Deep in the heart

The last stop on my two-month odyssey was Houston, a city I had never visited before. I went for a board exam that consists of an entire day of encounters with simulated patients, all for the low, low fee of $1000 to take the test, plus airfare and accommodation. Not a very rewarding experience, I thought, but with luck I will be pronounced competent and pass the test (a requirement for various details that are coming up, such as getting a medical license).

However, I did have some time to take a quick look around Houston. And it was a very pleasant surprise! Everybody I met was unfailingly friendly and helpful. Although I didn't find too much in the way of distinguished architecture (admittedly I didn't have much time to look) I thought the city still has a distinctive character. On my night off I found a Mexican restaurant where I sat on the patio enjoying the tamales compuestos, watching a lightning storm while sprays of warm mist blew under the awning, and drinking bottles of beer that came wrapped in napkins -- it had a satisfying Gulf Coast feel, especially considering the blizzard conditions waiting for me back home. And on my way to the airport the next morning (Hobby Airport, with its charming 1930s-era control tower, not the grandiosely-named George Bush Intercontinental Airport) I even found time to stop off at the Johnson Space Center for some nerd tourism.

Glazed

On my walk to the hospital today I had a chance to appreciate the effects of the latest ice storm to blow through these parts. It was pretty magical: everything, and I mean everything, is encased in a quarter inch of clear ice. Each large tree must be covered with hundreds of pounds of ice; each individual needle on the pines is locked in its own crystalline sheath; even the snow is covered with a thick layer of ice. Walking on it, the crust shatters with every step. The trees make a particularly impressive sound in the wind: a sort of crinkling groan, due to the extra weight they're bearing combined with shearing ice. Watch out for those falling branches!

However, the board exam is the day after tomorrow, so the splendor of Nature must wait while Nerdery calls. Thus, this weather-appropriate quote of the day, from the section in the book on hypothermia: "A patient is not considered dead until he or she is warm and dead; in other words, do not give up resuscitation efforts until the patient has been warmed." And on that cheerful note, it's back to the books.

Busy, busy Cushing

A trend in medical terminology is to avoid the use of eponyms, or "tombstone names" -- a particular person's name given to an entity. For example, one might come across Cushing's syndrome, Cushing's disease (which can be a cause of Cushing's syndrome), Cushing's reflex, Cushing's triad (the classic sign of Cushing's reflex), or a Cushing's ulcer.

Of course, one has to admire the guy. Somehow while doing all that medical research he still found time to play Grand Moff Tarkin in the original Star Wars.

Anybody know how to get out highlighter stains?

One week to go until the boards. My fingers and clothes are starting to acquire errant highlighter marks (I never used to use a highlighter) and I'm sporting glasses (I never used to wear glasses).

Earlier this evening I was reviewing syndromes of overdose and withdrawal for various drugs of abuse. Which one presents with headaches, irritability, and fatigue? That would be caffeine withdrawal.

I'm trying not to fixate on the following from Chapter 15, Geriatrics, describing normal changes associated with aging: "...slightly decreased ability to learn new material."

Hey, does anybody remember the signs of caffeine withdrawal? And where's my highlighter?!?

Board Exams

In order to apply for a medical license in the U.S. you have to pass all three parts (Steps) of the United States Medical Licensing Examination (USMLE). I took Step 1 last year, a grueling, all-day testathon that Wikipedia describes as "arguably the hardest and most important examination a medical student will take during his/her career." And that's sayin' something. Made it through that one okay, and now Step 2 is coming up fast. Next week I take the written part of the test (another day-long gruel-a-thon), followed in a few weeks by a full day (in Houston, perhaps) of being observed on video camera examining a string of standardized patients.

So, as you can imagine, my days lately consist of reading Board exam review books, punctuated by sessions of doing practice exam questions, after which I go back and study some more. The big thrill for me is that I just got a new review book. (Sad, no?) Most review books consist of hundreds of pages of outlines, but I'm loving this one because it includes practical, real-world advice. For example, after an introduction to the etiologies of shock the author tells us "Your job is to figure out why the patient is in shock while keeping him or her alive. Give fluids while you're thinking." Sound advice.