Are You?

Actually, the question is, WERE you prepared for your final exam? Friday marked my last exam of year 2 of 5 (Final is relative). And the answer....I don't know. I'm not sure if the results of the final exam are posted yet. If they aren't posted before I leave DC, there is a good chance I won't know until I return to school in August. That is just how it goes in the world of graduate education. BYU (undergrad) posted exam results on a big screen, literally seconds after you walked out of the testing center. Right there in your face, no way of avoiding that stressful instant when you find the last four of your social security # on the screen and look one column to the right for the score. Now, I fumble my way to the front of the room to turn in my exam and days go by before the email appears in my Inbox reporting the class avg, etc and prompting me to login and check my score.

That is how most exams go in med school, but when it comes to the end of the year, I just don't take the time to log on and figure out what I scored--I'm onto bigger fish. I have no idea what I scored last yearon my final exams for my summer MBA courses. I have never even looked to see what my overall grade was for each class. What difference does it make? Is any doctor going to ask me what I got in Corporate Finance? I took the exam and what is done is done. Is my knowledge of Organizational Behavior dependent on me knowing my grade in econ 403? No. It is a liberating feeling to ignore the score. Empowering. It helps me believe that I am actually in school to earn an education instead of a transcript.

My fellow Americans, don't do it! Avoid those stressful moments of finding out your grade by never finding out. Be positive and believe that you did well. This is the freedom our founding fathers and people like Bob Marley were trying to help us achieve. Do it and you will feel this new sense of power, I promise...barring no emails show up from the dean reporting that you are on academic probation.

If you aren't taking tests at this point in your life, find some kind of reporting process at work that you can avoid. If you aren't taking tests and you aren't working, identify some form of feedback you receive and ignore it!

Yeah, a policy like this probably doesn't reflect kindly on my comprehension of organizational behavior. Hmmm.

Spring Happens Outside of the Hospital

Lilac Festival, Rochester '09

The Remains of a Saturday Trip to the Market

The spinach in my bag was off the chain

Looking into the Crystal Ball

Dr. A: Do you know what you want to go into yet?

Me: I don't know, I've really liked everything I've been exposed to.

Dr. A: Yeah, I can tell you are going to go into Family Medicine. You don't care about making money and I can tell you really care about the people.

Me: Yeah, (nodding, slightly flattered, slightly disturbed)

....Same day, three hours later...

Dr. A: So why did you go into medicine?

Me: Oh, I (Dr A cuts me off)

Dr. A: You probably went into medicine because you want to help people

Me: Yes, that's why I wanted to do medicine. I'm sure I would have been happy doing a lot of different things, but there is nothing I really WANTED to do like medicine.

Dr. A: Most people go into medicine because they want to help people out, but the truth is that you can't really help anyone change. They have to be the one to change.

Me: Yeah

Dr A: If you go into medicine wanting to change people, you are going to have a very unhappy life

Me: Yeah, I get that

Dr A: I think you would definitely suffer an existential crises if you specialized.

Me: haha, yeah, I could see that, haha (slightly flattered, slightly disturbed)

“This is not my beautiful house?”

Some classmates were talking about this program yesterday over our advisory dean lunch. It is a TV documentary that follows seven Harvard medical students from their first day of medical school in ~1985 and then looks at where they are now. You can watch six minute clips of the show but I warn you that you can't watch just one… I highly recommend the program.

http://www.pbs.org/wgbh/nova/doctors/program.html

I watched it last night as I finished up some work for today. I think I watched it out of curiosity. I wanted to know what medical school was like in the eighties. Was it any different? Was it any better? I think I was just curious to learn what this medical school experience meant to others with the hope that that would tell me what this experience meant to me.

I am sure I will spend the rest of my time here at Rochester trying to figure out what it is this experience means to me. These are not questions like, what am I doing here? Is this the right place for me? These are questions like, what does it mean that I spend all of my days looking at or talking about illness/health? Will the next five minutes of what the lecturer says affect a patient's health at any point in my future career? Will the feeling of not knowing enough go away tomorrow? Do I "work"? Am I asking the patient this for her sake? For mine? Where is my place in society? What is a medical student?

Dr. E shed a little light on the answer to that today. This afternoon, half of our class went to their respective clinics and the other half stayed at school to learn about the knee and ankle exam. I and eight of my classmates spent the afternoon with Dr. E, a world renowned orthopedic S. He spent the earlier half of the week with the Cornell Law faculty and students. According to him, law school doesn't really make the student think; he followed that with an equally presumptuous claim that he got the feeling that medical students are smarter than law students.

Just to clear his name (for all lawyers in the audience), Dr. E is a genuinely good man, a really caring doctor. He belongs to the old class of physicians who should have retired twenty years ago but they can't hang it up. They love to teach, they love patients, they love students. I am so lucky to have so many professors like this. Unfortunately, their passion for medicine can lead them to say things that aren't true.

Wrecking Ball

Working in the community health clinic makes me feel like I am on one of those Japanese game shows where the contestants attempt to navigate an impossible course of physically challenging and utterly embarrassing stunts. Here is how the sequence of events went today. Got out of lunch meeting late, got to the clinic late, nurse hands me a chart the second I walk back to the doctor offices, seconds later I am sitting down with a 52 yr female patient and her husband trying to go through the thick, cluttered PAPER medical chart while listening to her in Spanish as she rifles off a litany of symptoms, writing down what I deem pertinent, asking questions I deem relevant, and listening to her husband in English as he talks to me and to the patient.

I, myself started to feel a little sick trying to process all of the above. The first five or six minutes of the visit were almost completely lost. I did get some helpful information, but I felt so out of control that it was hard for me to recognize at the time that the information was salvageable, that it was actually telling me anything. With the rash and the fever I was thinking about the microbiology I studied on Saturday. The issues of vertigo had me thinking back to HSF and the inner ear complications. Her uncontrolled diabetes was working like a wrecking ball destroying the city of organization, the city of understanding that I desperately hoped to erect in my mind.

Then, after I accepted that the first five minutes was a loss, I observed the damaged city and was able to sift through the rubble to move the visit forward with an albeit tenuous plan. Some patients I present to my preceptor having a pretty good idea that my exam covered the right bases and led to the right diagnosis/plan. Then there are visits like this one where I report a weak hypothesis, essentially a white flag, to the preceptor and hope that he or she will look upon me with compassion. Today felt like there were only white flags, but now that I think about everyone I saw, I realize I forgot some of the simple, stress free victories of the day.

One reason why I might feel like there were no victories today was because before I leave the office in the evening, my preceptor and I sit down to go over any questions about the day's cases. I usually ask a couple, and then I have to answer her questions. It is a fun game we play, doctor vs student, and I actually like that I never win! I better get out my anatomy text already.