A Much Needed Rest

I'm going to keep this brief (for real this time).

I just got home from my second exam in CSF, the completion of which marks the beginning of my two week winter vacation!!!! Now, I've obviously had breaks like this before; I've been through demanding courses, taken big exams. I've even had whole weeks of tests for undergraduate finals. Yet I can honestly say that I have NEVER felt this excited, grateful, and utterly RELIEVED to go on break before today. Like the almighty Atlas on the day the Earth comes to an end, I feel like a huge weight has been lifted off my shoulders. These last few weeks in CSF have been long and exhausting. We started in on biochemistry during the latter portion of this block; while it was definitely nice to get back into familiar territory (this was the first time since the start of med. school that we have studied something that I have learned previously), the sheer extent of information was vastly overwhelming.  The material that we covered during the first two days of the biochemistry section--that's a total of just eight hours of lecture--was literally equivalent to what I learned in an entire 10-week term during undergrad. And that was just two days. We had another week of biochemistry to follow, not to mention the week and a half of histology that we had already suffered through. My head has never felt so jam-packed with cell types, tissue features, enzyme reactions, etc.

...But it was fun. And I'm super excited to be studying biochemistry (which we will cover exclusively in this class from here on out). And so far, I've been impressed with how much I have forgotten, but ASTONISHED with how fast it has come back. Next block is going to be another intense one, but I'm looking forward to it. But for now, all I'm looking forward to is a wonderfully relaxing two weeks of relaxing, reading, snowboarding, eating, video games and family time. Speaking of family, I'm just about to kick it all off by heading over to Mom/Dad's for what will surely be an incredible movie night. Could this get any better? ...Wait, what? IT'S ALMOST CHRISTMAS?! Why, that's my favorite holiday! And you brought me eggnog? You shouldn't have! And, are those cookies I smell my roommate baking this very moment? They most certainly are! Man... Life. Is. Goooood.

Life is Like a Box of Prostates...

We kicked off the new term in PCM last week learning how to perform breast, prostate and gynecological exams. They started off the class informing us that we would not, in fact, be practicing on each other as we had when learning previous physical examination skills (oh what a shame). Instead, we would use a series of very expensive, somewhat lifelike models.

As if performing these exams on lifeless, fleshy-plastic figurines wasn't weird enough, the models had a particular feature (or lack thereof) that made the experience even stranger: they were completely cut off both above the waist and below the knees, like some Old Navy commercial gone horribly wrong: "OK, Bill, put the cute dog with the Christmas sweater over there, aaaand let's go ahead and have the talking mannequins stand right over here, right next to the running wood chipper. Yeah, yeah, right there. Perfect.".

It was really quite the sight. The classroom was filled with these truncated teaching aids--dismembered, yet strangely anatomically correct--on which we spent the good part of an afternoon performing finger-orifice explorations. In addition to the models, we had some other fun learning aids as well. At one point we passed around a single, fleshy, lifelike breast in order to practice feeling palpating ("now I'm going to feel your breast, ma'am") for lesions. There were six lesions total in this particular breast model; we were instructed to employ to the aptly named "lawnmower" pattern in order to ensure a thorough examination (gotta catch 'em all!).

But my favorite part of this is-this-seriously-happening-in-real-life? afternoon wasn't the shaming of pelvic amputees; nor was it the disembodied breast, the dangling testicles, or even the bag of scrotums (about which our professor actually said: "hey, you don't happen to have any scrotums over there, do you? Oh, you do? Great. Could you toss me one"). No, in thinking back, my favorite part of this laughably educational day was, without question, the box of prostates. It was a small, white box, housing six heart-shaped prostates of various sizes, colors and consistencies. At first glance, it might even have been mistaken for something one might receive as a Valentine's gift, or perhaps as a token of apology after a particularly distressing argument. In fact, the over-sized, discolored one (prostate #4, I believe) even had a light-brownish tint to it, giving it a distinct caramel-like appearance (dulce de próstata, anyone?).

They were arranged in neat little rows--the prostates, I mean--each more interesting than the last. And so we passed the box down the line, taking our turn at trying to commit to haptic memory the difference between the feel of spongy, healthy prostate from that of hypertrophied, tumorous one. And though I will likely soon forget these tactile distinctions, the memory of this ridiculously outlandish day will forever remain. In fact, I'm sure it has already been stored safely away in my memory vault--filed appropriately under "P", for prostate--right along with other favorites like M:milking bowels, D:disarticulated heads, and S:skullcap removals. 

But never fear: I was sure to leave some room in the vault for the many more wacko, mysterious adventures that are surely to come. For if my medical education thus far has taught me anything, it's that life truly is like a box of [prostates]: ya really never know what you're gonna get.
 
Let's just hope it's not cancer. ...Or coconut.

Health Care Haiku #2

Haiku number two, for you (woo hoo!)...

Histology lab:

where else could you hear things like,

"Hey, hand me that (non-keratinized, stratified squamous epithelialized) skin"

Med. School Antics, Issue #1

Why, yes, I have been working 
out my gastrocnemius!

Ooo, that is a nice leg, you might say.

The Cut of His Jib

I know what you're thinking. And yes, I agree. I have been slacking off in my self-proclaimed duty to provide you, my readers, with unparalleled joy and entertainment in an otherwise mundane world. Believe me, I understand the melancholy you have felt while sitting at your computer, day after day, hour after hour, staring hopelessly at an ever-unchanging screen as you lackadaisically hit the refresh button, again and again, over and over to no avail. And for this, I am sorry. I have failed you as of late in my prolonged literary absence. And yet, I returned to you today in order to make amends, to rectify this injustice and to attempt to once again instill in you the sense of wonder and exultation that is my everyday life.

...Unfortunately, since I have just used virtually all of my oh-so limited time in composing the preface to my story--which was, dare I say, the literary equivalent to a finely-aged cheese (or, better yet, a properly cooked tuna melt)--I am going to have the keep this brief. So, here is an abridged summary of the last few weeks of my life. I apologize to those of you who have spoken with me recently: much of this will probably be old news (so hopefully you all find reviews as necessary, if not titillating, as I do).

1.  Gross Imagining and Embryology, the first course of my medical career, came to an official end a few weeks back. I don't have too much else to say about this, though I would like to describe for you one final laboratory experience. As you will understand momentarily, failing to tell you this little anecdotal gem would be an absolute detriment to your personal well-being, an injustice for which I refuse be held accountable. As for those less fortunate individuals who, for whatever inexcusable reason, lack access to my blog, I can only pray that they take refuge in some other source of literary enlightenment.

...But again, I ramble. On to the story. 

So, following Disarticulated Head Day*, we continued with the horror-fest some call learning anatomy. Being the sane people that I know you all are, you are probably wondering what further abhorrent experiences they could possibly subject us to now that the cadaver's head was practically detached from the body. Well, sanity, it seems, is not a prerequisite for medicine. We were next tasked with exposing the nasal cavities via a "bisection of the head." ...Let me elaborate. For this dissection, we split the cadaver's face in two with our choice of, and I quote, "a butcher’s saw" (I can't make this stuff up) or "a short bone saw." Now, for those of you who haven't had the pleasure of using a butcher's saw, let me describe it for you. It pretty much looks and functions just the way that it sounds: like a freakin' meat cleaver with teeth.

After selecting our weapon of choice (my group decided to go Paul Bunion style with the simple bone saw), we proceeded to cut through the face. Now, when I say cut, I don't mean cut as in using your steak knife to slice up a tasty summer sausage (an activity much better likened to our genitalia dissection), I'm talkin' 'bout 2-man, back-n-forth, heave-ho, jeans and plaid, lumberjack style sawing. Except, you know, through a human face.

Then came our final laboratory exam. As I'm sure you can imagine, after the final few days of dissection, identifying facial structures was no easy task. What we were left with hardly looked like anything, let alone a human face. I wish I could find the words to adequately describe the sheer mess that we were left with on exam day. Suffice it to say that the first step of every structural identification involved trying to find some sort of discernible landmark--a nose, a tongue, perhaps some teeth, if you were lucky--and ultimately guessing at  how far the structure had been displaced from its proper place of origin.

And just like that, it was on to our next class: Cell Structure and Function (CSF)!

2.  Well, since my first story got a bit out of hand, I'll try to keep the rest of these brief. Thus far, CSF has been an interesting change of pace. This class (along with all of my medical school classes from here on out) necessitates a completely different style of studying, a change which has been somewhat difficult to get used to. The material is just SO different. Not to mention the teaching styles, and even the course layout. For the first two blocks, we mostly focus on histology--the microscopic study of tissue. Although the lecture material is pretty dry, the labs have been fairly interesting. We are learning to identify different tissue/cell types under the microscope, which essentially comes down to trying to differentiate between a pinkish-purple blob and a purplish-pink dot. Simple, eh?

3.  I got to play doctor during my first OSCE (Objective Structured Clinical Examination). OSCEs are once-a-term tests of clinical skills; they require us to take histories and perform physical examinations on various standardized patients. It's a pretty cool idea (they have an entire building setup for clinical practice and examinations), and was actually fairly fun, though one of my cases ended up going really poorly. I feel that we were not at all adequately prepared to deal with that particular case, so I'm still a bit frustrated about that. Oh well.

4.  I start my new preceptorship next Tuesday. This time I will be working with a neurologist. I'm pretty excited to get started and see what will come of it.

That's it for now. Updates will be posted as they (and I) become available. In the meantime, I hope that I have temporarily satiated your lust for my written word. Adieu!



*To clear up any undesired confusion, "Disarticulated Head Day" does not in fact refer to some obscure national holiday, but rather to a previous blog post about one of my stranger experiences to date (see "An Ode to H.P. Lovecraft").

An Ode to H. P. Lovecraft

Here is the actual text from the instructions for today's lab:

"Today there are two dissections. Most tables will dissect the suboccipital region - a few tables will detach the head from the vertebral column."

Ahem.

Only a few tables? Oh please, please, please, please!

*Dramatic pause...*

I'm happy to say that my table was indeed one of the few, the proud, the....macabre.



So, we started off the dissection by

...On second thought, this really needs no further explanation.

Brains, Eyeballs & Mangled Faces: A Halloween-Themed Week in Med School

Those of you who read my previous post are privy to the fact that Tuesday's dissection was, well, epic. Human scalping (I actually forgot to mention this part), skull removal, brain adoration; essentially a day filled with revelry and stupefaction. After a day like that, the rest of the week must have been unbearably mundane, right? WRONG. Imagine my surprise when, upon arriving to lab on Thursday, I found myself in for yet another wonderful anatomical treat: the eye dissection.

Now, as many of you know, I absolutely LOVE the brain. Neuroscience was pretty much my passion during undergrad, and I continue to maintain an emphatic interest in the subject. However, I'd be outright lying if I said that the eye didn't have its own special place in my heart; if the brain is my high school sweetheart, the eye is my secret love affair. So although Thursday's dissection wasn't quite as thrilling (we don't have quite as much history together), it was still a remarkable experience. So here, back by popular demand, is another abridged* summary of lab-day events:

Step 1. Remove eyelids
Step 2. Deflate eyeball
Step 3. --
Step 4. Oh, yeah... It's probably going to squirt... Sorry about that.
Step 5. Remove Eyeball
Step 6. Check it out, man!

**Duh nuh nuh nuh! You've found a lens implant! These can be used to replace an old/faulty lens to correct for age-related vision loss. It has been added to your inventory.**

Step 7. Rejoice, marvel, revel, etc.

Awesome. End of story.

Story two: begin. We had the absolute COOLEST lecture on Friday. Throughout GIE, we will occasionally have guests give "Clinical Correlate" lectures, which are presentations that connect what we've been learning in anatomy to actual clinical medicine. This often includes surgeries/procedures that require the use of specific knowledge pertaining to the area we are studying at the time. Some past lectures have covered such topics as colorectal and urogenital surgeries, sports injury repairs, etc. Though these lectures have always been nice in that they provide a sense of context for the material, they haven't been particularly thrilling until now. But THIS week, oh man.

The lecturer this week, an absolutely hysterical, animated plastic surgeon, gave a halloween-themed presentation on facial reconstruction surgery. I have to say, the things these surgeons can do are absolutely unbelievable. He talked about reconstructing a patient's ear by tracing out a template and using cartilage from their ribs. He lectured on laparoscopic (minimally invasive surgery by camera) skull repairs. He described replacing a girl's scalp who had gotten her hair caught in farm machinery. He even told us about reconstructing AN ENTIRE FACE for a man who, in desperation, had shot himself with a shotgun. Un-be-lievable. And of course, along with the lecture, he provided us with ample, gruesome (perfectly appropriate for Halloween) pictures and videos of the procedures. What a perfect ending to a delightful week of fantastical anatomical exhibitions.



*NOTICE: Some artistic liberties have been taken. Events may have occurred slightly differently than portrayed.

A Brain in the Hand is Worth Two in the Head

Last Monday marked the beginning of the end (of anatomy, that is): our fourth and final block has begun. So far, this final block has proven to be fairly difficult in terms of the material. Having exhaustively covered the upper limbs and back (block 1); the thorax, abdomen and pelvis (block 2); and the lower limbs and perineum (block 3); we now find ourselves slogging through the head and neck, a rather complex set of structures confined to a comparatively meager area of the body.

As a rule in GIE, up until block 4, the heads on all the cadavers remain covered; they like to give everyone plenty of time to get acclimated before uncovering the face, seeing as it tends to affect people the most profoundly. But now it has come time to start in on the head and neck. Therefore, two weeks ago, during our first lab session for this block, we began the dissection by removing the head shrouds. Prior to this point, I had thought quite a bit about what uncovering the head would be like, wondering just how much it might affect me. I knew I would be able to handle it, but figured it would likely be a powerful moment, just as the very first day of lab--what now seems like decades ago--had been. As it turned out, although it certainly elicited some strange feelings for a moment or two, I ultimately found myself largely unmoved. I think this was partly because the face, preserved as it was, looked rather fake; unhuman. Beyond that, it seems that the whole lab process has been rather desensitizing: I've become so accustomed to the (intimate) exploration of my cadaver, starting in on the head just seemed like a perfectly normal next step.

And that step led us one closer to the finish.

I have to say, with our final anatomy exam a mere 1.5 weeks away, I am thrilled that the light at the end of the optic canal has finally come into view. Although I have truly enjoyed many aspects of the course, and it has certainly been an undeniably unique experience (as those of you who have stuck around for the ride know full well), I am desperately looking forward to moving on. I am tired of having to shower twice a day. I am tired of the unrelenting olfactory assault. I am tired of memorizing origins and insertions and the names of every single canal and fossa and hiatus and condyle and fascial layer known to man. I'm ready for to get back into the familiar, conceptual territory of biology and biochemistry.

...Then again, a few weeks from now, when I'm drowning in metabolic cycles and cellular signals, I'm sure I'll be begging to go back to the simple, straightforward material that so vexes me at the moment. So it goes.

But then again...again, this block also has some pretty sweet perks. How so, you ask? Please elaborate, you request? Just get on with it already, you vociferate? Well, if you insist.

Here is an abbreviated version of my lab instructions for Tuesday:

Step 1.  Remove the skullcap
Step 2.  Yeah, keep trying. This may take a while. I'll wait.
Step 3.  ...

Step 4.  Got it? Great. 
Step 5.  While you're at it, why don't you go ahead and take the brain out, too?

Step 6.  Hold brain in hand, admire it in all its brain-y glory
Step 7.  Rejoice

That's right, folks. You heard it here first. Tuesday was skullcap and brain day, the highlight of anatomy lab. It was glorious.

Days Like This Must Make My Parents Proud

I had relaxing, study-free evening yesterday following our second exam. I ate some comfort food (Mom's famous homemade mac 'n' cheese)...watched a little TV.... It was nice.

Today we jumped right into the dissection of the anal triangle.

...What a strange life I lead.

A day in the life...

Yesterday we were tasked with the exploration of the pelvis, an area both complex and elusive to even the most seasoned anatomist. Gaining access to the depths of our cadaver's pelvis meant snipping off the distal bowel and moving it to the side. Now, I know many of you--my fine readers--are thinking this to be a simple task, wondering quietly to yourselves as to why I would I would even bother to bring this up in passing conversation, let alone devote an entire blog entry to such a paltry matter. And you would most certainly be correct in your oh-so-naive assumption, were said bowels not filled, packed, dare I say SATURATED from end-to-end, stomach-to-rectum. With what you ask? Oh, don't be silly. You know just as well as I do that you could have identified the contents with one hand haughtily behind your back (and the other humbly upon your nose).

So there we found ourselves, the anatomical adventurers that we are, face to face with a task: to (and I quote) "milk" the fecal matter up the colon and away from the rectum--all the while praying that it didn't travel out the other end in the process--in order to establish an empty area in which to make our cut. Seeing as we were all udderly lacking in farmacological experience, we took turns milking as best we knew how. Next we tied (make that double tied) knots on either end of the "oh-man-I-hope-we-got-it-all" newly emptied region. At which point, after significant deliberation, perspiration and condemnation (and perhaps a little anxious micturation), it was finally time to separate the men from the boys, the colons from rectums. So, like the obliging mayor at a grand opening ceremony, I boldly stepped forward to make the cut. The only difference--whereas our friend the mayor might find himself rather embarrased upon missing the ribbon, I was praying to avoid it at all costs. Also my scissors weren't quite so big.

In the end, I'm happy to say that my aim held up and the crisis was averted. We got through the whole process with what I like to call "minimal leakage". Another day, another lesson learned (though I'm not quite sure what it was), another task completed. Digging in fat, suffering through ever-evolving odorous assults, and milking voluminous bowels. All in a day's work.

Elective Procedures

Since I have so much free time these days, I decided to go ahead and sign up for a "medical Spanish" elective. They typically offer the course at three different skill levels: advanced beginner, intermediate, and advanced. This year they were unable to offer the advanced level course, so only the first two are available. I just got home from taking a placement test to make sure that I am qualified to enroll in the course, and to find out which course is appropriate for my abilities. After a brief oral test (I also took a written test, but he hadn't even looked at it), the instructor told me that I am probably qualified for the advanced level, albeit "weakly" so, but definitely a solid candidate for the intermediate class. I was actually under the impression that I had performed pretty poorly, so I think with a little (or a lot) of practice, I should be able to do ok. I was pretty amazed at how much I had forgotten, though. Very basic words on the written test--like "green"--totally eluded me. I'm a little apprehensive about enrolling in the intermediate course; whereas the advanced beginner course offers a review of grammar and terminology, they skip over it entirely at the intermediate level. On the other hand, I think I will get a lot more out of the intermediate course, so I  think I'll go for it. I may simply have to put in a little more work. The class meets weekly from 6-8pm on Wednesdays. Unfortunately, Wednesday is also the day that I have PCM from 1-5pm, as well as a lunchtime meeting from 12-1pm, so I will essentially be in class from 8am-8pm, excluding a 1 hour break for dinner. Eek!

There are also a few other electives I'm considering taking, all of which take place weekly from 12-1pm on various days. One of them is called Global Health Talks and is simply a series of lectures on various topics regarding global and public health, disaster response, etc. I've recently become very interested in medical opportunities abroad (since my trip to Costa Rica/Panama, really), so I think this would be a great elective for me to take. There's also another one called "Specialty Talks" where they highlight a different medical specialty each week and have a panel of doctors specialized in that field provide info on their career. This one is great for people who are totally clueless about what area of medicine they want to pursue, just like your friendly neighborhood blog writer, yours truly.

I think it's really important to be involved outside of simply taking classes, and there are already so many great opportunities to do so; it's too bad I don't have the time to explore them all.

Health Care Haiku #1

Please enjoy the following haiku that I wrote:

Anatomy lab:

where else could you hear things like,

"Hey, hand me that skin"

CHAPTER 2: Over The First Hurdle, Onto The Second Lap

Monday was my first med school exam. We have four exams in GIE (anatomy) over the 11-week course, one for each of the 4 blocks. Each exam consists of a written portion and a practical (lab) portion. The written is multiple choice. For the practical, the course instructors "tag" different structures on the cadavers and we have to identify specifically what they are. During the exam, we rotate through different stations, each one containing a single tagged structure (to tag a structure they simply loop some string around it or stick a pin in it). We had something like 100 seconds at each station, and then we had to switch. After everyone had been through all the stations, we had half an hour to revisit whichever stations we needed.

I'm a little disappointed in how the test went. I haven't gotten my grade yet, but I know I didn't do as well as I wanted (or, more importantly, as well as I know I should have done based on how much I studied and how well I know the material). The practical was a lot harder than I expected. I've heard several other students say that as well. Also, I made a mistake with my approach. I was too ambivalent/unsure with my answers. I ended up with way too many stations to revisit at the end. Half an hour seemed like it would be more than enough time; I thought I would even be able to go back through and look over all my answers. But I ended up not being able to check over many of the ones I wanted to revisit, and not giving myself enough time to think about the really tough ones. I'll definitely be adjusting my strategy the next time around.

As for the written portion, it was really straightforward, and actually really easy. I'm confident that I did well. In fact, it turns out I definitely over-studied for the test in general. I think everyone did. Most of the exam consisted of broad, big-picture type questions, where I had learned the material down to the specific details. So this begs the following question: do I scale back my studying and enjoy life a bit more, or do I keep going full force, trying to perform the absolute best that I can? I think I'll wait to see how I did on this exam before I decide. I had really hoped to score super well, but I know that didn't happen this time around. So if all that extra effort is just going to be wasted, I think I'd rather live a slightly less stressful life (while I still can--I'm told anatomy is the easiest course I will be taking).

Overall, the whole test experience was exciting but exhausting, lasting an insane 4.75 hours (with a 15 minute shovel-some-parfait-in-my-mouth-while-putting-on-my-pants-and-running-from-lab-to-the-lecture-hall "snack break" in the middle). And now, the day after a huge exam and an intense weekend of studying/preparing, we're getting right back into it with block 2. ...And so the marathon continues.




Oh yeah, so today in lab, I totally used a bone saw to cut through some ribs, peeled back the thoracic cage/wall, and took a look inside the chest cavity. ...No big deal.


Man, lungs feel freakin' WEIRD!

Not THAT Kind of Catheter

As I mentioned in my last post, I was scheduled to start my preceptorship with the pediatric cardiologist this last week . Ideally, I am supposed to spend every Thursday working with her in the clinic. As it turns out, her schedule is somewhat variable from week to week, so there are going to be certain days where that just won't work. Last Thursday was one of those days--she wasn't working in clinic that afternoon, so I wasn't able to go in. To make up for it, she invited me in on Friday afternoon instead to observe her in the cath (catheterization) lab, which turned out to be a lot of fun. I'd seen some similar procedures in the past (while shadowing a cardiologist during college), but I felt like I learned/understood a lot more this time around. My preceptor seems very kind and easy to work with. She was also very willing to teach, and she tried to keep me informed about what she was doing.

The procedure was interesting: she was working with a really young patient who was born with a heart defect (called tetralogy of flow) that caused extreme hypoxia (not enough oxygen). The procedure was largely exploratory, making sure that the patient was ready for surgery, but the doctor did some intervention herself as well. I left after the procedure, which only took two and a half hours, so unfortunately I wasn't able to completely make up for missing Thursday.

For those wondering, cardiac catheterization (much different that the catheterization you're probably imagining) invovles the use of fluoroscopy, a technique that uses x-rays to get real-time images of internal structures (in this case, the heart and surrounding vessels). The doctors put tubes (catheters) up through arteries/veins and into the heart either for investigation or intervention (fixing defects). Radioactive dye can be injected for investigative purposes, yielding really cool looking images of the cardiac structures that show how well blood is flowing. On the other hand, I'm sure many of you, my avid readers, have heard of doctors placing a stent--this is an example of intervention. A stent is basically a metal tube used to expand a narrowed vessel. They can also use balloons to expand a narrowed vessel, which is what my preceptor did on Friday.

I was pretty disappointed when I first found out about my preceptor's schedule. It's rather unfortunate that I won't have a set schedule from week to week like I'm supposed to. On the other hand, it will allow me to observe the doctor in multiple avenues, such as in the clinic, on hospital rounds, during procedures, etc. So it isn't all bad, I suppose. Plus I really liked the doctor, so I'm very much looking forward to working with her.

It seems like this preceptorship is going to involve a lot more observing that actually contributing (although that is sort of the nature of the specialty preceptorship, as opposed to the primary care one). It will be interesting to see what working with her in clinic will be like. It's possible that I might get to contribute (actually see patients on my own, taking histories and vitals, etc.), which would be really exciting. At first I was pretty worried about seeing patients on my own so soon, but now I'm really looking forward to it. So now I'm a little disappointed that I didn't get assigned a primary care preceptorship for the first year. Then again, having it next year certainly has some advantages: I'll be much more knowledgeable and prepared as a second year. Hopefully I'll get to work with patients this year as well; that way I'd get the best of both worlds. I'll just have to wait until the 23rd (she's unavailable next week) to find out. And you'll be the first ones to hear!

Well...back to studying. GIE exam 1 on Monday. Eek!

Medical Musings, Part 1: A Lunchtime Lament

Since my schedule these days necessitates eating breakfast so early, I always end up starving during cadaver lab. I'm starting to worry that my brain is going to permanently associate being around dead bodies with being hungry.

Clinical Experience: The Heart of Medical School

Ok. So I have some news to report. But before I do, I should probably bring everybody up to speed on my current class schedule. For the first two years of medical school, my course schedule is pretty much predetermined. I do have the option of throwing in an elective now and again, but for the most part I will just be taking the core (basic science) courses.

You all know that I'm currently taking anatomy; I've made this very clear in my previous posts. Well, to be more specific, I'm class I'm in right now is called GIE, or Gross Anatomy, Imaging and Embryology. This is a daily course that lasts for the first 11 weeks. It focuses primarily on anatomy, but also includes includes lectures on the other topics mentioned in the title as well. It consists of both a lecture component, as well as lab (you know, that smelly place I mentioned previously). After GIE comes Cell Structure and Function (9 weeks), then Systems Processes and Homeostasis (9 weeks), and finally Biological Basis of Disease (9 weeks). And that's my core schedule for the year. Pretty simple, eh?

In addition to my basic science courses, I also have a class called PCM, or Principles of Clinical Medicine. PCM is a weekly course that lasts for the first two years of medical school. The purpose is to give us an early introduction to the true clinical aspect of medicine--a sort of practical application of the things we are learning in our science courses--as well as to teach us about ethics, finance, health organization, biostatistics, etc. There are two parts to this course: the didactic portion (a 4 hour weekly lecture) and the preceptorship. In addition to large and small group discussions surrounding the topics I listed above, the didactic portion of the course also serves to prepare us to see patients, teaching how to take histories, perform physical exams, take vitals, etc. The preceptorship, on the other hand, is what I really came here to tell you about.

A preceptorship is sort of like a shadowing experience on steroids. I've shadowed doctors in the past, and it essentially consists of a lot of watching. Preceptorships are all about doing. Whereas the PCM lectures teach us the practical knowledge, the preceptorship provides hands on experience. Though the experience will vary from student to student, I will likely have the opportunity to see patients (either with the doctor or prior to the doctor seeing them) and do all the doctor-y stuff I mentioned above (histories, vitals, exams, etc.) So basically, it's going to be an incredible experience. In fact, I've been told that the reason many students ultimately choose OHSU is for the early clinical experience they offer. I'm a little scared to dive in head first so soon, but it will certainly be well worth it.

Ok. Just a few more explanations, then I promise I'll tell you the news. Like I said, the preceptorship occurs weekly and lasts for the first two years. One year is the "primary care year" (either family practice or internal medicine), and the other year is the "specialty year". For primary care, you spend the whole year with the same doc. For specialty, you rotate between 3 difference specialists, one each term.

And finally, we have come to the purpose of this overly wordy, sleep inducing post: my announcement. My fate. My preceptorship. This year will be my specialty year. For the first term (starting next Thursday), I will be working with a pediatric cardiologist. Cardiology was one of the specialties I listed as an interest. Pediatrics was not, but I think it will add a very interesting perspective. Furthermore, I also discovered that the doctor specializes in transplants, which could potentially be really exciting. So, my friends--my most faithful of readers, those who have endured this lengthy post to the bitter end--please continue to feverishly check my blog for updates, for I will definitely be reporting all preceptorship-related developments as they arise. And arise they shall.

Now, before I click that long overdue Publish Post button at the bottom of my screen, here is my current class schedule, for anyone interested in seeing the thrilling occurrences of my day-to-day life in a neat, chart format. Enjoy!

	Monday	Tuesday	Wednesday	Thursday	Friday
8:00am	GIE Lecture	GIE Lecture	GIE Lecture	GIE Lecture	GIE Lecture
9:00am
10:00am	GIE Lab	GIE Lab	GIE Lab	GIE Lab	GIE Lab
11:00am
12:00pm
1:00pm			PCM Lecture	Preceptorship
2:00pm
3:00pm
4:00pm

Dias De Los Muertos

Yesterday was my first official day of medical school. I boarded the express bus promptly at 7:07 a.m. and made my way toward campus, loaded down with my supplies for anatomy lab: a pair of scrubs, spare socks, an undershirt and an old pair of tennis shoes. I also brought an extra pair of boxers (all of this was recommended by a 2nd year student), but that turned out to be overkill. In order to explain the reason behind all the extra clothing, I would like to quote the brilliantly talented Hugo Weaving in his role as Agent Smith: "It's the smell!"

I was warned beforehand that the smell of the embalming solution (formalin/formaldehyde) was overpowering at best. I've never really had an issue with strong odors, so I figured that it wouldn't really bother me. As it turns out, the 2nd year students weren't exaggerating. Though "overpowering" is certainly an appropriate adjective, I personally like to think that "kangaroo kicking you in the face asphyxiating" would perhaps better portray the relentless olfactory assault.

But in all seriousness, the smell really did make the entire experience very rough. The actual smell is very difficult to describe. It has that distinct "chemical" smell, and while it isn't a particularly offensive odor per se, it is super potent. I actually felt light headed for the first few minutes. And even with all of the precautions I took with extra clothes (that we leave in the anatomy lab changing room), the smell still stuck with me after I left: simply running my hands through my hair in the shower brought it back. The weird part was, even after the smell was physically gone (I took a very thorough shower), it seemed to stick with me psychologically. Every time that I even thought about the lab, particularly when I vividly pictured the cadaver, I could distinctly smell the formalin. In fact, it came back most strongly (virtually as potent as if I were actually in the room) while I was watching a video demonstration of the dissection for the following day. Clearly the smell had a profound effect on me.

In fact, the entire experience affected me more than I had anticipated. Going into the lab, I didn't think I would have any difficulty looking at/working on the cadaver. Though I had only (briefly) seen a cadaver once before, I really didn't feel like I would be emotionally moved by the experience--at least, not significantly so. However, as 123 students simultaneously uncovered 32 cadavers--and literally jumped immediately into the dissection procedure--I found myself much more taken aback than I had expected.  Now, don't get me wrong. It wasn't as if I passed out, threw up, or became immobilized with fear--in fact, I didn't even miss a beat, and jumped right in to help flip over our cadaver. Nevertheless, as I stood there, in the middle of a room filled with bodies of all shapes, sizes, genders and ages, I did feel...something. Something both unpleasant and unnerving.

So, from the very beginning, our first lab was tough. And it only got worse from there. The procedure focused on the back, which was a fairly simple dissection (in the sense that you couldn't mess anything up too badly), but VERY time consuming, especially since we were all beginners. Our first task was to remove the skin. In preparation for the lab, our instructor had told us that this should take about 8-10 minutes. So we went ahead and got started, timidly started making our initial incisions. Two...and...a...half....HOURS later, the skin had been removed. And it wasn't just our group that found the task so difficult. Though our group was probably one of the slower ones, it wasn't by much. So, here we found ourselves, fifty minutes PAST the time our lab was supposed to get out, finally getting to the actual meat of the dissection. Literally. The rest of the lab (identifying, dissecting and reflecting various muscles of the back) took almost another two hours. By the end, I was absolutely EXHAUSTED. My back hurt. My feet hurt. My brain hurt. I smelled terrible. I wanted nothing more than to go home and shower. The fact that it was hot outside made it even worse. All in all, the whole experience left me wondering how I was going to do this for 11 weeks. I had enjoyed the lecture that day, and I was really getting into the material, but I was left so drained after lab that I was a little discouraged.

This too shall pass...

And so it did. Today, my second day of medical school, was absolutely fantastic. Lecture was great once again. Though two hours is pretty long for a single lecture, it has flown by both days. And then came lab. Today we dissected the spinal cord out of the vertebral column. It was incredible. A seasoned surgeon pointed out to us during the procedure that we should enjoy ourselves, because this was the only time in our lives we would get to do/see this. I thought about it....he was right. What an unbelievable privilege. In less than the full two hours, we had finished the dissection--not perfectly, but sufficiently. But we were curious to see if we could do even better, if we could find some of the more elusive structures that we had missed. So we stayed. We kept working, we kept learning. We ended up finishing with not only a better looking dissection, but a better understanding of the structures themselves. It was profoundly enlightening. And incredibly fun. I left the lab feeling totally rejuvenated. THIS is what medical school is supposed to be.

And frankly, though I'm studying a lot, and will soon be studying a whole lot more (since we only had two days of class this week), it's not all that bad. In high school and college, I only studied for the sake of studying. I was always focusing on the next exam, the next class. Now I'm studying for practical reasons, learning things that I will be using for the rest of my life. It has a completely different feel. I never even liked anatomy in the past, but I'm really enjoying the material so far. And while I realize my enthusiasm and optimism is bound to fade--at least at times--in coming weeks/months/years, right now, this feels good. It feels right.

Freddie Mercury Said It Best...

Accompanied by my good friend Miguel de la Ryan, I made my first trek (ha ha ha) via bicycle to the OHSU campus this morning. After significant heated deliberation, we decided against attempting to ford the river (to avoid losing any precious oxen), and chose to take the Ross Island Bridge instead. The ride was actually pretty reasonable; we made it to the base of the tram in a brisk 23 minutes, with the entire door-to-door trip rounding out at about 35 minutes. I am now officially 1/30th of the way to receiving my sweet "commuter all star" $50 bicycling incentive! Woo!

On a related note, I will personally offer a 1000-point "avid reader incentive" to the first person to correctly guess the reason behind my recent purchase of the stylish eyewear seen below. LET THE GAMES BEGIN!

White Coat Ceremony

Hello there. Are you tired of your current appearance? Have you grown weary of your day-to-day routine? Does your wardrobe exude an air of apathy, poor taste and questionable judgment, consisting solely of a lackluster array of uninspired outerwear for the [insert age demographic] on the go? Well, those days are over, my clearly low self-esteemed friend! What if I told you that you could instead look just like an official, full-fledged doctor, emanating confidence and success from each and every pore? How, you might ask, is this possible!? Just follow our patented* three step method!

• Step 1: Suit and tie? 

Check.

• Step 2: Official ID badge?

Check.

Now what was that last one again? Ah, yes...

• Step 3: Spiffy white coat?

Check!



DUN DUH NUH NUH!

Congratulations! You've now joined the ranks of 'first-year-medical-students-who-are-mistaken-for-real-doctors-and-treated-as-if-they-actually-know-something' all over the country. Don't worry. I'm sure you'll catch on quickly enough.

Now that I have been endowed with my official white coat, I need only to receive my stethoscope in the mail, at which point my ensemble will be complete. Patients, here I come! I'm told that if I act confidently enough, I'll be treated like a real doctor from the very start. Empowering? Certainly. Terrifying? ...A bit.

*Patent pending

CHAPTER 1: The First Steps

"A journey of a thousand miles begins with a single step."

--Chinese Proverb

I had initially intended on starting this blog before beginning orientation, but alas, here I find myself already a failure in the expectant eyes of my (future) faithful readers. Forgive me. As a consequence, I have a few updates that need discussing. For those of you who don't know, I recently moved to an apartment in inner SE Portland so as to lessen my daily commute. Thus far the experience has been quite exciting. I'll probably post some pictures in the near future.

As I mentioned previously, yesterday, August 16, 2010 was quite a momentous event in the epic tale that I am preparing to tell you. In fact, it was the introduction, the very beginning, the opening sentence. Though it was neither the best of times nor the worst of times, it was a time: 7:57am, to be precise. Our dashing hero found himself--on time, of course--five dollar bill in hand (...no change? damn), taking his first steps onto the non-air conditioned bus to his future. As he stepped off the bus, nearly missing his stop, and walked into the atrium, he boldly announced to his peers, "Call me Ishmael." ...Or something.

Monday was the first day of my orientation to medical school. This Friday I will undergo my official "Transition to Medical School", during which time I will be presented with my very own (both ceremonial and practical) white coat. And finally, next Wednesday marks my first official class (more on my actual course schedule to come). Most of the orientation thus far has certainly been informative, though not very titillating. It has, however, been fun and exciting to interact with other students in my class (class size = 124). I have a few more days of orientation and a couple more last minute things to get in order (equipment, books, drug test), and then I will be physically, emotionally and mentally prepared to continue my journey through space and time (well, mostly just time). And you'll all be right there with me, along for the ride as my partners in crime, my faithful sidekicks, my bathroom buddies.

All in all, everything has been going really well so far and I am super excited for the next chapter of my story to unfold.

PROLOGUE: At Long Last, The Journey Begins

As most of you probably know, becoming a doctor has been an aspiration of mine for quite some time. In fact, ever since I officially made the decision to pursue medicine, my life has essentially been devoted entirely to that cause. And now, many years in the making, the day where all of my past efforts come to fruition has finally arrived: on August 16th, 2010, I will finally begin my journey into the realm of medicine. 

A good friend and mentor of mine at the University of Oregon made me assure him that, upon entering OHSU, I would give him frequent updates so that he could "experience medical school vicariously through me". Many others have made similar requests. In fact, people are constantly asking me questions about the process of becoming a doctor. And frankly, with my first medical school class mere days away, I still find my own knowledge on the subject wanting. The fact is that medical school is simply mysterious. And for many, that gives it a certain mystique, causing them to wonder "what the heck are they doing behind those closed doors, and how come I wasn't invited?"

And that, my friends, is where this blog comes in. I stand (sit?) before you today to officially offer you an invitation into my exclusive club. I decided to document my endeavors over the next 4 years so that my friends and family can enjoy the ride right along with me. Unfortunately, I can't promise that I'll have time to update often. I will, however, be sure to hit all the major events, experiences and milestones: clinical rotations, exams, boards, my first stress induced meltdown (likely sometime in the near future), residency applications, the first time I touch a heart (both beating and unbeating), mentors, friends, foes, my first diagnosis, and so on down the list...

So, my avid readers, let us embark together on this journey of discovery. Over the next few years, we shall explore the life of an everyday medical student, slowly uncovering the mysteries that await when one finds himself in pursuit of medicine.