how funny. It's been over a year and I'm still craving the same things to get me through. I keep thinking that perhaps I should update this more often. It might make me feel better to blog about some of the things I've seen 8 months into clinical rotations. Pretty beautiful and pretty horrible stuff. The experience goes both ways.
Maybe I will.
Or maybe I'll choose more sleep instead.
I can't do it. I always wind up wasting a crap-ton of time doing random things (like updating my blog and reading a bunch of blogs that I follow). Ugh.
But I guess yesterday I was super productive; 12 straight hours at school (yes that did make me want to jump through the window on the 4th floor but hey). I got through all the DNA viruses. Seems like a lot huh? Well verbalizing that to Shauna last night just made me depressed because I'd say that's about 1/5 of the info for my infectious disease exam which is one of three mothers of exams I have next week.
Now if that doesn't make you wanna cry I don't know what will.
Two weeks, I can do anything for two weeks. Then I have a month of freedom-filled, book-reading, doctor-Phil-mocking, sleep-chocked, random-hiking, outside-of-Houston, no-school goodness to look forward to.
I'm part of a website called Bzzagent which allows me to try free samples. Recently they've also been posting websites for us to try out. Mostly they're slightly boring or useless ones but today I found a pretty interesting one called Fact Check. It's run by a public policy group and it checks the public record to confirm or refute claims made by politicians during the campaign. I found it pretty enlightening.
Visit Fact Check
I was watching the CBS news tonight and a Hilary supporter brought up a good point.
A few months ago, a man showed up at a Hilary rally with a sign that said "Iron my Shirt" and she pointed out that if it had been at an Obama rally and a similar comment had been made regarding Obama's race the entire country would have been up in arms. And yet, nothing. No reaction. It's almost as if it's still okay to discriminate based on gender. I'm really not a feminist in many ways but I think only a person who has their head throughly shoved up their rectum could really believe that we've reached equality in this country.
(the following story I'll adjust slightly to protect the patient)
I was seeing a patient a few months ago with a group of several students; everyone else was male. As we were leaving as a group, he told us, "You're going to be great doctors." Then, I kid you not, he turns to me, literally pats me on the shoulder and says, "Oh, and great nurses."
Screw you.
I am not a nurse. I am not a nursing student. I'm a medical student. Someday I'll be a doctor. And quite frankly I'll be a better doctor than many of the males in my class.
(Please no angry comments about the importance of nurses. I'm well aware of that. I was introduced as a medical student and that's what I am).
I really hope that no one actually believes that sexism (or racism) is dead in America.
I really hope no one is that stupid.
Thursday was my last day to go see my preceptor. It was a strange day. The scope of patients was amazing. Sometimes I wish I could talk more openly about what I see but I respect the fact that these patients wouldn't want that. Hell I wouldn't want that. I'd be upset as hell to see the details of my illness plastered all over a blog. Let's just say I saw some interesting crap including one condition I am almost guaranteed never to see again in my career, like published in JAMA kind of bizarre. House MD kinda bizarre.
I was glad that I drove out by myself for the last day. I got to have another long discussion with my preceptor about life and residency choices. He said he couldn't really see me in Emergency Medicine but he could see me in rural medicine. Well, one out of two isn't bad. I still have the lingering thought that perhaps I'll end up in surgery. I don't want that life, but even talking to Dr. Templeton last fall couldn't completely squash that idea from my head. My father is convinced that's where I'll end up. I still remember a conversation with Pete where he wanted to bet me money that's where I'd end up. Funny because at the time he wanted to do Neurosurg but now he's been converted to the dark side of EM.
But the last day ended with a fizzle. The nurse took our picture and I left without any fan fair. A strange ending to my first exposure to healthcare as an honest to God healthcare worker. The school really needs to work on this curriculum. I'm still terrified at the thought of assuming any more responsibility for a person's health; terrified and exhilarated all at the same time.
Heh - at least I didn't break the teeth on my first intubation. Poor NA murse. I'd be pissed if that happened to me. I really don't know how they put themselves through all that crap knowing that they'll continually get crap from know-it-all MDs that don't respect their training. It irks me enough to know that most MDs don't respect the specialty of emergency med but at least I'll have the MD behind my name when I tell them where they can go.
Sometimes I get so frustrated with school I want to scream. For once it's not the ever mounting pile of infectious diseases that I must memorize before the block exam. It's the fact that in the entire TMC library system (including the school of public health) there is not a single book on rural health that was published in this century. What? Seriously - the most recent being 1999. That's kind of insane when you put it in perspective.
Around 20% of our country's population lives in a "rural" area according to the last census. There are literally entires shelves about rare conditions which affect fractions of a percent of our population but a real national issue that needs attention gets completely neglected.
A greater percentage of the rural population is uninsured. Rural children are more likely not to be enrolled in SCHIP even if they qualify.
So why the neglect? Personally I think it's because rural health isn't "sexy". How many people swoon at the idea of working for Doctors without Borders in a remote area of Africa but working in a town of less than 200 makes them run for the hills? And the truth is: there's a lot of cross-over there. What do you do without specialist back-up? Limited lab resources? No CT? No MRI? At least not in a 3 hour drive. I'm not knocking MSF. They do fantastic work and someday I hope to spend some time with them as well. But how many times do they serve only as a band aid on a system that is cracked and broken?
Paul Farmer - now there's an international health example I can get behind. You'll excuse the cliche of the med student worshiping at the altar of Paul Farmer for just a moment: He knew how to get stuff done. No infrastructure? No problem. We build it. Want sustainability? You involve the community, make them responsible for their own health. That's a model rural public health in this country could really look towards.
(On a side note: There is no rural health blog that I could find on the web. If you happen to read this and know of one, please post it!)
I finally finished the behemoth that is the review for the written clinical skills exam. Kill me now.
But at least I have this figured out: I know why I loath this class with such a deep and undying passion.
It's because it makes a mockery of how I really feel. I love this stuff! I love talking to patients. I love hearing their complaints and exploring their symptoms. When I was still working at the clinic I always got complements on my histories. The doctors were shocked at the amount of information I could actually gather. It's because I love the space between two people. I think humans are beautiful, complex things. We're so flawed and fragile and yet we keep going through grim and shit. We overcome unbelievable obstacles and are then put down by the most innocuous physical ailments. Each individual is unique and I never get tired of hearing the myriad of stories that exist. What other profession are we permitted to love people at their most broken and vulnerable state?
But then HE comes along and makes everything I love about medicine and turns it into this insincere, annoying contrivance that only serves to increase the cynicism of my classmates and lumps me right into the same pit they put him into. I hate this crap. Your praxis should be a natural outpouring of how you feel about life and your patients. No amount of badly written web material will turn judgmental, childish jackasses into compassionate doctors. Sorry, no dice. Our only hope is that eventually a patient will reach them. Because in the end the best teachers of compassion are our patients themselves.
So that's why if I don't honor my patient care class - I'm not going to be too worked up about it.
