Kevin and David say goodbye to Yellow Magic

Relax, it's not the end of our postings.  We have simply decided to rename the blog in the hopes of having a title that's more medically relevant.  If everything goes according to plan your browsers should automatically forward you to the new address and this post will be pointless.  But for those of you with antiquated software or are reading this via a RSS feed, please change your bookmarks, homepages, tattoos etc to:

http://www.iddxblog.com

David Discusses 5 Things He's Learned in Microbiology

One of the most important skills one acquires in medical school is the ability to synthesize endless amounts of information and develop useful frameworks with which to organize and understand seemingly disparate concepts. In Microbiology, we learn about myriad bacteria, viruses, fungi, and other baddies ad nauseum, and depend on a variety of such strategies in order to make sense of what sometimes feels like an insurmountable mountain of minutiae.

Looking for high-yield study tips? You've clearly come to the wrong place. Instead, here, in no particular order, are five important things I've learned in Micro so far:

5) Not all fungi are fun.

This pearl of wisdom is from Kevin. They can't all be winners...

4) It's time to page Dr. Robot.

So far, it seems like a computer would be as good or better at diagnosing all of the diseases we've studied. Sure, there are subtleties about each, but for the most part we're focusing on things that approximate a complicated checklist (Fever? Y/N. Burning while you pee? Y/N. Excessive play with turtles? Y/N).

Clearly, the next step is to invent Dr. Robot. One probe in the mouth, another down south, and a way to input the patient's responses to a series of questions that help the robot pinpoint the disease. You could even put a little white coat on him and give him some outstretched arms so people know he cares. (Alternatively, we could just find a human physician named Robot who's a whiz at ID. As long as someone's called Dr. Robot, I'm happy.)

3)Noah should have raised admissions requirements for the Ark.

After God told him to pack up the boat, perhaps Noah should have been a bit more selective about which animals made the cut. He really couldn't find two rabbits without Francisella or a couple flying squirrels that were disease free? He couldn't spare five minutes for a quick delousing effort? Pretty lazy, Noah, even for you.

If animal cleaning wasn't Noah's bag, at least he could've sealed the ship before the syph hopped on board. Nobody wins when genital lesions are involved.

2) There already is a Kevin* Disease (with a twist).

Apparently, a Kevin* Disease already exists. Yet instead of one that Kevin discovers and names after himself in order to watch his viral namesake wreak havoc across the third world, this is a bug seemingly tailor-made to infect Kevin. Perhaps we could call it Bizarro Kevin* Disease? BK*D is actually Bacillus cereus , a bacterium sometimes found in poorly heated fried rice. Tragically, his greatest friend has become his deadliest foe.

Now, every time Kevin uses the microwave, he's walking a tightrope walk of death, through a ring of fire, over a pool of sharks with laser beams mounted to their heads and dogs on their backs that shoot bees out of their mouths with each bark. His life has devolved into a terrifying game of Chopstick Roulette.

1) The vagina is an extremely dangerous place.

Contrary to popular belief, what may seem like a bed of daisies and kittens can actually be a raging cesspool of microbiological evil. Every bug and its brother kicks it in the vagina. Want more evidence? Look at all the bad times that befall neonates. What more would you expect from something that has to bust through this danger zone to make it to freedom?

David realizes things finally matter now

At this stage in our education, there has finally come the point where what we are learning will have an immediate, signficant, maybe even life-alterating effect on others in the relatively near future. For me, this marked shift from previous educational experiences seems like a big, perhaps too often glossed-over transition. That is not to say I didn't see this coming long ago - soothsaying and double-negatives are two of my hobbies - but I still think the distinction warrants mentioning.

In high school, some people may undergo fundamental intellectual changes, as they begin to think more abstractly and independently without necessarily allowing teachers or other authority figures to dictate their conclusions. Yet despite all this wonderful personal and intellectual growth, the main scholastic endgame is a golden ticket to the highly-coveted next round: college, and hopefully a good or great one at that. For a lot of students, the academic part of the high school years is less about truly learning and more about getting the grades and SAT/ACT/SATII/ACT3/PSAT9 scores to climb the ladder of undergraduate tiers and get as high up as possible. Though obviously not the only, or even most important, measure of success, getting into a good college still remains a landmark achievement that many identify as the primary educational goal of their upperclass years.

Once you reach Eden University, with its manicured lawns, red-brick quads, flowing fountains, and more libraries than one could ever imagine, then what? Do you learn for learning's sake and explore a whole new intellectual world whose vivacity tickles you deep within your knowledge loins? Maybe you do (or even should). Or maybe you, like countless overs have before, find yourself in the next race, working towards another weighty, seemingly nebulous yet arguably life-changing achievement four more years down the road - med school. That'll be a profound, baby-saving party that won't quit, right? Actually, yeah, it very well could be all that and a bag a Fritos.

Yet because reaching that goal can be challenging, your college time might be spent working towards similar grade/score ambitions that might occasionally force actual learning to the back-burner out of sheer practicality. This isn't necessarily bad. It's hard to do well enough in college to get into medical school, and sometimes, where learning best and improving a grade aren't 100% compatible, it makes sense to favor the latter for the time being. For many, paving the road to the next step is more important than appreciating or learning from every noteworthy stop along the way. Besides, there will be time to catch up on things that were missed or glossed over, and even what's been well-internalized will require quite a bit of brushing up in 1-2 years. So, even if one isn't completely sacrificing learning at the alter of the almighty 'A', a bit of a compromise is sometimes made en route to the ultimate goal.

BUT, once in med school, things actually matter. Sure, grades and scores remain important, but skating through important material with only a mind for H/P/F/whatever may leave students unprepared for the clinical applications that are fast approaching. In college, one could feasily put off O-chem and only do enough to get by in the class. Even the BS MCAT section doesn't require any particularly in-depth O-chem knowledge. In med school, we can't just ignore microbiology and expect it never to pop up in the future. Sure, one might pass the class without knowing all the important details, but the difference is that, sooner rather than later, this stuff is going to be of practical, unavoidable importance. Perhaps this is no big revelation for most people, but I'd argue it represents a fundamental difference in the educational endgame and significantly changes the required approach to the curriculum. This is simultaneously awesome ("Hey, this stuff actually means something now") and maybe even a bit daunting ("Hm, if I don't learn this, there will be real consequences for other people"). Or, perhaps, everyone knows and takes this concept for granted, and I'm just slow enough to find it worth discussing.

Hopefully, this is food for thought. As long as it's not Moroccan food. Excuse me, can I get a fork...

David presents 5 Guys You Don't Want to Be

As two-plus quarters of medical school have conclusively proven, the perfect complement to learning about baby-saving is complaining to random people you don't know who happened upon your blog because they shadily typed in "crazy hot" during a Google search. To continue this worthy pursuit, I present the following list (Kevin's to follow soon):

5 Guys You* Don't Want to Be**:

5) Bad Birthday Present-Giving Guy

Not everyone can give amazing birthday presents (like a giant gift-wrapped box that contains progressively smaller boxes, until all that's left is a lot of boxes, discarded wrapping paper, and no actual gift (or maybe a really nice card!) - Classic!), but some gifts really should have been reconsidered. If you're buying a present and thoughts like "Teehee, this'll be really funny because it's sexual!" or "Here's a novelty T-shirt no one in good conscience would ever wear" cross your mind, it might be time to move on to the next item.

4) Self-Righteous About Obvious Or Long-Ago-Resolved Causes Guy

"You know who I hate? Racists! How can they discriminate against people on the basis of something as superficial as skin color or ethnic heritage!!?" We've all met this guy once or twice and, despite his good intentions, it's a bit tiring to listen to him tear down prejudices or viewpoints no reasonable person you know actually supports.

Yes, SRAOOLARC Guy, we also believe that kicking puppies is bad and that that thing that happened decades ago that everyone back then agreed was wrong is still wrong today. Thanks for yelling.

(If SRAOOLARCG had a cousin, he'd probably complain about people who don't let him into their lane on the freeway and make jokes about how they should make the entire plane out of the black box.)

3) Jesse

Self-explanatory.

2) Cliche Tattoo Guy

Barbed wire may be good for keeping people off your fence, but the time for inking it into your arm has passed. And if you decide an Asian character is a must, make sure what you think means 'serenity' doesnt actually mean 'face.'

1) Picky About Ubiquitous Food Ingredients Guy

This guy, for whatever gastronomical, idiosyncratic reasons (not because of allergies or anything medical), refuses to eat foods with ingredients that are so common that it precludes a shockingly wide variety of options when you go out for a group dinner. I don't even know what cilantro is, are you really sure you can't eat it?

-------

*In the interests of fairness, you don't want to be these girls either.

**It might also be said that the guy you really, really don't want to be is the one who spends his time creating lists of guys you dont want to be. But that will not be said here.

David discusses the 15-15-1 Theory

In my glorious two-plus decades on this planet, I have been many things: scholar, playwright and, most recently, emo-blogger extraordinaire. Today, I add intellectual revolutionary to that storied list as I unveil a strategy that will forever alter the landscape of medical school admissions.

Just kidding. The following is more of a thought experiment. Nonetheless, ladies, gentleman, our #1 fan (that’s you, Julia), maybe even Kevin (but probably not Kevin), I present to you the 15-15-1 Theory:

As many of you know, the journey to medical school is filled with hurdles. One must do well in school and have a decent complement of extracurricular activities and/or research experiences to make the cut at many schools. On top of all that is the MCAT, perhaps the greatest, most-feared obstacle of all. The MCAT, in a nutshell, is comprised of three main multiple-choice sections – Biological Sciences, Physical Sciences, and Verbal Reasoning – each scored on a 15-point scale. There is also a short essay section that students generally believe carries less weight in admissions decisions. According to the American Association of Medical Colleges (AAMC), the group that administers the exam, the national average for applicants in 2007 was 27.8, while the average for matriculating students was 30.8.

According to conventional wisdom, a strong applicant has both a high MCAT score and a reasonably even distribution of scores among each subsection. A student with a 9-9-9 breakdown, ceteris paribus, is probably more desirable than one with a 15-6-6, as the former score may indicate a more well-rounded student. This rationale makes perfect sense; a strong medical student should be less a genius in only one subject and more a jack-of-all trades who is competent across the board. We’re not doing hardcore physics or PhD-level biochem here.

Yet how would you choose between a 15-15-1 and 10-10-11, again assuming all other primary characteristics are roughly the same? Here, the choice may not be so clear-cut. Let’s assume for a moment the school has no minimum subsection requirement – which may be highly unlikely, but potentially true in extreme circumstances such as this – and thus does not immediately exclude the 15-15-1. In this scenario, which student is likely to become the more competent physician?

Well, the lopsided genius (LG) is probably a lot more intellectually gifted than the jack of all trades (JT). Two perfect scores indicate LG is very bright and most likely hard-working, both desirable traits for a medical student. JT did fine in each section, but a 31, as evidenced above, is objectively average. Since the margin for error diminishes disproportionately as one approaches the higher scores, the difference between 15 and 11 on any given section is actually quite significant,. So, at least for those two subsections, LG is a world ahead.

But what about the third? Is LG a science whiz who struggles mightily in verbal? (That would be bad, since the VR section correlates most strongly with future clinical performance because it best approximates one’s ability to synthesize new, foreign information and make analytical choices without the benefit of tomes of background information and months of fact-cramming. It’s an extremely loose simulation of any clinical situation, sure, but the critical thinking it demands is a crucial asset for any physician.) Well, maybe LG is or isn’t, but looking at that score breakdown, my guess would be he/she was the victim of some unfortunate twist of fate. Perhaps LG mis-bubbled one of the earliest answers and thoroughly messed up the scantron. Maybe there was a scoring error that wasn’t corrected or some other inaccuracy that was no fault of LG’s. Contingent probability would suggest it’s extremely unlikely that someone capable of a 30 in two sections could possibly score 1 on the third. In fact, I imagine it improbable that LG would even get below a 10 if capable of such dual-section wizardry on the previous two.

What if we assume LG is not even capable of half of his typical brilliance, grant him the slight benefit of the doubt that something strange happened during his exam, and give him a 7. Now his conservative 37 is out of shouting distance from JT’s 31. And since these two candidates are more or less equally qualified in other respects, where does that leave them? At the very least, LG would deserve an interview and a chance to explain what happened, whereas JT might not even make that cut.

Admittedly, this is a unique, rather improbable scenario. To the extent that this would ever occur, the solution would likely be for the admissions committee to recommend LG take the test again to confirm his/her brilliance in all three subjects, reapply the next year, and then choose among the top med schools. But that’s just plain boring.

I’ve discussed this randomly with a number of people, most of whom would favor JT. I’m not so sure. As an extension, if it is completely inconceivable that someone with a 1 in any subsection could ever warrant admission, what if you had to choose, right now, who you’d prefer as your doctor in 10 years? That 1 might be a dealbreaker for acceptance, but who is more likely to pan out in the end?

Clearly, the only way to resolve this amazingly profound debate is for me to drop out, change my name to Lopsided Genius, retake the MCAT and get a 15-15-1, and see what happens. Might be unfair though – that name alone is probably worth an interview.

David is sad that young Dave was an idiot

Back after an extended hiatus, I have a fresh rant that is arguably less meaningful and more inane than any I have produced so far.

Over the past week, we have been on Spring Break. Since I had some time to relax and the weather was dreary, I made the fateful decision that I would find something to read besides my favorite book, Magazine. Ultimately, I ended up picking one of my sister’s many Narnia books. I remembered reading and thoroughly enjoying them when I was a kid – talking lions, heavy-handed Christian allegory, what’s not to love? – so I figured an hour or so reading one of the series might be worthwhile. Yet where I expected to find a dream world of magic, I instead met nearly unreadable prose. Sure, the words weren't too long, but after a few minutes it was so bad I just couldn’t continue.

Later on, I stumbled upon an old Saved By the Bell rerun. Surely, I thought, this would be an entertainment gold mine. Zach Morris, Kelly Kapowski, Screech, that really tall girl who took all those caffeine pills in the episode when they were making that awesome music video – good times all around. Everyone and their brother loved this show growing up. All teenage misadventures, no annoying angst. Alas, it was not to be; SBTB was more vapid and god-awful than I could possibly imagine.















You guys used to be so cool. Sigh...

All of this led me to the saddening realization that I was an idiot when I was 11 years old. I may have been the Tiger Woods of block-stacking, but apparently I was a bit dim when choosing my entertainment. Seriously, young Dave would’ve bet you six cookies and his entire collection of Ken Griffey Jr. baseball cards that SBTB would stand the eternal test of time as the greatest artistic masterpiece ever created. Now? I could barely stand to watch five minutes before changing the channel (although Zach was still up to his old tricks. What a rascal!).

On the bright side, I am much smarter now. I’d bet six cookies that Friday Night Lights will last forever and be the greatest TV show ever created…












Now this is ground-breakingly original programming (and promotional advertising)!

David advises pre-meds against Biology

It probably seems counterintuitive that anyone would seek my advice about anything. Yet, believe it or not, I often get asked for words of wisdom about navigating the pre-med and med school application process. For any current or prospective pre-meds, here is perhaps the best advice I have: unless you absolutely love biology, enjoy it on a profound and fundamental level that resonates within your pre-med soul, do not major in Biology*. (And if you do love it that much, I’d also argue you should eschew medicine entirely, get a PhD, and cure cancer instead of learning how to treat it. But that is a rant for another day.)

Why? I’m glad you asked. Not majoring in Bio*

1) will help you decide if medicine is really for you.

I know every 4th freshman in college has felt some burning, innate desire to become a doctor and save the world. They played with stethoscopes as toddlers, volunteered at the local children’s hospital during high school, and have told every teacher, relative, and college admissions officer that they’re going to become a whatever-ologist because they really want to help people. Yet despite that medical love-fest, most people have no clue what being a doctor really means. They’ve settled on the ideal of making a difference and saving lives, but haven’t necessarily explored alternative career paths or taken the time to really understand what a physician does on a day-to-day basis.

In high school, everyone takes more or less the same classes and meets roughly the same requirements. College is the best chance to learn new stuff and explore new opportunities. Why pigeon-hole yourself if you don’t have to? The path to physician-hood is a ridiculously long process that requires a lot of personal and financial sacrifice. Pre-meds too often do a disservice to themselves by not exploring other options. So delve into a new subject, not just on a superficial level or even to get that minor you think med schools will care about, but all the way into upper-division classes that really show what the field has to offer. At the same time, do all the shadowing/pre-med club stuff too. The point is to see what’s out there and what you like the best, rather than mindlessly following the rest of the sheep without a second thought.

Finally, what if you major in Bio* and decide medicine is not for you. That's better than entering med school and hating it, but you're still looking at an uphill battle. Unfortunately, a successful career in research is going to demand a hell of a lot more than your BS, and non-science employers won't be that impressed that you know about cells. Again, if you just love the natural sciences and want to pursue the next step in education, this isn't a problem, but if you're banking on med school and it doesn't pan out, things don't look as bright.

2) will teach you something new and valuable.

Ok, so you KNOW you want to become a doctor. There’s no point in even exploring another field, the ingrained instinct to save the children is that strong. If for some unknown reason you couldn’t get that coveted MD, you’d be so distraught that you’d forsake the professional world, tie up a hobo sack, and ride the rails. Well, that’s awesome, congrats on the choice. Now go find something besides bio to learn about for four years.

Contrary to popular belief, biology, chemistry, biochemistry, etc. do not equal Medicine in College. Sure, your O-chem prof might spice up his lectures by talking about the structure of taxol or have you make god-awfully impure aspirin in the lab, but you don’t get to play doctor until MS-1. And once you reach med school, you’ll have two intense years of science and a whole lifetime of literature to satisfy your urges for knowledge. Why not take the chance to put another shot in your bag while you have the time? Major in English and learn about rhetoric. There will be exactly one gazillion times in your life where being a good, persuasive writer will help you. Major in Economics, Finance, Accounting, etc., so you’ll be better able to invest in the future, understand financial markets, and read The Wall Street Journal while holding your glasses loosely with one hand so that the tip of one earpiece is touching the edge of your mouth (then bust out terms like ‘basis point’ and ‘expansionary’ and watch all hell break loose). All of eternity awaits for that medicine-only focus. Learn something cool that you can use later on and you’ll never regret missing that extra bio class on the mechanisms of something the cell does that no one cares about.

3) will HELP your chances of getting in to med school.

Even though I don’t advocate going the non-bio route purely as a way to game the system, I still find it exceedingly obvious that being a non-science major is an effective way to stand out from the crowd.

Sad though it may be, your 3.9/35 (or whatever strong combination you offer) from Look How Awesome I Am University doesn’t impress anyone on any admissions committee at any med school. They’ve seen you and a million more just like you come down the application pipeline over the years. Sure, there are amazing kids every so often that probably get in by virtue of their academic accomplishments alone, but that isn’t a feasible option for the average student. A History major, however, is relatively unique. Assuming you’ve done well in your science courses, the fact that you would bolster the intellectual diversity of an incoming class can only help. People reading your file are probably thinking “Wow, this kid did something cool and unique that will add to our student body,” not “Uh-oh, not enough science, he/she won’t cut it.” And in your interview, you’ll have the rare ability to talk about something you know more about than the interviewer. Who is Prof. Blah going to remember better, the mechanical engineer who worked on the solar car team or that other kid who did that one experiment with those flies?

4) will NOT hurt you once you reach the Promised Land.

“OK, David,” you say. “Sure, I can learn cool non-medical stuff and maybe even get a boost in the application process, but what about once I get accepted? It’s going to be all science, all the time, and my crappy Math degree is going to come back to bite me in the ass.”

Not so! There’s a reason med schools demand all those prerequisite courses in bio, chem, and physics. Those classes test your ability to work hard, internalize large amounts of information, and apply all the concepts you’ve memorized in new, unfamiliar situations. They also give you the necessary knowledge base to succeed in med school. Med schools aren’t in the business of accepting people who lack the requisite scientific background to keep up in class. Assuming you did well in your pre-reqs and got a good MCAT score, you definitely won’t be behind. If you can’t already tell, I was a non-science major in college, and I guarantee a PhD in biochem would not have had an appreciable influence on my experience in biochemistry so far as a med student.

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So, there you go, several reasons not to major in Biology*. Take ‘em or leave ‘em. Hopefully the former, since I knew from my earliest moments that all I wanted to do is help people…

*This extends to Bio, Biochem, and any hybrid pre-health major that pre-meds gravitate toward just because they think it’s relevant or helps their application

David discusses the neurosurgery interest group

All medical schools have a wealth of student interest groups in a variety of medical specialties such as psychiatry, OB-GYN, IM, family med, surgery, etc. These groups can be extremely helpful; they provide students with information about the specialty, the associated lifestyle, potential practical workshops, networking opportunities, and some useful guidance about how to strengthen a residency application for that field. Still, I find it a bit curious that our school has a neurosurgery interest group.

As many people know, neurosurgery is not one of those fields someone just wakes up and decides to enter. It is one of, if not the most competitive specialties, and demands a kick-ass application with top board scores, clinical evaluations, recommendations, and probably some strong research too. Those qualifications – and I know it is nearly forbidden to say people can’t do something if they really, really, really try – are realistically beyond the average, above-average, and maybe even the near-excellent student. If I devoted my life to becoming a neurosurgeon, there’s a ridiculously strong chance I just wouldn’t cut it no matter how much I wanted it. Out of the 20,000 or so med school grads that match each year, only ~150 are able to do so in neurosurgery. That’s more or less one spot per med school in the entire country, meaning one has to be, on average, the top pre-NSG student in one's school to snag a spot. Even Best Medical School has a snowball’s chance in hell of sending more than a couple in a given year. So while learning about future career options is extremely valuable, and no one should ever be discouraged from dreams/ambitions, all of this seems similar to having a Fortune 500 CEO interest group in B-school or NFL player interest group in a DIII football program.

OK, enough musing. I’m running late for my plastics interest group meeting…

Musings: Med School Seating Chart by Maturity Level

Musings: Chinese Restaurants

David and Kevin's Musings - A Visual Series

David quantifies his inanity

To those who know me, it's probably not a big surprise that I waste a lot of time talking about things that are completely meaningless and most likely offer zero benefit to anyone. To illustrate, I offer the following example. Recently, we have been studying childhood development. One important topic in the study of infants and toddlers is a milestone, a certain ability a child acquires at a certain age which is important in his or her development. Some one of these milestones involve how many blocks a kid can stack at, say, 20 months versus 24 months (only four at 20, but a whopping 4-5 at 24). This is important because it indicates the child's motor and cognitive skills are progressing appropriately.

Instead of taking this concept at face value, my friend and I launched into a 30 minute discussion about how exactly these block values are ascertained. Is there a block laboratory where babies perform thousands of stacking trials? Are there internationally standardized blocks sold by Welch Allyn? If there aren't, what's the point? A toddler might be able to toddle his way to a stack of 10 really stable blocks, but if one weighed 5lbs he probably wouldn't be able to add number two. What exactly is the limiting factor? Is there just an increasing error accumulation that is insurmountable once four blocks are reached? And perhaps most importantly, how much more awesome would we be at block-stacking than those little kids? If we had a crane and a really tall indoor space with virtually no airflow, couldn't we be an unstoppable block-stacking force the likes of the which the world has never seen?

As sad as it seems, I have at least 2-3 of these sorts of conversations per day. This one was sort of long, but if we assume I have 2.5 conversations at 15min per, and take about two weeks of vacation time to rest my rambling muscles, I waste over 9.1 full days on this nonsense annually ((15/[60*24])*2.5*350). That may not seem like a lot, but since I plan on saving at least 300 lives per day as a doctor, and the economic value of a statistical life has been argued to be about $5million*, my inanity will cost the world billions by the time I die. Good to know I'm making a difference...


*This is actually true, but don't expect me to cite any sources here.

David discusses med school by correspondence

Normally, my rant:rave ratio here is pretty high, and hopefully that's something the six dedicated readers have come love. For once, however, I'm going to discuss something neither rant nor rave, but rather simply a part of med school I never expected.

I'm not exactly sure what I thought med school class would be like, but I imagined it would more or less follow the structure of my undergrad pre-med courses: go to class, take some notes, maybe read a textbook, study for exams, bubble in the scantron to make a funny picture and hope to live to do it all again in a few weeks. I figured there would be great, inspire-you-to-learn teachers, other, less effective profs that droned on and on, and a wide variety in between. One thing I did not expect was how much of the first year could be just as easily taught by correspondence as in class.

It may be no great revelation that the MS-1 curriculum is mostly about learning the vocabulary of the body and disease and important background information about biochemical, immunological, blahblogical processes, etc. Beyond the obvious exceptions - anatomy lab, clinical stuff - most of this information can be effectively taught through textbooks or a solid syllabus. Of our many classes, a few have concise, well-written syllabi that comprehensively present the important information, some interesting extra details, and do a generally excellent job of teaching the material. It's no coincidence that the professors for these classes, as a result of good preparation/organization/whatever, also tend to deliver good lectures. Yet since the provided written materials are so strong, and because it takes even the most gifted lecturer much more time to deliver a talk than it takes a student to read that content in condensed form, many people appropriately choose to skip those lectures. And it's not because they're lazy students. I imagine they make the calculated decision that they can save time going over the material at home or would rather dictate their daily schedule and decide exactly when they want to review that information.

On the flip side, in classes without dependable syllabi, where the organization is relatively poor and the expectations for students consistently vague, attendance skyrockets. Not surprisingly, these lectures are often disjointed, even incomprehensible, and sometimes I come away far worse for the wear with almost no new knowledge to show for it. (Loyal reader, you might be thinking, "David, that's probably because you're an idiot." True though that may be, I assure you that I am not the only one that feels this way.) This theme doesn't necessarily depend on the content of the class or even the attitude of the professors towards student learning, it's just a product of how well the course and study materials are organized.

Maybe this isn't surprising, but it seems odd to me that the most engaging professors who have the most well-developed lectures are the ones that face an empty auditorium, while those running the classes that most frequently frustrate the students get a full house. What's more, if the latter profs emulated the former, there would be virtually no reason for many people to attend class at all. Students would have high-quality study material, complete all of the educational objectives set forth by the faculty, do well on exams, and basically be med students by mail. This dynamic would collapse later on during the transition to the wards, as well as in those aforementioned pre-clinical classes that provide exceptions. Still, on the whole, a University of Phoenix-style curriculum would be about as pedagogically sound as the one we have now (that's right, I used 'pedagogically', what of it?).

Not to complain, because I do think we are getting a good education, but isn't that still a bit strange?

David wins epic battle against co-walker

(Kevin recently contracted bird fru, so I will become the prolific scorer I always knew I was and continue to pick up the slack.)

Yesterday, I was walking towards my car with a jaunty spring in my step after managing to stay in class for two hours before calling it a day. A few minutes away from the parking lot, another random guy (RG) started walking alongside me, and initially I thought nothing of it. Normally, I’d give RG the patented Dave speed burst and launch ahead on the way to bigger and better things. Alternatively, I could’ve played it Mav style, hitting the brakes, letting him fly right by, then switching immediately to missile lock (or guns, if he remained too close). For some reason, I opted against either go-to strategy. The path was pretty wide, I was still happy about all the learning I’d just done, so I decided to let things play out naturally.

After a while, it became painfully obvious to both of us that we had been walking almost side by side for several minutes. Still, as is the case with 99% of my choices, inertia won out and we remained in relative lock-step. By the time we reached the parking lot, which is pretty large as public parking lots go, more than a few awkward side-glances had been exchanged, yet still no one made a move to take the lead or fall behind. And based on his body language, I’m almost completely certain he was thinking about our strange traveling dynamic as well. About fifteen rows in, we approached my car, and I veered off to the side appropriately. RG, seemingly confused, shifted almost instinctively in my direction before stutter-stepping and then finally grinding to a complete stop. Clearly disoriented, he looked around awkwardy and then started walking in the other direction. In my car, I watched as RG backtracked a few rows and proceeded to walk up and down each of them searching vainly for his car. Perhaps you had to be there, but watching him wander about for several minutes, potentially aware that I might be watching since I hadn’t left yet, was oddly mesmerizing. At one point, it appeared as though he was contemplating exiting the parking lot entirely so he could return with tabula rasa and try again. Or maybe he was thinking about giving up entirely and taking the bus home or buying a new car. In any case, after another minute or so, I finally forced myself to leave. Needless to say, I emerged the clear victor…

David rants about Dishes-it-out-yet-can’t-take-it-back Syndrome

When I hang out with my good friends, there is a lot of back-and-forth joking. It is generally good-natured ribbing, and each participant typically takes about as much flak as he or she dishes out to others. Perhaps this isn’t the most mature friendship dynamic, but I enjoy joking around and almost all of my friends do as well. Some topics are clearly over the line but, for the most part, everyone knows the humor isn’t serious and gets a kick out of the back-and-forth.

Now, not everyone is particularly jokey. Some (most?) people are orders of magnitude more mature than I am – which should make you extremely happy that I’ll be treating patients in T-minus 12 years – and may not trade similar barbs with their buddies. I have several such friends with whom I exchange mostly light-hearted or topical banter, without engaging in person-specific comedery or ever venturing into the purely golden “that’s what she said” domain. On the other end of the spectrum are friends with whom normal conversation has nearly no humor restrictions. We don’t seriously insult one another, but the phrase ‘yellow-on-yellow’ crime would apply with significant regularity.

The golden rule governing this intricate humor interplay, an unspoken law that most people find intuitively obvious, is that one must be able to take approximately as much as one dishes out. If Robert makes a joke about how long it takes Kevin’s mother to cook Minute Rice (Note to Robert: it’s not that funny if she’s really smart and cooks it in 25 seconds), Robert must be willing to endure a similar barb from Kevin’s humor repertoire.

To illustrate this issue, a simple 45-degree line will suffice. On the x-axis, we have “out-dishing;” on the y-axis, “back-taking.” Thus, the more you dish it out, the more you have to take in order to meet the perfect 1-for-1 Repartee Ratio. Now, it’s no good to make fun of someone who’s polite/mature/nice enough not to dish it out. Nor does he/she deserve it. Thus, that friend is forced to take little back in return. Moving along the line, your obnoxious buddy that makes all those ridiculous jokes better be willing to feel the heat.



The problem occurs when people are disproportionately over-sensitive; they love to make inappropriate, callous jokes about others yet become defensive or upset when someone sends a yo’-mamma missile their way. This is one of my big-time pet peeves, a common pathology I’d like to call Dishes-it-out-yet-can’t-take-it-back Syndrome (DS). People with DS put a serious strain on one’s humor game, completely throwing off the mostly well-meaning, tongue-in-cheek vibe that brings me so much joy. Each one of you knows someone afflicted with DS. You can all recall an otherwise awesome social situation where DS made everything end in tears.


Well, thanks to my burgeoning biotech firm, the solution is finally here in the handy, dandy, Rx-only Getoveryourselfafilnoprene. Only 50mg nightly before bed has been shown to yield clinically significant reductions in DS symptoms. Stay tuned for our next pharmaceutical innovation in the treatment of Always-make-everything-about-them Disease…

David takes a step back to reflect...

Do you ever stop to contemplate the little things that change the ultimate paths of our lives, those almost indefinable moments in time that can alter who we become or the impact we have on the world? I know I’m normally so caught up in the hustle and bustle of school and life that I don’t take the time to stop and smell the roses. Everything becomes such a whirlwind of tests, stress, drama, and hate crimes…I get so turned around I don’t know what’s important anymore…

A while back in this space I mentioned going out to lunch with a friend and how a bird pooped on him on the way back. I sort of made light of it at the time, but it’s been eating away at me ever since. If only we had stopped a moment longer to wait for the light to turn on the previous street, the bird and my friend would never have crossed paths. If I had noticed my shoe was untied, how would things have turned out differently? My friend wouldn’t have ruined his new coat. He wouldn’t have missed class to cry it out. Or maybe, just maybe, that bird impeded our path just long enough that we avoided something far worse...like being pooped on by a larger bird, or by two smaller birds whose cumulative poop volume exceeded that of the one average-sized bird.

So maybe that bird was meant to poop on him…if it hadn’t, we might’ve walked in front of a bus a couple blocks down. I might never have realized my ultimate dreams: saving African babies, walking on the moon, making it rain hundys at Club Isis. When I stop and consider the interconnectedness of our universe, I am overwhelmed. It’s beautiful, but, at the same time, it’s scary....................

I guess what I’m saying is, live while you can. Laugh out loud and don’t pay attention to who’s watching. Stumble once in a while, it’s OK. I know I’m going to try and follow this advice too. Maybe I’ll look back on this post when I start feeling blue and it will remind me to stop holding my breath so I can get oxygen again. I know there are still important things I need to learn about myself, but hopefully, this is a start…

The shadows surround me
Gripping
At
My soul.
No, Darkness, please
I have so much more to
Give.
Light. Peace. A second chance.
Thank you.

David is outraged by senseless krill murder

I am shocked and appalled that Kevin has condoned senseless krill-killing in his investigative report on the Little Mermaid. He quickly excludes the possibility of a Flounder feast or Sebastian sauté – on the basis of their demonstrated sentience – yet throws krill to the sea-wolves without a second thought. Why? Because they’re small and don’t crack the starting lineup for “Under the Sea.” That is unacceptable. I am taking a stand.

First, watch this video of arguably the finest impromptu-underwater-point-making-ensemble-musical-number ever:



Now, two things are painfully obvious. First, Sebastian is a frickin’ rhetorical genius. “The seaweed is always greener” is persuasive gold. That effeminate crab just knows how to sell it. Second, and far more importantly, there is established video evidence that shrimp are sentient. At 3:03 in the video, right after we learn that “each little snail here know how to wail here, that’s why it’s hotter under the water,” we see a bevy of shrimp, smiling, dancing, and jumping in a glorious air bubble cascade that would make anyone want to drown in a tide pool. The shrimp display obvious, visible emotions in their heartfelt attempt to keep Ariel from going above water, all the while maintaining admirable balance atop slippery bubbles in an impassioned jig.

Clearly, the shrimp have a lot going on upstairs. And krill, as everyone knows, are basically just mini-shrimp. Even Wikipedia – which will have been responsible for at least 29% of my medical education by the time I’m done – describes them as “shrimp-like.”
   
                                         
                                                     Can you tell the difference? I can't...

Adding two and two together, we realize that Triton and his Mer-peers are basically eating 1000s of conscious beings every day. Murdering countless krill families and destroying countless krill dreams. Stopping krill doctors from seeing krill patients and devastating krill adolescents worldwide by preventing krill Jessica Alba from reaching the level of irrelevance that would inevitably force her to do a nude scene to get back into the public eye. And all based on the shaky premise that, somewhere along the continuum between krill and shrimp, there is an arbitrary Eat Me line that makes it OK. Outrageous!

Triton, is that any way to lead your people? Shrimp, how could you pander to the princess whose father murders your cousins day after day after day? And you, Kevin, I am most disappointed in you. You’re just like Harry Potter, standing idly by, ignoring the problems of another world while you keep the platypus down…

Kevin and David Present: The Top 10 Things We've Learned in Med School

To commemorate the completion of our first half-year of med school, we present the top 10 things we've learned so far:

10)  Experts tell us having kids and being married both suck.

9)    Experts consist of random 38 year-old "young" adults.

8)    Eighty percent of future doctors are brunette white women.

7)    Kevin wants to learn, David wants The Truth.

6)    (Kevin doesn't really want to learn, but David really does want the Truth.)

5)    You can teach an entire lecture with inspirational quotes alone.

4)    We have something in common with a football player from Duvall (pronounced "Dooooo-         vuhl").

3)    Kevin is 1/32nd cardiothoracic surgeon but he's pretty sure he's ready now.

2)    David still thinks he's in business school. 

1.5) Your patients won't care how much you know until they know how much you care.

1)    Never donate your body to science.

David is curious why Kevin chose "Jessica Alba Plateau," with its inflammatory associated yellow-on-yellow-crime acronym, to describe his...

...Hot/Crazy Postulate, when “Pre-Downward Spiral Jennifer Love Hewitt Plateau (PDSJLHP)” would have worked just as well.

David Anticipates an Unexpected Consequence of Kevin*

After reading Kevin’s latest post, one can’t help but envision the following probabilistically inevitable scenario:

Kevin tells me his name is quite common amongst immigrants from the motherland. A quick Google search for “Kevin*” confirms this to be true, returning 22,800 hits. Given this high number of Kevin*s running around and the extreme virulence of the aforementioned disease, it seems likely that there might come a day when one of those countless Kevin*s was…wait for it…infected with Kevin*. How exactly would that doctor-patient interaction go?

------

Doctor: Kevin, I have some unfortunate news. You have Kevin*.
Kevin: Excuse me?
Doctor: Kevin*, you have it.
Kevin: Are you stupid? Have what?
Doctor: Who’s on firs…Err, there’s a disease called Kevin*, Kevin. Unfortunately, you’ve got it.
Kevin: You’re kidding?
Doctor: Actually I’m not.

Kevin: ...

Doctor: ... 

Kevin: ...

Doctor: What are the chances, eh? If you think about it, it’s actually kind of fun–
Kevin: Die.

------

One can only imagine what would happen if the original Kevin* was this Kevin*’s doctor, delivering the news and explaining his reasoning for naming the disease. Or maybe bad karma would win out and original Kevin* would get ALS.

These are the things I think about sometimes. Why does my brain hate me…