Now if I just had something to say

Just found out that my best-bet lab didn't get funded. Damn. It's great how NIH just got a bunch of money, but it doesn't help me because it won't actually get distributed to any labs for quite a while (peer-reviewed grant applications take fricken forever). And I need to start my PhD in about two and a half months. Yeah. I blame the republicans. It's easy to do, ya know? Much easier than writing a billion emails buggng other professors who probably also don't have money or space.

I just want to do cancer research. You'd think that would be easier to arrange.

 Fact #13: "If you're not eating the brains of your loved ones, you're not likely to come down with Creutzfeldt Jakob Disease." Umm...yeah, that was just an interesting quote from class today. I think the point was that prion diseases aren't easily transmissible. We also learned that the man who won a nobel for explaining Kuru, the prototypical prion disease, was a pedophile and just recently got out of jail. 

I am so ready for spring break! 

Fact #12: The worst thing about doing physical exams is the fear you’re hurting a patient. Sometimes, you can’t do the exam without hurting them. You cut out the less necessary things, and you do your best. The patient will even say it’s ok. It doesn’t matter though, because you’re doing the absolute opposite of what you want to be doing. And the worst part is, as a student, none of what you do will actually benefit the patient. You’re just practicing. Any real exam was done by a resident or attending.
There are mean patients, patients with terrible hygiene, patients that sexually harass you*...I'd take any of them before the guy who my exam causes to hurt.



* It's pretty amazing how many patients hit on you. Much more than in a bar or club. Too bad so many of them are addicts or 60 years old or gangsters. (I'm being trained at one of those types of hospitals. And proud of it, yo!)

Why is it that whenever people want to visit me, they pick the weekend before an exam? 

 Fact #11: A sense of impending doom is a symptom, and not just of anxiety disorders. It can also mean a heart attack or a pheocromocytoma, which is a rare adrenal tumor. 

Today we had a seminar on Sudden Infant Death Syndrome. Several parents talked about losing a child to SIDS, and how doctors could/did make it easier. It was really good...in a really sad sort of way. It was informative and helpful. 

So, um, just fyi: never let an infant sleep on its stomach. Put it on a firm surface that is near your bed (not on your bed. yet another thing yuppies do because it seems like it must be natural and therefor good, but actually is not), and keep the stuffed toys away from the child so they can't block breathing.

 

Monday it was all icy out. The whole way to school (2 miles, yo) the sidewalks were iced over, even in front of an elementary school. The crossing guard told me it was a sin, and the city should be ashamed, with all the little kids falling. I didn't fall, though, so I was proud of myself. You'd think Boston could handle ice better, though. I mean, that's the city's major product, right?

Tuesday I woke up to the sound of helicopters. This seemed odd, but it was early in the morning and I frankly didn't care. That evening I got home and found out that there was a huge fire just around the corner. 6 restaurants and a dry cleaning place are totally gone (they were empty so no one got hurt), including (imo)  the best burrito place in the city.

Today we learned about the thyroid! They're good things go have. They are also hard to palpate, unless there's something wrong. Our professor told us that most general practitioners do not even try. This, in his opinion, is because the vast majority of the time a thyroid exam means shoving your fingers into someone's neck so they feel like you're choking them, finding nothing, and feeling silly. This is causes negative reinforcement. He encourages all of us to fight the negative reinforcement, and backed up his encouragement by telling us about several types of thyroid cancers.

We also learned about goiters! They're common in people who grew up in the developing world and did not get enough iodine. In the US, they're now mostly found in yuppies. Specifically, yuppies who feel that regular (iodized!) salt is not natural and wholesome enough to put in their body, so they buy sea salt or something like that, which is very pretty and natural but also contains no iodine. My feeling on natural foods is that it is usually a good thing, but there are limits. Natural does not always equal better or even good. For instance, hemlock is a completely natural product.

Oh, randomly, older cats are prone to hyperthyroid disease. So if your cat gets all jumpy and extra-energetic (you know...hyper), and loses weight despite eating much more than usual, that could be why. Just fyi.

 You know what sounds really, really awful? Pemphigus vulgaris. Owww....

Fact #10: AIDS impacts everything (medically-speaking). Every section we do, every drug, every disease, every disorder, every bit of biochemistry, every...anything, there's a mention of how AIDS alters it or is altered by it, or how AIDS has affected our understanding of it. It comes up over and over and over again, way beyond simply learning to diagnose and treat. It is strange to think that just two decades ago medical schools would have taught things differently. All this information was only just being realized. Now, every organ system we do, we either have a whole lecture dedicated to AIDS or it will come up over and over in multiple lectures. It isn't just that we need to be able to recognize AIDS-defining illnesses, and to treat the virus. AIDS has actually given us a huge amount of information about how various disorders happen and how our immune systems function. I don't know if I sound like a total insensitive jerk writing this, so I want to make clear that AIDS is a horrific thing and that by suggesting it's interesting I don't mean that I am glad it's around, or anything like that. I just mean...I just mean that I think that one of the biggest changes in medical education in the last few decades is that now we learn about AIDS, and that it comes up pretty much every week.

In other news, I went climbing yesterday and my arms are sore. Also, I found my keys. This is a big deal. Oh, and I can't wait to take Esther climbing in Columbus. You are going to love it!

Just had a talk with a possible research advisor for my PhD. He seems like a nice guy with great science (immunotherapy for cancer!!!), and he would love to have an MD/PhD student in his lab. But, of course, funding is an issue. As in, he doesn't know if he'll have any in four months. This is the second person I've met with this week who said that. The fourth person this year. My advisor from undergrad is talking about getting out of research altogether because of the funding climate.
This is not good. I text'd my sister, who is a (very) low ranked person in a government economic office to complain about the how they ought to be making medical research more of a priority. She says it's a recession, and "Don't be selfish now! You WANT to cure cancer. I NEED soda." (The federal government provides her office with free soda. However, she has to drink it surrounded by pictures of Bush and Cheney. She says Cheney's eyes follow you wherever you go. In January she's gonna take one and put it up in her bathroom). 
So, it looks like I'd better go email someone else. Gotta have a backup plan. 
Or I could just ask for a government bailout for cancer research.... Think it would work?

One of the things that bothers me most about medical school is that although we're miserable, stressed, struggling, and often in total panic, we never admit it to each other. I know I'm not the only one who is not having a great time. I know I'm not the only one who's failed exams--I've seen the class averages. The majority of us failed the first biochem exam, for crisake. It is so weird. I think it's part of why we're not that close as class, too. How can you be close to people while hiding how scared and unhappy you are? I've been thinking about it for a while, trying to figure out what is going on. There are a few books I've looked through lately as well, written by doctors who are now much older and have finally casually mentioned to people they went to med school with how completely depressed (many even clinically depressed) they were at that time, only to find out that yeah, so was everyone else. They just pretended they weren't. Damn. I am doing an awful job of explaining this....
So, in my head, I know that everyone is feeling the same as I do. But then I have conversations with them, and they sound all upbeat and they go on about drug interactions and causes of liver failure so confidently. They always seem to know so much more than me, even though I studied 20 hours over the past weekend and couldn't shut my eyes without seeing diagrams of parasite lifecycles. And it terrifies me, realizing how much more there is for me to learn if I'm going to pass the next exam. Talking to my classmates is actually kinda scary. They act so confident. Naturally, I don't want to look like an idiot, so I pretend to be confident too. I smile and pretend like I haven't a worry in the world. It's so stupid, because it just reinforces their need to pretend, too. I thought maybe we do it because we're over-achieving dorks who lack identity outside of our ability to do well academically, but that just isn't true. You can't really get into med school with just good grades, these days. You need all these extracurriculars and good people skills (interviews!), volunteering experience, etc. At least a third of us aren't even straight out of undergrad---we've had jobs, lived abroad, gotten Master of Public Health, done Peace Core, Teach for America, CityYear, and a dozen other things. So no, it's not that our lives are defined by our academics (mine isn't, dammit). As I said, I've been wondering about this for a while, and today I think I figured it out.
It's hard to get into medical school. Most premeds get weeded out (yeah, organic chem! I actually miss that class, now...) before it's even time to apply, and then once you apply, well, you're chances of acceptance are less than 50%. So those of us in med school are damned lucky, and we've worked damned hard to be here. If we aren't happy as med students, it kind of invalidates that hard work. What's more, it suggests that maybe we aren't right for medicine. Maybe we don't deserve to be doctors. Shouldn't people with a real calling for medicine enjoy their training? If we don't, maybe our spot should have gone to someone else. Someone smarter, more mature, with better people skills, more empathy. Maybe we just aren't worthy of medicine. I realized today that that's why I don't tell let on to fellow students (or teachers! certainly not them!) how much I dislike med school. I don't want them to know that I don't deserve to be here. Sure, I logically I know that hating classroom work does not mean I'll be a bad doctor, and the test averages show me that although I'm struggling, it's not because I'm less capable than the rest of the class. But...but knowing doesn't always change how one feels. 
So there's my meandering bit of self-revelation for the day. I'm not sure if it makes sense cuz I haven't caught up on sleep from the last exam (I passed it well enough to make up for not passing the previous one. It's a huge relief). I hope it is at least interesting to someone other than me :-)

 A friend of mine from the med school class above mine recently told me a story from her anatomy days. They had just finished the pelvis, and she was in the lab, studying. Studying in anatomy mostly means looking at the dissected bodies and trying to identify structures. There were a couple of male students at the body next to hers, also studying, She couldn’t help overhearing them—they were frustrated, trying to find something. “Where is it? It’s supposed to be in here somewhere!” “I can’t find it. Let me see the book again.” And finally: “Dammit, where is the clitoris??” Yup. They, as so many men before them, were searching unsuccessfully for the clitoris. My friend of course went over to help them. I hope all their future girlfriends are greatful…

Fact #9: You can have fun with the gunners by playing gunner bingo.
I have personally never played gunner bingo, but I met some who did at another med school. How it works is, before class people make up bingo cards with the names of gunners in the squares, instead of numbers. Then in lecture they distribute the cards, and every time a gunner does something gunner-ish, you can cover their name on your card. If you get five in a row, you have to raise your hand and ask a ridiculous and unnecessary question, and then you win. 

 Fact #8: Much of what we know about the brainstem comes from kinda weird cat experiments. During neuroscience, they kept explaining parts of the medulla by saying what happens if you cut through it in a cat, and then throw the cat in the air. There was even a video of such a cat. The experiments had to do with muscle activation signals, and the vestibular system, and we really did learn a lot about the brain that way, but wow, they threw a lot of cats*. 

Today in the elevator there was a girl with a can of whipped cream in her pocket. A guy pointed it out and laughed a bit. She agreed it was funny, they made jokes about how you never know when you'll need whipped cream. She left, and he made another random comment about how odd it was to just carry around whipped cream. I noticed the grey box in his hand, and say "Yeah, but you're the one carrying around a skull." And he looked at me all surprised. Cuz, well, you never know when you'll need to act out the graveyard scene from Hamlet, right? 

 Fact 7: Dysgeusia (dis-goo-see-ah) sounds like maybe you insulted a goose, but really it means having a metallic taste in one's mouth, and it can be a sign of renal failure. Or your Campbell's Soup was in the can too long. 

It is a good week. Last Tuesday I did not study enough, and then I went home to watch the election returns. It turns out my roommate is, as she put it, a "rabid liberal". I'm liking her more and more, even if she is so young that she got the chickenpox vaccine instead of the disease, and did not know the difference between it and smallpox. Actually, that was kinda in her favor cuz it meant I got to tell her the story about how the Israeli government got confused and almost gave me a smallpox vaccine....anyway we bonded with pro-choice and anti-bush and pro-science-funding and education-funding rants. And then....yay! Obama won!

I'm a bit concerned that people have too high of expectations for him--he is a very talented man with sensible policy ideas who clearly wants to make America and the world better. He is certainly intelligent and gifted, and ran a hell of a campaign. I am proud to have voted for him. But the sad fact is that it is a lot easier for a president to screw a country up than to fix it. I don't think it's humanly possible for him to do or be all that so many people think he can. He's only human, and our government does not work quickly. The senate is not veto-proof for Dems, and even if it were, well, politics is a difficult business. A president works mostly through persuasion (yes, I got that last thing from a book I read for 11th grade government class, but it was a good book). So while I'm very happy, and optimistic, I am realistic as well, and concerned that people are going to be disappointed. If things do go perfectly, well, yay! I am happy to be wrong. I hope though that if people are disappointed they don't blame him and the democrats, because I do believe they will do best they can with the tools at their disposal (ie the US governmental structure and the current international and economic situations). So that's my two cents, completely unasked for.

Tomorrow is veterans day, which I have off school but I got all behind this weekend so I'm going to use it to play catch-up. We're doing the kidney, which is a lot of ion gradients as far as I can tell. It isn't bad, but we had an exam last monday and then started class up again on Tuesday, so we're all really burned out. The next exam is this coming Monday, so I better snap out of it soon. I can't wait for Thanksgiving. 

Saturday my sister was in town, and we went out to eat with a few of my friends and then to a comedy club. It was really good, although she had to leave to meet a friend and so missed some of the best comedians. It was great to see her. I miss her--I hope she moves up here again when she's done with her job. I have this plan where she goes to grad school at the Kennedy School. We have a few years together, and then she is off to build her political career, which will lead to her being president and me getting to go to two inaugural balls. She doesn't know this, though. So shhhh!

Wow, I wrote  a lot. I should stop now!

Why doesn't the LJ spellcheck recognize Obama? That needs to be fixed!

Anatomy is about halfway over, which means the first years have reached the pelvis. Everywhere you walk in the library, there are books open to some very interesting but anatomically correct pictures. I hope they know better than to study in the subway. Later they'll have the head and neck section, where they are issued skulls. A few years back someone opened one on a bus they were taking home for Thanksgiving. It started as a study session and ended with much screaming and the bus pulling over.
This morning I must have been in a hurry getting dressed, because about a half mile from my apartment I happened to look down and realize that I had on two different shoes. They were both puma sneakers--I have two pairs, one of which is older/close to falling apart--and the same size, but different colors. Damn. Kinda embarrassing. Fortunately I keep nice shoes in my locker for days involving actual patient encounters (rather not wear the heals on my 2 mile walk to school) so I was able to change. But wow, I felt dumb. Earlier this week I went to school with my shirt on backwards. This is not a good trend.
 

I was heating up some Quaker Oatmeal today, cuz it's getting cold enough in the morning to demand such a breakfast, and I noticed a cartoon on the back of the packet. According to this no-doubt-very-thoroughly-researched cartoon, it is possible to light an entire house with one shock from an electric eel. How cool is that? We should all switch from oil and coal to eel power! We'd have tanks full of them in our basements, and whenever the lights start to dim, we'd just prod them with a stick (but not a metal stick! That would be bad). Now, the cartoon didn't mention how long the eel shock would work on the lights, or if there was any way to harness that electricity anyway, and I've never learned much about practical electricity beyond how to fix a blown fuse, but I'm pretty positive this will work. PETA will be upset, but we'll just throw electric eels at them and they'll go away.