Med: End of the year

May 24, 2008

OK guys, I’ve gotta apologize…again.

My schoolyear ended on May 7th, but I hadn’t written anything else since then. I’m going to try and get better.

The main reason for this absence is pure burn out. After the year ended, I wanted absolutely NOTHING to do with medicine for a little while. And though I do feel the same way right now, I feel a slight foray back into the blogging world is acceptable.

As you may be able to gather, our finals week[s] were pretty much hell on earth: SEVEN exams in 10 days, including two cumulative final exams in anatomy and histology. All in all, I’d say my results were mixed. On the one hand, I did PASS everything so I need not worry about any retake exams this summer–MAJOR plus. On the other hand, some of the exams really left me disappointed in myself.

I was really struggling there at the end of the semester. My brain started checking out of the whole “school” thing roughly 3 weeks too early, and finals involved a lot of mad scrambling/cramming on my part. This worked for some classes (missed Honoring Brain & Behavior by only one point), while proving to be an epic failure in other classes (Only passed the microbiology final by one point, though I still passed the course by plenty).

The major bright spot in my final exams was the anatomy cumulative final. In both anatomy and histology, I was in good shape heading into the exams: It was impossibile for me to fail the course (I had enough points to pass), but even a 100% wouldn’t be enough to get me to Honors level. This fit right in with my “brain shutting down” schema, so I went into both of these exams cold turkey.

I know, sounds crazy right? But hear me out. Especially in anatomy, a LOT of the questions have to do with having an intuitive sense of the makeup of the body (What goes where, what’s behind structure X, etc). Sure, I could have crammed the exam, but instead I chose to see what I knew WITHOUT studying (and therefore, I wanted to find out just how much was actually INGRAINED in my brain vs. simply crammed). My friend told me I was just rationalizing laziness–and perhaps she was somewhat right–but it was a risk I was willing to take since I had that luxury.

And guess what? I scored in the 77-79th percentile nationally. Spectacular? Perhaps not…but still a major confidence boost for me considering I did not even study for the exam. In my mind, this bodes well for the future board exams–the anatomy component, at least.

Which is good…because I’m going to need that extra time to study the classes I managed to fuck up this semester.

Advertisements

Anyone that I talk to on a regular basis knows that I have been having a really difficult time trying to find a research position for the summer. Well, that search is FINALLY over–I have a PI, a lab, a project idea…and a research proposal that I need to have written up by May 1st while also balancing FINALS.  🙂   Good times.

With this first post, I’m going to talk about the search and give a little background on my thoughts. In a subsequent post, I’ll describe what it is that I’ll be doing.

When I began the search, I focused my efforts primarily on the Children’s Memorial Research Center in Lincoln Park. I definitely want to go into pediatrics, so it seemed like a great place to try to get into. After “cold-emailing” a few researchers expressing interest and attaching a CV, I interviewed with a lab performing work on cystic fibrosis. And as some of you know, this interview went QUITE well: I got along well with everyone, I fully understood their research, and we even know some of the same people down at Duke. In other words, I thought it was a slam-dunk. Needless to say, I received the email equivalent of a thin-envelope that weekend. The main reason, as she explained to me, was something I’ve been fighting against for the past few years now:
“Well, the problem is that you didn’t do any research as an undergraduate.”

Time and time again, I have interviewers that bring up this point. And technically, they are right: I did not conduct any formal research projects on my own. It all goes back to a decision I made during the middle of college: Research or Work? At the time, my dad had lost his job, and I made what I believed to be the responsible decision to WORK rather than pursue research. What’s more, I found a job working in a microarray facility (Translation for Non-Nerds: A lab that provides data to researchers about their experiments) which allowed me to gain a lot of insight into research–I thought it’d be a happy medium. I even got to do some side-projects for my boss because of the flexibility of the position. And I was being paid. I thought I was golden.

Fast forward to my medical school interview at Boston University. It was my first interview, I was nervous, and the interviewer was being a bit of an asshole. He directly critcized me for not pursuing research–especially since I was at such a research-oriented school (Duke). When I tried to explain how I actually had very similar experiences to other students doing projects on their own, he instantly shot back, “That isn’t research; you shouldn’t try to equate the two. You didn’t form ideas on your own, and didn’t design projects to test your ideas.” His statement wasn’t completely true–especially the latter parts of it–but at that point I didn’t really care all that much. He had jaded my opinion of BU so much that I just didn’t give a damn.

When I told my boss–whom, by the way, earned her Ph.D. in Genetics–she was furious. Having done plenty of her own research before becoming the director of the facility, she surely knew that what I did was pretty similar to other students’ research projects. Just a few months later, a coworker of mine had a very similar experience while trying to get into a Ph.D. program at Duke; he was told that his work at the facility and research should not be considered related. This made our boss even MORE angry because she had worked with that particular researcher, and claimed that he had no idea what any of his data meant: He just shipped her the samples, and our lab did the experiments and she analyzed the results. So while he got to say he postulated X and the results were Y, it was our work that actually got his name on that paper. Oh, the irony.

If I sound bitter, it’s because I am. Getting into research can be a bit of a catch-22: you need research experience to be able to get a research position. Now, I fully realize I could have made more of an effort while at Duke; however, as I mentioned, I made the choice that I had to make at that time.

And the Children’s Memorial thing just irked me, especially because otherwise the interview went perfectly. I fully understood what was going on, and the project that the PI suggested seemed a DIRECT followup of work I had done at the microarray facility at Duke. She even made a point to say that I was probably the only person that she’d be able to find that fully understood that particular project. But the lack of experience derailed that whole thing.

At the height of my annoyance, I remarked to my friend, “And please…researchers are just med school rejects. If they can handle the techniques, I’m sure I can do it too.” Now, I realize that the first part of that statement is rather rude, and frankly I don’t actually believe that–I was just angry at the time. But the second part still hold true in my mind: I’m more than capable of learning the necessary tissue culture techniques–I don’t exactly consider myself an idiot.

_____

Now as it turns out, that rejection may have been for the best. A month later, it was announced that the Children’s Memorial Research Center had suspended its formal summer research program for students, so there would be no official route through which I could find a stipend. I probably could have found more ways–and the PI could have just agreed to put me on the payroll–but it still would have made things more difficult.

Plus, I absolutely LOVE the position that I am now taking for the summer. Cystic Fibrosis research would have been quite interesting, but it’s not exactly something I was dying to do. My project, on the other hand, involves research into cancerous processes. I recently came to the [re]realization that I would like to get involved in oncology, so this should work out well (The oncology thing will be the subject of another post–it involves some pretty intense emotions that I had been repressing for a while, but that have recently resurfaced. Pediatric oncology is WHY I went to medical school, and it’s once again at the forefront of what I want to do with my career).

Well, that does it for now. Next time I will be discussing my future project a bit…rather than just ranting about my troubles finding a spot. But I can now rest easier about my summer–I’ve finally got something to do. The fact that it’s worthwhile, interesting, and related to my future is, of course, a major plus.  🙂

It’s happened to all of us. Someone says something to you, and you know immediately that you will NEVER forget those words, who said them, and why they said them.

I had one of those moments the other day while visiting my grandfather at the hospital. Without going into specifics about his condition, let me just say that it’s a rather difficult situation that still has a lot of unknowns–it’s pretty serious.

At the end of the visit, I went to hug him goodbye. As I did this, he held my hand and said to me:

“Study hard so you can make me better, ok?”

I could have just started crying right then and there–and I surely did so later. Sometimes when we’re spending all of our time in libraries learning obscure facts about the human body, it can be easy to forget just how intense some of the moments in this profession are going to be. We don’t just learn these things so that we can jump through another hoop and pass another test; rather, we learn them because in the not-so-distant future, peoples’ lives are literally going to depend on it.

It’s a strange thing being a first-year medical student. Because I don’t come from a family of doctors, I have suddenly become the person receiving calls from family members asking for clarification on grandpa’s condition: “Why did they take his adrenal gland, too?”    “Does the appendix really not have a use?”    “Why couldn’t they use a smaller incision?”     “What makes the lymph nodes important?”

Some of the questions I can answer just fine, or a least steer them in the right direction. But when my grandpa told me to study hard so that I could make him better, I felt completely helpless. I have no idea what’s going to make him better. I’m not even sure if anything can make him better. I’m 3 weeks away from being a second-year medical student, and I still don’t know a damn thing.

It’s rather humbling. And petrifying.

When I first decided to write this blog, it was because of a funny quote that I read from one of our lecture transcriptions: “One of the twins lost his penis at 8 months due to a fairly traumatic circumcision accident.” I wanted to write a comedic piece regarding malpractice and doctors’ opinions, using the word “fairly” as a starting point–it seemed odd to use the phrase fairly traumatic to characterize an event as significant as castration.

But as I began typing, I came to the realization that a serious exploration of the topic from which the above quote was derived could be warranted; after all, the many medical topics that we discuss everyday–even if we make light of them in class–have profound implications for the people experiencing them. And this was quite true about the case I’m going to discuss.

In 1975, a pair of monozygotic (identical) twin boys were born to the Reimer family. Around the age of 8 months they were taken into the hospital for circumcision; however, a “fairly” traumatic accident left one of the boys without a penis. Not knowing how to proceed, the mother read about Dr. John Money–a pioneer at the time in gender identity–and his work in identifying children as “blank slates” in regards to gender–that is, their gender is socially constructed AFTER the birth of the child and could therefore be changed. The mother soon wrote to Dr. Money, and it was ultimately decided that a full castration and creation of a blind-pouch vagina, in conjunction with hormone treatments and psychotherapy, would allow the boy (David) to actually be raised as a girl (Brenda). Dr. Money worked closely with them and used this case as proof of his theories, and he became famous by touting the “plasticity of gender.” Unfortunately, he could not have been more wrong.

The family did their best to raise Brenda as a girl: her hair was grown out, she was given girl toys, and she was dressed in girl clothing. But this never really worked out. Brenda never wanted to wear dresses, and had the aggressive demeanor of a young boy. In an article from Rolling Stone in 1997 from her identical brother: “She’d get a skipping rope for a gift, and the only thing we’d use that for was to tie people up, whip people with it.” And of course, we all know that schoolchildren can be cruel, and she spent her early years being made fun of and called names.

Around the age of 14, David/Brenda’s father decided to come out with the truth–which according to the mother ultimately brought contentment to her child. At the age of 16, David had his breasts surgically excised and a rudimentary penis was constructed: having identied with males for his entire life, David intended to live like one. He eventually married, but fought the shame of his situation and the torment he had endured as a child in each day of his life. He became famous himself, having been on Oprah to explain the situation to help others avoid making the same mistake with their child. Biology, it seemed, could not be fooled. Unfortunately, David committed suicide in 2004.

We’ve learned in our human development course that gender tendencies are not something that are completely socially contructed. During prenatal development, the brain defaults to feminimity, but can be masculinized by the presence of androgens. In David’s case, the brain had been fully developed into a “male brain,” and no amount of dress-wearing and playing with dolls was going to change that.

This case was specfically about castration taking place AFTER birth; however, 1/2,000 births result in babies with ambiguous genitalia. And as we discussed in class, what is the FIRST question always asked?      “Boy or girl?”

Sometimes there’s just not an accurate answer to give. The old way seemed to be “pick one” and we’ll make it work–a procedure that has been debunked. The recommendation is now to hold off on assigning a gender, and to essentially let the child pick for his/herself based on the gender to which they identify. This may be difficult in the short-term for the parents, but in the long-run should be very beneficial to the child.

For more on the David/Brenda case, check out this youtube clip from the CBC news:

http://youtube.com/watch?v=pZNjX5j6dNQ

I should have seen it coming–it’s pretty much how life works. The very day after I wrote a blog post about how I’m all about going to class now, I decide to…umm…take the morning off.

My alarm went off at 8:20, and there was just NO WAY that I was going to be able to function. So i set for 12:30–yes, FOUR HOURS later–and got back in my bed. I probably would have slept longer, too, had my afternoon course not been required.

Has anyone else ever had those days when even the best intentions are derailed by your body? I felt like I just had no control over my actions this morning as I got out of bed and reset the alarm.

Just goes to show that your body WILL pay your sleep debt at some point. My sleeping problem hasn’t gone away–I’m still not falling asleep until 4am or so. I’ve just gotten VERY good at forcing myself to get up, have caffeine, and get to class. But when you’re surviving on 4-5 hours every night, you gotta expect the chickens to eventually come home to roost.

Med: Still going…

March 25, 2008

Yup…here we are in the 3rd week of Post-ExamWeekFromHelldom, and I’m still attending class–go me. OK, so my attendance is no longer perfect, but I have legitimate excuses.

I missed Thursday afternoon’s histology lecture because I went in to work at the clinic. Of course, I SCHEDULE when I go into the clinic…and I just so happened to create a conflict with histology. Coincidence? You be the judge…and pay no attention to all of my I HATE HISTO posts from last fall.

And then I missed Friday morning–but that was legit, too. A) I had my Patient Interview Exam that afternoon and needed to get some more prep-work done & B) It was snowing. A lot. So there.

But other than those [pseudo] justified absences, I have done quite well with attendance–especially given that our days of ONLY morning or ONLY afternoon lectures are over. I even went to histology lab yesterday! For those who know me, this is a big accomplishment. As it was, only 7/24 people in our room showed up–and this was the first one.

All in all, I’m rather proud of myself–this is how learning is supposed to be. I’m going to class, reviewing at night, and getting to spend extra time NOW on things that give me trouble (rather than, say, the night before the exam). Maybe I can be a good student once again.

Today’s anatomy lecture, however, went until 5pm. I felt myself wavering a bit…but for now I’m good.

Med: Sleeping Disorder

March 16, 2008

For a large part of my time on the blog, I’ve made a big point about the fact that I haven’t attended class as often as I would have liked. I feel it prudent, now, to mention that my lack-of-attendance isn’t simply out of laziness but rather because my sleep cycles are completely screwed up.

I’m not exactly sure when this all started, and my gut feeling tells me I likely started skipping class more often, which led to sleeping later, leading to staying up later, etc. But now that I WANT to go to class again, the sleep cycle problem is proving an intimidating adversary. It’s actually referred to as, “Delayed Sleep Phase Syndrome,” and it is not made up, I promise. 🙂

In the clinic, this is a condition that is often diagnosed as insomnia–but is definitely not the same thing. I have no trouble falling asleep, getting 8 hours, and feeling refreshed each day. The problem inherent in this disorder, however, is that the sleep cycle is shifted to non-ideal times. For me, my body likes to fall asleep around 5am and sleep until 1pm. Most of my friends think I’m nuts, but I can stay up until 4-5am just about every night WITHOUT even ingesting any caffeine.

This, of course, is a problem for people trying to fit in with the standard 9-5 workday–or, in my case, trying to wake up for morning classes.

As noted in my last post, I’ve been getting better at getting myself to class in the AM. But also understand that I’ve been doing so after roughly 3-4 hours of sleep/night–NOT FUN. I have my computer as my alarm clock to blast music (ensuring I wake up), and I definitely need a morning caffeine blast as well as a late-afternoon nap to keep myself functioning. People love to say that I should stop napping and that will fix the problem, but it really doesn’t. If I nap, I’m able to be productive for the later portions of the night. If I don’t, I still don’t really fall asleep at a “normal” time, but I’m just kind of “out of it” for the night and cannot be productive.

I’m giving it a little more time to start resolving itself. The clock change & more sunlight should help, and I’ve been trying to integrate OTC sleep aids to make myself tired earlier. So far, results have been only “ok.” A little bit longer, and I’m going to probably ask my doctor for a sleep-aid prescription.

So when we laugh about my inability to go to class, remember I’m not just always being lazy. Sometimes 3 hours of sleep just doesn’t get the job done.

And if you’re interested, check out the link–I’ve actually found Wikipedia’s entry to be quite thorough:

http://en.wikipedia.org/wiki/Delayed_sleep_phase_syndrome 

I did something this past week that I haven’t done since probably September–made it to every hour of scheduled class. While there weren’t any labs, we did still have afternoon lectures and/or working-group seminars, and the days started at 8:30am.

I know, I know–for most of you, this probably isn’t a big deal. Plenty of medical students have been MUCH better than me at class attendance. But in all honesty, I think I’ve turned a corner and will be in-class as often as possible–saving an “out” for clinical activities, etc. I’ve had this sentiment before–and it generally tends to follow exam weeks–but this is different (i.e., it didn’t fade by the end of the first week).

My friends are still understandably skeptical, but I really think it’s something that I’m going to keep up. In the past I’ve rationalized my class attendance by saying that “I’m not an oral learner,” but each time hearing and/or reading a lecture benefits the learning process more-and-more, and I need to stop making excuses for not waking up in the morning. This is PROFESSIONAL school, and at times I treat it like second-semester of senior year. This needs to stop.

Already after this week, I feel MUCH more comfortable with the material–mainly because I’m now learning the right way: Going to class, and also REVIEWING the material sometime shortly thereafter. Hopefully by doing a little bit along the way, I prevent massive streesful pre-exam cram sessions. Or, if I do have those, I’ll just be that much better off for the test.

The true test of my newfound class attendance will be over the next few weeks, with both histology and anatomy starting back up. But given that I NEVER went to histology AND that histology was by far my worst class, I need to make more of an effort. I just better have a lot of caffeine.

I really think I’m going to be able to do it now…so I really hope I don’t let myself down.

Med: On Grades

March 15, 2008

Quick aside–I never know what to say about grades while talking about our exams. For now, I guess I’ll stick with comparing myself with the average.

When I made this blog, I wanted it to be for my non med-school friends and family, so I want them to know how I’m doing. But of course I have plenty of classmates reading this as well–and I encourage it–so I don’t want to just put the grades out there. But it’s a strange topic.

I don’t need to give grades to talk about medical school, but it doesn’t exactly seem like irrelevant information either. I guess I’ll just keep doing it like I am, and hopefully no one gets too agitated with me. And hey, if you’re agitated by our blog, don’t read it. 🙂

Thoughts?

Extra stress about both the neuroanatomy and head/neck anatomy DEFINITELY set in the night before the physio exam. It was at that point I realized I had certainly not left myself enough time. As mentioned above, we had two full weeks to do anatomy last semester. Because of the impending physiology test, I had been putting off neuroanatomy and anatomy, and it finally dawned on me that I had left just two days for neuroanat (sat/sun), and 1.5 days (later Monday, Tuesday) for anatomy. But hey, stress can be a motivator, right?

c) Neuroanatomy: At the time of studying, this test actually weighed on my mind much more heavily than the others–for a couple of reasons. First of all, I knew that neurophys hadn’t gone terribly well, and given that there was a lot of material overlap between the two, I was feeling like it was double jeopardy. Secondly–and more importantly–the neuroanatomy exam was the ONLY exam for the course. Failing it meant that I would be headed to summer school, whereas there was more wiggle room in other classes (More on that below).

The neuroanatomy exam had two parts–a conceptual multiple-choice exam, and a lab identification component. I had expected the lab identification to go pretty well, and the mcq to be “blah,” but the opposite actually was true. I did right around average on the lab exam (what more can you expect when you learn primarily out of books because you skip lab?), but did REALLY well on the written. In hindsight, I DID have a good handle on neuro topics–I just understood them much better in the “anatomy” sense rather than “physio” sense. Oh well.

d) Head/Neck Anatomy: Above, I alluded to the fact that because the neuroanatomy exam was our only grade, I had to sacrifice to ensure I passed that one–anatomy was that sacrifice. I had done rather well last semester, and knew that I could essentially fail this block and still be in good shape to pass the class. Of course, this “sacrifice” is not an inherent aspect of medical school–if I would have been working as I should have been along the way, things would have been fine.

Still, It hit me like a ton of bricks on Monday afternoon when I realized I had 1.5 days to cover the material–both reviewing stuff, but also learning some of the topics for the first time. And I hadn’t spent too much time up in the anatomy lab, so I felt like the Lab Exam/Identification component of the test would be a complete disaster. But you need to have a base of knowledge, so I decided I would do bookwork first, and then hit up the lab late on Tuesday.

I pulled all-nighters on both Monday and Tuesday night, though I did take midday naps along the way. I can’t even count how much caffeine I pumped into my system–I was jittery, my stomach hurt, and I had to keep a steady stream of Visine flowing into my eyes to keep them from hurting. It was awful–but I was petrified.

Having spent Monday night/Tuesday daytime reviewing, I finally decided on Tuesday night that it was time to get myself into the lab. Fortunately, I found that I knew more about the lab stuff than I thought I did–so that calmed me down a bit. Still, when I got home around midnight, I realized there were only 12 hours til the exam started and there was a LOT left.

I stayed up during the night–catching a few hours around 6-7am–and did the best I could to pound things into my head. I know its commonly said that at some point “it’s just not worth it,” and to some extent I believe that is true. But you also need to realize that there is a certain threshold of information that you absolutely NEED to get into your head…its not like sleeping will magically give you knowledge.
Results were a mixed bag. Going through the lab exam, I had felt pretty good about the answers I was coming up with; however, getting to see the key directly afterwards was a nice punch to the face. I passed–but barely–and certainly didn’t feel I had done as poorly as I did when I was taking it. The MCQ was kind of the opposite–I thought for SURE that I had failed the exam outright. I had to make “educated guesses” on more than 1/2 the exam, and literally filled in B’s for every embryology question because I never really got around to studying it…and missed every lecture (pattern?).

When we got the email that anatomy grades were posted, I was pretty scared. No, I didn’t need to pass the exam to still be passing the class, but I still didn’t wanna do poorly. However, I was pleasantly surprised when I saw the score–it was a decent amount above the average and made me feel a lot better. My friend Patti loves to say that I exaggerate, but that really wasn’t the case here–I had way too many guesses to feel comfortable.

___

In the end, things worked out alright–but not without a whole lot of caffeine, stomach pain, lack of sleep, and agitation. I think that I honored Genetics, will be CLOSE to honoring neuroanat (from the looks of last year, I’ll be just short), and I’m still on track to honor anatomy if I do well enough on the final two exams in May. Physiology is a lost cause, but that’s ok–I’ll just mail it in and go for PASS like I did last semester.

But regardless, what we’ve been told is the hardest stretch of academics at the UIC College of Medicine is now over. Phew!

We’ve now started into our next block, and I’ll write about them in the next few days.