Mexico Medical Student |

I volunteered to write a story to be included in a collection of “joke” stories by other medical bloggers. Our instructions were simple, but included the fact that it had to relate an encounter of some kind (not necessarily between people) and, “Make it cheesy, cheesy, cheesy! We want drama! More drama than that!” So here is my slice of the “Literary Cheese Wheel,” or in my case, “Literally Cheesy Wheal” when you swell with disgust at what follows.

Apologies to all who read this, but especially to Dr. Charles, a far better writer (conspicuously missing on this wheel of fromage) whose first name I shamelessly used to further the cheesiness of my story. Perdóname, por favor!

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It was a dark and stormy night, and his journey was a long one. Undaunted by unforgiving elements, Aiden pressed further on the winds of the storm, freed from his previous captor in a violent escape, almost killing him. How he longed for the supple flesh of a woman–perchance on a night like this, even one to give him shelter. No sooner than thinking this, he saw her: a visage so beautiful he could hardly believe his luck. In this case, luck was a lady tonight–a lady named Farah.

He approached gently, even stealthily, so as not to frighten her with the primal plans he had in store. A primitive creature, Aiden had one thing and one thing only on his mind…the absolute ravishing of Farah’s rosy, pink flesh. Like so many women, she acted as though he never existed, yet another in a long line of refusals and rejections.

But Aiden always got his way.

In a sudden, but sure-fire manner, he mounted on top of her. He deftly exposed his massive spike and threw off everything he had on, totally exposing himself to her as he positioned himself for his moment of truth. Before she knew what was happening, he had entered her.

Farah’s response was an avalanche of physiologic dominoes. Overcome by these wild, exotic events, her soft flesh engorged with increased blood flow: arterioles dilating, pink turning to red. Her defenses made a meek attempt to ward off this strange violator, but Aiden was too much. Her temperature raised a couple of degrees, but it was a pittance to how on fire he was. He took full control, working almost every cell he could manage to touch to do his bidding. Farah was powerless to resist.

He persisted for a good while, but the time for him to leave finally came. Instead of going quietly out the back door, the conquistador chose instead a more dramatic exit, bolting out with a flourish, not even looking back to the spent victim he left behind. Oh, she’d know he’d been there all right: the fatigue, the soreness, the still elevated temperature…

No one knows where Aiden O. Virus went from there, but he left Farah N. Gitis behind.

See you on the flip side. Things were too quiet anyway. It’s like the whole world was (is) on vacation–no comments, hardly any traffic…a good time as any to just go home and be with family for a bit.

I just got home having spent $450 in auto service. I went to get my shocks changed, which I’ve never done on my 7 year old truck. With the roads here, you can ruin a suspension quickly, and my suspension was already shot before I got here. I was expecting pay a really cheap $180 for everything (using Monroe shocks, not some local or Taiwanese brand), but of course, there were other things wrong from going far too long with a shot suspension. In some of the items, the verbal estimate was multiplied x4, but the quick talk made it seem that it was 1/4 that, so when I got the final estimate before the work was done, I had yet another round of sticker shock. All in all, this is not major auto repair–I know that–but it’s at an inconvenient time at the end of the year where I’ve already had to tap into a credit card to make it to my next student loan disbursement.

One of the motivating factors, aside from preventing catastrophic damage, for fixing everything de una vez was that baby will be riding in the truck at least for the trip home and probably off and on in general (small car will be primary). I can brace myself for a severe bump, but it’s probably not a good idea for baby. So imagine my disappointment when I drove home from the auto place, and I didn’t have the suspension of a Lincoln Town Car like I was expecting. Perhaps my expectations were a little high, but had this overriding feeling of, “WTF did I spend money for?” Yes, there’s a small difference in the small bumps of the road, and the large speed bumps you find everywhere produce one normal bump, not the multiple up-down demonstration of Hooke’s Law I most often experience.

Gotta refocus for pathology tomorrow, then I’m outta here.

A week ago, I made an open request to anyone wishing a to help with a general Q&A to help me build the “About” part of my site. I had intended to write the responses over the weekend, but internet and power outages (thunderstorms) kinda had me off schedule. To date, I have received only 3 replies (bless you), which kinda disappointed me since my web sadistics statistics seem to indicate a lot more people come through here. People I know in person sometimes write a personal email to me offering opinions on something I wrote on the blog. I appreciate the input, but next time, leave a comment! Please? (I even allow anonymous comments) Comments make me happy, regardless of how trivial.

I’ll leave my open question thingy up for another day or two, then it’s offline for good as I write my replies.

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OK, so to leave you with a funny story, I was telling Claudia I was going to finalize an Amazon.com order so it will be shipped during the 10 days or so I’ll be in Texas. She reminded me in IM about getting a fish spatula (these are harder to find than you think), but when I read it on the screen, my brain juxtaposed the two words into ‘fistula.‘ I’m sure it was funnier to me than anyone else, but I thought I’d share.

Amazon sells a $57 “fistula” for those who are suckers enough to buy it. Global makes great knives, but a fish spatula doesn’t do anything but flip. For $57, it better have Bluetooth at least.

It’s my first Father’s Day and I’m alone. I’m not doing anything socially (although I did help some friends study physiology and histology yesterday for their make-up exams this coming week), but really, I just feel like being a total couch potato. It’s depressing to reach this milestone and spend it alone, but I’ll be back stateside in five days. It kills me that I have to be here for a formality to make up a general pathology exam that I got at least a B on because of our administration’s screw-up, which is now preventing me from seeing my family and being with them today.

I’ll be fine. I talked to my dad and my father-in-law. Claudia decided to take baby to her dad’s and spend at least a couple of days over there, so that’s good–she’s been with my parents for some time and it will be good for a change of pace, but w/o a computer there (he’s elderly), ease of communication is harder. I also didn’t get a chance to webchat with them before they left.

I was promised we’d celebrate Father’s Day belatedly (and of course, my arrival in general) on Friday. I’m very much looking forward to that and finally being back together with my girls.

There quite a few things I’ve learned in my first year of medical school–most of them have been the second half of the year as I implemented those things which actually worked. The first semester was more finding out what I was doing wrong and although I did well grade-wise, it was WAY too costly in terms of time and energy in how I went about it. I know I have some pre-med readers, and this is focused especially to them, perhaps too to those already in med school who might benefit a trifle from all the wisdom I’ve gained so far. (pause for raucous laughter)

If I can sum up my study philosophy in a pithy saying, it’s this: study from general to specific. This, on the surface, sounds obvious as who in their right mind would study something in detail for which they don’t know the general, but you’d be surprised how many textbooks and lectures go about it exactly this way. My favorite example of this is gross anatomy. One studies the upper limbs for example, and the textbook will start with bony structures where applicable and go into all those details, then go to muscles and go into exhaustive detail, then go to vasculature in exhaustive detail, then to innervation, joints/ligaments, etc. Each mini-section is complete with its own table of nerves, vessels, muscle origin/insertions, etc. down to the last named nerve/artery/whatever. This is ridiculous. I can’t imagine the brain of a person who will know every last named arterial branches of a part of the body and when asked about nerves, say, “I don’t know–I haven’t gotten there yet.” By the time you’re “done” to put it all together, you’re overwhelmed and are forgetting very basic information.

Take something big and obvious: vasculature of the abdomen. The descending aorta gives rise to the celiac trunk which will provide blood to the stomach, spleen, liver, etc. This is where you should pause. Learn just enough branches to figure out a topology of the major vessels which feed the main organs then move on, in this case, to the superior mesenteric artery. Learn what it supplies in a macro sense, then move on. When you’re no longer in the abdomen (R/L ilac aa.), stop, then go back and learn a few branches deeper at each level. The mistake is to try to learn what’s on the page in Netter with 25+ labels facing you with no clue of a logical progression of bloodflow.

I used anatomy as my primary example because being visual, it’s a clear case of what I’m getting at. In a class like immunology, a subject I discussed the other day, this is a bit trickier since it’s much more at the cellular and molecular level. In spite of cross-over from general pathology, I bet good money that more than half my classmates can not answer the simple question, “How does the uncomfortable symptoms we associate with [normal] inflammation help the body?” This is a question that could be asked of a high school student when being told that inflammation is part of the immune response, and someone who really knows what they’re talking about can answer the question without using words like “interleukin,” “chemotaxis” or “degranulation.” It is the simplest questions which are often hardest to answer, and that leads me to tenet #2: never lose sight of the big picture. Ask imaginary questions your parents/spouse/patients(!!) would hypothetically ask and prepare mental answers in laymen’s terms. The famous Einstein quote, “You do not really understand something unless you can explain it to your grandmother,” applies here. The same students I refer to above that couldn’t answer the inflammation question could probably tell me IL-8 is an interleukin that’s chemotactic for neutrophils because it was a fact to memorize on a table (one of probably 25), but could not explain why it’s useful.

Lastly, I wanted to say that you have to study from primary sources–textbooks, good notes from professors, or the like. Reading the BRS, “High Yield” series, or hand-me-down Kaplan USMLE review books is not fully learning the material, it’s learning facts to regurgitate. Unfortunately, a good chunk of the first two years is doing exactly that, but you are setting the stage for serious pain when, in your clinical years, you have to synthesize that information into a logical whole in real-time and you don’t have any depth to draw from, just topical factoids with no sense of belonging. Don’t even get me started on studying from old tests…we all do it when we get our hands on them because as long as we are graded, we want to do as well as we can, but that should be last after you’ve put in your real time studying. It shouldn’t act as a checklist by which you go about learning something de novo. Just because it’s not asked doesn’t mean you don’t need to know it (and conversely, just because a professor has a pet topic doesn’t mean it needs to be memorized beyond the scope of the class). How does one know? Ah, that’s the rub… that’s part of the anxiety that drives us to keep learning when our own motivation wanes.

Well, that’s most of what I have to say about studying and learning. I hope this doesn’t come across as paternal or arrogant, but I’ve learned many of these things recently after hitting many a solid wall. I was a horrible, horrible undergraduate student, discipline-wise, and by the time I was taking graduate courses, I was burned out and still making it on raw aptitude. It wasn’t until I worked in the “real world” for a while and went back to school did I truly appreciate how much more I could have done with myself academically had I applied myself from day #1. Even straight-A students in college (way unlike myself) get a rude wake-up call in med school because this is an environment where you have to learn for yourself what’s important and what’s not–that reading 300 pages from Robbin’s Pathology and learning everything in a few days is impossible, but learning the important things are absolutely expected. Again, it’s about figuring out what exactly is important, and that’s a personal quest, but the common wisdom is this: never lose the big picture, never stop asking the reason “why”, and look up what you don’t know to answer those hypothetical questions. I promise you’ll be as good as you can be–as a med student, as a physician, and most importantly, as a well-rounded individual.

[Due to internet and power outages, as well as the final for this class, I am backposting the next two posts to Friday and Saturday, although they were written from Thursday to Saturday. --e]

Immunology is one of those subjects that kinda scared me more than usual. We breezed through immuno in histology doing lymphoid tissue in class, leaving most of us like, “Huh? What the hell was that?!” until we read the appropriate chapter(s) in the textbook. Even then, I at least, was still more than fuzzy. We covered aspects again in general pathology when we went over autoimmune diseases and again, it was a topical treatment, leaving a lot of same questions I had before.

To help with the non-medical readers (and to remind graduated physicians of the ick they had to endure their preclinical years), here is an example of some of the cryptic nature of immunology: a movie on the complement system. Naming things one letter + the number in the order it was found does not exactly give immunologists the distinction of being creative. Couldn’t they have better names than C1q, C5a, or C3bBb?

But I had a very positive immuno experience, I’m happy to say. I still think it’s an amazingly difficult subject to be sure, but once I took the time to really learn it, I appreciated all the molecular mechanisms, the biochemistry, the mind-boggling numbers involved (over 10¹⁵ possible gene recombination events!), I look back and am thankful I took the time to tackle it head-on instead of just saying, “Oh, that subject is not for me.”

The meat of immuno is not memorizing IL-2, IL-10, CD28, B7.1, Fas, Lck, src, and all that jazz, it’s understanding what gets turned on, what gets turned off, how lymphocytes respond to various signals, how lymphocytes affect other cells and tissues, all to finally understand the complexity the body goes through to defend itself. Everything meets that bottom line in a normal individual. Once you “get” what’s going on and the dependencies involved, then you, with time remaining, set out to memorize details like the above for a test. The goal is to understand the fundamentals and let the chips fall where they may with respect to a silly grade based on a professor’s personal picadillos of importance.

And that leads me to the next post which I’ve been chewing on for some time: lessons learned regarding studying in the first year of med school.

I don’t eat fish quite as often as I should, but today I resolved to make a nice fish dinner. I just got done eating it, and I’m rather pleased w/the result, so I’ll share my impromptu recipe (quantities are estimated since this wasn’t planned):

Ginger Garlic Sesame Fish

• filets of tilapia (or any other medium-flaky fish, such as trout)
• 2-3 Tbs olive oil or vegetable oil
• toasted sesame oil, < 2 tsp
• 1 Tbs fresh ginger, sliced thinly
• 2-4 tsp. fresh garlic, sliced
• pepper, salt, herbs
• lemon or lime, sliced in round, thin slices

Take the sesame oil and brush (or use your [washed] fingers, like I do) a thin coat onto the filets, both sides. Apply salt, pepper, herbs to both sides of filets, let rest. In a saute pan of your choice, heat olive oil (regular or light, not extra virgin as it has too strong a taste) or regular vegetable oil for a couple of minutes over a medium heat. Add the sliced ginger and garlic and saute for a good minute or two, allowing maximum extraction of flavor. Do not allow either to brown excessively. With a slotted spoon or the like, remove ginger and garlic; set aside for later.

Add fish filets by lying into the infused oil gently, then turning immediately, so the newly upturned side got a coat. Heat 3-5 minutes a side, depending on heat, perhaps a minute less on the second side. Do not overcook and dry out the fish; if in doubt, remove from heat and replace if not done (after a few minutes a side, it will almost certainly be done). Garnish the top of the filets with lemon/lime slices and optionally spoon a small amount of the garlic/ginger leftovers (depending on how done they became) on the slices so that you (and/or guest) can mix to taste  without overpowering the fish.

Don’t worry too much about the oil.  The sesame oil is very strongly flavored and is just used to coat the fish with that flavor. The olive oil is good for you, and you really are just using enough to extract/impart flavor, and coat the pan (which should be proportional in size to the amount of fish you are cooking at a time).

I had my fish with steamed chayote squash, a delicious variety I didn’t even know existed until I came to Mexico. And just to prove I’m not a snobby gourmand, the other side item I had was Kraft macaroni and cheese. It’s a childhood thing–we grew up eating it w/fish, so it makes me think of home. I hadn’t had it in forever, and besides–I put enough work into the above; I didn’t need to make anything else from scratch.

Enjoy!

OK, I’m totally ripping this idea off from Punchberry who posted a similar query to her readers a couple of months ago. I have been struggling to [re]write the “About Us” section on the site to give readers a bit more info about me, some background info that helps ppl understand where I’m coming from with my writings, etc. but I keep running into brick walls feeling that I’m giving info that nobody really wants, or I sound like I’m writing an autobiography (which I have no intention of doing) — it just hasn’t happened. Sooo…..

Instead of guessing, leave a comment with a question you’d like answered and I promise that I’ll field all serious questions. I’ll post a reply this weekend, so that gives 5 days or 10 questions, whichever comes first (almost certainly the former). Anyway, ask away!

Look at this as a collaborative effort at getting more content up on other parts of the blog.

Right now Mexico is playing Iran in the opening games of the FIFA World Cup. They’re playing in Germany, but you think they were playing in the soccer stadium down the street, people are yelling so loud. As I was making a late breakfast, I noticed a lot of yelling and hollering from houses behind our backyard. It wasn’t continuous, so I didn’t figure anything special. Then the yelling got more intense, and then whatever household lost it with screaming. I could have sworn I heard “GOL!” somewhere in there, and then I remembered the Mexico/Iran game was early in the schedule. Sure enough, I turned on the TV and there it was; they were continuously looping the goal that Mexico had just scored minutes earlier.

It’s hard for people in the US to wrap their heads around how intensely soccer (or fútbol, as it’s said in Spanish, “football” in all other English-speaking countries) is permeated in the culture here in Mexico and in most all Latin-American nations. In fact, the US is a worldwide oddity in that soccer is not a major sport; moreover, the US doesn’t even have a true national sport. Baseball is probably the closest thing, but there’s no international league participation that instills national spririt the way soccer exists in other countries. I never have been able to get into soccer; I’ve tried, but it’s just a lot of teasing with too little tangible action for me. At least hockey moves faster and has fights.
Just in case Mexico wins (and I wish them well, but they aren’t that strong of a team from what I hear), I think I’m going to stay inside today before the craziness ensues.

Update, 1PM: Mexico won 3-1. Glad I’m stocked with provisions.