I started to get into rock climbing about 5 months ago and recently it has been the only physical activity I’ve been engaged on a consistent basis recently. I been taking it pretty slow, trying to nail down easier climbs, improve my strength and endurance, and develop my climbing IQ before jumping into higher level climbs. What I’ve enjoyed about climbing is that each one is a puzzle, and as you move to more difficult climbs it doesn’t just get more physically demanding, but it also requires you to think more critically and creatively, and just like with mental puzzles, even when you get it wrong the first time something about it has you coming back to try it again to figure it out. There is not just one way to do any particular climb, but there usually is a “best” or “lowest effort” way. The freedom to fail and to try things out and work slowly is something I’ve missed since being back in school, so it’s been nice to have this as an outlet.
Drug reps coming to the office for lunch is so awkward. My attending clearly doesn’t want to talk to them, but obviously they are there to try and do their job and talk up their medication. I know it’s all about getting free lunch or whatever, and I don’t think anyone should feel bad about taking resources from pharmaceutical companies, but also I can’t help but feel bad for these folks who are being given a hard time just trying to do their job.
There’s going to be a lot of advancements in neurology in the coming decades I feel, and so maybe it is a could be a good place to be, I just need to find the kind of practice that matches what I’m looking for.
I’m learning. Each day I come in, I (we the students collectively) are answering more questions correctly. Today I impressed the attending by adding Lesch-Nyhan syndrome to the differential of a hypothetical patient. It was the first time I saw him say, “That’s a good thought,” non-sarcastically.
Being back in this community setting I think I am getting a better idea of what my ideal practice would look like in the future. Right now I feel like one of my biggest concerns is not having the bandwidth to do all the things I want to do in both my personal and professional life.
When talking about seizures, we often talk about a postictal state – a period of altered consciousness or fatigue after seizure stops. I only recently made the connection between that term ictal and something I learned about back in high school marching band. Ictus refers to an inciting event and is often synonymous with the onset of a seizure. In music, the ictus is like a recurrent beat and in the case of conducting, I was taught that the ictus was the bottom of my arm strokes, which indicates the exact moment of the beat (can also think of it as the apex of the stroke). I’ve known both these terms, at least since I was in high school but didn’t realize the connection/ similarity until my attending said the word ictus in clinic the other day (usually when talking about seizures we always hear -ictal).
I don’t have a deep life-lesson or reflection to glean from this realization, I just thought it was interesting.
I recently found out my entire existence up to this point has potentially been a lie. As long as I could remember, I lived believing I was a Sagittarius. All the basic astrology sites and calendars I’ve used told me November 22, 1995, the Sun was in Sag. Turns out at 7:00 AM that day, it was still in Scorpio. Every horoscope I’ve read, every personality reading rendered based on my birth chart, became a complete and utter farce. The thought had crossed my mind before since my birthday is right on the cusp and some astrological calendars consider Nov 22 to be in Scorpio depending on the year. But this was the first time I actually went through the trouble of confirming (as far as I could recall).
As I was planning out all the changes I would need to make to my personality, wardrobe, lifestyle choices, etc. I thought I’d better double check the time of my birth with Mother. I immediately called her with an urgency befitting the situation. She didn’t pick up, so naturally I called 3 more times before I decided to give it a rest for the time being.
Eventually, she called me back and confirmed that I was in fact born at 7:00… PM. So crises everted and the world will be ok. I moved all my bedroom decorations back to the way they were earlier that morning and canceled my appointment with the tattoo artist.
I was told several times today by patients that my Spanish sounded good. Part of that could be just because I always start this interview in Spanish with and introduction and do some simple history taking before explaining to them that my Spanish is actually not very good and that I will need to call a translator. Is this kinda fishing? Maybe, but also if I call the translator right in the beginning then I am missing and opportunity to practice my Spanish, and ultimately I verify everything to make sure patient care isn’t being compromised. Plus the positive affirmation is encouraging for me to continue practicing.
Anyways being back in this community clinic setting is reminding me how much I enjoy outpatient medicine. Neurology is growing me a bit, the puzzley aspect of it can be fun sometimes, but also much of the rest of medicine is pretty puzzley.
It can be hard being constantly confronted with the massive gap between where I am at and where I feel like I should be. That sad I do feel like I am making progress each day, even if small. Over the few days I’ve been able to go into clinic I definitely have had many opportunities to practice my Spanish and slowly I am feeling more comfortable with basic conversation.
I need to work on just being more comfortable with some material so I thinking about localization and stuff is just second nature. This is going to involve just making a lot of mental connection between things.
I found out that my attending is friends with my uncle. I don’t know if it’s a good thing or a bad thing that my attending knows that. Today one lady accused me of curing her tremors with my presence. The clinic was otherwise pretty standard, the usual Alzheimer’s, neuropathies, seizures. Been getting a lot of Spanish practice which has been nice, definitely getting more comfortable.
Still not sure how I feel about the pace of the clinic. On one hand things move fast, and the day goes by fast and it kinda feels efficient, and I the volume of patients and number of students spreads out some of the pressure, especially since we don’t even really present. On the other hand, sometimes I feel like the patients need more time, if nothing else to express their concerns in general. But maybe that’s the ~beauty~ of specialty work, you don’t really concern yourself with problems that aren’t related to your specialty, you just kinda hope they have good primary care.
It was my first full day in the clinic and there were 5 of us students total. It’s a busy clinic so it actually wasn’t terrible; I don’t feel like any one of us was just sitting around the whole time. In terms of what I am seeing in the clinic, it’s about what I expected. A lot of strokes, carpal tunnel, Parkinson, seizures, headaches. Mostly pretty straightforward stuff and the attending moves very quickly. Whether its a new consult or a returning patient, he typically doesn’t spend longer than 5 minutes in the room.
Lunch was provided by a drug rep today and all us med students sat with the attending for lunch. We had a pretty interesting conversation about how to “survive” after medical school. He was giving us all these tips about maximizing our deductibles and stuff.
Neurology seems like a decent lifestyle. Pretty predictable work, good clinic hours, possibility of inpatient work. I’m just not sure yet if I like the medicine, but I haven’t ruled it out yet.