Checking in

So much has happened since I last blogged (all of it good), that I'm not quite sure where to start. Just after the last post, Nicole and I went to pick up my 13 year old brother, and spend some time with the family. My maternal grandmother had been visiting my family in Texas, and he rode the Greyhound back with her to Miami. He spent a few days with us - we walked around various malls, blasted our way through hordes of zombies at Gameworks, went to church with the grandparents, and went to south beach.

After dropping him back off with the grandparents, Nicole and I started the final section of UMBR (Ross' step 1 review class we've been attending through the semester). This section - pharm and phys - was run by the esteemed Dr. Kudrath. I say "esteemed" because his part of the course is the reason Ross imposed their mandatory attendance policy on UMBR - 90% attendance, or no dice. See, he's so good, that people would just skip the earlier stuff, and come for his part. I believe he also teaches at a lot of the Texas medical schools, and had some very specific, tested-and-proven advice to hand down to us. It was a grueling 8 hours per day, but I think we came away with an excellent review, and some fantastic advice.

We'd planned to take that advice, and hit the ground running, but we needed a serious break. Thus, Nicole and I spent a few days doing nothing but hitting the gym and reading by the pool.

(This blogger website is being unreasonable today, and so I may not be able to post all the picture I'd like. You've been forewarned).

After our poolside relaxation, we flew to Spokane to visit Nicole's family for a week. The last time I was in Washington was about two years ago in November - I managed to fly in on the same day as their first big winter snow. However, my bags chose to wait a day, and arrive at their leisure (I believe they stopped off in Milwaukee or somewhere like that). So there I was, wearing jeans, a button-up dress shirt, and the the little zip-sweater I'd layered on in Houston. This time was different - it hovered around 80 during the days, and only dipped down to about the 70's during the night. Nicole's parents wanted to make sure to show me the town at this time of year, and I've got to say - it's a beautiful city. Part of it remind me of Augusta, GA, and other parts of New Haven, CT. The river running through the middle of the whole town, though, adds in a certain something that couldn't have been done by engineers and city planners.

The first day (if I remember correctly -they all sort of run into each other), we walked around the park that hugs the river that runs through the city.

(Nope...blogger isn't letting me post pics the way I'd like to - I'll do it in a separate post).

So we walked around the park that first day, and had a nice lunch at Rock City Grill. After that, Nicole and her mom walked around Nordstrom, looking for baby clothes for a friend of Nicole's, while her father and I browsed ties we couldn't afford. We spent the rest of the day relaxing and hanging out.

The next day, we went to Manito park - Spokane's got a lot of parks, but this one is more like a botanical garden. they had their little plant conservatory. We spent a good amount of time walking around and smelling the roses, before heading to the Elk Pub in Brown's Edition. I'm not sure what I was thinking when I heard "Elk Pub", but I wasn't too far off - it felt like it catered to the hipster set and businessmen alike, with a whole lot of Northwest charm.

The next day, we did a bit of shopping - hitting up the Nordstrom Rack (their big bargain basement that, for Nicole, is always good for hundreds of dollars of savings on jeans and tops, and for me, is always good for at least one tie), and costco. We also went to see a friend of Nicole's mother, who has this fantastic projector set up in their living room. Forget flat-screens - I want one.

There was a lot of hanging out, a lot of eating good food - I went to mass with the family, and we had a huge family barbecue, during which time I got to meet the rest of the family. It was like a matching game - Nicole had been telling me stories about all of these people for years now, and I just had to put names to faces. It was a lot of fun - we also spent some time with their next door neighbors, who have turned their back yard into a beautiful little park. Their fire pit was an ingenious little deal crafted from a tractor wheel.

One night we went to the Gibliano Brother's Dueling Piano bar. The whole idea of a piano bar is very northwest (very Seattle - very Billy Joel and Elton John ), and, as such, is something with which I had no experience other than Nicole's stories. She and her mother were all revved up to go, so her dad and I tagged along. It's been explained to me this way - you have two pianos, and everyone sings along. Part of the way the pianists make their tips is that you pay them to play or to stop playing something. It's supposed to be a lot of fun - apparently, though, the crowd we mixed in with that night didn't know how things were supposed to go. There were some older folks singing their hearts out, but the rest of the folks were the college-aged crowd who, apparently, thought it was just some regular bar. Nevertheless, after a few drinks, Nicole and I belted out all the verses to Billy Joel's Piano Man (which, in my heyday, I could have gotten up on stage and tickled from the ivories), and Don McLean's American Pie. I hate to say it, because it probably isn't true - but I had more Bon Jovi in my soul than that crowd. (It's impossible to go clubbing in a college town and not hear Livin' on a Prayer).

Following that rousing start to the night, I made an interesting discovery - I love ginger; not the spice girl, not the castaway - but the actual plant. I mean, I'd always liked ginger-ale, but ginger's great, especially when added to martinis and mojitos.

We went out for Anniversary dinner (our 2 year, her parent's 29 year) at Clinkerdagger - the same place we'd visited on my last trip. Afterwards, we walked over bridges, taking pictures of the city.

This trip - this time off - has allowed my to finally get into some reading I've been meaning to do for quite a while. I've managed to get through the following:

Irving Stone's The Agony and the Ecstasy

Justin Evans' The Good and Happy Child

Carlos Ruiz Zaffon's The Shadow of the Wind (one of my new all-time favorites !),

and I'm reading Andrew Davidson's The Gargoyle.

Right now, I should be plowing madly through hundreds of questions in preparation for step 1, but my package from Kaplan hasn't arrived yet (it should today). So, I'll go through a few from a q-book I have, and hit it tomorrow.

Who's Louise?

We had our final this morning, and I've got to say I'm disappointed. I'm glad that's over. Not the final - I meant this whole semester. Jeez Louise.

Germy little kids

I must have caught something from one of them - I've been snuffling and snorking since Friday. Due to the reading I've been working on I can, however, tell you that since I don't have serious muscle aches, fever, or cough, I probably don't have the flu. I do have a theory to share with you, though. I remember when I was a kid and folks would say that if you get cold, you'll catch a cold - vividly do I remember learning about bacteria and viruses, and easily dismissing those old wives' tales. I've come to a realization, though - those bacteria and viruses that cause colds (most commonly rhinoviruses) are everywhere, all the time. You can't get away from them, but your body normally does a good job of fighting them off. Until, that is, something happens to slightly depress your normally hearty immune system - something like not getting enough sleep, or being cold and lowering your body's temperature, or, as we med students are familiar with, too much stress. (I could go into how cortisol inhibits the immune system and how steroids similar to cortisol are used to treat inflammation and other auto-immune disease, but I digress).

I'm trying to focus on the past few weeks' worth of lectures - we've got our final on Friday, and it feels like my head is too small for my sinuses.

All doors open...

Today in our large group session (the mandatory didactic cluster plopped into the middle of our week like a lemon on a highway - completely disrupting the flow of things), we had a lecture from an Obstetrician on the CPR (clerkships, profession, and residency) or obstetrics-gynecology. Now, when I speak of my future, I generally say that (1) I don't think family medicine is for me - I want to have a deep responsibility, (2) I don't think I want to limit my practice to children and (3) I don't have any interest in OB-GYN. Well, the doc today said that, back when he was med student, he'd basically said the same things. I guess that just goes to show that, especially from the standpoint of someone who hasn't done those clerkships yet, I can't really rule anything out.

I've always thought of male OB-GYN's as the teensiest bit odd, but apparently, there's a need for them.

We give our Spanish presentation tonight (I had to keep it short and sweet because of Nicole's newness to the language), and then I've got a paper to wrap up - that'll be it before the final next week.

Out of the Mouths of Babes

We began our little, week-long pediatrics rotation yesterday. This one was a little northwest of us, and wasn't too terribly difficult to find - as usual, Nicole and I drove out there the day before. The first kid we saw was a big ol' (not obese) 10 or 12 year old kid who screamed bloody murder when it came time for his PPD (tuberculin skin test). Those things do, hurt, but the only time I've seen that big of a reaction from a kid that old has been when there was some mental illness involved. The nurse had such a difficult time holding the kid down, that the doctor himself - an older gentleman who may very well play Santa Claus during the holiday - had to rush in and administer the shot himself. At this point, I silently glanced over at Nicole, as if to say "Nuh-uh. No way in hell. Not for me".

But the next little boy might have changed all that. He was about 3.5 years old - the middle of three kids. His older brother kind of hung around the room, while his little sister broke into whimpers every time the doc came near her. So this little boy had some adenoid cyst at the back of his skull that was of a great deal more concern to the parents - one of who had been this pediatrician's patient - than to the doctor himself. He'd come in because he'd been having a fever, but he was looking and feeling better. The doctor had us listen to his heart, and I was expecting some kind of atrial septal defect (the most common kind in kids). I listened to the four valves at the top of his little heart, and they were clear as a whistle - S1, S2, and silence, nothing else. I got down to his mitral and tricuspid valves, and could very clearly hear his first and second heart sounds - separated by a little early systolic murmur. The important thing is that this murmur went away when the pediatrician had the kid lay down - that meant that it was just an innocent murmur, and there was nothing more for the parents to worry about.

I think I was a little floored at how clear this little kid's heart was. See, we have the Harvey patient simulators, with tons of different problems and all the possible abnormal sounds a heart can make (just about). However, whenever I practice with Harvey, I find myself going in a little skeptical; I know that in real life, no one's heart is going to be that clear; real people don't have volume controls like that. But you know what? This little kid's heart was the clearest I've ever heard - so clear that I didn't have to think about it at all. I've never really considered pediatric cardiology, but there's something nice about most of your patients having bell-clear heart sounds.

The rest of the day was fairly uneventful; an osteopathic medical student from Nicole's neck-of-the-woods was scheduled with us, so we chatted about the injustices and hardships we all face as med students (not quite a pity-party...but close). We got to a little kid with asthma get put on a nebulizer that looked like a train, we talked with the doc about fevers and medications for kids, we saw a healthy-baby check on a one-month old - and actually got to see some of the reflexes we read about, but rarely ever get to see.

Finals are next week, and then 5th semester will have been but a dream.

On the Madness of Girls

After finishing my Physical exam, SOAP presentation, and DxR clinician case last week, I found myself with a pleasant little oasis of free time amid all of the other craziness. I've just gotten to the part in Irving Stone's autobiography of Michelangelo (The Agony and the Ecstasy) in which the artist, seeking to understand the human body from the inside, in order to completely comprehend the form for sculpting, has begun sneaking into a monastery's room for the unclaimed dead - to dissect. I'm thoroughly enjoying it - while his trepidation is not something with which I can readily sympathize (I'd been looking forward to dissection for years, but I guess I'm not facing excommunication or death, either), I do understand his wonder and awe. However, as much as I'm enjoying Michelangelo's uncharted journey down through skin and fat, muscle and fascia, there was something else I've been waiting to do for a while: I've been planning on watching Twilight.

My reasons for this are two-fold. First, Stephenie Meyer's series about psychic vegetarian vampires and the teenage girls who love them is absolute literary gold right now. I'm very interested in the economics of literature, and how current trends (like Amazon's Kindle) are changing things. It could be argued that Ms. Meyer is the literary heir to the hysteria whipped up by J.K. Rowling, merely stepping into place behind her, rather than creating her own hysteria, but Ms. Meyer used a tried-and-true formula. First, the paranormal romance series is doing better than ever (just check it out on Amazon). Second, women love vampires - ever since Anne Rice made them sexy instead of scary. Third, after watching the movie, I can say that it's quite honestly unapologetically high-school, and thus aimed at the perfect group. While I wanted to read the book to understand the inner workings of this latest literary juggernaut, I heard that the movie was better (a very rare occurrence), and so settled on that.

My second reason is my interest was sparked due to the ongoing romance between the lead stars Kristin Stewart and Robert Pattison. While chemistry onscreen is great and necessary, you just can't fake some things. I feel that part of the reason Mr. and Mrs. Smith was so much fun was the near tangible chemistry between Pitt and Jolie.

After watching the movie, I've got to say that it's nothing amazing or fantastic. I'm a little miffed that, instead of making vampire's shrivel in the sunlight or burst into dust and whatnot, Ms. Meyer instead makes them sparkle. It does, however, manage to capture the manic self-importance of high school - the belief that everything will be the end of the world. It seems like just another outing in a long line of ubiquitous vampiromances, adding nothing special to the canon (as far as movies go, Interview with the Vampire was much better. As was Blade 2). I think the reason for the earth-shattering success of the whole Twilight series can be attributed entirely to the unashamed mania of the 13 year old girl.

Who screams their hearts out and faints at concerts? 13 year old girls. Who went to see Titanic double-digit times, making it one of the highest-grossing movies ever? 13 year old girls. I think that pretty much sums it up - the 13 year old girl is a fantastic fan to have. Looking at the big money-makers in books and movies, they're not responsible for everything. Harry Potter seemed to open a door into the world of reading, and J.K ushered little boys and girls alike through like the Pied Piper of Hamelin. Movies don't do well unless they ticket money from the whole family, like the recent slew of superhero-action flicks. The top books and movies tend to be family oriented, but there's something to be said for the sheer power of their mania.

I wonder why little 13 year old boys don't act like this. My younger brother is reading Rick Riordan's Percy Jackson and the Olympians series which, for all intents and purposes, sounds a hell of a lot more interesting than romances with sparkly vampires. Rick employs familiar and lesser known Greek gods and monsters, spinning an engrossing yarn for the young adult group, and though I haven't read it, the series seems to be a capable mixture of years of scholarship and fantastic story-writing. So where's the hysteria? Where are the movie contracts? Where are the thousands upon thousands of Amazon review? I think the differences are, simply, due to the fact that the fan base is made up of boys.

You know, I'll be part of it is that girls are a whole lot more social. There are some fantasy series that are doing fantastically right now, but the guys who read them would rather do so in the comfort of their own homes, and then sit around blogging about them (errr...ahem...), instead of gathering into giggly gaggles to talk about the character's feelings. Perhaps I shouldn't say it's just a 13 year old girl thing - who are predominantly members of book clubs?

Still Standing

We just had our physical exam practical today - a 45-minute crucible created solely to determine whether or not anything we've learned thus far is theoretically useful, or actually useful. Remember the last 2? I didn't do so well on the first one, but I rocked the second one - and I think I did pretty well on this one. Nicole and I had put in hours and hours of practice over the past few days, making sure that we not only remembered everything we were supposed to test, but could do it correctly and in a logical sequence, all within that 45 minutes. Now, when I say "correctly", what I mean is not exactly as it's shown in Bates' Guide, but rather as the staff here have deemed correct. For instance, there were a few places where Bates said one thing, but the staff decided that they knew better. There was one tiny little nit-picky detail on which Nicole and I both lost points - instead of testing merely light touch over the trigeminal nerve sensory distribution (the nerve that picks up sensation from your face), we tested light touch and pinprick sensation. I sent an email to the faculty - some of the handouts we'd received said that this way was correct as well - but que sera' sera' I suppose.

We gave our SOAP (subjective, objective, assessment, plan) note presentations on Tuesday - not a whole lot to report there. I went in an explained all about why our patient - this little girl Nicole and I interviewed - might have an inherited disorder in how her body breaks down and uses fats (probably hypertriglyceridemia), and how to treat her.

We finished our GI rotation - I don't think I posted anything during then. GI was fun, but I don't know if it's for me.

I thought this news story was incredibly cool - they can grow entire mice from mice skin cells! The ramifications are stunning. I think it says something very odd about me, that, upon reading that they'd successfully developed hundreds of third and fourth generation mice from one batch of skin cells - I immediately thought of a planet full of a million me's - all born from the patch of skin on my arm.