Stages of Change

Tomorrow brings the end of one more class: Human Behavior. It's been a very different class in that it focuses mainly on psychology and the practical aspects of medicine. It has been a nice change of pace but I'll be glad to move on to Immunology next.

One pearl/nugget/quanta of wisdom that I think was most useful from this class was a paradigm in which to view people as you seek to change their behavior - Prochaska & DiClemente's Stages of Change model. It is a way to understand and judge how willing people are to make a change and what is the best way to approach them at their readiness level. As you look at it, you'll see that the first stage is Pre-Contemplation, and next it tells how to approach someone who hasn't even considered changing.

As my fellow student JM said, it helps you anytime you're trying to manipulate someone else! Just jokes - it really would be useful in any relationship where you're trying to help someone make a change, e.g. a parent to a teenager, a friend to someone addicted to drugs, a church or community leader. It probably seems like common sense to most of you, but to me it is really powerful sometimes to have common sense outlined for us, especially when we're trying to help someone we love.

This table & more information at http://www.cellinteractive.com/ucla/physcian_ed/stages_change.html.

Catch Up

If you're wondering what life in med school has been like for the last four months since I posted, then look no further:

This is the view I enjoy every morning on the train as I study before class. However, I look at this picture from this morning and to me it looks like what you fear med school (or any other time-expensive endeavor) will become: claustrophobic, pervasive and oppressive. I mean, just look at me crammed in to that stainless steel seat staring at a neurotically highlighted syllabus! That's no way to start your morning! Thankfully, school (especially these last four months) have been far from this. There has been some challenging material to learn, but I'm lucky to be a part of a good study group to help me keep up and a great wife to help me stay balanced. That isn't to say that med school is neurosis-free. I do feel guilty when I spend time enjoying myself instead of studying & I do have to admit that my highlighting system is a little ridiculous - the picture above is my first pass through and by the time the test comes the syllabus will be rainbowfied with more highlighting. But it works for me.

One new experience for me these last few months was our cell biology class. It was my first full exposure to using microscopes to view tissue samples, which turned out to be possibly my favorite part of this first year. It's just incredible to see and finally truly understand the structures that make up our organs. Just take a look at some of these pictures (link) and try to tell me they're not incredible. I loved it so much that I shadowed some pathology residents for a day to see what else pathologists do (Pathologists being the physicians who examine tissue samples among other things to make diagnoses). Now we have started and have nearly finished neuroscience.

Other than that, our friends have kept us balanced with fun activities like checking out nearby San Antonio & beautiful wildflowers. I also recently got hooked on Billy Collins poetry, and in conclusion I'll leave my favorite 2 so far:

The History Teacher - Billy Collins

Trying to protect his students' innocence
he told them the Ice Age was really just
the Chilly Age, a period of a million years
when everyone had to wear sweaters.

And the Stone Age became the Gravel Age,
named after the long driveways of the time.

The Spanish Inquisition was nothing more
than an outbreak of questions such as
"How far is it from here to Madrid?"
"What do you call the matador's hat?"

The War of the Roses took place in a garden,
and the Enola Gay dropped one tiny atom on Japan.

The children would leave his classroom
for the playground to torment the weak
and the smart,
mussing up their hair and breaking their glasses,

while he gathered up his notes and walked home
past flower beds and white picket fences,
wondering if they would believe that soldiers
in the Boer War told long, rambling stories
designed to make the enemy nod off.

Skip ahead to 1:00 on this video for an intro & reading of "Litany" - a hilarious poem.

Feeling More Physiciany

One more post for the night. Since our genetics class also finished last month, we have now begun physiology! This is the class I've been most excited for during the 1st year and so far it's just as great as I'd hoped. We spent the first few weeks discussing the basics, but now we're in the middle of cardiovascular physiology.

This last Wednesday was the most enjoyable day of med school for most of the students. It was possibly the most interesting and integrated learning experience we've had. In the morning, our physiology lectures were on heart sounds and murmurs. We put on fake stethoscope headsets that replicated different heart sounds and we learned what they meant. It was much more intense than I expected. There is so much that a skilled physician could tell about a heart just by listening to it. It blows my mind.

Then that afternoon, we met with "standardized patients" - people payed to behave like patients so we can test out our clinical skills! So we spent the afternoon palpating, percussing and auscultating a person's heart! We got to immediately use the knowledge we'd gained that morning. It was a great experience. It was also a great feeling to finally understand that essential tool, the stethoscope. It's a good feeling to have the basic techniques down. There are still many nuances of the heart that will take some time for me to be able to hear, but that's why I have 3 1/2 more years of medical school, right?

First Sign of Learning!

As of this week, anatomy is officially over for me! It's both exciting and maybe a little sad... well, no, it's really just exciting to be done that small milestone of medical school. I almost feel like I need to change the name of the blog now!

Thanks to my great anatomy professors, I've finally experienced my first indication that I'm learning. Thank goodness.

On the train I see all kinds of people, and riding the train home after our anatomy midterm I noticed a lady with standing by the door with a drooping on one side of her face. I then noticed her hand on that side of her body was held like this:

It was the Claw Hand sign! It can be a sign of damage to the lower roots of the brachial plexus, mentioned earlier in the post about the mighty arm pit! It was a great day and a good reminder that I'm actually learning useful information seen in everyday life.

Manichaeism in Med School

Once again, interesting ideas from my high school English class resurface in my life. Mr. Juan Christian, the teacher I learned by far the most from in high school, talked about how Western cultures often view life with a Manichaeist perspective.


Manichaeism: A dualistic philosophy dividing the world between good and evil principles 


Good ol' Mr. Christian described this in contrast to Eastern philosophy of Yin and Yang, that define good as balance between two opposing sides.


Manichaeism struck in our biochemistry class (and a little in physiology)! Teachers and students alike, when teaching or trying to understand biochemical processes, tend to label molecules, organs and the like as: 

good 

or

EVIL

This method of learning just failed miserably! The labels failed because in some situations the villains were the good guys! When we learned about the liver, for example, a professor speaking on one disease would describe the liver as greedy and taking all of the fat, when the next day another professor disease of the day was described it as a protector. As students, when we were learning cancer biology, did the exact same thing with different proteins, only to confuse ourselves more by creating these labels. In reality, nothing was good or evil, it just was imbalanced or improperly used.

I think that this applies to so many things in life. Few things can be given such dichotomous labels. More often something we consider evil is something good when balanced or in the right context. Perhaps even viewing death as the villain of life is not the best perspective either.

Favorite Day of Anatomy (So Far)

These are some thoughts I had after an anatomy lab a month or so into school. I'm pretty sure it was still my favorite day of anatomy - although removing the heart was right up there.

Today's lab experience was very different. It was our first day using more brute force tools to find what we were looking for. Our goal was to see the spinal cord in all it's glory, but to do so we needed to chisel out the posterior portion of the vertebral column and pull it out to see underneath.

That was a bizarre experience: we students respect the body and the person who donated it to our education, we've tried to conduct ourselves with respect and we are inevitably filled with awe at the cadaver. However, here our thoughts and behavior didn't seem to match as we pounded a sharp chisel, snapping bones and wrenching forcefully on a body we previously too only precision scalpels to. It was a bit disturbing at first to hear the sounds, but it was all worth the end goal, to see the tiny glistening spinal cord on the other side. It's just incredible that such a small and delicate thing is what lies inside us, keeps us moving, working and experiencing so much of the world.

I feel like I just never really appreciated what I had under my skin and bones until I saw that spinal cord. As a child, all of the talk of people breaking their backs and causing spinal cord injuries made me think of it as a yellow Jell-O jiggler embedded in our vertebrae.

Then in school they show you diagrams like this one from Wikipedia, which never completely make sense on their own.

It all just made so much more sense after seeing the actual spinal cord. What we saw glistening under the vertebral fragment was the cord wrapped in it's tough meningeal covering, a cover that surrounds all of our central nervous system. We cut through that to find the the incredibly small spinal cord with even smaller (but strong) roots of the spinal nerves. All those images of lemon Jell-O are gone now, the spinal cord finally makes sense to me and the basics of it all make sense to me now. All this time in that smelly lab are paying off.

One final observation that deepened our respect for our donor: as we cut through the vertebral laminae, we found that the spinal column curved laterally as it went down the body in what looked like scoliosis. One of my tankmates and I both were diagnosed with scoliosis as children in middle school (yeah, we were the one's they called back after those physicals) and for me this made me feel an extra connection to the person who donated their body.

Urban Adjustments

Now that I've had a chance to write a few entries, I'm realizing that a significant number of stories I want to tell come from time spent not at school, and here is why:

Places I have Lived
Hometown - Brush Prairie, WA - Population: 2,384
Undergraduate Education - Provo, UT - Population: 117,592
Medical Education - Dallas, TX - Population: 1,279,910

As you can see above, the population of cities I've lived in has been growing very rapidly which has been quite a change for me (and I keep moving southeast... based on the incredibly straight trajectory below, Tatia and I will end up raising our family in either rural Louisiana, east Cuba or Haiti [Sorry Aunt Bonnie]).

This change is amplified by the fact that I spend at least 2 hours every week day on Dallas public transportation... which is a great way to really see what the big city is like. I ride from the north side of Dallas into downtown, so every morning the train is packed with people of all lifestyles and socioeconomic background. It's incredible... it's like going to the DMV everyday and seeing who walks through. There are businessman of all kinds, high school students in their fluorescent polo shirts uniforms (I feel bad for those kids), homeless, mother's taking their sick children to the hospital, handicapped, and people speaking all kinds of languages.



This is downtown Dallas; the tower with the round top at center is by Union Station - where I transfer trains each morning. Dallas does have an awesome skyline - that building on the far left is my favorite. From transferring downtown, the next train drops me off at the Medical Center, right in front of Parkland Hospital Emergency Room entrance.

Parkland is the county hospital, so anyone needing care can come there. So just on the walk from the train station to the hospital (which leads to the medical school) I pass more interesting people and situations (and more languages that I don't even recognize at times).

Thus, one major part of my medical school experience takes place not at school, but commuting through the urban environment around the school. It's teaching me a lot... mostly about the ills of society, the good people in society seeking to prevent those ills, and changing how I view these things (or at least solidifying my thoughts on them). Here are just a few quick examples:

1.) I really enjoy seeing how many people on the trains spend that time they travel reading! I'm a bit of a book snob - that is I tend to respect people who read... so it's great to see so many people learning or just escaping in books. I'm also pleased to see so many people reading various religious texts on the train... everybody is free to have their own opinion on religions, and I don't strictly correlate religious people with "good" people; however, I think that religion is a definite manifestation of people seeking to know how to do good in society and how to find meaning in daily life. And for that, I'm thrilled to see that so many people act on those impulses... to seek to do good and find meaning.

2.) Right next to the the hospital ER entrance is the huge laundry facility for the hospital(s). On one side of the building, there are enormous vents blowing out exhaust from the dryers - releasing gusts of hot, Downy-fresh air downward onto the grass by the sidewalk. One morning this fall when I arrived early to school on a particularly cold morning, I saw a one-legged homeless man on a wheel chair, sitting under those vents asleep. To me, it looked like he had stayed their all night, and it was a pathetic site to see that he had to sleep under those vents to stay warm.

Anyway, I'll definitely be posting experiences I have on the train, mostly those that relate back to medical school or those that are just funny... not too many that are downers because that's not my intention with writing this.