Anatomy Class

I find her, on her back, trembling,

Her legs swinging high above her head

As if she were climbing an invisible ladder,

Or a branch.

I can't tell if she is really female;

To me, all dragonflies look the same.

I search the ground for a makeshift gurney,

Hoping a tissue paper will do.

The cold autumn kills.

I can’t save her.

In my room, she rests inside a pickling jar.

I watch her breathing, seeing

The vibration of seraphim’s wings

Trembling before God.

Her opalescence overwhelms me.

She twitches, occasionally, in quiet agony.

Her winged body,

Outstretched like a cross

Encrusted in jewels that glisten

In the light from my halogen lamp,

Lies ever more still.

I breathe on her,

Hoping the warmth reminds her of sunlight,

a breeze of summer, a bit of grass.

She barely moves now;

Only a relaxing of joints,

I tell myself,

Only a relaxing of joints.

Night out...part 2

Some people procrastinate by watching TV. Absent one, I write. Since there’s nothing more exciting going on in my life than looking at sections of preserved vaginas, I’m going to recount a sordid act of infidelity I witnessed some nights ago. Some history: Todd and Andy are friends. Andy has always wanted to be more than just friends, but Todd’s bed had no vacancy for several years straight, apparently- until tonight.

Dugan, Todd, Andy and I went to Club Café with several people after the get together at Laurel. I, still analyzing what had transpired between John and me, was oblivious to the drama happening across the table. On the surface, Todd seems nice enough, and Andy’s manners would make him a great doc. He was rather cute. But the alcohol since dinner had made them more crude, and their intentions more obvious. Around us, the meat market was in full swing, set to the beat of Madonna and Cher. Let the games begin.

By my second Diet Coke Todd has introduced us all to his current boyfriend, whose name I didn’t catch but whose Aryan features I couldn’t ignore. He appeared gracious, debonair even, but his hand clutching Todd’s told me he was human too. He didn’t talk much and spent most of the time staring out at the dance floor. Todd and Andy were whispering beneath their breath, and I saw on Andy a devilish grin. Todd excused himself for a smoke. Andy followed. Todd’s boyfriend came running after.

We missed them for 20 minutes, when finally Todd came back, proclaiming exasperatedly “ I’m so fucked….I so want to sleep with Andy, and I want [the boyfriend] to go home, but he won’t leave.” Dugan suggested a solution. “Why don’t you just leave and come back in a while; we’ll make sure Andy will still be here.” It wasn’t as simple. This game of trying to ditch the boyfriend would continue for several hours into the night. Andy would bum a smoke, and Todd would follow with the boyfriend hung to his side. Finally, Todd came back with both his lovers and said his goodbyes, leaving with his boyfriend still attached. We looked to Andy. Sullen, calculating, with a flash of teeth, he has since ordered another martini.

Todd returned unaccompanied some time later to meet Andy. They danced. Hips, shoulders, sweat. “It’s just a one night thing. I used to like Andy, but he has such attitude.” Dugan scoffed. “I’m like, you’re cute, but not THAT cute to act that way to me!” I finished my Diet Coke, palming my phone, hoping my boyfriend would call.

Out of the blue minutes later Todd came running to us. “Shit, I’m busted. That was [the boyfriend]’s best friend; she definitely saw us. Shit!” Andy was now clutching Todd’s hand, beckoning him to leave. He still had that devilish grin. I guess Andy never really took the Hippocratic Oath to do no harm. Dugan schemed further with them, but not before I left. I heard Dugan remarking on Todd’s current relationship. “I’ll give it another 3 weeks at most.”

it's not all about studying

Social life is really hit or miss here, particularly for me. Harvard, being a hop and skip away, is where I spend most weekends with my boyfriend. But there are moments that beckon my presence, like the gay Christmas get-together with other doctors and med/dental students that any self-respecting homo would dare not miss. In my case, my exposure to gay-anything was new and exciting, a mixture of homecoming and coming-out, all for a bit of holiday fun.

We met at Laurel near Back Bay Station, and unlike usual, I was 10 minutes early. The hostess informed me that they were still setting our table, so I was free to sit by the bar and talk to the only other member of our party that was coincidentally extra punctual. His name was John, a tall brunette with a dimpled smile and piercing green eyes. I noticed him before; he smiled at me as I walked in. We talked. I ordered a diet coke; he ordered a scotch on the rocks. Within five minutes of conversation, I realized that I was in over my head. He was hitting on me, and I was flirting back. Badly. I’m not used to being hit on, much less do something about it. He had that look in his eyes, the kind that my boyfriend had (still does) when we first met that was electrifying, only this time it was one I didn't quite catch until it was too late to stop talking. It felt extra bad because we both have boyfriends. While his was slightly late, mine was faithfully typing away at a computer somewhere in the basement of the Science Center. When we finally got up, the bartender “assumed” we only wanted 1 bill.

We sat at opposite ends of the long, queer table. For the entire dinner, everytime I looked up I'd catch his eyes smiling at me, in full view of his boyfriend blabbering on about his workday with patients. I felt guilty, intrigued…more guilty as the night wore on. Before we left he made a point to shake my hand. I, meanwhile, awkwardly introduced myself to his boyfriend, who appeared oblivious to everything but the exhaustion evident on his face. He's a second year dental student, and works long hours. John said he'd offer me his card, but he doesn't have any on him without an expired email address (sure). I didn't offer mine. I faked a laugh and bid him good luck with his job. He promised we would definitely run into each other in the future. I know I'm not holding my breath.

My brief foray into the dating game has taught me this much: the game sucks. Even at this stage where my social life consists of ties with college and tentative relationships with the real world, I can't say I am ready to re-enter the dating pool as an 'adult'. More importantly though, I don't need to. Temptation is ever present, but stability and love is what I have. As a wiseman once said, " It don't matter where you get your appetite, as long as you eat at home." Amen.

Trust me...I'm a doctor (in training!!!)

I suspect that at this point in our careers, most med students are petrified at giving out medical advice when asked. This is a great thing of course, since like most med students I probably couldn't tell you the front end from the back end of an opthamoscope, much less give you cogent advice on your heart condition.

Inevitably, however, we do get asked. A couple weeks ago a friend of mine called nervously with the point blank question: "why is there blood in my stool?" Taking a moment to properly weigh the merit and urgency of the question, I wanted to yell back "OH MY GOD YOU HAVE COLON CANCER! That sounds horrible, have you visisted the emergency room?"

But I stopped myself. I mean, the words just didn't come out like that. Instead, I heard myself asking

"What have you eaten recently?"
"Do you feel sick/under the weather?"
"Can you tell me if it's dark brown/black or bright red?"
"For how long have you noticed it?"
"Are you on any blood thinner medication?"
"Was it hard/painful to pass stool? Was it loose or compact stool?"
"Does it hurt? Where?"

My voice slowed down as my tone deepened. I said things like 'uh huh', 'I see', and 'I understand' with every couple of sentences. I could see myself categorizing the information he was giving me and asking targeted questions to keep pace. I nodded my head as if he were able to see me.

After a while, I revealed that in class I ran across some common conditions that may cause blood to appear in stool. I told him what the research said, but that he should take everything I say with a huge grain of salt. However, I did tell him to make an appointment with his PCP asap. In the meantime, his best bet was keep making observations and bring a sample of stool to the doctors so they can analyze its content.

Somehow, I think the barage of information they keep on yelling at us in class is seeping in. At the very least, the method of questioning a patient for medical history, thinking logically and offering advice based on facts--they're all beginning to structure the way I think. It's exciting, and still very scary, but exciting nonetheless.

residency hours

Clearly, it's too early for me to be thinking about how long residents have to work, but the topic has been floating around my world often enough that it deserves my 2 cents. For the uninitiated, recent trends in American medical education have begun to limit resident work hours to 80hrs/week with some restrictions on 24 hr shifts and various other things. One of my upperclassmen was talking today about how surgical residents that she knew at MGH essentially under-report the hours they work per week by something like 10-30 hours (by the way, this is illegal). These residents apparently under report for fear of departmental backlash from program directors who would like their residents to work more than 80 hours (like back in the good old days) but legally have to follow the new laws. The monitoring board for this sort of thing has investigated programs that violate the law (for instance, Johns Hopkins was recently investigated--I don't know the specific residency program). Johns Hopkins, MGH...these are top places for residencies, especially for surgery. Is this the price for top trained doctors?

The controversy beckons the question: what is really at stake here? Is it resident training (surgical program directors argue that the training for surgery necessitate residents working over 80, even 100 hours in order for them to be trained adequately to take care of patients from A to Z) or is it patient safety (my impression is that there is a correlation between higher risk for patients with overworked residents making mistakes)? I know that the culture of medicine is slow to change, but at high powered and high stake places like MGH, what is truly going on? My understanding from the resident's perspective is that for some, they WANT to work more than 80 hours if it takes that much for them to take care of patients 'properly' and the new laws are compromising their superior training as physicians. For others, the requirement places them in a tight spot, especially if their program directors implicity want them to work over the limit, but by working over the limit they are legally held more responsible for their mistakes, and reporting the whole thing would mean being ostracized by their fellow doctors, perhaps even damaging their future career developments.

What depresses me the most is hearing/reading comments from surgical directors/ older surgeons who says essentially that students not prepared for this kind of work hour should choose another specialty or get out of medicine altogether. Mind you, I think this sentiment is rare, but nonetheless before the rules were applied surgical residencies were legally allowed to work you to death. 100-120 hours of work a week border on cruel and unusual punishment if you ask me, especially considering how a week only has 168 hours in it! It worries me that at the top training facilities in this country for surgeons, the cultural mentality of overworking residents still exist, and the peer pressure to interpret more hours as better training is still being encouraged. What kind of logic is operating if residents are asked to work without sleep, thus committing more errors and possibly compromising patient care so that they can be better physicians later on (to serve a richer clientele) because the patients they practice on now are generally poor?

If the aforementioned is a myth, I'd love to find evidence to debunk it before I have to choose residencies. I really do.

humor...

Is it wrong to find the story below extremely funny? I can't help but feel a little guilty...

From an Immunology professor (partly parapharased, partly quoted--all in quotations):
(imagine hearing this in a heavy British accent)

"I used to have a neighbor, you see, whose wife was sick, and he took her to the doctor to find out what was wrong. Now, I tell you, this doctor--well he's just terrible, absolutely terrible, and well I certainly would not want to be his patient. Anyway, this neighbor of mine had been waiting for his wife's results for some time now, and he was getting rather worried. He'd asked me to go and ask the doctor what was wrong, but of course I can't, you know, because of HIPPA (? sp), and patient confidentiality and all. So I told him, while he was over at my house, just to call the doctor and hear what he says, and maybe I can help interpret some things for him. So my neighbor did call this doctor, and you know, the doctor was just terrible, and he said: "well now I'm so sorry but I've just seen about 60 patients today and I've got no idea which patient is your wife." My neighbor, you know, ever so polite, patiently reminded the doctor that his wife's name was Rose, Rose M. Keller. This doctor then replied, "well, I've got 2 patients here with the name Rose M. Keller, but I can't tell which is your wife...one's got Alzheimer and the other's got AIDs." As you can probably understand, my poor neighbor was then pretty distraught and asked" doctor, this is terrible news, what am I supposed to do, does my wife have AIDs or Alzheimer?" this doctor, (he's terrible, I tell you, absolutely terrible) replied," Well here's what you do: you send her to the market, you see, and if she comes back, don't have sex with her."

The above is a joke. My prof is hilarious.

reflection on missed opportunities

There's no use regretting the past, because regretting doesn't change much. But what if you could re-live aspects of your past? What would you do differently?

Granted the above is an obtuse statement, but in my case, that's exactly what I'm doing. I'm revisiting my alma mater every weekend, hanging out with friends who have not graduated. In a cinch: I'm reliving Harvard. Why? Because not everyone gets a second chance, and there are compromises that I will not make anymore.

This weekend is the Head of the Charles, and the swell of school spirit moved me to put on my House's scarf, wearing it proudly because I didn't have my red Harvard one. At the risk of being mistaken for a Dartmouth student (those poor deprived kids in the woods of NH--tisk tisk) with my green and white garb, I headed proudly down to the River Houses that line one bank of the Charles, brushing pass a sea of Crimson pride in the form of red gortex worn by everyone from babies to alumni. The weekend was also host to a friend's b-day party, the typical kind of Harvard gathering that included good cheap wine from Trader Joe's, great cheeses, and the random conversation about post-modernism sprinkled with references to vaginas and penises. To think, I barely went to any of these things when I was in college. I was either too busy with extracurriculars, studying for biology exams, applying to internships, cramming for the MCAT, or applying to medical school. It's a sad feedback loop really, because once you have decided that as a pre-med you must limit your exposure to the outside world, fewer and fewer friends will want to invite you to go out. More to the point, pretty soon this pattern begins to seem normal: it's normal to stay in on the weekend, it's normal to take classes you hate because you think it'll help the GPA or do extracurriculars that you have a mild interest in but decides that it will look good on a resume--it's normal to be goal driven and targeted at the exclusion of your personal preferences for life.

My revolt against this line of masochistic devotion to 'medicine' happened near the end of college, but it was too little too late. I wished I'd taken more classes I liked, picked another concentration (major), maybe even quit whatever that wasn't working for me and tried something else. But would I still be where I am today had I made these different choices? I'm not sure, but there's plenty of annectodal evidence that had I made different choices I'd still be fine. All I know is that I would have been happier, and that, today, would make all the difference in the world.

Artbreak

Just finished 2 exams on Monday; gearing up for another round of exams this coming Tuesday. We have at least 1 exam every week now, until the end of the semester. I can't say that I have as much free time now as I did at the beginning of the year, but substantive changes to my routines are minimal. The exams have not gotten harder, just simply more material to cover in one sitting. Honestly, one really should never have to be that intimate with phosphofructokinase I, like--ever. I'm glad I know what makes enzymes in the cycles of intermediate metabolism tick--really, it's a great novelty. Having to memorizing all of their names, functions, products, and pathways however, was just masochistic.

The weekly visit to the Museum of Fine Arts, and the art class, is keeping me sane. As a friend and fellow medical student in the program said, "Every week, this is my 3 hours of relaxation. It's so great to just be able to engage your brain in a different way..." I couldn't agree with her more.

We had a visitation today by a poet, Erica Funkhouser. She's currently teaching at MIT, and studied under Robert Lowell at one point. Her poems remind me of Elizabeth Bishop's, but less multifaceted. She didn't really answer any of my questions about her poetry, really, which was a bit frustrating, but I guess that not all poets have developed philosphies about their artform's engagement with other artforms. What I really wanted to get from her was her sense of the differences/sameness between poetic imagery and photography/the visual arts, because so much of her work seems (in a cinch) to invoke the visual language of the photograph--in terms of framing, details, and visual metaphors.

Oh well.

I have to start seriously thinking about my art installation pretty soon. I'll do that after the Immunology & Cell-Tissue Biology exams next week.

X-rays are tricky....(true story!)

Recently, in our Problem Based Learning (PBL) class we were practicing how to make a diagnosis on a case-study patient. We reviewed some x-rays of the patient in question. The patient is suspected of having liver swelling and thus we were hoping to see on her X-rays an enlarged peritoneal cavity (abdominal area) and a decrease in size of her thoraxic cavity (chest area) due to the organs in the peritoneal cavity pushing up against the diaphram.

Anyway, one of my friend, upon viewing two x-rays, proclaimed loudly to the class: "This profile image of her abdominal and thoraxic regions clearly shows that her liver is greatly distended. Just look at that, it's practically outside of her body!"

The rest of us, meanwhile, looked at each other confusingly and said, " Eric, what do you mean? Where do you see the liver outside of her body?"

Eric replied, pointing to a large globular mass on the x-ray: "see here, this is her peritoneal cavity, and isn't that her liver all distended?"

After several seconds of awkward silence, finally, someone replied:" Um dude...that's her breast."

True story!!!

It's a sad state of affairs...

So today in my interviewing class we had a lecture on how to talk to patients on issues of sexuality. The interviewing class is meant as a course to teach students the art of talking to patients and present models for discussing various sensitive topics having to do with a patient's health and life quality. Before the lecture began, the following 'disclaimer' was displayed for all of us to see. It is a message from the Attorney General of the United States. It might as well could have come from communist China:

" The Attorney General of the United States has reviewed the content of this lecture. This material is deemed to be undermining of the values of the United States. The government does not sanction dissemination of sexually explicit information. Only information that deals with abstinence until marriage [man+ woman] will be tolerated."
(bold typeface added for emphasis)


I am appalled, shocked, digusted, to say the least. Mind you, this type of information is to be disseminated to health care providers (or in our case, potential health care providers) so that we may know how to deal with patients in the real world. These broad, sweeping edicts issued from on high to prevent access to life saving information (check it out for yourself; try to go find information on sexuality/sexual health on government websites...the information is scant, if any exists) is greatly demoralizing. Thankfully, health care providers in the real world ignores pretty much all of this. I don't think anybody grounded in the real world could.

To say that the material undermines the values of the United States beckons the question: what are the values of the United States nowadays? Do we live in George Orwell's 1984, or am I still in the nation that embraces freedom of information and embrace of dialogue and reason?

I don't think I want to know.

Sleep

I've fallen back into my old bad habits of wasting time and sleeping late. This is a problem now, as I feel more tired during the day, and less productive at night. I feel even more bad because the lack of sleep isn't necessarily from cramming for exams (I haven't cram for anything yet)...it's more about wasting time at odd hours when I should be sleeping.

A friend of mine, meanwhile, gave me some wise words as we were on our way to interview a patient because she thinks being tired is symptomatic of the onset of a cold:

"Seriously, everyone's been getting sick. We need to drink more water to have more mucus!"

..umm...yeah.

Imagination...101

I have now acquired the basic tools of an artist: a portfolio, drawing papers, charcoals soft and hard, gum erasers, an artist's journal, and a penchant for brooding. This is all for the new art class I'm taking over at the Boston MFA, a class sponsored by the medical school here with the twin lofty goals of exposing us medical students to "thinking outside of the box" while "giving back to the community" in unexpected ways. The course concludes with temporary installations of our art pieces at a local health clinic, along with a few exhibitions at the school of fine arts. To think, I'm getting free studio art lessons and unprecedented access to the museum's resources and collections. I'm certainly not complaining...too much.

However, being told that I need this course to teach me how to be a creative thinker with the implication that, in general, medical students coming into medical school lack imagination is, quite plainly, insulting. For one, anybody who has applied to medical school will tell you the protracted portions of the application devoted to inquiries about one's life outside of the classroom, beyond the lab work and the 'clinical experience'. I remember interviews with questions about "the difference between morals and ethics" and "the meaning of life..." With questions like these, don't tell me that medical students cannot be creative if we passed through these tests of intangibles. Now that's not to say that our creativity is solely about how to best answer questions in order to get ahead. So many of my premedical friends do things for the sheer joy of it: play an instrument, act, sing, read, travel, write poetry...the list is endless. I, for one, love to paint. Are we really the strict-laced, book-worm, antisocial overachievers who really lack any imaginagination except for how best to fight tooth and nail to get the higher GPA? I don't think so. After all, the selection process was meant precisely to weed out these 'uninspiring' candidates. Doesn't the faculty know that? We did make it here by overcoming criterias that creates ridiculous things like those interview questions above while proving that we are well rounded participants of society. Give us a little credit, will ya?

Depression and Med Student

Apparently, it is a big problem. A recent article in the New England Journal of Medicine reveals some interesting, if not alarming, statistics:

" Medical students are more prone to depression than their nonmedical peers. Researchers recently surveyed first and second years medical students at the University of California, San Francisco (UCSF) and found that about one fourth were depressed..."

" Laurie Raymond, a psychiatrist and the director of the Office of Advising Resources at Harvard Medical School [HMS] in Boston, said that she med individually with 208 medical students--about one quarter of the student body--between July 2003 and July 2005. Thirty-one students (15 percent) presented with self described depression-- 20 of them with transient, "reactive" depressed mood that improved with supportive counseling or therapy and 11 who had a history of major depression..." Some rough breakdown of the data in 322 students who responded to a questionaire and were later classified as either depressed (include all ranges of depression)or not depressed. Disclaimer: these data didn't come with p values or margins of error, so take it with a huge grain of salt:

*More Female than Male were classified as being depressed (18 vs 15%)
*More Hispanic, followed by Asian, White, and then Black were classifed as being depressed.
*More first and second years student were classified as being depressed than 3rd and 4th years
* More Homosexual/bisexual were classifed as being more depressed than heterosexual in their respective groupings
* More students with a history of depression prior to medical school were classified as being depressed than students without a history of depression prior to medical school

Among the hypothethized reasons for why being a medical student increases the risk of depression, the article cites Laurie Raymond saying " students see themselves going into a very narrow tunnel...a lot of the depression we see halfway through the [first] year--it's a reaction to having constricted themsevles down to studying these subjects in a very intense way. It's pretty unidimensional." Apparently as well, " all medical students aren't sleeping," concluded psychiatrist and dean of students at Northwestern U. Feinberg School of Medicine in Chicago, "They are overwhelmed, they are working hard, and they aren't having fun socially....of course they are fatigued."

If you're interested in the article, check it out in the New England Journal of Medicine: Rosenthal, Julie M. Okie, Susan. "White Coat, Mood Indigo--Depression in Medical School." N Engl J Med 353;11. September 15, 2005.

Personally, I'm getting more sleep in Med school than I ever did in college (7-8 hrs daily now, as opposed to 5-6 hrs). I'm having fun socially (albeit with my college friends most of the time, but the med school crowd ain't so bad), and I'm going to start taking a studio/art criticism class at the Boston Museum of Fine Arts tomorrow--something I never found the time to do while at college. Med classes meanwhile, are going extremely well.

Let's hope it stays this way.

True Doctor Stories

These stories are hilarious:

A man comes into the ER and yells, "My wife's going to have her baby in
the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's
dress, and began to take off her underwear. Suddenly, I noticed that
there were several cabs, and I was in the wrong one.

--Dr. Mark MacDonald, San Antonio, TX

+++++++++++++

At the beginning of my shift, I placed a stethoscope on an elderly and
slightly deaf female patient's anterior chest wall. "Big breaths," I
instructed. "Yes, they used to be," remorsefully replied the patient.

--Dr. Richard Byrnes, Seattle, WA

++++++++++++++++++++

One day I had to be the bearer of bad news when I told a wife that her
husband had died of a massive myocardial infarct. Not more than five
minutes later, I heard her reporting to the rest of the family that he
had died of a "massive internal fart."

--Dr. Susan Steinberg, Manitoba, Canada

++++++++++++++++++++++

I was performing a complete physical, including the visual acuity test.
I placed the patient twenty feet from the chart and began, "Cover your
right eye with your hand." He read the 20/20 line perfectly. Now your
left." Again, a flawless read. Now both," I requested. There was
silence. He couldn't even read the large E on the top line. I turned and
discovered that he had done exactly what I had asked; he was standing
there with both his eyes covered. I was laughing too hard to finish the
exam.

--Dr. Matthew Theodropolous, Worcester, M A

+++++++++++++++++++++++++++

During a patient's two week follow-up appointment with his cardiologist,
he informed me, his doctor, that he was having trouble with one of his
medications. Which one?" I asked. The patch. The nurse told me to put on
a new one every six hours and now I'm running out of places to put it!"
I had him quickly undress and discovered what I hoped I wouldn't see.
Yes, the man had over fifty patches on his body! Now the instructions
include removal of the old patch before applying a new one.

--Dr. Rebecca St. Clair, Norfolk, VA

+++++++++++++++++++++

While acquainting myself with a new elderly patient, I asked, "How long
have you been bed-ridden?" After a look of complete confusion she
answered ...Why, not for about twenty years -- when my husband was
alive."

--Dr. Steven Swanson, Corvallis, OR

+++++++++++++++++++++++++++

I was caring for a woman from Kentucky and asked, So, how's your
breakfast this morning?" It's very good, except for the Kentucky Jelly.
I can't seem to get used to the taste," the patient replied. I then
asked to see the jelly and the woman produced a foil packet labeled "KY
Jelly."

--Dr. Leonard Kransdorf, Detroit, MI

++++++++++++++++++++++++++++

And Finally . . .

A new, young MD doing his residency in OB was quite embarrassed
performing female pelvic exams. To cover his embarrassment he had
unconsciously formed a habit of whistling softly. The middle aged lady
upon whom he was performing this exam suddenly burst out laughing and
further embarrassed him. He looked up from his work and sheepishly said,
"I'm sorry. Was I tickling you?" She replied, "No doctor, but the song
you were whistling was 'I wish I was an Oscar Meyer Wiener."

--won't admit his name

This I believe...

Unbridled patriotism isn't usually my style, but this article by Andrew Sullivan is too good, and too succinctly correct, to be ignored. At any rate, it is much much more astute than anything you read in the news nowadays, from the left or the right.

3 down!

And...a whole lot more tests to go through. But at least right now, no more tests.
They maybe easy, but the stress of taking so many tests consecutively is rather draining. This Saturday, I will take the Hippocratic oath (a modern version of it, anyway) and formally receive my doctor's coat.

Joy.

John Roberts...

He really has no direct influence on my medical education, but my procrastination bouts have led me to discover the wealth of materials/commentaries on this judicial nominee. In the spirit of full disclosure, I will confess that I hold a mild interest in his past due to his nominal connection with my recent past (is that obtuse enough for you?). That said, he is truly a fascinating person to watch, literally and figurtively. Amidst Senator Kennedy's bevy of bloated, loaded words, Roberts holds his own. His tongue is so sharp it's scary. Is he guilty of obfuscation? I don't think so. The questions just have to be much smarter.

I'm back...

I am in the midst of exams, (3 of them, and 2 are midterms) after only 10 days of lectures/classes. The classes cram so much material into every lecture that keeping pace seems to be everyone's issue. Luckily, my biology background is leaving me with free time (gasp!), while my humanities-major classmates are really finding no time for sleep. I quite frankly found the exams to be too easy, or at least, not worthy of me spending so much time studying for them.

Come to think of it, it is rather strange how over half of my medical class comes to medical school without much of a biological/scientific background (this makes for painfully, agonizingly slow tutorial periods where the most basic of questions have to be answered and re-answered). This is not a really a surprise. Medical schools have been on a humanities-loving streak for the past several years. One only needs to look at admissions statistics to see this trend in motion. Sure, humanities/liberal arts major brings to the table many qualities that one would like to see in a competent doctor (communication skills, for one). But lest we forget, medicine is still a science based profession that requires a certain kind of finesse and skill sets. These skills are arguably best honed in science classes that teach critical thinking. (I love my alma mater for teaching me how to solve lab problems AND how to read Kant, even though I was a science concentrator. The school believed in broad exposures to many ways of thinking. I'm not sure that this is true at all schools.) However, when medical schools divide students into the broad distinctions between humanities and science majors, and then proceed to show a slight preference for one over the other, they are making a leap of faith that the humanities students they pick can make up for the deficiencies in their collegic science education while in medical school. After all, medical school is all science all the time, so they'll eventually get it, right?

As far as I can tell, the humanities students are having the hardest time adjusting to the onslaught of scientific material being force-fed to them during these first months. From my perspective, this material is already watered down: details are missing, concepts are barely touched upon, and jargon is tossed around as if everybody in the class know the vocabulary--all in a maddening effort to keep the pace brisk as we jump from one topic to another. There is simply no way that my fellow hummanities-major classmates have the level of understanding that biology majors have gained from years of study. This is truly a shame, because medical science builds upon foundational knowledge of the basic sciences; the deeper one understands the basics, the better one is at understanding the biology of diseases and treatments. In the short run, it means that humanities majors have a pretty rough time studying for all these exams. In the long run...well I don't know.

Of course they will be competent doctors. But competence, like anything else, can be stratified too.

word on the street...

Friend: "So I hear at Cornell Medical School med students aren't allowed to really do anything with patients."

Me: " Really? why?"

Friend: " Well, the patient population where Cornell Med is located is largely white, anglo saxon..."
Me: " you mean waspy?"

Friend:" Yeah, that which translates to: can sue your ass off if anything goes wrong because they are rich and powerful."
Me: " Well here we get to do a lot with patients..."

Friend:" Yeah, the population we serve is poor, and they don't usually sue."
Me: " That sucks---for them. But then I guess we are luckier because of it..."

-BM

Too poor to play...

Medical training costs money--a lot of money. Forget tuition for just a second (approx 40 thousand USD/year), and lets focus on my expenses after one week of entering school:

Books: approx 500 USD
Medical equipment: approx 800 USD
Office supplies: approx 200 USD
(not to mention living costs such as rent (in Boston no less!), food, and other incidentals...)

Things like stethoscope, diagnostic sets, penlights, among others, all are expensive. I understand that we are buying equipment "to lasts a lifetime" but that doesn't take away from the fact that one will inevitably lose, misplace, or have equipment stolen throughout a career (the professors have stated these facts plainly during orientation). When you lose a 200 dollars stethoscope, it will invariably hurt.

Luckily, the loan officers at Sally Mae have helped put a positive spin on the whole situation, positive outlooks such as viewing your debt as a 'money portfolio,' not too dissimilar to my investment banker friends' portfolios that are *actually* filled with cash. Well doesn't that sound nice. I can tend to my debt the way my friends tend to their annual earnings and 401k's. The only real difference, of course, is that they are actually accruing money, while I am spending money that doesn't belong to me and have to be paid back.

With debts like these, it really is hard to expect anybody to go through with so many years of living in destitution deprived of sleep. There is a reason why doctors are paid so high relative to other professions in the US. Quite simply, without such salaries, I can't pay off my loans! At the risk of medical training being reserved exclusively for those who could afford to pay out-of-pocket (but really, if you are that wealthy, why go to med school? why not just donate to charity and save thousands of African children or something?), loans have to be a fact of life here. Given also that medical students are in school for 4 years after completing 4 years of undergraduate work, and must do at least 2-3 years of residency practice ( I'm looking at specialities with an average of 4-5 years of residency training), the high salaries at the end of the long tunnel seem appropriate. Put another way, by the time I am able to practice with a normal doctor's salary and begin to pay off my debt, my friends would have already secured their retirement portfolios (or is damn close to doing so).

If one were to use the economic comparison between money and time, then the high salary for doctors could be said to be the compensation for the loss personal time it took to receive the necessary training. The equation could look like this:

(loss of prime years of youth + sleep deprivation + debt) = (eventually high salary + satisfaction in helping people + job stability+ relative high social status)

From my point of view, if you just want to help people, there are plenty of other professions out there that could use the dedication (like teaching...). 'Satisfaction from work' alone does not always pay the bills, feed the cat, or send kids to school. Medicine is a business, and compensation rates have to be where they are to continue to attract enough people to go through with sacrifices early on. After all, the common saying "medicine tends to eat its young" isn't exactly a welcoming introduction to this career path.

Welcome to Orientation...

So here I am, 21, fresh out of college, fresh into medical school. My kind of path seems, however, not typical here. The average age of incoming students is around 24 at this school. My classmates bring with them not only a love for organic chemistry, but long term relationships, fiancees--even husbands and wives. Dinner conversations drift naturally for everyone into where best to raise a family and what kind of practice would leave the most time for weekends trips with the kids. Of course, there are still others like me, young and bushy-tailed, and perhaps more prevalent would be the eager mid-twenties-career-switch students with one foot in collegic nostalgia-land and one foot already wearied by their stint in the corporate world. But in this infectious environment, it's hard not to get realistic about our futures. I'm feeling 5 years older already.

The first days of medical school here are all fun and games (as much fun as can be had with powerpoint slides and lectures on exposure to Hepatitis B and HIV that is). We try to bond as a class over 3 legged races, red rover games, and waterballoon toss, and so far the attempts seem to be working. Remarkable, though, is when it came time for each of us to try out our white coats, those lily colored cotton lab jackets that drapes over us like clean asceptic gloves (we're told ironically that this is clothing doctors wear to protect ourselves from the germs of the environment around us). By simply trying them on, I think everyone saw the glimmer of possiblity that, until now, seemed so far away: the chance to become real doctors. We are told we will need those coats very soon for our patient interviewing class. I am scared shitless, but I can't wait to start. Patient interview...as in me, 21 yrs old, fresh out of college, talking to patients within weeks of starting medical school.

Med school is no longer an idea. I'm really here.