Medicine

How time flies.

We're into the fourth month (phew!) of the residency year. Almost a third of the way through. Amazing.

There's still a lot of reading to be done, and if I were one to despair, that'd be happening every night. After all, it's quite daunting when you read about one disease and come across references to other diseases that you never knew existed.

It is interesting though, to realize that at least some of the new vocabulary is sticking. The fact that I don't reach for Stedman's when reading: Superficial and deep perivascular and periadnexal lymphocytic infiltrate, dermal mucin, with follicular plugging, and that I actually have a sense of what they're trying to say, is a good feeling.

Because this stuff can get a little overwhelming, it's easy to forget how amazing it is that our brains are plastic enough to learn such different things. And being at the cusp of closing the internal medicine chapter and beginning dermatology allows for an interesting perspective on some of the sillier "side effects" of becoming fluent in a medical specialty.

1) Basic English skills go down the tube. The more "work reading" there is, the less "fun reading" there is. Which means that spelling and grammar, at least what most people would recognize as such, deteriorate. As a kid, avid reading meant constant exposure to words used in every day language. The eyes became a sort of spell check, because if you wrote or typed something and it didn't look right, it was obviously mispelled. Well, many of those common English words are not found in a medical text, so have been mispelling for some time now. Quite embarrassing.

Grammar is also different in the dermatology world. For example, when one wants to describe an object, you usually use one adjective. Sunny day. Yellow flower. Being the descriptive field that it is, it is the norm to find sentences filled with adjectives. Quite against grammar rules somewhere, I'm afraid. Here's one of the shorter examples: Erythematous, lichenified, excoriated plaque. That's like saying Yellow, large, sturdy sunflower, and calling it a good sentence. Yet that's how the textbooks read, and that's how we talk to one another. Silly, no?

2) Medicine is very particular about how things are done. After taking a careful history and examining the patient, the goal is to distill what you have seen and heard into a "presentation," short, succinct, yet able to convey to the listener exactly what you saw and what you think is going on.

Think of it like this. In an ideal world, if you went into a room and saw a black cat sitting on the examining table, you'd come out and probably say,

"there's a black cat on the table."

Simple enough. But in medicine, you're not supposed to jump to the conclusion that what you saw was, indeed, a black cat. Instead, you should describe what you saw in an objective way, and have a list of possibilities of what kind of animal it could be. For example, you would come out of the room and say

I just saw a small, black, four-legged animal with whiskers. It could be a cat, a dog, a hamster, a rat, or a baby cow.

However, if you're adept at what you do, your description of the animal would use "key words" that would subtly tell the listener, who's seen quite a few black cats in his day, that you just saw a black cat. As in:

I just saw a small, black, four-legged animal with green eyes. She is often described as having many lives, enjoys rodents, and is most popular around Halloween. The most likely animal is a cat, however, you can never exclude dogs, as they can be the great imitator.

Basically a convoluted way of saying "I saw a black cat." The key words are like a secret language that people "in the know" share. Sometimes it's silly, when you have to try and describe a wart as "small skin-colored, verrucous or filiform papule" instead of just saying the patient has a wart. Other times, because you're the newbie to the specialty, you may have just seen a cow, which has its own buzz words, but since you've never seen a cow before, you're left fumbling for the right wording - four-legged, uh, large, uh, udder-looking things, etc.

beautiful flowers on the island of Hawai'i (anyone know what kind of flower?)