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!