The rock I live under…

…I feel like I live under a rock. Sleep. Study. Eat. Sleep. Repeat x (what feels like forever).

Thought I’d just jot down a quick post to document my 3/4 way mark. I have 12 exams this season and I’ve officially done 9…whew!

First off, the amount of exams we have is ridiculous. It feels like a non-stop marathon of studying and prepping for these exams. Right when you think you’re done one and can celebrate, you don’t have time and you gotta get cracking for the next exam.

How have they been going? Well, so far so good. With the exception of one though…the dreaded OSCE, the bane of my existence. I am 100% sure I actually failed 1 of the stations, which tests our reasoning abilities for some of the clinical skills we have learnt over the last 2 years. I haven’t seen that material for over a year (I had no idea it was even going to be examined!!) so I just blanked out for the solid duration of that station. I don’t know if that’s enough to warrant me doing a remedial exam, but I sure hope not…I am just hoping for the best that I don’t get pulled back. Other than that, the rest of the exams have gone smoothly. Not stellar but good enough for me to move onto 3rd year.

I’ve actually been HELLA proud of my willpower and stamina lately to be able to study all day and all night. And I’ve been trying this new thing for me where I get adequate sleep (a solid 7-9 hours), especially the night before the exam. It’s been helping to feel refreshed during the exam, and I’m not passing out and crashing from exhaustion after I’ve written one.

Admittedly, I haven’t been getting as much exercise as I usually do. I’ve been going for 1-hour runs every few days. It’s really sad that exercise is one of the first things I sacrifice when I’m feeling overwhelmed, but at this point in time where every hour is critical, it’s a decision between exercise and sleep. And I’d much rather sleep, thank you very much. Hopefully I can work on this in future years during clerkship and residency though.

The other thing to mention is that I’ve been to Starbucks *so* much lately that the barista knows my name. Now I get a friendly “How are you, Idiopathic?’” when I walk into the store to get my dark roast coffee. I guess the little things do matter; in the moments of dreading studying, a simple greeting from a stranger can brightens the start of your day!

Alright, back to studying…see you on the other side.

Clerkship is just around the corner!

So this week has been a VERY exciting week amidst the boring realm of exam preparation. Our class has found out what clerkship rotation schedule each one of us will be doing next year. For those unfamiliar to what this means, there are various rotations that we, well, rotate through each year, going from Surgery and Pediatrics, to Obstetrics and Psychiatry, and even Dermatology and Anesthesiology. Basically, we will be seeing the whole works next year! The thing is, all of us will be going through these rotations in different orders, at different times.

The non-medical student would ask, “Why does this order matter?” Well, the neurotic medical student can give you tons of reasons as to why this is HUGELY important in determining our fate… Although many upper year students have told us that, in the end, it may not matter, many in our class have been excited and some disappointed that they did not get their first choice of schedule. Here are a few reasons why rotation order matters:

1) Personality differences: some like to start off with the “hard” stuff first, like Surgery. Some like to ease into things and start with things that don’t require as much fundamentals, such as Psychiatry.

2) Specialty choices: If you’re interested in, say, Emergency Medicine, you wouldn’t want to start off your practicum in this rotation because you have no idea what you’re even doing yet! When you would rather be learning about emergency medicine, rather you are learning about how to turn on the computer, how to make orders, where the nurses are, where the washroom is, etc. Essentially, there is a lot of logistical learning to do and that could take away from actual learning of “medicine”.

3) Elective choices: We have to book our 4th year electives across Canada some time during our 3rd year. However, that means that we haven’t even had exposure to a bunch of specialties before we have to make this choice! And these choices are important for showing interest in CaRMS, which is important for determining our residency. So, indirectly, our rotation order may be determining our fate in what we’ve been exposed to, and thus what we will want to do for the rest of our lives!

4) Friends: There are groups of us that go through the year’s rotations together, and because clerkship is already tough, you of course would want to suffer together with your friends in the class. Some people want to stick with certain people and write the board exams together, so this is important to some, not so important to others.

These are probably the main reasons why my class has been obsessing about our rotation order. In fact, when we got the results, people were bribing each other to trade with others! (Seriously)

As for me? I got my first choice!! Boo-yah! I’m starting off with Internal Medicine, which I wanted because I see it as learning the fundamentals of medicine right off the bat. That way, I’ll have a framework for the rest of the year and as I rotate through the different specialties, I’ll be able to piece together my knowledge in a more systematic way. Some people would hate starting off with Internal, since it’s known as the hardest rotation. But for me, I like to kick-start the school year with a bang; I have the tendency to be pretty intense at the beginning of the year, then fizzle out of energy by the end, so this is perfect for me. Also, I get to experience some of the specialties I’m interested in before I have to make my 4th year elective choices; so, I will at least have proper clinical exposure to all of those specialties before I make some important decisions.

A bonus? I’m with a few of my friends from the class, plus some others that I don’t know as well, but are awesome people nonetheless. It’s going to be an AMAZING year next year and I’m too too excited.

Other than thinking about next year, my head has still been buried deep in the books. Studying is going well (could always be better) but I’m not feeling too stressed anymore now that I’ve had time to go through most of the material before I start exams next week. I haven’t been getting as much sleep as of late, but I’m wired enough on coffee that I can stay focused throughout the day and learn. Admittedly, I’ve been a coffee shop hobo, studying for hours and hours accompanied by my dark roast topped with soy milk. And, I have recently discovered my favourite spot to study in this city, where I will probably be spending much of time in the following weeks getting through my readings.

I’m so stressed..

Holy gajeebus…school is stressing me out right now.

I have exams coming up in less than a month, and I don’t feel like I will be prepared at all. I just made a study schedule for myself – I can’t believe how much there is to do in such a short time…!! Looking at my schedule, I’ve already subconsciously decided I won’t be seeing my friends for the next 6 weeks. I probably won’t be spending much time with my family either. I won’t be doing any of my musical activities either, and somehow I have to make time to continue my volunteer work. Oh yeah, and I’m out of the country for the summer, and I still need to book accomodation, apply for a visa, etc…

On top of that, I don’t see how I can fit in regular exercise (or maybe I should say any exercise), and time with the girlfriend. I don’t want to disappoint the people around me thinking they’re not important enough in my life.

Maybe I should have started preparing for exams earlier. Maybe I should have kept on top of things better. Maybe I should have been a better medical student…

…But then again, I HAVE been keeping up. I have been making adequate notes. I have been keeping up with lectures. I have been doing a weekly study group with a diligent group of friends. Then why do I feel like I don’t know anything?!

I guess it’s the sheer volume of material that I have to know for these exams. Not only is this material a lot more difficult than what I’m used to, but there is just so much sh*t to know. I counted 10 exams with about 11 physical exams I’m supposed to demonstrate how to do before I’m allowed on the wards later this year. I’ll just be glad if I come out of these exams without diagnosing myself with one of the gajillion psychiatric disorders that I’m memorizing right now. Add on top of that – the “clinical skills” I have to perform in my OSCE are accumulative from the last 2 years, which means I have to review things that I haven’t looked at for at least a year. WTF!!

Med school, you are being a pain in the ass right now.

Late again – part 3, and onwards to smoking

So I finished my rotation at this clinic this past week. It’s been an exhausting week trying to impress the man (see part 1 and 2), but I came out of it feeling good. I think he eases up on students as long as they prove they’re not dumbasses, and he’s not such a bad guy after all. He gave me my evaluation this week, and ranked me as one of the top 10% students he has come into his clinic. Woooot.

Next week, I start on a new rotation focused on tobacco dependency. I’m really excited for this one because, well, smoking is stupid. And I think even smokers know that. It predisposes to pretty much anything and every diseases that I’ve learnt about. It makes your arteries smaller, gives you hypertension, and puts you at a higher risk for strokes, heart attacks, and acute death. It puts you obviously at risk for lung cancer, but also all sorts of other cancers like down in the bladder and up in the mouth. And frankly, it just smells awful. And before anyone gets on my case about me making generalizations and about smoking being a difficult addiction, and how some people are genetically “primed” to being smokers, or they were brought up in a smoking household, I totally get that. But I think if patients truly, fully understood the consequences they’re putting themselves at from a health perspective, they would make more of a conscious effort to stop smoking. And we have so much power as healthcare practitioners to help smokers who want to stop smoking stop once and for all. Anyways, the guy I’m with is supposedly amazing at what he does. Nowhere in our curriculum do we get practical experience about teaching people how to stop smoking (which shocks me, since it should be such a useful skill to have), so I’m eager to learn how to facilitate this process for them.

Late again, part 2

First post I’m writing on my phone using the WordPress app!

I just finished my makeup session with that preceptor I was late for last week. After feeling pretty defeated and embarrassed last week, I made sure for this session I prepared, slept super early, got to the clinic early, and I was even waiting in his office before the man got there himself. 1 point there.

I remember he mentioned last week that complications are important to know, so I studied that information like a good med student would and even memorized the rates of each complication. Lo and behold, he asked me to list each complication (and get this), in decreasing order, as well as diagnosis, signs and symptoms, and treatment. And I regurgitated/spit-fired them back to him. “Well done” he said. Phew.

And as the day went and we saw patients, everything went smoothly. At the end, he told his MOAs to double his lunch order for me, and I now sit on the bus with a gigantic smorgasbord of fancy sushi. He told me I did a great job and I had a good rapport with patients. Scorrre.

I guess there’s something to be said about bouncing back from a fall after all. I was lucky to have a second chance this time around, though next time I may not be that lucky.

Late again

I really need to stop being late for things.

This morning I was supposed to be at clinic at 7:30, so I was supposed to leave my place by 6:30 to get there. Last night, I stayed up late because I was trying to read up on some of the procedures I was supposed to be helping with, and I zonked out with setting my alarm. when I woke up, I checked my phone, which read 8:39am.

“HOLY SHIT!!”

I freaked out, jumped out of bed, and booked it out of the house. I managed to make it to the clinic by 9:15am after zooming through traffic. I checked in with the receptionist and proceeded to wait in the conference room for the impending doom of facing my preceptor.

He walked in and proceeded to scold me for the next 15 minutes about how unprofessional and irresponsible I was. And how I missed out on an educational opportunity of learning medicine. And how I was going to manage in the E.R. one night when a patient comes in from a complication of the procedure, but I don’t know what to do because I only remember sleeping in that one morning in 2nd year. And how I am putting myself at a disservice for not showing up on time. I pretty much just sucked up and took it in – he wasn’t going to take any bullshit and it was my fault after all. After demoralizing me, he told me to leave and come back another day, when I could get the full educational experience from a full clinic day. He walked out of the room, leaving me defeated.

As I packed up my bag, he came back with a $10 gift card to Starbucks for me, because I now had time to kill. He walked out of the room again.

“WTF?!”

Here’s a guy who just pounded every bit of self-esteem out of me, only to return and give me a gift card?! I seriously don’t understand this guy. And so I walked out of the clinic confused, shocked, and stunned and what just happened…

The Brain

This month of med school has been absolutely friggin’ fantastic! I continue to be amazed at all the

cool stuff we get to do and learn about the intricacies of the human body.

I’ve been reading lots about the anatomy of the head and brain – to begin, it is some majorly

complicated shit. It’s been taking me lots of time just cracking the books, memorizing the various complexities of the brain and all the damn cranial nerves that pass through the skull. But it’s so rewarding in its own way, oddly enough.

As a med student at my school, I’m privileged enough to have a cadaver to work on for

the year. Earlier this month, I literally cracked open a skull with a hammer and chisel, revealing what was my cadaver’s brain that controlled her every thought process. I held the brain in my hands in awe that afternoon, dumbfounded at how cool it was to hold an actual brain.

Then on another day, we focused on the eye and all the small structures that surround it — allowing our eyes to move and respond to our environment. My group and I peered went through the skull and cracked open the “back entrance” to the eyes, literally gaining a new perspective of her eyes. Again I was amazed at how many tiny muscles, nerves and blood vessels are working in concert together to give us the abilities that make us human.

We also started to peel the skin off her face, which really bothered me. Here we are, picking away at what is probably the most sensitive part of someone’s very being. The face is, more often than not, how we recognize each other. Peeling skin off our cadaver wasn’t something new, but there was something about pulling at her face that really made me cringe, reminding me of my anxiety of cadavers in first year.

The brain is a complicated little sucker. And maybe I have a soft spot for the face, but there’s something about our head area that really makes us unique I suppose.  It’s no wonder there is still so much research into neuroscience and psychology. With all the complexities of the brain and its surrounding structures, so very many things can go wrong and lead to some pretty detrimental diseases — diseases that can alter our brain and ultimately change how we define own human nature.

Shit Med Students Say

So among all these new “Shit ___ Say” popping on youtube, is a “Shit Med Students Say”. There’s a few of them, this one from Johns Hopkins tops the cake. Thanks to my good ol’ nursing friend for passing this down to me.

I think I’ve *actually* said most of these things in some context or another…

Most notably:

“Hey I think I have this!!”

“Hey I think I have a murmur!!”

“Uh, does this feel normal?…”

“I had the best day in clinic today!”

“I’m sooo poooorr”

“I’m sooo tireddd”

It’s kinda freaky how universal some feelings and experiences being a med student can transcend through different schools..

 

For Grandma

Today marked the start of my exam period. I just finished my histology and anatomy exams, the latter of which I always manage to just scrape by. I’m really quite good with the theory behind the anatomy, but when it comes to identifying muscles and nerves and ligaments on a cadaver at a 60-second bellringer station, I just suck. So, judging from my first year track record, suffice it to say that I was really nervous for these upcoming exams today.

What did I do about it? Well, I tried to study extra hard, learning seemingly every imaginable muscle in the hands and feet, from the extensor carpi radialus longus to the flexor digitorum brevis and even the median nerve that innervates all the anterior muscles in the forearm! (Oh, but not really “all”! The ulnar nerve supplies the flexor carpi ulnaris and the medial half of the flexor digitorum profundus) But I digress…basically, what I’m trying to say is that I’ve had all these terribly named Latin terms mucking around in my head for the last week, while simultaneously trying to visualize them on a cadaver. Then came yesterday, when somehow it all didn’t seem to matter anymore.

Yesterday, my grandma passed away. We knew her health wasn’t so great recently, but it all seemed so sudden. None of us expected it to be so soon. Just the day before, I was having dinner with her and my grandpa, and she was talking about when to have our traditional family Christmas dinner, and when my uncle’s wedding ceremony was going to be. At the dinner table were grand plans of the family getting together; my sister was even coming back from England with her two kids to visit. It wasn’t her time to go.

But now, we won’t have that family Christmas dinner together. My grandmother won’t be attending my uncle’s wedding. My youngest nephew won’t get to see his great-grandmother. And I won’t ever get to see my grandma again.

Yesterday morning, after my grandpa told my family, we all sat for hours circled around my grandparents’ living room. We were all going through tissue boxes like I’ve never seen before. The paramedics had already tried to resuscitate her, but there was no electrical signal from her heart. The police then came and started up the paperwork. Her family doctor had given the confirmation. She was then taken away by two guys to have an autopsy done at the hospital to determine the cause of death. Does it really matter though? “Just protocol”, they said.

She was the matriarch of the family. The one that really held the family together. The one who showed her love to others like noone else could. She taught me what unconditional love really means; I really could do no wrong in her eyes. I spent a lot of time with her, since my grandparents practically raised me up while my parents worked full-time jobs to pay the bills. She walked me to kindergarten; made me lunch; took me to get haircuts; she cared for me when I was sick. My grandma wasn’t just my mum’s mum, she was like my second mum.

She always wanted me to be a doctor. As I was growing up, she told me to become a doctor so I could heal her aches and pains. So that I could understand what was going on inside her body. But most importantly, she wanted to become a doctor so that I could live a happy life. I’ve always wondered if this had any influence on my decision to become a doctor after all. I never thought so, but who knows, maybe it did. Nevertheless, the fact remains, Grandma: I am indeed becoming a doctor.

Two weeks ago, you asked me “How much longer?” I answered, “2.5 years, Grandma. 2.5 years until I graduate and become a doctor.” It’s almost like you knew your time was coming, but I guess you couldn’t wait that long…

Yesterday evening, I could barely focus as I tried to study for that stupid anatomy exam. But I knew you wouldn’t have wanted me lose track of my studies; no, you would’ve wanted me to focus and work hard, like always. So I’m trying to pull through.

I don’t know why you’ve left us, Grandma, but one thing’s for sure. Your grandson is going to make you proud. I may or may not have entered medical school because of you, but boy oh boy Grandma, I will work hard to be a great doctor not only because of you, but also for you.

Diabetes

A lot of what we learn in med school seems like fact after fact. Take for instance a new disease we are learning. Learnt the etiology? Check. Pathogenesis? Check. Risk factors? Yup. Treatment? Mmhm. Disease after disease after disease; it’s all so simple. One thing leads to another and one drug treats it. Tell a patient to exercise and their risk of cardiovascular events goes down. Simple right?

Today I received some surprising news, in the form of lab results. As part our learning of hormones and bloodwork, my school has all of its med students undergo blood testing for cholesterol, triglycerides, fasting glucose and HbA1C (a longer-term marker for glucose, on a red blood cell). My cholesterol was low-normal, HDL was high-normal, and my LDL was really really low. Trigs were normal. Then I looked at my fasting glucose, still a normal of 5.0, but my HbA1C was 6.0 (exactly the upper limit of normal). In fact, my Hb1Ac level was one of the highest in my entire class. Call me dramatic but I started getting weirdly freaked out. Now, I consider myself a pretty healthy and fit guy. I don’t eat much crap and am pretty restrictive with junk food/fast food etc.. I was also training for my half-marathon at the time, and exercise is supposed to lower the glucose levels.

Conclusion? I blame it on the genetics. (which is actually a major contributing factor to diabetes so I’ve learnt). I’ve got a grandma and two uncles with diabetes and a dad with borderline diabetes, so it’s running on both sides of the family. Also running in my family is a slew of hypertension of high cholesterol; along with diabetes, this ultra combination is called the “Metabolic Syndrome” which has a high genetic component to it. So I’ve pretty much concluded that, at least genetically, I’m at a pretty big risk for developing diabetes later in life. If I’m already borderline high in my 20s, it will only get worse unless I start making some bigger changes with my diet and exercise. No way in hell do I want to be one of the patients I see in the family doc’s clinic dependent on metformin and glyburide, staples of the diabetes treatment regimen. No way do I want to develop complications of diabetes I’ve seen in both my family and the patients I’ve encountered, from blindness and peripheral neuropathy to incontinence and an  immunocompromised state predisposing to infections. Nasty stuff.

Again, call me melodramatic but I will *not* succumb to the beast that is diabetes mellitus. I can’t change what my momma and poppa gave me, but I can change what I eat and how I live my life. It will be difficult, and it’s not as simple as my lectures make it out to be. They call it “lifestyle modifications” of diet and exercise…”If patients lose 10 pounds they can reduce their risk of diabetes by 50%!”…or something like that. What they don’t emphasize in my lectures is a lot of pragmatic issues with complying to treatment regimens, though compliance is a huge issue in the family practice clinic from what I can see. So, with today’s startle, now I’ve got some fuel under me to live a healthier life, cut down on simple carbohydrates, keep up with exercise and encourage future patients to do the same.