Learning curve: presenting patients on rounds

As medical students, we're learning how to give good patient presentations during rounds, which means giving the right amount of information as well as the right information, and it definitely takes time figuring out what that means.  While on rounds today, being the visual person that I am, I kind of pictured it like this:

The "whispering-type" med student

So, having given some thought to my EKG class indiscretions, I'd just like to add one small thought.  HOW ANNOYING is it when you're sitting in a class and the teacher is asking rhetorical questions (with obvious answers) and the person you're sitting next to is quietly answering them all.

It's like they think they are the ONLY ones who know the answer!  The rest of us are quiet because we know it's rhetorical, not because we DON'T know!  You'd think by the time you get to med school (again, 20 years in a classroom) you'd get this.

The person I was sitting next to today in the cardiology lecture did just that (I'M SO PROUD OF MYSELF, I didn't ask ANY sarcastic questions or make any comments except when called upon!!).  Every question the doctor asked, she answered.  Loud enough that the other students could hear (guess we were supposed to be impressed) but not loud enough that the doctor would hear and ask her to explain her answer, just in case she was wrong.

Well, about half the time she was wrong. Ok she definitely got a few right, but a lot of the ones she got right she said right after the doctor quickly answered his own question.  He would say something like, "what is the organ most affected by heart failure,that'srightthekidney" and just as he would start to say "kid" the girl next to me would enthusiastically utter under her breath, "KIDNEY!" like it was some huge surprise.

One whole hour of this.  Plus I was desperately trying to hold my tongue when someone said that nuclear stress tests were the primary immediate management for acute coronary syndrome, followed by someone else answering NSAIDs to the same question when the doctor gave us a dirty look.

Anywho, I'm just saying. 

Least I was RIGHT!

I like big MHC's and I cannot lie

This is from an article from health.com about how love changes your body chemistry, like releasing endorphins, oxytocin and other things like that.  Well, one of the last blurbs was about how we can (on a cellular level, in a way) detect genetic variances in partners.  This makes sense in an evolutionary (Mendelian) sense, in that more diverse mates make hardier offspring, but seriously??  And this isn't even a science journal.

Happy Valentine's Day!

Mnemonics, pneumonia and other words with silent first letters

So as in my last post, medical school is so full of information and memorization that the only way to retain any significant portion of it, you have to find funny and memorable ways to remember them.  Having spent some time trying to find a simple one for the last post, I ran across a few others that are classics and/or are just downright funny, and you quickly realize that the more crude, the easier to remember (in fact most of them are, and I had trouble finding some PG examples).  I know it's not intuitive to those without science backgrounds but you get the point.

Signs of a heart attack: "PULSE"

Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating

Hand bones:

"She Looks Too Pretty; Try To Catch Her": Scaphoid Lunate Triquetrium Pisiform TrapeziumTrapezoid Capate Hamate

Branches of the iliac artery, one of the big-uns:

What Bill admitted to Hilary: "I Milked Our Insatiable Intern's Udders Under the Desk": Inferior gluteal Middle rectal Obturator Inferior vesical artery Internal pudendal artery Umbilical U/D=Uterine artery (female)/ Deferential artery (male)

Nerves tested when you check reflexes:

One, two-- buckle my shoe. Three, four-- kick the door. Five, six-- pick up sticks. Seven, eight-- shut the gate. (S1,2 = ankle jerk L3,4 = knee jerk C5,6 = biceps and brachioradialis C7,8 = triceps)

Some other funny mnemonics that I won't include explanations for: 

Management of severe asthma (pardon the French!): "O SH!T"

Causes of acute pancreatitis: "GET SMASH'D"

Takayasu's Disease (pulseless disease): when you have Takayasu's, I can't Taka-ya-pulse

Branches of the Axillary Artery: "Screw the lawyer, save a patient"

Cranial bones: "Frat parties occasionally teach spam etiquette"

Confession: I named my car

So when I moved to Charleston (nearly three years ago- geez time flies!), I was driving a sporty red Honda Accord coupe, which sits about 5 inches off the ground.  It didn't take long to realize why Charleston is referred to as the "low country." Every time it rains, especially when it's also high tide, the city floods. Several months into my first year, I pushed my poor little car through 2 feet of standing water.  In hindsight, it was a poor decision but it was Friday and I REALLY wanted to go home.

Anyway, I sent lots of pictures to my dad of the car underwater (it took several floods), but he caved and graciously bought me an SUV (my sister is now the proud owner of the sport red coupe, which is unfortunate because she has quite the lead foot).

So I swear I've never, ever named my car.  My long-held belief is that car-naming is reserved for beefy, steroid-brained jocks with 2-word vocabularies.  The closest I've ever come is "others" giving my coupe the nickname "the red skittle" which I found a bit offensive.

Anyway, shortly after I got the car, we did a month of renal physiology which utterly bores me but is unfortunately extremely important clinically (even for cardiologists!).  So microscopically, the kidney is made up of all these little units of tubules and ducts and such that regulate water balance and electrolytes and proteins and stuff.

(The preschool version)

Each part of the system has a different function, but it's not really innate or logical in terms of location and function (unlike your eyes, for example- they're in front of you because that's the way you're facing and moving most of the time).  Basically, it's really confusing and I always forget which part of the tubule is permeable to what and impermeable to whatever else, despite having learned about it a million times.  (It really IS important to know because most drugs only work on one tiny portion and for example, you need to know whether it causes you to retain sodium or dump it when you're giving someone a diuretic, or more colloquially, "water pill.")

(The college biology class version.)

To get to the point, one part caught my attention. This one section, midway through the tubule system, is called the loop of Henle, and it does a lot of the water balance regulation.  Part of the loop, the ascending part, only allows solutes like sodium through, but is impermeable to water.  It was like a light bulb turned on in my head- my car is going to be like the ascending loop of Henle!  So I call it "Al Henle" now.

Proactive defensive side note: the only way to remember thousands of tidbits of unrelated information in med school is to make associations and mnemonics (couldn't spell that word till med school); for example, to remember the movements of supination versus pronation: to carry a bowl of SOUP your hand must be SUPINATED (palm up).

Anyway so in conclusion, the only part of renal physiology I really remember to this day is that the ascending loop of Henle is impermeable to water.

"Pen-" ultimate neuroticism

Sorry about all the cartoons!  The ICU has literally sucked all of my energy and creativity from me, so these will have to suffice for a bit.  Those of you who know me know how neurotic I am about my pens (patiently tolerated by my sweetheart Patrick); in fact, it was one of the "top 5 things I can't live without" on my eHarmony profile so he has no reason to complain that he didn't know beforehand.  

Anyway, found this and it made me laugh.  The only way it could be improved would be if it was an algorithm and/or had personality types based on the pen preference.

Dog days of med school

Having just sacrificed a week of sleep and relaxation (between shifts of course) to move, primarily for my dogs, an homage to all of us: