anna in med school

I’m a shy person.  (Don’t be fooled by the fact that I talk too much–a vice I’m working on.)  In new social environments, my face flushes, my hands sweat, my stomach flips.  Maybe it’s because I have this trepidation, but I find a lot of excitement in subtle interactions (looking someone in the eye, extending my hand).  Actually confronting someone in person (like that passive aggressive beret-wearing asshole in biomed last week…Doria, Sara, and Amy, you know who I’m talking about), well that’s just flat-out cathartic.  One of my goals with this blog is to be open about my experiences here; otherwise, what’s the point?  I might seem tame, but many of my posts are profoundly personal, and I frequently pause before I hesitantly click “publish.”

Still, I’ve never not hit “publish.”  I lean toward putting my foot in my mouth after it’s too late rather than restraining myself to begin with, and I rarely regret it (though maybe I should).  But there is one part of my life about which that is not always the case: myself as patient.

They don’t tell you (or at least I never considered) that when you sign up to enter a medical field, you likely give up some of your privacy as a patient, unless you’re super motivated and committed to seeking healthcare elsewhere (which I am not).  John, for example, was hit by a car on his way to his ER shift in his fourth year of medical school.  He was barely late for his shift, except that he showed up on a backboard rather than a bicycle.  (He subsequently refused all pain meds so that he could work the rest of his shift once he was discharged; crazy kid.)  I don’t think he gave a damn, really, but it is a little odd: colleagues becoming care providers.

When we lived in Boston, John and I worked at neighboring hospitals.  Due to insurance and convenience, it made sense for me to go in for my regular appointments just next door.  When I was asked if I could be seen by a resident: “Sure!”  He/She was going to discuss my history, measure and weigh me, maybe send me to the lab to get blood drawn.  No offense to residents, but it’s not brain surgery.  Of course, what I didn’t consider was that, especially in our second year in Boston, most of the internal medicine residents knew most of the ED residents…and with a last name like Jesus, you’re not easily forgotten.  Okay, so they knew my husband…and, while it did strike me as funny when a resident, while performing my pelvic exam, was going on about how John was always welcome over for dinner with her and her husband when I moved to Philly, I never felt uncomfortable.  There was still a level of distance.

But things have shifted again.  MS2s began their clerkships two weeks ago…and so my friends are roaming around the hospitals and clinics at which I’m a patient (mandated, in part, by student health insurance).  One day I’ll tell you more about my not-terribly-concerning-but-somewhat-annoying chronic condition.  For now, let’s just say that I was at a specialty clinic earlier this week.  As I was checking in, the door to the clinic swung open to reveal an MS2 completing paper work on the other side.  I startled myself by the speed at which I turned my back so he wouldn’t recognize me.  The desk nurse asked me if I would be willing to be interviewed by a student or a fellow before seeing the physician.  I swallowed (I don’t want to be one of those patients who refuses to be seen by a student), “Well, the thing is, I kind of know the student…”  Nurse: “Oh!  Of course, say no more!”  Everyone was super careful and discrete during my visit…but, just as I was leaving, I slipped and almost tumbled into the MS2, and we exchanged an awkward greeting as my face turned beet red.

Here’s what I can’t figure out: where did this embarrassment come from?  I’m all about respect for patient privacy, but my personal level of discomfort in this instance is disconcerting…especially considering that I would probably be okay divulging every other aspect of my life to this MS2.  Maybe even my health.  But not there.  I’ve come to expect that, when I walk into a clinic as a patient, I am relatively anonymous.  No one knows me as anything but a patient.

Click on “Publish.”

Just got this email from my friend Alex:

Here’s what I did at work today: science

I keep telling myself that the temporary inconvenience of not having Internet access for a night or two a month is worth what I’m saving by “borrowing” wireless from a generous neighbor…whatever; most of the people in my building dump their recyclables in my makeshift blue bin, so it’s a fair trade-off. But a comment or two on the talk I attended this evening, “The Quest for the Perfect Vagina: Understanding the What, How, and Why of Trendy Cosmetic Surgical Procedures and the Ethical Considerations Involved,” will have to wait until tomorrow.

In the mean time, I am putting in writing what my dissection group has already heard, oh, four or eight times: I am no longer allowed to take home a jar of nut butter of any kind. I hear that natural peanut butter actually helps prevent arterial blockages, but probably not in the quantities I consume.

Not to be self-deprecating–I truly don’t think I’m a hackjob–but my brain takes a while to absorb this science stuff.  I listen to lectures (often twice), fill composition books with notes, and just keep writing and rewriting and talking out-loud to myself and obliging peers until it starts to sink in.  Needless to say, I’m thrilled if that process reaches completion before our final, let alone before 8am discussion.  Therefore, my contribution to the learning process in discussion is questionable.

But not today.  I might not have been able to ID the all incidences of koilocytosis (the presence of various structural irregularities in squamous epithelial cells) in a Pap smear image, but I could succinctly elucidate the purpose of a speculum.  I suspect that some of my colleagues will not altogether love Repro.

Not that this information is at all helpful now, but I think I’ve picked up a few tricks from hanging out with doctors (probably sounds banal to anyone in clerkships and beyond).  How does one perform a thorough pelvic exam on a morbidly obese woman?  Use a plastic glove, cut off the tip of a finger, and wrap prepared portion around speculum.  Thank you, Tommy.

Regarding Mechanisms of Disease and Therapeutic Interventions, I’m not quite ready to throw in the towel…I have so many more related psychosomatic symptoms to experience!  But I’m also finding some relief from Lisa C’s advice regarding Mod 2: I don’t have to have “it” (study habits, methods by which I learn best, etc.) all figured out.  The beauty of Mod 2 is that we start fresh with every block.  If MDTI doesn’t go as planned, suck it up; Brain and Behavior starts the next day.  So right now I’m going try to wrap my mind around Warfarin-Vitamin K tango…and maybe later revisit my old friend, Ian McEwan:

For this was the point, surely: he would be a better doctor for having read literature.  What deep readings his modified sensibility might make of human suffering, of the self-destructive folly or sheer bad luck that drive men toward ill health!  Birth, death, and frailty in between.  Rise and fall–this was the doctor’s business, and it was literature’s too.  He was thinking of the nineteenth-century novel.  Broad tolerance and the long view, an inconspicously warm heart and cool judgement; his kind of doctor would be alive to the monstrous patterns of fate, and to the vain and comic denial of the inevitable; he would press the enfeebled pulse, hear the expiring breath, feel the fevered hand begin to cool and reflect, in the manner that only literature and religion teach, on the puniness and nobility of mankind.

Atonement

I still have his Saturday sitting on my nightstand, 2/3 read.  That’s practically blasphemy.

–Kevin Bacon’s reaction to the illegality of dancing in Footloose.  Not a concern at PennMed Prom 2011, where there was no lack of dancing.  A few points of interest:

• I woke up on Saturday still in my formal dress.  My eyes were pretty crusty after sleeping with my contacts, and the balls of my feet felt like I had run a marathon in stilettos.  All signs of a successful prom.
• With the exception of possibly the husband–and that’s just personal preference–Erica is, without question, the best date ever.  I don’t know that I’ve ever met anyone with a comparable social IQ, who can meet an onslaught of MS1s while being effortlessly gregarious and charming, and the best damn dancer this side of the Mason-Dixon line.  And her interest in getting to know my classmates actually gave me this fun opportunity to kind of rediscover how I met and got to know each of them, to articulate what I appreciated about the individuals and our relationships.  (Ivor, for example, I sat next to on the housing tour at Penn Preview.  My thoughts at the time: Oh, thank God!  Someone who doesn’t take himself so damn seriously!)  Awkward/Awesome moment: today one of my classmates told me that my husband and I looked so adorable on the dance floor together.  Um, if by husband, you mean that saucy minx in the gold dress (or Sara in the slinky teal number?), then yes, we are quite something… In all seriousness, thanks so much, Erica, for a wonderful visit!

• As I mentioned last week, it was a tough transition back to school.  Therefore, immediately after checking coats, we took the shortest path to the bar.  Me: “So, I’m not sure what liquor you have.  Do you make Manhattans?”  Bartender #1 (of many), deadpan: “We make everything.”  Good answer.
• One of the best parts of prom was meeting the significant others–such a privilege to start to get to know the people who mean so much to new friends and colleagues…or at least put faces to the names I’ve been hearing repeatedly in conversations since August.  If we talked too much about boring med school stuff, please forgive us…my last med prom, I went as the girlfriend of a med student, and I was certainly not as understanding/tolerant of the lack of variety in conversation as the VSOs I met on Friday (belated apologies UVA Med 2008 :/).  Thank you for joining us.
• Joe, a fellow learning team member and one of my favorite people, said that he didn’t recognize me at first.  I’m thrilled that, after five months of glasses and sloppy French braids, I’ve created such low expectations of my presentation that all I need to do to fly under the radar is pop in some contacts and straighten my hair.
• Having missed dessert in lieu of dancing, I might have enjoyed the leftovers of my dinner companions.  Classy, no?  I can’t believe I’m admitting this online.
• Despite the freakin’ freezing weather, a dear friend insisted on walking us home, and then he might have consoled my beloved neighbor after a trying day while I, in true Anna-fashion, proceeded to demonstrate my support by falling asleep on her shoulder.  Eric, you are a better man than I.

Oh man, did anyone read this post all the way through?  Today was a tough reality to which to return, as Bugsy Malone and I noted on parallel treadmills, a vain attempt to work off our alcohol guts.

I will drink at least two glasses of water for every cup of coffee consumed.  I still don’t believe in new year’s resolutions, but if I can’t beat the addiction, at least I can be well-hydrated, sort of.

Also, it appears as though we’re the only school back in classes at Penn.  I am missing the regular library and gym hours, but relishing the stillness on grounds.

What a great name, eh?

Today has not been the best.  But, all things considering, I am just really thankful that I don’t have lungs like some of the ones I handled today in pathology lab.  Liquefactive necrosis, you are one foul piece of work.  Caseous (meaning cheese-like) necrosis is pretty nasty…but the complete lack of lung tissue, the empty space that once contained healthy tissue, resulting from liquefactive necrosis is down-right terrifying. 

I was also reminded of this great video of Hans Rosling from four years ago.  Minutes 2:40-5:05 give you the breakdown.  This November/December, another video of his was circulating around the cyberspace, but I’m partial to this one.  Ted sent it to me as a pick-me-up while I was in the throes of my masters thesis.  I might be rewatching it right now…

How is it that the first time in my life that I wake up with heart burn is the week we’re learning about pulmonary embolisms?  Granted, it wasn’t necessarily on inspirations, and probably a little low for a pulmonary embolism.  And there are no other symptoms.  Whatever.

I am slowly going crazy.  Or I’m just becoming a typical medical student.

So, I didn’t take that many pictures over the break, but this series of my brother and niece on Christmas is pretty priceless.  We Oppenheimers can sleep through anything:

When people discuss the transition between Mod 1 and Mod 2, inevitably one of the first differences cited is that our courses are no longer pass/fail, cut-n-dry.  Understandable.  With the exception of very few (perhaps the best of us), we are a goal-oriented, grade-driven bunch.  Come on, we know the statistics.  They’re certainly not everything–thank God–but our grades and our MCAT scores mattered when applying to school.  Why else would I have obsessed over my post-bac grades in order to counter-balance my 2.0 undergrad science GPA?  (To be fair, I only took the one bio class over the course of my entire undergrad career, which I probably should have failed.  My dad made me take it.  I was trying to prove a point…I don’t remember what the point was, but boy did I show him!  Needless to say, he never made me take another science class again, for fear of permanent damage.)  Why else would I have taken the MCAT three times?  Hmmm…I might not have shared that adventure yet.  Long story short, I am not be the best test-taker, but I know what I want.  The last MCAT I took ten days after receiving the scores of MCAT round 2.  But I digress…

Okay, while I understand why we care about grades, and I appreciate that it is important for us to know how we’ll be evaluated and what is expected of us, I can’t get over it: why do we care so much?  Why has honors become the motivation, the carrot dangling in front of our noses?  I mean, aren’t we adults?  Shouldn’t we be passed this?

And I am 100% guilty.  I shrug my shoulders and try to come off like this change doesn’t make a difference to me, but I’m lying.  There is a variety of motivations to consider here.  There are my peers who know (how they know, I have no idea) that they want to enter into a competitive specialty, and will therefore work beyond the limits of sanity to honor in every subject.  And then there are those who simply don’t want to be embarrassed in comparison…I unfortunately fall, at least in part, into this latter category.  Every time a classmate says something to the effect of, “Well, it’s honors/pass/fail, now people are really going to bring it,” I’m left horrified: “Weren’t they already bringing it before??”

Of course, beneath this unfortunate layer of bullshit, there is good…a lot of good.  We are all motivated by a love of learning, a desire to develop ourselves as students of the medical profession, a hope of becoming great physicians.  If I believed in new year’s resolutions, I would say that I was going to try to, in all sincerity, keep these goals as the keystone in my Mod 2 efforts, and do my best to ignore the honors.  There are some Penn students who already succeed in this regard, like pros.  I have no idea how they obtained this truly remarkable combination of strength of character and work ethic, but I hope I might uncover their secrets.  The alternative is too frightening to consider.