Just another medblr

This blog describes my (currently ongoing) pursuit of becoming a medical doctor. It also includes interesting, weird, and cringeworthy medical stories I find floating around the web. Finally, other med posts that may be serious, heartwarming, gross, etc.

[medblrforlife]

MMW through med school: lessons from ENT

Parathyroidectomies are not to be trusted. Sometimes they can be these wonderfully short, satisfying procedures (30-45min), or so I’m told. The other option is they last hours and hours. So far I’ve only seen cases of the latter.

Retracting is actually quite important because ENT surgeries happen in small spaces/incisions. Yay, I’m helping!

Neck muscle anatomy is still an area for personal improvement.

Hope y’all are well. The main point of this post was to warn you about parathyroidectomies. I suggest having a snack nearby and being ready to ask for a break to hydrate and eat if you have one on your schedule.

[medblrforlife]

Lessons & Blessings: First Two Weeks of Surgery Clerkship

I posted the very first day in my last post. Here are the rest from my first two weeks of general surgery. Doing this has really helped me. It’s nice to look back and see that I have in fact been learning things. Another thing I have learned is that HY material for Step 1 has a pretty poor correlation with HY for clinical practice. We did not spend much time learning about the common, “bread and butter” diseases; we didn’t learn brand names for medications; we don’t know how to treat things; and, with the exception of maybe two occasions, all of our physical exam learning was virtual so we don’t really know how to perform physical exams in practice, etc. I am truly thankful for the wonderful team of people I have been able to work with so far. Everyone has been welcoming and has helped teach me things - nurses, residents, attendings, other students, and cleaning personnel. Anyways, I’m blathering. Here are my L’s & B’s:

3/29/22

Today I learned: better knot-tying technique (pulling direction, following knot down with pointer finger). How to insert a Foley. Different graft types and perf ratios. 

Today I am thankful for: residents who let me go home early from overnight call

Something I want to look up for next time is: my schedule? Also the reading they mentioned for basics of burn care stuff. 

3/31/22

Today I learned: the difference between cholecystitis and cholangitis. 

Today I am thankful for: The unexpected break I had in the middle of the day during lunch - I got to catch up with some classmates; my attending for running me through a work-up for abdominal pain; my resident for thanking me at the end of the day. 

Something I want to look up for next time is: the reading about critical/trauma burn care recommended to me by my attending. 

4/1/22

Today I learned: how to remove staples; what the Trendelenburg position is.

Today I am thankful for: the fact that nobody yelled at me when I made mistakes in the OR; my resident for taking the time to review my notes and give me feedback on them.

Something I want to look up for next time: everything about wound vacs

4/4/22

Today I learned: how a trialysis line is put in; pts with uremia make orange urine. 

Today I am thankful for: the compassion with which I saw critically ill patients being treated; feedback I got on my knots.

Something I want to look up for next time is: management of venous lines; management of transplant rejection; urine calculation for expected output. DTI which is some sort of vocabulary associated w/ pressure ulcers. Fistulas in dialysis things. 

4/5/22

Today I learned: how to check medication info in UpToDate

Today I am thankful for: my residents doing their best and still teaching me even when it is a busy, understaffed day/week.

Something I want to look up for next time is: complications of spinal injury/surgery

4/6/22

Today I learned: frostbite classification and tx

Today I am thankful for: my family; open communication from my team members (esp my resident!)

Something I want to look up for next time is: how to do a primary and secondary assessment on trauma pts once ABCs covered

4/7/22

Today I learned: how to write a hospital course

Today I am thankful for: feedback my other resident gave me on my charting 

Something I want to look up for next time is: CIWA

4/8/22

Today I learned: if applying pressure to stop venous oozing, apply for at least 5 consecutive minutes w/o moving. 

Today I am thankful for: my residents!!

Something I want to look up for next time is: trauma assessment algorithm

[medblrforlife]

MMW Through Med School: First day of clerkships

Yesterday was my first day in the hospital as an M3 and it was awesome! I am starting with general surgery and then some surgical subspecialties. The particular group I'm with for gen surg sees a lot of wounds and burns.

The team: The residents are really nice and down to earth. The attending is awesome, she has a good sense of humor and she and the resident were both very patient with me in my first time in the OR. The nurses have all been sweet and/or hilarious. Anesthesiologist was also great, she graduated from my med school back in the day and loves meeting the students. Overall, very welcoming group. I tried to introduce myself to everyone I met and am working on learning names.

I scrubbed in for all three surgeries and was suction for the third one. I got to participate a lot more on my first day than I was expecting.

Goals for clerkships

Every day I rotate I am going to try to write down three things:

Today I learned ___

Today I am thankful for ___

Something I want to review for next time is ___

Not sure what to call that yet for tags/record-keeping purposes. Thanks&More? Lessons & Blessings? I will work on it.

03/28/22 Lessons & Blessings: Gen Surg Day 1

Today I learned how to tell the difference between superficial and deep 2nd degree burns. If hair in the burned area resists being pulled out, and lifts the skin around it when you tug on it (like normal, healthy body hair does), then it is superficial. If, however, the hair comes out easily without any resistance and without really lifting or tugging the surrounding tissue, it is a deep 2nd degree burn. This matters because skin healing will differ depending on whether the stem cells in the base of the hair follicle are intact (superficial) or not (deep).

Today I am thankful for my attending and resident's grace and patience in helping me adjust to first day in the OR; my decision to stay for the last case when I could have gone home earlier.

Something I want to review for next time is the skin layers and types of burns.

[medblrforlife]

MMW Through Med School: Major Update

I passed Step 1* y’all! God is good. 

Now what? Rotations start in a few weeks and my first big chunk of rotations is surgery. While I’m not interested in becoming a surgeon, I am interested in some specialties that do some procedures and I am very excited to start clerkships. I have purchased many compression socks and plan to go shopping this weekend for shoes that are comfortable but more professional than sneakers. Any tips regarding surgical rotations or rotations in general would be greatly appreciated.

In other news, I have had an abstract accepted to a conference in May so I need to work on my slides now before rotations start. In the coming weeks we have some prep-work for clinical skills, review of important information, advanced life support and CPR training, etc. 

*What is Step 1? In the US, to become Board Certified (i.e. certified to practice medicine in the US as per the American Board of Medical Specialties), you have to pass a multi-part exam. The exam is colloquially called “the boards” and has several parts (“steps”). To graduate from medical school, a student needs to pass Step 1 (a test on all the classroom knowledge from the first half of school) and Step 2 (a test on all the clinical knowledge and skills from the second half of school). These make up the US Medical Licensing Exam (USMLE). After graduating medical school, students then apply to and hopefully get or “match” into an apprenticeship in a specific medical field. This apprenticeship is what we call residency (the first year of residency is called internship). During residency, the doctor will take a third exam, this time, however, the exam is for certification in the specific specialty the individual is pursuing - neurology, general surgery, internal medicine, etc. Sometimes you will see that a doctor is certified in multiple specialties, which means they took and passed the exams for multiple specialties, such as otolaryngology and pediatrics. 

[mdrambles]

after this fire has burned everything to the ground

i wonder who will stand among the ashes

and tell us,

“we did all we could.

this is a [damn] shame.”

if we wake up from this nightmare–

(because remember

some of us will not be waking up

and for some of us

it was your choices

that will bury us)

–i wonder who will look back and say,

“we got through this

together.”

we could point fingers

many already have; 

we could say, “it’s your fault, their fault, his fault”

but let us not forget

our world was already crumbling before it was set aflame

the fire was beyond anyone’s control

(things would have crumbled regardless,

but it’s true–

there is a difference between crumbling

and being razed to the ground)

and while we were all burning

let us not forget

that some were warming their hands by the fire;

and some, the even more detestable few,

they lined their wallets with our cries for help.

(at a time when there was not enough to go around;

isn’t it just human nature

that the wealthy few

continued to walk over our hollowed spines

to enter the mansions housing their riches?)

after this fire has burned everything there is to burn

i wonder if i will just be ash

blown away on the wind

or if i will become the fire

that lives to consume everything in rage

to feed the emptiness scraped out of me

by every loss

by every struggle

by every injustice

by every time i was told

in no uncertain terms

that something

someone

everything

was more important

than how deeply the burning had set in my flesh

(”don’t you know?

you’re one of the lucky ones.

at least you have a job,

and besides?

didn’t you 

sign up for this?)

when this fire has burned everything away

will i feel clean, instead?

left behind by all those around me with too much self-respect

to let the fire conquer them–

will it re-teach my soul the lightness that was stolen?

after this fire

will everything just go back to being exactly the same?

(just one slight breeze from breaking)

after this fire

who will be next in line

to tell me i’m unimportant,

disposable,

and

oh-

so-

flammable?

[cranquis]

now read it again.

[medblrforlife]

This is beautiful.

[medblrforlife]

Vocab of the day: Treponema pallidum

Howdy and happy new year folks. I have gotten all my grades and can happily say that I have passed all my preclinical courses! I am now in the process of studying for Step 1.

Let me tell you something about Step 1 studying. No one told me how long it takes to go through all the explanations on UWorld. Going into this I thought answering the questions in the allotted time would be difficult (40q/hr). But it turns out I’ve actually been doing that just fine. But Jiminy Cricket it takes hours (3-4!!) to review the answers and explanations for the same 40 questions. So that’s where my time has been going.

When I start cramming this thing happens where random words or phrases I’ve been studying will pop into my head. In high school biology I often just awoke in the morning thinking of adenosine triphosphate. Not thinking anything about it, just thinking the words very clearly in my mind. Well today’s vocab is Treponema pallidum. It is the spirochete (cork-screw-shaped bacterium) that causes syphilis among other things.

Stay safe and be well,

- just another medblr

[medblrforlife]

Oh Heme Module…

I feel like I’ve reviewed the heme stuff so many times, but it’s just not sticking. DIC, ITP, HUS, sure, I get those. The anemias are logical too and I think I’m starting to remember them without needing to logic my way through all the possibilities. But the cancers oh my goodness! So many, they all sound similar, and they all have translocations and mutations to learn and just argh. This quarter has not been my favorites. MSK test is done, path was fine for that but another subject on the test was much more difficult than I expected. Heme test is next, then head/neck/special senses. So excited to move on to next quarter when we do neuro and psych, which I find much more interesting and also am much more easily able to remember.

Unrelated, this is my new favorite story. I love all of u/medrajargon’s posts, but “Tim Stares” is just what my friends and I say now when drawing a blank or when something is absolutely ridiculous. Major #TrueStoryKiddos vibes so I think Dr. @cranquis will like this one.

Be well,

Just another medblr

[medblrforlife]

Had an interesting conversation with an M3 acquaintance this weekend…

So this Saturday I got to do my first clinical anything (it was volunteering) since medical school started! Usually we would have some longitudinal primary care experience starting in M1 but that pesky pandemic that’s still happening has put a hold on that. I learned how to do a general foot exam and then I got to actually do general foot exams, screening, and some basic foot care with patient education. It was pretty awesome to actually be able to do that and I actually noticed myself improving with each patient. Anyways, an M3 acquaintance of mine was there for a bit and we spoke about interests and every time I mentioned something she said, “you don’t make any money if you go into that field either.” While I don’t care about the salary, I realize that’s a privilege very few of my peers have these days. I know finances are part of the consideration, but it makes me sad when it seems like finances/salary become the only determining factor for which specialty to pursue.

For those wondering, my areas of interest are (in order): 1. EM 2. ID (specifically travel medicine/parasitology/tropical diseases) 3. Rheumatology?? Seems cool, not sure what actual clinic is like though so I reached out to a rheumatologist about maybe shadowing. 4. Derm seems cool but I really hope I’m not interested in derm because it’s competitive as heck and I’m not about that. EM is, and has been, significantly ahead of other things on my list, but the pandemic has brought some existing problems to a head and exacerbated them. Anyways, we’ll see where I’m at once rotations start. All I know is I’m not interested in going into a surgical specialty.

Oh btw I registered for Step 1 so that’s terrifying.

[wheresonichedgehogwnt]

Do I need to write and choreograph a short original musical call "Surgical Clearance is Not a Thing" and perform it across the country so surgeons stop asking me to provide something that doesn't exist?

Because if that would do it, I would

[wheresonichedgehogwnt]

This song will now be followed by a duet with me and @mashupofmylife called "Don't Consult Psych for Delirium, Treat the Underlying Medical Condition Instead, And While We're Here Don't Consult Psych About Patient Capacity Either (You Coward)"

It's going to be riveting, y'all

[wheresonichedgehogwnt]

Our third number will be a short but impactful performance by @francescagetthatpaper called "Don't Consult Speech for Confusion if They Have a UTI (or Swallowing if They Have Pneumonia)"

I can barely wait!

[luckyspike]

Don’t consult neurology for mental status changes if they have a clean MRI, the thrilling fourth number featuring a dance number comprised of only abnormal reflexes

[wheresonichedgehogwnt]

I like where that choreography idea started, but may suggest highly stylized reflexes with some acrobatics?

Thrilling, indeed!

[wheresonichedgehogwnt]

Worry not, y'all, I'm going to finish some yard work and be back with your suggestions for an an absolutely scintillating second act!

Enjoy some equids during the intermission!

[wheresonichedgehogwnt]

...aaaaand we’re back, with the second act of the Medblr Musical!

We start with an energetic double-act from folks in women’s health, who will start with  “Don’t consult OBGYN if the nurse notices vaginal discharge” by @oneuterustorulethemall , and followed by “A patient menstruating during her hospital stay is not a reason to consult OBGYN” by @biokitty

Next we’re back in Primary Care with “If you can’t distinguish a benign murmur from a nasty one maybe you shouldn’t be doing sports physicals”, followed closely by a moving ballad called “Not All Coughs Need Antibiotics (Zpak Remix)” by @wayfaringmd

To pick up the pace, the surgeons get their turn with “‘Patient Has Had Surgery Before’ Is Not an Indication For a Surgical Consult” and also “Disimpaction Is Not a Specialized Procedure That Can Only Be Performed By Surgeons” as proposed by @snowandstarlight

Following the surgeons is “No Palliative Care Does Not Need To Be Consulted To Discharge A Patient To Hospice, I Also Went To Medical School Y’all” as performed by @doctorofwhut ​

[cranquis]

I'd be glad to perform my Gilbert and Sullivan-inspired comedic soliloquy, "We are the doctors from Urgent Care, so we will consult YOU, not the other way 'round!" (a la "Modern Major General").

[medblrforlife]

If an encore is requested, I would suggest “don’t consult neuro if you haven’t examined the patient yet,” the alternate version of the original neuro song.

[medblrforlife]

What sports go with what specialties?

I’m learning the advanced MSK exam today and I’ve discovered several of these so called physical exam maneuvers are actually just Aikido grips. Like the Neer’s test and the Hawkins test. What specialties or maneuvers make you think of specific sports?

[medblrforlife]

Two weeks was too generous…

When I started this semester, my first in-person semester of med school, I told myself and my friends, “how long until the breakthrough Delta cases cause an outbreak? I give it two weeks.”

Fam, it didn’t even take one, some people tested positive the afternoon of orientation. SMH.

I don’t agree with all of the school’s decisions, and I wish there were a way to enforce the rules, but we could be doing worse. Most students keep their masks on in class (it’s required on campus even if not inside a building). But I’m pretty peeved when I see people who aren’t even pretending to be wearing their masks in lecture hall. We are all vaccinated, so there haven’t been tons of cases, and they’ve been mild from those I know of. But today someone said to me, “a lot of people are testing positive but how many are sick?” And I just kind of snapped back that it doesn’t matter whether people are sick or not, because if they’re infectious then their breath could literally kill people. What a bizarre concept, that someone who feels and looks healthy could kill someone just by coughing on them. I wonder how Typhoid Mary felt.

Hope you’re all well and staying safe. I know the cases are hitting hospitals hard now *again.* I don’t really have the words to express this but I know it’s sucks and it’s way more frustrating/enraging than the woes of a pre-clinical med student. I’m wishing you the best and hoping you’re able to keep your head above the waves and take breaks for yourself when you need to. I’ve been following some blogs and the burnout is real. Some people are flat out leaving the profession, others are taking sabbaticals. You matter too. Take care of yourself.

- just another medblr

[medblrforlife]

Must read/must have books for a medical collection?

I have recently acquired several wonderful books and have decided to start a collection. I would love your recommendations for any gems you’ve found along your journey, even if they are out of date or have info you can just look up. Things focused on clinical skills or reasoning would be extra welcome. Here’s what I have:

Cope’s early diagnosis of the acute abdomen 5th ed

The classic collector’s edition of Gray’s Anatomy (16th ed?)

Anatomy a regional atlas of the human body 2nd ed by Clemente

The biologic and clinical basis of infectious diseases by Youmans, Patterson, and Sommers

Obviously I have Pathoma how could I not Dr. Sattar is a gem

Looking forward to whatever recommendations y’all have. Hope you are all staying safe with Delta going around. My family and I are safe, praise the Lord. We were also all fully vaccinated before the summer, but we’re still being fairly cautious and leaning more towards the WHO’s recommendations (re: masks even if vaccinated).

[medblrforlife]

Officially passed all my first year classes! Took a while for grades to be released so I’ve been sitting on the update. This summer I’m working on some research projects and also working on my painting skills.

Hope you’re all staying safe and hydrated.

[medblrforlife]

Let’s play a game

What is a totally non-food-related thing that makes you think of food. Bonus points if medical/pathological.

Claudication makes me think of clotted cream. Because they sound similar.

My cardiovascular final is tomorrow and I’m desperately trying to deny how much studying I still need to do.

[ley-med]

Okay then…

Scarlet fever makes me think of strawberries (yeah yeah I know this one is obvious)

Lung oedema - raspberry mousse

Polyarteritis nodosa - panna cotta

Aaand I’m stopping thinking about this right there because it probably is not a healthy way of looking at humans 🙈

[lizziedoesvetpath]

@loreleys-road-to-md guilty as charged… If I don’t compare at least one thing on the necropsy floor to food, have I really done a necropsy?

The other week I had an abscess full of pus that looked exactly like cheap supermarket brand guacamole. And an egg yolk peritonitis that, unsurprisingly, looked like the world’s worst omelette

[medblrforlife]

yeah there’s definitely a lot of things that look like food, especially in path. Tbh I’m kinda disappointed when the path professor misses an opportunity to compare something to food.

[medblrforlife]

Let’s play a game

What is a totally non-food-related thing that makes you think of food. Bonus points if medical/pathological.

Claudication makes me think of clotted cream. Because they sound similar.

My cardiovascular final is tomorrow and I’m desperately trying to deny how much studying I still need to do.

[wayfaringmd]

I am going through the interview season and I will have to choose between "happiness" and "fellowship opportunities." Is it okay to go to a seemingly toxic program just for better opportunities? It's just 3 years, right? Or a big no?

NO. Huge big NO.

“Just” 3 years is a long freaking time to be unhappy.

I felt like my life and emotions had completely unraveled within 6 months of starting my previous job. By 12 months I was ready to resign and by 18 months when I did leave I thought that each day I had to stay there was a week off my life. I absolutely do not believe that I could have made it through my 3 year contract without ending up in a psych hospital.

Do NOT sacrifice happiness for prestige.

When you’re unhappy and in a toxic work environment, your performance suffers. People around you notice and it affects your reviews and test scores. That also affects your ability to get fellowships. When you’re happy you do good work and attendings can truthfully say you were an excellent resident. It’s not all about scores and name-brand residency programs.

Find your people. Find a place where you can enjoy work. Obviously residency is going to be hard anywhere and you are going to have crappy weeks and months. But having people you like around you and having a supportive work environment absolutely makes those crappy months do-able.

[poking-kids-with-needles]

Ya’ll, this is SO important!!

I tell every applicant that I meet while they’re interviewing here, “The ACGME is not going to let a program get away with training subpar pediatricians. Finding a hospital you’ll actually want to show up to every day, people you are excited to work with and a town you look forward to living in is more important than whether or not the program has an inpatient Pediatric Rheumatology service or how many patients they crank through their ED in a day.”

Does this work for our program because we’re a small hospital but we have amazing people? Yes. But just because it puts our program in a good light doesn’t mean it’s not true!! Good co-residents = life!

[medblrforlife]

Signal boost

[medblrforlife]

Concerning dismissiveness of medical symptoms & possible psych disorders

So with the pandemic there has been an increase in incidence of some psychiatric conditions and/or exacerbation of symptoms in patients with existing psychiatric conditions. However, at a friend’s hospital department the residents and/or fellows (can’t remember if both or just fellows) are using this as a way to do two things, both of which are unacceptable:

1. assume conversion disorder/psychogenic symptoms/functional disorder unless proven otherwise 

2. say “oh it’s just psychiatric disorder x” and immediately adopt a dismissive attitude towards patient, patient’s family, and patient’s symptoms.

Okay so first of all, I’m just a pre-clinical med student and even I know you don't make a psychiatric diagnosis until you’ve ruled out the non-psych medical  conditions that could be causing the symptoms. So you assume NOT psychiatric until proven otherwise, not the other way around. If this is confusing, please try reading ANY diagnostic criteria in the DSM. 

Second, symptoms don't suddenly become any less real, significant, severe, or life-impairing once they are determined to be of psychiatric origin. An epileptic seizure and a non-epileptic event are both physical convulsions that impair quality of life, affect ability to perform daily tasks, and can cause distress to the patient and their loved ones. If someone has excruciating physical pain, it still exists whether it is phantom pain in a limb that's no longer there or pain in a leg that was just squashed by some heavy object. The treatment may be different, but neither condition is more “real” or more “worthy” of treatment than the other.

Third, don’t dismiss patients with a history of psychiatric conditions and refuse to evaluate them when they have new symptoms. Everybody can get sick with physical illnesses, regardless of whether or not they have a history of psychiatric diagnoses. Please examine your patient before calling for a psych consult.

Furthermore, if a patient's symptoms could be due to a life-threatening condition but you assume they are psychogenic and dismiss the patient, they could die of that life threatening condition. Oh, and by the way, psychiatric disorders are also life threatening. So get your head out of wherever it's been hiding, assess the patient properly, do your job, and remember that psychiatry is a MEDICAL specialty, psychiatrists are MDs/DOs, and the diseases they treat may kill more patients than anything you treat so stop dismissing their whole specialty and their patients.

Sincerely,

An exasperated, and frankly appalled, medical student