Synaptic Reorganization

2012!

2012-01-02T07:43:00.000-08:00

And here we are, just one calendar year away from graduation! This year will bring residency field selection, more Boards, and actually applying and interviewing for chosen residency. But that's OK, because we're not going to panic.

I've actually been pleasantly surprised with my lack of panic of late. Early in the year when I was liking my surgery rotation, I felt a tiny panic. Opening more doors meant decisions would be harder to make and there were still so many doors to peep through this year! But then Family Medicine came along and showed me the way (oddly enough, it showed me the way to adult primary care). The deal was more or less sealed when I started my pediatrics rotation last month. It was rough at first in my 2 weeks of community practice, and then things got better in specialties and newborn nursery (a very busy, fun week of mostly healthy infants). But even though I found myself liking Pediatrics and the practitioners thereof, it just doesn't feel right (again I said it!). And Family Medicine is out because it seems like a waste of time, time that would be better spent learning more in depth about the population I do want to see, training for a population I'd really rather not see in my practice (sorry, kiddos). So, even though I haven't actually-officially done my internal medicine rotation, it is pretty much decided--sigh of relief--.

Now I just have to get Boards Part II under my belt, a solid team of advisers, a few good letters of recommendation, and I think I'll be on my way: ready to apply for residency, that is.

Those things aside, I'm not much into resolving to do things this year. I could improve/fine-tune some personality traits like projecting confidence and remembering to be a "yes" woman. I would love to find more time for exercise and healthy eating. But you know how those types of resolutions go...

Anyway, I wanted to wish you all (how ever few of you there are) a Happy, Healthy New Year!

Pediatrics: Part 2

2011-12-10T06:35:00.000-08:00

This week I completed the subspecialty portion of my Pediatrics rotation. Though I still maintain that Pediatrics is just not for me, it gave me some insight into the world of subspecialties (something we don't get a lot of exposure to this year....naturally, we have to learn the basics first after all).

It was definitely a whirlwind tour. In 5 days I rotated through Endocrinology, Gastroenterology, Pulmonology, Cardiology, Adolescent medicine, and a clinical research clinic looking at childhood obesity. I spent half days in some of the clinics, but fortunately we had the opportunity to spend more time in a few areas of interest (I chose to focus on Endocrine and GI).

And I realized a couple of things:

1. Specialists see a lot of unusual cases. Pediatricians in particular have the cornerstone on congenital disorders (problems that are present at birth). This week I saw kids with syndromes I had never heard of, and one case that most would not have heard of because it is so rare. What I had not realized about pediatrics was that some of these kids may stay with their pediatrician for life since they are more experienced in this area(I am a total sucker for continuity of care!).

2. Specialists see a lot of redundancy too. This wasn't exactly a surprise, but I was somewhat amazed that in 2 days of Gastroenterology I saw little variation on the themes of abdominal pain and failure to thrive. And in my morning of Pulmonology we only saw Asthma cases.

My insights are not groundbreaking by any means, but personally this was a helpful experience since these concepts apply to adult subspecialities as well. First, I did enjoy seeing some of the more unusual cases. I could tell that my attendings' years of experience made them well equipped to handle both usual and unusual presentations. I like the idea of becoming an "expert" in a field and not having to defer to someone else to make clinical decisions as primary care docs often have to. Naturally that leads to some redundancy. These doctors are able to tease out difficult diagnoses because they see the same things over and over again. I found that I liked the variety of cases I saw in Family Medicine (though there is certainly plenty of redundancy there too), so specializing might come at a cost for me. And perhaps many specialists temper the redundancy in their differential diagnoses by partaking in other things like research and clinical trials?

Next week I am headed back to the hospital to work in the Newborn nursery! Stay tuned...

Pediatrics: Part 1

2011-12-03T07:04:00.001-08:00

I just completed my 2-week community pediatrics rotation. Well, really it was a short 2 weeks because Thanksgiving break was right in the middle. I was placed in a small practice (2 doctors and one nurse practitioner) in a Richmond suburb, about 20 minutes outside the city.

The first week was kind of a wash since we had orientation on Monday and my preceptor works a half day on Tuesdays and I was a bad(!) medical student and asked for some time off on Wednesday to pick up my bestie from the airport....so I only worked one full day in total. Heh.

And Thanksgiving was marvelous! I hope yours was too! Not to mention, I turned another year older last week.

This week I had to get serious and make up for lost time. I am pretty sure my preceptor thought I was an idiot (and I probably was one), but in my defense I have pretty much never seen pediatric patients before (see my previous post on family medicine in which I almost never saw kiddos, or see way way early posts on my first 2 years' family medicine preceptorships in which I also basically never saw kids).

So I had to learn quickly how to examine babies, toddlers and adolescents. And trust me, they all require a different type of exam. It was also hysterical to me when I would listen to a 2 week old infant's heart and lungs with my adult sized stethoscope and it would basically cover their entire chest (hyperbole intended). In addition, kids have different types of medical problems than adults: ear infections, asthma/allergies/eczema, and tons of upper respiratory infections. Sure, adults have some of those problems too, but usually it's one of the above plus hypertension plus diabetes plus osteoarthritis, etc. Dare I say I got bored. I also might add, I got sick! All those kids are just running around incubating viral disease! Ew!

I will try not to run this conclusion into the ground over the next 2 months of my peds rotation (though it might happen), but I think pediatrics is just not for me. I sort of knew this going into the rotation, and I tried not to let my lack of experience and interest cloud my judgement (though it still may have). In the last 2 weeks, it seemed that the parent was the patient more than their kid (reassurance, reassurance, reassurance). The medical problems were not very complex nor the diagnoses/treatments. There were almost no procedures (though this is likely the choice of the practitioners and not a generalized truth). There is always someone screaming/crying -somewhere- in the office and it caused me a constant, mild amount of stress. It makes me really uncomfortable to cause distress in a small child (even if I know I am not hurting them and they are just scared). Ok, one positive: some of them are pretty gosh darn cute.

Next week I will rotate through a bunch of different pediatric specialty clinics (endocrinology, gastroenterology, cardiology, pulmonology, and adolescent clinic) and the following week I will be in the newborn nursery at the hospital! Until then...

Family Medicine: Part 2

2011-11-22T15:45:00.000-08:00

My one month stint in rural family medicine has sadly come and gone. In fact, I've already moved on to the world of Pediatrics. More on that later...I have been having trouble putting my experience in words (hence why I'm here 2 weeks late!).

So, way back last spring the department of family medicine asked us to write a wish list of sorts of things we would like to get out of our family medicine rotation. Many folks probably left the section blank or had a particular location in mind (ie, they could go home for the month). But if you know anything about the breadth of family medicine, from rural family docs to hospitalists to Emergency Room doctors to docs who deliver babies to your run of the mill suburban family practitioner to your urban underserved practice....the list goes on and on! Family doctors can do a variety of procedures too, like simple surgeries on the skin (for a large or deep biopsy, for example), joint injections, cryotherapy, delivering babies...there are probably many more, but you get the picture. Family docs do it all!

I knew that I was interested in family medicine back then, so I figured in order to experience a broad scope of family medicine I would have to land a rural rotation. When not too many doctors and large hospitals are around, doctors (hopefully) tend to do more for their patients to avoid having to send them out for many referrals and fancy diagnostic tests. Not to say that they are bad doctors, they just have to be more creative and use their diagnostic skills to save their patients time and money (shouldn't all doctors practice that way, really?).

I marked up my "wish list" with various procedures and rural practices and a few months later I was matched with the Crewe Medical Center! Crewe is only an hour and a half from Richmond, but it is definitely rural. The population for the entire county is only 15,000 and the nearest hospital was 30 minutes away in Farmville. Perfect, I thought!

As I said in my last post, there is a division of labor at CMC. The 2 nurse practitioners see all the well child visits, medication refills, and gynecological visits (basically, all the routine visits). That frees up the 3 doctors to see acute cases and uncontrolled chronic disease. Since I only worked with the doctors, that narrowed the scope for me quite a bit (I mostly only saw adults with acute and chronic disease), but it worked out for the best I think. I learned a lot of medicine in those 4 weeks! Dr. Hall (who I worked with most days) liked to joke that I was X patient's endocrinologist or Y patient's cardiologist. Perhaps a bit of a stretch, but fun nonetheless.

I could go on and on singing the praises of my month in Crewe, but I think I'll stop here. In short, I learned a ton, I loved the practitioners and patients, and I even narrowed down my list of specialties to one. See, I loved family medicine, but it wasn't really family medicine in my eyes. I saw acute and chronic adult medicine (internal medicine...right?). It will take more soul searching to be sure, but I don't see why the extra training in pediatrics would be of benefit to me if I really just want to see adults. Family medicine opens many doors since you can practice in so many settings, but I think Internal Medicine has many, if not more doors. It just narrows the patient population a bit.

Family Medicine: Part 1

2011-10-30T04:36:00.000-07:00

I'm back from the boonies for the weekend and I wanted to report on life in Crewe! I usually wait until the end of a rotation, but I'm just too excited to wait!

First, I'm staying at a lovely Bed & Breakfast called the Grey Swan Inn in Blackstone, VA just down the road from Crewe. It's cozy with a fireplace and endless bookshelves and floral sheets like my Grandma's. Every morning I eat breakfast with the other guests (they have been from near and far--Washington state even!). I have sat with an astronomer, two gents who are working on remote controlled helicopters for the military, and travelling substance abuse counselors to name a few. The Innkeepers make fresh breakfasts every morning with bottomless coffee, thick slices of bacon, creamy eggs, rhubarb crisps, homemade pumpkin butter...you get the idea. Heaven.

After filling up, I hop in the Mini and drive about 20 minutes through the countryside and down tree-lined highways bursting with fall colors to Crewe Medical Center. Patients are always lined up well before I arrive, since the clinic allows walk-ins. Dr. Hall and I review lab results that came in from previous days before seeing our first patients. We typically see patients non-stop until 2pm when Dr. Hall decides it's time for a lunch break (see, that big breakfast is key!). Then we power through until 5-6pm.

Since CMC is a little isolated (the nearest hospital is almost 20 miles away), we double as an emergency room too, it seems. The doctors joke as we sometimes "admit" patients to CMC to give IV fluids if someone is orthostatic or to suture lacerations. We also see the full spectrum of patients (young to old, well to quite ill), though many also make the trip to Richmond to see specialists. There is some division of labor within the practice though, as there are 3 docs and 2 Nurse Practitioners. One of the docs sees most of the kids, while the NP's see most of the OB/Gyn.

I mostly see chronic and acute adult medicine. I have helped diagnose and treat diabetes, heart failure, osteoarthritis, nephrolithiasis (a fancy word for kidney stones), a diverticular abscess, and a host of other problems! I have also gotten to do steroid injections of the knee and sacroiliac joints and my first fecal occult blood test.

In next week's edition I will talk more about my progress as a baby doc. This is my first real medicine rotation (on surgery and neurology most patients came in the door with a diagnosis), so I am finally getting to work on my differential diagnosis and reaching way back into the dusty cobwebs of my brain-space to remember how to test and treat for these diagnoses. It was a steep learning curve this first week, but I know I am making good progress!

Family Medicine

2011-10-23T06:22:00.001-07:00

Tomorrow I am moving to Crewe, VA to start my family medicine rotation. I requested a rural location for this month, and apparently my school obliged!!

Neurology

2011-10-23T05:47:00.000-07:00

Another rotation down!

Let me first explain the breakdown of the neurology rotation. We spend a month on the service but it is divided into thirds: wards, consults and clinics. The reason for this being that each service sees very different kinds of neurological cases. On wards, one is likely to see a lot of patients with strokes or epilepsy. Consults is more of the same with some oddballs added to the mix. A patient on, say, the cardiology service might suddenly develop leg weakness and the Neuro consult service would be called on to evaluate the patient's new problem, though their primary reason for being in the hospital is not a neurological issue. On the clinic service, anything is fair game. Headaches, Parkinson's, Alzheimer's, Epilepsy, Stroke follow-ups, Multiple Sclerosis and a variety of movement disorders.

Disclaimer: This blog has become my primary place to record my impressions on a given field to help guide my future career decisions. These are only my personal opinions based on a very limited exposure and are therefore not meant to dissuade anyone from entering a given field, or to detract from any department at this institution.

The pros and cons of Neurology as I see it:

Pros:

The neurology residents were top notch. Nerdy-cool, well-adjusted, friendly and they seem to love to teach!
Procedures: I helped perform 2 lumbar punctures (you may know them as spinal taps) and learned to place nerve blocks for people suffering from certain types of headaches
The physical exam in neurology is extremely detailed and it's pretty fun to try and localize the lesion (be it a stroke, tumor, abscess or a peripheral nerve problem) within the nervous system based on your exam findings.

Cons:

Lengthy and expensive work-ups (especially for strokes) with seemingly little knowledge gained or benefit to the patient
Very few diseases in Neurology have cures; treatments are symptomatic or merely intended to slow disease progression
Neurological diseases are devastating. It's heartbreaking to see patients with disabling movement or speech disorders, especially when they are entirely cognizant of their deficits.

One thing I am starting to learn about myself is that I love instant gratification! I like to see a patient, diagnose the problem, provide some sort of intervention, and see some immediate improvement in the patient's condition. I guess I am just simple minded like that. It's just funny because I used to think I would enjoy spending a lot of time educating patients and trying to help them modify risk factors for disease. Perhaps my ideal career will combine an intervention with some long-term/preventative care.

S/P Trauma

2011-09-25T15:45:00.002-07:00

One aspect of the surgery rotation I have neglected to mention elsewhere is Trauma. On weekends during the 2 month surgery rotation, we med students take 12 hour shifts in the trauma bay. For me, it was a dreadful part of the week.

My first Trauma shift took place on Sunday night after my first week of surgery. That means I went into the hospital at 7pm on Sunday, worked through the night, and then joined my primary surgery team at 5am and worked an entire work day--almost 24 hours total. Those who know me well know that I am far from a night owl. I like to be tucked in bed no later than 10 or 11pm. On surgery I regularly went to bed at 9pm or earlier given the early wake-up calls, sometimes as early as 4:30am.

That first night on trauma was perhaps one of the busiest of my 2 months. Students typically take turns "gowning" for traumas, meaning only one person actually needs to dawn the blue surgical gown, hair cap, mask and gloves. That person's primary objectives are to cut the clothes off the incoming trauma patient, get them warm blankets, and help the team roll the patient during the physical exam.

If you've seen medical shows on TV, you more or less know what the scene looks like. About 10 people are crammed around the patient trying to establish an airway, IV access, draw blood for labs, and assess the extent of the patient's injuries. It's an intimidating situation to say the least, especially for someone new to medical training. It wasn't uncommon to simply get pushed aside because you were taking too long. Nothing personal, it's just that it could be a life or death situation and things need to happen quickly.

After the airway is established and the initial assessments are done, the room clears out. Often the patients were then left alone, waiting for X-ray or the CT scanner to open up , or for a bed in the hospital to become available. Some needed lacerations sutured or bones reset. Needless to say, the trauma bay isn't a very warm and friendly place. Get in, establish diagnosis, get out.

My first patient was a "delta" meaning a more critically injured patient (as opposed to an "echo"). He was a young man out riding his motorcycle on a rainy evening and flipped over his handlebars, leaving him a quadriplegic. It was clear early on that this man had a severe spinal cord injury; he couldn't feel a bad break in his femur and even gentle touch on his arms caused him shooting pains.

The reason I struggled to like trauma began with that first trauma case. Although I cared that this young man was seriously injured and wanted to see an end to his suffering, it's hard to connect with patients in such a high speed environment. Since I never got to "know" patients like I have time to do in most other situations, I struggled to see them as more than a case or a procedure. Of course the point of trauma is to quickly direct patients to where they need to go, either to surgery or to be admitted for observation, not to bond and share warm fuzzies.

This is in stark contrast to how I see myself practicing medicine though. If I find myself in the trauma bay again, I think I will at least have more confidence and a larger skill set to help me function more effectively, but I think the pace and atmosphere are just not for me.

S/P Neurosurgery

2011-09-23T03:57:00.000-07:00

Yesterday was my last day on Neurosurgery, but more importantly it was the last day of my Surgery rotation!

Neurosurgery is not likely a field I'll be considering when it comes time to decide, but I signed up based on my previous work/interest in neuroscience and for the chance to see living, breathing neuroanatomy.

The work neurosurgeons do is indeed incredible, handling pathology of the brain, spinal cord and surrounding structures. I saw procedures to relieve chronic back or neck pain, to remove brain tumors, to decrease tremors and rigidity in Parkinson's patients, and even a vascular surgery to remove plaque from the carotid artery.

I'm just not sure my personality is a good fit for neurosurgery. It takes a certain kind of person to be confident about operating on such delicate anatomy.

Next up, Neurology.

S/P: Urology

2011-09-10T06:12:00.000-07:00

Another rotation down.

I spent the last 2 weeks learning about Urology, a field I have professed interest in since day 1 of medical school when I casually announced to my anatomy dissection group on our first meeting that I would love to handle the dissection of our cadaver's nether region. When the day came, I wielded my scalpel with a degree of avidity that no one who was nearby has forgotten (no really, they remind me whenever the topic re-surfaces). I then spent a few mornings of the following summer shadowing a urologist in a community hospital back home. Though I only saw the clinical side of her practice (urology is in fact a surgical field), my interest was still piqued and I sought out the Urology rotation as my Number 1 (and No. 2, actually, to reinforce the seriousness of my choice!) preference for the surgery rotation.

Skip ahead to approximately 2 weeks ago. Reviews from my classmates who had done the Urology rotation prior to me gave mediocre reviews of their experience and I had just come off of a rather excellent month of Surg Onc (though admittedly, my mood had sunk considerably by the end of the month too). Maybe we are all just tired. Let's face it, surgery is pretty physically demanding from the long hours to the standing around an operating table to the not peeing or drinking fluids or eating on a regular schedule (or sometimes at all) to the not exercising...It's easy to see how one's spirits might be crushed by this sort of lifestyle. Anyhow, I found myself less enthusiastic than I anticipated going into the Urology rotation.

At the start of my rotation I quickly learned that I had chosen a bad time to be on urology. Several attendings would be on vacation and the service was slow as molasses. Good for hours. Bad for urologic experience. The majority of my first week was spent in clinic seeing kids with voiding dysfunction (a general condition of irregular bowel and bladder emptying) or vesicoureteral reflux (the back flow of urine from the bladder into the ureters or kidneys, predisposing the kiddos to urinary tract infections) and adults with kidney stones, benign prostatic hypertrophy (BPH) and prostate cancer. Not to complain too much, but I did come here to see surgery! On the bright side, I did get to improve my clinical skills somewhat.

Week 2 had a bit more surgery on the schedule so I spent much less time in clinic. However, the majority of the cases I saw were "under water" (aka cystoscopy, where the surgery is performed through a rigid scope inserted into the urethra) or robotic (where the surgeon operates at a console that controls laparoscopic instruments inside the patient). Not much for a lowly medical student to do but sit in the corner on a stool and watch the monitors. Since I was not standing at the operating table, I was generally forgotten and not much teaching happened during these cases as is typically done during an open surgery. Dare I say, this was a tad boring.

I am hesitant to discount Urology as a potential career, even though I didn't have an ideal experience. The residents and attendings were extremely like-able, the patient population is varied (male/female, young/old), and there is a good balance of clinic and procedures. I guess we'll just have to see how the rest of this year goes!

POD1 S/P: SurgOnc

2011-08-28T05:32:00.000-07:00

That's surgery speak for post-operative day 1, status/post surgical oncology. AKA, my first rotation is over! And it's a bittersweet day indeed.

1. I loved surgery more than I thought possible. It is a mind-blowing task what surgeons do every day. To first earn the trust of their patients, then be allowed to put them to sleep and cut them open and put their hands all up in their insides...with the ultimate goal of fixing something and putting them back together again. And I do love putting my hands in people's insides! As my attending noted yesterday, it does not require such a high degree of trust to put a patient on, say, an antihypertensive medication (which the patient can opt to take or not), to follow up with them and tweak the dose as needed. It's just a different kind of relationship.

2. The surgeons and residents themselves were fantastic people who I would be honored to work with. Despite some of their less awesome quirks and occasional outbursts in the OR, they are a fun and intelligent bunch.

3. The patients, the majority being people who have cancer (though not all!), are phenomenal. A few patients were with our service the majority of our month on duty and we were able to form an admittedly strange but significant bond with them. Strange because of the types of conversations we have, either on rounds ("have you passed gas today?), or while packing a wound ("say, what's going on in the world?"). Others were in and out of the hospital quite quickly, but we saw many in clinic for follow-up or, unfortunately, back in the hospital due to complications. Some were rather sad, palliative cases. Some were there for curative treatment and watching their progress from a sick, surgical patient to a healthy patient walking out the door is really satisfying.

So, that is that.

This next month is my surgical subspecialty month where I will spend 2 weeks on Urology and 2 weeks on Neurosurgery.

2011-07-29T17:01:00.000-07:00

Summer has officially come and gone. Today was the last day of our orientation week where we tried our hand at intramuscular injections, Foley catheter insertions, phlebotomy, and learned how to use our hospital's Electronic Medical Records system. Though I can't say that I feel like an expert at any of these tasks, at least we got to try these procedures on plastic models or our classmates before we start performing them on patients.

On Monday, I'll be at the hospital bright and early for my first day of Surgical Oncology...I'll learn a little about the pre-, intra-, and post-operative care of cancer patients. During the month I'll also get to take call in the Trauma department. I will miss sleep and regular home-cooked meals and going to the bathroom at my leisure, but I am definitely excited to climb this first mountain of 3rd year! Excited and scared.

2011-07-15T08:01:00.000-07:00

So...I PASSED STEP 1 OF THE USMLE!

Though folks outside of medical school may not be able to comprehend the fear induced by this exam (it stems somewhat from the thought-seed that is planted at the beginning of medical school that Step 1 dictates much of your immediate future, ie residency, and also from the demoralizing month of studying and practice testing that takes place prior to the exam). Anyway, I believed deep down (and no wise words from outsiders could shake it) that I had really, truly failed. True, it's an extremely rare event, at least at my medical school. And true, I passed all the practice tests. But the length and arduousness of the thing left me doubting myself.

Let this be a lesson to myself: doubt not. There are many more of these hurdles ahead and let's not waste our time suffering such bouts of stress in the future. Life goes on (obla-di-obla-da)!

2011-06-29T09:08:00.000-07:00

Ok, now 2nd year is really over. Final exams taken. Grades finalized. Promotion letter received. This minor little thing called the Boards taken. And most importantly, vacation started.

I am writing from a lovely little screen porch overlooking Benton Pond near Otis, Massachusetts. Not a thing to do but drink coffee, lay by the water, read for-fun books, and take photos of fungi. HEAVEN.

Next up is a trip to my grandma's house in Coeur d'Alene, Idaho for our annual 4th of July celebrations and fun at home in Portland!

There have been a few minor changes to my surgery schedule in the fall, but let's worry about that at another time. The dock is calling...

2011-06-10T17:30:00.000-07:00

Another Crunch Month update from the desk (or kitchen table, if you will) of almost-Dr. V! I just wanted to share with you guys what Friday nights look like during Crunch Month. Which, by the way, is NEARLY over. 10 more days of hardcore study action before T-day. Thank goodness, I have pretty much had it with rigorous daily study schedules. It's summer!!

And now a little about how suppositories work:

The superior rectal veins drain to the portal circulation via the inferior mesenteric vein. The middle and inferior rectal veins, however, drain to the systemic circulation via the internal iliac and internal pudendal veins, respectively. Thus, two-thirds of the venous drainage of the rectal region goes directly into the systemic circulation, thereby increasing the bioavailability of drugs that are otherwise highly cleared by the liver after oral administration.

You are welcome.

2011-05-31T04:10:00.000-07:00

Just a quick update from the desk of almost-Dr. V. We're almost at the half-way mark! Boards study is going better than expected. I think being on a strict(ish) schedule suits me. I study as hard as I can manage during designated study time and am able to feel less guilt when taking the breaks. My only fear is that nothing I learn will stick, but there is plenty of repetition built in to the study plan, so I won't worry too much!

Also, I moved my test up by a day to allow for summer travel plans (haha!). Just 22 days left on the wee counter!! It seems so soon, but not...

On an unrelated note, you must see Bridesmaides! I laughed until my face hurt and then some!

2011-05-15T17:59:00.000-07:00

It's here folks. Tomorrow is the first day of my boards study month, or "crunch month" as we like to call it. Classes ended uneventfully on Friday and I spent this last free weekend celebrating with friends, cleaning house, trimming trees, pulling weeds, and running tons of errands (all the things that have been neglected over the last, uh, year...) to prepare for this next phase.

As you can see, I've got all the supplies I'll need. Highlighters, books, flashcards, and a pound of delicious Lamplighter beans. Here we go!!

2011-05-06T13:12:00.000-07:00

Just 47 days remain on the USMLE countdown! That means posts are about to become sparse here on S.R. I may still check in once or twice, but let's face it: I'll be locked up with a pile of books most days (and nights) with minimal human contact and probably won't be emanating much thoughtful prose. That said, I have tweaked my schedule to allow for more wiggle room near the end of the month and will try and stay as positive as one can.

In other news, my group-mates and I met yesterday to decide where we will each spend our surgery rotations (certain services require at least one or two students to be on staff, so not everyone can do what they want). For now, it looks like I'll be spending most of the two months at the Veteran's hospital doing a month of general surgery followed by a month of urology and neurosurgery. I can't wait! I've heard that the VA is a great place to learn and tends to be a more relaxed atmosphere than the academic center. Before you know it, I'll be trading in this pile of books for...a new pile of books...and holding retractors...and, who knows? Doctor-y stuff!

2011-05-01T04:56:00.000-07:00

This is it, you guys! We are in our last purely didactic class of medical school: the musculoskeletal system. I admit, it's not a class I was looking forward to, but so far I have found it enjoyable. Which is good because it's not like I'm distracted or anything. Definitely not about this insignificant exam we have coming up in June, nor about picking my first rotation schedule. Nope! Not at all!

Also, bunnyfish resting atop the completed pile 'o syllabi:

2011-04-23T18:08:00.000-07:00

Today was makeover day here at Synaptic Reorganization! I have added a Tumblr page so that I can add miscellaneous content and photos without disrupting the flow of med school-related news. On the side of the page is a handy Tumblr feed (thanks to Jeremiah!), or you can subscribe to the Tumblr feed by a separate means. Or you can go on ignoring me....

The blog itself got a wee face lift as well. Just a little spring cleaning!

2011-04-21T16:06:00.000-07:00

After nearly 3 years of neuroscience research and a few publications to show for myself, you'd think I'd be down with this neurology course. You'd be thinking WRONG! I feel like I am fumbling through this material with beer goggles on (hello, chorea!).

On the bright side, I have planned my summer vacation and just purchased a swimsuit and 2 new books for the break. It may be 2 months away, but it's all I've got to look forward to, people.

Summer goes like this:

Otis, MA: 6/25-7/1
PDX, OR: 7/1-7/23

With a reading list of Bossypants and This Won't Hurt a Bit (and other white lies): My Education in Medicine and Motherhood by one of my favorite bloggers!

2011-04-08T12:23:00.000-07:00

Rotation schedules are in!

Next year goes like this:

Surgery
Neurology
Family Medicine
Pediatrics
Internal Medicine
Ob/Gyn
Psychiatry

2011-04-05T16:32:00.000-07:00

Tick, tick, tick...

Time sure does fly. Women's health ends on Friday and then we only have Neuro and Musculoskeletal before "Crunch Month" begins. The month in which I crawl into my study cave and emerge a month later as a butterfly...or hopefully something resembling a human being, at which point I will take my Board exam and get on with my life.

Today I met with Dr. Costanzo to go over my study plan. Although it was silly of me to have any doubts, most of my fears were calmed and she definitely left me with a sense of I-can-do-this-ness.

Here is roughly what life will look like for 33 days:

8 hours of studying, 3 hours to exercise, eat and relax, 3 hours of practice questions, bedtime. Lather, rinse and repeat.

In other news, this was a big week in my medical training! Yesterday I completed workshops on rectal, pelvic and male genital exams. Though I am far from proficient, hopefully when it comes time to do these exams next year I will at least give patients the impression that I know what I'm doing!

2011-03-07T17:39:00.001-08:00

It has been surprisingly rare that I question my decision to attend medical school. The rigors of the preclinical years (these first two years) are certainly manageable. Stressful at times, but I think my classmates and I cope pretty well.

Enter Behavioral Sciences II. An intro to psychology and a smattering of topics that are important but don't fit in elsewhere in the year. Some of the cheerful topics included the high rates of physician suicide, drug and/or alcohol abuse. It was no secret to me upon starting this process that medicine is generally a high-stress field. However, these alarming statistics combined with horror stories from residents and upper level medical students about life, or lack thereof, down the not so distant road for the first time left me wondering what the hell I got myself into. Clearly not everyone copes in the above mentioned ways, but a life in any way resembling those things is not what I have planned for myself, nor my dear friends and colleagues.

Luckily, there was a light at the end of the tunnel: spring break! I got to spend an entire week visiting with family and friends, catching up on some Board review, and some much needed me-time.

Transitioning back to life in Richmond and school wasn't easy, but I am now feeling back in the swing of things and enjoying the Women's Health course. And now that we are back, it's full speed ahead. No rest until the Boards are over (more or less). Woo hoo!

2011-02-22T13:44:00.000-08:00

Second piece of news: The M3 year lottery has officially opened. This means my classmates and I are busy pouring over the 12 available rotation groups to decide which one best fits our schedules or fields of interest.

Our required rotations next year include psychology, obstetrics & gynecology, internal medicine, family medicine, neurology, pediatrics and surgery.

In just a few weeks (ok, more like 6) our groups will be revealed and our futures will be somewhat more certain. For now, M3 year remains part of the nebulous black hole that exists between summer break and graduation.

2011-02-22T13:14:00.000-08:00

I have so much to report! Unusual, coming from someone who does little besides sitting at a desk reading syllabi and downing extra large coffees.

This past weekend I participated in a dental school-sponsored event called Missions of Mercy Project (or MOM, for short). Several times a year, the dental hygiene students, dental students and faculty put on these massive events to provide free dental services to rural communities. Field clinics are set up, resembling a MASH unit with portable dental chairs, dental units, x-ray machines and sterilization facilities. Patients start lining up the night before to ensure that they have a place in line that guarantees that they will receive treatment.

It was unlike anything I've ever experienced, really. Some patients I spoke with did spend the night outside, others arrived from 2:30am and onwards to save a spot in line for treatment. We were set up in a high school, where the auditorium housed triage, hallways held lines of patients sorted by big yellow signs reading extractions, oral surgery, and hygiene. Finally, the gymnasium was ground zero, where all the magic was happening. Rows of portable dental chairs were lined up: hygiene on one end, fillings and extractions in the middle and surgery on the other end. I stood on the sideline for at least an hour just taking it all in. The smell of drilled teeth filled the air. Towards the end of the day, I shadowed a young dentist in the extractions area. Our patient said he had been in pain from a decayed wisdom tooth for six months and he was ready to get it removed. It took less than 10 minutes to drill and extract the tooth. A couple of stitches, and he was on his merry way. What an awesome gift!

The med students' role was less glamorous. We worked on the front line, ahead of triage, making sure the patients were fit for their dental procedures. In two days we screened about 700 patients' blood pressures, blood sugars, and medical histories. Things moved quickly, but I did note the excitement in some patients. In particular, one woman told me she had had had all her teeth removed earlier this year and was going to receive a full set of dentures that day. Others were more tense and afraid...justifiably so. One surgeon told us he had removed all of four patients' teeth that day. It was a bloody, gut-wrenching scene in the gym. But I am trying to focus on those who came away from the day smiling.

From the desk of Almost-Dr. V:

2011-02-16T12:53:00.001-08:00

When prepping for exams, it is of utmost importance that one stay hydrated and color coordinated.

2011-02-13T18:19:00.000-08:00

In case I didn't make myself clear in my last couple of posts, I LOVE GI. Intestinal mucosa, hepatobiliary tree, Ampulla of Vater. I. Love. It. All.

In other news, I am participating in a school-wide Ironman challenge on top of the other fitness activities I mentioned before. It's not the real deal; we get nine weeks to complete 26.2 miles of running, 112 miles of cycling, and 15,000 meters of rowing (or a lot of swimming if you prefer, and I do, but it takes longer and I have to keep up with med school afterall). Still, it's fun and we get a commemorative T-shirt for completing the challenge. I hope to finish a little early so I can focus on running for the 10k coming up in March!

And this is the new me. Well, kind of. I started this little strength training routine back in December, when I could barely lift the 45 lb bar and my chin-up count was 2. Now I am squatting 100 lbs, benching 75, and I did 11 chin-ups the other day! I feel stronger than ever.

2011-02-08T19:11:00.000-08:00

And here is another gem from the syllabus:

"Always remember this mandamus, never forget to put your finger in the patient's anus."

2011-02-08T18:40:00.000-08:00

Loving the GI course!

“HERE IS ANOTHER EXAMPLE OF ACUTE GASTRITIS, AND THIS ONE IS KIND OF FUN BECAUSE HERE WE SEE FUNGAL HYPHAE”

(Borrowed from the lovely Almost-Dr. K's blog.)

Plus, today, I got to listen to lectures on bowel disimpaction and diarrhea for hours on end in secret at the coffee shop. What the other patrons don't know can't hurt them.

2011-01-13T05:06:00.000-08:00

Almost-Dr. V makes house calls!

Today I'll be joining the house call team on an outing to see some of their patients. The team proactively treats these older, sicker patients to prevent the need for hospitalization, rather than bringing them into the hospital where they are exposed to any number of nosocomial (hospital-related) infections.

I doubt we will see any young healthy kids, like the picture depicts, but it's sure to be a great learning experience!

2011-01-02T15:49:00.000-08:00

A new year and a much larger pile of paper for our dear friend bunnyfish to sit on. In a month's time, it will be at my hip level (2.5 feet, give or take?)! Hard to believe.

I don't think I'll have time for the insightful new year's post I had imagined a few days ago (lo! I have a quiz to take tonight and a report to prepare for already). However, I do want to share a few thoughts, or resolutions if you will, before they vanish from the front of my brainspace with the onset of the Cardio block tomorrow.

#1 Watch the attitude. I don't think I have a particularly bad attitude about school or what lies ahead, but I have caught myself taking things and people for granted. I think it's something we should all be mindful of. Over the break I interacted with a few pre-meds and was quickly reminded of how lucky I am to be in this boat and how badly I wanted to be here for such a long time (and still do!). These pre-meds are just as qualified as I was when I applied, and they have been less fortunate in the admissions department. It is truly a blessing to be sitting where I am today.

Also, I often proclaim that I have learned nothing in this year and a half or whine that the information is simply not sticking with me. It's just not true--in fact, there have been several occasions where I knew exactly what was going on with a friend or family member's health--and I need to remember that in order to stay positive.

#2 Have more fun! It won't be easy...we are already stepping up the game this week in preparation for the Boards, but I have to remember to spend time wisely and make room for non-medical activities. I have already more or less given up hiking, crafting, reading for pleasure, and even photography (a pursuit that probably doesn't take that much time, but has nonetheless fallen by the wayside). Luckily, I always find time for my biggest joy, cooking. A girl's got to eat afterall!

#3 Diet and exercise. I am probably most serious about this category. My gal pal and I have started a strength training routine at the gym (ladies! get pumping iron!) and I've signed up for my first 10k this spring. Although it's high on my list of priorities, it's been one of the easier goals to keep this year. Having a friend at the gym and a race date are keeping me on track. My diet is ever-changing, and as I learn more about nutrition, my goals change too. I'm not sure exactly where I stand at the moment, but nutrition is almost always on my mind.

That about sums it up. I wish you all a happy new year!!

2010-12-27T11:20:00.000-08:00

Happy holidays everyone! I have done nothing this break save for relaxing, eating, and exercising. A wee bit of Christmas shopping as well :)

I know I don't say a lot on these pages, but I have gone back and read posts from last year and I can already see myself changing. Sometimes for the better, sometimes for the worse. I have been pretty reflective over the break, so stay tuned for a new year's post.

To the left are some snaps from this winter...snow in Richmond, cookie baking, corporate tomato gifts for dad, Denver airport yoga, and Christmas eve crabs!

All I can say for the conclusion of the semester is...wow. A snow storm came the day before our final exam in respiratory, causing the first two groups' exams to be postponed. The groups were given the option of taking the exam three days later (when we were scheduled to be on break) or when we return January 3. It was enlightening to see every one's response. Some protested that those taking the exam later had an advantage and wanted a similar extension. I, for one, was relieved to be in one of the groups still scheduled to take the exam so I could get out of town and forget the whole ordeal. I guess that's med school for you.

For now, I wish everyone a happy holiday season, warm snuggles, family, good food, and a safe end to the year.

2010-12-05T13:41:00.001-08:00

The countdown is on! Only 11 more days to go before the semester is over! Can you believe it?

The other, more ominous countdown ticks away...199 days until Step 1 of the Boards. Sigh.

For now, let us focus on the nearer and more exciting countdown, for it means I get to go back to the West Coast finally! And relax! And not think about school (mostly)!

I have nothing much to say, so I will leave you with this picture I found today on the school's Pathology Club website. A classmate and I are posing with the state's chief medical examiner before we headed over to their office for the grand tour.

2010-11-11T15:18:00.000-08:00

I thought I would make a post to mark this day in history (the history of me, that is). Today I chose my test date and location for the USMLE Step 1. The US Medical Licensing Exam, though dreaded by most medical students, is at least the first big mile-post in our training.

To mark the occasion, I have added a lovely countdown widget to the sidebar.

I have to say, I feel more at ease now that the date has been set. When we registered for the exam a few weeks ago, we only selected a period of three months within which we would select our test date. Now that I have a definite point in time to look forward to (either with anticipation or dread), I know when it is happening and I know when it will end. And then I will enjoy what little summer vacation I can afford. Hooray!

2010-10-14T11:26:00.000-07:00

I have heard that it is the critical moments in life that define us. Well, in these critical hours (of cramming for tomorrow's renal exam) I have interspersed cramming with peanut butter making (for peanut butter chocolate chip cookies), veggie stock making (for vegetable barley soup), coffee grinding (for caffeination, obviously), and dish washing....so I can make soup and cookies later!! It's just too bad we aren't studying the gastrointestinal system right now. I know all about digestion. So there you have it. You know the 'real' me.

Now it's really time to start thinking about kidneys.

2010-10-12T08:07:00.000-07:00

Class of 2013,

Please read the attached memo for information regarding the USMLE Step 1 registration.

Thanks for casting a dark shadow over this lovely fall morning...

2010-10-07T13:21:00.000-07:00

Well, hello there readers of my humble little blog! I felt it was time for my monthly update. I love the momentum of this year. We fly through classes so fast, I can actually feel the time passing. Pharmacology, Pathogenesis, Microbiology...check, check, check. And now here we are halfway through Renal!

In addition, I signed on for a month and a half long elective in Pathology. Unfortunately, there are a few fields of medicine we won't see much or at all during our third year rotations, a time where I hope to find out which field of medicine is right for me. Being that I am completely undecided about which field I will enter, I am trying my hardest to explore every path available.

Today that search led me to a lecture by the Chief Medical Examiner of Virginia on a domestic violence and murder case and a tour of the ME's office. Suffice it to say, I can finally cross something off my list. Forensics. And two examples of decomposing human was all it took! If only deciding between the other fields of medicine were that cut and dry for me.

Anyway, it's fall. It's beautiful outside. And I am no longer smelling decomp. Life is good.

2010-09-07T18:49:00.000-07:00

Why hello blogosphere! It's been a whole month, which means time for an update. Somehow we are already 6 weeks into the school year, 2 and 1/3 classes complete. Things are starting to heat up, my friends. We have already begun our Board review class (ok, so we just had one intro session, but it still feels alarmingly early...Boards are in July!) and Careers in Medicine. I can feel the momentum. In 2.5 weeks we will launch into systems-based classes and before you know it the holidays will be here and then a steady march to my funeral...er, the Boards.

New to the mix this year is my rural family medicine preceptorship, which is going just fine. My preceptor last year, for those of you who forgot, was in a suburban family medicine practice. I was hoping to expand my family medicine horizons by moving to a rural practice: a setting where I have come to believe one can practice a larger scope of medicine, including more in-office procedures. So far, I have not found that to be the case. Other than a slightly more rural patient population, not much has changed. Either my suburban preceptor saw an unusual amount of diversity, or I have been duped. Maybe I haven't gone rural enough. Whatever the case, I still enjoy family medicine and I am happy to be in a unique setting (we have a cornfield right outside the back door of the office!).

I hope you all had a relaxing Labor Day weekend! I enjoyed mine with good friends, a Flying Squirrels game, a trip to Virginia Beach, exploring in Richmond, and not enough studying. Time to catch up, and quick!

2010-08-04T07:31:00.000-07:00

Well, we had a great time at the conference, but now it's back to the books for...oh, the next 11 months..........

Fear not folks, I have my industrial sized binder, multi-highlighter, notes (oh so many notes), coffee cup, and robot friend keeping me company.

2010-07-27T13:36:00.000-07:00

Tomorrow I'm headed to Kansas City, MO for the remainder of the week for the AAFP national conference of family medicine residents and medical students. A few classmates and VCU colleagues will be joining me for what looks to be a whirlwind week of career planning and hands-on clinical skills workshops.

I'm looking forward to visiting KCMO, feeling overwhelmed (this is my first big conference), learning a lot, and hopefully meeting like-minded folks from around the country!

2010-07-27T13:28:00.000-07:00

...And the pile just keeps growing! For reference, this is what we are working towards. Pictured above is all of our M1 material. Still a long way to go this year!

Obviously my enthusiasm for tabbing has died down a little over time, but don't worry folks. I'm still keeping up with the tabbing and color coordinating :)

2010-07-26T03:53:00.001-07:00

First day of M2....here we go!

2010-06-29T12:36:00.001-07:00

No more downer posts from me. I promise. It's summer!!

2010-06-20T09:52:00.000-07:00

I have been putting off my summary post of M1 year for some time now! There are many reasons, but predominantly I feel like we have barely started on this journey of becoming doctors and summarizing the first baby steps seems silly to me now. We have laid the groundwork, no doubt, with volumes of background knowledge and the basics of communicating with patients and other doctors/health care workers. However, aside from a few exciting clinical experiences and 'a-ha moments' where some bit of classroom physiology became clinically relevant, I feel more or less the same about caring for patients as I did on the first day of medical school. My presence on a medical team is more of a burden at this point than a benefit to my patients.

I closed the year volunteering with the Una Vida Sana clinic, a free screening event for Latinos in the Richmond community. I worked closely with advanced nursing students and a volunteer doctor at the consult table where we pooled information collected at other stations on each person's BMI, blood pressure and blood glucose levels to determine relative risk for disease. We then advised the patients on seeking further care or making lifestyle modifications to reduce their risk. This was one of the most practical and fun learning experiences I've had to date, and I am so grateful to the doctors who help us staff and run these clinics. I am excited to be involved with these events in the years to come!

I also look forward to the upcoming year, as we will delve into the nuts and bolts of disease and treatments in the classroom and make real progress in physical exam skills and diagnosis. In just one year's time, we will be embarking on the first step of the Board exams and starting our clinical rotations. Scary, but exciting!!

2010-05-26T06:59:00.000-07:00

The final countdown!!

49.5 hours until summer vacation.

2010-04-11T15:30:00.000-07:00

Well folks, I was aiming for 2 blog posts a month, but it looks like we are down to 1. I guess that is just how it's going to be. I thought I might update since I have a moment while I am sitting here drinking a Hef on a warm Spring day.

First, an update on school: We are currently in our last block of Physiology/Histology and wrapping up a brief course in Immunology. Since my last post during renal physiology, we have completed respiratory and we are currently charging through the endocrine system and reproduction. Next up: Neuroscience (in which I hope I have some sort of advantage after 3 years of neuro research, but you never know with med school)!

In other news, I am an elected official! Next year I will be the vice president of Club Med (the newly re-activated internal medicine group on campus) and the community service chair for the Student Family Medicine Association. I am excited about the people I will meet and work with through these positions.

Finally, the main reason/inspiration for this post: today I shadowed the team of residents in OB/GYN! I arrived at 7am to dawn my mint green scrubs and watch the night team sign off to the morning crew. Within an hour the intern and I were delivering baby #1, a little 7lb boy. I was able to help with the delivery of the baby and the placenta, and I have to say it was a very calm and seemingly natural process. No theatrics whatsoever, but what can you expect at 8am? I spent about an hour chatting with the residents in the workroom, a command center of sorts lined with computer monitors and large screens projecting the status and progress of all the patients on the floor. Next it was off to the nursery where 2 very young gents were awaiting their circumcisions. I will leave out the details here for all you male readers. Then I followed the Gyn/Oncology crew to watch a paracentesis (draining of abdominal fluid) of a woman with stage 4 uterine cancer. It was quite a change from the squawking infants to the ravaged body of a woman battling her 3rd bout with cancer. We drained 3 liters of fluid from her abdomen and sent her home, hopefully more comfortable than when she arrived. Finally, after hours of liquid encouragement (pitocin), baby #2 was ready to be delivered. She also came without theatrics at 7.9lbs, but I got to clamp, cut the cord, and deliver the placenta by myself! Unlike the first placenta, this one was full of blood and fluid and I thought it was going to explode like a water balloon in my unsteady hands. Somehow, I eased it gently into the tub with no explosions or oozy mess. And just like that my first day in Ob/gyn came to a close.

Now back to reality, aka studying and my Hef.

2010-03-03T05:24:00.001-08:00

Blog....I don't know what to do with you. I try to keep you anonymous, but it seriously limits the content I can put on your pages.

What do you think, readers? Forgo anonymity (even though most of you know who I am) to allow for more pictures/videos/non-medically related fun?

I am waist deep in nephrons right now (get it, get it?):

2010-02-13T05:16:00.000-08:00

This is where you will find me, from now until Wednesday's exams are over. No need to go to my real home, I've got everything I need right here! You think I'm kidding.

After yesterday's nearly lost battle with Behavioral Science, I feel that I am going to have to step up my study strategy. Here goes nothing!

2010-02-04T17:30:00.000-08:00

Just a quick greeting from snow-covered Richmond! Plowing through another term with Physiology and Histology comprising the bulk of our work now. Is it spring break yet?

2010-01-08T05:43:00.000-08:00

Well, I learned my lesson. No more promising of posts, especially with a specific deadline. Let's face it, it's just not going to happen. There are more pressing things on my agenda, like saving lives, people!

To sum up the holiday break: relaxing and gluttonous. I didn't pick up a school book, I got to exercise regularly, and, oh, you know, I baked off an entire 5lb bag of flour (at least it was whole wheat, right?) in the form of cookies and bread.

We are almost through with 1 week of the new semester, starting with Physiology, Embryology and Histology. I can feel the gears turning a leetle bit faster this year as the amount of information we are expected to learn continues to grow. This term appears to be a lesson in speed, whereas Anatomy seemed to be a lesson in volume. That said, we finally are being graced by the famous Dr. Costanzo, and she is every bit as delightful as I had hoped. She feeds us physiology like a mother feeds an infant, pureed and with a tiny spoon (open wide for the choo choo!).

Another new change is the switch from seeing actor patients to practice our most basic skills of interviewing and some even more basic physical exam skills, to seeing real patients through a preceptorship. I wanted to post today, after my first session yesterday, while I am still giddy like a kid on a new bike (albeit one with training wheels and safety horns and helmets and knee pads). I know how I can get when I let the stress of school and busy schedules get me down, so I wanted you to hear from me now while those things are not clouding the excitement.

I am working with a family physician in a small practice in a suburb of Richmond. I have been lucky with my faculty assignments this year (advisors, small group leaders, etc.), so while it was possible to make certain requests regarding preceptor placement, I let fate alone guide me to my assignment. I couldn't be happier. A family medicine practice can play out many different ways depending on the location and patient population, and my placement has an excellent mix of ages and ethnicities. Yesterday we saw 3 month old twins, older adults (including a grave digger!!), and everything in between. There was also a good mix of problems, from regular check ups to patients with compound medical issues. Finally, I think my preceptor himself is a good teacher and someone I will have no trouble getting along with for the duration of the term. He gives good feedback and is very clear about his expectations.

Now, back to the books. It's going to be really hard to keep up this semester, as I am already falling a little behind. Go, go gadget brain!

2009-12-25T10:46:00.000-08:00

Happy Christmas everyone! Hope yours is filled with warmth and family...and maybe some chocolate-y cheer!

I'm in Palm Desert, CA this holiday. Missing everyone in Portland and VCU'ers around the country!

I promise a real post before the New Year.

<3 to you all!

2009-12-12T06:53:00.000-08:00

Just a quick note, as we have our last anatomy practical exam this week. Yesterday was our last official day in the lab (of course, you will still find me there studying intermittently this weekend). I am really glad it was an optional dissection (of the ear); instead my group opted to review and say a few last words of thanks to Bernie. He's been a great learning tool and he couldn't have given us a greater gift!

I am also a little sad to be leaving my anatomy group. Table 19, it's been swell. I may not have given my all every day, but as a group I think we all worked together pretty well and it was a pleasure getting to know you better! Jeff, if you are reading this, you know way too much about MM. Get a life (I jest)!

4 more days of studies, 1 day of exams, then I'm off to SoCal for break!

2009-11-22T20:03:00.000-08:00

Another year older! I have to say, 25 treated me well. I was accepted to and started medical school, which is going pretty well, I must say. I moved to Richmond (!!) and have been making a lot of new friends. Not to mention, I have some of the greatest friends at home cheering me on. I'm feeling the love!

I have been reflecting a lot on school thus far. I'm amazed at how quickly it goes. Test after test, week after week, and before you know it we are almost done with our first semester. I found this entry particularly amusing, as we are now quite literally doing battle with fat (of the cadaveric nature).

Right now we are wrapping up the second section of anatomy dealing with the thorax, abdomen and pelvis. After Thanksgiving, we start Head and Neck anatomy and then it's Christmas break just two weeks later! As much as I like anatomy, I can't wait to ditch my smelly scrubs and take a break from this madness.

2009-11-06T11:52:00.000-08:00

Anatomy exam 1 was touted to be the most difficult exam of the course, and it came with a great deal of stress. In just 2 weeks we covered all the bones, muscles, nerves, arteries and major veins and ligaments of the back, some of the neck, shoulders, arms, hips and legs. We spent much of those 2 weeks tracing nerves and arteries from their major outlets in the shoulders and hips down to their endpoints in the toes and fingers as they dove in and out of the surrounding musculature. I was starting to enjoy the class as the language became more familiar to me, but the sheer volume quickly made the class a stressful sprint through musculoskeletal system.

Now, on the downhill slope into thoracic and head and neck anatomy, I feel like I can slow down and enjoy what we are learning. We removed a large piece of the ribcage and began dissections of the lungs and heart yesterday. Not only is the material more interesting, but there is so much variation between the different bodies. It's like we are really starting to get to know our new "friends" as we learn more about their bodies. My group's cadaver seems to have had a quadruple bypass surgery, while a cadaver nearby had an extremely enlarged heart. Also, our cadaver's lungs were pink and soft, while another was riddled with white, lumpy tumors. It's definitely a privilege to get to know someone in this unique way!

For now, I am sighing a major sigh of relief for passing the first behemoth of an exam, and I am excited to take this trip through the thoracic cavity. We'll see if Bernie is has any more interesting anatomy to teach us!

2009-10-24T14:58:00.000-07:00

This is more or less my life right now, aside from the boiling of flesh, dogs, and silly hats. 6 of my classmates and I make up table 19 and every day we cut a little deeper into our dear friend, Earl Bernard Stratford III*, or Bernie as we call him.

Anatomy is a much anticipated course in medical school and I am happy to be participating, but it is also the hardest thing we have encountered thus far. I have seen a lot of stress and tears from my classmates (I am certainly not exempt from the stress) due to the speed and volume of information we are responsible for. So if you don't hear from me for a while, worry not! You will most likely find me on the 10th floor, wrist deep in a cadaver. The joys of medical school!

*Bernie's name is completely made up, for the record. I am in no way violating his or his family's right to confidentiality.

2009-10-18T05:16:00.000-07:00

Free weekend! Those two words have been said many times in anticipation over the past few weeks. We haven't had one since our first exam back in August! And now that it's here, everyone scrambled off to visit family or travel or whitewater raft in frigid West Virginian waters. I intended to go on an all day hike today but it was hampered by bad weather. Not that I am opposed to hiking in bad weather, I mean, I'm from the Northwest...we hike in rain and snow alike. However, when one is deprived of weekends (and the relaxation they usually bring) one tends to want to curl into a ball and do nothing. Because one can.

I certainly haven't done -nothing- but it's nice to do everything with less urgency and less--oh, i can't, i should be studying right now--thoughts. Friday was a pretty wild post-exam celebration for both M1s and M2s. Saturday a group of us M1s headed out to the Healing Eagle Clinic on the Mattaponi Indian Reservation to volunteer at their monthly clinic. Although clinically, I don't think I learned a lot yesterday, it was a good experience meeting the patients and other volunteer healthcare workers, all wonderful people (warm fuzzies!).

Today I intend to spend most of the day in the kitchen cooking up pots and pots of warm fall goodness and cleaning up around the house (a chore that sadly gets neglected in the daily hustle).

Hope everyone is doing well!

2009-10-05T15:47:00.000-07:00

A great weekend of diversion was had! An Oregonian meet-up of sorts took place in Washington D.C. this weekend, as we convened at a craft fair in Adams Morgan called Crafty Bastards. We all had fun and I enjoyed spending quality time with some familiar faces.

view of the Washington Monument from the fair

I am also thrilled that fall is near. The air is getting cooler and I am starting to cook more hearty, fall dishes. My favorites! It's still nowhere near the likes of fall on the west coast. It's still hot in the afternoon, and I hear this kind of behavior can last all the way into November. I wonder if I'll even need to wear my new winter coat before Thanksgiving...

Things are starting to wind down in terms of biochemistry and genetics. Only 2 weeks to go until completion! Then we launch into our next block: anatomy!

2009-09-26T03:40:00.000-07:00

Just a quick note since I am up before the birds today! Fall weather is finally landing here in Richmond. Yesterday was the first time I have felt a chill since I got here. The change in clime makes it just a little bit more bearable to be inside all day studying. I even got my first hot coffee yesterday (I much prefer iced, but when it's cold(er) out, one must sacrifice). Bring on the flannel sheets and fall jackets and falling leaves!

Exam #3 is on Monday: Biochemistry and our new course, Human Genetics. Back to the books I go!

2009-09-20T03:32:00.000-07:00

Well, the exam on glucose metabolism (see previous post) came and went. Silly me thought it would all be downhill form there. Much stress and anguish (and a fabulous exam score!) later I have come to realize that it was just the start. We are now slogging through fatty acid metabolism, which is still part of that crazy diagram, but feels like a completely new ballgame. While I learned glucose metabolism in my undergrad biochem courses, I have no recollection of the current material. Hence, I spent all of yesterday pampering myself in preparation for this week's battle with fat.

Aside from making every effort to keep my nose in the books, there have been a few clinically-related happenings that are keeping me motivated (eyes on the prize). We began our genetics course this week (population medicine ended with last Monday's exam), and they do a really nice job of bringing the clinical side of genetics to us. Friday afternoon they brought in some people with Down Syndrome and their families to share their experience with their healthcare providers and in general. It was definitely moving to hear their stories, both good and bad. We have also been learning to take blood pressures and I'm trying to work on some volunteering or shadowing opportunities. I think it's important to keep reminding myself why I'm here, because sometimes sitting in a cubicle reading course syllabi just isn't all that fun, believe it or not!

Finally, I am really excited about some upcoming trips! In October I'll be heading up to DC for a craft fair where I hope to meet one of my favorite crafters as well as possibly participating in Race for the Cure in Virginia Beach! Then in November I signed up to attend a conference for Physicians for Human Rights at George Washington University and I'll be spending Thanksgiving in New York with my best pal and her mom! Lots to look forward to!!

2009-09-03T18:39:00.000-07:00

This slide was in today's lecture, marking the start of a series of lectures on metabolism. I swear, biochem professors just love to torture us with these kinds of diagrams!

2009-08-29T04:30:00.000-07:00

2009-08-29T04:20:00.000-07:00

View of downtown RVA from Jefferson Park...on the right is VCU medical center/school.

Click on the photo for a better view, the thumbnail is pretty awful looking!

2009-08-29T03:12:00.000-07:00

Second week down and our first block exam as well!

All of our exams are in blocks, so whatever classes we are taking at a given time, usually 2 (that is, 2 core classes, not including some that run through the year which are not included on these exams), are both tested on the exam. They are really easing us in, giving us ample time to finish, but I heard a rumor that they gradually shorten the amount of time we are given per question. All of this is, of course, in preparation for the boards next year.

I am thrilled with my score and now I have a taste of what I should expect and how to stay on top of the material! It's a great feeling to know that I can now tuck away those 300 pages of syllabus (not burn them, as I heard one classmate suggest) and move on to the next round.

Just as a reference of how fast we move here, I believe in undergrad we spent somewhere around a week studying the lac operon in bacteria. In this course we covered approximately the same depth of material in 2 syllabus pages, or around 6 powerpoint slides! The material is really condensed and I do feel lucky to have taken biochemistry and molecular biology classes before. Some of my classmates are not so lucky!

I'm off to enjoy my last free weekend until October. These rare and special weekends after Friday exams are termed "golden weekends" because we essentially have no new material to learn over the weekend!

2009-08-22T04:15:00.001-07:00

I now have one week of medical school under my belt. This week they eased us in with just our first two classes, Medical Biochemistry and Population Medicine. Next week Foundations of Clinical Medicine is thrown into the mix as well as our first exam covering the first two weeks of Biochem and Pop Med. Time is already flying by!

I am already noticing an improvement in my study habits. My ability to focus has increased over the week and I am able to cover more material in a shorter amount of time. It's been over three years since I was in school, so this is a huge relief. Still, I'm not quite ready for the added classes and demand for my time. So it goes.

Other than school, I am working hard to achieve a good balance of working out, eating and sleeping. So far so good! Outside of that, well, there isn't a whole lot outside of that. I guess that's what I signed up for! Work, eat and sleep. That is my life now!

2009-08-14T05:57:00.001-07:00

Well folks, orientation week is about to wrap up. Meeting my 200 new classmates throughout the week has been exhausting and fun, but next week this gets real. No more 'for fun' quizzes or lectures about dealing with stress--on Monday at 9am we crack our phone book of a biochemistry syllabus and there's no turning back!

Yesterday, my classmates and I were cloaked in our first white coats in front of 1,000 of our parents and friends. I felt the pressures of being a pre-med melt away as the new pressures and responsibilities of being a student doctor and future physician were literally placed on my shoulders. During the ceremony we took the Oath of Hippocrates:

I do solemnly swear by that which I hold most sacred,

That I will be loyal to the profession of medicine and just and generous to its members.

That I will lead my life and practice my art in uprightness and honor.

That into whatsoever house I shall enter, it shall be for the good of the sick to the utmost of my power.

That I will hold myself aloof from wrong, from corruption, from the tempting of others to vice.

That I will exercise my art solely for the cure of my patients and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it.

That whatsoever I shall see or hear of the lives of men and women which is not fitting to be spoken, I will keep inviolably secret.

These things I promise and in proportions as I am faithful to this my oath, my happiness and good repute be ever mine, the opposite if I shall be forsworn.

2009-08-10T05:25:00.001-07:00

Today it all begins...with a lot of mundane activities: id card, bus pass, TB test check, picking up my white coat and orientation schedule, roll call, a history lesson...

Followed by a meet and greet of sorts and a night of bowling!

Let's do this thing!

2009-08-06T21:30:00.000-07:00

I am finally home (away from home) in Richmond! The road was long, but the trip was well worth it. My mom and I traveled over 3,000 miles, got to attend my grandparents' 60th wedding anniversary, visit my aunt in Spearfish, SD, see Mt. Rushmore and the Badlands, the world's largest ketchup bottle, and Santa Claus, IN (among other things). What an adventure! I will post more pictures and things when I have time to upload them and/or have a good internet connection.

Today I finally got to see my house and meet my roommate and landlord for the first time. The house has great character, is in a great neighborhood, and I look forward to getting to know my roommate better. The next few days will be busy buying, well, everything! I moved all my stuff in a Mini, for crying out loud! Orientation starts Monday and classes the following Monday. By the looks of our calendar, life is about to step into high gear. Goodbye lazy days of summer, hello doctor training!

2009-07-17T23:53:00.000-07:00

I am beginning my cross-country journey in exactly one week! I am equal parts thrilled and terrified. Lately, the terror side has been more obvious. More frequent stomach irritation, less sleep, and I think I am more irritable...

The anxiety isn't helped by the amount of stuff that needs doing this week: PACK! (so far I have but one box ready), prepare for the going away celebrations, catch up with friends before I embark, print maps for cross country travels, make sure housing and school documents are all in order...Lots to do!

As an aside, I just finished the book Complications: A Surgeon's Notes on an Imperfect Science, and I highly recommend it to anyone, especially those of you who are going into the health care field. The topics Gawande covered were both inspiring and frightening. I also started reading When the Air Hits Your Brain: Tales from Neurosurgery. The tag line for the book is, "when the air hits your brain, you ain't never the same." Probably holds true for most interventions, I think. Vertosick paints (in my opinion) a more realistic picture of surgery than Gawande sometimes, the stories he chooses to highlight don't always end with bunnies and rainbows. Patients will die on my watch and that's just part of learning to be a doctor.

2009-07-15T07:49:00.000-07:00

Home, sweet home!

2009-07-09T05:31:00.000-07:00

That counter (lower right) is sure ticking fast! I have exactly one month until orientation week begins, or until life as I know it is turned upside down. In even less time, my mom and I embark on what I am calling The Great Trek. My mom and I will load up my bitty car and drive just over 3,000 miles in about 6 days, and we'll see parts of the country neither of us has seen before. I, personally, have never driven east of Idaho! We'll stop at some key landmarks like Mt. Rushmore, the Badlands, and Montana Ale Works (that's key, right?). I am really looking forward to it, and I hope when the time comes my mom is too!

If you have suggestions of other places of interest along the way, please let me know! We don't have many stops planned after South Dakota, so if you have any suggestions for Omaha, St. Louis, Louisville (is Independence, MO worth a stop? I remember purchasing my oxen and wagon there in the Oregon Trail game) or anyplace else, please leave a comment!

In other news, I think I finally found a home in Richmond! My roommate and I will be living in the Church Hill neighborhood, just a mile or so from school. It's a historic neighborhood undergoing revitalization/preservation and is also the site where the largest Civil War hospital was located (according to wikipedia)! The church the area is named after was also the site where Patrick Henry famously declared, "Give me liberty or give me death."

I apologize for not updating frequently, for now I am spending most of my time getting organized for the move and enjoying my mini summer vacation. I'd hate to bore you (y'all) with tales of laying by the lake and cleaning my closet!

2009-06-21T22:01:00.000-07:00

To the left is Dr. Costanzo, an actual faculty member of Virginia Commonwealth University School of Medicine (the school I have chosen to attend), standing over all of the course material for the first two years of medical school. There are no fancy bindings or covers in that stack, just raw information in the form of course syllabi. I wonder if she is standing on a stool....

Needless to say, the challenge ahead is significant. I know 99% of the time that I am ready for this task, but one percent of the time I have my doubts. How will my brain cope with the floodgate of information about to be released? What if I don't retain any of that information once I've studied it?

Mostly though, I am just trying to enjoy my time before school starts in August. This week I saw my friend's band play, went to the strawberry festival, hiked to the beautiful Ramona Falls, and today made waffles with fresh cream and strawberries, strawberry jam and strawberry shortcake for my dad. Happy father's day dads out there!

2009-06-16T08:04:00.000-07:00

With a little over a month left until medical school begins, I thought it appropriate to begin a new blog. Rather than continue any previous, personal blogs, I wanted to start fresh as I feel momentous changes are coming my way. Hence the title, synaptic reorganization. Not only a phenomenon I have recently studied in the laboratory, but I also anticipate some serious neuronal changes as I am forced to digest an absurd amount of information over the next four years.

I hope you will follow along with me on this journey, but be forewarned. I am not squeamish and am fond of the grotesque and absurd. If I see something disgusting or strange, I will probably not hesitate to write about it.