End of the Maelstrom?

The third week is about to commence and I’ve noticed an evolution in my temperament.

Throughout the first week, I was overwhelmed and drowning in anxiety. Midway through the second week I was at peace with the daunting hurricane of information whirling around, threatening to destroy me.

Now? Serenity.

Well, almost. I’ve regained my composure, anyway. Many people prognosticated this, insisting that I’d feel better once I developed a study groove. I think it’s something else, though. I still haven’t determined which study methods/patterns/routines work best just yet. Rather, I think my brain is reconnecting its old synapses from college. For two years it’s been out of practice, forgetting how to remember. Learning is itself a learning curve, and my brain fell off the wagon. It’s that old neuroscience aphorism: use it or lose it.

In short, my brain couldn’t handle the extreme bandwidth of information coming its way. As time goes on, it’s becoming more “fit” and proficient, so the knowledge thrust its way is more easily accommodated. I feel less stupid.

One consequence of all this is that I have more free time for trumpet. I’m still not certain I can allot 4 (or 6?) hours a week for concert band rehearsals, but the audition is on September 23^rd, and I’m nearly in shape already. The audition piece is a cinch, and really plays to my strengths. It’s a lyrical, expressive excerpt from a piece called “A Hymn for the Lost and the Living.” Barring some unforeseen confound, I think I’ll nail it.

On a side note, I have to wonder to what extent I irritate my housemates when I practice. I always ask them beforehand if they mind (and I make sure they’re not studying), but you never know.

In anatomy, we’ve covered the musculoskeletal/integumentary/circulatory/nervous/lymphatic structures of the back, neck, shoulder, arm and hand (yes, in 2 weeks). Every once in a while, an anatomical term will really amuse me. For instance: hold your hand out and extend your thumb back toward you. Do you see that little pocket of skin formed by the tendons between your thumb and your wrist? That’s called the “anatomical snuffbox.” Snuff, as in powdered tobacco that people snorted back in the day (sometimes out of the “anatomical snuffbox,” too).

Week 2 Recap

Update on the cadaver: None of the initial names I suggested panned out. As a joke and last-ditch effort I threw out the name “Bertha,” since it’s a tired, cliché term for any large person. To my chagrin, the rest of the group was very enthusiastic about the idea, so it stuck. Bertha.

Apparently Bertha died at the ripe old age of 83 due to ovarian cancer, Alzheimer’s and COPD (chronic obstructive pulmonary disease). Many of the cadavers—since they’re mostly old folks—died of “failure to thrive.” That seems to be the medical phrase for “old age.”

Anatomy is progressing fairly well despite the huge (no pun intended) obstacle of Bertha’s obesity. We’ve dissected the entire upper and lower back down to the spinal cord, the neck region down to the suboccipital triangle, the pectoral, shoulder, axillary and upper arm regions down to the nerves and blood vessels. The latter two structures are very difficult to dissect on Bertha because they’re buried in layers of adipose globules that render them difficult to find and clean. It takes us nearly twice as long to dissect our body compared to the other groups.

My biggest obstacles regarding the material are the challenging new vocabulary and memorizing the nerve/vessel innervation of each muscle. It’s not uncommon to encounter 100 new words each day, most of which look positively alien (a couple of my favorites are syncitiotrophoblast and rectus capitis posterior major—and yes, spelling counts). Identifying structures on the cadavers can be challenging since they’re… I don’t want to say “mutilated,” but… not pretty. There’s also anatomical variability between different bodies.

I felt extremely overwhelmed and distressed the first week, and spent the vast majority of the weekend studying, thereby minimizing social activities and personal leisure. Although I never quite caught up with the material, I feel more at ease with the pace and volume of information and thus more inclined to be more outgoing again. I feel less stressed and I’ve already made weekend plans. I’m more comfortable feeling behind, and the pressure to master every last detail has waned. Much of the initial anxiety was probably due to the abrupt lifestyle change, and some of the repose stems from solidarity with members of a study group I’ve joined.

I’ve also made plans to shadow a neurologist and scope out the lab of a couple doctors so I can get a jump on summer research plans (if I apply early with a good project, I can obtain a Roessler scholarship). I’ve also signed up to volunteer at the Columbus Free Clinic, and I plan to join the neurology and dermatology interest groups. I’m considering applying for a leadership position in DIVE-IN, a student-run organization that seeks to coordinate shadowing opportunities, grand rounds and specialty panel discussions for medical students.

The title of this blog is called “NeuroTrumpet,” right? I’m trying to stay in shape with trumpet, but at the moment I only get a chance to practice every other day. Since I seem to be adapting to school, I’m optimistic that I’ll be playing every day in a week or two, and be back in shape by mid-September. That’s when the auditions are being held for the symphonic bands at OSU. More on that later.

I’ve decided to leave you with a “cool disease” at the conclusion of each blog, so here’s this week’s. It’s called a sacrococcygeal teratoma. It’s a birth defect that occurs early-on in fetal development and results from inadequate closure of the caudal (tail) end of the primitive streak (a structure that forms in the first few weeks). Since it is derived from pleuripotent stem cells, it contains tissue from all three germ layers. It’s commonly benign, and can be surgically excised.

Anatomy: Day 1

It happened again.

I got the obese cadaver. This happened in 11^th grade Anatomy when we were dissecting cats. It makes the process much more difficult; it takes a lot of time and energy to separate the superficial fascia (fat-containing subcutaneous layer) from the deep fascia and muscle.

On the other hand, the muscles of my cadaver were very large and defined (they must be in order to support the excess body weight), and the fatty tissue held in the moisture very well; the other groups’ cadavers dried out very quickly (although I do wish ours were less juicy—it gets all over the floor and our scrubs).

Since my group has an obese female, I suggested we name her "Merryweather" after the portly blue fairy from Sleeping Beauty. The other group members didn’t seem as enthusiastic about it as I was, so I guess she’s still anonymous for now. Hmm… perhaps "Ganymede," or "Gertrude."

"Marge?" I dunno…

We started with the superficial back. The first task was to make several incisions that essentially circumscribe the back, and then removed strips of the skin to reveal the underlying deep fascia and muscles. It took us about five times longer than other groups due to the body fat, and each strip of skin (approx. 12cm x 30cm) weighed several pounds. At her midsection, I had to cut a good 5 or 6 inches in before I got to the muscle. Each pound of fat, by the way, stores roughly 3,500 calories.

I recalled from 11^th grade that it’s very easy to cut into the muscle when skinning cadavers, so I winced every time one of the group members butchered the muscle. I dissected more conservatively, so the muscle in my quadrant of back was well-preserved (yes, I’m tooting my own horn). The lesson is, it’s best to separate the investing fascia with your fingers rather than the scalpel. It makes for the cleanest separation.

Overall it was a strange experience. Standing around a dead body (that looked like rubber) for 3 hours and inhaling formaldehyde fumes. The weirdest part? Formaldehyde causes one to feel hungry. It was a dissonant thought to feel hungry while staring at the gnarled insides of an obese cadaver.

Maybe Lorraine? Or Agatha? I will meditate on this.

Umm... med school is, like, hard and stuff

I’m already behind.

I’ve completed all the readings, but there’s simply too much information to absorb. After 8.5 hours of class, I spent 4 hours reading/studying and I’m still far from comfortable with the material—and it’s the first day!

Parry and I commiserated after we attempted to quiz each other (hint: it did not go well for either of us), and contemplated a career in Law or fast food. We concluded that a much more significant amount of weekend time would need to be devoted to school, and that we should forget about watching the cable TV we had installed today.

I do appreciate the manner in which anatomy and embryology are taught, though. Rather than presenting the material and having us memorize facts by rote, it’s taught from a practical, functional, clinical perspective. This approach somewhat attenuates the overwhelming mass of knowledge we are to acquire, but it’s still—as Vania would put it—like drinking water from a firehose.

I feel like I should be reviewing material right now instead of writing this blog entry, but I know my brain won’t retain anything more I try to shove inside it today. I need sleep to consolidate what I’ve already learned and refresh it for tomorrow’s overload—so that’s where I’m headed. Hello, pillow; you were sorely missed.

Preamble to Classes

Orientation is now over and classes begin in earnest tomorrow. There will be 4 hours of lecture that will cover the topics of:

1. Intro to Gross Anatomy

2. Anatomy as the Foundation for Clinical Exam

3. Embryology: Bilaminar Disk

4. Introduction to Medical Imaging

I am in CAPS (Clinical Assessment and Problem Solving) group A, which meets on Mondays, so I’ll go to that for 3 hours following lecture. It’s going to be a long first day.

We already have our first reading assignments, too. Our course packets tell us exactly what material we’ll need to pre-read in order to prepare ourselves for lecture. My reading assignment for tomorrow’s lecture included an overview of anatomicomedical terminology, a review of the body systems, a fairly in-depth coverage of skeletal morphology, a description of different medical imaging techniques, embryology, and finally a very technical case study intended to illustrate the utility of anatomical knowledge in clinical diagnoses.

I went to Caribou Coffee with my housemates in order to do the readings. Per usual, I ordered a “Northern Lite Cooler” and a multigrain bagel with cream cheese to get through the assignment. It was a fairly light read—only about 35 pages in total. There are some terms that were new to me that I’ll have to review later tonight before bed. For instance, there are 15 different kinds of bone markings (though several of them seem redundant to me), 4 of which I have never heard before: condyle, crest, epicondyle, facet, foramen, fossa, line, malleolus, notch, process, protuberance, spine, trochanter, tubercle, tuberosity.

Tuberosity is my favorite; it sounds completely made-up.

Sarah and Duane cooked some Korean food for Parry, Mike, Aaron and me, and then we all played Rockband 2 for a couple hours to celebrate the purchase of our new TV. We ended up getting a 32" HD from BestBuy.

Now the real work begins...

White Coat Ceremony

I feel bad for my parents. I thought that their visit on Sunday/Monday would be a nice respite from the harsh heat and humidity of Maryland’s August. Naturally (because the Levin’s universe is ruled by Murphy’s Law), Sunday was the hottest and most humid day of the year in Columbus. To add insult to injury, it rained a bit during the icecream social after the ceremony.

On Sunday I dragged my parents across a proportionally small—but still sizeable—segment of the OSU campus. The first stop on the tour was the RPAC. It’s the most immense gym I have ever seen in my life. If there were a gym atop Mount Olympus to which the greek gods belonged, it would have been something like this.

Our trek under the hot sun had caused most of the water in our bodies to take up residence in our clothes, so we decided upon reaching the medical campus to head back almost immediately.

Orientation spans four days—Monday through Thursday—and mainly involves lectures on things like professionalism, course overviews, student panels, tech and financial aid info, and of course social bonding exercises. Monday morning I had the pleasure of meeting Dr. Joanne Lynn, a neurologist who’s also chair for Student Life and thus actively involved with the students. She’s very gregarious (thus I wasn’t surprised to discover that she was the 2007 Professor of the Year) and invited me to shadow her, and to get involved with the neurology interest group.

The White Coat Ceremony was held at 4pm later that day. We walked across the stage, shook some doctors’ hands, handed one our coat and had him slip it on us. I was hoping to death I wouldn’t trip and fall, but luckily the bar ended up being set pretty low. One guy failed to unbutton his whitecoat, and another dude wore a coat about 10 sizes too small (they arrived late and didn’t have time to check/exchange their coats). I moseyed across stage without incident, and so began my long journey…

The Move

I was first to arrive at the house on Monday, August 3^rd. It’s a gem of a thing: 4 bedrooms, new kitchen appliances, two renovated bathrooms, a spacious living room addition, hardwood floors, a 1.5 car garage, a beautiful backyard and a sizable basement with a washer/dryer. Split four ways, the rent comes to $325 a month (though I will pay a larger share because I greedily usurped the largest bedroom). Better yet, it’s located less than a mile from the medical campus in a safe, quiet neighborhood populated mainly by young families and older folks.

I spent the following two days either furniture-shopping or twiddling my thumbs waiting for the utility companies to stop by (“We’ll be there sometime between 8am and 5pm.” Oh, wonderful).

Parveen (she goes by Parry) arrived Thursday (from Atlanta; went to Georgia Tech) with her family to scope out the place, and Duane (from California; went to Duke) followed shortly thereafter.

I couldn’t be more thrilled with my housemates. It didn’t take long to discover that we have much in common. In fact, we walked to campus together Friday morning to have our Myers-Briggs personality types characterized and discovered that we’re nearly identical. Parry and I are INTJ (Introversion, Intuition, Thinking, Judgment) and Duane is INTP (Perception). We spend half our time together laughing; I couldn’t have designed better housemates if I tried. We’re still looking for a fourth housemate—the other girl changed schools last-minute.

Over 4 hours on Friday were spent at the BMV while Parry got her Ohio License (Duane and I couldn’t get ours because we had insufficient documentation). I fell asleep there, as I often do, and some lesbians started playing with my leg hair and a fat women sat on my head, I wouldn’t have believed any of it were it not for the proof in Duane’s camera phone. Gee, thanks for sitting there and doing nothing, guys :-) Pictures of this are forthcoming...

Another M1 announced on the Class of 2013 Facebook group that he was having a cookout Friday night, and we all decided it’d be fun to attend and meet some classmates ahead of time. There were at least 50 people there at any given time, and a pile of booze/food the size of Mt. Everest. This cookout was the first instance in my life when I could walk up to any group of people and find every individual fun—even thrilling—to talk to. There was nobody I didn’t like. Everyone was intelligent, laid-back, well-rounded, geeky but cool, and very relatable. After all the intros (“Where’re you from? Where’d you go to school? What’d you study? What kind of medicine do you want to practice?”) died down and the alcohol fulfilled its role as social-lubricant (though I only had one beer since I was the driver), there was non-stop laughter. The best part of the night? Watching Duane get hammered. Every word out of his mouth was hilarious.

It’s now Sunday and my parents are arriving momentarily. My bedroom is finally coming together; here are a couple pics: