the beginning of the end

Today was the first day of my pediatrics rotation.  It involved lectures and tours and lectures and lectures.  I have yet to even see a child, and surprise surprise I have a runny nose, sore throat, and headache.

My roommate arrived to her first day of surgery 25 minutes late, got stuck on a team with someone with whom she once had a random and awkward make-out, and got assigned to the senior resident who likes to do pre-pre-rounds and be terribly mean.  She will be arriving at the hospital at 4:30am every day for the next 8 weeks.

It’s going to be an interesting year.

i’m impressed

Speaking of granulomas, this girl’s med school essay has already been written for her: Teen Diagnoses Her Own Disease in Science Class (CNN).

“It’s weird I had to solve my own medical problem,” Terry told CNN affiliate KOMO in Seattle, Washington. “There were just no answers anywhere. … I was always sick.”

Yes, it’s weird you had to solve your own medical problem.  But it’s also weird that this diagnosis was missed in the first place.  It’s not like Crohn’s disease is unheard of, and any second year medical student can identify a granuloma.

Back to work…

from the depths

1. I would like to anterogradely and retrogradely [in the ways of kinesin and dynein, if you will] apologize for a) not answering my phone, b) not listening to my voicemail, c) not reading emails, d) not writing emails, e) spilling honey nut cheerios all over the kitchen because instead of paying attention to how full my bowl was I was thinking about type IV hypersensitivity, epithelioid cells, and granulomas.

2. I clearly am in no state of mind to write, so instead I will direct you to a relevant post from one of my favorite blogs: USMLE Step 1: The Tale of the Tape

good morning

I fought with myself for a good thirty minutes before finally dragging myself out of bed.  I sludged upstairs and sank into my morning routine: coffee, honey nut cheerios, the paper.  Awake yet?  Not quite. More honey nut cheerios, more coffee, and how about just a few more honey nut cheerios.  After wasting enough time I went back downstairs to make myself presentable. It is impossible to make yourself presentable to the outside world when you are still half-asleep, when you are studying for the boards, or when you are a zombie. I gave up, packed up my books, and headed for the car.  I got in the car and drove about half way there before finally looking at the clock.  

The library doesn’t open for another hour.

the boards

About an hour ago I was on the verge of ripping my g.d. kidney out of my body and throwing it out of the window.  Luckily there are no windows in my study-dungeon, so my mind had a moment to wander: 

Hmmm, what arteries am I going to have to sever in the process? Renal artery and renal vein obviously, and maybe that stupid splenorenal ligament.  Oh and what should I do about my ureter, that could get messy.  I should probably rip out the left one because the ureter is longer and then I can donate it.  But I want to jump up and down and stomp on it, not donate it. Will ripping out one kidney increase the renal plasma flow (RPF) of the other kidney? Will the glomerular filtration rate (GFR) increase? Will an increased GFR lead to increased Na+ delivery to the macula densa in the distal tubules of the nephron and then lead to decreased renin secretion, decreased aldosterone production, hyperkalemia and hypotension? No, none of that makes sense.  You have it all backwards and that is why you wanted to rip out your kidney in the first place. Stop thinking about your kidneys.  

Okay.  So I’ll go on a run.  

It’s hot out.  I’m out of shape.  I can feel my heart beating.  Increased cardiac output.  Hmmm, cardiac output equals stroke volume times heart rate.  Which one is increased right now? Both.  I’m increasing sympathetic outflow, oh and I’m constricting my renal artery– take that,  you godforsaken kidney. Okay so blood flow to an organ is proportional to it’s metabolic activity, and my muscles are working hard right now. Blood flow is increasing.  How? Vasoactive metabolites (CO2, H+, adenosine, lactate, etc)! They cause vasodilation. Vasodilation? That’s also what causes an erection.  Mechanism of sildenafil? Increase nitric oxide (NO) which will bind to guanylate cyclase, increase levels of cGMP, smooth muscle relaxation and boom, you’ve got an erection.  Do not take with nitrates, it will cause severe hypotension.

It never ends! 

This evening I begin G.I.  You know what that means?   H. Pylori (booooring), over prescribed (?) Proton Pump Inhibitors, Familial Adenomatous Polyposis (was that the APC gene? Autosomal Dominant, no?), and lots and lots of diarrhea.  Cha cha cha.  

This, my friends, is the life of a medical student.  

21 days until I take the boards.

aviator sunglasses and leather jackets

“I want her brains and I want her charm.  Her husband, however, I could do without.” I’ll let you come to your own conclusions but I’m going to have to agree with my Aunt.  Hillary Clinton is an impressive and accomplished woman.  We were all (the Secretary of State included) at the United Nations this morning remembering Eleanor Roosevelt.  I couldn’t stop looking around the room at all the well-dressesd, important looking attendees.  Ten feet away from me sat an elegant and stylish older woman wearing aviator sunglasses and a leather jacket with her hair pulled back in a pony tail.  She looked so put together and so cool that I couldn’t stop looking at her.  Oh no big deal, it was just Gloria Steinem. 

Thirty minutes earlier I sat in the back seat of the car in Holland tunnel rush-hour traffic, trying desperately to find a way to remember that Donovan Bodies on biopsy go with granulomatous inguinale.  I asked my Mom and Aunt for help.  Oh, that’s easy, it sounds like a name:  Granuloma I. Donovan.  Not sure that’ll do the trick but I appreciated their effort (and enthusiasm).  The boards, Step 1, are hanging over my head and sucking the life out of me page by page, disease by disease, tumor supressor by oncogene.  

But this morning I took a break from my windowless study-dungeon and accompanied my Mom, my Aunt, and my Step-father to the U.N.  It was a fundraising event to preserve Eleanor Roosevelt’s house, Val Kill.  In my head I kept calling it Val Kilmer, and I was horrified I might accidentally say that outloud to someone.  

But anyway, the message that I took away from the morning was simple: you are surrounded by 300 incredibly impresssive women right now, look around and take note, now why don’t you get your ass in gear and do something, stop sitting on your bum and stop being useless.  The delivery and tone of this message was not nagging, however,  it was inspiring.  I left and I wanted to be like Hillary and Gloria and all the women who were sitting at my table: powerful, intelligent, and doing something. 

Instead, Granulomatous I. Donovan and I will return to my windowless basement/study-cave. When I emerge I might be 75 years old (or 30ish) but I know that whoever I am, where ever I am, and whatever I’m doing, I will be a woman who wears aviator sunglasses and who wears a leather jacket, and of course, who kicks ass.  

 

 

“It’s good to have an end to journey toward; but it is the journey that matters, in the end.” -E.H.

finals

Well, it’s officially exam week– I just accidentally washed my face with toothpaste.

confusion

Why is it a standard practice for the gauntest of nursing home residents to wheel themselves into the hallway, cover up with a blanket, tilt back their heads, and fall asleep right there in the middle of the hallway with their mouths wide open?  And why do nursing homes smell like pee?  I realize that incontinence is a devastating problem for the elderly.  But do they not wear diapers?  They don’t pee on the rug, do they?  The smell of urine penetrates the place.

Call me insensitive, but I hate nursing homes.

Yesterday four of us in short white coats and one man in a suit were walking through the Alzheimer’s unit.  We passed one wheelchair-sleeper on the left and were about to cruise by another on the right when I heard something.  “Stop! Stop!” I looked up and saw that this wheelchair-sleeper was awake.  Not only was he awake but he was inching toward us waving his hands wildly back and forth,  “I have to tell you something!!!” Uh oh.

“Stop right there! I’ve got to tell you something.  See this face? Remember this face! Look at it real good and remember it.  Do you remember it? Well you better, because I donated my body to your medical school.  So one day down the road when you are in that lab studying the bodies, you might see someone that looks familiar.  Well that’ll be me!”

I was speechless.

First of all, this was not at all what I was expecting.  Earlier in the day an elderly old woman with dementia was heart-breakingly and frantically searching for her deceased mother.  Another one was speaking lucidly of our president, Al Gore.

And second, this man has made an incredibly generous donation. I have never in my life been confronted with such a situation and had no idea how to respond.  I mean, we all awkwardly said thank-you, but communicating your appreciation ahead of time to a live human being who one day will be lying on a cold metal table with his chest sawed open with his heart in the hand of a young medical student… I am not sure a simple thank you is sufficient.

Anyway, the conversation concluded and we turned to walk away and he stopped us again, “Wait! There’s one more thing I have to tell you that I probably shouldn’t… I’M A LAWYER!!! HahahahaHAH haha!”

We all walked away and I was thoroughly confused.

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four kidneys

“I am driving around New Jersey right now with four kidneys in my trunk.” I emailed my sisters because sometimes you have to spread the ridiculousness.  I sent the email when I was driving around NJ looking for an apartment to move into.  I drove by a cop car and realized I was praying to something-or-other that he wouldn’t pull me over.  Cause I mean really, four kidneys?  How do you explain that to a cop?

I picked up the kidneys in the morgue in the basement of the medical school.  I was leading a workshop on diabetes at a local shelter.  Because kidney disease is so hard to explain I thought some props would spice things up.  And come on, if Dr. Oz can do it, I can do it. In order to borrow organs from the school you first must talk to the right people, and second must visit our lovely mortician, Bob.

A side note on Bob, last year during anatomy he would occasionally pop into the lab while we were dissecting.  He would arrive when body parts started to mold.  He would arrive with some sort of saw and amputate the infected dead limb before the mold could spread to other bodies.  Sometimes though I think he was there just to creep us out.  One day we were dissecting some part of the abdominal cavity and we stopped working to wait for a professor to come over to answer some questions.  Well, lucky for us Bob came by instead.  Before we could do anything about it he was elbow deep in our lady’s abdomen.  He was elbow deep and gloveless in our lady’s adbomen and the sleeves of his sweatshirt were soaking up some serious body juice.  Pretty sure I threw up in my mouth.

So anyway, I had to make a trip to the morgue to pick out the kidneys I wanted.  Since I had never been there before, and since there really wasn’t an option, I nodded when Bob asked if I wanted a tour.  Walking between dead bodies Bob did not forget to point out his cat.  His dissected, skinned cat.  The only sense I could make of this was that his cat died recently.  I asked no further questions as the logic behind his thought process I will never understand.  He brought his dead pet cat to the morgue, skinned it, and then opened it up.  Get me the kidneys and get me the hell out of here.

The entire day was a bit of a bust.  Sick and congested I spent the entire morning looking at apartments in the rain.  I showed up at the shelter prepared to give the workshop on diabetes but they didn’t have me on their calendar.  And because things always happen in three’s, on my way home I was pulled over.  Unbeknownst to me my registration was expired, my car was towed on the spot, and I was stranded in the middle of nowhere, in the freezing cold, with no jacket.  Thankfully the four kidneys made it out of my trunk and back to the morgue, a whole 13 minutes before this final escapade.