The one with tophi on a saturday morning

My preceptor is a family physician in a suburban-ish town about 20 minutes from my house. I usually go in to work with him on tuesday afternoons. For the most part I am his bitch and he is my pimp. He tells me to do stuff and I try to get it done properly, lest the wrath of Dr. Randy descend on me. I'm making it sound worse than it is, in reality Dr. Randy is an awesome person and I learn a ton at his practice. I have seen/done more procedures with him that I would have ever thought possible at a family clinic. The only problem I have with Dr. Randy is that since I go in on Tuesday's, there are only so many patients I get to see a week. Tuesdays are not really busy days, especially from 2-5 pm. So to change this up I decided to try going to preceptor on a saturday morning a couple weeks ago.

Holy crap.

As I walked in that morning Debby (head nurse at the clinic) ran up to me with a very excited hop in her step. "I'm really glad you came in today, you're gonna love looking at Frank." Frank as it turned out was a patient with some VERY advanced gout. Gout is a condition where uric acid crystals start to become deposited within your joints. This means that you get swelling around all of your joints because they start to fill up with these crystals and become whats known as "tophi." As a result you get gouty arthritis, it is painful to say the least. Now gout is a condition that is very treatable and with diet and medication it can be kept under control.

Frank's gout was definately NOT in control.

My first reaction when I saw him was "HOLY SHIT HOLY SHIT HOLY SHIT!!!!!!!" followed quite closely by "I'm gonna throw up." Imagine if you will a baseball, now put a baseball each on your elbows, neck, and knee. Add to that some seepage of white tophi fluid from said baseballs. Finish it off with little ping pong balls of seeping tophi fluid on the ears and eyebrows. That was Frank and this is what happens when gout gets really really out of control.

Dr. Randy told me that most physicians see this type of gout perhaps once in their career because it is so rare. The reason for it is simple, most people seek out help lonnnnng before gout gets this bad.

After seeing my reaction to Frank, which was mostly mental since the only physical reaction I had was a widening of the eyes, Dr. Randy decided that I should spend some time alone with frank getting his history. This was a pointless endeavor because they already had his history, but because I saw that Mr. Miyagi look in Dr. Randy's eyes I decided to suck it up and let the wax on wax off begin.

Frank was actually a pretty cool guy. He started talking to me as soon as I was alone with him and gave me the full breakdown of his current gouty condition. Frank was diagnosed with his gout by Dr. Randy about fifteen years ago. With the help of his wife he had been able to keep it in check without any flares of gouty arthritis. Frank's wife passed away about four years ago and ever since then he has been in depression. The depression wasn't what you might think it was. He was still the jovial person he normally is, he just stopped taking care of himself. It started small with skipping meds everynow and then until finally he quit on that altogether. Some time passed and without realizing it his gout had flared up to the stage where he was today. I asked him how he was able to bear the pain for so long without realizing the severity of it, but Frank was a 'Nam vet who was already used to dealing with massive amounts of paint. Thus his pain threshold was drastically higher than most peoples'.

What actually caused Frank to snap out of this depression was when he realized that all of his friends were no longer stopping by to visit and they were starting to shy away from him in public. This did not bode well for Frank because I imagine that like me he lives to entertain and be the life of the party. In this manner Frank found himself at Dr. Randy's that morning looking for a way out of his condition.

I was dumbfounded by Frank's story because it was completely unexpected. For the most part when you see someone with an illness, you tend to separate them from normal society and begin to treat them differently. This is what is known as "disease." It is a social condition, not a medical one. Illness can be treated, disease cannot because it is equal parts social as it is physical. The most debilitating part about disease is that once we associate somebody with it, they become just another statistic. We forget that they are people as well and that their lives have meaning.Dr. Randy was treating him with an IV dosage of medicine and I was in charge of monitoring his status; this worked out really well for me and over the course of the morning Frank continued to tell me about the ins and outs of his life.

I left Dr. Randy's clinic that morning with a newfound appreciation for medicine because not only does it help us cure an illness, it can help us begin the fight against disease. Frank showed me that just because a person might look grotesque, it does not mean that we should shun them. The treatment of disease begins by overcoming the mental barriers that society puts AGAINST helping the diseased. Once you start to peel back the layers of the patient, it becomes apparent that they are just another person with an illness. As people in the medical profession, it is our duty to go out and overcome these barriers so that we may better help out patients.

I have seen Frank a few more times since that first encounter and I am pleased to say that he is looking drastically better. His baseball tophi are now ping pong balls and the ping pong balls are now peas. His friends have started coming over again and he has confided that this turn of events is what is keeping him on his medication now. Frank no longer has a disease, he is merely ill.

PS: I have obviously changed the names of everyone involved. HIPAA bitches!

The one with the Lounge Games

It is currently 12:03 AM and I've just gotten back from a night of studying for ISF (screw you kidney, nobody ever told you to be complicated!). Ironically, whilst studying the properties of the wonderful limabean shaped organs that clean our blood, I drank so much caffeine that I demonstrated very well all of the properties of the collecting tubules. Ok thats enough with the nerd talk.

Anybody ever remember that episode of "The Fresh Prince of Bel-Air" where Will got hustled at a pool hall? Uncle Phil turns up to save the day and starts getting his ass handed to him. Eventually the hustler gets bored and decides to raise the ante to $100 a ball and then all of a sudden Uncle Phil gets serious and tells Jeffrey to "bust out Lucille." All of a sudden Uncle Phil is a beast at pool and it turns out he's the biggest hustler in the history of the sport (the one handed shot he takes while eating a sub still has me rolling on the floor). I've always wondered how Uncle Phil got so good at pool, now I know: dude obviously went to med school before going to law school.

The lounge at my school has two pool tables and at most hours of the day there is somebody playing there. More often than not, its somebody who should be studying but desperately needs a distraction. I count myself amongst this group of people because whenever I get sick and tired of staring at a book, nothing is better than a game of pool or darts or mario kart or etc. Hell if they had a shuffleboard set down there I'd probably play that too.

It doesn't matter what your interest is, if you want a distraction the lounge has it. It wouldn't shock me one bit if the next billiard world champion is an MD. Seriously, most nights watching the really good people play is like watching ESPN 2 at 3 in the morning.

Whats more is that pool isn't even the most followed game in the lounge, that honor is reserved for the king of all medschool distractions: Ping Pong.

There is a rumor floating around that a pre-requisite for admission to our school is being beastly at Ping Pong. I believe it. It seems to me that 99.999999% of our student body has some talent at this ludicrous game. Hell the lounge event of the year is the singles ping pong tournament, or as most people call it, "The Battle For the Paddle."

Night and day you'll find Colin, Shudan, Vivek, Lee, Neil, Kareem, (insert any name here) downstairs playing pong. And trust me, these guys are good. Take all the anal tendencies that go into creating a medical student and now apply them to ping pong and what you get is a beast that even ESPN is scared to cover.

If you move a little bit over from ping pong you'll find the THREE (!!!) TV's lined up against the wall that are host to most of the consoles in the lounge. Here is where the Mario Kart, Goldeneye, Gears of War, Halo, etc. matches live. I hear that the South Korean Video Game TV Channels are in negotiations with the Lounge Lords over exclusive rights to broadcast the ridiculous matches that take place here.

All I'm saying is, for all of you hustlers out there, if you ever find yourself at a bar playing against a kid that looks like he/she should be studying instead of being hustled, walk away. Because I guarantee you that if its a doctor/med student, you WILL get hustled.

I'll end this on the lounge game of my choice: darts. I used to suck at this game, but these days I'm like those assassins from "Wanted" (that Angelina Jolie film with the curving bullets). I can make this darts do whatever the hell I want. One day while playing Jeff, I needed to get 12 bullseyes before he got 3 to win. I hit that 12th one before he got his first.

The one with the beginning

My name is Zeeshan and I currently spend my days as a first year medical student. This blog will be my chronicle throughout my life in medical school, provided I have the time/desire to update often enough. I suppose I should have started this blog at the start of medical school. However due to the fact that I spent the first two months having near panic attacks, I think the late start can be excused.

Why do this blog? Simple, at some point in my life when I'm not in crippling debt or constantly studying I want to be able to look back and have something to show the journey it took to get there.

Additionally I want to be able to chronicle (if possible) the process of becoming a doctor. I know there are a lot of tv shows out there now that have tried to do the same thing but take it from somebody who is going through it, it is NOTHING like that. I WISH that medicine was like Grey's Anatomy or Scrubs. It would make life a lot more interesting and everybody would be hotter. But sadly it is not.

I once asked a classmate of mine at a party how he was doing and this is what he told me:

"You know how I'm doing because you're going through the exact same thing right now. All of us are. I think I have more in common with you right now than I do with my closest friends."

That is the frank truth because as medical students we all go through the same thing. Whether you're in California or Maine, its the same. At times it sucks and at times it is amazing, but the journey through medical school is both incredibly unique and incredibly commonplace.

However you found yourself on this blog, I hope you enjoy reading it. And future-self, if you're actually reading this you better have a great wife and kids, a job you love, a big ass house, and numerous fast cars. If you don't, get a time machine and stop yourself from doing this!