Rough seas ahead?

It should have been simple: finish the first year, get the house ready for sale, and concomitantly buy a house close to the university. The plan emerged literally 2 days before the last exam. My wife and I decided that it would be much easier if we lived in the same house when I worked my way through the second year. So for three weeks we feverishly worked on cleaning up the house and improving the property, to bring the whole thing to a sellable condition. And two-and-a-half weeks ago we finally put the house on the market. Yet the right house near the university has eluded us. We decided to withdraw our offer on what was supposed to be the 11th-hour house that would have closed right as the kids were ready to go to school. The house was in no condition to move in as I realized yesterday, so it became a no-go. Now we're staring the prospect of potentially moving in the middle of winter, when the kids finish their first semesters along with me.

Other than real-estate hell, though, it's been a decent vacation, if one could call it that. Early in June I visited Chicago for an AMA conference. It was an eye-opening chance to see politics of a large organization in action. Much of the student section's work was devoted to debating and voting on proposals that were to be later taken up by the doctors' sections.

No research for the summer. I was planning to get together with a radiologist in town to do a paper study that would have likely yielded a publication, but the family life won out in the end. I wanted to spend some time with the kids and do some studying. And I had a chance to do both. There is also a chance to do some research at the university once things start back up again. I'm counting on 2nd and 4th years to attempt the research, since I hear year 3 is jam-packed.

The time away from school has also given me some opportunity for reflection on my future role as a doctor, on medicine, and on that most precious thing that is health. In coming days I'd like to comment on a few things; hopefully there will be time to do a bit of writing.

$20,000 Words

Medical jargon, as it should be expected, is hardly limited to obscure conditions or highly technical procedures. While some of it has permeated into the common parlance, there are conditions that retain their common names, and only doctors end up knowing the 20-dollar words for such mundane things as hair loss. Seeing that our annual tuition hovers around the $20,000 mark, I call them the 20,000-dollar words. Alopecia (baldness), pruritis (itching), or exanthema (rash) are just few such examples. It's always fun to throw out a medical term for something common and watch for response. I suppose it's the geeky thing to do...

Econ 101 @ Med School

eBay or any large auction site is a great tool for learning the principles of supply and demand. The review books for USMLE 1 (part 1 of the board exams) are now in a price spike because the summertime boards are coming up. Naturally the most recent editions are fetching the highest prices, but even the 3-4 year old sets do pretty well. I look mostly at the tried and true Kaplan review materials, (worked well for the MCAT) though by the time my turn comes, I may have amassed a pile of books taller than me. But there is a way to circumvent the brutal market forces--4th year students. Right now most of them are moving out to their residencies and getting rid of everything. Furniture, TV's, and review books. Often at a price much lower than eBay's. So for now, I'm keeping my eyes peeled for good bargains. At worst, I can try eBay after Step 1 has been administered.

http://www.ttuhsc.edu/som/studentaffairs/documents/Step_1_Prep_Book.pdf

The other PETA

For a brief second I thought that there was some kind of joke. The site was dedicated to physical examination of a patient, yet it directed me to "Online PETA." As we all know, the People for Ethical Treatment of Animals oppose medical research on grounds that it is essentially animal cruelty. The organization's extreme methods of liberating research labs and pouring paint on fur coats have gained them enough notoriety, that most of us normal folk steer clear of them, which would include any of their websites. I clicked the link, just in case this was yet another instance of a famous acronym having a completely different meaning. Sure enough, PETA stands for Physical Exam Teaching Assistant. It's a nice site that I wish I had found about a month ago, though it's pretty obvious it'll be handy in the future. From the little that I've learned in medical school, one thing is quite obvious--no matter what you'll be doing, the physical exam will be a part of your daily routine. You'd better get it right sooner than later.

Link to Online PETA here.

Quiz Time

Coming fast on the heels of Monday's practical exam is today's "quiz." Feels more like a bona-fide exam, since it'll be a 25-question lecture-hall affair. But it's only worth 10% of the grade, which makes it that much more of a dry run before the single high-stakes exam we have at the end of this (musculoskeletal) module. We'll have 45 minutes do complete it, which is "twice as much as you'll get on the Boards." How generous...

After all this: 3 hours of lecture, a trip back home to meet an uncle who's visiting for one day, and then back to it on Thursday.

Transplant Trivia

The renal module is all wrapped up, but a few nagging thoughts remain. Transplantation in lay media, especially when it comes to kidneys, is seen as a fix-it-all procedure. "Yup, that brand spankin' new kidney there will make it all better. It's like poppin' in a new battery, and you won't need a new one for a 100 years." Just as I used to debunk bad science in movies (as my friends rolled their eyes and munched on the popcorn anyway), I suppose it's time to let the pocket protector ride again and point out bad medicine at the cinema.

One common preconception is at least true. You only need one kidney. Two kidneys filter around 180 L of blood each day, so cutting that in half still isn't too bad considering we only have 5-6 L of blood.

The transplant does not replace the original. It is instead placed somewhere below one of the existing kidneys. Reason? Higher morbidity.

Who does the transplants? A urologist. I was surprised to find this out, especially seeing that urologists usually do small procedures on the urinary tracts.

Who's the best donor? Related or not, a living one. Cadaveric donors, while still good, don't match the 5-year survival rates that the living donor kidneys do.

Transplants can be rejected, in a dazzling variety of ways. From hyperacute rejection which takes minutes--the kidney literally turns black as it's being sawed up, to chronic rejection which takes years. Once rejected, it's back to dialysis for the patient.

The transplant is good for about 10 to 15 years, though the recipient is permanently on a regiment of immunosuppressive drugs.

Appreciate your health, comrades!

Today is May Day, which in many countries is a day off, as it is the workers' holiday. During the heady years of the Soviet Union it was the day of missile parades in the Red Square. That's all gone, though maybe Cuba or China still let the workers know in a rather festive way who's in charge of those missiles. In the US, May 1st has morphed into "Illegal Immigrant Day" which our dutifully ignorant journalists routinely forget (or intentionally omit, who knows?) to associate with its origins.

Although Thanksgiving is really the holiday I should be talking about today, I'll take May Day. The more I learn about what can go wrong with the organs, the more grateful I am for being healthy. Kidneys alone, though we have two of them, can fail in many ways. Many diseases and conditions revolving around the kidneys or ones unrelated like type II diabetes, lead to the destruction of the organs. This is called ESRD--End Stage Kidney Disease, and it usually results from chronic conditions or genetic abnormalities. Oddly enough, acute conditions are often quite reversible if properly diagnosed and treated, and in the disease lottery, you want to draw their lot and hopefully have a competent physician nearby. In any case, life without kidneys plain sucks. While you do find out that ESRD is one condition that makes you automatically eligible for Medicare, being on dialysis 3 times a week is not fun. A surgeon makes you a fistula, which is a slight rerouting of an artery into a vein (in the arm) to create a blood vessel hospitable enough for large bore needles 6 times a week. Fistula takes a while to develop, but once there, it's good for several years. Dialysis takes 4-5h per session, so you're pretty much tied to that center. And the survival rates aren't necessarily all that hot, so if you meet all the criteria, you're placed on the transplant waiting list. Transplant itself is not fun either--immunosuppresive drugs keep that kidney from getting chewed up by the immune system, but cancer will go hogwild in such a body. So here's to our kidneys, comrades!

Reality.

It's been a while, but we've finally been treated to a patient presentation. The GI module had a patient back out, so we just had a dry recitation of facts, and that only on one occasion during an almost two-month battle with the stomach. Renal has come through for us, and we had probably the most touching meeting with a patient today.

Today we met a woman who went through many years of hardship and two kidney transplants, but ended up beating the odds and living well beyond the 50-year-old lifespan that was predicted by the doctors in the 80's. Being in sales, she was very comfortable with the audience and told her story without any assistance from the professors who typically guide the process along.

It was remarkable to be thrust into the reality of the patient's experiences where we would normally talk about transplantation techniques and immunosuppressive drugs. In my computer past, it was remarkably easy to put oneself into the users' shoes and try to look at things from a perspective of someone who wasn't familiar with technology. It's quite a different thing to find yourself confronting a patient who needs not only non-technical language, but also a simple human consideration for their emotions and fears. Our patient went through years of dialysis, and two kidney transplants. The second transplant worked out, and today she is reasonably healthy, though she will be immunosuppressed for the rest of her life in order to maintain the kidney.

We often hear about transplants or dialysis in a "no big deal" type of context. These words can become routine, yet they provide an umbrella for so many individuals, each with a rather sad story to tell. Although I don't know the statistics, I do hope that the first time transplants work out for majority of the patients.

Room 237

On the way to the computer lab, where more work awaits following the grueling Monday schedule, I chanced upon room 237, which is the server room. Definitely something from the past, funny to find it here, so close to the realities of medical school. We actually do have a demanding setup that would necessitate a sizable server and infrastructure support, so no surprise there. Back to work.

Timing, all timing

Had to work Scrubs into this blog somehow. Hmmm, medical student watching a medical comedy, how rare, eh?

We've bought a few things from Circuit City over the years, and using their rewards card, we've accumulated some points that can be traded in for some discount coupons. Considering that the company has been in trouble trying to compete with Best Buy and shrinking margins, I decided to turn in my points for all the coupons I could get. I figured I'll hang on to the coupons for when CC will have their predictable sale that'll follow the release of the newest Scrubs DVD set. I shot for around September/October timeframe. $20 for new set, $20 for back sets, which normally sell for $35-40. CC can't go out of business by then, can it?

Well, this weekend the coupons have arrived, and unfortunately, their expiration date was all too soon: July 9th. OK, the immediate disappointment turned into Obama-like hope that maybe during the summer months' slow sales, there will be some sort of an across-the-board price cut that'll include Scrubs. Realistically, though, I dreaded that I'll have to take what I'll get in the nearest two months.

Looked at CC's flyer for today, and surprise, surprise: all Scrubs collections on sale. Couldn't have asked for a better timing. Yay!

U/S

In the spirit of the renal exam, another kidney image. This time in ultrasound. Having actually learned how to do u/s today, I'm quite amazed at this picture, but we were told that it takes around 50 exams to get good at this thing. We were fortunate enough to have had eight volunteers, a few of whom were on abdominal dialysis which allowed us to view abdominal fluid pooling, something that u/s is very good at.

The primary advantage of the u/s is its rapidity. You turn on the machine, put the gel on the transducer, and you've got 60 seconds to do the FAST exam in a trauma setting. FAST is Focused Assessment with Sonography for Trauma (yeah, someone really tried fitting things into this acronym). It's designed for ultrafast assessment of abdominal injuries, but it also extends to the heart. The primary limitation should be obvious from my above comment: it's hard to obtain good, clear images.

A normal ultrasound scan will take longer, but since we're talking emergency medicine, things need to happen quickly, especially when there is some severe trauma like stab or bullet wounds. There is also some discussion in the medical circles as to the possibility of the venerable stethoscope being replaced by ultrasound in the near future.

A month already?

And it's been a busy month. It's odd to admit, but I'm studying now more than ever. The volume of material is simply incredible, once you wake up to the fact that what used to be anatomy lab, sometimes 3h of it in a day, is now 3 separate lectures. So lots of reviewing and re-reviewing has to go on.

So, we've sailed past the gastrointestinal module, which granted us such arcane knowledge as the secrets of two types of diarrheas you can get, the very specific difference between diarrhea and dysentery, and why you'd rather have IBS than IBD. The really pressing stuff like what does a colostomy bag feel like, and what is the composition of a standard flatus has been left for the eager beavers who will become GI docs. Due to time constraints (6-year residency) I will likely not be a part of the club, so I may never know the answers. Well, there is always Wikipedia.

So on to the renal module, hence the picture of the kidney outlines on the patient's back. Notice that the left kidney is higher than the right. This is due to the space taken up by the liver, along with the fact that the right lung is a bit longer than the left.

Like GI, the renal module offers a jolly mixture of how the stuff works and how it goes bad. It's all a bit like a movie that at first sucks you in and makes you feel good, but then your favorite character is killed off. And so far, all the characters in medical school have been quite likable. Hate to see what happens to the muscles in the upcoming musculoskeletal module.

The first renal exam is on Monday, just 3 days from now. Although it's Friday today, I'll be seeing the family tomorrow after lunch. We have an ultrasound clinic tomorrow morning, so I arranged to stay at the university, study in peace, and come back a bit later. It should work out well. And next week, thanks to the wonderful recorded lectures, I'll take off for home early.

JAMA once again!

Another pleasant surprise at the Journal of the AMA. It turns out that each issue has had a podcast associated with it since early 2006. It's a 10-minute summary of each issue, and the more I study medicine, the more I find each issue valuable and pertinent.

My membership in the AMA not only entitles me to electronically archived back issues, but all the other digital accoutrements that go along with them. Like with the Ginsu knives, you can just hear "but wait, there is more!" Every month, there is also a 55-minute interview with the Author in the Room, a feature that is "designed to bring clinical evidence into practice by connecting clinicians and others to authors of JAMA articles."

So good stuff all around. And I've got my membership paid up front for another 3.5 years.

Occasional Irony

As it should be in the hierarchical reality of medicine, the first years look up to the upperclassmen as the veterans who've seen it all and know even more. But once in a while I'd hear something just the opposite in conversations with my classmates: older residents and doctors telling us that we know more. It was something both difficult to believe and quite obvious. After all, we just had anatomy, we just did biochemistry, so it should still be fresh. All of this was basically anecdotal for me, until, that is, a few days ago, when an intern (1st year of residency) asked me some relatively straightforward anatomy question. Before I was able to register surprise, she added that I'd have a better idea since I just took the subject. The way medical school rolls along, we will end up remembering the most important details, which obviously will be repeated several more times in our schooling, but many things will fall by the wayside. Such is life and such is education.

Unconscious

Fainting, or syncope in medspeak, is not quite what I had in mind, but like the previously mentioned JAMA journal, I'd like to have some classical painting, preferably with 18th-century powdered wig extravaganza on my blog as well. So here it is. But the topic of discussion is really OLD CARTS. Thanks to our school's insistence on clinical exposure from year one, we had a chance to memorize this tried-and-true mnemonic that doctors use each time when they ask about pain. O=onset; L=location; D=duration; C=character; A=aggravating factors; R=relieving factors; T=temporal aspects; S=scale of 1-10. By the time a clinician is practicing, this is old hat, so ingrained that it's happens almost unconsciously. If you pay attention to your doctor, you'll find most of these elements when s/he asks you about your symptoms. Some doctors have such an awesome conversational style combined with just the right dose of personality, that it's tough to spot. But oftentimes the scale of 1-10 is the dead giveaway that you've been had, so to speak. And you thought you were entertaining the doc with your tales of last month's trip to that Star Trek convention.

I have a long way to go (the Star Trek convention's in Denver ;), but today, I was relaxed enough to lapse into OLD CARTS, all in Polish by the way, during a conversation with my mom. Oddly enough, we're covering the GI system, and she called me out of the blue with a related question. So after this "writeup," I'll be researching some stuff for her. HIPAA rules prevent me from elaborating any further.

Where's my paranoia?

I'm waiting for the unhealthy sense of paranoia to set in, as we sample from the buffet of diseases on almost weekly basis. So many things can go wrong, in so many horrible ways. Abdominal pain, since we're doing the GI module, can be so many things, from indigestion to pancreatic cancer. So far, I haven't worried my head of about any aches and pains. Exams are the biggest thing to worry about right now. The other reason is probably that everything is still in a very theoretical stage for us--that's how the first two years are: bookwork and exams. Once we start seeing patients in hospital settings, manifesting the symptoms we learned about, things will become more real, so to speak.

So paranoia is on a back burner. Black Sabbath had theirs in 1970; I'll have mine in 2010, perhaps. Let's hope that RIAA doesn't get too upset about this image.

This year and beyond.

We're knee deep in the GI module. From here on, the coursework marches to the steady beat of systems-based modules, which makes things very interesting. We cover all the standard goodies in each module: physiology, anatomy, histology, pathology, and biochemistry. It's called an integrated approach, which seems to be the way of teaching medicine that many schools are opting for these days. The classic method was to teach function of the healthy body the first year, and follow it up by disease the second year. In any case, I'm growing to like the integrated approach, since it feels like seeing all the dishes on the table and having a chance to sample all of them.

Up next are the renal and musculoskeletal modules--one month apiece. Exams will pretty much be with us on weekly basis, except for the spring break which is coming up at the end of March. Things will cool off a bit during renal & muscoskeletal, but the pressure, as always, will be on. Classes end in the last week of May, which gives us the very last summer vacation. There will be a bit of time off during the summer of the second year, but that will be spent preparing for USMLE Part 1, the famous board exam. The first part of the boards makes or breaks the career. A high score opens the doors to the competitive residencies. I'm sure I don't have to explain what happens with the low score.

“If you could only see what I have seen with your eyes”

So goes the quote from Bladerunner. But it's not about sci-fi cinema today, but about ER. Just finished up the first of 4 stints shadowing an ER physician which are part of an Intro to Emergency Medicine class. It's a nice chance to see the real world before we become a part of it, more than a year from now as rotations kick in.

While most of my classmates opted for the local trauma center, I said either that or the swanky suburban hospital was fine with me. I'm just here to check things out, see if the emergency thing may be in my future. Someone must have figured out that I'm a man of the suburbs, and I got the posh hospital. Still, an emergency department is an emergency department, and I've seen what I came to see. It started of with rather banal things: headaches, dizziness, a case of bleeding hemorrhoids, but towards the end, things kicked into high gear with congestive heart failure, malfunctioning heart pump, and non-Hodgkins lymphoma. Best of all, I saw the procedures that I wanted to see. IV lines being put in, catheterization, and a blood draw from the femoral vein (right near the groin, ouch!).

My ER preceptor is a nice, laid back guy. Very human with the patients, yet able to project the doctorliness in a professional manner. Residents were also cool, one of whom decided to give me some education while the doc was too busy. Now I have a few things to look up as "homework." Good stuff.

Back in my day...

I do get so say the words of today's title sometimes, and for effect, I deliver them with the old man voice. Though we won't be talking about the ailments of the elderly today. No, quite the opposite, we'll take a look at the technology available to a student these days.

First off is the indispensable Facebook. The first semester it was really all the rage (this phrase was used back in my day), although things cooled off by now a bit. It's especially funny to see an almost complete loss of activity the day before any major exam. Which brings us to email, which seems to be always used, even before exams, for various distractions. At least one or two posts to the class distribution list will be about this or that "study break," usually something someone found on YouTube, usually related to medicine.

OK, so internet is mostly for wasting time, but we do have lectures available there. Since the material is so dense, it's nearly impossible to take good notes, unless the official class notes are well done, which varies from professor to professor. This has been pretty much taken care of by lecture notes, and now lecture videos, available within a few hours after the actual event takes place. So if you want to sleep in, crash your car on the way to school, or just plain feel like reviewing that dense professor's lecture one time, there they are. Which makes me feel spoiled rotten, since when my friends were attending medical schools in the last century, they only had a note-taking service.

A writeup on technology in medical school wouldn't be complete without some kudos to the network and PC guys who make the wireless infrastructure, computer labs, and the basic internet access possible in a nearly flawless manner. I left that world ages ago, it seems, but I do appreciate all the work that goes into making that flawless appearance.

Onto things more medical. While we may have been still using real cadavers, all this in the days of virtual frog dissections for the squeamish 8-th grader, some of the more classical material has already been delivered virtually. A complete histology course, developed by one of the professors at the university, was done on a computer. No microscopes, no slides, just images on a PC screen with cursor-sensitive areas. Going over portions of a cell with a mouse would highlight various organelles, etc. Endoscopies of all sorts will also be done virtually. Apparently we'll be able to perform colonoscopies through a computer program. There is also a virtual patient that we were shown during the orientation. I forget what he's for, though I do remember that he can be made into a she with appropriate attachments.

One final technology note is that I have yet to see one Tablet PC, which was heralded a few years ago as a revolution in higher education. Now that everyone's got their Powerpoint notes printed out, it looks like the TPC is a technology that came too late. A bit like Blu-Ray, which might not matter to anyone in the days of downloadable music and movies.

On a lighter note.

Why is poop brown? Bet that question has been dogging mankind for centuries. For a mere $20,000 in first year's medical school tuition money, you can get your answer. The more budget-oriented answer seekers may always turn to Google. Wonder where Encyclopaedia Brittanica falls in this spectrum of knowledge authority...

Anyways, the answer is bilirubin, which, to make the long story short, is the end product of hemoglobin breakdown. Along the way, it ends up being slightly modified, excreted with bile into the gut, and voila, there's brown poo. Now back to studying.

For obvious reasons, no picture with today's blog.

More food.

So I just found out that, none other than the US Army will be giving a lunchtime presentation this Wednesday. And they're aiming to recruit doctor soldiers with sushi, rice-crusted chicken, and subs. War in Iraq? Who cares, they're feeding me sushi. Where do I sign up?

Pizza and flesh wounds.

Once the school year is in full swing, lunchtime presentations abound, and typically there is food involved. Oftentimes it's the healthiest of choices: pizza. But the more "prestigious" seminars have things like subs, wraps, or Panera Bread sandwiches. Today the Emergency Department was showing off the effects of trauma, so keeping with the bloody color theme, they served up a boatload of pizzas. And pop, naturally. Ironically enough, that's what we're trained to tell patients to avoid to maintain weight control--drop the pop down to one can per day, and limit the fat intake. But anyways, we're all slim future doctors, we could use some extra fuel, right? And they bash the smokers.

So the presentation showed photos that I obviously can't share, but mixed among the various types of trauma, we had motorcycle driver who crashed into a concrete post and was split in half. Next up was the classic, but still much-beloved self-inflicted gunshot wound to the face. Biggest problem there was finding the airway, since the face was unmistakably gone. Yes, this does bring up the main thrust of the presentation, which was the ABCDE prioritization scheme for trauma patients. Airway, Breathing, Circulation, Disability, Exposure. Anyways, next up were the frequent but oft-misunderstood stab wounds. Mostly to the head, but rarely knives. X-rays generously illustrated the extent of the object penetration in case the photographs didn't make it clear. The grand finale was of course missing limbs and digits, with some tips on what to do with the amputated parts to preserve them for the surgeons. All the while, about a 100 people were munching down on pepperoni pizza.

Later on in the day, we were learning the eye exam, part of which was the technique to flip the upper eyelid. Someone was very queasy with that exercise. I guess they didn't attend the lunchtime seminar either...

Diagnoses

Different kind of diagnoses in medicine. Doctors decide by first considering all the possibilities indicated by the symptoms: that's the differential diagnosis. Chills and fever suggest many things, so the doctor comes up with a short list of diseases, and eliminates them one by one until only one remains: that's the working diagnosis. The unpleasant part of dealing with biology whether in lab or in clinical setting is that often there is no 100% certainty, hence the working diagnosis is the physician's best conclusion at a given moment. Combined with unambiguous lab results we get the definitive diagnosis, which zeros in on the culprit.

This just in.

I pulled the trigger and ran for an office of the local chapter of the AMA. Figuring there is something worthwhile to be involved in, I fired off an email back to the current president, and found myself squaring off against a couple of classmates. Apparently my quirky sense of humor and the grizzly beard of experience swayed the voters, and I won.

Now back to the regularly scheduled blog.

And I thought I had a blog.

A treasure trove of clinical cases, something so useful to a starting doctor, can be found here:
http://clinicalcases.blogspot.com/

It's good to see people helping one another. In the hypercompetitive environment of a medical school, and probably beyond, this is a welcome resource. Whoever this person is, their blog is quite impressive.

Vocabulary lessons

It's the weekend, and I try to squeeze in some studying into the family time. It's tough, but it can be done, and my wife does all she can to help. That old cliched team effort.

As a member of AMA, I receive an automatic subscription to the Journal of the American Medical Association, otherwise known as JAMA. Funny enough, jama is what our kids call their pajamas.

One thing about reading medical journals, they're much more palatable that the old science journals from my previous life. It seems like chemists went out of their way to write as abstruse articles as they could. In medicine while the writing is technical and full of jargon, it is also quite lucid. Thus a busy doctor (or medical student) can quickly get his bearings and get an idea what's going on in the world of medicine this particular week. Much like medical school material, JAMA comes fast and furious, each week. Of course just to prove me wrong, this photograph is of that one particular issue that comes out around Christmas when they actually take a break. Anyways, this is really the first issue I've looked at seriously and read an article. The timing was very interesting: the material we learned in just the first week of the Hematology block armed me with good understanding of the vocabulary and concepts. Neat. But there were things that still needed underlining and defining, which is where the beloved internet came in.

Most pleasant was the realization that this process of "drinking from a firehose" is working. Each week there is more and more knowledge, vocabulary, and acronyms added. And each week that JAMA shows up in the mailbox, it becomes more understandable.

The article, btw, was about dengue fever, and its potential spread into the US.

And we're off...

Yup, this is as stereotypical as it gets: red blood cells imaged with a scanning electron microscope, the one that provides with those nifty 3D pictures which are later colorized. SEM's of course produce only b/w images, but that doesn't stop anyone from splashing some red in there.

The second semester of medical school started Monday, which made for a busy day, since Mondays are for regular classes, the Clinical Practice of Medicine class and associated seminar sessions on alternating weeks for each half of the class. This was my half's week to have the seminar session, so it was a packed day through 4 o'clock. But it was all fascinating, especially that this semester we are learning the ins and outs of the physical exam in the CPM class, and regular class is Hematology. No, we did not notice new students with elongated canine teeth suddenly auditing classes this semester.