Real Med School

That is how our current module, I2, was described to all of us, the wee-little first years, by a few of the M2s. Sadly, three weeks into the module (with the test looming on this coming Wednesday) it seems they are correct. Evidence of this? My lack of blog posts. Inflammation and Immunity, while great for a person's well-being, seems to be decidedly bad for any free time I might have had this month.

That being said, what have I been doing for the past half an hour?

Not I2.

After finishing my review of this morning's lecture and review (that's right, a review...of...a...review...) I felt like a break was in order before a student panel here in a few minutes. As some of you may or may not know, I have one blood sibling, an older sister, who also writes a blog. Now, while she is a great sister, loving mom, and probably caring wife, she also exploits her children for blog-hits. I thought, If she uses my nephews, why can't I?

So! Behold! I present photos that my sister took in an attempt to capture the spirit of her children. Sadly, where she fails, I succeed. She captured their expressions; I have revealed their true thoughts.

*Note*: As my sister was the photographer, the thoughts of the subjects naturally reference her.

Series 1!

Series 2!




This is all. I must study. Again.

Until next time.

A Unique Look

As GenNeo wraps up, I feel like I should make some kind of post that shows it actually even happened (other than Things I Like More Than GenNeo). While we have learned a lot of interesting things (and believe me, some things that were just not interesting at all), what I'm about to post really stuck with me as an interesting representation of just how much cancer can flat out screw your body up.

The typical person's genetic makeup consists of two copies of 23 chromosomes (one from each parent). Mishaps can occur on a large scale such as Down Syndrome (or Trisomy 21), where a person has an extra chromosome, or on a very small scale such as Sickle Cell Disease, where a single piece of your DNA (a nucleotide- the ATCGs) is inserted wrong (this is called a point mutation).

A karyotype provides a quick way to look at a person's genes to see big large-scale changes. It's really just a picture of each chromosome from a person's cell lined up in their respective pairs. A karyotype looks like this:
The chromosomes look very similar and seem pretty neat and orderly. If examined, we can see that this person was a male, we'll call him Clark, because there is a single X chromosome with a Y chromosome (a woman would have two X chromosomes). Clark inveitably has mutations. We all have tons of them that simply don't cause problems (silent mutations). It's possible that Clark even has cancer or some other ailment, it just apparently isn't affecting his genes on such a scale that looking at a karyotype can discern it.

So what kind of destruction can cancer rain down upon your harmless little nuclei, the keepers of your genes? BAM!
This karyotype was taken from the cancer cell of a person with lung cancer. Look at all that! Who even knows where to begin?

My diagnosis (or Dx)? Not good things.
My treatment? Uh... Quit smoking.

Until next time.

Wait...What?!

Being paired with a local physician (preceptor) that we visit at least once a module makes up one of the clinical aspects of our first two years. It is with these preceptors that we have some of our aforementioned "patient contact." The experience generally lets us get more comfortable pretending to be doctors with being student physicians, but more than anything it helps reaffirm why we're all here. What do I mean by this?

As my preceptor and I sit in the side office of the clinic and he fills out the chart of a patient we just saw, the nurse walks in and hands me (as the real doctor is still busy) the next patient's chart. I glance down to see at what we'll be looking and my eyes go wide with surprise.

The Chief Complaint (i.e. the reason for coming) box reads:

Right Thumb- splinter under nail (noodle).

As one might imagine, I reread that sentence a few times. Curious, I look up at the nurse and she, trying to contain her surprise/amusement/disbelief, explains that he was cleaning some dried pasta from a pan and voila:

Noodle + Under + Thumbnail = Pain.

The real downside of this for the patient (It was great for me. I got to watch and help with something unusual.) is that pasta, being a grain product and rather moist, acts as a pretty poor tenant when leasing sub-cuticle space. After about 10 minutes of Lidocaine shots to numb the area (oddly enough the most painful experience for the guy), half of his nail cut off, and some nimble forceps work by my preceptor, he left likely feeling physically worse but thumbnail-infection/pasta free.

I am certain that while this is the first semi-strange experience in my medical career, it will not be the last. Until next time.

What Think You I Take My Pen In Hand?

The Gen/Neo module currently dominates my calendar and all its time enclosed. So, in order to escape from its tedium and rote memorization, this post will instead focus on everything not medicine related. Specifically...

Things I Like More Than Gen/Neo:

-Pouring just the right amount of granola into a cup of yogurt so that it doesn't spill over when I mix it.

-Being able to "hide" the annoying status updates (such as "Farmville" and "MafiaWars") on Facebook.

-The chill an autumn evening's air leaves in your chest.

-Feeling completely content wandering through a book store, even when not buying anything.

-The 3rd or 4th bite of a really good apple, once you've really broken through the skin and can get a crisp chunk of it.

-Getting an unexpected package, letter, magazine, or item in the mail.

-Jason Sudeikis on SNL.

-Opening the door to the mail box and seeing anything there.

-Top 10 (or 20/25/30/50/100) lists of just about anything, but particularly things to do with books or movies.

-The Sandman series by Neil Gaiman.

-Getting a really good Sporcle game when the "random" button is clicked.

-Hyperlinking.

-Writing with a really nice pen.

-Coming up with (what I think are) clever tags for blog posts.

-Freshly baked chocolate chip cookies.

-Having a wonderful wife (not at all because she will make a few extra said cookies when she's making them for work).

-All of the backgrounds and photos of InterfaceLift.

-Hitting a crosswalk at just the right time so that you don't have to break stride.

-Getting more than 6 good songs in a row on Pandora.

-The Office.

-Reading.

-Finding a good excuse to not study.



Until next time.

A Firm Declaration

Thankfully, I can now declare with absolute certainty that I have passed my first module of medical school. Do I know what my final grade will be? No. That can still change depending on how the retake test goes on Friday. (We take each test twice. Two exams, Same material. Highest score stays). But I do know that I will be continuing onward and that's a nice feeling to have. (Let me be real- I'd be continuing forward regardless, but I know that I won't be making up this module in the summer).

When I try to proverbially step back and examine my situation and what the module has been like, it's an interesting picture. Simultaneously it seems as though we've just started and yet been here forever. I can't believe we're already done with EIGHT WEEKS, but then again, it feels like we've covered 8 months worth of material. Who knows the best way to describe it? I sure don't.

The only thing I know is that this tricky thing called medical school is starting to feel more and more like normal for me, and I think that's a good thing. Will I feel this way in 2 weeks, when we're half way through our Genetics and Neoplasia (Gen/Neo) module? Probably not. In fact, I can almost guarantee you that I won't, but that's okay. I know that 2 weeks after that, post Gen/Neo and pre-I2 (Inflammation and Immunity), things will probably be alright.

Until next time.

Team Moral Victory?

The battle has been fought. The victors revealed.

For the women: The M1s reign supreme. Although the much-hyped M2 team (previously undefeated) fought hard (and by that I mean they were NOT happy about losing), the M1 Ladies pulled ahead and won by two touchdowns.

For the men: This is where Team Moral Victory comes into play. By and large, it was really a draw. Final score: 6-7, with the win going to the M2s.

Overall, I'd say we did pretty well for ourselves.

Am I Ready For Some Football?

One of the most rewarding aspects of my life as a medical student thus far (aside from the known wonders that are my wife, family and current friends) has to be the relationships and friendships that have begun to flourish. Proximity and shared evils (or struggles if you want a synonym) will inevitably cause the fellows of my class to bond and gain an understanding of one another that typically never develops in daily life. On top of even this, occasionally something will come along to unite a population to a new level. Such a circumstance has presented itself to us. That event?

Football.

A.k.a., the gridiron where the 1st year students (M1s) will boldly triumph over their second year oppressors (M2s).

In a few hours, the two classes will meet on the grass battlefield for two games of "flag" football: one men's game, one women's game. Throughout the day, via email and with the cunning use of YouTube videos, trash has been electronically talked and the School of Medicine now has 350 very rowdy and excited students on their hands.

While the outcome of the game technically remains unknown (come on, the M1s will dominate), the fun of anticipation has likely made it worthwhile for all those involved. Having this game to look forward to helps remind all the students that we can still have fun and not study every waking hour. Plus, a bunch of money is being raised for Harversters through ticket sales.

I leave you with one image and two links to better summarize the coming clash.

M2 Trash Talk

M1 Honesty

A taste of what's to come:
Until next time.

Health Care Reform: My Thoughts on "The Speech"

This evening (as most people know), President Obama addressed a joint session of Congress on Health Care, specifically:

• the current state of it in the U.S.
  
• his thoughts on why reform is needed
• what reform should accomplish
• what is/is not true about the rumors that have circulated about the proposed reform "bill."
  
  (I put "bill" in quotations because no official bill has yet been agreed upon. Four submitted, one more on the way)
  

A number of things stand out with this address, both in regard to his speech, and the nature of the event. While the President often addresses the nation, be it on prime time TV or otherwise, presidential speeches to joint sessions of Congress come few and far between. The last one given, to my knowledge (and excluding State of the Union/Inaugural Addresses), was given by President Bush after 9/11. I personally think this scarcity is because of how much time is spent applauding (if you're the party in power) and attempting to look as-defiant-as-one-can-while-sitting-during-a-joint-session-of-Congress (the minority party). The fact that Obama chose to hold such an address on health care stands as a testament its importance.

So, enough about the actual event, what about the speech? Overall, I found myself pleased with the speech. The President seemed to approach the entire debate head-on and systematically work through some problem issues. Could there have been more discussed? Of course. More details given? Without a doubt. From a practical stance, however, he seemed to cover the most important things as best as he could for the time being (it was only a 45 min speech, after all). I was specifically glad to hear Obama address the few following things (among many others, because my opinion obviously weighs heavily on both him and Congress):

• The current outrageous costs of health care when compared to nations similar to the U.S. Health care accounts for ~18% of our GDP , while the next closest country slides in at ~9% (That link is also just a good website to checkout for general health care facts).
  
  When compared, health rankings between the US and similar nations have no real statistical difference (measures include infant mortality, life span, cancer survival rates, etc). If there's no real different in that, and in patients' satisfaction with their physician, why does our cost so much more? For more information, this article summarizes things pretty well and pulls statistics from the CIA World Fact Book.
  
  
• The idea that an extreme change, to either the right (complete individual privatization) or the left (national single payer), can not be viewed as a feasible option right now. The health care system ties too tightly into the entirety of our economy and way-of-life that any major overhaul would simply be too detrimental .
  
  One of the most frustrating things to hear others talk about is how the US will have "socialized medicine." It's just not going to happen, and really, socialized medicine wouldn't actually be the end of the world (surprised, no?), we as a country just make terrible connections when we hear the world "Socialism" (You can thank the National Socialist German Workers Party for that, along with the Cold War. Oddly enough neither are true examples of socialism).
  
  I'm also glad he addressed other silly things like the idea of death panels and the fact that many in the GOP (and some on the left) are actively choosing to not work because it's a better political move. I'm sorry, I like to think that you were elected to work. I wish all in Congress would work so hard that there was no one the people could NOT reelect them rather than sitting-bored because you'd rather not make waves.
  
  
• His inclusion of Ted Kennedy's well-touted view that the health care debate should not be a political or partisan debate, but a moral debate. It's not often that I would prefer our Congress to debate moral issues, however the issue of health care strikes a different chord with me.
  
  I've always thought a person's ability to easily access adequate medical care when needed as something that just makes sense. I cannot understand why people are more than okay with protecting citizens and their safety by having military/police/firefighters/clean water/etc but then run scared when prompted to protect a persons general well being.
  
  It just does not compute for me. I think when people get sick they should be able to focus on getting well rather than even entertaining the idea that they might not go see the doctor because of access/cost.
  

I could go on for pages explaining all of my thoughts and comments about the speech and debate, but I'm not sure how many people have made it this far. If you really want to read more of my rambling ideas: click here.

If you missed the speech, NPR has a pretty good summary , or you can read the entire text here (it's a few clicks down, past an initial summary).

For a good website that just has interesting health care facts, check out the NCHC (National Coalition on Health Care- they were linked above too). I find the "Facts" tab at the top to be most interesting.

Sidenote: I wish my time stamp was accurate. Anyone know how to change that?

Lastly, what did you all think of the speech? Or how do you feel about the debate/reform? I'm happy to discuss or just see what other people think. Until next time.

The First Reprieve

This weekend has functioned as the first real "break" of my medical school career. The School of Medicine teaches its Basic Science years with a module plan. For 4/6/8 weeks, we students learn about a specific subject or system (such as Genetics or Inflammation and Immunity) and everything involved with it (such as Biochemistry, Cell Biology, etc) instead of having individual lectures over each traditional science subject. It seems as though the module system produces the same scores (if not higher) on board exams and presents the material in a manner that is more intuitive to the students being able to assimilate it with how it will be used in practice.

These modules culminate in a final exam (or a midterm and final for longer modules) that accounts for the overwhelming majority of a student's final grade. This results in a very cyclical life for students, as they go from feeling good at the beginning of a module to being increasingly more stressed until, as one lecturer stated, their eyes explode with stress right before the exam. Post-exam, assuming one's scores are passing (that's what we shoot for in med school. Not high grades, just passing), the system resets and we're not longer stressed.

This past week we had our first exam and the past few days have been wonderful. No longer do I view time as studying/should-be-studying, but I can view it as busy/FREE, if only for a few days.

So, in honor of the first exam being out of the way, I leave you with a few (humorous?) mnemonics that helped along the way:

Can I Keep Selling Sex For Money, Officer?
(Citric Acid Cycle Intermediates)

High Profile People Act Too Glamorous, Picture Posing Every Place.
(Enzymes of Glycolysis)

Val Raced Harry Through Walmart For MILK.
(Essential Amino Acid Abbreviations)

Until next time.

People Eating Tasty Animals?

Today was our second session of the clinical skills lab. These sessions could best be described as trying to teach us how to actually be a doctor. It is here that we learn and practice patient history, vital signs, heart/chest sounds, and all physical exam techniques. The students attend each lab in professional dress (with white coat and stethoscope) and see "patients," actors who have been trained in the proper techniques.

We are currently learning how to measure vitals. There are typically four main vital signs that physicians (or nurses or whoever is seeing you) check.

-Pulse (Heart Rate)
-Blood Pressure
-Temperature
-Respiratory Rate

These signs assess basic bodily function and serve as the first physical step in the clinical process of diagnosis. I say the first physical step of diagnosis as the patient history (as stated in my previous post) typically holds the crown for most important aspect of diagnosis.

Fun fact: while most everyone is familiar with how a doctor will assess your pulse (feeling the radial artery), take your temperature (a thermometer, be it tympanic or oral) and check your blood pressure (a sphygmomanometer and stethoscope), measuring respiration is typically done a little more covertly.

Think about it. Has your doctor every told you she/her is checking your respiration and watched you breathe? The likely answer?

Nope.

When someone knows their respiration is being counted, they inevitably think about breathing and thereby change their normal rate. Doctors typically hold the pulse longer than needed and count breathes or gently place a hand on your shoulder while doing so, allowing them to easily count the number of breaths while also measuring your heart rate.

Of course, a physician can always just watch a patient breathe while taking the history and count the number. Yet, (as one lecturer noted to the awkward laughter of the students) this can be a bit challenging when done on a female patient. Polite society dictates that eyes be up top and not down at chest level, especially during conversation.

Until next time.