Quotable Quotes

Professor: Are there any patients in which you would not use a blood pressure cuff on the arm?
Student: Amputees.

The answer was mainly women who had a masectomy due to lymphadema and hemodialysis patients with vascular grafts.
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The professor who gave the lecture on the pelvis was so great. She not only explained the anatomy really clearly, but also threw in random jokes, as if it were a stand-up comedy set. At the end, she said, "So...yesterday, I had some problems with urination and I called the urology department here. I got their answering machine which said, 'Can you hold?'"
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In anatomy, we were looking at a prosection of the pelvis. (A prosection is a specific part of the cadaver pre-dissected by anatomy faculty to show things that might be hard to find). The problem is that a prosection is an isolated body part removed from the whole body. The second-year student explaining this said, "Sometimes, you can't tell what part of the body the prosection is from, and that can be a pain in the butt," as he pointed to prosection of the pelvis we were examining.

Talks

Like grad students, medical students develop a keen magnetic sense of free food at various talks. Pizza places must love us. I attended a panel discussion on primary care a week ago. It focused on allergy, immunology, rheumatology, and infectious disease. The lifestyles for those specialties is not bad, but the salary is relatively low. They love doing it though. A specialty like infectious disease ("fx dz" or "ID") requires someone really smart for tough differential diagnoses. It also puts the physician in a position to affect large amounts of people through policy, community health (such as HIV in San Francisco), international work, and regular patient care. Rheumatology deals with systemic inflammatory diseases like arthritis, and it's appeal for me is its systemic basis; I like thinking of the body as a whole. I remain interested and undecided about specialties. I learned a lot about the role of primary care and those particular disciplines, though, so it was a good panel.

I also attended a research presentation by the department head of Pathology here. It was a good presentation on current clinical trial issues, basic immunology, and the specific research the professor was interested in. I think that from hearing all these people, I have realized you can't do the triad of teaching, researching, and clinical medicine for long periods of time unless you don't sleep or have 30 hours in a day or something. His research was definitely interesting, and he teaches some of our core classes, so I enjoyed it a lot.

Interprofessionalism

We had an interprofessional education day last week with the schools of medicine, nursing, dental, pharmacy, and physical therapy. The goals, I think, were admirable; the theme was patient safety and teamwork. They really put on the table issues of working with different professionals, problems with hospital health care, and avoidance of medical mistakes. We got a complimentary book of "Internal Bleeding," cowritten by a UCSF professor Dr. Wachter. It explores the terrifying and shocking stories and statistics of preventable medical errors and tries to show how health care needs to move towards a system like aviation where there are very few (if any) mistakes.

The problem was our schedule that day sucked, so I was not too attentive. We went from 8 in the morning to 9 at night, though after the interprofessional education talk, we had a really nice reception with excellent food. In any case, I think the issues of working in a team, communicating with other professionals, and utilizing all resources are integral parts of health care.

Technological Dependency

Recently, my cell phone battery died. As far as I can tell (differential diagnosis), it's lost the ability to be recharged. I'm trying to get it replaced as soon as I can. What I've found out with this and the lack of Internet is that we (or I) really do live in a state of great technological dependency. I get anxiety traveling somewhere new without a cell phone. I have an itch to check my email at least once a day. It's just irritating when I lose these staple communication devices. I'm not sure how we operated before cell phones. No doubt the world was a more peaceful place.

Histo/Path and Small Groups

Histology is the microscopic study of normal cells while pathology is the study of abnormal cells. Every week, we have one or two histo/path labs (2-3 hours each). It's pretty tedious. I'm not thrilled about cell biology, and while I see the relevance to pathology, it's hard to see whether a lot of doctors need to know this stuff. A lot of people seem to hate histo/path, but I guess it's pretty cool when you finally find that monocyte when looking at a blood smear. In any case, all of this stuff is new; I didn't really do too much microscope stuff as an undergrad. I would have never guessed that I would be doing more of it as a medical student. We also have small group discussions, sort of like sections as undergrad where we work through problem sets. It's fun; I like my group, and the professor always brings in food.

Suturing

Today, we learned to do simple interrupted sutures and a simple running suture in anatomy lab. It was exciting using all the real equipment on actual fascia. These sutures are really useful, pretty much all you need to know for lacerations. I think I can do them decently, but it takes me a long time. I guess you just need practice.

Gray Anatomy

I've had two anatomy-related (scary) dreams. Also, I was eating chicken today and suddenly became very aware of the directions of the muscle fibers.

Greek Coincidence

My soon-to-be-defunct email address at Stanford was muses at stanford. My current address is on Parnassus Avenue. Mount Parnassus happens to be sacred to Apollo and home to the muses. Thanks to Rev for pointing that out.

I am the IHum Kid

Professor: Can anyone tell me what's special about buffalo lungs?
Me: Buffalo lungs have one pleura.
Rest of class: [silence]

So buffalo (and bison, incidentally) have a single pleural cavity, which means that if you shoot one arrow that pierces the cavity, their entire lung will collapse (called a pneumothorax). Nearly all other mammals, including humans, have separate pleural cavities (making up a left and right lung). So an arrow wound (or broken rib) piercing the pleural cavity will only cause collapse of one lung. I learned this freshman year from an anesthesia seminar.
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One of the anatomy texts we use (as well as most medical schools) is Netter's Atlas of Human Anatomy.
Elaine: Does anyone know if Netter is still alive?
Me: He died in 1991.
Elaine: [incredulous look]
Me: I read the preface.
Rest of anatomy group: [incredulous look]

Um, yeah.
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Professor: Can anyone name an effect of the sympathetic nervous system?
Another student: Bronchodilation (opening of blood vessels in the lungs).
Professor: [to that student] Do you know what receptor mediates that effect?
Me: The beta-2 adrenergic receptor!
Professor: [looks over, slightly annoyed]. Does anyone know another effect of the sympathetic nervous system?
Yet another student: Tachycardia (increased heart rate).
Professor: [to that student] Yes. Do you know what receptor mediates that effect?
Me: The beta-1 adrenergic receptor!
Professor: Who the hell is that guy?

Actually, the questions weren't that hard, but I had a leg up doing adrenergic receptor research for a couple years. Some people made some pretty funny comments about that incident later on.
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(The reference to "IHum kid" is a Stanford thing. Nobody likes an IHum kid.)

Foundations of Patient Care

One of our fuzzy longitudinal courses is Foundations of Patient Care. In small groups, we learn the patient interview (medical history) and the physical exam. Amazingly, by December or so, we should be capable of doing a complete basic physical (minus neurologic, breast, and pelvic exams). They put a lot of emphasis on the "touchy feely" aspects of patient care; we have to develop rapport with the patient and make him or her comfortable in a professional setting. To tell the truth, it is a welcome diversion from the regular bread and butter science lectures. But there's a lot of it. In any case, I have enjoyed my small groups were we have interviewed actual patients, learned to take blood pressure, and discussed working in a hospital setting. In October, we begin preceptorships, which allow us to work with and learn from a primary care doctor. It should be interesting.

Gross Anatomy

We had anatomy lab on our first full day of class. I realized at that point what I was in for. There was little preparation, no buttering us up for what was going to happen. It was the first day of school, and they handed us a scalpel and said, "Here are your cadavers. Go to it." As if we had an inkling of what we were doing.

Gross anatomy happens to be one of the defining experiences of medical school. Few other professions require training where one cuts apart a human body. When I came in, I had anxiety about it. Not too much, but enough. I wasn't sure how I felt about this endeavor or how to approach it. I have never been in a situation like this.

Luckily, a good friend from high school is in my anatomy group. Two other members of the group have done anatomy before. All of us are mature and professional. Roaming professors, physical therapy students, residents, and faculty help us out. It is not that the experience becomes completely detached and scientific; we appreciate that this person made an ultimate sacrifice to education, giving everything he had. I approached this exercise at first with great apprehension and hesitation. But over time, I have gotten much more comfortable.

We have, so far, dissected the muscles of the chest, back, and abdomen, opened up the abdominal cavity to locate those organs, studied the lungs and heart in situ, and examined the spinal cord. We have performed some clinical procedures including a chest tube, a cricothyroid emergency airway, and a lumbar puncture.

All in all, I am not enthralled. The experience is smelly, dirty, and slightly repulsive as you cut through tissue and reflect skin and muscle to locate organ. But I do realize that it is infinitely educational; there is nothing like looking at a real human heart with its great vessels. A book cannot teach us in the same way as this hands-on approach. I see how it is a necessary part of medical education. It has a morbid fascination, a scientific beauty, and a humanistic realism. Death takes on a new face, and as doctors, we have to recognize this and appreciate those who have made such a sacrifice. We realize that we have to distill from this experience as much as we can, since it is unique and fundamental to understanding the human body.

Courses

It is hard to explain how classes work here. While we are officially on a quarterly schedule, we operate on a block schedule involving Essential Core Classes. The blocks for first year are Prologue, Organs (heart, lungs, kidneys), Metabolism and Nutrition (gastrointestinal, endocrinology, metabolism), and Brain/Mind/Behavior (neuroscience, neurology, psychiatry). We also have a "Foundations of Patient Care" class that runs through the entire first year. These blocks aren't individuated by quarter; Prologue runs for 8 weeks, then Organs spans the rest of fall quarter and goes into the beginning of winter quarter.

In these Essential Core Classes, we take an integrated, interdisciplinary course rather than separate biochemistry, cell biology, physiology classes. In Prologue, they are trying to level the playing field (as many people have been out of school for several years or were humanities majors). Subjects that are new for me are anatomy and radiology. These are integrated with basic physiology. I am also new to histology and pathology (staring at things through microscopes). These are further supplemented with lectures on cell biology, biochemistry, molecular biology, and pharmacology. They also tell us we'll get a taste of fuzzy subjects like epidemiology and social/behavioral sciences.

In Foundations of Patient Care, we will learn how to interview patients and do the basics of the physical exam. They put a lot of emphasis on professionalism, developing a good relationship, and other warm fuzzy stuff. But we have already begun meeting patients and learning to use our equipment.

An odd byproduct of just taking this one integrated 19 unit course is that we don't have a regular schedule. Each day and each week is completely different (though there are patterns). This is because they organize classes by relevance of subject matter rather than convenience of habit. So we may have a physiology class of the pulmonary system and circulatory system. Then we may have an anatomy lab opening up the chest plate and studying the thoracic organs and great vessels. Then we may have a radiology of the chest lecture and a lab on epithelial cells. It makes a lot more sense in practice than it does in words.

We can also take electives. I'll blog specifically on all these classes in time.

'Frisco

I am growing to like the city. With the sun out and the fog lifted, I can see the bay and Golden Gate Bridge (a guess) from the anatomy labs. It's not unbearably cold, it's bustling yet comfortable, and I've felt out all the important landmarks around here. The bus system works, I can get down to Stanford when I want to, and I am enjoying life in an apartment. Things are going well.

September 11, 2006

Inevitably, life goes on. The media has started circling, respectful vultures treading the water with webbed feet, a pool that has for the last five years only been broken by teardrops and hurricanes. Some of us still live in flooded homes, sewage seeping under the doors and engorging the alleyways to peek through the windows. Others of us have long abandoned our shelters and have tried to rebuild something atop the water's reflection. But imagine this: a few of us have never ducked our heads below the water, waded the shallows, dived into the mud to look for picture frames and buried pets. A new generation emerges that will learn our shock and grief through history books. Sadly and undoubtedly, a new edition probably surfaced months after the fateful planes hit the World Trade Center. The media hound the literal and figurative blood-money, encapsulating emotion into paragraphs, soundbites. I pass no judgment for thus far, the hunters know what it is like to be victim. But what will happen when this next generation grows up? How will they feel? How can they feel? Optimism carries the winter's lantern, but I fear it may lead us down folly's path. My voice carries no accusation, but I offer these words of warning to renew a lease on the protection of our lake of memories. No whisper is unheard. 09.10.06

Thoughts from previous years can be found here on my personal website.

White Coat

Friday morning, we had our first class which was a case study of a motor vehicle accident. It was actually a whole lot more exciting than I expected, but I can't give away why because it's a surprise and I expect some people reading this might end up at UCSF. In any case, we learned a little about trauma and pneumothorax (collapsed lung) as well as diagnostic and therapeutic interventions.

My parents came up for the White Coat ceremony. Before the ceremony, I didn't expect too much. I'm not sure why, but I usually don't think these things are such a big deal. It was held at the new Mission Bay conference center (near SBC ballpark).

Everyone was all dressed up (which was nice, and we probably won't achieve that again until graduation). They had a string trio, elegant programs, and (I realize this is an odd observation) really comfortable chairs. Dean Kessler welcomed all 153 of us as people who are "willing to treat all patients equally, touch what others see as untouchable, sign up for the promise of blood, toil, tears, and sweat." Several of the other big names spoke, and I really enjoyed their comments. Unlike undergrad, the talks were all very specific to the practice of medicine and its relation to science and society.

We were then coated by our advisers, very reminiscent of grad students being hooded by their mentors. It was neat, and I was glad I didn't fumble putting on the coat. We also recited the modern version of the Hippocratic Oath, called the Oath of Lasagna (I'm not kidding, it's named after Louis Lasagna).

Afterwards, they had a very nice reception. My parents were really happy, the food was very good, and I got a lot of congratulations from the other people in my class and their families.

The Orient

Orientation was absolutely exhausting and slightly stressful, from eight to dinner pretty much all week. But it was fun meeting everyone, getting to know the campus and city, and having the white coat ceremony. At the very beginning, we had a welcome from the Vice Dean of Education and Associate Deans and stuff. One of them (Dr. Wofsy, Admissions) was very entertaining. He told a story about a kid whose dad was a rheumatologist. In kindergarten, the kid was asked what a rheumatologist was from the teacher (who didn't know). The kid answered that his dad went to the hospital every day and told people what rooms they had to go to. I was quite amused. Dr. Wofsy also had phrases like, "You may wonder how you got here, and indeed, at some point, we as faculty may wonder the same thing..." As a whole, the speeches were good; the usual inspiring, congratulatory stuff.

We had a registrar information session and an entrance financial aid thing (very boring). We got a lot of Orientation materials, including a free book on safety in the health profession. It was a little hectic, but fun. That afternoon (Tuesday), we had HIPAA training, which is incredibly dull (but, I suppose, necessary) and an introduction to the very odd curriculum here.

We don't actually have separate classes. Everyone takes this monstrous interdisciplinary essential core class, which covers all the subjects of medicine. So I won't be taking like "Biochemistry" and "Anatomy" and "Radiology" separately, but these core blocks called "Prologue" and "Organs." We were introduced to the computer system ("iRocket" = Stanford's "Coursework"). Then that evening, we went to the med student organizations fair where I signed up for way too many groups. Unlike college, medical school groups are very focused, and they all sound interesting ("Surgery Interest Group," "Internal Medicine Interest Group," etc.).

On Wednesday, we heard a little about clinical training and diversity, picked up our ID, and had advisory college lunches. Our entire class of 141 is broken up into 4 "advisory colleges" randomly. My advisers are an ENT (Head and Neck Surgeon) and an Anesthesiologist, and they seem very nice. Then, I slept through a talk on student health services and got scared by introduction to gross anatomy. Anatomy starts on virtually the first day of school! That night, we had a BBQ hosted by the alumni association, which was very yummy. Most of Thursday morning was spent figuring out technology issues like setting up internet and learning about small groups.

A lot of logistics, but at the end, I felt like I was pummeled by all the things involved in being in a new place.

Explanandum

I'm having difficulties establishing internet service in my apartment. This is the explanandum for the lack of blog. I really did mean to blog more often, and I'm sad this happened right at the beginning of medical school. Basically, I unknowingly signed up for internet through a (valid) third-party. However, that caused a lot of confusion between me, the internet company, and the third-party. They are sending someone to fix it next week. Currently, I am accessing internet through UCSF wireless. But never fear, I will catch up on blogs and all the things that have happened since orientation to the present.

Orientation Camping Trip

The first event of UCSF Med '10 Orientation was a two-day camping trip for us to meet the others in our class. It was at Huddart Park, which amusingly was near Redwood City (close to Stanford). It's beautiful with lots of towering trees, open fields, and trails. The day started early at 8:30. We drove down to the camp site; I was in the carpool with Ben, Dave (recently married), Pratheepa, and Elaine (from UNI). There, we mingled (awkward, but necessary) and had a few icebreakers. There was this pretty standard activity where we simulated a world on the ground and stood where we were from, where we went to school, etc. Stanford apparently has the largest contingent in this year's class, and we were highly obnoxious. While everyone else just said their school name, we spelled out "Leland Stanford Junior University" (some silly thing the band does). In any case, I met a lot of people; we seem like a cool and diverse bunch. One student, a capoeira expert, was a stunt double for Halle Berry in Catwoman.

We had some team-building activities in a group of 14 random students. We went around completing challenges which were really quite fun. They were reminiscent of middle school science camp. I never went to middle school science camp, but it was exactly how I imagined such a camp would be so I'm making up for lost childhood. One of the competitions had a six foot pipe open on one end with holes all along the length of the pipe. In the pipe was a ping-pong ball. The mission was to stop up the holes with our hands and pour in seven gallons of water to get the ball out. It was ridiculous; I was soaked, but it was quite fun! In another competition, we were partnered up. One person was blindfolded and the other person had to verbally navigate them through an obstacle course. Yet another required us to throw balls into buckets. In the end, we won first place! Which was surprising and quite funny. I enjoyed it a lot.

Then, I hung out with and met new people. I don't particularly like the awkward socializing, but the crowd seemed really nice. We have quite a unique group; though most people came from California schools, we had a good representation of people from all over the country and world. After dinner, two kegs appeared and people started drinking. That night, we had skits, many of which were highly inappropriate but quite funny. I didn't sleep too well due to the coldness of being outside, but it was very pretty. Our tent had a net top which allowed us to see the stars. The next morning, we had breakfast and went home. All in all, I learned the names of some people, became acquainted with many, and enjoyed myself.

First Impressions

I moved into my apartment last weekend (8/26-27). It's two blocks from the medical campus, which is very convenient. My family helped me assemble some basic furniture, clean, and settle in. Like all moving days, it was quite hectic; we were pretty rushed at the end and we didn't have a chance to pick up some staples (but I haven't needed a stapler yet). My apartment itself is quite nice and spacious (imagine, four years ago, I lived in a Lag mini-double). The kitchen, bedroom, and bathroom are pretty standard. The manager is quite a nice guy and has helped me take care of repairs and such.

Inner Sunset is unfortunately a wind-tunnel. It's foggy, wet, and cold. This reminds me of Oxford, with all the buses and old buildings and walking. UCSF is on top of a decently formidable mountain. I actually like it a lot, though it is very different from Stanford and sometimes a hassle to go outside. Several MUNI lines come very close (the 43, 6, and N-Judah) which makes it pretty easy to get around the city. Within walking distance (though not exceptionally close), there are restaurants, shops, and cafes. It's quite a nice area, and I think I will come to know it well.

Asclepion

Memories were made so we could have roses in winter. This blog is intended to chronicle my time during medical school. It's ambitious, I know, since my daily blogging from high school deteriorated to very spotty entries when I went to Stanford. However, I know that someday, I may be old and gray and want to indulge in the mindset and experiences of an earlier time.

My goal is to write at least three posts a week. I am starting on September 1, the day before orientation begins. However, I suppose I will include the events that have occupied my time since coming up to San Francisco. I am writing to no particular audience (other than myself), but I hope you find this educational, entertaining, or at the very least, a decent way to procrastinate.