Your Eureka! Path moment or when you decided path was for you

[yaah]

BCMD I think you missed the memo. All posts in the pathology forum must now contain some vague sexual innuendo. Kidding of course. Congratulations on your upcoming wedding! Obviously being a pathologist has increased your stud-quotient.

I still think gallbladders are cool. One of my favorite specimens. Never quite know what you're going to find. Bag of black rocks, bag of yellow rocks, bag of mucus, velvety walls, rock hard walls, +/- lymph node, perforation. Fantastic.

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[Doctor B.]

You know, that's the great thing, we pathologists get excited over esoteric and often very intellectual stuff. It's heady.

Thanks for the congrats on the wedding, yaah. I'm looking forward to it. The stud-quotient did go up. Having the MD is huge of course, but then having a good lifestyle as well completes the package.

I did miss the memo but I hope my use of "heady" and "package" qualifies . Maybe that's not so vague...

 

[yaah]

I just think this thread needs to be kept active. It simply pleases me. Thank you for your time.

Whenever you are sincerely pleased you are nourished.
-Emerson

The most exciting phrase to hear in science, the one that heralds the most discoveries, is not 'Eureka!' (I found it!) but 'That's funny'
-Isaac Asimov

 

[HotSteamingTurd]

Not my only Eureka moment but on surgery, I was scrubbed in a laparoscopic adrenalectomy in a patient with pheochromocytoma. To make a long story short, the senior resident in the case noted on the eval form, "likes to play with pheochromocytomas." I wish I could have gone to the path lab to see it studied but the senior made me scrub into a non-laparoscopic hemorrhoidectomy. ARGHHHH!!!!

 

[yaah]

A laparoscopic hemorrhoidectomy would be a tour de force of surgery. I might actually want to venture into the OR to get a glimpse of that one.

Brings up an interesting question. Is the plural of "pheochomocytoma" "pheochromocytomas" or is it "pheochromocytomata"?? These are the kinds of things I think about. One of my fears during third year was that I would have a patient with 2 pheochromocytoma(ta)(s) who was a linguist or other such academic and he would correct me. I hate getting stuff like that wrong in fron of people. It's like taking care of an historian and telling him WWI ended in 1921.

Evidence for the latter: Plural of Leiomyoma is Leiomyomata. Plural of paraganglion is paraganglia. But why isn't "pheochromocytoma" itself a plural word? Shouldn't the singular form be "pheochromocytomum?"

Well, screw it. I looked it up. Apparently it's both. Now I'm more confused than ever. You can say either pheochromocytomas or -ata. And I looked up "adenoma" and "Leiomyoma" just out of curiosity, and both have 2 plural forms. Adenomata and adenomas. I guess which one you use will depend on how much of a latin scholar one is.

What a waste of 10 minutes this was. Never gonna get those ten minutes of my life back. Oh well, can only blame myself here! But if I delete this post now without submitting it the last ten minutes would have been even more of a complete waste.

 

[pathdr2b]

Brings up an interesting question. Is the plural of "pheochomocytoma" "pheochromocytomas" or is it "pheochromocytomata"??.

In the VHL patients we normally see these tumors in, we just say pheo's.

 

[zeebs]

I'm starting med school in August, and have been reading all the specialty threads with interest. I've been speculating (yes I know it's too early) that I might lean towards internal medicine, without much solid support other than a general sense that it aligns with my question-asking, puzzle-solving, curious, like-to-know-odd-little-facts self. I never expected to be wooed by the whimsy of pathologists. I thought you all might be a rather drear lot, or have humor preferences a la Edward Gorey -- but you all seem charming and the things you've said about pathology and how you think are things that I had been identifying with internal medicine instead. Am I wrong? How do I make sure I get adequate exposure to pathology to make sure I get a chance to find out if it is for me? Is the general pathology course in second year an indication at all? Where do you get exposure to practical pathology in med school? I've really enjoyed reading this thread -- Thanks!

 

[b&ierstiefel]

You'll get plenty of experience looking at slides and learning histopathology during your first 2 years of med school. But realize that is the end result based on the actual work done in pathology. And you won't get to appreciate it until you do a rotation in pathology during 3rd or 4th year. Then you'll realize that pathology is more than slides; there are many facets to pathology to appreciate. (All this from a person who plans to do a path rotation in 2 months).

It's cool that you're considering pathology. I didn't consider pathology seriously until mid-M3 year. Like you I was originally intending on entering internal medicine. I just didn't see myself being happy doing the kind of work internists do though (you'll figure this out for yourself in a few years )

 

[yaah]

I'm starting med school in August, and have been reading all the specialty threads with interest. I've been speculating (yes I know it's too early) that I might lean towards internal medicine, without much solid support other than a general sense that it aligns with my question-asking, puzzle-solving, curious, like-to-know-odd-little-facts self. I never expected to be wooed by the whimsy of pathologists. I thought you all might be a rather drear lot, or have humor preferences a la Edward Gorey -- but you all seem charming and the things you've said about pathology and how you think are things that I had been identifying with internal medicine instead. Am I wrong? How do I make sure I get adequate exposure to pathology to make sure I get a chance to find out if it is for me? Is the general pathology course in second year an indication at all? Where do you get exposure to practical pathology in med school? I've really enjoyed reading this thread -- Thanks!

I think the general pathology course can serve to pique one's interest, if needed. I suppose there are those out there who HATE 2nd year and end up loving pathology, but I would wager that these individuals might be hard to find. People choosing path tend to like some of the things you refer to - puzzle solving, knowing odd little facts. I am a curious individual, I always want to know more about why things happen (or why things don't happen!). Pathology fits me well. I am sure you can always find a pathologist who teaches during the second year (or first year) and ask him/her if you could meet to talk about the field. They can possibly give you advice on what students at your school with similar interests have done to quantify that interest, or help you to better understand what their day-to-day job entails.

In a sense though, it's a lot more fun than internal medicine. If you REALLY love patient contact (and I mean REALLY love it) you would best be suited to go to another field. But if you like medicine, the mysteries, discovering things, working up diseases, this is all part of pathology. You might not have someone sitting in front of you saying "abdominal pain" and you have to decide how to work it up, but you will be presented with numerous problems, whether they are surgical specimens or lab information, that require similar mental pathways. Besides, I think it's a lot more satisfying. You don't need the patient taking up all your time and mucking things up. If you want to spend time with people and getting to know people, I can think of a lot more effective uses of your time than taking a history and doing a physical exam.

So, you're not wrong. There is a bit of pathology that becomes routine and pattern recognition, but there is always more information and more challenges out there if you get stuck in a rut. If you like research, path is also a perfect field.

The things that clinical fields have that path does not have are things like lots of paperwork, lots of phone calls, sick people, social work, long duty hours, and lots of running around. Pathology certainly has its paperwork and long hours at times, but in my opinion having to do all the crap that clinical medicine folks have to do detracts from the experience as a physician. You become less a physician and more social worker. That's fine if that's what you want out of a career. But for me, I went into medicine because the human body is a neverending wealth of information, mystery, and fascination. Learning about how and why certain changes cause the body to go into a different state and threaten its survival is a neverending task, and a forever surprising one. I do, at times, regret that I don't get to see patients, diagnose them with something, help them get better, and keep them healthy. But it's an acceptable tradeoff for me.

Besides, as I have said before, most patients are utter pills. People are not nice when they are sick. Their families are also very impatient. Diseases have defined causes (be they understandable or utterly confusing) and measureable effects. Patients are completely whack. You may think you like them now, but wait til you get to know them. My advice: don't pay attention to the nice patients who make you thrilled to be a clnician. Everyone likes these people. Pay attention to the other 75% who have issues.

p.s. Edward Gorey? Monty Python, perhaps!

 

[b&ierstiefel]

Also, think about what you job will be like AFTER residency. An internal medicine attending doesn't deal with too much of the social work, paperwork, etc crap...most of that will be done by residents. Don't get me wrong, medicine attendings still have to do some of that...lots of BS crap with outpatient work especially.

As an aside, most of the sick patients are unpleasant in my experience. What do you expect? They're sick and they're not happy. But then you gotta deal with their families. It's kinda why pediatrics was a turn off for me. The kids, even though they were slobbering and puking all over the place, were cute. The parents however.....enuff said.

Finally, I find it funny when attendings dictate their encounters with patients who are unpleasant to deal with and end the dictation with, "Dr. ____, thank you for the wonderful opportunity to allow me to participate in the care of this pleasant patient." I read this and I drop to the floor, roll around, and laugh my a$$ off.

 

[yaah]

Truly. If you ever see a dictation from a physician that doesn't include the term "pleasant" or words to that effect, you can be pretty sure that patient is a big enough pill that the dictating physician decided not to include it. It takes an awful lot for a patient to not be described as "pleasant." Ok Ok, some dictating people don't ever describe anyone as pleasant, but most do. Mrs Doe is a pleasant 55 year old woman......er.....Mrs. Doe is a cooperative....er.....Mrs Doe is a friendly....er....Mrs. Doe is a 55 year old woman who... I always wanted to dictate: Mrs. Doe is an obnoxious overweight pretentious selfish individual who is noncompliant with her prescribed treatments yet continually complaining of various symptoms who...

Because, dear Andy, you posted so quickly that my eloquent scribings have vanished into the nether regions of the previoius page of posts, I am taking the utterly obnoxious step of reposting the entirety of what I already said, because if I don't, I will feel as though my musings will be ignored, and I gave up reading about immunoassays to write that!

But anyway, internal medicine attendings do get to ignore lots of the crap that residents have to deal with. But then they get their own crap to deal with, like a neverending supply of patients calling (and now e-mailing) with their urgent concerns. And the paperwork and billing and insurance referrals......No thanks on my end!

I think the general pathology course can serve to pique one's interest, if needed. I suppose there are those out there who HATE 2nd year and end up loving pathology, but I would wager that these individuals might be hard to find. People choosing path tend to like some of the things you refer to - puzzle solving, knowing odd little facts. I am a curious individual, I always want to know more about why things happen (or why things don't happen!). Pathology fits me well. I am sure you can always find a pathologist who teaches during the second year (or first year) and ask him/her if you could meet to talk about the field. They can possibly give you advice on what students at your school with similar interests have done to quantify that interest, or help you to better understand what their day-to-day job entails.

In a sense though, it's a lot more fun than internal medicine. If you REALLY love patient contact (and I mean REALLY love it) you would best be suited to go to another field. But if you like medicine, the mysteries, discovering things, working up diseases, this is all part of pathology. You might not have someone sitting in front of you saying "abdominal pain" and you have to decide how to work it up, but you will be presented with numerous problems, whether they are surgical specimens or lab information, that require similar mental pathways. Besides, I think it's a lot more satisfying. You don't need the patient taking up all your time and mucking things up. If you want to spend time with people and getting to know people, I can think of a lot more effective uses of your time than taking a history and doing a physical exam.

So, you're not wrong. There is a bit of pathology that becomes routine and pattern recognition, but there is always more information and more challenges out there if you get stuck in a rut. If you like research, path is also a perfect field.

The things that clinical fields have that path does not have are things like lots of paperwork, lots of phone calls, sick people, social work, long duty hours, and lots of running around. Pathology certainly has its paperwork and long hours at times, but in my opinion having to do all the crap that clinical medicine folks have to do detracts from the experience as a physician. You become less a physician and more social worker. That's fine if that's what you want out of a career. But for me, I went into medicine because the human body is a neverending wealth of information, mystery, and fascination. Learning about how and why certain changes cause the body to go into a different state and threaten its survival is a neverending task, and a forever surprising one. I do, at times, regret that I don't get to see patients, diagnose them with something, help them get better, and keep them healthy. But it's an acceptable tradeoff for me.

Besides, as I have said before, most patients are utter pills. People are not nice when they are sick. Their families are also very impatient. Diseases have defined causes (be they understandable or utterly confusing) and measureable effects. Patients are completely whack. You may think you like them now, but wait til you get to know them. My advice: don't pay attention to the nice patients who make you thrilled to be a clnician. Everyone likes these people. Pay attention to the other 75% who have issues.

p.s. Edward Gorey? Monty Python, perhaps!

 

[b&ierstiefel]

damn yaah, you're smart. you got me again

let's see what page this ends up on...haha

 

[yaah]

damn yaah, you're smart. you got me again

let's see what page this ends up on...haha

Page 361 of the technical manual for the machine that measures thyroglobulin levels. Just after citation #451 in the chapter appendix "Physical chemistry phenomena" but before the description of the DC power adaptor needed if the machine is to be used south of the equator.

Thus, the only ones reading it will be you, me, and a Chilean lab technician named Hector who is looking for the section of the manual that reads "how to turn machine on." Although, sorry to say, Hector only speaks Spanish and parts of two obscure andean mountain dialects. And of those, he only knows how to barter for alpaca sweaters.

 

[b&ierstiefel]

Of course Hector can't find the section "how to turn the machine on" in the manual because based on what you said, he can't read english. he would technically have to look under the "Instrucciones" section of the manual.

BTW, Hector doesn't have internet access to be seeing these posts. He just emailed me and told me so.

 

[deschutes]

my 2 cents...

Both med schools I went to had a systems-based approach - in other words, we didn't actually have a histology class in 2nd year.

In retrospect, even with self-study, Robbins was my favourite textbook. It had all those neat pictures. It gave me tonnes of "OH so THIS is how it looks like!" moments.

First year in Calgary, people started asking what I wanted to do when I grew up. It wasn't something I had even thought about at that point, except for vague ideas about some aspect of Internal - hell, I'd already spent nearly 3 years studying Internal-type subjects.
(I thought maybe Haematology - the smears made everything make sense!)

So I realized I had to make a decision. I shadowed. And the first doc I shadowed was a pathologist.

"You mean I can actually DO pathology for a career!?"

I don't remember very much of what actually took place that afternoon, but I do remember that from the time I set foot in the buzzing gross room I was grinning and thinking "this is SOO KEWL!"

By the time 5pm rolled around, I was bouncing - I was convinced it did not get better than this

I shadowed in other things too.... ICU, GIM, Haematology... All were interesting to some degree or another, but GAWD THE ROUNDS. The paperwork. The phonecalls. The orders. It felt like groping around in the dark. I felt more of a communicator/coordinator than an actual doctor.

Multiply by n now that I'm a clerk. Add the responsibility of fiddling with drugs. Ugh.

Peds Emerg was sorta fun. It made me want to try adult Emerg.
I could maybe see myself doing Emerg as a hobby from Path.
But medicine does not let one do that.

~
I still work on my path project evenings and weekends. A classmate asked if I wasn't having too much on my plate. I said it actually makes me feel like I know something, keeps me sane.

 

[b&ierstiefel]

I shadowed in other things too.... ICU, GIM, Haematology... All were interesting to some degree or another, but GAWD THE ROUNDS. The paperwork. The phonecalls. The orders. It felt like groping around in the dark. I felt more of a communicator/coordinator than an actual doctor.

Dude, I'm totally with ya on this one!
Yes...the paperwork and writing all those damn orders and H&P and those endless notes suck. I thought my days on medicine revolved around writing stupid notes. You watch a resident do a procedure...you write the note. You write these obscenely long admit H&P notes. Then these long progress notes. Then I go to the bathroom, take a big steaming dump and I write a note on that too.
The phone calls are worse...especially as a student. Not only do the attendings pimp you during rounds and make you feel dumb. But now these bozos are pimping you via telephone.

As a sub-intern, I feel like a combination of 2 things: a monkey and a secretary (no offense to all the secretaries and monkeys out there).

 

[yaah]

Dude, I'm totally with ya on this one!
Yes...the paperwork and writing all those damn orders and H&P and those endless notes suck. I thought my days on medicine revolved around writing stupid notes. You watch a resident do a procedure...you write the note. You write these obscenely long admit H&P notes. Then these long progress notes. Then I go to the bathroom, take a big steaming dump and I write a note on that too.
The phone calls are worse...especially as a student. Not only do the attendings pimp you during rounds and make you feel dumb. But now these bozos are pimping you via telephone.

As a sub-intern, I feel like a combination of 2 things: a monkey and a secretary (no offense to all the secretaries and monkeys out there).

You know, it's funny. We had to take this "house officer assessment" thing before starting residency at U of M. Basically, had to rotate through 7-8 stations which tested our knowledge of important things interns should know, and tested our communication skills, and aseptic technique. I did really well (I mean really well) on the "paperwork and order writing" section. ???? I am not sure why. I hate writing orders.

In general most everything else I did there was right around the mean, but I didn't do so well on "pain assessment." Surprise. I hate pain assessment. If the freaking human population was honest in rating their own pain and weren't such babies, pain assessment would be easy. It would also help if there weren't all these people who end up addicted or abusing pain pills. They all mess it up for the rest of us. When I get my inevitable appendicitis, I want to be able to have some freaking pain pills! No Tylenol!

I agree about the phone calls. During my subI I was pining for the 1880s when in order to get things done you had to talk to people face to face. I still hate the phone. If it takes me another 10 minutes to walk somewhere and ask a question, I would prefer to do that then save the 10 minutes and call them. Because invariably you end up getting put on hold, or you forget to ask a certain question, or you don't remember what they said, etc.

Deschutes thank you for the British terms, I always enjoy seeing things like HAEMATOLOGY and OESOPHAGUS. The King's English I find is quite often better. Like how GERD in the UK is GORD because oesophageal is spelled differently. I'd rather have GORD.

 

[deschutes]

Deschutes thank you for the British terms,

Guys, just FYI, deschutes is a girl. But deschutes doesn't mind being called "dude" or "man" She is happy to be able to pass for a guy - at least in writing - a la the great J.K. Rowling.

deschutes is spelt with a small "d". It just looks more balanced, somehow.

I think it's a small thing to ask, since in real life I have to put up with my name being rearranged to fit the first-name-last-name format, in this country where they're happy to tailor your mayo/mustard/Dijon pickles/pretzels and brown/white bread sandwich.

(Imagine that you were Scott Ferguson all your life. It's just annoying when people take your name, turn it around and start writing Ferguson Scott everywhere. Idiots.)

~
Writing orders is a very "So what?" experience for me.

These Peds/Internal residents I've worked with... [and I don't mean to be prejudiced, but they are the only two groups of residents that I've met so far...(and one of the Peds Jrs said "Pathology? Not a people person, are you." But that's another story for another time.)] I'm not sure if they've actually seen the things that they've ordered, being done.

Resident writes order, something magical happens, CT comes up on the computer.​

People are happy with that?

Peds Day 2:
"This patient's family needs asthma teaching."
Hmm. You mean I have to go in there and teach them about asthma? I don't think I know enough about asthma to teach someone about it!
"No no no, you write the order, and then the unit clerk will phone pharmacy, and pharmacy will send someone over to teach the family."
Ah. Never would have guessed.

There are too many... layers. You're not actually doing anything or seeing anything. "Oh just let the unit clerk or nurse know."

I don't know, it just feels very... impersonal.
Sort of like what yaah was saying about face-to-face vs. phone calls.

Having said that, I would probably STILL forget a question, or forget what they said, and have to walk the 20 minutes to-and-fro to get those things, heh.

Like how GERD in the UK is GORD because oesophageal is spelled differently. I'd rather have GORD.

"OH MY GORD MY GORD!!!!!"
I can just see it now. *rotfl*

I've tended towards America spelling for medicine... simply because clinical medicine seems built on a (shaky) foundation of shortforms.

(I had fun doing a presentation for History of Medicine once; I called it "Abbreviations and Slang: The Language of Medicine". Vaguely historical, very rewarding - the audience was rolling in the aisles.)

Everywhere else I prefer the British, with one exception - I like the "zed" in "realize" etc.

I like Canadians - they're not picky about nationality in their spelling.

Then I go to the bathroom, take a big steaming dump and I write a note on that too.

Andy, what is it with the steam? I mean, dumps I understand - and turds, and bean burritos - but I really don't geddit with the steam.

 

[b&ierstiefel]

Andy, what is it with the steam? I mean, dumps I understand - and turds, and bean burritos - but I really don't geddit with the steam.

Well, have you seen dogs take a dump in the cold winter? It's just an observation of watching my 2 dogs who really liked to crap a lot in the backyard. The turds were hot and steaming My obsession with the "steaming" adjective is similar with pathologists' obsession with food (caseous "cheesy" necrosis, beefy heart, etc.)

Behold the hotsteamingturd...it's hot and it's steaming!

 

[yaah]

I think it's a small thing to ask, since in real life I have to put up with my name being rearranged to fit the first-name-last-name format, in this country where they're happy to tailor your mayo/mustard/Dijon pickles/pretzels and brown/white bread sandwich.

(Imagine that you were Scott Ferguson all your life. It's just annoying when people take your name, turn it around and start writing Ferguson Scott everywhere. Idiots.)

Well, the Olympics is coming up again, and once again about 75% of the americans watching on tv will see a competitor from China or Korea and see the names "reversed" and hear the commentators calling them "Xu" even though it looks like Xu is their first name. And these viewers will get headaches. "Why do they all get referred to that way? Are they weird or something?"

Americans screw up lots of names. I used to work in a registration office where lots of Russian immigrants came in, and the other people in the office had NO CLUE when they saw that the wife's last name was "Fetisova" and the husband's was "Fetisov" (or Kordunskaya and Kordunsky). "Is that like women in this country or keep their name when they get married?" NO! Depending on who registered first, the husband or the wife would end up with the improper last name.

You're very right about too many layers. That's a good way to put it. Nobody seems to be cross trained for things anymore. Everyone's an expert on one specific thing, and if you by chance get them on the phone for that reason, you're gold. But if it is for something that is closely related but not exactly the same, you are @#$!ed.

 

[b&ierstiefel]

Well, the Olympics is coming up again, and once again about 75% of the americans watching on tv will see a competitor from China or Korea and see the names "reversed" and hear the commentators calling them "Xu" even though it looks like Xu is their first name. And these viewers will get headaches. "Why do they all get referred to that way? Are they weird or something?"

The best was the women's speed skating in the last winter olympics. There were two skaters named Yang Yang (yes, the first = last name). To clear up any confusion, they called one of them Yang Yang A. So you'd think that they'd call the other one Yang Yang B right? NO! WRONG! TRY AGAIN! They ended labeling her Yang Yang S.

S? WTF? What's the logic in that?

 

[yaah]

The best was the women's speed skating in the last winter olympics. There were two skaters named Yang Yang (yes, the first = last name). To clear up any confusion, they called one of them Yang Yang A. So you'd think that they'd call the other one Yang Yang B right? NO! WRONG! TRY AGAIN! They ended labeling her Yang Yang S.

S? WTF? What's the logic in that?

I thought the S had something to do with another part of their names. I don't think it was totally random.

Of course, the other possibility is that Yang Yangs B-R were eliminated in the preliminary rounds.

That would kind of irritate me, if I was good enough to make it to the Olympics, train for years, and find out someone there had the same exact name as me and the billions of people watching on TV were laughing at my name.

I guess it's kind of like being from Massachusetts and being named John Sullivan. Even if you factor in middle name there are still going to be dozens with the same name as you. And everyone is still going to just call you Sully.

We might catch up with the Ophthos if we keep going.

 

[b&ierstiefel]

I thought the S had something to do with another part of their names. I don't think it was totally random.

Of course, the other possibility is that Yang Yangs B-R were eliminated in the preliminary rounds.

Hmm...definitely hadn't thought of that. You're smart yaah.

 

[yaah]

Hmm...definitely hadn't thought of that. You're smart yaah.

I do what I can.

This is what I think about.

 

[deschutes]

It's just an observation of watching my 2 dogs who really liked to crap a lot in the backyard. The turds were hot and steaming My obsession with the "steaming" adjective is similar with pathologists' obsession with food (caseous "cheesy" necrosis, beefy heart, etc.)

Behold the hotsteamingturd...it's hot and it's steaming!

Sounds like yellow snow. There is steam involved in the production of that too. Never eat yellow snow.

For some reason HotSteamingDog comes to mind. Count the cross-associations, why don't we.

I cannot believe I am talking about this. My reputation is in shreds! If I had one to begin with.

 

[deschutes]

Re: Xu's and Yang Yang's

An overwhelming majority of Chinese names have 3 names - the first is the surname, and the last two are given names, both used.
Which doesn't fit the firstname/middle initial/last name format.

I can imagine Yang A. Yang and Yang S. Yang as someone's attempt at problem-solving

Xu is actually a fairly common surname. And chances are the four Yang's were wildly different in written/spoken (Mandarin) Chinese. But we will never know.

You're very right about too many layers. That's a good way to put it. Nobody seems to be cross trained for things anymore.

I'm doing a "rural" Family Med rotation in a few months. Should be interesting. Some DIY medicine for a change, if I last that long.

It's only 8pm, it's only Tuesday, and I'm yawning already. Seems like the key to surviving clerkships is getting 10 hours of sleep a night.

 

[yaah]

It's only 8pm, it's only Tuesday, and I'm yawning already. Seems like the key to surviving clerkships is getting 10 hours of sleep a night.

Any clerkship where you can get 10 hours of sleep per night is a good clerkship. Don't worry I start yawning about 8pm too. It just means you're getting old and turning into your mother. Nothing to worry about.

I have averaged about 6-7 hours/night during my chemistry month, mostly because I always seem to end up sidetracked and forget to go to bed before 11. It's not like there's anything interesting on tv. Stupid crime scene and lawyer shows. Stupid unlikeable "family oriented" comedies. Stupid ESPN not showing sports and now showing poker, movies, and interminable "best 25 x kind of moments of the last 25 years" shows. Top 25 games. Top 25 coaches. Top 25 moments. Top 25 infield grass-mowing patterns. Top 25 highlight shows. Top 25 voice-overs for highlight shows.

I got one for you, I'd like to hear the top 25 SHUT THE HELL UP moments.

Sorry. Little sidetracked there.

 

[deschutes]

Any clerkship where you can get 10 hours of sleep per night is a good clerkship.

I was being facetious. I have yet to find a rotation that will let me get 10 hours of sleep per (week)night. Not even Psych.

Ipso facto it remains to be seen whether I will survive clerkship, chronically sleep-deprived! I'm an owl... the fog only really clears in the PM, only to be loom again post-prandially, whenever lunch happens to be.

Apparently I am doing a fairly good job keeping up an attentive competent appearance without, while within me my soul sleeps till noon.

ID is over. When in doubt, give Ancef.
One selective down! YAY! Only 10 weeks left to go!

 

[deschutes]

< mental exorcism >

What is it with these internists anyway?

Psychiatrists are okay with people not going into their field. So are pathologists, and to an extent, surgeons. Psychiatrists and pathologists can laugh at themselves.

But a disproportionate number of internists I've met cannot seem to comprehend why - and take it as a personal insult - should you choose anything other than the World of an Internist and the Path of Radiant Light and Glory.

< / mental exorcism >

 

[yaah]

Psychiatrists are okay with people not going into their field. So are pathologists, and to an extent, surgeons. Psychiatrists and pathologists can laugh at themselves.

But a disproportionate number of internists I've met cannot seem to comprehend why - and take it as a personal insult - should you choose anything other than the World of an Internist and the Path of Radiant Light and Glory.

You are right - they were the most frequent offenders on my end too. "You're wasting your talents! It's a shame! Blah blah blah!" I think I lot of them had just been around enough such that they saw how effective someone with good people skills and smarts was in internal medicine. So, take it as a compliment!

Have you ever been to the Temple of the Internist? It is where one learns of the ONE TRUE PATH and the sacrifices one must make to follow it. The gold-bound edition of Harrison's sits at the top of the stairs. You must, however, make an appointment between 9-1 or again between 2 and 4. Weekdays only.

 

[gungho]

To those seeking The Way of Osler, RUN FOR YOUR LIVES!!! It's all a mirage-you will find nothing but dreams of dust and years of toil and frustration!

I don't know if this expression is still around, but Q: Why are Internists called "fleas"?
A: Because they are the last to leave a dying dog.

Really don't have anything against Internal Medicine in theory-it's interesting. In practice, tho', it's a whole 'nother thing.

 

[deschutes]

You are right - they were the most frequent offenders on my end too. "You're wasting your talents! It's a shame! Blah blah blah!" I think I lot of them had just been around enough such that they saw how effective someone with good people skills and smarts was in internal medicine. So, take it as a compliment!

That's not QUITE what they've been saying to me They tend to drop me like a sack of potatoes.

I'm not yet comfortable with
(a) waking up a Resusc Level II patient just to ask "Hi sir, how are you doing today?" as a follow-up on an ID consult when I can just as easily tell from the chart that he's been afebrile overnight and he's probably just fallen asleep exhausted from the hordes of people who've been tramping through his room all day and night; or
(b) turning to my attending/resident and saying, "You know what, this guy needs sleep more than he needs to see me."

I'm still sort of caught in the middle, but more convinced than ever that if depriving patients of sleep is what it takes to be a "people-person", then I sure as heck am glad I'm not one.

Don't get me wrong - there are excellent internists out there. I have a great deal of respect for internists - as much respect as they have for me.

 

[yaah]

I'm not yet comfortable with
(a) waking up a Resusc Level II patient just to ask "Hi sir, how are you doing today?" as a follow-up on an ID consult when I can just as easily tell from the chart that he's been afebrile overnight and he's probably just fallen asleep exhausted from the hordes of people who've been tramping through his room all day and night; or
(b) turning to my attending/resident and saying, "You know what, this guy needs sleep more than he needs to see me."

Funny, I used to do the same thing. On my consult services I would go look through the chart, the nurses notes, lab results, etc. And I would know more about what happened to the patient that if I went and asked. Certainly, the important stuff that consult services want to know doesn't come out of interactions with the patient. WAKE UP SIR!! HOW ARE YOU FEELING? Plus, when they start consulting people they consult everyone, and they really shouldn't have to tell the same story to everyone. If the other people taking care of them write a decent enough note (rare) it's completely unnecessary. It's not as if the physical exam helps!

Plus, if you went and talked to the patient you run the risk of them going into the whole patient routine, like,
When am I going home?
Where's my lunch?
Can I go have a cigarette?
My roommate smells.
What did my tests show?
Can you call my wife and tell her what's going on?
Can you explain to my sister what I'm here for?
When is the surgeon coming by?

etc etc etc.
Again, if they have good primary residents, they won't ask you these questions. But usually the primary residents don't like the patients either (ironic because they want to help people, or so they say). So I always got stuck with having to answer those questions. Guess I have one of those faces.

 

[b&ierstiefel]

Plus, if you went and talked to the patient you run the risk of them going into the whole patient routine, like,
When am I going home?
Where's my lunch?
Can I go have a cigarette?
My roommate smells.
What did my tests show?
Can you call my wife and tell her what's going on?
Can you explain to my sister what I'm here for?
When is the surgeon coming by?

etc etc etc.

OMG, I don't like answering these questions too. Some of these patients just babble and babble and babble ... endlessly. And it's always the med student who has to entertain these questions although we know the least among the whole team.

Ugh...then there's that malingering patient who just won't shut up because they know that you know you might be onto them...so they endlessly try to rationalize all their actions, symptoms, experiences to cover their bases. I just end up calling them manic instead of malingerers.

 

[yaah]

OMG, I don't like answering these questions too. Some of these patients just babble and babble and babble ... endlessly. And it's always the med student who has to entertain these questions although we know the least among the whole team.

Ugh...then there's that malingering patient who just won't shut up because they know that you know you might be onto them...so they endlessly try to rationalize all their actions, symptoms, experiences to cover their bases. I just end up calling them manic instead of malingerers.

If they mention Fibromyalgia - run.

Wait doctor, I want to write this down.

 

[b&ierstiefel]

If they mention Fibromyalgia - run.

Wait doctor, I want to write this down.

Ahh...thank god the days of psychiatry are long behind me (damn, now that I think of it, that was exactly a year ago).

Fibromyalgia patients do indeed suck. Fortunately, I only ran into one of them and I wanted to....ARGH!

Of course, I did see two teenage girls who ended up having somatization disorder on psych consults. I appreciated the warning sign which was the neurology consult note which said, "neurological exam completely normal!" in big capital letters. Again, I just wanted to.......!!!!!!!!%@$%$%@$*&%@~~~!!!!!!!!

Then there was the schizophrenic woman who claimed she was Jesus. I asked her if she was Spanish.

 

[yaah]

Of course, I did see two teenage girls who ended up having somatization disorder on psych consults. I appreciated the warning sign which was the neurology consult note which said, "neurological exam completely normal!" in big capital letters. Again, I just wanted to.......!!!!!!!!%@$%$%@$*&%@~~~!!!!!!!!

Then there was the schizophrenic woman who claimed she was Jesus. I asked her if she was Spanish.

We had a teenage girl on neurology who was faking seizures because kids at school were making fun of her. You have to take it seriously, of course, but at the same time it was obviously fake. She kept saying she couldn't feel sensation on parts of her body. And she had no memory of the seizures. Unfortunately for her the school nurse was very experienced and the first thing she told the paramedics was that it was obviously not a real seizure.

But she got the MRI and the EEG anyway. Damn malpractice lawyers.

My psych patients who were schizophrenic thought they were either royalty or something else. One guy told me he was Ronald McNair, who died on the 1986 Challenger explosion. He said they staged the explosion to kill him off so that they could keep him institutionalized. He also wore about 6 layers of clothes so that he could try to prevent the government from following his moves.

We also had the king of jamaica. He was white.

 

[deschutes]

We had a patient who thought he was Isaac Newton. It took a while to retrieve his records from another hospital because he had been there as "Mr. Newton, Isaac".

 

[b&ierstiefel]

lol...i love psych stories.

btw, the schizophrenic Jesus lady clearly wasn't Spanish as I found out during our conversation (and also by just looking at her too).

i learned the hard way that delusions really are FIXED. I brought up the fact that Jesus was a guy and proceeded to ask her if she possessed a phallus and a pair of cajones. She seemed stumped at first but only for a little bit as she stated that the powers were transferred to her from Jesus and hence she became Jesus.

Yeeeaaaaahhhhh....rrrrrrriiiiiggggghhhhttttttttttttttttttttt.

 

[yaah]

My favorite psych patient, the jamaican king, had first been institutionalized in Jamaica where his father was an american working for a shipping company. He had been found naked, threatening local children with a machete.

Over the course of his institutionalized life, he maintained that he was a professor of psychology and psychiatry, and that was why he was in the hospitals. He worked there and helped to teach medical students like me. He also kind of sounded like Eric Cartman. He liked to tell me of his numerous conquests of all the female staff. They all lusted for him, apparently. Very entertaining. He said he was a highly trained ninja who was deadly with his hands and gained superpowers from smoking cigarettes.

 

[b&ierstiefel]

Here's a random eureka moment I thought of...

So when I was a 2nd year med student quite a while ago, me and my housemates (let's call them Jacko and Hong for now) went to our required autopsy shadowing experience. It was a patient who had a history of CHF and atrial fibrillation among other things. Anyways, we cut up the heart, examine the lungs, look at the liver, etc. Nothing was done with the bowel.

Pathology resident (PR): Any questions?
Jacko: Wow this was really interesting, can we go now?
Hong: No questions here. I think we covered all the major organs.
Andy: Well, could the intestines have been involved? (this young chap was thinking of bowel ischemia due to low systolic flow or whatever)
PR: Ah yes...excellent point. Let's run through the bowel to examine the mucosa.
Andy: Word.
Jacko: You ****er.
Hong: You owe us Sangria.

PR cuts open the bowel to yield cold non-steaming poo which pours out. Some evidence of corn.

Andy (doing his Cartman impression): Heh hehe...we know what he ate for dinner.

As PR runs the bowel and the students look intently, a ghastly awful smell permeates the room. The PR actually finds a segment of possibly infarcted bowel. Andy while breathing the odor of poo and doing his best to cover up his nose says "that was pretty cool." Andy however realizes for the first time that poo is a force to be reckoned with and that poo must be respected and even worshipped sometimes even requiring ritualistic sacrifices of goats and other farm animals.

several minutes elapse....

PR: We're done. Any questions.
Andy, Jacko, and Hong: Nope. Thanks for your time.

The three lads leave the basement of the U of Michigan hospitals.

Jacko: Andy, I hate you.
Hong: Yeah man, that was completely unnecessary.
Andy: Let's go to Dominick's...I need to reflect over this most excellent experience with beer in hand.

 

[yaah]

PR cuts open the bowel to yield cold non-steaming poo which pours out. Some evidence of corn.

Andy (doing his Cartman impression): Heh hehe...we know what he ate for dinner.

I think the most common "last meal" on earth has to be corn. If your bowel is close to perfing, eating corn will pretty much guarantee you a perf. I am not totally sure why corn is so good at this but it is. I have seen a bunch of autopsies and surgical specimens for perfed bowel and corn is invariably present.

Corn is deadly.

 

[b&ierstiefel]

I think the most common "last meal" on earth has to be corn. If your bowel is close to perfing, eating corn will pretty much guarantee you a perf. I am not totally sure why corn is so good at this but it is. I have seen a bunch of autopsies and surgical specimens for perfed bowel and corn is invariably present.

Corn is deadly.

Poo is more deadly than corn because corn can cause perforation but ultimately it is the poo that does one in.

 

[Brian Pavlovitz]

I think the most common "last meal" on earth has to be corn. If your bowel is close to perfing, eating corn will pretty much guarantee you a perf. I am not totally sure why corn is so good at this but it is. I have seen a bunch of autopsies and surgical specimens for perfed bowel and corn is invariably present.

Corn is deadly.

Now wouldn't this make for a nice paper for the NEJM: The probablility of bowel perforation after ingestion of corn , or perhaps: Perforated bowel: the role of corn in causality !

 

[b&ierstiefel]

Now wouldn't this make for a nice paper for the NEJM: The probablility of bowel perforation after ingestion of corn , or perhaps: Perforated bowel: the role of corn in causality !

It could be an EBM article easily! It would get a lot of press and med students would use it as a model for many years to learn EBM principles such as absolute risk reduction, relative risk reduction, etc. Ugh I'm gonna get sick just thinking about this now

 

[deschutes]

A few years back - to celebrate holiday-variety research - the CMAJ published "Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne"....

http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-163/issue-12/1557.htm

 

[yaah]

That cartoon would be a lot better if they managed to fit in the Zoloft bouncing and smiling blob.

This one:

Then the Zoloft blob could attack Pooh Bear. Poor Pooh and his Very Little Brain.

I like Eeyore. Eeyore rules.

 

[b&ierstiefel]

That cartoon would be a lot better if they managed to fit in the Zoloft bouncing and smiling blob.

This one:

Then the Zoloft blob could attack Pooh Bear. Poor Pooh and his Very Little Brain.

I like Eeyore. Eeyore rules.

So would Pooh be taken as the mascot/symbol for Aricept?

 

[deschutes]

The Zoloft bouncing and smiling blob....

..... looks Japanese.

I like Eeyore. Eeyore rules.

Eeyore is hot! Eeyore would stay even when Legolas vanished into the west. Eeyore likes red Piglet-sized balloons. Eeyore eats thistles, but would prefer the not-so-tough-or-prickly ones. Eeyore would stand out in the rain.

eor wud allso bee a cumfurtable snoogle.....

 

[b&ierstiefel]

I kinda ran across this cartoon show called Aqua Teen Hunger Force...quite interesting I must say. The whole eeyore bit reminded me of it because there's a character that kinda resembles eeyore in my mind. It's this little meatball or ball of turd that rolls around and talks.