Notice

This blog has been barren for a while, because I switched to a different platform in which most posts were "friends only."  I've decided to go back to public postings on this blog and to use the other one for more person posts, and I plan to migrate the rest of the med school-relevant entries to this blog in the next month.  I just need to finish off my last class of the year, and then I'll have the time to go through them.

How Does an Ugly Dockling Dress?

Winter break was great.  I did nothing but catch up with friends and play Minecraft.  I deliberately used my parents' desktop and did not put it on my laptop, because I cannot afford to get addicted to a computer game while trying to get through med school.

I thought I'd write a little about how I dress as a medical student, because that was something I really wanted to know before starting school.

My school does not have an every day dress code, but we are required to dress professionally whenever we see real patients (including standardized patients, and patients who talk to us during a lecture).  This is pretty standard.  There are some med schools that require their students to be in professional dress all the time, even for regular lectures.  Even if you don't go to one of those schools, your third and fourth years are all clinical rotations, so you'll need to be in professional dress all the time for those years.  So if you're starting med school, start building a professional wardrobe now, and keep an eye open for sales throughout the year.

I don't think there's a whole lot to say for men.  Trousers, dress shirt, tie (usually), non-sneaker shoes.  Maybe there are complexities to professional attire for men that I'm not aware of, but women certainly do have more choices to make, and there are changing opinions of how women should look.  Here's my take:

• Dresses, skirts, and dress pants are all acceptable.  I see my female professors and the doctors I shadow wearing all 3.  However, all female medical students should be aware that there will always be an older male physician or patient who still thinks that women should look like ladies: skirts, heels, pantyhose.  The flip of that is the older female physician who thinks high heels and pantyhose encourage people to objectify women, and therefore an empowered woman shouldn't wear them.  Whatever, wear what you want.  You can find countless articles about how professional women should dress, written with all kinds of social viewpoints.  Articles about how men should dress all say pretty much the same thing.  Bottom line: people pay an awful lot of attention to how women dress, and you can't please everyone.  So don't try.  I wear a lot of skirts because I like them.  (Dress pants are hard to shop for when you're short.)  I don't wear them to conform to a social standard or to make a political statement.
• You need to put a little practical thought into the sort of top you wear, whether it's a button-down blouse or a shell or a sweater or a cami and cardigan.  Obviously, cleavage is not acceptable.  Keep in mind that you're going to be examining people.  You're going to be very close to them, sometimes leaning forward with your patient sitting on a high table.  Even if your top isn't especially low-cut, the neck might still gape when you lean over, giving your patient the opportunity to see more than you bargained for.  So when you try something on in the dressing room, be sure to lean over and make sure you're not showing too much skin.  Also keep in mind that you'll probably want to wear your stethoscope around your neck, so avoid those tops with the really ruffly necklines or the attached jewelry so nothing gets tangled.
• Not everything looks good under that cheap white coat you're going to have to wear.  It's not a bad idea to take it shopping with you.  Don't wear it into the store, you'll look like an arrogant jerk, but maybe put it in a large purse or a backpack.  There have been several times when I've found a great dress and then discovered that its length or the placement of the belt or the width of its collar looked strange with my coat.
• White coats are boring.  Consider wearing something with a little color.  Don't go overboard.  "Professional" means not too distracting.  Really loud prints and all-over bright colors are not considered appropriate for professional dress by most people.  But since the white coat hides most of it anyway, you can absolutely wear a top with some color or texture.  That white dress shirt that people always say is the staple of a professional wardrobe is going to look really boring under a white coat.
• Here's the other reason for finding tops in interesting colors: you can't wear a lot of accessories.  Every accessory you put on is one more thing that will get in your way and carry around bacteria.  Long necklaces, scarves, bangles, rings, dangly earrings, those are all out.  Find a few elegant chokers or short necklaces that don't dangle much when you lean forward and just wear those.  Or wear something that doesn't need jewelry.
• Shoes MUST be comfortable.  If you go into the medical profession, you spend an awful lot of time on your feet.  That's probably not news to anyone.  I'm in the habit of wearing boots with a 2-inch heel, so wearing 2-inch heeled pumps all day doesn't bother me if they've got a good insole.  But I'd never want to wear anything higher than that.  I wear flats probably as often as I wear heels.  (So far, I've just been in offices and student exam rooms, not the hospital.  I don't think heels in a hospital are a good idea, even if you're just following some residents around during rounds.  I've worked in hospitals before, and there are always spills and tripping hazards around.)  Most of my friends also wear flats or low heels.  I have one classmate who always wears 3-inch heels and seems to do fine.  If that's somehow comfortable for you, go for it.
• Get your hair out of your eyes, and make sure it's not going to hit someone in the face when you're examining them.  Pulling the top layer back in a barrette works well for me.
• There seems to be a lot of debate about makeup.  I recently heard some female fourth years say that women should never wear makeup if they want to be respected.  My own research and experience tells me that's not true.  A lot of people see a little bit of natural makeup on a woman as the equivalent of a tie on a man.  Just remember that fluorescent light makes makeup look heavier, so stick with sheer colors and always err on the side of too little, rather than too much.

Standardized Patients

Standardized patients are like actors who pretend to have medical complaints and then put themselves in the hands of inexperienced medical students.  We practice basic skills on them.  Today, I had to be taped while interviewing a standardized patient.  Not for a grade, just for feedback, and then I have to do a graded one at the end of the year.

It's a very unnatural thing.  I realize it's probably the best way to assess interviewing skills, but knowing you're on camera makes it feel so different.  I think everyone was a little more nervous than they would have been because of that.  I certainly was.  Once I started the interview, I forgot about the camera, but first walking into the room and making introductions and trying to get things started in a way that feels natural is next to impossible when you feel like an actor who forgot to read the script.

I was also a little freaked out when I finished my interview before the end of the allotted time and left the room, only to find that I was the only person in my group who had finished already.  After a minute or two, someone else came out of her interview room, and then more people started finishing and coming out, so it's not like I finished in 3 minutes and everyone else took 15, but I still had one minute of panic alone in the hallway thinking I must have skipped a part of the interview without realizing it.  Actually, I didn't miss anything, though I know I could have gone into more detail about some things.  But someone had to finish first, and it happened to be me.

Next week is our second biochem exam, and then I leave to spend winter break with my parents.  This blog will probably lie fallow for the rest of December, as I intend to think no medically related thoughts during break.

Why Medical Students Should Take Acting Classes

The first biochem exam was pretty easy, but I'd had a lot of the material before.  Now we're getting into stuff that I'm familiar with, but never really studied in detail.  The more specifically medical stuff.  Chromosomal abnormalities, genetics and cancer, that sort of stuff.

Thanksgiving was restful.  My parents picked me up and we went to visit a close friend of the family.  I didn't have to fly anywhere, plan anything, or handle a large family meal.  I don't think my mind could have handled any of those things.

Our clinical medicine course has moved on to taking a sexual history.  A lot of students lead into these questions by saying something like, "Sorry, I know this is awkward, but..." which I don't understand.  I guess some people just process awkwardness out loud, but I don't.  If I'm feeling awkward about something, I don't usually tell people that.  I would just ask the question, which is what you're supposed to do anyway.  In my head, I'm going "Oh god, this lady is old enough to be my grandmother and I'm asking her how many sexual partners she has," but then the ego kicks in and I try to act like I'm totally cool and definitely know what I'm doing.  Which is exactly what you should do.  If you act confident, most people will buy it.  The first real patient I interviewed on my first shadowing experience this year said she liked my interview style and was surprised when I said she was the first person I'd interviewed besides my classmates.  The reason for that?  I acted like I knew exactly what I was doing, even though I had absolutely no clue what she was talking about half the time.  And forget trying to write down the drugs everyone is taking.  You have no chance of spelling them correctly, and they're all in the official chart anyway.

Dermatomes

I always meant to post this:



This diagram shows dermatomes: areas of skin that are innervated by a single spinal nerve.  It is commonly known as the Thank You, Sir, May I Have Another diagram.

Well Done, Brain!

I actually remember things!  Most of biochem has been genetics so far, and since that was my first biological love, most of it seems to have stuck in my head pretty well.  It's nice to sit through a lecture and think "Oh yeah, I remember that" instead of of the usual "Oh god, what are you saying, why are the words so long, and why are they all in Latin?!"

And I don't miss dissection.  I actually did like dissection.  Sometimes.  It is definitely fascinating, and an opportunity I'll probably never get again.  But it also smelled bad and consisted on standing up for several hours straight while cleaning fat off of tiny nerves, trying to figure out which ones they were.

I'd like to take a moment to go on a small rant.  I just googled something and got a Yahoo answers hit with a health-related question, so I read it to see what sort of answers it got.  (Yahoo answers always amuse me.)  The "best answer" was a decent stab at answering the question, but still inaccurate.  The answerer listed their source as "I'm a pre-med student."  I've been a pre-med student.  And I know for a fact that it doesn't qualify you to answer questions about anything other than the introductory sciences.  I'm an actual med student now, and I'm still not qualified to answer any real questions other than "How many bones are in the hand?"

I've met pre-meds like that in real life.  You meet someone at a party and they try to impress you by talking about some ground-breaking new cancer research or the healthcare bill or what's wrong with psychiatry today, and they back it all up by saying they're pre-med and you're supposed to think they're very knowledgeable about the subject.  And then you tell them you're pre-med too and watch them suddenly realize that they can't bullshit you.

If you're a pre-med (or have been one), you know exactly what I'm talking about.  You've either been guilty of it at some point (I think we all have), or you know someone who does it all the time.  Every college has one.  That freshman who just loves telling people he's pre-med, like it means something.  It doesn't.  Anyone can be pre-med when they're a freshman.  If you make it through the MCAT alive and maintain a competitive GPA, you earn a little bragging rights, but you still don't get to cite yourself as a source for medical information.

It's quite humbling to get to med school and suddenly realize that you know next to nothing.  Even with some EMT training, I didn't have an edge.  I knew the word "calcaneus."  That was about it.

(See why I'm so happy that I actually remembered stuff about genetics?)

Thank You, Academic Gods

Looking through the lecture topics for biochem, I think I've studied many of them before in undergrad biochem.  There's certainly nothing new in the first few weeks.  The last exam block looks like it might be a little more foreign to me, but it will be nice to have at least a few weeks of mostly familiar material.

I think I should sum up what I learned about studying anatomy.  I did a lot of "what is med school like" reading the summer before I started, and if I decide to actively promote this blog, my thoughts might be worth something to someone.

• Spend some time looking at different anatomy atlases, then pick your favorite, buy it, and  make it your own.  I wrote and highlighted all over mine.  Looking at a diagram of just muscles is a good way to see how they align with each other, but writing in which nerve innervates each one (even if you don't need to know them all yet) will help you put more of the puzzle pieces together.  If you like group study, see if you can get a study buddy who has a different atlas.  I went with Netter's, because the artwork is beautiful, but I liked occasionally looking at Grant's as well.  Sometime's seeing a different representation of something will make a complex structure or body system click.
• If the topic is limbs or the pelvis, go to lecture.  Many schools record their lectures so you can watch them online, and I think just about every school provides their students with print-outs of the slides.  I frequently skipped class and learned the material on my own; lots of people do.  But you really need to see someone talk about limbs, because they'll probably move around to demonstrate the various muscle movements they're talking about.  (The video in our recorded lectures is of the slides, not the lecturer.)  And the pelvis is just ridiculously complicated.  The 3-D structure is hard to visual and there are a ton of arteries and nerves, so go see the diagrams on the big screens in the lecture hall.  Don't squint at an atlas hoping to find everything.
• Try flashcards, even if you're not usually a flashcard person.  The key to learning those weird anatomical terms is to drill them over and over and over.  You can buy anatomical flash cards (again, I used Netter's).  I used to see half the class flipping through them before a quiz.  It was my primary mode of study.
• Touch yourself.  No, I mean...  There's no good way to phrase that.  But seriously, when you're learning surface anatomy, find all the features on yourself.  When you're learning bones, feel for them.  (You'll count your ribs so many times in med school.)  When you're learning muscles, use them.  When you're learning dermatomes (areas of skin innervated by the same nerve), trace that area of skin on yourself.  It really does help you remember things.  Anatomy practicals were always kind of funny, because you could look around the room and see people flexing their thumbs or bending their wrists or chewing.

Humans Can Be Really Weird

After a week of relearning the developmental and abnormal psychology I learned in high school and college, I am once again reminded that brains are amazing.  I studied neuroscience in undergrad, so I knew that already, but actually getting to see interviews with real patients made me understand it in a new way.  I've known people with anxiety disorders and depression and bipolar disorder and eating disorders, but I'd never really spent much time talking about what it was like for them.  You can't say to a friend over dinner, "Say, you have problems with mental illness.  How exactly does your brain work?"  Well, you can.  But you shouldn't.

I'd never known anyone with true OCD, though.  Not OCD in the way that most people mean when they say they're obsessive-compulsive.  I always double-check that my keys are in my purse, even though I know I just put them in there.  And I like colored pencils to be in rainbow order.  Someone who genuinely struggles with OCD will tell you that's nothing.

Schizophrenia is also very interesting to see.  Watching a movie or a TV show with a mentally ill character is not the same as being in the same room as someone who really believes their delusions are true.  And you can't convince them otherwise.  How could you?  Someone would have a hard time convincing me that I'm actually dairy maid who only thinks she's in med school, because I know I'm in med school.  I'm certain of it.  People can be just as certain of their delusions.

Brains can distort reality and create fantasies in a gazillion different ways, and yet patterns still emerge.  The amazing Oliver Sacks has earned a ton of money and a huge fan following because of it.  I've always enjoyed Sacks, because his vignettes tell the stories of complete people, not just a mental condition.  You're not paying a penny to see the lunatics in Bedlam, you're learning about the life of someone whose brain doesn't always work the way yours does.  A similar work is Phantoms in the Brain, which doesn't focus exclusively on what we might consider mental illness, but rather the way the brain can err or be tricked, both in normal people and in people who have a particular condition.  I wish I had time to read more books like this, but I don't really have the time to read much of anything besides course materials anymore.

Finally Awake Again

Anatomy is done!  I passed.  It's amazing.

After the final on Friday, I essentially just collapsed.  Then went out and got drunk.  Then collapsed again.

The worst thing about anatomy exams: the practicals.  Every cadaver in the dissection room has something tagged with a piece of red string and a question asking what it is or what it does.  Everyone starts at one station, gets one minute to answer, and rotates to the next.  Practicals themselves are not awful.  Studying for them is annoying because you have to spend hours looking at cadavers.  The awful thing is that after spending 3 hours taking a written exam in the morning, you have to come back and spend another hour taking the practical in the afternoon.  It's like the professors think we actually slept the night before and can handle two exams in one day.

But it's over now.  I should stop complaining.  Next we spend a week on behavior and then start the next real class: biochemistry.  (Please, Academic Gods, please let med school biochem be the same as undergrad biochem.)

I Feel Bad for the Students in the Pharmacy School

I've been in med school for two and a half months.  My once nearly calligraphic handwriting has deteriorated to a series of squiggles that somewhat approximate letters.  I now fully understand why I have never been able to read a prescription with any real confidence.

What Happens When Part of Your Heritage Is Scandinavian

When shown a photograph of a person with one very pale hand and one more reddish hand, most of the class answered aloud that there was something wrong with the pale one.  And they were right; there was an occlusion of the artery.  I assumed there was something wrong with the reddish one, because the pale one was about the color of my own normal hands.  Oh, the joy of never tanning, always burning...

I Could Make a Pun About Being a Drip, but I Won't

I had dissection at 8am this morning.  That was fun.  We were supposed to dissect the bladder and the rectum.  Some groups ran into some sort of trouble on the rectum (I have no idea what), so we were told not to bother with it.  So all we did was the bladder.  That consisted of going, "There are the ureters that we found several dissections ago.  There's the top of the bladder.  Oh, and there's the rest of it.  Let's open it and see the openings for the ureters and urethra.  There they are.  Um...  Did anyone watch Project Runway last night?"  Actually, my group is three guys plus me, so I didn't say the last part out loud (though I seriously considered it).  We spent some more time poking around the pelvis and looking at other bodies, but we still were out of there by 9:30 (and that was with a lot of procrastination).  So I got up at 7am on a Friday for nothing.

I got back to my apartment intending to take a shower and get rid of the formaldehyde smell that lingers after dissection.  Instead, I discovered a leak in my bathroom ceiling.  One drip was right over the tub, and another few drips were over the floor in front of the tub.  I called maintenance.  By the time the guy got here, the dripping had stopped, but I showed him where I had seen the dripping and where the floor was wet.  He went upstairs to turn on the water above me.  It didn't drip.  It's been several hours, and it hasn't dripped.  And of course, it's Friday, so if it starts again, I'll probably have to wait until Monday to get it fixed.  I'm sure this will be fun.

Amazon Student

If you haven't signed up for Amazon Student, do it now.  Free two-day shipping for a year, just for having a .edu email address.

Skyrates

Since I should be studying for my exam, I have instead decided to update my blog with a small procrastination tip.  Med school is intense.  That's not news, but I'm just reiterating, it's tough.  There are days when large amount of free time are hard to come by.  As you might imagine, this can seriously cut into the usual time-wasting activities that involve an internet connection.  Especially that most addictive of time-wasting activities: the online game.

Starting a game with any sort of complexity beyond the level of solitaire is dangerous.  If it's story-based, you have to know what happens next.  If there are levels, you must defeat them all before you go to sleep.  If there's a timer, you always have to play just one more time to see if you can beat your best score.  How, you ask, can a medical student possibly play an engaging online game and still pass anatomy?  Skyrates.

Skyrates is a exercise in sporadic gameplay created by a group of Carnegie Mellon grad students.  You create a character and fly a plane between "skylands," trading goods and doing favors to make money.  Along the way, you run into pirates to fight.  And it all takes place in real time.  As in, it may take at least an hour (or even day) to reach a certain skyland.  You spend a few minutes deciding what to buy and where to go, and then you wait for your character to fly there.  You can't spend hours at a time playing this game, because it won't let you.  You have to wait for your plane to get to wherever it's going.

I started playing over the summer, and my playing time has stayed pretty much the same through my first month of med school.  Definitely worth checking out if your real life prevents you from giving too much time to your virtual one.

Surface Anatomy

Surface anatomy is kind of fun.  You get to draw on your classmates and poke them.  Of course, they also get to draw on and poke you.  Fair is fair.  Though it is kind of strange to walk to a class with a bikini top on under your shirt.  Never had to do that in organic chemistry.

Fond Memories of Hox Genes

I'm so glad I took developmental biology in college.  We just started a series of embryology lectures that are included in our anatomy course.  I don't remember much detail (since it was two years ago), and we didn't focus on the embryology of all the systems as much, but at least knowing what all the words mean is helpful.

It's too early in the year to really be able to say what the best way to study is for me, but I can say that being familiar with the vocabulary is a huge help.  Just reading through the PowerPoint the night before and making a mental note of any big words I've never seen before.  Then when the lecturer blows through that part of the lecture at 350 miles an hour, at least I have a vague idea of how to spell some of the words he's using.

The other day I forgot the word "faucet" in the middle of a conversation.  That's because words like "splanchnic" and "mediastinum" have replaced words like "faucet" in my limited mental vocabulary space.

A Dream

Last night, I dreamed that my mom came to visit me, and when she left, I found that she had left me a huge roasted chicken on my counter.

I think my subconscious misses the days when I didn't have to cook for myself.

Dissection

Our first dissection was the back.  A good place to start, but rolling the cadaver was a little awkward.  We only did the superficial back.  The other group will go deeper, so we actually didn't see much more than muscles and fat.  A lot of fat.  Most of dissection is removing fat.  It's not nearly as gross as you think it is, though, just time-consuming.

My overall impression of med school after one week: I like it.  I'm still adjusting, and probably will be for a while, but it's an adjustment I genuinely want to make, not just one I have to make.

The most valuable piece of advice I've received so far: Work out after anatomy lab, because you smell anyway.

An Excuse to Wear Heels

Today we met our first patients.  (Well, our first living patients.  Our first patients are really our cadavers.)  We had to dress professionally, which I could understand for the afternoon stuff, but not the morning.  In the morning we watched a pediatric oncologist take a history from a teen-aged cancer survivor.  They were at the front of the lecture hall.  They could only see the first few rows of us.  It should have been Dress Professionally If You Sit In The First Four Rows, Otherwise Anything Goes Day.  But really, that lecture/history was fascinating.  It was another experience that made med school feel real.  The people who accepted me actually believe that I am capable of doing this kind of stuff myself one day.  It's not the same as when I used to tell people I wanted to be a doctor, and they would say things like "Good luck."  I don't need luck.  If doctors got their degrees only by luck, I'd never let any of them near me.  Also, I respect any fifteen-year-old who's willing to discuss their medical and social history in front of over 250 complete strangers who are all listening closely and taking notes.  And, um, blogging about them.

Which is why, by the way, I'm avoiding ever saying where I go to school.  I don't intend to ever reveal any more than the vaguest details about any patient I ever see.  There are too many med students who have inadvertently violated HIPAA by saying too much on their blogs.  So in the interest of airing on the side of caution, not to mention politeness and human decency, I'm not even mentioning the state I'm in.

We spent the afternoon in smaller groups talking to different patients.  We weren't really given a guide for questions; we were just encouraged to ask about whatever interested us.  Then we got together with some fourth years and fit the information we'd gotten into a history.  It was kind of cool to realize how much we'd learned about these people just by asking a bunch of questions in no particular order as they occurred to us.  You'd never want to take a real history that way, but it was an interesting way to start.

First Day of Class

Today was mainly Welcome to the Course, Here's How Everything Works lectures.  Actually kind of frustrating, because I've been in medical school for a week, and I haven't really had a real lecture yet.  We had our first lecture on taking a medical history, but it was more about the importance of taking a good history, which is still pretty introductiony.  I just want to start a real class.

We did, however, get our printed syllabi.  We get print-outs of the slides for each lecture, and the first three week's worth of lectures (the material for the first exam) have been bound together in one book.  We'll get another one for the next four weeks, and then another one after that.  But when they first handed it to me, I thought it was for the entire anatomy course.  Then I noticed the dates on the cover.  Nearly 400 pages of two-per-page PowerPoint slides for three weeks worth of material.  Oh my god.