Tuesday, August 30, 2011

Pimp my expensive education

There is a thing in medicine called, "pimping". Basically, pimping is when a higher up doctor puts a lower down doctor or medical student on the spot in front of the group and makes them answer a question about medicine.  The idea is to see what a young doctor knows about a subject that comes up on patient rounds regarding their disease.  Although sometimes it's about history.  Or trivia. Sports sometimes.  I once saw an attending pimp a patient.  No joke, the patient was a PhD in physics and he started asking him who discovered some string theory equation.  The guy was like, uh I don't know, but my ankle reallyl hurts.  He was then told to read more. Pimping is as old as medicine* (there is a story in the bible where Jesus, right before healing a sick man, asks one of his disciples to name the 4 kinds of gastric ulcers, then smotes him and tells him to read more.  I think it's in John somewhere) and has a lot of surrounding controversy.

The controversy exists because it sort of sucks to be made to look like an idiot in front of a bunch of people.  Generally, the term "unnecessary humiliation" gets thrown around in sensitivity meetings.  On the other side of the coin is that fact that frankly, you learn a lot from being pimped.  Once you get over the shear terror that is being asked a factual question in front of a bunch of people you don't really know who will judge and grade you based on your answer, you swallow your fear, take a small poop in your pants, and give an answer.  You will either surprise yourself with what you know, or get the answer wrong and be told the correct answer.  I know some of the most obscure facts in medicine because the emotion associated with the question burned the answer into my brain parts (but let's be clear, that emotion is fear).

A good pimper, one who asks relevant and useful questions (see this post about the difference) without adding too much visible weight to the answer, will teach you more than you can imagine.  In fact, once med students get over the sharp pain of being pimped, many will agree that a rotation without pimping is a decidedly dull one.  A lot of being a med student is scut work; a term that means "shit" work.  "Call this nursing home", "make sure that CT got done", "walk this patient down the hall"; those are things I am asked to do on a daily basis.  Only paying 70 grand a year, NBD.  So getting a little extra teaching in the form of a jeopardy (because you are in actual danger) style learn-a-thon is not that unpleasant.

*Note: I once looked up the origin to the use of the word, "pimping" in medicine.  It doesn't seem novel now, since MTV pimps everything that can be bejeweled, but it is listed in books and articles in the 70's.

I've seen the trifecta

My school health insurance requires that if you aren't going to use the school health insurance, that your alternate insurance plan has this stipulation, "My plan does cover me for Sports injuries, alcohol-related injuries or conditions, eating disorders." ...I'm offended by your accuracy.

Tuesday, August 16, 2011

Downer alert. My B.

People dying is sad.  That prolific statement is brought to you by my current rotation, Neurosurgery: "Where people die a lot."  Not the slogan of the national society, but certainly a reasonable runner-up option.

What I've discovered during my recent acclamation with death is that I find certain deaths more emotional and tragic than others.  This is another obvious statement, but instead of listing some criteria like "people with families" or "contributing members of society", I am basing this off of my emotional experience. I just sometimes walk away from a patient who died or is about to die, and find myself more moved than with a different patient.

The only variable I can seem to cite with some consistency is age.  Social status, family status, mechanism of injury, events leading up to death; all seem to not make a difference, but age fucks me up.  In particular, it's the 18-35 crowd that jerks my soul around.  There is something about seeing someone with the prime of their life torn from them that really gets me.

I realize this is very egocentric, I myself being in this age range, but I think there is more to it than that.  Older individuals have gotten to live an impressive amount of life.  From your 85 year old former paper editor, to your 55 year old father of 3, their death is sad without a doubt, but their life is established and in status quo.  A great place to be, but a plateaued place, at least from a year-to-year view.  But 18-35, that's when you are really setting up the rest of your life.  You are making the moves to get to that plateau.  You are starting college as a theater major; getting promoted to manager; knocking up that waitress; heroine binging your way onto a reality show.  You are a real fucking winner, and no one can tell you different.

Kids are obviously sad; there is so much life lost.  But when I was a kid, I wanted to grow up to be a fire-truck (Ding-ding!), now I want to grow up to be a doctor and I'm like 90% there.  If you robbed me of life when I was 8, then we can just build a new fire-engine.  If you rob me of my life when I'm 28, then we have just lost my realistic future as a physician (and my loans, see you in hell Sallie-Mae). 

People are in the active process of realizing their future.  It's not a pipe-dream anymore.  It might not be glamerous, it might be laying actual pipe, but it's an active, conscious persuit.  It can be painful, and full of introspective self-doubt, but at least it's not boring status quo, like 20 years from now, and it's not dinasaur catchering and wand-makering like 20 years ago.  It's like running a marathon and getting pulled at mile 16.  You'll never know if you could have made it.  And you won't care, you're dead.  But I will.  I care if you could have made it.  I wanted to see how you finished college.  Or even my Caesar salad.  I hear they were going to promote you to manager...

Anyway, back to work.

Sunday, August 14, 2011

Oh also the scrubs on Ob/Gyn were awesome and I stole like 10 pairs

I loved my Ob/Gyn rotation, unlike approximately 103% of other med students.  It was the weirdest, most fun experience, top to bottom (pun intended).  Oh sure, there were the bad residents.  Well just one really.  She was actually the worst human being I've ever met, but she was so bad it was comical.  Plus she hated me, and since I didn't use the adverb "fucking", that means she didn't make my life any particular hell.  My love of that rotation can also be qualified with, "it was your first," making it new and exciting and fun.

Still, it was a cool trip down memory lane (you know, because I was born there.  The vagina that is.  I came out of a vagina).  There is some surgery, some primary care (find that combo in another specialty) and an interesting patient population.  But what really made that rotation for me was one single person.

The head of the department was probably the best teacher I've ever had.  He was this hilarious guy who just knew exactly how to give you information so it was useful, relevant, and interesting.

Those are all code words.  Useful means it had the number one most important feature, it would appear on our test.  I know this sounds shallow.  I'm supposed to be a medical student learning for the sake of learning.  Learning so I can be a better doctor.  Learning so I can help people.  That's the kind of bullshit that I said to get into med school. The truth is that I will never remember even a 20th of what I learned over my clerkship year, so the fact that it got me through my test is the most important feature by far.

That being said, relevant refers to its usefulness in the actual clinic, helping actual people, when it actually matters.  The kind of stuff you need to know as an Ob/Gyn resident.  There is a large overlap between useful and relevant, but not nearly big enough. A good teacher can differentiate the two.  A bad one pimps you on both indiscriminately, then tells you to read more.

Interesting means what it sounds like, but it also means that it had a chance of sticking beyond my 6 week rotation.  It didn't, but it had a chance.  This is a rare skill indeed.  Let me provide an example.

"Fetal heart monitors are sensitive, but not specific (useful).  They help us decide whether or not to perform a C-section (relevant).  This is bullshit forced down our throats by lawyers.  They have never been proven to do anything, but increase the rate of C-section.  We use them because we can be sued if we don't (interesting)."

See how that is a unique skill?

Medicine often laments that the most influential aspects of choosing a specialty are the residents and attendings you worked with during your clerkship; the most dynamic and least legit reasons to choose a specialty, but true nonetheless.  I'm not going into Ob/Gyn, but if I did, it would definitely be because of him.  And vagina.  J/k, just him.

Monday, August 8, 2011

Please don't take all of my hatred the wrong way

I realize that my post about my sub I makes me sound very bitter and begs the question, "why are you doing this?"  And also, "please don't go anywhere near me if I'm in the hospital."  Those are legit concerns.  But let me reassure you, that was me bitching about the amount of work I'm doing and the basic quality, not me bitching about my future work.  Let me shed a different light on it.

I fucking love the OR.  I really do.  I once heard this melodramatic, masturbatory statement, "If you can think of yourself doing anything besides surgery, surgery isn't for you".  The same thing is told to ninjas before they start their training, imagines brain surgeon.  Get over yourself.

But, it is a really brutal life during residency and if you don't love the OR, it's just not worth the pain.  I don't get to do much in the OR.  I regularly stare down a tiny hole, in which at best, I can see some fat for 5 hours, just so at the end of the case I can tie a few knots.  Most of which will be cut out because they aren't tight enough and that layer of fat needs to be tightly tied to that other layer of fat.  But two things.  One, it is worth it.  I love tying those knots and suctioning that blood and irrigating that wound enough that I'm willing to wait until I climb the ladder.  And two, the shit I'm watching, if I can see, is awesome.  Being a surgeon and being a med student interested in surgery are two totally different things.

No one likes watching someone else do something, particularly not the A-type* personalities that go into the surgical specialties.  You have to imagine yourself on the other side of the body, the dude with his hands inside the human.  The lady under the microscope.  Those are the people you have to want to be.  If you want that, and can deal with mostly watching for a few years, surgery is for you.

And it is for me.  I love it and it's worth all of the pain.

People often comment that I'm a masochist for doing what I'm doing.  No, I just find the pain to be less painful than others, so the pain to pleasure ratio is in my favor (I guess the same can be said for masochists, but let's not get into a philosophical argument about the true nature of pain and pleasure). I'm allowed to bitch about paying 70 grand a year to work over 100 hours doing virtually nothing.  I earned that right, and in turn, earn that right to be the one elbow deep in a person**. Plus, I dropped out of ninja school and don't know what else to do.

*note: The A stands for asshole.  ADHD. Arrogant.  Get me a thesaurus and look up Douche-bag. 
**note: I'm going into neurosurgery, if I'm elbow deep inside someone, something has gone terribly wrong.

Saturday, August 6, 2011

I see what you did there

Because I'm a bit slower about posting, and I'd like not to be, I'm going to post more rough-cuts. I'm also applying for residency, so I'm going to shift to a little more auto-biography. Please let me know if you see any glaring erros.

Sorry mom, you may have to find a new blog to click 1000's of times

I haven't posted anything in almost a month.  This does not bode well for my future in residency when I will similarly have no time.  See right now I'm doing a "Sub I" in my chosen specialty, which happens to be a pretty intense one.  Like the most intense one (arguably).  And they are taking no shortcuts on mercilessly beating the living shit out of me at every turn.

See I'm on call literally every other day.  That means every day of my life, I'm either on call (staying over night with a pager and a sticker on my forehead that says, "your bitch") or post-call (the day after call, when you haven't slept).  That is brutal.  Literally more brutal than anything else possible.  You can't be on call more than that.  And it's much worse than that.  Instead of going home post-call at 11 or 12, like a resident on call, I'm going to the OR and staying until at least 530.  Calculating it out, that's 36+ hours of straight work*.  I've worked 41 hours in 2 days. That's overtime in 2 days. 

Generally, this is because I'm there to love surgery, and since I don't have real clinical responsibility, they send me to the OR, so I can love more surgery.  In the OR my duties range from suctioning blood to standing in a corner trying to peer over someone's shoulder.  Well appearing to try to peer over someone's shoulder

When I get out of the OR, I do scut work.  A term that means, scientifically, "shit work".  Taking off bandages, drawing blood, telling residents how pretty they look, stuff like that.  I do get to see patients that need a consult from my service, which can range from fun to extremely painful (turns out there are a lot of odd ducks in the world), but is generally the highlight of my non-OR time.  We do this all through the night, then back to the OR, then home to sleep for 4 hours and back again the next day at 5am.  So sorry about not posting a lot, mom.

*note: "Work" is a loose term.  Generally work implies receiving monetary compensation for effort and results.  Instead, I pay to do this.