Pimpery.

I would love to fill this space with some hilarious story of my own experiences at the mercy of my educators – but a good friend of mine has already done this.

If you’d like to read of the terror of medical student “pimping” please click this link – and make sure you’re not in public (undistinguished laughter has a habit of making your neighbors feel self-conscious)

http://ursnma.org/blog/    ( Scroll down to I AM A MEDICAL STUDENT: David Paul) <- College roommate.

The medical student’s baseline

They say that illness is “the great equalizer” as we are all destined to fall prey to something microbe-driven over the course of our lives.

however, seeing as medical students are fiercely competitive, and have been deceived to believe ourselves better than illness itself, (why else would we become doctors….to help people?) I thought I would share the other great equalizer…the standardized patient.

Most of you would prefer your doctor had some “hands-on” training prior to his/her assessment of your own illness yes? I imagine so…the better question is, upon whom should said doctor learn their craft?

“ain’t gonna be me” I can hear the masses crying – and let me stress now. You’re right. The bumbling, unsteady, nervous hands of a medical student are the last you would want to see coming through the door of your exam room.

Thankfully – a few brave souls have committed themselves to being scraped, pinched, poked and prodded by medical students learning the basics of the physical exam. We call them standardized patients. Ideally, they are the purest distillation of a patient that we might see, surly, uncomfortable, and annoyed at having taken time off work. When we turn our backs on them during an exam, they mark us down, when we fake a reflex test, they know, and when we speak to quietly, they gleefullly state “WHAT!?” to let our examiner (watching via CCTV in another room) know that we failed to confidently address the patient.

Now that you have met the standardized patient, let us meet the types of medical student her or she will be subduing:

The Gunner – Known for their ability to answer questions faster and more accurately than Ken Jennings, this medical student is the bane (batman!) of all us normal folk. They ask questions they know the answer to..despite the iPad clearly open to that very wikipedia page sitting in front of them. They springboard off of your failures on to greater heights…and the world cheers when they stumble. (sorry…just a lil’ cynical)

The stutterer – It’s unclear how this student made it through the interview process. They stutter incessantly, not because of a speech defect, but rather because they interrupt their every thought aloud with its answer while holding up the entire class with their question. Example:
“So Professor G, why is it that the patients exhibit splenic crises with Here…oh yes, because of the membrane deficiencies..and are those caus…yeah, oh y.y .that’s rig…..ankrin/spectr…is that with a y?”
This student get’s their answer by the end of class. The rest of us leave confused.

The Facebooker – SOMEHOW, this student has survived 7 years of higher education without ever having logged out of facebook, twitter, or TMZ, they saw Venus’ c-walk live, and were the first to inform us that Kim Kardashian is getting a divorce…and they STILL get better grades than you.

The drunk. – Yes. Medical students drink…likely more so than their free-willed counterparts. The amazing thing is their level of function while intoxicated. I once wrote about a student who broke down the cranial nerves while attempting to stumble up a stairwell.

The Diva – this may be a product of being at an institution with our demographic makeup, but the number of students here who are unafraid to make DEMANDS of professors is staggering. They speak their minds freely, and are sure to smack their lips loudly whenever they answer a question correctly in their minds. Incidentally – they are the most amazingly attractive humans I’ve ever seen.

The foreigner – This student for reasons unknown, has no interest in you, your class, or your education, their “fadda” said to “stoody de boooks” and that’s what they’ve come to do. Beware of this student, for they do not sleep, they do not eat, and they will not rest until you ar…sorry, got lost in the terminator reference. They’re pretty cool, if you can get over the inherent cultural differences that will exist between you and them.

So, the great equalizer.
Imagine if you will that on a bright tuesday afternoon, each of these students walked into their respective exam rooms, dressed in their [previously] white coats, and was faced with the patient I had. I’ll avoid all of those HIPPA – infringing descriptors and simply say she looked angry, with downturned lips, a scowl, and an unflinching gaze. I tried my usual cheery/suave and she cut through it like a scythe. At that moment I became the stutterer, and the drunk, making incoherent requests for the patient to raise her arms, do “the twist” and extend her legs.

When it came time to palpate her trochanteric bursa (a maneuver that requires the waist of the pants to be pulled down a good five inches, I froze. I know it’s hard to imagine a 24 y.o. male freezing up at the prospect of pulling any form of pants down, but in that moment, I was the African student, and this was my elder [read: matriarch]. I think I apologized three times before I exposed her hip, only to find that she’d chosen today to wear her tightest-fitting underwear, clothes that required me to confidently grab the elastic and pull. I won’t lie, I fudged the test, pressed convincingly around the upper buttock, and clearly stated, “no abnormalities present”

(did I mention that my evaluator was in the room because the CCTV was down?)

The best part. Every student mentioned above told me they had the same experience. I am REALLY not looking forward to this pelvic/rectal exam.

sincerely ,
the undeterred.

P.S. – we’re also graded down for the use of excessively complicated language with our patients.
I thought I was going to fail.
She looked at me quizzically when I asked her to “disrobe”

The Cords of Billroth

Ok. I had to write a post because that is just Cool, like something out of a sci-fi film. The CORDS OF BILLROTH (insert James Earl Jones here) are just some canals in your spleen, but they highlight a bigger concept.

2nd year is cool.

We just finished a block on the hematology (bloodiness), Lymph (protectiness), and Musculoskeletal (boniness) aspects of the body. I have had quite a few “wow! that’s cool!” moments here at school – but this last week was nothing but an incessant stream of them.

Here’s you’re (that’s funny) story for the day.

I like to believe that I am not a squeamish person. In fact, I’ll just come out and say it, outside of spiders, and…well, anything creepy-crawly like that, I’m pretty tough. If it smells, spurts, bubbles, or curdles…I’ll usually be alright. (It’s the only way I can stand living with all of those dishes I refuse to do) I was standing outside of TGI friday’s at about 6 yesterday, rewarding myself for having achieved nothing during the day – when a lady strolled up next to me and proceeded to vomit the entire contents of what I imagine was her lunch.

There’s a saying – when in Texas, think Horses…not Zebra’s – often aimed at excitable M2’s who want to be the first to catch Boorhave’s syndrome (thank’s ANW…) as it starts. (This was only worsened by a friend of mine at U Rochester who sent me an article about their medical students saving a father and two daughters from drowning in a canal) As you can imagine, I immediately went through a rather short and disjointed differential…DKA, Hemochromatosis, Trauma, pyloric stenosis…all of the dumbest possible options I could have picked…the last one is not even associated with adults. So…iPhone in hand, I did what I was trained to do…walked over and said,

“…uh..ma’am (this is the south)…are you…um…are you ok?”

– no response…just more watery afternoon delight.

“ma’am…are you ok? ”

(I couldn’t believe that 1 year of ER scribing, and 1.2 years of Medical school had left me less equipped to deal with a vomiting bystander than 2 years of elementary school.)

“ma’am…are you ..” finally she turned and gave me the classic “can’t you see i’m vomiting here?” look, spat out the rest, and continued with her day.

Rather makes it hard to go back and read Robbin’s pathology, when you realize that you haven’t learned basic survival support.

oh well. 2nd year is still a blast.

The blessings of an enriched education

So to be honest, it can at times be a little terrifying…

“What?” you say,

– Education.

A classmate of mine once remarked snidely, “Give the black man a book and you’ve either incapacitated him, or made him the singularly most dangerous force on earth.”

While a bit dramatic, his words came to mind tonight, while studying at Panera. (I left after spilling a box of cereal in my room) I was tapping my pen to the sounds of Phineas Newborn Jr.’s A Night in Tunisia and snickering about Hephaestin, an enzyme that transports iron…(clear reference to Hephaestus ).
when 6’4″ hulk of human being (in papery-thin vanderbilt scrubs) walks up and escorts his (presumed) girlfriend from the counter and out the door. As he left we shared that o-so-special nod.

“Nod?” you say,

Yes. That fleeting moment where you see someone defying the stereotype. Someone wearing a suit, scrubs, or Judge’s gown. Heck – anyone not dressed like BET/MTV/VH1/FOX/CNN/MSNBC and clearly in pursuit of something better. The moment comes when they recognize you…and is usually followed by a curt nod of the head.

It’s kinda like the look two bald eagles would share while flying past each other en route to the eagletown apple store.

The look says – you’re one of the last of our breed aren’t you? The nod says…yes, as are you.

“Ok, now you’re just being dramatic” – you say.

You’re probably right…but in the ever ongoing battle between Republicans and Democrats, the issue of Black voting has resurfaced. Despite the passage of the 15th Ammendment in 1970, we’re apparently still the group at risk if picture IDs are required at the polls.

Wait – you mean after 142 years and 3 generations of iPads minorities could be exiled by a vote that requires a picture ID?

……”*Expletive.*”.

So I bring you back to Panera, back to my thoughts. A black kid listening to jazz, studying pathology, and giggling over pharmocology references to roman greek gods. I could not be more grateful for my education and opportunities…or more crushed by the paucity of them elsewhere.

Chris Rock, the (hilarious/notorious) comedian was featured on NPR last week, and speaks of his million dollar mansion…a mansion in a neighborhood of 100 million dollar mansions. Among those 100 Owners he says, are 4 Black people. They are:

Jay-Z.
Eddie Murphy.
Mary-J Blige.
and himself.

He then proceeds to note that while each of them can lay claim to the term “greatest” (comic/rapper/R&B artist etc.)
…His next door neighbor is a dentist.

I can’t wait until the nod means nothing more than…”nice shoes.”

and to whom it may concern….thanks for the education.