Everything is Terrible on No One Knows Anything

Just kidding. When I thought about one sentence to sum up my third year of medicine so far, this is the first thought that came to my mind.

I haven’t written a single post in 6+ months. I’ve been pretty busy, but also extra lazy, and that combination doesn’t usually produce any meaningful posts. In my defense, there are at least 3 half finished drafts from those months that are mostly coherent, so I was making an effort to get stuff posted.

So while I intend to publish my “Survival Guide for the Clinical Years” very soon, I need to write a quick update of what I have done so far with my life as a clinical student.

OB-GYN:

I started out energetic, bright-eyed and bushy tailed on the OB-GYN service. Specifically, Labor and Delivery. We split our shifts between nights and days, working 12-14 hours per shift depending on how crazy the hospital was. I finished with rotations through Gynecologic Surgery and Gynecologic Oncology. I also pulled a rotation through the Emergency Room, but that’s a whole different story.

When I started medical school, the only thing I knew for sure was that I would not be a gynecologist. Much to my surprise (and disgust) I ended up liking this rotation quite a bit. I did completely horrible on the shelf exam because I broke Rule #1 of Being A Medical Student (more on that later as well), but I ended the rotation relatively happy.

Spoiler alert: I didn’t actually like Obstetrics or Gynecology. I liked being out of the classroom, I liked working with patients, and ultimately I liked the surgery that I was exposed to during my Oncology and Gyn Surg rotations. I just hadn’t figured that out yet.

Thankfully, my OB experience was pretty good. Because the hospital I worked in served a portion of the population I refer to as “Hoosiers” (not the basketball team….this is more like People of Walmart), I came away with a lot of great stories and met a lot of really cool people during the rotation.

Pediatrics:

This rotation is split into two halves. First, I spent a month on outpatient pediatrics. This was a total vacation since I had just come across town from 14 hour OB shifts and it was mid-summer, so outpatient visits were not exactly popular with kids on summer break. I often had the afternoon off to “study” and “read”, which I sometimes did. My second month was inpatient PEDS, working with the floor teams in our incredible, top notch children’s hospital. This was a great two weeks. My hours were reasonable (60 hrs a week, cover one day per weekend and one call night per week), and I had a lot of time to study. I have never had any intention of being a pediatrician, but kids are great and the vast majority of the pediatric doctors are incredible people, so this rotation was awesome. It helps that our pediatric hospital has an incredible cafeteria and nice facilities.

Surgery:

Disclaimer: surgery was easily the worst rotation I’ve experienced, and I think I will probably be a surgeon. This will take some explaining in a future post, but the main problem with surgery is that the actual surgery is awesome, but being a medical student in a surgery department is horrible. Surgeons have spent years cultivating bitterness and hate, combined with huge egos and fueled with long hours and crushing call schedules, and medical students (with our bumbling incompetence) are ideal targets for their scorn. Even if we aren’t abused directly, it tends to roll downhill from the attendings, the residents, the nurses, the janitor, or really anyone can then turn and yell at the medical student. Since we exist at the absolute bottom of the totem pole, there’s not much we can do about it, besides the usual crying yourself to sleep every night, but that’s par for the course. (just kidding…..a little)

My surgical experience was widespread. I did my first two weeks with this insane surgical oncologist who averaged about 6 words and maybe 3 emotions per week while operating 40+ hours each week. He managed this by doing 16 hour cases back to back on Thursday and Friday, then biking all day Saturday while we took call. The surgeries were “fascinating” and “interesting” (read that also as “exhausting” and “mind numbing”). Next up I did Orthopedics, which I loved and was literally the best possible rotation for medical students (all operating, no notes, no scut work), but that will get its own post down the road as well.

Next up was my trauma rotation. Important context is that our hospital is a Level 1 Trauma center serving an urban city center and about a gazillion square miles of rural farm country, so we see absolutely everything. Our trauma service is nationally recognized for being top notch and absolutely insane. We use a fun internal grading system on trauma to describe the severity of a trauma. On this scale, a 4 is something like scraping your knee. I’m not even sure what a 1 is. The only guy that got a 1 was shot 8 times and died before he made it to ER. We had a guy drive up to the doors and walk in the lobby with a 10 inch knife sticking out of his chest and he got a 2. We had another guy shoot himself in the face twice, bleeding out of every cranial orifice, and he also got a 2. Trust me when I tell you that this place is absolutely insane.

I learned a ton on trauma because I was the only medical student helping a service of 50+ patients with just one intern and one chief resident. I was able to act as a pseudo-resident and do all kinds of fun things (medical students don’t get to “do” a whole lot, sadly). I don’t know if I ever worked as hard as I did those two weeks, but I got an amazing review and recommendations from my team and realized how rewarding trauma can be. I also realized how exhausting it can be, and how difficult it will be to manage trauma responsibilities with family and having a social life as an attending someday in the future.

I finished with two weeks in Urology, which I liked quite a bit. I liked it so much that I did an additional three week elective in Pediatric Urology, as I thought I could be a good urologist someday, but I ended up deciding against it. This week I will finish up the final week of an elective and head to a nice break for Christmas, with Psychiatry and Neurology on board after the first of the year to get me started. I have a lot of other posts I need to write, most of which will include pictures and be a little more detailed. It continues to amaze me that people still read this every day even when I don’t post for months at a time.

As always, I’d be interested to hear from you at sortadrwordpress@gmail.com

 

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Let’s Talk About Mormonism

Before I launch into this post, I need to share some background info. Several years ago I made several new friends, and I realized that they were Mormons as I got to know them better over time. I was given a copy of the Book of Mormon and invited to lots of church events. Because I am a curious person, I gave it a run for its money. I read the book cover to cover, visited the website, talked with Mormon friends, etc. The product of that research has come to completion in this piece, which I hope will find its way to Mormons around the world. I know that my little blog doesn’t reach a huge audience, but I hear rumors that there are literally hundreds of people on the internet around the world, and someday this might make a difference in someone’s life. My goal is to describe, in some detail, my impression from the results of my research into Mormonism. I give full permission to anyone who wants to link or distribute this article for educational purposes, so long as they send me gift cards for Chipotle.

I’m going to break from my normal writing style and include links and references, although most of this stuff is common sense. In my experience talking to others about religion, we usually end up talking about really hard stuff. Why do bad things happen to good people? Is there a God? Are we created, or did we end up here as a result of random cosmic chance? These are tough questions with definitive answers that are either unreachable or shrouded deep in the recesses of history. Mormonism, in comparison, is a piece of cake. Because it started in the 1800’s, there are lots of primary source documents, easily attainable online, that spell out the origin of Mormonism. This post is longer, so grab yourself a drink and let’s get started.

1) Joseph Smith Was a Shady Dude

To quote Gordon Hinckley, “Our whole strength rests on the validity of that [First] vision. It either occurred or it did not occur. If it did not, then this work is a fraud.” He is referring to the initial vision Joseph Smith claimed to have, the one which drove him to find the golden plates, translate them, and establish the one and only true church on the face of the earth. So obviously we need to take a good, hard look at Joseph Smith.

There he is.

Before we even talk about the First Vision, let’s acknowledge that as a young man he used seer stones to find buried treasure. He didn’t just do it for fun, he actually convinced people to pay him to treasure hunt. Now lets fast forward a bit, past the whole First Vision account. Joe has founded this religion, which has relocated to Ohio. A traveling salesman comes buy, selling Egyptian scrolls. Joe decides to buy the scrolls, as he is convinced that they are written by Abraham himself. Let’s ignore the incredible leap of imagination and assume that a traveling salesman in 1830’s rural Ohio really is selling Egyptian scrolls actually written by Abraham thousands of years ago in a language that Joseph Smith can translate. Joe translates these scrolls into the Book of Abraham, and it is later canonized into Mormon scripture. Well, after a couple decades go by, it just so happens that we discover the Rosetta Stone, allowing us to actually translate the same Egyptian that Joseph Smith translated from this scroll. Turns out that his translation is completely, objectively wrong. The original scroll was actually like a guide to burying someone in a pyramid and had absolutely nothing to do with Abraham. I mean, I’m not saying he made it up just to publish weekly installments into a newspaper that he also happened to own……ok yes I am.

Knowing that Joe’s vision is sandwiched in known instances of him lying to take advantage of others makes the First Vision account even more important. It could be possible that he lied those two times and everything else really was from God, but it would take some extraordinary evidence to somehow confirm that. Because this section is full of problems and I have places to be, I will reference you to this well written account that takes these questions into more detail. Basically, problems around the First Vision and his subsequent translation of the plates include, at minimum, the following. There are several accounts of the First Vision, and they don’t really match up. When it comes to the golden plates themselves, it turns out that no one really saw them. Even Martin Harris admits that he only saw them with “spiritual sight”, which you may recognize as being different than “actually seeing them”. Joseph Smith was unable to retranslate the sections that Lucy Harris took, which he should have been able to do if he was in fact translating. The plates no longer exist (if they did at all), so we have nothing to compare the translations. Joe didn’t even translate from the plates. He looked into a hat and used his seer stone. I’ll ask the obvious question here: if God or Moroni or whoever went to all of the trouble to hide the plates for a thousand years just so Joe could find them in his backyard, why didn’t he actually translate from them? The church doesn’t like this idea very much, so they print lots of pictures depicting the translation like this:

From official church publications

When it actually happened like this.

I feel inspired already

Joseph’s “translation” and subsequent revelations then brought about practices that were not Biblical and made no sense. Polygamy is a great example of this. Joe claimed he received it as a revelation from God himself. The reasoning is unclear, but the most common reasons I hear from my Mormon friends are pathetically inadequate. One thought is that it was commanded for reproductive reasons, specifically population growth. This doesn’t make sense because he married women that were already married, and women can’t be doubly pregnant (I think. I haven’t finished med school yet so the jury is still out on this one). Another idea is that because entering the celestial kingdom requires a sealing to a Mormon man, marrying more women will allow more them to enter the Celestial Kingdom. This idea of eternal marriage is not found anywhere else in the Bible, is unique to Joseph Smith, and still doesn’t make sense because he married women who were already sealed to other men. To boil this down a little bit, Joseph Smith received a revelation from God Himself that he was to bring about a new institution called plural marriage, overturning all religious and social norms, and that his first step should be to have sex with his maid. He went on the marry more than 30 women, some of them only 14 years old (this LDS essay hilariously describes her as being “several months before her 15th birthday).

Yes, honey, God appeared and told me to sleep with the maid. He sure did.

The Book of Mormon itself is slow. After I read the whole thing, I realized that it was written exactly as if it was being made up on the spot. Over and over again, he writes “It came to pass”, “notwithstanding”, and “wherefore”, including the inspirational “It came to pass that a long time came to pass”.

Much of the actual content covers ancient North American civilizations. The Lamanites, Jaredites, and Nephites supposedly established cities, cultures, and trade routes all over North America. Ether 15:2 references a battle in which 4 million people supposedly died. Moroni 6 references a battle in Upstate New York where 100,000+ people died. He writes about cities with stone walls, chariots, spears, horses, and armor.

Bam. Nephites.

We have not found any of this. The lack of archaeological evidence for these people groups is shocking. If these groups existed right here in our backyard, surely there would be something (anything) to get people talking. Instead, there is an enormous void. This article sums up the problem nicely. There is no solid evidence from any scientist to actually support the Book of Mormon as a historical document. It’s embarrassing, really. My Mormon friend said “Well, how much do we know about ancient Aztecs, or Incas? Later civilizations came through and destroyed evidence of their culture”. Yes, but we still know they existed. At least they are known to have existed at a certain place and time, with some insight into their level of civilization and culture. And that’s way more evidence than anything in the Book of Mormon. Let me put this in perspective. If we can find the remains of a couple thousand 3rd Century Roman soldiers in Germany, why can we not find a North American battlefield where four million people supposedly died? Like I said, embarrassing.

2) The Church is Shady Today

How much money do you pay to the church? 10% for tithe, plus fast offerings, and probably more for miscellaneous things, right? Your children go on missions, you help out with church functions, donate extra for special occasions. Good for you. So where does your money go? If you answered “The church uses it to feed hungry children around the world”, I may have some bad news for you.

Hint: These kids don’t get the money.

First of all, the LDS church is hilariously secretive about its finances. Bloomberg used church sources and church statistics to do some calculations, and they are not impressive. According to the church itself, $1.3 billion was given in aid from 1985-2010. That is a big number, but they admit only a third of it was cash, the rest was volunteer hours and material donations. Also, it’s a tiny fraction of their income, which is estimated to be around $8 billion per year. This makes their donations to charity a pitiful 0.7% of their income, and that estimate is probably high due to the fact that the statistics came from the Church itself. You have probably lost that same percentage of your money to your washing machine. I spend way more than that on Chipotle.

I know the church demands financial accountability from Mormons. I know it’s part of the temple recommend process. Mormons are completely expected to be full tithers. I don’t understand how Mormons are fine with one way transparency. The LDS church doesn’t talk about where their money goes. My LDS friend told me he doesn’t worry about it because they have “lots of accountants that watch it all”. In contrast, my church has an annual meeting where they run through the entire budget line by line. It’s incredibly boring. Every expense, from the pastor’s salary to electric bill, is covered in detail and approved by the congregation. You can find copies of it online. They go out of their way to be transparent, and the LDS church goes out of their way to be secretive. This should be a huge red flag.

The church has a history of being dishonest with money. It goes all the way back to the Kirtland Bank, started by Joseph Smith himself.  Is there any evidence today that their financial priorities are out of line? Yes. A huge, expensive piece of evidence. It looks like this:

That is City Creek Center, a shopping mall in Salt Lake City. The church dropped around $1.5 billion on this mall. They spent more on this shopping mall than 25 years of humanitarian aid combined. I’d say that counts as at least some evidence that they aren’t spending money their money feeding hungry kids.

Next, would you believe me if I said the church has lied to you recently? How about last April, in General Conference? Elder Cook got up and said that the church “Has never been stronger”. Now, I could just link you to graphs, pictures, or ward reports to show that things aren’t exactly going splendidly for the church, but those are just facts. Instead I’ll just ask you two questions. First, are wards in your area dividing or merging? My Mormon friends are excited because three separate wards are joining to form a super ward in our city. A growing church does not merge their groups/wards/congregations, they start new ones. Second, how many people are on the books as “members” in your ward, and how many people actually show up on Sunday?

Also, are they as diverse and well dressed as this picture from the marketing department?

There are plenty of other issues to write about, but the only other issue I’ll talk about here is the Church’s fear of information. It is fascinating that each of my Mormon friends has urged me to go to lds.org. Some have even said specifically to not go to other sites that may be full of “anti-mormon lies”. There was even a conference talk last month about visiting Church sites and avoiding sites that are not faith promoting. I have never once told someone to go visit a website or read an article about my faith. Instead, we sit down with some drinks and talk about it. I fully support people researching online and bringing questions. I fully support clicking my links and researching my opinions. What is it that the LDS church is so afraid of online? Is it people like me that are spreading “anti-Mormon lies”? I’m just a normal guy with a laptop, and it only took me a minute to find primary historical documents that the church would find very embarrassing. Maybe that’s what they are afraid of.

3) Mormon Practices Are Shady

Here’s this tricky part. Mormons, you are great people. Every Mormon I have met is kind, friendly, smart, and genuinely good. They love their families, work hard in school and at their jobs, and are successful people. Here’s the problem:

The good things about the Mormon church are not unique, and the unique aspects of the Mormon church are not good. 

So you like that the church is pro family? You like the way they teach you to love your neighbor, help the poor, and be selfless? Yeah, me too. None of that stuff is uniquely Mormon.

Here’s the unique stuff. Your church location is assigned to you based on geography. You are expected to follow a specific set of rules that directly affects your standing in the church. You are a grown adult, and geriatric white men have decided the kind of underwear you should wear. The church claims to be pro-family, but pulls 19 year old teens from college and home to send them on missions, allowing minimal contact with families while they act as door to door salesman for the church. The church deliberately excluded black men from the priesthood as a matter of doctrine until 1978, at which point the unchanging, everlasting God of the Universe decided he was actually totally cool with black Mormons, a decision which had nothing at all to do with cultural movements at the time.

Now for the bonus round, AKA random questions that didn’t make it in yet. Why not drink alcohol? Is there a good reason for it? Why can’t you decide for yourself? Why can’t you drink alcohol, but Joseph Smith certainly did? I’ll let you find that reference on your own. He actually had a liquor license.

If the church leadership is really composed of prophets, seers, and revelators who speak directly with God, why is conference so uninspired? Main messages last month included life changing ideas like visiting the church website, protecting the family, and not using Snapchat.

If this is the one true church on the earth, why is it composed of a tiny fraction of the population located primarily in Utah? If this is the one true church, why are they building shopping malls?

I have so many more questions, but I’ll end this right now in the interests of time. For me,this was the ultimate killing blow. You may have heard of Occam’s razor. It basically says that you should pick the principle that has the fewest assumptions, as it is most likely to be correct. Let’s look at it this way.

For me to believe in Mormonism, I first have to believe in Joseph Smith. I need to believe that he was actually visited by an angel and given gold plates, which nobody saw and which we don’t have today. I need to believe that his translation was inspired by God and not his imagination, and that his stories are all true, despite the amazing lack of archaeological evidence otherwise. I have to be ok with Joe doing his translating with his head in a hat, instead of, you know, looking at the golden plates with writing shown to him directly by God. God really did command Joseph to practice polygamy, even though that had never happened before and there was no reason for him to start. Also, God did command him to start building temples and performing rituals like baptism for the dead, restoring the priesthood that Jesus Himself somehow forgot to restore to the apostles while He was on the Earth. Finally, after God appeared to Abraham, he has subsequently appeared to each Prophet since, and that every one of them has received divine instruction from God as a true prophet, even though all prophets have been old white guys that rose through church leadership and receive their position like a corporate promotion. Their leadership of the church and my tithing is currently my only way to enter the celestial kingdom where I can be with my family forever, eventually becoming a god of my own future planet, an idea that is taught nowhere in the Bible and exclusively in Mormonism.  Also, God lives on the planet Kolob.

Of course, the other explanation is much simpler. Joseph Smith made it all up.

If you want to dig deeper into this, I’d urge you to read either the CES letter or this publication, which go into much greater depth and detail. They are written by Mormons for other Mormons and offer a perspective which I cannot, having never been a Mormon. I would also encourage you to head over to this forum, full of smart, kind, beautiful people who have walked the road away from the Mormon church and help each other out.

Please leave comments, questions, and remarks in the comments below. You can also send them directly to my face, sortadrwordpress@gmail.com.

Thanks for reading!

Step 1… Closer to Being a Doctor

It’s been quite a while since I’ve written anything on this blog, and I’m sorry about that. I had to make a decision back in January, and it was really tough. Do I…..

1) Study really hard all day and every day for Step 1 so that I can become a doctor.

or

2) Continue to blog, increasing my status as an internet celebrity and cementing the love that both of my readers have for my writing (and one of them is still my mom).

I obviously went with the first option. I studied long, hard, cold days for that stupid test, and I’m here on the other side of it with a majority of my sanity intact. If you are here to read a little about the test, skip on down a few paragraphs for my take on the exam and studying. Sadly, studying for days and days on end does not lend itself well for blog posts. Frankly, nothing interesting really happened. My wife did a bunch of fun stuff, and I made sure to get out and do things in the world on a weekly basis, but the vast majority of my time (even weekends and evenings) was spent in the library or at my desk.

I received my score a few weeks ago, so I am past the nervous period of waiting for those 3 digits (hopefully 3 digits, I’d hate to be the first guy to score less than 100!). I did ok, but I feel like I was capable of scoring higher, which is a little frustrating. I would straight up just tell you guys what I got….but you know, it’s the internet, Obama, NSA, etc. I’ll just say I scored a little bit below average, which is kind of my place in the world of medical school. Not really dumb, but also not smart. It’s a good enough score for most of the specialties I am interested in, but it makes some of the competitive specialties more of a reach (orthopedics, for example). Thankfully, I’m not a super gunner (see below for explanations of new words) and I’m not trying to become a plastic surgeon at the Mayo Clinic, so my score should be just fine. To compensate for my subpar score in the dating scene that is residency applications, I plan to make sure programs know that I also have a terrific personality.

So how specifically did I study for this test? First Aid, UWorld, SketchyMicro, and Doctors in Training. Before you copy those down as bullet points, you need to read the next sentence. Figure out how YOU learn as a student, and tailor your studying to that. For example, if you don’t learn well from videos, don’t buy Doctors in Training, because you’ll just be wasting your time. I’ll run through these resources in order of importance:

1) Uworld – this is a giant question bank (2200+) that closely resembles the questions on the actual test. You simply must do the entire bank of questions. Don’t procrastinate doing these, either. Start early, take notes, and review your answers. This is as close as you can get to the actual exam, so spend a lot of time here.

2) First Aid – The Step 1 Bible, everything important can be found here once you learn where to look. Definitely have this open often. Definitely add information to the margins. Definitely never just sit and read this book. It’s not meant to be read. Because everything is in outline form, you won’t learn much from reading the words. It is useful to browse through sections to remind yourself of concepts you have already learned, but not very useful as a way to learn complex concepts.

3) Sketchy Micro- this is a series of cartoons drawn by some genius (who is also now rich). Each of the cartoons give you little memory aids for bacteria, viruses, etc. This is stupidly helpful, especially because I didn’t learn anything from out Microbiology course. It’s fairly cheap, quick and easy to watch, and I guarantee that it will add points to your exam. I hear they are also coming out with Sketchy Pharm for future tests, which should also be very helpful.

4) Doctors in Training – this is the least mandatory of all study options. First off, it’s pretty expensive. Secondly, it’s fairly time consuming. Last but not least, it’s pretty expensive. There are some advantages to it though. Let’s say you have your heart set on a specialty that is not competitive, so you just want to pass the test and have a score that starts with a 2. If you buy DIT, watch the videos, and fill in the workbook, you are going to pass the test. They do a good job covering material efficiently, and they have spaced recall built in to the workbook to help drill in some of the details. It seems like their motto is “If you don’t remember it the first time, you’ll remember it the 8th time”.

My last few thoughts on Step 1 are especially pertinent to students who didn’t do well (like me….just kidding). After just a month or so of clinical exposure, I’m beginning to realize how little anyone cares about Step 1. I think it gets overhyped to second year students (at least it was to us). The material tested on Step 1 has very little clinical significance or correlation. Attendings and residents have been very emphatic that we are just now beginning to learn actual medicine. Finally, there’s a lot more that goes in to your residency app than your Step 1 score. If you want to be a plastic surgeon or dermatologist, you may want to work crazy hard and score well, but don’t freak out because you scored 5 points under the average for your specialty.

To close out this post, I need to include a little dictionary (for people like Mom) who may not be familiar with some of the “buzzwords” of clinical medicine. I will use these words frequently in future posts. This will be on the test.

Attending – this is an actual, fully licensed physician. They lead treatment teams and represent the light at the end of a long tunnel. The attitude of the attending often determines your fate as a med student. Good ones will teach well, have a good attitude, let you do cool stuff, and let you leave to go study. Bad attendings pimp you mercilessly, make you stay tediously long hours, are cynical and jaded, or just aren’t involved with anything going on.

Pimping – this is what happens when a senior team member asks questions to a junior member, usually in a pressured setting. It’s kind of like teaching, just scarier and with a lot more crying. Pimping can be aggressive, like an attending asking rapid fire questions to a medical student in front of everyone at rounds. It can also be helpful, like a resident asking you which structures you can identify during a surgery, then helping identify ones that you have missed.

Resident – these people do most of the actual work. Residents have graduated medical school but not finished the required residency. They are doctors, but don’t have the freedom (or responsibility) of an attending. Residents come in several flavors. Interns are fresh out of med school and are highly supervised. Each successive year past intern year, residents are given more responsibility until their final year, where they transform into the chief resident, who does everything. Residents work long hours, are not appreciated by anyone, and can be the best/worst part of your rotation on the service as a medical student.

Rounds – the sacred ritual of medicine. This happens once (or more) daily, and comes in a few flavors. Walking rounds are exactly what they sound like. The team walks from room to room. First they talk about a patient in the hallway, then they go and see that patient. Sometimes they just talk, then people see patients later, but you get the idea. Sometimes everyone sits down at a table and just talks about the patients. Sometimes rounds only take 30 minutes. Sometimes it takes hours and hours and hours. Students often present their patient(s) during rounds, giving an attending or resident a chance to pimp the student on that disease/treatment.

Tune in next time for ER stories, featuring the lady you got drunk, passed out while smoking, lit her mattress on fire, and had to be admitted for simultaneous burns AND being super drunk (at 10am on a Monday). Or, tales from OB-GYN, featuring the legendary lady with a BMI of 92. I’m more motivated to write when I see stuff like that on a daily basis.

Thanks for reading!

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