MS-2

Wow

Thank god for the Internet, because apart from my parents and brother, I have not spoken to another human being in 30 days.  I did go to the mall a few weeks ago to buy a dress for my Transition Ceremony, but I nearly had a nervous breakdown with all the LIGHTS and PEOPLE and STROLLERS OF DEATH. (Apparently, my hometown is responding to the economic downturn by making babies.  Whatever works.)

Back when I was thinking about when to schedule this test, a few upperclassmen friends told me to take it “as early as possible, because you will burn out.”  I figured it would take at least a month to review two years’ worth of material.  (Not to mention learning biochem from scratch, because my school doesn’t teach it, wtf?) This was overkill.  I wish I had taken the exam early last week, because right now I’m pretty much just trying to kill time before Thursday.  I don’t particularly care what I get anymore — so long as it’s passing — I just want this to be over with.  In just a few days, it will be, and then I’ll be off on a much-deserved vacation.

Anyway, today is my incredibly belated birthday celebration with my family.  My mother baked my favorite cake, and now they are all watching a movie in the basement while I review QBank procrastinate by blogging.

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MS-2 · Step 1

Day 1

Today was my first real live, honest-to-goodness Boards Study Day (TM).  I listened to a Goljan lecture on my morning run (yes, they are awesome and no, don’t ask me where to get them), then went to the public library from 10 AM to 5 PM to go through BRS Behavioral Science and First Aid.  There is a quiet study area with cubicles, so I camped there for the day, but it turned out to be an airless, stuffy room, and the woman in the cubicle next to me kept answering her cell phone.  I think I’ll have to find somewhere else to study, which might prove difficult — I checked yelp.com for “best places to study” in my suburban home town and the only result was … Spa World?  Maybe coming home to study wasn’t the greatest idea after all.

Anyway, I came home when the library closed, had dinner, answered about fifteen emails, and then did two blocks’ worth of Kaplan QBank, which I bombed.  As first days go, it wasn’t awful, but I could definitely do better.

Tomorrow is biochem, which will be more hardcore.

MS-2

Apples and oranges

A couple of days ago, a class prank email was sent out, suggesting that we all set our cell phone alarms to go off at the same time in the middle of the last exam.  That idea was nixed in favor of a much better one: bring an apple for the teacher course director.

About five minutes before the exam started, one person went up and handed in his apple.  He got a funny look and our course director went back to setting out the exams.  Then more and more people came up with their pieces of fruit, and he got it and started laughing most adorably.  Some people couldn’t get an apple, or were a little more creative, so there was a fair showing of bananas and oranges, a bottle of apple juice, two pineapples, and a turnip.

All in all, a wonderful end to a wonderful — if intense — two years.

MS-2

Last one!

I am taking a study break from my LAST REAL EXAM of med school.*  How did that happen?

I did some math and figured that I need somewhere around a 60% to pass pathophysiology and an 18% to pass pharm.  So why am I still studying?  I ought to clean my apartment; a friend stopped by earlier this afternoon and was like “DUST!” Yes, indeed.  Not to mention the piles of books all over my floor, and the sinkful of dishes I only did because I had run out of coffee mugs.  (Mmmm coffee.  How do people live without it?)

There is a post-exam (and post-second year) dinner planned for tomorrow night.  By noon, the group was 10 people, so I called and made a reservation for 12, just in case more showed up.  But all afternoon, the emails and phone calls have been flooding in; we are now up to 20!  This restaurant is either going to love us or hate us.  Whatever, there’s a recession, and who eats out on a Wednesday night anyhow?

*Ok, yeah, I have the boards, and the shelfs.  But those are national standardized exams and presumably test material relevant to the practice of medicine and surgery.  As opposed to the last two years, which have been all about what any particular lecturer is researching.  It’s cute to see old guys get so worked up about ion channels, but seriously? I’m ready for the real world.

MS-2

The physical exam

In telling this story, I’ve intentionally been as vague as possible.  I changed specific details and avoided identifying information.  Don’t hate me, HIPAA!

Our physical diagnosis course is wrapping up.  I don’t feel nearly as awkward as I did originally, when it felt strange and weird and somehow wrong to poke and prod a total stranger.  There are still moments when I feel lost and wish I could surreptitiously whip out Bates’ Guide to the Physical Exam; I usually forget to ask or examine at least one pertinent organ; but by and large, the routine physical exam has become, well, routine.

Today I was going through the motions of the physical exam, the way I always do.  It almost seems a waste, sometimes, when you know that real doctors just draw bloods and image the crap out of everyone anyway.

Today’s patient had a bad shoulder, which my preceptor pointed out was probably due to brachial plexus injury from a prior surgery. Straightforward. The rest of the physical exam seemed almost extraneous, but the more practice the better (and we have an evaluation coming up), so we did it all. “Can you take a deep breath in and then out, please?  And again.  And again.  Say ninety-nine.  Ninety-nine.  Ninety-nine.  Now, I’m going to press gently on your tummy; let me know if anything feels uncomfortable.”

When I got to the left upper quadrant, the patient winced.

“Does that hurt?”

“A little,” she admitted.

That was unexpected.

I tried again, a little deeper, and saw her grimace as my hand felt something hard, about the size and consistency of an unripe grapefruit.  From there, it was like I’d opened a new door.  I percuss everyone’s liver like a drummer, but I’d never percussed a spleen before.  I didn’t remember the normal value, but I dutifully pulled out a  ruler to measure the approximate distance between upper and lower borders.  When I told my partner the size of the spleen, our preceptor came around the bed and performed the same maneuver herself.  She excused herself, saying she had to check on our classmates down the hall.

We continued the physical exam.  Check leg strength.  Reflexes.  Two-point discrimination.  Oh wait, you mentioned difficulty hearing, so how does this tuning fork sound to you?  Everything, even her deficits, were just as we expected.

Just as we were finishing up, our preceptor came back and pulled me aside to say that she’d just spoken to the patient’s physician and no one had noted splenomegaly.  Because no one had done an abdominal exam on this lady with shoulder pain.  After all, why would you?  But I looked it up after getting home, and there is one diagnosis that explains every single one of her symptoms, even the ones that only came out on the Spanish Inquisition that is the review of systems.

I’m not saying that you have to do a full work-up on every sucker that walks into the ED with specific symptoms.  That takes way too long, and I know that as a medical student I’m privileged to have enough time to spend two hours with a single patient.  (Two hours! I kid you not.)  But I guess the point of this long-winded story is that the unexpected demands attention.  And that the physical exam, contrary to popular (and to some extent my own) opinion, is far from worthless.