Resident Ghost

Anyone ever get that creepy feeling like a spirit or a ghost is in the room? Well, that happened to me the other day, and as I was recounting the story to my 90 year-old great grandmother, it reminded me of this little med school gem. 

Basically, I live at the med school. I am a night owl, so my most productive hours are about 7pm to 3am (extremely unfortunate... currently working on being a normal person who likes daytime). As a result, I am on first name basis with all of the janitors. One of them even bought me groceries first semester. I must have looked particularly haggard and starving that week, because she came into my study room with a huge Walmart bag full of my poor-student-microwaveable-food-of-choice: Thai Peanut Noodles. She set them down on the table, told me it looked like I needed some food, and wished me luck studying. Looking back, that's kind of embarrassing... but mostly awesome. She even included mini-Nerds and Smarties for dessert. Then there's the second floor janitor. He is actually an established artist. When he handed me his card to check out his artwork online, he gave me this warning, "Don't be alarmed or offended by the nude photos." Dude, I'm gonna be a doctor. Nudity is in. Anyway, his artwork is pretty incredible. His wife is an astrologist and did a reading for me... it's amazing the things you learn about others and yourself by just striking up random conversations. They even invite me to their house for holiday dinners now. 

Back on topic. Since I know all of the janitors, I also know their cleaning schedules. I know that every time I remember that I have to pee, they will be cleaning the downstairs bathrooms. Therefore, I walk upstairs to pee on the second floor. Late at night, when I walk out of the bathroom and turn left, I see a head and shoulders in the window of the last clinical suite. At first, this alarmed me. I was totally freaked out when I walked over to see who was studying inside, and no one was there. I attributed it to too much caffeine, exhaustion, and high stress levels. Then, I saw the face again, and I saw it disappear. I was even more freaked out. Over the course of the year, I saw the face ~10-15 times total, and I got used to it, referring to her in my head as the Resident Ghost. I never mentioned this to anyone, as I say weird things on a regularly basis, and decided it best to leave this one out. Then, one night during finals week, my two girlfriends and I were leaving school late, around 3am. We all had to go to the bathroom on our way out, and I suggested we use the downstairs one because occasionally the upstairs one freaks me out. My one friends says, "OMG! Have you seen her in the window too!!??" 

How crazy is that!? My med school has a ghost. Reppin.

Nerd, Geek, Dork: Which One Are You?

There is clearly a difference between a nerd, a geek, and a dork. 

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Nerd: someone who is passionate about learning, being smart, academia

Why They Are Nerds: thirsty for knowledge and life-long learning; innate desire to understand, rather than accept

What They Look Like: Nerds are the hardest to spot. Stereotypically, nerds look like Urkel - big glasses, pocket protector, high pants, tucked in shirt, etc. Realistically, nerds are just people that like to learn and work hard, ultimately achieving success. Therefore, the only difference between the Urkel and the sexy athletic M4 is the ability to hide their nerdiness. And even then, a lot of nerds prefer to own their nerdiness, taking it as a compliment when someone calls them "nerdy," and seeing it as a turn-on when they meet a fellow nerd.

What They Do For Fun: read, reorganize notes, color-code, study

Where They Like To Go: library

How They Rate a Movie: based on theme/meaning or how closely it followed the book

What They Collect: books, library cards, knowledge

Special Talents: Note-taking, extreme speed and accuracy with a dictionary/encyclopedia/search engine, ability to rattle off random facts

Annoying Traits: automatically correct spelling and grammar errors, obsess over grades, slight OCD

High School Superlative: Most Likely to Succeed

When They Act Like Nerds: All the time. Nerds are constantly thinking and over-loading their brains. Fortunately, most are able to remain socially competent by learning when to keep their mouth shut... unless surrounded by other nerds. 

Geek: someone who is passionate about a particular area or subject, usually an obscure, technological, or difficult one

Why They Are Geeks: obsess over acquiring information about their unique interests, but don't necessarily care about underlying principles

What They Look Like: Geeks are easier to spot than nerds, usually because they don't care as much about what people think of them. They tend not to follow fashion trends, sometimes not even caring if their clothes match or if their hair is combed. Occasionally appear disheveled.

What They Do For Fun: dress up as their favorite character to go to the midnight premiere of Star Trek/Harry Potter/Hunger Games/Lord of the Rings, join fan clubs, search internet forums

Where They Like To Go: Game Stop, Best Buy, movie theaters, anime conventions, Comicon

How They Rate a Movie: based on special effects

What They Collect: electronics, video games, comic books, action figures

Special Talents: speak Elvish, fix computers, hook you up with baller entertainment systems, Internet skills

Annoying Traits: begin conversations about hardware/software

High School Superlative: Most Likely to Work for Apple

When They Act Like Geeks: at home on their computers or anywhere around technology

Dork: someone who is socially awkward and relatively clumsy

Why Dorks Are Special: In my opinion, the term "dork" is usually used in a temporary fashion. While nerds and geeks tend to be nerds and geeks for life, "dork" is usually used to describe a person in a specific scenario. For example, I have a friend who is famously terrible for delivering bad pick-up lines. After watching him waltz over to a lady, who was clearly with her boyfriend, spin a chair around backwards like he was AC Slater, and then ask, "Can I buy you a drink? Because you sure do look like Snookie," I called him a dork. He has some of the best stories, all of which I wish I would have witnessed, because of his social awkwardness with the ladies.

What They Look Like: There are two types of dorks. 

Type I can be spotted tripping in public and laughing it off, because they are aware of their dorkiness. These dorks tend to embrace their social awkwardness, and you can laugh with them. They tend to be funny, silly, and a welcome addition to any party. 

Type II can be spotted tripping in public, turning bright red, and running away with their head hanging, because they are extremely self-conscious. These dorks tend to fear their social awkwardness, and you can't laugh with them. You could laugh at them, but then, if you are a good person, you usually feel bad and just wish you could help them. They tend to be quiet and sitting in the back of the classroom, in order to avoid all attention. Luckily, most Type II dorks tend to develop into Type I dorks after they learn to embrace their occasional clumsiness, leave the embarrassment behind, and just have a good laugh.

What They Do (For Fun?): trip, fall, joke, deliver bad pick-up lines (type I) or avoid flirting in general (type II)

Where They Like To Go: middle of the stage during a talent show (type I) or straight home after school (type II)

How They Rate a Movie: based on how many people are dorkier than they are

What They Collect: bruises, embarrassing stories (generally very funny to tell)

Special Talents: sense of humor (Type I), creating awkwardness

Annoying Traits: creating awkwardness

High School Superlative: Class Clown, Best Sense of Humor

When They Act Like Dorks: The dork holds the element of surprise, the wild card. You never know when the dork will shine. Be ready at all times, preferably with a First Aid kit. 

Which One Am I? Is this even a real question?

According to OKCupid.com, I am Pure Nerd. SURPRISE! 

96% Nerd, 48% Geek, 17% Dork, to be exact. 

I definitely could have predicted this, with my OCD note-taking skills, desire to build a two-story library in my house, and obsession with random facts. Come to think of it, I basically fit every part of nerd description, except I have a hard time keeping the nerd under control in social situations (and I do really, really try sometimes). I also suck at Trivial Pursuit if I'm playing with my parents. And my High School Superlative was Biggest Flirt, although I did get Most Likely to Succeed in the eighth grade.

I have to say, I am slightly impressed by my geekiness. In general, I am very directionally challenged and technologically disinclined. Although, my dad's geekiness results in me having way more technology than I know how to handle. I also admit I may or may not have dressed up for a Harry Potter midnight premiere... or two... or five actually. But, considering I thought "wi-fi" was pronounced "whiffy" up until recently, I can understand why I didn't hit the 50% mark.

As far as dork goes, I don't really like this term, so it's reassuring that I didn't score high on the list. This has nothing to do with not liking dorks or the description - in fact, I can be one of the most socially awkward people I know in some situations, and weird things happen to me that I attribute to clumsiness. Prime example: last summer I almost died (slight exaggeration). My obituary would have had to list the cause of death as "beach umbrella." My mom and I were enjoying a few days at the beach, and we went down to read at 7am. No one else is on the beach, except for one family, and they are sitting a quarter of a mile to our right. Not even within shouting distance. The wind starts to blow a bit, and they lose their beach umbrella. It comes cartwheeling across the vast sands, and they are chasing it. Now, it is heading right towards us. It would have been a jerk move if I got up and ran in the opposite direction instead of helping them out. So, I stand up, brace myself for the umbrella, try to catch it, and the pointy end comes right up, smacks me in the face and stabs me in the jugular. It knocks me over, stuns me, cuts my neck, and I start to bleed. Thankfully, the family could stop chasing their umbrella, since it was impaled in my neck and I was twisted all up in it. Clumsy? Yes. Socially awkward? Absolutely. 

Anyhow, the reason I don't like the term "dork," is because I am a Pure Nerd and actually know that people refer to a "whale penis" as a "dork." Therefore, I commonly refrain from using this term, as every time I do, I automatically think "whale penis." Weird. 

After looking at the other classifications, I'd have to say that the quiz hit the nail on the head, and I enjoy being dubbed Pure Nerd. It definitely fits me better than Pure Geek or Pure Dork. And Joe Normal just sounds boring. Now, Computer Savant, that's a scary one. I didn't even have to read the description to know I would never qualify for that title. Tri-Lamb Material sounds pretty badass (you need over a 50% in both Nerd and Geek to earn this awesome title), and so does Modern, Cool Nerd. Outcast Genius is the last of the categories, and this title makes me slightly sad for anyone who earns this honor, and slightly jealous of them (over 50% required in all three categories).

Which One Are You? 

Click HERE to determine your Nerd, Geek, Dork Status!

You know you're a med student when...

Yesterday, my family and I were driving in the car and I looked at the stereo system.

It read: 71 º , NE.

You know you're a med student when you automatically think "71 º, Norepinephrine,"  instead or "71 º, Northeast." This got me thinking about all of the weird things I do, probably because:

1. I am a medical student.

2. I am a really big nerd. 

I came home and googled "You know you're a med student when..." and came across a really depressing version, where the top reason was something like "you know you're a med student when 80% of your male colleagues will marry a nurse and 80% of your female colleagues won't marry at all." Yikes. So, after consulting some of my fellow classmates and contemplating the weird things that I do, I decided to create my own list.

You know you're a med student when:

1. You are in a car and think "norepinephrine" when you see "NE," instead of "northeast."

2. You see the following pattern on a papertowel and think "cholesterol."

3. You wake up terrified because you dreamed about forgetting to turn in homework or studying for a test for a class that you didn't even realize you were enrolled in... and then you realize it's summer.

4. You buy your first wrinkle cream and start checking for grey hair at the age of 23 because you're convinced med school adds 40 years to people.

5. People ask you what you do for fun, and you say, "SLEEP."

6. You look forward to family reunions so that you can offer free physicals to practice your exam skills... and you actually think this is a good idea, until you see the look on your mother's face.

7. You forget how to describe the locations of things without using the terms "superior, inferior, lateral, medial, anterior, posterior, etc."

8. You can't eat your roast beef sandwich because when you take the bread off to add mustard, it reminds you of the brachial plexus you just spent four hours dissecting.

9. You walk out of cadaver lab to the lockers, and think there is a blood clot on the floor... then realize it's a piece of brownie.

10. You own the following shoes, and you love them:

11. You wish you could listen to everyone on double speed.

12. You look at cross section of a penis, and compare it to Kanye West.

http://images.cheezburger.com/completestore/2010/8/3/84f15104-2ad4-4a42-a225-da9fd8755e49.jpg

13. You feel socially incompetent around non-medical people because you can't shut off the Med School Button, and therefore do not know what to talk about.

14. Because you can't shut off the Med School Button, you continually see the blank stares from your family and friends because they are totally tuned out to you... but you keep describing a disease or pathway anyway. It's good review.

Every med student needs THIS button!

15. One of your favorite games to play is "What would I name my kid: (Insert Med School Class Here) Version".

Neuroscience version: Tentorium Cerebelli

Anatomy version: Gubernaculum 

Pharmacology: Allegra

16. You thank your kidneys every time you pee while intoxicated. They just function so well!

17. The morning after you drink, you see the Tylenol bottle and automatically think "CYP, GSH, NAC, liver toxicity," as you reach past it for Aleve or ibuprofen.

18. You turn in your last final, and then somebody hands you 1200 pages of notes for one class, in case you want to read it over Christmas break.

19. You think you have every disorder that you read about. And when someone calls you a hypochondriac, you secretly think, "Yes, but "hypochondriac" also refers to the upper lateral sections of the abdomen, on either side of the epigastric area, below the rib cartilage."

http://shs.westport.k12.ct.us/forensics/02-evidence/regions_&_quadrants.gif

20. You can't eat eggs or fungus because you know too much "science-y" stuff about them.

21. You are excited when you get to shower before an exam, because it is a sign you feel "prepared."

22. Your friends text you pictures of random body parts and want a diagnosis and treatment plan. And they stop going to real doctor, because they think they can just ask you.

23. Your family asks you about all of their health problems during the holiday dinner. And then you make up something that sounds legit... and then tell them that you don't really know anything. Unfortunately, you've just lost your appetite because your great grandmother spent 20 minutes describing every colonoscopy she's ever received.

24. You know that "Army over Navy" and "Tom, Dick, and nervous Harry" don't refer to the military or three men.

25. You close your eyes at night and random body parts pop into your head, you start dissecting them and labeling them, and you are completely okay with this because you count it as studying. 

To be continued...

Pediatric Ponderings

Today was my first day in inpatient pediatrics. My love for pediatrics was reconfirmed, as I enjoyed all of the patients, was able to handle the parents, and preferred the illnesses/chief complaints over those of the usual adult inpatient setting. With this being said, here are the extremely important, life-changing points that I am left pondering at the end of the day:

1. If I have a stuffed animal wrapped around my stethoscope, at what age is it inappropriate to have the patient guess what animal it is or name the color? I think seven could be a good cut off (obviously taking development into consideration). Pretty sure the eight-year-old thought it was lame.

2. What kind of stuffed animal am I going to buy for my stethoscope!? Tigers are my favorite. But, a monkey could be cute. (Sidenote: I hope you can tell I am writing this with sarcastic tones... mostly...)

3. Do I have to ask patients if there are "monkeys in their bellies" or "potatoes in their ears"? I like the monkey idea... maybe... but, I am pretty sure half of the kids under three didn't know what a potato was yet. Could be a problem. Maybe I'll say "cookie."

Adorbs!!! http://swell247.com/baby-doctor-gift-set.html

4. Apparently, I need to borrow my friends' kids and practice changing their clothes. Did not realize I'd have to do that... very awkward, need some skills.

5. Definitely will enjoy a subspecialty over general peds. Something a little more hands on... and when a parent asks what my job is, I don't want to respond with "I'm here to monitor how much your kid eats, pees, and poops." Gen peds is great for being the hub of information and consultation, but I want my daily skills set to go beyond the basic physical exam. Also, I prefer what's going down inside the body, as opposed to what's coming out of the body.

6. I think physicians are either drawn towards peds or drawn towards adults, and there is only a select few that can thoroughly enjoy both categories. Yesterday, an elderly patient was hacking up a storm and I was legitimately scared - had to make a conscious effort not to slowly back out of the room. Lots of things flashed through my mind... getting puked on, dentures falling out, patient falling out of bed, patient dying. None of these are good things (May I point out that I excel at stating the obvious?). In comparison, today, a pediatric patient was hacking up a storm and I was legitimately in doctor mode, immediately consoling the patient and helping him through the fit. Who cares if I get puked on? It will be a smaller amount. The bed is three times the size of this kid, and the kid isn't obese... not gonna fall out of bed.

For some reason, I see kids as more resilient than adults. I appreciate their innocence and potential, and I have more internal faith and belief in them, which is probably the main reason I'm drawn towards peds. Interestingly, my fellow med student friend feels exactly the opposite. She's terrified of kids, I'm terrified of old people. She views pediatric patients as fragile and scary, I tip toe around everyone over 65. She prefers adult puke, I prefer kid puke (again... smaller quantity, yo!). She prefers black and white, I prefer colors and animation.

Edinburg Children's Hospital in Texas. Seriously!?!?! How could you not be happy working here!?!?

7. If I have nightmares tonight, I know exactly who to blame. I've seen students/interns/residents get yelled at and reemed out by attendings before, but only on TV. Today, I witnessed an attending open the gates of hell and unleash 1,000 furies on an intern, and for literally NO REASON! She was walking by as he was explaining why a particular patient was unable to receive oral medication to me. The attending heard only the words  "use oral meds" and flipped out on the intern, telling him how he was "only a first year resident and knows nothing and shouldn't be telling people information that you have no clue about." She then went on to yell how it was "inappropriate for this patient to be on oral medication, so why are you talking about using oral meds? That's wrong. You are wrong." Which, as you can see, he was not wrong, as this was exactly the point he was trying to make, that this patient shouldn't be on oral meds. He literally had to chase her down the hall and try to politely interrupt her rant to defend himself, and then report back to his attending and tell her about the misunderstanding. I literally feared for my life and I was just standing there. Can't wait until it's my turn!

Professional Sunscreen Applier? Sign Me Up

The first time I felt like a "doctor" was September of my M1 year when I signed up to help with the Special Olympics. First of all, this was an amazing experience and I plan on joining the Special Olympics medical team every chance I get - highly recommended! Second of all, at the time I signed up, I had only been in medical school for three weeks, and therefore knew absolutely nothing. So, I show up to volunteer, introduce myself as a "medical student," and they hand me a Med Team shirt and point me in the direction of the other health care professionals. I'm feeling pretty badass in my shirt, strolling over towards the make-shift exam rooms. I am told that I will be running exam room 1. It's at this point that I have a minor freakout because WTH DO I DO IN AN EXAM ROOM!? Oh God, oh God, these people think that I know how to do stuff! Crap. Thankfully, quite a few M4s show up, and they ask if anyone would like to partner up. I immediately find myself a partner who is actually qualified to do physical exams. This day turns into a fabulous experience. My M4 teaches me how to test reflexes and how to administer musculoskeletal exams. By our third patient, we develop a routine where the M4 performs the cardiovascular and pulmonary exams and let's me do the neuro and musculoskeletal exams. I hit it off with an athlete who has cerebral palsy and when his mom asks to take a picture of us together, it really hits home for me. After spending only 15 minutes with this family, I helped improve their day and make their experience memorable. Experiences like this are why I entered medicine. 

Throughout the school year, I signed up for numerous other volunteer experiences, eager to feel like I was making some kind of difference. Working with real patients is a wonderful reminder of why we kill ourselves during the week studying. Some of my experiences involved teaching physical exam skills to Girl Scouts and high school students interested in health care, speaking to undergrads and high school students about life in medical school, teaching anatomy to elementary school students, and skills clinics on phlebotomy and suturing. Each of these experiences again reminded me why I chose this profession.

Yesterday, I signed up for the medical team at a sprint triathlon. Basically, I will be working with Sports Medicine and Emergency Medicine physicians and other medical students to ensure the safety of the participating athletes. By now, I know how to do a complete physical examination and I won't be so shocked if they give me my own station. This will be a new environment for me, and hopefully a great learning experience. I was pretty excited about it, again thinking of how much I enjoy these experiences and how they always reinforce the fact that I am in the right field.

 And then today happened.

Today, a bunch of my classmates and I were celebrating Memorial Day at a local lake. Quite a few of the gentleman in our class are pretty buff, so when they asked me to apply their sun screen, it was not the worst of experiences. It was during this tedious task that I found out, much to my dismay, that I am clearly entering the wrong profession. Apparently, I should not be on the triathlon medical team, as there is another position even more glorious. Apparently, there are people that wait at the end of the swim and their sole job is to rip off the athletes' wet suits and apply sun tan lotion on them as fast as they can. Is it too late to change my mind about med school? Where can I get an application? Profession Sunscreen Applier!? SIGN. ME. UP. 

And, since this is a "medical" blog, I suppose I shall leave you with this:

1. Skin cancer is the most common form of cancer in the US.

2. One in five Americans will develop skin cancer.

3. There are three types of ultraviolet radiation, classified by wavelength. UVA usually makes you tan, especially since many sunscreens don't protect against UVA; UVB usually makes you burn; and UVC usually doesn't have an affect on you, since it is absorbed by the ozone layer.

4. Your skin has molecules called chromophores, which absorb specific wavelengths of UV. When a chromophore absorbs a photon of UV light, it becomes excited and must release its energy. Sometimes it does this through a photochemical reaction.

5. Photochemical reactions lead to visual biologic responses: tan, sunburn, dermatoheliosis (chronic photodamage, skin appears aged and wrinkly), and carcinogenesis (development of skin cancer).

6. Melanin is produced by specialized skin cells (melanocytes) to help protect the body from UV damage.

7. Wear sunscreen, limit time in the sun, and for gosh sakes, stay outta dem cancer coffins!!!!

"What's the grossest thing you've ever seen?"

Emergency Department, five years ago.

Curious Me: Dr. J, what's the grossest thing you've ever seen?

Dr. J: Easy. Maggots. My intern year and I will never forget it. Homeless woman comes into the ED holding her side. She has a huge abscess. I need to drain it. Cut it open, and out spills hundreds of maggots. I want to gag just thinking about it.

Shocked Me: No way. Really? That happens? Maggots?

This morning.

At 2 am I get an email from my mentor saying, "Hey! Why don't you come in tomorrow? 8 am?"

A serious Night Owl, I am wide awake at this hour and think, "CRAP! I can only get 5 hours of sleep!? What is this?! It's summer! I haven't functioned on less than ten hours of sleep in two weeks!"

I wake up at 7am, jump in the shower, and turn around to see a seriously large and thick massive black spider flying through the air to attack me. I scream and attack back. I win. At this point, I can't decide if this is a really good start to a day (up early, going to be productive, kill a spider) or a really bad start to a day (dang, I'm up early, a massive spider just attacked me). I get my answer when I pull my white coat out of the dryer and spill orange pop on it less than ten minutes later. Then, I realize I've lost my ID. Twenty minutes later, I find it, and I realize it's too late to walk to the hospital, so I jump in my car. I figure I will drive as far as I can and park on the curb where I do not have to pay millions to park. I notice all these signs on the sides of the street, forbidding me to park there. I turn around and drive until the signs stop. I park. I realize I am only five blocks from my house. I get out, walk to hospital, trip on curb, hurt my toe. I start to get nervous about what this day has in store for me.

I walk into the team room and read the board. "Maggs."

Mentor: Want to see something gross?

Me: Ummm... Sure?

Mentor: Ever see maggots?

Me (actually getting excited): OMG! No! But, I want to! I have probably asked 5-6 doctors what the grossest thing they've ever seen is, and the answer is always maggots!

Mentor: Oh crap, patient's already in surgery. (Gives me brief patient history) But, I can show you the pictures.

Me: Yeah!!!!!!! Awesome.

Me (looking at image one): WHAT? Oh my God, that is the grossest thing I have ever seen.

Me (looking at image two): OMG, I think I might throw up just looking at these. I can feel them crawling on me! There are thousands! How does this happen!?!?!?!?!?!???!!?!?

Even though I did not see these in real life, I saw enough to deter me from ever being excited about maggots again. I did not describe what it was like in good detail, because truthfully, it was the grossest thing I've ever seen and I want to save you from having any type of mental image. All I'm saying, is when I snuck into the staff meeting to steal some free Chinese food, I looked down at my fried rice and saw maggots. Appetite killed.

Good luck to everybody in healthcare. May none of us ever have to deal with maggots, and if we do, may we have the strongest of stomachs and a really bad cold at the time so we can't smell.

Diagnosis: Pigeons

I signed up for a mentor at the beginning of my M1 year, and Irish Luck was ever on my side that day. I hit the jackpot! My mentor is an internist and one of the coolest physicians I have ever had the pleasure of meeting. She's chill, realistic, amazing at her job, well-connected, and passionate about teaching med students - basically the perfect combination of mentor traits.  This morning, I walked into the team room and began perusing the boards, looking for something interesting. What do I see?

Patient: fever, pigeons

Pigeons? What kind of diagnosis is this? How does it present? Is this person sprouting wings and living in the streets, following close at a passerby's heels for spare food? Did I learn about this in biochem? Is there a pathway? Pigeons?

I contemplate asking the residents about it, but then decide they look exhausted, busy, and potentially very grouchy. So, I shuffle around awkwardly and sign on to a computer. I google a few other items on the board so I am semi-in-the-loop during presentations, and then I google "pigeons." Obviously, you know what comes up.

https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRCTpvDI9rQKxci8KVE3lDirJSkJDbKTYLffN8vmzZmSn3V6pQr9E4fDH1KP4zi911tdNXuFVxxzGovFbaanRugqva1828s_XJU6jKg5t9WRLWrG6pVg3osKMTD5LpVFi6E7kUNHdVzGo/s1600/pigeons.jpg

Google fail.