Archive for June, 2009

What A Long, Strange Trip It’s Been

During my family medicine clinical rotation, I treated a 7-year old girl for an ear infection. That might sound (pun intended) like a very mundane and simple thing to do, but technically it’s taken me over three years of medical school to get to this point. And during the past three years, I have accumulated a massive amount of medical knowledge and skills, but I have also accumulated a massive amount of wonderful experiences. Do let me explain.

In order to understand the anatomy of the ear, I was required to take a gross anatomy class during my first year of med school. I can still remember the first sight of my cadaver. I had never even seen a dead body before. I can recall the mixed feelings of excitement and anxiety when making the first cut into human flesh. What a thrilling experience, indeed.

Learning the normal anatomy of the ear is one thing. But to be a doctor, you must understand all the things that can go wrong. During my second year of med school, I learned about the huge numbers of pathologies that can happen to the human body. I was taught on topics like genetic malformations, cancer, and infectious processes. An ear infection results in increased numbers of white blood cells and mediators of inflammation. Pathology class instilled in me a (healthy?) fear of diseases and I developed my first case of medical student syndrome.

The first two years of med school gave me a firm basic science foundation. But it wasn’t until my third-year of school that I could really put these skills to good use. I’ll never forget my very first patient encounter (as a med student). I was a nervous wreck. The history took me over an hour to gather, and I missed tons of salient details. The physical exam basically involved me going through all the motions that I had been taught, but I didn’t have the slightest idea if any of my findings were pathologic. My hand trembled as I inserted the otoscope into my my patient’s ear canal. Everything looked fine to me. But what did I know? I had never seen an erythemic or bulging tympanic membrane.

Over the course of my third-year, my skills improved exponentially. I learned phlebotomy, intubation, line placements, suturing, and many other vital skills. My differential diagnoses became more dead on, and I knew which diseases were more likely. But then came learning about treatments. I had to figure out how much fluid to administer, and which antibiotics were appropriate. I distinctly remember writing my first prescription (signed by my attending, of course). It probably took me about 20 minutes to write a simple script for amoxicillin because I had to be sure of the dose and length of treatment.

And now, here I am. I have started my fourth and final year of medical school. When my patient walked into the examining room, I was able to examine him, diagnose his ear infection (properly called otitis media), and provide him with treatment in a matter of minutes. I still have many more years of learning to go. But so far, what a long, wonderful, challenging, intense, rewarding, and strange trip it’s been.

Click Here To View the Original Post on Medscape

Drop It Likes It’s Hawt

Kendra is a dork

That’s what I just did to my very last NBME Step 2 CK practice exam. I completely rocked it! As a reward to myself, I’m going out tonight to a comedy club in the city. I finished all my errands for the day, so I’m going to enjoy myself now. Next up, 3 more days of hardcore studying. After that, the exam. Hawt!

(Note, I am a dork.)

Kendra The Happy Camper

Chillin like a villian

Life for me is pretty cool right now. Today was my last day of radiology. I have one week off until I start an adult inpatient psych elective. I take the USMLE Step 2 CK in 4 days. I will be taking the last NBME practice exam tomorrow. It should be an excellent proxy of my real score on the exam. I have all kinds of random medical facts floating around in my skull right now. Am I freaked out about the exam? Not really. In true Kendra fashion, I’m not really sweating the exam. I never was one to get my panties in a bunch about a test. It’s just yet another hoop that I have to jump through to prove that I can be a doctor.

In other news, I went on another awesome run today. I think I have run over 40 miles so far this week. Not too shabby. And I have the legs to prove it. Is it just me or is the best thing in the world going for a super long run, hitting it as hard as you can, becoming completely soaked with sweat, and then coming home and taking a shower and putting on comfy clothes? Seriously, it is so sweet.

I just ate some yummy vegan Thai food. Speaking of, Jorkers, thanks for the comment about my tagged Del Sol! You made me laugh so hard I almost peed my pants! (I liked it better than Pirates of Penzance.)

The food is kicking in, and my poor bones are tired, so it’s time to watch some mind numbing movies and call it a night. Only four more days of studying, and I can finally take a breather. Hugs to the world!

Note: Photo is me post-shower in my comfy clothes and chillin in bed. Miso happy!

My Happy Place

I’m too tired to write anything right now, so please enjoy a blast from the past photo of my happy place (yes, that’s my blue hair and dirty butt). Good night and sweet dreams world.

My happy place

T Minus One Week

Micah around the world

I take the USMLE Step 2 CK in exactly one week (July 1). Do I feel prepared? Yes, actually. Do I have more to study? Yes, definitely. My studying has been progressing fairly well. I don’t know everything, but I definitely know a heckofalot more than I did before I started studying.

So, I just wanted to apologize in advance if I don’t post every single day. My schedule is fairly packed. Although, I must admit that my current guilty pleasure is a 2-hour run every day. I have become addicted to it. And I think it’s preserving my sanity, so I’m not going to stop.

Somone tagged my car

In other news, my doggy doo Scope has a nasty ear infection that I’m treating, and someone tagged my car. That’s right, someone tagged my incredibly awesome, coolest car ever, Honda Del Sol. I thought that there was some tagger law against this kind of thing. I mean, my car is not a box van. It’s a cute little white love ship. Why would someone tag it? It upsets me, but I’m not destroyed. One of the benefits of owning a car that has very little actual monetary value is that things like this aren’t the end of the world. I can prolly just cover it up with some white-out.

Anyway, that’s all I got for now. Time to sit on my fire escape and watch my garden grow!

Lose Yourself

“You better lose yourself in the music, the moment, you own it. You better never let it go. You only get one shot, do not miss your chance to blow. This opportunity comes once in a lifetime, yo.” -Eminem

Who am I? I am an optimist, a friend, a runner, a daughter, a creator, a dog lover, a sister, an artist, a medical student, and much more.

If I were to ask all you readers who you were, what would you say? What would be the first thing to come to your mind? A doctor? A musician? A medical student?

I made a commitment when I started med school to dedicate myself to it completely. It’s something that I’m very passionate about, however I have many assorted interests outside of the world of medicine. I have hobbies, relationships, and fascinations that are completely unrelated to health or medical school. Many people who are not involved in medicine might think that having a life outside of the hospital is a rather obvious benefit. But, they’ve never experienced the pressures we have.

From the first day I stepped foot inside the classroom, I felt the pressure to excel. We are compelled to study for very long hours every day. Then, during our clinical years, we spend every waking (and non-waking) hour at the hospital. We are supposed to be caring for our patients, and learning anything and everything possible. After all, if we miss something, it could mean a person’s life. During our internship and residency, the pressure is even greater. Having a life outside of the hospital is laughable at best. If you have any spare time, you should be studying, re-checking on your patients, or sleeping. Who has time for anything else?

I remember one night several years ago very clearly. It was during my second year of med school. We had a gigantic exam coming up the next day. I had finished studying around 9:00 p.m., and decided to go to a restaurant near the campus to have a glass of wine. While enjoying my beverage, I met several med students’ “spouses,” who were all having dinner to escape their insane companions. They looked up at me in disbelief. “What are you doing here… don’t you have an exam tomorrow?” they asked. “Yes, but I am finished studying,” I replied. They couldn’t comprehend the fact that I would actually stop studying and relax the night before an exam.

I have a million examples just like that one. There are many times that I have felt incredibly guilty for enjoying myself. When I take a little time off, I look around at other students who are still studying, and I question if they are more dedicated than I am. Ultimately it’s my duty to put my patients first. I wonder if there will always be that gnawing feeling in the back of my mind that missing one vital piece of information could mean a patient’s life.

This kind of thinking is a trap that has snared me at various points in my life. At times I have become lost in what I think other people expect of me. This is the paradox that exists in medical training: If we sacrifice ourselves to medicine, we lose what makes us who we are. But how can we give to our patients if we have nothing left to give to ourselves?

Click Here To View the Original Post on Medscape

links for 2009-06-20

Radio Head

Renfa and Rennic at the beach

Here is the long-awaited list of some more “stuff learned” in radiology. As always, this list is very incomplete.

1) You have to have at least 400 cc of fluid to be able to recognize and diagnose a pleural effusion on x-ray.

2) A positive HIDA scan is when you can’t see the gallbladder.

3) To best diagnose an aortic dissection, you should get a CT with contrast.

Renfa

4) If someone ODs on heroin, you miss see massive pulmonary edema on CXR.

5) A right lower lobe pneumonia does not obscure the right heart/lung border, but the middle does.

6) A left upper lobe pneumonia obscures the left heart/lung border.

7) Osteomyelitis tends to go to the vertebral discs, not the body.

Renon, Renfa and Rennic at the beach

8 ) MRI can date a fracture, whereas x-ray and CT cannot.

9) A sign of tethered cord syndrome is a sacral dimple.

10) Charcot’s joint happens to diabetics. Because of neuropathy, they feel no pain, although their feet can be destroyed all the way to the bone.

11) A fat pad sign is seen with a fracture. The fluid in the joint displaces the fat pad, and you can see it on x-ray.

12) Osteomyelitis doesn’t show up for over 3 weeks on x-ray, so doing a bone scan can help you better diagnose.

Fun with the Ren Brothers

13) Your “5 friends” on a chest x-ray are trachea, heart borders, hemidiaphragms and costophrenic angles, and aortic arch. You should also look at the hilum, and pulmonary vasculature.

14) Beware “breast attenuation” on female chest x-rays. The breast tissue can make the film appear more congested.

Note: Photos are of my bestest buds in Dominica, the Ren brothers. Oh how I miss them!

links for 2009-06-19

The Perfect Plan

It’s Friday again. That means that I took another NBME practice USMLE Step 2 CK exam (3rd one out of 4). I totally spanked it. I am teeming with happiness right now. My study plan is working out even better than I had anticipated. I done real good. Anyway, my brain is now fried, so I don’t have anything else to say right now. I promise to write some really good stuff tomorrow, including fun radiology tidbits.

For now, enjoy these two iPhone pics I took today. One of a cute doggy doo behind bars, and another of a discarded tree. Seriously, someone threw away a perfectly good tree!

Doggy behind bars

Discarded tree

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

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