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.
Sunday, December 27, 2009
Monday, December 21, 2009
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!
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!
Thursday, December 17, 2009
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.
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!
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!
Subscribe to:
Posts (Atom)
