Balls in the air

Before I complain, here's a picture from the beach yesterday. I sometimes forget it's even there, when I'm studying/stressing over something. So I go take a break, and then forget it once more, as I go back to the books.


There's so much to do, sometimes I wonder if I'll get through it all. Not that I'm preoccupied about making it - rather I'm concerned that, with this intense level of details, I won't know it all. It doesn't matter that I remember the lectures - I have to be prepared to recall a plethora of, at times, seemingly random bits of data. Sure, there has to be balance (between classes, not in life - are you kiddin?), but at the same time, grades are a numbers game. The lion's share of my focus always goes into the next big grade. Usually, that's a mini-exam, for which I have to study most things fairly equally. As is the case with lab practicals, though, I have to focus in on a few subjects. This time, I'm spreading my time between anatomy, neuroscience, and histology. I don't think the histo exam will be that bad - I just stare at it, and it makes sense. Now, I love anatomy, but I've heard that this particular exam is an absolute beast, so that's been getting extra time. Neurosci I love, but I havent' been giving it as much attention as I should have - especially since the practical is cumulative.

The fact of the matter is, though, that there isn't a whole lot of time to study - we get out of class around 3-4 most days, and and then the rest of the day is left going over old info, going over info from that day, and then the practicals (which are next Friday, by the way - so I have little more than a week). Just after that, though, the Shelves are going arrive, and then, we'll have mini 3, where will be tested the other information I've been complaining about.

There just doesn't seem to be any rhyme or reason to much of it. I know that, when I get to clinicals and even residency, those hours will make my current situation look like a walk in the park. However, it'll all be a bit more unified. I won't be running around like a chicken with my head cut off, trying to learn population genetics, which bony structures drain into which nasal meatus, and the exact cellular make-up of the eye, while trying to figure out the tracts of the limbic system, and what a histological slide of the gallbladder (no submucosa) looks like. I could be wrong, but I expect there to be an absolutely intense level of detail - I also expect it to be in the same ballpark, where the details will hopefully means something to each other.

I'm just complaining - I'm tired. Things seem to just suck up my time. Yesterday, we had a clinical applications quiz, worth possible extra credit, for physiology (male and female reproduction, fertilization and pregnancy, parturition and lactation, etc). The professor has this way of writing questions in such a way as to obscure what he's asking. It's almost like he takes some pleasure in obscurity, in confusing a whole bunch of second semesters. I look at things this way: I can accept getting questions wrong if I didn't know the information, or didn't remember it. That shows me that I have to study harder, and where I should focus my time. If, however, because of the way some professor wrote a questions - if, due to the random placement of words and arrows and boxes and positive or negative signs - I can't figure it, then that professor should re-write the damn question. No students should have to ask "exactly what do you mean who you put together this collage of symbols?" Give me a break. I don't like my grades depending on the fact that someone doesn't know how to write a question. That kind of thing pisses me off.

Today, though, the sucker of my time is going to be a charitable effort - I'm going to go and pretend to be sick so I can be interviewed by 3rd semester students. For one, I'll get to see the whole process, on which I will be graded in a few short months. Also, the director of behavioral science says he'll "note my participation" when he goes to write a letter of recommendation for me (and the 100 other students who volunteered).

In a perfect world, it wouldn't be storming outside right now (almost with the fury of a Texas thunderstorm). In a perfect world, I'd have class everyday until noon, spend the rest of the day studying with perhaps a quick break for the gym, and rarely be so tired I can't focus. When you get down to it, though, no one said it'd be easy, and I guess I oughta just suck it up. It's going to be a fight, and I'll be damned if I'm going to let them win.

On another and completely unrelated note, even though I have very, very fond memories of ours spent watching TV and playing video games in my room, I don't think I want my kids to have TVs in their rooms. As folks now think, TV might cause Autism.

No rest for the Weary

I think I know what insomnia feels like. It's not something I've ever had a problem with, but let me tell you - it's the damndest thing. I'll be bone-tired, barely able to keep my eyes open and knowing, deep down, than any further words I read printed upon the pages glowing so brilliantly beneath the halogen lights will but gloss across my memory like flat, smooth stones across a glassy sea at sunset. Perhaps they'll leave ripples, but they won't sink in. That's probably not the best analogy, because the stones will sink eventually - but the words won't sink in where I want them to; they won't slide comfortably down into the highway between short term and long term memory. So, when I get to that point, I quit - I pack up my things and go home, because anything else would just be a waste of time.

Like lobotomized zombie on a high dose of sedatives, I shower and/or brush me teeth - I can't really say; it's generally pretty bluury. With the finality of a really, really big tree falling for the first and last time into twilit leaf litter (because that's how I like to think of myself), I fall into bed, anticipating a deep and dreamless sleep. However, forty minutes later, I'm tossing and turning. It's like I'm missing some neural process necessary to completely descend the column of sleep, but rather hover between merely having my eyes closed and the beginnings of drifting off - when I'm sudenly yanked back to wakefulness. I thought that perhaps it was due to the heat - so I duct-taped 15 tall, white trashbags to my windows (which aren't really windows - they're wooden slats covered by mosquito screens), and turned up the AC. Oddly enough, that didn't really work.

It's really very strange. It almost always (listen to me - I'm talking like I'm a regular insomniac, but in actuality it's only been three or four times) happen when I'm really tired, and when I really need to study the next day. Truly, I have no idea, but I think there may be something I'm allergic to. Maybe it's my subconscious mind, running blindly through the ever-increasingly convoluted corridors of my memory like a screaming four-year old (but, since it's subconscious, it's completely unbeknownst to me - which is why I don't know what's going on).

I have three practical coming up next week - anatomy, histology, and neuroscience. Then, the week after that, I have 5 shelf exams from the National Board of Medical Examiners. After those, I have the third mini exam. I REALLY need to sleep. As much as it truly hurts my heart to consider, I might have to institute a "no coffee after dinner" policy.

Misdiagnosis

Here's a funny story. So Saturday morning, Nicole and were nearing the completion of our DPS practical (an assigment in our class Doctor, Patient, and Society in which we had to craft a History of the Present Illness for an imaginary patient), and were walking down the hallway after a breakfast of pancackes. I noticed the cleaning woman, walking very slowly towards the landing, leaning against the wall. Having just researched certain neurological conditions for the paper, I immediately wondered what could be wrong with her - was she experiencing some hemiparesis (one-sided weakness)? Should I check see if she was alright? We passed her, and as I glanced over my shoulder at her, she said something very softly, something that sounded like "be careful" or "watch out". And then I heard the scraping.

Just ahead of us, the hallway opened into an open-air landing, with a little white balcony and stairs heading down. Behind the traschcan, a large, scrambling shape caught my attention - it was a dark-green, 3 foot-long monster of an iguana that looked like it stepped right out of the cretaceous period, perched precariously over the edge of the railing. I saw it before Nicole did, and I must say - I thought it was the cooolest thing I'd seen all morning. However, in the next second, right before Nicole saw it, the thing disappeared from view for a few interminable seconds. Next came a solid, heavy *WHUMP* into the grass below. I quickly crossed to the balcony and peered over the edge, wondering what a 30-foot drop would do to 20 lbs. of reptilian muscle. Apparently, not a whole lot - the giant iguana scrambled away into some greenery.

When Nicole and I had descended the stairs and were making our way to the morning anatomy T.A. session, the beast was gone from sight. It then occured to me, that things would be very different had we been, say, 20 seconds earlier.

And the Crickets Sang.

That's not the sound of real crickets - it's the metaphorical humming emptiness of my blog posts, and therefore my life in Dominica. I don't mean to say that it's meaningless - just that, in the grand scheme of things to post about, my experiences here have been, and are generally, miniscule. I don't want this to end up as yet another revision of my class notes, although there are some interesting course-work related things I may briefly tell you about.

Nicole and i made our way to an AMSA suture clinic and tried our hands at subcuticular stiches. This is one of those things that the layman never really thinks about, but once you slip on some surgical gloves, makes complete sense. (Please don't think me pompous for phrasing it like that; in every meaning of the word, I'm still just a layman, although one who admittedly relishes the feel of those surgical gloves). People don't like scars, and the interrupted sutures can leave these unsightly pinpricks along the scar lines. Lucky for me, the suture clinic director (who happened to be one of my dissection supervisors from last semester) is also a plastic surgeon - enter the Subcuticular suture. The point and procedure are this: suture are made as alternating, horizontal loops within the layers of the skin, such that pulling taut the thread gives the appearnce of closing the skin with an invisible zipper. I wish I could explain it better - the suturing is completely hidden from sight, and heal that way, leaving minimal scarring - a must for cosmetic surgery patients.

That was, perhaps the most interesting spot in recent memory. Oh, I could elaborate on the many contributing factors in antibody diversity, or the differential memory formations. I could even explain the highly confusing muscles, vessels, and nerves of the neck. Speaking of the neck, I actually spent yesterday dissecting out the infratemporal region - facial arteries and the like. This was actually a pretty cool lab - you see, there's this nerve bundle that runs down in your jawbone (mandible) called the infra-alveolar nerve (along with its artery) and, which takes sensation to your teeth. My table was one of 2 of 20 tables selected (ok fine - we volunteered) to carefully chisel out the entire canal and follow the course the nerve, in addition to cleaning out the facial arteries and nerves. Maybe I'm just a little odd....I greatly prefer the labs that involve chisels and saw. To make a long story short, we chiseled through the mandible to expose the canal and sawed away the upper half, opening up the cavity behind the zygomatic arch (a.k.a. cheekbone, which we also sawed away).

Aside from that, I haven't been up to much else - going to class, stealing some gym time when I can, and doing a bit of reading. I downloaded R.A. Salvatore's Dark Elf Trilogy, after all of these years of intending to, and sneak a few pages during the boring points in class. On Sunday, Nicole and I took a stroll along the beach - we've been down to the sea surprisingly few times this semester, and we've snapped surprisingly few pictures. Here is one of the sea, and one of a flower that is definitely an orchid.

By the way, we had a BIG test last Monday - I usually post directly after them, but I must have been caught up in something else this time (I can almost assure you that it was the surgical triangles of the neck). Anyway, this was perhaps the most conceptually difficult exam I've ever taken, but it might have been my best exam so far.

To Sleep, Perchance to Dream

That sounds like the beginning to a really deep post, doesn't it? 'Fraid it won't be, though. Nevertheless, I do have a lecture on sleep today, and I think it's incredibly fitting. I haven't been getting the best sleep of my life over the past few months (big surprise there, right?). In fact, my relationship with sleep mirrors that of most Americans - I don't get enough. It all started back in high school -while I was studying world history, actually. I hadn't done all of the reading for the next day, and I realized with a dawning, life-changing moment of clarity, that I could simply stay up and work. That was the beginning of everything; I began to relish those quiet, lonely wee hours. I liked the fact that there would be no one awake but me. Of course I stayed up late playing video games and watching TV, but the soft silence of those hours completely changed the way I studied - I conditioned myself to be able to focus better after dark. In college, my best papers were written after 2 am. The other edge of that sword, though, is that people simply work best during the day - and my nighttime habits are perhaps a contributing factor to my ending up at a Caribbean medical school. I won't mince words - I partied too much - but implicit in my thinking that I could study better at night, after everyone else had gone to bed, was the sense that there was always time to work on things.

That spiraled out of control a bit - I didn't have a high-enough anxiety level to push me to work harder. I'd wait until night came to work on things. There was, however, one time in my life when I made absolutely sure to get 9 hours of sleep a night - during the summer of my sophomore year in undergrad, I worked as a phlebotomist. I was fortunate enough to be trained directly by the lab director at the hospital, rather than spending a lot of time on the certification course. It felt like real medicine, and that made things a bit more realistic for me - I was determined to get it right. I felt that I couldn't go in there and miss stick and stick, and I noticed an obvious correlation between how rested I felt and how well I performed. Thus, I slept peacefully that summer, and got to the place where I felt that I could draw blood with my eyes closed.

Undergrad continued, and with it the late nights and the quiet focus that lives in darkness and stillness - nothing had changed. Now i find myself in medical school, where I'm more dependent than ever on the effective shuffling of tiny details from short term memory into long term memroy, and the neural synthesis that only comes from substantial REM sleep. I see my classmates staying up long into the night to go over things, but here I've come to appreciate the fact that, in order to do well on the tests, I need a certain level of familiarity with the information - I need to see it with a certain clarity and transparency. I simply cannot reach that level if I stay up into the wee hours; it won't work if I don't sleep. Perhaps it's the 8 am classes every day - sure, I had to be up at the same time for my work at the health plan, but that didn't require the same level of cortical functioning. For me, now, the wee hours are after 8pm.

Now, my saying that I've cultivated a greater respect for sleep doesn't mean that I get enough, but I'm working on it. I know that I shouldn't watch TV just before going to sleep, because I need to be my brain to release melatonin - which it does in the dark. I need this sleep like I've never needed it before - I depend on it. I can thank Nicole in part for this ideological shift; the girl loves sleep like I love caffeine.

Our sleep lecture is next; right now, the professor is talking about neurotransmitters and how he rescued a cat poisoned by strychnine.

Recently, I read Almuric by Robert E. Howard - author of the Conan series. Apparently, he was good friends with H.P. Lovecraft -another one of my favorite authors. I miss reading for fun, but I guess I can take pleasure in reading about the thyroid gland. Psch....right.