Callous Callosotomy

Heard Around Town

I heard two things yesterday from attendings that I found distressing for different reasons, and thought I'd post here for posterity and comment.

Scene 1: Five MSIIs in an exam room with an attending and a patient. Attending doesn't say a single word to Pt or introduce himself. After 15 minutes of didactic discussion in the exam room with patient sans gown, we're each given 90 seconds to perform a cardiac exam. I'm first up to bat, so as I'm fumbling around for a radial pulse, I shake his hand, introduce myself, ask the patient's name, and ask how he's feeling today. Verbatim from the "old codger" (his words, not mine) attending: "You can talk all you like, but you just wasted 10 seconds of your exam time." Good point--there's really no medical reason to communicate with Pts; it's no doubt a sign of weakness to elicit hints of what to look for on physical exam by attempting to take a history. Great teaching point, sir. Thank you.

Scene 2: Four med students in anatomy lab quizzing each other on shoulder musculature while the attending helps tidy up our dissection. Student one: "What action does the deltoid perform?" Student two: "A-B-duction, with the supraspinatus providing the first 15 degrees of movement and deltoid taking over thereafter." Attending: "Yeah, that's what your textbook says and what you should learn for this class....but it's kind of a lie." [Consternation and grumbling amongst students] Attending: "You know, it's kind of like kids and Christmas: everyone starts out believing in Santa because everyone older perpetuates the myth, and then we let you down gently when you're ready." (Med student 3: "Wait, you mean there's no Santa?!") *sigh* I've known this was true since last year (not so much let down gently by Dr. Papa and Dr. Momma Bear, FYI), but hearing it admitted as a pedagogical institution is nevertheless a bit disconcerting. If I'm gonna bust my butt this hard to learn all of this, it'd be nice if at least most of it were true (and if Santa and Rudolph could make a cameo at my house this year).

Off the wagon...and my high horse

As always, there's good news and bad news. Good news: my "choice" paid off big time, and I killed my anatomy test. Seriously. Demolished. Relative to my class, best score I've ever had in med school.

Bad news: it didn't make me nearly as happy as it should have. First of all, I've come down with the Crud and it's nigh on 2.5 weeks now and I'm still coughing and sleeping 9 hours a night. Second, it was the first time anybody--in this case my faculty advisor--ever actually asked me "Why didn't you get 100%?" I'm almost certain that was a tongue-in-cheek comment. Almost. And then there was my dad, who was every bit as proud as I wanted to make him, but who didn't say "Y'know, it'd be okay to have a life and take care of yourself too." And mom's comeback: "You don't always have to be at the very top of your class to distinguish yourself...just, you know, the top 15%." Having surgeons (yes, plural) for parents can be wonderful, and I know they'd love me just as much if I'd wanted to be a starving artist in TriBeCa...but I've inherited their pathology, and I'm suddenly starting to feel pressure I've never noticed from them before. No doubt I'm projecting, but there you go.

And worst of all, that miracle switch I was so proud of a few weeks ago--the one that had me up at 0500 working out 6 days a week--has been switched back off due to the URI and other general malaise. But I'm not sure if I now have the energy to switch it on again. I can feel myself slipping into the dark fog of numb exhaustion. It feels like crap and like I don't have the energy to fix it. I maybe proved that wrong earlier this fall, but one wonders if that big push didn't have something to do with this bug that's put me back squarely on my ass. Sigh. I'm considering doing a research year out just to put my life back together before my clinical rotations. Thoughts?

In the meantime, it's bed time. Yes, at 9:35. No, I didn't accomplish squat with my afternoon/evening; especially nothing like the 50 pages of anatomy reading that needs doing, or the 4 weeks' worth of histology that needs memorizing. And the cycle of feeling awful and worthless continues. Awesome.

Choices

As my mother quite rightly pointed out to me yesterday, choosing to push for excellence rather than merely getting the job done is just that: a choice. Now, in the pursuit of medicine, and given my personality and background, it's maybe less of a choice for me than the average person off the street, but I accept that I've chosen a path, and that I've made active decisions about how I want to achieve those goals.

...and then I have the second or third encounter this month (who knows--they're so numerous now I'm losing count) that goes something like: "Hi CC, you sound like an amazing person that I'd really click with...but I've [choose one: started seeing someone else exclusively; gone back to my unloving ex; decided to join a religious cult and become celibate; realized I'm mentally unstable and incapable of meaningful interaction with the opposite sex...or maybe just you]. Best of luck to you." So, I'm that girl. Again. Looking back on the most recent episode, it's really not possible to correlate my unholy devotion to thoracic anatomy with the disappearance of yet another romantic impossibility, but I can't help but wonder whether I'm lying uncomfortably in a bed I've made.

Rationally, I know that underachieving or dumbing down will never get me in the long run where I want to be even in the unlikely event that it improved my short-term situation.

Irrationally, I return to my childish notion that this just isn't fair, and when will the karmic tide shift? When will it be my turn?? Do I have to give up my semi-occasional academic and corporate victories (such as today's better-than-expected anatomy exam result)?

Here's hoping the answer's no. Otherwise, it's going to be a damn long and lonely road as far as the eye can see going forward...pretty much just as it's been for the last 10 years too, come to think of it. Awesome.

So what's left to choose?

Anatomy...

...in addition to a nice upper respiratory infection, owns my life. Friday night "plans with friends" now involves the cadaver lab and our structures list. I don't remember the last time I was so happy to see Nyquil. I'm going to make a good-faith effort to get through a chapter in High Yield (because let's be honest: I can't open up baby Moore in good faith), but who wants to take bets on how long I last? Definitely brushing my teeth *before* settling in with a book this time...

And after Monday's exam, perhaps I'll get around to writing those posts on Wikipedia and my squeaky Danskos I've been saving. I can practically hear you waiting with baited breath.

You call me "Gunner" like it's a bad thing

A few brief thoughts for the day:

1) Why is it so truly abhorrent to want to do well? I'm getting more than a little sick of the proud underachiever attitude that seems so popular.

I'm not saying it's cool to go tell everyone how awesome you are (hint: if you are, everybody knows it already, and if you're not, trying to impress us isn't doing you any favors), or to be a tool in class to show everyone how smart you are(n't) by asking questions that elicit a measurable gag reflex from the faculty and the other [take your pick: prepared, sensible, secure, truly curious] students in class. All I'm saying is that someday, I'm thinking someone might just thank me for my current compulsive overachiever tendencies (with or without the results to show for it), so I'd consider it a personal  victory if we could all please try to refrain from giving folks, especially me, a bad time for a) buying required textbooks; b) wearing "geek chic" t-shirts with anatomic artwork; c) asking legitimate questions to which I do not already know the answer and genuinely believe an educator-type will be better suited to answer than me looking it up on my own (e.g. lab dissection issues); d) wanting unapologetically to be an exceptional doctor as actualized through exceptional performance as a medical student. Yes, I've been terminally uncool since, well, whenever it started to matter, but watch me not give a damn--someday, someone will be glad that *somebody* in our class actually learned something.

2) It's exciting to finally be immersed in that time-honored rite of passage that is Gross Anatomy. We were just introduced to our cadavers today. This will be the topic for another exceedingly unoriginal post at some later date, but I'm constantly humbled (and frankly a bit embarrassed and frightened) by the intangible cost of medical education to our patients, and how many of them bear it knowingly and willingly. In any case, after 3 hours of lecture and 5 hours in lab, I'm overwhelmed by how difficult it is to identify things on a cadaver that I actually already know the location and orientation of--I'm terrified of the units for which I have zero prior knowledge. Oh, and at 20 minutes past 8, I'm desperately wishing it were socially acceptable to have gone to sleep half an hour ago. One day into the semester and I'm exhausted by 7? This can't end well...

A New Year, A New Attitude

After a very relaxing summer, I returned to school as an MSII. I never really made a secret about how I felt about my first year of medical school, or about the part of the country in which I now find myself. However, sometime around Labor Day weekend this year, a switch went off. I said to myself:

"Self, you've had your year of self-pity and whingeing about wanting to be back in D.C. You had some great opportunities over the summer to get a glimpse of the future [likely involving lots of time in the OR], which will require working your not-so-little tail off now if you're gonna get there. So, how's about you remember that life is too short to be unhappy about and unappreciative of your incredible opportunities in life: embrace the suck with a smile, and focus on the prize." 

And just like that, I'm getting up at 5 am every weekday to work out before class, am going to bed at 10 pm most nights, have re-instated my supplement regime (including plenty of EPA/DHA and resveratrol!) and am largely succeeding in ignoring the dismal status of my romantic life in favor of studying stuff that will make me a better doc someday. It's amazing what a difference a few days' glimpse of the "real" world of medicine--beyond 32 hours of lecture/lab time a week--can make in terms of one's perspective. As part of my newfound empowerment, I'm trying to meditate and work on processing a lot of the emotions that I'm so good at burying (sort of like processed nuclear waste sitting under Yucca mountain: it's safe for a long while...until it's not). To that end, I'm hoping to resurrect this blog for the umpteenth time as a way to share my experiences in medical education with a growing and supportive medical blogging community and its readers.

So, without further adieu, here's to a new year, and a new attitude. Who else thinks it's a beautiful day? =)

Professionalism

To the professor who so disdained the pharmacology lecture topic he was assigned that he decided to read some poetry to us instead: being an ass is not professional, and being snarky and passive- aggressive about it is downright tacky. I have written you a very subdued, diplomatic and professional email enumerating my concerns, but I gotta say, I felt like throwing my coffee cup at you and walking out in the middle of your talk. Thanks for that. -CC

On the bright side, there's nothing like a fresh start...

...on the unbright side, I'm so fucking lonely these days I can barely stand to be in my own skin. Drowning in an ocean, dying of thirst.

Hot Date Friday

...with my Immuno book. Awesome. I heart med school. Thank whomever you like I managed to keep a thread of my old life going (more on this later), else I would have gone apeshit weeks ago.

Seriously, why does school have to suck all the fun out of learning? That part is school's fault. The fact that I can't be bothered to make friends with my classmates, whom I generally think of a tepid at best, well, that's on me. Actually, I'm quite proud of myself: I think I set a new record for the shortest amount of time taken to alienate potential friends through my generally unapologetic bitchy aloofness (or at least that's what my therapist from back east would tell you, though maybe not in so many words).

And to all the perpetually casual people here, why whenever you tell me I look nice today does it feel like an insult? Sue me for wanting to look semi-professional. Honestly, all politics aside, even a gun-toting hockey mom can look the part of a grown-up politician if she has to (and has a stylist).

Disease of the Day

While we're immersed in the drudgery of the preclinical basic science curriculum, our program tries to impress upon our impressionable minds that things like oxidative phosphorylation really do have clinical meaning. That'd be, like, patients. With diseases and stuff. (Yes, now that I'm back on the left coast, I've observed that I must begin saying "like" a lot more in order to blend back in with the natives.)

It actually is a very nice exercise, and some of the clinicians are not bad presenters (today's, however, might be an exception). This is also one of our most interactive opportunities, which is nice considering we don't know jack. However, that means during student Q&A with the patients and their families, the questions are always the same. For example, to the mother of a child with a debhilitating and progressive, probably terminal illness (and three other children): "So can you tell us what it was like when you found out you were going to bury a child, but not before they wasted away into immobility, incapacitation, multiple organ failure and dementia? What are some of the challenges you face?"

And, to ressurect a favorite feature from my old blog, let me say here what I couldn't say there. To the girl who loves to tee up and qualify her question, and then ask the question in 6 different nuanced ways, and then sum up the question, and then state for the record that she realizes that's more like three or four questions... You do realize, don't you, that even if someone were to answer your question (while you're still talking....still going....), you wouldn't hear it; or, by the time you get done with the tirade they won't know where to start? Silence is your shiny golden friend! Practice with me: *LISTEN* instead of thinking of your next question, in a brief pause think of and compose a *single, concise question*, ask it, and STOP. Listen, think, ask, stop. Easy, right?