Atrial Fibrillation

I heard atrial fibrillation for the first time while doing a physical exam today. I reviewed heart sounds on my own the night before (as we've never been lectured on abnormal heart sounds), but only the murmurs. Now I know that "holy crap, what is going on in there?" means atrial fibrillation. So that's what irregularly irregular sounds like! Ah, the power of learning by experience.

Registering to Vote

I have needed to register in my new precinct for some time. My roommate is very active politically and was horrified to discover I had not yet done this (October 4th deadline!). She printed off the voter registration form for me and heckled me daily until I found both my old registration number and enough stamps to send this off. Some day I will go to the post office and get some 1 cent stamps... and an enormous roll of those Forever stamps, as it would appear I haven't bought regular stamps since high school.

Ayche's 12 Step Program to Gunning - Steps 4-11

Step 4 - Skipping Class

I hate class.  I always have.  Not only am I not an auditory learner, I remain unconvinced that anyone can really focus on professors droning over powerpoint slides for FOUR HOURS.  I have become a highly selective class attender, and my grades second semester rose as a result.  If class isn't helpful, it is an enormous time sink.  This probably isn't for everyone.  The more general message is to not be afraid of learning the way that works best for you, even if it means giving up something that classmates may swear by or taking on something they have sworn off.*

Step 5 - Creating the Perfect Study Environment

I have a new, non-ghetto apartment.  It comes complete with a living room large enough for my desk and bookshelves, so I can move these items out of the bedroom.  If I learned anything in Doctoring last year, it is that studying near or on your bed is poor sleep hygiene.  Though I am usually in the library, it is good to have backup study spaces for when the library is overcrowded and for when you reach that special point during exam week that makes you deeply ponder stripping down and running through the library in your undies, clucking like a chicken, just to change things up a bit.

Step 6 - Embracing my Inner Homebody

I am not going to go out if I would honest-to-God rather be studying on a Saturday night.  While it is going to be important to take time to relax, it is also important to be able to stand up and proudly say, "I'm a dork and I am staying in."  Sometimes I find it more relaxing to read over some new material than to do something else and worry about the fact that I am not studying.

Step 7 - Textbook Selection

I am fed up with professors requiring books that they wrote, or that they have used for the past 20 years.  I'm not buying them.  They are in the library, and all my friends will have copies sitting in their carrels as well.  I am only buying books that I think will make good learning/reference aids based off of reviews from other students and online.  There are excellent textbooks out there.  Purchasing lousy ones kills me a little on the inside.

Step 8 - Remembering Step 2

I will lapse in my exercise program.  It is written in the stars.  No matter how busy I get, I am simply going to have to tell myself over and over to make the time.  Most likely, I am going to need to start getting up in the morning and exercising first thing every day to make myself keep a set schedule.  I cringe to think of it now.

Step 9 - It Is Never Too Early to Think About Boards

From everything I have read, it is helpful to have board review subject books that you use while taking the classes.  It is an extra resource while preparing for med school exams, and when board review time does come around you can study from books you are already familiar with.  I have heard some med schools actually get their students to read First Aid over the summer between 1st and 2nd year.  I have not done that, but it gives me something to think about.

Step 10  - Maintaining Mental Health

I was treated for depression during my first year.  I don't think this is uncommon.  Medical school is hard.  People get low grades.  People get stressed, so much so that marriages can fall apart.  I didn't have those particular problems, but people who get into medical school are the driven, tightly-wound types who are prone to be harsh self-critics.  As it turns out, self-worth is not determined by academic achievement, and a robust acknowledgment of this can do wonders for your mood.

Step 11 - Clinging to an Extracurricular

I sing in a chorus.  And don't you know?  Every performance we have seems to fall on an exam week.  But I will keep singing till I am blue in the face, because I need something that is completely unrelated to medicine that I do with an entirely different group of people than my classmates.  It is a healthy break.

*Eating the syllabus is not an effective study method.

Ayche's 12 Step Program to Gunning - Step 3

Step 3 - Cooking

Preparing your own food allows you to take control of eating habits. It is all too easy as a med student to spend every waking hour in class or at the library, and settle into the routine of eating solely at the hospital cafeteria and restaurants near campus. Eating out, especially on the student's budget, is usually not the healthiest option. And, diet aside, the hospital cafeteria can carry a certain "you are going to be eating an insipid dish with mushy vegetables and jello for every meal for the rest of your life" gloom. So cook! Cook up a meal you like that keeps well, and pack yourself meals to take with you when you study on campus in the evenings. You can also prepare your own snacks. If you are well stocked on food going onto campus, you are much less likely to end up hungry and hitting the vending machines. Eating right while studying helps keep you energized and focused, not to mention keeping you from backsliding when you are logging all those hard hours at the gym! (I had to break a pretty bad gummy fruit habit, myself. If the vending machines in the library ever get Dr. Pepper, I'll still be done for.)

Ayche's 12 Step Program to Gunning - Step 2

Step 2 - Getting ripped

The way I see it, part of being a gunner is getting into the gunner mentality. Success in all things! I will destroy all obstacles! Hulk smash!

If you are going to be "a winner," you must win at everything. A quick sampling of my gunnerific classmates reveals that includes turning heads at the beach. So when you aren't buried in the syllabus, you had better get your rear to the gym and tighten it. Pump that iron, and with every breath, remember "two-sixty, two-sixty, two-sixty..."

Ayche's 12 Step Program to Gunning - Step 1

Step 1 - Reviewing first-year material over the summer

Yes, I am really doing this. It is sick. I disgust myself, I really do. Though now that I have started, it is somewhat enjoyable. Without the stress of exam deadlines, I'm free to peruse what interests me, refreshing and filling in little gaps in knowledge as I come across them. It amazes me how much clearer the material becomes in review.

Ever helpful, my 11-year-old brother decided to contribute to my review of anatomy of the upper limb by slicing his flexor pollicis longus tendon on some broken glass. (He had surgery to repair the tendon today and is doing well.) My parents were quite pleased that I had recently reviewed the paths of all those tendons in the hand, as well as innervations. Knowledge in action!

1/4 of an MD

Despite the lag in my update time, I did not fail out of med school. Hurrah! I scraped by with Ps, except in Doctoring, where I earned my first med school H. My grades next semester will be different. I want you, non-existent readers, to be the first to know: I am becoming a gunner.

You read that correctly. I, Dr. Ayche, non-prereader, back-row-sitter, lab skip-outer... etc., am going to gun. The spirit possessed me, and I have been converted from the chosen leader of slakitude to a meek disciple of the curriculum. Next semester, you will find me in class on time with notes highlighted and supporting texts read. In the evening, every evening, I will be in the library with my massive Bose headphones canceling any possible distraction. Come Board time, lesser studiers will weep before my calm, unbreakable focus!

What has caused this sudden change in attitude? My home state. I will not, will not stay in this region of the country for my residency! I will not!

Med students aren't the only ones with a sense of humor

In less than a day my first year of medical school will be complete! (hopefully?)

Here is a gem that I didn't catch until the third time through our physiology notes...

b. Stress: Plasma cortisol levels can be increased by numerous factors characterized as stressors, both physical and psychological. Burns, infection, physical restraint, surgery, anxiety, reading the syllabus, and strenuous exercise will all elevate plasma cortisol levels.

Patch Adams

I met Patch Adams on Friday. My school, in typical form, notified us that he would be making an appearance in the atrium of the Children's Hospital a few hours before he was to appear. Only a handful of my classmates were present since it was short notice, and, never forget (oh, if only I could forgot!), one week till the final. Now, Patch Adams was interesting and all of that. Wacky. Dressed as a clown. In fact, he showed up with an entire clown entourage, when he finally did show up. He wrapped most of my classmates in enormous underwear and forced them to lead a parade of children down the hall of the hospital. The only reason I escaped this fate was that during the 45 min wait I stopped caring about meeting Patch Adams, as I had found myself in an enormous, airy, brightly decorated room chock-full of books and toys and children to entertain. I did not know that such a wonderful place existed! (Being a first-year, I've rarely explored the hospital.) First of all, this place is swank. The entire ceiling and outer wall is glass, with a view out over the city and the ocean beyond. It beats the pants off our dimly lit, freezing, burber carpeted library, a.k.a. "The Frozen Wasteland." Second of all, kids! Third of all, toy dinosaurs! Man, I hadn't played with toy dinosaurs in ages. I met a delightful 11-month-old in the process. (Years from now this same child will be coping with a deep-seated clown-fear, with no knowledge of its source.) I don't know about all the clown business, but there is something to be said for making a hospital more cheerful. I know it did wonders for me. Nothing like the sight of kids with bald heads and IVs just being kids to warm the depths of your "oh why the heck did I ever get myself into all this?" first-year med student heart.

Scheduling

One week till our final exam. Yesterday everyone in my class received a delightfully informative email from the new Associate Dean for Curriculum and Evaluation, detailing the "need to know" facts of our test. It included such helpful information as the number of questions (about 2/3 the number there will actually be), what material will be covered from our Doctoring class (including physical diagnosis, which is not included in the written exams), and the overall scope of the exam (both fall and spring semesters! Please fail us now and spare us the pain.) One would think that in 180 years, our college could manage to run a bit more smoothly, or, at the very least, learn to not irritate the crap out of its students.

One more week. One more week. One more week.

The End is Drawing Near...

I think my entire class stopped being able to study when we collectively hit April. The sun is shining, the water is sparkling, the beach is calling... The library is such a cold, desolate place. (It is also, and these two things might be related, the center of my social life.) All of the classes that we thought might be interesting (Physiology? Can't wait to learn how everything we memorized in anatomy actually works! Neuroscience? The inner-workings of the brain are fascinating!) turned out to be indistinguishable from last semester when the dry syllabus notes were stacked and compared. And at this point, no one really believes they will be flunked out. Sure there are the rumors. Did you hear, six people left after the second exam? Four people after the first? Yet no one can name all these people who have left. Mysterious. It could be everyone is just leading me on, saying "Sure, I know what you mean. Can't study an hour without going stir-crazy..." when secretly they are chugging Red Bull, sleeping five hours a night, and logging 15 hours a day at the library. But I doubt it.

Physical Diagnosis

First thing this morning I went to the student bookstore and bought some new toys--a cheap plastic ruler and a reflex hammer. The more items you have to put in the pockets of your short white coat, the less you feel like a sham. Anyhow, my plastic ruler was for estimating jugular venous pressure and my reflex hammer was for percussing because today I had my first physical diagnosis exam! It was about as spectacular as I expected it would be. I managed to briefly forget which of my hands was dominant and therefore capable of operating the valve of a blood pressure cuff. I, and this is a classic mistake, forgot to lower the round rolly-stool that our school puts in the exam rooms to cause us strife, so that it shot out behind me as I sat, losing me a good fifteen professionalism and personal dignity points. I spent a full thirty seconds pulling out the leg extension on the exam table, which had jammed. I was thankful to wash my hands before beginning the exam, not because neglecting to do so would earn me failing marks, but because it allowed me to disguise their clamminess. Despite all this, I think I managed to do my best patient interview yet, as well as bumble through the motions of the exam. I pretend to be a doctor, the actor pretends to be a patient, and it all works out in the end.

I should be asleep now, or studying, as it is test week. But I desperately needed to do something that wasn't studying respiratory physiology this evening, if only for a few moments.

Breast Exam

One of the more glorious parts of a medical education is the use of standardized patients. To make certain that you are fit to interact with real human beings, med schools start you off with actors that you get to "interview" (i.e. they act like they have a medical problem, you act like a doctor who is unaware of the fact that they are perfectly healthy actors, responding to their concerns with the full range of appropriate emotion and empathy that non-theater majors may find difficult to conjure) in front of a group of your peers, a preceptor who may or may not be grading you (or behind a two-way mirror) and, heck, sometimes a videocamera as well. And all of this starts before you have had any pathology or, in the case of Doctoring class last semester, human anatomy. This is the best way to get you "accustomed" to being in the role of a physician. I did the first interview in our Doctoring class, a few weeks into the semester last year. My standardized patient had pancreatic cancer, and it was my job to convince her to agree to conventional treatment. I thought, "Ah, yes, this is an excellent place to start. If they had waited a few months till I had seen a human pancreas, this exercise would have been quite dull."

This semester, Doctoring begins to encorporate aspects of the physical exam. In keeping with the trend of last semester, the first time we get to touch a standardized patient is to perform... a breast exam. Again, well done Doctoring curriculum committee! To begin by examining the ear, nose, and throat might have encouraged students to feel comfortable, even confident, in their interactions with fake patients. Far, far better to leave all those trivial aspects of the physical exam that don't involve nudity untouched until the student is called to perform them on a complete stranger for the first time during our graded exam. Clearly, this class is organized under the assumption that students who are allowed to feel confident in their abilities will only grow lazy.

As for the actual breast exam? Having spent three hours in a tiny exam room watching seven other people thoroughly explain, then perform a breast exam on the same SP I can safely say that I can both perform and teach a breast exam myself (bringing the number of things I know how to do to patients up to about four), and breasts will never be the slightest bit interesting again.

1/8 of an MD

That's right, folks! To all my nonexistent readers worrying themselves to death over my first semester grades, worry no longer! P=MD and I am one-eighth of the way there! (Plus residency. Plus fellowship. But again, quibble quibble.) (P=MD refers to the fact that my med school, like most out there at this point, has adopted a pass/fail grading system.) It was touch-and-go for a bit there during the final. All I could recall of cholesterol synthesis was HMG-CoA reductase, and while it is unarguably an import enzyme, my biochemistry was probably a little on the patchy side if that was all I could remember of a couple weeks of lecture. Additionally I got to one of those anatomy questions that read something like "a person receives a knife wound so many inches deep into the such-and-such intercostal space. what was pierced?" and I thought "Aha! The thorax. I KNEW I forgot to study something."

But here I am, rested from a pleasant winter break and ready to return. What is that sound? Ah, it must be the sweet sound of victory tinkering down from the heavens, to congratulate me on surviving, no excelling at my first semester of medical school.

Though more likely it's the hobos rooting through the garbage again.