primum non nocere....

coming soon to a webpage near you...

2009-08-10T15:23:00.002-04:00

nope, i'm not dead yet; this blog, however, is getting close, considering i haven't posted in a really long time.

there are myriad reasons for this, the main one being that i ended up having to leave medical school. how do you write as student doctor blaze when you're no longer student doctor blaze? i didn't know. and i still don't know.

on the upside, however, lately i've had a few ideas. enough that i even bought a domain and hope to move over to the new site soon. i haven't decided yet if i'll pull these posts over or not, but you'll still get the same, honest, WYSIWYG me. perhaps not as a med student (for now), but still me.

so, if you're still out there, watching for updates on this blog, stay tuned. there is, indeed, a new horizon ahead....

2008-10-20T12:24:00.001-04:00

according to the hospital computer system, i've expired....

2008-10-20T01:29:00.001-04:00

has fantasies of pulling a 'fight club.'

2008-10-16T16:20:00.001-04:00

is ridding the world of obesity, one 500lb 20yo at a time....

2008-10-16T00:06:00.001-04:00

hates it when she can't help, especially when someone is sick....

2008-10-13T17:42:00.001-04:00

is excited, because her mom is taking her out for Thai food tonight! :-)

2008-10-11T19:20:00.001-04:00

now knows the force behind the expression "I feel like I've been hit by a truck!" It's not pleasant. :-(

2008-10-10T09:22:00.001-04:00

: as my mom so aptly put it, "out of shock, but not out of shit."

2008-10-09T23:14:00.001-04:00

: ouch. ow. & ugh. whoever said 48-72 hrs out is the worst wasn't kidding.

2008-10-07T18:03:00.001-04:00

survived a bad car accident this morning. i'm bruised, but okay. car is totaled. i need better luck....

2008-10-06T07:47:00.001-04:00

is desperately trying not to scratch, despite the fact she's itching all over. If only she could identify a cause of this maddening allergy!

2008-10-04T01:39:00.001-04:00

enjoyed a fantastic Counting Crows concert!

2008-10-03T18:03:00.001-04:00

is off to the Counting Crows/Maroon 5 concert in Tampa! :-)

2008-10-03T09:15:00.001-04:00

wishes, wistfully, that the real world had Mountain Day, too....

2008-10-02T23:58:00.001-04:00

: to corrupt a favorite Smithie expression, "there's gotta be a better way to get a woman in the White House."

2008-10-02T17:50:00.001-04:00

is excited about going to dinner & watching the debate with her (LIBERAL) friend. :-)

2008-10-02T10:12:00.001-04:00

has a quiet office & no immediate crises at work for the first time this week. please, may it last....

2008-10-01T12:58:00.001-04:00

just heard from the classroom next to my office: "oh! i was wondering where my egg yolk had gone!" ah, nutritionists & their plastic food models.... ;-)

2008-09-26T00:00:00.001-04:00

thankful for the Daily Show, which helps her stay current without making her want to cry &/or throttle someone.

2008-07-24T10:20:00.001-04:00

at work, trying to stay awake & wondering why I don't get a summer vacation....

green patch!

2008-05-14T01:51:00.001-04:00

reverse graffiti

2007-10-26T12:25:00.000-04:00

super_blaze sent me this one & it's too good not to share (although, to be honest, it has little to do with medical school!). apparently an artist in sao paulo decided to make a statement against the city's extreme pollution by "erasing" the dirt and grime in city tunnels to create his art. the full story can be found here. but the video which follows sums it up best. enjoy!

counting down to the pbl exam...

2007-10-26T12:09:00.000-04:00

there's only one way to describe what the last few days before a pbl exam are like. this site sums it up nicely:

stress pig - click on its nose...

the fbi building

2007-10-25T11:35:00.000-04:00

mwms is one of several "new" branch campus medical schools that are popping up around the country. basically, this means that a medical school (usually in another state), builds a campus in another location. the branch campuses pretty much run themselves (i.e. have a separate faculty, student body, admissions process, etc.). so why do these campuses exist? because it's easier to open a branch of an existing school than it is to create a new school from scratch, thanks to the complexity of licensing and accreditation laws. basically, this means that mwms's "campus" is really only consists of a shiny new building. for now, the clinics, hospitals, & affiliated stuff are all located elsewhere.

this also means that the community in which mwms is located has no idea that it has a medical school in its midst. or, at least, they didn't know at the beginning, when the school opened. apparently, that lady they pay the big bucks to come into our classes and take pictures of us is supposed to have gotten the word out that we exist and are here to help the community. (r-i-g-h-t....) mwms should be known by everyone around here, given that the area is not yet very large and that the school has been placing all sorts of ads everywhere, right?

ah, but then we have experiences like these:

recently, a classmate of mine was talking to one of his neighbors.

the neighbor asked "where do you go to medical school? i didn't know there were any medical schools around here."
"oh, i go to mwms," my classmate replied, "you know, in the building next door to the ymca?" "you mean you go to school in the fbi building?!?!?!"

*headdesk*

boobs. again.

2007-10-20T20:14:00.000-04:00

This post makes me want to go out shirtless, just to see what would happen. Would I get arrested in this country (i.e. the U.S.) if I went out without a shirt? How come women in Europe and other parts of the world don't have to cover their breasts in public, but we do? Why is a breast, in any form, perceived as obscene? Does "the public" not realize that the difference between a man's breasts and a woman's amounts to some adipose (i.e. fat) tissue and developed ducts and glands? Or that breast milk is technically classified as a kind of mucus secretion?

It's just a breast people! Yes, i said it: breast. Maybe I should shout it: B-R-E-A-S-T.

And now for the point: to all those who have issues with seeing breasts, whether on a billboard, a magazine cover, a nursing mom, or on the street, or wherever, I say: GET OVER IT!

Seriously!

But I'm guessing that the people who have a problem with it are probably not reading my blog. *sigh* So what are we to do? How do we educate/liberate people? How do we get the advertisements and messages portraying women as mere sex objects to stop? Why do we buy products that are advertised like this? How come the conservative rhetoric seems to overpower the liberal voice these days?

????

I think I need to move to a blue state. Then again, here's some food for thought: none of the states seem to be doing well when it comes to women's health, in particular. Did you know that the majority of the states are not meeting the minimum basic requirements for women's health? The picture is bleak. Why aren't more people outraged?

"family planning"

2007-10-18T13:12:00.000-04:00

my mom forwarded an email to me about the recent appointment of Susan Orr, PhD, to head the Federal Family Planning programs at the Department of Health and Human Services. the message was rather tantalizingly incendiary, and while my personal beliefs meshed with their assertions, i was curious to know whether the piece was slanted. so, thanks to Google, i did a little research.

the liberal slant on this appointment is that it's yet another huge step backwards for women's reproductive rights because Dr. Orr proposed elimination of contraception coverage for federal workers' insurance plans. the conservative slant is that it's a positive movement toward affording a greater amount of choice to individuals, particularly in the form of what components of health insurance coverage they choose to elect.

but what does this office of Federal Family Planning do, exactly? i wondered. so i looked them up. after a bit of digging, i discovered that title x is the main "to do" of this governmental unit. given this, theoretically, their mission is the following:

Program Priorities

1. Assuring ongoing high quality family planning and related preventive health services that will improve the overall health of individuals;

2. Assuring access to a broad range of acceptable and effective family planning methods and related preventive health services that include natural family planning methods, infertility services, and services for adolescents; highly effective contraceptive methods; breast and cervical cancer screening and prevention that corresponds with nationally recognized standards of care; STD and HIV prevention education, counseling, and testing; extramarital abstinence education and counseling; and other preventive health services. The broad range of services does not include abortion as a method of family planning;

3. Encouraging participation of families, parents, and/or other adults acting in the role of parents in the decision of minors to seek family planning services, including activities that promote positive family relationships;

4. Improving the health of individuals and communities by partnering with community-based organizations (CBOs), faith-based organizations (FBOs), and other public health providers that work with vulnerable or at-risk populations;

5. Promoting individual and community health by emphasizing family planning andrelated preventive health services for hard-to-reach populations, such as uninsured or under-insured individuals, males, persons with limited English proficiency, adolescents, and other vulnerable or at-risk populations.

Sounds okay, right? I mean, I don't personally like the notion that they exclude institutions that do not provide abortion services while including faith-based institutions (seems to me that in order to be "neutral," they shouldn't allow either or should allow both), but I'm all for educating people about reproduction and providing health services, particularly in under served areas. I looked up their allocation of grant funds for FY 2006, and while some of the studies seem a bit unrealistic, others did seem like they'd result in some helpful information.

Here's the kicker, though. Any organization that applies for/receives a grant from the government under title X must agree to the following:

None of the funds appropriated in this Act may be made available to any entity under title X of the Public Health Service Act unless the applicant for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities

Um, is it just me, or does that sound like any applicable program has to teach abstinence and take away the rights of minors in order to be funded? *sigh*

I get that people are concerned about the appointment of Dr. Orr to this organization, but based upon what I've read, it seems like most of the funding has already been restricted and directed toward the conservative abstinence-only, family-centered approach. If she continues to support the current administration's conservative views, i suspect we're in for more of the same--a decrease in funding and support for any program that advocates something other than abstinence.

This isn't quite what bugs me most about the appointment, though. What I want to know is why someone with degrees in politics is running a branch of government that should, at the very least, be run by someone with training and expertise in public health, if not medicine? How will she be able to make educated decisions about policy if she can only rely on her own opinions to guide her? I dare say, it would be like putting me--a pacifist--in charge of the Army! ;-)

At any rate, it all makes for interesting debate. What do you think?

As for me, well, I don't know yet. I've got to go read a good five chapters of embryology before I can even begin to form a foundational knowledge of what, exactly, "family planning" means....

taking paranoia to a whole new level...

2007-10-15T11:44:00.000-04:00

i interrupt this day of testing to bring you the latest news from mwms. <--yup, it's that interesting that i feel the need to share now, even though i should be memorizing more "road-kill" slides for my practical at 1pm.* mwms is relatively new, and one of the things it's known for is its plethora of security cameras. seriously--there are security cameras everywhere, except the cadaver lab (for hippa reasons) and the restrooms. we also have to badge-swipe in and out of the building. this would all be par for the course if the school were located in the heart of some major metropolis like most schools. but, i kid you not, the only thing near the school is a field of cows. that, and the ymca & red cross. but i don't think any of those entities are dangerous enough to warrant the levels of security present. sure, it's nice to be able to leave my laptop in a study room for a while and not have to worry about it being stolen. but i think it would be that way even if we didn't have cameras everywhere. the school is just not that big. so....the secretary had emailed us on friday to remind us of the time our test was to begin (as if we'd forget...) and told us that cell phones would not be allowed in the lecture hall during the exam (duh). we had the written portion of our exam this morning. in the beginning, things went as usual...they let us into the room, we all found seats, we began bubbling those damn scantrons (someone should create a stamp or a barcode sticker or something so that i don't have to keep bubbling in my name, dammit!), etc. in the midst of this, the head anatomy instructor gave general instructions; you know, the usual: there are this many pages, don't forget to erase completely if you change an answer, use a #2 pencil or the world will come to an end, etc. but here was the kicker: he then announced that only one person at a time would be allowed to use the restroom during the exam. fair enough, right? oh, but it gets better.... everyone who needed to use the restroom during the exam had to be *chaperoned.* the chaperone would stand by the sinks in the restroom and give each person a total of 2 minutes max to do their business. i'm not kidding. i couldn't make this stuff up if i tried. now, i don't know about you, but i'm the kind of person that likes to use the bathroom in private. i have nothing against bodily processes--they don't bother me one bit and i'm not ashamed of them--but my sphincters have a different attitude. there are times in the past where i've had to take a drug test for a new job and it's taken me like 15 minutes to pee because i was being "watched." my sphincters don't like to be watched. they don't like to be heard, either, for that matter. so i'm really grateful that i didn't have to use the restroom during the exam because i think it would've been a huge problem. i'm surprised they didn't say we'd have to leave the stall doors open! and i feel for the guys--i've never understood how men manage to pee at urinals given how public they are--but can you imagine trying to pee knowing that your anatomy professor is staring at your parts? couldn't that be construed as sexual harassment or something? it just seems...ridiculous. as you can see, just about the time i start to feel like i'm not giving mwms enough credit for the things they do well, they pull stunts like this. i'm not in medical school, i'm in prison. and the guards are paranoid.

*gulp*
----
* I call our practical slides of gross dissections road-kill because that's what they look like to me--road-kill. some of them, particularly in this section (head/neck), are downright indecipherable unless we're given some point of orientation. which we're often not....

Breast Cancer Walk 2007

2007-10-13T17:23:00.000-04:00

i'm happy to report that, thanks in no small part to many of you, the mwms group raised over $1400 for breast cancer today! :-) the photos tell all....

the multitude of walkers

mwms students making strides!

the group pose

on a brighter note: giving thanks

2007-10-11T18:39:00.000-04:00

i want to give a big public thank you to the world's best realtor for sponsoring mwms's breast cancer walk! her donation not only helped us reach our goal, it put us over the top! i continue to be stunned by her generosity--who knew that in buying a home, you could also gain a wonderful, supportive friend? :-)

i have much to add to my blog this month about breast cancer--particularly about a new screening device that's just come on the market that's sure to help our efforts at early detection--but i really ought to go study now. i have to keep reminding myself that i won't be able to help anyone with any medical problems unless i get through medical school.

in the meantime, use the internet for good & educate yourself about breast cancer. and don't forget: guys, you're at risk, too!

the internet...

2007-10-11T18:19:00.001-04:00

...is a death trap for medical students.

i signed up to participate in mwms's breast cancer walk this weekend (see sidebar) & sent an email to some friends to ask if they'd help support us, as we were only 13% from our goal last night. one of my friends sent a message back to me, asking me to join her "facebook community." i'd heard about facebook, but never really looked at it.

that is, until today.

all i can say is: holy time-sucking vortex!

i've decided i like the internet a little too much. maybe more than too much. it fascinates me. i'm always finding new things here--new people, new places, new news, new stuff.... and it all keeps getting in the way of what i'm supposed to be doing, which is *studying medicine,* not studying the links to long-lost friend of a long-lost friend and oohing over pictures of their babies/cats/dogs/houses/etc. just when i thought i'd beaten the urge-to-check-email-every-5-seconds beast and had turned off all the chat features on my computer, what happens? i find something else to distract me!

so, it's official and i need to say it: hello, my name is student doctor blaze, and i'm an internetaholic. need i say more?

so much to say, no time to say it

2007-10-09T14:43:00.000-04:00

i'm now 6 days away from my anatomy final and have realized that every moment up to the exam will be excruciating no matter what i do.

i have so much that i want to say here--so many things to write about--but, with the impending exam & all it entails, i can't take the time right now to post about any of it. i promise you, though, there will be some interesting posts making their appearance after the 15th.

in the meantime, i'll leave you with a photo i took this morning (using my macbook pro, which, unfortunately, doesn't have a flash) during our osteopathic principles & practices lecture. we had a guest lecturer and even our regular professor fell asleep! (<--too bad i didn't catch a shot of him sleeping!)

the day was redeemed by an excellent lecture given my mrs_dr_do this afternoon on taking a social & sexual history--so at least i've learned something useful during all my hours of sitting in the lecture hall. overall, though, this picture nicely sums up the energy level/morale on campus....

halfway done

2007-09-24T11:14:00.000-04:00

well, i've made it through part one of the exam. it took me 3 hours to complete the written exam of 150 questions. i probably would've stayed longer and re-checked everything (the professors, i kid you not, misnumbered the exam, causing mass panic among the students. we had two #4s and no #71. fun!), but we've got the practical this afternoon, so i figured that rather than perseverate, i'd come home and review my labs.

the written was actually not as bad as i feared. it would've been as bad as the rest of the exams, except i finally got a bit of advice before this test that seemed to really help. i met with one of my pbl-mates from last year on wednesday, and he explained to me how he studies for one of these exams. he said that it's all about relationships--that i need to be able to take the 2D slide and translate it into 3D, because they'd be asking questions that are relational. maybe it sounds obvious to everyone else, but it dawned on me, in talking to him, that this business of "memorizing the lecture slides" doesn't help if i can't picture, in 3D, how the structures go together.

(aside: i guess i should mention that we're working on prosected cadavers. i'm beginning to think that perhaps this isn't such a good way to learn. staring at a cadaver isn't a heck of a lot different than staring at rohen's, you know?)

so this weekend i spent a considerable amount of time going through the cross sections in netter's atlas. i tried to view each picture and really *see* where things were. not only was it more fun to study it that way, but i started to feel like i had some direction to my study for a change.

i'll probably miss all the minutiae questions on the exam, because i didn't spend time memorizing little facts this time, but i'm hoping it doesn't matter too much. an overall understanding of the big picture will help me more in the long run...i think....

at any rate, it'll be interesting to see if my study changes made any difference.

as for the exercise some of you mentioned, i've been feeling a bit stymied lately. we're in our late summer weather pattern where i live, which means that the days are brutally hot and the evenings consist of a deluge of thunderstorms. it hasn't let up long enough for me to get on my bike, and it is starting to bug me. i need some exercise and some time outdoors. i snuck away last weekend to study in a quiet place with no interruptions--fortunately this place is on the beach, so i did get to swim in between my study sessions. <--that was really nice. i guess this is all to say that i'm waiting for a break in the weather. i'd ordinarily ride during a rainstorm (i don't melt when i get wet), but i currently live in one of those areas that's known as lightning capital of the world. seriously. so i figure i'll leave the golfers to get struck and keep my butt indoors. at least, for now. but i may go join the ymca. i'm not as into gym exercise, but something is better than nothing....

speaking of exercise--another side note--my brother completed another triathlon yesterday! he came in 5th overall in his age/gender bracket (39th overall out of a total of nearly 1,000 participants!)--for someone who has only been doing this for about 10 months, his abilities are incredible. he acts like it's nothing, but--damn--he's not far behind the times of the professional racers! it's amazing!

alas, i best get back to my mental triathlon. onward!

thunk

2007-09-23T21:54:00.000-04:00

my. brain. is. full.

seriously--i'm at that point in my studies where all i want to do is shake stuff out of my head like a dog shakes water off its back. i've been studying at home, alone, all day. haven't showered or eaten much, although i did manage to do some chores, just because i can only sit still for so long before my body starts screaming for movement. it's day two of non-stop studying and i'm exhausted. so exhausted, in fact, that i slept through two alarms, the telephone, and my roommate leaving this morning. agh! it really is insane, this process, on so many levels....

so what, you might ask, have i been stuffing into my head?

20 lectures at an average of 60 slides per lecture; 18 labs at an average of 40 slides per lab...so that's about 2,000 slides for the exam.

the material covers about 2/3rds of the anatomy textbook (Gray's) and 1/3rd of the histology text.

it was all covered in three weeks.

the whole thorax, abdomen, pelvis, & perineum, plus their histological components.

i may have mentioned this already. i think i keep repeating it so that i don't forget and answer some question with, well, innervation of the little toe by accident (gotta love digiti minimi!).

my brain is particularly fried at the moment, i think, because i've been reviewing cross-sectional anatomy. on the advice of a tutor, i'm attempting to get myself more grounded in what is where and answer questions based upon logic off of that rather than memorizing. i don't know if it will work--i usually leave these tests wishing i could have memorized every last word on every page of every slide. but it's impossible. it does make more sense to truly learn it--to get a sense of being able to see the anatomy in one's mind--but it's more difficult to do than i ever imagined. those diagrams we see everywhere of the human body? yeah, not so accurate. i feel like i have to erase all my prior knowledge and start over. <--i'm still cleaning! ;-)

anyway...i'm sitting here thinking that this is sort of a pointless post...but again, i want to capture this experience of medical school with as much truth & honesty as i can.

the truth of the moment: i'm exhausted & my brain is full.

*thunk*

'nuff said.

i exist, really.

2007-09-21T22:20:00.000-04:00

i do exist. i know this because of the amount of angst i'm currently experiencing re: my upcoming anatomy exam. no one else knows i exist because this anatomy exam keeps me from doing everything else. seriously. i went to the grocery store tonite for the first time in weeks and everything had been rearranged. i mean, whole isles. clearly, i'm not getting out much. nor have i been able to reply to emails, much to the dismay of many people.

i'd blame my lack of communication on myself, as i usually do, but i'm at the point where i'm so fed up with mwms that i've decided it's their turn to get the blame. so, yeah, i haven't returned phone calls, emails, snail mail, answered the door, or, on occassion, even a question posed directly to me. scary, i know. but this is what happens when you find yourself in a medical school that decides it's "special" and wants to do things differently from every other school.

evidence of this difference? our anatomy class. one of my pbl group mates reported today that he'd recently spoken to a friend who is a first year student at another medical school. the student asked him how many questions were going to be on our upcoming exam. "225," he replied. "wtf?!?!?" was reportedly his friend's response. apparently at other medical schools, they have a test every other week with about 50 questions per test. it's unheard of to wait 4 weeks to slap students with an exam, such that it covers all of the thorax, abdomen, pelvis, & perineum. and not just gross anatomy, oh no--we also have to know all the microanatomy (i.e. histology) of these structures, too. not to mention that our professors seem to be a bit confused. they keep adding in details that i could swear belong to the genre of physiology, not anatomy. but do they care? nope. still have to know the whole hormonal cycle in women for this exam. fun.

i guess this is all to say that i'm feeling a tad unmoored. i'm doing wonderfully in my other classes, but this one...it's kicking my ass, again. i fear i may be banging my head against a brick wall. <--so, truly, i'm still alive. wouldn't go so far as to say well (roommie gave me the stomach bug on top of everything else this week), but i'm surviving.

since i can't say much more (i'm already past my time limit for puttering on the computer), i'll leave you with an interesting clip. one of my classmates somehow recorded the power point presentation given by one of our professors last week. during this presentation, this professor--i've spoken of him before; he's dean_honey--starts flipping through slides and sort of murmuring to himself. then it happens. the it? well, you'll just have to watch/listen to the movie to find out. i couldn't make this stuff up if i tried.... enjoy! (btw--it's nsfw, just so you know....)

scrubbin'

2007-09-21T16:51:00.000-04:00

i'd heard the audio for this before, but the video is even better. a little humor about anatomy lab. enjoy!

practical exams

2007-09-20T09:31:00.000-04:00

practical exams are par for the course in medical school. in any given semester, between opp class and ce class, we have at least a half dozen of such exams. they involve being tested, live, in the presence of a professor, on one technique or another.

today we had our first opp practical exam. it wasn't a big deal--the information at the beginning is basic (e.g. identify these landmarks) and the techniques (basically massage-type) are also relatively straightforward (aside from their names, of course).

i wasn't particularly concerned about this practical--i've been through them before, and i happen to know for a fact that this will be, by far, the easiest one in medical school. i'd also planned to pair up with one of the guys in my advising group, who happens to be laid-back and kind.

aside from having a little difficulty at first understanding the question posed to me at the first station, i got through the techniques part without incident. then i went to the second station, where we were supposed to point out "landmarks" on one another.

one such landmark i was asked to identify on my classmate was the pubic symphysis:

No problem, right? it's an easy enough bone to find...but when someone is lying down on a table & you have to find it, you have to find a way to slide your hand down the abdomen and onto the bone without, well, staring at their crotch. when i'm trying to palpate something, i often look elsewhere or close my eyes, simply so that i can focus on what i'm feeling rather than what i'm seeing.

only, yeah...it kind of backfired on me today, as i veered a little too far left. oops. it's a good thing my lab partner was a good sport about it, but my goodness, did i feel like a goofball! i guess it's better to risk having someone think that you're staring at their crotch rather than accidentally grabbing it..... *cringe*

never a dull moment!

"going somewhere?"

2007-09-19T22:05:00.000-04:00

Tonight I went to meet one of my former classmates (in the '10 bunch) for tutoring at a local St@rbucks. I got there early, so I decided to indulge in my favorite shaken-iced-tea-lemonade drink, since it was almost 7pm and I was in dire need of some caffeine (nope, i'm not a coffee drinker--strange, i know).

I went to the register, where some lady took my order. While she was getting it, one of those little pimply high school guys in training behind the counter commented on my t-shirt. I've been having a rough time in my anatomy class lately, so after school today, I changed into one of my most-loved-for-bad-days t-shirts from think geek. :-)

Said guy, since I had his acknowledged his presence by saying thank you, decided it was time to engage in some small talk. Looking down at the bag parked beside me, he said, "oh are you going somewhere?" I looked at him, puzzled. "Where are you going on your trip," he asked me. I must have raised my eyebrow at this point, because he pointed at my bag and remarked, "the luggage?"

Uh, yeah... That bag on wheels? That's not luggage. It's my bookbag! All 50 lbs of it!!!!

Note to self: what looks ordinary on campus appears downright nerdy off-campus.

Trip...I wish! ;-)

are you kidding me?!?!?

2007-09-18T11:19:00.000-04:00

i interrupt my study time this morning to share a positively frightening story brought to us directly from the NYT. i think i mentioned previously that i haven't been following politics lately--i can't really remember the last time i watched the news or read a newspaper--but when i read this article and clicked on the links to the "videos," i was drop-jaw speechless. has politics come to this? have we deteriorated to rap debates between "obama girl" and "guliani girl"? is this the only way the media thinks it can capture the attention of the american people? and, my goodness, after all the chatter about conservativism over the past several years, should i consider it a good thing that this stuff hasn't been pulled off the net? when i wished for a more liberal discourse and debate in this country, i was thinking west wing, not mtv music video. i guess next time i wish for something, i should be more specific!

interested in sharing my shock? (for full effect, make sure to click the links to the two prior articles & videos contained therein.) here's the link:
Net Watch: Obama Girls New Crush - The Caucus - Politics - New York Times Blog
click away. but don't say i didn't warn you....

constitution day: w strikes again

2007-09-16T13:52:00.000-04:00

it's a fact: 99.9% of medical students depend upon federal funding from the U.S. government in order to pay for medical school and its associated costs (i.e. FOOD), while in school. the funding is not guaranteed--there are many, many hoops to jump through (read: 10,000 or so forms to fill out and sign) before a student can get such funding. if we do get student loans, we're considered "lucky." our interest rate on our student loans from the government is currently capped at 8%, as opposed to the uncapped rates, some upwards of 22%, on private loans. nevertheless, it goes without saying that if the government lends an average of $200,000.00 at 8% interest to almost every medical student (~4,000 nationwide?) in the country during his or her tenure in medical school, they end up earning quite a lot of money off of us. add to this the amount the government discounts our services once we do go into practice and one starts to wonder: is the government screwing over its healthcare providers? i'll leave you to chew on the answer to that one....

(aside: too bad michael moore left the education part out of "sicko"...it's another way that the U.S. is lagging behind the rest of the world with respect to health care.)

in the meantime, i'm here to report that the hoops have just become more numerous. why? because some idiot, somewhere in Washington D.C., decided that all institutions receiving federal funding must celebrate--are you ready for this?--CONSTITUTION DAY. [have any of you even heard of constitution day? did you know that it's tomorrow? sorry, no, you don't get the day off from work. not even if you're the postman.] as such, schools that funnel federal funding to their students--including medical schools--must hold activities to celebrate constitution day. i kid you not. we're talking lectures, people. videos. presentations by politicians. and attendance, as i've been informed, is MANDATORY.

apparently, this is simply one of the latest actions taken by the department of education, which is now diving wholeheartedly into its misdirected "no child left behind" and "american competitiveness initiative" programs. what i want to know is: how do they think they're helping medical students by forcing them to take time out of their studies to attend lectures on the constitution? (is it not bad enough that we only have, oh, a week to cover the anatomy of the abdomen? how about cutting that down to an hour? it's not like we need to know about the abdomen or anything....) do they not realize that the majority of medical students likely have better knowledge of the constitution than most politicians serving in government? (i'd dare them to test our knowledge versus W's, but it'd take them too long to decide on a color scheme for the scantron to actually give us the test before he's out of office....) do they actually think that we want to celebrate constitution day when we realize that (among other things) it does nothing to ensure healthcare for all citizens?

we'd be better off having lectures on how to understand medicare or medicaid or governmental policies on healthcare. but that would mean that the government would have to produce clear directives on such matters and be honest about them. not to mention, they'd have to acknowledge that many of the government's policies on healthcare go against one of the primary tenets of the constitution: to promote the general welfare of its citizens.

yes, let's celebrate the constitution--but, shh, don't let anyone point out what that really means.

....
do you need to rant about healthcare & the government, too? here's your chance:

week 4 mileage

2007-09-02T14:21:00.000-04:00

time spent...

studying outside of class: 39.5 h
taking an exam: 4 h
getting "ripped a new one" by the deans: 15 minutes

felt like...

studying: 23 h/d
taking exam: endless
meeting with the deans: an hellish eternity

overall?

moments when i temporarily forgot where i was: priceless.
for everything else, there was xanax....

on an entirely random note...

2007-08-29T23:52:00.000-04:00

one of super_blaze's photos, via the AP, was published on the front page of the NYT sports section this week. how cool is that?!?!? check it out!

students are stupid, too...

2007-08-28T11:09:00.002-04:00

the head anatomy instructor came in before the thoracic lecture this morning and mentioned that there had been a lot of coughing during the practical exam yesterday. this coughing, he said, corresponded to the answers on the test. Morse code coughing, he called it. he said that if he caught anybody cheating he'd ensure that that person never practiced medicine.

i feel a bit dumbfounded by this news. i didn't hear any coughing. then again, we were split into two groups--one group in each lecture hall. so perhaps whatever he noticed was happening in the other room. but more to the point: what kind of idiot cheats in medical school?

then again, this class is a lot younger than last year's. [<--one of the downsides to a school getting older/becoming recognized is that the applicant pool shifts; more and more of those straight-A right out of college 21 year-olds end up in these seats versus those of us who were "old pre-meds" struggling to do things like work or raise children while taking classes and might not look as good on paper as a result.] the class is academically/paper smarter, but socially? well...the group is a bit lacking. i'm not saying these students are undeserving of being here. they've worked hard, too. but many of them still have that work hard party hard attitude that they've carried over from undergrad. they haven't had the immaturity beaten out of them by a job, family, grad school, etc. they still think it's cool to go out and get drunk after an exam.

[interior monologue: *ugh* get over it already!]

so i guess, given this sometimes immature attitude, i shouldn't be shocked at the notion that there are students who are cheating--but, goodness, you'd think they'd know better. it's not merely an incredibly bad idea. it's also something that took them time to cook up. time they could've spent learning the material straight up.

stupid students.

so what?

2007-08-28T10:49:00.000-04:00

Heard in the lecture on the thoracic wall & lungs this morning:

“Breast cancer doesn’t kill people. So you lose your breast, so what? It’s metastasis to [other areas] that proves fatal. [….] What’s the matter? Why is everyone looking at me like I’m crazy?”

Oh. My. G-d.

I wish I had the balls to respond with: “What if you get penile cancer? So you lose your penis, so what?” Maybe then he would get the point.

Maybe.

We’re not looking at you like this because you’re crazy, Professor. We’re looking at you like this because we cannot believe you’re that ignorant. All those years of cadavers & formaldehyde have clearly affected your ability to remember that anatomy is about people.

*headdesk*

this one is for you, dad!

2007-08-26T16:06:00.000-04:00

my father has spent many, many years trying to get me to join the family business. needless to say, i've stubbornly continued to pursue this whole medical school thing rather than taking up his offer to become "president of the eastern seaboard," as he likes to say. ;-)

while looking for a few good jpgs to throw in amongst my weekly milage, i found the following. this one's for you, dad!

week 3 mileage

2007-08-26T15:58:00.000-04:00

time spent...

in class or lab (no dumb orientation presentations this week! yea!): 18 h
studying anatomy: 41 h
studying opp or ce: 0 h
buying organic veggies i haven't had time to cook: 2 h
taking biddle to the vet: 1 hr
experiencing anxiety about the upcoming anatomy exam: 24-7

'nuff said.

ooh! ooh! i hit a 1,000!

2007-08-25T12:57:00.000-04:00

one more moment of distraction before i dive back in to Gray's: my blog has reached 1,000 hits! wow! i'm stunned that people have come to read what i have to say that many times. i haven't even had time to post about the interesting stuff yet!!!! ;-)

thank you for reading! more 411 to come soon....

downright nauseated.

2007-08-25T12:44:00.000-04:00

i'm nauseated. and not in that physical i-can-go-take-my-zofran-to-fix-it way. i'm psychologically nauseated.

the second anatomy exam is on monday. <--this is the main reason for my present distress. while the first exam covered 2 weeks of material and was worth 10% of our grade (the anatomy professors dubbed it the "welcome to medical school" exam), the second exam covers everything we've learned over the past 4 weeks (i.e. all the way back to day 1) and is worth 30% of our grade. needless to say, i'm anxious! (as are the other 160+ people in my class...but maybe that goes without saying!)

i'm having an exceptionally difficult time focusing. it's amazing what can capture my attention when i'm supposed to be focused on anatomy. i knew i was getting truly neurotic on thursday when i found myself cleaning out the litterbox. i *hate* cleaning the litterbox. yet, there i was, hosing it down in the front yard. <--yeah, i wasn't just replacing the litter...i was *scrubbing* the damn thing. in the meantime, my roommate was upstairs scrubbing the dishes. i guess this kind of anxious neurosis is contagious. although, when i said that to her, she said, "dead tissue is contagious?" oh boy. that's neurosis, not necrosis! (<--thank god!)

anyway...i shouldn't be spending time posting right now. rather, i should be learning everything about the back, arms, & legs. but i couldn't help but take a moment to share the little discussed nasty underbelly of medical school: psychological nausea. i ought to come up with an icd-9 code for that one...after the test, that is. ;-)

oscar the cat

2007-08-19T16:08:00.000-04:00

by now, i'm sure you're aware that i love animals, particularly cats. my mom (thanks mom!) sent me an article last week that summarized a publication in the new england journal of medicine. i felt i should share. enjoy!
--

A Day in the Life of Oscar the Cat

David M. Dosa, M.D., M.P.H.

Oscar the Cat awakens from his nap, opening a single eye tosurvey his kingdom. From atop the desk in the doctor's chartingarea, the cat peers down the two wings of the nursing home'sadvanced dementia unit. All quiet on the western and easternfronts. Slowly, he rises and extravagantly stretches his 2-year-oldframe, first backward and then forward. He sits up and considershis next move.

In the distance, a resident approaches. It is Mrs. P., who hasbeen living on the dementia unit's third floor for 3 years now.She has long forgotten her family, even though they visit heralmost daily. Moderately disheveled after eating her lunch,half of which she now wears on her shirt, Mrs. P. is takingone of her many aimless strolls to nowhere. She glides towardOscar, pushing her walker and muttering to herself with completedisregard for her surroundings. Perturbed, Oscar watches hercarefully and, as she walks by, lets out a gentle hiss, a rattlesnake-likewarning that says "leave me alone." She passes him without aglance and continues down the hallway. Oscar is relieved. Itis not yet Mrs. P.'s time, and he wants nothing to do with her.

Oscar jumps down off the desk, relieved to be once more aloneand in control of his domain. He takes a few moments to drinkfrom his water bowl and grab a quick bite. Satisfied, he enjoysanother stretch and sets out on his rounds. Oscar decides tohead down the west wing first, along the way sidestepping Mr.S., who is slumped over on a couch in the hallway. With lipsslightly pursed, he snores peacefully — perhaps blissfullyunaware of where he is now living. Oscar continues down thehallway until he reaches its end and Room 310. The door is closed,so Oscar sits and waits. He has important business here.

Twenty-five minutes later, the door finally opens, and out walksa nurse's aide carrying dirty linens. "Hello, Oscar," she says."Are you going inside?" Oscar lets her pass, then makes hisway into the room, where there are two people. Lying in a cornerbed and facing the wall, Mrs. T. is asleep in a fetal position.Her body is thin and wasted from the breast cancer that hasbeen eating away at her organs. She is mildly jaundiced andhas not spoken in several days. Sitting next to her is her daughter,who glances up from her novel to warmly greet the visitor. "Hello,Oscar. How are you today?"

Oscar takes no notice of the woman and leaps up onto the bed.He surveys Mrs. T. She is clearly in the terminal phase of illness,and her breathing is labored. Oscar's examination is interruptedby a nurse, who walks in to ask the daughter whether Mrs. T.is uncomfortable and needs more morphine. The daughter shakesher head, and the nurse retreats. Oscar returns to his work.He sniffs the air, gives Mrs. T. one final look, then jumpsoff the bed and quickly leaves the room. Not today.

Making his way back up the hallway, Oscar arrives at Room 313.The door is open, and he proceeds inside. Mrs. K. is restingpeacefully in her bed, her breathing steady but shallow. Sheis surrounded by photographs of her grandchildren and one fromher wedding day. Despite these keepsakes, she is alone. Oscarjumps onto her bed and again sniffs the air. He pauses to considerthe situation, and then turns around twice before curling upbeside Mrs. K.

One hour passes. Oscar waits. A nurse walks into the room tocheck on her patient. She pauses to note Oscar's presence. Concerned,she hurriedly leaves the room and returns to her desk. She grabsMrs. K.'s chart off the medical-records rack and begins to makephone calls.

Within a half hour the family starts to arrive. Chairs are broughtinto the room, where the relatives begin their vigil. The priestis called to deliver last rites. And still, Oscar has not budged,instead purring and gently nuzzling Mrs. K. A young grandsonasks his mother, "What is the cat doing here?" The mother, fightingback tears, tells him, "He is here to help Grandma get to heaven."Thirty minutes later, Mrs. K. takes her last earthly breath.With this, Oscar sits up, looks around, then departs the roomso quietly that the grieving family barely notices.

On his way back to the charting area, Oscar passes a plaquemounted on the wall. On it is engraved a commendation from alocal hospice agency: "For his compassionate hospice care, thisplaque is awarded to Oscar the Cat." Oscar takes a quick drinkof water and returns to his desk to curl up for a long rest.His day's work is done. There will be no more deaths today,not in Room 310 or in any other room for that matter. Afterall, no one dies on the third floor unless Oscar pays a visitand stays awhile.

Note: Since he was adopted by staff members as a kitten, Oscarthe Cat has had an uncanny ability to predict when residentsare about to die. Thus far, he has presided over the deathsof more than 25 residents on the third floor of Steere HouseNursing and Rehabilitation Center in Providence, Rhode Island.His mere presence at the bedside is viewed by physicians andnursing home staff as an almost absolute indicator of impendingdeath, allowing staff members to adequately notify families.Oscar has also provided companionship to those who would otherwisehave died alone. For his work, he is highly regarded by thephysicians and staff at Steere House and by the families ofthe residents whom he serves.

Source Information

Dr. Dosa is a geriatrician at Rhode Island Hospital and an assistant professor of medicine at the Warren Alpert Medical School of Brown University — both in Providence.

PubMed Citation

week 2 mileage

2007-08-19T14:33:00.000-04:00

time spent...

classes, labs, lectures, & dumb presentations: 25 h
ce: 0.5 h
opp: 0 h
anatomy: 37.5 h
medical appointments: 5 h
exercise: does carrying my book bag up the stairs count?
crying & whining: >2 h

factoid of the week: skin cancer

2007-08-19T14:30:00.000-04:00

as i believe i mentioned in an earlier post, i've been making an effort to pay attention to material i come across during my studies that piques my curiosity or interest. i'm calling these little nuggets "factoids," for lack of a better term.

this week's factoid proved more difficult to study than i'd anticipated. it all began while i was studying the dreaded brachial plexus in lab on wednesday. our group went to look at this meshwork of nerves in one of the cadavers. it was the first time we'd seen one of the cadavers face up this year. for whatever reason, it's more difficult to see the ventral side of these bodies than the dorsal side. our group took it in stride, though, and began to make sense of the mass of nerves in the cadaver.

it's hard to tell what's what in a cadaver. the preservation process they undergo leaves the tissues looking rather like thanksgiving turkey meat--for the most part, all the tissues are the same color, and they're dehydrated, so they're not always in the same position as one would expect them to be. it takes quite a while to learn how to appreciate the difference between an artery and a nerve, as you can imagine--both look like beige string.

as we were reviewing the nerves and arteries in the brachial plexus, though, we noticed a large, brownish-red mass on one of the nerves. 'strange.' i thought. 'that shouldn't be there.' then as we were digging around in the cervical area, we found more of these masses. as we went through our studies, i wandered around to view the rest of the body, and then it hit me: this was the cadaver that had died of cancer. skin cancer, to be precise. the masses we saw were metastases. and they were spread *everywhere.*

friday, as i was sitting through yet another exceptionally droll administrative lecture, i went to a blog i'd heard mentioned on dr_couz's blog (gotta love the blog chain effect!) written by a woman with melanoma. in it, sarah, a woman who was born the same year i was, describes her battle with cancer. her blog is stunning. i highly recommend you read it, from beginning to end. now.

sarah's blog sent me to another, living with melanoma. between the two, i gained a whole new perspective on what it must be like to be a cancer patient, particularly a young one. some of what they experienced overlaps with my experience, and likely the experiences of anyone who has faced a chronic disorder that requires careful and consistent management; but their experiences run deeper than i could've ever imagined. i never really thought about what it must be like to live with a disease that you can literally watch eating you alive. i also had no idea it could spread so fast....

and that's what brings me to post about what i've seen and read: it's clear to me now that the signs of disease can be extremely subtle and that we need, more than ever, to pay attention to our bodies. i don't mean to suggest that we all become hypochondriacs--that would be counterproductive. but rather that we take time to really look at our bodies, to check in with them, to observe change over time, etc.

i read a post back in july by kevin_m.d. that, well, frankly pissed me off. it basically suggested that breast self-examination is a worthless tool for the detection of cancer. the post and linked article angered me not because i doubt the stated statistics, but rather because it implies that women should ignore their breasts. the trouble with this is that society tells us--particularly those of us who are women (and i say this not to be sexist, but i noticed that nobody's done a study on the efficacy of testicular self-exam in men*)--that we're not supposed to be in touch with our bodies.

doing breast self exams may or may not allow women to detect possible malignancies earlier than they would be detected by other screening measures. but they do give women permission to pay attention to their breasts. (you'd be surprised at how many people are afraid to look at their bodies--this concept of it being okay to look at oneself wasn't fixed with hand mirror parties in the late 60s, believe me.) and one bright physician, dr. christiane northrup, extends the concept further. in her book, women's bodies, women's wisdom, she recommends what she calls a "monthly self-care ritual." the concept is that a woman take time, once per month, to examine her whole body. the idea is not to look for tumors or cancer--the concept is to appreciate one's body and learn how it feels when it's well. When we're informed about our bodies--their anatomy, physiology, and their innate unique personal quirks--we're more in tune with them, and we're more likely to notice changes, good or bad!

i assert, as well, that such a monthly screening ritual is not just for women. men would benefit from doing this, too. again, not to seek out disease--but to know wellness.

my factoid for the week was melanoma. my message(s) for the week? wear sunscreen. learn from the experiences of others. get to know your body. touch yourself! i promise you won't be sorry.

as one of my professors said this week: the lecture is over. now go learn something! :-)

* yes, i did look it up on PubMed, in case you're wondering.

the medical school exam experience

2007-08-14T08:08:00.000-04:00

at present, i'm breaking about 10 rules by logging on to blogger from school, but it's 8am and they've dragged our butts here for a presentation by the president of a medical association (i.e. pr bullsh!t talk) and now they're telling us it's going to start at 8:30am instead of 8:00am, and i'm feeling just a tad bitter about missing out on that extra 30 minutes of sleep. <--yes, that was a run-on sentence. this is the kind of verbiage i produce after one very long, stressful day yesterday and not nearly enough sleep last night. but the point of my post is not to whine about my fatigue and the multiple unnecessary events i'm required to attend on a regular basis...rather it's to relate my experience of medical school exams.

i actually wrote a post about medical school exams yesterday, as i was sitting in one of the afternoon lectures. we have a new professor here who is from the former USSR. he's an interesting guy--exuberant and hyper educated (an md/phd breed) and has a wealth of information to share with us. alas, between his accent and his utter inability to create a useful powerpoint presentation, we're not quite benefiting as much as we could be under the circumstances. it's a shame, really.

so during lecture, i pulled up word, changed my font to some crazy small unlegible from (so as to prevent the faculty in the two rows behind me from reading my ramblings) and pretended to be taking notes while i was really going on a very long venting rant about how much i hate medical school exams. i'm not going to post that particular rant here. it contained one too many expletives, even for my taste. ;-)

the whole medical school experience is difficult to describe. i think that's one of the reasons i'm so interested in attempting to capture this process--how do i explain what i'm going through to others? i think it's important, to somehow articulate this so-called life, not just for my family and friends (so that they don't assume i've just fallen off the planet!), but also for those of you out there who may be contemplating this path. i sure wish i'd had a blog or two to read before jumping into the thick of this. then again, can a pre-medical student really hear what a medical student is saying? it's hard to know. as open-minded as i'd like to think i am, i'm not sure i could've heard what i have to say now before i began.

yet, i digress. again. (i seem to be getting better and better at rambling. it's a function of how much i'm studying and how little social interaction i'm getting!) what are medical school exams like? what makes them difficult? why do they trip up students who have been consistently successful in every other academic endeavor they've ever undertaken?

i can only speak from my experience--i doubt it's the same for everyone--but i know there are some common threads, so here's my attempt at a description: i'll use the exam we took on monday as an example. the faculty dubbed it the "welcome to medical school" exam. it was "only" worth 10% of our grade. i say only because most exams in medical school are worth, at a minimum, 30% of a student's grade for the semester. most are worth more than that. in some courses last year, our grades depended upon one examination. in other words--if you had a bad day on test day, it sucked to be you, because there was no room for improvement or remediation. harsh? hell, yes.

comparatively, then, monday's exam was one of the easier ones, simply because there was less performance pressure. however, just because the exam was worth less, doesn't mean that there wasn't less material on the exam. the test on monday comprised the following:

gross anatomy of the:

vertebral column
back muscles (superficial and deep)
sub occipital triangle
shoulder
scapula

microanatomy of:

epithelium
connective tissue
bone
cartilage
muscle
lymphoid tissue

on the exam, there were 60 written multiple-choice questions (all board-style, meaning that they're supposed to be representative of the type of questions we'll be asked on the qualifying examination for basic medical sciences that we take at the end of our second year and have to pass in order to move on to third year and the clinical rotations therein) and 30 practical questions (also board-style, but based upon powerpoint slides that were shown to us of different images, like a picture of one of our cadavers or a histological slide of a blood cell, etc.). this was all based upon two weeks of classes. <--yes, you read that right--all that, from two weeks of classes, intermingled with orientation and two other classes (osteopathic principles & practices and clinical exam). that's 14 days. to learn all that. now do you see why the analogy of medical school being like trying to learn how to drink out of a fire hose when you're not really thirsty is so apt? ;-)

as you can imagine, every student in the class was stressed out about this exam. that's another aspect of the examination process in medical school that makes exams so difficult--no matter how hard you work, you never feel like you've learned enough or are prepared. no, not even the second time around. the combination of quantity of material, insufficient amount of time, and weirdness of the questions themselves--well, it just makes for one heck of an exam experience.

--

i ended up being interrupted in the midst of my ramblings, as you can well imagine. there's only so long that even i can type while in a lecture without raising suspicions. it's now sunday. i'm still exhausted from last week's marathon, but, guess what? there's no time to rest. the next exam is in 8 days. and counting....

our class, as a whole, performed better on this year's exam than last year's class. that made the faculty happy, so they haven't started in on us with the "you're stupid" attitude. at least, not just yet. as for the results of the exam? the highest score (combined written + practical) was a 98%, the low was a 48%, and the mean was 80%.

the good news? i doubled my score from last year. the bad news? the score still wasn't high enough for me to pass. *ouch* <--feel free to cringe with me on this one. three lousy points, two lousy questions...that's all i needed....

i'm not sure how i'm going to remedy my test-taking deficiencies. i know this material. i have been teaching the material to others. but i suck at answering multiple choice questions, particularly ones like these. is it test anxiety? some of it, for sure. but that doesn't seem to be the whole problem. guessing by what it took to get through this last year, it looks like it's going to be another l-o-n-g semester....

so, in case you were wondering, that's a small (very small) glimpse into the world of how it feels to take a medical school exam. i hope it helps those of you who are curious. and for anyone who has been through this--any advice on correctly answering multiple-guess questions? this C-BAD-DAD method of bubbling in the scantron doesn't seem to work so well. ;-)

onward!

week 1 mileage

2007-08-12T13:14:00.000-04:00

this year, in an ingenious fit of inspiration, mwms decided to give all the incoming first-year students a survey to complete during the first four weeks of school. the concept is to calculate "the number of hours spent in studying the following subjects for the next four weeks" and then submit the form "anonymously" so that the administration can get a sense of how much students are studying. the first week of school they technically dubbed "week 0," so we began calculating this week (who starts counting from 0, i don't know...how can a week be 0?!?!?). for those readers interested in knowing what the life of a medical student is like, prepare to be amazed....

week 1 mileage:
time spent in class, labs and lectures: 25 hours
independent study (i.e. study time outside of class) for clinical exam (ce) course: 0.5 hours
independent study for osteopathic principles & practices (opp) course: 1 hour
independent study for anatomy: 35.5 hours
medical appointments/sessions: 5 hours
legitimate exercise: 1 hour
time spent reassuring classmates: endless

the big question: did i study enough to pass tomorrow's anatomy exam? who knows?

an excuse to procrastinate: i've been tagged!

2007-08-12T11:04:00.000-04:00

:-)

i've been tagged! this means that, for an actual, oh, 20 minutes or so, i get to stop thinking about anatomy! hooray!

okay, perhaps it seems a little strange for a medical student to want to be distracted from her studies, but you have to understand: i've just been through two weeks of anatomy, punctuated only by very droll orientation lectures and one too many doctors' appointments. it is a tad easier this time around--i've been able to stuff my own anxiety just long enough to look around and notice that when you take 160 overachieving type-A students and put them under a crazy amount of pressure, life gets rather comical. being on campus is akin to being put in a blender of self-doubt--i swear, i can hear the voices in other people's heads asking the same questions that mine does:

am i studying enough? am i smart enough to do this? how come everyone knows this material better than i do? what am i not doing? why can't i learn faster? did they make a mistake with my acceptance? did i do something to piss off the anatomy professors? is that why they ignore me? what if i fail? what if i get kicked out of school? what if i kill someone because i didn't learn the innervation of this muscle? who was that dead person? why do i have to study dead people? what was this person thinking when they put on that coat of nail polish for the last time? omg, i just wasted 5 minutes thinking about nothing! will i fail the exam on monday because i wasted 5 minutes?

i could go on for hours. but i'll spare you. but in case that wasn't quite enough of a description to give you a glimpse into this world, check this out--the following is the list of topics that will be on tomorrow's exam:

osteology/function/movement/characteristics of the vertebral column
all the muscles of the back, including their origin, insertion, innervation, blood supply, function, embryologic origin, etc.
all the muscles of the shoulder and upper limb, with all the same 411 as for the muscles of the back
the microanatomy/histology of all of the following, including how to recognize tissue type, cell type, function, composition, development, etc.:

epithelium
connective tissue
cartilage
bone
lymphoid system
muscle

any/all relevant clinical information to said areas, particularly as relates to "loss of function"

so that's what i have to know for tomorrow. no biggie, right? now if i could just keep myself from having a panic attack....

but i digress. the point of this post is not for me to whine about anatomy or share my anxiety. rather, the point is NOT to think about anatomy or the exam or about anything regarding the past two crazy weeks of my life! so, on to the point: 7 (random!) things about me.

i can witness human medical emergencies, whether on tv, in a movie, or in vivo, but i cannot watch animal emergencies. for some reason, i cannot bear the sight of a critter in pain. i suppose it has something to do with their inability to speak for/defend themselves, but i'm not really sure. what i do know is that i'm still haunted by images of animal abuse/injuries that i've seen in the past--even if they were part of a natural course of life documentary. roadkill breaks my heart. <--yes, even if it's "just a squirrel." i am, truly, that sensitive.
one of the best days of my life was a birthday on which a friend took me to see the rhind papyrus in the British museum in London. since the papyrus is sensitive to light, it's stored in a desolate hallway in the bowels of the behind-the-scenes portion of the museum. you can only get to it if you've got connections--case in point, my friend, who is a professor of math history. it's the most amazing thing, to end up in some random place like that, having a personal viewing of one of the oldest documents in the world. it was particularly special to me because i grew up with a considerable amount of math anxiety that i didn't confront until i went to do my post-bacc pre-medical studies and was shoved, head-first, into a calculus class after not having had a math class in, oh, probably 8 years or so. thanks to my fantastic professor, i overcame my anxiety such to the extent that i am now a student member of the Canadian society for the history and philosophy of mathematics. i now love math! i sh!t you not! how random is that?!? ;-)
i've been such a "good girl" that i've never experienced the kinds of things most people do either as teenagers or in college. yes, this means that i've never been drunk. or stoned. or any of that (although some of my family members would argue that i'd benefit from a bit of pot now and then....). my case of "goody-two-shoes" is bad enough that i actually missed points last year on one of my exams because i couldn't remember how many cigarettes were in a pack or how many ounces of beer equated to a shot. it's sad, i know. *however,* i can curse like a sailor. and often do. especially when i'm in medical school. apparently this started when i was a toddler. what can i say, i've always had a penchant for words!
my right ear sticks out. i don't really know if people notice it unless they look closely, but it is abnormal. most would probably deem it a congenital defect, but i blame it on the @sshole who delivered me via forceps because he was going to be late for his tennis match if i wasn't born on his schedule. apparently i was bruised for weeks after that delivery. people have suggested that i get my ear "pinned," but i've had enough medical procedures for one lifetime already. besides, i eschew the notion that one must be perfectly symmetrical in order to be beautiful.
along the lines of #3, i am probably the only person who has ever been accepted to medical school after saying the f-word in the interview. :-P oh, does that require some explanation? there's a good--and very true--story behind this. it's got to do with a professor i once had who directly said to a student (in the middle of class, mind you): "f*ck you." i personally asked her to cease and desist this behavior, one on one, like an adult, during her office hours (i may curse, but i never direct it *at* people...unless i'm in traffic....). her response? first, to tell me that i'd never get into medical school and that if i did, i'd never survive. second, she slapped me with a d- in the course (an essay based class with no other professor teaching the same subject in the school--how convenient!). i had to explain my grade, of course, which is how i came to say f*ck in my medical school interview. it's all about the context....
i have an intense phobia about the deep ends of pools and of drains in particular. why? i have no idea.
because this is such a good story--even i could not make this up if i tried--i will tell you about my most embarrassing moment ever. it happened when i was dating a certain someone. i'd escaped to his house one year when we had a particularly bad hurricane season. we had gotten several back to back storms where i lived at the time, so i ended up living with him for a month in a city without hurricanes. one day, while he was at work, his mom came over to look for a document (i.e. paper) that he had misplaced. she went into his home office and looked for it. i found this a bit odd, simply because i'm one of those people who does not go into another person's space uninvited. when she didn't find the paper in the office, she went into his bedroom and started looking for it there. why she expected that he'd put such a thing in his underwear drawer, i do not know. she said something to me about helping her look for the document, but i said that i don't go through people's drawers when they're not around. her reply? "oh, he doesn't have anything that's private." i'm pretty sure this is when i froze and stood there like a proverbial deer in headlights. before i could snap out of it, she went over to the nightstand and opened the drawer. yeah...that's where we kept the, erm, "toys" and such. i wished, at that moment, for the earth to crack open and swallow me whole. but it didn't. she said nothing; in fact, she kept going through drawers! 8-O By the way, did i mention that his mother had been my high school math teacher? *shudder* and you wonder why i had math anxiety.... i told you, i couldn't make this sh!t up if i tried.

so, there's seven (random) things that probably represent seven more things than you ever wanted to know about me! :-) but then, i bet i made you laugh. and i got to procrastinate. so it's all worth it!

since j.p. could likely use some distraction, i say: "tag! you're it!" ;-)

thanks, americanmum, for the reprieve from study!

the most prevalent question: what's a d.o.?

2007-08-03T14:10:00.001-04:00

i don't know if i've explicitly mentioned this before, but i'm an osteopathic medical student.

wtf does that mean?

i'm sure you're wondering.

in the u.s., there are two different types of physicians who are licensed as medical doctors. one group everyone knows about. these are the doctors who have "m.d." posted behind their names. (m.d. = medical doctor) they comprise, at present, the majority of physicians in the country. the medical schools that provide m.d. degrees are known as allopathic medical schools. the other group is lesser known. these are the doctors who have "d.o." posted behind their names. (d.o. = doctor of osteopathy) they comprise, at present, the majority of medical students in the country. the medical schools that provide d.o. degrees are known as osteopathic medical schools.

what does all this mean? well, truthfully, it depends upon who you ask. the history of how osteopathy came about and split from allopathy is one that proves quite complex. interesting, no doubt--but way beyond the scope of what i can explain here. historically, osteopathic medicine has proven more "holistic" than allopathic medicine. many (if not most) of allopathic physicians would say, however, that allopathic medicine is more grounded in medical science than osteopathic medicine. as with any fine splitting of hairs in a discipline, the two sides tend to bash each other quite a bit. this is unfortunate, because in reality, both types of practitioners and students have tremendous expertise that they could share with each other if they'd get over the notion that one type of doctor is "better" than another.

given the increase in awareness on both sides of the educational divide regarding "alternative" medical practices, today's medical school graduates are, imho, all equal. some people would argue with this--after all, is getting a degree from man's best medical school the same as getting a degree from man's worst medical school? i argue that either notion is fiction. there really aren't "opposites" in medical schools in terms of best and worst. some schools have better programs in certain areas than others, some have more research opportunities, some have superior clinical opportunities, some have different styles of instruction, etc. the old notion that some schools are better because they've attracted more students with 4.0 gpas and scores of 35+ on the mcat...these "predictors" (as they're dubbed by med school admissions committees) are rather arbitrary. of the thousands of people who apply to medical school, only about 1/10th actually get a seat at a school. i highly doubt that there's any "dumb" person amongst those who get in. in fact, it's arguable as to whether or not any applicants could be considered "dumb"--anyone who applies is hyper-educated, at the very least. also, as anyone who has been through the process can tell you, there's a point at which an applicant realizes that s/he doesn't care where s/he gets to go to school--everyone who gets in is simply grateful to be able to go. so, do the students at mbms have higher iq's than those at mwms? probably. does this mean they'll end up becoming better physicians? hell no.

in my opinion, it matters little which type of doctor one is or where one did her or his training. the important thing is how a physician practices.

nevertheless, the most oft asked question of an osteopathic medical student is "what is a d.o.?" everyone asks this question. some more than once. the students at my school have been talking about this all week. how do we answer this question? what is the difference? what do we want people to know?

a group of osteopathic physicians in california, in collaboration with two osteopathic medical schools in that state, created the following youtube video as a response. it's a little bit commercial-y for my taste, but it gives a very basic overview.

other than this, there are a few details about osteopathic physicians that i'll delineate here, particularly since they're often misunderstood:

d.o.s are licensed by the same medical board(s) as m.d.s
the curriculum in an allopathic medical school differs from a curriculum in an osteopathic medical school only by one class: d.o. students are required to spend the first two years studying osteopathic practices (osteopathic practices are similar to techniques used by a chiropractor, a physical therapist, or a massage therapist, etc.--i.e. they're hands-on techniques used to treat dysfunctions of the musculoskeletal system)
d.o.s and m.d.s, for the most part, end up doing residencies together (so their training is identical in the post-graduate sense)
d.o.s and m.d.s do the exact same things, ranging from performing a school physical on a kid in family practice to conducting a heart-lung transplant operation in surgery
the "holistic" philosophy to which d.o.'s subscribe is defined as follows:

the body is a unit; the person is a unit of body, mind, and spirit
the body is capable of self-regulation, self-healing and health maintenance
structure and function are reciprocally interrelated
rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function

so, there's my brief answer to the most prevalent question. if you find it helpful/interesting, please pass it on!

biddle says: no cheezburger 4 u!

2007-08-01T21:28:00.000-04:00

biddle has been upset since i've returned to medical school. she hasn't been getting enough attention. she wanted a forum for herself, so i submitted her photo to i can has cheezburger? please vote for her when she appears on the voting page!

the first day -- again...

2007-07-30T23:38:00.000-04:00

i'm amazed that one year after writing this post, i've just relived the first day of medical school again. today was like one gigantic deja-vue dream. the slides were the same. the lecturers were the same. the message was the same (aka: they own my ass. still.). the only difference? this time, they decided to begin anatomy on day one. so in addition to hours of talks on policies and procedures, we had two hours of anatomy lecture. that shocked most of the incoming students, i could tell. it's one thing to hear described how much information will be thrown at us; it's an entirely different thing to experience it. by the end of the day, it seemed like the class was rather sobered.

i feel like being a brat and saying 'i told you so,' particularly to my roommate, who was eyeing me suspiciously all weekend as i studied anatomy. "classes haven't even started yet!" she exclaimed. my response? "it doesn't matter." i kept studying.

when i mention to my new set of peers that i'm a returning student, i get some pretty odd looks. many people prickle a bit, on the assumption that i've got some kind of academic advantage. sure, i've heard these anatomy lectures before--but i'm not certain that makes up for the loss of confidence that comes from having done poorly in the course the first time around.

the days leading up to today were riddled with anxiety for me. can i do this? am i well enough? should i do this? am i making the right decision? is it worth it? what if i fail? <--these were just a few of the questions rattling around in my head. i still don't have answers to the questions. but i did come up with one crazy idea: to find one thing, each day, that i learned that interested me. i'm sure on many days there will be more than one thing that piques my curiosity--but it's not always easy to remember to be curious in the midst of such a pressured environment. since i'm here because i love to learn, though, i need to remind myself why i'm doing this. and i need to remind myself as often as possible. so...i'm off to a new start again. here's to hoping the road will be less bumpy this time around....

....

interesting factoid of the day:

"during early embryonic development cilia containing a 9 + 0 pattern of microtubules establish the left-right asymmetry of internal organs"*

this quotation refers to the fact that there are these itty bitty hairlike processes (cilia) that extend from cells that help cells to move (think of high school biology class and seeing weird critters move around under the microscope via what look like little caterpillar legs.). apparently, recent research studies have shown that the location of the internal organs in the body (i.e. that our heart is on the left & the liver on the right, etc.) comes from the movement of these little cilia found on cells really early in embryonic development. the significance? people who lack these little cilia end up with situs inversus, a condition in which the internal organs are reversed in their position, such that what is usually on the right ends up on the left and vice versa.

sketch of the apperance of situs inversus in the thorax

pretty cool, no? ;-)

....

daily mileage:
orientation lectures: 6.5 hours
anatomy lectures: 2 hours
time spent trying to get the class schedule to print properly: 1 hour
individual study time: 0 hours

....

* Ross, M et al. "Histology: A Text and Atlas." 5th ed. New York: Lippincott, 2006. Pp. 105

rant: Breaking News - Cleavage on Display

2007-07-20T15:38:00.000-04:00

Have we reverted to the Victorian Age? Based upon the following email I received from NOW, one would think so.

Breaking News: Cleavage on Display

"There was cleavage on display Wednesday afternoon on C-SPAN2. It belonged to Sen. Hillary Clinton... There wasn't an unseemly amount of cleavage showing, but there it was. Undeniable," the Washington Post reported.

NEWSFLASH: Hillary Clinton has breasts.

And apparently that "news" merits coverage in the Washington Post.

In a Style section cover story on Friday, fashion "reporter" Robin Givhan notes that Hillary Clinton has taken a brazen step for a woman politician by wearing a low neckline. "Showing cleavage," says Givhan, "is a request to be engaged in a particular way. It doesn't necessarily mean that a woman is asking to be objectified, but it does suggest a certain confidence and physical ease."

Shock! Horror! A prominent woman showing confidence and physical ease!

Givhan goes on with her psychobabble: "It means that a woman is content being perceived as a sexual person in addition to being seen as someone who is intelligent, authoritative, witty and whatever else might define her personality. It also means that she feels that all those other characteristics are so apparent and undeniable, that they will not be overshadowed."

This article about the frontrunning candidate for U.S. president caused quite a stir in the NOW office this morning, eliciting reactions ranging from "You've got to be kidding!" to "What century is this?" The piece is definitely outrageous, but it's also hilarious. Absurdly hilarious. And it's an indictment of our society's lingering archaic notions of femininity, assumptions about breasts and sexuality, and fears about powerful women.
What do you think? Share with us your take on this story -- whether analysis or satire. We'll post the best ones on the web site. Send your submissions to cleavage@now.org.

Read more on media treatment of politicians including Hillary Clinton. Sign our petition to major media outlets. Send this story to your friends.

my reaction to all of this?

*headdesk*

Basically, the Washington Post is saying that in order to be taken seriously in this world, I have to have a sex change operation. I mean, that can be the only conclusion, given that I am a woman who has breasts and that, no matter what I do, they're evident. As a future female physician, will I always be second-guessed because of them? What a horror, to think that a physician might *gasp* have breasts!

Come on, Victoria's Secret, where's your new line of cinch bands for women who want to have successful careers?

clearly, you've missed the market....

more fun, silly, taking-up-webspace things...

2007-07-08T16:54:00.000-04:00

i'm in a goofy mood today and have decided to waste time (i.e. procrastinate) by puttering around with my blog. i saw a meme on another site that i liked and decided to tweak it a little, answer it, then pass it on. i tag j.p., americanmum, and dr. cs. :-)

WERE YOU NAMED AFTER ANYONE? Yes. The poet Dylan Thomas' wife, but she was "star-crossed" so my mom changed the spelling. ;-)
WHEN WAS THE LAST TIME YOU CRIED? Last week. After waking up from a nightmare about my impending Anatomy class. (Okay, I admit it, I'm a wimp! I don't like being told that I'm stupid 10-20x per day for 10 weeks!)
DO YOU LIKE YOUR HANDWRITING? Yes, but everyone tells me it is too neat for a physician, so I may have to make it sloppier.
WHAT IS YOUR FAVORITE LUNCH MEAT? almond butter!
DO YOU HAVE KIDS? kids = baby goats, dammit. so, no, i don't have a goat and i don't own a farm. but if the question intends to ask whether i have children, do my cats count? if so, yes. if the human kind is being implied, then no.
IF YOU WERE ANOTHER PERSON WOULD YOU BE FRIENDS WITH YOU? i sure hope so.
DO YOU USE SARCASM A LOT? define "a lot"? ;-)
DO YOU STILL HAVE YOUR TONSILS? ooh, actually, YES--tonsils are a body part i've managed to retain (knock on wood).
WOULD YOU BUNGEE JUMP? no. working in the trauma center cured me from the desire to do anything of the sort.
WHAT IS YOUR FAVORITE CEREAL? i don't like cereal, unless you count granola or oatmeal...
DO YOU UNTIE YOUR SHOES WHEN YOU TAKE THEM OFF? people still wear shoes with laces?!? just kidding. ;-) no, i generally just slip 'em off.
DO YOU THINK YOU ARE STRONG? some days, yes. some days, no.
WHAT IS YOUR FAVORITE ICE CREAM? harrell's cinnamon nutmeg. but since i can only get harrell's at a certain time/place, ben & jerry's mint chocolate cookie is my most frequent choice.
WHAT IS THE FIRST THING YOU NOTICE ABOUT PEOPLE? their tone of voice.
RED OR PINK? red.
WHAT IS YOUR LEAST FAVORITE THING ABOUT YOURSELF? my sickly health.
WHO DO YOU MISS THE MOST? mjt
DO YOU WANT EVERYONE TO SEND THIS BACK TO YOU? no, i want them to post it on their blogs & pass it on.
WHAT COLOR PANTS AND SHOES ARE YOU WEARING? navy pajama pants, no shoes.
WHAT WAS THE LAST THING YOU ATE? whole food's organic instant oatmeal with flax seeds.
WHAT ARE YOU LISTENING TO RIGHT NOW? the sound of the wind in the trees (or what i can hear of it over the hum of the air conditioner and the tappity-tap of the keyboard).
IF YOU WHERE A CRAYON, WHAT COLOR WOULD YOU BE? midnight blue
WHAT ARE YOUR FAVORITE SMELLS? pumpkin or apple pie baking, fresh rain hitting the ground, & certain men's cologne's/soaps.
WHO WAS THE LAST PERSON YOU TALKED TO ON THE PHONE? my mom! :-)
DO YOU LIKE THE PERSON WHO SENT THIS TO YOU? erm, technically this wasn't sent to me--i nabbed it from monkeygirl...but, yes, i like this person's internet persona.
FAVORITE SPORTS TO WATCH? home renovation. ;-)
HAIR COLOR? mine? brown.
EYE COLOR? chestnut, with sprinkles of green.
ARE YOU: OVERWEIGHT, UNDERWEIGHT, JUST RIGHT, OR NEVER RIGHT? starved, because without my gallbladder, i can't eat ben & jerry's. :-( definitely moving back toward the underweight category at this point....
DO YOU WEAR CONTACTS? nope, just glasses for distance when I'm driving or trying to read another boring powerpoint lecture at school.
FAVORITE FOOD? does chocolate count? if not, thai masaman curry with tofu. (<--another thing i can't eat...i'm starting to sense a theme here....)
SCARY MOVIES OR HAPPY ENDINGS? happy endings.
LAST MOVIE YOU WATCHED? "carmen meets carmen" on the internet (my friend was conducting!); "stranger than fiction" on dvd.
WHAT COLOR SHIRT ARE YOU WEARING? heather grey.
SUMMER OR WINTER? depends upon where i'm living!
HUGS OR KISSES? hugs.
FAVORITE DESSERT? anything with chocolate or pumpkin (although not usually both at the same time).
WHAT BOOK ARE YOU READING NOW? besides the bazillion textbooks i'm constantly reading for med school? "between heaven and earth" a text about chinese medicine, which i highly recommend to anyone who is interested in the subject. (of course, with what i read, i'm like the new england weather--wait five minutes and it'll change. i should have begun this page with: "hello, my name is student_dr_blaze and i'm a biblioholic." ;-) )
WHAT IS ON YOUR MOUSE PAD? my alma mater's seal.
WHAT DID YOU WATCH ON T. V. LAST NIGHT? flip this or that house.
FAVORITE SOUND? the deep chuckle of a happy baby.
ROLLING STONES OR BEATLES? indigo girls.
WHAT IS THE FARTHEST YOU HAVE BEEN FROM HOME/HERE? israel.
DO YOU HAVE A SPECIAL TALENT? i can stand on my toes.
WHERE WERE YOU BORN? in a hospital on a sunny day.
WHAT IS YOUR FAVORITE VACATION SPOT? anywhere new.
WHAT'S THE ONE THING THAT YOU'VE BEEN DYING TO DO BUT HAVEN'T DONE YET? deliver a baby.
WHAT'S THE ONE SIMPLE THING THAT MAKES YOU HAPPY? a long, hot shower.
HAVE YOU EVER TRULY BEEN IN LOVE? yes.
WHAT'S YOUR FAVORITE BOOK/AUTHOR? i have to choose just one?!? <--that's a herculean task. i'll go with what i know best: adrienne rich's dream of a common language.
WHERE IS YOUR FAVORITE PLACE TO BE? on the wooden swing underneath the big maple tree overlooking the pond at my alma mater.
WHAT'S YOUR PERSONAL THEME SONG? currently: breathe/2am by anna nalick
ARE YOU REGISTERED AS A REPUBLICAN, A DEMOCRAT, OR AN INDEPENDENT? registered Democrat, independent at heart.
WHEN YOU WERE A KID, HOW DID YOU SPEND MOST OF YOUR TIME? reading or dancing.
WHAT IS THE AIR-SPEED VELOCITY OF AN UNLADEN SWALLOW? african or european?

the lemming effect

2007-07-08T16:31:00.000-04:00

first americanmum did it. then dr. cs followed suit. so, i decided to become a lemming, join in the fun, and turn it into a meme of sorts. j.p., i tag you--you're it!

what's the fun? the new simpsons movie has an avatar creator so that anyone can make their own simpson self. it's rather amusing and, in the midst of so much seriousness, i thought it couldn't hurt to spice things up with a little humor. try it out for yourself here.

as for me? within the parameters given (what? simpsons don't wear birkenstocks? what's up with that?!?), i found simpsons_me. ;-) enjoy!

oh, and in case you're wondering about the t-shirt choice...could there be a better option for a vegetarian? i think not. ;-)

rant: "...i hope he does a good job."

2007-07-05T15:02:00.000-04:00

just when it seemed that the situation couldn't get any worse...he used the pardon card. super_blaze pointed me to this video--hard to believe it actually appeared on live television, but i guess we haven't lost our 1st amendment rights (yet)--and i think it says, succinctly and eloquently, what so many americans wish they could say to w right about now.

pass it on!

A plea: support the Hate Crimes Act

2007-06-20T23:57:00.000-04:00

AmericanMum brought to my attention this powerful video from the Human Rights Campaign. It shows why we need to take a stand in support of the Hate Crimes Act and stop these senseless acts of violence. Please watch the video and write to your senators.

the ponderous patient: the magic needle

2007-06-18T22:37:00.001-04:00

in the continuing saga of my lack-of-a-gallbladder sod dysfunction, mr_dr_do suggested that i see an acupuncturist/traditional Chinese medicine (TCM) physician. i'd been to an acupressurist in college, but never to an acupuncturist. this was largely because, up until the last few years, i'd been terrified of needles. not to mention that i was a tad skeptical--in my years as a patient, the number of times i've been asked to purchase extras (i.e. herbs, vitamins, supplements, salves, etc.) from a physician has been directly proportional to how close one adheres to "western" medicine. in other words, the more "alternative" the practitioner, the more extras one has to buy, and therefore, the more expensive the overall treatment becomes. since i have some ethical qualms about whether physicians should sell products in their offices (a rant i'll indulge in at a later date), it's turned me off a bit to "alternative" pracitioners.* nevertheless, i'm curious about "integrative" medicine and what it can offer. so i decided, in spite of my fears about the costs, to pursue this course of treatment.

mr_dr_do clearly spent a considerable amount of time looking for an appropriate referral and came up with a female physician at a local college of acupuncture, whom i'll name here as dr_tcm. three weeks ago, i went to see dr_tcm for the first time. i liked her instantly (she personally came to the waiting room to get me! who does that?!?)--during the first appointment, i discovered that she's witty, intelligent, cogent, and thoughtful. she'd also been a medical doctor (md) in china, then came to the u.s. and got a ph.d. in endocrinology. this made our encounter all the more interesting because she knows the difference between which types of medicine work best in which situations. she's now one of the main faculty physicians at a local college of tcm.

she didn't promise me the world: "i don't have any magic needles!" she said. but she noted that she has worked on many patients who had various g.i. complaints following surgeries like mine and, based on her experience with them, felt that she could help me.

if somebody had told me that laying on a table naked with needles stuck in various parts of my body would help me feel better, i would have called him/her a fruitcake. i mean, seriously, can you imagine? it sounds like quack.

only, it's not.

when i appeared for my first session, i rated my pain and nausea at 4/10 (10 being highest). by the end of the session, i had *no* pain or nausea. at first i wondered if i'd merely not realized that lying down helps with the pain/nausea (i spent about 1.5 hours laying on the table with the needles in me). but the symptoms were better the next day, too. this continued--i noticed that after every session, i felt better. it didn't mean that my symptoms stopped completely--they haven't--but i've found some relief that doesn't involve massive amounts of heavy-duty medications or life-altering surgeries. how cool is that?!?!?

i did end up buying some products (the "pancakes" of chinese herbs she's given me to put on my abdomen at night were just too neat to pass up--i'd never seen anything like that before, even though "western" medicine now uses a transdermal approach frequently, so i was curious to try them). but most of what dr_tcm has suggested (prescribed?) has proven to be relatively straightforward. some of it, in fact, has been so straightforward that i've felt like smacking myself in the head for not thinking about it myself.

case in point: since surgery, i've been completely intolerant to food that contains fat. (i'm not going to delineate what intolerant means in this context--use your imagination.) so i've dropped all fat containing foods from my diet and had been eating a relatively "raw" diet--that is, i was only eating stuff that, if left on my kitchen counter for any period of time, would go bad (e.g. organic fruits & veggies, etc.). i always had been under the impression that such a diet is about the healthiest one a person can follow. (the only upside to this whole process is that i've dropped about 15 lbs and now weigh close to what i did in college; i don't recommend this as a weight loss program...but at least something good has come of it...i never imagined i'd have a flat tummy again!) the first thing that dr_tcm asked me to do, though, was to change my diet! needless to say, i was perplexed when she asked me to do this. but then she told me what she wanted me to do: eat foods that had been cooked, because the compounds in them would already be broken down a bit and thus would require less effort for my body to digest. she also asked me not to eat anything cold--only hot foods. puzzled by this, i asked my favorite question: why? and then she noted a basic science concept--the cold would make my gut seize as my body tried to regulate its internal temperature. duh, i thought, why didn't i think of that? what's more basic to science than the notion of how temperature is transferred and its effects? apparently, there's a reason i didn't major in science in college....

needless to say, between the diet, the funny herb pancakes, and the acupuncture sessions themselves, i've been beginning--albeit slowly--to feel better. i've got my fingers crossed in the hope that this will last. as she said, there are no magic needles in her arsenal...but there's something profound in her treatments, that's for sure. it's magic enough for me. :-)

....

recently, grey's anatomy had an episode in which they depicted acupuncture. it's a wonderful vignette on what having tcm done for the first time is like--particularly in this country. i hope you enjoy the video as much as i did! :-)

....

*a note on language: i have a strong dislike for the manner in which the english language has been used to name various medical practices. i don't believe that "western" medicine is better than "eastern" medicine; i have difficulties calling u.s. physicians (m.d.s or d.o.s) "traditional" given that tcm and other such practices have been around for many a millennia longer than the medicine we think of as traditional today; and, overall, i'm not the type to think in terms of opposing forces. mwms has just assigned us a new textbook for the upcoming year called "integrative medicine." it discusses the problematic aspects of the terminologies and suggests the term integrative to describe what practitioners with an "holistic" (<--another problematic term) perspective practice/perceive such medicine to be. i personally don't know the best way to describe these different types of medicine--hence i'll put the terms in quotation marks to indicate that they're not terms i've created/i'm not using them as labels.

rant: war

2007-05-31T23:45:00.001-04:00

this isn't my particular rant, but i couldn't have chosen a better way of expressing these sentiments against the war in iraq myself. (warning: video contains explicit anti-war remarks, complete with some choice 4 letter words.)

thanks super_blaze, for bringing this to my attention.

picking up the thread: is it worth it?

2007-05-29T21:31:00.000-04:00

first i must note that my beloved mac is finally back in my possession. i might not let it out of my sight again--that was one long tough week without it! i must thank the mac geniuses--they replaced both my fans, gratis. now the only periodic odd noise i hear is the sound of my cat, biddle, growling at the fed-ups man. did i mention that my cat thinks she's a dog? ;-)

....

i've spent a considerable amount of time lately pondering my pursuit of higher education. i'm not questioning the thirst for knowledge itself, mind you, but the actual paying-of-tuition / sitting-in-classes / eventually-getting-degree part of this whole journey to become a physician. choosing to delay my education for another year has left me feeling a bit depressed. this year, when (if?) i start medical school again, i'll be 30. i know chronological age is essentially meaningless (unless you're an actuary), but for some reason, i feel odd about this fact of turning 30. it's a petty thing, really--i'm experiencing that "always on the outside looking in on other's lives" syndrome that accompanies one of those life moments when everyone i come into contact with seems to have something that i want, yet lack. you know these people: they have the mcjob or the mchouse or the mcpartner or the mcbaby or the mcdog or...the real clincher for me these days...the mchealth. some people i come into contact with even have all of these things, including the mchappiness. i guess they got all the mcluck, too, eh?

the envy i feel probably stems most from having too much time to think. but recently, i realized that i'm not the only one gnawing on these feelings and issues, particularly as they relate to medical school and the sacrifice it entails. this is where i catch onto the thread--dr_panda_bear asked the question first, as far as i can tell, and dr_urostream mentioned it next--and so i might as well audibly voice the question that ricochets through the head of every med student as they hit yet another bump in the road: is it worth it?

it's a heavy question. one might think, based upon my recent "toad list" post where i ranted about some of the worst physicians on record, that i have a negative view of the medical profession. the truth is the opposite: i tend (to a fault?) to see the positive first. i'm a bit of an idealist in this way...and a tad gullible, i suspect, too. it's been difficult for me to answer questions posed to me about medical school and whether it's worth all the time/effort/energy/money/sacrifice/stress/etc. the other bloggers do a great job of addressing the issues in their posts--i wish i could write so cogently and analytically in response to the question.

....

when i ponder the question as to whether or not it's worth it for me to continue medical school, a certain experience comes to mind--the one that confirmed my convictions about being called to this career path. the story, i believe, speaks for itself:

when i first became interested in a career in medicine, one of my physicians, fertile_doc, hired me to work as the slave in his office for the summer. i spent most of my first few weeks on the job culling the thirty years of medical records and journals that were beginning to eat up all the storage space in the office. toward the end of the summer, though, i began doing more clerical work and having some interaction with patients.

the office was chronically busy, particularly on mornings when the ultrasound technician was present, as the majority of fertile_doc's practice surrounded treating couples with infertility issues and ultrasound plays a key role in this process. on one such morning, we were running a tad late. the waiting room was crowded and the staff was bustling about, trying to get all the phones answered, labs drawn, and insurance forms organized. i'd been assigned to "man the window," checking in patients and making sure charts made it to the appropriate spots on the racks for triage. and i was at the point where i was beginning to feel truly frazzled....

in the midst of this, someone knocked on the window. i groaned silently to myself; i'd thought all the morning's patients had been checked in already. what now? i was prepared to give my memorized, automaton directions to the bathroom, insurance policies, etc. i feared i'd strangle a drug rep if they appeared in the midst of our busiest hours. but i opened the window and was quite puzzled by what i saw. an elderly woman sat in a wheelchair with her husband standing behind her. they were definitely not the sort of people who'd show up for infertility treatment and i wondered as to whether they'd wandered into the wrong office. this was a situation that was going to require me to think. carefully.

"does fertile_doc work here?" the woman asked.
"uh...yes." i replied, still feeling puzzled.
"is fertile_doc here now?"
"yes" i replied. "do you have an appointment?"
"no" she said, "but i would like to speak to him."
"I'd be happy to schedule an appointment for you."
the woman looked at me--my confusion was no doubt clear by this point--and then struggled to pull herself up out of the wheelchair until she was standing. now eye-to-eye with me, she said:
"twenty-four years ago, fertile_doc detected my breast cancer during a routine exam. i survived because he discovered it early. i'm here because i would like to thank him."
she then carefully lowered herself back down into the wheelchair.

a few minutes later, i watched as this woman thanked fertile_doc for
what he'd done. most physicians i'd known treated breast exams as a perfunctory part of the physical examination. it's another one of those areas in which technology (in this case, mammography) often replaces good hands-on examination in medicine. but fertile_doc always took this portion of the exam seriously, taking time to really look and feel for lumps and changes in breast tissue. now i knew why he did so. it was a profound lesson.

as i watched this frail woman give fertile_doc a hug, i discovered something even more profound: fertile_doc had given this woman more time--time to be with her children, her husband, her loved ones...time to live. with one small, attentive act in the midst of an everyday job, fertile_doc made a huge difference in this woman's life.

it was in that moment, watching this interaction unfold, that i realized that there was nothing more meaningful i could do with my life than follow a career that had the potential to give even one person an extra minute, day, month, year, of quality life.

is anything worth more than that opportunity?

....

the answer for me, to the question "is it worth it?" is a simple resounding yes. in spite of all the bullsh!t that surrounds medicine these days, I believe it is a privilege to become a physician.

....

to all those physicians who have taken care of me, my loved ones, and even (especially?) the homeless jane & john does on the street: thank you for choosing to make the sacrifice, to dive in, & serve by example to show students that the pursuit of medicine is, indeed, worth it.

formatting issues?

2007-05-25T22:57:00.000-04:00

i had to leave my beloved laptop with the "geniuses" at the mac store a few days ago when i was in the nearest big city. poor thing's fan had started making funny whirring sounds (that were, of course, not reproducible in front of said geniuses). so my laptop is not with me, which leaves me not only with a good deal of separation anxiety, but means that i'm forced to use my old PC desktop.

the experience of using a PC again has proven to be very odd. I'd oh-so-joyously forgotten about the crashing, freezing, restart updates, and generalized slowness of windows. this is kind of funny, considering that i customized this desktop myself and spent a considerable amount of time tweaking it to my liking. i was annoyed last year when i learned i'd have to buy a laptop for school (no matter which direction you go, they're expensive). but i got my macbook pro and never looked back.

now that i'm having to spend a few days on the pc, though, i've noticed something that i'd forgotten to check about: web-page formatting. (i say forgotten, because when i use dreamweaver to work on a website, i'm always careful to check to see how the page will appear in the various different browsers.) i pulled up my blog on this pc in both firefox and ie and am seeing some egregious formatting errors. is my page appearing strange on anyone else's computer?

i had a moment today where my past-post widget appeared with the month names in spanish. how odd is that?!?!?

if anyone has thoughts on how to ensure that blogger behaves on all platforms, i'd love to know the secret. in the meantime, my apologies for missing pictures, strange languages, and other odd behaviors on the blog. never a dull moment, eh?

the ponderous patient: a panic attack

2007-05-25T14:23:00.000-04:00

i swore when i began this whole medical school process that i wasn't going to be one of those medical students who thinks she has every disease or physical problem about which she reads. (i knew i'd be the student with 500 different colored pens and notecards, but that OCD behavior began long before I ever considered this path.) i actually have made a point *not* to read about any treatments I've needed or medications I've taken since beginning med school, because I've been certain that my subconscious will suck up the information like a heavy-duty paper towel sucks up blue liquid on a commercial and that I would, ergo, become one of *those* students....

so. yesterday the cats woke me up at (i kid you not) 6am. i guess they decided it was play time. i disagreed, but couldn't go back to sleep, so i chose to drag myself out of bed and plop myself in front of my computer. i ended up chatting with j.p. (who never sleeps anymore) via gmail talk for quite some time. when the conversation was over, i decided to get myself a glass of chocolate soy milk. <--this has become my new favorite food. yes, i am that pathetic, being so unable to eat anything that tastes good that now fat-free soy chocolate milk is, to me, absolutely delicious. (have i mentioned recently that i'd like my gallbladder back?) so, as i was reaching into my near barren refrigerator for my yummy carton of chocolate soy milk, i noticed that i had a bright pinkred circle on my arm. i put down the carton, rubbed my eyes, and looked at my arm again. still pinkred. "hmm..." i thought, walking over to the ray of sun coming through livingroom window and looking at the spot again. still pinkred. uh-oh.

did i mention that the bright pinkred circle was precisely in the same location as where i had had a tb test done the day before?

so. i make my stupidest move ever and do what i've sworn not to do: i pull out my microbiology textbook. i flip to the index and look for tb and skin reaction. i turn to page 234. and i gasp. there, on the page, is a picture of someone's arm with--you guessed it--a big pinkred spot. "aaaggghhh!" i think. then i read a bit, realize that the circle's size matters, so i go find the handful of coins i keep in my backpack for those marathon lecture days when i cannot stay awake without making a mad-dash to grab a coke from the vending machine. "hmm... not as big as a quarter, but about the same size as a nickel. g-r-e-a-t." having had enough of my microbiology text, i toss it on the floor in disgust.

i then sit down at my computer and do a google image search for tb and skin reaction. up pops about 10 pages of images of arms with--you guessed it--round pinkred dots. it's about at this point that i believe i began cursing. audibly. i scanned a few pages and paragraphs--from places like nih.gov, not bigpinkspot.com--and see a few brilliant key words: weight loss, nausea, loss of appetite, yada, yada, yada; the sites list out about 60 % of the symptoms I've been experiencing lately. more cursing ensues.

my mind starts racing. i spent years working at a medical center that put me at high risk for tb, but i now comparatively live in the proverbial boonies. i had a tb test last year around this time (it's one of those annually "required" tests for medical school) and it was negative. "how the f*ck could i have gotten tb?" i wondered. in spite of the advertisements posted by medical schools, there really isn't any clinical contact during the first year of school. not unless you consider cpr to be a clinical contact experience, which i don't. so it's not like i've been around any patients. and, loathe as i am to admit it, i live in yuppie land. seriously. mcmansions, mcdogs, mcbabies, mchummers, mcgolfers--you mc it, we've got it. except for tb. tb is just not one of those things that gets mc'd. not in this day and age, anyway....

i start thinking about how crappy i've felt in the past year and all the medical problems i've been experiencing during my soon-to-be-over 20s. nobody my age should have this many medical problems. so, once again, up pops the hypothesis: what if all these things are not random individual events? could i have an immune disorder? it certainly would explain a lot...not to mention that one of the populations that most easily contracts tb involves those who are immunocompromised. hmm....

by this point, it's 10 till 9 am. just time for the doctor's office to open. i feel like a schmuck doing it, but i call at exactly 9 am. <--the emotionality about calling stems from having been on the other end of that phone on more than one occasion. medical staff are like any other mortals. talking to them first thing in the morning, just before or after lunch, or in the 5 minutes before closing--it's a bad idea. it gets you labeled as one of *those* patients. the kind of patients who copy down the phone number for the office's back line--since it appears on caller id when you call them to give them test results and such--and then proceed to call that number incessantly if they can't get through on the main number. as if there were enough hands to pick up another ringing phone! note to patients: just don't do it.

the nurse calls me back a while later and asks if the area is raised. nope, just redpink. round. and starting to get kinda itchy. she tells me not to put anything on it--no lotions, creams, soaps, etc--and to come in at my scheduled time on friday to have it checked. "some people have an allergic reaction," she says. so. i realize that there's nothing i can do about this bright redpink spot on my arm except wait.

this means that i now have to focus on my emotions, which have suddenly gone haywire. why did this freak me out so much? i really can't say. my only guess is that, at a certain point, we all hit our limits for the quantity and quality of physical ailments that we can take in any given period of time. for whatever reason (lack of sleep?), this damn redpink spot scares me.

i do the only thing i can think to do: i take a xanax and crawl back into bed.

needless to say, the redpink spot faded over the course of the day and gave rise to a purplegreen bruise. today, there is nothing on my arm save the remnants of said bruise, which is now about the size of a pencil eraser. definitely not tb material. not even in the least.
so. with my tail between my legs, i went into the doctor's office this afternoon to have the spot "read." "where's this pink spot you were worried about?" asks the receptionist, the nurse, and the doctor...although not all at the same time. it's a pity that we're not having hoodie weather, because i could have really used something to hide under. *blush*

so. it's official then: i'm as paranoid as the next medical student, if not more. i was hoping not to catch the disease bug, but like the highlighters, the notecards, the supplemental textbooks, and the 1,001 questions, all fingers point at me. even as a patient, i'm the penultimate med school nerd. penultimate because there are still a few worse than i am--they're the ones still sitting in the doctor's waiting room. ;-)

the ponderous patient: the list

2007-05-23T22:04:00.000-04:00

in the midst of my appointment with mr_dr_do today, he wondered aloud as to where he was on my "list." for some reason, he thinks i have a list of physicians in some sort of order--like my own personal rankings. lol. i've been a patient for a long time, but i don't make a habit of going back to "repeat offenders." nevertheless, i've since been pondering this list notion and have decided it would be pretty funny to give out some "awards," particularly to a few choice physicians whom i sincerely hope are no longer in practice anymore or that i hope have since learned not to do what they did to me and/or to my friends/relatives/etc. i certainly can't and won't mention names...but there may prove to be some great healing humor in this. feel free to add your own favorites! :-)

toad awards:

worst doctor ever award: dr_suicide. dr_suicide was my friend's psychiatrist. he wins the worst doctor ever award for telling my friend, during a suicidal episode, that life would never get better and that it would always be bad. needless to say, my friend attempted suicide after that appointment. that's a hell of a way to lighten a case load!
worst pelvic exam award: dr_3_fingers. this particular er doc performed a bimanual exam that nearly made me jump off the examining table. his response to my distress: "sorry, i'll only use two fingers next time."
worst rectal exam award: dr_gi_partner. this gi doc was a partner of a gi doc i had during one of my surgeries. put it this way: he must have learned in anatomy that you can palpate the brain through the rectum. enough said.
needs to remediate english award: dr_doogie. dr_doogie was a very young o.b./g.y.n. assigned to me at a small town hospital when i was in college. i discovered, upon obtaining my medical records, that he did not know the difference between an adjective and a noun. it's "virgin," you idiot, not "virginal." at least, not unless the patient's name happens to be mary and the year is 33 b.c.e.!
worst bedside manner: dr_old_gyn_surgeon. i heard the doctor i was seeing for an acute surgical problem talk to this guy in the hallway while i was still in the exam room (where the partner, who gets the worst bedside manner runner-up award, had left me in stirrups!). he'd never met me--didn't know anything about me except my age--and managed to blurt out: "well, if we go in there now, we'll have to take 1/2 her ovary. then in two years, we'll have to take the other 1/2. two years after that, we'll have to take the other, and, by the time she's 30 and wants to have kids, there will be nothing left!" he then flies into the room and proceeds to probe me with the ultrasound machine. (note to future doctors: don't assume that (a) every woman wants to reproduce, (b) every woman is straight, and (c) if you're a gyn, that every adenexal mass in a 20-something is ovarian--it was my *appendix* they were seeing on the scan, *not* my ovary. i'd have *died* if they hadn't done surgery. can't have kids if i'm dead, you know?)
most outrageous solicitation award: dr_repro_endo, in new England. no, i will not buy the cholesterol supplements that your husband has left medical practice to sell. i will not buy them even if you say you won't treat me unless i take them. if you want to sell stuff, join Amway.
sexist award: dr_teeth. i hate to break it to this guy, but having a statue of a "lady in distress" being saved by an oral surgeon does *not* earn him a vote of confidence from a woman, even if he was born before 1920.
w "family values" award: dr_teen_ob. my friend, who had a baby when she was in her teens and living in a small town, delivered her baby in the presence of this doctor, who gave her a completely unnecessary grade 4 episiotomy. i'm usually not the type to promote revenge, but i hope this guy ends up as my friend's patient...with a very embarrassing problem. have issues with teen pregnancy? then don't go into obstetrics!

those are just the ones that i can think of off the top of my head. there have been more, many more...i'll add more later....

[oh, and mr_dr_do, if you happen to have found my blog and are reading this, you no doubt now realize that you're nowhere near to getting on this particular list! don't worry!]

configurations of the past

2007-05-23T19:07:00.000-04:00

this is not a post about medicine. it is not a post about medical school. or patients. or being a patient. it is a story about the past. about configurations of the past. about love....

most girls would scream. most would run. but she doesn't. she stands, transfixed, as she watches the tiny egg in his hand shiver ever so slightly. it shivers; then it breaks. a crack clean down the center and then the sudden appearance of a slimy greenbrown creature, complete with tail. most girls would squeal. most would at least say "eww..." but she doesn't. she watches. she watches as a baby lizard unfurls in his palm. she watches it look at him, at them, and then she watches it disappear--almost instantly--as the little creature leaps onto the nearest bush.

most girls would never have noticed him. most would vanish. but she remains....

twenty years later, the girl--now a woman--sits cross-legged in her overalls, back pressed against a locked hotel room door, as she waits in the hallway, reading intently. the girl--the woman--she is intense. transfixed, she can sit for hours, reading, looking, watching...but never quite taking part fully in the world around her. she is still a bit shy. tentative. but she stays....

she sees them first, striding down the hallway. it's been nearly ten years since she last saw them. she feels her breath catch in her chest. they were boys...they were still boys when they all last parted. but these guys she sees now, these aren't boys. these are men. and she--a woman.

the sparks between she and he are instantaneous. he has the body of a man--lean, fit, inviting--yet retains the grin of the boy. that grin, that twinkle in the eyes, his laugh...the same she'd seen when the mama lizard bit him and hung from his finger--her punishment for his disturbance of her nest--juxtaposed against the joy of his curiosity and the surprise at her wonder. the curiosity, the wonder...it remains....

she learns this two days later when, after having spent the night together engaged deep in conversation, he kisses her, just before dawn. electricity. she feels electricity. she feels the heat from his lips, from his chest, and from the raw undeniable presence of his lust for her as he presses against her. she sees the curiosity, the wonder, the hunger in his eyes. when they leap, together, half-blindly like the baby lizard into the new relationship, she cries. she's waited for this, distracted mind wound up in her studies, observed the world from a distance, and longed for something real. something true. and this is, she thinks, this is true--and it remains....

it remains through the early days, from the first moments, when, breaking out of shyness, she discovers the power of her body. being with him is not an intrusion. it is not like one of the several dozen medical exams she's submitted to over the past few years in an attempt to find healing. it is not like being half-covered, she thinks, in a degrading paper gown. it does not hurt...it does not hurt like so much of her life has. this--this relationship--this is new. this is beautiful. in her interaction with him she feels, possibly for the first time, whole.

she puzzles over this new way of being with another person. perplexed by the complexity and depth of her feelings, she wonders at how non-intellectual life can be with him. he lives in the moment.

or so she thought.

they talked for hours, separated by thousands of miles, about the past, about the present, and about their dreams for the future. he lost some of his boyish spontaneity when he became a man, but had replaced it with a certain solidness and assurance that she felt she could wrap herself in, a warm blanket to protect her from the cold. one day, when they are together, riding on a bus, he leans over and kisses her on the cheek. a spontaneous act. loving. she imagines life between them could remain like this. she has no hope, no desire, no wish for anything more than just this: this spontaneous, tender love.

if she'd known...if she'd only known something about men, about what happens to boys when they become men, she might have seen it coming....

what she did not know was that her words would betray her. she'd spent years with words: learning how to put them together to weave a poem; discovering how to use them to persuade an audience in an argument; rolling the newness of foreign words from her tongue for the first time. some of her friends would say she was a word. she breathed language. she thought in streams of water, a constant flow of ideas flooding her brain.

it was her downfall.

the words, to him, to his man-self, were unquestionable. they were not spontaneous or flowing: they were bricks. they were to be stacked neatly in piles, here, and here, and there. once placed, they did not move. words were stone. sentences were walls. paragraphs became houses. there was no room for movement. this was how life was "supposed" to be.

she'd never known the true strength and immobility of the word "should" until he decided. he decided, without her, that her dreams were built on clouds. he convinced himself that a woman could not become both a doctor and a mother. he chose, instead, a concept, configured in the past, to guide his life. and no matter what remained of his curiosity, his spontaneity, his care, his love for her--it did not matter. her dreams were built on clouds--clouds he couldn't imagine being reached, not even as she lay, brick by brick, her own foundation....

he chose not to love her anymore. it wasn't a discussion. there was no discussion. one day they were together; the next, they were not. he decided. and he vanished.

a year and a half goes by.

the girl--the woman--continues reaching for her clouds. her foundation is not perfect. she does not always build upon it in order. it has holes. her walls are cracked and sometimes wobbly, but she persists. even when she has to go backwards--take a wall apart and build it again--she continues. she persists.

word comes to her, not from him--he has no time for her, for someone crooked, cracked, and sometimes kooky--word comes from afar. he has married. he has given himself to another woman, promised to love her, and has never looked back. his bricks are straight. his dreams are fulfilled, built on a solid foundation, for he has the new woman's word: her commitment, to place bricks on the ground, to make certain life is laid out perfectly, and to ensure that she reaches only for him, their future children, and never a dream upon a cloud in the sky.

the girl--the woman--knows she will never hear from him again. she knows the boy, the man, her lover, has vanished. she holds the fragile, fractured eggshell of a new world in her hand. she weeps. and she remains. these are her words.

the sound & the fury

2007-05-23T18:28:00.000-04:00

my apologies, dear readers, for the silence on this end of the blogosphere as of late. the past two weeks have been odd. i'm attempting to find a way to write about some of it without revealing too much about my characters. it's one thing when i "let it all hang out" about myself--it's an entirely other matter when i write about people i know.

i tend to be quite WYSIWYG (for those non-geeks, the translation: what you see is what you get) about my own thoughts and feelings, but i know most people are not like me in this respect. hence my dilemma: how do i write about my experiences without uncloaking others? i don't have a good answer to this yet. sometimes i wonder if i've already said too much. :-}

so...since i'm still in the process of tweaking my latest entries before posting, i'll offer a parting thought, straight from Macbeth, that aims at a certain peculiar truth of this time.

life's but a walking shadow, a poor player
that struts and frets his hour upon the stage
and then is heard no more: it is a tale
told by an idiot, full of sound and fury,
signifying nothing.

now if only i could get some help from Faulkner's muse....

super_blaze is #1!

2007-04-30T17:01:00.000-04:00

i had the incredible experience today of getting to watch super_blaze win his bracket of the st. anthony's triathlon! for a blow-by-blow account of the race, combined with the pictures i took of the event, check out the post by the blaze himself.

you go, blaze! :-)

rant: it's all about the tone....

2007-04-27T00:46:00.000-04:00

i cannot speak for all medical schools (there were certainly things in the 101 list that do *not* apply to my program), but it seems that there's a general tone of animosity directed at the students, particularly by the science ph.d. professors. anatomists, in particular, seem to despise medical students. they think we're stupid (<--heard at many an anatomy lecture last year: "if you don't understand this, you're so dumb you should get up, leave, and go fill out a subway application")*. one of my study buddies had a conversation with a physician she shadowed before beginning medical school and he issued this caveat: "watch out for the ph.d.s. they're bitter because they didn't get in to med school." ouch. ordinarily i'd have thought this physician's hypothesis was off, but after what i've observed, i'm not so sure anymore.... at the very least, they hate teaching--that much is clear. since mwms is an odd place that runs on a pbl program, the school has made some very bassackwards curricular decisions. they're still trying to figure out the best way to "teach" and test our knowledge. while our anatomy class was a 10 week marathon of lectures, we're now deep into the pbl portion of our program. so far, the way we've been tested is in the form of "learning issues." basically, after our group finishes a case, we're supposed to pick learning issues, relevant to the case, on which we want to be tested. the powers that be try to act like these should be discrete packets of knowledge for the case at hand, but since that's impossible (the books, after all, aren't designed around our cases!), what ends up happening is that we pick chapters from our various books. so, for any given exam, there might be 40 or so learning issues, all derived from different chapters. all the groups choose their own issues and go at their own pace, with some direction given by the faculty facilitator. for the last pbl exam that the class of 2010 took, the majority of the pbl cases were based on neuroanatomy. by the time they were finished with the 8 cases for that block, most groups had picked nearly the entire neuroanatomy textbook. *gulp* it's simply not possible (in my opinion) to learn all of neuroanatomy on one's own by reading the textbook, particularly in 6 weeks when that's not the only class/book/bit of material one has to learn during that time. there are only 6 hours of pbl class per week, so discussing all the material in group is not really an option, either. basically, we're left to sink or swim on our own. many groups, as a result, have attempted to make the learning issues more manageable. in other words, while the group as a whole reads broadly during the case, learning issues are picked with what the group feels it needs to be tested on in particular. the thought is that if the group is specific about learning issues, there won't end up being 50+ learning issues on an exam. basically, pbl groups are trying to choose wisely so as to survive these horrid exams. as list 101 indicates, though, everyone in medical school is smart. there's nobody there who didn't have to do some amount of more-than-ordinary work to get accepted. everyone is self-motivated, if not exceptionally so. but are we treated as if that's a given? heck no. we're treated like incorrigible schoolchildren. lest you think i jest, consider the following email (only modified by changing names to protect privacy) sent by the professor in charge of compiling all the learning issues for the exams. i swear to you, it's all about the tone.

Dear class of 2010:

After compiling the exam topics sheet from the 1st 2 cases, I have noticed that most groups are choosing only a few topics from each case. These cases contain many more basic science topics than are being chosen at this time. For example, why are most groups avoiding gross anatomy? If you are deciding to avoid gross anatomy because you “already had that,” you are making a huge mistake. What you already had was a “survey” course, not a full anatomy course. As stated by I and Dr. Head Anatomist several times during anatomy, you MUST choose anatomy exam topics in PBL to learn this science well enough. You were also told by Dr. Head of PBL and I that in PBL you must review topics several times to fully understand them. Why are you not reviewing anatomy? Aren’t you discussing gross anatomy during the cases? If not, you should be!

Please be reminded that you are in medical college where you need to learn all the basic sciences in a PBL curriculum. In this curriculum, it is assumed that you take the responsibility of learning seriously and become adult learners where you are responsible for your own education. Most of you are achieving that goal, but others need to be reminded from time to time that this freedom in your education comes at a price. If you continue to minimalize exam topics as a strategy to score better on PBL exams, this strategy WILL backfire: you will not learn enough basic science information to score well on PBL exams, the COMLEX exam, or to be a knowledgeable physician.

Please let me remind you that the PBL exam will be comprised of 185 questions. If you choose too few exam topics, your exam will have 8 or more questions from each topic. As you might not be aware, deriving 6, 7, 8, or more questions from a topic requires that I examine you on very minute details: the kind of details in which you may need to memorize charts or graphs to answer. If you choose enough topics, say 4, 5, or 6 from each case, then I can attempt to make your exam from big picture topics that are most important clinically. Although not always reached, this is my goal.

In closing, let me make it perfectly clear that choosing very few exam topics from cases in not a good strategy: neither for the PBL exam, nor for your medical education.

Another Frustrated Anatomist, Ph.D.

*no offense to anyone working for subway; i guess the anatomists just have issues with those employees, too, even though they eat lunch there almost every day.....

highlighter b!tch

2007-04-27T00:19:00.000-04:00

the med school hell blog just posted the "101 things you wish you knew before you began med school" list. i wish i could say the list was wrong or inaccurate, but much of it is true. dead-on true.

apparently, i'm a highlighter b!tch. hey, at least that indicates that i belong! ;-)

i.w.g.

2007-04-22T02:39:00.000-04:00

first, a bit of background: i was born and raised in a suburb of a large american city. during my school years, the public education system in my area was in turmoil. since my parents place a high value on education, they decided to make a huge financial sacrifice by sending me to a small private school for 6th-12th grades. although, like any other, my education had its ups and downs, the community of the school was, at the time, like a family. even though it's been over ten years since i graduated from high school (gasp), i still keep in touch with many of my friends from school. we rarely have a chance to see each other anymore, seeing as we're all scattered across the globe by this point, but these are all good friends--the kind that i can pick up the phone and call and talk to as if no time has passed. it's rare in life, i think, to find people with whom one can connect so well and i feel very blessed by their friendships.

yesterday i received an email from one of these friends, whom i'll call dr. cs (<--he's a doctoral student in computer science and is probably one of the few, like me, who will be an eternal student--i think he's more than earned the title of dr by now, even if the school wants to milk a few more research papers out of him before dubbing him officially). three years ago i attended dr. cs's wedding--a beautiful event that brought a bunch of us back together, reunion-style, as a rare treat. dr. cs married mrs. cs, who, although i don't know very well, i really, really like, and i suspect could become a good friend, were it not for the gap of many miles between us. in short, dr. & mrs. cs are a great fit. so i was thrilled, a few months back, to hear that they were expecting their first child. they're the type of people that you just know will make great parents.

so dr. cs sent this email yesterday, titled something to the effect of "greetings from x_state." this perplexed me a little, since x_state isn't where he lives, but it is where another of our friends live, so i thought maybe they were on vacation. unfortunately, the title of dr. cs's email belied the content. it turns out that they were in x_state for a friend's wedding. the night of said wedding, mrs. cs went into early labor and ended up giving birth to their son, i.w.g., at a mere 26 weeks' gestation. it was an unexpected early delivery with dire consequences.

for three weeks they went on the roller-coaster ride of having their baby in the nicu and all that that entails. on tuesday, after many ups and downs, little i.w.g. succumbed to his illnesses (primarily premature lung disease with what sounds like a secondary nosocomial pneumonia on top) and died. dr. & mrs. cs kept a blog about the experience--a heartbreaking, tender, thoughtfully written account of each day in this baby's life--and it absolutely crushed me to read it. i cannot even begin to fathom the pain and suffering they've endured. i thought about posting the link to the blog here, but in the interest of protecting their privacy, i've decided against it.

given that i'm still having a hard time wrapping my brain around the notion that my friends from middle school are even having babies, i can hardly grok the fact that something like this--something so tragic that involves such an adult, mature response to endure--has happened to my friends. i'm in utter shock. when did we all grow up? when did we become adults who have to decide on dnr orders for our babies? it makes me miss the days of worrying about getting my homework assignments in on time (for those of you who were there, think fruit flies!) and worrying about where we'd go to college. that time seems so much more tame and simple in comparison to this....

i couldn't help but wonder, as i read their blog, what it would have been like to be in their shoes these past few weeks. i've seen the sickest of the sick babies in the nicu (the university medical center in which i worked for a number of years has a level 5 nicu--the highest level of care available for infants), but i've always looked at these infants from a provider's perspective. i recall the first time i entered the nicu, while shadowing one of our attendings and a fellow, and my shock and awe at the fact that the first baby on whom we consulted had a foot (i kid you not) no bigger than the pad of my thumb. i imagined, at the time, how hard it would be to care for these tiny babies...but i didn't imagine how horrible it must feel to be the parent of one of these children. the sense of helplessness, in particular, must be overwhelming. i particularly never imagined that my friends could be in this position--especially when i'm not so sure that any of us feels so far from childhood ourselves....

all that said, my heart goes out to all the parents and caregivers who work so tirelessly to ensure the well-being of these tiny little babies. and to dr. and mrs. cs--i am in awe of your courage and fortitude throughout this nightmare of an experience. i know, in the deepest part of myself, that you touched little i.w.g. with your love and care. his time here may have been short--but because of you, i am certain it was also full of warmth.

~ i.w.g. ~ 3.25.07 - 4.17.07 ~

rant ii: the government versus a woman's body

2007-04-18T14:30:00.000-04:00

the supreme court released its decision re: partial birth abortion today. i wish i could provide a direct link to the court document, but it's a rather large pdf file, and i have nowhere on the web to store it myself. so if you're interested in the nitty gritty of what i'm about to say, you may want to go read that document first. now has a link to it in their news section, as do several other news pages and organizations.

if you've been reading my blog, you know by now that i consider myself a feminist. i tend to agree with liberal politics, primarily because i'm an academic at heart and i'm always questioning everything. (my favorite question growing up: why?) i believe that conventions are made to be questioned and analyzed, not reflexively followed. i also am an exceptionally sensitive person, one who holds life dearly enough that she's been known to run into traffic to save a turtle about to meet its demise by attempting to cross the street. i cried when someone killed the wasps outside my house recently, even though i was afraid of them (i don't like pain and therefore avoid critters that sting/bite/want to eat me). basically, i'm a big mush--my heart is always on my sleeve and, no matter how hard i try, i cannot conceal this fact.

that having been said, i struggle with the issue of abortion. i feel that life is sacred. i've always been fascinated by childbirth and i know i'll likely end up focusing my career on women's health. *and* i have a strong respect for women's bodies and their choices about what happens to their bodies. so although i don't think i could ever have an abortion myself (<--i'm a little biased because i have fertility problems and it would be pretty darn hard for me to get pregnant without medical intervention), i think every woman has a right to choose. i also acknowledge the fact that, given my interest in women's health care, i may be trained and/or asked to perform this procedure. this fact scares me, but i acknowledge the reality, nonetheless. i cannot imagine the suffering that an unwanted child must endure throughout his or her life. i also don't think any woman should be forced into poverty or put her life in jeopardy for a fetus. it's my opinion, plain and simple.

when i first heard about partial birth abortion, i was incredibly disgusted. the description of the procedure seemed absolutely horrific to me and i couldn't understand why anyone would ever want to have that kind of an abortion. then i read the supreme court ruling.

if i'm understanding it correctly, a partial birth abortion involves delivering the fetus to a certain point and then killing it. in contrast, other types of late-term abortion involve dis-membering the fetus in utero and then delivering it. knowing what i know about science (remember, i just studied embryology and neuroanatomy, among other things), if i had to choose between someone whacking me on the head to kill me versus tearing me to shreds, i'd choose to be whacked. it's not even in the realm of being contestable--one act causes immediate death, the other is pure torture. but what did the courts just do? they just prevented physicians from performing the "humane" form of abortion while permitting them to torture fetuses via the alternate method. they say they're trying to preserve the sanctity of life--how on earth does this decision uphold that sanctity? seriously! can anyone follow the logic here? or did they simply make the decision so ambiguous as to prevent providers from performing any late-term abortions? hmm....

i really don't understand how the same government that has allowed us to invade other countries where we are killing innocent children and that allows our children to access guns so that they can kill each other can take a stand against killing a fetus that cannot survive outside of its mother. i also don't understand how our government can refuse to allow sex education to be taught in schools. if they don't want women to have abortions, then why aren't they teaching pregnancy prevention? if they're professing abstinence as a "cure" to prevent pregnancy, then why is the government (in some states) requiring young girls to be vaccinated against sti's? if they truly believed in their abstinence programs, there would be no need for the vaccinations. oh, wait--that's right--boys can have all the sex they want and spread around the sti's while girls have to remain abstinent until marriage wherein they get exposed to sti's because the guys were sleeping around--that's why we're mandating the vaccines, right?

i swear, if it weren't for the right to free speech, i think i'd be on the next plane out of this country. until the government takes away my right to rant, though, they'll just have to deal with me screaming from my blogspot.

rant: my hatred of guns, reinforced

2007-04-18T04:37:00.000-04:00

i want somebody to give me one good reason as to why we should still be allowed to own guns in america.

seriously. why the heck should a college student be able to go out and buy two guns that give him the means to kill 33 people?!?!? i know, i know, some will argue that being able to own a gun is a fundamental american right--but just because however many hundreds of years ago (before we wiped out nearly the whole environment) we supposedly needed guns to "protect ourselves" from animals, does that mean that it's still a good idea for harboring weapons to remain a fundamental right? we're certainly not at risk from being eaten by bears anymore. it has also been proven that ownership of guns results in more intentional and accidental deaths than in protection from robbers or "bad guys," etc. so don't even try to tell me that people need guns for protection--i personally think that's absolute bullsh!t.

when i was in middle school, my friend's mom was shot in my front yard. in life before cell phones, she happened to have a c.b. radio underneath the passenger seat in her car. when the robber appeared at her car window, she reached for the radio, and the person trying to rob her thought she was reaching for a gun and shot her. my family and i ended up underneath the couch in the living room until the cops arrived. my friend's mom survived--luckily, she'd placed her arm up in a defensive position and the bullet lodged in her arm--but i don't think any of us felt safe again for a long time following. would owning or possessing a gun have helped us in this situation? not a chance.

about fifteen years after this incident, i worked in the burn unit at a large trauma center. the physician for whom i worked, an amazing burn and trauma surgeon, allowed me to shadow him one day when most people were on vacation (sometime between christmas and new year's day). i'd never gotten to observe surgery first-hand before that day, and what i saw, i'll never forget. sometime around 3pm on a bright, sunny afternoon, the trauma team was paged to the trauma bay for an incoming gsw (gun shot wound) victim. because of hipaa laws, i cannot go into the details here about why the guy had been shot in the middle of the day or by whom, in particular, he was shot. but what i observed that day in the o.r. only underscored my already strong anti-gun position. this guy had been shot by a member of a law enforcement agency in an effort to (supposedly) protect the public. what i learned during the surgery, however, was that he'd not been shot by just any kind of bullet. the bullet with which he was shot was of the sort that is created to cause the most damage to whatever it hits. and, believe me, it did more damage than you can imagine.

i guess i can understand why law enforcement members carry guns, even though in most other countries, they do not carry weapons. but in my opinion, there is something absolutely sick about the fact that we allow people (law enforcement or otherwise) to run around with guns that are made to be not only lethal, but totally destructive. i don't know enough about guns to know whether the student at vt was using unusually destructive guns or bullets, but the descriptions of the violence certainly make it sound as if the weapons he used were not "ordinary." why do we allow such weapons to be sold? if we really think that we still need to have the right to bear arms, why not make them single-bullet guns that have ordinary bullets? why do we allow the sale of such destructive weapons? do we really think the average citizen needs a multi-bullet containing super-gun to protect him- or herself?

here we are, invading other countries on the premise that they harbor weapons of mass destruction. has anyone bothered to look in our backyard?!?!? i wish somebody would invade us and save us from our own self-destruction....

sod

2007-04-15T06:07:00.000-04:00

i know it's spring, but nope, i'm not talking about dirt.

sod, aka sphincter of oddi dysfunction, is the most recent diagnosis i've been given for my abdominal ailments. those who know me well will attest to the fact that i have the unlucky misfortune of developing random medical problems...but this has to be one of the oddest. [no pun intended, of course. ;-) ] This wouldn’t necessarily be a bad thing, in and of itself, but the new GI I saw here (the last one went AWOL...so bizarre) doesn’t have the equipment (nor do any of the other docs/facilities around here) to do the serial manometry testing on my common bile duct (cbd) that is needed to prove the dysfunction and determine treatment.

Thursday, after learning all of this from the new GI, I called my GI in the large city in which I grew up. The city is not too terribly far from where I live now, and my parents still live there, so it seemed like returning to the GI who (a) knows my history, (b) i admire, and (c) has access to better/more/newer equipment than physicians in this area would be a logical next step. being the dedicated physician that she is (and yet another one of these amazing female docs that i'm afraid will burn out too early as a result), she called me that night at 9:30 pm from her office.

In speaking with her, however, I realized that being diagnosed with sod (and confirming the diagnosis) is more complex than I imagined or had been lead to believe by the GI doc here. She explained to me that, even in large metropolitan cities with major teaching hospitals such as the one with which she's affiliated, most docs/facilities don’t have the equipment for this procedure because it is not done often anymore. This has something to do with the fact that anesthesia and analgesics interfere with the function of the sphincter, such that the test has to be done under unusual conditions (<-- note that I didn't ask her to elaborate on this; my immediate ally mcbeal mental image of having a tube shoved down my throat while fully lucid frightened me into silence). So, basically, if this procedure is offered, it’s only performed at major medical school centers where it’s being used for clinical trials/exceptional cases/studies.

As a result, usually GIs go in "blind" (i.e. without the proof of elevated pressure in the cbd that clinches the diagnosis) and do a sphincterotomy. However, the risk of pancreatitis after the procedure and/or the need to have the procedure to repeated every few years is fairly high. Given these factors, the procedure is also not generally done in younger adults, since the risks increase over time. This makes me a bad candidate for an ercp with sphincterotomy, particularly without a proven diagnosis.

that evening, before this gi doc called me, I read some recent articles on PubMed to see if there were any new or alternative treatments available for sod. Some major medical centers have been experimenting with injection of botox into the sphincter, which prevents the sphincter from contracting and therefore reduces the pain-causing-pressure in the CBD. Of course, if this works, it has to be repeated every few months...but in my opinion, the possibility that it could work way outweighs the pain of the spasms. (I think there is only so much longer I can live on applesauce, rice, bananas, and toast before I go mad.... And the medications to treat the disorder, namely antispasmodics like levsin, are only so effective....)

She didn't know off hand whether anyone in the city is doing this procedure, so now I’m waiting to hear back from her as to whether anyone there is willing to shoot my sphincter up with botox. And my poor little sphincter doesn’t even have wrinkles yet! :-(

At one point, this GI doc, who is usually fairly upbeat (or at least on the optimistic side), asked me something to the effect of, "couldn't you get something that's treatable?!?" I know she meant it in kindness--she obviously does not like to see me suffer this way, particularly at such a (relatively) young age--but I was sobered. I'd never heard her sound quite so...well, almost hopeless, I guess.

It has taken me a while to digest all of this. Even after all I've been through medically, it didn't occur to me that this might be untreatable. I can't really wrap my brain around that notion yet--I'm simply not ready. A life of unpredictable, excruciating abdominal pain with intermittent bouts of diarrhea? No thank you.

Anyone know where I can get a refund for my body? I think mine may well be a lemon.

medical education reform

2007-04-09T23:11:00.000-04:00

In the midst of my sleepless nights, I've been reading medical blogs. There are some incredible students, residents, and physicians out there capturing life on the front lines. Hearing their stories reminds me that I am not alone in my struggles, that my opinions on medicine and medical education are not as outlandish as I'd thought, and gives me hope that there just may be a community of healthcare providers out there who are eager to initiate change.

Tonight I read such a great post on "learning the hard way" that I decided was too important not to pass along. In it, Dr. J. makes eloquent observations about the current state of medical education.

I may soon have to start one of these "blogrolls," and link to these sites, because I have a feeling there are some bloggers out there who are well worth highlighting. Dr. J.'s site, though, is my spot of the day. I hope you appreciate his comments as much as I do.

great horned owl

2007-04-07T21:19:00.000-04:00

when i finally got up later today (after finally fixing the smoke detector and getting some sleep), i realized that it was an absolutely beautiful day outside. since i haven't seen the sun in days, i decided i needed to get out. i'd never had the time before to check out some of the "trails" in my pud, so i grabbed my camera and ipod and set out on a walk. my expectations were minimal--the area i live in is truly beautiful, but the pud, like most, can be a little mc-village-y. i anticipated i'd find a long length of sidewalks through a few trees, with lots of views of the ubiquitous mc-lakes found in each and every neighborhood.

fortunately, i was wrong. the trails here are far from standard and the expanse of them is vast. i ended up wandering for two hours on dirt and mulch trails through pine thickets to wooden bridges to the bases of large moss-covered oaks. i got some amazing shots along the way, but none so impressive as the pictures i snagged of a gigantic great horned owl that i discovered perched in a pine tree. this bird was incredible--massive, majestic, and *present.* she didn't linger long (a family with some small, loud children came through on bikes and scared her off), but she remained still just long enough for me to capture her beauty.

on the whole, i feel amazed and astounded by my day's journey. seems like the pud really did earn its green title by preserving actual green space and not simply installing yet another over-fertilized golf course. and, i must say, it feels good to know that my condo association fees serve to provide owls with a habitat as much as they do to provide meticulous manicures to the bushes around my building. ;-)

~*~*~*~*~

want to see more photos? go to the picasa web album:

Summerfield Park

the joys of home ownership

2007-04-07T06:01:00.000-04:00

when i bought my condo, i felt really lucky. it had been the first time in a long time that i'd had a space to call my own, and i knew i was moving into a development that, while not wholly original, at least had won some awards for maintaining green space/being somewhat eco-friendly. i found a unit in one of the "older" sections of this PUD (planned urban development; older = 2003 ;-) ), so i'm in a part of the community that isn't still under construction. as an added bonus, the woman from whom i bought the condo was absolutely meticulous--so all those things that used to trouble me about living in other people's homes (e.g. lack of labels on the circuit breaker, no fire alarms/extinguishers, etc.) were not an issue here. the place was just broken-in enough to have all the wrinkles ironed out, so to speak. on top of that, the things i detest--like mowing a lawn--aren't a concern here because the condo association takes care of all the external features of the property, even down to changing the light bulbs for the outside lights. not a bad deal, eh?

except for the little details about home ownership that didn't come into my consciousness before move-in day. the first thing that caught my attention was the light in the foyer/over the stair landing. i have absolutely no idea as to how to reach the darn thing to change the light bulb, since it's located on the ceiling in an area where there's a story and a half between said ceiling and the stairs beneath it. and, no, after having worked a year in a trauma center, i have no desire to even attempt to balance my ladder on the stairs and risk major injury over such a relatively minor thing. i also wondered how on earth i was supposed to clean the window in this area, as it, too, is out of reach; nor did i quite understand the placement of a "plant shelf" next to this window. so far as i could tell, the shelf and window were merely playground pieces for the cats, who seem to revel in making death-defying leaps across chasms of space. or at least, that's what i thought...until one day i realized that one of the cats had barfed on said shelf. lovely. every time i contemplated cleaning it up, all i could think of was the potential conversation among my colleagues: "what happened to blaze?" "well, you see, there was this incident involving cat barf...." amusing, but not exactly where i want my life to go, you know?

ah, but it gets better. after spending the last seven days at home, literally wallowing in my post-medical-school-demise and recent attacks of my gut from hell, i finally had the energy to go out tonight. and it was wonderful--my mom and i had dinner and then went to a local "open gallery night" at an artists' area in town. we'd looked for this part of town before, but hadn't been able to find it; so we were quite excited to find an amazing few blocks of refurbished homes all decked out with great (and i mean great) artistic treasures. it helped that it was a beautiful evening--perfect weather--and although i was tired by the time i got home, i also felt more hopeful than i had in a while. i love studying medicine, but, at this point in my career, i have little room to express the creative side of myself; outings like this remind me that there's a world beyond medical parameters and that i do still have passions beyond the latest bug that needs to be learned. when i got home, i ended up staying up later than planned--the hazards of indulging in yet another one of my passions, reading--so i didn't go to sleep until about 4 am.

At 5:45 am one of the fire alarm units in my home decided it needed new batteries. Could it tell me this subtly? Could it tell me this at a normal hour? Could it at least realize that i couldn't instantaneously replace its batteries? Oh, no. that would be expecting way too much in this technological age. instead of some sensible indication, i awoke with a jolt as my cat bolted off the bed where she'd been curled at my feet, and then proceeded to hope that the loud, obnoxious, intermittent beeping sound would cease and desist before i had to shoot the darn thing. no such luck. not only did it not stop beeping, but it turned out that the particular smoke detector having a fit was the unit in--you guessed it--the foyer. there's nothing quite like balancing a ladder on stairs at 6 am on a saturday morning trying to replace a battery in a smoke detector that says "welcome to home ownership!" unless, of course, you count the darn tax bill, but at least the tax bill doesn't have a beep-until-you-pay-me device attached to it.... never a dull moment!

another med bites the dust...

2007-04-03T01:49:00.000-04:00

last night, while suffering the pains of yet another bout of gi upset, i thought about the recent medication therapies offered to me for my latest body wars. several years ago, after my first set of surgeries, i went through a rather rough period of time during which i suffered nearly constant abdominal pain. during that time, though, i did discover a few meds that helped. one of them, zelnorm, was released toward the end of my struggle, so i only took it for a few months, but i did find some benefit from it. it was one of the meds mr_dr_do and i considered when i saw him last week. i decided to take a different route, but with my latest symptoms, the medication came to mind again last night as a possible solution. that was, until i opened up my web browser today....

it turns out that the fda has decided to recall zelnorm due to some "serious side effects" that it has observed in a certain percentage of patients recently. this represents drug #3 that i've taken in the past ten years that has been pulled from the market in this manner. which makes me wonder: if zelnorm has now been on the market since 2002 and they're just now pulling it off, does that mean that the fda was over-hasty in its initial approval of the drug? how come the pre-marketing studies did not reveal these problems? i was under the impression (perhaps false?) that the u.s. has one of the more stringent approval codes/processes for pharmaceuticals--but this makes me wonder, particularly as i'm reading about this on the heels of removal of a new parkinson's drug we just studied for a pbl case....

i know the media will be rife with lawsuits now (a quick google search to find the fda page for zelnorm told me that much), but one must wonder--what happens to the patients who were benefiting from this drug? i can't imagine anything quite so depressing as having a disease like ibs, finally finding a drug that works, and then having it pulled from the market. i guess one could say that the parkinson's situation is worse--but i'm not the sort of person who believes that suffering can be compared--so, either way, i feel for these patients.

i also am experiencing one of those moments in which it's becoming readily apparent that my medical education may be obselete before it even begins. we were recently asked by our school to upgrade to the latest pharmacology text, fresh off the press from lange. guess what its recommended treatment is for ibs? yes, you guessed it, zelnorm. lovely. it makes me wonder--what's the point of even having a pharmacology textbook if it's out-of-date as soon as it's published (if not before it even hits the press)? couldn't we have a more effective learning tool with an online text that is continually updated? i keep wondering when the medical education system will match up to the electronic era, but it seems we're not there yet.

yet another case of one step forward, two steps back....

my heroes

2007-04-01T21:45:00.000-04:00

it's time for me to get away from whining for a moment and, instead, give thanks.

why? because in the midst of all the hardship this year, my "sisters" in the class of 2010 have helped me tremendously. they've shared study tips and notes. they've made me laugh. they've taught me: about medicine, life, and the world at large. they've hugged me when i cried. they've made me feel useful and important. they've fed me. they've listened. they've spoken. and, bottom line, they've been incredible friends throughout what has been a very difficult and trying year for all of us.

why mention them here? you might ask. because these women, these fine, intelligent, sensitive, and strong women are not only my sisters, but your future doctors. and what outstanding physicians they will be! not because of training, book-smarts, or any of that--but, more importantly, because of their generous hearts.

my thoughts are with you, my friends. may you be able to access even the least learned fact and nail those damned exams! :-)

the paradox of perspective

2007-04-01T20:17:00.000-04:00

a few days ago, my friend j.p. blogged about her frustrations with the healthcare system and being a patient in it. today i discovered a recent blog entry from dr_couz (a FP resident in Canada who writes a wonderful blog about her experiences in residency there) discussing the lines physicians must draw between their personal and professional lives. now here i sit, pondering the paradoxical perspectives.

on one hand, dr_couz's commentary on boundaries hits me hard. i have a hard time keeping and maintaing boundaries (but, no, i don't have a "caretaker" personality or anything! ;-) ) and i've watched many a physician get burned by an inability to balance work and life or friends and patients--or both. most recently, a wonderful geriatrician spoke to our class after her last day in private practice. she's hardly retirement age; yet, she's retiring. when describing why she's chosen to take "time out" from being a physician, she told us a story about how she recently sent her husband to a patient's house to fix the patient's leaky shower head. yes, we live in an area where there are many elderly people in need of assistance in one form or another--but it took her getting that involved in her patients' lives to realize why she had burnt out. she simply became over-involved. this physician stood in front of my class and told us, point blank, to maintain our boundaries. she's a sobering example of what can happen when one crosses too many lines.

so, i get that i'll need to be cautious when i go into practice (if i ever get there!), because i know i have tendencies to be like this geriatrician, to want to fix everything. [i'm pretty good with a wrench and plumber's tape, actually. ;-) ] but i also must wonder, what about the fire?

my friend j.p. eloquently captured her rage at the healthcare system and at doctors in particular. she's encountered at least a hundred (if not more?) physicians who have been distant, absent, and even downright cold. many have not been well-versed in their own specialty, let alone anything remote to it. one could argue, perhaps, that this is just one person's perspective. and, oh, how i wish that were true. but it isn't. i know because her words resonate with my experiences as a patient. her question--wanna be my doc?--has also been asked of me many times, by many friends (and even some strangers!) in similar situations. this is being asked. of me. the first-year medical student....

one of the reasons i am a first-year medical student, though, is because i feel the fire, the rage, the dissatisfaction shared by so many patients. it's an emotion that can't--indeed mustn't--be ignored. thus i'm left to wonder: given that i cannot be physician to the masses, given that i am human and will make mistakes during my career, given that i have to be able to take care of myself as well as those around me, given all the barriers present in healthcare, how can one person make a difference? how do i remain open to people, to learning, to the tenets of my profession when it seems that so many physicians give up, burn out, or sell out? and how do i become a decent physician if i can't manage my own healthcare problems? if i cannot take care of the people i love? if i pin the essence of primum non nocere to my heart, will i always remember?

once again, all i'm left with are questions.

speaking of which, hey j.p., wanna come to med school? ;-)

rant: female body processes

2007-03-31T22:00:00.000-04:00

**disclaimer: if you're a guy, reading my blog, you might want to skip this post. that is, unless you're the odd-man-out who can deal with rants about the female body's processes.**

I realized recently that the contents of my posts have taken an odd turn: I've ranted about being a patient much more than I've discussed medical school. perhaps that's because being a patient has taken over medical school. at any rate, this post will not be different. i need to rant.

i've mentioned previously that i've experienced various medical problems throughout my life. enough medical problems, in fact, that my classmates would likely freak out if my case file were presented in pbl instead of our usual, tame, uncomplicated case patients. (<--i say this because we once had a case where the patient--gasp--actually had a past medical history and my whole group started whining about how difficult the case was.) amongst my myriad pathophysiologies is an endocrine disorder that basically throws everything out of whack. generally what this means is that i don't get periods unless they're induced. now before you ladies utter the ubiquitous "lucky," let me tell you, this is not a bit of good fortune i've stumbled upon. having to induce periods sucks. i once had to buy $500 in medication to induce one. how lucky is that? you're right, it's not. [and, in case you're wondering, some scientist somewhere decided that women need an average of four periods a year in order to stave off the risk of endometrial cancer; hence the necessity of the inductions. no, i'm not yet convinced it's worth all of this trouble.]

this year, since i clearly don't have enough going on, my body has decided to mutate again. so last semester, right after the term ended, i got a spontaneous period. now, this should be no big deal, right? i mean, women go through this all the time, don't they? well, most do. but i don't. which means that every time i get a spontaneous period (all of the like seven or so times it's happened in my life), i spend the two days before it comes thinking i'm going insane because, of course, i don't recognize that what i'm suffering from is a huge hormone shift and not mental instability. in essence, i regress into an inept thirteen year-old girl who cannot figure out how to stave off cramps, what types of tampons to use to prevent flooding, how to keep from crying over everything, etc, etc. it's horrid.

so, when i went to see mr_dr_do the other day and ended up crying in the parking lot? should have been a clue, right? *sigh.* i'm hopeless. i came home from that appointment and proceeded straight to my bed and have not left the house since. sometime late friday night/early saturday morning, i was up reading another novel (yep, that makes two this week...), but i couldn't focus. i seriously thought i might be having a nervous breakdown, that's how agitated and out-of-sorts i felt.

as it turns out, i'm not insane. rather, i was experiencing pms but didn't realize it until the damn thing appeared saturday. now, on top of the abdominal pain i already have because of the lap chole and wtf has been going on since, i have cramps. and i, the person who is usually very peaceful and who saves turtles from certain disastrous death on the road (<--i'm not going to live that one down anytime soon; my mom was driving the other day and i made her stop so that i could carry a turtle across the street because it was going to become road-kill if it tried to reach the pond itself; she thought for sure the turtle was going to bite my finger off!), now am so angry that i want to castrate the first guy i see. why? because *they* don't have to do this. and this--this period thing--this *sucks*! seriously, how in the hell do women get anything done if we spend so much time feeling like this? it's as if somebody is trying to hoover all the energy out of me from below. (oops, can you tell i was reading a british book? ;-) ) i want to throw a temper tantrum. seriously.

the difficulties of being the patient in the doctor-patient relationship

2007-03-29T02:27:00.000-04:00

a few days ago, i had what i thought was a good idea. i thought that, after all that i'd been through recently, it would probably be a good idea for me to go see mr_dr_do and see if we could come up with a plan for my healthcare that would maximize the possibility of me being at least somewhat healthy by the time i return to school in august. what was not a good idea: scheduling this appointment for the day after i'd gone *splat.*

i started getting anxious about the appointment last night. that was my first indication that something was wrong. i tried to think about it--why am i feeling anxious? but i really couldn't put my finger on a precise cause. i thought some of it had to do with my embarrassment over having to leave school, another part to do with the fact that i was feeling just emotionally vulnerable enough that i was afraid i would cry (why it bothers me to cry in front of doctors, i really don't know--but it really bothers me), and some to do with the fact that, ever since i was a little, little kid and experienced some GI problems, i have absolutely detested talking about my bathroom habits. to anyone. you can tell me all about yours, just don't ask me about mine. it's an odd quirk for a doctor-to-be, but at least i know where my quirks lie.

needless to say, i didn't get much sleep last night. this was okay, because i was reading a really good book (the sunday list of dreams, by kris radish) and relishing it because it's been so long since i've had a chance to read a non-science text. but it also meant that i was tired today--more tired than usual--which just means that i was all the more vulnerable by the time i arrived for my appointment. this was not a good thing.

mr_dr_do's office is quite nice. it's the only primary care office i've ever been in where i didn't feel like i was one cow in a herd of cattle. everything is simple, efficient, and, aside from the argument i'd probably get from the lady who answers the phone over this one, it's actually quiet. this is a relief for me, as i hate being stuck in waiting rooms that feel like airport gate areas, with tv's blaring, tons of general noise, and, invariably, carpet patterns that make me dizzy. so, again, when i go to mr_dr_do's office, i really have nothing to be anxious about: i'm not overwhelmed by his office and i like having him as my doctor. but today, i was anxious.

it didn't help that the assistant who retrieved me from the waiting room was not in a good mood. and here's where i run into something i don't understand about certain medical offices: what is the deal with the assistants? she took my vitals (grudgingly), then asked me why i was here to see the doctor today. now, i get that one of the most important parts of the medical record is the chief complaint (cc for short), but seldom do i feel like talking to these people, given that the physician always proceeds to enter the room and ask me the same damn set of questions. what's the point? i really, really don't know. so...i was hoping (i must be delusional) that by giving this chick (<--i don't ordinarily use this term, but anyone who dyes their hair with blond streaks and has funny patterns on fake manicured nails fits the description too well for me not to use it) my letter of withdrawal from school, i (a) wouldn't have to talk to her for much longer, and (b) between that and my cc, should've been enough information to give the doctor a clue as to why i'd appeared for this appointment. i'm not sure, though, that she actually wrote anything down. the chick soon disappeared, and i was left alone to indulge in my book. here is where the experience begins to get even more problematic. the book itself is basically about a mom who finds out that her estranged daughter has opened an adult toy store in ny to provide women with options for obtaining and maintaining sexual health. so the part i was reading was describing one of the new employee's feelings about his first day on the job. he was astounded by the number of women who came in--particularly about their ages and the fact that so many were not sexually satisfied. i went to a women's college for my undergraduate degree, so i'm pretty opinionated about this subject. i didn't start off at this college, but rather at a catholic institution, at which they didn't even sell condoms on campus (in spite of the fact that 80% of the student body was engaging in random hook-ups every weekend). i transferred out of there after my first year and entered a totally different universe. i learned that women who are educated talk about things like birth control, masturbation, toys, fetishes, body-types, etc. you couldn't go to this school without learning about these things, and, i think, by the time most women graduate, they're pretty damn liberal about this stuff. (yes, even the republican women.) so, i was getting a little homesick as i was reading this book. i miss being in a place where sexuality is celebrated instead of suppressed. and i feel odd about the fact that i've landed in a medical school where they're still rather, well, in the dark about some of these things. it bugs me, in particular, because i want to encourage women to be more in touch with their bodies and know that liking sex doesn't make you a slut. not to mention that it is a woman's right to have an orgasm. but that's just my opinion....

anyway, it was an odd thing to be reading/feeling when the doctor walked in the door. i was relieved that he didn't have the hot 3rd year med student with him this time--i don't think i could have tolerated being outnumbered by that much testosterone/eye candy just then. it was also one of those times when i felt oddly ambivalent about seeing a male doctor. and this is something i still don't understand. most of my doctors are male. my main specialist in my hometown, who has handled the majority of my healthcare up until now, is male. he's seen it all, so to speak, and i don't have any problem with that. but i was struck, when i saw mrs_dr_do the week before, at the different type of energy she brought to the patient encounter. there was something comforting about knowing she's experienced being a woman and knows what it feels like to be in this type of body, and somehow that was expressed in the way she touched me. not to mention she didn't make a big fuss over things like listening to my heart under my shirt like physicians are supposed to do. nothing makes me quite so frustrated as knowing that a physician is taking a shortcut because he's too embarrassed to put the stethoscope under my shirt. i had a surgeon do that recently, before surgery, and i was stunned. there was an assistant in the room--it wasn't like i was going to claim being molested or something. but there's the rub--in today's pc, litigious society, doctors are coerced into taking shortcuts during exams. it's not only nuts, but it has the unfortunate effect causing me to dislike my breasts even more--they're always in the way. i know, intellectually, i "shouldn't" feel this way, but sometimes i feel like it's just another thing that makes an excuse for discrimination. then again, maybe this anger i have is more about the fact that i haven't had anyone around to enjoy them in a long time. did i mention that i miss having a boyfriend? <--odd thing for a feminist to say, isn't it? but i digress.

it was pretty clear to me, from the outset of this appointment, that i was not well-prepared to be there. one of the most profound difficulties i have as a patient is knowing how much information to provide a physician with, and how detailed i should be. it seems that i either haven't been paying enough attention (how often have you been taking x for your nausea? i dunno....), which frustrates the doctor, or i've been paying too much attention (here's the list of everything i've taken, experienced, etc), and get that you-must-have-ocd look. where's the balance? i still don't know. and i'm supposed to be on the professional side of this spectrum now. ha! as if that makes a difference! so, i wasn't prepared. and given the fact that the past ten days have been like a roller-coaster, i didn't know how to answer his questions. i felt myself starting to get frustrated, which wasn't a good thing, because i was already worried that i was going to burst into tears. which brings me to another difficulty of being a patient--communication. mr_dr_do said "i heard you were feeling better," and i looked at him, completely puzzled. "my wife told me," he pointed out. i didn't realize until later, after the appointment, that what i'd said to mrs_dr_do is that i'd been feeling better up until the time i landed in the er with the severe pain, but somehow that came across as i was better in general. given that i was (am?) still a bit freaked by that episode of pain, i don't know what to say about this.

and here we have another point: my desire to please people. especially with my male doctors, who seem to be more goal-oriented, i can see that they really, really, really want to hear that i'm feeling better. and i understand that, because i really, really, really want to stop feeling like crap. but i don't know what to say when everything remains uncertain. am i glad i'm only taking 1 of the nausea pills a day versus 3? yes. but it still sucks to be nauseated and i hate the fact that i have to take the medication at all. mr_dr_do caught this ("are you taking fewer because you're feeling better or because you're tired of taking them?" my answer: "both."), and that's one of the things i like about him--he picks up on such subtleties, unlike most PCPs I've encountered who may have been equally astute (I'm not entirely sure), but certainly never took the time to listen to me long enough to catch these nuances. And these are important nuances in the life of a patient. believe me.

but i so badly wanted to be able to tell him that i was feeling better that it hurt me not to be able to do so. i always end up in the doctor's office thinking, "please, please don't hate me for being a complicated case." sometimes i even go so far as to withhold information that i want to discuss with the doctor because it's clear that s/he is getting frustrated with me. the problem with this perspective, as well, is that i often run into another problem, the one i call the fascinoma syndrome. this is when my symptoms/disease process becomes so interesting to the doctor that s/he gets so caught up in my case as to forget that I'm a human with a life and not a lab rat. *sigh* i cannot even begin to describe the complications that arise from that type of doctor-patient encounter.

the odd part about today's encounter is that it took mr_dr_do a while to realize that part of the reason i was there is that i'd left school because of the medical problems and my anxiety about them. i did end up sharing some of my concerns about all this, but i don't think i was quite clear about how i felt. then again, what the hell does my emotional state have to do with my gut? everything. and nothing.

the other odd thing about being a patient is that for the patient, each encounter with the doctor is significant. i get almost hyper vigilant when i see a physician, in that i find myself latching on to their words and expressions so that i can sort out what happened later, when i'm less overwhelmed. this means that i'm a lot more aware of the encounter than usual; whereas, for them, I'm one of a steady stream of patients they've seen that day, barely distinguishable from the rest. So, i was a little surprised that mr_dr_do thought that i was younger than i am (this also made me a tad insecure: do i seem that immature when i'm here? is it my anxiety that makes me seem young? note that i think these things instead of, hmm...might it be that i don't look like i'm almost 30? why can't i think of the positive possibilities first?!?!?), that he'd forgotten i was an english major in college, and that he hadn't realized that i'm not one of the students who has come to medical school straight from college. he seemed a bit surprised to learn that i've had a long work history in healthcare, particularly in management. too bad i didn't get to tell him some of the crazy stories about managing odd groups of super intelligent doctors with not-so-great personal skills. those stories are unforgettable.

so, what makes a patient unforgettable? and why do we, as patients, care so much about what the doctor recalls about our personal lives? is it because the medicine impacts upon these lives? or are we merely making a mad cry for attention? or could it be both? i really don't know.

there was more to the encounter today--a lot more--but i won't ramble on about all the details. i think my point has been made. being a patient? it sucks. being the doctor? well, i guess i'll find that one out soon enough.

what i do know is that i left mr_dr_do's office today feeling out of sorts and confused. once again, i made it to the car before i started crying...but i'm not even sure why i cried. nothing bad had happened. i did get some help. so why did i feel so odd about the encounter?

maybe i'm just tired of being the difficult patient.

going awol: my exceptionally difficult decision

2007-03-29T01:18:00.000-04:00

when i last posted, i'd just experienced a day from hell in which my body revolted and the medical system pretty much tortured me. the time since then has been turbulent, to say the least. and what i'm about to describe may well surprise you.

first, my ct scan came back relatively normal. normal enough, that is, to rule out any kind of pathological process for my pain. the antispasmodics worked nicely to reduce spasms, but my gut remained tender and sore for several days. on the up side, my mom returned to town and proceeded to feed me--so i'm finally off my diet of applesauce, rice, toast and bananas. believe me, this is a good thing.

the whole experience of the pain, the er, etc, however, left me feeling quite anxious. most of you already know that i have a tendency to be an anxious person (again, i was the cautious one of the kids; my brother was the one always running toward fire instead of away from it, like me). but i have good reason for my anxieties regarding my healthcare. to bring the point home without offering too much information, i'll turn 30 this summer, and in this decade of my 20s, i'll have lost 3 different internal body parts, been put through chemical menopause, have endured four surgeries (three abdominal, one routine loss of wisdom teeth), spent more money than i've earned trying to pay for all the procedures and doctors' visits, and, at one point, counted up that I'd been put through more than 24 pelvic &/or rectal exams in a period of 18 months. No, i'm not making this up. and i don't have munchausen's, either. i've merely had a string of really, really, really bad luck. speaking of which, does anyone know where i can get a body transplant? or a refund? or at least some *good* luck? i feel like i could be despair.com's poster child.

so...anyway...let's just say that the recent medical events have pushed some major buttons in me and that now i'm at the point of feeling rather depressed by all of it. it didn't help that i was under tremendous stress in school. in fact, tremendous may be putting it lightly. since i failed a course in the fall (i'm blushing; this still embarrasses the heck out of me), mwms put me on "probation." i'm not the only one out of 163 that's now on the dean's hit list; in fact, 3 didn't even get a chance to return for this semester--but it still really stings to be in this position. not to mention that it makes me doubt myself even more. it's a tough spot to be in, considering that this is precisely the point when i need confidence the most. but the worst thing was the pressure of knowing that if i failed another class, i'd lose my seat in medical school. for good. and i've worked way too long and way too hard to get here to let that happen.

the_godfather has been working hard to coach me through this process and I really don't think i'd have gotten this far without him. in fact, i'm convinced i wouldn't have. but what he showed me last week was probably the most powerful thing of all. i've been doubting myself so much that i keep getting paralyzed. i freeze on tests and i've generally been feeling, well, stupid. in pbl last week, however, something major shifted.

throughout the week, i ended up in positions where i was leading the group. this was particularly profound last friday, when i was given the role of scribe (the person who writes case information on the board and directs the flow of the group discussion). that day, i realized that my intensive liberal arts training, in spite lacking science training, prepared me for clinical cases in an amazing way. i know how to ask questions. i know how to lead group discussion. i know how to teach. and, somehow, through all of this, i've developed instinct--this sense that i know how to approach a case in a logical, yet thorough, manner. and i remember the human side of it all, too, which is not always an easy feat when your patient is on paper and your whole group is intent on "solving the case" rather than thinking of it as a real live situation that we'll face someday soon. i was stunned by what i was able to do in pbl on friday. during wrap-up, all my group-mates commented on it. since beginning of medical school last august, it was the first time i've felt confident in my abilities. and let me tell you: it felt really, really good.

friday afternoon, after a long discussion with some of my classmates, i went for my weekly meeting with the_godfather. before i reached his office, though, i ran into biochem_enthusiast, my facilitator from the first 10 weeks of these past two semesters. he is also an exceptional teacher and a very interesting person, even if he does sometimes get hyper-obsessed with those pesky little molecules that do everything in our bodies. ;-) he was concerned about me and, for the second time, questioned as to whether i should take a leave of absence. hmm...

i went to see the_godfather next. 28 days out from a big pbl exam that would basically cover all of neuroanatomy (on which we have not been lectured; we've merely read the book and taught ourselves), i was starting to hit the peak of my panic. and that's when everything began to unravel. the_godfather pointed out that i was performing well in pbl--so well, in fact, that i'm often two steps ahead of my colleagues. he also noted that this is not showing in my exams because i'm freezing. i mentioned that i'd tried taking some anti-anxiety medication, but that it had been sedating (and therefore not very helpful for exam-taking purposes), but he stopped me. "this is not a physiological problem," he said. "this is a mental problem." and, in hearing him say that, i knew he was absolutely right. he was also quite accurate in pointing out that i've had a rough year. i threw out my back right at the beginning of the year, which subsequently threw off my studies at a crucial time, and then, right about the moment i was recovering from that, my grandmother died, as did one of my favorite high school teachers with whom i was close. combine that with undiagnosed gallstones and the pain they cause and, well, you get where i'm going: first semester was a nightmare. [a note on this: i wrote a lot during that time, but i haven't published it here yet. i haven't decided whether i'll go back and add these to the blog or not, but i thought i should explain why some of this is just being mentioned for the first time.]

when you add into the mix that this semester has involved illness, surgery, recovery, and more illness, it's clear that i haven't had the opportunity to adequately learn the material, let alone show that i've learned it. so, to make a long story shorter, i finally made the decision to take a leave of absence from medical school.

*gulp*

after working so hard for so many years to get here, it's hard to believe that i've made the decision to step away from medical school. in fact, it feels completely surreal. but here i am, one day after the official clearance from dean_honey (who, upon hearing my decision, said "honey, you're making the right decision. you should've done this months ago. i'm glad you've gotten over your stubbornness."), and i feel like i've been shot out of a cannon or something. it's...overwhelming.

so what does this all mean? well, other than another $50K in student loans (i must be crazy to be doing this), it means that i get to repeat the first year of medical school. so now i'll be in the class of 2011 instead of 2010. this feels *very* strange to me.

on the upside, though, i now have four months to get my health under control (<--maybe that's not the best phrase to use...maybe i should say more balanced...because i clearly have no control over this crap whatsoever). i also will have a chance to fill in some of the gaps in my education (since i wasn't a science major in college, i still have some areas of science that are unfamiliar to me, in spite of all those post bacc classes i took). if i can find someone willing to hire an overqualified slave (will work for food!), i may be able to earn a little money, too. that would certainly feel good.

in the meantime, though, i'm reminded of one of my favorite episodes of the west wing. (yes, i'm a wingnut. i loved that show. i'm not usually addicted to tv, but i never missed that one.) in it, cj is exercising on a treadmill and her pager goes off. so she's trying to check her pager and talk to the guy next to her. that's when she trips--splat--and gets thrown off the treadmill. that's *exactly* what this feels like.

*splat*

the human pincushion

2007-03-20T19:00:00.000-04:00

today began as a good day. thanks to the recent med changes made by mr_dr_do, i'd had a relatively productive weekend (one where i at least slept at night and was awake during the day--amazing how much that helps!) and i got to pbl bright and early, ready to dig in to another case. we'd just switched facilitators the week before (for our pbl groups, there are 8 students and 1 facilitator. the groups shift every semester, while we switch facilitators every 10 weeks or so) and i'd had the miraculously good fortune of getting my advisor, the_godfather, as a facilitator for this section of the term. i cannot even begin to tell you how excited i was by this. the_godfather is an amazing teacher, not to mention one of those rare people who can be honest and diplomatic at the same time. i knew he would mold our group dynamics to the point that we'd become a productive, respectful, and self-sufficient learning group.

when the_godfather walked into the room that morning, he asked me how i was feeling. it was the first time since the surgery that i reflexively and unhesitatingly said, "good!" and really meant it. we began our case, which involved some difficult interpretations of a CT scan, where we were trying to find one of the strangest-sounding tumors you can imagine (a pheochromocytoma). i had the opportunity, in the midst of this, to ask some particularly crucial questions. my colleagues tried to ignore me, but i became more persistent than usual. heck, i was feeling well--and i was very excited about how this case was teaching us to combine neuroanatomy and endocrinology. so, i particularly kept pushing for the group to identify a big glowing spot on the CT scan (in a CT, the stuff that shows up bright white is either really dense, like bone, or something that has picked up a lot of contrast material, if contrast was used, such as blood vessels). after a few minutes of tangents, the_godfather finally said to the group, "and what is that big glowing spot there?" sure enough, it turned out to be the tumor.

By the time we finished reading the scan, we'd been in group for almost an hour. then, all of a sudden, out of nowhere, my gut spazzed out. it was one of those experiences of pain where at first you think, 'oh, that really hurts...but it'll pass...it's probably gas or something.' but it didn't get better. in fact, it got worse. a *lot* worse. i lost track of where the group conversation had gone. i was trying to breathe and desperately hoping i wouldn't throw up on the table. within what must have only been a few moments, though, i broke out into a cold sweat. that's when i started to realize i was in trouble. after about ten minutes of sitting there like this, i finally whispered to the_godfather that i needed to leave. now.

i packed my books and practically ran from the room. i got to my car, hoping, again, that being out in the fresh air might make me feel better, but my pain was increasing. i didn't even think about it--i knew i needed to go to the er. stat. given that my mom, who'd stayed with me for a while after the surgery, had gone back home for a bit, i knew i had a small window in which to get myself to the hospital. fortunately, this new planned urban development (pud) i live in has a hospital in the middle of it, so i only had to drive a few miles.

i got to the er and it was busy considering the size of the small place. it took about 45 minutes before i was brought into an exam room, and, at that point, my pain had already begun to dissipate. i was relieved that it hadn't gotten worse, but also a tad undone by the fact that it had had a sudden onset and such deep intensity. the attending physician finally came in, poked my belly, and said he'd run some tests. he then asked me if i wanted anything for the pain. i didn't, at that point, feel that i needed a painkiller so much as an anti-spasmodic--a medication that would relax my muscles and stop them from remaining in this horrible contracted state. he agreed, and then went on his way. a little bit later, one of the nurses comes in with an injection. i raised my eyebrow at this--the antispasmodic i'd requested comes in a fast-acting sublingual form, as well as tablets, so i was surprised by the choice of an injection. now, my medical history is lengthy and complicated enough that i've long gotten over my fear of needles. i've even had to give myself intramuscular injections before. but i must say that any medication that does not last as long as the injection site remains sore is a medication that really needs to be rethunk. my butt hurt like mad for the rest of the day.

i slowly started to feel better, but still was unwilling to uncurl myself from around the quasi-pillow they'd provided me. a guy, resembling the age of a sixteen year-old, came in and placed my iv. i was surprised--and relieved--that he got it on the first try, as i have notoriously difficult veins. he drew several vials of my blood and then capped off the port in case i needed iv access later. then i waited. and shivered. and waited some more. an er is, truly, a terribly uncomfortable place to be when you're ill. i didn't want to complain--where i come from, er waits are usually about 12 hours long, and that's just to get through triage. so being in this small hospital, i actually felt relieved. it was a busy morning, but i knew that busy is relative. besides, i've worked long enough in healthcare to know when to be patient. the billing rep who came into the room to get my insurance information nearly passed out when i automatically handed her my insurance card, driver's license, and credit card for the copayment before she had a chance to ask. she spent the rest of the morning periodically walking past my room, popping her head in, and threatening to make me work if i didn't get out of there soon.

i think it was about 1:30pm when the doctor finally reappeared (the whole incident had started at just after 9am). he said that all my tests were negative and that i probably was just experiencing irritable bowel syndrome (ibs) from the surgery. that surprised me--ever since my appendix ruptured eight years ago (and wasn't diagnosed for over two months...), every doctor i've seen has given me this wastebasket diagnosis. [a note here: a wastebasket diagnosis is one that is given when there are clearly a constellation of symptoms that people have that can be grouped together, but where the cause is unknown. it's sort of like saying, we don't know what's wrong with you, but here's a label for it. it doesn't describe anything about how or why the problems occur, how it might progress, or even what might treat it best. hence the term, wastebasket diagnosis.] i get it--my bowel is pissed off. but any one's bowel would be pissed off after 2.5 months of purulent infection, followed by two surgeries and a host of other complicating factors. never, though, had my "ibs" ever caused pain that severe. never. nor had i ever read about someone experiencing this type of pain with ibs as the underlying cause. so i was, needless to say, skeptical. he then said he'd give me a prescription of the antispasmodic i'd been shot with; when i asked if it would impair my cognitive function (an important thing to know when one is a first year medical student), he said, "well, do you feel extremely sleepy now?" i didn't feel extremely sleepy right then--but i knew i was still on an adrenaline rush from the pain and my subsequent fear. so, thinking he'd proven his point, he attempted to leave, but before he could i asked about what i should do if the pain comes back this intensely again. he just shrugged, said to take the medication, and basically blew me off.

by the time the nurse came in with my discharge papers, i was angry. it didn't help that the first thing the nurse asked was whether or not i'd driven myself to the hospital. my response: why, yes, i had. to which the nurse replied, "oh. i don't know if you should drive after taking this medication, it can make you drowsy." i pointed out that the doctor had just told me that this wouldn't impair my function, but the nurse read down the sheet, found the section on side-effects, and sure enough, first thing: "may cause drowsiness or dizziness; avoid driving or operating heavy machinery until you know how this medication will affect you." it was a good thing the doctor was gone by this point, because i might have hit him if he'd still been around.

after finally getting the catheter removed from my arm and climbing back into my warm clothes, i left. i stepped out into the sunlight and walked to my car. i got into the car, and that's when i lost it. i just started crying...i couldn't believe i'd just been treated like an idiot by (yet another) physician...i couldn't believe i'd just paid out the nose for this privilege (er visits have a hefty copayment with my insurance)...and i couldn't believe that after all of this, i had no more idea as to what had just happened to me than i did when it started.

i decided to call the dr_do's and see if they could see me. fortunately their office is awesome (i swear, i have never seen a primary care physicians'/family practice office run so smoothly or be so accessible), and mrs_dr_do agreed to see me. within an hour, i was in her office, explaining what had happened. i'd had her as a professor for one of my classes in the fall, but had never seen her as a patient. i was a bit nervous about this at first (i'm really damn picky about who i allow to treat me after what i've been through over the years), but she immediately put me at ease. she was incredibly helpful, gave me advice, and then ordered a CT scan for me. since i could either go for the CT right then, or wait ten days for the first available spot, i decided to take the appointment that evening. i drove from their office to the CT place, which, fortunately, is only about a block from where i live.

i like this radiology center--i'd been there for my second abdominal ultrasound a few months prior, when my gallstones were finally discovered. the staff there is incredibly nice, and they do some neat things to ensure patient comfort--like providing us with scrubs to wear for the test instead of making us wear those ridiculous paper-thin hospital gowns. i felt relieved to be there and eager to get to the bottom of my problems.

unfortunately, however, i hadn't had anything to drink since before 8am except for the awful, horrible, barium contrast material. so i knew i was dehydrated, which is not a good position for me to be in when someone wants to place an iv in one of my veins. i inherited tiny, deep, rolly veins--in short, i'm a difficult stick. some phlebotomists continue to run in the opposite direction when they see me coming, that's how bad it is. but i'd been having good luck with labs in this town so far, so i wasn't overly worried. at least, not after the first attempt. then there was the second attempt. and a third. at this point, i was ready to let the guy do the damn scan without the intravenous contrast. but he said he'd try one more time (and not dig around this time) to see if he could get it. i guess for me, the fourth time is the charm, because he finally hit a vein in my hand and got the catheter to stay in place. by this time, though, i felt absolutely ill. the insides of both my elbows were raw, as were the backs of my hands. it sucked, to say the least.

antecubital fossa
(i.e. inside elbow)

back of right hand

in an attempt to appease me, though, the technician let me look at my CT scans on the computer. it was exciting to know that i could read them; thrilling to know that i didn't have a pheochromocytoma like the morning's patient; and basically amazing to get to see my body on a screen like that. i could see where the surgical clips had been placed during my laparoscopic cholecystectomy--so that was pretty amazing, too.

by the time i left the imaging center, though, i was a complete mess. i came home, tried to write out some of my feelings on this blog, but ended up saving it for publication until later. mrs_dr_do had insisted that i take a narcotic as well as an antispasmodic for the pain (my gut had been so tender when she examined me that i kept apologizing for guarding the whole time), and, although i really dislike taking narcotics, i followed her instructions and then proceeded to sleep through monday night and almost the entire day tuesday.

i was still sore when i awoke, but the medications had clearly helped. what i couldn't shake, though, was the fact that i'd spent a day as a human pincushion...and got no answers from it. the whole experience left me feeling bewildered, frustrated, angry, and a bit horrified that i'd gone from feeling well to feeling like someone was wringing my guts from the inside, within a matter of moments.

the lingering fears remain: will i ever feel better? will i ever have a consistent period of time where my interactions with the healthcare profession as a patient are positive? what the hell just happened to me? is something wrong, or am i going crazy? will i forever be a human pincushion? i guess only time will tell....

self-doubt

2007-03-18T15:59:00.000-04:00

like the proverbial deer in headlights, i'm paralyzed. i've spent the past hour "trying" to read a chapter from my neuroanatomy textbook, but without any success. but there's the rub: in medical school, is there such a thing as success? and if so, what does it look like? i ask because i haven't found it yet....

throughout this whole first year, my colleagues and i have been involved in a dance of sorts--one where we're constantly being evaluated (there is, i kid you not, an exam of some kind every week, if not more often) and consequently re-evaluating ourselves. it was suggested to me, when i was a pre-medical student, that it takes aggression to survive and succeed in medical school; this, of course, was always presented to me in the context of me being deemed by someone to not have enough aggression to get into medical school, let alone through it. what i'm finding, however, is that it isn't aggression that is needed to be successful here. rather, it seems one must be completely unaware of any self-doubt one might have--and that's where i get definitively stuck.

over the christmas "break," i spent some time with my younger brother--i'll call him super_blaze for reasons that will soon become evident--who has decided to train for a triathlon. he'd gotten a training book that he shared with me. in it, there was an anecdotal story that i found quite interesting. it was about bumble bees. apparently, some scientists decided to study the bumble bee to see how it flies. after all, it's shape isn't exactly aerodynamic, nor are its proportions particularly indicative of flight capacity. so, the scientists did tests, and more tests, and even more tests. do you know what they determined? their studies proved that the bumble bee can't fly. as the book aptly noted, it's a good thing nobody told the bumblebee that. :-)

i suspect this is a quality that must also be inherent in someone training for a triathlon--after all, is it not hubris to assume that one can swim, run, and bike all those miles in one stretch? apparently super_blaze doesn't think so, because he's doing it. and it's amazing. but then, he's always been the type of person who can, for instance, jump off an eighty foot water tower and enjoy it. (<--no, i'm not making that up. he did that. and he didn't end up in the er, either.)

but i'm not super_blaze. (i must have been the practice trial in the gene development department for my family, because i developed with an intense fear of adrenaline endeavors, as well as a predisposition for losing body parts in spite of being relatively kind to my body....) i'm rather conscious of the fact that i cannot fly. in fact, one might say that i'm hyper-conscious of my limitations. but i'm beginning to think that, rather than serving as some protective function, this awareness is turning out to be a barrier. one that, in particular, precludes success in medical school.

so...how do i unlearn the consciousness that trying to learn all of neuroanatomy in six weeks is absurd? how do i convince myself that i can learn this, rather than assuming from the outset that i'm doomed to fail (again)? if i've already experienced failure here, then how come i'm so afraid of having it happen again? why am i so tangled up in my feelings about all of this?

i sure wish i had some answers....

blog tweaks

2007-03-17T23:11:00.000-04:00

i decided to add some flavor to my blog and i want to share some of the changes, since they may not be readily apparent.

the most important change is my addition of case files. for those of you who've studied medicine and/or have been a patient long enough that you know how to read your own chart, my creative license will be readily apparent to you. for those of you who haven't studied medicine, a bit of background information here: during the first semester of medical school, medical students learn how to take a patient's history. this is always recorded in a particular manner and then presented back to the more senior member of the medical team as a "SOAP" note. since i want my blog to remain semi-anonymous, i didn't want to describe people by their real names. but people are what make my life colorful, so i wanted a way to bring them into my posts. hence, i made up "case files" for some of the people i talk about. the pseudonyms in the posts will allow you to link back to the case files so that you can learn more about that person if you so desire. i see it as a way of providing more context for my ramblings. [N.B. these case files are meant to be funny. they in no way represent a popularity contest or anything of the sort, and for some, identifying information has been tweaked to protect the innocent (or not so innocent, as the case may be!)].

in addition, thanks to google, snap and librarything, i've been able to add some neat features to the sidebar (like links to medical articles i read and find interesting) and also a preview feature for the links in posts (hover your mouse cursor over "history" in the paragraph above and you'll see what i mean). i've had fun with these; if there's anything else you'd like me to add, just let me know. i'm discovering that people put all sorts of random information in their sidebars, like what they read last, the last movie they saw, or their "favorites." i tend to want to share things, like articles and books, that open up peoples' knowledge of medicine and health care.

i also added a post about problem-based learning (pbl) since so much of my education is in that format right now. it helps explain all the little things that i may forget to describe when i'm writing a post.

so...that's the 411 for now. if you have any requests, please let me know! :-)

an addiction?

2007-03-13T17:22:00.000-04:00

can blogging become an addiction? if so, i'm in trouble. it's not even the writing itself that sucks me into the time abyss, but rather that this is yet another tekkie thing for me to learn--and yes, i'm a geek. a gadget whore. i should come with a warning label. today it would say: this is my brain without any sleep. any questions?

so it seems i'll be playing around with my blog template for days to come, especially since google is always adding such great features, and because my friends' sites inspire me to do more. the best thing about today (other than getting to be the female guinea pig for my clinical exam class...but more on that later....)? wee me. it's all j.p.'s fault. you'll see....

little known facts about women & aging

2007-03-13T03:14:00.000-04:00

this semester, in addition to being inundated with work for PBL, OMM, & CE, we first year medical students also have the privilege of taking on 4 additional 5-week classes: ethics, geriatrics, public health, & healthcare management. for geriatrics, one of our assignments is to write a review of an article. the particular one i chose, "comprehensive evaluation of the older woman," (H Amin MD et al. Symposium on Geriatrics: "Comprehensive Evaluation of the Older Woman." Mayo Clin Proc. 2003;78:1175-1185.) offered some surprising information. Here are some of the little-known facts I learned:

in general, the aging woman accounts for nearly 70% of the caregivers of older persons and a woman is more likely to live alone, experience more years of dependency, and, in her later years, experience more financial difficulty and/or poverty than a man
dementia, defined as an acquired persistent and progressive impairment in intellectual function with compromise in multiple cognitive domains is the fourth leading cause of death in older women, with a prevalence of 25% to 47% in patients over 85
delirium, defined as an acute, fluctuating disturbance of consciousness, associated with a change in cognition or the development of perceptual disturbances, and has two causes: an underlying medical condition or medication. the most common cause? polypharmacy (i.e. 5+ medications--including vitamins & herbal supplements--taken on a daily basis)
the prevalence of major and subclinical depression in older women is 15% and women aged 65+ are 2x as likely to have depression as men of the same age (so much for the theory that hormones cause our mood swings, eh?)
women are twice as likely as men to suffer urinary incontinence
falls are the 6th leading cause of death in elderly persons and contribute to 40% of nursing home admissions; there's a 20% mortality in the first year after sustaining a hip fracture
the lifetime mortality risk of coronary heart disease (CHD) among postmenopausal women is 31% compared with 2.8% for hip fracture, 2.8% for breast cancer, & 0.7% for endometrial cancer; of women 65+, 55% experience functional limitations, morbidity, & impairment of quality of life due to CHD (and yet we hear more about cancer than we ever do about CHD)
more than 1/3rd of women (ages 20-70 years) in the united states have hypertension, 25% have hyperlipidemia, 25% are smokers, 25% are obese, & nearly 60% are sedentary (i.e. all this mortality is relatively preventable)
nearly 70% of sudden deaths in women are from unrecognized CHD; in women, 40% of all coronary (i.e. heart) events are fatal, but women with CHD are not treated as aggressively as men (traditionally, anyway--let's hope that's changing!)
women who smoke present with their first MI (i.e. heart attack) 19 years earlier than female nonsmokers
the onset of type 2 diabetes can be reduced by 58% in women who exercise moderately 2.5 hours per week; improvement in cardiovascular risk has been shown even in women who walked only 1 hour per week
the lifetime risk of developing hypertension (i.e. high blood pressure) in people who never had it before who are 55+ is 90%; in persons over 50, the risk of cerebrovascular disease DOUBLES for each 20/10-mmHg increment of blood pressure level
more than 80% of patients with diabetes die of cardiovascular disease; the risk of CHD in women with diabetes is 3 to 7 times higher than in women without diabetes
after age 65, the risk of developing uterine cancer increases by 2x and the risk of ovarian cancer by 3x; and yet...15% of women aged 65 to 74 and 38% of women over 75 have never had a PAP smear
endometrial cancer is the most common invasive gynecologic malignancy (but we're not even close to having developed a reliable test for it)
age is the most predominant risk for breast cancer; 1/3rd of breast cancer cases are in women over 70; an increased risk of breast cancer was found in people who drink alcohol (but alcohol lowered the risk of CHD...pick your poison?)
decreased sexual activity is influenced by the fact that by age 80+, there are 39 men for every 100 women; the geriatric population has the second highest rate of HIV infection after teenagers (proving that viagra should be packaged with condoms)
in women aged 65+, 31% did not graduate from high school

dazed & confused

2007-03-11T15:40:00.000-04:00

i'm not sure how much i've written about my post-op experience. i seem to be in a never-ending battle vis-a-vis how much personal information to reveal here. that may sound funny after posting pictures of my healing gut, but, well, that was my gut. to me, emotions are much more personal.

four weeks out from surgery, i'm still being blasted by those pesky emotions. so much so, in fact, that i've had an incredible amount of difficulty sleeping...well, at least at normal times...i seem to only be awake in the wee hours of the night, which, contrary to what one might expect, is not a good thing. given that this was starting to make me feel crazy, i decided to go back to my primary care physician (pcp), mr_dr_do. [in an effort to maintain some degree of privacy, i've decided to follow granola_mom's lead and use euphemistic names in place of actual ones. in this instance, my pcp, who is a doctor of osteopathy, is in practice with his wife, mrs_dr_do, who is the fabulous female professor that my school managed to chase off.] mr_dr_do, upon hearing me say that i was beginning to fear that i am just going crazy, said "i hate that word." :-) he's been one of the few physicians i've ever encountered who unabashedly acknowledges the real difficulties of being ill without blaming me for my symptoms. amazing, no?

anyway, mr_dr_do decided to add to my ever-lengthening list of medications. [yes, "good people," as dean_honey likes to say, even physicians-to-be and physicians themselves have medical problems and have to take medication. contrary to past popular opinion, physicians are not infallible superheroes. <--and if you have one that thinks s/he is, run for your life in the opposite direction, stat!] the good news is that, as a result, i've finally gotten some decent sleep. the bad news? i feel dazed and confused.

for instance, at this moment, i should be studying for one of the three exams i have coming up over the next two days. [yes, you read that right: 3 exams in 2 days. and i'm literally paying for this. maybe it's time to re-think the crazy diagnosis....] however, since i keep catching myself staring off into space, lost in thought, instead of focusing on my studies, i decided that perhaps a writing session would do me some good. at least then i'm doing something instead of staring. i also decided to sit on my porch to write, since that way i'll get some sun, which may convince my body that day is day and night is night and not the other way around.

sitting on the porch is still a little strange for me, though. i live on the second floor, above one of the smaller units in my condo complex. these smaller units are invariably inhabited by retirees who spend an inordinate amount of time at home. the good news is that this means there's a built-in security system; the bad news is that someone is always watching me. so when i sit on the porch and hear little_old_man below me sneeze, am i supposed to say "bless you"? when little_old_woman starts cursing in spanish (<--thanks to my friends growing up, i pretty much only learned the bad words in spanish, in spite of being in a city that is predominantly hispanic), is it inappropriate if i begin laughing? what is the etiquette of sharing living space (even if only auditorily or visually) with other people? i wonder....

but i digress. i was talking about emotions, wasn't i? hmm....

lately my emotions have brought me nothing but confusion. as i'm learning (albeit the hard way), surgical recovery is not a linear slope back to health. rather, it's more like a roller coaster, fraught with ups, downs, upsidedowns, and inbetweens. when you add surgical recovery to the stress of being a first year medical student...it's beyond comprehension, let alone my writing abilities, to describe precisely what this feels like.

as you may have noticed from my last post, i tend to get angry more easily than usual. i also am not as good at censoring myself. the never-ending sense of frustration is what hits me hardest, though. i hate feeling scattered and unable to focus. i hate that, in spite of my place on the dean's hit list (it takes talent, does it not, to go from the dean's list in college to the dean's hit list in medical school? maybe not. both the student doctor and mr_dr_do mentioned having had difficulties with medical school. it took me until this week to earn my first A on an exam. imagine what that kind of challenge poses to 160 type-A students? okay, now you have a sense of the atmosphere at school.), i cannot force myself to sit down and study for hours on end. the "maybe-it's-time-to-take-a-leave-of-absence" rumblings have begun, mostly because, unlike most professional schools, mine takes attendance. oh, and attendance is mandatory. nevermind that we're all too anal-retentive to miss class except in dire circumstances.... do they really want me to barf on the floor in the middle of lecture?

anyway, i fear i'm starting to whine rather than write, and my typing, as soft as it is, seems to bother little_old_woman (i do recognize the phrases 'too fast' and 'girl upstairs' in addition to all the four-letter words i won't mention here--who knew that little old ladies cursed so much?!?!?), so i'm going to sign off for now. besides, i'm sure there will be more ramblings from this dazed & confused medical student soon....

time for change!

2007-03-10T23:42:00.000-05:00

first, i decided it was time to change my blog template. the dots were starting to drive me crazy. alas, my attempts to find some really neat artistic template failed when i realized that i was spending too much time tweaking and not enough time studying. so, for now, my html alterations on font, plus a different blogger template, will have to suffice.

but, when i titled this post "time for change," i wasn't thinking primarily about the template, or the impending daylight savings time debacle (does anyone know *why* we still do this? does it stem from hubris? i need my hour, dagnabit!). no, my thoughts were of a more radical sort: thoughts that call for alteration of our conventions.

my problem, at present, has to do with the conventions of being a woman in medical school. more specifically, my problem has to do with american definitions of "modesty," particularly in clinical settings. it's been insulting enough to be a female patient, one who gets asked to don a paper gown for every examination. does anybody really think that wrapping myself in paper preserves my modesty or my dignity? the darn things are practically translucent! not to mention they slide off with the slightest movement, rendering one nearly or totally naked in spite of the paper. but i digress. this week's problem isn't about being a patient, it's about the insult of being a female medical student.

****disclaimer: if you're the sort of person who cannot cope with precise anatomical descriptions of the human body, you might want to skip this post.****

that said, medical students, as i may have mentioned previously, learn the art of physical examination by practicing on one another. we do this in a large room, with a handful of physician instructors who wander around and monitor/amend our progress. it should, for all intents and purposes, be a very professional learning environment...right? wrong. first off, let me mention that the school chased off the only female physician instructor for our clinical exam class. (don't even get me started on how i feel about that--she was, after all, our best lecturer and really the only female role model here within an age range to which we could relate--i could vent for hours about my anger over her absence.) so, now, our clinical examination class (we call it ce for short) is led entirely by a staff of male physicians, most of whom are retired from clinical practice and/or getting there. don't get me wrong--some of these guys are brilliant and it's a privilege to get to learn from people who have been in practice for a number of years (i.e. 30+). since it's one of the anatomists/deans that refers to me (and every other woman in the class) as "honey," i can even say i have comparatively good rapport with these men.

however, on tuesday, our ce lab covered the cardiac exam. the night before, we got an email from one of the primary instructors, reminding us to wear our omm (osteopathic manipulative medicine) attire. this consists of shorts or sweatpants and a t-shirt. for the women, it also means we have to wear a sports bra. (the professor's email blithely mentioned that this piece of the attire was optional for the men.) supposedly, we have to wear sports bras to "preserve modesty" when doing the exam. whatever....

the cardiac exam requires that we remove our shirts, which is no big deal since we do it every week for our omm class anyway. however, in order to properly perform a cardiac exam (at least in the thorough manner in which we're taught to do it--i've never actually seen a physician perform each and every one of the components of the entire physical exam in a real clinical setting), we have to palpate the chest for the pmi (the pmi is the point of maximum impulse; it's about a 1cm spot on the chest where you can feel the heart beat up against the sternum/breastbone). when the physician instructor demonstrated this technique to the class, he (of course) chose some young chiseled man as his specimen. in order to find the pmi, the professor noted, we should find the level of the nipple line and move slightly inferior (below) that. any of you who are female readers should already begin to see the problem here. but did the professor mention it? no.

so, he instructs us to begin practicing on each other. several of the female students and i began working on each other. we quickly noticed a big problem: breasts. first off, when breasts are bound up in a tight-fitting sports bra, they don't move a whole lot. you can't really separate them, lift them, or otherwise get them out of the way without getting bound up and/or stuck in the elastic of the fabric. so, we tried to feel for the pmi around them. no luck. we tried to find the pmi on ourselves (so as not to have to molest our lab partners); again, no luck. at the 4th and 5th intercostal spaces (the areas between the fourth and fifth ribs), there is, in many of us, simply too much tissue to get anywhere near the breastbone. we were stumped. so, we did what any normal group of students would do: we called over one of our professors to ask for help.

the professor, upon hearing our question, turned bright red. by this point in the day (we'd had 5 hours of lecture already), i was too tired to censor myself, so i said, "haven't you seen like a million breasts in clinical practice? what's the big deal?" he stammered a bit and then said that it's different when it comes to students. what's different? i thought, my breasts? but fortunately, i bit my tongue before the questions came out of my mouth. essentially, we got no answer from him as to how to perform the exam properly. we were only given the impression that, in a room full of 80 students and a dozen faculty, the men were still afraid that someone would claim inappropriate behavior if they demonstrated on us.

after class, a bunch of us gathered and began talking about the experience. now i, having been a women's college graduate, really have no problem with breasts. (they're breasts, people! i wanted to shout. parts are parts!) in fact, as a medical student, after having seen cadavers and the like, i really don't have a problem with any body parts. but i also recognize that i am not everyone. some of my closest friends here are muslim. as such, they cannot remove their t-shirts in lab because we're in a co-ed lab. i asked one of them why the school did not offer her a separate lab session; apparently, one of the other medical schools kicked a muslim student out of school because she requested this. (can they do that?!?!? isn't that against our civil rights or something?!?!?)

is it 1950 again?

needless to say, i am angry. part of me wants to go to the next lab braless, but i have a feeling that'd give half the old guys heart attacks, and then i'd actually have to *use* the new cpr skills i just learned and...well...i'm not ready for that. i did end up emailing one of the professors and asking him to address the issue at the next session, but he hasn't replied to my message. am i surprised? no.

so, what is a girl to do? you might ask. for starters, never call a female over the age of 18 a girl. or honey for that matter. as for my solution? i scraped up my pennies and joined now.

a drug to endorse?

2007-03-04T05:25:00.000-05:00

I'm not usually the type of person to endorse medications, but this is one that just may be necessary to take in order to survive medical school. It goes well with the mandatory despair.com calendar.

Thanks, j.p., for passing along the latest pharmacological miracle pill! ;-)

the on/off switch?

2007-02-19T02:50:00.000-05:00

One of the biggest problems I have with med school is that I've discovered that my brain did not come equipped with an on/off switch. I've been awake now for about 28 hours straight, and I still cannot get it to shut up. It's a tad annoying that way....

I suspect this is not an uncommon problem, especially for those of us in PBL programs, and particularly during the high-pressure days before one of our big exams. On Friday, we have our first PBL exam of the semester. I'd try to correlate this to exams I took as an undergrad, perhaps like those at the end of a term...but really, there's no comparison. The amount of material we're being tested on is absolutely overwhelming. (I think I've said that before, but I don't think I can say it enough, you know?) On Friday, I'll be tested on 36 learning issues and 7 cases. What does that mean? Well, each learning issue is essentially one chapter from a textbook. This block of cases focused on cardiac, vascular, & renal physiology, so we're covering three units in Guyton's Physiology, which means all of cardiac physiology, all of vascular physiology, and all of renal physiology. That would be enough, in and of itself, but, wait, there's more: we've also got chapters from embryology, anatomy, histology, pathology, biochemistry, pharmacology, & genetics. Some of the material will overlap a little--e.g. there's a chapter in phys on lipid metabolism, as well as one in biochem--but basically we've got over 500 pages we're responsible to know. The cases, although much more interesting than just the chapters themselves, integrate much of the material, but they also challenge us in unusual ways. While most medical schools focus on one set of classes at a time (e.g., in a traditional allopathic medical school, I'd be taking lecture courses in physiology, histology, anatomy, embryo, etc, and they'd each be their own distinct entity like in undergrad), almost all of our work is done through the PBL format. It's great in the sense that we're getting clinical exposure early on in the form of learning how a medical case works, what lab results look like, how to interpret x-rays and such, etc; but it's also daunting to have to learn about all the different classes of hypertensive drugs when I feel I've only barely got a grasp on how normal kidney function works, let alone pathophysiology and treatment through pharmacology. And that's just one example of how I feel like I've been thrown in the deep end here, so to speak....

No doubt my experience right now is colored by my surgical recovery and all the time and energy that has eaten up, but I do wonder--is two years enough time to learn all the basic science needed to pass the boards and set foot in a hospital and start treating people? Sometimes it seems like sheer lunacy to me, this concept that I can learn all about the body so quickly.

Of course, it could be the precise reason as to why I seem to have lost my off switch: with this much information to incorporate, even sleep--however infrequently obtained--is permeated with thoughts of drug clearance curves, risk factors for atherosclerosis, and nagging questions about just how those kidney tubules actually work.... Anyone want to trade places for a day? I need a nap!

let the healing begin...

2007-02-18T03:40:00.000-05:00

There's a saying, popular among those in the medical profession, that says that doctors make bad patients. Over the past few weeks, I've gotten a first-hand glimpse of patient life (again) and it hasn't been pretty. I've decided that I make for a rather impatient patient....

Although I haven't hit the big 3-0 just yet (I have a few months left!), I have, in my short time on this planet, managed to lose many of my "spare parts." It all began in my early 20s with a ruptured appendix, followed by the near-loss of a fallopian tube, and then the ubiquitous removal of my wisdom teeth. But, because my body clearly wanted to end the decade in the manner in which it began, last week I lost another part--my gallbladder.

I cannot even begin to describe how mad I was about having to go under the knife again. For those of you who witnessed my appendix debacle (it took 2.5 months to diagnose my ruptured appendix; yes, I should've died, but I didn't), I know I don't need to explain any further, except to note that it happened again: medicine failed me. This may seem like a strange statement coming from a medical student, but one of the reasons I decided to attend medical school is precisely to prevent such mishaps. This time, although my health care providers all pointed in the right place (my gallbladder) based upon my symptoms, the first ultrasound I underwent missed the very obvious fact that I had gallstones. Here's where I begin to have difficulty with the current practice of medicine, particularly in the U.S.: we rely too much on tests and too often ignore our own instincts.

I'm guilty of it myself. When I underwent the first ultrasound, the technician performing the scan wouldn't talk to me. Now, I know, techs are trained not to engage with the patient about what they're seeing. But most are friendly enough to at least TALK to their patients, and many will allow the patient to watch the scan on the screen provided that the patient doesn't ask for an interpretation of what's been shown (since it's the radiologist's [<--aka physician who reads the x-rays or scans, etc.] job to do the interpreting, not the tech's). So I was a tad surprised that this particular tech was so reticent. I recall thinking, "whatever, this person is probably having a bad day." But the scan took a long time. A really long time. And ultrasounds aren't known to be the kind of tests that take more than, oh, twenty minutes or so, max. Again, though, I brushed off my feelings of doubt about the tech's competence and went on my way. Here's a little known fact about medical testing: some tests are only as good as the technician performing them. This is particularly true in cases of diagnostic medical imaging, like ultrasounds. Since the radiologist can only read the images provided to him/her by the technician, the technician's role becomes crucial to the radiologist's ability to make the proper diagnosis. In my case, the scans utterly and totally missed the fact that I had gallstones. Because of this, I entered into a veritable wild goose chase to find a "cure" for my abdominal pain. After countless blood tests, x-rays, CT scans, an upper endoscopy, several trials of medications, and a trip to the ER, I ended up having another ultrasound done in the beginning of January. In this case, the technician proved friendly. He turned the monitor so that I could watch what he was doing and within the first two minutes, before he even said a word, a nice big image of my very sick gallbladder appeared on the screen. It was obvious enough that even I, who have only seen a few ultrasounds throughout my textbooks, lectures, and random experiences thus far as a medical student, knew at once what was evident on the screen. Luckily, my suspicions were confirmed when he began pointing structures out to me (he technically wasn't supposed to talk about what was there, but since I mentioned I was a med student, he gave me a personal tour of my innards that day). So...a diagnosis of gallstones befell me. Unfortunately, gallstones are one of those nasty little problems for which the best cure remains surgical intervention. I spent a good week agonizing over what to do. Had the stones been caught the first time, I could've had surgery over the holiday break and recovered in time to be back at school without having to study while recovering. Alas, no such luck. So, I had to make a decision as to how to proceed with my health care while simultaneously managing my second semester of medical school. *Not* an easy decision to make, let me tell you.... With gallstones, it isn't so much the pain that they cause that is the biggest medical concern, although anyone who has experienced an attack of gallstones will tell you that the pain is not trivial. Rather, because of where they're located in the gallbladder, the stones can pass out of the gallbladder and into the duct that goes from the gallbladder to the intestines. Unfortunately, part of this duct is shared with the pancreas--the organ responsible for, among other things, providing us with some really important and potent digestive enzymes. If a gallstone blocks the duct, the enzymes can back up in the pancreas and cause it to start eating itself. <--this is not a good thing (read: death in about 24 hours). The pancreas is not on the list of spare parts. Since it became clear that I'd already passed a gallstone (my liver enzymes had been elevated and I'd gone to the ER in extreme pain), my case was one that my PCP aptly described as "not a matter of 'if,' but a matter of 'when'" the next stone would block the duct. So, I decided to have surgery, in the form of my third laparoscopy. All said and done, the procedure went well. I gave the surgeon a bit of a challenge with some unusual arterial structure (one artery formed in a W shape instead of the usual Y configuration), but otherwise mine was a standard operation. The after-effects have not been as easy. I had the very unpleasant experience of having my bladder seize up post-op--a not altogether uncommon response that some people have to surgery such that they cannot pee afterward and have to be catheterized. OUCH. I also have managed to develop an allergic reaction to the adhesive in the bandages; as I write this, I'm doing my best not to scratch my belly, but it isn't easy! All this aside, however, I must say that recovery from this surgery is a whole lot less painful than recovering from an appendectomy. For this, and the fact that the whole ordeal is over, I am extremely grateful. For you voyeurs who like the nitty-gritty, seldom-shared details, here's a closeup of the aftermath:

Anatomy of a Gut

Now, I have to go figure out how to learn all of cardiac and renal physiology in time to pass my PBL exam on Friday; a task which, ironically, feels a lot more scary than undergoing surgery! My revised favorite expression for the experience of medical school: this too shall pass, like a GALLSTONE! ;-)

Is a "Well-Rounded Physician" an Oxymoron?

2007-02-06T16:48:00.000-05:00

Is a "Well-Rounded Physician" an Oxymoron?
An apt way of saying what I couldn't have said better myself....

White Coat

2007-01-27T21:20:00.000-05:00

Today marked a new beginning as my classmates and I were officially inducted into medicine via the White Coat Ceremony. It was a beautiful, celebratory event (a rare occurrence, that, in medical school, I find...), and yet I'm left with the feeling that I've crossed some great divide and am now in no-man's-land, so to speak.

I suppose that this isn't really a definitive moment--the concept that one can go from lay person to physician so quickly is, truly, ludicrous--but rather that it catalyzed an awakening into consciousness of just how much the process of medical education is changing me.

I don't have adequate words to describe what the experience of medical school feels like. I stared across the table at my parents during dinner tonight, trying, in vain, to explain my learning process here. Likening it to literature was the best I could do. Anatomy, I explained, is like learning how to diagram a sentence--what parts of speech are found, how the words are spelled and arranged, how punctuation is used.... PBL (which comprises the study of the "basic" medical sciences, including anatomy, physiology, pathology, pharmacology, biochemistry, microbiology, etc.) is like reading an anthology of literature and being expected to know not only the sentence structure (i.e. the anatomy), but the paragraphs, the chapters, the genres, the historical context of the work, etc. I'm not sure, though, that this is a sufficient analogy--but how else am I to explain this? I can only stammer, grasp at straws, and watch the rift between myself and the rest of the world grow wider and wider....

I'm hesitant even to write here. I wrote volumes last term, but not much of it felt "publishable." Is it the context? Or have I already been inducted into secrecy? I don't know. I don't know how to describe this life...but I intend to keep making the effort....

Medical News: IQ & vegetarianism

2006-12-15T17:05:00.000-05:00

The British Medical Journal announced today its findings re: the relationship between IQ in childhood and vegetarianism in adulthood. Check it out!

2006-12-13T17:39:00.000-05:00

From Biddle & Little

I keep trying to get in her way, but all my mom does is study, study, study.... -Biddle

Snap, Crackle, Pop

2006-12-07T10:25:00.000-05:00

Guess what? I just cracked my first neck! :-)

In osteopathic manipulative medicine lab this morning, we began learning a method of treatment known as high-velocity low-amplitude (HVLA) therapy. It's the type of treatment you usually think of when you think of chiropractic treatment--you know, the one where the physician twists someone's neck really quickly and it looks like they're going to take the patients head off? Yep, that's the one. It's only one out of a ton of different types of treatments we learn (most of which are more like massage therapy or physical therapy), but it is, to the non-practitioner, the most high-profile/interesting treatment we use [see link above for a description of osteopathy, if you're curious to learn more].

It was pretty funny to watch a group of medical students walk into cadaver lab for the first time back in August, but telling them they have to crack each other's necks for the first time? That's truly hilarious. Everyone was nervous. We thought for sure that one of us was going to break someone's neck. In fact, the professor had us start with the neck first, because it's the scariest part--he says that once we learn this, none of the rest of it will intimidate us. It's pretty crazy, though, to see a room full of 80 students, all cracking necks for the first time.

Good news, though--I didn't kill my lab partner. Nor did I break his neck. In fact, with a satisfying pop, I fixed his neck dysfunction! Ah, the joys of medical school. It is, without a doubt, a place where there is never a dull moment. Anybody want to volunteer to be my next guinea pig? :-)