Pause for a moment of dissection

I had my first "Wow" moment of anatomy dissection this week. Not to say that other things haven't been interesting or informative, but what I saw this week was really amazing. Part of lab is the expectation that you will complete dissection on the cadaver at your table and learn from the variation present in other cadavers throughout the lab to make the most of the unique experience afforded by our generous donors and to give students a chance to learn about natural variation.

Most joints have nice smooth surfaces, you can see a glossy shine to the cartilage on the bone ends. My table dissected the hip joint and we noticed some degenerative changes at the head of the femur, but nothing which really made me stop and take note. As I circled the lab to see the other hips, knees and ankles which had been opened, I stopped and could not believe my eyes. This knee was matte, dull and had grooves on the back of the patella and the front of the femur. I don't mean little changes of less shiny or grooves you could play back on a record player. I mean you set a cheap ballpoint pen into the groove and it would almost disappear. And there were 4-5 grooves that deep. Amazing, this woman was walking around on a knee (or maybe knees) that was so worn. You'd have to ask an orthopedic doc, but I'd guess that didn't feel very good. As I examined the joint with other students at the table, we tried to find the medial meniscus (your main cushion for all the pounding of your femur onto your tibia) and only a thin rim of it remained at the inside and the back. The only word for the entire joint was wow.

Hermit crab lifestyle

Carrying your home on your back can be hard work. Students of many levels experience this phenomenon, but I think grad students living off campus take it to an extreme. In the age of electronic everything, a number of my textbooks are available on-line which allows me to live out of a backpack and lunchbox. I generally refuse to stay on campus for dinner and try not to return to campus in the evening since I study well at home. Others in my class travel with multiple bags for exercise clothing, other books, breakfast and lunch and dinner, and the variety of other junk people carry around when they don't know when it might be feasible to leave the building. If we really could invent some sort of portable shell which would allow us to curl up and nap securely on campus, I don't think some of my class would even bother to rent an apartment.

Exam results

Results were returned to us on Wednesday and I passed everything and medical school moves on. Grades are returned as percentages, even though they are officially recorded as Fail, Pass, High Pass and Honors. How that differs from an A/B/C/F system, I'm not really clear. You are not "high pass" compared to everyone else, you're just reaching the high pass standard for grades. With this set of exams I am now halfway through my first courses. Most courses are not cumulative for the next exam, but there were two courses that did not participate which are cumulative. (Of course everything is cumulative in the larger sense because board exams cover everything you were supposed to learn!)

In the grand scheme of things, official "terms" have little meaning because EVERY course I'm in continues into the next term. There is a big turnover after the second term because anatomy (including histology and embryo), physiology and biochem end. I'm not sure what comes after that because all the calendars I've been given only go until February, but I'll deal with those when they show up. Studying carries on, hopefully at a reasonable pace so I can continue my grades.

Wake up call

All the little details of fixing things around the house and remodeling can sometimes add up to unexpected fun. The house at school is from 1915 and needs a little work, so K's dad was working here last week while I was studying for exams. We've installed nifty smoke/CO detectors which communicate wirelessly so an alarm in the basement causes the detector on the second floor to activate. Pretty handy when your furnace is in the basement, less so when your chimney is under repair. K and dad had unhooked the chimney on Friday to insert a liner, found out the company shorted them 5 feet of liner and left it unhooked awaiting delivery of the missing 5 feet. Liner still hadn't showed up on Wednesday as the weather cooled with a night time low near 40 degrees. Everyone thought someone else had turned the furnace off and nobody had. 0430 rolls around with an ear-piercing "FIRE! FIRE! FIRE! Evacuate!" (did I mention the detectors talk?) followed by the same message in Spanish, at something like 90 decibels. My exam wasn't until 10a, but I was pretty well awake after that. I guess that's one way to avoid the dreaded oversleeping an exam.

Exams

My first set of exams is this week, one where I have to demonstrate skills on a patient, a cadaver lab exam, an histology lab exam and then the giant written exam. The written exam will cover didactic material from all the courses (see earlier post for list). This exam is six hours long, two fifteen minute breaks and a half-hour lunch break. I'm currently occupied cramming information into my head to attempt more than 70% recall since that is the pass level.

The amazing thing is the collective level of stress in the class. When I'm home, I feel as though I have a lot to study and not enough hours in the day but that somehow I will get enough to do okay. When I'm in the classroom with 124 other people, most of whom need to be peeled off the ceiling, my anxiety jumps from barely noticeable to overwhelming and I can't hardly get my thoughts in order. I've always been receptive to a collective mood and right now my best survival mechanism is to stay away from anybody who appears stressed or overly anxious. These are also the folks who appear to be getting the least done as they run around the building and consult with everyone else in sight.

Hours fly by when I barely even take note of the time and before I know it, another day is gone and I'm closer to the proving ground for classroom material. My biggest interest lies beyond the classroom though, I'd rather be heading for the proving ground of patient care.

Things I miss from before med school

1. My husband.
2. Reading things that entertained me and made me laugh in a good way (not in the current "you've GOT to be kidding me" kind of way).
3. Going to the grocery store or Wallyworld or the mall without trying to decide whether I'm going to stay up late or skip on some required reading. Food, underwear and an occasional pair of shoes are necessities.
4. Time to bake cookies.

I'm sure there's lots more, but these are the ones that occur to me at lunch time on my least busy day of the week.

First weeks: Survival

The information load during the beginning of medical school is massive, my science topics right now include gross anatomy, histology, embryology, physiology, biochemistry. These courses require massive amounts of reading and understanding of relationships, connections and general synthesis of information. The biggest problem is how to acquire all the information AND make those connections in the couple hours a day I'm not in class. One method would be to layout a coherent strategy of rotating through the topics for new reading, review and discussion, but my current strategy is more along the lines of reading and learning as much as I can for the next topic on the schedule then freaking out when I'm asked a question on an old topic that I "should know by now" and trying to emphasize that for a spare five minutes. Rather dizzying to be sure.

Then I've got three other, softer side classes, including one appropriately described as "how to be a doctor". I suppose it is good they require this class because some of the questions asked by fellow students seem to imply they believe they are training to be a life coach, a counselor, a law enforcement officer or something other than a physician. Community physicians come in and work with us in small groups on how to physically perform exams, how to get collect information from patients and then answer all our random questions on the social, business and lifestyle issues of being a practicing doctor.

The program I'm in also includes a large amount of "clinical correlation" which means that every time we talk about a scientific idea, we also get a patient presentation or diagnostic test result or something that would relate that idea to actually being someone's doctor. I can't decide whether I like the amount of it we get. I mean, sure it is great to go through some examples, but when every second or third paragraph in the text is interrupted by "this is why people get tennis elbow" or "clavicular fractures usually occur in this area" or "testicular swelling can cause discomfort", it makes for difficult reading. I know the program is responding to the complaints of prior students about making the information real and this is a nationwide trend, but I'm not convinced yet.

Welcome to campus

So, this was the first week of Medical School, two days of orientation and three days of classes. Orientation was pretty much the only preparation I had for how many hours I was going to have to sit still in a classroom. I can't speak for everyone, but my undergraduate and even graduate education included a number of different classes, scheduled specific days of the week at somewhat random times which allowed for a long lunch some days or an early afternoon or less often, a late morning. The transition from having an active, moving job to sitting still has not been easy. Count me as fully unprepared for what 8 hours of lecture might do to my rear end, my brain and everything in between. Today is the first day I left the building before 5p and I haven't even been studying on site!

We have already started dissecting our cadavers and the good news for me is that apparently I've already killed any negative olfactory response with some of the other odors I've encountered on the ambulance for the past 3 years. The dissection promises to be an interesting experience and I hope I can feel confident enough in locating the structures not to be completely annoyed by the process. We've also been dumped into the deep end for physiology and histology, hopefully I'll be able to get on top of some of the material soon so I feel less than completely lost.

It has been a long time (if ever) since I have felt so out of place and overwhelmed in an academic environment. The only saving grace is that most folks seem to feel pretty much the same way which means I'm not way behind, but ultimately the assessment is based on competence not on a comparison to the other students. I guess the only theory right now is just to keep plugging along and do the best I can.