To do list for break: regain social skills, improve drinking tolerance, snowboard A LOT, read non medical text,sleep, DO WHATEVER I WANT EVERYDAY :)
oh, and i am gonna try and get rid of the 'wake up automatically at 7am' impulse

Respiratory System Quotes

“Well I was up late last night and I was drawing this picture...” Pummy presenting immuno with Trush
::without dropping a beat:: “And its a wonderful picture!” - Thrush


“And then you see here the normal...” - Foley
::interupted by Pummy:: “yeah I just needed you to teach those two slides, since I couldn’t we will get more into that later.”

“And you’ve got this little guy here, and he wants to stop the party” - Issar giving a mini-pharm lecture on theophyline

“Oh... this was one of your actual patients... well then I won’t steal your thunder” - Pummy

“If your patients start to get goofy on you... you need to think about respiratory failure.” - Goya on physical findings of severe asthma exacerbation and altered mental status being a clue to respiratory failure

“The key thing you need to know about severe asthma is that you need to act quickly, you don’t have time to sit there and fart around...” -Goya

“There is a good study out about this, actually it was done by Kaiser... gotta throw my propaganda out there.” Goya on treatment for pulmonary embolism

“Well the police said this patient fell asleep at the wheel.. and he is not an ER doctor or a med student or anything, so this is abnormal...” - Pummy on Sleep apnea

“Where did Charles Dickens write about this problem???” Pummy
“Humpty-Dupmty” -Student
“Humpty Dumpty probably actually did have this problem.... that is why he fell” - El-Bershawi in regards to sleep apnea

“This is joe the fatboy, from the pickwick papers... and now you can discuss this albeit breifly at your next cocktail party...” - Pummy trying to give us some culture

“Okay and that is interesting... and we may p!$$ off our sleep partner... but is that the only reason we care about sleep apnea?” - Pummy

“And your patients, they never read the textbooks...” - Pummy

“We do have another patient who was kind enough to expire so we could do an autopsy...” - Pummy

“Okay, first I ask you about the pickwick papers... and now I ask you about a popular actor...” - Pummy voicing his frustration at our lack of knowledge about anything non-medical at this point
::the room is almost completely silent::
“That is good, that means they are smart.” - El-bershawi

“Other types of densities... you saw them before a couple cases ago? lacy pattern? does anyone wear lace anymore??? okay moving on.” -Pummy

“How about that lucency on the left side, what is that? Does he have two tracheas?... He’s got that new thing that is going around.... deviated trachea...” -Pummy pimping us on CT findings
“Okay, what do you call it when you come home from the dentist... you say look ma, no _____... cavities.”

“Let’s do some infectious disease calisthenics... this one isn’t too hard... come on... spit it out... what is your differential?” - pummy on the presentation of pharyngitis

“You are still in the virology part of your training so we have this question for you...” Pummy on a quiz question he was asking during large group “realistically most of you won’t care about this ever again after June.”
I couldn’t have said it better myself pummy =)

“How many of you are here today.... 200??? well come on the other 80 of you, go ahead and click in.” - Pummy on attendance to Large Group.

“Well a lot of people ask... who will eventually spend the time to find the cure to the common cold... I have a better question... who would waste their time looking for the cure.” Pummy on the multiple serotypes of rhinovirus and its high mutation rate which makes it impossible to engineer a vaccine for it.

“Well this patient comes in and it looks like she has a hot potato in her throat... and the first thing you should be thinking besides holy $h!t is...” - pummy the answer is epiglottitis

“Alright who answered 1 and 2??? be honest... you should all be ashamed of your selves... because how did they die? They were shot! And Franklin Roosevelt, how did he die?” - Pummy
“A wheelchair down the stairs?” - Student
“No that is not it either... malignant hypertension.” - Pummy “And what about Thomas Jefferson, how did he die?”
“Syphillis” - Student
“No! Not syphilis, although that did help him write the Declaration of Independence” - Pummy in regards to a quiz question about how some of our presidents died. ***the correct answer to who died from epiglottitis was George Washington

“Rhonchi are in the bronchi” - Pummy

“And the fun part of this is when you can predict what a chest x-ray is going to look like from your lung exam.... that is pretty fun.” - Pummy...... Riiiiight........

“And Birds... birds are the worst. For some reason people don’t think of birds as pets... they hug the bird, kiss the bird, but they don’t think the bird is a pet. When you ask them if they have any pets they say no, when you ask them if they have a bird they say yes...” - Goya on interstitial lung disease

“Purulent Tracheobronchitis wants to be pneumonia when it grows up.” -Pummy

“Hallitosis is better than no breath at all...” Quiz question from pummy.... he chuckles when 30% of us answer false.

“What is the most common cause of blood in the pleural fluid? The intern doing the tap...” Goya on pleural effusion.

“If it smells like pus, and looks like pus.... it’s pus” - Goya on Empyema

“I think the woman has a lower tolerance of everything” - Patel
“No comment” - El-Bershawi

“The lowest smoking rate out of any profession is among pulmonologists” El-Bershawi on lung cancer risk factors.

“Wait a second, did she just say that patients with HIV get infection from whores on the farm?” Student 1
“No, I think she meant from horses on the farm...” Student 2
“Oh...” Student 1

“See you all did very well on the quiz, less than a 100% was not acceptable” -Patel on large group after a disasterous midterm.

“How are you doing??? It is too much it seems.” Tiwari on the poor morale evident in the class

“I had a bunch of gadolinium MRIs during my training. I was part of a study that was developing that as an imaging modality.....That was a long time ago though.....anyway they never tested my kidney function.” El-Bershawi.

“You could give her a PFT.... maybe she is asymptomatic, but as a pulmonologist I am a bit paranoid, they always present to you without any problems. You need to lose 30-40% of your lung capacity before you start having problems.” El-Bershawi on giving a patient with sarcoidosis a pulmonary function test.

“As far as I know, if your books say otherwise... well they are probably correct...” El-Bershawi.

“What drugs can give you diffuse alveolar hemorrhage?” Patel
“Cocaine” Student
“Well, that is true, that’s why we don’t prescribe that anymore.” El-Bershawi

“Some magic seems to have occured here... They don’t transform into spherules until they are within a host.” Felton on his fungal life cycle image

“Well that is my part, and if you have any questions....” Venkentaraman giving a 15 min synopsis of Blood and lymph
“Oh God....I am confused again!” Patel
We know Dr. Patel.... we know

“Surgeons use colloid, Medicine uses crystalloid. Data suggests is doesn’t really make a hill of beans.” -Goya on fluid management of Sepsis.

“What drains into the R. Atria?” Kuehn
“SVC” Student
“Good, the SVC. What else?” Kuehn
“SVC” Different Student
“Right the SVC and the SVC.... what else?” Kuehn

“Are you guys exhausted?” Tiwari
“YES!” Entire Class
“I guessed that...” Tiwari

“Which species is going to attack us? We don’t know....” Tiwari on influenzae and its ability to trade antigens within other animals.

“Which vaccine you will get depends on a lot of factors, like your age. If you are young like me...” Tiwari on the flu vaccine

Summary of the Respiratory System:

Patient presents with cough, dyspnea, fever, and [insert random and isolated detail here]. Which one of the 1,234 diseases do they have...

and i thought this was going to be easier than the renal system. HA!

The home stretch...

what do you call the person who graduates last in their medical school class?
A. Doctor
B. Low Pass
C. Doctor in North Dakota
D. Doctor, eh?
E. life isn't fair. shut up.
-courtesy of Melinda

"Drinking from a firehouse? More like drinking from Niagara Falls at this point"
-Chris

"Hey, do you by any chance know how to fast-forward like 24 hours?"
-Nick

"I need some chocolate to continue on"
-Tan

"Is 55 hours (and counting) of study time in 6 days enough to pass a 2-hour test?? We shall see..."
-Justin

a day in the life of a medical student..

"Just woke up to someone "sssssshhhhh"-ing me in the library."
-Brent

"AMS [Acute Mountain Sickness] must be distinguished from exhaustion, dehydration, hypothermia, and alcoholic hangover"
- Harrison's Principles of Internal Medicine

i guess a hangover is a legit medical condition, i should be able to get a doctor's note next time i have one for an excused absence...

Second fail of my medical school career...and i was just getting over the first one

"Mid-20 year old patient presents with moderate distress, anxiety, depression, hypersomnolence, insomnia, confusion, tremors, headaches, and failure to thrive. What is the diagnosis? The patient is a Medical Student."
-Noah

UPDATE: the class average for our respiratory midterm was a 67% so my 64% doesn't feel that bad anymore. hah!

‎i wrote this as my facebook status:

"3rd week of respiratory and im pretty sure i still cant read a CXR hmmm"

Melinda, a 3rd year replied,
"you won't be able to for awhile. so it's normal."

i wrote back
"good to hear, looking forward to getting pimped on them for years to come haha"

Oh, and a CXR is a Chest X-Ray, just in case you are not versed in medical jibber jabber

Confidence Inspiring haha

"Recovery is usually quick if they are young and healthy but identifying the antigen is hard...good luck with that. We almost never find it"
-One of my professors in lecture speaking about Hypersensitivity Pneumonitis

Its the little things that excite me. I bought a computer monitor and found a cheap cord on ebay to hook up my Mac laptop to it and now i have TWO SCREENS when i study. makes life a lot easier to keep a powerpoint on the monitor and write my notes on the other screen. *sigh* its the little things

in other news, I am in the middle of picking/ trading rotation locations with my classmates and should have my final schedule in 2 weeks! I am very exited about the situation because it means I am one step closer to getting out of the classroom and into the HOSPITAL!!!

my criteria for what i think is a good rotation:
I can wear scrubs everyday instead of wearing 'dress up' clothes
I have an 8 hour shift or less
I am on call 2 or less times in a month
The hospital is close to my parents house so i can milk off of them for another year instead of paying rent

'halitosis' is the medical word for bad breathe. did they really need to come up with a fancy word for this? on that note, couldnt we just use the word fever instead of febrile? tooooo many medical terms. ive said it before and ill say it again, im gonna get paid the big bucks just to be able to translate medical terms on a chart

Can i just be a doctor already, gosh!

im picking out my rotations for 3rd year..basically setting up my 'work' schedule for June 2011 to June 2012. Kinda scary! I cant wait to get into the hospitals!!

Before I croak and donate my body to science, I'm gonna get a tattoo list of all the stuff that is wrong with me so 1st year med students can go on a treasure hunt. It'll also tell them that if they desecrate my body I'll haunt their children.
-CP

The medical school course load is like being given a tank of gatorade to drink in 10 min. you start out parched but after maybe 1 L you're no longer thirsty and you still have to keep drinking and you know you'll never finish it.
-MY

renal is officially over! the lungs cant be that complicated can they??

I just learned that I passed my renal final and I did well enough to bring my grade up. I passed the course and now dont have to worry about failing out of medical school. i guess i can throw out the McDonald's job application i filled out this weekend...

"Things I find more interesting than Renal: rocks, NASCAR, political ads, laundry, professional bowling, trying to find split ends in my hair, my brother's publications on....something really boring I can't remember, etc. FML."
-aurora

I have a slight concern that with the amount of hate i am building for each organ system i have to study, I will begin to hate the entire human body. by the end of medical school, i might want to quit and help animals or plants instead... I started off the year loathing the pituitary glad, then i started to resent the heart for its electrical complications, and now i just down right cant stand the kidneys for the million different things they do (and that can go wrong with them). Out of these I still dont mind the heart to much though. Lets hope the lungs are nice and uncomplicated...

First Fail--10/25/10

We have been in the Renal system for about 2 weeks and had a midterm yesterday. I found out today that I failed it. This is my first exam I have failed in medical school. I told Alissa this and her response was "You should be proud it took this long!"
Though that did make me feel better, what makes me feel even better is knowing 4 out of 5 people I have spoken to also failed. They school has not sent out the class average so i dont know how bad of a situation i am in until they do. We only have 2 exams for this system so i am going to have to do very well on the final. but like i said, i wont know how bad of a situation i am in until i see the class average because this will help predict the curve of the class. If enough of us failed they will either make the final a lot easier or they will curve up to make sure only a small amount of people fail and have to remediate the class.

As bad as it is to see this terrible grade i got, i cant say i am surprised. I mean i still studied all freaking weekend long and its not like i slacked off, its just they gave us so much to learn on our own and it was terribly organized. I probably could have studied for 2 more days and still failed. The information was never explained to us well enough so what do they expect? Another curriculum fail on their part. but, i will try to move past this and talk about other things

I worked at the Montclair clinic again on Tuesday the 19th and had a really good time. I knew it was going to be a good night when the resident that is in charge of us walked in and i recognized him because i worked with him the last time i was there. There are a lot of resident doctors who work at the clinic and it is always random who will be there. The resident who i worked with last time and then this night is a 30something year old guy who is from Brooklyn new york. he has a heavy accent and def has the east coast swagger. oh, and hes pretty good looking too. When we first met i made the mistake of assuming he was from new jersey and his reaction was 'from WHERE?' He pretended to be offended and then for the rest of the night we had a very good joking banter. I always like being able to joke around with people in charge because it takes pressure off of the situation. instead of being nervous and intimidated, I am able to relax and enjoy being a student doctor while also learning a lot. But in this particular situation, intimidation has been replaced with a slight nervousness since hes a very cute and funny doctor. Maybe i should ask him out next time i work with him...haha

In seriousness, this is one major reason I really like working at the clinic--not that they are cute, the fact that I dont have to fear them. It helps me to be comfortable in the learning situation and I know i will be much more confident and at ease when i start rotations in hospitals. Sadly, I wont be able to prepare myself for the times when the doctor i am working with is a complete asshole or when i am getting 'pimped' in anatomy during my surgery rotations...no, there is no preparing for that amount of stress and nervousness. i guess im just going to have to learn how to not break down crying (at least in front of people...i will be sure to do it in the comfort of my own home)

So this night at the clinic I saw two patients. One was a 20 year old man who was following up from his previous visit in which he presented with hematuria (blood in his urine). He was put on antibiotics and was doing find now (we would call that an unremarkable recovery). The other patient was a 40something year old female complaining of upper quadrant pain that was constant. This was the first time I had a patient with a new symptom that I got to do the detective work on it and was great! I started by asking her all about her symptoms (the HPI- history of present illness). This includes the onset, location, durtation, etc etc and then we went into associated symptoms. I may not have known what was causing the pain but i damn well narrowed down exactly when she started getting pain, when it gets better/worse, and all that jazz. After i asked the patient a million questions and was kinda sorta starting to think of some possibilities, i went back to the resident and presented the case to him. Within 1 minute (no joke) of reading the HPI to him, he knew exactly what it was....gallstones. We have not had our gastrointestinal system yet but apparently there is a very common presentation of gallstones...the 4 Fs: Female, Forty, Fat and Fertile. Well, this patient was pretty much a gallstones diagnosis wrapped in a bow because she was all of these things. At least i will remember this when we get to the section or if i ever see a similar patient!



well, i guess thats about it for now. im getting tired and need to be at school tomorrow at 8am. I am one of 8 volunteers from my class that are on a Q&A panel for the first year students. its basically a bunch of us talking about our experiences and study strategies. now that anatomy is over and the real medical school science classes have begun its a hard transition to adapt your study habits too. hearing how other students did it is really helpful. we had some 2nd years talk to us before MCBM last year and it was really helpful so I am hoping we can help out other students this year.

They have ended Anatomy and are moving on to MCBM (Molecular and Cellular Basis of Medicine). It is still very scary to think it has been a full year since i went through that. i cant believe i am 1 and a half years into my medical education. Almost half way there!!! (just need to make sure i pass renal....)

Raging Saturday night

My text to my roommate at 8:30pm having left the house at 9am to go to the library: I'm spending the night at my parents so I wont be coming home tonight. Didn't want you to think i feel asleep in the library

Roomate: haha ok thanks. I was wondering what time they closed or if you were just hiding in the shelves to get a good table in the morning

the kidneys are waaaaaay to complicated

Cardio is over, Renal has begun (i'll fill in the details later). Buuuuut, taking a weekend off and not studying (since it was a non test weekend) has resulted in a 12 hour study day on Monday. renal sucks, i miss cardio!

lots has happened between now and the last post but i have to get back to teaching myself renal physiology... no big deal.

Email from Student Affairs Office...

Remember – the refrigerators in the HPC student commons are cleaned every week between Friday night and Saturday morning. Anything left inside will be thrown out.

To the person who was frustrated and talking about how “someone drank my beer!!”… please note that not only was it left in the refrigerator over the weekend… but this is a substance free campus! It was thrown out for both reasons.

Michelle

Director for University Student Affair

Cardiology Quotes

“You find the isoelectric lead and then it’s positive, positive, positive, positive, negative, negative, negative, negative.” -Dr. White
Student: “What does that mean exactly?”
“It means you find the isoelectric lead, where the QRS is equally positive and negative and then from the point of the lead it goes positive, positive, positive, positive, negative, negative, negative, negative.” -Dr. White
Entire class scratches head....

“Alrighty everyone... lean forward (to hear the inaudible video he is trying to play)....(silence)... well that was fun...” -Pummy

“Here’s how to save a life... take off their socks and shoes..” -Pummy

“There’s a name for that point... do you know what it is?” -Pummy
Student: “The.... aortic murmur point?”
“Nope, everyone google erb’t point.” -Pummy

“This arrow is not inside the patient” -Pummy on TEE findings

“Dr. Keuhn, can we comment more on the normal anatomy of the heart?” -Pummy
“The what now??” -Dr. Keuhn

“What else could be calcifying the valve other than calcification?” - Parsa

“Wow, that’s a horrifying story...” -Pummy about how brushing your teeth can lead to viridans bacteremia and subsequent endocarditis as explained by Dr. Saviola

“I guess these slides are from the autopsy?” Parsa in response to Pummy’s continued wierd comment about our ‘dead patient’ whom had acute infectious endocarditis.

“Dr. Parsa, do you want to see the CT?” -Pummy
“Sure.....Whoa...okay...I haven’t looked at this before.”-Parsa “I’m not a radiologist, but I would say those are abscesses.”

In same lecture as above, different slide: “I haven’t seen this...”-Parsa

“Oh...” -Pummy on accidentally showing the class the answer to our last quiz question
“Happy Labor Day...” -Dr. White

“On the left you see a normal valve opened, you could drive a truck through that hole.” -Pummy

“Are we all in?”-Pummy

“(the calcification)...becomes rock hard, and very firm.”-Parsa

“you’re all gorgeous...you all look the same.” Pummy-->when addressing the class

“What if you’re a heart? What are you going to do?” -Pummy

“..and it came too fast! It’s not on time.” -White

“when something comes early, it’s called ‘premature’.. >snicker<” -Pummy

“these are supposed to be hard guys, I’m not going to be this mean on the test.” Dr. White
“good thing I’m not writing the EKG questions.”-Pummy, under his breath.

“if I hear any laughs..it’s gonna be ugly.” - Pummy

“so, just like in sesame street, this one does not look like that one”-pointing to the xrays - Pummy

“could it be this, could it be that? Yes yes yes, all of those things.”

“suppose dr parsa were here...bc the sad part, like last wk, the patient died in the CT scan”-Pum

“a question? Do you want a cookie?”-Pummy

“you get this little pooch here..and by pooch I mean aneurism...now, it pooched out more..bigger anuerysm..”-dr white

“okay, more technology..great.”-Pummy [this is after repeated failed attempts to do the clicker quiz an poll questions that day, again trying to show us an audio clip of a heart murmur.]

“if a patient comes in with a gripping pain in their chest, you’re not going to say, ‘Let me diagnose your OA’.”-Dr. Sanchez

“Is it regularly irregular? Or is it irregularly irregular?”-Pume

“your ruptured aneurysms are mostly going to present as death.”-dr white, when describing the difference btwn aortic dissections & aneurysms

“more bad art, from Dr. White.”
“you guys are like, ‘what’s paper?? Isn’t that what old people use??’”-Dr. White

After student asks how you figure it out, Dr. White answers: “Well, you know its double because you’re Dr. Pumerantz.”

“oh no....evil physics!”-Dr. White

“rookie move, to hit the code, and they’re just asleep and the lead fell off.”-Dr. White

“so why are we worried about this guy? He’s probably stressed from work..working at Walmart..he’s still wearing his blue shirt.”-Pummy

“how do I know it’s sinus? Casey, how do I know it’s sinus?”-Pummy

”Now, where in the heart are you thinking the IE is located? DENNIS! Tell me! Dennis thinks it’s the mitral valve. Disagree…whoever you are, you personless voice..”-Pummy

“is there a differential diagnosis? No! This is calcification!” –parsa.

“sometimes a cigar is just a cigar.”-Pummy

“it’s more like, how soon before they die? because they all die.” -Pummy

“what if you were a pig? and I don’t mean that metaphorically, literally, what if you were a pig??”

“Wow, that’s a horrifying story. I don’t wanna brush my teeth or even floss anymore. Oh, that’s terrible! No, just kidding..I will.”-pummy, after Saviola’s schpiel on formation of bacterial endocarditis.

“oh hey..where’s Ershad?”-Pummy (he must have been missing the questions)

“if you were your immune system, what would you say? Excuse me..you don’t belong here. So I am going to put out all of my defenses and try to FIGHT YOU!”-Pummy

“many of us say it’s like a knife...but, we’ve never been stabbed.”-Pummy

“so the blood says..’I don’t get paid that much, I’m going out the other way.”

::Pumerantz picks up phone:: “...I’m teaching..what?? Oh. Jesus. Okay, we’ll get a post. Alright..young guy (shakes head).::hangs up phone:: “patient just died.” Class laughs, awkwardly.

“let’s go into the quiz...Close ‘em baby.”-Pummy

“Today’s cases will get your heart racing...” - Pummy about Tachycardia cases

“Why is this so important? We’ll you’re in medical school so that’s why this is important.” - Pummy

“I’ll give you a hint... Tonto...oh there you go, that’s it, the lone ranger...” -Pummy about lone atrial fibrillation

“What do you know, the lights work. Finally something that works. Another Western First.
*Round of applause from class*
“Don’t tell the dean I said that” - Pumerantz

“the pulmonary vein bone is connected to the left atrium bone.”-Pume

“This is not a tuber or the root of something you’d find in a chinese market.” -Pummy on photo of the heart and pulmonary veins.

“ershad is nodding his head. Either he has acute aortic insufficiency, or he has something on his mind.”-Pume

“as long as YOU didn’t do it…it’s an act of God..”-Pume

“so, the Hamburgler says that’s correct..”-Pume

“Let me go out here and dance on the dance floor” Rhuby on his turn to talk during large group

“Can I phone a friend?” Rhuby on answering a questions asked of him.

“Dr. Walters can you explain all of this in five minutes since we are running out of time?” - Pummy
“Oh I’ll need more time than that to completely explain this...” Walters
“Oh Okay, how about 6-7 mins then..” - Pummy.

“we’re out of time for questions, it’s now time for answers”-Walters

“these drugs are very dirty”-Walters

“Which one does it stimulate? Well it’s beta, for the sake of time...” - Walters on the affects of atropine

“It’s just like a foreign body, they like to touch it.” Cardiologist about ‘twiddler’s syndrome’

“That’s about as deep as I expect you to know it, sometimes it’s fast, sometimes it’s slow.... put a pacemaker in.” - White on Sick Sinus Syndrome and treatment

“Sydenhams chorea is transient and will go away regardless of what you do, but it is fun to watch.” -Dr. Patel

“well a viral infection is there, that’s why I am here” - Tiwari

“Let me ask you this, if there is a bad guy on the street, how many good guys do you need to take him out? Well 1 or 2 if they are like me.” -Tiwari on the bodies reaction to coxsackie/adeno- viremia and resultant hypersensativity reaction

“Imma have Dr. Foley drop some physio on you guys.” - Barnes

“I heard Karotkof and Kosakof, which is correct?” - Barnes“One of those”
- Student “One of those..."
"so when you hear the karotosakof sounds....” - Barnes

“What else do you want to look for?” - Barne
“uhhhh...” Ashley
“Their race... that’s what Ashley said.” - Barnes on the epidemiology of HTN

“who... was that byron?” I saw your picture this morning, you had a big goatee...” - Barnes
“They take your photo & it’s the one you’re stuck with.” - Byron
“I Know, but Byron...” - Barnes

“What else can we see in the eye... cholera??? oh pallor.” - Barnes

“Dr. Foley is now going to drop some more physio on you guys...” - Barnes

“To discuss this further I am going to have Dr. Walters drop some pharmacology on you guys...” - Barnes

“C’mon I put a sweater vest on for you guys today... I’m very professorial...” - Barnes

“Who will tell me the answer??? Andrew??? I’ve heard your name but never met you. Okay he wants to phone a friend.... Casey I have also heard of you....” - Bahlodia

“Tissue is the issue” - Mehta

“He smells like he is having an acute ST elevation MI” - Agarwal

“I don’t know how much basic science they are teaching you...” -Agarwal
Don’t worry Dr. Agarwal... we aren’t sure either =)

“Let me ask you in a good hearted manner, what does a good heart use for energy?” - Kandpal

“One of you will develop a drug that modulates the hearts use of ATP and you can retire for life” - Kandpal

“Who wants to tell me what is on this chest x-ray. Raise a hand...... raise a leg...” - Pummy

“And there is autophagic death, which is the way I’d love to go” - Pummy

“There’s like arnold schwarzenager heart where the muscle gets all grrr and in a bikini...” - Pummerantz on the different kinds of cardiac hypertrophy

“This lady hasn’t seen a doctor in a long time, she thinks doctors don’t know what they are talking about, and sadly she may be right...” - Pummy on a case presentation after the class quiz average was 1 for 4.

“This oughta get your juices flowing, if this doesn’t get your juices flowing, I don’t know what will.” - Pummy on p pulmonale.

“cardio is cumulative. If you left your brains in the last session, go back and get it.” - Pummy

“Lisa very good, you get a brownie point. You can have my vicodin later. See all you had to do was get an answer right and you get pills...” -Pummy

“So you can recognize this person from across the waiting room, she usually has a cigarette in her hand.” - Pummy


From the Parsa Path lecture:
“oh, it’s not on the...??” - in regards to his ppt not displaying
“we talked about infarct last year, it seems like yesterday...”
“the reasons are several, I don’t want to go through them all...” - on the cause of MI
“in the real world your patients will come to you and they won’t have read Harrison’s”
“This has been everything you wanted to know about cardiac pathology...”

3 different groups of undergrads have occupied the table in front of me at the library, no one has lasted longer then 35 min.

sorry, but i think only my classmates are gonna find this one funny

Lisa's fb status: ‎"sweating, nausea, anxiety, and a sense of impending doom..."...Due to the approaching cardio final?? or is it STEMI?? ahhh!!
Oops it's probably *not appropriate* to make jokes like that...


Melissa responds with:

Other things this could be include
- panic attack
- taking a nasty climbing fall
- giving birth
- realizing that backstreet is not back alright...
- taking the MSK final with the naughty box sheet
- trying to determine what to wear to a fake patient encounter
- sitting through the pep talk immediately before a patient encounter
- GI problems from bad takeout

Well, its been a while since I have updated my life during Cardio so I am taking a break from learning about anticoagulants and ischemic heart disease.

Life has been very slow with little spurts of happiness in between. We have had 2 cardio exams...they were really nice to us on the first one and then decided to dumb us down a little bit on the second one (we must have done too well on the first exam so they needed to make sure grades arent too high). Now we have a cumulative final in exactly one week. If that isnt bad enough, we also have a OMM practical and we start the renal system next week..oh, we have a quiz in renal next Friday.

On the upside, I got a new car. Thats about it for the happy parts.

tip of the day...dont eat lots of licorice and use gum for fresh breathe

you can get severe Hypertension from eating a LOT of licorice or altoids, it has the same stuff in it that tobacco has that increases blood pressure. just an FYI... hahaha

This video was shown to us in class, someone found it on youtube. It might not be funny to non-medical students but its still very entertaining either way!!

1 more week of Cardio and then its on to Renal (Kidney stuff)!

Dishwasher, washing machine, or heart murmur? Your guess is as good as mine...
-Lisa

i should probably get a law degree on the side...

as much as school sucks and the new curriculum is kicking my ass, i have really really really enjoyed studying the heart. i find it fascinating and i can see myself going into cardiology. that all depends on how i do on board exams but who knows, its on the table of future specialties for now:)

Today we had our first lecture from a lawyer in our Physician and Society class. It is the first of 6 lectures we will get from lawyers and boy is it interesting to hear what I will be dealing with in the future (well hopefully not...but depending on what i go into its usually a given that I will be sued). We talked about introductory stuff like why people sue (apparently most are from the feeling that the doctor is 'hiding something') and some law vocabulary. We got a brief rundown of law and then moved on to talk about individual cases. Most medical malpractice suits are held in civil courts because they are disputes over monetary value. The good thing is there is a cap of $250,000 that the plaintiff can win in 'non economic loses' (basically pain and suffering). The bad thing is that a patient can sue you over ANYTHING as long as harm was done. Oh, and most arbitrations take about 18months to resolve. can you say anxiety???

The biggest piece of information we gained after sitting through this 3 hour lecture was DOCUMENT WELL. well that and dont fuck up...and dont leave tools inside someone before suturing them up in surgery. oh, and if a patient says dont touch my ovaries, DONT remove them during surgery even if they are bleeding out and it will KILL them because they will sue you..and that is battery (unlawful touching/procedure of a patient without consent). Battery is a criminal charge....bye bye license and all your money...hello jail.
[the lawyer that lectrued was one that defends doctors and she actually had this case. the women was dyeing in surgery from a hemorrhage in her ovaries and he took them out to save her life. she sued him. he won. damn straight he won.]

CARDIO!!!

Its my birthday! Big 25. Im spending the morning in the library studyin cardiology. Hey, its way better than endocrine. But, who knew i would need all that physics I learned at SDSU. To summarize. Endocrine=alphabet soup, Cardio= equation city. Its gonna be hard but I am excited, its the heart...how can that NOT be interesting?!

Endocrine Quotes

“You will all agree I hope that this is your favorite lecture of this system.... it’s the only lecture of this system...” - May

“there’s a certain amount of shrinkage in there…that’s normal.”-May

“this one he had a lot of trouble taking it out, it’s just extending always.”-Parsa

On insulinoma... “Very classic, you give them insulin and they jump right out of the chair...” -Parsa

“He got shut down” - Mehta on a student trying to answer a question during large group

“The answer was true” - Mehta on the answer to a polling question that we are supposed click in on, but haven’t had a chance to yet...

“I’m going to make a disclaimer.. I don’t know where my phone is... so if it goes off...” - Mehta --> a few minutes later her phone begins to ring --> “I still don’t know where it is, I dropped my real phone in the ocean this weekend.”

“Dr. Bi these next questions are yours, so don’t go anywhere.. come down here.” - Mehta on Dr. Bi wandering around the room to ask students questions.

“I can tell you that 76% of the class will become endocrinologists” Dr. Mehta on the right answer to a quiz question.

“I’m afraid to touch this thing again... It’s upsetting my mojo.” Pummy

“These pathologists, they come in late, they take out a journal...They are very busy saving lives.” Pummy

“Our pathologist just finished his coffee, so we’ll go back to him.” Pummy handing the mic off to Parsa after he walks in ten minutes late.

“Is his name really Elmer?” Pummy“Yeah, I think so...” Dr. MehtaEmory: “No, that’s not my name...”Dr. P will refer to him as Elmo for the rest of the large group session.

Dr. Mehta asks a question to us during large group. The room is filled with Silence.“John” Mehta calls out... “C’mon theres gotta be a John in the class...”There’s an Elmo, but no John.” Pummy

“An adenoma, is an adenoma, is an adenoma...” Dr Parsa

“Dr. Davis, should we ask you for a consult? Is that appropriate?” PummyDr. Davis, slowly grabs the mic, turns it on, and says “Yes.” and nothing else.

“So would ACTH affect the cortisol levels?” Pummy repeats a question from a student while wearing the lapel mic to Dr. Mehta.“The question is, would ACTH affect the corti....oh yeah, they can hear you...” Mehta

Mehta: “We had a patient who was called Annie, but my program director called her Robert.” - on her patient with Congenital Adrenal HyperplasiaPummy: “Where did she get Robert? Is it like Elmo? Did she just pull it out of the air?”

"you dont want her to go blind and then have to cut off her feet...so do you tell her to stop eating tortillas?" - Mehta

“Casey??? I didn’t want you guys to miss Dr. Pummerantz” - Mehta asking for the answer to a question in class.

“Hey, I’m running this show here, okay??”-Mehta

“...which is interestingly funny...”-Mehta

“Go ahed to the next sli... no wait go back...” - Parsa on having someone help him advance through his slide set.

“It’s not just a fanm it’s informative...” Pummy on the packet of papers that he has been waving in front of his face to cool off actually containing our quiz answers.

“We have a biochemist in the room.” -Mehta“What do I talk about?” - Kandpal

“When I asked my son, where do we get cholesterol, he said... McDonalds... and I said... Correct” - Kandpal

“We are all going to McDonald’s after...Supersize me baby, oh yeah!” -Dr. Pummy

Mehta:“So more than 66% of U.S. adults are obese..what’s the future of America?”Student (yells out in class): “Hispanic!”Mehta: “I’m not going to repeat that...”

“I’ve also taken Niacin..you know, I try ‘em all once,”-Walters, on drugs..


“Where is cholesterol made” RajStudent “The skin”Raj “yes”Mehta “Dr. Kandpal the student said skin, is that correct?”Raj “No”

“Look you’ve got a twin!” Mehta to Emory about the elmo doll Dr. Pummy put on the podium.... no one in the room understood why....

“Why is LDL bad... because the DO said so...” -Hu

“What if he goes home and dies?” MehtaEmory “That would be bad....”

Dr. Mehta calls on Casey.Casey: “I’m going to phone a friend [pulls out iphone] Ryan are you there?”Ryan: “Hey Casey, what’s up?”Casey: “Ryan, they are asking me a question and I don’t know the answer...”

“Why are we concerned about obesity?” - Mehta“Because americans are fat.” -Student“I didn’t say it, a caucasian did...” - Mehta

“...I start thinking, spontaneous human combustion. Seriously, I thought I would catch on fire!”-Walters, on Niacin

“...and if you don’t believe it..we have proof!”-Parsa

sunday funday (thats complete sarcasm FYI)

I have my first cumulative final tomorrow. Not that all of medical school isnt cumulative...its not like i can just forget stuff after i was taught it, im sure i will need to know most of this stuff for life, but being TESTED cumulatively is a different story. Covering a weeks worth of new material and 2 weeks worth of OLD material (pretty much learning about the entire endocrine system in the body) in a weekend? i don't want to say its impossible because I have to do it and that would be discouraging...but you can see where i am going with this. good lord tomorrow cant come fast enough, at least we get the afternoon off after the bloodbath.

from earlier today on facebook:

Leigh's status (she lives below me): WTF!!! Why does the car alarm right in front of my room keep going off???
(our responses to her status)
Dorothy Habrat: thank god im at the library!

Lindsay: i have no idea, im about to throw a gallon of milk at it. not yours dorothy, i will use mine.

Leigh: While you are throwing things from your balcony, I wouldn't mind if you "accidentally" hit one of those power scooter kids either :)

Dorothy: Library studying-1, Home-0

only 2 more days of endocrine....YAAAAAYYYY!

i live a pathetic life these days, and endocrine is OFF the list of interest (mostly because it is so damn tricky). life is pretty much 75% school and then 25% having a good time. but we still have a good time so thats all that matters.
its ok though, only 1 more year of classroom work and then they release me into the wild (what you would call the hospital). the more i learn the more i get excited. its also really fun to hear the 3rd years, who we got really close to last year, talk about their experiences.

oh, this was a fun quote from class today:
(after a question was asked to us about what drug you would prescribe a patient and everyone answered correctly):
"yes very good...theres really no science here this is just route memorization. theres really no way around route memorization in any subject.....whats your best long acting insulin? (as he casually goes back to the lecture topic)" -Dr. W

So today was our first standardized patient encounters of the year and my job was to counsel a patient on their drinking habits, even though they came in for back pain. it was an exercise on communicating with our patients and building repore again....blah blah blah. To get us back into the swing of things, they put us into groups of 6. Each one of us got 12 minutes with a SP (standardized patient--ps they call them standardized because every patient seen is the same to each student regardless of age or sex..they are all coming in with the same stories and symptoms so we can discuss them in lecture later). While we talked, 5 other students watched and then after the 12 min we got 5 min of feedback from the actor and our peers. after the encounter, the SP left the room and a new one came in. we had 3 scenarios, a diabetic patient, a smoker and an alcoholic then we had the same SPs come back and we pretended to do follow up visits. not sure if that makes sense but oh well.

Anywho, it was fine...nothing to write home about. its much more fun seeing ACTUAL patients. today was another 8:30 to 5 day and i got to unwind a bit by playing volleyball with my classmates. its always a good time. ok, im getting back to work. studying again till 12 and then bedtime.

a friend found this on the internet. sadly Ive tried all of them...the last one doesnt work. maybe it was because i feel asleep with the notes ON TOP of me rather than vice versa. hmmm..

to note; medical school mnemonics are WAAAY dirtier than that. think rated R, not G

round two...DING

Well, i just finished my second week of second year and am already sleep deprived, stressed and a little bitter about life. getting off of summer vacation/break is one thing but being thrown into school (especially with this new curriculum) is exhausting. I was speaking with my good friend/classmate Sarah who had gone on a long trip as well and both of us seemed to be in the same boat of depression. Not a true 'SIGECAPS' depression (that is a mnemonic for all the symptoms of depression we learned in Psych last year- sleep disorder, interest deficit, guilt, energy loss, etc etc) but just a minor depression...mostly sadness. It is very hard to have been allowed to sip from the glass of freedom and then now be dyeing of dehydration as it was taken away.... seriously, thats exactly what it feels like. free time has gone down the drain, sleep has been severely reduced and life is back to normal as a medical student. only now, I am an MS2 and classes are going to be more difficult and we are expecting to know stuff. i cant use the excuse that i am just a first year anymore. I CANT IMAGINE when one day i cant use the excuse 'I dont know, im just a medical student' or 'i dont know im just an intern' or 'i dont know im still in my residency.' There will be one day when i am on the top of the pecking order and i cant say 'i dont know' its gonna be Doctor, what do you want to do? and i will HAVE to know.....shit that scares me

well anyways, these two weeks have sucked (for lack of a better word). But last night I worked another shift at Montclair and that definitely added a bright light to the tunnel. First off, I got about 5 hours of sleep on Wednesday night mostly because I had coffee in the early afternoon and then couldn't fall asleep (and im sure anxiety wasnt helping) then I got up Thursday to be in class for 8am. After just an hour of one of our only lectures this week, i met with my small group at 9 until 12 going over our cases and answering the questions about differentials, further testing, treatments, mechanisms of treatment,etc. Then i took an hour lunch and went to OMM from 1 to 5. After OMM i went straight to the Montclair clinic were I worked until 10pm. Now THAT was a long day but it wasnt to bad because it was women's clinic and i have been wanting to work one for a while now.

SOoooo, one of my patients last night was a 41 yo F (who did not speak English). She presented for a routine women's health visit (you should start to learn the short hand too--42 year old female---that one was hopefully not to difficult). Basically, she was here for a pap smear and breast exam. This was the first exam I have seen and I felt privileged that this women trusted me to learn from her. The resident at the clinic did the exam, i watched as he explained and the clinic coordinator assisted. Sadly, the coordinator was the only one in the room who spoke Spanish and it was probably not the most uncomfortable experience for the patient. But, I was there and learned how to do both a pap smear and a breast exam and I will always remember her as my first womens health patient. There is another first.....and I may have ruled out OB/GYN with that one...

ok. its time for a nap, dinner and then a fun night of studying and playing music very very loudly in my headphones to keep up my moral. that is the silver lining of studying...good music. monday is our 2nd endocrine exam, its on the thyroid gland and adrenal glands...then next week we learn about the wonderful world of diabetes. that is gonna be an important week since its gonna affect my daily work for the rest of my life. ill try to pay attention and learn some stuff for my future patient's sake...cant make any promises though

back to spending the best days of my life (early 20s that is) studying. Only have a few weeks of them left since i turn 25 soon

summer made my body forget how to study

"I would be okay with being a quiter right now..."

Byron

PTH, FSH, LSH, GH, etc etc etc

"Studying endocrine = alphabet soup....CK14-, lower p27 index , PTH+, Ki-67+, cyclin D1 overexpression in >90%, DNA ploidy, Rb gene loss, HRPT2 gene mutation (hereditary hyperparathyroidism and jaw tumors syndrome)"
-Nolan

The acronyms just keep on coming....I think getting a medical degree is partly based on learning what a bunch of letters mean in the medical context. That way, you have to pay a doctor just to translate each others writing. its actually pretty brilliant!

Day One...again

Today was my first day of second year and it was.....uneventful. Unfortunately, school began just like every other day and before I knew it, I was sitting in a histology lecture again trying my hardest to keep my attention span. After 3 hours, we had lunch and got to catch up with each other but after that there was a realistic feeling of work looming. Our first quiz is Wednesday [in 2 days], then another one Friday and our first exam is Monday [one week from today]. We are going to be studying the endocrine system for 3 weeks and every week will be the same... Our school has changed the curriculum and we will be doing a part Problem Based Learning instead of lecture style. Basically, we are given 5 cases with questions and in a group of 10 selected peers we will meet up and come up with a diagnosis and answers to the questions. The quizzes we have are all based on these cases and then after the quiz we get lectured on them. If it sounds confusing its because it IS confusing and its going to take me a good amount of time to 'learn how to learn' best in this style of teaching. For example, this is next weeks schedule

Monday: Exam 1 [from the previous weeks material]

Tuesday: the entire day is blocked off to meet with our group to go over the 5 cases and for self study

Wednesday: 8:30am to 12-Quiz on the cases we covered Tuesday and then 3 hours of lecture on this material

1pm- 5pm-Essentials of Clinical Medicine [this is the class where we learn to deal with patients and see standardized patients [actors] every other week]

Thursday: AM is blocked off again for groups to meet about another 5 cases

1-4pm- Osteopathic Manipulative Medicine

Friday: 8:30am to 12-Quiz on the cases we covered Thursday and then 3 hours of lecture on this material

*note, there are some Medical Ethics classes and other randoms thrown in their as well. Also, this will change with each system but the general set up is the same.

As you can see, things are very different from the usual lecture day. I am not sure how i feel about it yet but im thinking positively and im sure it will be good for me to have my own free study days.

Sooooo, now that Africa and my incredible summer are behind me, im gonna go learn lots of stuff so i can eventually go back and be able to help [and not just look over people's shoulders].

And another thought, today was my last 'first day of school' EVER. Thats because next year [actually in July] I will be spending my first day of third year in a hospital...and then rotating in and out of hospitals. CRAZY to think about

ONE down THREE to go

Well, its been a lil over a week since my first year ended and its hard to reflect on what I just accomplished. It's also very hard to grasp that it has been a full year of quite possibly the hardest working year of my life. Having met so many new amazing people, I can't help but love what I am doing even though at times I was very miserable. Most of the time I was having fun, even if most of it was spent in the library. I was still in the library with friends and still had plenty of opportunities to get to know my classmates. Honestly, my classmates are the major contributing factor to my sanity. It actually is hard to relate to friends who aren't in my class because med school has become such a major part of my life....well, it IS my life. But, now I am on summer break and get 8 weeks of guilt free time. Right now I am sitting on my friend's couch in London just having made a great breakfast. I plan on sitting here for a lil while longer and then heading out into the city. Tomorrow is an England World Cup game and I am meeting a friend to watch it, should be a great time in a pub somewhere :) Then Thursday night I leave for MALAWIIIII!!!!!

Of course, I didnt let go of all responsibilities since break has started. Last week before I left for London, I volunteered for the third [or fourth, cant remember] time at the Montclair clinic. I had two patients, a Spanish speaking 45yo Male and a 44yo Female. The man was the first time i encountered a patient who did not understand English at all. I worked my way through it as best as possible. I led him to exam room one and with a smile on my face the entire time (it was the only way i knew to break the tension) I took his blood pressure, pulse, temperature, respiratory rate, height and weight. After doing his vitals, the only thing I could manage to say was 'dalor?' as I pointed to his eye [it looked a lil red and droopy...dalor means pain]. He said no....thats it. After an awkward pause and another smile, I told him [in english which he obviously couldnt understand] that I would be right back. I then got the Clinic Coordinator [our saving grace at the clinic...she helps us with everything] to interpret for me. Through her, we asked him a few questions and it was all I needed because he was just there for a BP check and medication refills for HTN and Diabetes.

After this patient I had a 44 year old lady who could speak English and suddenly I felt 20x more confident in myself. It seemed like a no brainer since i could ask her any question i wanted [retrospectively, having this spanish speaking patient was pretty good for my learning curve]. She was here for HTN medication refills but also because she wanted to switch her anti-depression medication. She was just put on them at her last visit 2 months ago and since then she was having major side affects of 'shaking' and 'trembling.' I asked her a ton of questions about her symptoms and didnt do any physical exam cause I didnt really think it through and didnt think it was needed. I went back to the resident and presented the cause and it became pretty clear that I did not do enough. He asked if I did any physical tests and educated me on why a neuro exam would be very important. So, I went back to the patient and did a full neuro exam to rule out any other causes. I did reflexes, muscle strength testing and sensation testing...all were intact and within normal limits. After going back and giving my pertinent negative findings to the resident, we went to see the patient together and ended up switching her medication.

Retrospectively, I really should have known to do the neuro exam and present this to the resident in the first place. We just learned about this a couple months ago and it should have been in the back of my mind when I was listening to the patient. I felt pretty stupid for having forgotten it. Its hard to see a patient, learn all their symptoms and really critically think while i am in front of them. Its hard enough trying to pretend and look semi-competent while in the exam room... its another to actually BE competent. So, I took this experience as a valuable one and next time, I will slow myself down a bit and not feel bad about thinking things through and making the patient wait while i study their chart and my notes. After all, thats what doctors are supposed to do, right?

On that note, I am also VERY happy I have been volunteering at the clinic because if I am already learning and becoming more comfortable with patients and charting, I wont make these basic mistakes when I start rotations. Then ill just look like a rockstar!

Anyways, it was a very long night at the clinic and we didnt get out until 10:30pm [we start at 5pm.] We had a resident that was pretty slow but he was also valuable as he spent a lot of time teaching us about the patients and also giving us pointers while writing our SOAP notes [the exam documentation complete with Assessment and Plan for treatment]. Sadly, its this kind of stuff that makes me dislike medicine. We spend about 20 minutes with the patients but then at least an hour on their chart. granted, charting will go much quicker and smoother when we are more experienced but for now, everything I am about to write gets scrutinized in my head a couple times before it actually get puts on paper. This is a legal document and I have to make sure everything is complete and accurate. Well... that and the resident and clinic coordinator have to sign off on our charts and i dont want to look/sound like a complete idiot. I havent been doing this for long but I should have some ideas of how to do this, it has been a year after all!

Every shift after our last patient appointment at 7:30pm, we all finish up our patients documentation [SOAP notes] and give them to the resident and then to the clinic coordinator to sign off. It has become a competition each shift to see who can write their chart without getting 'called back' from her to correct something.

I didnt get called back at this shift, she said my charts looked great and were done very well :)

A small triumph but a triumph nonetheless.

be back in a month when i return from Africa, will have lots of medical stuff to write about then!

Musculoskeletal Quotes

"And on his 2nd birthday you can imagine how happy we all were saying 'Yay! He's up to the 0th percentile!" -Dr. Rega about her son Darwin's inherited shortness

"I hate to break it to you, but fat shows up on x-rays.. can you hide it? No... Can patients hide it with clothes? No... but don't tell your patients that, it might give them a complex" Dr. Fraix on X-ray imaging

"Which finger do you guys think this is? It's the middle finger. It's my way of being politically incorrect to you. Just kidding, it's the ring finger." -Dr. Fraix

"Being a guy he was like 'I'm a guy, its not big deal... it'll go away.." Dr. Fraix describing the typical mentality of 20 something male patients.

"Dude, do you think this is a big deal?" -Dr. Fraix asking a professor about an injury that he was 'being a guy about' and ignored while in med school. Then later describing the wound saying 'Dude, this thing looks angry."

"I just lust after these nuts..all different kinds" -Dr. Redding on nutrition

" 'David... why are you so happy all the time...' Dr. Sugarman said to me... and I said.. well the first reason I won't tell you about... but the second was and attitude of gratitude." - Dr. Redding

"I started going to a doctor on a regular basis, even though I lectured him on being overweight... he was a student here at one point and I was worried about him." Dr. Redding on his longevity.

"I show this, not because it is a chicken wing from Hooters..." Dr. Finley on a picture of knee cartilage destroyed by osteoarthritis.

"They come in and can barely move and say okay Dr. I am ready to get that total joint replacement, and you think they are going to get up from their chair and rise like lazarus...that is not true, their pre-surgical status predicts their post-surgical status" Dr. Finley on joint replacement surgery.

"If you have ever driven over a pothole in the street, then you know what Osteoarthritis is." -Finley

"I had a dream that I was lecturing a group of students, and sure enough, when I woke up, there was an audience in front of me." Dr. Lin

"Do you understand this? No? go read my notes. If you still don't understand it...read them again."-Dr. Lin

"Any thing??? Is everything all right? I know these are very big words..." Dr. Lin's version of asking 'any questions?'

"Achondroplasia.. a failure of endochondral bone growth... this is what you see in the little people in the circus..." - Lin

"Am I talking to fast? No? Good, most orientals talk too fast and talk too soft." -Lin

"Should we begin, so you can go home, and study, and study, and study..." -Lin

"Sometimes you need to take the patients history to diagnose a muscle weakness. If you have a body builder come in and tell you they used to lift 310lbs and they can now only do 295lbs now... you have to trust them, there is no way for you to test their strength." - Lin

"You guys have all seen Barbara Walters on the TV right? She looks a little funny." - Dr. Wong on Botox and its cosmetic applications

"Nice thing is they dont know you so they cant sue you" -Dr Milton on performing muscle biopsies

"I weigh my board exams through guessing" -Dr Milton

"That's the thing, they are boring" -Dr. Milton on muscle biopsies.

"What is the first think you do if a patient comes into your office and then falls down dead on the way out the door? Well my father told me you need to turn the patient around so it looks like they were coming towards you not leaving" Dr. Milton.

Have any of you done a muscle biopsy? Its not so bad, you'd be surprised you can jam this thing into a persons bicep and they don't fight you to much." - Milton

"That works for the classic presentation of the disease, so you have to put a sign on your clinic that says 'only the classic presentation of the disease here please.'" - Milton

"So you are a nytella and you are sitting in a pond, and a moose comes by and munches on you... and your guts spill out into the pond..." -Milton trying to describe active transport???

"Atrophy... gee you know... it loses the mass... there's nothing secret about that" -Parsa

"These are the things were going to get to... you know.. objectives.." - Parsa

"If you are eating chick... kentucky fried chicken... you know the red and the white.." - Parsa

"All of the things I said were important are the things that you need to know for the test..." -Parsa during his most concise and hence enjoyable lecture to date.

"Ejection from a vehicle....thats probably not a good thing" -Doherty during ER lecture

"If you are going to sleep [during this lecture], don't sleep during this part..." - Sherman

"We took it back with us in a skippy peanut butter jar, and luckily customs didn't make us open it..." Faeber on a pathology sample they took home from Haiti.

"Here's Charlie Sheen being examined, not it's not him..." -Faeber on a photo of a patient examination technique.

"Is that me making that noise? It sounds like a river running?" -Faeber on the clicking from everyones lap-top after he told us he was going to go over all the concepts he felt were of importance.

"Lumbar vertebra are more prone to herniation because they are load bearing... for your big fat head." - Fraix

"Because the spinal cord is near and dear to our hearts..." - Fraix

"The reason I like to do EMG is because I get to poke people with needles and shock them... but don't tell people that..." - Fraix

"You are a physician, you need to make sure something else isn't going on... - Fraix about differential diagnoses.

"And thats why i get payed the big bucks...I dont get paid to diagnose Osgood-Shlatter, my grandmother can diagnose that" - Fraix

"I am going to keep repeating these things to you, because when you get on rotations you are going to be tempted to say 'fracture' when you see growth plates. And your attendings will wonder 'what are they teaching you at that school??? Obviously nothing..." - Fraix about growth plates on X rays

"You'll point at it and be like 'thats the problem!' Again, my grandmother could diagnose that" -Fraix on AC injury

"I would get a call on friday asking me to take a patient, so I would bring my junior resident with me who was a linebacker for stanford. I would walk into the hospital with him behind me and say 'what, do you want me to take this patient???" - Dr. Fraix on bullying his way out of getting stuck with a case.

"unfortunately you dont get these arrows in clinic" [on X rays in powerpoint]

"i'll also have patients do heel-toe walking...its not just for drunk driving, its for diagnosing too"

"so the moral of the story is..when you're out doing crack cocaine or whatever dancing all night...take a break!"-Fraix.

"i kinda feel like a talk show host" -Fraix passing the microphone around during large group

"other than guessing, did anybody find anything?" - Fraix

"Ottawa, its not just another place in Canada. Hopefully I didnt offend anyone by saying that.."
- Fraix

"as a medical student you want to put yourself out there because people dont expect much from you" -Fraix

"How many views is better than one view.... 2 or 3" -Fraix on how many xray views to ask for

"You look at your patient and realize 'oh my god he's from the 1950's." -Fraix on a stock photo of a child with DMD.

"XY, you remember it because guys will ask... why do I have to pick up my clothes off the floor, why do I have to get up early..." - Fraix

"Dr. Parsa talked about this 'c'mon guys what do you need to know... its necrotic, it's classic..." - Fraix doing a classic immitation of Parsa

"oh hypothermia, you might think to yourself, we can freeze people and thats a good thing... no it doesn't work out that way..." -Docherty on the effects of hypothermia.

"people will get really specific, 'oh i'm allergic to donuts', well thats okay, b/c we aren't going to feed you right now." -Docherty on taking a hx for a trauma patient.

"These guys are getting up close and personal" - Rao on two rugby guys on top of each other.

"when bones break break its loud...it even echoes off the wall" - Rao

"Must be better than 20/50 with both eyes ::repeats twice:: you know... that would be a good test question..." - Rao on requirements for the sports physical.

"I remember when i was a freshmen medical student and they were calling us doctors...thats pretty funny" -Dr Lee

"Im sitting there looking at the finish line at an old lady that looked like she just came out of a beauty palor with a shirt on that said 'circa 1909' on it as there are young kids laying in the medical tent hooked up to two IVs and im thinking 'whats wrong with this picture?'" -Dr Rice at a San Diego marathon

"This is a steroid induced, genetic freak..." - Rice on body building hypertrophy pic.

"being a freshmen medical student is not a good excuse to abuse yourself" -Rice

"can you imagine the stress of being a chronic sniper???" - Rice

"one monkey is no monkey" -Rice powerpoint

"You can see here ::points with a pencil to ppt on screen::" Steinmen trying to point out radiologic findings without the use of a laser pointer.

"If they got hit by the coca-cola truck & were involved in a lawsuit, then none of them got better..." Steinmen on the surprising finding on a study involving chronic back pain and treatment outcomes.

Are we there yet?

Nothing like getting up at 7am on a Sunday and starting the morning with a 247 slide powerpoint that will have 12 questions from it [of the total 100 on the exam].

http://www.youtube.com/watch?v=8dbDJzDV1CM

Procrastination Perfection

I have attempted to look over one lecture in the past two hours. I have yet to complete it....I just CANT physically learn anything right now. It already feels like summer, how am i supposed to be in school mode. WIth two more weeks left of my first year, I feel like my brain is jam packed with information yet I am supposed to cram in everything about the musculoskeletal system, like its no big deal or something. Where is this new information going to fit? I'll tell you where...in the spaces where Anatomy and Microbiology used to be...cause I sure as hell dont remember all that from months ago. HAHA. it occurs to me as i write this that I realistically remember 25% of what I learned this year [and that is being generous]. How am i supposed to take a Board exam at the end of NEXT YEAR after learning a whole other year of information? these people are nutso if they think i will remember all this stuff. 2 more weeks...just 2 more weeks! then i can pretend for 8 weeks that I live a normal life :)

I recently learned that my school has the shortest summer of ANY medical school in the country. my luck is exquisite

Last week I volunteered at the Montclair clinic again. It was pretty fun. Luck would have it that I examined the same patient I saw the last time I volunteered. This is pretty impossible as the clinic is open 3 days a week and there are a LOT of volunteers. That, and we randomly get assigned cases. Obviously, someone special was watching over me and decided I needed to learn some more about diabetic medications because the patient came in complaining about the drugs we had switched her too. It was a pretty obvious case and family practice may have lost a point in my book after this uneventful patient.

My next patient was a 80 something year old Philippino man who came in with a chief complaint of general fatigue and also to double check his blood pressure [I'll call him Mr. Grandpa]. Mr.Grandpa was pretty sweet as we chatted for a while and then after 10 minutes of learning about his family's health but not his, i realized i had to take control of the situation and ask about his symptoms. After we got that out of the way [he was much more interested in learning about me then telling me his problems] he asked what school I went to. I told him I was a first year medical student and my answer gave him a pretty puzzled look on his face. 'How old are you? You cant be more than 19' Mr. Grandpa said, I laughed and told him I was 24. of course his next question was if i was married and when i said no he said 'you should start working on that, dont want to get too old.' [Like I havent heard THAT before from a grandparent....] I told him i was in no rush to END my life and he smiled back [i dont think he understood my joke...but really, i wasnt joking]. While we spoke he kept staring at my ID badge so after a while I asked him what he was so curious about. He said he was trying to learn my name and see where my last name is from. I told him i was Polish [blah blah...all the usual 'Mom is from here, Dad is from here..stuff] and he still kept staring at it. So i took it off and gave it to him. Ss he grasped it he said, 'Ok, lets see if this picture does you justice. Does it? [looks at the ID card then back at me, shakes his head...] No..No it doesnt.' Im not sure if he meant it as an insult or a complement but either way, I was entertained.
I presented his case to the resident working that night and after he examined the patient, we all walked to the front desk to schedule his follow up. Mr. Grandpa made his appointment and then asked if he could schedule to see me again. ME, HE WANTED TO RESCHEDULE TO SEE ME!!! I had to apologize and tell him I was just a volunteer and that there was no way I could be here the next time he was to come. I explained that our schedules were already set for the next couple months. He was pretty disappointed and mentioned that every time he went to our clinic he saw a different doctor and that it was hard to build a relationship with a doctor this way. This small comment made me surprisingly sad as there are a LOT of uninsured [or underinsured] patients who must feel the same way. On the flip side, it made me confident knowing he thought I was competent enough to see him again [even though I was a 24 year old single woman..haha]. Either way, family practice gained a point on my list because I believe the aspect of continuity of care is something I want to uphold in my future as a physician. So, as of now peds and family practice are starting to lead the pack. BUT, dont be fooled, it is still a large and jumbled together pack. Of course, there is still the common understanding that surgery is not even IN the pack...its laying in a ditch somewhere crying about how all the gunners are fighting over it while.

have i mentioned that i will NEVER BE A SURGEON

ok, now that i have successfully wasted half an hour, I am going back to the embryology of muscle and skeletal development in the fetus. It would have been a lot easier if we just started as mini human beings and grew exactly like that instead of all the development that has to take place. Just so you know what the hell i am talking about, google 'mesodermal development' and then click images. YEAH, IT KINDA BLOWS.

14 days until summer!!!

Psychology Quotable Quotes again from Melissa

"Of course you could encourage some of these mal-adaptive behaviors in your patients, it might bring more people into your office." Martin on how behavior relates to illness.

"Are we living in a good environment in Pomona? You'd be crazy to get on your bike and ride to school here." Martin on the concept of wellness.

“guns…children find one and shoot someone with it.”-Martin

"… the president of the US should have a degree in anthro..I’m going to wait a long time for that for sure."-Martin

“instead of taking a hike up mt. baldy…WHY DID YOU COME HERE?"-Martin

"The status quo is not being maintained in our country…because some…groups..are reproducing more than others…"-Martin

"Adulters-do they have an illness? Well, maybe the church would say they did like 500 years ago…but I don’t think the church has much room to talk nowadays.” -Martin...oh snap!

“native hawaiians didn’t grow up eating things like spam.” -Martin

“my mom..can’t drink. She’s the cheapest date you’ve ever seen.” -KJ

“tell your pts to put their car keys and their cell phone in their pocket, cause they’re not going to remember where they put them….so I’ve heard…”-KJ, on the effects of marijuana

“let’s make pot legal, make $100 from it and give the $ to public schools…..THIS guy (points to picture of snoop) would be in favor of it…fo shizzle..”-KJ

"You shouldn't give this drug to truck drivers, school kids, and tight rope walkers." -KJ on SSRIs and the side effect of sedation.

These people will have their nose turned up like this ::points face toward ceiling:: - Heh on Manic Episodes.

"When I press the lever, I feel good" - KJ describing an experiment in which a rat stimulates its pleasure centers with electrodes... he is pretending to be the rat...

"My mom had an alcohol problem. But alcohol isn't my kind of thing, I like amphetamines" KJ on substance abuse

"What is so wrong with a baby breastfeeding the mother?" - Martin

"Maybe if you get the patient a new wife... they won't drink..." -Ask on alcoholism as a primary vs secondary process.

"Don't tell my wife, that's my mistress.." -Heh

"These people do not like buffets, they like to go to Black Angus." -Heh on Social Phobia and Social Anxiety Disorder

"If you are ill and you are treating sick patients, that is not cool." - Heh

Ershad: "Do you have any advice for us on how to study for Dr. Martin?"
Heh: ::looks at test, begins shaking head back and forth:: "No, its 15 questions, just do your best."

"Perhaps you should all go into farming, fishing, or forestry if you are prone to depression." Heh on the occurrence of depression amongst health care providers.

"If you try you die..." -Heh on suicide complete rate for MDs

"You might start to think this resembles you, your boyfriend, your parents, etc. Don’t take this to heart." Singer-Chang on studying psych and how students think they have every disorder studied.

“Becoming a high-functioning neurotic person is the most that we can hope for” - Singer-Chang

“they died…unfortunate for them, good for the rest of us cause now we know not to take those things together.”-KJ, on mixing certain drugs with grapefruit juice.

“my dad..oh I shouldn’t say this…nah, he’ll probably never watch this! My dad is probably dysthymic…he can find the cloud in any silver lining.”-KJ

“when I found out that brain cells could regenerate…I celebrated. All those nights in college of doing things…involving funnels and water pipes….”-KJ

“looking at this list..I dunno about you, but my risk of suicide just jumped up.”-KJ, in regards to the dietary restrictions of MAO inhibitors.

“I won’t bore you with the story…oh wait, I already did. Sorry.”-KJ

"Marty... he's out there somewhere probably growing [marijuana] legally and making more money than all of us" - Norcos referring to a classmate of his who was expelled his 4th year of medical school for substance abuse.

“pts with dementia have a hard time tying their shoes, putting their belt on, or putting their pants on. How do you treat this?..... Buy them stretch pants” - Heh on apraxia associated with dementia.

"Take the example of the lady who went into Target and began stabbing people. Is that woman bad? Is this really the product of a neuron in the thalamus that is having a bad day or firing too much?" -Martin on the concept of behavior as a scientific process or illness.

"We have to be concerned about fitness. Is med school conducive to reproduction? Not so much." -Martin

"Since Jerry Springer started our cultures perception of shame has changed." - Martin on emotion.

"In your 20’s alcohol is an aphrodisiac. But in your later years…he wrong head is flushing. Viagra doesn’t work if you drink too much."-Norcross

Neuroanatomy Quotes- 2010 Edition

Melissa made sure to keep track of all thee quotable quotes of neuro:


"I like to think of tear fluid as eye saliva" Dr. Bales

"This should all be coming back to you from gross... there should be a big sucking sound in this room as all the knowledge floods back into your brain." Dr. Bales on the ciliary ganglia

"You just can't move one eye out at a time. We're not chameleons, maybe it would be cool if we were, but were not." Dr. Bales on horizontal gaze.

"There is one thing that is almost impossible to get, and if your patient got it, they are probably dead." Dr. Bales on combined cranial nerve lesions.

"I always thought it was cheating to use the bar, you should just use your macula" Dr. Bales on tightropists walking the niagra gorge carrying poles to aid their balance.

Bales "What do you call it, The business in the....::gestures with hands::"
Student: "A mullet?"
Bales: "yeah, a mullet."

"If your motor thalamus is not properly inhibited, it's bad news." Dr. Bales

"Let's say that there are two college roomates, and they share a shower, well there may be fecal material in the shower..." Dr. Saviola on how tape worms can be transmitted from person to person.

"cannibalism is probably never a good idea" - Dr. Saviola

"So, what do you need to know? Well, all of them"-Al Tikriti

The cerebrum might say [to the cerebellum], "Mini brain, you complete me." -Bales (in his notes)

"Now this..is the speech banana."-Martin, on the sound level vs. frequency chart

“some excuse for women, they can kick their spouse at night. Like my wife…she always wake me up at night.”-Dr.Wong, on Restless Leg Syndrome

“the brain is sensitive to being injured… it doesn’t like it very much” Dr. Pummerantz on Bacterial Meningitis and its symptoms.

“Getting old is a good excuse for a lot of things, but not for Parkinson’s” Dr. Qazi on Parkinson's disease occuring more frequently in the middle aged individuals (less than 1% in age 65+)

"I’ve never really asked a patient what makes them develop the urge to utter an obscenity, but I think it is an urge that a lot of adults have too." Dr Qazi on Tourette’s Disorder.

“most of you have heard of this ::giggle::..get high and euphoric by sniffing cocaine and smoking it.”-Dr. Wong

“Did I mess this up…oh..well, let me go onto the next slide.”-Bales

"The Auricle is cartilage that is covered in skin, this is the part that flaps in the wind for some people" Dr. Felton on the External Ear

“eh, I think it’s true, but you can look it up. Swimmers ear, like for people in georgia, may be why people speak funny in that area." -Dr. Felton

"If some one is sweaty and has an itch in their ear, and they try and itch it with a paper clip…or an ice axe..”-Felton

“they didn’t actually take a person and slice their head open like that. It’s just a picture.”-Dr. Felton, referring to a cartoon drawing of the ear

“this is a hoaky picture, I hate this picture. At least they made it look pink.” -Felton, referring to an electron microscope picture.

“I wanted to show a picture of an eardrum with a Q-tip going through it. But I figured that you knew not to do that anyway, so I didn’t show it.” -Dr. Felton

Necrotizing external otitis (malignant external otitis): “you can tell they’re severe b/c they contain the words “necrotizing” and “malignant.” You NEVER want to hear those words.”-Felton

Aspergillus niger: “that’s the one when you pull an orange from behind the milk in the fridge, it’s been there for a few months…it’s all black or something…” -Felton

"I'm going to go a few minutes over and finish this up so you won't be in here til lunch time. You can then go and practice your movement disorders again." Dr. May in referrence to the DO 2013 class filming a dance bit before his lecture for the class video.

"I had a second year student come up to me and tell me, 'Oh Dr. Martin, I remember what you told us about the pinna'... and I thought to myself well that's good, at least you remember something." Dr. Martin on the function of the pinna

"One student looked into the ear of a child and found a cockroach, and that was unpleasant for the student *chuckles to self*" Dr. Martin on the things one can find in peoples ears.

"Those whacky early zoologists considered gill stuctures as visceral, so we are stuck with the term
“visceral” attached to striated muscles [a concept which makes my head hurt]" Dr. Bales on the difference between SVE of the head and GSE, in his lecture document.

"Massive excitation of the cerebellum makes you wonder why it doesn't just dance right out of your head." Dr. Bales on the circuitry of the cerebellum.

"Some part of your consciousness will put this image together, hopefully it is focused on me right now" Dr. Bales on your brain assimilating the parts of the visual field into a coherent image.

"Most of [the visual cortex] we don't know what it does yet. If I could tell you what it was doing I would have a bigger office with at least one window." Dr. Bales

“..this is done by the superior colliculus, which I already told you that I know nothing about…”-Dr. Bales

“Alpha, beta, gamma delta..uhh…::pauses:: all these Greek syllables…”-Dr. Wong

"When I was pregnant and got a cold sore on my lip...." Followed by an awkward pause as Saviola just realizes she told the entire class that she has Herpes! (TORCH & HSV-1 lecture)

"it is no accident that these two systems are related anatomically and functionally at the
cellular level (but that is a different lecture, in a different course, in a different discipline)" Dr. Bales on the vestibular and auditory system.

"the “rocks in your head” include otolith and statolith" Bales

"The CNS can suppress back ground irrelevant noise, like some people are doing with my lecture right now." Bales

"scientific summary --> there's a whole lot a connectin' goin' on" Bales

"When a train is here, you want to be able to see the engine number so you can report the engineer for not stopping when you are on the tracks" Bales

"Geometry is a requirement to be here [as a student], but it is not a requirement to lecture." Bales on an addition error he made during lecture.

"The olfactory system is relatively less important in primates, a shark will smell you before you smell the shark" Bales

"You walk out of a crowded bar into the daylight... or have you not had that opportunity yet?" Martin on the bleaching of the cones in the retina during phototopic vision.

"I don't know what konio means, perhaps one of you will tell me in a moment when you look it up on google..." Martin

"almost everyone smells with their nose" Martin on olfactory sense.

"How do you tell if there is a Herpes infection in the cornea? Well the answer is you go to the eye clinic." Tiwari

"The book is rambling, incoherent, and doesn't make a lot of sense, this could be due to the authors or the fact that the subject matter is just rambling, incoherent, and doesn't make sense." Bales on the Thalamus

"Think of the pulvinar as the butt of the 'thalamoose' and it is mooning the corpus quadrigemina" Bales

"Things that fluctuate during sleep... including penile erection, perhaps I should point out that this does not occur in females...." Martin

"If you lesion a rat and put it in a cage, it may be like 'hey what's happenin dude?' It gets even wierder, the rat may try to hump the snake..." Bales on lesions of the amygdala.

"So you get dressed, you put on one sleeve of your sweater and you are done." Bales on hemineglect.

“so when you see a big sign that says, DO NOT URINATE HERE…you don’t” -Bales

"continual inclusion of new structures to the expanding “system” are making it less meaningful
or useful (limbic lobe --> Papes circuit --> lymbic system --> extended limbic system -->
superginormous limbic system --> whole brain)" Bales on the limbic system.

"rats prefer electrical stimulation of the septal nuclei to food and water... stimulation and lesion studies in animals and some lesions in humans have implicated the septal region in sexuality and orgasm (hypersexuality); no wonder the rats prefer stimulaton to food and water !" Bales

"Amygdala, a complex nuclei with a fantastical number of connections... all of which you will need to know for the exam..." Bales (we all pray that he was actually being sarcastic on purpose)

"Layer 2 is the most boring layer, there is not much going on there..." Bales on layers of the cortex.

"This is a photo of Keith Richards, a long time heroin user (photo of him slumped over and passed out) it looks like he is having a good time." Wong on the effects of heroin.

"The reticular formation is very involved in maintaining consciousness, and arousal. It allows you to pay attention…if , indeed, you are”-Bales

"If you decorticate a cat with it’s feet on a sling, you can get it to walk still. The motor pattern in the brainstem is still there. uh, sorry if this offends anyone..but it has been done before…”-Bales

. “Ondine’s curse. That’s not a good thing to have.” -Bales (talking about a lesion that makes you stop breathing if you sleep.

“do you want to urinate now? In the middle of lecuture, while walking to the back? Well, maybe you could just do it in your seat...of course if you have had too much to drink”-Martin (on micturition reflex)

“people are ashamed to pee their pants”-Martin

“..this figure is taken from google again>snickers<..”-Wong

"You can ask your patient, 'Do you have problems with deglutition?' and your patient will ask you 'What the hell is that?' " Martin on swallowing reflex

"If you don't treat viral conjunctivitis it will probably go away in 7 days, if you do treat it... it will go away in about a week." Mintz

"Hopefully you can do some studying of this on your own... or maybe some research." Martin on the physiology of the autonomic sexual response and orgasm.

"Think about those cranial nerves.. you know those heads in a jar, like on futurama? There is no reason that shouldn't be..." - Bertetta on Cause of Death

"What would you predict the symptoms of thalamic lesion would be? Flip a coin or throw some darts at a dart board." Bales on thalamic lesions, and their many uncorrelatable effects

There is no such thing as brain transplants, only body transplants - Dr. Miulli, Neurosurgeon

"You will notice that I said Guillain-Barre' two times... and I didn't say the others two times." - Dr. Berman on his lectures and how to study for his Qs.

"What does the PC section have to say about this? We shouldn't ask the apple section. What's wrong you guys aren't answering? " Miulli
Student with apple "they got a virus..."
Miulli on how much of the brain has blood supply

"Brendon is going to come down here in a couple of minutes and give you a super secret password to win you $500 or something." Miulli on the lunch lecture he is giving and the intro for it.

"A few reasons not to do a rectal exam; patient does not have an anus (congenital colostomy), or the doctor has no fingers." Dr. Berman

"I'm being videotaped??? ::turns off microphone and walks out of camera range, proceeds to give answers to test:: "Well now those were the answers to the test." Miulli on the attendance to his lectures after the lunch break. -these were not actual answers to the test

"When you go into the room the pt is not going to say... I am a 45 yo right handed male with a 3 week history of back pain. It gets worse when I do the valsalvo maneuver..." Dr. Miulli on taking a thorough history.

"We are going to kill everyone in the next three slides..." Dr. Miulli on the NASCIS study I and II

"This is medicine at its best" Miulli on a massive academic spinal cord injury drug trial study where they 'forgot to use placebo'.

"Well this isn't on the test anyway so who cares..." Miulli on the difference between an epidural and subdural hematoma.

"Here is a tumor that I have made in photoshop..." Roscoe on neural pathology

"We do the same thing, freeze the tissue and put it on the shabu shabu slicer..." Roscoe on how they analyze surgical pathology specimens.

"Remember the brachial plexus? I don't.. remember that horrible thing that looks like a freeway accident... I always have to talk to students about it and pretend I know what I am talking about." - Roscoe

"We want to cut the brain open to see the germinal matrix ::cues animation of chainsaw being used to section a brain::" -Roscoe

"This is a photo of the infection occuring ::cue video of cute kittehs::" Atkinson on toxoplasmosis as a torch pathogen.

"Hopefully you don't have to remember the broadman areas... oh you do... sorry about that." Roscoe

"Use the objective when you start studying for my portion of the test at 4am the day of the test." Atkinson

"In Florida you eat the baracuda if you... want to be in a movie like Jackass or something." Atkinson on Red tide and other forms of toxin peripheral neuropathy.

"This is a horrible list... when I had to study for the neurology boards we had to memorize the inborn errors in metabolism. We had all these mnemonics, and a chart to understand the mnemonics... as soon as the test is over... you will forget them all." Roscoe

"BTW when you take your boards, and you open the letter and you pass, you realize that unless you let your driver's license lapse, you will never have to take another test again in your life, you will do a football touchdown dance ::proceeds to demonstrate::" Roscoe

"The teddy bear is the uncus, you can push on it and it is easy to push on it. But if I am the person pushing on it, and there are five of you pushing back against me there is a lot of resistance.... Now I know that is the lamest example you have ever heard...." Roscoe on uncal herniation

"Now I don't remember if theses are greek or roman columns, so we will just say their are greek or roman columns..." Roscoe on some insane way to remember that CN3 innervates levator palpebrae superioris.

"Its okay to say bruise on a medical record, but if you say contusion it sounds cooler..." Roscoe

"The teddy bear example was the worst example, well this is the second. Pretend you are ice skating on bear feet. You hit a patch that is kinda rough, you aren't moving very fast, but it still kinda hurts your feet... the brain is the same way." Roscoe on Contracoup contusion.

“I should take some of these out…I’m repeating the same things here..”-Parsa, on the repetitive slides

“the time is up, and..I’m over it…see you tomorrrow morning.” -Parsa at the end of lecture

“stage 4 is when people have diuresis, have their, um, ….episodes.”-Marti

Psych done tomorrow, 1 more system to go before summer!

[learning about substance abuse in psych]

it is clear we can substitute 'school' or 'studying' in for 'alcohol' or 'drinking' in diagnostic questions for alcoholism. A clear pattern of brain/studying abuse can be seen

Is School a problem in your life? Do you feel the need to cut down on studying? Do you get annoyed when people critize how much you study? Do you ever feel guilty about school? Do you need a little review in the morning to get your academic day going? Study Alone? Do you have a compulsion to study? Do you keep studying despite consequences to your happiness?

goodbye Neuro, hello life!

It has been a while since i have written, mostly because Neurology is over and i have been enjoying my life :) It was a brutal class and I am very glad to have passed and be done with it. sadly, the amount of hours i spent studying does not correlate well with the grade i will get in the class, but thats med school for ya. I have accepted that some things [like the million neuronal pathways that are all different and control every slight movement we make or feeling we have] are just beyond the scope of my memory. lets hope that i will learn them well enough to pass my first of many medical licensing board exams which is next year.

i have been out doing the things i love most. i have been out by the pool, hiking, playing tennis, camping with my classmates, and celebrating much much more. alcohol consumption has gone up exponentially since neuro finished, never to a huge excess though :) i have been able to see friends more often and have started buying the necessary clothes and equipment i will need for my trip to Africa this summer. Dont let me foul you, we still have school though. Right now we are in Behavioral Science [Psych] because the amount of class hours are greatly decreased. We also just finished ECM [essentials of clinical medicine]...the class where we see the actors and play dress up with our white coats and do history and physicals on them.

aside from all the goofing off, ending neuro has brought me more time to do more extracurricular activities. i have volunteered in the Montclair clinic again and worked in a club called PCHAT [Pomona Community Health Action Team]. PCAHT holds clinics every month in various locations throughout Pomona, usually in elementary schools. They are advertised and open to the public. Run by students and supervised by physicians through Western, PCHAT provides basic health screening for those that do not have access otherwise. I had an amazing experience when i volunteered last week. I worked in a team with two other colleagues and first we had an 8 year old patient that had a possible urinary tract infection. She was a sweet girl and I enjoyed interacting with her. We then had a 50something year old man which was pretty much was the most educational case I have seen yet.
So Mr. X [as i will refer to him] came in with his wife for what he says was just to get a routine checkup. He admitted to not being seen by a doctor in several years. Sitting down and getting a history, we discovered the real reason for his visit. He was having numbness in his feet and hands which was progressively getting worse. Mr X was not a obese man but he did admit to drug use in the past and was not an ideally healthy patient. HIs wife told us that he was pretty scared about coming. After doing a thorough history and neurological physical exam, we found everything to be pretty normal [so not a neuro problem] but he did answer a few questions that led us to believe he had diabetes. Questions we have been taught to ask like 'are you always really thirst, do you get up to urinate in the night multiple times, etc were all answered with a yes. Basically, this was the most classical and cliche presentation of diabetes that anyone could have thrown at us. So, we checked his blood sugar and sure enough, it was 460 and 470ish on re-check. Without any help from an attending, my colleagues and i diagnosed a man who walked in with a simple request for a 'routine check.' WIth the knowledge of what questions to ask and what physical exam aspects we should do, we truly were being doctors :) Granted, it was bittersweet because we were happy over a not so happy matter [diabetes is never a happy matter] but still, i was very very excited about what we had just done.
When we were done working up Mr. X I got to present this case to the attending and all of us were pretty damn excited that we did so well. Presenting is always fun because that is pretty much what i will be doing for the rest of my life. I have started to become familiar with the medical jargon and abbreviations and its really starting to click. I can rattle of "Mr. X, a 52 year old Male, presents to the clinic today for a routine visit. Upon questioning, it was reveled that he has had peripheral neuropathy symptoms in his upper and lower extremities for close to one year in duration. [then i would go on about the onset, location, duration, characteristics, aggravating factors, alleviating factors, if it radiates, the timing, severity and associated symtpomts..blah blah blah....yeah...its a mouthful]


After pretending to be a doctor for a night, I looked back at my two patients that were pretty much extremes. The young girl and the old man. For now, I will say I enjoyed working with the young girl more. Actually, having had a couple pediatric experiences...i think it could be something i enjoy and i am looking into the field more. stay tuned....

one thing i know i wont be doing is psych [and of course surgery...i will NEVER do surgery]. We just had a patient encounter [ya know, the actors] in psych. It was creepy. I had to deal with a 54 year old man who had bipolar disorder who repeatedly went out of his way to make me feel uncomfortable. not...so....fun.

well, im down with this computer for now and am going to pretend to study for a bit...we have our one and only test in Psych next week and then musculoskeletal begins. For now, im going to look forward to tomorrow, we are playing a pick up volleyball game. life is good :) 46 more days until summer!