Hope still looks pretty audacious in healthcare

This is depressingly true.

And apparently, this is currently our best crack at change

Oh my god, I heard he has a huuuuge (science) penis!

In order to keep us up to date with the latest developments in biomedical research, my school occasionally substitutes something called medium-sized group for lecture; we read a journal article the night before, and come prepared to discuss the salient aspects of the research. It’s a great idea to hone our understanding of research methods, the process of scientific inquiry, and the latest progress in a variety of fields.

It’s also a fertile ground for med student gunnerism, the way a pile of shit is a mushroom’s idea of Shangri-la. So of course, people got a little competitive in showing off their knowledge, one person in particular decided that it was their role to educate the rest of us fools. Clearly having spent a few hours of quality time with the journal article the night before, this individual proceeded to dominate our discussion of cystic fibrosis for the duration of 2 hours.

So I have no problem with people striving for excellence. That’s really….well, excellent. And needed, since there are med students like me who strive for passing with a bare minimum of effort. We need the former people to advance the science, and fire the engines of medicine. On some level I’m grateful to these folks, I’m not kidding.

But must you make it so fucking obvious that you know more about the delta-F508 cystic fibrosis mutation than me? I understand that cities would crumble before the force of your intellect, but must you so blatantly display your science penis? Because, really, that’s what this boils down to; a strange form of penis envy. Would you be satisfied if I bask in the eternal glory of your incredibly profound knowledge of cystic fibrosis? I will repent the diminutive capacities of my meager cerebral pecker before the sperm whale proportions of your cortical member. I’ll start a religion, you can be the messiah, and we will worship phallic monuments dedicated to your ginormous science penis.

Just one condition: please shut the fuck up more often? Please. Let idiots like me talk a little more. If anything, I’ll make you look good right?

"Daddy horny Michael"

Arrested Development anyone? Anyways....

Med school, how you continue to wreak havoc with my life. In an effort to preserve a semblance of normality, I enjoy studying at coffee shops. The ambient stimulation of people milling about, people who talk about relatively pleasant topics, like the weather, or how the Cleveland Browns have attained a yet more transcendent level of mediocrity, a cast of sunlight revealing the swirl of dust motes, and the waft of coffee, it all sure as hell beats the health science library. That dungeon of learning brings back memories of unintended naps, vitamin D deficiency, and the horrid smell of med student anxiety, which permeates the very walls.

But of course, I would be amiss if I failed to mention the very best part of the coffee shop studying: the hot mammas. Yes, in the asexual world of medicine, coffee shop women are a breath of beautiful, saucy, fresh air. I’ve always fancied myself something of a coffee shop Romeo (I don’t care what you think, grant me my petty delusions), gifted with the gab that these Java beauties like, and the suitably subversive political views that get them hot.

But med school, you could leave no stone unturned. As I’m starting to realize, trying to date in medical school is like trying to cheat on the most neurotic, jealous, possessive, and boring girl you’ve ever had the misfortune to sleep with. Jealous bitch that you are, you had to fuck it up for me didn’t you, Caseandra? You couldn’t let me have my little sugar on the side, could you?

How does she do it? It goes a little something like this:
Coffee shop mamma steps in, I spot her at my 6 o’clock, and she’s instantly a marked woman; I run through the mental check list: curly hair, check, mischievous eyes, check, no ring, check. She sidles over to a table by the window, just out of conversation range of my table, dammit. But oh so conveniently, my laptop battery is out of power! Yes, I need the power strip at the table next to hers. I introduce myself briefly, but don’t linger. I return to my studying, as I’m a man of serious work, of integrity, conscious of the serious responsibilities of my profession; I have to understand the role of wnta, Hox genes, and FGF in limb patterning during development, or people will die! I am not some cheap coffee shop pimp. And yet, sometime later, I can’t help but notice she’s reading one of my favorite works. After 15 minutes of scintillating conversation, however, the question comes up:

Arabica hottie: So, what do you do?

Ethnically Destined: I’m a medical student

Arabica hottie: Oh, that’s so impressive, what are you working on right now…

Ethnically Destined: Ummm, it’s really not that interesting….

Arabica hottie: No, I really want to know, let’s see it! (She leans over my shoulder to see what I’m working on)

Lo and behold, the picture on my screen is a big, hairy, diseased vagina! How about that for a conversation killer! Were I more interesting, sharper minded, I could spin it into a conversation on reproductive rights, or Georgia O’Keefe’s recognition of the striking beauty of the vagina, but no, I am no coffee shop Romeo, I am an awkward med student now. My wit abandons me, and I stammer,

Ethnically Destined: …ummmm…..goddammit, what do you want me to say. Yes, I look at vagina pictures in coffee shops, it’s what I do!

Arabica hottie:….so it was nice meeting you, maybe I’ll see you around?

So it goes. Fuck my life.

On that note, I’m note the only one who thinks so. Hipsters also think I’m lame!
http://stuffhipstershate.tumblr.com/ (look for the September 22nd post).

The upsides of Downs

I started real med school a few weeks ago, and it really hasn't been so bad so far. Yes, you do have to study more than you ever have in your life, but considering you don't have to work a job like many of us did in college, and that few of us are getting laid, there is plenty of free time in a day. It sure as hell beats working full time, and Cleveland is so damn cheap, I can still afford most things (alcoholo poisoning for less that $20 anyone?). So most days I wake up, with a vaguely positive attitude towards med school, bordering on largely ambivalent. Every 5th or 6th day, I have a few hours where I think, "What the f-ck am I doing with my life?" I had a moment like that yesterday, at the end of lecture. I had just risen from my customary nap, and I was a little groggy, perhaps even grumpy. Regardless, I wasn't feeling generous, and the didactics on limb development, images of fibroblast growth factors, and the incessant fall of nervous fingers on much used keyboards, in the dank cave that is our lecture hall, didn't help my mood. So when I look to my right, and see the girl next to me reading about current events on Fox News, I felt pretty pissed off. Really, Fox news? I love fiction too, but I get it from novels and comic books....anyways, I was in a dour mood for a few hours after that.

But to balance out the "f-ck my life" days, we have days like Tuesday. Days where you walk out with a greater appreciation for the human condition, and the sheer balls it sometimes takes to walk this earth. We've been studying development, and naturally, chromosomal defects are part of that. Trisomy 21, or Down's syndrome has been covered extensively, and we've gone into the clinical correlates as well. The disorder is typically screened for in the 1st or 2nd trimesters, and if identified, parents are given the choice to abort or not. More than 90% do. Damn....that's a lot. When I first read that statistic, I had no qualms with it. It's not that I think of a person's life with Down syndrome as less worthy than that of a normal kid's. I just figured the cost of raising such a child, in time, tears and money, would be too much. And so it seemed totally natural to me that you'd want to abort that fetus. And apparently, a lot of doctors encourage patients to do so.

To put a human face on it, our faculty had parents with Down's syndrome kids come in this morning, and the hour and a half we spent with them changed a lot of my assumptions. The mom we were with had six kids...shiiiit (trangely, she wasn't as Jerry Springer as you'd expect, I think she just liked having babies). The 5th kid was a Downs kid. She brought her baby with Downs, and the youngest one to the discussion; she had that autopilot tendency most harried mothers do, such that she could maintain conversation while breastfeeding one kid, playing with the other, and still making eye contact with each of us. And she looked tired, as mothers, particularly those with a half a dozen children, do.

But what she had to say was not something I had heard before. First, the Downs kid, George, was not that much extra work. Sure, he required more attention than the other children, but it wasn't like they were going broke caring for him (particularly noteworthy given that her husband was a teacher, and she only worked one day a week as a physical therapist).

Moreover, she went so far as to say that George was a blessing. Having him, she had really learned how to stop keeping up with the Joneses, because as she noted, "Once you have a kid with Downs, you really can't." She said it brought her family together, by the simple act of caring for George. She said that not only did she fall in love with George as one would any child, but that the love was more intense in a way, given that she would always be watching out for him. And she pointed out that while George would probably never go to college, or win any standard accolades, he would almost certainly never become a drug addict, or pain her in the numerous ways children can cause their parents endless grief.

So while George is mentally retarded, has congenital heart defects, will always rely on his parents, and will likely develop Alzheimer's type dementia by the age of fifty, his existence may be far more than tolerable. It could have a vital role in his family and community. There is no right answer, and up until now, I had been hubristic enough to think that aborting such kids was the scientifically sound thing to do. And it may still be, but that paradigm may be just as narrow-minded as those who seek to stop stem-cell research because they consider it equivalent to murder.

I make fun of all the moral, touchy feely stuff we talk about in our medical school ethics class, but that doesn't mean I'm not hearing it. If anything, humor is a coping mechanism to deflect awareness of the fragility of the human condition. And given that fragility, more than anything, George's mom impressed on me the need to approach such crossroads carefully, where science intersects with intangible, incalculable elements of emotion, value, ethics and all the related fuzziness. I will tread carefully from here on out....

Medical School Personality Types

This is sad, but true

Credit for the cartoon goes to, Michelle, a radiologist who blogs and cartoons over at: http://theunderweardrawer.homestead.com/

Medical School - full contact sport?

The foundation of the curriculum at my medical school is small-groups, referred to as Inquiry Sessions, or IQ groups for short. We’re given case vignettes at the beginning of each week, and during small group sessions, we discuss the case, in an effort to understand the problems facing the patient, identify learning objectives for ourselves, conduct research on the latter, and then discuss our research in subsequent sessions; we do this with the guide of a faculty facilitator, but their role is largely to guide us in a Socratic manner should we get off track. It makes for a very pro-active model of learning that is a departure from standard medical school didactics (many medical schools feature small groups, but few have designated them as the centerpiece of a curriculum). It also makes for absolutely priceless moments.

Small group are intended for us to learn to work with our colleagues (many of whom are completely fucking nuts) as much as with the material. Horrid tales of gunner excess have already emerged from small-groups; one nutty chick wrote up a 35 page report for her first IQ presentation (for comparison, the average person conducted about 2 hours of research for that case, and brought a few talking points). Thankfully, my IQ group has been one of the fortunate blessed with a complete lack of malignant personalities and basket cases; to boot we have an IQ facilitator who’s refreshingly down to earth.

But that doesn’t mean there is ever a dull moment. We’ve already had quite a few classic moments in IQ, whether it be yours truly bringing up “Two girls, One cup,” our Egyptian group member showing up 30 minutes later for everything, (his sad eyes always seem to say, “it’s in Allah’s hands ,” weakening any resolve we may have had to discipline him), or a number of other rich moments.

However, one moment towers above all others in our IQ group’s short history. We customarily start our IQ sessions with “check-in,” as a way to promote intra-group communication. People share stories about their weekend, their mood, anything at all really. Last Monday, rumors were buzzing about the class about weekend drama (med school is EXACTLY like high school with less sex, fewer attractive people, but more limited cruelty); one our classmates flipped out while drunk at a party, and started threatening drastic actions (I can't elaborate out of respect for privacy issues). It turned out one of our group members, we’ll call him Bob, was involved in restraining this girl, who we’ll call Jess; and subsequently calling campus security (which given the details he related, was entirely justified). The next morning, Jess sends Bob a message, in effect stating that Bob had ruined her life (by this point, the administration and his parents had found out about the incident). So Bob was worried about a physical altercation when he came to class that Monday, and jokingly related that he was wearing a cup just in case. We laughed heartily at the last detail, but Bob stared blankly at us, and once the laughter died out, somebody said, “Wait, you’re not serious, are you?” To which our intrepid friend replied by leaning back in his chair, thrusting out his crotch, and going tap-tap-tap. You really can’t make this shit up…..

More on healthcare reform

Gawande's written another very nice article about healthcare reform

Revenge of the Idiots

Ahhh, it's that time of year. Fall is not far off, Target is rolling out the back-to-school supplies, and my world is contented. Except as the days get shorter, my lectures seem to get longer. It started with a few good questions at the end of lecture....smart questions, reflective of incisive thought and careful study. Then it degenerated a little. Dumber questions came out, as did questions that were clearly intended to make the asker look smart. And now it's really starting to snowball, with profoundly retarded questions likely just around the corner (I really hope no one asks if they can go to the bathroom). Yes, at medical schools all across the country, this phenomenon is likely to repeat itself as the year progresses. I wont discuss anymore though, as this topic has been covered in depth by another, far funnier blogger. Enjoy:

Hypertalkers

A sane voice

I found the following comment on the blog Panda Bear MD, under a post about whether medicine is really worth it (http://pandabearmd.com/blog/2007/05/16/is-it-worth-it/):

I’ve been out of residency 12 years and love love love medicine, especially since the advent of Google. So take heart- I guarantee you will be so much happier when you never have to deal with the interior of a hospital…if you like people, you will love medicine once you survive the trauma that is residency.
Of course I say this because I work half-time in urgent medicine and have for years…whenever I work full-time I start to feel creaky and crusted over. So keep all your other talents and wits sharp, make money in other ways if you can, to get rid of the loan.
Learn to cook quickly, cheaply, and well. Shop at goodwill. Drive cars with salvage titles. Buy a fixer house and sand windowsills on the weekends. Take in short-term exchange students from cool countries like Japan. Maintain a massage table and chair if possible. You think I am kidding, but I am NOT.
Noone told anyone the best-kept secret in medicine- 30 hours a week is what most people thrive on. Beyond that, it’s diminshing returns on your personhood.

I've already been wondering about my decision to go to medical school, and reading things like this gives me heart. It's pretty much the angle I'm playing, that basically, medicine is a great job, but in limited doses with plenty of free time (so surgery, as cool as it sounds, already is a hell no).

I'm finding that culturally, I already feel very out of place in my class. About 80 -90% of people have 1.) either come straight from undergrad or 2.) taken time off to do research and then came to school. The two are almost equivalent in my mind, since biomedical research doesn't give one a break from the achievement focused culture prevalent in the medical sciences. As a result, most of the folks I'm going to school with are pretty ambitious, and willing to put in the hours to do well (although there are a fair number of lazy folks too). Additionally, many people have little exposure to peoples and countries beyond their own. Most people are upper-middle class (or straight upper-class), have lived in the US for the vast majority of their lives, and frankly, don't seem to have a lot of exposure beyond their upbringing. I don't hold this against them, I honestly don't. If my background is different, it is much due to chance and I think, good luck.

However, the sum of this to me (and I may be a total douchebag for making judgements like this; feel free to comment to that effect if you think so), is that people have had a chance to find out what's really important to them, and to explore additional dimensions of their personality. That'd be fine for most 22-24 year olds, but not this bunch. I say that because the next 4 years don't seem like they allow much room for exploration beyond medicine, and I think what makes a lot of my peers really tick is probably outside medicine (not to say that medicine isn't right for them, but hey, a lot of people work jobs that have little/nothing to do with their happiness). And so I wonder what's going to happen to everyone.

As for me, I've decided I find the social and cultural atmosphere of the school a little too intense and removed from my own values. As such, I think I'm going to shoot for a 70/30 balance in my personal life, with 70 being devoted to non-medical school friends/activities to keep my even-keeled, and the remaining 30 so I don't cut myself off entirely from my class (plus, most people in class are genuinely quite nice, and there are a rare few I can really have fun with).

The torch has been passed....

After raising a few red flags with the administration in the past few weeks, I'm happy to report that the torch has been passed. Following a night of heavy drinking, one of my peers sent the following email out to the entire class, and as it happens, our deans happen to be on the class listserve (FYI: Block one is the first portion of our curriculum):

BLOCK 1 IS BONK

"and you don't need to be sober for it"

And so flow the words of wisdom from those that come before us.

Take this as a challenge. We will not be sober. We will exceed nine days. We will be better. We will be stronger. We will push the boundaries of what is possible. We will go for at the very minimum ten days. We will make it clear that the class of 2013 will not be challenged, will not be surpassed. Will not be out-done. We will become what those before us have failed to be. We will be superior. We will be the best -- the greatest to grace the presence of Case Western Reserve University's School of Medicine.

And it will come to pass.

Today was but the first day of the epic struggle that we face.

Tomorrow, we meet at the Winking Lizard (9pm) or earlier for those valiant few that dare stretch to our reaches.

And Thursday, we will continue drinking. At McNulty's they promise one dollar drinks from 7 until 9.

On Friday, McNulty's promises once again, one dollar drinks from 7 until 9.

We shall prevail.

We shall surpass the weak nine days of drinking the 4th years have laid before us.

We shall show them how the class of 2013 drinks.

And we shall show them that we will not be stopped. We shall not be dominated. We shall not be shown the way that Block One will be approached.

We will make the way Block One is approached. We will be valiant. We shall be vigorous. And we shall be the best.

In other words, drink my friends. Drink the twenty-second of the month. Drink the twenty-third. Drink until the tenth night is reached. And once that is achieved - drink again. Drink the whole block through. Drink until the block is done. Drink until as a whole, we cannot continue any longer. If any one of us can continue, so shall we all.

"Sober is as sober does, and sober does as boring does."

"Drink Like a Champion EVERY Day."

These are the words of the strong.

Become the strong.

Come to the Winking Lizard on 7/22/09.

Drink on Thursday. (Dollar Power Hour at McNulty's)

And drink of Friday. (Again with the dollar power hour at McNulty's)

We shall overcome. We shall "Beat It".

We will be the "smooth criminal"

And we will be those that drink the whole ten days. We will even drink two weeks through. Join me, and we shall not be stopped. Come and be all that you can be. In the Block One drinking army.

Gregariously, affectionately, brutally, and honestly yours,
Student X

My entire class woke up the next morning, and when we got to lecture the next morning, found this email in our inboxes. And wait for it, waaaaaaait for it.....yup, the other shoe just dropped:


I would like to apologize for the e-mail I sent out to the listserv last night. It was inappropriate, unprofessional, and was in no way representative of myself or the way I want to be perceived. It was a very poor decision and I sincerely regret it.

The statements that I made regarding block one were uncalled for. In fact, the setup of this first part of the curriculum and its ease into the bulk of medical school contributed strongly to my decision to matriculate at Case.
Also, I think it is important that we have fun and find time to socialize during block one, but we need to be smart about it. We should not act in a way that would cause the community around us to see us in a bad light and we should be careful about what we post to the public domain.

Again, I am sincerely sorry for what I did.

Thank you,

X


Apparently the Deans ripped this poor person a new one, but I can't say I feel that bad, because I don't look so bad now with the d-bag comment.

I must be doing something right

So I just had my first day of "real" medical school. Lecture, followed by small group discussions, followed by 3 hours of administrative stuff. Followed by a strong reprimand from two deans of the medical school. Yup, that's right, my first day, and I'm already in trouble.

We had our White Coat ceremony on Sunday, a pomp and circumstance affair where the venerable heads of our school presented each member of the incoming class with a white coat, signifying our entrance to the medical profession. It was a glittering affair, with a rousing speech by an accomplished physician. It was pleasant, but honestly, I also think it's kind of a stupid tradition. We're not going to be doing anything even vaguely resembling real doctors for a few more years, and the coats we got were short coats, to signify that we're medical students (and therefore clueless). However, I made two mistakes. First, when I got my photo taken for the photo displayed at the ceremony, I made a funny face. Not weird, I just had a really big smile, and my eyes were open super-wide. I thought it was entertaining, but apparently the deans thought it reflected a lack of maturity. Second, a reporter interviewed me before the ceremony to ask what I thought of the whole affair; he noted that white coats have been linked to hospital based infections. While the jury is out , I think it's sort of a no-brainer to get rid of the damn things (so many other articles of clothing have been linked to hospital based infection, why should this one be any different), plus, I feel like a schmuck wearing one. Unfortunately, I used less than delicate language in wording it, and was stupid enough to joke around with a reporter (some of my politer comments were eventually published). When he asked me what I would think of a person wearing a white coat, I replied promptly with my customary irreverence "Douchebag." I was joking around, but should've realized any reporter would've seized an opportunity like that (I figured what I said could hardly be important). I should've also realized that the Case staff person with the reporter would relay my comments to the deans of the school, although in retrospect, that seems a little paranoid. Needless to say, the deans weren't please, and I was reprimanded for the photo and the interview. While I'm not too sorry about either one (although I regret having made the school looked bad with the douchebag comment), I apologized, deciding this was definitely a situation where you have to pick your battles, which if today was any indication, the next four years may be very much about. Oh medical school, how I love you already....

On a bright note though, our first month at school will be largely devoted to study of population and community health, including physician-patient interactions, epidemiology/biostatistics, and various other public health practices/concepts that are given short shrift in medical schools. I think it's an incredibly enlightened approach to easing medical students into the process, while equipping them with information that a lot of doctors may never learn (which I think has contributed to the bizarre dichotomy of medicine and public health; I was thrilled to learn that my school's curriculum groups them collectively under the auspices of population health).

A warm welcome

So I had my first official day of medical school todday, mostly just orientation, but the ridiculousness is already beginning.  As part of our introduction to our new medical school life, we were introduced to our first patient.  All 160 members of my class, simultaneously, to one brave soul, a college aged diabetic.  He did a great job telling us about his disease, and clearly was taking an active role in managing his lifestyle accordingly.  Of course, this wasn't enough though; my class set upon him pretty quickly oozing compassion..."What do you look for in a doctor," (he answered: someone honest, straightforward, and competent), "How did you feel when you found out about your diagnosis" (umm....pretty fucking depressed), "How were you able to afford care," and so on, so forth.  The individual questions weren't too bad, but after 40 minutes of it, I was going nuts.  I think some of us were really getting us off on feeling like doctors (I know, I'm a cynical bastard, but you trying sitting through this shit).

On a positive note though, we got to see what we might be like when we're 3rd years.  Earlier in the week, about 20 people from our class had wandered into a student lounge to get our class photos taken.  While we were waiting, we stood around, and exchanged backgrounds somewhat noisily. A med student on rotations who was studying in the same lounge was getting visibly irritated, but it's kind of difficult to shut up that many new med students meeting each other for the first time.  After 10 minutes, clearly pissed off, the 3rd year stood up, whirled around, exclaiming, "Would you all please shut the fuck up...." and stormed out.  Ah yes, medical school.....

Healthcare Reform in America

I could go on for pages, but the Economist sums it up with erudition that cuts through the bullshit politicization of topic (e.g. socialize medicine?  does anyone ever refer to the police or fire department as socialized?).  Anyways, don't get me started...enjoy.

Reforming American health care: Heading for the emergency room

Standards are dropping....

It's official folks, I will be starting medical school in three short weeks............Wow, I think I just shit my pants....I graduated from college 2.5 years ago, I can't even remember what it's like to sit in lecture (although I recall it's somewhat unpleasant), and the drugs did not help my learning abilities.

So in a nutshell, the next few weeks are going to be some combination of tough/depressing/neurotic/confusing/embarrassing/inebriated, will involve clueless 22-25 year olds, dead bodies, and me.....clearly a situation with promise of comedy, ripe for parody.

Thankfully, I'm going to a school I'm pretty excited about, which sadly, is located in a city I'm depressed about. The institution felt right from the moment I joined the backrow kids in a sample lecture; amidst the carnage of med school, they somehow found time to pay daily homage to the NY Times crossword puzzle, stalk love interests on Facebook, and throw paper airplanes at the front row kids, all while following an epically boring Ph.D lecturing about pharmacology. I got the impression that a lazy man cannot only survive at my medical school, but possibly thrive.

Which is exactly what I aspire to be in medical school. I spent my first few years as a medical student trying to talk the talk, walk the walk. I sat in the front row, had my colored pencils at ready for organic chemistry, and was contagiously neurotic. Perfect pre-med right? Except I wasn't. Definitely a case of square peg, round hole. Because I inevitably was always 10 minutes late to class, I always screwed up weeks of results in lab because I was spaced when we were getting instructions, and sometimes the relationship between the hours I studied and the score I achieved was decidedly inverse. After 2.5 years out of the game, I have embraced my square peg nature, perhaps a little too much.

Whatever the case, I'm entering medical school with expectations and goals that may be somewhat different from the average student.

1.) P=MD -> Pass equals MD. As in, if I get a 61% on a test, I studied too hard, because as long as I pass my classes, the USMLE, and don't piss off my attendings too much during clinical rotations, I can pass Go and collect $200 at some residency, somewhere in the US. I know, I know what you're thinking, "Oh my god, I never want this guy to be my doctor." A very healthy fear, Darwin has served you well. But hopefully that fear is a reflection of me and not so much the strategy of P=MD. I've heard the pre-clinical years have a good deal of bullshit thrown in (Krebs Cycle and pKa's anyone?), which you thankfully will probably never need to know. In theory, if you can pass your USMLE, you have an ample understanding of the material. Plus, with the extra free time I may have pissed away for that Honors score, I can enjoy what's left of my twenties.

2.) Boundaries, Boundaries, I said BOUNDARIES you crazy motherfuckers!
If you've ever been around doctors for an extended period, you start to realize as a community, they're pretty damn weird (I know, it's rich coming from me, but takes one to know one, right). But seriously, what kind of person decides whether they're 18 what they're going to do with life? And then pursues that with the sort of bloodthirsty rancor many pre-meds exhibit. Sounds like a great way to select for some malignant personalities. Moreover, I get the impression a lot of physicians started their training thinking, "Well, I'll get through college, and then I'll power through med school, and bust ass in residency, and then I'll have time to chill by the pool with my hot mamma/pappa and a stack of the Benjamins." Except, it doesn't always seem to work out that way. Because after you spend the majority of your twenties working, a time when your identity is still shifting and malleable, you might find out that's who you've become. After short-changing relationships with parents/siblings/spouses and making no time for interests outside of medicine, it may be your life. Which is why I think a fair number of doctors have malignant personalities (angry, cocky, mean, self-absorbed, God-complex, etc.). Call me crazy, but in a profession where your most personal of functions, the right to shit, eat, and sleep in peace are encroached upon (welcome to surgery rotation, where as medschoolhell beautifully points out, you're not the med student, but the retractor bitch), you need to make a stand for yourself, and how far you are willing to subsume yourself to your studies/job. So in medical school, I hope that when it comes time to choose between calling my parents or studying for that high pass on the test, I call my folks every damn time. I'll let you know how it works out.

3. Exit strategy anyone?
The American healthcare system is broken. That's not my opinion, that's not conjecture, it's a god damn fact. Talk to anyone on the front lines of medicine who doesn't have their head in the sand. And it needs fixing. Hopefully the solution will come around in the next few year, and hopefully, it will be one amicable to doctors. But what if it isn't? What if a profession that has seen declining reimbursements, increasing work hours, and skyrocketing educational tuition gets worse? Is it still worth it? Do you love your patients that much? Can you get out if you're carrying $250,00 in debt? I don't know, these are very troubling questions to ponder. So at every stage of my med school career, I'll be reading the papers, following the blogs, hey maybe even watching a little C-Span to figure out how things are looking. And if they get real bad, I may decide to get the hell out of clinical medicine. Because while I want to touch lives, and do good in medicine, I'm not going to martyr myself. I've seen too many unhappy doctors to want that for my life.


Some of my friends hear me bitch constantly about medical school, and they say, "Why do you want to go then?" And the truth is a

a.) I love to bitch about things....come on, it's kind of fun

b.) It's a great profession that comes with a pretty high price tag.

Who wouldn't want to save lives and get paid well for it? Sounds like a win-win, right? Except the more I learned about it, the more I realize it is a tough profession to enter. The work can be boring, dirty, and downright depressing. The pay could ultimately be shitty on a per hour basis. And the training can really, really suck a big one.

So that all gives me pause, but it still seems worth a shot. Hell, I can always drop out if I really hate it. And how is it going to get better if people don't bitch, and then do something about it. Which I plan to. I think physicians need to become more engaged in political issues, need to take an active role in administration at every level of healthcare, and need to address the lifestyle issue, so ultimately, medicine can be a people-friendly career instead of a meat-grinder.

It's always going to be a daunting endeavor. Taking care of the sick and the dying was never going to be fluffy bunnies and daisies in the springtime, but I think it could suck a whole lot less. Again, I'll let you know how it goes. Stay tuned for more.....