May 27 2003

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It was a lost holiday weekend as far as studying went. I did have a great time though. I cut grass, went fishing, watched Macey play four softball games, went to two cookouts, watched a thrilling Memorial Day Reds win, caught some NBA playoff games, and rocked McKenzie to sleep every night. Today though I got back after it. With only 8 days left before the Step, I need to focus hard.

To continue my recap of the M2 year let me tell you about one of my favorites, Pathology – the study of suffering. I probably learned more material in this course than in any other this year. It is kind of a sister course to Physiology. One is about how things are supposed to work and the other is the story of things gone bad. The course lasted the entire school year and used Robbin’s Pathologic Basis of Disease. Many of the lecturers compiled their own notes for us so we didn’t have to use the class note service. The syllabus was arranged by organ systems and for each unit we had lab sessions where we got to view actual tissue specimens recovered from surgery or autopsy. There was a lot of memorable material here – the tiny hearts of infants who had the Tetralogy of Fallot, colons with Crohn’s disease, emphysemic lungs which float in water, tumors of all sizes, and infarcted brains. I think the most disturbing thing I saw all year was a term fetus with anencephaly. This baby had been delivered at UMC only days earlier. In fact the grieving parents may have still been in the hospital, only yards from where 100 medical students gawked at their “monster baby” for all I know. Ladies – if you have any chance of conceiving, please take your folic acid! The faculty in this course did a fantastic job. The class average on the national board exam was well above the mean. There was also a lot if tie-in with our ICM class which focused a great deal on clinical diagnosis.

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>May 21 2003

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Today was the last day of school for the kids so my routine will get broken up. For the last week and a half I have enjoyed a nice leisurely morning. I get the girls up about 6:30 and they get ready on their own before catching a ride with a teacher friend. Then I start mixing Manning’s breakfast cocktail of Pediasure, phenobarbitol, and trileptal. He has to get his g-tube feeding started before 7:00 in order to be finished by the time his bus comes to get him at a few minutes after 8:00. He has been involved in a terrific head start program in the public schools here. A nurse rides on the chair-lift equipped bus and rides to school with him where he gets daily stimulation as well as physical therapy. I get started on the newspaper while catching SportsCenter and then some CNN. McKenzie gets up by 8:00 usually and she likes to sit in my lap for a few minutes while Angie gets her breakfast ready. By 8:45 we have all left for the gym. Angie participates in a variety of classes while I get about 30 minutes of weight lifting in followed by 30 minutes on the stair-master. After all of that I have been going to either the school library or an empty office at our church to study. My goal has been five solid hours of review material a day followed by Kaplan’s Q-Bank at night. While I haven’t met that goal every day, I feel like I am getting some good work done.

You would think two whole years of basic science would be impossible to cram into a three week study period, but it has amazed me how much of has seemed to stick. I think the biggest challenge in the first two years of medical school, is getting a framework in your mind to put all of this knowledge in. For much of my first year I felt like I was inundated with seemingly unrelated and random information. Memorizing it was like building big unorganized piles of paperwork on the desk of my mind. But toward the end of the year, I started seeing enough of the big picture to build a mental filing cabinet. Then it was easier to put information in the right drawers at least. As the second year wore on, I had file folders and indexes built into my mental library. Now when I am re-reading a review book, the information makes so much more sense and I know exactly where it goes and how it correlates to everything else in the cabinet. It is a great feeling. I am reading stuff that I never caught on to from last year, and the lights are coming on now. For you readers who will be entering med school this fall, I would really recommend trying to get your own mental filing system organized as soon as possible. It really makes things easier.

Since I have gone so long without writing, I will try to recap some of my experiences by course for the next few entries. Microbiology was a course that most people didn’t seem to care for. It lasted for the first two-thirds of the year and was broken down into 5 units: Immunology, bacterial physiology, bacteriology, virology, and parasites and fungi. I liked the first two of those because they were theoretical and involved concepts. The rest of them were just endless parades of pathogens to memorize. They were just rote memorization of hundreds upon hundreds of bugs and worms. The class had a lab component to it that brought about one of my big gripes of the year. We all were required to have a microscope last year for Histology. The scopes are also used in the M2 year for this course. The custom at UMC is to use your scope the first two years and then sell them to the incoming class. However the school has just removed the requirement for this fall’s incoming class. I think they are moving to some sort of web-based lab course for histology as laptop computers are now required instead. Since it looked like we might get stuck with our scopes a lot of M2s began selling their scopes to this year’s M1s before the microbiology course was completed. Meanwhile the course director demanded that we keep our scopes implying that they were required to pass the lab component. Also rumors swirled that some of the departments would buy our microscopes after the year was over. Well it turned out we needed them to look at a total of 10 or so slides over the course of they year. We did some gram stains of known and unknown cultures and did an acid fast stain of some mycobacteria. That was it. It was ridiculous to require one microscope per student. We could have easily gotten by with 10 or so for the whole class. Meanwhile those of us who tried to abide by the request of the professors got stuck when it turned out that no one wanted our scopes. I paid an M4 $600 for mine last year and hardly got any use out of it. It will go up on eBay soon.

While I did fine in the class, my board score was mediocre and I have found the Step 1 questions on Q-Bank for micro to be extremely tough. I just hope there won’t be too many of them.

 

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>May 19 2003

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As Twain remarked, “the reports of my death are greatly exaggerated.” Yes, I am still here and have made it through the M2 year. I am sorry to have gotten so lax in posting but the grind of constant studying begins to wear on you and all non-essential activities seem to fall by the wayside. I have not read a book for pleasure since last summer, have let my website site sit stagnant for over a year, and have not posted a diary entry since way back in December. The time just seems to fly by. While most of my classmates are ecstatic to be through with the classroom based pre-clinical science part of the curriculum, I am sort of melancholy about it being over. I know most medical students will think I am crazy, but after working for The Man for 13 years, the best part of school was the freedom and personal autonomy it allows. I have loved wearing shorts and t-shirts every day. Don’t feel like sitting through a Path lecture today? No problem – just go read in the library instead. Or better yet review some notes while eating a burrito at Moe’s. I am afraid all of this freedom will come to a screeching halt on June 16th when I begin my Family Medicine rotation and once again become expected to dress and act the part. Don’t get me wrong, I am looking forward to being a student doctor and I know I will have a lot of fun, but it is still sad to know that two of the most enjoyable years of my life are over. I am sure that I will never have quite the same lifestyle ever again and it is kind of a bummer.

One of the reasons I have had difficulty finding motivation to write for my diary is the lack of pay. I have been writing class notes like a madman this spring. I ended up writing up 56 hours of lecture notes and made a little over $2000 for my efforts. After spending better than 10 hours a week writing for pay it seemed hard to sit down and do it for free! I was sick of MS Word there for awhile. I fell like I had written enough for my own Step One review book.

Speaking of the USMLE Step 1 exam, it looms for me on June 5th. Our last exam was on May 9th and since then I have spent each weekday studying and taken nights and weekends off. I am working my way through a bunch of subject review books – I am partial to the BRS series for most subjects as well as First Aid. The school has purchased each of us a subscription to Kaplan’s Q-Bank, an online database of simulated test questions. I am working my way through that also. After the test, the family will take a weekend trip to Lafayette, LA to watch Macey’s softball team play in a tournament. Check her team out at http://www.margoscargo.net. Then we will spend a week with some friends in Destin, FL before I have to get back to school. My M3 rotations play out like this: 6 weeks of family med, 6 weeks of peds, 12 weeks of internal medicine, 6 weeks of OB-Gyn, 6 weeks of Psychiatry and I finish up with 12 weeks of surgery. Whew! It will be quite a year.

To encourage myself to write I plan to post my opinions about each of my M2 classes later this week. I hope you’ll stop back by and read them …

 

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>December 11 2002

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Things are getting just a little bit crazy in the last couple of weeks. First of all we have a big Pharm test coming up on Monday. This is the only class in the first two years of med school that likes to give comprehensive exams throughout the course of the year. This will be our third exam but will cover all the material we have had so far. This class is quickly becoming my M2 year Waterloo, much like Anatomy was last year. I just cannot seem to get into it. I haven’t found a good way to study and it the information seems so unorganized to me. I tried note cards for the last test, but it took me forever to make them and then I really didn’t have time to go back and study them. This time I’m building summary sheets in Excel for each class of drugs and will hopefully reduce my study material to 20 pages or so of concise information. But I’m not through with that yet either and I’m running out of time.

Also last week my lab partner of two years had to withdraw from school on a medical leave to try and get her health back in order. Not only has she been my lab partner for every class we have had, but she was also my partner for our ICM preceptor. I have to go that alone now also. I hate to sound selfish about it though. I know it is an extremely tough thing for her to have to sit out a year after working so hard to get to this point. I just hope she is able to bounce back. I had to do my first solo history and physical yesterday. My preceptor, an internal medicine doc, set me up with a list of patients in the hospital. I took down about five names and with white coat on, and my stethoscope around my neck I headed for the wards. I have to admit that I wasn’t really excited about doing it. Not that I was unconfident, but I needed to be studying Pharm and it seemed like an intrusion on my time this week. As I tromped down the second floor wing that my patients were on, I tried to tell myself that this is what I would be doing a LOT of for the next 2 and a half years so I better get a little enthusiastic about it. I found the first room on my list and knocked softly on the door, as I pushed it in wide enough to take a look. There was a large man moaning softly, with the lights out and no TV on. He looked to be only half conscious. I quickly decided that he would probably not make a good first H&P subject and quickly shut the door. It was a good call too, because the next guy on my list turned out to be a real easy guy to talk to. He is currently incarcerated at the MS state penitentiary and had a armed guard in the room with him. He had been told to expect me and was ready and eager to help out someone in the “free world” as he called it. I sat down on the bed with him and in the course of a good 45-minute chat, felt like I got most of the information I needed. I had lost the little white laminated cheat sheet our ICM director had made for us that covered all of the elements of a good history. I had reviewed them in our book (Bates’ Guide to Physical Examination and History Taking) before going and had made myself a little template. This guy was just so glad to have someone show an interest in him that he told me everything I wanted to know. The physical consisted only of a cardiac and pulmonary exam, as these are the areas we have covered in class so far. I left his room feeling satisfied and confident. It was easy to get a rapport going and I was nice and relaxed. I even got a little bit of an ego trip going when the security guard repeatedly addressed me as “Doc.” At one point a nurse came in the room and when she saw me, she said she would come back when I was through. It all made me feel like I was supposed to be there and was doing a good job. I have to write up my H&P tonight and get it to my preceptor tomorrow. He will meet with me Friday to give me some feedback. As I write it up, I may find some things I missed and can go back by to see my patient tomorrow. I may just stop by and see him anyway. A very cool thing about the preceptor I was matched with: no ties! Our course director said that we should take care to follow the lead of our doctor in deciding how to dress. When I saw my guy favored the open collar button down look, I was pumped up. No stupid neckwear for this preceptee!

The other time killer this week is microbiology lab. They are teaching us to be bacteriologists. After a couple of labs learning to do gram stains, and isolating cultures, we have to identify unknown species this week. Each student got a broth with two specimens mixed together that we have to culture, isolate and identify. We have a little flow chart algorithm and we’ve got to successfully identify at least one of the species to satisfactorily complete the lab. It takes several afternoons to complete, as you have to incubate cultures overnight a couple of times. I have my bacteria isolated and have each species narrowed down to two choices. Some tests tomorrow will hopefully complete my work. I find it pretty interesting, but again, I’m way behind on Pharm and every minute doing something else feels like a waste of time

After the exam on Monday though, things will be great for three whole weeks. We will finish out the week and then get our Christmas break and no more exams until January 10th! It will definitely be a relaxing Christmas!

 

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>November 25 2002

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A Thanksgiving Post …

In the summer of 1967, I was born during the midst of an incredible pennant chase in the American League. The Boston Red Sox had risen from the depths of a ninth place finish in ’66 to challenge for the A.L. crown. Led by the great Carl Yastrzemski, the Sox finished an improbable summer by clinching the title on the season’s last weekend. The accomplishment became known as “The Impossible Dream” to the Fenway faithful.

Now I feel like I am living an impossible dream. With Thanksgiving coming up this week, I have been reflecting on how much I have to be thankful for. I am doing exactly what I want to, and how many people can say that? When I first started seriously considering medical school about four years ago, the obstacles seemed almost insurmountable. I had a family, a mortgage, and a handicapped child. How in the world could I make this thing work? That turns out to be the number one question I get from the many people who have e-mailed me after reading this diary. Everyone wants to know how you go about financing something like this. All I can say is that somehow it all comes together. I saved as much money as possible for a few years, and hoped to borrow the rest. It can be somewhat awkward to tell people that you are quitting your job and planning to do something that pays no money over the next four years and not very much for several years after that. I knew my family would be supportive but it has gone way past that. While I have never asked them for help, my mother, father, and in-laws have all been incredibly generous both in understanding why I felt like I had to do this, and in making sure my family has everything they need. I will be eternally grateful. I almost feel guilty that they are making sacrifices to help me do what seems like playing instead of earning my keep. I want them all to know how thankful I am for everything they do for me. There are plenty of others who have given me reason for thanksgiving also. I have had people I know give me checks here and there and even had a nice anonymous gift last Christmas.

Just last night, I came home after a long day. We had taken a pathology exam that I spent all weekend studying for, and I was ready for some relaxation. Angie had just planned on soup for supper, but I decided to take the whole family out to a local eatery. I had just been paid $40 that day for a set of notes, and I figured what the heck. When we were seated, we recognized the couple at the next table as friends of ours. They were both in my high school class and the guy went to Millsaps with me. He went on to medical school here at UMC with a wife and young child, and is now an ER physician. He came over and asked how school was going and took a real interest. After they got up to leave, our waitress brought the little leather folder that holds the check, and instead of a bill I had a note from them …

“Dear Mark & Angie, We remember what it was like. This one is on us.”

We were really blown away and promised ourselves that we would do the same one day when we have arrived. Speaking of thanks, I really appreciate all of the nice notes you readers leave after my posts. You have inspired me to try to be more regular! I hope everyone has a great Thanksgiving Day! Let’s top it all off with a Cowboy victory over the ‘Skins!

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>November 9 2002

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I used to wonder why the original foursome on this site, Dan, Brian, Emily and Christy became so sporadic in their postings during the M2 year. Now I know. It is such a mental endurance test, that when you do have some time not devoted to learning 150 drugs, or the differences between trisomies 13, 18 and 21, that you just can hardly bring yourself to write about it. I have some free time virtually every day, but it seems like I am compelled to do something completely unrelated to school, like tossing the football with my kids, or doing crossword puzzles. Things are rolling along pretty well though. We are at the end of the fall quarter and I am enjoying a week without classes as we take exams. The Biostat final was Friday and this Wednesday we will have our Genetics final. This will leave us with just four courses for the winter quarter, which will seem to be less of a burden even though we will still have the same number of lecture hours per week. A week from Monday I will meet my preceptor for the ICM class. He or she will be kind of a mentor to a pair of us, and we will get some hands on clinical experience. So far I have probably liked pathology best (much to my surprise) this year. We studied congenital heart defects last week, and in lab had several autopsy specimens to examine. It was kind of sobering to see these little miniature hearts. They were perhaps a fourth the size of the ones we saw in gross anatomy last year. It is kind of cool to see how your heart grows right along with you. Most of the “material” as the lab folks call their organ stashes, was over a decade old. They told us that they don’t get nearly as many autopsies for these kinds of defects anymore due to better early diagnosis and intervention.

In Microbiology, I didn’t care much for the recent unit on parasitology. It consisted mainly of memorizing signs and symptoms and matching them with the causative organism. Of course there were plenty of disgusting pictures to go with the names. Now we our doing bacterial physiology which sounds incredibly boring but I have found it to actually be quite interesting. Why study the genome of these things? Because amazingly, much of the code has been conserved all the way into mammals. I am really fascinated by all the advances in genetics.

My least favorite course has been the horrible Pharmacology. The first block on kinetics with all the equations and graphs was fine, but the next unit began the torture of memorizing dozens upon dozens of meaningless chemical names. Index cards out the wazoo. Ugh. I just hope I can make it through this course.

On the family front, all is well. My sixth grader and fourth grader both had all A’s for the first term. Manning has shown some remarkable improvement in his seizure over the last two months. He just suddenly had a drastic reduction to only one or two a day, and the difference in his level of alertness has been amazing. He is moving his arms and legs much more and being a lot more vocal. He goes to a special education program that our local school district provides. They have some wonderful people. A special handicapped bus comes by each morning to pick him up and a teacher accompanies him. They bring him home after a day of physical, speech, and occupational therapy. Those sound more advanced then what Manning is really capable of. The PT is usually range of motion exercises, and attempts to maintain head control for more than a few seconds. The speech therapy is more of an oral manipulation and the encouragement to make cooing sounds. OT might be letting Manning put his hands in Jello or a bowl of dry beans.

Our baby McKenzie is the focus of attention in the household. She is happy and funny. It is a great send-off every morning to have her toddle to the screen door and say in her achingly sweet voice, “bye-bye” as she waves to me with her ferocious smile.

I am sorry for not posting more often, and I am really going to try to do better!

 

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>September 3 2002

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While it was nice to have the long holiday weekend, it was hard to appreciate it this early in the school year. I would have rather saved it for those interminable months of winter. February being the cruelest month, and all that. I felt guilty about how little studying I did until I talked to my classmates. Nobody would admit to hitting the books, so maybe I am not that far behind them yet.

I like to see the various little wrinkles that different departments like to put into their courses. In Biostats, rather than take attendance each day the professor gives a quiz. This way we have an extra grade and the professor can tell who was absent by the missing quizzes. Each quiz has three fairly trivial questions from the assigned reading for that day’s class. However, only one of the three questions is graded. To determine which one, the class selects one of our own, to go down to the front and select a numbered golf ball from a box. The number on the ball corresponds to the question that will be graded. The balls have some very subtle difference amongst them, and we always have a guy who is reportedly the top golfer in the class to be our drawer. After the administration of the quiz the class will call out which item they wish to be graded, and our man will draw the desired ball out. So far he is a perfect four-for-four. I went down today after class to fondle the balls myself, and I’ll be danged if I know how he does it. One of them has a small cut in it, but the other two seem indistinguishable to me.

In Pathology, we had a lecturer who I really liked for the first section on cellular pathology. While required by his department to give us a list of objectives, he commented that he always hated those kinds of things as they tend to be to vague to mean anything. “You should understand apoptosis.” OK, as he said, “There have been books written about it. What exactly should I know?” He kindly supplied us with a very detailed twelve-page handout of his lecture material, which apparently will suffice as a comprehensive document of things he expects us to know for his exam. The professor who followed him put a 25-page handout in our mailboxes. “Ah,” thought I, “another clean presentation of notes that will allow me to work crossword puzzles during lecture and still be able to read everything I need to know at my leisure.” Alas, it was not to be. This entire document consisted of objectives for the guy’s seven or so lectures on immunopathology. Ugh!

In Microbiology, the professors are much enamored of “POPS,” or “Patient-Oriented Problem Solving” sessions. In these we are divided up into groups of four, and work together to solve a clinical problem. These can be helpful, but only if we have had enough time to prepare for them before our scheduled meeting time. Inexplicably, however, the department doesn’t get us the material until the evening before the session. If you have already left school for the day, you don’t get it until the morning of the POPS session. Today we had one called “An Immunoassay Teaching Package.” It proved to be a total waste of time as nobody in my group had done enough background reading to contribute much.

The note-taking-for hire is going well. I have done four sets of notes so far, and have three more in the next few days lined up. I made the mistake of trying to do two lectures one night and it was too much. I drew an easy one today though in ICM. The lecture was on physical exams for pediatric patients and there was not a lot of hard, factual stuff, to go into the notes. Sometimes you draw a easy assignment and sometimes you get a marathon, non-stop, speaker who drones on for 50 minutes and you pretty much have to transcribe his lecture while searching the textbook for clarifications and background. For those the $40 isn’t nearly worth it, but I guess it all evens out.

 

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