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

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

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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

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

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

David breaks down his USMLE Step-1 study habits

*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

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

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:

1. Leaving Las Vegas
2. The Family Man
3. Adaptation
4. Matchstick Men
5. Lord of War
   
6. 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.