Becoming a Medical D.O.ctor

Your Worth

2011-04-22T20:15:00.004-05:00

The danger of deriving your worth from an outside source. I hear it all the time - "my life sucks." Or, "why me?." How about, "No matter what I do I can't get ahead." We blame our lot (reference intended) in life on our parents, our situation, and most disabling of all - God. Hold on a moment, I'm not suggesting you run away from your faith.

However, I am suggesting one place less emphasis on God for all of life's blessings or curses. As Americans we are a selfish nation, by design. We honor and cherish freedom and equality. I think that's wonderful. With that has come the obsession of God "doing" things to us or with us. As though the only thought in God's mind is - you. The "personal relationship with God" movement has gotten completely out-of-hand. Religious institutions use it to draw people into the community. It gives people a sense of wholeness and hope they might otherwise not have. Do I believe it is harmful? Yes.

Organizing your life is up to you. You chose to get up today. You chose to behave the way you did. You are excelling in life or merely getting by, because you chose your path. Which is not to say that sometimes terrible things happen that seem out of our control. But does God really only "bring you to it if he can get you through it?" I don't think so. You can get through it.

So what role does faith have in the 21st century? A sense of tradition. An ability to marvel at the greatness that exists. An example of how we ought to behave. A place to organize help in desperate situations. It is a community. It is a family. It can define and shape us, but again, that's because we allow faith to have that place in our lives. Religion is a steady mate, a perfect mate, a family, a home. It's a wonderful thing to have.

So whether your life is bursting with blessings or writhing in filth and despair, it is you who must live it. You who must shape it. I think God could use a little help from us. In fact, God might appreciate the assistance.

2011-01-12T20:52:00.003-06:00

Why me? I don't consider myself an especially empathetic person. In fact, if my Mother were reading this she might laugh at the thought. It's not that I don't care about people - I care deeply. However, I am extremely honest, sometimes to a fault, and that has gotten me into trouble from time to time. But now, now that is a huge asset. I can look my patients in the eye and tell them the truth - about me, about others, about themselves. And they open up. They let years of guilt and sadness and frustration out. They cry. They say things like, "I've never told anyone else about this. I feel very comfortable with you." It's extremely humbling and I cherish it.

Doctors often say, "Don't waste your time; patients never listen." I want to say, "Maybe it's you who isn't listening." People need to be heard. They need the time to find the words and courage to open up and have a discussion. I teach my patients by listening to them. I try to find where they are and join them on their path. Sometimes I suggest a new direction, but always with them by my side.

What will happen to me after I've been doing this for 10 years? I can only pray that G-d will give me the strength to keep on walking with my patients, because the journey is really amazing.

Real Men

2010-11-10T18:52:00.004-06:00

I wanted to write this for all men. Every man thinks they are the only one who -
cries - hard
feels guilty
has trouble being honest
loses his erection
can't get an erection
is ashamed to lose his hair
can't provide for his family
isn't very "manly"
enjoys beauty
feels unattractive
worries
feels emotions deeply
loves - and fears losing his love
likes to cook
wants to be at home with his kid(s) more
likes to sing, play an instrument, or write music
has inappropriate sexual thoughts, but tries not to act on them
loves his pet as if it were his child
feels very protective of his family
is tired

In fact, men are as varied, capable, and emotional as any other person - male or female. We give men far too little credit, and men don't tend to talk to other men about personal things. Gentlemen - I like this change. I like this "new" man. You are more interesting and worthwhile whole; please don't pretend to be "manly." You're much better this way.

Welcome to Ohio

2010-06-28T16:45:00.005-05:00

I love Ohio. I'm starting 3rd-year rotations next week and we are settled into our new apartment. Now I await board scores. G-d-willing I passed. Other than that, this no-stress time in my life is fantastic. I have slept more in the last week than I have in two years. It's wonderful.

One block from our home is a park. It's like going to a United Nations conference. The diversity and camaraderie are amazing. Everyone is so nice. People are exactly who they want to be or are becoming who they want to become. It's such a unique area. Love it!

I'm very excited to serve the patient population here. I like that I will get to meet so many different types of people. I get the opportunity to learn not only medicine, but how to care for people on a very individual level. From the Amish, to Orthodox Jews, the Urban black - it's all here.

I'll let you know how it goes. My first rotation - rural medicine.

I the meantime - I'm going to go get some coffee.

Retard

2010-04-21T22:56:00.003-05:00

Retarded. Slow. Someone who is retarded is slow. Someone who is a "retard" is a moron. No, not the definition of moron, a person with a mental age of 7-12, that's probably the definition of the person using the word "retard." Said "retard" is usually doing something that is considered stupid or otherwise uncool - often considered moronic. The standard moron is generally someone who would be concerned with appearing cool.

I challenge that your average retard - with an IQ of below 75 is probably operating at a higher mental age than your average moron.

The moron is concerned, because their mental age is probably permanent. However, they don't fully realize this. The moron will go on to live an utterly average life, always thinking he is better than a retard.

A retarded person, well before the moron, understands love and kindness. A retarded person does not understand hate. A retarded person excepts differences and embraces them. A retarded person is usually very gifted - in ways many people above a 75 IQ can't understand. It's a little too complicated for us. Example - a retarded person sees someone who is sick, dirty, homeless, possibly mentally ill lying on the sidewalk. The retarded person will note that this person needs some water and something with which to clean up. The retarded person, without hesitation, will offer help. Trusting completely. Knowing how to help. Loving unconditionally. I dare say, the entire country would be a veritable utopia if it were run by retarded persons and not morons.

Yet we are ashamed of retards. We look away, embarrassed by their utter disregard for our seemingly important conventions.

I'm thinking about this as I study congenital abnormalities and I'm faced with too much reality. Abortion. What do we do when we know the child is retarded? Abort. Not always. Certainly not, but often. Why? Really. Why?

I'm not with false hopes. I know that trying to get a child with Down Syndrome to understand that you're going to the park at 3:00 and it's only 10:00 is extremely frustrating. They have no concept of time. You will be asked 10,000 times if it's time to go to the park. No, you can't hug that stranger. Why? I don't know, it's weird.

I beg of you to say, "no" to all the prenatal testing. Cystic fibrosis? Abort. Really? Yes. Blue eyes. . .hmmm. . .risky. . . I joke because I'm uncomfortable.

Give the kid a chance. Are they going to cost us money? Of course, but so does the drunk, the illegal immigrant in the emergency room, the homeless person, the elder. . and on and on. I don't think you have that choice. Can't handle it - try adoption. Worried about your body getting all out of shape - try changing your insides instead of your outsides.

If they were meant to survive, they will. If they were meant to die, they will. Even if only for a few hours - they felt love. Everyone deserves at least that much. Please erase the word, "retard" from your list of insults.

The image was a very easy search. You may have laughed. I hope you'll go back, look at it again, and realize it wasn't funny. That would make you a recovering moron.

Elixirs!

2010-03-01T21:58:00.004-06:00

Okay, I must confess - I am a sucker for elixirs. Teas thrill me! I love putting together combinations of plants and voila - instantly healthier! Do I really believe that the kombucha fixed my week-long belly ache? No. Do I think that teas formulated especially for my girl-parts are going to make my plumbing healthier? No. What about things to increase memory? No. On and on and on. . .

It's the principle of the thing. The most gorgeous placebo. It works for me. I feel better. I am able to center my body and let it do the work of healing. Superstitious? Absolutely.

I have a kiddush cup that is called the four rivers. On that cup are 64 words written from the four rivers of Gan Eden. One who drinks from this cup, according to Kabbalistic teachings, is granted the secrets and blessings of healing from sickness - mental or physical, and infertility. According to Kabbalistic tradition, King Solomon learned these secrets from Gan Eden. I bought it. I promptly got pregnant - something I wasn't supposed to be able to do. Did the cup help? Doubtful, but it fed my placebo-addiction.

Why is our fascination with elixirs and placebos so alluring? Because it works. It works, because our bodies are exquisite in design. Leave it alone, focus, let it heal. Of course medicine is a great help - a life-saving help sometimes, but not always necessary.

It is a matter of trust. Trusting our bodies. Trusting ourselves to know when we need outside help. Which brings me to my soapbox - obstetrics.

For 200K years we've been able to keep the species going. Amazing! Hand washing was a great idea. It cut down on a lot of unnecessary deaths. C-sections, too. However, somewhere along the way we got lost, and we've never attempted to get back. We think we are improving outcomes, but we're not. We have entire generations of women who think they can't give birth without a doctor. And entire generations of doctors who are too afraid to say that obstetrics has become a sham. A type of, shall I say - quackery.

Why? Because if someone dies, the doctor is going to get sued into bankruptcy or worse yet, lose their license. We have forgotten that even in the best of circumstances, sometimes people die. But obstetricians rarely have a mother or baby die. Correct. The best midwives have the exact, even slightly better statistics.

Intervention is absolutely necessary sometimes. The real art is in knowing when to use it. In the meantime I encourage you to be realistic, honest, and drink more tea.

(the photo is from theinnershaman.com - no, I don't think these work)

Borrowed Time

2010-02-06T20:27:00.004-06:00

I have a friend who is battling stage 4 pancreatic cancer.

There is no stage 5.

Battling is not the right word.

I'm deeply troubled by this, because she is my age. Not because I see myself in her place, but because she has so much more left to do. She has so much talent. She is absolutely an original. She really thinks, which is such a rarity these days. She is an artist. She is a midwife (in training). She lives completely off the land. Or rather, she did. Now she's living with her parents and going to doctor's visits while trying to remain true to herself.

Is it the Tong Ren that is shrinking the cancer or the two sessions of chemotherapy she agreed to undergo? Is the special diet her alternative medicine practitioners have her on that is reducing her cancer and inflammation markers to normal levels? Is it her unbelievable strength that is helping her body combat such improbable odds? I have no idea, but it's got her doctors wondering. She has done the impossible - her doctors are asking about her alternative medicine practices, because they are completely shocked that she's not only not dead, but improving.

She's got physicians thinking outside the box. Is that the point? Has she done what she was put here to do? I don't know, but it is impressive. All I know for certain is that she is remarkable and I would miss her terribly if she were to die.

Every night when I lay my head on my pillow I reflect on how fortunate I am to have Jason and Helena in my life. I always thank G-d for the day and ask for just one more day with them. Please, just one more day. This ritual reminds me that we are mortal, and helps me to always re-evaluate how I'm doing as a wife and mother. If you were given just one more day, how did you do today?

Kol Tov.

(The photo is from a BBC News article about pancreatic cancer - it's a pancreatic cancer cell)

We are Dealing with People Here. . .

2009-12-21T21:16:00.005-06:00

The other day I was attempting to fill my car with gas. It was extremely cold outside and the card reader wasn't working and I was getting increasingly angrier. Finally, after three attempts I went into the station. I was prepared with a, "What the Hell?" kind of response. I waited while one women counted out her drawer and another put in hers. A shift change. Awesome.

The lady greeted me with such kindness and explained that the satellite was frozen, and that's why it wasn't working. She chatted a bit about having worked there for 20 years. We talked briefly about how things had changed since she started. She told me that a few years ago she would have just climbed onto the roof herself and fixed the satellite, but that was no longer legal. They were waiting for the satellite company to come and fix it. She talked about how fortunate she was to have such good employees and that she liked talking to customers. I had completely forgotten to be pissed off. I finished filling the car and headed home.

I hadn't really thought about it, but we really don't talk to people anymore. In fact, I'm so awkward on the phone that I dread making or receiving phone calls. I prefer email and text messaging. Almost every business call I've made recently is automated.

What do we, as future physicians do with this kind of patient? How do we handle ourselves? Is anyone well-versed in small talk anymore? Are we too "chief complaint" driven? I will not further complicate the matter with a discussion of time, because that will get me full-circle back to my original emotion - anger.

We are not solitary creatures. We are not meant to be alone. In fact, those that spend their lives in solitude are rarely well-adjusted. So why have we created this way of living? Why are we in such a hurry? I have one theory - money. The faster we see patients, the more money we make. Stupid, huh? Our job is to heal people or make their transitions into death as smooth and comfortable as possible. How can we do that if we don't know how to communicate with one another? We live all over the country, on small plots of land, using the internet to avoid each other. This will not end well. I can't find the exact quote, but I believe it was Sir William Osler who said, "If you listen long enough, the patient will give you the diagnosis."

"Next."

(The image is artwork by Andy Goldsworthy)

A Perfectly Different Baby

2009-11-24T22:43:00.005-06:00

Five down and two to go. Quarter five is now over. I didn't do too badly considering everything my little family has gone through in these last few months.

We knew when I got pregnant that I may not be able to carry her to term. We knew I might miscarry. When she was born five weeks early we were told she might have some brain damage due to her not receiving enough nutrition and possibly oxygen while I was pregnant. We knew she might have brain damage when her tiny four-pound body got bilirubin levels of twenty. We knew she might have cerebral palsy when she had sustained ankle clonus at two months. We knew she might have a seizure disorder. Now we are pretty sure she does not have cerebral palsy, but she might be autistic.

This all happened during fifth quarter. I did not fail even when I spent evenings playing with our Helena. I did not cry, because I love my daughter and will help her with whatever challenges she faces. Wasn't I even a little sad? Only occasionally, and then I am sad for her. I want Helena to enjoy her life and have every opportunity to thrive. She can do that even with a disability.

So does she have a disability? We don't know. The signs are there, but then again at nine weeks - Is she nine weeks old or developmentally only four, since she was born early? If she's only four weeks old she is nearly on schedule. We wait. We wait until she is six months old. That's a long wait.

My baby doesn't look at me. She doesn't smile much. She is very much in Helena's world. She loves music. She loves tummy-time. She loves to be tightly swaddled. She can stare at her grandma's quilt for hours. Is she disabled? I don't know. We wait.

People ask me - What can we do? I want you to look at my daughter. Hold her. Talk to her. You'll see - she's precious. She's perfect.

A New Baby, A Pile of Tests, and Contentment

2009-10-16T23:12:00.005-05:00

We are well into 5th quarter, and it has definitely been a busy time. Four weeks ago I had our daughter - a full five weeks early! After much drama and a week-stay in the hospital, we all came home and are doing well. Needless to say I didn't study that week. At all. Nothing. I thought I was sunk academically. However, I took five exams the following week, got caught-up and am now doing fine. I couldn't just let myself fail. I've come too far to just give up. Thankfully I have the world's best husband who made it possible.

In two days we have our second neuroscience exam of this quarter. It's not that neuro is particularly difficult. In terms of understanding the material, it isn't too bad. What's extremely challenging is remembering all of the pathways and putting it all together with increasing piles of information to hopefully sort out, in the end, what is wrong with the patient. I'm a little worried.

A lot of people think that I am somehow super-human for having a baby in the middle of 5th quarter and not failing out. It's like all things in a person's life - whatever pile is before you, you must either sort it or clean it. ;)

And now, after much sleep-deprivation, I will go to bed and get up tomorrow and study all day. I will take mini-breaks to kiss and hold my baby girl and talk with my husband. Really, I have an almost perfect life.

Interesting aside - as one gets further into medical school it starts getting easier. The classes don't get easier, but one acquires some duck-like skills and allows things to just run off. You do what you have to do when you have to do it and yet still make time for what's important. That's the difference between first and second year.

Survival!

2009-05-31T22:43:00.004-05:00

I cannot tell a lie - third quarter almost defeated me. It is also true that most of my classmates did well. I did not. In fact, I almost failed three courses. Yes, three. I managed to salvage everything from the wreckage, but it was absolutely the most stressful time in my life to date.

Most medical students don't fail - we fight and claw our way to the top or out of the hole. Unfortunately, I am not at the top of the pile. This makes it very difficult to see myself as a competent physician. Wait! This post is not about to deviate into the dark; do not fear. It is something I have had to contend with my entire life - I am not that intelligent. How did I possibly get into medical school? I'm above average, but that's about it.

You don't need me to point out to you all of the doctors of the world who could recite their lecture notes verbatim from all four years of medical school and yet they can't identify a disease in a real patient. The human body just doesn't like to play nice.

To future doctors - I urge you to remain interesting. If all you've ever wanted in your entire life is to be an otolaryngoloist, you're awfully myopic. There are all kinds of interesting things going on inside one's patients. I have three goals - one is ridiculously lofty and the other two are reasonable. I will not be upset if I don't make goal number one. I enjoy learning and people are fascinating. It's too bad some students can't find satisfaction in these things. Perhaps it is a mixed blessing that I have to struggle so much.

And now - I will continue to enjoy some break-time before preceptorship begins. I have never appreciated my free moments more than I do now. Medical school is kind of like being a POW - it's terrifying and sometimes unbelievably horrible, and then you're freed and it's unbelievable. The simplest things are so beautiful - like sleep and painting one's nails.

Medical Students are Crazy

2009-05-15T22:49:00.003-05:00

There must be an anatomy test in 2 days, because I've found time to blog. I'm not going to lie - the intimate details of the nasopharynx do not interest me one bit. Learning the material for this test is like trying to convince a teenager to practice the cello for 2-1/2 hours everyday. Considering that I used to attempt this feat on a daily basis I know it is impossible. Since I am not currently passing anatomy, this is a problem. Step one - I've admitted I have a problem. Step two - continue with blog and ignore problem.

We had a tornado this week which not only uprooted several locals and students, but uprooted our schedule as well. The dreaded microbiology case presentations were cancelled. I felt guilty for being so grateful, but there you have it, I was ecstatic - especially since I've chosen sleep over study recently. I spent Thursday helping clean up felled trees and brush from a local town. It was great. I became a doctor to work with and help people. Reality - medical school has nothing to do with that goal. I take every opportunity that presents itself to work with people in the community so I don't lose sight of my goals and forget that I really do like people. Okay, most people.

A room full of medical students - it sounds like the start to a joke - in a way, it is. I enjoy watching us, myself included, in groups like this. It's like having 172 type-A bosses all standing around and trying to be polite. It's downright hilarious. We enjoy each other, because we understand the pain and joys of medical school, but we can barely stand each other, because we're all so similar. Some take charge no matter what, and others stand back and talk about them behind their backs. Some ace test after test and they're idiots. Some fail constantly, and they're going to be amazing doctors. I have no idea how the world works. I'm not going to lie - it's fun to watch.

So there you have it - medical students are nuts. We know this, we're just trying not to have that fact documented on paper. Whatever you do, don't let them know you're bipolar! Good luck boys and girls. Now get back to studying.

Medical School with a Baby

2009-05-04T13:12:00.006-05:00

It has been quite awhile since my last post. Shame on me. Things really got interesting in second quarter, and third quarter is unrelenting. And then I found out, back in February that I'm pregnant. Mini-me was certainly planned, but not probable. I was not intended to have children, according to my doctors. Here I am, almost 17 weeks pregnant and at least so far, no signs of any problems.

I was waiting for some real inspiration for a post. Something uplifting and wholesome for future doctors. Something that will make the pre-meds very excited. Unfortunately I have had no such luck. It's not that I'm miserable, I'm not, but it's absolutely grueling, and sometimes that takes a toll on my usually positive self.

Balance. It's such a simple word, really. However, if one adds medical school and pregnancy to the equation the calculus becomes much more interesting. My pregnancy hasn't been too bad. I've been exhausted and quite sick, but nothing too major to report. Medicine of course does not care. It's not that my professors are callused and uncaring; they have been great. However, were I to put off a test on account of morning sickness, then I'd have to double-up studying for the next day's tests. Not an option. I dragged my sick and nauseated self to an anatomy final. I was sweating bullets trying not to hurl (chunder, vomit. . .). I managed and I even did all right on the exam, but it was pretty awful.

Balance. I cannot and will not spend all day and all night of everyday studying. The people who do that are machines, and not in a good way. People are not machines and algorithms do not always work. Creative thinking does have its place. I refuse to see people as merely a set of numbers. Those numbers are important, but if the doctor can't think beyond that - well then, you're going to have a problem.

Balance. What if I forget to listen? What if I'm so busy that I cannot really look? What am I then? I am that doctor that everyone complains about. The one who walks in the room and says without introduction to a cancer patient, "We're going to have to remove that finger." True story. It's unfortunate that every medical student (myself included) thinks that we're never going to get anywhere if we can't intelligently define LaPlace's Law. It's simply not true.

Balance. What does student Dr. Anne recommend? That you lay in bed for a few extra minutes every morning to take in the sounds. Look around at the trees. Have a good cry. Try to do better. We must do better.

The Physical Realm (not a medical musing)

2009-01-01T23:39:00.002-06:00

Today I went shopping. I hate shopping, and especially for clothes. Partly it's the guilt that overwhelms me. Guilt that because I have poor control of my food choices and my drive to exercise is weak, I am somehow not a good person. Okay, gross overstatement, but every heavy woman knows about what I write. It is so hard to be a fit American. We have french fries available to us every 20 meters or so, mochas at every corner, and fantastically comfortable furniture begging to be sat upon, layed in, or lounged across. I do love exercising. I used to be a weightlifter. So what's the problem? As with all medical students - I hate doing anything halfway. So - why exercise for only an hour? I want a three-hour-a-day body-busting routine. 60 pounds ago and a lot more free time - I had that. It's depressing to go run for 30 minutes and lift a few weights.

I need to get over it. Being a fat doctor just doesn't look too good. Be honest - you'd trust a fit doctor over a fat one. I could never look a patient in the eye when I had to tell them to lose weight. It's awful! I need accountability! I need time!

Fear not - I will not make this a New Year's resolution. That's just bad luck. Mope. That is what I will do. Then maybe I'll find the strength to take the cliched bull by the horns and treadmill by the rails. . .

Winter Break!

2008-12-19T14:31:00.006-06:00

Ah the sweet bliss that is break. Translation: opportunity to sleep. This is important. I had no idea what sleep deprivation really felt like. An all-nighter here, a few hours of sleep there - no big deal. In medical school we don't sleep, we take naps. My naps were getting shorter and shorter with the impending doom that is physiology. Last night (morning?) around 2:00AM I thought I felt a bug in my ear (literally). Then I felt something crawling in my shirt. I thought I saw a bug on the wall. I became quite paranoid - hating bugs and all. I removed my shirt to see if there was in fact a bug in there. Negative. Then it all rushed back at me in the silence of the night - I was hallucinating. I took a deep breath, inspected my garments and the walls, and realized there were no bugs. Problem averted. However, that ain't good. It's a very tenuous balance - do I get some sleep, or do I learn a few more tidbits in hopes of a few more points? Unfortunately, our tests are small and every point counts. So, usually we choose bugs in our clothes over sleep.

So why don't we all run away screaming? Because it's awesome. This week we learned how to perform an abdominal exam. I felt the aorta with my hands! I could feel my partner's kidney! I could hear what the bowels were doing. I could hear the clear pulses of a healthy person. It's amazing what goes on inside. It's amazing how beautiful is the human body. We worry about a little flesh here or a small this or that - missing what is to me, much more exquisite. Sometimes people don't understand how I can mean sincerely that everyone is beautiful. That sounds like cheap poetry, but it's true. The older individual that was my "simulated patient" - the body just looked and sounded like wisdom - its sounds are like, "Yes, I've been there and I've done that." It's physical history; living and breathing knowledge and experience. To have the opportunity to listen to and touch that person is quite a gift and one that requires an immense amount of trust. Trust that is bestowed upon me. That's worth some bugs in my shirt!

Post-Finals Quarter One

2008-11-21T18:13:00.002-06:00

Today marked the passage of quarter one. With complete exhaustion and utter humility I can say, I did well - despite it all. At 4:00AM this morning I was still begging my brain to remember countless dirty mnemonics to remember what all each of the 20 amino acids does/becomes. I was trying to remember every step and enzyme and enzymatic subunit of DNA replication, transcription, and translation. I was trying to remember what happens from the moment you eat your dinner to the moment what's left comes out. It seemed like billions of enzymes all starting with either gluco- or phospho- and ending in -ase. And the pathways! The pathways and their enzymes and things that can go wrong and what happens when things do go wrong, and what to do about it. . .and on and on and on. 500 pages of this!

If you are a pre-med student, do not tear-up your application. It's hard as Hell to get in. It's hard as Hell to succeed. However, it's great to be here. My friends and I discussed how it's similar to being in an abusive relationship - "It was my fault; I'll try harder next time." "If medical school didn't love me and want me to succeed, it wouldn't push me so hard." All right, that's a terrible analogy, but there's some truth to it. It's horrible, and yet, it's awesome. I bet you didn't know tonsils are also on your tongue and your palate. See - pretty damn cool.

It's worth it, even when I feel like I can't possibly take another day of this or another bad grade it all evens out, and by tomorrow, I will have had more than 3 hours of sleep, and that's truly wonderful.

What an honor - to learn so much about the secrets in every crevice and cell. It certainly isn't easy, but I'm glad I'm here.

Finals - Quarter One

2008-11-14T10:06:00.003-06:00

I can now understand, with a great degree of clarity, why medical students become hardened and uncaring. Unless you've been there, or are here, you can't possibly understand the enormity of the task and the feeling of utter hopelessness. It's just school, how can it be that bad? It is.

I'm not sure if it's the countless numbers of mind-numbing, "I'll never use this again," details, or the lack of time for anything else, or the bi-polar grades. Probably it is the combination of it all. The material is interesting; I wouldn't be here is I didn't think it was. The frustration of never being well-prepared is extremely taxing. There is not enough time. There is never enough time.

So what do we do? I think probably learn new coping skills. Take time when there isn't any. Understand that mediocrity doesn't equal bad doctor. In fact, some of the smartest people in my class are going to be awful doctors. It's too bad, really, that in the US we base success on the ability to memorize.

I can't see a better way to do it. You don't want a manual-dexterity genius taking out your gallbladder if they don't know exactly where it is and how to stop bleeding. You don't want a pediatrician for your baby with a cleft palate that doesn't understand where neural crest cells go. However, for those of us who struggle with memorization, we are suffering, and we will probably not have the option of a competitive residency. You're loss.

For now, I will be happy that I'm doing well-enough. I will play my cello and go on dates with my husband. I will play with my critters, and I will try to enjoy medical school without becoming a business-woman. "Next, please. . ." I will do my best to look you in the eye and give a damn.

Wellness

2008-10-03T13:14:00.002-05:00

Today is our once-a-semester wellness day. Though I need to study, I am listening to their advice and taking some much needed time off. I will study and work later today, but not right now.

Did I need a break? Yes! In fact, I slept for 11 hours today. It felt great. I feel so much healthier, especially mentally. I was getting depressed and overwhelmed, not because medical school isn't the greatest thing on Earth, but because it's so exhausting. The responsibilities are huge, and the amount of material is even more vast.

We are still learning about the upper extremities. I had no idea there were that many parts and connections. I still say - may you never need to memorize the brachial plexus. Also, I had no idea there were so many different muscle groups in the forearm and hand. Yesterday we dissected the hand on our cadaver, and I didn't expect to like it as much as I did. Everything was so neat and tidy - this small space of little muscles, nerves, and vessels. I don't know that I want to do such detailed work as hand surgery, but I certainly enjoyed learning the anatomy.

Other things that are humerous only from afar - carbohydrate metabolism. So, many people have heard of glycolysis or the Kreb's Cycle (currently called The Citric Acid Cycle - TCA Cycle). When everything starts with gly- or phospho- the brain starts getting mightily confused. I have over 60 pages of these words and diagrams to put into my brain by next Friday. Good times. It's really cool to see how that slice of bread becomes fuel, but it isn't straightforward or instinctive. However, I did learn why we fart. That was amusing. Unfortunately, it's not something I could explain without a fair bit of background information. If you want to know, ask, and I'll try to explain.

Send prayers to my little Francesca (one of my new mice). She has "wet tail," and although she is strong and determined, she is getting weak. I'm doing my best as "Student Doctor Anne," but I'm no veterinarian.

And now - off to study. Perhaps I will go get another piece of honey cake.

Rats

2008-09-24T19:41:00.004-05:00

I am trying to study anatomy. We are learning about the upper extremities. Though it is interesting, I have trouble focusing when reading Greek and Latin - neither of which I know to any usable extent. May you never need to memorize the brachial plexus. At first I thought our professor was making a joke. When I realized that he really does expect us to be able to draw it I wanted some Valium, a comfort blanket, and a little vodka.

My little rattie - Emmett has sustained neurological damage. Emmett got gravely sick about 11 days ago. He was fine and playful in the morning, and by evening I thought he had acute failure of something vital. He was barely breathing, immobile, and his face was crusted with porphyrin. I couldn't find a vet, so we had to wait until morning. By this time my little one was honestly starting to get stiff and cold. He was breathing a tiny bit. He had nothing to eat or drink for almost 24 hours. The vet was a jerk. He picked up my dying baby by the scruff and pronounced him "pneumonia." He injected him with Baytril and I requested some subcutaneous fluids. We took him home and waited for him to die.

Emmett didn't die. He did teach us that one can get really creative with baby food in order to hydrate and get nutrients into a sick rat. He got better, but he didn't. He was breathing fine and eating fine, but he couldn't follow my voice, and he was acting like he couldn't see. His pupils didn't respond to light. He is very sweet, but not playful anymore. I do believe my little rattie has come out a bit retarded from this experience.

Anyone who doesn't believe that all living creatures have a soul - I put him back in the cage with his brother (Martin). Martin is a very playful and instinctive little beast. I thought perhaps he might eat Emmett - thinking he was going to get them killed. In the wild, a disabled rat is like bait. Instead he started cleaning him and then cuddled up with him. This has been the pattern ever sense. He knows. He's being so gentle.

Another rat story - Martin decided that his fluffy "couch" should be in his purple house/nest. He dragged it into the house, and the next day, Georges (one cage over) did the same thing. He's almost three! It's not like he decided to do this all of the sudden. I do believe he learned from the other rat. And we think indiscriminate animal testing is okay. Stupid unfeeling rabbits and guinea pigs and rats. They are practically considered compost. Don't even get me started on mice. I hate it. I hate they way we do animal testing. There are so many things we can learn from tissue testing. We can keep growing tissues and cells in culture. Once that's well defined, then kill a critter. I wish we never had to do that.

And now - I go to the store to get foods for my Georges rat who is on antibiotics and hates them.

G'nite.

Mercury and Vaccines

2008-09-18T20:23:00.003-05:00

Today was a very mixed day. I failed my first exam - totally my own doing. I didn't study. So, I will be mending my ways. I'm not too upset. I just need to remember in the future that no medical school class is a blow-off class.

Also, today I participated in giving free health screenings to the under served. I was part of the blood pressure crew. I learned how to do it, and then I did several. It was just so gratifying to do something clinical - to work with people instead of sitting at my desk and studying. The participants were all very nice. I can see why a physician would choose to help the under served - it's a much different population. They were all very grateful and really seemed to want to take ownership of their health. Nobody came in with "yuppie disease." You know - "I'm allergic to soy, and my son has ADHD and Asperger's." Did you read in the news - people are pissed about chelating treatment for Autism being cancelled. That's where a chelating (tight binding) agent is administered into the bloodstream, in this case to sequester (grab) mercury molecules, because these people are convinced that vaccines containing mercury (more about that in a moment) "gave" their kids Autism. More likely - it's caused by excess opioids in the brain due to something vital missing - probably from a genetic mutation. This is similar, in my opinion, to Adrenoleukodystrophy - where one can't process certain long chain fatty acids correctly, and it causes all kinds of problems.

Some vaccines contain a mercury (thiomersal) compound. This is okay, because it is broken down in the body and eliminated in a maximum of 120 days. Small doses of mercury aren't going to harm a person. Remember when you played with an old broken mercury thermometer? You're okay, right? However, a fungal infection from the vaccine would kill a person. Additionally, you wouldn't think twice about using this compound if bitten by certain spiders or snakes. There are dying people who would love to have had these vaccines. People are ridiculous.

Anyway, I need to get back to biochemistry. You know, I'm sure glad not to have diphtheria (see photo - get your kid vaccinated!)

One Down. . .

2008-09-03T20:28:00.004-05:00

Today was the first exam of the quarter - it was beloved biochemistry. I was quite apprehensive - being that it was the first exam. I went in there quite prepared, and I'm very proud of the score I received.

Tomorrow is another day, and histology and anatomy are nipping at me for some attention. I better not get too confident, because the pile is getting higher and deeper, but this was a good way to get started.

I'm tired. I will have to write more at a later date. Is it bad to drink coffee, because I like it, and then have an alcoholic beverage so I can sleep? Hmmm, probably not something I should do too often.

Want Some Mo'? Gimme Some Mo'!

2008-08-31T21:35:00.004-05:00

All right - that was supposed to be funny. You know what's not funny? Studying all the freakin' time. When I take a break I feel guilty, because I know I need to be studying. When I'm studying and my brain turns into static in-between-stations fuzz, I feel guilty, because I am not the smartiest pants. My pants are going to get bigger if I don't get off my bum and start working out more!

So we were lectured on "balance." I understand that I need to close the books and forget about it sometimes, but it's so hard when I know the tests are creeping up, and the assignments are piling up. . .I've heard that shrugging the shoulders, saying something obscene, and walking away gets easier as the quarters go on, and on, and on. . .

However, despite my lack of focus and my heightened sense of dread at the impending exams, etc., I am having a wonderful time learning. The greatest word so far? Syncytiotrophoblast. Isn't that pretty. Say it again. Oh yeah!

Our first day of dissection was last Friday. I loved it times 10. It was extremely fascinating and absolutely exhausting. We, like several others, have an obese cadaver, and though I am endlessly grateful to this person for giving me an irreplaceable gift, it's a lot of work to get down to muscle. No doubt, it's a much better learning experience to go layer by layer, cut by cut, to learn anatomy. I hate the idea of prosection (where it's already done). Yes, dissection takes a huge amount of time, but I think it's absolutely necessary. Each body is different, and actually seeing it and discovering it is the best way to learn - in my not-so-humble opinion.

And now - tis time to spend some precious time with my husband. I think a little wine and relaxation will do a body good.

New Space

2008-08-28T18:19:00.004-05:00

I decided this new path deserved a new blog. Today was much better than yesterday. I was forced to use Excel yesterday, and that was a problem, since I have very diligently avoided learning how to use it. I honestly believe one could get a degree in Excel. Anyway, after three frustrating hours I found someone to help me. Voila! All I had to do was some algebra - that I can do.

I love medical school - so far. I've watched the second year students this week; they have finals. They are a tired and ratty-looking bunch of people right now.

Next week is my first exam - biochemistry. I'm nervous, because biochemistry was a disaster for me during undergrad, and it seems far too easy right now. Well, my first biochemistry teacher was a roaring drunk. Unfortunately I am being completely honest. His tests rarely matched what was taught. However, that lousy training made me ever-so-grateful for my current wonderful professors. I have one professor who could explain the derivation of the Michalis-Menten equation to a six year old.

After class today I worked out. I'm trying to get my fighter body back. We'll see how that goes when things get tough.

And now I bask in the glory that is medical school. For right now it is manageable and quite enjoyable. Today we started learning about the anatomy of the back. That, my friends, is some seriously cool stuff.

B'shalom