Thursday, April 23, 2009


So, we've been scheduling our classes for third year, and yours truly got his schedule for next year. For the 48 weeks following July 6, here is what I will be doing:

8 weeks of Pediatrics
8 weeks of Neuro/Psych
8 weeks of Surgery
Christmas break
12 Weeks of internal medicine
6 Weeks of Anesthesia -assuming I get the elective, and forcing me to postpone Family Med
6 weeks of Ob/Gyn

2 weeks of freedom, then 4th year which will include Family Medicine which I postponed from third year. I was pretty fortunate in that I got my first choice in scheduling, though I still need to get my elective.

Wednesday, April 15, 2009


So I think monkeys are pretty funny. I bet even, that you don't find monkeys as funny as I do. In 2001 before I served my mission, I watched the "Grinch who stole Christmas" with Jim Carrey. There's a scene wherein a frustrated grinch is getting his head smashed by a mechanical monkey banging cymbals together. If there's a funnier motif than a mechanical monkey with cymbals, I defy you to find it. The theatrical denizens tittered politely for an apropriate amount of time. Yours truly, however, was laughing loud and long, well after the scene had changed. I would have thought that 8 years had tempered my love of the primate percussionist, but that is not the case. We were learning about adrenal disorders in class, and the teacher drew the comparison between an adrenal gland spontaneously secreting cortisol to an elephant running wild and trampling the bleachers (which ones? I don't know, he didn't say). That got me smiling. Then he compared a small cell lung cancer secreting ACTH which causes unregulated cortisol release to a runaway elephant with a monkey on it, whipping it. The class chuckled gently, and, remembering my experience in the theater 8 years ago, I fought hard to not laugh out loud. But I was grinning to myself with my head bowed so the teacher wouldn't see me as he changed topics. I'm still grinning as I write this. I guess this is why my sister has managed to find a different monkey card for my birthday for at least a decade.

Tuesday, April 14, 2009

The palpable border

For the last 4 weeks we have been going once a week to work with a preceptor. We are to work in two pairs in conjunction with the preceptor in order to improve our history taking and exam skills. The last weeks have seen me in a nursing home near school. The clinical encounters we have rehearsed at school with standardized patients and in the lecture hall were not sufficient preparation to seeing real people. Our standardized patients are all very stereotyped and presenting in a pseudo-outpatient setting with some well defined chief complaint. The nursing home however, provides quite a different experience. The patient only grudgingly will consent to talk with you, as there is a bingo game impending, and they don't have any 'chief complaint' as such. "I'm doing ok" is not really a chief complaint. I also realized in this setting that, in the absence of a stilted semi-scripted interview, I suck at taking a history. I also suck at performing a physical exam.

To learn PE we were first instructed by one of our professors who demonstrated on a standardized patient. In small groups on various days, we then all took turns learning the PE from the standardized patient. While admittedly this saves on manpower because you don't have to get 8 different MD's to come in to teach small groups, this strategy also leaves somthing to be desired. I would prefer to have been taught by someone who has actually done a physical, rather than by an actor who knows approximately what a particular exam should include. There were sometimes 4th years around to help, but they were usually not helpful, nor particularly trustworthy. Usually I felt like I was being instructed by someone only marginally more familiar with this than me.

Last week and this week, my group and I asked our preceptor to help us improve our techniques in the various exams. Last week we did heart, lungs, and abdomen on real patients and this week it was the neuro exam. It's nice to examine someone who has real findings as well, because you're not just going through the motions.

Today we were examining a patient with stage 4 colon cancer. They were cachexic, but their abdomen was protruding outward, despite the patient's emaciated appearance. After talking briefly about their abdominal surgical scars, I palpated, percussed, and auscultated the abdomen. It was definitely unlike any standardized patient. This individual's liver margin was palpable nearly at the level of the iliac crest. Normally the liver is found approximately at the lower edge of the ribcage. There were firm nodules scattered diffusely over it as well. Our patient had metastases that had infiltrated the liver and caused the massive hepatomegaly that we observed.

It was a long, but very informative afternoon. I realize that it must sound callous that this poor individual's plight was educational for me in a very dry, clinical way.


Wednesday, April 08, 2009

Another unit down

Well, since I seem to post about once a month these days, I thought I'd update the world on my doings. I passed Skin, Bone, and Joint, our connective tissue module. As the name implies it is quite a wide assortment of subject material. This made finding a studying groove pretty much impossible since every week a totally new set of lecturers would speak to us. I have now safely ruled out dermatology as a specialty, (not that I think i'll have the board scores for it anyway), hematology/oncology, which is also something I think I would detest, rheumatology -hmm, chronic disease- my favorite!, and geriatrics. My school has the #3 geriatrics program in the country, but I don't find the material very engaging. I'm currently in the endocrine module which is refreshingly homogenous. My current quandary is how best to balance studying for USMLE step I and my coursework. If i study for classes, I have less time to review for the boards, but my courses are on the boards anyway, so it's still kind of a review. If, on the other hand, I devote some more time to reviewing material from last year like biochem and immunology, then I will sacrifice my performance in my current class. At least I will have 5 weeks to review in may/june which will be very helpful.

Wednesday, April 01, 2009

Poisson d'Avril

Spiff loves a good prank, so April Fool's Day is right up his alley. I, on the other hand, am not a prankster. Spiff usually doesn't act on his tricksy tendencies to me, it doesn't occur to me to be wary on a day like today.

This morning, I walked in on Spiff cutting out this little gem:
If you're anything like me, you would ask him, "What are you doing?" He would answer, "Just a project for school." And you'd sort of believe him, and promptly forget about it.

Then, when the mother of your only piano student pulls this off your back at 4:45 in the afternoon... realize that your dear, sweet husband got you! He really got you! I didn't suspect a thing, and I had been wearing a fish on my back all day long! Also, my 14-yr-old piano student had to explain to me the French tradition of sticking a paper fish on someone's back on April Fool's Day, since she learned about it at school today, and I had no idea about the significance of the paper fish I had been donning.

So, congratulations to Spiff on a great little prank. Here is what he got for dinner (keep in mind that every time I ask him what he would like for dinner, he very helpfully answers, "Beans").: