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.

Retention

As I cast my mind back over the past weeks and try to remember some of the anatomy I fought long and hard to learn, I come up blank in a lot of areas. I can, of course, remember the major things, big muscles etc.., but I can't recall necessarily the spinal segment of a given nerve, or the course of the lesser occipital nerve, or which muscles articulate the thumb. Even metabolism is fading, and it's only been a week since my last exam. I don't recall all the details of gluneogenesis regulation for example. Medical school is a process of cramming, literally. Recall those days in school right before a final exam when you were trying desperately to remember some fact only for the exam. That's how I study, only all the time. I don't know how long term retention is possible, given the pace and quantity of information to learn. I think the theory is that I will now have a context of information that I will reinforce during the last two years of school and eventually in residency. It's a sound idea in principle, and the quantity of information makes this system necessary, but it is quite frustrating to study 50-70 hours a week and not remember the things that took so much effort to learn.

The metabolism unit here is in dire need of reworking. The previous course director left and is in Atlanta now, but he would have been gone anyway because the students collectively upbraided him year after year in course evals. The resulting course that I have endured, is a hodgepodge of biochem and nutrition with some esoteric diseases thrown in for interest. I currently don't really think I could give decent nutritional advice to a patient based on information I learned here that I didn't already know from the Cheerio's box. That's not saying I haven't learned, but the things I have learned don't seem to be really applicable. Yes, I might understand the mechanism of non-classical galactosemia, but I can't explain in layman's (or Laman's as Aaron would say) terms how diabetes works, or the regulation of protein v. fat v. sugar usage in the body, or how satiety and appetite are currently understood, or the role of exercise on the whole system at a biochemical level. Some of this will hopefully be elucidated in the subsequent 4 weeks, but I'm not too sanguine. Perhaps, again, the current classes are laying a foundation for the GI unit next year and the wards in later years. If so, patience is in order, but the current unit is still a disjointed conglomeration of lectures loosely based on metabolism.
-Spiff

Free Money!!!!

So, out of the blue, the financial aid department decided to bequeath me $5000. I just got the email and out of the goodness of their hearts decided to give me some money. Very much appreciated (WooHoo!!!)I don't know why, but now I have a scholarship.

In other news, I did nothing all week. I have a flight simulator game that I have been playing all week and will be loath to put down once school starts again. Mindy and I went to the Missouri history museum which was moderately interesting. It was a pretty laid back vacation, with lots of lounging around doing nothing. I'm normally not a fan of that kind of leisure, but it was very restful after 14 weeks of craziness. I now have 4 more weeks of cell bio and metabolism, but then 2 weeks of vacation! whohoo!
that's all folks!

Vitamin C prophylaxis debunked

A large meta analysis was just published in the Cochrane Database of Systematic Reviews to determine the effectiveness of mega-dosage vitamin C (>0.2 g/day). For the those unfamiliar, a meta-analysis is a compilation of many researcher's work combined mathematically to yield results. In essence it combines many large studies into one huge study. The end result: large dosage vitamin C was ineffective in preventing or shortening to any significant degree the incidence of the common cold. Believe me? here's the abstract:

BACKGROUND: The role of vitamin C (ascorbic acid) in the prevention and treatment of the common cold has been a subject of controversy for 60 years, but is widely sold and used as both a preventive and therapeutic agent. OBJECTIVES: To discover whether oral doses of 0.2 g or more daily of vitamin C reduces the incidence, duration or severity of the common cold when used either as continuous prophylaxis or after the onset of symptoms. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006); MEDLINE (1966 to December 2006); and EMBASE (1990 to December 2006). SELECTION CRITERIA: Papers were excluded if a dose less than 0.2 g per day of vitamin C was used, or if there was no placebo comparison. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. 'Incidence' of colds during prophylaxis was assessed as the proportion of participants experiencing one or more colds during the study period. 'Duration' was the mean days of illness of cold episodes. MAIN RESULTS: Thirty trial comparisons involving 11,350 study participants contributed to the meta-analysis on the relative risk (RR) of developing a cold whilst taking prophylactic vitamin C. The pooled RR was 0.96 (95% confidence intervals (CI) 0.92 to 1.00). A subgroup of six trials involving a total of 642 marathon runners, skiers, and soldiers on sub-arctic exercises reported a pooled RR of 0.50 (95% CI 0.38 to 0.66).Thirty comparisons involving 9676 respiratory episodes contributed to a meta-analysis on common cold duration during prophylaxis. A consistent benefit was observed, representing a reduction in cold duration of 8% (95% CI 3% to 13%) for adults and 13.6% (95% CI 5% to 22%) for children.Seven trial comparisons involving 3294 respiratory episodes contributed to the meta-analysis of cold duration during therapy with vitamin C initiated after the onset of symptoms. No significant differences from placebo were seen. Four trial comparisons involving 2753 respiratory episodes contributed to the meta-analysis of cold severity during therapy and no significant differences from placebo were seen. AUTHORS' CONCLUSIONS: The failure of vitamin C supplementation to reduce the incidence of colds in the normal population indicates that routine mega-dose prophylaxis is not rationally justified for community use. But evidence suggests that it could be justified in people exposed to brief periods of severe physical exercise or cold environments.





The idea of megadosage became popular in 1970 when Linus Pauling the two time nobel laureate advocated its usage. Subsequent studies have had mixed results in substantiating his theory, and as this meta analyis proves, there really isn't any theraputic benefit, regarding colds at least. Most americans would probably not be hurt, however, by ingesting more fruit, even if it were in the mistaken belief that it would fortsall the dreaded cold.

At least it's done

Score:
Metabolism: 0 George: 1
Cell Biology: 1 George: 0

I was wayyyy overprepared for metabolism, or at least so prepared the thing was a cakewalk excepting the few questions that were on stuff we never covered, not even mentioned in the syllabus. Cell Bio was like a stay in a Turkish jail. Unpleasant, to put it nicely. BUT, they're both done, and now I have a week off.

Saturation Point

It's 9:45 on Friday night. I spent all day studying since we didn't have class. Tomorrow I have my first saturday exam of medical school. They are de rigeur next year, but this is the first so far. The curriculum deans decided to rearrange the schedule such that we have a week off for thanksgiving rather a the cost of having a saturday exam. I am desperately looking forward to a break. I haven't ever had so much consecutive school. 15 weeks straight. This week has been particularly brutal. Yesteray we (Aaron, Dan and I) started reviewing histology slides at school at 630. My study day ended at 10pm, with about 30 minutes off for lunch and some miscellaneous breaks. Today wasn't much better, but at least we started at 8.

I have finally put all the pieces together for the regulation of glycolysis, gluconeogenesis, TCA cycle, oxidative phosphorylation, the pentose shunt, glycogenolysis, glycogen synthesis and some other miscellaneous junk. These processes govern how and when sugar is both broken down and synthesizd. Mostly they follow common theme of phosphorylation inducing activation or inactivation of a particular key enzyme. It's a complex system of switches, where by inactivating one enzyme, you can activate another which deactivates a third, and allows the process to go. The logic of it can be kind of hard to get, but after taking genetics at UO, this makes a lot more sense.


To bring some clinical relevance to this very dry biochem, they bring up obscure metabolic anomalies with defects in these enzymes. For example, Galactosemia illustrates the importance of having a galactose-1 phospho uridyl transferase or a galactose kinase enzyme. Without one of these, an infant cannot process lactose in its mother's milk (lactose is a disaccharide made of galactose and glucose). The infant becomes severely hypoglycemic (CBG of ≈ 10 mg/dl), has seizures, coma, and if the deficiency isn't caught within 3 days, irreparable brain damage. Useful in real life? hmmmm. The pediatrician in the case we studied (this happened at SLU) hadn't ever seen it in 20 years. It has an incidence of 1/62,000. Useful for USMLE step 1, most definitely.

This is what's been on my mind all month, so now it's on yours.

And now I lay me down to sleep
my pile of textbooks at my feet
If I should die before I wake,
that's one less test I'll have to take.

Phrase of the week

Rather than bore you with my whining about how impenetrable some of my syllabus pages are, I thought I'd give a sample:

"Conversion of phosphorylase A to phosphorylase B is by protein phosphatase, which dephosphorylates phoshporylase A, resulting in the inactivation of this enzyme. Phosphorylase kinase activates glycogen phosphorylase by serine phosphorylation."

After many tortuous hours of study and some fortuitous revelation, I can now tell you what this means. The readable version would be this:

Conversion of A ---> B happens by addition of a phosphate group.

The reverse, B ---->A, occurs by the removal of this phosphate group.

2 different enzymes participate in these reactions.

Phosphatase kinase adds phosphate to B, making A.

Protein Phosphatase removes phosphate from A, making B.

A is active, B is inactive.

Active protein has a phosphate then.

Tell me which is clearer.

I'm sick of glucose metabolism

There, I've said it, and I don't feel bad about it. The metabolism unit here at school needs some serious re-working. The first two weeks after anatomy were really easy. The first lecture was ridiculous in fact. It was "this is where the elements come from ." I have taken genchem, thank you. Is the fact that Iodine is only made in supernovae relevant? NO! Do we need a lecture on peptide bonds? NO! we have all taken organic chemistry to get to medical school! DO we need a very general lecture on DNA transcription regulation when we have an entire 8 weeks of molecular biology in January? NO! Because the first two weeks were so general, they have really piled on the lectures in the last two weeks. 3 hours of lecture straight? no problem! 4? sure! Hey, and while you're at it, why don't we go to an IDIOTIC "interdisciplinary" class for two hours after spending 3 hours learning detailed glucose metabolism regulatory pathways!

I love to hear left-wing tubthumping about health care reform! Please, explain to me how obesity is an inquity in health care when it is mostly lifestyle derived (excepting the few with hormone problems). Oh, I see. You like Popeye's Fried Fat more than spinach. Well, it's just not fair now, is it? Those nasty goverment people, snatching you out of your house and forcing fried food down your throat against your will. No, no wait. YOU chose to eat that. You chose to smoke. You chose to sleep with 8 people a night, and now you're an STD poster child. (yes, I used D for disease, not the new politically correct "I" for infection. Syphyllis is a disease!) How the heck can it be an inequity if you chose something with poor consequences for your health? AUGGH.

This "interdisciplinary" class is really really annoying. It's the first year they've tried it and I have nothing but bad things to say for the experience. It's two hours I waste every week. The ostensibly interdisciplinary part comes because there are nursing students and social work students thrown in with the med-students. One curious observation is that the nursing students are extremely quick to tell us that they're 'accelerated nursing students', meaning they have a bachelors and will get a BSN in 1 year. I have spoken to several students who, right after we introduced ourselves, told me that they were accelerated nursing students. I don't know why, though. It's not like they've somehow gained or lost stature in my eyes because now I know that they'll have a BSN really quickly. Perhaps they're intimidated by a medstudent who is all but clueless? Generally, the nursing students are pretty bright, thought there are a few exceptions, though the same is true for my classmates. They seem to have a bit of a chip on their shoulders, however, at least from the few interactions I've had with them in small groups. Ok, now I've wasted 20 minutes venting online. Back to learning why cAMP and PKA upregulate the genes for PEPCK and increase the rate of gluconeogenesis.

In Flanders Fields

In Flanders fields the poppies blow
Between the crosses row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

- Lieutenant Colonel John McCrae, MD (1872-1918)
Canadian Army

Colonel McCrae died of pneumonia he contracted while sleeping year round in a tent, eschewing the huts his fellow officers lived in, as a show of solidarity for his comrades on the front. He wrote Flanders Fields after 17 hellacious days in an aid station at the second battle of Ypres in 1915. 69,000 Allied troops died during month long battle.

Returns on investment

For the crew at mission control in Eugene, I have officially passed Anatomy. With a Z score of a whopping +0.2. Simply stunning. That means I was slightly above the median score. Sadly, however, I didn't honor, for reasons discussed previously. I don't think I've ever had a class with such a low (study time)/(grade) ratio. I must have put in nearly 70 hours a week, more in exam weeks. I have, however, learned, that outlines, even exhaustively thorough ones, aren't as useful to me as a textbook with real english prose to read. I just do better when there are full sentences. I
wish, however, that the phrasing were less dry. I know, it's not 'scientific', but with history books it's so much easier to remember what you read because the phrasing can be varied and interesting.

I also took my one and only exam in Epidemiology and Biostatistics. It was a pretty dull class, but one of the most useful I'm told. It was a very qualitative, nearly non-mathematical version of biostats. I can at least understand more of what I read in the primary literature now.

We are also taking a new class called Critical Issues in Health Care, which is mercifully only once a week, and is 'inter-disciplinary', which means there are nursing and social work students in there with us. There is still a 3:1 ratio of medical to nursing students however. The class is supposed to make us aware of issues in american health care delivery. The first class didn't tell me anything I didn't already know, which is that things are pretty well screwed up. The lecturer for the first three lectures is some bigwig at the Missouri Foundation. He's a big proponent of a single payer system, and promised more polemical tubthumping next week. It's axiomatic among medical students at least, that a single-payer system is generally a bad idea, though I'm insufficiently familiar with its implementation in other countries to judge. I'm interested to see if this gentleman has any data to substantiate his position, or if he's just giving his opinions as fact. If the last lecture is anything to go by, I'm not too sanguine. The essence of his talk was that things have been broken since the 1930's, and fixing them isn't very feasible. He also talked about how our system is heavily weighted towards tertiary, high tech, expensive intervention based medicine rather than preventative primary care. He also talked about the fact that primary care docs are becoming increasingly hard to come by...

I have some major bones to pick with his last assertions: Why do you think that newly graduated physicians are drawn to choose tertiary specialties? For myself, my contracts with Total Higher Education Lenders influence those decisions heavily. My classmates and I borrow $65K a year, most of it at 6-8% interest. The principal alone is $260K for all 4 years, but at the end of a residency, the total will be in the 450K range. The ability to repay that in a timely manner most definitely is a factor in planning a career. If school were cheaper, there would definitely not be the disincentive to choose primary care. I'll have to update this as the class progresses because it'll be interesting to see how the various lecturers approach the problems in our system.

Professionalism-all the time?

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

Refractory periods

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

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

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

Anatomy Prank

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

J'ai Fini

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

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

Moron Dissecting

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

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

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

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

Quick update

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