I took my "Preventive Medicine" final today. It was a lot more difficult than I expected, but I think I did okay. Taking the stupid test wasn't the worst part of my day. The worst part of my day was walking out of the exam only to see the class of 2008 lined up in all their regalia. It's not fair!! I wanna graduate!!

After taking a walk on the undergrad campus, Jo and I slipped into the auditorium to watch a bit of the degree ceremony, or hooding or whatever you call it. I'm glad I caught a glimpse of what goes on. For example, I learned that as I am walking across the stage to receive my diploma, I will be called Dr. Pam. If I had not known that, I might've turned around and left the stage, thinking "Oh, they mean somebody else."

Okay, here's my to-do list for the weekend:

Physical Diagnosis final exam- this is open book, and the only reason I don't already have it done is sheer laziness.
The Great Closet Reorganizing of 2008- I started this last night, when I should've been studying biostats. As I was arranging all my "white coat" attire, I realized that the next time I wear any of that stuff, I'll be a third year. Scary!!
Pharm studying- It's not going to be pretty, but I have to do a lot of it between now and Thursday. I just don't know where I'm going to find the motivation.

It just hit me that while I have many more big exams ahead of me, this is my last Finals Week. Ever. It's a scary thought. On the one hand, I feel ready to move on to the clinic-based learning of third year (and the rest of my life). But I've been doing the classroom thing since I was four years old. I'm not quite sure how I'll handle leaving that behind.

The first years took their last (only) final on Friday, so it's a pretty exciting time for them. They still have school all next week, but it's an Intersession, a week of integrative lectures and activities. I don't think they're taking it very seriously. And after a year of Anatomy, Histology, Microbiology, etc., can you blame them? I would bet thousands of dollars that a lot of them will have hangovers for most of the week. Anyway, they're beginning to call themselves second years, which again makes me wonder just what my classmates and I should be calling ourselves.

So what stands between me and third year? I have a Genetics final on Wednesday, with review session on Monday. I have a "Preventive Medicine" final on Friday. The practical portion of my Physical Diagnosis exam will be on Thursday, with the take-home written exam due... at some point. I honestly have no idea. The Pharm Phinal is next Thursday. Then I'm flying home for the weekend, and coming back for about a week of Boards studying. Then I'm taking a weekend off to go to a wedding in Virginia. After that, there will be no fun in my life until after June 24. After taking the test, I plan to do nothing but sleep and hang out by the pool. And the next thing I know, I'll be starting Medicine.

It's going to be a crazy couple of months.

Well, I've been a deliquent for the past few days. I don't know why; I haven't been super busy.

Early Tuesday
Three MDs and/or PhDs totally disrupted a panel of domestic violence survivors who were speaking to my class. Not only did they waltz in fifteen minutes early to wait for the conference that was starting when we finished, but they actually opened up their lunches and started chowing down. Professionalism-wise, that is two big no-no's. Now I truly understand what my mom has been telling me all my life. That is, all the formal education in the world (these guys were in the top 3% of Americans, education-wise) can't give you common sense. And if you don't have that, you'll look stupid no matter how smart you are. That's a take-home lesson, kids.

Late Tuesday
TRIVIAAAAAAAAA!! We led the whole time, getting the mystery question and the impossible question right. The impossible question was basically, "How wide is Rhode Island?" the trick being translating that from miles to football fields. We actually put down the same number as another team, which meant we had to do a tiebreaker impossible question, and guess the population of Bulgaria. Which we did, within 400,000. We were pretty much on fire. Alas, we fell to a third place finish, because the final question was "Guess the total cost of these items at Walmart.com". Which, in my book, isn't real trivia.

Wednesday
I had an exam! I hope I didn't fail it. I also went out to dinner to celebrate my friend Jenn's birthday. The food (Turkish) was delicious and the conversation was great.

Thursday
My Physical Diagnosis group finally got set loose in the hospital to interview patients. It was an exciting time. My partner and I made some mistakes, of course, but overall I think we did well.

Also on Thursday, I began to put together my study schedule for Step 1. I may get mocked for this, but 1) it's closer than we think and 2) we have fewer days than we think. So I've got this Excel chart going, color-coded and everything. When it's finished, I'll have it tattooed onto my abdomen for quick reference. While I know things won't go strictly as I plan, I'm actually mapping things out by the hour because that's the only way my distractable ass will stay on task. Oh, and I'm going to have to ban myself from all non-question bank websites. BUT never fear, I've still built in time for TV most nights, and trivia every Tuesday.

Friday
Liz hosted a small dinner party at our apartment (I gave very little assistance). I went from there to a concert with my friends Lindsey and Sarah. The opening act was Okkervil River, with whom I wasn't familiar, and whose name makes me think of Aqua Velva, the aftershave. From what I heard of their set (we were late), they're pretty good. The headliners were The New Pornographers, and they were awesome. To be honest, I would've been happy if they'd played a one-song set consisting only of "Sing Me Spanish Techno."

Today
Spent recovering from the events of last night, and working on a small presentation I have to do for Pharm on Monday. In other words, a "spend the whole day in pajamas" day. Glorious.

I actually went to all classes today. Crazy!!

Let's review my performance on Pharm exams so far.

Exam 1: Went to class regularly. Was in full study mode weeks before the exam. Went over each lecture multiple times. Made flashcards for each lecture and went over those several times. Grade: x

Exam: 2: Went to class sporadically. Did not look at any lectures until a week before the exam. No flashcards, but in amped-up study mode (that's full study mode x 2) I managed to go over all the material at least twice. Grade: x-1

Exam 3: Pretended class didn't exist. Started looking at lectures about a week and a half before the exam. Didn't look at the unit's biggest lecture handout until two days before the exam. Didn't lay eyes on two of the lecture handouts until the day before. Completely failed to learn the material from two other lectures. (In other words, never entered full study mode.) Grade: x

Clearly, all effort is futile.

In other news, I had my research poster printed today. I was trying to wait for input from my mentor, but I figure after two weeks (and two weeks past the "deadline") I needed to go ahead and get that done. I think it looks nice. Oh, and today I did my very first breast and pelvic exam. God bless the standardized patients who volunteered to help us learn that.

Second-to-last Pharm exam tomorrow morning. I think you can imagine how I spent today.

Second Look Weekend festivities started today, but I'm going to start going to stuff tomorrow. Part of me thinks I'm a little too stressed to be selling the school. However, I also think it'll be good to talk to newbies, and be reminded of the time I was actually happy and excited to be in medical school. (That's right, in a world full of suffering, I complain when my only obligation in life is to sit on my butt and study. Yes, I would like some cheese with this whine.)

( Now, a poem. )

Today I'm going to whine about: typos in pharmacology handouts. They want me to not only memorize random strings of letters, but associate them with side effects and disease states. The least they could do is making sure I'm seeing the same string of letters every time. Am I learning about cehxrmitamide, or cehxrmitamine? I DON'T KNOW!!!!

Let's have a poem, shall we?

Monet's Waterlilies
Robert Hayden

Today as the news from Selma and Saigon
poisons the air like fallout,
I come again to see
the serene, great picture that I love.

Here space and time exist in light
the eye like the eye of faith believes.
The seen, the known
dissolve in iridescence, become
illusive flesh of light
that was not, was, forever is.

O light beheld as through refracting tears.
Here is the aura of that world
each of us has lost.
Here is the shadow of its joy.

Today, in my physical diagnosis tutor group, my partner and I actually saw a for real patient. It was okay, but I'm not super pleased with myself. For all my self-congratulation on the number of patients I've seen during my elective and voluntary shadowing, it didn't serve me very today. You know why? Because I'm not used to adults, and adults are sneaky.

Six year old patient: My tummy hurts.
Fifty-six year old patient: I'm going to talk for twenty minutes about the stress from my job. And another fifteen minutes about that one time I had chest pain in the 80s. And fifteen more minutes about my son who's a sophomore in college. Only then will I tell you that I'm constipated.

Eighteen month old patient: Hysterical screaming, which makes examination difficult. But at least if the kid's clutching an ear or something, you get some clue about the real problem.
Forty-seven year old patient: I'm going to talk for thirty-five minutes about that one time they thought I had asthma, but it turned out to be a panic attack, and now you think I'm in clinic because of asthma/panic attack symptoms, so I'll let you take a twenty-minute history about my breathing. Guess what, you've just been PUNK'D!!! I'm here because I have an ingrown toenail.

That very last scenario is pretty much exactly what happened to me today (with patient info and even symptoms changed, because HIPAA is nothing to play with). Realizing that I'd made such a rookie mistake in history-taking wasn't my proudest moment. For the first time, instead of thinking that I'd prefer to treat kids, I'm pretty sure that I have to be a pediatrician. I'm just not smart enough to keep up with those wily adults.

Biostats quiz today was fine. That's all I need to say about that.

My Physical Diagnosis partner and I were sent to the children's hospital to do a history and physical on an assigned patient. When we got there, we found out that she'd just been moved to the critical care unit. Sucks...I hope the kid's condition improves. My partner and I were kind of at a loss for what to do, but luckily, we ended up being "adopted" by two interns on the floor. They bent over backwards in an effort to find us another patient. And while we were waiting, they talked our ears off about why they like Pediatrics. Because people in Peds are Happy and Nice™. That's the rule.

We ended up being sent down to see a baby with a URI. I wish there'd been a kid old enough to talk to us himself or herself, but oh well. Also, I'm pretty sure I successfully heard stridor. Cool huh?? Meanwhile, I continue to be baffled by the fact that someone would let me just walk in off the street (for all they know), and poke and prod their weeks-old baby after the briefest of introductions. That white coat carries a lot of weight with the laypeople. (Not so with the nurses, every one of whom saw us and instantly assumed we were lost.)

National Poetry Month starts tomorrow! Get excited.

Friday marked the first time in a while that I've been at school from 8am to 4pm. I went to 8am pharm for no good reason, besides having to turn in a preferences form for some small group thing we're doing. I did not sit through the 9am lecture, choosing instead to go to the computer lab and do some database work for Emphasis. From 10am to noon, we had small group sessions for Biostats. Noon to 1pm, I tour guided for a pre-med club visiting from Oakwood University. 1 to 2:30, I ate lunch and did some studying.

From 2:30 to 4, I participated in a surgical skills workshop. In the almost two years since I've started medical school, this was the first time I acknowledged the fact that I'll have to spend some time in the OR. Actually, I take that back. I took a scrub class back in October. Anyway, I just haven't been dying to get into the OR like many of my classmates. But I figured that my Surgery rotation shouldn't be my first exposure to suturing and tying knots. So for an hour and a half, I "closed" "wounds" in pig feet and tied square knots with giant shoelace things. I got compliments on my vertical mattress, which was pretty cool. But I didn't leave any more eager to cut people open than I was before. I guess if I'm meant to fall in love with Surgery, it'll have to happen during my rotation.

You might remember that at the beginning of this school year, I talked about how all the first and second years were divided into four Advisory Colleges. Well, yesterday we had the first annual College Cup, competing against each other in feats of strength. My college ended up tied for the championship, aided by our first place finish in the trivia competition. The trivia was a bit harder than I expected, with entire categories dedicated to Seinfeld and beer slogans. (Note: Props to grorx for correctly identifying America's World Class Beer. I failed to give him credit at the actual event because I'm deaf in my left ear.) Overall, the questions were good and I had a lot of fun.

Today, I went to church, and then did some studying at school. What really happened was, I had my Biostats notes out, while I watched Elite 8 games online. (Davidson was so close to pulling off the upset!) I'm probably less prepared than I could be for tomorrow's quiz, but... blah.

I honestly think that second semester of second year exists for the sole purpose of making us sick of the classroom and eager to hit the wards. Case in point: the Biostats course directors didn't even know they were course directors until the day after the class was supposed to start, and the course organization clearly reflects that. I mean, after three and a half semesters of really well-organized classes, what other reason could there be for this foolishness?

Apparently, my class has a test every week from now until May 15, the date of our final final. I did not know that. Apparently, we have a test in our "preventative medicine" (aka, Biostats) class on Monday. I did not know that either. Seriously, if toastedkelp hadn't mentioned it in an email, I might not have gone to class that day. Although given the amount of studying I've put in, completely missing the exam wouldn't yield noticeably different results.

The to-do list that I've been working on since this morning:

1)Grocery shopping -The only thing I've completed. One of the needed items was OJ for Liz, who is currently fighting a nasty cold. To be honest, I have no idea why I haven't gotten sick yet. I'm usually a magnet for that kind of thing.

2)Finish my Emphasis poster. I wanted to have this done yesterday, but the going is sooooo slow. However, it's going to look pretty badass, if I do say so myself.

3)Study Biostats- there's some kind of test?

4)Study Pharm- especially the GI stuff. I'm going back to Peds GI clinic on Tuesday, and I'm going to need to know that stuff forwards, backwards, and inside out.

5)Write my Contemplative Summary (or whatever it's called) for Emphasis- This is where I write a glowing reflection on my experience in the program.

This could get long, so bear with me. A lot of stuff has happened in my life (actually, not really).

Sports: The NCAA Tournament
This is my ninth year of avidly following March Madness. For the first time ever, I convinced my parents to fill out brackets of their own this year. After the first day of games, I was kicking butt with a perfect score. Here's a screenshot of my bracket in first place (one of probably a hundred million brackets tied for first that day):


("Fruitcakes" is my mom's bracket.)

Instead of being happy about my success on Day 1 of the tourney, I was actually filled with dread. Whenever I do well one day, I always do abysmally the next day. Always. I tried to convince the Big Bracketologist in the sky that I would HAPPILY get 15 of 16 games wrong on Day 2 if my one correct prediction was a Vanderbilt win. Obviously, that didn't work out. On March 21, the city of Tampa was where higher seeds met their doom.

I don't know if the fact that our game against Siena wasn't even close makes me feel better, or worse. Losing by 1 against Georgetown last year was awful. Losing by 21 this year was awful. I mean, it's twenty-one freaking points! However, there's something to be said for the fact that victory wasn't snatched away after being so close. Either way, I now have unbridled hatred for a school I didn't even realize existed a mere week ago.

Med School: Match Day
On to happier things. In addition to being the first day of the Tournament, Thursday was also Match Day for the fourth years. I watched the webcast from home. Not as exciting as being there in person, of course. The fourth years seemed very pleased with their match results. These included Ortho at HSS, Radiation Oncology at MD Anderson, and one of the six(!) integrated cardiothoracic surgery residency spots in the entire country. (Translation: extremely good residency placements that people work very hard to attain.) I find it hard to believe that my classmates will be in that spot less than two years from now.

Miscellaneous Whining
I had a final exam today, the first day back from Spring Break. Yeah, I think that's stupid too.

I have to go to the dentist. I hate the dentist.

I hate pita chips, for reasons I will explain later.

Percy has apparently picked up the habit of meowing incessantly from 5 to 7 each morning. Yeah, that'll have to stop soon.

I need to do the poster I'm going to be presenting at our school research forum.

There's no lemonade in our fridge.

Okay, clearly I'm running out of things to whine about. That means it's time for bed! I'm sure tomorrow will bring a whole host of new things that irritate me.

Long time no write!! (Well, a long time for me.)

My instincts about Genetics and Preventative Medicine were right. They are rather annoying. You might think that these classes would instantly go on my 'skip' list, but...well, Preventative Medicine probably will. Genetics has in-class quiz thingies, so I guess I'll stick with it. We should be getting the results of our second Pharm exam back soon, so I'll be able to see if all the class skipping has really turned out the way I hoped.

Tomorrow I have my midterm practical exam in Physical Diagnosis. I get to go in and do a history and physical on a simulated patient, all by myself. I'm pretty excited about it. Remember back at the beginning of the semester, when the mere thought of seeing patients terrified me?? Yeah, those days are pretty much gone. The sheer annoyingness of the classes I'm taking probably helped with that. Out with the classroom, bring on the clinic, and all that good stuff.

The end of second year is fast approaching, but I have a couple more hurdles to clear before the glorious fun time of Boards prep. Just as I've really gotten into the swing of independent learning, here come Genetics and "Preventive Medicine" (name in quotes because that's not what the class is about AT ALL). Both classes involve such distasteful things as mandatory attendance and graded homework. I say again, GRADED HOMEWORK. Um, med school? High school called, it wants its... high school-ness back.

In other news, the first years finished Anatomy(/Histology/Physiology) today. Their final was cumulative, for reasons I can't imagine, other than the professors just wanted to be mean. I was super stressed about my Anatomy final, and I only had to worry about Head and Neck. Information from other units, like the median recurrent nerve of the palm, had been long gone from my memory. (In fact, I was only reminded of that nerve's existence last night, when a first year complained about how it was tagged on the practical.) Anyway, they're all done now, so congrats to them! They get to spend the weekend partying. I get to spend it learning how to treat epilepsy and high cholesterol. Different kinds of fun, I guess.

1) There's a good chance that the next time I attend a basketball game at Memorial Gym, I'll be a fourth year. That Ob/Gyn-Surgery combination means I'm not going to have a whole lot of free time this winter. I should have made a schedule request with the sports season in mind. (If you think that's silly, apparently two Notre Dame grads in my class did just that, only with football season. Further evidence that the place breeds nutjobs.)

2) There's some serious foofaraw over the clerkship schedules. Within an hour of the schedules being sent out, my email inbox and voice mailbox were inundated with messages from people wanting to switch. Some of these switch requests were sent out to the entire class. Others were sent just to specific blocks (like everyone who has Surgery third). A couple were sent just to me... I guess because I've fooled my classmates into thinking that I'm nice and would be willing to help them achieve the bliss of a perfect third year schedule. Unfortunately for them, I like my schedule and have no desire to switch.

Soon I'll get to submit preferences for subspecialty rotations within the larger blocks. Sadly, for the fields I'm currently most interested in (Peds and Medicine), we don't get to choose. I'm not stressing about the sub-rotations too much, since I know I'll see interesting stuff and learn a lot no matter what.

Y'all. I'm almost a third year.

Physical Diagnosis was pretty good today. First, the director of the Medicine clerkship came and talked to us about writing up H&Ps and presenting patients. Then, the director of the Pediatrics clerkship came and gave us our one lecture on the pediatric exam. (We've also had recent lectures by the directors of the Surgery and Ob/Gyn clerkships. Quite the parade of stars.) Anyway, I did something that I rarely do, which is speak up in class. I feel that I should explain how I knew that 'slapped cheek rash' means parvovirus. Because I didn't get it from a book, I got it from an entry in this blog, which I've been reading since I first started MCAT studying, which is... almost four years now. Crazy! Also crazy is the fact that one line in a blog that I casually read stuck with me more than actual learning materials. If only I could find a blog about Pharm*...



*I don't really mean that. Do NOT give me the link to any Pharm blogs that may be out there.

As of 25 minutes ago, my rotation schedule preference is officially locked and submitted. Despite getting all sorts of helpful tips about the best order, I've been assured that in the grand scheme of things, it doesn't really matter. It's up to me to do my best in every rotation, there's no secret to avoiding burnout, blah blah blah. I know of at least a couple of people in my class who weren't planning on submitting preferences at all. I wasn't quite ready to leave it completely up to chance. So of the six preferences we could have submitted, I put in three. In order of importance to me, they are:

1. Psych/Neuro, block 4.
2. Ob/Gyn/Peds, block 2.
3. Ob/Gyn/Peds, block 1.

I'd rather not do Peds in the winter, because if I do end up going into that field, I've got the rest of my life to catch every seasonal epidemic. Also, the more bright-eyed and bushy-tailed I am while doing Ob/Gyn, the better. Anyway, all I can do now is wait and see how things turn out. I think our schedules are supposed to be posted by Friday.

Lab Diagnosis is officially over. Hopefully, the lessons I took from the class will last throughout my medical career. Those lessons include:

1. Common things are common.

2. Vital signs are vital.

3. Before ordering a panel of tests, THINK!!!

4. Do not spend lots of time puzzling over the finer points of a lab finding if the patient is crashing in the meantime. That is Not. Good.

...and countless others. Even though I stopped going towards the end, I'm going to miss that class.

Now, it turns out I'm a little over a week away from another Pharm exam, and have yet to look at a single lecture. Also Not. Good.

My elective this semester is Pediatric Clinical Rounds. It's run by the two Peds chief residents, and the goal of the class is to make us comfortable examining children. This is helpful, since our Physical Diagnosis class focuses on adults and only has one lecture dedicated to the pediatric exam. There are only four of us in the class, so there's lots of face time and teaching. I love it. Last week, we learned the nuances of taking a pediatric history. Yesterday, we learned how to do a full physical exam on newborns. Have I mentioned that I love this class? Because I do. I looooooooove it. Love.

Our Lab Diagnosis final is a week from tomorrow. This class might as well be called "Everything You Need to Know to Not Suck as a Doctor." EKG, Acid-Base, Sodium problems, and so on and so forth. I want to know this stuff well, because I'll be using it a lot. To achieve that, I stopped going to class, stopped looking at the Powerpoints and stopped working my way through the problem sets. That means I really know my stuff, right???

As of an hour ago, I can submit my preferences for the order of my third year clerkships. For those of you unfamiliar with this, those eleven-week clerkships are 1) Internal Medicine, 2) Surgery, 3) Psychiatry/Neurology, and 4) Pediatrics/OB/Gyn. The latter two blocks are single units: I could have Psych followed by Neuro or vice versa, but I can't split them up.

These four big blocks can go in any order, and there's much talk and speculation about the best order. We're medical students; we neurotically obsess about everything. So we hear that if we really want to enter a certain field (and therefore need to shine on that rotation), we shouldn't have that clerkship first. The rationale is that as a new third year, you're confused and lost, having zero practical knowledge about how the hospital works. You'd want to wait until you're more comfortable on the wards.

We're also told not to have the clerkship of our preferred specialty last. Although we'll be very comfortable in the hospital by the end of third year, apparently that doesn't give very much time to arrange your fourth year schedule.

I've heard that I should do Medicine earlier, because it gives a good foundation for everything else. I've heard that doing Medicine last is great because by then you've already learned a lot and are ready to really apply your clinical knowledge. I've heard that you should do Psych/Neuro first because it's a good way to ease into third year, and that you should do Psych/Neuro last because it's like making fourth year start eleven weeks earlier.

So what's a girl who's interested in Pediatrics and Internal Medicine and possibly Surgery to do??