First of the Last Tests

Well, today we had our last anatomy test - yesterday I went to the Bay to Breakers event in San Francisco, so my head wasn't quite as into the test today as I'd have liked, and I wasn't nearly as prepared as I could have been. If I pass, I'll be satisfied.

In the meantime, we have three days of Jewish holidays this week AND on Friday's we're not allowed to be tested so we don't have any tests until Monday. They will be rather intense, and I'll need to do some practicing of various techniques for OMM and doctoring, among all the basic science and medicine studying, but at least I don't have too much exciting stuff planned, besides maybe watching a video or two and study breaks to hike. Gotta mix it up a bit or I'll go insane, after all.

Anyway, I need to rest my head - yesterday was insane, and I wish I were updating things more...there will probably be a decent number of updates once I go to Bolivia - leaving on May 29. I got my vaccinations, but I do need to fill my prescriptions...hmm...

Another Hurdle

Well, just finished a pseudo-midterm - feels like I've been doing nothing but study lately - and in my spare time, computer games. I really need to get out more and exercise... Feels like I'm trying to do a million things at once, but I guess that's nothing all that new. I can't believe I'm almost done with my first year of medical school. It's rather intimidating because sometimes I feel like I've learned a lot, and other times I feel like I haven't learned anything. Now with the midterm done, I plan to just relax as much as humanly possible between now and Saturday night - Saturday we have a semi-dance thing on campus, it's a fundraiser for the group that is going abroad to Ethiopia and Tanzania. Unfortunately they're more established, better organized, and have the Global Health program director in charge of their group, so they have been putting on a lot more events than my group (Bolivia) and the Taiwan and Israel group.

The latest stuff we have been studying is all the respiratory illnesses - mostly those that cause pneumonia, bronchitis, that sort of thing. There was a section on pediatric illnesses and upper respiratory problems, which was okay. I'm not a fan of babies in general, and learning about the millions of ways that babies can turn out wrong frustrates me, since there are no laws permitting parents to relinquish their responsibilities for an incredibly unfit offspring. Definitely a controversial view, which as far as I'm concerned will only apply to myself and my future offspring, not the patients for whom I care (so don't worry), but human societies have practiced infanticide since before they were even humans - all animals practice infanticide if they do not have the resources or the animal is too unfit to survive and care for itself. It seems a crime to force parents to spend say, 5 years of their lives caring for a child that is 99.99% doomed to die - that's 5 years in which the child will be suffering, becoming progressively more mentally retarded, and slowly wasting away until its inevitable demise. It's an emotional drain for sure, not to mention a financial drain on the parents.

Like I said, I know it is my duty as a physician do everything in my power to keep a patient alive, and I will do that wholeheartedly - I just don't want to end up a slave to any offspring I produce with conditions that are incompatible with life for which medicine can offer no acceptable end.

In other news, still doing bacteriophage research. My medical Spanish classes have picked up again, so we're practicing those and we have our practicals next week. The trip to Bolivia is essentially ready, though I still need to get all my vaccinations...mental note: call the travel center. OMM is going well, I suppose - we're learning the high velocity, low amplitude techniques (the cracking techniques). I've had mixed success with them, so I definitely need more practice. Thank goodness we don't need to make an audible crack for it to be 'treated' - otherwise I don't know how we could get anything to treat during a practical after we've been practicing on each other for days.

Still working on balancing personal life with school, but everything's a work in progress these days... Now for the joy of computer games!

Spring Break

Hooray for spring break and being done with blocks exams for the time being. I ended up going to Monterey for a week, and then down to San Diego for the remainder of the passover time we have off. I have done essentially no medicine-related stuff all break - a welcome change and break for my brain. Looks like we get to start out with venipuncture and the respiratory system next block. Makes sense, as we just covered the cardiovascular system. It should be interesting.

In other news, we're needing to raise some money for the Bolivia trip (as in, get money to buy supplies for the hospital, mobile unit, and for the impoverished down there). I'll be returning to my research soon enough, and want to exercise a bit more so I'll join in the weekly karate class and do pilates on the side. I also got a LASIK checkup and my eyes are still healing perfectly and there are no complications. I also need to start making my own food more often - as much as I like letting my parents cook everything, sometimes I really prefer my own cooking. Anyhow, back to enjoying the last couple days of leisure that I have...

Spring Semester, Block 2

Next week is our second block of exams for spring semester - it will mainly focus on the heart and related diseases. So...that includes hypertension, angina, valve disorders, congestive heart failure, arrhythmias, pericarditis, cardiomyopathy, etc. AND their pathologies, drugs, treatments, and more. Fun times...over a hundred drugs to learn, again. There's some OMM stuff to learn in there as well, specifically tender points and some cranial technique theory. I'm interested to learn cranial - supposedly it's really good for headaches (among other things...). Here is the first 1/4 I have completed of my study board:

Today is St. Patrick's day, so it won't be long before we medical students, once again, imbibe alcohol and kill our livers and brains counter to the advice we're required to give our patients. I guess alcohol isn't quite as bad as the McDonald's lunch I had, but hey, my BMI is 21, my system can take a few hits for the greater good. (Hears Dr. Clearfield's voice in my head..."Even people in their 20's, who look perfectly healthy, can have early and even middle-stage coronary artery disease and atheromas in their arteries"...oooooo...scary).

More and more, I realize how much I want to specialize in Infectious Disease. The fact that the thought of a lecture on anything related to bacteria, viruses, fungi, or parasites is enough to brighten my week is sure sign enough. I'm really amazed at how little surgery or other superspecialties appeal to me - cardiology? Meh. ER? Nah. Surgery? Too many hours standing over someone's guts while nurses wipe sweat off your face. I have the hand dexterity, focus, and attention to detail to be a surgeon, as I've been told many times, but it just holds no interest. Gimmie someone with a bug in them! I'm going to send a letter to an Infectious Disease DO to see about shadowing - as much as I love infectious diseases, I know very little about what an ID specialist would actually DO. Hopefully I'll mail that out and hear from her soon!

Bolivia and Research

Things are progressing as usual at school. We're studying drugs for treating hypertension, dyslipidemias, arrhythmias, angina, etc. Essentially this is the phase where we learn how to treat the diseases in the renal, cardiac, and respiratory systems, which we learned about last block.

In the meantime, I've gotten started on some research, fortunately with the same professor who is going to Bolivia with us. I'm glad I am on good terms with all the faculty so far - I have heard of a few students who think certain professors dislike them, and I haven't gotten that vibe from anyone yet, so hopefully I won't. The research is related to bacteriophages, as I mentioned before, and we will be growing bacteria (Salmonella) and determining under what conditions their bacteriophages become most activated to the lytic phase (where they reproduce themselves and lyse their host cell, looking for more hosts, compared to the lyosgenic phase where they lay dormant in the host cell's DNA). The professor I am working with, as well as others in the lab, seem to be really laid back, It's kind of a "when you can help out, come on in - put your studies first" situation. After the high-stress environment of working in a hospital laboratory, and even the strict environment at UCSD, this is a welcome change.

Also, the Bolivia trip is beginning to materialize more. We are about ready to book our flight to La Paz, are going to put together a presentation of pre-research about Bolivia, and are getting materials ready for the trip. I'm very much looking forward to the experience - Spanish immersion, health education, learning how to diagnose and possibly treat diseases we rarely will see here in the US. Anyhow, back to studying.

Fun and the Future

Even with so much to do, medical students can still have a little fun. The last weekend I went to a house party, with drinking and silly stuff, then to a shooting range, then a BBQ and a turkey dinner, and then played computer games all night. It's nice to know that we can kick back occasionally, but we better enjoy it now, because it's going to get a lot worse. The number of drugs we need to memorize is steadily adding up - I wish I knew them all as well as I know drugs like tylenol or omeprazole, typical OTC drugs that I've known about most of my life.

We're getting into hypertension lectures, angina, coronary artery disease (CAD), congestive heart failure (CHF) and similar problems. It's funny, with all the talk about eating healthy, and how CAD can be seen as early as in teenagers or people in their twenties - the food I'm craving the most right now is fast food. I haven't craved it in ages, but here we are.

Every so often, the curriculum at our school throws in a "Managing Stress" class, where we are told ways to deal with stress, as well as the kinds of stress we are going to encounter (which of course gives us a lot of stress right then and there). Today, the doctor teaching the class was talking about how the first two years of medical school are a breeze compared to third and fourth years when you begin your clinical rotations and have to use whole different sets of skills (communcation versus booksmarts). Then she went on to say you think rotations are bad, wait til residency - where there will be hallways or stairwells essentially devoted to hiding and crying when your attending shouts the crap out of you. I imagine something like Dr. Cox from Scrubs, except no one is laughing. She then added how even then, you start your internship somewhere and it's just as bad - with more power comes more responsibility, which comes with more and more work. It's like being spider man except that everyone knows where you live and you're expected to work 16 hours straight.

As she talked about us being on rotations or in residencies, I couldn't help picturing how some of my classmates would be during rotations - getting picked on by the attending, or stepping into a patient room with an air of authority and asking them what the problem is and trying to help. Now that I know more about a doctor's thought processes, and my classmates' strengths and weaknesses, it is hard to picture myself as a patient of theirs - putting my problem in their hands and trusting their judgment. Though, in my mind at least, I always picture my classmates looking very proper, professional, and knowledgeable in these situations. I suppose that means I have a good amount of respect for my peers as future physicians and human beings (well, most of them - there's always a couple you wouldn't want as your doctor). Hopefully I'll pull everything together and become as awesome a physician as I picture most of my peers becoming.

Studying, Advocating, Consoling...so much to do

Well, spring semester has been coming on fast and furious - been extremely busy. Have also had tests every other week, essentially, and our first Block exams of the semester are next week. We have had two standardized patient encounters with our small group - where we must take histories and perform a physical exam. It's amazing the things you notice yourself and your classmates doing when interacting with patients - strengths and weaknesses, the importance of listening... We have also practiced doing SOAP note write-ups (subjective, objective, assessment, plan) and worked on differential diagnoses. The ailments of the patients are in line with what we are learning, so we can apply what we learn clinically.

Tomorrow we get to explore a new aspect of the physician-patient relationship - breaking bad news. We will have 12 minutes to break bad news to a standardized patient who has been trained on how to react convincingly to the news, including shouting or crying. We will be faced with one of these: a son whose father unexpectedly died, a woman with a suspicious breast lump who needs a biopsy, a man with inoperable pancreatic cancer, a childless woman who just had a miscarriage, and a man with an STD from an affair. Should be interesting and nerve-wracking - but I imagine it will be more difficult for some of my colleagues than for me. Working in the lab, I definitely got to deal with very angry patients, and one woman I drew as a trainee had just learned her husband was going to die - that was a difficult one. You really don't know what to say to a stranger who suddenly starts crying, especially when they're still holding back so much pain and you know almost nothing about their situation. I almost cried myself that time - but sometimes all you can do is squeeze a person's hand to let them know you're there with them, even if it's for just a moment. I'm usually someone who insists on a 3 foot personal space bubble and never hugs people unless they're family (and even then not so much), but somehow I was able to recognize that at that moment, she really needed to feel physically that someone was there with her. If you're really with them, and not just going through the motion, time almost seems to stand still for you both in a good, or at least meaningful, way. They say, "You can touch patients during a bad news situation if you think they would be okay with it," and you kind of wonder, "How will I know if they would be okay with it?" Well, that was one of those moments, and I could definitely tell even with no experience - though my rule is that if in doubt, it's better NOT to touch.

On a more positive note, last Thursday we were bussed by the Osteopathic Physicians and Surgeons of California (OPSC) to the state capitol to speak with assembly members and fellows about the recent merger between the Doctor of Osteopathy and Doctor of Naturopathy boards. Essentially, bill AB X4 20 merged the boards because the governor wanted to make it look like he was cleaning up the government - busting excess bureaucracy and saving money. However, both our boards are funded by those in the profession, no tax money is involved, and they approve licenses as well as oversee malpractice issues. NDs do not prescribe medications without supervision (and even then, no category 2 drugs) nor do they perform surgeries - so having them oversee us, or even have us oversee them, is not fair to either profession. I was the designated group leader to the assembly member whose fellow we spoke to because apparently I live within the district (14). Definitely nerve wracking, but everyone seemed to think I made a very eloquent case. The fellow we spoke to seemed very supportive of our cause. One of the senators (Lee) has submitted two goldenrod bills to his boss for approval, which we need in order to get numbers on them, support, and signatures. It was really enlightening to see how the process works in state government, and that people in the offices actually will listen to you and you can make a difference. We also got to speak to one of the governor's aids right before he was going to a meeting with Mr. Schwarzenegger himself, with the promise of at least mentioning the issue with him, so that was exciting. There were a bunch of school children outside of the governor's offices as we walked in and they were all asking us to say "Hi" to the governor for them, ask for more money for schools, it was adorable. All in all, a very exciting day - here we all are in front of the capitol building!

Also, on one final note, the founder of Touro University, Bernard Lander, last night at the age of 94. All the Touro campuses were closed out of respect. I don't really know what to say about it, as I never met him or knew much about him before now, but I am kind of wondering how it will affect the universities. At the least, I was productive and used the day to get more caught up on classes.