anna in med school

We don’t really understand what dyspnea (difficulty breathing) is…but, as my Introduction to Clinical Medicine (ICM) preceptor (who lectured us on the topic in pulm last week) explained: “It’s a visceral sensation…uh…it’s kind of like love.  You know what love is, but you can’t define it.”

Josh, today being our last ICM session, this one’s for you!  FAR COLDER, for going through a history of present illness:

Frequency

Associated Symptoms

Radiation

Character

Onset

Location

Duration

Exacerbation &

Relieving factors

Hopefully I’ll channel more of your mad clinical skills during my final tomorrow, a full History & Physical!  Here’s hoping it takes less than an hour  I’ve been practicing my wrist flick for liver palpation and reflex testing on my wall at home…I’ve become an excellent stud finder.

Dr. R was kind enough to share this documentation of a wonderful mod 1 experience (thank you!):

John, as he was leaving for his overnight shift: “When you decided to take the MCAT for a third time, could you have imagined that you would ever be on the cover of Penn Medicine Magazine.”

No.  Absolutely not.  So I guess the message could be that I should keep wanting and working for it and maybe, just maybe, I’ll get to be a doctor one day.

I love cooking.  I love friends who let me cook for them.  It’s the best.

Tried this recipe out for our block-ly table six potluck two weeks ago, and I think I’m in love.  Simple and vibrant.  It’s important to eat in color.  My pictures via iPhone don’t do it justice but, just like smittenkitchen said, I absolutely love that “the day was saved by a something as humble as cauliflower.”

The second picture is of the ride home…we were hungry, so we asked Christina to bring down some spoons from her apartment so that we could consume Nathalie’s gallon of Dutch chocolate ice cream en route.  Only the best amuse-bouche for my girls.

The recipe made an encore performance for Erica, Dan, and Meta’s arrival last night.  Now I’m searching for brunch places in the ‘burbs for tomorrow, which is no simple feat.  Not sure this place will work for tomorrow, but I stumbled upon PB & U, and I’m literally drooling a little (just in the corner pockets of my lips, nothing too egregious).  Suggestions?

Finally, low-maintenance friends are the best, especially when they’re yayas and/or their very significant others and furry four-legged friends.  It felt so cozy to snuggle up with respiratory physiology while Erica and Dan graded his student’s math homework and Meta snuggled on a spot on the floor in-between.

Raise your two gloved, lubricated fingers: “I’m going to insert my two fingers into your vagina to examine your uterus and ovaries.”

On Wednesday night, I performed my first male genital exam and female breast and pelvic exam…with 5-7 of my colleagues watching.  The standardized patients were some of our best teachers yet, and I hope they get paid really really well.  (The male standardized said that the most discomfort he felt was that, at the end of the night, his throat was sore from all the times we asked him to “turn [his] head to the side and cough.”)

It’s amazing how, even though many of us are some combination of considerate, thoughtful, and/or well-spoken, inevitably some wrong words or catch-phrase tumbled off our tongue at one point or other.  To note: when in doubt, use the word “examine.”  Avoid: “inspect”; “squeeze”; “touch”; “expose”; “spread.”

Finally, everything looks “normal and healthy,” it doesn’t look “good.”

Not sure I would have stopped to think how truly bizarre this excerpt sounds if Eric hadn’t read it aloud:

The pulmonary capillaries form a dense network in the alveolar wall that makes an exceedingly efficient arrangement for gas exchange.  So rich is this mesh that some physiologists feel that it is misleading to talk of a network of individual capillary segments, and the prefer to regard the capillary bed as a sheet of flowing blood interrupted in places by posts, rather like an underground parking garage.  (John B. West, Respiratory Physiology: The Essentials, page 37)

Oh, yeah, I’m not sure I mentioned that we started Pulmonology on Monday.

I have been a bad, bad blogger as of late.  I miss the consistency.

One of the reasons behind the lack of writing here is that I’m writing elsewhere…scandalous!  Actually, I’ve taken on a project.  There is a physician who works in Maternal-Fetal Medicine whose work totally fascinates me and, last semester, she agreed to let me work with her for the next couple years.  Right now we’re working on a piece to submit to a few journals in the next couple months…will tell more once everything is in!

For now, I’m just happy to report that she’s become an invaluable mentor to me.  She’s truly an incredible woman, physician, and leader…and I kind of want to be her.  And she’s really given me a great deal of control in the shaping of this current piece.  I feel like I don’t know what I’m doing at all, but she seems to be convinced that I can write, so I’m just trying not to prove her wrong.  I love writing; this has been great fun for me.

Quickly, on the topic of mentors: I am so lucky to have them.  This weekend was our fall break, so John and I took advantage and hopped down to Charlottesville.  We could not possibly see everyone we love and admire in that wonderful town/city, but I did see two very special mentors.  As we talked over tea and snacks, as friends, I allowed myself to take the periodic deep breath to appreciate how much they helped shape my life, my profession, my passions.  After UVA and Goucher, Penn has not disappointed–I feel I already have a handful here.  I don’t think everyone needs mentors to succeed, but I certainly credit my successes, as well as my happiness, in large part to them.

With one fascinating friend (sustainability coordinator for UVA Dining–woot!) and one of my longest mentors (professor of music and conducting, director of too many ensembles to name):

Can you guess where I am??  Six years later, still on the U-Singers board.

During this weekend’s mini-vacation, a number of friends and family have asked me when I start on the wards.  “Oh, just a little over two months,” has been my standard response.  Imagine my shock when I looked at my calendar this morning and realized we had passed the two month mark.  58 days and counting!

And I am pumped (and terrified) about my schedule.  Here’s what:

January 3-March 23: INTERNAL MEDICINE (good God.)
March 26-June 15: SURGERY (have I lost what’s left of my mind?)
July 2-July 20: OPHTHALMOLOGY, ORTHOPAEDIC SURGERY, OTORHINOLARYNGOLOGY (breather!)
July 23-August 10: NEUROLOGY (seeing some daylight this summer?)
August 13-September 21: PSYCHIATRY (weekends!)
September 24-November 2: PEDIATRICS (love and fright.)
November 5-December 14: OBSTETRICS & GYNECOLOGY (holiday babies!)

This order was in my top four (we submitted our order preference about a month ago…1 to 48!), so I’m stoked, or course.  Although, as soon as it flashed before my eyes on Oasis, my first thought was, “What the hell have I done to myself??!”  The first six months of 2012 should be, well, an adventure…a scary, exhausting, but completely exhilarating one!  Wish me luck!

26 more days of lectures.  Two more exams of Mod 2.

I worry that there are matters about which I’m too closed-minded.  Then I stumble upon smart people who articulate my perspective respectfully and thoughtfully.  I might still not be as flexible in my philosophies as I’d like, but at least I’m in good company.

Thanks for the article, Koop!

The kidney.  Thank God there are are two of them, ‘sall I gots to say.  And no wonder the higher powers at Perelman have elected to devote not one but two four-hour testing blocks (this Friday and Monday) for our examination pleasure.  There’s a nice symmetry to it.

So, at some point, I’ll be back here to share, among other things:

• my VC debut…cliffnotes: I’m awkward, but at least others can now appreciate this quality at 2x.
• leading Doctoring with Derek on palliative care, hospice, and physician responsibilities toward a dying patient and his/her loved ones.  Trust me, read this letter.
• exciting plans for our fall break!
• some little tidbits about the kidney…it’s actually mildly interesting at times, and not only when it’s covered in cysts.
• apparently we find out the order of our clerkships on Monday!  !!!

doesn't begin to do it justice

Looking forward to being a better blogger!

On Sunday, Julia and I took a quick jaunt out of the city to take a yoga class at Crossing Vineyards.

Good little med students that we are, we went home to study acute kidney injury, forgoing the complimentary wine tasting.  A partially shot afternoon…well worth it for this view during supta vajrasana:

The picture, of course, doesn’t do it justice…to be fair, it was taken from a phone while my head was upside down.

One last thing, then I need to start acting like a student and prepare my case for tomorrow: maybe one of the hardest things about med school for me is missing the outdoors.  I just can’t justify spending nearly as much time as I would like to outside, and the weather has been teasing us with intermittent beautiful crisp fall days recently.  One more week until the end of renal!