25 posts tagged “medical school”

So, once again, it's midterm week, and if you look at the timestamp on this entry, you will notice that it is not an appropriate hour to be writing, much less thinking. And to be fair, I have stopped my organized, testable thought, and have entered far into the world of abstraction, as far as one my progress in the wee hours of the morning.

Everywhere I go, in every area of my life, I seem to be finding this funny wall. When I run, I call it my 60% wall - if I can make it through 60% of my workout, then I am certainly able to complete the last 40%. Those last few miles might hurt like a bitch, but I can push through it, and I have something to be proud of, tangible results in the form of distance and calories and time. Last week, I ran for over an hour, the first time in my life. I had two five mile runs - again, for the first time in my life. But my 60% is a calculable point there. And I know that there are some days when I just can't do it, for whatever reason. Many times, it's just because there is simply too much going on - I have too much on my mind to get a really good run in, or I am just too exhausted from everything else going on in my life. And other times, it just doesn't happen - you shake your head, do what you can, and then promise to make it happen tomorrow.

When I study, especially during these weeks, the wall is different. When I find the wall here, I often have to stop, quite literally, whatever I am doing, and take a proverbial look around. I'll get lost in a particular subject - tonight, I just happened to fall on natural killer cells, part of the innate immune system. Here's what happened tonight:

I was plugging along, rewriting notes and drawing pictures. My roommate came home at about 1AM, and we started talking about her final tomorrow (a class I'm not taking), and study strategies, and how she's really hoping just to pass. She went to bed and I headed back to my notes, but I was having a really difficult time getting started. I stopped and started to get tired, and my eyes would glaze over every so often before I would snap to it. My thoughts would wander, sometimes related and others not.

My last wind (I had lost track at this point over whether it was the 4th, 5th, or 6th) came when I hit the adaptive immunity lecture, and I got lost in this train of thought over how amazing our bodies really are, and how little we actually know about them. Yet, for all we don't know, our bodies have the remarkable ability to repair themselves. Modern medicine has, to be sure, presented a lot of treatments and cures, many of which are amazing. But our bodies' own natural defenses have protected us since the beginning of our existence, and in many times, without really adapting. Natural killer cells make it their function to find and kill that which it cannot recognize as self. Toll receptors can recognize non-self patterns on the molecular level - patterns present only on pathogenic cells - and destroy. And we haven't even talked about adaptive immunity - B cells, T cells, vaccinations.

It's the same with the brain. I've taken quite the interest in neurology the last few months. The brain is, as everyone knows, incredible. We don't know ANYTHING about the brain, if we consider the things we know and compare it to the list of things we don't know. But, if a patient walks in with a defect, and you know the symptoms and signs, you can say with high reliability exactly where the lesion is. We don't know why - why skills and characteristics localize, why some neurons produce this chemical instead of that one, anything - but it works and more often than not continues to work in spite of our ignorance. I am constantly amazed by the human body, and the finely tuned machine that it is.

So I hit this wall, sometime at around 2AM, where I quite literally got lost in the awesome of the human body. It was bizarrely renewing in a time of high stress... but it gave me what I needed, apparently, to work for another 90 minutes.

And with that said, I'm going to bed.

(How's that for a stream-of-consciousness entry?)

I have been in medical school for a little over two months now. While I can't yet tell you what I'm interested in specializing in (I have ideas, but nothing solid), I can tell you definitively a few things that I am absolutely NOT interested in:

1. Anything involving the GI tract. You make poop in it. Worms can live in it. Not for me.

2. Dermatology. The money is good. The hours are great. Yet, I cannot imagine a life of acne treatment, rash diagnosis, and tattoo removal.

3. Radiology. I plan on being able to use enough radiology to diagnose whatever I need to for my chosen specialty. As cool as some of the newer technology is, I'd be bored silly all of the time.

4. Pathology. I'm too socially-inclined to either stare through a microscope all day or stare at dead bodies. I like anatomy lab, but when it's over, it's going to be over for me.

5. Surgery (with a few reservations). Again, when I'm done with anatomy lab, I'm going to be done with anatomy lab. I'll do my surgical rotations, to be sure, but the only kind of surgery I'd really consider would be gynecological surgery. Surgeons are mean. I'm not that mean. I like to be friends with the people I work with. I will not do general surgery (too much GI tract), orthopaedics (physics, plus bone saws), etc. I might (very slim possibility) consider doing cardiothoracic, if I did my rotation and fell in love with it, which is a distinct possibility.

6. Otolaryngology: Also known as ENTs - this is kind of along the same lines as GI - you make snot. A lot of it. Your nose is pretty gross on the inside. Considering that half of your respiratory tract is concerned with making sure that the stuff you breathe either goes out the same way it came in, or it get swallowed (another strike against GI), I don't think I really want to mess with that.

This *just* happened to me, and is pretty much unrelated to what time I'm writing this, which signals that it's pretty much just another sad/disturbing/bizarre turn that my life has taken recently:

My parents sent me some new scrubs a couple of weeks ago as a present. I hadn't taken them into the anatomy lab yet, because I hadn't actually dissected since I got them. I have to go in for a few minutes tomorrow to self teach. This was the thought process:

I'm doing laundry tomorrow. Should I bring the new scrubs in and take the old ones home to wash before I go home this weekend?

I could do that. It'd be nice to wear the new scrubs. The other pair are getting pretty grungy.

What are we doing in lab tomorrow?

Oh, right. We're still in the pelvis.

Well, the old ones already have shit on them. (Yes, actual shit... no metaphors here).

Yeah, never mind. You may as well only have one pair of shitty scrubs, and you can just throw the old ones away and start wearing the new ones when you start lower extremity next week.

Followed by me realizing that I'm actually having this dialogue with myself, and thinking about how utterly bizarre my life has become over the past eight weeks.  

...but everything that happened yesterday was too really gross to write about for public consumption. In a nutshell, we began pelvic dissection yesterday, which includes the sigmoid colon.

So awful.

I have most assuredly ruled out anything having to do with the GI tract. This is not a new thing - think Medical Microbiology with Dr. Thai. If you think you'd like to gain a better grasp of why I will not be working intimately with the inner workings of the GI tract, and you have a strong stomach, I would encourage you to Google "ascaris." What we had to deal with wasn't *quite* that bad.

I did get to do a really good dissection of the uterus and ovaries. Gynecological surgery, I'm starting to think, would be really cool. So that can go into the pile of specialties I'm considering.

In other news, I'm meeting someone for coffee tomorrow in Evanston. An exciting prospect, if for no other reason than I'm leaving North Chicago during the week. I'm pretty anxious about the whole thing, actually. I sort of wanted to go to Simchat Torah services in Winnetka beforehand, but I know that would only give me a chance to crap out and cancel. So I'm not going to services. Instead, I'm going to take a chance and go get coffee in Evanston.

1. Finished my last midterm
2. Walked around Winnetka before services because I got there early and it was so nice out, and I wanted to be in the world for a little bit.
3. Went to services, which are rapidly becoming what I look forward to during the week.
4. Drank. Not a lot, but enough.
5. Ate fast food for the first time since I moved to Chicago.
6. Stayed up til 4AM talking with an old friend.
7. Walked barefoot in the grass outside my apartment building while I was on the phone.

Still to come: Cleaning my apartment, shopping, Chicago Botanical Gardens, grocery shopping, sukkah dining at the rabbi's.

Weekends like these remind me that I am indeed still a human being.  

Every time I've ever seen the big cats at the St. Louis Zoo, all of the big cats I've seen just pace back and forth.

No kidding, I just stood up and walked in circles around my living room, for no other reason than to move around.

If I appear a little bit crazy, it's because I haven't actually left campus since I got back from the break fast on Saturday night. I have only seen the inside of three rooms since Saturday: my living room, my bedroom, and the auditorium where we've been testing.

So yeah, I might be feeling a little stir-crazy.  

So this week is midterm week, meaning that my life has been made miserable by the presence of several very long, very difficult exams. I got stuck sitting next to Skeeve today, and hence cursing my placement in the alphabet. We were actually managing to have a pretty non-creepy conversation, and I made a comment about not seeing Anatomy Stud (the really hot guy in our dissection group), who should have been on my other side.

Skeeve says, "Who?"

Me: "You know, the other guy in our anatomy group."

Skeeve: "Ohhh... the gunner."

Me: "He's not a gunner."

Skeeve: "Well, I think you're a gunner, too."

Me: ::floored:: "I am NOT a gunner."

Skeeve: "Do you study? You're a gunner."

Umm... or I don't want to fail out of medical school and have to pay off $60,000 in loans.. but whatever.

Must... study... anatomy...

There are days when I really love it here. There are more of them lately, since I've joined my synagogue and I'm starting to learn my way around. It's nice to feel like I'm starting to build a support network that includes people who aren't in medical school. I'm blessed to have been welcomed into two great communities, one that supports my learning, and another that helps me to retreat a little bit from that life, even if only for a few hours a week. The days when I can take time to learn a place make me feel like I'm in control of my crazy life, and I love the days when I have a few hours to walk around in the city or on the North Shore, just to get a feel for where I am.

And there are moments where I hate it. They're mostly just moments, fleeting, frustrating spaces in time, usually when I'm lost in an unfamiliar place or when I have a great story to tell, but I can't just wander over to Lacey's, or when all of my Columbia friends are going out to dinner. I can almost forget sometimes how much I miss Columbia and the life I had there, or how far away I am from my parents and my Aunt Ruth. I hate those moments when I feel so far away from everyone I really care about, and I curl up and cry for a few minutes on my bed.

Wednesday will make it six weeks since I've been home in St. Louis. I won't make it back until the first weekend of next month. It will be the longest time I've ever been away from home. When I was in high school, I had these grandiose dreams of leaving St. Louis to go east for college and the rest of my life. Now, it's the place I want to be more than anything. I know that I have to get over this - this was supposed to happen. I'm supposed to grow up,  move on, and build a life of my own. But Chicago isn't home yet, and I'm not sure if/when it will be.

When nothing particularly exciting happens or I can't find the time or the motivation to write, I write in bullet points.

• Midterms start next Monday! ::projectile vomitting:: This weekend, I didn't even leave my apartment (not my apartment building... my apartment) for almost 2 days. More of the same to follow over the next two weeks, I'm sure.
  

• I'm going to Hawaii in November - it's official. I bought my tickets with help from the voucher I received from the disaster trip to Harrisburg in February. Buying the ticket was, not surprisingly, a real ordeal, and now that I have dispensed with the voucher, I think it's safe to say that I will avoid using USAirways if at all possible. I'd rather pay an extra couple hundred dollars not to have to deal with them. I'm not a mean person, but I've been fighting with them for seven months over everything. Prior to this, I always tried really hard not to be rude to customer service operators, because they're just doing their jobs. However, I have found that their job is to be exceedingly difficult so that I will give up and stop pursuing a refund. I showed those assholes - I perservered.
  
  So, I will spend the week after my first set of finals in Honolulu, with a few extra days for sightseeing! I'm really excited! I've gotten to go a lot of cool places the last couple years, but none of them really had a "vacation" feel. Israel was incredible, but the pace is frantic and you're on a bus with 59 other people for 10 days. The last time I was in DC, we had walk-around time, but only in the evenings, when the museums aren't open. New York and Amherst were all spent on conference time. And all of my other travels were related to med school stuff. So, I'm looking forward to going somewhere cool with extra time built in to play.

• I joined a synagogue on the North Shore about a week ago. It's probably the smallest Reform congregation in the area, but also probably the best. It's very close in practice to my synagogue in St. Louis. They don't have a building, which keeps their operating costs way down, and also allows them to tell the poor-ass medical students who wander their way that they are pleased to have you join them, and won't say no if you want to give a donation, but that they don't need my money. So, basically, they are allowing me to join for free. It's an amazing congregation - the rabbis are incredible and the congregation has strong roots in social action. It's a pretty perfect fit.
  
  I was too young when my parents joined Kol Am to really remember what it was like when we first started going, but I can say without question that the people that belong to my new synagogue are at least as welcoming as they were. The rabbi knew who I was when he introduced himself before the service, and spent a lot of time talking to me afterward. He asked if I had family in the area, and when I told him that I did not, he invited me to his family's dinner before Rosh Hashannah. The family who invited me to sit with them at services invited me to break the fast with them on Yom Kippur. The president's wife wants to have me over for dinner some weekend. It's so nice to spend a few hours each week connecting with people who aren't medical students and aren't connected to that part of my life in any way.
  
  I was pretty anxious about looking for a synagogue when I moved here. I've felt pretty out-of-sync with my spirituality for the last couple of years. I think it was mostly because while I was in Columbia, it became my job - I dreaded going to Hillel every week for services after spending so much time being Kerry's technoslave. I never found the services very inspiring, and the only other option was the congregation, which had the potential to be even less satisfying. So, I either suffered through it or didn't go. I came as close as I hopefully ever get to a crisis of faith this summer. There is nothing wrong with challenging your beliefs, but I hope that I have challenged mine sufficiently for long enough.

• My MOO cards come in soon! I'm so excited! And I can finally give people cards with updated addresses - this whole time, I've been giving out cards and saying, "The phone number is current, but the address isn't." Plus, they have a bunch of my beloved "Mizzou Spring" photos printed on them. I love MOO! Now I just need to find myself a pretty holder...
  

There is a guy in my medical school class who is really, really skeevy. He comes off very nice at first, but when you get to know him, he really turns on the skeeve. It just so happens that Mr. Skeeve is just above me in the alphabet. Ordinarily, this wouldn't be such a big deal, but my school defines our small groups largely by where you are the alphabet. This translates to a LOT of time with Mr. Skeeve - he was in my orientation group, and now he's in my physiology small group, anatomy dissection group, AND my clinical skills practice group. (On a random note, I am the only woman in my dissection group AND my clinical skills practice group.)

Mr. Skeeve did not show up to lab on Friday. This was fine, because we have four people in the group, and really, two people can do the job. On Tuesday, he apologized for not showing up to lab because he was, in his word, indisposed. Today, he did not show up for the teaching session, where we show the other group what we dissected in the previous section. Fine, whatever. It wasn't like he could contribute to the teaching part, but maybe he should have shown up to see what he missed.

I went into the other building for clinical skills practice, where we are learning how to do physicals, and practicing on each other. When I say "practicing," I mean really practicing - we gown up for each other, and the girls are protected from discomfort and the potential for roving hands by a sports bra. I got stuck practicing with Mr. Skeeve (which is good, because the only person I really like is someone I might be interested in dating, and so I'd rather not have him already feeling me up - it might destroy the mystery).

So, I practice palpating and percussing the back, listen for lung sounds. Palpate his chest, listen to his heart sounds. Percuss his abdomen, try to feel out the boundaries of his liver. I can't feel his liver at all. I can't percuss it. The professor can't either. He probably has a liver, but it's probably really degenerated.

My turn. I gown up, leaving my sports bra on, of course, because the professor said so, AND I'm in the group with Mr. Skeeve. He palpates and percusses the back with minimal difficulty. He has a little trouble getting through the heart palpations. When it comes time for him to listen to my heart sounds, he does the first three without problem (atrial, pulmonic, and tricuspid). When he gets to the fourth one (the mitral), he says:

"Can you please lift your boob so I can hear your mitral sound?"

I kid you not. Lift your boob. Not "would you mind lifting your breast so I might get a better sound?" No hesitation. Nothing. Lift your boob, please. (And really, can you not call it my boob?)

Great bedside manner, Mr. Skeeve.