wallet biopsy

So err, I'm very embarassed to admit that I've spent, to date, over 1000 dollars for this USMLE step 1 board exam business. 470 dollars to sign up for the exam, and close to 800 dollars worth of review material. I suppose it is rather sad that one would need to buy comprehensive review books when arguably medical school is supposed to teach all this material in a comprehensive way. However, it is a fact of life that school curricula (specifically at this school) are blissfully ignorant of the type of material and presentation that is on the USMLE. To put it another way, as a friend recently confesses, my knowledge base is more like a disparate series of wooden rafts bound together with twist ties, and life thus far at this medical school has been spent jumping from raft to raft, adequate enough to avoid drowning, but not good as a base for anything substantial. To be fair, many classes here are taught remarkably well and are comprehensive. But it's a pity that those courses are in topics that are considered minor on the USMLE, otherwise know as 'low yield'. The truth is, there is simply too much basic scientific material to be presented, and while a broad knowledge base is the aim, the result is often spotty coverage. To be really thorough, this process of basic science education would probably take 4 years, if not more. The content based exam, alas, tries to ensure some kind of uniformity in medical graduates, and that is a commendable goal. That still doesn't make studying for it any easier. Or cheaper.

And so it begins:

The free-fall.
I have to sign up for the step 1 USMLE tomorrow. This is the firstpart of the medical licencing board exams. The exam is in June. My, how time flies.

photoeye

Food for thought

Ok, I'm been meaning to say this for a while now, so I'm just gonna go ahead and speak frankly:

Why are the dental students so damn hot?
Clearly their admissions criteria involved some sort of photographic screening process. Unfair, so unfair.

One gram...

"One gram of tetanus, botulinum, or shiga toxin can kill about 10 million people...1 pound could theoretically kill all humankind."

-from my Infectious Disease book: Schaechter 's Mechanism of Microbial Disease

Body World

I don't know how I feel about it.

Yes, it's kinda neat, and having dissected cadavers, I do have an appreciation for the techniques required and such. But there's something about the way the bodies are posed that's very disturbing, the juxtaposition of death and art that's very Damien Hirst in a way, but more directly confrontational. Although not novel, the exhibit is fresh (pardon the pun) in its 3-D exploration of the human condition, a stripped, biological indictment of life and its varying effects on the body. Controversies about consent aside, the very idea of a biological display of human curiosities is very carnivalesque, and I suppose that's one of the reason for my inherent uneasiness about the whole thing. To be fair, I've seen old anatomy textbooks with illustrations of Man holding his own skin, or a 'thinker' stripped of his skin to reveal muscles in motion. Still, an illustration of motion is different from actual human remains posed in motion (I'll get back to the posing later). Medical uses of cadavers, although illustrative, are different. The teaching there is less about wonderment about the body, and much more so about practical principles of anatomy and organization (although again, wonderment comes with the territory of having your hands on someone's once beating heart). Secondly, part of the experience has to do with allowing the bodies to eventually decompose, to return to their families. The human condition is realized in this case, whereas plasticized samples of human corpses seem denied of this finality (and the emotional/cultural norms that comes with it), and it's the viewer that's doing the denial.

I say this fully knowing about the canopic jars filled with dead babies floating in formaldehyde in the anatomy lab at the school. Something about that unnerves me too, but the necessity there is about education, and I think the argument can certainly be made here as well. The public does get an educational experience from all of this, and so what if the exhibit people want to pose the bodies so as to get more variety into their 'show'. Maybe it's the posing that disturbs me more; the false life bestowed upon the lifeless seems incongruous with how we think dead people should be:eyes closed, lying flat, and in general, non-confrontational. So is this art? Is it spectacle? Is the 'education' worth the spectacle?

I'm conflicted about it.

pic stolen from here

Something in the water? Maybe?

Sometimes all it takes is five minutes to tell the difference between a good lecturer and a bad one. Even less to tell who is speaking out of his ass. It came as a pleasant surprise to me the other day to hear a series of lectures delivered with clarity, insight and energy come from lecturers at this medical school. I was struck by how eloquent the information was presented, how organized and clear the lecturers made their slides, despite cramming tons of primary literature into the process. It reminded me a lot of lectures at Harvard, especially those from the hummanities and social sciences. One of the lecture at the medschool recently was about smoking and smoking cessation. Yeah, we've all heard plenty on the topic, so I was gearing myself for yet another boring hour with lots of repetitive rhetoric and probably obscure, poorly explained facts. Instead, the lecturer was funny and precise, and she gave plenty of interesting facts:

1) there's very little convincing evidence that nicotine causes cancer (other components of smoke cause cancer)
2) smoking increases wrinkles, infertility (both sexes), early menopause, blindness, hearing loss...etc
3) never too late to quit (even after the age of 65, incremental reversal of pulmonary (heart related) damage happens very quickly, and can add years to life)
4) clinical trials for several new drugs are quite promising at helping people to quit
5) an exciting clinical trial that's going on right now for a nicotine vaccine, with the theory that if we combine nicotine with a hapten and trigger an immune reaction, the nicotine-antibody complex is too large to cross the blood brain barrier, and people who smoke (after receiving the vaccine) would never get addicted to cigarettes...wow! (or it could help addicts lessen dependency on nicotine).

She isn't the only lecturer that's been so engaging in recent months. Infact, it would seem there's an influx of exciting lecturers and professors who know what they're talking about, and can really teach. Where are they all coming from? yep. Harvard.

point of interest...hmm

10:00 am. monday. class is as boring as ever, and we're about to start another lecture. I'm sitting in the 4th row from the front, along side Ron and Tim. Ron wispered to me:

" Pss, phil, look over there!" He points to the 1st row, on the left side of the auditorium.
"Who? oh, yes. he's cute...very cute." I concurred.
"No, not him! the other one!"
"Oh okay, yeah, but that doctor is definitely cute." Tall, dark hair, medium complexion with a chiseled jawline you can probably grate cheese with--this was one hot doctor.
I noticed his perfectly fitted suit beneath the white coat, impecable shoes, and neatly trimmed hair. "He's a neurosurgeon!" I exclaimed to Ron.
"And he's also married," Tim chimed, "Notice the ring?"
"Lucky wife. Damn!" I sighed.
"No, no, not necessarily." Ron adamantly protested. "First of all, it's Massachusetts, so it may not be a wife. And second of all, plenty of gay guys wear wedding rings."
"You mean because they're in the closet?" I asked.
"Not exactly, they wear it so people won't question their private lives. " Ron patiently explained to me," This single gay guy I know from my gym says he wears a wedding ring because he works at a school, and he doesn't want people to ask questions."

"Really! That just makes it even more confusing! You know there was a Dean at Harvard who dressed impecably like the doctor over there, and it took me 2 years to figure out that he was gay." I exclaimed.

"Was it because he wore a ring?" Ron asked.
"No. Well, he had shirtless pictures of himself in his office though...very sporty, and he wore really nice shoes." I responded.
Ron sighed, and responded: "And it took you 2 years? In that case, Phil, your gaydar needs a tune up."