I feel like Dante.

I always feel this way, after a semester - I feel like Dante Alighieri. In the first and most hellish part of his Divine Comedy Trilogy, the excommunicated Italian poet Dante trudged through a lavish and brilliantly imagined Hell, led by the great poet Virgil. His trek began on Good Friday with a descent into the heart of the earth, and concluded on Easter Sunday morning, as he ascended from the depths of Hell, climbing out of the bowels of the earth to stand beneath a beautiful, starry sky. Yup - that's how I feel. The FINAL final was on Tuesday, and that's exactly how I feel.

It was a battle, to be sure, but, honestly, it wasn't that bad. The question-writing-professors could have been much more malicious, but in the way they put the questions together, I felt that they were, if anything, gracious. I think I did well - I am, perhaps, more positive since I did really well on that third mini (the test I had last Thursday). I feel that I'm getting a working understanding of this whole "studying for med school" thing - i kind of know the details they want from me, and I know the comfort level I need to have with the information. I know that I've got to do questions and questions and questions, and make sure that I've gone through everything several times. I've learned to stay extremely current - never letting a day go by without having covered the information. I've also learned about the changes that I have to make - taking a final gave me a unique perspective on the purging and retention of information, especially in light of (1) the Shelf exams I'll take next semester and (2) the Boards.

I finished the Beast about 40 minutes early, and went straightaway to James' Store, where I proceeded to purchase a case of Kubuli beer. It's not great - it's got a picture of Dominica on it, and it's smaller than the American beer, as well as being slightly less potent - but, like many brews out there, it's delicious when cold. This is one of those times that makes me truly glad to be here in the Caribbean with a favorable exchange rate - I bought a case of the stuff for about $60 EC - which roughly translates to each beer costing about $0.90 USD. I LOVE this place!

Also, I've finally been able to enjoy some much-needed gym time. Nicole's tagged along, and we're both working on getting beach-bodies. There's a delicious muscle-soreness that is only the product of careful, deliberate sarcomere trauma.

Perhaps the most exciting news concerning the ending of my first Lap around the medical school field of glory, is that I can read for pleasure without guilt. I love the Internet - I was very lucky to find the online text of one of the books I've been really looking forward to (Charles Stross' Accelerando). I say that I was lucky because this book was published in 2005 or 2006, and most of the books that one finds free online are either (1) very old, like The Wizard of Oz and Oliver Twist, or (2) so bad that no one wants to read them and publishers are still shaking their heads at the waste. So, I headed over to the computer lab and used my 140 page-a-week allowance to print out Accelerando, and now I have it next to me, hole-punched in a gray binder I bought off of a 4th semester student for $1 EC, as I sit here on the upper deck in front of Subway, listening to the breeze on this hot, carefree summer day.

Ugly Betty and Gray's Anatomy are on tonight, and Nicole's excited - I'm just glad that I have a new book, a mini-fridge full of Kubulis, and absolutely nothing to study for.

When the going gets tough...

The FINAL final is in 2 days. Last Thursday, we had mini 3. A week before that came 2 lab practicals. Sure, it seems crazy now, but second semester will only pile it up even higher with shelves and neuroanatomy practicals on top of everything else. Right now, the pile of stuff they want me to recall is overwhelming - I'm sure that, even though this is the final, they won't ask general, actual-medicine-based questions, and will continue to revel in pinging us with inconsequential minutiae.

The day before yesterday, I committed an almost unpardonable error - I read through James Patterson's Cross. For some reason, I have this horrible habit of beginning books right in the middle of finals. I started it a few days ago, and I wouldn't have been able to concentrate unless I finished it - I needed the mental break.

I keep motivated by telling myself two things:

1) God is in the details. If I'm searching for God's fingerprints while I study the body, and focus on the fact that I'm learning the rules by which He built His greatest creation, it makes it easier to concentrate. Also, I figure that if I take this attitude, He might be more inclined to help me do well.

2) The professors are trying to beat us down. Whether or not that's true, it feels that way at times, and it makes me defiant and competitive - more committed to success. I tell myself that they want me to fail, and I'll be damned if I'm going to let that happen. I've got a fight on my hands right now, and I'll be damned if I'm not going to win.

Prove you know something.

I've got a histology practicum AND an anatomy practicum today - it's going to be interesting. While I feel very prepared for both, there are still a few things I need to review. I guess I'm lucky that (1) the histology practicum is first, starting in about 45 minutes, and (2) I have some time to go over things for anatomy, since we'll all be sequestered while people are tested in groups. Maybe it's a mixed blessing that I'm in just about the last group to go (the practicum begins at 1:00, and my time is something like 4:24), but at least I'll have time to sit and go over radiographs and splanchnic nerves.

I was in the dissecting lab last night going over some of the mediastinal structures, and as we moved down the body going over nerves and arteries and muscles, a peculiar thought hit me - thank GOD I didn't go to podiatry school. For one thing, feet are very low on the list of cool things about the body, and for another, I'm so much happier to be here than there.

The next 2 weeks are going to be the most intense I've gone though thus far, but there will be many, many more times when I'll be called upon to prove that I actually know something - guess I oughta get used to it.

Dear Lord....Dermatology?

What does "doctor" mean to you? Since I'm a doctor's kid, I have a very well-defined idea. To me, doctoring is saving lives - digging down inside someone to fix something that's wrong and putting someone back on their feet. When I worked as a phlebotomist in the outpatient lab of our local hospital, I thought that it was a little unfair that ER docs - the life savers - were paid less than dermatologist and plastic surgeons, who, in my mind at the time, just took care of breast augmentations, nose jobs, and acne. It wasn't until I worked in health insurance that I learned things were much more complicated, but my idea of doctoring remains unshaken - I feel like there's a certain level of hands-on care that, since I've grown up with it, I don't know if I'd feel comfortable practicing without it.

I'd never thought very seriously about dermatology or plastics, but over the past few years I began reading about the lives and times of various plastic surgeons (they write the most). While there's no doubt I'd prefer a plastic surgeon over anyone else when it comes to the fine nerves of my face, I'd never considered a dermatologist - I break out every once in a while, but Neutrogena face wash generally does the job. Also, when considering the lives of dermatologist (which I admittedly have no experience with), I think I might get bored.

That was.....until today. I'm sitting here in my Histology lecture on the skin, and although I'm only learning fine details on top of the basic concepts I'd already known, for some reason, the skin is so much more fascinating! I learned that melanin actually blocks the sun from degrading DNA - skin cancer arises from the formation of pyrimidine dimers and the failure of genome-wide nucleotide base excision repair. Melanin also protects collagen and elastin from UV degradation by the sun - thus, darker-skinned people not only wrinkle less, but have a much lower instance of skin cancer. However, people with darker skin are also more susceptible to the formation of keloids - big, lumpy scars that are caused by the over-expression of collagen fibers.Interesting stuff - one of the things I learned before is that, if you want to look good in your old age, (1) stay out of the sun and(2) don't you DARE smoke. The first pictre below is a 91 year old monk who spent most of his life indoors. The second pictures is a 62 year old Native American woman, who lived her life in the sun. This is whatI think of whenever I see pasty, pale people tanning like they're vitamin D deficient.

Interestingly, when it comes to apocrine glands, there's still some debate about human pheromones. I think I'll leave that one to the perfumers.

The fact of the matter, is working with the skin now sounds cooler than I'd ever thought before. I at first wanted to be a psychiatrist, then surgery sounded cool, and somewhere in there neurology and internal medicine tickled my fancy. Today, Derm seems like something I could enjoy - ALL the doors are open! If I'm having this much fun now, I can't imagine what it'll be like when I get to clinicals!

Firm Foundations

As much as I may complain, I'm genuinely enjoying medical school. I struggled through classes in elementary school and distributional requirements in undergrad because I felt I was being forced to learn all of these things that were useless - things I was never going to use. I looked forward to getting into medicine, where at least the teaching would be linked to practice. Granted, these basic sciences years function primarily to set up a firm foundation so that I can understand the science of practice, but you know what? Even though I may not use 90% of this, especially if I specialize, at least I'll have it in my head - it applies to the human body, and, by golly, I think it's cool.

I like physiology- most folks hate it. Know why I like it? There aren't millions of tiny little pieces of information to slosh through, organize into some mental structure, and be able to recall at light speed. Rather, physiology is beautiful because it's built on just a few equations - if a system is working right, all of those equations work together to explain the system. In the case of pathology, though, things change - and they change in predictable ways. I'm not saying I'm great at physiology, but if I can work my way though things, they tend to go better for me.

Back to rote memorization - I have a histology practicum in a week (I also have an anatomy practical, but that one I'm looking forward to studying for - I can't wait to grab a beer and curl up with my Rohen, Yokochi, and Lutjen-Drecoll atlas). Essentially, I have to start staring at slides, so I can figure out the differences between chondrocytes and chondroblasts (cartilage cells), muscular and elastic arteries (it's all in that internal elastic lamina), and bone. It's not my favorite, but I can certainly see the merits - what good is a doctor who doesn't know what he's looking at?

Then there's the anatomy which I'm enjoying (although, honestly, I'm sitting in a lecture on the anterior mediastinum, typing this right now). I think I like it so much because I can actually hold it in my hands and turn it around - my cadaver is like my project, my first patient. You know, even after watching the layers of skin, fascia and muscle, veins and arteries and nerves stripped away from the frame of the man who so graciously donated his body to science that I may become a doctor - I'm considering doing the same thing. I've been in lab with people who've seen how the bodies slowly become quite unpleasant to look at (our cadaver didn't even look like a person after they dissected out the brain and saccral plexus), but I feel such an intense gratitude that it seems like I may do just as much good to donate my body so that others may learn, as I would if I donated my organs that others may live.

Yesterday, I hered cows on the way back from the gym. I didn't mean to - they were just kind of on the trail. I made sure to walk loudly to let them know I was coming, and so ended up driving them before me. Then the security guard from PBH came and shooed them away from the lawn below my balcony - I was worried I'd have to find a tree, but they turned aside, not wanting confrontation. Thank God cows are docile.

It pains me that mangos are out of season. However, I'll comfort myself with beautiful sunsets.

Three strikes and the Tin Man.

In the same vein as my last post, I consider myself fair and even keeled - not prone to snap judgments, willing to place myself in someone else's shoes (even though my first impressions are usually correct). Thus, when someone strikes out with me, they strike out. Today, I'm talking about one of our professors - a gentleman who has thus far proven a sore disappointment. I'm not going to tell you his name, but I guess I'll have to tell you his specialty later on; that was part of his third strike.

Strike 1: Remeber that post from way back when, in which I talked about how Nicole wasn't feeling good during an anatomy lab, and went to sit outside, looking, in her words, absolutely awful? I'll try to see if I can find the link, but I told how a professor just passed her by, without asking how she was doing. At first, I was a little upset - even if you're just a janitor, you're still med-school faculty - hell, all you need to be is a human being; one would think you can recognize someone who doesn't feel well. I'd eventually gotten over it by telling myself that he was probably a Ph.d who didn't have a lick of clinical experience. Well, I came to find out on Monday that this very same gentleman was going to be taking over our pulmonary physiology lectures - and he is an M.D Ph.D. So this trained medical doctor waltzed by a student who wasn't feeling well, not even stopping to ask.

Strike 2: During class yesterday, this professor, in a lecture on lung mechanics, was asked how one would administer synthetic surfactant to the little babies whose lungs aren't mature. Now, I was't listening, but when the question was posed to me, I thought for a second, and guessed that it must be inhaled somehow. Do you know what our professor - our M.D. Ph.D- said when posed the same question? "I don't know...." Wait....WHAT?!? What do you MEAN you don't know? How can you hold more than one advanced degrees in this area and NOT know?!? That really pissed me off, because if I was a Ph.D, I guaran-damn-tee you I'd know. That's like a surgeon not knowing what fentanyl is. Strike 1 was bad, but strike 2 is making me question this guy's professional qualifications.

Strike 3: You're out, prof. There's no arguing, the ball was perfectly pitched and gave such a titanic swing and a miss that my head is still spinning, and I'm still wondering what the hell is wrong with you. You see, Dr. Professor, when I came back from dissecting out the heart yesteday (and what a beautiful lab it was - but I'll get to that later), as I was walking to the ATM to get money for the laundry, I saw you smoking. Yes you, Dr. M.D. Ph.D Pulmonolgy professor who doesn't know how to give artificial surfactant, I saw you smoking. Thanks, Benedict Professor. You're failing as a human being on so many levels. I've complained about other professors, but you very clearly take the cake. Stick a cigarette in it - I'm done.

I did something yesterday that gave me extreme pleasure (they just about had to kick me out) - I dissected the heart. It was just play, really - instead of cleaning out fascia and fat and all of the unpleasant stuff living just beneath your skin, I got to look at Trabecula Carnae and papillary muscles. Actually, I made two observations that, if you've ever been inside a heart, will hopefully make complete sense. The first is that trabecular carnae (called pectinate muscles in the the R.atrium) looks like Freddy Kreuger's face. The second is that, after you cut into it (no easy task, I assure you), left ventricular myocardium looks jus like steak. There's just so much cool stuff in there! For one thing, on the prossector video shown at the beginning of every lab, the heart had a patent foramen ovale! My heart didn't, but we still found the fossa - I mean, how can you miss it?

The heart is absolutely beautiful - it's not like the lungs, or even the muscles of the legs. It's gorgous and perfect and so much can go wrong with it, but this twisted little bundle of highly complex muscle contracts about 1.5 million times during your life (learned that on jeopardy; not anatomy lab). Actually, it was much prettier after I cleared out a handful of clot and platelets from each chamber. The chordae tendinae were, literally, silvery white.

As displeased as I am with this current pulmonolgy professor, all of our anatomy professors absolutely rock.

Fear. My. Wrath.

This hasn't been the most productive of weekends, but I guess work is getting done. I've gone over the cardiac anatomy that I'll have to know for this upcoming week's dissection, plowed through all of the cardiac physiology notes, and am currently taking a break from working on our DPS (doctor, patient, and society) practical. MERP ran DPS a lot more smoothely - they had us research the methodology of the history and physical, interview classmates who had made-up illnesses, and then hand in what was supposed to be a polished HPI, complete with personal, social and family histories, and chief complaints. Here, instead of anything so dynamic and integrative, we were merely told to come up with a patient on our own (after being told that he or she will complain of "chest pain"), and then, in class on Monday, we are to hand-write the interview, providing both questions and answers. We were told that a good paper consists of 50 questions, so I'm not convinced that they'll read every single one with too much detail. I'll do mine well, and get it out of the way - it's not teaching me how to do a correct history and physical, or enlightening me concerning the differential diagnoses that surround as nebulous a complaint as "chest pain"; it is merely something to do well and get out of the way, so I can go do some cardio questions, review hematopoesis, and preread for all things respiratory. That, however, is not the reason why anyone should fear my wrath.

I consider myself a fairly even-keeled person - I have no trouble looking at both sides of a situation, and can easily place myself in the shoes of another. I try to let most things just slide, preferring not to get too worked up over pittances; they're usually not worth my attention, and I usually forget about them soon enough. Thus, I'm not a wrathful, bellicose individual. There is, however, one thing that will skyrocket me from placid to irrationally infuriated in a matter of milliseconds - being awakened by someone who is being too loud. I don't know what it is; it's like there's a slavering, hellish monstrosity caged behind my eyes, and the over-loud noise that somehow penetrates my slumber hits just the right tones to unlock that cage and set free the monstrosity. I wake up with my blood boiling. Generally, I sit and listen for a while, hoping that it'll die down - rarely does this happen to me, but it happened last night.

I was deep asleep - pleasantly so; Saturday night is one of 2 during the week when I can actually count on a blessed minimum of 8 hours, at least. So at 2:11 am, I hear someone talking at the top of their lungs. One thing about my apartment - sounds seem magnified; the way the balcony walls are built turns them into an effective bullhorn, funneling sound into my room. I'm on the third floor, and it sounds like the dogs running through the grass are just below my window; when people are talking normally on the trail beside my building, I can hear their every word. Last night, I walked out onto my balcony to see how far away this person was, and they were the next balcony over. I slapped my hand against the wall to get his attention, and asked him to quiet down. This guy didn't even respond. So, I very amicably left my apartment, and went and pounded on his door. He must have been still talking, or maybe he didn't hear me - no answer. I went back to my apartment and stewed for 10, maybe 15 minutes, and then went back and pounded on his door, louder this time. My heart was pounding like it was getting me ready for a fight - I could feel my pulse in my head, and distantly recalled something about sympathetic stimulation jacking up one's heart rate (beta one receptors) and clamping down on peripheral vessels (alpha one receptors - ever the med student) in anticipation of fight or flight. I banged on this guy's door a third time - apparently, he didn't want to come out, but I sure as hell wasn't going to go away; I'd already (perhaps irrationally, I know) decided that I'd stand out there banging on his door and keeping him up all night if need be. Third try, the door opens - and I tell this guy that I'd appreciate it if he would never be that loud, this late, ever again. I didn't scream, I didn't shout, but I didn't ask - I think, subconsciously, the "I would appreciate" part is thrown in so that my argument looks good on paper. He stares at me dumbly for a few seconds, and then says "Well I'm here, I'm having a good time, so whatever."

That being the case, the gentleman is lucky it ended how it did. I merely told him what I expected him to do, and left it at that, instead of risking a physical altercation - but that made me so mad I couldn't get back to sleep for half an hour. On Monday, I'm going to go file a formal complaint with the management, and I'm going to lay it out exactly as it happened. I hope they kick him out.

Anyway, I'm going to a study session later on today with Nicole, Glynis (our favorite med student/ PA), and Eddie, a Ph.D in inorganic chemistry who, prior to teaching at some university, worked at the Los Alamos nuclear plant. Needless to say, it'll be interesting, and hopefully quite useful. We start respiratory physiology tomorrow, and a week from Friday there will be a histology lab practical AND an anatomy practical - time to crack my knuckles, grit my teeth, and get down to business.