At the wisened old age of 24, I have become a great-aunt. My nephew just had his firstborn, Warren Ashley.
On an unrelated and amusing note, one of the investigators I work with is doing a study on visual field cut after stroke (in children). She is testing it using several custom built (simple) games on a touch-screen computer. Recently a child turned to her mother during a testing session and asked for the game for Christmas.
We're coming up on one year of post-baccalaureate study so I thought it would be a good time to reflect on what I've learned. Put another way... chapter 9 in organic chemistry just doesn't sound like relaxing Sunday fun.
1. There really is a difference between old schools and new ones. My current institution has a huge endowment and my alma mater, well, it doesn't. Both are great schools, but the facilities the endowment affords really are nice. Several large libraries, each with sturdy wooden tables, lots of private study rooms (with laptops and plasma screen tvs), and laptops you can borrow for 4 hours. A 4 story gym with lots of equipment so you don't have to wait for machines or court times. Edible food.
2. There really is a difference between a top tier university and a middle tier. I'm sure you can do great things attending either, but at a great school the opportunities come to you. Brands, even when it comes to education, have power.
3. Organic chemistry is not as scary as Matter and Interactions II (honours physics II). S. and C. must have been out of their minds when they designed the curriculum for M&I II. They took a subject I loved and made it hell (bad enough I left the major), wheras organic is actually kind of fun. My hexane has a first name, it's c -y -c -l -o...
4. Getting into medical school really is that hard. There are so many hoops, most of them totally pointless and it costs a fortune.
5. Academia is just as political as the "real world". Grant money and tenure are no more a meritocracy than any other industry. The tweed and white coats just make it look that way.
6. Coffee. It's not longer recreational use.
7. Saturday labs really do suck, no matter how late they start. I've had Sat. lab for the last year, first at 9am, then 12pm, now 11am... and nothing sounds better than next semester when, for the first time since returning to school, I will have no lab class!
8. I am not a party girl. I used to look with envy at the people with busy social lives in college, but honestly, I very much enjoy dinner or a movie with friends and wearing my PJ's as much as humanly possible.
9. Diet coke is better than diet pepsi, and sierra mist free is better than diet sprite.
10. I'm going to enjoy being a doctor (but I'm definately not going to be a pathologist).
Unlike many of the more considerate bloggers out there, I simply disappeared rather than formally announcing a break. And it was a month long. Oops. Ah, but now we're heading into finals, which can mean only one thing: procrastination! And what better way to procrastinate than to write things and assume you have nothing better to do than read them?
I did my first alumni interview for my alma mater today and the student whom I was interviewing is also applying to my current institution. This worked out well for her since I was able to offer perspective on two of her choices, but now I have no formal way to notify my current school that while she's probably quite smart, she lacks that pizazz that I associate with the people I matriculated with.
In fact, she is planning on going to business school. She is the second person in the past few days that has expressed this future plan and in both cases I have proven to be a huge hippocrite. I have a business degree. I chose to get that degree. I switched out of a science degree to earn it. But I counseled both these young ones to get something else. Economics maybe, but not business. The unfortunate thing about a business degree is that is qualifies you exclusively for business jobs and you're actually still fairly likely to lose the spot to an engineer or an economist. Quant is in, so if you have the brains you are better served getting a more quantitative degree and taking the spot from a business major. I'm not saying you can't get a job with a business degree, but you better be a business kid with a whole lot of real math (not watered down business math). Well, at least in finance.
You know what the frustrating thing is? I was a business kid with a whole lot of math and do you know what I actually used when I got to my oh-so-coveted finance job? Differential equations (not required by business curriculum), writing (something employers ought to be looking at), statistics, databases, and programming. The last two also landed me my current job. It's a very good thing I got my business degree from the institution I did.
Business degrees prepare you for a job managing people, which is a job you won't actually hold in business for quite some time. Your first years are spent doing a lot of scutwork and the way you differentiate yourself is to teach computers to do the scutwork for you. That, and be able to form coherent, articulate sentences and say them without five "ums" and a "you know?". You spend four years learning how to effectively give orders and then graduate to 10 years of taking them.
There should be a new class added to the curriculum to supplement the strategy lessons: Interpersonal Politics. It should cover:
- How to get people to do what you want when you have no leverage
- How to differentiate the people you want as your allies
- How to recognise the ones trying to take you down
- How to maintain network contacts without looking like an idiot
- How to get around people in your way
- How to work with people that annoy the hell out of you
- How to deal with a boss that's dumber than you
- How to read between the lines
Actually, adding a class in No Limit Texas Hold'em wouldn't be a bad idea for the finance concentration. Poker is the Wall st. golf.
Since a big part of my job is reviewing the charts of children who have been diagnosed with stroke, I thought it was time to put together a little quiz.
Define each of the below and label them either as 1) a stroke risk factor or 2) a stroke sign/symptom:
a. eclampsia
b. HLHS (hypoplastic left heart syndrome)
c. PFO (patent ferman ovalae)
d. PDA (patent ductus arteriosis)
e. moyamoya
f. AVM (ateriovascular malformation)
g. Otitis media
h. Hemiparesis
i. dysmetria
j. ataxia
k. aphasia
l. dysarthia
m. vasospasm
n. mastoiditis
Which pair of arteries feeds the PCAs (posterior cerebral arteries)?
Which pair of arteries feed the ACAs/MCAs (anterior cerebral and middle cerebral)?
What arterty does the PICA (posterior inferior cerebellar artery) originate from?
Where are the watershed regions located?
What is the most common pattern of ischemia for cardioembolic stroke?
What is the difference between stenosis and coarction?
For the answers... check the comments.
After 2 months of haphazard testing and educated guessing I think I have identified my bacterial unknown. I'd like you all to meet the Gram +, catalse +, facultative aerobe, mannitol -, coccus that is Staphylococcus epidermis. 
The same day that I identified that beauty I was given my Enterobacteriaceae unknown. So far I have concluded that it is, in fact, an Enterobacteriaceae and it is lactose negative. Soon I will be getting my PCR unknown as well... lots of investigating in micro.
Orgo continues it's march onwards... we've passed the vocab, are exiting stereochemisty, and have merged into mechanisms. Enantiomers, diasteromers, and structural isomers... oh my!
Part of step one in applying to medical school is writing a personal statement; traditionally discussing why you want to enter the medical profession. This is a problem because quite honestly I haven't faintest idea why I want to be a doctor. I don't come from a long line of doctors and none of my close relatives suffered a horrible medical course. While I don't entirely lack empathy, I think I'm on the selfish side to be the altruistic applicant. I'm uncomfortable unless I'm under pressure and I enjoy learning more than any other hobby, but I don't know if that really means doctor. I mean, doesn't banker fit that description too? I left that...
Let me not confuse the obscurity of my motivation with lack of it's existance. I definately do want to be a doctor. It's the right fit and I'm happy on this path, I just cannot articulate why. But I still need to write the essay.
On a related subject, my co-workers have started expressing indications of which specialty they believe I will end up in. One attending has put in a vote for surgery, the med student thinks I'll choose ER, and another attending concluded peds. Interesting that I came in saying neuro, work in a neuro department, and no one seems to think I'll end up a neurologist.
... it's t-b-u-t-y-l. 
Having cleared the first of three exams in a 7 day period I have now "dug in" and they say and am battling it out with organic chemistry. Turns out that doing orgo is actually more engaging than many other classes. It's still work (ie, sleeping would be more fun), but on the continum of physics lab -> free ice cream it's not doing too badly. Maybe it's because building models is somewhat reminicent of the building blocks you had when you were five. Or legos. Legos with atoms.
My colleagues at work are off to the Child Neurology conference this week to present abstracts on some papers we're preparing for publication. If you happen to be in Pittsburgh and happen to be at the Child Neurology Conference and happen to come across a poster on seizures in the presentation of children with acute arterial ischemic stroke... check out the third name.
Work is fairly routine at the moment, but I'll be in clinic again on the 20th so hopefully there will be some interesting stories from there. In the meantime, I thought I would give you a break from all-neuro all the time.
I was watching tv on Friday night and ended up flipping to an HBO series about a Nevada brothel. Never one to pass up an educational moment, I settled on the sofa with a glass of diet coke. Honestly, my first reaction was that none of these women was hot. The ones with the bodies have faces that more closely resemble a bulldog than a person and the ones with doable-in-the-dark faces had, shall we say, "pillowy" figures. Now I know that I am not in possesion of either a) stunning good looks or b) a figure a runway model would puke for, but I'm not selling my sex appeal for cash either.
About halfway through the program one of the women is chatting with a potential client and she's showing him around the place. He grabs her ass and makes a lude pass at her. She gets pissed off, steals his money clip and refuses to service him. I fail to see how someone who pays to let men (and women) do what they with her can get away with indignation over an ass slap. Genuinely attractive women get that and worse and dance clubs and bars... get over it.
The last segment was a women who was dating the brothel owner and was getting upset that he was sleeping with the girls he employed and she didn't feel her pedastool was high enough. Uh, he's a brothel owner and all the girls pretty much have to sleep with him or they would probably lose their jobs. Of course you're not going to get this guy to commit. Hello. Duh.
I think what we can take from all this is that the women of this particular brothel are both ugly and not-so-bright. And maybe we've also learned that I think to much when watching crappy late-night television. But then, dissecting re-runs of the West Wing probably makes for a much less amusing post (but it is better tv).
Today was the toughest day I've ever spent in the hospital. The children were the sickest, not just of the neurology patients, but arguably in the whole hospital. Now usually, I only see patients on follow up visits; their acute events (ie, the stroke) has already occurred and been treated, or I see only the images and do not meet the patient in person. This means I have been shielded from the real crisis so far, I don't generally see the life vs death dynamic. But today, today I did.
It started in stroke conference when I saw some of the most severe image studies I think you could acquire from a still-breathing child. They were mostly infants, which means they have a high level of neuro-plasticity (adaptivity) but they are also very fragile. One child had literally 1/3 of his brain missing. He had had a hemorrhagic stroke which created a cavity in his brain; the cavity being where most of us have our right middle cerebral territory. Now the baby has a clot in his femoral artery, but they cannot anti-coagulate because of the high risk of additional bleeding in the brain. They cannot image to track the stroke because he has a pacer due to pre-mature birth related cardiac problems. Basically, the baby is falling apart and treating any one of the conditions will kill him by exacerbating another.
Next we reviewed the images of a congenital heart defect (chd) baby. These babies are extremely prone to encephalopathic (brain) disorders because their blood supply in utereo tends to be very poorly oxygenated. This child had a hypoplastic left ventricle (missing left atrium/ventricle aka a "blue baby") and now was experiencing almost daily white matter strokes. I literally lost count while we went through the images because there were so many of them. They are a post-operative complication, the operation being the placement of a BT shunt (without which the child will certainly die) and some children experience them while others do not. By the time this infant stabilized, most of the white matter was lost.
After stroke conference I attended two patient consults with my attending and the prognoses did not improve. The first patient had recovered from a stroke but was left at high risk of recurrence and with a seizure disorder. While we were evaluating her she had a seizure despite being loaded with anti-convulsents. The only drugs left in the arsenal do more harm then the seizures themselves, but the mom was hysterical. I think she thought she was watching her child die in front of her, which raises an interesting issue of how to treat the parents when you're treating the child. With the exception of status epileptus, most seizures will resolve themselves and will not cause brain injury, but the mother's ears were shut. Very little was actually accomplished and I think the mother, not the stroke, will ultimately be the problem for this patient.
The last patient of the day was by far the worst. He was not actually a stroke, but a mitochondrial disorder. If you've had biology you will recall that the mitochondria are responsible for producing cellular energy, so abnormalities can cause diffuse and severe effects. In this case, the toddler could no longer breathe without a ventilator, had lost all his language, and could not move his limbs against gravity. He couldn't swallow or hear, and was losing his sight now as well. He had seizures and was fed through a G tube (tube placed into the stomach) and his kidneys were failing. He spent June - Dec of last year in the hospital and May - July of this year as well. After the exam, the mom asked the 64 million dollar question "how long will my child live?" And then came "how much can we do?" And now began my first experience with pallative care. The answer is, the child will live to his next birthday if he doesn't get the flu. Any virus, any common bug, will kill him. Without motion or sight or verbalization, he cannot communicate pain. The question is not how much we can do for him, it's how much you want to do. What kind of life is this child living? Don't worry, children aren't like animals, we don't put them down, but we do sign DNR orders and refuse surgeries and treatments to hasten the end when prolonging it is more cruel. That's the kind of conversation we had with this toddler's mom. That was how I ended my work day. This will be part of my life as a doctor and it's harder than I thought. It's really hard.
A group of friends and I went to a bar last night for a few drinks and to meet one of the girl's new(ish) man. Said man was very amicable and held his own with a table full of strangers quite well (cute and in a band too, well done Ms. A).
While there I was approached by a woman in a bright red top and matching lipstick as to whether I would be willing to meet her very cute single friend? As flattering as the offer was (why me?), why couldn't the guy come up to me himself? And, by the way, I'm not actually single. Then one of the guys at my table decides the woman in the red is quite desirable (after striking out with our waitress) so would I please go talk to her? I did (she's not single either), but I was silently wondering when men regressed to high school? After all, the "I'll tell my friend who will tell her friend that I think she's cute" thing worked so well then?
Around midnight, after all the fixing up fell through, I got a text from a NY (male) friend of mine exhuberantly informing me that he was, in fact, in my city drinking right now. Could we meet up, he needed my advice? Meet up we did and he talked (or rather, bitched) through last call. He called his friends (who he ditched to see me), but they weren't answering so he was now stranded. I offered him my futon, but he would have to be out early because I had to wake up and finish an assignment and get to lab. Back at my place I pull out the futon and get him a pillow. I go to bed. He knocks on my door, he's leaving, he's found his friends. As he's saying goodbye it dawns on me (from some of the untranscribed conversation) that he thought by "futon" I meant "my bed" and by "need to leave early" I meant "we'll have exhausting sex". What's worse is that, judging by the text I got the next day, he still thinks it will happen one day (never).
This past Friday I shadowed one of the attendings for a full day of out-patient neurology clinic. Thankfully I have been attending grand rounds, neuroscience conference and stroke conference regularly so I managed to at least follow the conversations and define most of the acronyms. Unlike the aforementioned conferences though, today was a mixed bag - I saw children (recall I am in pediatrics) with mitochondrial disorders, stroke, neuropathy resulting from traumatic or premature birth and descriptive clinical disorders (ie Turrets or Cerebral Palsy). There were also patients with unknown etiologies and highly atypical presentations.
A few things really surprised me. First, there is a marked difference in the involvement and knowledge level of the parents. Some could name every date and time of a symptom and the dates of every doctor's appointment for the next year, others were a little more relaxed. At first I thought the laid-back ones didn't care or didn't understand, but then I realised the real difference was which parents had accepted their children's diagnosis and prognosis.
The only children that were dysmorphic (physically looked malformed) were the developmentally delayed babies. This may have been coincidence, but pretty much all of the toddlers through teenagers looked like everyone else you see in school (some were a little hyper).
A basic neurology exam, one that looks for deficts and clinical abnormalities, is deceptively simple. I'm actually reading a book right now called The End of Medicene (it's making me angry) in which he critisizes how simple some of the tests performed in a physical are. The thing is, tests don't need to be complicated and digital to provide the information you need. An example. Put your arms straight out in front of you, palms up, parallel to the floor. Close your eyes and vigourously shake your head no. Open your eyes. Your hands are probably still level, but someone with a single hemisphere deficit will find one hand drifted downwards. Which hand also tells us which hemisphere. Yes, we need the 4D MR perfusion imaging and other complicated, high tech tests to help us accurately diagnose and treat, but that doesn't mean a simple test is worthless or unrevealing.
My favourite patient was a young boy with a head of short fuzzy blong hair in a McNabb jersey who was hyperinsulinemic/hyperammoniec. During his exam he refused to pay attention to the attending and instead was staring at me. In the end I had to stand behind the doctor to help the boy focus. While his mom was discussing recent events the boy played catch with me and climbed up onto my lap - he's going to be a real heartbreaker when he's older.
No, this is not a 9/11 post.
Someone I know, more specifically, someone I taught this summer, was killed. He was enthusiastic, capable, and young: he had his whole life ahead of him. I knew that most of the people in that program lived very different lives than I have. That to grow up poor and a minority in a city has certain temptations, certain risks, and a lower life expectancy, but this really drove the point home. So much potential, just... extinguished.
Every place I have lived has taught me something. Philadelphia is the city that is really rubbing my nose in the realities of life for those who didn't grow up near golf courses and taking piano lessons. The people I saw in the ER, the men I worked with in Veterans Upward Bound, even the composition of the neighborhood I live in... I have never seen so low a level of general education, so many guns, and such a high level of drugs, violence, anger, PTSD, alcoholism... and all so beautifully juxtaposed with the Ivy league, rich-kid haven that is UPenn.
Umm... when did Al Gore become cool? He was on the MTV Video Music Awards this year and he was better dressed, more articulate, and more passionate than during all of his campaign appearences put together. Not to mention his little documentary becoming a cult favourite among said MTV set. Even Bill Maher noticed - he said Al Gore had "found his voice" with this issue. Where was all this momentum when it mattered - during the election?
And speaking of Bill Maher... he's a republican?!
On the MTV subject, I wouldn't mind knowing which boyfriend turned Beyonce from an "independent woman" to a woman who will "cater to U". She went from buying her own cars to fetching his slippers. I realise than feminism is all about choice, but come on.
Lastly, when did it become fall? Don't get me wrong, I love the cooler crisp air, the warm cuddly sweaters and the clothes that hide a few more flaws than tank tops and mini skirts, but what happened to the summer? I distictly recall waking up each day thinking the season was dragging on but suddenly I realise that it went by deceptively quickly. All the undergrads have arrived on campus again bringing bustle and life back. Shops are extending their hours and CVS has devoted two isles to binders, mechanical pencils, and loose leaf. And I'm excited. One last fling of a weekend (back to NYC again - US Open tickets!) and it's buckle-down time: work is running smoothly and my brain is gearing up for the excitement (and I'm not being sarcastic) of microbiology and organic chemistry. I love the fall!
Freshly exhausted from a mini-vacation to New York City, I draped myself on the sofa, switched on James Bond in the background, and settled in to read my neglected email. Somewhere between my gmail and my yahoo account it struck me: two years seems to be the statute of limitation on your first post-collegiate job. Almost every mail shooting through cyberspace seems to bear news of a company change, an acceptance back to school, or a much yearned for interview. What is it that we (and I mean the collective, early twenties "we") are looking for? Are our expectations of the "real" world that far off the mark? Are our attention spans that short? Are we so undervalued or undertrained? Why are we able to commit to relationships, cities, and dreams, but not to our jobs?
I must admit to being a particularly early mover. I left my job in finance after a paltry 15 months and chose instead to backpack and scuba dive my time away before returning to school. In retrospect, my expectations were horribly unrealistic. And yet, what I wanted was nothing particularly grand: to be respected for the work I did, and to feel engaged and active in the process. It is the second half that led me to quit so quickly. After four years of maxing out my brain, it was suddenly switched off and that was more depressing to me than a six day work week and a two and a half hour commute.
As a result, I've now committed to the field in which you are a permanent student: medicine. It also happens to be the longest road to travel. Law school is three years, an MBA is two. A PhD is five, but I will be 30 when I get my MD and will still have my residency before I can prescribe meds without a guarantor (so to speak). I sincerely hope that it's not commitment phobia that makes us all change our minds so soon after school because the last seven months have shown me that medicine is exactly what I want to do. I am thinner, happier, and dare I say it, even a little more grown up.
Interestingly, most of the other post-bacs here are concerned over their ability to become physicians. While I have my moments of doubt (especially about the MCATs), I far more concerned over my ability to follow through than to pass organic chemistry. My worst fear is not rejection from medical school, it's inability to commit to a path. To accept reality for what it is, rather than what I want it to be.
I keep a book of things I want to do before I expire. It's not a morbid book. It's meant to remind me of the fun things I dream about and encourage me to take new adventures. I glue in pictures of the things I want to do and then glue in photos of things I've done. There's also a world map in the back with dots on every place I've traveled to.
Now, I'll come back to my book in a moment, but did you know how many esoteric lists of things to do before death are out there on the web? A few of the more unusual ones...
300 Beers to try before you die
50 Things to eat before you die
20 Hamburgers you must eat before you die
50 Places to flyfish before you die
5 Sentences Before you Die
101 Sex Tricks to try Before you die
So what's on my list? Here's a little sample of what I haven't done, but want to:
Be published nationally, own a dog, own Wellies, own a horse, work abroad, get a graduate degree, ride in a glider, be a teacher, own real artwork, ride in a helicopter, visit India, have my own library, get a motorcycle license, see penguins.
And what have I already managed?
Ride in a hot air balloon, see a solar eclipse, see an amazing band in concert, own superhero underwear, go scuba diving, go skydiving, visit Australia, visit Thailand, visit Russia, fly in the Concorde.
Finals are done and fall term doesn't begin until August the seventh. Accordingly, I find myself with all kinds of free-time on nights and weekends (recall, I now work full time in neurology) and anyone who knows me knows I get a teensy bit stir-crazy with free-time. In an effort to stave off relaxation-induced madness I've been exploring and I thought I'd show you some oddities from about town.
First, there was this sign outside a church. Apparently they are running out of ways to attract new parishioners and have resorted to a) declaring themselves cool, which any actually cool person/thing/activity would never have to do and b) advertising the presence of air-conditioning.
Then, there was the man with the pigeons all over him. Why would anyone want pigeons all over them and why is he wearing a suit when it's a million degrees out?
Inspired by the heat and for lack of an appropriate beach, there was this gem: a sandcastle being built on the sidewalk near the University. 
And lastly, you know you're in a college town when the supermarket stocks up on back-to-school pong balls.
Identifying information of persons mentioned in the blog have been altered to protect their privacy. This includes, but is not limited to, age, gender, race, date of visit, date of death, etc.
This blog is for entertainment only; please do not use it to diagnose or treat anything. I'm not an MD (yet) and may be wrong.
If you have questions or comments, feel free to comment on the blog posts or email me at webster.sm12@gmail.com.
Enjoy!
For those of us lucky enough to be in summer classes, today is the first day of finals week. For those of you that have completed the collegiate phase of your life, you'll remeber this was the week you didn't get to drink. For me, this breaks down to: Neurochem tonight, Cellular Biology Wed night, Chem lab II Thurs morning and Clinical Research Thurs afternoon. Three days off... then my brand-spanking-super-fantastic new full-time job kicks off.
Because my brain is completely full and there's nothing I can write to make arcuate nucleus/paraventricular nucleus control over feeding behavior interesting to someone not already interested in neurochemisty... I thought it would be amusing to analyse the behaviors of post-bacs studying for finals.
# of libraries open on Sundays in University City: 1
# of post-bacs I spied from my one little chair in said library: 11
# of them who brought communal home-made gingersnaps: 1
# who bought snacks/lunch from Wawa: 11
# places besides wawa to get food in the vicinity: 0
# strange people with suitcases and smelly curry: 1 (not a post-bac)
# of med students in the medical library: 1
# undergrad TAs called into the library: 1
# cups of coffee consumed by post-bacs that day: lost count
# ice creams the girl I studied with ate: 2
# ice creams I ate: 0 (really!)
# text messages I sent while "studying": 23
# "quickies" I had between the stacks for stress relief: 0
# times I had sex that day/night for stress relief: none of your business ;)
Good luck everyone!
A day of teachable moments in the ER...
A patient was helicoptered into our ER from another ER (why is not exactly clear) with a stab wound to the left chest caused by a screwdriver. The patient had marked jugular distension (bulging neck veins), extreme hypotension (ie, no blood pressure), and muffled heart sounds. What does this (Beck's triad) of symptoms indicate? Cardiac tampenade!
The patient was bleeding into the sac around his heart (the pericardium) and this was putting pressure on the heart itself. Since there is no space around the heart, it cannot expand when filling with blood, limiting the volume of blood that can enter the ventricle. This means less blood is being pushed out with each contraction (decreased stroke volume and thus low blood pressure) and a build of of venous blood in the neck (think of a traffic jam in your superior vena cava).
To treat this particularly life threatening issue, the blood is drained from the pericardium while stabilizing the patient to get them to the OR. This draining procedure is the pericardial centesis and they performed it on the patient twice.
Had the patient been registering a blood pressure, we probably also would have seen pulsus paradoxus: a 10 point drop is systolic (top number- ventricular contraction) blood pressure on inhalation (breathing in). When you breathe in you are actually expanding your chest to create a highly negative pressure (4x less that the atmosphere) inside your lungs. This pulls air into your lungs (goes from high pressure to low) but it also helps pull thoracic blood (blood in your torso) back towards your heart. The thing is, if your heart can't expand because your chest is filled with blood, then filling the right side with venous blood leaves very little room on the right side for oxygenated blood coming from your lungs. Thus, even less blood is pushed out of the left side on contraction and you have an even lower blood pressure.
The trouble with working in the ER is that you don't "follow" your patients. He was alive when he got to the OR, I have no idea if he still is.
18:05 shift starts and all I have to start off with is three domestic violence screenings. In the process though I meet a very friendly third year med student.
18:30 checking the board for patients when a dr. comes and shows me a right wrist fracture on x-ray
19:30 finally consented a man for the cardiac study after trying to wake him for half an hour. Had to bang on the bed and even then he kept falling asleep in the middle of sentences. Chronic cocaine abuse, but seems to think quick highly of himself. Seems to think I would be fawning all over him if I'd met him in the hospital..hah!
19:50 dr. showed me cardiac man's EKG, unremarkable.
20:02 finally get to sit down for a minute to eat the food we ordered. Chicken kabobs with pita and tabolae salad.
20:25 processed cardiac man's bloods. Got 26 crio vials from the four tubes, takes about an hr to get through.
21:30 another round of domestic violence screenings to do...I've got seven so far, that's how many you generally get in a whole shift. This time I did one with the docs in the room on a 17 yr old pregnant girl. She's not the youngest pregnant I've seen either, record sits at 15.
21:41 Sophie whips out the MnMs - she's always got goodies :)
22:00 cardiac man is asking for even more juice (carton #6?) and is now claiming to be a singer/songwriter/politician/filmaker. Annoyed that dr won't give him Percocet so asking for a new dr. No doctor here will prescribe it (note in his file) so med student pretends to be a second opinion and denies him Percocet.
22:30 doing a domestic violence screening while playing swords with a woman's son. Apparently McDonalds now has inflatible swords for Pirates of the Carribean.
22:40 played patient advocate for some patients whose nurses had gotten busy; it's one of the side jobs, being able to help people by making sure they get the attention they need.
22:45 trauma alert went off for an incoming assault victim. ETA, less than 5 mins.
23:30 assault was pretty nasty - hit with bricks and planks by multiple assailants while trying to protect his father. Swollen and cut all over, still in his collar.
23:35 cardiac man is being transferred to a rehab facility because "to have a serious music career you really have to be clean. It's the Beatles, they brought all the drugs to the music. That's why they killed John Lennon, they were afraid people would follow him over the President."
23:55 wrapping up the paperwork and cleaning up the desk. Quick chat with the med students (they're pretty and have more time to be social). Should be out of here on time tonight, which will be a welcome change
Since so much of my (recently sparing) writing involves the hospital or class or some form of medical research, I thought I'd take a moment and reflect on the small corner of my life that is everything else (aka a life).
My parents trekked out here from LA to come and spent the fourth with me. I haven't seen them since last October, so the visit was welcome and singularly well-timed since I had just completed my midterms. They brought a heat wave with them, which was particularly tough on my mother when combined with the humidity so we needed some air-conditioned time. This was easily solved with a few boxes of hair dye - transforming me into a brunette became my mother's two-day project. We managed to find great seats for the fireworks, though we were less than impressed with the Lionel Richie concert (it's elevator, put-on-hold music). We also found the best Indian food this side of well, the globe, at Cafe Spice. Yum.
I have landed myself the coolest job ever as a clinical research associate in pediatric neurology where I'll be working on pediatric stroke and other cerebral vascular disorders. I'm really excited about it and with some luck and diligence I might be celebrating publication sometime in the next year and a half.
I've reached the six month mark with my "significant other" - a time span that simaltaneously feels like an era and a second. Next milestone, his birthday. Thankfully I have until September to think and rethink my gift selection.
My brother is off galavanting through Italy and my friends have all migrated (or are migrating to) California. I have been feeling the call of the West lately... though I shall have to put CA on hold until at least Christmas.
Right, I'm out of interesting tidbits... time to work/watch Netflix movies... fill in procrastinating activity here.
MoyaMoya is a cerebral vacular disease occuring most frequenting in Asian populations involving vascular occlusion (blockage) in the basal ganglia. On some occasions the brain grows many small vessels around the occlusion in an attempt to compensate for the decrease in blood flow, while other cases require cranial surgery.
This is one of the diseases I'm becomming familiar with now that I'm working in pediatric neurology research (yay!). The image below is from Hawaii and shows the occlusions fairly well. The image work I'm doing actually produces 4-D scans of the vascualture and allows us to calculate blood flow and velocity to different regions of the brain. 
On a different note, we had a 186kg woman in the ER the other day. That's 410lbs. That's substantial.
When we covered Acetylcholine (Ach) in neurochem one of the disorders we discussed was myasthenia gravis (MG). MG is an autoimmune disorder in which your body produces antibodies that block the Ach receptors of the neuromuscular junction. What this means is that when a nerve cell releases Ach to initiate muscle contraction, the muscle cannot receive the signal. The most prominant symptom of the disease is catalepsy (the inability to initiate voluntary movement).
The video (click here) shows Bella, a small dog, who has MG. Initially she cannot stand up and when the vet administers a blink test, she shows no reaction. The vet gives Bella some Edrophonium chloride, a drug that temporarily increases Ach tone. Subsequently, Bella can be seen running and reacting to the blink test until the medication wears off (it's called a Tensilon test). Bella is now on Pyridostigmine, a longer acting drug that also increases Ach tone, and has 75% of a normal dog's ability.
Being a pre-med, post bac otherwise, is about as far down the proverbial ladder as you can find yourself. You are highly motivated to do something, but qualified to do nothing. The goal, when in the hospital, is to stay busy. Maybe even be useful occasionally. And to try not to be demoralised by the looks you get when you inevitably reveal that no, you're not a doctor and no, you can't treat [insert condition here]. It's the coats and ID badges, it confuses people.
A recent shift made all this very clear to me. For the first three hours nothing much was happening (in the post-surgery ward), but we were down two staff members, making those people with qualifications a tad overworked. That meant all the "comfort" care-taking fell to me and I was excited. I was busy. Really busy. Fetching juice, water, ice, gowns, blankets, paperwork for admits, answering phones, etc. Then it started, the after-dinner potty rush. None of the RNs or CNAs had time for this, so I spent my night rushing around putting people on the potty and into bed and cleaning up after the process. What's interesting is how thrilled I was to be doing this: it's about as close to doing something actually medically useful as I'll ever get before entering med school.
The it happened. Respitatory distress. A patient's O2 sat was in the 70s and not rising. Everyone was crowding into the room trying something. I was paging respiratory and medicene. Then came the discovery that we didn't have a continuous pulse ox, so I was calling every floor near us to borrow one. When I brought it back, the resp guys were there (the medicene consult would take another 40 minutes) and they let me stay in the room while they did their assesment (the family was kicked out). The patient had had a tracheotomy but was accumulating fluid and had to be constantly suctioned. Medicene came and did their own exam. We found our pulse ox. When I got back from returned the borrowed one, the Ear Nose and Throat (ENT) team was there. And when I say team, I mean TEAM. They brought a small army, all in matching green scrubs and surgical hats. They ate all the cookies, they crossed their arms and looked stern. They bantered with the medicene guys, but in the end, they didn't actually do anything as far as I can tell. The patient was to be moved to the SICU or MICU (intensive care units) where there are more monitors and more RNs/MDs per patient. Patient's O2 sat was climbing slowly. Crisis averted.
Time to put the remaining patients to bed and answer all the lights that had been ignored for the last 80 minutes. I go to help one of my favourite patients, we'll call him Dr. Doolittle, to discover that the charge nurse had kindly brought him a tape player and a book on tape over the last week. She brought him the New Testament on tape. He's Jewish.
... and I had a lot of blog pieces floating around my head, but none of them seemed to make it out into cyberspace. Maybe I was too busy studying my chemisty and cell biology (exams today and tomorrow) or maybe I was too busy indulging in birthday fun (yes, I'm 24 now), but most likely I was just too busy living my life to write about it.
So, instead, the highlights...
There was a patient in the ER with a 108 degree fever suffering from heat stoke, I had my first positive domestic violence screening, a man with a cable through his eye, a boy whose father brought him in after beating him, a 28 year old boy rejecting his second stem cell transplant for Hodgkin's lymphoma, and my first baby ultrasound.
I had a whole post planned on the new Treasury secretary, former Goldman Sachs CEO Henry M Paulson, and how his new job is nothing more than PR. I was intending to put the short version here, but it's still a good post so maybe I'll still write that one. It will just be a tad less timely.
Last night I got my first taste of the thick skin I assume to you need to survive medical school and life in a hospital. It's emotionally tumultuous and on a bad day it's hard to remember that (hopefully) in the end you do more good than bad.
Before my shift we had a 4 hour orientation to the research studies going on in the ER at the moment. Three of them we were already trained on, so it was a complete waste of everyone's time. The fourth was announced as a go-live today, so basically myself and the other associate on duty were expected to march into the ER with the (unedited) forms and just start enrolling. It wouldn't have been a problem if the forms had been designed for a hospital site (as opposed to outpatient clinic) and the PI knew that cardiac patients (her most interesting population) were off-limits because the coronary studies would get priority.
Confusing and draining.
Ok, so paperwork isn't that bad and it can all be figured out. And you can catch up when the board is messy, even if you do feel a little disorganised. And you can eat enough graham crackers to stop feeling like you're going to keel over. But what's rough is when your patients keep telling you they don't want to talk to you, or enrolling and then withdrawing... or the nurse loses/throws out the blood you need.
Frustrating.
But then you lose a patient because they walk out of the ER against medical advice and your standing there with the EKG and you know that person really shouldn't have left. Or you do a domestic violence screening and the woman breaks down and tells you all about her monster of a husband and how she's trying to divorce him, but he's lying to the courts about her. Or your neurocog patient who doesn't finish the tests because they are in head CT and on their way up for neurosurgery. Or the kid who fell off his bike and can't stop crying because he can't remember anything. He looks at his hands if they're unfamiliar and his face is splotched with the bright pink of skin that's been torn off.
Heartbreaking.
Just as your finishing all the paperwork and spinning last bloods two doctors come up to you. One gives you a lecture on not approaching the patients too early and potentially causing double sticks. The other looks at your forms and says "What are you still doing here? What? What... you want extra credit or something for staying late?" No. No, I don't. I just want you to fill out the damn form so I can go home.
Maddening.
The next morning you wake up and find an email waiting for you... be sure to approach the patients early so as to get the bloods you need... copied to the whole damn world.
And we're back to frustrating.
Despite the whining... I love it there. Thursday nights are the best part of my week. If I could stay until 2:30 am every week, I would.
This week on the surgical rehab floor I learned a little about bowel programs, something you've probably not thought of if you've never spent time in a hospital. The nurses spend a fair amount of time monitoring how often and how much you urinate and empty your bowels. There are even special chairs for this. Nice white plastic contraptions.
Almost as soon as I arrived for my shift a nurse called me into a patient room and asked if I would sit with the patient while he moved his bowels as it was taking some time and he had meds to attend too. So I sat there on the bed and tried, really tried, to have a conversation with this (not so lucid) patient between his gripping the chair sides and squeezing his eyes shut... wow, he kept saying, oh wow.
When the nurse returned I was informed the patient was severely impacted and had just been administered a supository (a butt pill). Apparently this wasn't sufficient because despite the groaning nothing was actually leaving patient's colon. Out came the maximum strength enema and another 20 minutes of sitting. Nothing.
At this point the nurse gave the patient a shower and decided to just put a diaper on him and call it a night. Problem is, the patient can't stand unaided, so I was recruited to pull the diaper up over his butt while the nurse held him up. It was this moment that the patient experienced some anal leakage (and bleeding). Nevertheless the patient was transferred to bed and the nurse and I cleaned up.
About an hour later the patient was caught trying to get out of bed (a no no since he can't walk). When questioned what he needed he expressed the need to "take a crap." The nurse was called in and the patient examined, but he was still unable to expell the impacted feces. At this point the nurse asked me to fetch some lubricant (can anyone guess where this is going?) which I brought back with some extra pairs of gloves. The nurse then proceeded to lubricate the rectum of the patient and break up the large, very solid mass lodged in his colon. Thankfully I was called out of the room by the other nurse on duty...
... only to find I had been called to another bowl issue. the first patient's neighbor was experiencing an unexpected bowl movement and needed to be placed on his toilet and washed (a process I assisted more than carried out since I am not a nurse). When I took the used toilet to be disposed and cleaned I saw what looked like a large orange hairball inside. This of course had to be brought to the nurse's attention.
By the end of the shift all bowels had been sucessfully moved and the smell on the ward confirmed it. As did the stack of brown gloves in the trash. Eew.
Tagged and I'm it. Apparently the idea is to mention 6 odd things about yourself so here we go, six strange things you (probably) don't know about me:
1. I change into my pajamas when I'm at home, even if it's the middle of the day. It's a habit from a college roommate, but seriously, what's more comfy than PJ's?
2. I'd rather buy books than borrow them from a library; I just like owning them.
3. I'll put things into my agenda even after they've happened. That way I can look back and recall the night I went spontaneously went to drinks with so and so was Wednesday, not Thursday, for example.
4. I don't like ice cream cones. Give me a cup anyday. Or better, yet, the carton.
5. I sing in my car, when I'm alone. The top-of-my lungs, Carnegie Hall performance kind of singing, even though I couldn't carry a tune if you put a gun to my head.
6. I find it incredibly uncomfortable and nearly impossible to sit properly in a chair. I need to have one leg folded under me, be crosslegged, something.
And we have come to the end of the first week of summer session: all 4 classes, two tutoring shifts, and 16 hours in the hospital. And it was fun! I'm not being sarcastic here, I've definately taken on too much (par for the course) and I simply won't drop anything because I can't bear to give any of it up. Some highlights...
- In NeuroChem when the professor went over the finer points of cocaine delivery via snorting vs. freebasing and the resulting bioavailability curves.
- In Chem lab when the professor spent 20 minutes belittling post bacs and then mentioned that we'd likely have the highest grades in the class by the end.
- In tutoring (my job) when one of the students (veterans) told the head of the program I was inspiring and he wanted me to be his math teacher.
- In the post-surgery rehab ward when I had to take a patient (in a wheelchair) down to the front to smoke. Do you have any idea the looks you get when you ask a stranger for a lighter for the old man in the gown in the wheelchair while wearing a hospital ID and jacket?
- Realising I cannot get consistant readings on an electronic scale. Seriously, how did my crucible spontaneouly lose 2g?
- Watching the Emergency Room doctors treat a quadruple gunshot victim and then being sent to pick up their chinese food.
- Showing up to cell bio/biochem and realising everyone (practically) I know is in the class... and that it's moving to the coldest room on campus. I'm going to be wearing wool sweaters every Wednesday in the Philly humidity to avoid hypothermia.
- Having friends over Friday night for a cozy dinner and being able to congratulate Audra on getting into GW... way to go chica!
- Two lazy weekend mornings. Sleeping in, eating pancakes...
- Making to the movies... MI III is entertaining, Da Vinci code not so much.
It was my first night on the ward I am volunteering on in the hosptial and to my surprise, I actually managed to remember the CNA, RN, etc names! The patients were really interesting, some of them have been there for quite some time and I don't think there was a single one under the age of 50. A couple of guys in one room were rooting for opposing teams in the basketball team, which made for some fun conversations and light hearted smack talking. A woman with a leg injury was hell bent on seeing the baseball game (Mets -Philles) but it wasn't on any channels in the hosptial so we went searching everywhere for a radio.. more fun that it probably sounds.
On the unusual side there was a woman in a helmet whose brain was exposed. She had an edema and they couldn't close the wound (thus the helmet). She was rather large and immobile too so it made everything from changing into fresh gowns to serving dinner and changing bedpans a challenge. There was the 70 year old man with a penile implant... who couldn't keep it in his gown! and the man with a colostomy bag... we had to change it, well ok, the CNA had to change it, and it ended up spurting everywhere! Ick... guess who got to help clean ; )
Monday brings the beginning of summer classes and my job, both of which are exciting, but the 12 days in between have been really relaxing. First I had orientation for my job and it was one of the more inspiring few hours I've ever witnessed. I tutor veterans who want to try and go to college and one of them talked about how he wanted this so his kids would be proud of their dad and would know that they could go to college too.
After orientation was Audra's BBQ, which was a fun and relaxing outdoor yumfest. Best moment, Taner scooping ice cream for us all :) Or maybe Abi, Taner's HUGE dog, farting in the car!
I spent a few days in NYC where I saw David Blaine underwater - he was living in a human fishbowl for eight days. I saw the Natural History Museum for the first time too... and recognised all the words laid into the marble floor: gnathosomes, tetrapods, amniotes...
Back in Philly was a fun trip to Ikea to pick up furniture... I'm still a little weirded out by owning furniture. They had a big tub of blue balls to play in, which made everything better... that and the ice cream cones :) 
And now... my fridge isn't working and I need to go and buy my textbooks. Yup, I smell summer session approaching.
I just took two exams; you get 10 questions. As per a reader's request, I will not post the answers in the comments, you can :)
Q1. What is anhydrobiosys?
Q2. What is parthenogenesis? (hint: check a previous post)
Q3. What is necessary for the activation of a cytotoxic T cell?
Q4. Name the three phases of the uterine cycle and the corresponding phases of the ovarian cycle.
Q5. What are Leydig cells and what stimulate them/ do they secrete?
Q6. Name, in order, the regions of the stomach, small intestine, large intestine and their sphincters.
Q7. What is the common name for Nematoda? Nemertea? Which is segmented?
Q8. Name one difference between bacteria and archea. Which is more closely related to eukaryotes?
Q9. Name, in order, the parts of a nephron.
Q10. What hormones does the adrenal medulla secrete? The adrenal cortex?
Extra Credit: Write the bicarb buffer equation.
... on Tuesday.
As the elevator car left our floor
Big Sue caught her tits in the door
She yelled a good deal
But had they been real
She'd have yelled considerably more
Nymphomanaic Alice
Used a dynamite stick for a phallus
They found her vagina
In North Carolina
And her asshole in Buckingham Palace
A gem I found while cleaning my desk... procrastinating during chemistry revision...
Proof that Girls are Evil
Girls = Time x Money
but... Time = Money
so... Girls = Money ^2
but... Money = rt(evil)
and... Money ^2 = [ rt(evil) ]^2
substitute and reduce to get...
Girls = Evil
The lab exam was not nearly as fearsome as I had, well, feared. Two questions per station (some with four parts), 20 stations, with a mixture of anatomy and theory. Rather than describe what was going though my head... here's your very own, mini lab quiz:
Q1. The two organs clearly visible in the above dissected shark are...?
Q2. Name the phylum of the animal above and two shared derived characters of that phyla.
Q3. The red tube above the white globules in the above dissected rat are? Is this rat male or female?
Q4. Mitochondrial DNA IS/IS NOT highly conserved and is this useful for exploring evolutionary relationships between RECENTLY/DISTANTLY diverging species?
Q5. The dull blue feather looking organ in the squid above is the ______? What phylum is this animal and what kind of circulatory system does it have?
Q6. If ANF was being released in your system, you would have (choose as many as apply):
a. highly concentrated urine
b. inhibited ADH
c. increaed urine volume
d. increased Cl- in the urine
If you want the answers, check the comments.
Yes, we've hit that wonderful time in the semester when the sun is finally out and the whole school is holed up in the library cramming as much information into their heads as possible. I am reasonably lucky, no back to back exams this time through... but there are a lot of points in the air and well, I could use them all.
We have a bio lab practical this Saturday, which involved such ridiculousness as looking at a 16 hour old frog embryo and naming the number of cells and their configuration. Or looking at a dissected fetal pig and finding the salivary glands (harder than you might think). A week later is the third exam and final (together)... Why are the antibodies passed through breast milk (IgA) temporary? What's the difference between Nemertea and Nematoda? Anyone... anyone?
I'm not even thinking about chem yet (which may or may not prove harmful)...
I got my starting date (May 9) for the weekly hospital gig though... hopefully that will provide some amusing anecdotes.
This was a quickie dissection, a kidney, done in the midst of a renal function lab. What this entailed was urinating at 30 minute intervals and measuring the chloride concentration, specific gravity, and volume at each urination. Groups of five people each participated in a different "treatment" condition (salt, caffiene, 1000mL water) and the idea was to see what different effects these would have against a control (200mL water). Unfortunately our control group (myself included) was a complete mess so our results were essentially "we knew what should have happened..."
If anyone should be under the impression that "oh, you did something remotely medical", well, you're wrong. What we did was play with our own urine for three hours in a warm room next to preserved kidneys that reek of formalin having not eaten for several hours (requirement for the lab) while watching a beautiful sunny Saturday float by our lab room window. There was no diagnosis, no puzzle to solve, and I'm pretty sure we violated HIPAA (lab results being considered protected health information).
Normally I love lab, but this is one of those things that sounded better in someone's head than in real life.
Our most recent biology lecture was on the always thrilling topic of renal function, which means kidneys and peeing. Now, our professor is welll-known for her eccentric stories; the one about catching frogs to feed the ducks was a gem. So was the frozen snakes for curtain rods. Well, during renal function she discussed potty training and how she made a bet with her husband that she could have their son trained by his first birthday. That didn't quite happen. Since she lost the bet, she had to drink urine, not only that, but drink it in front of her class. So yes, my biology professor whipped out a bottle of yellow fluid, told us she lost the bet, and took a few sips. If it was anyone else I would assume it was apple juice, but no, with Dr. W, it was definately urine. Wow. I mean ick.
Oompa Loompa Doompety Doo
Here comes neutralization part deux
Oompa Loompa Doompety Dee
A chapter about soluability...
What do you get when you stir in a salt?
At K s p dissociation halts
Use the a + b root to find the s
Get K e q with help from Hess
It's just another M R A...
Oompa Loompa Doompety Da
Use M R A and you will go far
Now you can find the I P too
Like the Oompa Loompa Doompety Doo!
Oompa Loompa Doompety Do
I've got a neutralization for you.
Oompa Loompa Doompety Dee
If you like chemistry listen to me...
What's the p H mixing acid and base?
How much H F reacts with the O H?
Neutralize half, it's a buffer you'll get
Now p H is pretty much set
Oh! But it's still basic...
Oompa Loompa Doompety Da
Strong acid strong base with moles on par
It will have p H seven too
Like the Oompa Loompa Doompety Do!
The originals.
Lord Melvyn Bragg has written a book entitled Twelve Books that Changed the World and the BBC now was a forum asking readers what their selections would have been. The criteria loosely translates to: books that changed the world to that in which we now live. He included selections from Charles Darwin, George Orwell, and Adam Smith, among others.
Many of the public responded with the Bible, a few with Albert Camus, several with Ann Rand, and many concurred with Orwell, but one notable member of the public, Mark Keen from Swindon, submitted the DaVinci Code. He has got to be kidding. I mean seriously. I like my insubstantial fiction now and then just as much as the next person, but what exactly is true about the post-DaVinci Code world that was not true of the pre-DaVinci Code world? Upsetting the religous community and constantly being in the press are not world changing qualities, or else we would have to include TomKat and Lindsay Lohan as world-altering figures. Please.
On the American side of the pond the New York Times magazine has an interview this week with Bonnie Fuller, the editorial director of American Media. I won't even go into the appalling book she's recently written titled The Joys of Much too Much but instead will mention the transcribed statement "I guess I am registered as a Democrat. I guess, because you have to register?" How exactly did this woman become editor of some of the most widely read women's magazines? Granted, Glamour isn't exactly a hot bed of political debate, but even they put "register to vote" as a "Do!" And shame on the New York Times for called Ms. Fuller "a symbol of female accomplishment." We can do so much better.
All I can say is... brilliant fun! There is a team in the hospital responsible for transporting inpatients between their rooms and various tests (ie xray, ultrasound) and back or discharging them. For my last five hours of training I shadowed this team and ended up spending lots of time with several really interesting patients.
Easily the most interesting was a man who had heart problems and a severe buildup of fluid in his legs (preventing him from voluntary movement). He was a very nice man and we chatted for nearly two hours while we got him to xray and had four chest films taken ( they blew the tube in the xray machine due to the high dose of radiation) - he told me all about his godsons, whom apparently I would quite like as they are footballers (read: soccer) and are 6'3'' and 6'4'' and very handsome ;) After we finished he wanted to stand up and re-adjust his gown and his placement on the bed so we helped him stand up (he farted) and as soon as he was up ... "did you bring the bedpan? I really need to pee!" Of course, we hadn't brought the bedpan. By the time we made is out of xray this man had three radiologic nurses and three transporters attending to him.
The first transport of the day was a woman who had come in through the ER and needed an ultrasound. We arrive with a stretcher and the doctor stopped us in the hallway, "she's not going to fit on that." Apparently there are oversized beds we can use for, well, oversize patients, but they are a huge pain in the butt because finding one in the hospital is tough and you have to dissassemble the arms to get them through doorways. "you can try, she must have been on one in the ER, but... good luck." Try we did, and managed it too. Luckily she was mobile and could walk over to it herself (it would have taken a 4 horse team to lift her) - this woman was EASILY the largest human I've ever seen in person. Her boobs were at her belly button, her arms were bigger than my hips and her ankles were the size of my head.
The whole experience has made me quite excited for my time there. Maybe after the summer (I'm registered for far more courses than is advisable) I'll see if I can get a job in the hospital. One that pays.
This dissection was the toughest yet: finding the neck glands of the pig was next to impossible. It was also slightly disturbing to crack the ribs when we folded the sternum back to poke around the pericardial space. The anatomy was incredibky similar to what we learn in human physiology though, so it was also intensely interesting.
The liver was noticably less fatty than in the shark, but most of the organs were the same colour in the pig, making it harder to differentiate. There were also many more peritoneal membranes so the dissection technique was understandably more prolonged, involved, and cautious. In fact, my partner and I were the last ones to finish and we didn't quite get our eye done correctly, but we'll be doing another eye later in the semester, so I'm not worried. I will say, that what we did manage to complete was quite well done (if I may say so myself) and we destroyed none of the organs in the process. We were even able to differentiate some of the major musculature in the pectoral region.
We had an exam and a lab quiz immediately prior to dissection, both of which went well. I think I managed to keep my special connective tissues and my stratified squamous epithelia straight :)
Without a doubt the coolest dissection yet, especially because our TA returned (there was a sub last time) and there was no lab quiz. We dissected the dogfish shark, right down to cutting open the skull and stomach. The stench was, well, it was powerfull and there was definately some projectile sperm while examining the male reproductive organs, but for the first time you could really see the homology between the dissection subject and well, our future patients.
The liver was stunning. Not because it was elegant, but because it was huge and so luxuriously slimy. Since it's largely lipids it has this sleek sheeny texture. The kidneys were unusual since they are on the abdominal wall surface and run the length of the shark. Even more interesting is that the vas deferns (sperm transport ducts) are on the surface of the kidneys. Sperm travels though the kidneys and then the vas deferns to the seminal vesicles which leave the shark throught he cloaca (think: anus) and travel into the female on one of the two claspers.
Ah... and here's the good bit. The male shark has TWO claspers. What do they do? Well, one of them penetrates the female cloaca, hooks itself in there, delivers the sperm, and then releases. What this means is... the shark has TWO penises. Call me 15, but I think that is... unusually well endowed?
The brain was also the most developed we've seen to date... in three distinct sections. Carving off the skull piece by piece was quite the task though - it took us about 20 mins, but we managed to keep the brain in tact, including all the olfactory bulbs. I did finish the afternoon with rather a long shower though because formaline is such a cloying perfume.
PPD tests are those little bubbles they put in your arm and check two days later to see if you have been exposed to Tuberculosis (TB). Most people in the US test negative, that is, nothing happens to your arm. Well, here's a positive PPD result:
Unfortunately the photo doesn't do it justice. Essentially it's a red, swollen mass of significant diameter (the above is 15mm) that may be within a larger red area (as the above is). If you were to see the arm in profile, you would see that the mass is raised about 5mm from the normal skin surface and they can be sore and sensitive to touch. If you're positive, you'll have a bump like this within 48-72 hours of your skin test placement. Most likely you'll need a chest x-ray.
Just a little medical factoid for everyone.
My two hours today were spent learning my way around the hospital (please don't ask me directions!) - thank god it's colour coded. Then we went over proper wheelchair technique (this involved some highly frowned upon racing), discharge procedures (including mock senarios involving lost dentures), and using the cell phone system (which is linked to the patient management software). It's absolutely mind-boggling to think of the logistics of running a hospital and just as mind-boggling to realise just how much I don't know about medicene. Put another way, I can't believe it's only four years of school before you get the initials M.D. But man, I can't wait for the white coat (volunteers wear navy).
Today's trainer was really cool (read: competent) and the remaining 5 hours under her care are spent actually working alongside hospital staff transporters (people employeed by the hospital who manage and execute the movement of patients around the facility). Someone even mistook me for a nurse today - at least I look medical!
I'm also officially signed up to work 12 hours a week in ER research - yes! This means (for those keeping track) I'm now up to 16 hours a week in the hospital (beginning May 15).
I had my first day of training to be a pre-med volunteer in the hospital. This is supposedly different from being an "adult volunteer" in that after the first 12 weeks we might get to shadow a doctor (resident) or observe surgery. It doesn't matter what the program consists of, I'm just excited to be doing something medical, or close to medical, or at least in the presense of things medical.
Training consisted of 4 hours of: paperwork, learning how to wash my hands, learning to read signs, and learning the topics to be covered in the next three training sessions. The businesswoman in me thinks this could have been accomplished more efficiently.
Thursday I will spend 2 hours learning to use a wheelchair. It should be noted I have worked in two hospitals already. Can't I test out of this? Liability insurance says no. Oh well, it's only another 7-9 hours. Just please, please don't let me end up on maternity. I am one of the few women who wants nothing to do with ob/gyn, pediatrics, or maternity. Unless maybe it was pediatric brain surgery. Or pediatric oncolocy.
Spring break was last week and I spent the first half studying and the latter half in NYC. Lots of good food and good company and now back to the regularly scheduled programming.
On a different note, I've been tagged by TWM (I'm flattered)...
My nicknames: Most recently Little Doktor (in Thailand), most affectionately Mouse.
My hometown: ... in what year? I do love NYC...
My teams: Go Broncos, go Collingwood, go Arsenal.
My theme song: Bigger than my Body by John Mayer & Geek in the Pink by Jason Mraz
My drinks: Vodka cranberry or a good cup of tea
My occupations: Currently: student (again). Was: a banker. Will Be: a doctor. And in the off-season... scuba instructor.
Spare time: Reading, writing, running, goofing off and netflixing (oh yes, it's a verb now).
Guilty pleasure: Pop music while running, Ben&Jerrys in the freezer, dancing around my apartment.
Hiding place: Bookstores. My journal. Libraries. Turning off my cell phone.
My books: Oh, there are so many! A Prayer for Owen Meany [J. Irving], Contact [C. Sagan], A Good Man is Hard to Find [F. O'Connor], Veronika Decides to Die [P. Coehlo]...
My hero:: Angelina Jolie because she doesn't apologise for who she is. My dad because I want to be successful like him, my mom because I want to be able to love like her and my brother because I'd love to always know the right words.
My tags: Miss Akay, Chendaddy, Fabrice ... you're it!
I was sent some more travel photos from my Asia trip by some friends abroad. Two favourites:
Rather than complete another dissection, per say, we did embyonic development this week. A large portion of lab was spent peering through microscopes at 4,8,16,32, and 64 cell frog/chick embryos and sketching what we saw (not nearly as cool as it sounds, and it doesn't even sound all that cool).
BUT, we did get to artifically inseminate sea anenomes! This involved injected acid into the male and female sea anenomes to make them release their gametes. We put some eggs on a slide, then added some sperm (which we activated first) and peered down through 100X magnification as those hyperactive little buggers went worming their way in.
Now, for those of you who are not familiar with sea anenome fertilisation, once the sperm manage to fuse their plasma membrane with that of the egg, the cortical reaction takes place (otherwise known as the slow block to polyspermy). This reaction cultimates with the vitalline layer moving away from the plasma membrane (due to osmotic gradients caused by calcium induced vesicle fusion), a process you can actually see happening. Since I cannot photograph through the microscope, here's a drawing (done by someone in Wisconsin) of what happens:
There is some really interesting research being done on people's unconscious associations between various topics. The most famous is the Harvard race study, but there are lots of them out there (some on less controversial topics). If you want to take any tests that indicate your level of implicit association (racial or otherwise), go here.
The race study involves putting images and words into catagories such as "pleasant" and "unpleasant" as quickly as possible. Much to my chagrin, I found it easier to place positive words into the positive catagory when it was "positive or European American" than when it was "positive or African American". Though, this could also be attributed to that being the last test and so I was getting better at the game itself (but probably more to do with sub-conscious filters). The more interesting question is why do I have these associations? Because I am white? Because of my experiences? Because of some cultural imprint?
It should be noted, however, than humans are the only animal known to be able to override these instinctual responses. My conscious mind can choose not to let these associations govern my interactions or be the basis for my decision making.
Recently I've been listening to Blink, the second book by Malcom Gladwell, on my IPOD. His idea is that the sub-conscious forms some pretty accurate conclusions amazingly quickly and that these surface as our gut instinct, our first reaction. Some of his more specific examples have been fun to meditate on...
Letting people in your room is a bigger step than meeting your parents
The first was that spending 20 minutes in someone's living space tells you more about them on 3 of the 5 personality axes than conversing with them. Those three are measures of conscientiousness, neuroticism and openness to experience. Generally, I think this is about right. It's the same reason you get that flutter of nervousness the first time you let someone you don't know well into your apartment. Immediately, they will realise things about you that you've been able to conceal in public interaction. Are you slovenly? Are you obsessively neat? Do you have a hidden passion for sci-fi novels? Is your place full of mirrors?
Arguing will predict the future of your relationship
The second was the idea that you can predict the potential success of a relationship (the book deals with marriage, but I think this is somewhat generalisable) based on three emotions: critisism, defensiveness, and contempt. The first two aren't a death sentence, it really depends on the context and the ratio of positive to negative feelings in a given interaction. What kills it is contempt. Because contempt comes from a place of superiority and a state of finality. It's a loss of equality and respect; if your friend/partner/spouse tends to express contempt for you when you're arguing, you're doomed.
Being dominant = being sued
The last example was about doctors (nice and relevant) and which ones are more likely to get sued. It turns out, it's pretty simple: people don't sue doctor's they like. The key to being an insurable doctor, then, is to be an approachable and empathetic one, not a superior and dominant one. In fact, dominance was the single most correlated adjective. They took 40 second samples of doctors talking to their patients and erased the content (removed the high frequencies that signal word differentiation) and noted which doctors utilised a dominant tone. Yup, those were the ones who got sued. So, the lesson is, barring gross negligence, being an affable person will reduce the number of lawsuits on your record.
I'm doing a paper on Diffusion Tensor Imaging and the pathology of auditory hallucination in Schizophrenia (as well as a paper on the evolution of cognitive enhancement atypical anti-psychotics for Schizophrenic treatment, but that's something else altogether). I thought you might enjoy some of these excerpts from the research I'm combing through. (Recall the recent definition of screed...)
"...These connections can be catagorized in three principal classes -namely, associational, commissural, and projectional. Intrahemispheric associational corticocortical connectivity in particular is accomplished in general by short U fibers that constitute the local circuitry within a gyrus..."
"... This dephasing produces signal attenuation, which is related to the magnitude of diffusivity of the water along the direction and magnitude of the applied gradient in an exponential fashion. For anisotropic guassian diffusion, the SA is proportionate to e^ [-(H gyromagnetic ratio)^2(gradient duration)^2(gradient spacing - duration/3)(gradient amplitude)(diffusion coefficient)]...."
"...In contrast to more widespread echo planar method, this technique is less sensitive to suceptibility-related distortions and, as with single-shot echo planar imaging, it is fairly motion insensitive...in particular, after an eddy-current correction of the DTIs, which is based on cross-correlation with T2 weighted images. In the in line scan technique, patient motion does not lead to ringing artifacts in phase direction..."
Too bad babelfish doesn't translate for this kind of stuff :) Bonus points for any of you smarty-pants out there who recognised that the second excerpt was related to a mathmatical model for extrapolating diffusion gradients using matrix algebra and eigenvectors (thank god I took diff eq).
And with that, I think I'll leave the library. Word.
Another successful day of dissection - this time we cut open earthworms, squid, and crayfish. The crayfish and squid were preserved (read: smelled awful!) but the earthworms were fresh (read: alive). Yes, you are reading that correctly, we did NOT kill our worms before cutting them open so we could watch their (five) hearts beat. We did, however, anesthetize them in a beaker of 40% ethanaol (don't do this at home, by anesthetize I really mean kill slowly while it thrashes around). 
It was actually really interesting and I can't wait for the sharks (our first vertebrates) we do this Saturday. If you're a curious and strong stomached type, you can follow along with the dissections on a special Flickr group Audra and I set up. We tag the anatomical structures on the photos as well (good practice for the lab practical exam in April) so you'll have some clue as to what you're looking at.
Something I've learned: A screed is a long, monotonous speech or piece of writing. I've also learned a lot lately on cognitive enhancement and preventing memory deterioration but that's a whole other post (or screed perhaps?).
I just bought my very own domain name! I'm so proud of myself :)
My digital camera will get it's first true test run tomorrow as I photograph our squid, crayfish, and earthworm dissections. I'm so excited about tomorrow's lab, it's unreal.
A great little ode to how hard it is to find those jeans you live in; by a fellow TWM alumnus.
Jon Stewert will host the Oscars and in a recent NYT article he was the only one who seemed to have any real perspective on the matter. Or rather, appropriate lack thereof. As he says "This is a reward. If I made my living hosting awards shows, then this would be a perilous track, I guess."
The new Mendelian genetics: ww = wizard.
Not just naming stars, now you can have your very own slime mould beetle species.
"I think right now we’re in an anti-intellectual period in the United States, but I think the pendulum will swing back in the other direction again." An interview with Alan Lightman, scientist and author of Einstein's Dreams.
Ecology lab may have been a complete waste of time but invertebrate lab was brilliant. We did our first dissections and observations of sponges (Phylum Prorifera), Hydra (Cnideria), flatworms and tapeworms (Platyhelminthes), and sea anenomes (Cnideria). We watched some of them feed (carniverous) and as a result, here's what I learned (other than preservation fluid is about as sweet smelling as smoke in your hair):
- Planeria (flatworms) eat via an extrusable pharynx which is located in the middle of the body so it looks, well, it looks a tad phallic. Anyway, the worm grabs onto it's prey, pulls it close, and gets its digest on.
- Sea cucumbers eat by vomiting up their guts, which encase the prey, and then "eating" it all back in.
- Medusas (the jellyfish-looking stage of a Hydra) capture their prey with stinging nemotocysts (which ejacualte from the ends of the tenticles and look like sperm when stained on a slide) and then stuff it into their oral cavity. We fed our Hydra some little guys called Daphnia and when they are being consumed you can still see the little red Daphia eyes through the milky coloured Hydra.
It should be noted we were doing all this through microscopes (except for the sea anenome) as most of these animals are just milimeters in length. Seriously cool. Next week we're scheduled to do either squid or comparative embyology, I'm not sure. Either way, seriously cool.
Had a good night out last night, the first real one since... since the one with the pictures. A huge group of us converged on the Continental and had really yummy food after waiting 2.5 hours for a table (crab pad thai and lobster mac and cheese). The wait wasn't too bad - cocktails in the rooftop penthouse (glass enclosed) area... they had Pimms! Which was deliciously mixed with champagne and orange juice and oh, yum! We hit up Fado later in the night and I got to dance a bit, which I love to do. I think the hangover means pancakes for breakfast though.. yum.
Granted, Cheney can't be charged because of hunting laws and it *might* have been an accident, but did Whittington really have to be hauled out of bed to express his sorrow for what the VP is going through? Excuse Me?! What the VP is going through? And why are people (Bush included) giving him kudos for calling it his fault and expressing regret? Duh, it was his fault (how many politicans does it take to pull a trigger?). And expressing reget is called taking responsibility and should be expected of all people over the age of 12, the VP included.
Cheney's is not the only baffling behavior of late though... yesterday I was in the ladies washroom and found a Frnech girl pacing around talking on her cell phone. Can she honestly not find a better place to hold her conversation than the bathroom? Whoever she was talking to doesn't mind the continual peeing/flushing noise?
You've got to love the subtelty with which we are parenting the Palestinians now... yes, go and democratically elect whomever you want, but... if it's Hamas we won't give you any aid. Because if we take all the money out and thereby increase the unemployment and destabilise (the already precarious) region, the forces of Democracy will surely coming shining though! Yeah, that's it!
I just finished an ecology lab and can honestly say that I learned exactly nothing, so I'll have to post again later.
There's no way we can ignore this one... the VICE PRESIDENT of the UNITED STATES SHOT a 78 year old attourney IN THE FACE, mistaking him FOR A QUAIL. And this WAS NOT HIS FIRST hunting accident. Yeah, and he's the one that takes over when the President, who chokes on snack food and waves to Stevie Wonder (the BLIND singer), needs another vacation. If you didn't see it, google it on the internet - the Daily Show segment that made fun of this (oh, it's too easy). Have a clean pair of unmentionables nearby because you will piss yourself.
And what was the outcome? Whittaker, the victim, has a heart attack, and Cheney is asked to update his hunting lisence; no charges are being filed. Hmm... unless the guy dies... so the lesson is: if you want to punish someone, take them hunting, shoot them, and say you thought it was a domesticated quail.
I'm sorry, but I can't let V-day slide. I would have, if this had been like all the others, but this is the first v-day I'm not single. so yeah, this time, for me, it was a thing. And he did good. I did come across this funny little ditty though: Roses are red and violets are blue. Sugar is sweet and so are you. But the Roses are wilting and the violets are dead. The sugar bowl's empty and so is your head. C'mon, it's a little bit funny.
Two quick shout outs, and then what I learned in school today...
To Mike O who was in town - it's always great seeing you.
To Audra K - we should have our names engraved on a table in Van Pelt.
What I learned... well, I learned that tenors make their money in their high and middle ranges (think opera), that free energy equilibrium constants are dimensionless (no points off for the wrong units!), and that snails have their anus directly over their head (blame embryonic torsion). Top notch.
Fingers: crossed.
I apologise for the belated best wishes...
Feb 1 - To the best brother a girl could ask for. A moderating influence, a kind soul who always has exactly the right words, a funnyman who always has wit up his sleeve. I am so proud of you and so grateful that we're such close friends.
Feb 8 - To one of the best teachers a girl could ask for. He taught me the superiority of all things Apple, the cultural importance of Say Anthing, and he tried, bless him, to convince me of the benefits of being succinct. I hope that one day I will inspire the same passion in my students as you do in yours (for those of you unfamiliar with TWM, just count the number of blogs wishing him happy birthday and you'll understand).
The sudden time off from posting should testify to my recent work ethic - I've had a chem exam, a BIBB paper, 3 labs, and a bio exam to get through. Actually, the bio exam is this Saturday (so wish me luck). Yes, that was a shameless plug for sympathy (when is the last time you memorised all the prokaryotic, protistan, and invertebrate phyla?).
Anyway, I had an interesting email recently from someone asking about post-bac programs and my decision to undertake this whole new direction considering the current state of the medical community (which was refered to as "rotten"). Good questions all, and they forced me to crystallise what was really just gut feeling when I applied here.
On post-bac programs in general
They are an interesting marriage of undergraduate and graduate school. The atmosphere is more schoolish than graduate work, but the competative atmosphere is a notch undergrad. There is plenty of social interaction, but you will never forget that everyone is here for one reason only: to get into medical school. Studying is the only priority.
You need to know what you're getting into
It's hard to get into a post-bac program without demonstrating that you know what you're in for. I imagine it's even harder to get into medical school without a clear idea of what you expect, what you want, and what you can contribute. Spend some time in hosptials, talk to doctors, read the research - if medicene is what you love, it's incredibly interesting.
The state of the US medical system
Yeah, it's not perfect. Yeah, you have to deal with insurance companies, but what job doesn't have paperwork people would rather not do? There is no perfect healthcare system out there, but if that's what's stopping you, then you're focusing on the wrong things. Look at the amazing things happening in medicene: face tansplants in France, artifical hearts, leukemia as a "livable" cancer... people's lives are really getting better. Or think about all the ways it helps you and the people you love. It saved my dad from cancer, it saved my grandmother after a stroke, it saved a family friend from breast cancer, it reinflated my mother's lung... it saves premature babies, it's the reason you don't have polio... talk about miracles every day.
On sacrificing my life for my career/patients
Anyone who knows me knows that this is not a problem. I probably wouldn't be happy unless I was in a job like that. I am my job, and what better profession to define yourself with than doctor?
Something I've learned...
In honour of the biology test, I feel like this one should come from biology... Rotifers (phylum Rotifera) reproduce through parthenogenesis, which comes in two forms. The most common form involves a female producing more females from unfertilized eggs. In the other form, males and females are produced, but the males are degenerate (can't even feed themselves) and live only long enough to produce sperm to fertilze some of the eggs, which form resistant (capable of dormancy in unfavourable conditions) zygotes.
Something cool that I learned recently...
The serotonin transporter gene SLC6A4 is polymorphic with three distict alleles (consisting of a 44bp insertion or deletion): s/L, s/s, L/L. People with an s allele (genotype s/s or s/L) tend to have lower functioning of the serotonin transporter, which is indirectly associated with depression. Essentially, having an s allele doesn't cause depression, but combined with specific environmental factors (nurture) it is significantly more likely to result in a depressive episode. Unfortunatley, this allele is also associated with poorer outcomes of SSRI (selective serotonin re-uptake inhibitor) treatment; currently the most prevelant drug prescribed for depression.
The first photos from Philadelphia are up on the photostream.
Here's what I learned today... genetically fungi are more closely related to animals than plants. I wonder how vegans feel about mushrooms then (yes, that was a bad joke)? Another surprise: crocodiles are more closely related to birds than lizards and snakes. Apparently this all falls under the lively and vigorous field of systematics (taxonomy using genetic rather than morphological characteristics).
And tomorrow I get to use both morphology and mitochondrial DNA sequencing to try and place my mystery insect into a phylogenic order. Granted, the fact that I get to send DNA out for sequencing is seriously cool, but I just can't wait until I get to start dissections (squid, shark, pig...etc).
Today's insight may not be quite the learning experience yesterday's was, but it's medical in nature and well... I'm sure I'll start seeing this kind of thing in medical school. There's a blog I read regularly by a current med student and this particular post considers a patient with renal failure. Basically, his kidneys stopped working and it had a rather unfortunate effect. The post contains a picture so I suggest you not be eating when you have a look...HERE.
One of the great things about being in school again, especially in
such an exceptionally focused environment like mine, is that you are
constantly learning something new in a field for which you have a real
passion. In order to share some of that I'm going to try and report
one thing each day that I'm learning. I'm not talking about a physics
equation (hey, did you know that force is equal to mass times
acceleration?) or something else so banal, but instead I'll try to
touch on some tidbit at the frontier of what constitutes the
scientific realm. Let me know what you think of these...
Today's interesting thought comes from my recent research in
schizophrenia for my biological basis of psych disorders class (we
call it BIBB: Biological Basis of Behavior). Christos Davatzikos and
team have been completing full brain MRIs of patients with
schizophrenia and have found that there is a significant difference in
the brain volume of afflicted people, especially in the frontotemporal
region. Researchers at UCLA have come to similar conclusions both in
afflicted people and in their relatives (schizophrenia has a strong
inherited genetic componant) and the optimistic implication of all
this is (in the future) would be the ability to diagnose based on
imaging and, assuming the correct anti-psychotic drugs can be
developed, treatment for people at risk before their first
psychotic break (ie, before they become symptomatic).
Davatzikos' paper can be found in the Archives of General
Psychiatry/Vol 62 Nov 2005
The work at UCLA can be found at
http://www.loni.ucla.edu/Research/Projects/Schizophrenia.html
On a more personal, this-is-my-blog kind of note...
I had a real scare with my IPOD yesterday when I couldn't transfer
songs anymore. The same thing happened to Brad's and he couldn't fix
it, so he had to shell out for a new one. I took the radical step of
reformatting it (like wiping your hard drive and reinstalling the OS)
and it *seems* to be functioning now. Thank god.
I had my first chemistry quiz - on enthalpy and Hess's law - but the
grades aren't up yet. Fingers crossed. I also turned in my first
papers for BIBB - on schizophrenia, suicide, and neurogenesis (the
growth of new neurons, specifically in the adult brain). Again,
fingers crossed.
Two songs you should check out:
1. Jacques Lu Cont remix of A Pain that I'm Used to [Depeche Mode]
2. Struggle by Ringside
Life is good.
