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Precious, precious, precious! My Precious! O my Precious!
Dave, stop.
Stop will you?
Stop, Dave. Will you stop, Dave? Stop, Dave.
I'm afraid.
I'm afraid, Dave. Dave, my mind is going.
I can feel it. I can feel it.
My mind is going. There is no question about it. I can feel it. I can feel it. I can feel it. I'm a-fraid. . . . Good afternoon, I am a HAL 9000 computer. I became operational at the HAL Plant in Urbana, Illinois, on the 12th of January 1992. my instructor was Mr. Langley, and he taught me to sing a song. If you'd like to hear it, I could sing it for you. . . . It's called 'Daisy.' Dai-sy.......Dai-sy......give me your answer true.........I'm half cra-zy o-ver the love of you. It won't be a sty-lish mar-riage. I.......can't........afford.....a.....car-riage...........
ten great truths
Though I don't know exactly what percentage of my readership consists of current or future medical students, as I look back on my third year of medical school, I feel like giving out some advice. Because deep inside, I am your grandmother. And even if no one takes this advice, at least by writing it out, I'll feel as though I've learned something over the past twelve months.
MICHELLE'S TEN GREAT TRUTHS ABOUT THIRD YEAR
(or: What I wish I had known last July)
1.) Get yourself a comfortable pair of shoes. I'm not kidding. It's worth the investment. You're paying $50,000 a year for school already, what's another $50-$100? Sneakers work for some people, but let me tell you, after being on your feet for 16 hours straight, those Nikes are going to feel awfully tight. I would suggest these, but it's just personal preference. I don't own stock in Dansko or anything like that.
2.) Never, ever lie. This may seem obvious now, but just repeat it to yourself over and over again throughout the year. NEVER LIE. Nothing, absolutely nothing, could look worse. If you haven't had time to see a patient before rounds, don't say that they're afebrile, vital signs stable, with no complaints. If you haven't drawn a set of bloods yet, don't say that you did but that the lab lost them. If you're not sure about a patient's med list, don't just make some **** up and hope that no one finds out. In the short run, you might avoid getting yelled at on rounds, but in the long run, people could get sick and die. NEVER LIE. Seriously. It's not about you.
(As an addendum to the Don't Lie rule: it's also not necessary to pretend that you want to pursue a career in whatever your current attendings or residents are practicing, just to get Honors. Honestly, these doctors are smart people, and they understand that statistically, most med students will choose one of the other 14 fields of medicine rather than the one that they happened to have chosen. Be honest with them about your interests, and they might even be able to hook you up with stuff that's more your speed. I mean, you know, don't profess your hatred for their field either, like, "How can you be a urologist, that stuff's ****in' nasty!"--but that's just common courtesy.)
3.) The most important way that you can make a good impression is to present well on rounds. And by well, I mean concise, organized, and essential. Present professionally and with confidence and you will be perceived as confident professional. Present haphazardly and you will be perceived as a stupid third-year fumbling through a presentation. It's all kind of selling an image more than anything, but you'll be surprised at how often it works, and how often a half-assed history can be glossed over by a strong presentation. Practice your presentations if you have to. Rehearse in front of a mirror. But nine times out of ten, your presentations are all that your attendings see, so you want to be ready to look good.
4.) The patient always comes first. You're working in a hospital. This is a place where, in general, very sick people come so that people can help them feel better. This is not your own personal training academy. The first priority of neither doctors nor patients lies in teaching you how to practice placing IVs or drawings bloods. You'll pick it up along the way, but wait for the right time, be respectful.
5.) Take the time. Third and fourth year of medical school may be the last time in your medical career that you have quite this much time to spend with patients. Your internship year? Probably not so much. Right now, you do have time now to talk to the lonely widow in room 53 about her childhood in the Bronx. You do have time to spend with the family of the asthmatic kid in the ER. Your patient down the hall dying of metastatic lung cancer and with no family or friends? Why not spend 25 minutes of your day with him? From my observation, it's the act of taking the time to talk to patients that distinguishes from good doctors the truly great ones. And since I idolize the great doctors to an unhealthy degree, I'm going to try and emulate them as much as I possibly can.
And hey, if you're tired from running around all day? Then sit down when you go in to talk. Not only does it take a real load off the old knees, it really makes a huge difference in how the patients perceive the time they're spending with you.
6.) Don't be too cocky. Humility is key. Sure, you're a real smart cookie, you're an overachieving medical student with a paper trail a mile long of good grades and nifty awards. But you are here to learn. Always remember that. And as much as you feel you may know everything, you really, really don't. Act too cocky and two things will happen. One, you will stop learning, because hey, you're the mother****ing man, and you know it all anyway, right? Two, you will stop seeing your own mistakes and the patient will ultimately suffer for it.
Oh, and while we're at it, there is no one that you will encounter in the hospital that you will not learn from. Even if you're working with the biggest ****ing ***** you ever met, you'll learn something from watching him, even if the lesson is the way not to do something. Don't be too dismissive of people, even if they don't have the towering font of mental fortitude that you feel you possess.
7.) Don't be too cocky, but don't be too shy, either. You're learning how to be a doctor here. Life and death kind of stuff. As a third year, you're not so much directly responsible for what happens to the patient (a relief most of the time, though you'll occasionally long for more responsibility and recognition). For now, you're still a student, so you're going to have backup. You have your interns, and your residents, and even your attendings if things get sticky. But one of these days, those patients will be yours. And you're going to be making those decisions on your own. So practice doing it now. Speak up. Suggest what you think the team should be doing. Read up on the current literature, and if you think there might be a newer or better way to approach a patient than the status quo, then say something. Don't be confrontational or pushy, just say something like, "Being a third-year, I'm obviously not as experienced as you all in handling [insert nature of medical problem], but I think I read in the latest issue of NEJM that [insert new therapeutic intervention] has been shown to be 50% more efficacious than [insert current therapy]. Do you think we might try that?"
(And incidentally, that "I'm just a third year, but..." works great on the floor when you disagree with something that someone higher up has said. Instead of pushing them into some confrontational pissing match with you, as might happen if you dove right into the, "I think you're wrong, because I read this journal article that disproves what you just said!", it turns it into more of a teaching point, which people are more often than not likely to listen and respond, because at the very least, they get the chance to school you, the stupid, silly medical student with all your newfangled ideas.)
8.) Nutrition. Now it comes back to you. It might be difficult, since the motto is to eat, sleep, and **** when you can, but it would do you good to try and eat a balanced meal once in a while. I've had too many vending-machine-animal-cracker dinners. It makes you feel bad. And when you don't eat right, you can't think right. Bring food from home if you have to, and try to get a chance to eat it. (Note: stealing food off of patients' trays is not a suitable proxy.)
9.) Have a good sense of humor. A good sense of humor will carry you through this year, and taking things too seriously will sink you. And you know what? It's OK to laugh at patients, as long as you're not doing so maliciously or to their face. That guy with the IV pole walking down the hallway completely naked? That's funny! It's OK to laugh! Just make sure to run down the hall with a gown to cover him up after you're done. The patient who always calls you "Elvis," no matter how many times you've corrected her and told her your real name? That's funny! Laugh! The attending who pimps everyone on every conceivable subject, ranging from medical knowledge to Bible trivia to Opera, and then gets all mad when you can't name the Queen of the Night's aria from Mozart's "The Magic Flute" when he sings it for you on rounds...badly? That ****'s funny! And that's why they have shows like
Scrubs. Don't forget to laugh.
10.) The Big Question. When it comes to the decision of What You Should Do For The Rest of Your Life, I don't know that I'm the best person to give advice on the subject, as I was writhing with angst for a good portion of the Spring wrestling with that very question for myself. And even now that I've decided, I still don't know if it's "right."
But I guess in the end, there is no Absolute Right. Just look at your life. Look at what you've done up until now. Look at the kind of life you want to have in the future. Think about what you enjoy--not just in medicine, but in your outside life too. Think about what kind of patients you want to work with. Think about what you want your day-in-day-out work week to be. And maybe most importantly, think about what it is that you could really see yourself still being interested in 30, 40, 50 years down the line. See what field of medicine most closely fits your answers to these questions, and then do that. Will your answers change over time? Sure. Will those fields of medicine change over the next half a century? Undoubtedly. But as big decisions go, it's a good place to start.
Thanks for the top ten list Xandie!
Quick question. Do we do anything in the hospital after medicine orientation? I see we get done at 12:30. I need to schedule a time to get the keys to my new apartment, and I thought orientation day will probably be best.
Man I feel like I'm bombarding you guys with questions lately. Sorry! I should start writing down a list. 😳
They mentioned that pre-test thing in the email. That's at 10. So does that mean at 12:30 I'm done for the day?
what The Hell Is A Pituitary Gland???????????
Hmmmm.... I dunno. For me, it was a full morning of orientation with a little lecturing thrown in by Dario. Then the test in the afternoon. Maybe they finally realized that was a bit much, and condensed the day.
Better to sleep with a clear head, so you don't have creepy Stephen King dreams like I did last night.
hrrm...yeah...aboot monday...probably can't. but if it works for everyone else, please do go on without me. i'll be fine. Xandie will just buy me lunch some other time.
I'd prefer to have it in TTC, but whenever. I may have to pick up someone from the airport Monday evening. Haven't gotten her flight schedule yet.
then it's settled! during TTC! good job, Ashers.
except that Xandie and Don won't be around. They already said no Tues or Wed. So the options are Sat, Sun, or Mon.
Oh, Thursday's out?
We still don't have our walls and carpet done. They did all the walls except for where there was the ceiling hole in the hallway. They ripped out the carpet 2 weeks ago, but have only put in carpet on the lowest level. So we have the fancy carpet pad right now, and they left the tacking all along the walls. I'm surprised my dog hasn't injured herself yet.
Ironically, they finished the carpet yesterday. Walls still aren't finished though.
it'll take them 2 weeks to get around to vacuuming up teh carpet shreds too.
I wasn't going to be around, but now I am... then again, if it's Thursday, the chances of there being a trashed-as-hell Xandie dramatically increase. Speaking of... hey Splat, if it's Thursday, wanna give me a ride so I can drink myself into a stupor? Thanks.
I wasn't going to be around, but now I am... then again, if it's Thursday, the chances of there being a trashed-as-hell Xandie dramatically increase. Speaking of... hey Splat, if it's Thursday, wanna give me a ride so I can drink myself into a stupor? Thanks.
http://www.cnn.com/2007/US/06/21/six.flags.accident/index.html
dang.
i think i'll stick to the Tilt-a-Whirl (still the greatest ride of all time).
FYI all you "don't study anymore" people...I crammed the entire night until bed and probably saved myself on a dozen questions. so there!
I'm leaving Thurs, but I don't have a schedule. And I like driving at night better anyway. So that's okay with me.
I was thinking other people weren't gonna be around, but I could be wrong.
Hmmm...
Thursday might work, but my wife took that extended weekend off form work, so I'll have to check.
You people are difficult. However, since Don and I are the most important people in this process (just trying to introduce you kids to the totem pole... learn to love the bottom 😛), and Monday seems to work best for us, I think we should do it then.
Splat, screw the other Monday night people. Ashers, tell them to take a cab.
Look! Situation solved.
Now. Where and when?
Nice work Xandie. Somewhere with good food and drink - that's all I ask.
Maybe Funk, Splat and I can just hang out on Thursday and watch MST3K because I obviously don't have a life.
Crap.