Neuro Case Study

Neck deep in learning cranial nerves (har, har), this case study from the wacky folks at QFever couldn’t be timed better.

Letter to a First-Year Medical Student

I came across this article from Dr. Centor’s blog, “DB’s Medical Rants.” It is posted on Medscape, but since some of you might not have a subscription, I’ll post the first part which deals with first year students such as myself (I don’t think Dr. Centor would mind). I encourage all fellow students to get a subscription to Medscape and eMedicine, both of which are free. I think the article is great; at this point, knowing that things get better with the things that frustrate us the most is relief in itself.

Letter to a First-Year Medical Student

Congratulations on being accepted into medical school! Now that you’re here, I’m sure you feel a sense of uncertainty. You’ve probably heard stories about medical school that may have caused you some trepidation. You know that you have to study long hours and that you will be expected to learn more than seems humanly possible. You know that you will be subjected to numerous multiple-choice tests on basic science problems to prepare you for the first part of the USMLE.

I was in your shoes 34 years ago. I remember how it feels.

One of my favorite authors, Stephen R. Covey, wrote in his very famous book, The 7 Habits of Highly Effective People, that each person should “begin” with an “end” in mind. I suspect that you decided to go to medical school with the end in mind of being an outstanding physician.

There will be many times during this year that you will wonder how all that you are learning relates to the act of being an outstanding physician. I admit that I often wondered that myself.

Now, I can tell you that you are learning many things that will be very important to you as a physician. You will learn the basics of biochemistry, cell biology, physiology, and anatomy. You will be tested on things that you will never use again, but you will also be tested on many things that will become part of your daily thought process in practice. Things that seem irrelevant now will become extremely important to you 5-10 years from now.

I predict that you will at times feel overwhelmed, because the magnitude of information presented to you is enormous. But believe me, by the end of this year, you will have a much better idea of what the human body is and how it works. You need this background to proceed to the second year, just as you need each subsequent year to proceed to the next.

I must warn you: This year will be difficult. You will get very tired of studying at times, and you’ll get tired of taking multiple-choice tests, but you will finish the year knowing much more than when you began it.

You will also start to learn the skills of talking to patients and examining patients. Your initial experiences probably will be amateurish; accept that.

My advice to you is this: Work hard, find some time to enjoy yourself outside of medical school, maintain some hobbies, and stay in good physical condition.

The first year is very important, but it seems so very far away from your eventual goal. Think of it as the first hurdle in a 4-hurdle race.

Forum temporarily disabled

Due to technical problems, the forum has been temporarily shut down. There was never a single post for almost two weeks except for me, so I doubt anybody is going to notice, but just in case, here’s the message.

Phallotherapy for back pain

Sometimes you just can’t make this stuff up … basically a doctor offered a female patient sex to relieve her back pain. The “treatments” were also billed to the state insurance policy at $5,000 a “pop.” Adding icing on the cake, he defends himself with respect to the patient by saying the sex was consensual.

Then again, having read the above, generic back exercises look a lot different. I don’t know what the authoritative texts are for physical/rehabilitative medicine, but I don’t think the Kama Sutra is one of them.

Current events wrapup

I have been refraining from posting anything political because there was already a lot of posts lately, particularly w/Katrina, Rita, FEMA, etc. However, there’s only so much self-restraint I can maintain, and I’m afraid I’ve reached my limit.

The indictment of Delay last week was utter joy to watch unfold. Seeing his smug ass with his “videotaped” response, I could only think that as he would say things like “partisan bullying” or “political vendetta” with respect to Delay being victimized (I almost choke when I type it), that if I were in the room, I’d move away from him as far as possible so as not to get hit with any lightning when it came down. That hypocritical thug single-handedly redistricted gerrymandered Texas by who-knows-what kind of Sopranos-horse-in-bed tactics. The fact that he had to step down (a rule the puppetmastered ethics committee agreed to dissolve, just for Delay, until they were pressured to retain it) isn’t even a huge blow, because Hastert has no problem having Delay call shots from his “real” office away from the leadership office. I can’t wait for “The Hammer” to appreciate other, not-so-subtle nuances to his nickname when he’s in prison… When the second indictment was announced yesterday, I think I had to smoke a cigarette after I heard it.

My father is an attorney. When all of Cronygate (my term) was happening right after Katrina (Brown most notably, but also Chertoff to a degree and a few other federal appointments that came to light as a result of insider buddy-buddy politics), I had started a post called “I nominate my father to replace Mike Brown.” After all, Brown’s most qualifying line-item on his resume (that was true, anyway) is that he is an attorney. Unfortunately, Dad knows nothing about horses, so my draft just fizzled at that point…

I was bracing for whom Bush was going to nominate this week. My worst fears would be realized in a judge that would make Scalia look like a socialist. The candidate, Hariet Miers, Bush’s personal attorney in the White House seemed an afterthought, a “Beats me what to do for dinner…you want to just order pizza?” kind-of lazy, sure-thing choice. This administration has always valued loyalty above all else. Well, I’ll restate Chuck Schumer’s words: “It could have been a lot worse.”

Law.com in an article from almost a year ago says she’s meticulous to a fault and basically got her job because she failed at other levels of Bush’s support staff:

“There’s a stalemate there,” says one person familiar with the chief of staff’s office. “The process can’t move forward because you have to get every conceivable piece of background before you can move onto the next level. People are talking about a focus on process that is so intense it gets in the way of substance.”

“She failed in Card’s office for two reasons,” the official says. “First, because she can’t make a decision, and second, because she can’t delegate, she can’t let anything go. And having failed for those two reasons, they move her to be the counsel for the president, which requires exactly those two talents.”

I don’t know, call me a fuddy-duddy, but with absolutely ZERO judicial experience–not even at a county level–it just goes against everything I’d think would be valuable to have in a near permanent position for the highest court in the land. Hell, near as I can tell, she hasn’t even argued a case before the Supreme Court, unlike Roberts who was 1) scarily brilliant, 2) had a somewhat short (for a chief justice) but distinguished judicial CV which shed much light before hearings began, and 3) clearly put himself on the line and said he was NOT an idealogue, that he would be his own justice. I can think of nothing more predictable than Ms. Miers being Mr. Bush’s justice, in spite of the constitutional gap between branches. Don’t think for one solitary second that Bush doesn’t know exactly how she’d vote on important issues. When Bush gave his press conference today, he said he never asked her about views on abortion. If Bush is telling the truth (not a good assumption), it’s because there was no need–her stance on key issues is already a known quantity from a longstanding relationship. And if the CIA leak scandal continues to develop as it has been, that relationship is convenient, given the attorney-client privilege, now on top of executive privilege.

I strongly am in favor of a woman’s right to choose. I glad that Bush nominated a woman to fill a woman’s seat (nominating O’Connor being one of the few great things Reagan did). I think the court could stand to have two more, but I wouldn’t select solely based on that. Unless Miers paints a detailed self-portrait during the confirmation hearings–regardless of where she stands on what issue–I can’t possibly see EITHER party confirming this nomination. In fact the most vocal criticism has come from the right wingers. It should be interesting!

Depression and Medical School

Proof that some of what I was writing about is normal, but also serious with respect to mental health. The New England Journal of Medicine published an article just two weeks ago on this very subject.

One excerpt:

Why does being a medical student increase the risk of depression? Raymond believes that students’ coping strategies and personal health deteriorate as they progress through medical school. Students “see themselves going into a very narrow tunnel,” she said. “A lot of the depression we see halfway through the [first] year — it’s a reaction to having constricted themselves down to studying these subjects in a very intense way. It’s pretty unidimensional.”

Symptoms of depression in medical students can be difficult to distinguish from the effects of the stress inherent in student life. Students often dismiss their feelings of despondency as a normal emotional response to medical school, where they live from test to test and don’t take time for themselves.

I think knowing what to watch out for and not having any stigmas about seeking help (so that you aren’t pressured to be “well” just for its own sake) is probably more than half the battle in preventing it from happening. They don’t say “Physician, heal thyself” for nothing!

More Mexican TV Problems

Apparently, their DBAs are also good-for-nothing…”PLACE EPISODE TITLE IN HERE” makes trying to find out what’s on TV just that much more fun!

A side note, I found out today that Rainman, the movie with Dustin Hoffman and Tom Cruise is called Cuando Dos Hermanos Se Encuentran (“When two brothers find each other”). I think I’m going to take this box back and see how many billing cycles it takes for them to credit my account…

Morning News Filth

The Red Sox lost the AL East series yesterday (much to Jessica’s chagrin ) but they lead the pack for the AL wild card and will probably play the Yankees AGAIN.

Even though I never watched it in the US, I record the CBS Early show because it’s the only “network” news we get. Imagine my surprise when I hear this flithy comment by one of the weekend anchors:

And when children are getting ready to watch their cartoons…

(video is slightly off-sync with voice, couldn’t fix)

Bear-y interesting

In reviewing for our upcoming biochem exam, I read the following in one of my biochemistry textbooks concerning Vitamin A:

“Vitamin A accumulates in the liver. Intake of large amounts [25-50 kRE/day over time] can be toxic…It is virtually impossible to ingest toxic amounts of vitamin A from normal foods unless one eats polar bear liver (6000 RE/g) regularly.”
    –Devlin’s Textbook of Biochemistry With Clinical Correlations

Mmmmm…polar bear liver….

Stages of Grief (2 of 2)

Preface:
Ok, so I re-read the first half, and I have to say I didn’t do the best job of writing…I was tired and didn’t mean to leave it hanging in quite that way. I know it was just the first half, but still, it wasn’t as clear as I wanted. Rather than re-do it, I’ll just finish here.

Part 2:
We got our grades back for our first anatomy exam and our embryology exam this week. In both cases, I did far worse than I would have thought. I passed, of course (I didn’t think I hadn’t in each case), but I’m not the type to celebrate mediocrity. In anatomy, the disparity was between what was emphasized in lecture vs. what was asked about on the exam. Most reasonable people would make a 1:1 connection between the two; however it clearly seems that if a topic is covered at all, it is fair game at any level of specificity for an exam. Ok, sucks to be me, but now I know better. I can look back and see where I could have studied certain areas more, given more emphasis to this or that, etc. I’ll take my lumps and move on.

With embryo, however, the questions themselves were ambiguous, and I’m convinced certain topics weren’t covered at all or not in the text. In one specific case, I was working on review questions to which the answer did not appear in the book, so I looked it up online. More than one source indicated that amnioblasts derive from the epiblast. The test said they were from cytotrophoblast (which would presumably be extraembryonic). At that level of development, there are only really 3-4 cell varieties, so it’s really splitting hairs any way you look at it, but that’s not what I’m talking about. He disagreed when I said it was epiblast, and when I offered to show him evidence to the contrary, he didn’t offer to accept it. At this point I’m not even trying to change my grade, and I told him so…I just wanted to know whether or not I’m right, am I being properly prepared for the future, etc. I have this prof for anatomy lab too, and half the time you get a different answer if you ask the same question. I know it’s not because he doesn’t know what he’s talking about, it’s a language barrier, but nothing is ever done about it.

But the most frustrating thing is that on the back of the exam is a page where you can list what you think might be wrong with the exam, such as ambiguous questions, no right answer, etc. I filled in the entire table plus, not just w/complaints, but an honest “secondary answer” where I said, “If you’re asking blah, it’s A; but if you mean blah blah, it’s C” I asked if he had looked at that back page and he said, “Yes.” His dismissal of my “alternate” point on 2-3 questions proved to me he never read it (or didn’t understand it), but more importantly, didn’t care what it said.

However, in looking at the exam, I see that I was responsible for the bulk of my mistakes. If I were to add up all the above-type questions where I felt the question was bullshit or had 2 right answers, etc., I might haven been able to come up with 8 questions out of 70. I got just over 20 wrong, so simple math tells me I screwed more than the test did. Unfortunately, most of the wrong answers were questions to which I already knew the answer. I just got frustrated with dealing with the exam itself, more concerned about making sure I specified which questions were not valid, etc. than just answering the rest as best as I could. I let the shitty nature of the test (and it was, trust me) distract me from doing my job and began to doubt myself. It was still my fault, but I felt so out of control.

During orientation, our associate dean said to pass anatomy, we’d need to study 4-5 hours a night on just that subject. Ummm, we get home at 4-5pm most days, so we study anatomy until 9pm, then how much biochem? Cell Bio or embryo? How much for those when we have to get up at 6:30am to make early-ass classes at 8? (some have 7am classes!) In a show of goodwill and support, he came to field questions, concerns, etc. one day (which we later would find out was only an exercise to make us feel he was listening). While fielding questions, he recounted his days at Harvard (he got his MD here in Mexico but his PhD in neuroscience from there) and marveled at how US students were “study machines.” He’d say, “They had an hour for lunch, but they’d eat in 15 minutes and then use the other 45 minutes for a nap” (as if that would put them back to “Energizer bunny” state). He’d follow that up with “They wouldn’t study all weekend, of course not! They took Friday night off, went on a date, had fun and slept in on Saturday morning,” as if that was some kind of luxury that made all the other days of sleeping <4 hours worth it. This is our “gold standard” by which our academic director feels exemplifies the ideal life-pattern of a medical student. So you see, any attempt to go over any given professor’s head with an academic grievance has to pass the above standard for this guy to feel any injustice has been done. Whatever.

I have come full circle with all these feelings to that last stage of grief, acceptance. I accept this is where I am, this is the school I have to deal with, and that this is a tiny, miniscule speck of nothing compared to the difficulty I’ll probably have to face with real people in this environment during clinical years when grading is even more subjective. I will be a stronger person for having to change myself a fuerza to become more adaptable and “go with the flow,” as much as it kills me. The fact I got a C/D/whatever in any given exam means nothing about what kind of medical student I am, much less how good of a doctor I’ll be, and least of all, my value and intellect as a person. This is not the whiny “grades don’t matter” excuse of a student who failed and didn’t take responsibility; this is the honest admission of a conscientious student who realizes that grades/exams/any given faculty member’s opinion/etc. are a means to an end, not the end itself. I’ll play by the rules and dance like a little monkey when the organ grinder starts playing, but I’m not going to redefine who I am and what’s most important to me in the process.