May 27, 2011

Step 1

AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AHHHHHHHHHHHHHHHHHHHHHHHHHHH!
AAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!

Ah. That is all.

May 20, 2011

Robert A. Swendiman, M_

It's official. I'm halfway through medical school! Well, almost. There's this little thing called the United States Medical Licensing Examination (USMLE) - Step 1, but let's just forget about that for a hot sec. I'm halfway done, which means I could be actually treating YOU in just two years. Isn't that scary? Actually, it should be terrifying. I know nothing. The fact that I can recall the five cofactors involved in metabolic dehydrogenase complex reactions (thiamine pyrophosphate, FAD, NAD, CoA, and lipoic acid) probably wouldn't be that comforting if I were treating you in a medical emergency. This is why for the remaining two years we will be out of the classroom and into the hospital. Speaking of next year, I found out just a week ago that I'll start my tour of Ash-Vegas in Surgery. It has the reputation for being one of the hardest clerkships, so I look forward to getting started. I need a 10 blade, STAT!

Although the past few weeks have been a lot of work, I have to admit it has been (somewhat) rewarding - the ultimate reward will be when I'm in Morocco, obviously. Many times during the first two years, I didn't understand why we were learning what we were learning. It seemed completely irrelevant to medicine. Biochemistry was Medieval torture, an unwelcome extension of undergrad. But, in putting it all together, I've found (some) of it quite useful.

For example, when I had the opportunity to volunteer with EMS, I worked with many wonderful paramedics. I remember all the Trauma 1s and scary calls we received, but recall fewer pure "medical" calls.  However, there were a couple of solid medical scenes I remember clearly. One afternoon we were dispatched to an apartment building for a 2 year old who was "blue." Yes, blue. Pediatric calls are always more intense, because the stakes are that much higher with kids. Emotions and tempers run high, and the parents are understandably shaken. Kids just aren't supposed to get sick. Well, this toddler was blue, and the dad was hysterical. Our lead medic (we'll call him "Todd") looked at the kid, looked back at Pops, and said, "We're going to bend him in half."

"What???" was the father's question, and I was thinking the exact same thing. "We're going to bend him in half. He's blue because he's not getting enough oxygen to his body. By folding he's knees to his chest, we can fix that and he'll pink right up." And that's what happened. Todd cradled the kid in his arms, and bent him in half. It was magic; our two year old was no longer cyanotic.

What I found out later was our patient had a congenital heart condition called "tetralogy of fallot" (TOF). TOF is actually relatively common. It is usually defined by four heart defects: pulmonic stenosis, overriding aorta, a ventricular septal defect, and subsequent right ventricular hypertrophy. In plain English, our toddler essentially had a "hole" that connected the right and left sides of his heart. This hole was not supposed to be there. In a normal heart, blood that isn't carrying oxygen flows from the right side of the heart (through the pulmonary artery) to the lungs to get oxygen. It then returns to the left side of the heart. There, the blood is pumped to the rest of the body to drop off the oxygen and make our muscles and organs work properly. The blood then comes back to the right heart "oxygen-depleted," and the cycle starts all over again. Unfortunately, the hole in this patient's heart allowed some of the blood without oxygen from the right side to bypass the lungs and go straight into the left side! This was made worse because his pulmonary artery (the one that takes blood from the right heart to the lungs) was smaller than normal and tougher to get through. Thus, "deoxygenated" blood was moved to the left side, and pumped to the rest of the body. Well that's no good.

So how do you fix that? You bend him in half! By bringing your knees to your chest, you can increase the "systemic vascular resistance," especially in the femoral arteries (the big blood vessels that supply your legs). This puts a lot of pressure on the blood coming out of the heart, making it harder to pump. In our little kiddo, this pressure was great enough that it transmitted all the way back to the left heart, and pushed blood from the left heart back into the right heart. That forced the blood through the pulmonary artery and into the lungs, allowing the blood to get oxygen! It's a neat concept.

I probably butchered that explanation, but at least I now understand the science behind "bending him in half." It actually stems from an anterior misaligned aorticopulmonary septum during embryogenesis. The embryology connects to the pathophysiology, which connects to the treatment: squatting, or bring one's knees to one's chest (of course, that's not the definitive treatment, but it's a quick, temporary fix). And in a split second, that's what was going through Todd's mind... blue baby - TOF - knees to the chest.

Whew.

I think the next two years are about further developing the knowledge we've already received, and bringing it into the clinical setting (that, plus cramming in about a thousand times more things into our noggins). It's taking the 3 Cs of the measles, and being able to recognize them during an office visit. Science to clinic to treatment. That's what makes a doctor.

But, until then, I'll settle for: "Robert A. Swendiman, M_"

(Only two more years until there's a "D"!)

May 13, 2011

Matteo Forrrguess

Most people think of their friends fondly. Friends are supposed to be the ones you have the "good times" with: the times you'll never remember with the people you'll never forget. Matt and I, on the other hand, consider ourselves friends during the least fun times ever, i.e., the first two years of medical school (well, it's not the worst, but it's not college). I thought about this for a while. What's the expression? Friends in the best of times, friends in the worst of times? Well, it's not that bad, but for a relationship where 90% of the time together is spent studying, I'd say it's not that "best of times" either. It's what you make of the 10% that matters though, and we've made the most of it. So with that, I begin Part VII in my multi-award winning series, “Wait, That Person Got into Medical School??”

Mathieu was born and raised in the French Canadian grasslands of Montreal. There he developed a healthy sense of nationalism (health care and hockey, eh!), yet ultimately realized that Canada is the schwag to America's northern lights (I kid, we love our Mathieu, despite looney Candianisms). So after his eighth birthday, his family left Montreal high and dry, heading to the most American place in the world: Texas! There, he spent about a decade in the blazing Southern sun, learning English and cattle-herding from scratch. On his first day of school in Amurrica, he didn't speak an ounce of Texan; by Christmas he was a budding cowboy and fully fluent. At sixteen, the Forgues Family said enough was enough with this "Everything's Bigger" bit, leaving the state for greener pastures. Matt finished out high school and pursued an undergraduate education at UNC-Chapel Hill. In college he quickly separated himself from the weeds by learning a new language (Spanish), becoming a chronic Dean List award winner, and ultimately being inducted into Phi Beta Kappa. After quick stints in Argentina, Chile, Uruguay, Colombia, Puerto Rico, Costa Rica, Panama, Nicaragua, Bosnia, Poland, Serbia, Montenegro, Croatia, Romania, Turkey, the Czech Republic, Ukraine, Hungary, Germany, Holland, and China (whew!), Matt returned to school as a first year medical student. Here he continues to smoke the competition. The rest is history.

Matt and I met after an unfortunate accident involving my car first year, but we became fast friends thereafter. Around the beginning of our second year, we realized that our study styles meshed. For the longest time I have been totally against group study. Usually that's my own fault - I tend to want to play and distract the group ("why do today what you can put off until tomorrow?"). My strategy has always been "skim over details and do the minimum amount of work." However, in medical school, that isn't always best form. Matt, on the other hand, has the opposite approach. His is meticulous about taking the time to learn details and understand concepts. He'll spend a great deal of time reading and re-reading a syllabus, and by the time he's done, its indelibly etched into his CNS. Ultimately, we agreed the neither is the best approach. I was spending too little time, Matt too much, on school. So we started studying together and boom, we were more efficient and our test scores went up considerably. A Boards partnership was born. Often I want to glaze over an important detail or two, and Matt ensures that we go back and learn it. Other times I put my foot down, deciding to totally ignore a concept that is better suited for the courtship of an MD in his or her fellowship.

Fastidious and detailed, Matt is also a stickler for pronunciation and correct grammar. It is in this respect that Kelly, Ronnie, and I enjoy acting as his folie a trois. We very much love to teach him English pneumonics and American pronunciations of commonly misused vocabulary (e.g. "debris" should be phonetically pronounced, "DAY-bris" with proper inclusion of the sssssss). Ultimately, we don't want him to look uber-European on rounds next year. God-forbid he encounters skin that appears "pew de o-range."

Kidding aside, for those of you who don't know Matt, I think some of his most impressive accomplishments in my mind surround his dedication to the community. Perhaps it is because of all the swimming I did in college, but I am always in awe of the service projects that many of my classmates have undertaken. Here is the short list of a few of Matt's highlights:
  • English-Spanish translator at UNC-Hospitals in the emergency room, GI unit, and high-risk OB-GYN clinic.
  • Habitat for Humanity.
  • After-school tutor programs in math, Spanish, and English with the L.I.F.E program in Argentina, serving some of the poorest communities in Buenos Aires.
  • Worked with the Newman Center on UNC's campus as a coordinator and volunteer to serve with the Boys and Girls Club, Susan G. Komen Race for the Cure, and served meals at the battered women's shelter and the homeless shelter in town.
Matt also worked for the Southwestern Company every summer during college. Here, he learned to run his own business, selling educational products door to door in Oklahoma City, Youngstown (OH), and Kansas City from dawn until dusk. His sales were in the 99th percentile, and this was where he developed his unwavering work ethic and mental toughness. One of the things I really appreciate about Matt is his work ethic. Knocking on doors from dawn to dusk every summer to pay for college is the epitome of this virtue.

No, Matt and I haven't had the opportunity to travel together during a semester abroad, nor celebrate an NCAA championship together despite both being in Chapel Hill for the last seven years, but we've made the most of the times we've had. I can honestly say that my past two years would've been duller, my grades lower, and my medical school experience lesser without Matt. So I am more than happy to accept that he is one of my closest friends in the worst of times.

And with that I say, au revoir!

(correctly pronounced "oww rev-ee-or")

May 6, 2011

Running with Music

I have become incredibly anal. I now make my bed every morning... without fail. When I was growing up, I actually argued with my parents about the utility of spending the time to make one's bed in the morning (time is money, especially to an eleven year old). I personally believed that since I tore up the sheets so badly each night, I should be able to make my bed right before I go to bed. That way I would have it just the way I wanted prior to each night's slumber, thus establishing a strong pre-sleep habitus. Flawless logic, I know. But that didn't fly at the Swendiman household (I believe I lost 50 cents off my allowance for each infraction - Mom, correct me if I am wrong). However, the second I got to college I let freedom ring! So why do I make my bed every morning now? Med school makes you incredibly anal.

I was talking with Matt Forgues specifically about this the other day. We both have become rather meticulous about our schedules. When we are at school or studying, 110% efficiency is crucial; when it's time to break and relax, those moments need to be equally maximized. Optimizing every aspect of life is becoming ingrained. Example: Is going to lecture worth it? No, not when you can watch lecture capture at 2.4x speed and do three hours of lecture in 62.5 minutes at home (plus, transportation time and the opportunity cost is astronomical!). Post-test relaxation? Yes, lunch with Ronnie on Franklin. Either way, I am trying to get the maximum return out of each investment of time, then reap the dividends. And yes, that's anal.

But there is one thing I can't do anymore... my goal this semester was to listen to the "Gol-Jan Pathology" lectures twice through on my iPod (Dr. G is a famous Boards prep lecturer from Brooklyn, see his Wiki - not my professor btw). There are 37 lectures, each about 50 minutes long. In order to accomplish that, I would have to listen to them whilst running 2-3 times per week (plus churning out lecture after lecture on long road trips). I successfully accomplished one time through a couple weeks ago, and now I am a third through my second round. But today I was just having a bad day. The test for our last real Block, "Dermatology and the Musculoskeletal System," was incredibly tough, and I'm not sure it was my best performance. Then I had a bad question block on USMLE world later in the day. Things weren't looking up. So I decided to go for a run without Dr. Gol-Jan.

And it was glorious.

Oh, the freeeeeedom! I decided to go buckwild with a hodgepodge by setting up a special playlist. I started things off strong with "6 in the Morning" with Eminem and D12, followed up by "How Come" (track 9 off the same album). Then it went new school with "Backseat" from the New Boyz and a little "More"- Usher. As I came around the Alta Vista neighborhood, Alanis Morrisette's "You Oughta Know" boomed from my iPizzle speakers. And then I let Tupac sit and picture me rolling down Finley Forest Drive. There were a few other special songs peppered in between, but the bottom line was sanity. I ran in peace. Plus it was one of my fastest runs in a long time; I wasn't thinking at all or trying to hang on to every word to understand some frivolous concept (That's a point, that's a point!).

I just ran. With music.

Let me tell you what I didn't hear (and those who have listened to Dr. Gol-Jan, you will hopefully be able to appreciate this). I didn't hear...
  • Now that's real coffee. It's not real coffee if it's not from Starbucks!
  • All the other students out there? They're the ones who should be scared. They have no idea what's on the exam. No i-dea. But you do. So you shouldn't be scared. You have a leg up.
  • That's a point! I just got you a point on the exam right there. It's all in my high yields guys.
  • The little kids call me Papi.
  • You hear that sound? That's the sound of a thousand sphincters just going "click"! HAHAHAHAHAHAHAAHAHA.
  • There's another point!
  • Look at all these ADDers! Every time someone walks in the door, 50 heads turn to look. Those are the ADDers right there!
  • Cryptococcus?? PIDGEONS!
  • I just wrote a book on this so I'm kinda up on this stuff if you know what I mean.
  • You know all this stuff is in my high yields guys. There's no reason be looking anywhere but at the screen. Don't look at me! You're not going to get the answer from looking at me!
  • 40 year old female... what's she got? Come on, come on. What's she got?!?
  • Okay, okay now what is this? Good, good. You guys are good. You're actually doing pretttttty goood. Better than my other classes, and that's the truth.
  • Is this normal? No. WHY? Because this is pathology! HAHA.
No, I didn't listen to that today. Instead I heard things like:

"I walk with a limp, pistol hangin offa the hip,
I'm awkward and quick enough an sick when sparkin a fith,
Your carcus is split even the beef is partially thick,
We can't take you serious, you a comedy skit."

And you know what? I have no idea what that means, but it was very refreshing. I'm Gol-Janned out.