My Shiny Yet Horribly Inaccurate Medical Bling!

As some of you may or may not know, I am a huge jewelry fan. At almost any given time during the day, I'll be wearing 4 pairs of earrings, a Swiss Army watch (and as a quick shameless plug for the Swiss, basically everything they make is built to last), a necklace, and possibly a bracelet or two. My mother has known about my affinity for jewelry for years and she usually indulges me on my birthday and holidays, with an occasional "I saw this in the jewelry store today and thought you might like it" gift thrown in every now and then. Nothing too ostentatious or insanely expensive, mind you, but I've acquired quite a nice assortment of pieces over the years.

The latest addition to my collection came earlier this week, when my mother handed me one of those cute little boxes that jewelry stores package earrings/rings/pendants in. Before I opened it, she told me not to wear it until I graduated, and when I pointed out that that was still quite a way's away, she said, "Okay, you can wear it for inspiration until then."

So I opened the box, and lo and behold, I found this:



Now I'm never one to turn jewelry down and unless something is incredibly tacky, chances are that I'm going to like whatever you want to give me. And I really do like this pendant, but one thing that whomever designed it failed to realize is that the Caduceus isn't a symbol for medicine. In fact, our good friends at Wikipedia go as far as to suggest that it's associated with "theft, commerce, deception and death" (and since it's on Wikipedia, clearly it must be true). The less aesthetically pleasing but far more mythologically accurate Rod of Asclepius is what the designer should have aimed for, but apparently confusion between the 2 symbols arose as far back as the 19th century. (It's also noted that the Americans realized the mistake not too long afterward, but maybe everyone figured that it was just funnier to not clear up the matter, even over 100 years later.)

It's still a lovely pendant, though. All the inaccuracies aside, I am wearing it for inspiration. Partially in a "think of all the lives you'll save one day!" sort of way, but mostly in a "Okay, this actually has 'MD' on it. So if you fail medical school, you are going to look like a giant ass and a raging liar and you will be stuck $50,000 in the hole. For the love of God, don't flunk out!" sort of way.


I secretly hope that if I don't flunk out, I someday might end up making enough money to be able to trick myself out with bling à la Lil Wayne. But hopefully without, you know, going to jail.

My Second Needlestick Injury (Now with 50% less badass!)

I was originally going to start this entry with a thrilling yet entirely made-up narrative of how I'd received my second needlestick injury, (i.e., I'd gotten jabbed while trying to inject epinephrine into a patient in cardiac arrest, with special emphasis on how I looked so sexy doing this that the handsome trauma resident working with me continuously shot me "Come hither" looks as he did chest compressions). But then I realized that my extensive fan base (all 2 of you) would immediately see right through this and probably call me out on my BS. So I grudgingly decided to be forthcoming and truthful about my second needlestick injury, even at the risk of sounding completely incompetent and far less awesome than I fancy myself to be. (Feel free to thank me for my honesty.)

What really happened is that I recently attended a workshop in which medical students could practice a number of different skills (IV insertion, intubation, injections, etc.) under the watch of a physician, nurse, or clerk. Since my last attempt at IV insertion and venipuncture was nothing short of a disaster, I deliberately signed up for this session to improve my skills and show that damned butterfly needle who's boss. Now, one of the main reasons why I'd gotten stuck with a needle during my last venipuncture attempt (aside from my general lack of know-how) was that I was unsupervised as I tried it, resulting in no one stopping me from doing something stupid like pulling the rubber casing off of the needle. However, in the workshop session I signed up for, there were going to be 3 preceptors minding only 6 students, and I figured that as long as I did everything under the watchful eye of someone who knew their stuff, nothing could possibly go wrong.

Clearly the fact that I'm even writing this suggests that something went wrong.

The session started out deceptively well, probably because life likes screwing around with me in that sort of way. I tried doing an IV insertion first, making sure that one of the nurses running the session gave me the green light for each move. In retrospect, this probably annoyed her to no end ("Okay, so do I advance the catheter now?", "Should I pull out the needle now?", "I apply a strip of tape here, right?"), but I was hellbent on not getting hurt. My irritating diligence did pay off in the end, as I managed to insert the IV without sticking myself, although the mannequin arm I was practicing on lost a decent amount of fake blood. (I may have been a bit slow in doing things like staunching blood flow and actually hooking the damn IV up, but we take victories wherever we can get them, right?)

Successfully inserting the IV gave me the boost of confidence I needed to try my hand at venipuncture. After taking out the IV from the mannequin arm and applying a tourniquet to it, I gathered the equipment I would need for a venipuncture: a collection tube, a vacutainer, and of course, the dreaded butterfly needle. As you may recall, my first needlestick injury was from this type of needle - more specifically, the end of the it that is supposed to be inserted into the collection tube. With this in mind, I was understandably more careful when handling this portion of the needle. Rather than trying to tug the rubber sheath off of it, I screwed it into the vacutainer as the nurse instructed me to do. To my delight I realized that the vacutainer would not only hold the end of the needle in place when it came time to attach the collection tube, but it would also act as a barrier between the needle's sharp tip and my hands. (To help you visualize this, I included one of my MS Paint-modified pictures below.)



So there was some nice, thick plastic separating the rubber encased needle from my fingers. If you guessed that that prevented me from getting the same sort of needlestick injury I got before, you are absolutely right. However, if you look at the picture a little more closely, you will see that the other end of the needle is not surrounded by a similar protective barrier, but is rather ensheathed in a tight, thin plastic covering that is really difficult to take off.



To my credit, I do learn from my mistakes to an extent. I figured that if the plastic covering was as tightly wrapped around this end of the needle as the rubber sheath on the opposite end, yanking it off would cause the needle to shoot unpredictably in my general direction and stab me in the process. Armed with this bit of foresight, I turned to the nurse and asked, "Is there a safe way to take this off?"

She said to hold the base of the needle steady and slowly ease off the covering, which sounded about right. Grasping the base of the needle with my right hand, I used the thumb and index finger of my left hand to gently pull at the thin plastic sheath. The sheath didn't budge.

I pulled a bit harder. Still nothing.

I pulled slightly harder, and that's when shit happened, as shit is wont to do.

The plastic sheath instantly slid off the needle, much like the rubber sheath did when I got jabbed the first time. But since my right hand was holding the needle in place, it didn't fly towards me. Rather, my left hand recoiled and jerked towards the needle. If you want to see this for yourself, find a pen with a cap that's too tight to fit properly and try pulling the two apart. Unless your hands are incredibly steady, they'll probably snap toward each other once you pull the pen and the cap apart. (Or if not, there's always the possibility that I just have the manual dexterity of a cabbage and should never, ever handle sharp objects like needles.)

So my left hand jerked towards the needle. I felt the stab of pain before I had time to fully process what was happening, and I looked down to see a drop of blood welling on the tip of my left index finger. A moment later I heard someone next to me gasp. It was none other than the same girl who had been in my group during the very first IV insertion and venipuncture session we had, the girl I had made small talk with.

I'd gotten stuck with the exact same type of needle, in the exact same finger, doing the exact same procedure, in front of the exact same girl as before. You have got to be kidding me, I thought. You have got to be fucking kidding me.

The only point to the good was that I didn't get the same apathetic reaction from everyone else as I did the first time around. After the nurse realized what had happened, she quickly handed me a piece of gauze and said, "Oh no! Would you like me to try to find you a band-aid?"

You still don't have bandages on hand in the anatomy lab? What is wrong with this school? went my inner monologue.

Outwardly I flashed her an embarrassed smile, wrapped the gauze around my finger, and told her that no, she needn't bother since I probably had a band-aid in my purse. She then asked if I was all right, and I assured her that yes, I was fine, and that I was used to being poked with needles, oftentimes willingly.

The uncomfortable look that crossed her face suggested that what I'd just said could probably be grossly misinterpreted (e.g., intravenous drug user!). I quickly flipped back my hair and gestured to the four piercings I had in each ear, which was I had meant when I said that I was used to being willingly poked with needles. Then, being the old pro that I was in dealing with needlestick injuries, I excused myself from the session, trudged over to the sink to wash the wound with soap and water, and retrieved a band-aid from my purse. I was also shouting a string of obscenities in my mind the entire time, being such a good multitasker and all.

And that is the story of my second needlestick injury. I know that I'm probably expected to have slip-ups like these so early on in my medical training, but this is just getting embarrassing. I mean, I come from a family of people who have displayed insane levels of badassery in the face of injury - my father took a freaking chainsaw to the throat (work-related accident), my brother managed to work out in the gym for 2 weeks before noticing that he had a pneumothorax, and my mother gave birth to both my brother and I without epidurals. And here I am, getting repeatedly jabbed by needles without even a cool backstory to show for it.

Ah, screw it. Stay tuned for my next needlestick injury (you know it's going to happen eventually), same Bat-time, same Bat-channel.

My First Needlestick Injury (Mistake #276 that I've made in med school so far)

Every doctor is guaranteed to get at least one needlestick injury at some point in his or her career. No matter how many precautions you take and protocols you follow, there will come a day when shit will hit the fan and the nasty end of a hypodermic needle will hit you. After listening to a lecture covering some of the occupational hazards that health care workers face, I began wondering what my first needlestick injury would be like. While I fervently prayed that it would be a relatively benign event (i.e., getting stuck with a sterile needle fresh out its packaging rather than getting stuck with a needle fresh out of a patient with an infectious disease), I found myself imagining that it would be like an epic movie scene. In this scene, I would step back from the patient whose life I'd just saved, yank the needle out of my arm, rip off my surgical mask, wipe the sweat off my brow, and look boldly off into the distance. "It had to be done," I would declare. "Damn it all, I'm a doctor. I save lives!"

(As you can see, I clearly have no future writing movie scripts, so let's hope this whole becoming-a-physician thing pans out for me.)

But based on the title of this post, you can hazard the guess that my first needlestick injury categorically did not occur in as awesome and badass a manner as I hoped it would. What actually happened is probably better described with words like "laughable" and "pathetic" and "Oh my God, I cannot believe this girl is going to be allowed to handle sharp objects like scalpels and loaded syringes. Someone take those away from her before she hurts herself!"

Like most things, it started off innocently enough. Our class was expected to attend a special skills session in the anatomy lab where we would practice inserting IVs and performing venipuncture. Excited at the prospect of doing something hands-on, I arrived at the lab early to check out what was set up for us. Laid out on a table were packages of alcohol swabs, tourniquets, IV catheters, tubing, butterfly needles, and two massive mannequin arms connected to bags of what looked like red food coloring. As I looked over all the equipment, a girl from my class joined me by the table and we started making small talk to pass the time. "I'm really excited to try this out," I told her. "Although knowing my luck, I'll probably be the first person in the class to get a needlestick injury doing this." (Hint: this is a little technique that them writer folk like to call foreshadowing.)

She laughed and replied that she was sure I'd be fine (if I'd known what was going to happen, I would've bet money against her wonderfully idealistic prediction). Shortly after, the rest of our classmates in our group started filing into the room, followed by our preceptor, an anesthesiology resident. He went through a handout that we'd been given on IV insertion and venipuncture, then gathered us around the table to demonstrate what we'd be doing. It all seemed simple enough - apply tourniquet to distend vein, disinfect site, insert needle, then either advance catheter and attach tubing (IV insertion) or attach other end of butterfly needle into collection tube (venipuncture). There was no possible way to screw that up, right? (Another bit of foreshadowing: there was totally a way to screw that up, and guess who discovered it?)

We were instructed to take turns practicing inserting an IV and drawing blood (well, red food coloring) from the mannequin arms. When my turn came, I decided to try venipuncture first, since it was the easier of the two techniques. To my credit, I started out like a seasoned veteran. Apply tourniquet? Check. Locate suitable vein? Check. Disinfect area around said vein with alcohol swab? Check. Now for the fun sharp stuff.

I removed a sterile butterfly needle from its packaging and carefully inserted it into one of the mannequin's veins. A moment later I was rewarded with a flashback of red food coloring into the hub of the needle - I was in the vein. As I held the needle in place with my right hand, I ran my left hand down the length of the attached tubing until I reached the second needle at the end of it. Now, this second needle is meant to be inserted into a blood collection tube. Since these tubes are under negative pressure, poking through it with the needle will draw blood out from the patient's vein, through the tubing, and ultimately into the collection tube. I'm sure anyone reading this has probably had blood drawn before and can hopefully visualize what I'm saying, but I included a picture below for reference.



To get back to the story, we're at the part where I'm holding the needle that I'm supposed to insert into the collection tube. And as I looked at the needle, I realized that it was covered with a rubber sheath (which I have marked on the diagram with my piss-poor attempt to draw an angry face using MS Paint - more foreshadowing!). Thinking that the rubber sheath was supposed to be removed prior to inserting the needle into the tube (look at the size of that sheath! Could you blame me for thinking that I wouldn't be able to just ram the whole thing through the top of the tube?), I started tugging at it with my left hand.

The fact that the sheath was tightly wrapped around the needle and difficult to remove should have led me to the very sensible conclusion that maybe it wasn't supposed to be removed at all. Unfortunately, brawn won out over brains, and I gave the sheath one last, forceful yank. What happened next was a bit of a blur since it all took place in the space of about a second, but I'll outline it as best I can.

The sheath snapped off and the now uncovered needle shot toward me like a rubber band. I reflexively jerked my head back to avoid getting hit in the face, but the rest of my body didn't respond as quickly. I felt something stab into the index finger of my left hand, and I looked down in time to see giant drops of blood fall from my fingertip onto the table, mixing in with some red food coloring that the mannequin arm had leaked out during another student's failed attempt at inserting an IV.

"Son of a bitch!" I snapped under my breath, as I frantically tried to think of what to do next. My right hand was still holding the opposite end of the butterfly needle in the mannequin's vein, so I yanked it out and chucked the whole thing into the sharps container. I then walked up to the anesthesiology resident, who was fiddling with his pager in the corner of the room, showed him my finger, and said, "I had a bit of an accident while trying to do a venipuncture." Completely unsupervised by you, I wanted to add, but I figured that I should probably first address the issue of how I was technically turning the lab into a biohazard by dripping blood onto the floor.

His reaction pissed me off. His eyes widened as he took a step back (what, did he think I was planning on bleeding onto his expensive-looking shoes?) and said, "Oh. Wow. That's not good. Um. Wow. You need to, uh, wash that out. Yeah, go wash it with soap and water."

Okay, so cleaning the wound was good advice, but this guy made no attempt to try to find a first aid kit, glance at the injury for more than 2 seconds, or even ask how exactly I'd gotten hurt. Realizing that I wasn't going to get any help from him whatsoever, I stalked out of the room to find the sink near the entrance to the anatomy lab, trying to ignore the stares of my classmates who had clued in to what had happened.

Once at the sink, I pumped a crapload of soap onto my hands and started rinsing the blood off my finger. It hurt like hell but I was still able to move it normally, so I figured that the needle hadn't jabbed in deep enough to do any major damage. As I left my hand under the running water for a minute, I glanced around at what everyone else was doing, wondering if anyone would come over and ask what was I was up to. I freely admit that I can be a mass of contradictions - while I didn't want to call attention to the fact that I'd been the class idiot and gotten stuck with a needle, it would've been nice to have someone show an iota of concern. Especially the tall, muscular, and incredibly sexy guy in my class that I'd been sneaking looks at during lecture for the past few weeks.

I ended up getting my wish in some sort of fashion, or at least I thought so at the time. As I was drying my hands and wrapping a paper towel around my finger to stop the bleeding (still no first aid kit in sight - shouldn't a medical school be rolling in enough money to have these on hand in rooms containing sharp objects?), I heard someone come up behind me and ask, "Hey, you still bleeding?"

I turned and saw one of the students from my group, a guy wearing a hoodie with a baseball cap pulled down almost entirely over his eyes. Figuring that the resident had sent him to check on me and pleased at the fact that at least one person was thinking of my well-being, I replied, "Well, just a little. I don't think the needle went in that deep. Did the resident ask you to see how I was doing?"

"Anesthesia Guy? No, he didn't say anything," the student said. "In fact, I'm just on my out to use the bathroom. Oh man, the lunch I had today - I really gotta take a dump. Never should've had that second enchilada."

I forced myself to smile politely and repress the I-cannot-believe-we-are-having-this-conversation look that was dying to replace my benign expression. As the guy gave me a parting nod and walked out of the anatomy lab to presumably face the wrath of those enchiladas, I went back to rejoin the group and finish the session with whatever dignity I could scrape together. I hadn't tried inserting an IV yet, and I was required to make at least a halfhearted attempt to do so in order to get full marks for the session.

I won't bother going into the details of how the IV insertion went. One point to the good was that I didn't stick myself with the stylet, thus leaving open the possibility that my second needlestick injury may be totally epic and badass. One point to the bad, however, was that the stylet actually ended up ripping through the mannequin's fake vein and overlying skin, which I could only imagine would've been incredibly painful had I been practicing on a real patient (thank God I wasn't). So I have quite a ways to go when it comes to learning how to properly insert IVs and draw blood from patients without a) stabbing myself with the tools of the trade and b) looking like a moron.

So there you have it - my first needlestick injury. All in all, things could've been a lot worse. For example, the offending needle could've come straight out of a patient infected with HIV or Hepatitis C, which I'm sure has happened to at least a few unfortunate health care workers in the past. However, I can also see how things could've gone a lot better. Namely I could've gotten jabbed in my middle finger instead of my index finger, thus giving me an excuse to flip people off for the rest of the day, under the guise of "Hey, look what happened to me at school today!"

...I'll have to keep that idea on the back burner.


(Pictured: Another idea I am keeping on the back burner. 3 cheers for wasting health care resources!)

This is Why Making Cybernetic Doctors Might Not Be Such a Bad Idea

I'll start this off by saying that most of my classmates (or at least the ones I've met so far) are friendly and intelligent people who will probably go on to become really great doctors. However, there's always a small handful of individuals who had to have pulled a fast one on the admissions committee, namely because there is something incredibly off-putting about them in a "Oh-God-please-don't-let-this-be-the-future-of-medicine" sort of way. Like the student who can't grasp basic, bare bones concepts despite having them explained to him/her multiple times. Or the douchebag who thinks he's like House but totally isn't because House is awesome and this guy's just a douchebag. And the girl who, as I will describe below for your reading (dis)pleasure, almost had me believing that she wasn't even human.

It all started on a typical weekday in November. I was on my way out of the medical library, after having acquired an impressive amount of knowledge regarding the workings of the human body (or was it after dicking around digg.com for awhile? It was one of the two.) As I neared the exit, I passed a girl whom I recognized from class but had never actually spoken to in any length. I smiled and said hello, since social convention dictates that sort of thing, and as she returned the gesture, our eyes met for a brief second. And in that brief second, I noticed something strange about her.

Her eyes were completely blank. Not just blanker-than-a-blank-slate sort of blank or "Don't bother stopping by because there's no one home!" blank (and yes, I'm aware that a) I've pulled these expressions out of my ass and b) I've grossly overused the word "blank".) I'm talking every character on every reality show ever featured on MTV, all rolled into one sort of blank. It was actually that bad.

Now since I fancy myself to be a fairly rational person, my first thought was "Well, maybe she's just really tired and sheer exhaustion is giving her that glazed over look. Hell, I'm pretty much on autopilot myself right now." And I just left it at that...for a few hours. But curiosity overwhelmed me later that afternoon, and since I'd mastered the art of Facebook stalking (I prefer to call it Facebook sleuthing) long ago, it didn't take me long to find her profile online. And lo and behold, there in her display picture for all of cyberspace to see, was that same vacuous look.

Initially I figured that it was just a fluke - sometimes people get a bit glassy-eyed when they stare into a camera lens for a long period of time, waiting for the photographer to take the damn picture. But this girl had some 230 photos of herself uploaded onto Facebook, and as I skimmed through the first batch of them, it was just that empty stare over and over again. These pictures were taken in different places, at different times of the year, with different friends, and yet that eerie, expressionless look persisted in each and every one of them. "What is going on with this chick?" I wondered.

I'm sure you've all heard that saying about the eyes being the windows to the soul, or however it goes. Well, I based my train of thought on that. Maybe this girl didn't have a soul. Maybe she wasn't even completely human. Maybe she was - dare I think it - a cyborg. Why couldn't she be a cyborg? Cybernetic doctors would be invaluable - they would have no need for food or sleep, they could assimilate massive amounts of information, and they're probably not going to unionize on you. Or maybe she was just designed by the school administration to keep medical students in line. Like she'll go T-1000 on your ass if you fail an exam or an attending calls you out for being unprofessional. Thank God I know where they store liquid nitrogen in this building; if Terminator 2 has taught me anything, that should at least slow her down if she ever turns on me for finding out her secret.

So I thought I had it all figured out at the time. And I more or less went about my business as usual, except for taking extra care to avoid passing Cyborg Girl in the halls because her blank stare still continued to both irritate and unnerve me. But, as fate would have it, we would run into each other again about a week later. This time it was while I was alone in the anatomy lab, poking around the cadavers and studying late into the evening for an anatomy exam that was coming up.

She came in with a few other girls from our class, who were presumably human (or at least a more advanced type of cyborg) since they lacked her cold and emotionless gaze. I watched them out of the corner of my eye as I worked, waiting to see if she would bench press a table or peel the skin off of one of the cadavers to patch up her metal exoskeleton or do whatever it is that cyborg medical students do on their Thursday nights. As she and her friends unzipped one of the body bags containing a cadaver, I heard her speak for the first time:

"Oh. My. God. This is, like, so nasty! Okay, girls, what am I, like, looking at? Like, is this supposed to be this guy's junk or something? Oh my God, it's, like, totally his junk! I- I can't touch this stuff. I mean, I got my nails done, like, two days ago. And it smells gross in here! I'm meeting my boyfriend in, like, an hour, and I don't want dead body stank in my hair! Ugh, this is, like, so unfair!"

That's when I realized the real reason why this girl looked vacuous all the time. She wasn't a cybernetic construct. She was just an airhead. And one day she's going to be someone's doctor. Maybe even yours.

Welcome to a small slice of the future of medicine, baby. Creating cybernetic doctors just might be a good idea.

Dracula the Undead or: How I Learned to Start Worrying that Bram Stoker was Spinning in His Grave (spoilers included)

Bram Stoker's Dracula is my second favorite book of all time. (Number one on my list, if you were curious, is Agatha Christie's And Then There Were None, which you should go out and read, like, right now if you haven't already.) However, I always have a bit of trouble explaining exactly why I like it so much. Delivering profound literary critiques and analyses is definitely not my strong suit, seeing as how I pretty much Coles Notes-ed my way through high school English and the 2 fiction classes I took during my Bachelor's degree. But I do know what I like and what I don't like, and Dracula falls nicely into the realm of what I like. There's just something very classic and sophisticated about it that is exceedingly hard to find in novels these days. I've always marveled at how Stoker managed to take a series of disjointed letters and diary entries and interweave them into one cohesive and creative story. That's not to say, though, that the novel doesn't have its weak points. In fact, it's actually pretty dry and even tedious at parts until [SPOILER] Lucy Westenra dies, at which point the story just gets so compelling for me that I can't put it down until things like sleep and using the bathroom mandate that I take a break. The gist of what I'm saying, really, is that I love the book, which is why I was completely stoked (yes, I know that was lame, but it had to be done) when I first saw this in a bookstore back in October:



A freaking sequel to Dracula actually written by a Stoker (and some other guy who's not nearly as important because he's not a Stoker). After nearly shitting a brick of pure excitement I snatched it off the shelf and looked at the text on the book jacket. Here's some of what it had to say:

"Dracula the Undead is a fast-paced, historically rich sequel that is as frightening and atmospheric as the original. Based on plot threads and characters on Bram Stoker's notes that he compiled while writing and researching Dracula, as well as extensive research on the historical Prince Dracula and other well-known figures, here is a suspenseful, fascinating tale that will resonate with readers of the original as well as modern fans."

That was all the convincing I needed. I had to get that book. Unfortunately it cost $34, which would have been just one more blow to a bank account already beaten half to death by med school tuition. So in a rare moment of compromise I decided to place a hold on it at the public library, knowing that although I would have to wait longer to read it, at least I wouldn't have to spend money on it. Props for being fiscally responsible, right?

To fast-forward from October to the present, I picked up the book on December 17 and I've been working through it since. I'm currently about 13 chapters into it and...well, I'm just completely baffled. In fact, I'm tempted to go out, buy a Ouija board, and try to contact Bram Stoker from beyond the grave, just to see what he thinks of Dracula the Undead. A small and idealistic part of me would like to think that he's proud of his great-grandnephew, Dacre Stoker, for trying to honor and pay tribute to his greatest literary accomplishment. But a much larger, realistic part of me thinks that poor old Bram is probably trying to claw his way out of his grave this very moment to bitch slap Dacre senseless.

In other words, I'm not enjoying this book.

I know I can't judge Dracula the Undead in its entirety since I'm only 82 pages into it. But the fact that I've taken issue with the novel so early on can't be a good sign. Hell, I don't even know if I want to finish reading it. If the first few chapters are any indication, this book is 424 pages of Dacre Stoker and Ian Holt taking a steaming dump on some of my fondest childhood memories of reading Dracula. Sadly I can't unread what I've already read of Dracula the Undead, but I can still spare myself further misery, no?

But perhaps I'm getting ahead of myself and should actually explain some of the reasons why I don't care for this novel. In fact, since it's the Christmas season, I'll start off with a few things that I actually like about it. I mentioned above that I'm a fan of Dracula's epistolary style, but one thing that it unfortunately does not lend itself well to is to really get into the heads and lives of the characters. This may seem to be a bit counterintuitive since diary entries and letters can very personal in nature, but each entry in Dracula had to pull the double duty of both revealing insight into the characters and advancing the plot. As a result, I sometimes felt that the elder Stoker had to sacrifice characterization in order to push the story forward, but he still ended up with a damned good product. In contrast, Dracula the Undead is written in the third person, but alternates from the perspective of Dr. Seward, Mina Harker, etc. The fact that the plot isn't confined to being told within letters and memorandums allows the younger Stoker to flesh out a character's thoughts and feelings a little more, and occasionally even provide some interesting bits of back story. When it comes to exploring the characters in more depth (and with regards to how they've changed 25 years after when Dracula was originally set), I thought Stoker and Holt did an interesting job with the character of Dr. Seward. In Dracula, Seward was portrayed as a clever but bumbling physician. Like, the very essence of uncool - you had to feel sorry for the guy. But do you know what Stoker and Holt turned him into in Dracula the Undead?

A morphine-addicted, total badass vampire hunter.

I'm not even kidding. The following is a passage from the book that highlights Seward's new-found brand of awesome. To set the scene, two vampire chicks are advancing towards the door of a room where Quincey Harker is hiding like a little girl, and they're about to strike:

Suddenly, a sandbag fell from above and hit the blonde [vampire], sending her chin into the floor. In that same instant, Seward swung down on one of the many ropes from the catwalks above. As he swooped close, he flicked a cross-etched bottle, splattering holy water onto the Women in White. Their skin sizzled and blistered. Their terrible wails echoed through the corridor.

While the Women in White ran off, flailing in pain, Seward dived toward Basarab's door and pounded on it. "Mr. Basarab! Save yourself!"

Okay, so Seward is no John McClane, but considering that the novel is set in the early 1900's, that's pretty badass for the times. Yet just as I'm getting all excited about the direction that Seward's character is taking, guess what Stoker and Holt decide to do to him, just for shits and giggles? (Beware, spoilers ahead.)

They kill him. And he doesn't even die an awesome death, like going down in a blaze of gunfire screaming, "Yippee ki-yay, motherf***er!". Instead he gets run over by a horse carriage driven by the vampire chicks as they escape. I swear, a part of me died after I read it. It was like a huge middle finger to physicians everywhere who crave badass role models to look up to, because all we have right now is the hematologist from Blade. Damn you, damn you, damn you, Stoker and Holt.

But wait! Our dynamic writing duo hasn't finished screwing things up character-wise! After the epic display of douchebaggery that was Seward's demise, we now need a new character. Time to throw Bram Stoker into the ring!

Yes, you read that correctly. Bram Stoker is actually a character in this novel. This makes absolutely no sense on more levels than I can describe. In no way did Bram Stoker try to insert himself into the original Dracula - the entire story was told through the works of characters like Jonathan and Mina Harker, Seward, Van Helsing, and so on. Yet in Dracula the Undead, Bram Stoker's character is supposedly a horror writer adapting the events of Dracula into a play, or some kind of BS like that. I mean, I guess I can understand Dacre Stoker and Ian Holt wanting to pay homage to Bram, but throwing in this confusing plot point is not the way to do it. The best way to pay homage to Bram would've been to not color Dracula the Undead seven shades of suck, but I think that ship has already sailed. Oh, Bram, you poor, poor bastard. I feel for you, I really do.

One last beef that I have with Dracula the Undead (so far) is the love triangle between Jonathan, Mina, and Dracula. If you remember Dracula and Mina actually being in love, then you're probably thinking of the film Bram Stoker's Dracula by Francis Ford Coppola. I'll come right out and say that I freaking love this film because it remained quite true to the original novel, save for Dracula and Mina's relationship and the back story behind it. And even though their relationship wasn't canon, I still enjoyed the portrayal of it in the movie (what can I say, an early 90's Gary Oldman makes me hot). Perhaps I didn't mind the Dracula/Mina romance in the film because the film never touted itself as an official, Stoker family-authorized movie adaptation - it was just Coppola's take on a great book. Dracula the Undead, on the other hand, goes around sporting words like "official sequel", yet doesn't even bother to take into account that Mina despised Dracula and declared that she would rather kill herself than become like him.

Early in Dracula the Undead (and by that I mean the book jacket), readers find out that Jonathan and Mina's marriage has gone belly up after the events of the original novel. However, Stoker and Holt don't allude as to why things didn't work out until Chapter 9, when Jonathan says to Mina, "I believe you want to have these dreams, Mina, that deep inside, you still desire him. You hold for him a passion I could never fulfill."

Now since the whole Dracula/Mina pairing didn't actually exist in the original novel, I could only assume from that line that Mina developed a crush on Dracula somewhere along the way. As to when that might have happened, I don't have a damned clue. As far as I can recall, the lengthiest interaction they had was the time where he drank her blood, forced her to drink his, and threatened to kill her husband, which certainly isn't a turn on in my book. So to get an idea of where Stoker and Holt were actually going with this plot twist, I flipped ahead to Chapter 16, where I found this literary gem explaining why Jonathan and Mina's marriage fell apart:

She [Mina] became insatiable in the bedchamber. Again, not something most men would complain about, but Jonathan found it physically impossible to keep up with her...While trying to make love to his wife, Jonathan discovered through a slip of his wife's tongue that it was Dracula who had taken Mina's virginity. Dracula, with centuries of experience, first introduced her to passion. He'd left such a profound impression on her that Jonathan, no matter how hard he tried, could never match it.

So basically, Dracula plowed Mina and was such a demon in the sack (both literally and figuratively) that Jonathan was never able to measure up, leaving the once-happy couple sexually dissatisfied and hating each other. When I first saw that excerpt I thought I might've wandered into an episode of Dr. Phil by mistake, but nope, I was still reading Dracula the Undead.

The irony of this is that Stoker and Holt know that they've strayed far, far beyond canon and they so much as acknowledge it and try to justify it in the Author's Note at the end of the book. Here's what they say:

We know there is a large segment of Dracula fans that have only seen the movies and have never read the book, and of course we wanted to inspire many of those folks to read Bram's original. Our dearest wish is all Dracula fans - of the book and of the films, will read and enjoy our sequel. To this end there are several areas which we felt that film fans had so embraced and had become so ingrained into Dracula legend that we could not overlook them. To the literary purists we apologize, but we feel this is a necessary concession, made in the hope of once and for all harmonizing all Dracula fans.

...As for the Mina-Dracula romance, Dacre and I agreed that this would have to be handled with greater care than in any of the films, and deal with the fact that Bram never clearly wrote that a romance occurred.

I couldn't stop shaking my head after I read that. Stoker and Holt will never be able to harmonize all Dracula fans, and by trying to cater to the film masses by making "concessions", they effectively alienated an audience who loved Bram's original work for what it was, and who longed for a proper sequel more than anyone else. And while I can grudgingly appreciate their intention to want to please the fans, I would've much rather they tried to honor Bram Stoker's work and memory by staying true to what he wanted, since we wouldn't even have Dracula without him.

(Not to mention that I would take a conservative Dracula the Undead free of shock value any day of the week rather than a Dracula the Undead that may one day be thought of as "OMG, you guys, it's totally like Bella and Edward, but they have sex and everything!")

Ugh. Well, that more or less concludes my rant about Dracula the Undead. If you're interested in reading Dracula (the one by the talented Stoker), there's a link for it here. Happy reading!

Taking a History (otherwise known as me struggling to keep my shit together for 10 minutes and failing miserably half the time)

One of the first things that's drilled into medical students from Day One is the importance of taking a careful and thorough patient history. Oddly enough, it's not something I ever gave much thought to as a patient. Whenever I went to see my family doctor for anything, I would simply rattle off a vague list of symptoms, he would nod appreciatively as he scribbled indecipherable notes on his prescription pad, and after a quick "Open your mouth and say 'Ah'" and "Take a deep breath and cough", he would have his diagnosis. Little did I know that the 4-5 minutes of me rambling about how I felt like crap and his thoughtful nodding and occasional question thrown in for clarification is pretty much the most important part of any given doctor-patient interaction. 85-90% of a doctor's diagnosis is based on a proper patient history, with about 5% based on physical exam, and the rest based on tests (ex. x-rays, blood work, etc.). So the long and short of it is, take a good history.

Since it's such an essential skill, we (and by that I mean myself and my fellow classmates) started learning how to take patient histories shortly after starting medical school. This entailed being divided into small groups of about 5 or 6 students and taking turns individually interviewing standardized patients (i.e., actors) under the guidance of a physician preceptor. For those of you who may not be aware of what a basic history includes, the following is a list of information that I, the future doctor extraordinaire, need to pry out of you, the wonderful patient:

ID (identifying data): Your name, age, gender, marital status, and any other tidbits about you that may be relevant to figuring out what ails you.
CC (chief complaint): Why you came in, basically.
HPI (history of present illness): The circumstances surrounding why you came in, basically. When you started feeling sick, how bad the pain is, and so on and so forth. (As a side note, if there's any part of the history where we want patients to ramble, this is it. The more you can tell about us about your current illness or whatever brought you in, the better).
Past Med Hx (past medical history): Any chronic or ongoing problems you may have, any past surgeries, etc.
Drugs/Allergies: This is pretty self-explanatory.
Fam Hx (family history): Any illnesses or conditions that may run in your family.
Social Hx (social history): Your occupation, diet, lifestyle, etc. Also includes things like whether you drink, smoke/use drugs, and your sexual history.
ROS (review of systems): A list of rapid-fire, seemingly random questions about the rest of your organ systems from head-to-toe. Mostly used to make sure that neither the doctor nor the patient has missed any other medical problems during the history.

While all of that doesn't seem too complex on the surface, taking a history involves much more than just an exchange of information. I actually have to do things like gain your trust, make you feel comfortable and at ease, and generally conduct myself in a way that won't make you go running off to report me to medical licensing authorities for unprofessional behavior.

Needless to say, I have trouble taking patient histories.

Don't get me wrong, I'm not a sociopath or a complete jerk. But I can be pretty socially inept, and in a casual conversation I can go from zero to "Oh shit, I can't believe I just said that" in about 10 seconds flat if I'm not careful. So I usually have to really concentrate on what I say, as I'm saying it, when I'm chatting with someone, just to make sure that I don't end up blurting out something stupid or offensive or just plain nonsensical. I have varying degrees of success with this, but for the most part I can hold my own just fine in a normal conversation. As a result, I wasn't too nervous when we started practicing taking patient histories, because I figured it would just be like a pleasant social visit. Just a normal, garden-variety, harmless conversation.

Patient histories are totally not normal, garden-variety, harmless conversations.

To illustrate this point, here's an excerpt from one of my first mock histories:

Me: "So, what brings you in today?"
Standardized patient (SP): "I have a sore throat."
Me: *waits patiently for SP to elaborate*
SP: "Yeah. Sore throat."
Me (thinking): This can't possibly be all you have to tell me.

[Room fills with a devastatingly awkward silence]

Now, in normal conversations, Person A says something, Person B responds, and things go back and forth like a game of tennis. In patient histories, Doctor A asks what's wrong and Patient B ideally gives a nice, long detailed account of what's wrong, uninterrupted by the doctor. In fact, since those first few sentences out of a patient's mouth are often key to making a diagnosis, med students are instructed to initially let the patient talk and talk, and only interject to ask for clarification on a muddy point or if the patient is getting insanely off track. This goes against the pattern of Person A talk, Person B respond, and some patients may politely give me one sentence detailing their problem while I'm expecting a paragraph. The awkward silence then ensues as I wait for the rest of their story and they wait for me to stop being a dumbass and actually reply like a normal person would in a normal conversation.

Luckily, there's a really simple solution for this that I should have figured out a lot faster than I actually did. And that's to just sit back, relax, pop the collar on my white coat and say, "Tell me more about that."


(A bit like this, but with a lot more awesome and a lot less douchebag...Wait, no, on second thought, nothing like this.)

So that's one minor and admittedly boring problem I had with taking patient histories. But where I really started having trouble was the part where you're supposed to make the patient feel at ease by essentially not conveying any emotions other than sympathy, concern, and all other things warm and fuzzy. As a patient I truly do understand the importance of this. When you're feeling sick and scared and vulnerable, the last thing you want is for your doctor to come across as hostile, judgmental, or completely shocked. But now that I've had a taste of both ends of the spectrum, I've realized that it can sometimes be as hard as hell to even appear neutral during certain parts of the history. If you read the components of the history that I outlined above, maybe you can guess which section I'm about to talk about.

Sexual history.

This will probably make me seem like an immature 12-year-old who still snickers at words like "erection" and ends every retort with "That's what SHE said!". But humor me for a minute and try to imagine how difficult taking a sexual history can potentially get. Sexuality is a sensitive subject to begin with, and I think it takes a fair bit of bravery for a patient to talk about their practices and preferences with a physician that they may just be meeting for the first time. In a normal conversation about sexuality, it may be okay for Person B to let out a bit of a laugh or maybe gape in horror at something Person A says. During a patient history, anything other than a neutral expression and a nod that says "I understand completely" on the part of the doctor may damn well ruin their chances of getting the patient's trust, and may even prompt the patient to lodge some kind of complaint. Considering how some of the sexual history portions of my mock history taking have gone, it's a good thing that I'm not an actual practicing physician yet:

Me: "If it's all right with you, I'd like to ask you some questions about your sexual history. These questions may be a bit sensitive, but we ask them of every patient in order to get a complete picture of their health."
SP: "Oh, sure, go ahead."
Me: "So, are you currently in a romantic relationship?"
SP: "Yes."
Me: "Tell me a bit about your partner."
SP: "My wife, you mean? Well, she and I have been married for about 12 years now."
Me: "Are you sexually active with your wife?"
SP: *shoots me a weird look* "Of course."
Me: "What precautions do you take during sex?"
SP: "'Precautions'? What do you mean by 'precautions'? Like, we have a 'no biting' policy, and we always use a safety word when we, you know, role play." *winks*

(Keeping in mind that standardized patients are actors, I think this one particular guy was just screwing with me to see if I would lose my composure in some way. Which I slightly did).

Me: *squeaky, strangled noise comes from my throat as I bite down on the inside of my cheeks to keep myself from laughing my ass off. It's not that he said something mind-blowingly awful, shocking or funny, but I think I'm just really sheltered. I may also have had a "Are you shitting me?" look on my face*
SP: "I'm sorry, did you say something?"
Me: "What? No! I- I'm sorry, I don't think my question was very clear. By 'precautions' I meant things like using condoms or birth control, b-because STDs are...they're bad, and you, uh, don't want to get them. Yeah."
SP: "Oh, yeah, my wife just uses the Pill. I'm clean, just so you know." *raises eyebrow and winks*

You may have noticed a few unusual things about that exchange of words. While the patient is free to be completely ballsy and blunt about what they say, I had to ease into things with neutral and non-presumptuous phrases that tend to beat around the bush. Like if a male patient says that he's married, you can't assume that his spouse is a woman. And instead of asking straightforward questions like "So...you gettin' any lately?", which would make the conversation flow so much better if the patient decides to drop a blunt, graphic bomb about his auto-erotic asphyxiation or something even more outlandish, you have to talk in terms of "romantic relationships" and whatnot. I'm all for approaching situations like this delicately, but I guess it can be a bit jarring when I'm talking as if my parents are in the room and the patient is talking as if he's bragging to his buddies about his conquests over a couple of beers. (Although bear in mind that this was just a mock history, the patient was just acting, and I'm just not good at taking sexual histories. I'm sure that real histories go much more smoothly, real patients are a lot more tactful, and real doctors are not like me at all).

So those are some of my qualms with histories thus far. I'm sure that with time and practice I'll eventually get the hang of things, and the future will hopefully see me making awesome House-like diagnoses and saving lives rather than making patients cry and getting fired.

What up, Internet?

After recently being on the fence about whether or not to actually kick-start a blog, I finally decided to do it. Mostly because my social life is kinda non-existent and I have nothing better to do on a Thursday night. But also because I miss writing. I'm not a phenomenal writer by any stretch of the imagination (in fact, I'm sure you'll find out in short order that I sort of suck), but I always found writing to be both fun and cathartic. For the past 4 years or so, most of my written work (outside of school) was limited to entries in private diaries that only I read. And prior to that, all I really had was some crappy fan fiction kicking around the Internet and a truckload of whiny teenage angst on a LiveJournal, (although to be fair, 80% of LiveJournals are all about whiny teenage angst). I'll try my damnedest not to turn this blog into a repeat of the latter, but I'm not expecting to turn into the next Hemingway overnight.

In terms of what I'll be writing about in this blog...well, that remains to be seen. For those of you who don't know me, I'm a 20-something-year-old medical student living in Canada. After being accepted into medical school a little while back, I secretly aspired to be the next Perri Klass and wanted to somehow chronicle the wacky adventures I would have during the long and arduous journey to getting my MD. So I'd like to think that this blog will contain some of my experiences in medical school (like how I'm bumbling my way through it), as well as intermittent bursts of whatever the hell happens to pop into my mind.

I'm not expecting too many people to read this (or really anyone, for that matter), but if anyone does, feel free to drop a comment about what you think of it. I'm always open to flattery, but I will grudgingly accept constructive criticism as well. Especially if you pad that constructive criticism with flattery.

So...here goes nothing!