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.

1/2 Way Done with Anatomy! & Current State of Healthcare

Today is an exciting day here in Texas... we have our anatomy lab exam in just 2 hours 41 minutes! The fact that I'm writing this right now means that I'm a tired of studying and ready for this test to come. It also means we're halfway through anatomy. We also recently took our biochemistry final, so we are beginning to feel like real med students.

The main thing I wanted to share today is a 2 part radio show on the current state of healthcare by This American Life and NPR. Tatia and I listened to the first episode, but we have not listened to the second. The first discusses possible reasons for rising healthcare costs, whereas the second discusses healthcare insurance and the challenges associated. I think that these episodes do a great job of sharing the BIG picture of the challenges in healthcare costs and insurance right now... which was helpful for me since it's hard for me to connect all the dots between all of the different news articles on the subject today. If you have the time, it's at least a start on understanding what is happening.

If you've never listened to This American Life, it's very informative and entertaining. The contributors do tend to be more on the liberal end of the political spectrum, but they usually do a great job of stating the facts (according to NPR) and letting you come to your own conclusions. The first episode does seem to favor insurance companies a bit, but the second is a full hour on insurance and will clearly have more to say on the subject.

Click below to listen!
Episode 1: More is Less
Epsiode 2: Someone Else's Money

from marriedtothesea.com

Take Nothing For Granted

These are some thoughts I had a few weeks ago (but it feels like months ago now) as we dissected the arm pits of our cadavers.



Axilla, that's just a fancy name for armpit, but it seems too elegant for such a mundane part of our bodies. What could possibly warrant such a special name for the part of our bodies that produces the funniest looking hair and arguably the smelliest odors?


I was personally blown away as we learned about the axilla... it's just full of beautiful structures that make us function with great abilities. Inside it is the infamous Brachial Plexus where the nerves from different levels of your spine mix as they extend out through your arm as far as your fingers. That arm pit of yours is a tunnel wherein cables were laid for data transmission and pipes for the needed flux of nutrients and waste to pass.


What my cadaver taught me today was not to take for granted even the seemingly most simple parts of our bodies... so next time your lathering your armpit in the shower and adduct your arm at the glenohumeral joint to produce faux-farts, remember that beauty and power lies beneath that axilla.

Exploring Dallas

In addition to giving a Blast to the Past entry for the day, I wanted to share some photos from today. I ride the light rail through downtown Dallas everyday, yet I had never spent much time exploring this big city. So today I took some time off from studying and got off the train downtown. Just next to one station is where President JFK was assassinated, something I ride passed everyday but hadn't fully appreciated.

The skyscrapers in Dallas are amazing, it makes a great skyline.

This is near one of the busiest transit centers in Dallas.

Here is another of my favorite buildings, but it's kind of sad how our new towers always dwarf the old cathedrals.

Lastly, here's an interesting sign of the times, with the current rail line in use in the background, and the old rail station being overgrown with grass in the foreground.

Now I just need to go on a date with Tatia down there!

Blast from the Past: Beginning Anatomy

Before school began, I read Atul Gawande's book Complications. He was a surgical resident when he wrote the book and not too far away from medical school. It's a really great read to learn about where medical practice and knowledge falls short. In one instance, he describes his first experience making the initial incision for a surgery with a scalpel. The skin was much tougher than he expected! We usually think of our skin and bodies as delicate around such sharp blades, but it took a surprising amount of force to open skin to the light. and taking a frightening amount of force to pierce.

That was on my mind as I entered the dissection lab for the first time. We had attended our first anatomy lecture for the hour before the lab, expecting to be taught lots of techniques and rules for dissection. Instead, we were simply instructed to enjoy this special experience and to respect the bodies of the kind donors, with just a few tips of techniques. The lab is a long room lined with 40 tanks; signs posted on the tanks stated ages and cause of death for each body. Ours was an 83 year old male who died of a pulmonary embolism. Our first dissection was the back, strategically planned so that we can be adjusted to situation before we see our donors face. When my tankmates pulled out the scalpels, that's when I remembered Atul Gawande's words... and that first cut was just like he described it, kind of like trying to push open a door slowly and quietly only to realize that it's stuck tight and you'll need to push with strong force.

I had seen cadavers before from some great experiences at BYU, but this was so much different in that we had to find the structures. We had to cut away skin, fat and connective tissue to reach the muscles below. In many ways, it was a sacred experience, opening a body for the first time, and the only body that I will dissect from head to toe just to learn on. It definitely leaves you with a deep sense of responsibility to learn as much as you can from the cadaver since the donor gave you such a special opportunity.

Not everything was exciting and novel. The preserving chemicals were strong and noxious. Especially our first day, our eyes, throats and noses burned. It was hard to breathe and awfully warm covered in scrubs and a gown. But even as I studied with my friends in the lab today, there was still a strong sense of awe as we looked at the inner workings of the bodies and see the structures and organs we take for granted every day. I definitely am impressed at the beauty and magnificent design of our bodies.

Daily Schedule & Fun Fact #2

One thing I wondered about med school before starting, and people ask me now, is if it is possible to have a life during medical school. Fortunately, school has been treating us very well so far. I understand that it will become very busy and hectic during the clinical years, but for now it does not feel too hectic. Thankfully, Tatia and I get several hours together each night, we get to have dinner together and work out together. She is also working on me to watch Gilmore Girls with her, her favorite TV show. I'm sure it will get crazier later on, but life during this part of medical school is nearly ideal. For my curious family, here is my schedule for this last week (pretty typical of non-test weeks).

This depicts all of the classroom time, so there is plenty to study during those white spaces. It is a little tricky to motivate yourself to study after spending so much time in class, but most of the lecturers are excellent and help you be excited for studying the subject.

Fun Fact #2

Now we are knee-deep in metabolism, so we recently discussed fat digestion and metabolism. The interesting thing about fats is that when you digest them and they are stored in your fat tissue, they are stored as the fats that you ingested (as opposed to carbohydrates you eat that get modified for storage). So say the only oil you ate was canola oil, and that you took in a little more than your body needs for it's daily energy (and that's probably all of us Americans) then the fat composition in your tissues will tend to resemble the composition of canola oil. So with fats, you really are what you eat!

I don't know if that really is a FUN fact, but I think it's pretty interesting to know what's going on with things after you ingest them.

Fun Fact #1

Today our biochemistry lectures covered our cells' usage and storage of sugar, which includes what I remember fearing in BYU's biochemistry course: THE KREBS CYCLE.

I just remembered going over every step and every enzyme in such detail that it felt incredibly difficult to learn! The picture above illustrates how I felt about it, like a complicated spiral of doom. Med school has a different approach to things like this. As there is so little time to cover everything, where at BYU we spent about 1 week on the above illustration, today we spent about 15-20 minutes on it. In fact, the illustration below depicts the level of detail with which covered it:

We had so little time that they basically had to say, "Krebs Cycle? It's just a wheel that spins round and round! Don't you forget it!" I hope that illustrates about how fast we have to cover some materials in school, thank goodness for remembering some things from BYU. Most importantly, today's lecture material covered:

FUN FACT #1

We were all taught in school that you breathe in oxygen, then use it in cellular respiration to create energy and carbon dioxide, which you breathe out. Just like all things you learn, there is deeper truth: The oxygen you breathe in is used in cellular respiration, but it becomes water. The food you eat and "burn" as fuel is broken down to carbon dioxide which you breathe out! So you pee out the air you breathe and breathe out the food you eat.

2nd Test & Adjusting to Med Students

I feel officially like a medical student now! This is indicated by
1.) my set of scrubs finally being stinky enough from anatomy to bring them home to be washed
2.) we had our 2nd Biochemistry exam this last Friday, and as you can see below, I'm feeling pretty hardcore with my new found highlighting skills. All of us students find our different methods for studying, I just happen to like the Fluorescent Triage method, where different colors represent my understanding of the material.

Now to jump back to one of my transitions into medical school:

Time circuits on. Flux Capacitor... fluxxing. Engine running. All right!

One of the exciting parts of starting medical school was getting to know our fellow classmates. Southwestern had a special retreat weekend for us to get to know one another and the faculty which was great because we quickly became so engrossed with learning once school started that we stopped meeting new people. At that retreat, I found out that a fair number of my classmates already finished graduate work, several having PhD's already. Now that school has begun, seeing these brains in action only makes me more impressed. For example, one student doesn't take notes in class from what I have seen, but from what I hear he knows the information with greater depth than anyone else and so far he has finished the tests in one hour where most students take 2.5 hours. It's incredible.

I feel like my class is just incredibly intelligent which makes going to school a lot of fun. Although it's great to have smart students to study with, it's even more fun to have smart students to discuss ideas with as well. I never really liked discussing politics at BYU because politics tended to inflame passions one way or the other (Granted, I was in the College of Life Sciences, not a political science by any stretch... and I did have quite a few good experiences at forums in the Kennedy Center). Here at Southwestern, with a generally similar student body, the students also have strong opinions but are much more willing to have friendly discussions. They leave me with better answers and help me refine the questions I ask myself as I examine my own values. I'm loving that.

(Don't get me wrong, I loved my time at BYU, but this comic reminds me of many discussions there)
from toothpastefordinner.com

One thing the pre-med advisers didn't warn us about medical school was the danger of bringing into proximity so many brains. Not only does our class consist of great intellectual potential & the great future doctors, but also the biggest local chapter of Overachiever's Anonymous. Basically, I think everyone that made it into our school is at least a mildly neurotic overachiever (including myself) such that if at any time you are not doing something productive, you feel guilty. One of my fellow LDS students compared this to being on an LDS mission where we feel like the need to use all of our time to promote sharing the gospel, now we feel like we should be using all of our time to prepare for the next test or the day when we'll need this information to help a patient. It's pretty hilarious actually. Pre-med advisers warn you about the long hours, the many pages of you will read, but they don't warn you that at the end of the day, medical school will make you feel just a little guilty when you're sitting down, relaxing, and enjoying yourself.

Don't you have enough studying to do?

Medical school is an interesting experience, one that I've been talking about for quite some time. I was a "pre-med" student for the last 3 years, planning and talking about medical school the entire time. As medical school started for me this fall I wasn't so sure if medical school would be as fun experiencing it as it was to talk about.
With a grand total of four weeks experience, my current estimate is that medical school is perfect for me: I love the experience and I love talking about it. There are many interesting experiences that make medical school unique and sometimes restricted to only health professions students. For example, anatomical dissection is something I'll only perform in entirety once... and it is experiences like that which I want to share with my family and friends, and record for my own memory. But really I'm doing this because my dad asked me to give it a try and I have a mom that would probably enjoy the anatomy lab more than I do.
Since my initial transition is complete, I'll be writing about the past for my first entries because those first weeks contained important experiences in moving from pre-med student to med student.

PS: You may also wonder why I'm not simply including this on our family blog - I just felt that some aspects of medical school simply aren't cute enough to fit onto our family blog... I mean, have you seen how cute our blog is? It's dang cute, and I think I'll need the liberty to include some less than cute topics in my record.