The other day in Biochem, Person #1 said something that made me gain an enormous amount of respect for her. As the prof called on her she looked over at the clock and realized there was only a minute or so left in class. And so, she said “oh, never mind. I didn’t realize what time it is, so I’ll just ask after class”. And that was it. Done. Finished. I was shocked. So, I have to give her credit. She (and honestly, everyone else targeted in Listserv Throwdown ’06) have really quieted down lately and I’m very, very grateful.

In other news, I’m not one to get nervous when I’m talking to people, but I just called up one of the pre-eminent Interventional Radiologists in the country to ask him for a research position. I’m meeting with him sometime next week, but I’m a little skittish. What if I don’t like the projects he’s running? What if he and I don’t get along? He sounded a bit gruff on the phone, but a good family friend of ours totally recommended him and said he was a really nice guy. Can I, as a lowly 1st year medical student, just say I’m not interested?

Plus, this time I really want it to count. I can’t get stuck doing crappy research again… I’ve been there, done that. It sucked. If I don’t enjoy myself doing research this summer I am totally going to kick myself for not going to Latin America and doing something that really made a difference.

Self-doubt and questions and worry… oh my!

They called me back to ask when I thought I’d be available, so they could postpone my jury duty. I said not for another 2 years. She said she’d just go ahead and excuse me then.

Yesssssssssssssss…

I have 1 summer left in my life. So, here’s the question.

1) Go to Ecuador. Have a really awesome experience taking care of indigent populations and feel very satisfied when a simple antibiotic cures a disease that has plagued a kid for years. Learn Spanish. Feel fulfilled.

2) Stay in town, in the blistering 120 degree heat… and do research.

Against all odds, I find myself leaning towards #2. I really want to learn Spanish, and do all sorts of awesome rural health stuff… but I feel like I didn’t give research enough of a chance up at CMU. The background on that, of course, is that I was turned off from research since my PI told me I would “never be able to cut it in medicine” and had me washing glassware for 3 months. Thanks, Alison.

So I’m thinking I might try to find some new, happening research in interventional radiology (something I’ve been thinking about a lot, lately- they do super-cutting-edge stuff like open heart surgery through a catheter) and do that. Another plus is that it pays $3400. Rockin’. Better than the -$2000 it would “pay” to go to South America.

I don’t know. I know it would probably end up being more rewarding to go do humanitarian work, but I feel like it could be potentially very awesome doing research. And frankly, I’m the kind of person that would love research. I think I just had a bad experience.

Random side note: apparently a search on Comcast for “vaginal waxing pictures” shows up with my site as the 34th most relevant hit… the text in question is “waxing nostalgic about anatomy lab”. Wierd how the internet works, yes?

No, not us. Next year’s class. I just did a pilot “small group” session that is supposed to mimic next year’s teaching style. Let me tell you a story about Histology- I promise it’s relevant.

The first day of Histo, we found out that we would be grading each other, in small group sessions, from 1-5 (very unsatisfactory to very satisfactory). We also were told that if we graded all of our peers 5, we would be docked points ourselves. This, of course, meant that no matter how well your group performed, you couldn’t give everyone an A… unless, of course, you screwed yourself over. Interestingly enough, myself and (via informal poll) ~50% of our class actually chose to do that rather than screw everyone else. Still, small groups quickly turned from a nice break from lecture into backstabbing, vicious point-mongering. My group learning grade in histo was a 72% by the end of the semester. Technically the process was anonymous but it became pretty obvious who was out for points. Nasty. We hated those sessions.

Back to today. 5 other students and I sat in a one-way mirrored room and worked our way through a case presentation. It turns out the kid had Marfan’s syndrome once we were given all the exam findings and lab tests. Once we were done, we were given the same sort of evaluation we had done in Histo to do for each other. Afterwards we found out that all the department heads were sitting on the other side of the mirror watching us. Cool. One free dinner later we were chatting about our opinions with the rollers and shakers.

Apparently the same system (or in some slightly modified form) is going to be released in full force on the next crop of first years. And it’s going to be a huge part of their grade, every 2 weeks. All 6 students in the pilot program kept telling the administrators that it was a bad idea and would only lead to problems, but I don’t think they wanted to hear it.

So, I guess we’ll see if the first year class rips itself apart next year. Honestly if they have to determine each other’s grades every 2 weeks the whole class is going to be looking over its shoulder every minute… not exactly an environment conducive to learning. Oh… and one of the docs kept coming back to the concept that “satisfactory” should be good enough, and “exceptional” should be reserved for only a select few. Nice try, doc, but here at med school, your peers grade like Harvard- everyone gets an A unless they really prove they don’t deserve it.

They were also talking about doing away with Honoring… which frankly, would mean that people who CAN honor would have no incentive to work past the 70% mark. You burn out pretty bad near exam time- if you knew you could coast those last few days, you’d better believe you’d do it. Personally I’d like to think that my doctor worked his or her respective tail off to make it through med school.

To Whom It May Concern;

I am a full-time medical student, and on the date that I am scheduled to perform jury duty, I have 5 hours of class that I cannot afford to miss. In addition, the postponement date that I have listed is one of only 2 days we have off for the entire semester; however, this date is scheduled as a “reading day” and is expressly given so that we can study for our upcoming exams. I am also going to Ecuador the monday after the semester is over to work in underpriviledged clinics (and therefore will be out of the country).

Thank you for your consideration.

If that puppy doesn’t get me out of jury duty, I’m telling them I love being an activist juror. Nothing scares them more. C’mon… poor starving kids of Ecuador? Criminal, what they’re trying to do.

I’m the new Tot-Shots co-coordinator, along with Courtney. Awesome. We get to give shots and vaccines to hundreds of screaming kids that are terrified of needles. Strangely, this is right up my alley.

I had to meet with Paula, along with Courtney and last year’s coordinator, Greg. On the way to the meeting, Greg did nothing but vent about the royal pain in the ass that is Paula, Queen of Darkness. Frankly, that’s giving her too much credit. Paula, Annoying Gnat of Little Itchy Insect Bites. Much better.

About a month ago, Paula came swooping into our classroom (buzz, buzz) informing us all about a new “Emergency Readiness” program being put on by the Health Department. Some legislator on high has decided that our city needs more Emergency Response people. Whatever. Just the sort of thing thats up our collective alley that we’d love to get trained for.

However, Paula continued talking. She informed us that there were, in fact, two workshops that we needed to sign up for. Furthermore, she would be in charge of both, and, additionally, we needed to sign up for both. If we failed to show, we would be docked CUP hours. Now, med students hoarde CUP hours like leprechauns do pots ‘o gold. Or whatever. C’mon, it was just St. Patty’s Day. Why, you ask? Because we get 3 weeks off in 4th year if we have 90 CUP hours. Clearly anything that jeapordizes that glorious vacation endangers attendance.

So, Paula, Insignificant Mote Of Dust Removed By My Swiffer effectively shot this program in the foot. First came the email informing us of the lifting of the “restriction on needing to sign up for both”. Then the entire program got cancelled.

My point, you ask? During our meeting, Paula proceeded to talk to us about how silly it was for the powers that be to schedule the programs “this late in the year”. Because, of course, it certainly wasn’t HER fault, now was it? In fact, she apparently went on record as saying that they should have scheduled the program earlier. It never would have had this problem if they had just listened to her. Blah blah blah blah.

The meeting turned into a power trip for her, like we knew it would. But, we smiled, and nodded, and played her little games. And now, we’re the coordinators for an awesome program.

I love you Paula.

One of the first days that we learned medical interview, we were sent into the hospital to interview real patients (most of our interviews were done on “Standardized Patients”, who were simply people who learned how to be interviewed/examined and taught to give feedback. They weren’t sick, but pretended to be, and we interviewed them in our classrooms).

The man that I interviewed in the hospital had multiple myeloma. At the time I didn’t (and frankly, still don’t) know exactly what it was, so I asked him to explain it to me. I remember him giving me a long explanation, most of which centered around how healthy he had been up until this point. Never a hospital visit. Never a broken bone. And now, this “growth”, as he put it. He said that some doctors had hinted that it was cancer, but he didn’t like to think of it that way. I was convinced, and remember assuring him that he “looked great”.

It is cancer. Incredibly painful, lethal bone cancer. It’s incurable, and from the onset of the disease to time of death, patients live an average of 3 years. He had end-stage disease, and he was only around 45.

I’m reading House Of God. If you haven’t read it, you should. It’s what my blog should be, but isn’t. Anyhow, a man with multiple myeloma is described in brutal, grisly detail… “I thought of the bones in multiple myeloma: eaten away by the cancer until they’re as brittle as Rice Krispies”. I just realized that the first patient I ever interviewed is probably dead.

That’s a sobering thought.

*edit* I finished House Of God. I’m not sure I’d say, after reading the whole thing, that it’s what my blog should be. I don’t think I’m anything like what he becomes near the end of the book. It starts out similar to Catch 22 – wickedly funny and unabashedly real – but then becomes something I can’t identify with.

So, I feel like I just haven’t been doing anything useful with my life. I’m signing up to be a CPR instructor, provided that there are still spots available. I should clean my house. My life is a shambles right now.

I can see it now. I’m 65, retired for one week, and all of a sudden I feel useless. For those who don’t know, we just got back to school after our week of break and now I’ve got nothing to study. Maybe I’ll go preread for tomorrow. I hate slow starts to semesters and “overview of” or “intro to” classes. Especially because then the prof has to ask the requisite 3 questions per lecture on the test, and then everyone gets them wrong even though its the easiest material in the world (note: for future reference, we’re asked roughly 3 questions per test per lecture, so 33 lectures x 3 questions ~ 100 questions).

Maybe I’ll go find a cat stuck in a tree somewhere and save it.

Why does health insurance cost so much?

I had a nasty sore throat a month ago, and went to campus health. The doc took one look and then sat on his rolly chair (editor’s note: I can’t wait to be the one who sits in the rolly chair). He was, in his words, “85% certain” I had strep. Now, there were several things I could do.

1) I could go on the assumption that I had strep and just take the antibiotics.
2) I could get a rapid strep culture that has a 13% false negative rate.
- If the rapid strep was positive, I would take the antibiotics.
- If the rapid strep was negative, we would assume I was the 13%. Then I’d take the antibiotics.
3) I could get the regular strep test and wait 2 days for the results, taking antibiotics in the meantime.

Now, the one hitch in all of this is that it didn’t smell like strep (believe it or not, smell is an important diagnostic tool. Several of the ER docs I worked for last summer could walk into a room and tell if the patient was sick simply from smell). So, like anybody, I would have loved to have known, for sure, if I had strep. Note that in all 3 cases, I would be taking the antibiotics regardless.

Lets introduce money into the situation. The doc’s visit cost $10. The antibiotics were going to cost $12. The rapid strep was $20, and the regular strep was $30. None of these were covered by insurance.

I walked out having paid $22 (choice #1). I think most people would have. If I still had a problem in a few days, I could go back for some testing. But, if insurance paid for it, you’d better believe that I would have had a rapid strep test. I mean, it’s free, right? I think you see where I’m going with this. That would have doubled the cost of the visit… and insurance would be the one to pay for it.

…except that in the end, of course insurance isn’t the one who pays. They pass the costs on in the form of higher premiums.

That’s exactly the problem with healthcare. People don’t see what things actually cost, and this is compounded by two things. First, they have already paid thousands of dollars per year for insurance, so they want to recoup the costs. Second, since they don’t have to pay the thousands of dollars for an MRI, or a CT, they want the diagnostic testing done. I mean, hey, if I can know what I’ve got for sure, and I can do it for free…

Of course, there are many other problems as well. The state of Pennsylvania spends $3 billion a year on prescription drugs for the elderly. 2.5% of that is spent on Nexium ALONE. Nexium is used for acid reflux. Only thing is, Prilosec OTC (OTC stands for Over The Counter) is infinitely cheaper, and in many cases, works just as well. Or, Tums cost $2. Or, god forbid, stop drinking a case a day, eating 40 spicy wings at dinner, and polishing it off with a 5th of vodka.

So, I just found out that the repairs on my car come to $1200.

…

I don’t have that kind of money. Keep in mind, it costs $14,000 per year to go to med school, on top of which I then need to pay for rent, utilities, food, etc. I’ll be in the hole about $150,000 with interest once I graduate. If I had gone to a private school (like Wake Forest) I would probably owe more like $250,000+ because their tuition is $45,000 a year.

And now you see why many doctors feel the need to go into specialties when they graduate, so they can pay off their debts. I’ll still only be making $30,000-$40,000 a year when I go off to residency. It’s not until after residency that you can start to make real money. And that, of course, is rapidly being whittled away by the drug companies and the HMOs. Medicine is no longer a good place to make money. The way to do THAT is to go to law school. And then sue me. Sharks.