5 Things No One Warns You About In Medical School

1. Your classmates’ career choices will depress the hell out of you.  Back in 1st year, I was constantly just in awe of my classmates – everyone had amazing talents or former careers. It’s depressing to remember how excited we all used to be about our future careers as Real Physicians (!) seeing Real Patients (!!).

It was hard to look around the lecture hall without seeing at least one person and thinking “That person is the most compassionate human on earth. They are going to be the most incredible doctor.“

Then 3rd year rolled around and after a year of being largely treated like dirt on the wards, those exact same people are – almost without exception – going into radiology, anesthesiology, or leaving medicine altogether for entrepreneurial or non-profit ventures.

And that’s depressing because you KNOW they’re making the right decision. No matter how much you want to fool yourself into selfishly dismissing their decisions as cynical or self-serving, you know the truth: leaving medicine is actually just kind of smart.

These are good people that were beaten down, chewed up, and spat out by the wards and have the self-awareness to leave because they realize there are careers out there that AREN’T fiscally and emotionally abusive.

2. Which leaves you and your career decision… where, exactly?  I mean, if you’re admitting to yourself that those classmates are making a smart decision, isn’t there an obvious link to be made…?  Like, I don’t know, some sort of natural continuation of this train of thought that indicates something about the wisdom of your own career choice?

You are choosing to ignore this. You are ignoring it so hard that simply acknowledging the possibility that you are making a huge mistake doesn’t even seem like an option.

But that’s okay! Because even though NORMALLY the statement “If I ignore the hints that I’m doing the wrong thing, they’ll go away” is stupid – his time it’s totally not! Because of reasons.

… quick, let’s move on.

3. There are a handful of facts you were better off never knowing.

I’m not referring to useless trivia that’s just taking up valuable room in your head without paying rent – that stuff was once worth valuable USMLE points.  I’m talking about tried-and-trued protocols that became out-of-date while you were on a different rotation and useless buzzwords (“spiral fracture” = “child abuse” has some damned important caveats – many of which have nothing to do with blue sclerae).

It feels like a miniature betrayal each and every time you are posed a question, answer “correctly”, and then hear, “Well.. actually – no. Absolutely not at all.”

4. Your career choice will depress the hell out of your classmates. “Pediatrics? Wow, I could never do that. It’s so depressing. Just think about it… sick and dying kids, every day for your entire career. God, that’d be terrible. Don’t you think it’s depressing?”

The counterpoint to point #1: Every few weeks or so, it’s important to find yourself on the awkward “… er, what am I supposed to say to that, exactly?” end of this exact conversation – it reminds you that you’re kind of a jerk for having similar opinions about the career choices of others and should probably continue to keep them to yourself.

5. You and your entire class will drop off the face of the earth. Between audition electives on the opposite coast, research, Sub-Is, and vacation months, you won’t be together again until Match Week. And even then, a bunch will have taken a year off for research or a second degree, so there’s a good chance you’ll just never see them again.

Lately I’ve been listening to how the M1s on campus talk about each other and honestly, sometimes it depresses me – they all seems so close. I remember feeling that way about our class.

But as soon as 3rd year starts, it becomes so easy for people to just slip away. 50% of conversations are about how much your current rotation sucks and the other half are people trying to remind each other who is actually still enrolled, who’s taking a year off, and who just left entirely without a word to anyone.

So, you know, it’s hard for me not to overhear happy conversations about impromptu M1 dorm parties without thinking things like “ENJOY IT WHILE YOU CAN. You’ve got like, 6 months, tops.”

Does that sound too ominous? That probably sounds too ominous.

… must be why no one ever warns us.

Last Day of Primary Care

Yesterday was our “shelf exam study day”, but due to my school’s leasing office not being open on weekends, I had to instead use it to move everything I own down to Metropolis for my Monday morning rotation.

This involved: ~8 hours of driving, 1 rented vehicle, 0 legal parking spaces, 1 missing student ID, 2 irritated security guards, 7 illegal parking jobs, 13 trips to and from a vehicle parked as far as 3 blocks away from actual building, 2 warnings from security, 1 near traffic accident, 1 ruined pair of shoes, and 4 hours of sleep.

Also, tomorrow we have our shelf exam, which while not something I am overly concerned about, is also not.. exactly.. something for which I have spent any time whatsoever studying.

(Oh, and a reflective writing paper on the biopsychosocial model/patient-centered communication? I guess? I mean, I haven’t actually looked at the requirements or anything, it’s totally not due for another two hours.)

(Ladies and gentlemen, we’ve reached a cruising altitude on this rotation. The captain has turned off the “Cool Disinterest” light, so you should now feel free to Mildly Panic about the cabin.)

I suspect my preceptor could tell I was stressed out / delirious / on-the-verge-of-a-nervous-breakdown, as after giving me my end-of-rotation feedback (which was good! Hooray!) he let me go home early.

(Is “let me” the right phrase? Because he did that awesome rare thing preceptors do when they know your “Oh, no, it’s okay – I’m happy to stay!” is just obligatory bullshit you have to say as a med student, so they ignore your half-hearted protestations and basically order you to leave.)

Anyway, I just got home and got this email from him:

[Action Potential],

Unsolicited and probably unnecessary advice:  one beer and a good night’s sleep on the eve of an exam are better preparation than studying.

Nice working with you.

[Preceptor].

PRIMARY CARE FOREVER.

Awkward Moments with Attendings: The EMR Edition

Dr Attending:  Okay!  We’re almost done here!  Just need to print your paperwork.  So we’ll just diagnose this as “neuropathy”… type that in to the “diagnosis” field box here… click “yes”… excellent!

Patient:  Great.

Dr Attending:  And we’ll just order you that Gabapentin, so… type Gabapentin into the box here…

Me:  *after a long pause in which I awkwardly hovered over his shoulder* Oh, see – your mouse cursor is still the diagnosis box.

Dr Attending:  Yes, I know that.  *clicks angrily* Why isn’t it working?

Me: … well, you want the order box.  That’s the diagnosis box.  That’s why the only option that popped up was “Gabapentin-induced toxicity in a newborn or fetus via breast milk or placenta.”

Dr Attending:  It’s not letting me order generic Gabapentin!  Ugh, I guess I’ll just order this one. *clicks “yes” and adds aforementioned diagnosis to list*  God, I hate this EMR.

Me:  … You just added “Gabapentin-induced toxicity in a newborn or fetus via breast milk or placenta” as a diagnosis.

Dr Attending:  *waves me away*  How do I order regular Gabapentin?  I can’t believe this EMR.  See, that’s the problem with computers.

Me:  *moves mouse to “orders” box* … Here, try now.

Dr Attending:  ”g-a-b-a-p-e-” Hey!  That works.  Great.  Thanks.  *clicks “print” decisively*  Printing!  All done!  Nice meeting you, Mr. Patient.

Patient:  Nice meeting you too.

Me: …. but… the patient is now diagnosed with gabapentin-induced toxicity in a newborn or fetus via breast milk or placenta.  It’s on his diagnosis list.  It’s -

Dr Attending:  Next patient!  Let’s go!

As it turns out, not only did Dr. Attending set that as a visit diagnosis, he actually clicked it angrily enough that he somehow made it the PRIMARY visit diagnosis.

Unsurprisingly, the insurance company called to inform him they will not, in fact, be paying for gabapentin to treat “gabapentin-induced toxicity in a newborn or fetus”

Dr. Attending was not pleased.

Good grief.

Last night I couldn’t catch my breath.  My throat felt exactly like how you feel after sprinting outside in super cold weather – raspy and sharp – and I finally realized what COPD’ers really mean when they describe “air hunger”.

It took me a really long time to realize it was 1) happening, and 2) not going away. Finally, it got distracting enough that I couldn’t concentrate on studying, so I switched gears and tried a differential diagnosis.

It wasn’t an allergic reaction, because benadryl didn’t help.  It wasn’t asthma, because I took a stethoscope and listened to my lungs for like 5 minutes without hearing a wheeze and besides, I don’t have asthma.  It wasn’t GERD because I had no weird taste and no chest discomfort and again, I don’t have GERD.  It wasn’t a PE because I’m still alive and kicking.

Eventually I realized by process of elimination what any sane outside observer would have concluded in the first place – that I must be having a panic attack.

It was weird.  I’ve had panic attacks before, and I usually felt… you know, panic.

Why the heck would a panic attack happen without panic?  Is that even possible? What is that, the psychiatric equivalent of a painless MI or foot wound in a diabetic?

… do I have psychiatric neuropathy?

Eventually I fell asleep and had a nightmare that our medicine shelf exam scores came back and I needed a 70 to make honors and I only got a 68 so obviously my entire medical career was ruined.

Guys.

I either need a benzo or a swift slap to the head.
The end of third year is officially driving me insane.

Real talk.

How I Feel When People Gossip About My Rotation Group:

How I Feel When People Gossip About Other Rotation Groups:

When People Gossip About Mean Attendings:

White Coats

I used to think it was a little extreme to set your white coat on fire.

But after 11 months of wearing it every day, I’m beginning to think that not only is burning it a fine idea, but that nuking it from space may in fact be more hygienic.  I totally get what those graduating 4th years were doing with the matches on the roof now.

Seriously, when I washed my white coats today, I tried twice unsuccessfully before realizing I needed to use half a bottle of bleach (bravely ignoring all manufacturer’s directions!) to even begin to scrub out the pen stains, coffee stains, and accidental foundation-on-the-collar incidents.

I was trying to wash my white coats because yesterday I did a psychiatric intake interview while wearing a white cardigan, and the nurse assumed I was just a family member with a clipboard.

… She had a point.

Anyway, I’ve begun to sneak out of the dark blue funk of med school burnout that I’ve been in.  I felt like I almost actually did something good for that psychiatric patient. There’s a light at the end of the tunnel.

… I don’t usually feel like I do something good for psychiatry patients.

Then last night my neurology preceptor took me and another student out for a few rounds of beer.  We talked about med school, residency, and the future in general.

Tonight, if you’re interviewing for a med school program that encourages interviewees to have a beer with current students, you should definitely show up.  I’ll be there.

It’ll be the best.

 

Ophthalmology

Today I spend 4 hours watching ocular injections.

Ocular injections are an interesting beast.  First, you have to get an injection to numb the eye. This numbing injection looks exactly like a PPD – meaning that the needle is delicately positioned right underneath the thinnest of the epithelial layers, causing a huge bubble to erupt out of the sclera.

This is disconcerting.

Then, you get the metal eye contraptions from A Clockwork Orange forcing your eyelids open, and finally, you get a violently deep injection of the intended medication.

I have perfected my “My, isn’t that fascinating!” look – which I attempt whilst looking at a point almost entirely – but not quite – as far away as I can get from looking at the violated eyeball.

That said, it’s still obvious that med school has desensitized me.  Sometimes I think of all the pictures on the internet that scar people for life, and how non-medical people can just… not look at those pictures.

But if you’re in medicine, and the person in that picture comes into the ED, there’s no “I don’t want to see that, ever” option.

You just have to look at the eyeball hanging out of their face, or the maggots waving hello from their bicep, or the bisected tongue, and fix it.

So in that respect, despite my lack of love for intraocular injections, I guess I’m still better than I would’ve been 3 years ago.

… mostly in that, instead of screaming and having nightmares about the mere possibility of these scenarios occurring, I now very maturely acknowledge their presence and bribe another medical student to handle them for me.

Progress!

Figures.

Thanks to everyone who e-mailed me and commented to send me stuff about amyloid and sarcoid.  I read everything you sent me, and it was marvelous.  I felt very smart.

So naturally, now that I actually knew things about these diseases (for example: amyloidosis is more than just “pink”!  It is also frequently different shades of pink!), the shelf exam proceeded to ask me these 2 puzzlers :

1.  An African-American walks in with some lung symptoms – you know this is sarcoid, right? and

2.  Hey, what’s that disease that sounds suspiciously like TB except for the “non-caseating granuloma” thing?

… Okay, those may not be entirely faithful word-for-word translations, but C’MON ASK ME SOMETHING WITH SUBSTANCE.

So it turns out I’ve now gotten through 75% of medical school without needing to know any other facts about this disease.

*jazz hands*  Medical education!

(Now, I know what you’re thinking.  You almost blurted out loud to your computer, “But Action Potential, those actually ARE the major facts about sarcoid”.  You didn’t say this, and I admire your restraint, but you definitely thought it.

All I can say is that if I were a patient with sarcoidosis, and I asked a doctor about it, I would be a little put off if they nodded their head sagely and said “Ah, yes. The disease with the… fibrosis.  But not the pink fibrosis, the other kind.  The kind you get if a question mentions African-Americans and chest x-rays.”)

But I guess my point should be that the shelf exam went okay and I’m pretty happy about it.

Does anyone have a lecture on amyloidosis or sarcoidosis?

If you could find it in your heart to send me a link, or a dropbox address, or really anything at all – that would be amazing, because I don’t know anything about them.  THINK OF THE FUTURE PATIENTS.

(Or, more selfishly, think of my medicine shelf grade.  I’m taking the exam on Monday, and I am in trouble, because

Literally Everything I Know About These 2 Diseases:

1.  Along with Lupus, they make up the holy differential diagnosis trinity of Confusing Multi-system Presentations.

2.  If the question stem says the patient is African-American, they have sarcoidosis and you should order a CXR.

3.  Amyloid is pink.

I realize this doesn’t exactly inspire confidence. That’s fair.)

The thing that bothers me about these 2 diseases is that it’s impossible to find a good summary.  Every textbook (and class) is broken up into sections by specialty, and so Amyloidosis & Sarcoidosis just get fricasseed into a billion pieces because no one wants to take ownership of diseases that cross their specialty lines.

(This is why, I suspect, Metropolis Med never covered them.  No sub-specialist feels qualified to talk about things outside their specialty.  So they’ll tell you about the fibrosis caused in their favorite organ, and if you ask about the extra-systemic manifestations, they’ll just wave their hands and say “more fibrosis” – which is probably the correct answer – but still.)

Anyway, seriously, the shelf is the day after tomorrow and I’ve got nothing.  If you could send me a link to your med school’s lecture on either of these diseases, you will be my new best friend.  You will make my weekend amazing.  You will cause me to fist-pump the air and say “yesss!” loudly.

action.potential.blog@gmail.com

… to everyone else, sorry this was a lame entry.  Here’s a baby being a flamingo.

If you had a magic wand, what single disease would choose to never, ever get?

You can choose something statistically unlikely but horrific – like hepatocellular carcinoma, or ebola, or Creutzfeld-Jacob’s disease – or you could choose something common with awful consequences, like diabetes or a CVA.

Whatever you choose, you are 100% guaranteed to never get it.  Everything else, your odds stay exactly the same as they were before.

Sometimes I think I’d choose diabetes, but today I think I’d choose gastric cancer.  Even though there’s next to no chance I’d get it – the symptoms are non-specific, I eat all the terrible foods you’re supposed to avoid, and the 5-year survival rate sucks.

It would just be nice to get it off the table, possibility-wise.

How about you?