Great Medical Acronyms
Ben Ferguson -- We all know the pedestrian medical acronyms and abbreviations -- bid, CXR, DNR, po, HMO, PE, AAA, CABG, appy, GSW, INR, lap chole. Pretty much anything and everything is acronymous or abbreviated in medicine these days, and if you’re not in the loop, you can go for entire conversations without knowing what the heck someone is talking about. Therefore, it’s important to stay up to date.
Here are some my favorites I’ve heard that are a bit more ... creative?
LGFD: looks good from door
LOLFDGB: little old lady, fall down go boom
CKS: cute kid syndrome
LFTWM: looking for three wise men (pregnant patient vehemently denying sexual activity)
CROACC: cannot rule out anything -> correlate clinically (often by radiologists)
UBI: unexplained beer injury
DBI: dirtbag index (roughly, tattoo count X missing teeth count = days since bathing)
LOBNH: lights on but nobody home
ECU: eternal care unit (dead)
TFTB: too fat to breathe
OBECALP: placebo backwards
OMGWTFBBQ: badly mangled patient, e.g. from MVA (among other things)
CCFCCP: cuckoo for Cocoa Puffs (a little demented)
LMC: low marble count
CTD: circling the drain (a patient expected to die at any moment)
WNL: we never looked
Got any others? Post them in a comment. I’ve come to the conclusion that this sort of creativity is absolutely limitless.
A Day in the Life
First-year medical student:
6am: Wake up, get ready, breakfast
8am: Arrive to campus in time for 8:30 lecture, sit in class until 10:30
10:30am: Lunch break
2pm: Lab until 4 or 5pm
Evening: Arrive home, dinner, look over a few notes, read a chapter or two, watch some tube, pass out at midnight
Second-year medical student:
6am: Wake up, get ready, +/-breakfast
8am: Arrive to campus in time for 8:30 lecture, sit in class until 11:30
11:30am: Read over notes, +/-lunch
1pm: Lab until 4 or 5pm
Evening: Arrive home, +/-dinner, look over a few notes, read up for next day, do boards questions, freak out about boards, do more questions, chat online with classmates about how mutually freaked out we are, pass out at 2am
First-year grad student:
7:30am: Wake up, get ready, eat breakfast
9am: Arrive to campus, +/-lab, +/-go to lecture at 10:30
11:30am: Lunch break, check on samples in lab
3:30pm: Lab until evening
Evening: Arrive home, dinner, +/-read paper for discussion tomorrow, +/-look over notes, +/-read up on potential thesis topics, pass out at 10pm or earlier
Early second-year grad student:
7:30am: Wake up, get ready, eat breakfast
9am: Arrive to campus, check email, check blogs, check news, check websites
11:30am: Finish checking email, blogs, news, sites; recheck to make sure nothing new popped up during initial round of checking
12pm: Lunch break
3pm: Think about starting experiment or two; decline
3:30pm: Finish thinking about starting experiment or two; begin round two of internet time
Evening: Arrive home, dinner, +/-care about anything, +/-read up on potential experiments for thesis, +/-consciousness, pass out at 10pm or earlier
Late second-year grad student:
5:30am: Wake up, +/-shower, +/-breakfast
6:30am: Arrive to lab, start experiments immediately, freak out about how, at this pace, you’re never going to graduate
12pm: Continue experiments, +/-check email, freak out more
3pm: Continue experiments, totally flip out
6pm: Continue experiments, call fiancee to get reamed for not calling/being home earlier, freak out and/or flip out, sweat profusely
8pm: Arrive home, dinner, +/-think about experiments, +/-catch up with the outside world, +/-appear to have a normal life, +/-freak out
9:30pm: Go back to lab, freak out more
Midnight: Pass out
Top 10 Signs You're Spending Too Much Time in the Lab
9. You come across seemingly random numbers, but to you they are far from random: They are the number of amino acids in your protein of interest (987), or the first page number of the landmark paper you read (again) that morning ($4.02), or the recipe for your cells’ media (449,501).
8. You feel naked without your gloves on and generous amounts of alcohol sprayed all over them. Surely you’ll contaminate something.
7. You develop a giant blister on your thumb from too much pipette use—”pipette thumb.”
6. You’re so tired/distracted/sick of loading plate after plate that you can barely insert a multichannel pipette into a set of strip tubes without hitting the top, so you decide to get some coffee. An hour later, you’re so jittery that you can barely insert a multichannel pipette into a set of strip tubes without hitting the top, so you decide that “some coffee” probably shouldn’t mean three cups in a row in the future.
5. You don’t know how you could possibly get through loading another plate without listening to the latest "Wait Wait... Don’t Tell Me!" podcast.
4. You become genuinely miffed when your lab switches from one pipette brand to another, signaling that fact that your life revolves around the differences between little pieces of molded plastic (and is more or less over).
3. Finding a good spot to hide your stash of pipettes is probably the most excitement you’ve had all week.
2. You know the catalog number for 96-well plates by heart.
1. When you have some free time, you write a blog post about how much time you’ve been spending in lab.
The Curious Similarities Between People and Cars
Ben Ferguson -- Ever since my car started having serious trouble early last year and eventually had to be sold (if you can call it that -- it netted $400), I have been particularly sentient of the comparisons that are commonly made between
glorified mechanics doctors and actual mechanics, as well as between the things they deal with: the human body and cars.
Both doctors and mechanics are sometimes seen as sketchy people who don’t always tell the whole truth, don’t appear to tell the whole truth, or tell outright lies at times, whether it’s because of potential financial gains, laziness, coercion, etc. Sometimes both are downright unethical in the way they communicate and interact with their patients and customers. Both are in possession of knowledge that most lay people aren’t privy to, and this places them squarely in a position of power relative to those they serve, allowing them to manipulate many aspects of decision-making about a person’s body or car should they want to engage in such decision-making.
Quick: Think of the last time you went to get an oil change and the mechanic told you that your system needed to be flushed in order for your car to run properly, or that you needed a new air filter because your current one is “reducing your car’s performance,” or that your battery may have needed to be replaced -- would you like to take care of that today? I bit the first time I was told some of these things, and I’ve been told them many times since.
Think of the last time repairs to your car were quoted at, say, $400 and you ended up paying $600. “Whoops,” they say, “we didn’t anticipate that.” But you know they did. You know -- at least you strongly suspect -- they underquoted you so that you’d have the work done. If they hadn’t, perhaps you’d have shopped around a bit more. Things like that happen all of the time in probably every field of work, but both doctors and mechanics are in especially enabled positions to pull that kind of crap. Trust can diminish quickly, and this is especially true in light of this recent evidence.
We are all unfortunately familiar with the universal fact of life that our bodies and our cars are expensive to maintain. They break down and inevitably need service every so often. When money is tight, the question of whether to spend money on needed repairs sometimes comes up with both. If you’re a college or grad student living from loan check to loan check, do you really need to get a referral for that back pain, or can you live with it? Don’t you ponder your account balance before filling that antibiotic script? Do you even fill it period? Do you really need to see a doctor for that wart on your hand, or for the abdominal pain you’ve had for the past 6 hours, or for the headache you’ve had for the past few days? Do you really want to blow all your money going to the ER just to r/o meningitis every time you’ve got a stiff neck? Do you think twice, like I did a few days ago, about making that dermatology appointment for five minutes just to get a skin cream script if it’s going to cost you $234.93 every time?
When money is tight, these things don’t seem so dire. What’s more important is not going broke, eating, preserving your sanity, etc. even if you have to live with an imperfect body for a while. Similarly, do you really need to head over to the body shop every time you see a dent in your car? Can you live without air conditioning for the last few weeks in September? Does the rattling under your hood really annoy you, or can you live with that too? Honestly, who needs side mirrors and hubcaps and AC dials anyway? When money is tight, these problems don’t seem like problems; they seem more like everyday annoyances, and even if they do seem like problems, what are you going to do about it beyond blowing the last few dollars in your bank account?
When money is tight, I think many of us would stop and think twice about fixing ourselves and our cars at the drop of a hat. Some extreme things just don’t seem all that extreme anymore. Even with insurance, there’s not much motivation to seek health care or car servicing. Is it really worth it to you to pay $25 for a medication when $50 of it is already covered and you’ve only got a few hundred in the bank to cover you for the month? Perhaps, but usually no: You’re still out $25 whether it’s discounted or not. Do you whip out your wallet and fork over the extra $100 over your $500 deductible to fix the body damage to your car? Likely, no; you can live with a deformed car for now. Spending money like that seems at times like a luxury, not a necessity.
The value of ourselves and our cars must come to mind too. Would you put $1000 worth of repairs into a car that’s worth $10,000? How would that decision change if fixing it would cost you $5000? $500?
You’re 90 and you’ve lived a great, full life; how much time and energy and money and optimism do you want to invest in yourself when you’re not doing so hot in the first place? How would that change if this were your first hospital admission in the past 20 years? Your twentieth in the past two years? How would it change if you’ve been diagnosed with a terminal, metastatic cancer just after your 90th birthday? Diagnosed with pneumonia? Diagnosed with the flu?
And so, as the cautious and skeptical former owner of a crappy car that was in and out of shops before finally breaking down for good, and the owner of a sometimes crappy body that has weird stuff happen to it from time to time, I am now, more than ever, aware of how cautious and skeptical patients who’ve been in and out of hospitals for the past year must feel and how most of the underinsured and, more often, uninsured population around Hyde Park must feel. I used to think it strange that some people with serious medical problems simply don’t seek care, but now I realize that “serious” becomes a seriously relative term depending on your life situation.
Some Good Advice
Ben Ferguson -- I generally have trouble talking about myself, especially in social situations where there are a lot of people I’ve never met. I say a few words and then don’t really feel like talking too much. I’ve often been told that I’m hard to get to know, that I have a wall up around me that’s hard to crack. (Granted, I say this as I’m writing about myself publicly in a weblog.) Regardless, I got some good advice from my mom several months ago when a bunch of family members were in town for a reunion.
She said, after noticing that I was starting to get pretty uncomfortable with the rapid-fire questions about what medical school is like, what I want to go into, whether I’m going to be a surgeon like my dad, whether I’m going to be an anesthesiologist like my mom, what my thoughts are regarding why they never started a surgical practice together, why I’m doing a PhD, how long it’s going to take, how much longer I have in school, what this thing on their foot is, why their fingers are so cold and whether they’re going to die from it and/or have cancer and/or should have it looked at, etc., “Ben, you have one of the most fascinating jobs on the planet. People are going to ask you about it every time they see you because they largely have boring jobs that they hate. You need to learn how to deflect the conversation to them: Ask them what they do, ask them how their job is going, ask them questions about them. Otherwise you’re going to go crazy with all the questions about you you you.”
The more I thought about it, it’s true, and it’s especially true with members of my extended family, who for the most part can and will talk and smother you until you sometimes want to take a bat to their head. Or your own. It figures that once the convo is placed squarely on them, they’d roll with it and back off of me so I can get a breather once in a while.
My dad also had some good advice for me a few years ago, something a mentor of his told him while he was a medical student, and it’s particularly timely for me given that I’m starting to put together some publications in the lab. It was regarding how one goes about writing journal articles: “First, you tell ‘em what you’re gonna tell ‘em, then you tell ‘em, then you tell ‘em what you just told ‘em.”
Great! If only it were that easy.
Game, Set, and Match
Ben Ferguson -- Match Day is upon us. On Thursday, March 20, thousands of medical students and recent graduates will find out where they’ll be spending the next several years of their lives in training. Some will have their prayers answered, some their hearts broken.
I literally would not be more excited or antsy if I were going through it myself, but I am not. My original classmates, those of the graduating class of 2008, are. These are people that I’ve known for four years and who have become some of my best friends. They are people that, at least for two years, went through the grind of medical school with me, took naps with me, helped me, taught me, and understood me. They, like me, began as lambs naive to medicine and have now emerged from the wards speaking a completely different language, one that feels so far removed from our pathophysiology and clinical skills courses that ended just a few years ago.
I remember an encounter I had with a former classmate shortly after we parted ways and I started grad school. “What are you on these days?” I asked -- that’s all anyone asks who’s trying to catch up with old colleagues. “Gens, Q4. Not too bad. After this it’s smooth sailing until winter,” he said. I nodded in acknowledgement as if I knew what the hell he was talking about. He had a partial beard and was wearing mismatched scrubs; I couldn’t even begin to tell you whether he was on a rough surgical service or had a few too many medicine patients, and I didn’t ask.
I see other former classmates randomly, walking down the street in Chicago, or at a street market, or reading books as they hustle through the bowels of the hospital (here, they truly are bowels, ones that have just been emptied in preparation for colonoscopy, perhaps), or running by the lake, or darting onto AIM for a quick semblance of a social life, or during pickup poker games during which everyone drinks Capri Suns in place of perhaps more exotic beverages because they need to be up at 4am to make grand rounds the following morning. They all look the same, not the same as before but the same as each other. They are unexpectedly awake, and they are unexpectedly alive. The ones on surgery don’t look any different from the ones on family medicine or on psychiatry, save for slight changes in facial hair upkeep. They largely do the same things outside of the hospital as they always have, albeit in less quantity. They are fighting to stay alive and to become doctors, and they are doing fantastically.
Fantastically enough, even, that in less than a week, they too will experience that rush of emotion that dozens of classes before them have felt, emotion that will fill an entire auditorium palpably as if surrounded by a thick, saline-filled ether. It’s truly one of the most incredible experiences I have in a given year, but this year will be even more special. I know them. I have listened to their dreams and watched them -- the dreams and the dreamers -- take shape and morph and evolve. I cannot wait until I too have that opportunity. But, for now, I’ll settle for getting as close as I can to theirs.
The Difference Between Medical School And Graduate School
Ben Ferguson -- Everyone always argues over whether graduate school or medical school is harder, or more difficult, or more tiresome. Everyone. If you’re not currently arguing over it at this very moment, you’re totally missing out.
Some say the former is far, far tougher; it comes in like a lamb, has its lion phases here and there, and then exits more or less like a lamb again depending on the niceness of one’s thesis committee and the degree of copying-and-pasting of one’s previous journal articles. Some feel that the latter, by its sheer time and physical demands and by its ubiquitous emotional toll, is far, far tougher; then they become interns and laugh it off. Some say that each is difficult in its own right, that each is physically and intellectually demanding in ways and over time periods different from the other.
Regardless of which is actually harder (for the record, at this point in my career, they’re about equal in my book), there are most definitely some black-and-white differences between the two:
1. Each has schedules to follow and places to be. It’s just that in medical school, you’re expected to be somewhere at a certain time of the day, but in graduate school, you’re expected to be somewhere at a certain time of the decade.
2. No one cares what you look like in graduate school. No one cares when you arrive, or how much progress you make, or how inattentive you are toward others, so long as you get your work done in a reasonable amount of time. (This all goes out the window when your advisor walks in.) In medical school, your appearance matters very much, both to attendings and to patients. You must arrive on time, make strides in making patients feel better (or at least act like you’re trying), and always be cordial to them.
3. The “DOOR CLOSE” buttons in hospital elevators actually work. In other educational buildings, not so much. (Isn’t it fascinating, though, that we always try? Apparently the variable ratio reinforcement is too engrained in us to ignore.)
4. In graduate school, you worry about the lives of worms and mice and rats and immortalized microscopic fragments of tissues that were intact decades ago. In medical school, you worry about the lives of humans, which is slightly more stressful.
5. Neither medical students nor graduate students are particularly well-versed in dressing well. They may even be known for their inability to dress well, or to even dress appropriately for the conditions or given situation at all. In this department though, medical students totally dominate. Graduate students are completely hopeless for the most part, but that’s okay because no one ever sees them anyway. (I’m not in any way excluding myself from this group, either.) Note to future graduate students (and future medical students for that matter): Black pants + black shoes + white, pilly, holey socks (+/- publication(s) +/- international awards +/- bubbly personality) = immediate rejection. Write it in your lab notebook so you don’t forget it.
6. In graduate school, you often spend entire days transferring liquid from one tube to another, perhaps after waiting for the liquid to thaw, and then adding some other liquid(s) to the tube, and then adding the mix to some other receptacle. If you’re lucky, you get to invert it several times, or if you hit the jackpot, you pipette up and down. Your life is liquids, receptacles, and vectors to get the first into the second. Amazingly, the final outcome of this fails more often than not, and you must redo everything several times. In medical school, depending on the service, you often spend entire days transferring liquids from vials to patients, removing pooled liquids from patients, observing liquids (and solids...ooh!) that patients excrete, measuring pressures of liquids, and writing stuff down about all of them.
7. The most common question you’re asked as a medical student, by far, is, “What are you going to go into?” (I have no idea.) The most common question you’re asked as a graduate student, by far, is, “When are you going to be done?” (Never?) or, if you’re also a medical student, “What were you thinking?” (At times, I wonder that myself.)
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?)
All Because of a Harmless Western Blot
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.
I’m A Happy(er) Scientist Now!
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.