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.

he said WHAT?

I just had to post this: we're doing the neurophyophsis in physiology, and right now (literally) we're talking about oxytocin (which stimulates milk release in lactating women). The professor said, that if a woman comes into the doctor's office, and is suckling her baby, but no milk is coming out, your first questions must be "Are they real?" Because, as he so eloquently explained, natural breasts are for suckling babies, but breasts that have perhaps been augmented somehow, are "for adult babies". I've never heard so much applause.

"Drink up me Hearties - Yo ho!"

It's a rainy Sunday evening. This has been a slow, although fairly productive weekend so far - yesterday after a morning of studying, Nicole and I went the gym and then to a birthday party for the husband of one of our good friends - Glynis the P.A. It was nice to get out of the house and socialize for a bit (I've always been accussed of being a little antisocial). After that, Nicole and I researched some of the hotels we're thinking of booking with in Buenos Aires - we found some bad reviews we hadn't expected, so it was nice to narrow down our choices and make some serious headway in the matter. (Oh dear...I hope that isn't a surprise to anyone...)

This morning, Nicole, Glynis and I pounded through some endocrine histology. We've got a very picky professor who seems to take pride in writing tricky questions(I only say that because it's true), so we dug down through thyroid hormone formation and ovulation. It's ironic -for all the pride he takes in his trickiness, his lectures left a lot to be desired; I had to go do a lot of outside research to get things to make sense. But you know what? I'm all OVER the pituitary gland.

I'm sure that's useful to someone. I mean, if I had a pituitary adenoma, I'd care. Endocrinology just doesn't interest me that much - it's something I have to learn, for the grade, and that's that. On the first day of this semseter, our anatomy professor (of whom I'm not the biggest fan - he talks too much, and still manages to not cover a whole lot) presented us with a quote from someone old and dead and Latin - "Non scolae sed vitae discimus" - which means "Don't learn for school; but for life". Give me a break. I'm learning all of this insignificant minutiae so that I can pass tests right now - I'm learning so that I can jump through hoops. Will some of it be useful? I'm betting on it. Will some of it form a firm foundation upon which I can build a mental library of medicine, which I will revisit every day during my practice? I'm betting on that too. However, is the most important reason I memorize the difference between red-staining and blue-staining pituitary cells because it's useful in practice? I...uh....I think that's just a test question.....I think for now, I'll scolae discimus.

Speaking of useful versus non-useful information, why can't someone explain to me why the theme song from the Pirates of the Caribbean ("Drink up me Hearties - Yo ho!") has become stuck in my head more profoundly than any other song I've ever heard? I have no idea! I remember when I dissected out the abdominal vessels - I closed my eyes, and I saw arterial arcades on the jejunum. This is like that, only so much worse! I'm listening to the theme song by Hans Zimmer right now, but if I were to turn it off, it would keep playing on loop just below my conscious perception, as if somewhere in my superior temporal gyrus (primary auditory cortex, that is), a new tract has been formed - one that connects to all memory stations, and somewhere, swimming in the neuronal cell bodies, are miniature Jack Sparrows!

Maybe it's just because I'm IN the Caribbean, and I really AM a pirate. Well, if med school doesn't work out.....

The games we Play

Most of the ones I play are in my head - I'm having to secondarily live vicariously through myself...if that makes any sense. I haven't really gotten a break - the first mini-exam was on Monday, and grades came out today. I did alright, but we have our neuroscience practicum tomorrow. I took a practice test yesterday, and another one today, and while I could walk in there and do fine, I'd like to grab my grades by the scruff of the neck and yank 'em up to where they oughta be. It's similar to the heart - I felt that I should understand all things cardiac because Dad's an interventional cardiologist - and I feel like I should be doing better than everyone else in neurosci because I cut open sheep brains as part of my major. Anyway, not having a break has pushed something deep down in my psyche to take little unscheduled recesses, like an antsy little kid. I'm studying for this neurosci practical, and in the thoracic cord central gray, I see an alien cat. Seriously. When I'm looking at the midbrain, I can't help but see a fetal mouse. Trust me - there's a moth in the shape of the rostral medulla (actually I see moths everywhere - have you ever seen a uterus?). Seriously...it can't be just me...I mean...don't you see the demon pig too?