The DO NOT MISStery

Part of the reason we take tests is so we can understand and handle the really important diseases of each specialty.  For instance in neuro, they want to make sure we never miss a burst aneurysm or stroke.  Or in Ob/Gyn, they don't want us to miss preeclampsia.  So they drill these into our head and make sure we never forget. But the funny thing is that although we never forget them*, we never really know them in the first place.  


For instance, a Tylenol overdose is something that was molded into my being during my peds rotation.  I've learned it literally 100 times. It was literally pounded into my head, where I literally had a subdural from this pounding, to use a certain drug for a Tylenol overdose. Except if someone ever walked in with a Tylenol overdose, I would be like, "Got it, I know this one, nurse, this diagnosis of Tylenol overdose should be treated with the Tylenol overdose antidote."


And the nurse would go, "Great job doctor, good catch.  Now what is that antidote?"


I know this too, because I've been studying very hard, "N-acetyl-something"


"N-acetylcysteine?"


"I think so.  If you give me 3 other choices and label them A, B, C and D**, I'll definitely be able to pick the correct answer".


Then the nurse will say, "Ok, how much do you want to give?"


To which I will cooley and calmly reply, "I have no idea.  5?  50? 500?  What year were you born?  Give her that many."  Because dosing is something I'll learn in medical school II, or by magic, or maybe twitter.


"So 1,974? You want me to give her 1,974mg? And what route would you like me to use?"


"I would take the elevator in the Southwest hallway, It's not the closest, but when you get off, it has the signs to the pharmacy so I don't get lost"


"It comes in pills or IV.  Your choices are 6.58 pills, based on your dose, or we can just give IV."

"By mouth sounds good."


"The patient can no longer swallow because this has taken so long.  I've already started her on an IV with the correct dose.  I'm so glad you did well on your peds rotation."


*This is not true, I've already forgotten it.
**I realize this is my second joke about Tylenol overdoses and multiple choice tests, but since it's the only thing I've actually learned this far, I have to keep using it or I fear I'll have to learn something new, which will push Tylenol overdose right out of my head.  I can't forget about Tylenol overdose.  I can't ever forget about Tylenol overdose.