How to NOT become a cardiologist

Ever wondered how to put the brakes on a career in cardiology or [insert medical specialty of choice]? Well, you’re in luck! Here’s a foolproof plan to help you on your way to early career ruination.

Step 1: Go on observership with cardiologist. Make sure resident happens to stop by for ‘chat’ with attending (and when I mean chat, I mean sucking up). [Note: For maximal effectiveness, resident should also be Chief Resident]

Step 2: Write and talk about such ‘chat’ with friends and have good laughs all around.
Step 3: Attend small group session led by said Chief Resident.

Step 4: At end of session walk out of class and be sure NOT to check if Chief Resident is walking behind you.

Step 5: Proceed talking about Chief Resident. Be sure to mention their Chiefiness multiple times.

Step 6: Turn around and realize they were behind you the entire time.

Step 7: Run away quickly.

So there you have it, 7 easy steps to a sure-fire one-way trip to a career in something other than cardiology. But in the off-chance this does not work, I suggest running around the Chief Resident shouting ‘yo mama jokes.’

If, however, you do want to become a cardiologist, then please disregard above plan (and may I ask why are you reading this?). In fact, you probably should do the opposite and start some major butt kissing. Also, if you want to be a heart doc but you have followed this plan accidentally (WTF?), then congratulations because:

A) You have exceedingly bad luck and may I suggest that you never gamble
OR
B) You are the hugest idiot in the world and may I also ask how you ever got into medical school in the first place?

If you selected A AND B, then congratulations again, your name must be Stuff.

This has been a public service announcement from Second Opinion.

Now if you’ll excuse me, I’ll be curled up in fetal position in a closet somewhere, crying myself to sleep.

Okay Truffles, please post something so we can never speak of this again. And if you are said Resident reading this, please understand this is all in good fun. Please don't hurt me... I like your hair and glasses, and you are smart??

Please, no questions

So we’ve had another riveting set of lectures today on arrhythmias (when your heart goes whack, and decides to beat crazily). I’ve seriously hit a road block. This is sad, considering how excited I was for cardio at the beginning (Truffles can attest to this). I think it’s because we’re on week 5 of 6. And now things are beginning to look the same. Anyway, two more months and it’s summer!!

In my boredom, and generalized lack of motivation these days, I find that I’ve been searching the internet a lot lately. I came across this blog awhile back, but we just realized how much his description of his med class actually applies to ours. For instance, Truffles, cramberry and I likely belong to the “Anonymous Asian Female Section.” We actually sit roughly in this area too. Except we DO NOT use Hello Kitty notepads, and we love to make a lot of snarky remarks in class (okay that’s just me, haha). We too have a ‘question girl.’ What’s uncanny is that she sits in the exact same spot as his pic. Every lecture, guaranteed she’ll have her hand up. Okay, given I don’t mind her. She’s very nice, but sometimes…yeesh…please put hand down. Some of her questions are good and interesting, but others are so dang obvious. They make me want to scream, or at least run around in circles in my frustration. As an example:

Week 1 of cardio block
Doctor/Lecturer
“…so increased heart rate can actually have negative effects because it decreases the time for diastolic filling (the time where the heart fills with blood)…”
Week 3
Doctor/Lecturer
“…compensatory tachycardia (fast heart rate) can be decompensatory over time because of decreased diastolic filling time…”
Week 4
Doctor/Lecturer
“…diastolic filling of the ventricles may be shortened with tachycardia…”

So clearly we all had it drilled into our head that increasing your heart rate gives you less time for your heart to fill with blood. Okay, we got it. It’s been repeated for the umpteenth time.

Today after four hours of sitting in class on arrhythmias, wanting to kill self due to combo of tiredness, hunger and generalized boredom
Doctor/lecturer
“…so arrhythmias may cause tachycardia, and that may ultimately may lead to decreased cardiac output (how much blood the heart pumps per minute).”
Question Girl
[hand shoots up]
“Why does tachycardia cause decreased cardiac output?”
Me to self
Decreased diastolic filling time, decreased diastolic filling time, decreased diastolic filling time!!!
Doctor/lecturer
Well, you see, if the heart pumps too fast, there’s not enough time for it to fill with blood.
Question Girl
Oh
Me
GAH!!!

Power in numbers

Yay! So there will be NO lab exam next week. The anatomy course coordinator sent around an email today:

“Due to a lack of communication the date for the CVS/RESP lab exam was not posted on [schedule website]. My sincerest apologies.

Since the class was only informed about it this week, we feel it would be unfair to ask you to write the lab exam on the scheduled date of Mar25th…

I hope you have still gained some knowledge from the lab and will carry this forward into other areas of your studying, but under the circumstances you will not be directly tested on the lab material.”

How lovely of her. I think we can attribute this to a number of our classmates who kindly mentioned our ‘concerns’ to the Associate Dean. Thanks D! We heart you!

On another note, has any one read this article from Maclean’s regarding the doctor shortage? If not, it basically makes the assertion that the doctor shortage we are having in Canada right now can be directly attributed to the increasing number of female doctors and medical students. When I read this, I was horrified, shocked and exceedingly angered on how such a sexist, and ignorant statement could be made. To say that my fellow female colleagues and I do not work as hard as our male counterparts or that the reason Canadians cannot find doctors is because there are more females, is beyond wrong.

It is true that this generation is working much less than the older generation. However, I think this actually a good thing when doctors balance both their personal and professional lives. Plus this phenomenon applies to both males AND females. I mean happier doctor means better doctor right? I certainly would not want a depressed, burned out physician taking care of me or my family. A good doctor is a good doctor, regardless of their gender.

This scapegoating of females is shocking, and it was certainly an awakening for me to realize that such sexist sentiments are still rampant in our society. The fact of the matter is the doctor shortage is a complex problem we are facing in this country today. Many factors are involved including our aging population, as well as earlier policies made in the early 90s to limit medical school enrolment. It DOES NOT, and I repeat, DOES NOT relate to the increasing number of females in the profession.

I am happy, though, that we have many health care leaders supporting us in this case. The Deans of two of Canada’s largest medical schools (University of Toronto & University of Western Ontario) have written editorials in recent publications of the CMAJ and The Toronto Star to denounce these statements. To quote from them:

“To suggest that a physician workforce that more equitably represents women in the workplace is the barrier to access is frankly a sexist excuse for logic. To disparage in any way the intelligent, dedicated women from Canada and elsewhere who have chosen to devote their lives to medical practice is shameful. The blame game gets us no closer to achieving what Canadians expect from us — a health care system that provides quality and timely access to well-trained, well-equipped, compassionate health care providers.”

You tell them ladies!

And so it begins...

Happy St. Patty's Day!! Sorry for the long hiatus. We were on March Break, so forgive us for the absence. Trust me, it was a break we REALLY needed. Anyways, we’re back, for better or worse

So it’s that time again. The inevitable has happened. You know, that time when all the assignments, tests, exams, obligations, LIFE just comes at you. It’s started for us. We have our cardiology block midterm next week, and as luck would have it, they casually announced yesterday that our lab bell-ringer (organs/dead human parts placed in interesting positions for us to guess what they are) would also be next week. And just for kicks, it’ll include both cardio & ENT. ENT!! I haven’t looked at that in 2 months. And did I mention it’s NEXT WEEK!! Hold me, save me!!

On a lighter note, today our prof said this in lecture: “…remodelling means the myocardium is remodelled.” Uh yeah, and a horse is a horse, and apples aren’t oranges.

P.S.I read this comment from a reader of theunderweardrawer (awesome med blog, I live vicariously through her life):

“A new-ish med student on a surgery rotation was told by the intern before his first case case that whenever he farted in the OR, he had to announce it, so the attending wouldn't think they had nicked the bowel.Unfortunately, he had also had made some not-so-good dietary choices, so he felt the need, was unable to hold it in, and passed gas. "Uh, I, uh, passed gas," he announced. No one said anything. After a little while, it happened again. "Sorry, I farted again." A little grunt of acknowledgment from the attending. Toward the end of the case, it happened again: "I passed gas again."The attending stopped what he was doing, looked up at him, and said, "Boy, what is WRONG with you? This is a KNEE!”

HAHAHAHA…oh sweet procrastination, I love you.

That lovey dovey, that kiss kiss

Sucking up. Fact of life??

When I was on my observership on Wednesday, one of the cardiology residents just happened to step by to have a “chat” with my facilitator. When the doc came in, the following convo ensued:

Doctor
Hey, what’s up?
Resident
Hey Dr. __, so I was wondering if you have plans tomorrow night?
Me to self
Oh boy…
Doctor
Hmm, well nothing really. Why?
Resident
Well it just happens that I have these tickets for tomorrow but I TOTALLY FORGOT that I have a meeting that night. So I just randomly thought of you, and wondered whether you’d be interested in going…
Me
[Eyes beginning to widen]
Doctor
Yeah that’s really nice of you. Thanks. How much are they?
Resident
Oh no, no don’t worry about it.
Doctor
No, seriously. I’ll pay you back. How much are they?
Resident
No, no, it’s nothing, it’s nothing.
Me
[Rolling eyes]
Doctor
C’mon. I’ll pay you
Resident
Okay fine, they’re $___ each. But honestly, it’s nothing.
Me

[Making kissy faces behind their backs]

The doctor then leaves to do another procedure, leaving the resident and me in the room by ourselves. They don't say anything to me at all, considering I’m just the lowly medical student in the room. They stay, I'm guessing they were hoping the doc comes back, but he doesn't. So they up and leave.

I have no idea how the doc felt about this. He knew right? Like c’mon I could see it a mile away. But maybe it’s just part of the culture. Thoughts??

Note: This post was edited to protect the identity of those involved. AKA Stuff does not want the off-chance that fellow reads this and recognizes themselves and then DESTROYS her (Please refer to March 20th) ....

And they called it puppy love

Okay, fair warning. This is going to be a LONG post. I think it’s more for myself, to remember in the future what it was like. I went on my first observership today with my clinical skills facilitator.

So I got to the cath lab this morning (after the perilous trek through the snowstorm) nice and early at around 7:50 AM. The nurses showed me into the room where he would be, but warned me that hadn’t arrived yet, so perhaps I should go get some coffee. Of course, as nervous & excited (in other words, paranoid) as I was, I did not want to leave. What if he came and I was gone? And then he’d leave without me? So I decided to stay and wait. And I waited, and waited, and waited…

I thought a lot while I was there by myself. The cath lab is a cold and large, metallic room. It looked really unfriendly. I wondered what it would be like to a patient. I would have been really scared. I WAS really scared, intimidated and overwhelmed by the whole situation. I prayed that I would not cry… so I waited, and waited some more.

Finally, 9AM, and the doc walks in, sounding super-happy & energized: HI Stuff!!! How are you? Me to self - I’m cold, and scared, and I want my mom…

But he didn’t realize that because I’m a good actress, haha. After all the pleasantries, he began explaining what the first procedure would be – a diagnostic angiogram (where they thread up a catheter into a person’s heart, and inject dye to see if there are any blockages). He told me to stay behind the glass, and the tech nurse could explain stuff to me. I was slightly relieved.

For the next procedure, the doc suggested I get a pair of scrubs so that I could actually BE in the lab. EXCITEMENT ensued!! I was going to tell him that I already had said scrubs but before I could, they gave me a pair. In MEDIUM. Needless to say, the pants came down to my knees, and I had to roll them up three times. They were still too long. I digress…on top of the scrubs we had to wear these lead shields. They weighed at least 40 pounds. The one my facilitator had on made him look like a superhero. It was tight, black and had one sleeve. (Okay I admit it, I thought he looked hot, but don’t tell). Mine had flowers. He looked like Batman. I looked like Mrs. Doubtfire.

So we went in, and he showed me what he was doing. The femoral artery at the femoral head was located by aspirating and looking for pulsatile flow. He thread the catheter up, and he explained how they were looking for blockages within the RCA, LAD, etc, and testing for LV function. It was fascinating. I mean, they had a tube right in this guy’s heart! An image of the vessels came up on screen. It was strangely beautiful, like rivers cascading down.

I observed another 4 cases throughout the day. One case was particularly interesting. The patient had multiple lesions, in addition to a huge thrombus (clot) occluding one artery. They had to suction the clot out, and balloon the vessel multiple times. This patient needed 3 stents (wires that keep the vessels open)! They even performed a technique called “kissing-balloons.” How romantic!

The doc taught me a lot today. He was very patient with my questions (even the stupid ones), and he took a lot of time to explain the little details of everything. I admit, I am in a little awe of him. Okay, fine I have a huge crush on him.

So the day was really great. The only thing was that it lasted until 5 PM. I just didn’t know how to leave. Every time I was working my way to tell him, he’d start explaining the next case. So I sort of felt obligated to stay. But I don’t regret it, because he went over a lot of stuff at the very end.

The other thing was that the whole day, I had at the back of mind: Do not be the overly eager med student. Give him his space!! But I was following him around so much, I felt like a lost puppy. He’d go out, I’d go out. He’d sit down, I’d sit down next to him. I hung on every word he said. I was his shadow. But I think I got better at the end, but only because I was pretty exhausted at the end of the day.

Yeah, so I learned A LOT today. I’m very happy that I went. My facilitator is awesome. He is my new idol…but enough with that, I’ve written too much already. Now time for cardio assignment, boo…

P.S. Oh I forgot to mention, I had to skip out on class today to go on this observership. And as luck would have it, I met the doctor who was giving our lecture today. He discovered my delinquency! I apologized, but he was cool with it…

[N.B: Advice for other students – be careful not to be TOO eager that you step into the sterile field. Consequences maybe severe. Proceed at own risk.]

My cat's breath smells like cat food

Today was one of those days where I really question my own intelligence. This afternoon, I had my advanced interviewing session. It was my turn, and even though it wasn't the easiest case, I think I did pretty well. I fleshed out a lot of the issues that the standardized patient (actor pretending to be sick) had.

So during the break, I was feeling pretty chuffed with myself. While everyone was getting them some Timmies, I decided to visit the little girls' room. Now, smart little me somehow decided to take a DIFFERENT route to said bathroom:

Me to self

Hey, let's go around back and save some time!...Oh no, there's another group in there...Okay, let's try this other door. Oh crud, it's locked. Man this is getting embarassing. Okay, better go back from where I came from.

[turns around and tries to go back]

What the flip...oh no, it's locked!!! OMIGOD, I've locked myself into a box.

I finally managed to open a third door, which led to the parking lot. Ah, what cleverness. What's ironic is that in 3 years, I could be YOUR future doctor. Be afraid, be very afraid.

Warning: May cause excessive daytime sleepiness

What is up with me and pathology? We’re now right in the middle of our Cardiology block, so for the past couple of weeks we’ve had a few lectures in cardiovascular pathology from this one doctor. Now don’t get me wrong, I find pathology pretty interesting (considering I had a specialist DEGREE in pathobiology), but every time this guy lectures, I fall asleep. And no, it’s not the subtle head-nodding or even brief eye-resting. I have a full-on snoring (if I snored), limb paralyzing, REM sleep.

So today I was fully ready for this. I propped myself up, I had a snack of cookies ready for a good jolt of sugar. But I couldn’t fight the inevitable loss of consciousness.

Doctor
“…ischemia in the epicardial coronary arteries… blah, blah, blah…”

Me to self
[eyes closing] Fight it! Fight it! NOOO! Cannot help it, eyes will not open…cannot fight it…okay give up…nap time for me

Yes, so I fell asleep. Completely unconscious, body horizontal onto the next seat, drooling from side of mouth (no I kid…at LEAST I didn’t drool). I think I even had a dream. I finally woke up when my pen fell from my hands.

I feel very embarrassed about my obvious narcolepsy. I don’t do it on purpose. But it’s almost like my body knows it has to sleep as soon as he opens his mouth. What’s worse, I saw him in the halls today. We made EYE CONTACT! And I knew, I just knew that he recognizes me as the girl who never stays awake. I guess cardio-pathology won’t be in my future anytime soon.

I think I have a pulmonary embolism...

Funny characteristics about the odd, pale, sleep mazed creatures that are your average medical student: (if you see one on the street, offer the poor thing the coffee sludge at the bottom of your cup... s/he needs it)

1) They immediately think the worst.
Doc: "56 y.o. male came in with history gradually increasing left hip pain starting 6 months ago and trouble sleeping at night because of the pain. Give me a differential."
Student: "Must be cancer metastasizing to the bone."
Doc: "You don't think it might be osteoarthritis?
Student: "Nope, it's gotta be cancer."

2) They go straight to the most aggressive (usually completely unnecessary and expensive) investigations.
Doc: "So what would you do to confirm the diagnosis of osteoarthritis?"
Student: "Full body MRI, stat. We don't want to miss any potential TUMOURS."

3) They're convinced that they have whatever disease/condition they're currently studying.
The entire lecture about soft tissue tumours, I was convinced I could feel a lump growing in my abdomen. During our week on back pain, I had shooting sciatica pain down my leg every morning. When we were studying the brachial plexus, I felt some mild tingling in my 4th and 5th fingers and was sure that my ulnar nerve was somehow pinched. No one ever told me that medical school was a risk factor for hypochondriasis. I'm sure Stuff can go into this in much more detail.

Let them eat cake

On Thursday night a couple of us went to a dinner sponsored by the Rheumatology department. It was basically a night to introduce medical students to the field of rheumatology. There were some talks by the rheumatologists and residents in the program and by the end of the night I think a lot of us were pretty pleasantly surprised by what we heard.

Rheumatology seems to involve a lot of interesting cases, patients and a great lifestyle. Love House? Then Rheumatology is for you (lupus anyone? vasculitis? how about sarcoidosis??). So it was an informative night, and a lot of people I think are now seriously considering going into rheum.

The only thing that sort of bugged me about this whole thing was the fact the night was paid for by a drug company. It was on my mind the whole night. I mean, what was their ulterior motive? I saw one lady from the company talking earnestly with a couple of my classmates, and wondered what were they discussing?

I don’t know if it’s just me, but I felt sort of strange and sheepish about the whole situation. Almost like Julia Roberts in Pretty Woman minus Richard Gere, and lemony cheesecake goodness in the place of money and clothes (mmm…cheesecake)…And what’s worse, there were no free pens or post-its!! (joking, but those would have been nice, haha).

I know this is the nature of the beast but I just hope that these sorts of things don’t sway or influence my judgment in the future. I would not want it to compromise my patients’ care, just because I got some fancy chicken for dinner. I don’t know…how do others feel about this?