Friday, August 28, 2009

Deep Inside Walter's Back

Or Why I"m Taking a Break From Eating Butter
(Or: Why I'll Never Again Look at a Wood Chisel the Same Way)
A couple of weeksa ago in Anatomy Lab, I used a wood chisel and a hammer to perform a laminectomy on Walter. We removed part of his vertebral column so that we could take a gander at his spinal cord. It was ridiculously cool but it will forever make me think of Walter whenever I see a wood chisel.

Also, during dissection, fat cells seem to "weep" their contents into your work space. While I was trying to clean around some muscles in the neck, these yellow fat cells kept oozing greasy fat. If I wasn't already a little put off by them, I certain was when one of my teammates remarked that it looked like melted butter. I immediately grabbed a dinner roll and, then, puked.

"Aww, man...these nuts taste like my cadaver smells."

Advising my classmate to stop eating the nuts seemed like a sensible reply that, if nothing else, completely let go of the comedic gem of his statement. He should consider it a freebie.

Saturday, August 22, 2009

The Matrix and BioChemistry

You know what I really, really want right now? I want to live in a Matrix-like world where I could just have someone download BioChemistry into this thick-assed noggin of mine. I just cannot seem to get a toehold on this subject; I think that I'm still carrying some resistance from Organic Chemistry (recap here) that is preventing me from opening up to BioChem. Nonetheless, I'd love to pause for a second or two until the download was complete and, in my best Keanu voice, look up and marvel "Whoa...I know Bio Chemistry."

Thursday, August 20, 2009

Sorry, Walter, This Might Hurt a Little

Another week of medical school in the books. I swear, some days are awesome and others just humble you; so it has been for another week. Once more I stare at an approaching weekend with little more than studying, doing laundry, and catching up on sleep on my list of things to do.

Another week in the books. The gloves are off, now. I am still running on adrenaline: staying up until midnight or 12:30 studying and getting up at 5:15 or 5:30 to, surprise, do more studying. I'm starting to feel a little run down. Guess that's part of what I signed up for, isn't it?

Classes were good. This week, we practiced doing a patient interview and taking a patient history which was pretty damned hard. Seriously, how the hell do you meet someone, figure out why they're seeing the doctor, get more information about their "chief complaint," take a medical history, make a diagnosis, and form a plan of attack in about fifteen minutes? Pretty tough to do. I have a great respect for those folks who make it look easy.

Anywho, I'm still struggling to keep up with the reading and make sense of everything covered in class. It's a battle that I don't imagine will end soon. At the very least, I hope to get used to the discomfort of it all.

My First (Human) Dissection
Today was our first dissection in anatomy lab. All day long, everyone was buzzing with excitement. Some were really looking forward to it, others were cautiously excited about it, and still others were pretty apprehensive. Prior to lab, we had to watch a video specifically about removing skin. Funny, when I mentioned wanted to hear "The Killing Moon" and made vague references to "putting the lotion in the basket," people didn't seem to know that I was talking about. It's a cultivated sense of humor, I suppose.

As the time neared for lab though, the joking seemed to dissipate and everyone got a little more serious. Our tasks for the day were to get to lab, flip our body onto the stomach, skin the back, and dissect some of the superficial muscles. Seriously, think about this for a moment: we were tasked with skinning a human back. Not really something that you do every day.

I grabbed a lab coat and joined my team at the dissection table. Everyone was really amped. I mentioned that I'd like to call the cadaver Walter and explained that, to me, he really looked like a Walter. One of my teammates confessed that, she too, had been thinking of the name Walter for him. I thought it was a little uncanny that we'd both thought the same thing but it was settled; we'd be working on Walter.

Our first task was to remove Walter from the body bad that we'd put him in the prior week and roll him over. Prior to doing this, though, we put some socks on his hands and feet and sprayed them with a moistening solution to prevent them from drying out too badly. Then, we need to put a wet cloth on his face and plastic bag over his head for the same reason.

As we're working on his hands and feet, I guess that we shook him a little. While I was staring right into Walter's lifeless eyes, the top of his skull pulled off to reveal that his brain had been removed. Immediately, I felt myself flush and felt beads of sweat on my forehead and upper lip.

"Why's it so hot in here?," I asked. "Seriously, are you guys hot?, " I asked, feeling a little lightheaded. "I'm really hot." Afraid that I would soon hit the floor, I tore myself away from Walter's vacant stare, replace the top of his head, took several deep breaths, and tried to think of something else. Within a few moments, I felt fine; crisis averted. In retrospect, I think that getting really freaked out and almost hitting the deck is pretty normal when staring into someone's eyes and their head comes apart. Hell, you're just not supposed to see that, you know?

With the help of a few other folks, we turned Walter onto his belly and worked a prop under his neck so that he wouldn't be laying on his face. Then, it was time to cut. Everyone else in our group was a little tentative about making the first incision, so I readily volunteered. Our job was to make a series of incisions in order to remove the skin from the back and get access to the musculature.

A guide to making incisions
from our dissection manual.

I thanked Walter for his gift to us, apologized to him, plunged the scalpel into the base of his skull and cut a line from his neck to his ass crack. Then, I carved around the top of this glutes, up to his armpits, down his arms and, finally, back up to his neck where we started. I must say, it's a pretty damned unnatural thing to do.

During the skinning, I felt like I was the king of the "finger hole," a technique that allows you to put a good bit on tension on a piece of epidermis that's being removed. Again, in any other context, it would be quite disturbing to think about but, hey, it's what goes on in lab. Finally, we got the skin off of his back and attempted to remove additional fatty tissue in order to get down to the superficial muscles. All the while, we kept pitching parts of Walter into a bin. During the semester, all parts of a cadaver are kept together so that, when the dissection is complete, the remains will be cremated and returned to the family. In all likelihood, I probably won't be eating steak for the near future (or, for that matter, visiting my local butcher).

Behold: the "finger hole."

After an eternity, we finally removed enough tissue to clearly identify the superficial muscles. We saw his atrophied trapezius muscles, his latissimus dorsi, his rhomboids, and a slew of nerves and arteries. It was pretty damned cool, I must say. During the dissection, I was trying to get a piece of fatty tissue off of the back when it tore loose and flew straight into my eye and onto my face.

Afterward, my fingers were tingling from the formaldehyde (through the gloves); my clothes stank of it. No matter how much I washed, I couldn't seem to get the smell off of me. I guess we're bonded now, Walter and me. BFFs or at least until the course ends and he goes home to his family after completing one final awesome deed.

Tuesday, August 18, 2009

Med School Is Like Golf

(Or How Thinking About Taking A Dump Gave Me Hope)

After a weekend spent trying to catch up on sleep and determine the best approach to studying, I find myself nearing the middle of week two. So far, the only constant is that the peaks and valleys are still there. One day, I feel like I'm about to get voted off the island. The next, I think that this crazy-assed plan just might work: we just might win this dance contest and save the old folks' home with the prize money.

In a lot of ways, it's like the game of golf. Or, more importantly, it's like the game of golf is for ME. I'm okay at it. During a typical round, I feel like I'm having to work hard just to be a moderately bad golfer. Just when I'm considering throwing in the towel, I hit a nice shot that lands in the fairway. Hell, if I'm lucky, I might make par on a hole. It's just enough, exactly when I need it to make me put the clubs back in the car instead of heaving them into the nearest water hazard.

Same thing with school. After a series of "defeats," something - some little insignificant thing - clicks and you think "I can do this. I'm going to make it. I'm going to be good."

Today's tiny victory came during Histology. After a great day of Physiology (diffusion, active transport, and action potentials), Biochem (protein folding and the health problems associated with incorrect folding), Gross Anatomy (lecture about the structure of the spinal column), we moved into Histology for a lecture on Epithelium and Connective Tissues.

Biologically speaking, one of my favorite cells is the goblet cell. Essentially, it's a single-celled gland, shaped like a wine glass, that secrets mucous in various places in your body, such as your esophagus and other places in your gut. Our professor was showing slides of goblet cells and happened to display one of a goblet cell in the colon. He described how, initially, one would encounter only a few goblet cells in the walls of the colon but as you move through it, you'd encounter an increasing number until, near the end, there are a substantial number. (I am, of course, paraphrasing a bit. A proper scientist might pick this one apart.)

He asked, "Why would you encounter an increasing number?" Then, silence.

"To help you poop more easily," I whisper to classmates around me.

Although nobody, including me, offered an answer, he confirmed what I'd said, albeit in a more eloquently stated manner. And I got to take down the following words in my notes:
Going down through colon: more and more goblet cells.
Needed for lubrication to aid removal of fecal matter from the anus.
All hail the goblet cell.

That was my victory for today. I shall try again tomorrow.

Monday, August 17, 2009

God Bless Skype

Made a few video calls this weekend to Winning Run and to my friend who's on active duty in Germany. Holy smokes, it's pretty damned cool. Really, it's the technological promise of the future. Next, I want my jet pack, dammit.

Back to the studying. I've scratched my ass twice today and those small insignigicant actions have got me behind. Boo me.

Friday, August 14, 2009

One Week

If anything, this experience has been about the emotional ups and downs that accompany being a new student in a med-school program. One day I'm thrilled and really positive that I'll succeed; the next day I'm pretty convinced that I'm going to fail everything and be asked to leave the program. So far, it's been a study in control and stress management. I worked with a guy who would describe it like a duck. "A duck?," you might think. Yep. A duck: on the surface it might look calm but underneath, it's paddling like hell.

So, I'm like a duck. Except I might not look as calm.

The Honeymoon Is Over
After the glorious "ease-in" of the first day, I've definitely been freaked out about everything. The volume of information is, as they put it, intense. If I've heard the phrase "it's like trying to take a drink of water from a fire hose" one time, I've heard it a thousand. It is, however, a pretty good way of looking at everything.

Here's a quick rundown of my classes with the official descriptions:
  • Clinical Skills - This course is designed to teach the students how to perform a proper history and physical examination. He/she will be assessed not only on the knowledge related to this activity, but also the practical skills related to (1) interviewing and history taking, (2) performing the physical examination, and (3) making clinical judgments. The course will teach the various systems and how to understand the importance of the history and physical examination for detecting pathophysiology. The student will learn to make a differential diagnosis, leading to the selection of "definitive" laboratory studies and then ultimately to diagnosis and treatment.
  • Community and Behavioral Medicine - This combination lecture, small group and problem-based learning course will focus on topics ranging from the behavioral sciences to health care systems management and public health. The emphasis will be to develop the student's process of clinical decision-making. PNWU curriculum goals regarding lifelong learning, self-care, ethics, and social and community contexts of care will be addressed. Other topics include biological correlates of behavior, personality, learning and behavioral change, life-span development, communication and interaction, group processes, family and community socio-cultural patterns of behavior, behavioral risk factors and disease, study design and biostatistics, and medical jurisprudence.
  • Physiology - This combination lecture and laboratory course is a comprehensive study of normal human physiology and neurophysiology. It will focus on properties and functions of living cells, tissues, organs, and organ systems with special emphasis on integration, control, and pathophysiology. The course includes an overview of normal and pathological physiology of the human nervous system as it relates to perception, behavior, and the control of bodily functions.
  • Biochemistry - Students will learn the structure and function of the human body's most basic constituents and the role of these components in normal body function and pathological processes. Major elements of the course include key concepts in biochemistry, nutrition, molecular biology, immunology and genetics.
  • Gross Anatomy - This combined lecture and laboratory course introduces the student to the macroscopic structure of the human body using a regional approach. Emphasis is placed on the correlation between anatomical structure and function, embryonic development, clinical application, radiologic interpretation, and usage of correct anatomical terminology. Study of the emergence of human form is oriented towards its relation to gross anatomy, on the one hand, and to the pathological conditions that have a developmental basis on the other. Resources used during the laboratory portion include cadaver dissection, radiographs, MRIs, CT scans, OPP, and orthopedic clinical correlation.
  • Pathology - This combined lecture and laboratory course explores functional anatomy principally at the light and electron microscope levels. Study of basic cell structure, the functions of cellular organelles, and the relationship between ultrastructure and cellular function will be emphasized. This course further highlights the intimate relationship between structure and function through the study of functional morphology of diverse cell types, their organization into tissues, and the properties of these tissues. In addition, this course examines contributions made by coherent organization of tissues into organs to human form (gross anatomy) and function (physiology) and provides a foundation for how its distortion correlates with disease.
  • Osteopathic Principles and Practice - Osteopathic Principles and Practice I is a combined lecture and laboratory course comprised of formal didactic lectures ("cognitive component") in an amphitheater setting, small group "problem based learning" (PBL) sessions ("cognitive component"), and clinical skills training (CST, "psychomotor" component) conducted in a large teaching laboratory setting. The skills and knowledge that will be taught and examined are done in a cumulative and comprehensive manner. The course will familiarize the students with the history of osteopathy, the research contribution, the future projections for the profession, and the anatomical and physiological basis of osteopathic medicine. The students will also understand the biomechanics of the various joints of the musculoskeletal system and how to manage them. The student will understand how to integrate osteopathic principles with clinical medicine, surgery, pediatrics, and gynecology/obstetrics.
  • Microbiology - This combination lecture and laboratory course presents virology, bacteriology, mycology, and parasitology from a medical standpoint and will emphasize microbe morphology, physiology, life history, pathogenicity, epidemiology, diagnosis, therapy, and prevention. A case history / problem-solving approach to infectious diseases will be incorporated throughout the course and will emphasize such clinical aspects as etiology, patient management, specimen collection, laboratory tests, pathologic findings, and prognosis. Most basic science concepts will be discussed via analysis of clinical case studies.
  • Current Issues - In this lecture course, osteopathic primary care physicians and other professionals will present lectures on specifics topics related to the present day practice of primary care medicine, especially in rural or underserved areas of the country.
So, as you can imagine, I'm a little busy with stuff. So far, I've had about a gajillion pages to read. I've literally gone to bed at around midnight or later and gotten up at about 5:30a.m. to begin the day with a little coffee and "light reading." Wow. This stuff is intense. And, they took it easy on us this week. Yippee.

I Met Walter, Our Cadaver
On Thursday of this week, we had our first official Gross Anatomy lab. During the course of the year, we'll be dissecting a human body. We've been reminded to think of the cadaver as our first patient, the one who will teach us so much more about medicine and about the body than we'll ever learn.

I'll admit that I was pretty anxious about going in there on the first day. Hell, with my luck, I would be the one to pass out or drop the body or set something on fire or throw up or something. Various scenarios ran through my head, you know. Anywho, we met in the lab to "unpack" our bodies. Our group of four cautiously opened the hood on the stainless steel table and looked inside. There, in two giant, plastic bags was our cadaver. Our task for the day was to remove the plastic bags, drain the preservative from the body, and put a body bag on it. Really, there was nothing to do but to dive right into it. I cut through the first bag and the smell of the formyl got really intense. If you've ever dissected a fetal pig or anything, magnify the scent by about 100. Then, we cut the second bag away to reveal the naked, preserved body of an older (maybe 70s) male.

So, a minute later, I'm there with a lab partner, wrestling with a preserved human body, trying to slide a body bag under it, occasionally glancing at the vacant eyes that keep staring at the ceiling, looking at the stubble on his face, and trying not to get the fluid all over me. Had the setting and circumstances been different, we could've been acting out a scene from a Scorsese film. Instead, I was surrounded by 74 other students trying to do the same thing to 19 other bodies. It was one of the most amazing things that I've done and I've not even started a dissection...this was just unpacking day.

I couldn't help thinking that this person had been someone's friend, somebody's husband, a father, a grandaddy. I thought about what we'd be doing to this body, how we'd be getting to know the most minute secrets it held and I couldn't help but be amazed by the beauty of the person's gift to us medical students. Dissection, after all, is not easy; it is a highly organized destruction of a body. To know what occurs during dissection and to still make the ultimate gift of yourself is nothing short of amazing. I've decided to call the cadaver Walter. (I don't know, he just seems like a Walter to me.) Anywho, thanks Walter. Look forward to spending more time with you.

The General Freak-Out
So, everyone is pretty much freaking out. We're right to do it, too. Already we're feeling behind in class and feeling that there is no way in hell that we'll be able to survive any of the testing. It's pretty funny (or not) to put 75 mostly Type A personalities in a room and watch their anxieties about grades manifest. The funniest are the youngest people who are fresh out of school and are terribly stressed. That being said, I need to quit writing and get some more studying done. I'll try to post as frequently as possible.

Monday, August 10, 2009

One Down...

Well, I made it through the first day of school: about four hours of Clinical Science and another three of Epidemiology. My brain hurts.

Gotta go read.

Thursday, August 06, 2009

Ready, Set ...

Got back from an orientation retreat on Thursday afternoon and joined a friend and his wife for dinner. I must say, everyone that I've met -- both students and faculty -- have been really friendly and genuinely excited about the school.

We spent the orientation at some cabins at Camp Prime Time,
a camp for seriously ill children and their families.

A lake near Camp Prime Time.

There are 75 of us in the incoming class. I've probably had a good conversation with about 65 of them. The other ten or so, I've not really gotten to know just yet. There are, however, a crap-ton of interesting people. For example, one guy used to train honeybees to identify landmines. (Apparently, they're also being trained to find dead bodies and meth labs.) Pretty stinking cool. Seriously, he used to train bees to find landmines. I still can't get my head around how freaking cool that must've been. Several have just left the military. One, I think, is fresh out of college.

Like me, several folks are without their wives and families. One friend just left his wife and two kids (3 and around 1) back east; they won't be out until next June. Strength in numbers, I guess.

I'm neither the oldest or the only person without a hardy science background.

I am not alone. (I knew I wouldn't be but still.) I am happy(-er).

Someone's Going to Show Up and Take It All Back
I've picked up about a ton of books, some scrubs, a stethoscope, and other diagnostic gear. I put it on and, next week, will wear it to school on certain days. At this point, I feel like they're a bunch of props for some costume party. Isn't someone going to come and take them away from me? It's all so new and strange.

Freshly unpacked, oversized scrubs.

Putting on the gear.

Seriously, my self image hasn't come up-to-speed with where I am in this process. I'm still holding on to my former identity as an instructional designer / software consultant or, at the very least, an applicant. Holy crap, I am a medical student; it's here.

The Crushing Weight of Study
I'm right on the precipice of my "Oh Shit Moment," where I'll absolutely lose it and freak the hell out. As expected, the faculty met with us during orientation to describe some typical study schedules and how we should expect to spend between 60 and 80 hours a weeks on coursework (in class and self-study). As expected, their plan to motivate everyone to begin their studies has worked. I've started to substitute Pepto Bismol for the half and half in my coffee.

Based on their professional estimates, I can probably have about four hours of waking time to myself. Subtract the time that I'll need for meals and stress-related bowel movements and I should have about 20 minutes per day. Holy smokes, what have I gotten myself into?

Monday, August 03, 2009

Scrambled Eggs; They're Calling Again

Last Tuesday, I met Winning Run in Seattle. She'd come out for a few days of R&R and to speak with a few firms in the area. I made the drive from Yakima to the Sea-Tac airport in a little over two hours; it was a very pretty drive. I'm still amazed at the change in topography: the closer you get to Seattle, the greener everything becomes. I really am in the high desert, I suppose.

View from the drive toward Seattle.

We drove from the airport to our meager hotel in downtown Seattle. In any other time of the year, it would've been just fine but, considering that Seattle was in the grips of a triple-digit heatwave, a Euro-style hotel without air-conditioning wasn't going to work out for us. So, we dipped into Pike Place Market for a bite to eat, to get a glimpse of the sunset, and to prepare ourselves for a restless night in a 9th floor sweat box.

Pike Place Market

The next day, we toured some interesting buildings: the Seattle Public Library and the Experience Music Project. The library rocked. I was sort of cool on Gehry's Experience Music Project / Science Fiction Hall of Fame. Like some of his other works, I think they're interesting at a distance but, up close, the detailing sort of detracts from everything.

Inside the library.

A view of the Experience Music Project.

Seattle's Space Needle.

Space Needle, The Scholar.
The Scholar, Space Needle.

Later, we stumbled across a gem: Maximus Minimus, a mobile BBQ joint. They served up some ridiculously good sandwiches and lemonades. Lucky, indeed!

Maximus Minimus, a rolling BBQ stand with kick-ass wares.

Portland, OR
Thursday evening, we headed down to Portland for more explanation and interviews. This city was amazing. Although we don't have the photos to show for it, the scale of Portland was great: smaller building, cool neighborhoods, and friendly people. Of course, we bumped into our share of homeless folks with severe mental health issues. Apparently, Meth is a helluva drug.

On our way back to Yakima, we drove along the Columbia River Gorge and we're awed by everything we saw along the way. Holy smokes, that river is amazing. The gorge is amazing. Oregon knows how to put in a freeway: make it run along stunning scenery. Two thumbs up.

We took a detour and headed down to Mt. Hood for a little sightseeing. It rocked. I'm looking forward to getting in some quality snow time in the future.

Back to the Yak
We made it back here late Saturday afternoon. Winning Run inspected the apartment and decided that it wasn't as bad as she expected. So, we've been trying to unpack and make it "homier." It's a big, big help to have her out here; it doesn't seem so bad when you're sharing it with someone.

Orientation starts tomorrow!