Day 139: Oh, hello 2012

Today’s inane image of the day:

Every winter, I find myself knitting for stress relief — something about the redundant motions and forming a pattern from string just seems magical and very appropriate for the season. This particular pattern is called Ripple Stitch.

It’s amazing how the new year seemed to creep up on me — it couldn’t have been more than a couple weeks ago that I was tossing and turning in bed waiting for my first day of medical school to begin. It feels like many years have passed since I sat at a pump of a gas station and squealed in delight when I saw an email from OUWB inviting me to interview. I remember noting how dirty the snow looked and how biting the air was when I finally got out of the car to fill up my gas tank, but the excitement was overwhelming and I can look back on that memory fondly.

2011 was filled with multitudes of contrasting emotions: heartache and excitement; stress and relaxation; fear and serenity. Not surprisingly, the year will be filed away in my memory as a crossroad in my life.

Last year
Around this time last year, I was sitting next to a fireplace at my favorite coffeeshop listening to Ben Harper and tapping away at my OUWB secondary essay. I remember feeling like I had nothing to lose by submitting the application [well, besides the $75 application fee] and let my words flow in response to the two prompts. I remember digging through the website to try to find any more information and recognizing Dr. Sabina as my tour guide during the 2010 Applicant Visit day. After finally submitting, I succumbed back into the waiting game.

Interviewing recap
As the interview invites slowly rolled in, my excitement morphed into fear. True, I had made it this far, but interviewing meant that I had to articulate in spoken words what brought me there. Although OUWB was my second interview invite, due to scheduling issues, it ended up being my first interview. I think the worst part of the experience was just getting into my car at the end of the day and feeling completely helpless and discouraged. I knew that I wouldn’t be getting a call from Dean Grabowski.

My second interview [NYMC] was tied with a much needed trip to New York City. Although I had a really good feeling about that interview, a couple months later I received an email notifying me that I was on the waitlist. Even though the decision was met with anguish, from where I’m sitting now, I really only remember catching up with my friend and how much fun it was to roam, see, smell and hear everything in the city.

My third interview [Wayne State] required that I miss class. It wasn’t particularly memorable except for getting momentarily lost in Detroit and catching up with a former classmate over coffee. I remember walking out of the interview and returning a smile to a homeless man passing by. Maybe that little gesture was what tipped the scales in my favor, because a little over a month later, I received my first acceptance. Thank you Wayne State for being the first school to pronounce me worthy of a medical education.

My last interview [MCW] was for a waitlist position. Although I hadn’t thought much of the school, after meeting a few students and conversing with my two interviewers, I fell in love. I’d guess that if home were closer to Wisconsin that I might be there right now. Regardless, it was a tough moment to call the admissions office and withdraw my application.

Everything else
Although my interviews were what stood out about the first half of 2011, I cannot disregard the fact that I was still finishing up my Master’s degree, was part of the SWE executive board, running a middle school club, peer advising and enjoying Mike’s company. We were taking the exact same classes during our last semester and I cannot imagine how difficult it would have been to get through the problem sets and projects without him by my side the entire way. I remember  the night we discussed where he should do this PhD and knowing that he would choose California over Michigan. Although I knew we would be in a long distance relationship, the fact didn’t sink in until I started classes.

The summer was a perfect mix of everything I needed before starting medical school. In a lot of ways, it was my first real break from everything academic — for the first time, I didn’t have to worry about taking classes, research or volunteering. It’s not that I didn’t enjoy these things, but for the first time in my life, I didn’t have to worry about getting into medical school. I also had a fun job, great coworkers, and ample time for myself in the evenings.

Oh, and the road trip! Since I haven’t traveled much, this was a much needed experience. No words can describe peering into the Grand Canyon or the Hoover Dam. And relaxing by the pool in Palm Springs. And the plains really are plain [but are nice to drive through!]. And seeing Hollywood for the first time. And so many new things!

Starting a new chapter
Leaving California, I was eager for the start of school. More and more updates came from OUWB and medical school was finally starting to feel like a reality. I didn’t know what to expect, yet I knew that it would be something amazing. Things were rough at the start and I still have some loose ends to tie up [remediation], but I know that I’m in the right place because I still love the school, the people and the material.

What’s next?
I’m starting the new year with a sense that things will work out… otherwise, why would I want to leave my warm bed each morning? Things have been tough with school and the long distance thing, but it worked out this last semester and will just have to work until the next crossroad. I’m not one to have new year’s resolutions, but I do want to try to stay positive this upcoming year. After all, this time next year, I’ll have to worry about setting up a study plan for the boards [eeek!].

Thank you
When I started this blog over the summer, I never expected to have more than 10 dedicated readers… but it looks like we’ve come a long way since then. Thanks for reading my rants and providing supportive comments during the rough patches — my success can be attributed in part to you!

Day 138: Exposing the spinal cord

Today’s inane image of the day:

When I was in high school, I was a part of the robotics team — this is what we came up with the second year I was on the team.

During our last BFCP2 Anatomy Lab session, we worked in teams [things were a bit scrambled since the physical therapy students were no longer joining us for lab] to expose the spinal cord. I didn’t really think much about the dissection until I walked into the lab and was greeted by saws, hammers and chisels. The sounds and scenes brought back fond memories of when I was a part of my high school’s robotics team — back then, I was all too familiar with using power tools to construct a final product, but I had never used those tools to do the opposite: uncover/reveal a structure.

Each of us [that wanted to — understandably, there were a few people who were uncomfortable with the tools] took turns reflecting the back muscles laterally to expose the spinous processes and laminae of the vertebral column. Once the bone was visible, we got the go-ahead to plug in our saws and start cutting into the laminae. Once again, each of us [that wished to participate] had the opportunity to direct the saw through the tough bone. I remember being surprised by just how tough the bone was and wondering if the blade we were given hadn’t been sharpened enough. Oddly [at least to me], the sound of saws cutting through bone didn’t seem that different from a ban saw cutting through wood.

Once the spinous and transverse processes had been divided, we took to our chisels and hammers to separate the two pieces. Quite a bit of force went into this [we let the males take over at this point], but eventually a strip of bone, ligament and other various structures was pulled away to reveal a grey-ish spinal cord wrapped in loose dura mater [the process of preserving the cadavers results in the loss of cerebral spinal fluid from the subarachnoid space]. Apparently, we were overzealous in our sawing because all of the dorsal roots were severed. Regardless, Dr. Forbes came over and excitedly pointed out an intact denticulate ligament as well as the pinkish-tinged filum terminale.

They say that exposing the spinal cord is one of the rites of passage of medical school, and I’m going to have to agree with that one. Even though the whole process took nowhere near the full 2 hours we were allotted, it will definitely remain a substantial memory to reflect back upon.

Day 137: Shadowing a cancer geneticist

Today’s inane image of the day:

Very late, I know… but this was from the [South] entrance of Beaumont that I’ve grown so used to walking through to get my caffeine fix at Starbucks.

A couple of weeks ago, I had the unique opportunity to shadow a cancer geneticist. Prior to meeting the program director (Dr. Dana Zakalik), I was completely unaware that cancer genetics was even a specialty option. But after coming in to give two fascinating lectures, I thought it would be interesting to see what a day in the clinic would be like.

The clinic team on the day I went in was composed of Dr. Zakalik and a few genetic counselors. Although the only cases I witnessed were patients concerned about breast/ovarian cancers [which make up the bulk of the patients that come in], the clinic also sees patients for hereditary colon cancer [e.g. Lynch syndrome, Familial Adenomatous Polyposis (FAP)]. The general procedure went something like this: a patient would come in for genetic testing [many times in the BRCA1/BRCA2 genes which are directly correlated with a significantly higher lifetime risk for breast/ovarian cancers], undergo a genetic counseling session, decided if a test is right for them, do the paperwork and the blood draw then return a couple of weeks later for the results and discussion with a genetic counselor and a physician. I’m really distilling this process down a lot, so please forgive me.

A couple of things really struck me about the experience: first, was how incredibly detailed the genetic counselor was during the preliminary session. She used a great analogy for what testing the BRCA1/BRCA2 genes means [I might be reproducing this slightly differently, but it’s the same idea] — basically, the genes are like an instruction book that every person has. Usually the book is spelled correctly and the genes can be transcribed/translated into their protein product. But in some cases, there is a misspelled word that leads to genes that don’t function properly. In the case of BRCA1/BRCA2, they are tumor supressor genes so a misspelling can lead to a higher likelihood of developing breast/ovarian cancers. Thus, the genetic test is like a spell check that lets you know if you have a misspelling.

Second, it really showed the importance of an accurate family history. Each patient is asked to provide information on first degree relatives and by the time the patient arrives for their counseling session, a pedigree is drawn up to show if there are any patterns. After seeing a few pedigrees, it became really apparent how much information can be gathered from the tool.

Third, it amazed me just how many people [it was a really busy day — there were so many patients to see!] yet how few people were aware of genetic testing. One patient was really disappointed that she hadn’t been referred by her physician to the clinic earlier on. Although not all hospitals are equipped with a cancer genetics clinic, awareness among physicians about these life-saving preventative measures could really make an impact in the long run.

Overall, I thought the experience was enlightening and really interesting. I was in the clinic for over four hours, but it felt like only an hour had passed. At this point, I’m really drawn to oncology but am still not sure where I want to go with it — although the shadowing experience piqued my interest in the specialty, I do still want a bit more of a patient relationship. I guess we’ll see what else is out there [after all, I do still have quite a bit of time to decide]!

Day 136: Doctors of osteopathic medicine (D.O.)

Today’s inane image of the day:

A photo from my road trip last summer — I find that taking the time to reflect upon moments of serenity and happiness really helps when the bleak winter starts to settle in.

A recent commenter posted on my “Contact Me” page asking for my thoughts on doctors of osteopathic medicine (D.O.) and I thought it was an appropriate topic for an entry. This being said, I don’t want to reinvent the wheel, or do my D.O. colleagues an injustice by trying to explain exactly what osteopathic medicine means, so I’m going to refer you to a guest post at Mind on Medicine [one of my favorite med student blogs] entitled, “My Doctor Has A D.O., What Is That?.” DrJonathan (currently a Family Medicine resident) does a fabulous job explaining what it means to be a doctor of osteopathic medicine.

As for my personal thoughts, I think that just noting that my own pediatrician and internist are D.O.s says a lot. As for why I didn’t choose to pursue osteopathic over allopathic medicine, well there a couple of reasons. Although it really is possible to go into any field of medicine as a DO, the osteopathic philosophy  goes hand in hand with primary care specialties such as Family Medicine, Internal Medicine, Pediatrics and Obstetrics and Gynecology [as DrJonathan notes in the post] and I wasn’t sure that I wanted to pursue primary care. Furthermore, there aren’t an overwhelming number of colleges of osteopathic medicine [although I seriously considered applying to MSU COM] and I preferred to stay in the area if possible. Basically, I do believe in holistic medicine and fully respect my osteopathic colleagues, but didn’t think it was the right fit for me.

Hopefully this answers your question!

Day 127: Spirituality rounds

Today’s inane image of the day:

One of my favorite walls of art in Beaumont Hospital. It always lifts my spirits to walk by this.

Each of us are required to spend 2 hours doing “spirituality rounds” with a chaplain through the PRISM program. I did mine today and thought I’d share my experience with you.

[I believe] the purpose of the rounds is to get a feel for the role of spirituality within the healing process. Spirituality is not synonymous with religious, but religion is a form of spirituality. I personally do not identify myself as religious, but I respect all beliefs and love learning more about various spiritual practices. Furthermore, there is immense value in understanding various beliefs — physicians need to be able to understand their patients.

One of the patients we visited today during rounds described the experience that led him to the hospital as, “like waking up in a nightmare.” I’m not quite sure why those particular words stuck, but they did. He was also the only patient we visited that asked for a prayer. Although I did not actively participate in the ritual, I found his response to it comforting — it seemed that after the words were spoken and the minister had taken his hand off of the patient’s shoulder, that some of the turmoil he was feeling had abated. Even if the prayer wasn’t a form of healing in the literal, physician’s-sense of the term, I do believe that he found those moments therapeutic. Hopefully, he’ll soon be jolted from that prolonged nightmare of his.

Another patient that stuck in my mind was one that couldn’t communicate with us. It was absolutely heartbreaking to watch her struggle to form coherent words while her eyes longed for us to understand the indiscernible moaning and grumbling. As we started walking toward the door, we heard an unmistakable, “I’m sorry.”

Although I was apprehensive to conduct a spirituality assessment on my own, the chaplain encouraged me to try it. I walked into the patient’s room and introduced myself as a medical student conducting spirituality rounds. Then, I asked if the patient had any spiritual needs at that time. He quickly shook his head and refused to converse with me. I pressed on once more before retreating back into the hallway where the chaplain applauded my effort and explained that many patients respond in the same manner.

Overall, I found the experience to be beneficial to my future as a physician. And it definitely didn’t hurt to spend time with patients on the floors.

Today’s medical school fact of the day: “Protein A, found on the surface of most Staphylococcus aureus strains binds to the Fc region of IgGs, preventing antibody-mediated immune clearance of the organism.” –Microbiology lecture notes

Day 125: At the bedside

[This is an account of my first encounter with an in-patient from a little while back — I have provided only minimal details about the patient to maintain compliance with HIPAA.]

After a firm handshake with each of us, our preceptor embarked purposefully up two floors to our first in-patient encounter. As we walked, I peeked into the rooms with the door left ajar and wondered what brought each individual to the hospital. I absorbed the environment full of harsh fluorescent lighting and the doppler effect of whirring machinery. As long white coats hurried past, I admired how they could make that swoosh sound of purpose that mine lacked.

Prior to meeting with our mentor, my partner and I discussed who would conduct the interview — he agreed that it was his turn [being the go-getter that I am, I offered to go first during previous patient encounters] and admitted to feeling nervous. Even without the pressure of being in the spotlight, I still felt like this was a test. An assessment of whether I truly possessed the humanistic, yet deductive ability required of physicians.

We walked up to the room and our preceptor grabbed the chart to secure a name. Before entering the room, he asked about the vital signs and I remember mumbling, “temperature, blood pressure, pulse, respiratory rate and sometimes pain.” At this point, I felt my own vital signs conveying my anxiety over meeting our first patient. Even though we were only charged with recording the history of present illness, it still felt like a tall order to fulfill. After all, many patients present with numerous chronic conditions, mounds of prescriptions and an extensive medical history. Since anything from the past could have contributed to precipitating the present condition, it didn’t seem like an hour was nearly enough time to gather every piece of the puzzle.

I don’t quite remember the rest of the conversation outside of the room, but I remember walking into the double room to greet our patient. Our preceptor introduced himself, then my partner, then I did while extending my hand to shake hers. Upon walking in, I was taken aback by her look of helplessness and how uncomfortably out of place she seemed — I envisioned that her life outside of the hospital involved young children and rosy cheeks from a slight chill in the autumn air. Her hand felt warm when it greeted mine, but I cringed slightly when my thumb brushed against her IV lines — I was scared that I might have grasped her hand too firmly.

My partner settled to the right of the patient while my preceptor pulled up two chairs for us to sit at the foot of the bed. As I opened a blank Word document to take notes, I heard quiet sobs from the other side of the curtain; I felt like we were unwelcome and intruding on an intimate moment. The “interview” commenced, but it was more like a guided tour of how to obtain important information. Our preceptor mentioned countless tricks he employed while he was still practicing [he’s currently retired] and by the time we were halfway through the interview, I already felt like I was only absorbing fragments of information. It was like a disorganized concept map in my head. I heard familiar and unfamiliar terms, but the lines connecting the ideas stopped appearing after a little while. By the end of the interview, I only really understood the diagnosis, but not the logic that brought us there.

Before leaving, we had to record the patient’s vital signs [minus temperature]. My partner went first, then I went ahead. Although we had practiced taking each other’s blood pressure, it wasn’t nearly enough practice to feel comfortable. I fumbled to put the cuff back around her upper arm and pumped it up to some large pressure value then listened carefully for the distinctive “lub-dub, lub-dub” Korotkoff sounds until they faded into oblivion. She sounded like she had a strong heart and I confidently reported a value similar to my partner’s. As I started to remove the cuff, our preceptor came over and noted that we had placed it on the patient backwards.

We thanked our patient profusely on our way out of the room. In the hallway, we discussed the interaction then parted our separate ways. At that point, I don’t remember anything else from that day besides the feeling of floating in a cloud of contentment. Despite the little mishaps of the encounter, the experience temporarily put the magic back into medicine and reminded me that someday the endless hours of studying and stress will pay off.

Day 122: I’m back!

Today’s inane image of the day:

I promised a photo of my binder… well here it is in all of it’s glory! 60 lectures worth of slides — all the material that I attempted to memorize in preparation for my BFCP2 final exam on Monday. 

First and foremost, please do not judge the state of my desk in the above photo… I tend to like to have everything in close proximity, which leads to quite a buildup of stuff on my desk. Also, note how I have my email open on my laptop screen — I assure you, that wasn’t the case for most of this last week of studying!

I’m excited to be writing regularly here again; I have some entry ideas saved as drafts right now [I know you’re all dying to hear about drilling into a patient’s vertebral column and my OSCE], so look forward to many updates over break.

As for the outcome of our 4 exams? Well, I’m still on the fence for the BFCP final exam [only need 1 more point to be in the clear], but I passed my Anatomy practical and PMH. I have not yet receive my score for Capstone, but I’m not overly concerned about that.

I’ll be back with more later!

Today’s medical school fact of the day: “The cholera toxin binds to a specific ganglioside (GM1) located on the luminal side of intestinal mucosal cells.” –Biochemistry lecture

EDIT: It’s official — I passed my BFCP2 Final Exam!

Day 117: How to win this nerdy medical student’s heart during finals

Coffee, donuts, fried carbs… or
EVERY COLOR G2 PEN EVER MADE [good way to extend that last entry, eh?].

[This one was a gift from Mike.]

Time to get ready to review anatomy and mingle with the interviewees over lunch! Hopefully today brings in a good batch of prospective students.

Today’s medical school fact of the day:
The snow is gorgeous and distracting me from learning about vitamins and minerals… but anyhow, did you know that there were a ton of B-vitamins? Yeah. And a deficiency in Niacin, or Vitamin B3 due to poor diets, alcoholism, AIDS, or other diseases results in Pellagra, or the 4D’s: dementia, diarrhea, dermatitis, death. Moral of the story? Eat a balanced diet and alcoholism leads to a lot of vitamin deficiencies.