Spring break was a complete success–my respite from the med school roller-coaster, however brief, was a welcome friend. Gone too soon of course.
I spent my week of no-responsibilities catching up on mundane adult life things–eye doctor, dentist, physical therapy and esthetician appointments. Picking up batteries for the garage door opener. Five loads of laundry. Napping in the middle of the afternoon. Starting and almost finishing a new book. Savoring the very rare opportunity to be ridiculously lazy.
Now we’re back and there are only 2.5 months of 1st year left. It feels like I was just getting ready for my first day of orientation, yet we are 9 months in and we’ve already covered:
- medical statistics and biometrics
- clinical foundations– including the art of the physical exam and the patient history
- ultrasound of the major body systems
- physiology of special senses (smell, sight, hearing),
- GI and
- histology covering all of the above
- 1/2 of genetics
- and anatomy and embryology touching on all of the above
I suppose I have a solid foundation, but mostly I just feel like I have a lot of random knowledge floating around my head that doesn’t quite fit together into actually helping out anyone who’s sick. For example, I know that tetrodotoxin is produced by puffer fish and inhibits action potentials by blocking voltage gated sodium channels—or that pre-term babies should be given cortisol to help produce surfactant–diarrhea causes non-anion gap metabolic acidosis, while diabetic keto acidosis will have an anion gap–or that opioid induced respiratory drive depression is managed by administering narcan. Yes, these are the random odds and ends that come to mind. I have amassed what comes to thousands of pages of preliminary knowledge. It will take the next several years to fill in the details and connect the thousands of small dots, until one day, in my mind will be a beautiful sight–an intricate, complex portrait of the human body and its delicate inner workings.
Sitting here today, I am far from seeing the big picture. I can hardly diagnose a cold. I have however gained a deeper obsession with medicine, the more I learn the more I want to know.
Tomorrow we start neuroscience– the last frontier in our introduction to the basic sciences which will form the basis for everything else we learn in our careers.
For the first time in a long time I woke up this morning with absolutely zero looming-exam anxiety. Constant examinations were so common to me that the lack of them is now what feels strange. I am coming down from my high–all of the endorphins and hormones that are released in the days leading up to and in the process of taking multiple three hour exams are slowly metabolizing away. My stress cleanse.
Speaking of hormones, I recently met with what I thought was supposed to be an introduction to alternative medicine techniques that might be able to complement my POTS treatment. However, as I began explaining my symptoms to a world renowned electrophysiology cardiologist MD/PhD-turned-alternative medicine expert who also happens to work at my medical school — he asked if I had ever been checked for a pheochromocytoma. A pheo!? We just learned about this in our endocrine section. This type of adrenal medulla tumor is highly unlikely (we are talking one in a million here) but I agreed to indulge him and check for it. It is a simple 24-hour urine test. Except you have to do a 3 day caffeine cleanse. I am barely on day two and already having withdrawals! I would kill for a cup of coffee or a soda right now. Heck, I’ll even settle for some hot tea, but no, that is banned as well. Interestingly, my do not eat list also includes avocados, tomatoes, eggplant, bananas, walnuts and plums. There goes my typical daily meal!
I think I’ll use my required cleanse as a jumping off point to just re-group this week. When we get back from spring break the only thing remaining between me and the end of first year is a neuroscience course and the rest of anatomy and genetics. I want to finish out strong! This week is all about rest and relaxation–since hanging out at the hospital is relaxing and fun–I am throwing that into the mix. Spending Tuesday night with a shift in the Emergency Department is the best R&R I could think of.
I consider myself to be extremely lucky to call home one of the most sought after corners of the United States. As the majority of the US struggles with capricious weather patterns, unable to let go of winter’s ugly grasp, the high today in beautiful, sunny California is 90 degrees. It is the perfect day to enjoy the beach, which is located roughly 8 miles from my front door. It is quite possibly the best location to place a medical school–or paradoxically, it may also be one of the cruelest. As I look out my window, the warm summer sun beaming in, beckoning me to come out, I must resist– I am chained to my desk.
My life at the moment revolves around completing five exams in two weeks. With three exams already behind me I am entering the home stretch–or otherwise called the dark zone–since the remaining two exams are cumulative shelves for Histology and Physiology (yes, time to pull out my notes from August!). One thing they never tell you about medical school is how much you better enjoy studying, especially on perfect days that call out to you to put on your bathing suit…
I find solace in knowing that in less than a week the stress of cumulative examinations will be long gone and I’ll be able to rest my over stimulated neuronal connections. In fact, you see that perfect spot on the beach in the photo above, that is where you will find me.
Time for the the Friday Rewind again! Here is the best and worst of what the week had to offer.
1. The Best of This Week
- Earlier this week we had a hands-on lecture on how to perform the Musculosketal exam. I am not sure if it was the physician who taught the course or the fact we got to do it together as a big group–half of the med students were paired up in one room–but this was one of the most enjoyable classes I have taken in my first year. My medical institution is all about technology, which of course as a technology aficionado, I love. But it was very refreshing to hear a physician highlight the importance of the physical exam. No amount of technology can ever replace what we can learn through observation and our hands. I walked away feeling like my hands had new powers. I feel confident I can correctly identify any suspect sprained ankle or swollen knee–which I learned could just be bodacious fat pads, so it is good to know what you are looking for!
- I had a 3 month follow-up with my cardiologist to discuss the new medication he put me on (pyridostigmine). I told him it helps with keeping my tachycardia at bay and limits my palpitations BUT it does nothing for the symptoms I really care about like chronic pain and fatigue. I was actually pretty surprised by his response. He said “great!” the medication is doing exactly what it is supposed to—we both knew it wouldn’t really help with the neurological symptoms but at least your heart is responding well. He said that this is probably as good as I am going to get and that in comparison to other POTS patients I am doing exceptionally well. Not having anything to compare to I didn’t realize I was actually a sterling example of the best case scenario for some people. This made me feel pretty good. All of my hard work in making sure I keep up with lifestyle changes has been paying off. He suggested my next step should be to try some eastern medicine things, which I am pretty curious about. I shall keep you updated with my foray into alternative medicine…
- I am not exactly sure what this says about me, but I got a new vacuum this week and that made me really happy. We are about to start 2 weeks of intense examinations, we don’t even have any classes, just dedicated study time and exams– and nothing helps me prepare for exams better than a clean house. I spent the morning cleaning my entire home and now I feel ready to crush my histo and pathology exams on Monday. That is of course after I spend all weekend studying in my very clean home.
2. The Worst of This Week:
- I had my anatomy dissection of the plantar foot this week. I love medicine but spending 3+ hours around cadavers is just not something I can get used to. I may still be jaded from my last exam but this is the class I have enjoyed the least in our training. Nothing will feel better than that Anatomy shelf on Friday, June 13th, which will mark not only the end of anatomy (forever!) but also the end of our first year of medical school!
3. Medical Breakthroughs of the Week:
- Researchers Report Treatment Clears HIV in Second Baby: Evidence is increasing that treating HIV-positive babies within a few hours of birth can dramatically restrict — and perhaps eliminate — infection.The baby, born at Long Beach’s Miller Children’s Hospital, was given triple drug HIV therapy starting within 4 hours of birth to a mother with untreated HIV.Tests at birth showed the presence of HIV DNA in the baby and testing 36 hours later — 32 hours after treatment was started — showed a plasma viral load of 217 copies per milliliter. A spinal tap when the child was 6 days old showed 32 copies of HIV RNA per milliliter of cerebrospinal fluid, Persaud reported. But within days, almost all signs of HIV had disappeared. The plasma viral load, for instance, was and has remained undetectable, defined as fewer than 20 copies per milliliter.
4. Just for Fun-The Friday Rewind Image Challenge
What’s the diagnosis? (My medical school friends better get this histo themed challenge!)
C) Dieulafoy’s lesion
D) Schatzki ring
E) Systemic sclerosis
*Courtesy of the New England Journal of Medicine. Answer in the comments sections.