When You Hear Footsteps, Think Zebra.

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His skin reminded me of a leather belt. His eyes were piercing under his overgrown eyebrows, and he gazed up at us all in our crisp white coats for a long minute before opening his mouth to reveal a gravelly voice that said, “I want to thank you all for what you’re striving for. I hope I can help your learning somehow.”

He wore soft, faded jeans and his careful sentences trailed with a hint of country twang. I imagined him as a cowboy in his past life. He told us he had always been healthy and active. Then the patches on his arm began appearing. Next it was the shortness of breath, and the fatigue, and the colds that kept him coughing while everyone around him recovered. The doctors dismissed it with a wave of the hand, and he did as well. Years passed, each a little worse than the last, until a chance X-ray revealed his tumor. It was the size of a cantaloupe.

He recovered from his surgery, and more months passed by while his symptoms continued to widen. He shrugged his shoulders as he spoke of the pain in his knees, attributing it to ‘getting older’. This was not a man to complain.

It wasn’t until the unrelenting diarrhea prompted him to get a colonoscopy, and a keen surgeon prepping his procedure saw a unique correlation in his symptoms. After countless months of doctors visits and tests and dismissals, he was finally tested for a simple molecule in his blood that had been overlooked.

He received the call before he even got home, confirming his diagnosis.

I will never forget the way he paused, trying to explain what he understood about his condition. “My little baby red blood cells were being killed off the second they left my bone marrow.”

 

“When you hear hoof steps, think horses. These are the patients you see every day: your common cold, pneumonia, a sinus infection. But when you keep hearing hoof steps, think zebras.”

 

 

Cat Feces and Rust-Colored Sputum.

Buzzwords.

This is my favorite thing about medical school thus far.

I have found that the pain of hours of memorizing an be greatly alleviated by the magic of recognizing buzzwords in a question step. Oh, there’s a 25 year old who is presenting with low grade fever, dyspnea, pleuritic chest pain, with RLL consolidation on CXR?

Is the sputum rust colored? Streptococcus pneumoniae.

Does he have a pet parrot?  Chlamydia psittaci.

Oh he’s a farmer? Coxiella burnetii.

But wait – he’s a Missouri chicken farmer? Histoplasma.

This is the funnest part of reading patient presentations and question stems, and really makes me feel like a detective unraveling the case. Applying buzzwords to clinical practice is crucial in preventing key aspects that could lead to a diagnosis. For example, a woman who recently gave birth to a child with microcephaly was suspected to have transmitted a TORCH infection.

Was she changing diapers or sharing drinks with other children while she was pregnant? CMV.

Was she changing the kitty litter? Toxoplasma gondii.

Recent travel to Columbia? Zika virus.

Mice droppings in the home? LCM.

Some of the buzzwords are so distinctive, you could literally pick them out of a question stem, having not read anything else, and get the correct answer:

Fruity, Grape-like odor of a wound: Pseudomonas.

Re-heated fried rice: Bacillus cereus.

Epiglottitis: Haemophilus.

Blue-white center: Rubeola.

Red currant jelly sputum: Klebsiella.

And the list goes on! I have done these “Buzzword lists” for every test in medical school, and they have honestly been a life saver. The best part is, when a patient presents in clinic with “LUQ pain radiates to flank” and you immediately remember your buzzwords to make

your

very

first

diagnosis.

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Unsteady.

Medical school comes in waves, and my muscles ache from swimming.
I usually glide in a routine: wake up at 5, I workout every day, I am on top of lectures and my studies. I am conscious of what I eat, and I find ways to integrate fun and balance. I am bursting with light, energy, happiness, inspiration, and passion.
I don’t recognize myself. I am flailing. I haven’t been to the gym in over a month. I eat anything I can between sleeping or class, I don’t care anymore. I am sleeping more, constantly feeling exhausted. Every drop of motivation has drained out of me, and I’m left staring into the empty bucket wondering where, and when, it will get refilled.