A Med School Memoir

remembering med school in real time

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Diabeetus, or, How I Learned to Stop Worrying and Love Endocrinology

February 18th, 2009 by The Memoirist
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Diabeetus

The endocrinology test is rapidly approaching, and I’m starting to get a little light-headed from the amount of information I’m trying to shovel into my brain.  Or maybe that’s just hypoglycemia from my insulin-secreting tumor.  Or maybe it’s a headache from the hypertension secondary to my Conn’s Disease.  (Or, maybe it’s just my med student syndrome acting up again.)  My brain feels like my backpack has begun to look from lugging around a dozen textbooks for the last few weeks: tattered, frayed, and on the verge of disintegrating.

Seriously though, endocrinology has been a very strange block.  It’s like biochemistry and cell biology had angry/drunk sex one night and nine-months later spawned this overly-convoluted demon subject.  Endocrinology takes the worst aspects of my least favorite classes (hello random enzymes! hello signaling pathways! hello second messenger systems!), and expands on them in mind-numbing detail.

Imagine your least favorite thing.  This varies by person, obviously, but for me, this happens to be the sound of fingernails on bluejeans.  I’m not sure why, but this sound, once I hear it, will get stuck in my head and linger there for several seconds, and all the while, it feels like it’s stripping layer after layer of flesh out from the inside of my head.  Now, instead of just hearing this sound, let’s say you record it, play it louder, play it slower, cut it up into tiny little chunks and examine each individual waveform.  You play it forwards and backwards, and put it on a loop.  You examine not only the sound itself, but what made the sound happen–you videotape the fingernail and the bluejeans.  You study the way the fingernail fits into the tiny little crevices in the threads of the jeans.  You determine the effects of fingernail length and thread count on the sound produced.  Every little detail that goes into making this sound, you examine the hell out of it.

This is endocrinology.

Now, before it sounds like I’m complaining, let me clarify.  Endocrinology may be filled with painful amounts of seemingly superfluous redundancy, but in the end, that’s okay, because you know the old adage: repetition is the key to all learning.  Even though there has been a lot of material presented in this unit, a lot of it is review.  As a result, I feel like I’ve learned a lot, and that’s always a good feeling.  If ever there was any doubt that I hadn’t learned every single little effect of insulin after I finished biochemistry, well, that has been remedied.  In the last couple weeks, I have reviewed the effects of insulin about 1,000 times from a 1,000 different angles.  I have reviewed the effects of insulin so much, in fact, that I probably have diabetes now.

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Med Student Syndrome

February 15th, 2009 by The Memoirist
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Last night I woke up around three in the morning.  I was sweating, my heart was beating super fast, and my blood pressure was so high that it felt like blood might shoot out of my eyes at any second.

Since we’re in the middle of the endocrine unit at school, my first reaction was that I have pheochromocytoma, a catecholamine-secreting tumor.  There’s no way I was having a bad dream, or am just a little over-anxious about the test coming up on Friday.  No, it’s much more likely that I have a disease that is seen in about five in a million people.

This is how I memorize my clinical correlations for the test, by the way.  I actually get the diseases we’re learning about.  It’s a bitch, but I’ve yet to find a better way.

I have a feeling that this will make pathology a very difficult class next year.

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On Genitals… part 1

February 13th, 2009 by The Memoirist
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Don't worry, we'll be in and out real quick.

Don't worry, we'll be in and out real quick.

Since the day I got my acceptance to medical school, I had been dreading one thing. Every time I thought about it, I felt my anxiety level bubble up like a two-liter of diet coke with a pack of mentos dropped in it. It wasn’t the thought of cutting up a dead body. No, that didn’t bother me too much. It wasn’t the promise of never-ending studying and a constant onslaught of tests. No, weirdly enough, I was actually excited about the prospect of getting to spend some time studying. (Weird as it may sound.) It wasn’t even the thought of spending hundreds of thousands of dollars for my education. No, I actually managed to get over that shock pretty fast.

No, without fail, the one thing that had been stressing me the fuck out since even before the first day of school was the dreaded pelvic exam. As part of the Intro to Clinical Medicine (ICM) curriculum here at my school, all first year students are expected to learn how to perform several different clinical exams, like the routine abdominal exam, lung exam, heart exam, yadda yadda yadda.

Even these normally routine and innocuous exams tend be anxiety-inducing on their own. I’ll never forget how nervous I was before the very first one–the upper limb exam. My palms were all sweaty and I felt incredibly self-conscious as I approached the standardized patient to feel his shoulder. See, it’s all about the anticipation of awkwardness to come; the thought that you’ll have to put your hands on some stranger’s body and pretend to feel something that you either can’t feel, or isn’t even actually there. Even though it’s an educational activity, it’s also an act–a ruse–pretending to be knowledgeable about something you’re not. It can at times seem so entirely disingenuous and outright phony as to induce some serious cognitive dissonance.

Read about my first GU clinic…

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On Gross Lab

November 13th, 2008 by The Memoirist
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My dissecting partner has put me off to any number of foods recently.  First, when we were removing the subcutaneous fat from our cadaver’s back, he noted the fat’s resemblance to undercooked scrambled eggs.  That comparison was so spot- on that I couldn’t even think of eggs without gagging for a little while.  This week, when we got into the heart, we cut away part of the aorta and set it aside.  “How about some bacon with your eggs,” he said.  Luckily for me, I don’t eat bacon, or that one would have been ruined as well.  All we need to do is find something in the human body that looks like a pancake, and we can make a cannibalistic Grand Slam Breakfast.

If it sounds to you like we’re being disrespectful or unprofessional about dissecting a human body, you’re probably right.  But I would also suggest you try taking a hammer and chisel to the spine of someone who resembles your grandmother, and hearing the bones crack, and feeling them give way from your blows, and then get back to me.  I defy you to do that without throwing up about 1,000 primordial defense mechanisms, because I say it can’t be done.  So yeah, we make some jokes about how her back fat looks like coconut creme pie, and we laugh, because really, we’re all traumatized as shit by having to mutilate a dead person every day.

So yeah, I cut open a human heart with a pair of scissors the other day.  Let me tell you, it sounds way more badass than it actually is.

My cadaver (”Dorothy”) was a pretty big lady (let’s just say she liked her McDonald’s).   She died of heart failure, and her heart was enlarged–probably a result of hypertension, which would not be not surprising considering that she was obese.  In addition, her heart was covered in a thick layer of fat that we had to dissect through to find all the intrinsic vessels of the heart.  I don’t know about you, but I’ve always thought of the heart as this solid, firm organ, kinda tough, but ultimately resilient.  I mean think about it–this thing beats millions of times in a normal person’s life–is more active than any other muscle in the body.  How could it be anything other than durable–that’s kind of the definition, right?  Able to withstand a lifetime of use?  Holding a heart–literally–in your hand, you realize just how fragile the thing really is.  I’m finding the same to be true of pretty much everything we dissect in lab–everything in the body.  It’s kind of startling to think how much work goes into building a human body–thermodynamically, chemically, etc.–that is so easily and irreversibly destroyed with one deliberate swipe of the scalpel.  It took this wonderful woman an entire life to make the body we now find splayed out in front of us in lab, and within a few hours, we’ve stripped her of her skin, or we’ve sawed through her chest and removed her lungs, or we’ve chiseled our way into her vertebral column to expose her spinal cord.  The net effect of all the cuts we make in a normal day in lab would most definitely kill a person, if they weren’t already dead.  It was tough to come to terms with this at first.  But you also know that you’ll never learn any of ten thousand things you have to learn if you don’t get in there and dig until you find it.

There is something very zen about picking away through layers of fascia for long stretches of time in order to find a tiny little nerve, no thicker than a spaghetti noodle.  And then, when you finally do find it, you must exercise the utmost caution not to apply too much pressure, or it will snap.  In a living person, severing that nerve might lead to irrevocable muscle atrophy, or paralysis of a limb, or loss of sensation to some portion of skin.  And if the same thing were done in a living person, it would never heal.

We are such intricate, delicate beings.  Life, in and of itself, is an amazing thing, and I think that goes without saying.  What’s also remarkable, and often under appreciated as the miracle that it is, I think, is that we can not only be born alive, but that we can be born healthy, and stay in relatively good health more or less until we die, riding the crest of a lifetime of subtle physiological equilibria that can usually keep things working as they are supposed to.  Knowing that so much can go wrong, sometimes it’s amazing to me that we aren’t always sick, all the time, and I’ve become hyper aware of my own health.  It’s not much fun.

A lot of cadavers in our lab had severe lung problems when they died.  Let me tell you, seeing firsthand the damage that smoking can do to your lungs will make you never want to touch a cigarette again, and regret the fact that you ever smoked at all.  The lungs of these smokers–the lifetime, pack a day habit smokers–they’re just so much worse than you can imagine.  We’ve all seen the pictures of the smoker’s lungs, dark and cruddy looking.  Well, that’s nothing.  The cadaver at the table next to mine died of lung cancer.  He had little meatballs growing in his lungs, but otherwise his lungs looked fine.  What is troubling are the other ones–the ones who were lucky enough to not get cancer, the ones who never had to quit smoking.  Their lungs are tiny little sacks of black tar, shriveled to less than a third of their normal size.  And they smell–even in a lab full of dead bodies, you can make out the smell of a stale ashtray wafting from these lungs.  And when we open up the trachea, we find congealed black mucous.

I used to smoke.  In college, I probably smoked a pack a day for a while, and even in the last couple years, though I have cut back significantly, there have been plenty of times when I smoked a pack over the course of  a weekend at the bars and then vowed to quit again on Monday.  But that’s all over now.  I’m done.

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On Things That Shouldn’t Happen Right Now…

August 31st, 2008 by The Memoirist
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So, I’m about three weeks into med school. We’re thigh-deep in glycolysis and the TCA cycle, and I should really be spending just about every free minute memorizing every last detail I can cram into my head about this whole thing.

The problem is, my head just isn’t in it.

I wish it was. But when I study, all I think about is the bad news I got on Thursday night. My dad left my mom and they’re probably going to get a divorce. Furthermore, both my parents are recovering alcoholics, and recent events have triggered a relapse in the family. Things in my family haven’t been this stressful since I was a teenager when they first went through treatment for their addictions. (More on that later–I’ve been meaning to talk about that anyway.)

Needless to say, I really wish I could be there for my mom. She’s emotionally devastated, and she needs some support in a bad way. Unfortunately, I’m hundreds of miles away, without much power to help. I wish I could go up to see her, but I can’t–not right now. I’ve got to study and get good grades. It has taken me years of hard work to get to where I am, and I can’t risk it not working. I’ve got to do my best to stick it out. At the same time, I feel incredibly guilty for not being there for my mom. I feel like, by not dropping everything to go up to see her, I’m effectively saying “what I’m doing is more important than you are.” While I can tell her I support her and love her and all that, actions speak louder than words, and I feel like my actions are screaming out something I would never say.

Bottom line is: it really, really sucks that this is happening right now. In hindsight, I suppose I saw it coming, but I wasn’t expecting it to happen now.

Oh well, c’est la vie. Gotta study. I have a date with phosphofructokinase-1.

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On Work and Reward

August 28th, 2008 by The Memoirist
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Holy hell.  I feel like a giant has scooped me up, shoved me in his mouth, and chewed on my skull before spitting me out.  It’s been a rough week.

Monday was the first test.

I studied.  Every day, after class, I reviewed the lectures, made notes.  Then, when I was through making notes, I previewed the next day’s material.  I studied every night, sometimes until well past midnight.  And as the test approached, I kicked it into high gear.  When I say I studied hard, good god, I mean, I studied hard.  I read.  I took notes.  I highlighted my notes.  I drew diagrams.  I made flash cards.  I did practice questions.  I did everything I could think of.  I stayed at the library for 12 hours on Saturday, and 8 or so on Sunday.  I thought I was golden.  I have never studied like that before.

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On Time Commitments, or, Why I Haven’t Updated in So Damn Long…

August 19th, 2008 by The Memoirist
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I wish I had a good excuse for why I haven’t updated in so long.

Oh, wait, I have several… The weeks stretching from the last part of July into the early part of August were hectic for me.  “Hectic,” actually, would have been nice.  No, those few weeks were something more–intolerably frustrating, perhaps?  Maybe they would be better described as “maddeningly overwrought with thousands of trivial loose ends that I was ethically and morally bound to tie up.”  Either way, from about July 15th to August 5th, I realized what it must feel like to be a pinball, bouncing around from one bumper to another at the whims of nothing/no one in particular except the force of gravity and whoever/whatever is controlling the flippers.  I was holding down a job and moving to another city, somehow, AT THE SAME TIME.  I wish I was joking, but I’m not–I actually moved to another city (hundreds of miles away) to start med school, then went BACK HOME to finish out my last two weeks of work, before moving AGAIN the weekend before school started.  Not the smartest way to take care of business, I know, but it was the only way I could make it all work.

And if all that business wasn’t enough to keep me from updating, there was also the lack of internet… that’s right, I didn’t get the internet hooked up until today, so it was pretty much impossible to update until now.  So, I apologize for the lack of any posting whatsoever for this last stretch of time, but I promise that you can expect more updates now that I have a reliable and private internet connection.  (I had thought about posting from the school library, but I’m still paranoid that someone might see me posting and put two and two together.  I’m not quite ready for that.)

Well, I have a ton I want to talk about, but it will have to wait until a little later, when I have a bit more time for a really good post.  Suffice it to say that I’ve recently completed my first week of medical school!  There was a quiz on the third day of class, and thankfully I knocked it out.  (Only missed one out of 15…)  There’s a test next week, too.  My, my, my…

During the first week, I went to lecture everyday, then when lecture got out, I went straight to the library for a few hours (until dinner), and then, after an hour or so of dinner, I hit the books again until midnight or so.  It was intense–Like 14 or 15 hours of class-related, ass-in-seat, nose-in-book learning every day.

I already know I can’t keep up that level of commitment, or I will do one of two things.

Either:

a.) go insane from lack of even a quasi-regular social life

or

b.) lose all normal cognitive function from lack of sleep, and wither away into a shriveled mass of lumpy tissues from lack of proper nutrition, exposure to sunlight, and exercise.  (In other words, I’ll turn into a World of Warcraft player.)

I’m hoping I can circumvent either of these two unfortunate outcomes by finding the happy medium between studying and living a healthy existence.  The problem is, I don’t know if such a thing exists.  We’ll see what I come up with.

Okay, so I promise I’ll give a more thorough update this weekend when I have a little more free time.  I just wanted to check in and let everyone know that I haven’t disappeared, and that I fully intend to keep this thing up!

Best of luck to those who, like me, have recently started med school!

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On Being A Patient

July 14th, 2008 by The Memoirist
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A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.

-Hippocrates

Last time I updated, I mentioned that I’ve been sick recently. What I failed to mention was what happened. Well, even though it’s a little embarrassing, I’m going to share my most recent experiences with being a patient.

First, it should be noted that I’m a really healthy guy. I’ve been a vegetarian for 8 years, I work out 3-5 times a week, I don’t drink too much, I don’t smoke (except when I drink, which again, is rarely). I’ve never done hard drugs or engaged in risky sexual activity. I’ve always been a firm believer that a healthy lifestyle is important in maintaining overall health. To that end, I’ve been successful. I’ve never been hospitalized or sick for more than a couple days with a cold or flu. I’ve been lucky.

Until recently.

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An Interesting Read

July 8th, 2008 by The Memoirist
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I’ve been really, really sick for the last week or so.  I’m starting to feel better, but every time I think I’m out of the woods, something else comes along.

Anyway, I’ll write more about it later, but for now, I just want to share a link.  I came across an interesting article at salon.com about the shortage of primary care docs in the US.

Go check it out: Where Have You Gone, Marcus Welby?

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The looming specter of financial aid

June 26th, 2008 by The Memoirist
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So, I finally got my financial aid package all sorted out the other day.  I’ve officially signed away my life.

It makes me want to cry.

This is what makes med school real.  Not the acceptance and the accompanying promise of a (potentially) rewarding career.  No.  What makes it real to me is the fact that now I have signed up to take out more loans for one year of medical school than I took out for my entire undergraduate education.  Med school is real now, because I can’t not do it at this point… as medicine will now be the only profession that will pay well enough to allow me to repay these massive loans.  Yay!

Let’s look at the numbers, shall we?

Subsidized loans– $8,500/academic year.

Unsubsidized loans– $25,322.00/academic year.

Total loans– $33,822/academic year.

$33,822/year x 4 years = $135,288!

And, I should note, my school is a “cheap” public university!  If I had wound up at a private school, I would probably be looking at twice this amount!

I should also mention that above figure is actually a low-ball estimate, because the costs of years 2-4 are going to be higher than the first year.  I’ll probably wind up closer to $140-$145K in debt by the end.  In order to pay that off in 10 years, I will be looking at making payments of around $1550 every month.  To put that in perspective, right now, I work in a job where I earn around $2000/month, after taxes… so if I were going to try to pay off my student loans with my current salary, I would be living on ~$450 per month.  So, obviously, it’s pretty imperative that I actually graduate from medical school and find a job.

But no stress.

So, do I really want to do this?

As intimidating as these figures are, I’m confident in myself.  Sure, the next several years are going to be immensely stressful.  Aside from the stresses of attending school, getting good grades, passing the boards, doing well on rotations, and finding a good residency, there will the the ever-looming specter of my loans hanging over my head.  If I fail, I will be consumed by debt.  That’s quite a stressful thought.  But despite this fact, I’m confident that I have what it takes to succeed.  And despite the cost of attending medical school, medicine is still the only career where I can see myself being happy 30 years from now.

I always knew this was coming, but I guess I just wasn’t completely prepared for it.

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