Death wish

After spending two years in the same place, for the same amount of time, with the same amount of people, in the same place (did I mention we were stuck in the same place?), I began to notice that something interesting developed in our lecture room. What was once a sickening collection of rundown seats and broken desks became…a sickening collection of rundown students and broken dreams. Coinciding with the twenty minutes I just spent futzing with Photoshop, it also became a fascinating lesson in geography. Much like in real life, your location determined who you were, who you spent time with, and whom you talked shit about behind their backs. In order to chart this territory for my own personal memory, and to give you an idea of the rough terrain associated with a typical medical school lecture hall, I have provided the map with an appropriate key. Explore. Discover. Apply to a different professional school. But, most importantly…actually, maybe you should consider business school. I hear they have nice mixers.

The Map of D.O.O.M. (Dungeon Of Oratory Medicine)

1: Entry/Exit door – symbolic of the wretched decay of the building that houses the lecture hall, this door came with a built in creak that can be heard up until at least twenty minutes have passed in the first lecture, as people file in late or check out (very) early. Also, this door can be so difficult to push open, people unfamiliar with this terrain often fall into the trap of thinking that location 2, and not this location, is the actual door. Extreme unintentional comedy ensues.
2: Lecture storage closet – created to store the vast array of tools and supplies necessary to maintain a room with…umm…a bunch of chairs, this door also serves as a place for people to enter when desiring to make out with that special someone during class, and/or when desiring to make a complete and utter ass out of oneself (see extreme unintentional comedy).
3: Computer Zone - Do you like to click incessantly on your computer, furiously transcribing every single word that comes out of the lecturers mouth and thoroughly annoying the crap out of everyone in the entire class? Do you not mind that lecturers publicly ridicule you for trying to write down every word of what they say, as even they recognize that half of what they are saying isn’t of the slightest bit of importance? If you answered yes to either one of these questions, then you belong here.
4: Computer Zone, Stinky Province - If you answered “yes” to both questions from location 3, and you also enjoy spending time in lecture eating the slimy, smelly crap you call a lunch but everyone else thinks is more vomit-inducing than Tom and Katie, then you belong here. And congrats, your new name is Mrs. Stinky.
5: Welcome to Little Utah, home of aging Mormons who like to berate and shush at anyone and anything that makes a peep of noise during lecture. You’d think the satisfaction of knowing that the rest of us are going to be spending eternity burning in hell would be enough, but you’d be wrong.
6: The Jew Crew – this region consists of four Jews, three Indians, and the feistiest African-American girl you’ll ever meet (I love you, Trish). This is also the famed location of a six-foot-tall, dark-haired, blue-eyed, dashing young Jewish medical student who bears a faint resemblance to Matthew Perry and who is not only single, but also is me.
7: Slackers Heaven - completely devoid of gunners (people who try so damn hard it pisses everyone off). Well, there is one nose-picking gunner who has infiltrated this section, but that’s another story. On any given day you’re likely to find an all-star lineup of people who can sleep through just about anything. Somebody give these guys a medal already.
8: Coolest Kids In School - where the coolest kids in class sit, where the best impromptu verbal smack-downs originate from, and where the best cat-calls can be heard from when any hot first year comes in to make an announcement. It therefore goes without saying that Whitey need not apply.
9: The Cursed Seat of Mr. Stinky. After his daily jog to class, Mr. Stinky, utterly drenched in sweat and dripping his salty bodily juices all over the seat cushion and desk, sits down here to enjoy lecture and make everyone around him uncomfortable and queasy. Not all is lost, however, because by observing the color change of his shirt (dark to light) as a result of the gallons of sweat evaporating into the musty lecture hall air, one can infer how much longer lecture will be going on. It just occurred to me that I have been breathing this air for two years. I think I’m going to be sick. Anyways, for a guy so devoted to his faith, you’d think he would remember the part that equated cleanliness with godliness. I guess he’s too busy trying to find that part banning gay marriage.
10: Authentic Trail of Sweat - This is the trail of sweat that Mr. Stinky leaves behind each and every day on his way to and from his seat (see location 9). The beads of sweat gracing the floor are actually visible on warm days. Now that’s a trail of tears! Zing! Is this thing on?
11: The Enchanted Forest – Named in honor of the female often found in this spot who received this name after the discovery that, at the age of 23 and currently studying medicine, she has not yet had a gynecologic exam and does not know what a speculum is. In other words, there are unconfirmed (pending a poor soul getting really really drunk) reports of undocumented species, exotic foliage, and even belligerent leprechauns roaming around in that forest. If you answer “yes” to any of the following questions, then perhaps you belong here, too. Do you ever find yourself raising your hand in class wanting to say something funny, only to find that no one else thinks what you are saying is even remotely funny? Do you ever find yourself raising your hand in class out of sheer indignation over something you found to be sexist, even when no one else in a ridiculously PC class read even a glimpse of sexism into the statement, thereby making a fool of yourself? Do you like sending dumb emails to the class list? Do you think people are following you? Does your name rhyme with “farta”? Welcome to your seat.
12: Seat reserved for boy geniuses. Whatever you do, don’t shop for clothes online during lecture when sitting behind this guy. Trust me.
13: Medical School Frat – where fart jokes, excessive wise-ass-ness, and blatant attempts to call attention to yourself pretending to fall asleep in the middle of lecture to show everyone that you are cool reside. Unless you are actually asleep, in which case, well played.
14: The Noah’s Bagels Crew – there is a saying that the only thing you can count on is death and taxes. I’d like to propose a third thing: Five minutes into lecture, I guarantee you that the door will open and the same three people will enter the lecture hall, noisily bumping there ways into the seats their devoted friend reserved from them while carrying massive bags from Noah’s Bagels. They will all proceed to eat bagel after bagel after bagel, fumbling while trying to spread their cream cheese and take notes at the same time. Apparently they didn’t get the memo that if you’re going to do that every day, you damn well better get enough for everyone. Assholes.
15: The Dreaded Front Row – don’t even think about taking a seat away from someone who has been sitting there for more than a year. These people are as protective of their seats as they are of whatever shred of dignity they have left. However, there are a couple of brave souls who have the balls to sit here and either fall asleep or blatantly open up the sports section of the newspaper one foot away from the lecturer. To that, I say well played. Weeeeeeell played.
16: Trusty and pointless table placed conveniently in front of the projector screen – where people put their audio recorders to tape lectures. The only thing worse than living through 97% of the lectures I heard over the course of two years of medical school is listening to them again. Which is apparently what a select few people do – listen to lectures over and over and over again. Maybe they have this crazy master plan to listen to two years worth of lectures straight while watching The Wizard of Oz, baked out of their minds and hoping to find the meaning of life. Maybe not. Either way, they’re assholes.
17: The Black Hole Vortex of Doom – also known as the location where Question Girl can be found most of the time. In this vortex, all concept of space, time, logic, intelligence, respect for time constraints on lecturers, ability to think more than one step ahead, and sheer decency are lost, ferociously devoured by the evil and disfigured creature that rules over this cruel dominion. Her two year reign of terror is over, but I still cannot understand how one person can ignore the pleas of just about every single person in our class and ask so many off-topic, disruptive, and irritating questions without any violent repercussions. There are rumors that those who plunge through this vortex are instantly crushed by a gravitational anomaly, but I’m pretty it’s just her ass.
18: Mature Interest Group – requirements for entry into this section include having a spouse and/or children, an interest in constant intellectual discourse on complex metaphysical topics, a taste for fine wine, and a general haughty nature. Other qualifications include being named Brandon (sorry Bizzle, it had to be done). If your name is Stacey, then you should be sitting in section 6, so please find your way there ASAP.
19: Oh the humanity! Shield your eyes from the horrors that sit in these seats. Unless you find yourself attracted to women who sound like Betty Boop but look more like Betty’s deformed aunt, Mertyl, or to pretentious East Coast men with curiously large and attractive breasts. In which case, approach with caution.
20: Anonymous Asian Female Section – do you ever feel like you blend into a crowd? That you’ve spent two years with the same group of people, but they either don’t know your name or consistently use the name of the person sitting next to you when addressing you? Then you and your Hello Kitty notepad belong here. The interesting thing is that I have spoken to two different people in two different medical school classes in different parts of the country, and they have independently described the exact same phenomenon. I smell a PhD thesis.
21: My artistic rendition of the hideous medical-related artwork plastered to the wall. Seriously, there are enough actual things about medicine that make me want to throw up, so these artistic depictions are really unnecessary. Furthermore, staring at said artwork for more than one year has still left me absolutely clueless as to what is actually being depicted, further bolstering my self esteem. Attempts to remove these works and put up a poster of Lindsay Lohan would be greatly appreciated.
22: Block Chairs Only – if you’re sitting here, that means you’ve truly made it as an academician, doctor, and medical scholar. You have masterfully choreographed a stunning array of stimulating and insightful lectures geared towards educating and enlightening medical students and giving them enou - hey…where are you going? Class isn’t ov - hey!
23: Track Marks – created over time by lecturers as they propel themselves out of the lecture hall with speeds not seen since the time I tried (but failed) to run away from the Creature of the Enchanted Forest at a medical school party last year. They are usually futile in their attempts to escape the hordes of medical students who flock to them at the end of class, and said lecturers must then field generally pointless questions for the next 30 to 45 minutes. I’d suggest getting better shoes or making clearer lectures to remedy this situation, but realistically that would not change anything because these freak medical students are more ferocious than those tigers on the Discovery channel when it comes to shit like this.
24: Lecturer’s podium and microphone equipment station – ever wonder where they came up with that noise for when the teacher talks in Peanuts? The magic happened here first. It’s amazing what happens when you combine the monotonous ramblings of an introverted pathology professor with publicly-funded audio-visual equipment that dates back to the discovery of cheese.
25: Exit, stage left – the mysterious abyss that block chairs run through when they just don’t want to be here anymore (see location 22). Surely, they are just so horrified by the classroom torture that they have spawned that they can no longer sit through it for another second. Well, that, or maybe Winona got caught stealing stuff again (obscure inside joke alert).


I hope you enjoyed the grand tour. For those of you interested in or about to begin your medical school career, I encourage you to stake out your spot in this vast landscape. However, if after reading enough of this you still want to go to medical school, might I also suggest some medication? Just a thought.

Silent Killer

I went to a funeral of a dear patient today. She was 72 years old, she was married for 54 years, and she had one son. She loved to play golf, to over-decorate the house for the holidays, and to spend time with her family. But she also loved to smoke her cigarettes despite our many discussions about the risks of smoking.

She had been fine until 3 months ago when she presented with abdominal pain. Shortly thereafter she was diagnosed with widespread lung cancer that was growing by the day. Six weeks is all that she had from the time of her lung biopsy to her death.

Lung cancer scares me because I know that no matter how complete a physical exam or how many tests that I perform, there is a chance that it may still be awaiting my patient. Lung cancer kills more people around the world than any other cancer. 10 million new lung cancer diagnoses are made each year. Most of these cases are diagnosed too late in the course for effective treatment. Over three quarters of all lung-cancer patients are/were long-term regular smokers. The only means of diagnosing lung cancer is by chest xray or chest CT scan. Neither of these tests is effective in detecting the cancer at an early stage.

A recent study in the Journal of Thoracic Oncology, however, has concluded that a blood test may be able to predict early non-small cell lung cancer with an accuracy rate of 87%. The cancer may be present 3-5 years before it is detected on the imaging tests. Although it is too late for this particular patient, there is promise that others may have a chance of earlier detection and therefore of cure of lung cancer by a simple blood test. More studies will be needed to better define the role of this technology in clinical context.

Thanatology

Thanatology is the study of everything that has to do with dying, death, and grief, including cemeteries and gravestones, such as AIDS, The Arts, Children, Counseling, Cancer &Heart Disease, Euthanasia, Funerals, Grief, History, Hospice, Multi-Cultural Rites, Pain, Counseling, Suicide, Widows & Widowers, etc. etc. etc.

"And there the children of dark Night have their dwellings, Sleep and Death, awful gods. The glowing Sun never looks upon them with his beams, neither as he goes up into heaven, nor as he comes down from heaven. And the former of them roams peacefully over the earth and the sea's broad back and is kindly to men; but the other has a heart of iron, and his spirit within him is pitiless as bronze: whomsoever of men he has once seized he holds fast: and he is hateful even to the deathless gods."

Death

Yet Another Patient Dies Waiting For Emergency Care « WhiteCoat Rants

Mr. Herrera waited 19 hours for care and still had not seen a doctor when he went into a cardiac arrest and died.

Dreadful. And, unfortunately, predictable.

ED’s are one of those “If you build it, they will come” things, but they’re not funded or equipped (those are related) to see everyone. I fear the answer will be some bureaucratic “Everyone must be screened within…” (some arbitrary number) and will generate the corresponding foolishness to comply with a foolish requirement.

It won’t change a thing. Until our ED’s are properly equipped and funded, this will keep happening.

(There’s a WTF in there for ?why is it okay to have patients waiting that long? and where is the administration? They should have a protocol to call in more of whatever is needed to keep anyone from waiting that long, absent Act of God. ‘Because we’ve always done it that way’ is an incorrect answer).

Fear

What does it take to get Vitum off his butt and into study mode?

Good intention? A desire to do well?

Try fear. Plain, simple fear of failure. That's all it takes.

Unlike last year, when around this time I was enjoying how slack I thought medical school was, this year is different. Not just for me - I've noticed that a lot of people who took it easy early in the semester for the last two terms are turning up at the hospital & university study rooms on the weekends / evenings. And I've got three things that are giving me enough fear to get me studying scared this early into the semester.

1. Life around finals time sucks.

First of all, now that I've been through a year of medical school, I'm more aware of what it involves. I know how hard I had to work when last year's finals were approaching. I spent entire days and entire weeks studying with few breaks. Seeing few friends outside of med - and even friends in med - was not an option, and how the only thing that kept me going was the thought that "if I don't work my butt off, I'm gonna fail." I don't want to be going through that again come finals at the end of this term, so I'm studying now. Hopefully, as a result, around finals I'll feel a bit more prepared and the stress level will be a bit lower.

2. Finals are gonna be brutally hard.

While that should be reason enough to get my nose in the books, there's another reason. If there's any truth to what the third-year students say, my finals this year are going to be tough... much harder than last year.

That could be because for some of our units, the course directors have decided that providing us with lecture notes and lectures that cover all the topics that will be on the final are ineffective strategies for teaching physicians, and so we're expected to do a lot of reading from a variety of sources outside our lecture material. That's intimidating... as is generally the case with medicine, there's not enough time to learn everything, which means I can only hope that which I've learned is enough to get me through.

3. I don't want to fail and have to repeat second year!

In addition to those first two reasons, there's something else. There are a few people in my class this year who are repeating second year. Their reasons for doing this span a wide range - personal reasons, lots of stuff going on in their lives, MD/PhD students who are doing bits of the program at different times as their classmates, and not doing well enough academically last year.

Despite the fact that I don't know the individual reasons that these people are in my class, every time I see them around I think of the last reason. Yeah, it's hard to fail out of med school, and if I do fail a few courses I'll be able to repeat the year, but the third reason I'm getting my study on is because the last thing I want to be doing next year is repeating second year. Med school is a long time and I'm excited for the clinical part of medicine, which doesn't happen until next year. I would hate to be stuck in another year of PBL and our physician and society course.


The funny thing is, I'm sure this year will be a lot like last year in that it seems 90% of the class is scared of failing, but 99% of the class ends up passing. I think it's because we former pre-meds are used to undergrad exams, which we would routinely go into feeling like we knew all the material. Med school exams are scary because there's no way you will know all the material... and getting your 60% for a pass is much harder and requires much more knowledge and understanding than getting a 95% in undergrad.

There's a few people I've talked to that are afraid of third year. Rightly so - from all accounts 80-hour work weeks, being on call all the time, and having the stress of working with attending physicians, seeing patients, and trying to figure out where all the equipment is - let alone knowing how to use it - will be stressful enough. But I'm not even thinking about that yet. I just want to get through second year.

Are you my brader?

We're all different, right? We beg to differ. Just take one look around the college football landscape and you'll see what we mean.
Irene Ryan, aka Granny Clampett of the Beverly Hillbillies, and ESPN analyst Lou Holtz, aka Granny Holtz....
Massachusetts Senator John Kerry and Michigan's Lloyd Carr....
Pianist and composer Bert Bacharach and USC's Pete Carroll....
Billionaire businessman Ross Perot and Auburn's Tommy Tuberville....
World Wrestling Entertainment performer Edward Fatu, aka Umaga, and Hawaii's Vili the Warrior....
Actor Wilford Brimley and Purdue's Joe Tiller....
Actor John Goodman and Notre Dame's Crewcut Charlie Weis....
Associate Justice of the Supreme Court Clarence Thomas and Mississippi State's Sylvester Croom....
World Wrestling Entertainment announcer Jim Ross and Arizona's Mike Stoops....
Republican presidential contender Fred Thompson and Tennessee's Phillip Fulmer....
Political analyst Newt Gingrich and Arizona State's Dennis Erickson....
Former major league pitcher Don Mossi and South Florida's Jim Leavitt....
Country musician Vince Gill and Texas Tech's Mike Leach....
Jabba the Hut and Kansas' Mark Mangino....
Serial killer Richard Ramirez, aka the "Night Stalker," and USC quarterback Mark Sanchez....
Iowa State kicker Bret Culbertson and Shaggy of Scooby-Doo....
Comedian Wanda Sykes and UCLA's Karl Dorrell....

Gotto keep going

Life: It sucks when you’re a medical student. I just finished an essay and about to start another one. I’m pretty sure the first one makes no sense but I don’t care anymore. I’m sick of looking at its ugly face all night. Why must they insist we keep writing about crap which I might add that it’s taking up some of my valuable tv watching time.

Relationships: It sucks. I’m single. I think I’ve found somebody I can crush on. I haven’t been able to do that for the longest time but I think I’m finally beginning to move on from my last relationship. Actually, I’m ok with being single at the moment. I don’t have time for something meaningful right now. A romp in the sack with some unsuspecting hooker is probably all I can handle at the moment.

Presentations: SUCKS. I hate presentations. I just want to sleep. I hate doing them and I hate watching my classmates put them on. People are boring - myself included. Nobody wants to hear your mouth diarrhoea. Thank god it’s not contagious or maybe it is… I think I might have it right now. Fecal vomitting anyone?

Housemates: Sucks a giant one. You sir, failed to mention that your f**king girlfriend has moved in to live with us without paying rent and using up all the resources. I’m f**king tired to taking cold showers in the morning and if I have to do it one more time I’m throwing her s**t out on the front lawn and burn it to hell. OH and you guys are dirty as f**k. Were you raised by wolves or just inbred parents? Empty the drain when you’re done washing the dishes, clean up your bathroom because it smells like s**t, and throw out your damn garbage. The vacuum cleaner was not invented yesterday.

RANT OVER.