Sunday, September 25, 2011

Oh, I remember - that's why I am here

This past week was another remarkably full one, but also great!

The stress level has been a bit higher among my classmates recently. The week before me is full of exams and the exams are mysterious enough that I, and most of my first-year classmates, am frantically studying and attempting to evaluate just how much sleep I need to sacrifice to pass our exams.

Last week had some refreshing moments that allowed me to reconnect with the real reason I am here. We had several occasions that reminded us of the healing art of medicine, the delicate balance between health, medicine, technology, and compassionate care. On Monday, we had a patient presentation regarding an unusual bone cancer. The patient presenting is a professor emeritus and Nobel prize winner. His story was incredible and it was wonderful to have him share so much with us. On Wednesday, we had a vital signs workshop where I honed my skills related to taking blood pressure, respiration rate, and pulse, testing for blood glucose levels, administering TB tests, performing intramuscular injections, and drawing blood. Much of that I had never done before and I successful drew blood from my fellow classmate on the first try (although he was so hydrated, my vial filled quickly - so I surpassed the couple of milliliters I was supposed to collect; as compensation I gave him a lollipop). I felt so happy after that workshop. I know that those skills are fairly mundane, but I am well-armed for being more useful at the free clinic and that is exciting.

On Thursday, the mother of a woman who had passed in June due to extremely aggressive metastatic lung cancer came and spoke with us about her experience sharing the diagnostic odyssey with her daughter and the challenges of a rapidly evolving terminal illness. She brought up several issues pertaining to doctor-patient communication, health team-family communication, and the confusion triggered by discontinuity in care plans among different health care providers (not enough cross-talk). She brought all of us back quickly to the emotional side of healing and reminded us that there is still a lot of room for improvement in terms of how we treat the patient and their family. She had a positive experience, overall, with how her daughter's illness had been handled by the health care team and she was so warm with us. To her, speaking with us and sharing her daughter's story was a privilege. I felt the same way about her being there.

The rest of my week consisted of wrapping up lectures, concocting various study groups and settings to help me and my classmates organize and synthesize all of the material we are accountable for.

Yesterday, Alex and I drove to Monterrey (Pacific Grove) to help celebrate his uncle Tom's 60th birthday. I studied on the way there and took an online molecular biology quiz at a lovely cafe (after having lunch on Cannery Row), which allowed me to relax a little bit. Having a midnight deadline hanging over my head during the birthday shindig would have been a bummer. After getting that out of the way, I was introduced to so many friends and family of Alex's uncle that my head was swimming. Still, I had a wonderful time - good food, great conversation, and an incredible view (right on the water, with the entire of Monterrey Bay before us).

Another perk of our Saturday excursion was having a taste of weather in the 60s. Overcast skies, sea mist, and a cool breeze - I was in love! Take me back to the northwest! :)

We drove back home late last night, both Alex and I tutored in the morning and afternoon, and more studying commenced. Now...more studying!!! Histology exam tomorrow, Cells to Tissues on Tuesday, and Molecular Foundations of Medicine on Thursday. In the midst of that, I will participate in the Multi-Mini Interview for the first medical school admissions interview on Wednesday. Go-go-go!

This coming weekend will be a nice treat. Practically no homework. My words will be leaping off the page next weekend.

Sunday, September 18, 2011

Is Wednesday the new Saturday? I'm still not a believer...

The last week was another busy one, full of lectures about DNA, bone, cartilage, blood, stem cells, and dissections of the heart and major vessels.

Some notable parts of my week occurred on Wednesday. Turns out that at Stanford, Wednesdays are meant to be our 'off day.' We don't have lecture, but somehow the days just fill up. In a couple of weeks, our electives start and many of them take place on Wednesday. I am always so ready for Wednesday, because I convince myself that it will function as a bit of a mid-week reset. It does have a different pace, and for that I am grateful. Nevertheless, the day fills rapidly. This past Wednesday, I participated in a training to be an MMI rater (multi-mini interview), which means I will be contributing as an interviewer for the first set of medical school applicants on September 28. I am so excited! I think it will actually be quite therapeutic to begin to reformulate my association with the simulation floor in the medical school building (being on the other side of the interview process might make the ground floor a little less intimidating).

Funnily enough, immediately following that training I made my way directly for the ground floor of the med school building to the very rooms where I had been interviewed in February. I had not been down there since then and it felt a little eerie. The reason for my being down there was for my first patient encounter. Several of my classmates were there as well (ten in total) to complete our 'baseline' encounter in which we interviewed a patient without having received any instruction or training interview skills, how to take a history, etc. I was a bit terrified and the interaction I had was by no means a masterful interview, but I survived and so did the patient. It felt weird to be walking into an exam room, clipboard in hand and wearing a white coat, awkwardly shaking my patient's hand with my hands still wet from the hand sanitizer I was instructed to use upon entering the room. We had a great debrief with some older medial students afterwards and we could all move on with our days without the mystery of the baseline patient encounter looming over our heads.

The rest of the week went by fairly quickly. The intensity and density I have been mentioning repeatedly still held true this week, although I think I am less surprised by it. The reality of medical school is settling in a little bit and I am adjusting quite well - I think.

Friday, I spent the morning at the Medicine 2.0 conference that was hosted at the medical school. The speakers focused on issues related to how technology and social media are shaping the doctor-patient relationship and altering the patient experience. I found it fascinating, although the conference setup felt like being at a rock concert or a laser show. They took the technology theme way too seriously I think (the whole thing started about 30 minutes late because they were having some issues with the special effects). I only could stay for a short period before heading to my literature discussion group and histology lab, but I did get to meet a few really cool people (including an ER physician who spends portions of her year as the doctor for National Geographic expeditions - CRAZY! Sign me up!).

Yesterday was Alex's birthday and we had about 8 of my medical school classmates over for margaritas, a pinata, and other birthday festivities. I even had the chance to devote an hour to coming up with a baked concoction for his dessert (peanut butter-dark chocolate chip-oatmeal cookies with homemade applesauce to cut out some of the butter and fat). Everyone had a great time and I think Alex really enjoyed having the chance to hang with people our age. Plus, I think we did a good job of making Alex feel like 22 is the new 21 (see evidence below). :)



Now, I am readying for another busy week. This week is my last week of classes for mini-quarter. It will consist of quite a bit of review time, a vital signs workshop, and a dinner with my faculty mentor.

The week of the 26th is all exams and then I start new classes on October 3rd. It is unreal that this my fourth week of class, but I look forward to seeing how all of the material gets pulled together.

Saturday, September 10, 2011

The Daily Marathon

Dean Pizzo told informed all of us at orientation that during medical school (and potentially beyond) we would become accustomed to a routine where every day feels like a marathon. I think I am beginning to understand what he meant that day.

After successfully completing two weeks of medical school, I am still excited, motivated, and increasingly inspired, but I am tired and trying my best to quickly establish the best kind of blend of school, friends, boyfriend, food, exercise, and sleep.

This week, I started biking from the Redwood City/Emerald Hills area to school. The route is a good one - the road isn't too busy, the scenery consists largely of beautiful residential neighborhoods, and although the ride is through rolling hills, it isn't too overwhelming. It takes me about 35 minutes to bike to school, and 40-45 minutes to bike back (more hills!). I like the fact that I now have structured exercise time and with the locker rooms provided in the medical school building I am able to easily shower and freshen up before class. Whether or not I continue to try and do another workouts with the personal trainers has yet to be determined. Bike commuting may be enough.

Our lectures progressed to discussions of cell cycles, muscular structure, gene expression, and gene regulation. In anatomy lab, we covered the lungs (an amazing dissection to see how big those suckers are!) and the heart. We had been warned by the anatomy TAs that the #($@! would hit the fan on Thursday, because now we are getting to the in-depth level of anatomical structure. In this case, they were referring to the vascularization of the heart and the process of understanding where all of the arteries and veins are in relation to one another and in relation to the other structures of the heart itself. I still love it. True, the sponge approach to learning anatomy is not quite as easy now that we are learning so many different terms, but the dissections are fascinating and it is great to learn from such enthusiastic professors. Our anatomy professors even performed a role-play for us on Thursday to demonstrate a differential diagnosis of a lung tumor that had invaded the pleural cavity. I love the integrative approach all of our professors use so that we can easily see how the content we are discussing in lecture might be relevant to clinical practice.

Alex started work this week, which has gone well so far, and I signed up to be a beta user for a new dining-deal website run by Stanford students. The bottom line is that Alex and I have gone out to eat (three dates) this week at good local restaurants essentially for free (very minimal financial burden for us...maybe $5-10 for the two of us for a $40 bill). It is fun and a nice treat, but we will have to be careful not to get too comfortable, because I only have one more week as a beta user and then it is back to the PB&J. :)

As for more about how things are going...I just have to rebuild the academic stamina I had as an undergrad and then strengthen it further. Being at school from 8am-6pm can be a drain and after that I still have to study at home. It is a nice break in the week to have Wednesdays free from class, but they easily get filled with meetings and study group sessions. Soon, they will also be filled with some elective coursework. We have had quizzes, problem sets, and other work to complete and in another two weeks we will be preparing for our big exams for our Cells to Tissues and Molecular Foundations courses. That will mark the end of mini-quarter and then we will start Developmental Biology, Applied Biochemistry, and Genetics. Woo hoo! Bring it on!

I am still completely in love with my classmates and continually find myself appreciating how warm, friendly, and inviting everyone is. On Thursday night, several of my new medical school classmates and I (all girls) got together for wine, cheese, and chocolate truffles to discuss a journal article we had to preview before a literature discussion yesterday. It was wonderful! We are already a community and I feel confident that I will be cultivating pretty phenomenal relationships via the camaraderie and intimacy that the medical school format fosters.

This afternoon, I have a reunion BBQ with my backpacking group from orientation and tomorrow I am volunteering at the Arbor Free Clinic (a student-run clinic) for the first half of the day - I get to wear my white coat and stethoscope for the first time - and then I am off to tutor two high school students before heading back home to study and take a quiz. The weekend will fly by I know, but I think it will give me enough time/space to refuel a bit. I will make the most of it!

Sending lots of love to you all!

Sunday, September 4, 2011

Adjustment and routine-setting

Wow, what an intense week! I am finally able to sit down, relax for a few moments, and reflect on the past week. The first week of med school was extremely intense. We were all so busy for the vast majority of each day and we were given so much information that one week felt much much longer.

On Tuesday, the highlight was our first gross anatomy lab. I was really really nervous beforehand and I was completely psyching myself out that I would not be able to handle the formaldehyde, or the cadavers, or I just would not be able to perform a dissection. Dressed in fresh, bright blue scrubs, we all descended into the basement of one of the clinical buildings and walked the long walk through bright green and orange hallways to the lab. Yes, it smelled like formaldehyde, but it was not as bad as I had Imagined it to be. The entire class gathered together with the professors at the start for an overview and to take a moment of silence to honor the people who had so generously donated their bodies to science. Next, standing beside my cadaver with my three anatomy teammates, all of the anticipation was getting to my head and I felt a bit iffy. Yet, the second we were given the thumbs up to open the bags and proceed with the dissection I was fine. In fact, I was more than fine. I had a terrific and exciting time in our first anatomy lab. Even before the go ahead, my group knew that we had a very petite cadaver compared to many of our classmates. Turns out we have a small older woman, probably less than 100 pounds, whereas others have large men and women - one group has a 300-pound individual who lived to be 91 years old. Turns out my group is lucky to have a petite, slender cadaver, since we do not have to deal with vast amounts of fat tissue during dissection.

We started with a midline cut from the top of the sternum to the bottom, then we made cuts from the midline across each clavicle, and then lower cuts across the lower ribs. Our objective was to separate The skin and deep fascia from the muscle so that the pectorals major (your breast muscle), the ribs, and other muscles would be exposed and ready for further dissection on Thursday. I left the lab that day feeling like I was on top of the world. Gross anatomy lab has the reputation of serving as a rite of passage for first year med students and I had successfully completed my first day.

After lab, I worked on some school stuff before heading to a personal training session with my classmate Nicole. We have become workout buddies and after our inaugural workout on Tuesday (a strength and cardio circuit that sufficiently kicked my ass), we did an ab session and a run on Wednesday, another circuit on Thursday, and a run with Alex on Friday. Hopefully we can keep up that routine amidst all of the other time constraints we have.

Wednesdays are technically our days off, but I arrived early for a learning strategy workshop, then worked out (the run Nicole and I have adopted is the campus loop which is gorgeous!), and then I studied, studied the rest of the day, both on my own and in a small study group, as we prepared for a histology quiz. Many people in my class felt surprised by the initial and sustained onslaught of information and how, as we studied for this quiz, we felt like we were preparing for a midterm, even after just 2 days of class. Well, after our study marathon, I went home to get things together and ready myself for Alex's arrival. He had spent all day Wednesday driving from Hood River to Palo Alto and was set to arrive around 7. I finished up school stuff, then we grabbed dinner, I completed my quiz and we called it a night.

Thursday was another good and very full day. We had lecture in the morning, a patient presentation with a family with myotonic dystrophy which was fascinating, a lunch pertaining to the Medical Education scholarly concentration, and anatomy lab in the afternoon. This time, during the anatomy lecture before the lab, we were able to test out how well our iPads accommodate drawing on the slides the anatomists give us to learn the tissues of the day. It was great and fun too. Dr. Gosling taught us about the muscles of the chest wall, the organization of the breast and about the innervation of the skin. Love it! Our dissection task was to separate the pectorals major from the pectoralis minor and expose the lateral side of serratus anterior muscle which rests along the outer edge of your rib cage. Once again, lab was successful, exciting, and very interesting.

Nicole and I made another visit to the personal trainers after having a brief literature discussion session and then I went home to meet Alex for dinner,

The rest of that evening was quite traumatic and I won't give the details here, but let's just say that I was kicked out of my apartment for no justifiable reason, Alex and I packed up all of my stuff that evening, and we both moved into our new place in Emerald Hills. The silver lining is I was able to move earlier in the month, move very quickly, and I don't have to deal with a crazy roommate situation that highlights the pitfalls of Craigslist-based deals. Ugh!

Friday was busy, but the day seemed to drag. I think all of us were so ready for the weekend and drained from the intensity and density of the first week, that we were all starting to tune out by the time our journal article discussion sessions commenced in the afternoon and, if not then, certainly by the time we got to histology lab.

At the end of the day, the Stanford Medical Students Association hosted a barbecue on the lawn in front of the med school building and Alex was able to join me for that. I was so happy to have him there and introduce him to many of my classmates. He heard a broken record story about how crazy the first week had been, how it had felt like a month, not a week, and how we are all still feeling the shock and awe of it. He connected easily with people and we both had a great time. Burgers, hot dogs, beer, and great people. What more could you ask for?

After that we met up with my friend Nick from high school and his fiancé Laurie for a little bite and some drinks in Palo Alto. Alex had never met either of them and I had not seen them since they so generously hosted me for my med school interview at Stanford. It was a great time for the four of us to connect in a better way and I am sure we will be seeing them more often.

Yesterday was largely all about outfitting our new place. We picked up a futon from the Stanford classifieds, went to a med student run tailgate for the Stanford - San Jose State game, went to Target, Costco, then back home to unload, and then we turned back around and went to Ikea for more furniture. I think we reminded ourselves of how exhausting moving can be. It was no big surprise that we crashed last night.

So, the first week was largely a big success. The quiz that me and my study buddies had frantically tried tried to prepare for was actually not that bad - we had over prepared. Actually, I think we were probably preparing more for the exam, but that's not a bad habit to get into. My roommate/apartment fiasco, while it has not been resolved, translated into an early move-in for Alex and I. I get to sleep in a place up in the hills, away from busy roads and the sounds of trains passing by at night. Today, I get to play catch up a bit, tutor a few kids in math and chemistry, meet up with some other med school couples at an old-fashioned creamery in Palo Alto and relax a bit more. A busy day, but busy in a great way.

Below you'll find a picture of my class after receiving our white coats (right before our stethoscope ceremony). Hope you all are well! Lots of hugs and love!