My last full week of Neurology is almost done. The shelf is on Tuesday. I took call Monday night, and there were four admissions to the General service alone. I think there were three admissions during the entire two week span prior to my joining the service. I am clearly the black cloud to end all black clouds. That's a term used to describe someone (usually a resident) who seems to attract patients to the hospital like moths to a flame. There will be no fewer than a dozen new admissions any time a black cloud takes call. Although now, it's not just when I take call. My mere existence on the service has caused the number of admissions to increase exponentially. I did predict this happening, before I even started General Neuro. Maybe my predicting it made it happen. Deep, I know.

Today, my resident gave me a teaching session with tips on how to examine uncooperative patients. It was really nice of him to take the time to do that, considering he was post-call. Alas, it made me late for lecture. For some reason, instead of just being more late in order to get food or go to the bathroom, I decided to forgo both. So by the end of our first hour, I really had to pee. While in the bathroom I missed hearing that there were extra free lunches in a different conference room, so I missed out on one of those. Then our second lecture was long by half an hour, so I didn't have enough time to get food before meeting our attending for afternoon rounds/teaching session.

I know that sounds super lame when it's typed out there, but it just about crushed my spirit as it was happening. It's Neuro. There's supposed to be time to eat on Neuro. I really don't consider myself an emotional eater, but once I left the hospital a nice bowl of Panera's broccoli cheddar soup sure did wonders for my mood. I stayed there for a productive study session. Then I had a nice long workout, then a nice hot shower, and then I watched 24. Now all is right with the world.

Liz was out of town this weekend for her sister's college graduation. That left me alone in the apartment with Guinevere and Percival. Since I believe that one becomes a Crazy Cat Person the moment cats outnumber humans, it was my Crazy Cat Lady weekend!! Wheee!

As soon as I had the apartment to myself, I tried really really hard to study Neuro. I ended up sleeping on the floor while the Music Choice 90s channel played in the background. Luckily Johanna saved me from my own lack of willpower by coming over to hang out and study. If I hadn't chatted with her on Friday night, I probably would have spent the whole weekend going from my bed to the couch without leaving my apartment or speaking to another human.

Instead, on Saturday I went to Whole Foods to study, but ended up spending more time thinking about fourth year stuff. Like my personal statement for residency applications, which is refusing to write itself. And trying to figure out just where in the country I'm interested in going. (It's a big country!! I'm taking suggestions.) I eventually gave up, and went to check out the local Latin American Street Festival with a couple of people. It turned out to be not that awesome (in fairness, we only caught the very tail end), so we went to dinner instead. Followed by giant ice cream cones at Maggie Moo's. Good times.

Sunday, I went to brunch to celebrate my friend Lindsey's birthday. You might think that Mother's Day brunch would be a madhouse, but the place we went to wasn't super crowded. It was one of the slowest brunches I've ever had. I think it took over half an hour just for our drinks to come. So it was well into the afternoon when I got home. After a workout and a few hours of The Food Network, I did a bit of Neuro studying.

(You know, if I actually bomb this shelf, I'm going to feel real bad about broadcasting just how little I studied.)

I decided to write an entry about how my days have been going recently. I understand that this is probably very very boring, but that's all I've got these days.

I wake up at 7 and read the daily sign-out email. That's where the person on call the previous night lists any new admissions or issues with patients. This morning, my team had a new patient, and since it was my turn to pick up a patient, she was mine. So I ate a leisurely breakfast, got ready, and got to the hospital a little before 8. That gave me half an hour to examine the new patient before the scheduled start time of rounds. Now, we haven't actually started rounds at 8:30 since I've been on the service. I'd just rather sit around with my work done than tempt fate and be unprepared the one time things started on time.

(I usually try to completely finish my progress note(s) before rounds begin. There are two schools of thought on this. One is that we should wait until after rounds, when the day's plan for each patient is formalized, before finalizing the note. The other is that since medical student notes don't matter for anything, we should go ahead and put whatever plan we think is appropriate into the chart. I subscribe to the latter. I figure, those times when I do have people reading my notes, it's better that they see my own thoughts about what should be done for the patients.)

Rounds start closer to 9 than 8:30, and usually last an hour and a half. That's ridiculous for only three or four patients, but such is life. Sometimes I think certain people go into academic medicine because they just love having an audience on rounds. There are definitely personality types out there who would thrive on being the center of a circle of residents and students. Nevermind that it's a captive audience, powerless to do anything but pointedly check their watches while the attending blathers on about the Gemini missions and riding lawnmowers... sigh. Whenever I start to get antsy, I just remind myself that rounds didn't start at 6am. That helps me feel better, but only slightly.

Our patient list tends to have only three or four people on it at any one time. On top of that, for most patients we aren't doing much besides giving them steroids or plasmapheresis. That means there aren't a lot of "medical student tasks" for me to work on during the day. (Yesterday, I got to pull a central line, and that was pretty much the highlight of my day.) So after rounds, I usually read up on all the neurologic diseases in the world until it's time for our clerkship lectures, which go from noon to 2pm. After that, I usually do something (ie, sporcle) to fill the time until 3pm, when my resident tells me to go home. Then I go home. Exciting, no?

Monthly rotation changes are common to most residency programs. Usually, the interns change rotations on the first of the month, with upper levels switching a couple of days later. Those couple of days allow the interns to get used to their new service under the guidance of a senior resident who's familiar with all the patients and how things are run. But neurology just has to be different. The other day, both the intern and the upper level were new to the service. PLUS the upper level was post-call and peaced out by noon, leaving the intern to cover the service by himself. PLUS the upper level foisted an incoming patient onto another resident on a different service without telling the intern. And the other resident thought it'd be appropriate to foist the patient onto the third year medical students without telling the intern. And by foist the patient on us, I mean give us approximately 20 seconds of guidance before leaving to go on rounds. Needless to say, while everything worked out in the end, it did not go as smoothly as they could have. However, I learned a lot, both about medical management of a certain disease, and things I shouldn't do when I'm a resident. And that's what third year is all about. I think.

Today I participated in a "field day for grownups," the proceeds from which went to the Siloam Clinic. With a huge storm Thursday night, downpours all day yesterday, and drizzle with 100% cloud cover today, the conditions could not have been worse. We weren't so much on a field as on a marsh. That said, I still had a blast! Events included a water balloon toss, a dizzy bat relay race, and a tug of war (which resulted in a pretty spectacular rope burn on my arm). Plus there was a ridiculous amount of food, and I happily canceled out every moment I spent at the gym for the past week and weeks to come.

Today I learned that pediatric neurology can sometimes be devastatingly sad.

I'm switching to general neurology at the main hospital tomorrow. I've heard that the service has been practically empty for the past two weeks, but I've already accepted the fact that it'll get real busy as soon as I'm on it. And I'm fine with that. Light days are great, but it might actually do me some good to be on a busy inpatient service again. Learning opportunities, and all that. Not to mention that after today I'm ready for any sort of change I can get.

I have to wake up at 6:15 tomorrow morning, and I kinda want to complain about it! Isn't it weird how quickly we can forget what it's like to have to wake up at 4:15?

I played trivia all by myself tonight, and got... what's the word?? Ah yes... OWNED. But I was actually this close to coming in 5th. Too bad I sucked it up on the final question. African geography is my enemy. Anyway, even if I was alone, I needed the time to decompress and do something fun.

And, a poem:

Holy Sonnet X
John Donne

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'rt 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.

Hatching Pete: A Disney Channel original movie. It had its amusing moments, but it was definitely no "High School Musical." I only sat and watched it all the way through because I really, really didn't want to study.

A League of Their Own: A classic. Seriously, the movie is seventeen years old. I felt really old when I figured that out.

17 Again: I expected this to be a "so cheesy, it's good" movie. It was actually legitimately good. I laughed out loud at several points throughout. You just have to ignore the fact that there's no way Zac Efron grows up to look like Matthew Perry.

Role Models: I actually thought this was less funny than "17 Again." It had its moments, but it was waaaaay more lowbrow. We watched the unrated version, though. I'm sure there were more unnecessary boob shots and f-bombs than we would've gotten in theaters.

This weekend also included lots of sitting out in the sun, as it was our first truly warm weekend of the year. On both Saturday and Sunday, I went down to my complex's garden to "study" with friends. Saturday, I ended up falling asleep on a bench swing. Sunday, I did more talking than studying. I'm hoping that it'll be easier to focus once I switch to adult neurology. It's hard to learn all the details of dementia and strokes when I'm bombarded by seizures and developmental stuff all the livelong day.

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I worked with a new attending today, and it was pretty awesome. On rounds, he actually asked how I thought we should manage the patient I had. At first I just blinked back at him in surprise, having not truly been asked my opinion on patient management since gyn clinic back in December. When I recovered, we had a nice brief discussion, there was some teaching... rounds like I like 'em!! It was nice to have a little reminder that I can enjoy the more Medicine-y aspects of life.

Today I finally "got to" participate in the time honored tradition of "Hey medical students, taste the medications you'll be prescribing!" Thanks, Neurology clerkship!!

We started with a tasteless food thickening agent mixed with water. They probably thought it'd be a good way to ease us into the exercise. However, I am very texture-conscious when it comes to food. Most of the reasons I don't eat certain foods (raw broccoli, bananas, pears, canteloupe to name a few) are texture based. So giving me water the consistency of grits is pretty much the worst thing you could ever do to me. In fact, I just gagged as I recalled the texture in an attempt to describe it.

Next, we got some strawberry flavored Boost that was actually fairly delicious. I have classmates who willingly drank the stuff while on surgery. Not that it's normal behavior. Just not outside the realm of behavior of the especially enthusiastic future surgeons. Time spent eating solid food means time not spent in the OR, after all. I like operating, but not that much.

Then we got liquid potassium. I joked with the professor that I have a rare hyperkalemic condition and "you just killed me." Alas, the joke was on me because up next was kayexalate, which we give when someone's potassium is too high. Those both tasted pretty bad, but I think even the most delicate palates would prefer that to the taste of DEATH from abnormal cardiac rhythms.

We also got Mucomyst, which is given to protect ailing kidneys from the IV contrast we use in CT scans. Now its chemical name is N-acetylcysteine, and cysteine contains sulfur. So you can imagine how that went. As we downed our shots, one of my classmates exclaimed "Oh!! Eggs!!" in a voice that was entirely too happy for the situation.

I think there were some other samples that I'm forgetting, but we finished with a chlorhexidine mouth rinse. The professor said we could swish and spit, or swallow, whichever we preferred. I was expecting it to be pretty horrible, like most of the other stuff. However, it tasted like minty fresh!!

Then I remembered that chlorhexidine is my soap of choice when I'm scrubbing in for surgery.

I spit.

Last week in Pediatric Neurology clinic, I saw kids with a dozen different seizure disorders, in addition to various nerve disorders, muscular disorders, and developmental disorders. Really interesting stuff, and exponentially less soul crushing than General Pediatrics cliic. However, after five days, I am sick unto death of parents who think it's appropriate to spend the entire appointment talking about their own problems. I mean, these parents obviously care enough about their kids to drive hundreds of miles and bring them to a fancy specialist. But once they get into the office, it's like the kid might as well not be there. One mom in particular made me use all my willpower to refrain from saying "No wonder your kid gets headaches every day; I have one after five minutes of you talking about your toe pain." Argh.

It is a truth universally acknowledged, that when you tell a group of third years to make their own call schedule, nobody takes call. That's what has happened on Neuro. There was a bit of a kerfluffle when word got out that nobody took call Monday, the first day of the clerkship. That's because when given a choice, nobody wants to be on call their first day on a service. Not to mention the confusion caused by the clerkship handbook itself, which says only people on inpatient services need to take call. What should have happened: somebody in charge creates a schedule. What happened: the students on Neuro were figuratively locked in a room and told not to come out until we'd created a call schedule. Not even residents make their own call schedules. Because it's a pain! It's kind of sad that I've reached a point in my life where I don't want freedom of choice. It's so much easier for me to just be where I'm told, when I'm told. And to calmly accept that sometimes that will be inconvenient and will suck. Thank you, third year!!

Fast fact: there are 7572 scheduled appointments at 336 clinic locations in the medical center today.

Hello world!! I've officially begun my neurology clerkship. I'm doing Pediatric Neurology first. That's mostly outpatient clinic, but I'll also switch to the pediatric neurology consult service for a few days. This will make Pediatric Neurology the one hospital division in which I do inpatient, outpatient, and consults. So far, I'm having a great time in clinic. The people are nice (they're pediatricians!!), the kids are cute (parents not so much), and I find the subject matter really interesting.

Um, that's actually all I have to say. Sorry for being boring!
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Continuing on the theme I started yesterday, 'poems I read in high school English'...

The Eagle
Alfred, Lord Tennyson

FRAGMENT

He clasps the crag with crooked hands;
Close to the sun in lonely lands,
Ring’d with the azure world, he stands.

The wrinkled sea beneath him crawls;
He watches from his mountain walls,
And like a thunderbolt he falls.

While the Ob/Gyn-Peds block has separate orientations for each clerkship, the Neurology-Psychiatry block has one combined orientation. Wednesday afternoon, we had psychiatry lectures, mostly about adolescent psych. Thursday was mostly Neuro, with a bit of psych thrown in. We had a neurosurgeon talk to us for an hour about using deep brain stimulation to help people with tremors. For that hour, I desperately wanted to become a neurosurgeon.

Today (meaning Friday.. I didn't realize it was so late!) we had psychiatry stuff in the morning. Then in the afternoon the group finally got split up. I and the other third years starting with neuro got a whirlwind introduction to the clerkship. In the categories of 'Most Organized Clerkship' and 'Most Enthusiastic Clerkship Director', Neurology is certainly giving Ob/Gyn a run for its money. I especially liked when Dr. V. told us, "As you can see, we've put a lot of effort into this clerkship. We want it back." I was all fired up and ready to start gunning right then! Here's the effort you wanted!! Yaaaay!!

They printed out business cards for us to give to the patients we work with. I expected this, since my roommate already did this rotation earlier. I thought it was cute when Dr. V said that he knew for most of us, it'd be our first business card, and he wanted that to be something special about Neuro. I'm still not sure how I feel about the practice itself, though. We can put our pager number or email address on the cards if we want. As a lowly, powerless third year, I'm don't think that giving patients my personal contact info can be any good for anyone. I do like the idea of being able to give them something to help remember my name. It's a tough name.

I get the weekend off, and start with pediatric neurology on Monday.