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.