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!

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.

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!

I don’t travel much, but I did pay attention when they started banning hair gel on flights. Now, I’m sure that’s a legitimate threat, but they’ve missed something that certainly has the potential to do tons of damage. Perhaps you have heard of the Mentos and Diet Coke phenomenon? If you haven’t, you should pay attention as it may have serious implications for your personal health. Now that is probably reason enough to ban mentos from airplanes, but now it’s gone nuclear! I am not kidding about this in the slightest. I have to fly to Houston soon, and if I see some bearded fucker 
munching a Mento on the plane I’m taking him out. Let’s roll.

PS New pics up at Phenie’s flickr page, including my favorite.

How badass is the internet?

This badass.

I used to hate Bill Simmons, but over the last few years he has really grown on me. He is possibly the only self-aware but completely fanatic sports-writer working today. I still think that a corporate international multi-media juggernaut like ESPN ought to be able to spring for an editor who could prevent things like the lack of closing quotes in the plug for Simmons’s book. Or even the act of using quotation marks around the title of a long work such as a book, which in the setting of italicized text (as at the bottom of the Simmons article) should be underlined. Whoever is supposed to be editing this stuff should also have realized that hot dogs don’t “live up the hype”, but rather live up to the hype. If they were really good and feeling ballsy they
 would have pointed out to Bill that you shouldn’t state that “Nothing, and I mean nothing, can remotely approach” the greatness of an event only to state two sentences later that “It can be approached, but it can’t be topped.” I’m very glad I’m not going to have to spend the rest of my life looking for shit like this to pay my bills, but somebody is getting paid, probably pretty well to fix this stuff, and they are blowing it.

I guess I should just be happy he spelled “definitely” right.

After working in the psych ER at Parkland and observing some of the interesting family dynamics involving most of the patients there, it’s easy to become cynical. Coming home from that to read children’s books to a (nearly) one-year-old little girl can be a little unsettling. In this case, however, it uncovered a blogging goldmine, baby!

Here’s what some children’s books might sound like if written by a cynical observer of the lives of psych patients.

Title: Mama do you love  me?
Synopsis: Eskimo child repeatedly questions mother’s love for her, and mother calmly answers affirmatively using obscure nature imagery (e.g., a puffin howling at the moon).
The Cynic’s Version:
pg 1 “Mama do you love me?”
pg 2 “No, but I would if you weren’t so fat.”

Title: Is your mama a llama?
Synopsis: Clever rhyming riddles about animals ranging from bats to seals.
The Cynic’s Version:
pg 1 “Is your mama a llama?”
pg 2 “No, my mama’s a lying ass bitch and she come near me again I’ll cut her ass real nice.”
pg 3 “Oh, I heard that once, no need to say it twice; your mama’s that ho that sucked my dick when she couldn’t pay for her ice.”

Title: Where’s the baby?/Donde esta el bebe?
Synopsis: Pictures of baby’s toys and places (crib, high chair, etc) with fold back panels that reveal the same pictures but with a baby included.
The Cynic’s Version: pg 1 [Picture of baby food in a bowl on high chair tray.] ”Where’s the baby?” fold back panel [exact same picture but with an arrow pointing to bowl of food] ”You’re eating it.”

Title: Guess how much I love you
Synopsis: Baby rabbit and his dad try to one-up each other with metaphors about the volume of their love for each other.
The Cynic’s Version:
pg 1 “Guess how much I love you.”
pg 2 [picture of daddy bunny with tourniquet in his teeth getting ready to shoot up] “Fuck off. Daddy’s busy.”
pg 3 [picture of daddy bunny passed out] 
pg 4 ”Fuckin’ asshole.” [picture of baby bunny pissing on daddy bunny]

That’s all the low-hanging fruit from the baby’s bookshelf. 
It frightens me how funny I think this post is. What the hell is wrong with me?

Dear Dr. Cunty McCuntybitch,

I just wanted to take the opportunity to apologize for my role in your poor choice of career. I know that I should have done more to prevent you from making the terrible decision to go into Ob-Gyn. I should have looked out for you, letting you know that as overweight, unattractive, and ill-tempered as you are the last thing you needed was a career that precludes having a lifestyle that allows time for the occasional relaxing night out, exercise, and (in your case) more exercise. I know we just met and I couldn’t have known you two years ago when you were making this ill-fated decision at whatever school your 23 on the MCAT got you into. Still, I recognize the crucial role I must have played, or rather, should have — and failed to — play. As you chewed my ass in front of everyone for thinking that the lower limit of normal for the length of a cervix was 2cm rather than 2.5cm, two things became obvious to me. One, I don’t give a flying fuck about the length of a woman’s cervix. Two, you blame me for your current predicament. The unprovoked and unwarranted hostility allows no other conclusion.

When you asked “Are the charts for rooms 4, 5, and 6 all toned?” and I replied in the affirmative only to hear “They better be”, it’s obvious you were really saying “I’m glad you did that awful busy-work for me even though you are not technically my employee, but I’m still nothing but a miserable fat ugly thirty-year old with no prospects for love or even companionship who foolishly chose a profession that works me to the bone (or at least to about halfway through my copious subcutaneous adipose tissue, but would be to the bone on any human with a BMI of less than 35) and surrounds me with the ultimate example of everything I will never achieve in my life: love, family, bringing life into the world.” And when I muttered under my breath “What a bitch,” what I was really saying was “What a stupid, fat, ugly bitch.”

At any rate, I just wanted to let you know I am sorry for letting you down. I hope you manage to overcome my failure and find it in yourself to forgive me. If you want to talk about it you can give me a call anytime. I’ll be at home. With my wife. And beautiful daughter. Who love me very much.

Bitch.

 

Sincerely,

Matt

… I’m in the lowerarchy.

… if I were in the clergy I’d be the altar boy’s bitch.

… if I were a monetary unit I’d be the tyiyn.

… if I were an ex-President of the United States I’d be William Henry Harrison.

… I’m like really far down and stuff.

 

Q: Why do they nail coffins shut?

A: To keep the oncologists from administering more chemo.

 

See, it’s funny because oncologists seem to routinely continue aggressive treatment of people who are obviously in their last throes and would actually benefit more from receiving better palliative care. Now that’s comedy!

What do pulmonolgists call blow jobs?

Incentive spirometry!

*crickets*