12.5% doctor

And a collective breath of relief was exhaled on the 21st of December after the last exam was completed. Provided we all passed, we were now 12.5% doctors, as one of my numbers-oriented friends observed. I passed it all, so looks like I qualify.

The last month of the first semester was most likely designed to be a push-out period. The conversations with the upperclassmen corroborate this thinking, because after enduring 5 exams in 4 weeks, how much worse can it get. After all, rotations will be like an intense job, so will the first year of residency; been there, done that.

Next semester looks promising, though busy. I will take two elective courses, and even though they're small ones, they may prove of some value. One will be Medicinal Spanish, which will likely come in handy. The other will be Intro to Emergency Medicine. It will be a nice way to learn some procedures, see how an emergency department operates, and give this particular specialization some serious thought. The regular coursework, thankfully, will consist of topic blocks of varying duration. And we'll be finally done with some of the drier theoretical subjects, and there will actually be some serious medical coverage.

That's it for this year--happy new year and best of luck.

Preceptorship

And since Aliens is one of my favorite movies, here's an image worthy of H.R. Geiger. The stained teeth come from administration of tetracycline, an antibiotic, in utero or early childhood, when teeth are developing. This is no longer done, but it brings me to the main point of today's blog: kids.

We have a class called Clinical Practice of Medicine, or CPM, where the basics of doctor-patient interaction are taught. It's one of the three courses given the first semester, combining lecture and practice of very basic medicine in a doctor's office, or preceptorship. We are assigned in pairs to various practices around Buffalo, and, alternating the weeks, we learn how to take a patient's history, how to present the patient to the doctor, and basic procedures. The variety of doctors is limited, usually family doctors, internists, and pediatricians. Because in the pre-assignment survey I let it slip that I have no difficulties with kids (for obvious reasons), I was assigned a pediatrician in a bad part of town. And it's been a wonderful experience so far. I worried that I wouldn't have an opportunity to see or learn much, being saddled with nothing but well-child visits, but it's been just the opposite. The variety of cases in an underserved area is just staggering. To resort to an old cliche, it's never the same day twice. Even routine well-child visits bring with them concerns, or problems that the doctor has to address.

Slice of Life Vignette

Continuing with Dr. Detroit's theme of obvious titles for the blogs, here's another one. To the left of the text is a cross section of a human body. Done at about heart level, this is a fairly standard learning tool in an anatomy class. As a matter of fact, we're to expect two of these guys during tomorrow's exam. Yup, tomorrow's the big exam: 40% of the grade is riding on it, and I can only study for a few more hours before my brain shuts down. A friend of mine vowed to stay up till 2 am. Others will be pulling overnighters. I'm too old for this, so maybe it'll be off to bed at 1 am, with a rousing to a freshly made coffee (whoever invented programmable coffeemakers needs a statue in the center of some European city) at 7 or so. Now, taking a little break, it occurred to me that once again I have the unique privilege to work and study things that 99% of people won't ever see or only in special settings like museums. These slices (click here for more) always remind me of the first time I've seen such things. It was in the Chicago Museum of Science, where longitudinal slices of human beings encased in glass were on display. It wasn't disturbing, but fascinating.

Another bit of trivia: McBurney's Point is the location used to locate the appendix. In the event of pain in the right lower quadrant of the abdomen, the doctor will press his finger at this location. Rebound pain--felt after the finger is released--will occur, and may indicate an inflamed appendix.

The last bit: when the doctor asks you to turn your head and cough when checking for hernia, he just doesn't want to breathe your gems. There is no diagnostic purpose to the turning of the head.

Crunch!

Calcifications of the blood vessels show up in x-rays, making these vessels visible where they normally wouldn't be seen. Here we've got the calcification of the aortic root (arrow). The other day in Anatomy, someone demonstrated the crunchiness (no better way of putting this) of the said structure. It felt like someone put a wafer tube inside a latex glove that kept on cracking as you touched it more and more. "99% of the people in the world will not experience what you will in medical school" we were told somewhere along the line. How true.

Anatomy labs are now open 24 hours, and usually there is someone there at all times. Often large groups of students congregate around a particular table and teach one another various parts of anatomy covered in lecture. Our exam is next week, Friday. Not to be outdone, the Fundo 2 (2nd part of the fundamentals track) class is throwing a big one our way on Monday of the said week. Parents: sign your kids up early. This is a lifestyle that many envy and few achieve.

Shooting Gallery

Last night was Injection Workshop night. We learned how to deliver three types of injections: intradermal, subcutaneous, and intramuscular, or for the neophytes: painless, painless, and painless. First we watched a grainy video from the early 80's on how nurses are supposed to do it, then we watched a nursing student inject a 3rd-year volunteer, and finally it was our turn. Being the "suck-it-up-this-is-medical-school" manly men that we are, my friend and I decided to postpone the experience a for a bit and ease into the process by watching our mutual friend deliver the first shot. She's a former nurse, after all, so she knows what's she's doing, right? Absolutely. It was all over before we could process what happened, and like a couple of gibbering chimps we settled to our task. I went first, and with surprisingly steady hands, delivered my very first intradermal (see picture--not my arm, but equally hairy). My head was preoccupied with the worry that I'm hurting my partner. I listened for ouches or yikeses, but none came, so I pushed the plunger and created the telltale bubble that a properly-administered intradermal would. The rest was easy, but we made sure we watched our friend deliver her shots before we tried. It all was pretty much painless, and I realized that obsessing about needles for so many years has ended in a rather anticlimactic experience. So, flu shot anyone?

Another Week, Another Exam

The normal pace of med school is one exam per week. A slight change of plans is coming up for the next week: two exams. One on Monday, and one on Wednesday. This is hard to get used to, especially for someone who's taken his last serious course 11 years ago, but since I'm not the oldest one in my class, I'll manage. From the comments I've gotten from the upperclasmen, one just gets used to it.

An average day is courses in the morning, a post-lunch workout, and studying with varying breaks till around midnight, especially on days preceding an exam.

No pictures of my own, yet. My camera phone from the profiteers at Samsung doesn't come with a data cable for transfer purposes. I did get one off eBay for a few bucks, since the official cable was around $20. But, and this is a big but, the phone refuses to show up as a drive! It turns out that you need a "Data Bundle" that includes special software (PC Studio 3.0) to read the contents of your phone. Cost? A mere $100, something this med student can't afford. Of course this will be addressed in other ways. In the meantime, enjoy the picture of some Medieval dude cramming.

Puns with Gross

Gross Lab. Day 2. You could make so many puns with the word "gross." I choose to forgo the tempting option.

The sense of awe is pretty much gone. You've cut into a human being who was once alive. You distanced yourself from it, and you're still here, still back for more. As the muscles are being exposed, you notice something familiar cutting through the ethanol fumes and formalin. That unmistakable smell: Meat. Right away I am reminded of my favorite childhood story: When escaping from the Russian gulags, prisoners would pick an extra man of sizable girth. Somewhere along their way through the unforgiving badlands of Siberia, they would kill him and eat him. Warped childhood? Nah, just useful tips from Soviet-era Pioneers (boy-scouts) disguised as didactic tall tales, all there just in case uncle Stalin decided to declare you an enemy of the people. Resisting the temptation, I forgo the opportunity to share the story (BTW, confirmed by real Russians) with my tablemates.

There are 8 of us. We are split into 4 groups of 2, and each group is assigned its own dissection. For those not mathematically inclined or currently attending dental school, 4 x 2 = 8. The dissections take several lab sessions to complete. Their culmination is the presentation, where we show off what we did, hopefully teaching everyone something in the process. The first presentation, as expected this being medical school and all, was an overachiever's multimedia extravaganza, and short of a string orchestra and a laser light show, everything was there. OK, OK, so it really was just handing out color printouts, some yammering about the dissection, poking the structures with a handy probe (see picture) which is the laser pointer of the anatomy lab, rattling some bones on a plastic man-sized skeleton, and guiding the tour to the cross-section pans filled with body slices. I always say, don't let the facts get in the way of a good exaggeration. The subsequent presentations lacked the pizazz of the original, but we're just an exhausted bunch of med students, right?

Gross

The most celebrated course in medical school is of course gross anatomy. In the light of recent findings about the next year's Procedures course, I would beg to differ and throw the pelvic exam right of passage in there, but who am I to upset the entrenched stereotypes. So gross it is, though it really isn't too, for the lack of better term, gross.

It all begins on the first day of lab. Yes, it's my blog and I get to state the obvious. Anyways. You get your notes, and in the excitement of the whole thing, actually read them the day ahead. Come to lab prepared, dressed in your blue or green scrubs (you picked during second week, remember?), and dive in. Pretty much like that. You first listen to a series of lectures on respect for the people who donated their bodies, on how a single off-color remark will get you booted from med school, and how you'd better be keeping up with your lab. You seriously ponder donating your own body to science. You wonder about the people who were once alive, and now will be the subjects of your first clumsy cuts. You ponder the human condition. But then the attention bell rings, quiets down the room, and the anticlimax is delivered: "Dont' forget the purple gloves! Mandatory once you're in the lab, off when you're in the atrium! They come in 3 comfortable sizes." By the time you pick up your scalpel, you think that the only course in medical school is gross anatomy. Well there are two others, and one of them counts for 10 credits, while gross is only 8. Hush, the cadaver corps don't want you to know that.

So it all begins with somewhat of a sense of awe. You're surrounded by dead people, there is a bona fide priest who says a brief nondenominational prayer, a Bible (New Testament to be precise, but the laid-back Jewish students aren't burning the lab director in effigy) on one of the shelves, there are people feeling weak, there are tiles on the walls and the floor, and there are 20+ stainless steel containers, henceforth known as "tables," with preserved bodies in plastic bags.

Each container has 1 bagged cadaver, 1 box of tools, and 1 set of grease copies of lab manuals, Grant's anatomy book, and Grant's dissector book. Now, the preservative used is a formalin solution (mostly ethanol), so the smell isn't as obnoxious as I remember it from my days as a young whipper snapper dissecting formaldehyde-dipped frogs in high-school bio. We begin by cutting the bag open and poking holes in the bottom to drain the solution. The bravest souls flip the cadaver on his stomach, and the bravest of the bravest makes the first incision with the scalpel. Once the appropriate incisions are made (down the spine and to the sides), you scrape the fascia (connective tissue between skin and muscle) away as the skin is being peeled back. Eventually everyone joins in, and we take turns peeling the skin back. We see our first muscles. We feel like we're the first people to land on Mars...Publish Post

Electron Microscopes and Mountain Bikes

Rode the bike to school for the first time today. It's the old Trek mountain bike with no kickstand, as was impractically fashionable 11 years ago. Since my brain is thoroughly embalmed with medicine now, I couldn't help but come up with the nerdy analogy number 247: driving a car somewhere and riding a bike to the same place is a lot like looking at cells with a light microscope or an electron microscope. One sees much more detail in his surroundings when riding a slow moving bike rather than when driving a faster moving car. With an electron microscope, one sees far more detail than with a light microscope. Not perfect, but, hey, it's 2:00am here.

Photos above illustrate the point. The color (light) micrograph shows oodles and oodles of pink cells spotted with dark nuclei in the rat liver. (ROS, I know) The purple-blue spots are nuclei. The black-and-white (electron) micrograph shows the detail of a single nucleus in the said rat liver.

Why? Because 2 delightful hours of histology await me in the morning, and I just spent 2 equally delightful hours studying it.

A Swerve into the Memory Lane, Pt. 3: A Month that was a Year

Like during some bizarre dinner party, the most miserable course was served first. Medicine and Society came with 200 pages of notes that seemed to have been the ramblings of a madman: outlines that began and went nowhere or stretched across pages and pages eventually fell over themselves, definitions that threw in so much extraneous information that nothing made sense in the end, etc. The dry subject of medical statistics was something I actually hoped to learn properly, since I never took a formal statistics course. But it wasn't meant to be. The stress, the disbelief that I'm actually in med school, and the lousy lecturing made for an uneven beginning. But two weeks and two tests later it was all over, and things began in earnest with a "gradual onset" of proper coursework.

In the meantime, the hunt was on for textbooks. The second year class decided to dispense advice on the subject, hoping to save us $$ on what seemed to be a Christmas wishlist that each prof had for their course. So the books deemed critical were grabbed up as soon as they appeared for sale on the distribution list. The young whipper snappers were always there first, hence I settled on Amazon. And then there are the notes. Ah yes, the notes. Unlike anywhere else, apparently, medical schools have either note-taking services or pre-printed notes available (as is in our case). So in lectures, one just marks up the notes in a high-contrast pen. Not bad.

As the classes hit full throttle, it became clear that the volume of the material will be overwhelming. The nightly study sessions begun; so did the weekend drives back home. Living the seeming double life, I have a chance to pause each weekend, and think about what the past five days were about. A month on, and it started to look like a year has passed, which leads me to propose Dr. Detroit's Law of Medical School: medical school month = 1 year perceived. As I write this nearly two months into the process, the law is holding. 2 months, albeit very interesting, seem like 2 years.

A Swerve into the Memory Lane, Pt. 2: Orientation

After taking care of the living arrangements, there came the nail-biting drama of the health form. Yes, HIPAA rules will be violated, but the story must be told. It's actually a mundane tale of immunization records going missing during the doctor's office's transition to a new computer system. The only way to verify my shots was through blood titers, which, when all was said and done, needed to be done 3 times (each time for a different set of immunizations). In a way, the experience provided me with a chance to stop worrying about being poked with needles--after all, medical school will be full of that stuff.

The school began the second week of August. First three days were orientation. Anxiety drove the agenda for me: restless night, early wakeup, and arrival way ahead of time in hope of avoiding a crowd of unknown faces on the first day. There were only a few people, so the atmosphere was comfortable from the start. As the group of ~140 students began to coalesce, the first day took shape. Like the two days that would follow, it was an extravaganza of lectures, presentations, pep talks, speeches, and sales pitches packed into the restless morning hours. Applause was generously dispensed. Afternoons and evenings were for socializing, all under the benevolent watch of the second year class who organized the picnics and the outings. Everything with food had a sponsor, and the Grand Island park picnic was no exception. It was the US Army that was there to plug their offering: free med school in exchange for 4 years of service (military residency, which pays well and is quite good from what I hear from third parties). Tough sale in times of war, especially when you're marketing to a pretty smart bunch of people. The Humvee that blasted "whatever it is that appeals to the 18-25 demographic" out of the speaker box in the rear seemed to be the loneliest place in that park.

As the orientation wound down, there was the palpable sense of impatience. Everyone just wanted to get started. The morning of day 4 ushered in the Medicine and Society course, and so it began.

A Swerve into the Memory Lane, Pt. 1: "I Accept!"

This is the first part of the short promenade down the very recent memory lane to bring the blog up to date.

The whole medical school to-do begins with what one would think is a simple thing: a phone call. But this is med school admissions, and nothing is simple. The offer to attend medical school is given in person, over the phone. Someone has to be at that phone--no messages will be left on voice mails or answering machines. So everyone provides a zillion phone numbers where they or their friends/relatives can be reached. As long as a live person answers, the offer is in play. If it isn't you, a message is left with the person who answered telling you that you've got an X number of hours to call the office of admissions. If it is you, better not pass out (there will be plenty of time for that in the gross anatomy or phlebotomy labs) before you utter "I accept" to the person at the other end of the line.

In my case, the first phone number on the list of around 10 I provided was reached. It was very late in the process, and I essentially had given up. Bought a car, made plans for the rest of the summer, and started counting the gray hairs showing up in my beard. I was at work when I was thinking about that skinny rejection letter landing in the mailbox, when the phone rang. With slightly more than three weeks to go before the orientation started (ie. end of the line), I finally got the offer, which I promptly accepted.

The rest of the pre-orientation time was spent looking for a place to live in Buffalo, filling out various forms, and tying up all the loose ends. I worked till the last week of July, and then said goodbye to my coworkers, my boss, and the last 7 1/2 years of my professional life. Time for bigger and better things.

Back to School!

Well, so the medical school thing worked out in the end. I set this site up to do a bit of metric system blogging before my MCAT results came back. Obviously, there wasn't too much time to blog, as it was just too difficult to pull myself away from chewing the fingernails (quite the hygienic preoccupation for a future M.D., eh?) . Everything hinged on that score, considering that I wasn't applying to many schools since I wanted to stay local to spare the family a big move. And the score came back. And it was good. But to make it all so much more fun, the application process ended up being A) late, and B) practically down to the last minute. A snafu with my transcripts restarted the application process, which put it past all of the schools' deadlines. Thankfully, it all worked out, and an interview and a waitlist later, I was accepted to UB SMBS (University at Buffalo School of Medicine and Biomedical Sciences).

Thus begins the making of Dr. Detroit. Stay tuned for thoughts, comments, and inane remarks about medical school from a perspective of a nontraditional student. After 9 years of life in the cubicle, I'm going back to school.