Monthly Archives: February 2014

The Friday Rewind 2/28

It’s hard to believe it is already time for another installment of the Friday Rewind! Here is the best and worst of what the week had to offer.

1. The Best of This Week

  • Participating in a colonoscopy simulator research study. UCI is just one of six institutions in the nation that has this technology, which made it pretty exciting to test out. It felt just like a video game, except for the colonoscope controller, but apparently the real thing is  comparable to what I was able to experience. Although I am not a big gamer– actually I am  among the limited few in my generation who never played video games– I scored a respectable 100% in polyp removal!Main
  • Learning about a whole spectrum of genetic disorders and diagnostics that were completely foreign to me until this week. I didn’t get a chance to take a genetics course as part of my post-bac program so all of the clinical correlates we’ve been learning are brand new and intensely interesting to me. It is estimated that all people carry about 20 recessive genes that cause genetic diseases or conditions. Of course, it’s only when a person has a child with a partner that carries the same recessive gene mutation, that there is a chance of having a child with a recessive disorder.  This has got me thinking a lot more about potential future children and the unfortunate (silent) things my husband and I could be passing on to them. On a separate note, I think this officially signals that I am getting old, as these are the new mundane things I worry about. You know you are crossing over into true adulthood when you watch movies and start siding with the parents vs the rebellious teen lead…
  • Now that I live in California I can’t get away with adding on those extra “winter” 5 lbs. It has been in the 70s (except for the much needed rain we are getting right now) and I really need to step up my healthy living routine. No more lazy microwavable meals! I am back to eating fresh, homemade dinners full of veggies and good for you things. I also stepped up my work-outs (as much as my back injury allows) by adding a nightly brisk walk with my husband. We did 3 one-hour night walks this week, which were not only good for our health but also time well spent catching up on future dreams (like the mountain home we want to one day buy…).

2. The Worst of This Week:

  • I was all set to travel to Mexico tomorrow morning to help run an underserved clinic I am involved with — until I came down with a nasty case of gastroenteritis. In an unfortunate twist of irony–I think this is what you are supposed to come back from Mexico with not go there with–I am too unwell to see patients, which made me feel like a cast-off, harboring some dangerous microbes. Very disappointing since I had been looking forward to this trip for a few weeks now.
  • Realizing I have 5 exams on the horizon, two of which are national shelf exams. A shelf is a cumulative exam in a particular topic (Physiology and Histology in my case) that you take together with other medical students across the country so your school can see how well you stack up against other med schools. Fun.
  • 8 am classes. Yes, becoming a physician means lots of early mornings and limited sleep. But being forced to be in class due to some ill-thought out mandatory attendance rules makes me grouchy. I also felt sick for the last few days, so that combination made me particularly cranky. If I didn’t say hi to you this week in class, please excuse my rudeness!

3. Medical Breakthroughs of the Week:

  • In keeping with our genetics trend for this week: Rocky Road for Mitochondrial Transfer
    Altering mitochondria during in vitro fertilization (IVF) as a means of preventing disease transmission won’t be moving to human trials any time soon, according to experts at a 2-day FDA hearing.Mitochondrial transfer — which some have termed “three-person embryo transfer” — was developed to prevent transmission of mitochondrial disease from mother to baby. This type of disease is rare in the U.S., with about 1,000 to 4,000 cases per year.Although there are different approaches, the basic idea of the procedure is to use the nucleus of the mother’s egg cell to retain her genetic identity while replacing the diseased mitochondria, which surround the nucleus.Researchers have been working with the technology for decades but have often found their efforts stymied.

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis?

A 23-year-old woman presented to the emergency department after 1 day of fever, sore throat, arthralgia, and rash. Diffuse erythema that blanched on pressure was noted over the face, neck, trunk, and arms, along with posterior cervical lymphadenopathy. The next day, the fever and rash subsided, but she reported pain in the oral cavity. Examination revealed petechial hemorrhages on the soft palate that disappeared spontaneously in 2 days.

Screen Shot 2014-02-28 at 2.16.32 PM

a) Adenovirus infection

b) Infectious mononucleosis

c) Measles

d) Rubella

e) Sarlet fever

*Courtesy of the New England Journal of Medicine. Answer in the comments sections. 

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The Friday Rewind 2/21

After considerable delay, the Friday Rewind is back on the blog! For those of you who remember this MedSchoolDiary feature, here is the best and worst of what the week had to offer.

1. The Best of This Week

  • Feeling ultimate redemption knowing that my study methods do work and kicking ass on two exams. Ahh, it feels good to be back! All of that anatomy induced self-doubt has melted away.
  • The freedom that comes with completing two exams and not having another one for what seems like eternity (I think 3 weeks?!). This lets me get back to focusing on things that genuinely excite me– like spending time in the Emergency Department; taking on a new and exciting research project; reviving an old research project; finally getting around to finishing a case report I was working on; and generally spending less time cramming information and more time with my husband doing the things we enjoy so much together–like our infamous movie watching marathons.
  • The feeling of happiness that comes with walking into the hospital in my white coat with my stethoscope in my pocket and a badge that identifies me as part of the patient medical team. In early 2009 I had a moment of clarity. I was at Johns Hopkins Hospital about to see a world renowned cardiologist and as I walked through the doors of the hospital I wasn’t thinking about the medical condition I had to deal with. All I could think of was how much I wanted to be one of the doctors in their scrubs and white coat walking through the doors. They all looked so preoccupied. I imagined the patients they had on their minds  and the moment in my life when I might one day look like them. Every time I catch a glimpse of myself in my white coat or the way patients walking into the hospital look at me with that familiar look, a surge of excitement comes over me.
  • Generally any time I go into the hospital is the highlight of my week. No crazy milestones to report. Well, maybe just the mini-milestone that my ECG interpretation skills have nominally improved. ST elevation and STEMI protocol are no longer just foreign acronyms.

2. The Worst of This Week:

  • After 6 weeks of following doctor’s orders I still haven’t seen any improvement in my back. I tried to go jogging for the first time and the experiment failed miserably, sending me into excruciating pain. I am too busy to actually follow-up and see what the status of my herniated disc is. I guess I was hoping it would just go away. Not being able to run is a huge disappointment and has played a large part in my brief brush with apathy.

3. Medical Breakthroughs of the Week:

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis?

nejmcpc0902221_f1

a) Adenoid cystic carcinoma

b) Cat scratch disease

c) Infectious mononucleosis

d)  Sclerosing sialadenitis

e)  Systemic lupus erythematosus

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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Perspective

Month after month of intense pressure to learn and perform on never ending exams. Mental fatigue. Information overload. Having to say “no” to my own birthday, date nights and normal 20-something-year-old things. Coupled with a chronic disease and a painful back injury. The combination of it all recently sent me into feeling the most terrifying of feelings–apathy. I was starting to see myself lose enjoyment in the thing that excited me most–learning.

I knew something was off when I was studying for my last huge anatomy exam. Usually, the process is tough yet still enjoyable in that I-love-a-challenge sort of way. But a few days before this exam my brain revolted. I was forgetting things I had learned the day before. My brain felt fried, useless, beaten up, not my own. In a word–I was unfocused.  Although the information was there, I had a hard time recalling it under time pressure. I became easily distracted. I was coming undone. Even though I had studied diligently, perhaps even over studied, exacerbating the underlying fatigue, I had my worst performance ever on a medical school exam. Although I didn’t “technically” fail anything, I failed myself. I had put so much pressure on myself that in the end I became my own worst enemy.

That exam was a wake up call. Not because I was in danger of failing or some real career repercussions, but because I was losing sight of why I was in medical school in the first place. I had become so focused on grades and outcome that I forgot to just enjoy the journey. The reason I am here is to learn medicine. I am here because the human body is the most fascinating subject I have ever come across and learning the intricacies of how it works gives me goosebumps.

I needed a perspective adjustment. I had become so myopic in my thinking, with this goal of wanting to continue to get high marks on exams, that I forgot the big picture. It was humbling to be reminded of what all these sacrifices are for. The funny thing is, as soon as I take myself back just one year ago when I had never wanted anything more than to be accepted into medical school so that I could become a doctor–all of the sacrifices suddenly seem worth it. I don’t feel jealous or sad that I sometimes miss out on things because I must dedicate myself to a greater long term goal. I feel it is a privilege I get that chance.

I am happy to say that I feel re-energized. Studying for my renal and respiratory physiology exam felt completely different than the mental state I was in just a few weeks ago. I am enjoying what I am learning, knowing that in just a few short years I will be putting everything into practice. It was important for me to recognize what was happening to me early on, before my fleeting apathy turned into something deep seeded and harder to turn back from.

Sometimes pressure can be a good thing, but you have to be careful not to let it overcome you. In the first year of medical school in particular,  it is very easy to get caught up in performing well on exams and losing sight of the big picture. So if you are going through it with me, let us not forget what brought us here. Watching this video made me pumped for what is ahead. I won’t let myself forget again.

   

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Bushed

My head is pounding so much my eyeballs hurt. Six hours post exam I am still reeling from the experience. Preparing for my last anatomy exam has left me completely– bushed. Out of necessity, the past four days were a blur of non-stop-all-day-marathon study sessions. Frying my brain and leaving me utterly exhausted. Not to mention bitterly jealous of my non-med school friends who were able to enjoy normal life events (I think there was some big game on yesterday?). Yes, I know–it will all be worth it one day, but right this second I am acutely aware of the price to be paid.

Usually, studying non-stop for exams comes with the instant gratification of being done! You walk out the door of the exam and a thousand pounds lifts off your shoulders. You feel so happy you just want to tap dance all the way home. For some reason, I am still waiting for the release. I think I need a good night’s sleep and a good recharge. Right now, I am feeling defeated, exhausted and completely NOT ready to start tackling the renal and lung physiology I’ve neglected for my next exam, which is already around the corner. The bullet train that is medical school is moving faster than ever. I just hope my brain can keep up.

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