Wackadoodle

Well that was fun...not! Hehe, never gets old.

I'm officially done with the USMLE Step 2 CK, or as I like to call it - Step Up 2: The Streets. It was brutal. The questions weren't so bad, but it is miserable to sit in front of a computer, reading paragraph-long questions and answering them for 7.5 straight hours. It combines my two least favorite activities: reading and thinking.

For those of you who have never has to indulge such standardized torture, be thankful. The best analogy I can come up with is this: imagine sitting at a computer for 7+ hours answering questions. Okay, so I'm not very good at analogies. On the plus side, I got some first hand learning about pressure ulcers. Who wants to change the dressing?

I was able to focus for most of the exam, but I started getting pretty flighty towards the end. Instead of actually reading the questions in the last blocks, I would just stare at the pretty arrangement of letters and make up my own questions. I'm worried about one question, though. It asked who Ziggy Stardust's bandmates were. "Weird & Gilly" were not options, so I went with "Spiders from Mars." I hope that's right.

If you're wondering what CK stands for, it's "Calvin Klein" because he wrote the test. The next big test is the Step 2 CS, which stands for "Counter Strike" because soon we shall have our revengeance!

And for any medical students reading this who haven't taken the CK yet, let me just say this: suckers! Have fun with that, jerkbags!

News Update
In case you hadn't heard, John McCain picked Tina Fey's older sister as his running mate. Bold move...

Case Presentation

In honor of my USMLE Step 2 CK exam tomorrow, I thought I'd do a quick case presentation.

A 27-year old man is brought to the emergency department 1 hour after a boating accident. The man was climbing the mast to untagle his sail when he fell off, striking the edge of the boat before falling in the water. He says he feels "okay" now, although he describes mild right-sided chest "discomfort" when breathing in. Vital signs are stable. Exam reveals a tall, lean man in no apparent distress. There are bruises over his chest on the right. Auscultation reveals decreased breath sounds and hyperresonance on the right. Chest x-ray shows:

What is the diagnosis? (the answer is in the black box below)

Nemothorax

Ebony and Ivory

Paraphrased conversation between Legal Counsel and myself:

Legal Counsel: Everybody says that Barack Obama might be the first black president, but really he's only half black. They just ignore the white half. Why don't they say he'll be our 44th white president - he's just as much white as he is black.
Montgomery: I wonder which half is his white half. I hope it's not in the trousers area.

As usual, Legal Counsel makes and interesting point and I say something ridiculous and borderline offensive. But it raises an interesting question: if I was half black, what pieces would I want of each race? So I got lost in thought for the next several hours about disease prevalence and races. I call it lost in thought, Legal Counsel calls it catatonic.

Here's the breakdown of how I would design my half-black/half-white self (the parantheses describe the disease more prevalent in the other race:

Black Pieces
Pancreas (Type I Diabetes)
All skin except palms and soles (most melanoma)
Intestines (IBD)
Chloride ion channels (cystic fibrosis)
HFE gene (hemochromatosis)
ATP7B protein (Wilson's Disease)
Liver (autoimmune hepatitis)
Thyroid (hypothyroidism)
Brain (glioblastoma multiforme)

White Pieces
Palm and sole skin (acrolentiginous melanoma)
Insulin receptors (Type II diabetes)
Bone marrow (sickle cell disease)
Heart (HOCM, ischemic heart disease)
Stomach, esophagus (gastric, esophageal cancer)
Eyes (glaucoma)
Kidney (chronic kidney disease)
Lungs (asthma)
Prostate (prostate cancer)

As you can see, it's a fairly even split. But biracial Montgomery would be protected from so many diseases! Excellent. Now I just need to figure out how to do genetic modification and I'm set! Also I want x-ray vision and the power to turn invisible. Sweet...

Down with Obama...question mark?

I found this on a "conservative" t-shirt website:I really don't know what it means. I just know it makes me want to vote for B-Rock.

It was categorized under the "Anti Obama shirts" section, but I can't figure out what it's supposed to mean. Are conservatives against Disneyland and/or Mickey Mouse? If so, damn them. Damn them to the hell they love talking about. I thought Mickey Mouse was a symbol of America.

Here are the results of a Montgomery Road exclusive international poll - 100 foreigners surveyed, top 5 answers on the board - "Name something that stands for America":

1. Uncle Sam - 45
2. Mickey Mouse - 25
3. Mr T - 13
4. James Woods - 6
5. Abe Vigoda - 3

Conservatives should love Disney/Mickey Mouse/Disneyland. Think about! Idolatry, capitalism, churros - what wouldn't they love? Well...maybe not the churros. Immigrant food, you know.

Maybe I'm wrong and those aren't the Mickey ears I so know and love. Maybe that's just my Rorschachian interpretation. But what else could it be? Bad hair cut? Record-setting bilateral seborrheic keratoses*? Simultaneous discus injuries?

I've got it! Barack Obama is an alien cyborg sent to Earth to collect data and transmit it back to his home-planet of Omicron Persei 8 using his readily-concealed scalp satellites! Of course! It's so obvious...why didn't I figure it out sooner? His early life is so convoluted and jumbled, it sounds like he just made it up on the spot. And compare this picture of Obama (upper) with a picture of an alien attacking Washington DC last year (lower):
It's uncanny!

Thank you, ThoseShirts.com, for revealing this sinister alien plot. Readers, vote for John McCain! He's just a zombie. And I'd rather have an American zombie than an alien cyborg.

* jibbly

What was I thinking?

Even during the dark times when I wasn't blogging, I was still keeping track of potential topics about which to write. The only problem is, I would usually write a brief snippet with no explanation. Then I'd come back and it would be completely out of context and I'd have no idea what the hell I was trying to say. It's like Seinfeld Season 2, Episode 13 (The Heart Attack) - Jerry writes a joke late at night and can't remember it or read it in the morning. "'Fax me some halibut.' Is that funny? Is that a joke?"

So today I thought I'd review some ideas that have been lost to the ages.

Detour - Wile E Coyote
Not sure what was going on here. I do love Wile E Coyote - he has both the inventiveness and bloodlust that make America great. And he would frequently send the Roadrunner on detours to try to catch him, which instilled in me at a young age a deep-rooted distrust of detours. But I really don't know how I was going to make that into a full post.

Batman: favorite non-marvel, non-constantine, non-hellboy, non-X, non-Y superhero
This may have been written around the time that the hype for The Dark Knight started ramping up. I think I was going to call Batman my favorite superhero, but with a bunch of qualifiers that imply he's my 11th or 12th favorite, so as to make it ridiculous. But come on! There's no way Constantine is better! And don't even get me started on X and Y!

Jokeback Mountain
Possible idea for a one-liner based on Heath Ledger's roles in Brokeback Mountain and The Dark Knight. Probably would be in bad taste now. Don't get me wrong, I'd still make a joke in bad taste. I just can't remember it.

Bankruptcy - horse saddle, toy tractors, wedding rings, guns, non-running cars
I may have been coked out of my mind when I wrote this one. It reminds me of Chris Farley in Black Sheep:

Hi there, this is Mike Donnelly. I work over here at the recreational center. To be honest with you I pretty much run the place ha, ha, ha. Is this ah Pat Gyles? Good, Good. Hey, hope everything's going great in your fine town of er Avery? Edward! Ha, ha, ha. Say, the reason I'm calling is I wanted to tell you a little bit about the candidacy of Al Donnelly. Al Donnelly's a guy with a dream. His dream is to become governor of this great state of Washington. Hell, every guy's got his dream, am I right? Between you, me and the wall here, I doozy myself last night. Ha ha, ha, ha. Get this: A corn-fed harvest mouse, a hooker, a nun, a Flemish peasant woman, whips, chains, whistles yo-yo's, a circus midget. My grandmother riding by on a bicycle give me the finger, and a duck! Now, I don't know ha, ha, ha. Are you crying? Oh my lord. I am sorry honey, please don't ! Could you get your daddy on the phone. No, don't hang up please I...

Hypothetics - French Wine Snob
First off, "hypothetics" isn't a word. Although it does sound like a new exercise for really lazy people. Second, there's nothing hypothetical about a French Wine Snob. They're real! I've seen one...and smelled others.

Shamrock shake - another reason to hate canada
As though I need another reason to hate Canada. Every year around St. Patrick's day I go hunting at nearby McDonald's restaurants for the elusive and delicious Shamrock Shake. Unfortunately every year I come up empty-handed. And by empty-handed I mean both my hands full of Big Macs, chicken strips, large fries and a coke. But no Shamrock Shake! Well this year my research revealed that McDonald's now only releases this ambrosia in Canada. Stinky, socialist Canada. So basically I think I was going to propose that we invade and take over Canada. And that we try Uncle O'Grimacey for treason.


So not all of my ideas are winners. And half of them aren't even memorable. On the plus side, while searching for the hastily scribbled txt files that are the basis of this post, I happened upon a stash of legitimately mediocre ideas that you might see in the future. Yay!

Listserved!

The College of Medicine listserv is a very...contentious place. It's the email equivalent of the Russia-Georgia border. Most of the time it's used for selling garbage, offering rooms for rent, medical news, and advertising high-class prostitutes. But every once in a while it erupts into an orgy of carnage and violence, by which I mean passive-aggressive debate. My personal past favorites include "I think all other students should shut their god-damn mouths and not ask questions during class" and "I'm sending this useless email to the listserv to tell y'all to stop sending useless emails to the listserv."

Well the theme of this week's debacle is bigotry. Some student sent an email announcing the California Supreme Court's decision that doctors can't deny care to homosexuals because of religious beliefs. It's a decision with which I personally agree. You can use religion to justify a lot of things - war, murder, hate - but violation of civil rights crosses the line! Plus, it opens up a whole slew of scary possibilities where doctors refuse care. Irregardless* of anybody's beliefs, it's a news story which is appropriate for a medical listserv.

Well some douchebag, who must be the King of Tools, disagreed. With a vengeance. He referred to the Gay-Straight Medical Student Alliance, of which I am former treasurer thank you, as a "support group." I'm getting the rage rigors just thinking about it. He also said that the list serve is not the place for "proselyting [sic] of ideas." I'm being honest when I say it was just the article, and no soap-boxing was going on.

And if that wasn't enough, this guy's BFF (I assume the Prince of Tools) decided to chime in with this little gem:

However there is a difference between a person and a practice. Just because I treat you respectfully doesn’t mean that I have to adjust my set of values so that I don’t offend you, nor should I have to join your church to be your friend.
Even though I do not agree with the practice of homosexuality...

You can see where this is going. Those are his underlines, by the way.My first reaction was disappointment that the UA actually admitted these students. The only student I knew of with this kind of prejudice was Bees, until now.

So after these two shining stars put in their two dinar, the whole listserv exploded. I've come up with three possible responses, but didn't send any because I'm not the kind of a-hole who argues over the internet. I'm a different kind of a-hole.

Option the first: Pulling Rank
"I know you guys haven't been here as long as I have, so I can't expect you to know as much as me. Having said that, let me just bring you up to speed on something: bitching about the listserv is the exclusive territory of 4th year students. In your first 3 years you should be too busy for this nonsense, and by 4th year you've earned the right to complain. Also, we 4th years are very bored and need some way to kill time. Thank you."

Option the second: Put my thing down flip it and reverse it
"I have to agree with the prince of tools, with a caveat: I don't agree with the practice of heterosexuality. I find it personally objectionable and offensive to my beliefs. I have many friends who are heterosexual, even though I find their lifestyle choices repugnant and believe they are going to hell. I personally practiced heterosexuality throughout most of high school and college, and I just ended up with chafing and a repetitive stress injury in my wrist. Of course, I was practicing alone. So that shows you where that road will take you. Please refrain from sending any emails which contain both the words 'penis' and 'vagina.' Thank you."

Option the third: Reductio ad Absurdum
"This article should never have been sent to the listserv. It is wrong for the Supreme Court to tell us how to run our medical practice, and I don't like having views shoved in my face. I personally don't approve of people who choose to be midgets, and don't plan to treat them when I'm a practicing physician. But there is a difference between a person and a practice. I don't agree with the practice of midgetry, but I can treat them with respect even if I'm secretly picturing them in hell. A tiny, tiny hell. Thank you."


Give me a break. Here's the bottom line: the email was totally appropriate because it pertains to medicine and law/ethics**, and is relevant. And those two guys are close-minded, hateful bigots who are likely to be eaten by a grue. Case closed.

Now that's prostheletyzing!

* I know it's not a word
** that's the first time "law" and "ethics" have appeared in the same sentence

Life updates

A couple of things unrelated to my post earlier this morning:

My new phone number
I got a new phone, and with it a new number. The phone is a BlackBerry...I feel like an adult! Rather than broadcast my phone number (and none of you jerks better do it, either), just follow these simple directions:

1. New area code is 602
2. Subtract 3 from the first number
3. Add 8 to the second
4. Third is the same
5. Subtract 4 from the fourth
6. Subtract six from the fifth
7. Subtract one from the sixth
8. Subtract 8 from the seventh

A lot of work for a phone that never gets calls, but you've got the info.

My medical specialty
I've chosen Family Medicine. Might blog about my reasons, might not.

With no power comes great responsibility

Here's a brief summary of medical school clinical rotations: you get thrown into a hospital where you have no real privileges, and pretty much everything you do has to be approved/co-signed by a resident or attending. Seriously, you can't even sneeze without some crazy doctor popping up and asking if your resident said it was okay to sneeze.

And I'm okay with that. It's all part of climbing the medical school ladder, the top of which leads you to the bottom of the residency ladder, the top of which leads you to the bottom of the attending ladder, etc. The problem is, we students look like doctors - we wear white coats*, we carry stethoscopes, we wear assless chaps. As such, I've grown accustomed to saying such phrases as "Sorry, I'm not a doctor," "I would do it if I could, but let me go get a resident to write a real order," and "Why are you touching me there - that's my special area."

And again, I'm okay with a little confusion. The problem is that when you're rocking the white coat, you're expected to act like a doctor. That means: no swearing**, no firing my pistols wildly into the air, no sniffing babies for that New Baby Smell™ without parental approval, and certainly no smoking meth on the job**.

But here's the real dilemma and the crux of this post: what's a student to do when leaving the hospital bathroom? When you're wandering around the hospital with enuresis and encopresis, trips to the bathroom are many. And let me tell you, these bathrooms are not the cleanest of places. Oftentimes it will look like somebody stuck a firecracker in a Snickers and ran off giggling. Alternatively, that person was trying to fill water balloons with yellow food-coloring and didn't care much for accuracy.

Then your humble narrator walks into this train-wreck of sanitation and is left with two options. Option the first, leave the bathroom and have the person who is invariably waiting right outside go in after and think that my pelvis exploded. Option the second, and I'm gagging just to mention it, clean it up. Oh gad, I need to vomit...

I'm back. Don't get me wrong, I don't mind cleaning bathrooms. I clean my own bathroom***, but when I do I'm wearing a Hazmat suit. And I'm not cleaning up a strangers lemonade for no pay. I'm already paying tens of thousands in tuition to work 80+ hours a week for no compensation - I draw the line at a forced janitorial clerkship.

So basically, there is probably a legion of nurses in the Phoenix area who think I have the worst aim in the world. But what should I do? I guess the only solution is a Foley catheter and leg bag. Then I'll never have to go to the bathroom. Brilliant!

* please don't get me started on the short coat/long coat debacle. Nurses don't know that rule, and the only people who care are extremely insecure doctors.
** totally not true for attendings, but true for everyone else
*** no I don't

We can stay up late, swapping manly stories, and in the morning, I'm making waffles!

In case I didn't make it abundantly clear, last Friday was my burfday. To celebrate such a momentous event, I decided I wanted to go somewhere fancy for lunch. A rare treat typically reserved for special occasions. So I swooped up Legal Counsel from work and we headed to Lo-Lo's Chicken and Waffles.

In case you don't know what words mean, chicken and waffles is a dish which consists of chicken and waffles. For the sake of clarity: the waffle is a traditional breakfast waffle with syrup, while the chicken is fried. According to Wikipedia and most other sources I've found, this tradition began with Southern African-Americans, either during the days of slavery when they'd make due with what little they got or immediately after slavery when they'd make due with what little they got. You know, those guys had it pretty rough. Why don't they teach us about that in school?

Let me begin this paragraph by saying that I'm not racist, and I don't intend to say anything that can be construed as racist or offensive. Having said that, let me just state a couple facts. First, rates of heart disease and type 2 diabetes are higher in African-American communities. Second, African-Americans invented chicken and waffles. I know correlation doesn't equal causation, but come on!

If you ever have a chance to go to Lo-Lo's, I highly recommend you take it. Let me break down the elements of my meal:

1. Two fried chicken drumsticks. Absolutely dripping in grease, saturated fats and cholesterol. Translation: delicious. It the taste I imagine you'd get if you killed and cooked Jesus H Chicken. He was betrayed by Judas Chicken, tried by Pontius Poultry, and finally crucifried.
2. One waffle with syrup. It was served with a heaping helping of butter but I'm not sure why: I'm pretty sure the waffle was just butter sculpted into waffle shape and lightly toasted. Probably the best waffle I've ever tasted. John Kerry would approve.
3. A mason jar full of Kool-Aid. I said it was probably the best waffle I'd ever tasted, but in this case there is no doubt. This is the best Kool-Aid in the world. I felt Legal Counsel and I were devouring the Kool-Aid Man's twin babies. His delicious twin babies. It's the kind of satisfaction I imagine a starving vampire feels after finally catching its victim.

Basically, Lo-Lo's Chicken and Waffles is amazingly good and I'm sad it took me this long to find it.
Pros: Delicious food, low prices, friendly atmosphere.
Cons: I'm pretty sure one meal there took 16 months off my life.
I give it 4.5/5 gastric bands.

Very Merry Unbirthday

Oh wait, it's my actual birthday! Happy birthday to me! It's not proper for a lady to reveal her age, but I will say the following: I can now rent cars, and my car insurance should go down. That is, if I actually paid car insurance.

I decided to read up on birthdays on Wikipedia, that oh-so-credible source of information. It says that birthdays first originated with the "non-Christian cult of Mithras" and was subsequently spread by Roman soldiers. I gotta be honest with you - that's pretty bad-ass.

Of course, not everybody celebrates birthdays. Jehovah's Witnesses, for example, view them as pagan and therefore non-Christian. So in addition to providing countless medical ethics questions regarding blood transfusions, Jehovah's Witnesses are kindof downers.

And Jewish folks, such as my lovely wife's family, celebrate the Bar Mitzvah when a boy turns 13 or Bat Mitzvah when a girl turns 12 (like my friend Ear Loeb). FYI, bar/bat mitzvah translates as "gifts for an awkward adolescent and adults getting plastered" in Hebrew. Since I'm somewhere between male and female, as outlined yesterday, I should celebrate today since it's the sum of the two! Who's going to bring the challah? "Baruch atah Adonai Elohenu..."

Well anyway, I do celebrate burfdays. And I'm going to party like it's my burfday...by studying. But I better get a cake! So help me if I don't get a cake. Our tradition here in the states is to eat cake and sing the exteremely depressing "Happy Birthday to You" song. It sounds like a funeral dirge, I swear. At one point I tried to start a movement to replace the birthday song with "Tom Sawyer" by Rush, but it never caught on. Too many lyrics, I s'pose.

Before I get out of here, let me just put in my endorsement for a few other birthday traditions to be adopted in our society, especially for my birthday.

1. In medieval England, small tokens such as gold coins were baked into birthday cakes. So I better see some damn gold in my cake!
2. From Wikipedia: "In Uruguay*, party guests touch the birthday person's shoulder or head following the singing of Happy Birthday to You." So gather round to touch my head, bitches.
3. Piñatas. Piñatas f***ing rock.

Get on that, would ya?

* funniest country name ever.

Macho, macho man

So today as I was walking out of the Victoria's Secret I noticed something...

Okay, a couple things before I go on. First off I know what you're thinking and the answer is no, you filthy-minded buggers. They don't carry my size so it wasn't for me. I was buying body spray for Legal Counsel, because the best message you can send your significant other is, "cover up your stink." Second off, there is no more awkward feeling than being a guy and walking into Victoria's Secret alone. Except maybe walking into Frederick's of Hollywood alone. Guys walking into VS will get the stare I imagine is typically reserved for the mustachioed gentleman as he nails a Megan's Law sign into his front yard.

Anyway, what I noticed was that I would not hold the bright pink bag by it's little string handle. I was gripping the bag itself and tucking it under my arm, as though I was preparing to run it in for a touchdown. Even after noticing how I was carrying it, I couldn't bring my to use the handle. My arm rejecting the command. It's as though my body was worried the jaunty swinging motion would make me look more girly as I carried the bright pink bag around.

I realized that the same is true for plastic bags. I don't grab the little handle-holes. I wrap up my product and carry it like a severed head in a Hefty bag. Or if you prefer a less morbid analogy, like I'm palming a dodgeball...in preparation for beating somebody to death with it. Dang it, I have to go there, don't I?

This train of thought (and yes, that was my actual train of thought) made me remember an observation Legal Counsel had made. If I, or most other guys, am offered a straw with my drink at a restaurant, I won't use it. More manly that way, I s'pose. Wouldn't want to put something so phallic in my mouth. Of course we men won't hesitate to use the straw if it's already in the drink, because...well...when opportunity knocks...this is uncomfortable. Moving on!

Don't get me wrong - I am in no way insecure about my masculinity. I'm an avid fan of Project Runway (go Kenley!), I keep an up-to-date list of my man-crushes (Ewan always has been and always will be #1), and I am currently on the waiting list for a Smart Car. But something inherent in my body refuses to let me do certain things. Maybe there's a gene on the Y chromosome that prevents guys from breaking certain Man Laws: skipping, singing in a falsetto voice in public, letting a stray deer get away without taking at least one shot at it, etc.

Wait, I do all of those things! Is my Y chromosome broken? Let me think...

• I can't throw a ball more than 10 feet (3.048m)
• I don't follow any sports teams
• I prefer drinks named after child actresses from the 1930s over beer
• I openly cry in front of people...constantly
• I know how to knit

Yep, I've definitely broken my Y chromosome. As an almost-a-doctor (yikes, scary thought), I should know how to fix it. Hmm... I know! Rub some dirt on it and walk it off. It's the only way!

Now if you'll excuse me, I need to get back to studying for the boards. And crocheting. Always with the crochet...