MEDICINE IS THE BEST MEDICINE.

When I was little and I thought my parents were being unfair, I would make lists of things I would never do to my kids. Now, in med school, I make lists of things I won’t do or say to my patients and staff, and ways I won’t treat them.

I have been doing this for 5 months, with surgeons and doctors who were arrogant as hell. The guy I’m working with tonight takes the jackass cake ten times over.

Greetings, friends, from the exciting world of Internal Medicine! That’s right - to the best of my knowledge, I have survived my surgery rotation, and all of its responsibilities, privileges, and awesomeness.

I have to admit that I liked surgery a lot more than I thought I would. The hours are intense, to be certain, but I got to do some truly amazing things, things I never thought I would be comfortable doing. For example:

• I scrubbed in to or observed around 40 procedures over the course of the month. 
• I took five overnight calls.
• I participated in a trauma surgery involving a ruptured bladder - I got to put my finger inside a human bladder.
• I learned how to steer a laparoscopic camera, and got pretty competent at it - I only got yelled at (on average) twice during each gallbladder surgery!
• I scrubbed into a surgery that started after midnight.
• I worked with very friendly patients, who were very patient with me as I learned.
• I found some residents and attendings that were excellent teachers, and really enjoyed working with almost everyone I met.

It really is as intense as two months could be outside of, say, Kabul. I took call on my first day in the hospital - feet to the fire, never mind that nobody told me that I was going to need a change of underwear and a toothbrush on my first day of work. And yeah, I did get socked in the face by a sundowning old lady that night… which kind of sucked. But for the most part, surgery was REALLY, REALLY fun, and I find myself missing it, now that I’ve arrived at the slower pace that internal medicine seems to take.

I wouldn’t trade the hours on IM for anything right now, though!

I keep a list.

It’s a list of people I’ve cared about, people I’ve taken care of, people I’ve loved. Some of the people on the list are people I’ve watched grow up. Some of them are people who watched me grow up.

Besides being on my list, the only thing that they all have in common is that they’ve passed on from this world. They’re taking their next great journey.

I keep a list because I need to remember. I need to honor their memories. I also need to remember that they are the reason why I’m going through this, the 30-hour shifts, the blistered feet and aching mind, the endless textbooks and journal articles. They are the reason. When I am mindful of their contributions to my life, I remember that my journey to becoming a physician is because of them. Their influence on my life, I can only hope, will make me a better doctor someday.

I added another name to the list tonight. A 20-year old boy that I’ve had the honor and blessing of knowing for the past nine years, who fought cancer and survived, who always had a winning attitude and a great sense of humor. He will be missed by all who knew him, but not forgotten.

Dear AMA,

Please do not try to sell things to me by telling me how expensive they are in terms of lattes. I don’t drink coffee. I drink water and chew wintermint gum. I wouldn’t need any of these things if I hadn’t been getting up at 4AM. I don’t mind being there early, really. I just don’t want you trying to sell me things that others consume so that they can manage the work hours.

Love,

A bedraggled third year medical student

Your best weapon on surgery- a big smile and a plate of cookies for your nurses. Yeah, that’s right - I went there!

In the hospital, remember this one thing: in almost every situation, no matter how bad your day has been, the patient in the bed is having a far worse day than you.

Your attending might yell at you, you might not do well when being pumped, you might resent being up at work at 5 am.

But you woke your patient up at 5 am too, in a strange bed in a strange place so that you could poke and listen and ask if they have passed gas. At the end of the day, your attending will have forgotten that they yelled, you will have learned something new, and you’ll get to go home to sleep in your own bed. So never forget to put your own feelings aside and remember - this experience is not just about you, and that getting to do this at all makes you very, very lucky.

Jumping Frenchman of Maine Disorder is a condition of abnormal, exaggerated startle reflex in response to a sudden sensory input. The example provided by George Miller Beard, the first physician to study and characterize the disorder, as that if one was “abruptly asked to strike another, he would do so without hesitation, even if it was his mother and he had an ax in his hand.” (1) It is an uncommon condition, with most observed cases occurring in the Moosehead Lake region of Maine and the Beauce region of Quebec (where many of the lumberjacks came from). There has been some evidence of family history, but most patients did not become symptomatic until beginning work as a lumberjack, suggesting that it is a psychologic, rather than neurologic, disorder.

While this condition is rare, it’s impact became far-reaching. Beard’s initial studies on the Jumping Frenchmen sparked an investigation by Georges Giles de la Tourette to study what is today known as Tourette’s syndrome.

(1) http://www.ncbi.nlm.nih.gov/omim/244100