menometrorrhagia

So I got hammered by Ob-Gyn on the USMLE step 2.  I know chics make up about half the population, but that doesn't mean that half my exam should be focused on strictly female diseases.  That sucked, but one of the clinical pearls from this post in the menometrorrhagia archive did show up on the test. Guess which one!

In honor of the one hundred and twelfth anniversary of President Grover Cleveland's pardoning of bigamists, adulterers, polygamists, and unlawful cohabitants (9/25/1894), I present the first and only menometrorrhagia poetry festival. Submissions to the comments are encouraged, especially along the themes of obesity, college football, or things that are better than sliced bread.

Lines written while walking along Inwood Drive
I saw a pigeon on a power line that looked like a hawk
I called out but he didn't want to talk
He just shit on my hat and flew off with a squawk
I said Up yours, buddy!

I saw a cat in the corner that looked like a lion
I got his attention without even tryin'
His piss on my shoe smelled like fish that was fryin'
I said Up yours, buddy!

I saw a dog in the dark that looked like a bear
I shook his paw and we were a pair
We got along til he licked off my hair
I said Up yours, buddy!

I saw a fox in a field that looked like a fox
I took off her shoes and nibbled her socks
She looked good with the mumps and hot with the pox
I said Will you have my baby!




Another Pawpaw limerick that would have worked better live
There once was a man from Nantucket
Traveling to the bay with a bucket
But his truck hit a bump and the bucket got dumped
And along came Pawpaw who took it.

1. Somebody somewhere is making a shit ton of money off the USMLE. I spent $455 to take step 1, another $455 to take step 2 CK, and $975 for step 2 CS. [For the uninitiated CK = clinical knowledge--standard multiple choice test, CS = clinical skills--pretend doctors meet pretend patients and play pretend with their future in the balance] So that's $1885. In a year or so I'll take step 3, which will cost somewhere around $650. After that my total will be $2535. But after that I get to be a practicing doctor right? Not so fast my friend. Then I get to take an addition jurisprudence exam (at least if I'm going to practice in Texas). I will also have board exams at the end of residency of unknown cost, but I feel confident it will be at least $500. So let's call it $3035 just for the privilege of taking these tests. But these are not tests you just walk up and take. I have a stack of review books about two and a half feet tall, some dozen volumes or more, which does not include the 8-10 books I had for step one that I pawned off earlier this year. These books average $25 a piece, about 20 books, so another $500. And I didn't shell out for the computer study courses that 90% of people use, but those go for about $250, times two is another $500 (for both step 1 and 2) that the vast majority of
people are spending on this. So all told the licensing exams costs about $4000, or slightly more than the average resident's monthly salary. What a deal!
Note: You could also include travel expenses for the step 2 CS because that is only offered at six places in the country, but that number is so variable it's not generally applicable.

2. "It's the best thing since sliced bread!" This expression has outlived it's relevance. First of all, there are a lot of things that are better than sliced bread. For instance, pussy. From now on I'm going to say "It's the best thing since pussy." What's worse is pussy has been around for a lot longer than sliced bread, or bread in any form, so the expression really should never have been born. When sliced bread was invented some dude should have said, "Wow, this is the best thing since pussy!"

3. The ERAS/NRMP system. For those who don't know, this is the system whereby medical students apply for residency positions in the specialty of their choice. ERAS is a phenomenal idea. It stands for Electronic Residency Application Service. It's basically a centralized digital clearing-house for applications. This means you only have to fill out a single application and never mess with the post office. A terrific idea. It costs you $40 up front, plus a fee for each program you apply to. This second fee is on a sliding scale. The first 10 programs cost you $60. The next 10 are $8 per, the next 10 are $15 each, and any more than that costs you $25 a pop.
The number of programs a person applies to is directly proportional to the competitiveness of the specialty choice and inversely proportional to the applicant's stature. For example, aspiring dermatologists apply to an average of 50 
programs each, while internists-to-be apply to an average of 10 each. Someone going into internal medicine with board scores in the 98%ile and membership in AOA (Phi Beta Kappa of med school) might apply to only six or seven programs, secure in the knowledge that he will match at one of those places. Someone going into internal medicine having failed the boards twice before passing with a score of 190 on each step and with straight C's in school will likely apply to 15 or more programs. You get the picture.
I'm applying to neurology, a lower-middle class specialty in terms of competitiveness, so I applied to 13 programs. Because not every program amongst those 13 includes an internship year, I also had to apply to preliminary year positions in internal medicine. So I hit up another 13 programs for internship year spots. This cost me $202. I felt that was a decent price for the service provided.
I am in the process of scheduling interviews, six so far (three prelims, three neuros). After the interviews are all done I get to do the Match. The Match is the common parlance for the National Residency Matching Program (NRMP). It costs $40 to register with NRMP, not too steep. My problem with NRMP is that it's a tool of the man. My understanding of the days prior to NRMP is that residency application was like any other job hunt. You apply, interview, get offers, negotiate salary and benefits, all that. Now, you don't get to negotiate at all. You rank every program at which you interviewed and the programs rank everyone that interviewed with them, and these lists are fed into a computer which spits out a match list that purportedly maximizes the happiness of all involved. Whether that algorithm favors the applicants, the programs, or doesn't work at all, I don't know. What I do know is that this system serves only to benefit the programs
who can now stipulate a fixed rate on salaries that is essentially the same whether you are at a Cadillac program (UCSF) or a Kia program (University of Nebraska at Omaha). The applicants have to compete like El Gallo de Cielo for 
spots, but the programs just sit back and pluck residents like grapes from a bunch that gets passed around the opulent dining table. It sucks almost as bad as the NFL draft. The only thing better is that the dude picked for the last spot in Omaha signs a guaranteed one year contract while the dude taken in the sixth round by the Texans may get cut two weeks later with nothing to show for his work.

4. Obesity: The discussion on Ojo's blog has me thinking about obesity and I plan a more thoughtful post on the
subject in the coming days. For now, however, I'm shooting from the hip. Obesity sucks. People who are obese deserve our empathy and compassion, certainly, and they should not be viewed as failures at all aspects of life because they thought the line at the buffet was a circle from which they could not escape. Any one of us could get to the 250 or 300 pound mark simply by eating at Mickey D's three times a day and never exercising. But. There is a difference between the 280 pound man and the 400 pound man, a 33% difference. Nobody gets to 400 pounds
by eating only three meals a day. It's not possible. We're talking an average consumption of about 6000 kcal per day. It's hard work to fit in all those calories. That's the equivalent of over 10 Big Macs in one day. So to the large man I say, "Keep your chin up, exercise a little, live longer," but to the morbidly and dysfunctionally obese man I say, "What the hell is wrong with you? Can't you see you are eating yourself to DEATH!? Seek help."
For the record, I have had patients who tipped the scales at more than four bills, and I treated them with dignity and respect, even as I endured the fetid stench of the yeast cultures growing in their creases while I changed their surgical dressings.

5. Eponymous medical terms: I'd like to send a hearty menometrorrhagiac F YOU! to the following (mostly deceased) physicians:
Adamkiewicz
Wiskott and Aldrich
Austin Flint (who almost gets a pass for coolest name ever)
Osgood and Schlatter
Ortolanni
Grey Turner and Stephen Cullen
Gilbert
Prinzmetal
and, especially, Dr. Jean-Martin fucking Charcot.
In fact, screw all the people you can find at www.whonamedit.com, except Dr. Harry Fitch Klinefelter, without whom a little bit of the humor would have gone out of all of our lives.

For the past month or so I've been staying at home, mostly, to study for the USMLE step 2. One of the myriad things I've found to do other than that has been taking walks with Phenie around our apartment complex. Our complex is a little bit older, probably built in the seventies, or at least long enough ago that these structures were still considered apartment homes rather than temporary housing. Because of this the six or so buildings in the complex are arranged such that they form multiple courtyards highlighted by large old oak and maple trees that provide the shade that makes the brutal heat of Dallas in the summer bearable.
Each courtyard has a slightly different character. One is home to the complex pool, another has a grill and a fountain with stone birds playing in it. "Our" courtyard has a stone elephant fountain (and a grill, but it's gas, and seriously, why grill on gas? You could just cook that shit inside on your gas stove.). There's even a long, narrow yard out front where people can walk their dogs. Our dining room window looks out over this yard, and Phenie spends hours searching for puppy dogs so she can go "whoof whooof" and squeal.
So that's where we walk everyday. There are numerous steps and uneven flagstone paths that can prove treacherous for a toddler still getting her sea legs. A couple of days ago we were walking and Phenie came to a step down and, with just the slightest hesitation, she put her right hand up toward me without even looking to see if I was there. I helped steady her, and she took the step like a champ. I was totally awed by her absolute trust that I was going to be there to take her hand just in time for her to get down the step without crashing. I assumed that trust was something that I had earned and felt better about myself than I ever have.
So of course this evening on our walk, when I was playing peek-a-boo from behind an oak tree, she came to a step down and walked down it like it was nothing. Another moment never to be repeated that I could have easily missed. And undoubtedly will miss with any future children as I work like a slave for the corporate/pharmwhore/federal health system. Sigh.

A: Gelastic seizure -- epileptic seizure manifesting as intense displays of emotion, classically bursts of laughter such as those induced by Ojo and Snake's definitions

Substantive posts to follow, but until then, if you haven't heard this, you should. And then you should check out the remixes at zefrank's site, especially this one.

Just a quick dirty post to sum up how my gridiron predictions have panned out.

Michigan rebounds to make me look more like a genius.
Baylor blows it to make me look like a fool.
Brian Brohm kicks ass to make me look like a genius.
Brian Brohm suffers injury to throwing hand, out for half the season, no chance for Heisman, I look like a fool.
Nebraska not quite ready for prime time, genius.
Texas lost to Buckeyes, sleepwalking through rest of season until Fiesta Bowl, genius.

Not too bad overall.

Just to get this blog back on track, here's a medical term you can come up with your own definition for. True definition to be revealed on Monday:

Gelastic seizure

Texas had two drives of over 70 yards in the first half predicated on running off-tackle. The passing game was adequate but not stellar. Texas should have scored a TD when Pittman did the worst thing possible. That play was a two-score swing because it set OSU up at midfield. Still, going into half-time felt pretty optimistic for the Horns since they were popping off 12 yard runs at a pretty good clip.

Which means of course that on a key third and four in the third quarter, following a disastrous interception on the opening drive of the half, Greg fucking Davis calls a shitty swing pass to the running back behind the line of scrimmage. They were averaging more than four yards per carry, dumbass! Run the ball, don't throw a dangerous, slow-developing pass two yards behind the line of scrimmage. If you're going to throw on third down you have to throw to or beyond the first down marker unless you're throwing a screen against an aggressive pass rush. Anything else is just passing time before the punt.

That was the play the whole game turned on. Texas was still in a position to overcome their two big fuckups (the TD at the end of the first half and the interception). After that series, however, the momentum was gone forever.

Here's a few observations:
1. Colt McCoy did a pretty good job. He only made one big mistake passing and there were a couple times in the first half that he should have kept the ball on the zone read instead of handing off. Otherwise he was pretty solid on the big stage and this loss can't really be hung on him. If his arm were a little stronger he could be brutal.

2. Quan Cosby is under-utilized. If I had a dude as fast and strong as Cosby is reported to be I would get him the ball a lot. Texas ran the shit out of the end-around with Tony fucking Jeffrey, but they can't see fit to run it with a guy who could smoke Jeffrey's ass? Get him the ball!

3. Foster and Palmer were weak, but Ross wasn't a whole hell of a lot better. Nobody on the UT defense made any money in the draft tonight (except maybe Robison who had a great sack).

4. Jermichael Finley should have been a huge part of the game plan. As it is he dropped the only ball I remember being thrown his way. He failed to capitalize on his few opportunities and Greg Davis failed to capitalize on the potential mismatches Finley could have had.

5. Brent Musberger sucks with gravitational force of a neutron star. He failed to get a single blurb about the Griffin twins attributed to the right twin.  For instance, MARCUS was the high school QB and Michael was the running back. See, that's interesting and easy to remember because you would expect the superior athlete, MICHAEL, would have been the high school QB. He also repeatedly compared Troy Smith to Vince Young. No one compares to Vince Young. That should be grounds for immediate dismissal for any talking head. He also kept verbally licking the chode of Lauranaitis. The INT and runback was a good play, but the shit was thrown right to him. The fumble, however, was hardly a stellar play on his part. That play was pure bonehead by Pittman. This Lauranaitis dude did not impress me nearly as much as he did Musberger.

6. Somebody involved in the broadcast production should be fired for putting up a graphic noting that Ohio State had scored ten points "of" Texas turnovers. This is the big-time and that sort of thing should not be acceptable.

7. Selvin Young and Jamaal Charles are both badass. I think Texas could have ridden them to victory if they had stuck with the run early in the second half. Disappointed to see that Henry Melton seems content to waste yet another year trying to prove that he can be a running back. He will probably have 80 yards on 10 carries against Rice next week, but he needs to pull his head out and get on the D-line.

8. OSU: Troy Smith is very good, but I think the Texas D made him look better than he is tonight. Their running backs were not that impressive. Teddy Ginn Jr was that impressive, but I'm starting the Anthony Gonzalez for Heisman campaign. The Horns made that dude look like Jerry Rice. Their defense looked good, but weak against the run.
I think that is because their linebackers aren't great. But don't tell Musberger. It would break his heart to see how they were out of position to stop the off-tackle run 80% of the time.

9. People from Ohio are unattractive.

10. Baylor kicked the shit out of the div I-AA Northwestern State Demons. Sic 'em, BEARS!

1. I made a dangerous discovery this weekend: TVU.
2. Notre Dame tried to make me look like a genius.
3. Baylor blew it but showed signs of being decent. Their defense was great for most of three quarters. Their offense did whatever they wanted until they got to the red zone. If they avoid the turnovers on their first two possessions of the second half they win this game.
4. Michigan made me look less like a genius than Notre Dame.
5. Auburn is now my team to beat for the NC.
6. Sucks for Michael Bush, but now if Louisville does anything my dark horse Heisman guy has a better shot. But not bloody likely.
7. I don't study enough.

Things I learned on my walk with Phenie this morning
1. Ducks don't like cantaloupe.
2. My pet allergies are getting worse, as evidenced by my breaking out into hives after a dog licked my arm.

Cover songs that would rotate through my set if I were a musician
1. God Will by Lyle Lovett
2. Sweet Caroline by Neil Diamond
3. Don't Think Twice (It's All Right) by Bob Dylan
4. Sunday Morning Coming Down by Kris Kristofferson
5. Elderly Woman Behind the Counter in a Small Town by Pearl Jam
6. Papa Was a Rodeo by Magnetic Fields
7. Better Man by Pearl Jam
8. Broke Down by Slaid Cleaves
9. I was just thinking by Teitur
10. Hooray for Tuesday by the Minders
11. Strawberry Fields by the Beatles
12. New Madrid by Uncle Tupelo
13. Four Leaf Clover by the Old 97s
14. You Might Think by the Cars
15. Don't Stand so Close to Me by the Police

Things to do other than study for step 2 of the USMLE
1. Blog
2. Bask in Phenie's glory
3. Laundry