Friday, March 07, 2008

Call of the Sirens (Part IV)

I know I've bored you all stiff with the first two years (bored myself reliving it), but I wanted you to get the idea of what it really involved. But now, NOW!, we finally get to what most people think of as med school: Running around in short white lab coats, making egregious errors that nearly cost people their lives! Woot!

Oh, but wait just a minute there, Grasshopper, before you hit the wards, you must take your Medical Boards Exam Part I. A two full day fill-in-the-bubbles exam over the first two years of your basic science knowledge. You were given 2 weeks at the end of your second year's courses and the exam to 'refresh' your knowledge. We mostly sat on the grass and tried to re-learn biochemistry and the vagueries of spleen pathophysiology while wishing we were on a beach with a drink in each hand. The only thing I recall about the exam, aside from the length, was one question that made me start to laugh hysterically and mostly silently, sitting in my seat, shaking violently making those Eeeeep! Eeeeeep! sounds that wouldn't be suppressed from my glottis. The question? "What is the velocity of the axon of the giant squid?", which was followed by your 5 choices: A-E.

For me, that question pretty much summed up the whole damn thing. I mean, really! REALLY!! What the hell?

Somehow, I passed. Chalk another one up to a personal skill in taking standardized bubble-tests.

Ok. Off to the wards in our business casual clothes and short white lab coats!

Can we take a minute to examine the horror that is the short white med student lab coat? Can we? White--for starters--because it will show every blood, pus, iodine and ink splatter to greatest effect. Short--cuts across the broadest part of the butt. Unflattering on Victoria's Secret models, horrific on we of the German thighs. Large pockets from waist to hem-- the better to cram with pounds of pocket sized reference books (at the minimum a Sandford Guide, a Washington Manuel and a pocket pharmacopaea), computer print-outs of patient labs and radiology reports, journal articles, reflex hammer, peripheral brain (the small self-made notebooks of our collected wisdom not found in the published reference books) tongue blades, phlebotomy tourniquet, vacutainer holder (called the 'vacutainer' for short) for drawing blood, hemoccult cards and bottle of developer (you know, to check the smear of poop on the tip of your finger for blood, after you did the rectal exam), pen lights, fistfuls of drug-rep pens, calipers, cotton swabs, culture tubes, and a cookie or some other snack, as god knows when your next meal would be.

The vacutainer holder was a particularly prized item and when we had one, we guarded it with our lives. It's that little 2" / 5 cm plastic sheath that you screw a phlebotomy needle into one end and slip the vial for the blood in the other, so you can easily draw blood with just your one hand, leaving the other to position the vein, grab the cotton ball, or eat your cookie with at the same time. If you didn't have one, you needed to use two hands and a syringe, which was much more awkward and left you without your cookie lunch. The only way to get a vacutainer was to inherit one from a finishing 4th year student, steal one (not too cool, unless it was from a non-med student) or somehow get one of the phlebotomists to give you theirs. That's how I got mine. She will ever be in my nightly prayers. You knew who your very good friends were, as they were the ones who would lend you their vacutainer if asked.

Within a month or 3 (If the coat were particularly well-made) all the pockets on the white lab coats sported a large safety pin at each corner to hold them in place, as the pockets were actively ripping off the coats. Still and all, it was pretty amazing what could be carried around on one's person, thanks to those wretched short coats.

So, now you have us in your mind, a shuffling army of quasi-alert Quasimotos, bent and twisted with the sheer weight of our pocket-crap, off to learn how to actually become doctors.

Being of cautious nature, I requested, and got my first assignment as the easy-peasy ambulatory care rotation. Basically, you were farmed out to area family practice and internal medicine docs and mostly followed them around like little shadows that bulged at the midsection. It was there that I learned that a 28 year old sales rep who comes in with vaguely cardiac sounding symptoms deserves a stress test, which was done during lunch, which was positive, which led to the urgent call to the cardiologist, which led him to the balloon angioplasty, which saved his heart and possibly his life, all done before dinner. Don't ever doubt the worst-case scenario and proceed accordingly.

Then Surgery I, which was basically hanging out in ortho, urology and general surgery out patient clinics. If surgery can be said to be dull, than this was, indeed, dull. The only operating room stuff you got was the occasional joint replacement with the ortho folks, and those usually went to the students that wanted to go into surgery as a prime chance to brown-nose. Meh. But, not too taxing and no on-call, so sleep at night and regular meals.

Fall brought 6 weeks on psychiatry, which landed me at the VA (veteran's hospital), which mostly had WWII vets on the medical wards and Vietnam vets in the psych unit. As with most psych units, the nurses basically ran the show, the residents groused about the damn bossy nurses, and the attending hid in his office. I recall the attending as being nice, quiet and brown -- brown hair, brown beard, brown tweed jacket, brown pants. Soothing to the extreme. We students hung out, discussed the pros and cons of various nasty psych drugs (This was just before Prozac came into wide use, and so we were still using tricyclics for depression and worrying about tricyclic overdoses -- nasty, nasty arrhythmias that you couldn't do much about except watch the monitor and pray.), watch various interventions and what-all through the one-way mirror, talk to the inpatients (mostly a group of nice, if really fucked up, guys) and eat lunch. So far, this third year med student stuff was a piece of cake, yes?

We also had to do a long evaluation on one patient, so I chose this nice guy that I seemed to hit it off with, exchanging pleasantries and the occasional joke, to do the extensive interview on. I asked him and he agreed (I think he was really bored), and so, over a couple of days, I got his whole life story and wrote it up. I then got torn a new orifice by one of the nurses, as how the hell could I have talked to someone as fragile as he was? (This was after I'd asked who'd be good to interview and was told, "Eh, anyone.") He had been admitted, once again, for barricading himself in his house with a shot gun while having flashbacks of his Vietnam experience. Seems he was a butcher by trade, and while he was not working as one, for obvious reasons, he'd occasionally agree to butcher a deer carcass that a buddy needed to have done, which would set him off, etc, etc, and he'd finally land in the VA for a few weeks of med adjusting, group therapy, and calm talk about how maybe he should just tell his buddies to go find someone else to cut up their dead deer. Actually, he seemed better adjusted than most of the staff, and as I'd been completely up front with him about what I needed and what it involved, and he seemed perfectly fine with it all, I though he'd be a good subject. Fortunately, he backed me up, also, so I was out of the mud I had inadvertently stepped in. As a group, the med students were also accused of sneaking in and viewing someone through the one-way mirror without permission of the staff. We hadn't, actually, and had all been together in the office doing chart stuff, so that didn't stick, either. It was a very strange place: orange and brown and creepy, messed up staff.

So, from psych, I learned that they are all bat-shit crazy, the staff even more so than the poor patients, who at least had an excuse and were trying to get better, and were a decent set, at least at the VA. The ones at the university were a different matter. There the borderlines flourished and the severly schizophrenic wallowed and the 4-point restraints were used with necessity, but as I was only there for a Saturday on call (Woot! Only one whole day on call! With a nice, casual, non-abusive intern, who was polite to the patients and knew how to ferret out this and that.)

I think we'll leave it there, as after psych, we hit the harder stuff, where sleep is removed, stress is amped up, lives are on the line, and many, many meals are missed. Even the cookie-meals.

Gritty stuff, indeed.

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Blogger Christina said...

Wow, I tip my hat to you!

11:14 AM  
Anonymous Ariella said...

Good God, not cookies!

We need to get together!

11:39 AM  
Anonymous Anonymous said...

And you wonder why this psych major never joined the fraternity. I seen to have acquired every neurosis we studied. I was, however, intent on doing experiments with rats, etc. But the department Christmas party was a real blast, until I had to go home and take my father downtown in a totally unsave alcoholic condition. But having much undergrad practice with this, it was no problem.

The Ole RF-er

5:55 PM  
Blogger Sweet Irene said...

I would have been most interested in the psych ward, but would have felt most frustrated there as well, it almost being impossible to "cure" anyone. Help them along a bit, yes and listen to their life stories, yes, but cure, no.

I guess you are now moving on to the real emergency drama of life and death situations and life on the E.R. Can't wait to hear that stuff.

9:04 PM  
Anonymous Kate W. said...

See- a perfect example of why I could never be a doctor... "many missed meals" sigh... I am SO laughing at your vacutainer stories. Did you see the snow we got yesterday and last night? I feel like I'm living in your snow pictures! The whole city is closed. Well except John because you know how important it is for people to have bread!

9:26 AM  
Blogger Teresa said...

I have my own set of sad and scary encounters with Vietnam vets from the 70s when I was a naive coed. Nothing like a war to ruin a good person.

10:46 AM  
Blogger Dumdad said...

This is fascinating for someone who knows nothing about medicine and the medical profession.

My mind made silly connections when you mentioned the Vietnam vet who was a butcher and cut up deer for friends. The Deer Hunter, of course, popped into my head. Did he ever suggest playing Russian roulette?

"hemoccult cards"? Is this some sort of witchcraft?!

I look forward to future instalments.

1:59 PM  
Blogger Coffee-Drinking Woman said...

but, wait! I wasn't bored.

And I'm now giggling endlessly at Dumdad's comments about hemoccult cards... witchcradt? errrr, no. Not quite...

10:17 PM  
Blogger listie said...

We used to have kids studying for the Medical Boards come into our library and basically camp out (our school had no connection to any medical school). I once asked a couple how they happened to choose to study at our place and they told me it was because it was quiet and we were nice to them. I felt sorry for them; they were obviously working their butts off and seemed so stressed.

11:39 AM  
Blogger Rozanne said...

You must have a large brain with plenty of storage space, that's all I can say.

9:53 PM  
Anonymous Anonymous said...

Wow - Large brain indeed! I don't recall half of the stuff that Diane does... and I was there! I too enjoyed psych - and the fact that there were no missed meals. But I don't ever recall having a vacutainer. You also forgot to mention the neck and backaches that come along with carrying 20#'s of crap in your pockets. Oh wait. Maybe that was residnency...
You may get to this part, but what I do remember about meals, is that I was just about to take my first bite.. when the residents would all stand up and say, "That was good, gotta go now" and off we were. Yes. Missed meals. I never did learn toeat fast (I know, it's much healthier to eat slowly.)
I had completely blocked out those 2 horrendous days of Boards I. I don't recall any of the questions... only the bout of Irritable Bowel just before it started. Oh, I made it out of the bathroom just in time! And by the hair of my chinny chin chin - I, too passed. Phew! (not so lucky w/ part deux).
Till next time - I'm off to Sunriver for an OHSU Musculoskelatal/Rheum conference (and some skiing w/ the family too!)

11:30 AM  
Anonymous Anonymous said...

Hi Honey - the last entry is from me, for some reason it forgot my password (Tee Hee)
xo again,

11:31 AM  
Anonymous Anonymous said...

It's me again - sorry for the mis-spell on your name!!!

11:32 AM  
Blogger Mother of Invention said...

Inside view of One Flew Over The Cuckoo's nest!
Do you still have your lab coat? Find any cookies in it?!!

11:33 AM  
Blogger Jocelyn said...

There are a couple dark nights of the soul when I could have used a bottle of that developer in my pocket.

Riveting, as always, my dear.

10:34 PM  
Blogger amymalia said...

I was sent to you. By god. (Well, okay...actually not GOD god, just Jocelyn God. Kind of the same when you get right to it.) Because she thought we'd have a thing a two in common. And even though I TOTALLY CAUGHT YOU talking about stealing vaccutainers from the "non-med-students" (read: me) I am so F-ING enamored with you that I'm not even mad. In fact, I am so in love with you I will send you a box of vaccutainers of your very own (also, I'm down with the nurses, which is HUGE). You do what I've been trying to do for months but are actually funny and good at it. Maybe I just quit medicine AND blogging and live vicariously through you.

6:53 PM  
Blogger amymalia said...

Of course. OF COURSE. Of course you guys had scrubs stocked and available to you. Because you also probably rotated through hospitals WITH SINKS. Because that kind of stuff makes sense. One would expect things like, mmm, sinks and maybe scrubs and possibly some soap. Oh no. No no no no no.

And don't even get me started on the fact that everything, EVERY THING in our hospital is scribbled onto pieces of paper in SANSCRIT and squirreled away in charts and then lorded over by fiesty woman who ARE NOT afraid to actually and physically bite your head off, decapitate you if you will, should you try to look into it to, I don't know, read the ER admission note or the last medication orders or something totally wacky like that.

Ahh. The glory. It's without number, really.

6:53 PM  
Blogger amymalia said...

Also, I feel that it's important to note here that I read this post as my first introduction to you and, as one would, assumed it was in real time. In which case, I rescind my offer for a full box of vaccutainers. Not out of any vitriol or contempt but because, well, you're all growns up now and probably have a room full of vaccutainers AND tourniquets.

Ah, the sweet sweet smell of syringes and success.

5:39 PM  
Blogger Lioness said...

I think I am a bit in love with Amymalia, she's hysterical and adores you already, very sane combo, I say.

I loveloveLOVE your medical posts, God knows why bcs oh, the suffering, but I do! I wish my lab coats had time to become worn out but they are all stolen long before that. WTBH? But I can tell you this, considering how I fare in exams, particulary multiple choice ones, it is a fine thing indeed that we don't have boards. I would never ever become a bloody vet - not that at this point I still believe I ever will, you understand, am just saying...

5:18 AM  
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