Infraspinatus Envy

Thursday, my lab group exposed the infraspinatus  (among other things), and let me tell you, it is textbook.  No fascia, beautiful striations.  It is even better then the prosection.  Everyone was coming over to look, even the fellows.  If our infraspinatus doesn't get tagged in the anatomy practical, I will be talking to the dean.  

I was convinced that I still had some piece of flesh on me this morning during lecture because I could smell it.  I think I will be smelling it for a long time, piece of flesh or not.  Like my brother once said, "if you smell it, you also taste it."  SWEET!  My group is pretty cool as well.  A lot of people were talking about how everyone at their tank was so serious and no one had a sense of humor (or should I say humerus).  My lab group was joking and laughing.  I could see the sadness in some people's eyes as they looked over at us like we had just beat them in the championship game and it was time for our trophy.  And that was before the infraspinatus was unleashed.

There were a few awkward moments in lectures this week.  The first was when the biochemistry professor asked a student in the front row if the word "invagination" turned him on.  The second was when one of the anatomy professors said to the other, (they are married to each other) in front of the whole class, "thanks for helping me with that, you are definitely getting dessert tonight.

How do you like them apples, gunner?

Before I get to the good stuff, I wanted to say that I am getting really sick of the 'professors' ending all their mid-finals-week-e-mails with "happy studying!"  It is just disgusting.  In fact, some students think it is a good idea to add little 'pick-me-ups' during their messages too.  "Good luck all" or "Have a good weekend" knowing full well that we will be locked inside without seeing the light of day, furiously trying to cram information into our overworked and under-rested brains in the hopes that all of a sudden we will be able to remember said piece of info.  I mean, it is not kosh to say to a person asking for change outside a quiktrip, "happy panhandling!"  Bosses do not say "happy job-hunting" to employees they just fired.  I am all for finding the silver-lining, but don't be ridiculous.  

So the night before every exam, our physiology professor goes onto the chat rooms (no matter how innocent that word is meant to be, there is still something odd about saying chat room) and helps answer any last minute questions we might have.  I was there one night watching questions when I noticed something distracting.  This young buck seemed to always have the first answer to everything.  You know, this kind of activity, but in a chat room!  He was also starting to get a little to friendly with the professor, acting like high school buddies that just met on myspace.  So I did something I do not normally do.  I spoke up in the chat room.  I have to say that I gave myself a high-five.  Normal guy 10, gunner 0.  It felt good.

Professor: And what is the neurotransmitter that activates the post-ganglionic sympathetic receptors? Aug 24, 2008 11:11:09 PM CDT
Professor: receptors should be neurons... Aug 24, 2008 11:11:16 PM CDT
Alpha Gunner: epi Aug 24, 2008 11:11:43 PM CDT
Beta Gunner: norepi? Aug 24, 2008 11:11:45 PM CDT
THE WEEK: ach? Aug 24, 2008 11:11:47 PM CDT
Prefessor: 10 points to THE WEEK... Aug 24, 2008 11:12:04 PM CDT
Confused Gunner: ? Aug 24, 2008 11:12:20 PM CDT
Prefessor: I worded the question differently than I said it in class, which is probably what caught you... Aug 24, 2008 11:12:24 PM CDT

Note to professor:  Do not sugar coat it.  They didn't know the answer...

Speaking of messing with gunners, there is talk amongst some of us about showing up one day in our pressed white coats, with ties and nice shoes and all taking up the first two front rows of seats.  Pretty sure you got to keep the gunners on their toes.  Chris Cocker has nothing on the gunner's potential reaction.  "Leave our seats alone!"

Christmas Is Coming...by Christmas I mean cadavers

So this week was interesting. We had a 'patient panel' on Tuesday which consisted of one patient (No, I wasn't attending class at Drexel, my school makes mistakes too). It was a lecture about obesity from a patient's prospective. I was intrigued to see if the man would change my opinion on obesity, but he didn't. Basically he was a 6' athlete that gained over 180lbs over the course of roughly 5 years and then tried to get it all off in 9 month spurts of exercise and diet. Well that didn't work, so after his daughter begged him for the sake of her unborn children to get a medical procedure to correct it, he finally did. I wanted to ask him questions to test his attempts to lose the weight, but I opted for keeping my mouth shut. I might have asked "Why didn't it work after 9 months of attempting to lose weight? Did you hit a plateau or did you give up?" or "Did you really expect to lose all the weight you gained in five years in 9 months?" I am not ready to stand out like that quite yet. If I was, I would have asked the Surgeon General, in front of a full auditorium a few weeks ago, "How is it that one day I will be on the phone with some 18-year old kid who works for an insurance company, telling me how to treat my patient because what I want to do isn't in the penny-pinching, actuary-produced flow chart that he is using to decide what I can and can't do?" But again, I am not ready to stand out like that quite yet. Those questions will not get me anywhere I am hoping to go. A lot of my thoughts are better kept in my head.

I know what it is like to lose a parent, but I cannot imagine the pain and frustration of watching your parent willingly (these were the patient's words) let him or herself get to the point that they would die a premature death. Three different times he was told that he would die within the year. But still he did nothing. There are so many people out there fighting cancer, and other unfortunate things they cannot control and to see someone who isn't willing to fight to prevent something they can control is disheartening. The people fighting cancer would love for the doctor to tell them, "All you have to do is exercise, and eat right and you will be fine." The patient said he knew what he was doing and he knew what it would take to lose the weight. Every time his daughter would say something, he would just eat more. I felt sorry for him and I am glad he was able to lose weight, surgery or no surgery. I do feel more sorry for the rest of his family though, but I am glad he might one day be able to run around with his grandchildren. He has lost about 80 pounds, but has hit a plateau which he wants to ask his doctors about. The procedure he had is more of a tool then and fix. I think it would also be very frustrating to be his doctor. You tell him, he does nothing, you tell him, he does nothing. It wasn't until he had that moment of clarity (him weighing in at 380 at the doctor's office) that he realized he needed to do something...anything. I can understand that, but that is tough. I have to say that sometimes, as a physician, there will be nothing more I can do. I will have to let fate take its course and at the end of the day just be able to feel confident that I tried my best and did everything I could to right the situation. I think this is definitely one reason I am so drawn to sports medicine. If the patient is an athlete, they will be somewhat healthy already, and they will be willing to to whatever it takes to get back onto the playing field again. I like the sounds of that patient.

We had a clinical didactic and practical exam on Wednesday which was nerve racking. It's one thing to take a multiple choice exam, but to have to answer and perform in front of a physician/observer/grader and mock patient in three minutes is difficult. Either you know it or you don't. There is no help if you draw a blank. They just stare at you and write notes on their paper. We also did some mock interviews. When you are at the doctors office, it seems like it is second nature to them to be able to ask questions, but what I never realized is that it is very awkward. I know it will come with time, but for the first interview, it was challenging.

Yesterday was my first taste of a medical school final exam. It was 4 hours long and I am pretty sure I was looking forward to this moment for the past six weeks. I seriously spent 5 minutes trying to figure out if my calculation of the range was wrong or if the professor didn't proofread his work. I chose for the latter. That is frustrating. We are under a lot of stress and when you have a question and do not give us the right answer, we begin to second guess ourselves. "Wait, I know this is correct. The range is not hard to calculate. But 18 is not there! 19 is. 25 - 7 is 18 not 19. Did he forget to make the 25 a 26? They should take away his preventive medicine title. He can't prevent a mathematical error.(Just kidding) You know, I was told once that the Challenger blew up because of a misplaced comma, but I am pretty sure our teacher was trying to get us to get into the whole grammar thing. Oh wait, I am supposed to be taking a medical school final not an algebra final..." I swear, if I get a 'calculate the mean, mode and range' question on the boards, I am going to ace it. I was more nervous about our clinical didactic and practical exam then I was for the final. I felt that after six weeks of information I couldn't learn much more. I had to use my time to refresh the things I once learned for the previous exams and make sure I had those things down. I didn't sleep much last night, not because I was so worried, but because I was 7 again and Santa was coming in the form of the musculoskeletal section. For the first time this year I hope that things will begin to make sense. Instead of some Russian dude telling me how much he is in love with cytokines, Tumor Necrosis Factor, and IgG (or is he saying IgD? maybe its IgE? I can never understand his accent) I will get to see some cool things. And by cool things I mean the cadavers. I am so grateful that we have this opportunity and I am grateful that someone was willing to donate their body to science.

I had an all-time high of 27 visitors to my blog two days ago. I am hoping that it was because a few of those visitors googled "Drexel University College of Medicine". Hey, one can dream.

Drexel University College of Medicine Thinks I am un-smart

Dear Drexel University College of Medicine,

I got your letter. Thank you for sending it to me. I was eagerly awaiting a phone call from you so it was disappointing to get this version. Even though I am here and going to a medical school already, I pretty much had my life on hold for you. I can finally exhale because I was still packed in anticipation of 'the call' at which point I would have left my life here for you. In my head I imagined 'the call' going something like this:

YOU: "Hello, this is Cheryl A. Hanau, assiciate dean of admissions at Drexel University College of Medicine. I know we have not interviewed you, but we feel we really got to know you by the way you answered our loaded questions such as 'Describe yourself' and 'Tell us about your activities since graduating from college' and 'What are your weaknesses'. I mean, even though we made you keep it under 250 words, essentially feeding us lines we wanted to hear, we feel that was enough to offer you a seat in our class of 2012."

ME: "Wow...uh...that's great, except I already started medical school."

YOU: "So did we, two weeks ago." (Notice the date difference in the letter)

ME: "Ok, great. So should I be there tomorrow? I will spend all night driving, if it means being there, with you."

YOU: "Yes, we are so excited for you to come."

ME: "You sure it isn't because you didn't have enough seats filled to make budget?"

YOU: "Don't be foolish. We got your AMCAS fee and your secondary fee. We have 12,000 applicants per year, which gives us our budget, everything after that is all gravey!"

ME: "So you really do want me there?"

YOU: "You bet!"

ME: "Do you have anywhere I can stay while I find a place to live?"

YOU: "No, in fact you owe us $40,000 by tomorrow. Good luck and welcome!"

ME: "Great! I will be there tomorrow, cash in hand."

YOU: "I like 100s."

Did you really think I was waiting around for you? How stupid do you think I am?  I understand a courtesey letter back when you filled the class, I don't know, maybe in March, but this is just an insult.  Apparently I am too stupid to know that the medical school semester is well under way and that I have about as much of a chance being a part of your class as I do leaving medical school free of debt. Maybe you think that I didn't get into a school anywhere and am just waiting around for something to happen?  I am such a kidder, because the truth is, I gave up on you the moment I had this conversation with one of your staff members back in July, 2007:

ME: "Hi, I looked online, and it says that my application says incomplete, but you cashed my check, which means you have processed my application."

YOU: "Oh yes, I see here [most likely looking at nothing more than a blank piece of paper as my application was already recycled and made into a milk carton at this point] that you are complete. You see, when you send us your application via snail mail, it will never get updated online. [wincing in anticipation of me calling 'SHENANIGANS!!]"

ME: "So you have my application?"

YOU: "Yes."

ME: "And it will never say that my application is complete online?"

YOU: "No. You will receive everything by snail mail, not online."[beginning to snicker]
ME: "So despite what I see online, I can take your word for it?"
YOU: "Yeeeees." [Flashing menacing smile]

I mean call me stupid (oh wait, you already did), but what is the point of having the online status check if it never gets updated? Do you enter through your exits and exit through your entrances as well? Do you make everyone walk backwards on campus, or is it just that way in admissions? Oh well, I hope you enjoyed my $120. I know, in your defense, that not charging people to apply to your school might diminish the respect you gain by making us broke before starting there. I respect that. But I do not understand why you would assume your applicants are this stupid. That's just bad for business. Maybe you just talk down to the rejects, and the people who get in actually get a letter that makes sense. I bet it has big words like confluence and extraordinary. Words I would have to look up before I could make sense of your letter.

I also knew to give up on you back when you started sending me your capitalist propaganda that said, "You might be interested in our school of nursing!" Save it, Drexel. Apparently you didn't read my personal essay that basically laid it out that my dream was to be a doctor and nothing else, whatever it takes. Seriously, this isn't Amazon.com and I am not shopping for books so do not try to sell me more stuff. Maybe your ploy was to make me watch you waste all $120 of my application fee, one postage stamp at a time, by sending those letters. I do not want you to try to guide my life. Do you really think I am stupid enough to think that I had a chance after the whole "we cashed your check, but your application still isn't complete" episode? Apparently you do. Or maybe you felt that I was going to fall for your "maybe you want to do something other than be a doctor" shell game. Yeah, you are right, forget the past four years and all the science I could cram into a semester, I should do something else.  Here is another application fee for you to insult me some more.  Do you maybe have a pyramid scheme I can join as well?

You should be careful, Drexel, because one day I might be in a position where I have to decide whether to hire the Drexel Graduate or someone else. I will think long and hard about how stupid you think I am and probably go with the other candidate, because, let's face it, hiring your graduate might be bad for business.  

Really though, thanks for bringing a smile to my face and allowing me to laugh a little.  When I saw the letter in my mailbox and saw it was from you, I shook my head and smiled.  I picked it up and shoved it between two medical school books I had with me FROM CLASS.  Only Drexel.  Only Drexel.

p.s. I know this pixelated 'signature' isn't really yours. I know you didn't actually put the pen to the paper. You didn't fool me there either. 'A' for effort though.

p.p.s. If I could somehow figure out how to make this post the first google result that pops up when you type in "Drexel University College of Medicine" I would.  Copying and pasting your double descriptive title 1000 times on my blog didn't do the trick.  I tried.  What is a university college anyways?  Your attempt at Jedi mind tricks?  Usually schools settle for X University SCHOOL of medicine.  Abraham Flexnerwould be rolling over in his grave.

Answer to the ethics question and a bonus ethics question (lucky you!)

Alright, ladies and gentlemen, here is the 'answer' to the ethical question. I use the term answer loosely, because in this article it basically says that other institutions have opted for the opposite route. So, this basically means that it is up to each institution to make the decision. So I hope the answer to my board question, should I get one, is any choice. The quotations below were taken from Urology Volume 64 , Issue 3 , Page 590 "Misattributed paternity in a living related donor: To disclose or not to disclose?"Douglas W. Soderdahl, Danny Rabah, Thomas McCune, John Colonna, Roland Frenc, Edwin Robey and Michael D. Fabrizio^,

Arguments for disclosure:

"Arguments for disclosing paternity are these. First, each patient must be treated as an autonomous agent who can make informed decisions, based on all the information available. In this case, the patient has a right to his test results and their interpretation. This allows for true informed consent when the patient is being counseled.

Second, to withhold the information, the physician acts in a paternalistic manner, whereby the doctor makes a value judgment as to how a patient might handle the information. Thus, the perceived potential beneficence and nonmaleficence of how information will be handled is valued above that of patient autonomy. The decision for nondisclosure is based entirely on hypothetical negative outcomes (ie, family break-up), which may or may not come to fruition.[3]

Third, one of the duties of the medical profession is to tell the truth, and although nondisclosure might not be on par with lying, deception, or misrepresentation, it still has ethical consequences. The truth has a tendency to become disclosed eventually and might irrevocably damage the patient-physician relationship when it does.[6] In addition, there might be legal ramifications if the information is discovered in the future under other circumstances.

Fourth, disclosure of the information allows the son to clarify his genetic heritage. His medical family history would not include that of his father or his father's relatives. His future health and life insurance might be affected by this information."

Arguments for non-disclosure:

"Arguments against disclosing paternity were as follows. First, by revealing the paternity information, there is a potential for irrevocable harmful effects on the emotional well-being of each patient and the family unit as a whole. Even though there are no legal or ethical obligations owed to the mother, this information is certainly sensitive to her, and her reaction must be considered as well. Ultimately, the information could prevent the potential transplantation and result in a break-up of the family unit. The “best” result in this case would be a successful transplantation and maintenance of stable family relationships.

Second, by informing both parties of the HLA typing results, one could argue that the physician breaches the confidentiality of each individual's findings. Each patient must give their own informed consent, even though the procedures are intimately related, and there is no absolute right to the other individual's test results even in the context of transplantation.

Third, because the testing was done solely to evaluate donor/recipient compatibility, one could argue that the unsought paternity implications are irrelevant. The son was still a suitable match for his father, and the results would not affect the transplant procedure. In that a similar situation could arise from simple ABO typing, eliminating HLA typing will not prevent situations like ours from occurring."

And what did they do?

"After much deliberation, we elected to inform the father, son, and mother of the results of testing. The paternity implications of the results were presented in as supportive a manner as possible. After a 2-week period requested by us, both patients consented to the procedures and underwent successful operations. At the time of the disclosure and in follow-up, the donor and recipient were both adamant that we did the right thing in informing them of the result and felt that it should always be done. Importantly, the family remains intact."

Here is another question. Is it ethical for the newly promoted Associate Dean for Curricular Affairs to change the long standing rule that states that if something was not presented in lecture, that it wouldn't be on the test?

How about if I tell you that she is also a professor?

How about if I tell you that she is also going to try to pass the rule that it is mandatory to purchase the books for each class?

How about if I told you that she also wrote the book for the class she teaches?

Perhaps a conflict of interest?

Stay tuned for the 2nd year students to take their first test from her. There is talk of a 2nd year student mutiny should she put a question on there that wasn't from lecture. Med school is so exciting. I hope the security guards have their riot gear.

Three and out

Well, we just got the second test results back today.  I will tell you that I am not happy with where I am.  I can do better.  I have not felt that I have been firing on all cylinders.  I feel like a football team that is able to move the ball, but just can't get to the end zone.  I will not settle for a punt or field goal.  [On a side note, when I was injured for football, I was responsible for writing down the result for every play.  Our team was struggling on offense, and it got to the point where I started to misspell 'field' in field goal because I was writing it so many times.  Now I know how you felt coach.]  I am faced with two possible ways out of this predicament.  I can completely throw out the practice plan and start changing things up everyday until I get it right, or I can slightly tweak the plan, while keeping the foundation I have built on.  Either way I suck at studying.  Yeah, I may be hard on myself, but I know no other way.  I could tell myself that I am not last so it is okay, but that would be cheating myself.  Like saying at the end of the loss, "at least we beat them in the second half."  You may be right, but we still lost.  I have yet to find a method that works for me.  I do believe I am on the right track, because the other option for me would be to just read through everything.  I know the notes are good, but just reading will not help me remember because I have been reading them when I review.  People will say what 'works' for them, but that is a relative term.  'Works' as in you are the top of the class, or 'works' as in you are not failing?  I assume the latter.  I do not want to win on a last second play, I want to have my subs in by the start of the fourth quarter.  What I do know is my brain is fried (I actually stopped myself putting dirty dishes into my refrigerator this morning) so there must be something going on inside my head.  Although, on the same token, I feel like I have learned nothing.  Just in one ear and out the other.  There is either severe learning trying to go on, or severe brain damage.  It is a good thing we are not in our neurology section or I would be self diagnosing.  I am already thinking I will develop ankylosing spondylitis, but that is a different topic.  Can't wait for each system so I can figure out what is wrong with me.   

This week is somewhat light and by light I mean I actually recognize some of the words in lecture so I will try to think of ways to do better.  The problem is I am too busy trying to grasp the large picture, and then they ask some detailed question on our test.  It kind of feels like a low blow.  If you spend 20 minutes on one subject and 2 on another, I assume you value the 20 minutes topic.  Either that or you are just wasting my time, and don't get me started on that!!!

Anyways, our section final is next friday along with the clinical final on thursday.  I will have no way to gauge if any new method works for me because the final is cumulative.  I think for now I will do a few things differently, but spend some time this week trying to figure out a game plan so the next time I get the ball I don't go three and out.  Yeah, that post was football themed.  Yeah, I work out.  Yeah, I eat protein.  You wanna wrestle over it?

p.s.  I will be posting the answer to the ethics question soon.

Ode to 'Shout out the answer to the histology slides before anyone else can think guy'

Dear 'Shout out the answer to the histology slides before anyone can think guy'

Congratulations are in order, fine sir. If this were a race, you would have more golds than Michael Phelps. With utter disregard for your fellow classmates, and the speed of Usain Bolt, you shout out what you think is the answer to every histology slide before any of our eyes can bring the image into focus. Even though you are wrong 80% of the time, you make sure none of us have a chance to answer. I can just see it now:

Patient:  "Hi doctor, I think I-"

You:  "Mesenchymal!!!"

Patient:  "What?  No, I need-"

You:  "Dextrocardia!"

Patient:  "No, you aren't-"

You:  "Collagen!!"

Patient:  "I don't underst-"

You:  "Simple cuboidal!!"

Patient:  "...."

You:  "Nodes of ranvier!!!!!!"

Patient:  "I am going to 'raise your hand in lecture guy', at least he talks to me"

Forget using the voice in your head to answer, you choose to use your monster truck ralley voice to provide us with what you think is amazing tissue recognition. Forget if you don't get it right the first time, because one of the next 6 names you yell out are bound to be right. My half-head turns with a rear glance do no good in persuading you to keep quiet, for you seem to have no social barometer that tells you when enough is enough. In fact, you take my half-head turns with a rear glance as a sign of encouragement and keep on going FOR ALL 80 SLIDES! 

I'm about to count out this bucket of loose change, you want to start yelling random numbers in my head while I do it, because that's what this is like.  "17, 32, 45, 98!!"  You are the marathon runner of the lecture and you always bring your A-game. Brett Farve couldn't beat your consistency, which is why I salute you!  (I would give you a high-five, but I am afraid you might talk loudly to me in the library. That's embarrassing, too.)

p.s. Say hi to your friends for me.  You know, 'Drop the f-bombs in front of the kids guy' and 'Kick my seat in the movie theater guy' and 'Rest your car door on mine guy' and 'Talk on your cell phone at socially awkward times guy' and 'Rush to the front of a new line at the grocery store even though you are last in this line guy'.