Wednesday, February 27, 2008

Today, in clerkship, my preceptor, a peds gastroenterologist, was running behind, so he threw a chart at me and told me to go in there and talk to the patient. The chart was completely empty except for a photocopy of their insurance card.

So I did my first Real Medical Interview today. For about half an hour. Completely unrealistic to have that kind of time, I know, but I got a ridiculously detailed history involving a rather dramatic family dynamic playing into the medical condition. Really, it was almost novelistic.

It was a little frightening, I admit. With less than a year of medical school under my belt, I have no clue what sorts of questions I need to ask. "So, what brings you here?" was my opening gambit. We rehashed the same topics over and over as I racked my brains for the best thing to say. At one point, the mother asked me, point-blank, for a diagnosis.

"Well," I demurred, "I'm just a medical student, so I can't tell you much."

"Oh." The corners of her mouth turned down. I felt terrible for not having an answer.

So I said, "I just learned about how sometimes, there might be a sort of block between the colon and the brain. Like the nerve cells in your intestine don't work properly, so your brain can't sense when to go to the bathroom. That might be something you could ask the doctor about when he comes in."

Very confident, as you can see.

Then I felt even worse, because I had no clue what I was talking about. All I know about GI, after three weeks in the block, are celiac sprue, Hirschsprung's, and cholera. Oh, and situs inversus. Everyone has situs inversus.

Luckily for me, the doc arrived; I fumbled my way through the presentation (first presentation as well!); and when he went in, his explanation also involved damage to the vagus nerve. So I didn't completely mislead the mother.

In short, my faith and interest in medicine are renewed once again. Thank God for clerkship.

Friday, February 22, 2008

Overtired and undermotivated.

I feel like I'm in over my head again and kind of want to shut the world out. Or at least the med school part of it. I just want to flit from one social engagement to another -- tonight I'm going to a play, tomorrow to a dance -- instead of being holed up in my room or the library wondering why, exactly, apical ENaC channels are so important. And because my heart isn't really in it, my studying is very unproductive. I stare at the wall a lot.

It snowed today, you see. Snowfall is always beautiful, but in New York the beauty is fleeting. Already, the streets have turned to brownish slush. I really wanted to make it down to Central Park to take pictures, but, like I said. Studying. Death.

Sometimes, I wonder if I'm missing out on life. I am living in the greatest city in the world, and I feel like I can't enjoy it because I have to study. And I know that these demands on my time will only get bigger as I move through the ranks of medicine.

*deep breath*

I am reading Jerome Groopman's How Doctors Think at bedtime, and it's wonderful. I wish that this, rather than The Spirit Catches You, had been our summer reading. The cultural dynamics of Spirit were fascinating and obviously relevant, but Groopman's book is more immediately applicable, I feel. Also better-written. Like Oliver Sacks, he revives the case study as a narrative form. Although it's billed as "how to avoid misdiagnosis," it's really just about listening to the patient and the patient's body. And zebras.

Monday, February 18, 2008

It's been a good week or so. The formal and afterparty were a lot of fun, just what I needed after exams. And my mother was visiting this weekend, so she and I had a good time exploring New York. We saw Curtains, a murder mystery musical about a theater troupe, set in the later 1950s. Think Kiss Me, Kate meets Radioland Murders.

Last week I went to a talk on the Science of Meditation, partly because there was food and partly because it seemed an interesting topic. The speaker, an alum of my med school, presented a bunch of data on melatonin as a contributer to tissue regeneration, which was intriguing. But then he started talking about the pineal gland being the "third eye" they talk about in Vedic scriptures (uh, did you ever think that might be a ... metaphor?), and yoga as promoting vagal maneuvers. Something about how standing on your head makes your diaphragm go slack? Didn't make a lot of sense to me, either. I'm cool with herbalism as a potential source of drug development, but this business of chakras and reiki and acupuncture is uncomfortably vague. Not to mention Orientalist. It is "Eastern," therefore it brings wisdom to the spiritually-deficient West. I am very, very tired of East-West Othering.

I know yoga and meditation are now trendy, stress-reducing ways for yuppies to achieve nirvana, but because of my background, they are very much a religious activity for me. And therefore intensely personal. And not scientific at all. Take yoga, for instance. It's not supposed to be about flexibility. It means "union," and it is supposed to be a way of moving past materialism and illusion into a spiritual plane in order to commune with God. I'm glad that people have some way of keeping fit and healthy, but it just seems, well, odd to me.

Now playing: Adam Pascal / Rosario Dawson - Light My Candle
via FoxyTunes

Friday, February 8, 2008

No more exams!

Well, for a month, anyway.

It wasn't such a bad block, since we didn't have anatomy. I can't wait for after Spring Break, when anatomy is Over For Good.

And now we have the med school formal tonight, which will be excellent. I love being all girly and getting dressed up for things -- don't get much chance for that these days.

Proof that med school takes over your life:
(3:40:04 PM) Laura: i was just painting my right hand
(3:40:15 PM) Laura: and im very unsteady with my left holding the brush
(3:40:34 PM) Me: uh oh
(3:40:39 PM) Laura: and the first thought to pop into my head is "gee i wonder if being ambidextrous makes you a better surgeon"

Now playing: Cast Of Rent - La Vie Boheme
via FoxyTunes

Wednesday, February 6, 2008

Surgeon's Blog has an excellent post on all that health economics/politics stuff that keeps coming up in connection with the election.

I would contribute actual content, but I'm tired, and sick, and studying for exams (just genetics to go!). My headaches have been getting more regular and more severe, which is really no fun. I consulted the wise and wonderful WebMD yesterday, which told me that I might have a subarachnoid hemorrhage. I love the internet.

Sunday, February 3, 2008

First, my big news: I got the summer internship I applied for at the American Academy of Pediatrics! It's mainly child health advocacy stuff, things like insurance and immunization, and apparently involves going to Congressional hearings. Woot! It's such a relief to have my summer taken care of, so I can start planning a short vacation. (Last summer? *sigh*)

Three exams next week, but no anatomy. So I'm sitting here twiddling my thumbs, wondering what more I can do. I've gone over my notes, taken ten exams from previous years (overkill? but they reuse questions like mad); I've even made flashcards for things that they specifically told us won't be on the exam.

Anatomy is just such a time drain for me -- it's not intuitive at all, and the exams test ridiculous (and often incorrect) detail from a book whose last edition was printed when I was in elementary school. Even after five months, I still find cadaveric dissection emotionally challenging. (Unfortunately, I appear to be a sap. Damn.) So usually, anatomy dominates my study time to the point where I fall behind in everything else. I know that's what's going to happen in March, when we have our last anatomy exam.

Interestingly, the last time we had an exam block that did not include anatomy, I felt the same way -- like I had adequate time to prepare for the other classes. The difficulty of classes, at least at this school, is all over the map. On one hand, you have Anatomy of Doom; on the other, human development, which is the biggest joke in the world. (If you show up to take the exam, you pass. I know someone last block who bubbled in C for every answer. And passed.) Most of our other courses fall somewhere in the middle.

Is this what life after anatomy will be like? Free time?

Now playing: NYMC - Studyback
via FoxyTunes