mudphudder

So it begins.

June 22nd, 2009 | Tags: internship | Category: personal | Comments (2)

So the regular readers of this blog probably thought this post was just going to be the video clip of “the Final Countdown” by Europe that I post every so often, but NO! it’s not!  :-)  So if you haven’t already flipped back to google, here we go.

My other first page (non-official, from me to me)

Tomorrow I start internship.  Crazy.  I last wrote about my fear of totally messing up this thing and I appreciate your kind comments suggesting the contrary.  At this point, I just want to get in there and fire it up baby.  I’ve spent this weekend going in, rounding with the current team, writing orders, learning the system, etc.  I put in my first official order as a physician.  I called my first consult as a physician.  I did my first discharge summary as a physician.  I received my first page–well, my first official page from someone else–as a physician.  Even better, my first page was back to a number that wasn’t working.  That’s not a good sign.

But I’ll make one last comment on the craziness of this all.  As medical students we get to write orders occasionally–mostly in advanced rotations (e.g. sub-internships) but those orders are always cosigned.  So while you are always approaching the process as though you are the doctor, deep down inside you know that someone will (has to) be double checking you on any little thing that could affect the patient.  I suspect the next few weeks won’t be too much different as an intern but quite frankly, my senior residents won’t be able to double everything that will affect the patients’ well-being.  So it is with some (serious) thought and rethinking and re-rethinking and re-re-rethinking that I am putting orders in right now.  I hope and I suspect that I will build up my confidence with time and experience but for now, I’ll just have to be inefficiently careful to the extreme.  Patient wants tylenol?  Hmmmmmmmmmmmmmmmmmmmmm.  Hmmmmmmmmmmmmmmmmmm.  Is there any reason not to give this guy some tylenol?   Hmmmmmmmmmmmmmmmmmmmm.   Hmmmmmmmmmmmmmmmm.  You get the picture.  But I’m happy that this kind of thought process is not sustainable throughout residency so at some point, I’ll have to get faster. 

Anyway, the last couple of days has seemed cautiously do-able.  I’m always discovering some new, critical responsibility that the intern is responsible for on our service, so I hope that I don’t bring the service to a screeching halt tomorrow.  But we’ll see.  100% is all I can give.

Wish me luck (although most of you already have, so thanks again).

I’ll write to you from the other side.

Mudphudder out.

June 21st, 2009 | Tags: internship | Category: md / medical student stuff, md / phd student stuff, personal | Comments (5)

Today I crossed the threshold of the hospital I will be doing intership in. I stopped at the front door, hung my head, took a deep breath and plunged myself in. My first reaction is some fear of the unknown. Not so much what to expect–I already know that I’m gonna get my ass kicked and then handed to me on a platter–but more along the lines of not messing up.  Too much. 

I just don’t want to be that bumble-fuck intern that’s in every residency program.  Some of you know what I’m talking about.  I recall one bumble-fuck intern I met during a rotation in medical school who started off presenting a patient on AM rounds with “Mrs. So-and-so is a … yr old female… who had no overnight issues and is doing well…”  At which point a few of us peered into the patient’s room and she honestly looked like she was dead.  I’m talking arm hanging off the side of the bed, mouth slightly open with eyes closed.  Long story short, she wasn’t dead but she had become septic overnight–while this intern was on call.  This was a recurring theme for this particular intern and very often to the dismay of the senior residents. 

I don’t want to be that guy.  I work hard.  Always have.  But then again, this guy must’ve too to get to where he was at.  Right? 

I don’t know–I guess what I am describing is a “fear of failure”.  This is a huge transition point in my infant career.  I actually have some responsibility for the lives of other people.  I’m a doctor and I don’t want to fuck it up.  I especially don’t want to fuck it up while putting in everything I’ve got.  I guess we’ll see how it goes.

June 16th, 2009 | Tags: internship | Category: personal | Comments (7)

Today I signed up for a gym membership.  The first time I’ve committed to working-out somewhere new in the last eight years.  It’s nice but small with not much weight-lifting equipment.  But this gym is close to home and I’ll have no excuses to not stop by for a 30 min workout occasionally.  And on the plus side it was the first time in about 3 or 4 years that I’ve felt comfortable leaving my wallet and keys in my gym locker rather than carrying them around the gym in a fanny pack. 

About 3 or 4 years ago, while I was working out at my other gym, a couple of guys went into the men’s locker room, cut the locks off of like 7 or 8 lockers and robbed everyone.  Some faculty members lost laptop computers, some people lost wallets, me–they took my raggedy jeans, with my wallet in them.  Even worse, my favorite belt went with my pants.  Motherfuckers.  There are few things as emasculating as getting your pants taken away.  Anyway, ever since then, I’ve carried everything of worth in a fanny pack while I lift weights, which was annoying.

Today, I felt emancipated.  I guess you can never be too sure but this seems like a nice place–and for what it costs, it better be nice. 

So I propose a toast: here’s to experiencing new things.  And not having my pants stolen.

June 13th, 2009 | Category: personal | Comments (2)

As of late I have made some fuss about my footwear to start off internship.  Yes, every young doctor secretly or not-so-secretly wants to be pimpin’ and for some, footwear is a big part of that.  I may have given that impression in the last post I made but for the sake of the youngins, I’ll clarify. 

First of all, you know me.  The mudphudder.   MP.  We already know that I’m the “why?” in “stYle”.  But make no mistake about it, when it comes to footwear and the wards, style is an afterthought.  Walking the wards for a sub-internship or any time consuming medical school rotation is no joke.  It kills your feet.  I suspect residency will be no different.  Going to the wards is like going to war.  And the preparation starts with your feet.  Without healthy feet, you can’t walk the wards or stand in the OR for 12 hours a day.  So when it comes to your feet, you gotta go with comfort and durability before the style factor even comes into play.  And I’m talking socks too: comfort and durability. 

You can always tell the newbie medical students on the wards: wearing pimped out shoes with dress socks.  I was one of them too once.  After a few weeks or months, spending evenings with your feet up on pillows wrapped in ice, it dawns on you that it may not be worth it.  True dat.  For the last few years, I’ve been wearing dansko clogs and sweat socks.  I love it.  It works–my feet don’t kill me when I go home (as much).  Plus, I can kick them off at anytime during conferences, lunch or even when I’m talking to patients to let my puppies breath a little.  Oh yeah.  Some of you know what I’m talking about.  Like when you’ve been on your feet for 15 hours straight and your feet hurt so bad that they’re numb and then you sit down, kick the shoes off and it feels so f’in good.  And to be quite frank, I don’t give a rat’s ass that some people may not like the white sock/black shoe look.  It’s comfortable and it’s professionally acceptable so all the haters out there can just eat it. 

Anyway, once the shoes have been narrowed down for comfort and durability (I once knew a crazy ass resident who actually used one of those podometers to calculate he walked an average of 5 miles per day in the hospital), then go for style.  I’m personally sticking with my trusty dansko clogs.  My bad-ass Johnston and Murphy shoes are strictly for walking Boston on my days off.  Yes, they’re comfortable but they’re not made for long hours.  My new Bruno Magli’s (I still love the fact that I have a pair) are strictly for *occasional* clinic use.  Yup–Even those bad boys I’m gonna be careful about taking out.  At the end of the day, despite my pimped out arsenal of footwear, I’ll mostly be relying on my clogs.

So to conclude, being pimped out is important but not at the cost of the feet.  Furthermore, being pimped-out is a state of mind so the “Superfly” should come across regardless of the footwear.  And if it doesn’t, then the fur on the collar of my white coat should give it away.

June 12th, 2009 | Category: md / medical student stuff, personal | Comments (3)

In an effort to be the most pimped out intern, I went out today and bought some new shoes and new shirts.  You already know that my tiny apartment is pimped–even more so since I posted that picture–more orchids out and a sweet printer/scanner/copier/fax hooked up to a wireless network so I can use it from anywhere.  Then again, my home is only 600 sq feet, so how far would I have to go?  I guess it’s the principle of it.  The state of “pimped-out-ness” is not about practicality. 

Mudphudder peacin' out with his new Johnston and Murphy's

Anyway, I hooked myself with some sweet Johnston and Murphy walking shoes on sale (big sale in the store right now) and a pair of black Bruno Magli’s for clinic.  Yeah that’s probably over-doing it, but as I said the state of “pimped-out-ness” is not about practicality.  I unfortunately have not included a pic of my Magli’s because they are resting comfortably in their shoe bag and I don’t want to disturb them.  Now that is soft leather.  To round out my efforts for the day, I ended with some non-iron shirts from the Banana Republic.  Now, I just heard about these and I’m still not convinced that I won’t have to iron these shirts after washing them, but I just had to try them out.  You see, a pimped out intern doesn’t have time to be ironing shirts.

Finally, I turned on my landline today and I got such a wicked awesome phone number!!!  Let’s just put it this way, I memorized it after hearing it once.  DANG!

Well my peeps, it’s getting late and I gotta start getting used to going to bed early so I can wake up early.  I’ll take my leave for tonight, but more to come.

June 11th, 2009 | Category: personal | Comments (7)

FINALLY!!!! I’m back online.  Sah-weeeeeeeet!  Mudphudder is back baby.  So what to write about?

To date, I’ve been a little secretive about myself and for good reason–it let’s me speak my mind quite freely without fear of reprisal.  But for the readers who’ve stuck with me through the last few weeks, when posts have been few and far between, in effort to bring this little thing called the mudphudder blog a little closer to home, here’s a rare glimpse into my new life.

For one, I recently moved to Boston, Massachusetts for residency.  Boston is one of the few major cities in which I had spent almost no time before residency interviews but I am finding it to be a most awesome place to live.  The city where I attended medical and graduate school was, shall we say, not great.  Don’t get me wrong, I met a lot of really nice and wonderful people while I was there, but the city itself–not so great.

My superfly pad.

So here I am in Boston.  The pad is set up.  Actually, more than just “set up”.  I would call it pimped out, to be quite frank.  I just bought a big-ass 40 inch flat panel TV.  I just bought some nice furniture, including a couch deep enough to accomodate my shoulders (I hate lying on a couch with my arm hanging off the side).  Plus, I have all of my orchids here with me.  That was so key.  I had to give away a lot of my houseplants but managed to also bring a few with me.  I’ve had all of these plants for 6, 7 or 8 years.  And in during that time, they haven’t argued, whined or yelled at me.  That is even more key. 

Anyway, I’m just catching my breath now.  Since I was last blogging on a regular basis, I went through graduation, saying good bye to everyone, packing up and moving up here to Boston.  Doesn’t sound like much but it was.  Anyway, things are finally starting to settle down around here so hopefully I’ll have more time to write about the last few weeks and what’s going on now.

On the top of my list, I just want to comment on the Boston weather, which so far has been awesome.  Not too hot and in fact often pretty cool.  Where I was at before, it’s like 80-90 degrees right now.  Here, cool and in the 60s (although rainy today).  We’ll see how much I’m loving the Boston weather in a few months…

Anyway, it’s getting late so I should hit the sack (right after I finish watching “A Few Good Men” in HD; awesome!).  But MP is back and now you know a little more about me.  In particular, that I’m super-fly.

June 9th, 2009 | Category: personal | Comments (7)

I’m on my way to buy my new wireless router now so hopefully my Internet will be up and running tonight and I can get to blogging (from my computer rather than from my phone).

June 9th, 2009 | Category: personal | Leave a comment

Hi everyone. No I’m not dead and no I haven’t quit blogging. As many of you know, I recently got residency on city far away from where I went to medical school and I have been in the painful process of packing and moving over the last few weeks. I apologize for my lack of blogging in that time but I have just been getting crushed. Between hosting family for graduation, finishing up 3 manuscripts (which mind you are not done yet) and of course the obviously painful process of packing up, I just have not had the time. Plus I haven’t had real Internet access in over a week. In fact, I am writing this entry on my new iPhone (which is Sah-weeeeeet by the way).

Anyway, please hang with me for another few days when I can set up my high speed Internet and I’ll fill you in ok the pain that has been the last two weeks.

With much love to my loyal readers,

MP

June 5th, 2009 | Category: personal, phd / graduate student stuff | Leave a comment

The bloggers out there know what I’m talking about when I refer to “spam commenting”.  These are people (or websites) who leave very generic but often flattering comments on other people’s posts in order to generate links back to their own websites, which usually are selling something.  In the last week, I’ve gotten my first two spam comments from what turned out to be porno sites.  Here’s one of my porno spam comments:

Do you do all your own writing? Or do you outsource some of it? I’m looking for some similar content for my blog! These are great posts!

Hells yeah porn-meister, in fact all that writing is mine.  You know, I get that question about outsourcing all of the time!  Something about my writing probably reminds readers of non-native english speakers in third world countries trying to write english.  And finally, damn right these are great posts.

Anyways, back to the story…  Of course I was as shocked as the certain someone, who found me looking at the porn sites, to find out that I was getting spammed by porno websites.  But I guess you know you’ve made it big when the porn sites start getting you.

In other news, most of my furniture is now gone.  I’ve come full circle.  I still remember the first night when I moved in here, eight years ago, when all I had was my bed and my TV.  Now it’s back to the same.  I can’t believe I’m talking about eight years ago like it was yesterday.  I can’t believe my frame of reference for time has gotten so long that eight years is not that much.  I’m getting old.

May 18th, 2009 | Category: personal | Comments (2)

I said goodbye to my best friend’s two year old daughter today (I’ve known her since she was 8 hrs old).  Sure I’ll see my best a friend a few more times before I head out of town (he’ll be heading out of town not too long after I do) but soon enough I’ll have to say goodbye to him too.  I’ve been saying my goodbyes for the last couple of weeks, so that’s not new.  But for those of you who care to know, I tend to be the kind of person who has a lot of “acquaintances” but I maintain only a very small number of really really close friends that I know I can completely trust, etc.  After six years in the trenches together, it’s a bummer to say goodbye to my best bud, my big bro.

A real bummer.

May 17th, 2009 | Category: personal | Leave a comment

Some of you may be wondering what the mudphudder is up to and some of you may not have even noticed no new posts in the last week.  I’ve now hit full-blown moving mode–packing stuff, selling stuff and storing stuff.  It’s brutal.  I’m hot, tired and sweaty.  And tonight, I’m being dragged to a party by a certain someone in about an hour.  No rest for the weary. 

As an update, I had one article that was published about a month finally show up on pubmed.  Instantly I received a number of questions and requests regarding the work.  So it is good to be indexed on pubmed.  Also, I had one manuscript rejected.  It was the kind of review, I’d call a “smackdown”.  Which is weird, considering we were invited to submit the manuscript to that journal.  Whatever.

Now, I’m stuck with two other manuscripts that I’m trying to finish before I move in a couple of weeks.  It’s gonna be tight.  And the last thing I need is a fucking party to go to right now.  But what are you gonna do?

Sorry about the lack of posts recently–I haven’t fallen off the face of the planet.  Please bear/bare (however the fuck you spell it) with me as I get through this. 

MP

May 16th, 2009 | Category: personal | Comments (4)

A good friend of mine is in town this weekend so I’ll keep it short and sweet. 

I recently came across a list of the 100 science articles that every graduate student should read on a scientist’s blog.  I curiously looked through the list and noticed very quickly that 9 of the about 76 (so far) posted articles were written by him!  HAHAHAHAHAHA!!!!!!  Watson and Crick’s Nature article on the double helix structure of DNA was not even on the list.  And the articles that were seemed to be mostly potentially useful to only a small subset of graduate students.  I won’t mention the scientist’s name because I don’t want to draw negative attention to this dude from my blog, but, COME ON!!!!  I pubmed-ed this scientist and noticed that, yes, he does good–no, great–science.  But to tell me that over 10% of the 100 articles every graduate student should read was written by this dude’s hand?  C’moooonnnnnnnnn…  A few of you might have seen this distributed over twitter and/or my response to it, so if you’ve taken a look at the list, am I wrong? 

This is what I look like on a bad hair day. Except that I'd never get caught dead in striped swim trunks.

Not that accolades mean much but even if this dude had won a Nobel prize, was a member of the National Academy of Sciences or HHMI (note though this person has accomplished none of those things), there’s been so much amazing science, which should be at foundation of every biomedical graduate student’s education, that no person could possibly take credit for such a large chunk of it.  That’s just my opinion though.  But hey, even I need my ego stroked sometimes–I just think it comes across better when it’s someone else doing it. 

So the final conclusion that I draw is that one’s blog must be the place for self-aggrandizement.  Therefore I just want to tell you that while this dude can take credit for roughly 10% of the 100 articles all graduate students should read, I can take credit for the other roughly 90%.  But then again, you already knew that.

Mudphudder out.

May 9th, 2009 | Category: personal | Comments (3)

As some of you may know, last week I started ACLS training last week (I’ve been twittering about it quite a bit and even posted some pictures from class).  For those of you who aren’t familiar with it, ACLS stands for “advanced cardiovascular life support” and I’m training so that I can participate in or even run codes in the hospital starting in July.  Part of the training consists of basic life support (CPR and using a defibrillator) and part of it–the “advanced” part–consists of recognizing when and in what order to use certain drugs or shock patients in order to bring them back from the light.  So when you’re watching Grey’s Anatomy and you see them yelling at each other, “EVERYBODY CLEAR”, “SHOCK”, “RESUME CHEST COMPRESSIONS”, “1 MG EPINEPHRINE IV”, and most importantly, “NOT ON MY WATCH–YOU’RE GONNA MAKE IT!!!”  That’s gonna be me in about a month and a half.   

Eew. Keep your spittle--and herpes--to yourself.

So the training has been rewarding so far but I was minorly disturbed by something one of the course directors said to me in response to a question I had.  As many of you know, a part of CPR is “rescue breathing”, which may have to be mouth-to-mouth resuscitation if you don’t have another way to push air into the patient’s lungs.  Rescue breathing is the only source of oxygen for a patient that has coded.  So in our class all of our mouth-to-mouth was done through a CPR mask that basically prevents direct mouth-to-mouth contact, for obvious “reasons”.  I put reasons in quotation marks because while it seems really “yucky” to do mouth-to-mouth on a stranger, it has repeatedly been shown to be safe–i.e. the risk of acquiring any kind of blood-borne infection (e.g. HIV) is incredibly low–on the order of 1:1,000,000 or less.  However, data also exist suggesting the rescue breathing may not be necessary in addition to chest compressions for a cardiac arrest.  The physiologic basis for reducing the number of rescue breaths is that stopping chest compressions to give the rescue breaths greatly reduces the blood flow to the heart and brain.  And a few studies suggest that chest compression-only CPR may be as effective as standard CPR for cardiac arrests.  The impact of these studies is that people who choose not to give rescue breaths to the dude they watched keel over at the Old Country Buffet, are off the hook.  The current recommendations by the American Heart Association are that rescue breaths be given at a ratio of 2:30 chest compressions, which is what you will see EMS/paramedics doing.  But, EMS always carry their handy-dandy masks plus they use a bag to ventilate people so they don’t have to worry about catching herpes or HIV from the arrested patient. 

So my question to one of our course instructors the other night was, how to do you feel about giving mouth-to-mouth given the strength of data suggesting that it’s pretty safe and probably worth the risk of saving somone’s life.  The response I got was that this instructor would never give mouth-to-mouth and the example I got was, ”you see a dude pass out at a bar in [popular part of town for bars]–would you want to give that dude mouth-to-mouth?  I don’t think so”.  To me it’s not so clear-cut and reminds me of a bumper sticker I saw recently: “What would Scooby do?” 

Scooby would probably say "I'm a dog, I don't know how to do CPR"

I’m not so sure how I feel about the thought of “yuck” coming into the decision making process of a healthcare professional performing life-saving measures.  I’m not saying it’s not practical but I’m just not at that point yet.  While some (and not rock-solid) data suggest no added benefit of rescue breaths for cardiac arrest, they don’t show any added harm either over the recommended guidelines.  Moreover, there are situations where using rescue breaths in CPR is superior to no rescue breathing, such as when the patient has a respiratory obstruction or arrest.  So while the two sides of the argument agree on little, I do think it can reliably be said that, for now at least, the data don’t show a harm from following the recommended 2:30 breaths:compression guidelines. 

I don’t carry my CPR mask/microshield around everywhere with me (and I never will) but then again the preponderance of data that I’m aware of suggests that mouth-to-mouth is safe.  So what to do?  What would you do and what would you want if you were the 350 pound dude with the lobster bib at the local Red Lobster who keels over?  If you’re giving different answers to those last two questions, you got a real dilemma on your hands, my friend.

May 8th, 2009 | Category: personal | Comments (2)

Yeah, that's how I roll.

…the mudphudder will play.  Today a certain someone went out of town for a five day trip to see the ‘rents, which means that I’m home alone.  Home alone.  Takes me back to a different time.  Except tonight I have two manuscripts that are in need of work and I have to move within the month.  I’m thinking this bottle of Bordeaux with a bag of Pepperidge Farm Milano Double Chocolate cookies will give me the power to plow through one of those manuscripts tonight.  Or put me to sleep and give me indigestion.  Probably the latter. 

So before I pass out or I start slurring my writing (already can feel the first half of that bottle taking effect), allow me to briefly wax nostalgic.  Today I picked up my graduation gown for the upcoming commencement.  Everyday I have more reminders of the fact that I’m jetting after spending eight years here.  Someone asked me recently if I was gonna miss the institution, and I said: “Hell no.  I’m gonna miss the people.”  I’ve met a lot of really nice people over the last eight years.  Today after I picked up my gown I ran into a security guard who I’ve said good morning to for the last seven years.  Today we talked at length.  I found out his life story.  And then I ran into a member of the cleaning staff who I’ve known for six years.  And so forth.  It’s pretty sad.  But isn’t that what life is all about?  Hear me out here–it’s not the wine talking–this thing we call life is all about experiences we have, the people we meet, the relationships we form.  Yeah, man.  That’s totally what it’s all about.  But it’s still sad.  It’s been fun, my peeps. 

I don’t know if it’s the, now 3/4, bottle of wine I’ve had but I have the urge to tell someone that I love them. 

I love you, reader. 

[Snoooooozzzzzzzzzzze]

May 6th, 2009 | Category: personal | Comments (4)

As a follow-up to my last post, I feel compelled come clean that I listen to Phil Collins’ music. Yes, I’ve been a fan since he rocked out on Invisible Touch with Genesis in the mid-80s. Much like Neil Diamond and Journey, Phil Collins rules–but in his own, semi-manly/wussy kind of way.  And what the fuck is this about Phil Collins being #5 on the list of “Top 10 Pop Artists for the Terminally Uncool“?!?!?!?  I’m outraged. Hello??!?!  These guys have obviously never heard about a ground-breaking band called Genesis.  When Peter Gabriel left Genesis, Phil Collins had the courage to step in and show us that having puppets in music videos is cool:

I won’t even get into his revolutionary solo work that includes the soundtrack of the Disney movie Tarzan. 

Moreover, what the fuck is up with that list in general?  I listen to at least half of those artists on a regular basis!  Bryan Adams?  What?!?!?!  C’mon!  (As a sidenote: I do the best Bryan Adams raspy voice the morning after I’ve had a couple of cigars and much too much to hard liquor on the night before).  I won’t even get into my outrage over seeing Neil Diamond on that list. 

Some people just have no taste in music…

May 4th, 2009 | Category: personal | Leave a comment

Score one for the bad guys.  I am seldom shocked anymore but even I was startled by this one.  A recent story published at gothamist.com reports on a recent slew of phone calls from the New York

Phil Collins sang a lot about poor people in this album so it seemed appropriate

University (NYU) to low-income families whose kids had gained acceptance for college to NYU just to remind them how expensive it is to attend NYU.  The story reports that officials at NYU, which will distribute $175 million in financial aid in the next school year, say the phone calls were simply intended to make sure families understood their often complex financial aid packages.  This was also confirmed and strongly condemned by the NYU school newspaper.

From what I’ve gathered now, NYU calls these poor low-income families and tells them, “it’s expensive here” and at best makes sure that they understand how much of a debt burden they will be taking on.  I can think of a few things that are not right (even for academia) with this picture.  First of all, everyone did not get this phone call, just low-income families.  It doesn’t take a genius to see why this would be offensive as the assumption seems to be that low-income families, perhaps by virtue of their low-income and socioeconomic class, are unable to even contemplate a number as big as $50,000 per year.  Oooooo–that’s so much money, I can’t even begin to understand what it means!  You know, this really does piss me off.  I’ve always felt that education should be accessible to anyone who was willing to work for it.  And as much as I used to bitch and moan about how much my university was giving me in financial aid and how much I had to borrow, the system did sort of work.  Yes, I was able to afford going to an expensive college but was I able to eat steak for dinner every night?  No.  I ate at the dining hall everyday (where rumor has it the food was laced with baking soda to make the students feel full on less food but that’s another story) and I had to cut out a lot of frills.  So what NYU appears to doing, in my opinion, is shear elitist intimidation and bullying.  These kids got into NYU and they clearly had loan packages to go there but instead of being recruited, their lack of money is being thrown in their faces.  As if these people didn’t know they come from a low-income family.  Unbelieveable.  As many have already pointed out these phone calls–while not directly pressuring these families–are just adding more pressure that these families must be feeling from their finances–a sentiment that has been echoed by some of the students whose families have received these phone calls from NYU. 

But as disgusting as I find NYU’s actual behavior, I find it even worse in light of the fact that they could be helping instead!  Rather than bullying low-income families and “reminding” them of how expensive it is for their child to go to NYU, they should be educating these families on the different ways of that education can be funded through grants and reasonable educational loans.  The “ins” and “outs” of financial aid are complicated–no question–and in my experience not really accessible to anyone who doesn’t work in a financial aid office.  As I am about to graduate from medical school, I now have to deal with all of those college loans I deferred for eight years.  Painful–not just the amount I owe but also all of the rules, forms, deadlines, etc.  I’ve been lucky that the financial aid office at our medical school has been really helpful in explaining things to me and hooking me up with the right people.  But this experience has also taught me that when financial aid is explained in the right way, all of the options and possibilities can be much clearer.  In the past, our financial aid office even alerted me when there were grants available that I was eligible for.  Over the last few years, I’ve come to realize that there’s a lot of free money out there that most people don’t know about.  Financial aid offices are gold mines.  These people are plugged in.  Talk to them–they can tell you about grants (free money) that you’ve never heard of.  That is, when the university isn’t busy trying to scare you into not going there.  I can’t say that I’ve talked personally to any of the kids or their low-income families that were contacted by NYU but in no story that I’ve read (including the responses from the NYU representatives) have I seen anything about the university also offering to provide guidance on how these families could afford to send their kids to NYU.  This is just disgusting.  I personally hope that I have misinterpreted what I have read or that I haven’t gotten a hold of the whole story but I’m skeptical that is the case.  But such a bold-faced and apparent attempt to weed out kids from low income families is appalling. 

NYU, help these families–don’t turn them away!  Shame on any college or university that turns away students who have been accepted with financial aid packages through the lowest forms of intimidation aimed at those who need help the most.

May 3rd, 2009 | Category: personal | Comments (4)

Someone wound up on my blog by searching google for:

do thesis advisors have big egos

What do you think, Buddy?  HAHAHAHAHAHAHAHAHAHAHA!!!!!!

May 2nd, 2009 | Category: md / phd student stuff, personal, phd / graduate student stuff | Leave a comment

I was recently asked by one of my readers to call attention to the need for more people to register for bone marrow donation–a request inspired by the illness of one of his classmates at Yale School of Medicine, Natasha Collins, who is battling recurrent leukemia but is unable to find a matched bone marrow donor for a life-saving bone marrow transplant (BMT) due to her mixed ethnic background and despite a recent online marrow drive.  There will be, however, a second online bone marrow drive for Natasha at www.marrow.org (click here for more information).

Every year, more than 10,000 men, women and children get life-threatening diseases that can only be cured with a BMT. Some of these people find a matched bone marrow donor in their family, but 70 percent do not. These patients search the National Marrow Donor Program Registry for a genetically matched donor and most likely match to a donor of their same race and ethnicity.  However, over half of these patients–corresponding to roughly 35% of patients requiring a BMT– are ultimately unable to find a matched bone marrow donor.  Many of these patients are of minority or mixed racial/ethnic backgrounds–patient subgroups that are grossly underrepresented in (comprising just 24% and 3%, respectively, of) the 7 million bone marrow donors registered with NMDP (check out NMDP facts and figures, 2009).  Thus on the basis of shear numbers of donors available, patients of minority or mixed ethnic background stand much slimmer odds of finding a matched bone marrow donor.  And as a result, efforts are currently being made to increase the number of minority and mixed ethnicity bone marrow donors, for example through the NMDP and the MAVIN Foundation.

But this is about everyone.  Everyone who needs a BMT should be able to get one.  The fact that 35% of these patients cannot find a bone marrow donor is unfortunate and unacceptable.  My goal in writing this post is to raise awareness through which more people will hopefully get registered as potential bone marrow donors and those who need a BMT can get one. 

I sincerely hope that Natasha and every other patient else who needs a BMT are all able to find a matched donor.  

Time to do something about it.

April 30th, 2009 | Category: personal | Comments (3)

Well, back to real life.  When I woke up this morning, I was in pain.  And not just because I have a sunburn.  Anyway, below are pictures of the beautiful country I left behind for another year–not to be seen again until after internship.  Also, there’s a gator in one of the pictures, which I only just noticed now.  See if you can find it…

I just noticed that I didn’t get any pictures of the beach.  Maybe because I was too busy getting this nice sunburn.

April 26th, 2009 | Category: personal | Comments (3)

Nothing to complain about today.  No outrage.  The soap opera that is living the academic life is on hold while I am on vacation.  I brought a digital camera with me but can’t find the adapter to upload the pics to my laptop, so I guess I’ll have to wait until I get home for some pictures of my last vacation before residency.  I cringe just looking at that last sentence.  Anyway, I just figured out how to use twitpic so you follow me on twitter, I’ll be posting pictures from my phone periodically. 

So that’s that.  Just living the dream for now.  Eating a lot.  A lot of seafood in particular.  Biking a lot.  Actually, I could complain about that.  Sore as heck after a 3 hour bike ride today.  Going to the beach.  Nothing to complain about there…

Anyway, going to have lunch tomorrow with an old friend who is now a professor at the university down here so I’m gonna hit the sack.

April 23rd, 2009 | Category: personal | Leave a comment

Here is a comment that was recently left on this blog:

You’re a total pussy and judging by the comments above, that’s the norm in academia.

There is no justice in the world and there are no other lives where people get their karmic reward. You need to have the courage to tell people where to get off here and now, that’s the only way to beat the a-holes.

HAHAHAHAHAHAHA!!!!!  Sounds like someone who (1) isn’t in academics and (2) wasn’t loved enough as a child. 

But, it raises an important issue related to academics–how far do you take a fight?  Do you walk away, take a stand or take the fight to others?  It depends.  There are times when you will have to take it up the ass because the alternate would come at too great a cost.  But there are also times when it is completely appropriate and worth it to follow this commenter’s philosophy. 

However, “You need to have the courage to tell people where to get off here and now, that’s the only way to beat the a-holes” is the fastest way to get kicked out of academics in my experience, which is why I am writing this post.  In my opinion, the hardest thing you will have to do in academics is when at some point you will have to hold back on the urge to tell an asshole where to get off.  One of the barriers to always speaking your mind is the fact that your career (especially early on–but really until you become a departmental chair it seems) is controlled by a small group of people who all know each, were med or grad school buddies, talk to each other and hire based on each others recommendations.  Which is why pissing off the wrong person can totally destroy a career.  Moreover, someone is always trying to stick it to you in academics.  Papers, authorship, reagents, call schedule, etc.  Sometimes you gotta take one.  It’s called being a “team player”–a buzz word in medicine, for sure.  Even a reputation as someone who is not a team player can hurt. 

My point is that I’ve known a number of people who have adopted the general approach of “You need to have the courage to tell people where to get off here and now, that’s the only way to beat the a-holes“.  They have either been kicked out of or nearly kicked out of medical school, graduate school, residency and fellowship.  None remain in academics.  Which is why my empiric evidence suggests to me that you gotta be careful when it comes to getting into major conflicts.  You can be as courageous as you want to be but if it costs you your academic career or even an extra year or two in training, will it be worth it then?  Everyone I know who has gone through this would say that it wasn’t worth it. I agree that sometimes it is worth it to throw down.  I’ve had to a number of times as well and while it wasn’t pretty, it was the right move to make at that point.  But those occasions were few and far between.  More often than not, I and everyone else I know have had to take it.

Some people may call that being a pussy.  I call it being careful, calculating and deliberate.   I also think telling off every asshole that gets in your way is a poor career move and usually makes you appear to be an asshole as well.  Finally, I would be wary of anyone who suggests this as a general approach to life in academics.  This is not meant as an offense to the commenter but is simply based on the outcomes I’ve seen. 

So what to do?  As I’ve tried to relay before, I think the key is to first and foremost avoid such situations if possible, which is why I’ve been writing about my experiences in order to give suggestions for how to do so.  Second, I think you always have to be calculating and deliberate in what actions you do take.  If you decide to fight, then make sure it’s worth it.  If it’s not worth it, then walk away.  In either case, you can’t take a general willy-nilly approach to every circumstance. 

I’ve put out my experience on this but if readers from any stage in academia want to share their thoughts, experiences, or suggestions in the comments, I’d love to hear them since I think this issue of when and how far to take a fight is an important one for an academic career.

April 20th, 2009 | Tags: academics | Category: md / medical student stuff, md / phd student stuff, personal, phd / graduate student stuff | Comments (4)

USMLE Step II.  Moving.  Finding an affordable place to live.  Applying for licensure.  Finishing my taxes.  I need a reality check.  Something that reminds me of the important things in life–like having big hair.  Take it all in: it’s Final Countdown by Europe.

April 14th, 2009 | Category: personal | Comments (2)

If you know that you will be moving–for whatever reason–I strongly suggest doing some serious investigation of housing options prior to 1.5 months before you have to move.  As you may know, I am now in the process of looking for a place to live during residency, which starts in late June.  And I am hurting.  I’ve already made two 8 hour treks and still haven’t found something that either has what I need or that I can afford.  Quite frankly, I should have been thinking about this even before the results of the match were released.  For those of you who will be going to through the residency interview process and match soon, start looking for places to live asap.  Most of the time, one can guess around what part of the rank list one will match too.  I was pretty sure I was going to match somewhere in my top 3 so I should have been seriously looking at places in those 3 cities back in february.  Instead now I’m hurting.  My taxes are due, I have to take USMLE Step II CK on monday, I need to complete and mail in my forms for medical licensure, my ill-advised, non-refundable  vacation is coming up and I need to take another 8 hour drive on monday afternoon.  Oh yes, I also need to get ACLS/ATLS certified too. 

So to summarize the lessons to be learned from this (i.e. what I should have done in hindsight): 1) get ACLS/ATLS certified asap–most of you will take a month off in december or january for interviews, get certified on one of your off days.  Also, most of your medical schools will offer these courses for free, so no excuses.  2) Start looking for residency housing ASAP.  If you know where you will be (to varying degrees of certainty), start looking even before the match.  Look in a few different cities if you have a gut feeling of where on your rank list you will land, but LOOK.

More lessons to follow as I find new mistakes I have made every day… 

April 11th, 2009 | Category: md / medical student stuff, personal | Comments (1)

I will begin this post by saying that I DO NOT listen to music by Paula Abdul.  When I first got my ipod, I put all of someone else’s mp3 files on it.  Some of these mp3s included tracks by Paula Abdul.  In the last 3 years, I have just been too lazy to erase those files so I just flip over them when they come on.  Long story short, I pulled up to swipe into the hospital garage at the same time a big shot faculty from my department pulled up in the lane next to me.  With my window rolled down while I swiped in, the track changes to “Straight Up” by Paula Abdul.  Volume loud of course.  And the faculty member turns over and looks into my car, spots me and gives me an expression of WTF?!?!?!.  So now of course I feel like a complete tool especially since it’s not even music I listen to.  Not that I have particularly good music taste anyway–the preceding track was “Wheel in the Sky” by Journey so I don’t know how much better that is (whatever, Journey RULES).  But what if I did listen to Paula Abdul?  Would I be any less of man?  Probably yes but is it grounds for thinking less of me as a person (which is most likely what was going through the mind of this faculty member)?  Borderline yes/no but I think no. 

Which brings me to my point.  What is the deal with walking on egg shells around big shot medical people?  I’m all for giving up the respect and love for the old school–in fact I would err on the side of too much love and respect.  But sometimes it feels like I’m always looking over my shoulder whenever I break from the military-style march down the hospital hallways and act a little human.  I have one buddy who won’t get caught with a cup of coffee in his hand in front of some faculty (even if he’s in the cafeteria).  Wouldn’t you consider that going too far?   Part of it is the fact that those of us on the lower end of the totem pole are always being evaluated or trying to prove ourselves for the big guys at the top.  But part of it is also just the culture.  This kind of thinking is really ingrained in the culture of medicine (some fields more than others) and my feeling is that it can be one of the aspects that turns people off from a medical career.  I’d like to think that I’ll be able to change the system from the inside once I get on top but by then I’ll probably be too old and tired to even remember about this. 

So how far do you go?  I don’t know.  I guess as far as your comfort zone will allow you to.  At the very least, as I was advised once, try not to call faculty members “dude” or “man”.  And that’s probably the best advice you will find on this blog.

April 7th, 2009 | Category: md / medical student stuff, personal | Comments (2)

It hurts me just to look at this picture

I think there are a few people from sunny san diego who read this blog.  I envy you.  I thought really long and hard about moving to san diego to go to UCSD for residency.  The program I was looking at was pretty good with good people–residents and faculty.  And the university is an amazing research center.  But beside all of that, I freakin love san diego.  How can you not?  It’s like heaven on earth.  I ultimately ranked my UCSD program really high and I remember talking to some people about it.  But one person said, but san diego is no san francisco in terms of the arts or culture.  And I said, “Who gives a shit?  I’ll be within driving distance of Coronado island.” 

Unfortunately I hide my love from the general public.  I like to say, “whatever, who wants to live in a place that has no seasons?”  Me, that’s who.  I’m just jealous that I’m not living in a place where the temperature is between 65 and 85 all year round.  And so is any one else who spews bullshit like that.  I mean seriously, like I enjoy shoveling 12 inches of snow off of my drive?  Because the variability that comes from herniating a couple of discs while ice cold water penetrates my shoes somehow makes the drudgery of life that much easier to bear?  Right.  But I’ll keep telling myself that until I can find the right situation to get myself there. 

Props to san diego.  Those of you who live there better love and appreciate it.  And don’t fuck it up before I get there.

April 3rd, 2009 | Category: personal | Comments (3)

Someone had asked in one of the recent comments about the painful graduate school to medical school transition that all mudphudders go through upon finishing the PhD, so I thought I’d write about that. 

First of all, I actually felt like the first two years of medical school had sapped intelligence from me so graduate school was a welcomed change.  The problem with medical school is that the “thinking” is mostly memorization and pattern recognition, not really any synthesis of ideas or problem solving per se.  In contrast, you could memorize like 5 equations in physics and in theory derive everything else from that.  No joke.  Remember F=ma?  Good stuff.  That’s what I used to do in college and before: memorize a few fundamentals and derive everything I needed from those.  Not so in medical school.  The only way to know the side effects of amiodarone (an anti-arrhythmic drug) is to memorize them.  But that’s the nature of practicing medicine.  It really does consist of a lot of pattern recognition so it’s all good.  And during the first two years of medical school, boy do you memorize a lot of patterns!  Especially during the second year.  I always felt that anyone who left second year of medical school, which for us was clinical in nature (e.g. pathophysiology and pharmacology), with everything memorized would make a really good intern.  When we started second year, we were told that our vocabulary would expand by 10,000 words during that year.  I believe it.  But I was a monster after those courses were over.  I even had the chance to do a couple of rotations, including my medicine clerkship, before I left for my PhD.  I’ll be honest with you, I was a stud on medicine because I easily memorized maybe 90% of our second year course work.  But then, medicine was over and I started graduate school.

Graduate school let me get back to that problem-solving mentality–”real thinking” I like to call it–which was refreshing.  The insides of my brain felt like the rusty gears of a pocket watch that had just been wound after two years of sitting on the dresser.  It felt good, at least after the initial shock.  And so I went for 4 years–problem solving and learning about immunology.  Without knowing it, slowly replacing most of the neuronal connections I had formed during the first two years of medical school.  Yup.  You can guess where this story is headed. 

I was always told by older mudphudders that my memory of all things clinical would come back to me after a few weeks back on the wards after finishing graduate school.  I don’t know, I guess that’s true.  I also think a lot of it came back because I read A LOT.  I think it was helpful that I restarted medical school with a pretty easy rotation–a family practice rotation where I was exposed to a lot of bread and butter medicine.  I also had a lot of time to read.  I think it hurt me in one way that I had taken my medicine clerkship before starting the PhD because I think the medicine clerkship is a great period of learning in a medical student’s training.  Although on the flipside, I think it gave me a good appreciation and understanding of medicine going into graduate school, which helped in other ways.  I think to this day I still feel a little self-conscious on the wards but performance-wise I think I have done well.  So maybe a lot of it tends to be in the mind of the mudphudder and we gotta just get over it. 

I knew a few mudphudders who would do clinical “activities” during graduate school.  Going to clinic once a week or month, etc.  I don’t think it really helped that much in terms of retaining knowledge.  I mean, you see 5 patients every week and that’s supposed to retain your 10,000 word vocabulary?  I don’t think so.  Moreover, think about the variety of clinical medicine we are exposed to in medical school.  Is one clinic going to cover all of that?  Most of that?  Half of that?  10% of that?  Probably not.  But at the same time, it keeps you in the loop somewhat.  My philosophy was always give 100% to graduate school when in graduate school and give 100% to medical school when in medical school.  But, I have friends who would argue against that as well so find what works for you or makes you happy. 

All in all, I think going from graduate school to medical school is not a bad transition.  I recall being ecstatic that I was done with graduate school.  But obviously when you’re away from something for that long, it takes some time and effort to regain the familiarity and knowledge.  Be smart and strategize about how you come back and to what rotation (which also means scheduling as far ahead of time as possible). 

In the end, it’s all a part of the process.  Medical school to graduate school to medical school to residency.  There’s pain associated with every transition but many have gone through it before you and many will after as well.  I think the key is in knowing yourself and therefore having the ability to identify what you need to keep you going in the context of whatever challenge (e.g. going back to medical school–> schedule an easy rotation so you have time to read) you are about to face. 

Anyway, I think that sounded pretty smart so I’ll end on that.

March 31st, 2009 | Category: md / phd student stuff, personal | Comments (1)

Feels like a long time since I’ve written something.  It’s been a busy weekend.  I have 3 manuscripts on my desk, two of which need urgent attention for upcoming journal submission deadlines.  I had a friend’s grant application to read through.  And, of yes, I’m studying for my medical licensing exam, USMLE Step II CK. 

To make matters worse, I cut a chunk of tissue out of my finger tip last night when I ripped the top off of a beer bottle and didn’t notice until it was too late.  I’m not even sure how it happened but I think I threw the bottle opener under the lip of the bottle rather than under the cap.  WHAT?  It was a little dark and I wasn’t in the mood to look.  Anyway, it’s making typing an awful chore since I am trying to avoid smashing the open would on my keyboard.   

So back to studying, so far I’m getting crushed on the practice questions I’m doing on USMLEworld, which does not bode well for my confidence.  But I’m working on it.  Spent a solid 6 hours doing practice problems today.  Maybe more tomorrow. 

Off to bed now with plans of a more informative post for you all tomorrow or the day after.

March 29th, 2009 | Category: personal | Comments (1)

So I just took a board exam towards medical licensure called the “USMLE Step II, CS” (US medical licensing exam Step 2, clinical skills).  The USMLE consists of 3 steps, each of which is taken at different points of medical training.  Step 2 is traditionally taken at the end of medical school.  Up until 4 or 5 years ago, all 3 steps of the USMLE consisted of written exams.  And then, someone had the brilliant idea of introducing a clinical skills portion to Step 2.  This practical exam is comprised of a rapid-fire history and physical of 12 actors pretending to have various, common medical problems, with subsequent documentation of the encounters.  To imagine how ridiculous this whole process is, think about the episode of Seinfeld where Kramer pretended to have gonorrhea for medical students (see below, skip to time = 3:01).

Anyway, so this exam costs over $1000 for medical students to take.  Moreover, there are only 5 centers around the US where students can take the exam, so if you don’t live nearby you also have to pay for transportation and an overnight hotel stay.  The biggest waste of $1000, well more like $1400 after all is said and done, that I’ve ever seen.

The general principle behind Step II CS is reasonable: that a graduating medical student going into residency training should be able to take a basic, focused history and physical from a patient with a common medical problem, then write a note about it.  Having taken the exam now, I can tell you that anyone who even performed sufficient motions to get through medical school should be able to pass this exam.  And anyone who couldn’t pass this exam probably wouldn’t be going to residency anyway.  Given the expense we go through with residency interviews and the subsequent move to residency, it’s such a crock of shit to have to pay so much money for such a waste of time.

Of course after my rant, watch me fail the exam.  Whatever.  Refer to my previous blog entry.

March 27th, 2009 | Category: md / medical student stuff, personal | Comments (1)