Grand Rounds 3:23

#1 Dinosaur hosts Grand Rounds this week–a nice, succinct presentation in a classic prose format. (pre-rounds). Check out the best of the medical blogosphere for this last week!

(one of these days, I’ll write something worthy of submission again, but for now, I’m content to be just another reader)

Car Accident, Part 1

At least this time, I have a good excuse for not having posted recently.

I was on my way to school last week when this white VW Bug came out of nowhere right into my lane. There are trees all along the median, long overdue for some branch trimming–anybody who lives in this neighborhood knows this and proceeds slowly before turning. This car, obviously didn’t even think twice about entering oncoming traffic without any clue as to whether or not there was anybody there. By the time I saw the car in front of me, I didn’t have more than 1 seccond to brake. The short time gained by my inadequate braking allowed for that movie-like slowdown of time where you know the crash is coming but are powerless to stop it, a ruthless hostage to momentum and other physical laws.

Bracing for impact, the inevitable happened–my neck snapped forward, my right knee hit the instrument panel and somehow, though I don’t remember it at the time, my right arm also hit something or other. A quick partial second later, I realized that although my foot was still pressing on the brake with <500 lbs of force, my truck was still being propelled like a billiard ball 45-degrees to the right to a rapidly-approaching telephone pole at about a 45-degree angle. I hit the pole and suffered a whole set of whiplash events all over again, albeit not so violently this time. Enkaphalins already surging through my body, the truth is that I didn’t even feel the impact. It all happened in this odd 3rd person perspective, which as I mentioned, was completely outside my control. I was both driver and involuntary passenger.

Everything that happened afterwards was a blur. All I know is that people spilled out from their houses, probably just getting ready to go to work themselves, surveying the scene and making the calls necessary. One person living nearby was an oncologist, and he asked me all the appropriate “status” questions about moving digits, paraesthesias, head trauma, etc. and told me not to move until the ambulance got there. He actually apologized he couldn’t do more (which I was actually thankful for!) but honestly there was nothing to do–I wasn’t bleeding, in respiratory distress, or in any other emergent situation, just hurting really badly. As the shock and disorientation slowly wore off, I was also getting more and more pissed that this happened to me.

We live 4 blocks away from the scene, so I called Claudia as soon as I was able, and she arrived with our baby daughter, freaking out. Not exactly what I needed at the moment, but being torn about what to do with the little one while a spouse is in this condition in a foreign country–well, the reaction was more than understandable. As foreigners here, we always hear about the horror stories that other Americans (through 2nd-hand accounts mind you) have had to go through, from bribing everyone in sight to outright being thrown in jail for being at the wrong place at the wrong time. I certainly didn’t know what was going to happen next from a standpoint of Mexican law. Thankfully, Claudia quickly snapped to, started handling some details, and eventually corralled her ‘posse’ with her–our viciously protective (especially of her) barracuda neighbor wives–to watch her back (and by proxy, mine) because this was about to get ugly.

To be continued…

Grand Rounds Update

Sorry for the lapse, you’ll see why in a post here quickly, but the last Grand Rounds was at Chronic Babe (pre-rounds here) and this week’s Grand Rounds is at the geekily funny Pure Pedantry (pre-rounds here).

Goodbye UAG classes, Hello Kaplan

My coursework, as it is taught from professors here on campus, is OVER. YAY! Now we begin a Kaplan review course (partially paid for out of pocket by us on top of our tuition, but that’s another story) to gear up for the USMLE Step 1. Kaplan actually offers a specialized program that’s a little longer, and one can only assume “slower,” than the standard course in the US for IMGs because the instruction here is (and I’ll be kind) “inconsistent.” The school, to its credit, actually takes this seriously knowing that something like Kaplan will bridge the gap between the idiosyncrasies of some of our coursework and the specific nuances of what’s “standard” in US medical schools. After all, we are talking about pleasing a standardized test here, not apologizing for our education. Moreover, IMGs have a hell of a lot more importance placed on our standardized test scores. For example, you can imagine a review committee at Big State U saying, “What the hell does a 9.4 average mean in a Mexican school, anyway?” (even if you convert to a 4.0 scale, the point is that the curriculum doesn’t match in a way they’d understand), so you can see they’d look to the “equalizer,” the “standard,” that which levels the playing field. On top of that, come match day, we have to compete with US students going to LCME-accredited schools that keep in step with the USMLE in their curriculum from day 1 of their education (or at least a lot more so) since their published pass rates, etc. factor back to their school. Our school, as you might imagine as a foreign institution with a minority of total students participating in the USMLE, does not feel the need to publish the aggregate performance. Read into that what you will.

Well all of the above aside, I had several social events this weekend and was able to have some fun without worrying about an exam or studying for ANY real length of time for the first time since, well, probably the first week of medical school. In fact, I’ve been thinking about what I want to get done now that I actually have some time. Well, in actuality I just have more flexibility over my time, but it’s good enough for me. If I want to not study at all one night and just organize this or that, cool. If I want to take a 3-day weekend w/family and go somewhere (our schedule is very irregular, going 6 days weeks through Saturdays sometimes and other times having 2-4 days off at odd times), I don’t have to sweat it while I’m there or making sure to study tons before. In short, I can actually enjoy time when I choose to with the freedom to actually do it. Obviously, everything I mention is w/in the confines of responsible preparation and study, but it’s on MY terms, not on the school’s terms, constantly having to have information bulemia for grades week after week.

I don’t like being in class from 9-3 (w/lunch break). That is a serious downer. I was hoping from talking with the previous batch of students that they were going to reduce the hours/day, but clearly they didn’t. I don’t know how they expect us to sit through lectures for that long, and then go home and study, do questions, make more notes, etc. But there are students I know–friends even–that couldn’t even wait the weekend to start studying for the upcoming lectures that hadn’t even begun. Not me. I get bored way too fast during most lectures if they don’t keep a good pace, so the idea of “pre reading” (when you already have the bulk of the notes in front of you) is just something I am not going to do–didn’t much need it before, less so now. To each their own. All I know is that I finally feel some breathing room, and I intend to breathe some fresh air before I go back to any sort of salt mine.

Pathopathology

Thanks to the work of pioneers like the late Dr. Robbins in the middle of the 20th century, pathology turned from a banal study of morphological aberrations to a study of the origins of disease. Pathology didn’t begin at the morgue; it began when the patient got sick. Since almost every subject we’ve studied comes into play when studying pathology–microbiology for infectious diseases, histology for recognition of tissue/cellular aberrations, genetics for chromosomal anomalies, etc.–it stands to reason that pathology would be the pinnacle of learning in the first two years, the nexus of all the knowledge that has come before, finally synthesized into an integrated whole.

Bullshit. At least not at my school. I have never felt so cheated in my time here as I do with this class. I have been wanting to write about this for some time, but I can’t possibly begin with out speaking ill of my institution. Well, after many incidents where my school certainly didn’t have my back, I’m certainly not going to return the favor.

All of this started last year when a leaked exam (a true mistake–no foul play involved) got out and gave certain students who had it an unfair advantage over those who didn’t. Here at UAG? Big f-ing deal–that’s the norm. Almost all classes have an officially labeled “question bank” (really a “test bank,” as it’s not a dynamic mix-and-match of questions), and it doesn’t take a very smart monkey to figure out that if one amasses enough old exams, one can have a good shot at some of the questions on the exam–sometimes even luck out having the very same exam! I have learned from other int’l med students’ blogs that this is not unique to UAG, so I just shrug my shoulders. After all, if ppl want to go nuts memorizing old exams, that’s fine–and I certainly look at them when I get my hands on them–but the people who do just that are in for a world of hurt. Natural selection is a cruel bitch, and she’s already culled 80 or so from our class since August of 2005. And that’s before USMLE.

The problem is that because of said fiasco, the pathology department was ordered to throw away their question/test bank and start anew. That’s a good mandate from administration, but what they wound up doing was simply cut-and-pasting questions from the Robbins review book, WebPath, and other online sources. Not a single original question was to be found. Oh sure, they’d change a few words here or there, but they didn’t care. After all,the department head of pathology isn’t even a pathologist; he’s simply a general practitioner who worked as a government doctor for Pemex, the country’s gas monopoly for 35+ years. The second in command is a pathologist at least, but her contributions mainly lie in flashy presentations that offer no substance beyond what is literally cut-and-pasted from the textbook. I thought at least the figures had their own original labels, only to find out that no, the captions too are copied. At least she gives proper credit in the slides. In all cases, we are simply read to. No additional instruction, no help if you talk to them in their office, as it is clear that they are not able or willing to explain any concept beyond what the book says. This is not a language barrier, it’s sloth. The one practicing clinical pathologist who is on staff and was the shining light in our lecture series a year ago was removed from teaching all but the newbies. How’s that for smarts: take the most knowledgeable, practicing faculty member and tie his hands so he teaches the very basics rather than the difficult. But this is Mexico, and Mexico rewards who you know, not what you know. Imagine who the department chair has in his pocket to be chair for which he has no credentials in that very subject.

Right now, we are racked with all of CNS pathology and all of hematopathology–hundreds of pages of the textbook to be sure. At least it’s two big sections. The last test was–and I shit you not–skin, muscle, bone, eye, kidney and urinary tract. What kind of hellish composition is that?!? Again, sloth. Whatever fit in the kitchen sink.

Like most things here, we’re on our own. I don’t mind that for histology or for behavioral science. Even things like pathophysiology–a potentially great class, subject-wise–was a waste because of who taught it. But it’s OK. Pathology, on the other hand is too important to be treated as just another castaway class. All of our complaints and petitions, however, are drowned out in the “cha-ching” of the cash registers as they process yet another semester’s tuition.

All I know is that I’m offline until Friday afternoon when this sadistic shit is overwith. Liver rounds to commence shortly thereafter, so it might be until Saturday before I am up for a debriefing. Wish me well.

How to achieve Blog Nirvana

Om….

I think the whole Venn diagram thing is hilarious. Personally, in my recent hiatus, I was actually thinking about what I could do to make my own site better, more appealing, not just for readers but for myself. The simple obvious answer is “POST, moron!” but I like the long, complicated answers.

To that end, I bought a book while in the States: The Forest For the Trees, because I thought, written by a professional editor, that it would help my get past all my perfectionistic “stop” energy to “let it flow.” Well, it turns out not to be what I needed, as the book deals more with career writers (or those who wish to be) and writers of books/thos involved in a formal publishing process. I was more looking for something along the lines of How To Stop Procrastinating Blogging Simple Things You Know Others Will Enjoy Because You Keep Saying “Later”, but I just didn’t find that on Amazon.

Grand Rounds 3:19

The business side of healtcare is not my thing, but this week’s GR is at Envisioning 2.0 with a healthcare marketing/business focus. (pre-rounds)

Groundhog Day

It’s fitting that today is Groundhog Day because I’ve finally decided to come out of my hole. No shadow-gazing here: I’m out for good. Since I started blogging, I’ve never gone that long without a post. At the same time, I’ve never gone through such a rough time since, either. I backdated a post about making a movie during my break, which you can read below. The prep and shooting of the short film did take a good chunk of vacation, but coming back to Mexico was the clincher.

A warning to those wanting to go abroad (and I should pause to remind people that Mexico with all its accessibility to Americans, is still VERY much a foreign country) for medical school who are married or will soon be: be careful. I thought we’d have it easier than most–we’re both originally from the same area growing up on the Texas/Mexican border, her Spanish was better than mine when we moved here, she saw this as an adventure from day #1–all the right ingredients. Surprise! Living here (and I’d imagine anywhere foreign) wears on you. I have school to occupy my time, and while it does also give its own unique blend of crapola aside from the academics, at the very least, I share the experience with 150+ other students. A spouse of a medical student is already somewhat widowed; add to that mix separation from their family/support structure, loss of a professional identity since they can’t work here (unless they are Mexican citizens or get special dispensation from the government (good luck!)), and you have a setup where they feel really useless really fast. Add a new child to the mix and it can turn into a festering cauldron of resentment. More than one spouse has packed their bags, and when I found out that’s what Claudia wanted to do, I did the best thing and understanding and supportive husband should do: I lost it.

We’d been here before, but looking back, it was more overly-exaggerated impulses (which she’s more inclined to than I) that didn’t really last. Cooler heads would prevail, and things would get better. With our daughter and the hardships of dealing with an obviously hyperactive/clingy baby, neither of us really had time to build up our reserves. The whole vacation of constantly “getting things done,” and then when the film shoot was over, switch to “Ok, let’s get ready to leave” (which for us means shopping for things to bring across that we can’t get here, on top of all the stuff people normally deal with) — we were just burnt out.

I do think a break could be good for us, but I don’t want to be without my daughter; however, having an unhappy mommy isn’t good for her either, so what do I do? Again, I dig deep into the well of my soul, and provide the most honest reaction I could: I freaked out again. (I’ll post about this later, but I’ll quickly mention the fact that dads get no respect, as conversations with family members quickly showed–mother knows all, father is an attachment to do labor mother can’t (not unlike attitudes towards weddings, except there I agree)). It turns out she’ll need a knee arthroscopy, so she’ll be going home later this month regardless. My hope is to have things worked out by then so she can go with my being 100% supportive, even though I hate the separation.

There’s been more going on academically and personally outside of this, but since I want this blog to be first and foremost about me–something for me to look back on–I wanted to make sure I wrote something about the above, even if it’s painfully personal. I tried, perhaps lamely, to turn it into a teaching moment for those wanting to embark on a med school journey far from home of some of the things that aren’t obvious about dealing with everyday things, the things that sneak up on you and before you know it consume everything. I am not a person who can compartmentalize my emotions very well. If things aren’t going well “at home,” it bleeds into my studying, my sleep, everything. I wish I could be one of those individuals that say, “I won’t worry about that right now,” and while I can get better, I can’t fundamentally change who I am. I will be the doctor that goes to sleep (ha!) thinking about the labs post-op, wondering what I’m going to find, fussing about this or that, because nothing ever changes for me because I walk out the door. I carry work home, and I carry home to work. At least I’m consistent.

So there you have it–the long, drawn out version of “There and Back Again” for the last six weeks or so. I promise I’m back for good. As a friend told me during my “hiatus,” blogging is a low priority given everything going on, but I need it. I don’t know why, but I have to write, and sharing in general is something that’s always been at the core of who I am. I have no idea who is still reading this, but if you are, thank you. More soon.