Island Med Student

Spotted today in Bushwick, during my doggy walk.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

It’s official. I am on vacation! Today was my last day in neuro. My next rotation (family medicine) doesn’t begin for two weeks. That means I have two weeks to do whatever the hell I feel like doing! I just realized that I haven’t had an actual vacation since July of last year. Except for a day off here and there, I’ve been inside a hospital every day for about 8 months. I’m soooo excited, I can barely contain myself!

My current plan is to pack up a few of my cherished belongings (clothes), my two doggies, and my stuffed dinosaur and head down to Bawlmore for the next two weeks. I’d like to actually go on a “real” vacation, aka go someplace warm and nice, but I don’t think my current budget will allow it. Perhaps I can do some road-tripping. We shall see.

Anyway, I just finished cleaning my apartment, and the weather is FAB today, and I’m listening to “Like a Prayer” by Madonna and all is goooood. Gonna go for a nice long doggy walk. I’m a happy little ducky, yesiree!

Note: Photos were taken at “Sea,” a Thai restaurant in Williamsburg.

This is some freaky stuff!

I have been a very bad girl for almost a year now. Since I was 16ish, I’ve belonged to/had access to some sort of gym. I have faithfully gone to the gym and done cardio, weight lifting, pilates, etc. etc.

However, since I came back from Dominica (April, 2008), I have failed to go to the gym even a single time. I have made up for this in other ways, like running outside, doing push-ups and sit-ups, Billy Blanking it up, etc.

But the time has come to take the plunge and get back in to weight lifting. It happens to be something that I enjoy, and it always makes me feel super energized and happy, both during and afterwards (prolly the endorphins).

I am VERY lucky to have a gym close by (1-2 minute walk, no joke!), which is called Richie’s Gym. It’s fairly crappy, but I don’t mind. It has everything that I need, so I’m happy. It also is at a BARGAIN price. I just paid $90 for 6 months. Yes, you read that correctly. The biggest drawback is that it is totally meathead central. “Like majorly, like whoah!” I was the only girl there today, and everyone else was lifting approximately 900 pounds more than me. I also seemed to draw a lot of attention (nothing new to me). But I don’t care too much. I’m good at ignoring the meatheads, and extinguishing their incredibly bad attempts to hit on me.

Today, I worked out for about 2 hours. I ran 5 miles on the treadmill, and worked out every single one of my muscle groups. There is a good chance that I won’t be able to walk tomorrow. It’s seriously gonna hurt! But I actually love that feeling, so it’s okay.

Here’s to many more workouts to come!

Note: Photo is poor quality. I apologize. But the light was crap. Was taken inside the gym. Cool, or what?

I feel like maybe I’m getting smarter or something. Or something.

Anyway, here is a list of more stuff learned in neuro:

1) “Frontal release signs” are primitive reflexes, which are signs of disorders that affect the frontal lobes. Examples are the palmar grasp reflex, the rooting reflex, the sucking reflex, and the snout reflex. These reflexes are normally inhibited by frontal lobe activity in the brain, but can be “released” from inhibition if the frontal lobes are damaged.

2) With Broca’s aphasia (comprehension is intact but fluency is affected), you can also find motor impairments. However, if it is the result of an embolism, you won’t have motor findings.

3) With Wernicke’s aphasia (fluency is intact but comprehension is affected) you will never have motor impairments.

4) The inferior branch of the middle cerebral artery is more straight, and hence it’s more likely to be affected by an embolic stroke than the superior branch.

5) Pseudobulbar palsy is a disconnect between the cortical bulbar fibers and the cranial nerves. You can see this with a pure embolic stroke.

6) Only give heparin to a stroke patient if you know there is thrombosis.

7) A “neural intubation” is what you would do for a stroke patient. You would give them mannitol and hyperventilate the patient.

8 ) A stroke causes intracellular edema, so there is no role for steroids. However, a brain tumor causes interstitial edema, so giving steroids can be helpful.

9) A stroke patient should be prescribed a pureed diet (unless otherwise indicated) because the first step involved in swallowing is what is affected by strokes, and not the other steps. This means they can handle pureed food, but not solids or liquids.

10) Transient global amnesia is an anxiety-producing temporary loss of the ability to form new long-term memories that by definition resolves within 24 hours and most commonly affects the middle-aged or elderly.

11) Jacksonian March involves the progression of a seizure, and can be seen as starting in the eyelids, and progressively moving down the body. (I witnessed one.)

12) How to differentiate between a real seizure and a pseudoseizure. With a real seizure, during the post-ictal state you will see a positive Babinski sign, dilated pupils, and elevated prolactin levels.

13) During a seizure, you should expect the gaze preference to be towards the seizing side.

14) The treatment for status epilepticus is benzodiazepines, intubation, and a dilantin drip. If that doesn’t work, you can try phenobarbitol.

15) Never give a muscle relaxant to a patient having a seizure.

16) Electrographic seizures are evidence of a seizure on EEG, but with no clinical manifestations.

17) With nystagmus, the fast component is towards the affected side (and I finally got to see it in real life).

18) The frontal gaze center affects the opposite side (left controls right), and with the pontine center, it is the same side (left controls left).

19) What internuclear opthalmoplegia is (a disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction), and what can cause it (multiple sclerosis, TB, fungal infections, small vessel lacunar strokes.)

20) Flu vaccinations can cause Acute disseminated encephalomyelitis (ADEM). Scary!

21) If you see bilateral Periodic lateralizing epileptiform discharge (PLED), it’s almost certainly being caused by herpes encephalitis.

22) You must be careful with correcting hyponatremia, because if you do it too quickly, you can cause central pontine myelinosis.

23) With multiple sclerosis, the plaque formations can cause seizures (same with Alzheimer’s disease.)

Now you can see the fun I’m having!

Note: Photos are me and one of my fave books, Robbins & Cotran Pathologic Basis of Disease, Seventh Edition

Please do check out Calibishie Cove if you are looking for a naturally beautiful place to stay in Dominica!

Our property provides a luxurious indoor-outdoor experience. The breeze on our site is fabulous, and we designed the windows and doors with louvers to maximize airflow. As a result, you also hear the sound of the waves crashing below, and the occasional forest bird. We embrace this concept and it is what makes us special. Those who are looking for a hermetically-sealed Holiday Inn experience are not our target market, but people looking for a uniquely beautiful, natural experience that captures the beauty of Dominica will be very happy with our property, as our Trip Advisor reviews will attest.

I was absolutely elated by the overwhelmingly positive response that my recent blog post received. The feedback and the poll results definitely proved one thing to me: I am not alone. Not only am I not completely insane for having doubts about wanting to become a doctor, but the vast majority of folks (98%, according to the poll results) have had some doubts about med school at some point in their life.

Reading all the responses to my post was an incredibly rewarding experience for me. Many people shared their own personal stories, and some also offered their advice. I feel so very fortunate to have an arena to share my thoughts, aspirations, and fears with the world.

It really got me thinking about what it means to have a blog, and especially one that is read by many people. It’s sort of like having your own set of personal therapists. I can bounce ideas off of, share my experiences with, and receive feedback from a variety of different folks. In some ways, it’s even better than a therapist I might randomly pick out of the Yellow Pages, as the readers of this blog are generally involved in the medical field, and hence can understand what I’m going through better than the “average joe.” Of course, blogging is no substitute for actual therapy. But it is an interesting complement to the typical therapy that existed prior to the advent of blogging.

Through reading the comments on my entry, I discovered some common themes in people’s stories. In doing so, it allowed me to hone in on some of the possible causes of my doubts about medicine as a career.

It seems as though being a third-year medical student provides some sort of breeding ground for doubts to thrive. After reflecting on this, I realized that this has a lot to do with my angst. Adding to this, is the fact that I worked for many years (14 to be exact) before going to med school. In fact, I had a full-time job even throughout my undergrad years. It wasn’t until med school that I gave up employment altogether. Now I’m a full-time professional student.

The problem is that the third year of med school (in the U.S.) is a limbo period. You are no longer focusing all your time on studying the basic sciences. However, you also know very little about the clinical world. While I have received much training on physical examination methods, history taking techniques, and many other clinical skills, I can honestly say that the majority of the time, I still feel like a complete idiot. I can’t consistently differentiate the various heart murmurs by auscultation. I still miss the vein many times when starting an IV. I have a hard time determining if a person has hepatomegaly. The list goes on and on, but I think you get the point.

As a student, I also have very little actual responsibility. Sure, the doctor listens when I present a patient, and takes my findings into account, but they will still usually go back and check things out for themselves. My treatment suggestions are heard, but they are still merely suggestions. The doctor who signs the orders has the ultimate say, and that’s definitely a good thing because I don’t trust my opinions very much.

As a fourth-year, you are still learning a lot, but from what I’ve seen, you have the confidence that comes with practice. And doctors are more likely to trust your findings and treatment plans.

When you take all of these factors into consideration, perhaps you can understand why the life of a third-year med student can be rough at times. When I worked at the AAMC, for example, I got paid to do tasks, and I did them all fairly well. As a third-year med student, I pay to do tasks, and I do them all fairly poorly. It’s an unnerving reversal of lifestyles.

After reading all the responses to my post, and evaluating my options, I’ve developed a rough draft of a plan for the next few years. I’m going to keep trudging along, and try to complete my M.D. degree. After I graduate, I will either apply for a psychiatry residency, apply to a clinical psychology Ph.D program, or perhaps I will open an animal rescue shelter. I really don’t know at this point. But for now, I will focus on the goal of receiving my “piece of paper” and try to develop some sort of plan along the way. I will also attempt to spend more time with my patients, and I have a feeling that in doing so, I will remember the reasons why I was initially inspired by a career in medicine.

Click Here To View the Original Post on Medscape

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Today’s pic was taken yesterday in Williamsburg, Brooklyn.

The mural of the monkey sparked a conversation between me and Micah. I shared with him the fact that chimpanzees are actually more genetically related to humans than they are any other type of ape. He acted like he wasn’t surprised, but I know he didn’t know that!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

For my birthday a few weeks ago, I went out with my son Tom and Micah to a few places in Williamsburg, Brooklyn. At some point in the evening, I found an empty stage and (of course) decided to do an impromptu performance.

Click here to view the pics.

This weekend, my BFF Laura came up from Baltimore to visit me for her birthday. We had so much fun! Friday night, we went to our fave local Italian restaurant, Il Passatore. Saturday, we went to Life Cafe for breakfast and bloody marys. Then we subwayed to Central Park to take some pics and video footage. After milling around in the park for a bit, we took a cab to Soho, Micah’s fave place to hang out. I found the coolest little shop, called Girl Props. It’s pretty much a store devoted to things I love, like huge colorful earrings and brightly colored wigs. I bought two new pairs of earrings, and two new wigs.

For dinner, we ate at Arturo’s, our fave Italian restaurant in the city. We then went for drinks at some darkly lit place that I can’t remember the name of. Eventually, we made it back home, and Laura and I donned my new wigs, fishnet body suits and sexy dresses. Looking damn hot, if I do say so myself (I just did), we hit up a bar down the street from my apartment, and then decided to call it a night.

Laura, thanks so much for coming to visit me in NY! I had an absolute blast! Please come again soon!

Click here to view the pics from this weekend.