My First Clinical Rotation of Third Year

July 5, 2010

Tomorrow morning I begin my second clinical rotation – internal medicine. I thought this would be a good time to share an amusing anecdote from my first month as a third year student during my hematology/oncology elective rotation.

On my very first day of third year, I spent most of the morning going through the orientation process at the hospital. I got security clearance, my ID badge, a tour of the building, and introductions to the important staff members I’d be interacting with. After the tour, I was on the floor being introduced to one of the doctor’s I’d be following for the month. His first consult that morning was a patient that needed a bone marrow biopsy, and I was asked to watch.

Bone marrow biopsies are usually performed when there is a problem with the body’s blood cell count. The marrow inside of your bones is responsible for creating platelets and red & white blood cells. To perform the biopsy, a region of the back is anesthetized, and a needle is driven into the pelvic bone to aspirate a sample of bone marrow. If done properly, the patient feels an intense pressure in their back, but no pain.

So, on the first day of my first clinical rotation of my third year of medical school, I was asked to watch a bone marrow biopsy. I should note a few things here. First, I have seen this procedure done before. My father is an oncologist, and I’ve watched him work. Second, I had just gotten back from my honeymoon the night before. Because I was nervous about starting my third year, finding a hospital I’d never been to before, and making a good first impression, I hadn’t slept well the previous night. I also hadn’t had anything to eat or drink since getting home that day.

I was fine throughout most of the procedure. The doctor was finished and began putting away his equipment when I started feeling dizzy. I excused myself and sat down for a few minutes, thinking I was OK to leave the room when the medical team was done. When I got into the hallway, my vision started to go black from the outside in. I remember telling a nearby nurse that I couldn’t see. The next thing I knew, it was a few minutes later and I was laying on the floor of the hospital hallway. The doctor who had performed the biopsy and the nurse who I told I couldn’t see were holding my legs in the air, trying to get some blood back into my head.

So everyone had a good laugh at my expense. The nurse sat me at her station and gave me some orange juice and crackers. Two minutes later, I was fine. It wasn’t for another 3 weeks that I got the opportunity to prove I could make it through another bone marrow. A couple of days before the rotation ended, I was with a different doctor for the same procedure. As it turns out, sleeping and eating breakfast are pretty good prophylaxis against passing out.


Halfway There

June 22, 2010

The last lecture of my second year of medical school was over a month ago, and I’ve been on my third year rotations for almost three weeks now. But I couldn’t really relax and take a break from studying until this week when I took Step 1 of my COMLEX medical licensing boards. I was originally scheduled to take the exam on May 28, two days before my wedding. As it turns out, people who are in the final stages of planning a wedding don’t really have too much spare time to study. So I postponed the exam until June 21.

In the meantime, on May 30, I married the love of my life, my high school sweetheart, and my best friend. Nine years ago, when I was a senior in high school, our two families booked a Spring Break cruise vacation to the Western Caribbean. I met Emily on the Enchantment of the Seas, asked her to my senior prom the following week, and we’ve been together ever since. The wedding was amazing. We all had a good laugh at the reception when the head waiter came to my table to confirm that I was a vegetarian. Literally three minutes later, he brought me a steak dinner. Little mishaps aside, I think everything went very well.

The next morning, on 4 hours of sleep, Emily and I boarded a flight to our honeymoon. Nine years after meeting there, we took a cruise back to the Western Caribbean and visited the same ports. We were in Grand Cayman for my 27th birthday and spent the day lounging on Seven Mile Beach. The next day, in Cozumel, we took a catamaran cruise to swim and snorkel. It was the same excursion we did on the first cruise and every bit as fun.

I started my third year rotations the day after we got back from the honeymoon. During the day, I alternate between rounding on inpatient service and following a hematologist/oncologist at his office. At night, I studied as much as I could for the exam. Now that the test is over, I can finally focus on my rotations during the day (more on that later) and relaxing, catching up on video games, and working on the new house at night. It still keeps me busy, but it’s nothing compared to two years of sitting in lecture for 9 hours a day. Only two years of medical school left. Halfway there.


Motivation

April 25, 2010

Every so often, when the endless hours of studying and lack of sleep start to catch up with me, it becomes difficult to find motivation to keep studying. Getting bogged down in the detailed symptoms of this disease or the inexplicable physiology of that syndrome makes it easy to lose sight of the big picture – of why I applied to medical school in the first place. It’s during these times that I take a 2 hour break from studying for the night and pop in my favorite movie.

During my junior of college, I had the privilege of meeting Patch Adams. He came to speak at my school, and, to be completely honest, I can’t even remember what the subject of his talk that day was. What I do remember is that he came out on stage wearing his trademark clown suit (pictured left) and made the entire audience laugh for a few hours. When I met him afterward to sign his book, I asked him what his recommendations were for a student who was thinking about going into medicine. It was fairly loud in the room and I couldn’t quite make out what he said, but above his signature he wrote ‘Follow Your Dreams.’ Cheesy, yes. But meaningful when coming from the right person.

There’s a scene toward the end of the movie where Patch is pleading for his right to graduate from medical school. The dialogue is, again, cheesy. But it’s an amazing philosophy and a great reminder of why I applied to medical school in the first place.

Patch: At what point in history did a doctor become more than a trusted and learned friend who visited and treated the ill? Now, you ask me if I have been practicing medicine. Well, if this means opening your door to those in need, those in pain, caring for them, listening to them, applying a cold cloth until a fever breaks; if this is practicing medicine, if this is treating a patient, then I am guilty as charged, sir.

Dean: Did you consider the ramifications of your actions? What if one of your patients had died?

Patch: What’s wrong with death, sir? What are we so mortally afraid of? Why can’t we treat death with a certain amount of humanity, and dignity, and decency, and god forbid maybe even humor. Death is not the enemy, gentlemen. If we’re going to fight a disease, let’s fight one of the most terrible diseases of all – indifference. Now, I’ve sat in your schools and heard people lecture on transference and professional distance. Transference is inevitable, sir. Every human being has an impact on another. Why don’t we want that in a patient-doctor relationship? That’s why I’ve listened to your teachings and I believe they’re wrong. A doctor’s mission should be not just to prevent death, but also to improve the quality of life. That’s why you treat a disease – you win, you lose. You treat a person -  I guarantee you’ll win no matter what the outcome.


Dynasty Warriors: Strikeforce X360 and PS3 Reviews

March 16, 2010

My reviews for the Xbox 360 and PS3 versions of Dynasty Warriors: Strikeforce finally went up on GameSpot last night. Even though I played the original PSP version pretty extensively, I had a lot of trouble with this one. The console versions are essentially the same game as the portable version, so it’s difficult to come up with new things to say. I’m also not exactly a Dynasty Warriors expert. Mindless combat and level grinding just aren’t my thing unless they’re in old-school RPG form (Final Fantasy, Chrono Trigger, etc).

I’m not sure if I’ll be doing any more reviews for a little while. With my wedding and board exams coming up in May, my free time is really limited. Hopefully I’ll have more time on rotations when I’m not studying around the clock. Until then, if I see the sun outside it’s been a good day.


Camaraderie

January 7, 2010

It’s no secret to anyone who knows me that I didn’t particularly care for my undergraduate experience. While I think I received a good education and met some great people, the extremely competitive environment bred a cutthroat attitude among the students. Because most courses were graded on a curve, other students had to perform poorly in order for you to do well. A certain amount of healthy competition is fine, but the survival-of-the-fittest atmosphere at my university went above and beyond.

When I started medical school, I thought this kind of pettiness was behind me. And for the most part, it is. Everyone is working toward the same goal, and while your class rank is certainly important when applying for residencies, letter grades and GPA aren’t nearly as worrisome. Regardless of how well everyone does, the valedictorian and the person with the lowest class rank will both still become doctors.

One of the grading policies that helped relax the students and give us a small cushion when we didn’t do as well on an exam as we’d like was the decision to drop test questions that performed poorly. At least two or three times on every test, a question would unintentionally be worded badly, contain a typo, or simply have more than one correct answer. These questions were either double-keyed or dropped, giving credit to students who got them right. As long as you were a decent guesser, you could usually count on an extra point or two on every exam.

However, today we were informed that, due to student complaints, professors would no longer be dropping questions with credit but rather removing the question from the exam entirely. So instead of an extra point or two, a poorly worded question makes it easier to do badly by lowering the total number of questions on the exam. Granted, we’re dealing with very small point values and the change isn’t likely to affect most grades or overall GPAs. But I cannot fathom why a fellow student would complain about a policy like this. The only possible benefit it could serve would be to raise his or her class rank a few points at the expense of the rest of the class.

If I had a choice between a doctor who performed well academically vs. one who barely made it through school, I’d obviously choose the one who got all A’s. But if those A’s come at the expense of common decency, I’d start looking for a third option.