Wednesday, October 31, 2007

Professionalism-all the time?

So is a doctor always "on" in the sense that they must refrain from certain activities in their non-professional lives that would cast a poor reflection on their profession as whole? I don't know. Is medicine just a job like any other? can a doctor afford to cut loose after work the same way that a construction worker can get soused and make a fool of himself in a bar after a week's work? I don't know the answers to these questions. For me, I don't think that my life is compartmentalized like that. I'm always an LDS guy which influences my behaviour across the board.
The reason I raise this question is not because I want to tout my own righteousness. Heaven knows I'm not perfect, just trying not to be too bad. I ask this because some of the after-school behaviour of my classmates. Med students seem to be just as hard drinking a group as any bunch of undergrads, with the exception that perhaps they time their binges more judiciously. After our anatomy test two weeks ago, there was quite a bash at a local bar. I know this because most of the drunken baccanalia was commemorated on Facebook. This is not any cause for alarm, or even anything of note. These fĂȘtes happen after every exam. The reason this boozefest is different was that some of the pictures are not what I would want floating around with my name attached. I only hope that my classmate in this picture (warning: immodestly dressed male in photo) somehow gets it off the internet before some program director at a residency finds this on google or facebook. I have blurred his image, but a fully labelled version is easily found.

Sunday, October 28, 2007

Refractory periods

So, the picture above is of an action potential, i.e the electrical excitation of a neuron. As you can see, there is a sharp spike, followed by a dip which is below the baseline of the initial spike. In this state, the neuron is unable to be excited and initiate another action potential. I would liken the graph to my brain. I studied my brains out in anatomy, took the last test, and have been in a refractory period wherein I can't excite my neurons to study hard again. Our new units are Cell Biology and Metabolism, which are really two sides of the same coin, but are separate classes. Cell bio is mainly histology, or the microscopic study of tissues. Metabolism is going to be protein regulation, and pathways, pathways, pathways. At the moment, we haven't had too much material that I hadn't at least had to some degree in undergrad. I'm actually glad that I studied the binding of O2 to Hemoglobin for 5 weeks in my biochem class. Anyway, back to the refractory period. So in essence, I'm having a hard time gearing up to study with the same intensity. I also have not yet figured out to what depth I need to know the material. In anatomy, it was easy but tedious. You just memorize the 9 pages of syllabus for the day and you were good to go. Right now, I don't have any idea what the best way to study is.

We have a lot of great resources to learn from here. For histo, the best thing we have is virtual microscopy. We have a microscope lab, and I can go there 24 hrs a day to look at slides if I want to. Or, I can stay at home and using my balky cable connection, I can access the same slides online. I can do all the same zooming, focusing, and examination, but with the added benefits of: no headaches from staring through lenses, having a thumbnail image to tell me where on the slide I'm looking, and best of all, labels that can appear to point out what the purple blobs really are. I have a friend who is red/green colorblind, but he seems to be doing ok. A lot to the slides we're looking at are H/E preparations (hematoxylin and eosin for the science geeks) so they're essentially various shades of pink and purple. He alleges, however, that he can figure stuff out from contrast alone, but we're all crossing our fingers he'll be ok.

Things are generally going pretty well, I have my one exam in Biostatistics this week, so I'll have to spend some time away from my main classes studying for that. Fortunately, as long as you study, the exam is reputedly an easy pass. Isn't that they way they all are? as long as you study, you won't have any problems? duh! Well, in anatomy, I don't know how I could have honored it unless I'd had the material before or unless I had a photographic memory, there was just so much in such a short time span. Fortunately, I like chemistry so this stuff now is pretty fun to learn. I might sing a different tune in the next few weeks, but that's how I feel now. It is time, however, that by hook or by crook, I must depolarize my brain again enough that I can study hard this week and get back to work.

Sunday, October 21, 2007

Anatomy Prank

So, CW commented on my post "Moron Dissecting" and it reminded me of a prank I played. Before exams a few friends and I usually get together to pin our own practice practicals in order to get in some more exposure. Prior to our exam on the head and neck we indulged in our ritual together. Everyone gets 5 pushpins to insert into the structures of their choosing and the rest of us get to identify them. I decided that a little humor was in order, so I found a brown rubber band that looked exactly like a dried up nerve. Carefully placing it next to the hypoglossal nerve, I stuck a pin in it. As people cycled through, I forcefully told them not to pick at it, it was a delicate structure. I could see most of my friends smiling to themselves as they passed through, but one stayed for about a minute puzzling through what I had pinned. Finally, after he picked at it, I told him it was 'nervus elasticus, cranial nerve XIII'. He smiled sheepishly. A small joke indeed.

J'ai Fini

Since I can't coax the internet into giving me a usable latin translation, I shall render it in the tongue of the Franks, "I'm done". Yes, I am done with the first course in medical school which here is Human Anatomy. The last test was gruelling and awful. No other description works. I felt short changed in my studying because I had to spend a week studying for embryology when I could have been mastering that section of anatomy. I think I passed at least. The last 3 weeks have been really tough, I've been studying non-stop and not sleeping well, and generally feeling pretty low. Now that I have slept 20 hours in two nights I feel much better. If you look in the literature, it's well documented that between 40-60% of medical students fit the clinical description of depression. I definitely know which side of the line I fall on there. The administration here is amazingly supportive, however, and do their best to mitigate the stressors in our lives. One of the most difficult habits to confront is that of comparison. I see how much other people study and how they seem to be doing, and it's discouraging to think that I seem to do more with worse results. I have to remember that appearances are decieving, and some gunners decieve willfully in order to subvert their classmates. Mercifully our class is not well stocked with gunners, at least they haven't shown up yet.

Completely unrelated: We are in the midwest, and folks are big here. Last night Mindy and I went to a church meeting for the adults in our stake. On the pew in front of us, there were 8 people whose combined weight was at least 1950lbs, perhaps as high as 2200. 3 of the females were morbidly obese, as were 2 of the males. In the congregation as a whole, 60% of the adults were overweight and 20% of them were obese. I was amazed. A recent study (the TFAH -trust for america's health) ranked Missouri as having 60.5% of the population being either overweight or obese, so my back of the envelope observation was spot on. I frankly wondered what would happen to the pew if they decided to shift on it, whether it would smash down on the ground, crushing my legs under it. I prudently withdrew my legs for the remainder of the meeting.

Sunday, October 14, 2007

Moron Dissecting

Last Dissection Day! So our last dissection was the lower leg and dorsum of the foot. This was a pretty easy dissection really, since the muscles are divided neatly into compartments. We pretty much had only to run our fingers between the muscles to free them up, cut them from their origins, and dissect the nerves and vessels on the posterior aspect of the knee. The only awkward thing was that our cadaver still had both legs attached at the pelvis. In order to dissect the aforementioned popliteal neurovasculature, I had to spent hours bent double looking backwards at what I was doing. Also, the amount of fat and grease was incredible. The floor around our table was like the inside of a McDonalds fish fryer and very slick. Two weeks ago we divided the pelvis on a few of the cadavers to more easily access the contents. In essence we divided the body in half the long way. Pretty interesting stuff.

Ok, now I'll explain the post title. Before we divided the pelvis, some of the other people on my cadaver were dissecting the pelvic contents. Since they are consistently clueless and generally not bright, they inadvertantly cut the uterus in half and removed it. You might argue, well, anyone can make a mistake like that, things are hard to see and distinguish. Ok, maybe that's true. There was, however, no instruction to remove anything. This is also the 9th week they've been dissecting.

The organs were pretty much exposed and only needed to be identified. I asked one of them why there was half the uterus missing. "I dunno, I guess we must have nicked it when we were removing some fascia. Ok, nicked sure. Removed????? What the heck were they using a scalpel for that far in? Fascia?? not where you were! peritoneum? Broad ligament? These are structures that are present, but what the heck were you using a scalpel for? Can't you tell the difference between fascia and organ??? The uterus has a lumen for crying out loud!

Ok tirade done. These two have been the bane of our team for several months and I am tired of their ineptitude.

Thursday, October 11, 2007

Quick update

I have passed my 2nd anatomy exam and would have Honored in Embryology except that this year the exam was only pass/fail. The second exam went quite well, much better than the first. In medical school it feels like we're always studying for a test, because in essence we are. One week after an exam you're already approaching the next. Unlike in undergrad when I would study maybe 3 days before, I have to start reviewing at least a week in advance. THat means there's only a week when I'm not cramming for an exam.

The grinding monotony

So, right now I'm a little tired of anatomy. I study sometimes from willpower, not because the material is intrinsically interesting. Some professors do a great job of tying in clinical correlations which makes learning a lot easier when you can see the relevance of the material. Others, however, are better at making a succinct, clear presentation devoid of context or utility. I generally prefer our retired surgeon to the full time anatomists. The two lectures we had on the perineum (leture and review) were excruciating. The first lasted 95 minutes, when we usually have 60. This is on top of a 50 minute review we had just finished. The lecturer must have said "perineal membrane" at least 45 times. We were tired and hungry and ready to go and study on our own rather than endure death by perineal powerpoint. The review the next day was almost as bad.
Bedtime for bonzo.