Pretend Patients

Last week, we had the joy of experiencing another OSCE exam. The OSCE exam consists of several rooms of standardized patients pretending to have some common complaint seen in an outpatient setting. The actors come in and tell us they have back pain, or chest pain, or burning with urination, and we ask them the standard questions. Have you had a recent fall? Does it radiate to your jaw? Are you sexually active with men, women, or both? What we never do is evaluate these fakers for what their symptoms really resemble - Munchausen Syndrome - a factitious disorder named for the German Baron Munchhausen (see photo) who liked to travel from town to town telling fantastical stories. These patients not only see several (potential) doctors throughout the day for attention, they've figured out how to get paid for it! They try to convince us they actually have back pain, but the limp is clearly feigned. They claim chest pain, but their S1 and S2 sound healthier than mine! I wonder what kind of reaction I would get if I told the fake patient that I simply can't ethically provide them an invasive test with the lack of symptoms on physical examination, but I can refer them to psychology if they are willing. I don't think the joke would be funny enough, totally not worth it.

In other news, I'm sad to see the end of internal medicine means the end of ethics class. I don't know why, but ethics sessions were the only part of medical school where I actively participated. I often interjected my opinion loudly with well though out, extremely liberal, socialist jargon. With all the conservatives in the class, I sometimes felt I had to stay true to my hippie roots from Boulder. I was so loud that it got to the point that with Mariam and I sitting off to the corner I wondered if I shouldn't notify the class that I am not in fact gay, but just really against denying anybody health care based on sexual orientation. For the rest of internal medicine, one student would turn to me for my opinion whenever anything vaguely liberal was brought up. "You believe in socialized health care don't you," he would say to me accusingly. I would promptly reply with, "You know it, I'm the only fraking liberal here." I sometimes would confuse this student by saying things like, "I can't believe that liberal biatch Tina Fey gets to play Sarah Palin." He would then ask me, "You're a Republican?" - yet another sign my face is too serious when I'm being sarcastic. I'm actually pretty moderate, but I think I just really enjoyed disagreeing with everybody - though, I usually also disagreed with them.  Now enjoy this clip of that liberal biatch playing the glorious Sarah Palin - what a hottie!!

--By Farrah, who got her first professionalism report yesterday for sleeping all the way through her family medicine orientation (I had two alarm clocks set, wtf!) - only two more reports and I get a verbal warning, oooooooh I'm sooo scared

My Sparkling Personality....

I am a huge fan of self-aggrandizement. For example, I think about my sparkling personality quite often. Other adjectives I use to describe my personality are "infectious," "witty," "sweet," "quirky," and even "eccentric."

In my 19th century British lit class, my professor once said of Oscar Wilde: "He was such an incredible conversationalist that his friends were amazed at his on-the-spot witticisms." At the time, I thought how weird it was that Wilde was remembered for his conversational skills rather than say, the convoluted genius of The Importance of Being Earnest. But then, eventually I wondered if I was the reincarnation of Wilde, an incredibly witty conversationalist, a type of person whose witticisms people remembered and posted on their Facebook profiles under "Quotes" (the 21st-century version of Bartlett's).

Of course, I thought that my comical and enthusiastic conversational style would be very helpful to me on my medical school rotations. I thought that 3rd and 4th year would a time when I would shine - I would literally charm these overworked, tired individuals with my exaggerated Southern drawl and cute expressions. My friend Blase even told me, "I'm sure patients love you!"

Ah, Blase, if that were reality.In fact, I have had a fair share of strange, awkward moments rather than charming moments of cuteness. Instead, I have found that some of my more awkward, decidedly less personable classmates have had a better time integrating themselves into the hospital hierarchy. Here is a round-up of some awkward moments for your reading enjoyment:

1) Last week, when rounds ended, I asked senior resident whether I should shadow him for the rest of the day. He told me, "Sure, I'm going to get a drink." I started to converse with him about some inane topic, and we kept walking down this really narrow hallway. Suddenly he stopped outside a door and said, "Uh, I have to use the bathroom." I had literally followed him to the door of the men's room without realizing it.
"Uhh..sure! Sorry!" I said and quickly booked it down the hallway. Yesterday, he actually told me in advance he was going to the bathroom so I wouldn't make the same faux pas again.

2)I was obsessed with trying to bond with our senior resident even though he was a strictly business. One day, he told us to read a boring biography about some doctor dude. I randomly said, "I started a humanities club at the medical school!" Silence all around. Yauss merely stared at me with an uncomprehending face that seemed to say, "Why did you just say that?"

3) One day, I went to use the phone on the hospital floor at the same time a rather heavyset nurse with over-processed blond hair reached for it. Ever polite, I said, "Oops sorry." She gave me the once-over, and rudely said, "What are you? Like 12?" Instead of saying, "Actually 11. And I'm going to be your boss one day. Unfair and scary, isn't it?", I said, "Uh, no...uh 24?"
"I must be getting old!" she said (most likely).
"Are you...uh...going to trust me when I'm a uh doctor?" I said nonsensically.
"If you learn to talk," she said. And scene, conversation over - no witty comeback, no biting remark. Just me mumbling and making no sense whatsoever. I resolved that I would give her one of my trademark withering stares the next time I saw her, but unfortunately, I have already forgotten what the nurse looks like, since all old, large ladies look the same to me.

4) #4 if too sensitive for blog, so if you are my friend and a girl, please ask me about the Aveda make-up bag incident.

Hopefully, my next rotation in pediatrics will go better - I love cute, fat babies, so if I'm unable to charm people my own age, maybe a kid will be easier to please.

--By Mariam, who thinks the Palin lady is very pretty but at the same time scary with all of her gun and anti-abortion talk.

Excuses

I can't study because my dog is sleeping on my books.  

Once again the bloggers will most likely be on a month hiatus with the upcoming shelf exam, but blogs to look forward to (if we ever manage to finish them) when we're back on track:

1.  Farrah and Mariam go to Zingerman's a la Harold and Kumar go to White Castle

2. My opinion of internal medicine

3. A woman vice president!?!?  Hitting that glass ceiling sure gave me a headache!

4. More pictures of my dog!

--By Farrah, who misses you, yes you, I miss you.

Cosmo Confession: I Hate Sex and the City

With a definitive lack of material to blog about, I thought I would reveal a secret that has burdened my frail shoulders for so long - I hate Sex and the City - from the characters to the horrific culture that it spawned. Now of course there is the obvious reason I hate the show - my prudish sensibilities deem it "sophisticated, Emmy-winning porn" for girls who like their adult entertainment to have more character and plot development than the average Girls Gone Wild by Joe Francis or Coed Confidential. But my hatred runs deeper.

Since every girl I know loved the show, I watched many episodes but found the characters really annoying. Samantha's cougar activities and affected staccato voice were grating on my nerves, and Charlotte's domesticated wholesomeness was really tiresome. Carrie's voice-overs that were supposed to reveal the secrets of relationships to the viewer were shallow, insipid, and nonsensical if you really sat there and listened to the content of her "column." If I were Samantha, Miranda, or Charlotte, I would have stopped sharing intimate secrets with my blabber mouth columnist friend a long ass time ago.

But beyond just the show, I hated the audience that were such fervent believers in the show - middle class girls who lived in the heartland and longed for a sexy, cool life in NYC, as they longed for Manolos with the religious fervor of a Catholic at the Vatican, and they bought the Steve Madden knock-offs in their desperate way to achieve the aspirational lifestyle of the characters. What was particularly sad was when girls compared themselves to the glamorous characters on the show - "I'm a Carrie!" their Facebook profiles would cheesily declare after they had taken a 4-quiz questionnaire.

Probably the saddest thing of all was when I read that a tourist could take a Sex and the City tour in NYC. Out-of-towners could get a glimpse at all the hot spots seen on the show, from Carrie's apartment to the sex shop where Charlotte got her rabbit vibrator. The tour then ended with pink Cosmos that were made infamous by the show. When I read this article in Radar, I realized how capitalist America suckered tourists into paying $50 during a recession to experience the life of the show in a third-hand way.

The bottom line was this: people didn't just gleam shitty relationship advice about becoming "romance intolerant," but they saw the fabulous wardrobe Patricia Field created for her characters as something that was attainable at the local H&M or Express. And the tragic truth of the world is this: Carrie's wardrobe in the movie or show were not attainable at a local Midwestern mall near you - as far as I can tell, the craft of Dries van Noten or Christian Dior couture are pretty hard to replicate decently even by the evil geniuses at Steve Madden and Forever 21 (both stores which have been slapped with lawsuits for their knock-offs).

And so, it's just so sad for young girls to aspire to supposedly "liberated" NYC life, filled with a stream of eligible men and a closet full of Jimmy Choo's and Giuseppe Zanotti's when the lives of the four characters are just shallow, superficial, and decidedly un-liberated. Because take this into account: these supposedly feminist women just sit around at lunch at a fancy chi-chi restaurant and define their identities around the men they date and their expensive "power" wardrobes rather than anything of real substance.

--By Mariam, who totally sounds like a pretentious, women's studies professor at some liberal arts college who hates fashion and looking cute. Sadly, that is really not the case as she has a shopping problem in reality.

The One Time I was Mean (Hard to Believe)!

Anyone who knows me thinks I am niceness personified. I am considered to be the epitome of nice. For instance, this is how I imagine conversations to be like when I'm not around:
Person X: I'm hanging out with Mariam today.
Person Y: OMG SHE IS SO NICE!
Now for those stranger blog readers out there, I'm sure the above hypothetical exchange just made you want to be my BFFF.*

Nevertheless, I recall a time when I was mean to someone, and when I think about it, I cringe inwardly from the memory. It was 10th grade, and I was still the hardcore conservative Jesus freak (or should I say Prophet Muhammad) that I am now. A boy, who we will call Chad Lowe, used to harass me in school all the time. He would make my life miserable - steal things from me, call me "DL, the dyslexic monkey," and generally harass me so that I could legitimately report him to HR had I been in an office-type setting.

I didn't think his sexual harassment was cute - I thought it was super annoying. I didn't find his attentions flattering, nor did I think of myself as super hot because I was the object of his continual attention. I just thought it was annoying as shit, and I wanted to get violent on his ass (the fact that I am a physically frail individual with fragility issues actually prevented me from unleashing my id throughout my time at Carlisle).

Anyway, one day, Chad Lowe stopped me in the hallway, and he said nervously, "Can I ask you something?"
He took me into a private classroom and asked me to the upcoming homecoming dance. I was merely annoyed that he had had the audacity to ask someone who was as religious as me. Didn't he know I was Muslim? I thought outraged. I didn't go to dances with boys (much less with a group of my single girls who were all going together...not because of religion but because it was fundamentally lame).
"NO!" I yelled meanly.
"Uhh..please?" he asked tentatively, his confidence faltering to subzero levels.
"Uh...NO!" And I stalked off, fuming.

In retrospect, I really feel bad for being mean to Chad Lowe. Ideally explaining the religious reasoning behind be defiant "no" would have been better, rather than just getting viscerally agitated. Who knows? Had I said yes, maybe today, I would be married to an infidel with 2.2 kids and a white picket fence living in in zina. So, I guess, things did work out because I just ended up having a reputation of being "stand-offish" at Carlisle (or at least according to Mr. Keefer). Did I learn a lesson about being mean? No, not really, because in the end, I didn't have reputation of ill repute, nor receive disapproving glances from Allah or my parents. Score: Mariam - 1, Chad Lowe - 0.

*Best f!*&ing friends forever - courtesy of Pineapple Express.

--By Mariam, who is so happy it is Pakistan Independence day! Happy PID!!!!! Pakistan zindabad!!!

The Most Romantic Day of My Life

I have to say one of my biggest regrets in life is how my husband proposed to me. Or rather, how I proposed to my husband.

All of it is a bit hazy, because at the time Adam was working for Anheuser Busch and through some miracle his free beer card had stayed active for the six months between his two internships leaving our dining room literally wallpapered with cases of beer. So I was enjoying one of America’s finest domestic beers and surfing the internet, looking for something to waste my waitressing money on. Somehow I got it into my head that I wanted to look at wedding dresses, but I wasn’t engaged to Adam yet and we all know looking at wedding dresses before you have any prospects is a little crazy. Or at least it’s crazy if the person you may have a prospect with is in the room. So rather than saying “Screw society, if I want to look at pretty white dresses, it’s my god damn right as an American with a fast internet connection,” I decided it was time to get engaged.

“So Adam,” I slurred, “we are gonna get married, right?”

“Yeah.”

“So we are engaged?”

“Well…”

“Can I call my mom?!?”

“No!”

“But we are gonna get married right? So we are engaged. I want to call my mom.”

“Don’t call your mom.”

“Pleeeeeeeeaaaaaaase can I call my mom? I want to call her!!!”

I imagine by this point my voice had gotten very loud and shrill. Anyone who has had the unfortunate task of sitting next to me in group discussions knows that when I get excited about something I lose all control of the volume of my voice. So by now, I must have been yelling about calling my mother to tell her we were engaged. And as with anything I really want, Adam caved.

“Fine, call your mom!”

And that is how I became engaged. Later on after we were married, Adam told me he had wanted to ask my dad’s permission for my hand and had begun planning exactly how he was going to propose and all this other romantic stuff. Instead I am left with a cautionary tale about the dangers of beer, internet shopping, and long term relationships.

--By Sarah, who thinks awesome, creative engagement stories are way overrated, right?

Difficult Communication

My first rotation had some minor problems with communication.  Many of the doctors in the internal medicine department were from India or Pakistan.  I had absolutely no problem with the people, they were friendly and open to teaching.  Occasionally, they would forget I was there and slip into Urdu.  I still actually understood a few words, like the numbers, which were similar to the numbers in Farsi.  Though, it was a little hard to understand a sentence where the only word you recognize is "five."  I would clear my throat, and they would realize I didn't understand and translate even if it was useless information, like "I had the eggs for breakfast" or "Mrs. Doe told me I was a gosh darn mother flubber when I didn't give her more percocet."  I had gotten completely used to my interns and residents a few weeks into my rotation, and the problems started when I was around them so much that I started to just barely develop an Indian accent of my own.  I wasn't trying to mock them, or even doing it consciously, but I noticed I was putting the emphasis on the wrong syllables while I was at the hospital.  I would tell my resident I was going down to the emerGENcy room to get an H&P, instead of my usual eMERgency room.  This just shows that I'm turning into Mariam circa kindergarten.  The subtle inflection left when this rotation was over, and hopefully I didn't offend anybody.  

Today, I had my first hostile patient.  I arrived at the outpatient clinic and this particular patient was too short of breath to explain their story to the medical student after she already explained it to the nurse.  She was not too short of breath to yell at me to get out of the room.  After this troublesome encounter, I overcompensated by being extra-friendly and asking permission to do anything.  Apparently, my compensation also involved developing a country accent for the small town patients at my AHEC rotation.  "What's that? Y'all try to get out on yer bicycle when ya can.  Well, that's downright healthy for yer heart, it sure will bring down yer cholesterol."  I can't help but annoy myself when I hear the country drawl coming out of my mouth.  I don't mind country accents - I just know I'm being  a total poseur and perpetuating the stereotype that country people are friendly.  One day I hope to find my own voice, my own self - just like Christina Aguilera sang in Mulan - when will my reflection show, who I am insi-aye-aye-ide.

--By Farrah, who's very happy to be back in Toledo from her AHEC, doesn't really know why she picked that picture of Dr. Nick, and realizes the video was probably overkill