29 July 2010

shelf exams

At the end of each rotation in your third year of medical school, you sit a national exam called the "shelf". It's made up of questions very similar to what will be on the USMLE step 2 (which you sit during your fourth year). Unlike USMLE step 1, the shelf exams and the step 2 are more clinically oriented; however, they are no less frustrating. Step 1 was a pain because of questions like "what arm of what chromosome is implicated in ridiculously rare disease X?" Answer: No idea, not relevant, don't care. The medicine shelf exam, it seems, will be a pain for an entirely different, but equally irritating reason: apparently I'm supposed to be psychic. For example, one question was about a 10-week pregnant woman with a swollen leg and shortness of breath. I was apparently supposed to deduce that her main problem was vomiting, despite the fact that pregnancy is known to place an increased risk for DVT (which the swollen leg would fit with). Another example? A woman with arthritis symptoms comes back for a follow up visit with gastric discomfort. I was supposed to infer that she was having methotrexate side effects, despite the question never describing any treatments being started. This all brings to mind another, perplexing question. I'm not a stupid person and I struggle with these exams. I know some stupid people who are doctors... how the hell did they pass them all?!

24 July 2010

I feel used

Me: Sir, I would like to do a rectal exam on you to be sure you're not bleeding before I give you a blood thinning medication.
Paranoid schizophrenic patient: As long as it's you and not that guy-doc
Me: Yes sir, it will be me doing the exam.
Patient: Do what you gotta.
[rectal exam]
Me: All done sir, I'll let you clean up now.
Patient: That was the best sex I've had in years.

22 July 2010

alternative treatment

Man walking in the VA hallway: Are you a doctor here?

Me: Sort of, I'm a medical student here.
Man: Well, I really like the care I get here.
Me: That's good to hear, I'm glad.
Man: I come all the way from [some town in Ohio] because this is a good VA.
Me: Well, I'm glad we can help you.
Man: You know, if this doctor thing doesn't work out for you, you could be a model.
Me: Thank you, that's very kind.
Man: You got it going on. I'm serious. You could be a model.
Me: Thanks, but, I think I'm going to stick with the doctor thing.
Man: Looking at you done cured my cataracts. Damn.
Me: Thank you. Have a good afternoon, sir.
Man: You too, gorgeous.

14 July 2010


hat tip: geekinheels blog.

08 July 2010

A little humour...

I find my white coat heavy and it contains: a pager, tiny notebook, pens, penlight, reflex hammer, pocket medicine book, alcohol swabs, my cellphone and a near card. That's light compared to.... The Mr. Always Prepared For Everything Guy. And yes, these students really do exist.

06 July 2010

Sad for me

My cardiology month is over. Sad for me. I think the heart is the most interesting organ in the body - it's both mechanical and electrical and just keeps going without any rest. Your brain needs sleep, but your heart just keeps beating minute after minute, day after day, year after year.

Cardiology highlights:
1. Man who did "only" 8 lines of cocaine before presenting with a "mysterious" BP of 200+ and no urine for three days.
2. Placing an arterial line and doing ABGs
3. Spending literally hours pouring over one man's EKGs to determine his AV nodal arryhthmia, which turned out to be... all of them
4. A patient who had a dream my attending was a rapper in a music video
5. Correctly identifying SVT with aberrancy at 3am when the telemetry monitor thought it was v-tac
6. Watching a man de-compensate into heart failure from a heart attack in front of me
7. Listening to a patient tell my attending about the "hind-lick" maneuver
8. Being the only person on the team who could draw the anatomy of a {I, D, D} congenital heart patient
9. Listening to an aortic stenosis murmur so severe you could hear it on her back - louder than her breath sounds
10. Being told by patient's and their family that my being on the team had made their stay better.

Now it's general medicine at the VA. Stories to come...