Ahh, another weekend, over!! OH NO!!!

Unfortunately, weekends are never quite long enough, and there's always plenty of things that I don't get done in them... I would say that this weekend was pretty productive, though, except that that would be a lie! Well, at least I'm on my neurosurgery rotation, which has been pretty cool.

At any rate, I'm super-excited (moreso than always!) because in two weeks, I have NINE DAYS OFF!!! Seriously, it's gonna be awesome! I haven't had nine days off in a row for about a year (even counting time off for the holidays). What am I going to do?

I have no idea whatsoever, but I think it will definitely involve a LOT of sleeping!

Much like this comic strip, I don't have many other thoughts at this point, so I think I'll draw this to a close.

Did you know that the entire archive of Calvin and Hobbes comics is available online for free!?

Majuscules

YEAH, SO THE DAY STARTED OUT BRIGHT AND EARLY AT 5:30 THIS MORNING, WHEN ABOUT 3 ALARM CLOCKS ALL WENT OFF. FORTUNATELY, THE MIRACLES OF COFFEE AND POP-TARTS WERE ABLE TO ROUSE ME FROM MY NIGHTLY COMA.
AFTER THAT, I MADE A BEELINE FOR THE HOSPITAL, WHERE WE MADE ROUNDS (FORTUNATELY IT ONLY TOOK ABOUT 2 AND A HALF HOURS THIS MORNING). AFTER ROUNDS, I HAD A "PEER AND SELF ASSESSMENT" REVIEW MEETING, WHERE I FOUND OUT THINGS THAT I PRETTY MUCH ALREADY KNEW (I.E., I'M NOT PERFECT, BUT I USUALLY DO ALRIGHT). IN THE AFTERNOON, THERE WERE SOME PATIENTS IN THE ER THAT NEEDED SEEN, SO WE WENT AND EVALUATED THEM, AND LATER, I WENT HOME.
AT ANY RATE, THE DAY WASN'T A TOTAL LOSS, BECAUSE I FINALLY GOT MY APARTMENT LINED UP TO MOVE INTO IN JUNE.

YOU'RE PROBABLY WONDERING WHY THIS IS IN ALL CAPS... YOU PROBABLY WANT TO "MAKE SENSE OF CHAOS" OR SOMETHING. AT ANY RATE, I JUST GOT BORED.

IN OTHER NEWS, I'VE RECENTLY DISCOVERED THE MAGIC OF AUDIOBOOKS. I HIGHLY RECOMMEND THEM FOR ALL YOUR READING/LISTENING NEEDS.

It's not like it's brain surgery, or anything

It's been soooooooo long since I wrote! (Oops!)

Anyway, here's the deal: Since last we met (or read, or wrote, or whatever), I have finished my rotation in Psychiatry. There, I learned that we're all a little crazy in our own way--not on the curriculum, but definitely true. Since I was at the VA hospital, I also learned a lot about the military.

Anyway, after that, I left for an extraordinary weekend in North Dakota. Unfortunately, it's quite flat there. Fortunately, there IS something called the "Fargodome", which is pretty awesome in my opinion!! Regardless of that, I did have a pretty good reason to be there.

After I dragged myself onto my flight back to Indy (kicking and screaming, I might add--or might not, as the case may be), my next rotation started off with a bang this Monday. Right now, I'm on the "Neurosensory" clerkship, but what that really means is I'm on the Neurosurgery team, which is pretty awesome, if I do say so. For example, I want you to look this up, and tell me it's not awesome: conscious open craniotomy. They did that, and I was there. Tell me how that isn't awesome. Also, I actually got to assist on two cases today (hooray!).

So, that's my life. Living the dream... :)

And racking up the debt... :(

Delusions of Granger, err, I mean, Grandeur

The inpatient psych ward is a new experience for me.

Occasionally in life I have (and I imagine other people do too) times when I have to step back, and think to myself, "this is real!" In the sense that, what's happening is not just some story, or a picture, but it's actually happening. My first time flying in an airplane is a good example. Well, in a different sense, I've had some experiences in the hospital (usually the emergency room, with a trauma case or something) where I've had the same thought. Well, I've had that same feeling quite a few times in just the first three days that I've been on the psych ward.

For some reason, it's easy to think about life for everyone as being a lot like mine (i.e. boring, and filled with studying books in my apartment), but in reality--this is the real-life reminder I've been getting--there are a lot of people out there who: spend a lot of time drunk, high, sleep in the street, and wander around with some SERIOUS delusions about life. These are people dealing (or not dealing) with some major problems.

Obviously not everyone there has got it so bad as all that. There's nothing magical or especially terrible about the psych ward (at least not that I am aware of). These aren't "bad" people, or even all that different from anyone else. But they do have some real problems.

Anyway, for me, it's totally unfamiliar, and definitely a learning experience.

Witty Title!

I figured it was time to write something...

So, here goes!

I'm coming toward the end of another rotation. This time it's the internal medicine exam that I'm in "freak-out mode" studying for. Well, maybe I NEED to get into that mode. In case you're wondering, freak-out mode is almost like "the zone", except not quite as good, and not quite as hard to get into! It has more to do with procrastination than it does to do with actually being good at something, and it tends to wear off a little sooner than anyone would like... But it serves its purpose.

Naturally, a little bit of a hypomanic episode might be a little bit cooler, but I'm not entirely sure that's something you can choose to have. You can, however, choose "freak-out mode"--it's as easy as making several pots of coffee!

Anyway, maybe I'm using all of these psychology terms because I'm just looking forward to my next rotation, which is psychiatry. It's my subconscious or something. Anyway, I've had a few thoughts on how to prepare/study for THAT rotation. Most of them center around buying a sweet new couch and free-associating. Others, however, involve buying one or more new t-shirts.

Beverages

Recently, there's been a lot of talk about beverages and politics. There's a long tradition of making beverages a part of politics. There's even a liquor store named "The 21st Amendment" (I've never been inside, but I assume that a reincarnated Samuel Adams works there).

But this is not about alcohol.

Everybody's heard of the "Tea Party", I'm sure. Now, there's a "Coffee Party" starting up (unfortunately, Juan Valdez isn't a US citizen, and cannot be a candidate). How long before we have a "Water Party", a "Grape Juice Party", and (shudder...) a "Frappucino Party"?!

Just exactly what these beverages have to do with politics is even more obscure than donkeys and elephants. But I am concerned that my interests are not being adequately represented. I assume† that the Tea Party is mostly concerned about eating crumpets (whatever those are), taxing those of us who drink coffee, and generally making life miserable for anyone who doesn't enjoy drinking from tiny cups, using saucers and having table manners (again, whatever those are). I also assume‡ that the Coffee Party platform will consist almost entirely of propaganda for the thermos industry. I foresee subsidies and tax credits for buying things like self-heating travel mugs, and robot baristas.

Neither of those two options fully suits me. "Why?", you ask?

Well, here's why:
Both of them leave out a massive segment of the population. One with energy (sometimes TOO MUCH energy), focus, and determination. People who aren't afraid to do extreme sports. People who don't shy away from the possibility of an irregular heartbeat. These people deserve our support. Who are these noble men and women?

The people who support the Diet Mountain Dew Agenda. They show their support daily. Sometimes more. They wake up early. They stay up late. All with one goal; of making their dream a reality. That dream is not so different from any other dream:

It's the hope that one day, a resting tremor won't mean a glass ceiling at the workplace. That sick days taken for withdrawal headaches won't result in job losses. That medical expenses (especially those related to treating atrial fibrillation) will be covered for all, and that this wonderful green beverage will be spread throughout the world as gifts of goodwill, fostering peace and harmony in our time.

That, my friends, is also my dream.

† I know what the Tea Party is.
‡ I know what the Coffee Party is.

As always, been too long since I wrote last... I have started several times, but actually fell asleep in my chair.

I've discovered (well, rediscovered) that I'm not exactly a "morning person" (turns out there's a physiologic basis for that, if you're interested), but I am more of a night person. Getting ANYWHERE at a reasonable hour of the morning is an epic battle for me. Exempli gratia, I'm supposed to get to the hospital and see all my patients in the morning. Well, on my current rotation, that means getting to the hospital at about 7am (could be worse, I know). Like I said, epic battle; getting up and ready is like pulling teeth.

On the other hand, staying up late is no big deal

In other news, it's still winter, snow's no fun, and I hate scraping car windows. Also, I'm doing residency somewhere warm.

Here we go again!

As always, there's not too much time for me to get used to doing any one thing, and right now is no exception! I start my two-month clerkship of "Internal Medicine" tomorrow morning. Just in case you don't know, internal medicine is, it's supposed to be about taking care of people with complex, serious medical problems. They're also known as "internists".

Anyway, I have the first month of the rotation on an inpatient ward at the county hospital, and then I have the second month in the "outpatient world". This is supposed to be one of the hardest rotations of medical school (along with surgery), and one of my goals for the next two months is to decide whether I want to be a "cutter" or a "thinker"--sort of the modern version of the age-old feud between physicians and surgeons. What that actually means is I'm hoping to decide if I want to be a surgeon or if I like internal medicine better.

In addition to that, I'll give you sort of the run-down of what's going on for me in my career planning right now... exciting, I know! My 3rd year is exactly 2/3s of the way over, and 4th year is breathing down my neck, if you will (or even if you won't). 4th year is somewhat like 3rd year, in that there are rotations in hospitals, but unlike 3rd year in that there are only 3 required rotations, and the rest of the year is made up of elective rotations that we choose to do. So, I've got to choose some electives in the next month or so. Therein lies my dilemma; usually 4th years do electives in the field that they are hoping to go into, and most will do "away" or "audition" rotations at a few residency programs that they are hoping to attend after graduation. Well, I plan to do just that, but I haven't quite figured out what I want to go into yet. So it's a little difficult to schedule things like that.

Of course the solution for this would be for me to go ahead and make a decision already!!!

Guess who's back, back again...

As usual, it's been too long since I posted an update. Earlier today I made the journey back to Indianapolis, having finished my clinic duties in South Bend. Now, I've got a day off tomorrow, which will be entirely spent studying for my family medicine final exam on Friday (can't wait!).

As you might expect, I have a hard time talking or writing for more than three words in a row without making a music reference so here we go... as I pulled back into the city today I kept hearing this song playing over and over in my head. I have no idea why it's called that, but I think we can all agree it is the antithesis of an epic fail. Which as we all know would be an epic win. Oh, and it also sounds kind of epic in general.

And while we're on the topic, I was thinking. (Dangerous, I know) Anyway, at my school, the grades you can get are "pass", "high pass", "honors", and "fail". I think there should be an "epic fail" category, reserved only for those students who do something so egregious that words normal people use can't express it. Like accidentally burning down a hospital, or defibrillating your attending on rounds or something.

Still doing Family Medicine. Enjoying most of it, except all the studying.
Hardest parts? Patients with ADHD, depression, and anxiety
Funniest? When I'm almost finished seeing a patient, I always ask if they have "other complaints or concerns", in hopes of not missing something they forgot to tell me. There's a lot of older folks in the practice I'm at, and a surprising number of them say something like, "well, I've got some complaints about society in general", or "yeah, the government".
Most unexpected? My preceptor keeps his puppy in a cage in his office all day.

Anyway, I can't think of any more.

New Year, new rotation

Finally getting back in the swing of things, after the holiday season, and I'm finally back in the clinic after a month in the morgue. It was a nice break, but it's good to be back to doing medicine on 'the living' for a change.

So, I've finished two days of my family medicine rotation, still in South Bend. It's been pretty good so far. I'm in a community practice in town, and they have me primarily with one preceptor for the month. Fortunately, he seems like a pretty good guy, and I found out that he takes an annual fishing trip somewhere in Canada every year, so I'm anticipating we'll continue to get along well.

Anyway, my role is pretty much to go in and see patients before he does (as long as things are going well and we're not too far behind schedule), talk to them about why they're there, do my exam, and make a diagnosis (hopefully the right one!), and then come out of the room, talk the patient over a little, and then we go back in, and my preceptor does his part of the visit while I mostly watch.

As you might imagine, it's like a test with every patient, to see if I can figure out what's going on, what needs to be done, and why. As a rule, common things are common, and to be honest, it's not to hard to diagnose somebody with something like the flu. However, things do get more complicated, and those are the times when it's really satisfying (at least right now) to make the right diagnosis, and know what to do about it.

To sum up, so far I'm enjoying the rotation, and except for all the lake-effect snow, I'm still enjoying being back in South Bend.

MERRY CHRISTMAS!!!

Hopefully the yule-log keeps burning, the sugar plums form a proper soul-train line in your head, and you don't have to call a chimney-sweep to get Uncle Charley out of the chimney after he had too much egg nog Santa Claus out of the chimney this morning.

Anyway, Merry Christmas, X-mas, EXTREME-mas, and, um... Winter Solstice.

Courtroom Drama

Well, finally I have something to write about...

As part of my "forensic education", I attended a murder trial yesterday, where my preceptor was testifying as an expert witness. Having never been in a murder trial before (unless, of course, you count the additive year of time I've probably spent watching Law and Order), it was all a little new to me.

The other student and I sat in the gallery, while the pathologist took the stand, and we watched and listened as he took the oath, was introduced to the jury, as began to be questioned by the prosecutor. They began to go through the grisly details of what had happened to the victim, i.e., what was found during the autopsy. As they did so, it became apparent that I was sitting next to the brother of the victim (it was a pretty small gallery). He was (quite understandably), visibly struggling with this information. In fact, families from both the victim and the accused were there, and as you would expect, no one was enjoying what they were hearing.

When it was time to begin viewing the evidence photos that were taken at the autopsy, the judge gave everyone the opportunity to leave if they did not think they could handle seeing them, and actually even had the defendant go look at them in another room before they were presented as evidence. To my surprise, no one from the gallery left. Apparently everyone wanted to, or felt like they had to, see these photographs.

When the defendant returned to the room (escorted by his lawyers and the bailiff, of course), he was obviously shaken, and it looked to me like he was crying. Well, the testimony resumed, and everyone looked through the autopsy photographs on a large projector screen, while my preceptor pointed out his various findings. Again, these photos had no small effect on the people in the gallery.

After that, there was some very perfunctory cross-examination by the defense, and then the judge read some questions from the jury, and just like that, our part of the trial was over. We promptly left the courthouse, and I immediately began wishing I had gone to law school instead returned to the medical foundation.

To sum up, it was a strange experience, and not like anything else I've done in medical school so far.

More than one?!

A day late, and a dollar short

As you may be aware, in addition to lawyer jokes, there are also doctor jokes. There's jokes for pretty much every specialty. Some are funny, and some are not, and others are more like proverbs than jokes. For example...

How do you hide a dollar from a general surgeon? Put it in a journal.
How do you hide a dollar from an orthopedist? Put it in a textbook.
How do you hide a dollar from a heart surgeon? Tape it to their kid's forehead.
How do you hide a dollar from a plastic surgeon? Trick question. You can't!

And some more...

Internists know everything and do nothing.
Surgeons know nothing and do everything.
Pathologists know everything, and do everything, but its always a day too late to help.

I would say that the last one may be right on target. Not that pathologists actually know everything, but when you're going through and doing an autopsy, you pretty much have to go through and look at everything, all the organs and such, to figure out what went wrong. And usually, you figure it out, because everything is opened up right there in front of you. But alas, in the real world (contrary to what happens on House), at that point, it's definitely too late to apologize help.

I apologize for being a bit morbid... To help cheer you up, I'll leave you with my all-time favorite doctor joke...
 What do you call two orthopedists looking at an EKG? A double-blind study!

Au jus...

Been back in South Bend for a few days, getting settled in, trying to get into the pathology swing of things for my Forensic Pathology rotation, and definitely liking the hours so far... went in at 9 am today, and not 'til noon tomorrow! (What is this, some kind of vacation or something?!)

So, most of what I'm doing for the month will be attending autopsies (only one so far), and learning all about how to do them, and also attempting to get a research paper published... ouch... oh, and did I mention studying?

At any rate, in addition to all the studying, I've decided that since I'm studying forensics, I should go ahead and read Crime and Punishment, while listening to this song, err... I mean this one on repeat.

I've also decided that while I'm in town I may as well stop in and give the higher-ups my two cents about who should replace Charlie Weiss... since I've got so much clout around here...

Today was my last clinic day of the pediatrics clerkship. As always, there's a big exam coming up tomorrow morning, and since I'm just about fed up with studying, I thought I'd give the world wide web the run-down. I think the most important thing at this point is just to recap what I feel were some of my successes in the past month.

First, I did not get sick from any of the kids. Even when they coughed in my face, which is a pretty common occurrence. I attribute this to a healthy immune system, daily multivitamins (well, actually, I always forget...), plenty of rest, good genes, a can-do attitude, and last--but not least--lots and lots of Diet Mountain Dew.

Second, I successfully avoided changing any babies' diapers throughout the entire clerkship. Not that I wouldn't have if the need arose. But it was sort of a goal of mine, and I'm certainly not complaining.

Third, I like to think I saved about 400 kids' lives in the past month.

On a more serious note, I'd like to think I learned a lot too. I doubt I'll be a pediatrician (don't think I could handle the parents...), but I did learn a lot about dealing with sick kids, and I think I learned a lot about medicine in general, and how to be a good doctor (which I guess could come in handy some day).

I also learned that most abdominal pain is children is caused by eating Fire-Hot Cheetos and the true meaning of the phrase "attention deficit"!

Earlier today I finished my week-long stint in the newborn infant nursery, where I was supposed to learn how to take care of the medical issues that newborn babies have. Mostly I spent the week learning how to do a good "check up" for a newborn baby, and trying to dress and undress babies.

What else did I learn in the past week? Well, for one thing, I learned that baby clothes are weird! How am I supposed to get those things on and off a baby?!

I'm just about done with my whole pediatrics experience, just another week and a half, and one of those national final exams to go, and then I'm off to South Bend and the wide world of forensic pathology! In an aside, if anyone ever suggests that you watch the movie "Pathology", don't.

So there you have it. To recap, baby clothes are confusing...

Skills

Occasionally, I think to myself about how it would be nice to have additional skills. Like maybe if I knew more about computers, or how to speak other languages. You know, things that might be useful in my day-to-day life, making work easier, or more productive or, just making life all-around more enjoyable.
And where would one go to acquire said skills? Well, depending on what the skill is, I suppose you could go to your local library, enroll yourself in some karate lessons, or quickly search the internet for a how-to video. Or in my case, you could have had a different major in college.

I mean, how often do I think to myself, "Matt, it would be really nice if you knew Spanish right now, so you could talk to these people without using the translator phone...", or, "If I knew more about computers, maybe I could sabotage the hospital's computer records system so they would decide that now's the time to get one that works, and also wasn't written in QuickBASIC."

But, as it is, I've just got my lowly degree in biology, which means I could probably tell you how to clone a gene, or calculate a mutation rate or maybe even tell you why moss grows on the north side of trees, but can't necessarily do "cold-call sales", "drive truck", negotiate a contract, or even properly operate an iron.

There is one major benefit to a working knowledge of biology in medicine, though. When a kid comes in, and I've got to look in their ears with my otoscope, I can tell them that they've got WAY cooler things in their ears than "a monkey" like my doctor told me as a kid. Like, orangutans, or bonobos. Well, on second thought, maybe not bonobos. Maybe fiddler crabs? Cacelians? Or trees with moss growing on the north side?

#1 Goal

So today, I had a mini-shift in the pediatric ER here in town as part of my "outpatient pediatrics" month. Anyway, I walked in like normal, and introduced myself to the staff, and the first thing one of the attending ER docs said to me was, "just try not to kill anyone while you're here". Initially I wasn't sure if this was supposed to 'put me in my place' or if he was just being, um, jovial. So I kind of chuckled and said to him, "Well, that's always one of my main goals." Anyway, some of the residents and nurses overheard this exchange, and started laughing (which I interpreted as a sign that this guy probably wasn't trying to be mean), and so he started telling everybody about this little ritual he does every day before work that includes "not killing anyone" at the top of the list.

Anyway, I thought that was probably not a bad idea, and perhaps I'll adopt such a ritual.