Cariodlogy

Medical School Third and Fourth Years: Clinical Rotations

Clinical Rotations

The third and fourth years of Medical School are entirely clinical involving monthly rotations through various subspecialties. The exposures focus on medicine and surgery, including certain required subjects as well as some leeway for choosing electives.

This is designed to expose the student, especially in the third year to a wide variety of basic elements, while forcing him/her in the fourth year to begin thinking about making a final decision on choosing an Internship. Although there are several choices, the critical choice boils down to whether someone wants to be a thinker or a cutter.

It also exposes the student to certain disciplines he will then automatically weed out potential future careers.

For example, when I had to spend thirty days on an in-patient psychiatric ward, I knew I would never be able to make a career out of the abstract qualitative issues associated with the mysteries of the scrambled brain. These were hard core cases, such a as incurable Schizophrenia and sometimes it was difficult to tell the inmates from the screwy attendants taking care of them. In this case, I chose to fly over the Cuckoo’s nest. 

On the Neurology Service, I knew that spending a career dealing with irreversible neurologic damage or chronic demyelinating diseases would make me suicidally depressed and that I would end up in the psychiatric ward anyway; without a real stroke, but equally incapacitated.

Hematology seemed too abstruse, and because it paired with Oncology was even more depressing than Neurology. I had a great deal of difficulty dealing with the depressing diagnosis of “cancer” knowing instinctively I would never be able to tell anyone they had it. The: “C” word. Or worse yet: the “Big C.” A bad one. Already spread everywhere. Metastatic and incurable.

Endocrinology seemed the most logical as it dealt with clearly defined human positive or negative feedback loops; but I found its scope too limiting. All glands. Not much fun. It would be like spending a lifetime adjusting a thermostat.

Pathology was a turn off after seeing only one autopsy. Bodies smell horrible because they have a sickeningly sweet odor when refrigerated. They also have a spooky color: Clay blue-grey.

Then when not cutting little specimens into pieces after extracting them from a corpse, the rest of it is spent squinting through a microscope to define well after it was too late to be of real assistance, what really happened to the person in question.

There is little satisfaction in telling the corpses’ doctor:

  • Hey, nice going. You were right about what he had but he died anyway.

Or

  • Hey, nice try but you royally fucked this one up. You had absolutely no clue whatsoever as to what it was that finally killed him.

Nephrology was too wrapped up in acid-base metabolism because I was never very good with ions and pHs. Beside that, if you look at the kidneys sideways, they curl up and die. This introduced the added negative feature of having to take care of dialysis patients; which for some reason offered no appeal. I think it was the machines, the constant smell of uremia, and the fact that all the patients are puffed up on enough steroids to make them look like pumpkins.

Pulmonary was boring. The lung. Oxygen: in. Carbon Dioxide: out. That’s what green plants do, only the opposite. Or maybe get a tumor or a blood clot. Maybe stiffen up. Mostly get infected or destroyed by chronic nicotine use.

Gastroenterology raised the exciting specter of spending a lifetime looking up peoples’ butt holes, and scoping other dirty orifices, or as necessary in Urology, if dealing with diseases of the penis, urethra, and bladder, offering the great opportunity to delve into some other equally enthralling orifices.

  • Yes. The bad news is that your prostate is larger than a grapefruit. But the good news is that it is still smaller than a watermelon. And the indifferent news is that none of that has anything at all to do with your erectile dysfunction.

Or

  • Oh, kidney stones. Take this little plastic cup home with you; filter every drop of your piss through a kitchen strainer, then save anything that looks remotely like a small meteorite, put it in the cup, and bring it back to me. That is, if the excruciating pain even allows you to get off the floor to go and pee in the first place.

Or

  • Sorry madam. But after six vaginal deliveries, bladder prolapse is an anticipated end game.

Pediatrics was out of the question simply because it broke my heart to see sick children; especially in the academic environment of seeing them referred for the worst childhood diseases; some of which were hopeless or incurable. There is nothing worse than having to deal with a child on chemotherapy or having handle those who suffer the world’s worst congenital deformities or inborn errors of metabolism.

Surgery was an extremely attractive option to the point I became enamored of going into plastic surgery. But after standing on my feet for long complicated general surgery or vascular cases and after seeing the gross disfigurations or severe burns that the plastic surgeons dealt with, I soon abandoned that plan.

Who knew at that time what lay ahead for the lucrative side of plastic surgery or that that soon a physician could make millions by adding or modifying lips, tits, cheeks, chins, noses and buns or by sucking out the unwanted fat pads and dough wads from the cadres of obese overeating Americans who were too lazy to want anything other than an instant cosmetic fix.

Then, there is the issue of being dissatisfied with your genetics. The only thing I ever really wanted to know about certain cosmetic repairs, is how much obligatory disclosure there might be on the part of the prospective spouse to tell his or her fiancé about whatever anatomical part was fixed before the prospective child was born with the same deficiency.

  • Honey. This baby has no chin. Are you sure it’s really mine?

Michael had a hand in talking me out of surgery because he said it was less than cerebral. He said if a monkey could be trained to be an astronaut, then given enough time any Simian could even learn to operate.

Being too smart to be a surgeon, he suggested I should stick with something in the domain of Internal Medicine.

Fate may have intervened, as when I became older my eyes got worse, I needed bifocals and developed a cervical disc related neuropathy that reduced my fine hand-finger coordination.

Nobody can put a lot of faith or trust in a surgeon who can’t see, feel, or properly tie and cut knots. Or worse, one who develops tremors.

Not wanting to be bogged down in generalities, and with diminishing choices, I gradually became enamored of Cardiology. The heart is not only complicated in that functioning primarily as a pump; it also has numerous other highly technical and interacting components to deal with: muscle function, chambers, pipes, valves, as well as an electrical system.It was a veritable gold mine for the intellect as well as having antiquity’s mystical aura as being the organ which is the repository of the soul. Most of the body’s other organs also think highly of the heart’s central importance, come to terms with having to depend upon it; and if possible avoid getting it too upset.

Later on in my career, however, I never ceased to marvel as to how many people could care less about their hearts or souls and more about what was in their wallets, or as equally superficial, who were especially fixated on how they looked.

Over the several decades after the great depression America became a society obsessed with youth and a quest for materialistic wealth.It was a quest that left a spiritual vacuum in the souls of many of the seekers and the perpetual impossible dream of turning back the clock on the natural aging process.

This obsession has progressively manifested itself in the worship of empty headed, uneducated teenaged Hollywood icons, their wastrel lifestyles and the materialistic trappings that goes with their territory or Hubris.

In this eternal quest for youth and prestige small fortunes are spent on plastic surgery, fraudulent cosmetic products, ineffective diet and weight loss plans, spas, automobiles, houses, clothes, and jewelry while at the same time having no attention paid to physical and/or spiritual health.

I have had patients who are driving Bentley or Mercedes Benz automobiles, then complain about the co-pay on an office visit dedicated to the ideal management of their cholesterol, or bitch about the cost of a diagnostic exercise test designed to see if their arteries are seriously plugged. Yet these are the same people who will think nothing of spending fourteen hundred dollars to tune up the carbureting heart of their fancy car.

One of the more extreme absurdities was the three-hundred-pound cigarette smoking diabetic who came in for a medical preoperative clearance to get his droopy eyelids cosmetically repaired. My diagnostic assessment was: What’s the point?

I have also seen people who have had breast implants, face lifts, nips, tucks, putty fills, hair transplants and wrinkles botoxed to oblivion, who also never once in their lives paid any attention to their blood lipids, only to then present to an emergency room in the throes of a massive heart attack.

In the Cardiology trade, we label this diagnosis: Drop Dead Gorgeous.

What a very different philosophy from that of the Native American who venerated: age over youth, the counsel, advice, and historical perspectives afforded by the village sage, as well as the desire to live in harmony with his environment; taking only what he needed while leaving the rest for someone else.

At a time when almost no one lived past forty, wrinkles were a sign of prestige. The old wizened shaman became a societal asset as well as a valuable cultural resource for helping the tribe to avoid potentially fatal pitfalls or for guiding young people to productively safe futures.

In our society, the tail of naïve youth wags the dog of lifetime experience as we discard our surfeit of wrinkled up old people like they were second hand clothes earmarked for the Goodwill Industry recycle bin.

 

 

Make be beautiful,

Make me thin,

Make me look like her or him.

Make me young,

Make me hot,

Make me something I am not.

 

 

   Photo source  www.impawards.com/1999/drop_dead_gorgeous.html