Top 3rd Year Moments

In commemeration of finishing what many consider the hardest year of medical school, I'd like to list out the most memorable moments of my third year.

• Flying across the state with the transplant team to do a donor harvest surgery. In a private jet. And being the only medical student in the surgery
• Being trusted to use the scalpel and bone saw during my CV surgery rotation
• Sewing up an incision better (but not faster) than the chief
• Being commended for being the only student on the team to turn in my required assignments on time
• Being taken to eat at Fogo de Chao by a fellow student
• Driving home from a far away clinic during peds during a horrible thunderstorm that actually flooded the highway making it impassable
• Being in the group that scored the highest average on the surgery board
• Trading to a different medicine month and team only to find out that I totally screwed myself over
• Making a TB diagnosis missed by my upper level in the county hospital ER
• Wearing a mask before talking to the above TB patient
• Seeing first hand both patients experience seemingly miraculous cures as well as patients suddenly or quite protractedly pass away
• The MR patient at the county hospital who, as I was examining another patient in the same room, shouted out, "Nurse, Nurse. Thank you for the underpants!!"
• Fun month was actually fun. Because I didn't study hardly at all
• Having the Director of Internal Medicine give me 100% on my eval and offering to write me a LoR
• Driving 64 miles everyday to the furthest away FP clinic. With Cecil
• Cecil somehow managing to get me out of lots of hours of FP clinic time
• Getting a super buzz off my first and only energy drink. And being told I was a little hypomanic from it
• My resident on neuro from Siberia. "Must to practice checkout sheet" and "Most of you (there was only 3 of us) very hard working"
• The neuro resident who called her patient a "carpet muncher", and then for some reason was threatened by the patient that they'd call the TV news stations to come report on the (ie her) poor quality of care
• The paraphilia lecture
• The county psych hospital
• Catching a baby for the first time
• Delivering a placenta and accidently squirting cord blood all over the room, and resident, when I moved the hemostat up during said delivery
• BV clinic

So that was my year in a nutshell. At least the most memorable parts of it. I am excited for fourth year. No call. No weekends. 2 months off. If you are still reading this and happen to also be ending your third year, I meme you!

Whiff Test

So today was my last glorious day of OB/Gyn, and more importantly, of my 3rd year. And I had an extra special way of rounding out my 3rd year experience.

Today I got the opportunity of going to the county jail OB clinic to treat all the incarcerated women. They should really change the name of the clinic though. I suggest they rename it, BV clinic, because everyone who came in (with one exception) had really florid BV.

So, for all my non-medical fans, BV stands for bacterial vaginosis. It is essentially an infection caused by overgrowth of certain types of normal vaginal flora, much like a yeast infection except with bacteria and not yeast. What is extra special about BV is that the discharge has these cells in it (see picture) called "Clue Cells". I have yet to figure out why they call them clue cells. Mostly because the first clue you get that someone has BV is not the clue cell, but by the very distinct odor that wafts your way as you get up close and personal with an infected person's nether region. Who needs yet another clue as to what's going on? There's actually a test called the "whiff test" where one adds potassium hydroxide to the already foul smelling substance to see if you can make your sample smell even worse than it already does. While clue cells are rather inappropriately named, the whiff test (much like dumping syndrome) is quite an accurate description of the test.

BV is also associated with a discharge. Usually its white and somewhat thick. Sometimes its a little different. My favorite was asking the patients about it. "It's like boogers coming out my hoochie," was my personal favorite description. At least it painted a vivid image.

End Of Slavery

You might have noticed a little clock counting down almost a year's worth of time there to the right. Actually it's really more like about 10 and a half months. It's the countdown to the end of slavery.

You may be thinking, "But slavery was abolished by Abraham Lincoln in the early 1860's". Wrong. Today in medical education medical students everywhere pay for the priveledge and honor to be able to take 30 hour shifts of doing work for people who are being paid to be there. Medical students everywhere are dumped on by residents, interns, nurses, LVNs, janitors, transport, and even volunteers. All for the low, low price of $10,000 / year. That's not a salary, that's "tuition". Multiply that by 220 students in a class and 4 classes in the school and that's like 10 million dollars of "tuition" that we pay.

And we still have to pay for parking, books, syllabuses, meals, etc, etc.

So keep an eye on that clock, because when it reaches zero, I no longer will be paying to work for the school.

On a side note, commencement was officially announced for exactly one month following the end of that countdown, on Saturday May 31st at 10 am.

Darwin Awards

By the year 2007, I'm sure everyone has heard of the infamous Darwin Awards, awarded annually to people who unsanctimoniously remove themselves from the human gene pool.

I've always thought it a little silly when people with small cars insist on backing into parking places for a quicker get away, like they were robbing a bank everywhere they go. If you have a big truck and have a hard time backing out, that's one thing. But if you drive, say, a Ford Mustang, that should be plenty maneuverable to just park normally. There's a certain group of people who seem more likely to do so, but that's neither here nor there.

So here's my nomination for a Darwin Award this year. A man living in a high rise apartment complex said to have very narrow parking places was backing his Ford Mustang into a parking spot on the fifth floor of the parking garage. One would think that at normal parking velocities a solid cinderblock wall might be able to withstand impact with a car. Based on the fact that there are tire marks indicating he was backing up, one can only guess at what the driver was thinking about as they peeled out in reverse into a small tight parking space. Perhaps they thought, "Maybe this skinny pedal on the left is the brake". In any event, the driver managed to reach escape velocity and launched their car through the wall onto a building below. Upside down. Unfortunately, the driver did not survive his short flight, but such is the nature of natural selection.

Strange Day

Today was perhaps one of the strangest day I've ever had on this rotation. It all started nice and early at 5 AM. I got to the hospital and rounded until 6 without ever seeing a resident. "That's weird," I thought.

At 630 at board checkout finally the residents showed up, a whole new set just because it was Thursday. Apparently the regularly scheduled residents all have clinic on Thursday and so the clinic residents come and take their place. We ran around the whole day with crosscover residents and a cross cover attending, on what was actually a pretty slow day, but somehow managed to not actually round on the patients at all. But back to my morning...

Then I went upstairs to see a baby born earlier. They told me I needed to see it for my education. So I get up there and the nurse says, "Oh, you want to see his malformations. Look here." And she takes off the diaper. I've seen ambigious genitalia before, but this was not ambiguous..definitely a boy. After trying to figure out what his problem was called, I found one single case report at pub med here. If the link is too medical mumbo jumbo for you, what it says is that this particular problem is where the scrotum is actually ABOVE the shaft. I didn't know what to think, and then the nurse says to look at his bottom. At which point I noticed his anus was way too high. It was posterior, just not low enough. The attending said he would never sit down to poo. Poor kid.

And then I met the mail-order bride. She was pregnant and not really having a problem but her husband was a complete nervous wreck. With way too much coffee. He kept checking the empty mug he brought in with himself in case magical coffee appeared in it again. And he never let her answer for herself. And asked a million and one irrelevant questions. "Why are you asking about that? Is something wrong? Is it bad that she is hurting like that? What should I do? Should she be taking her medicine more often? Is the baby a boy or girl? Is the cord wrapped around the neck? Is the baby too low? Where's her uterus?" 1) I can only answer 1 question at a time 2) I don't know the sex of a baby by asking about contraction pain 3) I don't have xray vision 4) I really wanted to find this guy some xanax just to shut him up so we could talk to his wife who actually knew what symptoms she was having.

At least it was interesting today.

SP Heaven

Today I had my end-of-third-year clinical skills test, aka the CCCE, or as I like to call it the CCCCCCCCCCCCE. I don't know what any of the C's actually stand for. It's just it's name. Because doctor's like abbreviations. Especially OB/Gyn's.

It was an standardized patient's dream. 11 of us showed up at 0730, which was sleeping in for me this month, and went and talked to 11 different "patients". Some of them had just histories to take, and some of them had physical exams on top. And the pedi patient wasn't even there, just their parent. It was a long grueling day of taking histories and doing physicals on people who were just pretending to be sick. My favorite was the patient who was supposed to be homeless and somehow the testing center had let a fly into that exam room. I guess they were just going for realism.

Anyway, I have a special place in my heart for standardized patients. They have a job that honestly you couldn't pay me enough to do. Especially brave are the patients who taught us the urology (DRE and male genital exam) and the breast/pelvic SP. Can you imagine having your prostate checked and then having to turn your head and cough 10 times in a row for people who have no real experience doing said exam? How about having your well-woman done 6 times in a day by people who are highly likely to do it wrong? Somebody should call Mike Rowe.