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oh to be young again

I was walking around Harvard Square today and saw all of the little college students running around, exploring with their families, etc.  And then I thought to myself, do I even remember college?  I think I do.  I mean, I remember college and I’ve thought about it before but I hadn’t thought about what it felt like to be in college for a looooonnngggg time.  Does anyone remember what it felt like to be college?  It was so long ago (ended ~10 yrs ago) for me.  When I started, the concept of taking care of myself was pretty foreign.  I’m pretty sure that was still the case when I graduated (at 155 pounds; now I’m at 200) and likely that is still the case now (I’m at 200 pounds).  The angst.  The worries–how different were my worries then and my worries now?  Crazy.  The kind of stuff I was worried/concerned about then (too trivial to even mention).  The kind of stuff I worry about now (e.g. managing career and family, getting my research published, my patients).  The crazy shit I used to do then (you don’t even want to know).  The crazy shit I do now (e.g. running a code!).  Big contrast. 

Those kids don’t even know what’s waiting for them.  Well not entirely.  Some them probably do, but most have no idea.  The scary thing is, I still don’t have any idea.  I talk to people with kids, people who are practicing doctors, people who are researchers, people who do all three, I have no idea.  I wonder if in another 10 years I’ll look back on these days and sigh and say that I had no idea.  Probably.


vacation recap

So I just returned from my first vacation of intern year. I started off with a couple of difficult rotations but somehow managed to get through–even learned something in the process. In all honesty, I was tired but I could have went another month easy without the vacation. Don’t get me wrong, it was nice and even at a nice time of the year (especially for Maine), but I’m looking forward to the rest of the year and I know that the time off would have come in handy during that 7 month stretch over the winter and spring without any vacation time.

Beautiful.  Just beautiful.

Beautiful. Just beautiful.

But anyway, I made the best of the situation and headed up to Maine–Acadia National Park for a week of relaxation. As a side note to anyone up in the north east who hasn’t been to Maine yet–it’s nice. Real nice. I enjoyed it tremendously. I’m used to my annual trips to south carolina but I suspect that Acadia will make a nice substitute for those years when I can’t find the time for the trip down south.  

Anyway, I think the keys to a good vacation are good relaxation and good eats.  And I got plenty of both.  It’s hard not to relax with scenary like this. 

5 pounds of lobster.  Onion rings.  Budweiser.  Does it get any better?

5 pounds of lobster. Onion rings. Budweiser. Does it get any better?

And, I was reminded why Maine is known for lobster.  I think I averaged >2 pounds of lobster per day while I was there.  As a side note, did anyone else know that lobster is really cheap this year?  I’m not quite sure why but apparently it is.  In Maine, I was paying $8 to $9 per pound.  Not too shabby.  I think it’s probably a little more expensive outside of Maine or the north east, but maybe not by too much. Anyways, I digress.  Good eats and good relaxation.  Those are the key.  I made the mistake of going hiking.  Now, hiking on it’s own can be relaxing and provide much needed personal satisfaction.  But, when you’ve spent almost every waking  moment of the last two months walking/running around the wards, up and down stairs, perhaps hiking up and down moutains is not the best idea for rest.  I kid you guys not, the medial aspect of both of my big toes are completely numb.  I’m not sure why but it’s been a gradual onset and I suspect it has something to do with running around/up and down stairs so much.  In any case, I probably should have considered this on my first day of vacation before I

At this point I was wonder if it would be more painful to jump or to continue the hike.

At this point I was wonder if it would be more painful to jump or to continue the hike.

went hiking.  Up and down 2 mountains.  For 5 hours.  With one small bottle of water.   And you know what the worst part of it all is?  When you get to the point where you know it will take you 2 or 3 hrs to finish the hike regardless of whether you turn back or keep going forward.  Painful.  Just painful.  But, all grumpiness aside, the hiking in Acadia is amazing.  I even went hiking every day I was there.  But it just helps if you’re well rested and have food/water. 

In all, it was a good intern year vacation.  It took some game-time adjustments in my activity, eating and sleeping, but I’ve come away well rested and ready to hit the wards again.  Not bad at all.


response to a reader

While I was away on vacation, a reader emailed me the following question:

Hey Mudpudder….I am in a combined BS/MD program in NYC and I really need your advice. I am asking you for advice because you are one of the few physicians I have encountered that are honest and open about their profession.  As mentioned before, I am in a BS/MD program that allows me to complete my undergrad and 2 years of my medical education at a University and the last 2 years of my medical education (rounds) have to be completed at a participating medical school. Now I just finished interviewing at SUNY Downstate, SUNY Stony brook, and NYU. They all have their pro’s and con’s.  My main goal for the last 2 years of medical school is to learn as much as I can from the wards, so that I can really decide what type of residency to apply for. Essentially, I want experience so that I can make the best decision regarding the residency to pursue. However, I am not too sure which medical college is right for me.
 NYU med is a world renowned institution with a lot of NIH funding, prominent faculty, with high tech facilities, etc. Most of all it is in NYC, so I will be exposed to a diverse population with different medical needs. However, it is a really expensive school and affiliated with mostly private hospitals. I do not know if I would really get a chance to practice my clinical skills in a private hospital. I have heard that private hospitals limit medical student/patient interactions because we are a liability. Is this true? SUNY Downstate is located in an underserved community in Brooklyn.  In addition, it is affiliated with mostly city hospitals and most of the hospitals are understaffed, so I know I will get a lot of experience. However, Downstate does not have as good of a reputation as NYU or Stony Brook in terms of research funding, facilities, etc. I am afraid that the reputation of my medical school I attend may negatively affect my residency match process in the long run. I want to do my residency in an institution that is renowned for whatever residency I choose. Does the name of your medical college have a big impact on your match process? As for Stony Brook, it is a great school that is expanding drastically in terms of research and is making a big push to attract prominent faculty. However, it is in the middle of nowhere and its affiliated hospitals serve a racially homogenous population. So I do not think I will be able to experience as many clinically diverse medical cases as I would as in an urban hospital. Now that I told you about all the factors revolving around my decision, what advice can you give me? If you were in my shoes, which medical college would you pick? And why?

First of all, I won’t tell you which medical school to pick, only what kind of logic I’d use to make the decision. 

What is the purpose of medical school?  In my opinion, to 1) prepare you for residency and 2) get you to residency. 

Your question touches on both of these points.  Let’s tackle number 1 first.  Where would you get the best preparation for residency?  Well that’s broken up in two parts too: the academic training and the clinical training.  You seem to be focusing more on the clinical training part.  Yes it is true that medical students (as do residents) get less hands-on experience at private hospitals compared to academic or low-income community hospitals.  Think about it this way, the more that patients pay, the more they expect the attending to do and the more they get pissed off when a medical student sticks them 5 times to get an IV in.  You know what I mean? 

However, it is my personal feeling based on my experience and those of friends as well as other residents is that the clinical training you get in medical school is, in general, pretty minimal.  Really.  Sure there are differences between the experience you get at different schools, but how big are those differences?  So you get to do a few more procedures at one place vs. another.  So what?  Putting in one central line vs. five or ten as a medical student under supervision of a resident still equates to zero when you start internship and you become submerged in that stuff all of the time.  There may be varying degrees of comfort between interns at the start, based on where they went to medical school, but those differences become virtually indistinguishable after one to two weeks of internship.  It’s actually quite interesting.  At no medical school will you be the intern or the resident.  Simply because you will be a medical student.  You will not spend your days doing procedures anywhere because the residents will be doing them since they need the experience more than you will as a medical student.  Make sense?  You will occasionally get thrown a bone as a medical student, which may depend on where you are training (e.g. community hospital vs. academic hospital) but again, I wouldn’t put this too high on my list of factors determining where I go to medical school.  In terms of procedures, the only thing I can think of that you should be sort of comfortable with after finishing medical school is suturing/tying knots and that’s only because you will have to do it to some degree in every residency.  Again, you don’t even need to be good at it–no one I know was good at it at the beginning of internship–just be familiar with it. 

When you start internship and you have to do pleural taps, put in central lines, suture, etc, you will do it so many times (initially under supervision) that it really won’t matter where you went to medical school.  If you want to get good at some of these things during medical school, it will mostly fall on you to practice (what you can) outside of school.  So to put it more directly, I don’t believe that going to any one of those schools that you named will give you any significant additional exposure to doing procedures.  Where the quality of your medical school plays a role in these procedures is in terms of what kinds of colleagues and residents you will have around you to teach you or to bounce ideas off of.   I learned a lot of useful tips from my residents or other medical students.

More along this route, the facts you need to learn are pretty much the same no matter where you go to school, right?  The side effects of an ACE inhibitor are the same whether you go to school A or B.  And you will have to work equally hard to memorize all of that stuff.  However, the more collegial the environment and the higher quality of medical students/residents that you surround yourself with, the more likely it is that you will get tipped off on that useful pnemonic or website that will help you to learn X, Y or Z. 

Finally, the name of your medical school does make a difference for residency applications.  It’s kind of bullshit that it should, but on some level it makes sense.  It’s bullshit because, in my opinion, the top performers at any medical school can usually always compete with each other (i.e. the top medical student at small medical school is usually in the same league as the top medical student at big-time medical school).  So I find it unfortunate when top medical students from smaller schools are passed over, especially for lesser students at bigger medical schools.  It happens.  More practically, if you are a “good” student, which most of us are, are a big school, then you will definitely get more looks during residency interviews than a “good” student at a small medical school.  It may be unpleasant to think about but it’s true. 

You mentioned the fact that one institution you are looking at may have better research and science, etc.  I’ve argued before that this doesn’t make much of a difference for medical training.  And, I stand by that.  However, being around smart people–clinical or research–is always good.  A lot of intangible characteristics get rubbed off on you just by being around them.  So while you may not “learn” anything about the side effects of ACE inhibitors from being around top notch scientists, you will however pick up lesser appreciated/unrecognized pearls such examples of how to look at problems in different ways, how to balance clinical and research careers, how to be a collegial participant in academics, etc. (some of these will apply more than others). 

Okay, so there you have it.  I think I’ve addressed the concerns you brought up and it’s probably pretty clear which way I lean, but I think it’s more important that you see my reasoning.  Maybe you agree or disagree with some or all of my points but then you can take that into account as you make your decision. 

Moreover, if any of the readers have any thoughts, please offer them.  I’m sure this reader will appreciate it.


taking care

As I sit here, on vacation in Acadia national park, I am reminded of the patient recovering from a spinal injury who asked ME how I was doing. It really is a sad commentary when the patient who is recovering from bilateral lower extremity paralysis is concerned with how the resident doing. But the point is that to take good care of our patients, we need to take care of ourselves. This has been a good vacation. Lots of good food (probably >20 pounds of lobster) and lots of good rest. I’m feeling recharged and ready-to-go for Monday morning.
I’m actually surprised by how prevalent the thought is amongst higher-ups in residency that to take good care of patients, we gotta take good care of ourselves. Don’t get me wrong–it’s not that prevalent–but I’ve been reminded of this a few times. So now in my moment if clarity, having consumed mad quantities of lobster, carrot cake and ice cream, I pass this on to anyone else in the game who may have missed the memo. Take care of yourself. It’s good for you, it’ll make you feel better and all of that will transfer to over to patient care.
Now, I’m gonna continue taking care of myself and go to bed…


laboratory interview questions for graduate students, post-docs and PIs

In the last post on the laboratory for graduate students, post-docs and PIs, I got into the basic approaches to the lab interview.  It appears that structured interviews, where every applicant is asked the same set of questions aimed at delving into the applicant’s abilities and personality, tend to produce the best results.  So how to prepare for the structured interview? 

If you are the interviewee: ideally you should just answer these questions honestly, on the spot in a very impromptu fashion (well, you should always answer questions honestly).  But sometimes these questions can catch you off guard and then you spend 10 minutes trying to remember what is a time when you had a conflict with a lab mate (at least an episode you can tell the interviewer about–leave out the fist fights).  So I’ve found that it can be really helpful to go over some sample questions before hand in order to jog my memory. 

If you are the interviewer: then you need to figure out what questions will be important in flushing out the applicants qualities, which you think are most important.

As I mentioned in the last post, with experience you will notice the same questions (in one shape or another) being recycled between interviews.  This is probably because these questions are good at bringing out the various qualities of applicants.  As a resource to you, below are some questions that I found in a pamphlet I got a while go, written for the Burroughs Wellcome Fund and Howard Hughes Medical Institute:

For evaluating experience and skills:

  • what is (are) your most significant accomplishment(s)
  • describe the part you played in conducting a specific project or implementing a new approach or technology in your lab
  • I see you have worked with [a specific technology or technique].  Tell me about its features and its benefits

For evaluating commitment and initiative:

  • why do you want to work in this lab?
  • where do you see yourself in 5 (or 10) years?
  • what kinds of projects do you want to do?  Why?
  • tell me how you stay current in your field?
  • describe a time when you were in charge of a project and what you feel you accomplished.
  • describe a project or situation in which you took initiative

For evaluating working and learning styles:

  • what motivates you to work?
  • would you rather work on several projects at a time or on one project?
  • do you learn better from books, hands-on experience or other people?
  • describe a time or project when you had to work as a part of a team?  What was the outcome of the team’s effort?
  • how would you feel about a leaving a project for a few hours to help someone else?
  • if you encountered a problem in lab, would you ask someone for help or would you try to deal with it yourself?
  • would it be a problem to work after hours or on the weekends, should the project need it?

For evaluating time management:

  • how do you prioritize your work?
  • how do you deal with multiple priorities competing for your time?

For evaluating decision making and problem solving:

  • what is the biggest challenge in your current job?  how are you dealing with it?
  • describe a time when you had to make a decision that resulted in unintended (or unexpected) consequences (either good or bad)?
  • describe a situation where you found it necessary to gather other opinions before you made a decision 

For evaluating interpersonal skills:

  • how important is it to you to be liked by your colleagues and why?
  • if you heard through the grapevine that someone didn’t care for you, what would you do, if anything?
  • describe a situation in which your work was criticized–how did you react to and address the situation?
  • name a scientist whom you like and respect.  What qualities do you like about this person?

the laboratory interview for graduate students, post-docs and PIs

Whether you are interviewing others for a job or you, yourself are being interviewed for a job, it is not a bad idea to know what kinds of questions are asked and how.  In this post, let’s consider the general approaches that are taken in interviews.  I was browsing through the book At The Helm: A Laboratory Navigatorby Kathy Barker and found the following passage:

There are several styles of interviewing, some of which most P.I.s might find too manipulative and distasteful.  For example, stress interviewing subjects candidates to difficult and hostile questioning to test their reaction to thinking under stress.  Other techniques are more useful and can be incorporated in your interviewing protocol.  Behavioral interviewing assumes that, if you can really find out what happened in the past, you can predict the future.  Asking questions about how candidates dealt with a difficult project or with other people at a previous job can suggest how they will act in your lab, and these types of questions will probably form the basis for your interview.

Personality profiling attempts to define candidates’ underlying personality by analyzing their responses to questions about real or theoretical situations.  An example of this would be to ask, ‘Upon finding out that a close colleague had fudged data, would you approach the person or go directly to the P.I.?’

Another technique that is actually part of many postdoc interviews is the situational interview, when the candidate is placed in a situation that might actually be on the job.  Giving a seminar and having to field questions about one’s own experiments much as are done day to day, is an example of this.  Some P.I.s do give a test or request a demonstration of a technique from candidate technicians.

The only kind of interview that has had any consistent success in predicting performance in the workplace is the structured interview, in which all applicants are subjected to the same questions and are rated according to predetermined objective scoring (Gladwell 2000).  The questions should examine past or present behavior to try to define the candidate’s ability to do the job and to predict future performance in the lab. 

excerpted from  At The Helm: A Laboratory Navigatorby Kathy Barker, p. 88-90

In the course of interviews, though, you may use or experience (depending on which side of the interview you are on) any of these approaches.  In my experience, the stress testing has largely fallen out of favor as it usually turns applicants off and can result in interviewers losing a lot of good applicants for the job.  If you are the interviewer, consider what kinds of approaches (and in what situations) you will take.  If you are going for interviews, consider how you will react to these various approaches. 

In stress interviews I’ve found that questions are often based on fallacies or they are just illogical.  So, as the interviewee, you just have to pick out that fallacy or the breakdown in logic and calmly answer the question by addressing those weaknesses in the question.  When it comes to personality profiling, I’ve found that you just have to be yourself.  There often is no right or wrong answer to these questions so it’s best to just say what you would actually do.  With these types of questions, I sometimes will ask the interviewer what he/she would do.  With experience you may notice that most people seem to expect one particular answer to a specific question.  Whether you agree or not, it’s up to you to decide how that should impact your own opinion.  The situational interview can sometimes be “interesting”.  You are basically called upon to do your everyday activities but this time you’re being evaluated!  It’s weird, when you’re doing your everyday work, sometimes you just “do” but when you’re being watched there’s a greater component of “think” that’s included, which can throw you off of your rhythm.  So before you go on your interviews, try preparing by practicing some of your everyday activities (or at least those you would be expected to do on the new job) with the mindset that someone is watching you–i.e. really think through what you are doing rather than letting muscle memory take you through it. 

Finally, the only way to prepare for the structured interview is really to think about as many questions as possible that could be asked.  After you’ve conducted or been on a few interviews, it becomes pretty obvious that there are subset of questions (still a long list) that are often adapted in one way or another to every interview.  I will address these in the next post… 

That’s right–always keeping you hungry for more! HAHAHAHAHAHAHAHA!!!!!!


MIT opencourseware

MIT OpenCourseWare (OCW) is a web-based publication of virtually all MIT course content. OCW is open and available to the world and is a permanent MIT activity. If you’re looking to supplement your class notes with extra material or if you’re looking to brush up on a specific subject, why not start here? Most classes give access to syllabi, class notes and examinations.


What is MIT OpenCourseWare?

MIT OpenCourseWare is a free publication of MIT course materials that reflects almost all the undergraduate and graduate subjects taught at MIT.

  • OCW is not an MIT education.
  • OCW does not grant degrees or certificates.
  • OCW does not provide access to MIT faculty.
  • Materials may not reflect entire content of the course.

How do I register to use MIT OpenCourseWare?
There is no registration or enrollment process because OCW is not a credit-bearing or degree-granting initiative.

Can I get a certificate?
No. MIT OpenCourseWare is a publication of the course materials that support the dynamic classroom interactions of an MIT education; it is not a degree-granting or credit-bearing initiative. However, you should work through the materials at your own pace, and in whatever manner you desire.

How do I find what courses are available? How do I search your site?
A site overview is available for MIT OpenCourseWare. You can also browse courses by department or use the advanced search to locate a specific course or topic.

High school students and educators should check out Highlights for High School.


my limits

My opinion is more and more that the point of internship is to push us to our breaking points. And then a little more. I’m fairly convinced that it won’t stop even at the breaking point. I’ve already seen a few people hit that wall and it hasn’t been pretty. Especially since after all the tears, all the screaming, the work is still there to do. 

I don’t know, has anyone who has done this or is in it now, ever had the thought, “I’m only ONE person”? I have that thought like 50 times a day. Today it was like a thousand times. I tweeted today that I felt like I was gonna cry. The old school doctors are all about telling us residents how weak we are, etc. but the fact of the matter is the amount of work that needs to get done hasn’t decreased since the introduction of work hours, etc. In fact, it has probably increased. The expectation is just that now we’re expected to get it all done in a limited amount of time. And that’s it. Get it done. Don’t ask, don’t make excuses, just get it done. I got des-troyed today. A huge service, discharged 7, admitted 3. Plus anything that could go wrong did. Patients changing their minds about wanting to take their medications, patients who were doing great yesterday were feeling like crap today or having intractable pain. And of course I’m the one all the nurses come to.  Pages all fucking day. My favorite is the two-fer. That’s when two pages come in at the same time and the pager makes an especially high-pitched squeal. It’s good stuff the way that a rusty nail is good stuff to step on.  

I mean some of the stuff that comes my way is ridiculous. I was dealing with a patient who wanted to do harm to himself (without getting too specific) and received 3 pages from one nurse, each increasingly angrier than the last about giving an other stable patient something for gas. And then when I went to call back, I got a ton of attitude. I gotta tell you, on some level that hurts. I really think that the worst is when you kicked while you’re down. For me personally, that’s why I always try to be nice. You just never know when you’ll run into someone who is having a miserable day and that niceness will actually do some good. Attitude, meanness and being an asshole do not Mudphudder a happy camper make when he is getting crushed. But, what can I do?  It’s not my style to really retalliate or get into it so I just do my thing and hope that my work gets done. 

So back to my original point, I really think that each day things are made a little tougher than the previous day just to see if that’s what pushes me over the edge. I know that’s really paranoid sounding and I don’t believe it either but it sure feels that way. I got some help down the stretch today from some students on our service in getting things ready and together for evening rounds. And we just barely made it. Not only in time for evening rounds but also making it through evening rounds. After rounds I thanked the students (you gotta do that–they work so hard and you just can’t forget what it was like to be a med student) and I expressed how I felt that today our little team was very much like a rickety old boat held together by duct tape and with bubble gum plugging the leaks. We were seaworthy, but just barely, and we wouldn’t have made it without every single little contribution. It was close. Sometimes I wonder how one person can be expected to do everything in one day. Sometimes it can be ridiculous. But somehow it (usually) all gets done. 

I don’t know, maybe I’m just whining too much. I’m definitely learning a lot. Not so much through active effort (too little energy and time) but because I have to do the same crazy stuff so many freakin times that it’s hard to forget. I’ve actually started dreaming about my patients and discharging them. It’s so sad–I used to dream about other things. Right now I’ll just settle for some sleep. 

Well, now I can go and get some sleep. This weekend I work over saturday night, so I can at least sleep in tomorrow. Hopefully it won’t be too bad but it probably will be. Whatever, though. If I didn’t cry today, I won’t cry tomorrow either–probably because I won’t have the time to.


response to a reader

A regular reader and commenter recently asked if the topic of a mudphudder’s PhD really matters toward the mudphudder’s residency and the long run in general. I apologize for the delayed response, but I’ve been getting slaughtered on the wards so I wanted to wait until I got some time off (now) to give you a thoughtful response.

Anyway, the short answer is, No. At least in my opinion. A lot of people assume that your field of research in graduate school does make a difference and there are even residency interviewers as well as more senior/important people who will argue with you that it does.
I am someone whose PhD topic did not obviously match with my residency field, without getting into too many specifics. There are also many mudphudders who do their PhDs in biochemistry, etc. So just because their chosen field of medicine doesn’t have to do with folded proteins, does that mean the PhD was a waste? Heck no. Let’s start with the very obvious fact that graduate school is meant to teach you how to become an independent investigator. That training is valuable to any field of medicine. As someone who has gone through graduate school–without quitting–you have demonstrated that you not only can survive but also thrive in the face of scientific/research adversity. Second, I would argue that you would be more of an asset to a field by bringing skills from a completely different background. Case in point, some of the best biologists I know have PhDs in physics. Some even were physics professors! Finally, you can always find a connection between things you learned in graduate school, if not your specific field of research, with what whatever field of medicine you want to go to.
In this regard, it’s really easy for mudphudders with translational research PhDs to apply into residences that are directly related to their research. However I sometimes wonder how many of these mudphudders actually go that route because it’s safe. Don’t get me wrong, most mudphudders I know seem to have a real love for what they’re doing but I really do wonder about that sometimes. I also wonder how many of these mudphudders didn’t let themselves explore other fields, just because their research matches so well with a field that they may have interest in.
Anyway, the short of it is that in my opinion, the topic of your phd research doesn’t make a huge difference on future career aspirations/ residency. The point of graduate school is to become a professional, independent researcher who can develop interesting questions and then answer them. If you can learn to do that, then your graduate school experience will be an asset to any field of medicine that you go into.


the residency gods are fair… mostly

I have come to grips with the fact that at the end of the day, the residency Gods are mostly fair. I think. At least so far. On some days I take the worst beating of my life. On those days I feel like I have done something to anger the Gods. More than likely though, they just have forgotten about me and are instead tending to the many other residents who need the help more than I do. However, then there are days when the residency Gods smile upon me. On those days, I am spared the bullshit that turns a routine 13 hr day into a 15 hour day. On those days, I get to hit the gym before heading home for my fifteen minutes of tv and dinner before bedtime. When I first started, I was getting routinely crushed so my general feeling was that I had been forgotten by the residency Gods but now, well, I’m starting to realize that in the end, it all evens out. So I guess on average, the residency Gods think of me as, “mehhh”. I guess that’s better than not at all.

My suspicion is that there will be days when I will rescind this post and say that I have been cast into residency Hell and there will likely be days when I will be in residency Heaven. I guess we’ll take those times one day at a time. In the meantime, with the benefit of the clear thought that comes from a golden weekend, I’ll just stick with “mehhh”.



Hey Everyone! This post is meant to test out a new app I downloaded so I can write posts from my cell phone. I hope this works…


nih grant codes – is k08 a grant or a type of submarine ?

How many times have you heard people talking about R01 grants or K22 grants and you’re like, “what the hell is he talking about?”  A lot for me.  Many years went by in medical and graduate school where I would hear people talking about these different NIH grants without any clue about what each grant was for.  Eventually I learned about some of them through just talking to people but then I recently discovered the internet and looked up this comprehensive table at the NIH website.  If you want to sound intelligent or be able to participate in conversations about the K02 independent scientist award, check out this site:

Sooner or later if you stay in academia, you’re gonna have to get awfully familiar with these grants…


an apt comparison

Where I spent four years of graduate school.

Where I spent four years of graduate school.

Not too long ago, someone happened onto the mudphudder blog by searching:


are med school and grad school the same


Are med school and grad school the same?  No.

Having been through both now, the best way I can put it is that medical school is like a four year jail sentence: you go in knowing you have to put in four years of hard time and along the way you take it up the ass occasionally.  Graduate school, on the other hand, is like solitary confinement: you’re wandering around in the dark, not knowing how much time has gone by or even what year it is, slowly losing your sanity until one day someone opens the door, you see the light and you’re out–smelly and a shell of your former self.  And you still have to take it up the ass occassionally.


fresh air



I think what I miss most about my previous life is fresh air.  These days I get mostly stuffy hospital air, with occasional whiffs of disinfectant.  This weekend is my golden weekend and I’m taking full advantage.  I’ve spent hours outside today.  I walked Back Bay, Coolidge Corner, Brookline Village and even a little in the West End.  And what a beautiful day.  After 2 weeks of rain, we finally got a sunny day.  I sort of wished I had been a little more productive with chores, but who cares?  I got some rest and spent some time being completely mindless.  I had dinner outdoors at a tapas restaurant on Newbury Street.  It was good.  And, I got some fresh air.



Here’s a post I wrote earlier today on my phone:

I’m not normal and my life clearly is not normal. I live in the hospital except for the few hours of sleep I get every night. I get my vitamin k  vitamin D (or lack there of) from fluorescent lights.  I’m wriing this entry as I stand in line in the hospital cafeteria for a grilled cheese sandwich. I wear pajamas all day long at work.  In my profession 80 hrs is the lower limit of acceptable time spent workig in a week. Actually, I don’t think the word “acceptable” is even accurate.

But in any case I am of the opinion that sometimes it’s nice, even therapeutic, to feel normal. So I do two things everyday to feel normal: 1) I come to work in jeans and a tshirt (ie civilian clothing) everyday. There’s something really relaxing, almost cathartic after 15 hrs in the hospital to put on a pair of jeans and go home.  It only adds an extra 4 minutes to both ends of my day to change, but it’s worth it. 2) I try to take 5 or 10 minutes everyday to sit outisde either in a hospital courtyard or even out in front of the hospital. I’ll get an iced tea +/- a chocolate chip cookie and just take in some fresh air.  It’s nice and also very normal feeling. As a sidenote, I’m not sure yet how I’ll adapt this to Boston winters but I’m thinking about it now. 

I know a lot of residents who deny themselves the chance to feel normal, either out of arrogance or feeling like they don’t have the time, but I thnk that’s a bad idea. My sense of normality is one of the ways through which I relate to my patients.  Everyone wants to be “normal” sometimes and everyone wants to relate to normal.  It’s why despite sleepiness and a list of boxes that need to get checked off pages long, I love sitting down to talk baseball with a patient.  It’s also why the same patient with untreatable cancer, for a even period of 5 minutes, will baseball with me.  Everyone wants to be normal sometimes.  Finally, occasional normalcy is also a reason why I haven’t and hopefully won’t turn into a complete asshole when the going gets tough (although some may disagree with my assessment that I’m ready not an asshole).  In any case, I should say when the going get tougher.  Plus, trying to be a little normal really doesn’t take that much time.  And as I like to say: even in medicine, 10 minutes never killled anyone, unless of course it was a code.


whazzup whazzup?

Yeah I should probably be going to bed, but fuck it, it’s been a while so I’ll blog :-) 

One of the realizations I’ve had in the last two weeks is that internship isn’t too too bad if you don’t have much of a life to begin with.  Luckily for me, I didn’t.  I mean think about it, I spend close to 15 hrs a day in the hospital on average, which leaves me about an hour in the morning and an hour in the evening. 

I guess it’s all good though.  Someone once told me that the purpose of residency was to become a doctor not to have fun.  So be it 😉

But I’m still lookin forward to this weekend.  I’ve worked everyday since since two fridays ago and I’m tired.  Just tired.  Last weekend I got destroyed.  It was the closest I’ve come to crying in public.  There was just so much stuff to do in each of my “12 hr” wink wink shifts that I didn’t think I’d get it all done even if I had 20 hr shifts.  It was brutal but I somehow pulled it off.  God knows how. 

But now I’m tired and I could really use a couple of days off.  My first day off of residency.  Good stuff.  I want to reward myself so I thought I’d buy some electronics or something but then the first paragraph of this post hit me–i.e. not having a life outside of the hospital–and I decided to do a spa day instead.  Yeah it’s a little soft but I think I’ll get a lot more out of a good back rub and maybe  a pedicure than an xbox, which will collect dust.  In fact I think the xbox would have the opposite effect and actually depress me each night when I came home to see it but not have time to use it.

Anyway, I better go and get some sleep now.  I hope everyone is doing well. 

More this weekend when I actually have some time.


cure for the first week of internship: a reality check

Internship has started. Getting crushed. One week down, 51 to go in internship and 259 to go in all of residency. Plus I’m on call both days this weekend.  Time for a reality check…

Take it all in: it’s Final Countdown by Europe.


past my bedtime



It’s after 9pm so I better keep this brief.  First week of internship is going… well it’s going.  Not too bad I guess.  I’m learning a lot and getting into the swing of things.  More on the specifics later, but it’s amazing how different life has quickly changed.  I feel like I’m in survival mode on most nights–just grab a something to eat and hit the hay.  Today I was shocked to get out at 5:30.  Just 12 hrs on the job!!!  Leaving me more time than I knew what to do with.  At least transiently.  I hit the gym for an old fashioned mudphudder workout and then ran across the street for some take bbq for dinner. 

I am adjusting to the fast pace of most everything–racing to get everything done at work, then racing to get home so I can have a few minutes of free time to unwind before going to sleep.  Yeah it’s crazy but it’s worth it.  I’m learning a lot everyday and it’s all practical knowledge–not random minutiae that I’ll never use.  Patient’s potassium is low, how much to replete with?  How long to bridge a patient starting on coumadin with lovenox?  It’s pretty useful. 

Anyway, I’ll write more in a bit when I have a few more hours consecutively off.  I hope you are all doing well. 



13 hours later…

And the first day of internship is done. Can’t complain–13 hours is not that bad even if I was hustling around the whole day. Picking up some thai food as a treat and then I’m going home. Thank you all again for the love that you have heaped on me in the last few days. I sincerely appreciate it.

Mudphudder out.


5:45 am, june 22 2009

So it begins.


the final countdown

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 first page (non-official)

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.


my fear

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.


experiencing new things

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.


footwear for the wards

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.


continuing the pimpin’ out process

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 Murphys

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.


a glimpse into my new life

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.

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.


back online tonight

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).


i’m almost back

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,



my first porno spam

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.



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.