Friday, May 24, 2013

Jealous

During a class discussion, Amelia used the word, "Ameliorate."

She was suggesting that we make a situation better. Not only did I have to give her props for a wonderful vocabulary word, and she rendered me instantly jealous that her name has a verb but mine doesn't.

I realized that's not the first time that I felt jealousy over something so trivial. My family went fishing once when I was four years-old at a place called Lee's Ferry. The only reason I remember that is because I was jealous that my older brother Lee had a fairy and I didn't. No one ever mentioned anything about my fairy...ever.

I was also jealous that my brother LaVar had two capital letters in his name and mine only had one.

Tuesday, May 21, 2013

Must Be Nice

I was in the zone studying for boards. Suddenly, one of my professors (a doctor) appeared behind me and read the question I was working.

The problem painted a clinical picture of Vitamin C deficiency to the point of scurvy and the question asked, "This patient's symptoms are most likely due to enzyme hypoactivity in which cellular compartment?"

The teacher thought he'd help me by supplying the diagnosis, which I'd already made. Then he read through the answer choices.

"Rough endoplasmic reticulum?! Does that mean there is a smooth endoplasmic reticulum? And what the heck is the Golgi? I guess that shows you how much you use this stuff once you're a doctor."

I laughed, he laughed, and I felt a little better about the world.

Friday, May 3, 2013

PBR

We recently completed the pelvic, breast, and rectal exams. There was a steady stream of students sitting outside the clinical simulation rooms and all the professors that passed by mentioned something about how glum we all looked. I was actually kind of thrilled, but they were running late and it's hard to keep excitement going for very long. Finally, after studying buzz words, clinical presentations, and going through the motions of pretending to be doing something important we were finally able to do something rather than just imagine it. It was kind of refreshing and made me look forward even more to June when we start clinical rotations.

I started off first with the female genital exam. Before I entered the room, the doctor that was walking me through the procedure showed me on a plastic model what structures and landmarks I should see, how to hold the speculum, etc. We walked in the room, I introduced myself to the girl on the exam table, and reached for the extra large green nitrile gloves as the model explained to me that she was on the tail end of her period and was a little bit embarrassed by the small amounts of blood I might see. I tried to put her at ease, and all things considered, she did seem pretty calm, but that might be because I was the fourteenth student to prod her that afternoon. I put the jelly on the speculum and inserted it at a fourty-five degree angle just as I was shown and tried to run it along the vaginal floor until my guiding hand reached the pubic symphysis. When it looked like I was in far enough, I was given the go ahead to open the speculum to try to grasp the cervix. As I opened the jaws, the cervix seemed to find it's way into my view from the left. The doctor explained where the opening of the cervix was and said that it was easier on this woman because of the posterior positioning of the uterus which pushed the cervix forward, but that I could count on having a harder time of it on a different patient. Next came the palpation of uterus and ovaries so I withdrew the speculum and used my pointer and middle finger to feel the cervix. Once I felt what was described as the cartilage on the tip of the nose, I brought my exterior hand to the belly button and palpated downward until when I moved the cervix I could feel motion of the uterus under my palpating hand. From there I swung out laterally to either side to try to palpate the ovaries. I felt like I might have been imagining the almond-sized nodules, but the patient said I was in the right place. Then it was over. I threw my gloves away, shook hands, and walked out for some final pointers.

The next room was the breast exam. We were told originally that all we had to say during the exams was, "Hi, my name is..." but the facilitator told me to ignore him and treat it like this was real even if it were my first time and that if I ran out of conversation pieces I should start talking about the weather to avoid any awkward silence. So again, I introduced my self, got some gloves, tried to make her feel at ease, and had her lower her gown. The first part is visualizing the breasts together to check symmetry and how they move with the hands over her head, on her hips, and flexing her pectoralis muscles. Then she covered up, laid down, revealed the right breast, and I told her I was going to palpate for any abnormalities (that's the word we were told to use because they recommend against using technical jargon like nodules, fibrosis, discharge, etc.) They recommend starting on the areola closest to the sternum and palpating in clockwise concentric circles until you reach the bra line inferiorly and the clavical superiorly. Then you move out laterally toward the armpit to palpate for the lymph nodes there. One breast done, I move on to the other while trying to engage in conversation. It's tough to keep so many things in my head at once, but we get through it and I didn't have to talk about the weather.

I got asked if I felt like I was being unfaithful to my wife by examining other women. I think you'd have to be a pretty sick person to find the clinical experience appealing in that way.

The last room was the male genital, hernia, and rectal exam. The facilitator here was really talkative and all I had to do was ask questions every now and then. He points out the testicles, epidydimus, and vas deferens then shows me how to insert a finger into the inguinal canal. That looks like it should hurt so I ask him and he says no. I guess I should have known. I've had it done during physicals, but I never knew how far the finger was stuck inside. If there is a hernia you should feel the intestines slapping at your finger. Also, the turning the head to the side to cough is only to keep the patient from coughing on the physician. Finally, its time for the DRE and this drew the most sympathy from me out of anything else that day. Vocalizing to the patient what I was doing, I spread the cheeks, placed my gloved and lubricated finger on his anus, and waited for the tone to relax. When I felt the resistance lessen, I started pushing and was struck by how warm it was. I tried to feel the prostate which is supposed to be the size of a walnut, but I couldn't be sure I was really feeling it. When I felt like welcome was overstayed, I got out, listened to a few final pointers, washed my hands and went about the rest of my life. However, the following ditty was stuck in my head.



Wednesday, May 1, 2013

No wonder

Board study and came across this gem.

A medical student is concerned with his academic performance, worrying about upcoming exams all day long. His worry is so intense that it interferes with activities, including studying. Outside of school, he worries whether his friends really like him and if he dresses well enough. He is concerned about how his school performance will affect his future and fears that he may never be able to get a residency. He is irritable, has difficulty sleeping, and his energy level is lower than usual. He reports that his symptoms have progressively worsened 23 months ago. What is the most likely diagnosis?

A. Situational anxiety
B. Generalized anxiety disorder
C. Social phobia
D. Major depressive disorder
E. Adjustment disorder

Correct answer said it was B, but they forgot the answer that says "as a medical student, that all sounds totally normal."