Occupational Diseases (Hypersensitivity Type III Reactions)

"There are many...pulmonary type III reactions that bear names related to the occupation...such as pigeon breeder's disease, cheese washer's disease, bagassosis (bagasse refers to sugarcane fiber), mapke bark stripper's disease, paprika worker's disease, and the increasingly rare thatched roof worker's lung." -Immunology: A Short Course, 4th ed. Benjamini, Coico, and Sunshine. 2000.

God I Suck at This (Board Review Tuesday)

So I missed Board Review Tuesday again. Maybe I should call it Board Review Wednesday and cut my losses.

Panic set in for the first time over my spring break (last week). This was probably due to a few of my classmates posting up pictures of the library to Facebook whilst complaining about how much they were studying.

I still am not 100% sure of how exactly I am going to study for boards, but I have an idea: I will write my own notes for each system of the body. System based learning done the right way because it will be personalized to me.

To start off each section, I would re-familiarize myself with anatomy and physiology of the system. Then I would discuss pathology, including microbiology and immunology if relevant to a specific condition. Finally, I would end with pharmacology and other treatments for the condition.

Hey! This could actually work! Of course, that's what I said about CramFighter, and I'm not really using it anymore.

I mentioned this to a friend--and it seemed like one of the truer things I have ever said--but essentially, the inexplicable feeling of doom that accompanies pancreatic cancer is exactly how I feel about boards. I'm not sure exactly what's wrong, I'm not exactly sure what I should fix: all I know is that I am screwed.

Advice from the Downeaster

Last week was our spring break (conveniently located in winter), and I spent some time in New York City before heading up to Maine to visit my older, lawyer sister. The Amtrak Downeaster travels between Boston and Brunswick, the largest town (not city, which would be Portland) in Maine with a population of over 20,000.

Regardless, I sat down next to a window, minding my own business, when an incredibly chatty older woman, her friend, and her friend's daughter, sat down in my row. I tried to quietly play Triple Town on my tablet, but I could not escape the questions and story tellings of the woman, and we eventually fell into an on-again, off-again conversation that eventually ended in me getting a free Shipyard Export Ale.

Thankfully for me, the woman was a retired nurse anesthetist, and therefore our conversation was a lot more interesting than the conversations I've had with other people I know nothing about. Pathologies and other medically related topics that came up in our conversation included the following:

• Neurofibromatosis Type I & Type II
• Renal Cell Carcinoma (RCC)
• Abdominal Aortic Aneurysm (AAA)
• Celiac's Disease
• Out of Sync Child
• Dyslipidemia
• Migraines
• Alcoholism
• Disseminated Intravascular Coagulopathy (DIC)
• Metastic Breast Cancer
• Bone Spurs
• Vaginal Birth after Cesarean (VBAC)

Incredibly fascinating! As it turned out, the group of three women had travelled down to Boston to get a better opinion on an AAA found in the friend. Originally, the AAA had been sized as a 4.7, but in Boston--with better equipment--it was sized at 4.2. And oddly! I knew exactly what that meant! 4.2 is in a lower risk group than 4.7. And so to celebrate, they had all gotten drinks and were still in a pretty joyous mood. Which is why, an hour away from Brunswick, this woman got herself a gin and tonic while also getting me a Shipyard (which is a delicious microbrew). 

Anyway, before leaving the train, she made sure that she had given me the following two pieces of advice, several times:

• You need disability insurance more than you need life insurance--start paying into it early.
• Keep a journal and write down the quirky/fascinating little stories that are part of your day to day life.

The first piece of advice was given to me because of the woman's personal experience: she had been a nurse anesthetist for a long time when she was injured on the job (broke her hand due to faulty hospital equipment), and found it impossible to keep going to work. Without disability insurance, her family would have struggled. A stark reminder of how important working mothers can be to their families.

And it was obvious why the latter one was pertinent--this woman had decades of really interesting stories to tell, ranging from the depressing and upsetting, to the hilariously unbelievable. I hope that this blog will function as a repository for the brief encounters in my day to day life as a healthcare professional, holding onto stories until one day I too can expound upon them with a much younger person I've capriciously decided to mentor on a three hour train trip.

Meanwhile! I love Portland, Maine. It is beautiful. It is cool. It has nice restaurants. It has nice beers. It has a lot of gay pride. It is nerdy. It is liberal. It is walkable. And it has a hospital in it! I kind of want to try and spend a part of my fourth year rotating through Maine Medical. 

Radiologists Suck

http://www.npr.org/blogs/health/2013/02/11/171409656/why-even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight?ft=1f=

BRT (It's Wednesday)

So I'm a failure at blogging. What else is new?

Regardless, it's BOARD REVIEW TUESDAY (it's Wednesday) so let's review!

There is absolutely NO WAY I can study for combined exams, study for step 1, and expect to stay alive. I've done nothing that I usually find enjoyable in the last week. To continue living this way for the next 107 days... Terrifying.

Let's take a look at a typical day:

7:30 AM: Wake-up. Probably. You let your alarm ring for 17 minutes before falling out of bed.
8:04 AM: Show up to your 8 o'clock class. Reluctantly remove ear-buds when you sit down near the back of the auditorium.
12:00 PM: Congratulations! You've just survived four lectures. (Only three of them were good... and you were on pinterest for a good fifteen minutes at one point).
12:05 PM: Back in your apartment, you think about eating lunch.
12:45 PM: Nope. You just spent 45 minutes dealing with obnoxious e-mail requests and finishing assignments, last minute. Now you go to the freezer and stare at a box of ice cream. You eventually put it back and eat left-overs instead (we're proud of you, you poor bastard).
1:45 PM: It took you an hour to eat. You also had a beer. And watched The Daily Show and The Colbert Report back to back on Hulu.
2:00 PM: You're back at school, doing something "additional" to your actual classes. Attendance is mandatory, although you have no idea why.
3:45 PM: You've finished interviewing what feels like thousands of fake patients (there were only three, but your legs are weak and you're shaking all over. When you're a real doctor, you will likely see forty patients a day. Good Luck!)
4:00 PM: Sit down to study. You can't decide what to study first: Lecture notes from last week or Case Studies for step 1. You listen to your heart. Your heart tells you lecture notes.
5:30 PM: You break. Who cares about parasites? They are disgusting. And now you are hungry. Plus Diane Sawyers is on WorldNews, and you need to remind yourself there's an outside world. Make dinner while watching television. Eat dinner during commercials.
6:03 PM: You pick up your Case Studies book. You skim through 2 and a half cases and stop because...
6:30 PM: Television is on again. It's Wheel of Fortune. You're still human, dammit.
6:58 PM: You're lying on your bed playing an addicting game called Triple Town on your tablet that you bought primarily for school work. Whatever. Triple Town is legitimately awesome. It's like if Farmville and Bejeweled had a baby.
7:24 PM: You really hate yourself. Also Triple Town. You start skimming tomorrow's lecture notes.
7:48 PM: First exposures are always the worst. Hepatitis D will probably make sense to you when you read about it next week. Fifteen minutes before your exam. Go on Facebook. You have 2 notifications. Respond to notifications. Nothing else is happening. Stay on Facebook for the next 11 minutes, waiting.
7:59 PM: Check e-mail. Start G-chat-ing with Charyse.
8:27 PM: You've been reading Jezebel.com and io9.com. You finally stop when you see a medical article on io9 that you kind of understand, making you feel guilty that you're not furthering medicine at this very moment. You make a grand attempt at getting through First Aid Cases. It appears to be working until....
9:44 PM: GAH. You can't read this anymore. You only have five cases left but you don't care. You get some cheese sticks, red wine, and 25 mg of Doxylamine succinate, the finest sleeping pills around.
10:35 PM: You zoned out and somehow ended up writing something on your personal blog that shall not be named. It's angry and sad and if you didn't hate hugging people so much, that's exactly what you would want. You gently slap yourself in the face and finish your First Aid Cases.
11:08 PM: Despite drugging yourself, you're still awake. Though mildly content that you finished all your CramFighter assignments. No, scratch that. Wildly ecstatic. You remember when normal things used to make you happy. You turn off all the lights and watch Futurama until you're at the verge of passing out.
11:47 PM: Once again, you've forgotten to brush your teeth. You stumble to your bathroom to clean your teeth.
12:20 PM: You actually fall asleep. You dream of your adolescence underneath an instagram filter. 

Sadly, that's a pretty accurate description of my days.

Baby Sunglasses

So today in pathology we learned about my favorite organ, the liver. But sometimes baby livers don't work as well as they should, and so babies are born with jaundice of the newborn (which sounds a lot better than hemolytic disease of the newborn but what do I know about newborns as a barren 23 year old?). Regardless, our professor was explaining that one of her children had this condition fresh out the womb, and they had to keep it overnight at the hospital in a light box*, and it was apparently incredibly traumatic for her. I suppose I can understand her emotional trauma. You're technically supposed to bond with your baby like, as soon as it's born, so to have it in a plastic box would kind of put me on edge. What if the baby ends up liking UV rays more than mommy? And as a young adult in college it gets more oxytocin visiting tanning salons than calling its own mother? Then it probably gets skin cancer (because it's probably white) because it can't stay away from L.A. Tan. #whitepeopleproblems

MY experience with jaundice of the newborn is much more amusing. I was beyond excited/curious during the gestation of my little sister, Erisa. One of my earliest memories is tapping on my mom's stomach to assess whether or not it actually contained a human or if my mom was just being lazy and taking weeks off of work to lie in bed. Regardless, when my baby sister Erisa was born she had a little jaundice. But we got to take her home, and so in the yellow walls of our home's nursery, I got to observe my little sister converting unconjugated bilirubin to photobilirubin while wearing super cool little baby sunglasses that I was hella jealous of. And so began my love/annoyance with my little sister. And my appreciation of cool shades.


*Why would you ever put a newborn in a light box?: You put babies with too much bilirubin/jaundice in light boxes because it converts the insoluble bilirubin into photobilirubin which is soluble and can be excreted in the urine. A lot of bad things can happen if you let bilirubin build up in a newborn, but by far the worst is kernicterus, which is a condition that damages the brain.

Board Review Tuesdays (CramFighter)

Fact: I am "getting serious" with USMLE Step 1 (Boards) studying.
Fact: I am attempting to have a weekly segment discussing various USMLE Step 1 topics.
Fact: I am starting that segment today.
Fact: That segment will be called Board Review Tuesdays.
Fact: That segment is this segment, and I'll start to talk about boards right now.

I stumbled onto CramFighter at around 4 in the morning during winter break, waking up in a panic, realizing that I would be taking the boards in less than half a year. But CramFighter is actually amazing, not just an impotent comfort against the waves of panic attacks that now assault me on a fairly regular basis. It's incredibly comprehensive, it's stylish (rockwell font in the logo, I'm pretty sure), it's simple, and it does what I cannot do: It makes a definitive time-line of what to study.

Well, almost definitive. You can change the schedule at any time by clicking on the "edit schedule" button. And I've been switching my scheduling a lot. I originally decided to read 18 review books in total, do 2185 UWorld questions, and look over 100s (read: 200) of flashcards for pharmacology and microbiology. This would later prove to fail.

But the CramFighter approach is very helpful for people who are preparing for the boards not through on-line or in-person classes, but through reading. It has proven incredibly helpful for me, in that I've actually studied for the boards instead of opening up First Aid and then promptly closing it, putting it aside for tomorrow, eating dinner, and going to sleep.

Ah yes, CramFighter is amazing. But it's not definitive. You can change it at any time, editing your schedule in the following ways:

• Learning Resources you want to use (text books, review books, flash cards, practice questions)
• Time you want to spend each day of the week reviewing
• Order in which you review topics (both systems based and course based)
• this is actually its best feature: it can scavenge for topics in the various review books you own so that you end up reading, say, all you have on psychiatry at the same time
• Days you want to take off (holidays, catch-up days)

So I started off with 18 review books, 2185 Uworld questions, and about 450 flashcards. This proved unsustainable: I was going to end up reading over 70 pages per day and doing about 100 practice questions a week. 

That's terrifying. And after only successfully completing my readings 4 out of about 15 days (and cheating crassly) I decided to remove all my Board Review Series books, 7 in total. Now CramFighter is telling me to read about 30-50 pages per day, which is much kinder to my psyche.  And actually manageable.

Although I want someone to appreciate the fact that I will be spending 2 hours every day on nothing other than preparing for an exam I will take four months from now. 

Pros: Plans my "life" for me, keeps all my books in order, helps me study in the most efficient way possible, knows my name (see above: Hi, Elora!) and seems excited that I exist

Cons: The full version costs $7.99 a month (I'm just going to assume online study/review courses are much more expensive), there is no extrinsic motivation (although most medical students seem to have intrinsic motivation down). 

Overall Impression: They should make this for other large exams, like the Bar. I have no idea how law school works, but I can only assume something like this would be helpful for all major exams that are terrifying and include literally every little detail on an entire field of academia.