UCSD in Reflection

Today marks the end of my time at UCSD. After 4 and 2/3 years at UCSD, I now have my B.S. in Biochemistry/Cell Biology, and B.A. in History. I hadn't intended to go to UCSD right from the start, I had applied to about 6 schools (Puget Sound, UCSD, UCD, UCB, Yale, MIT) and got into half of them (Puget Sound, UCSD, UCD). Ultimately, of those three, UCSD had the best pre-med program so I chose UCSD. It turned out to be a great choice - beautiful campus, emphasis on biology, family member close by, etc. I do wonder, though, what it would have been like to go to a small Ivy league or liberal arts college - really small classes and getting to know professors by first name, meeting with them after hours or for lunch as a class... To attain that level of familiarity with a professor at UCSD you have to try really hard - go to office hours, sit in front at every lecture, talk to them before and after lecture, distinguish yourself academically, and have a professor who actually cares about students. I only started to manage that near the end, when I was pressed to get to know professors for letters of recommendation.

It really feels like I applied to medical school for four and a half years - every class I took, every extra-curricular activity, my work, etc. was in order to get into medical school. The only part of my college life unrelated to medical school was my history major, and near the end medicine became intertwined (History of Medicine, History of Bioethics, History of Localization of Brain Function). In retrospect, it might have been nice to be involved in other things, but I'm not a particularly outgoing person, and I do have my pet projects - manga, writing, drawing, insect collecting, computer games. I feel nostalgic already - professors and classes I will miss, the times in the dorms/apartments. I think I would feel more sad if I were not going to continue higher education - the world of academia is too wonderful to leave just yet. It is easy to stop learning when you leave the classroom.

Caffeine and Touro

Well, I submitted my second deposit to Touro-CA for $1,000 today. I am really horrible with fax machines and phones - I don't know how to transfer calls for one, and I am so used to my cell phone I forgot that all other appliances require a "1" before an out of area phone number, so I wasted 5 pages thinking that the machine on the other end was busy (the option is busy/no response). I am getting more and more used to the idea of living at home again - I almost look forward to it. It'll be my last chance to really be a part of the family again, before I'm a truly independent adult and starting a family bud (only scientists can think of yeast while talking about starting their own family). Also, the prospect of saving an estimated 17k per year is very exciting - nearly 80k cut off my loans. The commute would be great also - 35 minutes each way, no traffic. Whether I stay at home more than a semester hinges on how well it works out for me, and for Kit (my boyfriend). Being long-distance and not having my own place will be difficult. We've worked out a contingency plan though, so we're prepared.

On an unrelated note, my cognitive science textbook has some very interesting tidbits thrown in, most recently on caffeine. It is a cool mechanism - as we are awake, adenosine accumulates in the brain and is thought to induce sleepiness. Caffeine acts as an adenosine antagonist, so it competes with adenosine for binding spots on adenosine receptors, but does not produce drowsiness when bound to the receptor. As more adenosine receptors are tied up with caffeine and not adenosine, the accumulated adenosine has a weaker effect. This explains why using caffeine too late has no effect, and why you "crash" after ingesting a lot of caffeine. First, if caffeine is administered after adenosine molecules have bound to a significant number of receptors, then you will be too sleepy for the caffeine to reduce the effect much. Second, if you have caffeine in the receptors, adenosine accumulates in the space near the receptors, so when the caffeine dissociates from the receptors you get a rush of adenosine binding and the subsequent drowsiness.

Vesalius

The first page I saw when I flipped open the cover of my cognitive science text book was page 3, including one of the woodblock prints from Andreas Vesalius' De humani corporis fabrica (On the Workings of the Human Body). Now, after my history of medicine class and my colloquium on localization of brain function, I have a profound respect for Andreas Vesalius - his work is simply remarkable. His work was the next step after centuries of following Galen. The detail and completeness of the text is staggering. I think I would like a copy of the translated text, including all the woodblock images, as a reference. It's pretty pricey. On a side note, the woodblock images were the inspiration for the poses and exhibits at the BODY WORLD/BODIES exhibits.

As far as other news, I sent in my $2,000 deposit to Touro-CA, and I received today a notification that they received that first deposit along with a reminder that I need to send them a second deposit of $1,000 by March 15th. Once these deposits are over, I'll be able to relax and earn money for a bit before I have to cash in checks on loan from the government or private institutions for the next four years. If I live with my parents, since they are about 35 minutes away from Touro-CA and in the opposite direction of traffic, I might be able to avoid taking out a private unsubsidized loan. I seriously think Wells Fargo would give me a better deal than the average grad-saver plus. I should plan to finish and submit my FAFSA by the end of next week...

Difficult Patients

I was able to access the study from work, but now that I am home I cannot access it. It has been written about in newspapers, blogs, and magazines across the country. The main gist: doctors who see more "difficult" patients are also more burned out, more stressed, and tend to be younger-than-average female physicians. The article does not make any attempts to establish causality, though the relationship between seeing difficult patients and stress levels would seem directly proportional to common sense.

What I found more interesting were the most common attributes of patients that made them qualify as "difficult." Over 1/3 of the difficult patients were so categorized for insisting on an unnecessary medication. Another ~10% were difficult for having unrealistic expectations for their care, and ~10% were unsatisfied with the care they were receiving. I have complained before, but the US is only one of two countries (the other is either Australia or New Zealand) which advertises prescription-only drugs in the media. It is creating a culture in which people who know nothing about medications and physiology of the body to demand new, expensive name brand drugs despite their doctors' medical opinions. When a physician has a full waiting and exam rooms, he is pressed for time and often does not feel he has the time to explain why the advertised drug is not as good as the currently prescribed medication, or why the drug is not needed at all. It has gotten to the point that dangerous surgical procedures like gastric bypasses are being advertised on television!

I admit that if a patient has a physician who has not kept up-to-date with the ever growing field of medicine, then bringing new medications to his attention could do some good. However, over half of the "new" drugs released each year qualify as "Incrementally Modified Drugs", in which a different but equally potent version of the same chemical is being advertised as a new drug. Honestly, I think pharmaceuticals should not be advertised through any media PERIOD.