Adventures in Child Neurology

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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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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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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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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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I’ve got a red Playmate cooler that I take to school most days packed with a few Diet Cokes (beats the 65 cent vending machines) and my lunch. It looks like one of those ice chests that people use to carry a harvested organ from an accident victim to the ER for transplant on all the TV shows. In fact I regularly get asked, “What exactly do you have in that thing?” to which I like to reply, “A set of lungs, need any?” I’ve got my name written in black on each side, which comes in handy when I leave it in the bookstore. (Thanks for retrieving it the other day, Charlane!) Well today, I am passing an M1 in the hallway, when he spots my name and stops me to tell me that he reads my diary. This is the second M1 whom I’ve met through the Internet connection. Which is really cool, but kind of freaky also. It really gives me pause when I’m writing to realize that real people at my real school could be reading. If I were to trash some professor, or ridicule one of my classmates, there’s a good chance that they would find out about it, and how could I deny it? There would be my words, for all the world to see. I guess the old advice, “If you can’t say anything nice, don’t say anything at all,” applies here.

Speaking of the M1 class, there are four of my classmates from last year repeating from last year for various reasons. I admire their fortitude. While I would certainly not want to have to do it again, I do think it would be nice to do the M1 year with a “I know now, what I didn’t know then,” mindset. I really felt for them when Gross Anatomy cranked up last week. Three months of formaldehyde, scraping adipose tissue, and tying off bowels. Yuck. I am glad to be an M2!

We had a relatively low flow of information today. Three of our seven class hours were lectures on patient histories and communication in ICM. Dr. Sharon Douglas is a very engaging speaker with a big interest in communication. She gave us a couple of lectures last year on the same sorts of things, so it was really just a sit back and listen time. Its all common sense really – the four E’s – engage, empathy, educate, and enlist.

In pathology lab we looked at some of the types of tissue necrosis that we have studied in lecture. The coolest thing was a heart specimen from a myocardial infarction (heart attack) victim. The professor showed us the damaged tissue in the ventricle. There was even evidence of an older infarct which the patient survived and the damage from the fatal one was plain. We also saw a gross brain specimen showing examples of liquefied necrosis. Then it was time for lunch, yum, yum!

There is so much material being thrown at us already, that organization is going to be a key for me. I have equipped my study table at home with stackable tray from Office Depot to keep the classes separate. I like to carry a light backpack, so each day I put what I want to study into one binder and limit my books to either lightweight review books or one larger textbook. There are a few people in my class who haul their entire library around with them every day. They use the luggage type packs with wheels and a pull handle. They always look like they are catching the next flight out of town to me.

Our class president spent the summer compiling a CD for us with a complete set of last year’s notes and lecture handouts, plus three years worth of all the old exams. It appears to be a monumental effort. Nice job, Calvin! I have been going through and printing out the notes for each days scheduled lecture the night before. Scanning over the notes makes the lecture time much more productive. Just six hours tomorrow, but they start 9 hours from now, so I better get to bed!

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Sunday night is always kind of tough for me. My trouble is not the mourning of a lost weekend, but of trying to get back into the five-day routine of the week. I usually have had an excess of sleep and thus am not tired at the normal bedtime. This sets off the familiar but vicious chain of staying up too late, sleeping too late Monday morning, being in a rush, missing the gym, etc.

I had a nice weekend, though I didn’t dive into the studies like I should have. I did read through most of the Microbiology notes though, so it wasn’t a total loss. We have a long day of class tomorrow. Intro to Clinical Med at 8:00 am and then two more hours in the afternoon. It is all fairly light stuff however – introduction to patient history and communication skills. The lecturer talked to us about these same things last year, and looking over my copy of last years notes for these lectures, it looks like the same old thing. We also have an hour of Micro, 2 hours of pathology including our first lab. Ugh – images of microscopic tissue samples – I thought I was through with histology! I really don’t like anything with a microscope component. We also get an hour of Genetics in the early afternoon. The first three hours of this class has not been what I imagined. We talked about birth defects and the causes – not necessarily genetic in many cases. Tomorrow though we get more into what I envisioned – Mendelian inheritance patterns and pedigrees.

I did my first set of notes Thursday night but only made $20. I gave a discount because the lecture was pretty much introductory and the notes were pretty easy. The only real job was getting the copies made and distributed of the handout the Prof gave. I got a call today from a classmate hiring me for Micro on Tuesday. I already had ICM notes that day on my regular turn, but I think I can get both sets done as it looks like ICM won’t require real rigorous notes, for a while anyways.

I’ve got to get this posted and get in bed. The gym looms at 6:00 am and I’ve just started a new audio book. I have never read any of Sue Grafton’s “alphabet novels” but am trying out “O” is For Outlaw. I have listened to the first 15 minutes, and I am really digging the raspy female narrator’s voice.

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Today was my oldest daughter’s eleventh birthday. I was ready to leave the house for the gym by 6:00 AM but I wanted to give Morgan her birthday gift, so I picked her up out of bed and moved her to the couch. She groggily opened her new Game Boy and Frogger game and happily dozed back off as I left home in the dark. One thing that I got into in the summer is audio books on my MP3 player. I am listening to Michael Connelly’s City of Bones right now and listening to it helps me keep my mind off the drudgery of the workout. I was in my seat by 7:45 for my first taste of Intro to Clinical Medicine. This class is really going to be a lot of fun. We will be assigned an MD preceptor in the hospital and have to do histories and physicals under their watch this year. We are required to have an ophthalmoscope, otoscope, stethoscope, and blood pressure cuff. I will be cruising eBay this weekend looking to pick up some on the cheap.

Next came Biostatistics. Being a math guy, I am expecting to jam in this course. I also had my first note-taking job of the year. I only charged the guy half-price, because all of the lecture was introductory and didn’t require much work. The main hassle will be getting the copies made and distributed. We all have a mailbox and the note-taker is responsible for getting copies made at a nearby copy shop and distributing them to each students box.

Two hours of pharmacology followed that. The first lecturer is a gray-haired bearded man with a real peculiar British sounding accent. I’ve got to ask him where exactly he is from. I had kind of dreaded Pharm as I envisioned it being just memorization of enormous lsit of drugs and their pathways. I am sure that is to come, but we are opening with pharmacodynamics – the actions of drugs on the body. There were lots of graphs and log scales, and equations so I felt better.

The two afternoon hours were microbiology. This is the course that has taken off the quickest. Already in two days we have had five hours of lecture material. The guy is just careening on out of control. I will definitely be studying it hard this weekend. Our first exam of the year is in micro and will be on September 9. After that, we have an exam on almost every Monday morning for the rest of the year.

I got home at 3:30 and just chilled for a while. The girls had a scrimmage soccer game at 5:30, so the whole family went, and I worked on the Biostat notes on my laptop. The stifling heat we have been having had broken, at least for one evening. The night then brought pizza and the first college football game of the year. I guess, I’ll hit the books tomorrow!

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Ok, I know I’ve been AWOL for quite awhile now. I have been really enjoying my summer and have pretty much avoided any academic pursuits. Which is not to say it had been an uneventful summer … I drove the whole family out to Alamogordo, New Mexico, was stranded in the desert in July with a failed alternator and a Suburban full of kids, spent time on the beautiful beaches of Destin, Florida, gave a talk on the Human Genome Project to some actuaries in New Orleans and read about ten books, none of which had anything to do with medicine. It has been fun, but I’m afraid it all came to a screeching halt today – my first day as an M2.

Classes began at 8:00 AM this morning. This is an hour earlier than we started last year, and though my excitement had me awake early this morning, I am sure that it will quickly become tough to get my brain in gear this early in the morning. I have been resuming my workouts at the gym, this summer, and I am hoping to get up early enough to get that in before class. I made it today and felt fresh and eager to get started on my M2 experience. First up out of the gate was Medical Genetics. My enthusiasm was quickly dampened as I sat through a monotone lecture on what was mainly introductory material; what genetics is, why we need to study it, etc. etc. Seven hours and six lectures later I felt like I had the life drained out of me. I am definitely out of “classroom shape.”
The rest of the day consisted of Microbiology at 9:00, two hours of Pathology from 10:00 until noon, and two more hours of Micro from 1:00 until three. Tomorrow we are introduced to three more classes, Pharmacology, Biostatistics, and Intro to Clinical Medicine.

Besides the actual medical stuff, I think I learned a lot last year about what it takes to be successful in medical school. I am going to attempt to study much smarter this year if not harder. For one thing, I am scrutinizing my book purchases much more carefully. After buying everything on the professor’s lists last year, I learned that age-old truth of medical school – what you need to know is in the notes. There are so many assigned readings that it is impossible to actually digest them all. You just have to accept the fact that you cannot read everything and concentrate on the items that will yield the most fruit when it comes to exams. And invariably those are the handouts and class notes. Today I only bought the books that are universally hailed as must-haves by the upper-classmen and I will sit in the classes for another week before deciding about any others.

Another thing I am going to do this year is to be a note-taker-for-hire in our note service. The going rate is $40 for one lecture. I already have taken a job for tomorrow morning’s Biostat class. Since it is the first lecture of the year it will just be introductory material and should be easy money. I am hoping that doing a few sets of notes a week will keep me focused on my studies as well as bringing in a little extra cash.

One of the best things about returning to school was seeing all of my classmates. I missed them more than I had realized over the summer. Going through a year of medical school together definitely instills a sense of kinship. I am sure that I will be close to many of my classmates for the rest of my life, and there are not many other experiences in which an already 35 year-old guy can form such friendships.

Now that we are back in class, I’m committed to keeping you posted pretty regularly. Hope everyone has a great year!

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I am three weeks into my summer break and I have been a lot busier than I ever anticipated. I am hoping things will slow down a bit for the next couple of weeks so I can just enjoy some down time.
I spent one day a couple of weeks ago shadowing an ER attending physician. This was a summer program set up by a student interest group. (The ubiquitous SIG – there is one on campus for every area of medicine!) I am not really inclined toward ER stuff as a career right now, but I did want the experience of seeing what it was like. It was a Wednesday, so the usual weekend gun and knife club members were not in view. The most dramatic patient was a construction worker who had his leg run over by a bulldozer. He was a flagman who sat down to drink a soda and apparently wasn’t paying attention. It was not terribly gruesome but he definitely needed orthopedic attention. I had to help roll him over. He probably weighed in at close to 300 pounds and was screaming in paid during his entire ER stay. Thankfully he was moved to surgery pretty quickly.

Another man was brought in with a sudden deterioration of mental status. He was 42 but looked 62. He had a history of seizures, alcoholism, and cancer to start with. He was running a 105 degree temperature and was incoherent. I got to assist an intern with a lumbar puncture to rule out meningitis. It was the first time I had seen one done, and it was cool to see the clear CSF draining from the needle and realizing it was in the dura of the spinal cord. The ugly politics of a charity hospital came into play on this guy. Nobody seemed to want him. ER had him stabilized and he obviously needed to be hospitalized. The internal guys wanted to shovel him off to neurology but they did not want a possible infectious disease patient. He was still taking up a room in the ER when I left 6 hours after he had arrived.

Many of the other cases were routine but disturbing. Patients complaining of back pain looking for prescriptions. A Mexican woman who had been in an automobile accident 18 months earlier and who was in chronic pain but could no longer afford the private doctors she had been seeing. She spoke no English and a social worker came in to translate because none of the residents or nurses on staff could speak Spanish. Growing up in El Paso, Texas, I had some Spanish education up through sixth grade but have lost it all now. However this incident has really made me think about trying to pick it up again. There is a growing population of Spanish speaker here in Mississippi working in the chicken processing plants and looking for temporary work.

There was a middle-aged woman who came in with a list of vague complaints. She had just been released from another hospital after a seven-day stay for similarly murky reasons. She came with her bags packed ready to be admitted, but wanted no part of a psychiatric admission. In fact between her discharge from the other hospital and her arrival at UMC she saw her psychiatrist who gave her a statement to bring in declaring her emotionally and mentally stable. She was accompanied by a “dear friend,” who antagonized the staff, demanded treatment for her friend, and informed us several times that this lady’s late father had been a doctor. Her chief complaint was “weakness” but in trying to get more details she just rambled, complaining about everything from allergies to her suspicion that she needed both knees replaced. The attending was hoping the blood work would come back showing anemia or something he could admit her for. Each time he got ready to enter her examining room I could see him gathering his patience to face her.

I was struck by the way this all becomes routine for the staff. They have seen it all, and cannot help but become inured to it. When one young woman came in and demanded a tray of food before she had seen a doctor, she was told, “this is a hospital, not a cafeteria.” The attitude you’ve got to have is even reflected on the dry-erase board that charts all of the current patients. As I looked it over I recognized most of the standard acronyms; SOB – shortness of breath, CP – chest pain, etc. I had to ask about one of them though – AAW. The attending told me that this person had endured an acute ass whupping. Ahh, emergency room medicine – you’ve got to love it.

>“What a long, strange trip it’s been.” – The Grateful Dead

It has been a long and strange trip, but also a wonderful and satisfying one. If not officially, I am at least a de facto M2 now. We finished school a week ago and it has taken me the whole seven days to sit back and contemplate on the last year enough to come up with what I want to write about. I still have my psychiatry final exam and NBME scores for neurobiology and physiology unreported, so it will be a few more weeks until I know my final grades and class rank. I finished on a strong note though, and even did well on the last of my practical exams, those horrible trials that proved to be the scourge of my first year experience.

Now the summer stretches out before me like it did when I was a kid, a road that at least from the starting gate, looks like it goes on forever. I know that when its in my rearview mirror however, that it will have been just a mere blip of pavement. I have plans that will more than fill it up. Reading stuff for fun – almost a forgotten pleasure. Coaching my daughters’ softball team – we are off to a 2-0 start and now have a 14 game winning streak dating back to last season. Movies! – I’ve already caught Attack of the Clones and Spider-Man at the big screen plus The Others and K-PAX on video. Theater – front row tickets for a production of Stephen King’s Misery at the local playhouse. Crossword puzzles. Workouts at the gym. A few weeks in New Mexico visiting Mom and Grandma. Besides all of the fun stuff, I guess I need to justify my school-free existence somewhat. Guilt over not earning my keep will force me to look for some computer work. Also I have a day scheduled to tail an ER physician and another to ride along on an ambulance service. And I’m running the outdoor play activities for Vacation Bible School at church next week. The one thing I won’t do this summer is complain about being bored.

Our coursework for the M1 year included the following which I have ranked from my highest to lowest grade:
1. Psychiatry
2. Physiology
3. Neurobiology
4. Histology
5. Gross Anatomy
6. Biochemistry

I think its no coincidence that my grades improved throughout the year. I came into medical school with a poor life science background. I did not have all of the typical pre-med courses. My knowledge of anatomy was so poor that I was not completely sure which side the liver was on. I was in way over my head for the first two months, but as each new course began, my confidence grew and they seemed to build on each other so that by the third or fourth time I was exposed to something it began to stick.

During the last weeks of school I was invited to a luncheon with a bunch of accepted applicants for this fall. The idea was to bring them in and let them ask questions and to avoid the long period of silence from the time they get accepted until school starts. The best advice I had for the incoming students at my table was, “have fun!” There are so many people in my class who are in such a hurry to get this “school stuff” over with so they can go about the business of being doctors. Medical school is seen as something you must suffer through and endure to get in the club. Maybe it is my perspective of having worked in an office for the last 13 years, but this is a pretty good life. I wear shorts and a t-shirt every day. I sit under trees to eat my lunch. I’m surrounded by really smart and motivated people, some of whom I am sure will go on to do great things. Sure there are stressful times and you get sick of cramming facts into your brain only to realize a week after the exam that they are mostly gone. But all in all, the good stuff so far outweighs the bad, I can’t imagine that I won’t someday look back, and consider these to be the best times of my life.

I know I have been slow to post the last month as I spent a lot of time studying for finals and then recovering from them. I am hoping to post pretty regularly over the summer with reflections about the year and thoughts of what’s to come. Thanks for reading!