Archive | September, 2011

a reminder

29 Sep

“Luck is believing you’re lucky.”  ~Tennessee Williams

I think sometimes when things don’t go initially as planned, I can so easily forget how lucky I am.  My goal for immediate future is just to keep reminding myself.

I found out yesterday that I passed cardiology.  We got one of those cryptic class-wide emails from our course director saying that, unless we had heard from him earlier that day, we passed the course.  Upon seeing this email, I immediately did a search through my inbox for any emails with his name in it.  Although I feel like my understanding of the subject matter is solid, Monday’s might have been the hardest exam I’d ever taken.  I’d never seen so many of my classmates stay the full five hours–there was a slowly moving line to turn in the test after the proctor called time.  Needless to say, although I think derm is interesting and certainly relevant, I am feeling pretty uninspired to study for our final that is–ugh!–tomorrow!

At least yesterday was broken up by a standardized patient skin exam.  We now see standardized patients in mock clinical rooms at PennMed at Rittenhouse.  It feels much more realistic…except, of course, that we’re being observed by our peers, video-taped, then immediately critiqued by the actors who are playing our patients.

learn

27 Sep

I am loving Rick Mereki’s videos.  Still feeling pummeled from yesterday’s cardio exam, “learn” is reminding me how special it is that one of my main purposes right now is simply that:

I’m saving “eat” for after I finish VC-ing this morning’s lecture on psoriasis…

interrogation is so cool

25 Sep

Well, I’m frantically trying to learn anything about anything having to do with this dumb pump that’s responsible for keeping me (and you!) alive.  It’s a little embarrassing, but I’ve never been one to fully appreciate or marvel at a good chunk of medical technology (I know, is that completely awful given my chosen profession?? I think it just says more about me being a complete technophobe).  However, I’ve found myself being swept up with some of this cardio stuff, like when we watched a video on induced pluripotent stem cells becoming heart muscle…actually able to beat on their own!  Can you imagine the possibilities that can have for heart repair?!

Now I’m reading about some older technology: electronic pacemakers.  We, or at least I, can easily take advantage of how jaw-dropping the concept is–after all, there is pretty much no medical drama out there that doesn’t feature at least a patient a season with some sort of synthetic pace-making device.  What I’m learning is that not only do these implants sense cardiac activity and stimulate beats in response, they also record useful information, like the amount of pacing required, whether increasingly faster rates can be sensed (indicating particular disease states), etc.  Then, an external radio frequency programming device (jigga what??) is used to “interrogate” the pacemaker to obtain such information, and adjust pacing accordingly.  Even a technophobe like me can recognize the cool factor here.

Please wish me luck tomorrow.  I feel like my heart is skipping a beat.  <sigh>  To think of all the puns I could have made this block, and now it’s 27 hours from being over…

HUA

23 Sep

Heard. Understood. Acknowledged.

Probably the only military-derived practice in my life, yet so integral to my marriage. With opposite work/study schedules coupled with the necessity of communication between two people who share a home, John and I converse a bunch over emails, texts, and google voice. And we like to know that the information’s gotten through, or we can get pissy…well, one of us, at least. So, a quick “HUA” in return has been our system for the last couple months. Since I haven’t seen John since I think Tuesday, I have a pretty long row of three-letter emails in my “John” folder.

I’m not really sure I want to know what this says about me, but I oscillate between being concerned and amused.

necessary study breaks

23 Sep

And, we’re at it again.  Those pesky things called “final examinations.”  Monday will be five hours of fun-filled cardiology mind acrobatics.  Friday, after a mere 3.5 days of lectures <she chortled to herself>, will be our dermatology final.  Weekend of hibernation (not of my myocardium, which would probably require catheterization) starts now.

I believe in the mini-study break.  Quick mind-relaxers to remind me what it feels like to have joy without stress…

tastes so good

21 Sep

I thought only pathologists compared their specimens to edible substances.  Apparently cardiologists do as well.  I’m not sure I’m ever going to be able to look at a Thomas’ English Muffin without thinking Left Ventricular Noncompaction, a banana without thinking Asymmetric Septal Hypertrophy, or a double-scoop ice cream come without thinking Restrictive Cardiomyopathy.

Today we also learned about broken heart syndrome, which, by the way, is supposed to look like an “octopus trap” (because we come in contact with so many of those on a regular basis) on an echo.  A strong, often sudden emotional stress, like the death of a loved one or a break-up, triggers an excess of catecholamine release, creating a weakening of the heart muscle.  On an EKG, it literally looks as though the person is having a heart attack.  More women are reported to experience this phenomenon than men.  Disheartening, no?

the truth about high fructose corn syrup

19 Sep

A response to the Corn Refiner’s Association’s “Sweet Surprise” ad campaign.

Med school agrees.  High fructose corn syrup produces more free fatty acids, increases insulin resistance, increases inflammatory markers, and increases the risk of atherosclerosis.  Trust me, having held a severely atherosclerotic aorta laden with calcified plaque, this is not a syndrome you want.

vomit

18 Sep

Running twice in the last three weeks then sleeping four hours last night was a great strategy, because I PR-ed at 2:03:35 in this morning’s half marathon.  It also probably helped that, after my most recent round of IV Venofer (iron infusions), my hemoglobin has not been this high in over a year: 12.7 baby, yeah!

Compared to my classmates, running warriors that they are, my time was nothing to write home about, but I do feel a little proud that I finished in the top third of all the women running today and of my age division.  One day, I’ll break two hours.

So, the funniest thing happened.  As you know, I’m pretty much anti-pain, so I don’t like to push myself all that much…I kind of trot along, and if I think a cramp might be coming on, I slow down.  Running is pleasant this way…listening to a freakish amount of Lady Gaga and Katy Perry makes it even better.  So I felt pretty okay for the first 13 miles.  Then, I don’t really know what happened/got into me, but I felt so great at 13 miles that I thought to myself, Hell, let’s sprint the last tenth of a mile.

What an idiot.  No sooner did my legs seem to make this decision for me that this wave of some sort of foul-smelling material came over me.  Totally nauseating.  But of course, I was so close to the finish, I couldn’t get myself to slow down, and I just let myself run as I felt the retroperistalsis in my abdomen.  I crossed the finish line, and then I vomited, twice.  Classy.

I met up with a bunch of MS2s on the steps of Art Museum.

Me: None of you saw me finish, did you?

Ben L: No, did you throw up?

Me (shocked): How’d you guess?

Ben: There’s vomit still stuck on your cheek.

Cyndi was sweet enough to wipe it off with water that had melted from her bag of ice.

We’re now a frightful eight days from our cardio exam–like with these races, I frequently ask myself regarding med school, How the hell did I get myself into this mess??  Today’s been pretty much blown, because the amount of energy/inspiration I have to do work post-race is next to nil.  I’m comforted only by the fact that at least I thought about Bernoulli’s principle several times throughout the run as the mean velocity of the runners had to vary inversely (somewhat) with the changing width of the course.  I might have even related it to Peripheral Artery Disease.  That totally counts.

cardio

16 Sep

anna in med school has been a bit light on the whole “med school” component.  I promise, I’m still going.  Things have pretty great, actually, though I think I need to make more of a conscious effort to be a good decent student.  I really like cardio.  Even though Dr. H refers to the heart as “just a dumb pump,” it’s a pretty gnarly organ, so clearly fundamental to…well…everything.  And, double bonus, it’s amazing to me that after only 3.5 weeks of this organ block, I already understand so much more about what John sees at work on a day-to-day basis.  He picked me up at the train station last night and was jabbering about some dude he saw with ST elevation (a portion of the EKG above where it should be when compared with other structures, indicating damage to the heart, particularly infarction)…and it occurred to me, Holy Shit, I actually understand all the words he’s saying right now.  (I think I had kind of gotten used to understanding only about 80%, if I’m lucky, of what John describes regarding work.)  So, in summary, this is important stuff, and I should learn it.

The past weekend was filled with two house-warmings (my friends are buying houses….dude!), a 30th birthday celebration, lots of cheap yoga, an attempt through the supposedly original recipe for Skyline Chili (it’s good, but not Skyline), and not enough study or sleep (though valiant efforts were made).  This weekend I’m apparently running a little race with Sara on next to no training save that 5K at 8,000 feet in honor of Caitlin and Chris.  Full patient history exam today, then cardio exam a week from Monday.  Then we’ll be a quarter done with our last preclinical semester.  !!!

A couple randoms:

My gorgeous city:

photo by e.r.

One of the many reasons to dig Art Caplan and to be proud to be a part of the Penn Bioethics community (click on link to read more about how hard he rocks).  And we have Zeke Emanuel as head of the Department of Medical Ethics & Health Policy…gotta love him and his brothers, or at least one of them?

the best card

15 Sep

I should rephrase, because this summer has blessed me with some pretty terrific hand-written correspondence (love to my pen pals in England, Boston, and Virginia!)…but this card from Erica was just the kind of pick-me-up I needed at the end of a long day.

Appropriately, today we practiced how to deal with difficult patients, including those who hit on their student-doctors.  I can only hope that, should I ever receive flirtations as an expression of appreciation by patients, they’ll be similar to some that John experienced during residency.  An elderly woman with an arrhythmia once told him, “Honey, my heart skips a beat every time you walk in the room.”  A gay gentleman inquired, gesturing toward John, “Who is that?  Who is Dr. Delish??!”  I was less amused when a forty-something told him repeatedly, a few months post-wedding, “I’m telling you, you can get that shit annulled!”