The nerve of drinking coffee during morning rounds

Most med students are quick to catch onto the fact that “sipping coffee” is synonymous with “standing there, doing nothing” (or even – god forbid! – “taking it easy“). It’s one of the many little rules you’re expected to absorb from thin air on your first day of third year.

Sure, it depends a lot on your hospital and team – but broadly speaking, having a cup of coffee in one hand during rounds gives off a certain “devil may care” attitude that doesn’t bode well for your med student reputation.

(That said – I did it on surgery rounds because 1) I already knew I wasn’t getting honors, 2) there were no old-school attendings, 3) I deeply suspected the residents were too sleep-deprived to register the sight of me, let alone notice a small coffee mug, and 4) it was freaking surgery; I needed coffee.  I mean, screw it, I’m not a machine.)

But this is SUCH a good example of why medicine is insane: there is nothing intrinsically lazy, unethical, or dangerous about simply holding a cup of coffee outside a patient care area.

But dude, if you’re on the bottom of the totem-pole of medicine, it makes you look like you’ve forgotten your place, and we can’t have that now can we.

So, right: Reddit’s medicine section has been having a discussion about it:

I cannot believe how many non-medical people responded to this topic by raising hell about how inconsiderate it would be to drink coffee in the patient rooms.  YES, WE KNOW.

But honestly – even if the medical team taking care of you does dare to flout JCAHO rules by bringing closed containers of coffee into the room for the whopping 3 minutes they spend with you – unless you are NPO or on chemo, I can’t help but feel detecting a slight whiff of coffee in your room at Crack of Dawn O’Clock is not unreasonable.

But, right, the point here is that we are talking about drinking coffee in the hallway, not a patient care area.

… Yep, pretty much.

It’s such a dead-on example of why students leave med school hating medicine: “don’t drink coffee within sight of your superior” is – for better or worse – the sort of thing we end up internalizing as “professionalism”.

USMLE Week 5: Eh, Good Enough.

So after that mini-mental-breakdown of a practice test, I regrouped.  I montage-ed.  I set out to target my lowest-scoring subjects, grudgingly relearned them from scratch, ultimately spent more time alone in my room listening to morose music than I did during my last major break-up, and then proceeded to score, on two separate tests, just flat-out ridiculously higher.

… which – thanks in part to my newly-acquired Biostats knowledge (see: “lowest-scoring subjects” above) – I now know says more about just how poorly designed this test truly is than it does about how talented I may or may not be at short-term memorization.

(Okay, calling the USMLE “poorly designed” might sound a little harsh and high-minded – but when the NBME is purposefully distancing themselves from the notion that it’s an “achievement” test - in other words, that the exact scores mean anything – preferring instead to categorize it as “minimum competence”, and then still steadfastly reporting 3 significant figures?  At the steep end?  All while knowing that they’re handing out these career-determining judgements to the most self-absorbed, breakdown-prone students in the world?

… if that’s not poorly-designed, it’s at the very least disturbingly cold-hearted.)

And while I’m relieved as hell about scoring better, the relief is transient and the tiredness is a slow burn.  I’m forgetting more and more while caring less and less.

The result of adding this kind of burn-out to the general theme of my Step 1 study plan (which, FYI, would be most appropriately titled “Ways In Which I Helpfully Verified Common Wisdom By Ignoring It Entirely” - subtitle, “Somehow, It Went Poorly”) is a schedule for the last three days that looks something like “do stuff, but not too much or too little”.

I guess I will probably go through my flashcards again.  Or my notes?  Or re-listen to the recording I made of me reading First Aid.  Or learn to juggle.

I DON’T KNOW.  THERE ARE OPTIONS.  It’ll work out – and someday, as a commenter recently reminded me, there will be happiness again.  (Seriously, thanks for reading/tolerating self-absorbed posts like this, you guys.  Thursday can’t come soon enough.)

Meanwhile, Here Are Some Awesome Step 1 Resources Buried Deep In The Depths of The Internet: 

• - Compiled USMLE Step 1 Mnemonics
• - Protein Synthesis Inhibitors: Never Mix Them Up Again!
• - Virology Cheat Sheet - pretty great starting point, and well-designed to boot.
• - The Ultimate Guide to Gastrointestinal Hormones - Dude, seriously, this guy can make a table.
• - Confidence Intervals vs P-Value 
• - Everything I Need To Know I Learned From USMLEWorld - Where has this blog been all my life?
• - Goljan Flashcards (or here, a more selective set strictly from the Goljan High Yield document everyone raves about but never links to.)

USMLE Week 4: A Light Update

… So that happened.

For my more visually-challenged readers, that disturbing sound you just heard was the sound of an NBME practice test exploding me into tiny bits of sub-par, clearly less-than-average, horrifyingly-close-to-my-pre-studying score self.

IT’S LIKE THE NBME DOESN’T EVEN CARE THAT UWORLD THINKS I’M SMART.

IT’S ALMOST LIKE THEY’RE RUN BY TWO SEPARATE COMPANIES OR SOMETHING.

(Yeah, I know statistical variation is a thing.. but I’m not willing to attribute a difference of almost 40 points to it.)

Luckily, even though I’m studying in the middle of Abandoned Rural America, I had a friend who was willing to listen to my hysterical panic attack and help point me towards a rational plan for the next few days.

So instead of following my regularly-scheduled Gut Instinct of Crazy (crying, staying awake for 120 hours straight, emailing the dean, and then pushing back my test date) I will instead follow her advice and spend the next few days addressing specific areas of weakness in a logical order.

Like a smart person would.

All of this to say: This blog will be taking a minor “crisis-mode” break until the 21st.

Turning This Sad Ship Around To Face The 230+ Iceburg Head-On

Today I put in 10 solid hours of pharm and cardiovascular pathophysiology.  Not even kidding, I haven’t been this productive since I first got into med school.  THE FIRE OF INADEQUACY IS KINDLING A FLAME OF RIGHTEOUS CAFFEINATION, which is in turn fueling focus, goddamnit.

… so you might say to yourself, “Gee, that’s nice, Action Potential – but why are still awake and writing on your blog at 4am?”

And to that, I would argue, “because… goddamnit.”

I don’t know.  I’ve been awake since 2pm yesterday.  EVERYTHING WAS GOING SO WELL until I realized how I had mutilated my sleep schedule.  It’s been a vicious cycle of caffeination that would fit really well in a G-rated adaptation of Trainspotting.

Definitely two Italian Roasts too many.  I think it’s caffeine’s fault.  I know blaming chemicals throws up a few red flags, but surely we can all agree caffeine is undermining my efforts, here.

I think I just need to drink 4 Italian Roasts tomorrow; just to show my plasma adenosine concentration who’s boss.

Or maybe not.  Maybe that’s a stupid plan.  It’s hard to tell given the extraordinarily low standards I currently have for the intellectual viability of any given “plan”, given that my current one relies on throwing all advice to the wind and just learning shit for the sake of maybe remembering it later.

Goals for Today/Tomorrow/Oh God What Day Is It:  200 UWorld questions and 5 solid hours of Pathoma!  THIS IS HAPPENING.

FULL SPEED AHEAD.

USMLE: Week 2

After multiple half-hearted attempts at writing this update, it looks like I’m kidding myself if I think it’s going to be coherent   I give up.  Just consider the lack of editing a testament to what studying is doing to me, please.  I am bleary-eyed and anergic to caffeine.

1.  My Step 2 CK score came in!  And I got my goal score: 200-and-Not-Outrightly-Memorable-In-A-Bad-Way points.

Seriously, I was dead-average and thrilled about it.  (Though – to be fair – I originally thought ~220 was average, which is why I was probably so thrilled to see that I got a 237.  Took me a second to parse that 237 was written twice because it was also the current Step 2 average.)

(By the way, did I just make up the “220 = roughly average” thing?  Was it ever true?  Is it something a med student told me years ago that I just internalized as the gospel truth?  Or are med students getting smarter?)

But, okay, DONE.  Nothing more to say on the subject.  No more speculation.  Back to Step 1.

2.  ”The best step 1 prep is to study hard for the pre-clinical tests.”  I can’t believe this saying actually turned out to be true.  I mean, sure, it makes sense, but I still thought it was mostly just a clever way for M3s and M4s to sound haughty when asked for advice.

All I know is that as an M1, I literally studied myself into an injury during Microbiology – probably the hardest I’ve ever studied in my life – and.. holy crap, I retained that information!  Even though it was all just random association.  It was amazing.

And I’m not saying that having a near-mental-and-physical-breakdown was “worth it”, exactly, but –  I scheduled myself 48 hours to review micro and only had to use 6.  So, time-wise, I guess overstudying for M1 Microbiology was as “worth it” as a near-breakdown is ever gonna get.

I just wish I could say that about the rest of the Step 1 subjects. Looking at my QBank breakdowns, it’s patently obvious that I barely passed M1 Embryology.  At the time, I just didn’t feel motivated to learn, and now I’m paying for it.

Actually, not only did I not feel motivated to study Embryo, but I distinctly remember explaining to someone that “You know what?  It doesn’t matter.  The only people who need to learn Embryology are future pediatricians.”  (Yeah, you tell them, M1 Action Potential!  … those.. future.. pediatricians…)

NO. BAD. Stop that RIGHT NOW, Former Me.  I am from the future and I am here to tell you are wrong.

But, too bad, I don’t have the time machine necessary to knock on my former self’s door and forcibly cancel her Netflix subscription, so instead I’m bitterly studying embryology 4-5 hours a day just to break even.

(Yes, I know it’s not “high-yield” for Step 1, but if I don’t learn about the embryonic origin of cleft palate anomalies now, when will I?  I made my bed and now I have to lie in it, etc.)  (Besides – for all I know, Future Pediatric Resident Me does have access to a time machine – and I really don’t want her to knock down my door to cancel my Netflix subscription.)

3.  Immunology: is, however, still stupid. 

4.  Stuff That Doesn’t Fit Anywhere Else:

• First Aid 2013 is a huge improvement from 2012.
• USMLERx “Flash Facts” has, by far, the worst interface and programming of anything I’ve ever regretted paid money for.
• That said, the USMLERx QBank is actually shockingly good – memorization-wise, it’s unbelievably helpful to have a picture from First Aid and page number for every answer explanation.
• I bought an extremely comfortable pillow and it was a major time-management mistake.
• Picmonic is new and brilliant.  I bet it’ll catch on as fast as Pathoma did.
• I am forcing myself to limit my prep books to 2 per subject, and it’s a daily battle.  This had better be good for me.
• I should have quit caffeine 3 weeks ago.

How the USMLE Tried to Kill Me

OK, yes – it’s a mistake. I know it’s a mistake, but there are certain things in life where you know it’s a mistake but you don’t really know it’s a mistake because the only way to really know it’s a mistake is to make the mistake and look back and say ‘yep, that was a mistake.’

- Lily, How I Met Your Mother

In the early morning hours before my Step 2 exam, I woke up, peeked out the window, and couldn’t see my rental car.  This induced mild panic until I took a closer look and realized that, in fact, my entire driveway appeared to have been turned into an impromptou snowdrift.

This was concerning.

I was still hoping for two more hours of sleep, but I sat up and checked the Prometric website anyway. It didn’t mention any cancellations, so I thought, “hey, maybe the snowstorm isn’t actually that bad!” and went on to check the weather – you know, just for validation that driving 2 hours east to the Prometric center wouldn’t be a big deal.

And after punching in the zip code, this is what weather.com told me:

THANKS A LOT, WEATHER CHANNEL. 

So there I was, at 4am, torn between Possibly Dying In An Icy Car Crash or being sensible and simply rescheduling the exam

Naturally, after a lot of guilt and soul-searching, I decided the only responsible choice was to leave immediately.  After all, I figured at 4 am, no one would be on the freeway yet, which would drastically reduce my chances of dying!  And by leaving with four hours to spare, I could – if necessary – drive at 30mph and still make it on time.

(Besides, it wasn’t like I was going to be able to get back to sleep at that point.)

The roads turned out to be icy enough that driving 30 mph for 3 hours was actually the correct decision, so that’s what I did.  As a precautionary measure, I threw at least 9 blankets into the backseat of the toyota, a flashlight, and some poster-board (for rescue signs, or impromptou pep ralleys, I don’t know) and headed to the interstate.

On the way, I got well-acquainted with a little yellow light on my rental car that occasionally blinked me friendly reminders about imminent doom.

“DEAR DRIVER, IF YOU DON’T ABANDON THIS FOOLISH MISSION IMMEDIATELY, YOU ARE AN IDIOT AND I HATE YOU.” – My Toyota’s Friendly Anti-Skid Warning System

But seriously, it was fine.  It may not have been fine if I had left any later than 4am (ice + skidding + other cars = no thanks), but my Prometric center was open and I’ll be damned if I was going to spend one more day studying – let alone the 2 weeks it would probably take them to reschedule me.

Oh, and Step 2 itself? Pretty anti-climactic considering the sheer adrenaline required just to get there.  It was hard to work up any actual anxiety for multiple choice questions after having survived the “deadly storm” on the interstate.

And now guess what time it is?

Time to study for USMLE Step 1, which I take in 7 weeks!

Just kidding.  I’m taking at least a full week of vacation first.

(… At some point, I will probably have to write an entry on why I decided to take Step 2 before Step 1 – but the short version is “my school’s schedule” + “my stubbornness” is sort of a winning combination for this type of thing.)

One foot in 3rd year, one foot in Madness

1.  Remember that time I swore I would never do research again?  That was cute.  Today I had a meeting with the head of our curriculum and tried to convince him to let me integrate a pet project of mine into the curriculum.

2.  ”That sounds publishable!  Let’s make it happen.  Here’s a good journal and a deadline for submission.”  … Wait, what?  Am I… why?

3.  WHY DO I HAVE NO STANDARDS.  I’m not very good at the “I don’t like academia” game.

4.  Step 1 Looms Ahead.  I went to a promotional session by Kaplan today – partially because of the free pizza, but mostly because I wanted to see if the Kaplan representatives in Metropolis were better than the Kaplan representatives at Midwestern U.

They were not.

… though, to be fair, I was a Kaplan representative at Midwestern U – so I may be biased.

(I am not.  This representative was genuinely terrible.)

(Also, they recommend taking 4 months to study for Step 1.  WHO DOES THAT?) (I’m looking at 4 weeks, personally.)

(Then again – I’m looking at pediatrics.  Perhaps I shouldn’t judge.)

(Or open any more parenthesis).

So much for science.

My only computer broke last night.  Poor laptop. It wasn’t entirely unexpected, because it’s been behaving like a cranky toddler for the past year and has had trouble since I bought it – but it was still sad.

I tried everything I knew.  Hard re-sets, switching outlets, replacing the battery, turning it upside down and shaking it, threatening it verbally, etc.  I even took it apart, blew air through a few of the more suspicious looking components, and putting it back together again.  Nothing worked.

So I spent like 4 hours researching and buying a new computer.  I went to bed defeated, but looking forward to a fancy new laptop that wouldn’t totally suck.

This morning, I wake up to a surprise.  My laptop is on.

It’s working perfectly as we speak.

Apparently the threat of competition succeeded when all rudimentary computer engineering techniques could not.

…  I think the lesson here is supposed to be something like “Be patient” or “Accept that electricity is a mysterious force that’s a little more difficult than the MCAT let on” – but all I got out of it was “All major problems in your life magically disappear if you just ignore them hard enough.”

I’d love to blame messages like this for my continued procrastination on responsible grown-up chores (This tax form mess will sort itself out eventually!  No need to spend 3 hours on the phone, I’m sure!), but I can’t.  I have an incredibly expensive laptop purchase to cancel.

Holy vasovagal syncope, Batman

Hey, everyone!  I’m writing this, at home, in the middle of the morning, because I had to step away from a surgery case.  Again.

(I like saying “step away“.  It makes it sound much more professional than “feel incredibly hot, nauseous, realize the room is threatening to spin, pray the surgeon is almost done suturing, but… nope.  Game over, verbal notice of giving up, head between my knees in a corner.”)

After a few minutes, it was obvious I wasn’t going to re-scrub in, so the surgeon suggested I leave.

Sometimes I think about writing a post called Lies Med School Tells You.  #1 would be “If you feel sick during a surgery, just politely tell the team and step back.  It happens all the time; they won’t bat an eye.”

HAH.  In my experience, they act like you just announced “I’m going to collapse on the patient immediately, maybe pull out a few tubes while I’m at it; hope that’s okay.”

I mean, who can blame them?  You should still calmly tell the team you’re going to step away – but don’t expect them to act like this is anything short of a national emergency.

(To any pre-meds worrying about this: don’t.  I learned months ago that this does not happen if I just drink 2 bottles of gatorade the day before & have a non-sugary breakfast with absolutely no coffee.

Naturally, this meant that yesterday I drank absolutely no water, and this morning had a reasonable breakfast of 4 cups of coffee and a cinnamon roll.  Because I make good choices.)

I don’t know if I should go back in for the next surgery.  The surgical team doesn’t expect me to (and would probably be happier if I didn’t.  Nobody likes having to hover over the notoriously vasovagal med student), I absolutely don’t want to, and even if it makes the surgeon think less of me, he’s not grading me.  And I physically feel like there’s a very good chance I’ll do this again on the next case.

But the fact remains: I’m scheduled to be in the OR today.  So naturally, there’s a really annoying voice in the back of my head that’s saying, “You idiot.  You know what you have to do.  Get back in there.”

… I hate that voice.

“Try a rubber mallet first, and, whatever might happen, keep a cool head.”

I’m buying a filing cabinet!

… Unfortunately, most of the Amazon reviews are… worrisome.

…