Kevin realizes year 2 is just year 1's uglier, more high-maintenance sister

Finals are finally over and that's the conclusion I've reached.

Kevin may have accidentally ruined someone's future

For everyday our school has applicant interviews, they invite 3 current medical students to come speak during the lunch session and answer any questions the applicants might have. This is a mutually beneficial setup: the applicants get to ask questions they might not otherwise ask, and medical students get some free food. Robby and I were coming out of one of these sessions when we noticed one of the applicants had apparently left his personalized packet of information (necessary for his interview) on the table. I argued that he would likely remember and come back for his stuff, Robby – citing a popular Abe Lincoln tale - insisted we return the materials to the admissions office lest it be stolen by less than scrupulous villains. Since I’m always ready to random conduct acts of charity, I acquiesced. When we finally made our way to the admissions office, we happened to run into the same gaggle of applicants and as well as the admissions tour guide. I immediately handed the packet to the guide only to hear “Oh this applicant should be interviewing right next door to where we ate lunch.” Oops.

So this then dawns on me: this applicant probably stepped out to use the restroom, prepping for a hour of good ol' ethical grillin, only to come back to find his stuff gone. I conjecture this is what most likely happened afterwards...

Finding his prized information stolen could have very well ruined his mental focus and mojo, causing him to give terrible answers at the interview. This would inevitably lead to his rejection at our school, undoubtedly his first choice institution. Distraught at this recent failure, he becomes so dejected he withdraws his other applications, sells his belongings and moves into the mountains to rough it as a grizzly man. Either that or he ends up in dental school, not sure which one is worse.

Clearly no good deed goes on unpunished.

Julia presents a landmark case of PMS

We here at IDDx are always looking for ways to improve the quality of our content (see: Beef Stew). A few months ago we experimented with guest authors by publishing an article written by the now infamous Jess. However, the reviews were less than favorable, featuring comments such as “Oh god my eyes,” “I think I just threw up a little in my mouth” and the much feared: “You’ll be hearing from my lawyer.” One drawn out mental anguish lawsuit later, we have decided to venture into the realm of guest authorship once again, this time with a new, less Jess-y, author. Enjoy

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Okay, so PMS in the general population may not be that remarkable, but when a landmark case - such as I am about to relate to you - is encountered… well, is there not an intellectual duty to report it?

I was in the hospital cafeteria trying to grab some lunch in the small window of time between my visit to the gym and class. I grab some veggie burrito and head over to the cashier. I get into a line behind a woman who is already checking out and thank my lucky stars that I managed to avoid what is normally a long line and crush of people at lunchtime. Things are working out today. Huzzah!

Wrong.

While this woman is seemingly gathering up her plate and soda, the cashier has already rung me up. As I am handing over my cash, this woman turns and tries to walk through me, presumably to get a napkin or utensil or something. Instead of then going AROUND me the way a normal person might, suddenly I hear her bark at me “Uh, could you not put your dirty hand over my food?!” I am so shocked by this I simply say sorry, take my change and go.

Come to think of it, I don’t even think my hand WAS over her food. Perhaps it was in the airspace adjacent to the plate in question. But, to be fair, there is no way to prove that the microbes on my hand WEREN’T propelling themselves into the air and free diving into her mashed potatoes, so we can probably overlook this. Aren’t we always hearing about what a problem iatrogenic infections are around hospitals?

So I walk out of the cafeteria, prized burrito in hand, and begin to head back to class. However, I quickly realized that someone was on my heels, tailgating me. I turn my head to look over my shoulder et voila! It is the nasty lady herself. Is she done with me yet? Oh no, dear reader, she still has a little something snotty left.

“Oh great and why don’t you get your hair everywhere too?”

Excuse me? Now, what we had here was a definite pot-and-kettle situation. I have long curly hair that I was wearing down at that moment. However, she ALSO had long, dark curly hair that was down.

Think, Julia, think! “Um, could you try and not ruin my day as well?” Ok, not the wittiest thing I could probably have come back with, but honestly I was so shocked by this behavior coming from a total stranger… I mean REALLY.

Well at this point she just ignored my existence and stalked back towards her office. Touche, cranky-professional woman. Until we meet again... one month from now.

Kevin falls, David watches

As many of you know, the second year of medical school is traditionally far harder than the first. We’re preparing for the USMLE Step 1, whose effect on our ultimate career opportunities makes the MCAT look like a third grade math quiz, juggling more clinical responsibilities, and incorporating significantly more pathological correlates into the basic science curriculum. To top it all off, the Candyland-like existence of Pass-Fail grading from first year has been replaced by the cruel Sorry-esque wasteland of the Honors-Pass-Fail system (stay tuned for more H/P/F musings from me soon).

This added pressure forces most people to adjust their study habits. Many students work harder, longer, or find methods to increase their academic efficiency. I’ve adapted by preparing myself for the inevitable career switch to some sort of trade school. Kevin, unfortunately, has fallen prey to a far more sinister path…

Recently during lecture, one of our professors relayed a humorous anecdote about his freshman year of college. In preparation for an exam, he had taken an ill-advised number of caffeine pills to gear up for an all-night learning extravaganza. Tears, as is often the case when anyone labels anything an “extravaganza,” were around the immediate corner; he was jittery, unable to study, and couldn’t even hold a pen in his hand when he entered the test completely sleep-deprived the next morning. Most people would react to such a story by learning a valuable lesson about using caffeine in moderation. Kevin? Not so much.

I’ll let him describe his thought process:

"Hmm...the professor is saying something, maybe I should listen. I like words! Caffeine pills to study for a test? That sounds like a good idea. Let me do a cost-benefit analysis. I'm already spending quite a few dollars buying coffee day in and day out. Why not switch to the pill form? After all, it’s considerably cheaper and more convenient, with the only difference being the stigma attached to taking a pill. I'll pick up a small bottle of No Doz over the weekend and use it as necessary. And, in other news relevant to this particular internal monologue, I’ve reached the obvious conclusion that David is far superior to me in many ways. I’ve come to view him as something of a demigod amongst the mere mortals that populate this particular institution. Self, let me enumerate the ways in which he brightens the world. Number one…"

Ok, so I may have fabricated some, or all, of the preceding stream of consciousness. Yet after Kevin brain-birthed the severe preemie that was this particular idea, I bore witness to the ebbs and flows of his No Doz-fueled journey. Here’s a running timeline of my observations:

Monday

1pm: Kevin is visibly tired. He’s nodding off a bit in class and mentions that he had to wake up extremely early to prepare for a lab meeting. His week is off to a good start.

2pm: Kevin puts his plan into action, taking one No Doz and washing it down with a Coke.

3pm: Kevin is taking notes like a madman. Holy crap, he’s a learning machine. How much knowledge can one man accumulate? Maybe he’ll remember me when he’s President of Medicine…

11pm: Kevin is online, working on an abstract he needs to submit for his research project. He indicates that it’s going to be a really long night. Good thing he had that No Doz earlier.

Tuesday

1pm: Kevin was up all night working on the abstract and only got a few hours of sleep. The solution? You guessed it - No Doz II: Son of No Doz. And he’s off to that rarified air of godly productivity most people can hardly fathom…

Midnight: Kevin is online. He has to get up early tomorrow yet again, but hasn’t been able to fall asleep.

Kevin: Ohhh noooo…I think I’ve made a terrible mistake.

Wednesday

12:30pm: Kevin, apparently unaware of the causal relationship between No Doz and his deteriorating QoL, stumbles into class on the strength of sheer willpower and an early-morning No Doz.

Kevin: I think I should’ve paid attention when they talked to us about D.A.R.E. in 5th grade.
David: I’m pretty sure we saw your story on a PSA. Except your name was Johnny…and then you died.
Kevin: …
Kevin: …
Kevin: …
David: If you develop an arrhythmia, can I listen?

2pm: Kevin is struggling. His head is on the desk. Hm…what should I do? Send him my notes? Try to wake him up? Or I could just poke him. Yeah, I’ll just poke him.

Julia: Uh, is Kevin OK? Maybe you should po-

David: Already on it.

2:30pm:

David: Are you OK?
Kevin: I need to leave class to go take a nap.
David: So this is how it ends, huh?
Kevin: It’s been a good run.
David: RIP, good sir.

5:30pm:

Kevin: I'm going home to sleep. Sooo tirrred.
David: Why is your eye twitching?
Kevin: Maybe this wasn't such a good idea.

---------------------------------------------------------------------

Luckily, after a few nights of rest, Kevin was back to normal by the following week. His No Doz days are now behind him. He’s a little bit older, a little bit wiser, and ultimately not much worse for the wear. Plus, I’ve inherited some No Doz…

Comic: Ideal vs. Reality - Anesthesiology

Perhaps I have these two cases flipped.

Musings: Oh sweet irony

Kevin and David are not good at diagnosing

Most of you guys probably know this, but in the second year of medical school the curriculum takes a much more clinical turn. For every physiological fact we learn, we learn 3 things that can go awry with the body Xenu has blessed us with. This newly acquired knowledge has given us great diagnosing power. And with great power comes great responsibility… responsibility David and I have not exercised well.

It’s a common saying that when you hear hoof beats, think horses, not zebras. The main point is to steer diagnosticians towards the most probable diagnosis, however mundane, rather than the flashiest. To that I say “no thanks.” After all, House didn’t become a network hit by diagnosing tennis elbow and the common cold. In order to keep my diagnosing mind sharp, I’m always diagnosing my friends, classmates, strangers, the hobo that lives outside Julia’s window, etc etc. Unfortunately our batting average in this zebra clubbing contest is sitting at a paltry .166, well below the Mendoza line. Anyways, to better illustrate my point, I've created a little table of all the misdiagnoses we've made so far.


Can I think of this instead?

What we observed	Our differential diagnosis	What it really was / most likely is
1. Bloodshot eyes 2. Excessive desire to eat	1. Cicatrical pemphigoid With comordibity of: 1. Pica	Riding the Pineapple Express
1. Wrinkles 2. Brittle bones 3. Liver spots 4. Hair loss 5. Member of our class	1. Hutchinson-Gilford Progeria Syndrome	John S. (apparently he's just really old)
1. Dozing off in class	1. Narcolepsy 2. Myasthenia Gravis	Boring lecture
1. High blood pressure	1. Pheochromocytoma	Too much beef stew
1. Lack of verbal impulse control 2. Erratic class attendance 3. Severe paranoia	1. Schizophrenia	Jess
1. Asian guy with a cough	1. SARS 2. Bird Flu	Both SARS and Bird Flu

David has difficulty with doors

Like several other buildings worldwide, our med center has doors. Thus, unless I want to enter the premises ninja-style through an open window or scale the formalin-scented tresses of an MS-1, I must navigate a minefield of door-related obstacles to get my daily dose of brain food. This may seem trivial to most of you but, as evidenced over and over again in this space, I am severely challenged (Kevin’s the brains; I’m just a pretty face).


Here are only a few of the misadventures I confront on a regular basis*:

1) The never-ending door hold

If I’m entering a door and notice a person or two following behind me in close succession, I do what most others do and hold the door open to save them a bit of time and effort. Sometimes I just keep the door pushed open until the follower reaches me and takes over for him/herself. On other occasions, I go all out and employ the full-blown stand-aside-and-let-the-other-person-go-first maneuver. If there is a steady flow of people, this latter scenario can turn into the dreaded never-ending door hold, wherein each person is followed by another, and there is no clear opportunity to exit Entryway Purgatory and actually go inside. The only alternative is to play Door God and jump in front of a hapless soul whose expectation of a sweet door handout is tragically dashed as I dart into the line. That, simply put, is a power I feel unprepared to wield.

2) The second-door betrayal

Our med school has two sets of doors in close succession in one of its main entryways. The first opens from the outside into an indoor area with stairwells to the floors above and below. The second opens into the interior of the building itself. For all intents and purposes, they function as one single entry entity. Whenever I’m crossing through this dual deathtrap – a modern-day Scylla and Charybdis – and there is someone behind me, I typically open the door twice for them in turn, both times using the more casual push move described above. However, if I decide to use the full-on opening, this results in the other person passing me and taking the lead. Now, my initial gesture came with no strings attached, but one might reasonably expect that, one good deed deserving another, the other person would repay the favor and hold the second door for me. Alas, such human decency often goes unexpressed; the other party just races ahead without throwing even a weak attempt my way. Why, traitorous two-door turncoat, must you bring your renegade ways to our hallowed medical halls?

3) The wrong-way chest bump

This is one of the more perplexing breaches of acceptable doorway etiquette. It occurs when I am innocently approaching a double door on the appropriate right-hand-side, thinking to myself, “Boo-yah, I’m about to enter the crap out of this door. Get ready, people already inside, you’re about to be more numerous by one…” Then, right as I open the door and begin my glorious entrance, some random person coming from the other direction swoops in on the same side, my side, and tries to slip past me, conceivably to avoid the unbelievably difficult ordeal of opening the door on the opposite side. Unless this door poaching is executed perfectly – and even if it is, seriously, why? – the two of us end up in an awkward situation where we have to shift quickly to avoid running into one another. I’m left feeling sad, violated, and a little bit empty inside.

-----------------------------------



*Credit goes to Jess and Luke, the resident MS-2 giant, for the inspiration for this rant. I couldn’t have done it without you two. Well, maybe I could’ve done it without Jess. Yeah, I definitely could’ve done it without Jess...

New poll up

Thanks to Scalpel or Sword, William the Coroner and several other blogs, we've received a large influx of visitors from all over the place, making our previous poll all but useless. Given the large number of new visitors, we're more interested in how often you guys check this blog so now there's a new poll off to the right . Perhaps the results will motivate us to produce more content in a timely fashion. But then again perhaps not.

Comic: Ideal vs. Reality - Gastroenterology

Seems like this series is slowly turning into a "Best case scenario vs. worst case scenario" kind of thing. Oh well, too late to change the name now.

David wonders when to wait while walking

Long-time readers of IDDx may remember previous entries Kevin and I wrote about awkward and/or strangely captivating interactions we had while walking in or around our med center. Today, another such scenario occurred, enabling me to complete the epic Really, Really Narcissistic Walking Post trilogy.

Allow me to explain…

After class let out this afternoon, Kevin and I started down the main walkway that leads from the med center to the primary bus stops and side streets that many students use to get home after a long day of edumacation. After a few minutes, we noticed Emily, one of our friends, walking behind us. She was close enough to recognize without difficulty, but far enough away that a wave wouldn’t necessarily grab her attention. I proposed waiting for her to catch up, but Kevin, who hates people, suggested we follow the Anti-Blackhawk Down Rule and leave every man behind.

This choice seemed fair, as Emily was a good hundred yards behind us and appeared engrossed in a phone conversation. Still, the event raised the question about proper Waiting While Walking etiquette that we inevitably beat into the ground. Specifically, how close must person A be before it becomes appropriate/expected for person B to wait for A to catch up? It’s probably a bit excessive to just wait for any person close enough for a positive ID. That might entail several minutes of waiting, and who knows if the other person is even interested in joint ambulation. On the other hand, it’s far more interesting to talk with a friend than it is to walk alone, so erring on the side of social interaction is always a plus.

Clearly, the decision is nuanced. Much depends on how well one knows the lagging party. If your girlfriend or close buddy were behind you, you’d definitely wait regardless of distance, but the Wait Zone diminishes significantly for mere acquaintances. Also relevant is the distance left to travel; if you’re a few steps away there’s little need to linger, but if you’ve got a mile to go both parties might enjoy a companion. Finally, there’s something to be said for avoiding the really awkward “Yes, I saw you look back, recognize me and then act like you didn’t and keep walking as if nothing had happened” scenario that I wouldn’t wish on my worst enemy (you’ve been spared, Jess…).

In the end, we concluded that the threshold distance is just close enough that the two people could communicate without resorting to strained yelling. If the rear party can flag down the leader without shouting too loudly, the person ahead is probably close enough to wait.

We attempted to test this theory with some “Can you hear me now?” trials, but one of those safety beacon things started beeping right where Kevin was standing. So, like any good scientists, we scrapped the experiment completely and just assumed we were right.

And by that time, Emily had caught up anyway…

Please vote... for our poll

Hey guys, some of you might have noticed that we added a little poll on the right side. We're interested to see how many people actuallly read our blog regularly and who you all are. Deep down we think its just our friends who are humoring us with pity visits, much like how parents think their toddler's handturkey drawing is an epic masterpiece.

Comic: Ideal vs. Reality - Summer Research

Kevin observes "John" preying on unsuspecting women at orientation

School has finally started for me and David, ending a glorious summer of groundbreaking research and lifesaving. Like most med schools, we started off with 3 days of mindnumbing orientation during the day and barhopping in the evening. In order to foster greater school unity, the 1st (Hi Robin, our first real fan) and 2nd year classes often go on these bar excursions together. Now perhaps we simply didn't notice this last year or maybe its only come up this year, but many of my fellow second years actively pursue any and all female underclassmen at these events. Let's take a hypothetical character, say... "John", and follow his foray into the 1st year herd.

Unlike most guys who are excited to see old classmates again, "John" is on a mission. A race against his biological clock to lock down the elusive Single Female Medical Student.


John

Unlike 30 years ago, female are the majority in medical schools today. Unfortunately, the majority of those women are in long term relationships, a fact that's not readily apparently upon initial contact. This is bad news for our friend "John", since he must slog through as much as 10 minutes of conversation (although could be as quick as 10 seconds) before finding out that important nugget of information. The conversation is always benign, an inquiry into where the girl is from, what college she went to, if she took anytime off. The usual. But somewhere along the way it comes out that she has a boyfriend, is engaged or worse yet, married. At those moments, one could see J's smile start to sag, his enthusiasm wane, having failed once again failed to find his soulmate.

Ladies, be on the look for "John" at a class orientation near you.

Comic: Ideal vs. Reality - Emergency Medicine

David thinks Michael Phelps is disproportionately Olympified

Since the Olympic Games began about a week ago, I, like nearly every other world citizen with a television, radio, or internet connection, have been following the aquatic pursuits of Michael Phelps. Phelps, in case you didn’t know, is on the precipice of heretofore unrealized Olympic greatness. Having already won more career gold medals than any other competitor in history, he is only three events away from breaking Mark Spitz’s mark of seven golds in a single Games. Along the way he has dominated nearly every event, setting world records in each and running away with all but one – a relay in which he was only one-fourth of the team. If Michael Jordan married a dolphin and the pair had a child with a slight underbite, that dolpho-Jordan would be Michael Phelps.

Yet despite MP's greatness, his medal count affords him acclaim disproportionate to his actual accomplishments. Sure, he wins a crap-load of gold medals, but is it really that impressive that he does a bunch of arbitrary variations of the same thing? Breaststroke, backstroke, butterfly, dog paddle, splashy-splashy…isn’t that just ‘swimming?’ What reason is there for him to earn a different gold for each one? Each stroke may utilize a unique skill set, but that doesn’t mean it deserves its own event. They wouldn’t give Tyson Gay another gold for running 100m with one arm tied behind his back, a third if he skipped every other step, or a fourth if he ran with a pirate patch over his right eye, so why do swimmers get a veritable medal buffet for doing more or less the same thing?

When the Olympics started in 776 BC, there were probably only a few events – wrasslin’ in oil, pissing off Zeus, epic poetry, etc. As the Games progressed, they probably added additional distances and disciplines in descending order of significance just to flesh out the schedule. But at what point did they start piling on really slight permutations of the same events?















But can he piss off Zeus?

I always thought the beauty of the games was the opportunity to see the superlative competitors in action. Who’s the fastest? Who jumps the highest? Can someone unseat Homer at writing poems that never end? These are challenges with practical applications in real life. If you’re running away from a bear, you better sprint like the wind. If you’re swimming away from a shark, you need to make it rain freestyle. Any other stroke would end in tears.

















Time for backstroke?

Sure, Michael Phelps is awesome. If he was a physician, he’d make Paul Farmer look like Dr. Nick. And yes, swimming isn’t the only offender – several other sports have way too many medals for what are essentially meaningless variations of the same basic challenge. Yet swimming is the biggest offender, making Phelps the most obvious medal baron. He may be the greatest swimmer ever – or at least the best without a kick-ass mustache – but until he oil wrassles like a champ, I will remain only moderately impressed.

David appreciates med school

Most of the time, when a new acquaintance or old friend learns that I’m a med student, his or her initial reaction is two-fold – “Wait, you’re going to be a doctor? Weren’t you always a bit…slow? (Note: they say more, but it just gets meaner from here)” and “Wow, I’ve heard that’s really stressful. Are you just working non-stop, 24/7?”

The answer, at least to the latter question, is thankfully, “No.”

Kevin has discussed this issue, at least tangentially, in previous posts about how smart and/or dedicated one needs to be to cut it on the other side of the pre-med tracks. Depending on one’s educational background, med school is likely to involve significantly more work and a far larger volume of material to toss in the ole’ rote memorization machine. Still, any additional stress stems mostly from the fact that students are one step closer to their ultimate professional path, and thus each accomplishment and setback resonates more permanently in one’s future career, rather than from anything inherently stressful about the content of the basic science curriculum. Sure, there are new and quite-significant responsibilities in the clinical arena – patient interviews, preceptorships that may involve a wide variety of “doin’ stuff,” etc. – that can be a big jump from many students’ pre-med activities. Yet for the most part, med school isn’t nearly as taxing, time-consuming, or “bad” as it is often cracked up to be.

The other day, I came across the story (read: stalked via his blog) of an old college classmate that shed further, wonderful light on how not-bad med school actually is. He graduated in 2006 and blazed a previously-unheard-of trail from my undergrad into the world of high finance (fuh-nance, not figh-nance), landing at a top bulge bracket bank in the city. There, he filled the high-paying, high-prestige, high-stress position of an investment banking analyst, a job almost universally associated with lots of work and never-ending hours. What makes his example more interesting than any other banker’s is that he managed to track his working hours rather meticulously throughout his two-year stint in IBD. So, rather than vague notions of “Duuude, I worked 120 hours last week,” he has hard data to back up his 671 day journey.


Well, that data shows that he worked over 11 hours everysinglefreakin’ day averaged across that two-year span. Not 11 hours per work day, mind you, with some weekends/holidays off, but 11+ hours every day including his much-needed time off for Christmas, vacationing, etc. (which, incidentally, ended up being less than one day off every two weeks). Including time for lunch/talking oneself out of quitting, that averages to a 9am-to-9pm gig every day, without fail, for two straight years. And this doesn’t account for the fact that this guy is one of the smartest people I know, and thus probably far more efficient at banking in an investment-y manner than the average analyst. So, whenever pre-med/med school life gets you down, dear reader, remember this anecdote for some wonderful perspective.


Damn, it feels good to (not) be a banker…

David and Kevin are scientists

As some of you know, we are both currently completing summer research projects within our medical school’s Dept. of Surgery. Our studies surround two different surgical procedures and both involve, at least in part, retrospective assessments of patient pain and/or quality of life following the respective operations.

These positions have put us in a very science-y mood, providing the impetus for our own groundbreaking experiment. Standing on the shoulders of previous scientific giants – Mendel, Pascal, this dude – we have decided to explore the relationship between the quality of our own lives and the consumption of one of their primary staples: beef stew.


Typical subjective assessments like visual analog scales or “numbers” clearly will not suffice for science of this magnitude. As such, we will employ a modified instrument using real-life QoL markers that everyone can understand. The upper bound is defined as “post-baby-saving euphoria,” while the lower bound is set at “really, really sad clown.” If those aren’t intuitive, can’t-miss distinctions, then I’m going to quit science right now.


Will unspeakable amounts of beef stew lead to a glorious potato, beef, and sodium-induced stupor or a cesspool of potato, beef, and sodium-induced self-loathing and despair? Only time will tell.


One thing is certain – alert Stockholm. They’ll want to know about this one…

What's the deal with Mesothelioma lawsuits?

How much money could class action lawsuit lawyers make from a mesothelioma lawsuit case? What's the lawsuit against, the asbestos manufacturers or the health insurance agencies themselves? What kind of health insurance policy wouldn't cover any kind of cancer?

Kevin gets served by the lunch lady

Cafeteria food is notoriously bad no matter where you are but for some reason, hospital food takes the disappointment to another level. During school, we are often forced to choose the least of many evils, which ends up being the chicken sandwich. However, a man can only consume so many chicken sandwiches before he is driven to madness. In an effort to avoid such embarassment, I try to alternate my nutritional choices while eating either.



Today, when the clock struck noon, I felt the rumble in my stomach indicating that a morning's worth of life saving has taken its toll. I prompty dropped what I was doing and went to down to the cafeteria to stuff my body with the necessary nutrients to saves even more lives, perhaps a child or two. I chose the chicken sandwich just yesterday so that option was out, instead I opted for the meatloaf. Everybody knows that any kind of loaf, whether that be bread or meat, comes out of the oven with a slightly tapered shape that's narrower at the ends. When I arrived at the head of the line, they were already at the middle of one of the loaves. Thinking I've lucked out with a huge piece, I asked for 1 serving. The lunch lady silently sized me up and down, took a look at the half loaf in front of her then proceed to swiftly cut a tiny slice from the uncut end. What. The. Fuck. At this point a flurry of emotions washed over me. But as I stared into the post-menopausal, estrogen-deficient, eyes of the ambiguous Asian country lunch lady, I knew this fight was not worth picking. Taking in a big sigh, I grabbed my plate and walked away in tiny-meatloaf-shame.



You win this one ambiguous Asian country lunchlady, you win this one.

Kevin witnesses a public shaming

It's been a few weeks since I started my job as a glorified secretary in a clinical research lab and I've finally settled into the daily ho-hum routine.  Every Monday we have a lab meeting where researchers go over their progress and a single research fellow presents his or her data to the group.  So I was in one of these meetings one day and the conversation came to the status of a certain patient info database that one lab tech was responsible for maintaining.  It became quickly apparent that the database was woefully underpopulated and outdated, much to the ire of my PI.  Before I give transcript of what followed, I need to tell everyone that my PI has a way of calling out every ouce of bullshit anyone ever says without a single smirk or grin.  Essentially, he's completely deadpan and unabashed in saying you suck.  Let's continue:

PI: So you haven't been updating the database is that correct?

LT: Well... no... I try to update the files of the patients already in there and I think that may be a lot of work, I go back and forth between two computers bla bla bla (at this point I tuned out).

PI: So you haven't been entering any new patients

LT: No

PI: So what exactly do you do...

*INSERT REALLY AWKWARD SILENCE*

LT: Well... I'm updating the people that are already (blablabla basically the same thing all over again)

PI: Ok ok, regardless of that.  By your estimate, how long would it take to fully populate the database with all the patient files

LT: *Long pensive silence* 2 weeks

PI: No, seriously.  How long

LT: *Looking even more awkward* If I just enter the most basic data... 3 weeks

PI: *Smirking slightly* Ok, if you say so.  But I think you're just telling me what I want to hear rather than what is realistic.

*Scene*

So basically I just saw the infamous scene of Office Space reinacted in real life without the employee blowup.  And now I live in fear of disappointing my boss.

David Gets Pimped

Our med school, like many others with a traditional curriculum, offers students a full three-month summer following the completion of their first year. This provides a valuable opportunity to gain more research or clinical exposure as well as a welcome reprieve from the constant flood of book larnin’ that demands almost all of the preceding nine months. I will be spending the time completing a research project in general surgery. One of the perks of my particular project is the chance to scrub in on a variety of cases with my PI, who is also a surgical attending. This is very cool. This also means I get pimped. This…not as cool.

For anyone familiar with medical school or residency training (or maybe even a medical TV show), the following will be no great revelation. Pimping occurs when junior trainees (med students, interns, residents) are asked questions of varying difficulty and/or obscurity by their superiors (typically more senior residents or the totem pole-topping attendings), often during rounds, patient presentations, or in the OR. As the pimpee, you’re put on the spot with a second or two to find the right answer and no other resources at your disposal. It is not unlike the common undergrad scenario in which the professor randomly calls on an often unsuspecting student to answer a question in front of the class.


Pimping comes in a variety of flavors. Older medical students have described its use as something of a punitive mechanism employed primarily against those who are unprepared, overconfident, or perhaps just annoying. For the most part, however, it functions as a valuable teaching tool; it takes a lot more study/review to be ready to answer a question you don’t know is coming. Further, the potential for shame is undeniably a major part of pimping’s effectiveness. Getting the answer right? Not particularly gratifying. Looking incompetent in front of an OR full of doctors and nurses? No thanks. After all, no one wants to look bad in front of his peers or, worse, the people who hand out the H’s. One’s only recourse is to prepare as thoroughly as possible for the case at hand and hope for a bit of good fortune in the question lottery.


So far, my experience as a medical working girl has been relatively painless. The attending isn’t grading me, so there’s no tangible punishment to be had for a series of incorrect answers. He’s also a cool guy, so he’s not interested in embarrassing me or fixating on minutiae. Basically, he or the senior resident assisting the procedure asks questions that someone with a year of med school – or at least a quarter of gross anatomy and some background prep – should be able to answer. Still, the exercise isn’t a walk in the park. Identifying real-life, bloody anatomy – especially if you’re looking inside-out from the view of a laparoscope – is a lot harder than picking out structures in Gray’s or Netter’s or the all-the-time-in-the-world-for-meticulous-dissection cadaver lab. And when the question is about anatomy, rather than the mechanism of some antibiotic/3 causes of X/common presentation of Y, it stings a bit more when you fail to hit the proverbial mark (“You don’t know what that is? It’s right there in front you…”).

All in all, getting pimped is sort of like med school in a nutshell – it’s not always fun, you periodically look stupid, and sometimes you have to walk the streets…er…

David and Kevin are awesome at How Bad Can You Be At Knowing Who People Are™

After a long break due to final exams and rugged mountain vacations, I am proud to announce that we have successfully completed the first year of medical school. I apologize for the intolerable aching that has surely penetrated your soul, loyal reader, as you have struggled to maintain the will to live during this blog’s extended hiatus.

To celebrate our triumphant return to the golden pedestal in your online lives, I present yet another random musing of arguable worth.

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Recently, during some downtime on a post-finals trip, Kevin and I played a popular game with a few med school buddies, Robby and John, that I will call How Bad Can You Be At Knowing Who People Are™. Kevin, Robby, and I are really, really good at this game. John is really, really old, so he gets to play the host to save his heart from the inevitable overexcitement that accompanies HBCYBAKWPA™. As host, John presented a picture of a classmate and asked if the three of us could pool our collective brainpower to identify him or her by name. Going through the class, the three of us, combined, could only pick out a first or last name for about two-thirds of the subjects. Keep in mind, this is after a year’s worth of classes.



I’m bad with names in general, and Kevin doesn’t speak the good English, so perhaps we lack the requisite skills to know who people are. However, a freak prosopagnosia outbreak notwithstanding, some responsibility belongs to the unique med school social dynamic. The shift from college to medical school is one of those lifestyle transitions that one is vaguely aware of during the admissions process, yet cannot truly be appreciate until being in the thick of the med school action. In many ways, at least for people coming straight from undergrad life, medical school is like College 2.0; we take more classes, sit for more exams, and waste a lot of time discussing what we’re going to be doing in a few years. We still have no money, and most of us are going further into the red. Yet people have far more independent lives and bring much more diverse backgrounds to each incoming class.

Beyond varied expertise in both baby-saving and non-baby-saving endeavors, students come from a broader spectrum of ages and life experiences than those one meets at earlier rungs of the academic ladder. During undergrad, if you live in a dorm, you see the same people daily; you share meals, do fun stuff together, and see the same friends before you go to sleep and as soon as you get up in the morning. In med school, many classmates have spouses and children and live far away. Classes last most of the day and studying demands much of the evening, so there’s a significant reduction in leisure time. Thus, despite having a class size of only 100-200 students, it’s often difficult to get to know each one of the people you see every day. Or, apparently, to even remember their names…

On the plus side, we now have our first elderly friend (Hi John!) and know what prosopagnosia means. On the down side, I have to live in fear of the moment when I ask a fellow classmate what year he or she is during a med school mixer next fall…

Kevin warns you about cranio-rectal impaction

Disease:
Cranio-rectal impaction (Having your head up your ass)

Symptoms:
Commonly misdiagnosed among the general population, a patient with cranio-rectal impaction will present with gross ignorance of current events or sociopolitical issues yet remain very outspoken. Unlike someone who is simply misinformed, people with CAI will claim to be experts in all fields of knowledge and refuse to acknowledge any information contrary to their own point of view (from inside the rectum). CAI patients are often combative, obstinate and generally annoying to be around.

Etiology and Epidemiology:
The direct cause of cranio-rectal impaction is, unfortunately, unknown but there are several correlative factors. Having a substandard IQ, illiteracy, and being Republican have all been traditionally correlated with CAI. However, recent epidemiological data has indicated a heavy correlation with extreme liberalism as well, thus suggesting a link between CAI and polarizing political views.

Treatment:
Standard treatment for CAI is difficult due to poor patient compliance. Symptomatic treatments via well-supported, cogent, arguments are usually useless, especially in cases of severe impaction. Family and friends of CAI patients are encouraged to take a hands-off approach and simply ignore the symptoms. Anecdotal evidence has suggested that unsuccessful attempts at treatment may exacerbate the symptoms, causing the patient’s head to be firmly impacted within the rectum.

Comic: Med Student Syndrome

Jess Judges People Who Take The Internet Too Seriously

Note: Jess, a frequent comedic muse for all of us here at IDDx, has chosen to grace us with his vitriolic brillance in this, the blog's inaugural guest post. Enjoy.
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In an effort to break the previously nigh-impenetrable color barrier of YM/IDDX, I have decided to end my months-long silence. Perhaps you’ve seen the way I seem to dominate the subconscious of our two gracious hosts and co-authors and wondered: “who is this mysterious and much-maligned ‘Jess’ about whom David and Kevin cannot stop thinking?” I know I have.

If you’re looking for a break from the pet peeves, the snap judgments, the arrogance, and general holier-than-thou attitude demonstrated by the Ubiquitous Duo, I’m afraid I’ll have to disappoint. In the spirit of this interblog, I’ve decided to contribute my own pet peeve, inspired by a recent firestorm of controversy surrounding David’s latest post. That’s right, Takes The Internet Far Too Seriously Guy, this post is about you. Your self-righteous but, ultimately, cowardly anonymous soapbox rant has found semi-permanent purchase in the electronic archives of Indifferential Diagnosis. Congratulations – if there’s one thing I love more than a good rant, it’s irony.

TTIFTSG, or TISG, for short, is an odd and unfortunate beast. Cursed with a chronic case of Perineal Silicosis, and a close relative of Self-Righteous About Obvious Or Long-Ago Resolved Causes Guy, he spends his evenings perusing and, usually, enjoying the assortment of witty banter that can be found on the internet. Usually benign, TISG has a proclivity for sudden bouts of ineffectual whining and self-righteousness which manifest, usually, in anonymous posts on blogs which have, intentionally or otherwise, touched him in a sensitive place. An ironic animal, TISG often vents his own insecurities by assuming the moral high ground over complete strangers, often engaging in copious amounts of projection in order to make himself feel like a sensitive, intelligent, and worthwhile human being. What places TISG an evolutionary stratum below his cousin SRAOOLARCG is that TISG often, by definition, hides behind the veil of internet anonymity to foist his presumed ethical superiority on others, thereby preventing any potential retaliation.

There are a number of logical fallacies inherent in our local variant of TISG’s behavior. In no particular order, they are:

1) TISG admits to having read at least ’10 other posts’ with ‘shit like this.’ Presumably, if it offended him in this post, ‘this shit’ offended him in these other posts – and yet, he visits this site frequently. Many times a day, in fact. That’s right, TISG – we can see you. In fact, I counter your rhetorical query with one of my own: who goes out of their way to read a blog, created by individuals he does not know, if it offends him so?

2) TISG has judged David and Kevin to be insecure, judgmental people based on their harmless, stream-of-consciousness rants in a blog predominantly intended for friends and classmates. His assertion is based on the UD’s habit of ‘going out of their way’ to judge others. By going out of your way to pass judgment on D and K, TISG, are you not every bit as insecure and judgmental as you accuse them of being?

3) That you continue to read the blog is evidence that you enjoy it. Therefore, one can only presume that you are looking to assure yourself that you can read this blog and still be a good person by condemning others – the difference between you and our hosts is that you, TISG, meant it. Don’t get me wrong, D and K mean every word – especially in re: me – but their intention is not to make anyone feel bad (though they obviously have), but to amuse others who enjoy such humor. You, on the other hand, are serious – and your intention was simple: to attempt (unsuccessfully) to make them feel bad for their work. I leave it to the kangaroo court of classmates and friends to determine which one is, as they say in ‘the biz,’ douchebaggier.

4) The simple truth is that David and Kevin’s posts are predominantly inspired by, to use your eloquent colloquialism, ‘shit like this.’ Without people who acted ridiculously, how would they propagate their insensitive and judgmental wisdom throughout the internet? The self-righteous hilarity of your comment is precisely what makes them, and their fateful readership, tick. That they are meant light-heartedly and sarcastically has obviously been lost upon you. Ergo, you’ve prompted precisely the sort of behavior to which you are opposed.

Still, I must commend you – comments like yours, coming from outside of the intended audience (comedically-astute and thick-skinned individuals) make this all the more enjoyable for those of us. Simply put, TISG, your presence, while confounding and ultimately self-contradictory, is panacea for a pair of writers with nothing better to do than belittle others for their own amusement – immediate reward for minimal effort, borne entirely of your embarrassing misstep. And make no mistake – this is embarrassing for you.

For those of you who want a one-sentence summation of this rant, here it is: the blog is called Indifferential Diagnosis for a reason. Thank you for coming, but check your soapbox at the door.

Unless you’re David or Kevin, of course. That’s just one of the many unfair societal double-standards to which we’re subjected.

I feel so much better about myself, now.

David Presents His #2 Pet Peeve: Considers It Tomorrow At Midnight Guy

It should be painfully (delightfully?) obvious that 1) Kevin and I enjoy ranting about random things; and 2) these rants are so inane and unproductive that each person who reads them finds himself or herself a bit dumber as a result. This bodes particularly poorly for Julia, whose previously ludicrous 200 IQ is probably at -5 now.

Nonetheless, in an effort to continue the general dumbing down of all those with whom I anonymously associate on the intertubes, I present my second greatest pet peeve of all: Considers It 'Tomorrow' At Midnight Guy (MG, because I'll definitely get tired of writing 'CITAMG' 20x in the next three paragraphs).

On the surface, MG probably doesn't seem like he'd be that annoying. After all, the next day does officially start at 12:00AM and, perhaps more importantly, you might find distinctions about when 'tomorrow' truly begins completely insignificant in the grand scheme of things.

Well, then, you'd be wrong. Sure, considering it to be tomorrow at the stroke of midnight doesn't necessarily hurt anyone, but MG goes far beyond this simple interpretation and uses it for pure evil. Most frequently, MG derails a random late-night social situation by being an unnecessary time-stickler:

Hero: Man, it's really late, I can't believe I have to get up so early tomorrow.
MG: You mean today.
Hero: What?
MG: You have to get up TODAY. It's past midnight, so it's actually the next day.
Hero: Gawd, why are you like this?

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Or, MG can make typical scheduling excessively difficult:

Hero (at 2AM): OK, so we're meeting tomorrow to discuss the project?
MG: You are correct, sir.
Hero: OK, later.
MG: See you Wednesday.
Hero: Wait, what? I thought we were meeting tomorrow...isn't that Tuesday?
MG: Today's Tuesday, tomorrow's Wednesday. Check your watch.
Hero: OK, you obviously knew, based on the context, that I was talking about Tuesday. You know on Wednesdays I teach that Being Awesome class and on Thursdays and Fridays I save babies.
MG: Yeah, but tomorrow's Wednesday.
Hero: Seriously...why?

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Thus, MG creates a significant hassle where there is absolutely no need for one. Everyone who knows him has to adjust their expectations purely because of his outlandish anal-retentiveness. No one really benefits, people are routinely confused, everyone dies a little bit inside, and sometimes people show up to meetings when no one else is there.

OK, end rant. It's way past midnight and I need to wake up early today...

Introducing: Indifferential Diagnosis

Greetings,

To the millions of loyal readers out there, we just wanted to give a quick heads-up that we decided to change the name of the site to Indifferential Diagnosis. We wanted to go with a more medically relevant name, but don't worry, everything else will continue as is. Same great taste with only half the calories.

The new website is http://iddxblog.blogspot.com, and going to the old site will just auto-link you here.

We managed to move all the old posts over so all the amazing content is still intact.  Unfortunately, the switch-over to the new site means we lost all of the comments on the older posts, so feel free to make it rain in that department.

Well, see you later!

Kevin and David

Kevin has too many med student pet peeves

I've noticed quite a few oddities in medical school that for some reason never really bothered me during my undergraduate studies. They’re not offensive but odd enough for me to take notice. I don’t think these people are unique to my particular medical school so maybe everyone can relate. Who knows, maybe you’re one of my pet peeves.  Here's my top 5

5. Inappropriate questions
We have one particularly gross offender that can just fire off questions non-stop. Most students average maybe 1 question per week, if that. I think I can count on my hands the number of questions I’ve had to ask in class. But this guy is prolific in his question asking. Most of the time, the questions are only marginally relevant to the discussion and usually much too in-depth to be of benefit for anyone else. Instead, the rest of us are forced sit through his ego stroking barrage of questions while subtly shaking our heads.

4. Too many colored pens
I never really understood this but some people still insist on taking all their notes on paper even though everything is prepared on powerpoint slides. Environmental irresponsibility aside, I’ve noticed some people who really really love color coding their printed notes. I’m not really sure what color corresponds with what, only that these people have upwards of 8 pens of lovely pastels to help them remember conjugation is just a fancy word for bacteria sex.

3. Laptop on laptop sleeve
This really isn’t bad or annoying as much as it’s perplexing. I’ve noticed that some people like to place their laptop sleeves underneath their laptops while in use. I can only assume this is somehow meant to protect the machine from the ravages of our plastic table top. Such misguided attempts to protect their $1000+ investment is understandable but ultimately ironic. The most likely source of damage to laptops, and most computers, comes from improper venting and the accumulation of heat that damages CPUs, RAM, Hard Drives etc. And nothing builds heat more than placing a insulating foam pad on the bottom of the computer to effectively block any and all vent holes the engineers might have placed. Don’t believe me? Try using your computer by putting it on top of a pillow or bed and feel how hot it gets.

2. Taking too long to leave the classroom
At the end of every class I’m among the first to pack up and get ready to head out the door. However, I am always impeded by those who are just a bit slower, leaving me in the middle of a row twiddling my thumbs. This is quite frustrating since I dont actively rush through my packing, yet somehow I'm always among the first to be ready. Other people seem to take an endless amount of time packing and talking (never at the same time). Perhaps they love medical school so much, they subconsciously stall their packing ritual to milk ever last drop of medical schoolness before the day is over. Who knows.

1.  Jess
No explanation necessary.

David Discusses 5 Things He's Learned in Microbiology

One of the most important skills one acquires in medical school is the ability to synthesize endless amounts of information and develop useful frameworks with which to organize and understand seemingly disparate concepts. In Microbiology, we learn about myriad bacteria, viruses, fungi, and other baddies ad nauseum, and depend on a variety of such strategies in order to make sense of what sometimes feels like an insurmountable mountain of minutiae.

Looking for high-yield study tips? You've clearly come to the wrong place. Instead, here, in no particular order, are five important things I've learned in Micro so far:

5) Not all fungi are fun.

This pearl of wisdom is from Kevin. They can't all be winners...

4) It's time to page Dr. Robot.

So far, it seems like a computer would be as good or better at diagnosing all of the diseases we've studied. Sure, there are subtleties about each, but for the most part we're focusing on things that approximate a complicated checklist (Fever? Y/N. Burning while you pee? Y/N. Excessive play with turtles? Y/N).

Clearly, the next step is to invent Dr. Robot. One probe in the mouth, another down south, and a way to input the patient's responses to a series of questions that help the robot pinpoint the disease. You could even put a little white coat on him and give him some outstretched arms so people know he cares. (Alternatively, we could just find a human physician named Robot who's a whiz at ID. As long as someone's called Dr. Robot, I'm happy.)

3)Noah should have raised admissions requirements for the Ark.

After God told him to pack up the boat, perhaps Noah should have been a bit more selective about which animals made the cut. He really couldn't find two rabbits without Francisella or a couple flying squirrels that were disease free? He couldn't spare five minutes for a quick delousing effort? Pretty lazy, Noah, even for you.

If animal cleaning wasn't Noah's bag, at least he could've sealed the ship before the syph hopped on board. Nobody wins when genital lesions are involved.

2) There already is a Kevin* Disease (with a twist).

Apparently, a Kevin* Disease already exists. Yet instead of one that Kevin discovers and names after himself in order to watch his viral namesake wreak havoc across the third world, this is a bug seemingly tailor-made to infect Kevin. Perhaps we could call it Bizarro Kevin* Disease? BK*D is actually Bacillus cereus , a bacterium sometimes found in poorly heated fried rice. Tragically, his greatest friend has become his deadliest foe.

Now, every time Kevin uses the microwave, he's walking a tightrope walk of death, through a ring of fire, over a pool of sharks with laser beams mounted to their heads and dogs on their backs that shoot bees out of their mouths with each bark. His life has devolved into a terrifying game of Chopstick Roulette.

1) The vagina is an extremely dangerous place.

Contrary to popular belief, what may seem like a bed of daisies and kittens can actually be a raging cesspool of microbiological evil. Every bug and its brother kicks it in the vagina. Want more evidence? Look at all the bad times that befall neonates. What more would you expect from something that has to bust through this danger zone to make it to freedom?

Kevin Warns You About Perineal Silicosis

Disease:
Perineal Silicosis aka Sand in your Crotch

Symptoms:
Perineal Silicosis is characterized by silicon dioxide deposition in the perineal region.  However, PS has a characteristic neurological component that is the basis of clinical diagnosis.  Patients with PS are irritable, adversarial, sarcastic and annoying during social situations. Behavior can best be described as "bitchy," complaining endlessly over trivial matters that no one else cares about. PS patients are prone to overreactions and endless whining. The rants generated by a patient with PS are frequently vitriolic, overly emotional, and most unfortunately, completely devoid of humor.

Etiology and Epidemiology:
The cause of perineal silicosis is currently unknown but recent studies suggest a heavy genetic influence, with certain populations more prone to infection than others. Rates of occurrence tend to increase during times of stress, perhaps hinting at a hormonal component. Though this is an acquired affliction, the source is undetermined and it is not believed to be communicable with human to human contact. It is believed to strike men and women at equal rates but more accurately diagnosed, and treated, among men.

Treatment:
There is no established treatment protocol for PS but common practices usually include social isolation and/or mockery of the patient. With extreme cases, blunt force trauma across the patient's face using either the metacarpal or dorsum of one's hand may be necessary.  Treatments should be applied PRN by classmates, co-workers, friends or any other volunteer nearby.

Kevin wishes these classes were real

Top 5 rejected class proposals

MED 451: Healthcare for the Overserved/Majority Communities
This course is designed to give graduate students in health sciences an introduction to the issues faced by overserved populations related to health and obtaining too much health care. Course will focus on proper treatment of ailments such as twisted ankles, tennis elbow, liposuction as well as breast augmentation. Students will be taught to overdiagnose ADD and dyslexia as well as overprescribing Ritalin and Prozac.

MED 454: Advanced Infectious Diseases. Pre-req: Infectious Diseases
This course prepares health profession students for work in an Infectious Disease specialty through first-hand experience. All registered students are infected with an infectious disease drawn at random. They have until the end of the quarter to identify the infectious agent and design a successful course of treatment.* Course is Pass/Fail. *No credit given posthumously.

MED 696: Medicine and future relationships
This course prepares physicians on leveraging their degrees in social situations for maximum benefit. Male students are taught subtle but useful tricks in a variety of situations to pick up unsuspecting ladies (and gentlemen if that's your style). Examples include casually saying "I'm sorry I can't do another shot, I have heart surgery tomorrow morning" at a bar and "I just love saving all those children" anywhere else. Women are taught to downplay their significantly above-average education as to not scare away insecure, but otherwise eligible males. Techniques include asking obvious questions you already know the answer to, twirling your hair and stressing your desire to practice only part-time. Final is a practical test of learned skills at the local college bar.

MED $$$: Advanced Selling Out. Sponsored by Pfizer (R)
This course prepares health profession students for work in private practice, specificially in surburbia. Curriculum will focus on the importance of prescribing commercial brand pharmaceuticals over the obviously inferior generics. Small group sections involve role-play situations in which students will learn to turn away the majority of medicare and medicaid patients and strictly adhere to a cash-only policy. However, students also learn the nuances of such a policy such as taking on flashy charity cases for publicity and dealing with medical errors through rapid and effective out-of-court settlements and non-disclosure agreements.

MED 000: Alternate career paths
This course prepares health profession students for work in fields other than medicine. Given the state of the healthcare system today, it is important to educate medical students on other career pathways that could make use of their skill set. The class will focus on three major alternative paths: 1. Medical TV show authenticity consultant, 2. Weightloss commercial spokesperson 3. Medical School professor.

David realizes things finally matter now

At this stage in our education, there has finally come the point where what we are learning will have an immediate, signficant, maybe even life-alterating effect on others in the relatively near future. For me, this marked shift from previous educational experiences seems like a big, perhaps too often glossed-over transition. That is not to say I didn't see this coming long ago - soothsaying and double-negatives are two of my hobbies - but I still think the distinction warrants mentioning.

In high school, some people may undergo fundamental intellectual changes, as they begin to think more abstractly and independently without necessarily allowing teachers or other authority figures to dictate their conclusions. Yet despite all this wonderful personal and intellectual growth, the main scholastic endgame is a golden ticket to the highly-coveted next round: college, and hopefully a good or great one at that. For a lot of students, the academic part of the high school years is less about truly learning and more about getting the grades and SAT/ACT/SATII/ACT3/PSAT9 scores to climb the ladder of undergraduate tiers and get as high up as possible. Though obviously not the only, or even most important, measure of success, getting into a good college still remains a landmark achievement that many identify as the primary educational goal of their upperclass years.

Once you reach Eden University, with its manicured lawns, red-brick quads, flowing fountains, and more libraries than one could ever imagine, then what? Do you learn for learning's sake and explore a whole new intellectual world whose vivacity tickles you deep within your knowledge loins? Maybe you do (or even should). Or maybe you, like countless overs have before, find yourself in the next race, working towards another weighty, seemingly nebulous yet arguably life-changing achievement four more years down the road - med school. That'll be a profound, baby-saving party that won't quit, right? Actually, yeah, it very well could be all that and a bag a Fritos.

Yet because reaching that goal can be challenging, your college time might be spent working towards similar grade/score ambitions that might occasionally force actual learning to the back-burner out of sheer practicality. This isn't necessarily bad. It's hard to do well enough in college to get into medical school, and sometimes, where learning best and improving a grade aren't 100% compatible, it makes sense to favor the latter for the time being. For many, paving the road to the next step is more important than appreciating or learning from every noteworthy stop along the way. Besides, there will be time to catch up on things that were missed or glossed over, and even what's been well-internalized will require quite a bit of brushing up in 1-2 years. So, even if one isn't completely sacrificing learning at the alter of the almighty 'A', a bit of a compromise is sometimes made en route to the ultimate goal.

BUT, once in med school, things actually matter. Sure, grades and scores remain important, but skating through important material with only a mind for H/P/F/whatever may leave students unprepared for the clinical applications that are fast approaching. In college, one could feasily put off O-chem and only do enough to get by in the class. Even the BS MCAT section doesn't require any particularly in-depth O-chem knowledge. In med school, we can't just ignore microbiology and expect it never to pop up in the future. Sure, one might pass the class without knowing all the important details, but the difference is that, sooner rather than later, this stuff is going to be of practical, unavoidable importance. Perhaps this is no big revelation for most people, but I'd argue it represents a fundamental difference in the educational endgame and significantly changes the required approach to the curriculum. This is simultaneously awesome ("Hey, this stuff actually means something now") and maybe even a bit daunting ("Hm, if I don't learn this, there will be real consequences for other people"). Or, perhaps, everyone knows and takes this concept for granted, and I'm just slow enough to find it worth discussing.

Hopefully, this is food for thought. As long as it's not Moroccan food. Excuse me, can I get a fork...

Kevin finds Moroccan Food Illogical

About a week ago I went to a Moroccan restaurant for a friend’s birthday. This was my first foray into Moroccan cuisine and the food, while good, left me confused. Throughout history cultures have had a myriad of methods for consuming their food, whether that be knife and fork, chopsticks or just using hands. Usually no method is better than the other since people modify their cuisine to fit the style (or perhaps vice versa). For example, it would be really inefficient to try to attack a steak with chopsticks, just like how it would be foolish to try to eat a bowl of ramenwith your hands.

Moroccans, flaunting conventional wisdom, have decided to take their cuisine in a different direction. They have opted for the use of hands, a fine and dandy , albeit unsanitary, option. However, unlike their smarter Indian friends, they’ve decided to eschew naan or some kind of bread-like staple. Instead, people simply bare fist hot saucy dishes without the benefit of some kind of protection. This might not be so bad if it’s just rice or a piece of sushi but Moroccans decided to go the couscous route. For those who don’t know, couscous is a type of wheat that is incredibly granular and thus really loose. This is served in conjunction with steaming hot meat (let’s stay professional here) piled on top. So as you try to scoop yourself some couscous goodness, you burn your million dollar fingers on the piping out dish all the while little bits of food is falling off the sides. By the time your hand actually makes it to your mouth, you’re left with maybe 25% of what was originally your share, with the remaining 75% becoming the tears of starving African children.


Do I have to re-invent the spoon from leftover chicken bones?

OtherMoroccan dishes don’t make much sense either. For example, they love serving meat on the bone. This would be fine as finger food if it was served individually, but given the Moroccans’ love of sharing, you feel obligated to break off tiny pieces rather than taking the whole thing. So basically there are multiple pairs of hands going over the same piece of chicken, tearing off tiny pieces of meat over and over again.



Just in case this might be too clean, all their meats feature some kind of fruit sauce that you would normally find in a dessert. Apparently, Moroccans have no time for multi-course meals (edit: in the traditional sense). Instead they prefer to lump all their meals into one dish, resulting in the b'stilla royale: puff pastry enclosing shredded chicken and scrambled egg, and topped with powdered sugar and cinnamon. So basically if your local KFC and Cinnabon collided in a tornado, the result is Moroccan food. Either way, I resisted being the guy to ask for a spoon and finished my meal like a champ, sticky fingers and all.

Kevin presents 5 More Guys You Don't Want To Be

5. Asking for knife and fork at a Chinese restaurant guy
I think everyone knows one or two guys like this. Even though they frequent Chinese restaurants regularly, they refuse or even attempt to use chopsticks. Instead, they flag down the nearest waitress and demand a knife and fork to go with his meal. More amusing than offensive, this guy has steadfastly resisted even the most minor amount of cultural immersion. A close cousin of :Knife and Fork at Chinese restaurant guy" is “Ordering the same thing every time guy.” A mainstay of every Panda Express and Safeway deli, this guy consumes “Chinese” food on a biweekly basis yet never wavers in his dedication to one particular order, whether that is sesame chicken, General Tso’s chicken, or some variant therein. Like true American heroes, these two guys tackle their local cultural forays with a dogmatic ethnocentrism that makes the whole experience rather pointless.

4. Too enthusiastic about racist jokes of other ethnicities guy
Everybody loves racist jokes, especially minorities. Look up any minority comedian and his set is inevitably racially oriented. Chris Rock, Carlos Mencia, Russell Peters… all comics working off of racists stereotypes. All this occurs on a smaller scale among groups of friends, especially ones that are racially diverse. Anyone that hangs out with me or David will inevitably discover our love of Asian jokes. For the most part it’s all in good fun and everyone has a good time. If the situation is right, even our white friend will toss in a couple of good natured ribs. When things go a little too far and the humor becomes just a little be offensive, most white guys will simply smile uncomfortably while observing from a distance. This is a pretty well understood social convention that while it might be ok to laugh with minorities as they make racist jokes, and maybe even toss out a few softballs, it’s never ok one-up your minority friends in their own proverbial house. However, there’s always that one guy who thinks he’s exempt from this convention. He might be inclined to toss out the occasional racial slur during the rowdiness and for the most part it goes unchallenged. After all, no one wants to be Overreacting guy either. But please take note, while it’s ok to laugh, it’s rarely ok to make jokes at or above the level of offensiveness your minority friend are tossing out.

3. Jesse
Yeah, I don’t want to be him either

2. Overplays inside-joke he’s not part of guy
“I love inside jokes. I hope to be a part of one some day. ” –Michael Scott, The Office. Inside jokes are a fundamental ingredient in any good friendship dynamic. They are inherently funny with very little set up and can be tossed out frequently as long as it’s situationally appropriate. Given their popularity and the overwhelmingly positive response among those “in the know,” some people might be inclined to force themselves into an inside joke they’re not really a part of. Often times they may hear the joke done once or twice but without fully understanding the back story. Thus, armed with an incomplete understanding on the inside joke, they’ll toss it out at random. This, of course, results in awkward silence or perhaps a pity laugh as the rest of group wonders who this guy is. Don’t be that guy.

1. Being named David guy
Historically, being David has been cushy. A biblical story here, a statue there, pretty good. However, if David was a stock, the opportunity to sell high has long passed. The current crop of Davids has been disappointing to say the least. The slide began with David Duke, born 1950.
After graduating LSU, he decided to dabble in politics and race relations by starting a local chapter of the KKK, eventually rising to the level of Grand Wizard.

Feeling this wasn’t douchey enough, he left the KKK in 1980 to form the NAAWP. Yep, the National Association for the Advancement of White People. Unwilling to settle for racist, Davids decided to enter the entertainment arena as well.

Born 2 years later than his fellow David, The Hoff has enjoyed a long and fruitful career making horrible television, songs, movies and anything else that was meant to entertain human beings. His last television outing was apparently “epically ironic guy”, being one of the regular judges on America’s Got Talent. Clearly, nows not a good time to be a David.

David presents 5 Guys You Don't Want to Be

As two-plus quarters of medical school have conclusively proven, the perfect complement to learning about baby-saving is complaining to random people you don't know who happened upon your blog because they shadily typed in "crazy hot" during a Google search. To continue this worthy pursuit, I present the following list (Kevin's to follow soon):

5 Guys You* Don't Want to Be**:

5) Bad Birthday Present-Giving Guy

Not everyone can give amazing birthday presents (like a giant gift-wrapped box that contains progressively smaller boxes, until all that's left is a lot of boxes, discarded wrapping paper, and no actual gift (or maybe a really nice card!) - Classic!), but some gifts really should have been reconsidered. If you're buying a present and thoughts like "Teehee, this'll be really funny because it's sexual!" or "Here's a novelty T-shirt no one in good conscience would ever wear" cross your mind, it might be time to move on to the next item.

4) Self-Righteous About Obvious Or Long-Ago-Resolved Causes Guy

"You know who I hate? Racists! How can they discriminate against people on the basis of something as superficial as skin color or ethnic heritage!!?" We've all met this guy once or twice and, despite his good intentions, it's a bit tiring to listen to him tear down prejudices or viewpoints no reasonable person you know actually supports.

Yes, SRAOOLARC Guy, we also believe that kicking puppies is bad and that that thing that happened decades ago that everyone back then agreed was wrong is still wrong today. Thanks for yelling.

(If SRAOOLARCG had a cousin, he'd probably complain about people who don't let him into their lane on the freeway and make jokes about how they should make the entire plane out of the black box.)

3) Jesse

Self-explanatory.

2) Cliche Tattoo Guy

Barbed wire may be good for keeping people off your fence, but the time for inking it into your arm has passed. And if you decide an Asian character is a must, make sure what you think means 'serenity' doesnt actually mean 'face.'

1) Picky About Ubiquitous Food Ingredients Guy

This guy, for whatever gastronomical, idiosyncratic reasons (not because of allergies or anything medical), refuses to eat foods with ingredients that are so common that it precludes a shockingly wide variety of options when you go out for a group dinner. I don't even know what cilantro is, are you really sure you can't eat it?

-------

*In the interests of fairness, you don't want to be these girls either.

**It might also be said that the guy you really, really don't want to be is the one who spends his time creating lists of guys you dont want to be. But that will not be said here.

Kevin is convinced all white people love white meat

In my 23 years on this good Earth, I’ve come to know quite a few white people, almost more than I can count on my two hands. And while they may all be unique in their education, religion, and politics, there is one unifying trait that is universal: they love white meat. I’m not sure what it is about the breast but white people can’t get enough of it. Today I conducted an informal poll among 8 white people in my vicinity and the results were clear, 100% of gringos love breast meat. This seems to be a distinctly Caucasian preference because all my Asian friends shun the white meat for their dark, succulent brethren. So why do white people love white meat so much? This is truly perplexing. There are several aspects of meat in general that we can examine as possible reasons.

1. You get more meat when you opt for white
I suppose that could be true but I’ve noticed that many white people will choose white meat regardless of quantity provided. This is apparent in buffet situations where the supply is infinite so it only falls upon personal preference.

2. White meat is healthier
This is undeniably true since the deliciousness of dark meat is mostly derived from this fatty goodness. But roast chicken is already pretty unhealthy, or fried chicken. So when your chosen food is already so unhealthy, might as well go with what you like. By this logic, when people choose white meat, its for taste reasons and not health.

So that leave taste, which is a personal thing. I think the reason I love dark meat is the reason people hate it. I love the juicy, fatty, succulent deliciousness of a drumstick. Oddly enough, whenever someone said they opt for white meat, they always explain by saying they hate the taste of dark meat, rather than providing evidence of white meat’s supposed goodness. Truly odd indeed.


Do you prefer white meat or dark meat

	I am White and I prefer White meat
	I am White and I prefer Dark meat
	I am NOT White and I prefer White meat
	I am NOT white and I prefer Dark meat
View Results

Free poll from Free Web Polls

David discusses the 15-15-1 Theory

In my glorious two-plus decades on this planet, I have been many things: scholar, playwright and, most recently, emo-blogger extraordinaire. Today, I add intellectual revolutionary to that storied list as I unveil a strategy that will forever alter the landscape of medical school admissions.

Just kidding. The following is more of a thought experiment. Nonetheless, ladies, gentleman, our #1 fan (that’s you, Julia), maybe even Kevin (but probably not Kevin), I present to you the 15-15-1 Theory:

As many of you know, the journey to medical school is filled with hurdles. One must do well in school and have a decent complement of extracurricular activities and/or research experiences to make the cut at many schools. On top of all that is the MCAT, perhaps the greatest, most-feared obstacle of all. The MCAT, in a nutshell, is comprised of three main multiple-choice sections – Biological Sciences, Physical Sciences, and Verbal Reasoning – each scored on a 15-point scale. There is also a short essay section that students generally believe carries less weight in admissions decisions. According to the American Association of Medical Colleges (AAMC), the group that administers the exam, the national average for applicants in 2007 was 27.8, while the average for matriculating students was 30.8.

According to conventional wisdom, a strong applicant has both a high MCAT score and a reasonably even distribution of scores among each subsection. A student with a 9-9-9 breakdown, ceteris paribus, is probably more desirable than one with a 15-6-6, as the former score may indicate a more well-rounded student. This rationale makes perfect sense; a strong medical student should be less a genius in only one subject and more a jack-of-all trades who is competent across the board. We’re not doing hardcore physics or PhD-level biochem here.

Yet how would you choose between a 15-15-1 and 10-10-11, again assuming all other primary characteristics are roughly the same? Here, the choice may not be so clear-cut. Let’s assume for a moment the school has no minimum subsection requirement – which may be highly unlikely, but potentially true in extreme circumstances such as this – and thus does not immediately exclude the 15-15-1. In this scenario, which student is likely to become the more competent physician?

Well, the lopsided genius (LG) is probably a lot more intellectually gifted than the jack of all trades (JT). Two perfect scores indicate LG is very bright and most likely hard-working, both desirable traits for a medical student. JT did fine in each section, but a 31, as evidenced above, is objectively average. Since the margin for error diminishes disproportionately as one approaches the higher scores, the difference between 15 and 11 on any given section is actually quite significant,. So, at least for those two subsections, LG is a world ahead.

But what about the third? Is LG a science whiz who struggles mightily in verbal? (That would be bad, since the VR section correlates most strongly with future clinical performance because it best approximates one’s ability to synthesize new, foreign information and make analytical choices without the benefit of tomes of background information and months of fact-cramming. It’s an extremely loose simulation of any clinical situation, sure, but the critical thinking it demands is a crucial asset for any physician.) Well, maybe LG is or isn’t, but looking at that score breakdown, my guess would be he/she was the victim of some unfortunate twist of fate. Perhaps LG mis-bubbled one of the earliest answers and thoroughly messed up the scantron. Maybe there was a scoring error that wasn’t corrected or some other inaccuracy that was no fault of LG’s. Contingent probability would suggest it’s extremely unlikely that someone capable of a 30 in two sections could possibly score 1 on the third. In fact, I imagine it improbable that LG would even get below a 10 if capable of such dual-section wizardry on the previous two.

What if we assume LG is not even capable of half of his typical brilliance, grant him the slight benefit of the doubt that something strange happened during his exam, and give him a 7. Now his conservative 37 is out of shouting distance from JT’s 31. And since these two candidates are more or less equally qualified in other respects, where does that leave them? At the very least, LG would deserve an interview and a chance to explain what happened, whereas JT might not even make that cut.

Admittedly, this is a unique, rather improbable scenario. To the extent that this would ever occur, the solution would likely be for the admissions committee to recommend LG take the test again to confirm his/her brilliance in all three subjects, reapply the next year, and then choose among the top med schools. But that’s just plain boring.

I’ve discussed this randomly with a number of people, most of whom would favor JT. I’m not so sure. As an extension, if it is completely inconceivable that someone with a 1 in any subsection could ever warrant admission, what if you had to choose, right now, who you’d prefer as your doctor in 10 years? That 1 might be a dealbreaker for acceptance, but who is more likely to pan out in the end?

Clearly, the only way to resolve this amazingly profound debate is for me to drop out, change my name to Lopsided Genius, retake the MCAT and get a 15-15-1, and see what happens. Might be unfair though – that name alone is probably worth an interview.

David is sad that young Dave was an idiot

Back after an extended hiatus, I have a fresh rant that is arguably less meaningful and more inane than any I have produced so far.

Over the past week, we have been on Spring Break. Since I had some time to relax and the weather was dreary, I made the fateful decision that I would find something to read besides my favorite book, Magazine. Ultimately, I ended up picking one of my sister’s many Narnia books. I remembered reading and thoroughly enjoying them when I was a kid – talking lions, heavy-handed Christian allegory, what’s not to love? – so I figured an hour or so reading one of the series might be worthwhile. Yet where I expected to find a dream world of magic, I instead met nearly unreadable prose. Sure, the words weren't too long, but after a few minutes it was so bad I just couldn’t continue.

Later on, I stumbled upon an old Saved By the Bell rerun. Surely, I thought, this would be an entertainment gold mine. Zach Morris, Kelly Kapowski, Screech, that really tall girl who took all those caffeine pills in the episode when they were making that awesome music video – good times all around. Everyone and their brother loved this show growing up. All teenage misadventures, no annoying angst. Alas, it was not to be; SBTB was more vapid and god-awful than I could possibly imagine.















You guys used to be so cool. Sigh...

All of this led me to the saddening realization that I was an idiot when I was 11 years old. I may have been the Tiger Woods of block-stacking, but apparently I was a bit dim when choosing my entertainment. Seriously, young Dave would’ve bet you six cookies and his entire collection of Ken Griffey Jr. baseball cards that SBTB would stand the eternal test of time as the greatest artistic masterpiece ever created. Now? I could barely stand to watch five minutes before changing the channel (although Zach was still up to his old tricks. What a rascal!).

On the bright side, I am much smarter now. I’d bet six cookies that Friday Night Lights will last forever and be the greatest TV show ever created…












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