Review: Sawbones (A Marital Tour of Misguided Medicine) the Podcast

Something that I've very recently discovered are Podcasts.  I realize this is about a decade late but I never quite understood the concept of podcasting.  To be honest the reason I started to explore is because we could subscribe to our course podcasts and have them automatically be downloaded when they were ready.

After clerkships began I had to spent a considerable chunk of time in the car and after a while the same four songs on the radio start to be more of a headache than any kind of enjoyment.  Some of my favorites include Radio Lab, 99 Percent Invisible, Stuff You Missed In History Class and of course Sawbones: A Marital Tour of Misguided Medicine.

I only happened to find this podcast more recently when a fellow medical student mentioned it in passing.  Sawbones takes a casual and comedic approach to some very serious medical history.  The hosts are a husband and wife pair Dr. Syndnee McElroy and her husband Justin  The two of them have amazing chemistry and their episodes are always well researched. . The topics they choose are essentially well intentioned but wholly incorrect, understanding and treatment of disease from back in the day.

One of my favorites episodes thus far has been one entitled Self Surgery that discussed some historic instances of people taking a knife to themselves, essentially performing self surgery.  Other topics have included: bloodletting, lobotomy and weight loss.

Overall I give it five stars for being both entertaining and intellectually stimulating simultaneously.If you're a semi-history buff and have any inclination towards medical history definitely check this out.

Now that my surgical rotation is over I just gained about 6 hours a day back into my life and am hoping to get back to my reading list which includes a fair handful of medically oriented texts including Cutting For Stone by Abraham Verghese, Arrowsmith by Sinclair Lewis and Complications by Atul Gawande.

Any other recommendations for this pseudo-Medical history buff?

The M3 Merry Go-Round

As an M1 and M2 everyone's ultimate goal is to finally wade their way out of the swamp of basic sciences and into the fairyland of clinical skills.  Now that I'm a majority of the way through my M3 year my understanding of its purpose has most certainly shifted. 

At the most basic level third year clerkships allows medical students a taste of all of the core rotations: Ob/Gyn, Surgery, Family Medicine, Internal Medicine, Psychiatry and Pediatrics.  Different schools have different time periods allotted to each but for the most part each of these lasts between 6 and 12 weeks.

There is a massive amount of variability associated with clerkships experiences based on many things.  The residents and attendings you work with and other members of your team have a tremendous impact on your experiences as does the actual hospital where you are working.  Some medical schools have their students rotate in house (at their own institution) for most of their rotations while others do a combination of in house and alternate sites.  This too significantly impacts a student's experience because the latter set up requires the student to consistently readjust to a new environment quite literally like a different hospital and likely a new electronic medical record and a variety of other infrastructural differences.  This is all layered atop the obvious difficulty in constantly being moved from one rotation to another. 

One of the biggest challenges for M3 years is being flexible and readjusting quickly to an ever changing environment.  The clerkship experience is built to show you a little bit of everything, something of an sampler platter of medicine and thus by the time you become comfortable and mildly adequate in your role you're whisked off to another place where you are once again a deer in the headlights.  

When I started out this year I thought the purpose of these clerkships was to see a wide array of medical practice and see what we liked.  Like walking through a restaurant kitchen and sampling a bit of what each chef is whipping together.  As I make my way through this process my understanding of it is starting to evolve and readjust.  

We aren't going to chose 90% of what we see, that is the nature of it.  We will choose one field of medicine and pursue that thus making a majority of our rotations useless.  But they infect will have taught us something even more valuable which is how to effectively communicate with our colleagues who will each pursue their own speciality choice. 

Communication is moving to the forefront of medicine, being able to communicate effectively with each other is the key to excellent patient care.  In 20 years when I'm an attending and have to call another physician for a patient for one thing or another, I hope I can hone my message in a way I know will make the most sense to that specialist.  This is the only time in my career I will so fluidly be able to move from one speciality to another and after just a few days come to be accepted as part of the team vs. a visitor. 

Medical Jargon Demystified II: Pecking Order

Something that I have always found incredibly confusing until I became a part of this structure myself was the hierarchy of medical education. I thought it may be useful to just clarify who is who and how far along in their educational journey in a post.

• Attending (This person is definitely a doctor, they are what we usually think of when we say doctor. Undergrad + Med School + Residency (depending on the field, fellowship))
• Resident (All of these people are technically doctors, they have an MD or DO after their name)
• PGY (INSERT #) (post graduate year) depending on how long their residency training program is this could be PGY 1 - 10)
• PGY 1 (these guys are the interns, they are the lowest of the low in the MD totem pole.  They are first years that were medical students between 2 and 10 months ago and act fairly clueless for the better portion of the year)
• Medical Student (These people are not doctors yet, they DO NOT have MD or DO after their name)
• M4 (4th year student, operates at a similar level to a PGY1)
• M3 (3rd year medical student, fairly clueless but depending on how far along in their 3rd year are closer in performance to an M4)
• M2 (2nd year medical student.  Still in the didactic learning years with minimal clinical exposure, have net to no idea what they're doing)
• M1 (1st year medical student.  In their first year of didactic learning, little to no clinical exposure, has absolutely no idea what is happening ever)

I hope that little snippet helps give a better understanding of what all these weird letters and titles really mean. 

Note To (Future) Self

As a student I often find myself wondering how a professor or an attending could have the expectations that they do for us.  I am particularly perturbed by this because I know for a fact that at one point they were in my very shoes.  How then could they have forgotten how it feels to be on the other side?  I am writing this post in hopes that my future self will stay connected to this, to remind myself as I trek through this journey where it all began:

***

The test is in 3 days, no big deal.  Study.  Flip through notes. Eat. Where did the day go? Dinner. Yawn. Two more days. Sleep.

Two days.  Geez.  I'm getting a little concerned that I'm going to know too much for this test.  Seriously, 48 hours to cover this material? Thats more than enough. TV break.  Review notes. Sleep

One day. Oh my god.  What happened? I had three days, now theres 24 hours.  If I sleep four hours that gives me 20 hours to review.  Theres about five sections.  Four hours per section.  That doesn't seem like enough.  I start frantically flipping through the pages of the text book realizing five minutes in that I have absorbed nothing.  I'm just flipping.  Where is the day going? Its already 1 pm.  I woke up at 7.  By now I should have finished reviewing half the material.  I start counting: 1 pm, 2 pm, 3 pm . . . . 11 pm, 12 am, 1 am.  Thats twelve hours.

Okay good. 12 hours, that should be enough.

Somehow its 8 pm.  I've managed to eat my way through a bag of candy and 3 cans of soda.  All of a sudden totally irrelevant, menail tasks became high priority.  I absolutely had to reorganize the bathroom drawer.  It was happening before I could stop and I had to finish.  Its okay, I've gone through most of the material.

There is an ebb and flow to the panic and serenity.  A little dance, my heart rate fluctuates between tachycardia and bradycardia.  One second its beating in my ears as I see the minutes of sleep slowly slipping away as the night grows closer and my pile of work remains the same.  Another I feel on top of the world, envisioning a 99%.  High pass for me.  Stress. Relax.

Finally I decide I need some sleep.  I'm not one of those people who can pull an all-nighter.  I need a little shut eye.  I drift off to sleep with a page of notes clutched in my fist.

The clanging of my cell phone awakens me from a non restorative sleep and I bound out of bed as the panic washes over me again.  Two hours.  Theres only two hours left.  Is any of this actually going to stick in my brain now? Should I just stop? No.  I know these little details I can't remember, if I can just come up with a way to remember them.  Some mneomonic: krazy kittens gurgling the night.  There is no way I'm going to remember all of this minutia, there is no way they're going to ask about that.

As I reach the exam room the stress reaches its zenith as I pick up bits and pieces of other peoples conversations.  Every so often I heard a tidbit that I don't know and a fresh wave of panic washes over my body.  Its too late now--I'll just have to guess if that comes up on the test.

"You may begin"

I hate that feeling.  The on where you remember where the answer is.  Its on the bottom right corner of the 3rd page, you highlighted it and scribbled a note next to it.  Thats all you know.

Thats the worst.  When you feel like you should have studied just a little bit more.  If you could have just pushed yourself a little bit harder.  Then you wouldn't be sitting here with an exam in front of you and absolutely having to guess on questions.

Somehow your body goes into exam mode, you just start churning out answers.  The test taking monster inside you takes over.  Process of elimination and educated guesses slowly dilutes down to sheer dumb luck and guessing.

The walk home from the exam is awful.  First you have to escape the group of students bickering about question #68.  How do they even remember? I don't want to know.  I jam my earbuds in my ears and high tail it out of there.

On my walk home I pull out my slightly crumpled study guide and race to the bottom of the 3rd page, where I highlighted and scribbled a note.  IL-10.  Thats what it was.  How could I not remember? There's something wrong with me.

What if somehow I literally answered every question wrong? Statistically pretty unlikely but even at 25% would be awful.  What if I fail? What am I going to do? I thought I studied, I thought I knew the material.

I hope they post grades soon.

3 days later . . . .pass. Phew.  Wasn't so bad was it?

***

Panic. Fear. Pressure. Self doubt. Confusion. Restlessness. Sheer exhaustion. Those are all a part of this temporary condition but the fact of the matter is to us, at that particular moment they are all too real.

I understand that some of this is a part of the package.  Medical school is a grueling undertaking I juts wish more attendings and professors could take a second to reflect on what it felt like to be where we were--just to ease the pain for us a little bit.

They say "be the change you wish to see".  Someone check in with me in 20 years and see how thats going.

Money, Money, Money, Money . . . MONEEYYY!

note: the title of this post was to belted out a la the apprentice theme song (if you need a little refresher click here)


There is no sense in denying the fact that one factor that often pulls people towards a career in medicine is the financial compensation.  For some reason it feels like a taboo topic, to admit out loud that the of course you have  passion for helping people and a strong desire to serve and it doesn't hurt that you're going to be making a fairly comfortable living.  Nobody gets upset at lawyers for being money grubbers (but then again, aren't we all just looking for an excuse to hate them) or accountants (although being such a personality less number-cruncher should have some kind of upside) for pursuing opportunities that pay the highest.  Its a very strange phenomenon that I think we somehow hold ourselves to a higher standard as well, when I consider my future I feel bad weighing the options because of how much pull salaries can have.

All that being said the more important point I wanted to bring up was that if you intention is to become very rich, very fast I implore you to explore other career options.  Although the compensation is likely in the 6 figure range even for those pursuing primary care positions the fact remains that compared to other career paths this one pays out far too slowly to be a viable option for those looking for quick monetary gains.  Let me explain a little bit of why I find this to be the case with a look at some numbers as well as some anecdotal experience.  Once again I have to emphasize this is how I have come to see the world, at the end of the day its my opinion and please take it as just that.

So lets look at a timeline of education and earning.  According to the AAMC the average age of matriculation to medical school for women is 24 and for men is 25 so lets put that at 24.5 years old (source).  Medical school across the board is always going to be four years and theses years have to be billed as negative income especially because as of this year all loan money is UNsubsidized which means every cent that you borrow will collect interest from the day you start to borrow it, this is a serious bummer for graduate students (source).  In any case if you bill each year at about 40,000 a year (this figure is debatable but just for argument's sake I picked a round number that comes close for many people) x four years according to the AMA the average medical student graduates with $157,944 because lets not forget the interest that will be accruing at about 7% which will be compounded at the end and you will be charged interest on the interest once you graduate (source).  So you finish medical school at 28.5 and finally start making money and residency is anywhere between 3 - 5 years during which according to the AAMC you will make an average of $48,4600 (increasing incrementally each year) (source)  So at this point you're between 31 - 33 and are about to plunge back in for some more training i.e. fellowship or you're out into the real work making some real monies.

If for example you decided to become an accountant at about 23 and start making $50,000 a year and lets say a very modest 3% raise per year, in the ten years your buddy was in medical school you've made about $570,000 assuming no bonuses or proper pay increases.

My point here was not to frighten you away from you dream of being a physician but rather to deter those who pursue this career path for reasons based in financial success.  Yes you are rewarded handsomely  eventually, but the road there is a long, long one.  If you don't do this because you absolutely love it you will without question be miserable.  Once you become a doctor paying back these loans is a matter of budgeting and financial savvy, nbd.  But the path there can be absolutely miserable.  I try to bring this back whenever I can but the best way to make it through medical school is to understand as a student (which you arguably will be for at least 7 years and longer when fellowship is considered, and don't even get me started on those MD/PhDs but most of them don't pay very much so thats a different story) your life doesn't end.

Medical education and training is a journey meant to run parallel to your life story, not completely take it over.  With that attitude you will be able to enjoy all of what your life experiences bring you instead of constantly looking to the end and making promises of what your life will be when you are finally a doctor.  I think what i'm trying to say is carpe diem (I refuse to say YOLO although it seems pretty appropriate here).

Oh yeah, with the average internist being offered $205,000 without bonuses and incentives x however may years you work for the rest of your life, I think at some point you will be able to recoup any and all  losses you have incurred.  Maybe you can even take your accountant friend out for lunch.

Doctors: Humanitarians First, People Later

Warning: I may get a little preachy here, the line between opinion and fact will be blurred, but please try to look past that and understand what I'm trying to get at

Whether you are currently a medical student or even a doctor or just beginning to contemplate the idea of pursuing a career in medicine you have at some point pondered what has pulled you that way. Stock answer "i want to help people".  We're so programmed to think that and to say that but I feel as though the true force behind that statement has been diluted.

What prompted me to write this post was the onslaught of status updates via different social media regarding the absolutely horrific events that unfolded at the Batman movie premiere.  There were a variety of different reactions as well as differing levels of sensitivity (or insensitivity) that got me to thinking.  I realized then that insensitivity (be it online or otherwise) strikes a chord with me the most when the individual is a medical student (and as the slow progression up the totem pole of medical education occurs for me eventually it will be residents, fellow doctors, etc).  No matter how human we may be by taking on the role of physician we are answering a higher calling.  People expect more.  There is an expectation that you are more caring, more understanding, more sensitive and more skilled in empathy than the average person.  Additionally, we are all in this thing together, if one med student is a jerk I feel like it reflects on use poorly as a community.

Maybe there isn't an expectation and I came into this with my head in the clouds but I do feel that way. We owe it to ourselves as well as our future patients to shift our world views in a way that allows us to empathize first, judge and mock later

One of the hardest lessons the past year has taught me is that although I chose medicine because I absolutely am enthralled by the inner working of the human body and because talking to people, learning their stories and understanding how I can bridge the gap between science and medicine and society and culture, not everyone does.  Sometimes people want to go to medical school because they have a passion to serve the underserved while others crave the honor and prestige of being a world renown surgeon while others still simply want to secure themselves a certain type of lifestyle.  The toughest pill for me to swallow is that its okay.

Medical school gives you ample opportunity to self reflect from a pit of angst and rage, it is easy to forget the optimism and lofty ideals that may have brought you where you are, but I implore each and every one of you to look deep down inside you and hang on to that thinnest thread of wanting to care for people.

I am a firm believer that little things like that can truly change the face of medicine.

Med School's Eyes Are Way Too Big

Everyone has had those days.  When you are so voraciously hungry you are confident you will be able to put away 4 boxes of Wendy’s chicken nuggets, a chicken sandwich, a side of fries and a large frosty.  Then you get your food and by the time you’re on the 5^th nugget you’re barely nibbling.  Cue the “your eyes must have been bigger than your stomach” which never made sense to me because that’s anatomically ridiculous but the gist of the story is you bit off more than you can chew, literally.

So now the title makes a little more sense, right?  I think that medical school’s eyes are far too large for my academic stomach.  Let me explain a little bit further.  The biggest shocker to me was not the difficulty of the subject matter in medical school but rather the sheer volume.  Never in my life have I had to study so many things at once.  Its like the academic wizards over in the college of medicine walked through a buffet line of classes and decided to just pile on heaping loads of biochemistry, histology, anatomy, physiology (which should be its own freaking restaurant) and all the other classes until it started to get so high they couldn’t see over the plate and then continued piling it on.  

The biggest mistake I made was underestimating when people described the volume of material, I figured I could handle it.  I did handle it, everyone does, but it is an epic shock to your system.  Here I have to warn that everyone has a very different experience and I can only speak form my own.  I have never been the type of student that holes up in the library right after class to review notes from that day or to pre-read chapters, I barely get to reading the chapters in the first place.  Medical school changed all of that. 

Study guides, those are my favorite.  I’m a study guide maker.  I’ll type up all my little notes from all my powerpoints with doodles and scribbles and bullet points and amass all of that information into a neatly stapled packet from which I can review.  And when I say review I mean just read over and over and over until I know what is going on, that’s the only way I know how to study.  Here is a little comparison, in undergrad I thought 6 page study guides were intense.  Any more than 8 pages had to be some kind of epic final exam study guide for a class that gave a cumulative final.  The first time I put one of these little guys together in med school it was like 34 pages long.  That’s not even a joke.  Its really difficult to explain that it isn’t really overwhelming, you know its what you have to do and so your mental mindset evolves and adjusts to your present circumstance.  At first you may feel a little at sea but then its fine and you just go with the flow.  

Being the kind of person that you are, utilizing the study skills that you have been have brought you as far as it has so whatever methods you have employed has obviously worked for you. Being in medical school is a shocker to the system, no doubt about it.  You will study harder than you ever have in your life, you will spend more hours sitting at a desk reviewing notes than you ever thought possible, your body will hate you for not sleeping enough because you got distracted by whatshouldwecallmedschool’s tumblr page instead of reviewing for shelf exams, but that is what its all about.  At the end of the day, you figure it out. 

Honestly, in retrospect, I can now say that it wasn’t all that bad.  In the throes of it, I was miserable, but I made it through and so did everyone else. People tend to overdramatize and act like being a medical student means you have no friends, no social life, no nothing,  I strongly disagree.  It is what you make of it so the biggest thing you can take with you to medical school is a positive attitude, as cheesy as it sounds, its so easy to get sucked into the vortex of complaints and frustration but don’t let yourself do it.  There are too many negative nancies in medical school just looking for something to leech on to and complain and whine about, FIGHT IT! You’ll be so much happier for it in the end. 

A little introduction

First things first, right? Who the hell am I? Why am I writing a blog? I hope in this first post to address some questions and then delve into the nitty gritties of M1 (<-- if you don't know what that means then probably the rest of this blog will be uninteresting to you either that or you call it MS1 and now I'm judging you.

Who am I? I have just kicked off what I have been told by many is the last summer of my entire life because my first year of medical school has just ended, so to answer your question: medical student (and for the uppity follow up lurking in some of your minds: I attend an allopathic medical school in the United States in a large Urban city)

What is this blog about? This blog will help document what I have experienced in the last year which was my first year of medical school as well as into the future as I progress through the remainder of my medical education.  Although I in the future I hope to mix in some posts that are in real time as things occur--for the first year I jotted some journal entries down and hope that using the added benefit of hindsight will be able to present a more complete picture of what this year was.  That being said this is in no way meant to lump all medical school experiences into one, this is my own personal journey and I hope to share the things that I learned, my successes and failures, random thoughts I had etc.  

Why am I doing this? I wanted to consolidate all my thoughts about this year into a format I could refer back to, I want to be able to reflect back on my naivety as I progress through this and hopefully have a way of keeping myself connected to the youthful energy and passion that I brought with me in this process. 

What does the title of this blog mean? I wanted to have a title that encapsulated exactly how I felt about the academic path I have chosen.  Much like the literary character Godot and MD seems like such a highly elusive and esoteric concept to me.  Most of my life I thought that once I entered medical school I would feel different, that I would feel like a future doctor and right now I don't and thus I am waiting for MD both figuratively and literally. 

I want to thank you for sharing your time with me and I encourage each one of you to share your own stories, pointers, tips, questions and experiences as well.

Happy Reading