In retrospect, the first two years were better

The end of third year is in sight (10 weeks!), and I can't help but think about how it's lived up to my expectations.  I spent most of my first two years wishing away the hours and days, convincing myself that I'd finally be happier once I was out of the classroom, no longer having to study 10 hours a day, and at the bedside polishing my clinical skills.

Things that were better first and second year (pre-clinical classroom years):

• When you do poorly, ie bad grade, you can wallow privately in despair, not looking the fool in front of residents and attendings. If you don't know the answer on an exam, skip it, there are 299 more, unlike on rounds.
• If you didn't feel like getting up to go to class, no big deal! Lectures are recorded and available online.
• You get to sleep in your OWN bed every single night for 2 years.
• You NEVER have obligations on the weekend, other than oyster roasts and beach parties, and rarely have a Friday afternoon activity
• You stand for long, long periods of time.  (See my Hospital Chair Hierarchy blog post.)
• You do nothing for long, long periods of time, after rounding on patients for long, long periods of time.
• You HAVE to go to your shift at the hospital, whether you have a nasty illness, it's snowing or you win the lottery (no joke, you'd still get in trouble).
• 80 hour work weeks.
• Pimping. This is solely a 3rd and 4th year issue.

Things that were NOT better first and second years:

• Fake patient care: you have a lot of these clinical exams where you examine a fake patient in front of a one-way mirror (a physician is sitting there grading and critiquing you). Not only is it unrealistic, it's difficult to do well (they're skilled at cornering you into a wrong diagnosis). We still do them third year but much less frequently, and now it's just pass/fail so no one cares.
• You have lots of silly activities that eat into that extra free time (ok granted, you still have weekends)
• Sitting in lecture for 4-5 hours a day. Wish I'd brought a crossword puzzle more often.
• Graduation seemed really, really far away. 

Wow, realizing that the first two years may have actually been better.  I'm sure I've consciously forgotten a lot of the bad stuff, though, so I guess I'll never really be able to compare the two.  I wouldn't go back for a million dollars, but would give that to be a month away from graduation like the fourth years are now!

Be a doctor, drive a Toyota

These statistics were taken from a Medscape article, but I thought they were pretty interesting. They were from a survey of approximately 29,000 physicians.

Specific to cardiologists:

The average happiness score for physicians who responded was 3.96 (cardiologists reported 3.92)

In their spare time, cardiologists can be found playing video games, making kaleidoscopes, studying the history of handguns, mind-bending games, restoring vintage electronic equipment, and studying the Talmud (although the number one answer was exercise)

The most unhappy physicians, according to self-rating, were those who didn't volunteer, followed by those who tutored or did counseling

A far higher percentage of married cardiologists (85%) in this survey compared with the general US population (48%)

In 2008, 32% of American men were obese, compared to only 8% of male physicians (the rate of overweight male physicians, however, is almost identical to the national rate). Only 4% of cardiologist reported obesity.

Fewer than 1% of cardiologists smoke, compared to 18% of Americans.

Top 5 cars driven by cardiologists, in descending order: Toyota (for real??), Lexus, Honda, BMW, Mercedes (Subaru was least favorite)

Physicians in general:

Happiest speciality: rheumatology (dermatology was a close second). Neurology was dead last, but GI, internal medicine, oncology and general surgery were close behind.

Apparently, sewing and knitting is a common pastime among all physician respondents.

Anesthesiologists and radiologists get the most yearly vacation.

Overall, 85% of male physicians are married, compared to 71% of female physicians.

Dermatologists rated their overall physical health the highest; critical care physicians and pediatricians ranked the lowest.

More, about 40%, consider themselves fiscally conservative but socially liberal, the most popular combination.

What's happening in medicine

What med student has time to keep up with all the new medical news?  I do!  I love the fact that I can follow all these huge names like Medscape and Mayo Clinic on Twitter, which give me a 140-character synopsis of the best.  Honestly I think that it's the most efficient way to see what's being published and what's being debated, as no student has time to scan through multiple sites daily.

Some fun headlines:

White Rice Consumption Linked to Type 2 Diabetes - Medscape

iPads Improve Resident Efficiency - Medscape

Botulinum to Relax Frown Lines Relieves Major Depression - Medscape

Cardiologist becomes heart patient (local news article)

Blackouts Predict Which Binge-Drinking Students Will End Up In ERs - NPR's Health Blog

LSD Gets Another Look As Alcoholism Treatment - NPR's Health Blog

Upset Men And The Happy Women Who Love Them - NPR's Health Blog

Medical students show gains in empathy are short-lived after training - American Medical News

Doctors can be sued for third-party injuries - American Medical News

Revised MCAT places broader expectations on students - American Medical News

Study: Doctors often lecture noncompliant patients too much - American Medical News

The curse of the eidetic memory

I used to complain relentlessly about how bad my memory is (in my defense, it's pretty horrific, I can't recall three items fifteen minutes later).  I still hate that I'm not able to recall things as easily as most of my classmates, who rattle off lists of criteria and lab values like it's no big deal.

People with photographic memories (also called eidetic memories) are amazing.  If you google "photographic memory," there seems to be a consensus that this doesn't really exist, but having known many people who could recall very long random lists after a single glance, I beg to differ.  (Disclaimer: we have different definitions, of course.)

People like me with "regular" memories rely on other clues, spacial relationships and mnemonics to remember things, but those with photographic memories don't use any of that.

When I was younger and presented my mom with "disappointing" grades (my opinion, and usually this meant low 90s), bemoaning how my friends had photographic memories, she would always remind me that a photographic memory hinders outside-the-box thinking.

If you have a list of a thousand symptoms memorized, for example, and a prototypical patient walks in with every symptom of Lyme disease, voila! You're a hero.  But what if you see a rash, and you think of the 100 differential diagnoses for that, but fail to consider the rash may be unrelated or atypical for that disease?  Or if the Lyme patient comes in with an atypical presentation, say, with only a joint ache?  Would you forget to include Lyme disease in your differential?

That aside, I've decided on my own opinion.  Having witnessed a lot of tragic accidents, sick people, dying people- I realized that I take for granted the one thing I always hated about myself- my horrible memory.  I've developed a mechanism that allows me to consciously forget those horrible images, feelings and emotions, which is definitely a protective mechanism.  Especially for surgery rotations, stupid answers in class, how difficult an exam was, and the like.

Embrace your weaknesses!  They're probably a blessing in disguise.

9 Types of Med Student Bloggers

In honor of match week, a great cartoon. I think I'm 50% over-competent 3rd year and 50% reverent third year, if that's possible. 

Apologies

I try to keep things lighthearted, but the past 4 weeks have been some of my most difficult and I need to get this off my chest, since I have very few people to confide in.

I'm sorry...

To the resident who only got 6 hours of sleep last night, I'd kill for that much

To my new townhouse, which hasn't been cleaned since I moved in

To the fellow student who I "whined" to today because I was so deliriously tired I lost my filter, you made it clear that I annoyed you greatly and I'll try my best not to do it again

To the secretaries I called today for patients' medical records, for inconveniencing you for five minutes

To the unit secretary who I asked for help to fax a document, because I interrupted your conversation about your big night out and clearly irritated you; wish you'd have let me know beforehand that the fax machine was broken

To the resident who I misunderstood, but I was appropriately ridiculed so hope that suffices



Ok but for real, I'm sorry, but very thankful:

For my mom who has to listen to me complain about my horrible day, every day

For the handful of residents who make me feel like I'm more than just a waste of oxygen

For my amazing, selfless dogs who love me unconditionally but who I don't have time to play with and have forgotten to feed on many occasions over the past few weeks

For my insanely resilient body, which I continually sleep deprive and starve (not by choice, however) and fill with crazy amounts of caffeine and ibuprofen

And most of all, for my wonderful amazing boyfriend who has suffered through all of this for an entire year, as of tomorrow, despite all of my flaws and shortcomings and commitments and neuroticism and dogs....love you sweetheart!

Mithril scrubs

An esteemed female cardiologist (who I would die of happiness if she could be my mentor!) recently did a huge favor for me, giving a talk to female med students about the challenges of being a woman in medicine, and especially in male-dominant fields which still includes cardiology.  The point she made was that gender aside, to succeed in medicine you have to work just as hard- or harder- than your colleagues in order to earn their respect.  You may have "girl issues" like wanting to take time off to have a child, but as long as you can hold your own in the workplace, they should still respect you.  So really, just put in 200% and put it farthest from your mind that gender differences still exist.

Now reading a book, "Heart Matters: A memoir of a female heart surgeon" by Kathy E. Magliato, MD, one of my favorite excerpts so far, reveals how the author dealt with the same issue in a different field.

"It took a certain amount of what surgeons like to call testicular fortitude to do this, but it also helped to have a full-metal jacket.

My full-metal jacket was unique to me.  It fit me perfectly because I had constructed it inch by inch.  Tailored, if you will, to conform to my exact shape.  Made of mithril, when I wore it, I was impervious to pain.  My pain.  My patient's pain. The pain of the world around me.  I could take on any challenge without fear of being harmed- I felt nothing. Emotionally, spiritually, psychologically. It made me so tough.  It allowed me to survive. The problem was that when I worse this jacket no one could get close to me.  Not my colleagues. Not my patients.  It was if I had a force field around me, and I liked it that way.  The jacket was somewhat versatile.  I could wear it on the outside of my clothing for all to see my virility or wear it on the inside so I just exuded toughness.  The trade-off was that when I wore it, I couldn't be a woman. I couldn't act like a woman. Because weren't women weak?  They certainly weren't surgeons.

When I look back on it now, I realize that I wore that jacket every day for a long, long time- indeed, throughout all of my training as a surgeon. And sometimes, it was the only thing holding me together..."

Surgery's a bear

So when I was in 9th grade, I had surgery on my ankle.  I was under 18, so still considered a pediatric patient, but it was that awkward time of being a teen when you don't feel like or want to be treated like a kid.  So I was definitely a bit embarrassed when a teddy bear was plopped next to me on the gurney as I was pushed into the operating room.

Luckily I don't remember much after that, until waking up and regretfully finding the bear still there after my surgery.  But there was a surprise!  Someone had dressed up the bear in scrubs!!

I already knew I wanted to be a doctor at that point, so it was endearing that they didn't put a bow on it, or a bandaid or something child-like (I was an ancient 16 years old by that point!!), and I still have that bear to this day, with the same hat and mask from 10 years ago.

NATIONAL HOLIDAY 3/3: MY DAY OFF!

I can't remember if I've blogged about days off, but obviously it's been so long since I've had one that I definitely don't remember writing about them, as all of my non-medical thoughts have been overwritten by medical thoughts.

Regardless, I feel like honoring my one day off this month with an entry!

Days off are bittersweet.  And this year I've learned that having two days off is worse than one.  Why, you ask?  Days off are great, you get to sleep in until 9am, and get the stuff done you haven't done in a month (laundry, cleaning, errands, groceries, etc).  But then you start to realize toward the end of the day, I didn't absolutely need this day off and probably should have taken it next week so I could have had two days off in a row.

So when you get those rare, coveted two-day vacations (I get one the weekend of St. Patty's day YAY!), you just can't believe your luck (no pun intended).  You do all that stuff on the first day thinking, I'll have a whole day to relax tomorrow!  Alas, being a medical student (or resident or doctor or other busy professional) you can't actually relax and you begin to become extremely anxious and start doing work or feeling guilty or doing hardcore work around the house. Three weeks ago I started painting the trim in my new place.  I took a picture this morning, as it's clearly unfinished (there are two unfinished ends, if you haven't inferred).

beautiful unfinished trim

So then you wish that you had taken that one day off earlier, to get the work done but not enough to make you feel guilty.  Or that you hadn't spent 6 hours painting part of your house.

So my advice would be to spread out your days off rather than taking them all at once, UNLESS OF COURSE you are going on a wonderful vacation, like to HAWAII!

107 days till my HAWAII VACATION!

If you're on time, you're late

So in honor of my being out of the loop this week for rounding times, I will share a nice cartoon.

The first time I wasn't told what time rounds were on a weekend, so I showed up at 6:30am to be safe.  We rounded at 10:30am.

The second time I got a text message at 2am from the other med student reminding me that rounds would be two hours early.  I got this message when I woke up at 6am, rounds were at 7:30.  Needless to say, I wasn't as prepared as I would have liked.