You could cut the irony with a knife

I’ve been off my Lexapro for a month and it turns out that’s bad.

Sometimes my patients have crippling anxiety.

When they do, I’ll take a few minutes to rule out other causes, report it to my preceptor, and they’ll breezily tell me “Fine – write a prescription for Zoloft, Lexapro, or Prozac – whatever you feel comfortable with. Do you know the dosing?”

Lady, you have no idea. By the way, I would also like a refill for myself.

… but for the life of me, I can’t find someone to take 10 seconds to write one for me.

I don’t feel it’s alarmist to say this is a problem.

I’ve been pretty open about my anxiety / depression. It’s been a non-issue for the last 4 years because my med school had outside psychiatrists.

But I’m not in med school anymore, and there are only a certain number of times you can refill a prescription from out-of-state without a visit – and I’ve gone way beyond that.

So now what?

I could set up an appointment at my current hospital, but I have to do a psychiatry rotation with these same attendings, so that seems… short-sighted.

I could call around at one of the competitor hospitals, but they’re all far enough away that I’d have to ask off work for “medical reasons”, which is a bit of a death knell. And why would they even accept our health insurance?

They probably don’t.

(Or maybe that’s just me making lame excuses? I honestly don’t know. My anxiety has ramped up to the point where the thought of just finding a phone number and calling someone is so mentally and emotionally exhausting that it’s impossible to tell.)

The thing that kills me (and the reason I’m writing this blog post at all) is that I know I’m not the only resident with this problem. I can’t be. Depression and anxiety are way too common – and the 80-hour work week and infeasibility of accessing your own hospital’s psychiatrists have to make this a global problem.

In the mean-time, there I am: taking a total of 10 seconds to jot down a prescription, then sitting in the corner anxiously twirling my pen and grinding my teeth.

Medicine sure can be stupid.

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A Conversation With The New M1s (My People Skills Are Rusty)

M1s: Oh, child neurology? Cool! I heard in child neurology you just play with kids. True?

Me: Sort of, yeah! I mean, young kids don’t exactly follow commands, so to some extent you’re just watching them play and trying to elicit reactions from them with pen lights and toys.

M1s: Cool. But… child neuro is really sad, right? I mean, so many deaths.

Me: Sure. But their deaths are nowhere near as sad as those of the adults. Like, Internal Medicine. So sad.

M1s: … wait, how is Internal Medicine sad?

bambi

Me: Well… every day, you deal with people who have wasted their whole life without doing anything they set out to do. And now it’s too late. And that dawning realization, seeing them realize they’re at the end of their life and it was all futile – it’ll haunt you.

And when you’re not with them, you’re with patients who you know will die the same way, with the same regrets – except, they won’t follow your warnings, so there’s nothing you can do to stop them. You’re powerless against their naive optimism that they won’t die of a stroke, they won’t die of a heart attack, they won’t leave their family alone.

But they will.

As will you.

See – every day you are confronted with existential terror that overwhelms you until you can no longer comfortably ignore its hopelessness. It’s no longer in the periphery of your vision – it’s the focal spot. So, despite the occasional pinprick of brightnesss and good outcomes, the overbearing futility of living becomes like a dark black cancer on your soul that grows and grows until you no longer feel anything – just numbness.

Even the patients who thought they had meaningful lives – you will watch their memory fade as they become present less and less until there is nothing. And you will realize the futility of life: a truth you will never again escape.

M1s: …..

bad3

Me: Welp! Good luck on the first anatomy test! I recommend the practice questions – they’re great! See you later byyeeee.

bein cute

M1s: …..

we're taking a moment and we're done

USMLE Week 4: A Light Update


day4
day3

nbme

… 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.

hitting door frustration

(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.

you have failed me brain

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

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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?”

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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.

there was an attempt

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.

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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 Day 1: Biochem Makes Me Feel Like Michelangelo

If you hired me solely to draw biochem pathways all day, I would buy the fanciest set of Staedtler pens and use only the heaviest of heavy-weight paper and I would buy a beret and no one could stop me from wearing it indoors, no one.

… luckily, when planning my Step 1 schedule, I grudgingly acknowledged this and gave myself an entire 48 hours to live out the dream, guilt-free, under the clever guise of “making flashcards”.

Urea Cycle(No, but seriously, I did really make flashcards – I just drew each pathway and saved it with different words blanked out.  I swear to god the effort was semi-productive.)

TCA Cycle alpha ketogultarate dehydrogenase

Actually, artists working on their Art and med students working on Step 1 are pretty damned similar.

Both artists and USMLE-studiers get to feel like nobody understands you, nobody really gets the true magnitude of what you’re attempting, or how it requires you to work through the night and not pay attention to trivial, mundane details like “dishes” and “laundry” and “social interaction”, god, can’t you see this is important?  

glycogenolysis and synthesis FULL

Also, both artists and USMLE-studiers get to drop a lot of humble-brags while being generally insufferable to everyone else around them and going through a lot of expensive paper and inner turmoil about how to color-code co-factors.

… I imagine.

… Hypothetically.

… I don’t actually know whether artists have inner turmoil about co-factors, I guess that one’s a bit of a miss.

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.

Why are Heberden and Bouchard’s nodes named after 2 different people?

(In osteoarthritis, enlarged DIP joints (knuckles closest to the end of your fingers) are called “Heberden’s nodes” and enlarged PIP joints (knuckles you use to knock on doors) are called “Bouchard’s nodes”.  And yes, I really am going to complain about it.)

Medicine is moving away from most eponyms, since they’re generally undeserved and were also inevitably given to some sketchy doctors who didn’t deserve to be immortalized (case in point: Wegener’s granulomatosis.  He was, it turns out, a nazi.

So that led to a 50-year-long awkward moment in medicine.  A moment which has only been extended by trying to rename the disease “granulomatosis with polyangiitis”).

To be fair, some people will try to tell you that, actually, medicine is moving away from eponyms because they’re “so difficult to memorize” – a viewpoint that’s, at best, pretty damned optimistic.  (Fun game:  Go find a physician, resident, or M4 and ask if they think organic chemistry was helpful.  Then, after they finish laughing, ask them if they’d be in favor of dropping it as a pre-med requirement.

… Yeah.  Spoiler alert: they’re not for it.  Neither am I. “Medical education” is practically synonymous with “Sure, some of it’s inefficient, but if my generation had to do it anyway, so do you.”   People who say that “medicine eats its young” aren’t kidding.)

Heberden’s and Bouchard’s nodes seem even sillier than most other eponyms.  Getting credit for seeing some weird manifestation of a disease, I understand.  Getting credit for some weird “you can only see this part of the anatomy if you cut a person open and squint at them sideways” piece of organ anatomy, I understand.

But getting credit for the fancy notion that sometimes when your knuckles are inflamed, they’re enlarged?  That’s ridiculous.  You may as well call a sore throat “Heberden’s throat”.  In either case, regardless of how fancy the pathogenesis is, I’m pretty sure people already knew the symptom was directly related to the disease.

So I looked it up.  Heberden was a fancy London physician from a good family, who wrote a chapter on arthritis in the medical book that was most in vogue at the time.  So they gave him the DIP-joint-is-inflamed eponym.  Okay, fine.

But nearly one hundred years later, the PIP -joint-is-inflamed symptom was – it appears – randomly assigned “Bouchard” as an eponym.  Bouchard was a French pathologist who studied under Charcot and doubtless did a lot of interesting things, but none of them seem to be related to arthritis.  I guess medicine felt like he was such a stand-up guy he deserved an orphan eponym?

If that’s a legitimate action to take when confronted with an awesome pathologist and an unnamed disease, Wegener’s Granulomatosis should just be renamed Goljan’s Granulomatosis.  TWO BIRDS. ONE STONE.

Goljan is a champion arm-wrestler. Hand over the eponym and no one gets hurt.

Bouchard’s nodes are less common than Heberden’s nodes, so maybe we should give Heberden a pass on not noticing that the swelling sometimes happened on the PIP joints. But I’m honestly not convinced that Heberden didn’t notice the “Bouchard’s nodes”.

You know what I think?  I think he was just like, “meh, it’s exactly the same thing in a location just centimeters away, no need to write about these nodes like they’re any different.  It’s not like they’re going to give it someone else’s name.”

Well, the joke’s on you, Heberden.

Joke’s on you.

Shoes.

When I was a kid, Mom took me to Payless once a year to buy shoes.  Specifically, to have me pick out a pair of sneakers and sandals.  The idea was that I could then buy nicer shoes – church shoes – with my allowance money.

Unfortunately for her, she severely miscalculated just how little I cared about the niceness of my shoes or their appropriateness for church.  So towards the end of every year she’d have to argue me down on a variety of issues I found extremely debateable, such as “Why can’t I just wear my sandals to the Christmas Eve service?” and “But if I jump from the car to the sidewalk, I might not get any snow in them!” and “BUT I DON’T WANT TO GO SHOPPING.

In fact, up until last week, I’m pretty sure I didn’t own any shoes that weren’t either a) from Payless, or b) a gift.  (Usually from my mother. With a vaguely threatening note attached.)

But after my last pair of flats gutted themselves tragically on a sewer grate (whyyy?), I realized that I should probably just accept that I need to actually go invest my money in A Pair of Forever Shoes, made out of real leather or something.  A Pair of Forever Shoes would’ve survived that sewer grate, damnit.

So I did.

And they cost two hundred dollars.

Oh god, I nearly passed out when I clicked “submit” on their website.  I feel incredibly guilty spending more than $50 on any one thing (thanks a lot, mom!)  (<– that may or may not be sarcastic!  I have not decided!)

Anyway, they came, and they are truly awesome.

Things to Do In $200 Shoes:

1.  Wear them to a day at the clinic – because they’re ridiculously comfortable and professional.  Sensible!

2.  Lie on your bed watching half a season of Arrested Development and eating nachos, and think to yourself, “I am watching Arrested Development and eating nachos while wearing $200 shoes.” and marvel at the direction your life has taken.

… Guess which one I’ve been using them for?

WORTH EVERY PENNY.

(Technically, if you want to follow in my very expensive footsteps, today you can get a 20% off coupon for liking their company on facebook.  I feel like a shill telling you guys that, but like – what if one of you decided to buy a pair?  And I didn’t tell you about the 20% off thing, so you spent an extra $40?  That would definitely be worse.)