Let the Voting Begin!

More than 20 years of working towards a life dream now fulfilled, I have shared my medical school experience for four years; week by week, dose by dose, the journey has been a roller coaster of fascination. Recently nominated as one of the most fascinating student blogs of 2012, the voting process has begun and I am asking for your participation. 

TO VOTE:
1. Follow this link to the voting page today through August 28th, 2012.

2. Make sure you have Google Plus. If not, you will find the Google Plus UPGRADE Button on the Top Left of the page. Creating your profile will only take a few minutes.

3. Click on the double arrow beside "Comments" to view the entire list of nominees and look for your blog of choice...Your vote for Life as a Medical Student would be much appreciated, it's a little more than halfway down the list :)

4. Hover your cursor at the end of the blog url and click the "+1".

5. Invite your friends to cast their vote!

6. MOST IMPORTANTLY: If you cast your vote for me, please send me an email here with your name, one of your dreams and a picture of yourself to be featured on my next blog post!

Updates from residency are soon to come, so stay tuned. Thank you for coming along for the ride.

Nominated Most Fascinating Student Blog of 2012

It is with great pleasure that I announce a nomination recently received for 2012's most fascinating student blog. Just being among the few student blogs on the internet has been quite a thrill, but this consideration is one I humbly accept. If you would like to voice your opinion and vote, the process will begin on August 21st and close on the 28th.

TO VOTE:
1. Follow this link to the voting page on or after August 21st, 2012.

2. Make sure you have Google Plus. If not, you will find the Google Plus UPGRADE Button on the Top Left of the page. Creating your profile will only take a few minutes.

3. Click on the double arrow beside "Comments" to view the entire list of nominees and look for your blog of choice...Your vote for Life as a Medical Student would be much appreciated :)

4. Hover your cursor at the end of the blog url and click the "+1". (Its in the same location where you see the votes for the other blogs.)

5. For blogs that already have votes, the  "+1" should be immediately beside the vote count to the right.

6. Invite your friends to cast their vote!

Thank you all for your support and encouragement! It has been a wonderful ride and I couldn't be happier living the dream that started so many years ago.

Things I Wish I Knew - Fourth Year

Once again, with my fourth year of medical school completed, it is time for me to break out the inner nerd and share the pictograph of my numerical note-taking. The chart above representing my fourth year of school with obvious end points when interviews finished and graduation approached.

The next chart is a culmination of first, second, third and fourth years combined. Initial observation would suggest that second year was almost twice as difficult as first year if not more so.The deep troughs usually representing times of vacation after exams or between years. The steady third year was a result of various preceptors and the work loads with each specialty. Obviously this would look different for every student depending on their scheduling. Things picked up again in fourth year with interviews, audition clerkships and the match process. Once matched, the intensity levels dropped significantly until the end of school all together.

Thoughts in Retrospection

Attempting to look back and decide on the few things that helped me along the way this last year is proving difficult, but as time passed, I have been looking forward to this post and mentally banking ideas along the way. Below are the top five things I wish I knew before my fourth year of medical school and probably could have been useful before school started.

1. Stand Tall - It can be difficult to show courage on rotations. Many times preceptors will "pimp" students or question our thinking to the point of making us feel smaller than ever before. Standing tall, using direct answers and showing interest made the difference on more than one occasion. Confidence, even if simulated, lets others know you have what it takes when challenges come.
2. Read regularly - Medicine is a profession of lifelong learning. Getting into the habit now of seeking the latest research in your field will serve you well when it comes time to managing your own patients. Obviously, there is more to know than can possibly be memorized, but taking an active roll in consistent reading can set you apart from your peers who only read to cram for exams. Make reading a regular part of your study routine.
3. Follow the rules - While this might seem like a no-brainer, it is surprising how many do not. Whether an assignment to study for the next day, a sterile field you are not to touch or paperwork your school needs, abiding by given instruction will only serve to help make your life easier. You will have a lifelong career where you get to be your own boss. Save your rule breaking and adventure seeking for then. Being a student means you are still governed by the rules of those who decide the receipt of your degree. 
4. Be proactive - Set up clerkships early, arrive on time ready to start everyday and actively look for opportunities to participate in patient care. Having my interview application submitted early allowed me to be on my eighth interview when some students were just starting their first. Procrastination means you may be eating crumbs. 
5. Have fun - This is what you came to medical school to do. You are paying good money to make the most of a four year education, even if long hours of studying depress you. The least you can do is make some friends along the way and have a good time in the process. There are some great memories to be had in medical school, don't miss out.

Medical school is honestly the hardest thing I have ever done in my life. The journey has been amazing to say the least. To be done is not only a dream come true, but a gift only I could have given to myself. I am grateful for all the support my family, friends and readers from around the world have given me along the way. While I do not know what awaits me over the next four years of residency, I am excited to be moving in the right direction. Now to start working on that quarter million dollar student loan.

Question of the Week

A 30 year old male medical student blogger has just graduated and is moving on to residency. If he continues to blog in the little free time he will have, where can his writings be found?

A. www.lifeasamedicalstudent.blogspot.com
B. www.lifeasaresident.blogspot.com
C. www.lifeasamedicalresident.blogspot.com
D. All of the above

Answer: It will not likely be all of the above, but all those are all good places to check. I will try my best to keep this site updated with changes or news.

Doctors at Last

From the bowels of the LVH (Las Vegas Hotel) at the head of the ballroom, my classmates and I have gathered to be hooded doctors of osteopathic medicine. Its official, we are now doctors!!!

Congratulations to all my TUN classmates and peers at other universities on a job well done!

Graduation Day Is Here!

This post comes as another milestone arrives. I wasn't certain if I wanted this to be my last post as a medical student or the first as a physician. In the end, I think this entire day is in limbo between those two phases. Today is graduation day and like many of my colleagues, I am excited to leave the last four years of medical school behind and move on to the next adventure.

THE Biggest Milestone

While trying to figure out how to wear the graduation regalia can be quite the confusing task, it is exciting to be the one donning the apparel. For years I have admired those dressed in the robes of a doctoral graduate and patiently awaited my turn. In a few hours I will be joining the ranks of those who have gone before to commemorate years of education, sacrifice and desire. All this fanfare for a little pomp and circumstance, that's worth a photograph or two.

It is likely that one of the orators today comments on the ceremony being the "commencement" of our careers as opposed to the kneel of our educational experience. As more time passes, I come closer to understanding the weighted responsibility of what it means to carry the title of a doctor. For once this really does feel like a commencement wherein there is more ahead than what the past has known. How this is possible and how I am going to make it is beyond me, but it's a new leaf in life. Today closes one book and opens another. I couldn't be happier that this day has come!

There's No Homework Like No Homework

Rotations are finished. Residency is on the horizon. I am basking in the space between...vacation-land. Although there is plenty to do in preparation for the next steps, this time is just as precious as it sounds. Letting go of the time schedule, burdens of major responsibility and trivial concerns is more relieving than I imagined it would be.

Recapturing Lost Time

While I could have been intently studying for my next board exam, reviewing the pharmacokinetics of anti-microbials or rehashing the Kreb's cycle, I chose to rest the organ I've exercised intensely for the last four years. Traveling here and there, sometimes without a phone or computer to really dive into the organic "R and R" so badly needed. Mother's Day was no exception. With no prior commitments and time to spare, I made the trek to surprise my mother even though it was the week before graduation where I would see her again. Why would I do it? Because I could. Time allowed and it makes for a better story than going to the arcade for a day.

With only one week remaining before graduation the obvious excitement has somewhat worn off since starting vacation. As it stands now, only time is between me and a degree. No more exams, interviews or documents need my attention. My vacation time seems more valuable at this point than a 4 hour meeting of name-calling and black robes. Yet we are required to attend the event, perhaps for the school to maintain its public appeal of graduating x number of doctors this year. Attending graduation will be the public culmination of all this hard work put to rest. An opportunity for close friends and relatives to say, "I know that guy, how on earth did he become a doctor?" I suppose deep down inside I want to be there too, because it is a proof-giving ceremony validating the last 25 years of my life. Something few events can do.

Here is to a lifetime of dreams, four years of hard work, relationships made and kept, mothers and fathers who support, being a medical student who experiences bipolar highs and lows, and most importantly to the years ahead. The next time I post here will be as a doctor, not that far removed from the student, but across the line a marathon winner.

Question of the Week

Was it hard?

Answer & Explanation

Doctoring Through Humor

Every once in a while, funny things happen. This time, brilliantly dressed man, tall in stature with half a head of blue hair paced on the stage recanting memories from his career as a medical doctor and health activist. There was no shortage of clowning, which was only exaggerated when he literally disappeared inside his over-sized pants...yes really. 

Smile, It Scares the Blues Away

Recently, I had the opportunity to listen to and chat with Hunter Adams, better known as "Patch" Adams. Most people recognize the Hollywood title, and in person, he was simply fantastic. Patch is a one of a kind personality who has established the Gesundheit Institute, a free medical clinic where health is paramount for the individual, family and community. While in his final years of medical school, Patch had a vision on how to change the world and healthcare itself by eliminating the "red tape" that is found in bureaucratic medicine. His cheery disposition, desire to spread happiness and creative outlook stoke a positive reaction in most people who have the pleasure of his company.

On the verge of practicing medicine myself as a rookie doctor, I spent a couple minutes consulting with Dr. Adams. After expressing my enthusiasm for my fast approaching residency and my simultaneous anxiety of the same, he could not fathom why as this is the best time to grow as a young doctor. His words of advice were to "never lose the humor." There are so many positive experiences to be had that it would be a shame to miss out on account of fearing the experience itself. Through his discourse, personality and example, I am reminded that we can be whoever we want and that it is acceptable to be the one who doesn't follow the norm. Compassion is a characteristic that is given to benefit the lives of others, and in my eyes, Patch exemplifies this quality with great finesse. Thank you for your words and example.

Question of the Week

What can I do to contribute to a happier me and society?

Answer & Explanation

The Ultimate Upgrade

This appears to be a very clean and tidy hospital room, ready for the next patient to fill its bed and utilize its healing equipment. I happened to come across it in the early morning hours on my way to see a patient assigned to my service, a patient who had occupied this bed less than 24 hours earlier.

The Morning After

I knew from the previous day that my patient was struggling to survive his declining medical condition and that it would only be a matter of time before his body decompensated. It just didn't occur to me that this particular morning would be the one I found his room void of active recovery. I was rather surprised when I passed the door mentally preparing myself to review his chart for daily rounds. This was not a novel experience for me, yet it was reason for pause in reflection of a life ended, that taught me in during his struggle to survive. Despite the frequency with which this happens, it resonates as a moment of appreciation for the health that I currently possess.

In medicine, we grapple to preserve life and health. Death is not failure in that equation, yet it is the antithesis of our goal. In fact, it may be the expectant end to the story, but our attempts at prolonging its arrival are the reason we prepare for years to work in healthcare. Sadly, it is something we have to accept as an outcome and become comfortable with despite our best efforts to thwart its occurrence. It happens and the morning I stopped in to see my patient, I could not think of a better scene than his empty bed with the light of the sun filling the corners of his room. It was serenely peaceful and appropriate. 

Question of the Week

An elderly woman, diagnosed with Parkinson's Disease, is very combative with hospital staff, refusing treatment except from her own family physician. Which of the following stages of death is she most likely experiencing?

A. Denial
B. Anger
C. Bargaining
D. Depression
E. Acceptance

Answer & Explanation

The Match Results Are In

Sleeping the night before was not as hard as I expected it to be, but the day of the match results (February 13th) I woke up early. Before I even made it out of bed, the email shown here greeted me with very good news! In just a few months, I will be joining Arrowhead Regional Medical Center's newest team of emergency medicine residents!

Residency Here I Come!

Like many of my colleagues, I had no idea that the match results would be emailed so early in the day. Social networks were abuzz from classmates and peers around the country celebrating and spreading the news. For some it was a time of joy and for others one of disappointment that they either did not get the program they wanted or none at all. It was the major topic of discussion; sometimes surprising and often times expected. Fortunately, in the osteopathic match we do not have to wait a number of days before knowing the results, they are given in the same email. For those attending allopathic schools, they learn that they have matched and wait a few more days before learning where to and in what specialty.

I feel so very fortunate to have matched with a strong institution replete with diversity and opportunity. With the news, I can start looking for housing arrangements and vacation opportunities before everything begins. It's a relief I thought would never come when I was starting out more than three years ago. Now the looming realization of being responsible for someone's health is setting in. For now, I am just going to enjoy knowing that things are going to work out just fine.

Question of the Week

Where did you match and into what specialty?

Answer & Explanation

Residency Interview - The First

Just coming off of night shifts, I had a difficult time falling asleep and the anxiety of an interview the next day didn't make things any better. In total I think I may have slept four hours before my alarm sounded at 3am.

St. Barnabas Hospital

I shuffled about my morning activities while the world around me still slept and the crickets chirped. It had been a while since I knotted a tie, but this morning it went on with no problem. I was out the door by 4am and on the road for an early morning cruise to New York. My destination, St. Barnabas Hospital in the Bronx, roughly three hours away. Traffic was nonexistent and the morning fog was the worst obstacle. The hurried feel of New York was obvious as I approached the hospital with people mulling about and a full ambulance bay. I had arrived for my first residency interview.

I was fascinated by the inherent antiquity of the buildings, it gave a sense of being well established in the community. The only person in a suit, I stood out like a sore thumb among those in scrubs and street clothes as I walked the campus. It was apparent that I was there on official business. Shortly after finding the morning meeting place, the faculty lectures and student case reports consumed the early hours of this program introduction. These were followed by a tour of the emergency department and hospital before grabbing lunch that was provided for Employee Appreciation Day.

While it was difficult to digest lunch due to the building anxiety, we conversed with residents and other interviewees about the program. One by one we made our way into the "hot seat" for our personal interviews in front of a panel made up of two residents and two faculty members. The questions were focused around the program and my submitted application, both of which I felt comfortable discussing. I was then given time to ask about the program and before I knew it, we were shaking hands and parting ways. It was a breath of fresh air to have my first interview behind me. I definitely enjoyed the experience and look forward to more like it as I explore the world of emergency medicine residencies.

Question of the Week

You have diagnosed a patient with a terminal illness or must give grave news. How would you share this new information with your patient?

Suggested Consideration

A Time for Celebration

Last week may have marked the last exam of my official educational career...assuming I passed. While I can think of no more depressing way of spending my 30th birthday than sitting for a medical school board exam on a rainy day in a foreign city, the celebration of being done was thoroughly enjoyable even if it was only a modest party for one.

Moving Right Along

All I could think was, "finally this exam is done." It has plagued me for so long trying to concentrate on rotations and applying to residency programs. With any luck I will have passed and can move on to worrying about interviews and the upcoming match. It seems like just yesterday one of the upperclassmen was telling me how fast medical school would go by. Of course at the time I couldn't believe the semester would ever come to an end. And now, looking back, we have been so busy that I barely noticed the elapsed time. Although we have not quite reached the summit of this experience, it is definitely in site and attainable at this point.

Reflecting on 30 years seems rather farcical and I wonder if the 20 some years of education has really paid its dividends. Does that mean that medicine can be considered my second career? At this point, I think I am ready to move on to career mode and at least realize a little of the benefits from all of this training even if that means more responsibility. But I am getting ahead of myself. I have yet to be officially told the examination was a success and I still have interviews to attend. Now, more than ever, is the time to sprint to the finish and focus on keeping my game face. There will be more time to celebrate later, but it was nice to pit-stop for a moment and feel human again.

Question of the Week

A 25 year old medical student who was PPD-negative when starting medical school tests PPD-positive after her first ward rotation. As her physician, what is your first step in managing this patient?

A. Repeat the PPD
B. Check her liver function
C. Obtain a sputum sample for culture
D. Order a chest roentgenogram
E. Order a urine culture

Answer & Explanation

Special Occasions

Some 2,500 miles away, my grandparents will be getting up in a few hours to go about their daily activities including opening their email and finding this delivered to their inbox. They just celebrated a wedding anniversary and today is Grandma's birthday. I want to dedicate this post to them as they have been so supportive throughout the years and especially during medical school.

Grandparents

The first chapter of my career in medicine started on their basement stairs when I was just a child. As the story goes, I am almost done with another chapter in this never ending book. In days, I will be taking another board exam and in weeks I will be starting interviews for residency. Like their significant milestone anniversaries, I am trudging past a few of my own, making small advancements that bring me steps closer to a goal I've had for so long. My grandparents have been there every step of the way, cheering me on, following my progress and feeding the cereal craved fiend inside. If I ever needed something, they were the first to offer a helping hand and always graciously generous when meeting those needs. It's too bad they are already taken, because I think everybody could benefit from the best grandparents in the world.

Through retrospective analysis, I have come to realize one of my weaknesses over the years. In short I have become a "yes" man. When a person requests my services, I have the hardest time turning them away and do what I can to provide for their need. Now I think I know where that comes from. So, Grandma and Grandpa, I want to thank you for all your support, for giving selflessly to see me succeed and for having the best cereal and treat stash I could ever imagine. You two are fantastic and I love you for who you have been in my life and the lives of others. Thank you for your examples of what genuinely caring people can do in this world. I hope you had a wonderful wedding anniversary and Grandma, HAPPY BIRTHDAY! I love you both and thank you for being such an integral part of who and where I am.

Question of the Week

A medical student writes a blog about his fantastic grandparents who are celebrating some incredible moments in life. Which of the following is true about this dedicated, hard working couple?

A. They are celebrating their 62nd wedding anniversary
B. Crossword puzzles are no match for them
C. They are the best grandparents ever
D. They still know how to have a good time
E. All of the above

Answer & Explanation

Providing Fresh Air

I have yet another first to add to my list of many as I trudge along the med student life. Like many, this one is procedural. In emergency medicine the procedures continue to accumulate the longer you are there. I think it falls into the "see one, do one, teach one" mantra.

Rapid Sequence Intubation

With little success at my previous attempts, intubations were starting to concern me when I could only see the epiglottis and no vocal cords. That was the closest I came before patients would start to lose oxygen and the attending moved in to finish the job. After wondering why I was going to an extra shift last week, I was glad it fit into my schedule. We had a patient with respiratory distress needing rapid intubation. Despite their predetermined status as a "difficult" airway, my attending gave me the opportunity to perform the skill. Focused and determined to finally have a successful intubation, I meticulously placed the endotracheal tube on my first attempt...in the right place! In a specialty where airway management is critical and a career of it ahead of me, it is nice to see where my first success actually occurred.

The physician with whom I was working mentioned the day before, "you have to respect the difficult airway." Although I may not completely understand that statement at this point in my career, I know that the skill is important enough to appreciate pitfalls and workarounds. My extra shift turned out to be rewarding on this particular occasion. A simple procedure to some happened to be another milestone in my book.

Question of the Week

A dialysis patient has missed their routine treatment and is now currently in respiratory distress as a result. You choose to intubate the patient. In preparation for this procedure, the use of which of the following paralytic medications would be discouraged?

A. Succinylcholine
B. Rocuronium
C. Vecuronium
D. Pancuronium
E. Rapacuronium

Answer & Explanation

The Moment Has Finally Come

It was not long ago that I had hoped for more aha moments to clarify what to do with my career. Now on rotation out of state, it didn't take long for me to realize that I felt right at home. Perhaps not in relation to my living arrangement, but at least along the lines of a specialty, I know what I want to do. [Pictured: Arrowhead Regional Medical Center, Colton, CA]

My Aha!

I had prepared well in advance for this rotation and anticipated it with great excitement. Everyone with whom I spoke had positive things to say which only fueled the fire. All year I have been craving that feeling that told me this is the right specialty for me. Despite previous experience in emergency medicine, I left room for any specialty that could woo me throughout the year. Although some came close, none were successful. My first shift this week was late into the night and twelve hours long. Only a couple hours into the shift and I was hooked...again. Emergency medicine feels right and holds my interest, even at 3 o'clock in the morning when the conditions may be less than favorable.

It is one of the more exciting events of my third year, to walk to my car after a long day of work and feel just as enthusiastic to return the following day. There is a sense of fulfillment and accomplishment which are perhaps afforded by the instant gratification that the treatment of acute conditions can offer. It is fast paced, full of variety, and there is room to really make a difference. If you don't believe me, ask the patient we coded last night whose heart started again after CPR and a few medications. In only a couple of nights I have been exposed to horrific cancers, multiple stab wounds, and minor illnesses alike. Somewhere between the medicine and procedures the coolness of it all sinks in. How reassuring to have finally figured out my specialty, because I was starting to worry that nothing would stand out.

Question of the Week

A 28-year-old HIV-positive male complains of pain on swallowing. Physical examination is remarkable for white plaque-like material on his tongue and buccal mucosa, which is scraped and sent to the laboratory. Based on these findings, and on the laboratory results, the man is diagnosed with acquired immunodeficiency syndrome (AIDS). With which of the following agents is the man most likely infected?

A. Candida albicans
B. Cytomegalovirus
C. Herpes simplex I
D. Human herpesvirus 8
E. Human papilloma virus

Answer & Explanation

Conquering the COMLEX PE

What seemed like an exam that would suck the life out of me actually turned into something memorable. The COMLEX Level 2 PE was no slice of cake, but it is finally over and behind me.


Visiting Philadelphia

I've been feeling a sense of hostility towards this exam for some time now. It just had to be done and put to rest however. Last week I made the trip, racking up miles and spending lots of cash to see it put to rest. The best part of it all was the Philly Cheese Steak sandwiches. Although my classmates and I were only in Philadelphia for a 24 hour period, we couldn't stop at one sandwich and filled our glutinous desires with a couple. I never would have thought Cheese Whiz on steak could taste so good.

Although I am not allowed to share information about the test in particular since it would violate the policies and jeopardize my grade, I will say it was quite unique moving from room to room in so short a time frame. If that was any indication of what clinical practice will be like, I had better get used to things soon. I don't know if anybody walks out of that exam feeling confident that they solidified a passing grade. All we can do is hope that we put our best foot forward and let our experience do the talking. The rest is in the hands of the graders to determine our fate. So begins the long wait in agony for a pass/fail test result. At least I have a 50% chance of doing well.  

Question of the Week

During a bitterly cold winter, an elderly couple is found dead in
their apartment. All of their windows are closed and their leaky old
furnace is on full. Which of the following is the primary mechanism
by which the toxin involved led to the death of this couple?

A. Decreasing intracellular calcium
B. Inhibition of cytochrome oxidase
C. Inhibition of Na+/K+ ATPase
D. Irreversibly binding to hemoglobin
E. Stimulation of cellular apoptosis

Answer & Explanation

Life as a Patient

Finally nearing the end of my hospital stay, I have gleaned a great deal of information and experienced my share of ups and downs. Surgery was a difficult experience as it left me with pain, wounds, and the after effects of anesthesia. Being in the ICU with all of its high-tech glory was much less fun than I remembered from rounds.


Post-Operative Recovery

Fortunately, I was able to avoid catheterization. Nonetheless, the anesthetics had a long lasting effect that disturbed both my gastrointestinal and urinary tracts. Every time I tried to drink fluids, my stomach would have nothing to do with it. I had to keep the emesis container within reach as there was no way of judging how my body would react. It was more annoying than anything as the cottonmouth was rather unpleasant. Between medicated naps and side aches from my freshly placed chest tube, all I could do was wait for the anesthesia to wear off with my barf bag in hand. Learning to adjust to my new wounds and pains was going to take some time, and all I could do was wait. As the clock rolled, I became hungrier and dared to try solids. It tasted good, went down well and sat well...but only for 10 minutes. It was then that I wished I had an emesis bag the most; a simple device I could put on and forget about. Luckily, it became easier to hold the food in and now I had to get my bladder to cooperate. With some serious concentration, faucets running and a friendly coaxing from my visitors, the bladder situation was overcome in due time.


Little did I know that the next few days would be worse. Inflammation, muscle aches, tubes, wires, medications and the list goes on. Now I was starting to understand what my post-operative patients had been experiencing. From one unpleasant experience to the next, I was now on the doctor's schedule awaiting instructions and decisions. My job was to report any problems, stay attached to all my wall connections, exercise my lungs and generally get better. I was happy to hear I was the most stable patient on the ward, which was to be expected as I was also the youngest. The TV was boring, my neighbor's moans annoying and the food not always appetizing. Getting up and walking around the unit was the most enjoyable activity I participated in during my stint. Something we so easily take for granted had now become the highlight of my day. At last discharge is in sight and I can soon recover in the comfort of my own home. This experience, however, has made a significant impact on my perception of health care and the way I intend to approach my future patients. What a great way to spend my vacation month.

Question of the Week

As a new patient on the surgery ward you are asked by the dietitian make your next meal order. Which of the following will have the worst effect on your health and recovery?

A. Turkey roast with mashed potatoes and broccoli
B. Chicken fingers and French fries
C. Meatloaf with mixed vegetables and a dinner roll
D. Shrimp pasta alfredo with garlic bread
E. Chicken salad wrap with clam chowder soup


Answer & Explanation

Home for the Holidays

Being in the hospital days before Christmas it was clear that patients really didn't want to be there. It's not their bed, their decorations or their roommate. They likely don't feel well and simply would rather be ill on their own terms in the comfort of their own home.

Deck the Halls

It was sad to see so many who were aching to be discharged from our care to be sent home for the holidays. They understood their illness was severe enough to warrant continued medical care, but like Dorothy said, "there's no place like home." For what it was worth, the halls were decorated with sparkling ornaments, holiday wreaths were hung near each door, and festive music echoed for those close enough to hear. The hospital staff were directly influenced by the trimmings and hopefully some of their holiday spirit spilled over into the patient rooms.

It made me reflect on the importance of relationships among friends and families. Being surrounded by strangers that have only known us for a few hours or days is in no way as fulfilling as family members and good friends. Cherish good health and loved ones because it is too easy to take them for granted. Despite being hospitalized, I hope those patients felt the holiday spirit even if it was briefly shared by a nurse, house keeper, medical student or other provider. May you and yours have a festive holiday season.

Question of the Week

A 26-year-old HIV-positive woman is brought into the emergency room after she is found lying unresponsive in the street. She has no recollection of what had occurred. She reports sensing a smell "like burning hair" and then blacking out. A medical history reveals that she has had a fever and a headache for the past week. An MRI of the brain shows multiple ring-enhancing lesions. Which of the following is the most likely cause of her symptoms?

A. Cryptococcus neoformans
B. Cryptosporidium
C. Cytomegalovirus
D. Pneumocystis carinii
E. Toxoplasma gondii

Answer & Explanation

Resident Fair

Perpetual planning is starting to get on my nerves. If it's not a test, quiz or assignment, it's setting up a rotation or more importantly the rest of my career.



Schmoozing

Normally you would think the opportunity to rub shoulders with resident program directors was a great thing. And it certainly can be in the long run, or at least when applying for programs. When I did it, my stress levels went through the roof. Putting on a best-in-show performance and asking smart questions was on everyone's mind and whether I obtained the information I needed is yet to be determined. Overall, the directors, residents and assistants made for very pleasant conversation. The type A personality in me, however, wonders how I measure up.

At least the forum lectures were exactly what I was hoping to learn; how to approach interviews, medical schools and stay strong during those crucial experiences. Despite the simplicity suggested, the emotional, financial, and time commitments are intense. Perhaps I am just exhausted from hours of study preparing for my upcoming shelf exam. Perhaps I am feeling exactly how all students would in this position. In any case, this year of planning is going to be more taxing than I initially imagined.

Question of the Week

In what state should I consider doing my residency and why? If you have the answer, I will gladly entertain your suggestions and reasoning. Otherwise, it may be some time before this question finds a solution.

Playing Doctor

Anticipating the start of clinical rotations, we were oriented to hospital procedures and scrubbing techniques this week. They made for long days...thankfully there won't be a test.

Sterile Technique

Despite having classes behind us and the board exams ahead of us, we couldn't quite crack the books until we were oriented properly for our rotations. This particular exercise gave us an opportunity to "scrub in" from fingernails to elbows and donning a sterile gown and gloves. It can be a challenge the first few times trying not to contaminate oneself, but the no-pressure environment was perfect for learning this skill. We may not be as proficient as some, but at least we know the basics of the surgical scrub.

It is hard to believe that the second year of medical school has passed so quickly. By keeping us busy all the time and always preparing for the next exam or quiz, we didn't have much time to really slow down. Fortunately, all the grades have been posted and I am still in "good standing" with the university. It's just a matter of time before I can say the same about board exams. In the meantime, the morale boost we get from doing doctorly things will have to feed our fires for this career we have been working hard to achieve.

Board Prep Question of the Week

An 8-year-old boy presents to your clinic with a history of nonproductive cough and recurrent opportunistic infections. His mother claims that the symptoms first arose about 2 years ago and previous physicians suspected an immune deficiency disorder. A chest X-ray reveals patchy infiltrates and diffuse clouding. Bronchiolar lavage identifies numerous neutrophils arranged in isolated conglomerates. Nitroblue tetrazolium dye reduction test is negative. Which enzyme is most likely deficient in this child?

A. Alpha-ketoglutarate dehydrogenase
B. Dihydrofolate Reductase
C. Glutathione Reductase
D. NADPH Oxidase
E. Topoisomerase

Answer & Explanation

Holiday Vacation

The holiday floor strewn with gifts both adult and child reminded me of days with less stress and responsibility. This year we were fortunate enough to have three such weeks between semesters.

Prescribed Relaxation

Using vacation to get away seemed like such a good thought at first and it did the job to some extent. With upcoming board examinations, there is a lot of preparation that merits some planning. Whether finding the right question bank, registering for appropriate exam dates or making the perfect study plan I cannot let all of the vacation slip away to misdirected productivity.

In the meantime, vacation is here, classes are just around the corner and boards will be here in no time. If you happen to have a well organized study plan for boards and don't mind sharing please let me know.

Board Prep Question of the Week

A 32-year-old woman with no significant medical history presents to the clinic with visual complaints. On a recent trip to Arizona, she suffered an acute episode of visual impairment. She experienced blurred and double vision, which made it difficult for her to drive. On visual examination, her vision is 20/20 in both eyes. When she is asked to look to the right, her left eye only reaches midline while her right eye shows a beating nystagmus. Testing for visual convergence is intact. Based on the clinical history and physical examination, what is the most likely cause of her complaints?

A. Amaurosis fugax
B. Cataract
C. Multiple sclerosis
D. Optic neuritis
E. Panophthalmitis

Answer & Explanation