Standardized Patients

Today was one of those days in my medical education where I caught myself thinking, "This kind of stuff could only happen in medical school." As I mentioned the other day, today marks the beginning of my Ob/Gyn rotation. I don't actually start doing real work until tomorrow when I report to the L&D department at Sutter Hospital. Today we had our orientation, which was accompanied by instruction from the unsung heroes of the medical world, the standardized patient.

To begin, I must help you to understand that doctors have to begin somewhere. I mean, people trust their docs to do a lot of really peculiar things to their bodies ("Now, if you would just turn your head and cough, sir"), ask them very peculiar and personal questions ("Do you have sex with men, women, or both?"), and basically get away with things that you would otherwise never dream of letting someone do. But would you feel comfortable letting your physician do those things if you knew that he or she had never done them before?

Let's be honest, no one would want to hear their doctor tell them: "For the next part of the exam I am going to need to insert my finger into your rectum. Now, I have never actually done this before, but have seen it performed and think I've got the basic idea. So, if you would just drop your pants and bend over we can get started..."

Nobody wants to be the guinea pig, right?

Well, see, there's where you might be wrong. In order to better help the medical students be able to adequately perform a clinical breast exam, the school arranged for a panel of women (the "standardized patients" or SPs) to come to the school and allow us to practice the skill on them. To help get us a feel for the variations in anatomy from person to person, we spent about 10 minutes at every station assessing and checking each pair of breasts before moving onto the next set. I give the school credit, from the pendulous to the petite and the saggy to the firm, they had assembled a fairly diverse array of breasts.

From an educational standpoint, it really was a unique opportunity--a chance to perform multiple exams in a row and get a sense for what a "normal" exam should be like. However, there were two nagging thoughts that I just couldn't seem to shake: 1) "Wow, under any other circumstances, this would be wildly inappropriate," and 2) "How much are these women getting paid to do this?" [Ed note: The answer to that query is they get paid quite well. If you are interested in becoming a standardized patient at UCD, please click here].

While I found it conceivable that a woman would agree to submit to multiple breast examinations if the price was right, I still have a hard time believing that each of these women also consented to receiving multiple pelvic exams at the hands of know-nothing students. Though I do not possess the necessary plumbing, I can only imagine a few things which might be more uncomfortable. Nevertheless, the SPs were all very friendly, funny, and informative ("No, I am pretty sure that is not an ovary you've got there"). Fortunately for them, we didn't practice doing Pap smears on them. Instead, we practiced that technique on apples (or "Papples," as the instructor liked to call them).

So, the next time your doctor asks you to turn your head and cough or scoot your butt to the edge of a table so that it's hanging off ("no, further, keep going..."), just remember, as uncomfortable as the experience may be, it would be even worse were it not for the sacrifice of the SPs.

On behalf of doctors and patients the world over: Standardized patients, we salute you.

Minesweeper!

According to Cami's unnamed sources, the average teenage male spends 1.5 hours a day watching videos on Youtube. With videos like this one, I can't really blame them. I stumbled across this little doozy and... well, anyone who has wasted a few hours playing Minesweeper can relate. I think the guy with the yellow face is supposed to represent the little smiley guy at the top of the Minesweeper screen.

Playing The Hausfrau

I don't think Cami really likes me using the term, but I have been the playing the role of Hausfrau these past few weeks. With my research projects on temporary hold and no clinical responsibilities I have been honing my homemaking skills.

You see, dear reader, while Cami is away "bringing home the bacon" and "busting her hump" at work all day (or any other work-related euphemism you may prefer), I am at home cleaning the kitchen, going grocery shopping and watching my soaps. Okay, I'm not watching soaps, but watching Euro 2008 can be every bit as dramatic. I've been potting plants, doing laundry, and cleaning the windows. In fact, I've been doing everything but the cooking... admittedly, my culinary skills are a little suspect. True story: I once melted a metal pot on a stove while trying to boil some water.

Being a Hausfrau is not all that bad. With no kiddos at home, I don't have any real responsibilities. Which leaves me with a lot of time for me. But let's be honest, it's hard to carry a worthwhile conversation on with yoruself, so I do get lonely sometimes . I also get a little cranky if Cami isn't home on time (especially if she doesn't call to let me know that she is going to be out late with the girls from work). I suppose, if nothing else, this experience has given me a new appreciation for all the stay-at-home moms out there (especially my own). It is definitely not easy to be home all day.

So there you have it, I am ready to go back to "work." I have to put the word "work" in quotation marks because Cami is quick to remind me that I go to "school." People who go to "work" actually get paid for what they do. Work or school, I am ready to get out of the house. Here's to finally starting my Ob/Gyn rotation on Monday! May it be every bit as entertaining as my last rotation!

Food Fight!

I can't speak for anyone else, but I have always wanted to be in a food fight. Not just a little food fight, but an all-out, food-flying frenzy. As a kid in the cafeteria at Peterson Elementary, I struggled to restrain the urge to just chuck my mini-pizza and chocolate milk across the room and scream "Food Fight!" at the top of my lungs as dozens of kids start throwing every consumable item in sight. Unfortunately, I never had the guts to actually start such a fight... until last Friday.

Cami's parents invite their grandkids eight years and older to their home for a week of EFG (Especially For Grandkids) festivities. A while ago, we were helping them brainstorm ideas for activities when I suggested having a food fight. Kathy was a little reluctant about the idea, but I could tell that Jerry thought it would be a lot of fun (he must have dreamed about having food fights as a kid, too). We started discussing what foodstuffs would be essential for an awesome fight and how best to stage it. We came up with pretty healthy food list and set the wheels in motion.

A few days before the scheduled event, Cami and I began stockpiling our edible arsenal. The fight was to include: spaghetti, ramen noodles, macaroni & cheese, chocolate pudding, mashed potatoes, pork & beans, whipped cream, dinner roles, watermelon slices and coleslaw. Honestly, what else do you need? We made great big pots of the stuff and readied it for the two hour trip to Merced.

The food fight was to be the culmination of EFG: the grand finale. The kids didn't know that Cami and I would be crashing the EFG party, so when we arrived they were super-duper excited that we came. They also had no idea that we were going to be staging a food fight later that evening. Unbeknownst to the distracted EFGers, we started hauling all the food we brought into the garage, so that it could be brought out after dinner.

We ate outside in the backyard and told the kids that we had brought a "special dessert" to be enjoyed after dinner was done. When everyone had gotten their fill, we blindfolded all the kids and they started guessing what their special dessert could be. Cami and I ran back and forth from the garage to the table to deliver the ammunition to the table. After we had set everything up, we let the kids take off their blindfolds. It was definitely not what they expected and I think they may have been a little confused. Then, as we rehearsed earlier that evening, Jerry said: "This is our treat? I think it looks kind of yucky." As I attempted to defend our culinary skills, he picked up a big glob of chocolate pudding and threw it across the table. Then Cami and I yelled "Food Fight!" and the melee began.

It may have been the best five minutes of my adult life. Pork & beans were flying everywhere. Jerry was smashing pudding in everyones' face. I smeared a whole stick of butter over Jake's head and back. Kathy was throwing entire plates of food across the table (her initial hesitance about the food fight disappeared faster than the coleslaw). Daniel immediately ran to the "Magic Tree" (the predetermined safety spot) and I'm not sure Megan was entirely comfortable with the idea of throwing food all over the yard, but the rest of us were loving it. The fight only lasted a few minutes (amazing how fast that food got used), but it was glorious!

When it was all over, the back yard was a mess and we were covered in goop. You couldn't walk through the yard without stepping in a puddle of mashed potatoes (a genuine tactile experience for those who have yet to try it). We took some family photos and then started hosing everyone and everything off.

It was an absolute blast. Fortunately, Wendy was kind enough to record the entire food fight and some of the entertaining clean-up. The video can be seen in 3 installments by clicking here, here, and here (sorry I didn't combine the clips, I don't have any good video editing software). The cleanup didn't take all that long (amazingly enough) and then we all hopped in the pool for a refreshing swim. Let's hope the food residue doesn't clog the pool drain.

Was all the preparation, cooking, traveling, and set-up worth it?

Absolutely.

Wisdom Teeth Are Overrated

I have never had a cavity. I never needed braces. I didn't need to get my wisdom teeth taken out. I think I have sat in a dentist's chair 6 times my entire life. While I wouldn't say I have "perfect" teeth (I do have a chipped lower incisor), I would liken my teeth to those skinny people who seem to be able to eat what they want and never exercise and still stay in perfect shape. What can I say? I was blessed with good teeth.

Imagine my surprise then, when the other day after dinner I had the sensation that there was something stuck in my back teeth. I reached back to pick the morsel out of my molars and discovered something poking through my gums. At the ripe old age of 27, my first and only wisdom tooth finally showed up.

Flashback to 1999: Shortly before my mission I had a dentist's appointment. My dentist at the time remarked that I appeared to only have one wisdom tooth. Additionally, my big mouth seemed large enough to accommodate any late-comers and did not appear to necessitate their preemptive removal. This was all fine with me, I had seen the way my friends and family members turned into chipmunks after having their wisdom teeth removed and I would just has soon avoid the whole process. The next nine years passed with nary a dental complaint.

Did you know that the term "wisdom tooth" originally stems from the Latin designation: dens sapientiae, and similar terms are found in dozens of other languages. The Koreans call them 사랑니, or the "love teeth" referring to the age at which they appear and the pain associated with a first love. The Japanese call them 親知らず, or "the teeth unknown to the parents" because they show up after the kids have left home. Whatever you call 'em, nine years after receiving a clean bill of health from my former dentist, I now had one poking it's little head out of my gums.

In any case, my uncle is a dentist up here in Sacramento. I scheduled an appointment with him to see if I need to take the tooth out. I showed up at 9:30 for my appointment, they took a Panorex and, sure enough, my wisdom tooth was impacted and would need to come out. The dental assistant told me if I wanted to wait around an hour, they could do it that day. Not one to delay the inevitable, I said "sure."

I phoned Cami to let her know I was going to have the tooth out. She asked if she needed to come pick me up. I told her I didn't think she would because they weren't going to use general anesthesia, just some local stuff. I could almost hear her shudder as she said, "That does NOT sound fun." I was expecting to be in the chair for about an hour and, as Cami's words echoed through my head, I braced myself for the worst.

Ladies and gentlemen, that tooth came out faster than you can say 親知らず! It took longer to numb me up than it did to actually pull the tooth out. I thought that they were about to get started when they handed me the tooth in a commemorative case and told me to leave the gauze in place for a little while. They were already done! Seven minutes! That sucker must have abandoned ship once he realized what was about to happen. My uncle told me I probably wouldn't need anything but ibuprofen for pain, he didn't need any stitches, and that he didn't anticipate the swelling to be all that bad.

Seriously, what is all the fuss about getting wisdom teeth taken out?

I was grateful for the commemorative case, but I think I am going to have the tooth either bronzed or attached to my favorite gold chain, 'cause I hear that's pretty hot right now. Well, either that or try my luck with the Tooth Fairy...

My Trachea Still Hurts

I've got a lot of time on my hands. Three weeks ago I started a "research" rotation. Essentially, I am working on two separate projects (which I will explain at a future date) and have been absolved of any clinical responsibilities whilst I go about "researching." However, research is an inherently slow process and I am left with a lot of free time on my hands. Enter my good friend Andre.

My HT companion is a Brazilian Jiu-Jitsu martial artist and trains with guys who do MMA. For several months now, he has been asking me to come and spar with him. I have had genuine interest in doing so, but have had precious little time to devote to such pursuits. We tried a few times to schedule something in, but it never worked out. With the advent of the aforementioned "research," I figured now was as good a time as any to take him up on his offer. So about a month ago, I went over to his place where he has an actual wrestling mat in the middle of his apartment.

Warning Sign #1: Dude has an actual wrestling mat in his apartment, he probably knows what he is doing.

When I got there I started doing some stretches and Andre was sort of explaining to me the basic premise behind jiu-jitsu. Now, my dad was a pretty good wrestler in high-school and used to rough me up pretty good as a kid... but then again, so did my big sister, Laynie. Nevertheless, combining the experiences with my dad (ok, ok and my sister too) with a little high-school wrestling experience of my own and a 15 pound weight advantage, I figured I could at least hold my own for a bit.

I had been kind of joking around with him since I got there, using phrases like "taking out the trash," and "bringing my A-game" (humor being my psychological defense mechanism of choice). He laughed and dished some out himself. We were laughing, having a good time when suddenly Andre got very serious: "The first thing you need to understand is how to tap-out."

Warning Sign #2: Dude very seriously informs you that the first thing you need to learn is how to tell him to stop beating you up, he probably intends on you needing to utilize that skill.

Now, I won't go into the details of jiu-jitsu, but it is basically comes down to forcing your opponent to submit. For the uninitiated, that usually means either choking your opponent or getting him into a joint-lock (hyper-extending a joint). I did not know any of that before Andre and I started sparring. Four seconds (seriously, four seconds) into our first bout, Andre had me in a vicious choke. I could feel the blood distending all the veins in my head and my eyeballs bulging out of my head. It is an odd sensation for those who have never experienced it.

Fortunately (or unfortunately, I suppose), my other big sister, Cindy, once put me in a rather nasty choke hold after I had teased her mercilessly while she was talking on the phone with some random boy. I knew from that experience that it does not take long to black out when being held in a decent choke. Grateful for Andre's foresight at teaching this lesson first: I tapped out.

My trachea hurt for about a week.

Andre is lightening fast and I had no idea how to keep myself out of arm-bars, triangles, and chokes. Seriously, he wiped the floor with me. Again and again and again. And again! All those advantages I listed a couple paragraphs back: useless. On top of that, I very quickly became exhausted. After 90 minutes of torture, he finally let me go.

Walking back to my apartment I was fairly confident that I was going to throw up. Just puke all over the parking lot. I walked very slowly and stopped by every grate I passed, you know, just in case. I figured that no one else in the apartment complex wanted my barf baking on the asphalt in 100° weather. Call it a hunch.

Since then, every Thursday I go over to Andre's for a slice of humble pie. I am getting better and have taken to watching UFC fights on YouTube. I have yet to force Andre to submit (will probably never happen), but at least our little exercises are taking longer than 4 seconds. I come home every Thursday with mat-burns and bruises all over, but I gotta admit: It feels pretty good.