Thursday, October 27, 2011

Instead of bidding 1 dollar over the previous bid, I might bet 5 dollars over just as a gesture of kindess and empathy.

Today is Thursday, we had an exam on Monday. We have another, bigger exam next Friday, and then the following Monday and Tuesday we have more exams and practicals awaiting us. Thankfully, some of the material presented this week is "reviewish" in that anyone who has had basic microbiology has seen this stuff before. For that matter, anyone who has taken the MCAT (all of us) have seen this stuff before. Unfortunately, there is a lot of bug and drug memorization going on as well -- some of it is familiar, some is not. Many of us (as students have done for thousands of years, I'm sure) tackle the rote memorization of seemingly (at this point, at least) abstract terms by making up sayings, or attaching stories or internal meanings to the words. Tetracylines and Aminoglycosides inhibit the 30S ribosome. I remember this by reciting: I mean, Tetris is for 30 somethings. It works. There are so many of these out there and there are abundant lists to be found on the internet, but sometimes it really is enjoyable to come up with my own relationship with the material we are learning.

On the way to school today, some retired NFL guy was talking about how during the NFL season's bye-week it is important to spend a few days away from the facilities, coaches and fellow players. But he went to great lengths to emphasize that even if a player is physically away from the game, that his mind will never be away, during the season at least. Of course, as most things do these days I couldn't help but relate that to medical school. The week prior to this one we didn't have any classes but I definitely spent most of my time studying. It was our bye-week. I did get to watch the Price is Right, though. Does anyone else think that Drew Carrey is doing a really good job? Don't get me wrong, Bob Barker was great too, but I can't take anything away from Drew's body of work on the Price is Right. He even chuckles when someone places a bid of "420" which I'm not sure Bob ever did, for better or worse I suppose.

Tuesday, October 18, 2011

Fun time is over!

I just posted a blog entry not more than 15 minutes ago. Like I usually do, I don't remember to briefly proofread it until I publish it. So then I go back and read through it. As I was scanning the last entry, I got to thinking that I really need to be documenting what is happening at school more, since I aim to use this blog as something to be able to come back to and see my thought's on things as they are happening. I do think that I've been putting tid-bits in here and there, and I really do enjoy writing down memories of this and that, but I think that I need to add just a little more of the boring, day to day stuff. So, I'm gonna start with that here.

This coming Monday is the Mini-exam for block2, and that is what I'm studying during this fall break. There is also some OMM and doctoring stuff to worry about for the end of the block fiasco. OMM is primarily concerned with Facet Diagnosis, in theory and in practice. In The doctoring lab, we've finally got our equipment and we have continued to learn how to examine each other. We've been learning how to take blood pressure with our Sphygmomanometer and conduct cardiovascular exams. It's all very real and exciting. In Fundamentals we have 6 neoplasia lectures, going all the way from the early physiology of cancer to cancer therapeutics. The pulpit was manned by 3 different lecturer's -- all very knowledgeable instructors. Our neoplasia lab was run by the typical path instructor and of course, our blood histology lab was from our histologist. We also had 5 or 6 clinical immunology lectures, kind of as a follow up to our first full blast of immunology, which was tested on during the previous exam. 

The most difficult part of this exam will be centered on the ability to cold memorize this stuff, as many, many therapeutics are introduced and discussed at length. I'm guessing that there are at least 65 different drugs that I need to know everything about, what they are, where they come from, where and when they work, toxicities and contraindications, etc. There is also plenty of signalling pathways and cascades to know. The nice thing is that so many of the players in these pathways are redundant at this point, which makes for an easier time with dynamic comprehension. Clinical immunology introduces a handful of new drugs, but much of it seems simple relative to the first time we were seeing this material, thankfully. 

My core study routine consists of making note-cards for all the pertinent material. I think there are nearly 500 note-cards, which has proven to be about what each exam needs. While crunching through the PPT I listen to the audio of the lecture, were I often find myself listening to selected parts over and over for clarification. I also have the accompanying text when available. I will be re-reading the selected text as  a whole prior to the exam, because as of now (5 and a half days before the exam) I've only read parts that I needed resolution above and beyond what the PPT's provide. I've already done all of the provided practice questions for the neoplasia lectures and will soon do the questions from the clinical immunology. The nice thing about completing whatever note-cards you may want to have early on in the exam cycle is than you actually have time to use them for what they were created for. It really helps. So, I'll be drilling with those for hours and hours the next few days and then during the weekend I'll go back through and make sure I'm not missing any concepts from the provided objectives. 

And that is what I'm doing this week.

Poop is to life-lesson vehicle as brachial pulse is to ______________?

In the backyard of the house where I grew  up, well -- the split level 2 car garage, (but only ever housed on automobile at a time) single family dwelling where I aged from 3  to around 18 years old my Dad built a 2 story play-house (as we called it) and a sand-box. Perhaps it was not as much 2 stories, but a little fort built with an open roof that had waist high walls all around the perimeter. It backed up to the property line that had a 12 foot tall hedge grown next to over a regular size chain-link fence. The name of the plant, bush or tree -- whatever it was kind of looked like the hedge here, though. They were fun to climb in, definitely. The hedge was nearly as high as the railing on top of the play-house. This meant that behind the play-house was a sheltered kind of a cool hiding, cave like place.

When I was in kindergarten I went to a elementary school, which is now a Montessori school and every time I drive by, the building and campus seem to get nicer and nicer. Granted, I only drive by once a year or these days, so maybe I just forget that they painted this or that. It was within the last couple of years that I actually stopped and got out of the car and went to the playground. In Portland, many playgrounds have this large structure that has no walls, only a high, usually slanted roof -- this is so the kids can still go out at recess even when it rains. We had many "Undercover-only recesses." Underneath were basketball courts and the like. When I was in either the 2nd grade or 3 grade, or, for that matter, 1st grade or kindergarten I remember we painted a huge map of the United States on the asphalt under neath the Under-Cover. It was still there, 25 years or so later. At some point in my elementary school career the empty lot that was across from the school grew a Fred Meyer, which is a one-stop-shopping-center. When in the Pacific Northwest, feel free to cal it Freddys. What was cool was that there was, at least at some time a crashed airplane that was hauled there after it crashed on 158th and Burnside in 1978. In fact, I really don't recall if I actually saw the fuselage and such there on the empty lot (pre-Freddys) on 148th and Division or if I just knew that at one time, there had been a crashed airplane on the lot. Didn't matter though, I will always remember that lot in what now is not such a nice part of town as the crashed airplane lot. Here is the information about that crash, that occured 75 days after I was born.

We lived quite close to the school, so much that I remember walking to school. I'm sure the first year or so It was with Mom. Eventually I would just meet up with other kids in the neighborhood and walk with them, and then walk home after school by ourselves as well. I remember one day better than the others -- the day that I pooped outside between the play-house's backside and in the thick, lush hedge. I think I was there with a friend, and we were waiting for my Mom to get home, but, I really, really had to go. So I went. And that was that. I have a vague feeling that I may have feared getting in trouble, but was really excited having poop in the hiding spot and maybe I could get a friend to step in my poop or something. In fact, I'm not really sure why or even if I was really excited about dropping a deuce in the backyard. What I do remember is going back the next day, and the next and the next trying to find the steaming pile. In my mind, it was going to stay as I had left it. Most likely it just rained all day and night, like it does in Portland and it just kind of moved along, washed away like every other turd in the history of mankind. Another good question is why I was so disappointed that it was now gone, just a short day later. I'd like to believe that it was some sort of deep truth learned about the constancy of change that we live with. And, I'm sticking with that. So, maybe I did grow up just a little bit at that house.

You cannot see the sandbox on what was (is?) the southern hall of the play-house. And, yes, there is the hedge as well.

The recall of this experience was catalyzed by an effort to recall my earliest memory. This was not the earliest, as I was at least in kindergarten (but probably a year or so older than that) and I, for sure have a memory of a spring-time day that occurred in year three, meaning that I was around 3 and a half years old. I remember walking out the side-door of the church that I grew up in, I was by myself and when I walked out it was a bright, blue shining day (these are memorable in Portland, no matter what the age) and then looking at the big, mature Oak tree (actually, thinking back I'm not sure if it was an Oak tree. If anyone knows what that tree is I'd like to know. I can picture the little helicopter thinks that would come off of it). Anyway, I looked at the tree and I though to myself, 'I am three.' Ever since that day I've always held on to that day. Sometimes I don't think about it for a few months at a time, but then something will just trigger that memory and then I'll pause and think about the day that I knew I was three. This may not be my earliest memory either, as I can remember living at the house that my parents had before the one with the play-house. It is very foggy though.

This is amazing to me -- the brain and it's ability to take in and store information. There will never be at time, barring some neurological injury or dementia, that I won't remember the day I knew I was three. It probably will be something that I would be able to recall even if I did have, God forbid, something happen. It may even be there after going through medical school, which is arguably more of a feat. Insert here: brief, obvious but poignant comment about the constant information diet med school students the nation over have been binging and purging.

Sunday, October 16, 2011

A new meaning of the word "eighth" for me.

Last night I was at a comedy club in San Francisco with some friends and my wife (not that she isn't also my friend) and, lo and behold, actually laughed. We saw Steve Byrne and an opening act, and even though I wouldn't call it the best show I've ever seen, we were laughing pretty much the entire time. Going to the club was a belated birthday present, especially picked out because my wife said I haven't been laughing enough lately. Well, that is probably true. Endless memorization of signalling cascades can do that. It was definitely nice to get out, especially since this upcoming week is our fall break. It will be void of lectures and labs, but there is more than enough to keep me busy, especially since next Monday morning opens with an exam -- what a nice way way to welcome us back.

As many of you know, medical school in the US is comprised of a total of four years, with the first two being (almost) exclusively classroom/lecture instruction, and the last two being all clinical rotations, where students spend six to eight weeks being involved in a specific specialty (surgical, internal medicine, OBGYN, etc). So, having the first two years so divorced from the experience of not only the second two years, but the real world experience of practicing medicine, I and many of my fellow students are focused on just getting through this first phase with the best grades possible and a good board score. We are just over the half-way point of the first semester, of the first year. This means I am 1/8th of the way through what many people have identified as the most difficult phase of medical school. It kind of feels like I just started, which makes sense, as it hasn't yet been three full months of school. On the other hand, life as it was prior to school seems like a distant, foggy memory. I still wouldn't trade this away though.

Thursday, October 6, 2011

So me and this Alkylating agent walk into a bar . . .

As this week's classes draw to an end (thankfully, we get a long weekend) and we finish our first foray into the science of cancer, I can't help but take a step back and contemplate the larger life lessons that cancer can teach us. Nearly two years ago I penned a short story which is still my favorite piece of writing that I've ever produced, even compared to this blog, unbelievable -- I know! It basically follows a world renowned cancer researcher  and his wife, who is dying of cancer. The researcher's lab wins the grant which allows him to get a new (fictitious) neutrino microscope which enables him to obtain resolutions much higher than an electron microscope. Of course, he peeks into the cancerous cells of his wife, only to find much more than he bargained for. (After finishing writing this post, I thought that it might be nice to include a link to the story. I copied the shortest, polished version (the published version) to a google document, so here is the link: Apoptotic Adventures While Whale Watching.) I hadn't read this story for quite some time. The last time was way before I made it into med school, and after revisiting it I'm glad that the science isn't completely incorrect -- with that being said, I'd change a couple of things if I were to get serious about it again.

This post isn't about a story I wrote, but rather, one of the issues I tried to touch (mostly unsuccessfully, but with short stories you really have to pick your poison) upon in the story. That is, the nature of cancer. Here is the thing, the more we learn and understand, the longer the list is for carcinogenic things. Chemicals, of course, but also bacterial and viral infections can cause cancer. Spontaneous genetic mutations or lack of exercise can all spur cancer's come-on. However, one thing all cancer in all parts of the body has in common is the refusal of at least one cell to die. And then, this cell recruits more cells in it's cause of selfish survival. In our bodies, at all times, cells are dying because that is the way things are supposed to go. Whether it be from old age, improper formation or some kind of injurious agent, the cell knows when it's time to go. A cell with cancer says "no way, I'm not sacrificing my life for the good of the organism" even though without the parent organism, the cell would've not existed and because of the refusal an immature death may befall the rest of the cells that comprise the whole organism. Does this attitude sound familiar to you?

Even though I am going to die, one way or another, I am willing to sink the whole ship in order to prolong my own life for a brief moment. This is despite the fact that the ship is a sound vessel and undoubtedly has many decades left of service. This is the attitude that the cancer cell has.

I'm sure you've been in a construction zone where one of the lanes merges with the other one. This is not a case of a last minute merge, we're talking about signs for at least a mile prior to the merge. Everyone who is driving knows there is a merge coming up. Most people take the first opportunity to get over into the lane that continues. However, we can all remember (I'm sure it has never been any of you!) the people who speed to the point of the merge and honk and force their way in, despite those who have been driving in a manner which benefits all those around them. These jerks are the cancer cells. I can remember a few times in these situations, where the backup was just horrible and a driver of a larger truck, who had been waiting in the through lane moved over so that the cancer cells couldn't speed to the front of the line anymore. I consider these large trucks to be the equivalent of anti-cancer drugs. Probably resembling the alkylating agents, as they don't destroy the car (cell) but just disable it from speeding to the front (metastasizing or invading surrounding tissue). I wish I could buy those alkylating agents a beer. I have a feeling I'll think of a better analogy when I'm trying to go to sleep tonight, but this is one I've actually had in mind for a long time, believe it or not.

There is no doubt that the signalling pathways, molecules and cancer drugs play a huge part in my education and I'll strive to know everything that I can about them. There are times, however, during my moments of introspection (which are of lesser quantity these days, but I think the quality has suffered less than I feared) that I have to wonder whether or not the cancerous cell is just mimicking the actions of the whole organism. Perhaps a question better left to the philosophers of our day, not the physicians. However, I've always hated the idea of being a one-trick pony.

Monday, October 3, 2011

When I was 22 years old, I was a contractor who, for the most part worked as a subcontractor for a couple of warehoused who contracted with different property management groups and small apartment buildings for floor covering replacement. It was lucrative work with minimal headaches, as most jobs could be completed with in the span of a day (granted, sometimes the days were excruciatingly long) and there was no sales or bidding of jobs -- which is really a headache. Work was often cyclic with the summers being the busiest times.

I remember the summer when I was 22 quite well. It was the summer that I eventually made the decision to get out of the construction business and move to Colorado. But that is a different story (kind of) and several months before I had the inkling that I would be moving out of Oregon (born and raised in the eastern edge of felony flats of Portland) I found myself trying to manage the flow of work, which was good. Between myself and my crew (a couple of friends who had as much experience as I did in the business, making the "boss" a title in name only) we sometimes came across apartments that needed carpet and pad replacement that still had quite decent padding. Perhaps the tenants made quick work of the carpet, staining it with various fluids (that I won't go into) and who knows what, but the carpet wasn't actually that old. These cases were candidates for leaving the existing padding, and just installing new carpet over the top. After all, who would know? This was especially tempting on concrete subfloors, as it means the pad was glued down and was really a pain in the rear end. Really, except for the fact that the property owners were paying for product they weren't actually getting it was a high reward, low risk type of risk.

One afternoon, somewhere in the west hills of Portland, I got a call from the warehouse manager who called to inquire about a unit that my crew had done a few days prior. It was a unit in the same complex that I was working at when I got the call -- we had actually been there working all week. The manager asked me if we had replaced the padding in the other unit. I could tell she wasn't happy. After a big breath and a big cringe, I decided to 'fess up. I also told her about another unit that we did in the complex without replacing the carpet padding. 

This is not one of those stories where I do the right thing, never to make another mistake again. This was just one in a long line of lessons learned. I really have no idea if that warehouse manager even remembers me, or that incident, but I sure do.

I was thinking about this today when I had the radio on coming home from school and the radio guy was talking about the 49ers win over the Eagles yesterday and how he thought that just the fact that they were able to pull off the comeback would yield one or two more victories this season. He wasn't saying that the abilities that got them the win yesterday would pay off, but that the momentum and the confidence that arose from the specific parameters of the victory was valuable in and of itself. I can't completely disagree. It got me to thinking about how I've heard others say (and have been known to say myself) that 'you just have to fake it until you make it.' Well, I would argue that faking it only goes so far, unless you do, indeed 'make it' at some point. I'm sure we can all envision that character who has shown so much confidence but failed to produce anything of value. That person sure was faking it, but just never made it.

That one incident, in what at times feels as if it were from another life, kind of allowed me to remind myself that I could indeed stand up and do the right thing. By no means have I always done the right thing in every situation since then, but I do think that it may have gotten me out from under the temptation to do the wrong thing, at least once or twice since then.

In medical school, we are taught to introduce ourselves as "student-doctor Smith" while in our doctoring labs, and I'm fairly sure that is how we'll be instructed to do it once in the clinical setting, you know, like, for reals. Perhaps I should amend that 'fake it 'til you make it' to a more situation appropriate 'forsake it 'til you make it' as far as thinking of myself as a doctor. Obvious, but sometimes I can get ahead of myself, no doubt. Especially after killing the test this morning -- finally, a performance I can be proud of. Granted, we haven't gotten the results back, but I already know that my amended studying techniques have payed off. Thank God . . .