Testing

In some ways, med school is easier than undergrad, or even high school.  In high school, we had classes from 8am to either 2 or 3pm depending on the day, and we had at least 6-7 completely unrelated courses.  And in undergrad, especially if you double majored and minored like me, we’d also be taking 4-5 different/unrelated classes at once, with different testing schedules for each.  I also went to an undergrad where we had semesters rather than quarters (thank goodness), so testing would come in waves after 4-5 weeks instead of 2-3… although now that I think about it, with the wide variety I had, it was kind of similar to what it is now.  Anyways.

Right now we have tests every 2-3 weeks, which is very short, and we cover a lot of material.  Today’s test, which I am about to take in 2 hours, is on Immunology.  I would venture to guess that we have covered at least 1-2 undergrad courses worth of material in the last 2 weeks.  That’s basically condensing half a year or a year into 2 weeks.  On the other hand, we are focusing (almost) completely on this topic for these two weeks.  Thus, many of the classes have overlapping themes, materials, and numbers/letters to memorize, although each focusing on different things. 

I find that makes it easier when studying at the end, because you can integrate different lectures and be like “oh, this goes with this,” and “oh that’s what that random receptor is for!”  Sadly, you have to kind of cobble together stuff on your own from different lectures, but I think it’s still better than having multiple unrelated classes.

For this test, what really is saving my butt right now is that a group of us started a system where we each made summaries for 2 class hours worth of class, and we made a dropbox account so we can upload and share them with each other.  I love that about our class, that we are so willing to help each other out.  And the funny thing is, a lot of us all haunt the same floor at the same times when studying!  I find that amusing because everyone in the class has their own study schedule and habits, so you end up rarely seeing many classmates, but most of the people in our summary-share group seem to study in the same areas.  We rarely all study together in the same room – usually it’s done individually in the study carrels – but it’s nice to run into familiar faces so one doesn’t feel like such a hermit.

Anyway, I highly encourage you to make study groups or things like this summary-sharing thing when you get to med school.  It is extremely helpful (and you get to bond with your classmates :P!)

For your information, if you’re curious, here’s a list of all the classes we covered in the last 2 weeks for this test (2 hour classes are denoted by “1 and 2”, and labs/quizzes are done outside of class, taking about 2 hours each). I’ve semi-sorted them out into topics for easier organization while studying:

Immunology
Innate/Adaptive Immunology
Cells of the Immune System 1 and 2
Cytokines
Complement
Trafficking
Phagocytosis
Antibodies 1 and 2
MHC Class I/II
Modulation of the Addaptive Immune Response
Lymphocyte activation
Transplant Immunity
Antigen-Antibody Interactions
Autoimmunity 1 and 2
Immunity and Infection
Overview of Immunology

Pathology
Hemodynamics + Lab/quiz
Hemostasis
Inflammation and repair 1 and 2 + Lab/quiz
Immunodeficiencies 1 and 2
Hypersensitivity
Childhood disease + Lab/quiz
Immunopathology + Lab/quiz

Pharmacology
Antihistamines
Opiods and Pain Management
NSAIDs and Gout

Clinical
Lab Medicine 1 and 2
Lab Medicine Case Reviews 1 and 2

Transplants

Throughout our labs and lectures, we talk about how people got a blood transfusion and were able to survive, or had organs resectioned (cut out) or received a transplant.  Today, I was reading in lab about how a patient got a living-related donor kidney transplant from his mother (which means she is still alive – this is possible because you can survive on just one kidney.  Liver is the other organ you can do this kind of transplant with, because the liver regenerates).

That got me thinking.  A lot of us would donate blood easily – just pop by the local blood bank, get a needle stuck in your arm for a little bit (*shudders*), wait a bit, and voila! Not too much pain, and you can feel good about possibly saving a life (or providing fodder for new-age vampires).  And many people also sign up to be organ donors if something should happen to them and they pass away.  That is very admirable – that they would give up their innards and other parts, because as they say, it wouldn’t be of use to them by then anyway.  (Although I must admit that after seeing those autopsy pictures of the removal process in class, I’m a little more queasy at the idea).

But when more substantial pain is involved, less and less people are eager to sign up.  The next step up would maybe be a bone marrow transplant – yes, signing up only takes a swab of the cheek to see if you are a match, but many of us have heard how painful it is, the bruising/aching it leaves behind, and just the idea of the big needle jabbing all the way to the bone is kind of freaky.  Yet some people with big hearts and courage greater than my own would sign up and volunteer.  And a step even greater are those who are willing to do what this mother did here – a living-related donor (LRD) transplant.  I guess it’s a testament to the extent of (a mother’s) love, that someone would be willing to go under the knife despite all the potential complications and the loss of one’s all organs for the chance to save or help another.  I say a chance because, as we are learning all too readily in med school, there is no guarantee that the patient won’t reject the transplant… which actually happened in this case.

I started thinking about my own life.  If my sister or my parents were in dire need – if they desperately needed a transplant and I was a match… would I be able to do that?  To say yes, take whatever you need?  I, with my fear of needles and high sensitivity to pain, the kind of person who put off her ACL surgery for two years just to try to avoid having her knee cut open and drilled through… would I be able to be so selfless?  Right now, all I can say is that I would probably be willing to go as far as a bone marrow transplant… but I don’t know yet if I could be a LRD.  Does that make me less of a doctor, that I would have these reservations?  I don’t know.  I hope not.

What about you?  How far would you be willing to go?

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Update: 
Huh, random fact of the day: we just learned in class today that when a kidney is transplanted, it’s not put back to where it usually is (around the lower back area), but instead is put near the groin area, next to the appendix.  Weird!  I wonder why?  Maybe so the urine doesn’t have to travel as far before it exits?

Macroscopic Pathology Lab (11/7/11)

Suppressing gag reflex for 2 hours – not. fun.

After getting lost in a rat maze of underground halls, I step into the demonstration room.  5/7 of us are already there, along with the girl leading our lab.  The room is filled with the rank smell of formalin and decaying organs, and buckets full of fluids and various organ parts line the tables and shelves of the small room.  On the demo table are 7 trays, like the ones you use to serve food, only the insides have towels wrapped around a netted bag containing organs of the recently deceased.  One student asks how long the organs are kept.  The answer was a couple weeks, and then they are stored in the jars for a few months until the case is closed, and then they are disposed of.

We are told to “play” with our organs for a while, and then the girl leading the lab would go over all the cases.  Honestly, as first years, none of us really know what we are doing or looking at, besides what we could vaguely recognize from the pictures from the few online lab we had gotten so far.  But we do as we are told.

Upon reading the notes from the examiner, I find that my specimens come from an inmate who had emphesema before he passed away.  I unwrap the towel and try to figure out what organ I have on hand while simultaneously trying to hold my breath at the sudden blast of noxious air.  Lung? Heart?  What is this random slice here?  Why is the kidney sliced up so much on one side like pre-cut slices of thick deli meat?  Oh, she’s talking to another student about how they cut so much through the heart and the chambers that even she can’t really orient herself on what part she’s looking at.  Now I don’t feel so bad about not recognizing the heart at first, despite having seen a pig’s heart in 5th grade.

Going through my organs, I really can’t tell much of what’s going on.  The most I can see is that the lungs are slightly paler than other people’s, and sponge-like.  There are also gaping holes where abscesses were, with an especially large one in one lower lobe.  I really have no clue what most of the other items are, besides a long smooth strip that reminds me of stomach lining in Chinese food, some kidneys, and testes, and the mess of what I presume is a thoroughly cut-up heart.

The lab leader begins going through the cases one by one.  She sees half of us hanging back a bit, and others sometimes recoiling backwards when she fishes out the next organ.  “Oh, does the formalin bother you?” she asks.  “Yeah, some people have problems with it, for some reason.  It doesn’t really bother me.  Maybe it’s just because I’m used to it.” The rest of us send furtive glances of silent, wry agreement.  I don’t know about the others, but I was trying hard not to pass out for most of the two hours, feeling more and more light-headed as the lab went on. 

 On the upside, we did see a few interesting things.  We had a few “nutmeg livers”, which we learned in class today (2 days later) about how it’s called that because the red spots and bumpy appearance of the liver looks like the inside of a nutmeg.  I found out that the gall bladder turns a brilliant green after fixation due to the bile acids – it’s really quite a pretty color, like green grass – the only nice-looking color in the whole bunch.  One guy had a huge stone in his tray’s kidney.  It had approximately the size, shape, and color of a dried date, although slightly pricklier on the surface and much harder.  Considering that the size of the kidney was only a bit larger than a fist, it was quite a significant portion of the organ.  We also saw lots of thrombi (clots), and plaques in people’s aortas (which is what that strip of yellow, stomach-lining looking thing was).  We also saw evidence of fatty liver (which turns the color tan-ish compared to the normal blue-ish color), and had it compared to pate or foie gras by the lab leader… apparently pathologists really like comparing things to food.

My case had the obvious signs of emphysema as mentioned above, and slight diveriticulitis of the colon (some pockets were we saw fecal matter was still trapped in in the gut), and a spleen that was dark red, congested (full of material), and twice the size it should be.  One person also had a liver that had a ton of metastases from cancer (lots of white spots all over). 

So, some interesting things.  But definitely not enough to make up for the smell and grossness, at least not for me.  Thank goodness we only have to do this once.  I can’t believe I’m saying this, but even anatomy lab was better.  Maybe it’s the fact that formaldehyde smells marginally better than formalin.  Maybe it’s the fact that bodies sprayed down with formaldehyde (or maybe the fact that most of what we’ve looked at in anatomy so far are muscles, nerves and vessels, which) tend to be drier and firmer, rather than squishy, slippery, and gushy with putrid masses.  I can now say that I have definitely rule out my nebulous consideration of going into forensic pathology.

Homecoming week (and Gurney Derby)!

It’s homecoming/spirit week for our school this week!  Most of what we’re doing is just dress-up days, but yesterday I was part of the group that helped cheer the Dean in (and her entourage) as they came to judge the med school’s spirit for Homecoming, and today, I was part of a 4-man team representing our school in the Gurney Derby!  

The Gurney Derby is a school tradition, where teams of 4 (2 girls, 2 boys) from every school (undergrad majors, graduate schools, health professional schools) within our school makes a theme for their gurney, and they dress up in costumes, decorate their gurney and passenger, and then race the gurneys down the street and back.  Rules are that one hand must be kept on the gurney at all times, the gurney must cross all the way across the line before you turn to go back, and the passenger cannot fall off the gurney.  We are also all geared up in helmets, knee, elbow, and wrist pads. 

Apparently, the school of medicine has not sent a team in for the Gurney Derby for at least the last 16 years because due to the way the scheduling works, the school of medicine always has a test for both first and second years during the week of homecoming.  The same is true this year, and yesterday we were feeling a bit apprehensive because not only do we have our first test for this module on Friday, but we also had to miss 1.5 hours of class today for it, which we have to make up somehow.  But we all decided to stick to it, and we all ended up being glad we did, because really, you’ve got to make some kind of memories in med school besides being stuck indoors studying in the Hall every day. 

This year, the Derby was run in 4 heats of 4 (16 teams total), and the four fastest times would compete in the finals.  Awards would be given for first and second place, fourth place (the “Dead Last” prize.. a misnomer, really), and for Best Passenger (aka best decorations). We were in the first heat, and man, I have never run so fast or hard in my life haha!  It is actually much harder than it looks to keep it straight and to even keep up with the rolling gurney (one hand on at all times).  Probably mostly because of my inability to keep up/keep the gurney stable, we got 2nd place in our heat.  It felt like we were pretty slow compared to the first team, so we didn’t expect to be called up for the finals, but stayed to watch all the other teams anyway.  Some of them were really fast! 

At the end of all 4 heats, they called up the names of the teams that made the finals.  First called was Team 2, the first place winner in our heat.  Next called was Team 4! Our team!! We were seriously surprised – my friend and I were shaking our heads in shock, repeating “no way… no way” over and over.  So, on we went to the finals.  A few of our classmates were able to catch the tail end of our run, which was super awesome of them because the race was a few blocks away and most people would have wanted to study, so I was really appreciative that they came.  We ended up in fourth place, so we got the “Dead Last” award, which was a hubcap in which they inscribed the title haha.  We also ended up getting the Best Passenger award! 2 prizes for the school of medicine, whoot whoot!  Not bad for a school that hasn’t competed in the derby for over 15 years 😉

Oki dokes, back to studying!

Surgical/clinical anatomy

Yesterday and today, we had a few hours of lecture on surgical and clinical anatomy (that is – how what we’re learning in gross anatomy and lectures applies to the real world in surgery).  On the one hand, it helped get across that what we’re doing right now is very relevant to the practice of medicine, which was pretty neat.  On the other hand… I don’t know if surgeons really like to show graphic pictures because they find it interesting, or if they just really like freaking med students out or what, but there were some really REALLY disturbing images in some of those surgical anatomy lectures.  In reviewing for the test on Friday, I need to go over them again, and every time I see them, my stomach twists in knots and I feel queasy for quite a while afterwards (even now, as I type).

Urgh.  Well, at least I know I don’t want to be a surgeon now.

(… weird, I definitely posted this in early October, like the 9th or so, but for some reason it changed to posting it now…)