There's different types of tired. There's just-had-a-crazy-intense-workout tired (which I actually enjoy). There's running-on-too-little-sleep tired (which I definitely don't enjoy). There's an emotionally drained tired. There's a been-running-around-all-day tired.
Right now I'm feeling a wholly different kind of tired. My brain is tired.
I am currently about to start the second week of a three week gauntlet where we have an exam each week. As I have already covered, preparing for a medical school exam is like preparing for 4 college exams in the same day - it's a week long process that requires a great deal of time and energy investment.
My previous strategy for surviving these draining cram-and-purge periods was by mailing in the week of school after the test. Not studying much (ok, at all). Maybe catching up on study objectives for a couple hours max on saturday. It worked well, gave my brain a nice break, gave me a chance to hit the gym, and when it came time to get back to work I was more than happy to jump right in. I really liked mailing it in.
I took my final GIE exam last week, a grueling exam on 3 weeks of material that was easily our most difficult challenge yet. This week I have a cumulative exam for our Principles of Clinical Medicine class. Next week is our first exam for our new Cell Structure and Function curriculum. Basically this requires me to be in full balls-to-the-wall study mode for 4 weeks straight. I can now understand why Pheidippides fell over dead after his sprint from Marathon to Athens.
So what's it like to be brain tired? Pretty easy to describe actually. Motivation? You lack any of it. Sense of humor? Well lets just say I have no problem perpetuating my blonde hair stereotype at the moment. A little slow on the uptake. Energy? Good luck, even on the back end of halloween and its copious amounts of candy lying about - no sugar high can touch my fatigue. Quad venti caramel low fat peppermint mocha latte extra hot? Please, I'm not even sure a line of coke could move my flatline.
Thankfully, at the end of the tunnel is a four day break for thanksgiving where I get to mail it in and not feel guilty about it. I think someone on our med school curriculum board has a soul. And if there's one undeniable truth, its that I will eat my weight in stuffing, park my butt on the couch, and have the most amazing nap of my life. Just got to get there first. Anyone got any coke?
“I had never done this surgery before,” my preceptor said as he pointed to the MRI on the screen. “I read about it in a journal. Didn’t turn out quite as well as I hoped. But next time I’ll read up on it some more and hope for better.”
As all things in life, practice makes perfect. Medicine uniquely requires one to practice on people. To further complicate things, medicine is always changing. Always improving. Of course, nothing in medicine is ever introduced without extensive testing to guarantee the safety of the people we treat. But eventually, every doctor has to make the jump and attempt that new treatment or new procedure. What happens to those first patients? Their results may be “not quite as well as we hoped.” Our patients unfortunately have to be the guinea pigs.
Even though I was not present for the conversation between my preceptor and his patient prior to the surgery, I can imagine somewhat how it may have transpired. He would have sat the patient down - explained all options. That a current surgery may exist which can help them. That he does not have experience with that surgery. Of course, many people put a great deal of trust in their physicians. When my preceptor explained “I have never done this surgery before,” many would likely hear “but I have done many surgeries like this before” as an unspoken affirmation. How close is that to the truth? How much does previous experience translate to future success?
Ultimately, I believe it is simply a matter of trust in the checks and balances in a system designed for change. As medical students, we bumble around learning the foundations of medicine that will help us function as the physicians of the future. In residency, we learn the skills and instincts that will help us succeed in the field we have chosen. New drugs and techniques are put through extensive trials. Surgeons travel to observe new procedures and read about them in journals. And ultimately it is all overseen by “experience.” Medical students are aided and corrected by the residents they work under. Residents are taught and covered by the attendings of their program. Surgeons learn from their peers who have pioneered and practiced new procedures. Drugs are tested and scrutinized by those involved and educated in their design and effects.
It may not be the best system, but it seems to be one that works. But with all things new, there are guinea pigs. Unfortunately in medicine, the guinea pigs are people, with the physician possessing only an instruction manual and trust in his or her skills and instincts to go on. This means people with "not quite good enough" results (which in reality in some cases means difficulties they will have to live with the rest of their lives). The best we can do is educate and hope for the best. Because it is ultimately about change, and change, as history has taught, is good for medicine. And good for the patient.
Everyone is fascinated with the brain. I spent the majority of my childhood obsessed with neurosurgery. The brain truly is one of those last frontiers in medicine where we still don't understand much about why it does the things it does. As my preceptor said the other day... "don't believe anything they tell you in your classes. everything between your ears is a black box."
This week we took a bone saw to the skulls of our bodies and took out the brain. Anatomy has had its fair share of awe inspiring moments. Taking out the heart. Looking in the knee. Dissecting out the sciatic nerve (its as thick as your thumb!) But the brain definitely takes the cake.
The first thing that really struck me was just how heavy it was. They say your brain weighs around 4 pounds. That doesn't sound like much, but when you hold it in your hands in has some real heft to it. Maybe its the philosopher in me, but I found it really fascinating to hold the organ that has allowed the great mind's over the course of history to make some of the incredible revelations they have. Those 4 pounds have produced Plato's Republic, Shakespeare's Macbeth, Bentham's Utilitarianism. Really cool to think about.
So what does your brain actually look like? Really, about what you would expect it to. I think that was really fascinating. The brain always seems like one of those magical mystical things but it really is just as you expect it to be.
It's also amazing the things you find out about your cadaver as you work on them. The death certificate said our person died of a heart attack but we noticed he had a massive brain bleed which wiped out the whole left half of his cerebrum. Basically, he most likely died of a stroke and not a heart attack. All in all in doesn't matter, but its interesting to think of how many people out there whose cause of death was incorrectly pronounced.
Anyways, enough procrastinating for one night. Back to the grind.
In the words of Seargeant Nicholas Angel from the incredible movie (seriously, see this movie) Hot Fuzz: "shit just got real."
Today marked the first day of our last block of GIE. At this point, we're seasoned medical students. We've become study machines, busting through our lecture hours every morning and meticulously working the dissection of the day in cadaver lab after. Until today. Today, our dissection lab gained 30 new members.
No, my medical school didn't suddenly decide to expand its medical school class from 120 to 150 two months into the year. But today, we removed the shrouds on the faces of our cadavers and began dissection of the head and neck.
Up to this point, the heads of our bodies have been wrapped in a cloth shroud. Besides serving a practical purpose (it prevents dessication of the skin while we worked elsewhere on the body), the purpose of the shroud was the help us rookie medical students adjust to the experience of taking apart another human body in less dramatic circumstances. When looking down at your body or looking around the room, you saw the project for the day. A shoulder. A lung. A foot. Until today. Today if you looked around you saw faces.
Today we weren't working on a body. We were working someone's mother. Someone's grandfather. Someone's child. Suddenly there weren't 30 bodies in the lab. There were 30 people. It really helped tie full circle that the hours we've toiled in the lab really were to give us an opportunity to gain perspective on the human body in order to help... real people. It's really easy to lose that perspective in medicine. In a few days, the skin will be gone from the faces, and we'll be back to working on bodies again. But part of me wishes that didn't happen. As eerie as it is, having those 30 extra people in the lab really is a profound reminder of what we're really here to do. Medical school isn't really about the tests. Or the board scores. Or the letters of recommendation. It's really about the adjustment of learning how to work on and work with people. Because that's what its really all about. You learn the nitty gritty of how to "doctor" in your specific field in residency. Medical school isn't going to make you a great doctor, but its going to give you the tools to start becoming one. Seeing those faces really reminded me of that, just as we all were settled into a routine, trucking along thinking we were hot shit first years who got everything down.
I guess, when it comes down to it, medical school (well, medicine in general) is a series of humbling experiences strung together. Even today, I saw a patient who completely fractured his leg apart two years ago. They tried a cast. Didn't heal. They tried plating the bone. Didn't heal. They tried a rod. Didn't heal. The surgeon I'm working under has exhausted all the options of treatment that he knows of and the patient is now considering amputation of the lower leg because at least he'll be able to walk with a prosthetic. Needless to say, the surgeon is effectively... humbled. I feel for him. And for the patient. Because I'm humbled today too.
Just when you think you have something figured out, you realize you're standing on the tip of the iceberg. But it also gives endless challenges as opportunity to grow and learn. To become better. And I like that. Because what's ultimately going to get you farthest in medicine to isn't knowing everything, but always being reminded that you don't.
I should be studying right now, but like all things in life, there are some things more important than school and one of those things is procrastinating.
Each classroom gains its own dynamic - an ebb and flow of personalities that can make your experience in that class either a joy or hell on earth. Luckily my experience in GIE has landed somewhere in the middle, but since I'm the type of sit back and enjoy lecture rather than furiously scribble down notes, its given me an opportunity to observe some of the idiosyncracies of our lecture hall at this time. Since we're over halfway done with the class and things will soon be changing, I thought this would be a great chance to give you all a look into the what its like to sit in a 160 person medical school lecture hall at god awful times in the morning digesting a truly evil amount of information.
Thus I present... my lecture hall and all that makes it wonderful.
Exhibit A. The Girl Who Sleeps. In my day, I have known many people with an incredible knack for being able to fall asleep anywhere at any time. But of my lord this girl takes the cake, sets the record, and is so far ahead she'll never be caught. 15 second between slides? 15 seconds of REM sleep please! 10 minute break? Why that's enough time to fit a dream or two in! I do not know what makes this girl so perpetually tired, but I am continually impressed at her ability to fall asleep faster than a narcoleptic who's 24 hours behind on their meds.
Exbihit B. The PAs. One day we will work together, since PAs are an essential and soon to become even more important component of our medical infrastructure. But for now... the line is drawn in the sand. There must be no mingling of MDs and PAs under any circumstances. The must be no acknowledgement of PAs by MDs. The PAs must always score higher than the MDs on exam. These are the rules of lecture hall.
Exhibit C. The kids. Adding further dynamic to our lecture hall, we have the pleasure of taking GIE with 7 radiology students. Radiology is a major offered through Portland State University, which means these 19 year olds have the exquisite *cough* pleasure of taking a medical school class with our future leaders of america... I mean future incompetant doctors of america. They resort to cowering in the back row, pretending they don't have to live through such a hell and hoping not to be seen.
Exhibit D. Death to All Who Come Here. These are the achievers of the group. Front row seats please, so I can digest directly from the mouth and not from the microphone all the wonderful insights into medicine our lecturers impart on us on a daily basis. The hierarchy of these seats have been established from the first day. Do not venture into this area and take someone's seat under the penalty of death.
Exhibit E. I didn't put in an E. This serves as further proof I am losing my mind.
Exhibit F. The Computer. Technology is a wonderful thing. Except when lecturers do not know how to use it. There is a guaranteed 15 technical difficulties per week in lecture hall. In case of said technical difficulties, count of some individual from Exhibit D (Death To All Who Come Here Zone) to run up eagerly to help. Because we must learn. We. Must. Learn.
Exhibit G. The Giant Projection Screen. This thing is like 80" big. It puts most MTV Cribs theater rooms to shame. That being said, count on at least 80% of all lectures to have slides with text and diagrams too small read, even on such a behemoth monstronsity.
Exhibit H. You're Late. This space on the stairs is reserved for those special individuals who arrive late. Seats taken? Tough luck. You are cursed to sit on your hard ass for an hour with your binder awkwardly on your lap until break. I think we should invest in pillows for zone H. I might be late on purpose if that was the case.
Exhibit I. Smelly Food Zone. People filter in and out of this zone but one thing is constant... the smell. I think it is required for someone to sit in this zone and open up their wonderful tupperware container of sliced eggs lain all over their tuna sandwhich. Yum.
Exhibit J. Dr. Feelgood. Dr. Feelgood is a general surgeon who helps out in anatomy lab. One caveat... Dr. Feelgood has been banned from the OR for being too old and senile. As a result, Dr. Feelgood uses lecture hall to flex his surgical prowess, challenging all guest lecturers that he knows just as much about the procedures on their specialty and they do. Oh, Dr. Feelgood. I hear Old Country Kitchen has continental breakfast all morning long.
The Star. Me. I do not move... My zone is my happy place.
So there you have it. Welcome to lecture hall.
I apologize for not posting for a while, but well, we've been studying the colon, rectum, and anal canal and I figured I would spare you all the pleasantries of my expeditions into our body's most... aromatic regions. That being said, getting to hear the word "anal" in lecture 200 times a day has still not ceased to be humorous in any way.
We have now moved onto genitalia, so I think I will spare you all some details now as well. Though it has been pretty funny to observe certain classmates of mine who are just now being exposed to many details of female anatomy which I have a hunch they had a very vague (if no) idea of before now.
We have just finished block II of our GIE block. Which means I am now officially halfway done with our cadaveric dissection. Studying for med school tests is hell. Between lab and my neighborhood 23rd Starbucks, I believe I put in around 25 hours of studying with my nose to the grindstone (often a very smelly grindstone) this weekend. That being said, one of the most satisfying moments in medical school is finishing an exam, and when you get home, unloading all that information from your binder because you know longer need to know it. I know, this is sad that this is now a highlight of my life, but I take my perks where I can get them. On that note, I now introduce you to...
The place where my medical knowledge goes to die.
Only a couple inches of paperwork in here now, but by the end of the year, this baby will be full of things I have (somewhat) successfully crammed into my head, regurgitated onto paper for 4 hours, then subsequently purged from my memory over a beer (or several) the night following.
On a completely unrelated note, I am continually amazed by the caliber of physicians that my medical school has in their hospital. Since my last post, I have met a surgeon who is helping pioneer a surgery that is going to replace microfracture, a surgeon who is considered one of the premiere pediatric cardiac surgeons in the nations if not world, a surgeon who is trained to operate using one of only 8 robotics units on the entire west coast. Yes I said robots. The hospital has a robot which performs surgery - a truly exciting field which I have a hunch people are going to see continue to expand over the coming years.
I am also continually amazed at how generous and gracious some of the patients are at a teaching institution. Last week our group was learning how to identify a variety of heart and lung sounds indicating various pathologies. Our small group leader took us out onto the wards to visit several of his patients, including one individual I'll call Stan. Stan had just been diagnosed with highly developed COPD (Chronic Obstructive Pulmonary Disease), an incurable condition which could end his life as soon as two weeks later. I know many people who would be in know mood to even interact with other people after receiving such news, especially bumbling loud curious first year medical students. But Stan simply wanted us to learn, and let each of us listen to all areas of his lungs for the distinctive crackling sound telling of COPD. Why? "If you can learn from me, maybe you can save someone's life one day, or at least prolong it." I am amazed at Stan's generosity and strength, and that even with the end of his life very near in sight, he simply wanted to give as much as he had to offer until the very end.
Not much else to report for now - though I am pleading with several physicians for as much OR time as possible so I am sure I will have some interesting stories soon.
BTW... over 300 hits on the site. That's awesome. Thanks to all of you who check in every once and a while!
