Darkness

An interesting thing happened to me last night, that really made me realize that I'm in an entirely different country. Nicole and I had just finished a hard day's work of studying at our favorite study space, and were heading back home. Quite suddenly and shockingly, everything went black - literally, profoundly black. We were suddenly plunged into such an utter, complete, stygian blackness that I was stunned for a moment. After a few moments of shock, I had to look up at the stars to see that I actually hadn't been struck blind. Everywhere around us had been plunged into a blackout of such impenetrable and complete darkness that the two or three seconds in between the actual blackout and the automatic engagement of the emergency generators seemed to drag on forever.

Blackouts in America aren't like that - there's always a streetlight living off of city power, or perhaps the other side of the road remains lit - at the very least there are car headlights somwhere - but never before in my life have I see it as dark as this. I didn't know the world could be that dark. Anotehr interesting thing is hat it was aboslutely silent as well - no sound, no light at all. Everything just very suddenly went very still and dark. I thought it was pretty cool, actually

In other news, I have a histology lab practical a week from today, and then, a week from Monday, we'll have our second big exam. I've come to realized that this is going to be all I do for quite a few years to come, and so I've enlisted my little brother to watch movies and read books, that I might live vicariously through him (as you may think you're doing through me, here on this warm, Caribbean island, taking pictures of brilliant sunsets. What you don't know is that I have my nose in my nose half the time, and the other half of the tim I'm splitting it between class and the anatomy lab).

Speaking of which, I had the pleasure of dissecting out the anterior leg yesterday, and it just wasn't as cool as it had been before -perhaps the lab has lost its luster. After a while, muscle looks like muscle. It is, however, a little humbling and surprising to realize that, after searching the whole time for the dorsalis pedis, it's right there on the top of the foot where it ought to be (and was just pretending to be a nerve). I should have followed it down from behind tibialis anterior like they suggested, but oh well - you live and you learn.

Fearfully and Wonderfully made

Here is my second home - this is the study space at which I spend almost all of my time. I should have taken the picture from the path to the school, because it would have cut out the telephone pole, but I didn't think about it - perhaps I'll replace it later. On another note, I perhaps should apologize to some of the Ph.Ds who may have been offended by my post-exam rant - I know they work hard and are respected members of our academic community. However, during a TA session in the anatomy lab today, Nicole started to not feel so well. She went outside, got some water, and sat on the steps. Apparently, a professor walked by, glanced sideways at her, and just kept on going. While I find it a little strange that they didn't stop to ask if she was alright, I'm not really surprised; they're not real doctors anyway.

There is a street, here in Dominica, called Moo Cow Trail. As you can probably tell by now, in addition to being populated by med school students, Moo Cow Trail is also home to many of the island's bovine residents (whose amorous lowing often keeps my classmates awake). It would appear that late February - early March is vacation time in cow-country. The cows have relocated from their trail to the grassy hills below my balcony, where they have a lovely view of the Caribbean Sea, and can rub elbows (hoofs?) with students returning from class. This one had horns, though, so I didnt' want to get close enough for a really crisp picture.



It's Sunday - I'm going to preach a bit.

My favorite Psalm (maybe my favorite chapter) in the entire Bible is the 139th Psalm. It's a somewhat atypical praise of God's goodness from David - instead of exalting the Lord for His faithfulness and mercy, David basically praise Him for two things - God knows us intimately, and planned out the human body with complexity and love. I've always liked it - the last two verses are my favorites, but the longer I'm here at medical school, two particular parts seem to become more true every day - the "fearfully and wonderfully made" portion, and the part in which David says "You are everywhere" Here it is:

For the director of music. Of David. A psalm.
1 O LORD, you have searched me

and you know me.

2 You know when I sit and when I rise;
you perceive my thoughts from afar.
3 You discern my going out and my lying down;

you are familiar with all my ways.
4 Before a word is on my tongue

you know it completely, O LORD.
5 You hem me in—behind and before;

you have laid your hand upon me.
6 Such knowledge is too wonderful for me,

too lofty for me to attain.
7 Where can I go from your Spirit?

Where can I flee from your presence?
8 If I go up to the heavens, you are there;

if I make my bed in the depths, [a] you are there.
9 If I rise on the wings of the dawn,

if I settle on the far side of the sea,
10 even there your hand will guide me,

your right hand will hold me fast.
11 If I say, "Surely the darkness will hide me

and the light become night around me,"
12 even the darkness will not be dark to you;

the night will shine like the day,

for darkness is as light to you.
13 For you created my inmost being;

you knit me together in my mother's womb.
14 I praise you because I am fearfully and wonderfully made;

your works are wonderful,

I know that full well.
15 My frame was not hidden from you

when I was made in the secret place.

When I was woven together in the depths of the earth,
16 your eyes saw my unformed body.

All the days ordained for me

were written in your book

before one of them came to be.
17 How precious to [b] me are your thoughts, O God!

How vast is the sum of them!
18 Were I to count them,

they would outnumber the grains of sand.

When I awake,

I am still with you.
19 If only you would slay the wicked, O God!

Away from me, you bloodthirsty men!
20 They speak of you with evil intent;

your adversaries misuse your name.
21 Do I not hate those who hate you, O LORD,

and abhor those who rise up against you?
22 I have nothing but hatred for them;

I count them my enemies.
23 Search me, O God, and know my heart;

test me and know my anxious thoughts.
24 See if there is any offensive way in me,

and lead me in the way everlasting."

Where can I go from your Spirit? Where can I flee from your presense? I don't know, but Dominica isn't one of those places. God's with me here too - in the study spaces when I'm trying to cram everything into my head, in the lecture hall when I'm taking notes, and in the anatomy lab, when I'm dissecting and studying. It's in there, more than anywhere else, that I see how fearfully and wonderfully made we are. Did we really need the flexor retinaculum to keep our wrist tendons from bowstringing? Was it absolutely necessary for our major arteries to be deep in our limbs, protected by muscles? Does the hand have to so intricate and complex? I don't think any of those are necessary, but I think that God loved us so much, that even before He created us, He planned to make us incredibly intricate, fully able to enjoy His creation. It's almost laughable to me that some people believe that millions of years of beneficial mutations got us where we are. The complexity of the clotting cascade alone is amazing - it's a system of checks and balances that makes the American government look like children playing in the sand. I can't believe how people can look at a handful of 15 (at least) different factors and proteins for blood clotting alone and ascribe it to chance. I prefer to believe that God planned it that way - it just makes more sense.

No wings, just thighs.

I've noticed that most of my wordier posts arise in response to my time spent in the anatomy lab, and this one will be no exception. First, let me start of by saying that I've been paying for it ever since we had that first, ridiculously simple lab - our exploration of the vertebral column involved so little time and effort (a mere incision along the dural sac), that everything we've done since then has resulted in the tedious removal of more fat and fascia than (I'm guessing) most plast surgeons do in a year. We cleaned out the thoracoacromial trunk from its fat-glob covered nest behind the pectoralis minor, we cleaned and separted the muscles of the forearm and demonstrated the structures within, and yesterday my group and cleaned the anterior and medial thigh compartments. It's funny...the group before us had to disarticulate the elbow and shoulder joints. What does my group get? Another muscle and nerve extravaganza. I'm not complaining - it was GREAT!

On another note, this stuff is starting to get thick, like the blood of a waldenstrom's macroglobulinemia patient. Just after the mini, they threw us into blood proteins, diagnostic enzymes, hemoglobin, and clotting. This week, it's been some more hemoglobin, a bit of neurophysiology, and some more histology (muscle and nervous tissue, the placenta, etc.) I don't know if the work is pickingup, or if it's just that I've been made aware that an entirely new and arbitrary level of detail is required of me. I don't think I'm going to let these Ph.D's slap me around anymore though - I'll show them; they'll be amazed at the useless trivia I can fill my head with.

On a more somber note, one of my roomates from MERP died last week - we had his memorial service two days ago. He'd had a bout with pancreatic cancer a few years ago, and, after some aggressive treatment (full whipple surgery), made a recovery. He passed MERP and was supposed to begin with us, but he must have relapsed, because he deferred. His girlfriend also goes to Ross, and he came down to visit her a few weeks ago, looking much thinner and much sicker (though he had all of his hair, so he probably wasn't on full-scale chemo).

Here's a picture of where I live. This is the view as I head back home from the special study space (which I havent' enjoyed as much recently; the home-desk has been sufficing). I'm planning on spending a big, fat chunk of time over there on Saturday; there's a level of comfort wtih the information I know that I need, and I'm going to get myself there, come hell or high water (Genetic pedigrees just aren't intuitive to me). I live on the third floor, so that top landing you can see just beneath the palm fronds is the entrance to my hallway. There are a couple telling things about this picture - first, the ocean is mere feet away. Second, that's actually a telephone pole with power-lines! I know, I know - the third world is coming alone. They've got telephones AND iguanas!

I spoke too soon!

So you know how, in my last post, I'd kind of downed Dominica, saying that there wasn't really anything special about the Nature Isle? Well, as I was walking to the upper deck (after a pizza-lunch at Perky's), I saw the coolest thing since the the Dirtfish on the Cabrits - check out this gigantic iguana! For some reason, seeing this just lifts my spirits - when I was a kid, I had this fascination with gigantic lizards (mostly dinosaurs, like all kids), but this is by far the biggest lizard I've seen in the wild, close enough to touch. I mean, look at that guy! Ok, Ok - I take it back; this island does have some cool stuff. I'll name a few: I can eat mangos every day, the beach is a few feet from my room, and there's a gigantic iguana sitting somewhere in the tree in front of me. Funny - it's a mango tree. If I was an iguana, I guess I'd hang out on the beach in mango trees too.

I'm really going to have to work hard on this semester; I've kind of been scared into reality by seeing that last exam - the level of detail permeates everything. I thought blood was really interesting, but we're kind of done with it for a while - today we were lectured on hemoglobin genes and basic neurology (which I know I'm going to enjoy). So, today's going to deal with a lot of reading - anatomy, biochemistry, histology, and I'm going to hope that, somehow, entire biochemical pathways, rather than just random (possibly useless) snippets of information stick in my head.

Back with a Vengeance

I'm feeling very vengeful - I feel betrayed and a tad jostled around. The reason for this - as well as the reason for my (conspicuous, I'm sure) absence over the past few days, is that Ross held their first semester I mini-examination a few days ago, on the 18th of February. Granted, I'm not feeling all that vengeful, really; I just feel like complaining a bit.
IT WAS REALLY HARD!!!
That was expected, though - I knew it wasn't going to be easy. I didn't expect it to be a cakewalk. Hold on - let me pause to say that I'm pretty sure I passed. I was just a little unpleasantly surprised by the level of attention to detail required of us - the questions didnt' so much reflect the teaching. Here's a primary point in my complaint: I'm being taught by Ph.D's - not medical doctors. They want me to know things in much more detail than any (dare I say) real doctor will ever use (Sorry about that, Uncle E).

Nevertheless, I did fairly well, considering that something like 43% of our class failed everything and 60% failed biochem (the big subject this semseter). Was I where I wanted to be? Not quite, but I can get there. There's a new level of detail I need to slip into my studying, and along with that comes the realization that God put every single one of those tiny little cellular junctions and molecules in there for a reason, so I shouldn't complain too much. Those numbers, though, are quite alarming, and lead me to wonder if (1) the professors are maliciously writing questions to bring people down, or (2) they're just bad test writers. Because, honestly a 60% failure rate can't be attributed entirely to the students.

I know, I know - I should post more; but I'd hate to bore you. If I posted every time I got the chance, it would sound a lot like "studying.....still studying......turned the page.......still studying....." However, this week I have the pleasure of dissecting the anterior and medial thigh, which I am very much looking forward to. In addition to that, this is blood week, and our professors are flying through hemoglobin and the clotting cascade so fast, it's making my head spin. Although, I've got to say, I've always though the heme molecule looked like a pretty flower.

Last weekend, Nicole and I went out to Tomatos - a nice, rather American establishment, and I had my first glass of wine since setting foot on this rock. To say that it was absolutely fantastic is needless; though Caribbean blood courses through my veins, I think that I shall always choose a hearty red over ginger wine.

Perhaps, in a few days, I'll have more tightly plotted, effectively constructed post - for now, I will simply be contend with building lasting mental structure for hemoglobinopathy and the joint capsules of the upper limbs. Though I may be delving deeper and deeper into the human body, this island is still pretty, although, the longer I live her, the less I think of Dominica. Not that I'm homesick, I'm just learning that there isn't really anything special about this place. The food isn't that great, and it's kind of a backwards little place. This is the kind of country I'd run to as a fugitive from somewhere first-world. Really, I'm not being unfair - it's still a beautiful island. But that's about it.

Vertebra Prominens is not an empty vessel

Now begins the stressing - the lab practical is on Friday, and the first mini-examination is on Monday (don't let the name fool you; it's a big deal). We had our practice lab practical on Sunday, and it was a near-fiasco. 2nd or 3rd Students put it together, complete with wrong anwers. What runs through the paired transverse foramina of C7? The answer is not nothing - the answer is small accessory veins. There's a difference between nothing and nothing important. Also, who tags a vein and asks "what runs through here?" Give me a break - how did they get to second semester if they couldn't tell the delto-pectoral triangle from the cephalic vein? Not a difficult distinction. I like the anatomy - I just don't like when it's run badly; I'm not throwing myself into a lifetime of debt for shoddy lab-practicals.

I'm torn between force-feeding myself the new coolness of embryology and the muscles of the forearm; and reviewing enzyme kinetics, cell biology, and the distinctions between anomer and epimers (anomers are always cyclic, btw). So I'm reviewing hardcore now, and I've got to do a bunch of questions just like in MERP, and make absolutely sure I'm ready for this. I'm not to thrilled about the pedigrees, because they don't come to me as intuitively as some of the biochem (I know, that's a shocker), and it's not as interesting as some of the anatomy, but I'll brute force it until I've got it down.

Aside from that, not much is going on. I've gotten into the mindset I need to make absolutely sure I cover everything I need to. It' kind of like prison, only I'm enjoying myself -rather, it's like I'm relishing my assimilation into a new culture (med school, not the island - they can keep their slow-pokedness). Nevertheless, I'm going to include a picture of another famous island prison:

Deep in the Heart of Man

Well, i wasn't really deep in the heart - but I was close. The little area that I was so desperately searching for (dissection is REALLY hard, by the way), is called the thyroacromial trunk - it's a branch of the axillary artery, and it's deep and surrounded by fat.

I was very excited to get this dissection under way - this was the first time I was actually going to make a cut! remember my last dissection - the gloriously planned laminectomy? Well, the teaching assistants and lab professors completed the lion's share of the work before my group ever arrived - all that was left for us to do was make a simple incision along the dural sack, and identify the contents and surrounding structures. While it was an essential learning experience, I felt a little shortchanged - the group before us dissected the superficial muscles of the back, right down to the erector spinae, and the group after us exposed and cleaned the suboccipital triangle.

Thus, I studied our plan of attack from Grant's Dissector thoroughly over the weekend - we were supposed to skin the chest, reflect the pectoralis (major and minor), find the branches of the thyrocercival trunk (and cephalic vein), and finally, dissect down throuh external, internal, and innermost intercostal muscle planes. So I got to the lab, and they were having trouble with the prossector video - thus, my group and I decided to dive right in. The gentleman upon whom we have the continuing pleasure of working was lying on what used to be his stomach, that day - task 1: flip him. That being accomplished, we set to palpating the jugular notch (sternoclavicular joint, whatever you want to call it), because that was the point of the first incision. Please, do not think me odd when I say that I enjoyed the fluidity of my no. 3 scalpel's glide through this gentleman's pectoral skin - nevertheless, once the easy part was finished, the rest became very tedious. A lab professor came along and helped us find the cephalic vein in the delto-pectoral triangle - suggesting that we find the easy things and follow them back, rather than searching for a needle in a haystack (followin the cephalic would take us back to the subclavian - right in the vicinty of our goal).

The going was incredibly slow - so much so, in fact, that, despite our attempts to dissect everything carefully and preserve every little possibly important strand and fiber (artery? nerve? just fascia? ), several lab professors came along and pointed out what we needed and what we didn't, demonstrating the proper dissection techniques all the while ("This is medical school - don't hold those scissors like you're in kindergarten"). One even went as far as to say "See this? What is it? That's right...it's a vein. Are you looking for veins? Then cut it out and get rid of it!" That was the end of the excitement, as our lab devoled into an exercise in the excision of the tiny globules of fat that God put in to cushion the branches of thoracoacromial artery (and to teach me patience). It actually wasn't until the very end of the dissection when I felt confident enough in this to explain it to people for the demo.

(Just so we're clear, the thoracoacromial artery is a branch of the axillary artery, which feeds the clavicular region, the acromial region, the pectoral region, and the deltoid region. Clinical relevance? Working on it - although I suppose that it's not something you'd want to cut in surgery. Like most arteries)

This past weekend was very productive; we had that extra day because of Carnival. While I didn't get to go "jump up" and "mash it up" over in the next town just around the bay, I did get to listen to the continual, repetitive thumping of bass as I studied. The mini is on it's way, and I feel like I've got a decent handle on things, but decent isn't enough - I want to be adept in all things biochemical; I want to have mastered the minutae of microbiology; I demand excellent in the anatomical. Nicole and I have begun this grand note-collation, in which we utilize the objectives posted by professors concerning their lectures slip our own notes into this Medical Magna Carta - a single document (growing by pages every day) from which, hopefully, we will be able to study for the minis and the comprehensive tests at the end. She's much better about it than I am - but at least I'm not skipping class. I mean...I could be...we can watch all of the lectures on Mediasite (ad double speed, no less, which really works for some people), but I need to get my butt to class. That "I'll learn it later" mentality is what drove me to the Caribbean in the first place.

I'll post those pictures of my domain as soon a possible. And by domain, I mean the Island I occupy for 16 months, and the school at which I study. Ok, back to class - today is eukaryotic gene expression, fertilization, and the brachial plexus.