Hurricane Jill

p.s. I don’t thrive on darkness and compost

So, I had my MSPE meeting with the dean of student affairs this past week. He was in a good mood, and kept telling me that neurosurgery matching was all about Step 1, and nothing else. Which isn’t quite true: it’s about Step 1 and letters and whether they can stand you hanging around for 7 years. And I’m generally pretty easy to be around, so I doubt I’ll get blackballed anywhere because of my personality.

But he seemed intent on reassuring me about my Step 1 score, which I thought was funny. Look, I know it’s fine, and that it clears the bar it needs to for neurosurgery. But I can still be annoyed that I could have scored 20 points higher on a better day, can’t I?

In any event, he asked me where I was going to apply. I listed various programs, and mentioned only one of the two programs in Houston and didn’t mention any programs in New Orleans. He seemed to think that I would want to stick around here, and I wondered how someone in his position could possibly be that far out of the loop. Surely the implosion was heard a couple states away in any direction?

The New Orleans programs are of course still on my list. But they’re more viable if they combine. I’ve been saying since I got here that’s there’s only room in this town for one academic neurosurgery program. And I’m not going to pretend I’m geographically restricted when I’m not, and the guy clearly doesn’t have the time of day for me. And if by some chance, this is an indication that he does want to fix things, then perhaps he should tell me that before talking to the dean of student affairs. It’s kind of important that I know these things.

So I’m not sure at this point who’s really the clueless one there. Although I’m clearly more clueless than both.

AOA rant

MSPE meeting done. I must have screwed up the neurology departmental exam, because my clinical eval was a solid grade higher than what I saw on my transcript. Or at least, that’s what the resident intended it to be. Who knows what sort of voodoo’s being done to our grades in an effort to compare us all?

Instead of making 1st and 2nd year pass/fail, they should have made 3rd year pass/fail. We’re the ones going to 30 different schools, all with different ideas about what constitutes an outstanding performance, and student populations that vary widely in average caliber. At least the 1st and 2nd years were all being compared against one standard. We definitely were not. As I’ve said before, the idea that Tulane could adequately oversee us and give appropriate weight to evaluations by other schools’ faculty was incredibly naive. How do they know which attendings just pass everyone and never give honors except to their pet students (for example one of the services where I did Surgery, despite repeatedly telling us what a great group we all were)? How do they know when a merely passing grade means the student was truly substandard, and the attending doesn’t have the balls to fail them because they tried hard (like the one student on my first month of surg, who I told what to look for and why on his physical exam each day)? They have no way of knowing.

If this ever happens to a school in the future, my recommendation is that the entire school needs to go pass/fail for that year. We have AOA at Tulane, and that’s the only reason clerkships had to be graded. We’ve shortened rotations, eliminated requirements, fired tenured professors and given up all kinds of things to graduate with a degree that means something, but God forbid we don’t have AOA elections despite the chaos. God forbid we admit that rotations among LCME-accredited schools vary widely in quality. That separate is inherently unequal.

AOA only means something if everyone’s taking the same classes and rotations. To have eligibility based on the unfamiliar and widely varying grading standards of other schools and their faculty is completely inappropriate, and worse than that, implies an even playing field that simply did not exist.

We haven’t had elections yet, but when we do, it’ll be a sham.

Today’s email from President Cowen

Dear Students:

As you know, at Mayor Ray Nagin’s request National Guard troops are
returning to New Orleans to resume the patrols they started in the aftermath
of Katrina. While the return of these troops is welcomed locally, there is
concern about how this deployment might be viewed in the eyes of the many
Tulane University students and prospective students from areas outside of
New Orleans.

It’s important to remember that the primary purpose of these troops is to
prevent looting and further damage to private property in devastated,
sparsely populated areas miles from Tulane’s campus. Having troops patrol
these areas will then free members of the New Orleans police department to
patrol the populated areas of the city and “hotspots” of criminal activity.

It is important that we communicate to those living outside our city and
state that New Orleans is not a militarized zone. The uptown area in which
Tulane University is located is thriving. This area and other parts of
the city frequented by Tulane students will not see the presence of
National Guard troops.

Moreover, it is expected that the National Guard’s presence will make New
Orleans safer than ever and allow residents to rebuild in a stable
environment, free from the scourge of thieves who would undo the hard work
and sacrifices they are making to repair Katrina’s damage.

So I ask that you appreciate and communicate the positive aspects of this
deployment and the fact that it will bring us a safer and stronger New
Orleans and Tulane.

Have a great weekend,

President Cowen

==================================================

I love how he signs it “President Cowen” rather than with his actual name. He probably had some underling write it, although I can very easily imagine him signing things that way himself.

In any event, that’s pretty much what I said in my last post. Uptown is mostly back to pre-storm activity levels, although businesses are still operating with limited hours. Perhaps that will get better once it becomes reasonably safe to be out on the streets in this city after 10pm.

Commentary on Crime and the National Guard

America Cuts and Runs (Wet Bank Guide)

So Obvious (Your Right Hand Thief)

Government by PTSD (Adrastos)

Seeking Targets of Opportunity (Tim’s Nameless Blog)

Two W0rds (Metroblogging New Orleans)

Triangle of Distraction (Moldy City)

What’s my opinion on all of this? Well, first of all I’ve been on clerkships for the last 3 months, so aside from grocery shopping, laundry and studying at the coffee shop, I don’t get out much. The grocery store closes at 9pm, the coffee shop at 10.

So I haven’t seen any violent crime. Plus I live in the Hurstville neighborhood association area, which apparently has a cloak of invisibility from the criminal element in this town. Plus there’s a NOPD officer and his daughter and granddaughter living in the other half of my duplex while their Lakeview home is being rebuilt. They’re nice people, and good neighbors. And they probably have a gun.

However, today at the coffee shop the increased police presence was very evident. I saw no less than 4 police officers stop there for coffee in the space of 3 hours. One of them was a meter maid, and she was ticketing cars like her life depended on it. I think that was the first time I’ve ever seen anyone get a parking ticket since the storm.

I haven’t seen any National Guardsmen, but then my daily travels only take me down Magazine to River Road and along the levee to Ochsner and back. Sometimes I drive down Claiborne/Jefferson Highway to get there. But both routes are almost entirely repopulated, and the National Guard are here to police the unpopulated areas, freeing the police to deal with violent crime in the repopulated areas. So I lead a very sheltered existence here, and I have to go out of my way to remind myself of the devastation that still affects most other people’s lives here significantly.

It’s all so much easier without those pesky clinical duties

Well, all I have left of 3rd year is my peds shelf tomorrow. There’s a happy hour, I forget where, tomorrow night to celebrate the end of 3rd year. Then next week I meet with the dean of student affairs about my dean’s letter. I’m supposed to bring my CV and personal statement. The CV is done, but I still have that last paragraph of my personal statement to write.

Tuesday I have a meeting at the Junior League. I signed up to be a photographer for the newsletter. It sounded like a fun way to ease into active membership. My Provisional year was entirely disrupted by Katrina, so I never really got to meet many people. The newsletter is a small group and I have a well-defined role that will force me to go to lots of events and meet people. So I’m looking forward to it. Next year, if I’m here next year, I’ll do something a little less behind-the-scenes.

Friday I’m back in Houston to spend some quality time with my slides. Apparently they’re back from Aberdeen, so they need to be scored. My research mentor emailed me to tell me to start writing the manuscript. But it’s already written–or at least as much as I can write without actual results. I wrote it back in March while I was waiting for my antibodies and reagents to arrive. But I do have to rewrite some parts, because I think we’ve changed the materials and methods pretty substantially since then.

The following week I have my first curriculum committee meeting of the year. The next day I fly out to visit mom. I get back sunday and start 4th year Monday. The third years are in orientation for the first three days, so during that time we’ll be picking the admissions committee members from their class. They’re all really good applicants, just like the applicants from my class. So I have no idea how we’re going to decide, and it’ll be interesting to see the process from the inside.

June and December: the poorest months of the year

Two more days of peds. I have two H&Ps to write and a presentation to do, 4-6 progress notes, 2 meetings and a shelf. And then I will be done with 3rd year.

Of course, if I were actually going to be done with required clerkships, I might actually feel like I’d accomplished something. Damn Katrina.

I finally wrote my letter today to petition for my pharmacist license to be renewed in Louisiana. I was in Houston and flat broke last December when it was time to renew. Also, Tulane had just canned almost the whole Neurosurgery department, and my plan at that time was not to come back at all. I didn’t know how I was going to swing it, but I wasn’t coming back. Then they rehired some people, and I reconsidered. Also I at least had to give things with the guy a chance to work out, and there was no way they could with me in Houston. It seems to have been a losing gamble, but that was a chance I had to take.

It costs $100/year to renew my pharmacist license, and another $50 if you miss the December deadline. Then if you miss the late renewal deadline, you have to petition the board and pay $300. So by the time I got my financial aid and thought about it again, I was well into the $300 period. So I figured, screw it, I don’t actually need my license till I get back to New Orleans, and as long as I petition before December 2006, I don’t have to retake any tests. The thing is, I’m back, and I have time to work now, but the board doesn’t meet till August. So I screwed myself out of several hundred bucks of income, on top of the $300 I have to pay.

I’m a little pissed off at myself over that. But at least the letter’s written, and all the supporting documents assembled.

Instead, I’m reviewing a couple of books for LWW. They only pay about $100 per book, but it’s better than nothing at this time of year. They prefer to pay us with free books, but I already have way more books than any student actually needs for med school. And I can’t exactly take Step Up to Medicine down the Winn-Dixie and trade it in for some groceries. And it’s not very nutritious itself. Or tasty. So thanks, but I’ll take the cash.

Speaking of the Winn-Dixie, when in the world is it going to start staying open past 9pm? Man, that’s irritating! Even 10pm would be an improvement.

Anyway, I have to get back to this H&P I’m supposed to be writing. Pediatric H&P’s are just painful. Particularly the Past Medical History part. It’s supposed to have prenatal, perinatal, birth and neonatal history, feeding, growth and development, and every major illness the kid has had. Good Lord, I don’t even know all that about myself. But I have to finish it tonight.

Chatty McChatterson

I had an interesting conversation today with a classmate, about email vs phone communication. He prefers to talk in person or on the phone, and hates email, whereas I prefer to talk in person or via email, and hate talking on the phone.

He hates email because it doesn’t convey any of the nonverbal components of communication. He likes the phone because you can at least hear someone’s tone of voice, and get some idea of their meaning.

I hate the phone because it gives you the illusion of having a sense of their meaning. It’s easy to lie to someone over the phone, because all they can hear is your voice. In fact, a friend of mine from college who was a pathological liar told me he preferred the phone for that very reason. If you’re trying, you can modulate your voice to convey whatever you want. But if you’re trying to have a serious conversation about a sensitive subject, where people’s voices aren’t necessarily as well-controlled, the phone gives you no information aside from the voice. Someone may say something that sounds like they’re half-joking, for example. On the phone, how do you respond? You can ask for clarification, sure, but often people do this half-joking thing to broach a topic that’s actually very serious. And your question will be in one of two forms: Are you joking? or Are you serious? Either one could shut them down. If you were there in person, you’d know from their nonverbal behavior what to say next. But you can’t tell from just their voice.

You could argue that it would be socially inept for that person to bring up a topic that sensitive over the phone. And I’d probably agree with that. It’s a no-win situation for the listener. But I’m sure everyone has done something inept at some point in their lives, and we’re lucky if it’s over something trivial.

With email, you don’t have that illusion of understanding the other person’s tone, so people are much more careful about assuming they understood your meaning. Well, at least I am. And it actually is possible to convey your emotional tone correctly in an email, if you’re paying specific attention to that component of what you write. It just requires a proficiency with written English that simply isn’t taught anymore, and hasn’t been for a couple of decades. But I was fortunate to go to a high school with an extremely strong English department.

I definitely prefer to communicate in person, though. There’s no substitute for the immediate nonverbal feedback you get from talking in person. Seriously, people are like an open book. Occasionally you encounter people who won’t shut up, and whom you have to interrupt to get a word in edgewise. And I hate being rude like that.

Like today on rounds, I was trying to present my three patients so I could go home. I would start to present, and maybe get to say a sentence or two before I was interrupted by the attending, who went on to finish my presentation. OK, that’s fine. My presentation was going to be pretty poor anyway. Then I started on the next patient, and was interrupted again, same story. They started talking about the seizures the patient had been having, and I wanted to ask how many minutes you wait before you start to treat a seizure. But I swear to god, there was not a single opening in the conversation, and then they went off on some tangent about the mom and her several boyfriends. Finally, there was a break, and I asked my question, hoping to get them back on track. But no. The three of them immediately got off on another tangent about dental grills. About 5 minutes into this, the other attending stopped and said to me, OK, go on with the presentation. So I open my mouth to start and the first attending starts talking again, still about dental grills. Another 5 minutes of conversation in which I can’t get a word in edgewise, either on or off topic. Finally they move on to the next patient, and I never actually did complete that presentation. Unbelievable. I’ve heard of this happening, but this is the first time it’s happened to me.

Decisions, decisions

My fall schedule has officially become one big SNAFU. My two aways got scheduled on top of each other (I got my first choice for one, my second choice for the other). I could change one, and that would make my schedule perfectly on track to start my next rotation, but that school doesn’t allow changes once it’s been scheduled. And I really don’t want to cancel either one.

On top of that, I would have to leave my OB/GYN rotation 8 days early. And while the administration has said they will make the departments give us a few days leeway for such things, I think they meant more like 3 or 4 days. Definitely not 8.

There’s absolutely zero chance of my going into OB, and I’ve heard it’s an easy shelf, so I don’t know what the harm would be in losing a week. Is it really going to matter if my OB/GYN rotation is 7 weeks rather than 8? Seriously, let’s have some perspective here.

The other big decision is whether or not I’m going to complete my MPH. I’m not even sure it’s academically possible at this point, so I have to go see my advisor and find out for sure one way or another. I hate to have been such a thorn in their side for the last three years with all my conflicting commitments elsewhere, and then not even finish the program. I should at least give them the satisfaction of knowing that all their help mattered in the end. I don’t want to let them down, because then the next time someone needs help, they’ll be all cynical about it. And I don’t want somebody else paying for my poor planning.

Anyway, I’ll admit that that’s a dumb reason to slog onward with this MPH thing. But the truth is that I do learn some interesting and useful things in these classes, despite the irritating PC-ness and dogma. I’m interested in learning about public health, but some of this stuff I kinda already learned about in pharmacy school. And they treat us like we’re in high school, with all the homework and group projects. That kind of stuff is really hard for med students to coordinate with all our other requirements. I’m just up against the wall and don’t know how I’ll be able to finish.

It was going to be tough even before the hurricane, and now I’ve lost two whole semesters. One because the school wasn’t functioning, and the other because I was already weeks behind by the time I had computer access to the online lectures. It would have been better if we’d just had reading assignments, but instead we were supposed to watch these lectures and then participate in a discussion of the lecture topic. But they set it up using some sort of proprietary software to record the lectures, and the Baylor computers wouldn’t allow us to install it. And as a 3rd year, I don’t have time to deal with stuff that doesn’t work, like the preclinical students do. Normally I’m pretty tolerant of all the gratuitous hoop-jumping required of us for the dual degree. But all of that plus the constant barrage of homework and assorted projects was just more than I could take. Damn Katrina!

Lucky? or just overeducated?

Man, those second years are gonna have some anger issues when they get back. I remember how chronically pissed off I was the last few months I was in Houston. We were truly the red-headed step-children of the Medical Center, and constantly made aware of the fact that we were on somebody else’s turf. I mean, people went out of their way to help us. But when you’re living on someone else’s charity, it doesn’t matter how nice they are about it. Anyway, at least we had options as third years, even if all our options sucked. The second years got totally hosed on their entire curriculum, and they know it.

The good thing, though, is that they’ll all be back in New Orleans for rotations, and everyone here knows they’ll need lots of extra help learning their role on the wards.

I’ve been talking to people who went to other places in Texas, and it sounds like everyone pretty much had a less than ideal experience regardless of where they went. Also it sounds like we ran circles around the students from most other schools (with the exception of Baylor). Which doesn’t surprise me, seeing as we’re the class with the highest Step 1 average ever in the history of the school. heh heh. I’m pretty sure the class of 2008 will outscore us, though, so our tenure at the top will likely be short-lived.

It’s been a while since I talked about my research project. We sent the slides off to Aberdeen and are just waiting for them to come back, all stained and pretty. In the meantime we sent off a request for money to the pharmaceutical company that asked us to do this study, mostly because it’s been a major PITA for everyone involved. It was my job to write the request. And even though I know how to write a grant request (those MPH classes are good for something), I had a major case of writer’s block. So she sent me a template, and I went to town. A month ago she had asked me to find a way to do a quantitative analysis of the slides, rather than the usual qualitative method most people use. It makes the paper an easier sell for publication. Which is important. But I was stumped as to a method, because any time you have a person looking at a slide, the results are going to be subjective.

Anyway, while I was writing the grant request, I decided to do a search to see what other people have done. And I found this awesome paper detailing a method to use adobe photoshop and some statistical software to do a true quantitative analysis. I mean, seriously, it’s a click-by-click setup for photoshop and line-by-line explanation of the programming for the software package. So simple a trained monkey (that would be me) could do it. Plus, it involves purchasing adobe photoshop with someone else’s money. And I mean, how can you beat that? Of course, it’ll belong to the lab, not me. But still.

Just goes to show you, it’s better to be lucky than smart.

Free at last

Ahh, Friday afternoon on a weekend I don’t have to work. Is there anything sweeter in medicine?

The Tulane crew had lunch en masse today. Like ten of us or something. The poor souls on neurology were discussing the merits of heavy drinking this evening. One of them is actually a Mormon, and he was bemoaning the fact that alcohol isn’t an option for him. Apparently it’s that bad. But the students on OB/GYN won the most sympathy, because everybody hated OB/GYN, no matter where they did it.

In any event, all the talk about alcohol led into a conversation about New Orleans bars versus Austin bars. My friend who’s going into pediatrics asked me where I wanted to end up. I told him I didn’t know (although if the truth be told, I don’t care where I am as long I can be a neurosurgeon AND married AND have my own kids). He’s from Texas, and so he was thinking of Austin. I told him I had thought Austin was the best city on earth until I moved to Seattle.

My derm friend is on OB/GYN this month, so she had lunch with us as well. The last time we talked, she was trying to decide whether or not to try for a derm residency. Apparently she’s decided to go for it. I’m sure she’ll make it–she was on my medicine team both months and if she didn’t honor that rotation, then somebody in that department needs a tox screen. And I wouldn’t be surprised if she honored everything else as well.

As for me, I downloaded the neurosurgery CAS form, which is the actual application that goes to all the programs, and started filling it out. Judging by how I look on paper, I bet people are surprised when they meet me that I’m not some arrogant tool. But who knows? My classmates think I’m smarter than them, and I can’t figure out what I ever did to earn such a reputation. I don’t share my grades, and I certainly didn’t Honor all my preclinical classes, or even most of them. It’s probably just because I’m going into neurosurgery, and people assume you have to be smart to do so. But I tell them you don’t have to be crazy-smart. You just have to be crazy.

Anyway, I gotta free weekend to spend, and not much on the to-do list. A perfect opportunity to get my personal life sorted out, if the situation permits. Let’s hope it does.

Oh my God, I haven’t laughed so hard in months

Warning: NSFW (not safe for work). Really not.

Link courtesy of our fabulous second year class. What cracks me up is the contrast between what they’re saying and the goofy smiles on their faces.

Wow, I haven’t laughed that hard since the last day of my neurosurgery rotation. The quick story: My last day on the rotation, the neurosurgery chief resident congratulated me on a job well done, and commented on how unflappable a student I was. I explained that nothing he could do or say would be worse than I had already experienced on my pharmacy clinical rotations. So we talked about that for a little bit, and it quickly degenerated into fits of laughter at my pharmacy professors for being all malignant about their clinical rotations.

So now every time I think about all the crap I went through at UT, I hear the MD Anderson chief’s voice saying, “boy, you gotta WANT that zipper!” and it just makes me laugh instead.

Chirpes on the move

Fast forward to 2007…
Congratulations on your MD! And welcome to the bird flu pandemic, which is guaranteed to happen sometime during your residency.

I can’t wait.

I was going to post the whole article, but I really don’t want to piss off the New York Times by infringing on their copyright. Especially since anyone can sign up to read it for free.