Match Day

So how does getting into a residency program work? For U.S. medical students, graduating from medical school is the first step. Residency program is where we complete our training, where we're no longer babied, and we have to work through sweat, tears, and blood, all that grueling stuff that shape us into doctors who can finally be sent out into the public to practice alone, safely and responsibly.

For most fourth year medical students, the big day is Match Day. It's the culmination of all your years of work and the past few months of applications, waiting for interview invitations, deciding which interviews to accept and which pre-interview social you'd attend, traveling for the actual interviews, hospital tours, meals with the residents, and struggling to come up with as many responses to "Do you have any questions for us?"

After all the interviews, we struggle to form our rank list in the order of which hospital program you'd like to work for more and the programs formulate their own rank list of all the candidates they've interviewed. A giant computer at NRMP takes in our rank lists, does its magic, and we all wait for Match Day, the day when we find out which residency program you're going to spend your lives at for the next x number of years.

So Match Day this year was officially March 21st. Some students applying for more competitive fields like dermatology care more about March 17th though, the Monday of that week when everyone gets a generic email informing them whether or not they matched. My classmate - a derm applicant - specifically took Monday off from our rotation while I covered for her because she didn't want to be working if she found out she didn't match (she did! Matched back to our home school program!). And you find out through the grapevine which of your classmates who sadly did not match.

Since I'm going into pediatrics, a less competitive field, Monday was not a super huge concern for me. I still had butterflies just in case I'm actually an extremely unlikable person and all my programs hated me on sight, but fortunately, all went well. On Monday at noon, I checked my email from NRMP with that suspenseful subject title "Did I Match?" And it was a very brief email with the most important words Congratulations!  You have matched! bolded. So YAY!

And then we had to wait another four days for Match Day on Friday to find out where we're matched to. Except for this dumb NRMP computer glitch this year that actually allowed some resourceful candidates to be able to check their match results earlier - a seriously dumb glitch involving a simple right click, view source code - but since I didn't find out about the glitch until NRMP fixed it and it was too late to check, this is all moot point to me.

But I have to say, not finding out earlier and being able to have anticipation build til Friday ... it was worth it in the end for me. Because there's nothing quite like that atmosphere of being in an auditorium with all your classmates and friends, that heady rush of excitement and nerves as you get up to collect your own sealed envelope, the countdown to noon when everyone, all at once, cracks open their letter and finds out where they're heading off to.

I, myself, took a few seconds to really absorb the words. My name ... my medical school name ... Congratulations, you have matched! ...

And then I saw the name of my first choice listed.

I think I must have let out some incomprehensible sound, like a whuh, covered my mouth and turned to my friend. She was shaking her head and just thrust her paper out to me. I shoved mine at her. We both got into our first choices.

There's a breath of silence and then screams of joy overfill the auditorium. Everyone gets out of their seats and starts running around, finding their friends, and grabbing each other in tight hugs. Some are crying, some are laughing, others are in shocked silence. Cameras flash and a school photographer follows people around, picking out the happy faces. A lot of people are bouncing around, especially my fellow pediatrics applicants - we're naturally bubbly people?

There is nothing quite like that roller coaster of emotions.

And then, of course, everything turns a bit anti-climatic in the aftermath. Your program emails you a welcome email and then starts cracking down with multiple HR forms, NPI request, resident work hour attestation, sleep deprivation attestation, etc. ("We own you now. Please sign your life over ASAP.") But yay, I don't care, I'm still living in my fourth year medical student bubble! I'm still excited over signing all your scary forms! Real job confirmed!

Whipple

Thanks for the support and response to my prior post, everyone! The plagiarist has been removed from Amazon and hopefully, this won't happen again. I'm revising False Facades so maybe, you'll be able to see the new version up on Amazon soon. Stay tuned, please.

In the meantime, I'm also in the midst of interview season for residency programs! Exciting and scary. I've finally decided to go into pediatrics after confirming my interest during my pediatrics sub-i. I got Step 2 CK done a while back, but I still have Step 2 CS to go in December. Smart me, planned it so that I would be cramming in between traveling around to programs. What was I thinking? Hopefully, everything continues to go smoothly into the new year.

So ... since I haven't posted in a while, I thought I should write up something about one of the experiences I had during clerkships. It's funny how things feel like it happened so long ago now when it's only been months, but at the same time, you look back at the year as a whole and feel like third year really went by in a blink. Everything was measured in blocks of time between shelf exams and you were constantly in motion, preparing for the next exam and the next. But sometimes, there are these moments that are especially memorable - whether it's in a good way or bad - that you continue to carry on as something you can look back on ... fondly?

The longest day I had during clerkship rotations was in surgery (of course) when I scrubbed in on a Whipple procedure immediately after rounds. During pre-op, the resident suggested, "Be sure to grab something to eat. This is going to take a while."

I had looked up Whipple procedure before so that I would be somewhat prepared to answer any pimping questions from the attending (you are never really prepared) and I had expected that it would be a long operation, likely lasting more than 6 hours. But to double check, I asked, "Around how long?"

The resident just gave me this faint noncommittal expression. "A while."

"Oh." I hesitated. "That's okay. I just had a cereal bar."

So much regret.

I started in the OR at 8am, watching the nurses and anesthesiologists prepare the patient. As the patient drifted away on propofol, I got the nod from the resident to go scrub and get gowned. By 9am, we were all gathered around the sterile field and the attending made the first incision.

Noon came along and drifted away. Still hadn't removed gallbladder yet.

2pm ... attending and resident still working. They didn't even need me to help suction and retract since the field was so small, I needed a stepstool to get a good peek. 3pm. Scrub nurse, pitying me, asked if I wanted to take a break. I glanced over at my resident and attending; they were so focused with laser intensity on the patient, I hadn't been acknowledged since pre-op. I wondered if they were even aware I was still there or was I just a blob at the periphery of their vision? But if attending and resident haven't taken a break yet, I wasn't going to so I shook my head, shifted my feet and continued to pretend I had thighs of steel, legs of titanium. Nurse crowed really loudly, "What a trooper! Gonna stick it out for the long haul, huh?" Attending's eyes barely flickered over to me.

Scrub nurses switched four times for breaks. Anesthesiologists changed shifts, one teasing me, "This is why anesthesiology is better than surgery." I continued to stand there, trying not to lean on patient's leg too much, hoping I get to do something, anything, or maybe the attending and resident can mention something educational to me or at the very least, mutter out loud exactly what they were probing at now. Even if it was to pimp me. Pimp me! Pimp me! Let me do something!

5:30pm. Attending and resident continued to go at it. Attending's surgical headlights set had long ran out of its charge, and had to be plugged in to an outlet. I jumped for any chance to irrigate, which essentially meant I squirted water wherever they wanted me to. New scrub nurse stared at me with more pity. My mask slipped down and I tried to shove it up with the back of my gowned arm and all the nurses jumped on me, "Oh, contamination! You should scrub out and ... maybe scrub back in later ... if you need to?" We all slipped the attending and resident inquiring looks. They didn't say anything.

Taking that to mean that I had to come back, I sidled to the door and hurried to the locker room where I crumpled into a chair and crammed another cereal bar down. Returned to the OR, scrubbed back in. Attending and resident barely glanced at me. Scrub nurse tapped my gloved hand and surreptitiously murmured, "You got food?"

I nodded, and she answered, "Good. Got to eat. Don't want you getting hypoglycemic."

By 7:30pm, the attending finally announced, "I need to pee."

Resident agreed, "Me, too."

While the attending went out to take his turn first, I asked resident, "Um, how long do you think until we close up? ... because someone is kinda going to pick me up ..."

"Oh, you could have gone home whenever you wanted," the resident answered.

I stared at him. Was this a trick question? Because I was ready to go hours ago. Why didn't you send me home then if I could have gone home at any time? Or is this reverse psychology? Do I need to continue to prove my dedication by clinging on til the very end? Tell me what to do.

The resident continued, "If your pick up is here already, you can go."

"Oh, he's coming," I said quickly. "He's here." He can be here. Right now. I will teleport myself into any moving vehicle heading home.

The nurse ripped off the ties to the back of my gown before anyone can say anything else and excused me quickly, "Go home then! Eat! Go! Sleep!"

"Oh ... okay ... thank you!" I announced to the general room with special gratitude to the nurses, gave a pathetic wave, and scurried out.

The next morning, I found out the case ended past midnight. Hardcore.

Face Full of Blood

Hello, hello! Super long time since I updated again, I know. I've been really awful about blogging because I've been on my surgery rotation. And no offense to surgeons, but I'm so not attracted to a surgeon's life. Super early mornings, long hours on your feet, meal breaks equivalent to quickstuffyourfacewithanythingnow, daily wound dressing changes, and when you're not spending long hours in the OR, there will still be long hours in clinic awaiting you. But fortunately, this lifestyle does appeal to certain folks (who are not me) and the world will hopefully always have some excellent, smart, hard-working surgeons (who are not me). I know this to be true because I know about five people, all quite sane and nice human beings, who will be/or is considering going into surgery.

So, for those of you interested in medical school ramblings ... for surgery, resident rounds start around 6-6:30am so for pre-rounds, we should check in even earlier. With long days when I generally leave past 6, I can go for days without seeing daylight because the sun will dawn while I'm in the hospital and set before I leave. Bright side of this? Vampires, too, can be surgeons.

Oh, you want a legit positive? When I drive in super early, it's quite nice because no one is up at 5am and you can go zoom zoom. And have your pick of parking spaces in the lot. Also, everyone can roll out of bed at 4:30am and wear whatever to the hospital because we're going to have to change into scrubs anyway. But after being on obgyn and surgery service back to back ... I missed nice clothes.

For rounds, medical students are generally responsible for carrying a bucket or stuffing their white coat pockets with sterile gauzes, kerlix, saline flushes, and tape. Lots of tape. We then flock after the team up and down stairs to the various patients, presenting the overnight information regarding patients we're following, changing the various patients' dressings and checking their drains. There were a lot of amputation wounds. Many legs to prop up, many oozing wounds to rewrap.

Speaking of amputations, I was scrubbed in to assist the vascular surgeon and resident on a BKA revision (the man is a diabetic whose foot got really infected so he had a guillotine ankle amputation in order to let the wound drain first to make sure the infection gets all taken care of before going back into the OR at a later date for a below the knee stump revision).

During the surgery, the attending hacked away at all the necrotic tissue, trying to roll up the flap into a nice looking stump. Really inappropriate, but it was close to lunch and for a while there, the stump looked like an empanada. A really thick, unwieldy empanada that refused to be wrapped up neatly. Cursing like a rap song, the attending muttered, "Oh, f***, man, this guy's a f****** squirter."

The next I knew, a jet of crimson spurted through the air and caught me right in the face. The attending jerked back, blood just barely grazing the bottom of his mask.

Likely because I was so tired, I just blinked. We all had masks with eye-guards so it wasn't as if the blood had made skin contact ... I hoped. No biggie, so what if there's this ketchupy blob across my vision, I can just peer around it -

The resident on the other side of the table stared at me as he ventured, "Um, maybe she should scrub out ..."

The attending turned his head to me, bovie in hand. "Yes," he decided. "Scrub out and come back."

"Uh ... okay." I turned away from the table and all three nurses in the corner went, "Whoa."

What? What? Did the blood actually manage to sneak past the eye guard? I just pictured a constellation of red on my forehead, forming a neon sign: SOAP PLZ.

One of them rushed forward as I stripped off my gloves, examining my mask closely. "It's okay. It's okay. Nothing got on your skin."

Another nurse laughed as he helped untie the back of my gown, "See now? This is why I said that you should go into dermatology."

When I removed my mask outside, it turned out that the blood had splashed across the mouth and up over the eye guard, ending just right at the upper border. Nice.

Happy New Year!

I hope everyone's been enjoying the holidays and is ready for 2013!

I've been blissfully lazing around during my winter break after wrapping up my ob-gyn clerkship. After seeing all these deliveries and scrubbing in on the C-sections, I have extreme respect for mothers. Mad respect.

As one of the many perks of being a lowly medical student, one of our duties is usually gathering the general history of the patient in triage. So when a woman in labor is busy breathing her way through a contraction and squeezing the threads out of the sheets, hey - you get a medical student hovering over you, asking about your chief complaint ("What do you think? I'm in freaking labor!"), past medical/surgical history, your previous deliveries ("Can't you pull up the information from my medical charts? I've been here before!"), current medications, allergies, STDs, abnormal pap smears ("No, no, no, NO."), etc. Believe me, we're very sorry, but we enjoy the process as much as you enjoy resisting the urge to throw something at our heads.

So ob-gyn was fun, in that mildly traumatizing way.

Anyway, a friend gave me this snow globe for Christmas and at first glance, I was like, "Aw, this is super adorable. It even plays music while I watch the snow fall. I'm going to treasure this forever!"

And then, the other day, I take a closer look:

Be happy, indeed. A bear gleefully prepared to trample a tiny turtle beneath its huge paw. Or caught right in that magical moment before he sends a flying kick at the turtle's head.

Am I to assume this is a subconscious manifestation of my friend's real feelings for me?

Am I a puny turtle, idiotically grinning away, while the shadow of a foot looms over my head?

No.

When the moment comes ...

I shall be the bear.

Sex Therapy

A lecture we had during psychiatry clerkship was on sex therapy.

The lecturer touched upon paraphilias (sexual arousal to objects, situations, or individuals that are not part of normative stimulation, causing distress to the individual or harm to others) for a while and described an experience she had:

One night, the phone rang and she went to pick it up. On the other end, a man breathed harshly before diving into obscene comments and lewd suggestions. Instinctively, she slammed the phone down.

Then, with her hand still on the phone, she thought about this.

The phone rang again and she picked it up. It was the same guy making the same crude remarks and this time, she informed him, "This is an impulse disorder you have, which I imagine would probably cause you a lot of distress. I know where you can get professional help -"

The guy hung up on her before she could finish.

But then, a few minutes later, the phone rang again and when she answered, he asked, "Does the place accept Medicaid?"

"True story!" she stressed as we all laughed in disbelief.


Sorry for being awol. Been really busy lately. I finished my psychiatry and neurology clerkships and I'm now on my pediatrics clerkship. I'm on nursery week and all the babies are so, so adorable - even though a fellow student said that he's since realized all newborns look like Winston Churchill.

Winston Churchill, Master of The Disgruntled Baby Stare-down

Psych Ward

Been rotating on the psych ward. Had a full week of orientation stuff which included getting a large set of keys since the entrances to the wards all have sally ports, a personal alarm (essentially a panic button that I should press in case I get trapped with a violent patient or something so that in the security guards' office, my picture and my location would flash on their screens and they can come rescue me) and a brief defense training which involves basically how to take down a patient without really hurting him/her. It involves two staff members and if it was two of us girls vs. a large, hostile man, would probably not bode very well for us girls.

All in all, it has been a nice experience so far. The attending seems to really enjoy teaching and the fellow is really nice. The patients are allowed to roam freely through the halls so a lot of times, when we're meeting in the office, the patients would stare and tap on the window on the door to the room as they mumble to themselves. It feels a bit like we're in a fishbowl sometimes.

We had a new patient transfer into the ward the other day and the woman seems to be bipolar with religious delusions and hallucinations. She also has a long list of serious medical conditions including breast cancer which had metastasized to her bones, but she has no insight regarding her problems.

During the initial interview, she refused to talk to the fellow, calling the doctor a prostitute who had tried to pretend to be the patient and had stolen her stuff to go to heaven. But that was alright because she had a bright light named Abraham who protects the patient and had impregnated her so that she gave birth to the other student with us.

The fellow tried to ask her a few more questions, but the lady refused, screaming, "I'm not talking to you! You're evil! I'm the prophet and the mediator of the bible and you're going down!"

The doctor gave us a look and I jumped in with a question about how long had Abraham been visiting her.

To which, the woman grinned. "He doesn't visit me. I go to see him. He's right there in the other building, helping the people find heaven. You can go there and see him, too." She sighed. "I like talking to you. Chinese people are always nice. Nice and delicious."

The room went quiet.

"I'm delicious?"

"Yes. Nice and delicious," the woman laughed.

"What do you mean by that?" I inquired to fill the silence in the room.

She just beamed and continued to giggle.

"Okay ... thank you," I said at last.

The fellow has since decided that since the patient "liked" me so much, I should follow up on the woman.

"Don't worry. We'll be with you," another student declared. "... so she doesn't eat you."

"Gee, thanks."

Vagina Actresses, Penis Actors

A while ago, we had gynecologic and genitourinary sessions to teach us how to perform a Pap smear, breast exam, and hernia assessment, digital rectal exam etc. on female and male standardized patients respectively.

Our standardized patients were actually instructors who walked us through the various steps and procedures as we practiced on their own bodies. They must get paid really well.

One distinct difference between the female and male sessions: females are a lot more complicated. Haha, generally, those who were doing the Gyn sessions got out later than the those in the GU sessions and the GU instructor said that was because for women, they want to know every detail and reasoning why we're doing such and such. We have to use the proper terminology and be careful of how we word things, i.e. "I'm going to palpate your breast now." versus "I'm going to feel your breast now."

As opposed to men, who are too busy staring up at the ceiling and thinking of other things so they don't have to focus on us examining their genitals to really process what we're saying during the exam anyway. Men are apparently more likely to feel embarrassed and may choose to turn a blind eye to any medical condition they have, especially of the GU type, rather than come in for a doctor's visit.

My group of three students started off with a GYN session where we spent some time staring at the instructor's breasts and describing them, from their shape, color, lesions to the way they hang. These instructors better be paid well.

After the breast exam, the lady got into position with her feet up in stirrups and legs spread apart while we learned how to work with a speculum and Pap smear test as the instructor watched our movements down below with a handheld mirror. I really, really hope these instructors get paid well.

Classmate got reminded several times to kindly keep his thumb on neutral position while wielding the speculum.

After the session, he murmured, "You know why I kept doing that? It's because I got so used to holding my game controller like that. I think she probably hates me."

"Catching you texting in the background while she was still exposed probably didn't win you any extra points," I said.

"I wasn't texting! I was checking the time on my phone."

Other classmate who had been wielding the speculum at that moment laughed and said that things couldn't be too safe, to which he was like "What? What was that? I didn't catch that."

"She means the instructor might have been worried you were texting pictures ..."

"No! I really was only checking the time!"

"Yeah. And then you asked her how many actresses come to do these sessions."

He covered his face with his hands. "It came out wrong. I meant - I meant like - I blanked out on how to refer to them ..."

The instructor had had a half amused, half puzzled expression on her face. She mused, "Actresses? What kind of actresses do you mean exactly? What, like vagina actresses?"

He stammered a lot.

All of the instructors were really nice and patient with us all and they were incredibly relaxed and professional even with a whole bunch of us getting all up in their private bits. My GU instructor, who works as a nurse in his daytime job, had a great sense of humor. He actually gave a little cheer when I asked him if he was circumcised. And ... that sounds completely wrong out of context so long story short, we were all supposed to ask if our patients are circumcised before we lift the blanket off of them to avoid a whole fiasco of staring at a penis and going ...

"You are not circumcised."
"Yes, actually, I am."
"Oh. Sorry, my bad."

So I was the only one who remembered to do so before the unveiling of the bits and the funny man actually pumped his fist in the air. We all cracked up and I thanked him for his support.

That's not to say I had no problems though. Since I was the last one to do the digital rectal exam, I had a bit of a ... lubrication mishap. Basically, I sat on the stool behind him for the longest time, my gloved finger probing for his anus in between his butt cheeks. It was a very surreal experience.

Instructor, elbows propped on the examination table and legs spread: "Ah, I'm sorry, this isn't your fault but since your classmates did such a good job before, I'm afraid there's a lot of lubrication and you just slipped away from the opening."
Me: "Uh ... okay ... right ... I have it now."
Instructor: "... No ... try a little higher."
Me: "Um ... here?"
Instructor: "Not quite."
Me: "Here?"
Instructor: "Eh ..."
Me (a little desperately now): "Here?"
Instructor: "Yep, good. Now you can push in."

I really wish all of our previous physical diagnosis sessions had these great teachers; it was a lot more thorough, hands-on experience of course and the one-on-one practice with the instructor really helped with correcting our mistakes and enforcing what we learned. But I guess the budget for hiring these folks is pretty limited.

But yay for vagina actresses, penis actors! (Really, those are not their official titles.)

Other news: I have not done any real writing except for a few pages for the next TM chapter. Sorry! I've been busy studying for Step 1, rejecting friends' fun summer plans, taking practice exams, then freaking out and postponing the date ... rinse and repeat. Haha, so I'm still studying, holed up in my room in this sweltering heat, but I will be taking a day off next week to finally see the last Harry Potter film with friends. We wanted to go later to avoid the mad rush and the kids. I don't think I've actually seen all of the HP films and I haven't particularly rated the earlier movies as must sees even though I think they were pretty good family fun movies - but I liked Deathly Hallows Part 1 and this is the last HP movie ever and just the idea of this being the last production together before the cast finally leaves these film sets they grew up on ... sadface! Plus, this being the epic conclusion with Hogwarts going down in flames and so. many. deaths. ... sadbawlingface.

Anyway, I thought this blog needed a long overdue update since it's been a while since I posted. I am still alive and once again, thank you all for your patience and support.

Eating Starch

Been on attending rounds and bedsides for a while now which is a nice experience since I'm not responsible for patients yet but I can observe the rest of the team doing their thing, help hold a patient in fetal position for a lumbar procedure, and listen in on patient reports and presentations.

For bedsides, I got to do a write up on a patient who was admitted to the hospital for complaints of fatigue and an extremely low hemoglobin count. She was a lovely, cooperative lady and she readily agreed to letting me perform a basic physical exam on her, but when the attending came in at the end and told her she could be discharged, the patient sighed in relief. "I can't wait to go home and get some real food."

The attending gave her a look. "I know what you're thinking of and the answer is no."

The patient rubbed her hands sheepishly. "I wasn't going to - no - well, just a little for the road?"

"No!"

"No?"

The attending shook her head, shaking her pen at the patient for emphasis. "It's going to kill you. No more starch."

"Okay ..." the patient agreed, resigned.

Out in the hallway, the attending asked my partner and I, "Did she tell you about her diet?"

"No ..."

"Yeah, well, she eats ... like, starch."

We nodded slowly. "Okay." What's so weird about starch?

"... As in laundry detergent," she explained.

"What?" We gaped at her.

The attending chuckled. "Yeah, we said her GI seemed irritated and she just goes, 'Oh yeah, that might be the starch'. So she's actually been eating Argo Starch which is something I believe that the cleaners use to starch clothes."

My partner blinked. "When you said no starch to her, I thought you meant ... real food ..."

"Like carbs," I added.

So the patient has pica, which is a disorder in which the patient craves non-food substances. Sometimes you see this more often in pregnant women when some of them start having a hankering for dirt, clay, or starch, etc. In the case of this patient, she had a previous history of eating starch during her pregnancy and recently picked up the habit again, popping these Argo Starch like popcorn while watching TV.

Yep. Other than bedsides, I've been studying for practicals and exams. Been busy and it's probably going to be busy for a while. Writing will be on hold til late summer probably. As always, thanks for your patience!

Oh wait, on a totally random note, it really hit me the other day that the last Harry Potter movie will be coming out this summer and at that moment, it felt like my childhood - tis OVER! Haha, this generation who grew up with Harry Potter and the Hogwarts bunch and lived through the anticipation of waiting for each book to come out ... this is it. The last movie. Just seeing the cast of Harry Potter all grown up and how mature and stylish they are now and going off on their own separate successful ways after completing this series and comparing them to the first movie when they were such cuties with their little chubby cheeks and ... my childhood is finished. TAKE ME BACK.

So when I saw this epic fan video ... I'm a dork. I teared up a little:



The magic will never die! Battle cry of the day.

Oh, and congrats to Prince William and Kate Middleton for getting hitched. It was the day after my formal so my friend woke me up freakishly too early to watch it be broadcast live and I kept passing out on the air mattress next to her TV in the living room where I had crashed for the night only to be wakened up sporadically by her comments on the dress, the hats and stuff. I think every time I opened my eyes, I saw Kate walking down the aisle again. I felt a little like I was in Twilight Zone, but since it got replayed so many times throughout the day, I was happy to be able to catch it later when I was less groggy. It was really a very lovely wedding and everyone looked absolutely spiffy.

Doctors Who Stalk

We had a lecture on lipid disorders.

One of the slides in the Powerpoint presentation featured a woman's eyes with xanthoma (fat deposits under the surface of the skin).

Here, the doctor paused. "Okay, this picture is of this patient - this is a true story - I first saw this woman on the train and she had this xanthoma around her eyes." He glanced at the slide again. "So I kept staring at her."

Some of us chuckled and even he broke off with a laugh when he realized how creepy that sounded.

"It's very typical for some people to not be aware of their condition, but anyway, so I kept staring at her and then this stop comes up and she gets off the train." He nodded. "So I followed her."

Now, we all started laughing.

"True story! So I caught up with her and I gave her my name and number -" He shook his head with another self-deprecating grin. "Good thing she still decided to come to the hospital anyway. She came to our office a few days later and we treated her. She actually wanted the xanthoma removed surgically, but without real treatment for her underlying condition, it would have recurred. But after we helped her, I think she's doing really well now. Nice and healthy life."

Score one for doctors who stalk.

Better than certain doctors who act like they can't be bothered to care.

The Red Reflex (Not A Superhero)

We have a practical exam for physical diagnosis coming up.

During a practice session last week:

Doctor: "So during the exam, you should announce your findings and steps for the preceptor."
Me (holding a fundoscope): "Okay."
Doctor (looking at me): "So you should say 'I see the red reflex.'"
Me: "I see the red reflex."
Doctor (eyes still on me): "Yep."
Me (what else now?): "I see the red reflex."
Doctor (still staring): "Uh huh."
Me (dramatically now): "I see the RED REFLEX!"
Doctor (turning away with a laugh): "Good!"

He flourished a hand like the maestro he is.

The red reflex is the reddish-orange reflection from the eye's retina that is observed using an ophthalmoscope in a dark room. Abnormal white spots or an absence of a normal red reflex can be caused by cataracts, glaucoma, retinoblastoma or retinal detachment. Red, good. White, bad. Kinda like Lunar New Year colors. 

Tap This

We practiced the neurologic exam last week. As part of the deep tendon reflexes overview, we checked for the ankle jerk reflex which is elicited by tapping on the Achilles tendon along the back of the foot.

"I've found what helps is to kinda ..." The doctor climbed up a table, leaning forward and hiking a leg up so that a knee was propped on the surface like so:

"Ah, like a stripper," my brain thought.

"Ah, like a stripper," my mouth said.

Clearly, my brain-to-mouth filter was on strike.

My group laughed and I tried to do a ninja shuffle to the background before the doctor can arch her back for a clear look at who was blurting out such inappropriate comments.

After the session:

Friend: That was one of your - no, your second most funniest line in class.

Me: ... You're remembering the missionary sex thing, aren't you?

When we practiced the visual fields exam on our partners, I just couldn't get her eyes to converge. So I sat there for the longest time bringing my finger close to her nose again and again trying to make the girl cross-eyed.

The doctor cocked her head. "You sure you don't see any convergence? It should be pretty obvious."

Feeling like a failure, I stammered, "Uh, well, her left eye kinda ... but it wasn't really ... I mean, the eyes didn't really move close together and -"

The doctor gave me an amused, indulgent smile as she shifted her seat next to me. I got out of her way, cringing. I will be branded as the dumb medical student who can't even get a patient to follow a freaking finger through the air. They will look at me in the future and think this is the girl who should go home and play with her fingers in some corner.

The doctor moved her finger in a wide H. The girl's eyes followed her finger perfectly. Then the convergence test and ...

"Huh. You're right."

"I am?" I tried not to sound too satisfied. Oh, who am I kidding? I was probably beaming.

"What?" The girl gaped at us. "There's a problem with my eye?"

"Yeah, have you ever been told your left eye's a little weak?" The doctor sat back in her seat.

"Uh, no, I wasn't even aware that ..." The girl looked worried.

"What happened?" The other girls in the session glanced over us.

"My eyes won't converge," my partner explained.

"Really?" One of them brought her finger up. "Look at my finger." Zoomed in toward partner's nose. Her hand dropped back down. "Oh, wow."

We were all fascinated. I was also probably smiling inappropriately again.

My partner touched her eye. "Well ... damn. Thanks for picking up on that."

"Uh, no problem. Don't worry. It'll be okay." And I poked her with a broken tongue depressor to distract her.

Kidding, that came a bit later. Sensory exam for pain, oh yeah.

A note about my masterpiece up there: I know, you're in awe of my artistic prowess. Since my drawings are so eerily lifelike, I purposely left the face blank to protect the identity of my instructor. Please don't be intimidated by my boundless skills. I'm still human.

Will You Look Up My Nose?

In our small group session, we practiced the basic head & neck, thorax & lungs examination on each other.

This basically meant we all got a tad more intimate with some people we've been hanging around with for too long.

We played with penlights and checked the direct and consensual light reaction (constrictions of the pupils). We half-assed the Snellen card exam since I should hope all of us already knew whether or not we needed eyeglasses and we took turns blinding each other with the ophthalmoscope until we figured out the dim setting.

We convinced a girl that we wouldn't judge her for having a dirty ear as she tried to wheedle her way out of getting it checked with the otoscope:

"I think I have earwax."

          "It's okay."

"No, really, it's stuck up there and I can't get rid of it! Q-tips don't work! Please, no!"

"Oh, silly, you're funny. It's okay. We doubt you'd be the last dirty ear we'd be seeing."

"No, really -"

"Just sit down."

The doctor then looked in my ear as a demonstration for the other students because everyone seemed to be having a hard time with it; apparently, we all have narrow ear canals. Nothing like having your classmates hovering around to study the inside of your ear to make a girl feel self-conscious.

Then we looked up a girl's nose. Then we looked up a sick girl's nose and admired her swollen turbinates. Then we made sick girl open up her mouth so we could inspect her swollen tonsils; white patches! We think it's a viral infection and we were so excited over the girl's sickness, it was pretty sad.

We went over the neck's lymph nodes and moved on to inspecting the thorax and lungs. Our small group sessions are separated into groups by sex so we had a bunch of girls pulling off their sweaters and unzipping their hoodies so that we can practice better in our tank tops. Of course, that's when some guys decided to wander over by our room. The doctor gave them a pointed look. "Do you need anything?"

"No, we're just -" They got the door slammed in their faces.

When one of the girls tried respiratory excursion on me (palpation by cupping your hands around the patient's posterior thorax to observe for symmetry), I'm ashamed to say I broke out into uncontrollable giggles. I'm extremely ticklish and just barely restrained myself from elbowing the girl in her face to free myself.

We went through tactile fremitus, percussion (that was fun), and auscultation. I think we're all healthy.

Dr. Chippendale

We had a lecture on head, eye, thorax physical examination procedure.

For the last demonstration, the doctor called up one of the guys to play guinea pig. When he made his way up to the front of the room, she asked, "Would you mind taking off your shirt?"

He froze. "Uh ..."

The class' response:

Half the guys: "We mind!"

Other half: "Do it! Take it off!" *wolf whistles*

Girls: Exactly which side do we take that would be least offensive?

Guy gamely decided to participate, turned his back to the class and tugged up his shirt. I really wanted to describe the scene in more detail, but all the lines I've typed up at this point made me sound like a really bad Harlequin novel. Suffice to say, the shirt made it up over the guy's face. His back: muscles flexed, light gleamed off skin.

Guys in our class snickering: "Whoo, baby!"

With his arms raised and the shirt still covering his face, he paused. Commencement of pelvic gyrations.

Class burst into loud guffaws. Yes, professionals we are.

Doctor, trying not to smile and probably wondering if this was such a good idea now, asked the guy to sit down on the bench, back still facing us. We then went through the techniques of tactile fremitus, percussion, and auscultation with the stethoscope. Percussion, by the way, is exactly what it sounds like; it's pretty much like playing drums on the patient's back with your fingers and listening for resonance. Next up, air guitar.

Guy was instructed to face us and while the doctor continued to explain what she was looking for, guy glanced down at his chest worriedly. As she continued to speak, he tried to subtly blow on his hands and pat his chest (specifically nipple range).

Doctor paused as she turned to him, stethoscope in hand.

He dropped his hand, cleared his throat. "Sorry. It was cold."

The class cracked up again.

Doctor: Must remember why I agreed to teach.

For Everything Else, There's Mastercard

Course director sent out a page of recommended tools we should purchase for our physical diagnosis course:

Littmann Cardio III Stethoscope: ~$150
Ophthalmoscope/Otoscope: ~$600
Sphygmomanometer: ~$150
Reflex Hammer: ~$10
Tuning Forks (128 and 512 Hz): ~ $14 each
Penlights: $5
Case Studies Workbook: $26
Textbook: $80

The Medical Diagnostic Experience: Priceless ... my ass.

If you are super close with any sad, poor medical students or you just really pity them sad, sad souls and/or want them to love you for life, gift them with a really good stethoscope. Adoration. For life.

Medical Bag: $ eff that, I'm wrapping this up in a plastic garbage bag and calling it a day. (Half joking.)

While waiting for our physical diagnosis preceptor to come for our session on vitals (it got so late, we joked that this really felt like a real medical office), we started chatting about movies.

One girl said she was going to see Black Swan which most of the group said was a really good movie. From there, we talked about Natalie Portman's pregnancy and from there, we talked about how she was going to be in this new movie with Ashton Kutcher.



We agreed it looked like a pretty bad movie.

One person laughed, "Friendship has its benefits. Yah, sure, right."

From there, we started talking about all the random movie trailers we've seen. Apparently, a lot of us enjoy watching trailers and not, you know, the actual movies themselves. Since classes had recently picked up, I'm assuming this is due to a decrease in free time to actually go sit through a two hour movie at the theaters when we can just squat at home with our textbooks and speculate happily over a two minute clip during procrastination breaks. Whatever the reason, yes, this still sounds pretty pathetic.

Anyway, one girl, half choking on a laugh, suddenly brought up: "Oh my gosh ... Gnomeo and Juliet."

The conversation tripped and we all gave her this quizzical look. I was pretty sure I must have misheard and was trying to decide if I should ask her to repeat or if I should just pretend to know what she was talking about and nod.

The girl seemed to realize we had no clue what she was talking about though and enlightened us: "Basically ... Romeo is a gnome."

Never in the world had I imagined I would ever hear that. So ridiculous, it was hilarious.

When we were done laughing:

"What? For real?"

Another girl: "I would think Juliet would rather die than be with a gnome though."

"They're all gnomes!"

"Oh man ... I'm sorry for Shakespeare."

Gnomeo & Juliet? Surely, this is one of those cases when someone (perhaps with the helpful aid of some mind-altering substance) comes up with the title first and then writes out a whole screenplay just for it. Because otherwise, the other scenario would mean that someone one day decided that a gnome story would be cute and since gnomes make people naturally think of Shakespeare and gnomefied witches for Macbeth would just be way too creepy, an adaptation of Romeo and Juliet would be ideal and even better, ooh, they can call it Gnomeo and Juliet ... yeah, I don't know, maybe if there were also some mind-altering substances in play here.

So I had to check out the trailer. And well ... it seems charming enough for kids and there's the Shrek 2 director and James McAvoy! (though sadly, he is gnomefied and I don't dig bearded gnomes even with the James McAvoy! voice), though I'm assuming this won't be a true adaptation of the classic what with the ... gnomes ... and probably no tragedy in the end because how exactly do you kill gnomes?

I'd like to know because garden gnomes kinda freak me out.

How to Ruin a Celebrity Sighting

Warning: This post contains some general spoilers for last season's Grey's Anatomy. 

I was on the train with a friend a while back when all of a sudden, she pulled out her cellphone and mumbled, "Here, I want to show you something."

Since this usually meant she had something to say that she couldn't voice out loud, I went silent and waited.

Her thumbs flew over her qwerty pad for a bit before she showed me the message: Doesn't that girl sitting across from us look a lot like Reed from Grey's Anatomy? 

First thing that popped into my head: Sure, celebrities on a train. Yeah, right. 

So ...

"Who's Reed?" I blurted out loudly. 

My friend gawked at me, her eyes flickering over to the girl in question, and she covered her face in mortification. "You know ... Grey's Anatomy!" she hissed.

"I don't know. I don't watch much Grey's. I only caught part of the season finale when most of them were dead or shot already. So ... she died, right? Like ... on the floor?" I asked, not bothering to whisper since there was no way the girl across from us could possibly connect the fact that we were talking about Grey's Anatomy in reference to her so-called resemblance to one of the characters. So what if she looked like this Reed character? It's not like she's actually Reed. "She must have been one of the first ones dead, right?"

Friend stares at me, speechless.

"So who is she exactly? Did you like her character?"

"Well, yeah ... she was ..." My friend gave up. "Google when you get home."

So I finally turned my full attention to the girl across from us and since her eyes were cast down, I helped myself to an unhealthy amount of ogling. Memorizing her face so I'd remember her features for googling purposes later. Admiring the knit hat she wore over her short pixie cut. Eyeing the black Chanel bag resting on her lap. Sighing over her knee high brown boots. Ogle ogle ogle.

But while she was very chic and pretty with this slight smile playing on her lips, she seemed like a regular rider blissfully unaware of the silent scrutiny from the strange girls across from her.

Later, when I got home, the first message I received from my friend was: GOOGLE REED! NOW!

Then she immediately followed that up with a link to the Google images she'd already pulled up. Reed a.k.a. Nora Zehetner.

 tvguide.com

Oh. Wow.

Reed from Grey's Anatomy was sitting on the train across from us.

Reed from Grey's Anatomy was sitting on the train across from us!, I typed to my friend.

Friend: yeah, it was totally her because when you said who's reed so loudly, she laughed a little when I looked over at her. thts why i covered my face!

Me: what? really? dude, i kept staring at her! i thought i was being so stealthy.

Friend: omg rofl.

Me: no wonder she kept smiling.

Friend: haha

Me: and there I was ... just leering at her.

Friend: lol it was totally her. i just can't believe you said who's reed so loudly.

Me: well ... i didn't believe you. 

Friend: i'm good with faces!

Me: i just thought you were one of those sad people who think they see celebrities everywhere. like elvis.

Friend: What??

More recently, a summary: School. Got dragged to one of those haunted attractions thingies by friends for Halloween; don't ask me to describe what happened in there because I came out in a bleary daze. School. Had Thanksgiving dinner at cousins' place where we roasted a whole turkey for the first time in our lives (we were more of a chicken family before). School. Had rounds shadowing doctor for chest pain and renal failure patients. Wrote a paper on pros and cons of TOLAC (trial of labor after c-sections) and had a workshop presentation debate on it yesterday. Exams on path and pathophys still coming up.

Question in a previous post comment from Anonymous: Can you please blog about your pre-med and med school experience in general? Like how hard it is? :O 

Sure! I'll try? Haha, I'll attempt to write some slightly interesting posts soon but sometimes, it's hard thinking of a good topic since not everything is cool and all shocking medical cases like you see on House or roller coaster drama like Grey's Anatomy or something like that. The life is more like ... a whole lotta studying. And running on little sleep. And trying not to give wrong answers to the doctors who point you out in your small group. Boring and a little sad. If I really write what goes on usually each day, you'll probably pass out asleep by the first paragraph.

But if you want to know a little about what I did yesterday, it went something like this:

9am: Trying to print paper in computer lab before workshop starts. Classmate runs up begging me to print two copies of his paper too. REJECTION! New cheap-ass environmentally friendly limitations on printing page quota means hell no, classmate should must log into his own account to print his own mess. He continues to beg, unwilling to deal with the hassle of logging in and out due to the time, and then offers an I.O.U. for double the pages on his account. Alright, fine. I will collect.

10am-noon: Workshop debate on VBAC versus C-sections. Doctor's wisdom: EBM ≠ CYAM. (Evidenced Based Medicine ≠ Cover Your Ass Medicine.)

12pm-1pm: Lunch from the nearby deli. I'm all sandwiched out. :(

1pm-4pm: Lectures ... oh my god ... must ... stay ... awake ... Oh, hey, crossword in the newspaper.

4pm-6pm: Small group on chest X-rays. Gets called up to the front of the room to point out what's abnormal. "Err ... look at the lines ... the EKG leads ... is this AP*? No? Okay ... well ... the heart is, um, pushed toward the right." "Yeah, good, sort of ... the patient has dextrocardia." "Right, exactly. ... I'll just go sit back down now."

And this has mostly been the general routine of my pathetic life, rinse and repeat. Now I just need to get through a chest x ray assignment, two more exams, and then it should be winter break! Where I'd then have board exams to prep for. Yippee. But I'll try to fit in some writing time too hopefully. Until then, please bear with me for my slow responses and updates.

TM Chapter 29 Status: 11 pages in

*By the way:
AP = anteroposterior (X-ray beams pass from front-to-back)
dextrocardia =  heart is located in the right side of the chest instead of the left

Taboo

I thought I'd be able to get through this summer without a single mosquito bite. Failed. My neck has a lump that's fast entering goiter size and my left foot is swollen from a bite so badly, it hurts. Today, the bite mark turned black like a bruise. Not good. I'm so allergic to bug bites, I should roll around in a bubble outside.

On Wednesday, my friend had her barbeque (where I picked up the bites); we burnt a lot of food to a crisp because we didn't want to pick up salmonella and then of course, we assessed the crispiness because we didn't want carcinogenic properties. Basically, we ate a whole lot, hung out with her golden retriever, and played Taboo. Except when you have a bunch of really competitive med students together, the clues we start giving get ... interesting. 

"This is what you give albuterol for!"

"ASTHMA!"

"What are we studying to be? But not primary care! Okay, what does this specialized person use?"

"SCALPEL!"

"This is where we purchase attires ... oh forget it, blank junction!"

"GAP!"

Yes, by interesting, I did mean way nerdy.

Of course, I'm a tad more eloquent and cool so I threw out a few gems of my own:

"Yo, this has a red ass."

"BABOON!"

Went out to lunch yesterday with a friend (she's also doing med - entering this year) and then we checked out Bed Bath & Beyond so that she can pick up some supplies for her dorm. It was nice to catch up since we hadn't sat down face to face in over a year now; especially lovely to do so while perusing cedar balls (only wish this were an interesting euphemism) and cushions. She got this giant under-bed storage box that's about her size which the saleslady wrapped up with two pieces of saran wrap before handing it back to friend; so she lugged it onto the train back to her place like a bulky surfboard ... or mini coffin. 

Folks were also passing out free samples of Science Diet dog treats on the streets so I swooped in to grab two bags for my friend's golden retriever. Now they just need to pass out free treats for humans, like chocolates and ice cream bars. Yes, please.

Studying for my exam next week has not been going well. Barely made a dent in neurology and I still have behavioral sci to review. I barely remember behavioral sci, but I have convinced myself I could go at it in one day since it should mostly be psych and child development stages. Yeah, this will probably come back to kick me in the butt in the upcoming weekend. Who else hates that summer is coming to an end?

Recent Debacles

In Which Brother Is Broken By Brethren, Volume II

Cousins, brother, and friend came back from their basketball game in the park the other day. Nothing like a bunch of funky, sweaty guys desperately gulping bottles of water in the kitchen to brighten the day. Except bro's glasses were shattered and he groped blindly around the kitchen, looking for the mini tool set in the drawers.

"What happened now? Did J (friend) break his glasses this time?" I joked from the doorway.

All their faces swiveled toward me except for J who sat stoically. "How'd you know?" cousin asked in surprise.

He's playing around, I thought. "I'm kidding because J was the one who caused bro's ankle sprain last time ..." J didn't meet my eyes. "Oh my god, you broke his glasses. What are you made of!"

Once again, like the ankle sprain case, bro was on the same team. J had passed the ball to bro, but the ball had caught bro in the face --> bye bye, glasses.

In Which Narrator Narrates Sad Life & Equally Sad, Not-Quite-Dangerous Incident

We just started a section of pathophysiology which we'd continue in the fall. Exam this coming Monday. In two weeks, we have our board exam for micro and immuno. Then it'd be summertime! And an exam in August before class starts that would require us to review all of the neurology and behavioral science we had learned before in preparation for our neuropsychiatry course. Which pretty much says "Screw your summer vacation, suckers." But I should be to able to finally update Through Me some time soon before things pick up again in August.

Today, we started hospital rounds, shadowing a nephrologist as he checked in on a patient with pleuritis (inflammation of the lining of the lungs and chest that leads to chest pain when you take a breath or cough), chronic obstructive pulmonary disease (COPD), and HIV.

It's cool how some of the terms that would have just flown over my head before are starting to come together. He also quizzed us in the hallway on what we know about pneumonia (S. pneumoniae is the top cause of community acquired pneumonia. Pseudomonas major concern for health care workers. For Methicillin-resistant Staphylococcus aureus (MRSA) sensitivity tests, they actually use oxacillin as opposed to methicillin.) Interesting. And somewhat uplifting that we knew more than we expected - or at the very least, had heard of so and so bacteria and drug before. However, at the same time, it sadly reminded us we still need to desperately polish up on more of the micro and pharm (oh god) - especially with our board exam coming up.

Otherwise, I've been having a week of bad luck and I've been in an especially foul mood lately. To finish me off, I stepped my heel into a pothole after leaving the hospital, nearly spraining my ankle and sending me toppling. I managed to grab hold of a friend who was thankfully right next to me so I didn't wind up sprawled on the ground in front of incoming cars, saving some face in front of this nice huge Asian family who was doing group pictures. I have the bad feeling some of their images might show this lopsided girl with her arms flying in the air and one foot in a hole in the background while they're busy grinning, pulling victory signs. Then they'd curse this mysterious loser for ruining a perfectly fine family photo. Story of my life.

Good thing I also clipped my nails recently so I didn't leave scratch marks on poor arm of friend. He was adamant that he would have saved me even if I hadn't grabbed onto him because he has quick reflexes like that. Yeah. Right. I'd probably have died.


Cyanide & Happiness @ Explosm.net

When I saw this, it made me think of a friend who had picked herself up a rape whistle, a siren, and licensed mace when she moved into an apartment by herself.

Monsters Inside Me

A guest lecturer showed us a clip from Animal Planet's documentary series Monsters Inside Me about malaria in class a few weeks ago. (Same professor who is friends with Edward Cullen.)



Anyway, we thought the featured doctor looked kinda familiar, but we were a bit preoccupied with laughing at the dramatic scrolling scene of the doctor posing in the hallway with arms crossed, superhero style.

Then his name was credited. Hey! Familiar looking superhero is our guest professor! Only he looked more, ah, studious in the clip with his eyeglasses and white coat and so ...

We laughed some more.

Professor's insight into the behind-the-scenes making of these documentaries: "We filmed it in one of those offices at Mount Sinai and for some reason, they had the heat on extremely high and they had all these lights so, uh, we would stop every two minutes because I was sweating and it looked like I had malaria."

Excellent.

Just had an exam on Monday, a presentation yesterday, and now I'm working on small group preparations and studying viruses.

Edward Cullen of Parasites

Had third exam yesterday. We did our lab presentations today regarding unknown diagnoses with our plate cultures. Our case was based on a blood and urine sample from a 9 month old baby girl and we identified E. coli and some S. epidermidis (the latter probably due to skin contamination during the sampling process though) through Gram stains, API test strip, and all that jazz.

After that, we had an introduction lecture about parasitology. Cool class and we learned about all sorts of icky parasites that are quite clever at stowing away into their hosts' bodies, including this little fellow:

Behold. The Hookworm!

And then I died some more as the professor oh so casually described it: "I'd imagine this to be the Edward Cullen of parasites."

Class: "Say what?"

"It sucks blood and ... yeah."

I choked on my half-bewildered, half-horrified laughter.

Confused folks in the back row: "What? What is this Cullen he speaks of?"

I was lost for words. Three extra lessons I learned today:

1) So actually, not everybody is aware of this Twilight business. I thought it had about taken over the world already.

2) But of all those people out there who does know of Twilight, one of them is my professor. Who is so familiar with the Twilight world, he can state the full name of our favorite sparkling vampire. (Extra odd because I'm glancing back and forth between one girl who's all blissfully confused, "What's he talking about?", and then back to our middle-aged male professor, who's eyeing the picture of the hookworm, "Sup, Cullen.")

3) And I will never look at Mr. Hookworm the same way again. There is a part of Mr. Hookworm that thirsts for my blood and I am unconditionally and irrevocably in love with - yeah, no. Just no.

Random facts about Hookworm (Necatur americanus, Ancylostoma duodenale):

• a parasitic nematode worm that lives in the small intestine of its host
• feeds on host's small bowel mucosa, sucking blood directly from site of attachment
• one of the most important causes of childhood anemia in developing nations 
• infective larvae develop and survive in an environment of damp dirt
• diagnosis depends on finding worm eggs through microscopic examination of the stools
• basic prevention: don't walk barefoot in suspicious areas, avoid using human excrement as fertilizers, and try to deworm pets

Apologies

Recently, I've received some emails from some pretty angry readers and I'd like to apologize here for the long wait since my last update. Status update: regarding the next chapter for Through Me, I have 15 pages. I'm not lying and I'm not making something up to pacify you guys.

Your next question might probably run something along the lines of: "Well, why don't you just post the goddamn thing then?"

Because I don't want to. Not because I adore making you all wait and I love receiving hate mail, but because I don't love the chapter in its current condition and it's already in its third rewrite. Something isn't jiving. However, in response to some readers' concerns, I can promise you that the story will be finished and I haven't abandoned it yet. I just need to work on it longer.

Why is it taking me so long? Because of school. And also, because of friends and the other distractions that come along with life. Yes, I'm aware some of you have said school can't be that busy, but I do like to spend the few breaks I have with friends and family sometimes. Or yes, to laze around and watch a little bit of TV. Call me weak, but I can't stop myself from slacking off with some mindless breathing moments too at times.

And why haven't I updated my blog in a while? Microbiology, Immunology, and General Pathology. I just finished a 15 page path essay, prepped for tomorrow's small group discussion on abscesses and septic shock, and I have to start cramming for Monday's exam. I would also possibly like to curl up in a ball and sleep too.

I can certainly update the blog with posts of daily blabbering about work, but the response I received since my last post didn't exactly go over too well ... and I began to feel guilty instead. Perhaps these readers think I should be working on the next chapter instead of blogging? Perhaps they'd rather wait for a post about an actual chapter update? Yep, I got intimidated. And just uncertain. I definitely understand the frustrations of readers when they have to wait and wait and wait ... only to find nothing, nope, no update yet. And I was just upset because I didn't have anything substantial to appease these readers. Not yet. So I kinda walled myself off, dropped everything else, and focused on school, thinking that "Okay, soon, I will post when I get the next chapter out. Soon."

Yeah, okay. Too bad getting the next chapter out hasn't been working out so far. Writing's definitely been on the backburner these past months and I'm sorry to say that it'd probably continue until summertime, at the very least. This course has exams and presentations mixed in with essays, lab reports, and so much other tedious work that I could scream. Plus, it starts 8am daily. Which means I wake up 5:30am daily. I average about five hours of sleep a night. I haven't been the kindest soul in the mornings this past year. 

The semi-good news though? Thanks to all your patience and understanding the previous months, I was able to really do nothing but focus on my Pharmacology class and I'm happy to report I got an A? Yay?

And for those who are interested in some random details about my recent non-life, I practiced giving PPD shots (The PPD shot is injected under the top layer of skin, causing a blister to form and it's a common test given to diagnose tuberculosis. I'm sure most of you have received this test before for school or work forms and what not) the other day. This means me giving my very first injection to a fellow classmate and her returning the favor. Only her needle slipped out the first time before she could administer the saline solution and she had to do it twice. I am self-sacrificing. Kidding, I didn't mind because she did it very well and it was relatively painless. We all ended the day at the clinic with our very own teeny bubbles on our arms. Gold stars and stickers? Pfft, those are for babies. 

Otherwise, I know, I suck. And I'm sorry for everything. I will try to fit in more writing, but I honestly am getting buried by the workload at this moment. Parents are also away on vacation for three weeks and us spoiled spawn of theirs are still figuring out how to survive on a day-to-day basis. My brother claims he's not hungry every time I ask him what he wants for dinner. Either he's going on a diet or he isn't quite willing to entrust his stomach and I suppose, his quality of life in my clumsy chef hands. What? Food poisoning's treatable.

If you wish to kick me off your reading lists, I completely understand. All I can offer right now are my meek apologies. And if you can find it in your hearts to lay off on the hate mail for now, I'd appreciate it too. Thank you, thank you, thank you for all your time and patience.