on an entirely random note...
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!
random thoughts on one woman's convoluted journey to transform from patient to physician without losing herself in the process.
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!
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.
created, written, & typed by student dr. blaze on 28.8.07
tags: exam, medical education
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*
created, written, & typed by student dr. blaze on 28.8.07
tags: medical education
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!
created, written, & typed by student dr. blaze on 26.8.07
tags: humor, medical education
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
created, written, & typed by student dr. blaze on 26.8.07
tags: exam, humor, medical education, time
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....
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. ;-)
created, written, & typed by student dr. blaze on 25.8.07
tags: exam, medical education, psychology
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!
--
Oscar the Cat awakens from his nap, opening a single eye to survey his kingdom. From atop the desk in the doctor's charting area, the cat peers down the two wings of the nursing home's advanced dementia unit. All quiet on the western and eastern fronts. Slowly, he rises and extravagantly stretches his 2-year-old frame, first backward and then forward. He sits up and considers his next move.
In the distance, a resident approaches. It is Mrs. P., who has been living on the dementia unit's third floor for 3 years now. She has long forgotten her family, even though they visit her almost daily. Moderately disheveled after eating her lunch, half of which she now wears on her shirt, Mrs. P. is taking one of her many aimless strolls to nowhere. She glides toward Oscar, pushing her walker and muttering to herself with complete disregard for her surroundings. Perturbed, Oscar watches her carefully and, as she walks by, lets out a gentle hiss, a rattlesnake-like warning that says "leave me alone." She passes him without a glance and continues down the hallway. Oscar is relieved. It is 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 alone and in control of his domain. He takes a few moments to drink from his water bowl and grab a quick bite. Satisfied, he enjoys another stretch and sets out on his rounds. Oscar decides to head down the west wing first, along the way sidestepping Mr. S., who is slumped over on a couch in the hallway. With lips slightly pursed, he snores peacefully — perhaps blissfully unaware of where he is now living. Oscar continues down the hallway 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 walks a nurse's aide carrying dirty linens. "Hello, Oscar," she says. "Are you going inside?" Oscar lets her pass, then makes his way into the room, where there are two people. Lying in a corner bed and facing the wall, Mrs. T. is asleep in a fetal position. Her body is thin and wasted from the breast cancer that has been eating away at her organs. She is mildly jaundiced and has 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 interrupted by a nurse, who walks in to ask the daughter whether Mrs. T. is uncomfortable and needs more morphine. The daughter shakes her head, and the nurse retreats. Oscar returns to his work. He sniffs the air, gives Mrs. T. one final look, then jumps off 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 resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.
One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar's presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.'s chart off the medical-records rack and begins to make phone calls.
Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, "What is the cat doing here?" The mother, fighting back 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 room so quietly that the grieving family barely notices.
On his way back to the charting area, Oscar passes a plaque mounted on the wall. On it is engraved a commendation from a local hospice agency: "For his compassionate hospice care, this plaque is awarded to Oscar the Cat." Oscar takes a quick drink of 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. After all, no one dies on the third floor unless Oscar pays a visit and stays awhile.
Note: Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the 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.
created, written, & typed by student dr. blaze on 19.8.07
tags: death, integrative medicine, patient, physician, story, transition
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
created, written, & typed by student dr. blaze on 19.8.07
tags: medical education, time
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.
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:
created, written, & typed by student dr. blaze on 14.8.07
tags: exam, medical education
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?
created, written, & typed by student dr. blaze on 12.8.07
tags: medical education, time
:-)
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:
created, written, & typed by student dr. blaze on 12.8.07
created, written, & typed by student dr. blaze on 3.8.07
tags: integrative medicine, medical education, osteopathy, physician
created, written, & typed by student dr. blaze on 1.8.07