I See Actual Patients Now

In an effort to keep us from looking completely ignorant in a few short months when we start our rotations, our school has implemented a “pre-clerkship” rotation where they show us the ropes for 3rd year in a low stress, low responsibility environment. A group of four students are paired with an attending physician and tasked with seeing a single patient, taking a history, doing a physical exam, and writing a note on the patient. You may recognize this as a pretty routine task in medicine. The reason I mentioned that this is a “low-stress” activity is because we were given 4 hours to do it.

In reality, it wasn’t that bad. The worst part was the walking. My group has two girls in it. One is under five feet tall, the other is maybe an inch taller than my petite wife. The other male medical student is from Kuwait and is maybe 5’8″, and he stands taller than our elderly attending. Now, I am fairly convinced that I am an average sized American male, but at 6’2 and 200lbs I felt like a yeti lumbering around the hospital with this group. It was worse when we all packed into the room, because they seemed to find all of the corners and wall spots, while I was stuck standing in the middle of the room with my head bent to avoid the ceiling mounted television.

That was the worst part. At first I wasn’t even doing anything except taking up space (the only marketable job skill I have after 6 years of schooling, for those of you taking score). I just took notes while one of the girls started taking a history from this elderly guy in the hospital for bowel problems. She started out terrifically, but ran out of steam after asking “So what brought you in to the hospital today?” She starts to flounder and get flustered and look at the floor, and the doctor is helping her along very gently and nicely. So I am slowly jotting important notes, thinking about how lucky I am that I get to be the note taking yeti this week, and the attending turns to me and says “Why don’t you jump in and finish the history?”

So I switch places with the girl, because we both know that his question was more like a command, and I pick up with the history. I know he told me to “finish” the history, but since she had just barely started it turned in to something more like “do all of it while we watch”. I did a fairly good job. I learned some better ways to ask questions, areas I need to focus more on, and in general had a fine educational experience. I feel like this guy was a great patient to interview, because his medical history looked like the table of contents in a pathology textbook. Multiple cancers, cardiac problems, lung problems, vascular problems, a couple dozen operations for a variety of issues. I got to hear all about all of it because the attending wanted me to do a review of systems and explore all positive answers, so that only took like 30 extra minutes. Shockingly, this guy still had perfect vision. Everything else in the world was wrong with him, but at 76 years old he didn’t need glasses or contacts.

So now we (I) have spent an hour talking to this guy and his family shows up for a visit. I am (finally) done taking this history, but the doctor also wants me to do the physical as well. A complete physical. Remember, we are supposed to splitting duties equally among the four people in the group, and so far I’ve done most of it. I ask how much of the complete physical exam we need to submit this poor guy to (pretty sure this guy has had enough stuff inserted into his rectum in the last few days), but the doctor tells me to do “most of it” and then steps outside to take a phone call. I fumbled through “most” of a physical exam, sparing him (and me) the really awkward parts, and we finished up early.

Even if it’s awkward seeing patients when we have little (or none at all) medical expertise, it’s certainly better than studying, which I should be doing right now. I’m looking forward to 3rd year because I get to leave the lecture halls and start seeing actual patients, which is the whole reason I got into medicine in the first place. This particular day was a good example of how we can “fake it till you make it”. When that patients family showed up to visit, they totally thought we were legitimate medical practitioners. All they saw was a group of white coats around his bed. What they should have seen was a bunch of hesitant newbies trying to figure out how to do this whole doctor thing.

Also, I get way better stories in the hospital. It’s hard to blog about studying for 8+ hours a day.

Thanks for reading!

Status Update

It’s been a while. I’ve been absent from this blog for nearly two months now. Shockingly, I still received a couple of messages from people despite my absence. One naive soul guessed that I was participating in NaNoWriMo, AKA National Novel Writing Month. I certainly wasn’t writing anything important, much less a full novel in a month that also featured medical school.

So here’s where we are at right now. I am 4 months and 2 weeks from taking Step 1 of the USMLE, which means it’s time to get my butt in gear and study. Hopefully the irony of me saying this while actively avoiding studying is not lost on anyone. We will finish up our current unit (GI) before Christmas, and then all we have is Endocrine, Reproductive, and Skin/Bone/Joint. Effectively classes end at the end of February, and we all become hermits and study for USMLE, which we take at our discretion (somewhere during April, most likely). After that ordeal is over, we will start our third year clinical rotations at the beginning of May. This means that I am nearly halfway done with medical school!

So the title of this blog is “Highs and Lows” in medical school, and I’m certainly in a rough patch right now. First of all, I have put myself in a bad place by doing poorly on the first half of the GI Module, meaning I need to drastically improve my score on the Final Exam in a few weeks. Unfortunately, it’s the Christmas season, I have lots of stuff I would rather be doing, and it’s crazy hard to study when we have had so many dark, rainy days (I’m a little bit solar powered). The study load isn’t just GI course stuff, which would be time consuming by itself. It’s also Qbank questions for Step 1, and it’s reviewing Microbiology from 3rd party sources (because our Microbiology education was severely lacking), and it’s also working on research, among other things.

Oh right, that might be another thing to mention. Even though I don’t have the faintest idea what I am doing in research (or life, for that matter), I now have my own research project. It’s a super exciting technical paper that has me swimming in PubMed articles up to my ears. I strongly dislike research, but I guess residency directors like it (I can’t see how), so I am spending portions of my already limited time on research now too. Hopefully I get a publication or something to show for it, besides the huge Excel document saved on my desktop.

The ironic part of (nearly) failing my first GI exam is that I really like it so far. I worked in a GI practice for several years before starting medical school, and those GI docs were doing just fine. The procedural aspect of GI appeals to me, the hours aren’t terrible, and it pays decently because you have to deal with everyone’s poop all day. On the flip side it can be pretty competitive to get into and has a long residency fellowship. I actually have done fairly well in GI, but leading up to the first exam I was busy achieving Platinum in League of Legends, finishing a great book, and going through a phase characterized by a deep aversion to studying. Truth is I was a little bit burned out and it came back and bit me in the butt. Oops.

So that’s the take away message from this point. Med school is very much a grind right now, but I’m grinding through it and it’s getting better. It helps that it’s a Friday afternoon and I have the weekend ahead of me to “catch up”.

Lots of good stories to share someday in the future. Hopefully I will get those posted sometime.

Thanks for Reading!

So You’re At Chipotle…

You aren’t quite sure how it happened. Maybe a coworker mentioned something earlier in the day. Maybe you saw sign while driving yesterday. Maybe you dreamed about Mexican food last night, and your subconscious mind steered you here today for lunch. However it happened, you’re here again. You just pulled in to your local Chipotle for lunch. Wherever you are, no matter the time of day, your Chipotle experience will always include these components.

1) The Line

And this is before they open.

So you walk up to the door and find a kind soul holding the door open for you. Just kidding, they are the end of the line. You take a glance inside to confirm that, yes, the line does in fact wrap around the entire restaurant and right out to the door, where you stand. You briefly consider going somewhere else to eat, but in that instance you smell the grill in the back and you know you’re staying. As you assume your position as designated door-holder, you evaluate the line in front of you. Because there seem to be 42 people making burritos behind the counter, you figure you won’t be in line too long. The line seems to be moving well, so you whip out your iPhone. A few minutes isn’t a big deal if there is a delicious steak burrito waiting for you afterwards.

2) The Other Customers

You glance up from your phone a few minutes later, annoyed that the line seems to have stopped moving. People have piled up around the block behind you, everyone looking at their phones and waiting for that sweet, sweet burrito. The problem is at the counter, the place where you choose your salsa/toppings for the burrito. You don’t know how you missed it earlier, but this lady is clearly the bane of lunch rush. She’s reading from her iPhone, attempting to keep the 8 burritos in front of her straight. There are also 6 quesadillas on the grill behind the counter, and oh wait she forgot she needs to order 3 veggies bowls. If you’re lucky, she will pay the total (probably about $580) and collect money later. If you are having a bad day or are exceptionally hungry, she will pay for each order separately with a wad of cash and debit cards that she has collected previously. The person immediately behind this woman is guaranteed to buy a margarita, even if its 11:15am on Sunday.

3) Ordering

Once that lady clears out the line shifts into overdrive. The workers seem to sense customer frustration and go into overdrive. The manager packs an extra dozen or so people on the line. Before you know it, you are finally at the glass. Almost reverently, you order the steak burrito. The kindly Chipotle minion immediately begins warming your tortilla. “White or brown rice?” he asks you. I’ll usually get the white rice, but I’m known to switch it up. I usually prefer white rice because of the nice cilantro flavor….ok I’m getting off topic. “Black or pinto beans?” he asks next. I have a secret theory that not getting beans results in getting more meat on your burrito, but I haven’t been able to confirm that. So I order no beans.

Boom. Out comes the hot steamy tortilla. Without fail, he will look back at me and say “Which rice do you want?” I will be confused because I ordered white rice exactly 8 seconds ago, and he seems to have no memory of our very special conversation. He will then ask which beans I want (which I don’t actually want, remember) and then he has the gall to ask what kind of meat I want! To his credit this was a whole 30 seconds ago at this point, but I very clearly ordered the sacred steak burrito. Even more confusing is when multiple people team up to warm tortillas, serve rice and beans, and portion meat. I will sometimes order at the tortilla guy, who will communicate my order to the next two people. If that happens, all three of them are guaranteed to ask me at least one more time what my rice/beans/meat combo was.

Good Chipotle customers know that there are some rules. First, don’t change your order. That’s just annoying. Don’t ask for more meat unless you are willing to pay to double the meat (which I totally recommend). If they are even slightly busy (which is always) do NOT order the quesarito. It takes forever, and while it is delicious, everyone will hate you. If you order a bowl, don’t get to the end of the line and ask for a tortilla on the side.

4) Toppings

Hungry yet?

This is where the magic happens. You can choose your salsa. You can choose your toppings. This is where a burrito becomes your burrito. If it’s a lunch rush there will be a committee of nearly 14 people working to serve the ingredients on to your burrito, wrap it, and also keep their ingredients stocked behind the counter. At my local Chipotle the last step is always “What vegetables would you like on this?” Careful examination of the pans in this section will reveal the following ingredient: sour cream, guacamole, shredded cheese, and lettuce. There is only one vegetable in that section, and it’s the wussiest vegetable in existence. I mean, you can add shredded romaine lettuce to just about anything and eat it without realizing it’s there. In no world can sour cream be considered a veggie, and while guacamole is undoubtedly the most delicious substance on the planet, I’m not sure I’d include it in a list of vegetables. That would just be embarrassing for the vegetables.

5) Heading Out

Despite the amount of food in your burrito, a friendly Chipotle minion has somehow managed to wrap your burrito neatly in aluminum foil in the time it took for you to reach for your wallet. Occasionally a burrito becomes so filled with delicious stuff that it breaks, which gives you the opportunity to double your tortilla. You can also have them re-wrap it, but do that at your own risk, as you don’t want to be the guy from section 2 above. The burrito wrapper extraordinaire will whip out a sharpie and graffiti your wrapped burrito before telling the cashier that it is, in fact, a steak burrito. The most shocking part is that this side of the counter has a working memory. The guy that heated my tortilla couldn’t seem to remember anything I ordered, but the cashier acknowledges the information and then uses it. Without asking me. The left side of the counter needs to get up to speed with the right side.

Finally, you can eat your burrito. A steak burrito is so delicious it’s making me want to head over and eat one right now. I totally can. It’s not that far from my house. But I’m off subject again.

While I freely admit that I can eat a lot of food when I want to, after my first bite of burrito I usually wonder if I will be able to finish it this time. Then ten minutes later I look down at my empty aluminum wrapper and think “Not this time, burrito”.

I’ve set myself up perfectly to make a Chipotle poop joke right here. It’s perfect timing, and it’s so easy, but I won’t do it. Everyone else can (even Jimmy Fallon, who does it all the time), but I’m just going to end this post and eat a burrito.

Thanks for reading!

*Full disclosure – I don’t work at Chipotle, receive compensation from Chipotle (unless you work for Chipotle, let’s talk. I’ve seen your bags and cups. I could totally write an ode to guacamole). I just eat there every now and then and like it.

sortadrwordpress@gmail.com

The Circus is In Town – Ferguson, MO

After a seemingly endless stream of news articles, Facebook posts, and other forms of media coverage regarding the last week of events in Ferguson, it was finally time to sit down and hopefully expose some of the truth that has been washed out by glare of the lights of national media. There is more to this story than most people realize, and there are so many issues I want to address that I am going to go through this whole thing chronologically, supplementing with Facebook posts from my own news feed. I have also included several videos in this post, which you should not watch if you are offended by violence, language, or poorly shot iPhone footage. I will warn you again before we get to those videos. This post is also long, because this whole thing makes me angry. Grab a drink and let’s get started.

1) The Shooting

We all know this part of the story. Last Saturday, Darren Wilson shot Michael Brown in Ferguson, MO. I won’t rehash this, because we all know what went on that day and everyone has their own opinion. I’d like to point out a few facts that people seem to be missing. First of all, the robbery that went down immediately before he was shot happened at 11:50am on a Saturday. How many crimes are committed before lunch on a Saturday morning? This guy walks into a convenience store, grabs some Swisher Sweets, and walks on out in broad daylight. 

So when he is confronted by an officer just moments later, something happens that results in him dying from multiple gunshot wounds. The preliminary story is that he is shot multiple times in the back, with a final killing shot to the head. Some witnesses report that he was even on his knees in surrender, and the cop executed him right on the sidewalk, because that sounds like something most cops do on Saturday before lunch. Despite the obvious problems with this story, it was nevertheless the story than ran during the early parts of last weekend. Michael Brown, a gentle giant, a boy scout volunteering for his community, mercilessly murdered by evil cops.

brown robbery stroe

Then other parts of the story started coming out. We saw the photos of him robbing the store (above). We heard that he had marijuana in his system (that fact doesn’t really matter, actually. Marijuana is metabolically detectable for weeks after use, and the swisher sweets he stole are very commonly used to roll blunts, so that’s all fairly straightforward). Then we heard the cops side of the story, and realized maybe he was being attacked. In fact, maybe his orbit was fractured during the encounter. Then the autopsies came out and showed that he was shot in the front, not the back. 

Of course, this all happened days later. While we waited for all of this, we had to deal with:

2) The Protests

Ferguson is a rough part of the world. Poverty, crime, gang and drug violence are all unfortunately common. So immediately following the shooting, we saw the beginning of the protests, with the familiar “Hands Up, Don’t Shoot” chant that became so popular. This is the part of the story where I can really understand the protests. This young man is shot, and it symbolizes the harsh and unjust realities of their lives, so they start protesting. This is a community mourning the death of a young neighbor and protesting against the circumstances that brought it out. 

Then things got crazy. National media start showing up. The protests turn violent, with people looting their own businesses, burning down the convenience store that was robbed, and the whole environment turns dangerous. This is the part I don’t understand. If you are angry enough to go out and protest, why would you ever begin to loot and destroy your own city? There’s a video linked farther down in this post, where a man sits outside a business and tries to dissuade looters by saying “I need to live here. My son needs to live here. Why do we need to do this?” Days later when the initial autopsy comes back and the world realizes that Michael Brown wasn’t exactly a boy scout and maybe we should think about this differently, the protests continue regardless.

So there’s a few things I want to mention here, at least regarding the autopsy. The first autopsy was performed by Dr. Mary Case, the St Louis County Medical Examiner. To say she is a capable professional is a gross understatement of her abilities. She is a well respected physician, both nationally and internationally. Her autopsy was the first to reveal that he was shot in the front of his body. The family requested another autopsy, and the government wants a third. This won’t change the findings at all. If Dr. Case said six wounds, the man had six wounds. The second autopsy came out and confirmed. This isn’t a game of interpretation. Medical pathology is pretty precise. If they continue to request autopsies, the body will decay to a point where by the 15th autopsy the quality of the exam will be so low that some schmuck will come back and say “You know, there could be 10-20 shots here, but it’s hard to tell because he is actively decomposing in my morgue”. The only pertinent part of this story we are still waiting on is medical toxicology, which should be another 4-6 weeks. It would not surprise me at all if some Doc comes out in six months at a trial and tries to sell us some alternative story, but it will basically be fiction at that point.

So back to the protests. The news channels are showing everyone pictures like this. 

And not showing you clips like this one (don’t watch if offended by language). That’s the kind of unrest that is happening every night. 

3. Where We Are Now

So my nightly routine of watching Jimmy Fallon has been interrupted by the Ferguson coverage, so I’ve seen essentially every single minute of local news on Ferguson. First of all, the number of protesters over the last few nights is very small, and they are dwarfed by the swarms of media members lined up on the sidewalks. In fact, last night each reporter probably could have been assigned their own individual protester to interview, with a few left over to film the police. 

Second, we’ve got all of these people from out of town. Al Sharpton is here. The New Black Panthers are here. A group of Tibetan monks is here and actually helping out. New Communist Party members are here. Why is everyone here? Because the circus is in town. Every night the police gear up, the protesters head out to do their thing, the media turn their cameras on, and the stage is set for a lunatic to do something really dumb and create a bunch of headlines. None of this is about Michael Brown, at least not anymore. How do I know? Because kids in Ferguson can’t go to school yet. Because Ferguson is getting lit up by news cameras every night so that people can throw rocks, yell and shout, and get arrested, all on camera. I bet you all of the money in my wallet ($4.75) that if the press goes home, the violence goes away.

4. Everyone Has Their Thing

So everyone reads this story, or sees the video, and uses it for their own thing. Even this article from Time manages to slip the racial factors in this case into the very first sentence. I have a friend on Facebook who posted stuff like this for days after the shooting, because his “thing” is hating the police.

Photo: "There's a reason you separate the military and the police. One fights the enemies of the state, the other serves and protects the people.  When the military becomes both, then the enemies of the state tend to become the people." - William Adama http://illmethodology.com

“Pictures with quotes them form the backbone of intelligent knowledge.” – Me

Based off of his news feed and the opinions of many, the problems in Ferguson are entirely the fault of the police. The only reason a cop would shoot a person is because they are mindless, barbaric, and also have a quota to shoot people to keep the population repressed, because that’s a thing. 

Remember that picture from earlier? Did you see how big Michael Brown was? Can you see why Officer Wilson might have felt threatened? If not, try to stop picturing a cruel hearted officer with a gun that he uses to cap thugs on the weekend, and instead picture him as a normal guy with a wife and kids and a job that makes him work nights and weekends. He probably has a dog and a lawn to mow. 

I’m purposefully not answering the question “Why did he have to use his gun? He should have used his taser! Or his nightstick.” I’m not answering that question specifically because I’m not in that position. I am not going to indulge in the intellectual ignorance it takes to sit on my couch and write on the internet about how that cop made the wrong decision, in the heat of the moment while Michael Brown came at him. Here’s the facts that matter though. Most cops go through their entire career and never shoot anyone. If a cop does shoot someone, he is immediately placed on administrative leave and an investigation is conducted. Even if he shot a serial killer that was actively threatening a troop of girl scouts, they still do an investigation. As a society, we have decided that our officers can carry firearms, so it should not be a surprise that they occasionally use them. As Kevin Hart so brilliantly explains, your risk of being beaten by the police can be easily modified by your own actions (don’t watch if offended by language or hilarious comedians). I am well aware that cops are capable of going too far, I’m trying to illustrate that this is an exception rather than the rule.

The police are also not militarized. Thinking that they are is just ludicrous. Let me show you a picture that popped up when I Googled “Ferguson Police”.

Looks like they’ve got some pretty crazy stuff there, right? I mean, those aren’t police cars. That’s some gear! They are militarized! First things first, this isn’t their stuff. It belongs to the county of St Louis, which got it from the Pentagon, who gave it to them because of a grant program that provides equipment to cash strapped police departments who may at some point need to respond to masses of potentially violent people while keeping their officers safe. Ironic, right? At least they can use it. The alternative is a mob of protesters actually succeeding in injuring or killing an officer, causing the cops to get angry and fight back, creating an actual Battle of Ferguson. At the left we see a converted ambulance, and some sort of tactical Jeep looking thing on the right. The officers are all protected by Kevlar vests and helmets, and armed with Airsoft guns (not all of them, calm down and don’t email me). The man in the front is armed with a menacing row of zip ties. The point I’m making is that they have acquired a bunch of specialized equipment whose purpose is to NOT KILL PEOPLE, making them the least effective military group in the world. If you get bombed with tear gas, you will not like your life. It is a severe irritant to your eyes and throat, and it will very much make you want to leave and rinse your eyes. Just like it’s supposed to. My same friend who graced the world with that picture up there also posted a status about how the world had somehow banned tear gas use in armed conflicts because it was inhumane (it made no sense, so I can’t really help explaining that). It was not long ago that Syria used Sarin gas on its population. Sarin gas will make you die a painful death. Keep things in perspective here people. There are people who legitimately want to kill cops, so this stuff is as much for their protection as ours. Second, they don’t cruise around on Sunday evenings in this stuff. They only drag it out when, for instance, crowds of angry people are throwing broken glass bottles at them.

military soldiers in combat

I included this image, which popped up when I googled “combat soldiers”, to contrast with the picture above. You will notice significantly more ways for them to kill people, and significantly fewer zip ties.

On to the next thing that makes me mad. Apparently I committed a crime earlier in my article. Indeed, by showing you the picture of Michael Brown robbing the convenience store, I am participating in the character assassination of Michael Brown. Yes. The Ferguson police are staging a campaign to make Michael Brown seem like a bad guy, some sort of evil human being. This isn’t character assassination, it’s evidence. Let’s flip this situation around and look at it the other way. Video surfaces of Officer Wilson beating up a kid a few days before the shooting. What happens now? When that video comes out, is it character assassination? NO WAY. Now all of the news channels (and CNN) are running stories on how this sets up a pattern of behavior for Wilson. Maybe he was unstable, but either way he was prone to violence. Also, news coverage is always leveraging their choice of words to insinuate different ideas. When USA Today reported that “….Darren Wilson, a white police officer, shot an unarmed black teenager six times…” they are shaping the way you read that. First, is six an unreasonable number of times to be shot? Nope. If you think yes, you need to spend some time around people who actually know about guns. There is no “bullet quota” for officers. The algorithm is simple. If you need to shoot, you shoot until you don’t need to shoot anymore. That could be 1 bullet, or it could be 10. Also, that headline adds the angle that somehow the fact the Brown was unarmed means he was not threatening. There are many reasons why Brown, who was a pretty hefty man, could possibly make a police officer feel threatened (especially if he fractured his orbit)

The last thing that annoys me here is the media coverage. This isn’t about Michael Brown anymore. This is about agendas, and the truth that will surface in six months doesn’t matter nearly as much as the angle that can be spun to advance an agenda today. The faster the news is breaking, the more likely it is to be wrong. I can’t even begin to count the tweets that have prematurely reported more people shot, stabbed, killed, arrested, or looking weird that ended up not being anything. This is an issue bigger than Ferguson, or even bigger than just our generation. The conflict brewing in Ferguson is deeply rooted in history, and I don’t trust a journalist with an iPhone and 140 characters to accurately tell me anything except whether or not the sun is shining.

Finally, the ultimate message here. Nobody is winning. Do you understand that? You may be on Michael Brown’s side, convinced he was executed in broad daylight for being black. You may be convinced he was a some sort of lowlife that somehow deserved what he got. Either way, the resolution of this issue isn’t ever going to be “my side won”. At least it shouldn’t be. Before Michael Brown was Trayvon Martin, and there will be another after Michael Brown. We live in a broken world and we have to deal with a broken system, but it’s the best system anyone has come up with for a long time, so let’s try to make the best of it. I doubt that this tragedy will somehow singlehandedly fix the problems in Ferguson and America, but I hope that this horrible event becomes a defining moment in someone’s life. I hope that person dedicates their life to their community and through their leadership changes the world as we know it. 

Thanks for reading.

sortadrwordpress@gmail.com

 

The Hardest Day

Second year has started off with a bang. If you are paying attention, you’ll see some crazy stuff in any medical school. Whether it’s an official lesson, or people watching, or patient encounters, or something you learn on accident while researching something else, there will surely be something to learn. Recently we had a deep lesson that I wanted to share, but first I need to set the stage.

All of the MS2 students are packed into our lecture hall. This isn’t the nice, new lecture with comfortable chairs that we used last year. This is the older lecture hall that doesn’t have enough seats for the whole class, the one with the terrible chairs, and the one with not enough room for your laptop and anything else on the desk. There are students standing in the back, and everyone looks sharp because we all are wearing our white coats and professional clothes.

On stage are six people. Standing at the podium is a Pediatric Hematologist who is running the event. She has a very serene demeanor, but seems to radiate strength from her small stature. Sitting at the table on stage are 5 others. There is a couple in their 40’s. He is lean and tan, with the muscle tone and hands of a construction worker. She sits next to him, well dressed and confident, if somewhat anxious. Another lady sits next to them. She is African American, somewhat heavyset, with a joyful face, floral blouse, and somewhat excessive afro. Next to her is an elderly little lady with thin gray hair and a stooped posture, and she is in deep conversation with the woman beside her, who is wearing scrubs and has two phones and a pager.

This is a lecture panel on handling the death of patients, specifically children. The couple on the end lost twin boys, their 5th and 6th children. The first died before being born. The second lived for 10 months, but had a debilitating matrix of health problems and lacked any ability to develop. The lady next to them had a daughter who developed bone cancer at age 11, which metastasized to her brain and took her life when she was 13. The older was a chaplain, and the last lady was a NICU nurse. Everyone was there to talk to us about handling death.

Most learning in medical school is very clinical and sterile. We learn about our bodies from distinguished looking old professors who wear white coats and use technical language to describe anatomy and physiology of organs and diseases, of which they are experts. That approach is obviously not practical when talking about handling death, so we learned from “experts” in their own way, people who had gone through this and were willing to talk to us about their experience.

I don’t like thinking about death, and I don’t think many of my fellow students do either. We are all young and vigorous, filled with the energy and optimism of youth. In my mind, death is something far off. It’s not that I’m scared of it, I just prefer not to think about it. I have been very fortunate to have made it this far in my life with living parents and grandparents.

This forum was not the first time that I had focused my heart and mind on this idea of death, and current events will tell you why. On Saturday evening the violence in Ferguson, MO erupted after a young man was shot and killed by police. Even as I write this tensions remain high, with protests and heavy police presence keeping the conflict in the national spotlight. It was only a few days ago that the world was shocked to discover that Robin Williams had ended his own life. Violence in Iraq and the Middle East have created a summer that will go down in history as a violent, restless summer.

I don’t want to talk specifically about any of those subjects listed above, at least not in this post. Instead, I want to talk about dying. The way someone reacts to death will tell me a lot about the way they view the world.

Death is a part of life, just like birth. Everyone is born, and everyone will die. What we do in between is what makes the difference. Death is also a great equalizer. I learned this lesson at a young age helping my dad clean our boat after a day on the lake. He always said that the boat ramp was the great equalizer. At the end of the day, everyone comes back to the ramp and goes home after a fun day of boating. It doesn’t matter how big your boat was, how big the truck you used to tow it, or how many fun inflatable things you could pull behind your boat. At the end of the day everyone comes back to the ramp sunburned and tired, and everybody had fun.

So when we die, as we know we will, we are all equalized again. Your influence, your money, and your responsibilities are all lost and left behind. What happens to you after you die? What or where do you think you will be after you die? Some believe that death causes you to cease to exist, but I find that hard to accept and impossible to believe.

The hardest part of the last few weeks has been actually organizing my thoughts on this matter. It’s not easy to do, when my cell phone keeps ringing, emails keep arriving, and the world flies by on my laptop screen. It’s easy to ride the wave of now, caught up in an endless progression of thinking about what happens next. Thankfully, I found the time to take my dog to a local state park and hike. So it was there that I hiked miles from any road, on trails not commonly traveled, and sat down for a water break. The sun was high in the sky, coming through the trees to turn the world green. Except for my trampling feet, the world was perfectly still. So I sat there for a long while, and I’m glad I did, because that’s how I was finally able to write this.

Lastly, I wanted to leave with the words to a poem. It was written in the 1600’s, but people then died at the same rate as they do now, and the words speak to people today just like they did 400 years ago.

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die.
Thanks for reading!

How To Be My Favorite Teacher

I wrote this post several years ago for a different blog. In talking to some friends tonight, I was inspired to dig it up, re-polish it, and publish it again. I still think the idea is great, and I hope to teach at some point in my future. I think this idea works, and it’s fun to talk about. So here we go. Gamification. 

Gamification is not a word I just invented. While it is a newer word (first coined in 2002), it is a real thing.

If you try to gamify something (ok…I may have made that one up), you apply gaming principles to something that is not a game in order to create a better experience, enhance participation, or make something more enjoyable for others.

You may be familiar with many of the modern applications of gamification. Achievement badges, leaderboards, challenges, and progress bars are all common examples. Many iPhone apps have these features to keep you playing (talking to you, Farmville). Every xBox game comes with a list of achievements to unlock, intended to encourage players to continue playing the game even after they have beaten it once or twice.

Turning chores into a game certainly makes them more entertaining. Why not teach classes in the same way? Please don’t tell me that college courses currently place an emphasis on attendance and participation. As a system, the college lecture format is dated and often amazingly inefficient (especially considering the price many students pay to attend college).

So here is my idea. I am going to pretend that I am a Chemistry professor, teaching a class called “Introduction to Chemistry” for incoming freshman science majors. I have 400 students in my class. The class teaches basic chemistry, and most of my students will continue to take harder chemistry classes later in their academic careers, so I can assume they are at least reasonably motivated to do well in this course

I will format my class somewhat traditionally:
5 Tests x 100 pts each
5 Quizzes x 10pts each
5 Pop Quizzes x 10pts each
5 HW Assignments x 40pts each
1 Final @ 200pts.

=1000 points total. In my experience as a science major, this is a fairly common syllabus. Here’s where I change it up. I will also distribute a “Game Card” to each student. I would probably create a point system called “moles” or something dorky like that. You could achieve up to 100 mole points in the semester, perhaps. Some you can get automatically, others would require direct effort. At the end of the semester, your mole points are converted to extra credit points. For the math wizards, that’s 10% extra credit available for free. A whole letter grade.

How do you get mole points? Stuff like this..

Attend Office Hours and Ask Questions- 5 Mole Points
Most students will never attend office hours and ask for help, but will instead futilely struggle, search the internet, and ask friends. I’m no expert, but I bet that getting individual help from a professor will improve classroom performance.

Achieve 90% or Greater on an Exam- 10 Mole Points
This rewards students who perform well. It offers a clear motivation to excel on exams. You could argue that students who receive this achievement don’t need it, as they are already smarter than the average bear. I argue that a C student could conceivably study hard, get a 90%, and would deserve a 10pt bonus for his effort. Also, see next achievement.

Improve Your Test Score by 10% or More -10 Mole Points
This one is not for the smart kids. If you scored a 94% on my first exam, you got the previous achievement and don’t really have hope for this one. For the C student above, who maybe got a 75% on the first exam, this doubles the incentive to buckle down and perform better on the next test.

Other incentives could include activities like writing a short report on a current research topic that you find interesting, exposing the student to some practical applications of their studies while forcing them to take some initiative and break new ground. Scheduling an appointment with a tutoring service (if the school supports one-mine does) during the week before a test will help their test score and increase retention. Other “achievements” would reward class attendance, for example, or perhaps encourage participation. I thought about including one that would reward students for finding an error that I would purposefully include on the slides each week, so that they are encouraged to ask questions and think critically about what I write instead of blindly memorizing it.

The weather is awful, can't go to class The weather is beautiful, can't waste it in class  Lazy College Senior

There is a valid argument against my little game I created. Students would need to have a level of motivation and achievement to do more than just immediately lose the “game board” I gave them on my first day of class. Also, the teachers likely to implement this game would be good teachers already. They would teach dynamically, interact with students, and have their own ways to implement all of the same things I am attempting to do with my game. 

I think that’s fantastic. Maybe they use part of my games, maybe they use their own system. Whatever. I think that a system like this (or similar to it) would improve the classroom experience for teachers and students alike.

Facets of gamification are already working. The Khan Academy incorporates these ideas into their online lessons. At the end of the day, doing your chemistry homework will never be as fun as playing real games, pursuing hobbies, or spending time with friends. If these ideas will give people extra motivation, and if that extra motivation translates to academic success, then I think they are worth pursuing. It may not be incredibly fun, but there are much worse games to play.

P.S. I first published this in 2011, so the Hunger Games reference was less dated. Also, I think I am a better writer now, but I’ll let you decide.

Year 2 Is Coming

I can feel the beginning of MS2. It’s lurking in the not-so-distant future, just over the horizon of next weekend. The funny thing is, it feels just like MS1.

Last Sunday was the white coat ceremony for the new first years. This week has been orientation week for them, which mostly means that they are drinking for free as a group at various locations around our city. Honestly, it was probably the most exhausting week of first year, just because you go to stuff from 8am-midnight every single day, surrounded by people you don’t know. Next week they will show up and start where we did, at Molecular Biology. Next Monday I also have to show up and start with Cardiology and Bedside Diagnosis.

So why does this year feel so similar to last year? First of all, the weather has been deceptively nice. With the exception of today’s non-stop rain and thunderstorms, we have had an abnormally cool summer. I live in a part of the country where early August brings scorching heat and stifling humidity on nice days, and intolerable misery on the rest. Thankfully, that hasn’t happened yet.

Secondly, at this time last year I had just moved here to start medical school while my wife stayed in our home city for a few weeks to finish her job and transition to a job out here. Remember, she is the one that works, makes all of our money, and buys Chick-fil-a. Well last week she ended up accepting another position, one with significantly higher salary and great potential for future raises and advancement. The downside is that she can’t start until August 25th. Because we just went on vacation and the mortgage company doesn’t care about where the money comes from, she ended up going back to work for her old company while they pay her a hefty “consulting fee” for the next three weeks while she helps them catch up on overdue projects. This works out really well for nearly everyone, except I’m living by myself for the next three weeks, just like last year when medical school started. (Because it actually hasn’t started yet, but she is already gone, my dog and I have spent a very slow, rainy day watching the rain and reading and playing video games.)

I’m secretly excited to kick off Year 2. This “year” will actually be over in March, at which point we will all go hibernate and study for Step 1, the first part of our board exams. After we pass Step 1 (nearly everyone passes it, but higher scores are important for residency down the road) we begin our 3rd year clerkships. Despite 3rd Year’s reputation as hell on earth for medical students, I’m beginning to look forward to it just to get out of the lecture hall and back into a hospital.

I didn’t accomplish a whole lot this summer. I think I blogged a little, and I ate a lot, but really that’s about all. The only really productive activity was tutoring online for money (it’s a thing, look it up) and working on Qbank. Medical students instantly know what I mean when I say the word Qbank, but I need to offer some background for my other readers (and Mom). Qbank is an online database of approximately one billion sample questions that could theoretically appear on Step 1. For medical students, Qbank is a primary tool for scoring well on Step 1. I have tried to do Qbank questions every single day, and have failed miserably, but I am getting better. First of all, I don’t actually know a whole lot, especially when it comes to organ systems, because we are going to learn that this coming year. The only system we have covered is Neuroscience, which I just barely passed. Second, Qbank will ask detailed questions about areas in which I have very broad knowledge. One question asked about a disease affecting newborns, options A-E were all diseases named after people, and I didn’t know even one of them.

The most humiliating part is that they have the data on how many students get that right, then compare your performance to the average right after you submit your answers. When my “Percent Correct” part of the graph is dwarfed by the “Student Average” part of the graph, I usually feel terrible and consider applying to law school. (Just kidding I could never do that)

Anyways, I’m improving at Qbank, and by the time I finish next year and do my studying for the boards I think I can perform well. 

Importantly, medical school provides the fuel that helps me sit down and write, because I get to do all kinds of crazy stuff on a weekly basis in medical school. Stay tuned, because Chapter 2 of Medical School is about to get underway.

 

P.S. No pictures in this entire post. Sorry about that!