Charlie goes to Medical School

Quick post to say that I took the one and only test for the last module for the year. I wish I could say I felt better about it, but I usually feel this way after tests.

Tomorrow starts the review sessions for our shelf exams. We actually do a bit more in the cumulative exams department than most schools, but it is pretty good to get a solid check point this year…because next year the end of year tests are much more important.

One bit of feedback that I got this week: I need to learn how to relax.

365::62 - moments so quietly gone by brdwatchr1

I was going to call this something else, but this picture so perfectly says it.

I still have review sessions and tests left, but today marked the end of lecture for Phase I, my first year of medical student.

We marked the end of class solemnly by throwing pies in the face of one of the course directors (it was part of a fundraiser). The throwers were picked out of a box, so I naturally started a movement to “nominate” one of our friends to do the throwing. Alas, it didn’t work.

We have a test on this module coming up, followed by shelf exams. Shelf exams serve as a checkpoint at the end of the first year, so students can gauge their retention of knowledge for second year when we have to take the step 1 boards. The lecturers in charge of the relevant subject areas are nicely putting together review sessions/materials to help us study.

These tests aside, I’ve covered all of the material from the first year of medical school. I can’t remember how much I’ve written about our curriculum, but medical school is basically broken into four parts. Roughly, the point of each year is as follows: The first year covers how the body should work. The second year covers how things can go wrong (and pharmacology). The third year is how you treat these disease states. The fourth year sort of continues the third, but with more of a focus on what you want to do (and where you are going to go…Match!).

So with Phase I nearly complete, I should have a fairly comprehensive understanding of how the human body works. I guess I’ll get to gauge that over the next few weeks as I take my shelf exams.

Non Sequitor (This gets just a tad graphic…and sad, so be forewarned.): So last night I had a pretty weird moment. I ran out to hit an ATM to deposit some checks and deposit some checks. On the way back, I swerved to miss a cat who had been hit. It wasn’t until I passed by that I realized that the cat was still moving. The cat rolled over on its back and onto the other side, clearly writhing in pain. By the time I pulled around and got out of the car, the cat had died (or seemed dead enough without me risking exposure to something like rabies). At the time, I remember feeling pretty powerless seeing as how my initial reaction was to actually ask the cat if it was okay. I whistled a few times and checked to see if it would respond, but there was enough blood on the pavement to rule out this cat’s survival. I was fairly sure that I could leave and be satisfied that the cat wasn’t hurting any more.

Of course, at the time my head reeled thinking about what actually was going on with the cat. Even moving the cat would have probably resulted in the cat’s death. I don’t really have much else to say about it. When I got home, I wound up staying up really late because I didn’t feel like going to bed or studying with those thoughts in my head.

The pen is mightier than my right second metacarpophalangeal joint. Photo by quinet on flickr.

I had a little pain in the index finger joint of my right hand followed by some erythema to go with it…i.e. It turned red.

Just a little. It doesn’t really hurt and is not swollen. I’m right handed. This is clearly from writing a lot with crappy pens.

If it isn’t, it’ll get worse over the next day or two and then I’ll deal with it.

If you are in medical school and something is wrong with you, you must wait until you have a definite symptom that you can demonstrate to someone. Then wait an appropriate time to see if it goes away (this time varies…if you need help call 911). Then go see an actual doctor.

You must not, ever, ever Google your symptoms.

According to Google, I have lupus.

I’m going to bed and buying better pens tomorrow.

Buried under a pile of paperwork. Photo by lotyloty.

One of the sadder aspects to medicine is the black mark on the history of medical research made by scientists performing unethical research. I don’t really want to turn this post into something about that negative part of that history, but there are two main points to learn from these events.

First, people have a tendency to judge others while maintaining a “Not in my Backyard” attitude (which has started being abbreviated to NIMBY). Following the Doctors’ Trial and the Nuremberg Code, the attitude in America was that this sort of thing couldn’t happen here. Meanwhile the Tuskegee syphilis experiment continued right here…in our backyard.

The second point is that these events occurred very recently. What happened in Tuskegee occurred through 1972. Many people alive still remember what happened affecting the way doctors are perceived in many parts of the country.

Because of this, the research that I am doing this summer must be submitted to review by a committee which is responsible for ensuring that all research at this institution is being conducted in an ethical manner. The unfortunate thing about this is that at an early stage we must plan out the research to a somewhat granular level.

For example, we are supposed to be doing a power analysis to determine what our sample size would be for this study. However, I don’t have a measure of variability for what we are doing, so power cannot be calculated. Issues like this makes for an interesting write up. Especially since I’m still taking classes, so I don’t have a lot of time to do stuff like literature reviews.

However, the important point is to go through and document things like risks and side effects. If you are performing the study on any “vulnerable” population (like minors or prisoners), you have to mitigate any risks accordingly. You have to document any exclusions and reinforce that you won’t be keeping participants out of the study because they may not be able to read or write or they speak a different language. I’m actually trying to avoid having to do consent because I’m not performing any diagnosing or treatment, so I have to write up the fact sheets that I’m handing out and document that I have minimal risk and the impracticality of obtaining full consent for my research.

In the end, this adds up to a lot of paperwork and a lot of redundant rewriting of the same things. However, this is a necessary step that every researcher has to do. Any ethical dilemma can turn into a slippery slope fairly quickly. The boundaries of what would be considered unethical are not always clearcut and not everyone sees things from the same perspective. What may seem like nitpicking actually keeps researchers from any ambiguous lines and that slippery slope which helps prevent undue harm to patients who volunteer for these studies. Institutional review boards are run to ensure that every perspective is considered and that no one crosses these ethical boundaries.

Image by armyengineersnorfolk

An internist, a surgeon and a pediatrician were stranded on a sinking ship and only had enough life rafts to save one of them…

…and then the devil says, “How did you manage to get three doctors on a boat without any booze?”.

So one of the favorite events across all levels of our medical school is the annual raft debate. This is a tradition at a few medical schools where one doctor from each of three specialties will come in and debate the merits of their chosen specialty over those of their colleagues.

There were opening statements followed by questions from the faculty, students and finally the moderator (although I think he just cherry-picked the best audience question and told them to hold on for his turn). The event was decided by a crowd vote with the medical students allowed to hoot and holler for their favorite debater.

Of course, the event participants were professionals entering into a lively discussion with their peers in front of a group of impressionable medical students, so the most stringent tenants of decorum were observed… Yup. Decorum.

Actually, apparently in past years this discussion had gotten a little too fun. Also, there was some bribery. So this year, the event was a little more restrained. However, there were still plenty of antics and hilarity to go around. Wife attended with me and we both had an excellent time.

It is always interesting to hear practicing physicians talk about their careers. We’ve had several events over the past year at interest group meetings, classes and other events where doctors will come and talk about the different specialties. What their work entails? What kind of lifestyle is working in that field conducive to? What is the day-to-day really like? Although this event wasn’t really about properly demonstrating the pros and cons of each field either from a doctor’s or a patient’s perspective. It was fun to sit down and watch some of the leaders from these fields come and openly mock each other for a couple of hours.

Jean-Auguste-Dominique Ingres (1780-1867), Study for Phidias in the Apotheosis of Homer, 1827. Courtesy of the San Diego Museum of Art.

One of the more laughable attempts that New Scrubs made at demonstrating a first year medical event was their “Thank You” day episode. In fact most of this new series has really been based around 5th grade skit versions of what I have been calling “medicine camp”. When I told some of my friends that I was going to speak for our group at our Cadaver Memorial, the one piece of advice I got was to not go with Lucy’s speech or really anywhere near it. I don’t really think the writers really understood what went on in Anatomy Lab.

Last night, our entire class and the anatomy faculty gathered to pay respect to the donors who gave their bodies so that we could learn and to their families as well.

Unfortunately, we didn’t get to meet with the families of the the donors last night. I really would have liked the chance to show my appreciation directly to the family. The school and some representatives of our class will be holding a memorial just for the families in the near future. I suppose an event with the entire class might be a little too much for the grieving families.

The entire class attended the event last night. At this point, it is definitely hard to wrangle the entire class together. People often take the day off from lecture to work on their own, so the class is hardly ever gathered in the same spot except for tests. Plus, at this point the energy level was really low. I know I’ve been a little snowed under with my research write-up for IRB. In spite of all this, the entire class showed up and we had a really great memorial service. In spite of everything, everyone was present and in the right frame of mind last night to pay respect to those who are making our education…our new careers and lives possible.

A few of our classmates performed some nice songs. A member of each dissection table spoke, saying something about their experience and thanking the donors. I spoke for our table and said something about connecting with the body and with our patients in the future, trying to be that thing that some people want…a connection to other people to last beyond their years. Something that we have to live up to.

We also got a chance to celebrate the woman who directed the Anatomy curriculum. She will unfortunately not be able to make our teacher appreciation day, so we took a moment to thank her for everything she had done.

And the entire thing was put together by members of our class. It dawned on me later that this was one of the first non-social events that was put together by the class (possibly with some guidance from Student Affairs, but it was mainly our Curriculum VPs…so thanks to them).

Anatomy lab has been a huge part of this year. I’m not going to be a surgeon or anything. At best I will probably only be doing some minor procedures. However, I learned so much about medicine in the lab and it will start helping us next year when we start learning more about what can go wrong with the human body. In fact, it already feels like it is starting to help out when I go to clinics to volunteer and actually talk with patients. So thank you to our friend. Thank you for helping me in my first year of medicine.

Checkin’ out the Wordpress app for the Droid.

Sorry for the downtime folks.  We’ve spent a couple of hours this afternoon updating the blog and getting everything together.

The short version of the story is that Wife totally outed the site in casual conversation about a month ago in front of a few of my classmates.  I really didn’t want this site to be a place for people I see everyday to come and find out my inner thoughts about our daily lives.  This was supposed to be more for random people who stumble across the site and some of you folks from back home.

So when I started getting a few questions and comments, I took the site down for a bit.  In fact, given some of the news stories about some medical bloggers being real morons and writing completely inappropriate stuff, I think it might be best to at least disclose the blog to our honor council so if word ever does get out it won’t be a surprise.

Today I wanted to bring it back up because the Cadaver Memorial is tonight and I want to write a bit about it.  I also need to fill in the gap.  My last post was in February.  Since then, we’ve covered the heart and lungs in the Cardiopulmonary module and the GI tract, accessory organs and kidneys in the GI module.  Now we are in Repro/Endo.  This module has one test and then we have our finals for the entire year.  At the beginning of the last test, the course director hung a big powerpoint slide on the big screen that said “25 Hours Left” of our first year.

I’ve been accepted into a summer research program for us first year medical students.  I may not talk about the specific research, but I will tell you that I’ve just spent the last 2-3 weeks getting my project written up for our IRB.

I’ll be keeping my tech officer post for the class, but I’m working to rearrange some of my duties to include a little more organizing with our sister campus so that some of our activities can cross over (Road trip!).

On a personal note, there was spring break.  Wife and I went to the coast and met up with a high school friend and his girlfriend.  Pretty low key compared to some of my classmates.  Then again, I’m in my 30s now, so just walking around and having a few beers with my fried seafood platter is about my appropriate speed.  The last day, I had a pimento cheese and chili on a cheeseburger and I think I felt my heart gasp.

So each of these little nuggets probably has enough material for a few blog posts.  We’ll see how that goes.

Hope all is well with everyone.  Peace out.

Admin Cat…

Ruler of the universe…as in a thing used to measure the universe.

Edit: WP to Twitter is working.  I’m going to leave it on for a while since posts are scarce.