First Shifts

The beginning of July marks a special event in the genesis of the doctor: spanking new interns work their first shifts as actual physicians.

As one of those interns, it's terrifying. And exhilarating. And exhausting. Once a lowly medical student, you've gone into the chrysalis of fourth year and emerged on the other side a butterfly who doesn't really know how to fly. Fragile. Awkward.

But very very pretty. (Just kidding.)

Some things I saw in my first two shifts as an emergency medicine intern:

• thrown from horse, landed on head
• psychotic patient becoming violent with family members (chief complaint was decreased urination)
• vaginal bleeding x 1.5 months
• abdominal pain in 18 year old female
• drunk, demented old man fell down stairs, cut open forehead
• neck laceration from broken beer bottle
• firework exploded into eye - globe rupture
• drug rash
• accidental finger amputation
• blurry vision x 1 week
• generalized itching with a "rash" that was invisible to my eyes
• out of percocet (x2)
• facial abscess
• urosepsis
• dog bite

Could there be a better field than this??? (I will give you a hint. The answer is no.) OK, so it takes me a ridiculously long time to sew up a small lac (I had to put in some deeps, though). And to write a basic prescription. And to dictate anything. I'll get better with time. And those crazy, funny, heart-warming, smelly, sweet, fantastic patients will still be there.

DT: David Tennant's first acting job

Oh, this is so eighties that it almost hurts to watch. Appears to be an anti-smoking teen sort of thing. A small part, but at least it was a speaking role. :-)

DW: why you should watch Doctor Who -- a brief introduction

Doctor Who is a cult phenomenon here in the US. If you've heard of it at all, it's likely in relation to crazy convention-going sci-fi fanatics who flinch at the sun and smell of elderberries. And yet it's one of the most popular television programs in Britain, where watching it is as much a part of pop culture as something like "Lost" or "The West Wing" is here and it is considered a show for the whole family to enjoy together.

The years and years and years of history can be intimidating to the new viewer -- it started in 1965 and has been going strong ever since. Even in the 15 year hiatus without new TV episodes, the story lived on in books and audio dramas (audio dramas! Radio plays! I love Britain!) and a TV movie. But don't despair -- the 2005 revival was conceived to be accessible to new audiences and it seems likely that the new season beginning in April 2010 under the new direction of showrunner Steven Moffat will be similarly kind to newbies.

So without further ado, a brief introduction to the Doctor.

Medicine: Dr. James Barry

Had to write a paper for my medical history class; this is the result. Interesting to speculate about, to say the least:

The Curious Story of Dr. James Barry
(Who May or May Not Have Been England’s First Female Physician)

In 1809, a young man named James Barry enrolled at the University of Edinburgh as a medical student. He graduated in 1812 and went on to a distinguished yet controversial career as a military surgeon and Inspector-General of Hospitals in the British army. On July 25, 1865, the lifelong bachelor Dr. Barry died, alone and penniless, of dysentery in a rented room. In August, 1865, the servant who had dressed his corpse for burial reported to Army agents and to Barry’s physician, Dr. William McKinnon, that the body she had dressed was a “perfect female.” And thereby hangs a tale.

DW: everywhere and anywhere

New trailer up!

"All of time and space. Everywhere and anywhere. Every star that ever was. Where do you want to start?"

This is why I watch Doctor Who.



(On the off chance that you actually watched it, the effects look a bit dodgy because this was actually shown in 3D in British theaters.)

gleeeeeeeeee!: new preview

So excited!!

Shopping: Chocolat Blu

So excited, darlings!!!

After months and months of looking at Rue La La and finding things I liked that were always either a) sold out or b) not available in my preferred size and/or color or c) way too frakking expensive, I finally managed to make a purchase!



I adore them. I hope they fit. Bring on summer!!!

Book reviews: The Secret Country and The Parable of the Sower

Sometimes I just need to disengage. To retreat from the-world-as-it-is into a world of another's dreaming. This weekend was one of those times.

I read The Secret Country trilogy by Pamela Dean. She is the author of one of my very favorite coming-of-age books, Tam Lin, and so I was excited to dive in. The basic premise is that a family of children (brother, sister, and cousins) have a game they play every summer in which they vividly imagine life in their "Secret Country," and act out all the different parts. They create tales of magic and intrigue, assassination and war, in which they are princes and princesses at court. Of course they are then somehow transported into a real live version of their game, but not everything looks as they had imagined it. Some things are just perfect, but there's a character that they didn't write, others won't stay on script, and while they've somehow managed to gain access to some of their character's abilities (magic, sword-fighting, musicianship), they don't have them all. Their attention is divided between trying to play their parts well enough that no one notices, trying to discover how they were able to get there in the first place, and trying to thwart the dramatic and disastrous plot that they themselves created.

On the whole, it was good but not great. (I don't mean to damn it with faint praise; I really did enjoy it.) I think it could have benefited a great deal from a little more aggressive editing. The pace is at times very slow and the story drags, but then all of a sudden things happen in the blink of an eye without a whole lot of explanation. It's a young adult series, really, and I think younger readers might have had trouble following a few of the story's twists and turns. It is my understanding that she has returned to this world and written some adult work, and I am interested in reading it.

The other book I read was Octavia E. Butler's The Parable of the Sower. This is a book (and an author) I've been meaning to read for ages so I'm delighted that I loved it every bit as much as I hoped I would. The setting is a near-future Southern California, which has become (along with the rest of the US) a dystopia in which law and order as we know it have essentially ceased to exist. Guns and drugs are everywhere, the police are expensive, ineffectual, and almost as likely to rob you as the roving bands of homeless people, drug addicts, and gangs. Water is more expensive than gasoline. Gasoline is no longer used to fuel vehicles, but instead to start arson fires that drive people out of their settlements so that the scavengers and squatters can move in. What few paying jobs still exist are largely in the hands of huge multinational corporations, and the recently elected President has created laws that essentially allow a return to the days of the "company town" and debt slavery.

Growing up in a small walled enclave, the main character, Lauren, struggles with normal late adolescence issues, with her strict Baptist minister father and her step-mother and step-brothers, with the immanent threat of the destruction of what remains of her community, and with an inherited condition passed to her by her dead, drug-addicted mother: hyperempathy syndrome. Lauren feels the pain (and, rarely, the pleasure) of those around her.

She also struggles with finding her own faith, her own reason for being, and her own God. She discovers/creates a religion she calls Earthseed, based on her own keen observances of life and her study of other religions. The basis of Earthseed, in her words, is:

All that you touch
You Change.

All that you Change
Changes you.

The only lasting truth
Is Change.

God
Is Change.

As Lauren and her discovered companions make their way north, fleeing the tragedies in their wake, these words take on enormous power. I absolutely loved this book. The writing is simply beautiful -- spare, haunting, and brilliant. The main character is a triumph. The religion piece is organic and thoughtful. There is a sequel -- The Parable of the Talents -- that I intend to read at my earliest opportunity. And I will be reading Butler's other works, as well, I can promise you that.

Lists: snow-things I would build if I had a yard

(image source)

And a modicum of artistic ability, too.

1. snow TARDIS
2. snow Alien (the one, the only)
3. snow Cylon
4. snow hand (Manos, baby, Manos)
5. snow Darth Vader
6. snow ROUS
7. snow Zoidberg
8. snow Ood
9. snow Weeping Angel
10. snow Godzilla

(h/t io9 for the idea)

I'm not sure I'm ready for all of this...

Just joined Twitter, and now there is the Google Buzz thing going on.

I'd just sort of gotten Google Reader figured out.

What on earth am I getting myself into???

A world of no: Tennant tattoo

As anyone who knows me could tell you, I'm more than a bit of a David Tennant fangirl.

My fannishness, however, positively pales in comparison to this person's:



For a tattoo, it's actually quite good. But, still... no. Just... no.

Window shopping: the art of medicine

For ages now I have wanted to decorate my dining room with vintage public health posters (mostly VD but with TB and other stuff thrown in, too). Thus far the primary limiting factor has been that I don't have a dining room. Why do this in a dining room? I don't know, exactly. Your average person probably does not find venereal disease an appetizing topic. It pretty much comes down to process of elimination. The bedroom? Even more inappropriate. The kitchen? Usually not enough wall space to do what I'd really like to do. The bathroom? Ditto. The living room? Perhaps, but I've got a bit of a different idea for that. And so on.

The secondary limiting factor has been finding high-quality, large reproductions of them. I've had seriously varying degrees of success buying prints online, so I'm a bit hesitant. I don't have the funds right now to frame them anyway, so I'm going to hold off for a bit. But that doesn't mean I can't look and imagine!!!

Take a tour through the wonderful world of public health after the jump.

Rambles: Poetry

(photo: my crappy iPhone camera)

A little patch of sun before the clouds and snow and gloom threaten again. Loved the twisted shapes of the dried vegetation on the iron gate.
__________________________________________

The memory throws up high and dry
A crowd of twisted things;
A twisted branch upon the beach
Eaten smooth, and polished
As if the world gave up
The secret of its skeleton,
Stiff and white.
A broken spring in a factory yard,
Rust that clings to the form that the strength has left
Hard and curled and ready to snap.

--T.S. Eliot, Rhapsody on a Windy Night

Window shopping: Hispanitas

So as I was walking past the shoe store, I noticed that they were having a weekend sale. I stopped in to see if the pair of Hispanitas shoes I'd been lusting after for the last few months were on sale. (The image above is sadly not of the ones I wanted, but I couldn't find a pic of them online after ages and ages of searching. They're fabulous, though, and I want them, too!)

The good news is that they were. The bad news is that they were still too expensive for me to buy.

More pics of gorgeous shoes that I want very badly, after the cut.

Feeding the YouTube addiction: bittersweet

The best Doctor Who vidder in the biz, Seduff, has posted a farewell to David Tennant. It's brilliant.

I recommend viewing full screen in HD (the picture quality is outstanding).

a friendly push + procrastination = me blogging again

Been quite a while, but I'm back. Thanks, t, for the provocation. :)

November surprise! WIth bonus parentheses!

It was damn cold this morning (well, 21 F, which is damn cold for the first week in November, anyways) and so I got out my winter coat. And lo and behold, there was a November surprise in it! Twenty bucks in the pocket! YES!!!! Finding money in my winter coat is the highlight of fall for me. I never intentionally leave any there, but almost every year I find some. Usually it's not quite twenty dollars, but I do remember one happy year that it was forty.

I needed the little lift because I was pretty tired. I must admit that by Friday of every week, I am more than ready for the weekend. One positive of the weekend is obvious -- I don't have to get up at 6:30 am. This is a big plus. The other positive is that I can get so much more work done! Looking back over that sentence I realize that it might sound a bit pathetic but it's true. By the time I get home from school most days it's almost 6 pm. Usually I take a shower because after gross lab, I stink. Make and eat dinner, and it's already 7. For my own sanity, I try to take a half-hour to an hour break at some point during the evening. I might watch a TV show, read a some of a non-med school book, talk to friends, or go online (or even blog!). That leaves maybe three-ish hours to get actual studying done if I want to get to bed "on time" (around 11 is my goal) (this almost never happens).

One thing I study every school night (even if I'm taking it "off") is the dissector for gross lab. It's rather sad how inadequate that always seems to be once I'm in lab, but it is infinitely better than not looking at it. In order to do this well (at least for the way my mind works), this involves reading the pages in the dissector and then matching them up with pictures from Rohen's (a photographic anatomy atlas that shows actual cadaver dissections), Netter's (idealized but wonderfully clear drawings), and information from Gray's (our required textbook). (I like Moore's a lot better but it's just easier to stick with Gray's since I don't have to go hunting down the requisite page numbers.) For a relatively straightforward lab, this takes roughly half an hour. There don't seem to be a whole lot of those, so mostly it's around an hour spent on that.

In an ideal world, I would then proceed to review the information from the day's lectures and read ahead for the next day. Please pardon me while I cackle rather maniacally at the notion of actually having the time and/or energy to do that every day for every subject. Basically I triage -- what concepts did I have the hardest time with during the day, what subjects did the lecturer gloss over and then say, "You'll have to read about that in your free time"? That's what gets my attention. I do almost always at least preview/skim the next day's lecture notes or PowerPoint slides so I have an idea of what to expect. Occasionally I have been rewarded for doing so by realizing that it's something I already know well, which gives me a nice warm happy glow (this has happened a few times in physio). When I preview biochem it's usually followed by some creative cursing. (Have I talked yet about how my anatomy lab partners know what time it is based on how much cussing I am doing in lab?) So really, on weeknights, I am just keeping my head above water.

It's on the weekends that I actually get the bulk of my effective studying in. A nice long stretch of uninterrupted time for me to get my study on is really what works best for me. I'm a slow starter, but once I get in the zone I am good for hours. Taking that day off last weekend really did set me behind for the week, I think. Unfortunately, next weekend I am going to be busy (but fortunately it will be with fun things!), and I've got two exams this week, so I foresee sacrificing sleep time on weeknights in order to make sure that I can stay close enough on top of things that the lost time won't be too detrimental. After that weekend, I have an anatomy exam on Tuesday, and then no more exams until finals, though, so I should have some catch up time in there. OMG, two and a half whole weeks without a test! It's going to seem like heaven. Of course, then there will be three in three days. But, bah, I'll cross that bridge when I get there.

One random observation before I head off to bed:

The Law of Lab: my partners and I have established that there is definitely a Law of Lab, which states that you will have alternatingly horrific and great days in gross lab. This phenomenon is totally independent of the intrinsic difficulty or lack thereof in any particular day's assigned dissection. Instead it is a function of TA/instructor availability. We do have a ridiculous amount of help available to us. Unfortunately the distribution of that help is very uneven. They, understandably, try to help out the people who seem to be having the most difficulty. These are usually the people who had a horrific day during the last lab and are hence behind. The instructor will then come over, wave their hands, and the anatomy of the requisite portion of the body will magically be made so apparent that even the most blithering idiot could clearly see order in what had previously been chaos. That instructor, having gotten into your group and your cadaver, will tend to remain highly involved for the remainder of the period and as such the day's dissection will proceed swimmingly. Meanwhile, of course, the group whose last lab session went great is now mired in horrificness and they are waving their hands futilely in an attempt to attract the attention of the engrossed instructor, and the minutes tick by. This group then does not finish their lab, which results in them getting all the instructor attention the next day. And so the vicious cycle continues. And such is the Law of Lab. The only thing that can modify the Law of Lab even slightly is the Interesting Finding. This results in everyone coming over to your table, which is great, since you get all sorts of instructor attention and learn a lot, but bad, because you lose valuable time while trying to explain the Interesting Finding to everyone else. So, in the end, it's usually pretty much a wash.

It's all good.

Had an anatomy exam today on the abdomen. It went pretty well, I thought. I felt good coming out of it primarily because I feel like I've gotten the hang on the way the course director writes the questions for the written portion of the exam. Seriously, while I'm not 100% sure I answered everything correctly, at least I felt like... yup, I knew the boundaries of the omental foramen were going to be on there, etc., etc. Nothing felt like a surprise, which was a pleasant contrast to the last exam. And he's already posted that we all passed the practical, so good on us. :) I do wish we'd had more time to spend on the material, but... bygones.

Took the night off, watched some old Buffy episodes and drank some wine. Felt rather rebellious. :) Two exams next week (physiology and biochemistry), so will be hitting the books hardcore starting tomorrow, though. My "pseudo" boyfriend is coming into town not this weekend, but the next, so I'm really looking forward to that. We will be attending a medical ethics conference, but at least we'll be together. :) :)

I've recently read a few blogs of some rather disaffected post-med school people. I had all sorts of thoughts about them, but I've thought better about posting them here. Suffice it to say that it takes all kinds to make the world go 'round. There are some people who are very dissatisfied with the fact that modern medicine, in large part, treats diseases that have a self-inflicted component to them. Why these physicians choose to blame their unhappiness about that on their patients or on the medical system in general rather than on their own choices in how they react to that fact will always be a little bit of a mystery to me. Then again, I knew what I was in for when I chose this path, so I suppose it is easy for me to be a little prejudicial.

Thank you!!

Thanks for the comments, people! It is kinda nice to know that someone is reading. :)

What a lovely weekend this was. On Saturday I decided that, abdomen exam on Wednesday or not, I needed a day off. In the morning I ran some errands and cleaned up my increasingly disgusting apartment to a level that, while hardly white-glove-worthy, is somewhat less biohazard-worthy. It was a lovely day so it was nice to walk around to the bank, the office supply store, the wine store, the bakery... it was almost idyllic. There's not going to be too many more weekends of pleasant weather so every one counts!

One of the nice things about living here (I can't remember if I've said this before) is that it feels like a small town in the big city. I almost always see someone I know when I'm walking around and, since I do like my classmates, that's very nice!

And then I took a decadent nap. Ahh, it was wonderful.

In the evening, I went out with some friends from class. We walked along the Magnificent Mile, window-shopping and enjoying the beautiful evening. We got some popcorn from Garrett's (they're a Chicago institution, and their reputation, I must say, is well deserved), walked around some more, went to dinner, and then had drinks up in the Signature Lounge in the John Hancock building. It was kind of a touristy evening but we all still feel a little like tourists so, hey, I guess that's appropriate. :) We talked a bit about school but mostly we talked about other things. It was really nice to have an interesting political conversation with someone I can respectfully disagree with. It stood in stark contrast to the vituperative discourse that has become the norm with the talking heads these days, that's for sure.

Today I luxuriated in the extra hour of sleep, which I needed after staying out until 2 am, and then went hard to work on anatomy. I've got a ways to go yet but the exam isn't until Wednesday and I'm pretty sure I'll be good to go by then. It's basically just a matter of continuing to review the blood supply and innervation... I have a good general understanding but sometimes I'm off by a vertebral level or two. :)

As of now, I'm officially halfway done with the first quarter of med school! In that strange way that time often has of flowing, it feels simultaneously like I just started and like I've been doing this forever.

Long time, no blog

Doesn't seem like it's been eleven days since I blogged, but I'm guessing Blogger is more reliable on this determination than I am.

Time flies when you're having fun. Time flies even faster when you're having fun at the pace of one or two weekly exams plus volunteering plus getting your ass kicked by a rhinovirus or some such infectious baddie. :)

I am hanging in there, though the last two weeks have probably been the most study-filled of my life. I'll admit that isn't saying a whole helluva lot... I have been gifted with the ability to cram and I utilized that ability way too often in undergrad. Marathon 16-hour study session before exams I am used to. Keeping up something like that kind of intensity (if in slightly shorter individual bursts) over the long haul is a novelty.

In this last while, I have (roughly in chronological order):

• discovered that I passed my first round of exams (though the physio was far dicier than I thought it would be... seems as though they got tired of keeping the exam the same)
• celebrated the above not by going out, but instead by collapsing in bed and sleeping for an amazingly luxurious twelve full hours
• sawed through the ribcage of my cadaver
  
• held a (dead) human heart and lungs in my hands
• been fairly certain that I failed my first gross anatomy written (No muscles? Anywhere?? WTF? Weird, I thought this was the back and thorax exam, not the PNS-and-embryo-to-the-exclusion-of-everything-else exam)
  
• performed my first standardized patient interview (complete with mildly humiliating DVD recording of same)
• performed my first interview on a patient in the ED
• volunteered at the free clinic
• dissected a six-pack (of muscle)
  
• performed a colectomy (on my cadaver, of course)
• relearned basic sugar chemistry, glycolysis, the TCA cycle, ETC/ox phos, gluconeogenesis, the pentose phosphate shunt, and glycogen metabolism
• located the ampulla of Vater, which for some reason always makes me think of Darth Vader's helmet
• discovered that I passed my first gross anatomy practical and written
  
• been very happy that this physiology module is cardiac and hence about 70% review
• (except for the thirty-seven brazillion different ion channels we are required to memorize)

And so that's what's new and exciting in Molly's world for the time being. I'll try to post more often, if only for my own sanity. No guarantees, though. :)