EgoViri's Xanga

Friday, December 09, 2005

Fri, 09 Dec 2005 00:39:59 GMT

Sweet. I just registered a new domain name. I'll be moving there soon (probably after finals... or sooner if I get really antsy).

www.agraphia.net

bookmark it. You know you want to. This will be the last entry on this site. I'll miss you Xanga (except not really, because frankly I never liked Xanga). Oh, and currently agraphia.net redirects to Xanga, so go ahead and just update your bookmark if you've got one. It'll be a seamless transition, no matter what host I end up using!

*edit* I just backed this entire Xanga up to word... 43 pages of Zac's ranty goodness. Nice.

Thursday, December 08, 2005

Thu, 08 Dec 2005 08:18:09 GMT

You know, I'm reading through some other med student/medical blog sites (www.lingualnerve.com being the one that convinced me it was a good idea to start writing in the first place) and it's funny, there are some consistent themes.

Endless studying. You'll never know what it's like to be here. Difficult. No time for friends. No time for family. Eating badly. Not enough sleep. Not enough exercise. Swamped. No time to go to class.

Then, I look at doctor blogs. One entry that stands out in particular from Lingual Nerve is spacefan's recent entry, where she (the older, wiser doctor) laughs at the idealistic premeds (i.e. me a year ago) for actually wanting to help people. Bitter. Cynical.

Anyway. I see a lot of what I've been writing about mirrored in other people's writings. I know I've been focusing on the burnout, and the difficulties. I'm not really sure why, either. Day in, day out, I'm totally happy to be here. I love studying. I love the material. I learn something (many things!) daily that amaze me. That being said, when I come home at 11, I'm tired, and that is when this blog gets updated. I'll try to remind myself to post positives here. Frankly, I'm surprised I don't more often.

So, I guess this is my pre-finals apology to myself, and to my readers (whoever you may be... drop me an email sometime if you care!) for sounding as negative as I do. Maybe subconsciously I'm looking for sympathy, or acceptance, or appreciation. I hope that's not why I'm writing all this. I'd like to think it's because there is an awful lot of introspection and constant new new new that's being thrown at me, and I need an outlet.

By the way. I got to practice laparoscopic surgery on the ASTEC simulator (UA has an incredible surgery simulation suite, including a full out patient model with pulses, full bladders (that's right, I put in a Foley Catheter, wincing all the while) blood supply, full windpipe (with constricting vocal cords so you might need to do an emergency cricothyroidotomy in case the tube fails!) and full eye movements including pupillary dilation and constriction). It... was awesome. And, laparoscopic surgery is kind of like video games. Which is sweet. And with my past history of constant video gaming action... well, lets just say I'm not ruling anything out.

Anywho, that's what I've got to say for right now. I feel pretty confident going into my exams, I've still got 4 days to study anything I missed, and frankly, I love where I am in my life. Note to self. Be positive in entries... because I always am during most of the day.

Oh. Quick note on the "no time for class" thing I mentioned above. Several of my colleagues (first time I've ever used THAT word) have just blatantly stopped going to class. They feel so overwhelmed by the amount of material to learn that they just... stop going. Class isn't the "best use of your time" because you can get more done in an hour of studying than an hour of lecture. I, personally, think that sucks. Class for me is social. 8-3 class on Wednesdays means a 10-minute break at 9,10,11, and 2, plus an hour and 10 minute lunch. That's roughly 2 solid hours of time I get to spend with my friends. Don't really know where I'm going with this other than to say to you, my long-lost classmates: I miss you. Come back to us. We're a rather fun bunch if you just spent the time to hang out with us. Books can be lonely by themselves.

Thursday, December 08, 2005

Thu, 08 Dec 2005 07:13:10 GMT

Its a gift and a curse, really. I can sleep for 15 minutes and then be totally refreshed... makes studying & midday naps amazing. Sucks when it's 1AM and I just woke up. Now I know I won't be sleeping again until the wee hours of the morning.

Time for some anatomy video review. Fun! This skill will come in handy for rotations and call.

Monday, December 05, 2005

Mon, 05 Dec 2005 22:19:02 GMT

Well, yet again I'm burnt out. This time it's only been really for the past day and a half, but the super-long 8-hour study session marathons for 2 weeks have taken their toll. Exams are next week, and I'm sitting here, doing laundry, chatting on IM, thinking that maybe now would be a good time to fire up the (now dusty) PS2. I miss video games.

I'm sure I'll do fine, but frankly it's just really, really hard to keep struggling uphill through all of this. It's the pressure of it, too... the pressure to perform. I mean, I'll be blatantly honest. At this point, I'm not going to fail any of my classes. I know several of my classmates for whom that's a concern, and I'm grateful it's not me. Still and all, now there's a second question. Can I honor? And does it matter? Honoring is only important if you want to get into competitive residencies.

I suppose I'm starting to think that it does. I know myself, and I know that I like fun toys, and really difficult things, and procedural stuff. That means the more competitive residencies, whether it be laparoscopic surgery, or ER, or what. I highly doubt I'll be a GP. It's too sedentary, in a way. That being said, GPs are the gatekeepers, and need to keep all of their medicine so that they can correctly funnel people's issues to the right specialists. I'm definitely not trying to knock on GPs.

One of the 4th years I've talked to said that you find out eventually if you have a medical or a surgical mind. Medical minds like to sit around and think about the problem for long periods of time. They mull over differential diagnoses. They, in an ER setting, will pull up a patient's past history and peruse it before entering the room. They are the kind of people who go on to be neurologists, GPs, and shrinks. Surgical minds, on the other hand, want answers. They like results, and quick fixes, and decisions. They (obviously) tend to be surgeons, and ER docs, and radiologists. They are the ER doc who walks into the room and instinctively knows if someone is sick or faking (interestingly enough, apparently there is some level of secondary cues that you can learn to pick up on- acidosis, ketosis, jaundice, etc that are not normal in healthy people).

I don't really know where I fall. I do know that sitting around in small groups and not getting anywhere for an hour on a case kills me. I also know that I really enjoy getting the answer "right". Wait-and-see doesn't really appeal to me (a few entries ago, the example of the woman with the ulcers is a perfect example).

Eh. I'm procrastinating. I should be working, so that I can get honors, so I can go on to be a cardiovascular surgeon making $600,000 a year with a huge house, fast cars, and 3 divorced trophy wives I pay alimony to.

Sarcasm, of course. I guess, though, I've always been the kind of person who likes to keep all my doors open. Keeping doors open means honoring. Honoring means kicking my ass for the next 2 weeks, drinking 5 sodas and coffee every day, sleeping poorly, and grunting through it.

On the blackboard outside our classroom somebody wrote "It's hard to see the forest... because the trees are in the way".

Someone else wrote in reply "...but the trees are so beautiful!"

Friday, December 02, 2005

Fri, 02 Dec 2005 19:41:27 GMT

I know I haven't been updating very much (or at all, depending on how you want to look at it), but finals are coming up and I'm definitely stepping it up a notch in terms of studying. I don't want to hit the same hellish 5-days-before-midterms-oh-my-god rut that I was in a couple months ago, so I've been pretty consistantly studying for 6-7 hours a day for the past week and a half or so. I don't know how I would last in med school if I didn't enjoy studying this stuff.

Anyway, I just went to a really awesome ER medicine talk. The guy gave a very honest presentation of ER medicine... the good, the bad, the ugly. And there is a lot of each. I guess I'm finding that to be true for most specialties (want to go through 2 years of residency, work for 40 hours a week and have no stress? Fine, but you'll be a GP and make almost nothing. Want to be hitting a half mil? Neurosurgery may be for you... but you'll wake up at 5AM and get home to the family at 7 every night... plus call).

There were a couple interesting things about this talk though. First off, even though he was presenting ER with all its warts, it still sounds fun as hell. One of the things I'd hate is to lose all of my medicine (I mean, right now I know all my anatomy. What happens if you become an opthamologist and focus on the eye? That's right... you forget almost everything you knew about the rest of the body). Obviously ER doctors are generalists in some respect... they see everything, and they see a lot MORE of everything than GPs do. Also, I know I've got kooky sleep schedules already... I mean, I stay up until 8AM playing Starcraft with TJ (not often, mind you, but it does happen from time to time) and of course, ER docs take shiftwork at all times of the day.

'Course, you have to tell more people that family members have died than any other specialty. And, you then have to put on your game face because you have 20 other patients waiting to be seen. And patients wait for 6 hours to see you, and you bill for a visit and then receive $.14 on the dollar.

*edit* So I wrote this a couple days ago and didn't post it, thinking I'd add more. Nope. Not gonna happen. Studying too much. Catch you after finals.

Thursday, November 24, 2005

Thu, 24 Nov 2005 06:49:54 GMT

My sciatic is almost better! Well... maybe that's pushing it a bit, but a bit of stretching, a massage (by the woman who used to take care of Crissy Ahmann-Leighton, incidentally), and a yoga class has made me able to sit through a whole class again! Without pain! I still notice it for longer periods, but I suppose it'll take a bit longer to heal.

I'll leave you with this to ponder for Thanksgiving.
Mr. T's incredible greatness has been attributed to the fact that his genetic code doesn't have any A, G, or C. His genetic code is in fact, nothing but T's.

Wednesday, November 16, 2005

Wed, 16 Nov 2005 09:29:57 GMT

I've been in the worst pain of my life for the past few days. I think it's because I've been sitting down so much in class (and, lets be real here... probably also because I haven't exercised in a month or so... been waiting for the iPod to come back. Any excuse works, hey?), but I have had sciatic radicular pain (translate: pain that shoots down the path of the nerve) for the last couple of weeks. It wakes me up at night it's so bad. I can't sit through a full class, have to stand in the back... it's terrible. I saw an orthopedic surgeon who told me that it was nothing to really worry about, and he sent me to PT. An X-ray showed that my secondary lumbar curvature is missing due to lower back spasms because of the pain, but apparently that isn't particularly serious.

Unfortunately the soonest the PT place could get me in is December 1st, and since the treatment course is 3x/week for 3 weeks, that means that I'll be in PT during finals. Which I suppose isn't that bad of a thing to have happen- maybe it'll even relax me during finals- but I'm worried that I won't be able to sit through class up until that point. I've even started wondering if it's the way that I sleep (I sleep on my side- maybe it aggravates it) that's causing the pain. Anyway, it has to stop. I can't make it through class, or sit down to study, without intense shooting pain from my butt down through my knee.

OK, enough whining about me. I got into family clinic tonight!

Family clinic is one of the CUP opportunities we have at U of A (Committment to Underserved People). It's basically a free clinic, manned by the medical students, that is a full-service doctor's visit. We draw blood, perform physicals and medical interviews, diagnose, prescribe, and (hopefully) treat patients who can't afford care elsewhere. My first CUP clinic was the Sight Savers glaucoma one that I did a few weeks ago.

It also moves very slowly. We saw one patient in 2 hours, though we were scheduled for two- our first was a no-show. Anywho, clinic was great. We saw a woman who had come in the week before for right upper quadrant epigastric pain for a follow up visit.

Allow me to proseletyze for one second. Hah.... give someone a tiny bit of knowledge and they want to tell EVERYBODY about it. Anyhow, one of the reasons that belly pain is difficult to treat is that there are, in essence, two ways that you feel pain in your body. One is very sharp and localized (ow, I pinched myself about 2 inches above my belly button), and the other is dull and diffuse (ow, I have [insert malady here] and it's causing me belly pain). One of the things we know is that certain internal organs refer pain to different areas, so when someone comes in complaining of right upper quadrant stomach pain- as opposed to right lower quadrant stomach pain- it narrows things down a bit.

So, our woman was getting worked up against several differential diagnoses. She could have ulcers, gastritis, hepatitis (bad!), gallstones, fatty liver, etc. etc. etc.

Now here's where the uneducated medical student in me comes in. I said that she had come in for a follow up, which means we already had a ton of labs on her. CBC (complete blood count, gives us an idea of your blood composition), BMP (basic metabolic profile, which gives us an idea of your basic body chemistry), and a test for H. Pylori, which is the bacteria that causes stomach ulcers. Most of her labs were completely normal, with 2 exceptions. She was ever so slightly off on her ALT levels, which indicated possible liver damage (possible hepatitis, but only if she's truthful about never drinking... your ALT levels can be raised after a hefty night at the bar as well as for chronic liver damage), but the glaring exception was a hefty antibody titer against H. Pylori. What this means is that either currently or sometime in the past, she has been infected with the bacteria that cause painful peptic ulcers.

A maxim has stuck with me for a while now- "if you hear hoofprints in Texas, don't go thinking zebras". Why? Because it's probably just a horse. Now to me, this positive antibody titer means that her pain is probably from stomach ulcers. The ulcers are my horse. Gastritis (a catch-all for a host of other stomach problems) is my zebra. For that matter, hepatitis is my bloody unicorn.

You may sense that I'm leading somewhere here. We didn't end up diagnosing her with ulcers, nor did we send her home with antibiotics to treat the bacteria causing them. The attending (a family physician in town who generously donates his or her time for the night) even got a GI consulation from a doc on call in the hospital, explained the case, and was told by the GI doc to put her on antibiotics for ulcers.

What did we do? Sent her home and told her to take Prilosec OTC for 2 months, then come back and see us. Why? Because she had been taking aspirin for the pain, which is considered an NSAID (non-steroidal anti-inflammatory drug). Aspirin, Ibuprofen (which I happen to be popping like candy for my sciatic pain) or Aleve can cause thinning of the stomach lining and therefore worsening of gastritis. If she were to have had ulcers in the past, she may still have a positive titer to H. Pylori, and the Aspirin, though she thought it was helping the pain, was actually making it worse.

Thing is, I still think I'm right. That's not to say that she won't come in 2 months from now, still in pain due to her ulcers, and I won't be vindicated. But, that being said, the treatment course for ulcers runs about $100... and that's $100 that she probably doesn't have. Killer thing is, the Prilosec will probably run her $30 or $40 (I'm guessing blindly here) for the next 2 months... and then she'll have to shell out the $100 for the antibiotics anyway. Sum total, $130, and 2 months more of pain than she needed to have.

Anyhow, it was interesting to see that already I have these ideas of what should happen. I don't feel like the attending or my 4th year did the right thing by her. They treated the symptom, not the disease (this, of course, coming from a 1st year medical student with 3 months of schooling, who has never even been to this clinic before). Ulcers keep recurring, too, unless you treat the bacteria (if you're still reading, check this story out- the guys who discovered that ulcers were actually caused by bacteria infected themselves and then cured their "ulcers" with antibiotics... they got the Nobel recently).

So, that's my story. Sorry it's so long, but it's 3:30 AM, I'm in a tremendous amount of sciatic pain, and frankly, I've got nothing else to do. Wonder if anybody actually is interested in what I have to say . You know, frankly, I don't care. I think it'll be fun to look back on this entry as a 4th year and say "hah, hah... I thought I totally knew what I was talking about with that ulcer patient... those are the clinical hallmarks of Hep B. And I called it a unicorn..."

Friday, November 11, 2005

Fri, 11 Nov 2005 03:45:24 GMT

Well, I'm back in the game, which is nice. Its interesting, though, that almost all of my classmates were going through the same burnout that I did- people have had nervous breakdowns (one of the people that was supposed to go to the conference with me backed out of a $150 plane ticket at the last minute because she was losing it), gotten sick, stopped coming to class... it's crazy.

Anyway, the good news is that I think our anatomy lab saved me. For whatever reason, I just started getting back into it, and my dissections have been better than ever lately. It kind of kick-started studying again.

Also, we cleaned out the rectum of our cadavers. I'm not going to go into particularly gory detail, but suffice it to say that THANK GOD the embalming process kills off all the bacteria in the body (poo, you see, smells due to the bacteria, not due to the contents itself. Kill off the bacteria, and it doesn't stink!).

Three day weekend this week! Good news, because it means I can try to catch up on all the classes I'm behind in... which is all of them.

Saturday, November 05, 2005

Sat, 05 Nov 2005 20:06:42 GMT

I'm sick. Maybe I can blame skipping my classes this week on that, because I feel terrible and I'm really just not ready to work. I know I have to, I know I need to... but I just can't.

Wednesday, November 02, 2005

Wed, 02 Nov 2005 22:21:29 GMT

So, the conference was great (met some interesting people, got to see two of my good friends who live in LA) but for some reason, I'm feeling totally, totally burnt out. I missed class on monday because of the conference, and barely managed to make my way to histology yesterday. Somehow we rocked anatomy lab (maybe because it's calming... it's hard to explain but there is something to be said about cleaning up a cadaver. Fat and fascia surround everything- especially in our guy, who was probably pushing 220 when he died- but then as you clear it away with your scalpel, there's a nerve, or an artery running within. Cut, clean, repeat... very mindless, very zen)... and then I went home, took a nap, and went back to anatomy lab, did more cutting. Its all I could force myself to do.

Today I skipped every class (and wednesdays are a bad day to skip.... 6 lectures I now have to make up) but I just couldn't bring myself to go. Frankly, I don't even want to study tonight... I just want to curl up with a book and forget about learning stuff for a while.

I know I've only got another 4 weeks until the end of the semester (SCARY) which is awesome... but frankly at this point, I'd be happy to just veg for 2-3 days. I don't think I can afford to, though.

Pressure sucks. I really want to just coast for a while, but I know I'll probably regret it later.