Indifferential Diagnosis

David finishes learning for the rest of his life

2011-05-02T09:37:00.000-07:00

As of last Friday, when I completed my last medical school clerkship, my brain has officially closed for business as far as all further medical edification is concerned. Now that I – and Kevin soon after – have fully internalized everything ever known about medicine, I have finally reached that ultimate goal set so many years ago in college: have another Senior Spring.

Goodbye, short coats. Hello, mid-week golf.

Ideal vs. Reality - Orthopedic Surgery

2011-04-02T21:59:00.000-07:00

David and Kevin match

2011-03-20T20:45:00.000-07:00

In what will clearly go down in history as an against-all-odds triumph of previously unfathomable proportions, Kevin and I have managed to successfully match into (what we’ve been told are) accredited residency programs, keeping our medical hoop dreams alive for at least a few more years.

Since extreme levels of sarcasm and immaturity aren’t good for patient care, the NRMP supercomputers have deemed it necessary to place us on different coasts, leaving a chasm of barren, uninhabitable flyover country (like Iowa) between our respective programs.

Where we go from here, no one knows. Still, one thing is certain – it would probably be a bad idea to get really sick this June…

The David and Kevin Story

David stares at your body (CT)

2011-03-09T19:03:00.000-08:00

After an extended hiatus to complete the residency application process - which is now out of our hands pending the upcoming NRMP Match - Kevin and I are making our triumphant return to the international zeitgeist. That special, tingly place in your hearts will once again be filled by our inter-musings, at least until the next point at which laziness, work, or lucrative alternatives occupy our lives.

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One of the greatest perks of the 4^th year of med school is the opportunity to relax once the rigors of application submissions and expensive interview trips are appropriately in the rearview mirror. Since med school isn’t over after rank lists go in or the Match occurs, most of us fill the remaining time with a combination of really relaxed rotations, useful electives we didn’t have time for earlier, and really, really relaxed rotations. Enter Radiology and a few thoughts about the pros and cons of a potential career in the reading room catacombs.

Pros:

1) You get to squeeze your mind grapes: Radiology requires a relatively unique combination of both general and specialized knowledge. Obviously, the field demands mastery of the intimate details of all of the numerous imaging modalities in the clinical repertoire. Yet it also requires a nuanced understanding of the clinical, anatomical, and surgical correlates of essentially all major radiological findings. Since clinicians order scans to assist in the diagnosis, treatment planning, or monitoring of disease, radiologists must have a working understanding of each of these processes in order to provide the most beneficial interpretation of whatever image comes their way. This keeps even a specialized radiologist fluent and up to date in many more facets of clinical and surgical medicine than many clinicians in any of those individual fields. For the learn-y types, this is a huge plus; you maintain a large database of clinical knowledge that’s not limited to any one particular patient population. For Jess, it’s probably a deal-breaker.

If Jess was a radiologist...

2) Calling out squiggles saves (many) lives: Though my role during the rotation was mainly perfecting formal terminology such as “badness,” “thatthingrightthere,” and “oooohhh noooo,” radiologists get the opportunity to employ the knowledge listed above to make a meaningful positive impact on a lot more patients than basically any clinician. An experienced radiologist can motor through figurative stacks of scans, each of which could provide the key finding that clinches an otherwise tentative diagnosis or redirects a lost primary team in an entirely new direction. Though the radiologist isn’t removing tumors or prescribing meds, she’s still saving babies as fast as anyone else in medicine.

3) You can make it rain then leave early and go play golf: It’s no secret that Rads offers a pretty cushy lifestyle relatively short on hours and long on compensation. In most practice settings, the time and energy sinks that plague other fields – things like overnight call and late-night emergencies – tend to be non-issues for radiologists. Come in at 8? Leave at 4? Don’t mind if I do!

Standard radiologist trophy wife

Cons:

1) No more patients (or people) for you: The stereotype of the isolated radiologist sitting alone in a dark room without that much human interaction really isn’t that far from the truth. Aside from the occasional image-guided biopsy or fluoro study, most radiologists spend the day…alone in a dark room without that much human interaction. Sure, they’ll chat with a few fellow radiologists, relay any pressing results to ordering clinicians, and talk with a variety of techs and administrators, but that’s essentially it. That may be a plus to some, but for the majority of those entering medicine, at least some meaningful patient interaction was probably a big part of their interest in becoming a doctor. In Radiology, you get vitamin D deficiency instead.

2) Med-malnanigans: The realities of Radiology make it an easy target for malpractice suits of all flavors. Any X-Ray, CT, MRI, etc., is saved and available in all its glory to anyone with 20/20 hindsight and a bone to pick after a less than favorable outcome. Though mistakes are made in rads as in any other field, the opportunity for second-guessing is greater when essentially the entirety of the clinical presentation is forever available for review. The byproduct is both frustrating and inevitable; many radiology reports devolve into nothing more than a list of sweet CYA nothings such as “cannot exclude,” “could represent,” “may suggest,” and a laundry list of kitchen-sink differentials. I’m sure the radiologists hate dictating those as much as everyone else hates reading them, but it’s hard to expect anything different in this particular medico-legal climate.

3) They could taakk yeerrrrrr jerrbs: A relatively hot-button topic, at least among many radiologists I’ve talked to, is the concept of outsourcing certain diagnostic radiological services to cheaper domestic areas or even abroad. After all, the radiologist doesn’t really need to be right downstairs all the time, and probably costs more sitting there in the dark than an equally competent physician working remotely (and sitting in the dark). If the notion of who is acceptably “remote” includes foreign docs or others willing to work more cheaply, then the current set-up for radiologists would clearly erode. Somewhat relatedly, Interventional Radiology, which can currently be pursued via post-Rads fellowship – and which offers patient contact, cutting-edge procedural awesomeness, and compensation up the wazoo – is also expected to diverge into its own completely independent residency and field in the not-too-distant future. Separating IR from diagnostic rads would remove one pretty appealing career path for the field, and only contributes to the uncertainty facing the profession in the next few years. (That said, given the scarcity of training positions and subsequent competitiveness of IR, going into diagnostic rads with an IR-or-bust mentality is sort of like getting a job at McDonald’s on the off-chance they’ll let you be the next Grimace. It’s risky to dream that big…)

Diagnostic or Interventional?

David and Kevin approach doctordom

2010-07-02T02:03:00.000-07:00

After a year of 6-week journeys into the depths of numerous medical specialties, acquiring enough experience along the way to become indubitable experts capable of writing a series of specialty summaries, Kevin and I are now newly minted MS-IVs.

Farewell, penultimance. Greetings, ultimiosity.

Kevin learns amusing words

2010-03-16T18:35:00.000-07:00

Rock
-noun
1. A currently admitted patient who no longer requires >$3000/day medical services but can not be discharged because of social/legal/financial reasons. He/she stays on service getting 3 hot meals a day and unnecessary daily CBC and chem7s.

Rock garden
-noun
1. A collection of rocks (see above) that demand increase your daily paperwork time for no educational gain.

"Hey, are you done with your daily notes yet?" "I've taken care of all the acute patients, just need to tend to my rock garden and I'll be done."

Kevin deals with the Cross-Eyed Gunner

2010-03-07T11:29:00.000-08:00

Medicine, much like golf, is often filled with oddball behavior that, while not being detrimental to patient care, can often raise the eyebrows of colleagues and patients alike. Medical students stumbling around in their 3rd year clerkships certainly aren't immune to this. So as a small case series, David and I would like to present a few of these "that-guy/girl" stereotypes

I'm sure most of you have all heard of "the gunner." The guy/girl that prerounds on your patients, asks questions during rounds to make you look bad and generally being an annoying dbag. I havent met one myself, but I'm sure they're out there... waiting to make me look bad. However, fewer people know of, or at least speak of, the cross-eyed gunner. This person has all the eagerness and moxie of a regular gunner but none of the competence and medical knowledge to match. This leads to a sad-parade of self-destruction that is pretty intriguing for an innocent bystander like myself.

The CEG is eager, very eager, to answer questions. Whenever the attending proposes a question, even if it's rhetorical, he/she will shout an answer as fast as possible. Unfortunately, the answers are usually wrong and only met by uncomfortable stares from the rest of the team. Often times CEGs have some self-awareness and realizes they've just given the wrong answer(once again) so they might backpedal and try to justify their answers in a really convoluted fashion that clearly has nothing to do with the actual patient. But luckily, this helps make me look good since I can step in and give the correct answer (although ultimately adding nothing to the overall care of the patient). Ah, the simple joys of medicine.

Comic: Ideal vs. Reality - Dermatology

2010-02-23T08:48:00.000-08:00

David doesn't believe in magic

2010-02-21T19:39:00.001-08:00

As scientific, evidence-based fields go, medicine has to rank at or near the top. The best doctors make clinical decisions based on both years of experience and what the newest research has identified as the appropriate standard of care. Yet anyone who’s seen a medical TV show or spent any time on an inpatient ward has probably noticed the prominent role of superstition in what is otherwise a primarily logic-based endeavor.

One of the more benign examples is the concept of “clouds.” For those unfamiliar, a white cloud is someone who brings good luck and light call nights along wherever he or she goes, while a black cloud puts Murphy’s Law to the test with regularity. These terms are often applied jokingly or even affectionately on the wards, yet it’s not uncommon hear them said with a completely straight face. I’ve also heard students and interns scolded for predicting easy call nights or forecasting uncomplicated patient stays based on all of the relevant admitting information.

I hope this isn't the MI cloud...

Admittedly, a fair amount of this superstition is tongue-in-cheek inside joking. Yet I’ve been repeatedly surprised at how superstitious nurses, residents, and even attendings can be, particularly with regard to call nights and new patient admissions. As another example, during sign-out, when the daytime team gives a quick heads-up to the call team or night float about any pressing patient issues to be aware of overnight, I’ve had multiple permutations of the following exchange:

David: Ok, for Mr. X, I don’t anticipate any issues…

On-call Intern: Gah! Don’t say that! [Scrambles to knock on table]

David: …with him…wait, what?

On-call Intern: Never. Say. That. It’s bad luck. [Knocks on wood again and prepares to sacrifice small bunny on a tiny altar made of old reflex hammers and adorned with four-leaf clovers]

David: Uh…Ok, sorry. I, uh, hope everything goes to pot and you get called all night about him…?

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After a few of these encounters on multiple rotations, I’ve come to take a slightly different tact, at least with those superstitious housestaff members with whom I’ve developed a friendly rapport:

David: Light call so far? No admissions?

On-call Intern: Shhhhh! Don’t jinx it!

David: Jinx what? The fact that tonight guarantees to be a complete admissions shut-out?

On-call Intern: Dude…

David: That this call will henceforth be the standard against which all other easy calls will forever be judged?

On-call Intern: I’m going to slap you…

David: The fact that the Deities of Patient Admissions – may they smite you if they exist – are clearly too impotent to put forward a worthy challenge on your call night?

On-call Intern: Forget the bunny, I’m going to sacrifice you instead.

David: That…

On-call Intern: You do realize I evaluate you, right?

David: Ruh-roh.

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Maybe this is why I’m a black cloud…

Kevin and David think you might be interested in some merchandise

2010-02-19T22:13:00.000-08:00

Now that David and I have reached our goal of becoming internet hundredaires, the next goal is to be come gajillionaires. After some brainstorming, we decided selling various merchandise at a 10% commission rate is the obvious way to go. So I've gone ahead and started a Zazzle store using the comics on iddx. Feel free to buy one or ninety. This is a pretty preliminary start but theres some mousepads available and a calendar of the comics. If you guys have any specific requests, let me know and I'll make it available (iddx underwear perhaps?). All proceeds do not go to charity. Unless you consider sleep-deprived med students to be charity cases, in which case 100% of the proceeds will be going to charity.

Store link: http://www.zazzle.com/iddxblog

make custom gifts at Zazzle

David and Kevin become internet hundredaires

2010-02-15T22:20:00.000-08:00

When Kevin and I first started this blog, we wanted to provoke meaningful thought and discussion about medical education and chronicle the early steps towards physician-hood from the basic sciences to graduation and everything along the baby-saving, Jess-antagonizing, sleep-not-having way. All this, of course, only if the blog failed in its primary purpose of making us wealthy internet blogopreneurs who could quit med school and live a life of leisure for rest of our days.

Well, friends, that day has finally arrived. Buoyed by a 100% legitimate string of ad-clicks, Kevin and I have reached the rarified status of making $100 in advertising revenue over the course of only two years. Averaged over all of the time spent writing and brainstorming, we’re in the oft-discussed yet rarely realized realm of multiple cents per-hour earnings.

While we contemplate which Cayman isle to retire to now that this gravy train is going full-bore, we're planning a celebration in the interim, funded entirely by this massive windfall. Expect a spread truly befitting our recent successes; every attendee will get at least 1-2 pretzels, maybe more.

See you there!

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What?: IDDx Earnings Extravaganza

When?: Saturday, March 27^th, 8PM - ???!?!?

Where?: TBD

Who?: Kevin, David, Julia, you, maybe Jess

Kevin is Fat Joe...

Kevin might want to know watcha thinkin' about.

2010-01-30T12:26:00.000-08:00

Time is winding down on my psych rotation and it’s given me plenty of time to reflect on the experience. I think it’s safe to say most students do not go into medical school with a yearning desire to enter psychiatry, quite a shame really. This little odd niche of medicine has quite a lot to offer.

3 Reasons to enter psychiatry

1) The sweet life
It’s no secret that the work hours in psych are awesome. As a medical student I got into the hospital at around 8:30, rounded with the attending and resident (no prerounding) until 11:30, wrote my notes and done by 2pm at the latest. Hey, they don’t call it psychation for nothing. This sweet life style extends to the residents as well. They all come in at around 8 and are done by 4 or 5pm. And EVERYONE is happy. I think in all my other rotations, people are always bitching about something related to their work hours (and I haven’t had surgery yet). It’s really no wonder our friend Jess is seriously considering psych as his future career as a way to maximize the amount of time for his video games.

2) Helping the underserved

Everyone says this during their medical school interview, but if residency match is any indication, most don’t follow through. The patients seen on psych truly are the most in need. These are patients who are so sick that they do not even know they’re sick. Combined with inevitable social and financial losses, these are the neediest group of patients any clinician will see. If you truly believe in the schpiel you gave to the admissions committee, you should take a good hard look at psych.

3) Hilariously bizarre
Mental illness is weird, I mean really weird. When schizophrenics develop bizarre delusions, they can be so bizarre it boggles the mind. I had one patient explain to me that she can see people’s sin by staring into their eyes and that’s how she knows her stepfather was a murderer. Hilarious. Although it became significantly less hilarious when she ran into their house with a knife…

3 reasons not to go into psychiatry

1) You’ll forget everything you learned in medical school

I feel bad for saying this but psychiatrists really don’t know that much about medicine. When you become so specialized in psychological illness, you end up forgetting a lot about physiological illness. At my hospital, we had to consult medicine/derm/neuro/etc for every minor medical issue. Morning blood sugar 180? Stat med consult. Odd looking rash on hand? Holy shit we need to page derm. Maybe this isn’t such a big deal for the future psychiatrists but I would feel like I wasted 4 years of medical school learnin’ by going into psych. Going along those same lines, there are only about 15-20 drugs that are ever used in psychiatry. What’s more interesting is that they all seem to be able to treat everything. I got the feeling that regardless of what your patient has, you can just shout out a random psych drug and there’s a greater than 50% chance you’re right.

2) Holy ambiguity

Mental illness is ambiguous. After all, what separates someone who is truly sick from someone that’s just a bit of an oddball? Psychiatrists tend to refer to the DSM-IV as their holy grail of diagnosis but even then, there are a lot of patients who are right on the edge who end up getting treated anyways. What’s more hilarious is that they are allowed to write things like “Possible Axis II features.” For those who don’t know, Axis II refers to the range of personality disorders people can have that can be maladaptive. But when you just say “possible Axis II features” it’s so ambiguous that you’re essentially saying the person is a bit of a douchebag but you’re not sure why.

3) Nonmedical BS

Treating acute mental illness is only half the battle in most patients. I would say a huge majority of the time and effort spent on patients is in finding appropriate living situations for them after discharge. This involves a herculean effort between social work, PT, OT etc etc to find the right place to live and the necessary financial support. This ties directly into point #3 in the other section. If you love that stuff, psych is perfect for you. If you want to enter tertiary or perhaps quaternary care, worrying this stuff will make you want to end it all, and ironically maybe bring you right back to the psych ward.

Comic: Ideal vs. Reality - Psychiatry

2010-01-04T20:04:00.001-08:00

David and Kevin present some old favorites

2009-12-09T20:36:00.000-08:00

Almost 2 years ago, David and I started IDDx with the humble hope of turning this site into a blogging powerhouse that could be our one-way ticket out of the obvious career dead-end that is medicine. Clearly that has not happened. But we have still managed to build (and re-build) a loyal following of readers that have somehow found our inane drivel to be entertaining (or at least interesting in a car crash-y kind of way). We thought this would be an appropriate time to revisit some of our old posts as a kind of year-end-review and maybe serve as a best-of (or worst-of, as the case may be with Jess) list for the newer readers. (Re)Enjoy.

-Kevin and David

Medical student life: A few insights into the fast-paced world of call-taking, baby-saving, and retractor-holding.

David, Robby, Dan, Beth, and the Johns save lives while on vacation.

Kevin wishes these classes were real.

Kevin falls, David watches.

Pre-medical advice: Words from the arguably wise about facing the application gauntlet.

David tells you what to do (in an admissions interview).

Kevin debunks 2 myths about med school.

David presents the 15-15-1 theory.

Comics: Only stick figures can provide a true window into the inner med student soul.

MCAT - Then and Now

OB exams are tricky

Ideal vs. Reality - Emergency Medicine

Guest authors: Who's better - Julia, Jess, Julia, or Julia? You decide.

Julia knows exactly the kind of doctor she will become.

Jess tries to reach the keeds.

Julia presents a landmark case of PMS.

Random thoughts, pet peeves, and theories about life: A potpourri of IDDx musings.

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

David has difficulty with doors.

Kevin contemplates the diet of the Little Mermaid

David treats a wise child

2009-12-04T20:22:00.000-08:00

During a recent shift at a pediatric urgent care center, a young boy came in with a scald burn to his arm. As I debrided his wound, we discussed some of the pressing issues of youth, including how awesome dinosaurs are and whether or not mall Santas are real (consensus: of course they are). All of 5 years old, he was a total fighter and didn't complain one bit throughout the procedure.

After a heated debate about how fast Spot runs - we both said some things we didn't mean - the following exchange occurred:

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David: This must've been pretty scary, but you've been doing great.

Kid: Hey, I'm not scared of anything.

David: Nothing? Really (unsure whether or not to entrust him with my fear of clowns)? That's pretty impressive.

Kid: Nope, nothing...

...except bush babies.

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Mildly confused about what he was taking about, I allowed the conversation to shift, and soon he was all fixed up and on his way home. Later, a quick Google search provided the images that will give me night terrors for the rest of my natural life.

Wise choice, kid...

Kevin might save babies like it's his job

2009-12-01T11:53:00.000-08:00

The next installment of our career choice series.

3 reasons to do pediatrics
1. Congenital disease is fascinating
The magical journey from fish-like zygote to full blown baby is fraught with wrong turns and side streets to the bad part of town. Sometimes what comes out of the oven isn't what you expect. While most adult medicine follows some kind of logical pathology and things often dont stray too far from the norm, the presentation of congenital disease can be so bizarre it boggles the mind. Situs inversus (your insides are backwards), lissencephaly (your brain is flat), Transposition of the Great Vessels (your aorta and pulmonary artery are plugged into the wrong ends of the heart) are just a taste of some of the things you see as a pediatric specialist. A lot more interesting than COPD or diabeetus.

2. Plenty of subspecialties to suit your fancy
This is likely personal to me but during the first two years of medical school I always pictured pediatrics as a primary care residency with no subspecialty tracks. “Well where do pediatrics cardiologists come from?” you might ask. For some reason I thought you got there through internal medicine, cardiology then a fellowship in pediatric cardiology. Clearly I’m an idiot (but hopefully someone out there on the interweb is with me). In reality pediatrics is just like internal medicine, except you treat little people. This also means there’s a huge range of subspecialties to choose from, and as I mentioned in point #1, you get to focus on a lot of congenital malformations rather than the end result of a lifetime of self-neglect.

3. Saving lives (no seriously)
Adult medicine often revolves around management of chronic disease. Patients undergoing slow, methodical heart failure/COPD/diabetes/lupus(sometimes it is lupus), are never fully cured. The best you can do is manage their symptoms in order to extend/improve their quality of life. On the other hand, pediatrics is full of one-off illnesses that you can definitively treat and they can be on their merry way. Back when medical school was only 1-semester long and involved memorizing the 4-humors, congenital malformations was often a death sentence. Fortunately, we've come a long ways from then and there's a myriad of treatments for what ails children. You have a giant septal heart defect? No problem. Bowels outside the abdomen rather than inside? Just shove that right back in there. As a pediatrician you're really making a huge impact in the "total # of years saved" category. If there was a MD fantasy league, you'd want at least 1 pediatrician to pad those stats.

3 reasons to avoid pediatrics
1. Bad logistics
Unlike what your career counselor might have told you, you should never choose a career just because you like the subject matter. Every field has pros and cons in terms of call structure, location constraints, average salary etc etc that are all vital in making an informed career decision. For example, if you love cardiology but are on the fence on whether to treat big hearts or little hearts, here are some things to consider before you devote yourself to baby saving. Despite all my talk about congenital disease, kids are actually pretty healthy. And being healthy is bad for business. Because of the low demand, you will also make less money than your adult-caring counterparts. So do you really love congenital disease so much that you're willing to take a $100,000/yr pay cut? Furthermore, there are significantly less pediatric specialists than there are adult specialists. Because there simply isnt as many you, your group will be small, which is synonymous with lots and lots of call. What this also means is that there isnt a need for a pediatric neurologist in every town. If you want to subspecialize in pediatrics, you're almost guaranteed to be forced into a large-ish city in order to field the necessary amount of patients to stay afloat. Sorry, no country livin' for you.

2. Noncompliant ~~patients~~parents.
When I asked a lot of pediatricians why they decided to do pediatrics and not internal medicine, they often cited that they were frustrated by noncompliant patients such as COPD'ers that kept smoking or CAD'ers that kept eating McDonalds. For some reason, I have no problem with that. As long as the check clears, I dont care what you do. My job is to give you the knowledge, services and tools to allow you to live a healthy productive life. If you refuse, so be it. In pediatrics, the kids barely know what's going on so the work falls on the parents to follow through with the care plan. In this case, noncompliance by the parents means the kid is getting hurt. This I have a problem with. Even though CPS can step in during extreme cases, theres a huge gamut of noncompliance where you really can't do anything even though you really want to punch them in the head.

3. Child abuse
During my peds rotation I had the displeasure of seeing 3 child abuse patients. One of was severely overfed, one was severely underfed and the 3rd was an infant that had a broken femur and two broken clavicles. Obviously by ferreting out child abuse you're saving the child, but it's still a terrible thing to be a part of. Seeing that on a regular basis can be a real drain on the mental psyche.

Comic: Ideal vs. Reality - Plastic Surgery

2009-11-30T12:17:00.000-08:00

Julia ponders a career in Neurology

2009-11-25T13:19:00.000-08:00

As one of our school's rare 3rd years over-eager enough to attempt Neuro before 4th year, the mantle falls to me to talk about the good and negative aspects of this specialty. That… and Jesse is trying to steal away my tiara for himself. For shame.

Jesse's MRI confirmed some long-held suspicions...

3 Reasons for going into Neurology:

1. You might actually get to see your kids grow up.
It’s no psych, but damn it’s good to be a neurologist. During my time on this rotation, on most days it seemed possible for the non-call residents to get their patients tucked in and notes written by mid-afternoon. Plenty of time for David to get home and watch the nanny take care of the kids. Definite life-style points.

2. Fascinating pathology
While the neuro hospital floor is primarily dominated by strokes and seizures, consults come from all over the hospital. Although much of this will inevitably end up being delirium (or even nothing), every now and then the illusive and coveted zebra appears. The brain truly is a wonderful and enigmatic organ, and just because everyone keeps cheering that we’ve made so much progress in the past 10-20 years it doesn’t mean you still wont be surprised.
For example, I will truly never forget the consult on a patient with anoxic brain injury where, about 15 minutes into the interview, I realized the patient was confabulating everything! Because of his brain damage, he had gaps in his memory where he would fill in with false information. If the lie is subtle enough, it can be difficult to discern the confabulations from the truths. But then again, sometimes the lies are so outrageous they become readily apparent. No sir, I dont believe I've asked you these same questions 30 years ago...

Anyways, just remember the next time you see a patient who just had a right-sided intraparenchymal hemorrhage (i.e. brain bleed), it probably is worth it to ask them to draw a clock face.

3. Informative physical exams
Depending on which specialty you go into, the physical exam could either be a crucial component of the clinical picture or only a necessary hassle for billing purposes. For example in surgery the physical exam boils down to two things: bowel sounds = good, no bowel sounds = bad. Neurology lets you do a bit more. If you like solving puzzles, this is where it’s at. If you’re savvy enough with your physical exam skills and knowledge, not only can you identify at which level of the nervous system the lesion is located, you could probably tell something about exactly where in the brain or spinal cord you expect it to be. Some party trick, huh? Then you order the appropriate scan plus labs to get a more definitive answer. Neurologists out in the community or away from a major academic center may be the true LOTPEs.

It's (reflex) hammer time

3 Reasons to stay away from Neurology:

1. You can't cure a lot of the things you diagnose
Here’s a quote from a real-life attending: “Hmm… you know, I’ve never really felt the need to cure anything—sometimes it’s enough to just be able to tell them what it is.” While this is true, in some cases just being able to put a name on what ails you is therapeutic enough, it may not be very satisfying to you. Not mention, even if you do locate a resectable lesion, the patient gets bounced to neurosurgery. Sigh, those guys hog all the glory (and reimbursement). So if you’re on your neuro rotation and find yourself feeling a little too excited and relieved by meningitis because you can kills the buggers with antibiotics, then maybe this isn’t the field for you.

2. Medically sanctioned elder abuse
The patient might look like your favorite grandparent or that sweet little old lady down the street, but if they’ve got a decreased level of consciousness you can be sure you’ll be giving them a strong pinch! The idea is that you’re looking at their ability to sense, localize, and/or withdraw from painful stimuli. Keyword: Painful. Abnormal posturing (e.g. decorticate – flexor, decerebrate – extensor) can tell you something about the severity of what’s going on in the ole think-box. However, when my patient’s tearful and terrified wife is standing right there, it can be a pretty uncomfortable to do what would be considered elder abuse in any other situation.

Your heart sounds great ma'am. Just FYI, I may or may not need to jab you with a sharp stick in the near future.

3. Half your patients are delirious
For me, this is the biggest problem in neuro. Inpatient neuro is dominated by strokes, withdrawal, seizures, delirium, coma, and bad ass brain tumors. In short, most of your patients are going to have some sort of altered consciousness, so the normal exchange of the physician-patient relationship is lacking. Oncology is another specialty where there is a relatively low “cure” rate, but in the battle against cancer you the provider can learn so much from your patients. For me, this is probably the most challenging aspect to deal with day in and day out in neurology. It's hard feeling connected to my patients when they're accusing you of stealing their Jello to give to our alien overlords.

Comic: G16P10

2009-11-23T12:46:00.000-08:00

Jess tries to reach the keeds

2009-11-20T12:05:00.000-08:00

Back and angy as ever, Jess attempts to unseat Julia as the premiere guest author with this, his latest rant. Enjoy.

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The recent revival of this blog and its stream-of-consciousness ranting affords a golden opportunity to similarly revitalize my own journalistic career – since this medicine thing may soon come to a screeching halt. I’m currently on pediatrics. I could simply refer you to Kevin’s elegant artistry to depict my feelings about the rotation, but that would ruin the cathartic nature of this medium. I’ll take a more positive approach than my colleague did with childbirthing – I’ll give one positive before launching into my top pediatric peeves.

The Good: A lot of kids are cute. When they’re in a good mood, they’re friendly and laugh and want to see how your tools work and it gives you that warm fuzzy/good feeling that you can only get from the sound of a child’s laughter – before passing them off to the demonized shot-giving nurse (which, by the way, must be the worst job in the world). I genuinely enjoy kids in general so this works out well. But there’s a lot to hate in general, so let’s not delay:

1. The Vaccine Talk.

Every physician knows this one. For those of you unawares, let me break this down for you. We have, on one side, modern medicine and every doctor you’re likely to ever meet who contend that babies shouldn’t die. We have, on the other side, this guy. Now here’s the kicker: People believe Jim Carrey. To be fair, a “doctor” did originally perpetrate this bogus theory. One Andrew Wakefield proposed that MMR vaccine was related to a small subset of cases of autism via immunologic shenanigans. He then proceeded to present this and cause a panic which led to refusal of immunizations and then an outbreak of measles. Read that again. Of measles. Let’s get one thing clear: no one in the Western world should ever contract measles. The only time anyone should get measles is playing Oregon Trail.

If only YOUR MOM had vaccinated you.

Meanwhile, of course, autism didn’t miss a beat. Andrew Wakefield has now lost his medical license and practices homeopathic medicine in Texas. There are even new allegations that he fudged his data – but by God, that doesn’t matter, because a lack of understanding of basic statistics or physiology is no reason you should listen to your “doctor” about vaccines, because he’s probably just brainwashed and doesn’t think for himself (I swear, people say this). And you’ll hear the same random half-baked logic:

“Too many shots these days,” “given too young,” “those diseases don’t exist anymore (AND WHY MIGHT THAT BE?!?!)”

It wouldn’t be so bad if these people listened to reason. Or at least attempted to listen to reason. The following is an almost word-for-word transcription of my preceptor’s attempt to convince someone to get their kid a meningitis vaccine:

“Here’s all the excellent and well-founded scientific reasons why your kid is way more likely to die from meningitis than from getting this very safe vaccine.”

“Yeah but I don’t give my kids shots until they’re 1 year old.”

“Why?”

“I just don’t. I’m convinced I know better than decades of data and scientific research and besides I can selfishly rely on herd immunity which, by the way, I undermine by not getting vaccinated.”

“…..Kay. But seriously, why?”

“I just don’t.”

You get the picture.

2. Schools waste doctors’ time.

Everyone has had this experience –little Johnny had a cough/cold/stubbed toe but, because he missed time from school, he requires a doctor’s note to allow him back. This means that little Johnny gets to wait in the office for 2 hours with all the bacon-lungers so that he can get a doctor to confirm that yes, in fact, he was coughing, and no this was not some elaborate falsehood perpetrated by the parent. But even if he wasn’t sick, he sure as hell is now. In which case, of course, he’ll have to come back and get a separate doctor’s note just so he can expose everyone to it. At what point did we stop believing parents when they say their child is ill? Congratulations, Principal Jones, you’ve once more saved the integrity of your pedagogical bureaucracy – but at what cost?

At least they're NOT VACCINATED.

3. First-time parents possess no common sense.

This may represent a failing of our public education in some ways, but so many new parents seem to have no other option when their child is ill but to come to the ER in the middle of the night and/or demand to speak to the pediatrician on call. I understand that you can’t tell for sure how sick your 10-month-old child is. He can’t talk. But with a few tidbits of arcane medical knowledge, several ER visits could be avoided:

1) 99 degrees is never, under any circumstances, a fever. I don’t care that your baby usually runs 98.4 so it’s a little hot. Being asked to write a note justifying school or daycare absence for a temperature of 99.1F rings hollow. Pediatricians don’t get too concerned until 100.5F, so don’t bother them.

2) Babies are rashy. Please do not demand to speak to the on-call pediatrician because your child has one new red mark on their skin. It’s not cancer. It will likely be gone within a week without a single symptom. Go to bed.

3) Babies are loud. If your baby is crying, try feeding the baby. Try holding the baby. Try rocking, cuddling, or singing to the baby. (Do not ever shake or throw your baby). If these don’t work, does baby otherwise seem sick? If not, it’s probably not an emergency.

4) For God’s sake, triage nurses exist for a reason. Self-explanatory.

I enjoyed my time on peds, but as you can tell, there are more than a few things which could be more satisfying about the setup. I did almost entirely outpatient pediatrics, so I was mostly in clinic the entire time – which can be numbing on its worst days.

David breaks down Surgery

2009-11-17T19:10:00.000-08:00

3 reasons to become a surgeon:

1. You get to do stuff and see if it works

Surgery is the pinnacle of immediate feedback; you identify a problem, do something concrete to fix it, and then evaluate whether or not it worked. More than any other specialty, the outcomes are measurable, tangible, and observable. You may sacrifice the continuity of primary care fields, but you also experience the unique satisfactions of knowing what’s wrong and getting your hands dirty trying to make things right. Fields like neurology, psychiatry, and others may involve long battles with nebulously defined disease processes where victories are measured in small, incremental improvements over years. That process yields its own personal and professional rewards and frustrations, but may not provide the same acute results that some students may find particularly appealing and which surgery deals out in spades.

2. Certified badassery

Few things in medicine are cooler than surgery. Though it may not be for everyone, no one can deny the sheer awesomeness of removing tumors, transplanting organs, and augmenting breasts (just kidding…?). Perhaps more commonly than in other fields, decisions are realistically life or death; a miscue here or a careless error there in the OR could have disastrous results. What’s more, the wealth of new technologies and general trend towards minimally-invasive procedures ensure that general surgery and the many surgical subspecialties will only further badassify in the future. Sure, more surgeons spend their lives in the bread and butter world of inguinal hernias and appendectomies than in the rarified air of reconstructive plastics and neurosurgery, but even the more vanilla procedures provide all the benefits listed above and below and may, due to volume, be even more targeted for technological advancement in the coming years.

I can’t believe Da Vinci painted the Mona Lisa and invented this robot…

3. Options like whoa

It is generally believed that medical students should first and foremost decide whether they want to be surgical or medical. If surgery is your cup of tea, there is a seemingly limitless array of opportunities to pursue. A general surgery residency is a common gateway to further subspecialty options such as burns, cardiothoracic, vascular, and pediatric surgery, among others, while other students choose to enter fields such as orthopedics, plastics, and ENT straightaway. Going further, many surgeons identify a specific procedure or set of similar procedures that becomes their uber-specialty within their broader branch of surgery. Basically, if there’s some type of cutting you want to do, you can probably make a career out of it.

3 reasons not to:

1. Training don’t quit

More than any other field, surgery demands an extensive period of training. A typical general surgery residency lasts five years, and further subspecialty fellowships can push that requirement into the two-digit territory. An R3 I worked with recently is pursuing a career in pediatric cardiothoracic surgery, a path that, with a general surgery residency, two years of research, a three-year CT fellowship, and a one-year peds CT fellowship, will ultimately require 11 years of training after medical school. Assuming one entered medical school immediately after undergrad at 21-23 years old, this would push off attending status – and the benefits of a legitimate salary and some semblance of a personal life – until one’s mid-to-late 30s. And though in a badass field like peds CT surgery you’d make it rain early and often thereafter, you’d still be spending the majority of the prime of your youth before ever realizing many of your career goals.

2. The hours never stop

Similar to OBGYN, surgery in nearly all of its forms is notorious for an extremely demanding workload and long hours on call. Though some subspecialties and practice settings may be less demanding, the fact remains that surgeons spend more time in the hospital than almost any other type of physician. When you factor in the extensive training required before even reaching the attending level, the demands of the subsequent career may simply not be something many medical students want in their future. (On a related note, it's worth mentioning that the hours / training demands take their toll on relationships as well; some surgical residencies have been known to have divorce rates exceeding 100%. In other words, residents get divorced, remarry and get divorced again. Just FYI...)

3. High-intensity work environment

By its nature, surgery is a high-stress world. The patient is commonly under general anesthesia and the manipulations of the procedure often entail significant blood loss. Small or careless transgressions can kill a patient either immediately or as a post-operative complication, and the surgeon running the show is ultimately responsible. Many surgeons trumpet the philosophy “trust no one,” something potentially disheartening on its surface but logical in a world where the surgeon is held accountable for any number of errors in the pre-, intra-, and post-operative setting. All these truths foster an environment some find less than hospitable, especially to those lower in the training hierarchy. Surgeons, on average, may be blunter and less forgiving in a professional environment than other physicians, and this, coupled with the long hours, can create a working world some students may choose to avoid.

Kevin struggles to find a Thank You card

2009-11-15T08:50:00.000-08:00

After returning home from my most recent rotation I stopped by the stationary aisle in my local grocery store to look for a Thank You card for my preceptor, just a simple gesture of my gratitude. Little did I know, it would be the most frustrating 15 5 minutes of my life. Finding a card, whether it’s a thank you card or a birthday card, is tricky business. Not in the sense that I’m afraid the opposite party wont like the card, but more that the card is an extension of me and I don’t want to be represented by a glittered up pink butterfly with a bad sense of humor. The fact that I have to give a note in a professional capacity adds a further wrinkle into this dilemma. Sorry Mr. Butterfly, not today.

If you’ve ever spent any time in a card aisle or Hallmark store, you should know that it’s obviously geared towards women and children. The cards come in three general themes: cartoons, flowers or kittens. Even when I did find an acceptable design, there would be some message scrawled on the inside that was so sentimental it made me uncomfortable just reading it.

That's really nice, do these come in Mens?

This was also something I never understood. Why do people want their cards to have messages preprinted inside? Isn’t that a little impersonal? Most people write in messages anyways so the text just becomes some odd impediment to a continuous paragraph. If someone doesn’t write anything, it’s not like the receiver will attribute the printed text to the giver. They’d just assume the giver was a lazy asshole that didn’t write anything. Either way, the text is worthless at best, a net-negative at other times. Much like Jess. Anyways, I digress.
After much shuffling around and digging, I finally settled on a generic green card with no text inside. I guess that’s the best I can hope for. Now if I only knew what I should write…

Comics: Ideal vs. Reality - Pediatrics (2009 edition)

2009-11-11T00:27:00.001-08:00

Kevin might want to be an Ob/Gyn, yet might not.

2009-11-06T08:59:00.000-08:00

Choosing the right career is a difficult task and it certainly doesn’t end with your acceptance to medical school. Finding the right specialty is a challenging thing and the first 2 years of medical school really aren’t that helpful. Sure preceptorships give you a quick glimpse, but it really doesn’t give you the full experience of what a doctor does everyday. In an effort to help future medical students, and perhaps just to put our own thoughts down on paper, David and I are starting a new series of articles that weigh the pros and cons of each particular specialty. Each article will feature 3 reasons why we liked that particular specialty and 3 reasons why we didn’t. Even though each article will likely be personal to our own interests and preferences, hopefully it’ll bring up some interesting points to think about as you make your own career decisions. Enjoy

3 Reasons why I want to be an OB/GYN
1. It’s the black and white cookie of medicine

When choosing a medical specialty, one of the biggest questions people consider is whether they would like to do a lot of procedures or whether they’d prefer something more cerebral. One would naturally lead you down the surgical path and the other likely towards something like internal medicine. But for those who would like a little bit of both, Ob/Gyn offers an intriguing alternative. Before my rotation my only knowledge of Ob/Gyn is that you probably deliver a lot of babies and treat a lot of gonorrhea, neither of which were particularly appealing. But what I didn’t realize was that a lot of things can go wrong south of the border and often times you gotta cut ‘em to fix ‘em. The docs I followed did about 2 procedures each morning on Monday Wednesday and Thursday and a full day of procedures on Tuesday. This ranged from tumor removal to urethral slings, prolapse repairs, ovary removal and every flavor of hysterectomy you can imagine. That’s a lot of surgery considering a general surgeon without specialization likely does less with more training time.

Mmmm... tastes like placenta

On the medical side there are a lot of diseases to that can happen to the entire baby making apparatus and you’re the guy/gal to fix it. Often times symptoms can be vague or the etiology multifactorial so there’s a reasonable amount of brain power that must be expended to properly take care of your patients. Not too shabby

2. Good subspecialty options
I only spent 2 days with a gyn/onc but I found the subspecialty pretty fascinating. It’s the only surgical oncology specialty that also manages chemotherapy. So there’s a good amount of continuity of care that lets you manage a patient’s cancer from presentation to remission. Pretty cool.

The surgeries themselves are pretty interesting as well. They’re not particularly challenging from a technical standpoint but the stories I’ve heard at hilarious. My preceptor told me about an obese patient she had that had a slow growing tumor inside her that weighed over 70lbs at time of presentation. In order to do to the surgery, she had to perform a pannectomy as well. By the time the patient left the OR, she was half the weight she went in.

3. Strong continuity of care
My main preceptor was an older doc who had been in practice for over 30 years and many of his patients have been with him for about as long. He’s delivered entire families and really followed some patients from the beginning of motherhood to menopause. This seems like a rewarding process and something a lot of other specialties don’t get to experience, especially if you’re in surgical field.

3 reasons why that might not be a good idea
1. The hours are terrible
OB probably has one of the worst call schedules ever unless you’re part of a large practice with an elaborate call system. When a mother is ready to deliver, she’s ready to deliver and there’s nothing you can do about it. If you have a large patient base and there’s 3-4 women laboring at any given time, you could be in the hospital constantly, at all hours of the night. It sucks.

2. Childbirth
I think I’ve said enough on that subject

3. You get sued a lot. A LOT
Hopefully, if you give OB/GYN any consideration, you would know this fact but it bears mentioning again. Ob/Gyn's get sued all the time. Their malpractice insurance is some of the highest in the entire industry and everybody has had at least one case brought against them for something or other. Basically, it sucks ass. All kinds of things can go wrong and 98% of it isnt your fault, but that doesn't stop patients from suing your ass because little Timmy isn't reading up to his grade level.

Kevin learns some important facts about childbirth

2009-10-31T20:23:00.000-07:00

Ah, 3rd year. The promised land every 2nd year is dreaming of and the 9th level of hell that every 4th year wishes they could forget. So far David has given you a glimpse into the life of a 3rd year surgery rotation student. Now that I’m done with my OB/GYN rotation, I feel obliged to share some intriguing insights into the entire miracle of childbirth that people might not know.

1. It takes a long time
I know what you’ve seen in the movies: Katherine Heigl is out eating some dinner, talking about nothing, when suddenly her water breaks. She goes to the hospital and 15 minutes you have a baby. Not so much in real life. Life on the labor and delivery floor for a medical student is long and tedious. Your duties include watching the mom groan for a really long time, checking the fetal heart rate and then going back to watching the mom groan. Luckily most women are reasonable enough to ask for an epidural (or they’re so beaten down by the constant sensation of having a human being pass through their vagina that they’re willing to compromise on their previous beliefs) so that it’s mostly just waiting without having to hear the groaning. But really, the entire process from onset of labor to actual delivery can take hours, hours where you’re not allowed to sneak away and go watch ESPN in the doctor’s lounge. Or so I’ve been told…

Sigh... if only

2. It smells really really bad
Despite all the lectures about fetal positioning, physiology of pregnancy and the birthing process, no one bothered to tell me child birth is by far the smelliest processes a human being can experience. I mean seriously, it’s awful. First of all, everybody poops, especially in childbirth. When the pushing process takes an hour or two, it’s just a constant dribble of little poop balls. Luckily the nurses are really good about whisking them away but unfortunately the smell is always just hanging in the air. Then once the baby is delivered, there is a huge gush of amniotic fluid, blood, vernix and sometimes meconium. In case you don’t know what vernix is, here’s what up:

“Vernix has a highly variable makeup but is primarily composed of sebum, cells that have sloughed off the fetus's skin and shed lanugo hair.”

So in other words, if you were able to collect BO from 100 fat hairy dudes and somehow condense it into a paste, you’d have some vernix on your hands. I’m absolutely sure vernix was invented just to be the bane of my existence. Well… at least 80% sure.

This reminds me of one delivery I was on where I caught a vernix covered baby onto my chest, right between the numbers. Even though we clamped and cut the cord in a reasonable amount of time, it was too late. I was pasted in baby goo. No matter where I turned, the waft of vernix followed me. Unfortunately I still had to deliver the placenta (another thing people never tell you) and check vaginal lacerations. But, after being hit with the fetus grenade all I could focus on was not vomiting. Every time I moved, it would stir the air and I’d get a little more of that cheesy goodness. By the end I think I was taking about 1 breath a minute. If I was on a pulse ox someone probably would have called a codeAfter that delivery I had to excuse myself to dry heave in the bathroom.

3. You have to be happy for the parents
Maybe this is just a personal struggle of mine but I have a lot of trouble mustering up the happy feelings at 3am in the morning to congratulate the mom and dad on their new baby. Clearly the birth of a child, especially the first, is one of the greatest moments a person can experience… unless it’s not your baby, and especially if you’ve already seen 5 that day. At the end of the day, I really have trouble feigning the fake joy necessary to congratulate some new parents on their new baby, who happens to look exactly like the baby I saw 15 minutes ago. I can say he looks cute but really, that’s not true at all. New babies look like pink little aliens that cry a lot. That’s about all they do. It takes awhile before they develop the chubby cheeks necessary to look hilarious in lobster costumes, which you can then spread across the internet and hopefully haunt them in their adulthood. Until then, they really bring nothing to the table.

This is payback for being so smelly

David Takes Call

2009-10-26T15:58:00.000-07:00

As you may have noticed, many moons have passed since our last post. Due to a mind-boggling lapse in (Kevin’s) judgment, our previous intertube oasis at iddxblog.com has been seized by web squatters. Still, in an effort to better the world (and stop Amanda from crying), we will soldier on at this address until Kevin can undo his folly.

Meanwhile, Kevin and I have narrowly avoided board failure and transitioned to the world of white coats, SOAP notes, and Jesse’s iatrogenesis. For Kevin, this has meant a fantastic voyage of babies and bad smells, while on Surgery, I’ve realized I was never truly tired at any point in my life until now. To illustrate, here’s a quick running diary of a recent call night.

0400: Mmmm, a fresh new day! Only 30-plus hours until next we meet, bed. I’ll think of you fondly while I’m gone.

0505: Pre-rounds and dressing changes. Note to self: Try not to do heroin.

1015: OR, first case. I don’t even know what you’re asking, but I’m going to go with “atelectasis.” Please don’t take my suture scissors away; they’re all I have…

1400: Second case. Pros: I’m actually touching a beating heart. Cons: I can’t feel my legs.

1600: Back on the floor. Are those my bowel sounds or the patient’s? Will he see if I eat some of his pudding?

1830: ED: Hmm, so that’s the most common orifice to hide drugs and drug-related paraphernalia...

1945: I didn’t realize so many people are allergic to "everything but 'Dah-lowd-ee.'” Must be an epidemic.

2100: If I crawled into the scanner and acted somnolent, would the nap be worth the repercussions while they imaged my head? Tough call.

This is the dream…

0020: If only I had some No Doze…

0200: Boo-yah, there’s my second wind. This isn’t so bad. That stapler wasn’t an awful pillow and that guy waiting in the hall stopped giving me the stink-eye.

0600: Rounds II: Son of Rounds. I don’t even remember life on the outside. This must’ve been what Brooks felt like in Shawshank Redemption. I hope the sun is as bright as it is in my dreams. I hope…

It’s OK, Brooks. I understand.

0945: Clinic. Can you turn your head and cough, please?

1215: Off. If I don’t make it home alive, at least I touched a heart.

Comic: What I really think about

2009-08-25T15:40:00.000-07:00

David breaks down his USMLE Step-1 study habits

2009-06-08T19:16:00.000-07:00

*Including debating which Pandora channel best accompanies studying and using First Aid's cheap paper pages to wipe away tears.

David questions Kevin's sanity

2009-06-04T12:32:00.001-07:00

Just like grandma’s first resting tremor, Kevin’s recent post is an unfortunate sentinel sign of a burgeoning neurodegenerative disorder. Yet worse than Parkinson’s, Kevin’s affliction is a severe case of Nicolas Cageophilia. No other reasonable conclusion can justify his inexplicable love for the actor that brought us such cinematic asshattery as Snake Eyes, Ghost Rider, and The Wicker Man. Just look, if you dare, at the list of his four latest “films”:

1. Knowing - "Knowing is Everything."
2. Bangkok Dangerous - Something's happening in Bangkok, and it's probably not safe...
3. National Treasure: Book of Secrets - Fresh off a thrilling adventure in the first installment that involved a hidden treasure map on the back of the Declaration of Independence, the gang is back to uncover ancient Native American gold hidden within Mount Rushmore!
4. Next - Nuclear terrorism is afoot, and Nic Cage, Vegas magician, is the world's only hope.

This is a guy about whom YouTube videos are made en masse (thanks, NicCageFanClub1) solely to evidence the sheer ridiculousness of his frequent affronts to cinema. The actor whose movies even Kevin (and his early-onset Alzheimer’s) agrees he’d be most likely to avoid among Hollywood’s current leading men. The man who, after making the epic failure that was Ghost Rider, actually decided to re-up for a sequel to further his quest to make more people voluntarily claw out their own eyes. An actor whose recent run of movie-making futility has been so painful, I’m actually scared to turn on the TV during the summer for fear of watching 30 seconds of his next “I’ll-grow-out-my-hair-and-then-look-thinky-for-2-hours” debacle.

Knowing: Ooh, I’m thinky…

Next: Oh yeah, now my hair’s even longer, and I’m still thinky…

This isn’t even a movie, that’s how thinky I am!

Sure, Cage made a couple of decent movies in his distant past, but few of them depended on his acting prowess – The Rock was great, but does Nic Cage deserve a ton of credit for playing Overwhelmed Guy? – and none of his recent offerings have done anything but steal money from audiences and make babies cry. And yeah, he won an Oscar, which is basically a Hollywood political popularity vote, allowing him to join the illustrious ranks of Jennifer Connelly and Kate “The Female McConaughey” Hudson in the acting pantheon.

What’s worse, if Cage does possess any true talent, he’s even more unlikeable for electing to unleash such a garbage parade on humanity over the past half-decade. You can’t really criticize Keanu Reeves for poor acting; it’s all he can do. But if Cage can do better – and at this point, who would actually believe he can? – it’s an even bigger slap in the movie-going public’s face that he continues a nearly unprecedented run of sad clown cinema just to cash a check. In the medicine metaphor, Cage isn’t the plastic surgeon who sells out with breast augmentations instead of cleft palate repairs in the third world, he’s the doc that runs a healthy patient through the excessive work-up ringer to squeeze out as much insurance compensation as possible, delivering substandard care (and perhaps a bit of iatrogenic psychological trauma for good measure) to line his own and the hospital/movie studio’s pockets.

Honestly, Nic, how do you sleep at night? At least Kevin’s cortical tau body extravaganza gives him a legitimate excuse for supporting you…

Kevin is incensed at David's blatant consumption of Nicholas Cage Haterade

2009-06-03T00:18:00.000-07:00

So David and I were chatting about movies yesterday when the subject of Nicholas Cage came up. Throughout the course of the conversation it became clear that while David has yet to obtain his MD, he has long since obtained his PhD. I know Nicholas Cage is not the easiest actor to defend but I felt the need to step in to prevent David from OD'ing on Haterade. Allow me to make a few points in support of our friend Nicky-G.

1) He's a good actor
Yes, he's put out a lot of stinkers (more about that later) but he has also put out a lot of quality films. Let me just list off some awesome movies he's been in:

Leaving Las Vegas
The Family Man
Adaptation
Matchstick Men
Lord of War
The Weather Man

These are all quality films that span quite a few genres. His acting was bananas in Adaptation. Lets not forget that he actually won a god damn Oscar for Leaving Las Vegas. DIf you haven't seen any of these movies, I suggest you stop being like Jesse and go rent them now.

2) He makes a shit load of money for himself
Despite having been in several really solid movies, I admit he's had his share of clunkers. But I would argue that he knew these were crappy movies going in and is only in it for the money. And how can you fault a brother for just wanting some cheddar. He loves classic cars and castles, and last time I checked, neither were on the Wendy's 99c menu. A lot of people do things "just for the money," especially David and this whole "medicine" thing. All I'm sayin' is, if plastic surgeons are allowed to fill their pockets w/ boob job money, Nicholas Cage shouldn't be hassled for cashing in his $20 mil. for National Treasure. Plus, even his crappy movies are reasonably entertaining if you just want some mindless action. The Rock and Face/Off are action movies staples that every man should have seen twice if not three times. Simply put, he's stared in some kick ass movies.

3) He makes a shit load of money for the studios
From my research, he's starred in 48 movies, 7 of which have gone on to make over $100 million dollars. Furthermore, the average gross of his last 10 movies was $74 mil, which actually beats out the likes of John Travolta, Pierce Brosnan, Bruce Willis, Denzel Washington, all of whom had similar per movie salaries.

Overall, I'm not saying Nicholas Cage is at the acting caliber of Russell Crowe or Edward Norton nor is he as bankable as Brad Pitt or Tom Cruise but he's not as awful as people make him out to be. He takes good 'actor-y' roles when he wants and then makes $100 mil. in between those to fund his little hobbies. Just let the man enjoy his money.

David and Kevin escape MS-2

2009-05-28T23:24:00.000-07:00

As of approximately 4:30 PM tomorrow, Kevin and I, along with the rest of our intrepid graduating class of 2011 (and Jess, knock on wood), will move from the dark, windowless classrooms of MS-1/2 and on towards the glorious hit parade of life-saving, personal fulfillment, and sleepiness that is sure to be 3rd year.

All that remain in between are a few weeks of faux-summer and a wee board exam. Bring on the sweet downslope of this curve.

Comic: OB exams are tricky

2009-03-19T23:18:00.001-07:00

David, Robby, Dan, Beth and the Johns save lives while on vacation

2009-03-15T16:19:00.000-07:00

Recently, our MS-2 class finished winter quarter and moved one precarious step closer to the wonders of clinical Candyland and all its third-year clerkship glory. To celebrate this historic accomplishment, several of our noble band – including Dan, Old John, Stalker-y John, Robby, and Beth (Mrs. Robby) – traveled to Montana for a manly wilderness adventure. (Kevin wasn’t allowed because the state of Montana has an Asian quota that was met when I joined the trip).

This sort of trip means several things: (1) an ungodly amount of pork consumption (Beth managed to create this); (2) an uncomfortable amount of “That’s what she said" jokes; (3) a nonstop country music bonanza; and (4) 5 med students and an RN (who knows approximately 4.3x more than the rest of us combined) having nerdy faux-medical debates for 4 days.

After a productive morning of snowy adventuring (them) and sleeping (me), we cranked up the country and were treated with a stirring performance of Rascal Flatt’s “Skin,” which tells the story of Sara Beth and her fight against an unknown hematologic malignancy.

We did what any reasonable Spring Breakers would and beat the song to death with the following lively discussion:

After listening to the song, one thing’s for sure: someone’s a poor historian. Seriously Sara Beth, how can we help you without more details? Associated symptoms? Fatigue or fever? Throw us a bone. And Rascal Flatts, did you even go to med school? This OCP is just awful. Even the referring physician’s dropping the ball (“Between the red and the white cells, something’s not right?” At least give us a blood smear.). Clearly we have to do all the work…

First, Sara Beth’s only a teenager, so we’re immediately thinking ALL.

Easy bruising? Sounds like thrombocytopenia.

Mixed “red and…white cell” involvement? Could be an expected pancytopenia.

An aggressive chemotherapeutic regimen with a ~70% cure rate (lowered to "six chances in ten" for Sara Beth due to her older age and its negative prognostic contribution)? Perhaps a little CVAD induction therapy.

If needed, we’ll be ready for marrow transplant on second remission after relapse.

Go enjoy your prom, Sara Beth. We’ve got it from here. Now, if you’ll excuse us, the kid from "John Q" needs a cardio consult for his hypertrophic cardiomyopathy and then we’ve got a 3 o’clock to get a CD4 count from Andrew Beckett in "Philadelphia."

Your son's next, Denzel...

David tells you what to do (in an admissions interview)

2009-03-09T23:05:00.000-07:00

Previously, I’ve given advice of variable seriosity to pre-medical students, both here and in person, usually with respect to the MCAT, personal statement, and general application process. This year, due to a clear administrative error in the selection process, I was allowed to join our school’s admissions committee to serve as a student interviewer. In addition to granting me a golden opportunity to implement my subversive personal agenda, this position has further demonstrated how important the interview is in the admissions process and where applicants commonly stumble or succeed in separating themselves from the pack.

When Kevin and I are asked to speak to pre-meds about admissions, people often think of the interview as a high-stress, nebulous obstacle shrouded in enigmatic mysteriousness with a black-boxy finish. To assuage these concerns, and so that future generations of medical students will learn from those who came before, I present a few suggestions for anyone with an upcoming med school interview:

1) Prepare, prepare, prepare:

This one’s obvious, right? In med school interviews, as in “8 Mile,” you only get one shot. You spent weeks/months preparing for the MCAT and years kicking ass in your science courses, during extracurricular activities, and while saving babies in the free health clinic you established in between curing cancer and playing varsity lacrosse for a school that isn’t Duke. That work ethic is what got you to the interview in the first place, so don’t abandon it now. You’d be surprised how often people seem un- or underprepared to discuss the most basic topics they MUST know will be coming down the question pipeline. There is a 105% chance you’re going to be asked why you want to go into medicine, why it excites you, and what experiences led you to the decision that the next 7+ years of training and three subsequent decades of practice are what you want to do with your life. Think about how you’d answer these questions and practice discussing them in some sort of mock interview format. You don’t need a canned script, but if you don’t have a compelling reason why you want the MD, why would the admissions committee make one up for you?

Along these lines, make sure you’re familiar with the specific program for which you are interviewing. Why does the curriculum appeal to you? What’s unique to that school that will help you reach your professional goals and why are your strengths well suited to that school? This stuff is coming, so you might as well prepare for it. Be Eminem vs. Papa Doc, not Proof. (RIP, Proof.)

Your interview should be like this, but less profane and with fewer tanktops.

2) Research the health care system:

This is an extension of (1); you’re entering a system almost universally recognized as broken, with a myriad of significant issues and just as many proposed solutions. As Atul Gawande once said, “The infrastructure and delivery of American health care are wack, yo*.” This issue is all over the news and, more importantly, is going to affect you every day of your professional life. So spending 10 hours reading about our system and its major pros/cons, about the employees who studied in online medical coding courses, nationalized health programs implemented abroad, recent legislation, etc., would be extremely high-yield. And really, it’s not like anyone expects the applicant to solve the health crisis in one hour. Still, it’s reasonable to expect a candidate to be familiar with the major issues of the profession she wishes to enter; it shows the applicant cares and, just as significantly, that she took the effort to prepare for the interview.

3) Be honest:

Adcoms interview a lot of people. They hear a lot of stories and develop a sensitive radar for half-truths and general BS. If you don’t know in what or if you want to specialize, I think that’s fine, but a vague story about how reconstructive surgery is your calling will ring hollow if you have no experiences to back it up. If you get asked a factual question you can’t answer or are asked to discuss something that requires background information you don’t know, it’s better to admit it and ask for what you need or discuss ways you’d obtain the information required than to make stuff up on the fly. No one expects you to have all the answers. If you did, there’d be no need for med school. You’d just stop by the front desk for a white coat and board certification and be on your life-saving way.

4) Be engaging:

An interview is as much about figuring out who you are and how you interact with others as it is a discussion of your credentials / experiences. An interview is inherently subjective. Think about what types of interviewer-interviewee discussions would positively resonate with an interviewer when he or she evaluates a candidate. An applicant who is warm and personable makes a more favorable impression than one who is excessively reserved. Sure, the interview is serious, and it might not be the time for a risqué joke, but it’s still important to connect with your audience. Your demeanor during the interview can provide a window into how compassionate you might be with patients and how well you’d interact as part of a small team. Don’t affect insincere enthusiasm, but try your best to enjoy the interview and show your true personality. Smiling doesn’t hurt.

All of the above may seem intuitive, but you'd be surprised how often otherwise well-qualified candidates struggle in these areas. Mostly it appears to be an issue of preparation, so spend as much time thinking/talking through these issues as you can. It will definitely pay off in the end.

*He didn’t really say this. I think it was actually part of the Flexner Report…

Kevin is unimpressed with some of his future colleagues

2009-03-04T07:47:00.000-08:00

Recently David and I went with many of our classmates to a medical student research conference to present the groundbreaking research we all did this summer. There aren't a lot of requirements for submitting an abstract but nevertheless it’s a great opportunity to waste 4 days in a cool location meeting students from other medical schools and boozing it up at night. At the end of the weekend you get your “research” abstract published in a journal that will likely benefit no one. But we're really hoping JAMA accepts Beef Stew.

Anyone presenting at this conference is assigned a specific time slot which falls into one of many half-day time blocks at various rooms/locations around the conference site. The format is rather simple, you give a 10 minute talk followed by 3 minutes for questions from the audience. Our school was very insistent about students maintaining a certain level of professionalism at this event. Most of it is pretty straight forward: wear a suit, be respectful, don’t be drunk during the day. Easy. They were also especially adamant about students attending the entire half-day session they were assigned to rather than just showing up for your specific time slot then peacing out after the 15 minutes was up.

All this seems straight forward and self-apparent but not so for some of our colleagues from other medical schools... especially this one from the north. Instead of waking up early and showing up at the start of the half day session, these kids would swoop in about 5 minutes before their slotted time. Inevitably 10 of their classmates would also march in to root them on. When it was his turn the main kid would give his schpiel aboot his research into something related moose-related hunting injuries. Then as soon as his/her presentation was done, the entire posse would stand up and dash out before the moderator could make a passive-aggressive plea for students to stay.

So essentially a large gaggle of students would loudly file in during the middle of another student’s presentation, stay for 15 minutes for their friend's topic, then make a run for it when the next student is setting up his slides. Way to go guys.

*I just wanted to add that while I witnessed a few of these incidents, personally I was not a victim since there were no students from that school scheduled after me.

Julia knows exactly the kind of doctor she will become

2009-02-28T23:29:00.000-08:00

"Sorry, can't educate you about this Fragile X Syndrome your baby boy has, but I CAN talk to you about German health care reforms from 2003-2007."

Ladies and gentlemen, since you were aghast at the long silence on this blog, let me tell you what has been keeping our two class-clowns from their ranting: our med school’s obligatory course on health care structure, policy, and reform*.

Yes, this is a good idea at its core… after all, if we didn’t know anything about the organizations that will be paying us some day that would be pretty lame. However, this class is decidedly a scheduling bully—perhaps a little insecure about itself, and therefore going to make your life miserable to puff up it’s own sense of self-importance. Weekly quizzes requiring recall of minute details from the readings and lecture slides? Awesome. In-class “debate” group presentations, where the professor may-or-may-not call you a liar? Hmm… alright, I guess... Arbitrarily restrictive, two-page, double-spaced paper proposing 1-3 major health care reforms, while giving background and then providing objections to it? Ugh, just leave me alone already!

This class single-handedly managed to eat up more time weekly than musculoskeletal, genetics, and hematology combined!

So, while that pain in your shoulder causing you to be unable to raise your arm to shoulder-level may be very concerning… Can I interest you in a discussion on the pros-and-cons of a physician’s duty to follow public health mandates during a disaster?

David fails to understand honors (/pass/fail grading)

2009-02-16T19:07:00.000-08:00

In the long months since Kevin's illuminating "year 2 is just year 1's uglier, more high-maintenance sister" entry, we have received countless e-mails with pressing questions and comments about the absence of irreverent med school insider-y wit filling the empty spaces in the lives of our devoted public. Here's a sampling of our fan mail:

Whyyyyyyyyyyyyyy???!!!!!
- Julia

I miss you guys so much it hurts sometimes.
- Jess

My one goal in life is to live long enough to see just one more post.
- John (the old one, not the stalker-y one)

Well, the posting drought ends now. RIP, John. (Oh, and Kevin has promised to write several more posts in the near future, though the quality may not rival 'year 2/year 1' brilliance.)

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

Second year, in all of its we-survived-first-year-and-now-we’re-almost-to-third-year glory, has added a new wrinkle to our academic lives: the ‘H.’ Whereas our med school employed a strictly Pass-Fail system during year one, we now face the world-altering prospect of a 50% increase in the number of possible grades. And though popular wisdom places these grades well down the totem pole of importance in one’s residency application, most students are nonetheless interested in filling their transcripts with as many pre-clinical H’s as they can muster.

The logic behind second year grades seems pretty clear: after a transitional first year where mastery of basic concepts is most important, an H/P/F system gives students a chance to distinguish themselves as the material becomes more advanced/clinically relevant. It rewards those who make the extra effort to excel, and such sustained motivation can only have a positive influence on one’s ultimate clinical competence.

Grading systems are designed to both motivate students and, by definition, stratify them based on performance. Grades provide valuable feedback to students and also give administrators at the next step in the academic ladder an essential signal about student achievement. There’s a reason med schools don’t let pre-meds take their pre-reqs P/F; a P only indicates the student demonstrated the minimum competence required to complete the course. Student X may have excelled or almost failed, but no one can know for sure within a purely P/F system.

The major downside of the H/P system is that, though it provides more information than the P/F system, it falls short of a third choice with a full range of grades (akin to the GPA system in college or HS) for no real reason. If adding the H makes sense, why not just take the plunge to a 4.0 scale with the traditional complement of +/-‘s? The purpose of grading is to provide valuable information to all interested parties: to students about their performance, to teachers about how well the material is being learned, to residency administrators about the academic prowess of prospective applicants, etc. If information is the goal, what benefits are there to purposefully providing less information in an H/P/F-only system*? Here are a few I’ve heard, but for the most part, they don’t stack up to deeper review:

1) The H/P/F system is less stressful.

In our system, a final grade of 90% or above usually qualifies one for honors. There may be extra essays involved to reach the holy honors land, but there’s always a numerical cut-off that separates the two strata. Thus, grading is essentially an all-or-none exercise. There is really no major difference in mastery between someone who scores 90% and someone with an 89.1%, yet there’s a reasonable chasm in their ultimate grades. The person with the 90% is in rarified air. The sub-90 % kid is left with a grade that is indistinguishable from a 70% effort. Compare this to a system in which 89% is a B+ and the resultant grade-point differential of a question or two is far less consequential. Which one is more stressful?

2) The H/P/F system motivates students to excel.

Though this is true, it fails to acknowledge that a more traditional grading system incorporates the same educational incentives without dragging along a few major downsides. In a typical 4.0 system, a student who gets an 85% in every class collects a series of B’s that ends up numerically equivalent to a colleague who gets half A’s and half C’s. In the H/P/F system, the former is left with a dreaded P-fest (teehee) while the latter gets rewarded with 50% H’s. Yet who is really the better student? The person who does consistently well but never aces anything or the one who completely ignores half of his classes in order to honor the other half? There may be no clear answer, but it is intuitively obvious that the H/P/F system incentivizes just this sort of all-or-none effort. Grades can both motivate students toward better performance and lead them to utilize practical ways to game the system.

3) It doesn’t really matter; preclinical grades are of little importance and it’s what you learn that determines how you perform when it really counts (during Step 1 and on the wards).

Sure, those other things are more important predictors of matching success than the preclinical transcript, but that doesn’t mean the latter is insignificant. At our school, preclinical grades factor into the behind-closed-doors ranking system that determines whether or not we’re eligible for AOA, which almost everyone agrees is a meaningful distinction. And regardless of how much they ‘matter,’ we should still try to find the best way to dole ‘em out.

4) Stop ranting and go do something useful like studying.

OK fine, you win. But instead of studying, I’m going to figure out if there’s some sort of 15-15-1 equivalent to residency applications…

*It’s not even so much, or at all, about how high the ‘H’ threshold is – it’s actually a lot easier to honor any given class at our school relative to the stories I’ve heard from friends at other institutions – but rather about the utility of the H/P/F system itself.

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

2008-12-15T13:31:00.000-08:00

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

Kevin may have accidentally ruined someone's future

2008-10-21T16:57:00.000-07:00

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

2008-10-09T12:51:00.000-07:00

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

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

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

2008-10-06T00:05:00.000-07:00

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

2008-10-03T02:21:00.001-07:00

Perhaps I have these two cases flipped.

Musings: Oh sweet irony

2008-09-30T01:41:00.000-07:00

Kevin and David are not good at diagnosing

2008-09-22T21:17:00.000-07:00

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

2008-09-18T20:41:00.000-07:00

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

2008-09-14T03:27:00.000-07:00

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

2008-09-07T01:31:00.000-07:00

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

2008-09-04T01:16:00.000-07:00

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

2008-09-03T09:41:00.000-07:00

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

2008-09-03T07:53:00.000-07:00

Kevin observes "John" preying on unsuspecting women at orientation

2008-08-30T15:19:00.000-07:00

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

2008-08-20T18:14:00.000-07:00

David thinks Michael Phelps is disproportionately Olympified

2008-08-13T21:06:00.000-07:00

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

2008-08-12T00:20:00.000-07:00

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

2008-08-05T12:43:00.000-07:00

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?

2008-07-26T21:44:00.000-07:00

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

2008-07-16T22:55:00.000-07:00

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

2008-06-26T17:14:00.000-07:00

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

2008-06-25T00:55:00.000-07:00

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™

2008-06-15T13:02:00.001-07:00

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.

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

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

2008-05-12T18:05:00.000-07:00

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

2008-05-07T16:34:00.000-07:00

Jess Judges People Who Take The Internet Too Seriously

2008-05-04T20:13:00.000-07:00

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.
--------------

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

2008-05-04T01:25:00.000-07:00

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?

---------

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

2008-05-01T22:23:00.000-07:00

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

2008-04-30T15:10:00.000-07:00

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

2008-04-28T15:10:00.000-07:00

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

2008-04-22T12:53:00.000-07:00

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

2008-04-18T01:05:00.000-07:00

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

2008-04-10T18:31:00.000-07:00

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

2008-04-04T22:19:00.000-07:00

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

2008-04-02T12:21:00.000-07:00

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

2008-03-31T13:10:00.000-07:00

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

2008-03-28T13:59:00.000-07:00

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

David discusses the 15-15-1 Theory

2008-03-26T01:55:00.000-07:00

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

2008-03-22T00:45:00.000-07:00

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…

Now this is ground-breakingly original programming (and promotional advertising)!

Kevin debunks 2 myths about medical school

2008-03-05T00:36:00.000-08:00

1. Medical students are really smart

There seems to be some kind of general assumption that you have to be really smart to do medicine. Not true. Medical schools come in all shapes and sizes and with that, different entrance requirements. While the kids over at WashU are probably phenomenal test-takers and would be considered “smart”, the average med school is quite different. People come from all walks of life and while we’re certainly not dumb, most of us really aren’t that smart. The majority of medical students would not hack it in physics, mathematics, even engineering. Hell, looking at averaged VR MCAT scores, most of us are bad at reading as well. Unlike some other fields, medicine doesn’t require its applicants to be the sharpest knife the drawer, only the eagerest. Those who have academic deficits can more than make up for in volunteer work, perhaps save a few African babies. So what people lack in intelligence, they make up for in good ol’ fashion gumption. This isn’t really a bad thing. Medicine is ultimately a service industry and intelligence alone isn’t always enough (unless you’re a neurosurgeon, then it’s probably good enough). But regular people out there: your doctor may be smarter than the average Joe, but that doesn’t mean he’s a genius.

2. Medical school is difficult

The materials covered in medical school are not difficult. Everything is mostly memorization and regurgitation. Rarely do you have to take what you know and apply it to a truly novel situation. Perhaps this will change in second year but so far, it’s been pretty mundane. That’s not to say classes are not time consuming. Memorizing a lot of random facts takes a decent amount of work, but then again so is laying bricks and neither is really that challenging. A lot of my non-medicine friends really believe medical school is the pinnacle of academic rigor and honestly I don’t have the heart to tell them otherwise. Instead, I play into their assumption and pretend I’m just busy all the time with work. Sometimes I’ll tussle my hair up a little bit before approaching some non-medical friends so I look a bit more frazzled (ok not really but I’m willing to go this far if they catch wind of my ruse).

David advises pre-meds against Biology

2008-03-03T18:12:00.000-08:00

It probably seems counterintuitive that anyone would seek my advice about anything. Yet, believe it or not, I often get asked for words of wisdom about navigating the pre-med and med school application process. For any current or prospective pre-meds, here is perhaps the best advice I have: unless you absolutely love biology, enjoy it on a profound and fundamental level that resonates within your pre-med soul, do not major in Biology*. (And if you do love it that much, I’d also argue you should eschew medicine entirely, get a PhD, and cure cancer instead of learning how to treat it. But that is a rant for another day.)

Why? I’m glad you asked. Not majoring in Bio*

1) will help you decide if medicine is really for you.

I know every 4th freshman in college has felt some burning, innate desire to become a doctor and save the world. They played with stethoscopes as toddlers, volunteered at the local children’s hospital during high school, and have told every teacher, relative, and college admissions officer that they’re going to become a whatever-ologist because they really want to help people. Yet despite that medical love-fest, most people have no clue what being a doctor really means. They’ve settled on the ideal of making a difference and saving lives, but haven’t necessarily explored alternative career paths or taken the time to really understand what a physician does on a day-to-day basis.

In high school, everyone takes more or less the same classes and meets roughly the same requirements. College is the best chance to learn new stuff and explore new opportunities. Why pigeon-hole yourself if you don’t have to? The path to physician-hood is a ridiculously long process that requires a lot of personal and financial sacrifice. Pre-meds too often do a disservice to themselves by not exploring other options. So delve into a new subject, not just on a superficial level or even to get that minor you think med schools will care about, but all the way into upper-division classes that really show what the field has to offer. At the same time, do all the shadowing/pre-med club stuff too. The point is to see what’s out there and what you like the best, rather than mindlessly following the rest of the sheep without a second thought.

Finally, what if you major in Bio* and decide medicine is not for you. That's better than entering med school and hating it, but you're still looking at an uphill battle. Unfortunately, a successful career in research is going to demand a hell of a lot more than your BS, and non-science employers won't be that impressed that you know about cells. Again, if you just love the natural sciences and want to pursue the next step in education, this isn't a problem, but if you're banking on med school and it doesn't pan out, things don't look as bright.

2) will teach you something new and valuable.

Ok, so you KNOW you want to become a doctor. There’s no point in even exploring another field, the ingrained instinct to save the children is that strong. If for some unknown reason you couldn’t get that coveted MD, you’d be so distraught that you’d forsake the professional world, tie up a hobo sack, and ride the rails. Well, that’s awesome, congrats on the choice. Now go find something besides bio to learn about for four years.

Contrary to popular belief, biology, chemistry, biochemistry, etc. do not equal Medicine in College. Sure, your O-chem prof might spice up his lectures by talking about the structure of taxol or have you make god-awfully impure aspirin in the lab, but you don’t get to play doctor until MS-1. And once you reach med school, you’ll have two intense years of science and a whole lifetime of literature to satisfy your urges for knowledge. Why not take the chance to put another shot in your bag while you have the time? Major in English and learn about rhetoric. There will be exactly one gazillion times in your life where being a good, persuasive writer will help you. Major in Economics, Finance, Accounting, etc., so you’ll be better able to invest in the future, understand financial markets, and read The Wall Street Journal while holding your glasses loosely with one hand so that the tip of one earpiece is touching the edge of your mouth (then bust out terms like ‘basis point’ and ‘expansionary’ and watch all hell break loose). All of eternity awaits for that medicine-only focus. Learn something cool that you can use later on and you’ll never regret missing that extra bio class on the mechanisms of something the cell does that no one cares about.

3) will HELP your chances of getting in to med school.

Even though I don’t advocate going the non-bio route purely as a way to game the system, I still find it exceedingly obvious that being a non-science major is an effective way to stand out from the crowd.

Sad though it may be, your 3.9/35 (or whatever strong combination you offer) from Look How Awesome I Am University doesn’t impress anyone on any admissions committee at any med school. They’ve seen you and a million more just like you come down the application pipeline over the years. Sure, there are amazing kids every so often that probably get in by virtue of their academic accomplishments alone, but that isn’t a feasible option for the average student. A History major, however, is relatively unique. Assuming you’ve done well in your science courses, the fact that you would bolster the intellectual diversity of an incoming class can only help. People reading your file are probably thinking “Wow, this kid did something cool and unique that will add to our student body,” not “Uh-oh, not enough science, he/she won’t cut it.” And in your interview, you’ll have the rare ability to talk about something you know more about than the interviewer. Who is Prof. Blah going to remember better, the mechanical engineer who worked on the solar car team or that other kid who did that one experiment with those flies?

4) will NOT hurt you once you reach the Promised Land.

“OK, David,” you say. “Sure, I can learn cool non-medical stuff and maybe even get a boost in the application process, but what about once I get accepted? It’s going to be all science, all the time, and my crappy Math degree is going to come back to bite me in the ass.”

Not so! There’s a reason med schools demand all those prerequisite courses in bio, chem, and physics. Those classes test your ability to work hard, internalize large amounts of information, and apply all the concepts you’ve memorized in new, unfamiliar situations. They also give you the necessary knowledge base to succeed in med school. Med schools aren’t in the business of accepting people who lack the requisite scientific background to keep up in class. Assuming you did well in your pre-reqs and got a good MCAT score, you definitely won’t be behind. If you can’t already tell, I was a non-science major in college, and I guarantee a PhD in biochem would not have had an appreciable influence on my experience in biochemistry so far as a med student.

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

So, there you go, several reasons not to major in Biology*. Take ‘em or leave ‘em. Hopefully the former, since I knew from my earliest moments that all I wanted to do is help people…

*This extends to Bio, Biochem, and any hybrid pre-health major that pre-meds gravitate toward just because they think it’s relevant or helps their application

Musings: Med School Seating Chart by Maturity Level

2008-02-28T01:12:00.000-08:00

Musings: Chinese Restaurants

2008-02-27T00:05:00.000-08:00

David and Kevin's Musings - A Visual Series

2008-02-26T00:35:00.000-08:00

Comic: Hard of Hearing

2008-02-25T19:28:00.000-08:00

David quantifies his inanity

2008-02-24T12:47:00.000-08:00

To those who know me, it's probably not a big surprise that I waste a lot of time talking about things that are completely meaningless and most likely offer zero benefit to anyone. To illustrate, I offer the following example. Recently, we have been studying childhood development. One important topic in the study of infants and toddlers is a milestone, a certain ability a child acquires at a certain age which is important in his or her development. Some one of these milestones involve how many blocks a kid can stack at, say, 20 months versus 24 months (only four at 20, but a whopping 4-5 at 24). This is important because it indicates the child's motor and cognitive skills are progressing appropriately.

Instead of taking this concept at face value, my friend and I launched into a 30 minute discussion about how exactly these block values are ascertained. Is there a block laboratory where babies perform thousands of stacking trials? Are there internationally standardized blocks sold by Welch Allyn? If there aren't, what's the point? A toddler might be able to toddle his way to a stack of 10 really stable blocks, but if one weighed 5lbs he probably wouldn't be able to add number two. What exactly is the limiting factor? Is there just an increasing error accumulation that is insurmountable once four blocks are reached? And perhaps most importantly, how much more awesome would we be at block-stacking than those little kids? If we had a crane and a really tall indoor space with virtually no airflow, couldn't we be an unstoppable block-stacking force the likes of the which the world has never seen?

As sad as it seems, I have at least 2-3 of these sorts of conversations per day. This one was sort of long, but if we assume I have 2.5 conversations at 15min per, and take about two weeks of vacation time to rest my rambling muscles, I waste over 9.1 full days on this nonsense annually ((15/[60*24])*2.5*350). That may not seem like a lot, but since I plan on saving at least 300 lives per day as a doctor, and the economic value of a statistical life has been argued to be about $5million*, my inanity will cost the world billions by the time I die. Good to know I'm making a difference...

*This is actually true, but don't expect me to cite any sources here.

Comic: Oops

2008-02-22T10:03:00.000-08:00

David wins epic battle against co-walker

2008-02-21T00:02:00.000-08:00

(Kevin recently contracted bird fru, so I will become the prolific scorer I always knew I was and continue to pick up the slack.)

Yesterday, I was walking towards my car with a jaunty spring in my step after managing to stay in class for two hours before calling it a day. A few minutes away from the parking lot, another random guy (RG) started walking alongside me, and initially I thought nothing of it. Normally, I’d give RG the patented Dave speed burst and launch ahead on the way to bigger and better things. Alternatively, I could’ve played it Mav style, hitting the brakes, letting him fly right by, then switching immediately to missile lock (or guns, if he remained too close). For some reason, I opted against either go-to strategy. The path was pretty wide, I was still happy about all the learning I’d just done, so I decided to let things play out naturally.

After a while, it became painfully obvious to both of us that we had been walking almost side by side for several minutes. Still, as is the case with 99% of my choices, inertia won out and we remained in relative lock-step. By the time we reached the parking lot, which is pretty large as public parking lots go, more than a few awkward side-glances had been exchanged, yet still no one made a move to take the lead or fall behind. And based on his body language, I’m almost completely certain he was thinking about our strange traveling dynamic as well. About fifteen rows in, we approached my car, and I veered off to the side appropriately. RG, seemingly confused, shifted almost instinctively in my direction before stutter-stepping and then finally grinding to a complete stop. Clearly disoriented, he looked around awkwardy and then started walking in the other direction. In my car, I watched as RG backtracked a few rows and proceeded to walk up and down each of them searching vainly for his car. Perhaps you had to be there, but watching him wander about for several minutes, potentially aware that I might be watching since I hadn’t left yet, was oddly mesmerizing. At one point, it appeared as though he was contemplating exiting the parking lot entirely so he could return with tabula rasa and try again. Or maybe he was thinking about giving up entirely and taking the bus home or buying a new car. In any case, after another minute or so, I finally forced myself to leave. Needless to say, I emerged the clear victor…

David rants about Dishes-it-out-yet-can’t-take-it-back Syndrome

2008-02-18T23:14:00.000-08:00

When I hang out with my good friends, there is a lot of back-and-forth joking. It is generally good-natured ribbing, and each participant typically takes about as much flak as he or she dishes out to others. Perhaps this isn’t the most mature friendship dynamic, but I enjoy joking around and almost all of my friends do as well. Some topics are clearly over the line but, for the most part, everyone knows the humor isn’t serious and gets a kick out of the back-and-forth.

Now, not everyone is particularly jokey. Some (most?) people are orders of magnitude more mature than I am – which should make you extremely happy that I’ll be treating patients in T-minus 12 years – and may not trade similar barbs with their buddies. I have several such friends with whom I exchange mostly light-hearted or topical banter, without engaging in person-specific comedery or ever venturing into the purely golden “that’s what she said” domain. On the other end of the spectrum are friends with whom normal conversation has nearly no humor restrictions. We don’t seriously insult one another, but the phrase ‘yellow-on-yellow’ crime would apply with significant regularity.

The golden rule governing this intricate humor interplay, an unspoken law that most people find intuitively obvious, is that one must be able to take approximately as much as one dishes out. If Robert makes a joke about how long it takes Kevin’s mother to cook Minute Rice (Note to Robert: it’s not that funny if she’s really smart and cooks it in 25 seconds), Robert must be willing to endure a similar barb from Kevin’s humor repertoire.

To illustrate this issue, a simple 45-degree line will suffice. On the x-axis, we have “out-dishing;” on the y-axis, “back-taking.” Thus, the more you dish it out, the more you have to take in order to meet the perfect 1-for-1 Repartee Ratio. Now, it’s no good to make fun of someone who’s polite/mature/nice enough not to dish it out. Nor does he/she deserve it. Thus, that friend is forced to take little back in return. Moving along the line, your obnoxious buddy that makes all those ridiculous jokes better be willing to feel the heat.

The problem occurs when people are disproportionately over-sensitive; they love to make inappropriate, callous jokes about others yet become defensive or upset when someone sends a yo’-mamma missile their way. This is one of my big-time pet peeves, a common pathology I’d like to call Dishes-it-out-yet-can’t-take-it-back Syndrome (DS). People with DS put a serious strain on one’s humor game, completely throwing off the mostly well-meaning, tongue-in-cheek vibe that brings me so much joy. Each one of you knows someone afflicted with DS. You can all recall an otherwise awesome social situation where DS made everything end in tears.

Well, thanks to my burgeoning biotech firm, the solution is finally here in the handy, dandy, Rx-only Getoveryourselfafilnoprene. Only 50mg nightly before bed has been shown to yield clinically significant reductions in DS symptoms. Stay tuned for our next pharmaceutical innovation in the treatment of Always-make-everything-about-them Disease…

David takes a step back to reflect...

2008-02-17T20:24:00.000-08:00

Do you ever stop to contemplate the little things that change the ultimate paths of our lives, those almost indefinable moments in time that can alter who we become or the impact we have on the world? I know I’m normally so caught up in the hustle and bustle of school and life that I don’t take the time to stop and smell the roses. Everything becomes such a whirlwind of tests, stress, drama, and hate crimes…I get so turned around I don’t know what’s important anymore…

A while back in this space I mentioned going out to lunch with a friend and how a bird pooped on him on the way back. I sort of made light of it at the time, but it’s been eating away at me ever since. If only we had stopped a moment longer to wait for the light to turn on the previous street, the bird and my friend would never have crossed paths. If I had noticed my shoe was untied, how would things have turned out differently? My friend wouldn’t have ruined his new coat. He wouldn’t have missed class to cry it out. Or maybe, just maybe, that bird impeded our path just long enough that we avoided something far worse...like being pooped on by a larger bird, or by two smaller birds whose cumulative poop volume exceeded that of the one average-sized bird.

So maybe that bird was meant to poop on him…if it hadn’t, we might’ve walked in front of a bus a couple blocks down. I might never have realized my ultimate dreams: saving African babies, walking on the moon, making it rain hundys at Club Isis. When I stop and consider the interconnectedness of our universe, I am overwhelmed. It’s beautiful, but, at the same time, it’s scary....................

I guess what I’m saying is, live while you can. Laugh out loud and don’t pay attention to who’s watching. Stumble once in a while, it’s OK. I know I’m going to try and follow this advice too. Maybe I’ll look back on this post when I start feeling blue and it will remind me to stop holding my breath so I can get oxygen again. I know there are still important things I need to learn about myself, but hopefully, this is a start…

The shadows surround me
Gripping
At
My soul.
No, Darkness, please
I have so much more to
Give.
Light. Peace. A second chance.
Thank you.

David is outraged by senseless krill murder

2008-02-16T11:27:00.000-08:00

I am shocked and appalled that Kevin has condoned senseless krill-killing in his investigative report on the Little Mermaid. He quickly excludes the possibility of a Flounder feast or Sebastian sauté – on the basis of their demonstrated sentience – yet throws krill to the sea-wolves without a second thought. Why? Because they’re small and don’t crack the starting lineup for “Under the Sea.” That is unacceptable. I am taking a stand.

First, watch this video of arguably the finest impromptu-underwater-point-making-ensemble-musical-number ever:

Now, two things are painfully obvious. First, Sebastian is a frickin’ rhetorical genius. “The seaweed is always greener” is persuasive gold. That effeminate crab just knows how to sell it. Second, and far more importantly, there is established video evidence that shrimp are sentient. At 3:03 in the video, right after we learn that “each little snail here know how to wail here, that’s why it’s hotter under the water,” we see a bevy of shrimp, smiling, dancing, and jumping in a glorious air bubble cascade that would make anyone want to drown in a tide pool. The shrimp display obvious, visible emotions in their heartfelt attempt to keep Ariel from going above water, all the while maintaining admirable balance atop slippery bubbles in an impassioned jig.

Clearly, the shrimp have a lot going on upstairs. And krill, as everyone knows, are basically just mini-shrimp. Even Wikipedia – which will have been responsible for at least 29% of my medical education by the time I’m done – describes them as “shrimp-like.”


                                                     Can you tell the difference? I can't...

Adding two and two together, we realize that Triton and his Mer-peers are basically eating 1000s of conscious beings every day. Murdering countless krill families and destroying countless krill dreams. Stopping krill doctors from seeing krill patients and devastating krill adolescents worldwide by preventing krill Jessica Alba from reaching the level of irrelevance that would inevitably force her to do a nude scene to get back into the public eye. And all based on the shaky premise that, somewhere along the continuum between krill and shrimp, there is an arbitrary Eat Me line that makes it OK. Outrageous!

Triton, is that any way to lead your people? Shrimp, how could you pander to the princess whose father murders your cousins day after day after day? And you, Kevin, I am most disappointed in you. You’re just like Harry Potter, standing idly by, ignoring the problems of another world while you keep the platypus down…

Kevin Contemplates the Diet of the Little Mermaid

2008-02-15T22:07:00.000-08:00

Following David's intrepid exposé of Harry Potter, one can't help but wonder what questions remain unanswered from the movies our beloved childhood. Should Aladdin go to jail for stealing bread? Is Winnie the Pooh's honey addiction merely a stepping stone to black tar heroin? All the signs point to yes. But one question has dogged me until this day.

What did the Mermen eat in the Little Mermaid?

What a hottie

Looking at Ariel’s heroin-chic physique one might guess a subsistence of cigarettes and self-loathing but of course we all know you can’t smoke under the sea. The next thing that comes to mind is the wide assortment of aquatic plants at their disposal. So are the Mermen a bunch of kelp-hugging vegetarians? You might think so but looking at King Triton that simply can’t be true. Without the necessary high protein diet, a person simply cannot maintain such a physique without the help of BALCO.

Ladies, got your tickets to the gun show?

Thus, Triton must eat meat. While the film features a wide array of oceanic fauna, most of them appear sentient. Can you sink your knife into Flounder or toss Sebastian into the steamer? I didn’t think so. Finally we come to krill. While technically an animal, this tiny Sebastian is far too small to be capable of sentient thought much less performing spontaneous yet surprisingly well-coordinated musical numbers. Looks like we have a winner (or loser if you’re the krill.)

Common fare at any seafood restaurant

To find out how much of these tiny critters Triton must wolf down on a daily basis, I did a little digging into the daily diet of Blue Whales. According to one article, a single Blue Whale eats roughly 40 million krill per day (about 7715 lbs) to satiate a recommended 1.5 million calorie a day diet. With these figures, I surmise there’s about 0.00357 Cal/krill and each krill weight approximately 0.000192 lbs. Then assuming Triton maintains a 2000 Cal/day diet (pretty low given his body size), he would need to eat 10.28lbs of krill per day. A pretty ludicrous amount given that a single human being eats less than half of that (4.7 lbs). But I guess it’s not outside the realm of possibility.

Comic: Romance

2008-02-13T23:56:00.000-08:00

Kevin Realizes Mistakes Happen All the Time in Surgery

2008-02-13T21:48:00.000-08:00

For those who don't know, I'm in a surgery preceptorship this quarter where I get to watch a surgery once a week. This is quite an amazing experience since I'm literally standing shoulder to shoulder with someone who is wrist deep into someone's heart (not metaphorically either, although im not sure what that metaphor would imply). Of course this intimate glimpse into the OR is not without its surprises...

Just last week, I was observing an ascending aortic composite graft procedure when out of the corner of my eye I noticed the scrub nurse engaged in a muffled conversation with the circulating nurse about something. Then the circ nurse suddenly drops to the ground and starts crawling around. 5 minutes of her best illegal immigrant maid impersonation later, she comes up and seems to wave a "Negative" to her sterile compatriot. The scrub nurse then turns to and asks:

"Kevin, can you look around for a needle, it should be attached to some blue suture."
"Uh... sure," I said, fumbling around my little section. By the way, the universal "fumbling and patting the pockets" motion when pretending to look for something makes you look retarded while gowned up in an OR.

After 5 more minutes of my fumbling, I was forced to give a negative as well. So finally the nurse tells the surgeon: "Doctor, we're going to have to x-ray this guy after you're done, I can't find a needle." Oops.

Kevin and David Present: The Top 10 Things We've Learned in Med School

2008-02-11T23:48:00.000-08:00

To commemorate the completion of our first half-year of med school, we present the top 10 things we've learned so far:

10)  Experts tell us having kids and being married both suck.

9)    Experts consist of random 38 year-old "young" adults.

8)    Eighty percent of future doctors are brunette white women.

7)    Kevin wants to learn, David wants The Truth.

6)    (Kevin doesn't really want to learn, but David really does want the Truth.)

5)    You can teach an entire lecture with inspirational quotes alone.

4)    We have something in common with a football player from Duvall (pronounced "Dooooo-         vuhl").

3)    Kevin is 1/32nd cardiothoracic surgeon but he's pretty sure he's ready now.

2)    David still thinks he's in business school.

1.5) Your patients won't care how much you know until they know how much you care.

1)    Never donate your body to science.

Comic: Bad sign for the future

2008-02-11T21:37:00.000-08:00

Inspired by Linda's adventures with electronics:

I had just gotten the coffee maker, and I made coffee almost everyday. It was exhilerating[sic]. Then one morning, while I stood in the kitchen and Penny sat at the dining table, I was horrified to find that when I pressed the on button, nothing happened. No coffee.

NO COFFEE.

Shit! I said to Penny. Look! The coffee maker's broken.

She told me to check if it was plugged in. Oh, I said. So I picked up the white plug behind the coffee maker and plugged it in. But still, nothing happened, no red light. Now I was really scared; I started to panic.

I frantically pulled and replugged the cord into the wall socket. Oh no! It's broken! It's broken!

Then I looked emphatically back at Penny to see why she was not also panicking.

She said, Linda, that's the rice maker.

Apparently she had been sitting at the table watching me freak out while the light on the rice maker went on and off, on and off.

So I changed plugs, made coffee and we both went back to studying.

David Anticipates an Unexpected Consequence of Kevin*

2008-02-09T00:39:00.000-08:00

After reading Kevin’s latest post, one can’t help but envision the following probabilistically inevitable scenario:

Kevin tells me his name is quite common amongst immigrants from the motherland. A quick Google search for “Kevin*” confirms this to be true, returning 22,800 hits. Given this high number of Kevin*s running around and the extreme virulence of the aforementioned disease, it seems likely that there might come a day when one of those countless Kevin*s was…wait for it…infected with Kevin*. How exactly would that doctor-patient interaction go?

------

Doctor: Kevin, I have some unfortunate news. You have Kevin*.
Kevin: Excuse me?
Doctor: Kevin*, you have it.
Kevin: Are you stupid? Have what?
Doctor: Who’s on firs…Err, there’s a disease called Kevin*, Kevin. Unfortunately, you’ve got it.
Kevin: You’re kidding?
Doctor: Actually I’m not.

Kevin: ...

Doctor: ...

Kevin: ...

Doctor: What are the chances, eh? If you think about it, it’s actually kind of fun–
Kevin: Die.

------

One can only imagine what would happen if the original Kevin* was this Kevin*’s doctor, delivering the news and explaining his reasoning for naming the disease. Or maybe bad karma would win out and original Kevin* would get ALS.

These are the things I think about sometimes. Why does my brain hate me…

Kevin considers Infectious Disease

2008-02-08T22:07:00.000-08:00

Back in the glory days of medicine when old white men ran the show and nurses wore skirts and paper hats, medical research was pretty egotistical. Whenever someone discovered a genetic disorder, he would inevitably name said disorder after himself. Thus you have your well known diseases such as Alzheimer's, Huntington's, Tay-Sachs... the list goes on. Yet, even back then, no one wanted to name infectious diseases after himself. Dumb. Infectious diseases are the crazier, flashier, version of their more homely genetic counterparts. The evidence is in the movies. Infectious disease has given us adrenaline-pumping thrillers such as Outbreak, 28 Days Later, I Am Legend just to name a few. Genetic disorders on the otherhand gives us Bubble Boy, a trainwreck I'm sure Jake Gyllenhal would like back.

You decide

So that gets me thinking. Naming such diseases after the infectious agent is boring and predictable. If I become an infectious disease specialist I will dedicate my life's work to finding the most dangerous virus/bug out there. But I wont name it something boring like Africanized AIDS (although that has promise). No, I will name it after myself. Why, you might ask. I'll tell you why. Imagine the headline possibilities.

AFRICA IN CHAOS AS KEVIN* RAGES ACROSS CONTINENT

Or maybe something more akin to the movie Outbreak:

CALIFORNIA UNDER MARTIAL LAW TO CONTAIN KEVIN*

"Oh my God his body is completely destroyed by Kevin*"

I'm pretty sure that would cement my place in the medical as well as the history books.

*Obviously I would use my whole name to maximize my glory and minimize confusion, but for internet purposes, first name is enough.

David: Harry Potter and the Glaring Lack of Wizardkind’s Collective Social Conscience

2008-02-07T16:13:00.000-08:00

Today during lunch, the conversation turned to logical inconsistencies in popular entertainment. All kinds of movies require the audience to take large leaps of faith in order remain engaged in the storyline and enjoy the show. Can dinosaurs really be made from DNA taken from the blood sucked out of fossilized mosquitoes? In order for me to realize my life-long dream of riding on a pterodactyl, I can only pray that they can. But to really enjoy the movie, we all have to overlook that potential snag and get ready for the people-eating. In the end, no one gets hurt from the suspension of disbelief. Science may suffer briefly, but people aren’t looking for old tree sap to clone another T-Rex. Everybody wins.


                                                               If only…

Unfortunately, things are not always so harmless. Eventually, our lunchtime babbling focused on Harry Potter. (Harry Potter, for those who don’t know, is about a physically and emotionally scarred little boy who undergoes the trials and tribulations of adolescence. All the while, Harry fights some unspeakable evil that is really scary, yet somehow manages to be continually defeated by the power of love and unicorns and stuff. Forgive or correct me if that is wrong, but that’s the story as I know it.) Now, I am not entirely familiar with all of the rules of the wizard world or the guidelines J.K Rowling imposes on what wizards can and can’t do, but I’ve seen most of the movies, read some of the books, and have a general idea of what’s going down in Candyland. And as far as I can tell, Harry Potter is a terrible influence on today’s youth. Forget all of the religious conservatives that see the series as sacrilegious or anyone that may think believing in magic gives children false hopes or distorts their sense of reality. My major complaint is the blatant lack of a social conscience displayed by witches and wizards to those outside of their magical kingdom.

Wizards, it appears, can do whatever the hell they want. They can fly on brooms, conjure random shit out of midair, make food with magic, heal people, and do a million other things that could be ridiculously useful. Yet they never seem to apply their prodigious talents to saving non-wizards. What ‘s up with that , Harry et al? Basically, the next 10-plus years of my medical education will be spent learning to do things some magical person could do with unintelligible gibberish and the flick of the wrist. There would be no starvation, no disease, and no embarrassing ascites. The Gates Foundation’s philanthropic efforts would border on puppy-kicking in comparison to what a few wizards could do. Need a house/school/new pony? No problem, I’ll whip one right up! Oil conflict? Let me conjure a Hummer H4 that runs on baby laughter. If a normal person walks down the street, sees an accident, and fails to help in a situation where he might be reasonably expected to lend a hand, it's negligence. Jerry, Elaine , George and Kramer went to jail for that shit. Yet wizards let genocide happen without batting an eye. It's like one community-sized Milgram experiment gone wrong. On a more personal level, just today, on the way back from lunch, my friend got pooped on by a bird. Even now, I can see the solitary tear welling up in his eye. Magic could have stopped that from happening.

What are you teaching our children, J.K.? That it’s OK to turn a blind eye to the suffering of people who aren’t magical? That fighting some random bald dude who looks like a snake excuses one from addressing the greater problems of the world? I for one am saddened. For shame, J.K., for shame.

(On a mostly unrelated side note, how exactly do wizards decide what creatures are special or magical? Is it completely arbitrary? Everyone knows that dragons and centaurs are magical, that’s just common sense. What about alligators? They’re basically modern dinosaurs, but wizards don’t seem to give them much respect. Duck-billed platypi? Those mammals can lay eggs, for Xenu’s sake! Sounds like advanced witchcraft to me. And if talking is a general prerequisite – which it seems like it shouldn’t be – who’s to say the platypus can’t talk? I sure as hell haven’t ever seen one. I know I wouldn’t underestimate anything that looks like this:


                                                    How is this guy not magic?

I bet the platypus wouldn’t have let the bird poop on my friend…)

David: Hello World

2008-02-06T23:10:00.000-08:00

Since this is my inaugural entry, I’d like to start out with a brief mission statement for my contributions to Yellow Magic. Since my true Asian-ness has been diluted by generations of the American Dream and the sweet air of democracy, I did not jump on the Xanga bandwagon in high school or college like so many others. I had no outlet for my late-adolescent/early-adult self-discovery and, tragically, was forced to wallow in sadness without a forum for my archives of digital pictures in which I flash the V sign with both hands or point to the creases of my wide, wide smile, again with both hands.

Well, those days are finally over, so here’s what any of the paltry number of people that accidentally clicked to this page can expect from me. I can’t draw, and I’m not smart enough to come up with something funny anyway, so I will leave that stuff to Kevin. Instead, 60% of the time, I will be finding myself 100% of the time. I will make sappy metaphors about life, dramatic emo statements, follow everything with ellipses, and apologize for nothing. Poems that don’t rhyme? Don’t mind if I do…

Enjoy.

Kevin hates saying "Hi" to people

2008-02-06T23:03:00.000-08:00

I always hate it when I walk through campus or T-wing and I encounter someone I know and must say "Hi". The act of saying "Hi" is not bad part, the motions I have to do leading up to it is the bad part. I must note that this only pertains to people I know and thus feel obligated (and want) to say Hi , but not well enough to actually stop and have a conversation. And i alos MUST stress that it's not the person I hate but the awkward series of motions I need to do just to say Hi.
Anyways, the awkward moment is if I see them walking towards me from really far away. At this point I am completely unsure as to what to do, they are too far to talk to, you can't tell if they are actually looking at you, and any kind of hand motion could be meant for someone else. To make matters worse, even if you COULD communicate with them, by the time you've said Hi and held the canned mini conversation (I'll talk about that later), they're STILL in front you of and you have a super awkward moment where you are actually walking past each other and theres nothing else to say.
In order to remedy this, although not necessarily efficiently, I employ what I call the "anywhere but at you" maneuver. By this I mean I will first notice the person from far away, I will gauge their walking speed and my own and their distance from me. I will then either look down, left , right, basically anywhere but in front. I will continue to do so until they're at an acceptable distance for me to look up, "notice" them, feign surprise, wave high and hold the usual conversation of
"Hi'
"Hi, how are you"
"good, you?"
"good good".
If the timing is perfect, the final "good good" will occur just as the person passes. Wow that's quite a lot of analysis for something so small. Oh well, atleast it beats staring at the person for a full 30 seconds before speaking to them.

Past Comics

2007-02-06T23:08:00.000-08:00

Comic: You look smart

2007-02-06T23:05:00.000-08:00

http://medschoolcomics.blogspot.com/2007/10/you-look-smart.html

	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
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