Private Snowflake.

SEPTEMBER 6, 2007

I've never really had a problem with tests in my life. Not because they haven't been difficult, I've had my fair share of those. But I've never been the type to stress out before tests (or study for them). Get in, get out, quick f*ckin' about.

Enter medical school. Our first exam of the year looms at the end of the weekend, a 4 hour behemoth called "GIE Exam 1." I just battled my way through the first level of medical school, now I gotta beat the boss. And you know the funny thing? I'm not stressing too much. Oh, I have enough of apprehension in me to keep me in the library all weekend, but (and I can't believe I'm saying this), the material doesn't seem "that bad." Just 3 weeks ago, I got my 2 inch syllabus, and my jaw dropped 20 inches. Now, it all seems damn reasonable. A continual evolution of me, I guess. That being said...

Preparing for an exam in medical school is like preparing for war.

Studying for it is an intensive endeavor. Packing my bag in the morning is like preparing to go on a week long recon mission. I need my manuals (books), water to stay hydrated, source of energy, source of caffeine, radio (ipod). Throw it all on your back and trudge off for 12 hours.

The exam is close to 4 hours long. For comparison, the LSAT is close to four hours long. I am taking an LSAT I only had 2 1/2 weeks to prepare for.

The exam is split into two parts. The first half is multiple choice based on lecture material and the questions are framed to be like what we'll see when we take the United States Medical Licensing Exam (USMLE) Step 1 following our second year. I haven't taken a multiple choice test since my lower division sociology class at Gonzaga (upper division profs considered them "too easy"), but wouldn't you know, I'm taking them in medical school. The second half of the exam is the lab practical. The day before the exam, the lab professors and 4th year students go through each of our dissections. They grade the dissections, and choose structures from each group's cadaver that are good representations of what things SHOULD look like (or, as our course director says, "we're really superficial, we choose things that look pretty"). For the lab practical, you enter the lab and start at a station. In front of you is a cadaver, and in this cadaver are tiny metal pins. At the tip of these pins could be a variety of structures. The filum terminale of the spinal cord, the recurrent branch of the median nerve, the extensor carpi radialis brevis muscle, the thoracolumbar fascia. If its a muscle, you might not be asked the name, but will be asked where it originates, or where it inserts, or what it does, or what nerve innervates it. Obviously, this is a very daunting task with no Word Bank to help you out. You have 60 seconds to identify the pins, pick their names out of thin air, and move on to the next station, where a whole new set of pins await you. At least we get to stand.

Obviously, this sounds like a really fun way to spend a Monday (sarcasm). I've been trying to put my finger on why I'm not FLIPPING SH*T about this exam, and I've yet to find a good reason why not. Maybe its because I'm a person the world needs most (thank you Gonzaga). Maybe it's my ego. Or maybe my brain is really just running that well after years of lack of use (and abuse, likely). I think above all the main emotion I'm feeling going into the exam is simply... curiosity. These will be the things that judge my progress for the next two years, and I just want to get the first one out of the way to see whether my study strategies have been working so far.

So, we'll see how it goes. The class is going out to happy hour after the exam, and I'll either be celebrating or drowning my sorrows. The nice thing is all you need to do is pass. As they say, "P's get MDs."

Just call me Kobayashi.

AUGUST 29, 2007

My brain feels like it has been in a hot dog eating contest.

Now bear with my analogy. Hot dogs are like medical knowledge. I love hot dogs (as I love medicine). If I am feeling particularly adventurous at a bbq, I might polish off 4 or 5 hot dogs in an afternoon. But after I am full, hot dogs aren't as fun anymore. The winner of this year's competitive hot dog eating contest ate 66 hot dogs. It goes without saying, this is not an enjoyable experience, regards of how much you love hot dogs.

Med school is like a daily competitive eating contest and my brain is feeling like it was just forced to compete in said competition and had to wolf down 66 medical-knowledge hot dogs. Just when your brain thinks its full, that you can't POSSIBLY study more or retain more information, you simply force yourself to. It goes without saying, this takes a lot of the fun out of hot dogs (or medicine).

So what keeps people eating those hot dogs, pushing past levels of discomfort or pain? It could be competitive desire, to be the very best hot dog eater in the world. It could be personal motivation to prove the human body is capable of much more than one could ever expect. It could be that someone just really, really loves hot dogs, though I am sure this is certainly a diagnosable bizarre and rare psychological condition.

Similar things motivate med school students. Eventually, studying medicine is like eating too many hot dogs. No matter how much you love medicine, eventually you go into information overload and learning it isn't fun anymore (just as eating too many hot dogs makes you feel sick). So what forces us to keep studying, as fatigued as we are and as sick as we feel?

Competitive Desire. Nearly everyone gets into medical school because they are competitive. These are the people who take personal offense to a B, scoff at a C, and only like A's if they don't have a - next to them. These are the people who enjoy setting the curve. I admit I am somewhat competitive, especially self-competitive, because I certainly enjoy the feeling of being the best at something. The feeling of success is like an endorphin shot for me. It's only natural.

To Be The Best. Almost everyone goes to medical school because they want to help people. No one is naive enough to not acknowledge that the special privileges and the gifts of healing that doctors are afforded are largely afforded due to their extensive knowledge on medicine. And yes, it is easier to hit the books with a little voice in the back of your head telling you that one day, someone's life might be saved by the extra effort you put in now.

However, there is one predominant motivator to always study more.

FEAR.

Success in medical school is almost always correlated to time invested in studying. No one gets through medical school by simply being smart. But its a lot like treading water. Hours spent studying doesn't let you fly, it simply lets you keep your head above water. Slack off a little and all of a second you're breathing water. Considering medical school is a VERY expensive endeavor (I will be $200,000 in debt by the end), failure is simply not an option.

So we study.

Now I should note, just like the competitive eater, there is a training process and your body adapts to the rigors you put it through. In a couple months, the continual studying will not seem nearly as exhausting. Just as a competitive eater's stomach becomes more elastic and can distend to much larger sizes, my brain will become able to retain increasing quantities of information with more comfort. It's a lot like training for a marathon. Right now I just finished my first week of training. My body is sore, I'm tired, I don't think I'll ever be able to run 26 miles. But with time and effort, you can mold yourself into a marathon rider. I'm molding myself into a medical student.

It's also worth noting that no matter how many hot dogs I am forced to eat... I still like hot dogs. All the studying sucks, but the good thing is it doesn't make me love medicine less. It's a weird feeling, loving medicine and sometimes loathing it, but its a feeling that all in the medical field experience.

Some other things of note that have happened lately:

I got my faculty advisor/mentor... and he's a pediatric cardiac surgeon (one of only TWO at my school). Booya! I met him today and I have a feeling this is going to be a great experience. He's young (38), and was a straight-from-college med student as well. When I told him of my interest in congenital heart surgery, his first reaction was "well lets get you into the OR!" He also helped dispel a lot of stereotypes about pediatric cardiac surgery. While he's on call every other night, he hardly ever has to come into the hospital. He has a healthy marriage and a 4 month old baby. He doesn't seem worn out. It's was a very positive experience overall. And I'm sure I'll flip at my first chance to see a Norwood procedure or Fontan procedure.

I also got my first preceptorship assignment. I get to work with an orthopaedic trauma surgeon. I'm glad I got to start on a surgery rotation and I'm sure there will be some crazy things I get to see.

All in all, things are starting to fall into place. I'm beginning to run out of hours in a day, but I guess above all, I just need to keep eating those hot dogs.

Scalpel.

AUGUST 25, 2007

I preface this post by saying I have the utmost respect and appreciation for those that chose to donate their bodies to science so that we may learn from them. Any humor is not meant as disrespect to them or the very unique and powerful experience they have afforded us.

They say that the dissection of the human body is an important transition in medical school to the treatment of actual living, breathing patients.

I can see why.

The preserved cadaver walks this fine line between being something distinctly human and being some distinctly not. The formalin preservation process cross links proteins in the body. It makes skin feel almost rubbery. It makes joints difficult to manipulate. It distends the belly. But for all of that, it remains very, very human.

To run a scalpel through human flesh is a very powerful experience. It gives you a great appreciation for how fragile we are. But it also gives you a great appreciation of how well we are put together. Believe me, separating skin from your underlying muscle is a VERY difficult endeavor. Of our group of four, we often had two of us pulling with all our strength (yes, its that tough) while someone incised beneath. Everything is attached to everything. While we were instructed to use primarily blunt dissection to perform most of our dissection, the scalpel turned out to be our truest friend.

Funny anecdote though. Apparently there's a way that everyone holds scissors, then there's a different way that surgeons hold scissors. You have your thumb and ring finger in the scissor islets. You use your middle finger for guidance and place the index finger on top of the blade for greater control. Strangely enough, I've held scissors like that my entire life. Guess some things are meant to be.

Yesterday we got to use the bone saw to cut into the spine. The anatomy lab was like shop class. Power saws going everywhere, smoke rising up, hammers and chisels at work. And this is not a unique phenomenon to anatomy class. A lot of medicine is a lot more crude and brutal than people realize. Just last night a trauma surgeon was telling me about a time when a man came in impaled by rebar. They had to take it out of him using... a diamond cutter and monkey wrench. Guy turned out fine.

I guess that's the part of medicine that starts to get indoctrinated in anatomy lab. Working with the human body is a lot more brutal, aggressive, and messy then people realize. But thats part of what makes it so elegant, and what makes people so resilient.

Perhaps the coolest part of anatomy lab is to see the physical manifestations of pathologies. It's one thing to see a person die of spinal meningitis on the outside, where vitals slowly plummet and the person passes. It's a completely different experience to physically look at that person's spinal cord and actually see white growths of Staphylococcus pneumoniae all over it. You can read the story of the lives and last days of the people we dissect. Our cadaver died of a sudden massive myocardial infarction (heart attack). When we dissect his aorta, it will likely be sclerotic due to heart disease. His liver will tell us if he drank. His lungs will tell us if he smoked (and speaking of which, don't smoke. If you do, quit. You have no idea the ravages smoking leaves on the human body). We may find hip replacements. We may find previous surgical work.

It's a very personal experience. And really makes you marvel at medicine these days and our wealth of knowledge we have acquired.

Luckily, it'll be a while before I cut into a living person. But when that day comes, I know one of the cornerstones of what will give me the confidence to place a razor blade to another person's skin will be these days spent in the anatomy lab.

Gettin' toasty in here

AUGUST 22, 2007

So we've started to hit stride in the academic side of this whole medical school bit, and let me tell you, the stories of the wealth of information you are "afforded" are far from exagerrated. We received our first packet of material we are required to know for GIE (Gross Anatomy, Imaging, Embryology), and well, see for yourself:

My first impression was that "that isn't too bad for the whole 11 week GIE block" only to be informed by a classmate that it isn't the whole block, but rather for the first exam... two weeks from now. Boy did I feel like a dumbass.

So yes, 2" of material for 12 days of lecture. I was trying to find some comparison to undergrad, and I think the most accurate equivalent I could draw is that every day of lecture in med school covers about as much material as a whole week of lecture for an upper division biology course at GU. So we're covering the equivalent of 5 weeks of material a week.

To make matters... interesting... the information in the syllabus is highly condensed (see below). There is very little background on concepts, which means I'm often in a textbook looking up the background to the sentence I'm currently covering in my packet.

A very different style of studying which can leave you feeling scatterbrained. No more neat chapters in one textbook to skim before class. I feel the real barometer will be that first test, but some MS2s I talked to said it can take most of the entire first year to figure out your most effective and efficient studying regimen. The idea of floundering around in the library for 7 months before finally hitting stride isn't appealing, but I've been lucky to be pretty adaptive.

For all the crazy amount of material I'm being fed, it strangely doesn't feel overwhelming. I've been able to grasp everything conceptually, and above all...

THIS STUFF IS COOL!  

To be learning things that, in their own small way, will help me save someone's life someday... well it makes it a lot easier to throw the books into the bag and wander down to the library. And this is coming from the guy who went to the GU library TWICE in all four years of college.

I'm also really digging the integrated curriculum. Having embryology alongside gross anatomy is really awesome for me, considering I want to do some form of pediatric surgery, and pediatric surgery deals a lot with teratology (children born with malformed/deformed structures or organs) and this helps really hammer home the relation between development and structure.

Anyways, first day of cadaver dissection tomorrow. I'm sure another post will be following soon. For now you'll find me here:

Stay tuned for a preview of next week's episode of 24!

AUGUST 15, 2007

It's amazing how much you can start to change over the course of 48 hours.

48 hours ago I couldn't believe I was sitting in orientation in medical school. It's a very surreal feeling being exactly where you've been striving for your entire life.

48 hours later, I'm actually starting to feel like a medical student. I haven't made a single incision in a cadaver yet, haven't seen a single patient, but this week has already started to lay into me the gravity and excitement of the road I'm embarking down. There's been a lot done the past years to humanize doctors, which I think is a good thing, but this week has reinforced to me that medicine truly is a special profession and special calling.

The environment is VERY supportive and rankings and honors are not done on a bell curve. As such, if everyone in the class scores above 90, everyone in the class gets honors. Very cool, and tends to cut out a lot of the competition that seems to permeate medical school.

In a traditional med school format, the first two years are spent loaded with classes necessary to give you all you need to pass your United States Medical Licensing Exam (USMLE) Step 1. You might have a preceptorship, but its primarily in a shadowing format, following around a given physician. Your third and four year are spent in several week long blocks of clinical rotations in the different disciplines of medicine, eventually reaching electives where you are allowed to pursue experiences in tune with your specialization of choice.

My school (though not just my school) does things very differently. The curriculum is integrated, so instead of being loaded up with hours of lecture each day and exams pretty much every week, multiple disciplines are integrated into one "block" (our first block is a combination of gross anatomy, imaging, and embryology). As a result, lecture only takes up the morning, and you only have one exam to look forward to (typically every 3 weeks). This frees up time for what makes my school pretty innovative in my mind: their combination of preceptorship and PCM (Principles of Clinical Medicine).

PCM is a class focused on teaching you the skills to succeed in a clinical environment, focusing on performing the requisite physical exams, proper communication with patients, etc. This PCM is then coupled with a preceptor physician. At my school, one year is spent in 3 rotations of primary care, and the other is spent in 3 rotations of specialties of interest. I find out next Tuesday which block I will be completing this year, though I'm really hoping for specialty rotations this year. Since after your first block you can personally request physicians as preceptors, I'd have the opportunity the really look into the different areas of pediatric surgery I'm interested in.

Since your preceptorship is matched with PCM, MS1s and MS2s are given a much greater deal of responsibility in their preceptor rotations. Thus, I'll have the opportunity to scrub in for surgeries, treat and assist patients, participate (or not since my medical knowledge is basically zilch first year) in rounds, and generally do all the cool stuff I've dreamed of. So not only will I be out on the wards in two weeks, I will actually be DOING things on the wards in two weeks. In fact, the joke around my school is that you're almost loaded with too much responsibility at first, but I'd rather be thrown into the clinical fray right away instead of having to wait two years.

Tomorrow is the white coat ceremony, where we receive our coats "in recognition of our achievements which have granted us the privilege to study medicine." Perhaps a bit melodramatic, but I think that will really solidify the feelings I've had from the first week.

If this much can come in 48 hours, it really will be interesting to see how I feel after 2 weeks, or 2 months for that matter. One thing is sure, I'll be on my way.

Cause if I did, I wouldn't be a Toys-R-Us kid

AUGUST 13, 2007

So the first day of medical school has come and passed. I tried to keep expectations to a minimum, since generally expectations on the first day of anything tend to disappoint. Overall, I believe it really went well. I was curious to see how things turn out when you put a bunch of accomplished, motivated, type A personalities in a room together and let them get to work. Definitely fun to watch. Funny how everyone slips into a script when attempting to meet new people though. On the first day of undergraduate, things tended to progress like:

"Hi! My name is InsecureFroshZag!" (I was so young. *sniff*)
"Where are you from?"
"What high school did you go to?"
"What are you majoring in?"
"What dorm are you living in?"
*awkward silence*

In med school, its good to know things are totally different.

"Hi! My name is MedZag!"
"Where are you from?"
"Where did you go to undergraduate?"
"What was your major?"
"Where are you living?"
"What area of medicine are you thinking of going into?"
*awkward silence*

Ok maybe not.

Some people seemed intent on getting every name of every person in a room then moving on. For me... I'm horrible with names. Like pathetically, classic blonde spacey with names. So I'm taking my time. There's only 120 of us, so I'll get there eventually. Newfound respect for my professors who learn and relearn names every 4 months though. Props to professors. I'm the youngest person I've met so far (the class' average age is 26), so there's a bit of life experience gap compared to most of my peers, but I know in a month when we're knee deep in gross anatomy its going to matter a lot less whether you're right out of undergrad or are married with a child.

Besides, I hope there's more I can relate to with my classmates than simply the fact that we all happen to be at the same medical school together. Overall, some good conversations on a wide variety of subjects.

If med school was all like today (which it unfortunately isn't), well, sign me up for that Mayo residency. One word: lines. Wait in line to get your white coat size. Wait in line to get your class catalog picture taken. Wait in line then wait in line some more to get your ID badge. An obvious hassle, but also a good opportunity to chat it up with those stuck around you.

Overall, it was a pretty typical first day stuff. Good introduction to the history of the school, rundown of curriculum, all that jazz. My school seems to have things right (*chest thump*). Early exposure to patients (I'll see my first one by the end of August), curriculum focusing on understanding and diagnosing disease, lots of practice of clinical skills. We'll see if the actual thing stands up to the structure they trumpet to you in the beginning. Above all, right now is difficult because you can tell everyone is anxious to jump right in and get to work and it's going to be a more gradual introduction. Email addresses: later in the week. Big siblings: later in the week. Social events: later in the week But, the more I think about it, the more I like it this way. Set a solid foundation. Build up.

Today we set the cornerstone. We'll see whether I end up building an outhouse or nice gated villa. I just hope it ends up something with a view.

But I can't swim!

AUGUST 11, 2007

So I came up with a really good analogy for this post in my head while out for a run yesterday... and then subsequently completely forgot it. Hope this doesn't stay true in med school.

Speaking of which... MSI orientation begins in approximately 41 1/2 hours. There are many "typical" feelings that students experience as they get ready to start medical school. Some examples:

"Oh my god what if I'm not smart enough!"
"Oh my god what if I don't really want to be a doctor!"
"Oh my god what if my classmates suck!"
"Oh my god how am I going to be able to study enough!"
"Oh my god how will I be able to maintain even a semblance of a social life!"
"Oh my god what will I do if I fail!"

These are typical feelings experienced going into medical school. I've never considered myself typical. But I've come to realize in the past 48 hours...

...

I'm typical.

I've handled things pretty well so far, mainly due to my low key SoCal bloodline and my healthy ego. But in the past couple days, in has crept the apprehension, the worry, the nervousness, the dread. I have to keep telling myself that this is all normal. It will pass soon enough. I AM smart enough to cut it, and cut it well. I really DO want to be a doctor. My classmates will NOT be a bunch of bookhead drones who will simply nod at my sarcastic sense of humor. I WON'T become a nerd hermit (nerd hermit... sounds like an animal. I'll work on this one).

However, we all have ways of coping. I have been coping by milking every precious moment out of my last few days of freedom by doing everything I always wanted to do... like sky diving, and renting a stretch hummer, and doing a line of coke off of a stripper's back.

Ok, not really.

But the consecutive nights of going out on the town have taken a healthy bite out of my checking account... and given me a healthy peace of mind.

I think I'm ready. Ok, I know I'm ready, but part of me doesn't want to believe it. Guess I don't have a choice. Time to stop swimming in the shallows and jump into the deep end.

Welcome to medical school.

Because I Want To Help People!

AUGUST 6, 2007

Being a person who's going to med school, there's one question nearly all of us have fielded for years. We've heard it in at med school admissions interviews, from grandma at thanksgiving, from that cute brunette at the bar, in conversations with undergrad professors.

"What made you want to be a doctor?"

"Why medicine?"

"Why do you want to be a doctor?"

There's a certain way to answer this question during med school interviews. You're supposed to say because its intellectually stimulating. Because you want to be a lifelong learner. Because you want to operate in a prestigious field. Because you are fascinated by the human body. Under no circumstances are you to say it's because you want to help people (ironically, I actually used this in my interviews and my interviewer at one said it was refreshing... REFRESHING! to hear a prospective med school student say he wanted to go into medicine to help people. Ah, medicine!).

When talking to pretty much anyone else... you always say what made you want to be a doctor was to help people (especially if you're talking to that cute brunette). Grandma doesn't want to hear about your "intellectually stimulating-shmimulating" crap.

For me, it was none of those things which first made me want to be a doctor. It wasn't because I popped out of the womb all altruistic and empathetic and scoring 35s on my mock MCATs.

For all of you to see, I will now unveil what made me first want to be a doctor.

...drumroll please...

August 7th, 1989 I received my Fischer Price Medical Bag for my 4th birthday. And the rest is history. Oh sure, eventually (not too much later actually) I knew I wanted to help people, and that vibed with medicine. In high school I knew I'd be a lifelong learner, and that vibed with medicine. I learned I loved challenges, and that vibed with medicine.

But it was all really that bag. From that day on I was all about the doctor-ness. While moving the other day I recently rediscovered this bag and went about examining its treasurers.

The Stethoscope:

3M Littmann Canary Blue/Baby Blue vs. Welch Allyn Firetruck Red/Classic Blue

From day one I had two stethoscopes in my bag. Deep down, I believe its because 3m Littmann and Welch Allyn both knew that one day they would be competing for my loyalties.

Unfortunately, neither carry stethoscopes in Canary Yellow/Baby Blue or Firetruck Red/Classic Blue anymore. I had to settle for Black/Brushed Steel. Maybe one day I can work with some reps to get some poppin' color back on the line.

Sexy Grown-Up MedZag Stethoscope (Welch Allyn Elite)

The Sphygmomanometer:

Yes, I owned a sphygmomanometer at age 4. That means I owned one on average of 20 years before my med school classmates. Does this make me a gunner? It's open to debate.

It's worth noting, however, that even though I've owned a sphygmomanometer for 18 years now, I still have no idea how the f@*k to pronounce the word.

The Rest:

​Tons of stuff in this bag. At my med school, they recommend a student collect the following items before starting their clinical rotations: stethoscope, otoscope, sphygmomanometer, opthalmoscope, reflex hammer, and tuning fork. Of those items, I had 4 in my bag at age 4. The two I was missing, the opthalmoscope and tuning fork, I compensated with bandaids, a thermometer, and THREE syringes. So you could make the case that I was ready for clinical rotations from the day I received the bag. And ready for a crash code, since those three syringes are obviously filled with epi, atropine, and magnesium sulfate.

I'm considering taking the bag for a spin out in the bars here sometime soon. After all, next time I get asked "so why did you want to become a doctor?" (and it WILL happen soon), I figure it will be much easier to hold up the bag than launch into a rhetoric on my inherent altruistic nature.

Besides, it makes a great accessory. The cute brunette will appreciate that.