A sad case of warped thinking.

(source: Gawker.com)

There's a rather strange article in the NYT Modern Love column this weekend.

Essentially, a Mormon woman waits to have sex until she is married, but never gets married and at age 35 finally wakes up, realizes that saving sex for marriage doesn't guarantee that marriage will happen, and hauls herself off to Planned Parenthood to be outfitted with an IUD, presumably so she can begin to explore this heretofore uncharted territory.

There are some weird, judgmental statements: one offhand comment about a teenager in the PP waiting room who is "bound for an uncomfortable, humiliating four minutes in the back of a borrowed Chevy Chevelle."  Never mind that a teen seeking birth control is what many would view as responsible, and that 35-year old virgins are plenty weird themselves.

I'm not entirely sure what to make of this author.  On the one hand, the piece is a nice reminder of how religious indoctrination can fuck up one's thinking to the point where one deliberately misses out on life's pleasures in exchange for some nebulous concept of "reward."  Her explanation for why she didn't follow traditional Mormon doctrine and get married as early as possible is somewhat flimsy: "leftovers [men who did not marry young] were left over: closeted gay men, porn-addicted virgins, along with the merely awkward, uncompromising and unlucky."  While I don't doubt that SOME of the men she is referring to are indeed unsuitable heterosexual partners, at what point does this self-pitying woman take a look in mirror and ask, "What do I have to offer?"  It seems as though she was waiting for the right relationship to fall into her lap, without any effort or even mild inkling to search beyond the "leftovers."  And if that is the case, then it's is her own damn fault no one wanted her for a partner.  Whiny, oh-pity-me-I'm-such-a-martyr women do not make good companions, and if I were a man I would surely steer clear of someone who publishes such nonsense in a major newspaper.

Monayyyy.

(Credit: Stylefrizz.com)

There are a lot of wealthy people in medical school, and a lot of people who are secretly cheap but like to pretend they're wealthy. I have a sort-of friend who routinely orders expensive meals when we go out to eat, then casually suggests that we "split the bill," even if my meal was half the price of hers and I had no drinks or dessert. In fact, I now avoid going out to eat with her, and when we do go out I order the cheapest thing I can find, because I know I'll end up paying more than my fair share anyway.

I don't much see the point in getting dressed up for class, so I tend to throw on old sweatshirts and sweatpants and snowboots and head out the door. In contrast, many of the women show up to class dressed like they're ready to go party afterward (maybe that's the plan?). Mostly they carry designer handbags/totes; everyone wears the same pair of Uggs, and The North Face jackets are ubiquitous. And then there's me, trudging along with a faithful L. L. Bean bookbag which I've had since high school, wearing a highly unfashionable down parka because it's freaking COLD outside. I admit, I get a bit of a thrill watching some of the females shiver when they step outside in their sheer leggings and thin (BUT FASHIONABLE!) coats. So much vapid silliness. And really, it's not like the guys are paying attention to who has the most expensive purse - I strongly suspect the whole thing is all a show for the other ladies. Pathetic.

Relationships.

(Credit: XKCD)

I read a lot of online forums where it seems like all the participants are unhappy with their marriages and the few couples who are happy are the ones who elected not to have children. Naturally this is a self-selected group of people, and perhaps does not reflect on society at large (maybe because people who have good marriages are less likely to write about them than the people who are miserable?). But I have to wonder why so many people seem to have been duped into staying with partners they do not like. I suspect that the Disney fairy tale of meeting the "perfect" mate plays a role for many women, and I suspect that many men are pressured into marriage by their girlfriends/families/friends, even when they themselves would perhaps be happier without tying any legal bonds. In some respects I don't blame guys for wanting to stay free as long as possible; the stigma of divorce (even as it is paradoxically so common these days) and the fear of losing most of my income to pay alimony and child support would certainly make me think long and hard about getting married if I was a guy.

I'm not one to discuss my private life in public, but over the years my feelings toward marriage and relationships have changed. As a teenager I assumed I would probably remain single forever, would never have kids, and would be perfectly content providing for myself and going about my life. But, strange and unpredictable things happen, and halfway through college I found myself madly in love with a guy who, for inexplicable reasons, seemed not to mind me baking him chocolate chip cookies and buying him cases of beer. And now, several years later, we are still together and have managed to endure the drama of beginning two medical educations in different cities. It has been difficult at times, even to the point of wondering if we were going to make it, but we've somehow muddled through. The topic of marriage has come up many times in our conversations, and I believe we both envision tying the knot within the next few years, perhaps before I graduate so as to have some leverage when we apply to residency programs.

My teenage self would of course be horrified at this unlikely turn of events. She would probably tell me I sold out, that I had bought into a falsehood, and that I was dooming myself to a life of bickering and misery. Perhaps she is right. However, since my teen years I've spent many long hours pondering the ways of the universe, and I've reasoned that fear of the unknown is a poor excuse for not trying something. So, while it well may be that physicians have a higher divorce rate than the general population, to shy away from what could just as likely be a fulfilling and productive relationship seems silly. If, in the end, things don't work out, then so be it; at least I will not regret missing the experience because of mere uncertainty.

Few things.

(Credit: Google)

1) It's snowing. Sigh.

2) When asking questions in class, I wish people would just get to the point instead of prefacing their query with all sorts of nonsense. "Um, so I wasn't really sure if you addressed this earlier, but I was kind of curious, and um, I think it might be important, so, my question is blah blah blah." ANNOYING. Get to the point, Sparky. No one wants to hear your pontification.

3) Food, Inc. is a good documentary but it will make you not want to eat every again.

4) A fire alarm went off last week in the middle of a quiz. Prof said, "Okay folks, bubble in the answers that you have and hand them in." Naturally this did not go over well, since most of us had only answered a few questions. After the alarm, we reconvened in the lecture hall and the speaker was about to start giving his presentation when two of my moron classmates got up in front of the class and attempted to perform a skit. I think they were trying to be ironic, but instead they just convinced everyone that they needed to be punched in the face. It went something like this:

Student 1: Hey buttface, I wish I could complain about my grades.
Student 2: Hey dickwad, you can complain. We have a survey.
Student 1: Oh really? How do I fill it out?
Student 2: It's online, sent to you through email.
Student 1: Oh that's cool. Is there space to fill out how I feel about each prof?
Student 2: Yes there is.

And it went on for 5 minutes until our prof, who was looking pretty annoyed, stepped in and told them to wrap it the fuck up. Honestly, I hope those two assholes get run over by a truck. Hey retards, the beginning of class is NOT the appropriate time to be "performing" a skit. Make your announcement and sit the fuck down. I'm not paying to hear your useless lips flap. And no one cares about your stupid survey.

Breaking bad news to fake patients...

(Credit: Nodovisual.net)

...only works when the prewritten vignettes actually contain some bad news. Needing to perform a biopsy =/= bad news.

Student: Ma'am, I'm sorry to be the one to deliver this news, but your mammogram shows a mass in your breast that was not there a year ago. We are going to have to do a biopsy to determine what is going on.
Fake patient: Oh my god. Do I have cancer?!?
Student: I cannot tell you definitely at this time what is going on. As I said, this mass is new and we need to do a biopsy to find out what it is. I can tell you that there is less than a 50% chance that it is cancer, but we just won't know for certain until we obtain a biopsy.
Fake patient: ...So what you're telling me is that you don't know what it is.
Student: Correct.
Fake patient: But it could be cancer.
Student: Yes. We need to do a biopsy to find out. I understand that you must be very anxious and nervous, but there's no point in panicking until we know for sure, right?
Fake patient: Okay, I guess we have to do the biopsy then.
Student: Indeed. Let's schedule it for later this week.
Fake patient: Okay.

And there goes 2 hours of my morning.
What a waste.

A super friendly message to the IT department.

(Credit: theatlantic.com)

Dear IT Department,

Ever since you switched video formatting software earlier this year, you have, every Thursday, managed to mess up lecture video recording. You see, on Thursdays, the first years have class in the downstairs lecture hall, and the second years have class in the upstairs lecture hall. This is, indeed, a wee bit different than the usual arrangement. However, since it happens every week at the same predictable time (it's on the master schedule, even!), would it potentially be possible for you to manage to realize this change ahead of time and actually capture the first lecture of the day in the proper lecture hall? Because every Thursday afternoon, when I log onto the server to watch the morning's lectures, the first lecture of the day is always missing. It would be awesome if you could, um, do your job and get the proper lecture videos posted in a timely manner. You know, since we're paying $20k+/semester to be here. And also because the information contained in those early morning lectures might one day save your life.

Thanks very much, and have a delightful day!
Me

The blog...revamped!

(Credit: rethinker.net)

There are several reasons why I came crawling back to this miserable pit of a blog.

1) Various individuals have been pestering me to resume writing.

2) I have complaints about stuff.

3) I was directed to a fellow med student's blog and was absolutely repulsed by her positivity, sunshine, and general happiness that I felt I needed to counter with some good old-fashioned bitching.

4) I am good at bitching.

5) I am forgetting how to write things other than SOAP notes and would desperately like to retain a non-medical vocabulary.

So...I have returned.

The same individual who dares post such drivel as stated in Number 3 above is the girlfriend of the guy who lives next door to me. Not only am I convinced that I have heard these two rather pasty-looking blond-haired blue-eyed white people having, uh, relations, but the female in question has the LOUDEST sneeze I have ever encountered, excluding, say, a zoo animal. I have quite literally been startled awake by this lady's projectile sneezing. In fact, she sneezed this afternoon as I walked into my apartment and I nearly dropped my books on my foot. I think the next time she sneezes while I am trying to fall asleep I will tap on the wall diving our apartments and yell, "Bless you, you old horse!" Because that is what she sounds like. I am nothing if not accurate.

Erm...that's all for now. Back to work.

End-of-life ethics.

Today's ethics topic was a good one, although the lecture/panel discussion was poorly run and some of my classmates made rather astounding comments during the small group section.

The discussion was about a terminal cancer patient who wished to continue to receive aggressive treatment even when it was clear that she was not going to get well, and was probably going to die within the next six months. Her reasons for requesting continued treatment were ambiguous; the oncologist reported that she claimed to be "waiting for a miracle." At any rate, the treatment was continued at her request and she repeatedly refused to consider entering hospice care or even take any pain medication. Predictably, she became sicker and was moved to the ICU. At some point she became unable to make medical decisions and in spite of her previous request to "keep doing everything," her family requested that all life-sustaining measures be discontinued; she died shortly thereafter.

Now, the case was presently badly and the physicians failed to address some of the concerns which any first-year medical student could see coming a mile away (Why wasn't an ethics consult requested? Doesn't continuing treatments that have no chance of working send a mixed message?), but I found some of my classmates' comments needlessly hostile toward the physicians. One peer criticized the physicians for judging the woman based upon her religious convictions. Another student suggested that the physicians blamed the patient for putting them in an uncomfortable situation. I didn't hear anything quite so clear-cut during the discussion; what I inferred was that the physicians were incredibly frustrated with this woman, and were uncomfortable with continuing aggressive therapy, but did so anyway because it was what the patient wanted.

I find it a bit unsettling that my classmates are so quick to express strong opinions regarding a situation which was obviously very complicated and not easily resolved. It is presumptuous to assume that facing a similar situation, we would not follow the exact same path, or would even have much choice in the matter. Hindsight is 20/20; it is easy to argue anything from a philosophical or ethical standpoint, but it can be very difficult or impossible to implement those ideals into a real clinical situation, particularly if the doctor and patient have completely different opinions on the appropriate course of action. Assuming that the patent was made clearly aware of her prognosis, what choice did the doctors have but to keep treating her? They might have simply told her that there was nothing more they could do and shoved her out the door, but with no hospice care plan in place, that would have been tantamount to patient abandonment. The situation might have been ameliorated if other hospital personnel had been involved, but it seems unlikely that the patient would suddenly have had a change of heart and agreed to stop treatment. The only other recourse is the legal avenue, and I imagine that the doctors wanted to avoid dragging an extremely ill patient into a bitter legal battle to have her declared incompetent to make decisions.

It was undoubtedly a sad case, and I have no doubt that the physicians were extremely torn on what was the "right" thing to do for this woman. Sometimes there are no easy answers, and my classmates would be better served by thinking more deeply into these ethical problems than they currently are inclined.

"Forgoing care for the severely disabled newborn."

This was the topic of discussion in ethics today, and I thought the lecture beforehand and the small group discussion were very interesting. I don't know a whole lot about neonatology, but it seems like a pretty cool field - lots of (miniature!) medical toys, at any rate, and the opportunity to help people who really need it. I don't consider myself a "baby person" per se, but I could probably tolerate neonates much better than the general peds population (I don't know how pediatricians live through all the screaming).

I did not know prior to this morning that the "limit of viability" has been 24 weeks gestation for at least the past fifteen years or so. Prior to this point in development, a baby simply does not have enough alveoli in the lungs to survive - and in fact, the physicians at the NICU here will not resuscitate an infant born before 24 weeks. After this point, it's anyone's guess - a difference in birth weight by 100 or 200 grams can make all the difference. A "trial of therapy" will be initiated. If the baby does well, great; if not, the physicians can approach the family about initiating comfort care after the ethics committee has discussed the case. My instructor, a neonatologist himself, stated that in 18 years of practice, he has only disagreed with the family's decision to continue or discontinue care in two cases, and both were instances of mental illness and/or misinformation. Pretty impressive.

A moving cello performance.

Lovely.

Black Friday: A Happy Day for Idiots.

Anatomy is over, thank sweet baby Jesus. More on that in a future post.

For now, I'd like to expend some energy to discuss the abomination that is "Black Friday" shopping, and why we should have firebombed all the Wal-Marts of the world at 3 am today to rid ourselves of the morons who are out shopping for Christmas gifts at that time.

Perhaps I am not recalling history correctly, or perhaps my sheltered childhood led me to believe that the entire world wasn't actually insane, but it seems as though the entire "Black Friday" phenomenon really took off in the past ten years or so. When I was a kid, I don't remember anyone talking about running out early the day after Thanksgiving to stand in line for the year's hottest toys.

At any rate, the media and the businesses have formed an unholy partnership and convinced the public that they MUST sacrifice a good night's sleep in order to buy $10 Blu-Ray DVDs, and that stupid hamster thing that all the kiddos apparently want. Fine, fine, I guess if people really find that sort of thing fun, I shouldn't begrudge them their pleasures.

BUT...where is all the money coming from? Last time I checked, the economy was in the toilet, millions of people were out of jobs, an the price of everything has risen. So, how are people able to afford thousand-dollar plasma tvs? Moreover, do people really need thousand-dollar plasma tvs, and if so, why not wait until AFTER Christmas, when everything is even more on sale? The logic baffles me.

Perhaps the crazy conservatives really do have a point that the "Christ" has been taken out of "Christmas" - after all, I don't recall reading anywhere in the Bible, "And Jesus said unto his followers, 'Take thyself to a Target and buy thy kin all manner of worthless overpriced junk, in celebration of thy Lord's fabulous divine birthday!'" Of course, we are disregarding the fact that Jesus, if he even existed, was not born in December, and the "faithful" are really celebrating an amalgamation pagan solstice/Roman feast. But okay, so we'll ignore the history of Christmas too. And I won't even mention how sad it is that people like to chop down trees in order to drape them with tacky lights in their living rooms...

Americans should really try to calm the fuck down. They should be instructed by the major media personalities to take a deep breath, meditate for a while, and THEN trample Wal-Mart employees in the mad rush to get a Snuggie.

I'm just sayin'.

Regarding yesterday's post.

After an extended discussion last night regarding some of the contents of yesterday's post, I wish to make a clarification:

Since the article in question was decrying the IVF treatments which result in multiple fetuses in a single pregnancy, I concede the point that if a couple were to implant only a single embryo (or undergo selective reduction if multiple embryos implant), then because the pregnancy is more "normal," complications may or may not be traceable back to the way in which the fetus was conceived.

There is a follow-up article in today's NY Times which emphasizes the dangers of multiple births, and contains such happy descriptions as, "Dallin was the first to die. Blood seeped into his lungs from an open heart valve, the Stansels said. Kaitlyn soon followed. Braden lived for two weeks before an infection entered his trachea and killed him." In this instance, I stand by everything I wrote previously. Nothing but pure selfishness (and religious nuttery, in this case) would convince a woman that it was a good idea to keep her sextuplets because she wanted to "let God do what he’s going to do."

I could at this point launch into an essay asking why god hates this couple so much, and hates their babies so much (even though he created them...?), and generally seems like a very mean, spiteful, Old Testament kind of god, but I will refrain.

It seems obvious to me that there needs to be some sort of regulation of these procedures beyond the medical risks the doctors are required to assess. Why is it that in order to adopt, a couple must go through a lengthy screening process and have every part of their relationship dissected in order to ensure that the adopted child will be cared for, but nearly any couple willing to plunk down the money can walk into a fertilization clinic and potentially walk out with six fetuses in tow? It seems odd that in the latter case, the prospective parents would be given so much autonomy in deciding what is medically best for their children when it is obvious that they have no idea what sort of risks they are taking. The result of these uninformed decisions is, unfortunately, dead babies - which is exactly the opposite of what IVF is intended to do in the first place. Ironic, no?

Good article in today's NY Times...

http://www.nytimes.com/2009/10/11/health/11fertility.html?hp

In short, IVF babies are much more likely to have complications and be born prematurely than their naturally-conceived counterparts, as well as rack up multi-million dollar hospital bills.

From a biochemical standpoint, I find IVF technology exciting and interesting. On a personal level, however, I find the whole IVF phenomenon utterly disgusting and frightening. The risks that some people are willing to take to have a biological child are ridiculous, particularly because there is no shortage of already-born children who need loving parents. I'm completely unable to comprehend why someone would choose to have premature multiples with numerous health problems over adopting a child. The selfishness is takes to rationalize the first choice is sickening and strange to me.

The "humans are biologically programmed to want our own children" argument doesn't work because, after all, we're also biologically programmed to have many offspring with multiple partners to increase the chances that our genes will be passed on in future generations. How acceptable is polygamy these days? We're also biologically programmed to run barefooted on the African savanna, to hunt with rudimentary weapons, and to fear animals like cheetahs and snakes. We are most definitely NOT programmed to sit behind computers all day and eat Big Macs, and look at cheetahs and snakes in zoo cages. Since we probably agree that the latter activities are a consequence of modern life and that we are able to override our biological tendencies to accommodate those demands, we should agree that the desire to have biological children via IVF can and should be overridden in the face of overwhelming evidence that less selfish options exist.

Maybe it's a hard concept to swallow that some people who have difficulty conceiving and/or carrying healthy pregnancies are being warned by nature that there is something wrong with them, either physically or genetically, which would put a baby at risk for horrible disease and suffering, either at birth or later in life. What parent would chose that kind of misery for their child? The selfish parent who can think of nothing but having a child, and fails to think of the sad life the child might have to live if any of those scenarios should come true - these are the parents who undergo IVF and are "shocked" when their child turns out to have cerebral palsy, or in extreme cases dies in the NICU after being born at <24 weeks.

I have little sympathy for people who bring these problems upon themselves by allowing their "biological programming" (often hidden under the veil of dogmatic religious brainwashing) to rule their reproductive lives. The world does not need more babies with severe medical problems. The world needs more parents who define themselves not only as the caregivers of children X and Y, but also as members of the human species with a responsibility to act in a way which benefits a larger group of people than their immediate blood relations.

Med student types.

I suppose I should be working on something tonight, but I'm having difficulty focusing (and it probably doesn't help that my apartment is freezing cold and my nose is running).

I thought I might present observations about my classmates, some of which are probably a little snobby and curmudgeon-ish, but what the heck.

I preface by stating that my classmates are, for the most part, friendly and generally pleasant people. There are, of course, some notable exceptions, though I suspect that the following notes are not unique to the students at my school.

Annoying Medical Students Who Are Wasting My Oxygen By Simply Being Alive:

1) The Question Askers
There are only a handful of these highly infuriating students, but man, do they make my blood boil. I am of the opinion that unless a question is formulated to clarify an unclear point on the slides, or will generally benefit the class at large, it should not be asked. Try telling that to the Eager McBeavers who just love to vomit all sorts of useless questions, many of which the lecturer simply cannot be expected to answer ("How often does this mutation occur in sub-Saharan Africa, assuming that Martians have colonized Wyoming and Michael Jackson and Elvis are not, in fact, dead?"). Other questions are more reasonable ("Can men get breast cancer?") but could just as easily be looked up on the student's own time with a five-second Google search. Sometimes I want to stand up and inform these oblivious individuals that we are ALL paying an exorbitant amount of money to hear the lectures and would appreciate if the offending individual would refrain from melting our brains with such drivel.

2) The Involved Students
It's like high school all over again! There's me, sitting sullenly in class, usually wearing a wrinkled sweatshirt and my ubiquitous wool hat and nerd glasses, and then there are these freaks: the pristinely-dressed, Blackberry-wielding, hyperctive types who absolutely must be involved in every club/organization on campus, simply because they like to hear themselves talk. Attention do-gooders: please, for the love of the human race, sit down and shut up. No one cares that such-and-such club is hosting a volunteer clinic and we need to GET INVOLVED, BECAUSE WE ARE MEDICAL STUDENTS AND WE ARE REPRESENTING THE SCHOOL AND THE ENTIRE MEDICAL PROFESSION!!!!11 Oy. The involved types made me want to go on head-bashing rampages in high school, and some of my classmates are causing me to revert to those angsty teen tendencies. Not good.

Actually, med school is a lot like high school: it's a very small group of people who are forced together for hours at a time; inevitably, cliques will form. I still haven't spoken to the majority of my classmates, not because I actually tried to avoid conversation, but the groups of students had already formed well before classes started and have become more permanently cemented with each week. It's a little disturbing. I thought we, as presumed adults, would be beyond that? Guess not.

3) The Surgeon Wanabees
You can probably guess what these people are like. They're okay in lecture, but as soon as we hit the anatomy lab, watch out! Not only do they monopolize the dissections, they sometimes invade other groups' dissections as well. Case in point: last week, as we were making our way into the abdomen, a random Asian guy came over to our group (none of us knew who he was), said eagerly, "Does your cadaver have a uterus?" and before any of us could answer, shoved me out of the way (nearly sending me crashing into the next table) and plunged his hands in Gertrude's belly. There were a few seconds of unpleasant squelching, but he apparently couldn't find what he was looking for and left without another word. My groupmates and I could only exchange wide-eyed looks and tentatively resume our more controlled dissection.

In an ironic twist of fate, it turned out later in the week that Gertrude does, indeed, have a uterus, and the dumbass student had missed it in his haste. I know who I most certainly will NOT be calling should I ever need abdominal surgery...

And in a category all on their own, not really with the previous groups:
4) The Awkward Ones
They're just awkward - not necessarily annoying, just slightly off-kilter and weird. I sense a lot of computer gaming in their free time. They have difficulty stringing together coherent sentences and will probably become patholoists and radiologists. Some eschew showering. Enough said.


So, that's medical school. I hope I don't fit into any of those categories, but I'm likely in my own unpleasant category somehow - the "Blog-Maintaining Self-Aggrandizing Hell-Bound Sushi Connoisseurs," perhaps?

This post was inspired by the brilliant George Carlin.

First unit down, nine to go.

So I got my score back for the first biochem/genetics exam - I passed, hooray! I hit the class average, but I don't know the score distribution, so I don't know exactly where I fall percentile-wise. But who cares?! I passed! Woo!

We've started dissecting the abdomen, and it is much more difficult than the thorax. For one thing, Grandma Gertie's cause of death (colon cancer) and her obvious surgical history makes finding the "normal" structures something of a challenge (read: basically impossible, as half her colon is missing). We spent three hours this morning dissecting out ONE of the three main arteries which supply the gut, and even then we only managed to find maybe half the branches we were supposed to find. It was frustrating, and smelly, and I'm currently annoyed with my groupmates, who are spending an awful lot of time joking around in lab and very little time actually studying/helping with the dissection. We're all meeting tomorrow afternoon to look at some of the other cadavers (and hopefully find more of Gertie's missing structures). I'm not looking forward to it at all.

Ugh. Med school is so not fun. I'm totally missing undergrad, and research, and being able to do things when I wanted. Thanksgiving (and the end of anatomy) cannot come soon enough...

Studying.

It should come as no surprise to anyone that medical students spend most of their waking hours (and many of their should-be-sleeping hours) studying, but I must admit, nothing I have done in the past has prepared me for the sheer volume of material which will be tested on my first exam on Friday. I think I've studied more in the past five days than I did in my entire undergraduate career, and that includes the nightmare that was physical chemistry.

Example: Yesterday, I spent 9 hours reviewing 11 genetics/molecular biology lectures. That included 285+ pages of lecture notes as well as textbook problems. By 8 PM I was so exhausted I could barely keep my eyes open.

I'm not complaining, exactly; I knew coming into this that I'd be devoting all my time to studying. I've thus far managed to take Friday evenings off, but I don't know if I will continue to be able to do so once things really pick up.

There is a part of my brain which is teeming with barely-contained panic, ready to burst out at any moment. It's quite possible that a lot of the pressure I'm feeling is self-induced, but it's hard not to feel a bit anxious when, while reviewing a section of material with classmates, I realize that I'm behind on learning the details of X, Y, and Z, and that X, Y, and Z are very likely to appear on the exam, and that I only have a limited amount of time to learn X. Y, and Z because I still have to learn A through W as well. So, the panic is mostly contained, but I've had some stomach-churning moments...

Speaking of, it's time to get back to work. Blah.

Heart dissection.

Today we dissected our cadaver's heart. It was amazingly neat; I've always been a fan of cardiopulmonary stuff, and I thoroughly enjoyed yesterday's lung dissection, but I was really looking forward to doing the heart. It took a while to remove the organ from the abdominal cavity. After about an hour and a half of clearing away tissue, trying to preserve important structures (like the vagus nerve, which we accidentally severed in out excitement to hack away at the aorta), we dislodged the organ and passed it around. So cool! Granted, a preserved heart doesn't look exactly like a beating one, but it was still a wild moment. After getting our oohs and ahhhs out (none of the other groups seemed nearly as excited as we were), we started making incisions into each of the chambers to observe the walls, valves, etc. We ran out of time to complete the dissection, but will finish it up later this week.

As I said earlier, cadaver dissection really hasn't been too traumatic; we've christened ourselves "Team Awesome" (my idea) and named our cadaver Gertrude ("Grandma Gertie" when we're feeling affectionate), and my groupmates are pretty chill compared to some of the crazy surgery wannabees who hog the other dissections. We found out that our cadaver died from colon cancer and "failure to thrive," and I subtly impressed one of the instructors by locating a colectomy site on the cadaver's abdomen (okay, so it was kind of obvious, but my other group members thought it was her belly button...). It'll be interesting to see what her abdomen looks like, knowing that she must have had at least one surgery, possibly to remove necrotic tissue. One the downside, it means that her anatomy may not be the best for learning normal structures, but I guess we can always hover around another group's table when we get to that point.

Other than that, the lecture workload has eased up some, but I think that's mostly because I've gotten used to it, not because we're getting less material. I'm still up most nights until midnight or 1 am, looking over the day's lectures and pre-reading the next day's material, as well as working on long-term assignments for my medical literature and doctoring 101 class, but I've adjusted my sleep schedule (and caffeine intake) accordingly. Getting up in the morning for class is rather difficult, as my body could usually use another 2-3 hours of sleep to feel well-rested, but I guess that's what weekends are for, right? Actually, I spent most of last weekend tucked away in the library, and with my first exam fast approaching (next Friday, yikes!), I expect to repeat that same schedule this weekend.

It's hard to believe I'm in the second week already. Time flies when you're busy, though sometimes it feels like I've been in this study mode for much longer than nine days. Oh well...must keep chugging away, I suppose.

Week One.

So, I survived the first week! It wasn't terrible, though I certainly wasn't prepared for the speed at which some of the lecturers flew through the material. Thank goodness I have a solid background in biochem/molecular bio - I can't imagine having to learn all of the material we covered yesterday from scratch. Anatomy is my Achilles' heel, I think - more so the practical/lab stuff than the lecture material, which is largely conceptual. Granted, we've only had two lab sessions, so I imagine that as we get deeper into the dissections things will start making more sense. It's rather difficult to visualize some of the structures without seeing them in their real spatial location.

The first block exam is two weeks from yesterday, which is insanely close. I think I've kept up with the material okay this week, but god forbid I get sick and have to miss a day or two of lecture. In undergrad, that wouldn't have made any difference, but now I think it could completely screw up my exam score for that block. I'm trying not to worry too much about grades, since in terms of residency applications, scores in the preclinical years are much less important than board scores and letters of recommendation, but all the same I know I'm capable of doing very well, so I think I would be a little disappointed if I was consistently scoring "average" on the exams - or worse, failing. I suppose I'll just have to see how I do on the first block and modify my studying accordingly.

Back to the books now. Blah.

Laminectomy.

Today was the first dissection, and all things considered, it went well. I admit I was extremely nervous this morning when I walked into lab, but for all the nightmares I've had over the years regarding cadaver dissection, it was really much less daunting than I thought it was going to be. The smell wasn't even that bad, but perhaps that's because I worked often with phenol and formaldehyde in undergrad and have gotten used to them.

So, what was it like? Strange, but not entirely unfamiliar. Even though scalpels are much sharper than kitchen knives, once the skin was retracted, our cadaver resembled nothing more than a large piece of meat. It may be discourteous to compare a human body to something one would find in a butcher shop, but the unpleasant truth is that anatomically speaking, we are nothing more than sentient pieces of flesh, and we resemble our bovine and porcine foodstuffs more closely than we'd like to think.

It took about an hour to figure out the best way to slice through the layers of muscle on the back, and then another 45 minutes cleaning away the area around the spine. We then used a bone saw the cut through the laminae and removed the spinous processes (the sticking-out parts you can feel when you touch your spine). This exposed the dura mater (literally "hard mother," the outermost protective layer of the spinal cord). We were very surprised when, upon opening the dura mater and expecting to find the spinal cord, there was nothing inside. This is not to say that our cadaver didn't have a spinal cord at one point - mostly likely it disintegrated during the embalming process. It was a bit disappointing, however, since the entire procedure took well over two hours and in the end we couldn't identify the spinal structures we were looking for. I imagine we will have to get one of the other lab groups to show us their cadaver and point out the relevant structures.

I wish I had more time to ruminate on the experience, but it was truly rather anticlimactic. Moreover, I have at least three lectures to learn tonight, as well as prepare for tomorrow's dissection, so further reflection will have to wait for another time. The anxiety which has settled in my mind since starting med school is certainly something I will have to address at some point, but for now all I will say is that in two days I have accumulated more knowledge than in a year of college, and yet the fear of failing the first block of exams rests heavily in my thoughts at all hours of the day and night.

First day.

This will be a short post because I will not be able to stay awake for much longer.

Molecular/Cellular Principles of Medicine: Easy peasy lemon squeasy. Structure of DNA, RNA, and their roles in central dogma. Nothing I haven't seen a thousand times before.

Anatomy: Intro to spinal cord. Rather more difficult than MCP. I learned as much as I could on my own last night and so lecture was more review than anything else, but I'm nervous that I haven't looked at the material enough, or that I'm not going into enough detail in terms of surrounding structures, etc.

Anatomy Lab: Introductions, safety videos, demo on prosected specimens. My dissection group has 3 guys, 2 girls, and our cadaver is a 101-year old female (seriously!). We didn't do any dissecting today, which was okay because I was getting tired anyway. Tomorrow we perform a laminectomy to study the spinal cord and spinal nerves. I'm sure the guys will monopolize the bone saw, but that's fine with me...I'd rather not inhale bone dust.

Evening: Gym for an hour, quick dinner, then reviewing today's lectures and attempting to absorb as much of tomorrow's material as possible (autonomic nervous system - all new material to me, since I didn't take physio in undergrad). Brain feels like a pile of mushy spaghetti. Seriously looking forward to the weekend.

Sigh. Med school is HARD. :(