The Bad Side of the past week

Yesterday was the opening of our first online quiz - all of our quizzes are online and have a "time window" when you can take them on a library computer - and everybody was in a hazy mix of panic and sleep loss. I felt it most during anatomy lab when senses of humor were a little more sarcastic and harsh than normal, nobody could concentrate on their work, and everybody had a slightly stricken look on their face (or maybe it was just me). But anatomy lab was really just the climax of a pretty hectic few days.

The whole thing started building last week when the specifics of the anatomy quiz were announced - what would be covered, etc. The collective blood pressure of the lecture hall raised 20 points apiece. When I tried that night to study, I had to repeatedly focus and re-focus my attention on what I was studying right then. Left to my own devices I would stumble off on a tangent about some random muscle factoid, rare neurologic condition, or anatomical space, all the while convincing myself that this would surely be on the quiz!

Back to reality for a second, I should explain that the significance of the quiz had nothing to do with its grade weight. I could have refused to take it, and still done fine in anatomy...heck, if I aced our two exams this semester I could pass without ever taking a quiz. On the other hand 1) acing both anatomy exams is guaranteed not to happen and 2) it's not about the weight; its about knowing where you stand!

We judge ourselves by looking at others. We constantly ask ourselves if we know as much as the other guy. Did I know more structures than anybody else in lab today? That guy just rattled of every nerve in the back and shoulder...can I do that? Some hold this behavior up as evidence that med students are intensely competitive, but I disagree with that. Competitiveness involves me beating you...somebody wins, and somebody loses. What we have here is slightly different. We're just all really freaked out about our own failure.

This brings me to keeping up. The one mantra that was drilled into our heads the first week of med school was Don't Get Left Behind. You can't forget your studies, because the material will keep coming just as fast, if not faster. But how do you know if you're keeping up? There aren't any sirens or alarms that go off when you're lagging. How then do you know whether you're studying as much as you should; whether you'll excel at school, be loved and respected as a doctor, and find the cure to AIDS, or whether you're...*gasp*...falling behind?

You know by freaking out about insignificant anatomy quizzes, and by trying to read every little twitch and glitch in the med students around you. You know by studying until you dream about muscle innervations at night. You know by blowing your first online quiz completely out of the water, and seeing "15/15 correct, 100%". That's how this stupid little quiz came to mean so much. And that's why by Sunday night I had convinced myself that this single quiz would be the crystal ball that would determine my fate (AIDS cure vs. street bum).

So, its not competitiveness that drives the med student, its something called "cognitive distortion". Just for fun, follow that link and use it as a tally-sheet for how many cognitive distortions I comitted in this single posting.

First Anatomy Lab

As I walked into the anatomy lab, the smell of formaldehyde immediately turned my stomach. Thirty corpses, each laying on a cold metal gurney, were lined up in front of me. Our professors had counseled us that the first day would be an unusual experience, but I couldn’t shake the idea that this looked like a bad horror movie. As I approached my cadaver, I realized that this person – likely someone’s sweet little grandmother – had donated her body to me. She would be my anatomy teacher for the next semester, and would likely become permanently lodged in my memory. This no longer looked like horror, but rather like the greatest gift one could ever give a med student. Of course, I should thank my parents for the second greatest gift you could give, my new stethoscope (thanks mom!).

My four lab mates and I had read and re-read the instructions in preparation for today. Our first step was to clean and prepare the body. Everyone was putting on their stoic face, and doing the assigned steps with remarkable efficiency, but our bright red faces revealed how truly freaked out we all were. I noticed that I kept touching her arm, almost trying to comfort her through the transition from corpse – deceased person – to cadaver – tool of scientific learning. I kept wondering who she was before she died. Was she happy and fulfilled, or had she lived a hard life? Did she die peacefully one night, or had she succumbed to her illness after a long struggle? Her surgical scars pointed to the possibility of breast cancer, but we won’t find out her cause of death until the end of the semester.

Once the dissection commenced, I became wrapped up in the anatomy of the human body, and wondered less often about her life and death. She had donated her body to me in order for me to learn about and appreciate the human body, so I got right to work. Our group worked remarkably well, everyone sharing “scalpel time” and “book time”. One good thing about being surrounded by other intense over-achieving type A personalities is that communication and cooperation occur very efficiently and with few words.

The human body is beautiful. A drawing does not do justice to the perfect symmetry of the trapezius muscle, and the gleaming tendons intricately interwoven through the back. On a many occasions, a member of the group would just blurt out “whoa, that’s so cool”, and we would all gather around to marvel at a certain structure. There was also plenty of “Are we too shallow, or too deep? I think we cut through the muscle we’re supposed to be looking at…”, but overall everyone proved to have a pretty good hand at dissection.

As we zipped up the body bag on our first day’s dissection, I was again hit with the gift that had been provided us. At one point during the dissection, a member of our group pointed out that if we weren’t med students we would go to jail for cutting up a corpse. Even in our first week, we have been given such a privileged place in society. To everyone who plans on donating their body to science…thank you. To everyone who didn’t, that’s cool. Just remember not to get too angry at that jerk who cut you off in traffic; he may be the greatest learning tool a med student could have.

Remember that this post is a fictionalized account. Details about the "patient" were changed and/or just made up. I can do that, you know.

Big Boy School, Week One

My first day of med school (previously referred to as “real” med school, heretoafterforthwith just med school) was uncannily similar to the first day of kindergarten.

I woke up all nervous and excited, with no clue what the day would bring. I had never been to Big Boy School before. I packed my lunch and set off for the University, a little part of me wanting to turn around and stay home…maybe sip a juicebox and watch cartoons. But when I got there, everyone else was milling around (20mins early like the overachievers we are) and I got quickly caught up in the din of school…trying to figure out who I would sit with (the kid with the he-man lunchbox, obviously), where my anatomy group (playgroup) friends were, etc.

Once the professors started teaching about sedimentation coefficients and energetic coupling, the feelings of kindergarten faded quickly. I had seen this all before in undergrad biochemistry and…my goodness…I remembered it! Granted I couldn’t spit out s = MW(1-vp)/Nf on cue, but I felt a long atrophied intellectual machinery start creaking into motion. It felt really good!

My studies surround three courses that describe how the body works at varying levels of detail: Biochemistry (very tiny), Cell / Tissue Structure (medium, but still invisible), and Anatomy (the mouth bone’s connected to the face bone…). I feel most comfortable with biochemistry, and least comfortable with anatomy, mainly because I ate/slept/breathed biochem in college and the last time I studied anatomy was in high school.

Things revved up very quickly this week, and – by modeling my 2^nd year roomate’s study habits – I have so far stayed ahead of the game. While I am still attending every lecture, I have been assured by many that most students end up attending less and less class and studying more and more on their own. This statement may seem shocking and horrifying to you, and that’s okay. But the truth of the matter (as conveyed to me) is that lecture introduces the topic and allows you to chew on it for an hour, but studying is required to make the material your own (to digest it, perhaps), and to really understand it. The pace of information in med school is so fast, that there’s no time to chew your food. You have to just get it in and make it your own.

My Summer up to last Sunday

While my medical school experience officially started last month, "real" medical school started this week. I set out to describe in this post the past week's events, but I kept running against roadblocks as I realized that many people don't know the events that led up to this week. So I really have to start by describing what happened before my first week of school.

I started in July as part of the Generalist Scholars Program (GSP), which selects about 6 accepted matriculants who have a special interest in Generalist medicine (ie Family Practice, Pediatrics, Internal Medicine). While I admittedly don't know what specialty I want to go into, I am drawn to Generalist medicine and to Internal Medicine in particular. It seemed fitting to join the program, given my interests...and also the scholarship monies they offered (I am human... and poor).

During July I spent two weeks at the University receiving a healthy dose of How to be a Great Physician from about 10 physician faculty members. These docs are good at what they do, and they love teaching us about it. While these 2 weeks weren't particularly difficult, the classes reignited my fire for medical school and doctoring.

During the third week of the program, I went out to the boondocks and shadowed an Internist in a city of about 5,000. Shadowed, as it turns out, was a very appropriate verb. I wisked in the door 1 step behind Dr. Johnson(fictionalized), stood behind him while he performed a thorough history, put my stethoscope where he did...paused...looked thoughtful...nodded even if i didn't hear whatever he was pointing out (I'm such a fraud), then returned to my position behind Dr. Johnson.

The real fun of shadowing Dr. Johnson was that I could ask any question I could think of once the patient was gone. I learned alot about the practice of medicine during the visit (quiet time), but I got really passionate about the beauty of medicine between visits (recess). Now, if only medical school would start already...

August rolled around, and I got ready for my first day at "big boy school". But the first week of school was, well, not really school. On Monday, I performed with 3 other students what amounted to a scavenger hunt: Item one, find badge office; Item two find Mulholland lounge and sign lots of forms (yay, forms!), etc, etc for the rest of the day.

Tuesday through Friday everyone participated in Cells to Society. We studied diabetes all the way down to the cellular level (how insulin receptors work), all the way up to the societal level (obesity trends in the US...they're up), and we participated in group interviews of patients who have type 2 diabetes, which is always interesting…but, this wasn't really med school yet! To make it worse, our teachers kept playing up the importance of “keeping up”, basically equating “falling behind” with “you’re a goner”.

By the Sunday evening before "real" medical school, I was a nervous wreck. I was driving back from a wedding in Ohio, obsessing about starting medical school. What if I’m not ready? What if I fail? What if *shudder* I fall behind? I could barely concentrate on my driving, I was so "keyed up"...a term I stole from my mom (thanks mom!).

Needless to say, I didn’t sleep well Sunday night. But things changed quickly the following day.

Big, Bad Post #1

I did it. I have created a blog. While I feel obliged to fill this post with the necessary first-post nonsense, I promise that my next post will concern an event in my life that is actually significant: my first week at med school.

Obligatory Stuff:

The opinions I express on this blog are my own, are quite subject to the winds of change, and in no way represent the opinions of any organizations or educational institutions with which I am associated.

On occasion I may feel led to tell a story about clinical experiences...the operative word here is Story, and it will be fictional. Another blogger's disclaimer writes "Any and all names in my writings have been changed. The ... clinical stories have been altered substantially to the point of fictionalization in order to protect both my colleagues' and my own privacy, and most importantly the confidentiality of my patients. Characters, events, and stories depicted here are composites of many occurrences, patients, and conversations..." (drcharles), and I can't really improve on that. While I will do my best to make these stories as emotionally accurate as possible, I'm still writing fiction (lies).

Lastly, everyone always feels the need to explain why they started the blog. I have been kicking around the idea for a couple of months because a) I find myself checking blogs of friends and family members every time I get on the internet, and it has been a really good way to keep in touch, and b) it turns out I am terrible at sending email updates to those who are dear to me, mostly because I get frustrated with saying the same thing twice (ie how my 1st week was). The punchline to why I didn't just fire up a new blog 2 months ago is that I couldn't think of a snappy name!


Every blogger must have a smart, pithy blog name. Your blog name is to blogging as your lunchbox is to the first day of kindergarten. If you had the brand new He-Man lunchbox that day, you were the most popular kid in school for the next 6 years. Remember that kid who brought his lunch in a paper bag the first day?? Of course you don't, and that's my point exactly.

So, in the interest of my blog name being somewhat honest while also working in that oh-so-satisfying pun, I chose the one you see. Medically, the phrase Visceral Articulations is absurd. It means nothing. I warmed to it immediately though, because I believe that many of the ideas I express here and elsewhere are much less cerebral (logical, well thought out) and much more visceral (impulsive, total crap).

This is my blog. I hope it helps all of my friends and family stay abreast of my life. I'm sorry I'm not better about emailing, but hopefully I'll be able to escape the class-study-sleep-study routine often enough to write about the experience.