Tuesday, October 26, 2010

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....)

Saturday, October 23, 2010

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

Monday, October 18, 2010

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.

Friday, October 15, 2010

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

Sunday, October 10, 2010

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...”

Friday, October 8, 2010

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

Tuesday, October 5, 2010

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