A lot of people wonder why I even thought to do Rad Onc as an elective. Truth? Sometimes I wonder too, but in reality I have good reasons.
1. I really enjoyed my time doing surgery-oncology during my surgery block. And by that I mean I enjoyed my time in clinic more so than my time in the OR. Rad Onc has a similar way of seeing their outpatients -- mostly acute care revolving around their treatment, and very few well visits 6 years later.
2. The people I know who do rad onc seem happy.
3. Lots of MD-PhDs in the field = high proportion nerds. I like nerds.
4. The biology is interesting.
5. You can do interesting Epi research. You can do clinical trials, survivorship studies, emerging therapy trials, sociology research, medical ethics, cost-effectiveness research. It's right on the cutting edge of both medical and radiation oncology technologies and therapies, right on the cutting edge of what we know about tumors. You name it, it has it.
6. There are interesting new technologies.
7. It is procedure oriented, yet the procedures do not involve standing for 6 hours straight with no eating, drinking, peeing, moving, or scratching. The procedures instead involve data. I like data.
8. What you do helps people, and the side effects are usually manageable. And the benefit is usually apparent relatively quickly.
Anyway, lots of people think rad onc is all boring physics. First of all, physics isn't boring. Second, they have staff who are trained biophysicists do the boring part (who get paid a boat load to do it, but that is another story entirely). Most of my day today was spent doing ongoing treatment checks. Tomorrow I'll be in a different clinic seeing new patients and coordinating care with the med onc doctors. Later I might do some CT planning sessions. There are inpatient consults as well.
So I don't know. It's been pretty enjoyable so far. A nice group of people. Pretty relaxed. Interested in teaching. Happy. I don't know if this is what I want to do with my life, but I can definitely see the appeal.
Tuesday, March 31, 2009
Monday, March 30, 2009
The typical malaise of the first day
First day of rad onc and most of it was spent watching radiation occur on patients and listening to an explanation of how radiation gets planned. Some of it was pretty interesting. The watching part..... um..... would it be bad to say it was...... not exciting?
Not too worried about it though, since watching radiation is not likely to be a typical daily activity for me. I have concerns that extensive shadowing might be, but then maybe it won't. I did get to do a consult today. It was ok, though I have to say that I miss Pennsy's smaller size and friendlier staff whom I already know. Oh well. This should be fine too once I give it a little time.
The field is unlike any other I've ever seen before. Really neat. Especially the science behind it.
Not too worried about it though, since watching radiation is not likely to be a typical daily activity for me. I have concerns that extensive shadowing might be, but then maybe it won't. I did get to do a consult today. It was ok, though I have to say that I miss Pennsy's smaller size and friendlier staff whom I already know. Oh well. This should be fine too once I give it a little time.
The field is unlike any other I've ever seen before. Really neat. Especially the science behind it.
Saturday, March 28, 2009
Heme-Onc
So, Heme-Onc is done and I've been trying to organize my thoughts about it. At first I wasn't so crazy about it. I didn't really understand what my job was and what I was supposed to be getting out of the rotation. I worried about the impression I was making. Going back to my clerkships, this is par for the course. I never really like my new rotations until I've been doing them for at least a week.
As I went along I felt like I developed more autonomy. The rotation was pretty relaxed, and I had ample time to read about my patients as I was working them up so that I knew what I was talking about when I presented them. If the consult I did was BS (for instance, a hypercoagulability consult in a patient who had stopped taking her warfarin for a vascular graft), often the patient still had other things going on that I could also read about and learn something from. There were no residents, and the attendings I worked with were very relaxed and interesting in teaching.
The pros about this rotation:
- I liked the practice model. These doctors saw their patients as outpatients, and then were involved in their care when they were in the hospital as well. They also took new consults at the hospital. They had really close and involved relationships with their patients. It felt like "the right way" to practice medicine.
- The science is fascinating. There are a ton of new treatments coming out that have a biological basis. The monoclonal antibodies in particular are growing with leaps and bounds.
- I like the interdisciplinary nature of the field. The heme-onc doctors work with everyone in the hospital from rads and path to surgery and rad onc. All of the sub-specialists as well as the generalists. They end up being uber-hospitalists. They know a LOT about everything. Plus they know cancer.
- I like the culture of heme-onc. The doctors have better relationships with their patients than any others I've seen so far. I like the way they communicate with them. I like that in general they have a realistic and mature way of seeing "the difficult" patient -- i.e. in the context of everything else that is going on with them.
- There is some really interesting research to be done on survivorship and long term side effects of chemo.
The things I wasn't so crazy about:
- I don't find chemotherapy all that interesting, and prescribing these treatments in the outpatient setting is the majority of what these doctors do.
- A lot of what these doctors do is primary care on cancer patients. There are a lot of well checks for breast cancer patients, for instance. I just don't find this type of care very exciting, though it is necessary care.
- Doing heme-onc would require a MEDICINE residency. This is something I've been seeking to avoid ever since the PICK PICK PICK that I experienced on my medicine clerkship. I find rheumatology, ID, and heme-onc interesting, but not the rest nearly so much. And medicine docs tend to be abominably bad at neurology and psychiatry which are very important to me. I don't want to become the doc who tells everybody that his difficult patient with neurosyphillis has a personality disorder. It's just wrong and it happens every. single. day. (The heme-onc docs didn't really do this though.)
- I don't want to end up pigeonholed into running clinical trials. (B.O.R.I.N.G.) As an Epi person, there would be pressure to do this. Also, the heme-onc person in the Epi dept is the one of the one's who won't respond to my emails. This could be a problem in the long run.
So, now I'm onto Rad Onc. It will be very different. I have no idea if I will like it. We'll just have to see.
As I went along I felt like I developed more autonomy. The rotation was pretty relaxed, and I had ample time to read about my patients as I was working them up so that I knew what I was talking about when I presented them. If the consult I did was BS (for instance, a hypercoagulability consult in a patient who had stopped taking her warfarin for a vascular graft), often the patient still had other things going on that I could also read about and learn something from. There were no residents, and the attendings I worked with were very relaxed and interesting in teaching.
The pros about this rotation:
- I liked the practice model. These doctors saw their patients as outpatients, and then were involved in their care when they were in the hospital as well. They also took new consults at the hospital. They had really close and involved relationships with their patients. It felt like "the right way" to practice medicine.
- The science is fascinating. There are a ton of new treatments coming out that have a biological basis. The monoclonal antibodies in particular are growing with leaps and bounds.
- I like the interdisciplinary nature of the field. The heme-onc doctors work with everyone in the hospital from rads and path to surgery and rad onc. All of the sub-specialists as well as the generalists. They end up being uber-hospitalists. They know a LOT about everything. Plus they know cancer.
- I like the culture of heme-onc. The doctors have better relationships with their patients than any others I've seen so far. I like the way they communicate with them. I like that in general they have a realistic and mature way of seeing "the difficult" patient -- i.e. in the context of everything else that is going on with them.
- There is some really interesting research to be done on survivorship and long term side effects of chemo.
The things I wasn't so crazy about:
- I don't find chemotherapy all that interesting, and prescribing these treatments in the outpatient setting is the majority of what these doctors do.
- A lot of what these doctors do is primary care on cancer patients. There are a lot of well checks for breast cancer patients, for instance. I just don't find this type of care very exciting, though it is necessary care.
- Doing heme-onc would require a MEDICINE residency. This is something I've been seeking to avoid ever since the PICK PICK PICK that I experienced on my medicine clerkship. I find rheumatology, ID, and heme-onc interesting, but not the rest nearly so much. And medicine docs tend to be abominably bad at neurology and psychiatry which are very important to me. I don't want to become the doc who tells everybody that his difficult patient with neurosyphillis has a personality disorder. It's just wrong and it happens every. single. day. (The heme-onc docs didn't really do this though.)
- I don't want to end up pigeonholed into running clinical trials. (B.O.R.I.N.G.) As an Epi person, there would be pressure to do this. Also, the heme-onc person in the Epi dept is the one of the one's who won't respond to my emails. This could be a problem in the long run.
So, now I'm onto Rad Onc. It will be very different. I have no idea if I will like it. We'll just have to see.
Friday, March 27, 2009
Score!
Everyone seems to be talking about how they did on the boards. It's weird. Numbers are getting passed around. I had one person today ask me three times if I'd gotten a 270.
"Stop blowing smoke up my ass," I said, "Nobody gets a 270. Did YOU get a 270 or something?"
"I wish. No seriously though," he insisted, "How'd you do?"
My standard line is: I did well enough that I am certain my scores will not prevent me from getting whatever residency I want. That I'm very satisfied with my score.
For some reason, this doesn't satisfy people. They want THE NUMBER.
Once a pre-med, always a pre-med I guess.
The pathetic part on my behalf is that sometimes it seems like they think I'm actually disappointed in my score. That they think I did badly. Part of me wants to be like, "I got a 2XX. See you were WRONG. I did AWESOME, BIATCH. I'll bet my score kicks your score's ass." I want to wring their little competit-necks as they look sad and nod sympathetically when I refrain from such shenanigans.
But I don't.
Why do I even think about this crap? I'm just as bad as they are.
Is this something that people actually share? It seems to me beyond rude. Am I overreacting?
"Stop blowing smoke up my ass," I said, "Nobody gets a 270. Did YOU get a 270 or something?"
"I wish. No seriously though," he insisted, "How'd you do?"
My standard line is: I did well enough that I am certain my scores will not prevent me from getting whatever residency I want. That I'm very satisfied with my score.
For some reason, this doesn't satisfy people. They want THE NUMBER.
Once a pre-med, always a pre-med I guess.
The pathetic part on my behalf is that sometimes it seems like they think I'm actually disappointed in my score. That they think I did badly. Part of me wants to be like, "I got a 2XX. See you were WRONG. I did AWESOME, BIATCH. I'll bet my score kicks your score's ass." I want to wring their little competit-necks as they look sad and nod sympathetically when I refrain from such shenanigans.
But I don't.
Why do I even think about this crap? I'm just as bad as they are.
Is this something that people actually share? It seems to me beyond rude. Am I overreacting?
How was research day?
How was it? I'm so glad you asked.
So research day is a chance for people at my med school to add a line to their CVs. We get together and have a big poster session, presenting the research projects we have done during our time at med school.
And it was fine. I presented a project that I started 1.5 years ago and never got around to finishing. I still need to write it up, but at least the hard part is done. I got to field all sorts of fantastic questions about it though.
"Oh is THIS what you're going to be doing for your PhD?" (No.)
and...
"Oh, what ARE you planning on going into, then?" (Um, I don't know.)
and...
"Why haven't you signed up for the EM sub-i?" (Because there aren't enough months in the year.)
And then were the awkward questions from the few Epi people who came around to say hi.
"Oh you liked oncology. You should really talk to [the woman who only bothered to return your emails after being goaded by three separate faculty members -- and then refused to meet for two more months because she was writing a grant]. Or you could talk to [that professor who was kind of a dick to you during the intro class]."
and...
"Why haven't you signed up for EM? I don't want you to blow your chances at a good residency by having to do it when you come back to the clinics in a few years when you won't be on your game anymore."
OMG, AWKWARD!! I think everyone in my department thinks I am hopelessly aimless in my quest to find a mentor. I want to tell them to leave me alone. That it will all be fine, I will find someone. That their advice, though clearly well meaning, is not helping.
I want to run away.
But other than those particular problems, I felt the day went well. It was nice seeing people whom I hadn't seen in a while. I'm jealous that they all seem to know what they want to do with their lives. By the time I'm done with this program, some of them will be attendings.
Scary.
So research day is a chance for people at my med school to add a line to their CVs. We get together and have a big poster session, presenting the research projects we have done during our time at med school.
And it was fine. I presented a project that I started 1.5 years ago and never got around to finishing. I still need to write it up, but at least the hard part is done. I got to field all sorts of fantastic questions about it though.
"Oh is THIS what you're going to be doing for your PhD?" (No.)
and...
"Oh, what ARE you planning on going into, then?" (Um, I don't know.)
and...
"Why haven't you signed up for the EM sub-i?" (Because there aren't enough months in the year.)
And then were the awkward questions from the few Epi people who came around to say hi.
"Oh you liked oncology. You should really talk to [the woman who only bothered to return your emails after being goaded by three separate faculty members -- and then refused to meet for two more months because she was writing a grant]. Or you could talk to [that professor who was kind of a dick to you during the intro class]."
and...
"Why haven't you signed up for EM? I don't want you to blow your chances at a good residency by having to do it when you come back to the clinics in a few years when you won't be on your game anymore."
OMG, AWKWARD!! I think everyone in my department thinks I am hopelessly aimless in my quest to find a mentor. I want to tell them to leave me alone. That it will all be fine, I will find someone. That their advice, though clearly well meaning, is not helping.
I want to run away.
But other than those particular problems, I felt the day went well. It was nice seeing people whom I hadn't seen in a while. I'm jealous that they all seem to know what they want to do with their lives. By the time I'm done with this program, some of them will be attendings.
Scary.
Smelly
A few years ago, I was talking with an old mentor about which patients got better care. He made some comment about how he was pretty sure that if they did a study on body odor, they'd find that the smelly patients got worse care. The outcome of the study would be to encourage a shower before heading off to that doctor's appointment.
In a similar fashion, the Archives of Internal Medicine just came out (covered by Toilet Paper Pope on the Well Blog) with an article on how (GASP!) if you have a better relationship with your doctor, you are more likely to get good care.
A good relationship. You know. The kind of thing her blog seeks to destroy.
I'm not sure how this is in any way controversial. If I have a good relationship with the people who support me, they are more likely to prioritize work I give them over the work from someone else who is rude to them. This can be intentional or subconscious. I'm not sure if Toilet Paper thinks that doctors are supposed to be "above" that, but the fact is (and I know this is going to be a shocker too), doctors are people too. We put our pants on one leg at a time just like everyone else.
Despite our efforts to treat everyone equally, it is simply not physically possible.
I know from my standpoint that I just click better with certain patients. It's not that I actively try to dislike some, it's just that some people make me work a lot harder to extract their story, to find out what's going on.
Of course there are some loathsome patients thrown into the mix as well. The paranoid ones who think that doctors are all money grubbing bastards who don't care about their patients at all, who storm out of the room in a hissy fit the moment you say something that isn't music to their ears. They're not exactly easy to care for. You do try. But consider what you would do if your client started shrieking at you in monosyllables every time you went to talk to them. It would make the experience not only unpleasant, but also it would make it hard to figure out how to help this person.
You hear from a lot of people like this on the Toilet Paper blog.
This is common sense, people.
So folks, do your best to be pleasant to your doctors. And if you hate your doctor, try to switch. You and she clearly aren't connecting.
And for the love of God, if possible take a shower before you go. Rinse that fungus from underneath that breast and we're more likely to find the lump that is sitting there. Unfortunately, that pesky gag reflex simply can't be trained away.
In a similar fashion, the Archives of Internal Medicine just came out (covered by Toilet Paper Pope on the Well Blog) with an article on how (GASP!) if you have a better relationship with your doctor, you are more likely to get good care.
A good relationship. You know. The kind of thing her blog seeks to destroy.
I'm not sure how this is in any way controversial. If I have a good relationship with the people who support me, they are more likely to prioritize work I give them over the work from someone else who is rude to them. This can be intentional or subconscious. I'm not sure if Toilet Paper thinks that doctors are supposed to be "above" that, but the fact is (and I know this is going to be a shocker too), doctors are people too. We put our pants on one leg at a time just like everyone else.
Despite our efforts to treat everyone equally, it is simply not physically possible.
I know from my standpoint that I just click better with certain patients. It's not that I actively try to dislike some, it's just that some people make me work a lot harder to extract their story, to find out what's going on.
Of course there are some loathsome patients thrown into the mix as well. The paranoid ones who think that doctors are all money grubbing bastards who don't care about their patients at all, who storm out of the room in a hissy fit the moment you say something that isn't music to their ears. They're not exactly easy to care for. You do try. But consider what you would do if your client started shrieking at you in monosyllables every time you went to talk to them. It would make the experience not only unpleasant, but also it would make it hard to figure out how to help this person.
You hear from a lot of people like this on the Toilet Paper blog.
This is common sense, people.
So folks, do your best to be pleasant to your doctors. And if you hate your doctor, try to switch. You and she clearly aren't connecting.
And for the love of God, if possible take a shower before you go. Rinse that fungus from underneath that breast and we're more likely to find the lump that is sitting there. Unfortunately, that pesky gag reflex simply can't be trained away.
Thursday, March 26, 2009
Satan is your nurse
The following conversation took place a few months back when I was working in one of the ICUs.
OMDG: Good morning Mrs. R. How are you feeling today?
Mrs. R (wailing): The nurses all hate me!
OMDG: I'm sorry to hear that. Are you still having trouble breathing?
Mrs. R: I don't know why they're so mean to me. They put this thing.... in my.... OH MY GOD!! IT HURT SO BAD!!! They hurt me on purpose!! They were just mean horrible people. I can't possibly see a reason for them to do this. They won't even come in my room now. Just look at them, spending all that time with that NEW patient next door!
OMDG: Well Mrs. R, you needed the rectal tube because you were having diarrhea every few minutes. It would be really bad for your skin to have to lie in it all day. That's why they did the tube. I'm sorry it hurt when they put it in, but it really was necessary. Now, how is your breathing?
Mrs. R: I know my daughter must have said something to them now. They just give me these evil looks and don't come in here any more. They HATE ME. They just want to hurt me.
OMDG: It sounds to me like they're not coming in because you're getting better. You don't need as much help as you did before. So, your breathing is better then?
Mrs. R: I want you to talk to the nurses and make sure the one who did it gets punished. She should be punished, PUNISHED I TELL YOU, for what she did to me.
OMDG: I wasn't there, so I really can't weigh in on this Mrs. R, but I really suggest that you let it go. No good can come from antagonizing your nurse, even if they weren't so nice to you in the past.
Mrs. R: She should be punished, that one! I can't believe she did that to me. It was AWWWWFFUUUUULLLLLL!!!!!!!!
OMDG: Ok, Mrs. R, I'll be back a little later with the head doctor.
This is meant as an object lesson of how not to behave as a patient. Do not start shit with your nurses. Only bad things can happen if you do. Also, they are not waitresses or slaves. Their jobs are thankless. If you are nice to them, you will be rewarded. If you are not, they will talk about you behind your back and provide you worse care. It's just a fact. They are only people like you or I.
Also, complaining to your med student who wasn't there and doesn't even work on the floor is going to accomplish nothing. I'm sorry your rectal tube hurt. I doubt your nurse did it intentionally. Unfortunately, the hospital is not a place where pleasant and comfortable things happen to patients.
And I'm sorry. Asking that your nurse be punished? For your delectation? So not going to happen. Only a crappy human being would ask for something like that.
OMDG: Good morning Mrs. R. How are you feeling today?
Mrs. R (wailing): The nurses all hate me!
OMDG: I'm sorry to hear that. Are you still having trouble breathing?
Mrs. R: I don't know why they're so mean to me. They put this thing.... in my.... OH MY GOD!! IT HURT SO BAD!!! They hurt me on purpose!! They were just mean horrible people. I can't possibly see a reason for them to do this. They won't even come in my room now. Just look at them, spending all that time with that NEW patient next door!
OMDG: Well Mrs. R, you needed the rectal tube because you were having diarrhea every few minutes. It would be really bad for your skin to have to lie in it all day. That's why they did the tube. I'm sorry it hurt when they put it in, but it really was necessary. Now, how is your breathing?
Mrs. R: I know my daughter must have said something to them now. They just give me these evil looks and don't come in here any more. They HATE ME. They just want to hurt me.
OMDG: It sounds to me like they're not coming in because you're getting better. You don't need as much help as you did before. So, your breathing is better then?
Mrs. R: I want you to talk to the nurses and make sure the one who did it gets punished. She should be punished, PUNISHED I TELL YOU, for what she did to me.
OMDG: I wasn't there, so I really can't weigh in on this Mrs. R, but I really suggest that you let it go. No good can come from antagonizing your nurse, even if they weren't so nice to you in the past.
Mrs. R: She should be punished, that one! I can't believe she did that to me. It was AWWWWFFUUUUULLLLLL!!!!!!!!
OMDG: Ok, Mrs. R, I'll be back a little later with the head doctor.
This is meant as an object lesson of how not to behave as a patient. Do not start shit with your nurses. Only bad things can happen if you do. Also, they are not waitresses or slaves. Their jobs are thankless. If you are nice to them, you will be rewarded. If you are not, they will talk about you behind your back and provide you worse care. It's just a fact. They are only people like you or I.
Also, complaining to your med student who wasn't there and doesn't even work on the floor is going to accomplish nothing. I'm sorry your rectal tube hurt. I doubt your nurse did it intentionally. Unfortunately, the hospital is not a place where pleasant and comfortable things happen to patients.
And I'm sorry. Asking that your nurse be punished? For your delectation? So not going to happen. Only a crappy human being would ask for something like that.
Monday, March 23, 2009
Social Skills
As a group, I would venture to guess that the heme-onc attendings, NPs, and social workers that I have worked with on this rotation have some of the best social skills I have seen during my time in the clinics. They manage to be empathetic and exude competence all at the same time. They are great at building rapport with their patients and in communicating effectively.
It is truly a sight to behold at times. And honestly it was one of the reasons the field appealed to me from the beginning.
Still, every so often a callous remark occurs that takes me off guard. Like when a staff member bitches about how horribly the family member of one of the actively dying patients is behaving, and that she he/she must be a horrible person. I kind of feel that if your spouse is dying, you get a free pass from being on your best behavior. At least for the time being.
Being the caregiver of a dying person seems in many ways harder than being the dying person. When that person dies, you're left with... what exactly? Just contemplating that is enough to turn me in to a shrew.
It's easy to see how things like this happen. When I'm in the room and the attending is delivering bad news -- and in oncology usually bad news is REALLY bad news -- I find myself having to actively remind myself what this must be like for the patient. Otherwise I don't feel the delivery of the bad news. It runs the risk of feeling not much different from saying, "Gee, it's sunny out today." I can see under the circumstances how it must be easy to forget that there are people who've never heard anything worse in their whole lives on the receiving end, and that their reaction is likely to be justifiably upset.
Take today. I was really excited about making the diagnosis of [insert potentially lethal esoteric quasi-emergent hematalogic disease here] myself, but while talking to the patient and the family, I had to pinch myself. "Don't act excited. This is scary news for them," I actively thought.
I wonder if I would become callous if I became an oncologist, surrounded by death all the time. Horrible horrible death. Start treating bad news cavalierly.
I hope not.
That and the tendency I have to self diagnose might actually keep me away from the field. I don't know if I want to live my life constantly contemplating my own mortality. We'll have to see though.
It is truly a sight to behold at times. And honestly it was one of the reasons the field appealed to me from the beginning.
Still, every so often a callous remark occurs that takes me off guard. Like when a staff member bitches about how horribly the family member of one of the actively dying patients is behaving, and that she he/she must be a horrible person. I kind of feel that if your spouse is dying, you get a free pass from being on your best behavior. At least for the time being.
Being the caregiver of a dying person seems in many ways harder than being the dying person. When that person dies, you're left with... what exactly? Just contemplating that is enough to turn me in to a shrew.
It's easy to see how things like this happen. When I'm in the room and the attending is delivering bad news -- and in oncology usually bad news is REALLY bad news -- I find myself having to actively remind myself what this must be like for the patient. Otherwise I don't feel the delivery of the bad news. It runs the risk of feeling not much different from saying, "Gee, it's sunny out today." I can see under the circumstances how it must be easy to forget that there are people who've never heard anything worse in their whole lives on the receiving end, and that their reaction is likely to be justifiably upset.
Take today. I was really excited about making the diagnosis of [insert potentially lethal esoteric quasi-emergent hematalogic disease here] myself, but while talking to the patient and the family, I had to pinch myself. "Don't act excited. This is scary news for them," I actively thought.
I wonder if I would become callous if I became an oncologist, surrounded by death all the time. Horrible horrible death. Start treating bad news cavalierly.
I hope not.
That and the tendency I have to self diagnose might actually keep me away from the field. I don't know if I want to live my life constantly contemplating my own mortality. We'll have to see though.
Sunday, March 22, 2009
Taxes
Luca and I have just finished our taxes. Now all that is left is to make photocopies and mail them out. Whew! It really wasn't that bad this year since we only had to file in one state.
But you know what? We are the ONLY PEOPLE WE KNOW who prepare their own taxes. Every one else seems to have their parents or their father's accountant do it. I'm not sure I understand why.
I've done it myself ever since my mother transposed two digits of my social security number back in 1999 and I got audited in 2000, 2001, and 2002 all for the same mistake back that one year. That taught me a valuable lesson: never trust anything important to anyone else.
Ever.
Does anyone besides me do their own taxes?
But you know what? We are the ONLY PEOPLE WE KNOW who prepare their own taxes. Every one else seems to have their parents or their father's accountant do it. I'm not sure I understand why.
I've done it myself ever since my mother transposed two digits of my social security number back in 1999 and I got audited in 2000, 2001, and 2002 all for the same mistake back that one year. That taught me a valuable lesson: never trust anything important to anyone else.
Ever.
Does anyone besides me do their own taxes?
Saturday, March 21, 2009
Bye bye GND
Hello Rock of Love Bus.
Now that Bridget, Holly, and Kendra have abandoned poor Hugh for careers of their own (have you seen Bridget's new travel show?), I've had to find other alternatives for my reality tv fix.
Enter Rock of Love Bus. Now, I will admit that I watched snippets of season one and found it quite entertaining, but Rock of Love 3 has been awesome this season. Who knew such trashy people actually existed? Very entertaining. Even better than Keeping up with the Kardashians (who have some serious problems with their grammar, but that's another story entirely).
So it's trashy. What're you going to do about it?
I think my favorite part of the show is that Bret doesn't follow the rules of one elimination/week. In the true spirit of Rock N' Roll, he has no rules. If he wants to eliminate half the cast one week, he'll do it. If he wants to pick up some more girls in the middle of the tour that he meets at some bar, that's ok too. Can you say CAT FIGHT? The best part is when you see the stripper on some drunken diatribe about how trashy the Penthouse pin-up is and how she doesn't really care about Bret. It's awesome.
And whatever. I just finished watching I've Loved You So Long this morning. Ah the juxtaposition. At least I can say I have diverse tastes. And plus, you can't watch sophisticated French movies every night. That would just get old after a while.
Now that Bridget, Holly, and Kendra have abandoned poor Hugh for careers of their own (have you seen Bridget's new travel show?), I've had to find other alternatives for my reality tv fix.
Enter Rock of Love Bus. Now, I will admit that I watched snippets of season one and found it quite entertaining, but Rock of Love 3 has been awesome this season. Who knew such trashy people actually existed? Very entertaining. Even better than Keeping up with the Kardashians (who have some serious problems with their grammar, but that's another story entirely).
So it's trashy. What're you going to do about it?
I think my favorite part of the show is that Bret doesn't follow the rules of one elimination/week. In the true spirit of Rock N' Roll, he has no rules. If he wants to eliminate half the cast one week, he'll do it. If he wants to pick up some more girls in the middle of the tour that he meets at some bar, that's ok too. Can you say CAT FIGHT? The best part is when you see the stripper on some drunken diatribe about how trashy the Penthouse pin-up is and how she doesn't really care about Bret. It's awesome.
And whatever. I just finished watching I've Loved You So Long this morning. Ah the juxtaposition. At least I can say I have diverse tastes. And plus, you can't watch sophisticated French movies every night. That would just get old after a while.
Friday, March 20, 2009
Wuss
Today when I was rounding with the palliative care team, we gave some recs to the orthopedic service about basal IV pain meds in addition to the PCA pump to control the pain of a patient who had just had major reconstructive surgery on his leg.
FYI: Surgery services don't do basal pain meds. They're more afraid that they will "narc a patient out" than they will give them a PE from immobility secondary to acute pain. Understandable to a degree, but IMO it shouldn't be a blanket policy.
Anyhow, we suggested that it would be appropriate in the case of our young diaphoretic, tachycardic patient who was clutching the rails of his bed in pain this morning on post operative day #1.
The team's response? They'd suggest it, but they figured it would be denied (policy -- you know). And besides, the patient was kind of a wuss. Had been even before surgery.
Honestly? I was totally horrified and appalled by that statement. I think my attending was too, actually. I mean, if you'd only seen what they'd just done to his tibia and knee. Ouch! Not fun, people!
My attending made the crack, "I'm a little surprised that they didn't say, 'Yeah he's a wuss, and we think he might be gay,' as an excuse not to give him adequate pain meds," such was the extent of his disapproval of the ortho team.
God I hope I never end up in the hospital.*
*Oh yeah. This is an "isn't it horrible" post. See what a hypocrite I am?
FYI: Surgery services don't do basal pain meds. They're more afraid that they will "narc a patient out" than they will give them a PE from immobility secondary to acute pain. Understandable to a degree, but IMO it shouldn't be a blanket policy.
Anyhow, we suggested that it would be appropriate in the case of our young diaphoretic, tachycardic patient who was clutching the rails of his bed in pain this morning on post operative day #1.
The team's response? They'd suggest it, but they figured it would be denied (policy -- you know). And besides, the patient was kind of a wuss. Had been even before surgery.
Honestly? I was totally horrified and appalled by that statement. I think my attending was too, actually. I mean, if you'd only seen what they'd just done to his tibia and knee. Ouch! Not fun, people!
My attending made the crack, "I'm a little surprised that they didn't say, 'Yeah he's a wuss, and we think he might be gay,' as an excuse not to give him adequate pain meds," such was the extent of his disapproval of the ortho team.
God I hope I never end up in the hospital.*
*Oh yeah. This is an "isn't it horrible" post. See what a hypocrite I am?
Wednesday, March 18, 2009
Sarcoma
For the past few days I've been rounding with the sarcoma specialist in the clinic. Patients come from far and wide to see him. I find his manner with his patients pretty irritating. He seems to talk to all of them like they're 12. But? They don't seem to mind.... most of them maybe even like it. So, who am I to judge. It probably comes across differently when you're on the receiving end than as an observer.
We'll walk out of a patient's room and say, "We need to talk to the primary team about XYZ patient's pain management. To increase the dilaudid to q3h," he'll say, passing me the chart on a patient I've only just met three minutes ago. He'll give me a funny look. After a few seconds it will click. He wants ME to talk to the primary team. Oh ok. Well why didn't he just say so? What's with this "we" nonsense? Sheesh.
Anyhow. What has struck me is that all of his patients are young. With a capital Y. Like all less than 50. He has a bunch of peds patients with osteosarcoma and Ewing's as well. And he's like, "The 5 year survival is 75% for XYZ disease with wide resection and chemo," talking to this family with an 18 year old kid at diagnosis. And how these are "good" odds.
He talks amputation, craniotomy, resect, radiate, and poison. His in hospital patients are sick as dogs with their treatment regimens. All I can think when he sees them is, "I hope this never happens to anyone I know. God forbid it ever happen to ME."
As I was sitting in "teaching" conference today, (which was more or less a meeting in which we talked about 20 patients one by one with little to no teaching), all I could think about was how I would feel if this happened to me. I'd be so angry. So indignant. So Why did this happen to me. So You're going to cut my WHAT off? Or ELSE? Or else I'm gonna die? Great. Now I get to be a patient for the rest of my life.
It was frankly horrifying to think about. I guess I'm not the only one who feels that way since many of his patients refuse treatment until they actually get to the point where they feel sick. He talks about how foolish they are because then it can be too late, but I can completely see how they might feel that way.
The patients who are being treated? Some of the loveliest, most pleasant patients you will ever meet. It just sucks all around.
We'll walk out of a patient's room and say, "We need to talk to the primary team about XYZ patient's pain management. To increase the dilaudid to q3h," he'll say, passing me the chart on a patient I've only just met three minutes ago. He'll give me a funny look. After a few seconds it will click. He wants ME to talk to the primary team. Oh ok. Well why didn't he just say so? What's with this "we" nonsense? Sheesh.
Anyhow. What has struck me is that all of his patients are young. With a capital Y. Like all less than 50. He has a bunch of peds patients with osteosarcoma and Ewing's as well. And he's like, "The 5 year survival is 75% for XYZ disease with wide resection and chemo," talking to this family with an 18 year old kid at diagnosis. And how these are "good" odds.
He talks amputation, craniotomy, resect, radiate, and poison. His in hospital patients are sick as dogs with their treatment regimens. All I can think when he sees them is, "I hope this never happens to anyone I know. God forbid it ever happen to ME."
As I was sitting in "teaching" conference today, (which was more or less a meeting in which we talked about 20 patients one by one with little to no teaching), all I could think about was how I would feel if this happened to me. I'd be so angry. So indignant. So Why did this happen to me. So You're going to cut my WHAT off? Or ELSE? Or else I'm gonna die? Great. Now I get to be a patient for the rest of my life.
It was frankly horrifying to think about. I guess I'm not the only one who feels that way since many of his patients refuse treatment until they actually get to the point where they feel sick. He talks about how foolish they are because then it can be too late, but I can completely see how they might feel that way.
The patients who are being treated? Some of the loveliest, most pleasant patients you will ever meet. It just sucks all around.
Tuesday, March 17, 2009
Observations
I get called "doctor" as often as I get called "nurse." Being called "doctor" feels really weird, but not as weird as it did first year.
The young patients who get cancer that I've seen have done "really badly." For a translation on what that means, please see a previous post.
When I talk to the primary service, and they tell me that they have "talked to" the patient about their biopsy results, this does not mean that they have necessarily used the word "cancer" with them yet. Note to self!
When I wrote my senior thesis on voluntarism and hospices, and we found that hospices that had a lot of patients with substance abuse attracted fewer volunteers, I didn't really get why. Now I do.
To that end, when my alcoholic patients try to reason with me that they couldn't possibly have a drinking problem because their potassium is low in the hospital and they're not drinking now and therefore nothing that's wrong with them should be attributed to their 12 drinks/day, it makes me a little crazy.
I'm still not fond of shadowing. But when I get to see outpatients on my own it's a lot better.
I have spent the past three days working on a presentation on a completely non-cancer related project. Running stats, making graphs, putting together slides. I don't even care about the project. It has been FANTASTIC.
I went to a conference today at which I identified the surgeon within 30 seconds. It's interesting how different specialties have their own personalities. The pathologists are easy to identify too. I wonder if people become that way once they do a specialty for a number of years, or if like gravitates towards like. Or maybe a bit of both.
I wonder where I fit every day.
The young patients who get cancer that I've seen have done "really badly." For a translation on what that means, please see a previous post.
When I talk to the primary service, and they tell me that they have "talked to" the patient about their biopsy results, this does not mean that they have necessarily used the word "cancer" with them yet. Note to self!
When I wrote my senior thesis on voluntarism and hospices, and we found that hospices that had a lot of patients with substance abuse attracted fewer volunteers, I didn't really get why. Now I do.
To that end, when my alcoholic patients try to reason with me that they couldn't possibly have a drinking problem because their potassium is low in the hospital and they're not drinking now and therefore nothing that's wrong with them should be attributed to their 12 drinks/day, it makes me a little crazy.
I'm still not fond of shadowing. But when I get to see outpatients on my own it's a lot better.
I have spent the past three days working on a presentation on a completely non-cancer related project. Running stats, making graphs, putting together slides. I don't even care about the project. It has been FANTASTIC.
I went to a conference today at which I identified the surgeon within 30 seconds. It's interesting how different specialties have their own personalities. The pathologists are easy to identify too. I wonder if people become that way once they do a specialty for a number of years, or if like gravitates towards like. Or maybe a bit of both.
I wonder where I fit every day.
Sunday, March 15, 2009
U of C pride
People around here say to me all the time, "You went to The University of Chicago? Isn't that the place where fun comes to die? Did you hate it there? My [sister, friend, cousin, etc.] went there and said it was horrible. She couldn't wait to move back East."
I also get, "Really? The University of Chicago? But you don't SEEM like someone who went there," which I suppose is a commentary on the perception that University of Chicago students have no social skills. I guess it's a compliment?
Even my Epi advisor went to great lengths about how he and his son visited there when his son was applying to colleges and how his son thought it was SO AWFUL. What kind of place has as it's motto "Where fun comes to die?" he asked me.
(I told him that I actually thought our other motto, "Where the only thing that will go down on you is your GPA," was a lot funnier. Hee.)*
Anyway. I'm not sure why my alma mater has such a bad reputation. 4 of the best years of my life were spent as an undergrad there, and another 3 were spent doing my post-bac and working there. The University of Chicago is part of me. It has shaped the way I think about the world. And I LOVED it there. And yes, I had fun too. At the University of Chicago it was cool to be smart and interested in what you're studying. I've never been anyplace else quite like it.
Frankly, I think it's pretty rude of people here to make comments to me like they do. You'd be proud of me though. At least I restrain myself from making fun of how vacuous and vocation minded Penn students are right back at them. Nobody thinks ideas are fun here. It's all about praying to the almighty God of Wharton, which frankly, makes me cringe. We made fun of the MBA people back in Chicago with their BMWs and fancy suits. And that's the way it SHOULD be.*
And plus, every other week it seems like Penn students are on vacation. I suppose they need all that time to do their investment banking internships. And the libraries? Literally there is no place you can go on the entire campus that is quiet. I think this reflects the undercurrent of anti-intellectualism around here. George Bush would be proud.
Anyway, it was with great pleasure that I found this, and this, courtesy of Gabbiana.
Go U of C! Who said we can't have any fun. Sometimes we even do something productive in the process.
*No I didn't actually tell him that. But I should have.
*I said we made fun of MBAs. The econ department was a different story.
I also get, "Really? The University of Chicago? But you don't SEEM like someone who went there," which I suppose is a commentary on the perception that University of Chicago students have no social skills. I guess it's a compliment?
Even my Epi advisor went to great lengths about how he and his son visited there when his son was applying to colleges and how his son thought it was SO AWFUL. What kind of place has as it's motto "Where fun comes to die?" he asked me.
(I told him that I actually thought our other motto, "Where the only thing that will go down on you is your GPA," was a lot funnier. Hee.)*
Anyway. I'm not sure why my alma mater has such a bad reputation. 4 of the best years of my life were spent as an undergrad there, and another 3 were spent doing my post-bac and working there. The University of Chicago is part of me. It has shaped the way I think about the world. And I LOVED it there. And yes, I had fun too. At the University of Chicago it was cool to be smart and interested in what you're studying. I've never been anyplace else quite like it.
Frankly, I think it's pretty rude of people here to make comments to me like they do. You'd be proud of me though. At least I restrain myself from making fun of how vacuous and vocation minded Penn students are right back at them. Nobody thinks ideas are fun here. It's all about praying to the almighty God of Wharton, which frankly, makes me cringe. We made fun of the MBA people back in Chicago with their BMWs and fancy suits. And that's the way it SHOULD be.*
And plus, every other week it seems like Penn students are on vacation. I suppose they need all that time to do their investment banking internships. And the libraries? Literally there is no place you can go on the entire campus that is quiet. I think this reflects the undercurrent of anti-intellectualism around here. George Bush would be proud.
Anyway, it was with great pleasure that I found this, and this, courtesy of Gabbiana.
Go U of C! Who said we can't have any fun. Sometimes we even do something productive in the process.
*No I didn't actually tell him that. But I should have.
*I said we made fun of MBAs. The econ department was a different story.
Saturday, March 14, 2009
Dear President Obama,
The bane of many a medical student and resident's existence is the process of getting medical records on their patients from outside hospitals. Barriers are erected anywhere and everywhere and can cause a simple process to take hours. HOURS.
Let's take a typical example of a patient I had last week who told me he'd been hospitalized "someplace in x-town 3 years ago or so." When I got on the phone with the prospective hospital, they told me that they would be unable to tell me if they even had a patient with that name and birth date without a faxed consent form.
I'm sure some patients will get very excited about this. Their privacy is being protected! Yay! Wonderful! Finally something working they way it should!
Don't get too excited. In order to get these records, I had to fax a signed consent form from my hospital -- a piece of paper that included the patient's name, birth date, address, social security number -- to some anonymous voice on the other line whose number I had acquired on the internet. And now some random person who might not need to, knows that my patient is hospitalized at my hospital and that they have a disease that requires a pathological diagnosis or specific blood test.
Let's walk through the typical process of getting records:
1. Look up hospital on the internet. Obtain phone number.
2. Get transferred to the wrong person.
3. Get transferred again.
4. Get disconnected.
5. Finally be put in touch with the medical records department.
6. Hope and pray someone picks up the phone.
7. Find out that the office opens at 10, and it's 7:30.
8. Call back later.
9. Make nice with passive aggressive person or directly surly person who doesn't want more work to do.
10. Obtain fax # from the above person.
11. Find own hospital's consent form for the release of records from an outside hospital.
12. Fill out said form.
13. Locate patient.
14. Explain what you're doing to patient.
15. Deal with reluctance of patient to sign anything/ blindness/ proxy signature issues for the demented patient or one who is otherwise unable to sign for self.
16. Find fax machine.
17. Realize after several attempts that fax machine is broken or will not permit you to fax to a long distance #.
18 Successfully complete fax.
19. Wait for fax confirmation document.
20. Call medical records department to verify they have received the fax.
21. Listen to them tell you they haven't received the document.
22. Repeat steps 4 and 10-15.
23. File consent form in patient's chart.
24. Wait for several hours to receive fax.
25. Packet of 200 pages of nursing flowsheets arrives, occupying the fax machine for 30 minutes and causing it to run out of paper.
26. Wade through each sheet painstakingly to look for 1 path report/ discharge summary/ lab value that will alter the course of care for your patient.
27. Fail to find piece of relevant information, while at the same time not realizing that your other patient has decompensated as you haven't been able to see them yet (since you're getting medical records) and now must be transferred to the ICU.
28. Repeat steps 4 and 10-27.
It's enough to drive one to drink.
President Obama, please give us a universal electronic medical record. Not because it will fix the healthcare system, but because it will keep me from driving a pen through my eyeball when I become a resident and killing all my other patients via neglect.
Thank you.
Let's take a typical example of a patient I had last week who told me he'd been hospitalized "someplace in x-town 3 years ago or so." When I got on the phone with the prospective hospital, they told me that they would be unable to tell me if they even had a patient with that name and birth date without a faxed consent form.
I'm sure some patients will get very excited about this. Their privacy is being protected! Yay! Wonderful! Finally something working they way it should!
Don't get too excited. In order to get these records, I had to fax a signed consent form from my hospital -- a piece of paper that included the patient's name, birth date, address, social security number -- to some anonymous voice on the other line whose number I had acquired on the internet. And now some random person who might not need to, knows that my patient is hospitalized at my hospital and that they have a disease that requires a pathological diagnosis or specific blood test.
Let's walk through the typical process of getting records:
1. Look up hospital on the internet. Obtain phone number.
2. Get transferred to the wrong person.
3. Get transferred again.
4. Get disconnected.
5. Finally be put in touch with the medical records department.
6. Hope and pray someone picks up the phone.
7. Find out that the office opens at 10, and it's 7:30.
8. Call back later.
9. Make nice with passive aggressive person or directly surly person who doesn't want more work to do.
10. Obtain fax # from the above person.
11. Find own hospital's consent form for the release of records from an outside hospital.
12. Fill out said form.
13. Locate patient.
14. Explain what you're doing to patient.
15. Deal with reluctance of patient to sign anything/ blindness/ proxy signature issues for the demented patient or one who is otherwise unable to sign for self.
16. Find fax machine.
17. Realize after several attempts that fax machine is broken or will not permit you to fax to a long distance #.
18 Successfully complete fax.
19. Wait for fax confirmation document.
20. Call medical records department to verify they have received the fax.
21. Listen to them tell you they haven't received the document.
22. Repeat steps 4 and 10-15.
23. File consent form in patient's chart.
24. Wait for several hours to receive fax.
25. Packet of 200 pages of nursing flowsheets arrives, occupying the fax machine for 30 minutes and causing it to run out of paper.
26. Wade through each sheet painstakingly to look for 1 path report/ discharge summary/ lab value that will alter the course of care for your patient.
27. Fail to find piece of relevant information, while at the same time not realizing that your other patient has decompensated as you haven't been able to see them yet (since you're getting medical records) and now must be transferred to the ICU.
28. Repeat steps 4 and 10-27.
It's enough to drive one to drink.
President Obama, please give us a universal electronic medical record. Not because it will fix the healthcare system, but because it will keep me from driving a pen through my eyeball when I become a resident and killing all my other patients via neglect.
Thank you.
Friday, March 13, 2009
Things about blogging that annoy me
1) When people don't update. Like for a month.
2) When people complain about how busy they are and essentially put their to do list on their blog. And then you realize they have 7 hours of leisure time a day.
3) When the same people just came back from a 2 week vacation in Tahiti, and are going on another month long excursion two months from now. I so have no sympathy.
4) When people describe something bad that happened to them in terms intended to elicit how horrible the offender is, but written with just enough faux self analysis that you won't question whether the blogger's actions had any role in what happened.
5) Medical blogs that turn into mommy blogs.
6) When people feel the need to explain themselves to the trolls. The trolls need to be told to F*** off!
7) Uncritical support in the comments of things that you know nothing about. For some reason, some readers will never disagree with anything anyone says, as if they're afraid the blog writer won't like them or something. It should be ok to say you disagree or to offer constructive criticism in the comments section. That is not the same thing as being a troll.
8) The pathological need to have one's blog personality be universally liked and the consequential posting of nothing interesting whatsoever. Except anecdotes about how horrible other people are.
2) When people complain about how busy they are and essentially put their to do list on their blog. And then you realize they have 7 hours of leisure time a day.
3) When the same people just came back from a 2 week vacation in Tahiti, and are going on another month long excursion two months from now. I so have no sympathy.
4) When people describe something bad that happened to them in terms intended to elicit how horrible the offender is, but written with just enough faux self analysis that you won't question whether the blogger's actions had any role in what happened.
5) Medical blogs that turn into mommy blogs.
6) When people feel the need to explain themselves to the trolls. The trolls need to be told to F*** off!
7) Uncritical support in the comments of things that you know nothing about. For some reason, some readers will never disagree with anything anyone says, as if they're afraid the blog writer won't like them or something. It should be ok to say you disagree or to offer constructive criticism in the comments section. That is not the same thing as being a troll.
8) The pathological need to have one's blog personality be universally liked and the consequential posting of nothing interesting whatsoever. Except anecdotes about how horrible other people are.
Catch-22
This was the patient I hadn't seen the day before. There's nothing for us to do for him. He's waiting in the hospital because he can't go home until a nursing home can take him. I'd be surprised if he ever goes home again.
He was really ornery when I saw him in the hospital at first, and it feels weird stopping by for a social visit. He didn't seem like he'd have wanted me to come by.
When I stopped by yesterday, he was all smiles. "HEY!!! How're you doing?" He wanted to talk. When people are awaiting placement in the hospital, doctors come by less because there's less to do for them. As for a social visit, we do them, just less often. As with this man, it's sometimes hard to tell who wants to see you and who couldn't care less. I have another patient in a similar situation who seems like having me come by is a burden to him.
So yesterday, I talked with this man. Not for very long. I didn't even end up leaving a note on him because, well, there's nothing to do. When I left, I shook his hand. I told him I wouldn't be there today because of my exam, and that if he was still here on Monday I'd stop by then. He seemed really glad to have this closure. To know that I might not see him again. As I shook his hand before I left, he held it tightly and looked into my eyes and said Thank you.
I just felt guilty that I hadn't seen him the day before too. It's hard to tell who wants you there and who doesn't, but when they do, it seems to really matter to the patients.
So, now he's going to go to the nursing home to die, and it makes me sad since I've gotten to know him a bit more. I wonder how oncologists, who have long term relationships with their cancer patients who ALL end up dying on them, deal with this from an emotional standpoint.
He was really ornery when I saw him in the hospital at first, and it feels weird stopping by for a social visit. He didn't seem like he'd have wanted me to come by.
When I stopped by yesterday, he was all smiles. "HEY!!! How're you doing?" He wanted to talk. When people are awaiting placement in the hospital, doctors come by less because there's less to do for them. As for a social visit, we do them, just less often. As with this man, it's sometimes hard to tell who wants to see you and who couldn't care less. I have another patient in a similar situation who seems like having me come by is a burden to him.
So yesterday, I talked with this man. Not for very long. I didn't even end up leaving a note on him because, well, there's nothing to do. When I left, I shook his hand. I told him I wouldn't be there today because of my exam, and that if he was still here on Monday I'd stop by then. He seemed really glad to have this closure. To know that I might not see him again. As I shook his hand before I left, he held it tightly and looked into my eyes and said Thank you.
I just felt guilty that I hadn't seen him the day before too. It's hard to tell who wants you there and who doesn't, but when they do, it seems to really matter to the patients.
So, now he's going to go to the nursing home to die, and it makes me sad since I've gotten to know him a bit more. I wonder how oncologists, who have long term relationships with their cancer patients who ALL end up dying on them, deal with this from an emotional standpoint.
Thursday, March 12, 2009
Whores and misc thoughts
I went to my first pharma rep talk today. It was pretty much what I expected.
Here look at the BIG NUMBER. See our drug is good.
See these lines diverge. Pay no attention to the scale.
Oh yes, the FDA requires that I tell you about side effects. You already know about these, and anyway, the font on these slides is far too small to actually read, so WHY DON'T WE JUST BREEZE THROUGH THEM. They're boring anyway.
Oh certainly I would prescribe this medication even though it carries a 20% risk of arterial thromboembolism in this population.
This guy is supposedly a big and important doctor in his field too. It was sad. The drug is even effective, albeit very expensive and quite controversial because of that.
And then I found out another doctor in the practice was going to give talks for a different pharma company next week to the tune of $2000/talk, so I couldn't even discuss what a whore I felt like for listening to this tripe.
*****
The rest of the day was dull. No new consults and I sat around all day waiting for interesting things to happen after I'd rounded on my patients. Oh yes and I shadowed a lot. I suppose I could have taken more initiative and asked to shadow more (rather than sit and read up to date), but I just didn't have it in me.
I'm still having trouble re: what they expect of me this rotation. I do the consults and then follow the patients while they're in the hospital. But when a patient is there for many days awaiting placement or surgery or something -- basically when there is nothing for heme-onc to do for them for a few days -- I am not sure if I'm supposed to be still seeing them every day. I started off that way, but often the attending won't want to hear about them two days in a row.
So this happened on Tues, so I skipped Wed for a couple of these patients thinking I would see them today.
But I ended up rounding with a different attending in order to see this new consult this morning, and my usual attending rounded in the morning rather than in the evening and didn't tell me, so by the time I got to seeing my patients, he already knew everything and the notes were all written. I went and saw them anyway, but didn't write my own note because it would have been redundant and never would have gotten co-signed. My neurotic self worries that he was annoyed that I didn't already know what was going on with them. But then, the only reason he knew was that he had just seen them, not because I had been deficient the previous day.
I also often don't know which patients are "mine" and which aren't. Obviously I have all the consults I wrote notes on. But then sometimes I get asked about other ones too.
I have no idea whether this is what I'm supposed to be doing. I am trying to use my best judgment yet not create unnecessary work for myself, writing notes that never get reviewed or seeing patients when there is nothing to do for them. Anyone have thoughts on this?
I did see them all today though, since there wasn't much to do. Except one whom there hasn't been anything to do for for over a week now.
*****
Tomorrow I have my clinical skills exam (not the one for Step 2 -- one created special for us by our medical school) which should be just thrilling. 8 hours of unadulterated fun, I'm telling you.
*****
This weekend: taxes. Good thing I already have done most of them. Now all I have to do is proof read, photocopy, and send. My husband, who has an anxiety attack every time taxes are mentioned proofed them for me last week and found an error or two, thus proving to me that he is more than capable of doing the forms himself despite his protestations to the contrary.
:-P
*****
I'm still very ready to do PhD stuff, though I'm thinking more and more that I should try to keep doing something clinical while I'm out. Not because I'm afraid of losing my skills, but because I actually like it.
Here look at the BIG NUMBER. See our drug is good.
See these lines diverge. Pay no attention to the scale.
Oh yes, the FDA requires that I tell you about side effects. You already know about these, and anyway, the font on these slides is far too small to actually read, so WHY DON'T WE JUST BREEZE THROUGH THEM. They're boring anyway.
Oh certainly I would prescribe this medication even though it carries a 20% risk of arterial thromboembolism in this population.
This guy is supposedly a big and important doctor in his field too. It was sad. The drug is even effective, albeit very expensive and quite controversial because of that.
And then I found out another doctor in the practice was going to give talks for a different pharma company next week to the tune of $2000/talk, so I couldn't even discuss what a whore I felt like for listening to this tripe.
*****
The rest of the day was dull. No new consults and I sat around all day waiting for interesting things to happen after I'd rounded on my patients. Oh yes and I shadowed a lot. I suppose I could have taken more initiative and asked to shadow more (rather than sit and read up to date), but I just didn't have it in me.
I'm still having trouble re: what they expect of me this rotation. I do the consults and then follow the patients while they're in the hospital. But when a patient is there for many days awaiting placement or surgery or something -- basically when there is nothing for heme-onc to do for them for a few days -- I am not sure if I'm supposed to be still seeing them every day. I started off that way, but often the attending won't want to hear about them two days in a row.
So this happened on Tues, so I skipped Wed for a couple of these patients thinking I would see them today.
But I ended up rounding with a different attending in order to see this new consult this morning, and my usual attending rounded in the morning rather than in the evening and didn't tell me, so by the time I got to seeing my patients, he already knew everything and the notes were all written. I went and saw them anyway, but didn't write my own note because it would have been redundant and never would have gotten co-signed. My neurotic self worries that he was annoyed that I didn't already know what was going on with them. But then, the only reason he knew was that he had just seen them, not because I had been deficient the previous day.
I also often don't know which patients are "mine" and which aren't. Obviously I have all the consults I wrote notes on. But then sometimes I get asked about other ones too.
I have no idea whether this is what I'm supposed to be doing. I am trying to use my best judgment yet not create unnecessary work for myself, writing notes that never get reviewed or seeing patients when there is nothing to do for them. Anyone have thoughts on this?
I did see them all today though, since there wasn't much to do. Except one whom there hasn't been anything to do for for over a week now.
*****
Tomorrow I have my clinical skills exam (not the one for Step 2 -- one created special for us by our medical school) which should be just thrilling. 8 hours of unadulterated fun, I'm telling you.
*****
This weekend: taxes. Good thing I already have done most of them. Now all I have to do is proof read, photocopy, and send. My husband, who has an anxiety attack every time taxes are mentioned proofed them for me last week and found an error or two, thus proving to me that he is more than capable of doing the forms himself despite his protestations to the contrary.
:-P
*****
I'm still very ready to do PhD stuff, though I'm thinking more and more that I should try to keep doing something clinical while I'm out. Not because I'm afraid of losing my skills, but because I actually like it.
Wednesday, March 11, 2009
Translation
When a doctor tells a patient that people with their disease "don't do well," it means that people die. Often. Usually quickly.
I had a patient ask me what "don't do well" meant today. I told them that people die. Maybe not quite that bluntly, but close.
When I reiterated the story to one of the attendings later, they said, "You didn't SAY that did you?"
Well, what was I supposed to say?* I guess the D-word is taboo, for med students anyway. But I felt like the patient deserved a straight answer. It will probably affect the treatment she decides upon at very least.
I was told to ask, "What do you think it means?" right back at them. Really.
I had a patient ask me what "don't do well" meant today. I told them that people die. Maybe not quite that bluntly, but close.
When I reiterated the story to one of the attendings later, they said, "You didn't SAY that did you?"
Well, what was I supposed to say?* I guess the D-word is taboo, for med students anyway. But I felt like the patient deserved a straight answer. It will probably affect the treatment she decides upon at very least.
I was told to ask, "What do you think it means?" right back at them. Really.
Tuesday, March 10, 2009
The best part
Was when I got to tell my realtor last week that the neighborhood we were looking in last week was a mere 6 blocks away from where my crack addicted patient with 7 children lived.
She wasn't expecting that.
Hee.
On the plus side, we saw some houses that we liked in West Philly this weekend. A lot, actually. They generally have more square footage. We really could consider some of them.
It's funny when we walk around the house, and I start recognizing the people in the photos as former TAs, classmates, etc. They're almost invariably moving elsewhere for residency or fellowship. She'll be like, "Well if they're putting it on the market just last week, they'll probably be pretty firm on price."
We just say, "Yes but when they still haven't sold come June. And they're moving to St. Louis for fellowship, and have to sell before they can buy there.... Perhaps they will not be so firm on price."
"Oh?" She'll say, "How do you know they have to move by then?"
"Because that's just how it works with medicine."
Alas, we still haven't bought anything. But I am beginning to get a feel for what is well priced and what is not. There are still an awful lot of houses on the market that people are trying to sell for too much. You know this is happening when there are perfectly lovely houses in better neighborhoods that are in better condition with parking selling for 50K less than the house you are walking through.
The process of buying is still terrifying to us though. I hear that feeling won't ever go away.
At least we have what appears to be a decent agent.
I really ought to stop surfing the classifieds and start reading about oncology.
She wasn't expecting that.
Hee.
On the plus side, we saw some houses that we liked in West Philly this weekend. A lot, actually. They generally have more square footage. We really could consider some of them.
It's funny when we walk around the house, and I start recognizing the people in the photos as former TAs, classmates, etc. They're almost invariably moving elsewhere for residency or fellowship. She'll be like, "Well if they're putting it on the market just last week, they'll probably be pretty firm on price."
We just say, "Yes but when they still haven't sold come June. And they're moving to St. Louis for fellowship, and have to sell before they can buy there.... Perhaps they will not be so firm on price."
"Oh?" She'll say, "How do you know they have to move by then?"
"Because that's just how it works with medicine."
Alas, we still haven't bought anything. But I am beginning to get a feel for what is well priced and what is not. There are still an awful lot of houses on the market that people are trying to sell for too much. You know this is happening when there are perfectly lovely houses in better neighborhoods that are in better condition with parking selling for 50K less than the house you are walking through.
The process of buying is still terrifying to us though. I hear that feeling won't ever go away.
At least we have what appears to be a decent agent.
I really ought to stop surfing the classifieds and start reading about oncology.
Monday, March 09, 2009
ACLS
What does it say about me that I didn't mind having to do ACLS training this weekend? The mock codes we ran were actually kind of fun. I even enjoyed memorizing the algorithms.
And hey! I know what PEA arrest is now! And how to treat it!
This is not normal, I think.
And hey! I know what PEA arrest is now! And how to treat it!
This is not normal, I think.
Did you know?
People who do cocaine can get cancer pain.
Believe it or not.
If you had their pain, you'd be "drug seeking" too.
Believe it or not.
If you had their pain, you'd be "drug seeking" too.
Friday, March 06, 2009
Top 10 procrastination activities for boards studying
Even though I've been at the hospital ~12 hours/day for the past week, yesterday when talking to my surgery elective classmates I found that some of them had been in the OR until 11PM the previous night.
See this is the problem with surgery. You gotta love it more than you love sleep. I will never love to do anything more than I love sleeping.
Today I have ACLS. All. Day. Long. From 8-6 at least. Stick a fork in me. I'm done.
Doctoring yesterday was surprisingly ok. And I found out that there is an administrative snafu and my name has been removed from the list of students required to attend. I'm guessing this is because I'm MD-PhD (we got an email saying the MD-PhDs didn't have to go, but no one else besides me is still in the hospital so I assumed I wasn't included in that dictum).
I'll probably keep going though. I actually don't mind it so much, and it's gotten a lot more relaxed since it started 2 years ago.
I turns out Anesthesia has become the big elective for people who don't know what to do with their lives. Interesting. I wonder how many of them will go into it?
And finally, I present to you my top ten procrastination activities for when I was studying for the boards:
1) Swimming (takes 2.5 hours AT LEAST)
2) Blogging/reading other blogs
3) Trimming own split ends
4) Listening to new Lily Allen cd 15 times in one day
5) Checking email q15min
6) Cookies!
7) Taking nap
8) Plan elaborate get in shape schedule
9) Making appointments with prospective mentors
10) Fantasizing about potential research topics
Note: Cooking, Cleaning, Grocery Shopping, and Laundry did not make the list, much to the chagrin of my husband. Ah, the real reason I have to have a career -- so I can have an excuse not to do those activities!
See this is the problem with surgery. You gotta love it more than you love sleep. I will never love to do anything more than I love sleeping.
Today I have ACLS. All. Day. Long. From 8-6 at least. Stick a fork in me. I'm done.
Doctoring yesterday was surprisingly ok. And I found out that there is an administrative snafu and my name has been removed from the list of students required to attend. I'm guessing this is because I'm MD-PhD (we got an email saying the MD-PhDs didn't have to go, but no one else besides me is still in the hospital so I assumed I wasn't included in that dictum).
I'll probably keep going though. I actually don't mind it so much, and it's gotten a lot more relaxed since it started 2 years ago.
I turns out Anesthesia has become the big elective for people who don't know what to do with their lives. Interesting. I wonder how many of them will go into it?
And finally, I present to you my top ten procrastination activities for when I was studying for the boards:
1) Swimming (takes 2.5 hours AT LEAST)
2) Blogging/reading other blogs
3) Trimming own split ends
4) Listening to new Lily Allen cd 15 times in one day
5) Checking email q15min
6) Cookies!
7) Taking nap
8) Plan elaborate get in shape schedule
9) Making appointments with prospective mentors
10) Fantasizing about potential research topics
Note: Cooking, Cleaning, Grocery Shopping, and Laundry did not make the list, much to the chagrin of my husband. Ah, the real reason I have to have a career -- so I can have an excuse not to do those activities!
250
That's pack years.
I think that is a record for me.
Addendum: I spoke to a pulmonologist over the weekend, and he said he'd never seen a patient with 250 pack years before. 210, but not 250.
I think that is a record for me.
Addendum: I spoke to a pulmonologist over the weekend, and he said he'd never seen a patient with 250 pack years before. 210, but not 250.
PhD
I kind of wish I could start my PhD now. Enough of the pointless electives that aren't going to tell me anything about what I will want to do with my life 4 years from now. I like this current elective fine, especially now that I feel like I have a job, but I think I am probably not going to be an oncologist. So it kind of seems like a bit of a waste to have to keep going there for three more weeks.
I do like following my patients in the hospital as a consultant though. Today I saw 5 of them, wrote notes, and arranged follow-up. All before noon!
I don't think I'm ever going to figure out what I want to do clinically, though. I think part of the problem is that my clinical interests are so totally not the same as my research interests. I sometimes wonder what I'd choose if I were just going to be a clinician. And I think I'd choose something more procedural.
See on one hand, I like being really busy. Running around. Doing lots of things at once. On the other hand, I like to be able to think about things and see what happens to patients. I also like to take the time to do a good job talking to them. Address all their concerns.
I loved my surgery rotation, but I think I might actually die if I had to be one. You have to love surgery more than you love sleeping to be a happy surgeon, and that's just not me.
I don't know. Maybe I should try rads. Not that I have that option at this point since all the slots are taken. Of course then I'd throw the talking to patients part out the window. Something to think about anyway.
I just wish I could skip all this right now and start on my PhD. Save my electives for when I actually start having to decide on residency. This all seems like such a waste of time. Blah.
I do like following my patients in the hospital as a consultant though. Today I saw 5 of them, wrote notes, and arranged follow-up. All before noon!
I don't think I'm ever going to figure out what I want to do clinically, though. I think part of the problem is that my clinical interests are so totally not the same as my research interests. I sometimes wonder what I'd choose if I were just going to be a clinician. And I think I'd choose something more procedural.
See on one hand, I like being really busy. Running around. Doing lots of things at once. On the other hand, I like to be able to think about things and see what happens to patients. I also like to take the time to do a good job talking to them. Address all their concerns.
I loved my surgery rotation, but I think I might actually die if I had to be one. You have to love surgery more than you love sleeping to be a happy surgeon, and that's just not me.
I don't know. Maybe I should try rads. Not that I have that option at this point since all the slots are taken. Of course then I'd throw the talking to patients part out the window. Something to think about anyway.
I just wish I could skip all this right now and start on my PhD. Save my electives for when I actually start having to decide on residency. This all seems like such a waste of time. Blah.
Go attack the lawyers for goodness sake!
Today I have Doctoring, the class that teaches us the non-fact based curriculum. How to get along with people, how to give bad news to patients, etc.
Today we were supposed to read 2 articles from the Well Blog.
This is ironic. According to Tara Parker Pope, medical schools are in desperate need for classes like Doctoring. Because doctors mistreat their patients and are assholes in general. And then she elicits bad doctor stories from her readers. Fantastic quality journalism, isn't it?
It would have been ok the first time, but she has a column like this at least once a week. "READERS, COME SHARE YOUR BAD DOCTOR STORIES IN AN UNPRODUCTIVE INTERNET RANT FOR THE WORLD TO VIEW."
The fact that most medical schools have already implemented such programs seems to escape her. It wouldn't make exciting news, anyway. And besides, the lay public loves to weigh in on what the medical profession should and should not be doing.
Anyway, the fact that we are supposed to read her "work" for class today is beyond ironic. I'm really sorry PL dear course director, but this time you have gone too far.
Today we were supposed to read 2 articles from the Well Blog.
This is ironic. According to Tara Parker Pope, medical schools are in desperate need for classes like Doctoring. Because doctors mistreat their patients and are assholes in general. And then she elicits bad doctor stories from her readers. Fantastic quality journalism, isn't it?
It would have been ok the first time, but she has a column like this at least once a week. "READERS, COME SHARE YOUR BAD DOCTOR STORIES IN AN UNPRODUCTIVE INTERNET RANT FOR THE WORLD TO VIEW."
The fact that most medical schools have already implemented such programs seems to escape her. It wouldn't make exciting news, anyway. And besides, the lay public loves to weigh in on what the medical profession should and should not be doing.
Anyway, the fact that we are supposed to read her "work" for class today is beyond ironic. I'm really sorry PL dear course director, but this time you have gone too far.
Thursday, March 05, 2009
New job
Ah so I have a job now. I'm now seeing new consults and then continuing to follow them if the consult is actually meaningful.
I guess I should have figured this out.... but I was rounding with different attendings for the first couple of days, and I didn't actually know if the patients just followed up with onc as outpatients when they got discharged or if we saw them every day. And nobody every actually SAID anything to me.
Anyway, guess I know now. Seems pretty obvious actually.
Of course there is still the endless shadowing, but depending on who I go with it's less sleep inducing than others.
And tomorrow I have doctoring. Have to say I'm not really looking forward to it, or to seeing my classmates, but that's neither here nor there. I don't want to hear about how everyone else already knows what they're going into, or how great their rotations are.
Or their completely misguided suggestions about what I OBVIOUSLY should do with my life.
It's still a lot more relaxed than clerkships were, and I actually like the practice model and the relationships the doctors have with their patients, but I'm pretty sure I don't want to do this for a living. Maybe it will yield an interesting research topic though.
I guess I should have figured this out.... but I was rounding with different attendings for the first couple of days, and I didn't actually know if the patients just followed up with onc as outpatients when they got discharged or if we saw them every day. And nobody every actually SAID anything to me.
Anyway, guess I know now. Seems pretty obvious actually.
Of course there is still the endless shadowing, but depending on who I go with it's less sleep inducing than others.
And tomorrow I have doctoring. Have to say I'm not really looking forward to it, or to seeing my classmates, but that's neither here nor there. I don't want to hear about how everyone else already knows what they're going into, or how great their rotations are.
Or their completely misguided suggestions about what I OBVIOUSLY should do with my life.
It's still a lot more relaxed than clerkships were, and I actually like the practice model and the relationships the doctors have with their patients, but I'm pretty sure I don't want to do this for a living. Maybe it will yield an interesting research topic though.
I think the problem is
I need a job.
On this elective, I've been doing a lot of shadowing, doing some consults, writing a few notes, and going to conferences. Everyone is very nice, but I usually have to wait until someone says, "Hey go do this consult I just got," or, "There's a smear up on 7 for you to take a look at," for me to have anything to do.
So there's little room for taking initiative, getting stuff done, and feeling useful. Which is I suppose not supposed to be something we medical students care about. Something we're supposed to "take advantage of" before to drudgery of internship arrives.
But it makes me feel a little useless and lethargic.
On the other hand, I feel a lot more relaxed than I did last year. I guess we still get grades, but the presenting is a lot more natural and how to take a history is more in place than it was before. It's funny, I'll get to the end of a complete history in 15 minutes or so and think, "That was IT?" It feels as though it should take longer. But at least I feel confident enough to go with it.
I do feel like there are some gaping holes in what I know, but I suppose if last year was when I got the H+P down and the presenting, this is the year that I'm supposed to get better at my assessments and plans.
Ok, off to 7AM GI conference. I don't like waking up @5:30. :-P
On this elective, I've been doing a lot of shadowing, doing some consults, writing a few notes, and going to conferences. Everyone is very nice, but I usually have to wait until someone says, "Hey go do this consult I just got," or, "There's a smear up on 7 for you to take a look at," for me to have anything to do.
So there's little room for taking initiative, getting stuff done, and feeling useful. Which is I suppose not supposed to be something we medical students care about. Something we're supposed to "take advantage of" before to drudgery of internship arrives.
But it makes me feel a little useless and lethargic.
On the other hand, I feel a lot more relaxed than I did last year. I guess we still get grades, but the presenting is a lot more natural and how to take a history is more in place than it was before. It's funny, I'll get to the end of a complete history in 15 minutes or so and think, "That was IT?" It feels as though it should take longer. But at least I feel confident enough to go with it.
I do feel like there are some gaping holes in what I know, but I suppose if last year was when I got the H+P down and the presenting, this is the year that I'm supposed to get better at my assessments and plans.
Ok, off to 7AM GI conference. I don't like waking up @5:30. :-P
Wednesday, March 04, 2009
97
Yesterday I did a consult on a 97 year old woman with a new mass. It was the first time she'd ever been in the hospital aside from when she'd had her babies. She hadn't seen a doctor in over 50 years.
She refused to let me examine her, which was fine honestly. The mass had been biopsied, and the path was probably going to tell me more about the primary than any crap-ass breast exam I could perform anyway.
As I was talking to her, she kept going on about how she hated going to the doctor, and how she'd always refused to go. Ornery as hell, she was charming in her own way. I said, "Yeah, I hate going to the doctor too. It's not unreasonable. But sometimes they can be helpful...." as she ranted about how the doctor had come in with the medical students that morning and talked about her as though she wasn't there.
She was never going to let a medical student near her again. Ever.
"Even me?" I asked. Oh no, I was fine.
I laughed.
If only avoiding doctors kept sickness away. If only. I'd live to be 1,000.
She refused to let me examine her, which was fine honestly. The mass had been biopsied, and the path was probably going to tell me more about the primary than any crap-ass breast exam I could perform anyway.
As I was talking to her, she kept going on about how she hated going to the doctor, and how she'd always refused to go. Ornery as hell, she was charming in her own way. I said, "Yeah, I hate going to the doctor too. It's not unreasonable. But sometimes they can be helpful...." as she ranted about how the doctor had come in with the medical students that morning and talked about her as though she wasn't there.
She was never going to let a medical student near her again. Ever.
"Even me?" I asked. Oh no, I was fine.
I laughed.
If only avoiding doctors kept sickness away. If only. I'd live to be 1,000.
Monday, March 02, 2009
Oh yeah, and the day was interesting too
So, you do a lot of primary care in heme-onc too.
The morning was ok.... spent a lot of time shadowing in the outpatient setting. And shadowing can be a bit.... soporific.
But then we went and did some consults in the hospital. I did a little presenting, a little note writing. Went through a differential. Interestingly, the presenting and note writing came right back. I felt a little off my game, since it had been a little while, but I think I'll be back on it in a day or two.
I do seem to be missing some facts that I knew previously, which is scary since my medicine rotation didn't even end 6 months ago. Maybe that means the facts will come back quickly. Let's hope.
I'm not overly concerned. That's why we practice, after all.
And I have to say, I LOVE consult liaison medicine. I already knew that to a certain extent, but that feeling has just been reinforced.
So, folks, what does that mean about what kind of doctor I should be?
The morning was ok.... spent a lot of time shadowing in the outpatient setting. And shadowing can be a bit.... soporific.
But then we went and did some consults in the hospital. I did a little presenting, a little note writing. Went through a differential. Interestingly, the presenting and note writing came right back. I felt a little off my game, since it had been a little while, but I think I'll be back on it in a day or two.
I do seem to be missing some facts that I knew previously, which is scary since my medicine rotation didn't even end 6 months ago. Maybe that means the facts will come back quickly. Let's hope.
I'm not overly concerned. That's why we practice, after all.
And I have to say, I LOVE consult liaison medicine. I already knew that to a certain extent, but that feeling has just been reinforced.
So, folks, what does that mean about what kind of doctor I should be?
Small freaking world
Today on day one of my heme-onc rotation I met a patient who was the uncle of a former classmate at U Chicago. This girl was the most obnoxious gunner pre-med I knew. She actually went around the class after every gen-chem exam asking people not how they did, but what their score was in a really obtrusive, in-your-face kind of way.
I remember one exam in particular after which she interrogated me about my grades and I refused to tell her how I had done. And what did that girl do? She went and asked my boyfriend at the time what my score was. Of course, the idiot told her.
I might have felt differently had I done well on the test, but alas, it was not one of my finer moments. The plus side was she never bothered me about my grades again. The minus side was that I never had the opportunity to rub her face in the score I got on the subsequent exam that was 2+ SD above the mean.*
Apparently the uncle was cut from the same mold, as he proceeded to list all her accomplishments and all the various scholarships and awards she had received in med school.
"Oh that sounds wonderful!" I emoted. Gunner-bitch.
She is now a pediatrician. I feel sorry for all the mommies who have to take their poor offspring to her. The thought makes me shudder.
Her behavior and the behavior of others just like her was part of what turned me off of the idea of going to med school when I was 18. And now 14 years later? It's still a turn off.
God. No wonder so many patients hate their doctors. We really are a repugnant lot, aren't we?
*I fully acknowledge that I am a competitive bitch, but at least I have the class to keep the gunner-esque behavior under wraps.
I remember one exam in particular after which she interrogated me about my grades and I refused to tell her how I had done. And what did that girl do? She went and asked my boyfriend at the time what my score was. Of course, the idiot told her.
I might have felt differently had I done well on the test, but alas, it was not one of my finer moments. The plus side was she never bothered me about my grades again. The minus side was that I never had the opportunity to rub her face in the score I got on the subsequent exam that was 2+ SD above the mean.*
Apparently the uncle was cut from the same mold, as he proceeded to list all her accomplishments and all the various scholarships and awards she had received in med school.
"Oh that sounds wonderful!" I emoted. Gunner-bitch.
She is now a pediatrician. I feel sorry for all the mommies who have to take their poor offspring to her. The thought makes me shudder.
Her behavior and the behavior of others just like her was part of what turned me off of the idea of going to med school when I was 18. And now 14 years later? It's still a turn off.
God. No wonder so many patients hate their doctors. We really are a repugnant lot, aren't we?
*I fully acknowledge that I am a competitive bitch, but at least I have the class to keep the gunner-esque behavior under wraps.
Sunday, March 01, 2009
The promised land of PhD world awaits me
I was just looking at my schedule for the next six months or so. I have to go go go kind of hard until June 21st, culminating with my sub-i. I am not looking forward to this. What sane person would be?
Before the sub-i I have some electives. As is standard for medical school, I have no idea what the requirements will be for said electives, how much time they will consume, how easy/difficult it will be to get time to do things like Research Day(!) on a Friday, or purchase a house, and what my responsibilities will be when I'm there.
With all things medical school, it's usually safe to assume that there will be no extra time. Ever. And that you will have 5 bullshit assignments to complete during that period. OR ELSE.
I know on my sub-i I will not be doing much other than living in the hospital. Though I heard they were in the process of rolling out 24 hour call (as opposed to 30 hour). Maybe I'll get lucky and end up with something like that.
My first elective starts tomorrow, and is going to be Heme Onc at Pennsy. Supposedly, it will be 70% inpatient and 30% outpatient. From a pragmatic standpoint, I have no idea what this means. Supposedly there is not any call or any weekend days in the hospital. Hooray! I don't want to admit that I'm sometimes tempted to choose electives on that basis, but it is what it is.
But after that. After that!
I have two weeks of vacation in June, a 6 week long bio stats intro course (which should not be horribly time consuming) and which finishes August 14. Fall classes don't start until Sept 9th! What the heck am I going to do with 4 weeks of free time???
I'm sure I'll find something. Step 2s will be in there, for starters. And I'm sure I'll find some papers to work on that need to get published. But OMG!!
It definitely makes the early part of this year seem less heinous, knowing that I have PhD land (and not residency, at least not yet) awaiting me on the other side.
Oh, I suspect some bitter grad student will take it upon themselves to tell me how hard they work in grad school. I actually don't care what you do. All I can say is, if you've never been in med school, you have NO IDEA what it entails. Even my workaholic husband who totally busted his ass during his PhD tells me MD land is harder.
Before the sub-i I have some electives. As is standard for medical school, I have no idea what the requirements will be for said electives, how much time they will consume, how easy/difficult it will be to get time to do things like Research Day(!) on a Friday, or purchase a house, and what my responsibilities will be when I'm there.
With all things medical school, it's usually safe to assume that there will be no extra time. Ever. And that you will have 5 bullshit assignments to complete during that period. OR ELSE.
I know on my sub-i I will not be doing much other than living in the hospital. Though I heard they were in the process of rolling out 24 hour call (as opposed to 30 hour). Maybe I'll get lucky and end up with something like that.
My first elective starts tomorrow, and is going to be Heme Onc at Pennsy. Supposedly, it will be 70% inpatient and 30% outpatient. From a pragmatic standpoint, I have no idea what this means. Supposedly there is not any call or any weekend days in the hospital. Hooray! I don't want to admit that I'm sometimes tempted to choose electives on that basis, but it is what it is.
But after that. After that!
I have two weeks of vacation in June, a 6 week long bio stats intro course (which should not be horribly time consuming) and which finishes August 14. Fall classes don't start until Sept 9th! What the heck am I going to do with 4 weeks of free time???
I'm sure I'll find something. Step 2s will be in there, for starters. And I'm sure I'll find some papers to work on that need to get published. But OMG!!
It definitely makes the early part of this year seem less heinous, knowing that I have PhD land (and not residency, at least not yet) awaiting me on the other side.
Oh, I suspect some bitter grad student will take it upon themselves to tell me how hard they work in grad school. I actually don't care what you do. All I can say is, if you've never been in med school, you have NO IDEA what it entails. Even my workaholic husband who totally busted his ass during his PhD tells me MD land is harder.
12 inches?
Does the fact that it's supposed to snow 12" tonight in Philadelphia mean I don't have to go to the hospital tomorrow?
I didn't think so.
It should be an interesting walk from here to Pennsy tomorrow morning. Good thing I have my Chicago boots.
I didn't think so.
It should be an interesting walk from here to Pennsy tomorrow morning. Good thing I have my Chicago boots.
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