Any advice for the surgery clerkship? Any good books to buy? I start it on Monday; it’s my first clerkship ever. A little nervous. Advice appreciated. Thanks!

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This was the line I heard yesterday over the intercom 30 minutes into my flight from Minneapolis to New York, and it scared the crap out of me. I’m always freaked out that I’m going to be in a situation where I will have the most medical knowledge of anyone around, and I’ll have to use it. Luckily there were like 4 doctors on the plane; an elderly woman passed out at the back of the plane, I think from dehydration and heat (the plane was sitting on the runway for awhile, really stuffy). She was laying down in the aisle by the bathrooms.

When they made the announcement, I got this look of sheer terror on my face, hoping desperately there’d be someone else. And then my imagination started to run with it:

Me: Well, I’ve had two years of med school, but I’ve never actually treated anyone!
Flight Attendant: You’ve got to be kiddding! How can you be halfway done with medical school and you’ve never taken care of anyone?
Me: I don’t know, that’s how it works, you do your first two years preclinical, and then you take boards, and then…
FA: Okay, shut up already and help this lady!
Me: Okay, uh, get her some oxygen, and uh, water! And… stuff.
FA: We’re screwed.

The lady was sitting up and fine by the end of the flight; I hope she’s okay.

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Boards are done. Mexico is tomorrow.

In retrospect, I can say that studying for boards was actually worthwhile, but the actualy exam was extremely lame. It was really good to force me to review everything I’ve learned over the past two years and see it from different angles, integrate it, etc. But the test I took today had too much that reflected too little on practicing medicine. If I was studying to be a research scientist, test the hell out of me on biochemical pathways and cell signalling molecules, but I’m preparing to be a doctor, to take care of patients , not molecules. I couldn’t believe some of the questions that made it through the NBME’s screening process. Hey NBME-I don’t care about specific details about HLA types that some MD/PhD has written a question about.

Whatever, I’m done, hurrah. Expect a new redesign of the site in the coming weeks, as if anyone reads this anyway.

Yes, I’m cranky. Over and out.

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What?

With the exception of celebrities and politicians (our royalty?) you don’t really get preferential treatment based on your ability to pay. (in the US)

If MedPundit really thinks that insurance doesn’t get you any preferential treatment in the US, she’s totally jumped the shark. Newsflash: Getting treatment at all is preferential treatment, Dr. Smith.

And more to the point of her post: people die on waiting lists all the time in the US, too. And Canadians requiring emergency care get it.

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I’ve kind of learned it’s easier for my OCD/hypochondriac/med student syndrome self to just stop trying to diagnose myself, stop Googling every symptom, and stop palpating nodes, thinking that one will turn out to be Hodgkin’s (and still secretly knowing deep down that it won’t). But every time I read Effect Measure , I start to get a little scared. It’s a public health blog that’s doing some awesome blogging following the Avian flu virus (Influenza A H5N1).

A perfect example of a freak-out post . I really don’t think the writer is being alarmist; I get the sense he’s pretty well read, experienced with public health, and (gasp) uses data and facts for the basis of his posts. I’m mainly scared about this bird flu for my own personal concern: the flu seems to be hitting people in my age group . Combine that with the fact that that I’m an official first responder, starting work in the hospital in July, in California, in the Bay Area, with a constant huge influx of people from Vietnam and other bird flu hotspots, and you can color me nervous.

Yes, I know, it’s one of the risks I take as a future physician, but I think it’s absolutely ridiculous that this isn’t a bigger story in the news, or that our government is doing less for preventative measures. I guess that’s what happens when you’ve got a war going on to protect our security. My bet: when the bird flu hits, and if it hits as hard in the US as Effect Measure is reporting, “health security” will be a new buzzword, and could be the tipping point for a national health insurance system in the US. If there’s one thing the US is good at, it’s reacting once a problem has already hurt us. Go primary prevention!

The UK has ordered enough antiflu meds for 25% of its population; the US: 2%.

Sweden has ordered enough for half a million and tens of millions more doses have been ordered by Norway, Canada, Australia, New Zealand, Finland and France. The US has only ordered 2.3 million and may increase that to 6 million (enough for only 2% of our population). The UK is more ambitious with plans a $385 million for a quarter of its population. London wants 100,000 for its police fire and transport workers. WHO is trying to establish a “mobile stockpile” of 120,000.

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Why isn’t “Health Care for All” sexy?

We’ve got hundreds of thousands of people wearing those Lance Armstrong armbands , and tens of thousands I’m sure wearing those knock-offs, and I started wondering, “Why isn’t there one for the uninsured?”

If people can get behind supporting cancer victims, or donating money to Jerry’s kids, or walking for breast cancer, or basket-weaving to fight Prader-Willi’s, why not the uninsured? And where’s the celebrity spokesman? I started to think that it must just be that celebrities have insurance, and therefore don’t have any experience with being uninsured, but that’s completely untrue; almost all of them started out uninsured trying to make it big in LA or New York, I bet. Have they forgotten so quickly?

If people can so easily get behind some awful disease with no cure in sight (HIV, any number of rare genetic disorders, most cancers), why isn’t there more support for something that most other industrialized countries *have* been able to cure? (I’m using ‘cure’ liberally here, don’t get in a commenting tizzy.)

Is it that people think the uninsured don’t deserve insurance, or that it’s their fault they don’t have it? (There’s plenty of people that way about HIV, but it’s still supported.)

Or is it maybe that it’s easier to support something that we don’t entirely understand and know how to fix? That it’s something still beyond our grasp, beyond our means, that is dropped on unlucky individuals? There’s plenty of diseases out there that *are* 100% preventable; why aren’t we knocking those down quickly? (I’m thinking lead poisoning as an example.)

Maybe it’s that those diseases primarily affect the disenfranchised, impoverished, and the minorities? You don’t see a whole lot of funding out there for sarcoidosis, primarily affecting black people, or liver cancer, which is huge in Asia because of hepatitis.

So line right up celebrities and PR firms. Let’s make pre-existing conditions and 18,000 deaths a year the sexiest thing since testicular cancer.

On a side note: studying for the boards brings an insanely huge number of interesting ideas into one’s mind. My head is like an 8 year-old desperately trying to stall from having to go to bed. Boards studying is right up there with showering as far as number and quality of ideas go. I’m starting to think the great inventors and thinkers of all-time either a) took a lot of showers or b) studied for Step One for their entire lives.

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A quick jaunt through the little catch phrases that are my life right now (thank you, First Aid). And hey, you might learn a thing or two:

• Bladder Cancer (Transitional Cell Carcinoma) in your Pee SAC: caused by Phenacetin, Smoking, Schistosomiasis (thanks Kat), Aniline Dyes, and Cyclophosphamide. Pee Sac is just such a great way to refer to your bladder. Also reminds me of Forat from Ali G referring to the scrotum as the “testes satchel.”
• Citric Acid Cycle. Cindy Is Kinky So She Fornicates More Often. Citrate, Isocitrate, alphaKetoglutarate, SuccinylCoA, Succinate, Fumarate, Malate, Oxaloacetate. Replace “Fornicates” with something else for added fun.
• Urea Cycle. Ordinarily, Careless Crappers Are Also Frivolous About Urination. Ornithine, Carbamoyl phosphate, Citrulline, Aspartate, Arginosuccinate, Fumarate, Arginine, Urea.
• Burkitt’s Lymphoma. BurC-Myc’s. (C-myc oncogene, 8:14 translocation.)
• Complications of Lung Cancer: SPHERE. Superior Vena Cava Syndrome, Pancoast’s Tumor, Horner’s Syndrome, Endocrine/paraneoplastic, Recurrent Laryngeal Nerve Palsy, Effusions (pleural, pulmonary).
• SLE-like syndrome caused by drugs: It’s not HIPP to have lupus. anti-Histone antibody, Hydralazine (vasodilator), INH (TB), Procainamide (Ia anti-arrhythmic), Phenytoin (anti-epileptic).
• Hypercalcemia is a MISHAP! Malignancy, Intox of Vitamin D, Sarcoidosis, Hyperparathyroidism, Alkali Syndrome, Paget’s Disease of Bone!
• Dilated/Congestive Cardiomyopathy Causes: ABCD. Alcohol, wet Beriberi, Coxsackie, Cocaine, Chagas’s, Doxorubicin.
• INH: Injures neurons and hepatocytes. Prevent neuron damage by giving Vitamin B6.
• Vincristine and vinblastine: prevent formation of microtubules, anti-cancer drugs. VinCristine Crushes Neurons, and VinBlastine Blasts Bone Marrow.
• Causes of Fibronous Pericarditis: UReMIa. Uremia, Rheumatic Fever, Myocardial Infarction.
• Kawasaki’s Disease, a vasculitis: Kids, Koronaries, Konjunctivitis, Krusty Lips, Strawberry Tongue.
• Buerger’s Disease, a vasculitis: Try the world RENOWNED Smokey Burger! (Buerger’s has Reynaud’s phenomenon, plus gangrene, in smokers.)
• Post-Strep Glomerulonephritis: Sub-Epi (STREPI) humps.

And hundreds more where that came from. But I’ll stop boring you now.

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This new-fangled blogging software required me to approve comments, and didn’t email me when I got one to approve. Sorry about that. I’ve approved all the comments and fixed it so I should respond if you comment. Didn’t mean to offend or ignore, and thanks for writing!

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Dr. Quinn over at PushFluids has some words of advice for me and other second-years about to take boards. Thanks. I needed that. Always nice to know that everyone goes through this. (Except the insanely smart people with photographic memories in my class, who we all love to hate.) (You know who you are.) (And we do, too.)

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This blog will probably be pretty sparse for the next month, I’m sorry to say. Accept my sincerest apologies, faithful readers, but The Boards loom over my head. I take them on June 1.

It gives me approximately 5 weeks to review everything I’ve covered in the past two years, and even several large gaps in our knowledge that we weren’t taught. (Ahem, embryology and biochemistry.) I’ve got a calendar and everything to keep me on schedule, but the past couple days have been simply overwhelming. I’m basically fitting in 4 weeks of material into 10 hours of studying, if that.

Schedule as follows:
Wake up. Library by 8:30 at the latest.
Study until 12:30.
Lunch for an hour.
1:30 to 3:00, study.
By 3:00, I’ve lost all sense of hope, motivation, and drive, so I’ve been going to the gym then to destress.
Eat a snack, around 4:00?
Back to the library.
Eat dinner at some point.
Go home exhausted, and squeeze in an episode of Reno 911 to remind me that humor and fun still exist in the world.

Random thought collection:

• I think I diagnosed someone in high school with Cushing’s. I feel really bad, because all the people at school used to make fun of her for being fat, but now I’m really starting to think it was a hormone imbalance. She had the roundest moon facies I’ve ever seen. Can’t remember if she was hirsute or not.
• My computer is dead, for like the fifth time, but it’s probably a good thing: less time online to procrastinate and surf the web. The Lord works in mysterious ways.
• This test just seems like another stupid hazing ritual sometimes. Make us work our asses off so we get used to working hard, long hours.
• Other times it seems very valuable. I can’t count the number of times I’ve been reviewing something and think, “Oh, so that’s why that happens.”
• What I wouldn’t give for, like, a day where I could stay up late and play some stupid computer game all night. I miss undergrad.
• I probably would have already had a psychotic break, and be completely lazy and not studying when I’m tired if it weren’t for a special new significant other in my life. As my parents read this blog, they will inevitably start to pester me to find out more, but I’m really not in the mood. He is great, he is smart, he is cute, he’s a he. That’s not a typo, as someone once emailed me confusedly. Get over yourself.

Back to STDs and gynecological neoplasms. Woo.

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