Is that The Eye of The Tiger playing behind me?

If my life were a movie, this is where the Big Training Montage scene would go.

With only 6 more studying days until my big fight test, the studying has been in high gear for a while.

Actually, it is almost around the clock, literally. Between my usual dose of insomnia and Dylan's 2 middle-of-the-god-damned-night-feedings while Kathy is at work, I find myself watching review videos or reading by computer light while the little guy hungrily chows down a bottle. Afterwards, as I toss and turn, trying to fall asleep, I will inevitably think of something I wanted to look up or a practice question I got wrong. It will fester until I eventually give in to my compulsion and... out come the books.

I have been at this pace for a good while now and I seriously can't wait until this particular test is in my rearview mirror.

You always hear about the Herculean effort and multiple sacrifices that are needed to get through medical school. I wasn't naive. I understood what kind of work it was going to take. I knew what I was getting into. I entered into this journey eager, and with eyes wide open. Don't get me wrong, there have been a bunch of sacrifices and our road was not without its share of bumps, but frankly, I never felt like this whole thing was that bad . I'm not sure if it is because I have a supportive family around, or because I had a good bit of clinical experience before starting, or just that I am too damned old to get flustered about things. Whatever the reason, I had it all under control. Things, they are starting to change.

I am sure this is a very common feeling for most students around this time in their careers. So close to the end (or beginning, actually) and each next step is a bit harder to take. The feeling like it is NEVER going to end, and the mountains of tasks- still left to be done.

Yes, I am so ready to get this test over with and reclaim just a small part of my life.

So, if you are in the neighborhood of the Prometric Testing Center in Manhattan next week, and you spot a man with blood-shot eyes, sporting a "playoff beard", who smells of regurgitant breast milk and baby powder, mumbling to himself manicaly, "Yo, Adrian!", as he walks out of the building- just smile and nod and let me have my moment- I've earned it!

Weekend Update # 716....

This past weekend Kathy, Rileigh, Dylan, and I drove down to spend a few days at Chateau de Exwife . As usual we had a great time. We got to spend some time with the whole family before Susie, Bruce, and the girls head off for their annual vacation- this time it is Mexico for 10 days. Color me jealous.

Friday I spent the day at my mother's house taking care of a list of things she needed me to do: running some new pipes for a water spigot in her garage, repairing her kitchen faucet, replacing a dimmer switch in her dining room, replacing the toilet flange and re-mounting her toilet, and some other manual labor type things. Thankfully Bruce had the day off and offered to come along and help me get things done quicker. Everything got fixed and nary a trip to an ER- it was a good day.


Speaking of my mother... Let this be fair warning to all:

It now may be unsafe to drive (or walk, for that matter) about the streets of Philadelphia.

It seems those wacky, fun-loving pranksters over at the PA Department of Transportation thought it would be a good idea to issue her her first Driver's License! Congratulations, mom!


Because of an upcoming change to the test format, begining on August 10th, people who take Step 2 will experience a significant delay in score reporting. I wanted to avoid this and so I have re-scheduled my Step 2 exam for Thursday, July August 6th. Hopefully the 4 days of forsaken last-minute studying won't have an impact on my score. I can't wait for this to be over!

Lastly, file this under "David Hasselhoff, I ain't!"

While enjoying some barbecue yesterday in the back yard at Chateau de Exwife, Rileigh somehow managed to crawl underneath the ad hoc security gate at the bottom of the steps that lead up to the pool deck. She was up just about at the topmost step when we noticed her. My dad instincts took over and I lept up from the table stepping over a Sleeping Dylan in his carrier seat, and sprinted across the lawn to the steps. I'm not sure what exactly possessed me, but I hurdled over the gate at the bottom of the steps and nearly tackled poor Rileigh up on the deck. She was quite startled because she was only headed up the steps to retrieve a toy and here comes her dad barrling down on her like she stole something. After catching my breath for a second I recieved a strange message from my lower back.

It said, "You idiot! Apparently, you think you are some sort of athlete who can sprint off and go hurdling over things. You are so wrong. You will pay."

Almost immediately, I felt the wonderful searing hot pain of old age and deconditioning racing across the right side of my lower back. So today I am hobbling around half-crippled and hoping this goes away soon.

The safety gate has been repositioned and she can no longer get by it (for now). Sadly, I imagine my lower back will take a bit more effort to get back in shape.

Lessoned learned.

On losing one's mind...

Friday night was my last shift of my Emergency Medicine rotation. Unfortunately, it went out with a whimper and not a bang. My last 2 shifts there were uncharacteristically slow. I suppose that is a good thing for the citizens surrounding the hospital, but not necessarily how you want your shifts to go when you are an eager medical student. (paying not a small sum of money to 'get your learn on') The whole rotation went really well however, and it has been the most enjoyable rotation by far. I am looking forward to another ER rotation assuming I can successfully schedule one.

With only 5 months of rotations left, I am starting to see the light at the end of this tunnel. It is a pretty exciting time. I must admit my excitement is tempered a bit by the stress of all that remains left to do. There are personal statements to write, lists of residency programs to weed through, letters of recommendations to secure, applications to fill out etc. The seemingly endless administrative tasks are the bane of my existence, but a necessary evil so I'll stop whining now.

Before I can dedicate the time needed to get my applications in order, I have to tackle the USMLE Step 2. August 10th is my test date. I have been trying to study as much as I can and have been doing practice questions for almost 2 months now- squeezing in a block of questions whenever I could. Since I am rotation-free for the next 3 weeks, my studying will ratchet up to a full-time job (in addition to my Mr. Mom duties while Kathy is at work) so this should be a very interesting few weeks. I have been doing pretty well so far on the practice questions and I did well on the sample exam that you can download from the USMLE site; so far so good.

While I am fairly confident going into this exam, everyday it seems I uncover yet another piece of medical knowledge that yours truly has simply... forgotten. The information is gone and all that remains is the phantom of a memory, mocking you, like a dream you can barely remember. The harder I try to recall, the fuzzier the details get until I find myself at my desk drooling on myself and realize half an hour has passed. I realize that no one is expected to remeber everything, and I'm sure everyone has moments like these, but it is of little consulation when you feel the cruel grip of senility taking hold. Studying for an exam like this is quite the gut-check. I think half the battle is hanging on to your sanity.

I have a particular mental block when it comes to a few topics, try as I might they slide through the steel trap sieve that is my mind:

The glycogen storage diseases- once upon a time I could prattle on about them, now... nada.

The serological markers and the auto immune diseases they are associated with- anit-dna, ana, anti-centromere, smith, rho, jo, anca...calgon take me away!

The congenital adrenal hyperplasia enzyme deficiencies- 11, 17, 21...22 23 whatever it takes. ( I have drawn the chart about a bajillion times over the last 4 years- you think I would remeber... any of it!

The relationship of gnrh, fsh, lh, estrogen and progesterone in the menstural cycle/pregnancy. This one I can usually recall after a mini "drooling session" but it seems that my lack of understanding of women doesn't end with The Mystery of the toilet seat left in the UP position and the psychotic break it precipitates in those afflicted with 2 X chromosomes.

By no means is this list complete, the sheer weight of what I don't remember would sink the QE2.

Despite my selective amnesia, I push on, ego in tatters, and like Sisyphus, I am condmened to watch the boulder of my memory roll back down the hill. Maybe today some of it will stick.

Maybe.

X-Ray From Last Week

Things have been a bit on the busy side. I have switched to night shift in the ER for the next 2 weeks and have been struggling to get used to being awake all night again. Things are going really well on this rotation and time is flying by- as I imagined it would.

This was a case I had last week. I saw a gentleman with a bad venous stasis ulcer who had just been discharged from the hospital. He was returning because the ulcer had just started to drain some rather purulent material despite being on some antibiotics. After taking his history and doing a physical I went and looked in the computer system for a x-ray of his leg- since he had an old distal femur fracture that he chose not to have repaired for some reason. I saw the x-ray and it was quite an impressive fracture but other than that, the area of his leg where the ulcer was looked pretty good. When I presented the case to the attending I mentioned that I would like to get another x-ray even though the one on file was less than a week ago. He agreed, and I ordered the films. A little while later I went to pull up the x-rays and this is what I saw:




Click on the images to enlarge them, if you are having trouble seeing, there is subcutaneous air in the soft tissue.

Diagnosis: Gas Gangrene. Pt was scheduled for amputation of the leg above the knee for the morning.

Reason # 419 to keep your diabetes under control.