Research

So I am planning on doing my spring elective in a research lab, as well as spending the summer there. The school offers 35 or so research fellowships for summer research projects done by MS1s, and hopefully I can get one. After several years of being anti-research, I have decided to reverse my position in the interest of optimizing my chances of matching in a residency.

The PI (principal investigator) I'm going to work with does research on phospholipids and cardiac reperfusion injury. Phospholipids are the primary component of cell membranes. Those found in cardiac muscle cells are suscepible to oxidative damage from halogens like those found in white blood cells. What we'll be studying is the role that the products from these reactions play in atherosclerosis and in reperfusion injury. When the heart or any other tissue is ischemic for a period of time and oxygen flow is finally restored, the incoming oxygen damages the tissues more than the original ischemic insult. Oxygen alone is not responible for the additional damage, but other reactive chemical species as well. It is these other reactive species that we'll be studying, particularly halogenated aldehydes. The image at the top is of a plasmalogen, a phospholipid susceptible to chemical alteration by reactive halogens

Memory

As studying is my only pastime, I have given a lot of thought to the aquisition and retention of knowledge. As I have written before, the pace at which facts are fed to me is quite rapid, and the length of time permitted to learn them is correspondingly brief. Sadly, as I have also written, the length of retention is also rather brief.

The process of learning in many ways resembles an old-fashioned water driven mill. The sluice of water cascading over the wheel is like the knowledge my professors attempt to teach me. Unlike a mill, however, the flow rate is subjective. Though the actual pace remains more or less constant, previous exposure to similar material makes the flow seem more or less rapid. As the water hits the buckets the wheel begins to turn, slowly at first, but eventually at a rate that closely matches that of the water. Similarly, I learn slowly at first, but eventually similar information becomes easier to aquire, until at some point, I hardly need to study I'm so familiar with the concepts being presented. I have not reached this point by any means.

Retaining knowledge also fits the analogy, though now the wheel is running in reverse, like a pump. The buckets dip into a pond are carried up until the apex of the rotation, where they dump their contents into a drainage sluice. Some of the buckets in this case, are extremely leaky. So much so that at times they reach the apex of the arc nearly empty. Others, have hardly any cracks and are able to dump nearly all their contents into the sluice. Most of the buckets on the wheel are fairly leaky, however, requiring many revolutions of the wheel to fill the cistern. The cistern can fill more quickly if the wheel turns more rapidly, but as the wheel spins, some of the water slops out because of the speed. In order to fill the cistern most efficiently, the greatest number of buckets possible should be intact. I don't know how to fix the mental buckets, however, in such a way that learning either takes less time or with fewer repetitions.

You're in medschool when...

You read about a friend of a friend on facebook who hurt himself skiing and are more curious about the exploratory surgery than the patient's status. My comp described it thusly: they life-flighted him out and when they got to UofU hospital, they cut open his stomach to see where the bleeding was. After removing his gall bladder and a damaged spleen, he's doing ok. I immediately thought "what artery were they looking for when they cut open the stomach? shouldn't they be looking around it at the pancreaticoduodenal , proper hepatic or splenic arteries? I then realized that my comp probably didn't mean they literally cut open his stomach, but that they cut open the abdomen. Silly insensitive spaceman spiff.

Philosophical Wax

Sunday school provided me with an interesting insight today. One of my non-medical school friends here is a SLU history grad student. He specialized in classics as an undergrad and usually brings his Greek Bible to church to supplement his english quad. He sometimes gives great insights into the meaning of scriptural verses based on the etymology of their phrasing.
We were reading in 1 Peter a verse that is often quoted in Latter-Day Saint circles. 1 Peter 2: 9 "But ye are a chosen generation, a royal priesthood, an holy nation, a peculiar people; that ye should shew forth the praises of him who hath called you out of darkness into his marvelous light: " Three of these phrases "chosen generation, a royal priesthood, an holy nation" refer most definitely to the status of ancient Israel as God's people, handpicked from the inhabitants of the earth. Latter-day Saints include themselves in this description as well, being the modern day continuation of the House of Israel. What is curious, however, is that the term "peculiar people" is usually interpreted with the modern definition of peculiar meaning unique, strange, perhaps eccentric, odd, or different. What my friend pointed out was that in his Greek bible, the word used in place of peculiar did not have any connotation of uniqueness or idiosyncrasy. Instead, it shared a root -pecu , with the english word pecuniary, having to do with property, ownership , or money. According to an etymological dictionary, the root specifically pertains to private property, i.e. ownership by one individual, and in particular property defined in terms of cattle. In this context then, it is evident that the word "peculiar" in this sense is descriptive of God 'owning' the House of Israel, rather than any bizarreness on their part. Use of "peculiar" in the sense of oddity was actually first evinced only in 1608, three years prior to the publication of the King James Version of the Bible. The current usage, while apt, is not strictly the most accurate from a doctrinal point of view then.

More on the money

So, rather than letting me be 5K richer, the Financial Aid department decided I would be better if they just took the scholarship and applied it to the G.R.A.D Plus loan (GRAD PLUS stands for Government Rape And Defrauding of Professional, Law, and Uther Students since the loan is at an astronomical 8% interest, which is not deferred to graduation). This is both good and bad. Good because I don't have 5K of a high interest loan, but bad because it doesn't increase the net amount of money at my disposal. I wish they had let me keep some of the loan money because the amount budgeted to each student is only barely enough for even a small family such as mine. Oddly the health insurance is one of the most costly expenses we have. You would think that a medical school would understand the need for affordable insurance more than anyone else, but no. Everyone who has more than just themselves living on the financial aid disbursement has to take out more loans to pay the insurance. The coverage is phenomenal, but expensive. All of my friends are on WIC, food stamps, and those with several children are on Medicaid. Yet, for all this, some people claim that medical students are entitled and don't understand poverty.
One of the guest lecturers in our interdisciplinary health issues class made that very claim. She was a guest lecturer from Washington DC. She also said that few, if any of us, had worked to get into our seats, nor did we really deserve them. Are there a few entitled jerks in my class for whom daddy is paying their way? maybe a few, but I don't know any. I don't know how she had the gall to make her claim, since something like 65% of medical school applicants don't get in. If we got in, isn't it implicit that the admissions committee thought we deserved it? I was also enraged by her claim that we didn't understand poverty. The single students live at 161% of federal poverty, married but no kids 120%, 1 kid at about 100%, two kids at 79%, and the one guy in our class with 4 teenagers lives at 61%. These numbers are based on our maximum financial aid disbursement as a fraction of the federal poverty line for a family of the described size as indicated by the Department of Health and Human Services. Yup, that guy whose family survived medical school for 4 years on Medicaid sure doesn't know what it's like. I hope that we don't forget the years that we spent eking out a living when it comes time to treat Medicaid patients or the uninsured. Who knows what the "system" we have in place will be like in 7-10 years when we all start practicing.