Saturday, August 15, 2009

Things'll be different, baby. Promise.

So the new school year starts on Monday, and tomorrow we have our one and a half-hour 'second year orientation,' which the class ahead of us has said is basically 90 minutes of having the fear of God put into us...ie, this year we have real grades, this year even more is expected of us, no more messing around, no more procrastinating and trying to cram everything in two days before the exams, etc. A sort of preemptive strike against laziness; a preventive spanking.
Problem is: this is what I have going through my head 24/7, in stereo and at a volume setting of 11 (out of 10). Do I really need to have the shit scared out of me to do a good job? Especially when I'm already, so to speak, flowing in that direction? Now we have Honors, High Pass, Pass and...*Not a Pass* as grading options, rather than the previous Pass/Fail. Of course, I'm going to shoot for all Honors, but do I need to go to Gunner Attitude Boot Camp tomorrow to get ready for the coming year? Maybe I'll have a little Xanax before I go... Am I high strung? Pas de tout.

And this year it'll be different. Not so much with the studying (I studied a fair amount last year, and didn't generally put things off...just tried to stay on track, rather than trying to learn a semester's worth of material in three days like some people I know...who shall of course remain nameless), but with life. A balance. Social activities, studying, exercising, and perhaps most pertinent for those reading this: blogging. I'm going to update this site, if not daily, then at least 4x a week. Hopefully there will be hilarious hijinks to recount, poignant moments to share, and my strange mix of hippy-dippy idealism and cynical misanthropy to vent. Join the fun!

This first 'block' of courses includes
Pathology, ie: 'When stuff goes wrong,' or 'Looking at the process of disease' or 'The Microscope's Revenge: The Return of Histology--this time it's nasty.'

Pharmacology, or 'Yes, we can make even DRUGS monumentally un-fun. Who remembers what gets processed using Phytochrome 450? Or perhaps more trickily, what doesn't? Hands? Tell me the difference between adrenergics and cholinergics and be smart about it!'

and Otolaryngology, or "The only lecture you're really going to remember is the one about things kids have stuffed up their noses."

Tuesday, May 19, 2009

Why does everyone hate vegetarians???

So I've been invited out for dinner tomorrow night, and the woman doing the asking sent me a list of possible locations. Being the Type-A foodie that I am, I of course check the web sites (and pdf menus--what did those with food neuroses do before the InterWebz?) of all the restaurants and find that 1) They're all pretty expensive, which makes me...uncomfortable, and 2) My menu options are sorely and sadly limited (though not, to be fair, at the Indian place she mentioned).
What is it with Americans and the insatiable meatlust? Grrr.

Saturday, May 16, 2009

Abstinence Only?

So, thank God, Bush is no longer in the White House...but abstinence only education is still mandated in much of the US by state law. There are still abstinence-only government sites up on the web, too...the most interesting of which is 4parents.gov, which offers help in talking to your kid "early and often about waiting to have sex." Waiting till when? Til 18? 21? Whatever the age of consent is in your state (it's 14 in Missouri, and in some states as low as 12, to which I can only say...ew)? Til they're paying their own mortgage? No, silly...until their state-sanctioned, Judeo-Christian marriage! Which means that if I'm going to wait to have sex, I'll have to hold out until I have enough money to get my ass to Vermont (oh, wait--I could just go to Iowa, but then I'd have to live there permanently, because my marriage wouldn't be recognized in Missouri! Oh Joy!).

4Parents.gov also talks about the 'emotional' risks of early sexual involvement...for instance, girls who have sex, do drugs or drink are more likely to be depressed (first, this seems like a chicken/egg situation, and second, um, it seems a little...odd to put doing meth and doin' the nasty in the same category). Obviously, a middle-schooler isn't emotionally prepared for the sequelae of going all the way...but they're still going to, and perhaps it would be better to talk about REALISTIC ways to protect themselves--being assertive about their boundaries, using condoms and birth control, having sex with peers rather than falling for exploitive 'relationships' with older teens/adults--than to act as if the Magic Wand of Abstinence can make all these issues disappear.

Speaking of, apparently Bristol Palin and Jamie-Lynn Spears are working with the Candie's Foundation (I thought they sold shoes...WTF?) advocating--I kid you not--abstinence. Because, you know, it worked so well for them. So here's the real deal: Abstinence-only education and signing of chastity pledges generally does delay the age at which teens have their first intercourse (obviously we're talking hetero, lingam-in-yoni here). BUT when they do finally break down/give in to Satan/get coerced/whatever, they're less likely to use protection. And y'know what? The fact that you waited until you were 17 doesn't make you any less pregnant or any less infected if you don't use a condom.

Friday, April 24, 2009

The Level of Discourse

During our most recent "Practice of Medicine" small-group session, we were discussing interventions for a hypothetical obese pediatric patient. We started off OK, as we generally do, but it only took a few moments for people's real feelings about the issue to make themselves apparent. Let me make something very clear: I love my classmates, I really do; and I have great respect for the vast majority of them. However, even estimable people sometimes believe (and vocalize) less-than-estimable things.
Within ten minutes, we had gone from using the terms "obese" and "overweight" to 'fat;' within fifteen, 'fatty' and 'Porky' had been thrown out (I regret to say that our faculty preceptor was among those to use those epithets, though admittedly in jest). I felt like my head was going to explode, showering my tablemates with gray matter, if I didn't say something.

I raised my hand, and as calmly as I could, said that I would explain the need for change to the patient/family by emphasizing the importance of healthy eating habits and healthy exercise routines, and not necessarily focusing on weight or a need to slim down (In fact, in all but a few cases, it's best to try and keep overweight children's weights STABLE, and let them grow into their 'extra' weight--ie, let a 100 pound fourth grader become a 100 pound sixth grader; no weight loss necessary). I also said, through more or less clenched teeth, that I was not entirely comfortable with the level of discourse in the room, and that placing undue emphasis on weight rather than healthy behaviors could encourage or 'set off' an unhealthy relationship with food, particularly in girls. Another student (a guy!) agreed, and mentioned self-esteem issues, eating disorders, cutting--all those uglinesses that derive from body hatred. "We're going downhill fast!" the preceptor exclaimed, to general laughter, at which point I all but jumped on the table and said,
"We're acting as if precipitating an eating disorder is a remote possibility, as if an authority figure's judgement of a young person's physique carries no value. It does. Yes, there is an obesity epidemic. One in three kids is overweight. But by the time they reach college age, between one-tenth and one-quarter of women have an eating disorder. This isn't coming out of left field."

After this the preceptor sort of propitiated me, saying that in his experience girls with eating disorders actually start out slightly overweight. We reined ourselves in a little bit. I was still struck, however, by how glibly we treated what is for many people a lifelong and seemingly unwinnable struggle against weight issues, and how we assumed that obesity is largely the result of laziness and gluttony--how quickly we turned a medical issue into a moral one, patting ourselves on the back for eating five servings of veggies a day and deriding those who cannot, as we can, run five miles a day. I wanted to say that actually, having had an eating disorder for more than half my life, it would be much healthier for me to have carried around an extra twenty or even thirty pounds than to have done all the things I've done over the years (and still, unfortunately, do sometimes) to control my weight--things that have lead to arrythmias and seizures, things that have screwed with my reproductive and skeletal systems, and most importantly, with my brain. As students at one of the top medical schools in the country (as we are repeatedly reminded), we have a responsibility to become competent physicians not only in the realms of diagnosis and hard science, but in the realms of ethics and communication as well.

Tuesday, April 7, 2009

A to Z of Rare Medical Words

Words I didn't know before I started medical school...in alphabetical order (kewl).

anastamosis-communication between blood vessels

basilar artery-artery located (surprise!) at the base of the brain

Christmas disease-no shit, there really is a Christmas disease. Wouldn't it suck to have to tell someone, "Yes, you have Christmas disease...not Chanukah disease, not Ramadan or Holi disease...Christmas disease. Well, there's your present. Happy holidays." It's a sex-linked hemorrhagic disorder.

decidua--not related to trees; it's a kind of tissue found in the uterus.

enkephalin-a naturally occuring opiate, a la the endorphins.

falx-a sickle-shaped structure, a la the falx cerebri (look it up).

gastrocnemius-the big muscle in your calf.

hapten-a small, separable part of an antigen (look it up again).

imbrication-layers of overlapping tissues in a sutured wound. Use it in an everyday conversation and I'll pay you twenty dollars.

jake leg-paralysis caused by drinking improperly distilled liquor (not related to jimmy leg, which means--I dunno, actually, but it sounds bad. Oh, wait--according to the internet, it's Restless Legs Syndrome).

kallikrein- a vasodilatory peptide, ie, a molecule that dilates blood vessels.

labrum-a ring of cartilage attached to the rim of a joint. But doesn't it sound like a dirty word?

mediastinum- the space between the pleura of the lungs, where the heart is. So, y'know, home isn't where the heart is--the mediastinum is where the heart is.

natriuresis- When you piss away salt. Ie, when your urine contains too much sodium.

obtunded-passed out, to the extent that you don't feel pain when exposed to noxious stimuli.

palmaris longus- a superficial muscle of the forearm.

quinsy- an abcess around the tonsils. Seriously, there aren't a lot of words, period, that start with q, let alone medical words I didn't know before.

reamer-a dental instrument. Yes, it is in fact called that. Didn't you always feel like you were getting reamed at the dentist's?

Saint Louis encephalitis- a viral encephalitis named after the city in which I am now going to medical school. Normally you can't get that kind of deal without getting your MD in a tropical location.

tardive-the adjectival form of lateness. A fancier way to say tardiness-ness, I guess.

unctuous-fatty or oily; One of the side effects of Alli is unctuous anal leakage.

vasa vasorum-literally, vessels to vessels; the small blood vessels that supply the walls of larger arteries or veins.

Wharton's jelly-a form of connective tissue in the umbilical cord that, obviously, has a jellylike consistency. Impossible to eat on toast without vomiting afterward.

Yaws-a tropical infection of pretty much every tissue in your body, caused by a spirochete. Ew.

Zonule of Zinn- double credit! The suspensory ligament of the lens of the eye.

Hope you had fun! I know I did!

Saturday, March 21, 2009

Snoezelen!

Snoezelen rooms have recently come to my attention (actually, they came to my attention a year or so ago when I had a woman from my church tell me she thought I had a sensory integration disorder...make of that what you will, but there is the fact that I tend to be very sensitive to hyperstimulation. I do OK with things generally, which is good since 3rd and 4th year will basically be defined by 'hyperstimulation.').
They are simply these soothing, gentle rooms designed to help chill out people with developmental disorders, with a smorgasbord of subtle, calming sensory experiences available for the client who's using the room. They've been studied in this capacity, and actually appear to work for autism and Alzheimer's Disease (though of course a double-blind randomized controlled trial isn't possible in this case, which leads me to wonder if perhaps we don't need an alternate paradigm for assigning validity to studies; not a complete overhaul, just some new ways of looking at things that aren't so "pill vs. placebo"-centric). I really want one, or to spend some time in one, maybe...There are dim lights, but also things to look at--from my webcrawling it appears tropical fish tanks are popular--tactile experiences like padded walls (no jokes, please), pillows, satin and chenille throws; auditory experiences like soft music or the sound of rain or a babbling brook; Sometimes it's even possible to incorporate smells.
In the meantime I suppose I'll make do by lighting a tuberose candle, covering my lamp with a scarf, and wrapping myself in my fleece throw. It's not the same, but it'll have to do.

Thursday, February 12, 2009

quitting, and the placenta.

One of my classmates was able to witness the miracle of birth today ("Not as much screaming as I expected" was the general jist). What really freaked her out was not the birth itself, but the afterbirth--that's right, the placenta. "It was just this big...thing," she said, her eyes wide. "This mush. It was this big--" she spread her hands, as if demonstrating the size of a prize catch--"And just purple-y and huge and..." Obviously a terrifying thing.

I discussed this with my roommate, a NICU nurse, who concurred. "They aren't pretty. They never show it in movies, either," she said, her brows furrowed. "It's always just, yay, a pretty baby. No placenta. Sometimes when there's something wrong with the baby or the mother, they send it along to the NICU in a bag," she added. "Usually they're nice about it and put it in a black bag so we don't have to look at it. When the fellows come they're always really excited about it, too, because then they can send it to pathology." She shuddered.

The word itself comes from the Greek for "plate" via the Latin for "cake," both emphasizing the fact that the placenta's pretty flat. I've tried several times to link an image, but screw it. Look it up on Wikipedia; there are several images, some gorier than others.

I am updating in part to fill the time I would ordinarily be spending smoking. Also because I have been relentlessly badgered by a certain person whose name starts with a G and ends with an inder. Oh! So, a random recap of today's events, which may be elaborated in a later post:

Today we had the only dental lecture we will ever get in med school. Saw many images of periodontal disease, thrush, malocclusion and canker sores. Take home message: Brush. Floss. Use fluoride rinse if you have to. Just because you're smoking meth every five minutes doesn't mean you can't maintain a basic oral hygeine regime (although admittedly there are other factors at play in the development of 'meth mouth.' If you've never had the pleasure of seeing manifestations of that malady, please do google it, though not if you are eating, have recently eaten, or are planning on eating again, ever). Other take-home message: don't be afraid to get a dental consult, because as a physician one of the few areas of the body you are NOT required to know jack shit about = teeth (Note how I used the equal sign to avoid making a mistake in subject-verb agreement in the previous sentence. Is? Are? Is 'teeth' the antecedent or is 'one'? Because teeth are, but one is. Sorry. Grammar Gestapo.)

I wore my lucky turtle socks today, a gift from a college roommate, and subsequently discovered I'd gotten an honorable mention in the William Carlos Williams Poetry contest (a poetry competition for medical students). Now I just have to get the registrar to affirm that I am, in fact, a student at Wash-U med--because, according to the woman I spoke to on the phone, there was an 'unfortunate incident' several years ago. Erm. Go lucky turtle socks! My precious...

As far as quitting goes, I have my patch on. I have been chewing gum like crazy. Sugarless gum. The gum that warns you that "excessive consumption may have a laxative effect on susceptible individuals." Apparently I am a susceptible individual. Apparently I have also been consuming excessively. And now I am doing other things excessively as well. So that's fun.

Honestly, I think the patch is giving me a bigger dose of nicotine than I got when I was smoking, because I feel really revved up. For instance, I'm not tired right now at all, and I'm normally positively geriatric when it comes to bedtime (at least since I started taking Seroquel, the only thing that has EVER worked to KO my chronic insomnia...though I know one person in my class is achieving similar feats with codeine cough syrup. Meh. There have to be SOME benefits to being sick; I say ride the gravy train as far as you can if you're unfortunate enough to come down with something nasty). Also. Since the PI I wrote to earlier this month hasn't emailed me back, I am now expanding my horizons and sending out my CV to other PIs (that's 'principal investigators,' or 'people who are kind and generous enough to let me come work in their lab for the summer'). Also. I have been cunningly crafting Valentines all week and will spring them on the unsuspecting in the days to come.

Yesterday I had another MRI, of my ankle this time. Stress fracture. Big fun. Hopefully all will be healed in time for the marathon in April. If not, I may have to do the half instead, and I will be disappointed. Sad face.