Serious Blog Issues

I tried to use drop-down menus in my sidebar, but can't seem to get them to work properly (the ones below the "EMR"). Any ideas?


Edit: I have finally prevailed! Lo and behold, my much prettier, smaller sidebar. Go me!

Whew!

I got home today, after playing accountant this week, and dived right into making my fourth year schedule. We got the stuff to do this several weeks ago, but every time I looked at it, my stomach churned and I had to stop.

In an ideal world, if I got my first choice for every rotation I picked, then my schedule would look like this:

• July: Surgery Acting Internship at [county hospital]
• August: Away Rotation in Urology at school I might like to attend
  
• September: Urology at my school
• October: ICU
• November: Off to interview and take USMLE Step 2 CK & CS
• December: Infectious Disease
• January: Emergency Medicine (Urology Match!!!!)
• February: Family Practice (required outpatient clinic month)
• March: "Transition to Residency" required month of b.s.
• April: Off***
• May: Body CT/MRI, then I become an MD!!!!

***In April, I *may* take a working trip to China that month with other students from my school. In this case, I would probably take another month off.

This is all a shadow game, anyhow. Most of the electives will be add/dropped at some point, I'm sure, and I'm sure I'll change my mind about wanting to do stuff. Also, this is assuming that I actually GET the rotations I want, which is a huge assumption. Now, I just have to get my urology advisor to sign off on this monstrosity, and I can enter fourth year!

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I spoke to my paternal grandmother yesterday while I was at Dad's. She asked me what I wanted to do, and I said "I'm thinking about urology", and she said "Oh!"... (several seconds of silence). She asked a few questions about third year, and whether I had done urology yet, and when I applied to urology (September), and she said "Oh, well, then, you've still got time to make up your mind then." Gee, thanks, Nana!

Clip art licensed from the Clip Art Gallery on DiscoverySchool.com

For Those Who Were Wondering...

...I'm on spring break right now, and my dad needed someone to help him in the office, since Tax Day is 17 days away (as he reminded us at dinner). I think I cranked out around 10 tax returns today for $10/hour. Don't worry, I'll be returning to med school on Monday, where OB/Gyn awaits me. Woo!

And I chose the nickname "Tiny Surgeon" as a joke during my surgery rotation. I really enjoyed surgery, and I stand 61 inches tall. I thought the title fit. It's not a nickname I've ever used online before, so it doesn't link to anything from college I'd rather forget.

Ouch!

The perils of being an accountant: my hands are COVERED in papercuts. Every time I go to wash my hands, I'm reminded that I'm not in medicine right now.

West Texas

Yes, that is a wrench head on top of a violin, hence the term "City of Contrasts". That used to be the logo for the city of Odessa, Texas, a boom-and-bust oil town on I-20. I'm not too far from there for the rest of the week, working for my dad's accounting firm as an office girl. I've even done a few tax returns (badly).

Being a tax accountant, 3 weeks before Tax Day, is a tough job. My dad goes to work around 8:30 am and comes home around 10 pm (or later). He works similar hours on Saturdays and Sundays. One could even compare his hours to a medical resident's. The stress in his office right now is palpable. One poor CPA ran around earlier snapping at everyone to "get out of the tax program, NOW, there's a system error!"

There are several important differences between an accountant and a resident, however.

1. My dad's office has plush carpet on the floor, cushioning my feet as I run back and forth to the copy machine.
2. They have a kitchen, with a refrigerator stocked with Cokes.
3. The bathrooms are always clean.
4. Dad gets to take scheduled lunch and dinner breaks.
   
5. If I get tired and want to sit down, I get to sit down.
   
6. His chair is cushy leather. The chair I've been using is brocade. Neither is plastic nor uncomfortable.

And, perhaps the most important difference:

April 15 happens once a year. Sure, there are quarterly deadlines which require long hours, but in between, people work civilized 9-5 hours. With lunch breaks. And a nearby restroom, where one can take breaks as often as are needed, without having to get permission or apologize for one's absence.

Sometimes, I really wonder why I'm in medicine...

The Excuses

"I don't like taking my medicine."

"I don't like the side effects of my medicine--you know, it's, uh, a personal thing, uh, a sexual thing."

"I don't like being dependent on a medicine."

"What if I can't stop taking it?"

"I don't want to have to take a medicine to be normal."

"Taking an antidepressant makes me a weak person--I should be able to deal with my own problems."

The next time one of these phrases comes out of a patient's mouth, I should be reminded how many times they've entered my mind as an excuse for not taking my medicine. Which I did not bring on this trip to my dad's house. I feel fine for now, but I'm about to start my OB rotation and will need all the help I can get.

Blogs and Religion

Quick thought: why is it that anytime a person admits in a blog or on a website that they are not a believer in Christianity, Christians start commenting on that blog post about how they found Jesus and believe that Jesus could solve all their problems? My old website had some essays I wrote a LONG time ago about why I was no longer a Christian, and I received some very hateful comments from people about why I was SO WRONG and GOING TO HELL. I also received long, thoughtful emails from people who were convinced they were going to change my mind. Perhaps they even prayed for me once or twice, as that nameless atheist girl on the internet who is going to BURN (I was, after all, Southern Baptist--I know all about the burning and gnashing of teeth that is supposed to await me).

Another quick thought: just because someone is not a Christian does not necessarily mean they are intolerant of religion, or are condescending. It's always a possibility, of course, but in terms of logic, non-Christian does not equal disrespectful toward Christians.

Unfortunately, for me, it's a line I have to watch out for. For a long time after declaring my non-religiousness, I was very angry at Christianity in general. I was mad at myself for having worked so hard for so long at something that made me so incredibly miserable, and I was mad at church for making me so unhappy. I really have to watch my tone, because sometimes I do get mad and snippy (less now than it used to be).

Last point: telling your Southern Baptist and Presbyterian (but Texan) family that you are not religious is almost as difficult (I'd imagine) as coming out of the closet as gay to the same group of people. I was so frightened for so long of telling my parents--I thought I'd be disowned or tarred and feathered. My dad tried to tell me that "well, you'll grow out of it," which I found offensive. I'm open to the possibility of changing my mind someday--1) I'm a woman and 2) I changed it once already. However, to assume that I'll rejoin the true believers one day is to say it's just a phase, silly little girl, I know what is best for you (or that's how I heard it, anyway).

Fortunately, just as many people say religion brought them together, my husband and I can honestly say that a lack of religion brought us together. And it's a beautiful thing.

New FDA Rule

In news today, the new FDA Commissioner, Dr. Von Eschenbach, is trying to impose a rule that would a) exclude persons from advisory boards if they received >$50,000 from that drug's manufacturer and b) allow persons who received <$50,000 to serve on advisory boards, but would not allow them to vote.

While I agree with one of the representatives interviewed in the article that loopholes are likely, I would like to applaud the commissioner for this move. As is also in the article, in 2005 when the Cox-2 inhibitors were under fire, 10 of 32 people on the advisory board that allowed Bextra to remain on the market and allowed Vioxx to return to the market had received funds from the manufacturers; had they not been allowed to vote, both drugs would have been removed from the market at that vote (which they later were).

Seriously, if you are an "expert advisor" on a drug, who also receives $30,000 a year from the manufacturer of that drug, then you have a vested interest in seeing that drug be successful. I believe that such a person also has the company's information on that drug pouring out their ears; where else would you get this information, unless you are simultaneously getting paid by a rival manufacturer?

One last word. Yesterday, my clinic had a drug-rep lunch (which was quite tasty, I might add). During this lunch, the drug reps had us watch a video describing the study that proved that this particular asthma/COPD medication (a combo inhaler) was better than either of its two components alone. It sounded like a good study: double-blind, stringent requirements for enrollment, good endpoints, almost 2 years of average follow-up. One of the doctors and I asked for a copy of the article in print, which we were promptly given. Indeed, it was published in a decent journal (although a doctor I used to work with would disagree--he used to be on the advisory board of said journal and said it was worthless), and the study's PI was from a well-known medical institution. Then, I flipped to the fourth page of the study, and in tiny print at the bottom, I learned that 12 of the 13 listed authors were direct employees of the drug company, and the 13th (the PI) had received massive research funding from the drug company.
It doesn't negate the fact that it appears to be a good study, but I definitely took their findings with more than a grain of salt afterwards.

(For more info, I recommend the book Powerful Medicines. It goes into a lot of back history of the FDA and the current drug approval process, and how bad drugs make it through (and good). At times a slow read, it is highly informative, and will certainly make you look more carefully at the drug reps who bring you free lunch. Even while you're (I'm) eating it.)

Caricature of a Preceptor

One of my favorite preceptors this month was an unintentionally funny guy.

• He was Chinese, and his English was good but somewhat broken. He generally didn't like seeing Chinese patients, especially older ones, because he said "they act like I'm their son, and I should do everything for them." His Chinese patients loved him; I even saw a traditional-looking couple bow to him as they walked out of his room.
• His idea of panacea was a much photocopied page of back stretching exercises. Patient's here for a pap smear? Infertility and diabetes? Allergic rhinitis? Great! and out would come the sheet of exercises. Most patients took them solemnly, saying "Thank you doctor," folding it carefully like it was a birth certificate or marriage license.
• He had memorized the list of $4 medications at Wal-Mart. (There's a similar list at Target now, if you didn't know). He was genuinely excited about this idea, and often told patients "I prescribed you xxx, you can get it at Wal-Mart! Four dollars!"
• I admired that he attempted to speak Spanish, in addition to Chinese and English. However, it was only an attempt. "Hey there, soy Dr. C. Cabeza dolor? Estomago dolor? Peepee dolor? Poopoo dolor? Cuando ultimo Pap smear/exam de prostate?" was his standard Spanish exam, delivered rapidly and with a thick accent while he listened to lungs and heart. Often, the Spanglishese was accompanied by an odd pantomime; any urinary, vaginal, or rectal process was addressed by a waving of the hands towards his crotch. He had taken the time to learn certain small words, like one for "rash", but his pronunciation was so bad that the patients didn't know what he was talking about, and I couldn't often translate the Spanglishese for them. Fortunately, the words "okay", "here", "medicina", and "Wal-Mart" work in either language, and he generally gets by, especially with the help of a Hispanic nurse.
• This particular preceptor took more time to teach than any attending I've had so far. He had purchased a scanner through an education grant, and constantly scanned pictures from magazines, Reader's Digest, or pharmaceutical ads, then compiled them into large powerpoint files for "teaching". If the subject was complex, like EKG patterns in MI, the student often pointed out things he'd forgotten, or explained how to tell a posterior MI.
  

Much of my time thinking about Dr. C involves phrases like "aww, how cute!" like, "aww, he's trying to speak Spanish again!" or "aww, he's trying to teach again!" At least he enjoyed to teach and genuinely liked having students around; I never felt like he was upset that I'd asked him if I could work with him on a particular day. Instead, he'd say "pull up a chair, and I'll find a powerpoint." Refreshing.

Rhetorical Questions on Family Practice

1. What do you say to a woman who offers the information that she was sexually abused by her father as a child? In the middle of a conversation about her constipation problems?

2. Why is depression so prevalent? I mean, I suffer from it myself, so I shouldn't be so surprised, but I would say that up to 50% of the patients I've seen at this clinic have been depressed, anxious, or a combo thereof. Maybe this population of patients is just particularly stressed?

3. How many times in one week can my preceptor offer a handout on back stretching exercises to patients presenting for allergic rhinitis, depression, diabetes, pap smear, or carpal tunnel syndrome?

4. How does a person keep a straight face and not cringe when the answer to the question "Why are you here today?" is "I have this burning, stinky vaginal discharge"?

5. Why is it that last week on pap smear day, the attending told me "you're doing a great job, the only ones [cervix] you missed I had a hard time finding" and this week on pap smear day, the same attending rated me as "average" on my technical skills because "you had a hard time finding the cervix"?

6. For that matter, why is it that for most family docs at my clinic, "Procedure Day" = "Pap Smear Day"?

7. Why do I feel the need to apologize to my attending for spending 30 minutes interviewing, examining, and writing a note on a patient with depression, hypothyroidism, other psych issues, chronic pain issues, chronic vomiting, constipation, dizziness, arthritis, urge incontinence, and vaginal discharge, who feels the need to yell at me and cry about the inanities of the county medical system preventing her from seeing a doctor and receiving her medication?

8. Why are Hispanic patients so surprised that a white girl speaks Spanish?

9. Why do Hispanic patients get past their surprise that a white girl speaks Spanish and proceed to speak so rapidly that I am then forced to call a translator anyway?

10. If you were a young woman who weighed 350+ lbs, with a BMI of 62, diabetes, high cholesterol, and high blood pressure, and your husband weighed around 400 lbs, would you be so utterly shocked when told that you were having problems conceiving a baby because of your weight? I mean, I'm all about women having healthy curves, but seriously, at some point you have to realize that GIRL, YOU ARE HEAVY AND IT'S UNHEALTHY.

11. Why is it that some patients will ignore a health problem until their leg is falling off, their inflammatory breast cancer is visibly rotting, etc., but other patients come in for the least little thing (eg, "I have this tiny white spot on my arm that doesn't hurt and it looks the same for years--is it cancer?" or "I get these headaches when I'm working and I haven't eaten for hours, they go away with 1 Tylenol--is this okay?" or "I'm 35, with no family history of prostate problems or symptoms--can you check me for prostate cancer?" (bonus if this is a female!))???

Tomorrow is my last day on FP/FM!!!

Med Student

Today, we had several lecturers remind us of our "sacred" role as third year med students. In case we'd forgotten, they reminded us that our patients look to us for answers and appreciate the time we spend with them. Then, they reminded us how to interact with patients--don't forget to listen to what they're saying, and be empathetic.

I really doubt that most third year med students actually needed this lecture. (There are a certain few, however...) I would venture to say that most of my classmates and myself try our best to use our role as MS-III's wisely. I really enjoy my role as a third year student, and I have during this whole year. I carry fewer patients than an intern or resident, so I have more time to talk to each patient. As a result, I get more questions from the patients, and then spend more time answering questions, so my patients often know me better than any of the actual MD's. I have always treasured my role as a true advocate for my patients, and I have had many patients thank me. I know many (hopefully, most) of my classmates have had similar, equally rewarding experiences. I also know that, especially at [county hospital], most of my patients have been happy to have medical students involved in their care, because we spent much more time explaining things to them than the residents did (or the attendings, who pop in to say "Hi" and then fill out their billing card).
_______________________________________

One of my first patients, back on surgery, came in with a "diabetic foot". Basically, she had a horrible abscess/cellulitis in her 4th and 5th toes that was threatening her whole foot, and because of her uncontrolled diabetes her immune system was kaput. It was a call night, and my resident was in a hurry when he evaluated her in the [county hospital] ER. "Ma'am, we're going to remove your toes, and I'll try not to, but we may have to remove your whole foot."

She flipped out.

The resident spent a few minutes trying to explain the situation to her, then left, both because he was frustrated and because he had to call the OR to get set up (and fill out her admit orders, and tell the ER to call bed control to admit her, and check on the other ER consults...). The other MS-III and I were left to examine the patient. She begged us not to take her foot. She was caught off guard, she said; she wasn't expecting this, surely it wasn't that bad.

We spent several minutes trying to calm her down. We assured her that no one wanted to take her foot off; that we would use our power judiciously in the OR; that we would do everything in our power to save her foot; but that if we had to do so, we would amputate her foot to save her leg, and perhaps her life.

After several minutes, the patient calmed down. "Oh, you two are going to make such good doctors! You have such great bedside manners! Not like that other doctor at all--he was so gruff!"
_____________________________________

I seriously doubt that my class of med students is full of unusually empathic, kind people. What concerns me is what happened to the interns, residents, and attendings who get labeled as having a poor bedside manner. Sure, some of them had no social skillz when they entered med school, but the vast majority entered med school with a desire to help people. They also entered med school with the ability to talk to people, listen to people, and make human connections.

So what happened? Is it the lack of time that turns human beings into robotic interns? Is it the brutal call schedules that destroy doctors' abilities to interact with patients? Is it the constant exposure to human brutality, deliberate self-destruction, and great tragedy that turns doctors into automatons?

I have a lot of fear that I will become someone who can strike fear into a patient's heart and then turn around and leave, complaining that the patient should have expected her foot to rot since she didn't attempt to control her diabetes (in the resident's defense, the patient had prior surgery on her other foot for the exact same problem--this wasn't her first rodeo). I don't want to be so tired on call that I take poor care of my patients. I don't want to lose my humanity.

I am awfully glad, though, that my residency will most likely be in locations where medical students abound, so if I can't spend enough time with my patients, at least I can rely on the students.
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On a closely related topic, one of the things that bothers me most about my current experience in family practice is that the doctors go on and on about how they "take care of the whole patient and the whole family", yet they spend less than 5 minutes per patient, often telling med students "focus on only 1 or 2 problems this visit". One doctor told me "be done with this patient in 10 minutes MAX." Several of my attendings are from Asia, and there is a language barrier. If I am having difficulty communicating with these doctors, I KNOW the patients are. Sometimes, I have to "translate" for the patients--the doctor's broken English for regular layperson's English. It's far worse when we have Spanish-speaking patients.

When I present a patient to an attending in clinic, they are filling out prescriptions after I've said about 2 sentences. I find myself reminding them of stuff all the time: "Hey, she needs a mammogram", "Hey, that prescription printed wrong", "Hey, don't forget her Kegel instructions", "Hey, she needs a breast exam", etc. I know these doctors function without med students most of the time, but that actually kind of concerns me. If you don't recognize that your English is a problem when you are talking to me, how can you see it as a barrier between you and your patients?

And the 5 minute visit? Ridiculous. Many of these patients are diabetic hypertensives taking 5 or 6 medications at once. It takes me 5 minutes just to review all the medications, make sure the patient is actually taking them, and see which ones they need refilled. My physical exam, as taught to me by the attending this month, consists of listening to the heart/lungs, the belly, quickly feel their legs (through their pants!) for edema, and look in their mouth. It's the 30 second physical exam. I realize the importance of a "focused" exam, but honestly, is this 30 second crap helping anybody?

We had an excellent lunch lecture last week where the speaker focused on the problems in primary care (not unusual), and offered potential solutions (which made it unusual). The 5 minute visit, coupled with the 20+ patient workday, isn't satisfying to patients or doctors. Some clinics are offering increased email, computer, and telephone services for simple questions and patient-controlled scheduling of routine care; for a yearly fee, you can email simple questions or med refills to your doctor; if you need to be seen, you get an appointment. As a result of fewer office visits, appointments are much longer when they need to be.

Putting more of this stuff on a computer program or email raises a concern to me of "outsourcing" these services to third world countries, where low-paid workers will man the telephone banks, doling out cookie-cutter medical advice much the same way as tech support. However, if we can avoid a lot of that, and truly offer quality interfacing between a doctor and his patients, I think this idea has a lot of merit.

I've often wished I had health care as good as my dog's. For a monthly $25 fee, he gets two full check-ups with blood work per year, one tooth-cleaning (with general anesthesia) per year, free office visits at any time, and discounted care for anything else. Why are we paying insurance companies thousands of dollars for inferior care, when we could have a direct arrangement with the doctor's office, and cut out the middle man? The doctor wouldn't have to hire as much staff to deal with the insurance, so overhead would go down, and fees would be affordable. Insurance could go back to being "catastrophe coverage", but routine healthcare would be covered.

Sure, it's not a perfect idea, but it's a start. And yes, I'm saying I'm totally dissatisfied with family medicine, at least as I'm seeing it now, at a large county clinic. Thank god for the procedures, or I'd go freaking nuts.

My Garden

That's a view of our porch from below. My hibiscus bloomed spectacularly today, with 5 flowers open. I'm not sure why the petunias look blue in this picture; they're really a dark velvety purple which is luscious.

It wasn't terribly sunny this afternoon, but you get the idea. It's such a pretty plant.

Medical School Nerd Scale

(I borrowed this from this website)

The following scale has been developed in close cooperation with the UVA psychiatry services (Well at least I was thinking of some of their characteristics and used some of their class time to compose it). It is designed to test if you have spent too much time in medical school and whether you are having adverse side effects due to prolonged exposure.
Score one point for each statement that applies to you. [My answers are in bold]

1 You have ever said "Netter is god".
2 You can discuss autopsy/ anatomy over a meal
3 You own a 4 color pen
4 -it just isn't enough colors for you
5 You use more than one color to take notes
6 You have use up more than 6 highlighters in the past 6 months
7 you have ever highlighted something YOU wrote
8 you retype handouts given in class
9 you haven't had a date in 3 months
10 you haven't had a date since entering med school *[I was engaged/married, so it didn't matter]
11 you have not been able to remember the normal term for something because you were thinking of the medical term (ie reflux for heartburn)
12 You get more sleep in lecture than at home
13 You know the correct spelling for pruritus
14 - you also know what it means
15 You have ever asked a question in class *see below
16 - The prof. didn't understand the question*
17 - you didn't believe the answer the prof. gave*
18 - you went to look it up to see if they were right*
19 You can't hold a conversation on anything other than med school
20 You skip class to study
21 You've said you didn't do well on a test on which you beat the mean
22 You spend more than 15 hrs a week on e-mail
23 You have a callus on your finger from writing
24 More than one professor knows you by name
25 When you ask a question, a new professor has said "Oh, I've heard of you"
26 You can name more amino acids than past presidents
27 You use more than 5 acronyms an hour when talking
28 you actually know what PERRLA stands for
29 You know all the steps of the TCA cycle
30 You do not read PTA as parent teachers association
31 You can remember the muscles in the forearm
32 You know the structures in the urea cycle
33 You know the dermatome distribution
34 You can't remember what you had for breakfast
35 You can't spell world, much less backwards *[Only because I'm a spelling geek; I definitely fail other parts of the MMSE: the only way I know today's date is to look at my watch]
36 You've ever been sexually aroused by the breast shadow on an X ray
37 You equate "morning stiffness" with Rheumatoid Arthritis
38 You actually know normal values for plasma Na
39 -K
40 Missing class causes you extreme stress
41 You have seriously asked someone "So how does that make you feel?"
42 You have asked will this be on the exam
43 -Just after the prof. said it wouldn't
44 You identify with Deb on E.R.
45 You have made a medical joke
46 -no one laughed
47 -You figure they just weren't that far in their studying
48 You wear your stethoscope around your neck on the bus
49 - you don't even know which way the thing goes in your ears
50 "SOB" means short of breath to you
51 You have gone to student health with suspicion of a disease you have studied
52 -within 3 days of the lecture
53 You have answered a question in class
54 -asked by the professor
55 -it was a rhetorical question
56 You can quote lines from the movie "Malice"
57 -you believe them
58 You can flip your pen over your thumb
59 - with both hands
60 - you do so throughout class
61 You have corrected a professor in class *
62 -the rest of the class didn't understand the lecture to begin with
63 You know how to calculate specificity
64 -positive predictive value
65 - anion gap
66 -you can't balance your checkbook
67 You don't know what the weather was like for the past week
68 You don't know what the weather is like right now
69 You actually talk in open ended questions
70 DIC isn't a slang term for the penis in your book
71 You think B- is a bad grade
72 you have stressed about a pass/fail class
73 You study during most of your meals
74 You saw nothing abnormal about the Obsessive-Compulsive Disorder
75 You draw all of the slides not already provided in the handouts
76 -including the cartoons (humorous type)
77 Anatomy makes you hungry
78 You would even consider saying "Ease back on my finger at your own pace"
79 You know the size of a RBC
80 - you don't know the size of a football field [I was a marching band geek]
81 Your eyesight has worsened by 10 pts or more in the last year
82 You have the library hours memorized *
83 You have your own seat in the library
84 You score more than 95 on the Epidemiology final
85 You own more than one white coat *[I wish I did, mine is no longer white]
86 You have debated between giving up sleep or eating in order to find more time to study
87 You started studying for boards more than 2 months in advance
88 You have never received a personal invitation to discuss your grades with the dean
89 A tie is the only addition necessary to what you normally wear when you go to see patients
90 You wear scrubs to tests
91 You have made plans to study on a beach during vacation [Insert "mountain" for "beach"]
92 - you actually did
93 You have a designated seat in lecture
94 - You have ever asked someone to move from "your seat"
95 You sleep less than 4 hrs a night
96 -you think that is plenty
97 -you have thought about cutting back
98 You study more than 35 hrs outside of class [especially during 1st-2nd year]
99 -you think you are a slackard
100 You think everyone answers yes to most of these questions


Scale
<20>señor doctor"
35-45 Gotta love that Primary Care
45-60 Well, I never really thought about MD/Phd, but now that you mention it...
60-75 Your social life is shot, might as well try to earn lots of money (I got 62)
75-90 Which surgery subspecialty did you say you liked?
90 All hail, great Med School Nerd master.
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There were a few more I considered counting. Like, I doubt I would have dated much in med school if I had been single, for lack of time. I've never corrected a professor in a first or second year course (except the one that said "you, sir in the back"--I did holler "I'm female"), but I've probably corrected attendings on wards, and I KNOW I've asked attendings questions, didn't believe their answer, and looked it up myself later. I didn't have the library hours memorized, because I didn't study in the library. The library at my school is open 24 hours, and I often studied at a 24-hour coffee shop. If I add these points, it's 9 more, putting me at 71. Man, med school will screw you up!

Oh... My... God...

As usual, I'm spending my Saturday night on my bum watching TV (at least I worked out earlier today!). Fortunately for me, an episode of Mythbusters is on, and it's one I've never seen: the Shark Week Special. They're busting many of the "myths" of the movie Jaws, one of which is "can you punch a shark in the nose to fend it off?" They're attaching a punching robotic machine to their crash test dummy, Buster, and they're going to punch a shark in the nose.

So, to make the robot look more real, they needed rubber fists.

To procure these rubber fists, they sent Kari into an adult store. In San Francisco.

Buster is currently wearing dildo fists. Black, rubber, wiggly dildo fists; one in the shape of a fist and one with two fingers pointing up.

I don't even know what to say.

Quotes

Online friend to my husband: "Aren't you worried about your wife being around all those penises all day when she goes into urology?"

Husband to online friend: "No, because they're all broken."

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While walking back into the clinic carrying our McDonald's...

Me to med student at my FM clinic: "Hey, I actually found the cervix this morning during a Pap!"

Fellow med student: "The os usually looks like a donut to me."

Me: "Yeah, a lot of them do. This lady was 6 weeks postpartum, though."

Fellow med student: "Oh yeah, those always looks like smiles." (demonstrates a broad smile without teeth)

Me: "This one looked like a straight mouth, not a smile." (demonstrates a flat mouth)

Fellow med student: "It's so wrong that we're imitating the os with our faces."

In unison: "See, it looked like this!" (both purse lips to make a tiny hole)

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Me to patient: "Well, your test for Chlamydia [from last clinic visit] is positive, so we need to give you antibiotics."

Patient: "What about my pregnancy test [also from last clinic visit]?"

Me: "It's positive. Does that surprise you?"

Patient: "Not really. My last period was in November."

Me: "Well, congratulations, then."

Later...

Attending: "When did you stop taking your birth control pills?"

Patient: "November."

Attending to patient: "So your pregnancy test was positive? Do you feel pregnant?"

Patient: "No." (acts shocked)

A repeat UPT was also positive. The patient is 16 weeks pregnant. Apparently, missing periods for 4 months did not clue her in to the idea of a pregnancy; she thought it was because she'd quit taking her birth control pills that she missed her periods. In a way, she was right.

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Now, I'm going to go work on my fourth year scheduling, and try to make my stomach quit cramping up every time I look at the damn form. It looks like a freaking 1040, for god's sake. And I HATE taxes. It's a bad association to have.

Update on FP... I mean FM

So thus far, I've had three days of family medicine, and I must say it's been a most unusual FM experience. I've witnessed an adult circumcision and a vasectomy, I've injected steroids into a knee and a foot, I've done my first two Pap smears and pelvic exams, I found a breast lump, and I almost saw a third nipple removal. Sadly, the girl was resistant to lidocaine, and never achieved analgesia, so we had to refer her to general surgery for general anesthesia. All for a tiny third nipple, about an inch across. It even expressed a tiny bit of milk (she showed me). Woo!

I have seen my share of diabetes, hypertension, upper respiratory infection, and even MRSA skin infection this week, in addition to interesting procedures.

Most of my friends are working 8-5 or 8-6 with tiny short lunch breaks, seeing the same three problems every day: DM, HTN, URI. in other words, they're doing more traditional FM. At my clinic, I arrive around 8:30, see patients until 11:30, take a 2-hour lunch break with the rest of the clinic staff, work 1:30 until around 4, sometimes 5, then head home. In other words, it's pretty cush. AND, cool procedures! PROCEDURES! One of the FM docs at my clinic was a surgeon in his home country, so even though he practices FM here, he does a ton of outpatient procedures. To most of the other docs in my clinic, "procedures" means "pap smear" and, rarely, "IUD placement".

In other words, I could give a crap about FM, I just like the procedures. Somebody hand me a scalpel, I'm gonna be a surgeon!