I'm back...

It's almost two years since my last post, but lately, I've been feeling the itch for creative expression.

So why the hiatus? In a nutshell, the first two years of medical school were soul crushing for me. I entered medical education uncertain of my career choice, and if that's the case, the first two years of medical education are a leap of faith. You have to inhale reams of medical knowledge, with little regard to context, or understanding of its importance, for countless months on end. It's not terrible challenging from an intellectual standpoint, but it is a trying marathon of knowledge imbibement/regurgitation. All that to say, there wasn't much to write about; it was a rather quotidian existence that offered little creative inspiration, and which would be of little interest to anyone.

Enough about that though. In March of this year, my preclinical studies ended, and I entered the clinical years. During the clinical years (year 3 and 4), medical students transition from book to bedside, and finally join medicine as it takes place in the trenches. You learn how a hospital works, you learn about clinical presentations of disease, you learn how to function as part of a medical team, etc.

During the course of my third year, I will be exposed to 8 major areas of medicine (surgery, internal medicine, neurology, psychiatry, ob/gyn, pediatrics, and family medicine), and countless sub-specialties within each. It is actually a rather unique professional experience; how many professional training programs expose one to such a variety of vocations within one's trade in such a short time? It is akin to speed dating.

And like speed dating, it can be awkward, tiring and entail poor chemistry. But it also offers the promise of lifelong contentment, as the expectation is that you will find the specialty that best fits you.

As time permits, I hope to offer laypersons some insight into this world as I transition into it, before it becomes mundane, and before I become so accustomed to what is really and truly such a foreign territory.

Hope still looks pretty audacious in healthcare

This is depressingly true.

And apparently, this is currently our best crack at change

Oh my god, I heard he has a huuuuge (science) penis!

In order to keep us up to date with the latest developments in biomedical research, my school occasionally substitutes something called medium-sized group for lecture; we read a journal article the night before, and come prepared to discuss the salient aspects of the research. It’s a great idea to hone our understanding of research methods, the process of scientific inquiry, and the latest progress in a variety of fields.

It’s also a fertile ground for med student gunnerism, the way a pile of shit is a mushroom’s idea of Shangri-la. So of course, people got a little competitive in showing off their knowledge, one person in particular decided that it was their role to educate the rest of us fools. Clearly having spent a few hours of quality time with the journal article the night before, this individual proceeded to dominate our discussion of cystic fibrosis for the duration of 2 hours.

So I have no problem with people striving for excellence. That’s really….well, excellent. And needed, since there are med students like me who strive for passing with a bare minimum of effort. We need the former people to advance the science, and fire the engines of medicine. On some level I’m grateful to these folks, I’m not kidding.

But must you make it so fucking obvious that you know more about the delta-F508 cystic fibrosis mutation than me? I understand that cities would crumble before the force of your intellect, but must you so blatantly display your science penis? Because, really, that’s what this boils down to; a strange form of penis envy. Would you be satisfied if I bask in the eternal glory of your incredibly profound knowledge of cystic fibrosis? I will repent the diminutive capacities of my meager cerebral pecker before the sperm whale proportions of your cortical member. I’ll start a religion, you can be the messiah, and we will worship phallic monuments dedicated to your ginormous science penis.

Just one condition: please shut the fuck up more often? Please. Let idiots like me talk a little more. If anything, I’ll make you look good right?

"Daddy horny Michael"

Arrested Development anyone? Anyways....

Med school, how you continue to wreak havoc with my life. In an effort to preserve a semblance of normality, I enjoy studying at coffee shops. The ambient stimulation of people milling about, people who talk about relatively pleasant topics, like the weather, or how the Cleveland Browns have attained a yet more transcendent level of mediocrity, a cast of sunlight revealing the swirl of dust motes, and the waft of coffee, it all sure as hell beats the health science library. That dungeon of learning brings back memories of unintended naps, vitamin D deficiency, and the horrid smell of med student anxiety, which permeates the very walls.

But of course, I would be amiss if I failed to mention the very best part of the coffee shop studying: the hot mammas. Yes, in the asexual world of medicine, coffee shop women are a breath of beautiful, saucy, fresh air. I’ve always fancied myself something of a coffee shop Romeo (I don’t care what you think, grant me my petty delusions), gifted with the gab that these Java beauties like, and the suitably subversive political views that get them hot.

But med school, you could leave no stone unturned. As I’m starting to realize, trying to date in medical school is like trying to cheat on the most neurotic, jealous, possessive, and boring girl you’ve ever had the misfortune to sleep with. Jealous bitch that you are, you had to fuck it up for me didn’t you, Caseandra? You couldn’t let me have my little sugar on the side, could you?

How does she do it? It goes a little something like this:
Coffee shop mamma steps in, I spot her at my 6 o’clock, and she’s instantly a marked woman; I run through the mental check list: curly hair, check, mischievous eyes, check, no ring, check. She sidles over to a table by the window, just out of conversation range of my table, dammit. But oh so conveniently, my laptop battery is out of power! Yes, I need the power strip at the table next to hers. I introduce myself briefly, but don’t linger. I return to my studying, as I’m a man of serious work, of integrity, conscious of the serious responsibilities of my profession; I have to understand the role of wnta, Hox genes, and FGF in limb patterning during development, or people will die! I am not some cheap coffee shop pimp. And yet, sometime later, I can’t help but notice she’s reading one of my favorite works. After 15 minutes of scintillating conversation, however, the question comes up:

Arabica hottie: So, what do you do?

Ethnically Destined: I’m a medical student

Arabica hottie: Oh, that’s so impressive, what are you working on right now…

Ethnically Destined: Ummm, it’s really not that interesting….

Arabica hottie: No, I really want to know, let’s see it! (She leans over my shoulder to see what I’m working on)

Lo and behold, the picture on my screen is a big, hairy, diseased vagina! How about that for a conversation killer! Were I more interesting, sharper minded, I could spin it into a conversation on reproductive rights, or Georgia O’Keefe’s recognition of the striking beauty of the vagina, but no, I am no coffee shop Romeo, I am an awkward med student now. My wit abandons me, and I stammer,

Ethnically Destined: …ummmm…..goddammit, what do you want me to say. Yes, I look at vagina pictures in coffee shops, it’s what I do!

Arabica hottie:….so it was nice meeting you, maybe I’ll see you around?

So it goes. Fuck my life.

On that note, I’m note the only one who thinks so. Hipsters also think I’m lame!
http://stuffhipstershate.tumblr.com/ (look for the September 22nd post).

The upsides of Downs

I started real med school a few weeks ago, and it really hasn't been so bad so far. Yes, you do have to study more than you ever have in your life, but considering you don't have to work a job like many of us did in college, and that few of us are getting laid, there is plenty of free time in a day. It sure as hell beats working full time, and Cleveland is so damn cheap, I can still afford most things (alcoholo poisoning for less that $20 anyone?). So most days I wake up, with a vaguely positive attitude towards med school, bordering on largely ambivalent. Every 5th or 6th day, I have a few hours where I think, "What the f-ck am I doing with my life?" I had a moment like that yesterday, at the end of lecture. I had just risen from my customary nap, and I was a little groggy, perhaps even grumpy. Regardless, I wasn't feeling generous, and the didactics on limb development, images of fibroblast growth factors, and the incessant fall of nervous fingers on much used keyboards, in the dank cave that is our lecture hall, didn't help my mood. So when I look to my right, and see the girl next to me reading about current events on Fox News, I felt pretty pissed off. Really, Fox news? I love fiction too, but I get it from novels and comic books....anyways, I was in a dour mood for a few hours after that.

But to balance out the "f-ck my life" days, we have days like Tuesday. Days where you walk out with a greater appreciation for the human condition, and the sheer balls it sometimes takes to walk this earth. We've been studying development, and naturally, chromosomal defects are part of that. Trisomy 21, or Down's syndrome has been covered extensively, and we've gone into the clinical correlates as well. The disorder is typically screened for in the 1st or 2nd trimesters, and if identified, parents are given the choice to abort or not. More than 90% do. Damn....that's a lot. When I first read that statistic, I had no qualms with it. It's not that I think of a person's life with Down syndrome as less worthy than that of a normal kid's. I just figured the cost of raising such a child, in time, tears and money, would be too much. And so it seemed totally natural to me that you'd want to abort that fetus. And apparently, a lot of doctors encourage patients to do so.

To put a human face on it, our faculty had parents with Down's syndrome kids come in this morning, and the hour and a half we spent with them changed a lot of my assumptions. The mom we were with had six kids...shiiiit (trangely, she wasn't as Jerry Springer as you'd expect, I think she just liked having babies). The 5th kid was a Downs kid. She brought her baby with Downs, and the youngest one to the discussion; she had that autopilot tendency most harried mothers do, such that she could maintain conversation while breastfeeding one kid, playing with the other, and still making eye contact with each of us. And she looked tired, as mothers, particularly those with a half a dozen children, do.

But what she had to say was not something I had heard before. First, the Downs kid, George, was not that much extra work. Sure, he required more attention than the other children, but it wasn't like they were going broke caring for him (particularly noteworthy given that her husband was a teacher, and she only worked one day a week as a physical therapist).

Moreover, she went so far as to say that George was a blessing. Having him, she had really learned how to stop keeping up with the Joneses, because as she noted, "Once you have a kid with Downs, you really can't." She said it brought her family together, by the simple act of caring for George. She said that not only did she fall in love with George as one would any child, but that the love was more intense in a way, given that she would always be watching out for him. And she pointed out that while George would probably never go to college, or win any standard accolades, he would almost certainly never become a drug addict, or pain her in the numerous ways children can cause their parents endless grief.

So while George is mentally retarded, has congenital heart defects, will always rely on his parents, and will likely develop Alzheimer's type dementia by the age of fifty, his existence may be far more than tolerable. It could have a vital role in his family and community. There is no right answer, and up until now, I had been hubristic enough to think that aborting such kids was the scientifically sound thing to do. And it may still be, but that paradigm may be just as narrow-minded as those who seek to stop stem-cell research because they consider it equivalent to murder.

I make fun of all the moral, touchy feely stuff we talk about in our medical school ethics class, but that doesn't mean I'm not hearing it. If anything, humor is a coping mechanism to deflect awareness of the fragility of the human condition. And given that fragility, more than anything, George's mom impressed on me the need to approach such crossroads carefully, where science intersects with intangible, incalculable elements of emotion, value, ethics and all the related fuzziness. I will tread carefully from here on out....

Medical School Personality Types

This is sad, but true

Credit for the cartoon goes to, Michelle, a radiologist who blogs and cartoons over at: http://theunderweardrawer.homestead.com/

Medical School - full contact sport?

The foundation of the curriculum at my medical school is small-groups, referred to as Inquiry Sessions, or IQ groups for short. We’re given case vignettes at the beginning of each week, and during small group sessions, we discuss the case, in an effort to understand the problems facing the patient, identify learning objectives for ourselves, conduct research on the latter, and then discuss our research in subsequent sessions; we do this with the guide of a faculty facilitator, but their role is largely to guide us in a Socratic manner should we get off track. It makes for a very pro-active model of learning that is a departure from standard medical school didactics (many medical schools feature small groups, but few have designated them as the centerpiece of a curriculum). It also makes for absolutely priceless moments.

Small group are intended for us to learn to work with our colleagues (many of whom are completely fucking nuts) as much as with the material. Horrid tales of gunner excess have already emerged from small-groups; one nutty chick wrote up a 35 page report for her first IQ presentation (for comparison, the average person conducted about 2 hours of research for that case, and brought a few talking points). Thankfully, my IQ group has been one of the fortunate blessed with a complete lack of malignant personalities and basket cases; to boot we have an IQ facilitator who’s refreshingly down to earth.

But that doesn’t mean there is ever a dull moment. We’ve already had quite a few classic moments in IQ, whether it be yours truly bringing up “Two girls, One cup,” our Egyptian group member showing up 30 minutes later for everything, (his sad eyes always seem to say, “it’s in Allah’s hands ,” weakening any resolve we may have had to discipline him), or a number of other rich moments.

However, one moment towers above all others in our IQ group’s short history. We customarily start our IQ sessions with “check-in,” as a way to promote intra-group communication. People share stories about their weekend, their mood, anything at all really. Last Monday, rumors were buzzing about the class about weekend drama (med school is EXACTLY like high school with less sex, fewer attractive people, but more limited cruelty); one our classmates flipped out while drunk at a party, and started threatening drastic actions (I can't elaborate out of respect for privacy issues). It turned out one of our group members, we’ll call him Bob, was involved in restraining this girl, who we’ll call Jess; and subsequently calling campus security (which given the details he related, was entirely justified). The next morning, Jess sends Bob a message, in effect stating that Bob had ruined her life (by this point, the administration and his parents had found out about the incident). So Bob was worried about a physical altercation when he came to class that Monday, and jokingly related that he was wearing a cup just in case. We laughed heartily at the last detail, but Bob stared blankly at us, and once the laughter died out, somebody said, “Wait, you’re not serious, are you?” To which our intrepid friend replied by leaning back in his chair, thrusting out his crotch, and going tap-tap-tap. You really can’t make this shit up…..