I started blogging as a way to keep in touch with my friends and family while I was studying abroad in Italy; it was much easier than emailing everyone separately. Posts were long, rambling, and only a select few people would ever want to read them†. They were probably just humoring me anyway. After I came back from Italy, I stopped writing, and my blog hit the proverbial backwaters of the internet.

Then medical school started, and I found I needed an outlet. Touching a dead body for the first time. Not getting enough sleep. Seeing people deny their cancer diagnosis. Still thinking penis jokes were funny (they are!) but trying to be “professional” about it. Becoming apathetic about learning. Losing my sense of self-importance††. Putting on 5 pounds from eating at a hospital cafeteria every day. I needed somewhere to vent.

Moreena over at Wait&Wonder wrote an incredibly insightful piece that sums up my feelings. I blog because it’s my outlet, my way of processing this life I’m leading. It helps me come to terms with the sobering realization that I have agreed to trade away 2 months of my life to study for the boards – and also lets me record some genuinely hysterical stories for posterity. Blogging is catharsis.

But I cannot hope to stay anonymous. For anyone who hasn’t been following the recent drama in the medical blogosphere, read this article – because it could be me in 15 years.

To be unmasked in court means that Flea’s real name is forever linked with opinions that were supposed to be unhinged from reality. With the story splashed all over the Boston Globe, the entire Boston medical community now knows what he really thought about his coworkers, his administrators, his patients. It’s the adult equivalent of having your diary photocopied and passed out at school. It’s the risk you take.

Howdy, prosecutor from the future. Please remind me to read this post (hi me!) so I remember why it was worth it. And Flea- here’s to hoping you come back soon (and welcome back, Fat Doctor)!

†Hi mom!

††Every med student gets excited when they first get their ID badge and sign up for “harder courses than the undergrads take”. Though I definitely still get occasional bursts of superiority complex (everybody’s human!), my badge is now just what gets me into study rooms and taking harder courses just means I get less sleep.

Cool! I got featured on the weekly med-blog-o-sphere Grand Rounds for my first time! Go read about myself writing about… myself.

Oh, and if you’re new here, hi!

A few fracture types:

Greenstick Fracture: Similar in appearance to a green twig that has broken only halfway through and then splayed out. More common in kids.
Chalkstick Fracture: Looks like a piece of chalk snapped clean in half. More common in Paget’s Disease of the bone.

Sorry it’s short… I’m exhausted!

QBank has consumed my life, and I’m fairly certain this is also true for all the other med students out there about to take the USMLE. There are over 2,000 questions on QBank, which is really pretty staggering if you stop to think about it. I try to do at least 50 a day, with my entire Saturday devoted to nothing but testing. I’m still going to have trouble finishing them all.

Then again…

Over the past 2 years, we’ve taken Anatomy, Neuroscience, Histology, SBS, Genetics, Physiology, Biochemistry, Pathology, Pharmacology, and Microbiology.

My rough guesstimate is that we answered 300 questions per course per semester (with 2 semesters of Micro and Path, and 4 of SBS). That works out to 4,500 questions overall.

Assuming that everyone in our class passed with at least a 70% in every course, that means that we have all answered at least 3150 questions correctly over the course of the last two years. Given that in order to correctly answer the question we have to link 2 choices together (question stem + answer) and usually rule out 3 other answer choices, (requiring us to know 5 distinct facts)†, that means that over the past 2 years everyone in my class has successfully assimilated over 15,750 medical factoids.

That works out to 20 a day – and I actually think that’s lowballing it.

†clearly you don’t need to rule out EVERY answer choice – and some of them overlap – but I’m throwing in some extra wiggle room.

Proving yet again that the Wii heralds a new era of humanity, I present to you:

Rejected Wii Games

I firmly believe that this video proves that the Wii (or something like it) will train all doctors in the future. We already know that surgeons who play video games make fewer mistakes… and believe me, I play more than 3 hours a week. Told you it wasn’t a waste of time, mom.

By the way, check out the end of that article. Being forced to play video games before operating? By my boss? Can someone please explain to me how this is anything other than my ultimate fantasy?

While I’m at it, I might as well mention that I’ve made a few tweaks around the site. If you’re a regular reader (and I know you are!), go ahead and subscribe to my blog via my shiny new RSS feed, if you know what that is. Or, if you don’t, use the email subscribe box on the lower right to get my ranty goodness delivered straight to your inbox†.

Even better, use the new “Email this” link on the bottom of any post to send it to someone who might enjoy it (all you meddies out there who have friends at other medical schools, this means YOU). I promise, I’ll make it worth your while.

†I should say that I routinely edit posts for about 30 minutes after they go live, so you should check back on agraphia to make sure you get the final version. As a bonus, it’s usually more offensive until I tone it down…

We were studying SBS today at our local pizza place, and the waitress figured that we needed a break from studying. After making sure that we wouldn’t be offended, she told us the following joke:

What’s the difference between Jesus and a pictures of Jesus?
Only takes one nail to hang a picture.

Most interesting thing I learned all day.

Best mnemonic I’ve heard yet (as long as we’re still stereotyping): NAACP.

National Association for the Advancement of Colored People, you say? WRONG! NAACP actually stands for Neoplasia, Asthma, Allergy, Collagen Vascular Disease, and Parasites… all the things that cause “colored” cells to increase in number. Oh… by “colored”, I mean “red”. As in eosinophils.

And the award for Most Misplaced Section In First Aid (drumroll please!) goes to the section on Psammoma Bodies. If you thought you’d find it in endocrine (papillary CA of the thyroid), reproductive (serous cystadenoCA of the ovary), neuro (meningioma), or respiratory (mesothelioma), you’d be wrong. It’s in hematology, on page 307. Why, I have no idea… psammoma bodies are a far cry from a blood-based disease.

Earlier on, when I was talking about my golden rules for SBS, I mentioned that you shouldn’t stereotype… openly. The USMLE is your chance to practice. Nobody ever needs to know that the instant you see lawyer you immediately think scumbag who sleeps with prostitutes and therefore has gonorrhea, syphilis, chlamydia, and herpes. It’ll stay our dirty little secret.

Stereotyping for the USMLE:
How To Discriminate Your Way To The Top

Race/Ethnicity

African Americans have sarcoid and sickle cell.
Africans have Burkitt’s, malaria, sleeping sickness, or worse.
White kids have cystic fibrosis and can’t dance.
Jewish girls have ulcerative colitis or crohn’s.
Eastern Europeans have glycogen storage diseases (oy vey!).
Gorgeous Mediterranian men have beta thalassemia.
Japanese people have stomach cancer and ninja skills.
Peruvians have huge lungs, hypoxia, and polycythemia.
Native Americans are obese, have diabetes, high cholesterol, and gallstones.
Indians (from India) have TB and oral cancer from chewing Betel nuts .
Immigrants all have a disease that we can prevent with a vaccine.
Central Americans have Chagas and can dance the tango.
Mexican Kids have lead poisoning (lead-laced candy was a bad call, vatos).
French people – particularly from Paris, that dirty, dirty city – have toxoplasmosis.
Asians have alpha thalassemia, Takayasu Arteritis, and asian glow.
Americans are fat. Actually, thats just an observation of mine.
“Urban” patients present to the ER with knife wounds that conveniently test your knowledge of anatomy.

Professions

Lawyers have STD’s (gotcha now, suckas!).
Dentists and aerospace workers have Berylliosis.
Explosives experts / Explosives plant workers get “monday morning headache”.
Coal miners have CWP, TB, and Rheumatoid Arthritis.
Cave explorers have cryptococcus.
Sheepherders have echinococcus and a dog named Lassie.
Radiologists have any blood cancer but CLL.
Nurses and pharmacists have factitious disorder.
Football players, wrestlers, and weight lifters are taking anabolic steroids.
Young athletes have osteogenic sarcoma.

Pathologic States

Kids (0-14) who are tired have ALL.
Young Adults (14-40) who are tired have AML.
Adults (40-60) who are tired have CML.
Elderly (60-?) who are tired have CLL.
Kids with Downs have a VSD, Hirschsprungs, ALL, and Alzheimers.
Transplant patients got CMV in addition to their shiny new organ.
Diabetics have life-threatening mucor infection. Every freakin’ time.
HIV patients have toxoplasmosis, if it’s a multiloculated brain cyst.
Moms who lose their first baby have type O blood.

Lifestyles

Women are always pregnant. No matter how careful they were.
Alcoholics have HCC, B12 deficiency, Klebs pneumonia, and Wernicke-Korsikoff.
IV drug users have right sided endocarditis and multiple parietal strokes.
Smokers have both COPD and lung cancer (+ mets to the organ system in question).
Coke Addicts had an MI (don’t smoke crack, kids!)
Travelers get giardiasis, amoebiasis, yellow fever, dengue, hepatitis.
Kids swimming in lakes get Naegleria Fowleri.
Kids playing in the sandbox have cutaneous or visceral larva migrans.
People who look tan either have skin cancer or hemochromatosis.
Patients with a swollen knee are female, young, hot, and caught gonorrhea from their last boyfriend.

Alright, folks. It’s time for me to get this off my chest.

Starbucks’ Ethos water and Einstein’s Breast Cancer Awareness Mug promotions are really, really getting to me. I bought an Einstein’s bagel this morning for breakfast, and on my way out of the store I noticed this: For every $17 mug you buy, Einstein’s donates $1.50 to breast cancer research.

At Starbucks, every $1.80 bottle of Ethos water contributes a whopping $.05 to “helping children around the world get clean water”. For that matter, American Idol’s Idol Gives Back campaign raised $60 million… while every 30 second ad spot on the show runs for over $750,000 a pop.

Look, I think it’s great that some kids in Ethiopia are going to get $10 million worth of clean water from Ethos. Or that $60 million went from Idol to UNICEF and others. Or that Einstein’s is giving some money to fight cancer, or whatever†. But what really gets me going is that these companies are profiting off the guilt of some yuppie who just spent $5 on a mocha-latte-frappucino-extra-foam-hold-the-cinnamon-i’m-on-a-diet and wants to “help” the wide-eyed photogenic African kid in the glossy photo.

Lets rag on Starbucks for a moment, because it’s just so blatant. Current market price for a bottle of water is $1.00. If Aquafina, Dasani, or Deja Blue decided to charge $1.80 for their water, they would be laughed right in to bankruptcy. So what did Ethos do?

They realized that they could effectively charge $1.75 for the same goddamn water by claiming that it would help charity.

And then Starbucks decided it was a good PR move and sponsored Ethos in all its stores. Same goes for Einstein’s. $1.50 off a $17 mug that cost you $4 to make? Charity is about giving, not recieving. Didn’t your parents teach you that?

So, this is me, giving the proverbial finger to all you corporate chains that are profiting off the backs of other people’s misery. And because I know corporations can’t have feelings, ethics, or morals, instead I’m pointing that finger directly at the CEOs and CFOs of all three. I sincerely hope you can’t sleep at night.

†Actually, I think this is what irks me the most. We med students have strong feelings about fighting breast cancer… our team raised almost $10,000 last year on our walk.

Quinine: Stereoisomer of quinidine: antimalarial agent (Fun fact: also prevents shivering. Next time you’re cold, drink a Gin & Tonic!)
Quinidine: Stereoisomer of quinine: class Ia antiarrhythmic.

How do you tell the difference? Easy: be an alcoholic. That way, you know that you always order your G&T with gen-u-ine quinine. Ooooh look! It rhymes!

—

Here’s my personal favorite mnemonic, ever (and I am not, by any means, a mnemonic person). 100% of the credit goes to Peas:

The 5 Right to Left Shunts (The T’s):

0: Total Anomalous Pulmonary Venous Return (0 connections back from the lung)
1: Truncus Arteriosus (1 big-ass trunk)
2: Transposition of the Great Vessels (2 switched vessels)
3: Tricuspid Atresia (3 fused leaflets in the tricuspid valve)
4: Tetralogy of Fallot (c’mon, you should know these 4 cold by this point)

—

Last one, then I’m done, I promise. It’s HARD to have Cardiomyopathy:
Hypertrophic: Basketball players who drop dead during a game.
Arrythmogenic: Right Ventricular Dysplasia. Thin-walled right ventricle.
Restrictive: sarcoid, amyloid, radiation, endocardial fibrosis (high eosinophil count for >6 months), hemochromatosis.
Dilated: Most common. The ABCCDs – Alcohol, Beriberi, Cocaine (don’t smoke crack, kids!), Chagas, Doxorubicin.

—

First Aid Mnemonic That Sucked The Hardest Today: REd = REperfusion. Guys… this is like, the most basic of all pathology concepts. I believe I can safely say that this is not mnemonic-able (braces for hate mail).

I should mention that I always write in pencil in my book, unless I’m crossing out stupid mnemonics. That’s done in black pen… with a vengeance.