How Waitressing Prepares You For The ED

The ED is pretty awesome at times: I get to suture, splint, order tests, and see patients actually being worked up for diagnoses instead of just arriving in the hospital diagnosis already in hand.

But mostly, it just reminds me of the year I spent as a waitress at a 24-hour diner in The Middle of Nowhere, America.

Luckily, most of the experiences and skills have transferred to the ED.  For example:

1. Dealing with drunk people making poor decisions.  Though I’ll admit, the drunks at the diners were mostly making the kind of poor decisions that could be worked off with a few hours at the gym.

The ED drunks’ poor decisions are a bit more..excessive.

2.  Everyone is always pissed.  The servers are pissed, the customers who’ve been waiting forever are pissed – and even the customers who actually got the right meal at the right time are pissed because of some trivial crap like how the vegetables on their plate are touching their mashed potatoes, or how they can’t have their cell phone with them in the MRI.

(Granted, if the nurses or cooks are pissed, it’s because I did something either incredibly unhelpful or stupid, so they have a right.  But it still sucks.)

3.  You’re running around trying to remember 15 things at once.  Which is actually really satisfying and an awesome way to make the time pass quickly – but it does tend to mean that – statistically speaking – something’s bound to slip your mind every other shift or so.

… I much preferred the worst-case scenario being “Forgetting to refill the diet pepsi at Table 15″ to “Forgetting to check the results of the head CT in room 4.”

4.  People are crazy.  And by “crazy”, I don’t mean merely psychotic.  The psychotic people are GREAT.  The real crazies the people who just have this warped view of the world where they’re convinced their bloody knuckles deserve to be seen before the guy with crushing chest pain, or that they should be able to substitute the side of coleslaw for “a side of ‘steak’” without paying any extra.

I’ll take the mentally ill over the crazies, every time.

5.  The cynicism always wins.  I don’t know if the atmosphere actually changes you, or if it just weeds you out if you don’t meet specifications – but there are plenty of optimistic and happy new nurses, medical students, and diner waitresses out there.

But there is nobody on earth more crotchety or intimidating than a career-long ED physician, nurse, or waitress.

Nobody.

Med Student Law of Averages

Our OB/GYN shelf scores came back!  I saw my raw score and felt surprisingly relieved.  … But then I translated it into a percentile.

All I can say is “I did better than the national and local average?  I’M A CHAMPION.” feels a hell of a lot better than “... wait, but… gah.  How is that still “55th percentile.”?*

And sure, I get that 55th percentile is completely different from 55% – and I truly am happy with my score – but either way, I think it’s funny that I’m still falling victim to a personal Lake Woebegone effect.  It just won’t die.  There’ll this shockingly irrational part of me that can’t seem to reconcile “trying my absolute hardest” with “less than 90th percentile”.

You’d think my carefully curated collection of perfectly average M1 test scores would have knocked all of the 90th-percentile-ambition out of me by now, but no.  False.  

Welcome to med school: where superiority complexes go to die.

… and are then summarily resurrected after every test, living forever as intense zombified versions of their former selves.

BRAAIINS.

“And THAT, kids, is why you never slouch to suture.”

The other night, during an emergency C-section, I was first assist on the case.  (To answer the question “why?” I point you towards the “emergency” part.

And to answer the question “that’s no excuse – WHY?”  - well, believe me, I told the surgeon to call the on-call PA.  I can’t assist worth crap – I can barely retract without somehow managing to obstruct the field.  But when I told the obstetrician this, his face assumed the “CHALLENGE: ACCEPTED” expression that generally indicates we’re all screwed.)

This doctor is, by the way, a legend here - the kind of guy who overhears you confessing that you are totally inept at suturing despite all of your best efforts, and proceeds to hand you the needle-driver and make you suture every single abdominal layer closed – just patiently watching and helping even though you’re making the case last twice as long, so the anesthesiologist, patient, and nurses all want to kill you.

… err, hypothetically.

So there I am, trying to suture a horizontal mattress layer without looking like too much of a drugged-up monkey, and I keep leaning over the field to see what I’m doing.

“Straighten up.  There is no hunching in surgery.”

Every time he said this, I would immediately straighten up.  But I was concentrating so hard on the stitches that I would inevitably find myself hunched over again.

Finally, he asked for a pair of suture scissors, and held them out, pointy-end right below my face.

“This is not meant to obstruct your field; merely to discourage that posture.”

Aaaaand so I finished suturing while staring down a pair of pointy scissors.

To me, the moral of this story is “3rd year is awesome”.  But I must not be telling said story right – because when other people have heard it, they think “3rd year is scary as hell.”  And maybe it’s the Lexapro talking – but I’m pretty sure I’m right.

When someone is pointing scissors at your face, you can either choose to take offense (“This would never happen in an office job!“), or you can see the humor in the guy’s reckless crazy.  And I’m a complainer by nature – I love nothing more than a really good angry rant – but c’mon.

One choice involves wishing for a world where everyone does things exactly by the book, with no surprise whatsoever.  The other makes for better stories.

Thoughts I have while standing in line at Starbucks

At traditional med schools (where the order is Pre-clinicals –> Step 1 –> clinical rotations + shelf exams) the saying goes “Study two months for Step 1, two weeks for Step 2, and for Step 3, bring a #2 pencil.”

At non-traditional med schools like mine (where the order is Pre-clinicals –> clinical rotations + shelf exams –> Step 1), the saying goes “THERE IS NO SAYING. ONLY CHAOS.“

One of my classmates cleverly wrangled the entire class a group discount with a popular QBank in preparation for going into clinical year.  And almost all of us – including me – are using it for a Step 2 QBank instead of a Step 1.  It just makes more sense.

After all,  as cute as it would be to imagine that I’d have the drive to memorize HLA subtypes for rare diseases (Step 1 stuff) before a rotation, hahahaha.  But I could see myself reviewing basic diagnostic tests and treatments, so, thus the Step 2 review.  (And hell, more importantly – we’ll be taking our shelves before Step 1 – so it seems necessary to have practice questions for those.)

In short, by the end of my clinical year, we should be ready to take Step 2.

But – no, we’ll be scheduled to take Step 1 instead.  So we’ll have to totally switch study gears and relearn the molecular pathogenesis stuff – which sounds like it would be a huge pain, but would it really?

I”d guess that it would actually be EASIER to look at the big picture first (Step 2) and then add in all the details (Step 1) than vice-versa.  And though I have no idea, at least no one else does either.  As far as I’m aware, this is new territory for everyone who’s not in a traditional curriculum.

If this sounds too confusing (after studying for Step 2, we take Step 1, then re-study for Step 2!) that’s… sort of the point.

To make it even more confusing, I’m currently studying the hell out of Step 3 books because our History & Physical Diagnosis class has a final on Monday, and the “haha, so simple you only need a #2 pencil” nature of Step 3 means it actually… is kind of a good review.

In fact, Step 3 books look like an amazing review for rotations – they’re much more basic than Step 2 books are. “Common orthopedic fractures”.  ”Current HTN guidelines.”  ”Quick review of renal diseases” – it’s perfect.

So now I’ve decided that the most efficient way to review for my rotations over winter break will be by looking at Step 3 material.  (I know it sounds gunner-ish, but let’s keep in mind that every other med student actually studies for and takes Step 1 before rotations.  Whereas I don’t remember what the lungs are, so, you know.  Perspective.)

In short, I’m currently studying Step 3 books.  Then I will spend a year studying Step 2.  Then I will spend 2 months studying Step 1.

Then I will use my experience and inevitable wealth of “What not to do” stories to write a book called “Stepping Backwards:  How to Study for the USMLE at a 1.5 Pre-clinical Year School” and all the students at all of those medical schools will buy it, because hell, I totally would’ve bought it. 

And I will either A) make back all the money I spent on buying all these USMLE review books, or B) have an interesting failed side-project to talk about at fellowship interviews.  Win/win.

(… and then I bought my latte.)

Phlebotomized

Good lord, I actually stuck my partner’s vein on the first try.  Nearly fainted from shock.

(Honestly, I’m uncomfortable with the amount of success I had last week.  It feels like the first 20 minutes of a horror movie: sure, there’s a chance nothing bad has happened because you got the genre wrong, and it’s actually a feel-good film about the Robinson family’s camping trip.  But more likely – the longer the happy part lasts, the more gruesome it will be when half the family is pulverized by sentient lawnmowers.)

Speaking of gruesome (transition clauses!  Oh, if my 7th grade English teacher could see me now!) , we’re in the midst of a barrage of Transition to 3rd Year events, where we get called into the auditorium every other day to be told pearls like what to do if you’re sick (go to work anyway), how to look up clinical information (apparently there’s a magic thing called “using The Google”), and what to do if you’re being harassed or bullied by a surgeon.

(I don’t remember the answer to that last one.  Except that it was lame.  I Am Not House‘s suggestions were better.)

My Reaction When Last Year’s M2 Class Was Going Through This:

  

 

My Reaction Now That I Am Going Through This:

  

Three weeks!  Stay tuned.

Thanks, dear.

Me:  Hey, quick question: what format do you use for the write-up of a neuro exam?

Boyfriend:  … Format?

Me:  See, I’m working on my write-up.  And in the “motor” category I usually list strengths for both flexion and extension of the major joints, then the same thing for DTRs.  But it takes up a TON of space.  Maybe I shouldn’t write them in list format?  Is that how you usually do it?

Boyfriend:  .. No.

Me: Oh, okay!  How do you write it up, then?

Boyfriend:  *scribbles*  Here.

Me: Thanks, let’s see wha- …. “Cranial Nerves II-XII:  Grossly intact“?

Boyfriend:

Me:  

… I should probably just be thankful for his help with pathology.

How to Have A Class Meeting About 3rd Year

Welcome!  Good morning!  Take your seats!

I’m so glad you could all be here for this mandatory meeting.  Now, you may have heard some rumors about 3rd year – rumors that it’s filled with soul-crushing paperwork, vague directions, and a surgeon who has driven at least 2 students to suicide.  We hope to set the record straight that those rumors are all absolutely true.

… Just kidding!  Haha, jeez, lighten up everyone.  No, those bodies were in too many pieces to be legally identified.

Let’s get right to it:  How to schedule your rotations.  It’s a simple process, really:

While we don’t have time to go through it in detail, if you’d like a closer look, this chart is on our website.

Oh, the young woman in the back – a question?  Yes?

… Where on the website?  It’s not, uh… well, I’m not quite.. Hmm.

Okay, look, it’s not there right this instant, per se.  The IT guys are redesigning the site because “it’s impossible to navigate”, and I guess we’ll get it back online when they’re done?  It should be soon, though – maybe a few weeks.  One year, tops.

Still,  I want to let you know that my entire office is here for you during the transition period. I know it’s difficult to schedule your life and med school at the same time.

So if you’re planning on having an important family event – such as a graduation, marriage, or tragic death – just give me a call!  I can easily sit down with you and discuss how best to schedule this event so that it coincides with your vacation week.

But most importantly, remember:

Meeting dismissed.

How to Get Financial Aid for Med School

There are 8 easy steps to getting financial aid for med school.  

And because those 8 easy steps are forbidden by the laws of most nations and at least two major religions, I am instead offering you these 8 really sucky ones.  Because that’s the kind of reliable blogger I am.

1.  Print out all necessary forms and tax info, grab pen, sit down purposefully at desk.

Yes, your college financial aid was always filled out by your parents – but now that you’re in med school, you are going to fill out these forms yourself.  Because you are an adult. An adult who knows exactly what your – let’s see here – “parent’s J509b form categorization” is.

2.  …Call Parent

You:  Hey, can you, um… tell me what your J509b form categorization is?  Also the original and adjusted-current worth of your car, house, all savings accounts, major electronics, and SSN?

After several incredulous phone conversations (“I thought graduate schools weren’t allowed to require our info for financial aid.”  ”Right. They don’t require it as long as you don’t need the financial aid.”) they will end up filling out almost all the forms themselves.

3.  And now you can fill out the rest of the forms

Like an adult!  An adult who knows things like your “total income from part-time employment”!  And the total amount of Stafford loans you’ve taken out over the… past 4 years…

… Hmm. Okay, but you can still be an adult who knows things like “where you put the tax info from your last job” and “what your FAFSA account and PIN number are”.

4.  Repeat Step 2 with “former employer” and “US Department of Education”

DAMNIT.

5.  Submit all seventy pages of it.  Be proud of yourself.

You did it!  Like.. okay, not like an adult at all.  That’s okay.  Whatever.  It’s over.

6.  Receive financial aid award letter

YES!  … Wait a minute.  That.. can’t be right.

7.  Inform parents what your school thinks their “Expected Family Contribution” should be

Mom:  Ahaahahahaha, this is hilarious.
You:  It’s not a joke. After considering your assets and salaries, my school thinks you’ve put aside this much money for m-
Mom:  HAHAHA, wait until I tell your dad.
Dad:  Tell me what, dear?
Mom:  Look!  The med school – hahaha – thinks we can -hahaha – pay -haha, oh I can’t breathe..
Dad:  HAHAHAHAHAHA-.
You: Please stop laughing.
Dad:  Ahaha, I’ll stop laughing as soon as it stops being funny.  Hey, check out this line – they think you have an “expected individual contribution”!
Mom:  Oh, that’s adorable.  Look at all those zeros!
You:  *abject horror*

8.  Inform school that you would like to take out additional federal loans. Repeat steps 1-7.

College Courses That Will Prepare You For Med School

ETOH766 – Advanced Techniques in Binge Drinking:  Students undertaking this tutorial section should be prepared to decrease their binge drinking from “every weekend” to “after every major med school test”. Please note that this is a graduate-level course, and thus the intensity of drinking will be greater than at the undergraduate level. Appropriate dress required.

BUS115 – Introduction to E-mail:  ”Reply-all” and how it is rarely your friend.  Required for all students.

BUS427- Advanced E-mail Etiquette:  A discussion examining the ethics of BCC’ing, the politics of quick replies, and the point at which a lengthy email signature goes from “informative” to “douchetastic”. Final grading will be determined by attendance and one 40 page essay on the merits of various e-mail sign-offs.

FASH109 – Survey of Professional Dress:  This is the “pre-health” version of the upper-level “Principles of Professional Dress”. Topics covered will only include basic color coordination and evaluating the “attractive” vs “professional” balance of various ruffled blouses. (Due to limited time, the topic of “how to come up with the $300 to build a post-college wardrobe” will no longer be covered.) It is suggested that FASH207 – Introduction to Ironing be taken concurrently.

CHEM527 – Chemistry of Caffeine (Lab):  During the first quarter of the course, students will be expected to investigate kinetics of caffeine metabolism via oral administration. In the second quarter students will continue on to the study of calibrating levels of caffeine dependence to personal metabolism and study schedule.

LANG407 – Latin I & II:  This course sequence will prepare students for scientific terminology that wilhahahaha just kidding. Listen, I’m no expert – I just write the course catalog – but spending $2000 and untold hours of your life on a dead language, just to maybe recognize some prefixes of medical words later is like using a jackhammer to pop a zit.  I mean, hey, if your goal is to legitimately read Aegil – well, more power to you – but otherwise you’ll be better off spending 30 minutes with a pamphlet on medical terminology. True facts. (Prerequisite: LANG405 or permission of instructor.)

How to study for med school

Congratulations!  It’s your first day of med school!  Your most immediate tasks are to get your ID badge and to avoid having a panic attack.

You are nervously watching a bored second-year student sift through the box of IDs.  He is looking for your name.  Now, it may seem like he’s taking a long time to find it, that he’s close to frowning and saying “Uh, I don’t see your name here.. so..”:  But relax: he will not say this.  (If he does he is either a]. looking in the wrong box, or b]. not nearly as funny as he thinks.)

Do you have your ID badge now?  Fantastic.  This should remove all doubt in your mind that you are not supposed to be here.  (It won’t.  But it should.)  You’re now ready to learn how to study for med school.

1.  Gather school supplies.  You will spare no expense, because if med school isn’t important enough to justify the $20 highlighter pack, what the hell is?

For example, I... may have bought said pack multiple time.

2.  Listen to advice of sage second-year students:

“Keep your priorities straight,” one will tell you.  ”Remember, you’re here to learn to be a good doctor.  So don’t waste your time on the dumb stuff.”

“What’s the dumb stuff?” you’ll ask.

“Oh, biochem, molecular bio, embryology, genetics – stuff like that.”

“… That’s the entire 1st semester.”

“Oh, is it?  I forgot.”

“Dude, just chill and enjoy the ride,” another will reassure you.  ”The most important thing is to get a schedule.  Like me: I always start my day with a couple hours in the gym, coffee, racquetball, a run, a shower, research at the lab, and 4 hours of Halo.  Then I study til’ 3am and wake up two hours later.  No prob.”

3.  Disregard advice of sage second-year students.

Hmph.

4.  Try random study techniques in rapid succession

You will experiment with the highly technical “write things until you get tired of writing things” method, the Cornell Method, OneNote, and flashcards.  You will write these flashcards in impeccable hand-writing, with your new med school pens, and then set them aside.  You will find them 5 months later, shoved in a desk drawer.

Hey.  Cheer up.  You tried.

While you're at it, weigh the pros and cons of different study locations! ... Some pros will mean more than others.

5.  Your First Test Day

Wow, that really crept up out of nowhere, didn’t it?  You will ignore the advice of your professors, the Student Health people, and the second years – all of whom are constantly assuring your class that failing the first test is no big deal.

You know the truth:  If you fail, you will be all alone in the world, fail the retake too, and then be fed to lions.  (Or even worse: summoned to the Dean’s office, where you will be subjected to a disappointed gaze.)

As you open the test and realize you don’t know the first question, you reflect on your options.  You decide that, if offered the choice, you’ll take the lions.

At the post-test party, a 2nd year will congratulate you on finding your med school groove.  ”Now you know how to study!” they will say, clapping you on the back.

“But I don’t know how to study,” you’ll protest.  ”I just did a bunch of random things and then freaked out at the end.”

“… Well, yeah,” the 2nd year will say.  ”Like I said.  Now grab a beer.”

And now you know.