We Scare Because We Care

There were some awesome Halloween costumes today. I saw a stranger in a Captain Jack Sparrow costume that looked awfully authentic, with braided hair and jewelry, the make-up, the clothes, hat, and boots. It was quite a good costume. One of the shuttle drivers dressed up as Indiana Jones, complete with whip. When he was driving, he suddenly yelled out, "Oh no! Up ahead! There's a huge traffic jam! We'll take a detour." I'm not sure that's very Indiana Jones-like, but it was quite funny. Also, when we were waiting for some people crossing the road, he yelled out the window "Great costumes! You look just like little kids!" They were in fact, little kids.

Our class had even better costumes. Three guys dressed up as a huge yellow bottle of mustard, a matching red bottle of ketchup, and a can of Coors lite. The professor then commented that "All we need now is a hot-dog and a baseball game." Immediately, we started clamoring for the hot-dog and applauded when the fourth guy came in, fulfilling our wishes.

Then, there was a guy dressed as a hippie with a huge 80s hairdo, sparkling, glittery, and elaborate. Half-way through lecture, while the professor was answering questions, we hear this odd spraying sound in the back. We turn around and there he is, with a can of hairspray, looking into a small pink mirror, fixing it up. It was hilarious.

Christina just IMed me and said, "You'll like this. One of my coworkers dressed up as a 'cereal killer.'" I love it.

Preceptorship

We have preceptorship about once every other week. A preceptor is a physician who volunteers his time to teach a medical student in something like an apprenticeship. It's pretty close to shadowing doctors as an undergrad, except you get a lot more freedom in what you can do. This acts as a precursor for third year clerkships to get us more comfortable and knowledgeable about the health care delivery setting. Our responsibilities include interviewing patients (taking the history), presenting the patient to the preceptor, and doing physical exams.

My preceptor is in Oakland. He is an internal medicine doctor, but the day of my preceptorship, he moonlights in a retirement facility. Our patients are older, often with complicated and chronic conditions. This makes the practice of medicine fascinating. My preceptor is very nice and has done this for several years. The first day, he had me interview two patients on my own. It was quite an experience. In theory, taking a history is not hard; there's a checklist of questions you want to ask and things you want to elicit. But in practice, it's very difficult keeping track of everything; patients obviously don't present things in order, prioritize things differently, and take divergent lines of thought. Even presenting the patients to the preceptor ("a 55 year old female enter with a chief complaint of...") takes practice. But I am sure in time I will become more familiar with it.

White Coatness

Simply being in medical school, wearing a white coat, and sporting a stethoscope changes the way people view you. I noticed this the second week of school when I had to find a patient for my Patient Care class to interview. I explained that I was a first year medical student (or rather, I had paid tuition for my first quarter just a week ago). But the patients implicitly trusted me, as if I knew what I was doing, and they agreed to whatever I requested. On my first day of preceptorship, the nurse asked me if I was already to be called "Dr. Chen." Uh, no. Not even in four years. I don't know what I'm doing. And I'm fairly certain I won't know four years from now. It's a weird sensation, as if somehow I have unknowingly (or rather, without realizing it) acquired some aura or magical power. People look at me differently. They treat me differently. I'm not sure how I feel about it, but it is a transition that I cannot reverse. I do think I have begun to see the world in a different way. Perhaps the subject of a future blog.

Finishing up Prologue

After taking molecular and cellular immunology as an undergrad, I don't feel intimidated at all by the basic immunology presented in the second half of our first block (Prologue). When you first learn immunology, it's pretty overwhelming because there is a lot of nomenclature; luckily, I feel pretty good about this stuff. The other major component of this block is pharmacokinetics, which isn't too bad either. In any case, we just finished the Prologue block. Now I should have a little more time to catch up on these blogs.

Out on a Limb

The last four anatomy labs have focused on the extremities. They are really complicated, but that's in part because I have never studied them in any depth before. The arm, forearm, thigh, and leg are all divided into multiple compartments. Each compartment has several different muscles (some muscles have four words in the name: extensor carpi radialis brevis), unique innervation, and its own vascular system. The hand and foot have a range of motions, muscles, and neurovascular structures. This is very good for people in general, allowing us to type out blogs and such. But it's very bad news for medical students. I'm never going to be able to say, "I know that like the back of my hand" again.

More on Specialties

The most common question beginning med students get asked is what field they want to go into. We have no idea. Really. It's like asking freshmen what they are going to major in. They might have an idea, but it'll change. I remember having intense contemplations on deciding my majors as an undergrad, and I expect this may be even harder. However, even after just 7 weeks of medical school, I have a sense of things that interest me and things to rule out.

I have always had anesthesia on the table, though my old PI Drew has very compelling reasons why it may not be the best field in the future (surgeries are becoming more and more noninvasive that anesthesiologists in the OR will not be as necessary). I also think cardiology is fascinating. I'm drawn to fields with lots of physiology (pulmonology, nephrology) or potential to change (infectious diseases, interventional neurology). The best thing at this point of my career, I think, is the ability to rule out specialties that do not interest me at all. So far, these include orthopedic surgery (I don't find bones and muscles that riveting), radiology (I don't like staring at films), and histopathology (tissues under microscopes aren't that fascinating to me). Hopefully as we start our organs block soon, I can narrow down the fields even more.

Specialties

There are several divisions you can make among specialties in medicine. They can be surgical and nonsurgical. I don't think I want to go into a surgical specialty because they emphasize technical skills (which I may not have) over cognitive ones. They focus on anatomy of a specific region of the body. The training is longer, and there is a culture of surgeons. You can also split specialties by procedural and nonprocedural. Procedural specialties (like surgery) do technically difficult stuff; they put in central lines and Foley catheters and repair cataracts. Nonprocedural specialties include pediatrics and family medicine and infectious diseases. They see patients and do regular check-ups and are involved with a lot of the intellectual differential diagnosis. But they don't do technically challenging (and expensive) maneuvers. Finally, there's a division between patient care and non-patient care. This is a little confusing for people not familiar with medicine. All doctors are involved with treating patients, but some are more direct than others. Primary care doctors (family practice, pediatrics) are all patient care; they are the first people you go to when you have problems. Non-patient care specialties include pathology, radiology, and dermatology. These doctors will analyze tissue biopsies, X-rays, and skin disorders, but they don't have a regular cohort of patients. Sometimes the best way to choose a specialty is to decide which of these divisions plays out best for you. I think I would lean toward a nonsurgical procedural specialty, but I don't know at the moment.

Midterm

We had our first exam last week. Most people (including me) were stressed about it because there was a lot of material, and we weren't sure what to expect. In any case, it turned out fine. I thought it was a very fair test, somewhat harder than undergrad tests. There was a three-hour multiple choice section, with the distribution of questions reflecting the amount of time spent studying those topics. We also had some short answer questions, one of which was on adrenergic receptors. In the afternoon, we had an anatomy practical exam. Luckily, they had a practice practical the week before to familiarize us with the protocol. They have a large circle of cadavers, each with two flags marking organs, anatomical structures, vessels, or nerves. We have 45 seconds for each flag, and each minute and a half, we switch from station to station, frantically trying to locate and identify the marked structures. It's quite an experience. Sometimes, the body is covered such that it's not easy to tell whether it's the front side or back side of the patient, or the right half or the left half. It's definitely a medical school experience. You learn to compartmentalize things, use landmarks, and recognize structures that look different in different people. As a whole, I learned a lot, felt the test was fair, and did okay on everything.

FPC

Foundations of Patient Care is a longitudinal course through our first two years to teach us to interact with patients. It's a bit of a relief to have such a fuzzy course, but it also helps us feel more like doctors. We've been learning the medical interview and how to talk to patients. I feel fairly comfortable with most of that because of volunteering at the VA when I was an undergrad; I can deal with fairly sick patients, problems in communication, and stuff like that. However, taking a history seems fairly complicated; there's a lot to cover in a short amount of time, but with practice, I am sure I'll get the hang of it. We've started a little on learning the differential diagnosis diagnosis process (like House, MD).

The other aspect of the course is the physical exam. We've covered vital signs, abdominal exam, pulmonary exam, and cardiac exam. We'll also learn the musculoskeletal in the next few weeks. That's pretty exciting; we get to play with our stethoscopes and stuff. It's not an easy thing to do, but I guess that's why practice is so important.

Electives

The electives I'm taking this quarter include something called Medical Scholars Program. It sounds nifty and official but really, it's just an anatomy review/discussion section. It's run by second-year students and pretty useful. It's important to see different cadavers in anatomy since anatomical structures vary a lot depending on lifestyle, age, gender, etc.

I'm also taking Introduction to Ophthalmology, which is important for me since it might be a field to pursue. It's a seminar-size lecture-style class that covers a lot (in my opinion). We've done a basic overview of eye anatomy (which I know very little about) and covered a few eye diseases and disorders. At the end of November, we'll have a practical clinical skills session where we play with our ophthalmascopes and try to inspect each other's optic nerves. We'll also get to use the microdissection lab to dissect a cow's eye I believe. Hopefully by the end of this quarter, I'll know whether I want to be an ophthalmologist. One big downside, however, is that I can't spell ophthalmologist.

The last class I'm taking is a course offered in the Ob/Gyn department. I attend a weekly lecture series on childbirth and am paired with an expectant mother. I attend her prenatal visits and am also present at the birth. It sounded like a pretty interesting program (though I have no real interest in going into Ob/Gyn) and I expect I'll learn a lot. Originally, I was thinking of a more standard elective, but I decided to push my boundaries with this one.

Exam Week

The exam is this Friday, explaining why I'm so slow at blogging. Our classes have made a genetics turn and started encroaching upon fuzzy subjects dealing with behavioral and social biology (especially on race). We moved from abdomen to pelvis, dissecting much of both, which was an interesting experience. I feel like I'm less inclined to go into gastroenterology or urology. The exam Friday covers a whole lot of material and includes multiple choice questions, short answers, and an anatomy practical. We do have a dead day ("reading day") to focus on our studying. The exam is completely pass/fail, with the threshold set at a very meager 70%.