Ode to the Patient History

I walk in the room, we shake hands and you grin,
We sit down together, I tell you the position I'm in,
"Sir, I'm a student working with your doctor today,
And I have a few questions, if that is OK..."
I want to know how you are and what's wrong,
Where does it hurt? Has it been going on long?
I need to know if you have pain or can't breathe,
I promise to report all this to your doc when I leave.

Cuz you see, if I have the facts, I can make up a plan,
Present to my attending, and demonstrate that I can
Master the Art of Medicine, show her I'm tip-top,
Until we return to the room and you do a flip-flop!
If you say it's your chest, but now it's your back,
I didn't consider "triple A," and I'll hear so much flack,
She now thinks I didn't ask the right questions at all,
Because you changed your story while we talked in the hall!

See, if you'd mentioned your piercing and new onset pruritus,
I could've looked smart diagnosing nickel-contact dermatitis,
And you didn't say that you had a pet turtle named 'Bella,'
Suggesting your diarrhea might be from the bug Salmonella,
If you had told me you drink twenty beers in a week,
That your liver's cirrhotic, your breath's started to reek,
Then that would explain why you're sweating and shaking,
DTs are why you're sick and your body is aching!

So please (oh please!) just tell me the truth,
Tell me every pain that you have, from your toes to your tooth,
Tell me your story, and if you've been traveling of late,
Tell me if you have the clap after last Friday's blind date,
I won't tell a soul, 'cept your doc that's the law!
But please don't you stutter, don't you hem and don't haw.
If you don't want to see me, why don't you just say this?
So I don't end up looking like an unskilled ignoramus.

This is what I go through: my struggles and my pain,
"Now, please just remind me, Sir, I've forgotten your name..."

Ode to the Placenta

Placenta, oh Placenta! Why are you so vile?
I cannot believe you follow the birth of a child.
It's the miracle of life, a baby is born!
And then you too must pass, from uterus torn.
It's such a wondrous event, as child enters the world,
Mothers weep, fathers cheer! for their new boy or girl.
Yet when baby breathes its first breath in the hospital ward,
It is still not rid of you, attached firmly by cord.

I stand in front of mother, offering a hand of support,
I checked in every 2 hours, building a strong rapport.
Then when the time came, I put on my gown and my glove,
A mask on my face to protect from splashes of love.
Push! we yell to mom as the contractions come quicker,
Push! Push! through the crowning, the head's getting bigger!
I put an arm underneath, and secure the nape of his neck,
While dad passes out and mom's screaming like heck.

Oh my God! It's a boy! Congrats all around!
The baby is out of his sac and on solid ground.
The family rejoices, they've waited 9 months for a son,
But while they cheer on, I am nowhere near done.
Even after the baby is out, and the cord has been cut,
I stand between her legs, til the placenta's unstuck.
I tug and I tug, gently pull and then twist,
Throw it all in a bucket, unless membranes persist.

And as you lie there amorphous in a bucket of steel,
A little sick to my stomach is how you make me feel.
An organ of tissue, all gooey and gross,
All grimy and oozy, all slippery and morose.
In some cultures you're eaten, in others you're buried,
For me it's bad enough that in my hands you are carried.
I'm usually not squeamish, but I loathe you and your stroma,
I think the only thing worser is the mature teratoma (yuck!).

So Placenta, Oh Placenta! You're so gross that just maybe,
Next time I'll quickly unscrub, status post birth of the baby...

Ode to Neuroanatomy II

Damn you Neuroanatomy, you've come back to haunt me!
With your cross-sections and nuclei, you eagerly taunt me.
You want me to remember it all? That's absolutely redunkulous,
Even something as simple as the motor homunculus.
But nay! I must recall the pathways for somatosenation,
And lesions of the paramedian pontine ridiculous formation.
Then you add pathology (ugh!), now I'm filled with nostalgia,
For a Block that's far less painful than trigeminal neralgia.

First year was simple, just little axons and gliosis,
But now studying this path gives me hyperhidrosis,
This year it's ptosis, psychosis, and the nucleus pulposus,
Plus all the co-morbidities of tuberous sclerosis:
Okay, you've got seizures, ash spots, and angiomyolipomas,
Shagreen patches, hamartomas, and rhabdomyomas.
But this is just the beginning of the tumors and "-omas",
There's the meningioma, schwannomas, and medulloblastomas!

Wait! I failed to mention the pilocytic astrocytoma!
And its nasty adult partner, the grade IV glioblastoma.
These diseases are no joke, it's all serious business,
That's why when I'm wrong on a question I get hemiballismus,
Not because I've lost the ability to inhibit my thalamus,
Nothing's wrong with the stimulation of my trusty G pallidus,
If I'm wrong I throw a tantrum, develop chorea, and flail,
Because I know I must study even more! Else I'll surely fail.

But if I fail I'll defend my ego with conscious suppression,
And turn back the clock like maturational regression,
Forget med school, I'll drop out! See what else is in store,
Maybe make like an oligodendrocyte and turn into a whore,
Myelinate dozens axons and forget all of my scruples,
Although I'd rather not end up with Argyll-Robertson pupils.
That work would be easier, I could get help from Cialis,
But it's these kind of thoughts that get you tabes dorsalis.

Now it's one year later, and I still can't pay attention in class,
My right hemisphere has failed me (again!), there's no way I will pass.

(in case you missed the original from last year, check out Ode to Neuroanatomy)

Ode to Neuroanatomy

Since the New Year began, it's been nothing but Neuro,
Constantly taxing my brain, leaving my brow ever furrowed.
I could be surfing in Hawaii, maybe learning the hula,
Instead I'm studying all the nuclei in the caudal medulla.
They say med school is tough, otherwise anyone could do it,
But this pain in my brain won't go away til I'm through it.
The Neuro final's on Monday, so I must cram in a million facts,
And thus I feel it coursing thru my spinothalamic tracts.

This pain (oh the pain!) goes straight to my cingulate gyrus,
(The part that makes you feel crappy when catching a virus).
Because it's not enough to simply feel crummy inside,
Attaching emotion helps you remember to run and go hide
From that bug or that virus, from heights and hard falls,
And that's why you won't find me in the MBRB lecture hall.
Worrying about nuclei, axons, and fascicles makes me abstain,
Because I can't remember if the PCA gives blood to mid-brain.

That's not right, it's something else, perhaps it is PICA?
Or basilar or vertebral, what about anterior spinal or AICA?
Oh, why can't I remember anything that's truly essential.
Clearly my neurons have none of this "long term potential."
I think the dorsal column is why I run like a stallion,
But apparently we know nothing, says our crazy Italian.
"The brain is too complex for us mortals to understand,
Years of research are needed to fully map something so grand."

And so I pray to the gods to help my synapses stay strong!
And let my hippocampus tell me what's right and what's wrong.
Help me learn the function of every sulcus and gyrus,
And all of the pathways that control my pupils and iris.
I beseech you to teach me the types of somatosensation:
Touch, pain, and pressure, as well as proprioception.
Amensia, ataxia, aphasia, none of these can I define,
Unless I study all weekend, (with help from the divine).

If only, If only! I was able to pay attention in class,
But if I fail, I can now blame my right hemisphere for not helping me pass!

Med School Tomfoolery - "5 Star Nerve"

In an effort to lighten the medical school gloom and doom, I decided to write a "medical school rap." Yesterday while learning the brachial plexus, a complex bundle of nerves that split and merge and divide and rejoin multiple times in the shoulder and upper arm, I put together a little breakdown of each nerve and what it does. My glorificaiton of the brachial plexus is dubbed "5 Star Nerve," a parody of Yo Gotti's "5 Star Bitch." Go ahead and download the song if you'd like to follow along (you can also find it on YouTube), or just read it as a simple poem. One of my fellow first-years (Ronnie Milam) and I will lay down this track on mp3, hopefully sometime next week. There probably won't be a music video parody on YouTube for this one unfortunately, but no worries! The next rap remix we do (for next year's incoming class - Orientation 2010) will be video taped, edited, and special effected for your viewing pleasure. Until then you'll just have to do with this one. I'll post a link to our version on the song once it's recorded. DJ MS1 aka the White Lightning is back...


[Intro]
Yeeeeeah, yo I’m looking for a 5 star nerve you know, I’m talking about something I can break down for you real simple like, something like this…

[Chorus]
If you got that C-5,
In the arm and its high,
Innervatin up and down,
Plus other muscles on the side,
Then that’s a 5 star nerve,
Yeah it’s a 5 star nerve,
I need a 5 star nerve,
See this 5 star nerve…

[Verse 1]
Yo you gotta start with them roots, C-5 to T-1,
And you’ll end up with the branches when it’s all said and done,
Man it sounds really tough, why learn the brachial plexus?
So if you’re at the beach, spittin game, then you know the nerve to flex it!
So after these roots combine into three little chunks,
You got the superior, and the middle, and inferior trunks,
C-5 and 6 merged, so do T-1 and C-8,
But C7 stayed alone, not gonna to help them innervate,
Now the trunks split up, making 6 small divisions,
3 on the top and 3 more in the posterior positions.
The 2 anteriors all combine, and all the posteriors do too,
As they run down your arm, you can feel em coursin through you (YOU!)

[Chorus 2x]

[Verse 2]
We done roots, trunks, divisions, now we onto them cords,
Keep payin close attention, cuz you’ll find this on the Boards,
Look for the lateral on the outside, and the medial on the in,
The posterior’s in the back, and if you see it with a pin,
Then the axillary artery must be sitting in betweens,
Holdin on them cords like some Skinny tight jeans.
All three cords split in 2, then they branch into five,
Its musculocutaneous nerve that makes your upper arm thrive,
the axillary nerve hits the delts and teres minor,
while the radial helps extend your arms like a recliner,
Median gets forearm flexors and the muscles of the thumb,
And the intrinsic hand connects with C-8 and T-1 (ULNER!)

[Chorus 2x]

[Verse 3]
Now that’s the basic structure, but there’s more branching on the side,
Let’s start back at the top, and down the plexus we’ll slide,
Our first little break comes off the C-5 root,
The levator and the rhoms get that dorsal scap chute,
Then the long thoracic nerve roots from C-5, 6, and 7,
Breathing life in front serratus like the Spirit from Heaven,
The suprascapular nerve comes off the superior trunk,
and walks it out on both spinati like my boy DJ Unk,
The thoracodorsal nerve comes off the posterior cord,
So my lats extend my arms to 10 and 2 on my Ford,
Medial and lateral pectoral, you know what they serve,
And that’s five star rap, about some five star nerves!

[Chorus 3x]

[Outro]
Annnnnnnnd done.