Like I just don’t get what people would POSSIBLY think is being set up on the show?  Like … if something happened and went badly with Hook and Emma, HE WOULD LEAVE.  He would have nothing else keeping him in Storybrooke, that much has been pointed out EXPLICITLY.  He wouldn’t just hang out and bang every chick in town.

It’s been made clear that anyone besides Emma, for Hook, would be second choice at best.  And if Emma wanted him, he’d drop them SO FAST.  That’s not exactly the stuff dreams are made of for any other Hook ship.  And as for Emma … she’s never BEEN this close to any other person, not romantically, not ever.  This is a HUGE DEAL for her to be letting him in, and if things go south with him, guess what?  GIRLFRIEND WILL PROBABLY NEVER GET INVOLVED WITH ANYONE EVER AGAIN.

And the stuff that’s happened between Hook and Emma thus far is TOO important for both of them, TOO real, to be a flash in the pan, a thing that’s going to fizzle out and go nowhere.  No.  This is the real deal, we’re in the beginning of the journey.

This is not just gonna be some fling that’s gonna be over and done and forgotten about, sorry haters.  Hook and Emma are INCREDIBLY important to each other, and that’s not gonna get erased because you don’t like him or you want her with someone else.

Our Deepest Condolences

One of the very first patients I had admitted was a 50-some year old father of three with a newly diagnosed colon cancer. His case read just like my father’s. Sudden changes in stool caliber. More bloating and fatigue. His wife started noticing that he looked thinner. 

By the time I had approached him in the hustle and bustle of the emergency department, the news had already been broken by the emergency physician. “You have colon cancer,” he remarked on the bluntness of that interaction. It had left him in such shock that he had little to say for most of the day. I took my time to be thorough, answering questions, gathering the history, doing the physical - his moderately ascitic belly and an enlarged liver already hinted at something more sinister. Having already been subjected to one rectal exam, he asked if I needed to double check again. I politely declined to which he breathed a great relief. 

I excused myself to review his CT scan, to get a better understanding of what was driving everything. There, on the black and white screen I saw a liver so large it seemed there would be no space for anything else in that belly. Pocked full of cysts and irregular tissue, it screamed only one conclusion: gross metastasis. 

"A few more tests," I reassured him and then he would go home, to follow up with the oncologist for further management options. I explained that the cancer had spread and that the options will be limited. He digested the news silently, his eyes flickered across the floor as he concentrated. When his wife arrived, I made sure to break the news gently. She wept regardless.

By the time I had sent him home, his belly was flatter once again, having been drained of all of the malignant fluid. The oncologist was to follow up with him within a week’s time. The prognosis was guarded but we agreed that he will be fine for at least the week.

Or so we thought.

It was a surprise to me then that not one week later, I saw him again on call in the emergency department, this time looking worse. He was confused, agitated, and grim - his skin had turned yellow. I quickly texted my attending: “Encephalopathy. Icterus.” The response was immediate: “Shit.”

Because most of the patient’s liver had been replaced by metastatic tissue, his body could no longer bear the burden. The liver had started to fail and with that, his kidneys were beginning to shut down. He was quickly transferred to the ward. 

We rediscussed code status with the family with the end drawing near and it was decided to change his care to palliative. We kept him comfortable until he died a few days later.  

Precipitous multi-organ failure is uncommon to see in someone who is still very high functioning. We never would have expected him to decline so rapidly. It was a surprise to everyone that he could be here one week and gone the next. Given his disease, there would not have been much more we could do medically.

But there are always things we could have improved on. From delivering the diagnosis with care, to advocating for a private room in his final days, to addressing the psychosocial needs of the family. These are areas that we can strive to do better. At the end of the day, this patient was not his colon cancer, he was a person. With a wife and three children. A friend to many. 

These were the pieces, in the torrent of changes that ensued on his second admission, that were lost.

"The patient died surrounded by his loved ones. We are grateful to have been involved in his care and offer our deepest condolences to his family and friends…End dictation."

Maria Bamford is one of the top comedians in the country, but like many other people she suffers from bipolar disorder. Maria has discovered a website that helps her cope with the stigma of treating mental illness by using humor and community. 

Watch her episode of Modern Comedian here: http://youtu.be/f6fKarmaphY

the way nancy deals with bess’ crush on sonny really pisses me off:

  • she talks about/dissects it with george (we can assume george picked up on it/was told by bess, but even so it’s kind of a rule of friendship to not talk about someone behind their back)
  • she mocks bess about it-"is this ‘regular’ bess or (*in exaggerated voice*) ‘pining-for-sonny’ bess?"
  • flat-out tells sonny that bess has a crush on him (?!?!) and assumes he doesn’t like her back, tells him to let her down easy

jeez, nance, just because you’ve been in a relationship for 80 years you can’t remember what the beginning of romantic attraction feels like and how difficult it can be to deal with?

Just thought I’d let everyone know that scientists have discovered a foolproof method of ADHD diagnosis.

Based on involuntary eye movements in anticipation of visual stimuli, this method not only is a objective method of detection of the disorder, but provides ample evidence that stimulants do infact help!

[This is just a first study but they are trying to replicate it with more subjects; so far it looks really promising! -J]

z33r0 said:

in another post you said this: "2. Hardest? Knowing that I’m being broken down and built back up into something that’s not considered completely human, while fighting for my humanity throughout the process." What exactly do you mean by not considered completely human?

Hey there, z33r0!

When you get pushed to your physical, emotional, psychological, psychiatric, spiritual, and personal breaking points during this training process, you have to make a choice: get hard and cynical, or fight for your humanity.

Medicine rewards a certain level of cynicism or “gallows humor” because sometimes, it’s the only way to get through the day. As my wisest internal med R2 once said:

"When a person dies, everyone in that person’s life stops and respects the one who passed. People take a day or two or a week off. But does a doctor get to take a day off when someone dies? No. You keep working. And you go to work the next day and the day after that. That’s going to mess you up a little, somehow, someway."

When people run away from an emergency, we run towards it. When people cry or hurt, we go to them. You go from a first year kinda grossed out about a cadaver, but by second year, you’re hacking away and don’t think twice; from someone who giggles when thinking about a rectal exam to calmly talking someone through it (although you’ll laugh about it later). All your human instincts tell you to balk, to think first. But medical training removes or at least suppresses it. Think about it. You’ve already been messed up a little, somehow, someway, right?  

Part of it is the sacrifice and honor of being in this profession; we trade a part of our humanity, time, and life to learn how to protect or save others. But some of it, like rude superiors, getting sued despite doing your job, mistakes you didn’t mean to make killing or hurting people, gunning, really mean pimping, misogynist/genderphobic/racist remarks are unnecessary. However, they continue to exist in the field. It is these things where I believe we can choose: we can choose to remain kind, gentle, forgiving. Or we can choose to join our tormentors and perpetuate the cycle. 

That’s what I mean by fighting for my humanity :)

anonymous said:

so how long would it take to pay off all the crippling debt on average

Depends on what payment plan you pick. Most of us go with the income-based plan now, which requires you to make 120 payments (yup, 10 years) and the amount is based on how much money you make. The new deal is that after those 120 payments, you’re done, even if there’s a balance left on the principal payment.

image

Then you’ve got the Standard plan, where your payments are based on how much money you owe. They are often structured over 10, 20, or even 30 years. But people who are really motivated or who have great jobs sometimes pay them off in as little as 5 years.

Right now I’m doing the income based plan because my debt is so high it’s the only way I can afford to pay anything. I haven’t paid anything on my principal yet. Not even covering my interest actually. It’s still compounding.

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Study Tag

I was tagged by pequalsmd, and I’m excited to share with you all!

1. How do you motivate yourself to start working?

  • I like to use my planner to write down due dates and times of classes, but I use my calendar on my Mac to give me a timeline of my week. I schedule study time like non-negotiable meetings or classes and schedule study time down to the area I will be studying. If its on my calendar and I get a ping on my phone I have to go do it, it’s as simple as that for me.

2. How do you stop yourself from procrastinating?

  • A couple things about me. I don’t sit down for hours upon hours unless I absolutely must, I take things a little at a time and a week before school I try to read or do a little bit to be ahead. I like to a week ahead of all my classes in my reading and in the homework (if possible). I get pretty terrible anxiety about school work and tests, so staying a decent amount ahead keeps me sane and functioning as I should!

3. What are your personal study tips?

  • GO TO CLASS, READ THE CHAPTERS, DO THE HOMEWORK AND DO THE EXTRA PROBLEMS!
  • I take really detailed notes. I hate when my notes are messy, so a part of my studying is taking class notes and making them “acceptable” in my eyes. I don’t just write down verbatim though! i reorganize and try to make my notes more concise. I remember by color and writing things down. If the notes have a certain scheme, I can mentally map out my notes by imaging them in my mind. 
  • So AKA COLOR CODING IS LIFE
  • Studying for tests can be tricky. Once you get your syllabi, mark all important deadlines and start planning times to study. Sure, it may be tentative, but again, if you schedule things as non-negotiable, you’ll have to follow through. To start studying, I make a study guide. I get very very detailed with these. Second, you have to know your professor’s style. If they do difficult multiple choice, make practice tests! If there are only short answer, come up with possible short answer questions from your notes, book, homework and study the same way you will be tested. I cannot stress that enough.
  • I like to make things fun. As strange as it is, I enjoy making my notes pretty: it brings me joy. Also, I try not to make studying a pain and give meaning and purpose to everything I learn. Makes all your time worth while if you feel like what your learning isn’t useless. 

4. What is your ideal study space?

  • I like anywhere with a clean nice surface and a non-hectic surrounding. The student unions are usually out of the question. On campus, my favorite building is the Human Ecology building. It’s not too loud, not too quiet, and not a lot of people know about it. I do live in Wisconsin, so when it gets cold, I study in my apartment quite a bit!

5. What are your school-related pet peeves?

  • People who genuinely don’t give a crap and think it’s funny to announce themselves as so: “Oh the quiz is today?” “Oh yeah I totally didn’t study” “Wow, why do you work so hard? You don’t have to”
  • Don’t mark on my notes, don’t write on my notes, don’t crumple my notes. Do. Not. Touch. My. Notes.

6. What is your must have food while studying?

  • For long study stints, I will get coffee and bring a snack with me where I am. I usually don’t have it until I’m half done (or starving! haha)

7. How do you de-stress yourself from school?

  • Working out! Running especially. I love my friends as well, we all live in our apartment together and being with them is always such a good time. I also paint with watercolors a lot. 

8. What do you do after you take a very stressful exam?

  • Nap. Always (well if I don’t have a class).

9. Do you have any study habits?

  • I always listen to music! I also like to study with my friends around. We all understand not to talk to each other while we are focused. It’s good to have company.

10. Where do you see yourself in ten years?

  • I will be 29, so a few years into surgical residency! Hopefully married, but I can be patient on that.

11. What is your favorite movie?

  • Anything Audrey Hepburn. I watch Audrey Hepburn movies when I have a bad day.

12. Do you have a favorite subject?

  • Like I said, I try to make everything have purpose and be important. Of course I love the sciences the most, but I’ve also enjoyed classes like Biblical Literature, Sociology of Marriage and Family, etc.

13. Is your best subject different from your favorite subject?

  • I try to do well at all my subjects :)

14. What do you do the morning/night before an exam?

  • The night before, I review about a million times. Go over notecards, talk out my study guide. When I feel like I know the material very solid, I take a shower and go to bed. The morning before, I do a light workout on the elliptical or something and look over my review and notes. I arrive 30 minutes early and mediate on the information. I’ll say a quick prayer and let myself relax right before.

15. Do you have tips for stress/anxiety?

  • Workout and stay ahead of the game. Be organized and overly prepared.

16. How do you use post-it notes?

  • Not for very much, actually. I use them for little lists inside my planner: grocery lists, guidelines for an assignment that were given in class, etc.

17. What is your best method of studying?

  • Take things seriously. You can always know it better, you can always look at things another way. When you’re done you can relax.

18. What is your opinion on studying in groups?

  • I don’t do study groups usually, but sometimes it’s helpful to get a second opinion on things. I only ask people I trust. I don’t really do group study though.

19. What is your ultimate goal?

  • To become all that I am supposed to be: a surgeon, a healer, a success.

I tag: doitforthea and premedmotivation

breakempire said:

What was your fav part of the first year of medical school? (I just started!)

My favorite day was probably the afternoon that I found out I passed my first test—when I realized, hey, maybe I can do this. 

Overall though, my favorite things in first year were the times that I was allowed to work with real people instead of books. I loved anatomy lab and I loved my community medicine placement in a family practice office. I didn’t love the massive paper I had to write on community med, but I did appreciate the break from the books and the fact that my preceptor let me see patients on my own even as a first year. 

Pre-Med Resources

One of the most important part of being enrolled in a post-bacc program  is sharing resources among classmates. Don’t mind if I share with y’all ;)

OPEN MSAR - get the stats you need on allopathic schools

http://open-msra.herokuapp.com/#/

DO Handbook -  same for osteopathic schools

http://www.aacom.org/resources/bookstore/cib/Pages/default.aspx

DO secondary thread - pre-write your secondaries

http://forums.studentdoctor.net/threads/official-secondary-application-thread-2013-2014.1002478/

Ignore this

Things would be infinitely easier for me if I could just take a bunch of drugs or drink whenever I got into one of these moods. If I could just keep a bottle of xanax, and casually joke about it knowingly to people, and get sleepy and forget things, and feel fuzzy but not sad, well that would probably be a lot easier. I have too many feelings. I’m too sensitive. If I had the ability to dilute myself, things would probably be a lot easier.

Last night I dreamt that somebody took the emergency ativan out of my purse and swallowed it. I woke up crying, and at that point I probably should’ve taken the emergency ativan out my my purse and swallowed it, but I didn’t. I’m just too scared of life.

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