Many More ER Questions and Answers--Part 3

Q: I recently had a pelvic exam in the ER. I wonder if doctors get excited doing them? Wendy

A: Usually not. With the exception of a few sex maniacs such as the doc I previously mentioned, most ER physicians don't relish pelvic exams. In fact, we often dislike doing them. Why? Most emergency rooms I worked in were very busy, and the last thing I wanted was more work. If you're busy, there are some things that can be rushed to save time, but a pelvic exam isn't one of them.

Q: So you never got excited? I hope I don't sound conceited, but I'm really hot, and I don't see how a man could look at me without becoming aroused.

A: If a woman is exceptionally attractive, a doc is bound to notice that. I have. I'm not blind. Out of thousands of pelvic exams, however, I recall only a few women whose beauty was enough to cause reflexive excitement. Being human, a doc can't help that. What he can help is how he acts, which should be no different than when the woman is repulsive.

Q: To tell you the truth, it wouldn't bother me if the doc became excited. During the exam, I thought, "I know you're lovin' it, fella, so why don't you show it?" Instead, he just went through the whole procedure with an expressionless face, like he was a robot or something.

Q: Oh, come on, doc. I can understand why it would be undesirable for a doctor to reveal that he found a woman disgusting, but what's the big deal about fessing up that he thinks a woman is hot in a case in which it's so obvious that she is?

A: No self-esteem problems on your end, eh Wendy? The reason why that doc did not give you the effusive praise you deserve and rhapsodize about your pelvic perfection is because docs don't want to get personal with patients, especially patients receiving a pelvic exam. We want to keep the encounter on a professional level so that patients feel free to open up to us. If a woman thinks a doc is thinking about her in a sexual way, it would make it more difficult for that woman to think of him as a doctor, instead of as a man who is often a stranger, especially in an ER.

Q: I can understand that, but I'm not some uptight chick. I was playfully flirting with the doc, and trying to kid with him.

A: With a seductive patient in such a circumstance, it would be natural for a physician to bend over backwards to project propriety. If he reciprocated your banter, it might be misconstrued by some patients.

Q: Not by me. I just wanted to have a good time. I'm used to guys drooling over me and, frankly, it bugs me a bit when they don't.

Q: Such sarcasm! By the way, I thought about submitting my photo for your "beautiful women in the ER" contest, but I doubt you'd post a nude picture.

Q: I look better without clothes on. I attached two pictures so you can see for yourself. Now tell me that you could look at me naked and not get aroused enough to show it.

A: Such rhetorical questions. Yes, I have libido, but the stress of working in an ER puts my sex drive into a nosedive.

A: Briefly, it is my contention that there are scientific reasons why attractive women are less likely to be emergency room patients. However, I can't think of anything I've done that has been more misconstrued. That may be because the very premise of my hypothesis is so politically incorrect. However, if anyone dispassionately analyzes my conclusions, they will see that I have a point. Several of them, in fact.

A: No. In addition to discussing what I think is an interesting and provocative (albeit contentious) subject, I want good ER stories I can use in upcoming books. Now that I no longer work in the ER, I need submitted stories. I get some from ER docs, nurses, and paramedics around the world, but I also solicit stories from patients, too, and the contest is just one of the ways I obtain stories.

A: I usually don't. The vast majority of stories sent to me aren't submitted for inclusion in that contest, but for the few that are, attractiveness is essential. After all, this is a contest about beautiful women in the ER, not average women or men. I'm not seeking to prove that emergency rooms draw plenty of average-looking women; of course they do, so there is no point in proving that. However, by offering what I think is a sufficient inducement (an award of up to $1000) for beautiful women to retell their ER stories, I think I will be able to show just how infrequent it is that beautiful women are ER patients. Thus, this substantiates the observation I made during my ER career, when it'd be a banner year if I had three pulchritudinous patients. Of course, I usually worked the night shift, a shift that sees more than its share of dregs — of both sexes. In the years since the inception of the contest, I average about one woman per year with any story, and about one woman every two years with a good story. So far, I have a Miss Coors Light who is also a Ph.D. at a prestigious university, a beauty who excited a doc so much that he virtually went into heat, and a stunningly beautiful woman who had a number of ER visits. I also had an entrant who claimed she was a fox, but, alas, no picture, and a few other submissions. In any case, the contest is doing just what I thought it would do: prove my point about how beautiful women rarely go to an ER, and draw attention from male readers. After all, what red-blooded American male wouldn't want to know why Miss Coors Light ended up in the ER? Advertisers often use sex to sell their products, so I'm not breaking new ground here. I rarely use it — certainly far less than 1% of my marketing efforts thus far — so it's not as if I've made this a cornerstone of my schtick.

Q: Did you ever want to be something other than a doctor (either before or after you became one)? Rachel

A: Yes. My first career aspiration (circa age 8) was to be an architect. At 14, my nascent interest in health and nutrition propelled me into reading books on those subjects, which eventually led me to read medical books. In high school, I twice read The Merck Manual, a 2000-page book primarily intended as a synoptic reference guide for physicians. At the time, I did not have enough background to understand everything in it, so some of it seemed like hieroglyphics. Nevertheless, I absorbed a lot of its information, which gave me a fairly comprehensive groundwork for facilitating later learning. In short, it seemingly gave me a knack for medicine. In medical school, there were times when my classmates were struggling, and occasionally a clinical professor would make a somewhat snide comment to other students that they should be more like me, someone who'd obviously read and absorbed the books for that rotation. Little did they know that I was sometimes too busy with my new girlfriend to read the assigned books. However, thanks to my preceding readings of The Merck Manual, I often knew that material, anyway. What's the difference?

In college, I briefly considered other careers, including engineering and working for the CIA. I ruled out the latter career when I learned of its agent mortality rate. Engineering intrigued me (and still does), but I realized that working as an engineer would not be as fun as it is to do engineering on my own. Typically, engineers are assigned a project to work on, whether that interests them or not. I prefer to work on diverse projects of my own choosing, all of which obviously interest me.

In terms of occupational interests kindled after I became a doctor, I've been interested in countless things, but they generally fall into the category of either writing or inventing. The inventions pictured on my web site are just a few of the things I've worked on (and not my best ones, for obvious reasons), but the things I've worked on are just a small percentage of the inventions I've conceived. I think of so many things (sometimes a dozen per day) that it is impossible to develop all of them. I've considered contacting the renowned inventor Dean Kamen, of Segway (et cetera) fame, and suggesting that he hire me. We're both idea factories, but I don't possess a knack for business, like he does. I can easily invent something, prototype it, and produce a working device (even for some highly complex things) . . . but then I fall flat. Marketing and business? Not my forte.

Q: How did you decide what you should do?

A: I cannot recall any one conscious moment in which I decided to become a physician. My interests naturally evolved in that direction. In terms of my other interests (writing and inventing), my impetus to do them stems from a desire to create or break new ground. Breaking new ground is of course at the heart of inventing, but not always writing. However, my primary motivation for writing is to relay information that other authors aren't covering well, or at all. For example, in my two health books (Fascinating Health Secrets and The Science of Sex), I presented many tips that I know readers can't obtain from other books. I read extensively, and some of that material just isn't available elsewhere. In True Emergency Room Stories, I took my gloves off and presented a wide range of ER stories, some of which covered topics avoided by other authors because they want to keep their day jobs. I don't intend to ever work in the ER again, so I had free rein to cover even politically incorrect, inflammatory, and touchy subjects. I'm now working on a subsequent book, tentatively entitled ER Doctor, in which I have many new heated matters, such as paramedics raping unconscious female patients (just the beautiful ones, of course) in the back of an ambulance. Yes, it happens. And, of course, there is your question, and others like it, that I've turned into a book (So You Want to be an ER Doctor?) to help students decide if they want a career in emergency medicine and, if so, how to improve their chances for achieving that goal. Currently, there is no similar book. There are a handful of ones that cover medicine in general, but none that specifically discuss the specialty of emergency medicine. Furthermore, I cover topics that transcend the usual "how to do well in school" tips by discussing how students can improve their memories and even IQ's in a metamorphic transformation, not just a minor incremental improvement. Anyone assiduous enough to follow all my advice will be a success.

She wants me to enumerate the positive aspects of emergency medicine . . . again?
. . . and to discuss the potential for promotion, an average workday, on-call time, and vacation time
A few requisites for ER doctors

Q: Hello. My name is Christine and I am a senior in high school. I have been assigned to create a Power Point presentation on a specific medical profession. I have, obviously, chosen ER physician which is a position that I am very interested in. I have been volunteering at a local ER for one of my school classes as a CNA, and I thoroughly enjoy it. Anyway, I have some questions regarding the basics involved with being an ER doc. I found some answers from reading the other questions, but I still have some holes to fill. These categories are promotion potential . . .

A: Generally, there isn't much opportunity for advancement. Once you're an ER doc, you're an ER doc. You could form your own group and make considerably more money, but there are a number of drawbacks associated with that because medical businesses are fraught with nightmarish regulations, courtesy of the United States government. However, considering your e-mail address/sobriquet, you may live in Australia and hence be immune to these problems.

Q: . . . positive aspects (I've already got the negative ones) . . .

A: I certainly emphasized those, didn't I? :-) My primary reason for doing that is because other authors gloss over them, or ignore them entirely. For example, in The Pfizer Guide: Medical Career Opportunities, there is no mention of the fact that many ER docs are plagued by chronic sleep problems, thanks to the ever-changing work schedules that most of us endure. Instead, they laud the "regular hours." REGULAR HOURS? How can anyone say that ER docs have "regular hours" when they work days, afternoons, and night shifts during the week, on weekends, and on holidays? In most ER groups, the schedules frequently change. I've gone from days to afternoons to nights and back again several times in a week. It's impossible to acclimate to such irregularity. Another problem is indefinite shifts. On any given shift, an ER doc might get out on time (if he is very lucky), or he may have to spend a few hours wrapping up patient care and paperwork. I once worked a 12-hour shift that turned into a 20-plus hour shift. Bottom line? Once an ER doc begins a shift, he'd need a crystal ball to know when his shift will truly be over. Furthermore, some doctors work in more than one ER (as I have), so we must juggle shifts at various institutions. And then there are countless meetings and seminars that interrupt our off-time. In view of this, not even Walt Disney or a fairy-tale author would have the audacity to claim that ER docs have regular hours. For reasons I cannot fathom, many authors writing about medical careers feel compelled to give you an impossibly sugar-coated depiction of those careers, and they're so willing to trivialize the drawbacks, they even turn them into a plus, as this author did! Regular hours? That is preposterous!

Furthermore, The Pfizer Guide whitewashes other problems, too. They don't mention lawyers even once. Now how realistic is that? ER physicians are taught to constantly be thinking of malpractice, and how they can take CYA steps to insulate themselves as much as possible from allegations of that.

The Pfizer Guide also trivializes other drawbacks of emergency medicine. Instead of openly discussing the shortcomings as I have, they instead assert that "the lifestyle offered is an extremely attractive one." I agree that there are some definite plusses to emergency medicine, but there are some unbelievably noxious minuses, too. I shudder to think of how much lithium or Jack Daniels it'd take to wipe the frown off the faces of most ER docs I know, and have them asseverate that "the lifestyle offered is an extremely attractive one."

The Pfizer Guide fails to broach a subject that is well-known to ER physicians, namely how emergency rooms tend to attract a higher proportion of undesirable patients than what is found in the overall population. My ER residency director aptly summarized this problem with the following pithy comment: "ER medicine is scumbag medicine." At the time she told me that, I had no idea what a scumbag is or why serving them can be wearisome. The Pfizer Guide cryptically states that ER docs see "a wide range of patients." Well, sure they do, but that fails to convey an adequate warning of what ER docs actually face.

The Pfizer Guide isn't worthless; it's just worthless in providing a balanced perspective so students can make a fully informed decision that allows them to choose on the basis of facts, not fantasy. On the positive side, The Pfizer Guide briefly mentions a few requisites for ER doctors, such as:

Here is another requisite they did not mention: the need to have tolerance for uncertainty. Medicine is not as black and white as most people imagine. There are countless unknowns and gray areas. This uncertainty is magnified in the ER, where a number of factors conspire to make this job a nightmare for people who can't sleep at night because they're fretting about the nebulous aspects of the last shift. As an ER doc, you can count on the following:

Even if you are the world's best ER doctor, you cannot be certain of everything. You must learn to guess, and wish for the best. I used to hope that by learning enough I could be insulated from the painful uncertainties of practicing emergency medicine. How naive that was! I am imperfect, my co-workers were imperfect, my patients were imperfect, and the medical system itself is highly imperfect . . . and I expected certainty and results that were invariably perfect? What a pipe dream!

Regarding the positive aspects of emergency medicine: believe it or not, but I already mentioned them in other sections.

Q: . . . an average workday (how long, what can one expect to do) . . .

A: Shifts typically range from 8 to 12 hours, although a few ER groups still use 24-hour shifts. With any shift, even an 8-hour one, it's not uncommon to work two or three hours of overtime (usually unpaid) to "clean up" remaining patients and do charting and dictations. As far as what an ER doc does during those shifts, well, imagine just about any conceivable medical or surgical problem in patients of any age. Then image countless unimaginable problems and situations that make you wonder if you're in The Twilight Zone.

Q: . . . on-call time . . .

A: This is one of the benefits of ER, since we're virtually never on-call.

Q: . . . and time off/vacation.

A: As much or as little as you want, or can afford, since you're rarely paid for vacations in most groups. If you work a shift, you're paid; don't work it, you're not paid. No paid vacations, no sick days, no personal days, and no paid holidays. Give the government a few more years, and they'll take away the nifty notepads and pens we get from the pharmaceutical companies!

Q: I know some of these might be different at different places, and I also need at least three different sources. If you know of any other websites or sources that I could use (besides your site) I would greatly appreciate it because I'm not turning up many results.

A: I've yet to see an ER site that is remotely similar to mine. I think most emergency room docs are so burned out that when they're out of the ER, the last thing they'd want to do is to spend hundreds of hours working on an ER web site.

Will attending a technical high school ruin your chances of going to medical school?
Will volunteering help?
Forget about volunteering and do something that will truly impress the Admissions Committee!
Learning to make medical devices at a seminar/workshop

Q: I've wanted to be an ER doctor for as long as I remember. I go to a technical high school and I wonder if medical schools would even consider me? Thanks Kristina

A: In general, medical schools are not interested in your high school. Their primary criteria are college grades and MCAT scores. As long as your high school grades are good enough so you're accepted into college, that is all that matters. If high school grades mattered, I never would have been accepted into medical school. I obtained all A's my last two years of high school, but my freshman and sophomore grades were highly unimpressive.

Q: Also, I do volunteer service at area hospitals. Would that look good for getting into med school?

A: It's a plus, but a minor one. Most people who wish to attend medical school are looking for something to give them an edge over other applicants. Everything else being equal, you're better off volunteering than not volunteering. Volunteering is good because it demonstrates initiative and the desire to "get your feet wet," but it will not significantly help you because it is very common amongst medical school applicants; hence it cannot do much to make you stand out from the crowd. In all of the emergency departments in which I worked, volunteers had very little contact with patients. Instead, they performed chores such as retrieving charts from the medical records department, running specimens to the lab, bringing food from the cafeteria, or performing miscellaneous errands. Now for a rhetorical question: should medical school Admissions Committees be impressed by these activities?

Let me cut to the heart of the matter. Given that there are only 24 hours in a day, you can't do everything. Most volunteers that I knew spent a considerable amount of time in the ER — that's time they could not spend doing other things. While volunteering is a minor plus if you do it in lieu of nothing, it can actually be a negative if you do it in lieu of something that might truly impress the Admissions Committee, such as building a new medical device (as I discussed before). If you walk in for your interview with an innovative device that you made, the Committee will think you're a freaking genius, and you're virtually assured of being a shoo-in for admission.

Most people harbor the notion that building electronic devices is incredibly difficult and requires years of training. Not true. Thanks to integrated circuits (IC's or chips), building things is easier than ever. When I got my start in electronics, it was common to build devices with discrete transistors. That was fine for simple things (such as radio receivers or transmitters), but it was challenging to build complex devices. When Radio Shack (my primary parts source at that time) de-emphasized transistors to provide room for their new line of IC's, I first lamented the switchover because I hadn't the slightest idea of how to build things with chips. After thumbing through a few books, including some of the Radio Shack circuit "cookbooks," I realized that using IC's was even easier than using transistors. I could plug a chip into a breadboard, add a few external components (e.g., resistors, capacitors, LED's, buzzers, etc.), and connect wires as instructed in the "cookbooks" (so-called because they're just as easy as following a recipe in a food cookbook). In anywhere from a few minutes to an hour, I had a working circuit. Think of one circuit as a building block. By simply combining various building blocks, you can easily build very complex circuits just by wiring one to another. To make a finished device, you usually make a prototype of the circuit on a breadboard to verify that everything works, then design a printed circuit board pattern that replicates the circuit connections. There are many ways to do this. You could simply draw on a piece of copper-coated circuit board stock using a special "etch resist" pen, or you could use rub-on dry transfers to do a much neater job. You can also use Windows PaintBrush (called Paint in Windows XP) to lay out the circuit pattern. Using a laser printer, print on clear film, then place this over photosensitive circuit board stock and expose it to a source of ultraviolet light such as a tanning lamp or even just sunlight. After exposure, swish the circuit board in a developing solution, rinse it, then place it into etchant that removes copper from undesired areas. What remains is your original pattern that you printed out. Drill holes as needed to accept leads from the components (this step isn't required if you use surface mount components), place them on the board, and solder into place. Add a case, some switches or LED's as needed, a battery, and you're finished. That's it! A working circuit!

In anywhere from a few days to a few weeks, you can go from being clueless about electronics to producing working devices. I had some courses in electronics in high school and college, but the subject matter was theoretical. Those classes did not teach me to make devices; I learned that on my own. Hence, you don't need electronics classes to make things. It helps, because that knowledge will enable you to design circuits from scratch (as I later did), but it isn't essential. Hence, this stuff isn't rocket science. However, few people do it (and understand how easy it is!), so it retains an air of being difficult and esoteric. Admissions Committee members will probably yawn if they see you've volunteered, but their jaws will likely drop in utter amazement if you make a new medical device. Remember, your goal is to stand out from the crowd, not be just another cookie-cutter applicant.

The most difficult part of this process is conceiving the idea, not making the device. However, you don't need to have Edisonian genes to invent something. Necessity is the mother of invention, so thinking of a new device often spontaneously occurs when you think of a problem that needs solving. Or, if you're still stumped, ask some physicians for things they'd like to have but are not yet available. You're bound to obtain some nifty ideas.

In this discussion, I assumed that the device you make would be electronic because most gee-whiz devices are electronic. However, some of my inventions were mechanical devices. Some were complex, but others were very simple. Therefore, you can make something even if you're convinced that making electronic devices is too difficult. Probably the simplest invention I made was a new type of finger splint. It required plastic, but no tools. It could be made in less time than it takes for an average television commercial.

If you make such a simple device, the way you present it is important. Don't just whip it out and say, "Here's a new finger splint I made." Before you show it, describe its advantages over existing splints. Here is an excerpt from my web site that describes my splint:

So what is wrong with the traditional aluminum/foam bar splints used in most emergency rooms? Gee, where do I begin? Those splints have sharp edges, they're easily bent out of their correct shape, their foam acts like a magnet for dirt and germs, they're bulky, and they don't do a good job of maintaining precise alignment of the finger during the healing process. Oh, and they're ugly, too. Other than that, they're fine.

My splint is made from a plastic material that can be quickly (within seconds) molded to fit any finger. Once formed, it is very rigid, providing excellent stability (including lateral stability, which is a weak point for aluminum bar splints), but the splint is very comfortable to wear. I don't know why, but my finger feels better with the splint on than with it off—it's that comfortable. It has no sharp edges, it is much less bulky than a bar splint, and the plastic inherently repels dirt (if needed, it can be quickly rinsed). The only drawback is that it can trap skin moisture, but that problem is easily solved by punching a few holes in it to allow the skin to "breathe." These holes do not substantially detract from the strength of the splint (engineers often purposely design holes in many different structural elements to lighten them).

Hence, you should enumerate all it advantages, then show the device. While the splint is not complex, it is still impressive because it's a heck of a lot better than the traditional aluminum/foam bar splints. Because my splint assuredly maintains more exact alignment, healing is quicker and more precise. That's good for patients. So would an Admissions Committee member yawn just because the device isn't complex? I doubt it. Anything that advances medical care is bound to impress them. And if you impress them, you'll get into medical school.

Let me know if you (or anyone else reading this) is interested in attending a seminar/workshop in which I demonstrate how to make devices, and then give you hands-on instruction as you build things. I know that most premed students aren't rich, so I won't charge you an arm and a leg. If enough people are interested, I'll host this seminar at various times of the year to make it convenient for you to attend. If you're interested, contact me via this page: www.MySpamSponge.com/send.php?handle=erdoc I live near Traverse City, Michigan, which is a great spot for a seminar because it's a beautiful, upscale tourist area. However, I will travel to your area if you recruit enough participants.

A premedical student on an emergency medicine Internet discussion group asked for advice on getting into medical school. Here is my response (please pardon the fact that some of this repeats what I just said):

On my web site I have numerous tips for enhancing memory and brainpower to augment academic success. I also discuss a fairly novel way for a medical school applicant to set himself apart from the crowd: to invent and make an innovative medical device. That's bound to make an applicant stand out. First, let me dispel a few myths: making electronic devices isn't rocket science. I've made dozens of medical devices, ranging from pocket phonocardiograms and echophonocardiograms to noninvasive cardiac output monitors, intubation detectors, foreign body detectors, etc. A few of my devices are posted on this page.

On to the next myth: people often assume that most of the good ideas have already been thought of, and they don't stand a chance of developing anything new. Not true. You're probably far more creative than you imagine. Also, we're not nearly as advanced as we sometimes think. At any given time, people tend to be overly impressed with the current state of the art in medicine. To gain some perspective on this, you might want to read some actual newspaper and magazine articles from a century or more ago. I did that as an undergrad, and it helped me understand this tendency. I think people have an innate need to glorify the current medical technology and knowledge base, because that helps mitigate their fear of disease and death. In any case, we're not in the Stone Ages, but we have a long way to go before we know everything. And won't that day be a sad day for the malpractice attorneys! :-)

Next myth: it takes a fortune to develop electronic circuits. Not true. Most integrated circuits, transistors, diodes, capacitors, resistors, and whatnot are dirt cheap. You can spend more money on a meal at McDonald's than you can on some circuits. I think the most expensive circuit I made was the one for the echophonocardiogram, which combined a pocket electronic stethoscope with a digital filter along with a phonocardiogram and an echocardiogram. The cost for this was about $110, but most of this was in the case, lithium batteries, and precision Swiss gear motor used for driving the paper. In any case, $110 is a drop in the bucket compared to the total spent by medical school applicants.

Next myth: it takes a long time to develop circuits. Again, not true. A prototype circuit can be whipped up in anywhere from a few minutes to a few days in most cases, and making a finished device with a case and printed circuit board usually takes a few days to a week. Learning how to make circuits might take a few months, but many medical school applicants will think that's a small price to pay for something that will give them an edge over other applicants. In my experience, most docs are enamored with gizmos. If you can show one that you've created to the person who interviews you, you're almost bound to be a shoo-in.

Review of
TRUE Emergency Room Stories
by Kevin Pezzi, M.D.
Book info Ordering info

Now available as a free e-book download

What really goes on in emergency rooms? If you're a fan of the television show ER, you might think that you know. Not so, asserts Kevin Pezzi, M.D., an ER doctor and author of True Emergency Room Stories. Pezzi says the show ER only scratches the surface; the truth is far more interesting — and bizarre. So bizarre, in fact, that the cases could shock even an experienced ER physician. "I'm now a firm believer in the saying that truth is stranger than fiction," he says. "I don't think that anyone could dream up such unusual stories."

Pezzi's book is packed with nothing but unusual stories. There are no "the patient's in v-tach, shock 'em with 200 J and give 'em 100 mg of lidocaine, stat" type of cases. While such cases are a mainstay of the show ER, Dr. Pezzi believes that they quickly become repetitious. Instead, he presents an amazing collection of true stories. The book begins with a story of how he may have saved Michael Jackson's life by averting an assassination attempt by a person who claimed to be a Cosmopolitan cover model, and ends with an interesting tale of how he was propositioned on a beach by a relative of a recent ER patient. In between, he recounts stories of unusual murders and other crimes, truly odd reasons for dialing 911, unfathomable reasons for visiting the ER, and people with an extraordinary affinity for their pets. Then there's a shocking end to a pregnancy, a twisted tale of revenge that would be a spellbinding plot for a movie, and the story of a man who attempted to remove his liver at home.

In this book, you'll accompany Dr. Pezzi as he meets the world's unluckiest man and woman, deals with people who have strange requests, and attends to a bride whose genetic disorder wasn't discovered until her wedding night. There is also the story of the man who didn't know that he had been shot in the head, and the case of the pit bull who picked on the wrong person.

True Emergency Room Stories has something for everyone. Besides the strange cases, readers will be captivated by dozens of incredible, tragic, humorous, steamy, heartwarming, thought-provoking, and poignant tales.

Q: Hi, my name is Ashley and I go to school at Michigan State. Do medical schools look down upon students who struggled their first year in college?

A: Unfortunately, yes. Did you see my discussion of "the Lucas strategy" on my web site?

Q: Also, what kind of community service or jobs should I look for in college?

A: If you are now struggling academically, forget about community service or working — just focus on your studies and improving your grades.

Q: I have a hard time concentrating. I mean all my friends study for like 15 hours a day and I can only study 2 hours at most. Is something wrong with me? Please write back soon. Ash

A: I had the same problem. I could usually concentrate for just a few minutes before I'd begin daydreaming. I have some questions for you, so I can understand you better and therefore be of more help to you:

1. Do you consume caffeine (coffee, tea, caffeinated beverages, etc.)? If so, how much? For how long have you consumed caffeine?
2. Do you enjoy school? It's OK to admit that you don't, if that's the case. I love learning, but I hated school. Of all the lectures I had in college and medical school, there were only two that I enjoyed. The rest of the time I had to force myself to concentrate and study, and that made it very difficult.
3. Do you sleep well? Is the room you sleep in totally dark and reasonably quiet?
4. Are you taking any medications (prescription or non-prescription)? Any street drugs? Any herbs?
5. Have you tried studying in alternative environments? For example, I had an easier time studying if I didn't do it at the library or at a desk. I'd sometimes drive my car to a pretty spot, or drive my family's tractor out into the woods, sit on it, and study.
6. Do you eat well?
7. Are you generally happy and content?
8. How was your concentration in high school? Did you have an easier time studying then?
9. Do you exercise? If so, what type and how often, and for how long?

Q: Dear Dr Pezzi,
Thank you for writing me back so quickly. The chem course I took was an introductory course (it isn't a required course for med school). Should I just go ahead on to the next chemistry? I made a D in History; should I take that over in summer school?

A: It doesn't matter if the course is or is not a medical school prerequisite; it will appear on your transcript, and the Admissions Committee will see it. Taking a course over, and acing it, is certainly better than letting a poor grade stand, but since the original grade will also appear, this will still be a black mark on your record. Given the mind-boggling pace of medical school, Admissions Committees must select people who can master material on the first try. I am not saying that you can't, but a transcript showing a few poor grades that improve on retaking a class will give the Admissions Committee some concern. If you do this a few more times so it becomes a pattern, your chances of acceptance will plummet.

In your last e-mail you asked, "Do medical schools look down upon students who struggled their first year in college?" This led me to believe that you may have had problems in classes besides the two classes (chemistry and history) you specifically mentioned. If you aced your other classes, I wouldn't worry too much about two bad grades. However, if your other grades were lackluster but not poor, I think you should think about the Lucas strategy before you invest any more time into a transcript that will likely end up in the Admission Committee's rejected pile. Your freshman year is a big chunk of what the Admissions Committee will see. Unfortunately, you need something that doesn't exist: a crystal ball. If you could see into the future and know that you'd ace everything henceforth, then a bad first year might not totally destroy your chances. However, you'll need to perform considerably better than most other applicants, since the transcripts of most successful applicants show a consistent pattern of high grades. Given that most successful applicants have high GPA's, it won't be easy to do much better. Basically, you must obtain virtually all 4.0's from now on. If you could tell me the grades for all your freshman classes, I could give you my opinion on what you should do. It is difficult to make a recommendation when I am just guessing about most of your grades.

Q: I am a walk-on for the MSU women's basketball team. So my time is limited and I have to cram practice and studying in. If you have any advice, I'd appreciate it (the premed advisors are not that great here). Well Merry Christmas and have a happy new year. Ashley

A: Do they give you a scholarship? Unless they give you some irresistible reason to participate, or unless you love basketball so much that you're willing to let it ruin your chances of becoming a doctor, I'd resign from the team.

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