Block 2

It seems like everytime I post I start by saying "wow, its been a long time". So I've decided to stop saying this. Just assume that it's been a long time from here on out.

In case you were wondering, I passed all my classes first block. I was right about the 50th percentile with scores that would have all been B's if we actually got grades. Which is good enough for me.

Over break, I skied 9 days. 7 of those were patrolling so I'm done with my requirement and have a nice pile of free lift tickets for the rest of the year. If anyone would like to sponsor me, I'd love to just be a ski bum for the rest of my life...

Now we're back and two weeks into block 2. Block 2 consists of:

-MERN: a mega-class that stands for Metabolism, Endocrinology (hormones), Reproduction and Nutrition

-Pharmacology: aka drugs. This class will follow MERN (so when we do endocrine in MERN, we'll do drugs that treat endocrine disorders etc) and it continues through next year

-Pathology: starting with general and endocrine. This class will also run through next  year

-Immunology: Body's defense system

-Microbiology: BUGS! <3

-Doctoring: still working with small groups, now learning patient interview techniques, also AMP which is our small groups for learning how to do an effective differential diagnosis  (which is when a doctor tries to figure out what's most likely wrong with a patient based on symptoms, physical exam, history etc) and with lectures on behavior and neuroscience.

I'm also starting to think about my summer now. Right now there's two options that sound interesting:

-preceptorship: either a competitive one through Kaiser or a rural one through Davis. Basically following a primary care provider around their office for 4 weeks this summer. I'd really like to do it in a rural setting... specifically in the mountains if possible :)

-On my own I've also been looking into volunteering at a camp/forest service/outdoor something that needs a medical person. You know how when you go to camp, they  have a camp nurse/doctor? Something like that. Because if this is really the last summer of my life, I really want to spend it outside  :)

So, that's the update on my life! This block has significantly less lab and significantly more case-based learning and more lecture. So it'll be a bit of a shift but it should be fun :)

Anyone have a transected eyeball I can borrow?

So much has happened since I last shared with you all. Friday will be my last day of class in block one (HOORAY) followed by finals. My finals will consist of:

-Multiple choice exams in: cell/tissue biology (aka histology), molecular medicine (aka biochemistry and genetics), anatomy and doctoring

-essay exam in physiology

-practical exams in anatomy (structures tagged on cadavers and models) and doctoring (performing a complete physical exam on a classmate. Note that "complete" means: neurological, musculoskeletal, thoracic, abdominal, and head-eyes-ears-nose-throat exams. No pelvic exams or any such things on each other thankfully.)

It's been a rough week or so with a lot going on in addition to finals. I gave my anatomy oral presentation today on the orbit (which is the little pocket in your skull that holds your eyeball). Anatomy presentations basically mean you pick a structure/compartment, stand in front of your cadaver and point to/explain things and their clinical significance to an instructor for 10 mins. Then they ask you questions. After much stress and many hours of work (dissecting, researching and prepping) I did fantastically on my presentation and the instructor asked me to preserve my dissection so it can be used in the future to teach undergrads. That's the second time an instructor has asked me to save a dissection (the other being the coronary arteries and cardiac veins on our heart). Maybe thats a little bit of bragging but its been a hard week so I think I deserve to be pleased with myself. I also just finished my doctoring presentation on the HEENT exam- and i successfully saw the optic disc through an ophthalmoscope! (that thing that doctors use to look inside your eyes.) I also can't remember if I said this before or not buuuut... I'm officially a new co-director of one of our student run clinics. We have training now through January and starting late January, my classmates and I (there are 7 of us) will officially be running a clinic (Eeeep). So excited :)

In other life news (the source of much roughness this week) I have one dear friend who lost a family member last week, another having lung surgery this week, a third who is also going through a tough time and a roommate who's having issues with her fiancee. Because when it rains it pours and finals is ALWAYS the best time for personal problems. yay!

For anyone wondering about break: I get two and a half weeks off. I'll be home at my parents house from 12/19 until christmas-ish. Then I plan to be in the mountains from Christmas-ish until Saturday January 5th (when I'll be sitting bump at the top of 7/8 for ski patrol and you should all come visit me so I'm not bored. If this sentence makes no sense to you, you can ignore it.) then back to Sac to start block 2 on Jan 7th! Woowoo! 

I leave you with these two GIFs to summarize my feelings:

http://whatshouldwecallmedschool.tumblr.com/post/37141139498/just-after-my-exam

http://whatshouldwecallmedschool.tumblr.com/post/37066833649/after-m1-year

your interpretation should be "come to the mountains and drink with me"

PS- the title today comes from a post in our class facebook group. The response was "sure boo, you can borrow ours!" Another great post along the same lines "Does anyone have a good falx cerebri I can borrow? I will repay you with scalpel blades." (falx cerebri is the fold of dura that divides your cerebral hemispheres in your brain. see wiki)

Clinic

My its been a long time. Everything's settled into routines and I've felt like I've either had nothing exciting to post or I've been to busy to post.
Two weeks ago, we started dissecting Stanley's face, then we moved on to opening his skull to study the nerves, spinal cord and blood supply (we do the brain this summer). Those dissections were really intense. For whatever reason, the fact that he has eyelashes caught me off guard. Also holding a brain in my hands was a bit bizarre. There's a lot that we don't understand about the brain. It was weird to think that even though we can't access them, I was holding someone's memories, emotions and personality in my hands.

But now for the purpose of my post. I'm excited to report to you all that I'm officially an incoming Co-Director for one of our student run clinics! I'll be taking over responsibilities by January and running the clinic with a team of 6 of my classmates for the next year! So, I decided to go work in the clinic two days ago (Saturday).
On Saturday, I saw a patient who we'll just call M. M came in for a pretty typical appointment- med refills, get lab results, monitoring diabetes etc. After a full patient interview in which M basically said there's been no major changes in her health, we moved on to do a quick physical exam. The plan was since she had no new complaints we just listen to her heart and her lungs and check sensation in her feet (which is part of a routine exam for diabetic patients). So I explain to her what I'm going to do, M says ok so I put my stethoscope in my ears and go to listen to her heart. But without saying anything she takes my hand and puts it just above her left breast- where she has a lump the size of a baseball. I'm a little afraid of what my face probably gave away to her. I've never felt a mass like that before. M then told me that she found the mass 4 months ago but it's grown a lot recently and become painful. She hasn't gone to the place that does free mammograms because she doesn't drive and doesn't know how to get there. M is unemployed and has no health insurance.

While we could process this on a social level and be frustrated that M was put in a position where her disease outcome may be effected simply because she doesn't know how to drive, or because she was afraid to tell someone sooner, but I think the greatest impact on me was in a different way. Its been humbling to realize that she couldn't even find words to tell me she had found a mass. Its moving to realize I was the first person to feel that besides M. I've been in the medical education system for 3 months, and already someone's willing to trust me with something like this. A bit of an eye opener.
The little shiny positive I can give you here is to say that there are people who really care. M brought the paper with mammogram information on it with her to clinic. So one of our fantastic undergrads who run the front office and intake at clinic used the wonders of google maps to find a place with free mammograms less than a mile from M's house. We sent her home with a map and the phone number to call Monday morning and make an appointment (our undergrad even tried to call on M's behalf but the place was closed on weekends).

Happy Playoff Season!

So today, after taking our biweekly quiz, sitting through a lecture and working through a histology (cell bio) lab, I did something I haven't done since starting medical school. I came home and climbed back into bed (yes, during the day) and after catching up on new Big Bang Theory (which is the 3rd best show ever, after firefly and BSG, Arrested Development and Scrubs come in a close 4th and 5th) I am still laying here under my covers watching the Cards/Nats game. For those who don't understand, this is my version of a nap (I pretty much don't sleep during the day unless I'm sick). And I haven't done this for the last two months.

BY THE WAY, as of today, I'm half way through my first block!!! This calls for a celebration (which will be put off for two weeks until my FOUR DAY WEEKEND).

On the schedule for this week:
-Finish dissecting our cadaver's hemisected pelvis (Tuesday)
-Do my first ever breast exam on a (practice) patient (Wednesday)
-Second anatomy practical exam- thats the one where they put the little tags on the cadavers (Friday)
-WATCH AS MUCH PLAYOFF BASEBALL AS HUMANLY POSSIBLE (ALL DAY EVERYDAY)
-Plan to either wallow in misery on Tues/Wed (If the Giants lose) or celebrate an epic comeback on Thurs (if the Giants win)

In case anyone was wondering, here's how I WANT the playoffs to go (not necessarily how I expect them to go...)
NLDS: Giants beat the Reds and Cards beat the Nats
NLCS: Giants beat the Cards
ALDS: A's beat the tigers and Orioles beat the Yankees
ALCS: A's beat the Orioles
WS: GIANTS BEAT THE A'S IN A BAY BRIDGE WORLD SERIES

Happy Genitalia Week

Warning in advance: this week has been slightly disturbing, and I very much need to get it all out. So the content of this blog might be (will be) slightly (more) disturbing. Here's a list of things I did this week, I'll write about them in this order so if you want to skip something you can (If you'd like to continue thinking of me as a normal human being, I suggest you only read #5).

1. On Monday we had our male GU lecture- so we looked at normal and abnormal penises for an hour

2. On Tuesday we dissected the anal triangle (yes, its pretty much what it sounds like)

3. On Wednesday, I did my first rectal and male GU exam and had a lecture on pelvic and breast exams

4. Today we hemisected our cadaver's pelvis (cut it straight into right and left halves) and removed the right leg from the body (with a hammer and chisel).

5. Tomorrow is my roommie's birthday (guess what we'll be consuming large quantities of after a week like that?)

1. So Monday actually wasn't that bad. It's just that anything male is very un-intuitive for me (being female...). Fun fact of the day: men have a tiny little vestigial homolog to the uterus. (translation for non-science folks: guys have a little tiny womb inside of them. No, it doesn't work.) And women have a homolog to the penis which has some function (sort of...) I'll let you figure out what it is and what it's function is ;-) if you're stumped, you can ask me. And a fabulous direct quote from our anatomy instructor "The pudendal nerve provides sensory innervation to the penis or the clitoris. It also provides motor innervation to the voluntary sphincters of the urethra and the anus. So it's kind of important, you should try not to cut it in surgery" (Translation: One nerve lets you feel your penis/clit AND keeps you from pissing and crapping your pants. It's just a little important)

2. The anal triangle is the space between your ishial tuberosities (if you sit up nice and straight, they're the bones that poke down into the floor) and your asshole. We started this dissection by putting an excessively large tampon up our cadavers ass (my job since my lab partners literally couldn't do it). Which was somewhere beyond disturbing. Then we spent 3 hrs digging through the fat around the ass looking for nerves. Disgusting and unrewarding.

3. So doing an exam (on a practice patient who gets paid... not on my classmates) wasn't as rough as I expected. It's like there's a switch I can flip in my head that turns off the part of your brain that recognizes what you're really doing and just focuses on learning and doing it right. I think the most disconcerting part of the exam for me wasn't actually the rectal exam. It was the inguinal canal exam (checking for an inguinal hernia)... you can google it if you want to know whats involved. anyways, it was disturbing because to me, it really looks like it should hurt (but apparently it doesn't really?). Made me realize I don't really have a good understanding of man-parts and what is and isn't painful

In order to let you all still consider me a semi-normal human being, I'll stop describing this :)

Pelvic and breast lectures were a lot of "yeah yeah I've heard all that before", but apparently a lot of it went over the guys' heads. (The guy next to me didn't know what a cervix was for example, he definitely asked me in the middle of lecture). They also clearly didn't know what to do with the speculums they were passing around.

4. So today's lab was quite brutal. we've gone entirely through the abdomen and pelvis so today we literally took a chisel and hammer and cut straight through L4 and L5 vertebrae and the sacrum, then used a scalpel to extend the cut from the spine horizontally through the posterior wall (aka the cadaver's right lower back). Then we cut straight through the genitalia (yeah, go ahead and shudder at the thought of cutting personal parts in half. It made me shudder). And here's the best part: Stanley's bowels and rectum are really really really full (of poop). So we were having a hard time completing the cut to remove his right leg without cutting his bowels open. So we called over an instructor to help.

Instructor: well, you aren't cutting along the midline, you're too far off to the side

Me: well, his rectum is really full, and we really don't want to perforate it.

Instructor: It is really full, you just have to pull it off to the side like this [pulls].... and I just stuck my finger through his rectal wall, sorry guys, that's poop on my gloves.

[uuuuuuuuuugh]

so according to the instructor, our rectum was so very very full, that rupturing it was basically inevitable. In the end, she actually removed the entire thing which will make future dissections easier. So not the happiest day in lab. It smelled horrible, and it was rather violent. Seeing the sagital section (from the midline cut) of the male pelvis/genitalia wasn't that exciting, the female was pretty cool though, even if the ovaries and uterus are all shrunken in the few old ladies who haven't had a hysterectomy by the time they donate their bodies.

5. So party tomorrow :) One day to relax before we gear up for an exam on Monday, an anatomy practical on Friday and a visit to the "pelvic exam simulator" so we can all practice our pelvic exams on plastic lady parts before we see a real patient in two weeks.... shit just got real :-)

New Routines

Well everyone, it's official. I think med school's finally starting to settle into a routine. I realized its been about 10 days since I've written and I had to think what we've done over the past few days and my first thought was "well, nothing really special happened" (which isn't REALLY true, but that was my first thought). At the end of this week, we'll be half way through block 1 (and I'll be 1/8 of the way to becoming a real doctor!)

So my classes... Biochem spent the last two weeks trying to get us to do "self study modules" then spend class time teaching each other/making up skits and other nonsense. Needless to say, it didn't go well (as reflected by nearly half the class failing the biochem portion of our last quiz). So note to anyone who might someday want to go to medical school: schools are all soooo proud of their attempts to integrate curriculum and offer "group learning experiences" instead of just lecture. Fair warning "group learning" translates to "waste of your time". I never thought I'd say this, but I really wish they'd just lecture to us.

Physio has gotten harder but more interesting. We've moved through cardiac physiology and now to respiratory physiology. Best part about physio: its currently taught by an instructor who looks EXACTLY like Saul Tigh. I really really want him to come to class with an eye patch on one day (I know theres a couple of you who will be tempted to comment on this, but careful with any spoilers, at least one or two people who read this are still in the middle of the show :) )

and now for anatomy... Stanley's abdomen has been.. interesting. The first day we opened the abdominal cavity a TA came over and said "what the fuck is wrong with your guy's abdomen?" It turns out Stanley's had a couple of abdominal surgeries- his appendix and gall bladder were both removed. And after abdominal surgery all the connective tissue in your abdomen creates "adhesions"- which are exactly what they sound like... everything gets stuck together which makes dissecting (without breaking open any bowels) really difficult. The abdomen also smells realy REALLY bad (just in case you wanted to know). And the blood supply to abdominal organs is really complicated (although I did get another compliment on my dissection skills. The instructor said my dissection of the inferior mesentaric artery was "beautiful, even though the cadaver's guts are all stuck together").

Up next: we're learning the male GU system this week. I'll once again refrain from details but basically we're learning the exams for male genitalia and the rectal exam (yes they're exactly what they sound like. No, I don't know why this is one of the first exams we learn and no, we do not practice on each other). So this should  be an... interesting week. 

My new favorite body part

It's been much too long since I shared my adventures with you all, so here's a synopsis of my last 10 days (I'm hoping to get some sympathetic "aaaw, its ok, now I understand" sentiments.
So last Monday was quiz three, which I studied for like a mad lady since my anatomy grade was a little borderline (the quiz also covered physio, histology, biochem and epidemiology/biostats). Did well on the quiz (yay). Then Friday was our anatomy practical exam where the instructors put little tags all over the cadavers and ask questions like "which nerve innervates this muscle?" "what flows through this vessel?" "if I cut this nerve here, what functions are lost?" etc. (with a few "easy" questions thrown in asking "what's this?"). So I spent all last week prepping for that (about 5 hrs a day in lab... pretty sure I permanently smelled like fermaldahyde last week). This was all in addition to normal classes. All the exams led to a back log of work plus a parental visit on Saturday and a visit to this years OEC class on Sunday. Now I have a little room to breathe and tell you about our dissections over the last week or two :)

Last week we dissected the heart, (we'd already taken the heart out of the chest, now we actually cut open the chambers and looked inside) and I have a new favorite body part. Amazing pictures (not mine) here: http://www.tumblr.com/tagged/chordae-tendineae
This is inside your heart. The little strings are called chordae tendineae and they attach to little muscles called papillary muscles. The chordae tendineae attach to your mitral and tricuspid valves in your heart (those are the ones between the atria and the ventricles) and hold the valves shut while the ventricles contract. These pretty little muscles and chords are what makes sure blood flows FORWARD into your lungs/body instead of backwards into the atria/veins. Aren't they gorgeous? Anyhow the heart dissection was pretty much amazing. If you're ever bored, look up pictures of the internal anatomy of the heart and you'll be completely amazed.
Last week we also dissected the posterior mediastinum- think of this as the inside of the back wall of your chest cavity (so if I cut you open from the front, then pulled out your lungs, its the area thats usually behind the lungs). And there, we discovered that Stanley had bone cancer. We'd found one bony nodule/mass on his external ribs, but didn't know what it was. When we found a second nodule, this one internally we asked about it and the docs said its most likely bone cancer. That one was a little eerie for me...
This week we've so far only dissected the abdominal wall, inguinal canal and testes I'll refrain from sharing details to keep the guys from shuddering, other than to say when you dissect out the testis, it really does look like a nut, specifically like a walnut in the shell still.. or maybe an egg (and my roommate says Russian slang calls them eggs...) funny that we use anatomically accurate slang.

We've also started meeting with our physical exam groups. So far we've only worked with taking vitals, which isn't really new for me. I'm not really impressed with our facilitator so far, but my friend (in my group) and I decided we'll give him one more meeting before we talk to the IORs about him. He's very casual and didn't really teach much, which was really hard for the people in our group who had never taken a manual blood pressure or listend to lung sounds (example: I asked "where specifically do we listen to lung sounds?" since this is a point we'll eventually be evaluated on in our practical exams and his answer was "oh you know, 2 or 3 places on the front on each side and 2 or 3 on the back"... no, actually I don't know, that's why I'm here. Oh well...

So now that I've vomited the last 10 days of my life onto the page, I"ll try and post more often... all this writing is a little overwhelming :p