Monthly Archives: August 2013

Unbearable

I’ve had this thought bouncing around in my head for a while and thought I’d share. I talked about it with my wife already, and admittedly it is a little bit trippy. Stick with me though, because you could use this to start an interesting conversation sometime soon. Or just skip down about four paragraphs to see what I’m getting at. 

What’s the worst pain you have ever experienced? Some readers may have some horrific trauma, like a car accident, perhaps, that left them with multiple physical injuries that were extremely painful. Maybe a compound fracture of long bone, where part of the bone was even coming through the skin? It could be a burn or series of burns, which are incredibly painful. Whatever it is, think back to what it felt like. How would you describe it? Pain is often described with words like sharp, dull, burning, throbbing, pulsing, or heavy. Pain is also the reason most patients show up in a doctor’s office to have something examined.

But pain is really strange. Years ago pain was thought to be a strictly physical phenomenon. For example, if I were to drop a heavy piece of furniture on my foot, it would cause damage to the cells in my foot, which would then send signals to my brain saying “The foot says it is hurt”, and I would then perceive pain in my foot. This misses out on several key components of pain, however. People perceive pain differently, and some are better able to handle it. Even the way we are trained to ask about pain is subjective. If you’ve been asked to rate, on a scale of 1-10, how bad you pain is, that puts me in a tough spot to evaluate. Consider a professional athlete or manual laborer, used to dealing with pain and its symptoms, who tells me this pain is a 9/10. That’s much different than hearing the same thing from a 16 year old who plays video games all night. 

This is where it gets really weird. It might not even matter, as pain is subjective anyway. It doesn’t matter if there is a physical basis for the pain, some people have chronic unexplained pain. Veterans with amputations frequently experience “phantom pain” in the limbs that they lost. Stress can cause headaches that hurt extremely badly. People can experience chronic back pain with or without bulging discs and other physical problems. Treating pain in these patients is confusing. Is pain a symptom, or the problem? Or both? 

I had to put a picture in here somewhere. Get it? UnBEARable? Sorry.

This brings me to the final point I wanted to make here, one that might make you think a little bit harder (or not) tonight. We don’t truly ever experience the world around us. Our body, instead, carefully remains separated from it as much as possible. Consider your skin as one giant shield to keep out everything. The rest of your body is generally sealed off from the exterior, except for one hollow reservoir which cycles air and another hollow tube the runs from mouth to anus. Everything else on the inside is kept at stable, comfortable conditions, similar to climate controlling a building. So our cells exist in this cozy, carefully maintained interior of our body, happy and warm. Everything we sense is then just a relay from nerves to brain, letting us know what’s going on outside of our climate controlled self. When the temperature drops outside and we begin getting cold, we sense that and have mechanisms to deal with it (shivering, moving around, or putting on a coat). 

What if it isn’t cold outside? Is it possible for that sensation to be activated while it’s a nice balmy day? Can the pain pathway I mentioned earlier be started without having furniture dropped on it? If so, it may not matter whether or not it happened, because MY FOOT HURTS. That’s why treating pain must be incredibly tricky, and that’s why pain is weird. 

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I’m Predicting the Future

Friday was a good day for me. I received good feedback from a very intimidating surgeon who facilitates our small group project and scored well on our first exam thus far. I typically finish exams earlier than most of the class, which gives me time to sit around, read, and just generally waste time until everyone else finishes the test.

And so there I was, sitting in the lobby outside the lecture hall after my first exam, still shaking slightly from the extra cup of coffee I drank that morning, returning to all of my normal time wasting habits (Facebook, surfing the internet, etc). That is when I saw another trailer for Ender’s Game. Click the link if you haven’t heard about it yet. The movie is based off a fantastic series of science fiction novels published in the 1980’s. There are four in the series, and each one is distinctly different from the others. I highly recommend all four of them, even if you don’t think you like science fiction. My sister read them, and she doesn’t care at all for science fiction, but she thoroughly enjoyed them.

It also has Han Solo in it, so you have to go see it.

Not only is the book amazing, the movie looks like it was done really well. It has all of the ingredients to be a hit at the box office, except for one little detail. Orson Scott Card, the author of the series, is decidedly anti-homosexual. He has gone on the record and made multiple comments regarding his views on homosexuality and politicals, and that has created controversy in the past. Of course, until recently, he has been only the author of a (relatively) obscure collection of books in science fiction. That is all about to change. His first book is about to become a major movie, and there are billions of dollars on the line, as the success of his first movie could well dictate whether or not the next three are made. Which they should. But that’s an entirely different discussion.

So here is what’s going to happen. I’m predicting the future right now. As we get closer to November, we will first begin to see articles about this upcoming movie, with little blurbs about how the author of the book is homophobic. This will morph into newspaper editorials, blog posts, and news specials about how his intolerant views just aren’t acceptable in modern society. Eventually, a boycott movement will be started, and we may even see people with signs at the theater during opening weekend. In fact, the storm is already brewing.

Everybody loves signs!

I can predict this months in advance because it follows a well established pattern. Do you remember the fiasco with Chick-fil-a last summer? I do, since I head there at least six times a week for delicious chicken sandwiches. The boss of CFA is Dan Cathy. His dad started the first CFA, and it remains a family business to this day. The family is openly Christian (and very generous as well). It should be no surprise that, when asked about their views on gay marriage, they were not exactly supportive of it. Not only did they support traditional marriage and Biblical beliefs, the non-profit arm of Chick-fil-a had given money to lobbying groups that fought against LGBT organizations. Several LGBT groups organized “kiss-ins” at local restaurants as a protest, but with the support of Mike Huckabee, everyone and their mom ate at Chick-fil-a on August 1st to support the company. Since I know several people who work at CFA, I also happen to know that they broke exactly every sales record ever set that day. Many places ran out of food, and still people lined up to buy waffle fries and drinks.

So I predict the same backlash against Ender’s Game later this year. What I can’t predict is the response. I don’t know if the Chick-fil-a mob will all go see the movie in a sort of counter-demonstration, or whether the controversy will generate more hype (and more profit), or whether the backlash will actually succeed in keeping people from the theaters, but either way it sucks. The CFA incident and Ender’s game both show a hilarious double standard in society today regarding homosexuality (and expressing your opinion, really).

I’m not supporting either side in this debate, either. Don’t get worked up over that. Get this. Orson Scott Card is a Mormon. It should be no surprise to anyone that he doesn’t support gay rights. Additionally, Ender’s Game really has nothing to do with homosexuality. At all. Even remotely. In fact, the major themes in the story will make those who see the movie think long and hard about the way they see the world. So when gay rights activists pick up on his beliefs and decide to organize a boycott of the film, they get coverage and support. Consider an opposite scenario, where I decide that Tom Cruise and his crazy practice of scientology is too much for me, so I organize a boycott of his film. Even if I got all of the Mormons in the state to boycott the film, I doubt I’d generate the firestorm that is surely coming this fall. That’s one half of the problem.

Now I arrive at my main point. Orson Scott Card could believe he worshiped a giant panda in outer space and I’d still see his movies, if they were good. The same first amendment rights that allow musical “artist” and general douchebag Macklemore to sing/talk his way through seven minutes of his own opinion is the same first amendment that lets Orson Scott Card or Dan Cathy express their own opinion. If you plan on skipping Ender’s Game because Orson Scott Card is “intolerant”, I hope you see the irony in refusing to acknowledge his view out of your absolute belief in your own. Tolerance, after all, is not a one way street. Get over yourself and try to enjoy a good movie.

Or don’t. Go make signs and demonstrate at your local theater. Who knows….you just might make it on the news.

Rusty Iron

After gorging myself on a delicious, satisfying, probably diabetes-inducing dinner, I sat down and proceeded to study for about an hour and a half. This is pretty typical for me, since I don’t study well late at night and prefer to relax and spend time with my wife in the evening. I also go running in the evening, since my part of the country boasts disgusting heat and humidity for 90% of the summer. To compensate, I run at dusk. I could run in the morning, I realize, but I’m lazy and want to sleep, so that never works.

So two hours after the carb fest I called dinner, I laced up my shoes and headed out to a nearby trail to put in my nightly run. Since moving a few weeks ago, I have managed to run at least 4 days a week, even on some days where I just wanted to sleep, play Xbox, or otherwise vegetate myself for a few hours.

What a happy potato….wait…is that cannibalism?

I have been attempting to retrain myself in this whole running endeavor. It used to be that my “shortest” run was 3 miles. Anything less than that didn’t count as running. This was probably drilled into me by years of high school cross country. I am trying to adjust that setting to 4 miles, a run that I can usually fit in right under 30 minutes. Usually. Not lately. See I am now almost exactly two months removed from the Ironman. I can no longer say “I just did an Ironman” and value size my meal at Chick-fil-a (I still value size, I just come up with different reasons).

Who’s hungry?

I am now at the point where I must stop “recovering” and begin “exercising”, and that means running. Why? It’s simple. I don’t like swimming, and the pool is 6 whole minutes from school, and that’s way too far out of the way. Also, I don’t really like swimming. Cycling is time consuming. What I can accomplish in an hour of running would take about 3 hours to accomplish on my bike, unless I ride it on the trainer, which is also pretty boring and hard to justify unless it’s snowing outside.

Yet another problem: after the Ironman, I did not do a good job of recovering. In the two weeks immediately after the race, I went out on two or three bike rides with my very persuasive wife and some friends, and those did NOT go well. Stupidly, I also tried multiple times to go for short runs and loosen up, also without success. I had no rhythm (thank God for spell check, I never get that word right on the first try), couldn’t keep a tempo or pace, and everything hurt. I realize now I should never have done that. One bike ride in particular prompted me to declare the need to not bike for a while. I think that was about a month ago, and I just now am beginning to feel the slightest desire to cycle during the fall. Maybe some shorter rides on the weekend with my wife will be fun.

Back to point, which is that this combination of Ironman “recovery”, starting medical school, and generalized chaos in my life has led me to become fat. Just kidding, I’m not fat, just much heavier and slower than I have ever been (AKA fat). Which is why this daily four mile run started out at a crawl. The first evening I tried it I ended up walking quite a bit of the hills. Yesterday I finally ran it in 29 minutes and felt pretty good the whole time. I’m enjoying running, and will need to run some more to compensate for all of the sitting I’ve been doing.

That’s the last part of this picture. A typical day for me now involves at least 6 hours of sitting in lecture, a few more hours of sitting while I study, and then to relax after all of that I will sit in a different place and do other things like blog or watch Netflix. Combine this new sedentary schedule with my pathetic weakness for carbs and sugary drinks (sweet tea, Dr. Pepper) and I am well on my way to becoming a fatasauraus. Ultimately, I need a race in my future to get me motivated, preferably another marathon. It’s hard to motivate myself for that quite yet, so I will just work on speed and strength on my own. In the process, I may just fall in love with running all over again.

Note: You may have noticed that I posted twice today! That does occasionally happen, since I sometimes finish two posts in a day from draft. Also, I tend to post most often when there are other pressing things in my life I need to be putting off until later (like this first exam coming up).

Thanks for reading!

Sharp

One week down. Arguably, this may have been the easiest week of medical school we will yet experience, but I am starting to get a feel for the routine I will need to establish. I have been waking up a few hours before lecture and having breakfast while reviewing material for lecture that day. I then head to class and attend all of the lecture and small group sessions (this is around 6-8hrs a day). After that I have time to go home and get a quick run in before I grab dinner and spend perhaps another hour reviewing what we went over. That gives me plenty of time in the evening to relax and unwind a bit. This will likely change when exams and quizzes come around, but I seem to be getting through the material with pretty recall so far. In two weeks my wife will finally move in and start her new job, forcing me to do things like “clean” and “shower”. Lame. (just kidding, I actually do most of the cleaning because I have a thing about cleaning)

I went to a panel earlier this week. The AMA sponsored several fourth years with high board scores and strong residency applications to come and give us some advice on Step 1, study habits, and other things that they learned during their four years of medical school. The most common theme in their advice was to enjoy the first few years of medical school, make friends, and study enough to pass. There is no need to study for Step 1, try to shadow, or do anything extra, according to the fourth years. Just pass your classes and set yourself up to do well in the coming years.

That’s kind of hard to hear, especially since we are all eager-beaver first year students. Every single student attended training to volunteer at our campus free clinic that offers healthcare for uninsured in the area. Several people in our class are working on getting research spots in labs. Why? Probably because most people in our class are pretty smart.

That’s a generalization, don’t get me wrong. There are several people I have already noticed seem to be a few fries short of a happy meal, but most of the class seems to be generally intelligent. I can tell this by the attitude in the class. In every class I have ever been in that was considered “hard” (organic chemistry, anatomy, even general chemistry for some people), every lecture was followed with something like “How are we supposed to learn all of this? We covered so much material today! There’s no way I am going to learn this!” Even after flying through a lot of Cell Biology in this first section, I have’t heard a single person mention feeling overwhelmed or even the least bit daunted by the volume yet. There is this feeling of grim optimism/determination to get through the material and do well. I like it. It’s contagious.

So there are lots of people that are really good at a huge variety of things. Last week during venipuncture practice I discovered that a new friend of mine has years and years of phlebotomy experience and could probably draw blood from me blindfolded. I managed to get my sticks done in one shot (beginner’s luck) but I felt like a baby giraffe trying to walk for the first time. I got the job done. I was also told repeatedly that I have great friends, and my partner got envious looks from the girl next to me, who had spend quite a while searching desperately for a vein in her partners arm.

I also went to a lecture given by a neurosurgeon at our associated hospital who is a total stud (I go to these lectures for the free food, by the way. I’m not a gunner or anything). What I thought would be a Q+A session for the gunners looking for neurosurgery residency spots ended up being a video demonstration of this guy doing cranial bypasses, stitching vessels together under a microscope with thread so thin that the naked eye can’t even see it.

The AMA panel featured people who had scored “240+” on their Step 1, and I happen to know of a certain first year who sits behind me that scored north of 42 on his/her MCAT. Yikes.

So all of these smart people are currently studying hard for our first exam type thing this Friday, and I’m writing online while waiting for my car to get a new set of tires (and it’s taking forever). Then I realized that I do have some advantages going for me, if I think very hard. I certainly have an advantage in physical endurance. I’m the only triathlete in the class (unless someone is living at home and watching lectures online), and I have stood out at the first few softball/frisbee/football games, so I’ve got that going for me. I also probably drink the most sweet tea of anyone in the class. That’s about it.

Sweet, my car is ready. Thanks for reading.

Mind Games

Have you ever taken an IQ test? A real IQ test. By real I mean it is not online, administered by a professional, and takes a few hours to administer. If you’re like me, this probably doesn’t sound like much fun. I had to take one of these back in high school, and it was really interesting. 

One of the exercises was simple memory recall. The person doing the test read me numbers, which I parroted back to him. It started out with him saying something like “Four, six” and I would obediently reply “Four, Six”. Of course he kept going, and next thing I knew I was trying to remember upwards of a dozen random digits. Here’s a test for you to do at home. Read these numbers to yourself, out loud, then close your eyes and try to say them again from memory. Ready? Go.

14829731864

How many did you get? All of them? Most of them? Three of them? Doesn’t matter. Here’s the second part of the test. A different set of random numbers. Repeat the test above

1 583 548 9624

I bet you got most of them that time. Why? Well it’s a phone number! Turns out brains can remember things better when they are grouped into chunks like this. That’s why phone numbers have their distinct pattern of groups, and some states have license plates that consist of two groups of numbers and letters (the phone example isn’t as good as it once was, since most people my age don’t actually know any phone numbers, as they are stored in our iPhones and not our brains.)

That’s a memory trick. Sitting in that IQ test in high school, I began doing this naturally when the numbers I had to remember started to get bigger (more than six stressed my little brain).

So today we were handed our syllabus in class. In most classes the syllabus is a sheet of paper with basic course info and contact info for the professor. At my medical school, however, the syllabus is a set of phone books that, when stacked, are about as high as a coffee mug. They represent the sum total of everything we need to learn before October 4th, at which point we will be given a new set of books and start over. The administration itself has likened the process of learning all of this to “drinking from a fire hose”.

A Dean actually used this slide during orientation last week

So I’m pretty interested in memory tricks. I bet you are as well, whether you are in medical school or elementary school, much of your academic success relies on your ability to retain information and supply it when required on exams. Eventually, just knowing the information is no longer enough, and you are actually required to apply it solve new problems (gasp). 

My school is offering optional memory training sessions for us later in the year, but I need to be learning things today. Thankfully, Year One of medical school is also just like starting 17th grade, so I already have some tricks up my sleeve. Hopefully I’ll learn more and share them with you all (both of you that read my blog 🙂

My first trick is to start with what I know best, then work my way to the hard stuff, then recap on what I know well. This is like…uh..building a bridge over a river, begin and ending with familiar, solid ground. I do this because it helps integrate the harder stuff with the easy stuff, which is my second trick. Some things are just stupid and impossible to learn (I’m looking at you, Organic Chemistry). In these instances, I’ve always benefited by trying to understand how something I don’t understand (that’s pretty much everything) is like something else I do understand (a very small and useless set of knowledge, by the way). 

I also study actively. I don’t just read my notes while watching Netflix. I may have just lied. I sometimes do that, but I first go through and actively outline chapters, draw pathways, summarize systems, etc. This is not a very eco-friendly process. I use up lots of plain paper and sticky notes trying to put all of the pieces together, but then I’ve usually got it. Some people are freaking geniuses and can sort of glance over material, scan it into some freakish mental hard drive, and just recall it at will (I’m not bitter), but I am not one of those people, and you probably aren’t either. Grab your pen or start typing, and the info will stick better. 

Final memory/study tip before I call it quits: go for a run. Or exercise somehow. If I were a responsible writer (which I’m clearly not), I would link to some journal article with a clear positive correlation between exercise and academic success. All I can share is my own personal experience with running, and I KNOW it has made me a better student. Also, I find it hard to believe that having gallons and gallons of highly oxygenated blood pump around your skull a few times can be anything but beneficial.

Class is going well so far. My greatest struggle has been staying warm in our ridiculously frigid lecture hall all day. I’m going to wear a sweater to class tomorrow in the middle of August…crazy. 

Thanks for reading.

 

 

Ignorance is Bliss

As I sit at my desk on this last final beautiful day before med school really gets started, I think it appropriate to make a list of all the things that make me excited or nervous going in to my first full day of lecture. This could very well be my last day of freedom, as one of the MS2’s mentioned in an email to the class today, so I intend to enjoy every last second of it.

– I am excited that I have made so many friends already. Through the last few days of orientation I have met lots of guys that I like and whom (who? whom? I don’t know) I believe will make great friends through school. It’s easy to overlook how much better my day seems knowing that I have people to sit with through lecture and during lunch break, instead of wandering around by myself all day.

-I am excited to begin with material that is somewhat familiar to me. After reworking the curriculum, all MS1’s now begin their first year with Cell Biology and Metabolism. Since I majored in this for four years, I ought to know a thing or two about it. At least that’s the plan, I’ll get back with you in a few weeks and let you know how that went.

-I’m nervous about the volume of material. I think everyone is nervous about this as well, but I’m more nervous about not knowing what is expected. Hand me a big thick book of stuff to learn, and I won’t be as nervous, just because I know what is expected.

– I’m excited to know that I belong in this group of people. There has been some discreet MCAT and GPA sharing among certain people, and I am happy to say that my “stats”, as they are, place me squarely in the middle of pack of people I have talked to about such things. As one of the Deans mentioned last week, “Half of you will fall below the median on the first exam. For most of you, this will be the first time in your life that has happened. Most of you grew up as the smartest kid in your classroom, and that will change here.” I figure that if, in a room of smarties, I fall right about at the average, that’s probably all right. If I beat the average on the first exam, I’m getting lunch at Chick-fil-a that day. (any excuse for CFA)

– I’m excited to learn. I’ve always been kind of a dork, in that I enjoy learning things just for the sake of learning them, and so I have always been excited for each school year to start. This year, however, there are no grades. We either pass or fail. The emphasis now seems set on learning the material together, so hopefully we won’t have as many gunners and tools in the class as some friends of mine report having at their medical schools on a graded curriculum.

-In general, this feels pretty similar to the day before the Ironman. In both instances, I had a huge challenge sitting before me, and all I wanted to do was start. Before the Ironman, I had spent so much time being nervous that I just wanted to start checking things off of my list. Swim? Check. First lap of the bike? Check. In the same way, I have a lot of medical school in front of me. I’m ready to start checking things off that list, so long as I don’t disregard the journey for the destination. One of my least favorite quotes is “Wherever you’re going, that’s where you are” (most typically seen on advertisements and such). If you are going someplace, you are, by definition, not there yet. Be present wherever you are, and you’ll enjoy your destination more when you arrive.

Also before the Ironman I had a hefty dose of ignorance regarding all of the pain I was about to experience, and that ignorance (also the fact that I paid a lot of money to be there) was the reason I waded into the water in the first place. (This analogy kind of falls apart here, because even now that I know exactly how hard an Ironman is, I still fully intend to do another one. Triathletes don’t make any sense…I know). And so I have no clue how many hours of studying and lecture lay ahead (about, 8,250 according to the Deans), or how many exams there will be (45 in two years) or the difficulty of the exams, or any of the stressful things to come, but I’m excited to get started, and I know the journey is going to be worth it. That’s why I’m excited to dive in.

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Paying Your Dues

Medicine, as a profession, has a reputation for taking a long time. Doctors go to school for years and years, often not beginning their careers in earnest until after turning 30. So it’s pretty common for people to comment on this fact when I discuss what medical school I am attending, what kind of doctor I will be, etc. 

If you think about it, however, this isn’t too dissimilar from many other professions. I have friends that are business majors, some in my class and some in classes before me. After their undergrad, many have gone back to do graduate work, as the four year degree is less and less competitive. The two years they spend in graduate school is mostly the same as our two pre-clinical years. Another trend I have noticed is that business majors often spend several semesters doing internships, often after graduation. Even once they find a position, it is often entry level, and they must work for several years to become a partner, a VP, or an established member of the company. 

This is much the same as medical training, except that in medicine we formally identify the period of working a lot for very little money as “residency”. In the business world it’s just this vague idea of “paying your dues” or “working your way up”. I’m not too worked up about the time commitment I am making to medicine, as I know any other field I would consider would mean similar time frames. 

On this note, however, I do have a decision to consider. Do I take out around $180k in student loans, to be repaid over the course of 5-10 years of practicing medicine? Or should I instead opt to go with a service scholarship, resulting in no debt but extra years of “paying my dues” to the military even after I finish residency. I have to admit, leaving school in a few years with no debt is very tempting.

That’s pretty much it for this post. I drafted it a while ago, and since then have attended a fancy social dinner at the beautiful home of a certain doctor on faculty here at school, further reinforcing my belief in my ability to repay these loans on my own. I can also say that “orientation week” really translates to “drinking at various places around city”. I’m pretty sure this holds true for most medical schools. 

Thanks for reading.