September Update: School

September has come and gone, and it feels like my second year is going by even faster than the first. Things have been busy and it's been hard to find time to write, but here is a snapshot update of some high points over the last month:

School

just finished another round of exams and closed out a block on cardiology, hematology-oncology, pulmonology, and nephrology. Now that things are more clinical, and more related to pathophysiology, I'm getting a better feel for the different fields, what they do, and how much I like/dislike what I see. This is tentative, of course, since I haven't done my rotations. But I decided to weigh in and grade the courses anyway (note: these are the subjective scores I am giving the specialties, not the all-too-objective grades I got in the courses).

cardiology: A

very clean, very intuitive. if you like connecting dots between pressures and flow and volumes, this is a good one. also if you like plumbing. but i think they teach this first for a reason, namely because it's the easiest to get because the pathology is pretty much what you would expect it to be. common sense reigns supreme, and there's not a lot of abstract thinking. to be fair, it can get borderline boring, but there's probably enough patient interaction to get you through the dry seasons, i suspect.

word to describe cardio: clean/pristine.

hematology-oncology: A-

i thought the course wasn't taught brilliantly, but that the material itself was pretty interesting. Once you get a handle on it, it's pretty cool. Obviously things like anemia are common and useful for physicians to know, but even the blood disorders and malignancies have their own charm once you become facile with the terms and classifications. And regardless of taste, there tends to be more variation in patient presentations than other fields, and you don't have to touch pee! (see below) word to describe hem-onc: flavorful/variety-ful.

pulmonology: B

big fan of the way the course was taught, but not a big fan of lung pathology. maybe it's because the pathophys isn't very nuanced, and maybe because treatment seems so broad and general (you seem to hit everything with steroids and/or bronchodilators). i think i'm also bothered by the fact that there is no good screening for lung cancer, so the vast majority of cases end up presenting clinically when it's too late and when their 5-year survival rate is super low. tends to depress and make you feel like you are just trying to keep them alive and functioning, necessarily ignoring degrees of morbidity.

word to describe pulmonology: functional.

nephrology: C-

the kidney can be complicated, and nephrology is mathematical and abstract. there is a certain beauty to it, imagining thousands and thousands of nephrons. but it can also be a headache to imagine mechanisms for parts of one single nephron and then expand that to cover the whole kidney. and then remember there are two kidneys. I have great respect for skilled nephrologists because i think it takes a lot of thought and "art" to practice . . . the diagnoses are heavy on science, the management on art. but definitely not for me - at least at this point - because the feedback loop is so weak. you can treat and manage pts for months/years and see minimal changes (compared to other fields). plus, the main modality is the "poor man's biopsy," aka pee in a cup. I have never met a nephrologist who doesn't have a story about spilling pee somewhere. think about it.

word to describe nephrology: cerebral/abstract.