books · MS-1

We have summer reading! Again! As BH, who is in math grad school (taking classes like “topological algebra” and “partial semi-differential hand-waving”) said when I told her: “Buh?”

Last year’s summer reading was on The Spirit Catches You and You Fall Down, a rather sad story of cultural clashes. It frustrated me no end, which I suppose was the point. We were supposed to discuss in small group but never actually got around to it, so my understanding of cultural competence, $60k later, is not really much better than what it was around this time last year. (I do, however, have a much better understanding of rotation of the gut, for what it’s worth. Everyone has situs inversus.)

This year’s summer reading is Mountain Beyond Mountains, Tracy Kidder’s biography of Paul Farmer. I’m holding off judgment until I actually receive it (could be a while, given the Fourth of July shipping delays), but it should be an interesting read, if nothing else. I’d like to do international work eventually, and Dr. Farmer’s kind of a Big Deal in the global health arena. It is gratifying to see that idealism can actually work.

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exams · MS-1

What just happened?

I am DONE with first year! It really doesn’t feel like summer yet — for one thing, it’s freezing — but it’s Very Nice Indeed to take a break from studying. I went out to dinner with med school friends on Monday (the day of our last exam), and last night I finished off the leftovers in my defrosting minifridge while watching Bleak House on DVD — guilt-free! It’s awesome.

One really good thing about being done — I get to spend more time with my friends who aren’t in med school.

exams · MS-1

You know those anxiety dreams where you go to take an exam and as soon as you get the paper you blank out? That was me and the neuroanatomy exam yesterday. I was exhausted from a marathon study session the day before, and apparently I actually fell asleep during the exam. The parts where I was awake weren’t much better.

Oh well! The other exams were alright, and I really am not stressed about anything. (Sleep-deprived, yes, but not stressed.) I took yesterday night off to recuperate and eat applesauce and watch a melodramatic costume drama on DVD. Good times. There’s one more to go, and then I am done.

It’s really shocking to think that the year is almost over. In a lot of ways, I feel like we just got here. I’m moving back home on Thursday; starting work the day after Memorial Day. Perhaps I should have looked into something international — I’m very interested in global health as a possible career, and I’m exceedingly jealous of my friends who are going abroad (postcards, please!) — but I think the job will be interesting, and I’m not going to deny that it’ll be nice to be home and taken care of for a few months. (I’m grown up, really!)

—————-
Now playing: Virginia Hullabahoos – Your Song
via FoxyTunes

exams · MS-1

Not that I loved trees less, but that I loved passing more

Yesterday I printed:

-a 22 page review guide for epidemiology
-a 14 page review guide for psych
-a 124 page review guide for neuro
-a 54 page review guide for endocrine

Also miscellaneous practice exams, one-off review sheets, etc. The goal for today is to quit slacking and get through at least the epi and psych.

Poor rainforest.

MS-1

Anatomy

The anatomy memorial service was this afternoon. As far I could tell, there were no families there — I don’t know if that’s a common occurrence or just because the date got switched around a lot this year. Several of my classmates read poems or short essays. One theme that came up over and over in the student readings was the difficulty of knowing the body so intimately and the person not at all. I understand the need for privacy, and knowing too much, especially at the beginning of the course, would have made it even harder to do what we had to do. Over the course of the year, as we got to know each other, we got to know her as well: she had severe scoliosis, blue eyes, pierced ears. Something of her past medical/surgical history as well: a hole in her skull for trepanning, a stent in her inferior vena cava, no gallbladder. But knowing the little things would have provided a little closure. What was her occupation? Did she have children? Grandchildren? How old was she? What language(s) did she speak? Did she live alone? What did she like to do in the evenings? I don’t mean to sound sentimental, but the relationship with the cadaver is such a unique one — intimate strangerhood — that I can’t help but compare her to my grandfather, who was a donor as well. Presumably, she had a family as well.

Looking back, I don’t really know how I got through anatomy. I detested lab; dissection never came naturally to me, and the phenol made me tired and cranky. I still can’t recall the goalpost labs without wanting to throw something at a wall. There were good moments, though. My group was perfectly amazing, and those friendships are the best thing to come out of lab — better even than my actual knowledge of anatomy, which is tenuous at best.

MS-1

Amazing! Things are happening here

Ever since I read Panda Bear’s post about the futility of student governance in med school, I’ve been dying to write a rebuttal. I graduated from a university where student self-governance was practically a founding principle, like liberty in the Declaration of Independence. I had plenty of examples of students effecting change in undergrad, but med school’s a very different system, so I decided to hold off until I had a more concrete success than “They modify lectures based on student feedback after each block.”

You see, since about January, there have been rumblings of eliminating Honors from the second-year grading scheme. (We are pass/fail for first year, H/P/F for second, and actual grades for third and fourth.) We all felt honors was a carrot of competition they held in front of us, creating extra short-term stress with little long-term yield — “everyone knows” residency directors don’t really care about grades in the pre-clinical years. Anecdotally, there’s also a lot of faculty support for the change. There is a big curriculum reorganization in the offing, and the Big People already decided to make the preclinical months honors-free. So why not for us?

A couple of weeks ago, we had a curriculum survey of the entire first year. On the question of honors, almost 80% of the class voted to remove it and go to a straight P/F system. In light of that result, we had an open meeting with the dean of students and the curriculum committee chair. It was remarkably well-attended, much better than lectures for sure. I got the impression that Dr. D, the chair of the curriculum committee and kind of an old-school guy, was very pro-honors and that he would be the one we’d have to win over if we wanted this change to occur.

After the meeting and question/answer session, we took another survey, which revealed that 86% of the class wanted to remove honors from the system. The results were presented at the curriculum committee meeting this morning, after which we received an email informing us that second-year, like first, would now be pass/fail.

So you see, the administration, at least at this august institution, can and does listen to student input.

Now, if we can just convince them to waive our tuition….

MS-1 · psychiatry

MSE

I’ve been back for a week now. Without anatomy (I passed!), I have copious amounts of free time, which I fill by watching videos on youtube and strolling around the city. It’s wonderful.

We started psych med on Tuesday and have thus far learned about the Mental Status Exam. The examples given in the book are very novelistic (“She seductively sweeps her bangs away from her face….”) and so I present for your amusement a quick game of Guess the Patient.

Patient X is a student (age debatable), about 5’10 and 160 pounds. His facial appearance is marked by distinct pallor, which contrasts sharply with the inky black of his open doublet and dirty socks that fall around his ankles. He enters the room in a distracted fashion, looking around him as though afraid of being followed. The knocking of his knees also suggests fear. As the interviewer rose to greet him, Patient X drews his right hand slowly to his forehead, then extended it in a flowing motion to meet the interviewer’s outstretched hand. He then sank into a chair, where he remained for the duration of the interview.

The patient answers all the interviewer’s questions readily. His speech pattern alternates between slow, monotonous responses and garrulous outbursts. When asked about his mood, he says that he is “very like a whale.” On being asked to explain, he winked at the interviewer but did not elaborate.

He has a full range of affect, although occasionally a question about his family causes a shadow to pass over his face and shuts down his emotional response. This is brief, however. Thought process is circumstantial and tangential; long digression of the death of an older man who played with him as a child and appears to have been a surrogate father figure. Some loosening of associations. Thought content is obsessive, centering on the recent death of his father and his mother’s subsequent remarriage. Grandiose delusions of his “destiny” as the savior of his family and friends. His girlfriend recently broke up with him, an event he attributes to the influence of her father, a friend of his stepfather.

Some evidence of visual and auditory hallucinations, primarily of his father. These hallucinations command him to avenge his father’s death. Admits to passive suicidal ideations (longing for the “sleep of death”) but has not made a plan due to fear of the afterlife he believes to exist. He also shows evidence of homicidal ideation against his mother, stepfather, and girlfriend’s father.

Cognition: fair. Alert and oriented to self; described interviewer as “fishmonger.” Recalls 3/3 objects in two minutes. Digit span 7 forward, 5 reverse. Does not know own age or age of father at death. Frequently confused two childhood friends. Fund of knowledge good on current events, somewhat shaky on chronology and dates of the past. Above average intelligence, reflected in sophisticated vocabulary. Occasionally invents words.

Poor insight. Patient is aware that his friends and family are “concerned” about his recent behavior. He insists that he is “but mad north by northwest.”

Judgment: Patient does not appear to understand the need for treatment. Recommend hospitalization for suicidal and homicidal ideations.