I’m the education coordinator for both Medical Students For Choice and the Surgery Club. Now, this is ostensibly the sweetest position in a club. You don’t have to run everything, like the president. You don’t have to do all the administrative work, like the secretary. You don’t have to deal with reimbursements and paperwork, like the treasurer. Instead, you ask cool doctors to come speak to medical students, and give said students free food. It’s sweet. I love it.

However, what just happened ruined my day. I called Chipotle on Saturday to order burritos for an MSFC talk on Plan B, and made sure that they would be ready by 11:30AM, sharp. Talk starts at noon, so I figured that was plenty of leeway. The manager was so stoked that I was ordering 60 burritos that he offered to comp 15 of them. This was great for my budget- I just fed everyone for $3 a head.

Then, last night I realized that I had to skip out of a small group session in order to make it to Chipotle by 11:30. This was unfortunate, as the doctor leading the discussion is a known hardass and probably was going to dock me points. Medical students hate being docked points. It didn’t help that as I asked if I could leave, he said “well, it’s your choice”. Awesome.

So I roll up to Chipotle at 11:33 and see a glorious box ‘o burritos sitting there, waiting for me. I apologized for being late, and the manager (not the one I had been talking to Saturday) said that it would be another 10 minutes before they were all done. This still gave me at least 10 minutes leeway.

11:45 ticks by. 11:55. The manager, looking harried, apologizes for the delay. I tell him I need the burritos at the medical school in 5 minutes. My phone rings- the other MSFC leaders want to know where the burritos are. By this point, they’ll be at least 5 minutes late, no matter what I do.

As I go to pay, the new manager quotes me $345 as my price for all these burritos. Chris, the weekend manager, had quoted me $250. I start to lose it. The new manager says there is no way he can comp me 15 burritos, as this will run into his profit margin. He offers 10. Desperate, I take it, and walk out of Chipotle at 12:10 $290 poorer.

The burritos arrive at 12:20. Anybody who is still waiting around for the talk is hungry and pissed. I’m pissed. MSFC leaders are pissed. I assume the doctor speaking was also pissed.

AND we got shafted for $40.

I probably should have refused to pay, but I just wanted to get the food to school as fast as possible. I’m never going to Chipotle again. Plus, they’re owned by McDonalds. Corporate assholes.

*Edit* I just got a call from my bank… they thought that the credit card charge at Chipotle was fraudulent today and temporarily shut down my card.

How is it that Nicolas Cage easily stabs a giant needle of VX gas antidote directly into his heart… when all we learn about is experienced, trained surgeons giving their patients a pneumothorax from missing the heart and hitting the lung?

I call shenanigans.

I practiced a regular physical exam yesterday (as I’ve mentioned before, there are several specialty exams – heart, lungs, knee, etc – but this was vanilla head-to-toe). One of the things that they’ve pounded into our heads is that keeping the patient comfortable is really important. There are all sorts of complicated draping methods you can do with sheets to *ahem* keep certain body parts covered while still allowing access to others, if you catch my drift.

The woman that I was examining has been doing this for 33 years, and apparently even used to go on lecture circuits about how to properly examine a patient. She was sitting in a patient gown as I walked in the room. I made a little chit-chat, washed my hands (key!), and then got down to the examination.

As I neared the cardiac part of the exam (which you do entirely from the front) I started wondering how I was going to “preserve her modesty” while still listening to her heart. It’s essentially impossible to listen for cardiac problems through any sort of fabric – your stethoscope needs to be touching skin. Apparently I didn’t have to worry. At the slightest hint that I was going to need to listen to her chest, she reached back, and in one swift motion, dropped the entire gown to her waist.

Now, I will say that the cardiac exam was one hell of a lot easier without having to worry about patient comfort. She obviously didn’t mind at all (and I suppose it says something for medical school desensitization that I wasn’t uncomfortable myself), but she’s a unique case. What happens when I’m not dealing with someone who has been doing this for 30-odd years?

Anyhow, there’s my first brush with patient nudity. It was easy this time, but I think she had a lot to do with it. Any advice?

It often amazes me how daunting something can be the first time, and how much easier it becomes the second. Not to say that congenital heart diseases are easy, of course.

Every time I sit in class and the prof chugs through 20 diseases I’ve never heard of, I freak out quietly. There is no way in hell I will ever know all of this information, I think to myself. 1 hour later it happens again. And again. And again, all day. And then the next day, and the next week, and the next month.

The funny thing is, I just opened my path notebook to study the congenital heart malformations (and yes, I’m blogging rather than commit them to memory), and something about the second time is just… easier. Coarctation of the Aorta? Never heard about it before a week ago, but suddenly it looks a little bit more familiar.

I wonder if the difference is that the first time, I wonder if it will ever end. The parade of diseases never seems to stop. But the second time I see it, I know it DOES stop, because I’ve sat through the end of the lecture. Maybe deep in the annals of Robbins Pathology there are lists of hundreds of congenital malformations, but we only need to know the most common 15.

I really wish it would stop, though. I’ve lost most of the excitement I had when I first started med school. Back then I wanted to know everything about how neuro, anatomy, and histology worked. I would spend hours going off on tangents. Now I just want to know how much I need to study for the test, because forcing myself to sit in the library is getting harder and harder to do.

I learned how to perform a pulmonary exam today. Now, I’ve found that I’m decent with the actual examination part. I can go through the motions pretty well (take a deeeeep breath in, hold it, breathe out, good), but when it comes to knowing what I’m seeing, I fail miserably. My patient’s lips looked slightly blueish to me, but not enough to call them “cyanotic”. He was a little on the heavy side, so his chest was big, but he wasn’t “barrel chested”. He got slightly out of breath when he talked too much, but his breathing wasn’t “labored”. His fingernails were a bit rounded, but they didn’t exhibit “clubbing”.

All of those are pathognomonic findings that show up on tests and boards, so you can say “ah HA! They said clubbing, which is usually associated with lung cancer!”. But what if you can’t see the symptom? They make this out like it’s a cakewalk – patients with EMPHYSEMA present with nicotine stains on their fingers, labored breathing, and a barrel chest – but I’m starting to get the sinking feeling that all of these symptoms are shades of grey.

After the exam was over I had to document my findings. He had an obvious wheeze upon expiration on the anterior chest wall, but that was the only thing I was 100% certain about. I threw in some other “findings” that I didn’t really find – which we are told NEVER to do – because just one finding didn’t seem like enough. Cyanosis, clubbing, barrel chest, and labored breathing all went on the sheet. I was then asked to make a diagnosis, which I hesitantly called chronic asthma. I had noticed that he was short of breath upon exertion and that he was wheezing at the very end of his exhalation. That’s all I had to go on. Then he took the sheet and corrected it. Turns out he did have asthma and wheezing, but that was about all I got right.

I’m feeling a bit unnerved by the whole experience. This time around I had someone to tell me what the correct answer was, but now I’m thinking back to this post and putting myself in the place of the doctor who doesn’t know what’s causing the woman’s abdominal pain.

Can I really tell a patient “I don’t know what’s wrong with you”? I’ve done it before, but I’m a medical student and there is always someone above me who can catch my mistake. I remember looking at docs in the ER who would say “we don’t know what’s wrong with you”… and I always nodded my head sagely and thought “medicine doesn’t know what’s wrong with you”. But now, I’m thinking that when I’m there, I’ll realize that “We don’t know what’s wrong with you” really means “I don’t know what’s wrong with you”. Me, personally. My fault. My failure.

I remember the doc I worked for this summer said something that struck me. “Zac, you keep thinking that as you advance in medicine, things will get more and more clear. They don’t. Medicine is always murky and confusing, and you hope to god that you’re doing the right thing for your patients, but you never know”.

That is one scary thing to have a 50-year old, phenomenally successful physician tell you.

I’m taking two electives this semester- Radiology for Dummies and The ABCs of ECGs. I figure both of those are important skills to have as a “health professional” (as they are apt to call us nowadays). Personally, I’d love for my doctor to be able to, say, look at an X-ray and know what it means.

I, on the other hand, look at an X-ray and all I see is some bones on a dark background. Perhaps some fuzzy white stuff in the lungs. Maybe some grey stuff in the abdomen that vaguely resembles the spaghetti I ate last night. I am incapable of seeing fractures, tumors, infiltrates, or anything else that you should see on X-ray (or CT scan, for that matter).

Needless to say, both of these classes have been quite the rude awakening. Our radiology prof pretended to be a patient the first day. “I come into the ER and I’ve got right-sided chest pain… what do you do?”, he said. We all stared at him, slack-jawed. The heart is on the left, I thought to myself. That wouldn’t cause right sided chest pain. And then I realized- I had no fucking idea.

You can ask me what causes a restrictive cardiomyopathy, or what the 4 components of the Tetralogy of Fallot are, or even what the symptoms of early Parkinson’s are. On a multiple choice exam. Faaaaar removed from a live patient.

I am now officially terrified to go onto the wards. I have no idea how we’re going to translate theoretical knowledge to clinical practice, because frankly I’m still scared to walk into a patient’s room by myself. I don’t know all the questions that I should ask. I don’t know all the signs and symptoms I should be looking for. And most of all, I fear the uncomfortable silence that is bound to come when it’s obvious that I don’t know what I’m doing!

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By the way, I’m sorry I haven’t been updating very much lately. I’ve got 5 posts saved as drafts that consist of nothing more than 1-2 sentences… for some reason I’ve been having trouble finding things to say. Not like I say anything worthwhile normally :-) .

During the summer I scanned in a couple of my favorite doodles. They’re nothing artistic, but you may get a kick out of them (especially if you were in class and know what I’m talking about…)

So, without further ado- Zac’s Doodles Part I (more to come when I get around to scanning more).

I love Neutrophils because I always think of them like this – they explode to kill off invading bacteria.

I’m seriously thinking of making this for this halloween.


I hated biochem.


My favorite diagram ever. Note the sweet crane hand coming off the HDL.