Saturday, August 29, 2009

Anatomy Ruins Porn

Ignore the title for a moment, I'll get back to that in a bit.
On Thursday I had my medical interviewing course, where we learn to take patient histories from and how to interact with a standardized patient (SP). There are 6 of us and a facilitator and each session 2 people are chosen to go interview the SP. Imagine my reaction when another girl and I were chosen to go this first session. o_O

Actually I think I did very well. The SP was supposed to present with a case of severe lower back pain. We had to take down the details of the pain (onset, location, kind, severity, etc) in addition to other info. The other girl went into the interview with a list of questions to ask and she was really nervous. I just went in with a more or less blank piece of paper to take notes on (because honestly, when in real life would you have a list of questions to ask every patient?). The SP said he felt more engaged with me, w00t! I followed the patient wherever one of us steered the interview and I tried to make it feel more "organic" rather than having him answering a list of my questions in a particular order. Apparently not everyone approves of this methodology, oh well. One person commented how I seemed a tad disorganized, BUT I did hit every major question - just not in any particular order. I was following the patient and "guiding" him towards the requisite questions. But overall I think people were impressed with us, considering it was our first time.

The other girl who went (she went first) kept telling me what a pro I was at this (am I? I was just doing what "felt right") . Later in anatomy lecture, one girl in my group sat next to me and told me again how impressed she was. She said that observing me with the SP she felt as if she were observing a real doctor-patient conversation, and that it seemed to come naturally for me. I had to lol inside a little at that. I don't think I have "natural talent" or whatever, but rather I developed my "style" of interaction from my teaching experience (I knew it'd be useful for something other than teaching!). Hmm, I guess I must be on the right track then. Go me! ^_^
On Friday I had a much-dreaded anatomy lecture and the accompanying lab. We were doing the hands. Ugh, there are like 1000 tendons, bones, and muscles in the hand! I think there's more to know about the hand and forearm than the upper arm, chest, and back combined!! T.T Then we had to dissect the hands. All 3 girls in my group would not even touch the hands, so it was just me and this other guy dissecting - one hand each. Omg, it's soooo hard to dissect the hands. A hand surgeon I will never be.

And this is for Dave83201: there is this really cute girl in my group. She's actually the oldest out of the 5 of us, haha. She has long wavy brunette hair, a really nice tan, and quite a bubbly personality. She's pretty short, but nicely formed. :P Good things come in small packages I guess.

She has the most "unique" scrubs of the 5 of us. Whereas we all wear the standard and boring blue scrubs, she has this bright orange scrub top with gray bottoms. She doesn't usually do much cutting (a surgeon she will not be), though she's pretty good at cleaning away fascia and fat. We make fun of the way she says the anatomic structures because she does this thing with her hands to help her memorize things. It's pretty cute. She's pretty cute.
Today I was invited - along with 3 other M1's - to a cardiothoracic surgeon's home for lunch. Perhaps a bit of back story is necessary here. Every M1 is given an "informal" and "formal" mentor. The informal mentor can be anyone from any specialty whereas the formal mentor has to be from primary care. My informal mentor is a cardiothoracic surgeon. The other guys were invited to his house because their informal mentor didn't show up at the meet and greet event, and they sat at our table. So my cardiothoracic guy "adopted" them, lol.

He's apparently one of the best cardiothoracic surgeons at the VA in town. He has a really nice house and his wife cooked really delicious Iranian food (they're originally from Iran). I don't think I've ever really had Iranian food, but I LOVE ethnic foods, so this was a real treat. ^_^

I was really surprised he had the time for us, being a top cardiothoracic surgeon and all. I was equally surprised how nice and down-to-earth he was. We kind of sat/stood around watching and talking about soccer a bit, as a game was on. He offered all of us an opportunity to shadow him in the OR which, even if you don't want to be a surgeon, is not an offer one can turn down. So that's definitely an opportunity I'm sure all of us will take.
Still reading? Okay, back to the title, lol.

So yeah, anatomy kind of ruins porn. It really does. It's weird when you're watching porn and then your attention suddenly shifts to identifying whatever superficial muscles and veins you can find. Oh that guy has a really nice latissimus dorsi! Wow, look at his serratus anterior! Hey he has a nicely defined trapezius, and really huge pectoralis major! Look at the cephalic vein bulging on that one!! -_-

No, just no. Ugh. I can only imagine what'd happen when we reach the later units of anatomy as it moves lower down on the body. Fuck.

Wednesday, August 26, 2009

I Hope We Never Stop

Just a forewarning, this post will probably be pretty long . . . Oh, and AD if you're reading this, go re-read my edits to this post please. :)
Last week during anatomy lab, a bit of cadaver juices spurted when cutting open some part. Someone said, "Ewww!" as we all jumped back a little. In response, a girl in my group said, "Ewww is good, I hope we never get used to this and stop saying 'ewww'."

I really really like my anatomy lab group. Since we're assigned to our groups alphabetically, it's sheer luck that my group is as amazing as it is. We almost always finish early and we don't have the problems that some of the other groups seem to be having. We've gotten into this unspoken groove and system.

At the beginning of each lab session we review everything we've dissected and identified the previous day. We don't move on until all 5 of us have got the structures down. The other guy in my group (JC-M) is an amazing dissector. Seriously, he's sooo good at cutting! He aspires to be a surgeon and I think he'll be a good one. I'm usually the "second dissector" because I can stomach some of the things that others in our group (*cough* girls *cough*) don't want to handle (they have a particular aversion to seeing scalp hair or touching the cadaver's hands). Unfortunately I'm not a particularly good dissector, because I tend to end up destroying some structure I really shouldn't (it's okay, we only need one good side dissected anyhow). My motto is: "We'll either find it or destroy it." It's all good though, because we generally switch off who's cutting and who's cleaning/tearing and work in teams of 2 people per side (the 5th person holds the anatomy textbook and helps us identify stuff or subs in for someone who's tired). We have 2 left-handed and 3 right-handed people in our group, so we can dissect at almost angle with relative ease. At the end of the lab right before we pack up and leave, we summarize everything we've dissected that day to make sure everyone has some idea of what we just cut into.

Yesterday we had to cut the spinous processes (the spiky part of the spine) off 5 of the vertebrae in order to see parts of the spinal cord underneath. When JC-M cut into the spine with an electric bone saw, it started to smoke. o_O The smell was awful. I had to move to another part of the lab room to just breathe. Yeah, bone-cutting is all JC-M's job, lol. We all stood pretty far away as he cut, for fear of being splattered by preserved spinal juices (yeah, gross right?). Anywho, I think some of the other groups are envious of us (and our cadaver with little body fat and pretty decent musculature).

Today we had the most ingenious way of dissecting the posterior (back) part of the upper arms. Whereas most groups left their cadavers flipped face down, we flipped our cadaver face up and dissected the forearms first. Then we crossed the arms up over the face, as if he were trying to block a blow to the face, and began to dissect the back of the upper arm. Several people came by and commended us on our creativity. :)
Genetics has been getting a bit better, we're actually talking about "real" genetics now. Though I still know like 80-90% of the material anyhow. Oh well, it's always good to review. Though yesterday, there were a few times during one of the lectures where the material was dumbed down so low that it was borderline wrong. I had to resist the urge to correct the lecturer but restrained myself, as that would probably be viewed upon unfavorably. At least I did really well on the first genetics quiz. :P

Today we had a case study presentation for cystic fibrosis. It was really nice to have a practicing clinican come in and talk about her experience with cystic fibrosis patients. At the end of her presentation she became a bit emotional for just a few seconds because one of her two patient speakers suddenly made a turn for the worst and was in the ICU with a low chance of surviving the day. She may no longer be with us as of right now. But to see the doctor affected that way, even momentarily, made me respect her all that much. That even after so many years, after so many patients with cystic fibrosis, that she can still be affected by the loss of a patient. It reminds me of a scene from the show Scrubs:

It is my sincere hope that we, as med students and doctors, never stop caring, never stop feeling, and never become jaded. The doctor left us with a great quote by Charles Dickens:
"Have a heart that never hardens, and a temper that never tires, and a touch that never hurts."
A few other miscellaneous things.

There's this one course, "Foundations of Human Behavior," that we have to take. Many interesting things I learned in that course. For example (my numbers may be slightly off), something like about 25% of med students have seriously thought about suicide at some point, 11% have thought about committing suicide in the last year, and about 2% have actually attempted suicide. And about 400 physicians commit suicide each year. It's rather distressing and ironic that there isn't enough support for us as med students and physicians, in general - but it's getting better somewhat. To have a health professional with an illness is to be stigmatized and shunned by your own patients. Oh the irony.

Last thing. Because I've spent the majority of the last several posts on my recent foray into med school, I'm going to back off that for a little bit. I'm sure you're all wondering about the hotties that might be wandering the halls of the med school and anatomy labs, lol.

There are a few pretty attractive girls but I'm sure you don't care much about that, haha, so I'm just going to talk about these two guys that keep catching my eye. One of them is an M1 like me, but he sits on the opposite side of the lecture hall. :( I've talked to him a few times and he's really nice (one thing I've noticed is that pretty much everyone is really nice and helpful). He's a bit taller than me, blond hair, blue eyes, glasses that make him look endearing in a nerdy way. I'm pretty sure he's straight because I think he has a girlfriend, at least that's what it seems like on Facebook. The other guy is this M4 that helps us out in anatomy lab, because he's doing his sports medicine rotation and they come into the lab and help us out. He's really sweet, has a hot deep voice, slightly taller than me, dark hair, bright blue-hazel eyes, and an amazing smile.

Gah! If there's one thing I dislike about this med school it's that everyone is scattered everywhere. Because the med school is located in this tiny nowhere town just outside a major city, people don't live really near the med school. So when people go home, they go home and don't come back until classes the next day. So I never really see anyone outside of classes. :-/ It really is a bit like high school again.

Tuesday, August 25, 2009

Farewell "Overrated Integrity"

There were other things I was going to blog about but this takes precedence. Randy over at Overrated Integrity has posted his last post. His abrupt leave reminds me of a poem by Antonio Machado, "Proverbios y cantares XXIX" in Campos de Camstilla. Here is a translation below:

"Proverbs and Songs XXIX"

Traveler, your tracks are
the road, and nothing more;
traveler, there is no road,
one makes the road by walking.
By walking one makes the road,
and by glancing behind
one sees the path that never
will be stepped again.
Traveler, there is no road,
but wakes in the sea.

I hope that your journeys are safe, that your wanderings bring you enlightenment, that your path brings you closer to what you seek, and that your travels eventually bring you back to us. Wherever you are, wherever you go, don't forget us because we won't forget you.

I will not forget your final words on your blog:
"Never under any circumstances take your freedoms for granted, never under any circumstances trust those who say they do things for the better good, and never under any circumstances blindly accept a decision that you know deep down is wrong."
So Randy, take care, be safe, and I hope we meet again.

Saturday, August 22, 2009

To: Anonymous (Doctor)

Yesterday I received a series of comments on my post from a doctor as Anonymous. I will refer to Anonymous doctor as AD in this post. AD, I hope you read this post and my response to your comments.

First and foremost, I am surprised and very appreciative that you have taken the time to comment on my blog. I understand that, as a practicing physician, you must be very busy and thus I thank you for taking time to contribute your insights and thoughts. I will re-post your comments below before I respond:
OK, I've refrained from commenting in the past, but I simply have to do so now.

I'm a physician, in practice. I understand your skepticism at the biochemical info, but like it or not, you will use it--more often than you can imagine. Especially once you're out of medical school. I suggest you learn it well now, because you will never again have the kind of time you now have to do so.

As for the inheritance patterns and the like, you won't know enough medicine to be able to understand such material until you're almost through your second year. Some schools start teaching this stuff in first year, but it's most schools' experience that few student can assimilate the information until they have a fair bit of pathology under their belts. For example, there's a lot more to sickle cell than just that the cells sickle in hypoxic conditions. No doubt, you'll argue that statistics isn't worth your time either, and epidemiology is a bore--though it will determine much if not most of how you will practice and be compensated. The pharmacology course won't cover drugs, because you really can not learn them until you're on the wards and in the clinic. I think U of Penn tried to bring drugs into pharmacology several years ago for about 3 classes, and it was little short of a disaster. As for why few med students go into genetics, it isn't a function of the way the material is taught. (Don't believe me if you don't want to, but that's the reality. Choice of speciality is entirely personality driven.)

As for Gross, ancient is good. Those are the folks who really know the material cold. And that's what you need during the dissection. As for the formaldehyde, you will survive. Everyone does. And it beats being exposed to some undiagnosed virus, which is the alternative.

The dissection may seem inhuman (and inhumane), but the reality is that the first step of becoming a physician is learning to detach yourself from your patients. Empathy is good, for sure, but unless one can objectively assess what's going on in a given situation, one is set up for failure as a physician. As you assemble the "pieces" back together when you get to the wards, you'll begin to look at your patients as people, but you'll also be able to take a step and figure out what's going on with them in a dispassionate way. That may sound cruel or like gobbly-gook, but it is what happens, either in medical school or, for some, during their internship. And it DOES happen.

And if you really think I'm full of it and have absolutely no idea what I'm talking about (and I remember thinking exactly the same as you), go volunteer as a med student in the ER for a weekend, or even just a Friday or Saturday night (as in when the Knife and Gun Club has its meetings/activities). Objective observation is often critical for saving someone's life, or at least making certain that nothing has been missed.

Enjoy this year. You'll never have the opportunity to learn this material the way you do now. Though I wouldn't want to go through med school again (three relationships lost in the first year alone), I'd do a lot to have the opportunity to learn that material again.

Oh, and with regard to the wasted info they're making you learn, hey, 50% of what you learn in med school will be out of date if not outrightly wrong within 5 years of your graduation. Which 50%? That's something no one knows.

Oh, one more thing--memorize the brachial plexus. It seems stupid to do so, but that shake one of your classmates' hands and ask them to pretend they lost innervation (through a lesion of the plexus) of one or two specific muscles. Then use what you memorized to figure out where the injury took place. Even with CT scans, knowing how to diagnose a neural injury based on simple things like where an injury took place in the plexus is quite important.
There are several things I would like to address and clarify. My aim is to neither challenge nor dismiss your views, as it is very valuable to me to have someone who's "been there done that" to comment. I would simply like to elaborate where I am coming from.

Our genetics course here is only 3-4 weeks long. Then it switches over to biochem for the remainder of the semester (until December). I fully understand and appreciate the importance of biochem, but in these precious 3-4 weeks I expected to learn genetics and not biochem, as I know biochem will shortly follow anyway. This has not happened. As far as "true genetics" (e.g. the inheritance patterns, genetic diseases, ELSI issues, etc) material goes, I have learned more in high school and undergrad compared to this course. It is my opinion that throughout my medical education there will never again come a point where the opportunity to learn about diseases from a purely genetics point-of-view will occur. To me, this (mini-)course is a missed opportunity to prime and sensitize med students to the emergent importance of genetics in medicine.

I do not believe a complete understanding of pathology is necessarily required in order to highlight the genetic components of diseases. I've taken courses before that have delved quite deeply into the genetics of sickle-cell anemia and Huntington's corea without more than the most basic understanding of their pathology. Pathology comes later to flesh out the details of diagnosis.

With respect to statistics and epidemiology, I was a grad student in Hospital & Molecular Epidemiology for a year before starting med school. Therefore I fully appreciate the importance and relevance of these subjects to clinical medicine. I am actually somewhat disappointed that my med school curriculum does not do much more than mention the most superficial aspects of these subjects. They are critical to evidence-based medicine and understanding the literature, so that each physician may make a critical judgment and opinion about whether the evidence is strong enough to affect his/her practice.

Back to the topic of genetics, in several of my public health courses, we had discussed at length the lack of genetics understanding most physicians possess and/or how they are learning/focusing on the "wrong" material. My genetic counseling friends lament how (many) doctors are not able to recognize what is a genetic disorder and what is not (especially with prenatal and pediatric genetic conditions), or attempt to order a genetic test without being able to understand the results. Many in my courses feel that physicians seem to dismiss the emergent importance of genetics in medicine, especially with the "promise" of personalized medicine on the horizon.

I do not know what to expect in regards to pharmacology. I will not take that course until next year. My friend at Case Western has lamented to me how she had to memorize a list of pain medications, blood pressure medications, and cholesterol medications (at the very least, the major name brands). I understand that each med school has a different way of teaching the same material, and when the time comes, I will likely call my pharmacy friend and ask her for help when studying pharmacology. Because that's what pharmacists are for (and she's pre-agreed to this). :)

While I agree with you that choice of specialty is personality-driven, I also believe it is also in part exposure to the field. Not many med students (that I've spoken to) know that medical genetics is an option. Other more "obscure" specialties (e.g. infectious disease, community health) aren't very well highlighted during rotations. Without exposure, how can a med student know what options there are? Furthermore, I also believe the way a course is taught does impact a med student's decision to pursue a particular specialty. If you're not interested in only looking at the heart, you won't be a cardiologist. If you suck at dissection in anatomy, you should not be a surgeon. Perhaps that's a gross oversimplication.

The curious thing about clinical human anatomy is that, on the first day, we were subjected to a 2-hour long lecture on the ethics of cadavers and respect for them. We were actually warned to not allow anatomy to distance ourselves from our future patients, but rather to bring us closer to them (I'm not exactly sure how this would work). It is interesting, however, that many mainstream media report how patients actually abhor doctors who view them with dispassionate interest - who view patients more as a "bag of symptoms" rather than as a holistic individual. We've been told, time and time again (and just within this last week), how patients don't care how much a doctor knows but rather how much a doctor cares. Call me idealistic (and I suppose I am, for being just a lowly M1), but I would like to believe there is a way to balance the "caring" side with the objective side of clinical medicine.

As for memorizing the brachial plexus, I don't have a choice. It will be on my exam (in quite a bit more detail than I'd like, I imagine) in a few weeks. Besides, I don't think anatomy's stupid. It's good to know where the major things are. I've heard that other med schools do less dissection work, as anatomy is a "dying art." That's rather unfortunate, in my opinion.

Finally, if you read this, thank you again for your comments. It would be interesting to read what you had to say about my previous posts, particularly the ones that relate to health and medicine. As it is, I understand you probably don't have time for that and so I truly do appreciate you taking the time to comment on my last post.

Hi again AD! :) Thanks for commenting further in this post. I won't copy your text, as people should just refer to the comments section of this post below.

I would like to ask you a few questions (if you don't mind answering, hopefully you read this): is it possible to do a fellowship in medical genetics after doing residency in pediatrics? Or is the only "route" to medical genetics through internal medicine? And what kind of physician are you?

I took an embryology course in undergrad and actually really enjoyed it. Even some people in the biology department lament at the "death" of embryology, as developmental biology seems to have overshadowed it. It's a little saddening.

I'm really glad you brought up that point about pharmacists. My friend who's finishing up pharmacy school is actually most interested in hospital pharmacy (I think that's what it's called), where they follow doctors and residents as a part of a team and advise them on which drugs the patient should take. I'm not sure if it's everywhere, but just there seems to be a culture shift in the way medicine is taught and practiced, there seems to be a cultural shift within pharmacy as well. So hopefully by the time I'm done with residency (and fellowship?) I will be able to defer to pharmacists.

I'm also glad you pointed out how it's okay to say "I don't know." I had been wondering/worrying about that aspect of medical culture. I've read (and heard) how mortally dangerous it can be for doctors to either admit fault or that they don't know, for malpractice reasons. Of course, as a fledgling M1 I don't know much in such matters, but I've never had the ego to not say "I don't know" when I truly didn't (in fact, I'm quite uncomfortable giving advice/info that I'm unsure about). My genetic counseling friend refers to that tendency as evidence for my "extensive" scientific background, lol.

Lastly, I have not read The House of God but I fully intend to over winter break. My brother read it in one of his freshman seminars and I've heard many good things about that book. So it's about time that I read it. A book I have read and enjoyed was The Spirit Catches You And You Fall Down.

Friday, August 21, 2009

The First Cut

I've only had two classes thus far: genetics and clinical human anatomy.

Ugh, this class is taught sooo poorly! We haven't really learned anything about genetics, just the biochemical mechanisms of genetic processes (like replication, transcription, translation, etc). This class is really biochem pretending to be genetics. This material isn't the important part about genetics!! It's not necessary that we know all the details of processes because 99% of us will NEVER use that info!

We should be learning about inheritance patterns (more than the grossly simplified Mendelian dominant/recessive inheritance), how to recognize genetic abnormalities, how to prevent them, etc. We do not cover things like: co-dominance, incomplete dominance, penetrance, expressivity, multigene traits and diseases, etc. One of our lecturers even oversimplified the definition of "allele" to the point that it was just wrong info. Honestly! Nothing in this class thus far is of clinical importance, unless you're a pharmacist and want to know how every drug mentioned in our notes thus far kills cancer. Always cancer. -_-

There are CLASSIC examples of genetic diseases that aren't even going to be mentioned (I know, I've flipped through all the notes already). Diseases like Huntington's corea, sickle-cell anemia, fragile-X, HNPCC, FAP, as well as multigenic ones like Alzheimer's and diabetes. We don't go over newborn blood screening and the metabolic and genetic diseases detected therein. In my opinion, we've learned very little useful info thus far. It gets marginally better, but not by too muich.

Ugh. No wonder why so few med students go into medical genetics. If I hadn't had such a strong genetics background, if I didn't already learn the clinical relevance and application of genetics, and if this was my first and only "real" exposure to genetics, I would NEVER go into medical genetics. This is just awful, truly. Again, this class is NOT genetics, it's biochem dressed up as genetics. I know there's a point where the two fields intersect, but what I think is more important simply isn't emphasized. It doesn't help that our professors are from the biochem department.

/end rant

Clinical Human Anatomy
This class is . . . I'm not sure what to think about this class. All of our professors are ancient. Omg, there's this one professor who's been teaching the course for 50+ years. He's been teaching this class at this institution way back when it was under a different name! He taught one of the other professor's dad as well as the other professor himself (and that guy isn't young either). He had to be at least 30 or so before he got his teaching position, so that makes this guy at least 80+ years old. And you know what's creepy? I think he's older than some (many?) of our cadavers. >.>

Now as for cadavers, we began dissection on Wednesday, the 3rd day of classes. It's truly a strange experience. To see all the humidors (yes, like the thing you keep cigars in, that's what the bodies are kept in to keep them moist) lined up in rows in a really large room. Then to see med students open the lids and slowly raise the cloth-covered bodies up, it's like watching the ressurection of mummies.

And then you're hit by the smell - the smell of formaldehyde (I had SO wished they used an alternative preservative). It's a strong odor that makes the saliva well up in the back of your throat, a similar feeling you might get right before you're about to vomit. And it burns the eyes if you lean too close, and gives you a headache that lasts hours if you inhale too much (which I think I did).

Then you pull back the cloth, uncovering the part of the body you're working on. In our case it was the chest. You see this leathery thing that somehow doesn't look quite human. You make the first cut, squirming at the easy with which your scalpel pierces and slices through skin and fat. Two of you grab the flap of skin you've just created and pull back, as someone on the other side lances away the connective tissues with scalpel and blunt probe. With each cut, with each peeling back, the body becomes somehow less human and you distance yourself - somehow it becomes easier to cut the deeper you go.

You encounter the muscle, the pectoralis major that you need to peel back (reflect) from the pectoralis minor. It has a curious red-brown color, with the muscle fibers looking even more curiously like the dark meat chicken. Someone remarks how they will become vegetarian for the duration of the semester as a result. You continue, removing the fascia from the muscles, going slowly and hoping you haven't severed important nerves, arteries, and veins. After all, for the 5 of you there is only one body, and you only have two chances to get it correct - once on the left side and once on the right.

You find the structures you're interested in and are ecstatic that you didn't eviscerate the body for nothing. Someone at a table further away yells out they encountered breast implants in their female cadaver (awkward . . .). You are thankful that your body is skinny with very little fat, as you look at the table across from you with the yellow fat dripping off the inner flesh. You wonder at the identity of this body but you dare not pull back the cloth that covers the face, for fear that the experience becomes "too human."

Today we proceeded further with the dissection of the chest and upper arm area. We had to tie up the arms of our cadaver to the sides of the humidor with rope. With the armpit area splayed open, the brachial plexus (nerves) and the assorted arteries and veins stretched out like cords, there was a disturbing Christ-like appearance to our cadaver. I refrained from much cutting because I discovered (not surprisingly) that I do not have "surgeon hands."

We sawed through the clavicle (collar bone) in order to expose the nerves, veins, and arteries hidden behind it. With an electric saw and much snapping and twisting, the sound of breaking bone is oddly familiar. The chicken analogy again works well. Another night of vegetarian for me.

We discovered a gash or some kind of laceration/puncture wound to our cadaver's skull. We wonder if that was how he died or if it was perhaps a part of the embalming. We have no idea who our person was, what his life was like, how his family was like, how he lived, and how he died. I suppose this was designed to distance us so that we may literally dig into his innards without much hesitation. When this is all over, when this is all said and done, then his identity will be revealed to us.

Anyway, to end on a completely different note to distract from the gruesomeness above, Courage from the (now finished) blog, A Beautiful Addiction... linked me to the following YouTube vid:

(D) Rep. Barney Frank SLAMS woman comparing Obama to Hitler at town hall

Rep. Frank's response is pretty epic, I must say. :P Ugh, people are being rude and really stupid at these town hall meetings. It's difficult to take away what's true and what's false about health care reform. Damn Palin for her "death panels" statement that ignited the flames. Someone should bitch-slap her for her idiocy.

Lastly, a song that rather warmed my heart, "Funny Little World" by Alexander Rybak.

It's such a cute song. I wish something like that would happen to me in real life. Ah well, I suppose such things might only happen in fairy tails. :-/ You can see a YouTube vid with lyrics here and a YouTube vid of him performing it live here.

Tuesday, August 18, 2009

Why Medicine?

So I'm going to get right to the point. Randy asked a few days ago (and I'm paraphrasing): "Why do people (and you) choose to go to med school?" So out of everything out there, why medicine?

I'm actually surprised I had not explained or elaborated on this before. Maybe I have in some post and forgot about it (and if so, I'm not going to dig through my 260+ posts to find it). I'll first enumerate some of the reasons that people go into medicine before I speak for myself.

Warning: This is a rather long post.
Money, power, prestige, fame, the title, wanting to do good, desire to serve the community, desire to heal/cure/save lives, a calling - these are the main reasons that I believe people choose to pursue medicine. I will first and foremost speak of my peers at my med school. Most of the people I've met in the last 2 weeks sincerely want to be good physicians and "do good." Everyone has his/her own opinions and leanings towards this specialty or that based on life experiences to date. We all entered med school knowing full well the "sacrifices" we would be required to make, to have the next decade (or even longer) of our lives "locked down." We all entered med school knowing full well the $160K+ debt we are incurring (not including interest). We all entered med school knowing full well we would be sacrificing sleep, food, and sometimes sanity. But we all chose to do it because that is where we see ourselves, that is where we feel our career niche lies.

But as a result I have sensed, however, a feeling of entitlement to satisfactory rewards when we're "done" and out of med school and residency. It is the feeling that, because we're sacrificing perhaps the second best years of our young lives (the first best years being the 3-5 years of undergrad), because we're incurring astronomical debts, because we're - almost literally and ironically - sacrificing our own health to learn how to heal others, we should be compensated. And it is for this reason that many of my peers dream of interesting specialties that they can flourish in and/or of specialties that have a more "cushy" lifestyle.

We know that fewer med students willingly choose to enter primary care and that primary care is approaching collapse in the US. Yet many of us still wish to avoid it if at all possible. Why? It is because we're wary of primary care - of the low reimbursements, of how you can spend 15-30 minutes with a patient and get paid less than an operation that takes 5-10 minutes, and of the sense of powerlessness in primary care (as you're always referring away patients to specialties). I don't know if I've said this before, but I heard on NPR about a month ago how many pediatricians back in my home state are leaving due to the high unemployment rate and the now heavy reliance on Medicare/Medicaid. It's scary to hear that pediatricians don't make enough to keep their practices open, that many who've practiced for years are now going bankrupt. Almost everyone I've talked to one-on-one - nurses, doctors, med students - warn us to avoid primary care like the plague because we will not be able to make enough money to pay for office rent, electricity, water, internet, heat, staff salaries, malpractice, loan repayments, etc.

And so, while many of us want to help the community and want to do the most good we can, we do not want to do it at our own expense. The culture of medicine is changing - med students today do not want to be on call all the time, med students today want to help others but also want to have a family and a life outside the hospital. I had linked to a blog article in my post here. As my friend, RZ-F (who's an M2 at Case Western), said: "I did not go into medicine to make a net income of $65K for a few years and have to pay the ridiculous loans. I did not go into medicine to not be able to truly help patients and having to refer them away. I did not go into medicine and 'sacrifice' a decade of my life for nothing." I found an interesting clip on NPR (here) that mirrors the sentiment med students have towards primary care; please listen to it as it really speaks the truth.
Now, as for me. I had wanted to go into pediatrics for a very long time (sorry, I won't be doing prostate exams, lol). A good part of me still does. But I've heard strong admonitions from the doctor I shadowed (an internist/endocrinologist, I'll call him Dr. L) against going into pediatrics and psychiatry. And every med student I've talked to kind of backs away from me slightly when I express my interest in pediatrics (they actually look at me as if I'm slightly crazy, no joke). One guy said, "Man, you must have a very good soul to go into pediatrics. AND you must be very tolerant, especially of parents." Of any of the primary care fields, pediatrics is the one to be most avoided. So then, why pediatrics?

I feel pediatrics is where I can do "the most good." And I LOVE kids, I think they're the best. I tend to connect with kids very well and I think they should be given more credit. I believe that children require a strong health advocate and also that they're entitled to know what's going on with them. Children should, to a certain and varying degrees (depending on age and maturity and such), be aware and have a role in their own health care. Many times doctors tend to talk at or to the patient, and not with them. I feel my communication skills, that I've learned and refined a bit from teaching undergrads, allow me to explain a complex issue in a simple way without simplying the issue. It allows me to be more of a teacher with patients, rather than a patronizing lecturer. I think I can even handle the parents too (hopefully).

That said, I know I cannot survive without incredible luck by being "just" a pediatrician. There are two specialties/sub-specialties that I'm considering: endocrinology or medical genetics. I shy away from most specialties because I don't like to delve too deep into one or a couple things, my interests are a bit ADHD for that, and I know right now I want nothing to do with surgery (the less cutting the better). General pediatrics is great because it spans the whole gamut of issues for individuals from 0 to 21 years old. Endocrinology is great because rather than focusing on one organ, it focuses on dozens scattered throughout the body. Medical genetics is great because genetics is emerging as being ever more important in medicine, and genes affect almost everything (and it'd be nice to "ride this wave" as it were). With pediatric endocrinology, I'd likely focus on obesity and diabetes, a growing epidemic in the US. With pediatrics and medical genetics, my primary patients would still remain children, but I could also see adults with genetics-related concerns (though I'd likely focus on prenatal and pediatric genetics, if possible).

So have I now mirrored my peers above? Have I sought a well-compensating specialty after doing residency in primary care? Actually no, lol. Pediatric endocrinologists don't make that much more than general pediatricians, and medical genetics actually makes somewhat less than general pediatricians (FUCK!!). I guess, if my current interests hold, I'm doomed to being a poor ass doctor. I can live with that, as long as no one sues me or yells at me . . . I didn't go into medicine for the money, or the power, or the prestige. I went into medicine believing I could truly help people and make them feel better, and maybe even save a life now and then. But man, that $160K+ debt is looking daunting about now . . . T.T

It's going to be a tough life, but maybe less so if I manage to achieve my even more ambitious goal. More than being "just" a pediatric endocrinologist or a general pediatrician with a focus in medical genetics, I want to go into academic medicine. While I have little interest in pursuing research as a primary focus, I wish to go into academic medicine (almost solely) for the opportunity to teach students, whether they are undergrads, grad students, or med students. I truly do love to teach and prior to last year, I wouldn't even have known. If I'm lucky I might get tenure, lol.

Suffice to say, I don't know if all will go as planned. I don't know if I'll break down and change my mind (and pursue a "cushier" specialty), or where life will take me in the coming decades of my rising career. But hopefully I'll have the resolve, the will, and the luck to make it out and still be me, still maintain my idealism, have a family, and have a life outside the examination room. Here's hoping.

Oh, and Dr. L told me an amusing joke. "The internist knows everything but does nothing. The surgeon knows nothing but does everything. The pathologist knows everything and does everything, but it's too late. The patient's already dead." I guess it might only be interesting to those in medicine . . . If you're curious as to what it all means, ask me about it.

Oh, I just read up on a new blog called Daze Gone Bi by Dave83201. If you haven't had the chance to go over and read, please do so and you can let him know I referred you. ;-)

Saturday, August 15, 2009

Orientation and the White Coat

I apologize for not posting yesterday as I said I would. I've been quite busy.

By and large, orientation week was long and not that useful. Oh well, we got some free stuff and free food. (Free food is definitely the way into anyone's heart.) I met many of my fellow M1's. We are a diverse bunch and everyone's really nice . . . so far. I met MJ-F, who I'm going to call "the Cutter." She worked in a hospital for a year or two, helping with organ transplants. So she was saying how her hands were itching to cut into the cadavers, and how she missed the bodies. We kind of scooted away from her slightly when she said this. Not many other people are looking forward to anatomy, lol. Then there's LV-M, a loud and funny guy from CA. Actually, there are a lot of people from CA and it's makes me chuckle inside as I sense their fear of the Midwestern winters. I've met 2-3 other people from my alma mater, so it might be nice getting together with them and reminiscing. :P

According to my roommate, most people seem really enthusiatic and/or intense. I think there are a lot of Type A personalities hiding behind the nice faces in med school. Type A personalities tend to be: impatient, time-conscious, concerned about their status, highly competitive, ambitious, business-like, aggressive, and having difficulty relaxing. Neither my roommate nor I are like that - we're too laid back, though I'm more Type A than my roommate, lol. But I think I'll get along just fine with most people.

Several of us sitting together at lunch the first day got to talking about things - about the direction of health care, about specialties, about the ridiculous debt we're incurring, about being poor for the next decade - yeah, we were all quite cynical by the end of lunch. LOL! In fact, during our financial aid session, this one presenter needlessly told us how we needed to scrimp and save wherever we could, even if that meant forgoing coffee. Seriously, we're med students; how're we supposed to get by (in the long run) without caffeine?!

The very last thing during orientation was the white coat ceremony, a long-time tradition where new med students are "cloaked" in their (short) white coats. I'm not entirely sure how I feel about the ceremony. On the one hand I'm honored to be a part of this elite section of society with the privilege of donning the white coat. My med school class has 204 students, the 3rd largest in the US. In total there are between 15,000 and 18,000 entering med students each year in the US. On the other hand, the white coat ceremony felt (to me) stiff and almost old-fashioned in the way it was done - in fear of being left behind in today's ever-changing culture of medicine.

There was a speech about the white coat - about what it should mean, about what it should be and about what it should not be. It should be a symbol that brings us closer to our patients, not further away emotionally. It should be a privilege and power to be used to heal others, not for personal gain. It should places us amongst equals within the health professions, not above nurses, social workers, public health officials, etc. When it all ended, my roommate and I decided that the white coat symbolized one thing to both of us: responsibility. In time I'll discover for myself all the other things my white coat means to me.

Ugh, it's late now. Sorry Randy, I'll answer your question in my next post. In case you forgot, your question was something along the lines of this: Why do people (and you) choose to go to med school?

Wednesday, August 12, 2009

Checking In and Some Plugs

Hey all,

Just checking in to say that everything's going fine with med school orientation. I'm surviving just fine, my roommate's really laid back and great, and I've met some awesome fellow future docs. :) I'll post more with details probably Friday night when orientation is all done with (yeah, orientation lasts a week, ick).

Thanks again Steevo for that really sweet "surprise!!" And thanks to everyone who either commented or wished me luck on your blogs, it means a ton. ^_^

Lastly, I'd like to plug two blogs. The one by Pilgrim, La route de Pilgrim - Pilgrim's ways, probably doesn't need much introduction here. But the other's a new blog by Fer, The maudlin story of a bisexual boy. I haven't read through them yet, but I've skimmed them a bit and they look great! I hope to read them in their entirety some time this weekend or next. So you should all stop by and say hello! :)

P.S. Steevo, I saw a pin like the stained glass picture in your latest post. I want one. :P

P.P.S. Randy, I'll answer a question you asked of me on MSN tonight (well, you asked it implicitly, but I'll answer it explicitly in my next post).

Sunday, August 9, 2009

Want to Reads

I came across this interesting post on Mike's blog, Random Thoughts In My Life.

"The BBC apparently says most people will have only read 6 of the 100 books here."

1) Bold what you have read.
2) Add a '+' to the ones you LOVE.
3) Italicize those you plan on reading.
4) Put in a note with your total in the subject.
1 Pride and Prejudice - Jane Austen
2 The Lord of the Rings - JRR Tolkien +
3 Jane Eyre - Charlotte Bronte
4 Harry Potter series - JK Rowling +
5 To Kill a Mockingbird - Harper Lee
6 The Bible
7 Wuthering Heights - Emily Bronte
8 Nineteen Eighty Four - George Orwell
9 His Dark Materials - Philip Pullman +
10 Great Expectations - Charles Dickens
11 Little Women - Louisa M Alcott
12 Tess of the D’Urbervilles - Thomas Hardy
13 Catch 22 - Joseph Heller
14 Complete Works of Shakespeare
15 Rebecca - Daphne Du Maurier
16 The Hobbit - JRR Tolkien
17 Birdsong - Sebastian Faulk
18 Catcher in the Rye - JD Salinger
19 The Time Traveller’s Wife - Audrey Niffenegger
20 Middlemarch - George Eliot
21 Gone With The Wind - Margaret Mitchell
22 The Great Gatsby - F Scott Fitzgerald
23 Bleak House - Charles Dickens
24 War and Peace - Leo Tolstoy
25 The Hitch Hiker’s Guide to the Galaxy - Douglas Adams
26 Brideshead Revisited - Evelyn Waugh
27 Crime and Punishment - Fyodor Dostoyevsky
28 Grapes of Wrath - John Steinbeck
29 Alice in Wonderland - Lewis Carroll
30 The Wind in the Willows - Kenneth Grahame
31 Anna Karenina - Leo Tolstoy
32 David Copperfield- Charles Dickens
33 Chronicles of Narnia - CS Lewis
34 Emma - Jane Austen
35 Persuasion - Jane Austen
36 The Lion, The Witch and The Wardrobe - CS Lewis
37 The Kite Runner - Khaled Hossein
38 Captain Corelli’s Mandolin - Louis De Bernieres
39 Memoirs of a Geisha - Arthur Golden
40 Winnie the Pooh - AA Milne
41 Animal Farm - George Orwell
42 The Da Vinci Code - Dan Brown
43 One Hundred Years of Solitude - Gabriel Garcia Marquez
44 A Prayer for Owen Meany - John Irving
45 The Woman in White - Wilkie Collins
46 Anne of Green Gables - LM Montgomery
47 Far From The Madding Crowd - Thomas Hardy
48 The Handmaid’s Tale - Margaret Atwood
49 Lord of the Flies - William Golding
50 Atonement - Ian McEwan
51 Life of Pi - Yann Martel
52 Dune - Frank Herbert
53 Cold Comfort Farm - Stella Gibbons
54 Sense and Sensibility - Jane Austen
55 A Suitable Boy - Vikram Seth
56 The Shadow of the Wind - Carlos Ruiz Zafon
57 A Tale Of Two Cities - Charles Dickens
58 Brave New World - Aldous Huxley
59 The Curious Incident of the Dog in the Night-time - Mark Haddon
60 Love In The Time Of Cholera - Gabriel Garcia Marquez
61 Of Mice and Men - John Steinbeck
62 Lolita - Vladimir Nabokov
63 The Secret History - Donna Tartt
64 The Lovely Bones - Alice Sebold
65 Count of Monte Cristo - Alexandre Dumas
66 On The Road - Jack Kerouac
67 Jude the Obscure - Thomas Hardy
68 Bridget Jones’s Diary - Helen Fielding
69 Midnight’s Children - Salman Rushdie
70 Moby Dick - Herman Melville
71 Oliver Twist - Charles Dickens
72 Dracula - Bram Stoker
73 The Secret Garden - Frances Hodgson Burnett
74 Notes From A Small Island - Bill Bryson
75 Ulysses - James Joyce
76 The Bell Jar - Sylvia Plath
77 Swallows and Amazons - Arthur Ransome
78 Germinal - Emile Zola
79 Vanity Fair - William Makepeace Thackeray
80 Possession - AS Byatt
81 A Christmas Carol - Charles Dickens
82 Cloud Atlas - David Mitchell
83 The Color Purple - Alice Walker
84 The Remains of the Day - Kazuo Ishiguro
85 Madame Bovary - Gustave Flaubert
86 A Fine Balance - Rohinton Mistry
87 Charlotte’s Web - EB White
88 The Five People You Meet In Heaven - Mitch Albom
89 Adventures of Sherlock Holmes - Sir Arthur Conan Doyle
90 The Faraway Tree Collection - Enid Blyton
91 Heart of Darkness - Joseph Conrad
92 The Little Prince - Antoine De Saint Exupery
93 The Wasp Factory - Iain Banks
94 Watership Down - Richard Adams
95 A Confederacy of Dunces - John Kennedy Toole
96 A Town Like Alice - Nevil Shute
97 The Three Musketeers - Alexandre Dumas
98 Hamlet - William Shakespeare
99 Charlie and the Chocolate Factory - Roald Dahl
100 Les Miserables - Victor Hugo
Count: 16 read, another 9 or so that I plan to read (someday . . . >.>).

Two of the ones I bolded, the Bible and The Adventures of Sherlock Holmes, I've only read part of (I mean, really, how many people have read the entire Bible from cover to cover?). There are a couple I'm not sure I've read or that I should've read by now, but somehow haven't. And some of the ones on that list I've never actually heard before.

So, how many have you read? :P

Saturday, August 8, 2009

On To the Next Stage

Well, here I am in another state in a new apartment about half a mile away from the medical school. I arrived here Thursday night around 11pm and I'm nearly done unpacking, just a few stray items that I'm not sure where they should go. My apartment's much nicer than the last 3 apartments I've lived in. I hope my roommate and I get along great and neither of us will move for the next 4 years (I'm a little tired of moving around every year).

This move was unlike any other move. It was actually a bit difficult emotionally. Now, I'm not generally an emotional person, but tears welled up in the corners of my eyes as I packed my things earlier this week. It seemed that almost everything I touched had some lingering memory attached to it. Notes for this class, that paper I wrote, that picture I never finished drawing, that concert program, that sheet of music, etc. Everything reminded me of my last 5 years at the same university institution - the good, the bad, the friends I made, the classes I took, the professors I had, the fun I had. Truly this was goodbye.

I've always wondered why people cried at graduation, clinging to each other and embracing hugs, sobbing while trying to smile for final pictures. Now I have a small sense of what that is like. It's difficult to describe; but by leaving some things behind, by "discarding" some memories, it feels like a part of one's soul is fractured and left behind. I've lived in this one Midwestern state for the last 18 years. I've wanted to leave, perhaps escape, for a while now. I had looked forward to this day but now that it's here, it makes me sad.

Now it's time to move on. I'm not sure how much I can call this place home, but I guess home is where I am. On to the next stage, on to med school. It's only 4 years, and then to somewhere else (hopefully). Time to find my bearings, rediscover balance, and tackle everything thrown my way.
Now for a completely different topic (because I'm too lazy to make a second post right away), a few YouTube vids that I found/was linked to by friends.

Clutter by Ronald Jenkees

This is actually a pretty cool song. It's a very ambient kind of music. I particularly like it at about 1:48 minutes in when a violin melody enters, and again at about 2:26 minutes in when the cellos bear down on their lower notes (it's a little hard to hear without good speakers/headphones).

Viva Forever

An online friend linked this to me a week or so ago. I thought it was really cute, so watch it. :)

Did You Know?

This vid is a bit of an eye-opener. It's really cool, and just a tad trippy once you absorb it all.

I'd like to say farewell to the blog Southern Inebriation. However, the author, J, started up a new blog called Be Kind Cali. So head over and check out this new iteration.