So I guess there comes a time in the process of indoctorination… I mean indoctrination (hahaha, I am so cute) – when ‘x’ just becomes shorthand for everything and you don’t even think twice about it anymore.
I always used to think it made perfect sense when they hit me with the first few, like Hx for history and Dx for diagnosis. It went something like this: “Well, okay, I guess the ‘x’ replaces the ssssss, like maybe ‘hixtory’. And I guess ‘diagnosis’ sort of does have an ‘x’ sound, doesn’t it? ‘Diagnoxis’. Yeah. That sounds right. So of course the shorthand for history is Hx, and of course the shorthand for Diagnosis is Dx.” And especially after you’ve written out the first few SOAP notes, you’re grateful for not having to write out the word “history” at least twenty times, on top of all the sectional headings that include the word. And over the course of the year, I saw “fracture” variably reduced to “fx” or “fxr” (in Kristen’s notes) and “function” to “fx” or my personal “fxn” and I didn’t think anything of it.
Then came the day I sat in “How to Write a SOAP Note That Will Impress Your Attendings 101″, whereupon “antibiotics” became “abx” and treatment became “Tx” and surgery became “Sx” and I remembered that “prescription” really did become “Rx” and I finally realized that none of it actually made phonetic sense and was never supposed to, either. I kind of had to laugh at myself a lot because it had taken me two years of seeing the acronyms and using them quite liberally to even come to that realization. One thing, I did have to do in my brain, though, was rewire where I had sometimes written down “abx” for antibodies even though I actually meant “ab”. Antibodies, antibiotics, oh, what’s the difference anyway?
Well, today in pathophys, we started talking about arrhythmias and gap junctions. After writing “gap junction” down once, I proceeded to write it down in shorthand. I paused for about two seconds to think about how I had done it in the past, way back in undergrad when I was having to write down “junction” about eighty times every lecture hour, wrote down “gap jx” and then moved on to listening to what Uncle Lenny was saying. It wasn’t until maybe six minutes later that I realized that I had never written down “jx” for junction before in my life. I had always abbreviated it as “jct” and if I had ever used an ‘x’ it would have probably been written “jxn”, but never just straight up “jx”.
… yeah. I knew they said it would come quickly; on our first day of medical school they told us that we were probably best equipped to talk to patients right then as we were because we had the medical knowledge base of the average layperson. We didn’t know the jargon, we didn’t know the lingo, so we knew to explain things in simple words because that was all we knew, but that period would be gone oh-too-quickly. And I guess, well, here’s the proof.
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Tags: life, lingo, silly
on compassion
This morning, as we were sitting around on rounds, the cardiologist attending grabbed us all and took us into this room to listen to a woman’s aortic stenosis murmur. It was amazing. I have never been so excited about hearing a heart murmur before in my life, but it’s the first real one on a real patient I’ve heard. Despite writing the auscultation rap, I’ve never been awesome at auscultation, but the excitement of the attending at teaching us was contagious. Her aortic valve was so stenotic you couldn’t hear the aortic component of S2 over her aortic valve area, but you could baaaarely hear the pulmonic component over her pulmonic valve, and he wanted to prove this to us. The woman was old, grumpy, and not entirely happy to see the four of us, but the attending joked with her that we were his groupies and followed him everywhere, at which she laughed and slapped at him playfully. I hesitated, because she was still grumping at the residents, but the attending looked at me and asked me if I wanted to hear and I of course said “Yes!” and he teased, “Don’t worry, I cleaned my ears out.” since we were all just using his stethoscope. And I heard it, after concentrating past her breathing, which was hard, because the murmur sounds a lot like breathing. But I heard it, fwoot fwoot fwoot fwoot, and then I ended up being the first to hear over the pulmonic valve, barely, fwoot dub fwoot dub fwoot dub fwoot dub and at that point I think my face broke out into this crazy grin as I looked at the attending and said, “I heard it!” I must have looked like an idiot at this point, but I didn’t care. I have the feeling that if I could learn cardiology from that attending, I would be amazing at it.
I grabbed lunch after we were done, called my mom and talked to her for a bit, which was lovely, and then took a nap until 2pm, whereupon I went down to the derm clinic that was going on in the family medicine offices today. It was really good; I got to see and feel and watch and assist a little in a lipoma removal, saw the hyphae of fungus, got a long lecture on the different kinds of tinea (I never really knew that ringworm wasn’t ringworm before, oops?) and if anything, I learned several things — never be lazy and prescribe a combination steroid/antifungal, always take the time to do a scraping for a KOH prep, and never ever ever use steroid creams to treat fungal infections, especially in the groin area. I also got to see, feel, watch, and assist (ever so slightly, just getting/holding stuff) with a lipoma removal! It had been on her forehead for the past 10 years.
It wasn’t very notable except for what I hope I will never forget about being a physician — how important the small things are. She was nervous and is afraid of pain, and I definitely empathized with her. They laid her down and got her ready for the lidocaine and I noticed her fingers laced together so very tightly, so I offered her my hand and told her, “Squeeze as hard as you can.” She did, squeezing her eyes shut as well as she was anesthetized, and when it was all over, she whispered to me, “Thank you.” I could hear the raw gratitude in her voice, and in that moment, I was incredibly grateful I had summoned the courage to ask if I could go with the resident and watch. I’m not going to pretend that what I did was medically significant, but I know that I touched her. And that, at the end of the day, is what I believe medicine is all about.
If you actually are a doctor and admitted it, you’d say, “I don’t cure a huge percentage, I don’t have a 50 percent cure rate… but I can have a 100 percent compassion rate.”- Hunter Patch Adams
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The apocalypse is upon us; I just cleaned the bathroom. I’m starting to understand why so many grad students have clean houses during finals week.
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Tags: life, time management
They are golden — perfectly yellow, spinning, spinning in the breeze that stirs ’round the tree as I walk out from Shryock Hall after UYP. They flutter, so light and gentle, spiraling down and down and down to finally rest on the already-thick carpet of gold. They crunch under my sandals as I cross the field to Alumni Hall, breathing in yet another reminder of God’s fingerprints on this world and on my heart.
I’ve never seen snow fall, but I imagine that it’s just like that. Breathtakingly beautiful, imbued with just enough magic to fill your heart in a way that words just can’t possibly hope to capture in anything but the sort of poetry that doesn’t speak words but just sings images over and into your soul. And I don’t want to come crashing back into the place in my mind where I just don’t really feel like I want this anymore. I never was one to run and hide, but as the days go by, I kind of want to do just that until I have the strength to come out and face the mountains and mountains of information that has become endlessly boring to me, a symbol of what holds my heart & mind prisoner rather than a symbol of what liberates me, what gives me strength and courage and beauty and resilience in the face of all that is wrong with this world. If I fall — if I have to fall at all — I want to fall like a leaf in the wind, graceful and serene, with faith and at peace with the seasons & the God that makes them, and not like the ticking time bomb of jittery doubt & wounded pride that I am right now.
I just want wonder again. I want life and energy and love and the feeling that I am doing this because I will enact change, because I will be the sort of physician that matters — and not because I’m too stubborn let go of who I’ve spent my entire life fighting to be & grow into to be reborn. Because at the end of the day, I know in my head that I am meant to be here, that I am meant to be a doctor, that I am meant to heal and serve and love and that I need to stop focusing and worrying about just what I am going to be doing. The journey and not the destination; the love is far more important than the specifics… than the specialty. Stripped of knowing precisely what I want to do anymore, the only thing left is to love and serve — and is that such a bad thing, after all? But as always, my heart doesn’t know what my head knows fully well. And then again, I was never good at leaving things to God. I was never good at not having a Plan. Never before in my life have I not known my destination.
But isn’t that what Abraham had to fight, too, the entire way from Ur to Caanan? The whole “I don’t know where I’m going, I don’t know what I’m doing, am I even supposed to be doing this still?” And at the end — despite all his mistakes, despite the times he’d failed God, despite the times he’d forgotten to trust that God’s hand was upon him, wasn’t he still called the father of the faithful? We say it all the time: By faith, Abraham… by faith, by faith, by faith. It was all done by faith.
It was by faith that Abraham obeyed when God called him to leave home and go to another land that God would give him as his inheritance. He went without knowing where he was going. And even when he reached the land God promised him, he lived there by faith — for he was like a foreigner, living in tents.
- Hebrews 11:8-9, NLT
I just want to fall.
I just want… I just want to be able to someday say this:
It was by faith that Prissi obeyed when God called her to leave home and go to another land that God would give her as her inheritance. She went without knowing where she was going. And even when she reached the land God promised her, she lived there by faith…
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Tags: faith, the why
You need to take the tags off an article of clothing you intend to wear. You cannot find a pair of scissors in your room. You:
- Run downstairs to get the kitchen scissors.
- Grab your nail clipper to snap off the tags (harder to do when you get to the tags tied on with thread, but… doable.)
- Use your teeth. That’s what they’re for!
- Look around for your scalpel.
It’s a good thing that I’ve got a nice supply of scalpel blades tucked away.
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Tags: life, silly
on fairy dust and training wings
As if I needed another announcement and more incriminating evidence of my incredible dorkitude, this idea was bugging me all yesterday evening. If there’s fairy dental school, then logically, there is fairy medical school, and therefore, if I was a fairy, I would be attending it. And the more I thought about it and what kinds of things they’d be taught in fairy medical school, the less it became silly, and the more it sort of became sensical in my head: there’s no magic in the world that can make tumors vanish. There’s no opthalmoscope-wand that can heal sight. All we can really do is sprinkle the fairy dust all over and pray for a miracle. Our job is to be that hope, and then to stand in awe when that miracle happens — and that it happened because we allowed ourselves to be used. To be a part of that is why I’m doing this. Again.
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Tags: life, silly, the why
on thorns
So to keep me from becoming proud, I was given a thorn in my flesh, a messenger from Satan to torment me and keep me from becoming proud. Three different times I begged the Lord to take it away. Each time he said, “My grace is all you need. My power works best in weakness.” So now I am glad to boast about my weaknesses, so the power of Christ can work through me… for when I am weak, then I am strong.
-2 Corinthians 2:7-10, NLT
I can’t count the number of times I’ve questioned God. It’s so hard to know what He’s up to sometimes, especially when my life is so scattered, so busy — too busy for God. I know my greatest daily struggle is learning the discipline of daily surrender, of daily asking for a renewal of that need, that dependance. So much of what Bob said this morning about Paul’s journey really made me think about my own. It made me realize that I, too, have been gifted with a thorn — the struggles I’m having in school, to keep me from becoming proud about how clever and smart I am, to keep me from making that my identity. It made me think about how so much of my life, I’ve been identified as being one of the smart ones, at the top of the class, a teacher’s dream, a quick learner — and now I am none of these. I am at the bottom of the class. It takes me so long to learn the simplest things, to commit what I learn to memory. But maybe I needed to learn compassion and patience. I needed to learn that I can’t do this on my own. I needed to learn that what I really needed, most of all, after all — is God.
I might otherwise have become like so many of the others.
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Tags: faith, people
from “Piled High and Deeper” by Jorge Cham.
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Tags: life, time management
on making time for everything
I think I have reached yet another milestone in the inevitable downward spiral that only whirls more quickly during third and fourth year. As evidence, here is a multiple-choice guess question.
You are running late for your appointment with your learning specialist, because getting together 25 test questions took a little longer than you figured on. You have to eat breakfast (a large bowl of porridge) before you go and wash your hair (and you have a humongous final tomorrow covering everything you’ve supposedly learned this year about Physical Diagnosis), so you:
- A. Eat breakfast, skip the shower. After all, Mikey once wore the same shirt for all five days of exams during Fall finals.
B. Enjoy your shower and skip breakfast… mum won’t mind if you grab the chips you forgot to eat yesterday, right?
C. No one’s going to mind if you show up a few minutes late… right? Scarf down the porridge, then take your shower… quickly.
D. Take your porridge into the shower, drinking it in big gulps with one hand as you scrub your head clean with the other hand.
I must say, standing under warm water while scarfing down warm porridge does make you feel warm in every possible way.
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Tags: life, time management
Recent Entries
- on abbreviations, jargon, and indoctorination
- on compassion
- on med school being applicable to real life, really
- on avoidance, productivity, and cleaning house
- on walking by faith and not by sight
- on creativity & imaginative ingenuity
- on fairy dust and training wings
- on thorns
- on the life cycle of a graduate student
- on making time for everything
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