Pre-test ritual

Crunch time..........
7:37 am - 23 minutes until test time! Approximately 1/2 hr pre-test I quit. I try to give my brain a little relaxing time before the test actually starts. I didn't used to study right before a morning exam, but now I review briefly a few things - hoping that the mechanism of action of one or two more drugs might stick. And I think it's a warm up for my brain prior to the test. I will be done in less than 5 hours! woo hoo.....

I know I'm not the only one who has a pre-test day ritual. Mel reads a book for fun prior to the exam. Me... I wake up, put on my lucky underwear (they are only lucky because I think they are cute and declared them to be lucky ), study until 1/2 hr pre-exam time, then do something relaxing (today writing in my blog), and then I have a song I listen to on my ipod by Yurima, entitled Maybe. It's piano music and it relaxes me. I sit in the lecture hall with the notes floating into my ears as I watch everyone find their seats, lay out their pencils, coffee, snacks, etc - doing their pre-test ritual thing. I enjoy sitting there in my own little musical world watching everyone else moving around me. I feel like an observer and not a participant in this crazy jumble. I'm calm from the music, yet anxious, and excited to get the test started. The sooner we start the sooner we're done!

Ok, I'm off.

Sounds Like Me?

"He developed a tendency to speak rapidly, explosively and unintelligibly when excited, and on several occasions became lost in familiar surroundings."

I came across this statement while studying for my exam. And hmmm...sounds familiar. Me? Just need to add the expressive hand motions that tend to accompany my moments of rapid fire speech. And those of you who know me - know that I have the worst sense of direction.

If you are curious to what the above description is in reference to - it went along with a description of a patient presenting with Alzheimer's Disease.

Short entry today - lots of work to get through and hopefully some relaxing for me tonight pre-exam!

Random pic - just for fun!

A peek into test week

Oh what fun.... it's test week. We have an exam this Friday. Neurology - this test spans 5 weeks of information, over 40 lectures + lab + pbl cases. I think this is the most info we've had on a single exam since anatomy.
Life tends to change during exam week. Everyone is a little bit tenser, stress fills the air, the library and study rooms fill with people. We tend to hide ourselves away in our own little worlds - either a cubby in the library or wherever your little space may be. Small groups here and there reviewing.
For me - it means more time at school. These are the weeks where I feel like I live at school. These are the days where I pack up all of my food for the day. Lunch, snacks, and dinner - all get thrown into my awesome lunch pail (not really a pail, but more of a bag), because I know I won't be making it home until probably around 10 or 11.

But it's not all bad. It's these stressful days or review sessions when things seem funnier. When we make up the most random pneumonics or make idiotic connections hoping we'll remember it for the exam.
(ex. Benzodiazepines - mechanism of action is by increasing the frequency that Cl- channels are open. BenzOdiazepines - O - for open, open, open) - yup that's how I remember what Benzos do)
And how do we remember what Kallmann's syndrome is? - well in class our prof informed us it is a guy with small balls, who can't smell - that's right - that's what I remember
- the problem is X-linked and due to a mutation in cell adhesion molecules that guide the development of axonal growth. It causes problems in nerves growing to the olfactory bulb and those cells that secrete hormones relating to gonad development to migrate to the correct places.

The coolest thing I learned yesterday, which of course will most likely not be tested is... Capsaicin which can be used medically as a non-opioid analgesic (decrease pain) - is found in hot peppers and pepper spray. The way it works is it causes the release of all of this painful neurotransmitter - Substance P and by depleting the stores of this painful stimulus it thus stops pain. The original release of Substance P is very painful (which is why it works for pepper spray). So if it is given as an analgesic medically - they first would use a local anesthetic so the patient would not feel that initial pain. The cooler part of this whole lesson is that plants that have Capsaicin in their fruits have their seeds distributed by birds. If mammals eat these fruits their digestive tract digests the seeds, so they are unable to grow - this is why these plants produce capsaicin, because it is painful and hopefully this will deter these animals that will digest the seeds from eating their fruits. Whereas birds find capsaicin to be an analgesic - so birds should be more likely to eat these fruits and thus distribute the seeds.

If you managed to stay with me throughout this entire post - congrats. This is where my mind lives during test week. I can't help it. 2 more days.....

3rd year!

Excitement and disappointment filled the air this afternoon as we were given our cohorts for next year. A cohort is the order in which we will do our rotations for 3rd year. There are a total of 16 cohorts and you rank these 16 in the order that you would like the rotations. We are required to do 8 rotations and 1 or 2 selectives. A selective can be a vacation month, because this will be the first year that even though I am in school - I won't have a summer :(
I'm happy with my cohort. It was probably my 5th or 6th choice. The reason it matters what order your rotations are in, is because next year we are supposed to narrow down what field within medicine we think we want to work. The general rule of thumb is what you think you want to do - don't do it first or last. If you do it first you don't know anything and if you do it last - well then they expect you to know more.

Right now I'm not sure what field of medicine I want to go into. I am leaning in the direction of Family Practice or OB/GYN (yes, I know when I cam into medical school I said I would never do it) and there's the possibility of internal medicine (but thats #3 on the list).
Family Practice and primary care in general is so important. I view it as prevention a person from getting diabetes or having a heart attack is 10 times better than treating the problem once it has happened. I realize that I am very idealistic and that getting people to make lifestyle changes is one of the hardest things to do, but I think it would be so rewarding. I have big plans that could be implemented into a primary care practice that would help people make some of these changes, but I will save that for another blog entry. I also like the idea with family practice that you can see a variety of patients throughout the day. It's not just one patient population - even though I do worry with the baby boomers that the possibility for nearly all elderly people does exist. Family doctors can do so much if they have the training - they can perform colonoscopies, assist in surgery, deliver babies, etc. It's just a matter of getting the training, having the drive, and being in the right place that will allow you to do all these things.

As for OB/GYN - I find it appealing because I do really enjoy women's health. I know some of you are wondering how could I stand to look at women's hoo hoo's all day. But it becomes part of the job. Right now I'm looking forward to delivering my first baby next year - I just think it will be soooooo cool. Watch a few months from now I'll write and comment on how disgusting it is and that I never want to do it. Who knows? The other big appeal for OB/GYN for me is that it is a surgical residency -I would get to do surgery. I really enjoyed anatomy when I was in it and that's used in surgery. Doing actual surgery as a residency isn't for me - I think it's too specialized and I don't want to be in school FOREVER.

Returning to my schedule for next year I have listed below the order of my rotations:

July-August: Primary Care (this is a rotation I can do in a rural area of PA)
Aug - Sept: Elective
Sept- Oct: Family Medicine
October - Nov: Pediatrics
Nov - Dec: Ob/Gyn
winter break

Jan-March: Internal Medicine
March-April: Elective/ Vacation
April - May: Psychiatry
May-July: Surgery

I'm so excited for 3rd year. I can't wait to actually be working with patient's everyday!

Memories from the road

It snowed about 4 inches or so the other day. As I was walking outside either to or from my car - don't remember which, I noticed the salt scattered on the ground to prevent people from slipping and falling. Don't as me why - but I was thinking in my head I wonder if the salt on the ground tastes just like table salt. No, I did not try it and I'm pretty sure it does taste the same. But this reminded me of my road trip out here with my two cousins, Colby and Taylor. The salted ground specifically took me back to a hot morning/afternoon on the Salt Flats of Utah. There we were pulled over on the side of the road (even though there are many signs telling you not to stop) standing outside on the salt flats. We search for rocks, an alligator (the tread off of a tire), and attempt to spell our names. Then Taylor and I convince Colby to lick the ground and tell us if it tastes like salt. Colby of course does it and it does taste like salt. Naturally, now that someone else has done it - I want to to do it too. Colby has salt stuck to her hand from being on the ground - so I lick her hand and yup - tastes just like table salt.

Adam's New Place

Congrats! Mr. Adam Kennedy bought a house yesterday! It's official he signed the papers and joined me in sinking further into debt. Only difference as he said is that he can sell his house - I can't really sell my brain.

The new house is definitely a move up from 158 1/2 Fern St. It even has a guest bedroom for me!!! I'm hoping that when I stay he'll bring me b-fast in bed! Love you Adam!

I'm happy to say that the new house is in a better neighborhood - I won't be afraid to spend the night there and Marianne & Conway will no longer be able to park on the front lawn :(

Old house:












Please note the van seats as couches.

New House:

Lab Rat

So I did it. Today I became the equivalent of a lab rat. All for the high price of a whole $20. A nice, new, clean, crisp $20 bill will buy you about 5 vials of my blood! Heck - I'll even let you stick me twice!

This morning I woke up and went and had my blood drawn for a research study here at the medical center. I am acting as a healthy control that is looking into Inflammatory Bowel Disease (Ulcerative Colitis and Chron's disease). They just needed a few vials of the blood. I have great veins - I'm sure some of my classmates are looking forward to practicing on me for blood draws and IV's when clinical skills week rolls around. I had to be stuck twice because my first vein didn't give enough blood to fill all the needed tubes. It's probably because I was somewhat dehydrated at 7:30 this morning. I could have stopped there and still made my money, but I let them stick my other arm and finished the job! If I'm going to be a lab rat - I at least want to be a good one.

This is what they do at the medical center if you need young healthy control subjects. There is a huge pool of poor in debt medical students at your finger tips - willing to do just about anything to make an extra buck. There are tons of studies going on, but obviously the line must be drawn somewhere & you have to find the studies. Some will pay big bucks.
I called on a study once that wanted to perform a spinal tap on healthy patients for I don't remember what. I was really curious to see how much they would pay - I'm thinking in my head I wouldn't do this for much less than a few hundred bucks and I still probably wouldn't do it. When I called and asked the lady on the phone said the compensation was $50!!!! I'm thinking you're crazy!

So there ya go - medical student/ lab rat. Awesome!

Nerd

I'm fully aware of my nerdiness at this point. There comes a point in time when you just have to learn to embrace it. I mean seriously - there's really no way to get to medical school without being a nerd, if even you are a closet nerd - you're still a nerd.
So, I'm going to share with you my nerdy moment of the day. I was in PBL (problem based learning) - which are small group classes (8-10 students and a facilitator). In these groups we are presented with a case similar to how we would see one in clinic. We first get a page stating the patient's chief complain. For example today: Painless Right Arm Weakness in a 55-yr old woman. Then as a group we try to come up with the differential diagnosis (what we think could be causing the problem). Then we are given another sheet with the patient's history, we narrow down our list of possibilities or move other diagnoses higher on the list etc. Then we receive a page with the physical exam, etc. We go through this process until we figure out the diagnosis and along the way we are given certain questions to look up for the next time we meet to resolve the case. This is one of the ways in which we learn certain diseases.

Anyway - back to my nerdy moment of the day. So while in case today I was reading aloud the physical exam

vital signs: pulse 70, BP 115/76, Respirations 20, Temp 36.6C
Head and Neck: Atraumatic, normocephalic. No scalp tenderness. Tympanic membranes pearly gray bilaterally. Nares patent without exudates or erythema. Conjunctivae clear without injection or scleral icterus. Posterior pharynx clear without erythema, cobblestoning, or exudate. No thyroid masses or enlargement. No lymphadenopathy.

And while I was reading this I was like - wow - I actually understand this. I get what these words mean and to a certain extent what this rules out. It was just this weird heightened sense of awareness of the comfort I felt with these words and the presentation. Most of the words the definition can be figured out if you just break them down into their basic parts, but together it sounds impressive. Medicine truly is another language full of abbreviations. I still have so much of this language left to learn, but its good to know that some stuff has stuck. I can't wait until next year- I feel that when I finally get to see patients my learning curve is going to increase dramatically.

Study Buddy

Study Buddy.... stay, sit here next to me, keep me company.
Sometimes that's all one needs. Is just a friend, companion, another body in the same room to make you feel less alone. No words need to be exchanged. Just their presence, the occasional turning of a page, or typing on the keyboard may be the only sounds. Yet, still just that is comforting. Is it that misery (assuming studying is miserable) likes company? Or rather you need to know someone is in the same place as you at that moment - that you are not alone, that you are not fighting this battle alone.

So thanks. Thank you for just sitting there and being my companion in this big sparsely furnished room. Having you here makes me more productive and prevents me from being completely isolated.










Pictures of two of my favorite study buddies. (<-- Richard Tran and Melanie Andrews -->)

Love, Pain, and the whole crazy thing

The concert was amazing! I had an absolutely fabulous time. I’ll try to start from the beginning and not go completely crazy by writing too much, but no guarantees.

It started out pretty much like any other day – with school and studying, etc.
I go home that evening around 5 after going shopping, looking for a new shirt and failing to find one. Check the mail at 5 – no boots. I had my parents send out my cowboy boots, hoping they would make it here in time for the concert. No boots.

Hop in the shower and dry my hair. Go to the kitchen pop in a lean cuisine garlic chicken pizza and jazz it up by adding tomatoes, roasted bell peppers and sautéed spinach. Grab a little side of pasta sauce to dip it in and then I head back to my bedroom to watch an episode of The Office on my computer. As I’m walking into my room, my robe sleeve gets caught on the door handle and……… The pasta sauce goes flying! Onto the floor, across my bed spread, OVER my bed to the other side on the floor AND it somehow manages to get all over the wall to my right. $#%!

So, I try to clean up as much as I can, as quickly as possible. 6pm Andy calls. “What time will you be ready?” We wanted to get there around 6:30, about an hour before to pick up tickets, etc. Me, “I’ll be ready in 20-30 minutes.” Mind you – I’m still eating, in my robe, no makeup, my hair is only dried AND I still don’t know what I’m going to wear. Somehow I manage to get ready in that amount of time. 6:30 door bell rings. I grab my camera, purse, jacket, etc and run downstairs only to find…….UPS had dropped off my boots!!!!! Back upstairs for a quick change and w/in 5 minutes Andy was there to pick me up.

6:35 we’re off! Went to will call and picked up the tickets. Walked down the stairs to the floor, continued walking toward the stage – closer and closer and closer and STOP – 5 rows back from the stage. And 5/6 seats from a stage that projected out into the crowd (sort of like a cat walk during a fashion show).

7:30 – show starts. Opens with Carrie Underwood. She was awesome. Her voice sounds as good or better live. She sang for

over an hour. Then they switched out her stage with Keith’s. This probably took about 20-30 minutes. I was thinking I hope Keith does a good job. I was really impressed with Carrie and actually more excited to see her. Recently I bought Keith’s greatest hits CD and didn’t realize how many good songs he sang, but I was still more excited about Carrie. Until…..

Keith opened with his first song and totally blew Carrie out of the water!!!! He was phenomenal. The music just pulsed through my body. I was on my feet the entire time he was playing. Keith was an overall better performer – he interacted with the crowd better and was about the music. He played the guitar and piano. Carrie played the guitar too, but Keith PLAYED the guitar. He did a few songs w/ just him the guitar or piano and sounded just as good. I love when artists do that – their voice and just one instrument. A few highlights from Keith’s performance:

• The drummer was walking back from playing at the end of the cat walk type of stage and threw a drum stick into the crowd. It hit Andy on the shoulder, but my reflexes weren’t quick enough to grab it.
• A guitar pick literally whizzed right past my right eye/ear.
• Another guitar pick fell under the little girl’s chair in front of me. I found it and gave it to her.
• During the middle of his concert at the end of a song, a drum line came out on stage and performed!!! It was pretty cool. It looked like one of the local high schools or something.
• Keith walks off stage down a little ways off to the side of the floor seats. He’s still singing as he’s going and he has his guitar with him. He leans against the railing between the floor and the next upper level and is just surrounded by fans from the upper level. Then his body guard hands him a pen. I’m like, “NO HE ISN’T!” And he does!!! He takes the pen rips off the cap with his mouth, signs his guitar and hands it to a guy in the crowd.

Keith never left the stage (except right before the encore) and he played until 11:30pm!!!! I had such an amazing time. Since the moment we saw how close our seats were until 1:30 am that night I was on an adrenaline high.

Ok, I’m tired from typing all of this out. I may go make some coffee / attempt to study. It’s Saturday and I have a lot of catching up to do! Wish me luck.

Yes - It's heart's day

The best way to spend Valentine's Day....

Being single works - because then I have no expectations. I can't be let down. It's great in that way. And yes today I became one of those people who buy themselves something. A group on campus was having a fundraiser - and I bought myself a carnation.

But...even though I am single I do have a date on Valentine's - no strings attached, no expectations. haha - sounds bad, but it's innocent. My date, Andy, has a girlfriend in the Caribbean! We are headed to a Keith Urban/ Carrie Underwood concert. I bought tickets a few weeks ago, which I have since sold - because Andy won tickets to the concert off of Keith Urban's website. I made him and a few others sign up to win tickets (this was before I decided to buy tickets) and then Andy WON!!!! So my fingers are crossed that we'll have AWESOME seats.

Love, Love, Love - there are so many of you out there that I love so very very much. It's a blessing and a curse that all of you are scattered across the states and the world. But do know I think of all of you often!

Back to studying for me for a bit before I head home to check the mail and in the hopes that my boots made it to PA in time for the concert!

Discuss

The way I see it #280 (from starbucks)

"You can learn a lot more from listening than you can from talking. Find someone with whom you don't agree in the slightest and ask them to explain themselves at length. Then take a seat, shut your mouth, and don't argue back. It's physically impossible to listen with your mouth open."

- John Moe (radio host & author of conservatize me)


Let the debates begin....
We've recently watched the movie Sicko by Michael Moore as part of an assignment for our Ethics class. It has stimulated this desire in me to learn more - to search for the truth and to attempt to make the most educated opinion that I can. I am fully aware that Micheal Moore only presents one side to the argument, but I find it hard to believe that there can be a counter argument that can withstand what is presented in the movie. Something needs to change with the American health care system. It is currently being run by insurance companies. The government, the physicians, nor do the patients have control. Arguments against a national plan for health care will say the wait for surgery is longer, the care isn't as good, doctors don't make as much, etc etc etc etc. And to a certain extent this is true. The US does have the best health care in the world and yet we still have a higher infant mortality rate and lower life expectancy than most Westernized countries and even some developing countries. This I believe is due to the lack of preventative health care, which is essential in lowering costs and providing better care to the masses.
Without getting into this too much and regardless of your beliefs - just ask yourself: Does everyone deserve to be healthy?

It only seems natural that every person should be given the chance to be healthy. Without health all other basic human rights seem irrelevant.

The Food Chain

1st I want to comment on the excitement of SNOW!!!! Woke up this morning got ready, opened my garage door & there was snow! Finally I've been waiting. And thank goodness too, because this morning it was a whole 16 degrees compared to yesterday's 7 (which felt like negative 4 according to the internet)

So last night my dad gave me a lesson on the food chain....

We had these neighbors around the corner from us who used to have ducks in their driveway. They used to put bread out for them and if I remember correctly they had a plastic kiddie pool of water for these ducks during the summer. I haven't seen the ducks in a while - don't know what happened. But anyways - this same house has apparently started putting out bird seed or bread again. My dad drives by and notices that now instead of ducks there are pigeons feasting on this yumminess in their driveway. Which if you ask me is gross - pigeons really are just rats with wings. Now maybe the pigeons in Chico aren't as nasty as those in the big city, but still - pigeons are pigeons. A few days later my dad drives by again and this time notices that there is a hawk in the driveway ....... eating one of the pigeons!!!!! Apparently there was blood and feathers everywhere. There you go - national geographic right in your front yard for all the small neighbor kids to see. Awesome!

A return to 1st year

Before I jump into all the craziness of 2nd year and I'm only beginning to imagine what next year has in store - I think it is important for me to look back at 1st year.
Here's a journal entry I wrote right after anatomy finished.

11/01/06
I am amazed at how fast the 1st 11 wks flew by. There are so many memories and images from the anatomy lab, that will always be a part of me. The smell, the green color of our scrubs, the rows of tables with plastic covered mounds.

I went in with the mentality that this person (husband, father, brother, son) donated his body in order for me to learn. The part of that body that made him a person is no longer here. His body is a shell. Don't get me wrong it's still emotionally difficult to see and there were lines I wasn't willing to cross. Namely, the sawing of bones or disarticulation of joints, head, etc.

Dr. Zagon played a clip from NPR at the beginning of the course. It was from the perspective of a medical student. The point made that stuck with me was...

In my practice when I read or hear about certain body parts - I will always return to my cadaver. It will always be his muscles I see when imagining them in my head.

It truly is such an amazing gift. I will never explore another human the way in which I explored our 90 year old male cadaver. Yes, the experience is morbid and disgusting at times, yet it was absolutely amazing and necessary for any medical student. It is essential to know what a nerve, vessels, ligaments, etc - actually feel like.
The experience made me realize that the structure of the human body is truly amazing. The physiology of the body normally receives more of the attention, but it is astonishing the number of muscles in the forearm. It seems ludicrous to me that we have a separate muscle to flex and abduct our little toe.

It's sad that during the course I didn't take more time to step back and look at the big picture and enjoy the overall exposure and experience. We all started out very respectful & conscious of our cadaver as a person, but it quickly changed to being focused on one body part or region of the body. He was no longer a human, but rather a guy with good back muscles. The humanness was lost and our minds were narrow and focused.

As the class progressed the cadavers began to look less and less human. We all become somewhat desensitized. I cannot imagine the effect it would have on an outsider to walk into our anatomy lab - 10 weeks into the course. (caution: I wouldn't suggest reading on if you are eating (marianne))
The image that would surely stick in their memory is one of a skinned form that resembles the top half of a human (the legs previously disposed of) The muscle would appear like jerky - dry and stringy and the smell...

The ending stages of the entire process are the most gruesome - disarticulating the head, removing the eye, skinning the face. This was by far the worst, because a face is hard to view as just another section of the body. It is unique and personal. I remember it was always the little things that brought me back to reality in lab. During a lab practical to answer a question for a tag and look down and see pink nail polish on the hand of this little old lady. Suddenly my mind would be brought back to the reality of the situation.

All I can say is thank you to my anonymous cadaver and all those who donate their body for medical students to learn. And I did - I learned more in those 11 wks than I thought possible. Granted in the past year I have forgotten a lot too, but my overall amazement of and respect of the human body still remains.

new beginning

I've decided to rejoin the blog train. I have been partially inspired by my good friend Nava. Reading her blog makes me want to start writing again. I can't promise this will be as exciting as my Honduras blog, seeing as now my days consist mainly of studying!

Now is a good time for me to start again though, because the toughest time of educational career is quickly approaching (aka Boards studying). I am also interested to see how my perspective changes in regards to my view on medicine and life, etc as I make the transition from my 2nd-3rd year. This is my transition from the 2 years of book studying to FINALLY getting to work with patients everyday. So hopefully once 3rd yr starts I'll have all sorts of interesting stories to share.