Pretty Laid Back

I'm a pretty laid back guy...

I've always prided myself on being able to distill things down to their essence and then accomplishing them with speed and efficiency. This applies to school, as I got through pre-med college work accomplishing the same as others while putting in 50%-75% of the energy.

I realized that a lot of energy is wasted on things as simple as gossip, freaking-out, and over-studying. The group of super-gunners at my school will study in the medical center for 12 hours straight with no breaks and burn out. I stick to a solid schedule of daily study, leaving time for relaxation, keeping my head fresh for the next day. All the while, I feel relatively comfortable with the material, though this will change as time goes on and things become more unfamiliar and nasty.

We had some "soft" classes today; I think I'll enjoy them because they provide the training for the other half of being a physician: clinical work. Actually, being a good clinician is probably 90% of being a doctor, while the hard-science background is still just as important.

Concepts of Health and Disease: This one is pretty cool. Think of the scenes in House M.D. when the team stands around a white-board and writes down what the diagnoses could be. Only in real life (on previously written-out cases). Seven of us sit in a little conference room with a faculty facilitator. In our case, it's a tough, mid-40s guy from Brooklyn with a thick New York accent. Seriously, the guy sounds like a mobster and you think he's picking a fight with you when he talks, but it's just how he talks! He's a Ph.D. in immunology and microbiology so he's going to be schooling your ass, too. And he does!

His job is to steer us in the right direction and keep us from going too deep into blind alleys. So we started with a case that seemed simple enough; a 45 year-old guy comes into the Emergency Dept. complaining of crushing chest-pain, shortness of breath, all that. Turns out, things get real tough real fast. We're all first-years, so we're all newbies when it comes to real medicine like this. We'd get stumped all the time and the facilitator would have to be like,

"...maybe....do a physical exam?"
"...try asking for a blood test? But be specific!"
"Hold on! Is a cholesterol level of 250 mg/dl really unremarkable?"
"You're missing an important detail!"

It got tough. We'd get to a part where we collectively said, "we need data from a physical exam" or "we need to do a urine test", at which point the facilitator would hand out the results of those tests. With the new data, we'd develop our hypotheses and think of more things to try to narrow things down. Along the way, we run into countless terms, procedures, tests that we know nothing about and have to go home and look them up. He had chest pain, but how can you rule out pulmonary edema? His WBC count was a little high, but that tells you nothing about a possible myocardial infarction. His serum albumin level was this but you thought it should be that...or his creatinine phosphokinase level said this.

It was all over and by the end of the session we only had a vague idea of what might be wrong with lots of data pointing nowhere (because we're all very new). Humbling, exciting!

Evidence Based Medicine: Decent. Not too exciting but kind of fun. Run by the emergency medicine department, so you get to see lots of Emerg. docs and read a lot of emerg. cases. I like that aspect of it. This course is about accessing data and articles and scientific/clinical studies within the scope of practice. It's about using patient data to help your own practice and how to know when a study has valid/invalid, relevant/irrelevant results. Cool.

Well...tonight I'm going to hit some more thoracic-region anatomy. Biochem and molecular cell started off really fast, but mostly college review. *deep breath* Let's do this...

MS1-WK1...over

So week one of MS one is over...meaning now things about only about to begin. All the little orientation activities drove me insane by the end. Lectures are one thing. But sitting through 2-hour session after 2-hour session back to back to back of boring presentations gets really old really fast. One more and I think I'd have just started skipping. I've already found a super-gunner...for those uninitiated:

Gunner = medical student hell-bent on achieving the most possible at all costs. Has no social life, does not go out on weekends, studies every waking moment, and will talk down to fellow class-mates. Extremely competitive. Usually going for surgery, plastics, dermatology, ophthalmology, and in some cases radiology. Always annoying.

This girl wears her scrubs...during morning lecture. There's no need for this, as you're given plenty of time to change around 3 PM before anatomy lab starts. I see her walking around at 9 AM in scrubs, her name-tag proudly and deliberately displayed on the front pocket. Nobody else does this, because there's just no need to. Plus, those are supposedly scrubs from lab...they're likely pretty nasty, unless (heaven forbid) she has a clean pair just to wear for the hell of it during the day. She goes to eat at one of the on-campus hospitals and makes sure everyone sees her, sits in the very front row at lecture, and doesn't talk to anyone. To her, I say: Have fun with that!

Anyway, I really enjoyed the intro. lecture to Molecular Cell Biology this morning. I like the room it is in, and the professors seem very excited, friendly, helpful, and even fun! It's probably my favorite topic of all the classes I'm in right now, so I see it as quickly becoming my favorite class of the semester. Speaking of which, this is my proposed schedule for next week, Monday through Thursday...I think this is a decent start. It's going to be madness, I tell you.

8:00a - Wake up (pissed, no doubt)
9:00a - Arrive at lectures at school
12:00p - Lunch
1:00p - Anatomy lecture (MWF), other classes (TR)
3:00p - Anatomy lab (MWF), other classes (TR)
4:00p - I'm outta here! (TR)
5:00p - Anatomy lab should end (MWF)
6:00p - Get home, grab dinner, shower anatomy-smell off, regroup my thoughts...
7:00p - Off to Barnes-and-Noble/Starbucks/Apartment for focused study
11:00p - Dedicated AIM/phone time for friends/additional study/thoughts of bed?
12:00a - Watch anime episode to cool-down before bed/go to bed
1:00a - Passed out

So, 7-11pm, if I can pull it off, is the most valuable time of my days. If I can make good use of that time and get in the habit of focusing daily, I can keep up (and still, jussst barely). Weekends are a wild-card. I can plan on Friday-night off, but towards exams, weekends will be crunched. Sundays are generally going to be full-on study days as well. You learn fast here that time is precious.

First semester is the big hump, the proving grounds, the do-or-die, the sink-or-swim. If I can get past this huge monster, no more labs await me, ever. Histology and Microbiology lab are nothing compared to the involvement of anatomy lab. Some gems lie ahead, such as Christmas break and next summer, but I'll get to those when they come. Right now? Day by day...

Calm.

Ok, so I've calmed down a little.

Found an alternate route to school that saves 5-7 minutes and bypasses about 8 (count 'em!) traffic lights, giving my car an easier time and increasing overall gas-mileage. Interstates can be crowded in the mornings, but they keep things moving nonetheless.

This first week is pretty light...I like to think of it as a transitional week. The only class I have is gross anatomy (and lab), plus a molecular cell biology (MCB) lecture Friday morning. The rest of the time is (unfortunately) spent doing what I call really soft stuff. Part of my school's curriculum is hard-science; the meat-and-potatoes of medical school. But, of course, they have a soft side that deals with ethics, moral reasoning, understanding patient's social contexts and all that. Good stuff, but I say its best left to specific classes like Intro to Clinical Medicine, which I'm taking.

So anyway, as part of this week, we spend time in ... workshops or modules, talking in little groups and "exploring" these other aspects of being a physician. Reasonable enough rationale, but in practice, it's really boring and annoying. I dread going in tomorrow morning to another four-hour block (8a-noon) of this crap. I'd rather wait and have an extra week of summer, then jump head-first into all my classes.

Whatever. It's just been funny, because here I am, officially started medical school, and I've spent my days playing games and watching anime. That'll all change soon enough, but I can't help but cling desperately to that last shred of freedom.

Ok, this is for real. This path is tough! You work your ass off to get in in the first place, then an up-hill battle awaits you. Talk about needing dedication! I'm already feeling like I'm drinking from a fire-hose and nothing has really started yet. But here are the good points, if there are any:

Textbooks Are History

That's right; virtually no textbooks. I know a 4th year who used none and did awesome. You can easily get by on notes alone. I personally have two and only two text-books. One is the anatomy dissection guide so I can study the cadaver better ($51.00). The other is a hand-me-down from my older sister; an anatomy atlas. That's it. I spent about 1/6 the money I usually do for a semester of college. But here's where it gets nasty. The notes, which you have to know cold, are pretty much entire reams of paper for each class.

I got my gross anatomy note packet (all shrink-wrapped and all) and was delighted! Oh, look at all these notes! It's 1 1/2" thick, thicker than a bible, and has to have around 400 pages! I realized only later that this is just the packet for exam 1, of which there will be 3 exams. Multiply that stack of paper by 3 and you have a stack of paper as high as about 3 Holy Bibles stacked on top of each other. Each page containing loads of information you are responsible for. And that's just anatomy...

Throw in Molecular Cell Biology, Immunology, Biochemistry, and two "soft" classes and you have a sick amount of information to learn, even if only by notes. And that's just first semester of first year.

Overwhelmed doesn't even start to describe what I am.

The fact that I haven't ran to the Dean's office crying "I quit" is testament to my desire to actually do this, so I think I'm going to make it.

Medicine really does threaten to consume you, but I've met enough Emergency Medicine doctors who have big-time lives outside of medicine to be convinced that you don't have to die for it. Plus, my friend from Livejournal graduated from my school and is a 1st year resident. A huge gamer like me, his advice to me was helpful.

I'm overwhelmed. As long as I retain important contacts/relationships and have fun now and then, I'm up for anything...

You'll Spend Less and Less Time at School

Yeah, my schedule is kind of crappy. 8a-5p most days for now. Later in the semester, it cuts back some and I get to come in a bit later, but typically, first semester is by far the worst when it comes to time spent at school. The reason is gross anatomy lab, which consumes hours and hours of time at school. I spend Mon/Wed/Fri in lecture for that class, 1p-2:30p, then hit the lab from 2:30p-5:00p and more if they had their way.

Spending 9 hours a day at school then going home with only studying to do is quite, quite demoralizing and dehumanizing. But there is hope...

All lectures are recorded and posted online. Most are even video-taped and posted online. All recordings are typed out verbatim and posted online. Get this? This means you don't have to come to lecture at all. And many don't. After the drudgery of first-year anatomy lab, the focus shifts to predominantly lectures, most of which I plan to skip. I retrieve the information at home and get a heck of a lot more done. Get this:

A) Spend the hour driving through rush-hour traffic to and from school, walking to and from your car, dealing with in-between class nonsense, lunch, etc to get home at 6:00pm exhausted

B) Get up, study, retrieve lectures, study them, finish a full day of focused work by dinner-time (at home) and spend the evening chilling out/going out.

Yeah, I choose choice B. You'll get just as much (or more) done during a full day at home from 9a-5p then you will from 9a-midnight going to school. Energy is important. Trying to get your best studying done when you're exhausted from a day at school is counter-productive. I'm all for efficient, convenient at-home learning which saves time for better things later.

Now, I can't practice this wonderful philosophy just yet; first year has far too many at-school engagements. But mark my words, I'm going to milk this system for all its worth and get the most out of it. That's how I like doing things and I plan on having fun!

Study Habits

Haven't figured this out yet. In college, I did my most heavy-duty work at the computer-lab, which was a 5-minute walk from my dorm. I can't just walk to places anymore. Studying in my room is looking to be more and more something I don't want to do, but it takes so much energy to go anywhere that I don't want to leave it. My 1st choice is Barnes and Noble; I can get my latte/chai/french-vanilla or what have you, and work efficiently. Then I can browse/buy manga when I'm done! There's a Starbucks really close to where I live, but I like the book-store aspect of things.

I'm not someone who likes studying at school (at all), so studying at the medical library or in a lounge on campus is out of the question. It's a decent campus, but to me it is strictly a tool for using and getting out when possible. I study best at my own places where I'm comfortable.

So I might try studying at home at first when things get tough. Then I'll see how that goes and try at the bookstore and compare the two. Who knows what will transpire. I'm just overwhelmed right now so excuse me.

You Get Used to It

It's not something that many people do, sinking a fresh scalpel blade into human flesh. I wasn't sure if I was putting enough pressure into the incision, but when I saw the layers of sub-cutaneous fascia peel back, I knew I had gone deep enough. Just above that lay the dermis and above that, the epidermis (skin). The epidermis is so thin; such a thin layer of cells to keep your body from catching the endless diseases and infections waiting just outside of it. The skin gave way so easily; a disturbing reminder of just how thin our security blanket is, like the skin on an apple.

The doors of the dissection table opened like a clam-shell, swinging 180-degrees down where we latched them back to each other at the bottom. Underneath lay a shrouded figure, a white-cloth covering a vague human form. I could see toes peeking out from underneath the bottom of the cloth...then, as about 25 other tables were opened, my nostrils flared and I coughed, the pungent smell of formaldehyde overcoming my senses.

We lifted the veil off and discovered an elderly lady underneath, lying sadly but intentionally on her stomach. Her arms and head covered in another white cloth, she didn't seem to mind the attention or the smell; she'd been dead for months after-all. Therefore, she didn't complain when we sunk our scalpel into her head, just inferior to her external occipital protuberance. It was an intense few hours. It took a little bit at first to overcome the psychological/emotional barrier of what we were doing. It's morbid, visceral, fascinating. I thought I'd know just what it would be like, but when you're there doing it...it is totally different. Within 15 minutes me and my lab partners were digging right in (literally). Clamp, forceps, scalpel...it all began to come together...if only it weren't for that strong smell in the air.

A network of large, flat plasma screens litter the lab. From the front, the professor or assistants display examples for all 125 or so students to see. We work fast. Dead bodies everywhere and after a few minutes, it all becomes normal, everyday business.

Anxious

Whenever I go through a huge change or my mind is reeling 10x faster than normal, I tend to have to write to keep things from getting out of control. It is partially therapeutic and it helps other people know what is going on with me. Case-in-point, I began my LJ when I began college back in fall of 2003. Wow...forever ago!

And here I am on the eve of my very first true day of medical school, writing again. I had two days of orientation, yes, but tomorrow is the official, actual first day when the material starts hitting me from all sides! I plan on starting on the right foot, on hitting the ground running so I don't fall behind from the get-go. Daily discipline is how I plan on attacking things; forming solid study-habits early on and keeping up as best I can.

I feel strangely ready and confident, having had practically a year of almost no academic commitments. I have no excuse not to be ready after the huge break I've had. Yet, you slip all too easily into routines, and it will take effort to get my brain churning again. Tomorrow I have some things to do for the school, like some CPR-training (who knows why...), fit-testing (for these M95 masks...), and first anatomy lecture/lab. Eh, it'll go, I'm sure.

I'll let you know how it goes.

First Day? Kind of?

All right, so I had orientation today. A long, boring day of buying materials, meetings, and more meetings.

Imagine sitting in a room with 290 other kids while department head after department head are thrown at you, presenting information on financial aid, student council, and various student services.

I arrived around 9:00AM and ended up being parked right across from the one other kid at this medical school that comes from my undergraduate college. He and I walked together to the main building (Medical Sciences) and got lost in the frenzy of kids and tables. I went to the first table and got my name-tag and folder full of orientation-type goodies. It was an hour and a half of scurrying about, getting money from the union building, getting my (anatomy) locker key, buying packets of notes, getting pictures taken, and other odds and ends. Boring.

We shuffled into the lecture hall for a few presentations from the faculty. A nice Dermatologist lady introduced us to the class she will teach: Introduction to Clinical Medicine: Patient-Doctor Relationship. That class seems like it will be really good. Then the anatomy professor came up...that class looks like it will be a real trip! The guy is really nice and seems cool, though. He told us all about cadavers and how those people died hoping that their bodies would educate doctors who would, in turn, heal many sick people.

Can you imagine the impact then, that these dead people have on ultimately 1,000s of patients? Accomplishing that much after you're dead is pretty cool!

We saw that we would end up having to learn over 10,000 terms over the course of anatomy, and that's just the terms. Agh! What a trip!

A word on the fellow students: boring! I'm sure that as the year begins, I will meet some neat people, but on the whole, typical medical crowd. Sports, boring stuff, sports all over. How did a geek like me get attracted to medicine when nobody else in medicine is like me? I'll never figure out how I share that one common point of interests with all those people.

Anyway, I met Johnny for lunch and he told me the stresses of Dental School. The afternoon was just a bunch of boring presentations from various people, and we took a Meyers-Briggs personality-type indicator. It tells you what kind of personality you have or something like that...last time I took it I got INTJ. But whatever, ya know?

We got it driven into our heads a lot that we will "undergo a transformation from civilian life to professional life", and even the financial guy was telling us about how huge income comes with huge responsibility. Yeah, yeah, I just wish I were in college again where things are actually fun. I'm here to learn a profession, not deal with all this paper-work!

Hmm, so it seems like a really good faculty and school. I have plenty of escapes around my state so I know I can stay sane. I look forward to getting the most out of my school, and then moving on to a really enjoyable career in perhaps Emergency Medicine or Anesthesia!

I'm sleepy. I have more "activities" tomorrow, including the white-coat ceremony.

Confucius

A journey of a thousand miles begins with...a single step. Well, no doubt about that; no way to get around the fact that everyone has to start somewhere, even the most arrogant, high-up guy or gal out there.

I have my orientation tomorrow - the day I consider to be the first day of actual medical school and the end of summer as I know it. We get ID cards, meet professors, meet each other (choke me now), and go through all the cute little motions you have to go through. Saturday is a few more activities (breakfast, tours) and then the initiation ceremony (white-coat). Then I have Sunday off before starting Monday. I'm petrified!

It all begins soon. It's all-or-nothing now. I plan to work very, very hard, but do not plan to be a gunner. I will balance myself and still enjoy life. Here goes...I'll keep you updated.