Callous Callosotomy

Extra Crispy

28 days until that whole Step 1 thing. Two more school exams. Already having anxiety dreams about the wards. It'll be a miracle if I don't implode between now and then...the sanity leaks have definitely started. I think it's a very good thing I decided to go home to study for a few days...if my parents can't keep me sane, no one can. Wish me luck!

 

Spread The Good Word

    It has been many weeks since my last confession, but it’s time for another one: I really like language when used well, and it’s a pet peeve of mine when people bastardize it or just plain get it wrong. The most prominent one in medicine is probably nauseous versus nauseated: if you feel sick to your stomach, you are nauseated; if you’re the resident who has been up for 48 hours sans shower, sans deodorant, and has just returned covered in poo from yet another ED consult for an outbreak of dysentery, then you’re nauseous and make everyone around you nauseated. (For a simple mnemonic, try a quick nauseous/noxious substitution in your head.) But I’m preaching to the choir on this one, n’est pas? What follows, I hope, will be more enlightening.

    One particular diction conundrum has piqued my interest since the beginning of medical school: what on earth is the difference between “dilation” and “dilatation”? Is the “-tation” version a made-up word that makes you sound ignorant if used? Or is it akin to the centimeter as “sontimeter” convention which is uniquely medical and as far as I can tell has no reason for its continued persistence other than to make doctors sound more erudite (which can ironically backfire when, as one of my classmates did this year, someone asks you what one is because it sounds so strange). Or could they actually be two different words describing two different things, the nuances of which were obvious to everyone but me? I leaned toward the latter option for a while, but then went more toward the first after asking a couple of surgeons in the family who couldn’t seem to agree or decide between the two. Ultimately, the uncertainty was just too much to bear and I succumbed to my inner geek (we’ll just pretend like that was a struggle) and did a lit search. I figured there had to be an obvious answer, since they are both so commonly used. As it turns out, there’s really not much in the medical literature on this. Maybe I’m the only one surprised by that. Alas, I was not to be deterred. I soldiered on, and am very (overly) proud to say that I have emerged victorious! I think the last time I needed a primary source that wasn’t electronically available was maybe six or seven years ago; at the very least, the miracle of interlibrary loans and PDF scans made it seem like it was all available electronically (a big “Thank You!” to all the librarians out there). But no, as an intrepid etymologist my quest would not be that easy; I was forced to go back to the stacks and sift through bound hard copies of The Journal of Urology, get myself a copy card, and photocopy the darned thing. And now that you’ve earned it by humoring me while I recount my epic odyssey, I will now share with you the Truth (are you as excited as I am? No? That probably speaks well of you):

    Bottom line: dilation and dilatation may used interchangeably, though the verb form “to dilatate” is rarely if ever heard. Dilatation appears to be the original word--first seen in Chaucer--from the Latin noun dilitatio (the verb: dilatare); for this reason, the OED sticks with dilatation as the more correct form, but in practice either are acceptable. Credit for all this goes to Bloom, Mory, and Hinman (1); see the citation below for more info and leave a note in the comments if you’re not keen to hunt for the original and I’ll send you the PDF.

So, go forth and spread EITHER of the good words and do so with the conviction of one who can cite a source!

1. Bloom et al. Dilation vs. dilatation: a brief history. J Urol (1992) vol. 147 (6) pp. 1682

Walk of Shame

No, it’s not what you’re thinking. Sorry.

I’m a med student, remember? And one with no game at that, at least at the moment, so get your mind out of whatever seedy locale it’s inhabiting, and let’s talk about anaerobes.

I wish it were a dirty little secret that I have zero horticultural follow-through. I love looking at plants and flowers, I do. And, before my cat started eating my houseplant, I was even keeping one of those alive. It’s not that I lack the proverbial green thumb--it’s that I lack the discipline to water, weed, prune, nurture, and otherwise induce plant life to thrive. I’m a plant killer. There, I said it. It’s not like they just die despite my best efforts...it’s that at some point I completely cease to make an effort. If plants were animals, I’d be brought up on charges by now. Thankfully, the last in my series of “nannies” who was essentially a live-in grandmother managed to drill through my thick skull that pets were a) precious, and b) had no way to fend for themselves (since we so blithely robbed them of natural instincts and/or opportunities) and so were always priority number one in terms of chores. Dishes can wait, and laundry will still be doable tomorrow--Spot cannot wait. Period. Alas, I had real pets growing up and never learned to think of my plants as “Spot”. So, when my mother decided I needed flowers and a tree for my patio, I was hesitant. But you’ve not met my mother, so let it suffice to say that saying no more than once wasn’t going to do me any good. If she wanted to envision my front porch with Bougainvillea, then I was damn well getting some.

It was lovely while it lasted. Really. Alas, not only the Bougainvillea, but also the beautiful flowering vine-tree-thingy and the two long beds of...Impatiens, maybe?...have been dead for a long time. Months. And they’ve been sitting on my front patio this whole time. Ugly as all hell, and the planters accumulating a pond-scum like substance that I’m certain would have spontaneously generated some nitrogen-based life forms if I’d just been allowed to leave it there for another year or two. Shockingly, the homeowner’s association found this....distasteful. So, I got an email from my landlord today--an apologetic email--asking would I please be so kind as to do something with the rotting carcasses of my plants? So sorry for the hassle. I can’t imagine why the homeowner’s association is so unreasonable. (For the record, they never NEVER contacted me directly. Just my out-of-state landlords. How delightfully passive-aggressive.)

As the wave of shame and guilt receded, I promptly sent back an email saying it was as good as done. Truthfully, I’ve been meaning to get around to that for ages. It’s just that I so rarely go in and out of my front door and past my front patio, so the evidence of murder was easy to ignore. Plus, I’m a very busy person. Right? Yeah, sure. I keep telling myself that...just not to my face in the mirror. Trash day is on Monday, so it really could have waited until tomorrow, but knowing it had to get done this weekend, it was going to haunt me. So, I drove home instead of going straight to where I’d planned to spend my evening. I rolled up my jeans, and put on my Wellies (yes, they have heels...let’s just move on, shall we?) and my semi-gross gym fleece and those yellow dish gloves (and a ball cap for the charade of anonymity), grabbed some big black trash bags, and went out to tackle the beast. Beasts, plural, actually. I’m not sure if you’ve ever considered how to get a six foot dead tree-vine-thingy plus its planter and wooden “posture” stake into a small garbage bin, but it’s not a trivial problem. Add to that the fact that my garage and my patio are on opposite sides of my house, and there was no way I was dragging carcasses through my house with my kitten in tow, and you’ve got a dilemma. As it turns out, the tree wasn’t nearly so bad as draining the swamp out of the planters. Having passed the bacteria section of micro, I’m confident in my assessment that the malodorous aspect of the task was attributable to anaerobes. If you’ve not had the pleasure of sticking your face in a culture full of them, I’ll try to explain the sensory experience of emptying my planters: you know that python in the Everglades that exploded after trying to eat an alligator? Imagine that, plus some swamp water, decomposing in a horse stall that hasn’t been mucked out for a solid week or two, and you’ll begin to get the gist. I’ll not expound on the details, except to say I hope there’s not a follow-on post about being fined for illegal dumping of potting soil in the community landscaping. However, the only way to get this embarrassment off my patio was to go around the block, and get my garbage bin. Yes, it got hauled up the stairs to my patio. And hauling it back down with an extra 30 pounds of plant carcass, potting soil, and planters...and then the roll back to my garage, when there didn’t seem to be any sound in the neighborhood except the harsh rattle of the wheels on concrete...me still in my wellies, yellow dish gloves, fleece and cap...yes, my friends, that was the walk of shame.

I really, really hope my garbage bin empties completely on Monday and nothing gets stuck. That tree planter was kind of a snug fit, and if it doesn’t come out, I’ll be haunted forever. Not to mention being completely unable to put any other rubbish in my bin. On the other hand, it would probably serve me right. Plant killer purgatory. Sigh.

Lonely No More: Isolation Comes Out Of The Closet - Jezebel

"The title Lonely tends to conjure up words like shy, sad, and withdrawn, so it's something of a surprise that Emily White has written an impassioned call to arms on behalf of a condition no one wants to talk about."

via jezebel.com

Medical school has a reputation for being socially isolating, and as a social hermit, I didn't think it would impact me much. Unsurprisingly and following a theme in my education, I was wrong. As I read this article via Jezebel , the concept really resonated with me: how much of the depression I see around me can be attributed to sheer loneliness? In my own dark moments, I think this is a huge component. Should it be its own DSM entity in the upcoming DSM V? I don't think so, since I don't think it's such a clinically relevant distinction with treatment implications, but psychiatry isn't my bailiwick. Anyone else have thoughts?

Hypochondriasis

I usually think of myself as a fairly level-headed person. I weigh evidence, I try to evaluate all sides of an argument, I gather data. I will admit to having a superstitious side--there was a gate where I went to undergrad that, legend had it, you couldn’t walk out of (walking in was a topic of popular debate) before your graduation or you’d fail out of school; I was one of several people who didn’t really believe that...but always took the side exit anyway, since it was just as easy. However, superstitions aside, I’m not usually the type to get bent out of shape over something without some reasonable demonstration that it’s actually a big deal. You can imagine my surprise then, to discover that I’ve become at least a little afflicted by the famed hypochondriasis that afflicts medial students when taking pathology.

Now I have another confession to make: I’m the child of two physicians. For those of you who’ve not had the pleasure, let me recount for you what it’s like to be sick or injured in a house like that:
CC: “Mom, I think I’m sick.”
Mom: “Did you take Advil? No? Take 2, then talk to me in a few hours.”
...a few hours later...
CC: “Mom...still sick.”
Mom: “Ok, take 4 Advil, and we’ll see how it’s going before bed.”
...before bed...
CC: “I still don’t feel well.”
Mom: “Ok, time for the big guns: take 4 Advil and 2 Tylenol, and we’ll see if you feel better in the morning.”
In the grand scheme of things, it’s a very sensible approach: most nondescript illnesses in kids are self-limiting, and symptoms are improved by anti-inflammatory and anti-pyretic drugs. To be fair, I never had anything with Strep-like symptoms that wasn’t properly evaluated, and any orthopedic trauma was also taken reasonably seriously. However, I was incorrectly treated for asthma for years before ever getting a proper workup (since the meds never really seemed to help...what a shock). In any case, the point is that, by and large, most illness in otherwise healthy people is pretty mild. So when I got my fourth upper respiratory infection (URI) this academic year, you’d think I’d chalk it up to working in a pediatrician’s office a couple of times a month, and leave it at that. Oh no, not CC. CC trotted down to Student Health for labs, and then spent the week conjuring up scenarios by which one might have acquired some immune deficiency or had an otherwise unremarkable exposure to blood-borne pathogens: I told my dad about my recurring illnesses, and he made a joke about checking an HIV titer....despite ZERO exposure/reason to believe I’d be HIV+, this comment freaked me out enough to get that done with the rest of my lab panel. I mean, there was a guy in another class who got leukemia after his first year--maybe I had that?! This was of course when I wasn’t sitting in Path lecture wondering how I’d ever know if I was getting acromegalic, since I don’t wear hats enough to notice an increase in hat size...

I’m really floored that I’ve completely been overtaken by this now-cliched phenomenon: I know better. I know better! Yet that little kernel of anxiety that I’ve learned to suppress with logic suddenly sprang to life, and I’ve been having a hell of a time putting it back in its little box that is supposed to sit in the proverbial basement of my psyche. Believe me, taking psychopathology concurrently hasn’t helped. The good news is that there’s a happy ending: all my labs were “within normal limits” (save an increased eosinophil count befitting someone as allergic as I am), so maybe now I can go back to studying for my micro exam without wondering if my last respiratory illness was Histoplasmosis...

The Courtship Conundrum

In belated honor of V-day, I thought I'd blog about a more personal subject--dating--as it relates to medical education.   Initially, I thought the two were completely independent, but then I had a conversation with a good friend of mine who is a fourth year, and was on her residency interview circuit at the time. The conversation went something like:

"Hey Jane! I'm a lowly second year desperate to live vicariously through your oh-so-exciting life as a big, bad fourth year. Tell me all about all the awesome residency programs you've visited."

"Hey CC. The interview trail has been great--I loved program X in particular. Wonderful training, great educational atmospherics, beautiful hospital, friendly people, all that..."

"And?!?! Sounds perfect!"

"And it's in the middle of nowhere, and everyone, including every other interviewee, was married." [Tragic circumstances ended Jane's long-term committed relationship late in her 3rd year.] "I'm just not sure I want to spend 4+ years in a place where I'm the only singleton. The program director asked me if I needed any more info, and when I asked to speak with any other female resident who entered the program single, it took him weeks to find one!"

And, sho' 'nuff, Program X didn't make Jane's top 4 in her final rank list. It had never even occurred to me to look at that dimension of a program, or more accurately, its location but I've been mulling it over ever since we had that conversation, and she's so right. When you think about it (I have) the complications of finding a partner while in medical training are myriad:

1. If you want to date non-medical types, you have to try to explain why your schedule is miserable, why you're exhausted during your free time, why studying for an exam that's 3 months away is a big deal, and all of this is AFTER you find someone non-medical during all that extra free time not spent in the library, the gym, etc. If it weren't for the Internet, I'd never have had met anyone to go out with; I can't blame the lack of a sustained relationship entirely on my lifestyle, but that's no small part of my, erm, less than stellar dating life;

2. If you DO want to date a medical type, then you have the fishbowl problem: medical schools and hospitals are just big fishbowls where everyone always sees--and discusses with aplomb--everyone else's social life. I've seen and heard of med student relationships go wrong in the first two years, and wow, talk about uncomfortable. It can only be marginally better in a hospital. And again, all this is only a problem if you can get past the initial hierarchy issues. For example, I'm a few years older than most of my classmates, and I routinely date people 5-9 years older than I am--that puts me squarely in med student/resident territory, and deity help me if he happens to be very junior faculty; that kind of thing is just not done. Nevermind that it's frowned upon by lots of very important folks with titles like "Dean", "Chair", etc. The chemistry would have to be off the chart for a resident or attending to violate the social hierarchy, not to mention any guidelines, explicit or otherwise, regarding relations between teachers and students. Given the number of male nurses, the student doctor/nurse scenario doesn't worry me too much, but I do wonder about my male colleagues and what would happen if one of them started dating one of the nurses while on clerkship...

Oiy, I'm demoralized (again) just thinking about it. Now I realize there are all kinds of exceptions, and people find each other every day despite these and worse circumstances. I'm just saying that, from a theoretical perspective, it's a challenging problem. My mother would tell me that this stuff just always works out, and worrying it to death is pointless. She's usually right, and no doubt in my mind she's right about this, too. You'll be shocked to learn, I'm sure, that I'm a compulsive worrier about life issues. Nevertheless, Program X has been knocked down a couple of pegs in my own "potential residency spots" list...

Mind Over (Brain) Matter

I just heard from my friend (see earlier post: "A Moment To Breathe") who called to let me know he passed his make-up anatomy exam, and thus the class. I'm so very happy for him, but the emails I got from him through the night last night as he was cramming were incredibly despondent--he was convinced he was stupid, incapable of learning anatomy, and destined to fail. This, after he took me aside after our last scheduled anatomy exam to tell me that my "attitude is everything" pep talks made all the difference for him while he was taking the test.

I always acknowledged that attitude was a fairly important part of my own performance under pressure. However, before watching my friend almost psych himself into failing anatomy, I never before understood just how powerful an effect one's "self-talk" could have on previously successful, experienced students. Just for fun, I did a (very) quick literature search on [academic performance AND attitude AND "self-talk"] just to see what would come up, and I was surprised by the results: about 4300 papers came up (maybe 3,000 more than I was expecting), and a few based on title alone seem to address aspects of my specific question going back as far as 1979*. (As I've moved more extensively into the biomedical realm, I seem to have picked up that nasty bias that any research done before 1995 is obsolete. Shame on me and my poor representation of my degree in psychology. ;) Not surprisingly, I've had yet another shockingly unoriginal observation. =)

I'm not sure when I became such a proponent of the "attitude as a determinant of outcome" theory of high-pressure academic/professional situations, but I know I owe any such beliefs to my mother. My conversion certainly wasn't in high school, when my mom "encouraged" me to listen to these guided imagery tapes made by a colleague...maybe it was in college when a few of us had a tradition of listening to a particular song--for most, it was "Eye of the Tiger"--and reciting "this test is my bit&#" while we walked to our exam. In any case, in those instances it was always difficult to determine how much of anyone's given success or failure was due to the psychological readiness factor. I grant you that my friend's situation is at best a case-report, and certainly not a randomized controlled trial, but I've been with him when he studies--he's not at all "disabled" in his learning of anatomy--and have watched the change in his attitudes and beliefs during the class. I'm more convinced than ever that his mind, and not his brain, almost failed him. Luckily, he managed to pull himself out of his downward spiral before impact, and I think he's learned a lot about himself. A happy ending, with lessons learned and everything. What a happy way to start the New Year!

*For example, see:

Fulkerson and Galassi. Relation between cognitions and performance in math anxious students: A failure of cognitive theory. Journal of Counseling Psychology (1984)

Neck and Manz. Thought self-leadership: the influence of self-talk and mental imagery on performance. Journal of Organizational Behavior (1992)

Schutz and Davis. Emotions and self-regulation during test taking. Educational Psychologist (2000)

Wachelka and Katz. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities. Journal of behavior therapy and experimental psychiatry (1999)

Wolters and Rosenthal. The relation between students' motivational beliefs and their use of motivational …. International Journal of Educational Research (2000)

The Science Behind Resolutions

The Science Behind Failed Resolutions - WSJ.com

For those getting ready to declare New Year's Resolutions, here's a link to one of my favorite findings in the psychology literature as reported by the WSJ. Forget about the "failed" part--just remember, there's only room in your prefrontal cortex for one act of willpower at a time! ;)

A Moment To Breathe

With 3 of 4 final exams for the semester under my belt, I finally feel like I have a free moment to look around and smell...something besides formaldehyde. This has been a very interesting quarter for me, probably more personally than professionally, and I'm not really sure it's been a positive change. Here's the quick recap:

1) Acquired a new nickname, which I believe coincides with spending enough time with some classmates that my apparently impenetrable shell was, well, penetrated. I knew people thought of me as a little intense, but I kinda chalked that up to being in a very, almost pathologically, laid back part of the country. However, I had no idea just exactly what that meant to people. One of my anatomy lab-mates on trying to set me up: "CC, I'm trying to think of people I know that I could introduce you to...[pensive pause]...well, they're all really nice, but you'd eat them alive." Eat them alive? Where does this come from?! Then there was the other comment about eating small children and kicking puppies, but I'm pretty sure that was a joke. I think. Though the repeated "gunner" comments were probably not so much in jest. Again, since when is wanting to be a good doctor a crime? I help anyone I can, and do my best not to make anyone else feel bad or stupid--how does this make me a gunner? As long as you don't steal my light while I'm dissecting, I'm a really nice person. I swear!

2) I might have done very well this semester, but the price was very high. My gym attendance has dropped precipitously, I'm terrified to get on a scale, and I've been ill twice in a single quarter. Is killing anatomy worth all that? My head is just not in a good place, which is in large part due to...

3) ...high-maintenance friends may or may not be better than no friends. As I mentioned, I spent more time with other folks this quarter, which ostensibly should be better for my non-existent social life, but honestly just feels like a big emotional energy suck. No doubt this is about my inability to lean on others, but somehow these two relationships have felt very one-sided... [Redacted to protect the guilty...that'd be me]

4) In the year-off-for-research debate, I've defaulted to no year off, but I continue to be nervous about my research exposure for residency applications. Then again, doing research as a resume building exercise is a bit foolish. So, I've decided to write a book with my mom instead. In all our free time. This of course begs the question: what kind of career do you really want for yourself? If you don't want an academic career, it's a moot point. However, I'm stuck in the academic cycle of "if you can, you should". That is, the expectation is that you'll go to an academic residency, and if you don't, it's because you weren't academically competitive enough. This was reinforced when a good friend was staying with me on the way to one of her residency interviews--she's been to every major academic program in the country (Boston, St. Louis, Rochester, Raleigh-Durham, Seattle, etc.), and mentioned feeling the same kind of pressure to me, though she's also not sure whether she wants anything more than to be a great all-around anesthesiologist at a community hospital. Sigh. Decisions, decisions.

I'm guessing there will be a "Part 2" to the recap once I get some more sleep and figure out what I'm missing, but this will have to suffice for now--off to lunch with my advisor. Here's hoping he's got some pearls of wisdom for me...

Happy Holidays everyone!

-CC

And my USMLE studying begins...

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