It's that time of year again

I've been reminded that USMLE part 1 is fast approaching. So I'm reposting my own memories of the test.

And this clip, from the movie "Real Genius". In 30 seconds it summarizes perfectly what studying for USMLE is like.






Anyway...

At the end of the second year of medical school is the USMLE-1 (United States Medical Licensing Boards, Part 1- the name is misleading, several countries use it). This covers every subject from the first 2 years of medical school: Anatomy, Biochemistry, Pathology, Pharmacology, Microbiology, Neuroanatomy, Physiology, Histology, and a few others. 2 years of learning, all in 1 awful test. When I took it the test consisted of 4 sessions spread out over 2 days. Each session had 200 questions, and 3 hours to answer them.

At my school, if you failed the test, you had to take it again. If you failed it twice, your medical career was over (though you still owed your student loans back).

It was the Summer of 1991.

I don't remember the specific dates. But basically, between the time med school ended for the Summer, and the dreaded test, was roughly 1 month. You had 30 days to re-study everything that had taken you 2 years to learn to that point. And pretty much your chances of a career in medicine depended on how you did.

So it was stressful. And, to this day, I still feel for all of you who are out there studying for it now. Any classmate, resident, or attending who tells you they weren't scared is lying.

Within hours of the semester ending, my class had gone into hiding.

I stopped shaving, to save time. My roommate, Enzyme, disconnected our TV, moved it across the room, and piled furniture in front of it.

My days consisted of me getting up at 7:30. I'd either stay at my apartment desk or walk over to campus to find an empty classroom to study in. I'd put in my trusty earplugs and the world around me ceased to exist.

Around noon I'd go back to my apartment for a PBJ, then go study again. At 5 I'd go back to my place for a sandwich, or ramen soup, or Rice-a-Roni. I'd sit out on my balcony and eat, for 15 minutes of relaxation. Or I'd read a book with dinner (Enzyme and I were both reading a single copy of "The Price of Admiralty" by John Keegan. It sat on our kitchen table for the month, and we'd have different eating times so we could share it). I never spent more than 30 minutes on a break. After dinner I'd go back to my desk, or campus. I'd study until around 3 a.m., then go home to sleep for a few hours.

I called my parents a few times. My daily outfit consisted of gym shorts (the short kind, from the 80's), T-shirt, sneakers, and the growing beard. Days blended together. There were no differences between weekends and weekdays. People I encountered were superfluous to my existence. I saw my classmates a few times, and we exchanged glassy-eyed nods as we passed.

I shaved a night or two before the test. I studied until around 11:30 p.m. on the eve of the test, re-reviewing a few last points.

It was weird, like I was living alone on another planet for 30 days. I have no idea what happened in the news that month. I was out-of-touch with everything but my books.

If there's one thing I came out of medical school with, it was this: The realization that there was absolutely, positively, no way you were EVER going to get everything read, studied, and reviewed that you needed to before the test.

And, somehow, when the test was over and the dust had settled, you'd done it. And you'd have no idea how. I still don't.

Good luck, everybody.

Memories

Occasionally someone will write in wondering why I became a neurologist. It was mostly by process of elimination, as I learned other things just weren't for me.


My pediatric career died fast in med school.

That rotation, during my 3rd year, was 8 weeks long. It took me 15 minutes to realize I didn't want to do this for a living. So I was left with 7 weeks, 6 days, 23 hours, and 45 minutes of waiting it out (and pretending to have a deep interest in hearing about the color of a child's diarrhea/mucus/whatever).


1. I can't see a tympanic membrane in a baby's ear canal (and am convinced most pediatricians just confabulate the "it's a little red" line).

2. I remember trying to examine a hysterically screaming infant in pediatric clinic. It was screaming before I went, in, and me trying to listen with a stethoscope only made things worse (and damaged my hearing).

Finally the mother said "FOR GOD'S SAKE! MAKE HIM STOP CRYING!!!"

So I left the room. That seemed to do the trick.

And that was how I realized I had absolutely no interest in doing peds.

And I feel fine...

If the world does end, I guess I'll be going to hell. So like I told Mary and Annie, I'll see them at the office on Monday no matter what happens.

Whatever

Mr. Ancient: "My pediatrician said I have nerve damage in the foot."

Dr. Grumpy: "You mean podiatrist?"

Mr. Ancient: "Whatever."

Dear patient I didn't see,

Sorry I refused to work you in yesterday afternoon. I had an open slot, and would much rather see you here, and get paid for it, then have an empty hour.

But when you called Mary and said you'd had a horrible headache all morning, and couldn't move your right arm very well, she quickly became alarmed that this wasn't something that should be handled in my office. In fact, she told you to call 911, and you refused, saying you'd rather just drive over to see me.

That personally alarmed me, because obviously you shouldn't be driving in your condition. When Mary told me that I decided to get on the phone myself.

Your speech was a bit slurred, and I again reiterated that you should call 911. I even offered to call them for you, and asked for your address or phone number, so I could get them to your house. You refused, on the grounds that your co-pay for an ER visit was higher than it was to come to my office.

Then you told me that you didn't want to see me anyway, because obviously I didn't care about someone who needed help. And you hung up.

Believe me, if I didn't care, I wouldn't have tried to get you to ER.

Overheard at home

Thing 1: "Pete was back at school today."

Thing 2: "Was he sick?"

Thing 1: "He was in the hospital. They had to do surgery."

Thing 2: "What happened?"

Thing 1: "He had appendagitis. His appendage was hurting. It's near your stomach. Anyway, the doctor cut it out."

Thing 2: "I didn't know that."

Thing 1: "I read somewhere that you don't really need your appendage anyway. I bet you could sell it for a lot of money."

Nowhere to hide

Our office break room is small, but practical. A table, microwave, toaster, fridge, coffee maker. A few chairs. A bathroom off to the side.

Yesterday a new drug rep brought lunch. She was a nice lady.

After lunch the staff were cleaning up the kitchen. Packing up leftovers, wiping the table. As usual they were chatting about the patients, Dancing With The Stars, their kids, etc.

At some point the conversation turned to the drug rep, and they were guessing as to how far along in her pregnancy she was, and whether she was having a boy or a girl.

And then the bathroom door opened. The drug rep was in there the whole time. They thought she'd left.

And she isn't pregnant.

My readers write

Okay, folks, time to hit the mail bag!

This letter came in today from a reader who says he's working at the NIH.

"I shadowed a pediatric neurologist this week. It was certainly interesting, but up until today I'd have guessed your blog was a little exaggerated in terms of humor.

That was before clinic this afternoon.

I saw the patient, an adorable four year old girl, grab the neurologist's reflex hammer from out of her coat, run over to the PA, and, uh, test his reflexes.

I'm not a physician, so I'm not sure if grabbing your crotch after it's been walloped with a reflex hammer is actually a reflex, but it sure was funny. Well, maybe not for the PA.

The kid really, really liked that hammer. The attending actually GAVE IT BACK to her later to buy her cooperation in the exam. I shielded my groin, so the patient had to settle for beating my leg with it.

Seems like a great field. I'll just remember to wear a cup."

Thank you! Just remember, folks- anyone who thinks this stuff doesn't happen, hasn't had the misfortune to work in the medical field.

So much for healthy eating

Apparently barter is becoming popular again.

She could at least have included some breadsticks.

Reliable sources

Mrs. Popliteal: "I've been having terrible pain in my knee. It needs an MRI."

Dr. Grumpy: "Hmmm. Have you talked to your internist about this?"

Mrs. Popliteal: "No, I talked to this lady at the Post Office."

Dr. Grumpy: "A lady at the..."

Mrs. Popliteal: "She was wearing a knee brace, so she must have known what she was talking about. Anyway, she said I need an MRI. Will you order one?"

Sounds right

Mr. Vague: "My mom died of vascular disease."

Dr. Grumpy: "What kind?"

Mr. Vague: "I don't know. The bad kind, I guess."

Oh no! Not BOTH!

I found this entry, presumably from the Department of Redundancy Department, in a hospital note this morning.

(click to enlarge)

Flattery

Mary: "Okay, your co-pay for today's visit is $50."

Mr. Aetna: "No, my co-pay is $25."

Mary: "It's $25 for your internist, sir. According to your card, a specialist, like Dr. Grumpy, is $50."

Pause

Mr. Aetna: "Here's $25. He wasn't that special."

Always in fashion

I'm ordering supplies this morning, and found this picture in the online catalog.





I just love the way they try to make the flimsy white paper gown look sexy. Maybe they should add a caption that says "Perfect for work, cocktail parties, and medical exams."