Endocrinology rocks.

One advantage about the way my preclinical curriculum is set up is that it is very similar to college.

Most med schools will put you in a bulimic state of learning: you spend a solid month in one class, learning all of human body's anatomy for example. You spend days memorizing every aspect of every piece of tissue until you start dreaming about it. Then come test time you have to vomit it all up. Repeat for every class, and it is a wonder we remember anything at all.

However, my days are spent learning all of the subjects at once by systems. Right now I am looking at butts and genitalia. I get to know everything about it: histology, anatomy, physiology, etc. I should know everything doctors know about how the body is when nothing is broken. I think it is great because everything is skillfully woven together, and I do not have to learn all about the hand in one day, then revisit it months later. The best part is that we get to keep the same professor for the whole subject, instead of the usual parade of PhD's needed to sustain a solid month scheduling for one subject.

I particularly love the endocrinology. The professor is pretty popular for several reasons, a great approach to teaching and a light British accent that all makes us swoon in particular.

Today, he proved he is also a gift to mankind by serving as the right hand of GOD, destroying rare diseases left and right. How so, you ask? Well we had a special session in class today, where he brought in two patients affected with diabetes. I won't go into too much detail, but basically one patient was recently afflicted with diabetes. That was the easy part, bread and butter cases for endocrinologist such as our professor.

The hard part was that the patient was had a extremely extremely rare form of diabetes. For months the patient was confined in the ICU while her blood sugar levels raced between record breaking highs, then record breaking lows. After her clinicians exhausted all options, including injecting ungodly levels of insulin to fight off the wave of sugar in her blood, our professor tried a specific anti-inflammatory drug.

It worked. In fact, it worked so well the patient was completely off any diabetes medicine when she spoke to our class. It turned out the patient had type 1 diabetes that attacked late in life when it really only shows up in kids. That kind of diabetes happens when your own body utterly renders the cells that makes insulin dead to the world, leaving none that can help you keep your blood sugar down. It is as if you want to go through a door that you have a key for, but someone stuffed gum into hole, so in frustration you keep jamming your key into the hole trying to get in. Our professor simply took out the gum, in one smooth stroke, with just one drug.

Now that is thinking outside of the box.

Quitting

Quitting. I thought about it today.

A big soft-skills final exam is coming up, and I feel totally unprepared. I mean yes, I know how to do a brief history/physical exam already, but not the "full" one that allows physicians to explore the full spectrum of disease a patient might have. My exam consisted of the ABC's - is your Airway open? Good. Can you Breath? Even better. Do you have a Circulation? Dandy. That's the big idea for medics out in the field.

But now, I actually need to be able to feel for splenomegaly, and listen for heart murmurs. What? My preceptorship is in the highest socio-economic strata of this part of the state. Before I even started my preceptor visits, he warned me on the phone that I might not be able to do as much as I could.

At the time, I brushed it off, thinking my previous experience would be fine. So up until today, I half-assed my visits. I played along, and thus became complacent. I didn't get any chance to practice skills that will enable me to detect diseases and tease out differential diagnoses.

As test time got closer and closer, I started to panic. My classmates started to catch up to me, and I realized I had gotten rusty. Some of them had preceptors that let them loose, and as a result they learned and learned about the most fundamental skills a physician should be perfect at. Soon, jealousy took hold, and I wanted to defect to perhaps another preceptor site. It was rare to do so, but it is possible. For example, one of my classmates was assigned to a gastroenterologist. When she needed to learn how to take vital signs, all of her patients just needed to get scoped.

I walked into the pediatrics clinic today, I mentally took a deep breath. It was the last visit of the year. Maybe forever. So let's make the most of it, I thought. If I piss off some anxious parent fussing over their trust fund kid...screw it. I need to learn, so that I can help scores of future patients.

I just kept jumping in all day, and surprisingly, no one stopped me. It reminded me of when I first realized what I could do as a supervisor EMT, leading a team at a major rollover accident. I just did it.

At the end of the day, my preceptor had a simple visit, but had grown up with the patient's grandfather. After almost six decades of friendship, my preceptor's friend passed away the same year as his wife, only a couple years ago. Everyone in the room teared up except for me when this was brought up. My preceptor had such a enduring bond with the families of his patients. It just took me a semester to realize it. My biggest lesson yet.

I'm not going to quit. I can still get a lot of learning experiences here, and my preceptor isn't some concierge physician catering to the rich and famous. He has taken care of many PARENTS of the patients here, and is a pillar of the local community here. I can learn so much from him, and I am going to stay.