The presentation went just fine, if you except lasting only 30 minutes instead of 45. I always do that when I get nervous; and I hadn’t had time to actually go through the speech once for practice. But the professor kept grinning and doing thumbs-up, so hopefully that’s a good sign. I’m actually glad now I went first, because I don’t have to compare myself to all the other speakers (who incidentally were much funnier, better organized, and more interactive; plus giving references in their handouts!)

At lunch time, by the time I went outside (a beautiful, sunny day), several people were already eating together at a picnic table. I decided I’d rather sit by myself and read, than listen to them. I felt sort of guilty for being antisocial, but I got plenty of their conversation later on, during breaks: such dirty and disgusting jokes as I haven’t heard for a while, on and on, all afternoon. Yuck. So I just got my book out and read it in the middle of the room, and they all teased me. I hate it when I can’t help laughing at a dirty joke; it’s like I consented to the conversation.

One of the afternoon lecturers was a psychologist, talking about behavior modification (ie, getting patients to change their diet, stop smoking, get exercise, etc). He asked what was the most powerful behavior modifier: reward or punishment? Me and the Indian student said punishment, he wanted reward. You see, in modern psychology, you don’t punish a child for wrong behavior, you reward him for right behavior. The other guy and I rolled our eyes at each other, and I asked the psychologist whether he had any children. Lost that one! He has two teenagers. I still don’t believe him. I think kids are too pre-logical-thinking and immediate-consequence-oriented to benefit from purely reward incentives. I know I was. (Plus, that’s what the Bible says: foolishness is bound up in the heart of a child, but the rod of reproof will drive it far from him.)

One thing I absolutely love about this rotation: It turns out I can actually hear heart murmurs and breath sounds. I’ve heard three aortic murmurs, and named them correctly, and have found three people in atrial fib – one that the doctor didn’t recognize right away. There’s something about the combination of having an actual patient in your hands, and knowing that the attending will definitely expect you to get the heart murmurs right. Now I just have to stop prefacing all my reports with, “I’m not really good at this, and I’m probably mistaken, but it sounded to me like. . .” Of course, the fact that I haven’t run across any mitral regurgitation yet, and had to distinguish it from aortic murmurs, also helps. Easier to guess, that way. My goal for tomorrow is to get the attending to let me see if I can figure out what medicine and what dosage are needed for at least three patients.

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