Island Med Student

Yesterday was an interesting day in gastroenterology. It was my last day in the rotation. I can now say without hesistation that I don’t want to be a gastroenterologist. And it’s definitely not because of all the poop. Actually, I just got fairly bored with the “same-old same-old” of colonoscopies and esophagogastroduodenoscopies all day long. I need some variety.

Anyway, yesterday, I got it. I had the opportunity to visit the morgue and see a partial autopsy on a patient who died of metastatic hepatocellular carcinoma. All I can say is wow. I have seen plenty of cadavers in gross anatomy class. Although, they were already embalmed and had died probably months before. Honestly, at the point when I saw them, they barely looked human anymore. And I have seen a few recently expired bodies. But I had never actually seen a fresh corpse be dissected. It was a moving experience. I held his liver, lungs, and brain in my hands. His eyes were open. He actually looked very alive. It was a brand new experience for me, and one that I will forever treasure.

I have always loved pathology, and have considered going into it many times. I really enjoy the investigatory aspect, and I think it’s a fascinating field. However, as I’ve mentioned many times before, I really do enjoy having live interactions with my patients, and this is really not possible in pathology.

But, I’m now planning on doing an elective pathology rotation. I’m sure it will be a great learning experience. The dead really do have so much to teach the living.

Check out my post on Medscape to read my thoughts on actually keeping my compassion once I’m a doctor.

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The pic above was my Easter lunch last month. I ate at the hospital, and as you can see, I balanced my “healthy” option with some “not-healthy” options. I love candy. And one of my most favorite things to do is raid the pharmacies after holidays in search of super cheap leftover candy. My hospital gift shop happened to have a huge variety of super cheap candy, so I splurged a little. Actually, I went back for seconds and thirds.

I don’t have a whole heck of a lot to say right now, but I realized I had not posted in a while, so I wanted to give some updates. I have one week left of my gastroenterology rotation, then in June, I will be doing a radiology elective, and then July 1st I take the USMLE Step 2 CK. I opted not to take any time off to study. I have yet to find out whether this was a good decision or bad.

Do you ever have those moments where you think, “wait, I’m an adult, I can do whatever I want”? It might sound strange, but I have those thoughts a lot. I wonder if I will continue to have them, even when I’m an old fart. Anyway, studying for the Step 2 CK has been like that so far. I have studied and done questions, but I definitely have not hit the books incredibly hard. I know I should. But I just haven’t had the motivation. And I’m an adult. I can study as little or as much as I want to. Today, I studied for a portion of the day, then went to the gym, and have taken the rest of the day off. I guess I keep thinking, “I’ve made it this far, so I must know what I’m doing.” I will study hard when I’m darn tooting ready.

It’s good to be an adult.

Here are some tidbits:

1) What the Discriminate function is (an equation to determine the severity of alcoholic hepatitis).

2) If you see massive, tender hepatomegaly and ascites, think budd-chiari syndrome.

3) What a GAVE (gastric antral vascular ectasia) is, what it looks like, and how to treat it (APC argon plasma coagulation).

5) If you see a colonic polyp < 7 mm, it is malignant less than .5% of the time, but many GI doctors remove anyway (better safe than sorry).

6) What a Klatskin tumor is (cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts).

7) What the Amsterdam criteria are (identifies families likely to have Hereditary nonpolyposis colorectal cancer (HNPCC)).

8 ) If a patient has abdominal pain and eosinophilia, think adrenal insufficiency (and check the cortisol levels to diagnose it).

9) How to perform an abdominal series, with small bowel follow through and do a 3 phase abdominal series (no contrast, IV contrast, arterial contrast).

I’m rather tired now, and don’t feel like writing a long post. But I wanted to let everyone know that I will be posting more “stuff learned” very soon. I really do enjoy gastroenterology.

Last night, Midori and I went on a fun doggy walk/neighborhood exploration/photographic excursion. I have a bunch of awesome pics to post, but I don’t feel like sorting through them right now, so please enjoy this very awesome one right now.

Also, I have a received many comments on my recent Medscape post, “That Is So Gay.” I have A LOT to say about all these comments, but right now I will comment on one item. 20% of people have responded to my poll saying that racist and homophobic comments in the medical setting do not bother them at all. REALLY?! I mean, REALLY?! These are my colleagues. It makes me incredibly sad.

Good night for now!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Since I promised I would update all of you on my “stuff learned” during my gastroenterology rotation, here is a very incomplete list:

1) Hepatitis B seroconversion involves going from Hep B E antigen positiive to Hep B E antibody positive.

2) Hep B is a unique virus in that it’s the only DNA virus that carries reverse transcriptase.

3) Interferon is not used to treat Hep B as much these days, due to the many side effects.

4) For Asians, if they have Hep B core IgG, it can progress to hepatocellular Ca, so you always treat (although you wouldn’t for other races).

5) Alkaline phosphatase can be found in 4 places: liver, bone, kidney and placenta.

6) With extra-hepatic cholestasis, you usually see more symptoms and the bile ducts become dilated.

7) WIth intra-hepatic cholestasis, it’s usually more subtle and chronic, and can be caused by drugs.

8 ) A nuclear scintigraphy scan can detect .1 ml/min of blood flow.

9) Hepatorenal sydrome involves increased amounts of estrogen, which leads to systemic vasodilation, which leads to renal hypoperfusion.

10) You can use Questran (a bile binding resin) to treat relapsing c diff infections.

11) With a paracentesis you want to send the fluid to analyze albumin levels, cell counts, cytology, and gram stain and culture.

12) Blind loop syndrome can occur with diabetic patients. There is decreased gut motility, which leads to increased bacteria, which causes increased folic acid production, and decreased B12.

13) It takes a few times, but eventually you get quite accustomed to the sounds of very loud, long burps and farts coming from your patients.

Check out my post on Medscape to learn about the tragedies I’ve encountered in my clinical rotations. Also (as always) please do fell free to leave comments on the post, as I appreciate and enjoy all the variety of reactions….

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So far, I am thoroughly enjoying my gastroenterology rotation. The butt, poop and fart jokes have also not ceased to be immensely entertaining to me.

I have some “stuff learned” to post, and a lot of other random thoughts. But right now, I am too pooped to write (the hours at the hospital are fairly long). So please enjoy a photo instead. I just took it, and it’s me, Scope, and the duck that Molly just eviscerated and de-eyeballed.

Good night!

It’s finally over. Micah and I just spent the last week emptying out our old apartment in Baltimore, and moving our stuff to my parents’ farm in Luray. It was a lot of work. There was a lot of sweat involved. But we finally got it all done.

Today is Sunday. I’m not feeling so well. But, I have to go in for the first day of my 4 week gastroenterology rotation tomorrow. Actually, I’m kind of looking forward to it. But right now my stomach is killing me, and I’ve had GI distress all day. Isn’t it ironic…..?

Note: Photo is Scope and Molly driving the Uhaul a few days ago. It’s a bad pic, but if you look closely you can make out Molly in the driver seat (of course she’s the one driving, not Scope).