Oh Yeah

Forgot on the last post...I SAW THE FUCKING SIMPSON'S MOVIE YESTERDAY!!!!

If you're a fan of the show it's worth the money. Some very funny parts, some lame, but all in all a great way to decompress. Homer is my hero.

Take That

Step 2 CK. Wow, that hurt. 6 hours, 8 blocks of 46 questions, and a desire to urinate several times throughout. What the hell happened to my bladder's normally huge capacity?

Anyway, I took 2 breaks - one for a whopping 3 minutes for the aforementioned issue, and one to eat and again take care of the issue - that took 10 minutes - and was able to complete a 9 hour exam with 3 hours to spare. Nice.

I hope I did well. I'm confident that I passed the thing, but I've already figured out a couple questions that I fucked up - the brain stopped thinking about block 5 and I had to keep trying to refocus my energies. Not fun. By the end I was ataxic and my eyes were so myopic I had to sit in my car for 10 minutes before I felt safe to drive. No, really. I had lost all peripheral vision and everything greater than 6 inches in front of me was a blur.

Interestingly though, I saw an upperclassman who matched in Anesthesia this year taking the exam. He was supposed to be in New York for both his prelim and advanced, but here he was, in my testing center, taking Step 2. At least it looked like he was. Whatever he was doing it wasn't where he was supposed to be. I know that he'd been behind and was running hard to graduate; he hadn't taken the exam before he matched, so who knows what could have happened.

I hope he didn't fail, lose his residency, and have to take the test again along with submitting to the match again this year. That would suck donkeyballs. I didn't talk to him because I just didn't want to know - and I was first done by a mile. I thought about staying to see what was up, but I decided I'd rather not hang around that ghetto area -get jacked, yo.

So, Step 2 CK: TAKE THAT! Time for a brain break. 4th year starts Monday!

Calm, Cool, Not So Collected

Obviously I’ve been busy getting ready for the exam looming ever so close. Recently I had a complete panic attack - OK, Sunday and Monday I was freaking. I’ve heard multiple people talking about how Step 2 CK is now as important, if not more, than the Step1 exam that is infamous for causing medical student panic attacks worldwide (congrats to all those who’ve passed it BTW).

When I entered medical school there was a phrase regarding the 3 exams required to become a licensed practitioner: Step 1: 2 months; Step 2 CK: 2 weeks; Step 3: two number 2 pencils. This thought process essentially stated that the hardest test was first and then, based on your exposure to real medicine and patients, you’d breeze through the other 2 exams. Ha.

Unfortunately it seems that the culture has changed in the last couple years regarding this philosophy with an even more dramatic change in the last few months. It used to be that a good step 1 score meant that you postponed taking step 2 in order to avoid looking like a real dumbass (should your score be fairly low), or taking the test but hiding the results in your ERAS.

Those are, much to my surprise, no longer options for this year. Many programs will not offer you interviews without knowing you’ve taken and passed the exam while being fully able to see your score for these exams. You can’t hide it anymore. That was huge news to me since I had planned on doing that till last week.

Yes, after moving my test up a week I’ve taken a simulated exam that scared the hell out of me. I had serious anxiety and discussed postponing the test, buying another Qbank (since I’m 100% done with Kaplan’s), and dropping my elective starting next week to prepare more thoroughly.

Then I took a breath, reviewed my scores, reviewed my progress, and paid for a NBME diagnostic exam (best estimate for Step 1 last year) and have felt a huge burden lifted. No, I’m not in the same realm as my Step 1 score, but that’s probably not going to happen. I did not prepare myself like I did last year and nothing's going to change that.

I have resigned myself to this fact and evaluated the score I was estimated to receive - 233. That’s good. Really good. So why am I freaking out about not being higher? Exactly, fuck it.
I’ve reached a good healthy level of anxiety - not too little, not too much. Hopefully this carries over on Friday.

So, with that lengthy discussion of boring test minutia, no more updates till after the exam is over - I need to read some of my notes and review weak areas. Then I’m getting toasted Friday, Saturday, and Sunday. Done with this shit.

Ready or Not

During my breaks from taking exams and reading I’ve been trying to get my profile and information onto ERAS (electronic residency application service). A sense of fear and excitement has developed within me as I realize that I’ve graduated from simply listening to others talk about what to do, to actually trying to remember what’s been advocated and doing it in order to match where I want.

A year from now I’m going to be a doctor, with a real job, taking care of real patients (seriously?) in some area of the US. That’s fucking terrifying. I have no idea where that will be, what the circumstances will entail, if our family will be together (Stepson will not be coming if we move), or whether anything that I know now will be the same. It’s frightening to consider the complete turn-around our lives might take in a just a few months and a conversation with Wife confirmed this.

She called me this week to ask whether she should buy shorts and tee-shirts for Daughter for next summer. The convo went something like this:

MSG: “Why not?”

Wife: “Because summer in [colder climate states] is not what it is here. 70 degrees is not shorts-wearing weather.”

MSG: “Oh…(puzzling look on face)…I hadn’t thought about that. Damn.”

Wife: “So? Should I get them or not. What do you think?”

MSG: “Get them. I honestly don’t think we’ll be moving out there anyways – it’s kinda a long shot and I most likely won’t rank them more than 3rd...I think. Yeah...get them.”

Wife: “Ok, love you, bye.”

The fact that we have to discuss whether we can even buy clothing for next summer is ridiculous, but necessary. We’ve looked at housing, schools, jobs, etc. in these areas while trying to determine where the best fit lies. Our lives revolve around my training and results of a computer-based lottery system - absolutely fantastic and sickening at the same time.

I'm ready for the change, but the complete lack of stability kills me. After all, we've lived here for almost 8 years and have some support systems developed despite the lack of family. The thought of moving to a place where we don't know anyone again and have no support system - lord.

Classless

I hate baseball. Sorry to all the fanatics out there, but I’ve never been a fan of games that go hours on end, have very little action, and the players act like they’re working really hard when all it seems like they do is sit on their fat asses. The only thing worse about baseball is having nothing to really listen to on sports radio or ESPN in the summer besides the “plays of the week” that essentially just mean watching guys hit balls and actually run – might be one of the reasons that baseball players always seem to look so “chunky” to me.

Of all the things about baseball I hate, Barry Bonds and what he stands for take the cake. Here is someone that, by all accounts, is a major dick. He treats people like subordinates, believes he’s above the law, and cheats like hell to get accolades. Unfortunately it seems that he’s about to break the home run record held by Hank Aaron, the polar opposite of Bonds.

Where Bonds is a crybaby, a nancy-boy, and all around class-less piece of dogshit who has to use illegal enhancements to do anything, Aaron endured some of the worst racism and scare tactics in order to accomplish his achievement. Aaron’s record has held strong for an incredibly long time, making it one of the best known sports records out there. Aaron's dogged determination and spirit sent a message about perseverance, strength, and character. It should be broken by someone with the same traits.

Unfortunately that does not seem to be. Bonds will most likely break the record this year after hitting 752 and 753 yesterday making him 2 shy of tying and 3 away from breaking the record. Of course he had to “rest” first before he could break out of a hitting slump. I guess standing around in the outfield, sitting in the dugout, throwing a baseball, and swinging a bat are just too much for this guy. Sounds like really hard work to me.

Taking the Plunge

I moved my test date up a week despite the couple bad days I had. I'm just not seeing much improvement or a considerable lapse in my question taking practice to justify putting it off for another couple weeks. I'm good about where I'm at and that's that. I had to change locations, but this test site is actually closer to my home anyway - why didn't I just go there in the first place? Oh yeah, kinda ghetto area and I'm an elitist.

Bad Day

Ever have one of those days were everything just doesn’t go your way? I had that yesterday, which resulted in me almost plowing my car into a light pole just to end the misery. Not really, but you get the point – no, I AM NOT suicidal, just maniacal. My car was almost hit 4 times either leaving my apartment or during the morning rush hour, I realized I'd forgotten my study materials and had to turn around when I was almost to the school, I had computer issues all day long resulting in low test scores (I hope it was because of this), and was stuck in traffic from 6pm-7pm because it fucking rained when I tried to get home.

Because I was so stressed I had a clove cigarette while sitting in the rain for the first time in while. My car door was soaked, but it helped - a little (and don't get going on the dangers of smoking here; I've had this clove pack for almost 4 months now so I really don't think I'm in much danger of cancer or COPD!).

To top the day off, while trying to get something to eat for dinner last night I completely annihilated the package of shredded cheese I was fighting to open and was forced to spend about half an hour cleaning up the mess. And, to add insult to injury, when I truly needed a beer we had none in the fridge. GOD!

My friend told me that she feels I need some counseling. Most likely anger management based on her response to a story I regaled her with while we waited to hear about applying for residency. I guess damn near throwing a pen into the wall because you’re computer’s internet connection is fucking around with you while taking practice tests is not “normal” Hmm, who knew?

The Eyes Don't Have It

I’ve hit a rut in my Step 2 studying. Ophtho keeps kicking my ass because 1) I don’t give a shit about the eye, 2) eyes are gross, 3) I never-EVER listened to the ophtho people who lectured during surgery, and 4) I’ve avoided studying this material because it pisses me off (I get mad when I study something that doesn’t interest me in the least). Therefore my latest exam demonstrates a large abundance of ophthalmology related questions resulting in a 64%. Bastards.

Seriously though, I’ve already peaked on my studies and am now irritable, bored, unmotivated, and all the other dangerously stupid things that happen with studying too much without tremendous improvement. Based on a Step 2 estimator I’ve been using I’m in the 230-240 range, but there’s a confidence interval of 14 points. Eh, whatever.

I know I’ve improved a lot, but then I have tests that are in the 60’s again (at least not in the 50’s anymore) and I lose motivation. So I keep plugging along, reading and taking tests only to see my performance remain stagnant. I think I’m going to move my test up a week rather than risk the loss of intellect that may happen during the first week of my Anesthesia rotation. I have to first check the available dates out first, though, to see if I can actually do this.

I also feel bad because a good friend of mine is getting married in September, but is having a bachelor's party this weekend that I'm unable to got to because of this exam. I haven't seen many of the guys who'll be there since I moved out here 7 years ago and it just sucks to not be able to be there for a friend. I can't even get to his wedding because I'll be on an away rotation that I fought hard to get.

Goddamn test.

Phobias and Phish

Today is Friday the 13th. The second superstitious day this year that I’m aware of - since I had to learn the psychiatric name for fear of Friday the 13th in order to avoid a very long and tedious training session on its origins during my Psych rotation in April. BTW, do you know what that name is? Major kudos to whomever guesses correctly first.

Anyway, now that we've those formalities out of the way I will let you know that Sparky died. Wife took care of him after I called to alert her to the possibility of a traumatic evening if Daughter found him, but unfortunately he succumbed. We had to purchase another fish in order to appease Daughter's sense of disbelief that her fish had died as she held fast to her notion that a simple visit to the doctor and some miraculous medicine were all that was needed to cure her fishie. Poor girl, poor fish.

Now that I've officially killed off one fish I’m going to take the many suggestions given freely on the last post (thanks) and try to keep from committing fish murder again. Personally I hate fish as pets; simply because they’re so hard to care for and many people have varying ideas on what to do to keep them healthy while the damn swimmers just inevitably die no matter what we do! I need something hearty, that won’t die, and is easy to take care of - like a lobster!*

* Name this Disney movie and you're a superstar! If you have kids you'll have a better chance.

Paranoid

After receiving a few comments regarding my last Wife Speak post I grew rather paranoid. What if Wife does read this (unlikely, but still)? What if she were to find out about this blog and read it? It just made me nervous especially with some of the comments being left, so I decided that I would delete the last post entirely. It was kinda mean anyway which was not something I was meaning to convey. We're just having a rough patch again and that came out harsher than I'd intended. If I decide to continue the Wife Speak it will be funny sayings that demean me and not a means to get something off my chest.

****

Weekday Update (cheesy I know): My Kaplan questions have improved fairly well and I'm feeling a lot better about my test date. I might move it a week up just to avoid losing some brain power while on my first week of Anesthesiology rotation (hurrah!), but like you care. I added the Step 2 CK update on the side of this blog in case you wonder how it's going. I've stopped contemplating suicide at this point which is a fairly good thing.

On another, completely off-topic topic, first year medical students stink. Sorry, but they do. They're not even in full-blown anatomy mode yet and already they have procured the stink of cadavers. Nasty little freshies. I wonder if there's ever been studies conducted on the decline in personal relationships during the first semester of medical school. Apart from the long hours and adjustment disorders that develop I imagine the ever present smell in a loved one's hair/ clothing/ skin would put a halt on any budding relationship. Thankfully I was married so I didn't experience too much of that.

I think Sparky, my kid's fish, is going to die today. He's not looking too good right now. We received him as a gift from Wife's supervisor after we tended her Betta for a week and a half. Sparky is a red Betta we've had for a couple weeks and he's been doing rather well up till yesterday. I changed his water last night, but he was acting funky. He wouldn't eat and this morning had the distinct look of a fish about to end this world. He swims down to the bottom of the bowl like he's lost or will just hover on the side without moving. Sometimes he atually starts to turn sideways, like he's going belly-up.

Daughter told me that he was "stuck". I think he's dying. I hope not, but he's not eaten at all since yesterday morning and is just acting funky. I may need to buy a replacement quickly.

Dude, Where's My Fife?

Fife Me is a blog that I've enjoyed for a little while now. She went private around the time the entire medical blog world was blowing up, but I'd not seen any recent indications that she was planning on pulling the plug.

Now there's nothing on her blog site at all. It's a "Page does not exist" website that I come across. Fife, where have you gone? Let me know, will ya?

Wife Sayings I

I think I'm going to write down some of the little sayings that Wife hits me with every now and then - mostly when I'm studying a lot or away from the house more than usual. So, here's the first installment:

Late last night I headed down to the apartment work-out room to get in some much needed exercise (I’d missed 3 days in a row after being so good for 3 months and felt terrible about it). Upon entering the building I was instantly floored with very hot, humid, and foul smelling air. The air conditioner was apparently not working and the bathrooms (most likely the mens - why can't guys flush a damn urinal?) emanated the lovely sickly-sweet smell of hot urine. Lovely.

However, this did not deter me. I was driven to get in at least 45 minutes and proceeded to do so and more. I almost quit when, drenched with sweat from head to toe, the water cooler was out of cups and the drinking fountain’s cooling mechanism was apparently also on the fritz, giving me hot nasty water for a refreshing drink. But I persisted.

Afterwards I told Wife about the experience and how miserable I was since I’m more prone to sweating here in the damn South. Her reply?

Snarkly: “Well, no one forced you to stay there!”

Tough love.

Dr. Fred

I’ve read more articles by this doctor and know that I will try and avoid applying there for my prelim year. My god, what doesn’t he understand about progress? I’m sure he’s a great teacher while being a crusty curmudgeon at the same time, but this really scares me. I agree that some of medicine is suffering from over-zealous use of technology, but that’s because studies are finding that CT scans and other tests actually diagnosed patients faster and with less error than “in the good ol’ days”. But hey, we’ve got women and minorities who are doctors now! Didn’t you hear – times change because of progress, not regress.

For your reading pleasure:
These are the days
Hyposkilia
Acronymesis

There are many more, but I don't have access. It's quite clear what this guy thinks of the current attendings, residents, and med students.

Questionable Admit

***This is a letter that I'd like to write to the various e-mails I receive from would-be medical students wanting to get an "advantage" before applying to med school.***

Would you do it all over if you knew then what you know now?

Seriously ask yourself this question about anything and I believe you’ll find yourself struggling with the answer more than you’d have thought. What if you didn’t take that job? What if you never had kids or married? What if you didn’t let that smooth talking guy/ girl get into your pants? And so forth.

Now imagine that you've spent the last 3 years thinking this, about one choice, that ultimately has decided your entire future, complete with ridiculously hazy details, complicated directions, and unknown outcome. Imagine that you know that the next 4-5 years (at least) will be filled with "mentors" like this *who hold you in nothing short of complete contempt and abhorrence for being weak and lazy because you don't work 24/7/365. Would you do it again or still continue?

What does the future hold for me once all this is complete? Will I be able to make a living while paying off my insane debt, have a decent life (being a lazy bastard and all), and take care of my patients without burning out? Did I have a better job and opportunity prior to entering medicine? These are all questions that I, personally, consider before drawing any conclusions about entering medical school. My reasons are varied and differ greatly with peers based on life experiences, situations, etc. I cannot tell you whether or not you’ve made the right choice by deciding to become a physician because my own basis is entirely personal and based solely on the immediate and unforeseen circumstances that plague me at that time.

And because my conclusion changes I find it hilarious and rather absurd that pre-med students often seek advice from medical students. Yet they're told that we're the beacons of light on this subject since we're knee-deep in and that true understanding of medical school can only come from a medical student. Questionable philosophy at best.


What can I honestly tell you about medical training that will truly benefit your own decision? That it’s hard? That during the first couple years I had short periods of tremendous exultation intermixed with long episodes of utter hopelessness; all while getting no more than 4 hours of sleep? That I can count the number of times I've almost been divorced on 2 hands? What about the panic-inducing debt that I've accumulated from loans, upcoming away rotations and interviews, and "emergency" car repairs? Believe me, I had people tell me all these things prior to my entrance and I still had no idea what to expect.

Simply put, no one can make a decision like this for you nor can they truly prepare you for what's to come. You have to do your homework, spend time with people who are in the thick of it all (and not just volunteer for simple shifts or work for uncle Larry's office), and evaluate the true reason you desire to become an MD or DO.

If I’m miserable I’d have opted out long ago. Sure I spend a great deal of time complaining about the process, but the fact that I can see some light ahead, have witnessed the transformation in myself from this process, and understand more than ever that medicine is not the utopian environment I’d believed so long ago and needs people to make a change keeps me going. You need to figure this out for yourself.

* Thanks to Panda Bear's recent post for this editorial.

A Different View

I thought I’d show you an alternative version to my most recent post. Dr. J, over at Adventures in Medicine, has studied addiction for a bit and works with people in areas of Canada where, I imagine, addiction is a major social and economic problem. He has a differing opinion of the drug seeking behavior that is in stark contrast to what many physicians would agree with, but it’s one that definitely holds merit.

Personally I’m not saying that drug seekers should be instantly turned away. After all, they are someone’s kid, possibly a parent, and most likely have at least a couple people who love or care about them. Therefore they should not be instantly vilified for poor life choices and neurologic or chemical changes that force them to “seek”. What I was trying to convey in my post, though, is the tremendous amount of resources that are lost on people like this just so that they can satisfy their “Jonesing”. It’s really quite sad to know that someone might lose a bed because a Demerol junkie needed a fix and the hospital caved.

Now, after reading the well formulated post by Dr. J, I would admit that his method seems to be a better way to handle drug seekers at their intial intake: by being forthright with them. Let them know upfront you’re not going to give them drugs, but that you can help them with treatment should they want it. Make it their decision to seek the proper healthcare rather than shuffling them off onto inpatient teams many times over who will spend days and thousands of dollars “treating” a malingerer. It’s a good thought process and I think, as medical personnel, it is essential to always remember that the vagrant, the asshole, the annoying drugged out jerk in bed 3 is still a human being.

Mining for Gold

“How’s your pain today, Ms. Drugseeker?”

“It still hurts like hell!”

“How’d you rate it?”

“Same as yesterday, a fucking 10! God, why don’t you give me anything?” Her eyes demonstrate a clear desire for pain meds; desperate and conniving as is often seen in connoisseurs of opiates.

“We are giving you pain medications. We aren’t going to increase the dose at this point as you've yet to gain any relief over several days.” I lie to the patient. Really we know she’s full of it and we’re planning on taking her down, giving something for her iatrogenic constipation, and giving her the boot.

I proceed to complete the requisite physical check which includes the patient jumping with “pain” each and every time I touch around her left chest. Oddly enough every test performed to this date has come back negative. Wonder of wonders. She doesn’t have ACS, an MI, or any other problems - except drug addiction and vagrancy. I’ll be glad when she’s outta my hair.

I learned quite early in my 3rd year of training that some patients need a place to stay, some need a bed and a meal for the night, and others just want drugs and use the hospital for these purposes. Things that I knew already, but never quite understood how it was that they were able to manipulate the system so well. I've seen the scams and read about others. Oddly many are very similar, but unique with the person involved.

Ms. Drugseeker will receive a bed because she is middle aged, has abused her physical and psychological health for years, ingests varied amounts of drugs which she obtains by doing unmentionable acts, and has not seen a regular physician since Nixon was in office. An abnormal EKG results and labs will most likely surface, relegating the on-call team to take on this freeloader in a useless search for the etiology.

The patient stays, getting a bed, free food, free healthcare, free drugs, and a place for her hubby to sleep as well while the doctors, nurses, and medical students try to not think about the waste of money this person has become. Hubby remains sedated throughout the process until he hears they're being "evicted". Then he suddenly is concerned about his wife's condition.

Unfortunately for our society this is an all too common occurrence. Many private hospitals won’t take them and will either give a quick drug cocktail and/ or street the druggie. Then the charade plays out all over again, at another ER, another clinic, wasting the same taxpayer dollars; but nothing can be done because god forbid if the constant abuse of heath resources by a parasite might actually lead to the discovery of some illness. Then the lottery is in town.

Hell, we might find gold in them thar hills…so wouldn’t it be a shame to not go looking at the same or slightly varied complaint for the upteenth time while knowing full well that you‘re most likely not going to find anything other than someone who can only tolerate a “D“ drug? That’s what a litigious society has constructed for our kids.

Personally this abuse pisses me off. If we’re going to ever have a healthcare system that has any potential to become universal this exploitation has got to stop. Personally I like the idea that people have a certain amount of points that they can use. Use it up and your done for the month, year, etc. If you’ve been diagnosed with a legitimate disease that will increase your healthcare use then you receive additional points.

This would reduce the overuse of ER’s for minor ailments, reduce the ICU stays with ridiculous attempts to prolong lives already long lost, and might just curtail drug seeking abuse. Of course there's a lot to be desired from this plan; it won't define what an actual "emergency" is, it won't create jobs and decrease poverty/ addiction in many abusers, and it won't take care of the illegal immigrant crisis. But I like it in it's infancy.

Till then the exploitations will continue, the drug seekers shall refine and perfect their lies, the viral URI's will get treated with antibiotics at 3am, illegal immigrants shall continue to invade ED’s for each and every complaint to avoid INS troubles, and my taxes and health insurance premiums will continue to increase.