The value of study

So little G.A. has been sick this week. I got a little tickle in my throat sitting in the airport waiting room on our way out here, and 24 hours later it was yet another cold. That makes 3 in 8 weeks. I hate colds, when the prodrome hits, I think "ok, i've done this, I know what this feels like, let's just fast forward 7 days and I'll be well again. I've been recovering, and now GA is sick. That makes you feel pretty terrible as a parent, knowing that you, and only you, are resposible for your little one's misery. He's a good little trooper though, and he smiles at me between his periodic bouts of coughing and congestion, which makes the smiling a little sad.

The midnight thought of a semi-awake medical student with a sick child make me realize that I know nothing about medicine. I study about 40-55 hours a week, and finished a unit on the respiratory system not quite 1 week ago. For all that work, however, I realized as I listened to my little boy's cough, that I didn't actually learn anything while studying respiratory viruses. The first clue of course was the fact that my second respiratory exam was the worst one I've had since anatomy a year and a half ago. It became obvious of course, as well, when I could not recall which viruses caused RSV, Croup, pertussis etc, nor which ones were associated with wheezing v. stridor v. cough v. rhinorrhea. Fortunately, it seems that GA has only a garden variety cold, but seeing costal retractions and hearing his cough made my mind whirl away to unpleasant places.

I imagine then, that the main purpose of 3rd year will be to actually acquaint me with the real presentation of these and other illnesses. What does a child with stridor actually present like? I know theoretically what to look for, but I'm a pretty visual learner, so I need to actually see something before I can really recall it in a useful way. It was pretty disheartening to realize that all my work is not as productive as I had imagined.

Things that make it feel like Christmas (to Mindy):

Shopping: I have done most of our Christmas shopping online this year. It has been cold, and I didn't want to take the baby out. Besides the fact that all of our gifts have to go to our families in Idaho, Utah, and Oregon. So, if we have to ship them anyway, we may as well let the company we buy from ship the stuff for us. I did send a couple packages yesterday via the US Postal Service. It cost $10 per package. Therefore, I am a huge fan of Amazon.com's super-save shipping and other companies' free shipping offers. I think online shopping will become a Christmas tradition.

Christmas Cards: I need to keep the promise I made to myself last year to sent my Christmas cards before December starts. They are so much work! At least I don't make my own cards, although I admire my sisters' beautiful home-made cards every year.

The Christmas Photo: I like getting photos in Christmas cards I receive, so I like to send photos in our cards. We didn't get a professional portrait taken this year. In fact, the only family picture we had was a snapshot a neighbor took of us when we happened to be out on a walk with her on a nice Fall day. So, that's what made it into our cards.

Music:
The Messiah
Nat King Cole (I love his rendition of "Sing Sweet and Low". So beautiful!)
The Manhatten Transfer
My family's old Christmas mix my dad made years & years ago (before I was born?). I couldn't tell you who the artists are, so don't bother asking.

I also don't think it would feel like Christmas without at least one summer sausage. We have experienced these things, and we're fully in the Christmas spirit. It's the end of Spiff's block of Pulm, and it's off to Oregon for family, fun, and a two-week vacation!
Merry Christmas!

Great Words Part II

Last year I had a post about great words in medicine. This is a follow up post to that one, demonstrating a few of the new words I have learned in the respiratory module.

Ferruginous: Having the color of iron rust; reddish-brown.
Choryza: sticky nasal secretions, seen in RSV
Recrudescence: To break out anew or come into renewed activity, as after a period of quiescence.
Birefringence: Double refraction. This is seen in microscopy with certain compounds in the body, namely talc and amyloid stained with Congo Red.
Atalectasis: Collapsed alveoli in the lung.

America the strange

So this is a picture of what I want for Christmas. This is the perfect gift. It combines NASCAR with Thomas Kinkade. Yes folks, for a limited time, two of the classiest things in America are united in one perfect painting. Look at the jets, and the little boy perched on his daddy's shoulders, just waiting for some fiery mayhem to entertain his drab little Dickensian life. It's almost Norman Rockwell-esque, only this is Art, whereas Norman Rockwell was just some paint-by-numbers hack. Perhaps I have those reversed. No matter, Thomas Kinkade has finally engraved the Sport of Kings with his enchanted brush.


Additionally, I have decided to use my car as a tombstone. There seems to be a trend in our fair city of putting up a sticker in the back window of the car saying "In Loving Memory of Wallace "Buck" Servohammer, 1981-2004." Granted, there are probably a disproportionate amount of untimely deaths, especially in the north. Why the automobile, however? What can a rolling epitaph acomplish that a stone monument cannot? I can only assume that the car itself is "in loving memory". That, to preserve the untainted memory of their loved one, the driver purchased this automobile. Thus, quite literally, the car is "in loving memory of Joe "pink-eye" Jones". Perhaps the phenomenon is even more macabre. The family, unable to afford a traditional burial plot, elected instead for a motorized one. The car, then, is a mausoleum with the remains inside, and the sticker is an affordable epitaph.

This brings me to another point. There is a local cemetery with an associated vault that claims on the entry sign to be "A Library of Lives". Implicit in the use of the term library, is the notion that items may be borrowed and returned. Presumably then, one can, as a member of the library, check out some remains, which are due back within a specified time period. I don't even want to contemplate what people do with the cadaver during their loan period. I wonder if there are very popular corpses which you can only check out on reserve? Also, if it truly is a library, doubtless one does not check out the same 'volume' every time. What do people look for as they comb the shelves? "Oh, this one looks good, he was around in the 1790's." They might say to themselves, hoping to check out a piece of history.

Well, these are the ghoulish thoughts that my have occupied my mind of late.
-SS

Respiratory

So we've been studying the respiratory system in school. Unlike the majority of my classmates, I have enjoyed the last two units immensly, namely cardio and pulmonary. Learning things in these last units has been different than anything else in medical school so far. It's all physiology, which is great because it's not memorizing meaningless details about the histology of ADEM TS-13 deficiency or which type of tick carries Lyme disease. This is medicine that will be relevant every day of my professional career, if in fact I decide to pursue anesthesiology. The other stuff is useful mainly as context for me, so that I can read an article and know all of the vocabulary. I realize that 'everything is important' but lets face it, sometimes a PhD will preach about his pet project and it's not important.

I really enjoy the respiratory syllabus, it's extremely well organized and full of cross references that I would otherwise have to make myself. Cardio as a subject was good, but it was really hit or miss with the instructors. The first half of pulm, has, so far, been well taught.

In other news, I have been nursing a rather intense cold for the last week , which has been pretty upleasant. It's really hard to study all day and evening when your head is leaking and your lungs are full and your eyes are watering and you feel miserable. Nevertheless and notwithstanding the greatness of my misery, I think I did pretty well on the pulm exam . We'll see next Monday.

This is a job for...

Accomplishment Girl! I love it when she comes to the rescue. What James & I accomplished by 11:00 this morning:
We were both showered/bathed and dressed by 8:00 a.m.
We were out of the house by 9:00 a.m.
And we took our first solo trip to the grocery store.
Big steps!

I have been nervous about the trip to the store, which is why it has taken me over a month to attempt it by myself. Thankfully, James was a dream! He slept almost the whole time, and when he started fussing, I popped his new beloved MAM-brand binkie in his mouth, and he was happy as a clam.

Also, I enjoyed all of the elderly people who adored my baby at the store today. I'm such a proud mommy!

And on a side note, I'm wearing my wedding ring again. I haven't been able to fit it onto my swollen hands since April. I was beginning to think I would have to get it resized. I guess I'm recovering from the pregnancy after all!
Like I said, big steps!

Nanny

My sisters have been here this week, and now I am wishing I could afford a nanny. I have loved having extra hands around the house to hold my baby. I feed him, change him, and pass him off to someone else who will cuddle him while I take a shower or a nap. Also, as Spiff mentioned, the baby has been sick, and we have had to hold him almost constantly over the past couple days. Every time we tried to put him down to sleep, the congestion would pool in his head, and he would wake up hurting and scared that he couldn't breathe. So, we held him upright or slightly inclined all day and night. It has been wonderful to have the aunties around to help us hold him so that we could all get at least a couple hours of sleep. They're leaving today, and we're all going to go through withdrawals.

Anyone know of a good nanny in town who will love my baby like his aunties?

Pulm

So I pretty much haven't posted in a while because I haven't had much to say. G.A. is doing pretty well, he has a little more food reserve on his body so he at least doesn't wake up starving anymore (much). We're studying pulmonology right now. The leung is pretty interesting and I enjoy the physiology, even if it's hard to wrap my mind around sometimes. So far most of the lecturers have been pretty strong, which is a nice change from cardio when some of the lecturers were pretty terrible. I'm looking forward to being done with this next test so I can have a week off for thanksgiving. Life is good, and will be much better when GA is no longer sick. A sick little infant is hard to have because you know he would feel better if he only knew how to sniff, rather than sitting there with a stuffy nose. Having 2 sisters-in-law around is also great because there are more hands to hold him at night when he doesn't want to sleep.
SS

Accomplishment Girl

I love superheroes. Some of my favorites: The Incredibles, The X-Men (only the first two movies), Batman, Heroes, and I admit that I used to faithfully watch Lois & Clark, the New Adventures of Superman. When I was in grad school, I created my own superhero persona to help me gear myself up to tackle my always way-too-long To Do List. I was always much more productive when I dubbed myself Accomplishment Girl than I ever was as just plain old Mindy. Sadly, when I graduated three years ago, Accomplishment Girl hasn't been needed as often, and I have rarely felt as productive as I did on those days in grad school.

Saturday, I felt like Accomplishment Girl made a return appearance! As a new mom, here is what I was able to accomplish in one day:
I fed my baby and put him down for a nap.
I did some dishes.
I took a shower!!!
I did some filing that I have been putting off for weeks and weeks.
I called the phone company and had them fix several problems with our bill. (Waging war with large corporations is never fun, but I was very pleased to speak to a competent customer service rep today! Rare occasion!)
I fed my baby...while talking on the phone to the AT&T lady.
I fixed lunch for George and me--post Cardio exam #2!
George and I went to a wedding reception.
Then we went to the grocery store.
I fixed dinner, proving to myself that I can be a mom and still make pizza.

All that in one day! Oh, and Friday, I did the laundry...all five loads of it washed, dried, folded and put away! Hard to believe, since I have spent every other day the past three weeks doing hardly more than getting myself out of the chair to wolf down a bowl of cereal before tending to the baby again. Anyone else impressed with me? I certainly am!

We're parents!

I have been wanting to post for a while, but have been at a complete loss as to what to say. We have our baby, and he's wonderful. We are also 100% overwhelmed and exhausted new parents. Having a baby is an indescribable experience. The whole experience is so much more physically, mentally, and spiritually consuming than I ever imagined. I knew it would be hard. I have seen friends and family go through it, and I know it was hard for them. I just didn't know how hard it actually was for them because everyone I know who has had a new baby is very good at putting on a happy face. Either that, or they're just big fat fakers who say they're okay when they are anything but.

We went on a walk yesterday. We bundled the baby up in some warm clothes, put him in his Snuggli carrier, and we walked to our neighbor's house to return the dishes they left with us when they brought us dinner just after we got home from the hospital. Our neighbors have two little boys, the youngest who is just a year old. They asked how we're doing. We smiled and replied, "We're okay." They laughed and said, "Don't lie to us." They know exactly how we feel, and they saw right through our happy faces. Everyone also says that the two-week mark is the hardest. I hope they're right, and that something gets easier from here.

The details:
James Reed was born at 7:56 a.m. on Friday October 17, after a 16+ hour labor and a 5-minute delivery! He weighed 7 lbs. 1 oz. and was 20 inches long. He weighed in at 7 lbs. 4 oz. at the doctor's office the other day! And we can tell that he is getting bigger and fatter, since his cheeks are filling out, and he is developing fat rolls on his thighs.

Two aspects of my current emotional roller coaster...
Moments I experience overwhelming joy:
~When my tiny baby curls up on my chest like a little frog.
~When he's hungry and triggers his rooting reflex with his hands and moves his little head back & forth.
~When he's awake and content, and his big dark eyes peer around at...whatever it is that fascinates little babies.
~When he spends time with his daddy. I have loved watching my husband become a father.
~Watching his face when he's dreaming. He has a very expressive little face, and I love catching the occasional little smile!
~When he gets done eating, and he gives me his "I'm done" face. It's the same every time. Pretty cute!

Moments I experience overwhelming frustration:
~When James has slept all day and decides to be wide awake at 2:00 in the morning.
~When he is fussy and crying in pain, and I can't figure out how to help him. (We think he has a tummy ache. And yes, we can tell the difference between his "I'm Hungry" cry and his "Something is hurting me" cry.
~When I have to take my 5-day-old baby boy to the doctor's office for a routine checkup. I wonder why I take so many precautions to keep my baby germ-free when I just have to take him to a germ-infested doctor's office at 5 days old!
~When I realize that I have gotten frustrated with my two-week-old tiny, helpless baby. Motherly guilt sets in very quickly!

I'm so grateful for all the help we have been given from friends and family. I have never been so grateful for my mother when she came to help us. She brought sanity with her when she walked in the door. And our friends have been unbelievably generous with us, giving so much time and energy on our behalf. I only hope that I am as willing and able to help them when they need it.

And Heath, I'm sorry for the Sap. But I'm a new mom, so I'm entitled to a little sap.

Change

Our little boy arrived last week. He's perfect and we love him. He has sandy blond hair, dark eyes, tiny hands and feet, and an insatiable apetite. Monday was a very difficult day for us, and tuesday was even worse. It's difficult to have a little boy whom you know is hungry, but can't eat very well, and who gets frustrated with our clumsy attempts to help him. He is doing much much better now, and has more or less figured out what breastfeeding entails. I love rocking him back and forth and watching his eyes track my face, even in his cross-eyed way. I can't really convey the wild emotional oscillations that we have both felt this week, but I haven't had as many profound spiritual experiences in so short a time as I had this week. We are all doing well, and so is our little boy.

The Debts We Owe

I am firmly convinced that the fact we have so many wonderful friends here is not chance. I know that we were all brought to this city to go through medical school together because Heavenly Father, in his wisdom, knew that we would need each other. I cannot express the gratitude I feel to our friends who are far more selfless than I'll probably ever be. Our friends who will drop what they're doing and be with my wife as she struggles with our newborn boy, who will help her learn to nurse, who will hold my crying baby so I can take a 35 minute nap, people who will just sit with mindy and be with her, these are people whose service I can never repay. You know who you are, know that your efforts are welcome and have bolstered our flagging spirits. Thank you.
-G, M, and J.

Gratitude

So I was studying some pharmacology for cardio and my mind wandered, as it usually does in the evening, to a talk by Elder Bednar given in conference two weeks ago. In it, he recounted a story wherein an apostle asked Elder Bednar's wife to pray, but only to express thanks. I made a little goal to try that for a week in my evening prayers and see how things went. I guess I'm pretty needy because I only went 2 days. Here are a few of the things I'm grateful for though:

Mindy's health
Our very nice but affordable apartment
The fact that our car hasn't died despite being close to 200K miles
Academic succcess (pending our neuro grades)
Our babie's health in utero
Good friends who are generous
The Bach Cello Suite in G prelude. Pretty much a perfect piece of music.

Endurance

I am 39 1/2 weeks pregnant. I went to the doctor yesterday, and all the news was good. I am 100% healthy, and so is the baby. My blood pressure was fine, the urine test was normal, the baby's heart rate is fine. I'm just a tiny bit dilated, and even just a tiny bit more than last week. I should be so relieved that everything is okay. But instead, the hormones of the irrational pregnant woman set in, and I broke down crying to the doctor in the middle of the examination room. I also continued to cry off and on for another two hours after leaving the doctor's office.

In a high school English class, we studied a story of a war-time message runner. He was assigned to take a message to the next unit over as quickly as he could. He took off running...and kept on running because he had no idea how far away the next unit was located, or how long it was going to take to get there. I ran my first half marathon this past spring, and it really wasn't all that bad. I trained for it, paced myself, and I really enjoyed it. Mile twelve wasn't even that bad because I knew that the finish line was only a mile away.

I feel a bit like the message runner right now. I have a general idea how long this pregnancy will last, and I know that I won't be "running" forever. But there is no finish line in sight. I am having a difficult time enduring the unknown distance. So I cry when the doctor tells me that everything is fine.

Nostalgia

After my neuro exam, we went out to dinner and stopped at an international market along the way home.  Finally, I've found somewhere that can both sell me individual quail's eggs, as well as individually shrink wrapped Norwegian Mackerel.  If they're out of those, I can make do with canned pig tongue or box of dried goldfish from the snack aisle.  Aside from the unique and bizarre (to my occidocentric mind) the international market stocks a candy from my childhood, the Kinder-egg.  

My visit to the market made me aware of a fluke of neuroanatomy.  The olfactory portion of our brains involves, in part, the amygdala which is part of the limbic system.  The amydala, among other things, integrates incoming smells with visceral input, and mediates such reactions as salivation in response to a savory scent, or nausea in response to a foul odor.   Though closely related anatomically to the hippocampus, to my knowledge, the hippocampal and amygdaloid paths do not share any common, direct connection.  The hippocampus is thought to be involved with the creation and consolidation of new memories.  Though I don't know, I postulate that the lack of common connections is why we can't remember smells the same way recall visual information.   We can all picture our first apartment or picture what an airplane looks like without too much difficulty.  I doubt, however, that you can 'remember' what a lemon meringue pie actually smells like, in the same way you recall visual information, which would be by actually mentally 'smelling' the pie at the moment of recall.  We all know that sweaty feet stink, but upon reading this, you don't actually smell feet (unless they're your own) instead, we can only recognize a smell upon smelling it again.  At the international market, we purchased a box of Lu butter cookies as as post-exam treat.   Upon opening the box, I instantly recognized and pictured my childhood time in France when I must have eaten those very same cookies as a kindergarten child in Paris.   It's strange that you can't smell something upon recall, but that olfaction is still a very powerful component of memory. 

The end of Neurosciences.

I finally finished Neuro. The last two days saw me in the lab and lecture hall taking my exam. There were a total 240 questions. Let me say just this: I HATE NEUROLOGY. There has not been a course in medical school that I have liked less. I hated learning the stupid pathways, I hated how everything is reversed and upside down, I dislike learning anatomy by cross section, I don't like localizing lesions, I don't like memorizing psych drugs that all sound the same (fluvoxamine, flurazepam, fluphenazine, flumazenil, fluoxetin, phenterezine, etc..). I do not like it on a bus, I do not like it, it makes me cuss! I would not, could not, like neuro, I will not, shall not like neuro. I will not study it Sam I AM! I hope I passed this execrable class because at least then I don't have to take it again. I pity neurologists who have subjected themselves to a lifetime of this specialty. NOPE, not for me; I can cross this one off the old list and never look back. Onwards we go, to Cardio! where things make sense, and you can actually intervene and have a beneficial impact. The fact that you can precisely localize someone's capsular stroke or their MS or their pontine hemorrhage is nice, but you CAN'T DO ANYTHING about it (ok you purists, you can treat MS with steroids, interferon B, Natalizumab, cyclophosphamide, interferon alpha, and other crap, but the disease isn't going away.) IT'S DONE, AND I DON'T HAVE TO LOOK BACK. The longest and worst block of MSII is over with.

Sentimental Piano Teacher

I have been reminiscing about my former piano studio lately. My friend, Maggie, used to be a children's art teacher, and she originally started her blog to record stories of her students. I really wish I had done that with my piano students. But since I didn't, here are a few little memories of conversations I had with some of my students that explain a bit why I love teaching so much:

#1: Dots
I taught a brilliant little six-year-old boy for a couple years. He picked up on piano very quickly, and he rarely had to work hard at it. He was very inquisitive, and sometimes the conversations we had in lessons would get a bit off-base. For example, in the middle of a lesson one summer day, he looked at my arm and asked,
"What are the dots for?"
Puzzled, I replied, "What dots?"
He pointed and waved his finger at my arm.
I said, "Oh, they're freckles!"
He said, "Yeah, but what are they for?"
I have never contemplated the purpose of a freckle before. I still don't know.

#2: Piano
Same little boy, same type of situation. In the middle of a lesson, he stops and asks,
"What is the piano for?"
Caught off guard by the question, I offer my best explanation, "It's for making music."
He says, "Yeah, but what is it for? Can I sell it?"
I reply, "You'll have to ask your mom."

#3: Lines
I taught another very talented little six-year-old girl. She was a beginner and was quickly progressing through the primer-level piano books, which begin with learning how to read music notes off the staff. She looked ahead in the book one day and got very excited to see that she would soon be learning the staff. She exclaimed to her neighbor (at whose house she took lessons and practiced), "Look, Bonnie, I'm only six, and I get lines!"

I have had a few inquiries about piano lessons recently. I don't know if anything will come of it, but I would love to start teaching again. With comments like these from students, wouldn't you?

On the edge of the maelstrom

The historicity of today compels me to at least note that I was aware of events. Today Congress rejected a $700 Billion bailout of the banking industry. I am both secretly pleased that the Bush administration's attempt to once again consolidate power failed, but I am also displeased that the banking industry appears about to slide into the abyss. I have no idea how this is going to affect me personally. If banks are unable to lend each other money, and consequently, lend their customers money, then presumably I might have difficulty in securing loans to live for the next two years. I don't fully understand the interconnections between retail and investment banking, so perhaps teh failure of major investment banks might not be as catastrophic as if the retail banks were failing. At least I have duly noted that on September 29 2008 I was scared as the stock market tumbled.

Becoming a Doctor

We had a lecture on psychological defense mechanisms in PPS a few days ago. Defense mechanisms are ways our psyche uses to cope with an adverse event, for example recieving bad news or coping with an illness. Denial, acceptance, humor, projection, or splitting are all subconcious or concious efforts to transform reality into a more palatable alternative. Dissociation is commonly found in the medical setting, especially in situations wherein the physician's emotions might otherwise compromise judgement; commonly we refer to this as being 'dispassionate' or 'professional.' The separation of emotion from analysis of the present is something we learn very early in medical school. For most, it probably begins with the first dissection in anatomy, where the expectation is that you will not be repulsed by the cadaver, but rather to just begin to treat the cadaver in a 'clinical' way, devoid of emotional overtones. Dissection, for me, was not the watershed event that many first years claim it to be, rather, in my dissociative way, I simply began the dissection. Most medical students I imagine, pretend to a greater degree of dissociation than they truly feel, since somewhere long before medical school we knew that doctors are not emotionally wrapped up in the illness, diagnosis, analysis, or treatment of the patient. The fact that most doctors probably aren't like this is irrelevant; what is important is that medical students think they ought to be dissociative in order to be a 'good' doctor.

I realized the frailty and insincerity of my dissociative defense mechanisms during our lecture on the pathology of head trauma. The lecturer was a forensic pathologist who spoke to us about the various injuries that can occur to the skull and how that injury affects the underlying brain tissue. She explained, with graphic pictures, just what happens when the head is run over by a tire, shot with a high velocity bullet, low velocity bullet, shotgun shell, stabbed, crushed with a hammer, crushed with something blunter, crushed from a low fall, high fall, and many other gruesome injuries. I could barely look at these images when looking up from my notes. The lecturer herself was pretty blasé, which I guess is understandable since this is what she does for a profession. It's curious that we strive to cultivate a degree of dissociation to normalize what would otherwise be repugnant.

The Balloon Glow

The Balloon Glow

Toys

I love our new apartment. We have a lot of space, a beautiful kitchen, and a neighbor who supplies the yard with beautiful flowers! We have been very happy here since we moved in July, and I am getting more in love with my new place as we slowly get it settled and organized. Yesterday, some friends came over and helped me set up our baby's crib and move around furniture in the baby's room (Thanks, Maggie & Bonnie!). Then I spent the morning putting away clothes, blankets and toys, and getting a little more ready for our baby. I think I'm nesting, but I do like how the apartment is turning out.

However, I had an experience today that made me realize how non-child-proof our apartment really is. I had some friends over for lunch today, and as I got ready for them to come, I cleaned and put more things away. I felt great about how organized, clean, and sparse everything looked. I got out some toys and books for the kids, and put on a movie to entertain them. I was feeling very proud of myself, until my friends' sweet little children educated me about what they really like to play with, and that things that we generally don't think of as toys...most definitely are!

My lesson: Kids' favorite toys are not generally the pretty books, wooden blocks, or stuffed animals we usually supply them with. Also, kids usually aren't that entertained (i.e. distracted) by Disney movies. These are the things that are much more fun to play with:
The Piano
Green Magic Markers
Magnets
Simpsons DVDs
Electronics (especially if they are attached to wires)
The Paper Shredder
The Bike Pump (which is more effective when used as a hammer)
Earplugs (the little foam parts apparently taste good, too)
Anything small enough to fit into small hands...which then goes directly into the garbage can.

I guess I'm in for a big surprise when our little boy starts moving around and discovering all of the excellent toys in our house. And to think, all this time, I have been worrying that we don't own enough toys to entertain our child! Apparently, instead of toys, we really need to be investing in child-proofing supplies!

October 1929, part II?

I am not very familiar with the world of international finance. It seems that the nationalization of two major investment firms in as many weeks is not good, though. I think that we might have ringside seats to another economic downturn like our grandparents faced. Hopefully I won't be reduced to selling apples and pencils on wall street. What will happen to medicine if we are faced with another depression? The last time we were in a depression, the Democratic president attempted to revitalize the economy with federal funds injected via public works projects, in the form of the TVA, CCC, and others. What will happen to the plans for centralized health care? Will a left-wing executive nationalize health care in an attempt to cover unemployed persons unable to ensure themselves? Will the government decide such a course of action is too expensive and unsustainable, despite its political popularity? People will always need doctors, for which I am grateful,but who will pay the doctor if nobody can pay for insurance because they're unemployed, or their employer can't afford insurance? During the last depression, health insurance was more or less an oddity. Patients paid their doctors in cash (or favors, or probably even in kind). The health insurance industry is more or less a relic of WWII when companies needed to provide incentives for workers in the presence of wage freezes. I'm probably betraying my profound ignorance of the health care system , so I will ask you, the readers, to post your thoughts and estimates for economic situation. Two of you I know were finance majors, so c'mon, be famous, and comment something constructive.



In other news, I bought a new stethoscope today. It's a Littman Cardiology III, and, as far as I can tell, is very nice. I find it peculiar that we buy expensive equipment before we really have an idea what we're looking for and what our preferences may be. The vendors at the equipment were really hawking their $600 panopthalmoscopes. What medical student has $600 to drop on something that is fastened to the wall of every clinic? Even the navy kids can't afford that kind of stuff.

Medical students are pretty ruthless with their time. Yesterday we had a lecture that was very difficult to follow, both because of the lecturer's accent, and because she chose to lecture at the level appropriate for 9th graders. At halftime, the entire class left, with the exception of about 15 people. Without exaggeration, there were no more than two dozen students left, from about 85 present initially.

Remnants of Hurricane Ike

This is the dregs of Ike as it hit our little home. We're doing ok, and the basement is dry.

Editor's Note: We recieved 5 in (12.8cm) of rain that day.

8 Months Pregnant...

And I feel like this lately:



Who's got the better waddle? The really pregnant lady or the duck? (Clarification Note: I am the really pregnant lady, and I am not in the video.)

Another trip to the ER

I judge people. There, I've said it. Today was day 4 of my shots, only one more round to go. The ER was really busy this morning. No traumas or anything, at least that I know of, just a busy day in the outpatient clinic. Oh wait, I mean ER. I was in the waiting room for about two and half hours to get my shot, which gave me ample time to watch and pass judgement on my fellow patients. The first thing I noticed was that, for the first hour and forty minutes, I was the only white patient there. I don't think there was anything special about that, since previous trips to the ED have shown a more or less balanced racial composition in the waiting room. Ever since our execrable class "Critical Issues in Healthcare", I have been more aware of my own attitudes towards racial issues. I'm from western Oregon, an area of the country which is nearly entirely racially homogenous. Surprisingly, my hometown also prides itself on respecting diversity. I guess that's easy to do when everyone looks like you, the only differences being in which gender you find attractive (your own or the opposite). I wonder how much self proclaimed respect we'd find if Eugene had a region of town like the north end of town here. Would Eugenenians embrace their violent, poor, black brothers as readily as their gay brothers? I doubt it, but I'm an inveterate cynic. I would wager that all the diversity talk would evaporate. Before I left home, I considered myself 'tolerant'. Faced with an opportunity to prove my tolerance, however, I'm rather disappointed with myself. Of course I'm not an overt racist, but I have discovered that outside of the insular homogeneity of my hometown that my attitudes are not quite as magnanimous as they ought to be.

On another note,
Today in the ED we had two sterling examples of people who don't know what the 'E' in ER stands for. One was a white woman who had a laceration on her finger. It was maybe 1cm in length, like you might get slicing an onion. You or I would have probably put a bandaid on it and called everything okay. The next patient was a black lady who had sprained her ankle 4 weeks ago (!) and was coming in for treatment with a loosely wrapped ACE bandage around her lower leg. I'm not sure if she was trying to scam the workman's comp system or what, but I'm pretty sure her case was not in any way emergent. Now, yours truly of course did not have an emergency either, far from it. It happens, however, that the only place you can procure the rabies vaccine happens to be the ER. Consequently, every week, I traipse my healthy little butt down to the ER for a $75 copay and a shot. $375 is what it costs to keep yourself free of rabies 'round these parts.

The Curious Powers of Jim Halpert

Ok, the title is a refrence to an episode of "The Office" when a bat flies around the office and Jim pretends he's a vampire. At three in the morning Monday, I was wide awake, my body having decided that 5 hours of sleep was about right. By 0530, I was fed up and decided to go for a run. As I was running, a bat flew into my neck and flew off. I didn't feel anything other than an impact, and the sound of leathery wings beating a hasty retreat. So I continued to run, and had a nice 3 mile loop. As I was running, however, the somber words of our microbiology professor kept tapping through my mind in time with my feet. "Most people don't know they've been bitten" "Bats are carriers", and "universally fatal" were the cheering sentiments that filled my wee imagination. I got home, showered, and looked up rabies in my microbiology textbook. I was still debating whether or not to tell Mindy or if I should just shrug it off and go to school like normal.
Thirty minutes later I was sitting in the ER across from school. Upton Sinclare, in his novel "The Jungle", opined that women tend to grow emotionally more or less constantly and gradually, but that men tended to grow suddenly in big sporadic spurts. That description fits me pretty well. It's pretty wierd, suddenly living with the possibility of having a fatal illness. I reassured myself that, as far as I knew, the post-exposure vaccine was very effective, and that, in all likelihood, nothing had in fact happened. Then the comforting voice of doubt would whisper, "but why would the bat fly into you in the first place unless it was deranged?" , and "if the vaccine doesn't work, then you'll die because only one person has ever survived symptomatic rabies, and she had severe neurological sequelae" or "if your neck feels numb or tingles, then you're a dead man, and you'll die right when your little boy is going to be born, and you'll never see him, and his mom's last memory will be of her husband, the deranged, rabid, lunatic who could no longer recognize her through his dementia." Perhaps ignorance can be somewhat blissful then.
At school, all I could do was joke around about it because really, worrying isn't going to make you feel better, so you might as well laugh. I am the inveterate sarcastic cynic, despite my best efforts to reform, so instead, I just whipped up some Alda-esque black humor. After 10ml of IM rabies immunoglobulin, I was pretty sure that things would be OK, especially since I had recieved it about 4 hours post exposure. When I was just sitting quietly in lecture, though, mr. comfort returned with his gloomy prognosis and dismal outlook should I develop 'la rage' as Jean Gaulois would say.

For those who cannot recall their infancy which is when the probably last recieved IM shots in the glute, it isn't too bad, really. I thought it would hurt like the dickens, but the glute shots hardly stung at all. The shot in my quad was no treat, nor the delt, but IM glute is a good way to go, I think . I have to return 3 more times, including tomorrow morning for more shots. After the 28th day, we cross our fingers and wait. Since there are no known failures of post-exposure rabies prophylaxis, I'm sure I'll be penning this blog sporadically for years to come. I do have a strange aversion to garlic, sunlight, and I can't see myself in the mirror anymore really. Oh well, you can't win 'em all. On the plus side, now I'll be able to relate to the plot of "Twilight."

Neuroanatomy

Well, school's in session again, and, true to form, I'm stressed out. Right now we're studying the brain, spinal chord, and nerves. Sounds neat- fascinating even, right? Learning neuro anatomy is roughly like trying to memorize the paths of spaghetti in a pot, using only cross-sections. You can have a saggital (midline dividing left from right) set of planes, or coronal (front/back), or transverse (top/bottom). Using these, you're supposed to be able to piece together how information travels from the cerebral cortex which is the upper half of teh brain concerned mainly with higher functions, to a peripheral nerve innervating a skeletal muscle of the arm, say. But, in the spaghetti in pot number 1 also spills out onto the stove, and into different pots too! We also have to learn how Pots 2 and 3 (the cerebellum and basal ganglia) influence the information flowing in the spaghetti in pot 1. To complicate things even futher, the brain is bilaterally symmetric, and some tracts cross from left to right, and some don't. Some inputs cross, and others don't. Using 4 different texts, I am slowly piecing things together.

This year is already more clinically oriented. We're learning how to do a screening neurological exam in ACS2, which is at least interesting. Perhaps when I can write diplomatically enough, I will describe what happened in my group during the practice exams.
-spiff.

Back to School

My husband has been in school for a week now. That makes him a 2nd-year veteran, doesn't it? Things seemed pretty calm for the first couple days; he told me that they reviewed a lot. And then by Wednesday, he got stressed with the sheer volume of information he is expected to learn (sound familiar?). It probably didn't help that he got a little sick this week. He had a weird little bug or something that caused him to be a bit achy and tired, and he woke up with a fever in the middle of the night. Weird! He's fine now, and he was able to put in a good five hours of studying today. And he says that the puzzle pieces of this new neuroanatomy stuff are coming together. I like hearing that.

I have had a good week, aside from the moment on Monday night that I realized that he is actually back in school for another long year. He reminded me that 7:00 pm is study time...and I almost cried. I am also fine now, and I spent the week getting things done around the house, scouring Craigslist for baby furniture, and catching up with friends. I have great friends here, and I feel very lucky!

The baby is doing well (31 weeks). He's very active and kicks me a lot. Last night, we were "playing" with him. He was poking his little fist (or something) out into my belly, and we poked him back. Then he would move his fist (or something) about an inch away, and we'd poke it again! That game went on for a while. Pretty darn cute! I'm getting very excited to meet him! I get to have another ultrasound in a couple weeks (because I measured a bit small at the doctor's office on Tuesday), and I get to see him again!

Christy Tagged Me

3 Joys

1. My Family.

2. Good Food.

3. The outdoors.

3 Fears

1. Losing my husband, family members or loved ones.  (As in death, not just losing them in the grocery store.  Thought I'd make that clear.)

2. The big, mean appointment lady at the doctor's office.

3. Car problems.

3 Goals

1. Be a good wife, mother (9 weeks to go...), and friend.

2. Learn to swim.

3. Run another half-marathon next spring.

3 Current Collections/Obsessions

1. I collect recipes.

2. I'm currently trying to collect baby things.

3. Obsession: Always George.

3 Random and Surprising Facts

1. I can't swim.  (Oh, did I already ruin that surprise?)

2. I have 81 first cousins.

3. I cry when I get angry.  Makes it hard to be dignified when you're blubbering at the person you're mad at.

I tag:

1. Maggie

2. Katie

3. George (does anyone think he will actually do it?  Do boys do these things?)

Worse

So, I realized that my mistake with the hymn was a bit embarrassing, and apparently, I did blush so badly that George thought I was crying. However, I wasn't really that embarrassed. Much more embarrassing for me was the time in February that I was subbing for the chorister in Sacrament Meeting. Before the rest hymn, George and I had been jokingly discussing how I should conduct a particular hymn in 6/8 time. We imagined that it would be funny to conduct it in 3/4, or 2/4, or my favorite, in a big, slow one-beat pattern. We had a good chuckle about it in our seats.

And then I got up in front of the congregation, started conducting the hymn...and got the giggles. I spent the entire 4-verse hymn in a fit of uncontrollable giggles, while blushing redder and redder the whole time. I was thankful that George pulled his hymn book up over his face so that I couldn't look at him because the giggles started up again every time I glanced in his direction. I could also see people in the congregation noticing...whispering to their neighbor, pointing, and laughing. Yes, that was a much more embarrassing moment than playing the wrong hymn.

A more pure fun

As you no doubt realized, we were not posting last week. This is because we were on vacation where we had no internet or even electricity. Yes, even in this modern age, we were able to scratch out a crude semi-life without the internet, even if it was only for a week. We were at camp, our summer cabin in upper michigan which has no electricity. Technically there is a generator we bought to power our new electric pump. It was great being up there where the stars come out at night and it gets deathly still after the sun goes down. Our good friends the Edvalsons joined us there for several days which was great fun. Colin, Henry, and Nathan all enjoyed the playmobils, particularly the race car and the arctic exploration snowcat. Though we were only gone a week, it felt like much longer, and consequently the vacation was all the more relaxing. Part of that may have been due to the fact that I didn't really wear my watch for a week, so I never really knew what time it was. I am ready to start neuroscience this week, though I could wait another week. Little Grwn is doing well, he has the hiccups (we presume) pretty regularly which is fun for me because I get to feel him move, but probably is less fun for mindy, because he keeps her up at night.

Oops!

I have been subbing for the organist in our ward for the past few weeks, something I always enjoy doing. Our ward chorister has a habit of choosing some of the more obscure hymns, which also tend to be the ones that are more difficult to play. Today, I put up the hymn numbers on the little board and looked over the hymns before beginning to play prelude. Listed as the opening hymn was #11 'Twas Witnessed in the Morning Sky, a hymn I have never heard before. As I started playing it, I realized that not many people were singing. I attributed this to people not knowing the hymn, like me, and I preceded to pump up the volume to compensate for the lack of singing.

After the hymn was over, the conducting member of the bishopric stood up and apologized to the congregation for the hymn, which he said was actually hymn #12. It was only after I looked back up to my music that I realized that I had played the wrong hymn! I had no idea, and I wouldn't have known if he hadn't said anything. Hymn #11 is "What Was Witnessed in the Heavens?". Oops!

Some people should never name children

The French have a system wherein you may choose your child's name from a long list of officially sanctioned, sufficiently French names. You are not, for instance, allowed to name your child "Talula does the hula from Hawaii" (the New Zealand government also just said 'no' to this, sparing a 9 year old a lifetime of humiliation). I was hasty in this week's name poll when I said that those were the 5 worst names ever. I gleaned those from a list here
I have, however, rediscovered a website that contains the worst names ever affixed to offspring. Sadly, this wellspring of crapulence gushes from our own LDS brothers and sisters in Utah. You can find it here. I include just a taste to whet your apetite for execritude.

Boys:

1. Auto (Otto?)
2. Bryce-Zock
3. Fermyn ( as in Fermyn the faith?)
4. Jedi Nephi
5. LaZello
6. Stockton Malone (a Jazz fan?)
   

Girls

1. Aarikkaa (Please. Spell it : Erica)
2. Bimberly
   
3. Chinchilla Zest (Hmmm. Spicy furball)
   
4. Christmas Contada (no, not Cantata, but Contada)
5. Confederate America (The south WILL rise again!)
6. DeFonda Virtue (We're fonda virtue too, how 'bout you?)
   

End of the Summer

I seem to be a glutton for punishment. I used to row in college, mainly because it was difficult and only rarely exhilarating. I voluntarily enrolled in medical school, which means I study 40-60 hours a week. For my summer 'vacation' for the last 10 weeks, I have been working in a research lab rather than riding my bike at home in Oregon with my friends all summer. This week has been especially brutal. I have a presentation tomorrow at a little cardiovascular conference that Dr F. has thrown together. I really hope that nobody knowledgeable will be there, that way they can't ask questions. I have a few preliminary results from my work this summer, which is great, but I'm not sure what they mean, hence my apprehension about explaining them to smart people. There is still a lot of work to do left on this project. I have hardly touched the liver samples, and there is no time left for me to analyze them. I don't really know what will happen when I stop on the 30th, whether I'm expected to come in during the school year and finish up, or if one of the lab folks will just tie up my loose ends when I'm done, who knows. Right now I just need a break so I can get ready for the hell of neuro that begins in August.
-Spiff.

The HRC

Yesterday I went to the student run clinic, called the HRC (health resource center). It's in the north part of the city, which is a pretty bad neighborhood. I was signed up to be the official phlebotomist, which meant that I was also supposed to give shots and PPD's (TB tests). Working there is always interesting, because I meet people with whom I would never otherwise have had contact. It reminds me of the pompous British officer in Beyond the Fringe's skit, The Aftermyth of War. "You know Perkins, before this horrible war started, I had never come across men of your social class before. Let me say just this, it's been a privilege". Hopefully it's not like that in real life. I worked with a young man who had just gotten out of jail for a drug charge and who needed to get a physical so he could get a job as a construction laborer through some rehabilitation program. He sounded like he really wanted to turn his life around, had stopped smoking and drinking, and wanted to work. I enjoy working at the HRC because it gives me a chance to work on history taking skills. Since there is a third or fourth year student and the attending who see the patient after I do, it's ok for now if I miss something in the history. Since I'm obviously very inexperienced at this, having so much built in redundancy is a good thing. Ironically, despite being the designated phlebotomist, I never actually drew blood yesterday. I should really go to the HRC more often. It's good for the soul to help out those who are truly in need, even if it is in my own fumbling inept way.

Educational Confession

George and I are watching the Ken Burns Civil War Series. For those who don't know, George has a college degree in History. In comparison, I was apparently mentally absent for each and every history lesson I ever had from kindergarten through college. I have vague memories of studying certain topics, but the details are completely lost to me. This has become apparent as we watch these films, and I realize that I recognize names of people and events, but I have no context for them. I can't keep all the people, places, dates and events straight in my mental time line. (George was surprised to discover that I don't even have a mental time line like he does.) I make George pause the movie to ask him questions, and he is surprised every time that I don't know or understand what he does.

I am really enjoying this series of documentaries, and I recommend them to anyone, either as a good review of the Civil War, or as a completely enlightening education experience (like my own). This experience has also made me wonder how I can encourage my children to learn about history. How can I make them understand that history is not just dates in an "overly huge and boring" text book that an unenthusiastic history teacher is making them read? How can I encourage them to actually learn the details, instead of studying them for the test and immediately forgetting them, like I did? How can I get them to not only learn about it, but to find it interesting and important to know? Is it possible for my childred to love it, like their dad does?

George's answer is to give them lots of books. I believe him because that was his experience, and he loves history. I just don't want my little boy to have my experience, and then to have to admit, as a 28-yr-old adult, that you can't place the people and events of the Civil War.

Vacation?

So, I've been pretty spotty with the posting recently. We went camping this weekend at a state park about an hour away. It was pretty hot and sticky friday night and saturday. We went for a short 3 mile hike, which was just long enough. Right after we got back the heavens opened for a little while. They opened again in the evening too. I discovered a place where my rain fly leaks a little, which let just a small amount of water into the tent.

Work has been pretty tough. It's a lot of work, and the hours have been pretty tiring. I have 2 weeks left to get stuff done, and it doesnt' feel like i'm going to get everything done. I have to give a talk on the 25 and the 30th about my research, and I don't have enough data crunched to present anything. I have a significant portion of the project left to do as well, which really sucks, because I need to get the stinking numbers crunched to have something to present!! ugh. Not really a great summer as far as R and R.

Moved

We have officially relocated to another apartment. Many thanks to our friends Jeremy, Dan W and Dan W, Maggie, Angela, Aaron, Rich (for the truck) for helping us out. Our new place is pretty sweet, though at the moment it is full of our junk. We live a somewhat adapted law of consecration here in medschool. We have a friend who needed room for a new chair, so they lent us their loveseat (brining our total to 2). In turn, another friend's washer and dryer died, so they now have ours because we don't need it anymore . Childcare is freely exchanged as well. For instance yesterday Angela watched the kids so everyone else could focus on moving stuff. Rich and Bonnie lent their entire house to two other friends while he's in basic training. I'm amazed at how generous our friends are, especially given our general poverty. I hope that when we all have real jobs someday that we will still be generous.

Moving

George and I are moving this weekend.  We are very excited about our new apartment, which is big and beautiful, and has two bedrooms (the whole reason for the move in the first place).  We have been packing and moving stuff all week long.  I am always amazed at how much stuff we actually have...every time I move it all.  I am happy to be moved, and I will be happier when the move is over and we are settled.

The piano movers came this morning.  If there is anything worth spending money on, in my humble opinion, it is professional piano movers.  My piano is little, but very heavy.  And we have lots of stairs.  And there are tricky hallways and doors to maneuver around.  And I would feel so badly if we tried to do it ourselves and we wrecked (or even scratched) our beautiful little piano.  It is so nice to have the pros come in with their dolly, their ramps, their truck, their moving blankets, their big muscles, and their experience.  They make it look relatively easy, and now our piano is safely in it's new place in our new home.  I also realized that I'm pretty attached to my little piano.  I miss it already.  I am glad we're moving tomorrow so that I can be with it again.

Also, I love the piano moving company (A Piano's Friend), and I will recommend them any day.

Another week down

This week was something of a drag. I spent a lot of time in the lab trying to analyze my data, but without significant result. Reading mass spec peaks is hard and takes a lot of time, I learned. Even once I've identified what things are, the "so what" question remains frustratingly unanswered. Before medschool I always figured I didn't want to spend my life as a researcher, and I'm beginning to confirm that. I haven't written much recently, mainly because nothing of interest has occured. We're moving on saturday, which hardly seems real. I haven't really thought about our new place very much, so the moving date kind of crept up on me. The only reason we're moving is so that we can have another bedroom when young Grwn arrives . I'm surprised that Jefferson was as popular a name on the poll as it was.

The Learning Curve

(Editor's note: this is was written a week before it was posted for editorial reasons)

This was an interesting week. First, loyal readers will be delighted to know that I am penning this missive from a new MacBook.

So, this week I felt incompetent. In the lab I was trying to do stuff on my own so that I could learn as much as possible, but when you walk by yourself, you can trip. I did just that. Two days this week were true blunderfests. It seems that there's a threshold error level, above which errors tend to accumulate more rapidly. That happened with my neutral lipid samples. Without delving into the gory details, I managed to mis-transfer about half of my samples at one time or another. Rather than having nice vials containing only triglyceride or fatty acid, I now have a nice mixture, exactly what I was hoping to avoid. Yesterday, before acid methanolyzing my samples, I managed to contaminate two reagent bottles. Then, flustered, I also forgot to remove the chloroform from my samples before adding the acid methanol. I don't actually think there was a long term effect to this, but it made me feel dumb. We'll see tomorrow if they turned out.

After bumbling around the lab, Mindy and I went over to our friends Dan and Maggie to eat dinner and help them with their house. The girls left together to get paint while Dan, Rich, and I worked on the kitchen. Dan and Rich are rather deft with their hands, while yours truly is not. Obviously this is not some innate capacity, but of course skills learned by practice. I just have never been taught how to hang a door for instance. So, I stood around foolishly until Dan and I figured out something I could do that didn't require too much skill. Combined with the morning's mistakes in the lab, I felt pretty incompetant by the late evening.

Epilogue: The specimens didn't turn out too well, though not strictly because of my blunders. The purification method we were using wasn't high enough yield, so we have gone with another route for purifying the lipids. The TLC extractions weren't working because the lipids would oxidize in the atmosphere while the plates were drying. Consequently we are going to use HPLC in order to purify the lipids for use on the GC. In english, this means we are going to use a machine to purify the lipids rather than using glorified sand covered glass.

Nailing down a topic

This weeks has been a relaxing, occupied week. Compared with school, it's downright slack, but at least I have something to do during the day that isn't just time-wasting. I've alluded in the past to what I'm doing this summer, and now I know. I have to give a 10 minute talk (with flannelboard) about what I'm doing, so I'll give the loyal readers a sneak peak. Medical posts were not very highly ranked on the ol' survey-o-meter, so I'll try to keep this non-technical.

The liver, or as the French would say "le foi" (not to be confused with "la foi" - faith, a common missionary blunder) is the center of our focus. The liver metabolizes the fats and carbohydrates we eat. Excess of either are stored as triglyceride, which can simply be thought of as fat. What we're looking at mice who live on a diet rich in trans fat and high fructose corn syrup. Trans fats are not found in nature in very high quantities. They are made in the gut of ruminants, but not in great amounts. Trans fats are a by-product of the hydrogenation of natural oils, often soybean oil. Natural fats have reactive carbon bonds in them which can lead to rancidification, unless the bonds are modified. This modification involves heating and bubbling hydrogen into the oil to remove some of the double bonds. In the process, the orientation of the bonds is changed from a curved to a straight orientation. Saturated fats are fats from whom all of the double bonds have been removed, rendering the final product stiff like lard. Unsaturated fats have a few remaining double bonds, and are consequently more fluid and malleable.

Why should this organic chemistry affect you? Trans fat intake is associated with significantly higher risks of cardiovascular disease, as shown in several large epidemiological studies. It also has some disturbing effects on the liver, which is what we're studying. Our mice live a small, mousey, American life. They can eat all they want (known as feeding ad libitum), their diet is rich in trans fats, and their water is filled with high fructose corn syrup, so that they drink the equivalent of 8 cans of soda a day. We also remove the portions of their cage that they can climb on, rendering them much more sedentary.

When you examine the liver of the mouse (post mortem naturally), it shows changes known as steatosis, which means simply that lipids are accumulating in the liver. This occurs in humans too, in the context of obesity, alcoholism, diabetes, and also in cases of poisoning by certain toxins (CCl4 for the really curious). Steatosis is largely reversible, if the instigating stimulus is removed, i.e. diet modification or cessation of alcohol. If prolonged however, the accumulating fat kills the liver cells and causes inflammation, or steatohepatitis (fatty hepatitis). The inflammatory process can lead to fibrosis (scarring) which in the liver is known as cirrhosis. Most people associate liver cirrhosis with alcoholism, but it can occur just as easily in the context of excess lipid accumulation. In fact, under the microscope, cirrhosis looks the same, regardless of what caused it. Once the liver is cirrhosed, it no longer functions and needs to be replaced, either by transplant or resurrection.

When you look at the microscopic images of these fatty livers, the cells are filled with little droplets of lipid. Normally the body can mobilize stored lipids for energy, as in the case of prolonged fasting. Trans fats change that somehow, and we're hoping to clarify how. What I'm going to be determining is where in the cell the trans fats wind up. Are they stored in membranes? in the lipid droplet? This can be determined by analyzing the various classes of lipids and discerning which ones are enriched for trans fats (which, you recall, aren't there naturally). Once we know where they are, we can begin to postulate mechanisms for how they change lipid trafficking. Hopefully you could follow along with me, and if you're curious, I can give you the more detailed version via email.

Non-pharmaceutical Emetic

There's a sufficiently medical title. What you are about to witness is, quite simply, nauseating. I gagged, and Mindy, delicate flower that she is, soiled our rug. Those of you well acquainted with Dave Barry's Book of Bad Songs are undoubtedly familiar with this gem. To the uninitiated, however, hold on to your lunches because, without hyperbole, this is the worst song ever written. Both singers are clearly under the influence of some of 1976's finest illicit drugs, if you look closely. Behold:

NB: some browsers don't display the video properly. You might find you have to scroll down a little for the video to appear.

The Tender Mercies

As a kid, I would was taught in Primary that you should pray before a test, and the Spirit would help you remember the things you studied. I was always puzzled though, and wondered, 'well, if I'm studying, aren't I simply going to remember what I studied anyway? how does the Spirit actually help?'. As I grew more spiritually sophisticated on my mission, I realized that often times, the act of studying itself is what is needed, and that occasionally the Spirit would tell you things that you know you had never studied before, because you had prepared yourself by studying. I can recall an example of this from anatomy in the fall. It was a practical exam where things are tagged on cadavers and you have identify them. There was a hyoid bone sitting on a stool with a little tag that said "how many muscles attach to me?" I had never actually memorized the number, but into my head popped the exact number. I wrote it down, hoping it was right, but then tried to scribble all of the muscles that I knew attached to the hyoid in hopes of hedging my bet and getting partial credit. It later turned out that the number I had scrawled down was correct. I had always imagined this was the type of inspiration that the Spirit was supposed to give, but it never seemed to happen to me.

Today I learned another mechanism by which the Spirit helps us to learn. I had exactly one and a half days to prepare for the pathology final, which was cumulative. I spent 9 hours wednesday afternoon, and 13.5 hours yesterday cramming. Yesterday was the most focussed I have been all year, my mind was definitely in high gear . This morning I got up at 6 and reviewed cases online hoping to glean some gem that would be on the exam. I was reviewing pediatric neoplasia (tumors) and one of the pages had a chart delineating which tumors are common at which ages. Ewing's sarcoma caught my eye, and I happened to glance up and see that it was common in kids 5-9 years old. We have never discussed Ewing's in class, never mentioned it, I don't know what kind of cancer it is even. But, on the exam, there was a question "which one of the following would you most likely find in a 7 year old child ?" I checked Ewing's. I realize now, thinking back on the questions that Dan and Aaron and I asked each other while studying, that many of those questions were nearly verbatim test questions. Also, things that caught my attention for a brief moment before I moved on proved to be testable points. Reflecting on my childhood misunderstanding of inspiration, I realize now that many times, the Spirit is directing me what to study, so that I can remember it, rather than whispering the answer into my ear (though, as I showed, this does happen too).

Last Day of First Year

George is currently taking his final exam of the first year! I can't believe that this day is here! It seems like we just moved here, and that school just started, and that he cannot possibly be 1/4 of the way done with medical school already. This year has gone by so quickly, with the exception of the first three months that seemed to drag on forever while George was taking anatomy, and while I was not comfortable enough with anything here to feel remotely "at home". It is better now. George seems more comfortable with school and with the workload. He doesn't seem to get as stressed out about exams, and he really seems to be enjoying what he is doing...if it's not a test week. I am happier because my husband is happy. I have some friends now, and I have a bit of a routine. I still desperately miss the West: our family and friends, the mountains, the coast, stunning nature within minutes of my front door. Sigh.

However, I do feel more at home here. We came to medical school together knowing it would be hard work, hoping things would work out, and also having many misgivings about how life would be for us here. We happened to end up in a place where there are many young couples in exactly our situation, a place where we have many people to be good friends with, and for that I am eternally grateful. This whole experience would be infinitely more difficult if it weren't for my little support system of George's classmates' wives. We can be each other's families while our real families are all hundreds of miles away, and we can keep each other company while our husbands are working hard and are otherwise unavailable to us.

For example, this test George is currently slaving through is an accumulative Pathology exam. He took a Pharmacology exam two days ago, and he has been studying for weeks to cram the vast quantity of information into his head. Absolutely brutal! Test weeks are difficult because there is so much studying to do. I know it is more difficult for George than for me because he is the one actually having to put in all the work. I'm grateful that George is a hard-worker, but I get a bit stir-crazy when I haven't talked to him in days. So while he was studying last night, I went out with my good friends, Maggie & Bonnie. We got out of our houses and wandered around Target. It sounds like such a boring thing to do, but it was fabulous! I love my friends here, and I honestly don't know what I would do without them.

I am excited to spend some time with my husband after this test is over. And he is excited to sleep and to do non-medically-related things. I think a picnic and a trip to the park are in order today, if the weather allows it. And then we have eleven weeks of glorious, glorious Summer! George will still be working, but I'm counting on my assumption that there will be no late-night homework, no weekend studying, and no test weeks!

A most profound dullness

It's exam week again. The pharm exam is tomorrow, path is on friday. I have been cramming pharm since last wednesday, and continuing tonight. Total study time since last wed: more than a normal workweek's hours. Sunday was a day off. I''m exhausted, but I still have to study path. I have barely touched it since last week, and that's the exam that's cumulative. The profound dullness is my mind. Flat, out of gas, and tired. Time for bed so I can hit the books before the exam one last time. Will I pass? no question. Anything special? hmm. we'll see.



image from: http://a.abcnews.com/images/Politics/drowsy_2_080228_ms.jpg

Why write?

When the muse whispers, you must write. This is the thought I had as I was brushing my teeth a moment ago. Why must I write? The act of writing at once places the writer into history. I rekindled my love for history and literature again tonight. Mindy and I had just finished the final episode of The Office. Television is not a literary art form, by definition. It is an explicit medium simply because every image is shown explicitly and each viewer sees exactly the same thing. What they feel may vary, but everyone has seen the same thing. The beauty of literature, however, is that everyone imagines Tolkein's Middle Earth to be someplace else. My Narnia looks different than your Narnia, and Ramona and Beezus don't look the same to you as they do to me. I love the infinite variety of writing. Admittedly, I also like the quick fix entertainment afforded by television's omni-directional sludge pump - to steal a phrase from the Simpson's Side Show Bob.

While brushing my teeth I was thinking about some of the Balzac novels I read as a french major, and the 19th century France they portrayed. Balzac did not follow the conventions of contemporary story telling, where the audience is lead down a path by brute force and coerced into feeling prescribed emotions. The essential element of American popular narratives was also missing- the happy ending. Balzac described a time period in his character's lives, simply as a kind of decade long snapshot, without necessarily resolving everything, just simply to illustrate humanity. This blog serves, in its crude way, as a Balzacien glimpse into our world. I retitled it "Another Day in the Crucible" a few months ago in order to emphasize that this rather intense experience is a profoundly changing one.

I never realized, for instance, how long and hard I really could work and remain sane. I know how to study better than I ever have. I have learned, forgotten, relearned, and half-remembered an impressive collection of knowledge. I am more assertive in seeking knowledge. I learn now not just for exams, but for future utility. Personally, I am now coming to terms with becoming a father to a little boy in October. The thought is flooring, exciting, terrifying, all at once. I think I write to remain sane and to mimic real writers, so that one day I can pass this public journal on to my kids and say "look what Daddy learned and did in school".
-Spaceman Spiff

The Great Naming Contest

Now that we're in the 21st century, we don't have to rely solely on our own ideas of child naming. Instead, we have opened the floor to all you denizens of cyperspace to name our child. Here's how it will work: each week I will propose several names for you to vote on. At the the end of each month, there will be a vote off from the winners of each week. At the end of every trimester, there will be a vote-off from every month's winner. Finally, the trimester winners will be tallied and voted upon to decide the final name. In the event of a tie, the most popular two names will be used, in alphabetical order, as first and middle names. Use the surveys on the right of the page to vote!

Survey says:

Well, it looks like the readers have voted, and the consensus is that I should share more about what I do, and so should Mindy. Sadly, I don't have a lot of leisure activities. I did, however, play racquetball with my friend Dan this morning. I acquitted myself rather well, though I did lose every game. At least I kept the score reasonably close, and for a brief moment, was actually in the lead at one point. Dan has a wicked serve that is nearly un-returnable, but I managed to slap it back a few times. We had a very brief day of school, only 1 hr of path lab. I wasn't feeling great though, so I came home at 3 ish and crashed for the afternoon. Having taken microbiology and pathology, I can now understand in intimate detail how and why my nose runs, and why the phenylephrine I take to relieve it works. That doesn't do me any good though, because my teeth still hurt and I'm still really warm.

Other leisure activities. I went for a bona fide ride on Saturday. Aaron Y, some other guys from my ward and I all went for a ride out in the country. A real ride! It's been almost a year. We had to drive for about a half hour to get out of St Louis but it was a nice rural road with some nice bucolic scenery. Riding is so cathartic for me, it just helps me to relax and just 'flow' to use the pop-psychology term. I'm a lot slower than I was before, but I still enjoy cranking the pedals and flying along. I should do it more often. I really should, especially since it's good for me.

Spring Morning in the Park

It is a beautiful Spring morning.  It's also a Saturday and the first day since we moved from Oregon that George has gone out on a bike ride with cycling buddies.  I also had a first today; I ventured out on a run by myself for the first time since we moved here.  As per my husband's safety request, I waited to go out until late morning so it would be light out and there would be more people around.  And here's what I saw at 9:00 am:  I saw a 5K Fun Run with about 1000 runners (including young, spunky and healthy school children) and other people volunteering and organizing.  I saw some sort of street fair with tents and booths.  I saw a group of people doing Tai Chi.  I saw another group of people bird watching, with binoculars in hand.  I saw people setting up for picnics in the pavilions.  I saw the Palm House setting up for what looked like a wedding.  I saw parents taking their kids to the park playgrounds.  I also saw countless people out walking dogs and other people jogging...just like me.

Now, this is not a normal day in the park.  I have been out running with George and other partners many times, usually earlier in the morning.  We are usually one group out of perhaps five that we see out jogging or walking dogs.  I know I won't usually have this type of people-watching experience while I run.  But really, what a great day to enjoy some exercise, some fresh air, and a little of what this city has to offer.

I guess I have had another first today.  It's the first time I have felt inspired to contribute to our little family's blog.  My Spring morning in the park was really that enjoyable.

Intubation Lab

So I just finished a really cool after school lab with the anesthesia interest group. We were down in the sim lab and learned how to intubate. A third year resident showed us how to use the bag valve mask and then how to intubate. We split off into groups and practiced intubating on dummies, then on each other. No, I'm just kidding. We were only practicing on dummies. The laryngoscope is basically an "L" shaped instrument with a light pointing down the short part of the 'L'. There are two types, the Miller and the Macintosh, which vary in the degree of curvature of the blade (short part of the 'L'). We were using Macs since that's what works with the dummies. So, with a Mac blade here's how you intubate: Holding the scope in your left hand, you sweep the patient's tongue out of the way, inserting from the right and sweeping left. You then pull the scope upwards and away, at about a 45º. The end of the blade should be in the valecula. This should expose the vocal cords, which are your target. Once you can see the cords, you take your endotracheal tube which has a stylet in it for rigity, and attempt to place the tube between the cords and into the trachea. The tube should be positioned about 7cm above the carina (where the trachea branches into the two main bronchi). Then you inflate the balloon at the end with about 10cc of air and withdraw the stylet. The patient is then ready for ventilation! It was a lot of fun to actually do something clinical with my hands, as opposed to studying the side effects of chemotherapy drugs, which is what I'll get to do tonight.

An exercise in futility?

The other day in toxicology the professor recounted a trivial anecdote (or should I say antidote, considering the circumstances?) which seems to encapsulate a central dilemma in health care. 3 guys drive up to the ED and drop one of their buddies out at the door before speeding off. The guy was whacked out on heroin, emaciated, and incoherent. The ED doc pushes some naloxone (Narcan™) which is a reversal agent for opiates. It acts by competing for the same receptors as the opioid, and winning the competition. Since the heroin can't bind the receptor, no response is iniated and the addict's high is prematurely terminated. It also suppresses other effects of opioids aside from the high, depressed respiration for instance. The guy gets better and leaves, presumably to go shoot up and continue to ruin his life.

The episode raises several ethical questions which delineate some of the problems with US healthcare. What good did the doctor's intervention do? Yes, he saved the guy's life, but to what end? Should the doctor be legally required to help the guy? Should he have treated the guy in the first place, given that by treating him, he would likely be perpetuating a pattern of illegal behavior?

*editor's note: I deleted the rest of this post because it didn't say what I wanted it to.

Final 4

No, it's not the last four teams in the NCAA basketball championship. It's the last 4 weeks of school! I had a pharm exam on friday and a path exam on saturday. Both went well, the grades are already back, surprisingly. I did quite well on path which was a pleasant surprise since I had studied pharm far more. I'm going to have to bust my butt on the next exam to do as well as I'd like to in pharm. So far, I think that I can say that medical school isn't too bad. I study a lot, last week put in about 60 hours before the exam, but overall, it's not bad. I can't believe that in a few weeks I can consider myself an MSII. I don't have much else to write. Mindy and I are finding out in two weeks if we're going to have a Dayshawn or a LaFonda.

To potentiate or to antagonize, that is the question

A few things are new: first, we are getting a new bed. The current bed has gotten so bad that I spent last night on the floor in a sleeping bag. I would liken it to sleeping in a ladle. Your spine is bent laterally along its longitudinal axis, and also the anterior/posterior axis. If you lie on your back, your sacrum slowly drifts down so you have a nice anteriorly rotated pelvis. This, combined with my year old running shoes means that I live with constant back pain. Having slept a grand total of 5 (ish) hours Sunday evening, I said enough's enough, and moved to the floor where I slept soundly all last night.

To rectify this crappiness, Mindy and I bought a new mattress today. Hopefully this one will last through residency. I have been sleeping like the happy fellow above, and I'm tired of it.


On a more medical note, path and pharm are a lethal combination. There's just so much testable material! We're covering ANS (autonomic nervous system) agents right now, which will be useful if I go into anesthesia. This week we covered muscarinic agonists, antagonists, and acetylcholinesterase inhibitors. We're also covering the α and β agonists, antagonists, and re-uptake inhibitors. Perhaps a brief exposition will clarify and edify:


The ANS is divided into two main branches that govern all of our subconcious bodily functions, including sweating, heart rate, vascular tone, digestive secretions, eye focusing, dilating and contraction, and to some extent the reproductive organs, as well as many others. These two branches are respectively, the sympathetic, and the parasympathetic. These are mainly anatomical terms, referring primarily to the site of origin for the respective nerves. The parasympathetic nervous system is mostly in charge of the "rest and digest" functions, e.g. secreting gastric juices, slowing heart rate, contracting the pupil, constricting bronchiolar smooth muscle (sound familiar all you asthmatics?). The sympathetic nervous system, on the other hand, is in charge of the "fight or flight" response that you associate with fright or stress. This means it increases heart rate, dilates the pupil, dilates the bronchioles, constricts the peripheral vasculature to raise blood pressure, reduces gastric motility, reduces gastric secretions, etc. Still with me? Good.

The two systems also differ in the neurotransmitter secreted at the synapse or junction. The sympathetics release norepinephrine (mostly) and the parasympathetics release acetylcholine. What about adrenaline (which is epinephrine in the US)? It is mainly released by sympathetic stimulation of the adrenal medulla, a wee gland perched on your kidney. These chemicals elicit the effects described previously.

Once the transmitter has been released, it acts on a receptor, which is a molecule that protrudes from the cell membrane. When the transmitter binds the receptor, the receptor modifies other molecules inside the cell and elicits the appropriate response (e.g. secretion or contraction of muscle). Sympathetic drugs stimulate α and β receptors, while parasympathetic drugs stimulate muscarinic and nicotinic receptors (it's a little more complex, but this will suffice).

The real fun begins when you consider the multiple ways to antagonize or potentiate the effects of endogenous neurotransmitters. You can irreversibly inhibit a receptor which means you chemically modify it so it no longer recognizes acetylcholine or norepi. You can competitively inhibit it which means that Ach (acetylcholine) or NE (norepi) have to fight for a spot to bind with the drug. These facts are pretty straight forward though, in comparison with the real meat of the course

When it gets really interesting is when you start considering multiple drugs. What happens to heart rate and blood pressure if you agonize muscarinic receptors, while simultaneously blocking alpha receptors? What's going to happen in the GI if you do this? is the patient going to crap themselves because you overstimulated the parasympathetics?

Ahh fun.



Answer: (as I can figure it out): muscaranic agonization: slow HR due to Ach on M receptor. Increased GI motility. Alpha block prevents baroreflex from stimulating α1 vasoconstriction, so BP stays lower than normal. Also decreases sympathetic tone in GI, allowing paras to dominate. Not sure when you would want the patient hypotensive and bradycardic, but there you have it. Wow. look ma! I larned something!

Slogging along a Path(ology)

(left: Arachidonic acid molecule)

The title is something of a misnomer. Pathology is actually a great class. It uses thing from pharm, micro, and cell bio. This means that I have to dredge up memories from cell bio of things I haven't seen in maybe 6 months. Path is, to use the current pedagogical buzzword, "integrative." We have lecture only once a week, and then gross lab for 90 minutes once a week, and another small group activity for another 90 minutes. This small group activity is far superior to the organized dawdling that was genetics PBL. First, these groups are self-selected, so I only work with people I know work hard. Second, there is not moderator to dampen any collaboration. The moderators in genetics, just by being present and having control of our grades were likely, even without any effort or outward expression, to quell a lot of the error prone dialogue which makes this kind of exercise educational. The absence of a moderator permits us to explore freely and make mistakes, but also to learn faster because we can be wrong and learn from it. The book is a ponderous compendium, but nevertheless a great resource.

In other news, it looks like my summer research project is going to be funded. Do I fully know what I'm going to be doing? hmmm not really. At least they'll pay me to do it though. This week I learned how (sort of) to do a protein assay. The project I'm currently working on is comparing the lipid content of mouse livers from a high fructose corn syrup (HFCS) and trans fat (TF) diet, vs. control of normal chow. In quantifying the lipids, we quantify them relative to themselves, i.e. what percentage of the fatty acids are arachidonic acid for instance. We also quantify them absolutely by comparing them to the protein content of the liver. Since fatty livers have varying amounts of water, using a dry weight/ wet weight comparison is not as accurate as simply using the absolute amount of protein present which is more or less invariate.

To do this, we extract the protein from the protein layer of a liver homogenate. The liver homogenate is basically ground up liver in a solvent, which is then centrifuged. Different cellular components sediment to different layers, which we can remove by pipette. The protein layer is removed and put into an aliquot. We put a known amount of protein into de-ionized water and run it on a spectroscope. The spectroscope bounces light off the protein, and quantifies the amount reflected. This number then is to give an amount of protein present in the sample that can then be compared with the lipid content. Still with me? basically, the process I just described is what I learned to do last week. I don't know that I could do it again by myself, but I would make a valiant stab at it.

Back to the track

I might have been a little premature in thinking that school was getting easier. Pharm is pretty tough right now. All of the kinetics (i.e. rates of absorption, excretion, etc.) stuff I thought I could safely leave in gen chem has come back to haunt me with a vengeance. I finally got my grades from Genetics and things went pretty well there after all. I've noticed in medical school I'm a lot more ambivalent about grades. As an undergrad, a 91 % on a test would send me into a depression for a week. Now, as long as I'm passing and doing a little better than average, I'm ok. I don't sweat failing, and, as the truism goes P= MD. I'm not slacking, but I don't really care as much about the grade, which is very freeing. Perhaps I've finally grown up. Unlikely. I'm still 13 on the inside, I just have good days when I act my age.