Happy Birthday Mom!!!

Sending out a big ray of filial love to Mom. See you this weekend!

How old is old?

They say that you're only as young as you feel. Well, considering my recent experiences with inadvertent agism, a back injury, and now e-mails landing in my inbox regarding my upcoming 20-year college class reunion, I'm starting to feel a little, shall we say, experienced. Or at least in comparison to the twentysomething colleagues and fellow students with whom I share my daily challenges, bless their youthful hearts.

And, as it turns out, I can put some hard numbers on how old I really am in terms of being a medical student. When I was interviewing at medical schools I would always ask if there were any students significantly older than the mean age. And the answer was surprisingly consistent: "Oh, yeah, there's this person in our class who's 43/used to be a lawyer/has kids in high school." Now, there's no official cutoff age for being accepted to med school, but I had the chance to see the admission numbers for the several years immediately preceding my application in 2002. The med school admission curve peaked with 23- and 24-year-olds. There was a slow but steady decline as applicants approached 30. But there was an inflection point at age 32 -- admissions of people older than 32 quickly dropped off to almost nothing. In fact, in the entering class of 2002 (about 16,000 people) only 142 people older than 32 were admitted to medical school nationwide (that is, less than 1% of the total). Since there were, at the time, 125 medical schools in the US, this works out to slightly more than one person older than 32 per med school class per year. Hence the surprisingly consistent answer to my question.

Since I was comfortably older than 32 myself when I applied, I guess I'm just as glad that I wasn't aware of these slightly daunting statistics at the outset. (Applying to medical school can be daunting enough, anyway.)

Urology Lounge

My Urology clerkship starts on Monday, and an e-mail just arrived announcing that the orientation will begin at 6:30 in the Urology Lounge. I had no idea there was a place with such a delightful name in the hospital. The Urology Lounge--I love it!

Department of Pet Peeves

Fourth-year med students are frequently asked by interns, residents, and staff physicians, "what do you want to be when you grow up?" This is a way of asking "what medical specialty are you planning to enter?" Now, I would probably find this formulation slightly irritating in any case, but when it's posed by a 27-year-old intern to someone who, like myself, is of a certain age--well, let's just say it's a bit jarring.

As I've been preparing my applications to residency programs over the past month I've had plenty of time to ponder my CV, reminding me that while living in Boston in the 80s I was a teaching assistant for a music theory class at Harvard. And I must admit that it has crossed my mind to reply to that twentysomething intern, "kid, I was teaching at Harvard when you were in grade school." Wouldn't do much for my grade, but it would probably be satisfying enough to make it worth it.

Sioux City Redux

You may recall that this summer I spent a rewarding month in Sioux City for my Family Practice sub-internship, staying in an apartment that featured a rotating reality TV cast of various students. Well, I just heard from a fellow student who recently started a month there and sent greetings from some of the people I knew. It means a lot to me, and I'm sending out a big, warm hello to the folks reading this in Sioux City.

Back out

Yesterday I spent almost twelve hours in surgical cases, culminating in an excruciating forty-five minutes holding a 100-pound leg at an intervertebral disc-popping angle. Then on the way out of the O.R. suite I was reminded by the posters and screen savers appearing around the hospital lately that September is Pain Awareness Month. Didn't have to tell me that twice. Maybe I can befriend an orthopaedic surgeon on this rotation who can fix me up after it's done.

Views of Afghanistan

Tom "Danger" Haythornthwaite is on the loose in Afghanistan with a camera, and the magnificent results are posted on his blog.

Busted

This evening there was a big meeting for the fourth-year medical students about the upcoming interview process for residency positions. My residents were very nice about letting me leave clinic early for it--in fact, I got to go about an hour early, specifically to have a chance to go read about orthopaedics. Well, I wound up sitting in the cafeteria eating a cheeseburger and yukking it up with a bunch of other med students, quite obviously neither attending a meeting nor reading my ortho text. So who should I spy sitting two tables over? My chief resident and another resident on the team, grabbing a quick bite before afternoon rounds. Ouch.

The meeting itself was a bit stress-provoking. Plenty of reminders of how much this is going to cost (multiple flights, hotel stays, and car rentals all over the country) and plenty of reminders of how competitive this is going to be (dozens of bright, accomplished young high-achievers vying for each spot). Ah well, I guess if it was easy it wouldn't be fun.

Mallet, please.

I'm really digging the orthopaedics surgeries I've been scrubbing into. (That is, apart from getting to wear the super-cool space suit headgear.) A typical case involves power drills, reciprocating saws, various sizes and types of mallets, and mixing cement. In other surgical fields you manipulate tiny, delicate structures with subtle instrumentation. In ortho you saw off the end of a bone and hammer a long metal rod into it. Gotta admit that it's really fun. Hey, I'm a boy; what can I say?

Open the pod bay doors, HAL.

Haven't been much of a blogger lately, have I? The feeble excuse is my current run of back-to-back surgical clerkships but, as noted, that's pretty feeble.

These days pre-dawn rounds find me on Orthopaedics--which, charmingly, is still spelled with the "ae." Yesterday I wore the ortho "space suit" in the O.R. for the first time. It's a tall helmet with a frame, over which is draped a sterile head covering with a fully-enclosed faceplate. When assembled it looks sort of like the space helmets in 2001: A Space Odyssey. (I seem to be fixated on exotic medical headgear these days, don't I?) What with the surgical gown, a warm O.R., and possibly even a lead vest and skirt under there if the procedure includes radiography, it can get pretty hot inside, so the headpiece has a small fan for ventilation, powered by a battery pack that clips to your scrubs.

After I suited up in this contraption for the first time, I noticed that it began getting really, really warm in there. Really fast. Worse, the faceplate fogged over, blinding me. After a couple of minutes it was getting hard to breathe, and I started to feel faint. Of course, at this point I've already scrubbed and gowned for sterile conditions, so it's a big deal to "break scrub," or take anything off. Fortunately one of the techs noticed my distress and realized that my fan wasn't working. He ran to the storeroom, came back with a new battery pack, and got it hooked up. As the fan started blowing fresh, cool air into my oxygen-deprived microenvironment I regained consciousness and my faceplate quickly defrosted. I'm just glad I didn't go have to leave, or even go down on the floor (which does happen to people from time to time in the O.R.)--not the impression you want to make on your first day. Many thanks, attentive tech guy!

Headgear Gearhead

A couple of nights ago, in a fit of on-call caffeine-stoked enthusiasm, I expressed my eagerness to learn to use the traditional physician's head mirror. Today in clinic I started with my very first patient of the day, and whaddya know--it's a great piece of equipment! You can deliver the light exactly where you want it, and it leaves both hands free for palpating, prodding, and otherwise harassing the patient. I'm sold!

Big Moment

Five minutes ago I submitted my electronic application to a list of Emergency Medicine residency programs. This is it--the start of a many-month season of trying to land just the right post-graduate medical education slot. It's exciting and nervous-making. (And expensive.) Wish me luck!

Headgear

So let's say an illustrator or cartoonist wants to depict a character instantly recognizable as a doctor. What attributes will the drawing be given? Probably two: a long white coat, and a big round mirror on a headband. If you keep track of doctors in, say, cartoons in The New Yorker, I bet you'll find that at least half of them are wearing head mirrors. Now think back to the last time you were in a clinic and the doctor walked in wearing a head mirror. Yeah, me neither.

I would have thought they were extinct. However, this week I started an Otolaryngology clerkship, and on the first day each of us was issued...a head mirror! Later this week I'll be making my first attempt to examine the back of someone's throat in, truly, the old-fashioned way. (Word is that examining ears this way is much harder.) Have to admit, I think this would be a very cool skill to learn.

So watch out, gentle readers. Someday you may wander into my ER with a sore throat, and actually have the classic experience of being examined by someone with a big ol' mirror on his head.

(By the way, for anyone tempted to make a crack about us rural folk making do without electricity, may I point out that Iowa has the #2 ranked Otolaryngology program in the country. So there, all you high-tech city folk with your electric light bulbs and your 24-hour power supply.)

Putting the "Hi!" in hiatus

Reading this blog you're probably under the impression that a medical student's life is all life-and-death excitement, glamour, and profound scholarly inquiries. But on Friday I experienced the darker side of med school: a big, mean exam. Between that and the impending application to residency programs (of which more--much more--later) I have been neglecting my blogging.

So this post is a big "hi, welcome back!" and an invitation to follow along as I dive into the thrills, chills, and spills of the National Resident Matching Program.