Due to lack of interest.

I might discontinue this blog due to lack of interest, my own lack of interest that is. I will be back in the states and hopefully I'll get myself an iphone. In the event I do this perhaps I will continue this blog as a moblog cause it'll be easier. These days I'm spending more time on facebook so anyone interested should find me on facebook. But for all of those interested here's a quick update:

I got no residency this year and for that I'm bummed. I'm not sure why. It could be cause my USMLE scores sucked but it could also be because they didn't all come in until December when the application process for next year was almost over. I'd like to think it's the second cause many people with shitty credentials still get jobs. Anyway, here's what I will be doing: I will be starting as a research assistant at a University's Biomedical Engineering department in July and I will be working there at least for a few months. The research I will be involved with involve intraoperative physiological monitoring and it is affiliated with an anesthesia department so I'm kind of excited about this. I did some biomedical engineering coursework after my math degree and really liked it so in addition to being interesting it could also help me get something next year in anesthesia, that's the hope at least.

Till Death Do Us Part

So this is where I used to work and who I used to work for.  Got an email this morning from sister saying my boss was on trial for murdering his wife.  Searched the internet and found this article with a picture of him and the store I worked at when it happened...WOW.  They were not blissfully married I could tell you that.  

http://www.longislandernews.com/papers/longislander/news/news1.html

CS

Ok, well I'm well rested, well caffeinated and I have Miles going on the iTunes for a long song.  I think I can finally tell the story which was my Step 2 CS experience.

When I planned to take the USMLEs this year I was planning it in such a manner as to allow me to take them all and apply for residencies for post graduation in July of 2009.  Having said that I was on a tight time table.  I took Step 2 CK in Berlin in August and the earliest available step 2 CS date after that was September 13th in Los Angeles.  I took CK I think on the 24th so that gave me about two weeks until CS but about 10 days of actual studying time because coming back from Berlin I couldn't get the last train to Prague that night.  I took the last train of the night from Berlin at about 9:30 P.M.  I ended up in Dresden, Germany about midnight and was thrown out of the train station until they opened it up the next morning.  I walked around the streets of Dresden and I had had hopes of finding some little forest or something somewhere that I could take a nap but every place I found that proved to be suitable for lying down was too close to the general public and I was deathly afraid of being shanked by a homeless guy or pissed on by a drunk American tourist.  Doesn't matter the heavens opened up and it pissed down rain all night.  Luckily I had all of my worldly posessions with me as I always do and I whipped out the backpacker poncho and trudged around Dresden all night long waiting for the train station to open.  I got on the train at 6:30 a.m. dry as a martini.  The poncho I bought for $40 three years ago is the best $40 I've spent in a long time.  Anyway, I kept falling asleep and waiting up until I arrived in Prague at holesovice around 10 a.m.  I walked from the train station home and arrived in my bed at about 11:30.  I slept until the next morning I think at which time I woke up and started to prepare for CS.  My friends who took CS told me that academically it's not hard you just need to be able to accomplish all of the pertinent interview and physical exam stuff in the alotted time.  I had two books:  First aid for CS and Kaplan's book for CS.  Both books were good and told you everything needed but I found Kaplan's CS book to be better for learning the method to interview and do physical exam and I found the First Aid for CS to be better for practicing cases and notes.  All of my cases that I had on test day were what I saw in First Aid for CS.  

How I prepped:  I sat in my kitchen for about ten days.  My room is next to the kitchen.  I kept my computer logged on to the USMLE website where they have a simulator online for typing the patient note.  I would start my stop watch, go into the kitchen, drape my imaginary patient (the table chair) with a dish cloth and go through the whole interview according to the case from First Aid for CS that I was prepping.  I timed this as well as a physical exam on the chair and then I would tell the chair what I thought was wrong with it and how the chair should practice more safe sex practices and stop smoking, then I would run to my bedroom and type up a patient note on my computer.  I tried to get all of this stuff down to 25 minutes and I guess everything I did worked.  A friend of mine came over one day to pretend to be a patient but it just didn't work out.  He was hamming it up too much and doing too much improv.  If you practice CS with a friend it has to be a friend who is going to be taking CS because they understand the test and what it's about.  The most important part of prep I think is knowing what is important to ask in the interview and knowing what is important to test in the physical for each case and knowing each case.  It's like everyone says you can't do it all and you just need to try and get as many checkboxes checked on the standardized patient's evaluation of you.

The actual test:

I was nervous because I wasn't nervous.  I stayed at the Motel 6 in Inglewood about three miles away from the test center:  DO NOT STAY HERE!!!!  The place was filthy, the people who worked there were assholes who told me a million times I could leave my luggage at the front desk on test day and then almost wouldn't let me on the morning of the test.  I should have known better than to stay at a hotel which has posters at the front desk about not taking kindly to hotel guests bringing prostitutes back there.  On a good note though there was a hawaiian barbecue place across the street in the 7-11 shopping center which had great food, friendly staff, and a clean restaraunt and bathroom.  The cute Asian girl that worked there let me use her phone to call my ride after I took CS and was waiting to head north to Bakersfield to do diving shows for three weeks.

Anyway, test day was like this:  I got to the testing center about 30 minutes early and sat in the lobby waiting with the other doctors to go upstairs.  I was the only one who didn't wear his labcoat in the cab to the testing center.  I had it folded up inside my backpack.  I went upstairs to check in with the other students.  I didn't feel comfortable leaving my computer at the hotel so I brought it with me.  I travel with my laptop in a "pelican case" which is an indestructible, foam lined, dust proof, water proof case which is kind of funny looking.  One of the other medical students (American medical students) looked at my briefcase and told me that he had an indestructible case too for his laptop and it was a Haliburton Sub Zero.  These are those steel briefcases that cost $500+ and scream that you are important and have money.  I didn't know what the significance of him telling me this was but it made for an interesting reflection now and actually he was a nice guy who I spoke to a few times that day but it was interesting to see the differences between American medical students and foreign medical students.  Unfortunately I have to say that the American medical students seemed really snooty and pompous.  One guy was talking during the break about how he didn't need to study at all for this and it was a breeze cause at his school in the third year they do a mock Step 2 CS and "the cases were way more complex."  Anyway, we got funneled into this staging are where the proctors checked you in and you had to deposit your stuff.  I looked around and all the American medical students had nice white coats and were all dressed up like they were going to a weeding.  I was wearing brown shoes, cleaned and ironed khakis with a blue dress shirt and a blue tie.  My labcoat was the labcoat I have used all the time at school.  I bleached, washed, and ironed my lab coat for the occasion though but to tell you the truth if I could do it all over again I would buy a nice labcoat for the occasion because my central european lab coat made me look like some sort of chemist working in the Semtex lab in Pardubice, not a doctor.  After the checking in process we had to watch a short movie about how not to be singled out as being a cheater.  We had to take all of our belongings and put them in a locked room which we would not have access to until the end of the day.  We were forced to take a credit card and some cash out of our wallet and put it into our lab coat pocket in the event that there was an emergency and the building needed to be evacuated.  God damn Al Qaeda!!!  Even on test day in LA their plotting.  After all of these festivities we were led into the place where the test took place.  It was a long hallway with 12 doors on each side.  We stood in front of a doorway and an overhead speaker would make announcements telling us when the encounter could begin, etc.  It was all unbelievably orchestrated and precise like a swiss watch.  We had five encounters which lasted something like three and a half hours, a 30 minute lunch, 3 encounters, a 15 minute break, and the last two encounters.  The whole process took something like 7 hours and I was not as tired when I left that day as when I took Step 2 CK.  I left the testing center and walked the three miles back to the hotel to get my bags.  It was a nice day in LA and I just didn't want to pay $30 for a 3 mile cab ride that I could walk.  I got back to the hotel, got my bags, went across the street to the hawaiian barbecue and asked if I could use a phone and in return I'd eat there.  the cute asian girl cheerily and bouncifully gave me her phone, I called my friend Mike to pick me up, and then I got the BBQ chicken, Potato Salad, and some mango soda.  I sat in the BBQ joint for about an hour, changed my shoes into sandals and I was officially on vacation.  Mike arrived we loaded up his jeep with my crap and we drove to Bakersfield which took about 2 hours.  We stopped along the way and got some really bad junk food and arrived at the Red Lion Hotel which has the most luxuriously comfortable beds I have ever slept in and for the next three weeks I did high diving shows and felt my aching bones every day.  After the last show we tore down the site and I drove a rental car from Bakersfield to LA via Northridge to drop off a friend.  I drove down the Pacific Coast Highway, stopped along some beaches in Malibu, ate at Panera, and went to LAX.  I sat in LAX all night til my flight left the next morning at 8 and then I started school in Prague again almost immediately upon landing.  About three months went by andI sweated whether or not I passed CS cause I had already registered for the ERAS match and applied for some residencies. Thankfully I found out last week that I passed Step 2 CS and the odyssey that has been my USMLE experience is for the time being over.  Two years ago I was horribly unprepared for the test and now I'm just waiting to graduate from school and get a job.  I think I did everything right at the time I did it but being a foreign student at a foreign school makes it difficult to do well on the USMLEs cause you really don't know what you're up against.  American schools prep you for these tests (as they should) and it's a real crap shoot when you approach it from the outside in.  I don't know what else to say about the USMLEs, I'm glad they're over and I just hope I get A Job.

Sit down, shut up and show me your penis.

Those were the words spoken by one of the doctors in the Urology department to an elderly overtalkative patient. The patient didn't speak English so when the doctor said that in English it was more for our benefit than the patient's. It was funny and I am sure that the doctor wasn't saying that to be rude.

This two week block in Urology was like the rest: a whole bunch of lectures followed by some practicals which as always included the obligatory trip to the O.R. to stand around for a few hours and get asked anatomy questions by surgeons. There were once again way too many of us students in the department and it as always meant that several of us would be standing in an exam room looking ominous to patients. I decided to snap a picture of what the exam room that I was in looked like. When you see all of us standing there just ask yourself this: "Would I want my penis examined in front of them?"

Also included in the pictures on this page is one I snapped while walking from the main train station in Berlin to my hotel for the USMLE step 2 back in August, it's a statue to honor Rudy Virchow the father of pathology.  Let's all honor Virchow by chanting:  "Hypercoaguable state, Endothelial dysfunction, Stasis"

THROMBOSIS!!

Passed them all!

I came from Urology this afternoon and I took a nap. I just awoke and there's an email saying that my score report for USMLE Step 2 CS is available. I nervously navigated to the ECFMG page and opened up the report: Passed. Now everyone said I would and the odds were in my favor for CS because it's really a stupid test that tests how you speak English but i felt I could not rest until I had it in writing that I passed.

So here I am. Winter of my last year in Medical School hell with all of the USMLEs necessary passed in order to work in America. I haven't gotten any interviews for residencies but as I understand it it shouldn't be a big problem to obtain a one year internship (preliminary) in internal medicine or a transitional year. All I have to do is register for the NRMP match and see what's available during the post match scramble in March. I'm willing to go anywhere for an internship or residency. At this point in time I would just be happy to get out of here, start working, and start learning some real shit. The only limiting factor now is school. For some odd reason school goes until the end of June this year and in order to start a residency in America July 1st I need to be able to finish around end of May. I have to do some talking with the administration now because it wouldn't only make my life easier to be able to leave here and start a residency in July but it would behoove this school to have someone graduate in six years and go directly into a residency in the states. We'll see what happens but one thing is for sure: I'm going to deliver on my promise of going on vacation once I find out I passed all USMLEs. I made myself promise that if I pass all the USMLEs I'd go somewhere and I have some time to do it this month.

Sir William Osler

To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.
Sir William Osler

Sir William Osler was a very famous Canadian physician for which many eponyms bare his name. He would be appalled by our school. About eight months from graduation and I think we can count all the patients we have seen as less than 200 in our five years here.

Even if things were to become wonderful at school it would be too late, we're done. I'm sickened at how our school can't organize anything but payment of tuition. During our internal medicine clerkship we were told to stay home and read and not bother coming in. I popped my head in one day to get my credit and low and behold I saw the Czech students in small groups of 3 or 4 with doctors by bedsides talking about things.

Our group of English students at Charles University does not represent diversity, enrichment, or breadth for the University it merely represents income. I could talk til I was blue in the face about how let down I am with my education but it wouldn't make a difference. At present I'm concentrating on just getting the hell out of here and hopefully into a job come July.

I hope before I leave Prague I will get to take a trip somewhere because in my 5 years in Europe I haven't been anywhere but Slovakia and Germany, but unfortunately I'm all too prudent an individual. I could have done lots of travelling but then I'd be even broker than I am now. At least at present I can afford rice and beans and the occasional muffin but if I had gone to rome, venice, paris, and other locales I'd be sleeping in a dumpster eating apple cores.

I hope they all burn

About eight years ago I had a credit card from MBNA. I payed off this credit card and closed it before I left for Prague. MBNA was bought out by Bank of America some years back. I had been in Prague for about a year when I got a call from my sister saying that someone from a collections agency had been looking for me. I got in touch with the collections agency and they told me that I owed $300 on that credit card. i told them that was impossible because I had in fact closed that account after paying in full. They told me that they didn't know anything about my account and that I should call MBNA for specifics. After spending many hours on the phone MBNA, now Bank of America told me that they knew nothing about my account except that I owed money. They couldn't tell me for what. I thought this was fishy, they could just tell me that I owe money but they couldn't tell me for what. i called up the collections agency and things got heated between me and the woman on the phone. She hung up on me and I called a few more times and spoke with her. She hung up on me a few times. After that I decided that I wouldn't pay because nobody could prove anything. All I was hearing was that I had to pay but noone could tell me for what or why. My guess is that my old bank's credit card got bought out and the new bank changed all the cardholders agreements and just started to charge them for stupidity. Fast forward a few years. My sister sends me an email saying that a lawyer has been calling my aunt's house looking for me many times. I call this guy up today. He tells me that I still owe on this credit card and that this is my last chance before it goes to court. In the event that it goes to court I will lose cause there's no way I can afford to travel all the way back to America without any sort of proof of my innocence. So I tell this guy OK, what's it gonna cost. Well my $300 bill with interest and legal fees is $1200, but if I settle today they'll knock off the legal fees and just charge interest and that will only cost $600. Seeing as though I'm in six figures of debt and I don't know what kind of loan consolidation or additional loans I will need next year it appears the best thing for me to do is just pay. I pay for it over the phone, the guy tells me that immediately my credit score will go up 60-70 points and that all the credit agencies will be notified that I was a good boy. He also tells me I have excellent credit as if that makes my life all of a sudden worth living. I don't want good credit, I want to not have to need credit, I want to stop living beyond my means, I want to stop being harrassed by corportate America. This is why America sucks. You are sucked into the life of debt and loans in order to chase down your dreams and you may never get out. My American dream isn't a house, a car, and a white picket fence rather it's a cabin in the woods where nobody threatens to take it away leaving me homeless and destitute cause I didn't get my mail in time. America, speciifcally corporate America the banks and the credit agencies are a bunch of con men and I hope that they all burn in hell after this economic crisis that they created rights itself. If I ever have children believe you me I will do everything I can to steer them away from student loans and credit. I will teach them that you don't need to pay thousands of dollars to become "educated" and if they really want to sit in lectures at a university they'll need to become good at something so that they get sent to school on scholarship.