Adventures in Child Neurology

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What a great Christmas! I feel a tremendous sense of satisfaction when I sit back and look at what has happened to me and for me this year.. I know I am blessed to be doing exactly what I want to do. I have learned a lot of science, but of more lasting significance, I have learned how many true friends I have, and how many people love me. I have had so much support from people that I feel like I am not just going to medical school for me but for all of them too. One particular anonymous benefactor overwhelmed Angie and I with their generosity. We wrote them a letter expressing our gratitude and pledged to pass along their gift by helping out others in the future when we have the means.

Everything can’t always be rosy though. We started our son, Manning on a new anti-seizure medication called Zonegran a few weeks ago, and so far we have not seen much in the way of results. Manning was still having multiple seizures a day, and they seemed to be getting rougher in intensity. One night Angie was near tears saying she had been really praying for a Christmas miracle. Again. I have stopped looking for those kinds of things, I guess because I am tired of being disappointed. I am not sure which is sadder … her dashed hopes or my lack of hope. For me, it is just easier to be accepting and happy in a poor situation than to continually get knocked in the teeth. But on the more merry thoughts!

I have had a lot of questions lately about how my family is handling my schooling. I think it has gone great thus far, and the whole family is real supportive. Angie actually complains that I should be studying sometimes when she sees me goofing off. I think I am spending almost as much time with them as when I was working. Maybe that’s the problem with some of my grades! Anyway, I had the wife of a fourth-year student from my school write me and suggest that it would be good to get Angie’s take on the whole thing. I am going to try to get her to post a “guest entry” and let her tell about the experience in her own words.
I had a great time last night going out with a bunch of my buddies including one from out-of-town whom I hadn’t seen in a year. We went to a local sports bar to watch some football and eat our weight in buffalo wings. Life has been good, but I have got to shake it off and hit the books!

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Christmas Break. My first since 1988 and it feels great. I can’t believe it took me this long to go back to school! As I was riding around town today, I couldn’t help but laugh at all the poor stiffs who were going to work. Not that I can take it easy. With a comprehensive Biochemistry final and our first Histology exam coming within the first four days of our return, I have a lot of work to do. I have made myself a schedule out for the rest of the holidays and plan to do some studying every day except Christmas and New Years. I even went into the library and got some reading in the last two days.

There is a lot of construction going on all of the time at our school. The original teaching hospital for the University of Mississippi opened in 1955 and they have been expanding ever since. In the last five years a new children’s hospital, a women’s and infants hospital and an adult acute care hospital have all been built. Work on the fourth and final hospital in the grand scheme to replace the outdated original structure began this fall. Each day I have to park in the parking lot of a large stadium and walk to the School of Medicine and I go right by the construction site. I was thinking about how easy it is to go by each day and not really see what is going on. Some people walked by the site for a week before they noticed that a new circular drive had been put in to divert traffic at the main hospital entrance. I decided that I was going to really look every day and see what new things were going on. It has become a metaphor for the world outside of medical school for me. It is so easy to get so immersed in metabolic pathways and cellular ultrastructure that you don’t have time for anything else. I am not going to let my blinders stay on so tight that I walk up one day and say, “Wow! When did this new building get here?”

I have also found a new goal for medical school. The hospital has an emergency air-lift helicopter that brings in patients and lands on top of the acute care hospital. I have found myself watching it come in and land several times with fascination. I want a ride in that thing! It looks so cool. I am going to try to find out who I need to kiss up to get a ride on the chopper before I graduate from this place.

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First of all, I want to tell Dan that he has done a nice job on the revamping of the web site. Just one issue – the font is pretty small and its hard for my Mom to read! She is having cataract surgery during her Christmas break, and should be better able to see then, but I am sure we probably have some other older readers out there, don’t we? Speaking of my Mom, she is a long time school teacher and is my grammar checker. In fact she called me out publicly in a comment on my last post. Ma, couldn’t you just send me a private e-mail so I can edit out my mistakes quietly?

My Mom has been a great source of encouragement and support in all sorts of ways since I began to pursue medical school three years ago. Thanks Mom, I love you!

I forgot to mention that within just a couple of days of becoming a writer on this site that a classmate told me he was a reader and saw that I had come on board. I had wondered if anybody at my school would see me. Somehow it seems a little scarier when people that you know are reading your thoughts as well as strangers.

Today was a full lecture day we two hours worth of biochem, two hours of Histology and then a 3 hour lab session.. We are winding down biochemistry with only 4 lectures to go before the Christmas break and then 3 more afterward before our comprehensive final exam. We have our last regular test on Tuesday and it covers only 9 lectures plus a two-hour case study we did on the biochemistry of atherosclerosis. Our exams are weighted by the number of lecture hours covered and this is the smallest one of the year. I have been thinking that if there were ever a test that I could ace in my whole medical school career, it would probably be this one. There is just not nearly the amount of material on it as most of our tests. I am going to use that goal to motivate my studying over the weekend.

I took the night off from studying to go to a local theatre for a production of Dickens’ A Christmas Carol. Angie and I got free tickets from a friend who played Mrs. Cratchit ,and she did a super job. It really started to get me in the Christmas spirit. I have been so busy that Christmas has really been one of the last things on my mind.

>Today I tried to put myself in the shoes of our professors. We had to fill out a survey on our Anatomy class in order to give the department feedback. We evaluated the materials, the professors, and the method of instruction. I had no real big complaints. My main advice was that a lot of learning could be facilitated by the instructors doing a lot more hands on teaching in the dissecting lab. I would have liked a professor to come around each day as we did our dissection and give us a many “tour” of that day’s material. Often our group would tentatively identify a structure only to find out the next day we had it wrong.
Anyway all of this led me to thinking about what it would be like to be a professional scientist like these guys. For the life of me I cannot imagine what would possess anyone to pursue a PhD in anatomy but I am glad that there are some people who want to. A career in Biochemistry seems much more appealing. I think our professors there are pretty cool for the most part. One guy in particular I like is a real funny guy. He wears a diamond stud earring and shorts and sandals most days. During his lectures he likes to put attention getters in his PowerPoint slides. During one recent lecture, in the middle of talking about the synthesis of lipoproteins he put up a shot of Britney Spears from the cover of Rolling Stone magazine. He told us he had just thrown that in because he worried that “she wasn’t getting enough exposure.” He loves to fish and will pepper his lectures with photos of him holding fish that he’s caught. The other day he was talking about wasting diseases and he flashed a picture of Keith Richards up. I was a little surprised when both of the twenty-something girls sitting next to me didn’t know who he was.
Anyway, I just wonder what life is like for a researcher / teacher? Do they think we are a bunch of spoiled prima donnas? Sometimes a few people in the class act like it. A few weeks ago, a professor posted an assignment for us that we were to do in small groups. We were supposed to research some dubious nutritional / supplement claims and report our findings back to the class. Somebody in our class posted an anonymous message to our electronic blackboard ripping the professor, saying we didn’t have time for that; didn’t they know that anatomy was more important than biochemistry; we were paying out tuition for them to teach us, not so we could do our own research; and blah, blah, blah. Needless to say it was embarrassing to most of us and I personally apologized to the professor in question for the comments that reflected upon all of us. I guess out of a class of 100 plus there will always be a few whiners.
The other big time killer today was a required library research “test” we had to take. Last week we endured a two hour library orientation session where we learned how to access the electronic resources of the library. We then had a test that we had to complete to show we knew how to look things up. It took about three hours and I couldn’t help but think I would have been much better off reading some Histology.

On a personal note, Angie and I went out to eat at a local BBQ place while the older kids were at a Christmas party. Little McKenzie (6.5 mos) sat up in a high chair for the first time and had a fine time. She’s a big girl now!

Well I’ve got to memorize the Urea cycle before bedtime.

>We only have 5 more days of classes before Christmas break! I cannot believe how fast the first semester has gone by. We do not really get much of a break from studies though. We return to school on January 2nd, and have a final exam in Biochemistry on the Friday the 4th. Then our first Histology exam hits on Monday and a National Board exam in Biochemistry on the 10th. So I will be studying over the holidays, but at least there will be no new material being thrown on top of the pile.
I have gotten pretty frustrated with my study results in Biochemistry. We had our test Monday and I just wasn’t as prepared as I wanted to be. I find that the material is not integrated very well and seems to be presented as just a bunch of random facts and chemical pathways. I spend a lot of time trying to put it all together in my head and get the big picture before jumping into the details, but by the time I have everything squared away and understand how everything relates, I run out of time to memorize all the catalyzing enzymes and what disease is caused by an excess of what chemical intermediate.
Unlike many of my classmates who were pre-med in college, I have never had a Biochemistry class. Adding to the problem is the course is taught by a team of seven professors and they each lecture on a particular topic, but nobody ties it all together for us. While studying all of the metabolic pathways, I would like to step back at each new concept and be shown how it all fits in the big picture, but it seems I have to get that on my own.
My biggest problem is that I have been studying in such a way as to understand the material rather than to perform well on the exams, and there is a difference. I have seen some of classmates just memorize old exam questions. They play a word association game, where they know a certain enzyme goes with a particular pathway, but they may not really understand what is going on. That is not to knock them, they have just figured out the game a bit better than I have at this point. Hopefully though, my extra efforts will pay off on the final and the board exam, as I hope my methods of study will lead to better recall for the long haul.
One of the great things about being in a hospital every day is access to quick medical care when you need it. Last week we had some kind of crud going around my house and I got congested and it led to an ear infection. It is so easy to go by student health services and get a prescription for an antibiotic.
Also I am getting some physical therapy for the broken arm I suffered eight weeks ago. I fractured the head of my radius in a furious driveway basketball game. It has been improving steadily but I still don’t have my full range of motion back. When I started therapy two weeks ago I was at 150 degrees of extension, but I am now at about 165 on my own, and my therapist has gotten me close to 175 while stretching me. She starts out each session by putting a heat pack around my elbow while I lay on my back with my arm extended. An elastic band is wrapped around my wrist and then tied beneath the table so that it straightens my arm out. Then she takes the heat off and pushes my arm down as hard as she can. I just try not to cry. Then she flexes it as far as it will go and starts shoving my fist into my shoulder. After some strengthening exercises comes my favorite part – the ice packs. She wraps my elbow up good and I imagine I am Curt Schilling after nine tough innings.
It has definitely paid off. I hadn’t been able to engage in my Sunday afternoon games since I had broken it. I have an awesome driveway for hoops – about 40 feet by 30 feet and perfectly flat. I’ve got a gang of about 8 buddies that come over and we have three-on-three games. I couldn’t stand to watch them while I was on the disabled list so I would go to school to study, but last week I gave it a shot. I had extremely limited range and shot like a sissy but it was good to be back out there. Then this Sunday, my jump shot was back! No real pain and most of the strength back. I can tell its still not 100% but I could play hard and not hurt my team too bad.

>Wow! I am amazed at the number of people reading my entries and contacting me! Thanks everyone, I appreciate the sentiments. The e-mail form does not have the new writers listed so if you would like to reach me personally you can do so at mark@manninglee.com. I will try my best to reply quickly but it may be a few days before I get back to you.
Today was a great one. We had an optional review for the Biochem test on Monday. I have found that there is really not much to gain in these sessions so I skipped out to study in the library. We then had two hours worth of Histology lecture on ultra-structure of epithelium tissue and blood cells. I also punted on the regularly scheduled lab time. We have 24 hour a day access to the lab so it is really a situation where you can put in your time whenever you like .The professors are on hand during the regularly scheduled class times to answer any questions you have. Plus they set up some demonstration microscopes with good examples of whatever we are looking for that day. I figured I needed the time for Biochem more so I put in another few hours in the library. The last two days have yielded me some excellent study time and I am trying to figure out how come sometimes I feel like I am really making headway while other days I can just sit and look at the pages and not get anything done. If I could just capture the groove I get in on the quality study days, I feel like I would be much more productive. It kind of reminds me of an article I read years ago. When I was a kid, Hall-of-Fame baseball pitcher Tom Seaver was my hero. I read an interview with him once in a Boy’s Life magazine. In the story Tom Terrific told the writer that he only had his very best stuff 3 or 4 times a season out of 36-38 starts. He said on those days every pitch was working and he had great command. He felt totally in control. But for most of his starts there would be something not quite right. Perhaps his fastball was off a couple of MPH or was not moving. Maybe the slider wasn’t breaking or he was struggling with his control. I remember being taken aback by Tom’s comments. I thought my man was near perfect EVERY time! Well I’ve learned my studying is like that. I just cannot get into that super focused absorb everything mode every time. In fact I only get in “the zone” a few days a month probably. I just need to try to learn to approach that zone a little more often.
A good productive study time allows me to enjoy everything else a little bit more. The weather was awesome here today. Sunny skies with temps in the 70s. I wore shorts and a polo shirt and even when I left school after dark, it was warm enough to ride with the windows down. I love to unwind by driving fast with the windows open and jam to some tunes. I stopped by a Target to pick up a birthday gift for my middle daughter who turns nine tomorrow. She asked for a Gameboy, and even though they’re a little pricey, I got her one, plus a game cartridge of some of the classics of my youth – Ms. Pac-Man, Galaga, Dig Dug, and Pole Position. I can’t wait to see her face tomorrow. And then to top the day off, when I got home Angie had prepared an awesome dinner of porkchops with rice and gravy. Some people have asked about the difficulties of going to medical school with a family, but in some cases it makes things easier! It sure is nice to come home to a great meal and not have to heat up a chicken pot pie. And when Macey gets her Gameboy tomorrow, she won’t care what grade I make on Monday’s Biochem test … she’ll love me anyway!

>I am up late studying Biochem. We have an exam Monday covering oxidative phosphorylation, carbohydrate metabolism, and lipid metabolism. I am kind of frustrated with our note-taking service. Everybody in the service takes turns preparing notes from our lectures and getting them printed and distributed to the rest of the class. It is so time consuming to prepare detailed notes that it would be almost impossible to do your own notes for every lecture. You simply don’t have time to take good notes in class because the lecturer moves too fast. Each lecture is taped and the note taker can then listen to the tape that evening while he prepares the notes. The problem is that everyone has their own style of note-taking. Most of the professors use either PowerPoint presentations or slides to give their lecture. These usually are distributed as separate handouts. I would prefer that the note-takers consolidate the information so that reviewing the handouts would be unnecessary. Unfortunately most of my classmates don’t do that but only add any extra information that the professor talked about but didn’t put on the slide. Thus while studying you have to constantly flip back and forth from the slide to the notes. Even more aggravating is when people waste space in their notes to say, “Dr. Brown read the slide.” I KNOW he read the slide! I was there! Either repeat what was on the slide or just move on without comment! Maybe I just like to study in a different manner than most of my classmates. I just like to consolidate the material as much as possible. End of rant.

We started Histology yesterday to take the place of our completed Anatomy time slot. This is where we get to use the microscope we bought. I really like it so far. I have never had much course work where microscopes were used and I’m still in the “gee whiz this is really cool!” phase. I went the cheap route and bought a used Accuscope microscope which are cheaper than the recommended Nikon and Olympus models. It seems fine for our purposes though, and the slides I look at seem just like the images in the textbook, so I should be okay. The head of the course approves all of our microscopes anyway. We each have a lab partner and we get a set of 300 slides assigned to us to share. My partner is a girl I get along with well who was also one of my Gross Anatomy lab partners. They always break us down alphabetically so you tend to wind up working with the same people. Good in my case, but I imagine some people would like to swap up. I have kept up pretty well with the first two days of Histology but I am going to have to really get after the Biochem material in the next five days and then play catch-up as usual!

>One of the great things about academic life is the constant cycling of finishing a course and starting something new. You continually get a fresh start. I love the feeling of relief when something is over and that is the way I feel about Gross Anatomy today. It was kind of like hitting yourself with a hammer because you knew how good it would feel when you quit!

We had our last regular exam on Tuesday covering head and neck. The way our school handles exams is to divide our 105 member class into two groups. One group does the written portion first while the other group has the lab practical exam and then we swap out. It has taken me all term to figure out how best to prepare for these exams. I had improved my grade on each of the first three exams and was hoping to continue the trend.

On Friday we took the National Board subject exam in Gross Anatomy and Embryology as our final. It was to count for 20% of our final grade but after our results are curved by the department it usually pulls peoples grades up a bit. The rumor is that no one has ever failed the Board exam. I suppose that means that they set the lowest mark in the class to a 70 and curve it from there.

As soon as the exam was completed I rushed to my mailbox to get my head and neck results. The department doesn’t get our scores out until the Board exam is complete so as not to interfere with our studying, or so I presume. When I opened mine, I felt like I had been kicked in the teeth. The first number I saw was my practical exam score and I completely bombed it. I felt a cold fear going through me until I saw that I had done enough on the written portion to keep my head above water. Still it was a major disappointment. I had not done as poorly on an exam since the first anatomy test.

A fundamental part of medical school is learning how to cope with the fact that for most of us, there will be exams that we do not do well on. Some are dealing with it better than others. We had our second casualty of the year as one of my classmates dropped out this week. I hated to see each of them go, knowing how much effort was put into getting into school in the first place.

To celebrate completing our first course in medical school we had a “Claus Ball” Friday night. The schools of Dentistry, Nursing and Health Related Professions were there too, but I don’t think any class looked as happy as the M1 class. Angie’s Mom stayed with our four kids and we had our first night out alone since school started. It was a great time. Angie was impressed when several of my classmates said some flattering things about me. Since I am older than most of them (I’m 34 and the average age is 24.5) I am glad to know that I fit in well. I actually feel as young at heart as any of them. Angie was particularly taken in when one girl on the dance floor took her arm and told her what “a great guy” I was. I had to point out that she was pretty drunk.

Another thing I like about school is the feeling of starting fresh with a new class. We start Histology Monday and I am eager to get into it and as usual, have big visions about staying caught up with the readings and really being on top of things. Of course we are still in Biochemistry and have a big exam a week from Monday that I must start busting my tail for. And today was a big zero for academic progress. We saw our second daughter Macey on a float in the town Christmas parade with her school choir. I then got our Christmas tree up and put the lights on. The girls and Angie do the rest of the decorating. The rest of the day was spent watching football. Oh well, all work and no play make Mark a grumpy boy.

>Today was almost a free day. We had a Biochemistry test at 9:00 and a break from our normal Wednesday afternoon Case Study session. That meant I got to go home when I finished my test at 10:30! Once again, I did not feel great about my test. I still have not been able to jam on a Biochem test since I made an A on the first one. I am getting frustrated with not doing as well as I want. I went into my bunker mentality and started getting organized for the next test as soon as I got home. I like to build a spreadsheet with all the lecture topics and assigned readings for the next exam block. For our fifth Biochem test (which won’t be for four weeks due to Veteran’s Day and Thanksgiving holidays!) we have material from 20 lecture hours and 3 two hour long case studies. I like to try to get everything laid out before me so I can see the big picture before we dive in. I think one of the weaknesses in this class is that there doesn’t seem to be a coherent view of where we are going. There are seven different professors who give the lectures and they each speak on their individual topics but nothing seems to tie them together for me. It just seems like a mish mash of material. I go through this after each test. I get all fired up about how I will be the MASTER of Oxidative Phosphorylation Reactions in the Mitochondria. I review the class notes as soon as they come out and do all my readings for a couple of days, but then the fear of the next Amatomy test descends upon me and I neglect Biochemistry until I realize that I cannot be the master of it. I then shoot for being proficient. Then comes the stage where I just hope to have a vague concept of some parts of it. But this time I really will do better!
For many people in medical school, this is the first time in their life they have failed an exam. It really gets to some of them. I cannot say that I’ve never failed a test before but I do think that I can say that I had never failed a test that I actually studied for until this year. Not that I am making a habit of failing … I just am not doing as well as I am used to.
We had a great Clinical Correlation lecture in Anatomy yesterday. Dr. Galli of the UMC Emergency Medicine department spoke to us about emergency procedures. If you watch E.R. on TV, this was your guy. He had worked in Los Angeles before coming here and actually had given war stories to some of the producers of the show to aid them in storylines.
He opened the class by telling us what many of my classmates are starting to suspect, “your first two years of medical school are all bullshit.” This prompted a spirited round of applause and hoots, much to the chagrin of our professors. He told us that all of the details we were learning would soon be forgotten but did concede that a few of the biggies would stick. He then told us that despite all that we should be busting our chops to get all this stuff, not because we would need it as doctors, but because it was important to have good marks when our residency applications came up in a few years.
Then we jumped right into how to give a choking person a tracheotomy. You can do it with a pocket knife and a ball point pen if need be. He made it look so easy, I really think I could do one if necessary. We saw all kinds of gory photos of stab wounds and botched suicide attempts. Perhaps the most interesting procedure Dr. Galli showed us was “cracking somebody’s chest.” In the case of a penetrating wound to the heart, such as from a knife or bullet, the patient may be bleeding into the pericardial sack which surrounds the heart. The heart, though damaged, is still pumping enough blood to keep the patient alive. However too much bleeding into the pericardium can build up pressure and compress the heart enough to interrupt circulation. In a case like this you have just a minute or two to get inside the thorax and cut the pericardium open to allow the blood to escape. To get in, you have to be “fairly aggressive and fast.” You make an incision between a pair of ribs and even crack a few of them open if need be, to access the pericardium and cut it open. You may also need to manually massage the heart at this point to restore a heartbeat. Of course while you are being aggressive, you must avoid cutting a lung open or severing the phrenic nerve to the diaphragm, without which you can’t breathe.
He was a great speaker and cracked jokes while showing us these photos. I would guess that being able to laugh at this kind of stuff is necessary to be able to stay in his kind of work. He claims that all of us will be able to do stuff like this even if we don’t go into emergency medicine. I was kind of horrified at the thought. Not because I am squeamish about the blood and gore, but because of the split second decision you must make about what needs to be done. I can’t imagine cracking someone’s chest open and then discovering that the heart is not damaged after all. Of course he told us that in those particular situations, the patient is probably dead already and you’re just trying to pull a rabbit out of the hat.
He ended by encouraging all of us to come to the ER and hang out when we had time. If we wear our white coat, they will hook us up with the resident on duty and let us observe and maybe even “actually touch a patient!” He told us that Friday and Saturday night are the best times to come because you will see more cool stuff. I think the next time I am having a slow weekend, I may take him up on it!

>I have finally figured out how to prepare myself for Gross Anatomy exams but I’m falling behind in Biochemistry! I got my Pelvis and Lower Limb exam score back this week and am pleased to report that I made a B! I have improved my grade on each exam so far with only one more to go. We will take our Head and Neck exam on November 27th and then the National Board subject exam on the 30th, and I will be through with this brutal course! The whole class is counting down the days … only 10 more lecture and lab periods.

Unfortunately as I have improved my score on all 3 Anatomy exams, not coincidentally, my Biochem grade has dropped on all of the first three tests. As I spend more time on Anatomy I cut my Biochem study time. Fortunately I started very strong in that class though and have not damaged myself too badly. I intend to crank it up for our fourth test on Wednesday. I even conned my lab partners into promising to buy me lunch if I ace the test. Highly unlikely, no one in the class has had a perfect score on any of the first three tests, but it gives me a goal to shoot for.

Special aside to Paul Bourgeois:

Mr. Bourgeois, I know I promised you I would become a die hard Rebel since I started school, but I can’t take games like tonight! I’ll go broke from buying Rolaids! (I am still counting on the cap for Christmas though!)