The Differential: Medscape Med Students Blogs

The Fix

Thomas Robey -- It is a widely held belief that medical students and coffee are inseparable. Almost equally connected (in collective impressions) are Seattlites and Starbucks. You’ll be surprised that this Seattle medical student can count on one hand the number of times he’s consumed said black beverage –- even the milk and sugar-laden preparations. Until my third year, I even fit qualifications for caffeine-naïve. Sure, I drank caffeine heavily as an undergrad, but I went cold turkey when I moved to Seattle.

When I relapsed about a year ago, I had forgotten about the world of stimulation available to me as a user... Now, I’m amped to share with you some of what I know -– endure my efforts to teach you about the science of caffeine, and you’ll get a new-found caffeine junky’s guide to improved cognitive performance.

We in the medical profession should know that caffeine is a potent drug. PICU docs give it to newborns to boost respiratory effort. Caffeine is used to relieve the pesky headache that follows a spinal tap; it treats other headaches, too. You’re probably familiar with the OTC labeled use as a stimulant (NoDoz, etc.) and for mild headaches (Excedrin, etc.). Caffeine is metabolized in the liver (demethylation by CYP1A2). The serum half-life for neonates is about 4 days; in adults it’s around 4 hours. The time to peak serum concentration is between 30 and 90 minutes for orally delivered drug. But caffeine is not limited to hospital use!

Caffeine is a member of the large class of mind-altering substances called nootropics. In drinking your morning coffee, you are not only gearing up for the day but increasing vigilance, the speed at which you work and, possibly, memory recall. Unfortunately, most medical students misuse caffeine.

I’m not talking about abuse here, but rather the failure to use it to its optimal benefit. Most folks I know have a cup in the morning and then some more in the middle of the day. This behavior works more to quench symptoms of withdrawal than to confer any benefit. Want to best use this most popular psychoactive substance in the world? Follow these tips:

1. Use caffeine in small doses. 20-100 mg per hour increase speed and accuracy of simple tasks. Don’t know how much you’re getting in your drink of choice? This page breaks it down for you. 8 oz of drip is 135 mg. One espresso shot is (surprise!) 30-50 mg. Soft drinks run 35-55 mg. Teas are 25-70 mg and energy drinks 75-150 mg.

2. Boost the effect of caffeine by consuming with sugar. A well-designed study showed that 150 calories of glucose -– the same as in a 12 oz can of cola –- with caffeine is better than either alone. It would be nice to know if such caloric intake is needed for the additive effect. Until that study is done, you’ll just have to weigh your waist against your cognitive ability. (I’m staying with diet soda.)

3. Drink responsibly. The cognitive benefits are lost after the body builds up a tolerance. So if you find yourself needing a fix every morning, you have probably lost any benefit that could be gained from regular small doses. Taper yourself off your high AM loading dose to reset your body. Then, when you need to buckle down for the next board exam, you can let loose the nootropic power of caffeine. Just try not to exceed 2500 mg in a day.

There you have it. That’s all this recently relapsed caffeine user can offer. Are you craving more info like your morning cup of joe? Head over to Chris Chatham’s blog, Developing Intelligence, for a nice summary of the major scientific studies testing the effect of caffeine on cognition, or to WebMD’s drug info about caffeine.

Channeling Your Inner Pediatrician

Ben Bryner -- Pediatrics can be one of the best rotations, even if you’re not planning on going into it. I went into my peds rotation not considering it at all, and by the end of it was fairly certain that I wanted to go into some sort of pediatric specialty. But it’s very different from the other rotations. A lot of peds-haters will tell you that dealing with parents is so bad that it ruins pediatrics. True, they can be really difficult. But on the other hand, you’re really treating the entire family when you treat a kid; and when they get better it’s like an entire family has been healed and made whole again. Certainly the tragic cases on pediatrics are harder to handle than about anything else the hospital can throw at you. But nowhere else will you routinely see patients recover so completely; nowhere else will you laugh so much, nowhere else will you get peed on and still love your job. Here are three tips that I hope will help out for this rotation.

Note: If you haven’t heard the term, gunners are students who are fanatically driven to get top grades, even if that means interfering with their fellow students to get ahead. Like Swiper, the kleptomaniacal fox from Dora the Explorer (see tip #2), they can really ruin the fun. Still, I’m trying to provide something for everyone, so each tip has a gunner-level modification for the gunner who wants to take things up a notch.

1. Carry around a small plastic toy to “entertain” (i.e. distract) small children. Do not bring a fuzzy stuffed animal to share with multiple children; that is disgusting. Bring a plastic toy that you can wash or wipe off with an alcohol swab between each patient.

- Gunner level: Steal your fellow students’ toys so you are the only one who looks prepared on rounds.

2. Memorize all the songs and dance steps to High School Musical. OK, I actually don’t know any of them. But one evening in the Peds ER, I was able to tell a kid watching the movie that I had been to the actual high school in which the musical takes place (the exterior shots were filmed in Salt Lake City). She was duly impressed, and let me stitch up a big gash in her arm with almost no complaints. The larger point here is that it helps to know the names of popular references for kids of different ages. But you can always just ask, since most kids can ramble on about whatever topic they’re into for 18 hours or so.

- Gunner level: Memorize all the songs and dance steps to High School Musicals 1 AND 2.

3. Know your milestones (i.e. kids should have a good pincer grasp by nine months, be able to ride a tricycle at age 3, etc.) If you have some experience with kids, that’s helpful for a very rough guideline. But almost any given kid will be ahead of the “magic number” for some milestones, right on for some milestones, and maybe slightly behind on a few. But the shelf exam demands to know specific months, even when it doesn’t really matter, so on a certain level you’ll have to memorize them. I had the hardest time with milestones because I kept picturing my own kids, who are brilliant and wonderful, and therefore the worst kind of kids to have when it comes to learning these things.

Gunner level: Commit the entire Denver II to memory.

Have fun!

There Aren't Enough Words To Go Around

Ben Ferguson -- I’ve spent the last four hours staring at the evaluation form for the last med school applicant I’ll be interviewing this season. After doing 30 of them, I find myself completely out of words. I’ve been particularly blown away by the quality of interviewees this year, but even that can be problematic: How is one supposed to describe these people and differentiate them from one another? You can only use cookie-cutter adjectives so often before inevitably having to resort to the more exotic ones, and there are only so many of those to go around, too.

It makes me wonder: How on Earth do deans do it? Deans have to write lots of letters every year, or at least get help writing them, and at most schools there aren’t just 30; there are potentially hundreds. Being at a school with no grades for three of the four years, it’s made me acutely aware of the importance of the dean’s letter -- and of the need for the dean’s letter to effectively serve as the surrogate in differentiating students from one another in the absence of grades and class ranks. Is it possible? Apparently; people do well enough in the match, and the same goes for students from other schools with such grading systems, too. But honestly, how many “exceptional,” “outstanding,” “brilliant,” “extraordinary,” “remarkable” students can residency programs read about before going insane? (And how many of those students actually are any of those things?)

It’s a good problem to have, this abundance of quality applicants. But writing these interview reports seriously gets to be a pain after a while. When you start wondering how to incorporate “skookum” into someone’s evaluation, you know you’ve lost your marbles. (A recurring theme of mine?)

The Fun of Performing Rectal Exams

Kendra Campbell -- This past week I have been rotating in the Accidents and Emergency (A&E) department at the local hospital. I think I’ve had more fun this week than I’ve had in all the other weeks combined. Our attending physician is absolutely amazing. The A&E department at this hospital is at times pretty chaotic. There are patients literally everywhere. The nurses (or sisters, as they are called here) are always trying to keep up, but there is always a constant flow of patients. Usually, there are only three med students following around the physician, but due to a scheduling conflict, they had to assign six students to this one physician. In the midst of all the chaos and confusion, our doctor remains completely calm and manages to teach us quite a bit in the process.

On the first day of my rotation, I was already writing notes in patients’ charts, writing orders, and even writing scripts (with his signature as well). Okay, so this might sound pretty lame to all of you, but this is the first time I’ve ever actually written a script! It was so much fun!

By the second day, we were interviewing all the patients and performing exams on them. The physician would leave us alone and return a little while later for our report. Then we’d tell him our proposed diagnosis, and usually we were right on. It made me think that I actually might know a thing or two.

The most interesting part of the second day was a 78-year old man with BPH. He was very friendly and smiled at all three of us med students as we filed in the room. The next thing I knew, our doctor was asking us all if we had performed a rectal exam yet. “Only on the model,” we all replied. “Well,” he said, “today is your lucky day!” I was so excited that I almost started shaking. I gloved up, applied the lube, and performed the exam. Afterwards, the other two students also took a shot. Luckily, our patient was more than willing to allow us the opportunity to learn (amazing!).

After we performed the rectal exam, it was time to change his urinary catheter. I guessed the right number, so the doctor gave me the responsibility. This was the first time I’d ever performed a procedure that required sterile gloves, and I stumbled a bit getting them on. I removed the old catheter, inserted the new one, and inflated the bladder, all with instructions from the doctor. After it was all over, I stepped back and admired my work! I was incredibly proud of this quite miniscule accomplishment.

Today was just as much fun as the first two days, and I have learned that I absolutely love A&E. I feel more like a doctor now than I ever have before. I can’t believe that I can actually diagnose patients correctly and come up with treatment plans. I’ve come a long way since my first days of med school. But there is one thing that hasn’t changed, and that’s my giddy excitement over learning the little things. Many people consider performing rectal exams to be scut work that’s given to med students as a sort of rite of passage. But I don’t mind performing them in the least. I’m actually thrilled and enthused to have the opportunity to perform one. Now, I know this might seem silly and ignorant to many of you seasoned med students and physicians out there, but I don’t care. I like getting excited about seemingly insignificant or boring tasks. It’s what makes life fun and interesting. People all too frequently lose the childlike excitement with their jobs and their lives, because they stop seeing the importance of things, and they just mindlessly float (half asleep) through life.

It reminds me of a sign I once read: “You don’t become old and stop playing in playgrounds. You become old BECAUSE you stop playing in playgrounds.” So, here’s to never getting tired of performing rectal exams!

When Doctors Become Patients

Anna Burkhead -- An otherwise healthy, middle-aged patient was admitted to the Neurology service last week with new-onset ataxia, clumsiness, and weakness. Pretty interesting, right? For me and the other students, yes. But for the Neurology residents, it was just another presentation of a new patient on rounds. Until came the punchline: “He’s an oncologist”. They looked up from typing their notes, entering orders, and whatever else they were doing to ask, “How old is he?” “When did this start?” “What are his symptoms again?”

We finished this patient’s presentation and went on to the next patient. But before we got too far into the H&P, a nurse entered the conference room and informed us that the “doctor patient” was getting agitated, because he thought we would be in to round on him much earlier in the morning. So, we decided to do “walk rounds” for the rest of the new patients, and we left as a team to go tend to the doctor patient.

He was still down in the Emergency Department, because a bed had not opened up on the floor. A family member was with him, and she promptly informed us that she was a physician as well. She demanded in a firm, bordering on insulting way to know why his blood pressure hadn’t been addressed since he arrived. Eight pairs of eyes immediately fled to the monitor blinking “160-something over 100” and one pair of eyes (the intern who had been on call) fled to her stack of papers as she tried to organize her thoughts.

We spent nearly 20 minutes in the ED bay with this patient, which is more than we usually spend (since there are usually at least five new patients on the service every day). The attending discussed his thoughts and differential diagnosis frankly with the patient. He showed him the MRI. The leading possibilities for what process was causing his symptoms were all fairly serious. When the attending recommended a lumbar puncture to be done later in the day, the patient nearly jumped off the bed in surprise. “NO WAY am I having that done,” he exclaimed. “I’ll let you think about it,” the attending replied.

Later in the afternoon, I went with my senior resident to check on the patient and to find out whether he’d made a decision regarding the LP. When the resident asked him if he’d agree to it, the patient said nothing and continued to stare out the window. His family member informed us that, yes, he’d go through with it, but he was not happy about having to undergo the procedure. (As if we couldn’t tell…) I stepped outside to get the consent form while the resident gathered all the necessary supplies. We decided to do the LP right then and there before he changed his mind!

I haven’t seen that many LPs, but I’ve seen a few. They go pretty smoothly; the patients tolerate it well. Afterwards they say, “That wasn’t as bad as I thought it would be.” I thought this LP would be no different, but I was wrong…

The patient, a grown, middle-aged, medical professional male squirmed and screamed throughout the entire process, from the application of the betadine to the application of the band-aid. The combination of the patient’s uncooperativeness with other non-controllable factors made it a difficult LP, and it took nearly an hour to perform.

The remainder of the patient’s hospital stay was equally difficult, with many special requests and lots of opposition.

It turned out that the patient did, in fact, have something serious as the cause for his symptoms. Maybe deep down he knew that, and his behavior was a reflection of his fear and uncertainty.

Has anyone out there had experiences with doctors or other healthcare professionals turned patients? This was my first time. How do attendings and residents usually react? Are they treated differently? Do they always make for difficult patients?

"How Much Longer Will It Be?"

Thomas Robey -- The third year of medical school is full of firsts. With new experiences, sensory collection mechanisms kick into overdrive and the brain says, “Hey, I should record this.” These first experiences and emotions stay with you forever. Some firsts that I remember as clearly as if they were yesterday are my first delivery, first terminal diagnosis, first surgical scrub, first admission, and first code.

I remember another first as though it was yesterday. It was yesterday. I was doing chest compressions an hour after a patient came in to the ER. I heard, “strong femoral pulse with CPR,” and focused on locking my arms, lifting my fingertips off the chest wall and maintaining a fast rhythm. In my mind: “four and five and six and...” I did not realize how fast she had deteriorated. When the attending ER doc told me I should stop compressions, I stepped away from the body only to notice her family watching from the hall. They had asked to observe. By the time I had gathered my thoughts, the tubes and wires had been removed from her body and she was covered to her neck in a clean white blanket. Her lifeless face looked at peace. No longer scared. No more strain. The family slowly filed in. How I wish I could transplant her last squeeze from my hand into her granddaughter’s palm.

She was 89 and had been discharged only days before following treatment for a pulmonary embolus. Lung function was compromised. Her anti-coagulation was therapeutic. Even so, we think a clot found its way into a renal vein. Her kidneys failed. She became toxic on the digoxin she took for her arrythmias and heart failure. This is all to say that she was very sick. Her family knew this. They had spoken with her about resuscitation. She wanted it, but not with an endotracheal tube.

Thirty minutes previous, she told me through her oxygen mask that she had not eaten in days: the nursing home food was terrible. Could we bring her some food? Yes, we could. No, she’s not in any pain, she says. She is very tired. I explain that we’ll need to admit her to the ICU tonight.

Later: “How much longer will it be?” I say “not long,” thinking she’s asking about the bed or the food. Was she asking me something else?

Note: This patient’s daughter-in-law told me I could write about this without using the family’s name.

All Because of a Harmless Western Blot

Ben Ferguson -- Sometimes, the simplest things can test your patience and your sanity. At times, you wonder how you ever were able to do them in the first place.

While in Los Angeles a few weeks ago visiting a collaborator’s laboratory, I was in a car accident during the morning rush hour. (I’m totally fine -- just a scrape on my forehead -- but my glasses unfortunately suffered fatal injuries and have been reincarnated as a pair of hip, exorbitantly-priced specs.) For the next week, I was kind of terrified to drive. I drove ten miles under the speed limit, stopped for a three-count at all stop signs, white-knuckled 9 and 3 o’clock, and let people go in front of me in heavy traffic. You know, things everybody does on a regular basis, including me. I felt as though I was 16 again and just learning how to drive. The world moved so fast! How could I ever have driven with such little attention paid to the road and yet been in so few accidents?

In the lab, I’ve done roughly the same experiment six times over the past four days: a Western blot -- one of the most ubiquitous, simplest experiments in research and one that virtually everybody working in basic science knows how to do. Well, I’m 0-for-6. It was a week full of ... profanities?

I’ve done plenty of Western blots in my research career. When I was a summer researcher early during medical school, I did them regularly and successfully. But I cannot do it now, and it’s driving me nuts. The problem with these sorts of things is that they can be so simple, or perhaps that we can get so accustomed to doing relatively complex things, that we do them without thinking. They often have many steps to them too, each with their own chance of failure. By the last step, the compounded chance of failure is enormous. When the experiments fail, we must take a step back and examine why they -- or we -- failed.

Did I make the gels correctly? Are my units right? Is the glassware clean enough? Which cables am I supposed to use again? Are the protein estimations accurate? How old are these antibodies? Did I not transfer long enough? What’s with that funky noise coming from the developer? Did I touch the membrane too much? Wait, do I even know how to operate this pipette properly, or have I been doing this wrong all along?! WHAT IS A PIPETTE ANYWAY?? It’s enough to drive a person mad, especially when you ask these questions over and over, make what you think are the appropriate changes, and still fail. To make matters worse, some of these things are within your control; some are clearly not, at least not immediately.

This leads to a cycle of overthinking things. Overthinking the most minute of details that may, but probably don’t, have anything to do with the outcome of the experiment. Overthinking which combination of changes you need to make in order to do it right the next time. Overthinking how terribly long all of these repeats are taking you, and overthinking how you might speed up the process (which is almost never a good thing to do in the lab in times of distress). Overthinking precisely how and why you’re overthinking these things and overthinking how you can stop overthinking about overthinking these things.

It’s a damn mess. All because of a harmless Western blot.

Don't Go Breaking My Heart

Ben Bryner -- Around Valentine's day you see pink heart shapes everywhere, symbolizing love and all kinds of warm feelings. But of course, the heart is actually entirely unsentimental -- beating constantly and relentlessly, billions of times over a lifetime. It's the hardest-working part of the body -- the James Brown of organs. The shadowy, impossible mysteries of the brain, the alien squirming of the gut, the intricacies of the eyes -- these are all fascinating, but the brute force and dedication of the heart make it quite impressive. It's hard not to be struck by the heart when you see it up close. I remember being particularly impressed during a dissection of a pig's heart in a high school biology class. Dissecting the heart was one of the most rewarding parts of our gross anatomy class in the first year of med school.

But (again like James Brown) seeing it perform live was a whole different experience. Last year I watched a CABG (coronary artery bypass graft, or "cabbage"). The whole procedure was very interesting, but the most amazing part of the whole spectacle was at the beginning, right after the surgeon opened the chest. He sliced through the sternum and parted the bony halves, revealing the heart pumping away with incredible force. I hadn't expected to see it contracting so violently; it looked like a wet towel being wrung out over and over, but without any hands doing the wringing. I'm sure a sternotomy is something you get used to seeing if you're in that line of work, but to a newbie it was pretty impressive. It was hard to believe my own heart was working that hard under my layers of gown, scrubs, skin, and bone. I resolved to treat my own heart better from that day forward.

That said, I'm not planning on going into cardiology or cardiac surgery. There's a difference between finding an organ system academically interesting and actually wanting to work on that system for the rest of your life. The nervous system is endlessly interesting, and before medical school I thought I might end up in one of the specialties that deal with it. But when I got actual exposure to those fields in the third year, they just didn't feel like the right place for me, despite the fact that I worked with some great people on those services. (Since I can't do everything, I feel fortunate to have found something I am really interested in, as well as to have found lots of fields that I'm not interested in going into.) Of course, you certainly need to know a lot about cardiac pathology and treatments to be a good doctor in any specialty. But I'm happy being impressed with the heart from afar, not from inside the cath lab or the cardiology clinic. Also, the idea of treating my own heart better hasn't really panned out. I ate way too many heavily-frosted sugar cookies this week, all of them shaped like little hearts.

Finding Inspiration

Kendra Campbell -- My last post involved a little bit of me ranting about losing my study groove. Well, I’m happy and proud to say that I think I finally found it again. I actually did end up putting on a festive outfit and joining in the Carnival activities. Dancing with my friends turned out to be exactly what I needed that night. But the next few days I continued to be in somewhat of a slump. I started questioning my dedication to medicine, and even my dedication to myself.

Yesterday morning, I worked at the outpatient Ob/Gyn clinic at the local hospital. I had the opportunity to interview a few patients, and then got to observe an abdominal and pelvic exam on a few pregnant patients. Talking with the women, and learning about their pregnancies and their lives, really sparked my interest. These women are bringing human beings into the world. And my input has the possibility of making an impact on both the mother and child’s lives. As the attending physician starting pimping me on complications due to the mother’s uncontrolled diabetes, I felt an energy welling up inside me. I really did care, and I really wanted to answer her questions correctly. It wasn’t a multiple-choice question on an exam. It was a question that affected the outcome of someone’s life.

That afternoon, we had a clinical skills review session with a doctor from the hospital. I could tell that he loves being a physician, as well as being a teacher. His energy and enthusiasm were quite contagious. He really cares about his patients, and has a burning passion for medicine. He taught me new ways of thinking about patient care, and explained “why” we perform certain exams in certain ways. Before yesterday, I don’t think I really understood the “why” portion of some of the exams. But as he explained the techniques, a huge, brilliant light bulb lit up above my head, and I could hear the angels’ chorus. It finally all started to click. Moments like that are what got me interested in medicine in the first place.

So, as you can tell by now, yesterday was a good day. I can feel the fire burning inside me yet again. I remember why I wanted to pursue this crazy field called medicine. I have the energy and motivation to study, and to improve my clinical skills. I actually feel like it’s a privilege to be on the path towards becoming a physician. I really want to change the world. Of course, none of this has anything to do with the fact that I had espresso yesterday and coffee this morning! (And some of you said that caffeine was bad!)

In reality, I know that I am back in my groove. In my last post, I also mentioned my view of the Caribbean Sea from my balcony. It is in fact completely and utterly gorgeous. The last time I looked out at the view, I was inspired to go join the Carnival revelers. Now that I have my study groove back, I’m inspired to go down to campus and catch up on my lectures. The same view inspired completely different actions on different days. I think it’s because true inspiration is not generated from things external, but rather is something that comes from within. Or perhaps external events provide the kindling for the fire that’s always burning inside. And on two different days, the view from my balcony helped to light two different fires.

Come On Down!

Ben Bryner -- I didn't always want to be a doctor. Though it's sometimes fashionable in personal statements to act like you wanted to go into medicine since implanting into the uterine wall, it's not true for me. When I was four, I had it all figured out: I was going to be a game show host. This, I was convinced, was the best job in the world. They played games all day! They gave things away! What more could anybody want?

Somewhere along the line my plan got derailed. I've gotten over the disappointment, though, because some of the things we do in the hospital are a little like some of these classic game shows.

For example, when you're considering asking for a consult on a patient, it's kind of like playing Hollywood Squares (a show where the contestants played tic-tac-toe with the help of celebrities). When you're part of the primary team for a patient, consults may be providing a lot of the care, but you need to arrange and coordinate it all, making sure any questions are resolved. When asking for a consult, there are a lot of choices: Do I want Infectious Diseases? Psychiatry? Plastic Surgery? Dentistry? Who's going to help me answer this question, and who (like some of the celebrities on the show) is going to try to make a joke and then leave me hanging?

Coming up with a diagnosis in the ER is a little like Wheel of Fortune (where contestants guess a phrase from a limited number of letters). Complete information is rarely there; most of the time you have to take a limited amount of information and make an educated guess. Sometimes the diagnosis is easy to guess up front; sometimes you sit around buying vowels (ordering imaging studies, requesting consults, drawing labs) to get closer to the answer.

And of course there's the crown jewel of American game shows when I was growing up, The Price is Right. Each episode, hosted by the epitome of game show hosts, Bob Barker, featured a series of games that tested the contestants' knowledge of how much things cost. Actually, this is the opposite of modern medicine, in which (as is often bemoaned) we do all sorts of things with no thought for the costs. Some attendings get a kick out of asking students about how much it cost to do the workup for a given patient, and then watching the student's eyes glaze over as the dollars add up in their heads. Between tuition bills and the astronomical costs of health care in general, the kind of numbers students see can start to lose meaning.

Anyway, the unquestionably best game on The Price is Right was Plinko. Not to be confused with "pinko," the slang term for a Communist sympathizer, Plinko was an all-American game of chance. After the contestant earned cardboard discs by correctly guessing prices, he or she stood at the top of a large board with pins in it. Then he or she would drop the disc down the board one at a time, watching as it bounced randomly between the pins and into one of several bins at the bottom that determined how much they won. Ultimately, despite all the advantages we can give patients, there's an element of chance to their outcomes. Once somebody gets sick, virtually anything can go wrong outside the control of medical interventions. Any very sick patient in the hospital is one of those Plinko discs, first careening toward a full recovery, now bouncing toward death, now angling for survival but with a long stay in the rehab hospital. We can certainly do a lot for patients, but as in every other part of life there are no perfect predictions and no absolute guarantees.

Obviously patient care is not a game (although laparoscopic surgery feels like one) and should be taken very seriously. But I think virtually any physician who enjoys his or her job will say that part of what makes it enjoyable is the intellectual challenge. Finally, I realize a lot of these programs are not familiar to some readers, and I apologize that I can't explain them better. Not only have game shows really gone downhill in this country, but we have never produced anything quite as amazing as this.

Why It's Great to Be a Perma-Student

Anna Burkhead -- Most medical students would probably agree that they feel like they’ve been in school forever. Personally, with the exceptions of the time I spent as a teacher and the time I spent in diapers, I have been a student my entire life. Actually I think I am ringing in year #20 right now…

The clinical years of medical school can be a bit confusing, because at times, depending on the service and how much confidence they have in the student, the medical student can feel more like “a real doctor” and less like a student. But when the time comes to write orders, answer a page about a new admission, or cash a paycheck, reality sets in: We are still students.

But I am here to say that it is not such a sad reality. As much as I am excited to be a doctor in fifteen months, it’s not such a raw deal to be a student. In fact, it’s pretty great. Here’s why.

- Every six months I get a letter from the loan company I used during my undergraduate studies. Every six months, the gist of this letter is, “We checked. You’re STILL a student. Have another six-month deferment on paying this loan back. You’re welcome.”

- We can bounce crazy ideas and medical theories off doctors all day. We can even put them in the chart, since our notes only “sorta” matter. We are fortunate that we are not yet legally responsible for the medical care of patients.

- We’re not really expected to know anything… anything…

- It’s easier to explain your job to a person you’re meeting for the first time:

     “I’m a medical student.”

     vs

     “I’m an intern. What? No, it’s different from an unpaid summer employee.”

     or

     “I’m a resident. What? Oh, yes, you’re a resident too. Of North Carolina.”

- We have more time to spend with patients.

- Two words: SPRING BREAK!!! (What happens in the med student call room stays in the med student call room….?)

- Who doesn’t love doing rectal exams?

- We occasionally get breaks from the tedium of rounds or floor work to attend a required lecture or workshop.

For the reasons listed above, along with many others, I am going to savor the next fifteen months. They may be my last years as a student, in the traditional sense of the word.

Sure, I complain with the best of them about all the board exams and shelf exams and digital rectal exams, but the truth is, a student’s life is a good life.

How Kendra Got Her Groove Back

Kendra Campbell -- I’m currently sitting on my balcony, which overlooks the Caribbean Sea. Today is the Carnival celebration here in Dominica. I can hear the calypso music blaring from the speakers in town, and I know that the city is currently full of half naked drunk people dancing in the street. I don’t have to go to the hospital for two more days. We had a long weekend because of the Carnival celebration. I don’t really feel so much like a med student right now.

This semester has been so different from the previous ones. We only have a few hours of lecture every week, and we only have one written exam. I have to go to the hospital three times a week, but other than that, my schedule is very open. So, with all this free time on my hands, I have plenty of time to study for the USMLE Step 1 … right? Well, that was the plan. In fact, I should be studying right now instead of pondering whether or not I should put on a colorful outfit and go join the Carnival festivities.

So, why am I not studying? I think it’s a multitude of reasons. Firstly, I know that I won’t have an exam for many more weeks. It’s simply so far in the future that it’s really hard to get motivated for it. We also have very few lectures, so there isn’t all that much to study for this semester. I think I also never really made it back mentally from my vacation a few weeks ago. It was just so long, and I had so much fun that I think I forgot how to be a student.

Strangely, it’s times like this that I question whether or not medicine is a good fit for me. I’d think that most people question their decision when they’re right in the middle of studying, or when they just received a bad grade. But I’m basically the opposite. It’s when I’m doing well, or when I’m just really bored that I wonder whether or not I’ve made the right decision. Maybe I’ve just had too much time to think about things. When I’m super busy and in the middle of a hectic schedule, I simply don’t have enough time to ponder my life’s purpose.

Anyway, I think I’ll stop pontificating now and get off my butt and do some work. Maybe I’ll do some practice questions or something. Perhaps that will distract me long enough that I can get back into my groove. On second thought, maybe I’ll go check out Carnival instead. I know how easy it is for me to dance the day away. At least that’s a groove that I know I can get back.

Artificial Heart

It was my privilege to meet his wife

And find out he was a joyful man:

A doctor,

Always with a joke or smile,

With three children: an artist, a lawyer, an auto mechanic.

The youngest, he visited the most:

Always checking on the waveform,

Looking for assistance to love.

It was my privilege to teach the son.

It was my privilege to learn the procedures:

Which numbers required intervention;

Which were optimal.

Mathematics: a hobby of his

–You know, the games in the dime store window

That come in the mail from Aunt Betsy every Christmas–

Today he likes them for the bright colors.

It’s his son’s way of connecting to an age he once fought,

But now glorifies

It was my privilege to know the teaser’s trick.

It was my privilege to get to know a patient:

Two years I knew his shadow;

Now he tries to trip the caretaker.

Still the prankster.

Two months before we met,

A Reynolds number

In the outflow cannula

Leading to the mind’s demise

It was my privilege to witness this spiral?

It was my privilege to roll the machine back to the lab.

Like Atlas, bearing the console down five flights.

I do the diagnostic.

Did the computer fail?

It was my privilege to solve the final puzzle.

And my pain.

Psych Me Out Too

Aaron Singh -- (To those of you who have noticed: yes, I did indeed just steal the title of this post from my colleague Anna’s earlier post, because a) it had something to do with my post and b) I couldn’t be bothered to think up a new and original one. Amazingly lazy? Yes, but hello - this IS me we’re talking about.)

As I mentioned in a previous post, one of the idiosyncrasies (and attractions) of the highly traditional course at Cambridge is that in our third year we’re free to do whatever course we want, even non-medically related ones, and earn a BSc in that subject. After throwing around a few options (including Pathology, Neuroscience, and the curiously popular that’s-it-I-can’t-stand-medicine-anymore option Law) I settled on Experimental Psychology, partly because I really enjoyed the Psych lectures last year, and partly because one of the lecturers is Professor Simon Baron-Cohen. If the name sounds familiar, it’s because he’s the most handsome man in the world OMG I love his eyes the cousin of Sacha Baron-Cohen, the actor who plays ‘Borat’ and ‘Signor Pirelli’ in the new film ‘Sweeney Todd’. Professor Baron-Cohen is sadly more well-known for this fact than for being amongst the world’s foremost psychopathologists and a leader in autism research, as well as a damned good lecturer. I’m doing my dissertation under his supervision this year, as well as trying hard to avoid getting slapped with a restraining order trying to be more disciplined and organised with my work this year to avoid last year’s fiasco (and the subsequent death threats from my tutors. It’s nice to be alive, you know).

Next year however, we get to go to clinical school, also known as the ‘OHMIGAWD I’M FINALLY GONNA BE A DOCTOR!’ stage of our medical education. Yes, ladies and gentlemen, for those of you just starting to read my posts (you have my sympathies – run whilst you still can), the Cambridge system means that for the first three years of medical school we get to park our butts in lecture theatres all day getting biochemical minutiae shovelled down our throats and seeing patients an average of 2 times a year. Next year however, we get to apply to clinical schools (yes folks – another round of application forms, interviews, and chewing your nails whilst harassing the postman every day for results letters – even when you’ve ALREADY gotten into med school! And you wonder why I’m deranged?).

I’ll write more about where I applied to after the results come out (so that anybody already studying there can immediately apply for transfer on grounds of fearing for their mental health). Wish me luck!

I’m A Happy(er) Scientist Now!

Ben Ferguson -- I was in a funk. Now, I’m out. Mostly.

Just as funks come and go, grooves come and go too. Grooves are what make this all worth it, the drug that keeps the highs high enough and the troughs infrequent enough to stay hooked on this stuff.

One of my research advisors in college related to me once the time when he finally fell in love with research. He’d not done much research during his college time, and what little research he did do didn’t appeal to him too much. (In retrospect, it was an experience not dissimilar from my own.) When the time came to decide where his life after college would take him, he could think of only two things: medical school or graduate school, neither of which really stimulated him all that much. He chose the latter -- med school seemed too hard and was too certain for someone in a very uncertain phase of his life.

Shortly after starting grad school, he did find some success with it and eventually came to love it. That first piece of good data, he said, data that both demonstrates something of importance but also leads to bigger and better questions, was the clincher for him. It was like an addiction that he couldn’t shake. He was hooked, and each new experiment led to new insights and questions that demanded answers. It’s like reading a mystery novel but pausing at the last ten pages; how could you not go on?

So, I’m getting there. While my data isn’t spectacular at the moment, it’s really interesting in that it’s somewhat unexpected. Pair that with a fairly new and unexplored area of research, and I’ve got myself a nice little project. Each new piece of the puzzle leads to more questions, and to say I’m excited to see what comes out of it would be an understatement. Stay tuned.