Saturday, March 6, 2010

The Last Disciple

Last night I had a rather odd dream. I was in a pediatric clinic (as an M1, or M3, or doctor, I don't remember which) - in fact, I was in my mentor's office - and I remember seeing these two patients.

The first patient was this boy well into his teen years who came in for a sore throat or something. He came with his dad. At some point, the kid blurted out that he was bisexual and somehow that was important to the patient history or something. The dad was surprised but just sat there kind of stunned, as the kid talked about it rather matter-of-factly. I think I gave him the "alcohol, drugs, smoking, sex" talk that pediatricians often give to teens, lol.

The second patient was this boy, around the same age, who came in for a physical or something. As he undressed I noticed that this kid had a swimsuit under his T-shirt and jeans - a woman's swimsuit. This kid's dad is exasperated at this. This kid was somewhat thin and a tad effeminate. Apparently, the kid is a cross-dresser but only with swimwear. So for whatever reason, the kid just likes to dress up in women's swimsuits. o_O

And then my dream ends. Note: no one got fully undressed in my dream, lol.
Incidentally, today (well, now yesterday), I shadowed my mentor.

At lunch I talked to this nice drug rep who's quitting her job in May to apply to med school because she hated working as a drug rep, lol. After lunch, my mentor took me to his office and basically gave me a nice lecture for half an hour on the privilege of being a doctor. He talked about how communication and caring about your patients are key to being a great doctor - not just technical skill/diagnosing prowess. He told me about his dad, who was a TV advertiser. At his dad's funeral, he said that the 2 most important people who showed up were the elevator lady who his dad always talked to, and his mechanic whose son he helped out once.

At the end of one's life, you want people to remember you positively. It doesn't matter how skilled you are, how amazingly talented you are at being a doctor, because if you're an asshole, people will remember you for that. And we should strive to be remembered as honorable people. I think this little spiel came as a result of him announcing his retirement from practicing medicine for about 35 years. As such, I am the last student to be paired up under him - his last disciple, as it were. I do feel truly lucky to have him as a mentor this year.

The clinic today was largely uneventful - mostly physical exams (PE's). Notably I was able to observe a couple PE's on pre-teens/teens, as both the kids and their parents were comfortable (indifferent?) enough with having me in the room. A PE on a pre-teen/teen is somewhat different than a PE on a little kid or baby, I've noticed. My mentor did actually give the "alcohol, drugs, smoking, sex" talk to a few of his patients today, haha.

I saw one baby with my mentor who had these cafe-au-lait spots. The moment I heard it mentioned, a switch turned on in my brain. I had heard that term somewhere before . . . The baby had 6+ of them and my mentor told the mom that the baby may have von Recklinghausen's disease. Then it clicked and in the back of my head I was thinking, "Hmm, are you sure it's not neurofibromatosis?" I had done research over a summer at one point in undergrad on neurofibromatosis, and cafe-au-lait spots are one of the features of the disease. I also instinctively tried to look at the baby's eyes for Lisch nodules (even though I couldn't remember what they looked like or how to find them). Afterwards, my mentor asked me to look up von Recklinghausen's disease and to my surprise, it's just another name for neurofibromatosis. Score! I got a diagnosis, lol. But now I feel bad for the baby if it's confirmed as neurofibromatosis. :-(

The last patient I saw with my mentor was a PE on a teenage boy. There was really nothing medically special about that patient - pretty ordinary and good kid. Curiously, he looked somewhat like the first patient in my dream. o_O Anyway, there was just something about the . . . "ordinary-ness" of today's clinic that left me smiling on my way back home.
Today was also the 2nd day in a row that I studied until midnight. I've some pretty tough exams coming up next week. The brain is not my friend. My brain is rather sick of learning about itself. And I've made 4 charts/tables for renal physiology. And the bit of cardiovascular physiology on this block exam made no sense to me; I looked at a friend's typed up notes and was like, "Wait, we learned this?! How come none of this is even recognizable to me?!!" That was just so poorly taught. :-/

It's kind of funny - several of my friends and I are using how well/poorly something is taught to rule out specialties. We reason that by the end of med school it'll be easy to decide what to go into because there will be so few choices left, lol.

Radiology - ruled out
Cardiology - ruled out
Neurology - ruled out (not because it's not taught well, but because it doesn't click with me)
Ophthalmology - ruled out
Surgery - ruled out (because I don't ever want to do surgery)
Dermatology - ruled out (no interest - plus, I'm not #1-10 in my class)

My original interests of pediatrics, infectious disease, genetics, and endocrinology are still in the running though. So we'll see what the future brings.


Uncutplus said...

Pediatrics certainly seems to be calling you, but I don't understand why you have already ruled neurology out. IMHO it is the most interesting field of medicine, and you certainly have the aptitude for it, proven today for the baby with cafe au lait spots. Not only does neurology include the brain, but the whole peripheral nervous system. And those nerves travel all the way down to the big toe! Just think of all the reflexes you could test.

Yes -- I sense the perfect specialty for you is pediatric neurology!

Best wishes on your exams next week, but I have no fear -- you will excel!


Manu said...

Yay lol I knew it was neurofibromatosis, I saw it last semester on Embriology. Not bad for a first year student rigth? lol.
Poor baby :(

So far I only have in mind peds and later neonatologist or pediatric surgeon. I love kids :)

Lol and is little to say that I love Allison and Arizona of grey's anatomy xD lol.

I think someone is sending you a message in your dreams :)

Anonymous said...

How could you have no interest in dermatology!? You disappoint me... -.-

Rex said...

fascinating random stuff... :)

Earl Grey said...

Interesting diagnosis, but my combined sources suggest either lupus or every possible ailment which could present with any sympton (Sources: House, WebMD) jk

. said...

I like this line of the blog

"At the end of one's life, you want people to remember you positively. It doesn't matter how skilled you are, how amazingly talented you are at being a doctor, because if you're an asshole, people will remember you for that. And we should strive to be remembered as honorable people."

Oh yeah and the dream sequence was rather interesting too. Hope you have a great week...I enjoy your blog a lot...keep on writing. :) Ummm, even if I am not on a regular basis. haha

Aaron said...

i think i like your mentor already. :) exactly what i think about most times. i was going to comment on the specialisation but decided against it.

Anonymous said...

Anon MD

You will find, as will your peers, that the selection of a specialty to pursue if purely personality driven. There are surgeons I know who are ignoramouses, but they have no qualms about dropping $10 on a 5 cent anty poker game with an ace high hand (and nothing else) while the future internists sit with a straight flush wondering if they should raise by 50 cents. Just accept that it's personality-determined and enjoy the training.

And though you may not like surgery, you will go to the OR and learn about it, perhaps hold a retractor or even cut a muscle during a cholecystectomy. It really isn't that bad--it's a great learning experience. Doesn't mean you're going to be a surgeon.

Aek said...

Uncutplus: I categorize neurofibromatosis under "genetics" more so than "neurology." :-P The thing I've noticed about neurology is that a lot of things you can't fix . . . not easily anyway. And it's so complicated! It just doesn't click with me. :-/

Manu: Neonatology sounds pretty interesting, but I don't think I have will for it. I wonder who's sending messages in my dream . . . >_>

James: Lol, sorry. Dermatology just doesn't interest me much - plus, I need to be in like the top 5% of my class to even consider it since it's so competitive.

Rex: Yes, isn't it? :-P

Earl Grey: Haha, lupus. It's never lupus. :-P Actually, it seems that auto-immune diseases (like lupus) are more common in females. So hmm . . .

.: Yeah, I like that little blurb by him too. :-)

Aaron: I like my mentor too! Too bad he's retiring. So what exactly do you think about most times? And I'm curious as to your comment about specialties. :-P

Anon MD: I know that specialties are largely personality-driven. You can spot the die-hard surgeons a mile away (and they're generally the people I don't hang out with). I somewhat dread the surgery rotation, but I'm sure it'll be quite interesting. It's not like I can get out of it, so might as well make it a good ride, lol.

B said...

Aw, pity the brain isn't your friend :-) Neurology's really interesting but you're right, for a lot of neurological disorders there's not much that can be done.

Bubby said...

Hey, i have just come across your blog and have become your newest follower.
Really interesting perspectives that you have, i look forward to reading back through your blog and seeing further postings.

I love watching how everyone treats life differently, I also like that as a Dr you don't seem clinical in your approach to life at all.

All the best

B. said...

Hahahahaha (about your dream)... Very weird one, especially with this bisexual stuff...

Aek said...

B: Yup, the brain's not my friend, hehe. I'll leave that up to the people who're good at it and enjoy it. ;-)

Bubby; Hey thanks for following! I've a huge backlog of blogs I'm trying to catch up on, but when I get to yours I'll like ya. I, too, like my mentor's outlook on things. He's one of those people who truly believes in what he does.

B.: Yes, weird dream indeed. :-P