On Monday, I dropped by the Peds GI clinic for the first time this year. A few minutes after I came in, my old preceptor said "Hey, it's good to see you again! I have to run down to endoscopy. Want to see a patient for me??" Of course, I nodded confidently (I hope) and said "Sure." Inside, my thoughts were a combination of "Hells yeah!!" and "OMG really??" So that's how I ended up taking my first patient history all by myself. It was pretty awesome (slash terrifying). But it was good, and the doctor gave me positive feedback, and it was awesome, and it rocked.

(Like first year, second year is spent more in the classroom than in clinic, so we don't get to do stuff like this very often. When I'm a third year, it'll be practically all I do.)

Yesterday was Trivia Day!!!!!!!! We followed up last week's win with a second-place finish.

TV Night starts in 6 hours...I'm hoping to get a lot of studying done between now and then. Off I go!

Today was my last day in Peds GI clinic. I am unspeakably sad and empty inside.

During my preceptorship today, I learned about heart murmurs! They have an intensity scale that goes from 1 to 6, but they don't get too interesting until Grade 4. That's when the murmur is not only audible, but you can actually feel it as you hold the stethoscope in place. Grade 5 is a murmur that's still audible if you hold your stethoscope at a 45-degree angle, with just the edge touching the patient's chest. A grade 6 heart murmur is still audible when you lift the stethoscope off the chest. Maybe it's just me, but that boggles my mind. There was much debate in the clinic today about whether a murmur was a 6 or only a 5, and I was enlisted to cast the tiebreaking vote. Me. I can barely point to where the heart is, let alone hear a murmur by hovering my stethoscope over the spot. Luckily, it was just a good natured debate, and my ruling had absolutely no impact on any sort of treatment plan.

Also today: finally began actual work on my Emphasis project. Today was observing a meal at a local nursing home, and recording all sorts of data about the levels of assistance residents got. Tomorrow I learn data entry procedures! Woooo!

Last night's sleep schedule: 9:30pm-3:15am, 4:30am-8:30am. I'm going to see if I can't be a little more normal tonight.

In the GI clinic a few weeks ago, we saw a baby, only a couple of weeks old, who presented with (that's doctor talk for 'came to the doctor because of') "failure to thrive." When she fed, she hardly got any milk down, and pretty much threw up everything she managed to swallow. The kid was so poorly nourished she couldn't even cry properly. The parents, aunts, grandparents, etc. were beside themselves with worry. They didn't know if it was something they were doing wrong, or if their baby had some horrible digestive condition. The doctor went in, saw the kid, and almost instantly diagnosed severe reflux and oropharyngeal dysphagia. You see, swallowing is a surprisingly complicated process, and it's not uncommon for some babies to take time to get everything coordinated. It's also common for the little sphincter that keeps your stomach contents from going up into your esophagus to take time to fully mature. So the baby left the clinic after a few tests and with a plan to have a feeding tube placed. Just a thin plastic tube, up the nose and into the stomach, bypassing all the troublesome parts.

On Monday, the baby was back in clinic for follow-up. After one month, she was the most adorable, roly-poly, happy baby you could ever imagine. The parents, aunts, grandparents etc. were beside themselves with relief and gratitude. She'll have a couple more months with the tube, while her swallowing reflexes straighten themselves out, and that'll be it. One fat, happy baby, ready to go live life. When we left the room, the doctor turned to me and said, with this genuine sound of awe in his voice, "One tiny plastic tube made all the difference for that family. That never gets old." I could only nod and blink rapidly because of the sudden accumulation of dust in my eyes. So...that was an experience. And now I have an answer to the question in the entry title. For the time being.

The other day I realized that I haven't said a whole lot about my preceptorship in the Peds GI clinic. Yes, it's pimptastic. Each week, the attending gives me a topic to research and "present" to him the following week. In between cases, he asks me questions about anatomy and the GI physio I've learned so far (under his direction, since we haven't covered it in class yet). But it's not a bad thing! There's no pressure. I'm not berated if I get an answer wrong (which is often), and I'm showered with praise when I (occasionally) get something right. Seriously, one week I made the connection between pancreatic insufficiency and fat-soluble vitamin deficiencies, and was told I was ready to be a fellow. Clearly not an exact preview of what life will be like as a third year. However, it has helped me develop my "roundsmanship," as the attendings like to call it.

Best of all, my time in clinic is about the only time I feel like I'm actually a student of medicine. I usually go in with the resident to take the initial history of a new patient. When we come out, the attending is seeing another patient, so the resident tells me about any teaching points she can come up with. Then we present to the attending, and he brings up more teaching points, and asks us questions, and we discuss the case. That's when I see how the Anatomy and Biochem and Micro and Histo and Physio is actually useful in helping sick people get better. That's what I signed up for when I applied to med school. I love it. Love love LOVE it.

In other news, went to the Radiation Oncology interest group meeting today. I'm now almost 100% sure I don't want to go into RadOnc. I wouldn't get to diagnose or go in and patch things up myself! I'd have to take more physics!!! Of course, there's the 200K+ starting salary to consider. And the fact that it's basically a 9-5 with no weekends or in-house call. OH WAIT THERE'S PHYSICS. No thanks!

During my preceptorship on Thursday, I realized that while I see myself entering Medicine as opposed to surgery, a completely procedure-free practice would make me want to end myself. There's only so much excitement to be had from looking at scans.

On Friday, get this. I went to Physio. Twice. Keep in mind, I have skipped 4 of our 6 heart lectures, and all the vascular system lectures, and all but one of the muscle lectures, and... you get the picture. But I saw on the schedule that we were covering temperature regulation in a single day. I figured I could show up for that one day and know my shit when it came to temperature regulation, if nothing else.

This will not seem nearly as amusing if I fail our upcoming midterm. Highly likely, considering I haven't been using the skipped class time to study physio on my own.

Saturday. Today. I woke up early and headed to school to get in a little histo lab time before the basketball game against Florida. Vandy did pretty well, maybe you read about it on the front page of espn.com??? Being at the game was so far beyond awesome, I don't have the words for it. The twenty bucks I paid to attend home games? Worth it. Basing my decision to apply to schools on the presence of Division I sports? Worth it.

There was other social stuff this weekend, a Mardi Gras party and a med/law/business/nursing school mixer. Fun enough, but not the highlight of the weekend (see above).

And now I sleep.

Immunology lecture today was a review of stuff I should really really study before the exam next Friday. But it also involved the professor randomly throwing stuffed critters out into the class. Perhaps the best part was at the end of the lecture, when he asked for the critters back and got pelted.

Today was my first afternoon at my second preceptorship, pediatric cardiology. It was cool, and more laid back than the gastro clinic. I'm glad, because while I need to prepare for third year, I'm not quite ready to subject myself to that much pimping. If asked, I might've been able to come up with the four conditions of Tetralogy of Fallot, but only if I thought and thought and thought about it. But the doctor spent most of the time showing me things and explaining things, not asking questions. I spent most of the time wondering where exactly the heart was on the echocardiograms. Something that gets better with practice, I guess. Ooh, and I got to use my stethoscope on patients for the first time! I "heard" murmurs caused by aortic insufficiency, VSD, and something else that I forget right now. "Heard" is in quotes because the sounds were in my ears, but it all sounded the same to me. Another thing that comes with practice.

Kind of related to my complete lack of knowledge, I was struck by the level of completely undeserved trust and respect I get because of that stupid white coat. Parents let me, a total stranger, poke and prod their small sick children, and then thanked me when I was done being clumsy and ineffectual. They thanked me. Something is very, very wrong with that. Right?

Kudos to all of you who read that incredibly long and rambling entry about Cadaver Ball. You deserve a medal or something. By the way, I fixed the link to the Gunnerol commercial.

Yesterday was my first day at my peds gastro preceptorship. The quizzing (pimping, if you will) got off to a much quicker start than last semester. That's probably because I started this one with far more than eight days of medical education, but I don't feel any more knowledgeable than I did then. Almost as soon as I walked in, I was given a textbook to use for the semester. I barely had time to process that before I got "Tell me what you know about hiatal hernias." And since I've finished Anatomy and am taking Physio, each week when I go in, I get to give a short presentation on a gastrointestinal anatomy/physiology topic of the doctor's choice. Next week it's H+/K+ ATP-ase. This may sound intense, but I think it's going to be good for me. I tend to clam up when I'm put on the spot, and I definitely need to get over that before third year. The sooner the better.

Now, if you'll excuse me, I'm going to disappear into StudyLand until next Friday.

Today was my final day in the Head and Neck clinic. I saw a teenager come in with a fistula (meaning,a communication that should not be there) between her external carotid artery and internal jugular vein. The artery just dumps its blood into the vein, and veins really aren't meant to have arterial blood in them. The end result was this visibly pulsatile mass just behind the ear. It had what's called a 'palpable thrill', which means you could palpate it and feel the blood whirring around. I thought it was really interesting, but the attending told me that I couldn't even comprehend how unusual it really was. Of course it was new and interesting to me, I've seen nothing. The doctors who've been doing head and neck surgery for 20+ years had never seen one, either. We spent almost half an hour just looking at the scans. It was awesome. And you know what they're going to do to fix it? Tie off the external carotid, just after the common carotid bifurcates.

So. Apparently, the external carotid artery is not quite as essential as our Gross Anatomy professors would have us believe. I feel like I've been lied to. Why in the WORLD am I memorizing the eight branches of the external carotid, and the fifteen branches of one of the branches, if you could just clamp off the whole thing with no ill effects? In an attempt to further my own education (and do better on the upcoming final), I asked if we could talk about the arteries that take over when you get rid of the ECA. The attending's reply? "Oh, I couldn't give you names, it just works." It just works. Nanney and Dalley would have us believe that we wouldn't even have heads if it weren't for the ECA. Yet actual medical doctors practicing actual medicine will not hesitate to tie them off. Bilaterally, even! And it just works!!!!!!!! I am wasting my life.

I also got to see a couple of facial nerve tests. Another thing that in actual clinic, is not nearly as meticulous and drawn-out as Dalley & Co. would have us believe. All in all, it was a great day to wrap up the preceptorship. Now I get to focus on wasting my life... I mean, studying all this super-important minutiae.

With my preceptorship basically being in oncology, people have asked me if I'd been in the room for the "This is bad news" talk. I hadn't; all the visits I observed were post-ops, long-term followups and things like that. Until today. First patient I saw was about my sister's age. She got the news that she could have nothing done and basically have six months, or have half her face taken off and reconstructed. If the latter, the chance of her having a normal life expectancy was just ten percent. But in that ten percent...that's decades. That's graduations and weddings and grandkids. There's definitely a strong argument that it's a chance worth taking. And there's a strong argument that it's not worth taking. Either way, I was in there as the news was being delivered. As some of you know, I have trouble with particularly emotional grocery store commercials, so I don't know what made me think I could handle real emotional situations in my professional career. I was doing okay, until the patient started to cry. All the advice we get about it being okay to be emotional becomes a whole different thing when you're standing there, in your white coat, in a room where it's obvious that only one person at a time can be losing their shit. I kept it together in the room, took a moment after we were done, and then the doctor and I talked about it a little afterward. But we didn't have much time, because there were more patients that needed to be seen.

Didn't have Ecology of Healthcare today, because of Yom Kippur. We'll be making up today's session on Wednesday, having dinner at the group leader's house. Should be interesting. Anyway, since I was free during the lunch hour,I followed my second tour. It was fun! I'm done with observing now, and can be a proper tour guide. I'll probably start next week. It's kinda funny..when I was going through the whole process, I couldn't imagine myself being that enthusiastic about any school. But during the two tours I've been on, I've been practically bubbling over. I love this place! (Except when they reject my friends. Jerks.)

ANYWAY. Preceptorship was quite awesome today. There was a 2nd year ENT resident who was on the first day of his head and neck rotation; I followed him around more than Dr. B. It was good to see the actual, "What's the problem?" interviews first, and then go in with Dr. B. Today we saw a lot of post-op visits from reconstructive surgery. One guy had a new nose made from a chunk of his forehead. Another patient had an entire side of her face reconstructed from her iliac crest (we've studied that!) and her latissimus dorsi (we've studied that!). ANOTHER patient had a flap of tissue taken from her radial forearm to reconstruct the floor of her mouth. I loved seeing and learning about that stuff.

Some of my classmates don't have nearly as much patience for clinic as I do. They want to scrub in and see surgeries and get into the OR as soon as humanly possible. Which is understandable, because that stuff is interesting too. But the class is Intro to the Patient, not Intro to the Procedure. A lot of good having seen five thousand surgeries will do me when the time comes for me to interact, on my own, with a conscious patient. (Which is Saturday, by the way, and I'm kinda nervous.) Of course, I might be different from most of my classmates, in that worries about my interpersonal skills were what kept me from considering a medical career for quite a long time. So now that I have the chance, I'd like as much observational time as possible. Finally, there's the fact that most of my friends who are bored with clinic are pretty gung-ho about careers in Surgery. Despite the allure of wearing scrubs all the time, I feel deep down that I'm probably destined for Medicine. Clinic is fun!!