with a skull fracture. I was reading through his chart during pre-rounds when I noticed something odd on the Neurosurgery note.  I would've taken a picture, but I'm just a timid med student and don't want to get yelled at [more]:

"Reason for operation: Surgery for fix skull"

I shit you not. I expected that from ortho, but neurosugery?

Terrible Two's?

Whoever thinks two is the hardest age has clearly never tried to bear wrestle an equally contrary but far more strong three-year-old down in order to look in their ears.

Finito

So I survived Step 1 (well, I've made it like 12 hours since it ended, so my chances are looking good).

It proved what I already suspected: the extent of my medical knowledge is only eclipsed by...the extent of things I don't know about medicine.

That's my way of saying I don't know jack shit.

Anyway, it's over and I probably did OK. I mean, I feel like I failed massively, but I think that's normal. I felt that way during all my practice questions sets and I was really doing OK. I find out in about a month, and I think until then I will just repress all thoughts of the exam (oh, excuse me Step 1, I mean suppress).

Now on to clerkships. I start with Pediatrics, which is a terrifying thing because:
1) Kids are petri dishes- my stomach just cramped thinking about the fun viruses I am likely to pick up
2) I'm afraid I will accidentally break the little ones, somehow
3) Screaming baby otoscopic exams

Should be an experience. In the meantime I'm taking a vacation to Asia! Yeah, bitches. And I'm not going to think about medicine at all!

Step 1 Made Me Racist

Studying for Step 1 has made me a buzzword-recognizing machine. My brain is like a little medical landmine - one of those crappy, homemade ones - that gets tripped every time I hear something that sounds remotely like a buzzword.

"Blah blah blah roses," old lady at a table near me says, and suddenly my mind is full of Homer-Wright pseudorosettes, medulloblastoma, and neuroblastoma (oh my!). Some dude in the other window chair says, "Yada yada writing," and things like HLA-B27 and "can't see, can't pee, can't climb a tree" bounce around in my head.

Buzzwords aside, Step 1 studying has also made me TOTALLY racist (and ageist and sexist).

Every black person has either sickle cell or HIV. If you're a black woman, you definitely have sarcoidosis (in fact, as far as I can tell, the only reason to EVER do a CXR on a black woman is to see bilateral hilar lymphadenopathy).

If you're a young whitish female and you fell down? You have MS.
Teenage female with a bad attitude? Acute intermitten porphyria.
The right side of your heart is mentioned at all? IV drug user.
Mediterranean anything? G6PD deficiency. (And lay off those fava beans.)
White kid with a respiratory infection? CF, bitches.
Acting an aggressive fool, even if you're an old dude? PCP.

And I assure you, there is a pretty good chance that it is lupus.

The Brain

...cannot be explained by anything but magic. And not in a nice way, as in, "Wow, it sure is magical how awesome our brains are!"

I'm not going to be a neurologist, guys. I think I'll get a Harry Potter-esque wand for my neuro clerkship next year. Here is how this goes down in my head:

Attending: "Sassy, what causes Wallenberg syndrome and what is the clinical presentation?"
Me, waving wand vigorously: "Magic!"

Attending: "Sassy, what does this patient's CT scan suggest?"
Me, brandishing wand at image: "Magic!"

Attending: "Sassy, how in the hell did you get into this school?"
Me, flourishing wand: "Dark magic!"

Resident: "Med student, get me a cup of coffee!"
Me, stirring in creamer and sugar with wand: "MAGIC!"

They will love me. You have to admit the wand would be useful in the last situation.

Life Sucks, But My Roses Are Bloomin'

I have nothing funny to say at this point. I hate Boards. Studying (and life issues) have more or less turned me into Eeyore, but with a fouler mouth and better access to stimulants and depressants.

This is my schedule:
-Wake up late in the early afternoon
-Shower and "dress" (AKA put on the same scrubs as yesterday, with different underwear)
-Go to a coffeehouse
-Drink a Big-Mother-Effing™ iced latte...or three
-Study in somehow the most inefficient way possible until 8pm
-Go home and fail at studying some more
-Stay up 'til 6 or 7 am so that I will be too exhausted to lay awake worrying and/or being depressed
-Crawl into bed and, invariably, wind up still worrying and/or being depressed
-Pop a trazodone or zolpidem and either fall asleep (with the former) or hallucinate for a while, then fall asleep (with the latter)
-Wake up, lather, rinse, repeat

My mental state is a scary thing to examine right now. I think (hope?) I will probably look back on myself in a few years and go, "Wow, Sassy, that really wasn't that important, you were being such a whiny little drama queen!" But as of right now, I have had Step 1 sold to me as *THE MOST IMPORTANT TEST OF YOUR ENTIRE LIFE AND YOUR ENTIRE FUTURE DEPENDS ONLY ON THIS ZOMG* by classmates, teachers, my school's administration, peers on the intranetz, etc. I tried to resist for a while, but I've now been totally sucked in. Oh well, as a recently-graduated friend told me, "Do what you gotta do. Here's a bunch of Ambien. Please don't OD on them. We'll deal with any addictions or health problems when this is over."

On a less "woe is me" note, I took up gardening (I use this term lightly, as I still don't really understand how to not kill most plants) this year. One of the plants I shoved into the ground was a raggedy little stub of a baby rose that I got at a bargain store for $2. I fully expected it to die, but instead it has grown and when I peeked out my back window this morning - tada! It is blooming!! Finally, something not totally shitty!

OK, back to the books.

Step 1 Bitchin'

I'm about to go all Hulk Smash on Qbank. I only have three weeks 'til Step 1 and I am suckin' it up.

I can't wait to light my notebook on fire after this is all said and done.

USA, USA, USA!

Step 1 and Other Bullshit

I've got Step 1 looming over me, and it's totally gnawing away at my sanity (OK, what sanity I still possessed at this point in life). I've been having tiny panic attacks every time I think about it too much. It might not seem so bad, but I've been spending too much time around gunners, who all pull this, "OMG I'VE ONLY SPENT TEN HOURS STUDYING FOR STEP TODAY AND IT'S ONLY FOUR MONTHS AWAY AND OMG I'M SOOO STUPID" bullshit. The only thing that seems to make them feel better is making everyone else around them feel worse than they do (they succeed, because who the fuck else studies that much that early?).

Anyway, the point I'm getting to is...I'm out for a while.

Hopefully I'll have some funny stories worth writing down when clerkships start.

An Old ER Doc's Favorite Story

So an older ER doc told me his favorite story not too long ago. It went something like this:

A woman is brought in by police at 5 am on a week day to be checked out for "being maced in the eyes." Apparently she was drinking earlier and had gotten combative with the cops, leading to her getting maced. The ER doc went into her room to check her out and noticed she wasn't looking too bothered by the whole "mace-to-the-face" thing.

Doc: "Ma'am, I understand you were maced, how are you feeling?"
Mrs. Demeanor: "Fine."
Doc, getting a little confused now: "You aren't feeling any pain?"
Mrs. Demeanor: "Naw, my eyes hurt when they firs' did it, but I took care of it."
Doc: "You took care of it? You were maced. How did you take care of it?"
Mrs. Demeanor: "I put beer in 'em."
Doc, really confused now: "You...put...beer in them? And that worked?"
Mrs. Demeanor, as if this is quite obvious: "Yeah."
Doc: "Can I ask you were you got beer at 4:30 in the morning?"
Mrs. Demeanor, giving him a look of disgust and putting as much condescension as possible into her voice: "From my purse."
She then reached into her purse to prove that she was packin'..cheap beer.

So there it is ladies and gentlemen. If you get maced and your eyes are on fire, just rub some beer in them. Even better than the good old "rub some dirt on it" solution...

Standardized Patients

So my medical school has us work with standardized patients sometimes. This basically allows us to sort of kind of learn to take a history and do a physical exam without actually being let loose on some poor person with real medical problems. These people get paid to spend a couple hours being poked and prodded by a bunch of 20-somethings who feel all kinds of uncomfortable with tasks such as asking obese older women to lift their breasts out of the way and feelin' up femoral pulses on crusty old guys.

Now most of these SP's have been doing this for a while and it's old hat to them. They have their chief complaint, they know their story and what answers they should give to relevant questions, and the feedback they give is usually something along the lines of: "Explained what she was doing well."; "Was very compassionate."; "Know hows to act like a human being."...or some other generic shit like that. But sometimes the feedback is off-topic or even downright crazy-pants, and of course we all like to share those fun stories. A few examples:

Mrs. Old-Fashioned: "Blouse was too low and distracted me."
The student's 'blouse' was a dress with a buttoned-up cardigan over it, but this one's still not too out there. At least it wasn't a male patient talking about how distracting it was.

Mrs. Fashion Police: "She should not have been wearing boots with heels!"
It was 15 degrees outside. Unfortunately she did not share what kind of shoes she would have considered more appropriate.

Mrs. PC: "Beard made me uncomfortable, unless it was for religious or cultural reasons."
10 to 1 odds she clutched her purse closer then he walked in the room.

This gem happened after an encounter where the patient was supposedly angry and the student was supposed to placate him.
Mr. Drug Seeker: "He did an OK job [of apologizing], but he should have offered me free drug samples."

This happened with an actual patient who gave permission to be examined by two students in a group of four.
Mr. Creepster: "Is there a girl in the group? Yeah? She can definitely examine me."
He got two burly male students.

Good Advice

Dr. Obvious: "The key to the test is just to put down the right answers."

THAT'S what I was supposed to be doing? Shit, all this time I thought I was supposed to make a pretty design on my scantron sheet. Now I'll start getting 100's for sure.

Shit Old Surgeons Say

So this grouchy old surgeon came in to give us information about our surgical clerkships next year. He did manage to stay on topic for a little while.

Dr. Inmy Day: "Well, we can't require you to be at the hospital before 5 am anymore. But, dedicated students show up before 5."

Then he somehow got on the subject of his residents.

Dr. Inmy Day: “They already have their damn 80-hour work weeks. And starting July 1^st, our interns are limited to just 16 hour shifts. The only thing they haven’t told us yet is that we have to give them milk and cookies every night.”

Not gonna lie, I laughed. Throw in bed time stories and I'm sold!

Sassy's First Night in the ED

I spent a few hours last night sort of shadowing in the ED. I say sort of, because I pretty much wandered at will and followed whichever resident or attending didn't give me the stink eye into the rooms. They're pretty casual about students shadowing at Med School Hospital's ED. It was my maiden voyage in the ED (no one put big red V on my forehead with lipstick, sadly). I saw some really interesting stuff, some OKish stuff, and some "WTF are you doing in the ER for this shit?" stuff.

My favorite, though? A severely autistic patient who was sent in (and by "sent in", I really mean "dumped") by his home with some paperwork. On his chart was written:

"Chronic Illness:          Artistic         "

I'd love to see the DSM IV criteria for that.