The Chameleon

Way back in high school, I had an English teacher my senior year whom I really loved. She was an excellent teacher, a truly Southern woman, yet totally liberated. After I'd received my acceptance to college, and gotten accepted into a pre-med program, I told her all about it. Her response? "You should be an English teacher." I thanked her politely, but I told her I had my heart set on being a doctor.

One of my high school band directors also played trumpet with me in our church orchestra on Sundays. I told him about my plans to go to medical school after college; he told me "I can see you going to a small liberal arts college, majoring in music, and becoming a band director." It really was too bad that I didn't see myself that way at ALL. I thanked him politely, and told him I really didn't think I wanted to be a band director. Although, there are times when that option seems more appealing than it did then...

One of my surgery chiefs got all into the idea of my being a surgeon; she offered to help me find an adviser, and help me write and publish a case review. Both of my pediatrics attendings asked me if I was going into pediatrics, and were visibly disappointed when I politely (but firmly!) told them I had no interest in pediatrics.

Last night, on call for internal medicine, was one of the worst nights ever. I made several screw-ups that got me (nicely, and rightfully) chewed out by my upper-level resident. I misunderstood an errand I'd been asked to run, and instead of heading upstairs to fetch the cards, I drove to the med school and back (an hour round-trip in 5 pm traffic). As I got progressively sleepier and more brain-dead, only 3 Cokes and intense, unholy fear of my attending kept me moving. As I prepared my notes, I kept filling in blanks I'd left: a finger-stick glucose here, a TSH there. I finished and signed my notes, transferred data around until my scut sheets had all the values I'd need (hopefully), and felt the pressure in my chest get heavier and heavier. 6 am: go time. My respiratory rate sped up. The onslaught began with chest x-rays: "what do you see?", "why do we have this CT?" (the answer was almost always, "the ER ordered it") "what other abnormalities are there?" (after we'd discussed the only abnormalities I could see). One of my fellow students, a studious but nervous guy, had a visible tremor as he fumbled his papers looking for lab values (this same student has Gilbert's syndrome, and was a distinct shade of yellow this morning from the stress). It went on, and on, and on, for 6 hours and 20 patients. Constant calm criticisms flowed: "this is unacceptable", "you guys' physical exam skills suck", "that's not the question I asked you", "I'm asking you guys to use some common sense," etc. It was brutal. I managed to escape the worst of it, and after my first patient to present, the shaking stopped, and all I could think about was the fact that I hadn't peed in 6, 8, 10, 12 hours (nor did I really need to, which was more worrisome). Finally, the last quick staff note hit the last chart, and Dr. H said "Students, come with me."

We entered his lair, I mean office, and settled in for a quick chat. "I only yell because I care", "don't be overwhelmed", "medicine is tough--a lifelong process" were only a few of the quick phrases that were tossed around. As this was our last (and only) call with him, he asked if we had any problems or questions. When no one spoke for 2 seconds, he said "Great. I want to talk to you [pointing at me] for a second--the rest of you can go." The other three filed out, relieved at having gotten off so lightly, and looking at me with pity. I collapsed in a chair and waited while he made a phone call. What had I done wrong? Did I kill a patient? Did I forget yet another lab value? My notes went on the chart at the correct time, I had all my vitals, and I'd escaped the most furious of the tongue-lashings. Then I wondered, did he want to talk about my intern or resident? My intern was convinced she was failing, although I didn't think she was the most yelled-at of the interns. My resident was definitely the better of the two on the team. WHAT THE HELL DID I DO WRONG OH GOD I SWEAR I DIDN'T MEAN IT JUST GET IT OVER WITH AND KILL ME NOW! He hung up the phone, turned his chair around to face me, and said...

"You were made to be an internist."

I don't know how I kept my mouth from dropping open. My heart had definitely stopped.

He proceeded to tell me that I asked the right questions (I didn't recall asking any), that I had a good knowledge base, that I was not only made to be an internist but also a subspecialist, because I needed to know everything, to be an expert. He discussed an article I'd given him (at his request), and how I was obviously thinking in the right way. He said he wanted me to seriously consider internal medicine as a career, that he didn't know if I already had plans but he wanted me to keep medicine in mind. He then asked if I had any plans and I politely said "I'm keeping my options open now". I thanked him and told him I'd never felt as stupid as I had during the past week and a half. He reiterated the don't get overwhelmed speech, I said "thank you, sir", and we walked out.

I didn't know whether to laugh or cry or tell him how much I'd hated the previous evening, how many times I'd picked up my purse to see the next patient and thought "I could just leave now". I didn't tell him I'd never considered internal medicine, or that I liked surgery or OB. I just said "thank you, sir".

Even now, after a refreshing post-call nap, I still think I was hallucinating.

I Talk A Lot

As I went through to edit the HTML of my blog layout and some of the posts that never quite worked right (like the Hangover post--I finally got it to work!), I noticed something. I make excessively long posts. In other words, I am exceedingly verbose (even when I'm saying that I talk too much). My apologies if the mega posts are annoying. Take some Ritalin--you'll make it through. (By "you" I'm referring to any of the 1,062 people who have visited my blog. Thanks! Fortunately, SiteMeter doesn't tell me how many of those visits are me, checking to make sure stuff worked.) I'll try to work harder at not rambling for hours through every single last detail of my boring, lame life that nobody wants to read, not even myself. I promise. I will stop talking. I swear.

More Mythbusters, then bed. I have my first call on internal medicine tomorrow, and I'm terrified. I only have 4 more days of Dr. Hardass! My goals: learn LOTS (the man is truly a walking library of evidence-based medical facts) while NOT receiving any ass chewings. We'll see.

Too Boring to Blog

Get up, go to work, quiver in face of attending, come home, watch TV (lots of CSI: Miami and Mythbusters), whine about cooking dinner, go to bed. Get up, repeat (insert a chewing-out by said attending). Get up, repeat. Get up extremely late, bake a gingerbread (I took it out of the oven a shade early, so it was too gooey in the middle), drive to the boonies, have Thanksgiving with hubby's grandmother, drive home, go to bed. Get up, watch football, go shopping to finish wedding registry, go out to dinner with father-in-law, come home, go to bed. Work Saturday, come home, watch lots of TV. Work Sunday, come home, watch even more TV. That brings us up to tonight, where I'm watching Mythbusters and reading other people's blogs.

It was a bit of a depressing week. I'm usually a "superstar" in medical things. My peds attending told me she wished all students were like me (I blushed). Fast forward a month, and I'm a gibbering idiot. Thanks to a miscalculation of my time and a misunderstanding, I failed to write any notes on my patients before rounds and failed to check DTR's on a patient with a TSH of 53, so I was told I obviously didn't want to learn and that my performance was "unacceptable". All this on the second day of the rotation. Ever since, when I have to speak to my attending, I've started shaking like a leaf--it's truly pitiful.

He's a hardass, this is true. He's also an unbelievably intelligent man, a very caring physician, and a demanding teacher. He won't be doing my eval, so I don't necessarily have to impress him; I just don't want to be a blithering idiot. It doesn't help when I have interactions like this:

Surgery intern: Hey, how's it going?
Me: Hey, I haven't seen you since trauma. I'm on medicine now.
Intern: Oh yeah? Who's your attending?
Me: [Dr. Hardass]
Intern: *Laughter*
Me: Gee, thanks.

If people didn't continue to say things like this to me, maybe my stomach wouldn't be tied in so many knots. Perhaps I'd be sleeping better, not constantly imagining my next interaction with the man.

Other than that, the only news I have to report is that one of my patients gave me a bracelet this morning. I tossed it in the trash (out of his view, of course), as it was constructed of the band from a latex glove and some sort of paper, and it wasn't entirely clean. He told me it had the power of the Bible in it. Who knew dressing a guy's decubitus ulcer could prompt such gratitude.

Scary

My new attending literally told a patient today that if he continued to do cocaine and drink alcohol, that not only would his bleeding ulcers get worse, but that he could possibly die. The attending then told him that he should find another hospital if he was going to continue these habits and quit wasting the county's money.

Last night my new team admitted patients; this morning was our first day, post call for the rest of the team. One of my interns wrote a little note on her papers and showed it to another while we were rounding (very middle school). It said "3/4 of my patients are cocaine positive".

As I read through the H&P my intern wrote, I noticed that she said the patient was "hyperthyroid" at least 4 times, yet her plan included "thyroid replacement hormone" for "hyperthyroidism". It's a good thing this patient is actually hypothyroid, or this plan could be really dangerous.

Ah, good times at ye olde county hospital. It's going to be an exciting month.

Ugh

I'm sure most people already know about this, but OJ Simpson has written a book entitled "If I Did It", detailing how he would have killed his wife (if he had, of course). This announcement comes very soon after the court ruling denying Ron Goldman the rights to Simpson's celebrity persona (which is probably a good decision, in my opinion, even if it is a hard one to swallow). This whole thing is disgusting and trashy, and to make it worse, Fox is going to air an interview where he will discuss these issues (NBC turned it down). My computer is freezing up, or I would post a link to the times of this airing.

It's entirely within Simpson's First Amendment rights to say these things, and the precedent of double jeopardy prevents any further prosecution in these matters. Therefore, my only recourse is to exercise my civil rights NOT TO WATCH THIS MAN'S SHOW and NOT TO READ THIS MAN'S TRASH.

Breaking Bad News

We had our first-ever class on how to break bad news to a patient this week. I say "first-ever" because I actually think I might have benefited from having such a class earlier in my training, followed by a refresher course now. The class didn't really contain any instruction; instead, a standardized patient (SP) sat in the front, and two student volunteers each attempted to break the news to her that a routine chest x-ray revealed a lung mass suspicious for cancer (confirmed by CT). The first student did an excellent job; the only thing I would have done differently is that I wouldn't have interrupted the patient's questions to read things like "pleural effusion and right pleural mass" off the CT findings. The second student didn't really have a chance. The SP changed her tactics: instead of being quietly shocked and tearful, this time she was fuming mad from the get-go. "Some idiot called me and said there was a mistake on the x-ray, and instead of repeating it I got some cat scan thing, and all I wanted is your signature so I can go get my new job!" The poor student, flustered from the beginning, struggled to do his best, but the SP wouldn't give him any ground. At one point, he looked at the audience and the instructor and said "Can I call a friend?" He was given no lifelines, however, and literally ran out of the "patient's room" at the end of the encounter (amongst much laughter, including his).

I, fortunately, was not chosen for this encounter, and studiously avoided the instructor's eyes when she asked for volunteers. During both students' attempts, I squirmed in my chair, especially during the second. All I could think was "Thank GOD that isn't me up there!" It's one thing to deliberately enter an encounter that is guaranteed to be uncomfortable; it's entirely another to do so in front of a room of your classmates. I do think it might have been nice to have a little more instruction, like "What NOT to do when breaking bad news", or "How to pass the SP interaction on Thursday".

My extreme discomfort showed me that I have an awful lot to learn about this topic. I was present when my senior resident confirmed that the "head mass" seen CT was indeed most likely cancer for the family of the fifteen-year-old patient, and it didn't feel so awkward, just sad. But I didn't really have to talk. I've never had to break that news myself. I'm really not looking forward to the "practice session" on Thursday, where I will get my own SP and I will have to tell them something bad. However, I think this is something, like the rectal exam, that I'd rather practice on someone who's getting paid before I have to do it for real.

I do have a fear about breaking bad news, and that is that I will cry. I don't know if a patient or their family would be offended if their doctor cried while delivering bad news. Would it be a sign that the doctor cared, or would it make the encounter more about the doctor than the patient? Is it a sign of weakness?

On a slightly related tangent, I expect to have to use my new-found knowledge during this year, because one of the oddities of being a third year medical student is becoming a "patient advocate". We really get the most time to be with each patient, since we have (far) fewer duties than any of the actual MD's or nurses: we generally only carry 3-4 patients at a time, and we are only marginally useful in doing actual work, AND we are inefficient at conducting H&P's, so the combination gives us the most time to spend with the patients. I've had patients tell me I'm the only person who answered their questions. Most residents and doctors I've worked with cared about the patients, answered questions, and tried to keep patients informed. Yet, the perception was one of confusion and lack of information on the part of the patients. As I'm getting ready to go back to the county hospital for internal medicine, I'm trying to get back into that mindset, to remind myself that it's so busy at this place that questions get lost and patient care may be cursory. We'll see how well I do.

Why I'm Still in Med School

As a third year student, I finally get to interact with patients. It's so strange, finally getting to do what I came here to do (except, of course, this month). I had occasion to give a tour to some interviewees last week, and it reminded me just how far I've come since I got here two and a half years ago. Ah, to be so naive, thinking medical school is all about gross anatomy and learning to be a doctor. All these kids wanted was to talk to a "real live med student" about what life is like on the inside. How busy will they be? What is gross anatomy like? What are the students like? How competitive is it here? Can we go to the gross anatomy lab? What does it feel like, to almost be a doctor?

I get that kind of question a lot. Other common questions I get when I tell people I'm in medical school: Is it like Grey's Anatomy? (Of course! I have sex in call rooms with my supervisors ALL THE TIME.) Medical school? So you're going to be a nurse? (Nurses work hard, but I'm paying an awful lot to go to school for that MD, dammit.) What is internship like? (Why are people so obsessed with interns? I guess that goes back to the first question.) What is it like, getting to see patients and treat them?

Two years ago, these questions were a little more painful for me. The first year of medical school (at my particular institution; it varies) is split in half. The first semester consists of gross anatomy, biochemistry, histology, developmental anatomy, and the first part of a course on learning how to take a history and physical (called ICM). The second semester contains physiology, immunology, neuroscience (blegh), microbiology, and the continuation of the "being a doctor" course. The first semester is physically and mentally gruelling. Lectures are held every morning from 8 to noon, gross lab MWF, histo lab T/Thur, ICM whenever they can fit it in. Week-long blocks of exams occur 3 times, with the last block running into 2 weeks of finals. The second semester has a little more free time in the afternoons, with the exception of neuro lab on Mondays, but there are 4 week-long blocks of exams plus two weeks of finals.

I did okay through the first semester of first year. I was living alone at the time, since my fiance was living in DC, so I was able to keep basically whatever hours I wanted. I made some close friends within the med school class, and we had marathon bitch sessions about the hardships of med school. I started going to the homeless clinic that December, seeing patients and trying to reconcile learning dense enzymatic pathways with "being a doctor". I did okay. I even started seeing a psychologist at the school, beginning to work out my years of depression, anxiety, and neuroses (I said "beginning", okay?? Geez!).

After Christmas, the semester started badly. I had traveled too much over the break, beginning the semester exhausted. The neuro professors emailed us over the break, giving us homework that I couldn't complete (along with a majority of the class) because I was out of town. I started thinking, why am I here in medical school? I didn't come here to learn 80 different cytokines, I didn't come here to learn every single neural pathway (especially when we don't *really* know how they work, anyway), and I didn't see how learning the delicate nuances of gas exchange across lung membranes was going to affect me as a doctor. I got more and more depressed, more and more avoidant. I quit going to school, relying instead on the school's streaming video system to race through lectures as quickly as possible. I only showed up for neuro lab, which was mandatory, and sometimes microbiology, which I inexplicably loved (and which most everyone else in my class HATED). I took spring break up to my mom's house in the mountains and slept nearly the whole week, watching CSI when I was awake; I actually took the following week off of school, renting CSI DVD's from Blockbuster one at a time (on one of those unlimited rental passes). I knew my behavior was destructive. I didn't like how I felt sitting on the couch for hours unshowered, eating frozen dinners, barely getting up to walk the dog. My whole life's direction seemed up in the air. Why was I in medical school? I wanted to be a doctor, not a biochemist, not a physiologist, not an immunologist, and certainly not a neuroscientist. I hated being in the school building. One of the few things that I did that semester that helped (aside from continuing to see my counselor) was that I continued to visit the homeless clinic. I don't remember how many times I went, perhaps 4 or 5 times, but those were the few times I felt like I was in the right place. This is why I'm here, I'd think, I just have to make it through this other bullshit.

Since I've wanted to be a doctor pretty much as long as I can remember, this existential crisis really threw me. If I weren't going to be a doctor, what would I be? There was no answer to this question. With only a few weeks left to go in the semester, I made myself a deal: if I couldn't hack it, I'd take a year off, do some research, work a part-time job, and come back in a year. That way, I allowed myself room to maneuver, so I didn't feel so trapped. I also signed up to do a couple of preceptorships over the upcoming summer, where I'd follow doctors, see patients, and try to rejuvenate.

I thought I hid all this pretty well from my classmates. I've always worked hard to hide my depression from people: the harder I've cried, the giddier I am when I see my friends later. The lower I am inside, the louder I laugh. And, to be honest, I didn't feel this bad every single minute of every single day. I may or may not have met the criteria for major depression, I'm not really sure. It was a close thing. Also, medical students are fairly notorious for "playing tough", since ego drives medicine.

Later, when I've mentioned to classmates that I had a rough semester, I've been told that I looked sad, but most people assumed it was because my fiance was so far away. Even my family assumed my unhappiness had more to do with my fiance than with depression or medical school.

After I made it through the final final, an enormous load lifted. My earlier bargain was rendered obsolete--why would I need to take a year off med school? That would just prolong the ordeal. I'd heard second year was oh so much better than first year, I had preceptorships to look forward to, and my fiance had finally been able to make plans to move to be with me.

Now, over a year later, things are much rosier. Second year was so much more clinically relevant that it passed very quickly. Even with the terror of the USMLE, and the agony of taking so many exams in so little time, I never had that crisis again. Now, my panic is thinking "how will I ever pick a specialty?" But that's for another post, since this one is already approaching War and Peace proportions. So, I feel uniquely suited to talk to interviewees, and to first and second year students about why it's rough to be a med student. I tutored many first years as a second year, and we discussed these issues over and over. I promised them it would get better, and that if they were truly in the right place it would get easier. I actually got a "referral" the other day, a first year student who was having a similar crisis. After a morning interviewing patients at the homeless clinic (using my Maxwell's), she said she felt better, like it worthwhile to be in medical school again. It gave me a warm fuzzy.

Where's Mine?

Man, I'm going to Burger King tonight!

What???

Many thanks to a friend for pointing me to this link on USA Today. Since the abstinence only message is oh so effective in the teenagers it's aimed at, apparently now states seeking federal funding for sex ed... I mean abstinence education are required to target "adolescents and/or adults within the 12- through 29-year-old age range". The reason for this change: "Childbearing by unmarried women reached a record high of almost 1.5 million births in 2004, up 4 percent from 2003", according to the National Center for Health Statistics. However, at the same time, "childbearing by women in their early twenties showed a decline" of 1%, so my highly uneducated interpretation is that fewer women 20-24 had children, but more of them were unmarried.

I was going to expound on this topic, but I really can't. So all I'm going to say is wow. >90% of the population over 20 has had sex at some time. I really think abstinence-only education, aimed at people my age, is going to be EXTREMELY effective. Cuz, you know, sex isn't so great, I'm sure we can all do without. Of course, my personal opinion is that this funding would be better spent educating people about proper birth control, RECOGNIZING that a) abstinence is the only way to avoid pregnancy and STD's and b) over 90% of the population are already having sex, so message a is already obsolete! But again, that's only my opinion. For more information on an excellent article reviewing both the federal abstinence-only policy, as well as the "evidence" behind it, go here.

Boy, I'm glad I'm married now. If I got pregnant now, I'm automatically qualified to handle it well. I mean, they give out "Entitled to Bear Children" cards when you get married. The magic switch was flipped in June: before, I was unfit to be a mother; since then, I'm fit to be a mother. Except I'm not.

Fun Month, or School of Ineptitude

It's 9:52 am, and I'm sitting in my school's computer lab, blogging. At noon, I'll give a talk to the future surgeon's club in exchange for free food; at 1:30, I'll give a tour to a visiting potential student. Then I'll go home, finish the last remnants of the laundry, beat my husband into helping me clean the apartment, and hopefully head to the gym.

Why am I telling you this? And what happened to medical school? Surely, a busy third year student shouldn't have time to do all these things. She should be running around the hospital, doing scut and "saving lives".

This year, my school enacted the "fundamentals month", aka "Fun Month", during internal medicine. The orientation power point described the objectives of fun month as follows:

• Acquire, record, organize and analyze patient data.
• Independently identify key problems of patients
• Application of this knowledge and formulation of an appropriate differential diagnosis
• Perform focused interviews and physical exams on standardized
• Reflect on the ethical and professional boundaries of patient care.
• Demonstrate understanding of ethical and professional issues in patient care.
• Identify basic EKG conditions.
• Understanding and application of therapeutic options for thee diseases including any related issues of pharmacology.
• Understand pathophysiology of all disease processes you encounter.

What this actually translates into:

• Attending 5 lectures on "clinical reasoning", where I wrote a brief paper on CHF, a briefer paper on treatment on high blood pressure and cholesterol in diabetics, and a rough draft of what questions I'd ask a patient with shortness of breath
• Attending 1 lecture on "Diabetes", where we "learned" how to prescribe insulin
• Taking an EKG baseline exam, on which I scored 62%
• Reading Dubin's "Rapid Interpretation of EKG's"--useful. Amazingly, I do actually feel that I understand some of the principles behind EKG interpretation now. It makes me feel so smrt.
• Attending 2 lectures on EKG's, which reiterated the reading materials
• Reading "Cecil Essentials of Medicine"--I've gotten through about 6 chapters
• Attending 3 ethics lectures, including discussions of HIV confidentiality, US healthcare system, Doctors Without Borders, and How to Break Bad News--somewhat useful
• Attending 4 standardized patient encounters, where I pretend that their complaint is valid in the face of their entirely normal physical exam. My grade on the first one, where the patient said I did "great": 77%. My grade on the second one, where I forgot more stuff, had to ask the patient to sit up and lie down 3 times (he had "abdominal pain"), and misdiagnosed his pancreatitis as a perforated gastric ulcer: 87.5%. I think I'm going to be a better doctor because of this.

Note that only the material I specifically marked as "useful" is actually useful.

What I've actually done with my "Fun Month", since all of the above amounts to less than 2 hours at school per day:

• Contacted a personal trainer at the gym, meeting once a week. More on this later.
• Worked out at least every other day
• Done mountains of laundry
• Taken up a new hobby: jewelry making. I'm being cheap for Christmas!
• Watched weeks of TV. I've probably watched 20 episodes of Mythbusters on my first two weeks of Fun Month.
• Donated blood
• Got a flu shot and a PPD (totally flat! No TB here!)
• Cuddled with my husband a lot
• Taken my dog to the dog park at least 3 times so far
• Getting my oil changed this week
• Went out to lunch and shopping with a friend and her baby
• Got a massage

Obviously, I'm using this time to my best advantage.

Why does Fun Month make me mad? After all, I'm basically on vacation this month. I get up at 7:30 or later, I'm working out a lot, I'm getting some basic stuff done that I can't really do when I'm on rotations. The reason it makes me mad is that I'm not supposed to be on vacation now. I'm supposed to be working my ass off. I was ready to work, not ready to vegetate. I'm a little worried that next month will hurt more because this month was so easy.

I'm also mad because they changed the format of third year for our class. They took 2 weeks off OB/Gyn and 2 weeks off Psychiatry to give us 1 month of Neurology during the third year. Ugh, I hate Neurology. Anyway, they took a month out of what might be useful rotations to add Neurology. Internal Medicine has traditionally been 3 months long, with 1 month at the county hospital, 1 month at the "nice" hospital, and 1 month spent in a subspecialty. This year, they took off the subspecialty to add Fun Month. So, they cut other rotations which might have been useful to add Neurology, but they took a whole month out of Medicine to allow me to vacuum my apartment more often. If the subspecialty month of medicine was so useless, why didn't they cut it to add neuro? One reason I heard they added neuro was that it's an early match, so people need to see it during third year. Well, now it's NOT an early match--it just joined ERAS. Most of the internal medicine subspecialties don't match until after residency, so there's no real trade-off here. My only concern about losing subspecialty month is that we're losing exposure to some of the variety of internal medicine. They might not get us a whole lot of test questions on the shelf exam, but the subspecialties provide us a break from "standard" internal medicine. Not to mention, many 4th years I talked to said the subspecialty month provided plenty of time to read Cecil's.

Giving me a whole month to read Cecil's has translated to my reading almost nothing. I work best under pressure. I also know that I won't be taking the shelf exam until the end of February. I don't even like to read too much 1.5 months in advance of the exam, because I forget it all and have to go reread it, let alone 4 months in advance.

But TS, isn't the point of third year to learn how to be a good doctor? Shouldn't you read Cecil's just because you should? Probably. If I were a better student, and more self-motivated right now, I probably would read Cecil's. But I'm not. I learn better when I'm faced with a patient and I have to go look up the appropriate therapy than when I'm reading about abstract concepts in a book. I would also like to point out that the book chosen is 1216 pages. This is both too long and too short. Too long is obvious. Too short because Cecil's is a little too concise. Harrison's Principles of Internal Medicine, or "the Bible", is 2607 pages. Of course, I'm not reading it, either, so it's a moot point.

The big point here is that I'm lazy, and this month is allowing me to feed my laziness. The only useful thing I'm getting out of this month is how to read EKG's, which didn't require a whole month with nothing else to do to learn.

How dare they give me time off. Which wasn't necessarily the school's intention, but it is the (predictable) result. Bastards.

Huh?

So if "sleep medicines can cause dependence", or in other words you can get addicted to them, and this manufacturer is giving away free samples of this sleep medicine, how is this different from a drug dealer giving you the first sample of crack so you'll become addicted and continue to need their product?